RESUMO
BACKGROUND: To examine the effect of the histology of carcinoma and sarcoma components on survival outcome of uterine carcinosarcoma. PATIENTS AND METHODS: A multicenter retrospective study was conducted to examine uterine carcinosarcoma cases that underwent primary surgical staging. Archived slides were examined and histologic patterns were grouped based on carcinoma (low-grade versus high-grade) and sarcoma (homologous versus heterologous) components, correlating to clinico-pathological demographics and outcomes. RESULTS: Among 1192 cases identified, 906 cases were evaluated for histologic patterns (carcinoma/sarcoma) with high-grade/homologous (40.8%) being the most common type followed by high-grade/heterologous (30.9%), low-grade/homologous (18.0%), and low-grade/heterologous (10.3%). On multivariate analysis, high-grade/heterologous (5-year rate, 34.0%, P = 0.024) and high-grade/homologous (45.8%, P = 0.017) but not low-grade/heterologous (50.6%, P = 0.089) were independently associated with decreased progression-free survival (PFS) compared with low-grade/homologous (60.3%). In addition, older age, residual disease at surgery, large tumor, sarcoma dominance, deep myometrial invasion, lymphovascular space invasion, and advanced-stage disease were independently associated with decreased PFS (all, P < 0.01). Both postoperative chemotherapy (5-year rates, 48.6% versus 39.0%, P < 0.001) and radiotherapy (50.1% versus 44.1%, P = 0.007) were significantly associated with improved PFS in univariate analysis. However, on multivariate analysis, only postoperative chemotherapy remained an independent predictor for improved PFS [hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.27-0.43, P < 0.001]. On univariate analysis, significant treatment benefits for PFS were seen with ifosfamide for low-grade carcinoma (82.0% versus 49.8%, P = 0.001), platinum for high-grade carcinoma (46.9% versus 32.4%, P = 0.034) and homologous sarcoma (53.1% versus 38.2%, P = 0.017), and anthracycline for heterologous sarcoma (66.2% versus 39.3%, P = 0.005). Conversely, platinum, taxane, and anthracycline for low-grade carcinoma, and anthracycline for homologous sarcoma had no effect on PFS compared with non-chemotherapy group (all, P > 0.05). On multivariate analysis, ifosfamide for low-grade/homologous (HR 0.21, 95% CI 0.07-0.63, P = 0.005), platinum for high-grade/homologous (HR 0.36, 95% CI 0.22-0.60, P < 0.001), and anthracycline for high-grade/heterologous (HR 0.30, 95% CI 0.14-0.62, P = 0.001) remained independent predictors for improved PFS. Analyses of 1096 metastatic sites showed that carcinoma components tended to spread lymphatically, while sarcoma components tended to spread loco-regionally (P < 0.001). CONCLUSION: Characterization of histologic pattern provides valuable information in the management of uterine carcinosarcoma.
Assuntos
Carcinoma/patologia , Carcinossarcoma/patologia , Sarcoma/patologia , Neoplasias Uterinas/patologia , Adulto , Idoso , Carcinoma/tratamento farmacológico , Carcinoma/epidemiologia , Carcinoma/radioterapia , Carcinossarcoma/tratamento farmacológico , Carcinossarcoma/epidemiologia , Carcinossarcoma/radioterapia , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Humanos , Ifosfamida , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioterapia Adjuvante , Estudos Retrospectivos , Sarcoma/tratamento farmacológico , Sarcoma/epidemiologia , Sarcoma/radioterapia , Análise de Sobrevida , Resultado do Tratamento , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/radioterapiaRESUMO
OBJECTIVE: The aim of this study was to examine the osteoarthritis (OA)-related structural changes associated with histological synovitis in end-stage knee OA patients. METHODS: Forty end-stage knee OA patients (female: 88%, mean age: 71.8 y) were enrolled. All participants underwent 3.0-T MRI. The structural changes, such as cartilage morphology, subchondral bone marrow lesion (BML), subchondral bone cyst (SBC), subchondral bone attrition (SBA), osteophytes, meniscal lesion and synovitis, were scored using the whole-organ MRI scoring (WORMS) method. Synovial samples were obtained from five regions of interest (ROIs) of the knee joint during total joint replacement surgery. The associations between the histological synovitis score (HSS) and WORMS or the synovial expression levels of cyclooxygenase (COX)-2, interleukin (IL)-1ß, IL-6 and transforming growth factor (TGF)-ß were examined using Spearman's correlation coefficient. RESULTS: Among the seven OA-related structural changes, the BML, SBC, SBA and synovitis were significantly associated with the HSS (r = 0.33, 0.35, 0.48 and 0.36, respectively), while other morphological changes were not. Although synovial COX-2, IL-1ß or IL-6 expression levels were not associated with the HSS, the synovial TGF-ß expression levels were associated with the HSS. CONCLUSION: The presence of BML, SBC and SBA was associated with histological synovitis in end-stage knee OA patients.
