Steroid hormones polymorphisms and cholelithiasis in Greek population.

BACKGROUND: Genetic variation in genes involved in steroid biosynthesis, metabolism and signal transduction have been suggested to play a role in gallstone disease. METHODS: To elucidate the possible role of genetic variation in the estrogen receptors alpha and beta (ER-alpha, ER-beta) and androgen receptor (AR) genes in breast cancer risk, the -1174(TA)n, c.1092+3607(CA)(n) and c.172(CAG)n repeat polymorphisms of the three genes were studied. A case-control cohort of 99 patients with cholelithiasis and 179 controls were used. RESULTS: No significant difference was observed in the frequency distribution of -1174(TA)(0-26) in the ER-alpha gene between patients and controls, while a significant difference was observed in the frequency distribution of repeat polymorphism c.1092+3607(CA)5-27 and c.172(CAG)5-32 in the ER-beta gene and AR gene, respectively (P< or =0.001 and P=0.05, respectively). A significant difference was observed in the repeat genotype distribution (SS, SL, LL) in the (CA)n of the ER-beta gene (P<0.0001) and in the (CAG)n of the AR gene (P< or =0.0001). A significantly decreased odds ratio for cholelithiasis risk was observed in individuals having the SL and LL genotype for ER-beta gene compared with SS genotype (OR=0.212; 95% CI 0.105-0.426; P<0.0001 and OR=0.042; 95% CI 0.018-0.097, respectively) and LL genotype for AR gene (OR=0.622; 95% CI 0.345-1.121; P=0.114 and OR=0.287; 95% CI 0.151-0.543, P<0.0001, respectively). This protective effect of SL and LL genotypes for ER-beta and LL for AR gene remained evident (P<0.0001 for all of them) even after adjustment for various risk factors. CONCLUSIONS: In conclusion an association for cholelithiasis risk between short alleles for both c.1092+3607(CA)5-27 and c.172(CAG)5-32 repeat polymorphisms of the ER-beta and AR was found in individuals of Greek descent.

The expression of epithelial specific antigen in cervical intraepithelial neoplasia and adenocarcinoma.

There is a spectrum of changes described as cervical glandular intraepithelial neoplasia (CGIN) with adenocarcinoma in situ (AIS) considered to represent the most severe lesion in that spectrum. Although there is evidence to suggest a progression of CGIN to AIS and to invasive adenocarcinoma, the natural history of these potential precursor lesions has not been fully elucidated. The aim of this project was to establish the relationship of endocervical glandular intraepithelial neoplasias to uterine endocervical adenocarcinoma. Our study included 40 cases of glandular lesions of the cervix (15 cases of endocervical glandular intraepithelial neoplasia, eight of adenocarcinoma in situ and 17 cases of invasive adenocarcinoma). An attempt was made to examine the immunohistochemical localization of epithelial specific antigen (ESA) in those lesions and compare the results with ten cases of normal endocervical epithelium. ESA showed positive staining of the basolateral membrane of endocervical cells in the normal endocervix. The expression of ESA was found to increase from the basolateral to the diffuse cytoplasmic membrane in 12 out of 15 cases of CGIN (80%), in seven out of eight cases of AIS (84%) and in all of the 17 invasive adenocarcinomas (100%). This finding indicates that ESA is a useful marker in the diagnosis of glandular intraepithelial neoplasia and suggests that CGIN and AIS may be precursor lesions of cervical adenocarcinoma.

Tension-free vaginal tape in the management of recurrent stress incontinence.

METHODS: Thirty-three patients with failed previous incontinence surgery had a Tension-free vaginal tape (TVT) inserted. Preoperative evaluation included uroflow, filing and voiding cystometry, urethral profilometry and a Q-tip test. Factors assessed postoperatively included cure, improvement or failure rates at 20.5 months follow-up, complications, and preoperative and postoperative values of a Q-tip test. RESULTS: The overall success rate was 70% at a mean of 20.5 months follow up (range 12-29 months). In patients with sufficient preoperative mobility of urethra the success rate was 90%, while in patients with a fixed urethra preoperatively the success rate was 33%.

Cat-scratch disease presenting as a solitary tumour in the breast: report of three cases.

Cat-scratch disease (CSD) may appear as a solitary mass in the breast and give the impression of a breast carcinoma. In this case, further clinical and laboratory investigation is required to rule out malignancy. We present three cases of CSD of the breast in women of 64, 31 and 61 years old. Each presented with enlarged lymph-nodes in the breast, which were clinically mistaken for solitary tumours. In the first two patients, the mammography was negative. The third patient had a mammogram which indicated a well-defined solid mass in the parenchyma without calcifications. We discuss the clinical, histological and histochemical findings, analyze the differential diagnosis and review the literature.

Leiomyosarcoma of the breast. A clinicopathologic and immunohistochemical study.

