Ovarian cancer after successful ovulation induction: a case report

BACKGROUND

Questions have been raised regarding the potential association of ovulation-inducing drugs and ovarian cancer. Worldwide there have been 13 cases of ovarian carcinoma reported to occur in women previously treated with ovulation-inducing drugs (clomiphene citrate and/or gonadotropins).

CASE

A 40-year-old woman complained of secondary infertility. She conceived after five cycles of human menopausal gonadotropins with intrauterine insemination. Eight months after cesarean delivery, she presented with right lower quadrant pain and a right adnexal mass. At exploratory laparotomy the patient was found to have a poorly differentiated papillary serous carcinoma of the ovary.

CONCLUSION

Ovarian carcinoma developed within 18 months of exposure to ovulation-inducing agents, human menopausal gonadotropins. It would be prudent to gather a registry of cases to assess the risk associated with human menopausal gonadotropins with or without gonadotropin-releasing hormone analogs.

An evaluation of the safety and efficacy of fluconazole in the treatment of onychomycosis

Sixteen subjects were enrolled in this open-label noncomparative study to evaluate the safety and efficacy of fluconazole as a single daily dose for a period of 6 months. Liver function enzymes were monitored to assess safety. An adverse function questionnaire was used on a monthly basis to assess patient tolerance. A visual analogue scale was used to assess efficacy of treatment. After 6 months of fluconazole, all subjects experienced improvement in the appearance of their nails. None of the subjects evidenced any elevation in liver function enzymes. Adverse reactions were limited and consistent with other studies involving fluconazole. Fluconazole proved to be safe and efficacious in the treatment of onychomycosis. Further studies are needed to determine a cost-effective dosing regimen for the treatment of onychomycosis with fluconazole.

Vanadate and bafilomycin A1 are potent inhibitors of the ATPase activity of the reconstituted bacterial ATP-binding cassette transporter for maltose (MalFGK2)

Vanadate and Bafilomycin A1 were shown to inhibit the ATPase activity of the reconstituted binding protein-dependent ATP-binding Cassette (ABC) transporter for maltose (MalFGK2) of Salmonella typhimurium in the micromolar range. This is in sharp contrast to the recent finding that the isolated ATPase subunit MalK was insensitive to both compounds. Our data provide the first experimental evidence for the view that functional coupling of the ATPase domain of an ABC transporter to the membrane-integral domains is crucial for conferring sensitivity to vanadate and bafilomycin A1. Possible consequences for the mode of action of ABC transport proteins are discussed.

Renal artery velocity mapping with MR imaging

An MR phase imaging sequence with a very short echo time was used to assess blood velocity and flow at the renal artery bifurcation. Cardiac-gated MR imaging data were obtained in six healthy subjects in sagittal planes adjacent to the abdominal aorta and transverse planes above and below the renal artery bifurcation. Average renal artery flow rate was 23.8 +/- 9 mL/sec. A strong individual variability was found for the velocity profiles in the abdominal aorta during end-systolic regurgitation. Flow rate was also determined in three patients with reduced renal artery blood flow. Two patients received therapy with percutaneous transluminal angioplasty. The successful outcome was documented with MR imaging. A reliable assessment of renal artery flow with MR phase imaging is feasible. Measurement of the velocity profiles yields valuable insights in the complicated flow regime at the renal artery bifurcation.

Cross-resistance to camptothecin analogues in a mitoxantrone-resistant human breast carcinoma cell line is not due to DNA topoisomerase I alterations

