[Preoperative respiratory training for a patient with chronic obstructive pulmonary disease undergoing redo mitral valve replacement].

The patient is a 76-year-old woman. She had undergone double valve replacement for rheumatic mitral and aortic valve regurgitation at the age of 64. She was diagnosed with chronic obstructive pulmonary disease (COPD) at 73 years old (Hugh-Jones class IV) . She was admitted to our hospital because of severe hemolytic anemia at 76 years old. Perivalvular leakage of mitral prosthetic valve was noted by transesophageal echocardiography. Preoperative respiratory physiotherapy was performed (breath muscle training, expectoration of sputum training, a therapeutic exercise, and Souffle training) for 3 weeks, because she was a high risk patient for postoperative respiratory complications. Her respiratory function (vital capacity, FEV1.0) was improved. Re-replacement of the mitral valve was performed using On-X valve 23 mm. She was extubated on the 1st postoperative day, and her postoperative course was uneventful. Preoperative respiratory physiotherapy might be very important for patients with COPD to prevent post operative pulmonary complications.

Age-dependent differences in tumor cell polarity in endometrial carcinomas.

PURPOSE: Cell polarization is dependent on the structural asymmetry of apical and basolateral domains. Although clinical and biological heterogeneity of endometrial carcinomas in aged individuals has been proposed, little is known about the age-dependent differences in tumor morphology in terms of cell polarity. To clarify a possible significance of tumor cell polarity, a total of 92 cases of grade (G) 1 and G2 endometrial carcinomas (endometrioid type) were investigated. METHODS: Cell polarity for tumor glandular components was evaluated by examining the degree of three morphological parameters: nuclear ordering, basal positioning of nuclei within cells, and papillary snouting/glandular convolution. The results were also compared with findings for cell proliferation, expression of p21(Cip1)(p21), p27(Kip1)(p27), estrogen and progesterone receptors, p53 accumulation, and several clinicopathological factors. RESULTS: Average values for each polarity parameter showed a stepwise decrease from tumors of pre-, through peri-, to post-menopausal patients, the difference being significant. Significantly high values for all polarity scores were also evident in tumors adjacent to secretory non-neoplastic endometrium as compared to those in non-secretory tissue. Positive correlations with low cell proliferation determined with respect to Ki-67 labeling indices, early clinical stage, and upper myometrial invasion were also noted, while there were no associations with expression of p21, p27, p53, and two hormone receptors. CONCLUSIONS: These findings indicate that in endometrial carcinomas, the age-dependent differences in tumor cell polarity may be related to status of endogenous ovarian hormones, closely linked with cell proliferation and some prognostic factors.

Loss of DCC gene expression during ovarian tumorigenesis: relation to tumour differentiation and progression.

To clarify the possible role of DCC gene alteration in ovarian neoplasias, we immunohistochemically investigated 124 carcinomas, as well as 55 cystadenomas and 41 low malignant potential (LMP) tumours and compared the results with those for p53 protein expression, clinicopathological factors and survival. A combination of the reverse transcription polymerase chain reaction (RT-PCR) and Southern blot hybridization (SBH) for DCC mRNA levels was also carried out on 26 malignant, five LMP, eight benign and seven normal ovarian samples. Significantly decreased levels of overall DCC values in carcinomas compared with benign and LMP lesions were revealed by both immunohistochemical and RT-PCR/SBH assays. Similar findings were also noted when subdivision was into serous and mucinous categories. In carcinomas, reduction or loss of DCC expression was significantly related to the serous phenotype (serous vs non-serous, P < 0.0001), a high histological grade (grade 1 vs 2 or 3, P < 0.02) and a more advanced stage (FIGO stage I vs II/III/IV, P = 0.0083), while no association was noted with survival. Although p53 immunopositivity demonstrated significant stepwise increase from benign through to malignant lesions, there was no clear association with DCC score values. The results indicated that impaired DCC expression may play an important role in ovarian tumorigenesis. In ovarian carcinomas, the altered expression is closely linked with tumour differentiation and progression.

CD44 expression in benign, premalignant, and malignant ovarian neoplasms: relation to tumour development and progression.

To clarify the possible role of CD44 expression in ovarian tumour development and progression, an immunohistochemical investigation was undertaken of a series of 115 carcinomas, 32 tumours with low malignant potential (LMP), and 53 cystadenomas. A combination of the reverse transcription-polymerase chain reaction (RT-PCR) and Southern blot hybridization (SBH) assays was also performed for 17 malignant, four LMP, six cystadenoma, and seven normal ovarian samples. Immunoreactivity scores for CD44s, CD44v3, and CD44v6 were significantly higher in LMP and malignant tumours than in the benign or normal cases, in line with the results of gross mRNA-based assays. Exon-specific RT-PCR/SBH assays revealed that the expression of large CD44 transcripts containing v6 to v8 exons and small isoforms containing v2 and v3 was common among normal and neoplastic tissues, while a simultaneous increase of large isoforms containing v2 to v5 was also revealed in LMP and malignant tumours. In ovarian carcinomas, the scores for CD44s, CD44v3, and CD44v6 were inversely related to the FIGO stage, but there was no association with lymph node status or expression of hormone receptors. Multivariate analysis revealed loss of CD44v3 expression to be an independent factor for poor survival. The findings indicate that CD44 is up-regulated during the development of ovarian carcinomas but is subsequently down-regulated during their progression, resulting in aggressive behaviour and an unfavourable prognosis.

Down-regulation of CD44 standard and variant isoforms during the development and progression of uterine cervical tumours.

To clarify the possible role of CD44 in the development or progression of uterine cervical tumours, an immunohistochemical investigation was carried out on 125 cases of cervical intraepithelial neoplasia (CIN), 78 invasive squamous cell carcinomas (ISCC), 61 cervical adenocarcinomas (AC), nine adenosquamous carcinomas (ASq), and 15 carcinomas with co-existent SCC and AC components, as well as 87 samples of normal cervix. A combination of reverse transcription-polymerase chain reaction (RT-PCR) and Southern blot hybridization (SBH) was also applied to 16 cervical carcinomas and 24 normal cervical specimens. Immunoreactivity for CD44s, CD44v3, and CD44v6 did not alter during the progression of CIN, while significantly decreased expression was observed in ISCC, associated with invasive features in some tumours. Reduced levels of CD44 expression in AC were also found, compared with normal cervical glandular epithelia. The average immunoreactivity scores for CD44s, CD44v3, and CD44v6 were significantly higher in ISCC than in AC, in line with the RT-PCR/SBH assay results. However, CD44 scores did not correlate with any clinicopathological factors or with survival in ISCC or AC. The ASq and AC CD44 scores were similar, while staining patterns in mixed tumours were dependent on the morphological phenotype, suggesting a close association between CD44 expression and the cell types. The results suggest that whereas CD44 is down-regulated during cervical tumourigenesis, positivity may not be useful as a consistent prognostic indicator.