gamma-H2AX: Can it be established as a classical cancer prognostic factor?

Double-strand breaks are among the first procedures taking place in cancer formation and progression as a result of endogenic and exogenic factors. The histone variant H2AX undergoes phosphorylation at serine 139 due to double-strand breaks, and the gamma-H2AX is formatted as a result of genomic instability. The detection of gamma-H2AX can potentially serve as a biomarker for transformation of normal tissue to premalignant and consequently to malignant tissues. gamma-H2AX has already been investigated in a variety of cancer types, including breast, lung, colon, cervix, and ovary cancers. The prognostic value of gamma-H2AX is indicated in certain cancer types, such as breast or endometrial cancer, but further investigation is needed to establish gamma-H2AX as a prognostic marker. This review outlines the role of gamma-H2AX in cell cycle, and its formation as a result of DNA damage. We investigate the role of gamma-H2AX formation in several cancer types and its correlation with other prognostic factors, and we try to find out whether it fulfills the requirements for its establishment as a classical cancer prognostic factor.

Influence of HIV virus in the hospital stay and the occurrence of postoperative complications classified according to the Clavien-Dindo classification and in comparison with the Charlson Comorbidity Index in patients subjected to urologic and general surgery operations. Our preliminary results.

OBJECTIVES: From the first time that human immunodeficiency virus (HIV) was discovered, till today both the quality of life and survival expectancy of HIV-infected patients have markedly improved. As the life expectancy of these patients increases due to the use of highly active anti-retroviral therapy (HAART) also increases the number of HIV-positive patient to be subjected to an operation. Different studies have examined the occurrence of complications in this particular group of patients and their possible susceptibility to infections or other complications that could lead to increased hospital stay, morbidity and mortality with controversial results. MATERIAL AND METHODS: We retrospectively analyzed the data of 25 HIV-patients that were subjected to general surgery and urologic operations and we also examined in comparison with the Charlson score and their comorbidities the occurrence of complications and subsequently the possibility of an increase hospital stay due to their HIV infection. Alongside we classified their complications according to the Clavien-Dindo and compared these complications in relation to their Charlson score and CD4 count. RESULTS: 10/25 (40%) of the population had prolonged hospital stay and from this population 6 (6/25) (24%) patients had less than 200 CD4 constituting the AIDS subpopulation. The decline of the CD4 count showed a tendency for the occurrence of a complication and comorbidities to HIV-positive patients seem to affect more the AIDS subpopulation. CONCLUSIONS: Although this is a small retrospective study, we tried to classify our complications according to the Clavien- Dindo classification and combine the classification to the age adjusted Charlson score index of comorbidities.

Ureteral endometriosis: A systematic literature review.

INTRODUCTION: Ureteral endometriosis is a rare disease affecting women of childbearing age which presents with nonspecific symptoms and it may result in severe morbidity. The aim of this study was to review evidence about incidence, pathogenesis, clinical presentation, diagnosis, and management of ureteral endometriosis. MATERIALS AND METHODS: PubMed Central database was searched to identify studies reporting cases of ureteral endometriosis. "Ureter" or "Ureteral" and "Endometriosis" were used as key words. Database was searched for articles published since 1996, in English without restrictions regarding the study design. RESULTS: From 420 studies obtained through database search, 104 articles were finally included in this review, including a total of 1384 patients with ureteral endometriosis. Data regarding age, location, pathological findings, and interventions were extracted. Mean patients' age was 38.6 years, whereas the therapeutic arsenal included hormonal, endoscopic, and/or surgical treatment. CONCLUSIONS: Ureteral endometriosis represents a diagnostic and therapeutic challenge for the clinicians and high clinical suspicion is needed to identify it.

Fascia Suture Technique and Suture-mediated Closure Devices: Systematic Review.