We have previously described a mitoxantrone-resistant human breast carcinoma cell line, MCF7/MX, in which resistance was associated with a defect in the energy-dependent accumulation of mitoxantrone in the absence of P-glycoprotein overexpression (M. Nakagawa et al., Cancer Res. 52: 6175-6181, 1992). We now report that this cell line is highly cross-resistant to the camptothecin analogues topotecan (180-fold), 9-aminocamptothecin (120-fold), CPT-11 (56-fold), and SN38 (101-fold), but is only mildly cross-resistant to the parent compound camptothecin (3.2-fold) and 10,11-methylenedioxy-camptothecin (2.9-fold). Topotecan accumulation was decreased in MCF7/MX cells compared to parental MCF7/WT cells, and there was a corresponding reduction in topotecan-mediated stimulation of the enzyme/DNA complex formation in MCF7/MX cells compared to MCF7/WT cells. No overexpression of the multidrug resistance-associated protein was detected compared to parental MCF7/WT cells. Furthermore, both sensitive MCF7/WT and mitoxantrone-resistant MCF7/MX cells contain equal amounts of DNA topoisomerase I protein, and DNA relaxation activities were equal in both cell lines and inhibited to the same extent by topotecan and camptothecin. Thus, these results suggest a novel mechanism of resistance to topoisomerase I inhibitors in cancer cells.

The MalK protein of the ATP-binding cassette transporter for maltose of Escherichia coli is accessible to protease digestion from the periplasmic side of the membrane

The ATP-hydrolyzing subunit MalK of the ATP-binding cassette transporter for maltose of Escherichia coli is demonstrated to be accessible to digestion by proteinase K in right-side-out membrane vesicles. This finding suggests a partial transmembrane orientation of the protein.

Precise epitope mapping of three monoclonal antibodies raised against tms1 protein of fission yeast

Recently we described the production of two monoclonal antibodies 10G2 and 10C4 of IgG3 subclass raised against the recombinant tms1 protein of fission yeast. Here we introduce a new monoclonal antibody 2E2 of IgG1 subclass and present the precise epitope mapping of these monoclonal antibodies using tms1 deletion mutants and synthetically produced oligopeptides spanning the tms1 protein by immunoblot analysis.

A new therapeutic approach to popliteal artery entrapment syndrome (PAES)

OBJECTIVES

An alternative therapeutic approach to popliteal artery entrapment syndrome (PAES) with vascular complications.

MATERIALS

Three male patients (16, 42 and 68 years) with thrombotic and/or embolic obstructions of popliteal or crural vessels as a consequence of popliteal entrapment syndrome.

METHODS

Combined catheter treatment consisting of percutaneous transluminal thrombembolectomy (PTEE), local thrombolysis (LTL) and percutaneous transluminal dilatation (PTA) was performed for thrombotic and embolic obstructions of popliteal or crural vessels. The aberrant tendomuscular structures were surgically corrected at a later date.

RESULTS

After the procedure systolic ankle/arm pressure ratios in the three patients improved from 0.66 to 1.13, 0.57 to 1.07 and 0.46 to 1.10. Twelve, 8 and 4 months later the patients were asymptomatic. None of the patients showed popliteal artery compression during plantar flexion on Duplex scanning.

CONCLUSIONS

This new therapeutic approach avoids direct vascular surgery with bypass or patch implantation in patients with PAES who are often young. The long term results remain to be evaluated.

Murine hematopoietic progenitors are capable of both histamine synthesis and uptake

We examined various murine hematopoietic cell populations for their capacity to interact with radiolabeled histamine. Only bone marrow cells (BMC) retained substantial amounts of radioactivity, in contrast to thymus, spleen, and peritoneal cells. The characteristics of this interaction are consistent with histamine uptake rather than receptor binding. Indeed, this process is temperature and sodium dependent and reduced by various metabolic inhibitors. Furthermore, the effect of antagonists or agonists of the H1, H2, and H3 receptor subtypes is not in accordance with the involvement of either of these receptors in histamine binding. The target cells of histamine copurify with hematopoietic progenitors in the low-density BM population. They are most enriched in the subset sorted from the blast cell window on the basis of high rhodamine retention. This fraction contains on the average 80% to 90% immature cells and is highly enriched for several clonogenic progenitor subsets. Sixty percent of the Rh-bright cells are labeled by 3H-histamine, as assessed by autoradiography, suggesting that a variety of immature cells participates in this phenomenon. Furthermore, in all sorting procedures used here, the cells capable of histamine uptake coenrich with those producing histamine in response to interleukin-3, indicating at least a partial identity between these cells.

