Endometriosis is a common gynecologic disease, which generally follows a benign course. Notwithstanding, several clinical and histologic studies as well as molecular data show that endometriosis could be a precursor of sporadic endometrioid and clear cell carcinomas at extrauterine loci. Several reports have implicated alterations of the hMLH1 and p16 ink4a (p16) genes, in particular hypermethylation of the promoter region, and of the PTEN gene, principally genetic mutations, in endometrial and ovarian cancers and have indicated that these alterations are already present in precancer conditions. In this report, we analyzed the methylation status of hMLH1 and p16 and the protein expression of PTEN and hMLH1 in 46 cases of endometriosis stages III and IV to better define the possible involvement of these genes in the malignant transformation of endometriosis. We found abnormal methylation of hMLH1 in 4 of the 46 cases (8.6%). In addition, these cases had no detectable hMLH1 protein expression. Regarding patients with hMLH1 alterations, 2 were classified as stage IV and 2 showed coexistent endometriosis and carcinoma. Only 1 case of endometriosis (2.17%), classified as atypical, showed abnormal methylation of p16. Reduced PTEN protein expression was detected in 7 of 46 cases (15.21%): 5 were clinically classified as stage IV, and the other 2 presented both cancer and hypermethylated hMLH1. Our preliminary study suggests that reduced expression of both hMLH1 and PTEN may be involved in the malignant evolution of endometriosis and should be used as markers of neoplastic transformation in aggressive endometriosis with elevated tumor markers. The term endometriosis strictly indicates the presence of ectopic endometrial glands and stroma outside the uterus. When endometrial tissue is instead located within the myometrium, the conventional term is adenomyosis. Endometriosis is an important clinical condition, whose principal symptoms are dysmenorrhea, deep dyspareunia and chronic pelvic pain. There is a high prevalence of endometriosis, ranging between 20% and 90%, in women with pelvic pain and/or infertility, while among multiparous women, the prevalence is very low (3.7%). 1-5 Even if endometriosis generally follows a benign course, it may show some malignant features, such as invasiveness and metastatic capacity. 6 In addition, a strict relationship between endometriosis and extrauterine clear cell and endometrioid carcinomas has been suspected as evidenced by their frequent coexistence in surgical specimens (17%). 7-9 The risk factors for endometriosis and ovarian malignancy are similar and include early menarche, regular periods, short menstrual cycles and low parity. Tubal ligation is protective for endometrioid and clear cell carcinomas of the ovary but not for serous and mucinous carcinomas. 9 Several molecular data indicate the malignant precursor role of endometriosis. Endometriosis exhibits LOH at 1 or more chromosomal loci (5q, 6q, 9p, 11q and 22q) in about 82% of cases. 10,11 Analysis of clonality in endomet...
The aim of this study was to compare the peripheral bone damage induced by different cutting systems. Four devices were tested: Er:YAG laser (2.94 mm), Piezosurgery, high-speed drill and low-speed drill. Forty-five bone sections, divided into 9 groups according to different parameters, were taken from pig mandibles within 1 h post mortem. Specimens were fixed in 10% buffered formalin, decalcified and cut in thin sections. Four different parameters were analyzed: cut precision, depth of incision, peripheral carbonization and presence of bone fragments. For statistical analysis, the Kruskal-Wallis test was applied to assess equality of sample medians among groups. All sections obtained with the Er:YAG laser showed poor peripheral carbonization. The edges of the incisions were always well-shaped and regular, no melting was observed. Piezosurgery specimens revealed superficial incisions without thermal damage but with irregular edges. The sections obtained by traditional drilling showed poor peripheral carbonization, especially if obtained at lower speed. There was statistically significant differences (p<0.01) among the cutting systems for all analyzed parameters. Er:YAG laser, gave poor peripheral carbonization, and may be considered an effective method in oral bone biopsies and permits to obtain clear and readable tissue specimens.
We describe popliteal arterial adventitial cystic disease which causes intermittent claudication in a young athletic man, with atypical manifestation, without loss of foot pulses on knee flexion nor murmur in the popliteal fossa. The findings obtained from Magnetic Resonance Imaging were nondiagnostic. The diagnosis resulted from Echo-Doppler ultrasonography along with peak exercise testing. Ultrasonography also provided useful physiopathological informations suggesting that a popliteal artery adventitial cyst can become symptomatic if muscle exertion increases fluid pressure within the cyst, enough to cause hemodynamically significant endoluminal stenosis. Rapid diagnosis is essential to prevent progressive claudication threatening limb viability. To guarantee this professional sportsman a reliable and durable outcome, instead of less aggressive management, we resected the involved arterial segment and interposed an autologous saphenous-vein graft.
Background: Distant spread from breast cancer is commonly found in bones, lungs, liver and central nervous system. Metastatic involvement of peritoneum and retroperitoneum is unusual and unexpected.
Experimental evaluation of a new type of dacron graft, pretreated with mod ified mammalian gelatin, has been performed on the beagle dog. After grafting of the infrarenal aorta, dogs were monitored from three days to three months. Pretreatment with gelatin effectively avoided the need for preclotting and did not affect the normal healing of the prosthesis as compared with similarly tex tured not pretreated grafts. This graft, when applied in man as an abdominal aortic substitute, has yielded uniformly gratifying results (within a follow-up range of twenty to twenty-seven months)
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