Μελέτη του γH2AX σε ασθενείς με βλάβες του μαστού. Συσχέτιση με κλασικούς προγνωστικούς δείκτες.

Σκοπός : Η ιστόνη Η2ΑΧ υποβάλλεται σε φωσφορυλίωση ως απάντηση στις βλάβες της διπλής έλικας του DNA , οι οποίες με τη σειρά τους αποτελούν μέρος της ογκογενετικής διαδικασίας. Η ανίχνευση της gH2AX μπορεί δυνητικά να λειτουργήσει ως βιοδείκτης για τη μετατροπή του φυσιολογικού ιστού σε προκακοήθη και στη συνέχεια σε κακοήθη ιστό. H παρούσα μελέτη αποσκοπεί στη διερεύνηση της κλινικής σημασίας της έκφρασης της gH2AX στον καρκίνο του μαστού. Μέθοδος: Έγινε ανάλυση της ανοσοϊστοχημικής έκφρασης της ιστόνης gH2AX σε ιστούς προερχόμενους από εκατόν δέκα (110) ασθενείς πάσχοντες από καρκίνο του μαστού και η έκφραση αυτή συσχετίστηκε με κλινικοπαθολογοανατομικούς παράγοντες. Αποτελέσματα: Μεγαλύτερο μέγεθος του όγκου, υψηλότερος βαθμός διαφοροποίησης και μεγαλύτερος αριθμός παθολογικών λεμφαδένων σχετίζονται σημαντικά με υψηλότερες τιμές έκφρασης gH2AX. Επιπλέον, η έκφραση της gH2AX διαφέρει σημαντικά ανάμεσα σε ασθενείς με διαφορετικό FIGO στάδιο. Υψηλότερη έκφραση οιστρογονικών και προγεστερονικών υποδοχέων σχετίζεται σημαντικά με χαμηλότερες τιμές έκφρασης της gH2AX. Συμπεράσματα: Παρατηρήθηκε θετική συσχέτιση μεταξύ της έκφρασης της gH2AX και δυσμενών παθολογοανατομικών παραμέτρων.Objectives: Histone H2AX undergoes phosphorylation as an answer to DNA double-strand breaks, which in turn are part of the oncogenic procedure. The detection of gH2AX can potentially serve as a biomarker for transformation of normal tissue to premalignant and consequently to malignant tissue. The aim of this study was to evaluate the clinical significance of gH2AX expression in breast cancer. Method: gH2AX expression in tissues from 110 breast cancer patients was analyzed by immunohistochemistry and correlated with clinicopathological variables. Results: Greater tumor size, higher grade and number of affected lymph nodes are significantly associated with greater values of gΗ2ΑΧ (Table 3). In addition, gΗ2ΑΧ differs significantly among patients’ FIGO stage. Higher values of ER and PgR are significantly associated with lower gΗ2ΑΧ values Conclusions: A positive association between gH2AX expression and infaust histopathological parameters was observed

Θεραπευτική προσέγγιση έκτοπης κύησης στην ουλή της καισαρικής. Ανασκόπηση της βιβλιογραφίας.

