TGF-ß1 expression in chromophobe renal cell carcinoma and renal oncocytoma.

Distinguishing renal oncocytoma (RO) from the eosinophilic variant of chromophobe renal cell carcinoma (ChRCC) under the light microscope is a common diagnostic problem. Our recent research has shown significant difference between the presence of tumor fibrous capsule in ChRCCs and ROs. Transforming growth factor beta 1 (TGF-ß1) is a potent cytokine involved in regulating a number of cellular processes. Two main purposes of this research were to investigate whether the TGF-ß1 staining could be related to the presence of tumor fibrous capsule and if it could be used in the differential diagnosis between ChRCC and RO. We investigated 34 cases: 16 ChRCCs (8 eosinophilic and 8 classic) and 18 ROs. All available slides of each tumor, routinely stained with hematoxylin and eosin (H&E) were first analyzed to note the presence of tumor fibrous capsule. One paraffin embedded tissue block matching the representative H&E slide was selected for the immunohistochemical analysis. TGF-ß1 expression was analyzed semiquantitatively in the tumor tissue, the tumor fibrous capsule, if present and the peritumoral renal parenchyma. Intensity of TGF-ß1 expression was weaker in ChRCCs than the one observed in ROs (P<0.05). The type of reaction in ChRCCs was predominantly membranous unlike in ROs, which exhibited a predominantly cytoplasmic reaction (P<0.05). Moreover, none of the ROs showed membranous type of reaction for TGF-ß1. In the group of ChRCCs, tumors with capsule had statistically significant higher quantity of TGF-ß1 expression in tumor tissue and in peritumoral renal parenchyma compared to the tumors without capsule (P<0.05). Our results showed different types of TGF-ß1 expression in ChRCCs and ROs: ChRCCs had predominantly membranous type of reaction, and ROs predominantly cytoplasmic. Furthermore, ChRCCs with capsule had statistically significant higher quantity of TGF-ß1 expression in tumor tissue and in peritumoral renal parenchyma compared to the tumors without capsule. Based on these findings we can speculate that it could be possible that TGF-ß1 plays a role in the formation of fibrous capsule in ChRCCs.

MAGE-A3/4 and NY-ESO-1 antigens expression in metastatic esophageal squamous cell carcinoma.

In the present study we analyzed immunohistochemical expression of MAGE-A 3/4 and NY-ESO-1 in 55 samples of esophageal squamous cell carcinomas (ESCC) and their respective lymph node metastases. To our knowledge this is the first study to assess and compare the expression of these antigens in ESCC lymph node metastases. Fifty (90.9%) primary ESCC were positive for MAGE-A 3/4 and 53 (96.6%) were positive for NY-ESO-1. MAGE-A 3/4 was expressed in all lymph node metastases and the intensity of expression was high in a majority of cases. NY-ESO-1 was negative in 2 (7.1%) lymph nodes metastases, while the reaction was predominantly moderate in the positive group. In primary tumors MAGE-A 3/4 showed a significantly higher intensity of expression compared to NY-ESO-1 (P=0.047), while in lymph node metastases the intensity of expression was not significantly different (P=0.387). Primary tumors with and without lymph node metastases showed no significant differences in MAGE-A 3/4 (P=0.672) and NY-ESO-1 (P=0.444) expression. Intensity of MAGE-A 3/4 (P=0.461) and NY-ESO-1 (P=0.414) expression in primary tumors was not significantly different compared to the expression in their respective lymph nodes metastases. Expression of MAGE-A 3/4 in primary tumors showed significant positive correlation with primary tumor expression of NY-ESO-1 (P=0.021) but no significant correlation with the expression of MAGE-A 3/4 in lymph node metastases (P=0.056). Expression of NY-ESO-1 in primary tumors showed significant positive correlation with the expression of NY-ESO-1 in lymph node metastases (P=0.001) and significant negative correlation with patients’ age (P<0.001). Expression of MAGE-A 3/4 and NY-ESO-1 in primary tumors and lymph node metastases showed no significant correlation with prognostic parameters such as tumor grade and TNM stage (P>0.05). We have shown different levels of MAGE-A 3/4 and NY-ESO-1 expression in almost all specimens of primary tumor and lymph node metastases, suggesting that ESCC may be possible target of immunotherapy and anti-tumor vaccination. High levels of expression in lymph node metastases indicate possible clinical benefit of postoperative vaccine with MAGE-A3 and NY-ESO-1 in advanced stage of disease.

