Limb-sparing surgery as an alternative for limb amputation in an invasive myxoid liposarcoma--case report.

In medical practice, plastic surgeons confront with patients with sarcomas of the extremities that require a radical surgical approach. Knowing when to attempt limb-sparing surgery and when to give in to limb amputation is one of the most difficult decisions a surgeon can take. The correct approach and management of such cases ensure surgical success and the patient survival. In this paper, the case of a 56-year-old man, admitted in our clinic with a crush injury of the right calf and subsequent haematoma is presented. During haematoma drainage, the surgeon noticed abnormal tissue and performed an incisional biopsy. The patient was diagnosed with myxoid liposarcoma of the external compartment of the right calf. Limb amputation was proposed, but the patient refused. After the clinical examination, blood tests and diagnostic imaging, which allowed the correct evaluation of the case-tumor sizes and neighboring tissue reports, and preoperatory radiotherapy, limb sparing surgery, respectively primary tumor excision was decided to be performed. Negative margins could not be obtained by 3 successive resections or by adjuvant chemotherapy. The presented case supports the idea that limb-sparing surgery is only applicable to carefully selected patients with soft tissue sarcoma. In some cases, radical excision involving even mutilating amputations may provide a better oncologic and functional result.

Mean platelet volume variability in young patients with non-ST elevation acute myocardial infarction.

INTRODUCTION: Platelet activation plays an important role in the pathophysiology of non-ST elevation acute coronary syndromes (ACS). Mean platelet volume (MPV), an indicator of platelet reactivity, was previously associated with an increased risk of acute coronary events. OBJECTIVE: To investigate the MPV variability in young patients presenting with NSTEMI, as compared to young patients with cardiovascular risk factors and no overt ischemic cardiac disease, as well as with elderly patients presenting with NSTEMI. METHODS: We analyzed data from 174 patients admitted in our cardiology department between January 2009 and December 2010: 35 patients younger than 45 years of age with NSTEMI, 41 patients younger than 45 without ACS and 98 patients older than 45 with NSTEMI. RESULTS: Young patients with NSTEMI had a significantly higher mean MPV (8.88 ± 1.14fl) than young patients without ACS (8.31 ± 0.37fl, p<0.01), while the older subjects with NSTEMI had the highest mean MPV (9.48 ± 1.35fl, p=0.02). MPV correlated with age (r=0.375, p<0.0001). After a multivariate analysis, elevated levels of MPV were independent predictors of NSTEMI in young patients (odds ratio [OR] 2.75, 95% CI 1.04-7.92, p=0.04), while hypertension (OR 0.34, 95% CI 0.6-1.78, p=0.20), dyslipidemia (OR 1.61, 95% CI 0.17-14.51, p=0.67), obesity (OR 5.77, 95% CI 0.80-41.53, p=0.08) and smoking status (OR 8.97, 95% CI 0.84-95.26, p=0.06) were not. CONCLUSION: NSTEMI is associated with high MPV in old as well as in young patients. Elevated MPV is predictive for NSTEMI in young patients, separately of a high cardiovascular risk profile.

Metabolic syndrome and mean platelet volume variation in patients with chest pain and negative cardiac enzymes.

INTRODUCTION: The mean platelet volume (MPV) is an easily measurable parameter directly correlated with platelet aggregation function, proven to be increased in acute coronary syndromes, but also in the presence of cardiovascular risk factors such as the metabolic syndrome, dyslipidemia, diabetes mellitus, arterial hypertension. OBJECTIVE: This study intended to assess the role of the metabolic syndrome in MPV variation in patients presenting with chest pain. MATERIALS AND METHODS: We retrospectively analyzed data from 122 patients with chest pain and negative cardiac enzymes admitted consecutively to our clinic from September 1st 2011 to January 30th 2012. Our group included 27 (22.13%) patients with stable angina (SA), 74 (60.65%) patients with unstable angina (UA) and 21 (17.22%) patients with non-coronary chest pain. RESULTS: Patients with UA had a higher mean value of the MPV 9.31 ± 1.19 fL compared to patients with SA 8.72 ± 1.14 fL (p=0.0279) and patients with non-coronary chest pain 8.85 ± 0.90 L (p=0.0908). All the patients with metabolic syndrome had increased MPVs, regardless of the etiology of chest pain. Patients with non-coronary chest pain presented significantly higher MPVs if associated with metabolic syndrome or arterial hypertension. CONCLUSIONS: Patients with cardiovascular risk factors, especially complex ones like the metabolic syndrome had an increased MPV, as did the patients with UA whether or not associated with the risk factors. In patients without such comorbidities, the MPV could be useful in distinguishing unstable angina from non-coronary chest pain.

Foxp3 and IL17 expression in tumor infiltrating lymphocytes (TIL) and tumor cells - correlated or independent factors?