Σκοπός: Τα αυξανόμενα ποσοστά καισαρικών τομών ως μέθοδος τοκετού τα προηγούμενα έτη έχουν οδηγήσει σε ποικίλες επιπλοκές, μεταξύ των οποίων και η εμφάνιση έκτοπης κύησης στην ουλή της προηγηθείσας καισαρικής τομής. Η παρούσα εργασία αποτελεί μια ανασκόπηση της βιβλιογραφίας, η οποία στοχεύει στην ανάδειξη των μεθόδων θεραπευτικής προσέγγισης που έχουν έως τώρα αναφερθεί στη βιβλιογραφία. Μέθοδοι: Διενεργήθηκε μια συστηματική αναζήτηση στο Medline, και εν συνεχεία εφαρμόστηκε η μέθοδος της χιονοστιβάδας στην ανευρεθείσα βιβλιογραφία με σκοπό την προσθήκη επιπλέον βιβλιογραφικών αναφορών. Στη μελέτη συμπεριλήφθηκαν άρθρα από το 2015 έως σήμερα. Λόγω των μικρών αριθμών ασθενών που υπεβλήθησαν στις διάφορες θεραπευτικές μεθόδους, δεν ήταν δυνατή η διενέργεια μίας μεταανάλυσης. Αποτελέσματα: Σχετικά με την αντιμετώπιση των ασθενών με έκτοπη κύηση εμφυτευμένη στην ουλή προηγηθείσας καισαρικής, υπάρχει ποικιλία στη θεραπευτική προσέγγιση, και επιπλέον δεν έχουν δημιουργηθεί επίσημες κατευθυντήριες οδηγίες. Η απλή παρακολούθηση, η συστηματική θεραπεία με μεθοτρεξάτη, τοπικές θεραπείες που περιλαμβάνουν τη χρήση μεθοτρεξάτης, KCL, NaCl, αιθανόλης, lauromacrogol, και λιγνοκαΐνης, η κωνοειδής εκτομή και αποκατάσταση της μήτρας, η απόξεση, η υστεροσκόπηση, η υστερεκτομή, ο εμβολισμός της μητριαίας αρτηρίας (UAE), η υψηλής έντασης εστιασμένη υπερηχογραφία (HIFU) καθώς και άλλες θεραπείες έχουν αναφερθεί στη βιβλιογραφία. Συμπεράσματα : Παρά το γεγονός ότι ποικίλες θεραπείες έχουν αναφερθεί στη βιβλιογραφία για αυτήν την κλινική οντότητα, δεν έχει θεμελιωθεί μια ενιαία θεραπευτική προσέγγιση. Είναι σημαντική η εξατομικευμένη αντιμετώπιση, λαμβάνοντας υπόψη την κλινική εικόνα, τα επίπεδα β-χοριακής γοναδοτροπίνης, τα απεικονιστικά χαρακτηριστικά, την επιθυμία για διατήρηση της γονιμότητας και την εμπειρία του θεράποντος ιατρού.Purpose: The increasing rates of caesarean section as a delivery mode over the past years has led to several complications, with cesarean scar pregnancy being one of them. The present study is a review of the literature which aims to reveal the different management approaches used. Methods: Medline was systematically searched, and thereafter, a snowball process in the reference lists of the eligible articles for additional titles was performed. Articles from 2015 up to now were included in the study. It was not possible to perform meta-analysis on the available data owing to the large proportion of different treatments. Results: Regarding management of patients with cesarean scar pregnancy, there is a variety of treatment modalities, but further no official consensus. Expectant management, systemic Methotrexate , local therapies including local methotrexate, KCL, NaCl, ethanol, lauromacrogol, and lignocaine, wedge resection and uterus reconstruction, curettage , hysteroscopy , hysterectomy , uterine artery embolization (UAE) , High-intensity Focused Ultrasound (HIFU) ablation and other therapies were reported in the literature. Conclusion: Although several treatments have been reported for this disorder, the optimal approach remains uncertain. Individualised treatment, taking in consideration the clinical presentation, the bhCG levels, the imaging features, the desire for fertility preservation and the experience of the therapist should be performed

Case Report Absence of Clinical and Hemodynamic Consequences due to Posterior Tibial Artery Congenital Aplasia

The exact knowledge of popliteal artery and its branches' anatomic variations is important for the clinical practice of angiology, vascular surgery, and interventional procedures. Congenital absence of the artery leads, in some cases, to early malformations of the extremity in the childhood; however, it may also remain asymptomatic. We present an unusual case of a 76-year-old male patient complaining of paraesthesia in both limbs and bilateral aplasia of posterior tibial artery (PTA). Physical examination, ankle-brachial indexes, before and after exercise, arterial duplex scan, and magnetic resonance arteriography were performed. Arterial pulses for PTA at the level of the ankle were normal; arterial duplex study showed biphasic arterial flow at the level of the ankle. Color duplex ultrasound as well as magnetic resonance arteriography revealed the absence of the PTA in both limbs. The vascularization of the fibula was bilaterally normal. The patient underwent also neurological examination and electromyography, which were normal. The evaluation of the possible clinical signs and symptoms and the hemodynamic consequences of this condition are further discussed

gamma-H2AX: είναι δυνατή η καθιέρωσή του ως κλασικoύ καρκινικού προγνωστικού δείκτη;

