Publications by authors named "Janusz Jaśkiewicz"

36 Publications

Methylene Blue-Current Knowledge, Fluorescent Properties, and Its Future Use.

J Clin Med 2020 Nov 2;9(11). Epub 2020 Nov 2.

Department of Surgical Oncology, Medical University of Gdansk, 80-214 Gdansk, Poland.

Methylene blue is a fluorescent dye discovered in 1876 and has since been used in different scientific fields. Only recently has methylene blue been used for intraoperative fluorescent imaging. Here, the authors review the emerging role of methylene blue, not only as a dye used in clinical practice, but also as a fluorophore in a surgical setting. We discuss the promising potential of methylene blue together with the challenges and limitations among specific surgical techniques. A literature review of PubMed and Medline was conducted based on the historical, current and future usage of methylene blue within the field of medicine. We reviewed not only the current usage of methylene blue, but we also tried to grasp its' function as a fluorophore in five main domains. These domains include the near-infrared imaging visualization of ureters, parathyroid gland identification, pancreatic tumors imaging, detection of breast cancer tumor margins, as well as breast cancer sentinel node biopsy. Methylene blue is used in countless clinical procedures with a relatively low risk for patients. Usage of its fluorescent properties is still at an early stage and more pre-clinical, as well as clinical research, must be performed to fully understand its potentials and limitations.
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http://dx.doi.org/10.3390/jcm9113538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693951PMC
November 2020

New technologies in breast cancer sentinel lymph node biopsy; from the current gold standard to artificial intelligence.

Surg Oncol 2020 Sep 7;34:324-335. Epub 2020 Jul 7.

Department of Surgical Oncology, Medical University of Gdansk, Gdańsk, 80-211, Poland.

Sentinel lymph node biopsy is an important diagnostic procedure performed in early breast cancer patients with clinically negative axillary lymph nodes. Detection and examination of sentinel lymph nodes determine further therapy decisions, therefore a choice of optimal technique minimising the risk of false-negative results is of great importance. Currently, the gold standard is the dual technique comprising the blue dye and radiotracer, however, this method creates a logistical problem for many medical units. The intrinsic constraints of the existing methods led to the development of a very wide range of alternatives with varying clinical efficiency and feasibility. While each method presents with its own advantages and disadvantages, many techniques have improved enough to become a non-inferior alternative in the sentinel lymph node biopsy. Along with the improvement of the existing technologies, there are evolving trends such as multimodality of the techniques maximising the diagnostic outcome or an emerging use of artificial intelligence (AI) improving the workflow of the procedure. This literature review aims to give an overview of the current status of the standard techniques and emerging cutting-edge technologies in the sentinel lymph node biopsy.
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http://dx.doi.org/10.1016/j.suronc.2020.06.005DOI Listing
September 2020

Surgical Site Infection after Breast Surgery: A Retrospective Analysis of 5-Year Postoperative Data from a Single Center in Poland.

Medicina (Kaunas) 2019 Aug 21;55(9). Epub 2019 Aug 21.

Department of Surgical Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland.

Surgical site infection (SSI) is a significant complication of non-reconstructive and reconstructive breast surgery. This study aimed to assess SSI after breast surgery over five years in a single center in Poland. The microorganisms responsible for SSI and their antibiotic susceptibilities were determined. Data from 2129 patients acquired over five years postoperatively by the Department of Surgical Oncology, Medical University of Gdansk in Poland were analyzed. SSI was diagnosed in 132 patients (6.2%) and was an early infection in most cases (65.2%). The incidence of SSI was highest in patients who underwent subcutaneous amputation with simultaneous reconstruction using an artificial prosthesis (14.6%), and breast reconstruction via the transverse rectus abdominis muscle (TRAM) flap method (14.3%). Gram-positive bacteria were responsible for SSI in most cases (72.1%), and these were mainly strains (53.6%). These strains were 100% susceptible to all beta-lactam antibiotics (except penicillin) but were less susceptible to macrolides and lincosamides. SSI is a serious problem, and attention should be focused on its prevention. Reconstruction using an artificial prosthesis or via the TRAM flap method is connected to increased SSI incidence. Further studies are required to prevent SSI following breast surgery.
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http://dx.doi.org/10.3390/medicina55090512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780406PMC
August 2019

Use of fiberoductoscopy for the management of patients with pathological nipple discharge: experience of a single center in Poland.

Breast Cancer 2018 Nov 25;25(6):753-758. Epub 2018 Jun 25.

Department of Surgical Oncology, Medical University of Gdansk, Smoluchowski Str 17, 80-214, Gdansk, Poland.

Background: Pathological nipple discharge (PND) is associated with serious clinical and diagnostic issues. Fiberoductoscopy (FDS) is a new diagnostic option in PND patients. This study summarizes our initial experience of FDS for the management of PND patients in a single center in Poland and assesses its safety.

Methods: A total of 256 women with PND were included in this prospective, case-controlled, single-center study between 2006 and 2014. Of the 250 patients who underwent FDS, 154 had mammary duct lesions and 96 had no visible lesions. Subsequently, 129 patients with lesions identified by FDS underwent microductectomy and the lesions were pathologically evaluated.

Results: The mean duration of FDS examination was 17 min. The most frequent intraductal lesion was amputation of a duct (35.1%), followed by circular narrowing or hyperplasia (22.7%). Final histological findings were unremarkable in 11.6% of cases, whereas mammary duct papilloma, duct ectasia, and ductal carcinoma in situ were detected in 71.3, 10.9, and 6.2% of cases, respectively.

Conclusions: FDS is an innovative method for visualizing intraductal mammary lesions and allows accurate selection of mammary ducts with suspicious lesions that require surgical removal in women with PND.
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http://dx.doi.org/10.1007/s12282-018-0883-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208849PMC
November 2018

Primary Ewing Sarcoma of the Thyroid-Eight Cases in a Decade: A Case Report and Literature Review.

