Post-transplant epididymitis and orchitis following Listeria monocytogenes septicaemia

We report the occurrence of epididymitis and orchitis 1 week after the onset of Listeriosis in an 11-month-old boy receiving an orthotopic liver transplantation for biliary atresia. Immunologic implications of Listeria monocytogenes-induced testicular inflammation are discussed, and the potential role of immunosuppression with tacrolimus is also discussed.

Modification of spatial and temporal gains of stimulated brillouin and raman scattering by polarization smoothing

Significant reductions of stimulated Brillouin (SBS) and Raman (SRS) scattering are measured by adding polarization smoothing (PS) to a random phase plate smoothed beam. The associated plasma waves, as measured by Thomson scattering, are spatially and temporally modified and reveal that the interplay between SBS and SRS has to be taken into account to understand the effect of the smoothing. The results also support the numerical simulations [S. Huller et al., Phys. Plasmas 5, 2706 (1998); R. Berger et al., Phys. Plasmas 6, 1043 (1999)] predicting a reduction of self-focusing with PS, resulting in a decrease of the maximum laser intensity and consequently of SBS and SRS gains.

[Surgical specialty department in the world wide web. Tribute to contemporary life style or information network?]

An increasing number of surgical departments is creating its own home-page in the World Wide Web (WWW). We investigated 184 presentations concerning their quality in content and technical realization. Our research revealed that most presentations regard patients as their main target group in order to meet the patients' demand for information and transparency. However, universities are especially concentrating on scientific development and neglecting the patients. Only a few presentations contain means for web-based training. In general, technical realization seems to be much better than the content itself. As patients tend to appear as customers who will choose the hospital they feel comfortable with, every clinical department that is a competitor should create a communication and information base for their customers. Thus, they will be able to keep in touch, present their treatment types and to enable patients to compare a multitude of surgical departments. The usefulness for colleagues or cooperating institutions must be improved. The WWW has become an important center of information in surgery.

Assessing the prevalence of hand osteoarthritis in epidemiological studies. The reliability of a radiological hand scale

OBJECTIVE

The hands are often involved in the osteoarthritic disease process. A radiological grading scale is presented, derived from a published atlas, to assess the prevalence of hand osteoarthritis (OA) involvement in clinical and epidemiological studies and its reproducibility is studied.

METHODS

This hand scale is based on the radiological feature "joint space narrowing", which represents the macromorphological process of cartilage loss. Osteophytes and sclerosis are less important unless seen in conjuction with joint space narrowing. Nine individual joints per hand (four proximal interphalangeal joints (PIP), four distal interphalangeal joints (DIP), first carpometacarpal joint (CMC-1)) are scored dichotomously for the presence of OA. To save time and to increase reliability a severity grading of radiological features is not performed. To determine inter-rater and intra-rater reliability of the individual joints and the presence of OA in two separate joint groups (>/= 2 PIP or DIP and at least one CMC-1, used to define "generalised OA" in the ongoing Ulm Osteoarthritis Study) 50 pairs of anteroposterior hand radiographs were read by two investigators twice within one month. The kappa coefficient was calculated to quantify the strength of associations.

RESULTS

On average five minutes were needed to score one hand radiograph. Both raters were able to reproduce their own readings in all individual joints and for the presence of OA in two separate joint groups after one month. Reliability was highest for the PIP joints (kappa: 0.56-1. 00) it was slightly lower for the DIP joints (0.38-0.87), for the CMC-1 joints (0.58-0.69) and for OA in two separate joint groups (0. 54). The values for inter-rater agreement were good as well, kappa coefficients ranged from 0.52 to 0.92.

CONCLUSION

This grading scale was shown to be reliable within and between readers for all the individual joints as well as for the presence of OA in two separate joint groups. Scoring a limited number of joints dichotomously makes this scale efficient and therefore useful for clinical and epidemiological trials, when dealing with large patient samples.

