H2AX a promising biomarker for lung cancer: a review.

Histone's H2A variant (H2AX) phosphorylation is an early indicator of DNA double-strand breaks formation and DNA damage response. Thus, it may act as a novel biomarker to monitor genotoxic events that can drive cancer development and tumor progression. This review will focus on the possible applications of H2AX as a key regulator of DNA damage response in lung cancer and as a biomarker of: sensitivity of lung tumors to chemotherapy and radiotherapy, treatment with PARP inhibitors, bystander effect, multistep lung carcinogenesis, environmental smoking, and chemical genotoxicity, chemoprevention, prognosis, and also as therapeutic targets in lung cancers.

Effects on the immune system and toxicity of carboplatin/paclitaxel combination chemotherapy in patients with stage III-IV ovarian and non small cell lung cancer and its role in survival and toxicity.

PURPOSE: To examine the impact of paclitaxel and carboplatin combination chemotherapy on the parameters of the immune system in patients with non small cell lung cancer (NSCLC) and with ovarian cancer before, during and after chemotherapy, and the effect of this combination on the overall patient survival. METHODS: 24 patients with NSCLC and 20 with ovarian cancer (all in stage IIIb-IV) treated with 6 courses of paclitaxel and carboplatin combination chemotherapy were separated into two groups according to their survival group A: long survival (> 12 months for NSCLC; > 30 months for ovarian cancer) group B: short survival (<12 months for NSCLC; <30 months for ovarian cancer). At the same time we studied some immunological parameters (CD3, CD4, CD8, CD56, CD34, IL-3, IFN-γ) in relation with the induced toxicity during chemotherapy. The results were analysed using the ANOVA method. RESULTS: We observed a statistically significant difference of CD4 and CD4/CD8 after chemotherapy between groups A and B (p<0.001 and p< 0.006 respectively), implying that the further increase of T-helper cells after chemotherapy had a positive impact on survival. In addition, statistically interesting was the difference in values of IFN-γ between patients of groups A and B before and after chemotherapy (p< 0.039 and p< 0.027, respectively). Patients with high IL-3 had little chance of toxicity. CONCLUSION: Our findings support that with carboplatin/ paclitaxel combination chemotherapy, important parameters of the immune system (IFN-γ, CD4, CD4/CD8) can be used as prognostic factors for survival, while others (IL-3) as indicators of toxicity.

Type I collagen biomarkers in the diagnosis of bone metastases in breast cancer, lung cancer, urinary bladder cancer and prostate cancer. Comparison to CEA, CA 15-3, PSA and bone scintigraphy.

PURPOSE: In this study we evaluated the clinical usefulness of serum pro-I collagen peptide (PICP) and I collagen telopeptide (ICTP) as indicators of early bone metastases in patients with breast (BC), lung (LC), urinary bladder (UBC) and prostate cancer (PC). PATIENTS AND METHODS: 305 patients were examined. 145 had histologically confirmed BC (92 with bone metastases), 20 UBC (6 with bone metastases), 11 LC (3 with bone metastases) and 129 PC (68 with bone metastases). In BC patients we compared the PICP and ICTP levels with those of CA 15-3, CEA and bone scintigraphy. Patients with LC and UBC had PICP and ICTP measurements, PC patients had serum PICP, prostate specific antigen (PSA) measurements and bone scans. 104 healthy individuals served as controls. RESULTS: ICTP and CA 15-3 levels were significantly higher in patients with BC and bone metastases in comparison to patients without metastases (p <0.05), while PICP and CEA were only marginally higher. Significant correlation was observed between existence of bone metastases and ICTP levels (p <0.05). The sensitivity of PICP, ICTP, CEA and CA 15-3 was 28.1, 48.6, 42, and 78%, respectively and specificity was 83.9, 94, 65 and 86%, respectively. ICTP and CA 15-3 were the most reliable markers for early diagnosis of bone metastases in BC. PICP alone or with ICTP were not sensitive enough. Only CA 15-3 showed sensitivity 78% and specificity 86%. When combined CA 15-3, ICTP and CEA the sensitivity and specificity increased to 82% and 96%, respectively. Furthermore, PICP and PSA levels were significantly higher in patients with PC and bone metastases in comparison to patients with benign prostate hyperplasia (BPH) (p <0.0001) or in patients with PC without bone metastases (p <0.0005 for PICP and p <0.0001 for PSA). The co-evaluation of PICP and PSA improved the sensitivity (78%), specificity (96%), accuracy (97%) and positive predictive value (97%). In LC patients, ICTP levels differed significantly between patients with and without bone metastases (p=0.025). In UBC patients, PICP levels differed significantly between patients with and without bone metastases (p=0.017). CONCLUSION: ICTP and CA 15-3 are the most reliable markers for early diagnosis of bone metastases in BC patients. PICP could be useful for diagnosing early bone metastases of PC and combined with PSA and bone scan can be an additional tool in the follow-up of PC patients. For LC patients, ICTP showed a significant difference in the discrimination of patients with and without bone metastases. In UBC patients, PICP showed a significant difference in the discrimination of patients with and without bone metastases.

