Drug evaluation of concurrent Pneumocystis carinii, Toxoplasma gondii, and Mycobacterium avium complex infections in a rat model

We present a new experimental model for the simultaneous evaluation of the activities of drugs against Pneumocystis carinii, Toxoplasma gondii, and Mycobacterium avium complex infections. Rats latently infected with P. carinii were challenged with the MO-1 strain of M. avium and then immunosuppressed with corticosteroids for 7 weeks. At week 5 the RH strain of T. gondii was intraperitoneally injected. Organs were examined for the three pathogens after death or killing of the animals at week 7. Without treatment, rats challenged with T. gondii died with pulmonary P. carinii infection and disseminated T. gondii and M. avium infections. In order to assess the value of the model for evaluation of the activities of drugs, we administered by oral gavage for 7 weeks drugs or combinations of drugs selected for their individual efficacies against at least one pathogen. We found that clarithromycin with sulfamethoxazole, clarithromycin with atovaquone, roxithromycin with sulfamethoxazole or dapsone, and rifabutin with atovaquone were effective against the three infections, whereas PS-15 with dapsone and trimethoprim with sulfamethoxazole were active against Toxoplasma and Pneumocystis infections only. This triple-infection rat model offers a new tool for the simultaneous evaluation of the activities of drugs against three of the major opportunistic infections occurring in immunosuppressed individuals.

Isolation of a benzene valence isomer with one-electron phosphorus-phosphorus bonds

A tetraphosphabenzene analog of the postulated anti-tricyclohexylene, a singlet biradical valence isomer of benzene, has been isolated. The tricyclic derivative features one-electron phosphorus-phosphorus bonds, which result from the pi*-pi* interaction between two diphosphirenyl radicals. Such one-electron bonds may play a wider role in phosphorus chemistry.

Comparative effects of adenosine-5'-triphosphate and related analogues on insulin secretion from the rat pancreas

Adenosine tri- and diphosphate (ATP and ADP) and their structural analogues stimulate insulin secretion from the isolated perfused rat pancreas, an effect mediated by P2Y-purinoceptor activation. Concerning the base moiety of the nucleotide, it was previously shown that purine but not pyrimidine nucleoside triphosphates were active and that substitution on purine C2 with the 2-methylthio group greatly enhanced the potency. In this study, we further analyze the consequences of ribose and polyphosphate chain modifications. Modifications in 2' and 3' position on the ribose led to a decrease in insulin response when bulky substitutions were made: indeed, 2'-deoxy ATP was similar in activity to ATP, whereas arylazido-aminopropionyl ATP (ANAPP3) was weakly effective and trinitrophenyl ATP (TNP-ATP) was inactive. Substitution on the gamma phosphorus of the triphosphate chain led to a decrease (gamma-anilide ATP) or no change (gamma-azido ATP) in potency; the replacement of the bridging oxygen between beta and gamma phosphorus by a peroxide group did not significantly change the activity, whereas substitution by a methylene group completely abolished stimulation of insulin secretion. As for the phosphorothioate analogues, adenosine-5'-O-(3-thiotriphosphate) (ATP gamma S) induced an insulin response similar to that produced by ATP, whereas adenosine-5'-O-(2-thiodiphosphate) (ADP beta S) was about 100-fold more potent than ATP, as previously shown. In conclusion, two structural features seem to have a strategic importance for increasing the insulin secretory activity of ATP analogues: substitution at the C2 position on the adenine ring of ATP and modifications of the polyphosphate chain at the level of the beta phosphorus.

