Analgesic effect of erector spinae plane block after cesarean section: A randomized controlled trial.

Background: Ultrasound-guided bilateral erector spinae plane block is also a technique for providing analgesia after a cesarean section. Aim: We hypothesized that bilateral erector spinae plane block applied from the transverse process of T9 who underwent elective cesarean section could provide effective postoperative analgesia. Patients and Methods: Fifty parturients who were scheduled to undergo elective cesarean section under spinal anesthesia were included in the study. Group SA (n = 25) was categorized as the group in which spinal anesthesia alone (SA) was performed, and Group SA+ESP (n = 25) was categorized as the group in which SA + ESP block was performed. All patients were given a solution containing 7 mg isobaric bupivacaine + 15 µg fentanyl intrathecally through spinal anesthesia. In the SA + ESP group, the bilateral ESPB was performed at level T9 with 20 ml 0.25% bupivacaine + 2 mg dexamethasone immediately after the operation. Total fentanyl consumption in 24 h, the visual analogue scale for pain, and time to the first analgesic request were evaluated postoperatively. Results: The total fentanyl consumption in 24 h was statistically significantly lower in the SA + ESP group than the SA group (279 ± 242.99 µg vs. 423.08 ± 212.55 µg, respectively, P = 0.003). The first analgesic requirement time was statistically significantly shorter in the SA group than the SA + ESP group (150.20 ± 51.83 min vs. 197.60 ± 84.49 min, respectively, P = 0.022). Postoperative VAS scores at 4th, 8th, and 12th h at rest were statistically significantly lower in group SA + ESP than in group SA (P = 0.004, P = 0.046, P = 0.044, respectively). VAS scores during the postoperative 4th, 8th, and 12th h cough were statistically significantly lower in group SA + ESP than in group SA (P = 0.002, P = 0.008, P = 0.028, respectively). Conclusion: Ultrasound-guided bilateral ESP provided adequate postoperative analgesia and significantly decreased postoperative fentanyl consumption in patients having cesarean section. Also, it has a longer analgesia time than the control group, and it has been shown to delay the first analgesic requirement.

Thoracic sympathetic nuclei ischemia: Effects on lower heart rates following experimentally induced spinal subarachnoid hemorrhage.

BACKGROUND: The neuropathological mechanism of heart rhythm disorders, following spinal cord pathologies, to our knowledge, has not yet been adequately investigated. In this study, the effect of the ischemic neurodegeneration of the thoracic sympathetic nuclei (TSN) on the heart rate (HR) was examined following a spinal subarachnoid hemorrhage (SSAH). METHODS: This study was conducted on 22 rabbits. Five rabbits were used as a control group, five as SHAM, and twelve as a study group. The animals' HRs were recorded via monitoring devices on the first day, and those results were accepted as baseline values. The HRs were remeasured after injecting 0.5 cc of isotonic saline for SHAM and 0.5 cc of autolog arterial blood into the thoracic spinal subarachnoid space at T4-T5 for the study group. After a three-week follow-up with continuous monitoring of their HRs, the rabbit's thoracic spinal cords and stellate ganglia were extracted. The specimens were evaluated by histopathological methods. The densities of degenerated neurons in the TSN and stellate ganglia were compared with the HRs. RESULTS: The mean HRs and mean degenerated neuron density of the TSN and stellate ganglia in control group were 251±18/min, 5±2/mm3, and 3±1/mm3, respectively. The mean HRs and the mean degenerated neuron density of the TSN and stellate ganglia were detected as 242±13/min, 6±2/mm3, and 4±2/mm3 in SHAM (P>0.05 vs. control); 176±19/min, 94±12/mm3, and 28±6/mm3 in the study group (P<0.0001 vs. control and P<0.005 vs. SHAM), respectively. CONCLUSIONS: SAH induced TSN neurodegeneration may have been responsible for low HRs following SSAH. To date this has not been mentioned in the literature.

Evaluation of tooth wear and associated risk factors: A matched case-Control study.

