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.

Fiberoptic bronchoscopic guidance in percutaneous dilational tracheotomy

Blind percutaneous dilational tracheotomy [PDT] holds a lot of peri-operative complications. A lot of assisting tools have long been used to facilitate guidance during PDT, e.g., laryngeal mask airway [LMA], ultrasound [US] imaging of the neck, light wand for trails-illumination of the soft tissues of the neck, and flexible fiberoptic bronchoscopy. The aim of this work was to compare between blind and fiberoptic bronchoscopic guided PDT as regards ease of the technique and complications of the procedure. A randomized prospective comparative trial. Critical care department, main Alexandria university hospital. Thirty adult patients, requiring elective PDT, and need to maintain a secure airway. They were randomly assigned to 2 groups; blind PDT group I and fiberoptic bronchoscopic guided PDT group II. Both groups used Griggs' forceps technique for PDT. Post-operative complications were recorded. End point was 48-h after the procedure. Number of trials was 1.27 +/- 0.46 and 1.00 +/- 0.00 for groups I and II, respectively. Success rate was 100% in both groups. Procedural duration [in minutes] was 2.93 +/- 1.10 in group I versus 3.93 +/- 1.10 in group II. Bleeding was found in 3 patients and 1 patient for groups I and II. Subcutaneous emphysema occurred in one patient in each group, while tube misplacement was recorded in 2 patients in group I and none in group II. Aspiration pneumonia was found in 2 patients in group I and none in group II. Use of flexible bronchoscopy has succeeded in decreasing the number of trials of needle insertion and decreasing the incidence of overall complications, while blind technique was better in shortening procedural time and avoidance of hypercapnia

Medullary carcinoma of the breast: ten year clinical experience of the Kuwait cancer control centre

Medullary carcinomas of the breast account for fewer than 7% of all invasive breast cancers. Some investigators include medullary carcinomas in the favourable histologic subtype, despite its aggressive histologic appearance. However, others fail to confirm its favourable prognosis. This was a retrospective analysis of sixty-one [61] cases of breast cancer cases diagnosed with Medullary Carcinoma, presenting to the Kuwait Cancer Control Center between 1995 and 2005. Median survival time was 122 months and the seven-year disease free survival was 82%. Overall survival rate was not assessed as no case died during the study period. No cases were metastatic from the start and only eight cases developed metastases, local recurrence or contralateral breast primary. 68.8% of the cases were Stage I or IIA [i.e. no lymph node affection]. There is no overt favourable prognosis of medullary carcinoma when compared to invasive ductal carcinoma. prognosis is more related to stage than histologic subtyping. The majority of cases were negative estrogen and progesterone receptor status and node negative

Infected non-union of the humerus after failure of surgical treatment: management using the Orthofix external fixator

<p><b>INTRODUCTION</b>The failure of a humeral fracture to unite after surgical treatment may be due to many factors. When there are additional complications of infection, treatment by conventional methods of internal fixation becomes very difficult.</p><p><b>MATERIALS AND METHODS</b>We treated 8 infected non-union of diaphyseal fracture of the humerus by the Orthofix external fixator. All had previous surgical treatment. Non-union followed plating in 6 cases and in 2 cases after the external fixator. All patients had pain, at least one sinus discharging pus and severe functional impairment of the affected arm. There were 6 men and 2 women with a mean age 40.6 years.</p><p><b>RESULTS</b>Bone union was achieved in all cases. The mean time to union was 4.5 months (range, 2 to 8). Patients expressed high levels of satisfaction with the outcome, despite relatively modest improvement in pain and function, mainly because of long standing infection and intractable non-union. There were no major pin tract problems requiring the removal of the Schanz screws. Radial nerve palsy developed in 1 patient who recovered spontaneously. No patient required an additional bone grafting procedure.</p><p><b>CONCLUSION</b>The use of the Orthofix external fixator without bone grafting was successful in the treatment of infected non-union of the humeral shaft. It shortened the duration of hospitalisation and immobilisation with moderate functional recovery.</p>