Percutaneous distal osteotomy of the first metatarsal (PDO) for the surgical treatment of hallux valgus.

The authors report their experience in the treatment of hallux valgus by percutaneous distal osteotomy (PDO) of the first metatarsal. Surgery is performed under truncular anaesthesia, in day-surgery, and weight-bearing is allowed immediately. Between January 2001 and December 2002 this procedure was used to treat 83 patients (90 feet). Long-term clinical and radiographic follow-up revealed the percentage of excellent results, in line with open surgery. Post-surgical complications are also considerably reduced, with better patient compliance.

Intracystic evaluation of tumor markers in benign and malignant ovarian pathology.

OBJECTIVE: To evaluate, in patients with benign and malignant ovarian cysts, serum samples and ovarian intracystic fluids for the presence of tumor markers such as CA 125, CA 15.3, tissue polypeptide antigen (TPA), CA 19.9 and the carcinoembryonic antigen (CEA). MATERIAL AND METHOD: We studied overall 64 patients with ovarian pathology. Sixteen patients were affected by functional cysts, 28 women by benign cystic tumors and 20 by cystoadenocarcinomas. RESULTS: Average serum levels of all but CA 15.3, TPA and CEA tumor markers of benign cystic ovarian tumors were higher than those of functional cysts. All but CA 19.9 mean intracystic fluid markers levels were more elevated in benign tumors than in functional cysts. In patients with malignant cystic tumors, all but CEA mean serum marker levels were higher than those of benign tumors; furthermore even all mean intracystic levels of markers were more elevated than those of benign tumors. CONCLUSION: This study confirmed the high positivity of tumor markers such as CA 125, CA 15.3, TPA, CA 19.9 and CEA in both the serum and intracystic fluid of patients with malignant epithelial ovarian tumors.

Microsatellite analysis at 10q25-q26 in Sardinian patients with sporadic endometrial carcinoma: identification of specification patterns of genetic alteration.

BACKGROUND: Loss of heterozygosity (LOH) at chromosome 10q25-q26 has been reported previously in endometrial carcinoma (EC), suggesting the presence of tumor suppressor gene(s). Nevertheless, frequency of genome-wide microsatellite instability (MSI) has been demonstrated higher in EC than in other common malignancy, mostly due to defective DNA mismatch repair. The authors further evaluated the role of the chromosome 10q25-q26 in endometrial tumorigenesis as well as the clinical significance of any observed genetic alteration in sporadic EC. METHODS: Paired normal and tumor samples from 94 Sardinian patients with sporadic EC at various stages of disease were screened by polymerase chain reaction (PCR)-based microsatellite analysis. Genomic DNA was isolated from paraffin embedded tissues and amplified by PCR using microsatellite markers spanning approximately 14 cM at 10q25-q26. Microsatellite instability was studied at four loci mapping to different chromosomal locations. RESULTS: Thirty-two (34%) EC patients were found negative for genetic alterations within the 10q25-q26 region. Among the remaining 62 (66%) EC cases, the authors identified 1) a minimum consensus region of LOH of approximately 1 cM, between D10S610 and D10S542 markers; and 2) a subset of tumors with prevalence of instability at 10q25-q26 (10qMI+), as expression of the presence of a MSI+ phenotype. CONCLUSIONS: The authors' data establish the existence of significant correlations between disease stages and 10qMI+ (with or without MSI+). However, longer follow-up and additional studies are required to define the clinical significance of these findings as prognostic factors. Moreover, the minimum region of LOH at 10q25-q26 will be further analyzed for identifying the putative tumor suppressor gene involved in EC pathogenesis.

Coexistence of a heterotopic pregnancy associated with a homolateral ovarian cyst in a patient submitted to elective abortion.

The authors describe the case of a right tubal pregnancy of delayed diagnosis in a 31-year-old nullipara, who was submitted to voluntary termination during the 7th week of pregnancy and who presented a homolateral ovarian cyst. Two weeks later the patient presented pelvic pain and intraperitoneal fluid layer, while plasma beta-hCG was 1,262 IU/ml. The case history was complicated by recent termination surgery and presence of an ovarian cyst, but a plasma beta-hCG assay and transvaginal ultrasonography oriented the diagnosis towards a previously unrevealed heterotopic pregnancy. The fallopian tube and the ovarian cyst were removed by laparoscopy. The case points out to the fact that, though rare, heterotopic pregnancy must always be considered one of the possible complications of spontaneous pregnancy.

