Predictors of Wound Healing Following Revascularization for Chronic Limb-Threatening Ischemia

Objectives: After surgical or endovascular revascularization, some ischemic lesions will not heal, while some others will heal at a variable period of time from the intervention, indicating a multifactorial interaction between local and systematic "wound healing-promoting" factors. Our objective was to identify predictors of wound healing following revascularization for chronic limb-threatening ischemia (CLTI). Methods: A literature review was performed to identify published research concerning clinical, biochemical, and noninvasive methods as predictors of wound healing time and wound-free period after surgical and endovascular revascularization for CLTI. Results: Our review indicated that potential predictors included local wound factors, wound depth, patient's comorbidities, medications, smoking and alcohol abuse, poor vessel runoff, and direct versus indirect revascularization. Among the clinical biomarkers, platelet-derived growth factor, transforming growth factor beta, basic fibroblast growth factor, tumor necrosis factor alpha, interleukin (IL) 1, and IL-6 have been proposed as potential predictors. Furthermore, the potential of noninvasive microcirculation assessment to predict proper wound healing has been the topic of extensive investigation. Among the novel methods, transcutaneous measurement of oxygen partial pressure, skin perfusion pressure, oxygen-to-see method, indocyanine green fluorescence imaging, and multispectral optoacoustic tomography have shown promising results. Conclusions: The risk factor profile of an ischemic lesion in the lower extremities with a delayed/failed healing response, following a successful revascularization, is not fully clarified. Although many predictors have been assessed so far, further research needs to be done to identify the optimal clinical and biochemical indices and the noninvasive technique assessing the microcirculation that is associated with complete wound healing.Peer reviewe

Non-healing tongue ulcer in a rheumatoid arthritis patient medicated with leflunomide. An adverse drug event?

Leflunomide is a member of the disease modifying anti-rheumatic drugs group used as a treatment modality in active rheumatoid and psoriatic arthritis. “Oral ulcers” are reported in 3-5% of leflunomide medicated rheumatoid arthritis patients with adverse events, but they are not described in detail in the literature. We present a case of an ulcer in the tongue of a rheumatoid arthritis patient managed with leflunomide and contemplate on its pathogenesis

Tiam1 Protein Expression in Primary and Metastatic Colorectal Carcinoma: A Retrospective Study of 200 Cases

Objective: T-cell Lymphoma Invasion and Metastasis 1 (Tiam1)protein is a guanine nucleotide exchange factor that activates proteins of the Rho family of GTPases, specifically Rac1. Expression of Tiam1 protein has been reported in various human cancers and has been associated with lymphangiogenesis and promotion of tumor metastasis. The objective of this study was to further evaluate the expression of Tiam1 in primary and metastatic colorectal cancer (CRC) and its association withvariousclinicopathological parameters, includinggender, age, tumor size, Dukes stage, tumor grade, lymph node status and original location of the primary tumor (colon versus rectum).Methods: The expression of Tiam1 was detected by immunohistochemistry in 200 samples of primary CRC tissues and in 100 samples of lymph node tissue with CRC metastases.Results: Tiam1 was overexpressed in the majority of both primary (69,5% of the cases) and metastatic (63% of the cases) CRC tumor tissues. Overexpression of Tiam1 in primary CRC was statistically associated withlowertumor grade(P=0,04), whereas in metastatic CRC a statistically significant association between Tiam1 expression and  female gender (P=0,003), tumor size 5cm (P=0,001) and localization  of the primary tumor in the colon (P=0,009) was found.Conclusion: Overexpression of Tiam1 protein may represent a frequent event in CRC. Additional studies are warranted to further investigate its potential value as a marker of prognosis and treatment response in this form of cancer

Immunocytochemical Expression of BAX and BAK Proteins in Cervical Smears of Women Positive for HPV Types: A Study of 120 Cases

