Sleep-disordered breathing includes disorders of breathing that affect airway patency, e.g. obstructive sleep apnoea syndrome, and also conditions that affect respiratory drive (central sleep disorders) or cause hypoventilation, either as a direct central effect or due to peripheral muscle weakness.
Obstructive sleep apnoea syndrome (OSAS) is an increasingly-recognised clinical entity affecting up to 5.7% of children, which, if left untreated, is associated with adverse effects on growth and development including deleterious cognitive and behavioural outcomes. Evidence exists also that untreated OSAS impacts on cardiovascular risk. Close attention should be paid to assessment and investigation of this relatively common condition, instigating early and appropriate treatment to children with OSAS. First-line treatment in younger children is adenotonsillectomy, although other treatment options available include continuous positive airways pressure (CPAP), anti-inflammatory therapies (nasal corticosteroids and anti-leukotrienes), airway adjuncts and orthodontic appliances.
Central sleep-disordered breathing may be related to immaturity of respiratory control and can be associated with prematurity as well as disorders such as Prader-Willi syndrome. In some cases, central apnoeas occur as part of a central hypoventilation disorder, which may be inherited, e.g. Congenital Central hypoventilation Syndrome, or acquired, e.g. Arnold-Chiari malformation, brain tumour, or spinal injury. The treatments of central breathing problems depend upon the underlying aetiology.
Sleep-disordered breathing; obstructive sleep apnoea syndrome; OSAS; cognition; polysomnography; adenotonsillectomy; continuous positive airways pressure; CPAP
There are numerous researches dealing with the correlation between the seasons and climatic factors and the pathogenesis of deep vein thrombosis (DVT). The presented researches show an undoubted correlation between the climatic factors and the pathogenesis of DVT. In the majority of researches, retrospection is noted as a disadvantage. Further prospective researches could aim on testing the correlation between both climatic and thrombotics factors and the pathogenesis of DVT. This may additionally clarify the pathophysiological mechanism of the DVT incidence and contribute to the prevention and treatment of risk groups of patients in certain periods of the year.
Deep vein thrombosis; climatic factors; pathogenesis; prevention
Alport syndrome (ATS) results from X-linked, COL4A5 mutations (85%) or from autosomal recessive homozygous
or compound heterozygous COL4A3/A4 mutations (15%), associated with
alternate thinning and thickening as well as splitting and lamellation of the
glomerular basement membranes. In contrast, familial microhematuria with thin
basement membranes is thought to result from heterozygous COL4A3/A4
mutations. This absolute separation may not always be true. Renal biopsies and
molecular genetics were used to study microhematuric families in the Hellenic
population we serve. The COL4A5 gene was studied by PCR and direct
re-sequencing for new mutations, while PCR-RFLP was used to identify more
carriers of known COL4A5 and COL4A3/A4 mutations. Molecular genetics in two undiagnosed
microhematuric Cypriot families, revealed COL4A5 mutation P628L
indicating X-linked ATS. Of nine males, seven developed end stage kidney
disease (ESKD) between 31 and 56, while two are well at 51 and 57, exhibiting
microhematuria and thin basement membrane nephropathy (TBMN). COL4A5
mutation G624D was also identified in six Greek families. Seventy five members
had DNA tests and 37 proved positive. Four positive males developed ESKD at 61,
51, 50 and 39 years, while the remaining and all females showed only
microhematuria. A literature search revealed eight papers with six similar
hypomorphic COL4A5 mutations presenting as phenocopies of TBMN. In
conclusion, X-linked COL4A5 ATS mutations produce a phenotypic
spectrum with a) classical ATS with early onset ESKD, neurosensory deafness and
ocular defects b) males with only ESKD and late deafness and c) males due to
missense mutations, such as G624D and P628L that may only exhibit
microhematuria, TBMN, mild chronic renal failure (CRF) or late onset ESKD.
Consequently when investigating “benign familial hematuria” these and other
similar X-linked COL4A5 mutations should also be searched for.
Alport syndrome; benign familial hematuria; COL4A3/COLA4/COL4A5 mutations; hypomorphic COL4A5 mutations; phenotypic heterogeneity; thin basement membrane nephropathy
Background and aim: Νon-motor symptoms in Parkinson’s disease (PD) are very common and contribute to the severity of patient’s disability. We evaluated the frequency of nonmotor symptoms in patients with PD and we explored the influence of disease characteristics on the presence of these symptoms.
