Inhibitory effects of octreotide on renal and glomerular growth in early experimental diabetes in mice

It was recently discovered that the streptozotocin (STZ)-diabetic mouse model is characterised by GH hypersecretion in contrast to the STZ-diabetic rat, the former thus mimicking the changes in GH in human type 1 diabetes. Inhibition of circulating and renal IGF-I by long-acting somatostatin analogues reduces renal and glomerular growth and urinary albumin excretion in diabetic rats. The aim of the present study was to examine renal and glomerular growth in early experimental diabetes in mice along with changes in the GH/IGF-I axis following treatment with the somatostatin analogue octreotide. Balb/C(a) mice were randomised into non-diabetic controls, placebo-treated and octreotide-treated diabetic (50 microg/day) mice and examined 7 and 14 days after induction of diabetes. There was no effect of octreotide treatment on body weight, glycaemic control or food intake. However, octreotide treatment significantly inhibited renal and glomerular growth by the end of the study period when compared with placebo treatment. In addition, octreotide prevented an increase in kidney IGF-I by day 7. GH hypersecretion was observed in the diabetic groups but octreotide treatment reduced GH levels compared with placebo treatment by day 14. No significant differences in serum or kidney IGF-binding protein-3 levels were observed between placebo- and octreotide-treated diabetic mice. In conclusion, this new diabetic mouse model mimicking human type 1 diabetes is characterised by GH hypersecretion and the somatostatin analogue octreotide is able to prevent renal and glomerular growth, probably mediated through changes in circulating GH and local kidney IGF-I levels.

Disseminated tumour cells. Their detection and significance for prognosis of gastrointestinal and pancreatic carcinomas

Metastatic spread is a major factor in the prognosis of cancer patients. Early detection and eradication of circulating tumour cells prior to the development of metastases could help to improve the outcome of patients after tumour resection. Disseminated tumour cells have been detected in different compartments of the body using cytological and immunostaining methods and, more recently, using different molecular biological techniques. The most frequently studied body compartments are the bone marrow, peritoneal cavity, blood and lymph nodes, but other body fluids such as urine, bile, pancreatic juice and sputum have also been analysed. At all of these sites, tumour cells have been detected. However, the specificity and sensitivity of the methods and their prognostic impact are still being debated. This review discusses the accuracy of the detection methods and the prognostic value of detecting disseminated tumour cells in the bone marrow, blood and peritoneal lavage of patients with colorectal, gastric and pancreatic carcinomas.

Identification of biological/biochemical marker(s) for preterm delivery

Fetal and neonatal mortality and morbidity rates are strongly associated with gestational age for delivery: the risk for poor outcome increases as gestational age decreases. Attempts to predict preterm delivery (PTD, spontaneous delivery before 37 weeks' gestation) have been largely unsuccessful, and rates of PTD have not improved in recent decades. More recently, the reported associations between infections in pregnancy and PTD suggest preventive initiatives that could be taken. The overall objective of the current study is to assess whether specific markers of infection (primarily interleukin (IL) 1beta, tumour necrosis factor (TNF) alpha, IL-6, and IL-10) obtained from maternal blood during pregnancy, alone or in combination with other risk factors for PTD, permit identification of women at risk for spontaneous PTD. To achieve this objective, data are obtained from two Danish prospective cohort studies involving serial collection of maternal blood samples, newborn cord blood samples, and relevant confounders and other risk factors for PTD. The first study consists of a completed Danish regional cohort of 3000 pregnant women enrolled in a study of microbiological causes of PTD, upon which a nested case-control study of PTD in 84 cases and 400 controls has been performed. The second study is a nested case-control study of 675 PTD cases (equally divided into three gestational age categories of 24-29 weeks' gestation, 30-33 weeks' gestation, and 34-36 weeks' gestation) and 675 controls drawn from the ongoing Danish National Birth Cohort study of 100 000 pregnant women enrolled during 1997-2001. The second study will provide the opportunity to refine and retest hypotheses from the first study, as well as to explore new hypotheses. Our preliminary work suggests that a single predictive marker effectively accounting for a large proportion of PTD is unlikely to be found. Rather, a search for multiple markers indicative of the multifactorial aetiology of PTD is likely to be more successful. Knowledge gained from the proposed studies will be implemented in a third, clinical intervention study against PTD. The first phase of the clinical intervention study will be to establish a risk-assessment model based on the "best" combination of biological/biochemical measures and other factors associated with PTD in order to identify pregnant women at very high risk of PTD. The second phase will be to apply an intervention model of tailored obstetric care to the very high-risk pregnant women for PTD identified in phase one. The intervention will be carried out against each specific risk factor associated with PTD identified for the individual. The aim is to reduce the risk for PTD attributed to the combination of risk factors included in the clinical intervention study.