Multiple injuries in peacetime and wartime estimate of severity of injury by the Injury Severity Score and Polytraumaschlüssel.

OBJECTIVE: To compare the Injury Severity Score (ISS) and Polytraumaschlüssel (PTS) in patients with multiple peacetime and wartime injuries. DESIGN: Prospective and retrospective study. SETTING: General hospital, Croatia. SUBJECTS: 71 patients with multiple injuries admitted between 1 January 1993 and 30 September 1994; 41 had peacetime (road traffic accident) injuries and 30 had been injured in battle. INTERVENTIONS: ISS and PTS scores. MAIN OUTCOME MEASURE: Correlation of scores with morbidity and mortality. RESULTS: All patients with wartime injuries were men, compared with 30/41 (73%) of those with peacetime injuries (p < 0.0001). Those with wartime injuries were slightly but not significant younger (mean 35 years, range 17-69, compared with 44 years, range 17-87). Mortality was higher among those with peacetime injuries, but not significantly so (11/41 compared with 5/30, p=0.39). The two scores correlated well for all injuries (r=0.76), and peacetime (r=0.71) and wartime injuries (r=0.84) separately (all correlations p < 0.0001). In both groups, patients who subsequently died scored significantly higher with both scores (p < 0.001). CONCLUSIONS: The two scores were equally good at describing the severity of injury, and the likelihood of subsequent death, however the injuries were caused.

A scoring system for early differentiation of the etiology of acute pancreatitis.

BACKGROUND: The purpose of this study was to find a new scoring system for early differentiation between the two commonest etiologies of acute pancreatitis (biliary and alcoholic), because biliary pancreatitis can be treated early by endoscopic sphincterotomy, whereas such treatment is unnecessary in alcoholics. METHODS: One hundred and forty-five patients satisfied the requirements for participation in the study and were divided into groups A (alcoholic pancreatitis) and B (biliary pancreatitis). Seven variables (serum and urine amylase, aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), alkaline phosphatase (ALP), lipase/amylase (L/A) ratio, and erythrocyte mean corpuscular volume (MCV)) that differed in a statistically significant manner between patients of the two groups were included in the scoring system. Each parameter was counted as 0 or 1 on the basis of its values, so the patients reached scores from 0 to 7. RESULTS: Scores > or =4 (P < 0.0001) were consistently present in biliary pancreatitis, whereas alcoholics scored <4, with a sensitivity of 92.04% and a specificity of 93.75%. CONCLUSIONS: Our new scoring system could be important in the early diagnosis of the etiology of acute pancreatitis in a manner that is non-invasive, easy to calculate, inexpensive, and readily available.

Methods and results of the treatment of peacetime and wartime multiple injuries--a comparative study.

Seventy-one patients suffering from multiple injuries were divided into two groups, according to the manner in which the injuries were inflicted. Forty-one were injured in 'peacetime' circumstances (road traffic accidents, 85.4 per cent), and 30 patients were injured during 'military' shelling or in combat. Since there is no generally accepted severity scoring of wartime multiple injuries, this paper has offered one. A 'peacetime' scoring system was used to compare the hospital mortality in the two groups. The severity of injuries in both groups was estimated by using the Injury Severity Score. There was no statistically significant difference between the two groups with regard to injury severity, age, hospital mortality rate, received infusion, or the number of specialists involved in treatment. The differences between the two groups were significant in the application of transfusion and antibiotics, number of operations performed, and the time span between injury and operation.

Cessation of long-term nicotine gum use--a prospective, randomized trial.

