[Myomectomy and uterine desarterialization as conservative treatment for uterine fibroids: Review of clinic case]. / Miomectomía y desarterialización uterina como tratamiento conservador de la miomatosis de grandes elementos: reporte de un caso.

BACKGROUND: Uterine fibroids are the most common gynecological tumors; the prevalence increases with age. They can cause symptoms (20-50%). Myomectomy is an alternative for women who wish to preserve their fertility, increased risk of blood loss and longer operative time. Since 2000, a significant number of surgeons have performed occlusion of uterine arteries prior to myomectomy successfully. CASE REPORT: We report the case of a 24-year-old patient, with a history of premature birth; and starts her condition after obstetric event with abnormal uterine bleeding and postcoital bleeding, accompanied by intense, oppressive and stabbing abdominal pain and increased ab-dominal volume. At physical examination an enlarged abdominal wall by a tumor involving, abdominal pain on palpation, at the gynecological examination: frankly enlarged uterus, about 25 x 20 cm, painful and tenderness. Prior to myomectomy, uterine externalization takes place and proceeds to dearterialization of uterine arteries under the García-González technique, removing the tumor without complications, with an estimated 100 cc bleeding. The bilateral uterine artery ligation, is one of the methods used to re-duce intraoperative blood loss. It is a quick, simple technique, whose theoretical basis is that 90% of the irrigation of the uterus comes from the uterine arteries.

Self-Management and Transition Readiness Assessment: Development, Reliability, and Factor Structure of the STARx Questionnaire.

INTRODUCTION: The Self-Management and Transition to Adulthood with Rx=Treatment (STARx) Questionnaire was developed to collect information on self-management and health care transition (HCT) skills, via self-report, in a broad population of adolescents and young adults (AYAs) with chronic conditions. METHODS: Over several iterations, the STARx questionnaire was created with AYA, family, and health provider input. The development and pilot testing of the STARx Questionnaire took place with the assistance of 1219 AYAs with different chronic health conditions, in multiple institutions and settings over three phases: item development, pilot testing, reliability and factor structuring. RESULTS: The three development phases resulted in a final version of the STARx Questionnaire. The exploratory factor analysis of the third version of the 18-item STARx identified six factors that accounted for about 65% of the variance: Medication management, Provider communication, Engagement during appointments, Disease knowledge, Adult health responsibilities, and Resource utilization. Reliability estimates revealed good internal consistency and temporal stability, with the alpha coefficient for the overall scale being .80. The STARx was developmentally sensitive, with older patients scoring significantly higher on nearly every factor than younger patients. CONCLUSION: The STARx Questionnaire is a reliable, self-report tool with adequate internal consistency, temporal stability, and a strong, multidimensional factor structure. It provides another assessment strategy to measure self-management and transition skills in AYAs with chronic conditions.

Head and neck soft tissue sarcomas: prognostic factors and outcome in a series of patients treated at a single institution.

BACKGROUND: Head and neck soft tissue sarcomas (STS) represent a rare disease. PATIENTS AND METHODS: One hundred and sixty-seven patients underwent surgery at our institution with an eradicating intent between 1990 and 2010. Local recurrence (LR), distant metastasis (DM) and disease-specific mortality (DSM) incidence were studied along with clinicopathological prognostic factors. RESULTS: Ten-year crude cumulative incidence (CCI) of LR, DM and DSM were 19%, 11% and 26%, respectively (median follow-up 66 months). Independent prognostic factors for DSM were tumor size (P < 0.001) and grade (P = 0.032), while surgical margins obtained a border-line significance (0.070); LR was affected by the tumor size (P = 0.001), while DM only by grade (P = 0.047). The median survival after LR and DM were 14 months and 7 months, respectively. Tumors sited in the paranasal sinus and supraclavicular region had the worst survival. CONCLUSIONS: Head and neck represent a very critical anatomical site for STS. Achievement of local disease control appears to be crucial, since even LR could be a life-threatening event.

Role of EGFR family receptors in proliferation of squamous carcinoma cells induced by wound healing fluids of head and neck cancer patients.