Spontaneous pneumomediastinum treatment.

The authors report 5 cases that presented to the emergency department of the Athens Naval and Veterans Hospital (Athens, Greece) with spontaneous pneumomediastinum. The clinical picture was not diagnostic in most of the cases, with symptoms of acute retrosternal pain and severe dyspnea in just one case. Diagnostic work disclosed the presence of mediastinal air, and after the exclusion of other diagnoses, spontaneous pneumomediastinum was treated conservatively in all cases. In this case series the authors discuss the main aspects of treatment of these patients, the value of antibiotics during the recovery period and the air distribution in the thoracic tissues.

Compression of the right atrium due to coexistence of diaphragmatic eventration and Chilaiditi's syndrome.

We report on a 70-year-old male who was admitted to hospital due to progressive onset of dyspnea and fever. Diagnostic work-up revealed a high diaphragmatic position, compression of the right heart and supraventricular tachycardia. A simultaneous incidental finding was hepatodiaphragmatic colonic interposition (Chilaiditi's syndrome). Diaphragmatic plication through a right thoracotomy with bowel reduction was effective to treat the patient.This is the second reported case in the literature of a simultaneous occurrence of diaphragmatic eventration and Chilaiditi's syndrome.

Relationship between Helicobacter pylori seropositivity and hyperemesis gravidarum with the use of questionnaire.

AIM: The aim of the present study was to investigate the relationship between Helicobacter pylori (HP) infection and Hyperemesis gravidarum (HG) by using a questionnaire. METHODS: Twenty-five pregnant women with HG and 85 asymptomatic pregnant women (aged 14-40) of matching gestational age were enrolled between October 2004 and January 2006. Anti-HP immunoglobin G (IgG) serum antibody was tested to establish seropositivity. In our study we used a multi variable questionnaire (name, age, gravida, number of vomits daily etc.). The results were analyzed using chi squared and Mann-Whitney U- test. RESULTS: The prevalence of HP infection was 56% (14 of 25) among patients with Hyperemesis gravidarum and 48.2% (41 of 85) among control subjects (P>0.05, chi squared test). In the same study the HP seropositivity is not related to age of the woman (50%, 55 of 110 were HP positive, P>0.05 chi squared test) but there was a significantly association between number of deliveries and HP seropositivity (primigravida [+] 34.2% versus 65.8%, multigravida [+] 6.1% versus 38.9%, P<0.05 chi squared test). The history for gastrointestinal problems of the tested women and their husbands is not related to HP seropositivity(38.1% positive for HP and with gastrointestinal disorders she/he or both versus 61.8% positive and without problems both, P>0.05, Mann-Whitney U- test). Finally there was no relativity between the number of vomits daily and the HP seropositivity (48.2% with HP [+] and 0-3 vomits daily versus 56% with HP [+] and 4-8 vomits daily, P>0.05 chi squared). CONCLUSIONS: Our findings do not support any direct correlation between HP seropositivity and Hyperemesis gravidarum, number of vomits daily, age of woman, history for gastrointestinal problems but only with the number of deliveries.

Familiar hypertrophic cardiomyopathy in association with coarctation of the aorta and coronary artery disease. Importance of family screening. A brief report.

