The impact of Girdin expression on recurrence-free survival in patients with luminal-type breast cancer.

BACKGROUND: In patients with luminal-type breast cancer (positive for ER and/or PgR), a complete consensus on the threshold indication for a combination of chemotherapy and endocrine therapy has not been achieved, especially for patients with HER2-negative luminal type (HNLT). Girdin, an actin-binding Akt substrate, plays a crucial role in the migration of cancer cells. This study examined the expression of Girdin in relation to clinicopathological features and other immunohistochemical markers (HER2, Ki-67), especially in patients with HNLT breast cancer. METHODS: One hundred one breast cancer patients who underwent surgery were evaluated. Immunohistochemical staining was performed for Girdin and other biomarkers, such as ER, PgR, HER2, and Ki-67. RESULTS: Positive expression of Girdin was observed in 26 patients. The expression of Girdin was significantly associated with the incidence of lymph node metastases (p = 0.001). Among the other examined biomarkers, positive expression of Ki-67 also showed a significant association with the incidence of lymph node metastases (p = 0.04). In the HNLT breast cancer patients (n = 73), the 5-year recurrence-free survival rate was significantly lower (57 %) in patients with positive expression of both Girdin and Ki-67 than the rate in other patients (92 %) (p = 0.002). CONCLUSION: This study demonstrated that the expression of Girdin in invasive breast cancer is strongly associated with lymph node metastasis. The expression status of Girdin and Ki-67 can be a useful biomarker in stratifying patients with HNLT breast cancer into those with high risk of recurrence and the need for additional chemotherapy.

Efficacy of preoperative dexamethasone in patients with laparoscopic cholecystectomy: a prospective randomized double-blind study.

BACKGROUND/PURPOSE: Dexamethasone has been reported to reduce postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC). However, its effect on other surgical outcomes such as pain and fatigue have been unclear. The purpose of this clinical study was to evaluate the efficacy of preoperative dexamethasone in ameliorating postoperative symptoms after LC. METHODS: In this prospective, double-blind, placebo-controlled study, 80 patients scheduled for LC were analyzed after randomization to intravenous dexamethasone (8 mg) or placebo. All patients underwent standardized procedures for general anesthesia and surgery, and were recommended to remain in hospital for 3 postoperative days. Episodes of PONV, and pain and fatigue scores on a visual analogue scale (VAS) were recorded. Analgesic and antiemetic requirements were also recorded. RESULTS: There were no apparent side effects of the study drug. Seven patients (18%) in the dexamethasone group reported nausea, compared with 16 (40%) in the placebo group (p = 0.026). One patient (3%) in the dexamethasone group and 7 (18%) in the placebo group reported vomiting (p = 0.025). Dexamethasone significantly reduced the postoperative VAS pain score (p = 0.030) and VAS fatigue score (p = 0.023). The mean number of patients requiring diclofenac sodium 50 mg was 0.9 +/- 1.3 in the dexamethasone group and 2.2 +/- 2.5 in the placebo group (p = 0.002). CONCLUSIONS: The regimen we employed is safe and without apparent side effects. These results suggest that preoperative dexamethasone (8 mg) significantly reduces the incidence of PONV, pain, and fatigue after LC.

Side-to-end anastomosis in a colostomy for acute malignant large-bowel obstruction: side-to-end anastomosis with a colostomy (STEC procedure).

This report describes the use of side-to-end anastomosis in a colostomy for an acute malignant large-bowel obstruction. A 59-year-old man presented with a colonic obstruction due to advanced descending colon cancer. The preoperative imaging studies revealed a complete obstruction of the descending colon at the site of the splenic flexure, a remarkably dilated transverse colon, and no other metastatic lesions. Side-to-end anastomosis was performed with the colostomy because of the high comorbidity associated with such cases. When the patient's general condition improved, a stoma closure was performed under local anesthesia. In conclusion, a side-to-end anastomosis with a colostomy (STEC procedure) was found to be a simple, useful, and cost-effective technique for an acute malignant large-bowel obstruction, particularly in a high-risk patient.

A case of anaplastic carcinoma of the pancreas producing granulocyte-colony stimulating factor.

We report a case of anaplastic carcinoma of the pancreas with production of granulocyte-colony stimulating factor (G-CSF) in a 59-year-old male. He was referred to our hospital with a chief complaint of epigastralgia and suffered from leukocytosis. Differential diagnosis included pancreatic tumors and submucosal tumor of the stomach, but definite preoperative diagnosis could not be made. He underwent distal pancreactomy, total gastrectomy with Roux-en-Y reconstruction and splenectomy. He recovered uneventfully postoperatively and was discharged from hospital on the 14th postoperative day. Histological examination showed anaplastic carcinoma of the pancreas. Since the peripheral leukocyte count was sharply decreased after the operation, we suspected the tumor would be producing G-CSF. Then immunohistochemistry showed a positive stain in the tumor. Therefore, we diagnosed the tumor as anaplastic carcinoma of the pancreas producing G-CSF. Three months after the resection, local recurrence was detected by abdominal computed tomography. The patient died of hemorrhagic shock due to tumor invasion of the intestine 8 months after the operation.