First observation of ion acoustic waves produced by the langmuir decay instability

Thomson scattering measurements are presented which demonstrate conclusively the occurrence of the Langmuir decay instability (LDI) in a laser-produced plasma experiment. Both products of the instability, the ion acoustic wave and the electron plasma wave, were simultaneously observed and identified with their spectral characteristics. The secondary decay of the LDI-generated electron plasma wave, into another Langmuir wave and an ion acoustic wave, has been observed for the first time. The connection with growth and saturation of the stimulated Raman instability is discussed.

Clustering of mutations associated with mild Marfan-like phenotypes in the 3' region of FBN1 suggests a potential genotype-phenotype correlation

Mutations in the gene for fibrillin-1 (FBN1) cause Marfan syndrome, a dominantly inherited disorder of connective tissue that primarily involves the cardiovascular, ocular, and skeletal systems. There is a remarkable degree of variability both within and between families with Marfan syndrome, and FBN1 mutations have also been found in a range of other related connective tissue disorders collectively termed type-1 fibrillinopathies. FBN1 mutations have been found in almost all of the 65 exons of the FBN1 gene and for the most part have been unique to one affected patient or family. Aside from the "hot spots" for the neonatal Marfan syndrome in exons 24-27 and 31-32, genotype-phenotype correlations have been slow to emerge. Here we present the results of temperature-gradient gel electrophoresis analysis of FBN1 exons 59-65. Six mutations were identified, only one of which had been previously reported. Two of the six mutations were found in patients with mild phenotypes. Taken together with other published reports, our results suggest that a sizable subset (ca. 40%) of mutations in this region is associated with mild phenotypes characterized by the lack of significant aortic pathology, compared with about 7% in the rest of the gene. In two cases, mutations affecting analogous positions within one of the 43 cbEGF modules of FBN1 are associated with mild phenotypes when found in one of the 6 C-terminal modules (encoded by exons 59-63), but are associated with classic or severe phenotypes when found in cbEGF modules elsewhere in the gene.

Congenital adrenal hyperplasia associated with maternal pregnancy luteoma and the Antley-Bixler syndrome

The authors report on a child with indifferent external genitalia consisting of severe micropenis with penile urethra leading to the tip of the glans and bilateral cryptorchidism. Diagnostic workup findings showed a female karyotype, homozygous 21-hydroxylase deficiency, and excessive testosterone exposure prenatally as a consequence of maternal pregnancy luteoma, altogether causing this unusual phenotype. In addition, the girl suffered from skeletal anomalies consistent with the diagnosis of Antley-Bixler syndrome. Our case shows that, although the association of congenital adrenal hyperplasia with other syndromes is rare, and even if other possible reasons for in utero virilization are present, complete diagnostic workup including karyotyping and hormonal status should be done in all patients with ambiguous genitalia, especially in cases of an unusual phenotype. The authors report on the diagnostic procedures and discuss the surgical approach in this particular case, never described before in the literature.

Conformal boundary conditions and three-dimensional topological field theory

We present a general construction of all correlation functions of a two-dimensional rational conformal field theory, for an arbitrary number of bulk and boundary fields and arbitrary topologies. The correlators are expressed in terms of Wilson graphs in a certain three-manifold, the connecting manifold. The amplitudes constructed this way can be shown to be modular invariant and to obey the correct factorization rules.

Genotoxic potential of porphyrin type photosensitizers with particular emphasis on 5-aminolevulinic acid: implications for clinical photodynamic therapy

Photodynamic therapy (PDT) uses exogenously administered photosensitizers activated by light to induce cell death or modulation of immunological cascades, presumably via formation of reactive oxygen species (ROS). 5-Aminolevulinic acid (ALA) mediated photosensitization is increasingly used for the treatment of nonmelanoma skin cancer and other indications including benign skin disorders. Long-term side effects of this investigational modality are presently unknown. Just as tumor treatments such as ionizing radiation and chemotherapy can cause secondary tumor induction, PDT may potentially have a carcinogenic risk. Evaluation of the biological effects of ALA in absence of activating light and analysis of the mechanism of ALA-PDT and porphyrin-type photosensitizers mediated photosensitization indicate that this therapy has a pro-oxidant and genotoxic potential. However, porphyrin type molecules also possess antioxidant and antimutagenic properties. ALA-PDT delays photocarcinogenesis in mice, and topical ALA alone does not increase skin cancer incidence in these animals. Patients with increased tissue levels of ALA have an increased incidence of internal carcinoma, however, it is not clear whether this relationship is casual or causal. There is no evidence indicating higher rates of skin cancer in patients with photosensitivity diseases due to presence of high protoporphyrin IX (PP) levels in skin. Overall, the presently available data indicate that the risk for secondary skin carcinoma after topical ALA-PDT seems to be low, but further studies must be carried out to evaluate the carcinogenic risk of ALA-PDT in conditions predisposed to skin cancer.

