Prognostic significance of claudin expression changes in breast cancer with regional lymph node metastasis.

Adherent and tight junction molecules have been described to contribute to carcinogenesis and tumor progression. Additionally, the group of claudin-low tumors have recently been identified as a molecular subgroup of breast carcinoma. In our study, we examined the expression pattern of claudins, beta-catenin and E-cadherin in invasive ductal (IDCs) and lobular (ILCs) carcinomas and their corresponding lymph node metastases (LNMs). Tissue microarrays of 97 breast samples (60 invasive ductal carcinomas, 37 invasive lobular carcinomas) and their corresponding LNMs have been analyzed immunohistochemically for claudin-1, -2, -3, -4, -5, -7, beta-catenin and E-cadherin expression. The stained slides were digitalized with a slide scanner and the reactions were evaluated semiquantitatively. When compared to LNMs, in the IDC group beta-catenin and claudin-2, -3, -4 and -7 protein expression showed different pattern while claudin-1, -2, -3, -4 and -7 were differently expressed in the ILC group. Lymph node metastases developed a notable increase of claudin-5 expression in both groups. Decrease or loss of claudin-1 and expression of claudin-4 in lymph node metastases correlated with reduced disease-free survival in our patients. According to our observations, the expression of epithelial junctional molecules, especially claudins, is different in primary breast carcinomas compared to their lymph node metastases as demonstrated by immunohistochemistry. Loss of claudin junctional molecules might contribute to tumor progression, and certain claudin expression pattern might be of prognostic relevance.

Percutaneous endovascular treatment of innominate artery lesions: a single-centre experience on 77 lesions.

PURPOSE: To assess primary success and safety of percutaneous transluminal angioplasty and/or stenting of innominate artery lesions and to compare its 30-day stroke/mortality level with the literature data. METHODS: A total of 72 patients (77 stenoses, five recurrent, 58 symptomatic and 39 female) with seven innominate vessel occlusions, nine subocclusive lesions and 61 significant (>60%) stenoses of innominate artery treated between 2000 and 2009 were retrospectively reviewed. With the exception of seven, all procedures were performed using a transfemoral approach. A stent was implanted in 49 (63.6%) cases. Follow-up included neurological examination, carotid duplex scan and office/telephone interview. RESULTS: Primary technical success was 93.5% (72/77). There was neither periprocedural (<48 h) death, nor major neurological complication. Minor periprocedural neurological complications consisted of 2/72 (2.6%) ipsilateral TIAs. Access site complications included 4 (5.2%) access site bleedings. Follow-up was achieved in 65/72 (90.3%) of all patients and 68 (88.3%) of all procedures for a mean of 42.3 months and revealed neither major neurological complication, nor additional TIA. The cumulative primary patency rate was 100% at 12 months, 98+/-1.6% at 24 months, and 69.9+/-8.5% at 96 months. The cumulative secondary patency rate was 100% at 12 and at 24 months, and 81.5+/-7.7% at 96 months. Log-rank test showed no significant difference (p=0.79) in primary cumulative patencies between PTA alone (n=28) or PTA/stent (n=49). CONCLUSION: Transfemoral PTA with or without stent appears to be a safe treatment option for innominate artery lesions.

Long-term followup of dermal substitution with acellular dermal implant in burns and postburn scar corrections.

Full-thickness burn and other types of deep skin loss will result in scar formation. For at least partial replacement of the lost dermal layer, there are several options to use biotechnologically derived extracellular matrix components or tissue scaffolds of cadaver skin origin. In a survey, we have collected data on 18 pts who have previously received acellular dermal implant Alloderm. The age of these patients at the injury varied between 16 months and 84 years. The average area of the implants was 185 cm(2). Among those, 15 implant sites of 14 patients were assessed at an average of 50 months after surgery. The scar function was assessed by using the modified Vancouver Scar Scale. We have found that the overall scar quality and function was significantly better over the implanted areas than over the surrounding skin. Also these areas received a better score for scar height and pliability. Our findings suggest that acellular dermal implants are especially useful tools in the treatment of full-thickness burns as well as postburn scar contractures.

Complications following esophageal surgery.

