Gastric cancer: biology and clinical manifestations in Israel.

BACKGROUND: Gastric cancer (GC) in Israel remains incompletely characterized. The aim of this study was to define the clinical and pathological characteristics of GC in Israel and to compare them to the general Western population. PATIENTS AND METHODS: This is a retrospective analysis of 461 consecutive GC patients treated at a single institution between 1995 and 2007. Epidemiological and clinical-pathological data were retrieved from the patients' medical files and the institutional electronic database and analyzed using standard statistical methods. RESULTS: Epidemiology, clinical manifestations, histopathological findings, clinical course, and prognostic factors for disease outcome were all similar to those reported in the Western literature. Findings unique to the Israeli population included: (1) rarity of GC-associated risk factors; (2) increased GC incidence in Ashkenazi Jews; (3) high incidence of second primary malignancy and family history of cancer; and (4) no dominancy of proximal GCs. CONCLUSION: There do not appear to be any major differences in the biology or clinical manifestations of GC in Israel. Western recommendations for diagnosis and treatment of GC may therefore be applied to the Israeli patient population.

Metabolic syndrome in liver transplant recipients: prevalence, risk factors, and association with cardiovascular events.

Features of metabolic syndrome are not uncommon in patients after liver transplantation. To examine the prevalence and risk factors of posttransplantation metabolic syndrome (PTMS), the files of 252 transplant recipients (mean age, 54.5 ± 2.8 years, 57.9% male) were reviewed for pretransplant and posttransplant clinical and laboratory parameters (mean follow-up, 6.2 ± 4.4 years). Rates of obesity (body mass index >30 kg/m(2) ), hypertriglyceridemia (>150 mg/dL), high-density lipoprotein cholesterol <40 mg/dL (men) or <50 mg/dL (women), hypertension, and diabetes were significantly higher after transplantation than before. Metabolic syndrome was diagnosed in 5.4% of patients before transplantation and 51.9% after. Besides significantly higher rates of the typical metabolic derangements (P < 0.0001), the patients with PTMS were older and heavier than those without PTMS, and they had a higher rate of pretransplant hepatitis C virus infection (P < 0.03) and more posttransplant major vascular and cardiac events (20 events in 15.2% of patients with PTMS versus 6 events in 4.9% of patients without PTMS; P < 0.007). There was no between-group difference in mortality or causes of death (mainly related to recurrent disease, graft failure, and sepsis). Significant independent predictors of PTMS on logistic regression analysis were age (odds ratio [OR] = 1.04), pretransplant nonalcoholic fatty liver disease (OR = 3.4), body mass index (OR = 1.13), diabetes (OR = 5.95), and triglycerides (OR = 1.01). The rate of metabolic syndrome in liver transplant recipients is more than twice that reported for the general population. PTMS is associated with cardiovascular morbidity but not mortality, and it may be predicted by pretransplantation conditions. Prospective studies are required to determine the significance and management of PTMS.

Birth month and longevity - monthly birth distribution in acute coronary events provoked by atherothrombosis in patients treated with percutaneous coronary intervention (PCI).

BACKGROUND: Human homeostasis is time related. Environmental physical factors also play a role. Recent studies published by the National Academy of Sciences (USA) describe human longevity links with the month of birth. The aim of this study was to check monthly birth distribution in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) related to atherothrombosis - one of the main causes of morbidity and mortality in the industrial world. METHODS: A total of 4732 (3594 men) subjects were included in the study. Patients treated with PCI for AMI in the years 2000 to March 2010 were studied. The population registry specific to 1950 excluded 1024 patients, i.e., those registered as born on January 1 and they were replaced with patients with an average of births from January 2 to 31. A total of 3675 patients were finally studied (2839 men, 836 women). RESULTS: The average monthly birth number was 306±60.38. Significant monthly differences in birth number (q2=21.077, p<0.03) were observed. A higher birth rate in the first four months of the year was revealed, with the exception of February. The number of births in these months exceeded the following two four-month data (q2=20.57, p<0.024). March births exceeded the monthly average by more than two standard deviations (SD) - 462, with an analogical increase for both genders. In May-December births were below average. CONCLUSIONS: Patients with AMI treated with PCI show differences in the month of birth with the majority being born in the first four months of the year and of those most were born in March. Possible implications on pathogenetic clues of atherothrombosis can be assumed.