AIM: The aim of this case-control study was to compare the associated risk factors between adults with tooth wear (TW) and age- and sex-matched controls without TW. METHODS: Fifty participants with TW and 50 age- and sex-matched controls participated in this study. A questionnaire was prepared to assess oral healthcare and consumption of erosive food and drinks. All participants completed the diet analysis forms. Saliva characteristics were evaluated with GC Saliva-Check BUFFER test. Examiners measured the TW of case patients, using the TW index. Data were statistically analyzed using Chi-square and Mann-Whitney U-tests (P < 0.05). RESULTS: Individuals in the case group brush their teeth more often (P < 0.05). The difference in erosive food consumption between the case and control groups was significant (P < 0.05). There was no erosive effect of acidic food when consumed as a main meal or a snack (P > 0.05). Although there was no difference between stimulated saliva flow rate and buffering capacity between groups, the difference between the resting saliva flow rates and pH values was significant (P < 0.05). Although some wear was seen on buccal/labial surfaces of teeth, cervical and occlusal/incisal surfaces were scored higher. No TW was observed on palatal/lingual surfaces. The cervical surfaces of mandibular premolars and incisal surfaces of anterior teeth were most affected. CONCLUSION: Of the factors investigated, TW in the case group was correlated with consumption of acidic foods, lower salivary flow rate, and pH.

Fracture Resistance of Endodontically Treated Teeth Restored With Bulk Fill, Bulk Fill Flowable, Fiber-reinforced, and Conventional Resin Composite.

The aim of this in vitro study was to evaluate the fracture resistance of endodontically treated teeth restored with different types of restorative resins. METHODS AND MATERIALS: Seventy-two sound maxillary premolar teeth were randomly divided into six groups (n=12). The teeth in the first group were left intact and tested as unprepared negative control (group I) specimens. The teeth in the remaining five groups were prepared with MOD cavities and endodontically treated. The teeth in one of the five groups (positive control group II) were unrestored. The rest of the prepared cavities were restored as follows: group III: bulk fill resin composite/Filtek Bulk Fill (3M ESPE); group IV: bulk fill flowable resin composite + nanohybrid/SureFil SDR Flow + Ceram.X Mono (Dentsply); group V: fiber-reinforced composite + posterior resin composite/GC everX posterior + G-aenial posterior (GC Corp.); and group VI: nanohybrid resin composite/Tetric N-Ceram (Ivoclar/Vivadent). Each restorative material was used with its respective adhesive system. The restored teeth were stored in distilled water for 24 hours at 37°C and were then thermocycled (5-55°C, 1000×). Specimens were subjected to a compressive load until fracture at a crosshead speed of 0.5 mm/min. The data were analyzed using one-way analysis of variance followed by the post hoc Tukey honestly significantly different test (p<0.05). RESULTS: Sound premolar teeth (group I negative control) showed significantly higher fracture resistance than did the other tested groups (p<0.05). No statistically significant differences were found in the fracture resistance values of the restored groups (groups III, IV, V, and VI) (p>0.05). The lowest values were obtained in the positive control group (group II); these values were significantly lower than those of the other groups (p<0.05). CONCLUSION: The fracture resistance values of endodontically treated teeth restored with either bulk fill/bulk fill flowable or fiber-reinforced composite were not different from those restored with conventional nanohybrid resin composite.

Serum galectin-3 levels in women with PCOS.

