Postural and trunk responses to unexpected perturbations depend on the velocity and direction of platform motion.

This study compares postural and trunk responses to translating platform perturbations of varied velocities and directions. A group of 18 young and physically active subjects were exposed to a set of postural perturbations at varied velocities (5, 10, 15, and 20 cm/s) and directions of platform movement (forward, backward, left-lateral, and right-lateral). The center of pressure (CoP) displacement measurement, in addition to the trunk motion (representing the center of mass (CoM) displacement), were both monitored. Results identified that the CoP displacement increased from slow to faster velocities of platform motion more widely in both anterior and posterior directions (50.4 % and 48.4 %) as compared to the CoM displacement (17.8 % and 14.9 %). However a greater increase in the peak CoM velocity (70.3 % and 69.6 %) and the peak CoM acceleration (60.5 % and 53.1 %) was observed. The values in the anterior and posterior direction only differed significantly at the highest velocity of platform motion (i.e. 20 cm/s). A similar tendency was observed in the medio-lateral direction, but there were no significant differences in any parameter in the left-lateral and right-lateral direction. The velocity of the platform motion highly correlated with peak velocity (r=0.92-0.97, P<0.01) and moderately with amplitude of trunk displacement (r=0.56-0.63, P<0.05). These findings indicate that the velocity of perturbation alters peak CoM velocity rather than the magnitude of CoM displacement. The effect of the direction of perturbations on the trunk response emerges only at a high velocity of platform motion, such that the peak CoM velocity and peak CoM acceleration are significantly greater in anterior than posterior direction.

Histiocytic necrotising lymphadenitis in mediastinum mimicking thymoma or lymphoma - case presentation and literature review of Kikuchi Fujimoto disease.

Kikuchi Fujimoto disease (KFD) as a rare self-limiting lymphadenopathy of short and benign course concerns most frequently the lymph nodes of the neck. The most common symptoms are painfulness of the diseased area, fever and night sweating. The etiology is not well understood, but in the role of pathogenesis viral, autoimmune and genetic factors are taken into account. In the presented case of 37-year-old female it was necessary to exclude diseases such as lymphoma or thymoma because of atypical mediastinal location of Kikuchi Fujimoto disease. After multidisciplinary consultation the lymph node was resected from the mediastinum with videothoracoscopic approach. The diagnosis was difficult for the pathologist because of the large percentage of necrosis of the lymph node but the image was typical for histiocytic necrotizing lymphadenitis. Two cases of patients with KFD limited to the mediastinum have been previously reported in the literature. This article presents the world's first reported case of this disease in the topographic location of the thymus. Furthermore, a review of current literature was made.

Reliability and methodological issues of power assessment during chest presses on unstable surface with different weights.

AIM: The study compares the reliability of peak power (Ppeak) and mean power in acceleration (Pmean acc) and entire concentric phase (Pmean total) of chest presses on the bench and unstable Swiss ball with different weights. METHODS: A group of 32 fit men performed over 2 testing sessions 3 trials of barbell chest presses on the bench and Swiss ball, without and with countermovement, with weights of 40, 60 and 80% 1RM. RESULTS: High values of correlation coefficients (above .80) and no significant differences between trials signify stability of measurement under both stable and unstable conditions. When chest presses were performed on the bench, ICC and SEM% values were in range .97 to .98 and 7.6 to 7.7%, respectively for Pmean total, .96 to .98 and 9.1 to 9.6%, respectively for Pmean acc, and .94 to .97 and 9.2 to 10.0%, respectively for Ppeak. Their values during chest presses on a Swiss ball ranged from .93 to .96 and 8.4 to 9.1%, respectively for Pmean total, from .87 to .90 and 11.7 to 12.2%, respectively for Pmean acc, and from .79 to .82 and 12.1 to 13.4%, respectively for Ppeak at weights of 40 and 60% 1RM, and from .70 to .76 and 17.6 to 19.8%, respectively at weight of 80% 1RM. CONCLUSION: Measurement of peak and mean power during unstable chest presses provides reliable data comparable to those obtained during bench presses under all conditions tested. However, peak values of power measured during unstable chest presses with weights ≥80% 1RM should be interpreted with caution.

