Parathormone and 1,25(OH)2D3 but not 25(OH)D3 serum levels, in an inverse correlation, reveal an association with advanced stages of colorectal cancer.

Experimental, epidemiologic, and clinical trial data indicate the antineoplastic effects of calcium and vitamin D in large-bowel neoplasia. The aim of this study was to determine serum levels of vitamin D metabolites and parathormone (PTH) in patients with colorectal cancer (CRC) and to extract conclusions comparing their different levels in serum with healthy individuals. Group 1 (cancer patients) was consisted of 140 patients with CRC with clinical stages Duke's A: 12, B: 52, C: 62, and D: 14. Serum levels of 25(OH)D(3), 1,25(OH)(2)D(3), and PTH were determined in all patients. The findings are: (a) No significant difference was found in the serum levels of 25(OH)D(3) in each Duke's clinical stage in cancer patients, (b) serum 1,25(OH)(2)D(3) levels decreased with advanced cancer stages, and (c) serum levels of PTH showed a corresponding increase. Low serum levels of 1,25(OH)(2)D(3) on one hand and increased levels of PTH in patients with CRC on the other might be strongly related to the carcinogenetic process.

Serum and tissue selenium levels in gastric cancer patients and correlation with CEA.

BACKGROUND: An inverse relationship between selenium (Se) intake and cancer mortality is evident in humans. MATERIALS AND METHODS: In eighty patients who had been operated on for primary gastric cancer, serum Se and carcinoembryonic antigen (CEA) levels were measured preoperatively using a fluorometric and immunoradiometric assay (IRMA), respectively. RESULTS: The serum Se levels were 43+/-6.3 microg l(-1) in the patient group and 68.7+/-4.5 microg l(-1) in healthy individuals (p<0.001). The serum CEA was 12+/-1.9 U ml(-1) in the gastric cancer patients and 2.1 U ml(-1) in the control group (p<0.001). The Se tissue concentrations were 2,640+/-220 mg g(-1) in excised neoplastic tissue and 685+/-115 mg g(-1) in non-neoplastic tissue (p<0.001). An inverse correlation between Se and CEA serum levels was found (r=-0.782). There was no correlation between serum/tissue Se concentration and disease stage/histological type or gender in the patient group.

Alterations in arterial blood parameters in patients with liver cirrhosis and ascites.

In cirrhotic patients, in addition to hepatocytes and Kuppfer cells dysfunction circulatory anatomic shunt and ventilation/perfusion (V(A)/ Q) ratio abnormalities can induce decrease in partial pressure of oxygen in arterial blood (PaO(2)), in oxygen saturation of hemoglobin (SaO(2)) as well as various acid-base disturbances. We studied 49 cases of liver cirrhosis (LC) with ascites compared to 50 normal controls. Causes were: posthepatic 37 (75.51%), alcoholic 7 (14.24%), cardiac 2 (4.08%), and cryptogenic 3 (6.12%). Complications were: upper gastrointestinal bleeding 24 (48.97), hepatic encephalopathy 20 (40.81%), gastritis 28 (57.14%), hepatoma 5 (10.2%), renal hepatic syndrome 2 (4.01%), HbsAg (+) 24 (48.97%), and hepatic pleural effusions 7 (14.28%). Average PaO(2) and SaO(2) were 75.2 mmHg and 94.5 mmHg, respectively, compared to 94.2 mmHg and 97.1 mmHg of the control group, respectively (p value in both PaO(2) and SaO(2 )was p<0.01). Respiratory alkalosis, metabolic alkalosis, metabolic acidosis, respiratory acidosis and metabolic acidosis with respiratory alkalosis were acid-base disturbances observed. In conclusion, portopulmonary shunt, intrapulmonary arteriovenous shunt and V(A)/Q inequality can induce a decrease in PaO(2) and SaO(2) as well as various acid-base disturbances. As a result, pulmonary resistance is impaired and patients more likely succumb to infections and adult respiratory distress syndrome.