Leiomyosarcoma is one of the rarest sarcomas of the breast. We present the clinical, histological and immunohistochemical findings of two new cases of leiomyosarcomas of the breast in 42 and 65 years old women. We analyze the differential diagnostic problems and we review the literature.

A tragic case of complicated labour in early Byzantium (404 A.D.).

OBJECTIVES: Presentation and comment on the problematic delivery of the Byzantine empress Eudoxia's stillborn child. STUDY DESIGN: The original Greek language Byzantine histories, chronicles and hagiographical sources were investigated. Comparisons were then made of the knowledge of obstetrics among contemporary and ancient physicians. RESULTS: The case of Eudoxia's delivery is described in various literary sources with details regarding the fatal clinical picture of the parturient after the embryo's death. The study of early and contemporary medical texts proves that in similar cases conservative treatment was preferred but embryotomy was followed in the event of failure. CONCLUSIONS: Eudoxia's labour represents a characteristic paradigm of the difficulties involved in the confrontation of complicated deliveries in mediaeval times, often resulting in the death of both the mother and embryo. The treatments follow the ancient Hippocratic, Hellenistic and Roman traditions and influence medieval European medicine, thus constituting significant roots of obstetrics.

Clinical experience with Norplant subdermal implant system as long-term contraception during adolescence.

OBJECTIVE: This study was undertaken to assess the efficacy, acceptability and side-effects of the Norplant (Leiras) contraceptive system during adolescence. METHODS: A total of 13 adolescents were implanted with Norplant immediately after menstruation. Adolescents were advised to present for follow-up visits at 3 days after implantation, at 3, 6 and 12 months and every 1 year thereafter. Blood pressure, menstrual disorders, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, glucose and side-effects were recorded at every visit. RESULTS: The follow-up period was 24 months with a continuation rate of 100% (13/13) for the first 6 months, 92.5% (12/13) for 12 months and 53.8% (7/13) for the whole period. No pregnancies were observed. No infections at the implant site or expulsions were observed. Menorrhagia was observed in 4/13 (30.76%) adolescents in the third month. Thereafter all adolescents were treated with tenoxicam (prostaglandin synthetase inhibitor), so that by the end of the sixth month of treatment menorrhagia was not present in any of the 13 adolescents. No increase of blood pressure was observed. A statistically significant increase (p < 0.01) of triglycerides at 6 months after implantation was found; however, no difference was observed in the values of serum glucose, total cholesterol, HDL and LDL. CONCLUSIONS: This preliminary study has shown that Norplant is acceptable as a contraceptive method among adolescents in Greece and can be prescribed safely.

99mTc-(V)DMSA scintimammography in the assessment of breast lesions: comparative study with 99mTc-MIBI.

The purpose of this study was to evaluate and compare the diagnostic accuracy of pentavalent technetium-99m dimercaptosuccinic acid [99mTc-(V)DMSA] and 99mTc-methoxyisobutylisonitrile (MIBI) in the detection of primary breast cancer and metastatic lymph node involvement, and in the clarification of cases with indeterminate mammograms. Forty-one women (mean age+/-SD 55+/-7 years) referred for a suspicious breast lesion on physical examination and/or an abnormal mammogram underwent MIBI and (V)DMSA scintimammography (SMM) at separate sessions (48-h interval). Lateral prone and anterior supine images were obtained at 10 and 60 min after administration of 740-925 MBq of each tracer, in the arm contralateral to the breast lesion. The ipsilateral axillary region was also included in the field of view. The results of SMM and mammography were compared with histological findings. Breast cancer was histologically confirmed in 26 patients (mean diameter+/-SD 2.87+/-1.5 cm). Benign lesions were found in 15 patients (mean diameter+/-SD 2.04+/-2.7 cm). Mammography was definitely positive in 23/26 patients with breast cancer and indeterminate in 3/26 (sensitivity 88.4%). In benign lesions, mammography was true negative in 5/15 cases and indeterminate in 10/15 (specificity 33.3%). Both MIBI and (V)DMSA SMM detected 23/26 breast cancers (sensitivity 88.4%) and were true negative in 14/15 (specificity 93.3%). T/B ratios for breast cancer in MIBI and (V)DMSA scans were similar, and significantly higher than for benign lesions. MIBI correctly diagnosed 12/13 and (V)DMSA 11/13 cases in which the findings of mammography were indeterminate. In addition, (V)DMSA detected seven of eight cases of in situ ductal carcinoma (DCIS) associated with infiltrating carcinomas, while MIBI detected only two of these eight cases. (V)DSMA was also diffusely concentrated in benign lesions complicated by epithelial hyperplasia. Metastatic lymph node involvement was successfully imaged in 15/19 patients with metastatic disease by both agents (sensitivity 78.9%), while true-negative scans were observed in 19/22 (specificity 86.3%) patients with benign or malignant tumours without lymph node metastases. Linear regression analysis revealed a high coefficient of correlation between the (V)DMSA and the MIBI T/B ratios (r=0.8 P<0.001). We conclude that both (V)DMSA and MIBI show an excellent ability to detect breast cancer and its lymph node metastases. (V)DMSA also has a tendency to be diffusely and more intensely localised than MIBI in pre-invasive lesions, such as DCIS or epitheliosis, which are at risk of developing into malignancies. (V)DMSA could therefore provide a useful tool in the diagnosis of such lesions and possibly modify a predefined surgical plan. Finally, we believe that both tracers could offer an alternative method for elucidating nondiagnostic mammograms.

