The incidence of low-level HER2 gene amplification and chromosome 17 polysomy in cases of newly diagnosed breast cancer and their association with clinical prognostic markers

e22012

Background: The purpose of this study is to describe the frequency of low level HER2 gene amplification and chromosome 17 polysomy, and its association with known clinical prognostic markers. Methods: We retrospectively reviewed all cases of newly diagnosed invasive breast cancer referred to the Colorado Cytogenetic laboratory for FISH testing from either the University of Colorado Breast Center or St. Mary's Hospital in Grand Junction, CO between October 2000 and May 2005, excluding patients treated with HER2-directed therapy. Cases were classified into positive for HER2 gene amplification (FISH ratio ≥ 2.2), negative for HER2 gene amplification (FISH ratio <1.8), or intermediate for HER2 gene amplification (FISH ratio of 1.8- 2.1 or presence of chromosome 17 polysomy). IRB approved chart review was performed . Results: Of the 177 patients referred for FISH testing during the study period, 27.7 % (49/177) had intermediate HER2 gene amplification as defined as a FISH ratio of 1.8–2.1 or chromosome 17 polysomy. There was a statistically significant increase in stage, lymph node involvement, and histologic grade at diagnosis in the intermediate HER2 group compared to negative controls ( Table ). Conclusions: The incidence of intermediate HER2 gene amplification is clinically significant and associated with higher histologic grade and stage at diagnosis compared to HER2 negative controls. This patient population should be investigated further for long term disease outcomes and impact of HER2 - based targeted therapy.

[Table: see text]

No significant financial relationships to disclose.

Proinsulin processing in the diabetic Goto-Kakizaki rat

The biosynthesis and processing of proinsulin was investigated in the diabetic Goto-Kakizaki (GK) rat. Immunofluorescence microscopy comparing GK and Wistar control rat pancreata revealed marked changes in the distribution of alpha-cells and pronounced beta-cell heterogeneity in the expression patterns of insulin, prohormone convertases PC1, PC2, carboxypeptidase E (CPE) and the PC-binding proteins 7B2 and ProSAAS. Western blot analyses of isolated islets revealed little difference in PC1 and CPE expression but PC2 immunoreactivity was markedly lower in the GK islets. The processing of the PC2-dependent substrate chromogranin A was reduced as evidenced by the appearance of intermediates. No differences were seen in the biosynthesis and post-translational modification of PC1, PC2 or CPE following incubation of islets in 16.7 mM glucose, but incubation in 3.3 mM glucose resulted in decreased PC2 biosynthesis in the GK islets. The rates of biosynthesis, processing and secretion of newly synthesized (pro)insulin were comparable. Circulating insulin immunoreactivity in both Wistar and GK rats was predominantly insulin 1 and 2 in the expected ratios with no (pro)insulin evident. Thus, the marked changes in islet morphology and PC2 expression did not impact the rate or extent of proinsulin processing either in vitro or in vivo in this experimental model.

[Quality management in the hospital environment: ISO 9002 certification: our experience]

The nephrology-dialysis department of the Havre's hospital has launched a project of certification ISO 9002 in 1996, based on reflections from the centers of dialysis Upper Normandy. The problems encountered were mainly the lack of ways, a bad documentary structure, false ideas on the quality and a bad perception from the client. With the help of a quality manager, il has enable the project to advance and finalized, obtaining the certification of activity. In june 2000 "Procedure of taking in charge all the patient's medical and para-medical cost in the center of the Nephrology-Dialysis service" of the GHH (Hospital Group of the Havre) has brought not only the certificate but notable improvements on the level of documentary management, the errors, relationship clients-suppliers and projects of collaboration with the other services of nephrology dialysis of France.

[Nephrotic syndrome complicating treatment with interferon alpha]

We report two cases of nephrotic syndrome with minimal glomerular change complicating alpha-interferon therapy.

CASE REPORTS

The first patient was a 60-year-old man with Waldenström's disease who was given 1 million units of alpha-interferon three times a week for 22 months. Acute renal failure developed when a second protocol was started. Renal biopsy revealed intraglomerular deposits and no cellular proliferation. Total remission could not be achieved with corticosteroids. The second case was a 46-year-old man given high dose alpha-interferon (15 million units 3 times a week) for lymph node metastasis of a malignant melanoma. A nephrotic syndrome without renal failure developed during the third month of treatment. Minimal glomerular involvement was seen. Symptomatic treatment led to resolution of the nephrotic syndrome.

DISCUSSION

Nine other cases of nephrotic syndrome complicating alpha-interferon therapy have been reported in the literature.