Hepatocyte growth-factor-scatter factor can stimulate post-operative tumor-cell proliferation in childhood hepatoblastoma

Rapid growth of residual tumor after partial hepatectomy has been observed during the period of liver regeneration in children with malignant embryonal hepatoblastoma. The aim of this study was to elucidate the role of hepatocyte growth-factor-scatter factor (HGF-SF) in this phenomenon. Markedly increased serum levels of HGF-SF up to 15 ng/ml were found in 13/18 patients after liver resection and in 6/16 patients with regressive tumors after chemotherapy, in comparison with 15 patients with non-pre-treated hepatoblastoma and 20 healthy children of the same age group. In the tumors, epithelial tumor cells highly expressed the HGF-SF receptor c-met, as shown by immunohistochemistry and m-RNA RT-PCR. The hepatoblastoma cell lines HepT1, HepT3 and HUH6 reacted with significantly increased proliferation to rhHGF-SF in these concentrations (1-15 ng/ml). In the tumors, HGF-SF was found to be expressed in the stromal fibroblasts. In culture, hepatoblastoma cells (HepT3, HUH6) stimulated secretion of the factor by human fibroblasts, indicating the paracrine fashion of intratumoral HGF-SF production. Cultured hepatoblastoma cells ceased to proliferate at 20-50 ng/ml HGF-SF, and they underwent cell death at >/=100 ng/ml. In contrast, the hepatocellular-carcinoma cell line HepG2 decreased growth under HGF-SF in a dose-dependent manner. We conclude that post-operatively secreted and intratumorally produced HGF-SF can function as a growth factor for hepatoblastoma, while the same agent has a cytostatic effect in unphysiologically high concentrations.

Hepatocyte growth-factor-scatter factor can stimulate post-operative tumor-cell proliferation in childhood hepatoblastoma

Rapid growth of residual tumor after partial hepatectomy has been observed during the period of liver regeneration in children with malignant embryonal hepatoblastoma. The aim of this study was to elucidate the role of hepatocyte growth-factor-scatter factor (HGF-SF) in this phenomenon. Markedly increased serum levels of HGF-SF up to 15 ng/ml were found in 13/18 patients after liver resection and in 6/16 patients with regressive tumors after chemotherapy, in comparison with 15 patients with non-pre-treated hepatoblastoma and 20 healthy children of the same age group. In the tumors, epithelial tumor cells highly expressed the HGF-SF receptor c-met, as shown by immunohistochemistry and m-RNA RT-PCR. The hepatoblastoma cell lines HepT1, HepT3 and HUH6 reacted with significantly increased proliferation to rhHGF-SF in these concentrations (1-15 ng/ml). In the tumors, HGF-SF was found to be expressed in the stromal fibroblasts. In culture, hepatoblastoma cells (HepT3, HUH6) stimulated secretion of the factor by human fibroblasts, indicating the paracrine fashion of intratumoral HGF-SF production. Cultured hepatoblastoma cells ceased to proliferate at 20-50 ng/ml HGF-SF, and they underwent cell death at >/=100 ng/ml. In contrast, the hepatocellular-carcinoma cell line HepG2 decreased growth under HGF-SF in a dose-dependent manner. We conclude that post-operatively secreted and intratumorally produced HGF-SF can function as a growth factor for hepatoblastoma, while the same agent has a cytostatic effect in unphysiologically high concentrations.

