Laparoscopic fenestration for the treatment of patients with severe adult polycystic liver disease

Background: The purpose of this study was to present our experience in laparoscopic fenestration for patients with severe symptomatic adult polycystic liver disease (APLD), analyze its feasibility, and evaluate its immediate and mid-term outcome. Methods: Between January 2000 and January 2002, 9 patients underwent laparoscopic fenestration for symptomatic APLD in our laparoendoscopic unit. All patients had both liver lobes affected with Multiple cysts, whereas type If disease (present in 8 patients) was not a contraindication for the procedure. The results were retrospectively evaluated. Results: Conversion to laparotomy was required in 1 patient who was submitted to a second laparoscopic procedure (2 years postoperatively) after being admitted to our department with sepsis. Complete regression of symptoms was achieved in 7 of our patients (77.8 %). One death occurred because of acute renal failure established 5 weeks after the patient was discharged. During a mean follow-up of 25.8 months, 2 patients presented with recurrence of their symptoms (22.2 %). One of them was reoperated on; both of them remain symptom free 14 months postoperatively. Conclusions: Laparoscopic fenestration appears to be a useful and effective approach for severe APLD. It is associated with short hospital stay and a significant symptom-free period. Despite the reported morbidity, aggressive and meticulous deroofing of as many cysts as possible can be successfully applied for carefully Selected patients with type II disease. (C) 2005 Excerpta Medica Inc. All rights reserved

Cell kinetics and apoptosis in laryngeal carcinoma patients

Cellular proliferation and apoptosis are both implicated in the process of carcinogenesis. The objective of this study was to access the prognostic significance of the expression of proliferating cell nuclear antigen (PCNA) and the apoptosis-related genes (bax, bcl-2, and p53) in laryngeal carcinoma patients. Thirty consecutive patients with stage I to IV squamous cell laryngeal carcinoma were treated in our department from 1992 to 1994. We immunohistochemically studied the expression of PCNA and bax, bcl2, and p53 genes in their tumor specimens. Five healthy men were used as the control group. The staining results were correlated with clinicopathologic data. The PCNA protein expression was correlated with a significantly worse survival in those patients who were bax-negative (0% versus 42.86%, p = .0445). Similarly, the presence of PCNA led to an unfavorable clinical outcome in those patients who were bax-negative, bcl-2-negative, and p53-negative (0% versus 50%, p = .0278). Expression of bcl-2 protein was found to be an independent prognostic factor related to an unfavorable clinical outcome (p = .0262). The expression of bcl-2 protein appears to predict survival in laryngeal carcinoma patients. Furthermore, the combined study of proliferation markers and apoptosis related genes helped us to identify a high-risk group of patients who may benefit from a more aggressive treatment protocol

HLA-DR antigen and bax protein expression in patients with primary non-Hodgkin's gastric lymphoma

Primary gastric lymphoma represents a rare gastrointestinal malignancy with an unclear prognosis. The aim of this study was to determine the prognostic significance of HLA-DR antigen and bax expression in patients with primary non-Hodgkin’s gastric lymphoma. We immunohistochemically studied bax protein and HLA-DR antigen expression in 36 B-cell, MALT-type primary gastric lymphoma patients diagnosed and treated in our department from 1990 to 1995. Ten non-malignant gastric tissue specimens were used as benign controls. Clinicopathological and survival data were correlated with the staining results. HLA-DR antigen expression was observed in 33 gastric lymphoma patients (91.7%). Positive bax staining was found in 24 gastric lymphomas (66.7%) and in none of the benign cases studied. In the univariate analysis, those gastric lymphoma patients who expressed HLA-DR antigen in more than 15% of their tumor cells, presented a significantly improved 5-year survival rate (75% vs. 37.5%, p = 0.04). Furthermore, gastric lymphoma patients who were bax(+)/HLA-DR(+) had a statistically better overall survival compared to those who were bax(-)/HLA-DR(-) (82.4% vs. 25%, p = 0.01). HLA-DR antigen expression was associated with a favorable clinical outcome. Its expression improved the predictive value of bax protein expression in non-Hodgkin’s gastric lymphoma patients. The combined use of these markers permits the identification of a high-risk group of patients that may benefit from a more aggressive therapeutic approach

