Torsion of a wandering spleen presenting with acute abdomen: a case report

Wandering spleen is a rare condition characterized by increased splenic mobility due to the absence or laxity of its suspensory ligaments that may present as acute abdomen when it is twisted on its pedicle. Herein we report a case of torsion of a wandering spleen in a 17-year-old male patient with communicating hidrocephalus and ventriculoperitoneal shunt. The patient presented with suspicious clinical findings of acute abdomen, a laparotomy was performed and the infarcted spleen was removed. Although wandering spleen is a rare clinical entity, the possibility of torsion should be kept in mind in the differential diagnosis of acute abdomen.     

Efficacy and safety of sildenafil citrate in hemodialysis patients

Erectile dysfunction (ED) is more frequent among end-stage renal failure patients than the normal population. Sildenafil citrate has been successfully used for the symptomatic treatment of erectile dysfunction. The aim of this study was to determine the efficacy and safety of sildenafil citrate in the treatment of ED in patients on hemodialysis. Fifty-five hemodialysis patients above 18 years suffering from ED with steady sexual partners were included in the study. The first five and fifteenth questions of the International Index of Erectile Function were employed to evaluate ED in the patient group. A Single 50-mg sildenafil citrate tablet was prescribed for each patient. The patients were encouraged to take it on the day after hemodialysis and 1 hour before sexual intercourse. The erectile function of the patients after the treatment was re-evaluated in the same manner by International Index of Erectile Function. The ages of the patients ranged between 30 and 73 years (mean 50.6 +/- 10.9). The overall response rate was 74.5% (38/51). Side effects were nausea (n = 2), palpitation (n = 2), flushing (n = 1), and angina (n = 1). Sildenafil citrate (50 mg) was observed to be safe and effective for treatment of hemodialysis patients with careful evaluation and proper patient selection.     

The effects of dimethyl sulfoxide on liver damage caused by ischemia-reperfusion

INTRODUCTION: The aim of this study was to investigate the effects of dimethyl sulfoxide on liver damage caused by ischemia-reperfusion after portal vein clamping. MATERIAL AND METHODS: Forty New Zealand rabbits were divided into three groups with the portal veins of all the rabbits except the sham group clamped for 30 minutes: group I, sham procedure; group II, control group; and group III, 500 mg/kg DMSO. The drug was administered IM in the left inguinal region 30 minutes before the operation. Blood samples (5 mL) were taken from the animals at 15, 30, and 45 minutes. At the end of the experiment 1 g of liver tissue samples were obtained. Malondialdhyde (MDA), nitric oxide (NO), AST, ALT, and LDH plasma levels were measured in the blood samples. Liver tissue samples stained with hematoxylin eosin were examined under light microscopy for histopathological changes. FINDING: The liver enzymes in both clamping groups increased significantly compared with the sham group (P < .01). Enzyme levels of the DMSO group decreased significantly compared to the control clamping group (P < .05). Similar to the enzyme changes, MDA and NO levels increased in the portal vein clamping versus the sham group and decreased in the drug-administered group versus the control clamped group (P < .03). The severity of histopathological changes was less in the DMSO group than in the clamped controls. CONCLUSION: DMSO decreased the severity of liver damage after portal vein clamping.     

Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy.

PURPOSE: Pathologic complete remission (pCR) of primary breast tumors after primary chemotherapy (PCT) is associated with higher relapse-free survival (RFS) and overall survival (OS) rates. The purpose of this study was to determine long-term outcome in patients achieving pCR of cytologically proven axillary lymph node (ALN) metastases. METHODS: Patients with cytologically documented ALN metastases were treated in five prospective PCT trials. After surgery, patients were subdivided into those with and without residual ALN carcinoma. Survival was calculated by the Kaplan-Meier method. RESULTS: Of 925 patients treated, 403 patients had cytologically confirmed ALN metastases. Eighty-nine patients (22%) achieved ALN pCR after PCT. Compared with the group without ALN pCR, 5-year OS and RFS were improved in patients achieving ALN pCR (93% [95% CI, 87.5 to 98.5] and 87% [95% CI, 79.7 to 94.3] v 72% [95% CI, 66.5 to 77.5] and 60% [95% CI, 54.1 to 65.9], respectively; P < .0001). Residual primary tumor did not affect outcome of those with ALN pCR. Combination anthracycline/taxane-based PCT resulted in significantly more ALN pCRs, although outcome after ALN pCR was not improved by taxanes. We constructed a nomogram demonstrating that patients who do not benefit from neoadjuvant anthracyclines are unlikely to benefit from subsequent taxanes. CONCLUSION: ALN pCR is associated with an excellent prognosis, even with a residual primary tumor, pointing to biologic differences between primary and metastatic cells. ALN pCR represents an early surrogate marker of long-term outcome. Response to initial PCT has important potential as a guide to subsequent therapy.     

CD44 expression is associated with increased survival in node-negative invasive breast carcinoma.

