Juxtatumoral desmoplastic stromal reaction is associated with high tumor cell dissociation in squamous cell carcinomas of the uterine cervix

There are different types of tumoral growth patterns invading host tissue. During tumor infiltration, cancer cells not only destroy the pre-existing extracellular matrix, but usually induce new matrix formation by activating the peritumoral stromal cells; that is, desmoplastic stromal reaction (DSR) at the front of invasion (juxtatumoral stroma). This study evaluates the association between different types of invasion and DSR. Eighty-eight squamous cell carcinomas (Fédération Internationale de Gynécologie et d'Obstétrique [FIGO] stage IB to IV) were evaluated histologically for different patterns of invasion (PI) using a 3-level scoring system (pushing, finger-like, and spray-like). Desmoplastic stromal reaction was scored from none to weak, moderate, or strong. The pattern of invasion and DSR were compared with patients' age, FIGO stage, clinical tumor size, tumor grade, and the presence of lymphovascular space involvement. Finger-like PI was the most common (72.7%), followed by the spray-like PI (27.3%), whereas pushing PI was not seen. Of the tumors, 23.9% showed no DSR; 51.1%, weak; 14.8%, moderate; and 10.2%, strong DSR. Tumors with spray-like PI showed a significantly stronger desmoplastic reaction compared with the finger-like PI (P < .0001) and were significantly associated with poor tumor cell differentiation (P = .018). Moderate or strong DSR was associated with G2 and G3 carcinomas (P = .027). No correlation was seen neither for PI and DSR to lymphovascular space involvement, FIGO stage, and tumor size. The intensity of DSR, as understood in the context of a remodeling of the juxtatumoral stroma to the infiltrative tumor growth, might be indicative of a highly dissociative tumor growth and is correlated to poorly differentiated tumors.     

Serum levels of interleukin-1 receptor antagonist (IL-1ra) in thyroid cancer patients

Background and aims There is growing evidence that cytokines and their antagonists are important in the pathogenesis of various malignancies. While there are several reports on interleukin-1 receptor antagonist (IL-1ra) gene polymorphism and tissue expression, there is only little data available on the impact of IL-1ra serum levels. Therefore, we performed a prospective study, analyzing IL-1ra in thyroid cancer patients. Materials and methods We measured preoperative IL-1ra serum levels of 52 consecutive patients with thyroid cancer, 15 with benign adenoma and 27 healthy volunteers. The final histological diagnosis revealed 21 patients with papillary and 8 patients with follicular carcinoma (FTC), while 12 cases of medullary and 11 cases of anaplastic carcinoma (ATC) were observed. Results Compared to the control group, serum concentrations of IL-1ra were significantly higher in ATC and FTC patients. Concerning gender differences, this effect reached significance only in women with ATC and FTC. Except for the stage IV disease in ATC, there was no correlation between IL-1ra levels and International Union Against Cancer staging. Conclusion The findings of our study indicate that IL-1ra may play an important role in the development of ATC and FTC. Future efforts should focus on the possible application of IL-1ra as a biomarker for the above-mentioned thyroid malignancies.     

Analysis of platelet function during left ventricular support with the Incor and Excor system

Improvements in pump technology and the scarcity of donor organs have led to an increased use of mechanical assist devices, but the problem of thromboembolism has still not been solved. We report on our initial experience with sequentially analyzing platelet function in patients provided with the Incor left ventricular assist device (LVAD) and the Excor LVAD system. Thirteen patients 5 to 61 years old with acute or end-stage heart failure were included in a pilot study. Five of the 10 Incor patients underwent LVAD placement under emergency conditions, and 5 were electively scheduled for surgery. All 3 patients with an Excor device had been connected to an extracorporeal membrane oxygenation system prior to insertion of the device. An anticoagulation protocol including heparin, aspirin, and clopidogrel was employed, and the patients were closely monitored with a special platelet analyzing system that allows dose optimization for antiplatelet drugs. Initial platelet function was normal in only 2 patients (15%). During a follow-up period of 1770 days (cumulative >4.8 years), no early (<30 days) bleeding complications related to device implantation occurred. Late cerebral thromboembolic events were noted in 3 patients. One patient experienced severe stroke mandating neurosurgery during mechanical assist, and 1 patient experienced systemic embolism. The PAP platelet analyzer offers a cheap and reliable alternative to the more expensive thromboelastography method for adequately surveying the efficacy of aspirin and clopidogrel treatment, even if late thromboembolic events cannot be prevented.     

Different hemodynamic stress of the ascending aorta wall in patients with bicuspid and tricuspid aortic valve

It is unclear whether ascending aorta dilation in patients with bicuspid aortic valve is caused by abnormal hemodynamics or by a common developmental defect of the aortic valve and aortic wall. We performed an echocardiographic study to examine the differences in hemodynamic stress at the ascending aorta in patients with bicuspid and tricuspid aortic valve. We studied prospectively 58 consecutive patients referred for preoperative echocardiographic examination with aortic valve stenosis and either bicuspid or tricuspid valve and an ascending aortic diameter of 相似文献   

Decreased cerebral ��4��2* nicotinic acetylcholine receptor availability in patients with mild cognitive impairment and Alzheimer��s disease assessed with positron emission tomography

Purpose

Postmortem studies indicate a loss of nicotinic acetylcholine receptor (nAChRs) in Alzheimer??s disease (AD). In order to establish whether these changes in the cholinergic system occur at an early stage of AD, we carried out positron emission tomography (PET) with a specific radioligand for the ??4??2* nicotinic acetylcholine receptor (??4??2* nAChR) in patients with mild to moderate AD and in patients with amnestic mild cognitive impairment (MCI), who have a high risk to progress to AD.

