Intracellular diglycerides in relation to glycaemic control in the myocardium: A pilot study in humans.

AIM: Intramyocellular diglycerides have been implicated in the development of insulin resistance in skeletal muscle. In the myocardium, excess lipid storage may also contribute to the appearance of diabetic cardiomyopathy, while diglycerides may have certain cardio-protective functions. However, little is known on intracellular diglyceride accumulation in the human heart. We aimed to determine diglyceride accumulation in the human myocardium in relation to diabetes status. METHODS: Six diabetic and six non-diabetic aged human subjects undergoing by-pass surgery participated in the study. Subjects were matched for age and body mass index. Intracellular diglyceride levels were measured in heart biopsy samples. Additional samples were taken from pectoralis major muscle that served as control. Whole body glycaemic control was assessed as the percent glycated haemoglobin. RESULTS: Intracellular diglycerides were significantly higher in the myocardium compared to pectoralis major (P<0.05). Although not statistically significant, diabetic subjects tended to accumulate smaller amounts of diglycerides compared to non-diabetic subjects in the myocardium. A linear negative correlation was observed between myocardial diglycerides and glycaemic control (r=0.632, P<0.05). CONCLUSIONS: Our data suggest that poor glycaemic control and diabetes may be associated with a defective accumulation of myocardial diglycerides, possibly blunting intracellular processes and contributing to the development of cardiomyopathy.

Non-small cell lung cancer: The role of surgery after induction chemo and/or radiotherapy.

Stages I and II non small cell lung cancer (NSCLC) are primarily treated by anatomic pulmonary resection. Selected patients with stage IIIB disease are still candidates for surgical treatment. Unfortunately, most patients with locally advanced NSCLC don't benefit from surgery alone or even by the combination of chemotherapy and radiotherapy. In order to achieve local and distant disease control, which seems to be the cause of failure of the above mentioned treatments, surgery after induction chemoradiotherapy has been proposed. This approach seems to be the state of the art of therapy for stage IIIB patients improving survival but with eventual increased risk, especially pulmonary and septic complications. This review of previously published studies indicates the important role of this combined treatment in terms of survival and its risks related either to induction treatment or to surgery.

Non small cell lung cancer: surgical treatment in the elderly.

Lung cancer resection in elderly patients is justified and has decreasing morbidity and mortality rates. Careful patient selection and operative planning are necessary, however. It is wise to have a diagnosis and staging done before the patient arrives in the operating theater. The surgeon should avoid extended resections when possible. In addition, elderly patients should be ambulated as soon as possible and adequate pain control should be ensured. Finally, the stage of the disease and occurrence of cardiopulmonary complications are the main determinants of outcome.

Malignant pleural effusion and talc pleurodesis. Experimental model regarding early kinetics of talc particle dissemination in the chest after experimental talc pleurodesis.

PURPOSE: Talc remains a commonly used agent for pleurodesis malignant pleural effusion. Nevertheless, it is associated with a 3-9% incidence of pulmonary reactions ranging from simple pneumonitis to acute respiratory distress syndrome (ARDS). The underlying lung pathology and the size and rate of talc particle dissemination have been implicated as the cause of these complications. There seems to be an acknowledged lack of evidence regarding detailed very early intrathoracic talc particle migration. MATERIALS AND METHODS: Thirty white male New Zealand rabbits underwent experimental pleurodesis and were randomly assigned to 3 (A, B, C) study groups (10 in each group). Rabbits were sacrificed 6, 12 and 18 h after talc administration. Samples from both lungs, mediastinum and parietal pleura were obtained. The number of talc crystals (m) deposited was counted and averaged along all slices of the various tissue samples. RESULTS: A high degree of early talc deposition and subsequent epithelial injury in all examined tissues was observed. Diffuse talc deposition occurred in both lungs, but in a different manner. On the side of talc administration, talc particles were deposited in a time-dependent fashion. On the contralateral side, talc was rapidly deposited during the first hours after the procedure, then the rate of deposition decreased, and increased again between 12 and 18 h after the procedure. CONCLUSION: Large-sized talc particles are deposited on both lungs very early after pleurodesis. At the same time inflammatory pulmonary changes appear bilaterally. Despite contradicting data in the literature, these findings should always be kept in mind when performing this procedure in high risk patients.

Non-small cell lung cancer: pulmonary parenchyma resection in lung-compromised patients.

