Development of T-tube tracts in piglets: effect of insertion method and material of T-tubes

T-tube-related bile leakage is a considerable problem in liver transplantation but rather rare in surgery of biliary lithiasis. To investigate the effect of T-tube insertion method and material on the intraperitoneal T-tube tract, we performed a choledochotomy and insertion of T-tube (four of silicone, seven of latex, four of silicone with a latex sheath around the long arm) for 2 weeks on 15 piglets (choledochotomy group), and sutured a transected bile duct over a T-tube stent in nine piglets (five silicone, four latex), inserted similarly as in liver transplantations, for 6 weeks. Sixteen patients underwent cholectochotomy and T-tube drainage with a latex T-tube (n = 8) and latex-sheathed silicone T-tube (n = 8) for a median 9 (7-21) days. Histological examination of T-tube tracts in piglets was made, and complications after T-tube removal in the latex T-tube group were compared with those in the latex-sheathed silicone T-tube group. In piglets, latex T-tubes induced better tracts than silicone T-tubes (P < 0.05). Piglets in the choledochotomy group had tracts superior to those in the anastomotic stent group (P < 0.05). There was one bile leakage in the latex T-tube group, and none in the latex-sheathed silicone T-tube group. We conclude that T-tube tract development is affected by both the material and the insertion method of T-tubes. A silicone T-tube with a latex sheath around the long arm may also be a good choice for T-tube material in liver transplantation.

Biocompatibility of latex and silicone T tubes in the porcine common bile duct: an experimental study

Toxicity of materials used in indwelling drains or catheters has the potential to damage surrounding tissues. The biocompatibility of biliary T-tubes was investigated using in groups of piglets (total 30 animals). In group 1 (n=16) a choledochotomy was performed with insertion of a latex T-tube (n=6) or a silicone T-tube (n=8), or without a T-tube (n=2). In group 2 (n=14) the common bile duct (CBD) was 3/4-transected, and the lesion was sutured over a latex T-tube (n=4) or a silicone T-tube (n=5), or without a T-tube (n=5). The groups were reoperated upon after 2 and 6 weeks respectively, and the CBD was harvested for scanning electron microscopy and light microscopy. The T-tubes were examined for cell culture toxicity with a DNA synthesis inhibition test. According to the cell culture tests, latex T-tubes were toxic and silicone T-tubes nontoxic. T-tubes induced moderate to pronounced fibrosis and epithelial damage in the CBD wall, but did not induce excessive fibrosis or scarring at the site of CBD suture. In the 6-week study period, however, the grade of tissue reactions in the CBD did not correlate with the toxicity of the T-tube materials, but rather reflected a foreign body reaction and mechanical pressure. Although gross anatomical changes did not occur, neither material seemed to be completely harmless for porcine CBD wall.

Characterization of H4: a mouse T lymphocyte activation molecule functionally associated with the CD3/T cell receptor

The monoclonal antibody C398.4A was produced by immunizing Armenian hamsters with the mouse T cell clone D10.G4.1. It recognizes a molecule selectively expressed by activated mouse T cells and was named H4. H4 is expressed on the T cell surface about 24 h after activation and peaks at day 7. By contrast, it is not expressed by resting or activated B cells, macrophages, or fibroblasts. It is also expressed by CD4 or CD8 single-positive mature thymocytes. Immunoprecipitation showed that H4 is a disulfide-linked dimer, precipitating as a broad band at about 50-65 kDa under nonreducing conditions and at 25 and 29 kDa under reducing conditions. Deglycosylation of the reduced H4 by N-glycanase gave rise to a single band of about 21 kDa, suggesting that the two chains may be differentially glycosylated forms of the same protein. The H4 expression pattern and biochemical features, together with cross-blocking, co-capping, co-modulation, and immunoprecipitation preclearing experiments showed that H4 is different from other known co-stimulatory molecules such as CD69, CD2, Ly-6, CD25, OX-40, Mac-1 and LFA-1. By in vitro kinase assay, H4 was found to co-precipitate a tyrosine kinase activity that phosphorylated substrates of about 29 and 25 kDa. Co-modulation and co-capping experiments showed that H4 is physically associated with the CD3/T cell receptor. These data suggest that H4 may function as a T cell-specific co-stimulatory molecule and play a role in the T cell response when the activation stimulus is limited either because the antigen is only available in low concentration or has a low agonistic activity.

Human papillomavirus infections in nonmelanoma skin cancers from renal transplant recipients and nonimmunosuppressed patients

BACKGROUND

Nonmelanoma carcinomas of the skin represent the most frequent cancers among the Caucasian population worldwide. They occur with high frequency in renal allograft recipient patients after prolonged immunosuppression.

PURPOSE

We analyzed tumors obtained from both immunosuppressed and nonimmunosuppressed patients for human papillomavirus (HPV) DNA.

