Clinical value of serum hepatocyte growth factor, B-cell lymphoma-2 and nitric oxide in primary breast cancer patients.

OBJECTIVES: The present study was undertaken to determine the clinical significance of serum levels of HGF, Bcl-2 and NO in the diagnosis and prognosis of breast cancer patients. PATIENTS AND METHODS: Forty four primary invasive breast cancer patients and fifteen health control subjects were enrolled in the present study. Serum HGF, Bcl-2 and No levels were assayed and correlated with clinico pathological parameters. ROS curve analysis was also done for each biochemical marker. RESULTS: The mean level of HGF was 1198.79 +/- 76.32 pg/ml versus 884.67 +/- 66.88 pg/ml for the control (p = 0.026). The HGF levels were significantly elevated in the patients with increasing the tumor stage (p = 0.036). In addition, HGF levels were markedly increased in negative estrogen receptor patients (p = 0.039). The mean level of Bcl-2 in patients was 12.83 +/- 1.97 ng/ml versus 5.09 +/- 0.40 ng/ml in control (p = 0.027). Levels of Bcl-2 were elevated but not statistically significant in patients with grade I (GI) tumors, negative nodes, ER negative tumors and postmenopausal patients (p = 0.4, 0.8, 0.7 and 0.5, respectively). The patients mean serum levels of NO were 63.07 +/- 4.14 micromol/L versus 43.99 +/- 4.21 micromol/L in control (p = 0.014). The levels of NO were elevated but also not statistically significant in patients with tumor size I, GI tumors, ER negative tumors, positive nodes, stage II tumors and postmenopausal patients (p = 0.3, 0.6, 0.3, 0.7, 0.3 and 0.2 respectively). From the ROC curve analysis, it was observed that the area under curve for HGF, Bcl-2 and NO was 0.695, 0.842 and 0.711, respectively. This result indicates the good validity of the above biomarkers especially Bcl-2 to discriminate the ER positive from the negative tumors in primary breast cancer patients. CONCLUSION: This study demonstrates that the serum levels of HGF, Bcl-2 or NO may help in the diagnosis of breast cancer patients and may aid in disease prognosis. However, larger study with more patients are required.

Postoperative granuloma after stapedectomy: is it destiny or avoidable?

OBJECTIVE: The aims of this study were (1) to investigate the pathophysiological characteristics of the middle ear mucoperiosteum against the caustic nature of the gastric content (GC), which consists largely of acid and pepsin components, and (2) to investigate the possible role of gastroesophageal reflux and postoperative vomiting (POV) in the etiology of poststapedectomy granuloma. METHODS: 40 Spraque-Dawley rats of either sex and with a body weight of 200-300 g were used, and divided into different study groups: group 1: GC administration to the middle ear (n = 8); group 2: phosphate-buffered saline administration to the middle ear (n = 8); group 3: GC (pH: 2) administration in the presence of a Teflon piston (TP) (n = 6); group 4: phosphate-buffered saline administration in the presence of a TP (n = 6); group 5: GC administration in the presence of a wired piston (WP) (n = 6); group 6: phosphate- buffered saline administration in the presence of a WP (n = 6). GC was administrated to the middle ear cavities by way of the eustachian tube (ET). In order to overcome the pressure of the ET, a pump mechanism was used. The increased nasopharyngeal pressure caused a passive opening of the ET, and transferred a bolus to the middle ear. The animals were decapitated after 1 week, and the bullae were isolated. The tympanic bullae were serially cut and examined with light microscopy. RESULTS: In the saline controls, there was only a mild amount of polymorphonuclear cell (PMN) infiltration in the mildly thickened subepithelial space, indicating a less pronounced inflammation as compared to the gastric acid group. In the GC group, in addition to focal hemorrhage and severe subepithelial infiltration of PMNs, the middle ear mucosa was dramatically thickened with subepithelial edema and dilated capillaries. In the subepithelial tissue, retention cysts and granulation tissue were present. In the piston groups (TP and WP), there was extensive subepithelial inflammation and edema after GC and saline administrations. Granulation tissue filling the entire bulla around the piston segments was detected. CONCLUSION: The relationship between the administration of GC and middle ear inflammation, and the possible role of POV in the etiology of poststapedectomy granuloma are emphasized with our experimental study. The length of the TP may be considerably important to prevent POV which may lead to gastric reflux to the middle ear.