Front Endocrinol (Lausanne) 2017 27;8:257. Epub 2017 Oct 27.

Department of Surgical Oncology, Medical University of Gdańsk, Gdańsk, Poland.

Sarcomas represent less than 1% of all malignant tumors found in the thyroid. Of these, primary extraosseoussarcoma has been reported only a few times in the past decade. We present the case of a 34-year-old male who had a fast-growing hard mass in the lower left neck. FNA was inconclusive. Core needle biopsy revealed the diagnosis of an Ewing sarcoma/primitive neuroectodermal tumor. Mutation of EWSR1 was confirmed using the FISH method. Following treatment by neoadjuvant chemotherapy, we observed clinical, radiological, and finally histopathological remission. This was followed by a left-sided isthmolobectomy with unilateral cervical lymph node dissection by lateral lymphadenectomy, which revealed no residual disease. Posttreatment radiotherapy was administered but discontinued upon the patient's request. After 18 months of observation, the patient had no recurrence or metastasis and required l-thyroxine supplementation. We discuss our case using a comparative literature review to the few other known case reports.
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http://dx.doi.org/10.3389/fendo.2017.00257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663906PMC
October 2017

The impact of the Polish mass breast cancer screening program on prognosis in the Pomeranian Province.

Arch Med Sci 2017 Mar 6;13(2):441-447. Epub 2016 Jun 6.

Department of Oncological Surgery, Medical University of Gdansk, Gdansk, Poland.

Introduction: Mammographic screening results in diagnosis of less advanced breast cancer (BC). A meta-analysis of randomized clinical trials confirmed that BC screening reduces mortality. In 2007, the National Breast Cancer Screening Program (NBCSP) was established in Poland with the crucial aim of reducing mortality from BC. The purpose of this study was to assess the impact of participation in the NBCSP on prognosis.

Material And Methods: A single institution, non-randomized retrospective study was undertaken. The study population comprised 643 patients with BC treated in the Department of Surgical Oncology (DSO) at the Medical University of Gdansk over a 4-year period, from 01.01.2007 until 31.12.2010. Patients were divided into two groups: group A - patients who participated in the NBCSP ( = 238, 37.0%); and group B - patients who did not participate in the NBCSP ( = 405, 63.0%).

Results: Statistical analysis revealed that group A displayed a less advanced AJCC stage (more patients in AJCC stage I, = 0.002), lower tumor diameter (more patients with pT1, = 0.006, and pT < 15 mm, = 0.008) and a lower incidence of metastases to axillary lymph nodes (more patients with pNO, = 0.01). From 2009 to 2010 the NBCSP revealed a statistically significant benefit - significantly more patients in stage 0 + I (60.7% vs. 48.8%, = 0.018) and with tumors pT < 15 mm (48.8% vs. 35.1%, = 0.011) were observed in group A.

Conclusions: The study results revealed the beneficial impact of the NBCSP. Superior prognostic factors and favorable staging were observed in women who participated in the NBCSP.
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http://dx.doi.org/10.5114/aoms.2016.60387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332447PMC
March 2017

Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer.

J Contemp Brachytherapy 2016 Dec 9;8(6):492-496. Epub 2016 Dec 9.

Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk.

Purpose: To evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT) with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively.

Material And Methods: Between May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT) including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT). The BT dose of 15 Gy (1 Gy/pulse/h) was given on the following day after surgery.

Results: No increased bleeding or delayed wound healing related to the implants were observed. The only side effects included one case of temporary peri-operative breast infection and 3 cases of fat necrosis, both early and late. In 11 patients (11.4%), subsequent WBRT was omitted owing to the final pathology findings. These included eight patients who underwent mastectomy due to multiple adverse prognostic pathological features, one case of lobular carcinoma , and two cases with no malignant tumor. With a median follow-up of 12 years (range: 7-14 years), among 85 patients who completed BCT, there was one ipsilateral breast tumor and one locoregional nodal recurrence. Six patients developed distant metastases and one was diagnosed with angiosarcoma within irradiated breast. The actuarial 5- and 10-year disease free survival was 90% (95% CI: 84-96%) and 87% (95% CI: 80-94%), respectively, for the patients with invasive breast cancer, and 91% (95% CI: 84-97%) and 89% (95% CI: 82-96%), respectively, for patients who completed BCT. Good cosmetic outcome by self-assessment was achieved in 58 out of 64 (91%) evaluable patients.

Conclusions: Peri-operative PDR-BT boost with intra-operative tube placement followed by EBRT is feasible and devoid of considerable toxicity, and provides excellent long-term local control. However, this strategy necessitates careful patient selection and histological confirmation of primary diagnosis.
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http://dx.doi.org/10.5114/jcb.2016.64512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241379PMC
December 2016

Retroperitoneal tumor: giant cavernous hemangioma - case presentation and literature review.

Kardiochir Torakochirurgia Pol 2016 Dec 30;13(4):375-379. Epub 2016 Dec 30.

Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland.

Retroperitoneal hemangiomas are very rare. This paper presents the case of a 71-year-old female patient with giant cavernous hemangioma of the retroperitoneum who underwent surgical treatment for abdominal pain and left lower limb edema. Interventional staged treatment with percutaneous transcatheter arterial embolization prior to surgery was considered. Radical resection of the tumor was performed, which caused the symptoms to abate. Additionally a literature review of cases involving cavernous hemangioma in the retroperitoneal space is presented. No description of retroperitoneal cavernous hemangioma originating from the bowel was found in the analyzed reports.
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http://dx.doi.org/10.5114/kitp.2016.64889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5233774PMC
December 2016

Prognostic value of 5-microRNA based signature in T2-T3N0 colon cancer.

Clin Exp Metastasis 2016 12 2;33(8):765-773. Epub 2016 Aug 2.

