Spontaneous rupture of the digital extensor tendons of the hand in unrecognized carpal lunatefracture.

Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbocks disease, rheumatoid arthritis, Vaughan-Jackson syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.

La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.

Spontaneous rupture of the digital extensor tendons of the hand in unrecognized carpal lunatefracture / Ruptura espontánea de los tendones extensores de los dedos de la mano en una fractura oculta del semilunar

Abstract: Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbock's disease, rheumatoid arthritis, Vaughan-Jackson' syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.

Resumen: La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.

QF-PCR and MLPA: a reliable molecular system to detect chromosomal alterations in miscarriages.

PURPOSE OF INVESTIGATION: The aim of this study was to assess the efficacy of the quantitative fluorescent-polymerase chain reaction (QF-PCR) and multiplex ligation-dependent probe amplification (MLPA) combined system to detect chromosome alterations in miscarriage products, as an alternative to conventional cytogenetic testing. MATERIAL AND METHODS: This study was conducted between 2011 and 2015 on 264 samples, analyzed using the combined system: QF-PCR/MLPA. This approach first analyzed miscarriage products for chromosomes 13, 18, 21, X and Y, using QF-PCR analysis; in case of ovular fragments, an analysis of maternal DNA was carried out in order to establish the origin of material. Whenever fetal origin was determined, MLPA analysis on the subtelomeric regions was car- ried out. RESULTS: On 264 miscarriages analyzed, 229 were of fetal origin and produced the following results: 53.7% normal and 46.3% pathological. Of the latter, 74.4% were autosomal aneuploidies, 10.4% triploidies, 8.5% sex chromosomal aneuploidies, 3.7% structural alterations, and 2.7% multiple aneuploidies. Results from QF-PCR were obtained from all samples, whereas unambiguous MLPA re- sults were obtained in about 90% of all cases. CONCLUSION: This approach results being highly effective for examining all chromosome aneuploidies, triploidies, as well as structural unbalanced alterations in the subtelomeric regions.

Hot-flashes in breast cancer survivors: effectiveness of low-dosage fluoxetine. A pilot study.

Breast carcinoma survivors suffering from hot-flashes experience a negative impact on their quality of life. Antidepressants have recently been proven to be effective in these women, significantly reducing the vasomotor symptoms. With this in mind, a single-arm clinical trial low-dose regimen of Fluoxetine (10 mg/day for 4 weeks) was given to twenty symptomatic breast cancer patients. Among the 12 women evaluated at the end of treatment, a statistically significant reduction of the mean number of daily hot-flashes (-36.3%, p = 0.001) and hot-flashes score (-46.2%, p = 0.0006) had been detected as compared to the baseline data. Although the dosage of Fluoxetine used in these trials was lower than earlier published, it should be noted that these positive results were achieved without any relevant side effects.

Serum evaluation of P53 protein in patients with gynaecological cancer.

Sera from patients with gynaecological cancer including the ovary, endometrium or cervix were examined for p53 protein, using the Pantropic p53 quantitative ELISA. Patients with benign gynaecological pathologies were included as a control group. p53 values ranged from undetectable to high levels of the protein (range: 0-531 pg/ml). Using the value of 200 pg/ml as the cut-off, p53 serum levels were found to be elevated in 23% of the patients with ovarian cancer, in 16% of the patients with endometrial cancer and in 14% of the patients with cervical cancer. In the control group, increased serum p53 levels were found in 3.3% of patients. No differences were observed among the groups with different types of cancer or at different stages, but the differences between the cancer groups and the control group were statistically significant. Our results suggest that serum p53 evaluation could be an adjunctive tool to the diagnostic laboratory tests for preoperatively gynaecological cancers and both a competitive and alternative useful procedure for the detection of p53 gene mutations.

Value of c-erbB-2 and p53 oncoprotein co-overexpression in human breast cancer.

p53 and c-erbB-2 protein expression was immunohistochemically examined in a consecutive series of 49 primary breast cancer patients with a 10-year follow-up. The study was performed on paraffin sections using the monoclonal antibodies DO7 and CBE1; the former recognizes both the wild-type and the mutant p53 forms, the latter recognizes the external domain of the transmembrane c-erbB-2 protein. Positive staining was expressed in 12.2% and 16.3% of cases for p53 and c-erbB-2 proteins, respectively. The results were related to clinicopathological parameters by the chi 2 test. A significant correlation was found between positive c-erbB-2 immunostaining and poor survival (P = 0.04) and between p53 and c-erbB-2 overexpression (P = 0.003); this co-overexpression correlated well with a poor clinical outcome (P = 0.040). From our results, we may speculate that simultaneous expression of p53 and c-erbB-2 oncoproteins could be a critical event in breast tumor progression, and therefore, of prognostic value to identify patients at high risk.