Effects of monoionic and nonionic radiographic contrast media on cutaneous microcirculation in patients with peripheral arterial occlusive disease

The purpose of the study was to compare the in vivo effects of two low-osmolar radiographic contrast media, a monoionic (sodium/-meglumine ioxaglate, Hexabrix) and a non-ionic one (iopromide, Ultravist 300) on the cutaneous microcirculation in patients with peripheral arterial occlusive disease in a prospective randomised double-blind study. In 20 patients with peripheral arterial occlusive disease scheduled for percutaneous transluminal angioplasty skin microcirculation was assessed by laser Doppler fluxmetry and transcutaneous oxygen tension measurements at the foot dorsum for continuous recordings of the cutaneous microvascular perfusion and skin oxygenation. Before angioplasty 10 ml nondiluted contrast medium was injected intraarterially and the acute effect on transcutaneous oxygen tension and laser Doppler flux was registered. Mean laser Doppler flux and oxygen tension were evaluated initially, after arterial puncture and after contrast medium injection. In addition, flux motion was analysed with respect to frequency and amplitudes changes. No significant changes in laser Doppler flux and fluxmotion patterns were found between both groups after contrast medium injection. However, mean transcutaneous oxygen tension of the patients receiving monoionic ioxaglate dropped significantly (P = 0.01). The differences of both contrast media on red blood cell aggregation shown in vitro do not correlate to intravital microcirculatory measurements in patients with arterial occlusive disease of the lower limb. Microvascular skin blood flow and flux motion at the foot in these patients do not change significantly after intraarterial injection of ioxaglate and iopromide. However, oxygen supply of the skin is transient impaired after interarterial injection of the anionic contrast agent ioxaglate, which was not associated with clinical symptoms.

Role of interleukin-2 receptors in the suppressive effect of spleen cells from anti-CD3-treated mice

In the present study, we demonstrate that unresponsive spleen T cells from mice injected with a low dose of anti-CD3 mAb (single 10 micrograms i.v. injection) significantly inhibit Con A-induced proliferation of normal spleen cells. The induction of this phenomenon requires in vivo activation since spleen cells from mice injected with the F(ab')2 fragment of anti-CD3 mAb fail to promote it. Suppression of normal T cell proliferation is concomitant with increased expression of IL-2 receptor on spleen cells from anti-CD3-treated mice. It disappears within 3 days when IL-2R has returned to background levels. A normal proliferative response to Con A can be restored when high concentrations of IL-2 are added together with the "suppressor" cells. Taken together, these data support the notion that activated spleen cells from anti-CD3-injected mice exert their inhibitory effect by competing for the IL-2 generated during culture.

Heavy ion-induced DNA double-strand breaks with yeast as a model system

Cells of diploid yeast, Saccharomyces cerevisiae, were exposed to a variety of energetic heavy ions (provided by the UNILAC facility at the Gesellschaft für Schwerionenforschung, GSI), 241Am alpha-particles and 80-keV x-rays after which they were assessed for DNA double-strand breaks (DSB) using either the neutral sedimentation or the pulsed-field gel electrophoresis (PFGE) technique. Both yielded comparable results. The DSB production cross-sections are compared with inactivation studies performed for the same cells under identical conditions. The measurements show that with lighter ions DSB induction cross-sections increase with linear energy transfer (LET), but the situation is less clear with the heavier ions. A close parallelism was found between DSB induction and cell inactivation in these yeast cells.

Filgrastim treatment of three patients with clozapine-induced agranulocytosis

BACKGROUND

Agranulocytosis is the most serious side effect of clozapine therapy, occurring in approximately 1% of all treated patients. Despite careful blood monitoring, a significant number of cases of agranulocytosis and resulting fatalities have occurred. Strategies are needed to manage clozapine-induced agranulocytosis more safely.

