Angiogenesis and angiogenic factor expression in thyroid cancer.

PURPOSE: Increased expression of angiogenic factors and high vascular density characterize tumors with increased invasive and metastatic capability. Anti-vascular endothelial growth factor (VEGF) therapies have shown an important potentiation of chemotherapy and radiotherapy in experimental and clinical studies. The purpose of this study was to investigate whether it could be possible to identify a subgroup of thyroid cancer patients with high angiogenic activity. METHODS: Formalin-fixed paraffin-embedded tissues from 25 papillary and 18 follicular thyroid carcinomas were assessed immunohistochemically for angiogenic activity, i.e. vascular density (VD) and expression of VEGF and basic fibroblast growth factor (bFGF). RESULTS: VD was significantly higher in follicular tumors (p=0.05). Tumors > 4 cm had a significantly higher VD (p=0.001). High VEGF expression was significantly related to high VD (p=0.05). There was no association of bFGF with histological characteristics. CONCLUSIONS: Increased angiogenic activity is a common feature of thyroid carcinomas, particularly in follicular tumors and larger carcinomas. These results support the testing of anti-VEGF therapies in combination with radiotherapy and chemotherapy in advanced thyroid tumors.

Prevalence of joint hypermobility and patterns of articular manifestations in patients with inflammatory bowel disease.

OBJECTIVE: The objective is the investigation of Joint Hypermobility (JH) and the Hypermobility Syndrome (HMS) in patients with inflammatory bowel disease (IBD). METHODS: We examined 83 patients with IBD and 67 healthy individuals for the presence of JH. Patients were excluded if they were under 18 or over 50 years of age and if they had other conditions which affect joint mobility. The x(2) and the Fisher exact test were used appropriately between study groups. Odds ratios (ORs) for the risk of JH and HMS in IBD groups were calculated. RESULTS: A total of 150 individuals (83 IBD patients and 67 healthy controls) participated in the study. 69 IBD patients, 41 with Crohn's Disease (CD) and 28 with ulcerative colitis (UC), were finally eligible. JH was detected in 29 CD patients (70.7%), in 10 UC patients (35.7%), and in 17 healthy control subjects (25.4%). Significant difference was detected on JH in CD patients as compared to UC patients (P = .0063) and controls (P < .0001). The estimated OR for JH was 7.108 (95% CI: 2.98-16.95) in CD and 1.634 (95% CI: 0.63-4.22) in UC patients. HMS was detected in 5 (12.2%) CD and in 1 (3.57%) UC patients. The OR for HMS in CD was 3.75 (95% CI: 0.41-34.007), while 7 (17.1%) CD patients had overlapping symptoms for both HMS and early spondylarthropathy. CONCLUSIONS: JH and the HMS are common in CD patients, thus articular manifestations should be carefully interpreted. This implies an involvement of collagen varieties in the pathogenesis of IBD.

Emergency operations for carcinoma of the colon.

The aim of this retrospective clinical study was to record and analyse the immediate and long term results obtained from emergency operation for carcinoma of the large bowel. In a 12-year period (1991-2003), 154 patients were operated on for carcinoma of the colon. In 29 patients (19%; 11 males, 18 females, m.a. 72.8 years and 67.5 years respectively), the operation was performed urgently. In 21 (72.5%) there was a complete obstruction located in 17 (81%) at the sigmoid, in 2 (9.5%) in right flexure and in 2 (9.5%) in left flexure. Five patients (17%) had developed peritonitis due to perforation proximal to the tumour and three patients (10.5%) had developed necrotic colitis and haemorrhage due to the obstruction. In 23 patients (79.5%) a radical curative operation was feasible [11 (38%) subtotal colectomies with ileo-rectal anastomosis, seven (24%) Hartman's, three (10%) right hemicolectomy and two (7%) on table bowel lavage plus colectomy with ileo-rectal anastomosis] and in six (11%) only palliative operations could be done (transverse loop colostomy). In all cases the postoperative period was uneventful. Three patients with palliative operation were submitted to a radical curative operation 2 months later and the other three patients died 6 months later from causes irrelevant to the primary disease. It is concluded that in this series of patients radical curative operations for carcinoma of the large bowel even under urgent conditions were feasible in the cases without additional complications, eliminating the necessity for reoperations later on.

Treatment of recurrent epithelial ovarian cancer with secondary cytoreduction and continuous intraoperative intraperitoneal hyperthermic chemoperfusion (CIIPHCP).

OBJECTIVE: Evaluation of the combined effect of secondary cytoreduction and continuous intraoperative intraperitoneal hyperthermic chemoperfusion (CIIPHCP), in the treatment of recurrent ovarian cancer, in a phase II clinical study. MATERIAL AND METHODS: Twenty consecutive, heavily pre-treated patients with recurrent epithelial ovarian cancer, were treated with a combination of cytoreductive surgery and CIIPHCP. All patients had extended peritoneal carcinomatosis. In 14 out of the 20 pts (70 %) the recurrence occurred during chemotherapy or within 6 months after the end of the chemotherapy. Thirteen pts (65 %) had preoperatively malignant ascites, whereas the remaining seven pts (35 %) had positive peritoneal cytology washings. RESULTS: No complications emerged during operation and CIIPHCP. Median ascites-free period after CIIPHCP was 21 months (range 3-109). Median survival time for patients with residual disease less than 1.5 cm was 29.0 months, whereas for patients with residual disease equal or greater than 1.5 cm, the median survival time was 7.0 months. This difference was statistically significant (P < 0.05). CONCLUSIONS: The survival data of our patients and the disappearance of the malignant ascites postoperatively suggest that continuous intraoperative intraperitoneal hyperthermic chemoperfusion is an effective treatment option for patients with recurrent ovarian cancer.