Effects of recombinant human granulocyte colony-stimulating factor on the mice receiving bone marrow transplantation following lethal irradiation: acceleration of recovery of the peripheral blood neutrophils and potentiation of anti-Pseudomonas resistance

The effects of recombinant human granulocyte colony-stimulating factor (rG-CSF) on the recovery of peripheral blood neutrophil counts and resistance to i.p. infection by Pseudomonas aeruginosa were studied using a mouse bone marrow transplantation (BMT) model. A severe neutropenic period continued in the BMT mice for greater than 9 days following BMT. In contrast, the number of peripheral blood neutrophils in the BMT mice that received a daily administration of 2.5 micrograms of rG-CSF following BMT returned to normal by day 9. Thus, rG-CSF accelerated the recovery of the peripheral blood neutrophil counts in BMT mice. Anti-Pseudomonas resistance of the control BMT mice examined on days 7, 9, and 11 following BMT was one fifteenth to one fiftieth of normal mice, as indicated by the LD50 value. The anti-Pseudomonas resistance was elevated six- to sevenfold by the rG-CSF treatment. A marked increase in the neutrophils exudating into the peritoneal cavity in response to casein injection was observed in the rG-CSF-treated BMT mice. In addition, the reduced superoxide generative and phagocytic activity of the peritoneal neutrophils of the BMT mice were restored to normal by the rG-CSF treatment. It is suggested that rG-CSF potentiated anti-Pseudomonas resistance of the BMT mice by increasing neutrophils migrating to the infection site and restoring their functions; this may result from a prompt recovery of the peripheral blood neutrophil level together with the effect on neutrophil functions. These results indicate the clinical usefulness of rG-CSF in applications for BMT.

Symptomatic pericardial effusion in breast cancer patients: the role of fluid cytology

Clinical and cytologic findings in 21 breast cancer patients with symptomatic pericardial effusion are presented. The etiology of the pericardial effusion was definitely malignant, by cytology/histology in 13 patients (62%), and suspected malignant by cytology in 2 patients (9%). One patient (5%) with definitely nonmalignant pericardial effusion by cytology was found to be histologically positive at autopsy. In 5 patients (24%) there was no histological/cytological evidence of malignancy; radiation pericarditis could be the etiology in 4 of these 5 patients. The median time from the diagnosis of breast cancer to the development of symptomatic pericardial effusion was 60 months (range: 1-219 months). Ten patients developed cardiac tamponade; they were treated by either pericardiocentesis or pericardiectomy. The mean survival of patients with negative cytology/histology was 12 months; patients with suspicious cytology had a mean survival of 9 months; patients with malignant effusion, treated by pericardiectomy, had a mean survival of 22.3 months, while patients with malignant pericardial effusion, who were not subjected to surgery, had a mean survival of 4.7 months, only. It is concluded that the etiology of symptomatic pericardial effusion in breast cancer patients is not always malignant, which emphasizes the role of fluid cytology in establishing definite diagnosis. The survival probability is a function of the extent of extracardiac disease; among patients with malignant pericardial effusion those selected for pericardiectomy have a longer than average survival.

The cell block for body cavity fluids: do the results justify the cost?

We reviewed retrospectively reports on cytologic smears and cell blocks from body cavity fluids received in our department over a 12-mo period. In order to evaluate the usefulness of the two modalities independently, all available slides were studied with the reviewers blinded to the original diagnoses, history, and appearances on corresponding cytology/cell block. Of 524 cytology samples, 283 had cell blocks, of which 263 were available for comparative cytologic and histologic review. Twenty-four cases based on the original reports and 22 cases in the review had diagnoses with major discrepancies between the cell block and cytology. On original reports, cytology favored malignancy in 21 cases in which the cell block was benign, with one false suspicious cytology. In three cases, the cell block was suspicious/positive (two false suspicious cell blocks), but cytology was negative/atypical. In the review diagnoses, there were also 21 cases of suspicious/positive cytology (one false suspicious cytology) and negative/atypical cell blocks. In only one case did the cell block favor malignancy when cytology was benign (a false suspicious cell block). Review of Medicare data indicated that the physician's fee charged for these 283 cell blocks would range from about $7,000 to $28,000 to detect one additional malignancy. We conclude that the routine use of cell blocks is not a cost-effective method of detecting malignancy in body cavity fluids. We advise that samples be refrigerated or be kept fixed. If immunoperoxidase studies are desired following cytologic evaluation, they may be performed subsequently on fresh smears or a cell block.

