Survinin expression in patients with breast cancer during chemotherapy.

Breast cancer (BC) is the second most common cancer worldwide and the first among women. If early diagnosed and treated, this disease has a good prognosis. However, it is believed that 90 % of all patients who have had cancer died due to metastatic disease, which highlights the need for a marker which allows the detection of latent cancer cells spread from the primary tumor. The objective of this study was to investigate the expression of survinin in peripheral blood of patients with breast cancer at diagnosis and during chemotherapy aiming correlation with minimal residual disease, clinical and pathological findings. The study included 40 patients with breast cancer and 12 healthy donors as a comparison group. Survinin expression was verified by real-time PCR. For diagnosis, survinin expression cutoff point was 1.05; considering this cutoff point, we obtained a test sensitivity of 85.3 %, specificity of 75.0 %, positive predictive value of 90.6 %, negative predictive value of 64.3 %, and accuracy of 82.6 %. There was statistical significance between groups (patients × control group), presenting to patients a significantly higher value than the control group (p < 0.001). Patients that presented at the diagnosis a survinin gene expression ≥ 1.05 are 17 times more likely to develop metastatic disease.

The identification of irreversible rituximab-resistant lymphoma caused by CD20 gene mutations.

C-terminal mutations of CD20 constitute part of the mechanisms that resist rituximab therapy. Most CD20 having a C-terminal mutation was not recognized by L26 antibody. As the exact epitope of L26 has not been determined, expression and localization of mutated CD20 have not been completely elucidated. In this study, we revealed that the binding site of L26 monoclonal antibody is located in the C-terminal cytoplasmic region of CD20 molecule, which was often lost in mutated CD20 molecules. This indicates that it is difficult to distinguish the mutation of CD20 from under expression of the CD20 protein. To detect comprehensive CD20 molecules including the resistant mutants, we developed a novel monoclonal antibody that recognizes the N-terminal cytoplasm region of CD20 molecule. We screened L26-negative cases with our antibody and found several mutations. A rituximab-binding analysis using the cryopreserved specimen that mutation was identified in CD20 molecules indicated that the C-terminal region of CD20 undertakes a critical role in presentation of the large loop in which the rituximab-binding site locates. Thus, combination of antibodies of two kinds of epitope permits the identification of C-terminal CD20 mutations associated with irreversible resistance to rituximab and may help the decision of the treatment strategy.

Isolated noncompaction of the myocardium.

We report the case of a 42-year-old female with fatigue on exertion and palpitation consequent to the existence of isolated noncompaction of the myocardium. We discuss clinical and familial findings, diagnostic possibilities, and prognostic and therapeutical implications of this rare disorder of endomyocardial morphogenesis.

[Relationship between conduction persistence through the slow pathway after atrioventricular nodal reentry tachycardia radiofrequency ablation and its recurrence]. / Relação entre a persistência da condução pela via lenta nodal após ablação de taquicardia por reentrada nodal e a recorrência clínica.

PURPOSE: The aim of this study is to verify whether the persistence of conduction over the slow pathway is related to an increased trend for recurrence. METHODS: Recurrence rate was retrospectively analyzed in 126 patients who underwent slow pathway radiofrequency (RF) catheter ablation during a follow-up of 20 +/- 12 months. The ablative procedure was interrupted when AVNRT was no longer induced by atrial stimulation after intravenous infusion of isoproterenol. Ninety-eight patients had no evidence of slow pathway whereas 28 patients persisted with AV node jump and atrial echo beat. RESULTS: There were 15 recurrences: 9% of those who had no evidence of slow pathway (9 of 98 patients) and 21% of those with AV node jump and/or atrial echo beat but this difference was not statistically significant. CONCLUSION: As long as AVNRT cannot be induced by atrial pacing and isoproterenol infusion after slow pathway RF catheter ablation, the presence of AV node jump and/or atrial echo beat does not increase the risk of recurrence of AVNRT.

Electrocardiographic identification of mid-septal accessory pathways in close proximity to the atrioventricular conduction system.

In order to identify ECG characteristics of overt mid-septal accessory pathways (APs) predictive of close proximity to the AV conduction system we analyzed data from patients who underwent successful RF catheter ablation of a mid-septal AP. Mean patient age was 31 +/- 16 years, and 13 were male. The 40 degrees right anterior oblique view was used to divide the mid-septal area into 3 zones: 1 (anterior portion); 2 (intermediate); and 3 (posterior portion). The 12-lead ECG was analyzed with regard to delta wave polarity and R/S transition in the precordial leads. The findings from patients ablated at zone 3 were compared to those at zones 1 and 2. All patients had a positive delta wave in the leads I, II, aVL, and negative delta wave in the leads III and aVR. The R/S transition occurred in lead V2 in 80% of patients. The delta wave in lead aVF was the only ECG characteristic that correlated with the AP ablation zone. Six of 8 patients ablated at zone 3 had a negative delta wave in lead aVF while 6 out of 7 patients ablated at zone 1 or 2 had a positive or isoelectric delta wave in lead aVF (P = 0.03). A positive or isoelectric delta wave in lead aVF identifies mid-septal AP in close proximity to the AV conduction system.

[Radiofrequency catheter ablation of type I atrial flutter]. / Ablação com radiofreqüência do flutter atrial tipo I.

PURPOSE: To verify the efficacy and safety of the creation of a barrier with radiofrequency (RF) in the tricuspid annulus and the vena cava ostium (TA-IVC). METHODS: Nine consecutive patients, 7 males, with age ranging from 36 to 76 years, with paroxysmal (7 patients) or permanent (2) type I atrial flutter (negative P wave in lead II, III and F) were submitted to RF ablation of TA-IVC istmo. One deflectable catheter with 4mm size tip was introduced into the right ventricle apex and pulled back to the inferior vena cava. When the atrial electrogram was detected the RF application was started. The RF was applied (20 watts during 60s) up to the proximity of inferior vena cava ostium. The end point was to stop atrial flutter. Then a vigorous atrial stimulation protocol, including isoproterenol infusion was used. In the next day, patients were submitted to transesophageal stimulation with the same protocol. RESULTS: Atrial flutter was interrupted in all patients (100%) with 4 to 28 (mean 16.7 +/- 7.7) applications. Eight patients (88.8%) with one session and 1 (11.1%) with two sessions. The mean time spent to stop the atrial flutter with one application was 30.5 +/- 18.5s. There were no complications. After a mean follow up of 3 +/- 1.6 month all patients (100%) are asymptomatic. Two of them are taking propranolol to control symptomatic atrial and ventricular ectopic beats. CONCLUSION: RF ablation of the TA-IVC istmo is efficient and safe in a short term follow up to interrupt and prevent re-induction and recurrence of type I atrial flutter.

[The pseudo-pacemaker syndrome]. / Pseudo-síndrome de marcapasso.

We describe three cases of the pseudo-pacemaker syndrome. One of them due to selective fast pathway fulguration of atrioventricular nodal reentrant tachycardia and two others have occurred in spontaneous form. All cases were related with the presence of first-degree atrioventricular block and sinus node tachycardia. The treatment was done with complete atrioventricular block induction catheter ablation and permanent pacemaker implantation in two patients. In conclusion, the procedure of radiofrequency ablation to control AV nodal reentry tachycardia must preserve the fast nodal pathway in order to avoid the pseudo-pacemaker syndrome and this syndrome can spontaneously occur and must be considered during investigation of etiology of syncope.