Uterine adenocarcinoma after GnRH agonist treatment.

We report endometrial adenocarcinoma in two patients shortly after suspending GnRH-agonist treatment for menometrorrhagia and uterine fibromata.

Immunohistochemical expression of BerEP4, a new epithelial antigen, in endometrial carcinoma: correlation with clinical parameters.

OBJECTIVE: To assess the immunochemical expression of BerEP4, a new epithelial antigen in endometrial carcinoma. METHODS: We studied 45 cases of endometrial carcinoma in which the BerEP4, CEA and TAG-72 antigens were searched by an immunohistochemical method. We evaluated the correlations among the immunohistochemical positivity and the grading, histotype, stage and receptorial status of the neoplasia. RESULTS: CEA was positive in 29 out of 45 cases (64.4%), TAG-72 in 17 out of 45 cases (37.7%) and BerEP4 in 31 out of 45 cases (68.9%). Both TAG-72 and CEA were inversely related to the grading while, with regard to the histotype, CEA resulted as highly positive in the 5 cases of adenoacanthoma. CONCLUSION: BerEP4 did not show any correlation with grading, histotype, stage of disease or receptorial status of the carcinoma.

Uterine metastases from breast cancer in a patient under tamoxifen therapy. Case report.

The authors report a case of metastases of breast cancer confined to the uterus and cervical subserous leiomyoma in a postmenopausal woman under tamoxifen therapy for two years. After abnormal uterine bleeding, pathologic examination on biopsy of a cervical polyp revealed cervical involvement secondary to lobular breast cancer. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Pathologic examination of the surgical specimen revealed both invasion of breast origin and of the cervix until the isthmus, endometrium and cervical subserous leiomyoma. The adnexa uteri were not affected. The possibility of uterine metastases in patients suffering from breast cancer, either undergoing tamoxifen therapy or not, always has to be considered.

The value of serum CA 125 and association CA 125/CA 19-9 in endometrial carcinoma.

One hundred and twelve women with endometrial carcinoma were studied with serum sampling to determine preoperative and postoperative levels of CEA, CA 15-3, CA 19-9, TPA and CA 125. After surgical treatment 88 patients had stage I, 8 stage II, 14 stage III and 2 stage IV disease. Before treatment the sensitivity of CEA, CA 15-3, CA 19-9, TPA and CA 125 was 22.3% (25/112), 32.1% (36/112), 22.3% (25/112), 45.5% (51/112), 33.9% (38/112), respectively. According to pathological stage a statistically significant difference between intrauterine (96 cases) and extrauterine disease (16 cases) was noted only for CA 125 (28.1% vs. 68.7%) and CA 15.3 (28.1% vs. 56.2%). In relation to histological grading CA 125 rises progressively from well-differentiated cases to poorly-differentiated tumors. During the follow-up the most reliable marker was CA 125: values more than 35 U/ml of this marker resulted positive in 50% of relapsed cases and only in 5.1% of disease-free cases, thus demonstrating a high specificity. The association of various markers during the follow-up allowed us to reveal interesting results only for the CA 125/CA 19-9 combination. In fact the combined use of these markers permitted a high sensitivity (83.3%), with only 12.8% false positive cases, so with a high specificity.

The binding of apolipoprotein H (beta2-Glycoprotein I) to lipoproteins.

Beta2-glycoprotein I has a high affinity for triglyceride-rich particles, activates lipoprotein lipase, and is also defined as an apolipoprotein H. Previous studies have shown that apolipoprotein H is a regular structural component of the major classes of lipoproteins. In view of these findings, we analyzed the interactions of apolipoprotein H with lipoproteins in the fasting plasma of eight normal, seven hypertriglyceridemic, and seven hypercholesterolemic subjects. After rate-zonal, density gradient ultracentrifugation, apolipoprotein H was little distributed among the different density fractions, and most of it was recovered in the last fraction that contained the lipoprotein-free plasma. A small percentage (4-13%) of the apolipoprotein H associated with plasma lipoproteins was detected at the density ranging from 1.090 to 1.225 g/ml. This result means that apolipoprotein H is little associated with lipoproteins.

Apolipoprotein H is not affected by in vitro glycosylation.