Clinical usefulness, safety, and plasma concentration of ropivacaine 0.5% for inguinal hernia repair in regional anesthesia

BACKGROUND AND OBJECTIVE

The aim of this study was to evaluate the pharmacokinetics, feasibility, and clinical effects of ropivacaine in regional anesthesia (ilioinguinal-iliohypogastric blocks [IIB], genitofemoral block plus local infiltration) for inguinal hernia repair.

METHODS

Following ethics committee approval and informed consent, 21 male adults received 60 mL ropivacaine 0.5% (without vasoconstrictor). In 11 patients, further injections of 5 to 10 mL were given while preparing the hernial sack. Plasma concentration of ropivacaine was determined in venous blood after 10, 20, 30, 45, 60, 90, 120, and 300 minutes using reversed-phase high pressure liquid chromatography (HPLC).

RESULTS

Peak plasma concentrations of ropivacaine were 1.5 +/- 0.6 (0.7 to 2.6) microg/mL (mean +/- SD [range]). These maximum concentrations occurred after 45 (30 to 60) minutes (median [range]). No signs of central nervous or cardiovascular toxicity were observed. Twelve of 21 patients did not need any additional analgesics within 24 hours postoperatively. One patient had a femoral motor block lasting 6 hours, 5 patients reported sensory femoral block lasting 5 to 12 hours. Patients, as well as the surgeon, were very satisfied with the procedure, and all patients stated that they would like to have it performed again that way in case of an inguinal hernia on the opposite side.

CONCLUSION

A ropivacaine dose of 60 to 70 mL of 0.5% appears adequate for regional anesthesia for inguinal hernia repair regarding conditions for surgery, safety, ambulation, and postoperative pain relief.

Health evaluation of translocated free-ranging primates in French Guiana

Among over 40 mammal species threatened by the filling of a hydroelectric dam reservoir in French Guiana, three species of primates have been translocated, comprising 124 red howler monkeys, six white-faced sakis, and 95 golden-handed tamarins. Health status of the animals was evaluated by direct physical examination and by hematological, biochemical, virological, and parasitological surveys of collected blood. The physical condition of the howlers was slightly worse toward the end of the capture period, but that of sakis and tamarins remained satisfactory. Several ectoparasites (ticks, larvae of dipterous insects, fleas, and lice) were collected, and various wounds, apparently nondebilitating, were recorded in howlers. Hematological and biochemical profiles determined for the three species revealed a slight anemia in howlers. Entamoeba, Strongyloides, and Trypanoxyurus were common in fecal samples of howlers. A survey of blood smears from the three species revealed infection by several types of microfilaria, Trypanosoma rangeli-like and Plasmodium brasilianum in all three, and Trypanosoma cruzi-like in howlers. These infections had no significant impact on the health status or the hematological profiles. Serologic investigations revealed occasional reactions against Toxoplasma gondii, a strong anti-Plasmodium response in the two Cebidae species, and a weaker one in tamarins. Attempts to isolate arbovirus failed, but antibody responses to Mayaro and yellow fever viruses were strong, especially in the howlers. A strong correlation between age and serological status led to a better understanding of the epidemic cycles. Our survey indicates French Guianan primates are reservoirs for several anthropozoonoses, including malaria, Chagas disease, and arboviruses.

