Does fecal diversion offer any chance for spontaneous closure of the radiation-induced rectovaginal fistula?

Analysis of the clinical course of patients with postirradiation rectovaginal fistula after fecal diversion. The studied group included 17 women with postirradiation rectovaginal fistula who underwent fecal diversion as a sole mode of treatment, between January 1987 and December 2002, in our department. All patients were subjected to radiotherapy due to cancer of the uterine cervix, administered 5-107 months before the fistula appearance (mean, 22.9 months). In 3 of 17 patients (18%), spontaneous closure of fistula was observed after 5, 6, and 9 months, respectively, from fecal diversion. Closure was confirmed by endoscopy. Length of follow-up after fecal diversion ranged from 0.5 to 122 months. The actuarial probability of spontaneous closure of postradiotherapy rectovaginal fistula was 0.24 at 9 months of follow-up and then remained stable thereafter. In conclusion, colostomy alone gives hardly a chance for closure of the postradiotherapy rectovaginal fistula. Additional surgical measures are necessary.

Clinical significance of CK5/6 and PTEN protein expression in patients with bilateral breast carcinoma.

AIMS: To assess the expression of cytokeratin (CK) 5/6 in bilateral breast cancers and to assess the relationship between its expression and other prognostic variables, as well as between CK5/6 expression and patients' survival. METHODS AND RESULTS: The expression of CK5/6, PTEN protein, oestrogen receptor, progesterone receptor, p53 and c-erbB-2 protein were evaluated by immunohistochemistry in 88 primary breast cancers diagnosed in 44 women. To assess the prognostic value of studied factors, Cox regression analysis was performed. Expression of CK5/6 was found in 23 of 88 primary breast carcinomas (23/88; 26%). The hazard ratio of development of distant metastasis in patients in whom at least one cancer was CK5/6+ was 99.8 (P=0.037) and in patients with at least one carcinoma with reduced PTEN expression it was 10.8 (P=0.044). CK5/6 expression was correlated with absence of oestrogen (P<0.0001) and progesterone receptors (P<0.0001) and very strong expression of p53 (P<0.05). Reduced PTEN expression was correlated with presence of axillary metastases (P<0.01), with very strong expression of c-erbB-2 (P<0.05) and with reduced expression of oestrogen receptor (P<0.05). CONCLUSIONS: Analysis of expression of CK5/6 and PTEN protein in bilateral breast carcinomas may be of value in clinical practice and warrant further studies.