AIM: Galectin-3 (Gal-3) plays a role in modulation of adiposity, glucose hemostasis and inflammation. The association between Gal-3 and the polycystic ovary syndrome (PCOS), is not investigated. We aimed to evaluate galectin-3 levels in serum and their relation with hyperandrogenism and insulin resistance (IR) in women with polycystic ovary syndrome (PCOS) and in control subjects. MATERIALS AND METHODS: 56 women with PCOS were enrolled along with a control group of 41 healthy women, matched for age and body mass index. We measured hormonal and metabolic parameters, as well as the serum galectin-3 concentration of each participant. We estimated the IR according to the homeostasis model assessment-insulin resistance (HOMA-IR). RESULTS: Women with PCOS had higher levels of serum Gal-3 compared to healthy individuals (3,588.77 ± 1,566.94 vs 2,491.33 ± 812.04, P < 0.001). Serum Gal-3 levels were correlated with progesterone (r = 0.241, P = 0.025), hirsutism score (r = 0.296, P = 0.006), insulin (r = 0.479, P = 0.028), HOMA-IR (r = 0.514, P = 0.017), dehydroepiandrosterone sulfate (r = 0.246, P = 0.022), testosterone (r = 0.252, P = 0.019), and free testosterone (r = 0.306, P = 0.004). CONCLUSION: Galectin-3 levels are higher in patients with PCOS, and there is a positive correlation between galectin-3 level and IR, androgen levels and hirsutismus scores. Gal-3 may be a new mediator of PCOS via IR, hyperandrogenism.

In which cases surgical gastrostomy and jejunostomy techniques are inevitable?

PURPOSE: This study investigated the surgical gastrostomy and jejunostomy procedures in cancer patients who needed nutritional support and endoscopy was unattainable. METHODS: Operation time and procedure, anesthesia and tube types, procedure-specific and surgical complications, and tube replacement at the follow up period were retrospectively analyzed. RESULTS: 109 patients (44 female, 65 male, mean age 50.9 years, range 14-87) were subjected to surgical gastrostomy/ jejunostomy. Ninety-three (85.4%) patients had head-neck and gastrointestinal cancers. In 94 (86.2%) patients endoscopy was impossible due to obstruction of the esophagus and stomach. Gastrostomy/jejunostomy was combined with other surgical procedures in 12 (11 %) patients. Procedure- related complications occurred in 22 (20.7%) patients. Early 30-day mortality occurred in 12 (11 %) cases. The median follow up period was 3.6 months (range 0-18). CONCLUSION: Obstructing cancer, obesity or previous laparotomy make the use of endoscopic techniques impossible. For these patients, surgical gastrostomy/jejunostomy is safe with acceptable complication rates and improves the treatment outcomes with nutritional support.

Epigenetics in breast cancer.

Epigenetic information has recently gained the attention of researchers and epigenetics in breast cancer is still an evolving area of research. Epigenetic modifications such as DNA methylation and histone acetylation have been thoroughly evaluated in breast cancer. New methods to detect epigenetic changes with higher specificity have been developed. These methods are utilized to find new markers for the diagnosis and prognosis of breast cancer. In addition, epigenetic modifications are assumed as new targets in the treatment of breast cancer and new drugs alone or in combination with conventional therapies such as chemotherapy or hormone treatment are being tested in clinical trials.

Metaplastic carcinoma of the breast: clinicopathological features and immunohistochemical analysis.

PURPOSE: Metaplastic breast carcinoma (MBC) is a rare and heterogeneous group of neoplasms characterized by a mixture of spindle, squamous and/or mesenchymal cells. The purpose of this study was to assess the immunohistochemical features, biological characteristics and myoepithelial differentiation of a series of MBC patients. METHODS: The archival pathological material from 33 MBC patients was evaluated. Analysed were patient characteristics, pathological and immunohistochemical features and their relevance as prognostic factors of patient survival. RESULTS: The median patient age was 44 years (range 17-82), and the median tumor size 5 cm (range 0.5-17.0). The majority of patients (n=29; 87.8%) were treated by modified radical mastectomy, 1 (3%) patient had breast-conserving surgery and another 1 (3%) had latissimus dorsi flap reconstruction. Metastasis to axillary lymph nodes was found in 14 (42.4%) patients, 18 (54.5%) patients were triple negative, and 22 (66.7%) were epidermal growth factor receptor (EGFR) positive. The 5-year event-free survival was 25.9%, whereas the 5-year overall survival was 27.5%. Immunohistochemical analysis showed the following: vimentin positivity in 31 (93.9%) patients, high molecular weight cytokeratin (HMWCK) positivity in 31 (93.9%), CK 5/6 positivity in 28 (84.8%), P 63 positivity in 19 (57.6%) and calponin positivity in 18 (54.5%) patients. Two particularly interesting findings were noted, namely, myoepithelial differentiation in the carcinomatous and sarcomatous elements of MBC, and EGFR immunopositivity. CONCLUSION: Immunohistochemistry has an important role to play in the diagnosis and treatment decision of MBC. This report presents findings related to a broad panel of immunohistochemical markers for a large series of metaplastic cases, which indicate poor prognosis for this tumor.