Meningeal melanocytoma. Report of a case and a historical comparison

Meningeal melanocytomas are rare tumors of the central nervous system that are found almost exclusively in the posterior fossa and spinal cord and whose natural history is poorly defined. In this report, the authors review the clinical presentation, radiological appearance, operative findings, and histological features in two cases of meningeal melanocytoma: one cranial and one spinal. Two women, aged 21 and 30 years, were admitted to the hospital 60 years apart: the first because of progressive paraplegia and the second because of slowly progressive hearing loss. The first patient had an extradural tumor that was treated by laminectomy, subtotal resection, and postoperative radiotherapy in 1936. Her symptoms recurred 16 years later and she underwent reoperation of the residual tumor, which was found to have an intradural component. The authors' patient, who presented 60 years later, underwent plain and enhanced computerized tomography and magnetic resonance imaging that demonstrated a large posterior fossa lesion indicative of either an acoustic neuroma or a meningioma. She underwent posterior fossa decompression but only partial excision of the tumor could be accomplished because vigorous bleeding limited the extent of the resection. Surgery was followed by radiotherapy. The residual tumor enlarged despite these measures and required repeated resection 6 months later. At the second operation the tumor was much less vascular, perhaps reflecting the effects of radiotherapy, and was removed almost entirely. The patient died 6 months later from an anticoagulant-related cerebellar hemorrhage. In both cases the lesions were jet black, and histological examination revealed melanin-containing hypercellular tumors with rare mitotic figures. Meningeal melanocytomas are being diagnosed with increased frequency in parallel with improvements in neuroimaging and clarification of histological features. Clinical presentation of patients with these tumors typically occurs in their fifth decade and women are affected twice as often as men. The posterior fossa lesions can mimic acoustic neuromas and meningiomas in location and radiological appearance; however, the internal auditory canal is normal. In the spine, meningeal melanocytomas present with the clinical features of myeloradiculopathy. Diagnosis is made intraoperatively from the gross, jet-black appearance of the tumor and from histological examination. Vascularity, size, and location may render complete resection unfeasible. Because of the tumor's propensity to recur, radiotherapy has been recommended but its role remains to be elucidated.

Arthur Roland Elvidge (1899-1985): contributions to the diagnosis of brain tumors and cerebrovascular disease

The contributions of Arthur Elvidge (1899-1985), Wilder Penfield's first neurosurgical recruit, to the development of neurosurgery have been relatively neglected, although his work in brain tumors extended the previous work of Percival Bailey and Harvey Cushing. He published rigorous correlations of clinical and histological information and formulated a revised, modern nosology for neuroepithelial tumors, including a modern histological definition of glioblastoma multiforme. Well ahead of his time, he believed that glioblastoma was not strictly localized and was the first to comment that the tumor frequently showed "satellitosis." He was the first neurosurgeon in North America to use angiography as a radiographic aid in the diagnosis of cerebrovascular disease. Having studied with Egas Moniz, he was the first to detail the use of angiographic examinations specifically for demonstrating cerebrovascular disorders, believing that it would make possible routine surgery of the intracranial blood vessels. Seeking to visualize all phases of angiography, he was the impetus behind the design of one of the first semi-automatic film changers. Elvidge and Egas Moniz made the first observations on thrombosis of the carotid vessels independently of each other. Elvidge elucidated the significance of embolic stroke and commented on the ischemic sequelae of subarachnoid hemorrhage. Besides his contributions to neurosurgery, he codiscovered the mode of transmission of poliomyelitis. Elvidge's soft-spoken manner, his dry wit and candor, mastery of the understatement, love of exotic travel, and consummate dedication to neurosurgery made him a favorite of patients, neurosurgery residents, nurses, and other hospital staff. His accomplishments and example as teacher and physician have become part of neurosurgery's growing legacy.

[Intra-nodal palisading leiomyoblastoma expression HMB 45]

With a follow up of 14 years, a benign intra nodal palissading smooth muscle tumor is reported as an original lesion because of the expression of HMB 45. This antibody is now well known to be expressed by non melanocytic smooth muscle lesions, like angiomyolipoma, "sugar tumors" of the lung, pulmonary lymphangiomyomatosis and some others, often linked to tuberous sclerosis. The case reported seems to be a new member of the merging concept of "Perivascular Epithelioid Cells (PEC)".

Flow cytometric DNA content analysis of 185 soft tissue neoplasms indicates that S-phase fraction is a prognostic factor for sarcomas. French Federation of Cancer Centers (FNCLCC) Sarcoma Group

BACKGROUND

The authors determined the flow cytometric (FCM) DNA characteristics of 53 benign tumors and 132 malignant (71 primary, 61 recurrent) soft tissue sarcomas to investigate their heterogeneity and to evaluate the prognostic values of DNA ploidy status and S-phase fraction (SPF).

METHODS

One to 11 frozen samples were collected from 185 tumors at 10 participating centers of the French Federation of Cancer Centers (FNCLCC). All FCM analyses were performed in the same laboratory. Histologic diagnoses were collegially reviewed, and grade was assessed by the pathologists of the FNCLCC Sarcoma Group. Relationships between FCM, clinical, and pathologic data were investigated using univariate and multivariate analyses for risks of mortality and metastasis.