Immunoblotting characterization of CA 125 in biological fluids: difference between pregnancy and cancer CA 125 origin.

The CA 125 present in various biological fluids (serum, cyst, peritoneal and amniotic fluids, human milk, seminal plasma, cervical mucus and Wish culture medium), was characterized by gel chromatography and immunoblotting analysis. The elution profile of CA 125 from different sources was closely related. The antigen was eluted primarily in the void volume of a Sephadex G-200 column. Immunoblotting analysis showed that the CA 125 epitopes reside on a high molecular weight species of greater than 900 kDaltons, and are between approximately 900 and 200 kDaltons. The expression of the immunoreactive bands was characteristic for each type of sample was examined. A strong difference was identified between CA 125 from pregnancy and that from ovarian cancer. There differences suggest that the production and/or metabolism of CA 125 glycoprotein might be different from tissue to tissue.

No evidence of the hook effect in peritoneal fluid CA 125 measurement using immunoenzymatic second generation assays: comparison with immunoradiometric assays.

OBJECTIVE: To monitor the occurrence of the hook effect in measurements of peritoneal fluid CA 125 levels using two different immunoenzymatic second generation assays (ETI-II and EIA-II), and to compare these results with those obtained using the respective immunoradiometric versions of the assays (IRMA-II and ELSA-II). STUDY DESIGN: CA 125 levels were determined in peritoneal fluid and serum samples obtained from 45 women with gynecological diseases. The assays were carried out using IRMA-II and ETI-II (Sorin Biomedica) and ELSA-II and EIA-II (CIS Bio International) assays. Occurrence of the hook effect and linearity of the assays were evaluated. Statistical analyses were performed by Wilcoxon's test and linear regression analysis. RESULTS: Undiluted peritoneal fluids, assayed for their CA 125 content, showed falsely underestimated values of the antigen when IRMA-II and ELSA-II assays were performed. The phenomenon disappeared only at high dilutions of the sample (> 50). Conversely, immunoenzymatic ETI-II and EIA-II assays performed on undiluted peritoneal fluids did not show underestimated CA 125 values. CA 125 values obtained by immunoenzymatic assay were lower than those obtained using their respective immunoradiometric versions at a dilution of 1:100 (P < 0.001). A good correlation was observed between ELSA-II and EIA-II (r = 0.929) CA 125 values. CONCLUSION: The EIA-II immunoenzymatic assay appears to be more suitable for CA 125 measurement in peritoneal fluid in that it is not subject to the hook effect and its results correlated well with those obtained via its immunoradiometric version.

Evaluation of second generation CA 125 assays.

OBJECTIVE: This study was performed in order to evaluate and compare the serum CA 125 values obtained using an immunoradiometric (IRMA-II) and an immunoenzymatic (ETI-II) second generation assay, and to establish whether or not the two methods may be used interchangeably. STUDY DESIGN: Serum CA 125 levels were measured in parallel using IRMA-II and ETI-II CA 125 assays (Sorin Biomedica), in 82 women with benign or malignant gynecological diseases. Statistical analysis was performed by linear regression analysis and Wilcoxon's test. RESULTS: Serum CA 125 levels measured using the immunoenzymatic method were lower than those obtained by the immunoradiometric assay. The largest discrepancies between the two methods were found at concentrations of 35-100 U/ml, within which fall cutoff values for the immunoradiometric assay. The cutoff values of 35 or 65 U/ml, frequently used in the original immunoradiometric assay and retained for the immunoradiometric second generation assay, corresponded to 18 and 47 U/ml in the immunoenzymatic second generation assay. CONCLUSION: The discrepancies in CA 125 results obtained by the two detection methods imply that the cutoff values used in the immunoenzymatic procedure should have a lower reference value in order to eliminate high rates of false negative results. Furthermore, their interchangeable use should be avoided in the monitoring of ovarian cancer and other gynecological diseases.

Serum and peritoneal fluid CA-125 levels in patients with endometriosis.

