[Cardiovascular effects of sodium chloride bath and underwater shower in coronary ischemia]

Two hundred and eighteen patients (209 males and 9 females, mean age 57.1 +/- 0.6 years) with I class coronary ischemia were subdivided into two groups of 109 subjects each. Group I received NaCl baths, group II underwater massage-showers. On days 2-3 and 23-24 of treatment all underwent incremental stress testing until exhaustion. In group I, only subjects with moderate maximal muscular power improved their stress endurance. In group II, stress endurance significantly improved in all subjects: all hemodynamic indices (cardiac, output, stroke volume, systemic vascular resistances) showed variations indicative of improved cardiorespiratory function and peripheral blood supply.

[Effects of sauna on the values of blood circulation studied by the isometric exercise test]

Cardiovascular responses to isometric muscular exercise were evaluated during sauna. Nine healthy men aged 26 to 46 underwent testing during 5-6 saunas with one week interval between sessions. Each sauna included 2-6 heatings of 8-15 minutes (80-85 degrees C, humidity 15%) followed by complete cooling. Cardiovascular response during handgrip (45 seconds) were measured before sauna, after the first interval and 25 minutes after the end of sauna treatment.

[Effects of short-wave therapy in patients with chronic pyelonephritis]

One hundred and twenty patients (64 men and 56 women, aged 19 to 63) with chronic pyelonephritis were subdivided into two groups: a control group of 30 subjects and an experimental one of 90 subjects. Experimental subjects underwent short wave therapy (460 MHz, 50-60 W, for 8-20 minutes) in the lumbar area. Lumbosacral pain disappeared in 87 out of 90, subjects, intercostal pain in 20 out of 28, headache mitigated in 40 out of 53, asthenia was markedly reduced in 49 out of 50. Systolic and diastolic hypertension was reduced, as well as the Kakorski-Addis count in urine. Diurnal diuresis and lysozyme increased, while IgG, IgA and IgM were reduced.

[Climate and psychosomatic medicine]

In the last few years, psychosomatic medicine has accomplished very important and interesting analyses of several medical syndromes. On the contrary, medical climatology, even with the development of new tools for climate research, has remained linked to old ideas which need to be revised in order to keep pace with the latest discoveries in this field. It is therefore desirable to undertake research on the action of different climates and microclimates on the human organism, and also to take into account the patients, tendencies and aspirations, because "the climate that will yield the best results is the climate the patient likes best". In conclusion, taking into account a patient's personality and aspirations, thermal therapies and climate treatments may be coupled. As a matter of fact, in our country it is possible to find spas with the same kind of waters but with completely different climates.

Effects of L-acetylcarnitine (LAC) on the post-injury recovery of mouse spermatogenesis monitored by flow cytometry. 2. Recovery after hyperthermic treatment

It has been demonstrated that L-acetylcarnitine (LAC) can enhance the recovery of spermatogonial cells after X-ray damage. In the present work, the effects of LAC on the recovery processes of mouse spermatogenesis after local acute hyperthermia (42 degrees C, 1 hour) was investigated. LAC was administered i.p. (100 mg/kg body weight) every other day for four weeks after heat treatment. At intervals of 8, 14, 21, 28, 35, 40, 45, and 60 days after hyperthermic treatment, testes were weighed and their DNA content analysed by flow cytometry; the round spermatid fraction was found to be higher at 45 days in the LAC-treated animals than in controls (P less than 0.01). Correspondingly, at the same experimental point, the animals without LAC administration showed a lower testicular weight (P less than 0.05). Combined with histological analysis, these results suggest a more rapid recovery of normal spermatogenesis after physical insult with LAC treatment.

Flow cytometric analysis in colorectal carcinoma: prognostic significance of cellular DNA content

The prognostic value of DNA ploidy status was evaluated prospectively in 70 patients with colorectal carcinoma. Cellular DNA content was measured by flow cytometry from fresh specimens with multiple site sampling. Seventy-five percent of cases exhibited a DNA aneuploid pattern. In a univariate analysis, DNA ploidy status showed a statistically significant correlation with survival (p less than 0.05), weaker than Dukes' stage (p less than 0.001). No correlation was observed between survival and presence of multiple DNA stemlines. In a multivariate analysis, Dukes' stage was the strongest prognostic indicator (p = 0.01) while DNA ploidy status did not show an independent prognostic value. It is concluded that DNA ploidy status is associated with pathological features of aggressive malignancy, but it does not have a determinant role in predicting survival.

