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SURVIVIN MRNA EXPRESSION PATTERN IN NON-SMALL-CELL LUNG CANCERS
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112 SURVIVIN MRNA EXPRESSION PATTERN IN NON-SMALL-CELL LUNG CANCERS Gerasimos Kapellos1, Aikaterini Polonyfi1, Periklis Tomos2, Helena Gogas1, Athanassios Aissopos1, Marina Mantzourani1. 1First Department of Internal Medicine National and Kapodistrian University of Athens Laikon Hospital Greece; 2 Second Department of Propaedeutic Surgery National and Kapodistrian University of Athens, Laikon Hospital Greece Background: Survivin an apoptosis inhibitor protein has multiple fuctions including apoptosis regulation and mitosis promotion, both processes that favor cancer survival. Its expression is low in most terminally differentiated adult tissues but at high levels during fetal development as well as in cancer. Taking in account that NSCLC even in early disease stages present micrometastatic cells in the bone marrow of resectable NSCLC patients and that the prognosis for those patients is poor compared to other operable tumors, it is essential to find biomarkers that could indicate the high-risk metastasize patients. In this study SURVIVIN expression pattern in NSCLC has been investigated. For this purpose SURVIVIN’s mRNA expression levels in NSCLC tissues biopsies were compared to normal ones. Methods: RNA were obtained from eleven operative samples, 6 NSCLC biopsies and 5 of the paired, histopathologically normal lung tissues from patients with written consent forms. For quantitative evaluation of survivin mRNA expression, hybridization PCR methods were used. Results: Survivin’s mRNA levels expression in lung tissues is: 1. Low detected in normal lung specimens (m.v. ± sem, sur/ abl=0,0883±0,0098) with no significant differences among the five lung biopsies, identifying the basal level of survivin mRNA 2. 12,8 times higher in NSCLC biopsies (m.v. ±sem, sur/abl=1,1337±0,11337 p=0,01005) compared to normal ones. Conclusion: The increased mRNA expression levels in tumor lung biopsies indicate SURVIVIN transcript as a possible biomarker of diagnosis and furthermore of prognosis as well as a useful tool of therapy strategy. CORONARY CALCIUM SCORE IN ASYMPTOMATIC PATIENTS WITH METABOLIC SYNDROME Stanciu Silviu1, Dumitrescu Silviu2, Muresan Mihai1, Iriciuc Magda1, Roul Gerald3. Military Universitary Hospital, 1Cardiology Army Centre; 1 Universitary Hospital of Strasbourg Background: The majority of patients with metabolic syndrome (MS) have a Framingham high risk score but there are a lot of patients with intermediate risk Framingham score. The aim of this study is to determine the amount of coronary calcium and distribution of the plaques in untreated metabolic syndrome patients with Framingham high risk score compared to a group of metabolic syndrome patients with intermediate Framingham risk score using 64-multislice detector computed tomography (MDCT). Methods: We prospectively included 53 untreated asymptomatic patients with high risk score (HRS) MS (male 69%, 54 ± 7 years, mean Framingham score 24) and 39 untreated asymptomatic patients with intermediate risk score (IRS) MS (male 59%, 56 ± 6 years, mean Framingham score 15). All patients underwent both MDCT calcium scoring and coronary angiography. Agatston score and coronary plaque burden were calculated. Results: There was no difference regarding calcium score and coronary plaque burden in patients with HRS-MS compared to patients with IRS-MS (Agatston= 47 vs 38). Moreover the prevalence of significant obstructive CAD was similar in both groups (22 % vs 21%). Conclusions: The patients with HRS-MS have the same anatomical coronary profile like patients with IRS-MS highlighting the problem of limited power of imaging risk score versus low predictability of the traditional risk prediction models in this population. The patients with MS represent a heterogenic group where the limit between high and intermediate risk score is flu. BETWEEN AUTOIMMUNITY AND MALIGNANCY: A CASE REPORT Filipe Perneta1, Denise Lopes2, Joana Pestana3, Margarida Fonseca4, Ernestina Santos5, Isabel Almeida6, Carlos A. Vasconcelos6. 1Internal Medicine Department, Hospital Central do Funchal, Madeira, Portugal; 2Internal Medicine Department, Hospital Pedro Hispano, Matosinhos, Portugal; 3Internal Medicina Department, Centro Hospitalar V. N. Gaia, V. N. Gaia, Portugal; 4Internal Medicine Department, Hospital de Braga, Braga, Portugal; 5Neurology Department, Hospital Geral de Santo António, Porto, Portugal; 6Clinical Immunology Unit, Internal Medicine Department, Hospital Geral de Santo António, Porto, Portugal
