ABSTRACT
The relationship between bone marrow (BM) cytokine and chemokine levels, cytogenetic profiles and skeletal involvement in multiple myeloma (MM) patients is not yet defined. This study investigated a cohort of 455 patients including monoclonal gammopathy of uncertain significance (MGUS), smoldering MM and symptomatic MM patients. Skeletal surveys, positron emission tomography (PET)/computerized tomography (CT) and magnetic resonance imaging (MRI) were used to identify myeloma bone disease. Significantly higher median BM levels of both C-C motif Ligand (CCL)3 and CCL20 were found in MM patients with radiographic evidence of osteolytic lesions as compared with those without, and in all MM patients with positive PET/CT scans. BM levels of CCL3, CCL20, Activin-A and Dickkopf-1 (DKK-1) were significantly higher in patients with high bone disease as compared with patients with low bone disease. Moreover, CCL20 BM levels were significant predictors of osteolysis on X-rays by multivariate logistic analysis. On the other hand, DKK-1 levels were related to the presence of MRI lesions independently of the osteolysis at the X-rays. Our data define the relationship between bone disease and the BM cytokine and chemokine patterns highlighting the tight relationship between CCL20 BM levels and osteolysis in MM.
Subject(s)
Bone Marrow/immunology , Chemokine CCL20/physiology , Chemokines/analysis , Chromosome Aberrations , Cytokines/analysis , Multiple Myeloma/immunology , Osteolysis/etiology , Aged , Chemokine CCL3/analysis , Female , Humans , Intercellular Signaling Peptides and Proteins/analysis , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Myeloma/complications , Multiple Myeloma/genetics , Osteoprotegerin/analysis , RANK Ligand/analysisABSTRACT
BACKGROUND: Although Indocyanine green (ICG) is used to find sentinel nodes (SN) in patients with breast cancer (BC), its role in clinical practice is still debated, and needs a definitive validation to be included in the standard approach to finding sentinel nodes in breast cancer. MATERIALS AND METHODS: To validate the ICG methods of detecting the SN in BC we have recently concluded a prospective validation trial. Patients with clinically node-negative, invasive early BC scheduled for breast surgery and SN biopsy were included in the trial. All the patients underwent SN detection using both the standard-of-care procedure using radioisotope technetium (99mTc) and the ICG, using the Photodynamic Eye camera. A comparison of the detection rate and the diagnostic accuracy of the two methods was performed to detect the equivalency of the two approaches. RESULTS: At the end of the enrollment, 301 patients were considered eligible and included in the trial, and 589 nodes were removed. Five hundred and eighty-three nodes (99%) were identified with ICG (median 2 nodes per patient) and 452 (76.7%) were identified with 99mTc (median 2 nodes per patient). A concordance index of 98.75% (CI, 95% = 97.1%-99.5%) was detected. The dosage given ranged from 0.3 to 1.4 ml. ICG was used in all patients eligible for SN biopsy without any significant acute side effects. CONCLUSIONS: The index of concordance between 99mTc and ICG seems to be extremely high, suggesting that ICG could be validated as an alternative method to 99mTc in the detection of SN in BC.
Subject(s)
Breast Neoplasms/pathology , Carcinoma/pathology , Fluorescent Dyes , Indocyanine Green , Lymph Nodes/pathology , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Aged, 80 and over , Breast Neoplasms/surgery , Carcinoma/surgery , Cohort Studies , Female , Humans , Mastectomy/methods , Mastectomy, Segmental/methods , Middle Aged , Prospective Studies , Radiopharmaceuticals , Technetium Tc 99m Aggregated AlbuminABSTRACT
The symptoms of the retrosternal goitre are due to the compression especially on airway, by thyroid growth in mediastinum. We present a case of an old woman affected by chronic obstructive broncopneumopathy, atrial fibrillation and mediastinal goitre. The previous growth in mediastinum was the cause of compression on airway with unexpected worsening of respiratory function. The risk of total thyroidectomy was related to the possible tracheomalacia. The surgery improved respiratory performance.
Subject(s)
Airway Obstruction/etiology , Atrial Fibrillation/complications , Goiter/complications , Pulmonary Disease, Chronic Obstructive/complications , Aged, 80 and over , Female , Humans , Mediastinum , Severity of Illness IndexSubject(s)
Adenocarcinoma/pathology , HIV Seropositivity/complications , Orbital Neoplasms/pathology , Stomach Neoplasms/pathology , Adenocarcinoma/complications , Adenocarcinoma/secondary , Adult , Biopsy, Needle , Humans , Male , Orbit/pathology , Orbital Neoplasms/complications , Orbital Neoplasms/secondary , Stomach Neoplasms/complicationsABSTRACT
The causes of blindness in 105 consecutive legally blind patients were analyzed in a large urban multidisciplinary medical center. It was found that the leading causes of blindness, in order of frequency of incidence, were glaucoma, diabetic retinopathy, senile macular degeneration, and cataract. The periodic collection of statistics on the relative frequency of the causes of blindness is strongly suggested so that possible changes and improvements in health care may be determined.