The efficacy of spironolactone in the treatment of acute respiratory distress syndrome-induced rats.

INTRODUCTION: This study aimed to test the feasibility of spironolactone treatment in comparison with a surfactant in the early stage of acute respiratory distress syndrome (ARDS) in rats, as assessed by the acute lung injury (ALI) score, blood gas, brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP). METHODS: A total of 40 rats were randomly allocated into one of five groups (n is eight). The baseline group (Group B) was subjected to neither tracheotomy nor ARDS induction, while the sham group (Group N) was subjected to tracheotomy upon ARDS induction by acid aspiration. The other three groups were administered either a single dose of spironolactone (100 mg/kg, Group Sp) or surfactant (100 mg/kg, Group S), or were untreated (Group A). Blood samples were collected from the femoral artery for blood gases, BNP and NT-proBNP measurements. RESULTS: ARDS induction decreased the blood PO2 /FiO2 ratio and increased the BNP and NT-proBNP levels (p is less than 0.001). Compared with the ARDS-untreated group, spironolactone treatment was more effective at reducing the elevated BNP (72 percent versus 37 percent) and NT-proBNP (53 percent versus 23 percent) levels and ALI score (28 percent versus 7 percent) than surfactant treatment. Moreover, the blood PO2 / FiO2 ratio was negatively correlated with the BNP (r is -0.79), NT-proBNP (r is -0.85) and ALI scores (r is -0.85). CONCLUSION: Spironolactone is an effective form of treatment for ARDS at an early stage, as reflected by an increased blood O2 /FiO2 ratio, decreased BNP and NT-proBNP levels, and ALI score.

Characteristics and risk factors for colorectal cancer recurrence.

PURPOSE: To evaluate the characteristics of recurrence and examine the clinicopathological factors related to disease- free (DFS) and overall survival (OS) of patients with colorectal cancer (CRC) recurrence. METHODS: One hundred and sixteen CRC patients with stage II and III disease that had been resected curatively in our clinic between 1999 and 2006 were retrospectively evaluated. The parameters evaluated were gender, age, preoperative CEA levels, tumor localisation, duration of surgery, the units of perioperative blood transfusion, tumor differentiation, TNM stages and adjuvant therapies. The presence of preoperative intestinal obstruction, radical abdominopelvic lymph node (RAPL) dissection and lymphatic, vascular and perineural invasion were also evaluated. RESULTS: With 36.6+/-2 months follow-up, 49 (42%) patients developed local recurrence and/or distant metastases. Twenty-three (19.8%) patients presented with isolated local recurrence. Thirteen of 49 patients with local recurrence were successfully operated with R0 curative resection. The OS survival rates for those with curatively and palliatively resected recurrences were 29 and 19 months, respectively. In multivariate analysis, the factors related to DFS were tumor localisation and differentiation, neurovascular invasion, blood transfusion and RAPL dissection. Among these factors, only RAPL dissection was not statistically significant for OS. CONCLUSION: The factors increasing local recurrence rates of CRC should be clearly described. Local and systemic treatment modalities, like preoperative chemoradiotherapy should be planned for patients carrying these risk factors.

Combining intrathecal bupivacaine and meperidine during caesarean section to prevent spinal anaesthesia-induced hypotension and other side-effects.