Women gynecologists' attitude toward their own health.

BACKGROUND: Following the publication of the results of Women's Health Initiative in 2002 there have been gross changes in the attitude of women and physicians towards the risks and benefits of hormone replacement therapy (HRT). We evaluated the attitude of women gynecologist towards their own health, including adherence to recommended screening tests and self usage and prescription of hormone replacement therapy. MATERIAL/METHODS: Questionnaires regarding performance of screening tests, self usage and recommendation of HRT were posted by mail to all Israel's women gynecologists. RESULTS: Ninety questionnaires were eligible for analysis (43.2% response rate). Average age was 48+/-7.7 years. Only 7/90 (7.8%) gynecologists smoke regularly and average body mass index was 25+/-3.8 kg/m2. Most participants performed at least one screening tests in the past 2 years. The median interval from the last self breast exam, mammography, gynecologisy exam, Papanicolaou test, colonoscopy and bone density test was 0.2, 1.82, 1.79, 1.95, 3.27 and 1.41 years, respectively. Most of them (68.3%) did not routinely recommend HRT to their patients. The duration of self HRT usage ranged between 1-20 years (average 5.1+/-3.4 years). Most gynecologists (87.7%) recommended continuous estrogen and progesterone for women with their uterus in place. CONCLUSIONS: The health profile of Israeli women gynecologists is chracterized by a high performance of screening tests for cancer and low rate of smoking. Our study also demonstrates that the impact of the results of the WHI trial is still well manifested and most Israeli women gynecologists do not routinely recommend HRT to postmenopausal women.

Different patterns of expression of the erbB family of receptor tyrosine kinases in common nevi, dysplastic nevi, and primary malignant melanomas: an immunohistochemical study.

erbB receptors contribute to tumor formation and progression. Variable expression of erbB1, erbB2, and erbB3 has been reported in nevi and melanomas; erbB4 has hardly been investigated. We examined the expression of all 4 erbB receptors in common and dysplastic nevi and melanomas. Formalin-fixed, paraffin-embedded tissues of 100 melanomas, 27 common nevi, and 23 dysplastic nevi were immunostained with antibodies against the 4 erbB receptors. erbB3 and erbB4 showed stronger positivity in nevi than in melanomas, and in common than in dysplastic nevi. Staining pattern was more orderly in nevi than in melanomas. Common nevi showed more prominent membranous staining for erbB3 than dysplastic nevi followed by melanomas. In melanomas, greater thickness was associated with more widespread erbB2 and erbB3 staining in the vertical than in the radial growth phase, and in the dermal than in the epidermal component. Higher mitotic counts were associated with more widespread and intense erbB2 expression in the vertical growth phase than in the radial growth phase and in the dermal than in the epidermal component. Melanomas with more widespread erbB2 staining had heavier lymphocytic infiltrates. erbB1 expression was negligible in all groups. erbB2, erbB3, and erbB4 are expressed in all subtypes of melanocytic lesions, but with quantitative and qualitative differences. Receptor expression seems to decrease and to become less mature and orderly with tumor progression. The complex patterns of erbB receptor expression in melanocytic lesions warrant further investigation.

Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients.