Background The aim of the present study is to review the available data on suture-mediated closure devices (SMCDs) and fascia suture technique (FST), which are alternatives for minimizing the invasiveness of percutaneous endovascular aortic aneurysm repair (p-EVAR) and reduce the complications related to groin dissections. Methods The Medline, ClinicalTrials.gov, and Cochrane library - Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for publications regarding SMCD and FST between January 1999 and December 2016. Results We review 37 original articles, 30 referring to SMCDs (Prostar XL and Proglide), which included 3,992 patients, and 6 articles referring to FST, which include 426 patients. The two techniques are compared only in one article (100 patients). The two types of SMCDs were Prostar and Proglide. In most studies on SMCDs, the reported technical success rates were between 89 and 100%, but the complication rates varied greatly between 0 and 25%. Concerning FST, the technical success rates were also high, ranging between 87 and 99%. However, intraoperative complication rates ranged between 1.2 and 13%, whereas postoperative complication rates varied from 0.9 to 6.2% for the short-term and from 1.9 to 13.6% for the long-term. Conclusions SMCDs and FST seem to be effective and simple methods for closing common femoral artery (CFA) punctures after p-EVAR. FST can reduce the access closure time and the procedural costs with a quite short learning curve, whereas it can work as a bailout procedure for failed SMCDs suture. The few failures of the SMCDs and FST that may occur due to bleeding or occlusion can easily be managed.

A critical reappraisal of the treatment modalities of normal appearing thoracic aorta mural thrombi.

Mural thrombus in non-atherosclerotic or aneurysmatic thoracic aorta is a relatively uncommon entity. Currently there is no consensus on the appropriate therapeutic algorithm of its management. We aim to present the current knowledge on the treatment of thoracic aorta mural thrombi (TAMT) in minimally atherosclerotic vessels and we hope that the juxtaposed discussions will shed light on the uncharted waters regarding this rare syndrome. The MEDLINE/PubMed database was searched for publications with the medical subject "aortic mural thrombus" and keywords "thoracic", "embolism", "normal vessel", "minimally atherosclerotic vessel" or "treatment". We restricted our search to English language, till January 2017. The electronic literature search yielded 23 reports that were deemed appropriate for further analysis. Anticoagulation is the standard of care for the treatment of the thrombus whereas surgical and interventional treatment seems to be related with increased mortality and lower recurrence rates. TAMT treatment is controversial. Anticoagulants are the mainstay of treatment but surgery seems to gain ground in several settings as an only therapy or a combined treatment modality. More data are needed on the role of novel oral anticoagulants and endografts.

Pulmonary Embolism in a Young Immunocompetent Adult Infected with Cytomegalovirus. Are Novel Oral Anticoagulants an Efficient Alternative?

BACKGROUND/AIM: Cytomegalovirus (CMV) infection is a common disease especially in young adults. Thromboembolism like deep vein thrombosis and pulmonary embolism is increased among patients with CMV infection. Most cases represent immunocompromised patients usually treated with low molecular weight heparin. CASE REPORT: Herein, we describe a 25-year-old immunocompetent male who presented at the emergency department with sudden onset of chest pain. One month prior to admission, he had developed persistent fever and cough and the diagnosis of CMV infection had been established. After extensive workup, the diagnosis of pulmonary embolism after CMV infection was set and he was treated with rivaroxaban. During the next six months the patient continued on the same anticoagulant therapy with no other episode of pulmonary embolism at 1-year follow-up. CONCLUSION: To our knowledge, this is the first case of CMV-associated pulmonary embolism treated with novel oral anticoagulants (NOACs). NOACs, such as rivaroxaban, seem to be safe and may represent an attractive alternative with promising results in this particular group of patients. Studies incorporating a greater cohort of patients are needed in order to draw safe conclusions regarding the relationship between NOACs and CMV infection.

Endometrioid adenocarcinoma arising from colon endometriosis.