Department of Oncology and Radiotherapy, Medical University of Gdansk, 7 Dębinki St., 80-211, Gdańsk, Poland.

The role of adjuvant chemotherapy in stage T2-T3N0 colon cancer (CC) is controversial and there are currently no reliable factors allowing for individual selection of patients with high risk of relapse for such therapy. We searched for microRNA-based signature with prognostic significance in this group. We assessed by qRT-PCR expression of 754 microRNAs (miRNAs) in tumour samples from 85 stage pT2-3N0 CC patients treated with surgery alone. MiRNA expression was compared between two groups of patients: 40 and 45 patients who did and did not develop distant metastases after resection, respectively. Additionally, miRNA expression was compared between CC and normal colon mucosa samples and between the mismatch repair (MMR) competent and deficient tumours. Low expression of miR-1300 and miR-939 was significantly correlated with shorter distant metastasis-free survival (DMFS) in Cox univariate analysis (p.adjusted = 0.049). The expression signature of five miRNAs (miR-1296, miR-135b, miR-539, miR-572 and miR-185) was found to be prognostic [p = 1.28E-07, HR 8.4 (95 % CI: 3.81-18.52)] for DMFS and cross-validated in a leave-one-out analysis, with the sensitivity and specificity of 74 and 78 %, respectively. The expression of miR-592 was significantly associated with the MMR status (p.adjusted <0.01). The expression of several novel miRNAs were found to be tumour specific, e.g. miR-888, miR-523, miR-18b, miR-302a, miR-423-5p, miR-582-3p (p < 0.05). We developed a miRNA expression signature that may be predictive for the risk of distant relapse in early stage CC and confirmed previously reported association between miR-592 expression and MMR status.
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http://dx.doi.org/10.1007/s10585-016-9810-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110606PMC
December 2016

Total mechanical stapled oesophagogastric anastomosis on the neck in oesophageal cancer - prevention of postoperative mediastinal complications.

Kardiochir Torakochirurgia Pol 2015 Dec 30;12(4):318-21. Epub 2015 Dec 30.

Department of Oncological Surgery, Medical University of Gdansk, Poland.

Oesophagogastric anastomosis after oesophagus resection is commonly performed on the neck. Even though a few different techniques of oesophagogastric anastomosis have been previously detailed, both manual and mechanical procedures have been burdened with leakages and strictures. Our simple technique of oesophagogastric anastomosis is a modification of mechanical anastomosis with the use of a circular stapler in order to prevent postoperative leak and concomitant mediastinal complications. Since 2008, we have performed nine oesophagogastric anastomoses following oesophagus resection. The mean age of the operated patients was 54 years. There was no mortality among the operated patients in the early post-operative period. The mean follow-up period for the patients operated on in our department was 17 months until the time of the analysis. None of the patients showed any leakage or stricture, and no mediastinal complications were reported in the group. Following our own experience, mechanical anastomosis with the use of a circular stapler seems to decrease the time of the operation as well as significantly reducing the incidence of leakages from the anastomosis. This type of anastomosis may decrease the number of postoperative strictures and the most dangerous mediastinal infections.
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http://dx.doi.org/10.5114/kitp.2015.56781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735532PMC
December 2015

Concurrent DNA Copy-Number Alterations and Mutations in Genes Related to Maintenance of Genome Stability in Uninvolved Mammary Glandular Tissue from Breast Cancer Patients.

Hum Mutat 2015 Nov 14;36(11):1088-99. Epub 2015 Aug 14.

Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland.

Somatic mosaicism for DNA copy-number alterations (SMC-CNAs) is defined as gain or loss of chromosomal segments in somatic cells within a single organism. As cells harboring SMC-CNAs can undergo clonal expansion, it has been proposed that SMC-CNAs may contribute to the predisposition of these cells to genetic disease including cancer. Herein, the gross genomic alterations (>500 kbp) were characterized in uninvolved mammary glandular tissue from 59 breast cancer patients and matched samples of primary tumors and lymph node metastases. Array-based comparative genomic hybridization showed 10% (6/59) of patients harbored one to 359 large SMC-CNAs (mean: 1,328 kbp; median: 961 kbp) in a substantial portion of glandular tissue cells, distal from the primary tumor site. SMC-CNAs were partially recurrent in tumors, albeit with considerable contribution of stochastic SMC-CNAs indicating genomic destabilization. Targeted resequencing of 301 known predisposition and somatic driver loci revealed mutations and rare variants in genes related to maintenance of genomic integrity: BRCA1 (p.Gln1756Profs*74, p.Arg504Cys), BRCA2 (p.Asn3124Ile), NCOR1 (p.Pro1570Glnfs*45), PALB2 (p.Ser500Pro), and TP53 (p.Arg306*). Co-occurrence of gross SMC-CNAs along with point mutations or rare variants in genes responsible for safeguarding genomic integrity highlights the temporal and spatial neoplastic potential of uninvolved glandular tissue in breast cancer patients.
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http://dx.doi.org/10.1002/humu.22845DOI Listing
November 2015

The significance of ductoscopy of mammary ducts in the diagnostics of breast neoplasms.

Wideochir Inne Tech Maloinwazyjne 2015 Apr 3;10(1):79-86. Epub 2014 Dec 3.

Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland.

Introduction: Ductoscopy is a low invasive method enabling the diagnostics of intraductal proliferative lesions in breasts. Fiberoptic ductoscopy (FDS) is important in the diagnosis of patients with pathological nipple discharge. There are attempts to apply FDS in patients with breast cancer without the presence of nipple discharge.

Aim: To assess fiberoptic ductoscopy in the diagnostics of breast neoplasms.

Material And Methods: The material was composed of a group of 164 patients treated for intraductal proliferative lesions in breasts. In the analyzed group of patients, FDS was conducted in 128 patients with pathological nipple discharge and 36 patients with the presence of breast cancer. The analyzed period was divided into three sub-periods. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FDS examination verified by post-operative histopathological examination were analyzed. The safety of the method was also assessed, taking into consideration the complications.