Flow cytometric DNA analysis of the human cervix affected by human papillomavirus and/or intraepithelial neoplasia

The relative DNA contents of 164 cellular samples from 59 patients affected by the viral cytopathic effects (VCE) of human papillomavirus (HPV) infection and/or by cervical intraepithelial neoplasia (CIN) and 12 cellular samples from 12 normal donors were analyzed by flow cytometry (FCM) with the aim of correlating the cytometric measurements with the morphologic and etiologic parameters. The unselected group of 59 patients was found to be characterized by statistically significant differences in average ages in the VCE and CIN (31.4 years) and CIN only (44.8 years) subgroups. Of the pathologic samples, 32 (54%) exhibited at least one cell subpopulation with an abnormal DNA content; in all but 2 of those cases, a diploid cell subpopulation was also present. The results indicate a relationship between the FCM ploidy and the morphologic classification, as shown by the increase in the occurrence of subpopulations with abnormal DNA contents from VCE only (38%) to VCE + CIN 1 (57%), to VCE + CIN 2/3 (70%). These results suggest that cytometric parameters, in association with the determination of the HPV types and in parallel to the colpocytohistopathologic criteria, can contribute to a more accurate characterization of cervical lesions in diagnostic and prognostic terms.

Cytokinetic investigation of lung tumors using the anti-bromodeoxyuridine (BUdR) monoclonal antibody method: comparison with DNA flow cytometric data

In order to investigate the cytokinetics of malignant tumors and non-malignant lesions of the lung, tissue samples from 57 patients affected by non-small-cell carcinoma (NSCLC), small-cell carcinoma (SCLC), and benign and inflammatory lesions have been analyzed using the BUdR monoclonal antibody (MAb) method. This method is based on the preparation, at the time of surgery, of viable monocellular suspensions (using collagenase and DNase treatment) and the concomitant administration of BudR. The percentage of BudR-labelled cells was monitored by fluorescent microscopy using an FITC-labelled second antibody. In NSCLC, each histological group showed a wide range of labelling index (LI) values. On the contrary, SCLC exhibited a more homogeneous kinetic behaviour as evidenced by a narrowly distributed, higher LI. Tumors shown to be diploid by flow cytometry did not show a lower LI than aneuploid tumors. Furthermore, differences were constantly observed between the S-phase percent calculated using BUdR and that calculated using the DNA flow cytometric (FC) histogram, the latter always showing higher S-phase values. In an attempt to study the intra-tumor proliferative heterogeneity, multiple-site sampling was performed. Proliferative heterogeneity seemed to be higher inter-tumor than intra-tumor. Finally, a positive correlation (p less than 0.05) was found between LI and the actual doubling time (DT) of the primary tumor mass, evaluated using sequential radiographs. In conclusion, the present BUdR method can be considered a useful source of relevant information on in vivo cell growth, in parallel to other clinical (DT) and biological (DNA content) approaches.

Effects of heat on mouse spermatogenesis monitored by flow cytometry

The effects of heat on mouse spermatogenesis have been determined using both testis weight and flow cytometrically determined DNA content distribution as experimental end-points. Temperatures of 38-42 degrees C and exposure times of 20-60 min have been tested. The results concerning the testis weight substantially confirm those reported by other authors (Hand et al. 1979). The measurement of DNA content distributions shows a relatively higher depletion, 14 days after treatment, of the cytometric compartment containing elongated spermatids in respect to that containing round spermatids. The analysis of the cytotoxic effects, monitored 14 vs. 28 days after treatment, as a function of the exposure time at a given temperature, or of the temperature for a fixed exposure time, indicates that, in the course of spermatogenesis, late spermatocytes are more sensitive to heat than differentiated spermatogonia. Following the approach based on flow cytometry, the effect of exposures as low as 20 min at 38 degrees C can be appreciated.

Cytogenetic follow-up after allogeneic bone-marrow transplantation for Ph1-positive chronic myelogenous leukemia

Serial cytogenetic studies were carried out on 36 patients with Ph1-positive chronic myelogenous leukemia treated with allogeneic bone-marrow transplantation from unlike sex (21 patients) or like sex (15 patients) donors. Fourteen of the 21 sex-mismatched and 12 of the 15 sex-matched donor marrows were T cell depleted. Disease relapse was documented in 19 of the 26 patients who received T cell-depleted marrow, and in none of the 10 patients who received non-T cell-depleted marrow. In the group of patients with unlike sex donor, a triple donor/normal recipient/Ph1-positive recipient or a double donor/Ph1-positive recipient chimerism was documented during the subsequent months, while on alpha-interferon treatment for relapse. Two of these patients subsequently showed a complete disappearance of the Ph1 chromosome. Unstable and/or stable, clonal or non-clonal chromosome changes were detected in Ph1-positive cells from 12 of the 19 patients who relapsed. Analysis of the identified stable changes showed a non-random distribution of breakpoints with clustering to chromosome nos. 1, 4, 7 and 12.