METHODS

Twenty-nine specimens of nonmelanoma carcinomas of the skin were obtained from 19 renal allograft recipient patients; these included 20 specimens of squamous cell carcinoma (SCC) from 11 patients, five specimens of basal cell carcinoma (BCC) from four patients, and four specimens of carcinoma in situ (CIS) from four patients. Forty-one specimens of nonmelanoma carcinomas of the skin were obtained from 32 nonimmunosuppressed patients; these included 26 SCC specimens from 19 patients, 11 BCC specimens from nine patients, and four keratoacanthoma (benign epithelial tumor) specimens from four patients. A polymerase chain reaction method involving use of degenerate oligonucleotide primers, in which the conserved region of the open reading frame of the HPV L1 (major capsid protein) gene is amplified, was used to amplify total cellular DNA purified from individual tumors. The DNA of each specimen was subjected to 16 different amplification reactions; different primer combinations were used in order to increase the sensitivity and specificity of HPV detection. Resulting products were probed with a radioactively labeled, degenerate oligonucleotide. HPV-specific DNA was either sequenced directly after elution from the gel or amplified with semi-nested, degenerate primers, after which the products were cloned and sequenced. Sequences were compared with all known papillomavirus sequences.

RESULTS

Thirteen (65%) of the 20 SCC specimens and three of the five BCC specimens from immunosuppressed (renal allograft recipient) patients contained identifiable HPV-related sequences, among them 13 putative novel HPV genomes. In addition, all other malignant tumor specimens from this patient group revealed faint signals upon amplification and hybridization; the origin of these signals has not been identified in the present study. In nonimmunosuppressed patients, eight (31%) of 26 SCC specimens and four (36%) of 11 BCC specimens contained sequences of HPV types. Two putative novel HPV sequences could be identified in this group. Faint signals of yet undetermined origin were observed in eight of the SCC specimens and in two of the BCC specimens. Two of four keratoacanthoma specimens contained sequences of known HPV type. (Keratoacanthoma is a nonmalignant lesion for which the natural history has not been defined.) The spectrum of HPV types in both groups of patients differed substantially.

CONCLUSIONS

These data point to the frequent presence of HPV sequences in SCCs and BCCs of the skin. The etiologic relationship of these infections to the respective malignant tumors remains to be evaluated.

IMPLICATIONS

The presence of HPV DNA in a large percentage of specimens of nonmelanoma carcinomas of the skin from immunosuppressed patients, as well as from nonimmmunosuppressed patients, renders a papillomavirus infection as a possible factor in the etiology of this disease.

[Electroencephalographic changes in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency]

Electroencephalographic changes have been detected in children with premature pubarche. These findings might be the result from past or current central nervous system dysfunction, or from increased sex steroids. In order to test the last assertion we have performed electroencephalographic studies in 10 patients (7F, 3M) with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, of whom 4 classic and 6 nonclassic forms of the syndrome. Traditional neurologic examination was performed in 7 patients, the result being considered normal in everyone, while evolutional neurologic examination detected hyperactive disturbance and attention deficit in two patients. In another patient, the clinical findings were compatible with delay of neuropsychomotor development. Quantitative electroencephalography with brain mapping in patients over three years-old (n = 9), and conventional EEG in the remaining patient, were considered abnormal for age in 8 patients (80%), the record being characterized as slow in 7 patients. The high rate of electroencephalographic changes in this sample, as well as in premature pubarche, suggests that these findings might result from high inappropriate for age androgenic levels, and warns about the importance of neurologic examination and follow-up in children with CAH.

[Eruptive vellus hair cysts]

Eruptive vellus hair cysts are rare epidermal cysts with vellus hairs, which appear in children or young adults. A 21-year-old patient is reported who developed asymptomatic comedo-like papules on his face, neck and chest. Histopathologically, epidermoid cysts with a fine stratum granulosum, laminated keratinous material and numerous vellus hairs were found in the mid-dermis. Evaluation of immediate family members revealed that the patient's father was similarly affected. Eruptive vellus hair cysts and steatocystoma multiplex are clinically similar, but have distinctive histopathological features and should be regarded as distinct entities.

Multiple keratoacanthomas, giant keratoacanthoma and keratoacanthoma centrifugum marginatum: development in a single patient and treatment with oral isotretinoin

A 78-year-old man is described, who over 18 years developed three different types of keratoacanthoma: multiple keratoacanthomas, keratoacanthoma centrifugum marginatum and giant keratoacanthoma. Histological examination of the different neoplasms showed similar changes, all typical of a keratoacanthoma. In situ hybridisation revealed no human papilloma virus in the tumours. Complete examination showed no associated internal malignancy. After repeated surgical treatment oral isotretinoin treatment was administered (1 mg/kg per day). This treatment produced clearing of existing keratoacanthomas and, during a period of 2 months, further keratoacanthoma formation was completely suppressed. Treatment was stopped after 3 months by the patient because of side-effects. Numerous keratoacanthomas developed during the following 6 weeks.

The biologic significance of white blood cells in semen

OBJECTIVE

To analyze the data available on the biologic significance of white blood cells (WBC) in semen of infertility patients.

DATA RESOURCES

The relevant literature was reviewed.

