Prognostic Value of Elevated Cyclooxygenase-2 Expression in Breast Cancer

PURPOSE: Cyclooxygenase-2 (Cox-2) is the rate-limiting enzyme in the conversion of arachidonic acid to prostaglandins and can be induced by various agents such as growth factors and tumor promoters. Cox-2 contributes to carcinogenesis and tumor growth. This study was performed to demonstrate the correlation between elevated expression of Cox-2 and pathologic factors in breast cancer. METHODS: Cox-2 expression was analyzed immunohistochemically in paraffin-embedded tumor samples from 40 patients with breast cancer. Cox-2 expression was defined as negative or positive. The correlation between Cox-2 expression and pathologic factors (tumor size, axillary lymph node metastasis, TNM stage and histologic grade) was analyzed. RESULTS: Cox-2 was highly expressed in proportion to tumor size, but the difference was not significant (P>0.05). High Cox-2 expression was observed in the presence of axillary lymph node metastasis and TNM stage III, but was not significant (P>0.05). The Cox-2 expression rate was significantly associated with high histologic grade (I: 42.9%, II: 50.0%, III: 80.0%) (P=0.046). CONCLUSION: Elevated levels of Cox-2 expression were associated with large tumor size, presence of axillary lymph node metastasis, high TNM stage and high histologic grade, and can therefore be a possible marker for poor prognosis. Due to the small number of cases, we couldn't confirm the statistical significance except in terms of histologic grade. Further prospective studies with a large number of cases are required.

Native Ureterotransplant Ureterostomy for Ureteral Obstruction after Simultaneous Pancreas Kidney Transplantation

Significant surgical complications occur in about half of patients after simultaneous pancreas kidney transplantation (SPK) with bladder drainage. Urologic complications are very common in bladder-drained pancreas transplants. Urinary obstruction occurs in either the early or the late period following transplantation. Predictors of urological complications after transplantation have not been well established. Early obstruction is usually diagnosed by an increment of serum creatinine or through imaging studies, such as ultrasound and antegrade pyelogram. Surgical management is inevitable when conservative managements fails. If the length of the donor ureter is sufficient, it is possible to redo the ureteroneocystostomy. However, if this is not the case or the stricture is at a high level, a native ureterotransplant ureterostomy may be the procedure of choice. SPK was performed on a 36 year old male patient with insulin dependent diabetes mellitus and diabetic nephropathy. The pancreatic exocrine secretion was drained by duodenocystostomy. The patient developed an obstruction in upper ureter on the postoperative 16th day. On the postoperative 32nd day, a native ureterotransplant ureterostomy with a double J stent was performed. The postoperative course was uneventful. The double J stent was removed on postoperative 112nd day by cystoscope. A subsequent follow up showed excellent pancreatic and renal function.