This study compared intrathecal hyperbaric bupivacaine with low-dose intrathecal plain bupivacaine plus different doses of meperidine (pethidine), administered sequentially, with regard to blood pressure stability, post-operative analgesia and incidence of side-effects in 80 parturients undergoing caesarean section. Patients were randomly assigned to one of four groups (n=20 each group): the HB group received 10 mg hyperbaric bupivacaine intrathecally; the BM35, BM30 and BM25 groups received 5 mg plain bupivacaine plus 35, 30 or 25 mg of meperidine intrathecally, respectively. The incidence of hypotension in the BM25 group was significantly lower than in the HB group. Nausea and vomiting were less prevalent in the BM25 group than in the HB and BM35 groups. In conclusion, sequential administration of 5 mg plain bupivacaine and 25 mg meperidine intrathecally provided better blood pressure stability and a lower incidence of side-effects than bupivacaine alone, without affecting quality of anaesthesia or surgical and patient satisfaction.

Prognosis in hormon receptor negative breast cancer patients according to ERBB2 status.

Breast carcinomas represent a heterogenous group of tumors and recent studies have demonstrated several subtypes of breast cancer by gene expression profiles. This study aimed to compare hormon receptor negative (ER-/PR-/ERBB2+) and triple negative (ER-/PR-/ERBB2-) patients in terms of prognosis and to show that molecularly defined subtypes can be distinguished by conventional laboratory methods. Patients treated between 2001-2007 for hormon receptor negative breast cancer were retrospectively studied. In addition to the conventional prognostic factors, effect of ERBB2 status of the patients on disease-free and overall survival was evaluated. Hormon receptor and ERBB2 status were determined by immunuhistochemistry and fluorescence in-situ hybridization. 141 patients were eligible for the study. Number of patients with ERBB2 positive and triple negative tumors was 70 and 71, respectively, and two groups were comparable in terms of study parameters. Tumor size, grade, axillary status, patient groups, and adjuvant chemotherapy and radiotherapy showed significant impact on disease-free survival and overall survival was significantly dependent on axillary status, type of surgery, and patient groups in univariate analysis. In multivariate analysis, patient groups, tumor grade, and axillary status were independent prognostic factors for disease-free survival whereas patient groups, extent of surgery, and axillary status were independent prognostic factors for overall survival. This study has indicated that ERBB2 negative patients had worse survival among hormon receptor negative breast cancer patients and showed that molecularly defined subtypes of breast cancer can be differentiated by immunuhistochemistry in terms of prognosis.

Role of ABCB1 and ABCC1 gene induction on survival in locally advanced breast cancer.

Drug resistance to chemotherapy in patients with locally advanced breast cancer results in a decrease in treatment efficacy and in patient survival. This study aimed to evaluate the impact of ABCB1 and ABCC1 gene induction during chemotherapy on disease-free and overall survival of breast cancer patients. Patients with locally advanced breast cancer were prospectively included. All patients were preoperatively treated with chemotherapy and underwent mastectomy. ABCB1 and ABCC1 gene and protein expressions were evaluated both before and after chemotherapy and investigated as molecular predictive parameters affecting diseasefree and overall survival. ABCB1 and ABCC1 gene expressions were evaluated with RTPCR following RNA isolation from tissue samples. P-glycoprotein and MRP1 in tissues were detected using immunohistochemistry. Twenty-five female patients treated with either doxorubicin or epirubicin were included. Median follow-up time was 36 months during which 11 patients (44%) had recurrence, all of whom died. Mean disease-free survival for patients with and without ABCB1 gene induction was 13 and 55 months (p=0.0004), respectively, whereas overall survival was 21 and 57 months (p=0.0025), respectively. Mean disease-free survival for patients with and without ABCC1 gene induction was 32 and 48 months (p=0.97), respectively, and overall survival was 43 and 49 months (p=0.36), respectively. ABCB1 gene induction decreases disease-free and overall survival in patients with locally advanced breast cancer due to anthracycline resistance. Detecting ABCB1 gene expression during chemotherapy helps to increase the efficacy of drug treatment by choosing the appropriate drugs resulting in prolonged survival.