Increased nonenzymatic glycosylation of all major classes of apolipoproteins has been demonstrated in diabetes. In this work we deal with the in vitro nonenzymatic glycosylation of apolipoprotein H, whose role in lipid metabolism is still poorly understood and whose levels increase in diabetes. Apolipoprotein H was isolated from human plasma and purified through a combination of affinity chromatography and continuous elution electrophoresis. The in vitro glycosylation was performed by incubating purified apolipoprotein H with high concentration of glucose. Our results indicate that the in vitro nonenzymatic glycosylation has no effect on the physical properties of apolipoprotein H, despite the fact that this apolipoprotein contains a high number of lysine residues. Since the in vitro concentration of glucose was far higher than the levels normally found in diabetic subjects, it is unlikely for apolipoprotein H to become glycosylated in diabetes.

Study of the glycosylation of apolipoprotein H.

Apolipoprotein H is a single chain polypeptide composed of 326 amino acids highly glycosylated. Its carbohydrate content is approximately 19% of the molecular weight. We show that it is rich in sialic acid linked alpha (2-6) to galactose or N-acetylgalactosamine. Sialic acid is not alpha (2-3) linked to galactose. Galactose is beta (1-4) linked to N-acetylglucosamine and beta (1-3) linked to N-acetylgalactosamine. Carbohydrate O-linked chains (mainly sialic acid) are alpha (2-6) linked to galactose or N-acetylgalactosamine. Galactose is also organised in O-linked chains and beta (1-4) linked to N-acetylglucosamine and beta (1-3) linked to acetylgalactosamine. Concanavalin A lectin was used to isolate two groups of apolipoprotein H molecules bearing biantennary and truncated hybrids and high mannose and hybrid oligosaccharides. Apolipoprotein H fails to bind lysine-Sepharose. Our results thus show that it presents truncated hybrid or hybrid-type carbohydrate chains which bear few unmasked mannose residues as a terminal sugar. Biochemical analysis of carbohydrate structures conducted on single isoforms separated through IEF revealed that no specific carbohydrate complex is bound to a single isoform.

Pharmacokinetic effects of conversion to a new formulation of cyclosporin A in rheumatoid arthritis patients.

In this study we aimed at evaluating the modifications in the pharmacokinetic profile of cyclosporin A (CyA) after conversion from standard formulation (CyA-ST) to a new formulation (CyA-NF, Sandimmun Neoral) in patients with rheumatoid arthritis (RA). It was an open, crossover study that involved 15 RA patients who were on stabilized treatment with CyA-ST. The patient continued receiving CyA-ST (mean dose of 3.0 +/- 0.7 mg/kg per day) for 3 weeks and then converted 1:1 to CyA-NF for a further 3 weeks. CyA pharmacokinetics were established on day 1 (CyA-ST evaluation) and +21 (CyA-NF evaluation). The results showed that the bioavailability of CyA-NF was greater than that of CyA-ST (AUC tau, bss: 3335 +/- 1300 vs 2667 +/- 1155 ng.h/ml, P = 0.0073; AUC tau, bss ratio 1.26 +/- 0.40 vs 1.0 as reference, P < 0.05), with higher and earlier peak blood concentrations (Cmax: 677 +/- 256 vs 475 +/- 213 ng/ml, P = 0.0329; tmax: 1.5 +/- 0.7 vs 2.6 +/- 1.6 h, P = 0.0720). The pharmacokinetic profile of CyA-NF showed greater between-patient reproducibility (lower CV% for all of the considered parameters). In conclusion, when using CyA-NF instead of CyA-ST, greater and more constant exposure to CyA should be expected.

Influence of APOH protein polymorphism on apoH levels in normal and diabetic subjects.

