MicroRNAs involved in the HMGA2 deregulation and its co-occurrence with MED12 mutation in uterine leiomyoma.

STUDY QUESTION: Can the mediator complex subunit 12 (MED12) mutation and high mobility group AT-hook 2 (HMGA2) overexpression co-occurrence be explained by the alternative mechanism of HMGA2 dysregulation in uterine leiomyomas (UL)? SUMMARY ANSWER: The co-occurrence of MED12 mutation and HMGA2 overexpression, and a negative correlation of five validated or predicted microRNAs that target HMGA2 were reported. WHAT IS KNOWN ALREADY: The recent stratification of UL, according to recurrent and mutually exclusive genomic alterations affecting HMGA2, MED12, fumarate hydratase (FH) and collagen type IV alpha 5-alpha 6 (COL4A5-COL4A6) pointed out the involvement of distinct molecular pathways. However, the mechanisms of regulation involving these drivers are poorly explored. STUDY DESIGN, SIZE, DURATION: A total of 78 UL and 34 adjacent normal myometrium (NM) tissues was collected from 56 patients who underwent hysterectomies at a single institution. The patients were treated at the Department of Gynecology and Obstetrics, School of Medicine, Sao Paulo State University, Botucatu, SP, Brazil, from October 1995 to February 2004. PARTICIPANTS/MATERIALS, SETTING, METHODS: Gene expression profiling was evaluated from fresh frozen tissues and compared with MED12 mutations at exon 2. In addition, RT-qPCR was applied to evaluate the expression levels of HMGA2 and their predictive miRNA regulators: hsa-let-7a, miR-26a, miR-26b, mir-93 and mir-106b. MAIN RESULTS AND THE ROLE OF CHANCE: An unsupervised hierarchical clustering analysis revealed two main clusters with one of them (26 of 42 UL) showing an enrichment of MED12 mutated cases (18 of 26 UL). Increased expression levels of HMGA2 were observed in both clusters, including cases with MED12 mutation (cluster 1:18 UL). A significant HMGA2 overexpression (P < 0.001) in UL in comparison with NM was found. Five miRNAs predicted to regulate HMGA2 were significantly downregulated (P < 0.001) and negatively correlated to HMGA2 expression levels (P < 0.05) in UL. LIMITATIONS REASONS FOR CAUTION: An in vivo functional study was not performed to validate the microRNAs and HMGA2 interaction due to technical limitations. WIDER IMPLICATIONS OF THE FINDINGS: HMGA2 overexpression was detected in a significant number of MED12 mutated ULs, suggesting that these alterations coexist. Furthermore, five miRNAs were described as potential regulators of HMGA2 expression in UL. LARGE-SCALE DATA: Data available in the Gene Expression Omnibus GSE42939. STUDY FUNDING AND COMPETING INTEREST(S): This study was supported by grants from Fundação de Amparo a Pesquisa do Estado de São Paulo (# 2008/58835-2) and Conselho Nacional de Pesquisa (# 485032/2007-4), Brazil. The authors declared having no conflicts of interest.

In vitro study of the Nd:YAG laser effect on human dental enamel: optical and scanning electron microscope analysis.

OBJECTIVE: The Nd:YAG laser irradiation of dental enamel was evaluated in enamel demineralization experiments in a Streptococcus mutans culture media. SUMMARY BACKGROUND DATA: Previous studies had shown that a continuous wave Nd:YAG laser at an energy of approximately 67 mJ may induce an increased acid resistance in human dental enamel when exposed to severe demineralization conditions. METHODS: Enamel windows of 3 x 4 cm in the buccal surface were irradiated with a continuous wave Nd:YAG laser at a wavelength of 1,064 microns using energy densities of from 83.75 to 187.50 J/cm2. Enamel windows of 3 x 4 cm on the lingual surface served as control (without the laser irradiation). The enamel windows were then exposed to a Streptococcus mutans culture media at a temperature of 37 degrees C for 15 and 21 days. The laser effects and demineralization were examined both by optical microscopy and scanning electron microscopy (SEM). RESULTS: A comparison between the lased and the unlased windows of enamel showed fusion and recrystalization of the enamel and increased acid-resistance in all groups irradiated with the Nd:YAG laser. On the other hand, the 3 x 4 delimited enamel surfaces from the control group (not irradiated with the Nd:YAG laser) showed 100% demineralization. CONCLUSIONS: These findings are consistent with the finding that laser irradiation of dental results in significant reduction of the effective solubility of enamel mineral.

[Annular pancreas. Report of a case and review of the literature]. / Pâncreas anular. Apresentação de caso e revisão da literatura.

The authors present a case of newborn pre-term with birthweight of 2,250 g. There was polyhydramnios. On the first day she developed jaundice suggested upper intestinal obstruction. A plain radiograph of the abdomen confirmed the previous finding of obstruction of the duodenum, which showed a "double bubble" image with no other gas shadow in the rest of the abdomen. Contrast rodiologic examination of the abdomen confirmed total obstruction of the duodenum second portion. On the 2nd day after birth, laparotomy revealed an annular pancreas. The reconstruction was made by a side-to-side proximal duodeno-jejuno-anastomosis. The postoperative course was uneventful. Barium radiography at one month postoperatively was good.