Objective: Human Papillomavirus (HPV) infection is clearly associated with cervical cancer development. However, only a very small percentage of HPV-infected women will eventually develop cancer and the factors determining that progression have not yet been sufficiently clarified. It is known that HPV oncoproteins E6 and E7 interact with various squamous cell molecules towards promoting cell immortalization and carcinogenesis. Among these molecules are the proapoptotic proteins Bax and Bak, two key regulators of the intrinsic apoptotic pathway. The aim of this study is to test for possible statistically significant differences in the Bax and Bak expression in the Pap smears of HPV-positive and HPV-negative women and thus examine their potential value as prognostic markers.Methods: One hundred and twenty women were subtyped for HPV using microarrays hybridization and then Bax and Bak expression was assessed using immunocytochemistry staining on cytocentrifuged ThinPrep samples.Results: Statistical analysis determined that there was no statistically significant difference between the expression of Bax and Bak in the HPV-positive and HPV-negative women as this expression was detected by immunocytochemical assessment of ThinPrep samples.Conclusion: Although in several published studies there is evidence of HPV oncoproteins affecting the expression of Bax and Bak on squamous cells, our study indicates that this effect is not apparent by immunocytochemical protein staining

Pseudosarcomatous myofibroblastic lesion of the urinary bladder: A rare entity posing a diagnostic challenge and therapeutic dilemma

<p>Abstract</p> <p>Background</p> <p>Pseudosarcomatous myofibroblastic lesions of the urinary bladder are relatively rare entities of an uncertain pathogenesis and benign indolent nature.</p> <p>Case presentation</p> <p>We present an extremely rare case of an ALK-1-positive pseudosarcomatous myofibroblastic lesion of the urinary bladder, which was initially misinterpreted as a low-grade leiomyosarcoma of myxoid subtype on histologic examination owing to prominent atypia, high mitotic activity, abnormal mitotic figures and infiltration of the bladder wall. Although the histologic features were suggestive of a sarcoma, the correct diagnosis was finally established and radical surgical treatment was subsequently avoided. The patient is currently free of disease without any evidence of tumor recurrence or metastasis at 3 years post-operatively.</p> <p>Conclusion</p> <p>The key differentiating point rests in distinguishing the aforementioned mass forming lesion from the myxoid subtype of low-grade leiomyosarcoma in order to avoid unnecessary radical therapy.</p

Canalicular adenoma with unicystic morphology. A rare entity

Canalicular adenoma (CA) is a benign salivary gland tumor (SGT) almost exclusively affecting the minor salivary glands, predominantly of the upper lip, and exhibiting characteristic histopathologic features. As observed in several other SGTs, a commonly

Giant liposarcoma of the back with 4 types of histopathology: a case report

The incidence of soft tissue tumours, both malignant and benign, is very common. However, the coexistence of 4 types of histopathology is rare and the aim of this article is to present one treated in our Department. An 87-year-old Greek man was treated in our Department for a huge tumour on his back, under local anaesthesia. The pathology report of the specimen referred 4 types of neoplasia. This case represents this incidence in a giant liposarcoma of the back

Inflammatory pseudotumor associated with Mycobacterium tuberculosis infection

SummaryBackgroundInflammatory pseudotumor is a relatively rare entity; originally identified in the lung, it has been described in multiple extrapulmonary anatomic locations.Case reportWe report on the unusual case of an inflammatory pseudotumor associated with Mycobacterium tuberculosis infection, which was initially mistaken for a renal malignancy both in clinical and radiological settings. We additionally present three brief reviews concerning: (1) infectious agents postulated to induce morphological changes of an inflammatory pseudotumor; (2) mycobacterial pseudotumors; and (3) distinction from inflammatory myofibroblastic tumors of the renal pelvis.ConclusionsThe present case highlights the diagnostic importance of PCR-based detection of mycobacterial DNA in granulomatous tissue responses. It is of crucial importance that clinicians are aware of this unusual manifestation of mycobacterial infection to ensure that pertinent laboratory evaluation is employed and appropriate treatment is administered in order to avoid potential clinical implications

Prevalence of Human Papillomavirus in 45 Greek Patients with Oral Cancer

The relation between HPV and head and neck cancer has recently and extensively been investigated. The purpose of this study was to indentify HPV genotypes, as well as E6/E7 mRNA expression of high-risk HPVs (16, 18, 31, 33 and 45) in oral squamous cell carcinomas (OSCCs) from 45 Greek patients. The overall prevalence of HPV DNA positive OSCCs was 11.1% (5/45), while high-risk HPV DNA was found in 6.7% (3/45) of OSCCs. E6/E7 mRNA expression was detected in 8.9% (4/45) of the oral cavity samples. Our data indicated that HPV 16 was the commonest genotype identified in HPV-positive OSCCs by both DNA and RNA tests. This study confirms the prevalence of HPV infections among patients with OSCCs. Future analysis and followup of more OSCCs will enable us to correlate HPV detection and clinical outcome