Functional innervation of the isolated bowel segment

PURPOSE

The aim of this study is to investigate whether there might be an eventual change in the enteric nerve responses to electrical field stimulation (EFS) of the isolated bowel segment (IBS) created by omentoenteropexy.

METHODS

In the experimental group, an IBS was created in 10 rats using the omentum as the host organ by dividing of its mesentery 4 weeks later. In the control group, a jejunal loop of identical site and length to the IBS was studied in another 10 rats as normal jejunal segment. Longitudinal muscle strips were prepared from the IBSs (n 20) and the normal jejunal segments (n = 20). The effects of atropine, tetrodotoxin, L-arginine, and L-nitroarginine methyl ester (L-NAME) on the responses to transmural EFS were examined in both the IBS and normal jejunal segment using the isometric tension recording technique.

RESULTS

Transmural EFS of the IBS strips produced contractile responses. Atropine and tetrodotoxin abolished the EFS-induced contractions of the IBS. Moreover, EFS-induced contractions were increased by the application of L-NAME, and were decreased by the application of L-arginine in the IBS. Mean percent change of IBS's contraction was not found statistically different from mean percent change of normal jejunal segment's contraction on the effects of L-NAME and L-arginine.

CONCLUSION

These results suggest that the IBS, created by omentoenteropexy, produced enteric nerve responses to EFS as seen as in normal jejunal segment.

Interobserver reproducibility of the Lagios nuclear grading system for ductal carcinoma in situ

Several studies have shown an association between high nuclear grade or necrosis of ductal carcinoma in situ (DCIS) lesions and the risk of local disease recurrence in patients with DCIS treated surgically with less than mastectomy. Although criteria for separating low from high nuclear grade lesions have been published, no information exists regarding interobserver reproducibility (IR). To assess IR in the classification of DCIS, six surgical pathologists from four institutions used the Lagios grading system to grade 125 DCIS lesions. Before meeting to evaluate the cases, a training set of 12 glass slides, including cases chosen to present conflicting cues for classification, was mailed to the participants with a written criteria summary. This was followed by a working session in which criteria were reviewed and agreed on. The pathologists then graded the lesions independently. The area of interest was marked on each slide before grading. After initial grading, the pathologists met again to resolve discrepant lesion classifications. A complete agreement among raters was achieved in 43 (35%) cases, with five of six raters agreeing in another 45 (36%) cases. In no case did two raters differ by more than one grade. The pairwise kappa agreement values ranged from fair to substantial (0.30 to 0.61). Generalized kappa value indicated moderate agreement (0.46, standard error = 0.02). Kappa statistics for the distinction between grades 1 and 2 and 2 and 3 were 0.29 and 0.48, respectively, (standard error = 0.02). Only one of the six raters differed significantly in scoring. With adherence to specific criteria, IR in the classification of DCIS cases can be obtained in most cases. Although these pathologists made a few grading system modifications, further refinements are needed, especially if grading will influence future therapy.

Comparison of grading systems for estimating the prognosis of renal cell carcinoma

In this study histologic slides of 165 patients who were diagnosed as RCC between 1983 and 1993 were re-evaluated and each tumour was graded according to Thoenes, Fuhrman, Arner and Skinner's grading systems. According to Thoenes' system, patients with grade (G) 2 and 3 tumours had significantly shorter survival compared to patients with G 1 tumours. The survival difference between the subgroups of Fuhrman and Skinner's grading systems did not reach statistical significance. When the histologic differentiation was grouped as low grade (G 1&2) and high grade (G 3&4) tumours in Fuhrman and Skinner's systems, a statistically significant difference was noted between the groups in terms of survival.

Tracheobronchial foreign body aspirations in childhood: a 10-year experience

OBJECTIVE

Tracheobronchial foreign body aspirations comprise the majority of accidental deaths in childhood. Diagnostic delay may cause an increase in mortality and morbidity in cases without acute respiratory failure. We report our diagnostic and therapeutic modalities.