Patients and methods: One hundred sixty six patients and sixty six matched controls were enrolled in the study. The Non-Motor Symptoms Questionnaire (NMSQuest), a 30-item self-completed questionnaire, was used for the evaluation of nonmotor symptoms.
Results: Non-motor symptoms were more common in PD patients than controls. Mean ± SD NMSQuest score was 6.76 ± 4.22 in PD patients and 5.44 ± 4.45 in controls (p=0.035). The more common non-motor symptoms in PD patients were urinary urgency (54.3%), nocturia (51.8%), constipation (45.7%) and sadness (42.1%). There was a correlation between NMSQuest score and severity of the disease.
Conclusion: Non-motor symptoms in PD are too important to remain undetected. By incorporating into every day practice the use of suitable, reliable questionnaires, we will be able to facilitate detection and management of these symptoms.
Parkinson disease; non-motor symptoms; NMS Questionnaire
Introduction: Laryngeal cancer, especially in the advanced stages, is a highly devastating disease, characterized by increased invasiveness and high rates of metastasis. Gelatinases A and B (MMP-2 and -9 respectively) are of particular interest due to their contribution to various stages of carcinogenesis. There is a growing body of evidence with regard to the prognostic value of certain MMPs and their possible role as tumour markers.
Aim: To identify the pattern of alteration of serum gelatinases A and B in patients with laryngeal cancer following treatment, and a possible correlation with various clinicopathological parameters.
Materials and methods: Forty nine patients were included in this study. Pre-treatment and post-treatment serum samples were collected and processed by gelatin zymography and western blotting.
Results: Only the latent forms of MMP-2 and -9 were identified. Both gelatinases were increased in the serum of laryngeal cancer patients compared to healthy individuals. Patients with supraglottic tumours and active smokers had significantly higher pre-treatment levels of proMMP-2 than patients with glottic tumours (p < 0.05) and ex-smokers (p < 0.05), respectively. Patients with primary disease and patients with lymph node involvement showed lower serum proMMP-9 pre-treatment levels than patients with recurrence (p < 0.05) and patients without neck disease (p < 0.1), respectively. During the follow-up period the proMMP-2 serum levels increased significantly in the first ten to fifteen days after treatment, gradually decreasing over the following months. The proMMP-9 serum levels showed a gradual decrease after treatment, which was statistically significant (p<0.05).
Conclusions: The post-treatment alteration pattern of proMMP-9 serum levels shows a possible role of this molecule as a tumour marker in laryngeal cancer. Further research is necessary to clarify the contribution of both gelatinases to the disease progress and determine their role as prognostic factors and tumour markers.
MMP-2; MMP-9; matrix metalloproteinases; gelatinases; serum; head and neck cancer; laryngeal cancer
Aim: This study was to investigate whether the use of hormonotherapy after concurrent radiotherapy (RT) and trastuzumab (T) has a contribution to the development of radiation fibrosis in the lungs.
Materials and Methods: Seventy Wistar Albino rats were divided into seven groups as follows: Group C: control, Group RT: RT only; Group T: trastuzumab only; Group RT+T+Tam: tamoxifen following concurrent RT and trastuzumab; Group RT+T+Le: letrozole following concurrent RT and trastuzumab; Group RT+T+An: anastrazole following concurrent RT and trastuzumab; Group RT+T+Exe: exemestane following concurrent RT and trastuzumab. Trastuzumab was prepared at an equivalent dose of 6 mg/kg. RT was administered 2 hours after T to the thoracic region at a dose of 12 Gy. Hormonotherapy was initiated one week after RT and administered by oral gavage once daily for 6 months. At the end of 24 weeks, the rats were sacrificed after being sedated with anesthesia. Both lungs were removed en bloc and blocked in paraffin. The level of fibrosis in each cross-section was assessed with the help of a scale.
Results: Significant differences were observed between the groups in terms of pulmonary fibrosis scoring. Statistically significant differences were observed when the radiotherapy group was compared to the C, T, T+RT+An, T+RT+Le and T+RT+Exe groups (p<0.05). Significant differences were found between the T+RT+Tam group and the C, T, T+RT+An, T+RT+Le and T+RT+Exe groups (p<0.05).