Sequential evaluation of gastric intraluminal prostaglandin E2 release, acid secretion and DNA-flow cytometry in N-methyl-N-nitro-N-nitrosoguanidine gastric carcinogenesis in the rat

The study was initiated to evaluate the sequential changes of gastric intraluminal prostaglandin E2 (PGE2), gastric acid secretion and of the DNA-flowcytometric patterns during gastric carcinogenesis induced by 45-week N-methyl-N-nitro-N-nitrosoguanidine (NG) administration in the rat. Twenty male chronic gastric fistula Sprague-Dawley rats received NG solution (120 mg/l) for 45 weeks and 20 were used as controls. Samples of gastric juice (1 h) were obtained from all animals under basal conditions and every 5 weeks until the end of the experiment. Aliquots of gastric juice were titrated with 0.1 N NaOH. Other aliquots were extracted with ethylacetate and processed for specific PGE2 RIA. On the day following gastric juice collection a gastric lavage and gastric biopsies (n = 4) were obtained through the fistula and processed for flowcytometry. All surviving animals were killed after 45 weeks and histology was obtained. The incidence of cancer in NG treated chronic gastric fistula rats was 66%. Flowcytometry segregated at an early stage (30-35 weeks) those animals which were to develop gastric carcinoma from those which were not. Administration of NG decreased gastric secretion volume, acid and intraluminal PGE2 concentration both in animals developing and not developing cancer. During the last 10 weeks a sharp rise in gastric intraluminal PGE2 concentration was observed in tumor-bearing animals only probably due to production by tumor cells. Prostaglandin deficiency may contribute to the NG-induced mucosal damage and may be involved in gastric carcinogenesis.

Effects of L-acetylcarnitine (LAC) on the post-injury recovery of mouse spermatogenesis monitored by flow cytometry. 1. Recovery after X-irradiation

L-acetylcarnitine plays a key role in sperm metabolism and in the whole spermatogenetic process. In the present work, the influence of L-acetylcarnitine, administered i.p. (100 mg/kg body weight), on the recovery processes of mouse spermatogenesis after local acute irradiation with 10 Gy X-rays has been investigated. The effects were monitored 28, 35, 40, 45, 50, 55, and 60 days after irradiation by flow cytometric analysis of cellular DNA content. In the LAC-treated animals, the fraction of tetraploid cells is higher at 28 (p less than 0.05) and 45 days (p less than 0.02). Corresponding with the timing of the stages of murine spermatogenesis, the round spermatid fraction is higher at 45 days (p less than 0.1) and the elongated spermatid fraction is higher at 50 days (p less than 0.1) after irradiation. In addition, the LAC-treated animals show a faster recovery throughout the maturation process, from tetraploid to round and elongated spermatids. These results indicate that the presence of exogenous LAC could enhance the recovery of spermatogonial cells.

[Primary duodenal lymphoma. Communication of a case]

Primary malignant lymphoma of the duodenum is a rarity. A case of primary non-Hodgkin lymphoma of the duodenum is reported. Symptoms, signs, radiographic and endoscopic findings are discussed. C.T. with C.V.P. were performed in addition to subtotal pancreatico-duodenectomy Follow-up, after one year, did not show any signs of recurrence.

Radiation-induced diploid spermatids in mice

Diploid elongated spermatids of mice were enriched by flow cytometry and cell sorting using a new type of sorter (Partec). The sorted abnormal spermatids were identified morphologically and by nuclear area integration. The radiation-induced increase in the frequency of diploid elongated spermatids was monitored with time following acute X-ray exposure of mice. Dose-response curves for acute 60Co-gamma and 14 MeV neutron irradiations yielded an RBE value of 4.3 for the doubling of the control level.

Association of near-diploid DNA content and N-myc amplification in neuroblastomas

Seventeen neuroblastomas at different clinical stages were analysed for their N-myc copy number and flow cytometrically determined DNA content. Aneuploidy was found in 11 patients (65 per cent), whereas the remaining were near-diploid. N-myc amplification was found significantly (P less than 0.05) confined to near-diploid tumors (3 out of 6 cases). This finding indicates a very selective mechanism of oncogene amplification which is independent of gross chromosomal imbalance and limited to specific loci in the human genome. Association of near-diploidy and age at diagnosis older than 24 months was also demonstrated (P less than 0.05). Thus, flow cytometric analysis of DNA content together with N-myc gene dosage allowed us to distinguish two different subsets of neuroblastoma tumors: the first one aneuploid, with single-copy N-myc, usually observed in patients younger than 24 months with localized or IV-S clinical stages; the second one near-diploid, with frequent N-myc amplification, usually observed in patients older than 24 months with advanced clinical stages.

