Prognostic value of IMP3 immunohistochemical expression in triple negative breast cancer.

Triple negative breast cancer (TNBC) account for 12% to 17% of all breast cancers. It is a heterogeneous group of tumors associated with aggressive clinical course. Insulin-like growth factor II mRNA binding protein 3 (IMP3) belongs to a family of insulin-like growth factor type II (IGF2), which plays a key role in the transmission and stabilization of mRNA, cell growth, and migration during embryogenesis. Increased expression of IMP3 is associated with aggressive behavior of different tumor types, advanced clinical stage, distant metastasis, and shorter overall survival (OS).The study included 118 patients with breast carcinoma diagnosed as TNBC and immunohistochemical staining for estrogen receptors (ER), progesterone receptors (PR), epidermal growth factor receptor 2 (HER2/neu), Ki-67, and IMP3 was performed. Correlations between categorical variables were studied using the chi-square and the Mann-Whitney U test. For survival analysis, the Kaplan-Meier method, log-rank test and the Cox proportional hazard regression model were used.Positive expression of IMP3 protein was present in 35.6% of TNBC. The presence of basal morphology was observed in 46.6% of TNBC. Positive IMP3 expression was connected with larger size of tumor, higher clinical stage, and basal morphology (P = .039, P = .034, P < .001). Disease-free survival and OS were significantly shorter in IMP3 positive TNBC.According to results of our study IMP3 expression can be used as negative prognostic factor for triple negative breast carcinomas. Targeting IMP3 molecule could be an effective approach to the management of a triple negative breast cancer with new immunological therapies, which does not yet exist for this group of tumors.

Case report: successful endoscopic treatment of a large bowel perforation caused by chicken bone ingestion.

RATIONALE: Large bowel perforations by a foreign body are rarely diagnosed pre-operatively due to non-specific clinical symptoms. The safety and efficacy of foreign body removal via upper endoscopy is well-established and strongly recommended. There is far less experience of endoscopic treatment of sharp foreign bodies impacted in lower parts of gastrointestinal tract. PATIENT CONCERNS: The patient was 78-year-old female with abdominal pain and nausea. Symptoms had begun 48 hours prior to hospital admission. She had lost over 10 kg of body weight in the previous couple of months DIAGNOSIS:: A multidetector-row computed tomography (MDCT) examination of the abdomen revealed mural thickening and enhancement of the cecum with haziness and linear areas of high attenuation in the pericecal fat tissue. A colonoscopy showed, the clear presence of a sharp 5.5-cm-long chicken bone perforating the cecal wall at the antemesenteric site close to the Bauchini valve. INTERVENTIONS: A quarter of the bone that had penetrated the cecal wall was pulled out with a flexible colonoscopy using a polypectomy snare. Due to the form and length of the bone, it was withdrawn through the entire colon, using pointed end trailing. OUTCOMES: The patient was discharged three days after colonoscopy with normal laboratory results and without any pain. LESSONS: In cases where sharp foreign bodies stuck into the large bowel, it is highly advisable to try to remove them via colonoscopy, before deciding to resolve the issue through a surgical intervention.

Colonoscopic Polypectomies and Recommendations on the Colonoscopy Follow-up Intervals Depending on Endoscopic and Histopathological Findings.

THE AIM: To show histopathological diagnoses after colonoscopic polypectomy in the University Hospital Center (KBC) Split with recommendations on further follow-up colonoscopy depending on the endoscopic and histological findings. PATIENTS AND METHODS: The study included 2842 patients who underwent colonoscopy in a two-year period (2008-2009), followed by a detailed analysis of 350 patients in which one or more polyps were simultaneously removed and 163 patients who were only sampled for histological analysis. Patients from the National Program for Colorectal Cancer Prevention and patients in which colonoscopy is indicated as part of daily outpatient or inpatient treatment were included as well. RESULTS: During 2008 and 2009 in KBC Split, out of a total of 2842 colonoscopies, 350 patients underwent colonoscopic polypectomy, whereby 618 polyps were removed (1-8 polyps in individual patients), while in 163 patients only biopsy specimens were sampled. Out of the total of 557 polyps sent for histological analysis, 236 were hyperplastic (42%), 193 were identified as tubular adenoma (35%), 84 were tubulovillous (15%), 18 villous (3%), 9 were adenocarcinoma (2%) and other 17 (3%). In 35 (15.4%) polyps high-grade dysplasia was found. The largest number of nonpolypectomized changes confirmed the presence of adenocarcinoma (76-47%), adenomas and hyperplastic polyps were 37 (22%) and regular findings 23 (14%). Mucosal high-grade dysplasia was demonstrated in 35 (23.1%) biopsied changes. CONCLUSION: Colonoscopies with polypectomy decreased the risk of the formation of colorectal cancer in these patients almost to the level of risk in patients who have not even had a polyp during colonoscopy. Arguably the best method of prevention and early detection of colorectal cancer are already widely established national programs. The next qualitative level is constantly improving the quality of colonoscopy with clear criteria and the establishment of a body to evaluate the performers and the equipment, and making recommendations on the colonoscopy follow-up intervals depending on endoscopic and histopathological findings of patients who for any reason underwent colonoscopy.