RESULTS

It is not possible to identify reliably WBC by conventional sperm staining techniques. The peroxidase method is sufficient for quantification of granulocytes, but immunocytology is the gold standard for the detection of all WBC populations in semen. Granulocytes are the most prevalent WBC type in semen (50% to 60%), followed by macrophages (20% to 30%) and T-lymphocytes (2% to 5%). The prevalence of leukocytospermia (> 10(6) WBC/mL semen) among male infertility patients is approximately 10% to 20%. There is controversy on the significance of WBC in semen. Whereas some authors did not observe sperm damage in the presence of leukocytospermia, others have found evidence that WBC are significant cofactors of male infertility: [1] seminal WBC numbers were higher in infertility patients than among fertile men; [2] leukocytospermia was associated with decreased sperm numbers and impaired sperm motility; [3] WBC damaged sperm function and hamster ovum penetration in vitro and were important prognostic factors for IVF-ET failure. Because of absence of clinical symptoms, the origin of WBC is difficult to determine. Normally, most WBC appear to originate from the epididymis because vasectomized men show very few WBC in semen. On the other hand, leukocytospermic samples show low citric acid levels, pointing to asymptomatic prostatitis as a source of WBC in semen. Surprisingly, approximately 80% of leukocytospermic samples are microbiologically negative. In some cases Chlamydia trachomatis might have triggered a persistent inflammatory reaction leading to leukocytospermia. Sperm damage by WBC can be mediated by reactive oxygen species, proteases and cytokines. Furthermore, genital tract inflammation facilitates the formation of sperm antibodies. As seminal plasma has strong anti-inflammatory properties and because there is only short contact between sperm and WBC in prostatitis and seminal vesiculitis, inflammations of the epididymis and testis are likely to have the largest impact on sperm.

CONCLUSIONS

There is ample evidence that WBC can affect sperm function. Further studies are needed to define cofactors that increase or decrease the risk of sperm damage by WBC.

Biocompatibility of various indwelling double-J stents

The biocompatibility of 8 double-J stent brands was evaluated both in vivo, by scanning electron microscopy and histological analysis of pig ureters intubated for 6 weeks, and in vitro, by cell culture methods. In vivo findings showed that superficial epithelial destruction was milder in the ureters intubated with hydrogel-coated stents than in those intubated with other stents. Inflammatory reactive changes were milder in the ureters intubated with silicone stents than in those intubated with other stents, while encrustation was more severe on silicone and Grey stents than the others. In vitro, the 3 stent brands made of "modified polyurethane" were found to be cytotoxic while the others were not. Overall, silicone and hydrogel-coated stents seemed to be more biocompatible than the others, and hydrogel-coated stents to be more suitable than silicone stents for long-term ureteral stenting, being less prone to encrustation. Although they are of an experimental nature, these findings may be of relevance to clinical practice.

Detection of Chlamydia trachomatis in semen by antibody-enzyme immunoassay compared with polymerase chain reaction, antigen-enzyme immunoassay, and urethral cell culture

OBJECTIVE

To compare the results obtained by four different techniques for the detection of Chlamydia trachomatis in the male genital tract.

DESIGN

Prospective study.

SETTING

Andrology unit of a university hospital.

PATIENTS

Male infertility patients.

INTERVENTIONS

Analysis of semen samples and urethral swabs for the presence of C. trachomatis by recombinant antibody-enzyme-linked immunosorbent assay (rELISA), polymerase chain reaction (PCR), antigen-enzyme immunoassay (EIA) and McCoy cell culture.

MAIN OUTCOME MEASURE

Detection of C. trachomatis.

RESULTS

In 57 of 205 semen samples (27.8%) immunoglobulin A-antibodies against C. trachomatis were found. In contrast, only 1 of 56 semen samples (1.8%) was positive for C. trachomatis-DNA by PCR, only 1 of 139 semen samples (0.7%) was positive by antigen-EIA, and only 4 of 173 urethral swabs (2.3%) grew C. trachomatis in cell culture.

CONCLUSIONS

The discrepancy of positive results found by the antibody-rELISA and direct methods for the detection of C. trachomatis indicates successful eradication of the microorganism in > 90% of antibody-positive men. Therefore, detection of antibodies against C. trachomatis in seminal plasma appears to be of limited diagnostic value.

The effects of various indwelling JJ stents on renal pelvic pressure and renal parenchymal thickness in the pig

OBJECTIVE

To determine whether indwelling JJ stents significantly alter renal pelvic pressure and consequently have deleterious effects on renal function.

MATERIALS AND METHODS

Thirteen piglets were used totalling 26 renal units. Using an open, sterile surgical procedure, 23 renal units were stented with 6 F JJ catheters of eight different types: three renal units were not stented and served as controls. Intra-pelvic pressure values during diuretic stress were measured before and after 6 weeks of intubation. The kidneys were then removed and sent for pathological evaluation of renal parenchymal thickness.

RESULTS

A marked increase in intra-pelvic pressure values was found in two of the 19 stented renal units suitable for this measurement. A significant reduction (more than one third with respect to the control values) in renal parenchymal thickness was found in six of the 21 stented renal units suitable for this measurement, three of which had been intubated with a Cook polyurethane stent and three with an Angiomed Puroflex stent.

CONCLUSION

In the present experimental study some JJ stents seemed to cause long-lasting changes in renal pelvic pressure and consequently to have deleterious effects on renal function. Although experimental findings are not always fully related to clinical practice, a knowledge of the potential effects of these prostheses is essential to minimize complications related to their use.