BACKGROUND: Mounting evidence suggests that recurrence of resected head and neck squamous cell carcinomas (HNSCCs) is due to the outgrowth of unrecognized residual tumor cells as well as to the premalignant and/or precursor-field epithelial cells. We studied the impact of processes triggered by HNSCC surgery in stimulating both residual tumor cells [demonstrated to overexpress epidermal growth factor receptor (EGFR)], and premalignant cells surrounding the resected lesion. PATIENTS AND METHODS: EGFR expression/activation by immunohistochemistry/biochemistry and gene status by FISH were investigated in 23 primary HNSCCs and surrounding tissues. The ability to induce cell proliferation of wound healing drainages collected from 12 relapsed and 11 not relapsed patients was evaluated by a colorimetric assay in squamous cell carcinoma cell lines A431 (carrying EGFR amplification) and CAL27 (carrying three EGFR copies) in the presence/absence of EGFR therapeutic inhibitors. RESULTS: Primary tumors showed intermediate/high EGFR expression (91%), EGFR phosphorylation and EGFR-positive FISH (35%). Normal, metaplastic and dysplastic epithelium surrounding the resected tumor displayed EGFR overexpression. EGFR activation and gene amplification were observed in normal and dysplastic epithelium, respectively. Each tested wound healing drainage induced the cells to proliferate and the proliferation was significantly higher in relapsed compared with not relapsed HNSCC patients (P = 0.02 and P = 0.03). Anti-EGFR treatments inhibited the drainage-induced proliferation, with the highest inhibitory efficiency by cetuximab on A431 cells, while CAL27 cell growth was more efficiently inhibited by tyrosine kinase inhibitors. CONCLUSIONS: Surgery could favor the proliferation of cells showing EGFR overexpression/activation/amplification such as residual tumor cells and/or precursor-field epithelial cells already present after surgery. Treatment with anti-EGFR reagents inhibits wound-induced stimulation, according to the EGFR family status.

Spatially resolved fluorescence lifetime mapping of enzyme kinetics in living cells.

Traditional cuvette-based enzyme studies lack spatial information and do not allow real-time monitoring of the effects of modulating enzyme functions in vivo. In order to probe the realistic timescales of steric modifications in enzyme-substrate complexes and functional binding-unbinding kinetics in living cells without losing spatial information, it is imperative to develop sensitive imaging strategies that can report enzyme kinetics in real time over a wide dynamic range of timescales. Here we present a multi-photon excitation-based, ultra-fast photon detection using a streak camera and Laguerre expansion-based fast deconvolution approach for achieving high spatio-temporal resolution in monitoring real-time enzyme kinetics in single cells. In particular, we report spatially resolved, nanosecond-scale fluorescence dynamics associated with binding-unbinding kinetics of endogenous metabolic co-factor nicotinamide adenine dinucleotide with enzymes in intact living cells. By monitoring real-time kinetics of NAD(P)H-enzyme kinetics in primary hepatocytes isolated from young and aged mouse models, we observed that the mechanism of inhibition of mitochondrial respiration at complex I site is mediated by redistribution of free and protein-bound nicotinamide adenine dinucleotide pools and that this equilibrium redistribution is affected by age-related modifications in mitochondrial function. We describe unique advantages of Laguerre deconvolution algorithm in comparison with conventional lifetime analysis approaches. Non-invasive monitoring of metabolic dysfunctions in intact animal models is an attractive strategy for gaining insight into the dynamics of tissue metabolism in health and in various metabolic syndromes such as cancer, diabetes and aging-induced metabolic dysfunctions. Besides the example demonstrated above, we envisage that the proposed method can find applications in a variety of other situations where intensity-based approaches fall short owing to spectroscopic artefacts.

In vivo interleukin 2-induced activation of lymphokine-activated killer cells and tumor cytotoxic T-cells in cervical lymph nodes of patients with head and neck tumors.

