Bad Prognostic Sign Research Articles

Can combined tomosynthesis with unenhanced MRI be used as a predictive tool for lymphovascular invasion?

BackgroundThe presence of lymphovascular invasion (LVI) in cases with breast cancer is considered a bad prognostic sign. The purpose of this study is to compare the efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) versus unenhanced magnetic resonance imaging (UE-MRI + DBT) in predicting LVI in women with pathologically confirmed breast cancer.MethodsThis prospective self-controlled study enrolled a total of 70 cases of pathologically proven breast cancer. All the patients underwent tomosynthesis, non-contrast, and post-contrast MRI. Depending on the broken halo sign seen in tomosynthesis, peritumoral edema, dark rim diffusion at diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) values evaluated in MRI.ResultsThe accuracy of LVI detection by tomosynthesis was 58%; unenhanced and enhanced MRI had the same results at 60%. The accuracy of detecting LVI was raised to 64% by combining the tomosynthesis results with unenhanced MRI.ConclusionsTomosynthesis parameters are promising tools in detecting LVI in breast cancer with better diagnostic accuracy in combination with unenhanced MRI.

Asymptomatic skin lesions as a diagnostic clue in multiple myeloma – A case report

Multiple myeloma (MM) is a rare cancer of plasma cells in the bone marrow. Cutaneous plasmacytoma is an uncommon but specific skin lesion in MM with an incidence of 2%. Cutaneous plasma cell infiltration in pre-existing MM is a very rare phenomenon, with approximately 100 cases described in the literature. Here, we report a case of a 61-year-old male who presented with asymptomatic skin nodules and plaques over the chest, abdomen, and back of the trunk for five months. Histopathological examination showed mononuclear cells with moderate cytoplasm and round to ovoid nuclei. Immunohistochemistry showed CD138 and kappa positivity and lambda and CD20 negativity, confirming the diagnosis of cutaneous plasmacytoma. Bone marrow biopsy and immunohistochemistry revealed bone marrow plasmacytosis with kappa light chain restriction. Serum free light chain ratio was 106.61 and fluorescence in situ hybridization showed del 13q. The clinical features and investigations fulfilled the diagnostic criteria for MM, and the patient was started on chemotherapy, following which the skin lesions improved. Development of skin lesions is seen in the advanced stages of MM and is considered a bad prognostic sign. However, they can also be seen as initial manifestations of the disease, as in this case. Hence, meticulous investigations and early diagnosis are of paramount importance.

The first experience of parallel measurements of objective accommodation parameters in children with myopia using various instruments: in search of a common denominator

Purpose: to study the relationship between the parameters of reflex and tonic accommodation measured using various objective methods.Material and methods. A comprehensive parallel study of objective accommodation parameters of 57 children (114 eyes) with low and moderate myopia (average -2.6 ± 1.4 D) aged from 8 to 12 years (average 9.9 ± 1.6 years) was carried out on three devices: Grand Seiko WAM-5500K, Acomoref 2 K-model Righton; TONOREF III, Nidek.Results. Both coincidences and differences of the indicators obtained by different methods as well as their correlations were revealed: positive - between the values of AR in the open field and in the virtual space (r = 0.23, r = 0.2); between the virtual responses to Righton K-2 and Nidek (r = 0.38); direct correlations of the accommodation response with accommodation tones. A correlation of average strength (r = 0.44) was found between the HAT on the Grand Seiko WR-5100K and the CMF on the Righton K2, which allows us to consider them as synonymous indicators. A negative relationship of CMF with PRA and SE refraction was found. A positive correlation of CMF with the rate of progression of myopia and a negative one with PRA suggests that a high CMF is a bad prognostic sign. However, CMF positively correlates with the magnitude of the accommodative response on all three devices. In this case, it turns out that an increase in CMF accompanies an increase in the amplitude of accommodation and, therefore, is not always a troublesome factor. Perhaps we are dealing with the limits of the norm for this indicator, which still need to be studied.Conclusion. With the help of objective methods of studying qualitatively different characteristics of one process, it is possible to investigate the actual and prognostic parameters of accommodation, which will allow us to offer an individualized approach to the treatment of patients with myopia using optical and drug instruments.