The role of neuron numbers of the petrosal ganglion in the determination of blood pressure: an experimental study.

BACKGROUND: Baroreceptor reflexes are regulated by nerve terminals of the glossopharyngeal and vagal nerves. The body of pressure-sensitive neurons of these nerves is located in the petrosal ganglion of both nerves. We examined whether there is a relationship between the neuron numbers of the inferior ganglion of the glossopharyngeal nerve and blood pressure values. METHODS: Petrosal ganglions were examined in 18 male hybrid rabbits divided into three equal groups: Group A normotensive (TA=90-100 mmHg), Group B hypertensive (TA>100 mmHg); and Group C hypotensive (TA<90 mmHg). After examination of blood pressure for one week, all animals were sacrificed, and the petrosal ganglions extracted bilaterally and examined histopathologically using the physical dissector method. RESULTS: The mean (+/-SD) neuronal density was: Group A 8700+/-200, Group B 7800+/-250 and Group C 9800+/-300, respectively. The difference between the groups B and C as compared to A was significant (p<0.01) while the difference between Groups B and C was highly significant (p<0.001). CONCLUSIONS: An inverse relationship was noticed between the neuronal density in the petrosal ganglion and blood pressure values with potential implications in the study of the etiology of hypertension.

Effects of trimetazidine on lipid peroxidation, antioxidant enzyme activities and plasma brain natriuretic peptide levels in patients with chronic cor pulmonale.

An oxidant/antioxidant imbalance in favour of oxidants appears to occur in chronic cor pulmonale (CCP). Oxidative stress could also be a critical event in the pathogenesis of this condition. Trimetazidine (TMZ) has antioxidant properties and may affect the utilization of oxygen radicals. We investigated the effect of TMZ (20 mg three times daily, orally) on activities of erythrocyte malondialdehyde (MDA) and catalase (eCAT), erythrocyte and plasma glutathione peroxidase (GSH-Px) and plasma superoxide dismutase (pSOD) in CCP patients. We also assessed changes in plasma levels of brain natriuretic peptide (BNP) with TMZ therapy. Sixty CCP patients with significantly higher MDA and markedly lower pSOD, eCAT and GSH-Px (erythrocyte) activities than 24 healthy controls were randomly allocated to receive routine treatment or routine treatment plus TMZ. After 3 months' therapy, greater pSOD, eCAT and GSH-Px (erythrocyte and plasma) activities and lower MDA activity were found with TMZ treatment compared with routine treatment. Plasma BNP levels were significantly lower in TMZ-treated patients and higher in the routine treatment group than in the control group. TMZ improved antioxidant levels, decreased oxidative stress and decreased plasma BNP levels in CCP patients.

A comparison of the outcomes of non-randomised chemotherapy regimens in node positive breast cancer.

Adjuvant chemotherapy increases disease-free survival (DFS) and overall survival (OS) following surgery for breast cancer. However, debates concerning the type of adjuvant chemotherapy continue. The effect of adjuvant chemotherapy on loco-regional recurrence-free survival (LFS) was also reported. The present study was undertaken to compare the results of adjuvant FAC (5-fluorouracil, Doxorubicin, Cyclophosphamide) and CMF (Cyclophosphamide, Methotrexate, 5-fluorouracil) chemotherapy on DFS, OS and LFS for node positive breast carcinoma treated with mastectomy in a non-randomised setting. Data from 688 consecutive lymph node positive breast cancer patients who underwent radical or modified radical mastectomy and received adjuvant FAC (600/60/600 mgr/m2 for 6 cycles every three weeks) or CMF (600/40/600 mgr/m2 for 6 cycles on days land 8 every four weeks) chemotherapy were reviewed. The effect of FAC on DFS, OS and LFS as compared with CMF was analysed. Survival curves were generated by the Kaplan-Meier method, and a multivariate analysis was performed by the Cox proportional hazard model. Adjuvant FAC was found to improve DFS, OS and LFS. 5-year DFS, OS and LFS were longer for patients treated with FAC as compared to CMF (67% versus 53%, p < 0.001; 77% versus 66%, p < 0.001, and 97% versus 91%). Adjusted hazard ratio (HR) for potential risk factors and tamoxifen treatment showed that FAC treated patients much benefitted in terms of survival as compared to CMF treated patients (HR 0.53, CI 0.40-0.69 for DFS; HR 0.48, CI 0.35-0.65 for OS, and HR 0.33, CI 0.16-0.65 for LFS). In conclusion, adjuvant FAC improves DFS, OS and LFS as compared to CMF in node positive breast carcinoma patients treated with mastectomy.