Systemic and local immunosuppression in pancreatic cancer patients

Pancreatic cancer is characterized by an extremely poor prognosis. For the development of more effective immunotherapies, the systemic and local immunological escape mechanisms need to be further elaborated. These mechanisms may include the secretion of immunosuppressive cytokines, the local hindrance of tumor-infiltrating lymphocytes (TILs), or the loss of the signal transducing CD3 zeta-chain of TILs. In this study, we have analyzed these parameters in 116 patients suffering from pancreatic ductal adenocarcinoma. Mean concentrations of interleukin (IL)-10 and transforming growth factor-beta1/2 were considerably higher than in control sera (P < 0.0001). Disseminated tumor cells were found in 16 of 39 cases. In 28 of 33 surgical specimens, TILs did not reach tumor cells in significant numbers, being "trapped" in the peritumoral tissues. We suggest this as a simple but highly effective tumor escape mechanism. In cases of a TIL/tumor cell contact, CD3 zeta was mostly lost. Overall, 27 of 33 surgical specimens, 9 of 19 peritumoral lymph nodes, and 13 of 25 peritoneal lavage specimens showed significant loss of CD3 zeta (P < 0.02). Elevated concentrations of IL-10/TGF-beta1/2 were, in all but one of three cases, correlated with a CD3 zeta loss in corresponding specimens. Patients with disseminated tumor cells also showed a CD3 zeta loss in all but two corresponding tumor specimens. These results present strong evidence for an active systemic immunosuppression in pancreatic cancer, as shown by elevated IL-10 and TGF-beta1/2 serum levels as well as the presence of disseminated tumor cells. Killing of tumor cells by potentially cytotoxic TILs is obviously suppressed by the prevention of a direct TIL/tumor cell contact and the inactivation of TILs, as shown by a severe loss of CD3 zeta. In addition to active immunization strategies, successful immunotherapies have to focus on restoring in vivo T-cell function to improve the almost always fatal prognosis of pancreatic cancer.

Association between raised serum relaxin levels during the eighteenth gestational week and very preterm delivery

OBJECTIVE

Our aim was to evaluate a possible association between serum relaxin levels in the 18th gestational week and preterm delivery.

STUDY DESIGN

We conducted a nested case-control study that was based on serum samples obtained in the 18th week of gestation from 1545 unselected healthy primiparous women. Eleven case subjects were delivered very early (9 spontaneously, 2 by indicated cesarean delivery) and 42 moderately early (41 spontaneously, 1 by indicated cesarean delivery); 123 control subjects (121 having spontaneous labor, 2 undergoing indicated cesarean delivery) were randomly selected among the women with delivery at term.

RESULTS

The serum relaxin concentration during the 18th gestational week was 63% higher among subjects with very preterm deliveries than among control subjects (P = .01, Mann-Whitney test). High relaxin levels during the 18th gestational week were associated with an increased risk of very preterm delivery (odds ratio, 11.3; 95% confidence interval, 2.14-59.1) and spontaneous very preterm delivery (odds ratio, 5.5; 95% confidence interval, 1.3-23). There was a negative correlation for case subjects and control subjects between serum relaxin concentrations during the 18th gestational week and gestational age at delivery (P < .05).

CONCLUSION

Serum relaxin may be an independent predictor when identification of women at risk of very preterm delivery is attempted in the 18th gestational week.

The carcinoembryonic antigen and its prognostic impact on immunocytologically detected intraperitoneal colorectal cancer cells

BACKGROUND

Carcinoembryonic antigen (CEA) has been suggested to promote colon cancer progression. In this study we analyzed the prognostic impact of CEA expression on intraperitoneally detected single colon cancer cells.

METHODS

Peritoneal lavage samples of 135 colorectal cancer patients were immunocytologically analyzed, including a staining of cellular CEA; serum CEA levels were measured; and 5-year survival rates were calculated according to immunocytological findings and CEA expression.

RESULTS

The worst survival rate of 20% was found in patients suffering from CEA-expressing intraperitoneal tumor cells (P = 0.0006). The prognostic impact of an intraperitoneal tumor cell finding significantly increased when serum CEA levels were elevated: only 23% survived 5 years in contrast to a 85% 5-year survival rate of patients who neither had signs of dissemination nor showed elevated serum CEA values (P = 0.0010).

CONCLUSIONS

This study shows that the determination of CEA expression improves the prognostic impact of an intraperitoneal tumor cell finding.

A survey of hemoparasite infections in free-ranging mammals and reptiles in French Guiana