Huge alveolar soft part sarcoma of the retroperitoneum - case report.

Alveolar soft part sarcoma (ASPS) is a rare type of neoplasm, typically occurring in adolescents and young adults. Because of the rarity of this disease, there is no standard treatment plan. Chemotherapy and radiotherapy are not effective in this type of malignancy. Surgical excision is considered to be the treatment of choice. We report a case of a young woman with a painless mass in her left lower abdomen. Ultrasonography and CT scan revealed a large (21 cm) hard tumor occupying the left retroperitoneal space, which was surgically excised in our surgery department. The pathological diagnosis was ASPS.

A giant primary thyroid fibrosarcoma in an octogenarian.

We present an 89-year-old patient who was suffering from severe dyspnoea and mild dysphagia due to tracheal and esophagus compression by a giant goitre. The patient was euthyreotic. A total thyroidectomy was successfully performed. The pathology examination revealed fibrosarcoma G1, which is an extremely rare tumor of the thyroid.

Histopathological evaluation of recurrent goiter.

The recurrent goiter is the regrowth of thyroid tissue after thyroidectomy. An inadequate surgical removal of the thyroid gland, lack of substitution therapy and pathological stimulation of the thyroid growth can all promote the recurrence. The aim of this study was to find the connection between the histopathological findings during the first and second operation and the recurrence of goiter. The study group consisted of 29 women and 1 man. The mean time to recurrence was 15 years. The most frequent histopathological finding during the first and second operation was struma nodosa. According to our observations different histopathological findings were found in 63.4% cases after primary and secondary thyroidectomy. Some genetic investigations showed that nodules in recurrent goiters did not derive from nodules left during the first operation but from a group of cells which had high growth potential. Thus, not only the operation technique and substitution after operation are key factors of successful therapy of goiter, but also other factors which stimulate the re-growth of thyroid tissue.

Prognostic value of CA 19-9 level in resectable pancreatic adenocarcinoma.

The prognosis in patients with pancreatic cancer is poor and some authors describe it as a lethal disease. At the time of diagnosis only 14% of patients could be surgically treated and up to 30% of them die within 12 months. Therefore, further clinical investigations on preoperative patient qualification are needed. A total of 81 patients were included into the study. The CA 19-9 concentration was measured before surgery by an automated, commercially available enzyme immunoassay in Axsym analyzer (Abott Diagnostics Laboratory). A value of 37 U/ml was used as the upper limit of normal levels. Tumors were staged according to the Union Against Cancer (UICC) of 2004 and graded during the histological evaluation according to the G0-G4 scale. All patients were monitored every three month via outpatient clinic visits. In the case of missing visit we contacted the families to establish the cause. We assessed perioperative, 12 month, 2 year and 5 year survival. Twelve moth, 2 year and 5 year survival were assessed in the whole studied population and in the group of patients with the exception of these who died during the perioperative period. The total five year survival was 6%. The median time of survival was 467 days (range: 163 - 586 days). The perioperative period was survived by 91.4% patients, 12 months were survived by 71.6% patients, 2 years were survived by 35.8% patients, 5 years were survived by 6.2% patients. The serum Ca 19-9 level was above the normal limit in 80.5% patients. ROC curve analysis revealed that CA 19-9 level of more than 106 U/ml was linked to 2 year survival with 79.3% sensitivity and 74.5% specificity. Preoperative level of CA 19-9 below 106U/ml represents a predictive factor of 2- and 5-year survival, independent of other factors, such as lower size of the tumor, absence of metastases to lymph nodes, female gender of patients. After exclusion of the patients who died in the perioperative period, no relationship could have been disclosed between preoperative CA 19-9 levels and one year survival. The observation points to the chance that patients with higher levels of CA 19-9 harbour micrometastases, the development of which is sufficiently slow to allow for a one-year survival of the patients but which increase the risk of death after two and five years.

The importance of preoperative elevated serum levels of CEA and CA15-3 in patients with breast cancer in predicting its histological type.