Assuntos
Cistos Ósseos/patologia , Doenças da Medula Óssea/patologia , Medula Óssea/patologia , Cartilagem Articular/patologia , Imageamento por Ressonância Magnética/métodos , Osteoartrite do Joelho/patologia , Sinovite/patologia , Idoso , Cistos Ósseos/complicações , Cistos Ósseos/metabolismo , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/metabolismo , Estudos Transversais , Citocinas/biossíntese , Feminino , Humanos , Imuno-Histoquímica , Masculino , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/metabolismo , Líquido Sinovial/metabolismo , Sinovite/etiologia , Sinovite/metabolismoRESUMO
OBJECTIVE: The aim of the present study was to examine whether the degenerative and morphological changes of articular cartilage in early stage knee osteoarthritis (OA) occurred equally for both femoral- and tibial- or patellar- articular cartilage using magnetic resonance imaging (MRI)-based analyses. DESIGN: This cross-sectional study was approved by the ethics committee of our university. Fifty patients with early stage painful knee OA were enrolled. The patients underwent 3.0 T MRI on the affected knee joint. Healthy volunteers who did not show MRI-based OA changes were also recruited as controls (n = 19). The degenerative changes of the articular cartilage were quantified by a T2 mapping analysis, and any structural changes were conducted using Whole Organ Magnetic Resonance Imaging Score (WORMS) technique. RESULTS: All patients showed MRI-detected OA morphological changes. The T2 values of femoral condyle (FC) (P < 0.0001) and groove (P = 0.0001) in patients with early stage knee OA were significantly increased in comparison to those in the control, while no significant differences in the T2 values of patellar and tibial plateau (TP) were observed between the patients and the control. The WORMS cartilage and osteophyte scores of the femoral articular cartilage were significantly higher than those in the patellar- (P = 0.001 and P = 0.007, respectively) and tibial- (P = 0.0001 and P < 0.0001, respectively) articular cartilage in the patients with early stage knee OA. CONCLUSIONS: The degradation and destruction of the femoral articular cartilage demonstrated a greater degree of deterioration than those of the tibial- and patellar- articular cartilage in patients with early stage knee OA.
Assuntos
Doenças das Cartilagens/patologia , Cartilagem Articular/patologia , Fêmur/patologia , Articulação do Joelho/patologia , Osteoartrite do Joelho/patologia , Patela/patologia , Tíbia/patologia , Adulto , Idoso , Doenças das Cartilagens/etiologia , Estudos de Casos e Controles , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteófito/etiologia , Osteófito/patologia , Índice de Gravidade de DoençaRESUMO
Adenocarcinoma of the thymus is a very rare malignant tumor. The standard treatment for advanced thymic carcinoma has not yet been established, and the prognosis is poor. We report a case of thymic carcinoma that involving the aortic arch and the innominate vein. A 78-year-old woman was admitted to our hospital complaining of hoarseness in April 2007. The computed tomography (CT) scan showed an anterior mediastinal tumor contiguous to the aortic arch and the innominate vein with swelling lymphnodes. Microspcopic examinations of specimens obtained by CT-guided needle biopsy revealed poorly differenciated adenocarcinoma. The carcinoembryonic antigen (CEA) level of serum elevated at 54.9 ng/ml. Thymic carcinoma was diagnosed. The chemoradiotherapy [concurrent, carboplatin (CBDCA) + paclitaxel(TXL)-->vinorelbine (NVB), 60 Gy] was performed, but the effect of the therapy was limited. The resection of the tumor with a part of aortic arch and other peripheral tissues was performed in Augast 2007. The postoperative course was uneventful and the CEA level of serum lowered to the normal. She was discharged 30 days after surgery.