PURPOSE: This study describes and reports the results of a new, minimally-invasive surgical technique for pilonidal disease. METHODS: From March 1993 to January 2003, 1,358 patients (out of a total of 1,435 patients) with symptomatic pilonidal disease underwent treatment in a military surgical clinic dedicated for pilonidal disease. Patients were operated on under local anesthesia, utilizing trephines to excise pilonidal pits and to débride underlying cavities and tracts. RESULTS: One thousand three hundred fifty-eight symptomatic patients participated in the study and were mostly male (84.3 percent) and the mean age 20.9 +/- 3.6 years. Rates of postoperative infection, secondary bleeding, and early failure were 1.5, 0.2, and 4.4 percent, respectively. In patients with full postoperative clinical attendance, complete healing was observed within 3.4 +/- 1.9 weeks. Phone interview included 1,165 patients (85.8 percent) with a mean follow-up interval of 6.9 +/- 1.8 years. Recurrence rates after 1 year was 6.5 percent, 5 years was 13.2 percent, and 10 years was 16.2 percent. Mean time to recurrence was 2.7 +/- 2.6 years postoperatively. The disease-free probability estimate was 93.5 percent at one year and 86.5 percent at 5 years. CONCLUSIONS: Compared with frequently used pilonidal operations, the trephine technique is associated with a lower recurrence rate and a low postoperative morbidity rate.

Correlation of vascular endothelial growth factor with the severity of thalassemia intermedia.

Several lines of evidence indicate that thalassemia intermedia is associated with disturbances in vascular endothelial cell proliferation. In addition, autopsy studies of thalassemia intermedia reported obstructive lesions in the pulmonary artery in 44% of cases, especially splenectomized patients, and a recent in-vivo study reported increased level of vascular endothelial growth factor (VEGF) in thalassemia intermedia. The aim of the present study was to determine whether VEGF levels are correlated with the severity of the disease. Blood samples were collected from 21 patients with thalassemia intermedia and assayed for VEGF by a two-site enzyme-linked immunosorbent assay. A significant correlation was noted between VEGF levels and patient age (P = 0.0022, r = 0.82), presence of splenomegaly (P = 0.004, r = 0.79) and hepatomegaly (P = 0.023, r = 0.82). VEGF levels were also significantly correlated with both left ventricular end-diastolic diameter and left ventricular end-systolic diameter (P = 0.02, r = 0.84 and P = 0.01, r = 0.86, respectively). The study indicates that VEGF levels may be related to the clinical severity of thalassemia intermedia, as expressed by the degree of hepatomegaly and splenectomy and cardiac indexes. Further and larger studies are needed to confirm these observations.

Cyclooxygenase-2 expression in dermatofibroma and dermatofibrosarcoma protuberans.

BACKGROUND: Dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP) occasionally resemble each other histologically but differ in histogenesis and biological behavior. This study sought to determine if these lesions can be differentiated by the quantity or quality of expression of cyclooxygenase-2 (COX-2), an enzyme associated with both reactive and neoplastic processes. PATIENTS AND METHODS: Formalin-fixed and paraffin-embedded samples from 20 DFs and 20 DFSPs were stained immunohistochemically with antibodies directed against COX-2. Staining was evaluated semiquantitatively for percentage and intensity using a three-tiered system. DFs were graded and analyzed by cellularity. Findings within the tumors were compared with fibrocyte staining in adjacent tissue. The results were analyzed. RESULTS: Nineteen DFs (95%) and 15 DFSPs (75%) were immunopositive for COX-2; this difference was not statistically significant. Highly cellular DFs showed more widespread (p = 0.0039; r = 0.614) and more intense (p = 0.0586; r = 0.429) staining than less cellular DFs and more prominent staining in adjacent fibroblasts (p = 0.044; r = 0.608). CONCLUSIONS: COX-2 immunostaining does not distinguish DFs from DFSPs. However, the enzyme is expressed more widely and more intensely in more cellular, possibly younger, DFs. The prominent expression of COX-2 in DFSP may have clinical implications for treatment with COX-2 inhibitors in tumors that are not amenable to surgery.

Predicting outcome of malignant external otitis.

