Inflammatory response in 85 patients with loosened hip prostheses: a prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening.

BACKGROUND: The most common complications of prosthetic hip joints are aseptic mechanical failure and infection. Delayed low-grade infections are seen most often, and they are also most difficult to distinguish from aseptic mechanical failures. METHODS: We conducted a prospective study to compare inflammatory markers in patients diagnosed with aseptic or septic prosthetic loosening. The diagnostic criteria were based on the decisions of experienced orthopedic surgeons and microbiological analysis of periprosthetic tissue samples taken perioperatively. RESULTS: Coagulase-negative staphylococci were the commonest pathogens in the infected patients. Pre- or perioperative elevation of C-reactive protein and erythrocyte sedimentation rate were significantly greater in the infection group, as were white blood cell count and levels of cytokines in synovial fluid. The patterns of infiltration of inflammatory cells in periprosthetic tissue were also significantly different between the groups. INTERPRETATION: A combination of clinical judgment and multiple tissue samples constitutes a good platform for distinguishing between septic and aseptic loosening of prostheses. Moreover, the combined use of several laboratory and histopathological markers of inflammation, especially infiltration of polymorphonuclear cells, further helps the diagnosis.

Long-term follow-up of conservatively managed incidental carcinoma of the prostate: a multivariate analysis of prognostic factors.

OBJECTIVE: To evaluate the disease-specific mortality of conservatively managed incidental carcinoma of the prostate (T1a and T1b) in relation to prognostic factors. MATERIAL AND METHODS: Since 1987 all patients with prostate cancer have been recorded and followed in the population-based Prostate Cancer Register of the South-East Healthcare Region in Sweden, which is covered by four departments of pathology. At two of these departments, tissue was obtained from 197 consecutive, previously untreated patients (aged <80 years) with incidental carcinoma who underwent transurethral resection of the prostate between 1987 and 1991. The amount of tumour, Gleason score and levels of Ki-67, p53, chromogranin A and serotonin were determined. Univariate analysis and multiple Cox regression hazard analysis were used for analysis. RESULTS: During follow-up (mean 7.8 years; maximum 17.5 years), 158 patients (80%) had died, 33 of them of prostate cancer, corresponding to 17% of the entire cohort. Of 86 patients with Gleason score < or =5, three died of prostate cancer. Independent predictors of disease-specific mortality in multivariate analysis were category T1b prostate cancer, Gleason score >5 and high immunoreactivity of Ki-67. CONCLUSIONS: Elderly men with category T1a and/or Gleason score 4-5 prostate cancer have a favourable prognosis with conservative management. Immunohistochemical staining with Ki-67 may be of help in situations where further prognostic information is required.

Telomerase activity in surgical specimens and fine-needle aspiration biopsies from hyperplastic and neoplastic human thyroid tissues.

BACKGROUND: Telomerase activity (TA) indicates malignancy, but activated lymphocytes also express TA. Correlation between TA in thyroid tissues and fine-needle aspiration (FNA) samples and knowledge about TA in adjacent tissue are of importance. METHODS: The telomeric repeat amplification protocol assay followed by enzyme-linked immunosorbent assay detection was performed on 78 thyroid cases including 53 suspected malignancies, preoperative and perioperative FNA specimens, and adjacent tissue. RESULTS: Benign lesions in cancer-suspected cases were TA negative. Eight of 13 papillary (62%) and 4 of 5 follicular (80%) tumors were TA positive (TA+). Lower TA was observed in conventional papillary cancer than in follicular, tall cell variant of papillary and anaplastic cancers. Adjacent tissues with lymphocyte infiltration were TA+ in 9 of 17 cases (53%). Nine of 65 adjacent tissues (14%) were TA+. Three of 6 preoperative and 9 of 11 perioperative FNA samples from malignant tumors corresponded to the tissue TA. CONCLUSIONS; High TA may reflect more severe thyroid cancer. Telomerase activity in FNA biopsies does not add reliable diagnostic information, and presence of lymphocytes can give false-positive results.