Quantitative karyotyping and dual-color FISH mapping of 5S and 18S-25S rDNA probes in the cultivated Phaseolus species (Leguminosae)

Double-color fluorescence in situ hybridization (FISH) followed by DAPI counterstaining allowed the chromosomal assignment of 5S and 18S-25S rRNA genes in the four cultivated Phaseolus Species; P. vulgaris, P. coccineus, P. acutifolius, and P. lunatus (all: 2n = 2x = 22). The rRNA gene loci display variation between species as reflected in differences of signal size and (or) number. From one to three pairs of 5S sites and one to seven pairs of 18S-25S sites were found in the diploid complements of the four taxa studied. Intraspecific variation was studied in P. vulgaris, and it is shown that the number of 18S-25S rDNA sites differs between cultivars. Cytogenetic mapping was complemented by karyotype analyses. Each of the four cultivated Phaseolus species exhibits a characteristic heterochromatin endowment, with P. acutifolius var. latifolius having the highest amount of C-band material. Quantitative karyotyping in combination with cytogenetic mapping allowed the identification of homeologous chromosomes in the different species.

Nephron-sparing surgery in synchronous bilateral Wilms' tumors

BACKGROUND

Synchronous bilateral Wilms' tumor is rare and experience with renal salvage procedures and their limitations accumulates slowly at single institutions. The authors analyzed whether their growing experience with atypical renal resections and awareness of nephroblastomatosis had influenced the outcome of surgical procedures.

METHODS

Retrospective analysis of patients treated from 1977 to 1995 was performed. Surgical reports, clinical sheets, and follow-up data were evaluated. All pathology slides were reviewed for histological classification and presence of nephroblastomatosis. Renal function was evaluated pre- and postoperatively and at final follow-up.

RESULTS

Fourteen patients were treated. Two to 20 years after surgery, 13 patients are alive, and none has had renal failure. Five patients had unilateral nephrectomies, and a renal salvage procedure was performed on 22 kidneys. One patient with an anaplastic bilateral Wilms' tumor died of tumor progress 1 year after surgery. Several kidneys, which would have been sacrificed by application of traditional criteria, could be salvaged by atypical and unconventional tumor resections and by superficial dissection and enucleation of supposed nephroblastomatosis. Nephrectomy appeared unavoidable with hilar invasion by tumor.

CONCLUSION

Atypical resections of localized lesions and superficial dissections of suspected nephroblastomatosis appeared as valid surgical treatment options for patients who would otherwise have been candidates for nephrectomy. In the case of hilar tumor invasion, however, nephrectomy seems unavoidable.

Immunoscintigraphy of xenotransplanted hepatoblastoma with iodine 131-labeled anti-alpha-fetoprotein monoclonal antibody

BACKGROUND/PURPOSE

Hepatoblastoma (HB) is the most common primary malignant liver tumor affecting infants and young children. The alpha-fetoprotein level is elevated in 95% of all children with hepatoblastoma. Therefore, it is of interest to assess targeting of the HB marker alpha-fetoprotein by antibody imaging. In this pilot study, the authors investigated the radioimmunoscintigraphy of xenotransplanted HB in nude mice utilizing an anti-alpha-fetoprotein antibody.

METHODS

HB cell suspensions from tumors of 3 children were transplanted subcutaneously into nude mice NMRI (nu/nu). A total of 200 microg of intact anti-alpha-fetoprotein antibody was injected intravenously into 8 animals from each HB. Before injection, the monoclonal antibody was labeled with iodine (I) 131 (specific activity of 75 MBq/mg, labeling yield of 95%) using the conventional iodogen method. Planar scintigraphic images of anesthetized mice in posterior views were acquired with a gamma camera immediately after injection, and after 1, 2, 3, 7, and 14 days. The biodistribution data were obtained by killing and dissecting animals, and the activity in the tissues was measured in a gamma counter. The alpha-fetoprotein levels in the animals' sera were recorded 15 days after imaging and were compared with the control group.

RESULTS

A total of 66% of the hepatoblastomas could be detected by scintigraphy. Within 24 hours, the mean specific tumor uptake in nude mice hepatoblastomas with a volume of over 1,000 mm3, was 14% per injected dose (+/-3.9%). The biological half-life of the labeled antibody complex in the tumor was 3.86 (+/-0.84) days. Thyroid uptake of free I-131 was 2.85% per injected dose (+/-1.5%) reflecting the deiodination of the labeled antibody complex.