Automatic analysis of flow cytometric DNA histograms from irradiated mouse male germ cells

An automatic procedure for recovering the DNA content distribution of mouse irradiated testis cells from flow cytometric histograms is presented. First, a suitable mathematical model is developed, to represent the pattern of DNA content and fluorescence distribution in the sample. Then a parameter estimation procedure, based on the maximum likelihood approach, is constructed by means of an optimization technique. This procedure has been applied to a set of DNA histograms relative to different doses of 0.4-MeV neutrons and to different time intervals after irradiation. In each case, a good agreement between the measured histograms and the corresponding fits has been obtained. The results indicate that the proposed method for the quantitative analysis of germ cell DNA histograms can be usefully applied to the study of the cytotoxic and mutagenic action of agents of toxicological interest such as ionizing radiations.

Radiotherapy and hyperthermia. Analysis of clinical results and identification of prognostic variables

Site- and tumor-specific data obtained from two groups of patients with head and neck and melanoma lesions, respectively, showed that both immediate response and response duration were enhanced by the addition of heat. Two important variables, however, such as tumor volume and "isoeffect thermal dose" appeared to influence local tumor control. The volume effect was less pronounced in the lesions treated with radiotherapy plus heat than in those treated with radiotherapy alone, suggesting that the addition of heat was more damaging to the large than to the small lesions. Furthermore, a striking isoeffect thermal dose-response relationship was shown in head and neck lesions. Those data were collected and used to design a mathematical model relating the probability of local control to clinical and treatment variables. The analysis shows that, by using the same radiation parameters, the probability of local tumor control is a function of both "isoeffect thermal dose" and tumor volume.

Prognostic significance of flow cytometry in lung cancer. A 5-year study

Flow cytometrically determined cellular DNA content has been measured on specimens from 101 patients affected by lung cancer (40 epidermoid cell carcinoma, 22 adenocarcinoma, 21 large cell carcinoma, 11 small cell carcinoma, and seven undifferentiated carcinoma), and one by mesothelioma. Ninety-eight of 102 (96%) patients with neoplastic disease evidenced the occurrence of at least one cytometrically aneuploid cell subpopulation. Fifty-five of 102 (54%) cases evidenced the occurrence of multiclonality, that is, the presence of more than one aneuploid stem cell line. However, the incidence of multiclonality in lung carcinoma was statistically different in surgical cases (where multiple site sampling from the primary and lymph nodes was possible) in comparison to the nonsurgical ones (e.g., bronchial washing): 48/77 (62%) and six of 24 (25%), respectively. Therefore, only the 77 surgical patients were used for further analysis. The cases were classified according to the DNA index (DI) in the following way: Group A (tumors with one or more stem lines with DI ranging from 1 to 2) and Group B (tumors with at least one stem line with DI less than 1 or greater than 2). A significant correlation has been found between the cytometric ploidy condition so defined (Groups A and B) and the tumor mass doubling time (DT), Group B being associated with fast growing tumors (DT lower than 90 days). A statistically better 12-month survival rate (5-year maximum follow-up) was observed in Group A (88%) in respect to Group B (47%) and is evident in the patient survival time course. A better prognostic indication can be achieved by stratifying the patients according to both the cytometric ploidy condition and the tumor DT. Flow cytometric data can usefully contribute to the prognostic assessment of lung carcinoma provided that representative cellular material is collected by multiple site sampling.

Flow cytometric analysis of the effects of 0.4 MeV fission neutrons on mouse spermatogenesis

(C57Bl/Cne X C3H/Cne)F1 male mice were irradiated with single acute doses of 0.4 MeV neutrons ranging from 0.05 to 2 Gy, and testis cell suspensions were prepared for cytometric analysis of the DNA content 2-70 days after irradiation. Various cell subpopulations could be identified in the control histogram including mature and immature spermatids, diploid spermatogonia and spermatocytes, tetraploid cells and cells in the S-phase. Variations in the relative proportions of different cell types were detected at each dose and time, reflecting lethal damage induced on specific spermatogenetic stages. The reduction of the number of elongated spermatids 28 days after irradiation was shown to be a particularly sensitive parameter for the cytometrical assessment of the radiosensitivity of differentiating gonia. A D0 value of 0.13 Gy was calculated and compared with data obtained after X-irradiation, using the same experimental protocol. In the latter case a biphasic curve was obtained over the dose range from 0.25 to 10 Gy, possibly reflecting the existence of some cell population heterogeneity. RBE values were estimated at different neutron doses relative to the radiosensitive component of the X-ray curve, and ranged from 3.3 to 4, in agreement with data in the literature. Genotoxic effects were monitored 7 days after irradiation by a dose-dependent increase of the coefficient of variation (CV) values of the round spermatid peak, reflecting the induction of numerical and structural chromosome aberrations, and 14 or 21 days after irradiation by the detection of diploid elongated spermatids, probably arising from a radiation-induced complete failure of the first or second meiotic division.

