An investigation into the serum thioredoxin, superoxide dismutase, malondialdehyde, and advanced oxidation protein products in patients with breast cancer.

BACKGROUND: Reactive oxygen species (free radicals) play an important role in carcinogenesis. Extensive antioxidant defense mechanisms counteract free radicals in mammalian cells. Oxidative stress is a disturbance in the balance between the production of free radicals and antioxidant defenses. There is direct evidence that oxidative stress and lipid peroxidation (LPO) are linked to the etiology of breast cancer. The increasing global incidence of breast cancer emphasizes the need to understand the various mechanisms involved in breast tumorigenesis. The present study was undertaken to investigate the oxidative stress and antioxidant status in the blood samples of patients with breast cancer. METHODS: The present study was based on 23 women who were surgically treated at Gazi University, Faculty of Medicine, Department of General Surgery. The malondialdehyde (MDA) levels as an index of LPO along with the examination of superoxide dismutase (SOD) activities and advanced oxidation protein product (AOPP) and thioredoxin (Trx) levels were determined in the blood samples of 23 patients with breast cancer and 13 healthy controls. RESULTS: MDA, AOPP, and Trx levels and SOD activities were significantly higher in patients with breast cancer than the controls. CONCLUSIONS: The results showed that oxidative stress may be related to breast cancer and especially some molecules, such as Trx and AOPP, may be useful biomarkers in breast cancer diagnosis and treatment. More detailed knowledge related to the pathophysiology of these molecules could provide valuable information on the origin and development of malignant tumors, such as breast cancer.

The effect of calcitonin gene-related peptide on healing of intestinal anastomosis in rats with experimental obstructive jaundice.

PURPOSE: Intestinal anastomotic healing is a complex procedure in which several mediators and cytokines play roles. Calcitonin gene-related peptide is an important neuropeptide in inflammation. In this study we aimed to investigate the effect of calcitonin gene-related peptide on healing of intestinal anastomosis in rats with obstructive jaundice. MATERIALS AND METHODS: Obstructive jaundice was induced in rats by the ligation and division of the common bile duct. Four days after the operation, intestinal anastomosis was performed, and either calcitonin gene-related peptide or 0.9% NaCl was administered intraperitoneally to these jaundiced rats and controls. The concentrations of serum tumor necrosis factor-alpha (TNF-alpha) and triglyceride levels of all rats were measured, and healing of the anastomosis was evaluated by measuring the bursting pressure and hydroxyproline content on the 7th postoperative day. RESULTS: Calcitonin gene-related peptide was found to have positive effects on healing of the anastomosis by inhibiting the effects of TNF-alpha and increasing the bursting pressure and hydroxyproline content of the anastomosis. CONCLUSION: Calcitonin gene-related peptide increases anastomotic wound healing in experimental anastomosis in the presence of obstructive jaundice in rats.

WITHDRAWN: Significance of serum vascular endothelial growth factor, insulin-like growth factor-I levels and nitric oxide activity in breast cancer patients.

The publisher regrets that this is an accidental duplication of an article that has already been published in The Breast, 12 (2003) 1-9, doi:10.1016/S0960-9776(02)00214-X. The duplicate article has therefore been withdrawn.

Total thyroidectomy for the treatment of Hashimoto's thyroiditis coexisting with papillary thyroid carcinoma.

The coexistence of Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) is controversial. This study was conducted to evaluate the correlation between HT and PTC and to identify predictive factors for the coexistence of PTC and HT. A total of 922 patients underwent surgery for thyroid disorders between January 2001 and August 2005. In all, 199 patients had been diagnosed with PTC, 37 of whom had coexistent HT; in 689 patients, benign thyroid disease had been diagnosed. Patients' age and sex, as well as histopathology, tumor size, nodal involvement status, multicentricity, presence of metastasis, and serum thyroglobulin levels, were retrospectively reviewed. A significant correlation was observed between HT and PTC, although no statistical significance was noted between PTC and HT type (nodular or diffuse). Most patients with PTC+HT were female and younger (<40 y old) than those with PTC only. The rate of occult tumor in patients with PTC+HT was higher than that in patients with PTC alone. Data indicate the coexistence of PTC and HT and suggest that PTC may develop even in cases of diffuse HT. Total thyroidectomy is the surgical procedure of choice, especially in young, female patients with HT.

Potential benefit of oral calcium/vitamin D administration for prevention of symptomatic hypocalcemia after total thyroidectomy.