A Management of Chronic Frequent Hiccup by Kankasava

Hikka is a disease of serious nature and can cause death if not treated properly. The general causative factors include dietary and environmental pathogens and specific pathogenesis is due to involvement of vata and kapha as major dosha. Thus five types of Hikka are elaborated. The classification is based upon clinical presentation of disease and includes three types each of Hikka with bad prognostic signs pointing to worse condition. The description comprehends basic principles of management focused on removing obstruction of kapha and allowing proper flow of vata by means of purification therapies, sudation, nasal errhines, medicated smoking and various formulations. The management emphasizes on nourishment and pacification therapies to successfully treat and prevent the Hikka conditions. Depletion therapies are strongly contraindicated as they may worsen the condition of patient and disease. A 60 years old patient came in opd with complaint of frequent hiccup since 1 month. He has taken allopathic medicine for this but found no result. The condition was managed by Kanakasav 40 ml BD with leuke warm water before meal internally and got instant result. Within one day he became normal.

Monitoring of cerebrovascular pressure reactivity in children may predict neurologic outcome after hypoxic-ischemic brain injury

ObjectivesImpaired cerebral blood flow is a first-line reason of ischemic-hypoxic brain injury in children. The principal goal of intensive care management is to detect and prevent further cerebral blood flow deficits. This can be achieved by actively managing cerebral perfusion pressure (CPP) using input from cerebrovascular autoregulation (CAR). The main objective of the current study was to investigate CAR after cardiac arrest in children.MethodsNineteen consecutive children younger than 18 years after cardiopulmonary resuscitation, in whom intracranial pressure (ICP) was continuously measured, were included. Blood pressure and ICP were continuously monitored via ICM + software and actively managed using the pressure reactivity index (PRx) to achieve and maintain an optimal CPP. Outcome was scored using the extended Glasgow outcome scale (eGOS) at discharge and 6 months.ResultsEight children died in hospital. At 6 months, further 4 children had an unfavorable (eGOS1–4) and 7 a favorable (eGOS5–8) outcome. Over the entire monitoring period, we found an elevated ICP (24.5 vs 7.4 mmHg), a lower CPP (50.3 vs 66.2 mmHg) and a higher PRx (0.24 vs − 0.01), indicating impaired CAR, in patients with unfavorable outcome. The dose of impaired autoregulation was significantly higher in unfavorable outcome (54.6 vs 29.3%). Analyzing only the first 72 h after cardiac arrest, ICP ≥ 10 mmHg and PRx > 0.2 correlated to unfavorable outcome.ConclusionsSignificant doses of impaired CAR within 72 h after resuscitation are associated with unfavorable outcome. The inability to restore autoregulation despite active attempts to do so as well as an elevated ICP may serve as a bad prognostic sign indicating a severe initial hypoxic-ischemic brain injury.

Karshya -A Critical Review on Nutritional Deficiency as per Ayurveda

Ayurveda emphasize prevention over cure. A balanced diet with proper dietetic rule can help avoid a lot of common health concerns. The source of life for all living beings is food, growth, strength, intelligence, satisfaction, all are established in food. Food is significant as a nutritional source, as well as having therapeutic value, and it plays an important part in regaining strength lost due to the disease's detrimental effects throughout the post-treatment phase and also excess exercise, or addiction too. Ayurveda classic haphazardly explain nutritional issues. Each and every disease is due to faulty Ahara and Vihara. Ahara vidhi is equally important to get optimum benefits from consumed food. Childhood malnutrition is thought to be the cause of 35% of all fatalities in children under the age of five, as well as 21% of total worldwide disability-adjusted life years lost in children. Karshya not only concerns with weight loss, but also compares with malnutrition-like disorders. In Ayurveda, Karshya is a disease as well as cause, prodromal symptoms, feature of different diseases and bad prognostic sign. Karsha is also a physiological in Vataja prakriti individual. This illness is linked to growth and development issues in children and adolescence group. In adults, malnutrition results in weakness, fatigue, low immune response, protein, vitamin, minerals, fats deficiencies, and more prone to degenerative diseases. The aim of this review article is highlighted the Ayurvedic perspective on Karsha in term of malnutrition. All material for this article is collected from classical Ayurvedic texts. Understanding the cause and pathophysiology and accurate treatment as per Ayurved classics all are discussed here elaborately