RESULTS

All except 2 of the 53 benign lesions were DNA diploid. One schwannoma and one desmoid tumor exhibited small abnormal DNA peaks. SPF was low in all benign lesions. One-third of the sarcomas were DNA diploid, whereas two-thirds were DNA aneuploid. Relationships were found between aneuploidy and mitotic count, grade, and histologic subtype of malignant fibrous histiocytoma. DNA ploidy status did not influence the clinical outcome. Multiple sampling performed in 32 sarcomas showed both diploid and aneuploid samples in 6 tumors. Heterogeneity was related to tumor size. SPF evaluated in 85 sarcomas was related to DNA ploidy status, mitotic count, and grade. SPF > or = 4% was significantly associated with a low overall survival rate. In a multivariate analysis performed for the whole group of 132 patients, the single factors with independent prognostic value for patient mortality were disease free status after the treatment course (P < 0.0001) and SPF (P = 0.03). In the subgroup of patients who were initially free of metastases and free of tumor after the treatment course, SPF remained the only factor that significantly influenced the overall survival rate (P = 0.021).

CONCLUSIONS

Despite its high failure rate, SPF is an independent factor in the prognosis of soft tissue sarcoma and should be considered when patients with a high mortality risk need to be selected for adjuvant chemotherapy.

Antazoline increases insulin secretion and improves glucose tolerance in rats and dogs

In vivo effects of an imidazoline devoid of alpha2-adrenoceptor antagonistic properties, antazoline, on insulin secretion and glycemia were investigated both in fasted rats and dogs. In both species, antazoline (1.5 mg/kg i.v.) transiently increased insulinemia without affecting basal plasma glucose levels. In contrast, during an i.v. glucose tolerance test, antazoline markedly potentiated insulin release and thus increased the glucose disappearance rate. In rats, during an oral glucose tolerance test, the intragastric administration of antazoline (1.5 mg/kg) clearly enhanced insulin secretion and reduced hyperglycemia. In dogs provided with a venous pancreatico-duodenal bypass, antazoline (0.5 mg/kg i.v.) induced an immediate and transient increase in insulin and somatostatin but not in glucagon pancreatico-duodenal outputs. In conclusion, intravenously and orally administered, the imidazoline antazoline is able to stimulate insulin secretion in vivo and improve glucose tolerance. The imidazoline compounds could therefore have a potential therapeutic relevance as new antihyperglycemic insulinotropic agents.

[Granulocytic sarcoma of the testis without hematological manifestations]

A 30-year-old man with a testicular tumor ressembling a "round cell sarcoma" was treated for rhabdomyosarcoma. Complete remission was achieved but the patient relapsed and died of the disease. A retrospective diagnosis of granulocytic sarcoma was established using an anti-myeloperoxidase antibody, unfortunately not available at the time of the initial diagnosis. No hematological disorders were observed during the course of the disease. Four cases of granulocytic sarcoma of the testis have been reported in the literature. All these cases where accompanied or followed by leukemia. The present case seems to be the first case of granulocytic sarcoma of the testis not accompanied by hematological disorders.

Pancreastatin modulates glucose-stimulated insulin secretion from the perfused rat pancreas

Pancreastatin is known to be produced in islet B cells and to inhibit insulin secretion. In this study, we examined whether the peptide affects insulin secretion from the perfused rat pancreas during raising or lowering the glucose concentration within the physiological range. We found that synthetic porcine pancreastatin (15 nmol L-1) significantly inhibited the first phase (5 min) of insulin release induced by raising the glucose concentration from 4.2 to 8.3 mmol L-1 (P < 0.05) without affecting the second phase. Furthermore, the fall in insulin secretion induced by lowering the glucose concentration from 8.3 to 5.5 mmol L-1 was significantly exaggerated in presence of pancreastatin during the first 5 min (P < 0.05). In contrast, pancreastatin did not affect the inhibition of insulin secretion induced by either the alpha 2-adrenoceptor agonist, clonidine (2 nmol L-1), or the P1-purinoceptor (A1-subtype) agonist, N6 (+)-phenylisopropyladenosine (D-PIA) (1.65 mumol L-1). In conclusion, our results show that pancreastatin is a modulator of the early changes in insulin secretion after increase or decrease of the glucose concentration within the physiological range. This suggests that pancreastatin is a modulator of glucose-stimulated insulin secretion.