Results: An increasing number of successful ductoscopies together with the number of performed FDS examinations was noted. There were statistically significant differences in the percentage of successful cannulations in relation to the number of performed FDS examinations in the three subsequent stages of the project (p = 0.011). The duration of FDS examination in the third period was reduced in comparison with the first and second period (p < 0.001). Sensitivity of fiberoptic ductoscopy is 68.1%, specificity 77.3% and PPV 90.4%, but NPV is 44.1%.

Conclusions: The introduction of fiberoptic ductoscopy in our clinic has contributed to the widening of the diagnostic possibilities of small intraductal lesions of the mammary gland.
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http://dx.doi.org/10.5114/wiitm.2014.46823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415260PMC
April 2015

Preoperative nutritional support in cancer patients with no clinical signs of malnutrition--prospective randomized controlled trial.

Support Care Cancer 2015 Feb 6;23(2):365-70. Epub 2014 Aug 6.

Department of Surgical Oncology, Medical University of Gdańsk, Smoluchowskiego 17, 80-952, Gdańsk, Poland,

Purpose: Preoperative nutrition is beneficial for malnourished cancer patients. Yet, there is little evidence whether or not it should be given to nonmalnourished patients. The aim of this study was to assess the need to introduce preoperative nutritional support in patients without malnutrition at qualification for surgery.

Methods: This was a prospective, two-arm, randomized, controlled, open-label study. Patients in interventional group received nutritional supplementation for 14 days before surgery, while control group kept on to their everyday diet. Each patient's nutritional status was assessed twice--at qualification (weight loss in 6 months, laboratory parameters: albumin, total protein, transferrin, and total lymphocyte count) and 1 day before surgery (change in body weight and laboratory parameters). After surgery, all patients were followed up for 30 days for postoperative complications.

Results: Fifty-four patients in interventional and 48 in control group were analyzed. In postoperative period, patients in control group suffered from significantly higher (p < 0.001) number of serious complications compared with patients receiving nutritional supplementation. Moreover, levels of all laboratory parameters declined significantly (p < 0.001) in these patients, while in interventional arm were stable (albumin and total protein) or raised (transferrin and total lymphocyte count).

Conclusions: Preoperative nutritional support should be introduced for nonmalnourished patients as it helps to maintain proper nutritional status and reduce number and severity of postoperative complications compared with patients without such support.
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http://dx.doi.org/10.1007/s00520-014-2363-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289010PMC
February 2015

Endoscopic submucosal dissection of gastric ectopic pancreas.

Wideochir Inne Tech Maloinwazyjne 2013 Sep 5;8(3):249-52. Epub 2013 Mar 5.

Department of Oncological Surgery, University Clinical Center, Medical University of Gdansk, Poland.

Patients with gastric tumors usually present with symptoms of discomfort or pain in the epigastrium, regurgitations, nausea, vomiting or melena. Treatment options include open and laparoscopic total or partial gastrectomy and recently endoscopic mucosal resection. A case of successful endoscopic submucosal dissection is described with the unusual pathological finding of heterotopic pancreatic tissue forming a gastric tumor. The 67-year-old male patient was operated on due to the initial diagnosis of gastro-intestinal stromal tumor of the gastric trunk. Two intra-operative biopsies were negative for cancer cells. Submucosal endoscopic dissection was performed with IT and Hook knives (Olympus). A literature review was performed. The operative time was 180 min with hospital stay of 6 days. During the injection of the carmine dye and the air insufflation pneumoperitoneum occurred and remained clinically silent during the observation period. The pathology result showed a heterotopic pancreatic tissue type 2 according to Heinrich's classification with microfoci of intestinal metaplasia. Preoperative diagnostics of gastric masses might be misleading and such tumors not necessarily should be excised. There are several surgical options with endoscopic submucosal dissection being probably the safest one and a non-disabling approach. Patients tolerate that kind of surgery well with good postoperative functional outcomes.
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http://dx.doi.org/10.5114/wiitm.2011.33709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796718PMC
September 2013

Prognostic significance of ESR1 amplification and ESR1 PvuII, CYP2C19*2, UGT2B15*2 polymorphisms in breast cancer patients.

PLoS One 2013 8;8(8):e72219. Epub 2013 Aug 8.

Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland.

Introduction: Amplification of the ESR1 gene, coding for estrogen receptor alpha, was shown to predict responsiveness to tamoxifen, however its prognostic impact in breast cancer patients has not been thoroughly investigated. Other factors that could contribute to responsiveness to tamoxifen treatment are polymorphisms in ESR1 gene and genes involved in tamoxifen metabolism. The aim of this study was to assess the prognostic role of ESR1 gene dosage in a consecutive group of breast cancer patients and to correlate this feature with clinico-pathological factors. Additionally, ESR1 PvuII, CYP2C19*2 and UGT2B15*2 polymorphisms were analyzed in the tamoxifen-treated subgroup of patients.

Materials And Methods: Primary tumor samples from 281 stage I-III consecutive breast cancer patients were analyzed for ESR1 gene dosage using real-time PCR with locked nucleic acids hydrolysis probes. In the tamoxifen-treated subgroup of patients, ESR1 PvuII, CYP2C19*2 and UGT2B15*2 polymorphism in leukocytes genomic DNA were analyzed. Results were correlated with clinico-pathological factors and with disease-free survival (DFS) and overall survival (OS).

Results: ESR1 amplification (with a cut-off level of 2.0) was found in 12% of the entire group of breast cancer patients, and in 18% of the ER-negative subgroup. This feature was associated with decreased DFS both in the entire group (P=0.007) and in the ER-negative subgroup (P=0.03), but not in the tamoxifen-treated patients. Patients with ESR1 PvuII wt/wt genotype and at least one UGT2B15 wt allele had a worse DFS (P=0.03) and showed a trend towards decreased Os (P=0.08) in comparison to patients with ESR1 PvuII wt/vt or vt/vt genotype and UGT2B15 *2/*2 genotype.