Inflammation‐related MiRNAs are associated with Monosomy 3 in Uveal Melanoma

PurposeInflammation is a bad prognostic sign in Uveal Melanoma (UM), but it is as yet unclear how it is regulated. We set out to investigate the relation between microRNA’s and inflammation in UM and their potential regulation by chromosome 3 and 8.MethodsThe expression of 125 microRNA’s was determined using an Illumina HT12V4 array in 64 primary UM. Similarly, the mRNA expression of HLA‐A, HLA‐B and markers of tumor‐infiltrating lymphocytes (TIL) such as CD3E, CD4, CD8, and tumor‐associated macrophages (TAM), such as CD68 and CD163, was obtained from the array.ResultsWhen looking at all 64 UM tumors, expression levels of seven of the 125 miRNA’s that were analysed correlated with the presence of tumor‐infiltrating lymphocytes (TIL), tumor‐associated macrophages (TAM) and HLA Class I expression. Increased levels of miRNA 22 and 155 were associated with increased HLA expression and high numbers of TIL and TAM, while expression of miRNAs 7, 98, 125, 302 and 599 was associated with less infiltrate and a lower HLA expression. MiRNAs 22 (p ≤ 0.001) and 155 (p = 0.005) were upregulated in monosomy 3 tumors and expression of miRNAs 7 (p = 0.35), 98 (p = 0.26), 125 (p = 0.91) and 599 (p = 0.80) was not related to monosomy 3, while miR‐302 (p = 0.02) was slightly higher in D3 tumors. MiR‐22 was positively associated to chromosome 8q gain (p = 0.01) but miRNA’s 7 (p = 0.004), 98 (p = 0.002), 125 (p = 0.005), 302 (p = 0.02), and 599 (p ≤ 0.001) were all decreased in tumours with 8q gain.ConclusionsWe identified a set of microRNA’s associated with inflammatory markers (HLA Class I, TIL’s and TAM’s) in UM. The microRNA’s that are positively associated with inflammation are highly expressed in tumors with one copy of chromosome 3 and 8q gain while this is the opposite for microRNA’s negatively associated with inflammation. We propose a regulatory role for chromosome 3 and 8q abnormality in the control of inflammation‐related microRNA’s and suggest a potential involvement of these microRNA’s in the development of inflammation in UM.

Brain metastatic breast cancer: Epidemiology, survival and prognosis: Single center experience

IntroductionBreast carcinoma is the most common malignancy in women worldwide. It is also one of the most frequent causes of brain metastasis (BM). Studies have identified BM as one of the worst prognostic signs. MethodsWe retrospectively analyzed data from 71 patients with BM from BC with the aim of clarifying the epidemiological criteria and management in our setting. We also aimed to identify predictors of survival and factors affecting the length of the BM-free interval in our group of patients. ResultsAll the patients were female with a mean age at diagnosis of primary cancer of 41.6 years. The most common site of BM was the parietal lobe. The BM-free interval was longer with N1 disease (in comparison to N2 and 3) and in luminal B breast cancer subtype. Survival was shorter in older patients, those with hormone receptor negative and/or HER2-neu positive disease, synchronous BM, primary tumour not removed, soft tissue/non-regional nodes concomitant metastasis, and those who did not receive palliative chemotherapy. Survival tended to be longer in patients with temporal lobe metastasis, but this result was not statistically significant. ConclusionBM is a bad prognostic sign. Large scale prospective studies are needed to further delineate its nature.

