Concurrent production of calcitonin and thyroglobulin by the same neoplastic cells

A case of MCT with immunoreactivity for both thyroglobulin and calcitonin in the same neoplastic cells is reported. Double-stained tumor cells were present both in the primary tumor and in lymph node metastases.

Primary malignant fibrous histiocytoma of the breast

Clinical, light microscopic, electron microscopic and immunocytochemical features of 4 cases (3 women and 1 man) of primary malignant fibrous histiocytoma (MFH) of the breast are presented. The literature is reviewed and the diagnosis and treatment discussed. The good outcome is stressed and local excision or simple mastectomy recommended as appropriate treatment.

Crystalluria and ciprofloxacin, influence of urinary pH and hydration

Ciprofloxacin is one of the newer 4-quinolones. It combines a high antibacterial activity and a broad spectrum with favourable pharmacokinetic properties. The present study was designed to detect the influence of urinary pH and fluid consumption on crystalluria. Six healthy volunteers aged 25-41 years, 3 of each sex, participated in the study. Single doses of 1,000 and 500 mg of ciprofloxacin were given orally. The urinary pH was varied by giving each subject three different diets: a regular diet, a diet supplemented by ammonium chloride to acidify urine, and a diet supplemented by sodium bicarbonate to obtain alkaline urine. The urine volume and pH were measured and microscopically examined at 37 degrees C immediately after voiding. After the very high dose of 1,000 mg ciprofloxacin the regular diet regimen led to crystalluria in only one subject. Even with this high dose, but with the acidifying regimen, no crystals were observed in any one of the volunteers. When bicarbonate was supplemented 5 to 6 volunteers presented crystals in 22 of the 36 urine samples. 21 of the crystalluric urine samples showed a pH greater than or equal to 7.3. After the usual 500-mg dose and regular diet no crystals were observed at all; only in 3 subjects who received bicarbonate supplement crystals have been seen. In the urine of two subjects crystals emerged 'ex vivo' after some hours of storage at both 37 degrees C and room temperature; these results show the importance of sediment observation at 37 degrees C immediately after voiding to differentiate between real and 'ex vivo' crystalluria. Results of different examinations permit the conclusion that the crystals contain mostly unchanged ciprofloxacin as major component and magnesium as characteristic element. Participation of the metabolite 2 in the crystal formation cannot be excluded. No significant change was observed in blood counts and blood chemistry of any subject. Urinalysis showed no modifications except the eventual presence of the typical drug-related crystals. Hematuria never occurred.

A human autoantibody to peroxisomes

A complement fixing, non-organ specific IgG autoantibody is described in 29 patients. The autoantibody gives a highly characteristic, granular staining of liver cells, proximal kidney tubules and stomach surface epithelium. By studies with various subcellular fractions from rat liver, employing two different techniques (quantitative complement fixation, and absorption combined with indirect immunofluorescence) the autoantibody was shown to react with a peroxisomal antigen. No convincing clinical correlations were found.

Medullary carcinoma of the thyroid gland: an immunocytochemical study

Twenty-seven cases of medullary carcinoma of the thyroid gland (MCT) were studied by light microscopy, immunocytochemistry, and electron microscopy. Immunoreactivity for neuron-specific enolase (NSE) and calcitonin was present in all tumors. The numbers of peptides and serotonin demonstrated in each case varied from one to eight. Bombesin was present in 18 of the 27 cases, serotonin in 15, leu-enkephalin in 8, somatostatin in 8, gastrin in 3, substance P in 1, vasoactive intestinal peptide (VIP) in 1, and ACTH in 1. Insulin and glucagon were not encountered in any of the tumors. Immunoreactivity for thyroglobulin was seen in five primary tumors as well as in one lymph node metastasis. The finding of concurrent production of calcitonin and thyroglobulin within the same tumor is enough to question the dogma of the separate origin of follicular cells and C-cells. We were unable to attach any clinical importance to the production of multiple peptides and/or amines.

