Operative treatment of unstable injuries of the cervicothoracic junction

The authors present their experience in the operative treatment of unstable lesions at the cervicothoracic junction. Ten patients, six men and four women, underwent operative procedures at the cervicothoracic junction (C7-T1) between 1990 and 1997. Six patients had sustained fracture-dislocations, three patients had metastases and one patient had a primary malignant lesion. All the patients had significant cervical pain and neurologic deficit. The spinal cord and nerves were decompressed in all cases. Posterior stabilization was accomplished using various types of implants including hooks, wires and rods. Anteriorly, the spine was stabilized with plates and screws. Partial or complete vertebrectomy was performed in five cases and a titanium cylinder or an iliac autograft replaced the vertebral body. Five patients were submitted to a posterior operation only, and the other five to bilateral procedures. In four of these a one-stage operation was performed and in the last case a two-stage procedure. The anatomic and biomechanical characteristics of the cervicothoracic junction require a precise pre-operative analysis of the local anatomy and the selection of the proper implants for anterior and posterior stabilization. Received: 6 December 1997 Revised: 12 February 1999 Accepted: 2 March 1999     

HER-2/neu is an independent prognostic factor in type I endometrial adenocarcinoma

Purpose

Το define the prognostic significance of HER-2/neu and PTEN expression in patients with endometrioid (type I) endometrial cancer.

Methods

Seventy-seven patients with endometrioid endometrial carcinoma were included in the study, in a period between 1996 and 2009. Patients with coexisting malignancy and those having incomplete immunohistochemical data or clinical follow-up were excluded. Histological staging was defined according to the revised FIGO staging (2009). Clinico-pathologic and immunohistochemical characteristics were correlated in a multivariate Cox regression analysis with overall survival (OS), cancer-related survival (CRS) and disease-free survival (DFS).

Results

Mean age of the patients was 62.7 years. The median follow-up was 67 months (9–124 months). HER-2/neu expression was detected in 18.2 % (n = 14), and PTEN expression in 72.7 % (n = 56) of our patients. Multivariate Cox regression analysis showed that patient’s age, FIGO staging and HER-2/neu expression were independent prognostic factors for OS, CRS and DFS. PTEN expression did not significantly affect survival outcomes of the present study.

Conclusions

HER-2/neu but not PTEN expression is an independent prognostic factor for type I endometrial carcinoma.     

Treatment of Axillary Bromhidrosis with Topical 2% Glycopyrronium Bromide Cream: A Prospective,Non-randomized,Open-label Study

BackgroundTopical glycopyrrolate is a well-established therapeutic option for focal hyperhidrosis; however, there are no data on its efficacy in the treatment of bromhidrosis.ObjectivesThe objective of this open-label, non-randomized study was to investigate the efficacy and safety of a galenic formulation of 2% glycopyrronium bromide cream, in the treatment of bromhidrosis.MethodsNineteen patients with bromhidrosis were prescribed a 2% glycopyrronium bromide cream, to apply in both axillae, every night, for 12 weeks. Malodor was assessed on a four-point scale. Scores for the Dermatology Life Quality Index (DLQI), Hyperhidrosis Disease Severity Scale (HDSS), and the Hospital Anxiety and Depression Scale (HADS) were recorded at baseline and after 12 weeks. ResultsStatistically significant improvements in malodor and HDSS, DLQI, and HADS scores, respectively, were observed after treatment. One patient reported irritation at the site of application and another reported mydriasis, which resolved spontaneously. All but one of the patients declared that they were either completely (52/6%) or partially (42.1%) satisfied regarding the treatment.ConclusionOur results indicate that 2% glycopyrronium bromide cream is effective and safe for 12 weeks of application in patients with axillary bromhidrosis.     

Intracoronary stent placement proximal to a myocardial bridge: Immediate and long-term results

The intracoronary stent placement in a lesion proximal to a myocardial bridge is of special importance and is considered to be a challenge for the interventional cardiologist. In this study 4 cases of stent implantation proximal to a coronary bridged segment are described. In all cases complications were observed after the procedure. The patients remained free of symptoms and the exercise Tl²⁰¹ test was negative for ischemia 8.5 ± 2.6 months later. Although there is skepticism because of the abnormal coronary flow pattern, the endothelial dysfunction and the subsequent thrombogenicity, the stent placement proximal to a myocardial bridge was safe and with favorable long term results in all 4 cases. However, further studies in large populations are necessary. Cathet. Cardiovasc. Intervent. 46:363–367, 1999. © 1999 Wiley-Liss, Inc.     

Conservative management of cervical pregnancy with intramuscular administration of methotrexate and KCl injection: Case report and review of the literature

We report the case of a cervical pregnancy successfully treated with intramuscular injection of methotrexate(MTX) and intramniotic administration of potassium chloride. A 41-year-old woman was admitted to our Department with the suspicion of ectopic pregnancy. Transvaginal ultrasound revealed empty endometrialcavity, gestational sac within the cervical canal and embryonic echo measuring crown rump length 1.5 mm. Serum beta human chorionic gonadotropine(β-HCG) was measured 28590 IU/L. No cardiac activity was detected. The diagnosis of a cervical pregnancy was made. Patient was treated with intramuscular administration of methotrexate(50 mg/m2) in combination with ultrasoundguided intramniotic injection of KCl(2 meq/mL). Gradual decrease of β-HCG levels as well as ultrasound observation of collapsed gestational sac was observed. No curettage was necessitated. Patient was discharged on day 10 th and was set in follow-up on a weekly basis. β-HCG values were measured 10 IU/L on 56 th day after MTX administration. Intramuscular administration of MTX may be effective in treatment of cervical pregnancy without additional interventional measures.