Factors affecting sentinel lymph node metastasis in Turkish breast cancer patients: Predictive value of Ki-67 and the size of lymph node.

OBJECTIVES: We aimed to analyze the factors that affect the axillary lymph node involvement in Turkish breast cancer patients with clinically non-palpable axillary lymph node. BACKGROUND: Sentinel lymph node biopsy is the gold standard technique to evaluate the axillary lymph node status that directly influences the prognosis and the treatment options in breast cancer. METHODS: Breast cancer patients without axillary lymph node involvement in clinic examination were enrolled the study. Patients were categorized into the two groups according to existence of axillary lymph node metastasis or not. Demographic, histopathological and clinical data of patients were revealed retrospectively. RESULTS: One-hundred and eighty-seven patients were analyzed and 101 of patients fulfilled the criteria and were included the study. Metastatic lymph node was detected in 38 (37.6 %) patients (Group 1), and was negative in 63 (62.4 %) patients (Group 2). Sentinel lymph node metastasis were statistically significant higher in patients with Ki-67 ≥ 14 % than patients with Ki-67 < 14 % (51.9 % vs 22.4 %; p < 0.01). Likewise, the mean size of the sentinel lymph node was statistically significant higher in Group 1 compared to Group 2 (p < 0.01). CONCLUSION: Ki-67 proliferation index and sentinel lymph node size may provide a higher prediction about the sentinel lymph node involvement in patients with clinically negative axillary lymph nodes (Tab. 3, Fig. 1, Ref. 31).

Abdominal cocoon with imaging findings: Importance of radiology.

Abdominal cocoon is a rare disease characterized by a thick fibrous membrane surrounding and compressing the small intestines completely or partially, which results in mechanical small bowel obstruction. The clinical findings of the disease include recurrent ileus and subileus episodes, colicky abdominal pain, weight loss, and abdominal distension. The etiology and pathogenesis of abdominal cocoon is not clearly defined. Detection of the disease is essential for accurate treatment. Imaging modalities come into prominence due to the nonspecific clinical findings of the disease.

Giant seminoma in an undescended testis presenting as an abdominal wall mass.

Seminomas in undescended testes may present as abdominal wall tumours. A unilateral testis tumour in a 29 year old man with ipsilateral undescended testis is presented and relevant literature is reviewed. A 29 year old man presenting with a tender left lower abdominal mass was admitted to our clinic and initial diagnostic tests followed by abdominal computerized tomography (CT) and positron emission tomography/computerized tomography (PET/CT) were performed. Abdominal CT clearly demonstrated the tumour location between the lower left abdominal subcutaneous layer and the external oblique fascia. He underwent surgery and the tumour was resected via en-bloc excision. Pathological diagnosis of the resected specimen was consistent with classical seminoma and no distant metastasis was detected with PET/CT. He was referred to oncology clinic after discharge. Tumours of undescended testis can present as an abdominal wall mass and clinicians must be aware of their existence.

Analysis of TGF-beta production by fusing and nonfusing mouse cranial sutures in vitro.

The role of transforming growth factor beta (TGF-beta) in the regulation of cranial suture fusion has been studied by various qualitative techniques such as in situ hybridization and immunohistochemistry. Although the relative expression of TGF-beta isoforms has been assessed in these studies, increased expression of TGF-beta has not been demonstrated in a quantitative fashion. Therefore, the purpose of this study was to quantify TGF-beta production by fusing (posterofrontal [PF]) and nonfusing (sagittal) mouse sutures using two different quantitative TGF-beta assays. The PF and sagittal sutures of 25-day-old mice were harvested and cultured separately in vitro. Culture media conditioned for 48 hours were collected after 3, 6, 9, 12, 15, 18, 21, 24, 27, and 30 days of culture, and total TGF-beta production was assessed using a TGF-beta bioassay. For a quantitative TGF-beta1 immunoassay, media conditioned for 48 hours were collected after 3, 5, 7, 9, 14, 22, and 28 days of culture. The TGF-beta bioassay revealed large amounts of total TGF-beta activity in both PF and sagittal sutures during the first week of culture, with decreasing amounts thereafter. Absolute TGF-beta activity in conditioned media collected from PF sutures at several early time points was higher than those obtained from sagittal sutures; however, these differences were not statistically significant. The results of the TGF-beta1 immunoassay (enzyme-linked immunosorbent assay) were similar to the bioassay in that the highest TGF-beta1 levels were noted during the first week of culture period and decreased thereafter. Analysis of variance of these samples, however, revealed significantly more TGF-beta1 protein in samples collected from the PF suture compared with the sagittal suture on days 3 and 5 of culture (p < 0.05). TGF-beta1 levels in the conditioned media obtained from PF sutures remained elevated compared with the sagittal suture on days 7 and 9; however, these differences were not statistically significant. Increased production of TGF-beta in the conditioned media of fusing PF sutures is the first such quantitative demonstration of growth factor upregulation during suture fusion and supports the hypothesis that TGF-beta expression may be important in cranial suture fusion.

Humorally mediated thrombocytosis in major lower extremity trauma.

Thrombocytosis in patients undergoing free tissue transfer for coverage of posttraumatic lower extremity defects may be associated with an increased incidence of microvascular thrombosis. Patients with isolated lower extremity trauma have an elevated platelet count that peaks approximately 2 weeks after injury. It is our theory that a humoral component of trauma sera is responsible for the induction of this thrombocytosis. Eight patients with isolated soft-tissue and bony trauma were included in the study. Serum was collected at baseline and throughout the study period. Platelet count, leukocyte count, hemoglobin concentration, and hematocrit were determined. Immunoassay for human interleukin-3 (IL-3), IL-6, and IL-11 as well as granulocyte macrophage colony stimulating factor (GM-CSF) were performed by solid-phase enzyme-linked immunosorbent assay. Balb-C mice were then injected intraperitoneally with the human trauma sera from all time points. Blood was collected at baseline and throughout the study period for determination of platelet count, hemoglobin, and hematocrit. Mean initial platelet count in the 8 human subjects was 152,000 per cubic millimeter with an average peak to 642,000 per cubic millimeter. IL-3, IL-11, and GM-CSF were not detectable in the serum of any patient. Elevated levels of IL-6 were detected in all patients in a nonspecific pattern. In the murine model, an early and late thrombocytosis was elicited. The early peak averaged 78.6% over baseline whereas the late peak average 81.0% over baseline. The induction by human trauma sera of an early and late thrombocytosis in this mouse bioassay supports the theory of humoral mediators. The humoral mediators are yet to be determined but may include IL-6.

A nerve distraction model in the rat.

Segmental loss of a peripheral nerve has been a challenging reconstructive problem. Management of the nerve gap has been accomplished classically with nerve grafting. However, autogenous nerve grafts are not always available for bridging large nerve gaps, and clinical results of large nerve cable grafts have been disappointing. Newer techniques concentrate on nerve lengthening with different methods. Tissue expansion of peripheral nerves has been producing promising results. Since the introduction of the Ilizarov external fixator, much attention has turned to limb-lengthening techniques and studies investigating the results of nerve and soft tissues lengthened during the course of this procedure. Primary nerve distraction may be an alternative to nerve elongation, by expansion or nerve grafting to repair the peripheral nerve gap. This study describes a device and a model for peripheral nerve distraction in a rat. Primary nerve distraction will need to be subjected to vigorous studies before clinical application.