S105
Background: Immune system disorders present themselves as a myriad of diseases related to autoimmunity, hypersensitivity, immunodeficiency and cellular proliferation. Methods: Review of the clinical file of the patient, collecting data concerning past illnesses, laboratory and imaging studies and current health status. Results: The authors present the case of a 72-year old patient referred to our Internal Medicine Consultation with Raynaud’s phenomenon of recent onset (2 months) and inflammatory arthralgia involving the small joints of both hands. Past medical history included multinodular goiter with low T3 level (1996) and two non-Hodgkin lymphomas (NHL) of the colon in 1999 and MALT NHL of the tongue in 2002. Monoclonal gammopathy of undetermined significance was detected in 2000 with an increasing serum M-protein level, apparently unrelated to other diseases. In 2010 the patient developed a sensorimotor axonal polyneuropathy with concurrent EMG and sural nerve biopsy findings, and positive anti-ganglioside antibodies. POEMS syndrome was considered in the differential diagnosis due to the presence of a polyneuropathy, endocrinopathy, monoclonal gammopathy and skin changes (Raynaud). Discussion/Conclusion: It seems clear that this particular patient suffers from an immune system disorder, the nature and cause of which remain to be determined. Nonetheless, a POEMS syndrome seems to be surfacing and additional studies are required. MANAGING DELIRIUM IN THE TERMINALLY ILL Belen Garrido1, Manuel Castillo2, Susana Vicente1, Marcos Marrero2, Miguel A Benitez2, Pedro Laynez1. 1Hospital Universitario Ntra Sra de Candelaria, Internal Medicine; 2Hospital Universitario Ntra Sra de Candelaria, Palliative Care Background: Delirium is the most common neuropsychiatric complication experienced by patients with advanced illness, occurring in up to 85% of patients in the last weeks of life. Usually involves multiple causes, including infection, organ failure, and medication adverse effects. Most of the times these causes of delirium are not reversible in the dying patient, and this influences the outcomes of its management. Methods: We followed 163 consecutive patients with advanced cancer suffering delirium (according to DSM-IV criteria) admitted to our Hospital during 2010. Variables: gender, age, type of cancer, comorbility, prior cognitive status and psychopathology, involved causes (medication, metabolic, infections, organ failure), type of delirium, time to diagnosis and evolution, initial and final treatment, need of extra medication. Results: Median age 70 years, 60% male. Most frequent cancer was digestive (35%) followed by lung (25%). Median Charlson Index of 8. Prior cognitive decline in 35% and psychopathology in 25%. Delirium was hyperactive in 43% of patients. Median time to diagnose 1 day and total time 5 days. 80% of patients without identification of reversible causes. Initially treated with Haloperidol in 70% with median starting dose of 20 mg/24h and final of 30 mg/24h. In 80% of cases patients with hyperactive delirium precised extra medication (midazolam 70% of times). Conclusions: Delirium in terminally ill patients is associated in the majority of cases with a life prognosis of less than a week. It’s treatment requires high doses of neuroleptics and specially in hyperactive cases of the association of sedative medication. ANAPLASTIC THYROID CANCER: A RARE AND AGRESSIVE NEOPLASM Diana Santos Freitas, Adriana Rua, Francisco Rosa, Marina Alves, Luísa Pinto. Braga Hospital, Portugal Introduction: Anaplastic Thyroid Cancer (ATC) is an undifferentiated tumor of the thyroid follicular epithelium, representing 2.5% of all thyroid carcinomas. It affects older people compared with differentiated carcinomas with an average 65 years of age at diagnosis, more common in females. It is rapidly progressive with a poor therapeutic outcome. The majority are presented with cervical mass of rapid growth. Description: Female, 67 years old without a significant background, turn to ER for coughing up mucous, dyspnea for 15 days and weight loss of 10kg in 3 months. Physical examination: Good general condition and afebrile. Thyroid palpable, stony, painless, immobile, with no nodules individualized. Right cervical
