Prognostic assessment of uncomplicated first myocardial infarction by exercise echocardiography and Tc-99m tetrofosmin gated SPECT

BACKGROUND

We evaluate the prognostic value of stress echo and gated single photon emission computed tomography (SPECT) after a first uncomplicated acute myocardial infarction.

METHODS AND RESULTS

We used predischarge maximal subjective exercise echocardiography and gated SPECT with technetium 99m tetrofosmin to prospectively study 103 patients younger than 70 years with a first acute myocardial infarction. During a 12-month follow-up period, 2 patients died, 9 had heart failure, and 29 had ischemic complications (4 reinfarction and 25 angina). Predictive variables for heart failure in multivariate analysis were ejection fraction evaluated by echocardiography (odds ratio [OR] 8.5, P =.016) or by gated SPECT (OR 10.7, P =.009). Predictive variables for ischemic complications in multivariate analysis were less than 5 metabolic equivalents (METS) in exercise test (OR 5.2, P =.007) and greater than 15% ischemic extent in the polar map (OR 3.6, P =.04) of SPECT.

CONCLUSIONS

Exercise echocardiography and Tc-99m tetrofosmin gated SPECT were predictive for heart failure, but exercise SPECT was the only test with predictive power for ischemic complications.

Early sepsis, obstructive jaundice and right-sided diaphragmatic hernia in the newborn

A male newborn was admitted to our Unit because of early sepsis and shock. He required antimicrobial therapy and mechanical ventilation and initially did well, although he exhibited jaundice and cholestasis. During the second week he deteriorated, with radiological opacification of the right hemithorax and pleural effusion, and did poorly in spite of antibiotical therapy and drainage of the effusion. In the third week, the X-ray suggested some bowel loops in the right hemithorax. A right-sided diaphragmatic hernia was confirmed by a CT-scan, and surgery was performed with good outcome. The association of delayed-onset right-sided CDH following early sepsis and obstructive jaundice has not been published before, and illustrates a scarcely known form of presentation of this condition.

Tryptophan ingestion by pregnant rats induces pituitary and mammary tumours in the adult female offspring

The present study was designed to evaluate the long-term consequences of tryptophan treatment on the central serotonergic activity in the female offspring of rats, and particularly on serotonin-controlled hormone release. During the second half of gestation, tryptophan (200 mg/kg/day) was given daily by stomach intubation to pregnant rats and the brain concentrations of serotonin and 5-hydroxyindole acetic acid and the plasma concentrations of prolactin, progesterone, oestradiol and luteinizing hormone were quantified in the adult female offspring. The offspring showed an increase in hypothalamic serotonin and serum progesterone and prolactin. In addition, maternal ingestion of tryptophan induced a marked rise in 665-day-old offspring in the incidence of both pituitary prolactinomas (62%) and mammary adenomas (49%). Present data suggest that tryptophan regulates serotonergic differentiation during early development. A transitory modification of the tryptophan concentration in the fetal brain induces a permanent increase in hypothalamic serotonin level and, in addition to modifying the release of prolactin, increases the incidence of tumours in the hypophysis and mammary gland.

Apoptosis in carcinoma of the bladder: relation with radiation treatment results

PURPOSE

Radiotherapy is widely used in the treatment of bladder cancer. The search for biological parameters that could select patients who will respond to radiation treatment has become essential. The aim of this study is to assess whether the pretreatment apoptotic index is useful in predicting local control and survival in a group of bladder cancer patients treated by radiotherapy.

METHODS AND MATERIALS

Fifty-five patients with invasive bladder carcinoma treated between 1983 and 1996 were included in this study. Radiotherapy was given to a median dose of 66 Gy, mean 63.28 Gy, in 1.8-2 Gy daily fractions. Apoptotic cells were studied in hematoxylin-eosin slides. Clinicopathological tumor characteristics were studied in relation to the apoptotic index, and as prognostic factors for local control and survival in both univariate and multivariate analysis.

RESULTS

Pretreatment apoptotic indexes were related to tumor stage, mitotic index, and Ki67 proliferation index. Five-year actuarial local control for the whole group was 45%. Patients with tumors showing low pretreatment apoptotic indexes had better local control (p < 0.037) and survival (p < 0.01) than highly apoptotic tumors. Tumor stage (T2 vs. T3-4) and the pretreatment apoptotic index were significant predictive factors for local control and survival in multivariate analysis.

CONCLUSIONS

The pretreatment apoptotic index is useful in predicting the clinical outcome of bladder cancer patients treated by radiotherapy. Assessment of biological tumor characteristics could allow the selection of patients for different treatment strategies.