To study whether regional injection of recombinant interleukin 2 (rIL-2) can induce an in vivo lymphocyte activation in cervical lymph nodes (LNs) of patients with head and neck carcinoma, 12 patients, candidates for prophylactic dissection, were treated for 7-10 days prior to surgery with rIL-2, 10(5) units/day, injected in the perimastoid region. A marked induction of cytotoxic activity against allogeneic (K562 and Daudi lines) and autologous target cells (fresh spindle cell carcinomas of the tongue) was observed in lymphocytes obtained from jugular, spinal, and, to a lesser extent, submandibular LNs of all treated patients. An increase of cytotoxicity was also present in LNs contralateral to the rIL-2 injection side. On the other hand, only a borderline increase in spontaneous proliferation was detected. Moreover, in the two cases tested, a marked and apparently autologous tumor (Auto-Tu)-specific lysis was found in CD5+ lymphocytes obtained from LNs, whereas lymphokine-activated killer activity was mainly exerted by CD16+ natural killer cells. T-lymphocytes, when cultured with irradiated Auto-Tu cells and low doses of rIL-2, showed an increased Auto-Tu lysis, while cytotoxicity against allogeneic tumor cells (including K562) was not observed. These data indicate that regional injection of rIL-2 can activate lymphokine-activated killer cells from LN lymphocytes but also induce and/or expand a T-cell population expressing a restricted Auto-Tu cytotoxicity.

Causes for an Incomplete Donation Process at a Tertiary Care Hospital.

INTRODUCTION: This study aims to identify the causes for the incomplete donation process at a tertiary care hospital. MATERIALS AND METHODS: A descriptive, retrospective study was performed; all potential donors reported to the Transplant Service within the period of 2005 to 2014 were included. Descriptive statistics were used across frequencies and proportions for categorical variables, central tendency, and dispersion for continuous variables. RESULTS: The total number of deaths reported at the University Hospital (HU) was 8472, of which 815 (n = 815) were reported to COETRA ("Consejo Estatal de Trasplantes"). Among organ or tissue donors, the main known cause of death was head trauma (HT) in 26% (72). Cardiac arrest (CA) as cause of death provided the largest number of donations (141, 57%); of these, 102 (41%) were male and 39 (16%) were female. In comparison, brain death (BD) provided 104 (43%); of these, 65 (27%) were male, and 39 (16%) were female. The age interval was with a higher donation rate was 45 to 49 y (BD 18, CA 22). Donation request was not performed in 359 patients because of medical contraindication 60% (215), rapid deterioration 18% (64), and incomplete donation process 8% (27). Of 452 organ requests, 207 were not accomplished, because of body integrity 28% (57), family disagreement 20% (42), and no acceptance of BE 13% (26). CONCLUSIONS: Opportunity areas: (1) Ensure the notification of all deaths to Transplant Department for identification of potential donors; (2) Reduce rapid deterioration and raise number of completed donation protocols; (3) Increase the donation rate.

Prediction of TP53 status for primary cisplatin, fluorouracil, and leucovorin chemotherapy in ethmoid sinus intestinal-type adenocarcinoma.

PURPOSE: To assess the role of TP53 status in predicting pathologic complete remission after primary chemotherapy in patients with ethmoidal intestinal-type adenocarcinoma (ITAC). PATIENTS AND METHODS: Thirty patients with ethmoidal ITAC enrolled onto a phase II study received chemotherapy with cisplatin, fluorouracil, and leucovorin (PFL) followed by surgery and radiation. On surgical specimens, absence of viable tumor cells was defined as pathologic complete remission (pCR). TP53 status/p53 function, analyzed on pretreatment biopsies, were retrospectively correlated with pathologic results and patient outcome. RESULTS: Twelve patients achieved a pCR; 18 patients did not (overall response rate, 40%). In patients with wild-type (wt) TP53 or functional p53 protein, the pCRs were 83% and 80%, respectively; in patients with mutated TP53 or impaired p53 protein, pCRs were 11% and 0%, respectively (P < or = .0001). At a median 55-month follow-up, all pCR patients were disease-free; 44% of nonresponding patients experienced relapse (P = .0061). CONCLUSION: The results indicate the existence of two genetic ITAC subgroups, defined by differences in TP53 mutational status or protein functionality, that strongly influence pathologic response to primary chemotherapy and, ultimately, prognosis. PFL seems to be highly effective in terms of pCR and disease-free survival in the presence of a wt or a still-efficient p53 protein, even when encoded by a mutated TP53 gene (eg, early-stop codon mutation), but ineffective in ITACs carrying a disabled p53 protein. Whether this model is extensible to other head and neck cancers needs appropriate investigation.