Surgery remains the primary curative treatment for patients who have early-stage non-small cell lung cancer (NSCLC). The proper use of surgical resection depends on a careful assessment of the extent of disease and the cardiopulmonary function. Because lung cancer is more common in patients who have chronic obstructive pulmonary disease (COPD), it is important to select carefully those patients who can safely undergo potentially curative therapy, thereby minimizing postoperative morbidity and mortality. This article discusses the preoperative pulmonary assessment for patient selection, the preparation of high-risk patients, special surgical considerations, and patient management in the immediate postoperative period.

Screening practice and misplaced priorities

PURPOSE: To estimate cancer screening coverage among a large sample of Greek individuals. METHODS: 7012 adults from 30 Hellenic areas were surveyed. Tests included: faecal occult blood test, sigmoidoscopy,chest X-ray, urine test, testicular examination,trans-rectal ultrasound, full blood count, skin examination,digital rectal examination, PSA, Pap test, mammography,clinical breast examination (CBE), self breast examination and breast ultrasound. RESULTS: Eighty-eight percent of males and 93% of females declared being interested in cancer screening; 37.8% of men and 37.9% of women had had a medical consultation for screening purpose in the previous 2 years. Less than 2%reported having received screening for colorectal cancer or skin malignancies. Screening for cervical cancer, mammography and CBE was reported by 39.6%, 22.8% and 27.9% of females respectively. Twenty percent of males reported screening for prostate cancer. CONCLUSION: The actual opportunistic screening approach presents important deficiencies with displaced priorities in test performance and a low proportion of individuals undergoing recommended tests (AU)

Compression of the right atrium due to coexistence of diaphragmatic eventration and Chilaiditi's syndrome.

We report on a 70-year-old male who was admitted to hospital due to progressive onset of dyspnea and fever. Diagnostic work-up revealed a high diaphragmatic position, compression of the right heart and supraventricular tachycardia. A simultaneous incidental finding was hepatodiaphragmatic colonic interposition (Chilaiditi's syndrome). Diaphragmatic plication through a right thoracotomy with bowel reduction was effective to treat the patient.This is the second reported case in the literature of a simultaneous occurrence of diaphragmatic eventration and Chilaiditi's syndrome.

Patient management with a solitary pulmonary nodule.

Solitary pulmonary nodules are a common problem presented to the chest physicians. In our era, with the integration of new technologies, an increasing number of smaller-sized solitary pulmonary nodules are being detected. The primary objective in evaluating a solitary pulmonary nodule is prompt identification and treatment of early-stage lung cancer. A secondary objective is the avoidance of surgical morbidity in the diagnosis of a benign lung lesion.

What does impact factor depend upon?

Nobody doubts the importance of the scientific performance's evaluation. The journal impact factor is increasingly employed to evaluate the quality of scientific research. The use of term "impact factor" has gradually evolved, especially in Europe, to include both journal and author impact. This ambiguity often causes problems. It is one thing to use impact factors to compare journals and quite another to use them to compare authors. Journals impact factors generally involve relatively large numbers of articles and citations. Individual authors, on average, produce much smaller numbers of articles. Many scientists consider that impact factor is not the perfect tool to measure the quality of articles but there is nothing better and it has the advantage of already being in existence and is, therefore, a good technique for scientific evaluation. However, the use of journal impact factor is probably the most controversial issue.

Lung cancer: quality of life after surgery.

PURPOSE: Lung cancer is the most common cause of cancer death in both men and women in our country. It has been estimated that there will be 6,000 lung cancer deaths every year in Greece. However, many patients with bronchogenic carcinoma also have coexistent obstructive lung disease. In these patients, preoperative prediction of functional status after lung resection is mandatory. The aim of our study was to determine the effect of lung resection on postoperative spirometric lung function. PATIENTS AND METHODS: 112 patients underwent spirometric pulmonary tests preoperatively, and at 3 and 6 months after their operation. The predicted postoperative forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were calculated using the formula of Juhl and Frost: predicted postoperative FEV1 (or FVC)=preoperative FEV1(or FVC) x[1-(S x 0.0526)], where S=number of segments resected. Statistical significance was defined as a p value < 0.05. RESULTS: The functional percentage losses at 6 months for lobectomies and pneumonectomies were 7.34% and 34.89% for FVC and 7.72%; and 32.53% for FEV, respectively. The linear regression analysis derived from the correlation between predicted and measured FEV1 resulted in 2 equations for lobectomy and pneumonectomy. The first, for lobectomy, was: FEV1POSTOP=0.00211 + 0.896660 x FEV1PREOP; and the second, for pneumonectomy, was: FEV1POSTOP=0.145 + 0.65318 x FEV1PREOP. CONCLUSION: We conclude that our formulas are a reliable method for predicting postoperative respiratory function of the patients with lung cancer.

