Top PDF Recurrent cervical tumor in the elderly

The tuberculosis, is known since ancient times, but suspicion that tuberculosis was an infectious nature, began to speak in a more concrete in the mid- sixteenth century. The causative agent of tuberculosis, was discovered by Robert Koch in 1882. It is found in the various excretions of people and animals suffering from the disease. Are important in practice, essentially two types of tuberculous mycobacteria: the human type and bovine type. Tuberculosis is distinguished by the variety of its manifestations, this depends on the infection itself and the variety of alterations that occur in the organs.

A 27-year-old female patient presented with a 1.8-cm supericial, irm mass in the upper third of the posterior right leg subcutaneous tissue. The patient noted the nodule seven months before surgical biopsy and reported additional growth in the last month. At physical examination and imaging, the nodule was irm and exhibited no adherences to deep tissues (Figure 1). After histopathology report suggestive of extranodal RDD, the patient underwent tumor excision presenting two local recurrences within two months. On the second recurrent tumor resection, the surgical specimen exhibited an additional 0.4-cm nodule in a different site (intermediate third) in the posterior right leg. After a new surgical resection, a recurrent tumor grew rapidly reaching 4 cm within two months in the intermediate third of the posterior right leg. A fourth surgical procedure of extended skin and subcutaneous

marker for detecting cervical adenocarcinoma in situ. The diagnostic performance of the marker can be evaluated for the diagnosis of adenocarcinoma, considering the gold stan- dard agreement between two pathologists blindly and taking into account the observed Kappa that was considered good. From this, we can infer that, although not absolute in the final diagnosis, doubtful cases can be clarified with the use of p16 ink4a .

As shown in Fig. 3A, with immunocytochemical assays, the KLF4 protein was found to be strongly expressed in HeLa and CaSki cells and weakly expressed in SiHa cells, but it was barely expressed in C33A cells. RT-PCR and western blot analyses further confirmed the expression results in these four cell lines at the transcriptional and translational levels, respectively (Fig. 3B). We applied the human embryonic stem cell line H7 as a positive Figure 3. Methylation of the KLF4 promoter in cervical cancer cell lines. (A and B) KLF4 expression in the 4 cervical cancer cell-lines HeLa, CaSki, SiHa and C33A was detected by IHC (A) and by PCR and western blot (B). We applied the human embryonic stem cell line H7 as a positive control and the rabbit IgG polyclonal antibody as the isotype control in immunocytochemistry. (C) Bisulfite sequencing of the KLF4 promoter in cervical cancer cell-lines. (D) Statistical analysis of KLF4 promoter methylation in cervical cancer cell-lines. (E) MS-PCR for a region of the KLF4 promoter in the 4 cervical cancer cell lines. A methylated band was amplified in SiHa and C33A cells. Globally methylated DNA from normal fetal cord blood samples was included as a positive control for the methylated (M) and unmethylated (U) primers.

Several studies describing the ultrastructure and extracellular matrix (ECM) of intervertebral discs (IVDs) involve animal models and specimens obtained from symptomatic individuals during surgery for degenerative disease or scoliosis, which may not necessarily correlate to changes secondary to normal aging in humans. These changes may also be segment-spe- cific based on different load patterns throughout life. Our objective was to describe the ECM and collagen profile of cervical IVDs in young (G1 - <35 years) and elderly (G2 - >65 years) presumably-asymptomatic individuals. Thirty cervical discs per group were obtained during autopsies of presumably-asymptomatic individuals. IVDs were analyzed with MRI, a morphological grading scale, light microscopy, scanning electron microscopy (SEM) and immunohistochemistry (IHC) for collagen types I, II, III, IV, V, VI, IX and X. Macroscopic degenerative features such as loss of annulus-nucleus distinction and fissures were found in both groups and significantly more severe in G2 as expected. MRI could not detect all morphological changes when compared even with simple morphological inspection. The loose fibrocartilaginous G1 matrix was replaced by a denser ECM in G2 with predominantly cartilaginous characteristics, chondrocyte clusters and absent elastic fibers. SEM demon- strated persistence of an identifiable nucleus and Sharpey-type insertion of cervical annulus fibers even in highly-degenerated G2 specimens. All collagen types were detected in every disc sector except for collagen X, with the largest area stained by collagens II and IV. Colla- gen detection was significantly decreased in G2: although significant intradiscal differences were rare, changes may occur faster or earlier in the posterior annulus. These results dem- onstrate an extensive modification of the ECM with maintenance of basic ultrastructural fea- tures despite severe macroscopic degeneration. Collagen analysis supports there is not a “pathologic” collagen type and changes are generally similar throughout the disc. Under- standing the collagen and ultrastructural substrate of degenerative changes in the human disc is an essential step in planning restorative therapies.