Blood smears of 1,353 free-ranging mammals (35 species) and 112 reptiles (31 species) from French Guiana were examined for hemoparasites. Parasites from 3 major groups were recorded: Apicomplexa (including hemogregarines, piroplasms, and Plasmodium spp.), Trypanosomatidae, and Filaroidea. Fifty percent of the individuals (86% of the species) were infected by parasites from at least 1 group. Hemogregarines, identified as Hepatozoon sp., infected numerous snakes with high prevalences (30-100%); infection is reported for the first time in 5 host genera of snakes: Clelia, Oxybelis, Pseustes, Rhinobotryum, and Bothriopsis. Infections were also observed in 4 marsupial species and 1 rodent. Hepatozoon spp. recorded in Didelphis albiventris (Marsupialia) and Coendou prehensilis (Rodentia) may be new species. Plasmodium sp. were observed in 2 snake species, Dipsas indica (Colubridae) and Bothrops atrox (Viperidae). Plasmodium brasilianum was recorded in all 5 primate species examined. Piroplasms were observed in all mammal orders except primates. Large terrestrial rodents were the main hosts of members of the Babesidae; 42% of Myoprocta acouchy, 36% of Dasyprocta agouti, and 44% of Agouti paca were infected. Trypanosomes were common in mammals and were recorded in 70% of the examined genera. Trypanosoma cruzi-like infections were reported in 21 mammal species, including sloths, rodents, carnivores, and primates. Microfilariae were also widespread, with higher prevalences in sloths, anteaters, and porcupines (>40% of the individuals infected) and in tamarins (95% infected). This survey highlights some potential anthropozoonotic risks due to the recent further evidence of Plasmodium brasilianum and P. malariae as a single species and to the increased diversity of hosts for Trypanosoma cruzi.

Ductal lesions in patients with chronic pancreatitis show K-ras mutations in a frequency similar to that in the normal pancreas and lack nuclear immunoreactivity for p53

BACKGROUND

Chronic pancreatitis (CP) is considered to be a risk factor for the development of pancreatic carcinoma. The detection of K-ras mutations in the duodenal or pancreatic juice has been held to be a reliable tool for its early diagnosis. However, K-ras mutations also occur in hyperplastic ductal epithelium, making it difficult to interpret their role in pancreatic carcinogenesis.

METHODS

The study included 30 resection specimens, 15 from patients with alcoholic CP, and 15 from patients with idiopathic CP. The mean duration of disease was 6.8 years. A total of 429 ductal lesions were classified according to the World Health Organization classification (1996) and microdissected. K-ras analysis was performed by means of polymerase chain reaction (45 cycles), constant denaturing gel electrophoresis, and sequencing. Immunostaining was performed with antibodies against p53, Ki-S5, carcinoembryonic antigen, and two types of mucins.

RESULTS

The 30 specimens demonstrated all types of ductal lesions. Severe cellular atypia was not observed. A total of 429 ductal lesions were analyzed. Approximately 4.4% of the lesions (19 of 429) from 27% of the patients (8 of 30) showed K-ras mutations, but they were unrelated to the duration or type of CP. Immunostaining for mutated p53 protein always was negative. Increased proliferative activity was noted only in patients with papillary hyperplasia. No patient developed pancreatic carcinoma within a follow-up period of at least 3 years.

CONCLUSIONS

Ductal lesions in patients with CP exhibit K-ras mutations without additional indications of neoplastic transformation such as severe dysplasia or mutated p53 protein. Therefore, for diagnostic and therapeutic purposes, the detection of K-ras mutations should be supplemented by the demonstration of additional genetic alterations or clinical signs of malignancy.

The grade of pancreatic ductal carcinoma is an independent prognostic factor and is superior to the immunohistochemical assessment of proliferation

Tumour grade is one of the prognostic factors in pancreatic ductal adenocarcinoma, but its value is controversial. In this study, the predictive value and the reproducibility of the WHO grading system were reconsidered and the possibility of supplementing it with the immunohistochemically assessed proliferative activity was investigated. Seventy resected ductal adenocarcinomas of the head of the pancreas were evaluated. A total of 60 HPF fields on two to four sections per tumour were screened for glandular differentiation, mucin production, mitosis, and nuclear atypia by two observers with different degrees of experience. Each criterion was scored and the grade was calculated from the mean value of all single scores. Corresponding slides were immunohistochemically stained with the proliferation marker Ki-S5. The percentage of positive nuclei was assessed and a proliferation index (PI) assigned (<10%=1; 10-50%=2; >50%=3). Multivariate analysis (Cox regression) identified grade and R stage as the most significant factors for predicting survival. The PI determined on the basis of Ki-S5 staining did not prove to be an independent prognostic factor. In 30 of 70 carcinomas, it correlated with the tumour grade. Within a given tumour grade, the cases with the least favourable prognosis could be distinguished on the basis of their PI. The inter-observer variability was considerable, with the main differences occurring in the group of G1 tumours. According to the refined WHO criteria, the histopathological grade of pancreatic ductal carcinoma is an important independent prognostic factor, but reproducibility depends on the expertise of the observer. Criteria that relate to cellular and structural differentiation seem to be more predictive than those related to proliferation.

