Medical Library

Effects of environmental stress on intertidal mussels and their sea star predators.

Consumer stress models of ecological theory predict that predators are more susceptible to stress than their prey. Intertidal mussels, Mytilus californianus, span a vertical stress gradient from the low zone (lower stress) to the high zone (higher thermal and desiccation stress), while their sea star predators, Pisaster ochraceus, range from the low zone only into the lower edge of the mussel zone. In summer 2003, we tested the responses of sea stars and mussels to environmental stress in an experiment conducted on the Oregon coast. Mussels were transplanted from the middle of the mussel bed to cages in the low and high edges of the mussel bed. Sea star predators were added to half of the mussel cages. Mussels and sea stars were sampled between June and August for indicators of sublethal stress. Mussel growth was measured, and tissues were collected for heat shock protein (Hsp70) analyses and histological analyses of reproduction. Sea stars were weighed, and tissues were sampled for Hsp70 analyses. Mussels in high-edge cages had higher levels of total Hsp70 and exhibited spawning activity earlier in the summer than mussels in the low-edge cages. Sea stars suffered high mortality in the high edge, and low-edge sea stars lost weight but showed no differences in Hsp70 production. These results suggest that stress in the intertidal zone affected the mobile predator more than its sessile prey, which is consistent with predictions of consumer stress models.

Petes LE, Mouchka ME, Milston-Clements RH, Momoda TS, Menge BA.

Department of Zoology, Oregon State University, Corvallis, OR, USA, lpetes@bio.fsu.edu.

B7-H1 up-regulated expression in human pancreatic carcinoma tissue associates with tumor progression.

PURPOSE: Aberrant tumor cell B7-H1 expression, a member of B7 family that can predominantly stimulate interleukin 10 (IL-10) products, contributed to the tumor immune evasion and tumor progression. This study was designed to investigate the expression of B7-H1 and IL-10 in normal pancreas tissues and pancreatic carcinoma samples, and to evaluate clinical significance of B7-H1 expression in pancreatic carcinoma. METHODS: First, the B7-H1 and IL-10 expression in 40 pancreatic carcinoma samples and 8 healthy pancreas specimens using reverse transcription-PCR (RT-PCR) and western-blotting was detected. Localization of B7-H1 and IL-10 was confirmed by immunohistochemical (IHC) staining. Next, the association between B7-H1 expression and tumor differentiation and tumor stage was analyzed. Finally, the correlation between tumor-associated B7-H1 and IL-10 was evaluated. RESULTS: Pancreatic carcinoma samples demonstrated the up-regulated expression of B7-H1 and IL-10 at mRNA and protein level compared with normal pancreas tissues. IHC staining revealed that B7-H1 and IL-10 was almost localized in tumor cells. Analysis of relationship between B7-H1 and tumor clinicopathological characteristics showed that B7-H1 expression was significantly associated with poor tumor differentiation (P < 0.01) and advanced tumor stage (P < 0.01). Meanwhile, tumor-associated B7-H1 expression was also correlated with IL-10 products (P < 0.01, R (2) = 0.6985, mRNA level; P < 0.01, R (2) = 0.7236, protein level) in tumor cells. CONCLUSIONS: Our findings for the first time demonstrated up-regulated B7-H1 expression in human pancreatic carcinoma tissues, which might play a role in tumor progression and invasiveness. This expression seemed to be related to the ability of B7-H1 to promoting IL-10 secretion.

Geng L, Huang D, Liu J, Qian Y, Deng J, Li D, Hu Z, Zhang J, Jiang G, Zheng S.

Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Department of Hepato-Biliary-Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.

Tamoxifen for salivary gland adenoid cystic carcinoma: report of two cases.

PURPOSE: Adenoid cystic carcinoma of the salivary gland (ACC-SG) is a slow-growing tumor that is refractory to most chemotherapeutic agents. Estrogen receptor (ER) antagonists provide a novel approach for recurrent disease. METHODS: We report two cases of ACC-SC in which Tamoxifen/Toremifene were used. RESULTS: Both patients obtained long-term stability of disease with no associated toxicity. CONCLUSIONS: Given the relatively unsuccessful treatments for ACC-SC and the low toxicity of ER antagonists, such therapy should be considered in these patients for its potential disease-stabilizing effects.

Elkin AD, Jacobs CD.

Department of Medicine, Stanford University School of Medicine, Stanford Cancer Center, 875 Blake Wilbur Dr, Stanford, CA, 94305, USA.

Baseline elevated leukocyte count in peripheral blood is associated with poor survival in patients with advanced non-small cell lung cancer: a prognostic model.

