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, ERRβ 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, ERRβ 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.

Can reverse shoulder arthroplasty be used with few complications in rheumatoid arthritis?

BACKGROUND

Many patients with rheumatoid arthritis develop superior migration of the humeral head because of massive cuff tears, causing loss of active motion. Reverse shoulder arthroplasty could potentially restore biomechanical balance but a high incidence of glenoid failure has been reported. These studies do not, however, typically include many patients with rheumatoid arthritis (RA) and it is unclear whether the failure rates are similar.

QUESTIONS/PURPOSES

We therefore (1) evaluated pain relief and shoulder function after reverse arthroplasty in RA; (2) compared results between primary and revision procedures; (3) determined the incidence of scapular notching; and (4) determined the complication rate.

METHODS

We identified 29 patients with RA who had 33 reverse arthroplasties from among 412 patients having the surgery. Six patients were lost to followup. Twenty three patients (27 shoulders) were evaluated after a minimum followup of 18 months (mean, 56 months; range, 18-143 months), including 18 primary and nine revision arthroplasties. All patients were evaluated preoperatively and 23 shoulders postoperatively by an independent physiotherapist and four were assessed postoperatively by phone. Level of pain, range of motion, and Constant-Murley score were recorded and new radiographs taken.

RESULTS

Visual Analog Scale score for pain decreased from 8.0 to 1.0. Constant-Murley score increased from 13 to 52. Primary procedures had higher scores compared with revisions. Three patients had revision surgery. Notching occurred in 52% of shoulders but no loosening was seen.

CONCLUSIONS

Reverse arthroplasty in rheumatoid arthritis improved shoulder function with a low incidence of complications. We believe it should be considered in elderly patients with rheumatoid arthritis with pain and poor active range of motion resulting from massive cuff tears.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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.

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.