The grade of pancreatic ductal carcinoma is an independent prognostic factor and is superior to the immunohistochemical assessment of proliferation

Tumour grade is one of the prognostic factors in pancreatic ductal adenocarcinoma, but its value is controversial. In this study, the predictive value and the reproducibility of the WHO grading system were reconsidered and the possibility of supplementing it with the immunohistochemically assessed proliferative activity was investigated. Seventy resected ductal adenocarcinomas of the head of the pancreas were evaluated. A total of 60 HPF fields on two to four sections per tumour were screened for glandular differentiation, mucin production, mitosis, and nuclear atypia by two observers with different degrees of experience. Each criterion was scored and the grade was calculated from the mean value of all single scores. Corresponding slides were immunohistochemically stained with the proliferation marker Ki-S5. The percentage of positive nuclei was assessed and a proliferation index (PI) assigned (<10%=1; 10-50%=2; >50%=3). Multivariate analysis (Cox regression) identified grade and R stage as the most significant factors for predicting survival. The PI determined on the basis of Ki-S5 staining did not prove to be an independent prognostic factor. In 30 of 70 carcinomas, it correlated with the tumour grade. Within a given tumour grade, the cases with the least favourable prognosis could be distinguished on the basis of their PI. The inter-observer variability was considerable, with the main differences occurring in the group of G1 tumours. According to the refined WHO criteria, the histopathological grade of pancreatic ductal carcinoma is an important independent prognostic factor, but reproducibility depends on the expertise of the observer. Criteria that relate to cellular and structural differentiation seem to be more predictive than those related to proliferation.

The grade of pancreatic ductal carcinoma is an independent prognostic factor and is superior to the immunohistochemical assessment of proliferation

Tumour grade is one of the prognostic factors in pancreatic ductal adenocarcinoma, but its value is controversial. In this study, the predictive value and the reproducibility of the WHO grading system were reconsidered and the possibility of supplementing it with the immunohistochemically assessed proliferative activity was investigated. Seventy resected ductal adenocarcinomas of the head of the pancreas were evaluated. A total of 60 HPF fields on two to four sections per tumour were screened for glandular differentiation, mucin production, mitosis, and nuclear atypia by two observers with different degrees of experience. Each criterion was scored and the grade was calculated from the mean value of all single scores. Corresponding slides were immunohistochemically stained with the proliferation marker Ki-S5. The percentage of positive nuclei was assessed and a proliferation index (PI) assigned (<10%=1; 10-50%=2; >50%=3). Multivariate analysis (Cox regression) identified grade and R stage as the most significant factors for predicting survival. The PI determined on the basis of Ki-S5 staining did not prove to be an independent prognostic factor. In 30 of 70 carcinomas, it correlated with the tumour grade. Within a given tumour grade, the cases with the least favourable prognosis could be distinguished on the basis of their PI. The inter-observer variability was considerable, with the main differences occurring in the group of G1 tumours. According to the refined WHO criteria, the histopathological grade of pancreatic ductal carcinoma is an important independent prognostic factor, but reproducibility depends on the expertise of the observer. Criteria that relate to cellular and structural differentiation seem to be more predictive than those related to proliferation.

Ductal lesions in patients with chronic pancreatitis show K-ras mutations in a frequency similar to that in the normal pancreas and lack nuclear immunoreactivity for p53

BACKGROUND

Chronic pancreatitis (CP) is considered to be a risk factor for the development of pancreatic carcinoma. The detection of K-ras mutations in the duodenal or pancreatic juice has been held to be a reliable tool for its early diagnosis. However, K-ras mutations also occur in hyperplastic ductal epithelium, making it difficult to interpret their role in pancreatic carcinogenesis.

METHODS

The study included 30 resection specimens, 15 from patients with alcoholic CP, and 15 from patients with idiopathic CP. The mean duration of disease was 6.8 years. A total of 429 ductal lesions were classified according to the World Health Organization classification (1996) and microdissected. K-ras analysis was performed by means of polymerase chain reaction (45 cycles), constant denaturing gel electrophoresis, and sequencing. Immunostaining was performed with antibodies against p53, Ki-S5, carcinoembryonic antigen, and two types of mucins.

