Risk of donor-site lymphatic vessel dysfunction after microvascular lymph node transfer.

BACKGROUND: Microvascular lymph node transfer has been used to improve lymphatic function in patients with lymphoedema. We previously reported changes in the lymphatic function of the donor limb after lymph node transfer. For this reason, we modified our surgical method to be more conservative. SUBJECTS AND METHODS: Microvascular lymph node transfer was performed in 13 patients using the previously reported original method. Sixteen patients were operated upon using the more conservative modified method. Lymphatic function in the donor limb was evaluated using volumetry, lymphoscintigraphy and tissue water percentage. RESULTS: In the original method group, the donor-limb volume was on average greater (199 ± 540 ml) than in the non-operated control limb. The volume difference between the limbs was smaller (151 ± 463 ml) in the modified method group. Two patients in the original method group had abnormal transport index (Ti) values in lymphoscintigraphy indicating decreased lymphatic function of the donor limb. In the modified method group, the Ti-values remained normal. The tissue water percentage of the donor limb was on average 40% ± 4% in the original method group and 40% ± 3% in the modified method group. Importantly, none of the patients in either group developed clinical lymphoedema in the donor limb during the 11-84-month follow-up. CONCLUSIONS: Even with the more conservative lymph node transfer method, we can observe slight, subclinical signs of lymphatic dysfunction in the donor limb. These results highlight the importance of minimizing the surgical exploration in the inguinal area and avoiding damage to the lymphatic vessels or sentinel nodes draining the lower limb.

Localised changes in glaucomatous visual fields after trabeculectomy.

BACKGROUND AND OBJECTIVE: Modern techniques of automated perimetry have shown that surgical reduction of intraocular pressure (IOP) may have a beneficial effect on the glaucomatous visual field. The purpose of the present study was to analyse and quantify the changes in the visual fields of glaucoma patients after trabeculectomy. MATERIALS AND METHODS: Octopus visual fields of twenty-seven glaucoma patients were analysed. Change in visual field mean sensitivity (MS) was calculated to detect total field changes. A clinical and a statistical analysis of small clusters of test points were used to define whether local changes had occurred. RESULTS: MS in the operated eyes improved significantly from 16.4+/-5.6 to 18.2+/-5.5 dB. The patients had on average 3.9+/-6.2 clusters where the retinal sensitivity had improved at least 5 dB and only 0.4+/-0.9 clusters where sensitivity had deteriorated at least 5 dB after trabeculectomy. 17 patients had more improved than deteriorated clusters postoperatively. CONCLUSION: Statistically significant improvement was seen in the MS, but improvement was also found in small local areas of the visual fields after trabeculectomy.

"Scleral tunnel incision"-trabeculectomy with one releasable suture.

PURPOSE: To describe a modified surgical technique, a scleral tunnel incision- trabeculectomy (STIT) and evaluate its safety and efficacy in lowering IOP in glaucoma patients. METHODS: One hundred and three patients were included in a retrospective, nonrandomized clinical study. Fifty-three patients were operated conventionally and 40 patients underwent STIT. In the modified technique the sides of the scleral flap are opened only half-way to the limbus and the flap is closed with a single releasable "slipknot"-suture. RESULTS: The mean IOP on the first postoperative day was 4.5 +/- 6.8 mmHg in the conventional group and 7.4 +/- 7.1 mmHg in the tunnel incision group (p = 0.012). On the second postoperative day the mean IOP was 4.5 +/- 7.3 mmHg and 6.3 +/- 6.5 mmHg in the conventional group and tunnel incision group, respectively (p = 0.065). There was no statistically significant difference in the mean postoperative IOP between the groups at one month and at 6-12 months. Shallow anterior chamber and iridocorneal touch occurred statistically significantly less in the tunnel incision group than in the conventional group. CONCLUSION: STIT appears to be equivalent to conventional trabeculectomy (CT) in lowering IOP during the first 6-12 months postoperatively. It is also relatively safe and has fewer early complications related to excessive aqueous outflow than CT.

Enhanced invasion and tumor growth of fibroblast growth factor 8b-overexpressing MCF-7 human breast cancer cells.

Fibroblast growth factor 8 (FGF-8) is a secreted heparin-binding protein, which has mitogenic and transforming activity. Increased expression of FGF-8 has been found in human breast cancer, and it has a potential autocrine role in its progression. Human FGF-8 is alternatively spliced to generate four protein isoforms (a, b, e, and f). Isoform b has been shown to be the most transforming. In this work, we studied the role of FGF-8b in the growth (in vitro and in vivo) of MCF-7 human breast cancer cells, which proliferate in an estrogen-dependent manner. Constitutive overexpression of FGF-8b in MCF-7 cells down-regulated FGF-8b-binding receptors FGF receptor (FGFR) 1IIIc, FGFR2IIIc, and FGFR4 found to be expressed in these cells. FGF-8b overexpression led to an increase in the anchorage-independent proliferation rate in suspension culture and colony formation in soft agar, when MCF-7 cells were cultured with or without estradiol. FGF-8b also provided an additional growth advantage for cells stimulated with estradiol. In addition, FGF-8b-transfected cells invaded more actively through Matrigel than did control cells. This was possibly due to the increased secretion of matrix metalloproteinase 9. In vivo, FGF-8b-transfected MCF-7 cells formed faster growing tumors than vector-only-transfected cells when xenografted into nude mice. The tumors formed by FGF-8b-transfected cells were more vascular than the tumors formed by vector-only-transfected cells. In conclusion, FGF-8b expression confers a growth advantage to MCF-7 breast carcinoma cells, both in vitro and in vivo. In addition to stimulation of proliferation, this growth advantage probably arises from increased invasion and tumor vascularization induced by FGF-8b. The results suggest that FGF-8b signaling may be an important factor in the regulation of tumorigenesis and progression of human breast cancer.

Aneuploidy in sperm and exposure to fungicides and lifestyle factors. ASCLEPIOS. A European Concerted Action on Occupational Hazards to Male Reproductive Capability.

Fungicides include chemicals that are known aneugens. The purpose of the present study was to investigate whether occupational exposure to these and other agricultural pesticides induces aneuploidy in human sperm. The contribution of lifestyle factors (smoking and alcohol consumption) to the frequency of aneuploid sperm was evaluated as well. The effects of age and sperm concentration were analyzed as confounders. Spermatozoa from 30 healthy farmers were studied before and after exposure to fungicides, using fluorescence in situ hybridization (FISH). Ten thousand spermatozoa were scored per semen sample to determine the disomy and diploidy frequencies for chromosomes 1 and 7. Exposure to fungicides was not associated with sperm aneuploidy. Smoking was significantly associated with sperm carrying an extra chromosome 1 and with diploid sperm as well as with the aggregate frequency of aneuploid sperm. Alcohol consumption, sperm concentration, and age showed inconsistent results before and after the season of exposure to fungicides. For low-level exposures, such as occupational exposures, the sensitivity of the sperm-FISH method may not be sufficient. The present study supports earlier ones showing that smoking can increase aneuploidy in human sperm.