Chronologically, complications can be classified as intraoperative, early, and late. The authors analyze complications according to this classification on the basis of more than 400 esophageal operations and related literary data. As regards intraoperative complications, they deal only with those occurring at transhiatal esophagectomy (e.g., tracheal tear, bleeding, pneumothorax, laryngeal nerve injury). Among the early complications, they survey the incidence of transplant necrosis and related mortality, further sequelae ensuing from subacute ischemia of the replaced organ and analyze in detail the questions which arise regarding anastomotic leakage. Firstly, they deal with those causative factors that influence the frequency of anastomotic insufficiency, such as the technical "know-how" of anastomosis making (e.g., one layer vs two layers; stapling or manual suture; interrupted or running suture), the way of replacement using whole stomach or tube-stomach and the consequences originating from the route of replacement (e.g., anterior or posterior mediastinal route). Incidence and management of chylothorax are also dealt with. While dealing with late complications, the authors give a detailed comment on anastomotic strictures and also other factors facilitating the development of late dysphagia, such as peptic stricture and tumor of the organ remnant. Finally, some cases successfully treated by surgery are presented (skin-tube formation in cases following transplant necrosis; abolition of a pharyngogastric anastomosis stricture using a free jejunal transplant and surgical solution of an anastomotic stricture from median sternotomy approach).

Skin tube esophagus: present indications and late malignization.

If there is no other possibility for the replacement of the whole esophagus, skin tube esophageal reconstruction gives a good result. Three successful cases treated with the antethoracal neoesophagus formed from musculocutaneous flaps are discussed. All patients recovered successfully. However, there exists the possibility of late malignization in the skin tube esophagus. Two such cases are also presented.

[Using the radial artery in myocardial revascularization]. / Az arteria radialis alkalmazása a szívizom revascularisatiójában.

Between March 1996 and April 1998, 10 patients underwent myocardial revascularization using radial artery grafts. The age ranged between 59-81 (mean 67.7) years. The mean left ventricular ejection fraction was found to be 0.53 (range 0.45-0.62). A mean of 3.2 distal anastomoses per patient were performed. There was no operative mortality and no perioperative myocardial infraction was observed. No ischaemia of the hand was noticed. At a mean follow-up of 16.6 months (range 3-27) all patients are alive and free of symptoms. Only one patient had angina at bicycle ergometer test. The precise and atraumatic harvesting of radial artery and use of calcium antagonists prevent vasospasm and early graft occlusion on the short term. To assess the late results longer follow-up is necessary.

[Use of an internal mammary artery graft in the revascularization of the myocardium. A ten-year follow up study]. / Az arteria mammaria interna graftok alkalmazása a szívizom revascularisatiójában. Tízéves nyomon követési vizsgálat.

Between September 1986 and August 1996, 233 patients (187 males, 46 females) ranging in age from 32 to 81 (mean 54.7) years received at least one internal mammary artery (IMA) graft for coronary artery bypass procedures. The mean left ventricular ejection fraction was 55.1% (range, 17 to 75%). An average of 3.1 distal anastomoses per patient was constructed. Hospital mortality was 2.1%. Perioperative myocardial infraction was seen in 2.1%. The mean follow-up of hospital survivors was 39.2 (range, 4 to 123) months. Ten-year actuarial survival for patients discharged from the hospital was 96%. Recurrence of angina occurred in 18 patients and reoperation or PTCA was performed in 3 patients in the late follow-up period. These results support the continuing use of IMA grafts for myocardial revascularization.

Reverse two-stage procedure in the surgical treatment of esophageal cancer.

Authors have performed 266 one-stage resections and 6 reversed two-stage operations for the treatment of esophageal cancer during a 10-year-period. In six cases first a substernal bypass with colon or stomach was carried out while the tumourous esophagus was removed only 3-4 weeks later from a right thoracic approach. All six patients recovered. The reverse two-stage operation for esophageal cancer can be suggested with rare indications (pulmonary abscess, previous abdominal operations, severe malnutrition, etc.) and it is only justified when the advantage gained by increased operability and decreased morbidity and/or mortality is higher than the disadvantage ensuing from oncological, financial and patient demanding considerations.

Aortico-left ventricular tunnel: late reoperations.

Aortico-left ventricular tunnel is a rare congenital anomaly that presents as aortic regurgitation in infancy or childhood. Information on late results of surgery, especially with reoperations for progressive aortic regurgitation and recurrences are limited. The case histories of two patients with reoperations following correction of aortico-left ventricular tunnel are reported.

Surgical treatment of cardiac myxomas: a 20-year follow-up.

Clinical experience in the diagnosis and management of 50 cases of cardiac myxoma seen over a 20-year period from 1974 to 1994 has been reviewed. There were 17 men and 33 women of mean age 55.2 (range 16-81) years. Echocardiography confirmed the diagnosis in all patients. The location of myxomas was as follows: left atrial alone in 42 patients, right atrial alone in three, right ventricular alone in one, left atrial+right atrial in two, left atrial+right atrial+right ventricular in one, and left atrial+left ventricular in one. Nineteen patients were operated on within 48 hours of the diagnosis. All tumours were successfully removed with the aid of cardiopulmonary bypass. The hospital mortality rate was 10%. Excision of the tumour resulted in marked symptomatic improvement. There was one late death. The current survivors are symptom-free at a mean follow-up of 76.4 (range 1-241) months. Echocardiographic studies were performed in all survivors and no recurrences have been observed. It is concluded that excision of cardiac myxomas is curative and long-term survival is excellent. Radical tumour excision may prevent recurrences.