Nicotine gum is an important adjunct for smoking cessation for many smokers, and long-term use of nicotine gum will occur in a small percentage of patients. To date, no method of cessation in long-term users has been studied in a randomized trial. We enrolled 26 subjects at the Mayo Clinic site of the Lung Health Study who had used nicotine gum for more than 6 months to participate in a trial where subjects were randomly assigned to: (1) abrupt cessation, (2) taper with placebo gum, or (3) taper with active gum. At the end of the 6-week trial, the percentage of subjects abstinent from gum use and not smoking was not different among the three groups: 66.7% for the abrupt cessation group, 71.4% for the taper with placebo gum group and 60% for the taper with active gum group. One subject in the taper with placebo gum group relapsed to smoking during the trial but was abstinent from smoking again at long-term follow-up. Long-term follow-up (median 284 days) showed 65% of subjects were abstinent from all nicotine products. Motivated subjects can stop long-term nicotine gum use without relapse to gum use or smoking by either abrupt cessation or brief tapering.

Predicting smoking cessation outcome in a medical center from stage of readiness: contemplation versus action.

BACKGROUND: This study shows the clinical utility of Prochaska and DiClemente's stages of readiness for treating nicotine dependence in a medical center. METHODS: Six hundred forty-eight patients were retrospectively studied in either the contemplation or the action stage of readiness. RESULTS: Statistical analysis showed the action stage to be the most significant predictor of smoking cessation at 6 months. Individuals in the action stage had twice the 6-month cessation rate as those in the contemplation stage (41.5% versus 20.3%, P < 0.001). Other significant predictors of smoking cessation included a low Fagerström Tolerance Questionnaire score (< or = 6) and the patient's report of a current disease but no past history of disease worsened by smoking. CONCLUSIONS: This study shows the potential clinical application of this theoretical model for providing treatment for smokers.

Nicotine patch therapy for smoking cessation combined with physician advice and nurse follow-up. One-year outcome and percentage of nicotine replacement.

OBJECTIVE: To determine the efficacy of a 22-mg nicotine patch combined with the National Cancer Institute program for physician advice and nurse follow-up in providing withdrawal symptom relief, 1-year smoking cessation outcome, and percentage of nicotine replacement. DESIGN: Randomized, double-blind, placebo-controlled trial. SUBJECTS: Two-hundred forty healthy volunteers who were smoking at least 20 cigarettes per day. INTERVENTIONS: Based on the National Cancer Institute program, subjects received smoking cessation advice from a physician. Follow-up and relapse prevention were provided by a study nurse during individual counseling sessions. Subjects were randomly assigned to 8 weeks of a 22-mg nicotine or placebo patch. MAIN OUTCOME MEASURES: Abstinence from smoking was verified by expired air carbon monoxide levels. Withdrawal symptoms were recorded during patch therapy, and the percentage of nicotine replacement was calculated by dividing serum nicotine and cotinine levels at week 8 of patch therapy by levels obtained while smoking. RESULTS: Higher smoking cessation rates were observed in the active nicotine patch group at 8 weeks (46.7% vs 20%) (P < .001) and at 1 year (27.5% vs 14.2%) (P = .011). Higher smoking cessation rates were also observed in subjects assigned to the active patch who had lower serum levels of nicotine and cotinine at baseline, and withdrawal symptom relief was better in the active patch group compared with placebo. CONCLUSIONS: Clinically significant smoking cessation can be achieved using nicotine patch therapy combined with physician intervention, nurse counseling, follow-up, and relapse prevention. Smokers with lower baseline nicotine and cotinine levels had better cessation rates, which provides indirect evidence that they had more adequate nicotine replacement with this fixed dose of transdermal nicotine than those smokers with higher baseline levels.

[Mioconverter]. / Miokonverter.

Mioconverter is a new appliance created by author used in the treatment of open bite. It is consisted of two free plates connected by added joint (similar to connection in the TMJ) Plates have lateral bite blocks, anchorage elements in the frontal region and a joint at the back. Joints are originally created by the author as an imitation of TMJ and mandibular ramus. The appliance converts muscle strength in the way of extruding frontal teeth, intruding molars, and rotating the upper and lower jaw. Finally, mioconverter reduces vertical skeletal discrepancy. The leaning plate is under the occlusal level. Therefore, mioconverter utilizes all types of forces used in the lower jaw movements. Results of treatment of a case with an open bite are illustrated.