Lyn dissociation from phosphorylated Fc epsilon RI subunits: a new regulatory step in the Fc epsilon RI signaling cascade revealed by studies of Fc epsilon RI dimer signaling activity

Cross-linking the heterotrimeric (alpha beta gamma 2) IgE receptor, Fc epsilon RI, of mast cells activates two tyrosine kinases: Lyn, which phosphorylates beta and gamma subunit immunoreceptor tyrosine-based activation motifs, and Syk, which binds gamma-phospho-immunoreceptor tyrosine-based activation motifs and initiates cellular responses. We studied three Fc epsilon RI-dimerizing mAbs that maintain similar dispersed distributions over the surface of RBL-2H3 mast cells but elicit very different signaling responses. Specifically, mAb H10 receptor dimers induce very little inositol 1,4,5-trisphosphate synthesis, Ca2+ mobilization, secretion, spreading, ruffling, and actin plaque assembly, whereas dimers generated with the other anti-Fc epsilon RI mAbs induce responses that are only modestly lower than that to multivalent Ag. H10 receptor dimers activate Lyn and support Fc epsilon RI beta and gamma subunit phosphorylation but are poor Syk activators compared with Ag and the other anti-Fc epsilon RI mAbs. H10 receptor dimers have two other distinguishing features. First, they induce stable complexes between activated Lyn and receptor subunits. Second, the predominant Lyn-binding phospho-beta isoform found in mAb H10-treated cells is a less tyrosine phosphorylated, more electrophoretically mobile species than the predominant isoform in Ag-treated cells that does not coprecipitate with Lyn. These studies implicate Lyn dissociation from highly phosphorylated receptor subunits as a new regulatory step in the Fc epsilon RI signaling cascade required for Syk activation and signal progression.

Tumor proliferation, p53 expression, and apoptosis in laryngeal carcinoma: relation to the results of radiotherapy

BACKGROUND

Radiotherapy is used in the treatment of laryngeal carcinoma. The search for biologic parameters that could be used to identify patients who will respond to radiotherapy is crucial. The aim of this study was to determine whether the Ki-67 and p53 indices and the pretreatment apoptotic index would be useful in predicting local control and survival for a group of laryngeal carcinoma patients given postoperative radiotherapy.

METHODS

Fifty-seven patients with laryngeal carcinoma treated between 1988 and 1993 were included in this study. Postoperative radiotherapy was given to a mean dose of 57.7 gray (Gy) (range, 50-68; median, 60) in 2-Gy daily fractions. Ki-67 and p53 immunostaining were performed on paraffin-embedded tissue. Cells were evaluated for apoptosis using hematoxylin and eosin-stained slides. Clinicopathologic tumor characteristics were studied in relation to Ki-67, p53, and apoptotic indices, and as prognostic factors for local control and survival in both univariate and multivariate analysis.

RESULTS

The Ki-67, p53, and pretreatment apoptotic indices were not related to any clinicopathologic tumor characteristics. Five-year actuarial local control for the whole group was 47%. Patients with tumors that had low Ki-67 proliferation had better long term local control (P < 0.01). and survival (P < 0.03). p53 expression was not predictive of local control or survival in this study. Patients with tumors that had low pretreatment apoptotic indices had better local control (P < 0.049) and survival (P < 0.056) than patients with highly apoptotic tumors. Tumor extension and the pretreatment apoptotic index were significant predictive factors for local control and survival in multivariate analysis.

CONCLUSIONS

Ki-67 proliferation measurement and the pretreatment apoptotic index are useful in predicting the clinical outcome of laryngeal carcinoma patients referred for radiotherapy. The role of p53 oncoprotein determination in predicting these outcomes is unclear. Assessment of biologic tumor characteristics could aid in the selection of patients for different treatment strategies.

Signet-ring cells in a Waldenström's Macroglobulinaemia

A case of signet-ring cell lymphoma affecting bone marrow is reported. The patient was diagnosed as Waldenström's Macroglobulinaemia on the basis of clinical and laboratory features including morphology, immunohistochemistry and gene rearrangement studies. Light microscopy examination showed cells contained large globular inclusions (signet-ring cells) that stained for kappa immunoglobulin light chain by immunohistochemistry. In addition, the neoplastic cells expressed the common leukocyte antigen CD45 and the B cell marker CD19. This to the best of our knowledge is the first report of a patient with Waldenström's Macroglobulinaemia with the presence of vacuolated signet ring- cells in the bone marrow. Differential diagnosis arises with non-haemopoietic tumours and this needs to be based on specific immunostaining. Tumours and this need to be based on specific immunostaining.