Preoperative cytology and mammography in patients with single-duct nipple discharge treated by surgery

Microdochectomy has been the routine management for single-duct nipple discharge. Our review of 176 consecutive patients surgically treated between 1975 and 1988 revealed eight patients with in situ carcinomas and seven with infiltrative carcinomas. Seventeen patients had multiple papillomas, two had atypical hyperplasia and two had atypical epitheliosis. Case selection for surgery has recently been advocated. In our study, nipple discharge cytology was helpful in 67 per cent of cases with underlying malignant pathology. Mammography was found to be unreliable, alerting suspicion in only two of 15 cases.

Comparison of cell membrane phospholipid fatty acids in five rat strains fed four test diets

The fatty acid composition of phospholipids in peritoneal exudate cells and spleen cells was assessed in five rat strains fed four test diets of differing fatty acid composition. Distinctive patterns of fatty acids were seen in the total phospholipid preparations in both cell types in response to the diets which contained either olive, sunflower, linseed or fish oil. In general, similar fatty acid profiles were seen in each of the rat strains fed the same diet with the only evidence of possible genetic (strain) variation being a relative deficiency of delta 4 desaturase in Dark Agouti rats.

[Leukemic infiltration of the mastoid bone--cytologic examination of exudate in the tympanic cavity as a useful diagnostic method]

Although otologic involvement by leukemic infiltration was supposed to be unusual, increasing number of cases have been reported in recent years, probably due to the advance of chemotherapy, improved remission rate and longer survival of leukemic patients. Two cases of myelogenous leukemia with infiltration of mastoid bone were reported. One is 15-year-old girl with acute myelogenous leukemia, which had been well controlled for 1 year, developed a sudden onset of facial nerve palsy. The other is 30-year-old female with chronic myelogenous leukemia and blastic crisis, complained hearing loss. As both cases had exudate in the tympanic cavity, the punctures were carried out through the eardrum. The pathological study of these exudate cells revealed the involvement of mastoid bone by leukemia. The cytologic examination of exudate in the tympanic cavity is simple, time-sparing and of little burden to the patient. This technique is very useful and supposed to take the place of the exploratory surgery of mastoid cavity which is previously considered necessary for the correct diagnosis.

Inhibitors of immune complex-induced inflammation: 5-substituted 3-[1-(2-benzoxazolyl)hydrazino]propanenitrile derivatives

A number of 5-substituted 3-[1-(2-benzoxazolyl)hydrazino]propanenitrile analogues have been studied as inhibitors of the rat pleural reverse passive Arthus reaction, and quantitative structure-activity relationships (QSAR) of these analogues have been examined. The QSAR equations indicate that hydrophilic substituents at the 5-position produce more potent compounds, while electron-releasing groups decrease activity. The results supplement QSAR data we previously obtained from the dermal reverse passive Arthus reaction.

Components of image intensive diagnosis. Codifying visual features for effusion cytology

Components of visual assessment in the diagnosis of effusions were analyzed using relative operating characteristic. Diagnostic performance in the assessment of malignancy and the specification of metastatic origin was measured for two expert cytologists. The component of performance attributable to feature interpretation was measured in protocols which minimized the effects of clinical information and visual search in the decision process. Feature interpretation, as a process, contributed significantly to the evaluation of malignancy and marginally to the specification of metastatic origin. For each of these diagnostic tasks, the process of feature interpretation was codified in the construction of explicit models. The expert cytologists were asked to define a set of localized visual features that incorporate essential visual elements for diagnosis. These features were evaluated for a set of test cases, and regression models were constructed defining malignancy and metastatic origin. Relative operating characteristic analysis indicated that the predictive value of the models for diagnosis was very similar to the component of human performance attributable to feature interpretation.

Distinction between carcinoma cells and mesothelial cells in serous effusions. Usefulness of immunohistochemistry

The usefulness of an immunoperoxidase battery to distinguish carcinomatous from benign effusions was examined. Cell block sections from 90 previously diagnosed effusions were stained with antibodies to Leu-M1, B72.3, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA) and vimentin. The 90 cases comprised 69 carcinomas (23 mammary, 16 ovarian, 10 pulmonary, 7 gastrointestinal [GI] and 13 others), 2 malignant mesotheliomas and 19 cases with reactive mesothelial cells only. EMA and vimentin were the most useful markers for distinguishing carcinoma cells from reactive mesothelial cells. EMA reacted with 86% of the carcinomas while vimentin reacted with 90% of the reactive cases. Leu-M1, B72.3 and CEA, although generally less sensitive than EMA, were also helpful in this regard. Additionally, the use of Leu-M1 and CEA together may help to distinguish pulmonary from GI carcinomas.