OSBORN WAVES DURING TARGETED TEMPERATURE MANAGEMENT

SESSION TITLE: Fellows Cardiovascular Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Osborn waves also known as current of injury, J waves, camel-hump waves, hypothermic waves, late delta wave; is a deflection with a dome/ hump at the J point (R-ST junction) on the EKG. First described in 1953 by Dr. John Osborn while studying effects of hypothermia in dogs and was considered a bad prognostic sign leading to ventricular fibrillation. Most commonly seen in hypothermia and other causes include hypercalcemia, brain injury, subarachnoid hemorrhage, cardiopulmonary arrest from oversedation, vasospastic angina or idiopathic ventricular fibrillation, early repolarization and Brugada syndrome. Osborn waves are usually seen in the inferior and lateral precordial leads while in Brugada syndrome the EKG changes are seen in the right precordial leads. CASE PRESENTATION: A 50 year old female with past medical history of schizoaffective disorder , diabetes mellitus, hypothyroidism, obesity, sleep apnea presented to the Emergency room s/p cardiac arrest secondary to aspiration and ROSC achieved after 25minutes. Initial arterial blood gas post intubation showed respiratory acidosis with arterial Ph of 7.18 which was appropriately corrected with ventilatory changes. Targeted temperature management (TTM) was initiated post ROSC. Patient was admitted to the Medical ICU. She was sedated and paralysed for shivering while on TTM. Initial Troponin was 0.06. Patient was hemodynamically stable. Initial EKG showed narrow complex tachycardia (figure1). She was cooled using arctic sun protocol with goal of 33 F (92C). 12hrs into TTM patient developed bradycardia with heart rate of 40bpm , QTc 574 with characteristic osborn waves on EKG (figure2). Blood pressure was stable. She was rewarmed with resolution of bradycardia and osborn waves (figure3). 2decho with ejection fraction of 36-40% and no valvular or wall motion abnormality. DISCUSSION: Hypothermia is defined as core body temperature <95°F (35°C), and causes EKG changes of diagnostic and prognostic significance. Sinus tachycardia develops initially as part of the general stress reaction, however sinus bradycardia with prolongation of PR, QRS and QTc intervals occurs at temperatures less than 90°F. Atrial ectopic activity leading to atrial fibrillation and ventricular fibrillation can occur when temperatures reach 86°F or lower. At this level of hypothermia, 80% of patients have Osborn waves that consist of an extra deflection at the end of the QRS complex. Asystole occurs at temperature <60°F. CONCLUSIONS: Osborn waves are known to result from the high potassium gradient within the epicardium relative to the endocardium during ventricular repolarization. The differential diagnosis of prominent Osborn waves including early repolarization, hypercalcemia, and the Brugada syndrome should be considered and risk of ventricular arrhythmias should be considered. Reference #1: Maruyama M, Kobayashi Y, Kodani E, et al. Osborn waves: history and significance. Indian Pacing Electrophysiol J. 2004;4(1):33-39. Published 2004 Jan 1. Reference #2: Imad A. Alhaddad, Mohammed Khalil, and Edward J. BrownJr. Osborn Waves of Hypothermia. Circulation. 2000;101:e233–e244 Reference #3: Mori J. Krantz, M.D., and Christopher M. Lowery, M.D. Giant Osborn Waves in Hypothermia. N Engl J Med 2005; 352:184. DOI: 10.1056/NEJMicm030851 DISCLOSURES: Speaker/Speaker's Bureau relationship with pfizer Please note: $1001 - $5000 Added 06/11/2020 by Yizhak Kupfer, source=Web Response, value=Consulting fee No relevant relationships by Ratnam Santoshi, source=Web Response

Multiple hormone secretion may indicate worse prognosis in patients with ectopic Cushing\u2019s syndrome

