Are biopsy specimens predictive of HER2 status in gastric cancer patients?

BACKGROUND: Trastuzumab has been recently proposed as a treatment for patients with HER2-positive advanced/metastatic gastric cancer (GC). Since most patients have inoperable disease at diagnosis, accurate assessment of HER2 status on biopsy specimens is essential to select the patients who may benefit from therapy. AIM: The aim of this study is to establish whether HER2 status assessed on biopsy material could be reliable for treatment decisions using anti-HER2 agents. METHODS: The HER2 status was evaluated in 61 consecutive pairs of biopsy and surgical GCs samples by immunohistochemistry and chromogenic in situ hybridization. RESULTS: The overall concordance of HER2 status between biopsy and surgical specimens was 91.8 % with a predictive positive value of 71.4 % and a negative predictive value of 94.4 %. Of five discordant cases, there were three negative and two positive false biopsy results. All the false negative cases showed heterogeneous expression of HER2 protein in surgical samples. Two cases displayed overexpression of the receptors without corresponding gene amplification. CONCLUSIONS: HER2 status as evaluated on biopsy samples is a fairly good predictor of HER2 status of surgically-excised GCs. The most important influence for discordant results is tumor heterogeneity. However, HER2 overexpression, especially without coexisting gene amplification, may only be a temporary change in a tumor population. This may explain those cases with positive HER2 evaluation on biopsy material and a negative result on corresponding surgical specimen.

Emotional expression and coping style in female breast cancer.

BACKGROUND: The study of the relationship of emotional status and tumor etiology has been investigated in order to elaborate a multifactorial model able to provide an answer integrating the different disciplines on cancer. The aim of this work is to investigate the knowledge on the alexithymia construct, exploring the presence of such trait in women affected by mammary carcinoma and analyzing the used coping strategies. The study has also examined personal thoughts related to event control (locus of control). METHOD: The Toronto Alexithymia Scale, Coping Orientation to Problems Experienced, and Locus of Control questionnaires were administered to a group of 86 women aged 31-55 years (mean = 43.7; SD 6.57)-experimental group (N = 44): women with breast cancer diagnosed in the last 6 months; control group (N = 42): women without oncologic pathology, referred at the aforementioned institutions to undergo a breast check-up. RESULTS: According to our hypothesis and literature data, a significant presence of alexithymic subjects (36.4% versus 2.4%; chi2 = 20.9; P < 0.0001) and a tendency to adopt coping strategies not focused on the problem were reported among women with mammary carcinoma. This causes incapability to act in order to actively contrast pathology-linked stress or to lower the effects. CONCLUSION: Our results indicate that the tendency to repress one's emotions is associated to some general schemes of reaction to stress which, when used in a dysfunctional manner (such as the attempt to ignore how threatening an event is), are maladaptive in the end.

High pressure assisted coronary stent implantation accomplished without intravascular ultrasound guidance and subsequent anticoagulation.

OBJECTIVES: The purpose of this study was to determine the efficacy of treatment with antiplatelet therapy and no anticoagulation after high pressure assisted coronary stent implantation performed without intravascular ultrasound (IVUS) guidance. BACKGROUND: Previous studies have shown that during IVUS-guided Palmaz-Schatz coronary stenting, it is safe to withhold anticoagulation when stent expansion has been optimized by high pressure balloon dilation. METHODS: Patients that had successful coronary stenting without IVUS guidance were treated with ticlopidine, 500 mg/day, and aspirin, 325 mg/day, for 1 month and then received only aspirin, 325 mg/day, indefinitely. Patients were not treated with warfarin (Coumadin) or heparin after successful stenting. Clinical and angiographic events were assessed at 1 month. RESULTS: A total of 201 intracoronary stents were implanted in 127 patients with 137 lesions. The average number of stents per lesion was 1.4 +/- 0.8, and the average number of stents per patient was 1.6 +/- 1.1. Stent deployment was performed for elective indications in 79% of procedures and for emergency indications in 21%. There were four stent thrombosis events for a per patient event rate of 3.1% and a per lesion event rate of 2.9%. CONCLUSIONS: After high pressure assisted stenting performed without IVUS guidance, there was an acceptable incidence of 3.1% of stent thrombosis with the combination of short-term ticlopidine and aspirin therapy and no anticoagulation. Although the study involved only 127 patients, the results support the relative safety of stenting without IVUS guidance and with antiplatelet therapy only in comparison to historical trials on stenting performed with postprocedure anticoagulation.

Short- and long-term reproducibility of time and frequency domain heart rate variability measurements in normal subjects.

OBJECTIVE: To obtain data relating to the reproducibility of the time and frequency domain measurements obtained from 10-min ECG recordings. METHODS: Eighteen normal volunteers underwent evaluations of time and frequency domain heart rate variability 2 weeks and 7 months after baseline analysis. The time domain parameters were mean NN, the standard deviation of NN intervals, the percentage of successive NN intervals > 50 ms and the root mean square successive difference of NN intervals. The frequency domain evaluations (total power, low frequency, and high frequency) were made by means of both the Fast Fourier Transform algorithm (FFT) and the autoregressive method (AR) from 10-min ECG recordings made under three different conditions: rest, controlled respiration, and after a passive head-up tilt test. Reproducibility was evaluated by means of the interclass correlation coefficient (ICC), comparing baseline values with the results obtained at the second week and the seventh month. Time domain evaluation were also made from 10-min ECG. RESULTS: All of the time domain measurements had an ICC > or = 0.75, except for the standard deviation of NN intervals, which had an ICC of 0.57. The frequency domain parameters obtained by means of either FFT or AR showed similar reproducibility. Low frequency was reproducible under all three conditions, total power only at rest, and high frequency only during controlled respiration. CONCLUSION: The reproducibility of frequency domain parameters depends on the analysed condition. These results are of primary importance when the effects of drugs or other interventions on heart rate variability are under investigation.