PURPOSE: We aimed to investigate the prognostic significance of several baseline variables in stage IIIB-IV non-small cell lung cancer to create a model based on independent prognostic factors. METHODS/RESULTS: A total of 320 patients were treated with last generation chemotherapy regimens. The majority of patients received treatment with cisplatin + gemcitabine or gemcitabine alone if older than 70 years or with an ECOG performance status (PS) = 2. Performance status of 2, squamous histology, number of metastatic sites >2, presence of bone, brain, liver and contralateral lung metastases and elevated leukocyte count in peripheral blood were all statistically significant prognostic factors in univariate analyses whereas the other tested variables (sex, stage, age, presence of adrenal gland and skin metastases) were not. Subsequently, a multivariate Cox\’s regression analysis identified PS 2 (P < 0.001, hazard ratio 2.57), elevated leukocyte count (P < 0.001, hazard ratio 1.79), squamous histology (P = 0.005, hazard ratio 1.45) and presence of brain metastases (P = 0.035, hazard ratio 1.5) as independent prognostic factors for poor survival. Patients were assigned to one of three risk groups according to the cumulative risk defined as the sum of simplified risk scores of the four independent prognostic factors. Low-, intermediate- and high-risk patients achieved a median survival of 10.2 months (95% confidence interval (CI) 8.9-11.6), 5.1 months (95% CI 4.0-6.2) and 2.8 months (95% CI 0.5-5.2), respectively. The high-risk group encompassed PS 2 patients with two or three adjunctive unfavourable independent prognostic factors. CONCLUSIONS: Performance status, white blood cells count, histology and brain metastases resulted in our series prognostic factors of survival in NSCLC patients treated with chemotherapy at a multivariate analysis. Leukocyte count resulted the stronger factor after performance status. If prospectly validated, the proposed prognostic model could be useful to stratify performance status 2 patients in specific future trials.

Tibaldi C, Vasile E, Bernardini I, Orlandini C, Andreuccetti M, Falcone A.

Division of Medical Oncology, Civil Hospital, Viale Alfieri 36, 57100, Livorno, Italy, tiby@katamail.com.

An unusual complication of umbilical catheterisation.

We report the first case of perforated Meckel\’s diverticulum in a 1-day-old pre-term infant as a consequence of umbilical vein catheterisation. The clinical course consisted of abdominal distension and pneumoperitoneum that occurred after 12 h of life. Perforated Meckel\’s diverticulum was found at laparotomy. Neither inflammatory phenomena nor ectopic mucosa were found at microscopical examination. Perforation of the diverticulum was a complication of umbilical catheter insertion through a narrow lumen in the umbilical cord mistaken for an umbilical vein and connected to Meckel\’s diverticulum through a very short fibrous band. A search of the literature did not reveal any similar cases.

Costa S, De Carolis MP, Savarese I, Manzoni C, Lacerenza S, Romagnoli C.

Division of Neonatology, Department of Pediatrics, Catholic University of Sacred Heart, Largo A. Gemelli, 8, 00168, Rome, Italy, simocosta@yahoo.it.

UPPP combined with radiofrequency thermotherapy of the tongue base for the treatment of obstructive sleep apnea syndrome.

We investigated the outcome of uvulopalatopharyngoplasty (UPPP) combined with radiofrequency thermotherapy of the tongue base (RFTB) in patients with obstructive sleep apnea syndrome (OSAS) with both palatal and retroglossal obstruction, and we compared these results with the results of single level surgery (UPPP). A retrospective cohort study was performed in patients with mild to severe OSAS who underwent UPPP with or without RFTB. Seventy-five patients with both palatal and retroglossal obstruction underwent UPPP, 38 patients without RFTB (group 1) and 37 patients with RFTB (group 2). The outcome of the surgery was measured by both objective success (defined as a reduction of AHI >50% and AHI below 20) and subjective improvement. In group 1 the overall success rate was 42%, and in group 2 49%. Other polysomnographic values (AI, DI, mean SaO2) improved after surgery (not significant). No serious adverse events occurred. Surgical treatment of combined palatal and retroglossal obstruction remains a challenge. Adding RFTB to UPPP results in a mild improvement compared to UPPP alone. Although the addition of RFTB to UPPP seems to result in only a limited improvement, there is no major downside to it. RFTB is well tolerated and safe.

van den Broek E, Richard W, van Tinteren H, de Vries N.

Department of Otorhinolaryngology, Head and Neck Surgery, St. Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.

Ex vivo evaluation of force data and tissue elasticity for robot-assisted FESS.