METHODS

In our department, bronchoscopy was performed on 548 patients with the diagnosis of tracheobronchial foreign body aspirations (from 1987 to 1997). Of these cases, 55.6% were male and 44.4% female. Their ages ranged from 2 months to 16 years (average 5.5 years). Diagnosis was made on history, physical examination, radiological methods and bronchoscopy.

RESULTS

Foreign bodies were localized in the right bronchial tree in 312 cases (56.9%), the left in 126 cases (23.0%) and in the trachea in 62 cases ( 1.3%). Foreign body was not found during bronchoscopy in 48 cases (8.7%). The majority of the foreign bodies were vegetable matters. Foreign bodies were removed with bronchoscopy in all but two cases which underwent limited thoracotomy. In the late period, pulmonary resection was performed in five cases because of irreversible complications. After bronchoscopy, hypoxia developed in four patients, requiring mechanical ventilation. Pneumothorax developed in two cases and mediastinal emphysema in two. Four patients (0.7%) died because of respiratory failure.

CONCLUSION

Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory.

Tumour amplified kinase STK15/BTAK induces centrosome amplification, aneuploidy and transformation

The centrosomes are thought to maintain genomic stability through the establishment of bipolar spindles during cell division, ensuring equal segregation of replicated chromosomes to two daughter cells. Deregulated duplication and distribution of centrosomes have been implicated in chromosome segregation abnormalities, leading to aneuploidy seen in many cancer cell types. Here, we report that STK15 (also known as BTAK and aurora2), encoding a centrosome-associated kinase, is amplified and overexpressed in multiple human tumour cell types, and is involved in the induction of centrosome duplication-distribution abnormalities and aneuploidy in mammalian cells. STK15 amplification has been previously detected in breast tumour cell lines and in colon tumours; here, we report its amplification in approximately 12% of primary breast tumours, as well as in breast, ovarian, colon, prostate, neuroblastoma and cervical cancer cell lines. Additionally, high expression of STK15 mRNA was detected in tumour cell lines without evidence of gene amplification. Ectopic expression of STK15 in mouse NIH 3T3 cells led to the appearance of abnormal centrosome number (amplification) and transformation in vitro. Finally, overexpression of STK15 in near diploid human breast epithelial cells revealed similar centrosome abnormality, as well as induction of aneuploidy. These findings suggest that STK15 is a critical kinase-encoding gene, whose overexpression leads to centrosome amplification, chromosomal instability and transformation in mammalian cells.

The in vitro bactericidal effect of microwave energy on bacteria that cause prostatitis

OBJECTIVES

We investigated the in vitro nonthermal effects of microwaves delivered from Prostatron 2.0 on Escherichia coli and Enterobacter cloacae.

METHODS

The fingers of powder-free, sterile gloves were ligated, and bacterial solutions were transferred into the remaining area of the glove. The gloves were then sealed using silk ligatures. One set of gloves was subjected to the microwave treatment while another set was placed in a temperature-matched waterbath to act as control samples. The gloves containing the treatment group were taped around the probe, at the site where microwave energy exits the probe. During the treatment period, the temperatures from the urethral probe and the rectal probe were carefully monitored.

RESULTS

The mean (+/-SD) energy delivered was 46.6 +/- 9.5 kJ (range 30.0 to 59.5) for the 10 trials on E. coli and colony counts in the experimental microwaved gloves decreased significantly compared with control samples (5.26 +/- 4.5 x 10(5) versus 10.16 +/- 9.3 x 10(5) CFU/mL, P = 0.02). For the experiments on E. cloacae the mean (+/-SD) energy applied was 38.5 +/- 12.5 kJ, and a significant decrease in colony counts of microwaved samples was also observed compared with controls (11.04 +/- 4.8 x 10(5) versus 20.08 +/- 10.1 x 10(5) CFU/mL, P = 0.004).

CONCLUSIONS

Microwave energy, delivered from Prostatron 2.0, independent of heat production has an in vitro bactericidal effect on laboratory-cultured E. coli and E. cloacae.