RESULTS

The 30 specimens demonstrated all types of ductal lesions. Severe cellular atypia was not observed. A total of 429 ductal lesions were analyzed. Approximately 4.4% of the lesions (19 of 429) from 27% of the patients (8 of 30) showed K-ras mutations, but they were unrelated to the duration or type of CP. Immunostaining for mutated p53 protein always was negative. Increased proliferative activity was noted only in patients with papillary hyperplasia. No patient developed pancreatic carcinoma within a follow-up period of at least 3 years.

CONCLUSIONS

Ductal lesions in patients with CP exhibit K-ras mutations without additional indications of neoplastic transformation such as severe dysplasia or mutated p53 protein. Therefore, for diagnostic and therapeutic purposes, the detection of K-ras mutations should be supplemented by the demonstration of additional genetic alterations or clinical signs of malignancy.

Surgery for ductal adenocarcinoma of the pancreatic head: staging, complications, and survival after regional versus extended lymphadenectomy

The purpose of this study was to evaluate the influence of regional versus extended lymphadenectomy on survival after partial pancreaticoduodenectomy for pancreatic cancer. From October 1988 to December 1991 (Department of Surgery, University of Hamburg) and from January 1992 to March 1998 (Department of Surgery, University of Kiel) 72 patients with histologically proven ductal adenocarcinoma of the pancreatic head were treated. Partial pancreaticoduodenectomy with regional lymphadenectomy was performed in 26 patients. In 46 patients lymphadenectomy was expanded to include extended retroperitoneal lymphatic and connective tissue clearance. Comparing these two groups and including only patients with R0 resections (n = 58) no significant differences in long-term survival could be shown. The following parameters were shown to have a significant or nearly significant influence on long-term survival: (1) stage of the disease: The 5-year survival of patients with stage I/II pancreatic head cancer was 63%, compared to 15% in patients with stage III/IV a + b of the disease (p = 0.0087). (2) Grading: The 1-year survival of patients with well or moderately differentiated tumors was 55%, compared to 0% for patients with poorly differentiated ductal adenocarcinoma (p = 0.0022). (3) N stage: The 5-year survival of patients in N0 stage was 46.9%, compared with 15% for N1 stage patients. The difference was not quite significant (p = 0.081). (4) Portal vein involvement: The 1-year survival was 0% in patients with R0 resections and histologically proven tumor infiltration of the portal vein, compared to 63% for patients with curative resections without portal vein involvement (p = 0.0063). In conclusion our data indicate that extensive retroperitoneal tissue clearance during pancreaticoduodenectomy for ductal pancreatic cancer does not improve survival compared to regional lymphadenectomy restricted to the right side of the mesenteric artery.

[Comparative study of metastasis-associated characteristics of tumor cells with different metastatic capacities]

OBJECTIVE

To investigate the relationship between metastatic potential and other biological properties of tumor cells.

METHODS

Three human colon carcinoma cell lines WiDr, HT-29 and HT-29b with similar genetic background were hetero-transplanted into nude rats by mesenteric intravenous inoculation and their dissemination was observed. Homotypic aggregation, target organ colonization, cell proliferation and apoptosis, expression of c-erbB-2, EGFR, p53 and mucin, CA19-9 and CEA of tumor cells of these 3 cell lines were comparatively studied by using three dimensional spheroid cell culture, TUNEL and immunocytochemistry.

RESULTS

The three cell lines differed significantly in their metastatic capacities. HT29b and HT29 cells metastasized to the liver, lungs and other parts of the body but the metastasis was more marked in the former than in the latter. WiDr cells did not metastasize at all. In 50%-60% of nude rats with HT-29 and HT29b xenografts, tumor cells were colonized in the liver while no such colonization was seen in rats with WiDr xenograft. The metastatic potential was found to be negatively correlated with the in vitro homotypic aggregating capacity of the tumor cells. The tumor cells with high metastatic potential were found to have higher cell proliferation index but lower cell apoptosis index as compared to those with low metastatic potential. Higher expression of EGFR and mutant p53 in tumor cells with high than in those with low metastatic potential was also observed. No such difference existed in the expression of mucin, CA19-9 and CEA.

CONCLUSION

The metastatic capacity of colon carcinoma is associated with such biological properties of tumor cells as homotypic adhesion, target organ colonization, status of cell proliferation and apoptosis, and expression of EGFR and mutant p53.