Flow cytometry as a tool for the prognostic assessment of human neoplasia

Flow cytometry permits the quantitative description of neoplastic cell populations from the point of view of their cytogenetic and cytokinetic features. The advances in preparation of cellular monodispersed samples allow the examination not only of in vitro and hematological, but also of surgical, biopsy, endoscopic, and lavage specimens. The analysis of cytometric DNA content has evidenced the importance of (aneu)ploidy as a remarkable tumor marker. Tumors of different sites and, in some cases, stages and/or grades are characterized by a differential occurrence of diploid vs. aneuploid cell subpopulations and by the eventual presence of different stem cell lines within the same tumor. For certain classes of neoplasms, these parameters can be used for the early recognition of neoplasia and related to disease evolution and dissemination and to the results of therapy. Flow cytometry can also be used to evaluate the fraction of (cycling) cells in the S-phase and of proliferating cells (growth fraction). The percent of S cells can be extracted from cytometric DNA content histograms. Furthermore, the method of Bromodeoxyuridine (BrdUrd) incorporation has been recently introduced into flow cytometry. BrdUrd labeling in cycling cells can be detected either by the induction of quenching or enhancement of specific DNA-dye fluorescence or by fluorescent anti-BrdUrd monoclonal antibodies. This approach has been confirmed by preliminary comparative tests on cultured cells, normal and malignant bone marrow, and human solid tumor specimens. These parameters, together with other cytometric parameters of potential importance for the cellular characterization of malignancy, offer a reliable and real time-saving tool for the prognostic assessment of human tumors and the predicting and monitoring of the results of therapy.

Considerations in the design of possible cell cycle effective drugs

Antineoplastic agents are known to induce differential cytotoxic and cytostatic effects throughout the cell cycle. Many drugs have greater toxicity for cycling cells and act selectively at one or more phases of the cycle and may cause partial synchrony of surviving cells. However, these observations have been generally carried out on in vitro systems only and present a variety of complexities and pitfalls. Furthermore, human tumours are often characterized by a relatively low fraction of proliferating cells and present a large cellular heterogeneity as far as their cytogenetic, cytokinetic, and clonogenic features and their responses to drugs are concerned. Therefore, resistance to chemotherapy is due to various factors characterizing, in some instances, each individual tumour. In spite of the advent of technological advances such as flow cytometry, it is still difficult to design kinetic-orientated therapies especially for the treatment of solid tumours. Consequently, it is also difficult to design protocols based on cell cycle effective drugs. The possibility remains, at least for the moment, to stratify tumours according to their cellular heterogeneity. Different protocols could then be assigned to classes of tumours. Such an approach could be completed by further advances in the cellular monitoring of individual tumours.

[Spigelian hernia: presentation and discussion of 3 clinical cases]

The authors describe three cases of ventral-lateral hernia (Spigelian hernia), with their clinic and diagnostic features. They also make a revision of the literature about this disease and some considerations about the relatively high incidence and the frequent diagnostic difficulties.

Tumour response to heat and radiation: prognostic variables in the treatment of neck node metastases from head and neck cancer

A total of 38 patients with 81 multiple neck node metastases from squamous cell carcinoma of head and neck were treated with radiotherapy alone or with radiotherapy plus hyperthermia. Irradiation was delivered following a three fractions per day schedule of 2 + 1.5 + 1.5 Gy/day, with 4 h intervals between fractions, up to a total dose of 60 Gy. Heat was applied by means of a 500 MHz apparatus. Temperature data were converted to equivalent minutes at 42.5 degrees (Eq 42.5). Initial complete response rates and local control distribution were compared for subgroups of tumour volume and thermal dose. The data indicated that the volume effect was less pronounced in the combined modality than in the radiation alone arm, suggesting that the addition of heat was more damaging to the large than to the small lesions. A striking thermal dose-response relationship was shown, although complete response rates increased only after a certain thermal dose was accumulated, clearly indicating the presence of a threshold dose.