Exudate variation in the rabbit gastrointestinal tract: a scanning electron microscope study

The mucosal exudate from the gastrointestinal tract of six adult female New Zealand rabbits was studied using scanning electron microscopy and without any attempt being made to clean the luminal surface before screening. The exudate consisted of mucus, debris and bacteria. Qualitative assessment showed that the nature and distribution of exudate varied along the length of the gastrointestinal tract from the oesophagus to the anal canal, with little variation from animal to animal. Bacterial counts for rod-shaped bacteria were carried out on areas randomly selected from the upper, middle and lower oesophagus and the oesophageal-cardiac junction. The degree of bacterial colonisation was found to decrease along the length of the oesophagus from upper to lower parts, but it was increased at the oesophageal-cardiac junction. This assessment was not undertaken in the other regions of the gastrointestinal tract as the mucosal surface areas could not be easily measured owing to their undulating nature. The study indicates the variability of the mucosal exudate, which should be recognised as part of the true interface between ingested food and the cell surface along the gastrointestinal tract.

Intraarticular noninflammatory free urate suspension (urate milk) in 3 patients with painful joints

We describe 3 patients with painful intraarticular knee effusions composed of a viscous milky white suspension of monosodium urate crystals, in the absence of any cellular component. Two patients presented with acute bilateral knee pain. One patient presented with unilateral knee pain of gradual onset. All 3 patients had a history of ethanol abuse. Two patients had a history of gout. Two patients had chronic renal insufficiency, hypertension, and congestive heart failure. One patient had alcoholic cirrhosis. Two patients' pain responded to colchicine. One patient's discomfort was relieved only by repeated arthrocentesis. We conclude that intraarticular free urate can cause painful joints in the absence of an apparent inflammatory response.

Differentiation between intra-abdominal neoplasms and abscesses in horses, using clinical and laboratory data: 40 cases (1973-1988)

The medical records of 25 horses with intra-abdominal neoplasms and 15 horses with intra-abdominal abscesses were reviewed. Common clinical signs of disease observed by owners of horses in both groups included anorexia, weight loss, fever, signs of colic, and depression. Clinical laboratory abnormalities included leukocytosis, hyperfibrinogenemia, hypoalbuminemia, and hypocalcemia. There was considerable overlap of laboratory test results within and between the 2 groups of horses. Peritoneal fluid was classified as an exudate in 12 of 15 horses with intra-abdominal abscesses and in 14 of 25 horses with intra-abdominal neoplasms. Cytologic examination of peritoneal fluid yielded an accurate diagnosis in 11 of 25 horses with neoplasia and in 3 of 15 horses with abscesses. A mean number of 1.45 cytologic analyses/horse was needed to diagnose neoplasms in the 11 horses in which the analysis was successful in definitively diagnosing the condition.

Nipple discharge cytology in mass screening for breast cancer

Since 1977 mass screening for breast cancer has been conducted in Miyagi Prefecture, Japan; inspection, palpation and cytologic examination of any nipple discharge are part of the initial screening procedures. Among 149,681 subjects examined, 404 cancer cases and 63 papilloma cases were detected. The nipple discharges from 20,537 women were examined cytologically; of the 61 cancer cases, the smears were positive in 18 cases, suspicious in 7, negative with atypical findings in 12 and negative in 24. Ten of the cancer cases were detected exclusively by the cytologic examination of a nipple discharge. In eight of these ten cancer cases, there was no other initial evidence of the primary tumor. The cytologic diagnosis of discharges without blood from 28 cancer cases was positive or suspicious in 10 cases and negative in 18. Thirty-seven of the papilloma cases were initially detected only by the cytologic examination of a nipple discharge; neither physical examination nor mammography showed any abnormal findings.

The application of monoclonal antibodies in the cytologic evaluation of tumors

The focus of this review has been the application of MAbs as adjuncts in the interpretation of cytology specimens. It is evident that most if not all of the MAbs studied thus far are neither completely tumor-specific nor -sensitive; however, when used to address a directed clinical question, they may be "operationally specific." More important, there continues to be no current substitute for the understanding and practice of sound diagnostic cytopathologic principles. Ultimately, the application of MAbs resides in the importance of tumor-associated antigen expression and phenotyping of tumors with therapeutic and prognostic implications.