Endometriosis-associated intestinal tumors represent the malignant transformation of gastrointestinal endometriosis. Approximately 50 cases have been reported in the literature. They are most commonly found among women aged 30-60 years, whereas exogenous hormone therapy and obesity are primary risk factors for the malignant transformation of endometriotic lesions. Clinical features simulate a primary colonic carcinoma. A high index of suspicion in conjunction with careful histological and immunohistochemical examination (CK7, CK20, CDX2, CD10, ER, and PR) is important for establishing a correct diagnosis. In this article, a rare case of a postmenopausal woman with no risk factors and conflicting clinical presentation, diagnosed with endometriosis-associated intestinal tumor, is described.

Intestinal adaptation in short bowel syndrome: A case report.

Short bowel syndrome is a clinical entity that includes loss of energy, fluid, electrolytes or micronutrient balance because of inadequate functional intestinal length. This case report demonstrates the case of a woman who compensated for short bowel syndrome through intestinal adaptation, which is a complex process worthy of further investigation for the avoidance of dependence on total parenteral nutrition and of intestinal transplantation in such patients.

Absence of Clinical and Hemodynamic Consequences due to Posterior Tibial Artery Congenital Aplasia.

The exact knowledge of popliteal artery and its branches' anatomic variations is important for the clinical practice of angiology, vascular surgery, and interventional procedures. Congenital absence of the artery leads, in some cases, to early malformations of the extremity in the childhood; however, it may also remain asymptomatic. We present an unusual case of a 76-year-old male patient complaining of paraesthesia in both limbs and bilateral aplasia of posterior tibial artery (PTA). Physical examination, ankle-brachial indexes, before and after exercise, arterial duplex scan, and magnetic resonance arteriography were performed. Arterial pulses for PTA at the level of the ankle were normal; arterial duplex study showed biphasic arterial flow at the level of the ankle. Color duplex ultrasound as well as magnetic resonance arteriography revealed the absence of the PTA in both limbs. The vascularization of the fibula was bilaterally normal. The patient underwent also neurological examination and electromyography, which were normal. The evaluation of the possible clinical signs and symptoms and the hemodynamic consequences of this condition are further discussed.

Neutrophil Gelatinase Associated Lipocalin (NGAL) as a Biomarker. Does It Apply in Abdominal Aortic Aneurysms? A Review of Literature.

Neutrophil gelatinase associated lipocalin (NGAL) as a protein derived from neutrophils has recently been the field of investigation in a wide range of diseases (renal disease, coronary artery disease, etc). The MEDLINE/PubMed database was searched for publications with the medical subject heading "NGAL" and keywords "Abdominal aortic aneurysm (AAA)," "biomarker," and "growth". We restricted our search to date. In this review, we included 38 articles and abstracts that were accessible and available in English. An effort to further explain the role of NGAL within AAA has been made. NGAL seems to be a hopeful marker for the pathogenesis and the progression of abdominal aortic aneurysms (AAAs), which has significant morbidity and mortality rates.

Urine NGAL as a biomarker of kidney damage after on- and off-pump coronary artery bypass graft surgery: a prospective pilot study.

INTRODUCTION: Acute kidney injury (AKI) is a relatively frequent complication after coronary artery bypass graft surgery (CABG). We compared the off- and on-pump CABG procedures with respect to changes in renal function as reflected by levels of urine neutrophil gelatinase-associated lipocalin (UrNGAL). METHODS: In a prospective design, we studied patients who underwent CABG, off- or on-pump, with respect to changes in glomerular filtration rate (GFR) and UrNGAL pre- and postoperatively. UrNGAL was measured using a chemiluminescent microparticle immunoassay. We recorded patients' demographics, past medical history, cardiac function and laboratory findings. Patients were grouped according to the CABG type. RESULTS: Of 72 patients, 31 underwent off-pump and 41 on-pump CABG. The mean age was 65.7 ± 8.1 years and 81.9% were males. Groups were similar with respect to the prevalence of hypertension, diabetes, dyslipidaemia, body mass index, and smoking at entry. No patient experienced acute renal failure and there were no deaths. At both time points, the UrNGAL levels were similar in the two groups. Patients in the on-pump group showed a significant improvement in renal function 48 hours postoperatively compared to baseline (p<0.001). UrNGAL levels decreased significantly 3 hours after surgery in the on-pump group (p=0.001), while they tended to decrease in the off-pump group (p=0.057). The overall change in UrNGAL did not differ significantly between groups. CONCLUSIONS: According to the UrNGAL measurements, neither of the two CABG techniques was superior in terms of their effect on postoperative renal function. Renal function significantly improved in the on-pump group while UrNGAL levels decreased after surgery in the same group.