P300 evoked potential in patients with mild cognitive impairment.

CONFLICT OF INTEREST: NONE DECLARED. AIM: The aim of this study is to present differences of amplitude and latency of P300 wave between examinees with mild cognitive impairment and examinees from the control group. METHODS: A cross-section study was performed between April 1(st) and July 10(th) 2012, with the diagnosis of mild cognitive impairment as the main criterion for inclusion. In the twenty-two examinees who participated in the research, mild cognitive impairment was confirmed by neuropsychological testing, following which they were subjected to the examination of auditory evoked potentials. The control group consisting of 22 examinees, for which the lack of the same diagnosis was previously ascertained, was also subjected to the examination of auditory evoked potentials. The main findings were the differences in the latency and amplitude size of P300 wave targeted and non-targeted stimuli. RESULTS: The latency of P300 wave targeted stimuli in patients with mild cognitive impairment has, in statistical terms, proven to be significantly longer when compared to the control group. The average latency length in those with MCI amounted to 306.18 ms, whereas the latency in the control group came to 295.95 ms. Similarly, the latency length of non-targeted stimuli turned out to be statistically higher, with the length of 320.00 ms in the former group, and 301.36 ms in the latter. Amplitudes in patients with mild cognitive impairment were lower in comparison to the control group, with extremely low amplitudes recorded in 36.36% of patients. CONCLUSION: In patients with mild cognitive impairment extended latency and lower amplitude of P300 wave are recorded.

Use of modified multidetector CT colonography for the evaluation of acute and subacute colon obstruction caused by colorectal cancer: a feasibility study.

PURPOSE: This study was designed to evaluate the feasibility of using CT colonography with a modified procedural protocol for diagnosis and cancer staging in patients with suspected acute or subacute colon obstruction caused by colorectal cancer. METHODS: Following colonic cleansing with lukewarm water enemas, thin-collimation CT colonography was performed on 47 patients (15 women and 32 men, mean age, 68 years) in the precontrast prone position and in the supine position after the intravenous administration of a contrast agent. The surgical and pathologic findings served as a reference standard. RESULTS: In 44 of 47 patients, colon distention was caused by obstruction, and pathologic examination confirmed colorectal cancer in 41 of these 44 patients. CT colonography correctly located all tumors and successfully identified noncancerous causes of colon distention in five patients. The overall accuracy of staging was 97.6 percent for the T category, 73.2 percent for N, and 100 percent for M. Two synchronous colorectal cancers were correctly identified. CONCLUSIONS: When appropriate protocol modifications regarding colon cleansing and air insufflation are made to take the clinical situation into account, CT colonography is a technically feasible, accurate, and well-tolerated method for tumor evaluation and cancer staging in patients with acute and subacute colon obstruction.

Massive gastrointestinal bleeding and obstruction of the ureter caused by the migration of a swallowed toothpick from the sigmoid colon--a case report.

In this study, a case of an ingested toothpick partially migrating from the sigmoid colon, causing massive lower gastrointestinal bleeding due to arterial-colic fistula, and stricture of the left ureter is presented. A 70-year-old male was admitted to the emergency department after having feces mixed with fresh and coagulated blood for the past two days. Computed tomography and retrograde ureteropyelography showed the stricture of the left ureter, 1.5 cm below the branching of iliac artery, without any signs of malignancy. Colonoscopy showed fresh blood in the rectum and sigmoid colon up to the neoplasm like granulation tissue mixed with fresh and coagulated blood, which almost obstructed the lumen. Explorative laparotomy showed a foreign body (toothpick) perforating the sigmoid colon through the mesenterial wall, and being stocked with one-third into the left internal iliac artery, causing arterial-colic fistula. The remaining part of the toothpick was surrounded by granulation tissue and chronic inflammatory process, pressing on the distal third of the left ureter. We conclude that a swallowed toothpick may cause a significant gastrointestinal injury with a wide variety of clinical manifestations, and it must be treated with caution. The imaging studies are often inadequate in detecting toothpicks, and thus, we insist on a physical examination, as the best indicator of injury.

Successful conservative and endoscopic treatment of pancreatic fistula due to splenectomy following blunt abdominal trauma.

Pancreatic fistula most commonly occur as a consequence of resective procedures and pseudocyst drainage, and rarely as a consequence of splenectomy. Conservative treatment can have good results, but it is long lasting and demands long hospitalization. In case of conservative treatment failure, operative treatment is indicated, but this has significantly higher percentage of morbidity and mortality. In selected cases, conservative treatment with somatostatine or octreotide, along with endoscopic procedure including the use of fibrin glue, significantly accelerates sanation of the fistula and reduces the length of hospitalization. We report a case of exterior pancreatic fistula due to splenectomy following blunt abdominal trauma, which were successfully treated with conservative (infusion, antibiotics, enteral nutrition, and octreotide) and endoscopic therapy. During ERCP papillotomy was performed, and good external drainage using drainage catheter was important in the patient outcome. Considering the initial secretion of 300 mL/24 h, our patient had a high output fistula. Despite that, fistula was quickly resolved after treatment. Our opinion is that octreotide therapy and unobstructed drainage of pancreatic duct into the duodenum were the most important in the rapid resolution of the fistula.