Conclusions: ESR1 amplification can occur in ER-negative tumors and may carry poor prognosis. In the tamoxifen-treated subgroup, poor prognosis was related to the combined presence of ESR1 PvuII wt/wt and UGT2B15wt/wt or wt/*2 genotype.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072219PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738574PMC
April 2014

Diffuse cavernous hemangioma of the rectum (DCHR)--diagnosis and treatment--case report and review of available literature.

Pol Przegl Chir 2013 Apr;85(4):216-8

Diffuse cavernous hemangioma of the rectum (DCHR) is a rare benign tumor of vascular origin. Approximately 200 such cases have been reported in the literature. Here we present a case of a 49-year old female patient who underwent a surgical procedure due to a mass of the rectum with a history of recurrent, painless gastrointestinal bleeding and anemia in whom DCHR was diagnosed postoperatively. This paper is intended as a metaanalysis of available diagnostic and therapeutic methods to be used in patients with DCHR.
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http://dx.doi.org/10.2478/pjs-2013-0033DOI Listing
April 2013

Analysis of selected factors influencing seroma formation in breast cancer patients undergoing mastectomy.

Arch Med Sci 2013 Feb 28;9(1):86-92. Epub 2012 Jun 28.

Department of Surgical Oncology, Medical University of Gdansk, Poland.

Introduction: The aim of the work was to analyze the impact of selected factors on the incidence of seroma formation in breast cancer patients undergoing mastectomy.

Material And Methods: One hundred and fifty breast cancer patients were prospectively enrolled in the study. All patients had mastectomy performed using the same operative technique with electrocoagulation. The amount of seroma formed after surgery and its duration were correlated with selected demographic, clinical and pathological parameters.

Results: The cumulative total seroma volume collected by the end of treatment was higher and the overall time of seroma treatment was longer in patients over the age of 60 years (p = 0.001 and p = 0.001 respectively). Duration of seroma was significantly longer in obese patients (p = 0.036). The cumulative total seroma volume collected by the end of treatment was higher and the overall time of seroma treatment was longer in patients who had over 130 ml of lymph drained during the first 24 postoperative hours (p < 0.001 and p = 0.001 respectively). Additionally, longer duration of seroma was observed in patients with pathological stage I and II according to TNM-UICC (p = 0.042) and in patients with ≥ 1200 g weight resected of mammary gland (p = 0.05).

Conclusions: Age and obesity are important prognostic factors influencing seroma formation in breast cancer patients undergoing mastectomy. The amount of lymph formed during first postoperative day may have predictive value in assessing cumulative total seroma volume collected during treatment and its overall duration.
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http://dx.doi.org/10.5114/aoms.2012.29219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598126PMC
February 2013

Evaluation of the pharmacodynamics and pharmacokinetics of the PARP inhibitor olaparib: a phase I multicentre trial in patients scheduled for elective breast cancer surgery.

Invest New Drugs 2013 Aug 13;31(4):949-58. Epub 2013 Jan 13.

Department of Academic Surgery, Education and Research Centre, University Hospital of South Manchester, Wythenshawe, M23 9LT Manchester, UK.

Olaparib (AZD2281) is an oral poly(ADP-ribose) polymerase (PARP) inhibitor with antitumour activity in cancer patients with BRCA1/2 germline mutations and in patients with homologous recombination deficiency. In this dose-finding study, patients were randomized to olaparib 10, 30, 100, 200 or 400 mg (capsule formulation) twice daily for the 4-5 days preceding breast cancer surgery. The primary objective was to identify an effective biological dose of olaparib for future trials. Secondary endpoints included evaluation of PARP-1 inhibition dose/exposure-response, and safety. Olaparib plasma pharmacokinetics (PK) and the pharmacodynamics (PD) in tumour and peripheral blood mononuclear cells (PBMCs) were evaluated. Population PK/PD modelling was performed on pooled data from this study and a previously reported study. Sixty patients were randomized (n = 12, each dose). Dose-dependent increases in exposure to olaparib were observed, but at ~50 % lower plasma exposure levels than seen in advanced disease studies. The mean maximal extent of PARP inhibition in PBMCs and tumour tissue was 50.6 % and 70.0 %, respectively, and was similar to inhibitory levels reported previously. No PARP inhibition-dose relationship was observed. Due to the unexpectedly low olaparib exposure, we were unable to determine an effective biological dose. Common adverse events included procedural pain (n = 31 patients), nausea, asthenia, malaise and increased blood creatinine (n = 6, each); these were of mild-to-moderate intensity, and all were manageable. Despite low olaparib exposure, PARP inhibition was consistent with previous reports. Reasons for the inter-study differences in exposure are unclear. The tolerability profile of olaparib was consistent with previous studies.
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http://dx.doi.org/10.1007/s10637-012-9922-7DOI Listing
August 2013

Totally laparoscopic feeding jejunostomy - a technique modification.

Wideochir Inne Tech Maloinwazyjne 2011 Dec 20;6(4):256-60. Epub 2011 Dec 20.

Department of Oncological Surgery, Hospital of Medical University of Gdansk, Poland.