Breast tumors during adolescence.

A variety of benign tumors may involve the breast of the adolescent female. Neoplasms and cysts originating from the breast tissue itself, as well as from anatomically related tissues such as lymph nodes may occur. Imaging of the adolescent with a breast mass varies from that of the mature women because of the extremely uncommon occurrence of breast malignancy is this younger population. During a 22-year period (1978-99), 684 young females (14-20 years) were referred to the Breast Unit of the 1st Department of Obstetrics and Gynecology in the major University-appointed hospital of the University of Athens, because of breast masses. The clinical and imaging evaluation of the masses confirmed their presence in the majority of cases. Most cases (442-64.6%) were managed conservatively and carefully followed-up. In 242 cases (35.4%) ablation of the masses was performed. Biopsy showed 236 (97.5%) benign and 6 (2.5%) malignant tumors. The malignant tumors were 2 cases of hemangiosarcoma, 1 case of rhabdomyosarcoma, 1 case of ductual carcinoma, 1 case of cystosarcoma phylloides and 1 case of metastatic rhabdomyosarcoma from the eye. In three cases patients died as a consequence of the disease, two survived and one was lost due to the family's wishes to be transfered to another oncology department abroad.

Vimentin and alpha-fetoprotein expression in breast cancer smears: relationship with various prognostic factors.

Estrogen (ER) and progesterone (PR) receptor status, factors known to influence the prognosis and therapeutic possibilities in patients with breast cancer; alpha-fetoprotein (AFP), which is an estrogen binder; and vimentin (V) were determined in cytological imprint smears of 75 mastectomy specimens. The results were classified according to tumor type and menopausal state and analyzed to determine possible relationships among these four markers under the different circumstances. There was a positive association of ER positivity with PR positivity, AFP positivity, and V negativity using chi 2 analysis. The lobular carcinomas studied were predominantly ER+, AFP+, V-, while in the ductal carcinomas V positivity was marginally predominant and also frequently associated with ER+ or PR+ status. The small number of medullary carcinomas made statistical analysis of this group difficult. It seemed probable that the marker status of the tumors was dependent more on the tumor type than on the menopausal state of the patients, thorough follow-up, especially of V+ medullary carcinomas, may provide insight into the value of vimentin as a primary rather than a secondary prognostic factor.

Immunocytochemical determination of EGFR, OV 632 and OC 125 in primary ovarian cancer patients.

An immunocytochemistry study was performed to compare the immunoreactivity of the monoclonal antibodies OC 125, EGFR and OV 632 with smear imprints from 60 ovarian tumours (21 serous cystadenocarcinomas, 12 mucinous cystadenocarcinomas, 9 endometrioid carcinomas, 5 clear cell carcinomas and 5 mixed tumours). Twenty-six patients were premenopausal and 34 postmenopausal. The results showed that 75% of mucinous cystadenocarcinomas were negative for all 3 antigens as were 2 of the 5 (40%) clear cell carcinomas. All other tumours were positive for at least one of the three antigens. OV 632 had an overall sensitivity of 73.3%, EGFR 55% and OC 125 46.6%. Four tumours were OC 125-positive and OV 632-negative. There was no significant difference in positivity of OV 632, OC 125 and EGFR, between pre- and post-menopausal patients (chi 2 = 0.03) or between tumours of stage I and stage III [chi 2 = 0.075 (EGFR) 0.95 (OV 632) and 10.49 (OC 125)]. OV 632 was conducted to be the most sensitive antibody in all types of tumours but OC 125, while less sensitive by itself, increased the overall sensitivity in combination with OV 632 from 73.3 to 80% (not statistically significant).

Immunocytochemical differentiation of reactive mesothelial cells and adenocarcinoma cells in serous effusions with the use of carcinoembryonic antigen and fibronectin.

Ninety effusions from patients with breast and ovarian cancer were studied cytologically and classified as benign, suspicious or malignant, and the same samples were studied for carcinoembryonic antigen (CEA) and fibronectin (F) immunostaining. The combination F positive/CEA negative was found to have 100% specificity and 92.3% sensitivity in patients with benign or reactive effusions, and F negative/CEA positive 85.7% specificity and 80.7% sensitivity for malignancy. Immunostaining provides valuable supplementary information in cytologically suspicious patients. In the presence of F negative/CEA negative effusions, it is probable that insufficient cellular material is present for either a cytologic or immunostaining diagnosis.