Coexistence of left main and right coronary artery ostial stenosis: demographic and angiographic features

This study was designed to evaluate ostial left main coronary artery (LMCA) stenosis and investigate concomitant stenotic lesions of LMCA and right coronary arteries (RCA) and their demographic and angiographic features. We evaluated 11,283 patients who underwent coronary angiography. Patients were placed into four groups according to having ostial or nonostial LMCA or RCA stenosis. Significant LMCA stenosis was observed in 242 (8.3%) of the patients, and only 68 (28.1%) of them had significant ostial LMCA stenosis. There was a significant correlation between ostial stenosis of LMCA and RCA (p = 0.03). The frequency of female gender was greater in ostial LMCA and ostial RCA stenosis groups compared with the other groups (p = 0.01). Ostial LMCA and RCA stenosis were related significantly. Both female predominance and coexistence of ostial LMCA and RCA stenosis might have suggest a different pathological ground for this disease.

Heparin inhibits Hepatocyte Growth Factor induced motility and invasion of hepatocellular carcinoma cells through early growth response protein 1

The Hepatocyte Growth Factor (HGF)/c-Met signaling pathway regulates hepatocyte proliferation, and pathway aberrations are implicated in the invasive and metastatic behaviors of hepatocellular carcinoma (HCC). In addition to c-Met, heparin acts as a co-receptor to modulate pathway activity. Recently, anti-metastatic and anti-cancer effects of heparin have been reported. However, the role of heparin in the regulation of HGF signaling remains controversial and the effects of heparin on HGF-induced biological responses during hepatocarcinogenesis is not yet defined. In this study we determined the effects of heparin on HGF-induced activities of HCC cells and the underlying molecular mechanisms. Here, we report for the first time that heparin inhibits HGF-induced adhesion, motility and invasion of HCC cells. In addition, heparin reduced HGF-induced activation of c-Met and MAPK in a dose-dependent manner, as well as decreased transcriptional activation and expression of Early growth response factor 1 (Egr1). HGF-induced MMP-2 and MMP-9 activation, and MT1-MMP expression, also were inhibited by heparin. Stable knockdown of Egr1 caused a significant decrease in HGF-induced invasion, as well as the activation and expression of MMPs. Parallel to these findings, the overexpression of Egr1 increased the invasiveness of HCC cells. Our results suggest that Egr1 activates HGF-induced cell invasion through the regulation of MMPs in HCC cells and heparin inhibits HGF-induced cellular invasion via the downregulation of Egr1. Therefore, heparin treatment might be a therapeutic approach to inhibit invasion and metastasis of HCC, especially for patients with active HGF/c-Met signaling.

Effect of sex hormones on lipid peroxidation in women with polycystic ovary syndrome, healthy women, and men

Recently, the influence of free radicals and lipid peroxides on many diseases, the effect of sex hormones on lipid peroxidation and antioxidant effects of estrogens have received considerable interest. In the present study we aimed to investigate the relationship between sex hormones and both lipid peroxidation and glutathione content in women with polycystic ovary syndrome (POS), in healthy women and in healthy men. We measured levels of lipid peroxides and sex hormones in plasma and levels of glutathione in erythrocytes of all cases. We evaluated the level of thiobarbituric acid reactive substances (TBARS) as an index of lipid peroxides and erythrocyte glutathione level as an index of antioxidant. We found that plasma levels of free testosterone, dehydroepiandrosterone sulfate (DHEAS) and estradiol significantly higher in the women with POS group than in the healthy women group. There was no significant difference in the levels of both plasma TBARS and erythrocyte glutathione, between women with POS group and healthy women group. Plasma DHEAS levels of healthy men and women with POS were similar. Plasma TBARS level was higher and erythrocyte glutathione level was lower in the healthy men group than in both the healthy women group and in the women with POS group. These data imply that testosterone has an oxidant effect. DHEAS which is an antioxidant, has a protective role in females with POS. Estrogens have an antioxidant effect but this action changes according to its dominant degradation pathway.

Quantification of tumor cellularity and mitotic index in invasive ductal carcinoma of the breast

OBJECTIVE

To evaluate the use of stereologically estimated tumor cell counts in the mitotic index as well as to investigate its correlation with the currently used method and test the reproducibility of the method.

STUDY DESIGN

The stereologic method described by Simpson et al was used to estimate tumor cellularity in 50 invasive ductal carcinomas. Mitotic counts were also performed, and the mitotic index was calculated by the use of estimated tumor cell counts. Estimated cell counts and the mitotic index calculated were compared statistically with the actual cell counts and the traditional mitotic grades, respectively. Interobserver reproducibility of the method was also tested.

RESULTS

Stereologically estimated tumor cell counts had a good correlation with actual cell counts (r = .891, P < .001). Besides, the mitotic indices calculated with tumor cell counts (calculated with both estimated and actual cell counts) in the denominator of the fraction of the mitotic index were in agreement with the currently used method (P < .01 for both). There was no statistically significant difference between the counts of two observers (P = .068).

