Tumor cell-specific Serpin A1 expression in vulvar squamous cell carcinoma.

PURPOSE: The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulvar dermatosis lichen sclerosus (LS) and high-risk human papillomavirus (hrHPV). Serpin A1 (α1-antitrypsin) is a serine protease inhibitor, which plays a role in the tumorigenesis of various cancer types. The aim of the study was to evaluate the expressions of Serpin A1 in LS, premalignant vulvar lesions, and vSCC using immunohistochemistry (IHC) and serum analysis, and to compare Serpin A1 stainings to the tumor markers p53 and p16. METHODS: In total, 120 samples from 74 patients were studied with IHC for Serpin A1, p53 and p16: 18 normal vulvar skin, 53 LS, 9 premalignant vulvar lesions (dVIN/HSIL) and 40 vSCC samples. Serum concentrations of Serpin A1 were analyzed from 30 LS, 44 vSCC and 10 control patients. Expressions were compared to clinical data. RESULTS: Tumor cell-specific Serpin A1 overexpression was detected in 88% of vSCC samples, independent of the etiology. The intensity of Serpin A1 expression was significantly higher in vSCC than in healthy vulvar skin, LS, or premalignant vulvar lesions. Serpin A1 showed an association with p53 positivity. No difference in overall survival was found between Serpin A1-, p53-, or p16-positive vSCC patients. Serum concentrations of Serpin A1 were equal in the LS, vSCC, and control groups. CONCLUSION: Tumor cell-specific Serpin A1 overexpression is a potential biomarker in vSCC.

Reduction in ERRα is associated with lichen sclerosus and vulvar squamous cell carcinoma.

OBJECTIVE: ERRs (estrogen-related receptors) regulate energy metabolism, the cell cycle and inflammatory processes in both normal and cancer cells. Chronic inflammation induced by lichen sclerosus (LS) or human papilloma virus (HPV) precedes vulvar squamous cell carcinoma (vulvar SCC). We investigated the expression of ERRα, ERRß and ERRγ in normal vulvar skin, LS as well as LS-dependent and LS-independent/HPV-related vulvar SCC. METHODS: A total of 203 samples were analyzed for ERRα, ERRß and ERRγ by using immunohistochemistry. These included 37 normal vulvar skin samples, 110 LS samples, 6 vulvar intraepithelial neoplasia (VIN) samples and 50 vulvar SCC samples. RESULTS: A substantial reduction in or disappearance of ERRα was detected in all vulvar SCC samples. A total of 79% of childhood-onset LS and 51% of adulthood-onset LS lesions showed decreases in ERRα staining. A gradual reduction in ERRα cytoplasmic staining was observed from healthy vulvar skin to precursor lesions and further to SCC. Nuclear ERRα staining was observed in 8/33 (24%) LS-dependent and 10/17 (59%) LS-independent SCC samples. CONCLUSIONS: ERRα, a key regulator of cell energy metabolism, may play a role in the pathogenesis of both LS and vulvar SCC.

Reconstruction of the vulva with sensate gluteal fold flaps.

BACKGROUND AND AIMS: Soft-tissue reconstruction of the vulva following resection of malignancies is challenging. The function of perineal organs should be preserved and the reconstructed area should maintain an acceptable cosmetic appearance. Reconstruction with local flaps is usually sufficient in the primary phase after a radical vulvectomy. Numerous flaps have been designed for vulvar reconstruction usually based on circulation from the internal pudendal artery branches. In this paper we introduce our modification of the gluteal fold V-Y advancement flap as a primary reconstruction after a radical vulvectomy. PATIENTS AND METHODS: Twenty-two patients were operated with a radical vulvectomy because of vulvar malignancies. The operation was primary in eight and secondary in 14 patients. The reconstruction of the vulva was performed in the same operation for each patient. RESULTS: All flaps survived completely. Wound complications were registered in three patients. Late problems with urinary stream were corrected in two patients. A local recurrence of the malignancy was observed in six patients during the follow-up period. CONCLUSIONS: Gluteal fold flap is easy to perform, has a low rate of complications and gives good functional results. Even a large defect can be reconstructed reliably with this method. A gluteal fold V-Y advancement flap is sensate and our modification allows the flap to be transposed with lesser dissection as presented before.