Assuntos
Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Aorta Torácica/patologia , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Adenocarcinoma/terapia , Idoso , Terapia Combinada , Feminino , Humanos , Invasividade Neoplásica , Neoplasias do Timo/terapiaRESUMO
Several investigators have reported the presence of biomechanical, kinematic, anatomic, fiber orientation patterns and biological differences between the anteromedial bundle and the posterolateral bundle of ACL. The purpose of this prospective randomized study was to compare the clinical, instrumental and X-ray outcome of two ACL reconstruction techniques with hamstring tendons: one with a single intra-articular bundle associated to an extra-articular sling, the second with a more anatomic double-bundle technique that reproduces better the native ACL function. From an initial group of 100 patients who underwent ACL reconstruction, 72 patients (35 single bundle plus lateral plasty and 37 double bundle) were evaluated with IKDC, Tegner score, KT2000 arthrometer, Activity Rating Scale, Psychovitality Questionnaire and Ahlback radiographic score at a mean 3 years follow-up. Double-bundle group showed significantly better results regarding IKDC, ROM, Activity Rating Scale and time to return to sport. Also KT 2000 showed significant differences in objective stability. The double-bundle technique for ACL reconstruction described in this paper has demonstrated significantly better subjective, objective and functional results compared with a double-stranded hamstrings plus extra-articular sling at a minimum 3-year follow-up.
Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho/cirurgia , Procedimentos Ortopédicos/métodos , Tendões/transplante , Adulto , Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Procedimentos de Cirurgia Plástica/métodos , Técnicas de Sutura , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Climatic droplet keratopathy (CDK), known as spheroid degeneration of the cornea, is one of the most frequent degenerative corneal disorders affecting visual function. However, the histochemical nature of the deposits seen in CDK is still unclear. AIM: To investigate the pathogenesis of CDK, we investigated the immunohistochemical localisation of advanced glycation end products (AGEs) in surgical specimens of CDK. METHODS: Immunohistochemical localisation of N(epsilon)-(carboxymethyl)-l-lysine (CML), N(epsilon)-(carboxyethyl)-l-lysine (CEL), pyrraline, pentosidine and imidazolone was examined in three corneas with CDK, six corneas with bullous keratopathy and three corneas without any corneal diseases. RESULTS: In all the specimens with CDK, immunoreactivity was strong in CML, moderate in pyrraline and pentosidine, and weak in imidazolone. Immunoreactivity was absent in CEL. In contrast, no immunoreactivity to CML, pyrraline, pentosidine, imidazolone or CEL was detected in corneas with bullous keratopathy, or in corneas without any corneal diseases. CONCLUSIONS: CDK is caused by an aggregation of AGE-modified proteins. The result is consistent with etiological findings that ultraviolet irradiation and ageing, both of which are accelerators of AGE formation, are closely related to the development of CDK.
Assuntos
Doenças da Córnea/metabolismo , Produtos Finais de Glicação Avançada/análise , Anticorpos Monoclonais/imunologia , Arginina/análogos & derivados , Arginina/imunologia , Córnea/metabolismo , Reagentes de Ligações Cruzadas , Feminino , Humanos , Imuno-Histoquímica/métodos , Lisina/análogos & derivados , Lisina/imunologia , Masculino , Pessoa de Meia-Idade , Pirróis/imunologiaAssuntos
Antígenos CD/imunologia , Transplante de Medula Óssea , Linfoma Cutâneo de Células T/imunologia , Micose Fungoide/imunologia , Recidiva Local de Neoplasia , Transplante de Células-Tronco Hematopoéticas , Humanos , Linfoma Cutâneo de Células T/patologia , Masculino , Pessoa de Meia-Idade , Micose Fungoide/patologia , Fenótipo , Falha de TratamentoRESUMO
Core-binding factor A1 (Cbfa1), also called Pebp2 alpha A/AML3, is a transcription factor that belongs to the runt-domain gene family. Cbfa1-deficient mice are completely incapable of both endochondral and intramembranous bone formation, indicating that Cbfa1 is indispensable for osteogenesis. Maturation of chondrocytes in these mice is also disorganized, suggesting that Cbfa1 may also play a role in chondrogenesis. The aim of this study was to examine the expression and regulation of Pebp2 alpha A/AML3/Cbfa1 expression in the chondrocyte-like cell line, TC6. Northern blot analysis indicated that Cbfa1 mRNA was constitutively expressed as a 6.3 kb message in TC6 cells and the level of Cbfa1 expression was enhanced by treatment with bone morphogenetic protein-2 (BMP2) in a time- and dose-dependent manner. This effect was blocked by an RNA polymerase inhibitor, 5,6-dichloro-1-beta-d-ribofuranosylbenzimidazole, but not by a protein synthesis inhibitor, cycloheximide. Western blot analysis of the cell lysates using polyclonal antibody raised against Cbfa1 indicated that BMP2 treatment increased the Cbfa1 protein level in TC6 cells. In TC6 cells, BMP2 treatment enhanced expression of alkaline phosphatase and type I collagen mRNAs but suppressed that of type II collagen mRNA. In addition to TC6 cells, Cbfa1 mRNA was also expressed in primary cultures of chondrocytes and BMP2 treatment enhanced Cbfa1 mRNA expression in these cells similarly to its effect on TC6 cells. These data indicate that the Pebp2 alpha A/AML3/Cbfa1 gene is expressed in a chondrocyte-like cell line, TC6, and its expression is enhanced by treatment with BMP.
