P16(INK4A) expression in Bowen's disease and Bowenoid papulosis.

BACKGROUND: Bowen's disease (BD) is a skin carcinoma in situ occurring over the entire body surface. It shares similar histopathological features with Bowenoid papulosis (BP) of the genitalia, but differs in etiology and clinical course. Increased p16(INK4A) (p16) tumor suppressor protein expression has been demonstrated in relation to the progression of cutaneous squamous neoplasms. OBJECTIVE: To evaluate the difference in p16 expression between Bowen's disease and Bowenoid papulosis. MATERIAL AND METHOD: Biopsies of 46 cases of BD in the period 1994 - 2003 and 14 cases of BP during 1987 - 2003 in the Anatomical Pathology Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Thailand were studied by immunohistochemical methods using the P16 kit (CINTec Histology Kit, clone E6H4, Code-Nr. K5334, DakoCytomation, Denmark). Nuclear/cytoplasmic immunoreactivity in more than 10% of neoplastic cells was considered positive. RESULTS: P16 expression was positive in 37 of 46 BD cases (80.4%) which was higher than that of BP (6 of 14 cases or 42.9%) (p value < 0.05, Chi-square test). The expression among the three groups of BD: extragenital (28 of 35), chronic arsenical-related (7 of 8) and genital lesions (2 of 3) was not significantly different (p value = 0.734, Chi-square test). CONCLUSION: P16 expression was more frequent in BD than BP. This suggests a possible association between p16 expression and tumorigenesis of these lesions.

Comparison of ultrasound score, CA125, menopausal status, and risk of malignancy index in differentiating between benign and borderline or malignant ovarian tumors.

OBJECTIVES: To evaluate the diagnostic performances of ultrasound score (US), CA 125, menopausal status, risk of malignancy index (RMI)-- in differentiating between benign and borderline or malignant ovarian tumors. MATERIAL AND METHOD: Women with ovarian masses who were scheduled to have elective surgery at the Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital between May 1999 and December 2001 were included in the study. Ultrasonographic study and CA 125 were examined preoperatively. The RMI was obtained from the ultrasound score, CA 125, and menopausal status. The diagnostic values of each parameter and the RMI were determined. RESULTS: From 175 women, 35 women (20%) had malignant ovarian tumors. RMI yielded better diagnostic performance to differentiate between benign and borderline or malignant ovarian tumors than US score, CA 125, and menopausal status in respective order The optimal RMI to predict malignancy was 0.135 with the sensitivity of 88.6% (95% CI; 81.1%-96.1%), specificity of 90.7% (95% CI; 83.9%-97.6%), positive and negative predictive value of 70.5% (95% CI; 59.7%-81.2%) and 97.0% (95% CI; 92.9%-100.0%) respectively. CONCLUSION: RMI yielded better diagnostic performance than the individual parameter of ultrasound score, CA 125, or menopausal status in differentiation of benign from borderline or malignant ovarian tumors.

Single dose oral clonidine premedication does not enhance postoperative, single low dose epidural morphine analgesia in hysterectomy patients.

In this randomized, double blind placebo controlled study, the authors evaluated the effects of oral clonidine premedication on very low dose epidural morphine analgesia in 50 hysterectomy patients. Patients were randomized to receive a single oral clonidine 300 microg (n = 25) or a placebo (n = 25) 90 minutes before insertion of the epidural catheter. 3 ml of 2% lidocaine with adrenaline (5 microg ml(-1) mixed with 2 mg morphine were injected via epidural, followed by an additional volume of 2% lidocaine with adrenaline (5 microg ml(-1)) titrated to T6 block height before commencing general anesthesia. The postoperative analgesia regimen was 2 mg of intravenous morphine every 10 minutes for the first 48 hr and 1 gm of oral acetaminophen every 4-6 hr after initiation of oral diet at 24-48 hr as required. Morphine consumption, acetaminophen, pain scores, and side effects were recorded thoughout 48 hr after surgery. The results show patients in the clonidine and placebo groups were not different in terms of local anesthetics dose (p = 0.27), total morphine and acetaminophen requirement (p = 0.34, p = 0.1) respectively. Pain scores at rest and movement were also not different in both groups (p = 0.83, p = 0.64) respectively. No serious adverse effects were noted. The authors concluded that oral clonidine approximately 6 microg kg(-1) does not enhance the analgesic effect of epidural morphine 2 mg after hysterectomy.