Methods

Nine patients with moderate AD, eight patients with MCI and seven age-matched healthy controls underwent 2-[¹⁸F]fluoro-3-(2(S)-azetidinylmethoxy)pyridine (2-[¹⁸F]FA-85380) PET. After coregistration with individual magnetic resonance imaging the binding potential (BP_ND) of 2-[¹⁸F]FA-85380 was calculated using either the corpus callosum or the cerebellum as reference regions. PET data were analysed by region of interest analysis and by voxel-based analysis.

Results

Both patients with AD and MCI showed a significant reduction in 2-[¹⁸F]FA-85380 BP_ND in typical AD-affected brain regions. Thereby, the corpus callosum was identified as the most suitable reference region. The 2-[¹⁸F]FA-85380 BP_ND correlated with the severity of cognitive impairment. Only MCI patients that converted to AD in the later course (n?=?5) had a reduction in 2-[¹⁸F]FA-85380 BP_ND.

Conclusion

2-[¹⁸F]FA-85380 PET appears to be a sensitive and feasible tool for the detection of a reduction in ??4??2* nAChRs which seems to be an early event in AD. In addition, 2-[¹⁸F]FA-85380 PET might give prognostic information about a conversion from MCI to AD.     

Simultaneous PET/MRI in stroke: a case series

Prospective studies on magnetic resonance imaging (MRI)-guided systemic thrombolysis >4.5 hours after stroke onset did not reach their primary end points. It was discussed and observed in post hoc data re-assessment that this was partly because of limited MRI accuracy to measure critical hypoperfusion. We report the first cases of simultaneous [¹⁵O]H₂O-positron emission tomography (PET)/MRI in stroke patients and an ovine model. Discrepancies between simultaneously obtained PET and MRI readouts were observed that might explain the above current limitations of stroke MRI. By offering highly complementary information, [¹⁵O]H₂O-PET/MRI might help to identify critically hypoperfused tissue resulting in an improved patient stratification in thrombolysis trials.     

Surgical treatment of brainstem gliomas and other tumors in adults

BACKGROUND AND PURPOSE: After the introduction of MR imaging to the diagnostics of brainstem tumors and after the introduction of microsurgical procedures to their treatment, the successful treatment, particularly of focal and exophytic forms of these tumors has begun all over the world. The objective of this paper is to establish indications for surgical treatment of gliomas and other tumors of brainstem, to determine surgical approaches and to establish the outcome. MATERIAL AND METHODS: Within the last 6 years, 12 patients with focal and exophytic tumors of the brainstem in adults were operated on. 5 tumors were located in the midbrain, 4 in the pons, 2 in the medulla oblongata and 1 was a cervicomedullary one. With one exception, all tumors were approached via the posterior fossa. Results: The total removal was performed in 75% and a subtotal one in 25% of cases. A serious complication in 2 patients was bilateral ptosis after the removal of midbrain tumors. This lesion gradually regressed. A similar dangerous complication is impaired swallowing and coughing reflex loss which, by exposing the patient to the risk of aspiration pneumonia, occurred in 2 patients. One of these patients died after the operation. CONCLUSIONS: Patients with focal and exophytic forms of the brainstem tumors in MR imaging are qualified for surgical treatment. Immediate results of the treatment depend on the localization and size of the neoplasm. A precise operative approach, use of the neurophysiological examination and postoperative care at the Intensive Care Unit are essential conditions to obtain good results of the operative treatment.     

Surgical technique in operations for brainstem gliomas

The article presents an MRI-based classification of brainstem gliomas into focal, cervicomedullary, dorsal exophytic and diffuse ones. This classification provides the basis for specifying indications for surgical treatment and outcome. The article also presents the most frequent approaches to the midbrain, pons and medulla oblongata. These approaches include the pterional, orbito-zygomatic, subtemporal transtentorial and supracerebellar approaches to the midbrain. Suboccipital, trans fourth ventricle, subtonsillar, retrosigmoid and anterior petrosal approaches were used in the case of the pons. Suboccipital, trans fourth ventricle and transcondylar approaches were applied for the removal of tumors of medulla oblongata. This paper elaborates on rare approaches: transcondylar, paramedian-supracerebellar, subtonsillar and anterior petrosal ones effectively applied in our clinic. The resection of brain stem tumors is performed by piecemeal resection and not by removal en bloc. We stress the significance of safe entry zones to the brain stem and places at the fossa rhomboidea whose impairment may cause severe disability. Lesion of trigonum nervi hypoglossi, trigonum nervi vagi, colliculus facialis and fasciculus longitudinalis medialis leads to severe disability or death of the patient.