Holter-guided identification of premature ventricular contractions susceptible to suppression by beta-blockers.

To evaluate whether the identification of the different types of relations between premature ventricular contractions (PVCs) and the preceding sinus cycle length is capable of predicting the effect of beta-blockers on the PVCs themselves, 55 patients (43 men, 12 women, mean age 52.6 +/- 15.6 years) with different cardiac diseases, and >30 PVCs/hr characterized by stability and the same relation at two Holter monitoring periods were studied. The relation was tachycardia enhanced (the shorter the preceding cycle length, the higher the incidence of PVCs) in 23 patients (group 1); indifferent (no correlation between the preceding cycle length and PVC incidence) in 21 (group 2); and bradycardia enhanced (the longer the preceding cycle length, the higher the incidence of PVCs) in 11 (group 3). A third Holter monitoring was performed 6 days after nadolol administration (80 mg/day) to evaluate its effect on the three types of PVCs. Incidence in all patients (-88;p<0.001). In group 2, it caused a reduction in the majority of patients (-60%;p<0.05) but an increase in five. In group 3, it caused a reduction in only half of the patients (-45%) and a 91% increase in the remainder. The difference in the effect of nadolol in the three groups was highly significant (X2=27.5;p<0.0001). The relation between the incidence of PVCs and the preceding cycle length is a useful means of identifying subsets of patients with PVCs who will benefit from beta-blockers.

Clinical and angiographic outcome after Palmaz-Schatz stent implantation guided by intravascular ultrasound.

Intracoronary stents can be implanted with a low incidence of stent thrombosis (< 1%) when the stent procedure is guided by intravascular ultrasound. The long-term clinical and angiographic effects, however, have not been reported. This study assesses the 6 month clinical and angiographic results of a consecutive series of patients with intravascular ultrasound guided Palmaz-Schatz stent deployment that were not treated with subsequent anticoagulation after a successful stent implantation procedure. From March, 1993 to April 1994, 411 patients underwent Palmaz-Schatz stent implantation. There were 26 patients that had uncomplicated Palmaz-Schatz stent implantation that were treated with a standard anticoagulation regimen that are not evaluated in this study. Thus, this study includes an assessment of 385 patients that had either a successful intravascular ultrasound guided stent implantation procedure and did not receive post procedure anticoagulation or had a procedural complication. Procedural success was achieved in 369 patients (96%). Clinical success (procedure success without early post procedure event) was achieved in 363 patients (94%). There were 2 acute stent thrombosis events (0.5%) and 1 subacute stent thrombosis (0.3%) in the group of 369 patients with 454 lesions treated without anticoagulation. At 6 month clinical follow-up the incidence of myocardial infarction was 4.9% and the rate of coronary bypass surgery was 6.2%. There was a 2.1% incidence of death. Emergency intervention (emergency angioplasty or bailout stent implantation was necessary in 3 patients (0.8%). The total incidence of repeat percutaneous intervention was 11.4%. By 6 months clinical follow-up, major events had occurred in 19.2% of patients. The angiographic lesion restenosis rate, according to 50% diameter stenosis criteria, was 19%. The incidence of restenosis per patient was 22%. In conclusion, intravascular ultrasound guided Palmaz-Schatz can be performed without subsequent anticoagulation with a low incidence of stent thrombosis and acceptable clinical and angiographic outcome at 6 month clinical follow-up.

[Kawasaki disease: recent findings in etiology, pathogenesis and therapy]. / Malattia di Kawasaki: recenti acquisizioni in eziologia, patogenesi e terapia.

The number of cases of Kawasaki disease increases in Japan. The aetiology is still unknown but epidemiological studies suggest an infectious aetiology in spite that no specific microorganism has been implicated; it must be, probably present a hereditary predisposition connected with HLA subtypes. Many investigators reported an increase in the antibody level against several agents, among which bacteria and virus. Recently they found that aberrant regulation of T- and B-cells functions was associated with initiation of such antibody production, that in the majority of cases is self-limiting. The effectiveness of high- and low-doses of salicylates, given always associated with steroids, only up to fifteen days of illness, and Intravenous Gamma Globulin (IVGG), is also discussed.

[Cardiologic aspects of Kawasaki's disease]. / Aspetti cardiologici della malattia di Kawasaki.

Both immediate and long-term prognosis of Kawasaki's disease (K. D.) are due to cardiac involvement and, particularly, to coronary artery aneurysms formation. Of 19 cases that we studied, age ranging between 7 months and 8 years, 18 has been followed clinically and with echocardiographic procedure. In 1 case (10 years old), which underwent a triple bypass surgical operation due to the presence of multiple aneurysms, diagnosis was made retrospectively. In 2 of 19 cases (10.52%) coronary artery aneurysms were present. One case showed aneurysm's partial regression two years later. In 10 of 18 cases (55.5%) clinical evidence of cardiac compromise was present, whereas in no patient ECG alterations occurred at all. Our data prove the poor benefit of clinical approach and ECG interpretation in K. D., whereas we believe that echocardiographic study is the best method in early identification of aneurysms.

[Cariostatic effect of Fluocaril; controlled clinical research]. / Effetto cariostatico del Fluocaril; ricerca clinica controllata.

A controlled, double-blind trial on 42 children showed that a dentrifrice containing 0,25% fluorine clearly prevented caries when used continuously for 2 years. This effects was greater than that of a similar toothpaste containing fluorine. Tolerance was excellent.