Nonseparable two-dimensional fractional fourier transform

Previous generalizations of the fractional Fourier transform to two dimensions assumed separable kernels. We present a nonseparable definition for the two-dimensional fractional Fourier transform that includes the separable definition as a special case. Its digital and optical implementations are presented. The usefulness of the nonseparable transform is justified with an image-restoration example.

Proliferative and cytokine responses to class II HER-2/neu-associated peptides in breast cancer patients

Previous studies have characterized the reactivity of CD8+ CTLs with ovarian and breast cancer. There is little information about the antigens and epitopes recognized by CD4+ T cells in these patients. In this study, we analyzed the ability of T cells from peripheral blood mononuclear cells of breast cancer patients to recognize HER-2/neu (HER-2) peptides. We found that 13 of 18 patients responded by proliferation to at least one of the HER-2 peptides tested. Of these peptides, one designated G89 (HER-2: 777-789) was recognized by T cells from 10 patients. Seven of nine responding patients were HLA-DR4+, suggesting that this peptide is recognized preferentially in association with HLA-DR4. Analysis of the specificity and restriction of the cytokine responses to G89 by G89-stimulated T cells revealed that these cells secreted significantly higher levels of IFN-gamma than interleukin 4 and interleukin 10, suggesting priming for a Th0-T helper 1 response. The same pattern of cytokine responses was observed to the intracellular domain of HER-2 protein, suggesting that G89-stimulated T cells recognized epitopes of the HER-2 protein in association with HLA-DR4. Because HLA-DR4 is present in 25% of humans, characterization of MHC class II-restricted epitopes inducing Th0-T helper 1 responses may provide a basis for the development of multivalent HER-2-based vaccines against breast and ovarian cancer.

Psychosocial adjustment after testicular cancer treatment

PURPOSE

The high cure rate in testicular cancer has provoked investigations relating to the quality of life in long-term survivors. We determine the psychosocial consequences of the disease especially in regard to sexual and professional performance.

MATERIALS AND METHODS

Among the testicular cancer patients treated with various treatment modalities 140 rendered free of disease for at least a year were included in this study. General Health Questionnaire 28 and a general survey were used to determine quality of life issues.

RESULTS

Regarding the sexual life of these patients, problems related to libido, erection and ejaculation increased significantly during treatment and subsequently recovered but did not return to baseline after treatment. During treatment the frequency of sexual intercourse and/or masturbation decreased significantly in all patients. Of the single patients 35% thought that medical history would be a concern for the potential spouse. Regarding professional lives, 22.4% thought that they had better performance after treatment compared to before therapy, whereas only 6.1% reported it to be worse. When professional performance was analyzed according to the treatment modalities those who had received radiotherapy did worse. General Health Questionnaire scores indicated that patients with this disease had a positive view of life compared to that of the normal population.

CONCLUSIONS

Although we observed a substantial recovery in sexual life after treatment, it was evident that therapy did have a negative effect on sexual functions. There was no effect on occupational performance and perspective of life, which may be related to the fact of having overcome a life threatening disease.

The effect of Ginkgo biloba on the activity of catalase and lipid peroxidation in experimental strangulation ileus

This study was designed to assess the therapeutic effect of Ginkgo biloba extract (EGb 761) in experimental strangulation ileus. Rats were divided into control (n = 7), placebo (n = 11), and EGb-treated (n = 11) groups. No surgical procedure was carried out on the control group. Strangulation ileus was produced in the placebo and EGb groups for 2.5 h. At the end of this period, 100 mg/kg EGb in 1 ml of saline was injected intraperitoneally to the EGb-treated group. In the placebo group, animals received an equivalent amount of saline intraperitoneally; 24 h later, repeat laparotomies were performed to take blood and intestinal tissue samples. The EGb treatment decreased tissue malondialdehyde levels and increased catalase activities compared with the placebo group (P < 0.05 for both). Serum creatine kinase and phosphorus levels were also determined in all groups. In the placebo group these were significantly higher than in the control group (P < 0.01 and P < 0.05, respectively). In the EGb group these were not different from controls and the increase in creatine kinase activity in the EGb group was not as high as in the placebo group (P < 0.05). Our results suggest that EGb could be preventive against the effects of strangulation ileus in a rat model.