The objective of this study was to describe and evaluate soft tissue and bone properties of nasal cavity and paranasal sinuses in ex vivo preparations for a safe robot-assisted endoscope movement during functional endoscopic sinus surgery (FESS). In a first experiment we measured forces exerted by the endoscope during FESS with a force/torque sensor. In a second experiment we used a purpose built device to exert forces on chosen tissue structures. The experiment was monitored by a custom software, which records force of the endoscope and the deformation and the breaking point of tissue. All tests were performed on five formalin fixed cadaver heads. In the first experiment we found that the average force during FESS is 2.21 N and the maximal force is 7.96 N. The force-way-ratio measurement shows highest elasticity for the ethmoidal bulla, followed by the lamina papyracea; however, they break at low forces (>/=6 N). Furthermore the carotid canal seems to have the lowest elasticity but it can tolerate forces up to 30 N. Based on these measurements force thresholds can be defined for robot-assisted endoscope guidance. All thresholds have to be assigned to subregions of the nasal cavity and paranasal sinuses.

Wagner I, Tingelhoff K, Westphal R, Kunkel ME, Wahl F, Bootz F, Eichhorn K.

Clinic and Polyclinic for Otolaryngology/Ear, Nose and Throat Surgery, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany, ingo.wagner@ukb.uni-bonn.de.

Recurrent mutation in keratin 17 in a large family with pachyonychia congenita type 2.

Oh Adib C, Jones B, Liao H, Smith FJ, Solomon R, Egan CA, Leachman S.

Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland, caroloh@bigpond.net.au.

Double-level posterior spinal shortening for paralytic osteoporotic vertebral collapse of two vertebral bodies with a normal vertebra in between: a case report.

INTRODUCTION: Spinal shortening is indicated for osteoporotic vertebral collapse. However, this surgical procedure has not been indicated for more than two vertebral levels that are not adjacent. We experienced a rare case of paraparesis due to osteoporotic vertebral collapse of two vertebral bodies with a normal vertebra in between and treated successfully by the double-level posterior shortening procedure. MATERIALS AND METHODS: A 79-year-old woman suffered from delayed paraparesis 2 years after L1 and Th11 vertebral body compression fracture. Plain X-ray photographs showed Th11 and L1 vertebral body collapse, Th7 compression fracture and a kyphosis angle of 30 degrees from Th10 to L2. Plain magnetic resonance imaging showed spinal canal stenosis at Th11 and L1 vertebral body levels. She was treated by double-level posterior spinal shortening using pedicle screw and hook systems. RESULTS: After the procedure, the patient\’s kyphosis angle decreased to 10 degrees and her back pain, leg pain, and sensory deficits improved. She was able to walk by herself. Although new vertebral compression fractures occurred at L4 and L5 in the follow-up period, there has been no deterioration of the neurological symptoms 5 years after the operation. CONCLUSION: Delayed paraparesis after double-level thoracolumbar vertebral collapse due to osteoporosis was treated successfully by double-level posterior spinal shortening using a pedicle screw and hook system.

Kikuike K, Miyamoto K, Hosoe H, Kushima Y, Shimizu K.

Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.

Acetabular reinforcement ring in primary total hip arthroplasty: a minimum 10-year follow-up.

INTRODUCTION: We report the results of a titanium acetabular reinforcement ring with a hook (ARRH) in primary total hip arthroplasty (THA), which was introduced in 1987 and continues to be used routinely in our center. The favorable results of this device in arthroplasty for developmental dysplasia and difficult revisions motivated its use in primary THA. With this implant only minimal acetabular reaming is necessary, anatomic positioning is achieved by placing the hook around the teardrop and a homogenous base for cementing the polyethylene cup is provided. MATERIALS AND METHODS: Between April 1987 and December 1991, 241 THAs with insertion of an ARRH were performed in 178 unselected, consecutive patients (average age 58 years; range 30-84 years) with a secondary osteoarthrosis in 41% of the cases. RESULTS: At the time of the latest follow-up, 33 patients (39 hips) had died and 17 cases had been lost to follow-up. The median follow-up was 122 months with a minimum of 10 years. Eight hips had been revised, leaving 177 hips in 120 living patients without revision. Six cups were revised because of aseptic loosening. Two hips were revised for sepsis. The mean Merle d\’Aubigné score for the remaining hips was 16 (range 7-18) at the latest follow-up. For aseptic loosening, the probability of survival of the cup was 0.97 (95% confidence interval, 0.94-0.99). However, analysis of radiographs implied loosening in seven other cups without clinical symptoms. CONCLUSIONS: The results of primary THA using an acetabular reinforcement ring parallel the excellent results of these implants often observed in difficult primary and revision arthroplasty at a minimum of 10 years. Survivorship is comparable to modern cementless implants. Medial migration that occurs with loosening of the acetabular component seems to be prevented with this implant. Radiographic loosening signs can exist without clinical symptoms.

Sadri H, Pfander G, Siebenrock KA, Tannast M, Koch P, Fujita H, Ballmer P, Ganz R.

Department of Orthopaedic Surgery, Inselspital, University of Bern, 3010, Bern, Switzerland.