Immobilization of free-ranging nine-banded and great long-nosed armadillos with three anesthetic combinations

Nine-banded (n = 47) and great (n = 31) long-nosed armadillos (Dasypus novemcinctus and Dasypus kappleri) were immobilized for clinical examination and collection of biological samples as part of a wildlife rescue during the filling of a hydroelectric dam (Petit Saut, French Guiana) from May 1994 to April 1995. Three intramuscular (i.m.) anesthetic combinations were evaluated: (1) tiletamine/zolazepam (T/Z) at a dose of 8.5 mg/kg in 12 nine-banded long-nosed armadillos (NBA) and 10 great long-nosed armadillos (GLA), (2) ketamine at 40 mg/kg combined with xylazine at 1.0 mg/kg (K/X) in 18 NBA and nine GLA, and (3) ketamine at 7.5 mg/kg combined with medetomidine at 75 microng/kg (K/M) in 17 NBA and 12 GLA, antagonized by 375 microg/kg atipamezole. Induction was smooth, ranged from mean +/- SD = 2.8+/-0.6 to 4.3+/-1.8 min, and did not differ significantly between protocols, species, or sex. In NBA, immobilization time ranged from 43.8+/-27.8 to 66.5+/-40.0 min and did not differ between protocols or sex. Muscle relaxation was judged to be better with K/X and K/M versus T/Z. In GLA, the response to the anesthetic protocols was more variable and immobilization time ranged from 30.4+/-6.2 to 98.4+/-33.7 min. The main difference was observed in GLA females receiving the T/Z combination, in which immobilization time was significantly longer versus males, but also versus GLA K/M group, and versus NBA T/Z group. Effects on body temperature, heart rate and respiratory rate were limited. Thirty six to 50% of the individuals showed hypoxemia (SpO2 < 85%) throughout anesthesia and values <80% also were recorded but the hypoxemia was not associated with clinical signs. With T/Z and K/X, recovery was irregular and prolonged up to 2 to 3 hr in some individuals. In K/M groups, first standing was observed 1.0 to 16.4 min after i.m. atipamezole injection without adverse effects. Finally, the three anesthetic combinations used in this study were effective and safe agents for 30 to 40 min immobilizations including minor surgery procedures. The ability to antagonize the medetomidine-induced sedation with atipamezole significantly reduces the recovery time, making the K/M combination preferable, especially in field conditions.

Surgical possibilities for pancreatic cancer: extended resection

DESIGN

It was the aim of this study to investigate the influence of extended retroperitoneal tissue clearance on long-term survival in patients with ductal adenocarcinoma of the head of the pancreas.

PATIENTS AND METHODS

From 10/1988 to 3/1998 a prospective observation study was initiated in 108 patients with malignant growth in the head of the pancreas to compare patients with regional lymphadenectomy (RLA) versus extended retroperitoneal tissue clearance (ELA). In 36 patients other tumors than ductal adenocarcinomas were found, so that 72 patients with a partial pancreaticoduodenectomy and a histologically established diagnosis of ductal adenocarcinoma were included. Pancreaticoduodenectomy was combined with RLA in 26 cases and with ELA in 46 patients.

RESULTS

Comparing only R0-resected patients (n = 58) no significant difference in long-term survival rates between the RLA and the ELA group was found. Hospital mortality was 3.8% in the RLA group and 6.5% in the ELA group. Significant or nearly significant results were shown for the following parameters: STAGE OF THE DISEASE: Patients after partial pancreaticoduodenectomy of a stage I/II cancer of the head of the pancreas showed a 63% 5-year survival rate compared to 15% in patients in stage III or IV (p = 0.0087). GRADING: No patient with a poorly differentiated ductal adenocarcinoma of the head of the pancreas survived the first year in comparison to 55% of patients with well or moderately differentiated tumors (p = 0.0022). N-STAGE: 5-year survival of patients in NO stage was 46.9% and 15% for N1 stage patients (p = 0.081). PORTAL VEIN INFILTRATION: No patient with a R0-resection and histologically proven tumor infiltration of the portal vein survived the first year whereas 63% of patients did so after curative resection without portal vein involvement (p = 0.0063).

CONCLUSION

Our data indicate that extensive retroperitoneal tissue clearance does not improve long-term survival rates compared to regional lymphadenectomy restricted to the right side of the mesenteric artery.

Surgical possibilities for pancreatic cancer: extended resection

DESIGN

It was the aim of this study to investigate the influence of extended retroperitoneal tissue clearance on long-term survival in patients with ductal adenocarcinoma of the head of the pancreas.