PurposeEctopic Cushing’s syndrome (ECS) caused by an ACTH secreting neuroendocrine neoplasm (NEN) is a rare and challenging condition. We aimed to detect predictive and prognostic parameters for ECS patients identified from a retrospective, comprehensive cohort of NENs treated at a tertiary referral center.MethodsMedical records of 886 patients with NENs were reviewed. We identified 51 patients with ECS (33 females/18 men); mean age 52 ± 15 years (SD). Clinical parameters including symptoms, biochemical markers, and survival were extracted and further analyzed.ResultsThe primary tumor was located in the thorax (n = 28) or pancreas (n = 15) or was of unknown primary origin (n = 8). In 30 patients, tumor and ECS were diagnosed simultaneously. In 12 patients, the NEN diagnosis preceded ECS development, with a median time of 43.5 months (range: 9–96), and 10 of these showed radiological tumor progression at ECS diagnosis. Twenty-one patients had multiple hormone secretion, which correlated with shorter overall survival (OS), p = 0.012 (HR 2.4 (95% CI 1.2–4.9)), as did high morning cortisol, p = 0.037 (HR 2.3 (1.0–5.2)), higher tumor grade, p = 0.044 (HR 2.3 (1.0–5.1)), and diabetes, p = 0.050 (HR 2.4 (1.0–6.0)).ConclusionsMultiple hormone secretion, high morning cortisol, higher tumor grade, and diabetes were correlated with shorter OS. Development of ECS in patients with a non-functioning NEN may indicate tumor progression. Multiple hormone secretion should be considered as a bad prognostic sign in ECS patients and should lead to intensified clinical management.

PROGNOSTIC VALUE OF SEX-DETERMINING REGION Y-BOX 2 (SOX2) IN PROSTATE CANCER

Objectives: The objectives of this study were to evaluate the expression of sex-determining region-Y BOX 2 (SOX2) markers and their association with clinicopathological parameters.&#x0D; Methods: A cross-sectional study was carried out to involve 90 specimens from patients diagnosed with prostatic cancer (PC) and benign prostatic hypertrophy (BPH) compared with positive control (human bronchial tissue for SOX2 marker) with each run.&#x0D; Results: The highest proportion of specimens of PC was graded ≤7 by Gleason grading system (53.3%). There were significant associations (p&lt;0.05) between all this cancer stem cell marker results and prevalence of PC. Positive SOX2 marker result was significantly associated with bad prognostic sign (81.3%, p=0.001). This marker was highly sensitive (100%) specificity (82.4%), with high accuracy (90%).&#x0D; Conclusion: There was a significant expression of SOX2 in prostate adenocarcinomas. SOX2 can be considered as a key regulator of tumor progression, aggressive behavior, and metastasis. Furthermore, it is a reliable marker for the early diagnosis and the designed chemotherapy of prostate adenocarcinomas.

Endotoxicosis indices as means of prognosis in surgical sepsis caused by purulent-necrotic complications of sugar diabetes

Purpose of the study. to study how the consequences of surgical sepsis caused by purulent-necrotic complications of sugar diabetes depend on the dynamics of endotoxicosis indices in the course of treatment.&#x0D; Material and methods. The research included 30 patients with the symptoms correlating with the criteria for surgical sepsis caused by purulentnecrotic complications of sugar diabetes. The patients had their level of endotoxicosis measured and the severity of their condition evaluated according to the scale.&#x0D; Results. 26 patients were discharged from hospital due to their recovery, 4 patients died. The purulent-necrotic complications lead to the development of intoxication syndrome and sepsis causing, in its turn, the decompensating of the disease, poly-organic insufficiency and the high lethality. Despite the conservative and surgical treatment carried out, the high indices of endogenic intoxication in the dynamics of the treatment proved to be a bad prognostic sign.&#x0D; Conclusion. the monitoring of endogenous intoxication in patients with surgical sepsis caused by the purulent-necrotic complications of sugar diabetes in the treatment dynamics proves to be an important diagnostic and prognostic element helping to correct the treatment tactics and diminish the lethality.