S105
Background: Immune system disorders present themselves as a myriad of diseases related to autoimmunity, hypersensitivity, immunodeficiency and cellular proliferation. Methods: Review of the clinical file of the patient, collecting data concerning past illnesses, laboratory and imaging studies and current health status. Results: The authors present the case of a 72-year old patient referred to our Internal Medicine Consultation with Raynaud’s phenomenon of recent onset (2 months) and inflammatory arthralgia involving the small joints of both hands. Past medical history included multinodular goiter with low T3 level (1996) and two non-Hodgkin lymphomas (NHL) of the colon in 1999 and MALT NHL of the tongue in 2002. Monoclonal gammopathy of undetermined significance was detected in 2000 with an increasing serum M-protein level, apparently unrelated to other diseases. In 2010 the patient developed a sensorimotor axonal polyneuropathy with concurrent EMG and sural nerve biopsy findings, and positive anti-ganglioside antibodies. POEMS syndrome was considered in the differential diagnosis due to the presence of a polyneuropathy, endocrinopathy, monoclonal gammopathy and skin changes (Raynaud). Discussion/Conclusion: It seems clear that this particular patient suffers from an immune system disorder, the nature and cause of which remain to be determined. Nonetheless, a POEMS syndrome seems to be surfacing and additional studies are required. MANAGING DELIRIUM IN THE TERMINALLY ILL Belen Garrido1, Manuel Castillo2, Susana Vicente1, Marcos Marrero2, Miguel A Benitez2, Pedro Laynez1. 1Hospital Universitario Ntra Sra de Candelaria, Internal Medicine; 2Hospital Universitario Ntra Sra de Candelaria, Palliative Care Background: Delirium is the most common neuropsychiatric complication experienced by patients with advanced illness, occurring in up to 85% of patients in the last weeks of life. Usually involves multiple causes, including infection, organ failure, and medication adverse effects. Most of the times these causes of delirium are not reversible in the dying patient, and this influences the outcomes of its management. Methods: We followed 163 consecutive patients with advanced cancer suffering delirium (according to DSM-IV criteria) admitted to our Hospital during 2010. Variables: gender, age, type of cancer, comorbility, prior cognitive status and psychopathology, involved causes (medication, metabolic, infections, organ failure), type of delirium, time to diagnosis and evolution, initial and final treatment, need of extra medication. Results: Median age 70 years, 60% male. Most frequent cancer was digestive (35%) followed by lung (25%). Median Charlson Index of 8. Prior cognitive decline in 35% and psychopathology in 25%. Delirium was hyperactive in 43% of patients. Median time to diagnose 1 day and total time 5 days. 80% of patients without identification of reversible causes. Initially treated with Haloperidol in 70% with median starting dose of 20 mg/24h and final of 30 mg/24h. In 80% of cases patients with hyperactive delirium precised extra medication (midazolam 70% of times). Conclusions: Delirium in terminally ill patients is associated in the majority of cases with a life prognosis of less than a week. It’s treatment requires high doses of neuroleptics and specially in hyperactive cases of the association of sedative medication. ANAPLASTIC THYROID CANCER: A RARE AND AGRESSIVE NEOPLASM Diana Santos Freitas, Adriana Rua, Francisco Rosa, Marina Alves, Luísa Pinto. Braga Hospital, Portugal Introduction: Anaplastic Thyroid Cancer (ATC) is an undifferentiated tumor of the thyroid follicular epithelium, representing 2.5% of all thyroid carcinomas. It affects older people compared with differentiated carcinomas with an average 65 years of age at diagnosis, more common in females. It is rapidly progressive with a poor therapeutic outcome. The majority are presented with cervical mass of rapid growth. Description: Female, 67 years old without a significant background, turn to ER for coughing up mucous, dyspnea for 15 days and weight loss of 10kg in 3 months. Physical examination: Good general condition and afebrile. Thyroid palpable, stony, painless, immobile, with no nodules individualized. Right cervical