Time resolution for visual information processing in Parkinson's disease

It has been suggested that a deficit in timing could be the cause of the sensory disturbances reported for Parkinson's disease. To test this hypothesis the temporal discrimination thresholds in four visual tasks were used to study 45 healthy young people, 14 healthy elderly people, and 17 patients with Parkinson's disease. In these tasks, subjects watched a computer controlled light emitting diode display and pushed a button when the visual event previously specified by the researcher was perceived. The time between successive images required to discriminate a visual detail was accurately quantified. In two of the four tasks, the time for visual processing of image sequences was longer in the elderly group than in the young group. No significant differences were found between patients with Parkinson's disease and their age matched controls for any of the four tasks. Present data show normal temporal discrimination and no slowing in the initial steps of visual processing in Parkinson's disease.

The role of Ki67 proliferation assessment in predicting local control in bladder cancer patients treated by radical radiation therapy

PURPOSE

To assess whether tumour proliferation as measured by Ki67 immunostaining has any predictive value for local control in bladder cancer patients treated by radiotherapy.

PATIENTS AND METHODS

Fifty-five patients suffering from infiltrating bladder carcinoma recommended for radical radiotherapy (66 Gy/6-7 weeks) were included in this study. Paraffin-embedded pre-treatment tumour sections were stained with the Ki67 antibody. The percentage of Ki67-positive nuclei was correlated with established prognostic factors, local control and survival.

RESULTS

The Ki67 index was not related to local control in our patients when the median was selected as the cut-off value. Patients with tumours with a very low (<27%) Ki67 index had better local control at 5 years (69%) than patients with tumours with greater (>27%) Ki67 expression indices (31.5%) (P<0.05; log-rank test).

CONCLUSIONS

Ki67 immunostaining was a feasible method to estimate tumour proliferation. Patients with very low proliferating tumours seemed to achieve better local control after fractionated radiotherapy compared to other patients. Further studies are needed with a greater number of patients to accurately define the role of Ki67 expression in predicting tumour repopulation during fractionated radiotherapy.

Tryptophan ingestion by gestant mothers alters prolactin and luteinizing hormone release in the adult male offspring

The effect of tryptophan administration to pregnant rats on the development of serotonergic systems and serotonin-related hormones in the offspring was studied. The male offspring of rats treated with tryptophan (200 mg/kg/day) during the second half of gestation showed a 4- to 7-fold increase in serum prolactin 40 and 70 days after birth and a 2-fold increase in serum luteinizing hormone 70 days after birth. The forebrain of adult offspring of tryptophan-treated rats showed an increase in serotonin and 5-hydroxyindoleacetic acid levels. Present data suggest that tryptophan regulates serotonergic differentiation during early development.

Motor lateralization, behavioral despair and dopaminergic brain asymmetry after prenatal stress

This paper presents data suggesting a relationship between rat behavioral despair in the Porsolt test and motor lateralization in the T-maze test. In addition, experimental evidence suggests a functional coupling among dopaminergic systems, behavioral despair and motor lateralization. In the first experiment, female, not male, rats with a high level of behavioral despair showed a low level of behavioral lateralization. The inverse relationship was found in female offspring of mothers stressed during gestation. In comparison with unstressed-mother rats, the female offspring of stressed mothers showed an increase of dopamine (DA) and a decrease of dihydroxyphenylacetic acid (DOPAC) and Homovanillic (HVA) levels and of DOPAC:DA and HVA:DA indexes in the n. accumbens of the right side of the brain. No significant differences were found in the n. accumbens of the left brain. Taken together, the present data provide evidence of a relation between behavioral despair and motor lateralization, suggesting that the biological dopaminergic inervation of n. accumbens could be the basis for this functional coupling. Because the stress of gestant mothers modified these biochemical and behavioral variables, the present study also suggests that lateralization of behavior and emotion during adulthood can be modified by prenatal variables.

Daily time course of the contents in monoamines and their metabolites in the pineal gland of Syrian hamster

Twenty-four h changes in endogenous tyrosine hydroxylase (TH) activity, monoamines and their metabolites as well as N-acetyltransferase (NAT) activity and melatonin content were investigated in the Syrian hamster pineal gland. Both NAT activity and melatonin content exhibited an expected rise 8 h (0400 h) after darkness onset. Pineal dopamine (DA) and 3,4-dihydroxyphenyl acetic acid (DOPAC) levels were highest during the dark phase reaching a peak at 0200 h, just prior to the rise in melatonin production. However no significant difference were found in both norepinephrine (NE) and TH activity levels during the 24 h period. However, in the present study, the rat pineal gland exhibited a clear day/night difference in its TH activity. These data suggest a possible role of pineal DA in the induction of melatonin synthesis in addition to its function as a NE precursor in the Syrian hamster pineal gland and also indicate that catecholamines may act on the hamster pineal in a different manner than in the rat.