Prophylactic appendicectomy due to foreign body. Case report.

A 11-year-old mentally ill male who had swallowed a metal necklace that has been lodged on the cecal appendix is presented. Because of the relatively high risk of an acute appendicitis a prophylactic appendicectomy was performed.

[Surgical treatment of intestinal obstruction]. / Tratamento cirúrgico da obstrução intestinal.

The etiology of intestinal obstruction (I.O.) has changed markedly since the beginning of this century. In this series, the authors studied 121 cases of I.O. treated surgically; adhesions were the commonest cause of high intestinal obstruction, accounting for 43.03 percent in a total of 79 patients, with hernia being the obstruction lesion in 16.45 percent. Colo-rectal cancer were the commonest cause of low intestinal obstruction accounted for 73.81 percent, with volvulus of the sigmoid colon in 14.28 percent. Complications occurred in 15.7 percent of patients following operative intervention; wound infection was the most common postoperative complication. The overall operative mortality was 9.09 percent.

[Crepitant abdominal cellulitis: a rare clinical presentation of sigmoid tumor]. / Celulite crepitante abdominal: uma rara forma de apresentaacão do tumor do sigmóide.

Unusual infections associated with colorectal tumors may, in some instances, be the sole clue to presence of malignancy. The infections are either related to invasion of tissues or organs in close proximity to the tumor or secondary to distant seeding by transient bacteremia arising from necrotic tumors. The authors present one case of spontaneous crepitant cellulitis in the lower abdominal wall, associated with sigmoid tumor. The patient had abdominal pain in the left iliaca fossa, fever and skin necrosis of the lower abdominal wall in the last 4 hours. At surgery they performed debridement and excision of necrotic tissue (lower abdominal wall) and partial sigmoidectomy with sigmoid colostomy. The patient died 9 months after initial surgery. A study of tumor mass revealed an adenocarcinoma. The presence of crepitant cellulitis in a lower abdominal wall should result in a search for bowel perforation.

[Is it necessary to perform routine intraoperative cholangiography during cholecystectomy?]. / E necessário realizar colangiografia operatória como rotina nas colecistectomias?

The intraoperative cholangiography was carried out in 361 patients with gallstone disease. In 293 (81.16%) patients cholangiography was normal, in 68 (18.83%) was abnormal. Thirty-six (9.97%) patients had pre-operative asymptomatic common bile duct calculi and 20 (5.54%) patients had confirmed suspect of common bile duct calculi during cholangiography. Twelve (3.32%) patients were false-positive and one (0.27%) was false-negative. It is discussed the value of routine intraoperative cholangiography in patients with gallstone disease.

[A single layer suture in gastric cancer surgery]. / Anastomose em plano único de sutura na cirurgia do câncer gástrico.

A total or nearly total gastrectomy was performed in 30 patients with adenocarcinoma of the stomach. The continuity of the alimentary tract was restored by end-to-side esophagojejunostomy or gastrojejunostomy using a Roux-Y and all the cases had one layer extramucosa suture with 3-0 mononylon. The complications were: one case of left subphrenic abscess; one case of anastomotic leakage (esophagojejunum anastomosis); 2 cases of abdominal wound infection. Surgical mortality was 0%.

[Volvulus of the cecum. A case report]. / Volvo do ceco. Relato de caso.

The authors present one case of intestinal obstruction by volvulus of the cecum. The patient had abdominal pain for 4 days. This pain was colicky in nature and of greatest in density in the left iliac fossa. He was nauseated, had anorexia, and had been vomiting. Abdominal distension was present. Plain-roentgenogram of the abdomen showed an enormously distended gas-filled intestinal loop in the upper abdomen just to the left of midline. At surgery there was volvulus of the cecum located in the upper abdomen to the left of midline. The cecum was viable and was relocated in the right lower quadrant and secured to the antero-lateral abdominal wall (cecopexy). The patient made a good postoperative recovery.

Obstructive jaundice caused by blastomycosis of the lymph nodes around the common bile duct.

A case of obstructive jaundice due to granulomatous blastomycosis is presented. The patient had complained of abdominal pain in the right hypochondrium and jaundice. During hospitalization, the laboratory tests showed evidence of obstructive jaundice and complementary tests a distended gallbladder, dilatation of the intra and extrahepatic bile ducts with enlarged lymph nodes of the hepatic hilus. During the operation a cholestatic liver, distended gallbladder and enlarged lymph nodes around the common bile duct were found. Histopathology of the lymph nodes revealed South American blastomycosis. The medical management consisted of amphotericin B. At present the patient is alive and well.