Cerebral aneurysm surgery in a patient with phaeochromocytoma

This case report describes the peri-operative management of a 48-year-old woman with three cerebral aneurysms and phaeochromocytoma. The pharmacological and anaesthetic management of such patients is complex, and needs to be managed carefully by titrating anaesthetic agents and vasoactive drugs. The primary concern is the maintenance of cerebral perfusion pressure and autoregulation throughout the procedure, although these states cannot be monitored directly. The patient survived the operation neurologically intact, and it is presumed that the course of management which was chosen helped to achieve this result.

Optical implementations of two-dimensional fractional fourier transforms and linear canonical transforms with arbitrary parameters

We provide a general treatment of optical two-dimensional fractional Fourier transforming systems. We not only allow the fractional Fourier transform orders to be specified independently for the two dimensions but also allow the input and output scale parameters and the residual spherical phase factors to be controlled. We further discuss systems that do not allow all these parameters to be controlled at the same time but are simpler and employ a fewer number of lenses. The variety of systems discussed and the design equations provided should be useful in practical applications for which an optical fractional Fourier transforming stage is to be employed.

Can a hydrophilic guidewire be resterilized?

The Glidewire (Microvasive, Natick, MA) or Terumo wire (Terumo, Japan) is constructed with a hydrophilic polymer surface that enables easier passage through narrowed lumens in the urinary tract. This study examined the effects of gas sterilization on Glidewire surface structure, slipperiness, and ability to support bacterial growth. Light microscopy at 100x and 400x and scanning electron microscopy at 100 to 1300x were used to compare the surface tips of five new 0.038-inch Glidewires with those resterilized one or three times. The tips were immersed in water prior to standard gas sterilization for operating room equipment. Subjective evaluation of slipperiness involved asking 10 blinded urologists to assess the nature of new and resterilized wires by feel. Support of bacterial growth was assessed by comparing cultures performed on new wires (control) with those of wires incubated with Bacillus stearothermophilus. Microscopy, reviewed by a pathologist, revealed no perceivable surface differences after one and three gas sterilizations. Eight of the urologists noted similar or improved slipperiness of resterilized wires compared with new wires. Bacterial cultures of intentionally infected wire segments showed no growth after standard gas sterilization in all cases. In this study, gas sterilization did not adversely affect the lubricious nature or the surface coating of the hydrophilic coating of Glidewires. Also, gas resterilization was bactericidal to new and used wires that had been infected with a heat-tolerant organism.

Expression of leukemia inhibitory factor and its receptor in breast cancer: a potential autocrine and paracrine growth regulatory mechanism

Leukemia inhibitory factor (LIF) is a pluripotent cytokine which has a diverse array of effects on hematopoietic and epithelial cells. Depending on the nature of the target cells, these effects can be growth-stimulatory or growth-inhibitory. Receptors for leukemia inhibitory factor (LIFR) have been identified on a variety of hematopoietic and epithelial cells. We have recently demonstrated in vitro growth stimulation of human breast cancer cells, both primary tumors and cultured cell lines, by LIF. To begin to understand the in vivo relevance of these observations, we investigated the expression of LIF and LIFR in human breast cancer specimens. Specimens from 50 cases were immunostained with mouse monoclonal antibodies D62.3 and M1 (to stain for LIF and LIFR, respectively). LIF expression was observed in 78% of the specimens and correlated with favorable biological features, i.e. low S-phase fraction (SPF) (P = 0.001) and diploidy (P = 0.08). LIFR expression was observed in 80% of the tumors and correlated with the presence of estrogen receptor (ER) (P = 0.04) and diploidy (P = 0.07). Coexpression of LIF and LIFR was associated with diploidy (P = 0.02) and low SPF (P = 0.05). LIF staining was primarily cytoplasmic whereas LIFR staining was cytoplasmic in the majority of cases and membranous in a minority of cases. The presence of LIFR in the primary tumor specimens correlated with the growth stimulation of tumor cells (derived from the same specimens) by exogenous LIF in methylcellulose colony assays. The findings support a widespread but probably complex role for LIF and LIFR in breast tumor growth regulation which should be investigated in greater detail in larger cohorts of tumors.