It is not known whether in patients with breast cancer the occurrence of elevated serum tumour markers depends on its histological type. The aim of the study was to assess relationship between breast cancer histological type and the presence of increased serum levels of CEA and CA 15-3. The study population was 428 patients (all women, mean age 52.5 years), treated at The Department of Surgery of Wroclaw Medical University from 2005 to 2008 due to breast cancer. All of them had their preoperative CA 15-3 and CEA serum concentrations measured. According to the TNM system, 21% of patients were in stage I, 32.5% in stage II, 46.5% in stage III of the disease. In patients with ductal type of the cancer the elevated serum levels of CEA and CA 15-3 were observed in 48.7% and 42.2%, in lobular type in 42.4% and 52.5%, and in non-ductal/tubular types in 48.1% and 40.4% (p=N/S). Stepwise logistic regression analyses showed that ductal breast cancer is related to elevated CEA and normal CA 15-3 serum levels. The histological types of breast cancer are not significantly related to elevated serum levels of CEA and/or CA 15-3.

The role of computer-assisted analysis in the evaluation of nuclear characteristics for the diagnosis of precancerous and cancerous lesions by contact laryngoscopy.

PURPOSE: Contact endoscopy (CE) through the direct contact with the surface of the mucosa enables in vivo visualization of upper epithelial layers. There is a broad spectrum of laryngeal pathologies, as has been confirmed by earlier CE reports. The aim of the study was to resolve some of the limitations of CE through the application of computer-assisted image analysis. Quantitative and qualitative evaluation of nuclei was applied in the diagnosis of precancerous and cancerous lesions. MATERIALS AND METHODS: Fifty four patients with various laryngeal pathologies were included in the study. Paraffin section histopathology showed 15 benign lesions, 12 precancerous lesions (5 mild and 7 severe dysplasias) and 27 invasive squamous cell cancers (SCC). After staining the mucous with 1% methylen blue, examination with contact endoscope (Karl Storz, Germany) connected to the C-7070 Wide Zoom Olympus high-resolution camera was performed. RESULTS: The most discriminative parameters were revealed to be as follows: nucleus area (p<0.001), nuclei density index (p<0.001), elongation coefficient (p<0.05), nucleus area to equivalent area ratio (p<0.05). Computer-assisted image analysis composed with data mining techniques is presented for nuclei categorization. CONCLUSIONS: We established that computer-aided image analysis can indicate, with a high level of reliability, cases of severe dysplasia and carcinoma. By implementing the technique described in this paper, we can substantially increase the sensitivity of CE.

The role of nuclear morphometry in prediction of prognosis for rhabdomyosarcoma in children.

AIMS: To determine whether nuclear morphometry can be used in pretreatment diagnostic procedures to guide the therapy of childhood rhabdomyosarcoma (RMS). MATERIALS AND METHODS: Biopsy specimens obtained from 108 patients with rhabdomyosarcoma aged between 1 and 217 months treated in 12 paediatric oncology departments in Poland were evaluated. There were 65 (60.2%) specimens of embryonal rhabdomyosarcoma (RME), 32 (29.6%) of alveolar RMS (RMA) and 11 (10.2%) cases of undifferentiated RMS (RMU). The clinical data from all analysed patients were evaluated. Nuclear morphometry was performed semiautomatically on haematoxylin-eosin-stained sections using the MultiScan v.8.08 Computer Scanning System and an Olympus BX 50 microscope with a x 40 magnification lens. RESULTS: In the RMA subtype cells with spindle-shape nuclei were less common (P = 0.013) and cell nuclei were generally more round in comparison with RME (P = 0.033). The clinical outcome was better if the nuclei seen in biopsies of RMS were more spindle-shaped (event-free survival 0.51 and 0.23, respectively; P = 0.04) or more cells with spindle-shaped nuclei were observed (event-free survival 0.5 and 0.28, P = 0.035). RME patients with small nuclei had a better outcome then patients with large nuclei (P = 0.014). In the RMA/RMU group, patients with small tumour cell nuclei had a worse prognosis than patients with larg tumour cell nuclei (P = 0.046). CONCLUSIONS: Nuclear morphometry is a useful tool in the assessment of children with RMS. Additionally, certain morphometric parameters could be easily applied in a selection of patients with good prognosis.

Contribution of flow cytometric immunophenotyping and bone marrow trephine biopsy in the detection of lymphoid bone marrow infiltration in non-Hodgkin's lymphomas.

