Hypoxia-Inducible Factor 2a Expression Is Positively Correlated With Gleason Score in Prostate Cancer.

BACKGROUND: One of the main factors in response to hypoxia in the tumor microenvironment is the hypoxia-inducible factor (HIF) pathway. Although its role in other solid tumors, particularly renal cell carcinoma, has been sufficiently elucidated, it remains elusive in prostate cancer. The aim of the present study was to investigate the expression of main proteins involved in this pathway and determine the correlation of the results with clinicopathological outcomes of patients with prostate cancer. METHODS: The immunohistochemical expression of HIF-1a, HIF-2a and their regulators, prolyl hydroxylase domain (PHD)1, PHD2 and PHD3 and factor inhibiting HIF (FIH), was assessed on a tissue microarray. This was constructed from radical prostatectomy specimens, involving both tumor and corresponding adjacent non-tumoral prostate tissues from 50 patients with localized or locally advanced prostate cancer. RESULTS: In comparison with non-tumoral adjacent tissue, HIF-1a exhibited an equal or lower expression in 86% of the specimens (P = 0.017), while HIF-2a was overexpressed in 52% (P = 0.032) of the cases. HIF-1a protein expression was correlated with HIF-2a (P < 0.001), FIH (P = 0.004), PHD1 (P < 0.001), PHD2 (P < 0.001) and PHD3 (P = 0.035). HIF-2a expression was positively correlated with Gleason score (P = 0.017) and International Society of Urological Pathologists (ISUP) grade group (P = 0.022). CONCLUSIONS: The findings of the present study suggest a key role for HIF-2a in prostate cancer, as HIF-2a expression was found to be correlated with Gleason score and ISUP grade of the patients. However, further studies are required to validate these results and investigate the potential value of HIF-2a as a therapeutic target in prostate cancer.

A giant adrenal cyst difficult to diagnose except by surgery.

INTRODUCTION: Adrenal cysts represent rare clinical entities. Although surgical indications are well defined, pitfalls arise from the failure to establish an accurate preoperative diagnosis. Cystic lesions of other abdominal organs especially the pancreas complicate the diagnostic field. PRESENTATION OF CASE: We present the case of a giant adrenal cyst in a young female causing diagnostic dilemma. Imaging studies revealed a large cystic lesion of uncertain origin located between the spleen and the tail of the pancreas. It was decided to perform a laparotomy which confirmed the presence of an adrenal cyst and enucleation of the cyst was performed. Examination at one year confirmed no complications. DISCUSSION: Adrenal cysts should always be included in the differential diagnosis of cystic abdominal lesions. CONCLUSION: When the preoperative diagnosis is uncertain, surgical intervention can be both diagnostic and therapeutic.

Neurovascular injury during primary total hip arthroplasty caused by a threaded acetabulum cup.

We report an iatrogenic neurovascular injury during hip arthroplasty surgery. During insertion of a threaded titanium cup into a dysplastic acetabulum (lack of anterior wall), both the common femoral artery and nerve were crushed. It is therefore recommended that, if the soft tissues are exposed and can interfere with the instruments, inserts that require rotation should not be selected to be placed in the acetabulum. To the best of our knowledge, such a mechanism of injury has never been reported.

Fatal intra-operative pulmonary embolism following application of an Esmarch bandage.

The objective of this paper is to raise the awareness of a possible fatal complication during operations in the lower limbs, when an Esmarch bandage is used for exsanguination of the affected limb during the operation. After reviewing the literature, four cases of fatal massive pulmonary embolism have been identified after Esmarch bandage application in trauma patients [Acta Anaesthesiol Belg 50(2) (1999) 95, Reg. Anaesth 6 (1983) 83, Anesthesiology 58 (1983) 373, Anaesthesia 25(3) (1970) 445] but there is no any reference to an elective case. The authors would like to report two cases of fatal embolism after Esmarch bandage application for both elective surgery (total knee replacement) and trauma (trimalleolar fracture). Both patients had received regional anaesthesia. After comparing the data from our cases and the literature, it is recommended that the Esmarch bandage should not be used in trauma, especially when there has been a delay in time for surgery. In elective cases of the lower limbs, preoperative cardiovascular evaluation and the exclusion of other factors predisposing to DVT are necessary, especially for patients more than 50 years old.