Background: dizziness impact on the quality of life (QoL) of elderly patients with chronic vestibular dysfunction. Aim: to evaluate the association between the impact of dizziness on the QoL of elderly patients with chronic vestibular dysfunction and demographic and clinical variables. Method: a prospective study. A hundred and twenty elderly patients with chronic vestibular dysfunction underwent the Brazilian version of the Dizziness Handicap Inventory (DHI). In order to verify the association between the QoL and the demographic and clinical variables, the following testes were used: Mann-Whitney, Kruskal- Wallis and Spearman's correlation coefficient. Results: there were significant associations between the presence of rotating and non-rotating dizziness with the total score of the DHI (p = 0.010) and physical (p = 0.049) and functional (p = 0.009) subscales; between recurrent falls with total DHI (p = 0.004) and physical (p = 0.045), functional (p = 0.010) and emotional (p = 0.011) subscales. Significant correlations were found between functional incapacity and total DHI (r = + 0,557; p < 0.001) and physical (r = + 0,326; p < 0.001), functional (r = + 0,570; p < 0.001) and emotional (r = + 0,521; p < 0.001) subscales. Conclusions: the impact of dizziness on the QoL is higher in elderly patients with rotating and non- rotating dizziness, recurrent falls and functional incapacity.

In conclusion, elderly patients are at risk for minor head trauma and for cervical spine fractures, the major- ity being type II dens fractures. Our findings demonstrate that the inclusion of the first two cervical vertebrae in head CT scans performed in elderly individuals with minor head trauma helped identify a quite significant rate of up- per cervical spine injuries, even in the absence of cervical symptoms. The frequency of cervical injury observed in our sample (1.26%) is relevant because these kinds of fractures have potentially life-threatening consequences. Our proto- col changed the treatment plan for the affected patients with an acceptable increase in the effective dose.

RESULTS: Inactive women have reported pain in lower and up- per limbs, lumbar and/or cervical region and in body in general as factors preventing their practice of regular physical activities. CONCLUSION: he understanding of such pains may help the planning of interventions with longevous people, contributing for actions fostering behavioral changes toward adopting an ac- tive lifestyle, which may contribute for a better functional capac- ity, health conditions and independence of longevous people. Keywords: Barriers, Elderly aged 80 years or above, Facilitators, Motor activity, Pain.

To evaluate the impact of HPV immunization and possible changes in virus type-speciic prevalence associated with cervical cancer, it is important to obtain baseline information based on socioeconomic, educational, and environmental characteristics in human populations. We describe these characteristics and the type-speciic HPV distribution in 1,183 women diagnosed with cervical cancer in two Brazilian healthcare institutions located at the Southeastern (Rio de Janeiro/RJ) and the Amazonian (Bel´em/PA) regions. Large diferences were observed between women in these regions regarding economic, educational, and reproductive characteristics. he eight most frequent HPV types found in tumor samples were the following: 16, 18, 31, 33, 35, 45, 52, and 58. Some HPV types classiied as unknown or low risk were found in tumor samples with single infections, HPV 83 in RJ and HPV 11, 61, and 69 in PA. he proportion of squamous cervical cancer was lower in RJ than in PA (76.3% versus 87.3%, 푝 < 0.001). Adenocarcinoma was more frequent in RJ than in PA (13.5% versus 6.9%, 푝 < 0.001). he frequency of HPV 16 in PA was higher in younger women ( 푝 < 0.05). he success of a cervical cancer control program should consider HPV types, local health system organization, and sociodemographic diversity of Brazilian regions.

Although chemotherapy remains the major treatment modality in the management of patients with recurrent and metastatic cervical cancer, its effectiveness is relative poor comparing to other gynecologic malignancies. Disruption of blood vessels by operation or high doses of radiation may lead to lower perfusion of the relapsed cancer. Although various regimens have been used in a various studies, the response rates are low and the toxicities are severe. Cisplatin has emerged as the most active single agent with overall response rates of 19% [4]. Recent phase III trial has documented response rates of 29.1%, 25.9%, 22.3% and 23.4% when cisplatin has been combined with paclitaxel, vinorelbine, gemcitabine and topotecan, respectively [5]. Despite these encouraging results, however, most of the responses are partial and of short duration.