Conclusions: This study showed that the sequential administration of aromatase inhibitors following concurrent thoracic irradiation and T decreases radiation-induced pulmonary fibrosis. However, tamoxifen was found to have an opposite effect.
Pulmonary fibrosis; hormonotherapy; trastuzumab; irradiation; rats
Background: Hypofractionated Radiotherapy (RT) regimens for breast cancer, although reduce cost and time for patients and health care systems, could have a negative impact on normal underlying lung tissue. We studied and compared lung function and the post–RT radiological changes using High-Resolution Computed Tomography (HRCT) in early breast cancer patients, treated with 3-Dimentional conformal whole breast radiotherapy (WBRT) using either conventional or hypofractionated regime.
Patients and Methods: Between 2008 and 2009, 61 early breast cancer patients (T1-2N0M0) were randomised into two groups .Group A (n=31) received standard radiotherapy with 50Gy/25f/5w plus boost 10Gy/5f/1w to tumour bed. Group B (n=30) received 43.2Gy/16f/22d plus boost 10Gy/5f/1w to tumour bed. Patients of both groups were subjected to dynamic lung testing, using spirometry and gas diffusion tests on Day 0 (D0, before RT), during RT and after completion of RT at 3 and 6 months. HRCT scans were performed in all patients at baseline, and 3,6,12 months after completion of RT. Respiratory symptoms were recorded at 3 and 6 months post completion of RT. Dosimetric factors, such as Central Lung Dose (CLD), lung Volume receiving more 20 Gy (V20), D25 and Mean Lung Dose (MLD) were calculated for all patients.
Results: At 3 months after RT, the pulmonary changes were classified at HRCT as follows: 91.8 % were Grade 0, 8.19 % Grade 1, and 0 % Grade 2. At 6 months, 86.98 % were Grade 0, 11.47 % Grade 1, and 1.6 % Grade 2. At 12 months, 88.52 % were Grade 0, 9.19 % Grade 1 and 3.27% Grade 2. Univariate analysis showed strong association between radiation pneumonitis, age and all dosimetric parameters. There was no association between fractionation type and incidence of RN. FEV1, FVC, FEV 25, FEV 50 and DLCO showed no statistically significant reduction in both treatment groups in 3 and 6 months following completion of RT, compared to baseline. Multivariate analysis showed no relation between HRCT findings and other variables (age, smoking, chemotherapy, hormonotherapy, V20).
Conclusion: Lung toxicity, as assessed with HRCT and PFTs, was minimal in both treatment arms and our results are in consistency with other published data. Hypofractionated RT was a safe modality and well tolerated by the majority of the patients. Longer follow-up is required for robust assessment of incidence of late lung fibrosis in our series.
Hypofractionated breast radiotherapy; whole breast radiotherapy; radiation pneumonitis; spirometric tests; high resolution computed tomography
Introduction: Acute kidney injury (AKI) may result in complete recovery in some of the patients and partial recovery in others. AKI episodes may accelerate the progression to chronic kidney disease and end-stage renal failure, while risk for morbidity and mortality is high following AKI. Discharge of patients from the hospital, independently from dialysis is a crucial outcome. Many patients without a need for dialysis, require follow-up for various durations and different treatments. The objective of this study was to compare mean recovery time of the patients followed-up due to prerenal, renal and postrenal AKIs.
Method: In this prospective observational study, a total of 159 patients hospitalized in Bulent Ecevit Hospital, clinic of nephrology or monitored in the other wards and intensive care unit due to AKI, between June 2011 and January 2012, were enrolled. The cases were divided into three groups as prerenal, renal and postrenal, and monitored with the daily visits and renal function testing.
Results: Prerenal AKI was seen by 54%, while renal AKI was observed by 34% and post-renal AKI by 12%. Incidence of chronic kidney disease was 17.6%. Totally 43 patients required hemodialysis (27%). Of these patients, 23 were in the prerenal AKI (53.4%), 15 in the renal AKI (34.8%) and 5 (11.6%) in the postrenal AKI group. Blood urea nitrogen (BUN) and creatinine levels were dropped to the basal values only in the prerenal AKI group, on the seventh day of treatment. These levels remained higher in the postrenal and renal groups on the 7th day of treatment compared to the basal values. BUN levels decreased to the normal values on average 7th day in the postrenal, while remained higher in the renal group.