Common pathways for primary hypertrophic and dilated cardiomyopathy

Testing the hypothesis that hypertrophic and dilated cardiomyopathy as well as viral myocarditis share a common mitogenic growth response pathway with mitotically competent cell types are the aims of this study. The expression of the c-fos, H-ras and c-myc genes was immunohistochemically determined in biopsies from 12 patients with dilated cardiomyopathy, 24 patients with hypertrophic cardiomyopathy, and 4 patients with myocarditis. Normal myocardium from 9 subjects was used as the control group. Staining results were correlated with patient’s demographic data. C-fos, H-ras and c-myc protein overexpression was seen in 15 patients (62.5%) with primary hypertrophic and 4 patients (33.3%) with dilated cardiomyopathy. The majority of hypertrophic and dilated cardiomyopathy patients expressed at least one of the genes studied compared with the control group (p=0.006). Primary cardiomyopathy patients also showed a statistically significant difference in the gene co-expression compared with the control group (p=0.042). C-fos, H-ras, and C-myc protein expression did not differ substantially between patients with hypertrophic and dilated cardiomyopathy. Patients with myocarditis expressed only the C-fos protein (n=2, 50%). C-fos, h-ras and c-myc genes are overexpressed in patients with cardiac hypertrophy and cardiac dilation. Cardiac myocytes respond to biomechanical stress by initiating several different processes. One of them is oncogene expression. This results in a hypertrophy of the myocytes proportional in length and width (hypertrophic cardiomyopathy or with a relatively greater increase in length than in the width (dilated cardiomyopathy)

Prognostic significance of p53, bax and bcl-2 gene expression in patients with laryngeal carcinoma

Aim: This study was designed to examine the prognostic significance of the coexpression of three genes (bax, bcl-2 and p53) which play a critical role in the apoptotic mechanisms in patients with squamous cell laryngeal carcinoma.(1-3) Materials and Methods: The immunohistochemical expression of bcl-2, bax and p53 genes was retrospectively examined in 38 patients with squarrous cell laryngeal carcinoma and in five controls (necrotomic tissue). Tissue specimens were obtained both during the diagnostic biopsy and at the time of surgery. Clinicopathological and survival data were correlated with the staining results. Results: Bcl-2 protein expression (P=0.0472), stage (P=0.0087) and lymph-node involvement (P=0.0488) were found to be independent prognostic factors. Increased bcl-2 protein expression correlated with a better 5-year survival (P=0.0472). Patients who were bcl-2(-)/p53(-) (n=25) or bax(+)/bcl-2(-) (n = 13) had a significantly worse overall survival (P=0.0305 andP=0.0482, respectively). Similarly, patients who were bax(+)/bcl-2(-)/p53(-) (n = 11) also had a worse 5-year survival compared with the rest of the group (P=0.0088). Changes that were noticed in bax and p53 protein expression from the time of biopsy until the time of surgery did not correlate with a significant increase in the overall survival. Conclusions: The expression of bcl-2 gene appears to be an independent prognostic factor for patients with laryngeal carcinoma. The coexpression of the genes studied can be used to determine aggressive clinical phenotypes. (C) 2001 Harcourt Publishers Ltd

Two-trocar laparoscopic-assisted appendectomy versus conventional laparoscopic appendectomy in patients with acute appendicitis

Background: In order to reduce abdominal trauma and operative costs we have adopted a two-trocar laparoscopic-assisted appendectomy for patients with acute appendicitis. In the current study, the proposed technique is prospectively evaluated against conventional laparoscopic appendectomy with respect to feasibility, safety, and postoperative outcome. Materials and Methods: Between July 2001 and July 2003, 83 consecutive patients were admitted with clinically diagnosed acute appendicitis and were randomly assigned to two-trocar laparoscopic-assisted appendectomy (n = 40, 48.2%) or conventional laparoscopic appendectomy (n = 43, 51.8%). Results: Two-trocar laparoscopic-assisted appendectomy was successfully completed in 30 patients (80.1%). Four patients initially scheduled for two-trocar laparoscopic-assisted appendectomy (1.0.8%) were converted to laparotomy due to excessive body weight (BMI >= 40), while an additional 5-mm infraumbilical trocar was inserted in another 3 patients (8.1%). The procedure was associated with decreased operative time and more rapid return to normal activity compared to laparoscopic appendectomy (P < 0.001 and P = 0.038, respectively). There was no statistically significant difference regarding the duration of hospitalization or the morbidity rate between the two groups. Conversion of the initial procedure was associated with increased wound infection rate and higher morbidity (P = 0.032 and P = 0.018, respectively). Conclusion: Two-trocar laparoscopic-assisted appendectomy represents a promising minimally invasive procedure for the treatment of acute appendicitis. It is fast and easy to perform, and it is expected to decrease the overall cost of laparoscopic appendectomy. Its only contraindication is excessive body weight; it remains to be evaluated in the setting of perforated appendicitis and retrocecally located appendices