Assuntos
Proteínas Morfogenéticas Ósseas/farmacologia , Condrócitos/metabolismo , Proteínas de Neoplasias , Fatores de Transcrição/metabolismo , Fator de Crescimento Transformador beta , Regulação para Cima/efeitos dos fármacos , Animais , Northern Blotting , Western Blotting , Proteína Morfogenética Óssea 2 , Técnicas de Cultura de Células , Linhagem Celular , Subunidade alfa 1 de Fator de Ligação ao Core , Fatores de Ligação ao Core , RNA Polimerases Dirigidas por DNA/antagonistas & inibidores , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Osteogênese/fisiologia , RNA Mensageiro/genética , Proteínas Recombinantes/farmacologia , Fatores de Transcrição/genéticaRESUMO
We report a quite rare case of acquired type 3-like von Willebrand syndrome (vWS) that preceded full-blown systemic lupus erythematosus (SLE). A 16-year-old woman with no previous disease history and no family history of hemorrhagic diathesis was referred to our hospital because of recurrent epistaxis and gingival bleeding. She was diagnosed as having atypical type 3 von Willebrand disease because of prolonged bleeding time with normal platelet count and prolonged activated partial thromboplastin time (aPTT), and an almost complete absence of von Willebrand factor (vWF) antigen, ristocetin cofactor activity (vWF:RCo) and ristocetin-induced platelet agglutination (RIPA). Furthermore, electrophoretic analysis of plasma vWF revealed a trace amount of vWF and an absence of the multimeric form of vWF. Infusions of either vasopressin or factor VIII/vWF concentrates improved bleeding symptoms and corrected the aPTT and RIPA. However, she complained of low-grade fever, general fatigue and polyarthralgia 5 months later, and leukocytepenia and hypo-complementemia developed. Anti-double-stranded DNA antibodies and lupus erythematosus cells became positive. These findings were compatible with SLE. Mixing the patient's platelet-poor plasma (PPP) with normal platelet-rich plasma (PRP) (PPP/PRP = 2/1) resulted in a complete inhibition of RIPA, suggesting the presence of vWF inhibitor in her plasma. Treatment with prednisolone (40 mg/day) started and the bleeding tendency gradually improved. One month later, all of the laboratory data including aPTT, bleeding time, RIPA and vWF:RCo became normal. These findings indicate that she has an acquired type 3-like vWS associated with SLE.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Doenças de von Willebrand/complicações , Adolescente , Desamino Arginina Vasopressina/administração & dosagem , Desamino Arginina Vasopressina/farmacologia , Feminino , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Prednisolona/administração & dosagem , Doenças de von Willebrand/diagnóstico , Doenças de von Willebrand/tratamento farmacológicoRESUMO
During the last five-year period between 1985 and 1989, serotypes of 671 strains of group A and 238 strains of group B streptococci isolated from clinical specimens in Sapporo city general hospital were studied. Results of serotyping were given as under; Type T4 (25.8%), T12 (25.6%), T1 (11.5%), T3 (9.2%), T6 and T28 (6.3% each), T8 and T22 (0.6% each), T13 (0.4%), T9 and B3264 were found in group A. Type T4 and T12 formed main types up to this time and T1, T3, T6 and T28 were other predominant types. The elevated isolation rates of type T3 and T28 were remarkable in this period. In group B, Ia (31.5%), III (16.8%), Ib (14.3%), II (8.0%) and V (4.2%) were observed. On 617 samples (391 group A, 226 group B) out of these strains, antibiotic susceptibility to 9 drugs were examined. No resistant strain (MIC greater than or equal to 25 micrograms/ml) to beta-lactam antibiotics was found in each group. Resistant strains in group A streptococci were demonstrated 24.3% to TC, 0.5% to OL. No resistant strain, however, was observed to CP or EM. In group B, resistant strains were found in 39.8% to TC, 6.6% to CP, 2.2% to EM. Strains resistant to only TC (31.0%) were most prevalent followed by TC.CP (6.2%) and TC.MLs (2.7%). Multi-resistant strain (to TC.CP.MLs) was not found.