METHOD

This report describes the management of three state hospital inpatients who developed clozapine-induced agranulocytosis. All patients were diagnosed as having chronic paranoid schizophrenia according to DSM-III-R criteria and had previously failed to respond to treatment with standard antipsychotic medications. After onset of agranulocytosis, all patients were transferred to a medical service in a university hospital and treated with recombinant granulocyte colony-stimulating factor (filgrastim).

RESULTS

White blood count and absolute neutrophil count returned to within normal limits in each patient after 5 to 8 days of treatment with filgrastim 300 micrograms/day subcutaneously. No side effects were observed during filgrastim treatment.

CONCLUSION

Treatment with filgrastim appears to be safe and effective in decreasing the duration of clozapine-induced agranulocytosis. While further studies are necessary to establish the safety and effectiveness of this treatment, filgrastim should presently be considered a treatment of choice for clozapine-induced agranulocytosis.

[Diagnosis of Lyme borreliosis]

Lyme borreliosis is an infectious disease, caused by the spirochaete Borrelia burgdorferi and transmitted by ticks, in our regions by the tick Ixodes ricinus. The disease mainly affects skin, nervous system, joints and heart. Lyme borreliosis develops in three stages, and the various clinical manifestations may assigned to the respective stages. As far as skin is concerned, in stage I typically appears erythema chronicum migrans, very often accompanied by flu-like symptoms; in stage III, months to years after the manifestations of the early phase, acrodermatitis chronica atrophicans, may be encountered. Among the neurological manifestations, in stage II, meningoradiculoneuritis (Bannwarth's syndrome) develops as the most frequent disease, characterized by pheripheral paresis at the lower extremities and bilateral facial nerve palsy. Lyme arthritis mainly affects the knee. To assure the diagnosis of Lyme borreliosis, a number of serological tests is performed as the direct detection of the causative agent is rather difficult and time consuming. Possibly, the use of the polymerase chain reaction to detect B. burgdorferi DNA may improve the diagnostic tools.

Induction of HPRT- mutants in Chinese hamster V79 cells after heavy ion exposure

The induction of resistance to 6-thioguanine by heavy ion exposure was investigated with various accelerated ions (oxygen-uranium) up to linear energy transfer (LET) values of about 15,000 keV/microns. Survival curves are exponential with fluence; mutation induction shows a linear dependence. Cross-sections (sigma i: inactivation, sigma m: mutation) were derived from the respective slopes. Generally, sigma i rises over the whole LET range, but separates into different declining curves for single ions with LET values above 200 keV/microns. Similar behaviour is seen for sigma m. The new SIS facility at GSI, Darmstadt, makes it possible to study the effects of ions with the same LET but very different energies and track structures. Experiments using nickel and oxygen ions (up to 400 MeV/u) showed that inactivation cross-sections do not depend very much on track structure, i.e. similar values are found with different ions at the same LET. This is not the case for mutation induction, where very energetic ions display considerably smaller induction cross-sections, compared with low-energy ions of identical LET. Preliminary analyses using the polymerase chain reaction (PCR) demonstrate that even heavy ions cause "small alterations" (small deletions or base changes). The proportion of the total deletions seems to increase with LET.

Killing and mutation of Chinese hamster V79 cells exposed to accelerated oxygen and neon ions

Mutation induction by accelerated heavy ions to 6-thioguanine resistance (HPRT system) in Chinese hamster V79 cells was investigated using oxygen and neon ions with energies between 1.9 and 400 MeV/mu, corresponding to LET values between 18 and 754 keV/microns, respectively. Because of technical limitations most experiments could be performed only once. Inactivation and mutation induction cross sections, sigma i and sigma m, were obtained from the slopes of the exponential survival and the linear mutation induction curves, respectively. Both parameters increased with LET up to about 200 keV/microns, where the curves separated for the two types of ions. Calculated RBEs were higher for mutation induction than for killing for all LET values.