Rare association of chronic lymphocytic thyroiditis with dermatomyositis.

Autoimmune thyroid disease (AITD) has been associated with other autoimmune diseases such as chronic urticaria, insulin-dependent diabetes mellitus, Sjøgren's syndrome, inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus, psoriasis, ankylosing spondylitis, and dermatomyositis (DM). AITD is a common disorder affecting primarily women, and both genetic and environmental factors are included in its pathogenesis. DM is considered an autoimmune disease of the muscles and skin. Although AITD is the most common cause of hypothyroidism, to the best of our knowledge, only three cases of DM and AITD in the same patient have been reported in the last 40 years. We consider that both are developed from the same autoimmune background. Herein, we present a case of a 30-year-old man with a 4-year history of AITD who was diagnosed as suffering as well from DM.

Expression patterns of dysadherin and E-cadherin in lymph node metastases of colorectal carcinoma.

Reduction/loss of E-cadherin is associated with the development and progression of many epithelial tumors, while in a limited number of neoplasms, E-cadherin is re-expressed in metastases. Dysadherin, recently characterized by members of our research team, has an anti-cell-cell adhesion function and downregulates E-cadherin in a posttranscriptional manner. Colorectal cancer (CRC) is one of the most common tumors in the developed world, and lymph node metastases are harbingers of aggressive behavior. The aim of the present study was to examine the dysadherin and E-cadherin expression patterns in lymph node metastases vs primary CRC. Dysadherin and E-cadherin expression was examined immunohistochemically in 78 patients with CRC, Dukes' stage C in the primary tumor and in one lymph node metastasis. Dysadherin was expressed in 42% while E-cadherin immunoreactivity was reduced in 45% of primary tumors. In lymph nodes, 33 and 81% of metastatic tumors were positive for dysadherin and E-cadherin, respectively. Dysadherin expression was not correlated with E-cadherin expression in the primary tumor with a reverse correlation evident in the lymph node metastases. Our results suggest that different mechanisms govern E-cadherin expression in the primary tumor and the corresponding lymph node metastases.

Penile erection during transurethral surgery.

Intraoperative penile erection during endoscopic surgery, although an infrequent occurrence, is a troublesome complication and a challenge to the urologist. It is difficult to perform the procedure during penile erection, because various complications may occur. The etiology is unclear, and a number of pharmacological remedies have been discussed in the literature. Herein, we describe the treatment and outcomes for 3 patients with intraoperative penile erection and provide a brief review of the associated literature. Intraoperative penile erection is a rare event during transurethral procedures, with a frequency of approximately 0.1% in our institution. To our knowledge, no generally accepted protocols for the prevention or treatment of this phenomenon have been reported in the literature. We recommend intracorporeal injection of 250 microg of phenylephrine: detumescence occurred rapidly in all patients after a single injection. The mode of administration is simple, and no complications have been reported.

Penetration of antimicrobial agents into the prostate.

In the present review article, the penetration of antimicrobial agents into prostatic fluid and tissue was examined. Three major factors determining the diffusion and concentration of antimicrobial agents in prostatic fluid and tissue are the lipid solubility, dissociation constant (pKa) and protein binding. The normal pH of human prostatic fluid is 6.5-6.7, and it increases in chronic prostatitis, ranging from 7.0 to 8.3. A greater concentration of antimicrobial agents in the prostatic fluid occurs in the presence of a pH gradient across the membrane separating plasma from prostatic fluid. Of the available antimicrobial agents, beta-lactam drugs have a low pKa and poor lipid solubility, and thus penetrate poorly into prostatic fluid, expect for some cephalosporins, which achieve greater than or equal to the inhibitory concentration. Good to excellent penetration into prostatic fluid and tissue has been demonstrated with many antimicrobial agents, including tobramycin, netilmicin, tetracyclines, macrolides, quinolones, sulfonamides and nitrofurantoin.

Pleural effusion in temporal arteritis.