Conclusion: Prerenal AKI patients recovered in seven days with a proper treatment, although AKI patients due to other reasons should be followed-up for a longer time.
Acute kidney injury; prerenal; renal; postrenal acute kidney injury; recovery time
Background: Despite the efforts for more transplants performed with organs from deceased donors, the living renal transplantation is still the predominant transplant activity in the Balkan region. In order to adress the severe organ shortage, we started accepting unrelated (emotionally related) living donors (LURD). Here we present our 10-year experience with living unrelated renal transplantation (LURT).
Methods: Twenty four LURT were performed in our center in the last 10 years. The mean recipients and donors age was 41.7 and 47.2 years, respectively. As LURD spouses (n=17) and extended family members (n=7) were accepted predominantly. All donors went through careful psychological evaluation in order to confirm emotional relationship. The final decision was taken after both the recipient and the donor signed a consent in front of a judge. A quadruple sequential immunosuppressive protocol was used in all recipients. The 5-year Kaplan Meier graft survival rate, HLA mismatch, rejection episodes, delayed graft function, serum creatinine and Glomerular filtration rate-Modification of the diet in renal disease (GFR-MDRD) were analyzed. The results were compared with 30 living related renal transplants (LRT) performed during the same time with mean recipients and donors age of 35.9 and 58.5 years, respectively.
Results: The mean follow up for LURT and LRT recipients were 81.4 and 79.6 months, respectively. There was a significant difference regarding recipients and donors age, HLA mismatch (5.07 and 2.9) and rejection episodes (16% vs. 11%) in LURT and LRT recipients. The 5 years graft survival rate was excellent in both groups (83 and 81%, respectively). There was no significant difference in 5 years serum creatinine (129.3 vs 121.1 μmol/lit) and 5 years GFR-MDRD (56.6 and 58.6 ml/min).
Conclusion: The authors present an excellent 5-year graft survival rate in both LURT and LRT recipients. Therefore, LURT could ameliorate the severe organ shortage in the region and could be recommended as a valuable source of organs in the countries with developed and underdeveloped deceased donor donation.
Kidney unrelated transplantation; Kaplan-Meier surviving curves; glomerular filtration rate
Background/Aim: Residual or recurrent medullary thyroid carcinoma (MTC) after thyroidectomy is diagnosed by elevated serum calcitonin (CT) levels. However, in minimal residual MTC or C-cell hyperplasia (CCH), where imaging studies are often negative, basal CT levels are frequently normal and CT stimulation tests are required. We aimed to compare CT stimulation tests with calcium, pentagastrin and their combination in identifying minimal residual MTC and CCH.
Material and methods: We studied 10 post-thyroidectomy patients with MTC and 20 first-degree relatives of the patients who had no clinically apparent MTC. We performed 54 combined (calcium plus pentagastrin) stimulation tests, 35 calcium stimulation tests and 26 pentagastrin stimulation tests.
Results: Basal CT levels were abnormal (≥500 pg/ml) in 4 patients with apparent metastatic disease (Group 1A) and in 2 patients with minimal residual disease (Group 1B) but were normal (0-300 pg/ml) in 4 patients with no residual disease (Group 1C) and in the relatives (Group 2). In Groups 1A, 1B and 1C, maximal elevation in CT levels was greater after the combined stimulation test than after calcium or pentagastrin tests. The combined stimulation test induced the greatest increases (920, 700 and 706 pg/ml, respectively) in 3 relatives (Group 2); CCH was confirmed histologically in these patients. Side-effects were mild, short-lasting and of similar intensity and duration during all tests.
Conclusions: Patients with subclinical MTC (minimal residual or recurrent MTC) or their relatives (with CCH) usually have normal basal CT levels and stimulation tests are necessary. Combined test represents the most sensitive and safe stimulation test for the diagnosis of subclinical hypercalcitonemia.
Medullary thyroid carcinoma; C cell hyperplasia; calcium stimulation test; pentagastrin stimulation test; combined stimulation test; residual disease
Background: Data for osteoporotic hip fractures in Greece is limited and little is known upon the meaning of family support during the postoperative/rehabilitation period.
Objective: To identify the factors influencing the mortality after hip fractures in the elderly, the effect of rehabilitation and family support in the post-fracture course, and the impact of these fractures on the family of the injured elderly.
