Potential Role for a Panel of Immunohistochemical Markers in the Management of Endometrial Carcinoma

BACKGROUND: In order to improve the efficacy of endometrial carcinoma (EC) treatment, identifying prognostic factors for high risk patients is a high research priority. This study aimed to assess the relationships among the expression of estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, and the different histopathological prognostic parameters in EC and to assess the value of these in the management of EC. METHODS: We examined 109 cases of EC. Immunohistochemistry for ER, PR, HER2, and Ki-67 were evaluated in relation to age, tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage and grade, depth of infiltration, cervical and ovarian involvement, lymphovascular space invasion (LVSI), and lymph node (LN) metastasis. RESULTS: The mean age of patients in this study was 59.8 ± 8.2 years. Low ER and PR expression scores and high Ki-67 expression showed highly significant associations with non-endometrioid histology (p = .007, p < .001, and p < .001, respectively) and poor differentiation (p = .007, p < .001, and p <. 001, respectively). Low PR score showed a significant association with advanced stage (p = .009). Low ER score was highly associated with LVSI (p = .006), and low PR scores were associated significantly with LN metastasis (p = .026). HER2 expression was significantly related to advanced stages (p = .04), increased depth of infiltration (p = .02), LVSI (p = .017), ovarian involvement (p = .038), and LN metastasis (p = .038). There was a close relationship between HER2 expression and uterine cervical involvement (p = .009). Higher Ki-67 values were associated with LN involvement (p = .012). CONCLUSIONS: The over-expression of HER2 and Ki-67 and low expression of ER and PR indicate a more malignant EC behavior. An immunohistochemical panel for the identification of high risk tumors can contribute significantly to prognostic assessments.

Sensorineural hearing loss following radiotherapy in patients with nasopharyngeal carcinoma. A prospective study

This prospective study was designed to evaluate the effect of radical external irradiation on hearing function after treatment of nasopharyngeal carcinoma. Twenty-eight patients [52 ears] were included in the study. Pure tone audiogram was performed before and one year after completion of the radiotherapy course. The results revealed a deterioration of bone conduction threshold at 4 kHz in eight ears. Patients older than 50 years and ears with bone conduction threshold >10 dB at 4 kHz before radiotherapy were more vulnerable

Effect of atropine and diclofenac on the contractility of dog's vesico-urethral smooth muscls vitro

Smooth muscle preparations from various parts of the vesicourethral system of dogs and cats were used. These were suspended in Tyrode's solution at 37°C, bubbled with carbogen. The contractile response was recorded through an isotonic muscle transducer on a chartmover. It was observed that while the response to the ganglion stimulant Dimethyl phenyl piperazinium [D, M.P.P] is variable i.e. contraction, relaxation or no response acetyl choline induced contraction in all specimens. In addition atropine escape phenomenon was not uniformly distributed.Also alpha and beta adrenergic blockers in combination with prostaglandins synthetase inhibitor can induce complete block in response to acetyl choline in areas where atropine escape phenomenon was observed.These observations, in addition to the constant demonstration of atropine escape phenomenon in our in vivo experiments, suggest that a central mechanism plays an important role in atropine escape phenomenon and this phenomenon is variable in our in vitro experiments. Also, prostaglandins may be partially responsible for atropine resistance of the detrusor

Effect of atropine and diclofenac on the contractility of dog's vesico-urethral smooth muscle in vivo

Female dogs were used, the bladder body was surgically separated from the trigone and urethra. A millar transducer was used to record the intravesical pressure.Another double channel transducer records pressure changes at the level of trigone and proximal urethra These transducers were connected to honeywell amplifier. The signals were recorded on a honeywell multichannel vesicorder. The response of the lower urinary tract of chemical or electrical stimulation was recorded as pressure changes which represent either contraction or relaxation. In vivo studies revealed that atropine can block 40% of detrusor and trigonal contractions and 30% of the proximal urethral contractions induced by both intra-arterial injection of dimethyl phenylpiperazinium [D.M.P.P] and electrical stimulation of pelvic nerves. The addition of adrenergic blockers did not block completely the contractions except in the proximal urethra where 90% of the contractile response was blocked. Thus atropine escape phenomenon was mainly manifested in the fundus and trigonal regions. Prostaglandins may be responsible for atropine escape phenomenon since diclofenac [prostaglandins synthetase inhibitor] and the multiple autonomic blockers can block about 90-95% of fundus and trigonal induced contractions meanwhile complete block in the proximal urethra was observed. Injection of prostaglandins after autonomic blockers and diclofenac led to contraction of the bladder body, trigone and urethra [PG F2alpha] and contraction of the bladder body and relaxation of trigone and urethra [PG E2]

Ileal replacement of the bilharzial ureter

Our 14 years experience with the use of isolated ileal segments, for replacement of the bilharzial ureter is retrospectively analyzed. Fifty two patients were subjected to this procedure. Follow up data are available for 38 patients in whom 52 ureters were repaired. The results are generally unsatisfactory because of the high rate of morbidity and mortality and the low percentage of functional improvement. The risk is higher in those with low creatinine clearance. We recommend avoiding this operation as far as possible. If the operation is unavoidable tapering of the ileal segment with antireflux ileovesical anastomosis may improve the outcome, although this has to be proved

Long term effects of oral hormonal contraceptives on the urinary tract

One Hundred healthy women in the childbearing period and a similar number of pill users for more than three years were investigated. Significant bacteriuria was demonstrated in 36% of pill users compared with 16% in healthy controls. Dilatation of the lower ureter was encountered in 24% of pill users and in 8% of controls. Grade I vesicoureteric reflux was demonstrated in 15 women on oral hormonal contraceptives compared with 4% in controls. Hypotonicity of the urinary tract musculature, as well as other factors, are believed to be responsible for these changes. Periodic urologic investigations are suggested for these who use pills for prolonged time. Structural changes demonstrated in the urinary tract during normal pregnancy have been attributed at least in part to the presence of placental steroid hormones [Youssef, 1956 : Fainstat, 1963]. The effects of oral hormonal contraceptives on the upper urinary tract had been studied with contradictory results. Marshall et al., [1966] observed dilatation of the ureters and renal pelvis in women using oral hormonal con-pills were discontinued. However felding [1966] who followed a small group of women taking Anovlar I for 3-9 months, found no radiologic evidence of ureteral dilatation. Descending urograms were normal in 10 patients on oestrogen-progestagen combination studied by Marchant [1972]. Couriere et al., [1970] observed no urologic changes in women after year of pill use. Recently, Youssef et al., [1975] demonstrated bladder hypotonia and increased capacity durign the use of oral hormonal contraceptive which was more manifest during the second year. Aaso, Zahran et al., [1976] observed bladder trabeculations in pill users. However, the susceptibility of the urinary system to infection after servical years of pill use is not clear. In most of the reports, the duration of pill use was in the range of 1-3 years [Courriere et al., 1970 and Zahran et al., 1976]. This stimulated us to study women on oral hormonal contraceptives for more than three years