Macrocephaly-cutis marmorata telangiectatica congenita syndrome--prenatal signs in ultrasonography.

A new case of macrocephaly-cutis marmorata telangiectatica congenita (M-CMTC) syndrome is described. The patient presented typical congenital findings in utero, although the syndrome was diagnosed postnatally. The M-CMTC syndrome should be considered when there is a marked fetal overgrowth and progressive macrocephaly with no indications of maternal hyperglycemia or fetal hyperinsulinism. Our patient also had unilateral pleural effusion, curved femur and frontal bossing.

Arthroscopic shoulder stabilization using transglenoid sutures.

The results of arthroscopic stabilization using multiple transglenoid sutures in 24 patients with posttraumatic recurrent anterior shoulder instability are presented with a minimum follow-up of 2 years. No serious complications were recorded. There were 2 recurrences. The remaining 22 patients had good or excellent results according to the modified Rowe score, with a median score of 89. The median value for loss of external rotation was 5 degrees. Seventeen patients were active in sports and 11 returned to the same sports at the same competitive level.

The 48,XXYY syndrome: a case detected by maternal serum alpha-fetoprotein screening.

A 17-year-old woman was referred for amniocentesis due to a low maternal serum alpha-fetoprotein (AFP) concentration in a voluntary screening test. The fetal karyotype was 48,XXYY, and the pregnancy was terminated. Autopsy of the fetus disclosed agenesis of the corpus callosum and unusual facial features.

A case of human chimerism detected by unbalanced chromosomal translocation.

Chimerism in humans is usually found only because of discrepancies in unique blood group typing or sex chromosome complements. We describe a case found because of an inherited chromosomal translocation. A female carrier of the balanced reciprocal translocation t(14;20)(q31;q13.3) had a twin pregnancy. After birth the B-twin, a girl, was found to have the balanced translocation. The A-twin, a severely malformed and stillborn boy, had two different karyotypes; a normal 46,XY and an unbalanced translocation derivative 46,XY,-14, +der(14)t(14;20)(q31;q13.3). He was a dispermic chimera, formed by two fertilized oocytes.

Quantitative analysis of surface and percutaneous electromyographic activity in lumbar erector spinae of normal young women.

Bilateral surface and fine-wire electromyographic activity from the erector spinae at the L4-5 interspace was recorded from 10 female subjects during flexion, extension, rotation to right/left, and sidebending to right/left. Fine-wire electrodes demonstrated significant left-right electromyographic differences during terminal flexion. Surface and fine-wire electromyographic recordings demonstrated a symmetric pattern of activity during extension. A symmetric pattern of erector spinae activity was observed during rotation using fine-wire electrodes but not from surface electrodes. Increased electromyographic activity from the contralateral erector spinae was detected by the surface electrodes during sidebending to neutral movements.

Lisinopril: dose-peak effect relationship in essential hypertension.

1. The dose-peak effect relationship of lisinopril was evaluated in a double-blind, parallel study in 83 patients with mild to moderate essential hypertension (supine diastolic blood pressure = 95-115 mm Hg). 2. After a 4 week placebo washout, patients were randomly assigned to one of four treatments: lisinopril 2.5, 10, 20 or 80 mg day-1 for 1 week. 3. Lisinopril 10 and 20 mg day-1 produced similar peak antihypertensive effects which were greater than that produced by 2.5 mg day-1, but less than that of 80 mg day-1. If the incidence of first-dose symptomatic hypotension is related to the peak effect, then an initial lisinopril dose of 20 mg should not pose any greater risk than a 10 mg dose. 4. The magnitude of antihypertensive response at 24 h postdrug appeared to be dose related across the 2.5 to 80 mg day-1 range.

Therapist agreement for palpation and observation of iliac crest heights.