lesions which may lead to development and proliferation of cervical tumors and hence, it is one of the possible transducer of cervical carcinogenesis. Here, our results are in accordance with Yeasmin et al 2010 [17] partially who also showed an over- expression of Notch-3 in ISCC. However, we have extended our work with respect to HPV status. By analyzing the impact of HPV infection on this increase of Notch-3 expression, we found that in HPV-16 negative precancerous lesions and in ISCC, nuclear Notch-3 expression was decreased (33.3%, 31.3%) and in HPV-16 positive ones it was found to be increased (91.7%, 95.1%) respectively. It was observed that only Notch-3 was found to be significantly associated with HPV-16 in precancer (p = 0.0001) and both Notch-1 and Notch-3 with HPV infected ISCC (p = 0.0001, p = 0.0001). This up-regulated expression of Notch-3 in precancer and ISCC may trigger E6 and E7 oncoproteins of HPV which may promote tumor formation in precancer and late stages of cervical cancer. This shows that de-regulated signalling of above proteins indicates their possible involvement in establishment of HPV infection and persistence, suggesting that there may a complex interplay between Notch signalling and papillomaviruses in the context of development of cervical carcinogenesis. This study is also supported by Leong and Karson, 2006 [13] who discussed two mechanisms involved in Notch-induced oncogenesis in hematologic malignancies which include inhibition of apoptosis and induction of proliferation. These Notch proteins do not physically interact with each other, but may activate various signalling pathways to inhibit apoptosis and promote cell proliferation. Notch-3 can activate the PI3kinase-PKB/Akt pathway, a signalling cascade that is active in diverse cancers– and this along with the multifunctional HPV oncoproteins (E6 and E7) synergise with each other in tumorigenesis [48]. Above results showed that Notch receptors participate in the early and late stages of tumor progression and the expression of oncoproteins E6 and E7 is hypothesized to antagonize late stages of tumor progression.

Knowledge of the wide spectrum of imaging indings ater surgery and radiotherapy is crucial for evaluation ater cervical cancer therapy. Reconstitution of the normal zonal anatomy of the cervix and homogeneous cervical low signal have high negative predictive value (97%) for recurrence. he most speciic sign of central recurrence is a hyperintense sot-tissue mass (T2WI) with earlier and pronounced enhancement. Imaging criteria of pelvic wall recurrence are the same used for the initial staging (distance tumor–side wall is less than 3 mm). Published studies show a certain degree of overlap between benign and malignant pelvic lymph nodes, similar accuracy for CT and MR and have not been able to deine the negative predictive value of DW imaging [31]. Lung, bone and liver are the most common locations of distance recurrence [32].

Common peripheral vestibular disorders in the elderly include: self-limiting benign paroxysmal positional vertigo, recurrent or persistent; Meniere’s disease or syndrome; vestibular neuritis affecting the upper or lower vestibular nerve; metabolic labyrinthine disorders; idiopathic bilat- eral vestibular hyporeflexia or areflexia and persistent postural---perceptual dizziness (the new name for chronic subjective dizziness). Proprioceptive dysfunction in cervi- cal syndromes of different etiologies may also be a source of dizziness and imbalance. Each of these conditions has its clinical and therapeutic peculiarities. Vertigo and other types of dizziness may be present in different diseases of the central nervous system, such as migraine and its equivalents, strokes, tumors, other brainstem or cerebellar syndromes, and Parkinson’s disease.

This study allowed to describe the perception of elderly women about the preventive examination of cervical cancer. The testimonies of the participants made it possible to understand that, although the elderly women expressed fears, fear of the test result, they recognize it as important to their health and that the reasons for the delay or even not performing this test, in most cases, They are attributed to the attitude of health professionals, who, guided by governmental public policies, discourage their continuity over the years.

Abstract: A female patient, 62 years old, with a history of postmenopausal vaginal bleeding, abundant and intermittent, lasting six months, associated with significant weight loss, pelvic pain and voiding difficulty. Complementary exams revealed an expansive lesion in the isthmus and cervix, with signs of bilateral parametrial invasion and superior third of the vagina, in close contact with the bladder and rectum. The biopsy revealed high-grade fusocellular sarcoma. The patient was referred to chemotherapy and neoadjuvant radiotherapy with programming for further surgical treatment. This case corroborates with the thought that although rare, it is important to suggest the possibility of uterine sarcoma in cases of vaginal bleeding after menopause. Histological study and staging are essential to obtain a better therapeutic quality. Key words: uterine hemorrhage, uterine neoplasia, sarcoma.