Οι ρήξεις της διπλής έλικας του DNA αποτελούν ένα από τα πρώτα γεγονότα που επισυμβαίνουν κατά τη διαδικασία γένεσης και περαιτέρω εξέλιξης κακοηθειών ως αποτέλεσμα ενδογενών και εξωγενών παραγόντων. Η ιστόνη H2AX υφίσταται φωσφορυλίωση στο αμινοξύ σερίνη στη θέση 139 εξαιτίας ρήξεων της διπλής έλικας DNA και η gΗ2ΑΧ σχηματίζεται ως αποτέλεσμα γενωμικής αστάθειας. Η ανίχνευση του gH2AX θα μπορούσε δυνητικά να χρησιμοποιηθεί ως βιοδείκτης μεταλλαγής των φυσιολογικών ιστών σε προκαρκινικούς και στη συνέχεια σε καρκινικούς ιστούς. Το gH2AX έχει ήδη μελετηθεί σε μια ποικιλία καρκινικών τύπων συμπεριλαμβανομένων του καρκίνου του μαστού, του πνεύμονα, του εντέρου, του τραχήλου και των ωοθηκών. Η προγνωστική αξία του gH2AX είναι ενδεικτική σε ορισμένους τύπους καρκίνου, όπως ο καρκίνος του μαστού και του ενδομητρίου, ενώ περαιτέρω έρευνα απαιτείται για την καθιέρωση του gH2AX ως προγνωστικού δείκτη. Η παρούσα ανασκόπηση περιγράφει το ρόλο του gΗ2ΑΧ στον κυτταρικό κύκλο καθώς και το σχηματισμό της συγκεκριμένης ιστόνης ως αποτέλεσμα της βλάβης του DNA. Διερευνάται ο ρόλος του gH2AX σε διάφορους καρκινικούς τύπους και η συσχέτισή του με άλλους προγνωστικούς παράγοντες καθώς επίσης εξετάζεται το ερώτημα αν πληροί τα κριτήρια για την καθιέρωσή του ως κλασικού καρκινικού προγνωστικού δείκτη.Double-strand breaks are among the first procedures taking place in cancer formation and progression as a result of endogenic and exogenic factors. The histone variant H2AX undergoes phosphorylation at serine 139 due to double- strand breaks, and the gamma-H2AX is formatted as a result of genomic instability. The detection of gamma-H2AX can potentially serve as a biomarker for transformation of normal tissue to premalignant and consequently to malignant tissues. gamma-H2AX has already been investigated in a variety of cancer types, including breast, lung, colon, cervix, and ovary cancers. The prognostic value of gamma-H2AX is indicated in certain cancer types, such as breast or endometrial cancer, but further investigation is needed to establish gamma-H2AX as a prognostic marker. This review outlines the role of gamma-H2AX in cell cycle, and its formation as a result of DNA damage. We investigate the role of gamma- H2AX formation in several cancer types and its correlation with other prognostic factors, and we try to find out whether it fulfills the requirements for its establishment as a classical cancer prognostic factor

Ureteral endometriosis: A systematic literature review

Introduction: Ureteral endometriosis is a rare disease affecting women of childbearing age which presents with nonspecific symptoms and it may result in severe morbidity. The aim of this study was to review evidence about incidence, pathogenesis, clinical presentation, diagnosis, and management of ureteral endometriosis. Materials and Methods: PubMed Central database was searched to identify studies reporting cases of ureteral endometriosis. “Ureter” or “Ureteral” and “Endometriosis” were used as key words. Database was searched for articles published since 1996, in English without restrictions regarding the study design. Results: From 420 studies obtained through database search, 104 articles were finally included in this review, including a total of 1384 patients with ureteral endometriosis. Data regarding age, location, pathological findings, and interventions were extracted. Mean patients' age was 38.6 years, whereas the therapeutic arsenal included hormonal, endoscopic, and/or surgical treatment. Conclusions: Ureteral endometriosis represents a diagnostic and therapeutic challenge for the clinicians and high clinical suspicion is needed to identify it

Sentinel lymph node biopsy in uterine cervical cancer patients: ready for clinical use? A review of the literature.