The significance of smoking as a risk factor for the disorder of the obstructive pulmonary pattern in the patients with systemic sclerosis

Background/Aim. Systemic sclerosis (SSc) is a chronic systemic disease of the connective tissue. It is characterized by diffuse microangiopathy, increased activity and creating deposits of collagen in the skin and internal organs. Involvement of the lung function disturbances in SSc is a bad prognostic sign. The aim of our study was to investigate the association between smoking habits and lung function disorder in the SSc patients. Methods. The testing was conducted at the Clinic for Rheumatology and Immunology of the Military Medical Academy in 2016. In this study, we included 42 patients with the newly diagnosed SSc and the patients whose disease had been diagnosed earlier. Results. The patients were classified according to the smoking habits, 14 (33.3%) patients were nonsmokers, while 28 (66.7%) patients were current (23 patients) or ex-smokers (5 patients). We found no significant differences in examined parameters among smokers and nonsmokers. In addition, distribution of the patients with the obstructive pulmonary pattern revealed by spirometry was uniform between smokers and nonsmokers. The concentrations of C reactive protein (CRP) were significantly higher in the SSc patients with the obstructive pulmonary pattern. The patients with the obstructive pattern on spirometry had significantly lower values of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, diffusing lung capacity for carbon monoxide (DLCO) and FVC/DLCO ratio. Conclusion. In our study, we concluded that in the SSc patients with the obstructive pulmonary pattern revealed by spirometry, there were no significant differences between smokers and nonsmokers. CRP is a significant predictor of the lung involvement existence in the SSc patients.

Can early dopamine transporter imaging serve as a predictor of Parkinson's disease progression and late motor complications?

BackgroundThe role of nuclear imaging in predicting Parkinson's disease (PD) progression is unclear. This study investigated whether the degree of reduced striatal dopamine transporter binding at diagnosis of PD predicts later motor complications and time to disease progression. MethodsWe retrospectively studied 41 patients with early PD who underwent 123I-FP-CIT SPECT and were followed thereafter with a mean disease duration of 9.51 ± 3.18 years. The association of quantitatively analyzed 123I-FP-CIT binding in striatal subregions with the development of motor fluctuations, dyskinesias, freezing of gait (FOG) and falls as well as the time to Hoehn and Yahr (H&Y) stage 3 was evaluated. ResultsLogistic regression models controlling for age at diagnosis, sex, disease duration, and L-dopa dose revealed that 123I-FP-CIT binding in the putamen and striatum significantly predicted FOG (OR = 0.02, p = 0.03; OR = 0.01, p = 0.04; respectively) but not falls. Cox proportional hazard analysis did not reveal significant relationship between 123I-FP-CIT binding and motor fluctuations, dyskinesias, or H&Y stage 3. ConclusionsOur results suggest that a more severe depletion of presynaptic dopamine in early PD is a bad prognostic sign in terms of FOG development. These findings, if replicated, may point to dopaminergic transmission as part of the mechanism underlying FOG in PD.

A Case of Orbital Granulocytic Sarcoma (Chloroma) Well Responded to the Treatment

Granulocytic sarcoma (GS), myeloid sarcoma (MS) or extra medullary leukemic deposits is an unusual manifestation of AML, accounting for about 3% of acute leukaemia’s. GS may occur as a manifestation of a systemic myelogenic leukaemia or it may precede systemic manifestations of peripheral blood and bone marrow. When GS precedes the development of systemic leukemia the diagnosis can be difficult for clinicians. Owing to the rarity of GS there are no large studies analyzing prognostic factors in these patients. The presence of MS at diagnosis in a leukaemic patient was traditionally considered to represent a marker for poor clinical outcome and shorter survival. Herein, we described a patient with newly diagnosed AML and right orbital GS which treated with standard chemotherapy regime and responded dramatically in two weeks. An extra-medullary leukemic infiltration is a bad prognostic sign, because it might act as a reservoir for proliferation of leukaemic cells and an eventual relapse. In addition to good medical response of our case we want to note that a variety of ophthalmologic findings can be seen in leukaemia’s. Careful and detailed ophthalmologic examination plays crucial role in timely diagnosis of many curable disordered including leukaemia’s and has vital importance on the management of leukaemia’s.