OBJECTIVE: To evaluate routine oral calcium and vitamin D administration for preventing symptoms of hypocalcemia after total thyroidectomy. SUBJECTS AND METHODS: A total of 487 consecutive patients were prospectively randomized into two groups in terms of routine oral calcium and vitamin D supplementation: In the control group (244 patients) the treatment was not routinely started after surgery, whereas the treated group (243 patients) received routine supplementation that started on postoperative day 1. RESULTS: Patients of treated group had only minor hypocalcemia symptoms, whereas 7 patients of control group experienced carpopedal spasm as a major symptom (p<0.001). None of the patients in the treated group required intravenous calcium administration. Average hospital stay of the treated group patients was significantly shorter than that of control group (p<0.001). CONCLUSIONS: Routine postoperative calcium and vitamin D supplementation therapy may be useful for the prevention of symptomatic hypocalcemia after total thyroidectomy and may allow for a safe and early discharge from the hospital.

Microanatomy of milk ducts in the nipple.

The aim of this study was to determine number and diameter of milk ducts in the nipple and to investigate the possible influences of age, breast weight, and diameter of the nipple on the number of ducts. Two hundred and twenty-six carcinoma mastectomy specimens were weighed and the nipple diameters measured. The number of ducts was counted in histological cross sections. Mean diameter of the nipple and mean breast weight were 13.9 mm and 844.6 g, respectively. There was a small but statistically significant positive correlation between nipple diameter and number of milk ducts (rho = 0.158; p = 0.01), but no correlation with breast weight. The mean number of ducts in the nipple duct bundle was 17.5. This is significantly higher than the number of ducts reported to open on the nipple surface. This discrepancy could reflect duct branching within the nipple or the presence of some ducts which do not reach the nipple surface. Smaller breast ducts (diameter < 0.5 mm) represent nearly 50% of the nipple ducts and could be a challenge to the ductoscopy technology.

Postoperative analgesic effects of lornoxicam after thyroidectomy: a placebo controlled randomized study.

The purpose of the present study was to determine the postoperative analgesic effects of lornoxicam and the reduction in tramadol consumption. Fourty patients of ASA class I-II, 18-70 years of age, undergoing thyroidectomy were assigned in a randomized manner into two groups: GroupL received 8 mg of lornoxicam i.v. at the end of the operation followed by 8 mg of lornoxicam b.i.d., i.v. for 24 hours postoperatively. GroupP received 4 ml of saline solution i.v. at the end of the operation and the same amount b.i.d., i.v. for 24 hours postoperatively. The requirements for supplemental analgesics were recorded at 0-6, 6-12 and 12-24 hour intervals. Postoperative pain scores were evaluated at 15th min. and 1, 2, 4, 6, 8, 12, 18 and 24th hours using Visual Analogue Scale (VAS). The time to first analgesic requirement was significantly longer in GroupL compared to GroupP (101.7 vs 37.9 min, p<0.001). Pain scores were significantly lower in GroupL compared to GroupP at 15th min, 1, 8 ,12 and 18th hours. Twenty four hour analgesic consumption was significantly lower in GroupL compared to GroupP (p<0.05). The amount of tramadol consumed in GroupL was 60% lower compared to GroupP (100 mg and 250 mg (mean), respectively). 100% of the patients in GroupL and 60 % of the patients in GroupP needed supplemental analgesics. The degree of satisfaction with postoperative pain management was excellent in 95 % of patients in GroupL and 25 % of patients in GroupP. Eighteen patients in GroupP and 9 patients in GroupL had nausea (p=0.002), and fifteen patients in GroupP and 8 patients in GroupL had vomiting (p=0.025). Lornoxicam decreased the opioid need, the incidence of nausea and vomiting and postoperative pain scores. Moreover, it was observed that the time needed for the first analgesic requirement was prolonged following thyroidectomies.

The effects of carbon dioxide pneumoperitoneum on tyrosine hydroxylase activity.

PURPOSE: The aim of this study is to investigate the effects of carbon dioxide (CO2) pneumoperitoneum on tyrosine hydroxylase (TH) activity and total protein (TP) levels. METHODS: Forty male Sprague-Dawley rats were randomized into 10 groups, each consisting of 10 rats. Groups 1 and 2 consisted of anesthesia and sham-operated control rats, respectively. In the study groups, 10 mm Hg (group 3) and 15 mm Hg (group 4) pneumoperitoneum with CO2 were accomplished. At the end of the procedures, the brains and adrenals were removed quickly, and the hypothalamus and adrenal medulla separated, weighed, and homogenized. TH activity and TP levels were determined. RESULTS: The adrenal medulla TP and TH activity levels were decreased consistently and this decrease was significant in the sham and pneumoperitoneum groups compared with the control group (P<0.05). The adrenal medulla TP and TH activity levels were reduced significantly in group 4, as compared with the other groups (P<0.05). Elevation of hypothalamic TH activity in group 4 was significantly higher than in the other groups (P<0.05). CONCLUSIONS: These results indicate that CO2 pneumoperitoneum applied with 10 and 15 mm Hg pressure gradually decreases the adrenal medulla TH activity; TH is an indispensable enzyme for the biosynthesis of catecholamines. CO2 pneumoperitoneum with 15 mm Hg pressure significantly elevated hypothalamus TH activity.