OBJECTIVE: To evaluate CA-125 in peritoneal fluid (PF) as an indicator of endometriosis. DESIGN: CA-125 levels in paired serum and PF were determined by the one-step immunoradiometric assay. For peritoneal samples, high dilution of the sample (1:100) was used to avoid false low results, caused by the "hook effect" phenomenon. PATIENTS: Forty-one women with and without endometriosis, undergoing laparoscopy or laparotomy during the follicular phase of the menstrual cycle, were selected. SETTING: 2nd Institute of Obstetrics and Gynecology, University of Rome "La Sapienza," Rome, Italy. MAIN OUTCOME MEASURE: Peritoneal fluid CA-125 levels obtained using diluted samples were significantly higher than those found using undiluted ones. RESULTS: CA-125 levels in PF were approximately 100 times higher than those found in paired serum, ranging from 970 to 10,636 U/mL. In patients with endometriosis, CA-125 levels in PF were significantly elevated when compared with the control group. In serum, CA-125 levels increased only in advanced stages of endometriosis. CONCLUSIONS: The sensitivity of the CA-125 test for endometriosis in PF is greater than in serum. Therefore, the measurement of CA-125 levels in PF could be useful in the detection of early stage endometriosis, which tends to be overlooked by the CA-125 serum test.

CA 125 in peritoneal fluid: reliable values at high dilutions.

Forty-three samples of peritoneal fluid from women undergoing laparotomy or laparoscopy for various gynecologic diseases were examined to determine and characterize CA 125 antigen. The data were compared with the corresponding serum levels. CA 125 levels in undiluted peritoneal fluid ranged between 41-301 U/mL and were significantly higher than levels in serum, except in cases of ovarian carcinoma. However, when CA 125 of peritoneal fluid was measured at dilutions greater than 1:50, higher antigen levels were measured (1120-31,500 U/mL), with the highest CA 125 values in patients with ovarian carcinoma. Measurements at dilutions of less than 1:50 were also affected but did not show any decreased binding of the antigen. Immunoblotting analysis of serum and peritoneal fluid indicated the presence of two main bands in each. The monoclonal antibody OC 125 reacted strongly with peritoneal fluid CA 125, in agreement with the CA 125 values obtained by immunoradiometric assay using high dilutions. These data suggest that CA 125 measurements in peritoneal fluid are unreliable unless the samples are diluted 1:50 or more. Furthermore, the statistical difference found between patients with benign and malignant tumors and those with leiomyomata uteri and controls suggests that diluted peritoneal fluid could have a role in identifying abnormal antigen levels.

Regulation of CA 125 production by amnion and WISH cells in culture.

Amnion and human amnion-derived WISH cells release CA 125 antigen into culture medium. CA 125 output was higher in WISH cells than in amnion cells. In this study we showed that release of the antigen is regulated, with both amnion and WISH cells responding in a similar manner to the tested agents. Release of CA 125 decreased in the presence of dexamethasone (10(-6) mol/L) or cycloheximide (0.1 micrograms/ml) and increased when colchicine (0.01 micrograms/ml) was added to the culture medium. Stimulatory and inhibitory effects were more apparent after 3 days in culture. The precise mechanisms by which some of these agents (colchicine and dexamethasone) affect CA 125 release remain unknown. We propose that amnion and WISH cells in culture represent a useful model to investigate some regulatory aspects of the production of CA 125 in normal tissues.

Immunochemical and immunohistochemical evaluation of lung permeability in ventilated newborn rabbits.

These experiments were designed to quantify the vascular-to-alveolar leakage albumin in the neonatal lung and to analyze the distribution of leaking airspaces in the lung parenchyma. Immediately after delivery, newborn rabbits with gestational age 27-29 days received an intravenous injection of human albumin as a marker and were ventilated for 15 min with standardized tidal volume (10 ml/kg). After the period of ventilation the lungs were either lavaged via the airways or fixed for histological studies. The median amount of albumin in lung lavage fluid, determined by immunodiffusion, was 4.8% of the injected dose after 27 days, 1.3% after 28 days, and 0.4% after 29 days of gestation; it was inversely correlated with the compliance of the respiratory system (r = -0.78; p less than .001). Immunohistochemical examination of lung section revealed that the leak was not diffuse; even in animals with gestational age 27 days it involved only a median of 48% of total alveoli. The median amount of alveoli containing the label fell to 6% after 28 days and to 0% after 29 days gestation, correlating inversely with the compliance of the respiratory system (r = -0.53; p less than 0.01). We suggest that our experimental model is useful for histological demonstration of serum proteins leaking into the airpaces under experimental conditions and for evaluating the effect of therapeutic regiments on neonatal lung permeability.

CA 125 is released by human amnion cells in culture.

CA 125 was measured in the medium of human amnion cells in primary culture after confluence. The antigen accumulated as a function of time with a median value of 1897 U/mg protein after 7 days in culture. CA 125 was detectable by immunoperoxidase staining in the cells, which supports the possibility that amnion cells play a role as a source of the CA 125 found in the amniotic fluid.