Georgios K. Georgiou

Impact of breast cancer surgery on angiogenesis circulating biomarkers: a prospective longitudinal study

BackgroundDebate about the potential effects that surgery might have on cancer cells dormancy and angiogenesis prompted us to investigate the impact of breast surgery on circulating angiogenesis modulating gene transcripts and proteins.MethodsBlood samples from 10 female patients diagnosed with breast cancer and 6 with fibroadenoma were collected before surgery and post-operatively on days 3 and 7 (breast cancer patients only). A set of 84 angiogenesis-associated transcripts were assessed using quantitative PCR arrays, and circulating protein levels (vascular endothelial growth factor A (VEGFA), IL8 and fibroblast growth factor 2 (FGF2) were measured using ELISA in the same samples. The results were investigated against clinicopathological data and patient outcome.ResultsPlasma levels of VEGFA and IL8 after surgery were significantly elevated in the breast cancer group compared to the control group (P = 0.038 and P = 0.021, respectively). In the cohort of breast cancer patients, VEGFA increased on day 3 (P = 0.038) and declined on day 7 (P= 0.017), while IL8 did not change on day 3 but showed a significant decline on day 7 (P = 0.02). FGF2 levels did not change significantly over time. Regarding gene transcripts, we detected upregulation of a significant number of angiogenesis-specific genes in patients with breast cancer versus controls: sphingosine kinase 1(SPHK1), epidermal growth factor (EGF), vascular endothelial growth factor C (VEGFC), neuropilin 1 (NRP1), fibroblast growth factor (FGF1), laminin alpha 5 (LAMA5), collagen type IV alpha 3 (COL4A3), IL8, ephrin B2 (EFNB2), ephrin A3 (EFNA3), tyrosine endothelial kinase (TEK), integrin beta 3 (ITGB3), AKT1, thrombospondin 1 (THBS1), chemokine (C-C motif) ligand 11 (CCL11) and TIMP metallopeptidase inhibitor 3 (TIMP3). Surgery induced an altered expression in several keygenes in breast cancer patients. We identified an upregulation of COL4A3 and downregulation of chemokine (C-X-C motif) ligand 9 (CXCL9), EGF, FGF1, Kinase insert domain receptor (KDR), Placental growth factor (PGF), TIMP3 and VEGFC.ConclusionBreast cancer patients have a different expression profile of circulating angiogenesis biomarkers compared to patients with fibroadenoma. Moreover, mastectomy promotes a transient increase of VEGFA and a shift in the expression patterns of a broad panel of angiogenesis-related circulating gene transcripts.

Submucosal resection of the appendiceal base

of Victoria and as to whether this demonstrates inadequate publishing efforts in NSW or excellence in publishing efforts in Victorian or perhaps both. The health system is similar although public hospital outpatient clinics in NSW are less supported, leading to new patient referrals being made to private practice rooms and perhaps creating an imperative for urologists to focus upon covering private practice costs. If these differences remain stagnant or increase, there should be efforts to identify underlying reasons.

Spontaneous biloma due to an intrahepatic cholangiocarcinoma: An extremely rare case report with long term survival and literature review

Cholangiocarcinomas are tumors that arise from the ductal epithelium of the intrahepatic or extra-hepatic bile ducts. Patients are usually asymptomatic or may present with weight loss, fatigue, loss of appetite and abdominal pain (intrahepatic cholangiocarcinomas) or jaundice (extra-hepatic cholangiocarcinomas). Subcapsular bile vessel rupture, due to intrahepatic cholangiocarcinoma, is an extremely rare clinical presentation, which is an emergent and potentially life-threatening complication. We report the case of a 79-year-old female patient suffering from an intrahepatic cholangiocarcinoma that completely obliterated the left main hepatic duct. This obstruction in intrahepatic bile flow had resulted in intraperitoneal rupture of subcapsular bile vessels (not infiltrated by the tumor) of the left liver lobe and formation of spontaneous biloma. The patient was admitted for acute abdominal pain. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) revealed the tumor and an upper abdominal fluid collection. Since the patient was hemodynamically stable and afebrile, a CT-guided percutaneous aspiration of the collection was undertaken, showing a biloma. A left hepatectomy was performed two weeks later and today, sixty months since the incident, the patient enjoys good health, with no signs of local recurrence or distant metastases. Intraperitoneal rupture of bile ducts and subsequent spontaneous biloma formation, due to an intrahepatic cholangiocarcinoma which completely obstructed the left main hepatic duct, is a unique situation and this is the first time to be reported. Prompt surgical management can lead to successful treatment of this rare and difficult entity.

Peri-operative Shift in Angiogenesis-Related Factors in Breast Cancer Patients

Surgery still remains the cornerstone of breast cancer treatment but in some cases it has been implicated for stimulating early locoregional recurrence or even distant metastatic spread. There is evidence that angiogenesis, initiated by the surgical wounding itself during the process of healing, could offer valuable answers in such matters as well as enable a more profound understanding of the mechanisms of carcinogenesis in general. In our study, we investigated the impact of breast surgery on circulating angiogenesis-related factors in the peripheral blood. We used plasma samples from ten female patients with biopsy-proven breast cancer (Ca group) and six other females with fibroadenoma (Control group) before surgery (PRO) and post-operatively on days 3 (D3) and 7 (D7, only for breast cancer patients). These samples were analyzed for circulating levels of vascular endothelial growth factor A (VEGF-A), Interleukin-8 (IL-8) and fibroblast growth factor 2 (FGF2/bFGF) using ELISA. Moreover, 84 angiogenesis-associated mRNA transcripts were also assessed using quantitative RT-PCR arrays at the same time points. We were able to find a different angiogenic profile between breast cancer patients and those with benign breast disease (fibroadenoma). The effect of surgery on the mechanism of new blood vessel formation was found to be more robust and far more prolonged in women suffering from malignancy of the breast, than those operated for fibroadenoma. Mastectomy provoked a transient increase in VEGF-A plasma levels and altered the expression of many angiogenesis-related circulating gene transcripts.

A case of encapsulating peritoneal sclerosis presented shortly after renal transplantation

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD), characterized by extensive intraperitoneal fibrosis and encasement of bowel loops. It typically associates with long-term PD and progressive loss of ultrafiltration. The management of EPS has evolved substantially from the original report of this entity and now includes immunosuppressive agents, antifibrotic agents, nutritional support, and surgical intervention. Although the exact cause of this condition remains obscure and despite the possible positive effect of immunosuppression on EPS, it has been described in the post-transplant setting upon the discontinuation of PD. We report such a case of a former PD patient who presented with EPS a month after renal transplantation. This article will highlight the current views regarding the management of post-transplant EPS and introduce the problem of long-term PD patients on the deceased-donor transplant waiting list.