Hürthle cell and mitochondrion-rich papillary carcinomas of the thyroid gland: an ultrastructural and immunocytochemical study

Of 52 consecutive papillary carcinomas of the thyroid, the following cases were included in this study: one Hürthle cell papillary carcinoma, one papillary carcinoma with foci of Hürthle cells, and 10 cases of papillary carcinoma with abundant mitochondria (volumetric density of mitochondria greater than or equal to 20%). All cases were studied by light microscopy, transmission electron microscopy (TEM), scanning electron microscopy (SEM), and immunocytochemistry. Our results showed that papillary carcinomas mainly or exclusively composed of Hürthle cells are very rare; that Hürthle cell papillary carcinomas of the thyroid share the biologic characteristics and blend insidiously with the so-called mitochondrion-rich papillary carcinomas; that TEM and SEM can provide useful evidence for achieving the differential diagnosis between Hürthle cell and so-called mitochondrion-rich papillary carcinomas; and that immunocytochemical studies are useless in the aforementioned differential diagnosis.

Hürthle-cell lesions of the thyroid: a combined study using transmission electron microscopy, scanning electron microscopy, and immunocytochemistry

Hürthle cell transformation found in 2 nodular goiters, 2 cases of Hashimoto's thyroiditis, 4 follicular adenomas, 3 follicular carcinomas, 2 papillary carcinomas and 1 anaplastic carcinoma were studied by transmission electron microscopy, scanning electron microscopy and immunocytochemistry. Ultrastructural features of Hürthle cells were identical in non-neoplastic and neoplastic lesions. Cells crammed with mitochondria, showing abnormalities in size, shape and content were prominent in most cases. The presence of distinct smooth-surfaced cells interspersed with cells with many microvilli is almost a pathognomonic scanning electron microscopic feature of benign and malignant Hürthle cell lesions. Most Hürthle cells stained positively for thyroglobulin in all cases, but no immunoreactivity for CEA and calcitonin was found.

Ultrastructural and immunohistochemical features of lobular carcinoma of the breast

Twenty cases of infiltrating lobular carcinoma (12 of classical type, five of trabecular type and three of alveolar type) and one case of lobular carcinoma in situ were studied by transmission electron microscopy. The in situ component in three of the infiltrating carcinomas was also studied. The ultrastructure of the tumour cells in the alveolar variant of infiltrating lobular carcinoma was the same as seen in the tumour cells of lobular carcinoma in situ. The tumour cells in infiltrating lobular carcinoma of the classical and trabecular types had more irregular nuclei and were more organelle- and filament-rich. Immunohistochemical staining for the presence of alpha-lactalbumin was proved in 19 per cent of the cases, casein 81 per cent, CEA in 65 per cent and prekeratin in 90 per cent. The light microscopic separation of some subgroups of infiltrating lobular carcinoma may be difficult, in particular the distinction between the classical and the trabecular variants. Unfortunately, our study shows that these distinctions cannot easily be made either by electron microscopy or by light microscopic immunohistochemistry with antibodies against prekeratin, CEA, casein and alpha-lactalbumin.

Breast carcinomas with neuroendocrine differentiation

Twenty-two breast carcinomas with membrane bound granules by electron microscopy were tested for the presence of neuron specific enolase (NSE), neuropeptides and serotonin by immunohistochemistry. By light microscopy the cases studied included infiltrating ductal carcinomas, intraductal carcinomas, apocrine carcinomas, infiltrating lobular carcinomas of both classical and alveolar types, mixed lobular/colloid carcinomas, carcinoid growth pattern and one unclassified carcinoma. Ten cases showed immunoreactivity for 1 or 2 neuropeptides in scattered cells whereas all cases were positively and rather diffusely stained with anti-NSE. Immunohistochemical staining at the ultrastructural level was carried out; the presence of neuropeptides could not be confirmed. Scattered granules were marked with gold particles when antiserum against casein was used. We conclude that neither argyrophilia, nor NSE immunoreactivity nor membrane bound granules seen by electron microscopy constitute at present sufficient evidence to designate a breast carcinoma as neuroendocrine. However, our study indicates that certain breast carcinomas of several types do include cells with neuroendocrine features demonstrable convincingly by light microscopic immunohistochemistry. We have no evidence that these breast carcinomas with neuroendocrine features behave differently from their counterparts lacking such features. The intriguing speculation is that neuropeptides produced by certain breast carcinomas may act as local modulators of tumor growth and differentiation.

Carbamazepine in restless legs. A controlled pilot study

Carbamazepine or placebo were given in random order, during two four-week periods, in a double-blind, cross-over trial in six patients presenting with symptoms of restless legs. On global evaluation after completing the trial three patients and the physician preferred to continue treatment with carbamazepine. In the remaining three cases both the physician and the patients preferred not to continue with either of the treatments. However, the patients who did not give any preference also had less pronounced symptoms during treatment with carbamazepine. No patient felt better during treatment with placebo as compared to carbamazepine. The results indicate that certain patients have fewer attacks of restless legs during treatment with carbamazepine.