[Andrologic variables for in vitro fertilization]

The purpose of the study was to identify semen parameters relevant for in vitro fertilization (IVF). A total of 151 ejaculates from 130 patients were analyzed. There was a significant association between successful IVF, high sperm concentration and good sperm motility. Progressive sperm motility correlated best with successful fertilization of oocytes (r = +0.427) and was the only parameter significantly linked to pregnancy. Very low values were sufficient for fertilization in vitro: a sperm concentration of 4.5 x 10(6)/ml and a progressive sperm motility of 20%. The results of analysis of fructose, citrate and neutral alpha-glucosidase as markers of seminal vesicle, prostate and epididymal functions were not different in fertilizing and non-fertilizing semen samples. Moderate increases in granulocyte elastase levels, between 250 and 1000 ng/ml, did not influence IVF. However, two patients with genital tract inflammation (PMN-elastase > 1000 ng/ml) did not fertilize despite excellent semen parameters. These results stress the importance of andrological factors for in vitro fertilization outcome.

[The immotile cilia syndrome. A rare form of male infertility]

A man presented with 100% immotile spermatozoa. Transmission electron microscopy showed the absence of both central tubules in all sperm tails; the nine peripheral tubules, dynein arms, radial spokes and other structures of the sperm tail were normal. Immotile cilia syndrome of the 9 + 0 tubular pattern was diagnosed. Other anomalies frequently associated with immotile cilia syndrome, such as recurrent airway infections, bronchiectases and situs inversus (Kartagener's syndrome), were not present in this case.

Anti-CD45 augments response of a Th2 clone to TCR cross-linking

The CD45 molecule is a transmembrane tyrosine phosphatase that may be associated with the T-cell receptor (TCR). This has led to the suggestion that CD45 may be important for the regulation of signal transduction in T cells. This idea is supported by the finding that antibodies against CD45 are comitogenic in proliferation assays. In the present work, we have examined the comitogenicity of CD45 antibodies by studying the effect of CD45, CD45RA, and CD45RB monoclonal antibodies (MoAbs) on proliferation of D10 cells induced with T-cell receptor (TCR) MoAbs. In addition interactions with some other proliferation inducing agents namely CD3 antibodies, lectins, and IL-2, are examined here. We have found that in general the CD45 MoAbs would significantly enhance proliferation induced by a wide spectrum of TCR MoAbs and other proliferation inducing agents, with some minor quantitative differences. The CD45 and CD45RB MoAbs were equally potent in their comitogenic activity while the CD45RA antibody was somewhat less potent. The comitogenic effect was maximal when CD45 antibodies were added simultaneously with the TCR MoAb, but significant comitogenicity could be detected when CD45 MoAbs were added up to 24 h after the initiation of the culture indicating that the CD45 antibodies also affect other processes than the initial signal transduction cascade.

Co-stimulatory signal delivered by CD73 molecule to human CD45RAhiCD45ROlo (naive) CD8+ T lymphocytes

CD73 is a molecule expressed by a subset of CD8+ human T lymphocytes and is involved in T cell activation. CD73 expression and function were analyzed in peripheral blood CD45RAhiCD45ROlo (naive) and CD45RAloCD45ROhi (memory) CD8+ cells. We found that CD73 was expressed by a majority of naive cells (74 +/- 12%), whereas fewer memory cells were CD73+ (29 +/- 10%). Moreover, CD73 was selectively expressed by the CD11b- subset of naive CD8+ cells, which were almost all CD73+. The same result was found on CD8+ cord blood lymphocytes, which prevalently display the naive phenotype. Naive CD8+ CD11b- cells were almost unresponsive to CD3 engagement, but this apparent anergy was completely overcome when CD3 and CD73 were simultaneously cross-linked by plastic-immobilized CD73 and CD3 mAb, showing that CD73 delivers an accessory signal that allows their activation via the CD3/TCR. This costimulatory signal was tenfold more potent than that induced by CD28 ligation. A phosphotyrosine analysis by Western blotting showed that cross-linking of CD73 induced the phosphorylation of two proteins with a molecular mass of approximately 28 and 100 kDa respectively, whereas ligation of CD3 induced phosphorylation of many substrates. When CD3 and CD73 were simultaneously triggered these substrates were hypophosphorylated. Because CD73 is linked to the cell surface by a GPI anchor, the transduction of this signal is probably mediated by a lateral interaction with transmembrane molecules. This hypothesis was assessed by cocapping, which showed that CD73 associates strongly with CD45RC, moderately with CD8, and weakly with CD3. These data suggest that CD73 signaling is coupled to both tyrosine kinase and phosphatase activities.

Co-stimulatory signal delivered by CD73 molecule to human CD45RAhiCD45ROlo (naive) CD8+ T lymphocytes