Superoxide production by stimulated equine polymorphonuclear leukocytes--inhibition by anti-inflammatory drugs

Polymorphonuclear leukocytes (PMNLs) were isolated from an inflammatory exudate induced in the intercarpal joints of horses by an administration of carrageenin. Their superoxide production at rest and following stimulation with either serum-treated zymosan (STZ) or phorbol myristate acetate (PMA) was measured by cytochrome-c reduction. Stimulation of the cells increased the cytochrome-c reduction 10-15 times that of resting cells. The maxima were 20 nmol of reduced cytochrome-c per 10(6) cells per ml at 120 min (STZ) and 35 nmol of reduced cytochrome-c per 10(6) cells per ml at 60 min (PMA). The maximum inhibition of the cytochrome-c reduction by superoxide dismutase (Palosein) was 83.6% (STZ stimulation) and 72.1% (PMA stimulation). The non-steroidal anti-inflammatory drugs, phenylbutazone, salicylic acid, aspirin, sodium salicylate in addition to D-penicillamine and dimethylsulfoxide caused dose-dependent inhibition of the cytochrome-c reduction when the cells were stimulated by PMA. The maximum inhibitions were 64% and 36% for aspirin (10(-2) M), 32% and 17% for phenylbutazone (10(-3) M), 15% and 31% for dimethylsulfoxide (6.4 x 10(-1) M), 32% and 19% for salicylic acid (10(-2) M), 0% and 17% for sodium salicylate (10(-2) M) and 2.2% and 2.5% for D-penicillamine (10(-4) M) when the cells were stimulated by STZ and PMA, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Biocompatibility of clinically applied hydroxylapatite ceramic

The biocompatibility of 11 porous canal wall prostheses and 4 dense incus prostheses, both types made of hydroxylapatite, was studied by light microscopy, scanning electron microscopy, transmission electron microscopy, and x-ray microanalysis. The duration of implantation varied between 4 and 40 months, and the 15 retrieved implants constitute 4% of the 375 clinically applied hydroxylapatite prostheses involved in this study. With respect to integration characteristics, coverage by epithelium and fibrous tissue, and biodegradation, the performance of clinically applied hydroxylapatite generally resembled that seen in animal experiments. However, the reactions during chronic infection in the human ear were more severe than those in experimentally induced acute infections in the rat middle ear. One of the canal wall prostheses showed trace element accumulation in the cytoplasm of phagocytes.

Endogenous histamine in immune inflammation in 6-day-old air pouch of facsimile synovium

Immune inflammation was induced by injecting bovine serum albumin (BSA) into 6-day-old air pouches of mice presensitized with 2 weekly injections of an emulsion containing BSA and complete Freund's adjuvant. Control mice were also similarly pretreated with the same emulsion without BSA. The results show that the numbers of exudate leucocytes in the air pouches of both test and control groups increased and peaked at 4 h and then declined after the antigen challenge. However, the values of exudate leucocytes in the test animals at 4- and 24-hour intervals were significantly lower than those of the control. On the other hand, exudate histamine of the test group peaked at 1 h, and this was significantly higher than that of the control. Injection of exogenous histamine or histaminase with the challenging antigen increased the number of exudate leucocytes in both test and control animals. The findings thus suggest that endogenous histamine released in immune inflammation most probably plays the same role as in non-immune inflammation by enhancing the vascular permeability at the inflammatory site in the early phase of the inflammatory reaction.

Dendritic cells in human blood and synovial exudates

Dendritic cells from human blood and synovial exudates are distinct from other leukocytes and are homogeneous by several criteria. Morphologically, their most prominent feature is numerous veils. Phenotypically, dendritic cells lack the surface antigens that identify monocytes, T cells, B cells, and NK cells. Human dendritic cells strongly express class I and class II MHC products, and have a distinct array of integrin and adhesin molecules. In many systems, dendritic cells are potent stimulators of T cell function. In the allogeneic mixed leukocyte reaction, for example, dendritic cells are 30-100 times more efficient than other cells in presenting transplantation antigens, for the induction of DNA synthesis, cytokine release, and generation of cytotoxic T cells. In addition, dendritic cells can induce the long-term clonal growth of T lymphocytes. Although dendritic cells are a minor subpopulation in human blood, new isolation protocols are available that permit efficient isolation and enrichment to > 90%.