In oncological patients with upper gastrointestinal tract tumours, dysphagia and cachexy necessitate gastrostomy or jejunostomy as the only options of enteral access for long-term feeding. In this article the authors describe a modified technique of laparoscopic feeding jejunostomy applied during the staging laparoscopy. A 48-year-old male patient with gastroesophageal junction tumour and a 68-year-old male patient with oesophageal tumour were operated on using the described technique. Exploratory laparoscopy was performed. Then the feeding jejunostomy was made using a Cystofix(®) TUR catheter. The jejunum was fixed to the abdominal wall with four 2.0 Novafil™ transabdominal stitches. Two additional sutures were placed caudally about 4 cm and 8 cm from the jejunostomy, aiming at prevention of jejunal torsion. Total operating time was 45 min. There was no blood loss. There were no intraoperative complications. The only adverse event was one jejunostomy wound infection that responded well to oral antibiotics. There were no mortalities. The described technique has most of the benefits of laparoscopic feeding jejunostomy with some steps added from the open operation making the procedure easier to perform as part of a staging operation with a relatively short additional operating time. The proposed transabdominal stitches make the technique easier to apply. Two additional 'anti-torsion sutures' prevent postoperative volvulus. Use of the Cystofix catheter allows easy introduction of the catheter into the peritoneal cavity and the jejunal lumen, providing a good seal at the same time. Further studies on larger groups of patients are required to assess long-term outcomes of the proposed modified technique.
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http://dx.doi.org/10.5114/wiitm.2011.26262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516942PMC
December 2011

[Risk factors for skin cancer development in patients after organ transplantation].

Postepy Hig Med Dosw (Online) 2012 Nov 13;66:818-27. Epub 2012 Nov 13.

Oddział Dermatologii Pomorskiego Centrum Traumatologii im. Mikołaja Kopernika w Gdańsku, ul. Nowe Ogrody 1-6, 80-803 Gdańsk, Poland.

Cancer has become the second most common cause of death in patients after organ transplantation. Among all cancers arising de novo after transplantation skin cancers are the most common, accounting for 95% of all skin neoplasms. Due to the significantly higher morbidity, aggressive, rapid progression of cancer and unfavorable prognosis, the population requires a specific oncological approach. Therefore, special attention should be paid to factors predisposing to the development of cancer, including skin cancer, in patients after organ transplantation. Some of these factors are well understood, while the role of others is still ambiguous. Among the etiological factors mentioned are those that are associated with the recipient. These include genetic factors such as male sex, fair skin and inability to be tanned, and compatibility of the HLA system, and non genetic factors such as patient age, chronic skin ulcers and scars, the type of transplanted organ, immunosuppression, and particularly the type and cumulative doses of drugs. In addition, the pathogenesis of cancer is influenced by environmental factors such as exposure to sunlight and therefore latitude, ionizing radiation, chemical carcinogens and viral infections. Knowledge of etiological factors and mechanisms of etiopathogenesis allow for indication and observation of patients with increased risk of cancer as well as faster healing in these patients.  
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http://dx.doi.org/10.5604/17322693.1019530DOI Listing
November 2012

Expression of epithelial to mesenchymal transition-related markers in lymph node metastases as a surrogate for primary tumor metastatic potential in breast cancer.

J Transl Med 2012 Nov 19;10:226. Epub 2012 Nov 19.

Laboratory of Cell Biology, Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Dębinki 1, Gdańsk, Poland.

Background: Breast cancers are phenotypically and genotypically heterogeneous tumors containing multiple cancer cell populations with various metastatic potential. Aggressive tumor cell subpopulations might more easily be captured in lymph nodes metastases (LNM) than in primary tumors (PT). We evaluated mRNA and protein levels of master EMT regulators: TWIST1, SNAIL and SLUG, protein levels of EMT-related markers: E-cadherin, vimentin, and expression of classical breast cancer receptors: HER2, ER and PgR in PT and corresponding LNM. The results were correlated with clinicopathological data and patients outcomes.

Methods: Formalin-fixed paraffin-embedded samples from PT and matched LNM from 42 stage II-III breast cancer patients were examined. Expression of TWIST1, SNAIL and SLUG was measured by reverse-transcription quantitative PCR. Protein expression was examined by immunohistochemistry on tissue microarrays. Kaplan-Meier curves for disease-free survival (DFS) and overall survival (OS) were compared using F-Cox test. Hazard ratios (HRs) with 95% confidence intervals (95% CI) were computed using Cox regression analysis.

Results: On average, mRNA expression of TWIST1, SNAIL and SLUG was significantly higher in LNM compared to PT (P < 0.00001 for all). Gene and protein levels of TWIST1, SNAIL and SLUG were highly discordant between PT and matched LNM. Increased mRNA expression of TWIST1 and SNAIL in LNM was associated with shorter OS (P = 0.04 and P = 0.02, respectively) and DFS (P = 0.02 and P = 0.01, respectively), whereas their expression in PT had no prognostic impact. Negative-to-positive switch of SNAIL protein correlated with decreased OS and DFS (HR = 4.6; 1.1-18.7; P = 0.03 and HR = 3.8; 1.0-48.7; P = 0.05, respectively).

Conclusions: LNM are enriched in cells with more aggressive phenotype, marked by elevated levels of EMT regulators. High expression of TWIST1 and SNAIL in LNM, as well as negative-to-positive conversion of SNAIL confer worse prognosis, confirming the correlation of EMT with aggressive disease behavior. Thus, molecular profiling of LNM may be used as surrogate marker for aggressiveness and metastatic potential of PT.
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http://dx.doi.org/10.1186/1479-5876-10-226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3524044PMC
November 2012

Paraesophageal hernia repair followed by cardiac tamponade caused by ProTacks.

Ann Thorac Surg 2012 Oct;94(4):e87-9

Department of Oncological Surgery, Academic Clinical Center, Medical University of Gdansk, Gdansk, Poland.

We describe a case of cardiac tamponade caused by ProTacks Autosuture used for mesh fixation during a laparoscopic Nissen operation with giant paraesophageal hernia repair. Perforations of the posterior descendent artery and epicardial vein of the right ventricle were caused by ProTacks used for Parietex Composite Mesh fixation. Protruding ProTacks were secured from inside the pericardiac sac with a synthetic vascular patch during emergency sternotomy. Quick and multidisciplinary cooperation ended with emergency cardiothoracic procedure saving the patient's life and preventing further damage to the heart muscle and its vessels.
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http://dx.doi.org/10.1016/j.athoracsur.2012.03.107DOI Listing
October 2012

Prognostic significance of TOP2A gene dosage in HER-2-negative breast cancer.