CONCLUSIONS

The results show the possibility of imaging xenotransplanted hepatoblastoma with 131I-labeled anti-alpha-fetoprotein and may, in the future, determine tumor recurrence and extension, and thereby improve the prognosis of advanced HBs.

Antioxidant protection from solar-simulated radiation-induced suppression of contact hypersensitivity to the recall antigen nickel sulfate in human skin

Solar radiation induces suppression of the local effector mechanisms involved in immune responses to recall antigens. By using a low-dose solar-simulated radiation protocol, we investigated whether oral supplementation of the antioxidants RRR-alpha-tocopherol combined with L-ascorbic acid prevented radiation-induced suppression of the contact hypersensitivity response to nickel sulfate. In a prospective, randomized study, nickel-sensitive individuals were given RRR-alpha-tocopherol 2 g/d oral supplements combined with L-ascorbic acid 3 g/d for 50 d (group 1). Individuals in the control group were given a placebo (group 2). The reaction to a standardized patch test with serial dilutions of nickel sulfate and the irritant skin reaction to sodium lauryl sulfate were assessed by visual grading and by reflectance spectrophotometry in radiation-exposed and nonexposed skin 50 days after supplementation. Results showed that the contact hypersensitivity response to the recall antigen nickel sulfate was significantly suppressed in the radiation-exposed skin of those who took the placebo. Supplementation with RRR-alpha-tocopherol combined with L-ascorbic acid significantly protected against the radiation-induced suppression of the contact hypersensitivity response to nickel sulfate. The irritant reaction to sodium lauryl sulfate was not suppressed by radiation, and antioxidant supplementation did not modulate this response. In conclusion, a combination therapy of systemic high-dose RRR-alpha-tocopherol combined with L-ascorbic acid prevented solar-simulated radiation-induced suppression of the local immune response to the recall antigen nickel sulfate in human skin. This immunoprotective effect of combined RRR-alpha-tocopherol and L-ascorbic acid could be exploited for the prevention of solar radiation-induced skin cancer in an antioxidant intervention study.

Analysis of treatment efficiency of carboplatin and etoposide in combination with radical surgery in advanced and recurrent childhood hepatoblastoma: a report of the German Cooperative Pediatric Liver Tumor Study HB 89 and HB 94

BACKGROUND

Hepatoblastoma (HB) is the most common liver tumor of childhood, and comprises approximately 1% of all pediatric malignancies. Although recent data from multicenter trials of GPOH, SIOP, CCG and POG indicate a remarkable improvement of therapy results, the prognosis of advanced or recurrent HB is still not satisfying.

PATIENTS AND METHODS

During 1989 and 1997, the German Cooperative Pediatric Liver Tumor Studies HB 89 and HB 94 registered 141 patients with HB, who were treated according to the study protocols. These patients received standard chemotherapy with ifosfamide, cisplatin and doxorubicin (IPA) pre-operatively and/or post-operatively. Fourteen children with recurrent or advanced HB were additionally treated with carboplatin and etoposide (CARBO/VP 16), the reason being observations of drug resistance in children with HB after four or more courses of IPA-therapy in the HB 89 study. The clinical data and course of these patients were evaluated to investigate the efficiency of CARBO/VP 16 chemotherapy and for analyzing the role of surgery.

RESULTS

Mean follow-up for survivors was 4.3 years (range 13 months-8 years). Tumor resection was attempted in 13 children but, in only 3 cases, was a complete tumor resection achieved in one operation. There was no perioperative death, and 7 of the patients (50%) are in remission. Two patients underwent adjuvant chemotherapy with CARBO/VP 16 for advanced HB at first operation: all are alive and well. Five patients with local relapse and/or distant metastases responded partially to CARBO/VP 16 therapy, and a complete remission was achieved in one patient. In five patients, progressive disease was observed during therapy with CARBO/VP 16. One patient, stable while on chemotherapy, had a successful resection. Acute toxicity of chemotherapy was observed in 7 patients (50%).