Densitometry: modern approaches advance an established technique.

Densitometry is an established technique used in most biological research laboratories. Established techniques are often assumed to be stable and therefore not subject to advancement by the application of newer technology. However, when new technology is applied to an established technique, great advances can suddenly occur. Using the latest in laser optics design, semiconductor technology and state-of-the-art software implementation, Molecular Dynamics has developed and recently introduced a new Personal Densitometer SI that has performance capabilities considered impossible only a few years ago. In addition, the entire system can be priced lower than was previously possible.

Squamous-cell carcinoma of the upper lip - analysis of 123 cases.

Squamous cell carcinoma of the upper lip is rare and poorly described in the literature. We analysed retrospectively 123 cases occurring from 1929 to 1987. Greatest incidence was in the seventh decade and the M/F ratio was 2:1. Treatment was radiotherapy (36) or surgery (87). In early disease stages radiotherapy and surgery were equally effective, but in advanced disease surgery provided better results. Involved nodes indicate mandatory laterocervical submandibular lymph node dissection (bilateral for central lesions) but prophylactic dissection is inappropriate. The high frequency of relapse, tendency to plurifocality (as with all cercicofacial tumors) and risk of lymph node involvement underline the importance of regular and careful follow-up.

Skeletal muscle lipid peroxidation in exercised and food-restricted rats during aging.

The effects of chronic endurance exercise and food restriction on nonenzymatic lipid peroxidation (LP) of gastrocnemius muscle during aging were studied in male, Fischer 344 rats. One set of rats aged 6 and 18 mo were assigned to an exercise group (treadmill running) or an age-matched sedentary control group. After 6 mo (at the ages of 12 and 24 mo), LP and levels of alpha-tocopherol and its oxidized form, alpha-tocopheryl quinone, were measured. The extent of LP was determined in homogenates by measuring the content of thiobarbituric acid-reactive substances. After homogenization, the muscles were immediately evaluated for basal LP and also incubated in the presence of oxidant stressors for 2 h to assess antioxidant capacity (AOC) and for 24 h to estimate total peroxidizable lipid (TPL). Basal LP was not affected by age or exercise. AOC was not affected by exercise at either age. However aging significantly decreased AOC and increased alpha-tocopheryl quinone in both sedentary and exercised groups. TPL was not affected by age, but was increased by exercise training (P less than 0.05). Another set of rats was divided into the following three groups at 3 mo of age: sedentary, fed ad libitum (S); sedentary, caloric restricted by alternate day feeding (R); and exercised by forced treadmill running (E). Two years later, when the rats were 27 mo of age, the extent of LP was assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined anterior craniofacial resection for tumors involving the cribriform plate: early postoperative complications and technical considerations.

OBJECTIVE: Combined craniofacial resection has become the standard approach for malignant tumors involving the cribriform plate and anterior cranial fossa. Despite its widespread application, however, many surgeons agree that the procedure carries a risk of significant morbidity and even mortality. The purpose of this study was to analyze the experience at a single institution to determine the incidence of early postoperative complications encountered after combined craniofacial resection of tumors involving the cribriform plate and to provide information to improve management. METHODS: Between 1987 and 1997, 168 patients underwent combined craniofacial resection at the National Cancer Institute of Milan for tumors involving the cribriform plate. Patient charts, operative notes, follow-up clinic notes, radiographic studies, and pathology reports were analyzed. Morbidity encountered in the first 30 cases was compared with that encountered in the subsequent 138 cases. RESULTS: The most frequently encountered pathological findings were adenocarcinoma (53.6%), squamous cell carcinoma (17%), and esthesioneuroblastoma (9.8%). Eight patients (4.7%) died, 6 of whom were among the first 30 patients to undergo resection. Among patients with fatal complications were three with meningoencephalitis, three with intracranial hemorrhage, and one with myocardial infarction. Fifty patients (29.7%) had nonfatal morbidity; 16 of these patients were among the first 30 patients operated. Transient cerebrospinal fluid leakage was the most frequent adverse effect (9.5%); 12 patients (7.1%) had pneumocephalus, 3 (1.8%) had meningitis, 4 (2.4%) had wound infections, 3 (1.8%) experienced transient impairment of mental status, 3 (1.8%) had transient diplopia, 2 (1.2%) had diabetes insipidus, and 1 (0.6%) had bone flap necrosis. CONCLUSION: We observed a dramatic decrease in mortality and morbidity in patients who underwent combined craniofacial resection after the first 30 cases in our series. Improvement of specific aspects of surgical technique, such as more refined reconstructive methods and improved prophylactic antibiotic therapy, is at least partly responsible for this favorable trend.