Prognostic value of immunohistochemical marker HER2/neu in patients resected for gastric cancer stage IIIA

IntroductionPatients with the same stage of malignancy often have different life-span, which makes it necessary to search for new prognostic factors.The high incidence and low survival rate of patients with gastric cancer also cause an increased interest in studying the immunohistochemical profile of tumors of the stomach. Recently, researchers are studying the prognostic significance of immunohistochemical markers such as: EGFR [10], VEGF [12,15,18], HER2/neu [8,17,19], expression of betakatenin [1], hERG1 [7], p53 [14], PCNA [14,20]Of particular interest is the HER2/neu. Overexpression of HER2/neu promotes tumor growth and plays an important role in the pathogenesis of some human malignancies [17].Nevertheless, the impact of HER2/neu status on the prognosis of patients with gastric cancer remains controversial [6,11,19]. Nakajima Garcia and colleagues believe that the increased expression of HER2/neu in patients with gastric cancer correlates with poor prognosis and more aggressive disease [11]. At the same time, Begnami found that life expectancy in gastric cancer patients with HER-2/neu-positively stained tumors was significantly shorter than in patients with HER-2/neu-negatively stained tumors (17 months vs. 40 months, respectively, p=0.023) [5].The aim of researchStudy the prognostic significance of immunohistochemical marker HER-2/neu in patients resected for gastric cancer stage IIIA.Materials and methodsMaterials for the study were histologic surgical specimens of the primary tumor in 21 patients who had surgery in the Zaporozhye Regional Clinical Oncology Center due to stomach cancer stage IIIA, including 14 men (67%) and 7 females (33%).Patients underwent surgery in the volume: gastrectomy and distal subtotal resection, 86% of patients received adjuvant chemotherapy of standard schemes.Immunohistochemical study of HER2/neu (erbB-2) used a rabbit polyclonal antibody. Immunohistochemical reaction was evaluated as negative in the absence of expression of membrane receptors or HER2/neu coloring immunopositive less than 5% of tumor cells ("-" - no reaction) as low positive - in the presence of 6-10 % of tumor cells immunopositive ("+"), moderately positive - 10-50% ("++") and high pozitive - 50% positive tumor cells ("+++"). For further comparative immunohistochemical study identified two main levels of immunoreactivity: low or reduced protein expression (-/+) and high level or overexpression of the marker (++/+++).To assess survival used the Kaplan - Meier. Comparison of survival curves was performed using the Cox-F test.ResultsThe largest group of patients with gastric cancer stage IIIA consisted of patients with a negative reaction to the presence of receptor HER2/neu (47,6%), the second place is a group of patients with moderately positive reaction - 23.8%, patients with low positive and high pozitive reactions were equally divided - by 14.3%.Median survival of patients with gastric cancer stage IIIA was 19.8 months.The study two groups of patients with a low level or reduced protein expression (-/+) and high level or overexpression of the marker (++/+++) showed a higher survival rate in the former group (median survival was 50 months) compared to the second group, where the median was equal to 16 months (p&lt;0.05).Conclusion1. Median survival of patients with gastric cancer operated stage IIIA was on average 19.8 months.2. High level or overexpression of marker HER2/neu (++/+++) is bad prognostic sign for life expectancy of patients with stage IIIA (p&lt;0.05).3. The prospect of further study is research of the prognostic value of marker HER2/neu in patients with gastric cancer stages I and II.

Immunohistochemical evaluation of vitiliginous hair follicle melanocyte reservoir: is it retained?

