Pelvic pain, free fluid in pelvis, and human chorionic gonadotropin serum elevation: recurrence of malignant ovarian germ-cell tumor or early pregnancy?

Conservative treatment of metastatic germ-cell tumor of the ovary does not exclude the possibility of pregnancy in the future. Serum beta-human chorionic gonadotropin (beta-hCG) serves as pregnancy test, and has also been proven to be a useful marker for ovarian germ-cell tumors. This paper is a case report of a 19-year-old patient who was admitted to a district hospital in emergency due to pelvic pain, amenorrhoea, and free fluid in the pelvis. Laboratory tests demonstrated slight increase in beta-hCG serum concentration and transvaginal ultrasound (TVUS) showed no evidence of gestational sac in the uterus. At the age of 14, the patient was diagnosed with malignant germ-cell tumor of the left ovary in FIGO Stage IV and was treated with four courses of chemotherapy according to TGM-95 protocol with etoposide, ifosfamide, and cisplatin, followed by conservative surgery and adjuvant two courses of cytostatics. The initial diagnosis was recurrence of ovarian malignancy and the patient was referred to an oncology center. Wait-and-see approach and repeated ultrasound examination confirmed a normal intrauterine pregnancy which concluded with the delivery of a healthy newborn through cesarean section.

Prevalence of dental erosion in adolescent competitive swimmers exposed to gas-chlorinated swimming pool water

Objectives

The purpose of this study was to analyze the prevalence of dental erosion among competitive swimmers of the local swimming club in Szczecin, Poland, who train in closely monitored gas-chlorinated swimming pool water.

Materials and methods

The population for this survey consisted of a group of junior competitive swimmers who had been training for an average of 7 years, a group of senior competitive swimmers who had been training for an average of 10 years, and a group of recreational swimmers. All subjects underwent a clinical dental examination and responded to a questionnaire regarding aspects of dental erosion. In pool water samples, the concentration of calcium, magnesium, phosphate, sodium, and potassium ions and pH were determined. The degree of hydroxyapatite saturation was also calculated.

Results

Dental erosion was found in more than 26 % of the competitive swimmers and 10 % of the recreational swimmers. The lesions in competitive swimmers were on both the labial and palatal surfaces of the anterior teeth, whereas erosions in recreational swimmers developed exclusively on the palatal surfaces. Although the pH of the pool water was neutral, it was undersaturated with respect to hydroxyapatite.

Conclusion

The factors that increase the risk of dental erosion include the duration of swimming and the amount of training. An increased risk of erosion may be related to undersaturation of pool water with hydroxyapatite components.

Clinical relevance

To decrease the risk of erosion in competitive swimmers, the degree of dental hydroxyapatite saturation should be a controlled parameter in pool water.

Brillouin study of photopolymerization process of two-monomer systems

The results of Brillouin scattering investigations of two-component system: 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane/polyethylene glycol methacrylate (bis-GMA/PEGMM) containing 0, 30, 50, 70, 85 and 100 mol% of PEGMM are presented. For the first time the Brillouin spectroscopy was used to monitor the progress of the polymerization process. The polymerization was initiated by ultraviolet radiation (λ=365 nm), at temperature 20°C and 40°C. Some of the physical parameters characteristic for this system such as velocity V, adiabatic compressibility β(ad) and attenuation coefficient α of the acoustic waves have been estimated from Brillouin spectra as a functions of the polymerization time. The obtained results have been discussed in terms of changes of the elastic properties of the two-component system occurring during polymerization process and their dependence on bis-GMA/PEGMM system composition.

Evaluation of the phenotype pattern of macrophages isolated from malignant and non-malignant pleural effusions

Macrophages are among the infiltrate components of most malignant tumors. Tumor-associated macrophages (TAMs) may secrete a variety of humoral factors, which promote or inhibit tumor growth. In general, depending on their activation pathway, macrophages exhibit two different patterns of phenotype, M1 or M2. It is assumed that TAMs comprise pattern M2. In the malignant pleural effusion, macrophages are a frequent component of cytological evaluation. In this microenvironment, TAMs could be involved in the development of immunity. The phenotype of macrophages represented in malignant and non-malignant pleural effusions is unknown. In this study, macrophages were isolated from 38 pleural effusions (15 malignant and 23 non-malignant) and the expression of a variety of immune mediators and their receptors was assessed to determine the type of activation (M1 vs. M2). The expression of mRNA was analyzed for IL-1β, IL-4, IL-6, IL-10, IL-11, IL-18, TNFα, TGFβ1, IL1R1, IL1RAP, TLR2, TLR4, VLA4, CD62L, MMP2, MMP9, VEGFA, PDGFA, and PDGFB. In immunohistochemical evaluation, the expressions of CD68, mesothelin, MAC387, IL-1β, IL-6, IL-10, IL-12, TNFα, and CD105 were assessed. The cytoplasmic expression of IFNγ, TNFα, IL-6, and IL-10 and the surface expression of CD11a, CD14, CD15, CD16, CD23, CD25, CD45, CD54, CD62L, CD69, VLA2, VLA3, VLA4, VLA6, TLR2, TLR4, and CCR7 were tested using flow cytometry. In supernatants from macrophages cultures, TNFα, IL-1β, IL-6, IL-8, IL-10, IL-12, MCP1, and VEGF were investigated by cytometric beads array method (CBA flex sets) and TGFβ1 by ELISA. Our results indicate that macrophages from malignant and non-malignant pleural effusions differ from each other and suggest that macrophages isolated from non-malignant effusions show a pattern comparable to M1 while those isolated from malignant effusions express similarity to M2 phenotype, but they have not shown a classical M2 pattern.