Drug-induced apoptosis is not necessarily dependent on macromolecular synthesis or proliferation in the p53-negative human prostate cancer cell line PC-3

The propensity of a cell to undergo apoptosis has been proposed to be a determinant for chemotherapy sensitivity that is not directly dependent on specific drug-target interactions. Androgen-independent prostate cancer is typically refractory to cytotoxic drugs, and we tested whether this is due to a loss of the ability to undergo apoptosis. Exposure of the hormone-insensitive and p53-negative human prostate carcinoma cell line PC-3 to 22 microM cisplatin, 1 microM camptothecin, 10 microM tenoposide, 135 nM vincristine, or 10 microM lovastatin for 72 h caused cell death, internucleosomal DNA fragmentation, and morphological changes typical for apoptosis. One microM cycloheximide prevented anticancer drug-induced apoptosis, whereas high concentration (1 mM) of cycloheximide alone induced apoptosis, indicating that protein synthesis was not needed for these cells to undergo apoptosis. Since cycloheximide affected DNA synthesis and proliferation of PC-3 cells, we tested whether the DNA polymerase inhibitor aphidicolin could also suppress drug-induced apoptosis. In contrast to cycloheximide, aphidicolin inhibited only vincristine-induced apoptosis. Cycloheximide prevented drug-induced changes in cell cycle distribution except for vincristine, while aphidicolin led to an accumulation of cells at the G1-S border independent of the drug used. These data indicate that macromolecular synthesis, active cell cycling, and p53 expression are not required for apoptosis to proceed in this system.

Two formats of enzyme immunoassay for the detection of saxitoxin and other paralytic shellfish poisoning toxins

A competitive direct enzyme-linked immunofiltration assay for the detection of saxitoxin was developed, using polyclonal antibodies against saxitoxin and a saxitoxin-horseradish peroxidase conjugate. The test was performed in an eight-well plastic test device, in which antibody-coated nylon membranes were pressed tightly to an absorbent cellulose layer. Saxitoxin standard or sample extract solution, saxitoxin-conjugate, and enzyme substrate/chromogen solution were sequentially added on to the membrane. The test was evaluated visually by comparing the intensity of the resulting coloured (blue) dot with that of a negative control. The detection limits for saxitoxin in buffer solution and in shellfish tissue were 4 ng/ml and 80 ng/g respectively, with an assay time of less than 15 min. Under the conditions of the immunofiltration assay, decarbamoyl-saxitoxin, gonyautoxin 2/3, and neosaxitoxin standards (in buffer) gave a positive response at concentrations of about 10 ng/ml, 40 ng/ml, and 80 ng/ml, respectively. The relative cross-reactivity of the antibody to these PSPs was similar when determined using both direct and indirect (using a saxitoxin-bovine serum albumin conjugate) competitive enzyme immunoassays in microtitre plate format. In competitive direct microtitre plate assays, the 50% binding values found for saxitoxin, decarbamoyl-saxitoxin, gonyautoxin 2/3 and neosaxitoxin were 15 pg/ml, 47.5 pg/ml, 163.5 pg/ml, and 510 pg/ml respectively. In competitive indirect microtitre assay, the respective values were 138 pg/ml, 404 pg/ml, 1582 pg/ml, and 6982 pg/ml.

Multimycotoxin dipstick enzyme immunoassay applied to wheat

A membrane-based visual dipstick enzyme immunoassay for the simultaneous detection of up to five mycotoxins was developed. Multiple dots of the respective antibodies against aflatoxin B1 (AFB1), T-2 toxin (T-2), 3-acetyldeoxynivalenol (3-AcDON), roridin A (RA), and zearalenone (ZEA) were applied onto a dipstick membrane. The competitive immunoreactions were performed by incubation of the dipstick in a test tube containing sample solution and a mixture of the respective toxin-horseradish peroxidase conjugates. After a second incubation in enzyme substrate/chromogen solution, a complete suppression of the (blue) colour development of the respective dot was scored positive. Visual detection limits for AFB1, T-2, 3-AcDON, RA, and ZEA in buffer solution were 2 ng/ml, 5 ng/ml, 50 ng/ml, 30 ng/ml, and 5 ng/ml respectively. Using a simple extraction procedure, the detection limits of the multimycotoxin assay in artificially contaminated wheat samples were 30 ng/g, 100 ng/g, 600 ng/g, 500 ng/g, and 60 ng/g, respectively.