The bone marrow (BM) is a frequent site of involvement in non-Hodgkins lymphomas (NHL) and evidence of an infiltrated BM may implicate different therapeutical regimens. Flow cytometric immunophenotyping of bone marrow aspirates now is included in the assessment of patients with NHL and used as an adjunct to morphologic evaluation in the staging of lymphoma. The aim of the study was to compare flow cytometric immunophenotyping of BM and paraffin section staining of BM biopsies in the marrow involvement of NHL. Cytometric immunophenotyping of bone marrow and immunohistochemical paraffin section staining of bone marrow biopsies in 53 B- and T-cell lymphoma patients were performed. We used the following fluorochrom conjugated monoclonal antibodies specific for: CD3, CD4, CD5, CD7, CD8, CD10, CD19, CD20, CD22, CD23, CD79B, FMC7 and Ig kappagamma light chain. Unilateral BM trephine biopsies were obtained in all cases, fixed, decalcified and paraffin-embedded. Morphologic marrow involvement by lymphoma was found in 24 cases; flow immunophenotyping identified 26 cases with NHL: morphology-positive/flow-positive (n=21), morphology positive/flow-negative (n=3), morphology-negative/flow-positive (n=4), and morphology-negative/flow-negative (n=23). The concurrence rate of BM trephine biopsy and flow cytometric immunophenotyping in evaluation of NHL bone marrow infiltration was 88.7%. Immunophenotyping of the bone marrow of NHL patients by flow cytometry is helpful for assessment of bone marrow infiltration, especially in B-cell disorders. Both trephine biopsies and flow cytometry are better than single investigation for detection of infiltration in NHL.

Bcl-Xl protein expression in laryngeal squamous cell carcinoma.

The Bcl-2 family of proteins regulate one of the steps in an evolutionary conserved apoptotic pathway. The long splice variant of Bcl-X (Bcl-Xl) is a potent antagonist of apoptosis. The aim of the study was to evaluate the relation between the presence of immunohistochemically detectable Bcl-Xl protein in laryngeal squamous cell carcinomas (LSCCs) and clinicopathological data, as well as DNA ploidy status and proliferative activity. In 50 specimens of LSCC, Bcl-Xl protein expression was evaluated immunohistochemically. Proliferative activity (SG2M-phase index) and DNA ploidy were measured by flow cytometry. In our study, Bcl-Xl protein expression decreased with decreasing tumour differentiation (P = 0.04). The majority of patients with Bcl-Xl protein immunoreactivity had no metastatic lymph node involvement (P = 0.01). Other factors such as age, gender, primary tumour size (pT) and type of cancer (keratinizing/non-keratinizing) were not associated with Bcl-Xl protein level. There was no correlation between Bcl-Xl protein and SG2M-phase index or DNA ploidy status. Our findings show that expression of Bcl-Xl protein is increased in a great fraction of laryngeal cancers. Further studies, however, are needed to clarify association between Bcl-Xl protein expression and clinical course of patients.

Role of metallothionein expression in non-small cell lung carcinomas.

Metallothionein (MT) is a low molecular weight protein, which participates in differentiation and proliferation of normal and tumour cells. In some malignant tumours (mammary, renal, ovarian cancers), its increased expression is thought to represent an unfavourable prognostic factor. Non-small-cellular lung cancers (mainly squamocellular cancer and adenocarcinoma) are characterised by ill-defined prognosis, which poses problems in the selection of effective post-surgical therapy. The present study aimed at demonstration of the prognostic significance of MT expression in cells of non-small cell lung cancers, attempting to correlate the intensity of MT expression with G grade and with the intensity of proliferation-associated antigen, Ki-67 expression. The studies were performed on archival paraffin blocks with samples of 25 cases of non-small cell lung cancers (5 squamous cell cancers, 20 adenocarcinomas). In paraffin sections of the studied tumours, immunocytochemical reactions were performed, using mouse monoclonal anti-MT and anti-Ki-67 antibodies. The expressions of MT and Ki-67 were demonstrated in all the studied tumours. An analysis of correlation between the expression of MT, Ki-67 antigen and G grade demonstrated a strong positive relation between the latter two parameters (r=0.70; p<0.05). Less pronounced positive correlations were disclosed between MT expression and G grade (r=0.44; p<0.05) and between MT expression and the expression of Ki-67 antigen (r=0.41; p<0.05). In addition, in 15 cases of examined tumours, survival analysis was performed, which disclosed a shorter survival in patients with high MT expression. The obtained results confirmed the relationship between MT expression and Ki-67 antigen expression, indicating an involvement of the proteins in processes of tumour cell proliferation. In turn, the shorter survival of patients with high expression of MT pointed to prognostic significance of the protein in non-small cell lung cancers.