CD73 is a molecule expressed by a subset of CD8+ human T lymphocytes and is involved in T cell activation. CD73 expression and function were analyzed in peripheral blood CD45RAhiCD45ROlo (naive) and CD45RAloCD45ROhi (memory) CD8+ cells. We found that CD73 was expressed by a majority of naive cells (74 +/- 12%), whereas fewer memory cells were CD73+ (29 +/- 10%). Moreover, CD73 was selectively expressed by the CD11b- subset of naive CD8+ cells, which were almost all CD73+. The same result was found on CD8+ cord blood lymphocytes, which prevalently display the naive phenotype. Naive CD8+ CD11b- cells were almost unresponsive to CD3 engagement, but this apparent anergy was completely overcome when CD3 and CD73 were simultaneously cross-linked by plastic-immobilized CD73 and CD3 mAb, showing that CD73 delivers an accessory signal that allows their activation via the CD3/TCR. This costimulatory signal was tenfold more potent than that induced by CD28 ligation. A phosphotyrosine analysis by Western blotting showed that cross-linking of CD73 induced the phosphorylation of two proteins with a molecular mass of approximately 28 and 100 kDa respectively, whereas ligation of CD3 induced phosphorylation of many substrates. When CD3 and CD73 were simultaneously triggered these substrates were hypophosphorylated. Because CD73 is linked to the cell surface by a GPI anchor, the transduction of this signal is probably mediated by a lateral interaction with transmembrane molecules. This hypothesis was assessed by cocapping, which showed that CD73 associates strongly with CD45RC, moderately with CD8, and weakly with CD3. These data suggest that CD73 signaling is coupled to both tyrosine kinase and phosphatase activities.

Comparison of methods to enumerate white blood cells in semen

Seminal WBC counts obtained by an mAb-based immunohistologic method correlated well with seminal granulocyte counts obtained with a simple peroxidase method (rho = +0.70; P < 0.0001). However, total WBC counts were significantly higher than granulocyte counts for most samples. With the immunohistologic method, 17 of 112 samples (15.2%) contained > 10(6) WBC/mL semen, whereas the peroxidase method resulted in only 10 samples (8.9%) with > 10(6) WBC/mL. When the threshold defining leukocytospermia was set at 1 x 10(6) positive cells/mL for both methods, the specificity of the peroxidase test compared with the immunohistology technique was 100% (10/10), but the sensitivity was only 58.8% (10/17). When the threshold for leukocytospermia in the peroxidase test was lowered to 5 x 10(5) positive cells/mL semen, the sensitivity relative to the immunohistology technique increased to 94.1% (16/17), and specificity remained 100% (16/16). Likewise, good interassay sensitivity and specificity values were obtained with thresholds of 10(6) WBC/mL for the peroxidase assay and 2 x 10(6) WBC/mL for the immunohistology assay. We conclude that either peroxidase or immunohistology assays can be used to screen for leukocytospermia, but that more research is needed to establish thresholds for pathological levels of WBC in semen using these two approaches. Total round cell counts are of no value for enumerating WBC in semen.

Adherence of Escherichia coli to sperm: a mannose mediated phenomenon leading to agglutination of sperm and E. coli

OBJECTIVE

To investigate the mechanism of adherence between Escherichia coli and sperm.

DESIGN

Experimental study performed with donor sperm and male genital tract-derived E. coli.

SETTING

Andrology unit of a university hospital.

PATIENTS

None.

INTERVENTIONS

Monitoring of sperm-E. coli agglutination; addition of sugars to block adherence; electron microscopy.

MAIN OUTCOME MEASURE

Sperm-E. coli agglutination.

RESULTS

Escherichia coli readily adhered to and agglutinated sperm. The phenomenon was observed at E. coli to sperm ratios as low as 1:20; maximum sperm agglutination involving approximately 90% of spermatozoa was seen with ratios of 1:5 or higher. By transmission electron microscopy, E. coli adherence was observed both on sperm heads and tails. Heteroagglutination could be blocked by D-mannose and alpha-methyl-mannopyranoside but not by other sugars. Preincubation of sperm or E. coli with mannose resulted in block of agglutination, indicating mannose-binding structures both on sperm and E. coli.

CONCLUSIONS

Adherence of E. coli to sperm is mediated by mannose and mannose-binding structures present on both cell types. Agglutination of sperm by E. coli may be relevant in male and female infertility.

Birth weight and smoking practices during pregnancy among Mexican-American women

The smoking practices of a national sample of Mexican-American mothers and the resulting effects of those practices on birth weight were examined. Data were from the Hispanic Health and Nutrition Examination Survey conducted by the U.S. National Center for Health Statistics during 1983-1984. We found that 24% of the mothers had smoked during their pregnancy, with a mean of 11 cigarettes per day. Infants of these women weighed 101 g less at birth than did infants of nonsmoking mothers and had a low birth weight rate of 8.0% compared with the 5.1% low birth weight rate for the sample as a whole. Multiple regression results indicate a 7.4 g decrease in birth weight for each cigarette smoked per day during pregnancy. Cultural factors that promote a low birth weight rate for Mexican-Americans that is comparable to that of non-Hispanic whites despite increased rates of poverty and inadequate health care do not protect against the insidious effects of cigarette smoking.

In vitro stimulation of human fetal lymphocytes by mitogens and interleukins

Human lymphocytes derived from fetal spleen and liver were studied for their capacity to respond to mitogens and interleukins using different in vitro models (cell volume increase, [3H]thymidine incorporation, Ig secretion). Although the number of mature B and T cells in the fetal liver preparations remained nearly constant [Settmacher et al. (1991) Immunobiol. 182, 256], only lymphocytes obtained from fetal organisms before the 25th week of gestation could respond to some of the polyclonal stimulators (PWM, anti-CD3 + IL-2, SAC + IL-2, SAC + IL-4) tested, whereas cells obtained after that period failed. In the fetal spleen, however, with increasing percentages of mature B and T cells during fetal development, a growing ability to respond to mitogens was registered, which, however, did not achieve the values found for the adult spleen material.

