Relationship between Cathepsin-D and Other Prognostic Factors in Human Breast Cancer

Cathepsin-D (CATH-D) is a lysosomal protease induced by estrogens in estrogen receptor-positive breast cancer cell lines and constitutively produced by estrogen receptor-negative breast cancer cells. The concentration of CATH-D in the cytosol of 97 human breast tumor tissues was correlated with other well-known prognostic factors for human breast cancer. CATH-D was significantly higher in node-positive than in node-negative tumors (P = 0.042, Kruskal-Wallis test). However, no correlation was found between enzyme levels and the number of positive nodes. CATH-D concentration did not correlate with age, menopausal status, clinical stage of the disease, size of the primary tumor, steroid receptors, thymidine labeling index, histological grade, nuclear grade or cellularity. CATH-D did not show any association with the known prognostic factors evaluated in this study and its association with lymph nodes was only weak.

Primary empty sella (PES): a review of 175 cases

The term primary empty sella (PES) makes reference to the herniation of the subarachnoid space within the sella turcica in patients with no history of pituitary tumor, surgery or radiotherapy. To retrospectively assess clinical features, radiological findings and the biochemical endocrine function from the records of 175 patients with a diagnosis of PES. One hundred seventy-five patients (150 females) were studied. The mean age at diagnosis was 48.2 ± 14 year. Most diagnoses were made by magnetic resonance imaging (n = 172). In most patients, the pituitary function was assessed by basal pituitary hormones measurements. Pituitary scans were ordered for different reasons: headache (33.1 %), endocrine disorders (30.6 %), neurological symptoms (12.5 %), visual disturbances (8.75 %), abnormalities on sella turcica radiograph (8.75 %) and others (6.25 %). Multiple pregnancies were observed in 58.3 % of women; headaches, obesity, and hypertension were found in 59.4, 49.5, and 27.3 % of the studied population, respectively. Mild hyperprolactinemia (<50 ng/ml) was present in 11.6 % of women and 17.3 % of men. Twenty-eight percent of our patients had some degree of hypopituitarism. In the male population, hypopituitarism represented 64 % of cases, whereas it accounted for 22 % of all females. PES seems to be more commonly found in middle-aged women, with a history of multiple pregnancies. In most patients, PES was discovered as an incidental finding on imaging studies, while in almost a quarter of patients PES was found during the diagnostic evaluation of anterior pituitary deficiency, which was more common in men.

Evaluation and analysis of patient outcomes with an intrasegmental fixation system in lumbar spinal fusion

BACKGROUND CONTEXT

A new spinal fixation system with polydirectional screws and modular links with interconnecting radial serrations has been developed. The system allows the linking of multiple points of fixation, two points at a time (intrasegmental fixation), thus eliminating the need for intraoperative contouring of rods or plates.

PURPOSE

Evaluation of this new type of spine system was done through biomechanical studies, analysis of lumbar lordosis preservation postoperatively, and multicenter review of patient outcomes with a minimum of 1 year follow-up.

STUDY DESIGN/SETTING

Biomechanical studies of the spine system were performed according to American Society for Testing and Materials (ASTM) standards. To evaluate the maintenance of lordosis, radiographs from the first 119 patients were reviewed by the authors. Analysis of patient outcomes consisted of a review of the first 259 patients who underwent spinal fusion surgery with the new spine system.

PATIENT SAMPLE

Evaluation of patient outcomes consisted of 122 men and 137 women with an average age of 50+/-13 years (range, 22-96 years) and a mean follow-up of 20+/-6 months (range, 12-54 months). The patient population was at high risk for fusion failure, with 127 smokers (49%), 141 who had previous spine surgery (54%), 22 with osteoporosis (8%), 63 were obese (24%), and 32 with diabetes (12%). One hundred two patients (39%) had a one-level fusion, 105 patients (41%) had two levels fused, and 52 patients (20%) had three or more levels fused. The majority of patients (66%) were covered under workers' compensation. OUTCOME MEASURES/METHODS: Radiographic fusion was deemed successful when the presence of trabecular bridging bone from transverse process to transverse process was observed, as well as no fixation failure nor radiographic evidence of screw loosening. Clinical success was rated excellent, good, fair, or poor depending on the patients pain level, function, and pain medication intake.

RESULTS

Biomechanical studies of this intrasegmental fixation system have shown it to be strong under both static and fatigue testing, with exceptional strength in compression bending. In evaluating preservation of lumbar lordosis, no statistically significant loss of lordosis was observed. Overall, radiographic fusion was noted in 229 of 259 patients (88%) and did not differ significantly (p>.10) by the number of levels fused. Clinically, 69 patients (27%) had an excellent result, 111 patients (43%) had a good result, 50 patients (19%) had a fair result, and 29 patients (11%) had a poor result. The high rate of successful patient outcomes did not differ significantly (p>.10) by the number of levels fused, or other patient or surgical variables, except for the satisfaction level of workers' compensation versus nonworkers' compensation. One hundred of 118 patients (85%) who were working before surgery returned to work at an average 9+/-4 months postoperatively (range, 2-20 months). The use of direct current (DC) stimulation in this population was reserved for patients with one or more risk factors for fusion failure and was noted to be of benefit. There were no recorded intraoperative complications, but postoperatively 5 device and 19 non-device-related complications (9%) were noted, which is comparable to other lumbar fusion series.

CONCLUSIONS

The results of these analyses show consistent patient outcomes regardless of the number of levels fused with an intrasegmental system. This may be attributable to the increased biomechanical strength of the system at each segment, coupled with the ability of intrasegmental fixation to maintain sagittal plane balance through preservation of the patient's lordotic curve.

Efficacy of implanted bone growth stimulation in instrumented lumbosacral spinal fusion

STUDY DESIGN

Ninety-four patients were assigned to groups either with or without implanted bone growth stimulation as an adjunct to instrumented animal fusion between May 1990 and December 1992. Consecutive groups with or without stimulation were compared prospectively; a small group was compared with random assignment of surgery with or without stimulation.

OBJECTIVE

To test the efficacy of implanted bone growth stimulation in instrumented fusion, especially regarding high-rist patient groups including smokers, those with previous back surgery, and those with multiple fusion levels.

SUMMARY OF BACKGROUND DATA

No reports have specifically addressed implanted bone growth stimulation with instrumented spinal fusion, although the effects of stimulation on long-bone and in situ spinal fusion have been reported.

METHODS

Fusion surgery was performed by the same two surgeons for all patients, using autologous graft and instrumentation (pedicle screw and rod). Surgical indications and pre- and postoperative regimens were similar for all patients. Average follow-up period was 20.5 months.

RESULTS

Ninety-six percent of patients with stimulation had solid fusion versus 85% fusion in patients who did not have stimulation.

CONCLUSIONS

Implanted bone growth stimulation can improve fusion results in patients with instrumented lumbosacral fusion as has been demonstrated in in situ fusions. Patients in high-risk categories (smokers, those with multiple back surgeries, and multilevel fusions) also are demonstrated to have higher fusion rates with implanted bone growth stimulation than those without benefit of stimulation.