Fig 5. Effect of Tim-3 inhibition on Hela cell migration and invasion in vitro. (A) Cell migration capability was determined with a wound healing assay. Photographs were taken immediately (0 h), at 24 h and 48 h after wounding. (B) Quantification of wound closure. The data present the mean distance of cell migration to the wound area at 24 h and 48 h after wounding in three independent wound sites per group. (C) The ability of the cells to invade Matrigel was analyzed by the transwell invasion assay through a gel matrix. Hela cells were either infected with ADV-GFP or with ADV-antisense Tim-3, After 10 h viable invasive cells were fixed and counted. Values and error bars shown in this graph represent the averages and standard deviations respectively, of three independent experiments. (D) Representative images of the transwell invasion assay. doi:10.1371/journal.pone.0152830.g001

Background: Our objetive is to assess the lymph node reactivity in patients with neck metastasis from occult primary tumor. Methods: We perform a retrospective analysis of 24 patients submitted to neck dissection between 1983 and 1995 due to metastasis of occult primary tumor. Slices of 601 resulting lymph nodes was colored with hematoxilin-eosin and evaluated by optical microscopy. Lymph node reactivity patterns considered the presence of paracortical hyperplasia, germinal center hyperplasia and sinus hyperplasia. We evaluated relationship between lymph node reactivity, capsular rupture, necrosis and desmoplasia with relapse of disease. Statiscal analyses were performed through a Fisher Test with 2 error less than 5%. Results: Seventy seven percent of the lymph nodes were reactive. Fifty five percent of patients with paracortical or mixed hyperplasia and 16% of the patients with germinal center hiperplasia or non reactive lymph nodes were free of disease at the longest follow up (p=0,11). The presence of necrosis and desmoplasia showed a significant relation (p=0,02). Conclusions: The lymph node reactivity is usual in the great majority of primary unknown metastasis; tumoral necrosis is directly related with desmoplasia.

Methods and Findings: We retrospectively analyzed outcomes and factors affecting survival of 53 recipients who received SLT in the Liver Transplantation Center, The First Affiliated Hospital of Zhejiang University between 2004 and 2012. Thirty recipients fulfilled the Hangzhou criteria, of which 16 also fulfilled the Milan criteria, while the remaining 23 exceeded both criteria. The 1-year, 3-year and 5-year overall survival rates and tumor-free survival rates were both superior in patients fulfilling Milan or Hangzhou criteria compared with those exceeding the criteria. For recipients outside Milan criteria but within Hangzhou criteria, the 1-year, 3-year overall survival rates were 70.1%, 70.1%, similar to recipients within Milan criteria, with the 1-year, 3-year and 5-year overall survival of 93.8%%, 62.1% and 62.1% (P = 0.586). The tumor-free survival rates were also similar between these two subgroups, with 51.9% and 51.9% vs. 85.6%, 85.6% and 64.2% during the same time interval, respectively (P = 0.054). Cox regression analysis identified Hangzhou criteria (within vs. outside, hazard ratio (HR) 0.376) and diameter of the largest tumor (HR 3.523) to be independent predictors for overall survival. The only predictor for tumor-free survival was diameter of the largest tumor (HR 22.289).

Introduction: For the elderly, falling constitute an important cause of morbidity and mortality. Objective: Verify the recurrence of falls and identify factors associated with falls and recurrent falls. Methodology: A 4-year follow-up study using two survey waves (2010 and 2014/2015), with a cohort of 218 elderly people, both genders and non-institutionalized, in Juiz de Fora-MG. Multinomial logistic regression was used to estimate the association of each independent variable with the outcomes analyzed. In the final model, variables with p ≤ 0.05 were maintained. Odds Ratio (OR) was calculated with a 95% confidence interval. Results: 33.5% of the participants reported falling in the prior year of the first inquiry. In the second inquiry, the frequency was 38.5%. During the follow-up study, 44.5% did not report falls, 39% suffered a fall in at least one of the surveys, and 16.5% reported falling in both waves. No associations for recurrent falls were found. In the follow-up, falls were associated with female gender and age (71 to 80 years old). Conclusion: The results demonstrate and confirm the magnitude with which falls and recurrent falls affect the elderly population, and indicate the need for preventive strategies based on the identification of groups at risk.

The preparation of the casting process included heating the mould in 70°C, which caused water to evaporate. Next, the mould parts were joined together and filled with an aluminum alloy. After the alloy solidified, the mould was broken and the cast cooled (fig. 3).