Protein tyrosine phosphorylation in leukocyte activation through receptors for IgG

Membrane receptors for the Fc portion of immunoglobulin G (IgG) antibodies (Fc(gamma)Rs) are expressed on almost every type of hematopoietic cells, where they mediate a wide variety of effector functions. A high degree of structural heterogeneity exists among Fc(gamma)Rs. The biological significance of such heterogeneity is unknown, since the structural diversity does not appear to be reflected in the binding specificity nor in the effector functions that each distinct receptor is able to mediate. Recent work has emphasized the essential role of protein tyrosine phosphorylation in the initiation of transmembrane signaling by these receptors. In this article we review the role of protein tyrosine phosphorylation in signal transduction by the different types of Fc(gamma)Rs in order to assess to what extent the structural heterogeneity of this receptor family is related to different activation pathways utilized by each of its members.

Induced mitotic death of HeLa cells by abnormal expression of c-H-ras

When HeLa cells were selected for stable expression of a neo gene, linked either to mutated or wt c-H-ras genes, morphological examination of selected clones from several experiments revealed formation of giant multinucleated cells. These morphological alterations culminate in cell death, as a consequence of mitotic catastrophe (or mitotic death). Although clones expressing the mutated gene produced significantly larger numbers of these giant cells, those transfected with the normal allele were also found to produce significantly more giant multinucleated cells than non-transfected HeLa cells. Northern blot analysis of mRNA revealed overexpression of the normal H-ras gene in these clones. Chromatin structure analysis of these clones showed gross alterations, including the presence of micronuclei and heteroploid nuclei. Interestingly, odd numbers of nuclei were found in colonies of these giant cells. In addition, alterations in cell cycle parameters were observed, including the appearance of a subpopulation of cells with an abnormal content of DNA, probably representing dying cells. Our data support the notion that abnormal expression of H-ras contributes to mitotic catastrophe and death of a subpopulation of HeLa cells.

[Splenic lymphoma with circulating hairy lymphocytes lymphoma. Clinical cytological study of 4 patients]

PURPOSE

The splenic lymphoma with circulating villous lymphocytes (SLCVL) is an infrequent disease included within the low grade non Hodgkin's lymphoma, B-cell type. The results of the study of four patients are reported.

PATIENTS AND METHODS

Clinical, cytological, immunophenotypic, ultrastructural, evolutive and therapeutic data have been revised in all the cases.

RESULTS

Two males and 2 females of 76, 66, 68 and 62 years, respectively were diagnosed as having SLCVL. The initial symptoms were scarce, basically asthenia, and a big spleen without significant lymphadenopaty was the most relevant physical finding in each of them. In peripheral blood leukocyte count was normal with a slight lymphocytosis and a variable percentage of villous circulating lymphocytes. The immunophenotype of peripheral blood obtained by flow cytometry was according with a mature B-cell lymphocyte population, CD 5 and CD 25 negative. The cells were positive to acid phosphatase with a diffuse pattern of variable intensity; the reaction was inhibited by tartaric acid. All the patients had BM infiltration, studied with aspiration and biopsy. One case (M,66) had an IgM monoclonal gammopathy. The ultrastructural study, performed in 3 cases, showed thin and short villous prolongations. After splenectomy, a low degree lymphoma therapy has been employed in all the cases. The follow-up ranges between, 4 years and 4 months, all the patients being alive.

CONCLUSIONS

The SLCVL is a definitive entity regarding the clinical, morphologic and immunophenotype features. A long clinical evolution and a good prognosis after splenectomy are common.

Arteriosclerotic histologic evaluation of the internal mammary artery in patients undergoing coronary artery bypass grafting

During 1991, 52 patients undergoing myocardial revascularization had a biopsy of the distal internal left mammary artery (IMA) taken. There were 48 male and 4 female patients with a medium age of 58 years. Arteriosclerotic involvement of the IMA was assessed according to the scale of Kay. Using this index, grade 0 corresponds to a normal artery without atherosclerosis, grade 1 represents minimal disease, grade 2 a narrowing of less than 25% of the lumen, grade 3 narrowing between 25 and 50%, and grade 4 narrowing of 50% or greater of the lumen. Of the 52 IMA examined, the arteries with degree 0, 1, 2, 3, and 4 were: 19 (36.5%), 20 (38.4%), 9 (17.6%), 4 (7.6%) and zero. Thirty-three arteries (63.4%) had some degree of atherosclerosis. Considering the arteries with some atherosclerotic narrowing, 13 (25%) of the whole group had this pathological alteration. The IMA has a low but consistent incidence of arteriosclerosis involvement. Preoperative angiographic investigation of the IMA could be routinely performed.