Hypertrophic cardiomyopathy (HCM) is a condition of unknown etiology with thickening of the interventricular septum. It is better defined as a genetic disorder of autosomal dominant inheritance with variable left ventricular hypertrophy and symptoms. HCM has been rarely reported in association with other causes of hypertrophy such as hypertension and aortic stenosis. The combination of aortic stenosis or other arterial stenosis such as coronary artery disease with HCM is unusual. We present a case of a middle aged male with an unusual combination of cardiac diseases. Mild coarctation of aorta, mild aortic stenosis in association with familial HCM and the difficulty in diagnosis are the salient features. The acute change on ECG underscores the presence of coronary artery disease coexistent with the above mentioned diagnosis. The importance of family screening in this situation is highlighted. On the other hand, combined forms of left ventricular outflow obstruction are being recognized with increasing frequency. The importance of recognizing multiple levels of obstruction in such patients is emphasized.

Spontaneous pneumothorax: are we missing something?

Most thoracic surgeons overlook the fact that spontaneous pneumothorax is one of the pulmonary complications of connective tissue disorders such as Marfan or Ehlers-Danlos syndromes, and they consider it as primary. In the following report we describe a unique case of spontaneous rupture of the sigmoid secondary to a spontaneous recurrent contralateral pneumothorax in a young patient with undiagnosed Marfan syndrome. The aim of this presentation is to raise a high index of suspicion of every thoracic surgeon to include in his differential diagnosis the connective tissue disorders in any case of spontaneous pneumothorax and if so, to follow further diagnostic procedures to anticipate any other visceral complications.

A cohort study on Helicobacter pylori serology before and after induction in the Hellenic Navy.

BACKGROUND AND AIMS: To determine whether military personnel are at increased risk of Helicobacter pylori (HP) infection in proportion to their occupation during their national service in the armed forces. MATERIALS AND METHODS: Serum samples were obtained from 142 young male Hellenic Navy recruits (mean age, 23.6 years; range, 20-30 years). The first specimen was obtained during their induction into the Hellenic Navy, and the second was obtained after having served for 8 months in different services within Greece. An enzyme-linked immunosorbent assay was used to detect HP-specific immunoglobulin G antibodies. Statistical analysis was performed using the sign test, logistic regression, and the chi 2 test. RESULTS: The crude seropositivity rate increased from 19.01% to 28.16% (p = 0.007). Of the 115 initially seronegative subjects, 17 (14.8%) seroconverted. The most important predictive variable for seroconversion was deployment in a crowded commission (> 20 subjects) combined with the absence of air conditioning in personnel sleeping quarters (p = 0.03, odds ratio = 3.14). CONCLUSION: Our data suggest that the risk of HP infection increases among 20- to 30-year-old individuals during their national service. Degrading environmental conditions may play a major role in HP transmission between young adults who serve in the armed forces.

Seroepidemiology of Helicobacter pylori infection in hellenic navy recruits.

BACKGROUND AND AIMS: To investigate the prevalence of Helicobacter pylori (HP) infection, as well as possible risk factors affecting its acquisition among young Greek adults. METHODOLOGY: Sera were collected from 153 male young Hellenic Navy recruits (mean age 23.6 y.o.; range, 20-30 y.o.) at induction into the Hellenic Navy during January 1999. An enzyme-linked immunosorbent assay was used to detect HP-specific-IgG antibodies. All the subjects completed a structured questionnaire regarding demographic and socioeconomic data, as well as dietary habits, alcohol and tobacco use and gastrointestinal complaints. Statistical analysis was performed using logistic regression and the chi2 test. RESULTS: The observed crude seropositivity rate was 19.01%. Among the examined parameters the most important predictive variable for HP-IgG status was the current median family income (B = +0.98, SE(B) = 0.56, p = 0.08, by logistic regression), which however, did not attain adequate statistical significance. The rate of seropositivity for HP that we observed is much lower than rates reported in older studies in this narrow-aged group in Greece. Probably the changes that ensued in life-style in Greece during the last 10 years resulted in a reduction in HP seropositivity.