Does immediate operation for symptomatic non-ruptured abdominal aortic aneurysm compromise outcome?

Background. The optimum timing of surgery for acutely symptomatic abdominal aortic aneurysm (AAA) remains a clinical dilemma: should symptomatic aneurysm be operated on urgently for fear of impending rupture, or should there be a period of preoperative evaluation to optimise the patient's medical co-morbidity, with a consequent delay in surgery? Method. Ninety-five patients were diagnosed with acutely symptomatic AAA (back pain, abdominal pain or a tender aneurysmal aorta) between 1995 and 2001 and included in a retrospective case-cohort study. The in-hospital mortality rates for patients undergoing early surgery (within 24h of presentation) were compared to those of patients whose surgery had been delayed to allow further evaluation. Results. Of 95 patients with an acutely symptomatic AAA, 70 had surgery within 24h of admission. The remaining 25 underwent planned delayed surgery after a median of (range) three (2-17) days. The reasons for delay to AAA repair were primarily to allow further cardiorespiratory assessment and radiological imaging. In the early surgery group, there were six postoperative deaths (9%); in the group who were to have delayed surgery, there were three (12%) deaths (P=0.694). Conclusion. Early operation for acutely symptomatic AAA, in selected patients, is not associated with an excessive mortality rate compared to delayed operation.     

Measurement of apoptosis, proliferation and three cytokines in 46 patients with myelodysplastic syndromes

Extensive apoptosis or programmed cell death (PCD) of both hematopoietic (erythroid, myeloid, megakaryocytic) and stromal cells in myelodysplastic syndromes (MDS) cancels the high birth-rate resulting in ineffective hematopoiesis and has been demonstrated as the probable basis for peripheral cytopenias in MDS by our group. It is proposed that factors present in the microenvironment are inducing apoptosis in all the cells whether stromal or parenchymal. To investigate this hypothesis further, bone marrow biopsies from 46 MDS patients and eight normal individuals were examined for the presence of three cytokines, tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta (TGF-β) and granulocyte macrophage-colony stimulating factor (GM-CSF) and one cellular component, macrophages, by the use of monoclonal antibodies immunohistochemically. Results showed the presence of TNF-α and TGF-β in 41/46 and 40/46 cases of MDS respectively, while only 15 cases showed the presence of GM-CSF. Further a significant direct relationship was found between the degree of TNF-α and the incidence of PCD (p = 0.0015). Patients who showed high PCD also had an elevated TNF-α level. Thus, the expression of high amounts of TNF-α and TGF-β and low amounts of the viability factor GM-CSF may be responsible for the high incidence of PCD leading to ineffective hematopoiesis in MDS. Future studies will be directed at attempting to reverse the lesion in MDS by using anti-TNF-α drugs such as pentoxifylline.     

Alteration of the proliferative rate of acute myelogenous leukemia cells in vivo in patients.

Ten patients with active acute myelogenous leukemia (AML) received either 13 cis retinoic acid (RA) + alpha interferon (IFN) or recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) for 3 days. Cell cycle measurements were performed before and at the conclusion of administration of the bioactive agent(s). The proliferative rate of the leukemia cells in vivo decreased in four of five patients receiving RA+IFN whereas in one patient proliferation accelerated. The proliferative rate of AML cells accelerated in three of the five patients who received rhGM-CSF and slowed in two patients. These data show that while the proliferative rate of AML cells can be altered in vivo, the effect produced by bioactive agents may be the opposite of the desired effect. Furthermore, the studies described here demonstrate the usefulness of marrow biopsies for measuring the percent S-phase cells and the importance of measuring the duration of S phase so that the effects of bioactive agents on the cell cycle time of the leukemia cells can be determined.     

Purification and molecular characterization of beta-naphthoflavone-inducible cytochrome P-450 from rat epidermis.