Apolipoprotein (apo)H (also known as beta 2 glycoprotein-I) is a glycoprotein synthesized by liver cells and it is present in the blood associated with plasma lipoproteins. APOH displays a genetically determined structural polymorphism: three alleles (APOH*1, APOH*2, APOH*3) at a single locus on chromosome 17 code for different isoforms, and population studies have shown that APOH*2 is the most frequent allele. This paper assesses the relation between APOH phenotypes and plasma apoH levels in a population composed of 278 healthy subjects (243 H2/2, 32 H3/2, 2 H3/3, 1 H2/1; allele frequencies APOH*1 0.002, APOH*2 0.934, APOH*3 0.064) and 245 diabetics (212 H2/2, 30 H3/2, 3 H3/3; allele frequencies APOH*2 0.927 and APOH*3 0.073). Determination of apoH levels by competitive ELISA gave a mean value of 26.3 +/- 9.8 mg/dl for all subjects, 22.6 +/- 7.7 in normals vs 30.6 +/- 10.3 in diabetics (p = 0.0001), and 23.0 +/- 7.9, 19.3 +/- 5.4 and 18.5 +/- 3.5 mg/dl for H2/2, H3/2 and H3/3 in normals and 31.1 +/- 10.1, 28.2 +/- 10.8 and 15.7 +/- 9.0 mg/dl in diabetics, respectively. ANCOVA of the adjusted data revealed a significant difference in apoH levels for the three phenotypes in both the normal subjects (p = 0.01) and the diabetics (p = 0.02). ANCOVA of the whole samples of subjects, controlling for diabetes as well as age, sex and total cholesterol, indicated a substantial effect of phenotype, independent of the other variables (p = 0.0007).

Characterization of the carbohydrate structures of apolipoprotein H through concanavalin A affinity chromatography.

Apolipoprotein H, also known as beta 2-Glycoprotein I, is a single chain highly glycosylated polypeptide of 326 amino acids. The carbohydrate content of apolipoprotein H is approximately 19% of the molecular weight. Some studies have described the main oligosaccharides forming the glycosylated chains but the carbohydrate inner structures of apolipoprotein H has not been investigated yet. This gap should be filled being glycosylation a very important process which is able to regulate the structure and the biological functions of proteins. Lectins are proteins which specifically bind carbohydrate structures. Affinity chromatography of glycoproteins on immobilized lectins, such as Concanavalin A (Con A), has been proved to be a useful method for oligosaccharide fractionation. N-Linked oligosaccharide structures were shown to interact with Con A according to their branching properties. In the present study, we analyzed the patterns of Con A elution of apolipoprotein H isolated from human plasma. Using Con A affinity chromatography we show that apolipoprotein H has a high degree of heterogeneity in its glycosylated structure. It allowed one to isolate two groups of apolipoprotein H molecules bearing biantennary and truncated hybrids and high mannose and hybrid oligosaccharides. Since Con A affinity chromatography allows fractionation of molecules differing in the extent of carbohydrate branching irrespective of the sialyl residues, we can conclude that mannose residues are masked with other sugars such as galactose-beta (1-4)N-acetylglucosamine, galactose-beta (1-3)N-acetyl-galactosamine and sialic acid linked alpha (2-6) to galactose or to N-acetylgalactosamine, or capped with sulfated residues. Thus, according to our results apolipoprotein H presents truncated hybryd or hybrid-type carbohydrate chains which bear few unmasked mannose residues as terminal sugar. Moreover, isoelectrofocusing of apolipoprotein H forms fractionated on Con A demostrates that weakly bound material presents a predominance of more acidic isoforms than that firmly bound to the lectin, indicating that weakly bound fractions contain molecules which are more negatively charged and that Con A is able to separate glycosylated forms which are not discriminated by isoelectrofocusing.

Apolipoprotein H levels in diabetic subjects: correlation with cholesterol levels.

To assess the relationship between apolipoprotein H (apo H) plasma levels and lipid metabolism in diabetes mellitus, we have examined the correlation between apo H plasma concentration and the main plasma lipid levels in 127 non-insulin-dependent (NIDDM) and 118 insulin-dependent (IDDM) diabetes mellitus patients. The data are compared with those in 286 nondiabetics. Our data show a significant increase in plasma apo H in diabetic as opposed to nondiabetic subjects (NIDDM, 29.9 +/- 10.8 mg/dL; IDDM, 31.3 +/- 9.9; controls, 22.5 +/- 7.7; F = 53.3, P = .0001). The relation between plasma lipids and apo H was simultaneously evaluated in the three groups with inclusion of diabetes, sex, body mass index (BMI), and age as covariates in the model. This analysis showed a strong positive correlation (P = .0009) between apo H and total cholesterol, and a weaker positive correlation with triglycerides ([TGs] P = .016). The correlation between apo H and hemoglobin A1c (HbA1c) levels in diabetics (P = .03) highlights the importance of glycemic control for plasma levels of this apoprotein, which is highly glycated. Although the role of apo H in lipid metabolism is still uncertain, recent investigations on the possible relation between plasma apo H levels and increased plasma lipids and thrombotic risk could explain the increased atherosclerotic risk in diabetic patients.