The effect of metabolic acidosis on serum apolipoprotein A I and apolipoprotein B levels in children with chronic renal failure

In this report serum apolipoprotein A I (Apo A I) and apolipoprotein B (Apo B) levels were determined in children with chronic renal disease (CRD) during metabolic acidosis, after the correction of metabolic acidosis and in healthy children to look for the effect of metabolic acidosis on Apo A I and B levels. It was found that Apo A I levels were significantly decreased during metabolic acidosis (p < 0.05) but Apo A I/Apo B ratios were not affected before and after the correction of acidosis in the CRD group (p > 0.05) although it was significantly different from those in the controls (p < 0.01).

[Sudden death of Alpine cattle in the canton Graubünden]

The aetiology of sudden deaths of cattle in the Kanton Graubünden has been elucidated by a multi-disciplinary approach. Certain small rivers and ponds located in the affected Alpine pastures in the areas of Misox, Rheinwald and Engadin provide favourable habitats for the growth of hepatotoxic cyanobacteria, particularly during long periods of hot and dry weather. As cattle frequently take up water from these sources, the toxins produced by cyanobacteria may lead to lethal poisonings that are typically associated with hemorrhagic liver necrosis. The latest reported case of cyanobacteria poisoning of Alpine cattle occurred during the summer of 1996. Further animal losses may be avoided by the implementation of appropriate pasture management schemes. To identify sites of potential hazards to human or animal health, we have developed a sensitive screening assay for the detection of cyanobacteria hepatotoxins in algae and water samples.

The prognostic significance of sialyl-Tn antigen in women treated with breast carcinoma treated with adjuvant chemotherapy

BACKGROUND

Sialyl-Tn (STn) represents an aberrantly glycosylated mucin epitope that is expressed in breast carcinoma and other adenocarcinomas and is an important factor in the development of novel immunotherapeutic approaches. The primary aim of the current study was to investigate the influence of STn expression on the prognoses of patients with breast carcinoma.

METHODS

A cohort of 207 women diagnosed with invasive breast carcinoma who were treated with anthracycline-containing adjuvant chemotherapy and were enrolled in a randomized clinical trial were studied. Expression of STn was determined by an immunohistochemical procedure in which the B72.3 monoclonal antibody was used. Kaplan-Meier and Cox proportional regression survival analyses were used to compare low STn and high STn patients.

RESULTS

Forty-eight (23%) of the 207 specimens demonstrated high STn staining (>25% cells were immunoreactive). During a median follow-up of 5 years, high STn patients had worse disease free survival than low STn patients (55% vs. 74%, respectively; P = 0.03). High STn expression was significantly associated with age (P = 0.04) but not with other conventional prognostic markers. In multivariate analysis using the Cox regression model, high STn emerged as an independent prognostic indicator for disease free survival (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.09-3.73) and for overall survival (HR, 2.16; 95% CI, 0.95-4.92).

CONCLUSIONS

The results of this study suggest that STn may be a valuable marker for identifying women at high risk of developing recurrent breast carcinoma who may be candidates for trials investigating new therapies in combination with standard adjuvant therapy.

Unusually located hydatid cysts: intrathoracic but extrapulmonary

BACKGROUND

Hydatid cyst disease is still a problem in Turkey, as well as in many other places in the world. Extrapulmonary location of the disease in the thorax is very rare, and surgical procedures can be considered that differ from those used for pulmonary hydatid cysts.