Recent aspects regarding carcinogenesis in non-small-cell lung cancer.

Lung carcinogenesis is a field which is yet to be exploited and its molecular mechanisms to be more clearly defined. The goal of this article is to present the major alterations that occur in lung cancer, especially those that happen in the early stages of carcinogenesis. Finally, in this review we present the latest methods that are used to study the cellular/molecular pathophysiology of lung cancer and their clinical appliance.

Chromogenic in situ hybridization analysis of chromosomes 7, 9, and 17 in pancreatic ductal adenocarcinoma based on tissue microarrays.

PURPOSE: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive neoplasm. Many different chromosomal alterations have been identified including structural or numerical changes. In this study we performed a molecular analysis of chromosomes 7,9, and 17 based on tissue microarrays (TMA). MATERIALS AND METHODS: Using TMA technology, 50 paraffin-embedded tissue samples of histologically confirmed primary PDACs were cored twice and re-embedded to the final recipient block. Chromogenic in situ hybridization (CISH) was performed using centromeric probes of the corresponding chromosomes. SPSS(chi square test and interrater kappa) was performed for statistical analysis. RESULTS: Chromosome 17 analysis detected aneuploidy in 19 (38%) cases. Similarly, aneuploidy regarding chromosome 9 was identified in 9 (18%) cases, whereas 14 (28%) cases were aneuploid, concerning chromosome 7. Statistical significance was assessed, correlating chromosome 7 with grade and stage (p=0.016 and p=0.027, respectively) and chromosome 9 to grade (p=0.023). Similarly, analyzing normal-appearing ductal epithelia adjacent to cancer cell populations, 2 cases were found with alterations regarding chromosome 9 and 17. CONCLUSION: Molecular analysis for chromosomes 7, 9 and 17 in PDAC confirmed that there is a variety of numerical alterations, and some of them represent very early genetic events in the progression of carcinogenetic process. Performance of CISH, also, provides an easy, accurate approach for their detection, even in a small tissue sample, such as TMA cylindrical cores.

Evaluation of combined telomerase and c-myc expression in non-small cell lung carcinomas using tissue microarrays and computerized image analysis.

PURPOSE: Telomerase activation plays a crucial role in tumorigenesis by sustaining cellular immortality. It consists of two main components which include a RNA subunit (h-TERC) and a catalytic protein subunit (h-TERT). Similarly, amplification or deletion correlating with overexpression of c-myc is a common event in various neoplasias, including non-small cell lung carcinoma (NSCLC). Because c-myc activates telomerase by inducing expression of its catalytic subunit, our aim was to correlate the expression of these two proteins with the biological behavior in NSCLC. MATERIALS AND METHODS: Using tissue microarrays technology (TMA) we evaluated by computerized image analysis (CIA) the results of h-TERT and c-myc immuno-histochemistry (IHC) in 40 NSCLCs, which were cored and re-embedded into one TMA block. RESULTS: Co-overexpression (moderate or high levels of NLI: Nuclear Labeling Index) of h-TERT and c-myc was observed in the majority of cases and found to be statistically significant (p=0.001). The results showed also strong association between c-myc and h-TERT overexpression correlating with stage (p=0.001 for both of them), but not with grade (p=0.206 and p=0.313, respectively). CONCLUSION: Our combined study showed that there is a strong correlation between the activation and expression of these two genes and maybe this co-deregulation could be used as a prognostic factor for the evaluation of biological behavior in NSCLCs.

Isolated first rib fracture in athletes.

Isolated fractures of the first rib are uncommon. They are caused by major blunt trauma, a violent muscular pull, or fatigue. Diagnosis is usually made by chest radiography and computed tomography. Angiography is justified when certain criteria are met. Treatment is rest and mild analgesia. Early and late complications have been reported and are treated accordingly. The purpose of this article is to report a case of first rib stress fracture in a kick boxer and review the pertinent literature.