Methods: We conducted an observational study of 218 consecutive patients older than 60 years of age, who underwent surgical management of a unilateral hip fracture at a tertiary hospital of Central Greece, with follow-up contacts at 30 days, 3 months and one year. Demographic characteristics, pre- and post-fracture residential and functional status, assessment of basic activities of daily living (ADL), co-morbidities, type and mechanism of fracture and hospitalization data as well as the modification of activities of the patients’ relatives were recorded.
Results: Fifteen patients (6.9%) died during hospitalization; thirty-nine (17.9%) died within one year of fracture. The factors that were predictive of in-hospital, 30-days and one-year mortality, based on multivariate analysis, were male sex, advanced age >85 and Charson index >3.
There was a significant association between delayed surgery (>48 hours) and increased in-hospital mortality. The percentage of patients assessed as ADL A or B at baseline, decreased form 84% preoperatively to 50.4% one year postoperatively. Only one-third of patients walking without aid before the fracture returned to the previous state. Family members modified their activities in 48% of cases to assist their relatives with a hip fracture.
Conclusions: One-year mortality in patients with hip fractures was 17.9%. Surgical delay (>48 hours) increased in-hospital mortality. Comorbidities >3, male sex, and advanced age increased the risk of in-hospital and post-discharge mortality during the 1st year. Twelve months postoperatively, half of patients walking without aid before the fracture returned to the previous state. Despite the beneficial effect of family support, the lack of organized rehabilitation programs and geriatric units are potential negative factors for patients’ functional outcome. In addition, 48% of patients’ relatives changed their daily activities to assist their relatives.
Hip fractures; one-year mortality; risk factors; rehabilitation; family support
Background and Aim: Extracapillary proliferation (crescent) was not included in the Oxford classification, although previous attempts to correlate the crescent with clinical outcomes have produced conflicting results. In this study, we investigated the clinical and morphological significance of extracapillary proliferation in a group of IgA nephropathy (IgAN) patients with regard to the Oxford classification.
Patients and Methods: In an observational study conducted on IgAN patients, we collected a total of 114 biopsies. We diagnosed IgAN by light and immunofluorescence for all patients.
Results: Of the 114 patients, 70.2% were male. The mean age of the patients was 37.7 ± 13.6 years. The mean proteinuria was 1742 ± 1324 mg/day. The mean serum creatinine was 1.6 ± 1.5 mg/dL. Twenty-five (21.9%) patient kidney biopsies had extracapillary proliferation. We found a significant positive correlation between the number of crescents and serum creatinine (p<0.001). Furthermore, we found a positive association between the nephrotic syndrome and the total number of crescents (p<0.05). Additionally, we observed a significant positive correlation between the amount of sclerosed glomeruli and extracapillary proliferation (p=0.028).
Conclusion: Our findings confirm that extracapillary proliferation has a significant association with proteinuria and sclerotic glomeruli. We anticipate that extracapillary proliferation will be included in a revision of the Oxford classification of IgAN to widen the scope of the classification.
IgA nephropathy; nephrotic syndrome; Oxford classification; endocapillary proliferation; crescent; end-stage renal disease; proteinuria
Background: Intrathecal combination of local anaesthetics with opioids produces a synergistic effect without intensifying motor and sympathetic blockades. It also enables successful anaesthesia with use of a low dose of local anaesthetic, which also results in more stable haemodynamics. We compared the characteristics of blockade and maternal–neonatal effects of low-dose levobupivacaine and low-dose bupivacaine combined with fentanyl used in spinal anaesthesia for caesarean section.
Methods: Seventy-two patients undergoing caesarean section with spinal anaesthesia received low-dose 0.5% levobupivacaine (7 mg) plus fentanyl 25 µg (group L) or low-dose 0.5% bupivacaine (7 mg) plus fentanyl 25 µg (group B). The time to achieve sensory blockade of T6, the maximum spread of sensory blockade, time to S2 regression, sensorial blockade levels and motor blockade at the beginning and end of surgery were the parameters assessed. Haemodynamic parameters (systolic and diastolic blood pressures, heart rate), neonatal effects (APGAR scores at 1. and 5. min, umblical-cord gas analyses) were recorded, as were side-effects.
Results: The qualities of sensory blockade were similar and clinically effective in both groups. Significantly more patients had complete motor blockade in group B than in group L at the beginning and end of surgery. Haemodynamic and neonatal parameters were similar between the two groups. Pruritis was a common side-effect in both groups.