OBJECTIVE: Malignant external otitis (MEO) continues to pose a diagnostic and therapeutic challenge. The lack of a diagnostic study since 1987 combined with recent findings of quinolone-resistant MEO prompted the present analysis of MEO outcome in a major tertiary medical center. METHODS: Seventy-five consecutive patients hospitalized for suspected MEO between 1990 and 2003 were divided into 2 diagnostic groups: MEO Type 1, presence of all obligatory clinical and radiologic criteria and most of the occasional criteria of Cohen and Friedman or absence of 1 obligatory criterion with failure of intensive treatment, and MEO Type 2, absence of one of the obligatory criteria with treatment response within 1 week. The groups were compared for demographic data, underlying diseases, ear parameters, culture findings, length of hospitalization, and treatment before hospitalization, obtained from the charts. RESULTS: Both types of MEO affected mostly diabetic patients and were characterized by granulations and discharge in the external ear, severe prolonged pain, soft tissue involvement and bone destruction on computed tomographic scan, and growth of Pseudomonas aeruginosa in culture. However, Type 1 MEO was associated with a significantly older patient age at presentation, higher rate of oral antidiabetic treatment, history of diabetic (vascular) complications, computed tomographic findings of nasopharyngeal involvement (soft tissue swelling, soft tissue asymmetry, or abscess formation), bone destruction, and temporomandibular joint involvement-all of which led to significantly longer treatment and shorter survival. CONCLUSION: The worse prognosis of Type 1 MEO compared with Type 2 should alert clinicians to establish earlier diagnosis and treatment.

Characteristics and prognosis of malignant external otitis with facial paralysis.

OBJECTIVE: To compare the characteristics and prognosis of patients with malignant (necrotizing) external otitis (MEO) with and without facial nerve palsy in today's era of third-generation antibiotics. DESIGN: Comparative retrospective case series. SETTING: Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, a tertiary care medical center. PATIENTS: Forty-eight patients with MEO diagnosed and treated from 1990 to 2004. Eight had facial paralysis and 40 had normal facial nerve function. MAIN OUTCOME MEASURES: Clinical, laboratory, and imaging findings and survival. RESULTS: There was no statistically significant difference between patients with and without facial nerve involvement in terms of age, comorbidities, duration of complaints, physical findings, erythrocyte sedimentation rate, and bone scan findings. Computed tomography indicated a more progressive disease in patients with facial nerve involvement. However, no statistically significant between-group difference was found in overall survival. CONCLUSION: Although facial nerve involvement is a sign of progression of MEO, it does not, by itself, worsen prognosis.

Dynamics of serum C-reactive protein (CRP) level and cosmophysical activity.

BACKGROUND: C-reactive protein (CRP), an acute phase reactant, plays an important part in the investigation of the role of inflammation in pathology. Many cardiovascular events show significant associations with various cosmophysical parameters. The aim of this study was to investigate the relationship between the level of CRP and the levels of solar, geomagnetic (GMA), and cosmic ray activity. METHODS: The results of 25,399 serum CRP tests carried out over a 3-year period were compared with the monthly and daily levels of solar, geomagnetic, and cosmic ray activity during the same period. The cosmophysical data were obtained from the National Oceanic Atmospheric Administration (NOAA) in the U.S. and from the Russian Academy of Science. RESULTS: On a monthly basis, CRP levels showed no correlation with GMA (n=36, r=0.258, p=0.13), but there was a significant inverse relationship with neutron activity (r=-0.35, p=0.03). For the daily comparisons, CRP levels were significantly correlated with GMA (n=1057, r=0.97, p=0.02), and there was a significant inverse relationship with neutron activity (r=-0.97, p=0.025). Daily neutron activity was higher on days with CRP levels of 0-1.0 mg/dl (n=289) and above1.0-1.5 mg/dl (n=1213) than on days with higher CRP values (>1.5; n=23,897; p<0.0001). CONCLUSION: The level of serum CRP, in addition to its association with inflammation, is related to the daily level of GMA and inversely to the level of neutron activity.

Bone conduction in otosclerosis--operated versus non-operated ears.