Laminin, Her2/neu and Ki-67 as prognostic factors in non-small cell lung cancer.

PURPOSE: The aim of this study was to determine the values of Ki-67 antigen, oncoprotein Her2/neu and laminin, as prognostic and predictive factors in NSCLC, and on the basis of these markers to create a prognostic model which would make it possible to identify patients with a high risk of disease recurrence. MATERIAL AND METHODS: The material for the study came from 64 patients with NSCLC, who underwent surgery in Dolnoslaskie Centrum Gruzlicy i Chorób Pluc i 1996-2000, and subsequently were given radiation therapy in Dolnoslaskie Centrum Onkologii. RESULTS: Among the markers researched, a high level of (intracellular) laminin in carcinoma cells was found to be an unfavourable prognostic factor. Also, another group of patients with an overexpression of oncoprotein Her2/neu were found to have a poorer prognosis, although the influence of proliferative index Ki-67 on patient survival could not be explained. The prognostic model LAMHER, which was defined on the basis of the intracellular laminin level and expression HER2/neu, enables the identification of a group of patients with a high risk of disease recurrence. In a multidimensional analysis of the "classification tree", it was found that patients with the highest risk of disease recurrence were those with LAMHER = 1 (overexpression Her2/neu and/or a high level of intracellular laminin), and patients with LAMHER = 0 but a Fractionation Dilution Factor higher than 1.57. CONCLUSIONS: The conclusion of this study is that multiple molecular marker testing is necessary to detect an independent prognostic impact on survival and is therefore superior to single marker testing. Based on LAMHER testing, two groups of patients could be defined: a low-risk group (LAMHER = 0) and a high-risk group (LAMHER = 1) for failure of standardized treatment.

[Hematological disorder caused by a giant myoma of the uterus]. / Zaburzenia hematologiczne wywolane miesniakiem macicy.

OBJECTIVES: Polycythaemia means an increase in the number of red blood cells and usually a corresponding increase in the haematocrit and in the quantity of haemoglobin. Regarding etiology, primary and secondary forms of polycythaemia can be distinguished. The primary form--polycythaemia vera--is caused by autonomous erythroblastic hyperplasia. Secondary polycythaemia--erythrocythosis--may arise as a consequence of erythropoietin (EP) overproduction due to tissue hypoxia. These changes may stimulate the EP synthesis in the kidneys. EP may also be produced in metaplastic cells. STUDY DESIGN: A 59-year-old woman was admitted to the Clinic of Haematology of the Wroclaw Medical University with a 10-years' history of significant increase in HB, VPRC and RBC. Physical examination showed an obvious plethora and a large intra-abdominal painless tumour. Laboratory data revealed increases in Hb, VPRC, RBC and EP. A bone marrow aspiration was normal. During surgery, a large leiomyoma of the uterus was found and a total hysterectomy was performed. Pathological examination showed the tumour to be fibroleiomyoma. 4 weeks after surgery Hb, VPRC, RBC and EP, all returned to normal levels. RESULTS: Excluding the effect of the renal compression, it can be concluded that erythropoietin secreted by the the tumour caused the secondary haematological changes.

[The evaluation of the relationship between malignancy grade and cytokeratin-10 accumulation in human skin squamous cell carcinoma]. / Ocena zaleznosci pomiedzy stopniem dojrzalosci histologicznej w ludzkim raku kolczystokomórkowym skóry a obecnoscia CK-10.