Urodynamic evaluation of lower urinary tract function in relation to total abdominal hysterectomy.

This study was performed to evaluate lower urinary tract functions in asymptomatic patients by urodynamic measurements after total abdominal hysterectomy and bilateral salpingo-oophorectomy. Twenty asymptomatic patients who had undergone hysterectomy for benign diseases were included in the study and urodynamic measurements were performed before and 6 weeks after total abdominal hysterectomy and bilateral salpingo-oophorectomy. There was no postoperative difference in first urge, normal urge, urgency and maximum bladder capacity but average urethral length, functional urethral length and maximum urethral closing pressure were decreased and also bladder discharging time was increased. Voided volume and residual urine volume were unchanged. It was concluded that total abdominal hysterectomy and bilateral salpingo-oophorectomy did not change the postoperative bladder loading functions in asymptomatic patients but that significant changes occurred in urethral functions.

The role of anti-CENP-B and anti-SS-B antibodies in breast cancer.

A close relationship between autoimmunity and malignant diseases has been supposed for a long time. In clinical practice, anti-SS-B and anti-CENP-B antibodies are used as serologic markers for autoimmune diseases. In this study, anti-SS-B and anti-CENP-B autoantibodies were studied in breast cancer patients and compared to a control group surgically treated due to benign diseases. These antibodies were evaluated by enzyme linked immunoassay and serum values >10 U/ml were accepted as positive. Fifty-five patients with breast cancer and 25 patients with benign diseases were prospectively included in the study. In the breast cancer group, both anti-CENP-B (33% vs. 8%) and anti-SS-B (44% vs. 24%) autoantibodies had higher positivity compared to the control group, but this difference reached statistical significance only for anti-CENP-B antibodies (p=0.02). Besides, anti-SS-B positivity was detected more frequently in breast cancer patients with axillary involvement (63% vs. 24%) (p=0.006) and increased as the number of involved lymph nodes increased in the axilla (p=0.03). Although the clinical significance of autoantibody detection in cancer patients is still not clear, autoantibodies especially detected in individuals without proven autoimmune diseases needs to be thoroughly evaluated for early diagnosis and treatment of various cancers.

Identification of the culprit artery involved in inferior wall acute myocardial infarction using electrocardiographic criteria.

We tested whether particular electrocardiogram (ECG) changes can identify the right coronary (RCA) or left circumflex (LCX) artery as the responsible vessel in inferior wall acute myocardial infarction (AMI) in 73 patients. A standard 12-lead ECG was performed within 6 h of onset of chest pain. Coronary angiography was performed between 1 week and 6 weeks after the infarction. RCA and LCX lesions were detected in 53 and 20 patients, respectively. The most useful ECG parameters for implicating the RCA were a higher ST elevation in lead III than lead II (specificity 94%, sensitivity 86%) and an S/R wave ratio > 0.33 plus ST segment depression > 1 mm in lead aVL (specificity 94%, sensitivity 92%). Absence of these criteria was associated with LCX occlusion (specificity 100%, sensitivity 87%). These results indicate that composite ECG criteria are useful in predicting the artery involved in inferior wall AMI.