OBJECTIVE: To examine whether stapes surgery improves long-term bone conduction in patients with otosclerosis. SETTING: Tertiary university hospital. METHODS: Thirty patients (52 ears) who underwent stapedectomy between 1988 and 1994. Hearing tests were performed pre-operatively and 5 years postoperatively. RESULTS: The operated ears showed significant improvement in speech reception threshold and air conduction (250-4,000 Hz). Over the follow-up period, there were no significant differences in bone conduction thresholds between the operated and non-operated ears and no deterioration during follow-up in both bilateral and unilateral disease. CONCLUSIONS: This series did not provide evidence that the deterioration in bone conduction over the follow-up period in otosclerotic ears exceeds the level that can be explained by presbycusis and the Carhart effect. However, the follow-up time may have been insufficient. Stapedectomy appears to have no effect on bone conduction in this patient group. The similar bone conduction thresholds in the non-operated and operated ears in unilateral otosclerosis at the end of follow-up suggest that the thresholds in the non-operated ears approached those in the operated ones.

Monthly number of preterm births and environmental physical activity.

UNLABELLED: Recent studies have reported links between external physical factors and human homeostasis. OBJECTIVE: to determine whether the monthly values of specific physical environmental factors are associated with the monthly number of preterm births in a major medical center in Israel. METHODS: The sample included 1006 infants weighing less than 1500g born live to 774 mothers during 96 consecutive months (1995-2002) at a tertiary medical center in Israel. Monthly values of indices of solar, cosmic ray, and geomagnetic activity for the same period were obtained from national data monitoring facilities in the United States of America, Russia, and Finland. The findings were statistically correlated with the monthly number of preterm births. RESULTS: The number of preterm births correlated with the month of the year (1-12), with a progressive rise in the number of infants born as the year progressed (p = .02). The monthly number of preterm births showed a significant and direct correlation with solar activity indices (r = .32, p = .0016), and a significant and inverse correlation with cosmic ray activity indices (r = -0.3, p = .008). The relation was significant only for singelton births and for the whole group of preterm newborns, but not for multiple pregnancies. CONCLUSION: Our findings suggest that solar and cosmic ray activity may play a role in the timing of premature labor, however in multiple pregnancies additional factors are dominant.

Clinical cosmobiology: distribution of deaths during 180 months and cosmophysical activity. The Lithuanian study, 1990-2004. The role of cosmic rays.

UNLABELLED: The aim of this study is a next step of our previous, initial, publications--to explore the links between monthly death number (total, and for the major death causes and each gender) with levels of monthly cosmophysical activity in a long-term, big cohort observation. METHODS: Death number during 180 consecutive months from the National Registry of Lithuania for years 1990-2004 were studied. A total of 630,205 deaths were analyzed (333,035 males). For comparison, monthly indices of solar activity, geomagnetic activity, and cosmic ray activity and year and month (1-12) of the study were used. The cosmophysical data were obtained from space research centers in the USA, Russia, and Finland. Statistics. Pearson correlation coefficients (r) and their probabilities (P) between compared parameters were calculated. A multivariate model of prediction was designed. RESULTS: It was a significant correlation between total monthly death number and indices of cosmic ray activity and, inverse, of solar activity; in men stronger than in women. Monthly geomagnetic activity was significantly correlated with traffic accidents, ischemic heart disease/stroke ratio, suicide victim number. Deaths from stroke, noncardiovascular causes, suicide, traffic accidents were related with cosmic ray activity and, inverse, with solar activity. Relationship of ischemic heart disease/stroke ratio to year of observation showed additional evidence for the growing role of stroke in cardiovascular mortality. CONCLUSIONS: Monthly death number is linked to cosmic ray activity, and inverse, to solar activity. Central place of stroke-related deaths in cardiovascular mortality is emerging. Geomagnetic activity, in monthly account, plays a relatively minor role. We presume that forces antagonistic to cosmic ray activity, like solar activity and geomagnetic activity, can prevent some negative biologic effects of cosmic ray.

Heart valve calcification in young patients with systemic lupus erythematosus: a window to premature atherosclerotic vascular morbidity and a risk factor for all-cause mortality.