METHODS

We reviewed retrospectively our experience in the surgical treatment of 22 patients with intrathoracic, extrapulmonary hydatid cysts. In our department, 297 patients with thoracic hydatid cysts were managed surgically in the last 14 years, in 22 (7.4%) of whom the cysts were localized extrapulmonarily in the thorax. The locations of these hydatid cysts were a fissure, the pleural cavity, chest wall, mediastinum, myocardium, and diaphragm.

RESULTS

Total resection was chosen as the surgical procedure in all patients except 4 (18.2%), 1 of whom had cystectomy and capitonnage for cardiac hydatid cyst and 3 of whom had cystectomy and local curettage for cysts located in the chest wall. Empyema developed postoperatively in 1 case (4.5%) with a cyst in the fissure. The follow-up period was 1 year, and there were no deaths.

CONCLUSIONS

Hydatid cyst may be found in many different sites, including extrapulmonarily in the thorax, and bearing this in mind will facilitate planning of the operation.

Intraluminal crystalloids in breast carcinoma. Immunohistochemical, ultrastructural, and energy-dispersive x-ray element analysis in four cases

OBJECTIVE

Intraluminal crystalloids have been described in the prostate, salivary gland, and ovary, but have not yet been reported in the breast. We report four cases of breast carcinoma in which these crystalloids were found in ducts with intraductal carcinoma or atypical hyperplasia. The presence of intraluminal crystalloids may be a useful adjunct in making a diagnosis of carcinoma or may be a feature to look for as a marker for the presence of carcinoma.

DESIGN

Four cases of breast carcinoma containing intraluminal crystalloids were identified among 6900 surgical breast specimens between January 1990 and June 1995 at M. D. Anderson Cancer Center, Houston, Tex. Those sections with crystalloids identified by hematoxylin-eosin stain were stained with periodic acid-Schiff, Alcian blue, and mucicarmine stains. Immunohistochemical and ultrastructural studies and energy-dispersive x-ray analysis were also performed on these sections.

RESULTS

The intraluminal crystalloids were eosinophilic, varied in shape and size, and did not exhibit birefringence under polarized light. Immunohistochemically, the crystalloids were negative for keratin, muscle-specific actin, and kappa and lambda light chains, but the surfaces stained positively for epithelial membrane antigen. By electron microscopy, the crystalloids had no limiting membrane and were composed of an electron-dense material with no discernible periodicity. By energy-dispersive x-ray element analysis, the crystalloids had no mineral content; however, sulfur was found, indicating a protein content.

CONCLUSIONS

The pathogenesis and constituents of these intraluminal crystalloids remain to be determined. Inasmuch as intraluminal crystalloids have not been found in normal ducts or acini, or in ductal hyperplasia without atypia, their presence may serve as a marker for breast carcinoma.

Dexamethasone and flumethasone residues in milk of intramuscularly dosed cows

A field study was performed to assess the level of drug residues in milk after therapeutic application of highly potent synthetic glucocorticoids. Dexamethasone was tested either as a crystalline suspension or as a combination of sodium phosphate and phenylpropionate esters. Intramuscular injection of these preparations in lactating dairy cows (60 micrograms dexamethasone/kg body wt) yielded drug residues in milk of up to 8.4 ng/mL 12 h after treatment. These dexamethasone residues fell to below 1.0 ng/mL within 3 days after treatment. Intramuscular injection of an aqueous flumethasone preparation (13.5 micrograms/kg body wt) produced drug residues in milk in the range of 0.7-1.2 ng/mL 12 h after treatment, whereas flumethasone was below the detection limit of 0.23 ng/mL 2 days after administration. These results indicate that toxicologically significant residues may arise transiently in the milk during the first 2-3 days after intramuscular injection of synthetic glucocorticoids. Urine from the same animals contained 5- to 50-fold higher glucocorticoid concentrations than the corresponding milk samples. Thus, urine analysis appears to be an effective method to monitor the use of synthetic glucocorticoids in food producing animals.