Exudative indices in airways inflammation

Airways inflammation has come to be equated with the presence of inflammatory cells and their products in airway lumen and tissue. However, the inflammatory condition must also, or rather, be determined by indices which show to what degree the tissue itself is affected by the process. Plasma exudation from abundant subepithelial microvessels is a specific defence/inflammatory tissue response to mucosal provocations; promptly after extravasation, the plasma exudate reversibly and non-injuriously creates intercellular pathways across the mucosa; the exudate enters the airway lumen without compromising the epithelial lining as a barrier to luminal solutes; there is a good correlation between surface and tissue plasma exudates. I propose that plasma tracers on the mucosal surface can identify the ongoing airway inflammation, its intensity and time-course in great detail.

Enhancement of inflammatory reactions in a non-immunological air pouch model in rats

In a carboxymethyl cellulose (CMC) air pouch inflammation model, accumulation of exudate decreased at a relatively rapid rate and almost disappeared 3 days after a 2% CMC injection into the preformed air pouch. After a second injection of 2% CMC solution into the 1-day-old CMC pouch on the day following the first CMC injection, the decrease in rate of exudate was similar to the change seen after the first CMC injection. In another group of rats, 3 days after the first CMC injection when inflammation had subsided, a second injection of 2% CMC solution into the 3-day-old CMC pouch resulted in a marked increase of exudate accumulation, inflammatory cell infiltration and vascular permeability. Histologically, large numbers of macrophages accumulated in the 3-day-old CMC pouch and fibroblast proliferation and newly formed blood vessels were also visible. The enhanced exudative reaction was significantly inhibited by dexamethasone but not by indomethacin. These results indicate that the enhanced inflammatory reactions appear to be closely correlated with the increase of reactivity at the site of inflammation and the exudative reaction was not mediated by cyclo-oxygenase products.

Intravenous endotoxin recruits a distinct subset of human neutrophils, defined by monoclonal antibody 31D8, from bone marrow to the peripheral circulation

Human neutrophils label with fluorochrome-labeled monoclonal antibody 31D8 as bright or dull. We determined the source and fate of 31D8 dull neutrophils by studying volunteers injected with endotoxin, epinephrine, or hydrocortisone, by examining bone marrow, and by examining skin blister exudate. We find that 31D8 dull neutrophils are normally not present in significant numbers in the circulation, are present in large numbers in normal marrow, and are recruited from the marrow by endotoxin, to a lesser extent by steroid, but not at all by epinephrine. 31D8 dull pattern correlates with morphologic immaturity in postendotoxin peripheral blood and bone marrow; however, blister exudate neutrophils contain only morphologically mature neutrophils, of which a significant number are 31D8 dull. We conclude that 31D8 dull neutrophils reside primarily in bone marrow and are released by agents which enhance bone marrow release of neutrophils. Their accumulation in skin blister exudate is unexplained, but suggests a special role in the inflammatory process.

The cellular exudate--Mycobacterium leprae relationship and the critical reading of skin smears

A careful reading of conventionally stained Ziehl-Neelsen skin smear preparations in leprosy provides a number of insights into the patient's situation, including his approximate position in the spectrum. This data serves as a cross-check on the primary results of the smear examination, and aids their interpretation for the purposes of diagnosis, assessment of the response to chemotherapy and the possible onset of relapse.

Differential expression of membrane sialoglycoproteins in exudate and resident mouse peritoneal macrophages

Wheat germ agglutinin (WGA) has been used to define biochemical differences between exudate and resident macrophages in the peritoneal cavity of mice. Western blotting with 125I-WGA identifies a restricted set of glycoproteins in elicited peritoneal macrophages (M phi) (recruited with thioglycollate or periodate) and fully activated M phi (recruited with live Bacille Calmette-Guerin, or heat-killed Corynebacterium parvum); the major species migrates with Mr 89–115 kDa in 10% acrylamide gels. These glycoproteins are not detected in resident peritoneal M phi, nor in thymocytes, neutrophils, lymphocytes and a variety of non-M phi cell lines. The binding of WGA is sensitive to neuraminidase, which exposes binding sites on these proteins for peanut agglutinin and reduces their electrophoretic mobility; these features are typical of O-linked sialo-oligosaccharides. In culture, exudate M phi increase their WGA-binding content over 48 h, and continue to display a phenotype distinct from that of resident peritoneal M phi. The stable differential expression of these sialoglycoproteins, by elicited and activated versus resident peritoneal M phi, suggests that biochemical modification during the synthesis and expression of membrane glycoproteins accompanies M phi recruitment to an inflammatory focus.