Ten subjects were assessed by 11 examiners (three physical therapy students, three physical therapists experienced in rehabilitation, and five physical therapists experienced in orthopedics) to determine intrarater and interrater agreement for an assessment procedure involving palpation and observation of iliac crest heights. The results of two separate trials in a single session showed that both groups of experienced physical therapists had slightly higher intrarater and interrater agreement than student physical therapists. Findings suggest that a need exists to improve the reliability of this commonly used physical therapy assessment procedure.

Vaginal administration of 15-methyl-PGF2 alpha-methyl ester prior to vacuum aspiration. Peri- and postoperative complications.

In order to simplify the operative technique and lower the postoperative complication rate, 354 healthy primigravidae were treated with a vaginal suppository containing 1 mg of 15-methyl-prostaglandin F2 alpha 12 hours prior to vacuum aspiration abortion in the first trimester. The mean cervical diameter found at the operation was 8.5 mm and in 38% of the women no further mechanical dilatation of the cervix was needed. The amount of bleeding during the operation was low (mean 30 ml, max. 300 ml). No perforations of the uterus or cervical lacerations occurred at operation. Side effects of the prostaglandin such as vomiting, diarrhea and lower abdominal pain occurred in 80% of the women and must be regarded as disturbing to the patient and seem to require that the women be hospitalized. The incidence of genital infection following the abortion was found to be 6.2%. In 8.2% of the women, the postoperative bleeding persisted for more than 14 days. It is concluded that if the frequency of side effects can be lowered by using new analogues of prostaglandins, pretreatment with vaginal suppositories may be recommended before vacuum-aspiration at legal abortion in the first trimester.

Intraamniotic and intramuscular administration of 15-methyl prostaglandin F 2alpha for midtrimester abortion.

Two series of midtrimester abortion inductions are compared. In one series of 68 cases of midtrimester pregnancies (12-24 weeks), legal abortion was induced by one intraamniotic injection of 2.5 mg 15-methyl prostaglandin F 2alpha. Fetus was expelled in 67 cases (98.5%) after a mean time of 18.4 hours. One case with duplex failed to abort (1.5%). Abortion was complete in 54% of the aborted cases. In the second series of 93 cases abortion was induced by intramuscular injection of 300 microgram 15-methyl PGF 2alpha every third hour (the first dose was 200 microgram) during 30 hours. Fetus was expelled in 79 cases (85%) after a mean time of 16.7 hours. Failure occurred in 14 cases (15%). Abortion was complete in 57% of the aborted cases. Side effects (vomiting and diarrhea) were more frequent in the intramuscular series and very inconvenient to many of the patients. Excessive bleeding occurred more often in the intraamniotic series. A small rupture of the cervix was noted once (primigravida) in the intramuscular group. It is concluded that the intramuscular way of administration is a simple method of second trimester pregnancy termination with small bleedings but that otherwise it is inferior to the intraamniotic route.

Intraamniotic administration of prostaglandin F2alpha for therapeutic abortion.

The present study was made to evaluate the efficiency of intraamiotically administered prostaglandin F2alpha upon unselected consecutive patients, hospitalized for legal abortion after the 12th week of pregnancy. In the first series, 178 cases were studied and in these the initial dose was related to the size of the uterus, i. e. 25 mg at 13 weeks, up to 40 mg at 24 weeks. A repeat injection of the same dose was required in 21% of the cases. Abortion occurred in 53% within 24 hours and in 81% within 48 hours. The mean abortion time was 32.3 hours. No failures occurred. In the second series, 73 patients were given an initial standardized dose of 40 mg irrespective of the size of the uterus. A repeat injection of 40 mg was given in 11%. Abortion occurred in 67% of the cases within 24 hours and in 80% within 48 hours. Four cases (5%) were failures. The mean time until expulsion of the fetus was 24.3 hours. Side effects in the form of vomiting and/or diarrhoea occurred about 2 times per patient in both series. In 20-30% a blood loss was sustained of more than 500 ml. Rupture of the cervix occurred in 3 cases. In both series multigravidae aborted faster than primigravidae. Early rupture of the membranes before the cervix was effaced caused very long abortion times in several cases.