Synchronous Bilateral Testicular Tumors with Different Histopathology.

A 40-year-old male presented to our outpatient department with the chief complaint of a painless mass on his right testis with gradual size increase over the past two months. Physical examination and ultrasound revealed a firm and nontender mass both on the right and on the left testis. The only elevated biomarker was b-hcG (24,7 mIU/mL) and computer tomography (CT) did not reveal any pathology. Bilateral high orchiectomies were performed, without previous frozen storage of the sperm. Histology proved typical seminoma of the left testis and embryonal carcinoma of the right testis. He received two cycles of adjuvant combination chemotherapy with bleomycin, etoposide, and cisplatin. Six months after the operation no residual tumor or recurrence was observed.

Sentinel lymph node biopsy in uterine cervical cancer patients: ready for clinical use? A review of the literature.

Sentinel lymph node biopsy has been widely studied in a number of cancer types. As far as cervical cancer is concerned, this technique has already been used, revealing both positive results and several issues to be solved. The debate on the role of sentinel lymph node biopsy in cervical cancer is still open although most of the studies have already revealed its superiority over complete lymphadenectomy and the best handling possible of the emerging practical problems. Further research should be made in order to standardize this method and include it in the clinical routine.

Secondary hyperoxaluria: a risk factor for kidney stone formation and renal failure in native kidneys and renal grafts.

Secondary hyperoxaluria is a multifactorial disease affecting several organs and tissues, among which stand native and transplanted kidneys. Nephrocalcinosis and nephrolithiasis may lead to renal insufficiency. Patients suffering from secondary hyperoxaluria, should be promptly identified and appropriately treated, so that less renal damage occurs. The aim of this review is to underline the causes of hyperoxaluria and the related pathophysiologic mechanisms, which are involved, along with the description of seven cases of irreversible renal graft injury due to secondary hyperoxaluria.

Giant popliteal artery aneurysm: case report and review of the literature.

Popliteal artery aneurysms (PAAs) are rare in general population but represent the second most common peripheral arterial aneurysms following those located in the aortoiliac segment. They usually affect men over 60 years old with established cardiovascular disease caused by atherosclerosis. Other more unusual conditions such as trauma, congenital popliteal aneurysm, mycotic aneurysm, inflammatory arteritis, or popliteal entrapment are responsible. The authors report the first ever case of a male diagnosed with chronic renal failure with giant popliteal artery aneurysm. We have successfully resected the aneurysm and revascularized with synthetic graft.

High grade myofibroblastic sarcoma of paratesticular soft tissues.

Tumors of the paratesticular region most often arise from the soft tissue surrounding the spermatic cord and the epididymis or from the soft tissue (dartos muscle) of the scrotal wall. Paratesticular tumors, despite their rarity, present a high incidence of malignancy (30%), and the therapeutic approach of choice is surgical resection with negative margin. The grade, the histology type, the presence of metastases during the diagnosis, the size of the tumor, the age of the patients, and the surgical margins are all important prognostic factors. We present a case report of a 86-year-old patient with a high grade paratesticular and scrotum sarcoma of soft tissues which was presented as a hard painful mass of the scrotum. The patient was subjected to high ligation of the spermatic cord and received no further treatment and 6 months after the operation no local or systematic recurrence was observed.