Phenotype of dendritic cells generated from peripheral blood monocytes of patients with ovarian cancer

OBJECTIVES

The aim of our study was to generate dendritic cells (DCs) from peripheral blood monocytes (PBMC) of patients suffering from ovarian cancer.

MATERIALS AND METHODS

Immature DCs were generated from PBMC cultured in RPMI 1640 medium with 2% human serum albumin (HSA), supplemented with recombinant human (rh) granulocyte macrophage colony stimulating factor (GM-CSF) and rh interleukin (IL)-4. After 5 days of culture, DC maturation was induced by the addition of an ovarian cancer cell line (CAOV3) lysate and after 6 days of rh tumor necrosis factor (TNF)-α for a further 2 days. The phenotype of the generated cells was assessed by flow cytometry for the expressions of human leukocyte antigen (HLA)-DR, costimulatory molecules (e.g., CD86, CD80), CD83, CD1a, and CD14. PBMC cultured in 2% HSA without rhIL-4, rhGM-CSF, rh-TNF-α, or tumor cell lysate formed the control group.

RESULTS

The 2.41% (interquartile range, 1.51%-3.52%) of CD45+/CD14+ cells in cultures with rhIL-4, rhGM-CSF, rhTNF-α and tumor cell lysate was significantly lower than in the control group (31.10%; interquartile range, 11.11%-64.06%). Cultures with rhIL-4, rhGM-CSF, rhTNF-α, and tumor cell lysate showed a higher percentage (19.96%; interquartile range, 9.30%-24.42%) of fully mature CD83+/CD1a-/HLA-DR+ DCs compared with control culture (6.02%; interquartile range, 3.01%-7.37%). There was no significant difference in the expression of the immature DC marker (CD1a) between the cultures. The expression of co-stimulatory markers (CD80, CD86, HLA-DR) was greater (24.29%; interquartile range, 18.68%-33.95%) on DCs from cultures with rhIL-4, rhGM-CSF, TNF-α, and tumor cell lysate versus controls (4.93%; interquartile range, 2.67%-9.09%).

CONCLUSION

Our data demonstrated that immature and mature DCs can be generated from adherent human PBMC from ovarian cancer patients cultured with rhIL-4, rhGM-CSF, rhTNF-α, and tumor cell lysates.

Is it about the self or the significance? An fMRI study of self-name recognition

Our own name, due to its high social relevance, is supposed to have a unique status in our information processing. However, demonstrating this phenomenon empirically proves difficult as famous and unknown names, to which self-name is often compared in the studies, may differ from self-name not only in terms of the 'me vs. not-me' distinction, but also as regards their emotional content and frequency of occurrence in everyday life. In this fMRI study, apart from famous and unknown names we used the names of the most important persons in our subjects' lives. When compared to famous or unknown names recognition, self-name recognition was associated with robust activations in widely distributed bilateral network including fronto-temporal, limbic and subcortical structures, however, when compared to significant other's name, the activations were present specifically in the right inferior frontal gyrus. In addition, the significant other's name produced a similar pattern of activations to the one activated by self-name. These results suggest that the differences between own and other's name processing may rather be quantitative than qualitative in nature.

Influence of pleural macrophages on proliferative activity and apoptosis regulating proteins of malignant cells

Malignant tumors contain numerous macrophages as a major component of the leukocytic infiltrate. Only few studies have evaluated the interaction between products secreted by macrophages and tumor cells. Our objective was to study soluble factors produced by pleural macrophages. We sampled pleural effusions from patients with cancer and used human tumor cell lines as targets. Pleural macrophages were cultured and the supernatants were used as a conditioned medium for cultures of human cell lines A549, HT29, HCT116, SW620, MCF7, MDA-MB231, JURKAT, and HL60. We investigated apoptosis, proliferative activity, and expression of apoptosis regulating proteins Fas, Bcl2, Caspase-3, and survivin of malignant cells cultured in the conditioned medium. Our findings raise the possibility that macrophages from malignant pleural effusions can act as a factor inhibiting apoptosis of malignant cells.