Sentinel lymph node biopsy has been widely studied in a number of cancer types. As far as cervical cancer is concerned, this technique has already been used, revealing both positive results and several issues to be solved. The debate on the role of sentinel lymph node biopsy in cervical cancer is still open although most of the studies have already revealed its superiority over complete lymphadenectomy and the best handling possible of the emerging practical problems. Further research should be made in order to standardize this method and include it in the clinical routine

Endometrioid adenocarcinoma arising from colon endometriosis

Endometriosis-associated intestinal tumors represent the malignant transformation of gastrointestinal endometriosis. Approximately 50 cases have been reported in the literature. They are most commonly found among women aged 30–60 years, whereas exogenous hormone therapy and obesity are primary risk factors for the malignant transformation of endometriotic lesions. Clinical features simulate a primary colonic carcinoma. A high index of suspicion in conjunction with careful histological and immunohistochemical examination (CK7, CK20, CDX2, CD10, ER, and PR) is important for establishing a correct diagnosis. In this article, a rare case of a postmenopausal woman with no risk factors and conflicting clinical presentation, diagnosed with endometriosis-associated intestinal tumor, is described

Endometrioid adenocarcinoma arising from colon endometriosis

Endometriosis-associated intestinal tumors represent the malignant transformation of gastrointestinal endometriosis. Approximately 50 cases have been reported in the literature. They are most commonly found among women aged 3060 years, whereas exogenous hormone therapy and obesity are primary risk factors for the malignant transformation of endometriotic lesions. Clinical features simulate a primary colonic carcinoma. A high index of suspicion in conjunction with careful histological and immunohistochemical examination (CK7, CK20, CDX2, CD10, ER, and PR) is important for establishing a correct diagnosis. In this article, a rare case of a postmenopausal woman with no risk factors and conflicting clinical presentation, diagnosed with endometriosis-associated intestinal tumor, is described

Neutrophil Gelatinase Associated Lipocalin (NGAL) as a Biomarker. Does It Apply in Abdominal Aortic Aneurysms? A Review of Literature

Neutrophil gelatinase associated lipocalin (NGAL) as a protein derived from neutrophils has recently been the field of investigation in a wide range of diseases (renal disease, coronary artery disease, etc). The MEDLINE/PubMed database was searched for publications with the medical subject heading “NGAL” and keywords “Abdominal aortic aneurysm (AAA),” “biomarker,” and “growth”. We restricted our search to date. In this review, we included 38 articles and abstracts that were accessible and available in English. An effort to further explain the role of NGAL within AAA has been made. NGAL seems to be a hopeful marker for the pathogenesis and the progression of abdominal aortic aneurysms (AAAs), which has significant morbidity and mortality rates

Influence of HIV virus in the hospital stay and the occurrence of postoperative complications classified according to the Clavien-Dindo classification and in comparison with the Charlson Comorbidity Index in patients subjected to urologic and general surgery operations. Our preliminary results

Objectives: From the first time that human immunodeficiency virus (HIV) was discovered, till today both the quality of life and survival expectancy of HIV-infected patients have markedly improved. As the life expectancy of these patients increases due to the use of highly active anti-retroviral therapy (HAART) also increases the number of HIV-positive patient to be subjected to an operation. Different studies have examined the occurrence of complications in this particular group of patients and their possible susceptibility to infections or other complications that could lead to increased hospital stay, morbidity and mortality with controversial results. Material and methods: We retrospectively analyzed the data of 25 HIV-patients that were subjected to general surgery and urologic operations and we also examined in comparison with the Charlson score and their comorbidities the occurrence of complications and subsequently the possibility of an increase hospital stay due to their HIV infection. Alongside we classified their complications according to the Clavien-Dindo and compared these complications in relation to their Charlson score and CD4 count. Results: 10/25 (40%) of the population had prolonged hospital stay and from this population 6 (6/25) (24%) patients had less than 200 CD4 constituting the AIDS subpopulation. The decline of the CD4 count showed a tendency for the occurrence of a complication and comorbidities to HIV-positive patients seem to affect more the AIDS subpopulation. Conclusions: Although this is a small retrospective study, we tried to classify our complications according to the Clavien-Dindo classification and combine the classification to the age adjusted Charlson score index of comorbidities