PATIENTS AND METHODS

From 10/1988 to 3/1998 a prospective observation study was initiated in 108 patients with malignant growth in the head of the pancreas to compare patients with regional lymphadenectomy (RLA) versus extended retroperitoneal tissue clearance (ELA). In 36 patients other tumors than ductal adenocarcinomas were found, so that 72 patients with a partial pancreaticoduodenectomy and a histologically established diagnosis of ductal adenocarcinoma were included. Pancreaticoduodenectomy was combined with RLA in 26 cases and with ELA in 46 patients.

RESULTS

Comparing only R0-resected patients (n = 58) no significant difference in long-term survival rates between the RLA and the ELA group was found. Hospital mortality was 3.8% in the RLA group and 6.5% in the ELA group. Significant or nearly significant results were shown for the following parameters: STAGE OF THE DISEASE: Patients after partial pancreaticoduodenectomy of a stage I/II cancer of the head of the pancreas showed a 63% 5-year survival rate compared to 15% in patients in stage III or IV (p = 0.0087). GRADING: No patient with a poorly differentiated ductal adenocarcinoma of the head of the pancreas survived the first year in comparison to 55% of patients with well or moderately differentiated tumors (p = 0.0022). N-STAGE: 5-year survival of patients in NO stage was 46.9% and 15% for N1 stage patients (p = 0.081). PORTAL VEIN INFILTRATION: No patient with a R0-resection and histologically proven tumor infiltration of the portal vein survived the first year whereas 63% of patients did so after curative resection without portal vein involvement (p = 0.0063).

CONCLUSION

Our data indicate that extensive retroperitoneal tissue clearance does not improve long-term survival rates compared to regional lymphadenectomy restricted to the right side of the mesenteric artery.

Hematological and serum chemistry profiles of free-ranging southern two-toed sloths in French Guiana

Free-ranging southern two-toed sloths (Choloepus didactylus) were translocated during the flooding of a forest at a hydroelectric dam site in French Guiana. Over an 11 mo period blood samples were collected from 90 sloths (38 males, 52 females) in order to determine hematological and serum chemistry reference values. Mean values and range of values were calculated for 13 hematological and 21 serum chemistry parameters. Variations associated with sex, age and reproductive status were identified. Males had a significantly lower red blood cell count than females. Immature animals had more monocytes while adults had more neutrophils and higher mean corpuscular hemoglobin concentration. Aspartate aminotransferase and triglyceride values were higher in young than in adult sloths but uric acid was lower. Lactating females showed lower red blood cells count and iron levels than non-lactating females. These profiles will help to provide reliable baseline data for medical evaluation of sloths.

The K-ras mutation pattern in pancreatic ductal adenocarcinoma usually is identical to that in associated normal, hyperplastic, and metaplastic ductal epithelium

BACKGROUND

Hyperplastic ductal lesions of the pancreas are believed to represent precursors of ductal adenocarcinoma. The most frequent mutation in manifest ductal carcinoma of the pancreas is the K-ras mutation at codon 12. The frequency and significance of this mutation in precursor lesions are a matter of controversy.

METHODS

The study included 35 resection specimens of ductal adenocarcinoma of the head of the pancreas and 3 noncancerous, noninflammatory pancreases. Ductal lesions were classified according to established criteria. Single cells from these lesions were microdissected and analyzed by the denaturing gradient gel electrophoresis polymerase chain reaction method.

RESULTS

All primary adenocarcinomas showed a K-ras mutation at codon 12 (25 cases with GAT, 7 cases with GTT, and 3 cases with CGT). One hundred and six of 364 ductal lesions were positive for the mutation. The highest relative percentage (53%) occurred in adenomatoid hyperplasia, followed by 36% in papillary hyperplasia, 26% in mucinous hypertrophy, and 14% in squamous metaplasia. With only two exceptions the mutation pattern of the ductal lesions and that of the corresponding primary tumor were identical. Twenty-one samples from normal ducts (17%) also harbored the K-ras mutation, as did 3 lesions from noncancerous specimens.

CONCLUSIONS

K-ras mutations are common events in normal, hyperplastic, metaplastic, and neoplastic pancreatic ductal cells. Because K-ras mutations frequently, although not exclusively, are related to mucinous differentiation of pancreatic cells, this mutation may not cause but only promote mucinous differentiation. The prevalence of a certain mutation pattern in nonneoplastic and neoplastic ductal cells in an individual pancreas suggests the dominance of one carcinogenic factor.