Reduction in early alcohol abstinence fits by administration of carbamazepine syrup instead of tablets

All convulsive fits during ethanol abstinence in the acute ward of a Department of Alcohol Diseases were recorded during two 11-month periods. The patients and the treatment given were similar during the 2 periods, except that the initial dose of carbamazepine was given as tablets during the first period and as syrup during the second period. The rate of withdrawal fits between 2 and 10 h after the initial dose of carbamazepine was significantly lower in the group given the syrup, which is suggestive of greater efficacy. This is probably due to faster absorption of carbamazepine from the syrup, promoting more rapid attainment of an anticonvulsant concentration.

[Electron spectroscopy for chemical analysis. (ESCA). Examinations on formation and re-formation of the passive layer on vitallium (author's transl)]

The passive layer of a metal implant is responsible for its tolerance in a biological environment. A report is given on ESCA-investigations on the passive layer on Vitallium implants which consists largely of Cr-oxide and is only approx. 3-5 micrometer thick. This passive layer can easily be damaged with OP-instruments. The oxide layers rebuilt on exposure to air or on sterilization in boiling water were also investigated by ESCA. Oxide layers normally formed are very similar to the original passive layer. Accumulations of Co- and Mo-oxides are also observed, however. Some short implantation experiments show that the thin Cr-oxide layer is indeed effective as a passive layer. The analytical findings indicate that the formation or re-formation of the passive layer is due to a selective dissolution process. This accords with results obtained by the neutron activation analysis of the serum.

Unusual silica granulomas of the skin with massive involvement of axillary lymph nodes

Silica granulomas are rare in the skin. Involvement of the regional lymph nodes seems to be unusual. The case of a 35-year-old man with massive diffuse fibrosis of the axilla with multiple foreign body granulomas and involvement of axillary lymph nodes is presented. The lymph nodes exhibit multiple epithelioid cell granulomas and silicotic nodules which are indistinguishable from similar nodules in mediastinal lymph nodes in pulmonary silicosis. It is assumed that the numerous silica particles which were identified by X-ray microanalysis under the scanning electron microscope and recovered from the mineral ash after incineration were accidentally implanted into the skin at the time of an injury 26 years previously. The long delay between silica exposure and granuloma development is a typical feature of these lesions. The possible mechanisms operative in this process are discussed.

The metabolism of floctafenin in man and rodents

Floctafenin (FFn), 2,3-dihydroxypropyl--N--(8--trifluoromethyl--4--quinolyl) anthranilate, a new nonnarcotic analgesic drug, was studied in man, mice, and the isolated perfused rat liver. In all species the drug is rapidly hydrolyzed to floctafenic acid (FFa). In seven volunteer subjects who each received a single oral dose of 400 mg floctafenin on an empty stomach, the blood concentration of FFa usually reached a maximum between 1 and 2 hours (mean 1.57 +/- 1.28 microgram/ml at 1.5 hours) and declined over the next 6 hours. Eight hours after drug administration the mean concentration of FFa in the blood of the volunteers was 0.1 +/- .05 microgram/ml. Approximately 25 per cent of the administered dose of floctafenin was recovered as FFa and hydroxy-FFa in the urine collected from each subject for 48 hours after drug administration. In mice each having received a single intraperitoneal dose of floctafenin (2 mg), the concentration of floctafenin declined by about 50 per cent in 15 minutes, and this decline was accompanied by a rise in the concentration of FFa that remained constant for 3 hours. The analgesic effect observed after administration of floctafenin to humans is likely to be mediated by its major metabolite, FFa. In these volunteers no free floctafenin was detected in the blood.

Surface investigations of oxide layers on cobalt-chromium-alloyed orthopedic implants using ESCA technique

The uppermost monolayers of a metal implant are far more important for the corrosion resistance than the alloy itself. Using electron spectroscopy for chemical analysis (ESCA) technique these oxide layers on Vitallium specimens were investigated regarding thickness, elemental composition, and valence state of the elements. The oxide layers on metal implants are not very strong, as they can be easily damaged mechanically. According to environmental conditions, oxide layers of different elemental composition can be grown on the same specimen.