Comparison of three methods to detect white blood cells in semen: leukocyte esterase dipstick test, granulocyte elastase enzymeimmunoassay, and peroxidase cytochemistry

Comparison of three methods for the detection of WBC in semen revealed a low concordance of positive test results. Among 557 semen samples, most positives were observed with the leukocyte esterase dipstick test (n = 95; 17.1%) followed by the peroxidase test (n = 51; 9.2%). There was little overlap between positives in the esterase-dipstick and the peroxidase method (29/117; 24.8%). With only 4 of 557 samples (0.7%), the PMN-elastase ELISA showed a surprisingly low incidence of positives. Because of lack of a gold standard, none of the three methods could be identified as superior. Because of its simplicity, specificity, and cost-effectiveness, the peroxidase method appeared most suited for clinical application.

High levels of IL-2 alter signal transduction in cloned IL-4-producing CD4 T cells

Cloned CD4 T cells of the Th2 type make IL-4 and related cytokines upon receptor cross-linking, whereas cloned CD4 T cells of the Th1 type make IL-2, IFN-gamma, and TNF-beta. These two types of CD4 T cell are also reported to use distinct mechanisms of signal transduction. It has been reported that Th1 cells flux Ca2+ upon receptor cross-linking, whereas Th2 cells do not. We have noted that when cloned Th2 cells are exposed to high levels (20 U/ml) of IL-2, they show an altered phenotype. Such cells are much more sensitive to activation by certain antireceptor antibodies, they flux calcium upon receptor ligation without additional cross-linking with anti-Ig antibodies, and they make much larger amounts of IL-4. In addition, the organization of their TCR is altered, with increased levels of the TCR-eta chain and an increase in the extent of association of CD4 with CD3 and CD45, changes similar to those found in Th1 cells. These results suggest that there is no fundamental difference in the signal transduction apparatus of Th1 and Th2 cells; rather, the IL-2 made by Th1 cells may create similar phenotypic changes in these cells and thus create the impression of altered signal transduction mechanisms. These results do show that exposure to high levels of IL-2 can profoundly affect signal transduction in T cells. Furthermore, we found that the Ca2+ signal caused by CD3 antibodies seemed to differ in character from that caused by TCR antibodies suggesting that the use of CD3 antibodies is not always a good model for activation through the TCR.

High levels of IL-2 alter signal transduction in cloned IL-4-producing CD4 T cells

Cloned CD4 T cells of the Th2 type make IL-4 and related cytokines upon receptor cross-linking, whereas cloned CD4 T cells of the Th1 type make IL-2, IFN-gamma, and TNF-beta. These two types of CD4 T cell are also reported to use distinct mechanisms of signal transduction. It has been reported that Th1 cells flux Ca2+ upon receptor cross-linking, whereas Th2 cells do not. We have noted that when cloned Th2 cells are exposed to high levels (20 U/ml) of IL-2, they show an altered phenotype. Such cells are much more sensitive to activation by certain antireceptor antibodies, they flux calcium upon receptor ligation without additional cross-linking with anti-Ig antibodies, and they make much larger amounts of IL-4. In addition, the organization of their TCR is altered, with increased levels of the TCR-eta chain and an increase in the extent of association of CD4 with CD3 and CD45, changes similar to those found in Th1 cells. These results suggest that there is no fundamental difference in the signal transduction apparatus of Th1 and Th2 cells; rather, the IL-2 made by Th1 cells may create similar phenotypic changes in these cells and thus create the impression of altered signal transduction mechanisms. These results do show that exposure to high levels of IL-2 can profoundly affect signal transduction in T cells. Furthermore, we found that the Ca2+ signal caused by CD3 antibodies seemed to differ in character from that caused by TCR antibodies suggesting that the use of CD3 antibodies is not always a good model for activation through the TCR.

[Pancreas transplantation with exocrine bypass to the gallbladder as receiver. Experimental results and the first clinical case]

A new procedure for intraperitoneal pancreas transplantation, donor-pancreatoduodenectomy/receiver-cholecystectomy, is described. The pancreas, with a segment of the duodenum, is placed dorsally in the peritoneal cavity. The portal vein is anastomosed to the sub-hepatic caval vein and the long aortic segment of the graft is anastomosed with the receiver's aorta. Pancreas exocrine excretion is deviated to the receiver's gallbladder via a duodenobladder bypass.

Impact of clinically silent inflammation on male genital tract organs as reflected by biochemical markers in semen

Three hundred eight-nine healthy, infertile patients were studied to determine the effects of inflammation on genital tract organs. Clinically silent inflammation was diagnosed by measuring polymorphonuclear granulocyte (PMN) elastase in semen. Seminal vesicle, prostate, and epididymis functions were assessed by measuring fructose, citric acid, and neutral alpha-glucosidase in semen. There was a significant relationship between high PMN elastase levels and low citric acid levels in semen; fructose and neutral alpha-glucosidase were not related to PMN elastase. Semen samples with increased PMN elastase levels (greater than 250 and greater than 1,000 ng/ml) showed a high incidence of pathologic citric acid levels (67% and 73%, respectively). These biochemical data indicate that the prostate is the main target in clinically silent male genital tract inflammation.