Concentration of matrix metalloproteinase-9 in serum of patients with chronic obstructive pulmonary disease and a degree of airway obstruction and disease progression

Chronic obstructive pulmonary disease (COPD) is chronic inflammation leading to irreversible airway obstruction. Previous studies showed increased metalloproteinases (MMP) level, especially MMP-9, as a sign of local inflammation. Up-to-date, only a few studies estimated the MMP-9 serum concentration in COPD with respect to correlation with systemic inflammation. The aim of the present study was to estimate the MMP-9 serum concentration in COPD and to evaluate the correlation between MMP-9 and a degree of airway obstruction in COPD. Twenty three COPD patients and 23 healthy controls were enrolled. In both groups spirometry was performed. MMP-9 concentration in sera taken from both groups was studied using ELISA. We found that COPD patients had increased serum MMP-9 concentration compared with the control group (P=0.0005). In the COPD group, the MMP-9 levels were negatively correlated with FEV1 (P=0.01) and FEV1/FVC (P=0.0002). In conclusion, the results suggest that MMP-9 plays an important role in systemic inflammation in COPD. Higher MMP-9 serum concentration is connected with higher airway obstruction and disease progression.

[Multiple brain tuberculomas]

A case of multiple brain tuberculosis in 32-year-old men was described. The diagnosis was made on the result of histopathological examination of excised tuberculoma. Basing on the described case, current possibilities of tuberculoma diagnostic difficulties, caused by unspecific clinical manifestation and atypical radiological lesions, was drawn.

Challenges in care of adult CF patients--the specialist cystic fibrosis team

Cystic fibrosis (CF) is the most common life-limiting, autosomal, recessive genetic disorder. The gene which is responsible for the symptoms of this disease is located on the long arm of chromosome 7 and encodes the protein called Cystic Fibrosis Transmembrane Conductance Regulator (CFTR), an apical chloride channel in epithelial cells. CF is a "multi-system" disease. It affects many parts of the body and it has a varied clinical expression. All patients with CF should have access to specialist services and the treatment must be comprehensive and multidisciplinary. The multidisciplinary team approach is important when trying to optimize care given to the patient and their family. The cystic fibrosis team may include personnel from the following specialist areas: medical, nursing, physiotherapy, dietetics, psychological, social/supportive. Close coordination is vital. Ideally, 'all members of the team' should have had CF care-related training. The specialist team approach ensures that such specialized multidisciplinary expertise is applied in all aspects of care, better knowledge of individual families, continuity, knowledge of treatment advances and the ability to apply these in daily management. Doubtlessly CF team ensures families a specific point of contact and they know who to talk to. In 1997 The Department of Pulmonology Diseases in Poznań started running a programme for CF adults at our University--the second CF adult centre in Poland. Members of our CF team have experience in the management of adults who have cystic fibrosis. Its members include physicians, nurses, a physiotherpist, a dietitian, a social worker and a psychologist. We must to build the team approach in CF care and use effectively talents of multiprofessional team members as fully as possible to deliver better services to patients.

[Oral appliances in the treatment of snoring]

There are many methods of snoring treatment from conservative and prosthetic to surgical. The snoring sound is produced by vibration of the soft tissues of the pharynx, soft palate and also uvula. Snoring occurs in 50% of the adult male population and it can be isolated or sign of the obstructive sleep apnoea syndrome. Oral appliances modify the position of the mandibule, the tongue and other structures in oral cavity. Oral appliances are recommended for the treatment of snoring and mild obstructive sleep apnoea syndrome. That is why we constructed the study to assess wheather oral appliances correct snoring. 12 mails (aged 43-57) with intensive snoring for at least 50% of the sleep time were qualified to the treatment with oral appliances. The decision about the type of the device were made by ENT surgeon and maxillo-facial surgeon. The various oral appliances were used; some of which were modyfied by us. During the treatment snoring was tested with Poly-Mesam device. The best results were obtained with the use of devices that correct the position of soft palate and uvula. All the devices decreased snoring significantly. They were tolerated by the majority of patients.

[Cystic fibrosis diagnosed in 36-year old man]

Cystic fibrosis (CF) is the most common autosomal recessive disorder in Caucasians. There is considerable variability in the clinical presentation and course of cystic fibrosis. Adult patients with mild symptoms are increasingly being diagnosed with CF. We present a case of a man diagnosed with CF at age 36 years. The diagnosis was suspected because of recurrent nasal polyposis, bronchiectases, male infertility, and a positive sweat tests. One CFTR mutation was identified.

CONCLUSIONS

1. Cystic fibrosis should be included into the differential diagnosis of chronic respiratory symptoms in adults. 2. CF patients diagnosed in adulthood usually have milder clinical course of the disease.

[Adenocarcinoma of the lung with metastases to the pituitary and both adrenal glands]

A case of lung adenocarcinoma with metastases in both adrenals and pituitary gland in 52-year old patient is presented. Adrenal glands metastases were diagnosed on a base of CT scans. Pituitary metastases caused gradual loss of vision. MR imaging showed a lesion in the sella and suprasellar areas and suggested meningioma. Right frontal craniotomy with the partial removal of the tumor was performed. Three days later the patient died. Histopathological results of the pituitary masses revealed adenocarcinoma.