Intra-renal Arteries in Nephrectomy from a Historical Aspect, a Quest Originated by Medical Illustrations to Reach Modern Angiography.

The aim of the present paper is to contribute to the understanding of the history of the anatomical study of the intra-renal arteries. The vasculature and especially the intra-renal arteries of the kidneys are an intriguing field which was first studied through art and then perfected by medicine. Angiography and microsurgery have resulted in partial nephrectomy techniques for surviving kidneys with adequate functional results. Graves' categorization dating from 1954 opened the way for innovative approaches that have resulted in modern topographical anatomy. CONCLUSION: Our understanding of the anatomy of intra-renal arteries has played a significant role in surgical anatomy and internal medicine.

Diffuse malignant peritoneal mesothelioma presenting as intestinal obstruction.

Diffuse malignant peritoneal mesothelioma (DMPM) represents 90% of all peritoneal forms of mesothelioma. It affects mainly patients 50-69 years old. In 50% of cases there is a history of asbestos exposure. The clinical presentation of the disease is not characteristic: nonspecific abdominal pain, weight loss, and abdominal distension are common. Ascites occurs in 90% of the patients. Bowel obstruction is a late manifestation. We present three patients with DMPM, without a history of asbestos exposure and without ascites, who presented with complete bowel obstruction. All patients underwent emergency operations, and palliative surgical procedures were performed. Each patient died within 3 to 6 months postoperatively.

Increased incidence of papillary thyroid cancer detection among thyroidectomies in Greece between 1991 and 2006.

OBJECTIVE: To examine existing evidence, trends and possible factors that may have affected the incidence of papillary thyroid cancer (PTC) among patients undergoing thyroidectomies in an iodine-sufficient population of Greece. STUDY DESIGN: All histology records from the patients who had undergone thyroid surgery at the Department of Surgery Laiko Hospital, Athens, Greece from January 1991 to December 2006 were retrospectively analyzed. Records were placed in a database which included patients' demographics, history, and medical condition, clinical and surgical parameters. PATIENTS AND METHODS: One thousand four hundred and twenty-six patients (265 males and 1161 females) had undergone thyroidectomy during the above period of time. All surgeons favoured total thyroidectomy with resection of pro- and paratracheal lymph nodes. Thyroid tumors were classified according to the WHO classification system and were staged according to the TNM staging system. RESULTS: In 278 patients, PTC was histologically diagnosed. From 1999 onwards, thyroid surgery shifted towards total thyroidectomy, while statistically significantly increased incidence of PTC and papillary microcarcinoma detection and decreased incidence of PTC greater than 10 mm detection in the whole population were noticed. Moreover, from 1999 onwards, smaller size of primary tumors, higher incidence of T1 tumors, lower incidence of T4 tumors, lower incidence of metastatically infiltrated peritracheal lymph nodes, higher incidence of stage I tumors and lower incidence of stage IV tumors were documented. Finally, a higher incidence of PTC in males, females and the whole population aged 51-70 years compared to the other age groups since 2003 was noticed. CONCLUSION: The increased incidence of PTC clearly correlated to the increased incidence of papillary microcarcinoma detection, reflecting the proportion for total thyroidectomy as well as changes in the diagnostic approach boosted by more careful pathological examination, rather than the effect of environmental factors such as the Chernobyl accident. Whether the Chernobyl accident has any predisposing effect on the increased incidence of PTC remains to be proven.

Topoisomerase I and IIalpha protein expression in primary colorectal cancer and recurrences following 5-fluorouracil-based adjuvant chemotherapy.

PURPOSE: Human DNA topoisomerases I and II (topo-I and -II) are essential for vital cellular processes such as DNA replication, transcription, translation, recombination, and repair. In the present study, we correlate topo-I and -II expression and outcome after chemotherapy in primary and relapsed colorectal cancer. PATIENTS AND METHODS: Patients with colorectal cancer that had recurred, following surgery and adjuvant chemotherapy and underwent a second operation were included in the present study. All had undergone surgical resection of the primary tumor and received post-operatively 5-FU-based (5FU + Leucovorin, Mayo Clinic regimen) adjuvant chemotherapy. Tumor tissue was collected at the initial operation from the primary tumor and at the time of recurrence (during the second operation following chemotherapy). All tissue samples were analyzed for levels of expression of both topo-I and topo-IIa using standard three-step immunohistochemistry on paraffin sections. RESULTS: Forty patients were included. Levels of expression of topo-I and topo-II were higher in malignant cells from tumor recurrences compared to primary tumors (P = 0.0001 for both). There was a statistically significant positive relationship between patients age and levels of topo-I (P = 0.011) and topo-II (P = 0.011) expression. CONCLUSIONS: The study results reported here underscore the role of topoisomerase expression in colorectal cancer and suggest a potential role in tumor recurrence.

Immunohistochemical evaluation of immune response in invasive ductal breast cancer of not-otherwise-specified type.

We investigated endotumoral and peritumoral lymphocytic subsets [natural killer cells (NK), B-cells and cytotoxic/suppressor (CD(8)+) T-cells], and expression of MUC1 and MUC6 glycoprotein with regard to various clinicopathological parameters in invasive breast cancer tissues. The study population consisted of 64 female patients with invasive ductal breast cancer of not-otherwise-specified type. Thirty-five women with benign breast lesions served as controls. High-grade carcinomas exhibited higher numbers of endotumoral NK cells and B-cell aggregates than the rest of the tumors examined (P=0.0003 and 0.027, respectively). Cases with more than three positive lymph nodes and with tumors over 2 cm in diameter exhibited higher numbers of endotumoral NK cells (P=0.047 and 0.023, respectively). Increased numbers of peritumoral CD(8)+ T-cells were detected in cases with lymph node metastases (P=0.045). MUC1 was expressed with weaker staining intensity in the control group than in the group with breast cancer (P=0.011). Grade III carcinomas exhibited significantly stronger expression of MUC6 glycoprotein (P=0.001) than the control group. In conclusion, tumors with markers of poor prognosis exhibited increased numbers of lymphocytic infiltrates, and of NK cells in particular, and stronger MUC1 and MUC6 glycoprotein immunoreactivity than did the other tumors.

Strongyloides stercoralis infection as a cause of acute granulomatous appendicitis in an HIV-positive patient in Athens, Greece.

A case of acute granulomatous appendicitis due to Strongyloides stercoralis infection in an HIV-positive patient is described. To our knowledge this is the first case presented in the literature.