The objective of the study was to evaluate the association between heart valve calcification and atherosclerosis and outcome in systemic lupus erythematosus (SLE). One-hundred and seven patients with SLE (mean age 45.9 +/- 14.7 years) were studied by 2D transthoracic echocardiography. Mitral annulus calcification (MAC) was detected in 24 patients (22.6%) and aortic valve calcification (AVC) in 22 (20.1%). Both MAC and AVC were associated with older age (r = 0.2, p = 0.02; r = 0.40, p

Platelet-derived growth factor gene polymorphism in recurrent hepatitis C infection after liver transplantation.

BACKGROUND: Recurrent hepatitis C virus (HCV) infection is particularly aggressive in the post liver transplantation setting, with rapid progression of liver fibrosis. Platelet-derived growth factor (PDGF) is reportedly involved in the pathogenesis of liver fibrosis. The aim of this study was to evaluate the possible contribution of molecular variants of the PDGF-B gene to recurrent HCV infection after liver transplantation. METHODS: DNA was extracted from peripheral blood mononuclear cells of 40 patients who underwent liver transplantation for chronic HCV infection and genotyped for polymorphisms in PDGF-B at positions +1135 (A to C) and +286 (A to G). Intrahepatic PDGF-B expression was detected by immunohistochemistry and assessed semiquantitatively. Forty-seven healthy individuals served as controls. RESULTS: Recurrent HCV infection occurred in 34 patients (85%) after a median interval of 10.5 months (range 1.5-60.0). A statistically significant difference was observed in the distribution of the PDGF-B gene polymorphism at position +1135, but not +286 between patients and controls (P=0.05). The A/A genotype occurred at a highly significantly increased rate in patients with recurrent HCV infection than in those without (64.7% vs. 16.67%, P=0.0001), and in patients with severe than in those with nonsevere recurrence (100% vs. 53.85%, P=0.05). The expression level of intrahepatic PDGF-B was found to be highly correlated with the fibrosis stage (P<0.0001). Further analysis yielded a highly statistically significant relationship between the PDGF-B gene polymorphism at position +1135 and clinical parameters of disease severity. CONCLUSIONS: PDGF-B gene polymorphism appears to be associated with severe recurrent HCV infection after liver transplantation. PDGF-B may play an essential role in the development and progression of hepatic fibrosis. These findings, if confirmed, may have important therapeutic implications.

Adenoidectomy: long-term follow-up.

OBJECTIVE: To assess the long-term (3-5 years) success of adenoidectomy and reasons for unsatisfactory results. STUDY DESIGN AND SETTING: The parents of all children who underwent adenoidectomy alone at a major tertiary center from 1998 to 2000 were asked to complete a questionnaire assessing their child's well-being and symptomatology 3-5 years after surgery; some were invited for follow-up. Symptom improvement, persistent symptoms, and adenoid regrowth were evaluated. RESULTS: Among the 206 parents who complied, 74%-87% reported improvement in all main symptoms: nasal obstruction, snoring, chronic rhinorrhea, hyponasal speech, and obstructive sleep disorder. At follow-up (n = 36), the symptomatic patients had significantly more anatomic nasal abnormalities (P = 0.01) and a higher rate of significant adenoid enlargement (P = 0.08), 3 patients (19%) vs none (0%). CONCLUSIONS AND SIGNIFICANCE: Adenoidectomy alone is satisfactory treatment for nasal obstruction and obstructive sleep apnea in selected children. Though some adenoid regrowth is not rare, clinically significant adenoid regrowth is infrequent. Persistent or recurrent symptoms are attributable mainly to nasal pathology.

Monthly number of newborns and environmental physical activity.

UNLABELLED: In the last decades many studies have demonstrated the cosmophysical influences on human homeostasis. The aim of the study was to explore links between environmental physical activity--solar, geomagnetic, cosmic ray--and monthly number of newborns in general and, separately, for each gender. MATERIAL AND METHODS: The distribution of newborns' number (n=286,963) over 96 months in the Republic of Lithuania from 1995 to 2002 was compared with the monthly cosmophysical indices nine months before the month of delivery. For the comparison of gender ratio, other 52,289 newborns at the same time were studied in a big Israeli hospital. Pearson's correlation coefficients and their probabilities between the newborns' number and cosmophysical indices were established. RESULTS: A strong and significant inverse correlation of monthly newborns' number with monthly solar activity indices (r=-0.72, p<0.0001) and similar, but positive, with cosmic ray activity was shown (r=0.67, p<0.0001). CONCLUSIONS: The monthly number of newborns of both genders is strongly and significantly related to the level of monthly cosmic ray and, inverse, to solar activity indices nine months before the month of delivery. Geomagnetic activity was not significantly related to the monthly number of newborns. The subject and mechanism of these relationships needs further investigation.