This study was designed to characterize epidermal cytochrome P-450 (P-450) induced by skin application of beta-naphthoflavone (beta-NF). Topical application of beta-NF (40 mg/kg) to rats resulted in a 2.6-times increase in epidermal P-450 content and a 3--14-times increase in epidermal monooxygenase activities. The purified epidermal P-450 showed a major band at 54 kDa on SDS-PAGE, which comigrated with hepatic P-4501A1 and cross-reacted with monoclonal and polyclonal antibodies specific to P-4501A1. The specific content of purified epidermal P-450 was 1.53 nmol/mg protein, representing 42-times purification. HPLC analysis of the purified epidermal P-450 showed similar elution profile and retention time as that of hepatic P-4501A1. The purified preparation efficiently catalyzed-benzo(a)pyrene hydroxylation when reconstituted with purified NADPH--P-450 reductase and phospholipid. Peptide fingerprint analysis of the purified epidermal P-450 and hepatic P-4501A1 showed similar monoclonal antibody 1-7-1 reacting epitopes. Partial N-terminal amino acid sequence analysis of purified epidermal P-450 showed complete homology with the known sequence of P-4501A1. Similarly, HPLC analysis of tryptic digest of purified epidermal P-450 and hepatic P-4501A1 showed identical peptide peaks with comparable retention times. N-terminal amino acid sequence analysis of three randomly selected tryptic peptides showed complete homology with the known sequence of P-4501A1. These results indicate that rat epidermal P-450 induced by beta-NF is similar to hepatic P-4501A1.     

Corneal white-to-white distance and mesopic pupil diameter

AIM: To study the relationship between corneal white-to-white (WTW) distance and mesopic pupil diameter. METHODS: This study is composed of 30 cases that underwent photorefractive keratotomy (PRK). Pupil size measurements were performed with Schwind ORK wavefront analyzer in mesopic conditions. WTW distance was measured with a measuring caliper. Also, A-scan ultrasound examination was performed in all patients. The relationship among the mesopic pupil diameter and age, sex, axial length, lens thickness, anterior chamber depth(ACD), horizontal WTW distance, vertical WTW distance, spherical equivalent, and average keratometry were analyzed with univariate and multivariate regression analysis. RESULTS: Mean pupil diameter was (6.39±0.80)mm (range: 3.70mm-7.73mm). Horizontal WTW distance measurements were between 11.00mm and 12.50mm and mean horizontal WTW distance was (11.79±0.43)mm. On the other hand, vertical WTW distances ranged between 10.00mm and 13.00mm, and their mean was (11.42±0.72)mm. Bivariate correlation between pupil diameter and other variables showed that the axial length, ACD, spherical equivalent, and horizontal WTW distance had a moderate correlation with mesopic pupil diameter. Multiple regression analysis revealed that spherical equivalent and horizontal WTW distances were significantly associated with mesopic pupil diameter (R=0.598, R²=0.358 P=0.02). CONCLUSION: This study shows that mesopic pupil diameter is closely related to horizontal WTW distance. These two factors must be taken in consideration together in preoperative ablation zone planning.     

Papillary Thyroid Cancer in Struma Testis with Malignant Transformation in the Lung Associated with Trisomy 17 Successfully Treated with Total Thyroidectomy and Radioiodine Ablation

Background

Struma testis is a rare entity, and there are only few reports on the malignant transformation of a testicular teratoma to papillary thyroid carcinoma in the literature. In this report, we describe the malignant transformation of struma testis with distant lung metastasis associated with trisomy 17 and a coexisting papillary microcarcinoma in the thyroid.

Case Report

A 56-year-old man presented after a left orchiectomy for an undescended left testicle. Pathologic examination identified a monodermal teratoma composed of thyroid parenchyma and associated with a 1.7-cm papillary thyroid carcinoma. Further evaluation showed a pulmonary mass on a chest CT scan. Total thyroidectomy revealed a 0.5-mm focus of papillary thyroid cancer, and removal of the lung mass confirmed metastatic papillary thyroid cancer. Array-comparative genomic hybridization of both tumors showed trisomy 17 in the struma testes and the lung metastasis. The patient responded well to radioactive iodine ablation and has no evidence of cancer 3 years later.

Conclusion

To our knowledge, this is the first case of papillary thyroid cancer in struma testes metastatic to the lung. It highlights the difficulties in treating these patients. Surgery to remove cancer foci, followed by radioactive iodine ablation, resulted in an excellent response in our patient. Interestingly, trisomy 17, which has so far been observed only in noninvasive thyroid nodules, was associated with pulmonary metastasis in our patient.Key words: Trisomy 17, Struma testis, Papillary thyroid cancer, Comparative genomic hybridization