Fas and WAF1 expression in esophageal squamous cell carcinomas

The Fas/FasL system plays an important role in the regulation of tumor apoptosis. This study examined the correlation between the expression levels of Fas and WAF1 with the clinicopathological characteristics of esophageal squamous cell carcinoma (SCC) tumors. Paraffin-embedded sections from 19 surgically resected primary esophageal squamous cell carcinomas were examined by immunohistochemistry. At low expression levels (5% to 24%), a 4-fold higher expression of Fas relative to WAF1 expression was observed. High expression levels (50% to 74%) of Fas were not recorded, whereas such levels of expression for WAF1 were retained in a proportion of cells > 20%. Proteins WAF1 and Fas were both expressed in all lesions of SCCs. Lesions showing high expression levels of WAF1 have a high degree of differentiation, but a sample that expresses WAF1 and belongs to the morphology I category probably has a medium degree of differentiation.     

Factors affecting the increased prevalence of erectile dysfunction in Greek hypertensive compared with normotensive subjects

Arterial hypertension is considered a risk factor for erectile dysfunction. The aim of the study was to evaluate the prevalence of erectile dysfunction in hypertensive compared with normotensive individuals of similar demographic characteristics in Greece. Furthermore, the effect of age, hypertension severity, hypertension duration, and antihypertension medication on erectile function of these subjects was investigated. The study population consisted of 634 consecutive young and middle-aged men (31-65 years) that visited our outpatient clinic. From them, 358 patients had arterial hypertension and 276 were normotensive. Erectile dysfunction was evaluated with the International Index for Erectile Function questionnaire. Erectile dysfunction was found in 35.2% of patients with essential hypertension compared with 14.1% of normotensive subjects (chi(2) = 35.92, P < .001). Patients with essential hypertension had more severe erectile dysfunction than their normotensive counterparts (chi(2) = 17.1, P < .001). Hypertension duration, hypertension severity, antihypertension medication, and age were positively correlated with erectile dysfunction. The prevalence of erectile dysfunction is higher in patients with essential hypertension compared with normotensive subjects of similar demographic characteristics. Erectile dysfunction is related to age in both groups, whereas duration and severity of hypertension as well as antihypertension drugs affect erectile function of hypertensive patients. Erectile dysfunction affects patient quality of life, underlining the need for vigorous research of this condition and appropriate management.     

Lip defects due to tumor excision: apropos of 899 cases

Reconstructive surgery of the lips after resection of tumors requires a complete understanding of the anatomy of this region. Most lip cancers remain localized and grow slowly, with a propensity for superficial rather than vertical spread. From January 1983 to December of 2005, 899 patients underwent reconstructive surgery for skin tumors involving the lips. SCCs were the most frequent skin tumors on male patients whereas BCCs were most common on the female patients. The lower lip was the anatomic zone most frequently involved in our series. Preoperative evaluation of the patients was performed in all cases. In the last five-years, we have performed preoperative fine needle aspiration (FNA) biopsy of the tumor. The FNA sample was then examined by ThinPrep technique (Cytolyt; Cytyc, Co, Boxborough, MA, USA). In our series, from the 550 patients who had a five-year follow-up we observed 62 recurrences of the primary tumor. The five-year recurrence rate was 11.28%. The aim of this retrospective study is to report our experience in the treatment of lips tumors with selective combination of treatment modalities.     

Recurrent responses to non-small cell lung cancer brain metastases with erlotinib

We report the case of a Caucasian female never smoker with erlotinib sensitive metastatic non-small cell lung cancer in the brain. Having progressed after receiving whole brain radiotherapy, her brain metastases responded both initially and on re-treatment with erlotinib. However, her extra-cranial disease remained erlotinib-resistant throughout. This case demonstrates that brain metastases may be sensitive to erlotinib and also highlights the oligoclonal nature of non-small cell lung cancer reflected by differential tyrosine kinase inhibitor tumour sensitivity. On the basis of this case we suggest that erlotinib should be considered in the treatment paradigm for patients with intra-cranial disease and propose further study into the continued use of this drug in the situation where there is a differential response.     