Prospective analysis of 518 cases with thyroidectomy in Turkey.

OBJECTIVE: Thyroid malignancies can present in different manners, among them as asymptomatic solid nodule being the most puzzling. Nodules have been found in the 60-70 % of autopsy specimens and it is very important to rule out the malignancies in such cases. Incidence of carcinomatous changes is reported in 5-15 % of solitary nodules. We present the results of prospective study on 418 thyroidectomies with the aim to review the experience of our unit, to establish the correlation between clinical presentation and histopathology, to discuss the malignancy rates and surgical complications. PATIENTS AND METHODS: Five hundred eighteen consecutive cases of thyroidectomy 419 female (80.8 %), and 99 male (19.2 %) patients performed between January 2002 and October 2004 were included in this prospective study. RESULTS: In 71 (13.7 %) cases the malignancy was found by paraffin specimens, the highest prevalence of malignancy being found in patients with nodular goiter (NG-18 %) followed by 14.6 % in multinodular goiter (MNG). The sensitivity of preoperative fine needle cytology (FNAC) was 83.3 % with false positive rate of 1.3 %. Complications were seen in 5.2 % of cases of which 4 (0.7 %) had hypoparathyroidism and 7 (1.3 %) had recurrent laryngeal nerve injury. All patients observed came from endemic area. Family history nearly doubles the risk of malignancy. CONCLUSIONS: In an endemic area the nodular goiter is the most common. Preoperative cytology, although sensitive, gives a considerable number of false positive results. Results of thyroid surgery at a high volume centre are satisfactory with very low rates of recurrent laryngeal nerve and parathyroid injury. Probability of malignant transformation in a long standing thyroid swelling should always be kept in mind. There appears to be an increase in prevalence of thyroid malignancies in Turkey after Chernobyl disaster.

Clinical presentation and treatment of hyperthyroidism associated with thyroid cancer.

OBJECTIVE: Hyperthyroidism apparently does not protect the patients from thyroid cancer as believed before. In contrast, hyperthyroidism with concurrent thyroid cancer can be diagnosed after pathological examination of unsuspect nodules. The aim of this study was to evaluate the coexistence of hyperthyroidism and thyroid carcinoma and to discuss the advantages of total thyroidectomy in such cases. METHODS: Between January 2002 and October 2004, 120 hyperthyroid patients underwent surgical treatment in our clinic. All patients with hyperthyroidism in this study underwent fine-needle aspiration biopsy and cytologic examination. Frozen section evaluation was performed in all of these patients during the operation. RESULTS: Among these patients 10 had concurrent thyroid cancer. Only one of these patients was examined by fine needle aspiration biopsy prior to operation, while the rest of malignancies was diagnosed from unsuspect nodules. CONCLUSIONS: The selection of appropriate operation procedure appears very important to find out and treat concurrent thyroid cancers. We diagnosed 90 % of thyroid cancers incidentally. If there are no technical difficulties, we prefer total thyroidectomy for the patients with toxic multinodular goiter and Graves' disease with nodules.

Significance of serum vascular endothelial growth factor, insulin-like growth factor-I levels and nitric oxide activity in breast cancer patients.

Vascular endothelial growth factor (VEGF) is used to evaluate the angiogenic activity in breast carcinoma. Nitric oxide (NO) and insulin-like growth factor-I (IGF-I) are also implicated in breast tumorigenesis, including angiogenesis. We measured serum VEGF, IGF-I and nitrate+nitrite levels in 38 patients with metastatic and 23 with nonmetastatic breast cancer and in 16 controls. Serum VEGF and IGF-I levels were higher in patients with metastatic disease than in those with nonmetastatic disease or in controls (P<0.001). Serum nitrate+nitrite levels were higher in patients with metastatic and nonmetastatic disease than in controls (P<0.001). Patients with visceral metastasis and local metastasis had higher serum VEGF and nitrate+nitrite levels than patients with bone metastasis (P<0.05). In the metastatic disease group, there was a positive correlation between serum VEGF levels and nitrate+nitrite levels (r=0.436, P<0.05). Within the group with nonmetastatic disease, premenopausal patients had higher serum IGF-I levels than did postmenopausal patients (P<0.001). NO may involve an angiogenic process that is stimulated by VEGF in breast carcinoma. Larger studies are required to clarify these suggestions.