Oncologist 2012 7;17(10):1246-55. Epub 2012 Aug 7.

Laboratory of Cell Biology, Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Dêbinki 1, 80-211 Gdańsk, Poland.

Background: Previous studies showed the prognostic and predictive impact of human epidermal growth factor receptor 2 (HER-2) gene alterations analyzed separately and jointly with topoisomerase II α (TOP2A) gene alterations; however, the role of TOP2A gene abnormalities alone has not been thoroughly investigated. Additionally, TOP2A aberrations were typically studied in HER-2-positive (HER-2(+)) tumors because these genes are frequently coamplified. Therefore, the knowledge concerning the impact of TOP2A abnormalities in HER-2-negative (HER-2(-)) patients is scarce. This study aimed to investigate the clinical significance of TOP2A anomalies in breast cancer patients with HER-2(-) and HER-2(+) tumors.

Materials And Methods: Snap-frozen tumor samples from 322 consecutive stage I-III breast cancer patients were analyzed for TOP2A gene dosage using quantitative real-time PCR (qPCR).

Results: A high TOP2A gene dosage was found in 94 tumors (29%)-32% and 27% of HER-2(+) and HER-2(-) tumors, respectively. The mean TOP2A gene dosages in the HER-2(+) and HER-2(-) groups were 1.49 ± 1.03 and 1.09 ± 0.35, respectively. High TOP2A gene dosage had an inverse prognostic impact in terms of shorter disease-free survival (DFS) and overall survival (OS) times in the entire group and in both the HER-2(-) and HER-2(+) subgroups. The unfavorable prognostic impact of TOP2A gene dosage was maintained in the multivariate Cox regression analysis in the entire group and in HER-2(-) patients.

Conclusions: A high gene dosage of TOP2A determined using qPCR occurs frequently both in HER-2(+) and HER-2(-) tumors and has a strong adverse prognostic impact.
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http://dx.doi.org/10.1634/theoncologist.2012-0023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481890PMC
June 2013

A randomized, double-blind, placebo-controlled trial of preemptive analgesia with bupivacaine in patients undergoing mastectomy for carcinoma of the breast.

Med Sci Monit 2011 Oct;17(10):CR589-97

Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland.

Background: In this prospective, randomized, placebo-controlled, double-blinded clinical trial we tested the hypothesis that preemptive analgesia with bupivacaine applied in the area of the surgical incision in patients undergoing mastectomy for breast cancer would reduce post-operative acute pain and would reduce the amount of analgesics used during surgery and in the post-operative period.

Material/methods: Participants were assigned into 1 of 2 groups--with bupivacaine applied in the area of surgical incision or with placebo. We assessed the intraoperative consumption of fentanyl, the postoperative consumption of morphine delivered using a PCA method, and the subjective pain intensity according to VAS score reported by patients in the early post-operative period.

Results: Out of 121 consecutive cases qualified for mastectomy, 112 women were allocated randomly to 1 of 2 groups--group A (bupivacaine) and group B (placebo). The final study group comprised 106 breast cancer cases. Between the groups, a statistically significant difference was observed with respect to: lower fentanyl consumption during surgery (p = 0.011), lower morphine (delivered by means of a PCA) consumption between the 4-12th postoperative hours (p = 0.02) and significantly lower pain intensity assessed according to VAS score at the 4th and 12th hours after surgery (p = 0.004 and p = 0.02 respectively) for the group A patients.

Conclusions: Preemptive analgesia application in the form of infiltration of the area of planned surgical incisions with bupivacaine in breast cancer patients undergoing mastectomy decreases post-operative pain sensation, limits the amount of fentanyl used during surgery, and reduces the demand for opiates in the hours soon after surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539479PMC
http://dx.doi.org/10.12659/msm.881986DOI Listing
October 2011

Prognostic relevance of demographics and surgical practice for patients with gastric cancer in two centers: in Poland versus Germany.

Gastric Cancer 2011 Aug 26;14(3):234-41. Epub 2011 Mar 26.

Department of Surgical Oncology, Medical University of Gdansk, Gdańsk, Poland.

Background: Although studies comparing the surgical treatment of gastric carcinoma in Japan and Western industrialized countries have revealed differing survival rates, no studies to date have been performed comparing Western and Eastern Europe. This study aimed to compare demographics and surgical practice as well as the related prognostic impact on gastric cancer patients treated in Poland and Germany.

Methods: This retrospective study included gastric cancer patients treated between 1999 and 2004 by surgical departments in Gdansk (Poland) and Cologne (Germany). Univariate and multivariate analyses of demographic, histopathological, surgical, and prognostic data were performed.

Results: Included were 117 patients from Gdansk and 130 patients from Cologne. The Cologne patients showed higher incidence rates of serious comorbidity, pT1 cancer, and distant metastasis than those from Gdansk. Indications for and frequency of selected surgical procedures differed significantly. D2-lymphadenectomy was performed in 89% of the Cologne patients, while D1-lymphadenectomy was done for 85% of the Gdansk patients. Univariate analysis yielded a 5-year survival rate of 28.3% for the Gdansk patients, and 40.3% for the Cologne patients (p = 0.056). Independent prognostic factors were pT category (p = 0.002), pN category (p < 0.001), pM category (p = 0.027), residual tumor (R) category (p = 0.004), age (p = 0.012), and number of resected lymph nodes (p = 0.005).

Conclusions: Significant differences of clinical and surgical parameters exist between gastric cancer patients treated in Poland and Germany. In addition to established independent prognostic factors, we found that survival improved with each additionally resected lymph node.
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http://dx.doi.org/10.1007/s10120-011-0036-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159739PMC
August 2011

A new method for using a silicone rod for permanent nipple projection after breast reconstruction procedures.