A 73-year-old woman was admitted to hospital with a one-month history of temporal headache, low-grade fever, fatigue, nocturnal sweats and pleural pain. On the fifth day after admission she developed chest pain at the left site of the thorax, productive cough and progressive dyspnea. A pleural effusion was revealed on physical examination, as well as a bilateral temporal artery thickening. An erythrocyte sedimentation rate of 135 mm in the 1st hour was found. Chest X-ray showed left pleural effusion. Thoracocentesis revealed serous fluid exudate. A percutaneous pleural biopsy showed only minimal inflammatory changes. Temporal artery biopsy showed giant cell arteritis. The patient received prednisone 60 mg/daily with a dramatic clinical response. Pleural effusion is a rare manifestation of temporal arteritis; only seven cases have been reported worldwide. We present a new case of temporal arteritis with pleurisy.

Brucella melitensis infection stimulates an immune response leading to Kikuchi-Fujimoto disease.

A 43-year-old Greek cattler with a history of brucellosis three months previously for which he was treated with sulfonamides for three weeks, was admitted to the hospital complaining of fever, arthralgias, night sweats, painful cervical and axillary lymph nodes as well as a weight loss of 8 kg in the previous four months. Since microbiological and serological studies did not give a specific diagnosis, an open cervical lymph node biopsy was performed. The histological examination revealed Kikuchi-Fujimoto disease. The etiology of the disease is unknown but viral, bacterial, protozoal and neoplastic as well as physicochemical agents may stimulate a particular immune response leading to Kikuchi-Fujimoto disease. Hereby, we present a case in which Kikuchi-Fujimoto disease followed brucella melitensis infection. This association permits us to hypothesize that the initial brucella melitensis infection three months previously triggered an immune response leading to Kikuchi-Fujimoto disease. The association of the disease with brucellosis is very important since these two entities share some similar characteristics, with brucellosis being relatively common in Europe. To our best knowledge, in the English language bibliography, this is the first reported case worldwide, though another similar case was described in the Spanish literature ten years ago.

Kikuchi-Fujimoto disease in Greece. A study of four cases and review of the literature.

Kikuchi-Fujimoto disease is a rare disease first described in 1972 by Kikuchi and Fujimoto et al. (1,2). Clinically the disease presents with lymphadenitis usually in the cervical region. Most reported cases of Kikuchi-Fujimoto disease have been of Asian origin. The cause is unknown and the condition is self-limiting. Some kind of viral or postviral etiology has been implicated. Bacterial and protozoal organisms as well as various other antigens, chemical, physical and neoplastic, have also been postulated. An association with systemic lupus erythematosus has also been shown. Lymphadenitis, hepatomegaly and splenomegaly as well as leukopenia, elevated erythrocyte sedimentation rate and hepatic abnormalities are common findings. Fever, malaise, fatigue, headache, night sweats, nausea, vomiting, weight loss, cutaneous manifestations, and even neurological symptoms are other complaints. Histologically the lymph nodes show partial involvement with patchy irregular areas of necrosis in the paracortical area with absence of neutrophils. We describe four cases of Kikuchi-Fujimoto disease observed in Greece. Their characteristics are discussed, whilst a review of the literature is attempted.

Is implant pacemaker a physicochemical cause triggering Kikuchi-Fujimoto disease?

A 64 year-old Caucasian female of Greek origin was admitted to hospital with painful cervical and axillary lymphodenitis accompanied by fever and night sweats for 10 days. The patient had undergone a pacemaker implantation six weeks before disease onset because of heart conduction abnormalities. A diagnosis of Kikuchi-Fujimoto disease was established after lymph node biopsy. The etiology of the disease is unknown but viral, bacterial, protozoal; and neoplastic as well as physicochemical agents may stimulate a particular immune response. Hereby, we hypothesize that the implant pacemaker can act as a physicochemical agent triggering Kikuchi-Fujimoto disease. We present this case and we discuss various disease aspects. A brief review of the literature is also given.