Primary high-grade mucoepidermoid carcinoma of the minor salivary glands with cutaneous metastases at diagnosis.

Mucoepidermoid carcinoma (MEC) represents 15% of all salivary glands malignancies. Metastatic disease at diagnosis is observed in less than 5% of the cases. The lung is the most commonly involved site. This is the first reported case of high-grade MEC of the salivary gland with skin metastases at diagnosis. This feature was associated with a chemoresistant and aggressive behaviour. Differential diagnosis between metastatic MEC and primary skin MEC is essential for therapeutic management and prognosis.

A new classification for malignant tumors involving the anterior skull base.

OBJECTIVES: To propose our clinical classification of malignant ethmoid tumors and to compare it with the last American Joint Committee on Cancer (AJCC)-Union Internationale Contre le Cancer (UICC) classification, published in 1997. DESIGN: Retrospective review. SETTING: Tertiary cancer facility. PATIENTS: We evaluated 123 consecutive patients undergoing craniofacial resection for malignant ethmoid tumors involving the anterior skull base. The mean follow-up was 60 months. Fifty-nine patients (48%) presented with recurrent disease after prior therapy. We classified them with a new classification system (Istituto Nazionale per lo Studio e la Cura dei Tumori) based on the most commonly accepted unfavorable prognostic factors (involvement of dura mater; intradural extension; involvement of the orbit and, in particular, of its apex; invasion of maxillary, frontal, and/or sphenoid sinuses; and invasion of the infratemporal fossa and skin. We also classified patients with the AJCC classification published in 1997. MAIN OUTCOME MEASURES: Disease-free status and overall survival rate. To study a possible association with tumor stage, the Cox regression model was adopted. RESULTS: According to our classification, patient distribution by tumor type was T2, n = 46; T3, n = 29; and T4, n = 48 (no T1 tumors were present in the series). For previously untreated patients, 5-year disease-free survival estimates were T2, 57%; T3, 50%; and T4, 13%. For relapses, corresponding figures were T2, 31%; T3, 23%; and T4, 1%. The prognostic difference among stages was statistically significant (P<.001). Similar results were obtained for overall survival. In contrast, patient distribution among different AJCC stages was less balanced, and we failed to detect a significant association with the clinical outcome using this classification. CONCLUSION: We propose the use of our staging system by all those specialists in the field willing to validate the classification and possibly apply it for clinical and investigational purposes.

Skull base reconstruction after anterior craniofacial resection.

Anterior craniofacial resection has become a popular operation for nasoethmoid tumours involving the skull base. Many papers have been published since the first by Ketcham et al. in 1963. However, there is still controversy about the method for reconstruction of an anterior skull base defect after resection. The simple reconstruction of Ketcham has been followed by more sophisticated procedures using galeal-pericranial flaps, free flaps with microvascular anastomosis and bony or alloplastic augmentation. The main purposes of the reconstructions are to prevent brain herniation, to avoid intracranial infections, to diminish the risk of CSF leakage and to avoid pneumocephalus. From the relevant literature and our own experience of 168 anterior craniofacial resections, we conclude that a pedicled pericranial flap is the best choice for closing a cranial base defect.

Retrospective comparison of conservative and radical neck dissection in laryngeal cancer.

A retrospective comparison of radical and conservative technique for neck dissection in cancer of the larynx was made, starting from analysis of 98 patients operated on with the conservative procedure (128 cervical neck fields at risk of recurrence) at the Istituto Nazionale Tumori of Milan. Furthermore, a series of 162 patients was selected from more than 500 radical neck dissections performed in the past to set up a series as comparable as possible as far as several parameters were concerned. No significant difference was found between radical and conservative neck dissection with regard to the incidence of recurrences in the operative field, either considering the whole series (2.5% versus 1.6%), or cases with histologically proven metastases (9.4% versus 4.5%). Conservative neck dissection seems as safe as radical neck dissection, at least within the limits set in the present study for the indication of the former procedure, ie, nonsuspect nodes or metastatic mobile nodes not greater than 2.5 cm.