Breast 2011 Apr 5;20(2):124-8. Epub 2010 Nov 5.

Department of Plastic Surgery, Medical University of Gdansk, Debinki Str 7, 80-211 Gdansk, Poland.

Nipple-areola complex (NAC) is a unique part of the human body. Not only is it a functional structure, but it plays an aesthetic role as well. It offers the final touch to the convex shape of the breast. Its lack frequently leads to depression in patients. This paper describes the method used by the authors for reconstructing nipple mound projection in patients following an autologous breast reconstruction procedure. To reconstruct the nipple mound an adapted local C-V flap technique described by Losken was used, with a silicone rod to support the nipple. The new method is based on simple preparation of flaps, fixing the silicone rod at the nipple bottom and below the top, it is quick and efficient in terms of time and materials used. The procedure was conducted in 30 patients: 10 cases following LDf reconstruction and Becker prosthesis or expander prosthesis, 20 cases following body tissue reconstruction with TRAM flap (Transverse Rectus Abdominis Musculocutaneous flap). All the patients who had undergone the LDf procedure developed flap necrosis followed by rod removal. In the patients who had undergone TRAM flap reconstruction no necrosis or wound split was observed, healing progressed without complications. In this group durable nipple projection was achieved. The new method for reconstructing nipple projection may be applied both in simultaneous and staged procedures, only in patients who have undergone autologous breast reconstruction procedure.
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http://dx.doi.org/10.1016/j.breast.2010.10.001DOI Listing
April 2011

Gastric cancer in Poland - clinical characteristics and results of surgery.

Dig Surg 2010 15;27(5):409-16. Epub 2010 Oct 15.

Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland.

Aims: The aim of the study was to assess the long-term outcomes of the surgical-only management of gastric cancer (GC) patients treated in a single centre over 10-year span preceding introduction of multimodal therapy to the clinical practice.

Methods: Two hundred and one patients with pathologic confirmation of GC treated for resectable tumor mostly with curative intent were enrolled in the study. The analysis comprised a review of the medical histories, descriptions of the operations, results of histopathological studies and long-time survival.

Results: Median survival time and 5-year survival rate for patients with R0 vs. R1 and R2 resection were 3.85 years and 43.5% versus 0.86 years and 7.8%, respectively. Univariate analyses showed that 5-year survival rates were correlated with histopathological type according to Laurén, type of lymphadenectomy performed, spleen preservation, stage of disease and the degree of radical resection. Independent prognostic factors in multivariate analysis were: no residual tumor after resection, type of lymphadenectomy, depth of tumor invasion in the gastric wall and lymph nodes status.

Conclusions: Retrospective analysis of the long-term results of the surgical-only management of GC patients may be useful in assessment of the quality of medical services, especially prior to introduction of multimodal therapy.
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http://dx.doi.org/10.1159/000319324DOI Listing
March 2011

Flow cytometric sorting and analysis of human epidermal stem cell candidates.

Cell Biol Int 2010 Sep;34(9):911-5

Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Debinki 1, 80211 Gdansk, Poland.

ESC (epidermal stem cells) play a central role in the regeneration of human epidermis. These cells are also responsible for wound healing and neoplasm formation. Efficient isolation of ESC allows their use in medicine and pharmacy as well as in basic science. Cultured keratinocytes and ESC may be used as biological dressing in burn injuries, chronic wounds and hereditary disorders. Therefore, the isolation and characterization of ESC have been goals in biomedical science. Here, we present a flow cytometric method for the isolation and analysis of human ESC candidates. The strategy presented for the isolation of ESC combines previously proposed enzymatic digestion and FACS-sorting of the obtained cell suspension that utilizes morphological features, integrin-beta1 expression and Rh123 (Rhodamine 123) accumulation of the cells. We also performed a flow cytometric analysis of sorted cells using a cell tracer.
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http://dx.doi.org/10.1042/CBI20100223DOI Listing
September 2010

Clinical evaluation of developed PCR-based method with hydrolysis probes for TOP2A copy number evaluation in breast cancer samples.

Clin Biochem 2010 Jul 2;43(10-11):891-8. Epub 2010 May 2.

Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland.

Objectives: The objective of this study was to develop a new real time PCR-based method for quantitative detection of topoisomerase II alpha (TOP2A) aberrations and to evaluate its clinical utility in breast cancer.

Design And Methods: The method applied dually labelled hydrolysis probes and Pfaffl quantification method. The study group consisted of 83 consecutive breast cancer patients.

Results: In the examined tumour samples median TOP2A gene dosage was 1.08 (range 0.34-7.55). TOP2A amplifications were found in 12 tumours (14.5%), no deletion was detected. Statistically significant positive correlation of TOP2A gene dosage with nodal status, tumour grade, and HER2 protein status was found. TOP2A status also correlated with disease free survival.

Conclusions: The newly developed real time PCR assay showed to be fast and easy to perform. Determined by the method TOP2A gene dosage was shown to be a potent prognostic factor in breast cancer.
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http://dx.doi.org/10.1016/j.clinbiochem.2010.04.060DOI Listing
July 2010

Simultaneous surgery for critical aortic stenosis and gastric cancer: a case report.

World J Gastroenterol 2010 Mar;16(9):1161-4

Department of Surgical Oncology, Medical University of Gdansk, Debinki 7, Gdansk 80-952, Poland.

We describe simultaneous surgery performed on a 71-year-old woman with critical aortic stenosis and gastric cancer that were diagnosed at the same time. The patient qualified for simultaneous surgery for both these diseases. Good early outcome was achieved. There is a lack of standards for treatment of patients with coexistence of two life-threatening conditions. We discuss surgical tactics and potential benefits of such management.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835797PMC
http://dx.doi.org/10.3748/wjg.v16.i9.1161DOI Listing
March 2010