Changes in tyrosine hydroxylase activity and melatonin synthesis in rat pineal glands throughout 72 hours of incubation

Time-dependent modifications of N-acetyltransferase (NAT) activity, melatonin content, and tyrosine hydroxylase (TH) activity within the isolated rat pineal over a 72 h of incubation period were studied. Both pineal NAT activity and melatonin content displayed similar decreases after 12 h of incubation, and reached a maximal reduction of 82% or 93%, respectively, after 48 h. However, a maximal decrease of pineal TH activity was only 47% after 72 h of incubation. Neither the nuclear area of pinealocytes, nor lactate dehydrogenase (LDH) activity in the incubation medium showed any significant variation dependent on the incubation time. Treatment with isoproterenol caused an expected elevation of NAT activity and melatonin content but was unable to modify TH activity. Since a significant degree of pineal TH activity remained following 3 days of incubation, a non-sympathetic source of TH within the rat pineal gland is suggested.

[Synthesis, function, and evolutionary origin of secondary metabolites produced by micro-organisms]

The microbial secondary metabolites are compounds with a wide range of chemical structures, produced mainly by actinomycetales and some fungi, usually in the late growth phase. Although a high proportion of this metabolites are antibiotics, there are also examples with pigment, herbicide and surfactant properties. Its function has been correlated to bacterial pathogenicity and cellular differentiation, however, properties dealing with chelation, hormonal and antitumor activities as well as nutritional reserve have been also reported. As in other examples of cellular compounds, the secondary metabolites are produced from low molecular weight precursors. For this purpose, specific biosynthetic pathways are utilized and regulated by processes which generally affect either the activity or the synthesis of the enzymes involved in it. Considering the secondary metabolites apparently are dispensable compounds, there are difficulties to explain their existence from an evolutionary point of view. Explanations to their existence have gone from laboratory artifacts to those conferring them an adaptative value in the past. It seems that they were maintained due to selective advantages to the producer microorganisms and probably, their sometimes complex biosynthetic pathways, have emerged from primary metabolites and evolved later independently by random mutation, amplification and genetic transfer.

Maternal ingestion of tyrosine during rat pregnancy modifies the offspring behavioral lateralization

It was previously reported that oral administration of tyrosine (500 mg/kg) to pregnant rats increases tyrosine and monoamines level in the fetal brain and modifies locomotion during postnatal life. In the present study, it was found that this treatment alters behavioral lateralization in the offspring. Neonatal rats whose mothers received tyrosine during the second half of gestation showed a low level of absolute and population laterality in both tail and head movements. The alteration of behavioral lateralization was also found during postnatal development and during adulthood. The T-maze behavioral ontogeny was different for tyrosine-mother and sham-treated or untreated mother rats. During adulthood, the T-max lateralization after stress sessions (a procedure that decreases alternation behavior and facilitates the quantification of behavioral lateralization) was also different in control and tyrosine-mother groups. Neonatal and adult rats showed an increase in right-side movements probability. These data provide evidence that maternal ingestion of a catecholamine precursor during gestation may induce a long-lasting modification of the behavioral lateralization of the offspring.

Tyrosine ingestion during rat pregnancy alters postnatal development of dopaminergic neurons in the offspring

It has been previously reported that tyrosine ingestion by the mother rat during gestation modifies different behavioral patterns in the adult offspring. In the present study, the action of maternal mother tyrosine ingestion on the postnatal development of the dopaminergic system of the offspring was evaluated. The offspring of tyrosine-treated mothers showed a decrease in dopamine (DA) levels during the first 15 days of postnatal life and an increase in DA levels from day 30 to adulthood. The DOPAC level and the DOPAC/DA index were higher in the tyrosine group from postnatal life to adulthood. These differences reach statistical significance in both forebrain and mesencephalon. During adulthood the DA concentration in both s. nigra and ventral tegmental area were higher in the tyrosine group than in the control group. The behavioral postsynaptic response to a DA receptor agonist (apomorphine) was higher in the offspring of tyrosine treated rats than in the control group. These data suggest that the bioavailability of the DA precursor tyrosine during gestation may modify during postnatal life DA synapsis at both pre- and postsynaptic level.