Assuntos
Antibacterianos/farmacologia , Streptococcus agalactiae/efeitos dos fármacos , Streptococcus pyogenes/efeitos dos fármacos , Humanos , Japão , Lactamas , Testes de Sensibilidade Microbiana , Faringe/microbiologia , Sorotipagem , Escarro/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/classificação , Streptococcus agalactiae/isolamento & purificação , Streptococcus pyogenes/classificação , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
A 52-year-old female was presented to our hospital complaining of chest oppression and dyspnea on exercise. Preoperative angiography and catheterization revealed aortic regurgitation and ostial stenosis of the right coronary artery. Aortic valve replacement (AVR) with SJM 19 A and aortocoronary bypass (CABG) with saphenous vein graft were performed successfully. Histopathological examination of the aortic wall revealed healed phase aortitis syndrome. Post operative course was uneventful. For healed phase aortitis syndrome perioperative steroid administration was not necessary. However careful observation was recommended for long term complication such as recurrence of aortitis, valve detachment, perivalvular leakage and graft occlusion. This is the 16th case successfully treated with AVR and CABG for Aortitis syndrome.
Assuntos
Síndromes do Arco Aórtico/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Próteses Valvulares Cardíacas , Síndromes do Arco Aórtico/complicações , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Doença das Coronárias/etiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Coronary artery bypass graftings were performed to the left circumflex artery (LCX) system in the atrioventricular groove (#11 or #13) in addition to revascularization to the left anterior descending artery system using conventional technique in 10 patients with left main trunk lesion. Distal anastomosis was done at #11 of LCX in 6 patients using saphenous vein graft, and at #13 of LCX in 4 patients using 2 saphenous vein grafts and using 2 internal thoracic artery grafts. The mean flow rate of SVG operated by this technique showed larger values than that of SVGs by sequential bypass or individual bypass technique to #12 and/or #14 of LCX. Postoperative angiographies showed excellent graft patencies and symptomatic improvements were achieved. This technique of coronary artery revascularization is recommended and useful in patients whose #12 and #14 of LCX system is too small to make distal anastomosis.
Assuntos
Ponte de Artéria Coronária/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Doença das Coronárias/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Veia Safena/transplante , Artérias Torácicas/transplante , Grau de Desobstrução VascularAssuntos
Criopreservação/métodos , Sobrevivência de Enxerto/fisiologia , Transplante de Fígado/fisiologia , Fígado , Soluções para Preservação de Órgãos , Preservação de Órgãos/métodos , Adenosina , Alopurinol , Animais , Glutationa , Insulina , Fígado/patologia , Fígado/fisiologia , Transplante de Fígado/patologia , Masculino , Pressão , Rafinose , Ratos , Ratos Endogâmicos Lew , Fatores de Tempo , Transplante IsogênicoRESUMO
AIM: Biologically uncommon D-beta-aspartic acid (D-beta-Asp) accumulates in the body with age and is involved in the ageing process. In the present study, the localisation of D-beta-Asp-containing proteins was investigated in surgical specimens with climatic droplet keratopathy (CDK), one of the ocular changes related to the ageing process. METHODS: Immunohistochemical localisation of D-beta-Asp-containing proteins using polyclonal antibodies raised against D-beta-Asp-containing peptides was examined in three corneas with CDK, three corneas with interstitial keratitis, six corneas with bullous keratopathy, and three corneas without any corneal diseases. RESULTS: Strong immunoreactivity to D-beta-Asp-containing peptide was detected in all the surgical specimens with CDK. In contrast, no immunoreactivities to D-beta-Asp-containing peptides were detected in the surgical specimens with bullous keratopathy, interstitial keratitis, or no corneal diseases. CONCLUSIONS: CDK was regarded as aggregations of D-beta-Asp-containing proteins. The formation of D-amino acids in protein causes the different side chain orientations and beta-linkage of Asp residues elongates the main chain of proteins. Therefore, D-beta-Asp formation will result in a partial unfolding of proteins leading to the aggregation of proteins seen in CDK.