Selective effects of MAO inhibition on peripheral benzodiazepine receptor binding in the mouse.

Monoamine Oxidase (MAO) and the peripheral benzodiazepine binding site (PBR) share a close physical proximity to each other in the outer mitochondrial membrane. Furthermore, MAO activity and the density of PBR sites are affected by stress; benzodiazepines may influence stress-induced changes in MAO activity. In view of the close physical association between MAO and the PBR, we examined the effects of chronic administration of selective and nonselective MAO inhibitors to mice on the specific binding of 3H-Ro5-4864 and 3H-PK-11195 to crude membranes prepared from kidney, heart and liver. Chronic MAO inhibition was associated with alterations in PBR binding in all three tissues; however, in heart and liver changes were not detectable with 3H-PK-11195. Perhaps, the ability to discern changes with 3H-Ro5-4864 that are not detectable with 3H-PK-11195 reflects a functional change in the "activity" of the PBR site in heart and liver that is elicited by chronic MAO inhibition and mediated by a change in the "conformation" of the protein that is detected with 3H-Ro5-4864. Importantly, iproniazid, the nonselective MAO inhibitor, caused changes in PBR binding in all three of the tissues.

Lymphonodal response to sensitization with 2,4-dinitrochlorobenzene (DNCB) in laboratory rats.

White laboratory rats were used for the experiments. Their popliteal lymph nodes were investigated after sensitization with DNCB (2,4-dinitrochlorobenzene) and i.c. injection of 3-H-thymidine and Patent Blue Violet at several intervals following the challenge with the hapten DNCB. Changes of weight of lymph nodes, further uptake of tritiated thymidine by the cells were investigated by auto -radiography, while the content of 3-H-DNA indicating an increased DNA metabolism due to blastic transformation of the small lymphocytes was determined by a liquid scintillation method. The authors found a significantly increased weight of lymph nodes and a higher percentage of labelled cells following antigenic stimulus of i.c. injected DNCB compared to non-sensitized lymph nodes of the control rats.

Surgical removal from the descending aorta of a floating thrombus caused by blunt chest trauma.

A 44-year-old woman presented with a recurrent peripheral embolism. Her past history was remarkable for blunt chest trauma 7 years before presentation. Transoesophageal echocardiography showed a floating mass in the descending aorta. Operative and pathological findings revealed an aged thrombus. Reliable diagnostic methods and appropriate treatment can prevent further embolic events.

[Long-term results of surgical treatment of cardiac myxomas]. / A cardialis myxomák sebészi kezelésének késöi eredményei.

We have reviewed our clinical experience in the diagnosis and management of 50 cases of cardiac myxoma seen over a 20 year period, 1974 to 1994. There were 17 males and 33 females, their ages ranged from 16 to 81 years (mean 55.2 years). Echocardiography confirmed the diagnosis in all patients. The location of myxomas was as follows: left atrial alone in 42 patients, right atrial alone in 3, right ventricular alone in 1, left + right atrial in 2, left + right atrial + right ventricular in 1, and left atrial eft ventricular in 1. Nineteen patients were operated on within 48 hours following the diagnosis. All tumors were successfully removed with the aid of cardiopulmonary bypass. The hospital mortality rate was 10%. Excision of the tumor resulted in marked symptomatic improvement. There was one late death. The current survivors are asymptomatic at a mean follow-up of 76,4 months (range 1-241 months). Echocardiographic studies were performed in all survivors and no recurrences have been observed. We conclude that excision of cardiac myxomas is curative and long-term survival is excellent. Radical tumor excision may prevent recurrence.

Dissection of the atrial wall after mitral valve replacement.

We describe an unusual sequela of mitral valve replacement in a 50-year-old woman who had undergone a closed mitral commissurotomy in 1975. She was admitted to our hospital because of mitral restenosis in November 1993, at which time her mitral valve was replaced with a mechanical prosthesis. On the 8th postoperative day, the patient developed symptoms of heart failure; transesophageal echocardiography revealed dissection and rupture of the left atrial wall. At prompt reoperation, we found an interlayer dissection and rupture of the atrial wall into the left atrium. We repaired the ruptured atrial wall with a prosthetic patch. The postoperative course was uneventful, and postoperative transesophageal echocardiography showed normal prosthetic valve function and no dissection.

Valve repair in infective endocarditis.