PURPOSE: CD44 is a multifunctional cell surface receptor with many known splice variants, some of which have been reported to play a role in tumor progression. The purpose of this study was to evaluate the prognostic significance of CD44 isoforms in early-stage, lymph node-negative invasive breast carcinoma. EXPERIMENTAL DESIGN: Immunohistochemical staining for CD44 isoforms was done on archival paraffin tissue sections of invasive breast carcinoma from a cohort of lymph node-negative patients who received no adjuvant tamoxifen or chemotherapy and who had a mean clinical follow-up period of 15 years. Immunohistochemical staining was done with antibodies to CD44s, the standard isoform of CD44, and to isoforms containing variant exon 6 (CD44v6); levels of staining were correlated with clinical outcome data. RESULTS: There was a trend towards increased disease-free survival for patients whose tumors had high anti-CD44s positivity (P = 0.05), and a significant association was observed between anti-CD44s positivity and disease-related survival (P = 0.04). Expression of CD44v6 isoforms did not correlate with clinical outcome. CONCLUSION: CD44 expression, as assessed by immunohistochemical staining with anti-CD44s, may be a favorable prognostic factor in patients with node-negative invasive breast carcinoma.     

CCR7 and CXCR4 as novel biomarkers predicting axillary lymph node metastasis in T1 breast cancer.

PURPOSE: The chemokine receptors CCR7 and CXCR4 have been shown to play an important role in cancer metastasis. We therefore studied the differential expression of CCR7 and CXCR4, along with that of the biomarker HER2-neu, to evaluate whether these biomarkers could predict axillary lymph node metastasis in breast cancer. EXPERIMENTAL DESIGN: Biomarker expression levels were evaluated using paraffin-embedded tissue sections of lymph node-negative (n = 99) and lymph node-positive (n = 98) T1 breast cancer by immunohistochemical staining. RESULTS: Lymph node-positive tumors showed higher rates of high cytoplasmic CCR7 staining (21.5% versus 8.5%, P = 0.013) and HER2-neu overexpression (21.5% versus 9.3%, P = 0.019) than did lymph node-negative tumors. Similarly, high cytoplasmic CXCR4 expression occurred more commonly in lymph node-positive tumors (11.2% versus 5.1%, P = 0.113). In contrast, predominantly nuclear CXCR4 staining was more likely to be found in lymph node-negative tumors (54.5% versus 37.8%, P = 0.018). Furthermore, cytoplasmic CXCR4 coexpressed with HER2-neu was the only factor associated with involvement of four or more lymph nodes (16.7% versus 1.2%, P = 0.04) among lymph node-positive tumors. When all three biomarkers (CCR7, CXCR4, HER2-neu) were utilized together, 50.0% of lymph node-positive tumors highly expressed one of these biomarkers compared with 18.8% of the lymph node-negative tumors (P < 0.0001). CONCLUSIONS: Our results suggest that the chemokine receptor CCR7 is a novel biomarker that can predict lymph node metastases in breast cancer. Utilization of additional markers, such as CXCR4 and HER2-neu, further improves the prediction of the presence and extent of lymph node involvement.     

Estimation of numerical density and mean synaptic height in chick hippocampus 24 and 48 hours after passive avoidance training

The effects of passive avoidance learning on synaptic morphology and number in the dorsolateral hippocampus of chick were investigated at 24 and 48 h after training. Chicks of both sexes were used. The numerical density of synapses and mean synaptic height were determined using design-based quantitative electron microscopic techniques. Our results suggest that after training there is a significant increase in synaptic density in the dorsolateral hippocampus of chicks at both 24 and 48 h, and also that the mean synaptic height was significantly different between trained and control groups. The increase in synaptic density was due to shaft (type II) synapses. It is known that during synaptogenesis, shaft synapses are formed first and are then converted to spine synapses. The only hemispheric asymmetry was found in the 24 h water-trained (W-trained) males where the numerical density of spine synapses was significantly higher in the left hippocampus. No significant differences due to gender in either numerical synaptic density or synapse height were observed at either 24 and 48 h. Comparison of the 24 h with 48 h groups showed an increase in shaft synaptic density over time in the W-trained groups, and an increased density of both shaft and spine synapses with time in methylanthranilate-trained (MeA-trained) chicks. These results demonstrate that the dorsolateral hippocampus of the chick shows synaptic changes at both 24 and 48 h after training and implicates this region in the long-term memory process.     

Evaluation of auditory evoked potentials from the inferior colliculus in rat

This study aimed to investigate the usefulness of auditory evoked potentials (AEPs) in rats. To this end, N1, P2 latencies, and the N1-P2 amplitude of responses to different acoustic stimuli from rats, which were implanted with permanent electrodes in the inferior colliculus (IC), were evaluated and used to demonstrate the frequency characteristics of IC region. Permanent electrodes were implanted in IC regions of 7 male albino rats by the stereotaxic method. The animals were exposed to five tones series of stimuli (1000 Hz, 2000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz tones with 1500 ms interstimulus intervals) of 70 dB with a duration of 1000 ms. AEPs) were recorded and analyzed with the Brain-Data Acquisition system. There were no statistically significant differences in N1, P2 latencies, and the N1-P2 amplitude of AEPs from IC regions of rats as a result of changes in the frequency of stimulus. It was determined that the dominant frequency activity of the IC to acoustic stimulus was theta-alpha band, with theta as the peak frequency.