Conclusion: In spinal anaesthesia for caesarean section, using low-dose levobupivacaine in combination with fentanyl elicits effective sensorial blockade and less motor blockade with similar haemodynamic and neonatal effects than usage of low-dose bupivacaine in combination with fentanyl.
Local anaesthetics; levobupivacaine; bupivacaine; fentanyl; caesarean section
Background and Aim: Trisomy 13 (Patau syndrome) was first described by Patau et al in 1960. It is characterized by serious head, facial, and extremity anomalies, congenital heart defects, and mental abnormalities. The incidence rate of Trisomy 13 is 1/10.000 live births. Accompanying symptoms and findings vary in rate and severity among the cases. Tetralogy of Fallot and metopic synostosis are very rare abnormalities in patients with Trisomy 13. In this study, we aimed to present a newborn girl with trisomy 13 who had multiple congenital malformations accompanied by tetralogy of Fallot and metopic synostosis.
Description of the case: The patient was delivered at 40 weeks of gestation, and admitted to the neonatal intensive care unit due to respiratory distress and physical abnormalities. The newborn examination revealed multiple dysmorphic features. She had boot-shaped appearance on the chest radiograph. Chromosome analysis demonstrated mosaic trisomy 13.
Conclusion: Patients with trisomy 13 may have different type of gene variations and malformations; however, the most common type of gene variation is classic trisomy 47, XX +13, and the most common malformations are facial anomalies and congenital heart defects. In addition, tetralogy of Fallot and metopic synostosis may accompany trisomy 13.
Trisomy 13; tetralogy of Fallot; metopic synostosis
Background and Aim: Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is a very rare tumor. To date, less than 50 cases of PRMC have been described in the English literature.
Description of the case: We report a case of PRMC in a male patient who presented with chronic lower back pain for 8 months. Computed tomography (CT) showed a retroperitoneal mass in the right abdominal cavity, measuring approximately 4cm × 3cm. At laparotomy, a predominantly cystic, well-encapsulated mass was observed in the right retroperitoneum. The mass was excised without rupture. The final diagnosis of PRMC was confirmed by pathology.
Conclusion: To our knowledge, this is the 5th published case report of a PRMC in a male patient. No other reported cases of PRMC in Chinese men are available in the literature. A literature review of PRMC in the English language literature is also provided.
mucinous cystadenocarcinoma; retroperitoneal tumor; laparotomy; pathology; male; cystic neoplasm
Background: Although damage of the heart vessels is a possible complication of blunt thoracic trauma, occlusion of the right coronary artery is rare and demands high level of suspicion by the emergency physicians.
Objective: Our objective is to present a case of fatal acute occlusion of the right coronary artery after blunt thoracic trauma due to vehicle accident and conduct a brief review of the current literature.
Case report: A 58-year-old sustained chest trauma after a vehicle accident, complicated by acute occlusion of the right coronary artery. Despite invasive intervention the patient deteriorated and died due to multi-organ failure.
Conclusion: Acute occlusion of the right coronary artery is a rare complication of blunt chest trauma. Early diagnosis and intervention, collaboration between different specialties and proper hospitalization are vital for the outcome of the patient.
Inferior wall myocardial infarction; chest injury; fatal outcome
Background: Malignant triton tumor (MTT) is an histological deviation of malignant peripheral nerve sheath tumor with additional rhabdomyosarcomatous elements. It is very rare, profoundly aggressive, with a tendency to recur locally and metastasize early. If manifests itself more often in individuals with neurofibromatosis type I (NF-1) disease but also sporadically or post radiotherapy.
Description of case: A 57-year-old male was admitted with a history of malignant triton tumor of the chest wall. Despite prior aggressive locoregional treatment including wide excision and adjuvant consolidating radiotherapy, the tumor recurred. The patient underwent a new operation and systemic chemotherapy, but expired a few months later due to disease progression.
Conclusion: MTT is exceedingly malignant requiring multimodality treatment. The cornerstone of management is radical surgical resection with clear margins. Nevertheless, the overall prognosis remains dismal.
Masaoka operation; neurofibromatosis disease; malignant peripheral nerve sheath tumor; triton tumor
Background/Aim: Synovial chondromatosis associated, intra-articular loose bodies are usually small in size. Giant intra-articular loose bodies are rare.