Tumor infiltrating lymphocytes (TIL), as a microenvironment component were studied in various epithelial tumors, with contradictory results. Recent data about regulatory T-cells (Treg) revealed new explanations for pro- and anti-tumor implications of TIL. Tregs immunoprofile was recently completed with Foxp3 expression. A T-cell fraction (Th) is producing cytokine IL17 and is now considered acting in tumor progression. Our study aimed to analyze immunohistochemically (IHC) Foxp3+ and IL17 expression in resected lung adenocarcinomas, since they could become possible targets in the antitumor immunotherapy. The studied material was represented by paraffin-embedded tumor fragments from 59 patients with TIL identified on HE staining. The antibodies used were Foxp3 and IL17. The statistical analysis used logistical regression on SPSS19 software (Chicago, IL, USA). TIL was usually mild or scarce. A positive statistic correlation resulted between the amounts of TIL in peritumoral and intratumoral location but without correlation to histopathological grading. Foxp3 and IL17 were present in TIL lymphocytes, tumor cells and fibroblasts; IL17 was expressed also in periendothelial cells (PEC). Foxp3 positivity was significantly correlated for lymphocytes÷tumor cells, lymphocytes÷fibroblasts and tumor cells÷fibroblasts, suggesting their concerted action. Tumor cells and lymphocytes Foxp3 expression was inversely correlated with the amount of TIL. Between lymphocytic Foxp3 and PEC IL17, we found a weak negative correlation. The TIL had a quite positive correlation with PEC IL17. In these conditions, Foxp3 could be a mediator of the tumor cells inhibitory aggression upon the immune system and could be used as a molecular target for biological antitumor therapy.

Orbital exenteration - a salvage procedure?

Orbital exenteration is a procedure performed usually for malignancies. The subsequent reconstructive efforts are directed towards rapid and stable healing but allowing detection of recurrent disease, obliteration of any communication between the orbit and surrounding cavities and above all a good quality of life. The surgical options must be tailored to each patient; we have to achieve first disease control and to compensate a 3D defect as best as we can. In the following, we present a series of three patients with aggressive tumors of the midface, admitted in our clinic in the last four years. For each case, orbital exenteration was performed in order to achieve tumor clearance. The results were good excepting one case (a relapse at three years interval) with a squamous cell carcinoma and perineural invasion.

Clinical, biological, echocardiographic and therapeutic determinants of the length of hospital stay of patients with acute heart failure.

HYPOTHESIS: The length of hospital stay (LOS) is a unanimously accepted measure of risk and treatment efficacy for in-patients. PURPOSE: Our aim was to identify the parameters with predictive value for the LOS of patients with acute heart failure (AHF). METHODS: We analyzed 125 patients consecutively admitted to our clinic with a slight male predominance (54.4%) and a mean age of 71.54 years. Patients were divided into groups according to the clinical form at presentation and left ventricular function. Mean LOS was of 8.74 days. RESULTS: Patients with LVEF<30% had a significantly higher LOS compared to those with LVEF>30% (F(2)=6.54, p<0.05). The same difference was discovered for those who received inotropic support (p<0.001), i.v. loop diuretic>140mg (p<0.001) as well as for those with QRS>160ms (p<0.05) or LBBB. The linear regression equation exposed a single significant statistical model indicating that the need for vasopressor amines, mean diuretic dose and PAAT<90msec explain 56% of the variance of LOS F(3.46)=20.55, p<0.001. The highest contribution to the model was achieved by the need for vasopressor amines (ß=0.66), with a unique contribution of 42% to the variance of the number of days of stay. The mean dose of diuretic had ß=0.27 and a unique contribution to the model of 7.2%, followed by PAAT<90 msec with ß=0.26 and a unique contribution to the model of 7%. CONCLUSIONS: LOS is influenced by numerous parameters, some specific to certain clinical forms of AHF while others are independent, which is why evaluations on larger groups of patients are further needed.

Nestin and caveolin-1 in the diagnosis of GISTs.

Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal neoplasias of the gastrointestinal tract, typically expressing c-kit (CD117) and CD34. Recently, it was reported that nestin and caveolin-1 are also expressed in some human sarcomas, GISTs included. We performed a retrospective study on formalin fixed, paraffin embedded samples from 81 cases of confirmed GISTs, aiming to characterize their immunohistochemical profile, including nestin and caveolin-1 expressions. Tissue samples were evaluated immunohistochemically for CD117, CD34, nestin and caveolin-1. The patients (M:F 36:45), aged 46 to 84 years, had spindle cell type GISTs in 56.7% of cases, epithelioid in 30.8% and mixed pattern in 12.3%. Immunohistochemically, CD117 was positive in 88.9% of GISTs, CD34 in 85.1%, nestin in 77.7% and caveolin-1 in 71.6% of the tumors. Of nine c-kit negative GISTs, 66.7% expressed nestin, the same as caveolin-1 and 44.5% expressed both nestin and caveolin-1. Statistical analysis using Kendall's and Spearman's tests revealed significant correlations between nestin and caveolin-1 expressions (p=0.024). Our results suggest that nestin and caveolin-1 could be considered sensitive markers in GISTs, together with CD117 and CD34, for diagnostic purposes. Their significant expression in CD117 negative GISTs could represent an immunohistochemical alternative in establishing the diagnosis of these tumors.

A rare case of basaloid squamous cell carcinoma of the maxilla.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma (SCC) that occurs preferentially in the upper aerodigestive tract. Since the first description by Wain SL et al., in 1986, only 21 cases with BSCC in the nasal cavity or in the paranasal cavity have been reported in the English literature. We present here a case of BSCC arising in a paranasal sinus. The case was a 51-year-old male patient with four months history of right cheek swelling and unilateral nasal obstruction, who received operation and postoperative radiotherapy. Clinical, surgical and pathological findings in this case, including immunohistochemistry is presented along with brief discussion of literature.