The aim of the study was analysis of CK-10 expression in human skin squamous cell carcinoma (SCC) basing on immunohistochemical procedure. The study was carried out on 43 samples of skin SCC which were evaluated histopathologically with regard to 3-grade scale (G) of malignancy. In each case immunohistochemical reactions by use of ABC method were carried out in order to detect CK-10 within cancer cells. The expression of CK-10 was evaluated in accordance with arbitrary 3 grade scale: from +++ to +. The obtained results revealed affection of CK-10 expression in cancer cells. In G1 and G2 skin SCC a moderate expression of CK-10 was found and this occurred in cells grouped in nests. In G3 SCC the expression of CK-10 was very low and this was noted in single cells only. The use of immunohistochemical methods in evaluation of CK-10 expression can be a useful tool in routine histopathologic examination of tumors of epithelial origin.

Expression of type IV collagen and matrix metalloproteinase-2 (type IV collagenase) in relation to nodal status in laryngeal cancer.

Laryngeal carcinoma has a lower incidence of neck metastases than other malignant carcinomas of the head and neck region. However, some cases are very aggressive, showing neck metastases even in the early stages. In this study the expression of collagen IV and type IV collagenase (MMP-2) were examined immunohistologically in 50 patients with laryngeal carcinomas, and the results were compared with the incidence of neck metastases and other clinicopathological factors. The correlation between collagen IV expression and the existence of nodal metastases was statistically significant (P < 0.001). There was also significant correlation between collagen IV expression and the histological grading of the tumour. There was a tendency for samples with continuous collagen IV staining to have no matrix metalloproteinase-2 (MMP-2) immunoreactivity. No significant correlation was seen between MMP-2 protein expression and clinicopathological parameters although the correlation between MMP-2 and existence of nodal metastases was statistically borderline (P = 0.07). Multivariate analysis of the clinicopathological factors that may have an influence on the nodal status in laryngeal cancer revealed that, apart from T stage, collagen IV pattern in the basement membrane surrounding nests of carcinoma is an important prognostic factor.

Multiple metastases of carcinoma basocellulare into spinal column.

Basal cell carcinoma presents a relatively low potential and local malignancy and very slow growth giving only occasionally metastatic spreading. The frequency of occurrence of metastatic dissemination is estimated in the literature depending on examined population from 0.028% to 0.55%. Metastases are most often found in lymph nodes, lungs bones and internal organs: liver, spleen, kidneys, adrenal glands, pleura and the peritoneum. Authors present a case of a 69-years old female with an extensive basal cell carcinoma of the head convexity, infiltrating the subcutaneous tissue, periostium, bone and dura mater, giving distant metastases to other bone and soft tissue structures of a thoracic spine, which was confirmed by biopsy and histopathological findings of neoplasm tissue in spine. The primary lesion was successfully treated surgically. Despite administered radiotherapy of metastases in spine, progress of the disease during 1-year period was observed. The patient was alive with metastatic tumours present at last follow-up. Basing on the review of the literature and our case report we can distinguish following factors which may increase the risk of occurrence of basal cell carcinoma metastases: the great extent of the primary lesion, deep penetration to stromal tissue, blood and lymph vessel invasion, long history of tumour occurrence and the presence of metatypia in histopathological findings. The above-mentioned case fulfils the criteria of carcinoma basocellulare metastases proposed by Latters and Kessel and may be included to the general registration list of this cancer in the world.

[Abdominal presentation of B-cell non-Hodgkin's lymphoma (B-NHL) - surgical treatment and its results. Report of the Polish Paediatric Leukaemia/Lymphoma Study Group]. / Manifestacja brzuszna chloniaka B-komórkowego u dzieci - interwencja chirurgiczna i wyniki leczenia. Raport PPGLBC.

The aim of this study was to analyse the effect of LMB-89 protocol and surgical procedure at initial laparotomy on the outcome in children with abdominal B-cell NHL. The initial surgery intervention was: complete resection (20% pts), subtotal resection (20%), partial resection (4%), biopsy (36%). Postoperative complications occurred in 5 children. Complete recovery (CR) was achieved in 92% pts. There were 4% non responder patients. Two patients died before CR evaluation (tumour lysis syndrome; bleeding and multi organ failure after initial surgery). One patient died in CCR from sepsis probably influenced by the previous local operation. 10.8% patients relapsed. The estimate EFS for all patients with AB-NHL is 81%, 85% for stage III and 73% for stage IV. Major surgery in advanced stages is not recommended since it delays chemotherapy and fails to improve overall survival.