Expression of the forkhead box transcription factor FOXP1 is associated with oestrogen receptor alpha, oestrogen receptor beta and improved survival in familial breast cancers.

BACKGROUND: The role of FOXP1 in sporadic breast cancers has been widely studied but its role in familial breast cancers is yet unexplored. AIMS: To investigate FOXP1 expression in different molecular subtypes of familial breast cancers and to correlate its expression with clinicopathological parameters, oestrogen receptors (ER) and survival. METHODS: Immunohistochemical staining for FOXP1 was performed in 126 familial breast carcinomas comprising 35 BRCA1, 34 BRCA2 and 57 BRCAX. RESULTS: Nuclear FOXP1 expression ranged from focal weak to widespread strong expression. Expression of FOXP1 was higher in familial breast cancers (54%) compared with sporadic cancers (46%) (p<0.001). There was a significant correlation between FOXP1 with ERalpha (p = 0.038) and ERbeta (p = 0.007) in familial breast cancers. FOXP1 was more highly expressed in familial breast cancers compared with sporadic cancers for luminal (p = 0.021) and basal (p<0.001), but not HER2 and null phenotypes (both p>0.05). The absence of FOXP1 expression was associated with a shorter relapse-free (p = 0.025) and overall survival (p = 0.009) in familial breast cancer. Negativity for FOXP1 was associated with a significantly worse overall survival in BRCA2 cancers (p = 0.021) and there was a non-significant separation of the survival curves for BRCA1 cancers (p = 0.183). No differences in survival were seen for BRCAX cancers (p = 0.762). CONCLUSION: Results suggest that FOXP1 demonstrates different expression patterns in familial breast cancers than sporadic tumours, even in tumours showing similar phenotypes. They also suggest a different role of FOXP1 as a tumour suppressor in familial tumours, which is unrelated to ER expression and may impact on therapeutic options.

Hypohidrotic ectodermal dysplasia associated with squamous cell carcinoma of the trachea.

Hypohidrotic ectodermal dysplasia (HED) is a rare condition characterized by abnormalities to ectodermal derived tissues although other organs or systems are frequently involved. Patients with HED can have a number of symptoms that may lead them to present to the otolaryngologist. We present a case of a 37-year-old female with HED who initially presented with nasal obstruction but then very rapidly developed stridor due to a tracheal squamous cell carcinoma. We suggest a possible association between HED and carcinoma of the upper respiratory tract that has not previously been reported.

The inverted Schneiderian papilloma: a review and literature report of 43 new cases.

Inverted Schneiderian Papilloma remains a controversial nasal disease. Although a benign pathology it is associated with aggressive local destruction, recurrence after removal and malignancy. New information regarding aetiology may aid management which at present consists of surgical resection. The best method of resection is still undetermined. This paper describes 43 cases of Inverted Schneiderian Papilloma presenting to a tertiary referral centre and discusses the present knowledge surrounding the pathology and its treatment.

The role of Mucodyne in reducing the need for surgery in patients with persistent otitis media with effusion.

UNLABELLED: A recent meta-analysis suggested a possible beneficial effect of carboxymethylcysteine (Mucodyne) in resolving otitis media with effusion (OME), but the methodology in several of the included trials was flawed. A double-blind randomised controlled trial (RCT) involving 163 patients (78 randomised to Mucodyne and 85 to placebo) was therefore performed. MAIN OUTCOME MEASURE: operative intervention or not. Of the 28 patients with resolved OME, 17 were in the Mucodyne group and 11 in the placebo group. Although it appeared that patients treated with Mucodyne were 1.68 times more likely to undergo resolution of OME than patients receiving placebo, this did not reach statistical significance. [Risk ratio of 1.68 (95% C.I., 0.74-3.37)]. chi2 test (df = 162) = 2.24 (P = 0.134). The absolute risk difference in the study was 8.5% (95% C.I., -3-20). We cannot exclude the possibility that Mucodyne is as beneficial as a 20% additional resolution of OME, or as harmful as a 3% decrease in the resolution of OME.

Current practice in pharyngeal pouch surgery in England and Wales.

A survey of the current surgical practice for patients with a pharyngeal pouch was conducted among general surgeons, otolaryngologists and cardiothoracic surgeons in England and Wales. Our results show that while pouch excision remains the most common method used, endoscopic stapling diverticulotomy is rapidly being adopted. The reasons why this recently introduced technique is likely to become the definitive treatment of pharyngeal pouch are discussed.

Pediatric cochlear implantation: strategies to accommodate for head growth.