CONCLUSION

The suggested method, considering tumor cellularity as an influencing factor, was practical, reproducible and in agreement with the traditional method. This method should be studied in a large group of patients with follow-up data to determine the threshold values for different grades and determine its prognostic value during the disease course.

BRCA1, C-erbB-2, and H-ras gene expressions in young women with breast cancer. An immunohistochemical study

Young age does not seem to be directly related to the aggressiveness of the disease among patients with breast cancer. Identification and analysis of the alterations in a susceptibility gene expression in breast cancer occurring in young women may allow identification of those patients in whom tumors will show an aggressive clinical course. The purpose of the present study was to evaluate the association of BRCA1, H-ras, and c-erbB-2 gene expression with clinicopathologic parameters of prognosis in breast cancer. Formalin-fixed, paraffin-embedded tissue from 35 patients with breast cancer younger than 35 years were immunohistochemically stained for BRCA1, H-ras, and c-erbB-2 expression with monoclonal antibodies. For each antibody, immunoreactivity was assessed by a semiquantitative scoring system. Each case was also graded according to the modified Bloom-Richardson criteria and evaluated for Ki-67 labeling index, hormonal status, tumor size, distant metastasis, and axillary lymph node involvement. Strong expression of c-erbB-2 and H-ras were observed in 9 cases (25.7%) and 13 cases (37.2%), respectively. Loss of BRCA1 expression was found in five cases (14.3%). Statistical analysis showed that loss of BRCA1 expression was significantly associated with higher Ki-67 labeling index and greater tumor size. In addition, stronger H-ras expression was significantly associated with lymph node involvement and distant metastasis. However, c-erbB-2 immunoreactivity did not show statistical significance with any prognostic parameters. We conclude that, although care must be taken not to overstate the importance of our results in view of the lack of information on clinical outcome, alterations in BRCA1 and H-ras gene expression might be of prognostic importance because of the role of H-ras protein on metastatic behavior and the role of BRCA1 protein on tumor growth. However, c-erbB-2 expression seems to be of no importance in the prognosis of breast cancer occurring in young women.

A diffuse form of neurofibroma of bladder in a child with von Recklinghausen disease

Neurofibromatosis in infants is uncommon and involvement of the bladder is rare. The reported bladder lesions are rare, and in such patients include neurofibromas, neurofibrosarcomas and rhabdomyosarcomas. Neurofibromas can be of different histologic types. The histologic type of the about 20 reported bladder neurofibromas in children is not clarified or is stated to be of plexiform type. We describe herein an unusual case of a neurofibroma of bladder in a child with von Recklinghausen disease. The therapeutic management and the possible prognostic implication of the type of the bladder neurofibroma and bladder lesions other than neurofibroma are discussed.

A case of mixed gonadal dysgenesis with 45 X/46 XY karyotype and aortic coarctation

We report a case of mixed gonadal dysgenesis with 45 X/46 XY karyotype and aortic coarctation. An eight month-old patient was admitted to our endocrinology department for evaluation of ambiguous genitalia. On physical examination, a wide neck with a low posterior hairline, bifid scrotum, small phallus, testis in the right labioscrotal fold, single orifice and typical findings of aortic coarctation were present. The chromosome karyotype of the patient was 45 X/46 XY. On the laparotomy there was an infantile uterus, fallopian tubes, and a streak gonad on the left. The follow-up of the patient included sex assignment, genital reconstruction and cardiovascular treatment.

[Comparative clinical study of modified Widman flap and incisional curettage techniques]

In this study modified Widman flap and incisional curettage techniques were compared on ten patients who had symmetrical defects with moderate pocketlevels. (5-6 mm) Different techniques were applied on different segments of upper anterior teeth of the patients. At the end of the observation period of three months inter and intra group comparisons were made biometrically according to the following parameters: PI (Löe-Silness) GI (Silness-Löe), pocket depth level, gingival fluid flow rate, gingival margin position and attachment level. Results of this study showed that, there was no difference between two techniques. It may be proposed to apply incisional curettage technique on the patients with moderate pocket depth.

Radical vulvectomy for squamous cell carcinoma of the vulva

Twenty-one patients with squamous cell carcinoma of the vulva who were subjected to radical vulvectomy and inguinal-pelvic lymphadenectomy were studied. The overall mortality rate was 24%. Operative- and tumor-related mortalities were 9.5% and 14.2%, respectively. Recurrence was seen in 5 patients. The most common complication was wound infection and breakdown.

An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia

The 575 inhabitants of the remote Anatolian village of Karain suffered 11 deaths from pleural mesothelioma in 1975/76 and there were five cases of fibrosing pleurisy. In the previous five years there had been 25 cases of mesothelioma. Calcified pleural plaques were common on survey radiography. Asbestos does not occur in the local soil or rock, nor is it handled in the village, but a few fibres were found in the water. Fibres were also found in the pleural tissue of two of five cases examined. Inhabitants of the neighbouring villages are free of mesothelioma.