Malignant fibrous histiocytoma of the maxillary sinus. A case report.

We report a case of malignant fibrous histiocytoma of the left maxillary sinus in a 30 year-old man. The major problem encountered was the histological diagnosis of the first biopsy, which showed a non specific fasciculated, myxoid, alveolar pattern suggestive of a mesenchymal malignancy, thus preventing the correct diagnosis that became possible only when the surgical specimen was available.

An analysis of 800 breast cancer patients relapsed after radical mastectomy.

The chronology of first recurrences, their topographic distribution and survival from mastectomy were retrospectively studied in a series of 800 mastectomized women with special reference to the relationship between these data and treatment delay, TN categories and free interval. Visceral metastases were more frequent in patients under 50 years, whereas local recurrences were more common in patients over 50. The average free interval was 26 months (over 5 years in 18% of cases) and seemed to be influenced little by the treatment delay or by tumor size; it was shorter in patients under 50 years and shorter still in patients with lymph node involvement at operation. A similar correlation exists between these parameters and survival. The 5 years survival rate of the 800 cases with recurrence was 52%, which is quite different from the rate generally indicated for surgical cases, and much higher than the rate for the natural history of untreated breast cancer. The survival rate in cases with first metastases confined to the soft tissues is much higher than in those with bone and/or with visceral metastases. The survival after recurrence proves to be significantly influenced by the length of the free interval, but much more by the presence or absence of regional lymph node involvement so that the lymph nodes status (N--or N+) turns out to be a prognostic item of primary importance, even after the onset recurrence.

A statistical approach to detection of the primary cancer based on the site of neck lymph node metastases.

Preoperative differential diagnosis of a swelling in the neck is mandatory for a good therapeutic planning. Indiscriminate biopsy as first approach is to be disregarded, since it can compromise the result of a radical neck dissection in cases where a metastasis of epidermoid cancer is histologically recognized. A cervical biopsy is not to be performed until a complete HNT examination (including the thyroid and major salivary glands) has excluded the presence of a primary tumor in these regions. Since every localization of the head and neck malignancies shows rather fixed patterns in its lymphatic spreading, a correlation between site of T and particular localizations of N within the neck can be found. The knowledge of the probabilities that an adenopathy in a given region of the neck correlates with a primary tumor located in a given site of the body could strongly aid the physician in detecting the latter, following a rational statistically based approach. This study was performed applying Bayes theorem for probability calculus to the maps of distribution of metastases of tumors of different site in 3,700 patients who were taken into National Cancer Institute of Milan during 7 consecutive years. The results are gathered in tables and text-figures showing the great significance of some correlations, who become more evident when the adenopathies are multiple, but who usefully direct the physician also when the adenopathy is only one.

Local adoptive immunotherapy of advanced head and neck tumors with LAK cells and interleukin-2.

Since October 1987 a pilot phase I-II study on the effect of loco-regional injections of recombinant interleukin 2 (rIL-2) in association with LAK cells has been performed in advanced, recurrent head and neck cancer patients. Fourteen patients were treated with autologous LAKs and rIL-2 (Glaxo) given peritumorally and in the mastoid region (rIL-2 only in the latter site). LAKs (2-70 x 10(7)) + rIL-2 were injected on the first day of therapy, followed by 9 daily injections of rIL-2 only. The total daily dose of rIL-2 was escalated from 2,400 to 1.8 x 10(6) IU. Clinical evaluation was performed 30 days from the onset of therapy; 3 partial (95%, 66% and 50% reduction) and 3 minor responses were seen in the evaluated patients. All the other patients with a progressive disease after the first cycle were shifted to palliative chemotherapy. The partial responses were found in patients with a tumor burden less than 20 cm2. Cervical node metastasis did not respond to treatment. No relevant side effects occurred. These results indicate that loco-regional immunotherapy with rIL-2 and LAK cells can produce clinical responses in advanced head and neck cancer patients.