Vitiligo is an acquired depigmentaion of skin and hair. The presence of white hair within vitiligo lesions is considered a bad prognostic sign since these lesions are difficult to repigment. Melanocyte reservoir was not extensively studied in vitiliginous white hair. To evaluate pigment cell reservoir in vitiliginous black and white hair. Using immunohistochemical technique, skin biopsies from 30 vitiligo patients (including either black or white hair) and 10 age- and gender-matched healthy subjects were examined. Human Melanoma Black-45 (HMB-45) was used for detecting active melanocytes and Tyrosinase Related Protein 2 (TRP2) for detecting the whole melanocyte lineage including melanocyte stem cells (MelSC). About 61.1% of black hair was positive for HMB-45 and 83.3% was positive for TRP2. About 25% of white hair was positive for HMB-45 and 75% retained TRP2 positivity. Follicular HMB-45 expression and TRP2 expression percentage were significantly lower in white than black hair (P=0.05, 0.04 respectively). Epidermal HMB-45 and TRP2 expression percentages were significantly higher in lesions containing black rather than white hair (P<0.001, P=0.05 respectively). Black hair was significantly associated with histologically pigmented hair follicles (P=0.049), and with residual interfollicular melanin pigment (P=0.007). Melanocytes, either active (melanotic) or inactive (amelanotic which may include MelSC), are not totally absent from vitiliginous white hair. However, intact melanocyte reservoir was observed more in black than white hair. This may add avenues for future research about the possibility of white vitiliginous hair to repigment.

Stigmata of death: for kidneys and patients.

Stigmata of death: for kidneys and patients.

Early CT signs of cerebral infarction: Incidence and significance

Objective. Computerized tomography (CT), as an imaging method, has a key role in brain infarct diagnosis, and from aspect of modern therapy the most important are the first three hours of disease ('therapeutic window'), when application of thrombolytic therapy is possible, which leads to the more favorable outcome. Study aim was to determine possibilities of CT in detection and evaluation of early signs of brain infarct. Methods. Investigation represents four-year long prospective study, in period March 2002 - February 2006, and included 187 patients with suspicion of having acute ischemic stroke. Among early signs of ischemic stroke, hemisphere hypodensity (or part of it), 'insular ribbon' sign, obscuration of lentiform nucleus, cortical sulci loss and hyperdensity of middle cerebral artery (HMCAS), internal carotid artery (HICAS) and posterior cerebral artery (HPCAS), were monitored. Results. Confirmation of stroke did not much influence loss of 'insular ribbon' and lentiform nucleus, and hyperdensity in regions of MCA, ICA and PCA. Only appearance of hypodensity, loss of cortical sulci and timing had an effect on infarct confirmation. Conclusion. Our results suggest that in early infarct detection CT is of great importance, and that the key early infarct signs are hypodensity and cortical sulci loss, and to a lesser degree insular ribbon loss and MCA hyperdensity. An early appearance of brain edema has the highest influence on mortality rate. Appearance of early signs of embolism (HICAS and HMCAS) in the first three hours after attack, combined with early appearance of hyperdensity, represent a bad prognostic sign.

English

INTRODUCTION: Secondary PCL (Plasma Cell Leukemia), arising from multiple myeloma is aggressive and rare variant of multiple myeloma. It is known that AL (Amyloid Light Chain) type of Amyloidosis is primary amyloidosis occurring in multiple myeloma. Attempt to report this case of secondary PCL of light chain secretory type with primary amyloidosis. Emphasis given to this report is so as to highlight the helpful prognostic tools in this rare variety. CASE REPORT: 60 year old female presenting with Hepatosplenomegaly, severe anemia, bleeding manifestations and fever. She had pancytopenia with ESR of 170. Peripheral smear showed plenty of plasma cells >20% and bone marrow biopsy showed mature to immature plasma cells, plenty in number. Skull X ray showing multiple punched out lesions. Electrophoresis was normal, abdominal wall fat stained positive for Congo Red and Serum Free Light Chain Assay was positive. Diagnosed as PCL of light chain secretory type. CONCLUSION: PCL itself, high plasma cell labeling index, increased LDH, increased serum β2microglobulin,renal indices like increased serum creatinine, organomegaly, non secretory variety-all carry bad prognostic signs.