CONCLUSION

An aggressive approach using IPA and CARBO/VP 16 chemotherapy and highly developed surgical techniques may improve the prognosis of advanced or recurrent HBs.

Paclitaxel: an effective antineoplastic agent in the treatment of xenotransplanted hepatoblastoma

BACKGROUND

Hepatoblastoma is an uncommon liver tumor of infancy and early childhood. Though most patients with nonmetastatic hepatoblastomas can be cured by defining surgical strategies and chemotherapy regimes, new drugs are needed for children with advanced hepatoblastomas. The activity of paclitaxel as a new antineoplastic agent with limited experience in pediatric oncology was studied in a xenograft model.

PROCEDURE

Hepatoblastoma cell suspensions from three children were transplanted subcutaneously into nude mice NMRI (nu/nu). One of the primary tumors was an embryonal multifocal hepatoblastoma, whereas the other tumors were embryonal/fetal hepatoblastomas localized on a liver lobe. After 4 weeks, xenografted tumor sizes reached 50-100 mm3. The xenografted tumors resembled their originals histologically and produced high levels of alpha-fetoprotein. The efficiency of paclitaxel at equitoxic doses was analyzed.

RESULTS

Paclitaxel produced an effect in all three hepatoblastomas. There was a significant reduction of tumor volume (P < 0.001) and alpha-fetoprotein levels after chemotherapy (P < 0.0001). The proliferation activity of the tumor cells corresponded with these results. Histologically, after treatment with paclitaxel the tumor regression was 35%-49%. The mechanism of paclitaxel action could be demonstrated by light microscopy immunohistochemistry and electron microscopy.

CONCLUSIONS

The preliminary results in phase I trials of solid tumors in children and the results of this study suggest that paclitaxel in phase II studies can now be entertained for patients with hepatoblastoma.

CaDet, a computer-based clinical decision support system for early cancer detection

Cancer risk evaluation and early detection are subject to serious limitations mainly related to human factors and to characteristics of the data involved. To help overcome these problems, a computer-based system was designed to provide the physician with a clearer clinical picture and aid in directing patients to appropriate measures. Clinical and epidemiological data related to early cancer detection and to cancer risk factors was collected from the literature and incorporated in a database, together with heuristic rules for evaluating this data. Individual data obtained from patients through a questionnaire are input into CaDet, a computerized clinical decision support system. A report summarizing patient data and cancer hypotheses, with a scoring system that reflects degrees of alarm, is generated. The CaDet system, as well as some preliminary results of the clinical experience accumulated in its use, are described. These preliminary results suggest that the approach may be useful in improving cancer risk assessment and screening in primary care setups.

[Evaluation of in vitro susceptibility of hospital bacterial isolates to piperacillin and tazocin (piperacillin/tazobactam]

Due to increasing frequency of infections caused by pathogens that are resistant to beta-lactam antibiotics, combinations of such antibiotics and beta-lactamase inhibitors were introduced into therapy in last few years. Tazobactam is the most potent beta-lactamase inhibitor. The purpose of the study was to evaluate in vitro susceptibility to piperacillin and piperacillin with tazobactam of 256 isolates cultured from biological samples obtained from 203 patients. The biological materials obtained were as follows: urine (44.9%), post-operative and post-traumatic wound swabs (27.3%), BAL (12.1%), blood (6.6%), drain swabs and other (5.5%). The isolates predominantly found were Escherichia coli (22.3%), Pseudomonas aeruginosa (16.0%), Staphylococcus aureus MSSA (13.7%), Proteus mirabilis (11.7%) and other. There were 95.5% of strains found susceptible to piperacillin with tazobactam and only 4.3% resistant ones. On the other hand, piperacillin only susceptible strains were 59.4% and resistant ones in 40.6%. Great differences in susceptibility to examined antimicrobial agents were observed in Enterobacteriaceae family and Staphylococcus (MSS) genus. There were no differences in susceptibility to piperacillin and tazobactam and piperacillin alone in anaerobic Enterobacteriaceae strains and non-fermenting Gram-negative bacilli.