Qualitative analysis of the carbohydrate composition of apolipoprotein H.

The specific binding of digoxigenin-labeled lectins to carbohydrate moieties is used to characterize the carbohydrate chains bound to apolipoprotein H. Our results show that apolipoprotein H is rich in sialic acid linked alpha(2-6) to galactose or N-acetylgalactosamine. Sialic acid is not alpha(2-3)-linked to galactose. Galactose is beta(1-4)-linked to N-acetylglucosamine and beta(1-3)-linked to N-acetylgalactosamine. High-mannose N-glycan chains are barely detectable. After N-glycosidase F treatment the molecular weight is substantially reduced. The main band is 32,500 daltons. Carbohydrate O-linked chains, which are mainly represented by sialic acid, are alpha(2-6)-linked to galactose or N-acetylgalactosamine. Galactose is also organized in O-linked chains and it is beta(1-4)-linked to N-acetylglucosamine and beta(1-3)-linked to acetylgalactosamine. Biochemical analysis of carbohydrate structures reveals that no specific carbohydrate complex is bound to a single isoform.

Characterization and representative structures of N-oligosaccharides bound to apolipoprotein H.

We studied the structure of N-linked carbohydrates bound to apolipoprotein H by a combination of two methods which make use of lectins. Digoxigenin-labelled lectins are used for the structural characterization of carbohydrate chains of glycoproteins. Concanavalin A lectin affinity chromatography was used to analyse apolipoprotein H according to the characteristics of its carbohydrate chain inner to sialic acid residues. Our results from digoxigenin-labelled lectins analysis showed that apolipoprotein H gave positive bands to SNA, DSA, GNA, PNA and AAA lectins. Apolipoprotein H gave a negative band when reacted with MAA lectin. When we applied apolipoprotein H onto the Concanavalin A lectin column no detectable amounts of protein were eluted with Concanavalin A buffer. After adding a buffer with low sugar concentration (10 mM glucoside) a large amount of apolipoprotein H was recovered. These molecules of apolipoprotein H weakly bound to the lectin. When a higher sugar concentration (500 mM mannoside) was added most of the sample applied was eluted. These molecules of apolipoprotein H firmly bound to the column having high affinity for the lectin. These results combined with those coming from the digoxigen-labeled lectins method enable us to understand the inner structure of carbohydrate chains with their outer branches. Molecules of apolipoprotein H which weakly bind to Concanavalin A could bear complex N-glycans organized in biantennary or truncated hybrid structures. Firmly bound apolipoprotein H referred to molecules rich in N-glycan hybrid structures. They have an outer branch belonging to the high mannose carbohydrate chains which explain the ability to bind to the column and an other main branch bearing the sequence galactose beta-(1-4)-N-acetylglucosamine beta-(1-2) mannose. Galactose could be the terminal sugar or, alternatively, be masked with sialic acid alpha-(2-6) terminally linked.

[A new infusion method for a prostacyclin analogue]. / Nuova tecnica di infusione di un analogo delle prostacicline.

BACKGROUND: Iloprost, a prostaglandin I2, is chemically stable and it has been successfully used by intravenous infusion in severe limb ischemia. Usually Iloprost is diluted in 0.9% sodium chloride solution and infused intravenously for six hours each day for 28 days in hospital. METHODS: In the present study after the first three days of infusion with a traditional pump in hospital, a home pump has been utilised for the infusion of Iloprost at home. This device allows the continue infusion of Iloprost at a flow rate of 2 ml/h for six days, then the pump is filled with a new solution. The home pump consists of a protective shell in polycarbonate (10 x 12 cm), 270 ml of volume, inside there is a balloon reservoir (3 membranes) which is filled with Iloprost. The structure of Iloprost does not change into the home pump as evidenced by HPLC studies and its continue infusion allows plasmatic high levels of its active isomers during the 28 days of therapy. In 30 patients, 25 men and 5 women (mean age 61 years) with Fontaine stage IIB (6), III (5) and IV (19) POAD Iloprost has been infused with the home pump. The follow-up period was 1 to 16 months. RESULTS: The results have shown 4 major amputations and 1 death, in 9 patients complete pain relief and ulcer healing, and in 6 patients only improvement in relief of rest pain and ulcers. CONCLUSIONS: All the patients appreciated this system of infusion because they had a normal life; in addition it is less expensive because the patients stay in hospital only 3 days.