Ca2+/Mg(2+)-dependent endonuclease activation is an early event in VP-16-induced apoptosis of human breast cancer MCF7 cells in vitro

Apoptosis is now recognized as one of the major processes regulating the size of cell populations. However, despite intensive investigations the biochemical and enzymological mechanisms involved in apoptosis remain unclear. In the present study we demonstrate activation of a Ca2+/Mg(2+)-dependent endonuclease during VP-16-induced apoptosis in MCF7 cells. Nuclease activation occurred prior to the appearance of internucleosomal DNA fragmentation, suggesting that this activation may be an early and possibly critical step in drug-induced apoptosis. Analysis of the internucleosomal DNA fragments showed that they contained phosphorylated 5'-ends, indicating that they were produced by a Ca2+/Mg(2+)-dependent endonuclease.

Murine hematopoietic progenitor cells produce IL-6 in response to IgE

Similarly to interleukin-3 (IL-3), IgE is capable of inducing IL-6 production by murine bone marrow cells (BMC). IgE responder cells do not belong to the mature bone marrow compartment but coenrich with hematopoietic progenitors in the low-density fraction of a discontinuous Ficoll gradient. A significant enhancement of IL-6 production is observed after a 4-hour stimulation, reaching a maximum between 24 and 48 hours and is preceded by increased mRNA expression. The effect of IgE on IL-6 production is not mediated by IL-3 since it is not modified by anti-IL-3 antibodies. Upon a 4-hour exposure to IgE or IL-3, a similar percentage of progenitor-enriched BMC expresses IL-6 mRNA (3.9 and 5.4%, respectively, as determined by in situ hybridization), which is not further increased by a combination of both stimuli. IgE and IL-3 responder cells also cannot be distinguished on the basis of size, internal structure, and rhodamine (Rh) retention. The BMC sorted in the most fluorescent Rhbright subset (approximately 0.2% of total BMC) produce 30- to 40-fold more IL-6 than unfractionated cells and are similarly enriched for CFU-cells (CFU-C). The most primitive cells concentrated in the Rhdull fraction do not express this biological activity. The sorted Rhbright population does not contain mature mast cells/basophils or monocytes, and IL-6 is not produced in response to Fc epsilon RI cross-linkage after presensitization with IgE.

Buthionine sulphoximine-mediated sensitisation of etoposide-resistant human breast cancer MCF7 cells overexpressing the multidrug resistance-associated protein involves increased drug accumulation

Preincubation of etoposide-resistant human MCF7 breast cancer cells (MCF7/VP) with buthionine sulphoximine (BSO) resulted in their sensitisation to etoposide and vincristine. Chemosensitisation was accompanied by elevated intracellular drug levels. In contrast, simultaneous exposure to BSO did not result in increased drug accumulation. Similar, but quantitatively smaller, effects were also observed when sensitive wild-type MCF7/WT cells were treated with BSO. In agreement with its effect on drug accumulation, BSO pretreatment also increased VP-16-stimulated cleavable complex formation between DNA topoisomerase II and cellular DNA. BSO treatment also led to a significant increase in acid-precipitable VP-16 levels in MCF7/VP, but not MCF7/WT cells. In contrast, no clear effects of BSO on drug efflux were observed and drug retention was only minimally increased after BSO treatment of both MCF7/WT and MCF7/VP cells and no difference between the two cell lines was detected. Thus, chemosensitisation by BSO appeared to be mediated through increased intracellular drug concentrations and/or protein binding.