The prevalence of major congenital malformations during two periods of time, 1986-1994 and 1995-2002 in newborns conceived by assisted reproduction technology.

Evidence has emerged that assisted reproduction technology (ART) may be associated with an increased risk of congenital malformations, low birth weight, and genetic imprinting disorders. The aim of the study was to determine, the prevalence of major malformations in newborns conceived by standard in vitro fertilization (IVF) in 1986-1994 and newborns conceived by different types of ART procedures in 1995-2002. Data were collected from the IVF Registry and Israel Birth Defects Monitoring System for all infants (live births, stillbirths and terminations of pregnancy) delivered after 20 weeks' gestation who achieved a fetal weight of at least 500 g. The control groups consisted of all spontaneously conceived babies (live births, stillbirths and terminations of pregnancy) born in our center during the same time periods. During the first period, a total of 31,007 babies were born at our center, of whom 278 were conceived by standard IVF. Twenty-six of the IVF infants had major malformations, for a prevalence rate of 9.35%, which was 2.3-fold higher than that in the general population (4.05%). During the second period, 53,208 infants were born, of whom 1632 were conceived by ART. Major malformations were found in 147 ART infants, for a prevalence rate of 9.0%, which was 1.75-fold higher than in the general population (5.18%). Analysis of the clinical characteristics of the ART infants with major malformations showed that 70.3% were born preterm, 76.5% had low birth weight, 58.6 were twins, and 11.7% were triplets. The use of ART procedures increased by a factor of 3.4 in the second period. Two important outcomes of ART were observed: an increased prevalence of major malformations about double the general population in both periods, and a high frequency of adverse clinical characteristics among ART infants with major malformations. Infertile couples should be adequately counseled regarding the real risk of having a child with malformations or a preterm or low birth weight infant.

The use of molecular markers as an aid in the diagnosis of glandular odontogenic cyst.

UNLABELLED: (1) To investigate the use of p53, Ki67, and PCNA as an aid in the diagnosis of glandular odontogenic cyst (GOC); (2) To compare the expression of these markers in GOC, low-grade mucoepidermoid carcinoma (MEPCa), and radicular cyst with mucous metaplasia (RCM) as an aid in the differential diagnosis; (3) To establish guidelines for the diagnosis of GOC. STUDY GROUP: 35 patients: 10 GOC, 15 RCM, 9 MEPCa. Immunostaining of archival specimens for p53, Ki67, PCNA. Twenty-nine articles (1987-2004) with detailed histopathological descriptions of GOC, analyzed for frequency of histopathological characteristics. Mean p53 labeling index (LI) was higher in GOC (3.0+/-4.3%) and MEPCa (4.9+/-7.4%) than in RCM (0.4+/-1.2%, p=0.048). Ki67 LI was higher in GOC (4.4+/-4.7%) and RCM (3.7+/-6.7%) than in MEPCa (0.7+/-1.6%, p=0.03). There were no significant differences in the expression of PCNA. In the literature, the most consistent histopathological characteristics of GOC included epithelial spherules/"knobs"/whorls (82.8%), cuboidal eosinophilic cells (65.5%), goblet cells (65.5%), intraepithelial glandular/microcystic ducts (58.6%), variations in lining width (55.2%), ciliated cells (51.7%) and mucous pools/mucous-lined crypts (41.4%). These histopathological features were divided into major and minor signs. The diagnosis of GOC should be based on at least the focal presence of the major signs. Measurement of p53 and Ki67 may aid in the differential diagnosis of GOC.