Case report: We present the case of a patient with synovial chondromatosis associated giant intra-articular loose bodies located under the patella and the intercondylar fossa, treated successfully with combined arthroscopic and open excision.
Conclusion: Giant intra-articular loose bodies should be considered when treating patients with synovial chondromatosis. Arthroscopy confirms the diagnosis, allows the thorough examination of the knee joint, and subsequent excision of small or medium size attached synovial nodules or intra-articular loose bodies. Arthrotomy may be needed to excise giant loose bodies.
Synovial chondromatosis; knee joint; giant; joint loose bodies; arthroscopy
Myxoma; dyspnea; echocardography
Dialysis patients; haemodialysis; nutritional factors; malnutrition
Pneumococcosuria; child; female; dysuria; Streptococcus pneumoniae
BCG; intravesical; urinary bladder cancer; cyctitis; mycobacterium bovis; dysuria
Sentinel lymph node biopsy; lymphadenectomy; primary melanoma
Lithiasis continues to be an important factor in chronic renal disease, since it leads to chronic tubulo-interstitial nephritis, which is estimated to be involved in 15- 30% of cases of end stage chronic renal insufficiency. It is believed that in order for a stone to be formed, a solid phase needs to be first produced from microcrystals (the nucleus), which are formed from salts (and other substances) that are found dissolved in the urine (nucleosis of crystals). Afterwards, the crystals that constitute the core increase in size and link up with each other (incorporation). The main physiochemical factors that participate in the creation of the nucleus are the hypersaturation of urine, the lack of inhibitors of nucleosis and probably the organic substrate. In order for the increase in size and the incorporation of crystals to take place, hypersaturation, the lack of inhibitors, the organic substrate and the epitaxis, during which crystals of a substance are attached to the surface of other crystals of a different chemical structure (e.g. crystals of oxalic calcium onto crystals of uric acid) are needed. Various molecules have been found in urine, which modify to an important degree the adherence of crystals to the surface of epithelial cells. It also seems very likely that certain reactions of renal epithelial cells that follow the uptake of calcium oxalate monohydrate (COM) crystals are due to oxalate ions, which are released during the process of deconstruction of the intracellular crystals. From here, the crystals migrate in the median tissue, where an inflammatory reaction takes place and finally the crystals are destroyed. Macrophages gather in the crystals of the median tissue. The osteopontin which is related to the crystals acts as a chemotactic factor for the macrophages and therefore is perhaps involved in this process too. The uptake of crystals appears to be subjected to regulating mechanisms, as molecules which regulate the endocytosis of COM crystals, a process that is related to changes in the special components of the cytoskeleton, have been observed. In conclusion, the processes of adherence and of endocytosis promote the detention of crystals in the nephron, whilst intracellular deconstruction is an important factor of defence against the deposition of calcium in the kidney.
Urolithiasis; calcium oxalate; monohydrate crystals; MDCK; inhibitors
One of the four transmembrane receptors that belong to the erB family, is the HER2/neu oncoprotein. It forms heterodimers by binding to specific ligands, enhancing cell signaling and assisting in cell growth and differentiation. A variety of human epithelial tumors are characterised by an overexpression and gene amplification of the HER2/neu oncoprotein. This is the case of breast tumors, in which the receptor’s overexpression and its gene have been studied extensively and its overexpression has been associated with unfavorable prognosis.
In addition, HER2/neu plays a major role in understanding the oncogenesis of prostate adenocarcinoma. For this reason, clarifying the HER2/neu expression is particularly important in androgen independent prostate cancer (PCa), due to the increasing interest in using anti-HER2 targeted therapies for advanced disease treatment. On the other hand, the overexpression of HER2/neu has been reported to release soluble extracellular domain (ECD) in the serum of PCa patients. For this reason, the present review focuses only on studies referring to Serum HER2/neu levels in PCa patients. Serum levels of HER2/neu generally increase with advanced disease state and higher levels have been associated with recurrent or metastatic PCa and a clinically worse outcome. Therefore, it may be concluded that since there is a correlation between increased HER2/neu levels and a poor prognosis in prostate adenocarcinoma, serum HER2/neu could be used in clinical practice and follow up of patients with advanced PCa.
HER2/neu oncoprotein; prostate cancer; serum; ECD; metastatic; advanced disease