Chlamydia trachomatis induces an inflammatory response in the male genital tract and is associated with altered semen quality

U. urealyticum with 15.8% and C. trachomatis antibodies with 15.4% were the most prevalent microbiological findings in 209 male infertility patients. The inflammatory marker granulocyte-elastase was significantly increased in men with C. trachomatis; these men also showed significantly decreased citric acid levels indicating inflammatory damage of the prostate induced by C. trachomatis.

[Cardiopulmonary risk factors in patients with sleep apnea]

Since the interaction between disorders of the respiratory coordination and cardiovascular or cardiopulmonary regulation is still largely unknown the intention of the present investigation is to point out the coincidence of cardiac arrhythmias, such as premature ventricular capture (PVC) beats and conduction blocks, with obstructive sleep apnea (OSA). For the first time a group of more than 300 patients with suspected OSA is examined concerning risk factors and frequent diagnoses as obesity, hypertension, coronary heart disease (CHD), heart insufficiency, chronic obstructive pulmonary disease (COPD), and daytime hypoxaemia. Summarizing the results of lung function test, blood gas analysis, strain-ECG, Holter-ECG and inductive plethysmography with oxygen partial pressure measurement by ambulatory work-up the following statements can be made: PVC beats occurring markedly during sleep give hints for OSA being the underlying cause, especially if the patients are young and overweight. Hypoxaemia increasing during the apnea episodes should be considered as one possible pathogenetic mechanism. Second- and third degree conduction blocks and sinus arrest coincident very often with OSA. They suggest to be life-limiting factors the more so since they often go along with CHD or heart insufficiency. Systemic arterial hypertension and overweight have the highest prevalence in OSA, signs for heart insufficiency and daytime hypoxaemia are also significantly more frequent than in non-OSA patients. We could find no hints for direct pathogenetic coherence between CHD and OSA or between COPD and OSA, nevertheless pronounced nocturnal changes in blood gases and intrathoracic hemodynamics have important influence on the cardiopulmonary and cardiovascular system, as partly illuminated in other more pathogenetic oriented studies by the present time.

[The accuracy of the imaging procedures (sonography, MRT, CT, angio-CT,nuclear medicine) in characterizing liver tumors]

In a prospective study, an attempt was made to determine the specificity of various imaging methods for defining tumours of the liver rather than their ability to demonstrate them. It was based on 130 patients with histologically confirmed lesions (33 haemangiomas, 17 FNH, 4 hepatocellular adenomas, 28 HCC, 36 adenocarcinoma metastases). The methods were MRT (130 cases), sonography (119), CT (122), dynamic arterial angio-CT (15), 99TC-EHIDA or blood pool scintigraphy (4 FNH, haemangiomas, HCC, 44 cases). MRT showed somewhat better results (accuracy 80%) than CT (73%) and angio-CT (73%) in demonstrating the type of lesion. The results of scintigraphy (53%) and sonography (69%) were rather worse. The range of accuracy for MRT, CT and sonography varied from 94% (haemangiomas with MRT) to 47% (FNH with sonography).

Drug administration in relation to meals in the institutional setting

To investigate adherence to literature recommendations for administration of five cardiovascular drugs in relation to mealtimes, data from records of 183 adult patients in two short-term and two long-term care settings were tabulated. Ninety-three percent of patients taking quinidine sulfate and 85% of patients taking the other four study drugs received one or more doses incorrectly. Findings show that timing recommendations for dosing in relation to meals are not considered in these institutions when drug administration schedules are established. The practice of arbitrary schedule selection could have serious consequences, including adverse physiologic and financial impact on the patient from loss of therapeutic effectiveness or development of drug toxicosis. Medication schedules need to be designed to achieve the greatest drug bioavailability.

Percutaneous biopsy of the liver

Retrospective evaluation of 510 percutaneous CT-guided biopsies of the liver mainly fine-needle aspiration biopsies for cytology (89% of cases), yielded an overall accuracy rate of 92% and a sensitivity of 94%. The relatively high percentage of false-positive diagnoses (7% of all benign tumors) may be reduced by more consistent consideration of possible errors in cytology and a more consistent use of large bore biopsies.

[Psychological aspects of traffic fitness of aging car drivers]

With the increase in the proportion of older car drivers in road traffic of the G.D.R. it becomes more necessary to carry out traffic psychological fitness examinations stronger related to health indications. The present paper is occupied with accident frequency, accident causes, indications of age-induced changes in relevant traffic psychological performance demands, and it gives references with regard to a self-assessment of age-induced impairments in driving behaviour.

[Cushing's syndrome in CRF-producing mediastinal carcinoid]

A 36-year-old patient developed marked pigmentation, marked myopathy and severe hypokalaemic alkalosis which at first pointed towards an ectopic ACTH syndrome. The dexamethasone test at a high dose indicated cortisol suppression. A mediastinal tumour was seen radiologically, but the sella was of normal size. Computed tomography provided indirect signs of a sellar space-occupying lesion which suggested an ectopic production of corticotropin-releasing factor (CRF) as cause of the Cushing's syndrome. CRF concentration in antecubital venous blood was markedly elevated to 280 ng/l. The mediastinal tumour was excised and proved to be a carcinoid histologically. Postoperatively the CRF concentration fell to 70 ng/l. An extract of the carcinoid contained 15.5 ng/g wet-weight of CRF and 254 ng/g wet-weight of beta-endorphin. The patient died 5 weeks postoperatively of sepsis with bilateral pneumonia. At autopsy the hypophysis was of normal size but showed nodular ACTH-cell hyperplasia. This was thus a case of Cushing's syndrome resulting from ectopic CRF production in a mediastinal carcinoid tumour.