[Sphincteroplasty: its value in the treatment of distal lithiasis of the choledochus]. / Esfincteroplastia: sua validade no tratamento da litíase do colédoco terminal.

Twenty patients in whom sphincteroplasty was performed are presented. In 12 cases the indication was choledocholithiasis with stone impacted in the distal bile duct; 5 cases with choledocholithiasis and oddian stenosis, and 3 cases with residual choledocholithiasis associated with oddian stenosis. The average length of the incision of the ampullary area was 25 mm. The postoperative control made by tube cholangiography evidenced the presence of a wide open choledochoduodenal opening. Amylase activity was followed in all patients. One case of acute pancreatitis and one case of choledochal fistula were recorded as postoperative complications.

Estudo prospectivo na apendicite aguda, drenando ou nao a cavidade peritoneal apos a apendicectomia. / Prospective study in acute appendicitis with or without peritoneal drainage

Os autores apresentam estudo prospectivo sobre a drenagem ou nao da cavidade peritoneal, em 170 casos de apendicectomias por apendicite aguda. A drenagem da cavidade abdominal foi executada aleatoriamente, por sorteio, sem levar em consideracao o tipo de apendicite, grau de toxemia ou a extensao da peritonite. A idade media dos doentes foi de 24,8 anos, sendo 122 homens e 48 mulheres. O tempo medio de evolucao do quadro ate o momento da cirurgia foi de 38,8 horas. Em 150 casos foi realizada a incisao de Mac Burney e, em 20, incisao de Jalaguier. Setenta e cinco doentes foram drenados e 95 nao. Os drenos foram exteriorizados sistematicamente por contra-abertura na fossa iliaca direita. As condutas de drenagem, ou nao, ocorreram de forma equitativa nas diferentes formas anatomopatologicas do apendice (gangrenado ou nao-gangrenado) e nos diferentes tipos de liquido peritoneal (purulento ou nao-purulento, bacteriologicamente positivo e negativo).Os doentes drenados tiveram permanencia hospitalar mais prolongada e nitidamente maior numero de complicacoes pos-operatorias

[Critical analysis of the treatment of gastric ulcer by proximal gastric vagotomy]. / Análise crítica do tratamento da úlcera gástrica pela vagotomia gástrica proximal.

In the surgical treatment of gastric ulcer (G,U,), the same techniques have been employed as have been used in duodenal ulcer (D.U.). This correspondence also holds true with superselective vagotomy and proximal gastric vagotomy (P.G.V.). The technique was primarily indicated in the treatment of D.U. and had very exciting preliminary results, above all owing to its reduced morbidity both immediately and late after surgery, and to its almost null mortality. With a view to analyzing the results of the use of P.G.V. in the treatment of gastric ulcer, thirteen patients were operated upon who were bearers of G.U. not associated with D.U. nor prepyloric ulcer. There were no operating accidents or immediate post-operative complications, nor was there any mortality. In the post-operative period following lasting an average of 17.7 months, we observed the clinical manifestation of the ulcer and symptoms accompaning the operation in addition to performing endoscopy on all of the patients. Eight patients were absolutely asymptomatic after surgery; one had slight dysphagia that diminished about 3 months after P.G.V. Three patients had recurrence of the symptoms of ulcer and one complained of intense epigastric fullness, vomting, weight loss, and a crisis of diarrhea. Radiologic and endoscopic examinations showed that this last patient had hypotonia and marked gastric stasis that were corrected surgically by means of antrectomy and the reconstitution of GI tract by the BI technique, with good results. In three patients endoscopy showed postoperative recurrence of the G.U., one of whom is assymptomatic with the clinical treatment; the other two were submitted to antrectomy with BI anastomosis in one and a 2/3 gastrectomy with BI reconstruction in the other. The cure of the lesion in 23% of the cases in the post-operative follow-up lasting an average of 17.7 months permits us henceforward to contra-indicate the P.G.V. used per se for the treatment of G.U.

Ulcera gastrica pos-esofagogastroplastia. / Gastric ulcer post-esophagogastroplasty

Os autores relatam caso de ulcera peptica no estomago transposto ao torax em um doente com megaesofago grau IV, submetido a esofagectomia subtotal pela tecnica de Ferreira. O aparecimento da ulcera ocorreu no terceiro ano de pos-operatorio. A secrecao gastrica basal e estimulada pelo Histalog, assim como a dosagem da gastrina serica, foram considerados normais. O esvaziamento gastrico, prejudicado pelo mau funcionamento da piloroplastia, determinando estase foi considerado fator causal da ulcera gastrica e a realizacao de piloroctomia, melhorando a drenagem, levou a cicatrizacao da ulcera

Fratura do penis durante intercurso sexual: relato de um caso. / Fracture of the penis during sexual intercourse: report of a case

Os autores apresentam um caso de fratura de penis em paciente jovem durante o intercurso sexual. Comentam sobre a etiologia, quadro clinico e o tratamento, ressaltando a importancia da cirurgia imediata