Protein expression of bax, bcl-2, and p53 in patients with non-Hodgkin's gastric lymphoma: Prognostic significance

The biologic significance of bcl-2, bax, and p53 gene expression in patients with non-Hodgkin’s gastric lymphoma is unknown. We examined the prognostic value of these genes in 36 patients with gastric lymphoma treated in our clinic between 1990 and 1995. Paraffin-embedded specimens from 36 patients who underwent primary resection of the stomach for gastric lymphoma were analyzed immunohistochemically for p53, bax, and bcl-2 gene expression. Expression of bax was seen in 24 of 36 patients (66.7%), p53 expression was found in 8 of 36 tumors (22.2%), and bcl-2 cytoplasmic staining was detected in 6 of 36 patients (16.7%). We performed a univariate analysis to examine the possible correlation between the expression of these genes and the survival of our patients. Expression of bax protein proved to be a statistically significant prognostic factor (p = 0.049). Protein expression of p53 and bcl-2 did not statistically correlate with survival. In the bcl-2-negative (-) patient group (30 patients). those who were bax-positive had a statistically significant better survival than those who were bax-negative (63.3% vs. 36.7%, p = 0.03). There was also a statistically significant correlation between p53 expression and the grade of the tumor (p = 0.0014). P53 protein expression increased along with the grade. Expression of bax is a significant prognostic factor in patients with gastric lymphoma. Its prognostic value increases significantly when studied in bcl-2-negative patients: hut expression of bax failed to be an independent prognostic factor. Expression of bcl-2 and p53 has no prognostic significance. Expression of p53 seems to represent a marker for loss of differentiation

Identification of germline BRCA1 and BRCA2 genetic alterations in Greek breast cancer moderate-risk and low-risk individuals - correlation with clinicopathological data

The current study was designed to evaluate the prevalence of BRCA1 and BRCA2 germline mutations in Greek moderate- and low-risk individuals with respect to clinicopathological phenotype and clinical outcome of breast cancer. Ninety-four consecutive individuals were prospectively recruited from two University Breast Cancer Clinics (Hippokrateion Hospitan and Laikon Hospital) between 1989 and 1999 and were categorized as moderate-risk and low-risk individuals for carrying BRCA1/2 germline mutations. To identify the underlying mutations, protein-truncation test and single-strand conformation polymorphism methods were used, followed by direct sequencing. Three novel BRCA1 missense mutations, one novel BRCA1 intronic deletion, three novel (previously reported) BRCA2 truncating mutations, and one novel BRCA2 missense mutation were identified in the moderate-risk group of individuals studied. The BRCA1/2 missense mutations as well as the single intronic variant identified were designated as unclassified genetic variants. Two BRCA1 unclassified genetic variants (missense mutations) were detected in two of the three (66.7%) male breast cancer patients analyzed, while the third one was identified in a sporadic (low-risk) breast cancer patient. Clinicopathological characteristics of breast carcinomas originating from BRCA1/2 heterozygotes were consistent with those already reported and not different from those observed in BRCA1/2 mutation (-) breast cancer patients. Furthermore, BRCA1/2 mutation carriers presented an excellent 4.5-year overall survival (100%). Our results reveal the unique characteristics of BRCA1/2 mutation status, genotype-phenotype correlations, and prognosis, in moderate- and low-risk individuals of Greek ancestry. Breast cancer due to mutations in BRCA1 and BRCA2 genes appears to be a heterogeneous syndrome in the Greek population