Right coronary ostium agenesis with absence of the right coronary artery: a rare case of non-ST elevation coronary syndrome

We present a case with right coronary ostium agenesis with anomalous origin of the right coronary artery from the left circumflex artery, which caused a non-ST elevation coronary syndrome. A review of the literature indicates this to be an extremely rare case.     

Septic shock and multiple organ failure after hematopoietic stem cell transplantation: treatment with recombinant human activated protein C

Severe sepsis with multiple organ failure after hematopoietic stem cell transplantation (HSCT) results in extremely high morbidity and mortality. Recent studies have highlighted the importance of sepsis-induced activation of the coagulation system in the pathophysiology of severe sepsis. Activated protein C is an important modulator of coagulation and inflammatory derangements during severe sepsis. Low levels of protein C occur in severe sepsis and are predictive of poor outcome. Recombinant human activated protein C (drotrecogin alfa (activated)) was recently approved by the Food and Drug Administration (FDA) for severe sepsis. The phase III trial that resulted in the approval of this agent, however, enrolled a general sepsis population and excluded patients undergoing HSCT. We report a case of fulminant septic shock and multiple organ failure after HSCT that was treated with drotrecogin alfa (activated) in addition to standard therapy, and recovered. The high mortality rates of patients who develop severe sepsis after HSCT demand that new avenues of treatment be considered for this very high-risk patient population. This case illustrates the potential application of a novel therapeutic approach. Clinical trials are warranted to further investigate the safety and efficacy of drotrecogin alfa (activated) in patients with severe sepsis after HSCT.     

Testosterone suppresses the response of the hypothalamic-pituitary-adrenal axis to interleukin-6

OBJECTIVES: Endotoxin and the inflammatory cytokines interleukin (IL)-1 and IL-6 are potent activators of the hypothalamic-pituitary-adrenal (HPA) axis. Previous studies in the rodent and in the primate have shown that the responses of the HPA axis to endotoxin and to IL-1 were enhanced by gonadectomy and attenuated by testosterone or estradiol replacement. The mechanisms underlying these observations are unclear, but there is evidence that gonadal steroids have direct inhibitory effects on IL-6 synthesis and release. Since endotoxin and IL-1 both stimulate IL-6, the question arises as to whether the sex-steroid-induced suppression of the HPA response to endotoxin and IL-1 results solely from decreased IL-6 release, or whether other mediators are involved. METHODS: We have therefore examined the ACTH and corticosterone responses to IL-6 in intact and castrated male rats with and without testosterone replacement. Animals were castrated 2 weeks prior to study; testosterone was replaced by subcutaneous Silastic capsules. Four days prior to study, an indwelling right atrial catheter was implanted. Blood samples for ACTH and corticosterone radioimmunoassays were collected through the catheter 0, 20, 40, 60, 120 and 180 min after intravenous injection of recombinant human IL-6 (500 ng). RESULTS: IL-6 stimulated ACTH and corticosterone release in all groups, with peak stimulation occurring within the first hour. The release of both ACTH and corticosterone was significantly attenuated in the intact (n = 9) and testosterone-replaced (n = 5) animals compared to the castrated animals without replacement (n = 7). Peak ACTH levels were 340 +/- 58 and 133 +/- 41 pg/ml in the intact and testosterone-replaced animals versus 678 +/- 170 pg/ml in the castrated animals (p < 0.02). Peak corticosterone levels were 29 +/- 4.7 and 30 +/- 4.2 microg/dl in the intact and testosterone-replaced animals versus 47 +/- 5.8 microg/dl in the castrated animals (p < 0.05). CONCLUSIONS: We conclude that testosterone attenuates the response of the HPA axis to IL-6 in the rat. This would indicate that other mechanisms, in addition to the inhibition of IL-6 release, are responsible for restraining the HPA response to inflammatory stimuli in the presence of gonadal steroids.