Accommodation for head growth presents one of several challenges unique to pediatric cochlear implantation. Given contemporary cochlear implant device designs, an electrode cable implanted at the age of 2 years must extend 2 to 3 cm as the head grows during childhood. In an initial study we found that model lead wires with redundant loops extended effectively when they were maintained within air-containing spaces such as the mastoid cavity or middle ear space. However, when looped leads traversed soft tissues overlying the parietal bone, they became embedded in fibrous tissue and did not extend. The present study evaluated three different configurations of expansile devices that were enclosed in polytetrafluoroethylene (PTFE) envelopes to deter fibrous ingrowth. This simple strategy was designed to ensure effective cable extension over cable pathlengths by protecting the redundant leads from any mechanically significant connective tissue ingrowth. Twelve such devices were implanted across the calvaria of four newly weaned piglets. Skull growth and changes in electrode dimensions were documented by sequential computed tomographic scans. At 3 months of age, cranial circumferences had increased substantially. Animals were then killed, the model cable extension appliances examined physically, and their implantation sites examined histologically. For all experimental devices, extension of redundant lead wires was satisfactory, and there was no mechanically significant invasion of fibrous connective tissue into the PTFE envelope. This indicates that enclosure of excess lead wire within a PTFE envelope may be an effective means of inhibiting fibrous ingrowth. This strategy should prove useful for ensuring effective electrode cable extension in cochlear implants applied in young children.

Digital and mirror assessment of the adenoids at operation.

The size of an adenoid is generally considered to be a significant factor in the causation of Eustachian tube dysfunction and glue ear in children. We studied 120 consecutive cases of children undergoing adenoidectomy. Our aim was to assess the accuracy of the digital and mirror examinations in identifying adenoid size. Two surgeons of 1 and 2 years' experience in the speciality were found to have a statistically significant correlation between mirror examination and the amount of adenoid removed at operation. One surgeon of 4 years' experience was found to have a higher degree of correlation for both mirror and digital examinations.

Chondrosarcoma of the sphenoid--a case report and review.

The case of 57-year-old woman is presented with a chondrosarcoma of the sphenoid. The main symptom was rapid loss of vision and in order to halt this the tumour was debulked. The literature relating to chondrosarcomas of the head and neck is reviewed. These rare tumours are not radio-sensitive and surgery represents the best form of treatment at the present time. The prognosis is poor.

Can C.T. detect labyrinthine fistulae pre-operatively?

The aim of the study was to undertake a controlled prospective evaluation of high resolution computerized tomography in the pre-operative diagnosis of labyrinthine fistulae. Fifty consecutive patients with chronic suppurative otitis media were scanned prior to surgery, using a Siemens DRI scanner. The radiological predictions were then compared with the surgical findings. Five patients had labyrinthine erosions and these were predicted in 4 out of the 5 (80%). The one erosion that escaped radiological detection was less than 2 mm in length. The study shows that high resolution computerized tomography is a highly accurate method for demonstrating pre-operatively all but the smallest fistulae.

The predictive value of high resolution computerized tomography in chronic suppurative ear disease.

High resolution computerized tomographic scanning was used in the preoperative evaluation of 50 patients with chronic suppurative ear disease. The radiological predictions were compared with the operative findings in each case. This form of imaging proved to be highly accurate in depicting the extent of soft tissue within the middle ear cleft and mastoid. With the exception of the long process of the incus and the stapes superstructure, the state of the ossicular chain was correctly predicted in over 90% of cases. Erosion of the labyrinth was clearly depicted in 4 of the 5 cases in which it occurred. A correct pathological diagnosis was made radiologically in 44 cases (88%). The selective use of this modality in the evaluation of patients with chronic suppurative otitis media is valuable.

Jaundice and the effect of sodium taurocholate taken orally upon abdominal wound healing.

The effect of oral sodium taurocholate upon abdominal wound healing was assessed in an experimental study using rats. Bile duct ligation produced a significant reduction in wound bursting strength four and six days postoperatively compared with control rats, and sodium taurocholate in bile duct ligated rats resulted in a significant increase in wound strength six days postoperatively. There was no change in wound hydroxyproline concentrations between rats in the bile duct ligated and control groups. In the clinical situation, oral bile salts may be of value in the preoperative management of patients with obstructive jaundice.

Arterial embolectomy: a review of 100 cases.

The results of 100 consecutive patients undergoing arterial embolectomy at the Royal Brisbane Hospital between 1971 and 1981 are presented. Twenty-two patients died and 18 of these had unsuccessful procedures. Of the 82 patients surviving more than 30 days, 14 had a limb amputated and 12 underwent further vascular surgery. Duration of ischaemia was the most important predictive factor; 75% of cases with an ischaemia time of less than 12 h had a successful outcome whereas only 37% were successful when the ischaemia time exceeded 12 h. Anticoagulation improved the success rate, but resulted in a high incidence of wound haematoma.