From 1985 to 1995, 12 patients with native valve endocarditis underwent valve repair instead of replacement. Mean age was 41.9 years (range from 5 to 79 years). Eight patients had active and 4 patients inactive infection. The mitral valve was involved in 6 patients, the aortic valve in 1, both valves in 2, the tricuspid valve in 2, and the mitral and pulmonary valves in 1. The pathological findings were as follows: leaflet perforation in 2 patients, chordal rupture in 3, and vegetations in 10. Valve sparing procedures were carried out on the mitral valve in 8 patients, on the aortic valve in 1, on the tricuspid valve in 2, and on the pulmonary valve in 1. The following repair techniques were used: vegetectomy in 10 patients, leaflet patching in 2, posterior mitral leaflet resection in 3, mitral annuloplasty in 4, and pulmonary valve repair in 1. Uncontrolled sepsis, progressive heart failure, peripheral embolism, and echocardiographically demonstrated vegetations were the indications for surgery. There was no operative or late mortality and all infections were cured with no recurrences. One patient required valve replacement following aortic valve repair because of progressive aortic regurgitation. Postoperative Doppler echocardiography showed trivial to no regurgitation in 11 patients after valve repair. The overall outcome was favorable during the mean follow-up period of 39.3 months (range from 1 to 120 months). Reparative or reconstructive approaches for native valve endocarditis should be considered and can be successfully performed. Their advantages include (1) improved hemodynamics, (2) no recurrence, (3) no mortality, and (4) favorable long-term results.

MK-801 alters the GABAA receptor complex and potentiates flurazepam's antiseizure efficacy.

MK-801 is an uncompetitive allosteric antagonist that interferes with glutamate-gated calcium ion conductance through the NMDA receptor-associated ionophore. In an outbred strain of mouse, MK-801 elicits episodes of explosive "popping" behaviors that may serve as a preclinical screening paradigm for novel antipsychotic medications. This investigation examined the effects of MK-801, at doses associated with the elicitation of popping, on the GABAA receptor complex in cerebral cortex, and flurazepam's ability to antagonize electrically precipitated seizures. Twenty four hours after MK-801 administration, there was an increased density of the radiolabeled antagonist-preferring conformation of the central benzodiazepine binding site and a potentiation of flurazepam's antiseizure efficacy. The data show that interference with NMDA receptor-mediated calcium ion conductance is associated with a relatively selective change in the GABAA receptor complex in cerebral cortex, and has functional behavioral consequences. Moreover, the data provide additional evidence for a delicate balance between GABAergic and glutamatergic transmission. Disturbance of this balance can have behavioral consequences for the animal.

Safety and immunogenicity of Haemophilus influenzae type B-Neisseria meningitidis group B outer membrane protein complex conjugate vaccine mixed in the syringe with diphtheria-tetanus-pertussis vaccine in young Gambian infants.

To ensure compliance and to reduce costs it is important, especially in less developed countries, that programs of child immunization should require as few clinic attendances and as few injections as possible. Therefore we have investigated whether a Haemophilus influenzae type b conjugate vaccine could be given safely and effectively with diphtheria-tetanus-pertussis vaccine (DTP). One hundred twenty-six Gambian infants were given both polyribosylribitol phosphate (PRP)-outer membrane protein complex (PedvaxHIB) and DTP on the same day at 8, 12 and 16 weeks of age; 60 were given the vaccines mixed in the syringe and 66 were given the vaccines separately. To minimize the injection volume the dose of PRP-OMPC used in both groups was 7.5 micrograms, which is half the usual dose. There were no significant differences in anti-PRP antibody titers between the groups after 1, 2 or 3 doses. The geometric mean titers of antibody for the two groups combined were 0.29 micrograms/ml 1 month after the first dose, 1.03 micrograms/ml after the second dose and 1.11 micrograms/ml after the third dose. Concentrations of antibodies to diphtheria, tetanus and pertussis 1 month after the third dose were not significantly different between the two groups. Systemic side effects were reported with equal frequency in the two groups and were similar to those reported elsewhere for DTP. Tenderness at the injection site was more common where the combined injection (0.75 ml) had been given than where DTP alone (0.5 ml) had been given. The main drawback to the use of these 2 vaccines together is the complexity of the mixing procedure used in this clinical trial.

[Surgical management of left cor triatriatum in adults]. / A cor triatriatum sinistrum sebészi kezelése felnöttkorban.

Cor triatriatum sinistrum is a rare congenital cardiac anomaly in which a membrane divides the left atrium. Severity of the disease depends on the size of the opening on the membrane. The anomaly presents with severe pulmonary hypertension and prognosis is unfavourable without surgery. From 1976 through 1992, 5 adult patients were treated surgically in our institution. Cor triatriatum can be corrected surgically with a low mortality and excellent late results if an early preoperative diagnosis has been made. Clinical findings and cardiac catheterization do not provide sufficient data for the correct diagnosis. From a review of our experience it is concluded that echocardiography is superior to angiography for diagnosing cor triatriatum.