Leukocytospermia is associated with poor semen quality

Semen samples from 179 infertility patients were analyzed for type and number of white blood cells (WBC) by a combination of immunologic techniques. Forty-one (23%) had more than 10(6) WBC/mL semen (leukocytospermia). Semen parameters in patients with less than 10(6) WBC/mL were similar to those of 15 fertile donors. In contrast, the leukocytospermic group had significant reductions in total sperm number, percent sperm motility, sperm velocity, motility index, and total number of motile sperm. Patients with high concentrations of monocytes/macrophages (greater than 5 X 10(5)/mL; n = 27) had significantly reduced ejaculate volume; patients with high numbers of T lymphocytes (greater than 10(5)/mL; n = 19) had a significant reduction in sperm velocity; and patients with high levels of granulocyte elastase in semen (greater than 1,000 ng/mL; n = 26) had significant reductions in ejaculate volume, total sperm number, and total motile sperm number. There was no correlation between the presence of antisperm antibodies and leukocytospermia. Our data suggest that leukocytospermia may occur frequently in male infertility patients and show that elevated levels of WBC in semen are associated with poor semen quality. This provides further rationale for white blood cell testing in semen of male infertility patients, since antibiotic or anti-inflammatory therapy may be helpful in appropriately selected cases.

Differential diagnosis of immature germ cells in semen utilizing monoclonal antibody MHS-10 to the intra-acrosomal antigen SP-10

The monoclonal antibody (mAb) MHS-10 (IgG1) is a mouse antihuman sperm antibody which recognizes a polymorphic sperm protein, (SP-10), which has previously been localized within the acrosomal matrix and the acrosomal membranes. The SP-10 antigen has been shown to be sperm-specific and is not found in somatic tissues. It is stage specific, having been immunohistologically localized to Golgi phase spermatids and all subsequent phases of spermiogenesis. In the present study, acetone-dried smears from washed human semen containing significant numbers of round cells were probed with mAb MHS-10. Monoclonal antibody-labeled cells were visualized by a standard streptavidin-biotin immunoperoxidase method using a light microscope. The MHS-10 mAb immunoreacted with mature sperm and with a subset of round cells diagnosed as developing spermatids, which had been sloughed off from the testis at varying stages of acrosome formation. To rule out possible cross-reactivity of the mAb with leukocytes in semen, a leukocyte surface marker (anti-HLe-1) was used in conjunction with MHS-10. Round cell populations staining with MHS-10 did not stain with anti-HLe-1. The mAb MHS-10 is thus a promising probe for the identification and quantitation of immature germ cells in human semen.

[The atypical fibroxanthoma]

A 84-year-old female patient suffering from atypical fibroxanthoma is presented. A diagnosis of malignant melanoma or a cutaneous metastasis from an unknown primary tumor was suspected. The final diagnosis was established by immunohistological studies showing a strongly positive reaction to vimentin and a negative reaction to S-100 protein and cytokeratin.

[HIV in sperm]

HIV in the semen is located in the mononuclear cell fraction, which contains CD4 lymphocytes and monocytes/macrophages, i.e. the classic HIV host cells. In addition, HIV is also present in cell-free seminal fluid. The results on HIV binding to spermatozoa are still controversial. Genital tract infections are a possible cofactor that might increase the risk of HIV transmission by way of the semen, because they lead to a marked increase in the number of potential HIV host cells in semen.

[Feasibility and relevance of tumor volumetry for stage classification and assessment of remission of germ cell tumors]

Although tumor load has proven to be the most relevant prognostic factor in disseminated germ cell tumors (GCT), methods to determine tumor volume for staging have not been studied so far. In a prospective study, we therefore measured the volume of metastases before and during chemotherapy in 27 patients with disseminated GCT. Abdominal tumor volume was calculated using a General Electric CT scan 8800. Total volume was determined by cumulation of 1 cm slices measured by a cursor. Pulmonary volume was calculated by taking each metastasis as a sphere using V = 0.523 x d3, where V = volume and d = diameter. We used linear regression analysis to determine the dependence of tumor markers on volume. Before chemotherapy, the median tumor volume of all patients was 237 (range 4-2690) cm3. The tumor volume was 1-100 cm3 in 30%, 101-500 cm3 in 41%, and over 500 cm3 in 29% of the patients. NED (no evidence of disease) was achieved in 8/8 patients presenting with a small (1-100 cm3) and 9/10 with a moderate (101-500 cm3) tumor volume. In contrast, only 1/8 with advanced tumor load (greater than 500 cm3) achieved NED. While there was a significant correlation between the initial and the residual tumor volume (P = 0.0024, r = 0.72), there was none between the tumor volume and alpha fetoprotein, beta human chorionic gonadotropin, and lactate dehydrogenase. These results suggest that radiological determination of tumor volume is a reproducible and accurate staging method.