Influence of Pneumocystis carinii on nitrite production by rat alveolar macrophages

Nitrite production by rat alveolar macrophages was studied to determine the role of L-arginine oxidation in the interaction between these cells and Pneumocystis carinii. Alveolar macrophages from rats obtained from two different breeders were used: rats from Janvier breeder had latent P. carinii infection, while those from Charles River breeder were bred in a germ-free environment. Pneumocystis carinii increased in vitro nitrite generation by unstimulated alveolar macrophages from Janvier rats only, and this was blocked by NG-monomethyl-L-arginine. Incubation of cells from Janvier and Charles River rats with lipopolysaccharide and/or interferon-gamma increased nitrite production to a similar extent. Pneumocystis carinii partially decreased nitrite release by activated alveolar macrophages, and this was still inhibited by NG-monomethyl-L-arginine. In the presence of P. carinii, superoxide dismutase used as a superoxide anion scavenger had no effect on nitrite production by activated cells. These results show that prior exposure to P. carinii leads to nitric oxide production by rat alveolar macrophages. Although the magnitude of this production seems to be moderate, it is of biological significance since cells of P. carinii-naive rats do not generate nitrite whereas those of latently infected rats do.

Agmatine is not a good candidate as endogenous ligand for imidazoline sites of pancreatic B cells and vascular bed

In order to determine whether agmatine could be a putative endogenous ligand for imidazoline receptors mediating insulin secretion and vasoconstriction, we compared its effects with those of the imidazoline, efaroxan. Agmatine exhibited a much lower potency and efficacy than efaroxan on insulin secretion from rat pancreas perfused with 8.3 mM glucose. On the other hand, in contrast to efaroxan (100 microM), agmatine (3 mM) did not increase arginine-induced insulin release. In addition, agmatine failed to reproduce the vasoconstrictor effect of efaroxan on pancreatic vessels. These results show that agmatine does not behave like efaroxan, an agonist for the imidazoline receptors mediating insulin secretion or vasoconstriction in the pancreas.

Differential nitric oxide (NO) production by macrophages from mice and guinea pigs infected with virulent and avirulent Legionella pneumophila serogroup 1

L-arginine-dependent reactive nitrogen intermediates have been identified as macrophage cytotoxic effector molecules against intracellular pathogens. To determine its role, ex vivo production of NO by peritoneal macrophages of C3H/HeN mice and Dunkin-Hartley guinea pigs infected intraperitoneally with a virulent and isogenic avirulent Legionella pneumophila serogroup 1 strain was compared with bacterial clearance from the lungs. While the virulent strain was cleared from mice lungs, the guinea pigs died within 96 h. In vivo infection with both strains resulted in the production of NO by mouse peritoneal macrophages ex vivo. In contrast, guinea pig macrophages did not produce detectable NO. In addition, infection by the avirulent strain led to the production of significantly more NO by mouse macrophages than the virulent parent strain, irrespective of stimulation with lipopolysaccharide (LP) and/or interferon-gamma (ifn-gamma). These results suggest that resistance to Leg. pneumophila infection may depend on the production of NO by host macrophages.

Migration of metal and polyethylene particles from articular prostheses may generate lymphadenopathy with histiocytosis

Wear particles released from hip or knee prostheses are known to be involved in the fibrohistiocytic membrane interposed between bone and implant. During surgical treatment for pelvic carcinoma (5 cases) and for isolated pseudomalignant lymphadenopathy (4 cases) lymph nodes in 9 patients who had had lower limb articular replacement were harvested. Light microscopy and image analysis of the nodes showed florid endosinusal histiocytosis, predominant in the cortical area. Using Oil Red O staining and polarized light, metal particles and polyethylene particles were detected in the large histiocytes. Scanning electron microscopy with electron backscattering allowed us to localize metal particles and perform elemental microanalysis. Iron, cobalt, chromium, nickel, zirconium, and barium, known to be used in prosthetic and cementing materials, were identified as component of these particles. Large amounts of polyethylene particles appeared in all cases while metal particles were found to be abundant in only 2 cases. Thus, migration of polyethylene debris from the prosthetic site seems to be the major factor in development of the histiocytes induced in satellite lymph nodes.

Comparative effects of PACAP and VIP on pancreatic endocrine secretions and vascular resistance in rat

1. The effects of pituitary adenylate cyclase-activating polypeptide (PACAP), vasoactive intestinal peptide (VIP) and secretin on pancreatic endocrine secretions and vascular resistance were investigated and compared in the isolated perfused pancreas of the rat. The PACAP/VIP receptor types involved have been characterized. 2. On insulin secretion, in the range 10(-11) to 10(-8) M, PACAP and VIP elicited a concentration-dependent biphasic response from pancreas perfused with 8.3 mM glucose; the peptides were equipotent. In contrast, secretin was ineffective in the range 10(-11) to 10(-9) M; at 10(-8) and 10(-7) M, it induced only low and transient insulin responses. On the other hand, the peptides did not modify the basal insulin release in the presence of a non stimulating glucose concentration (2.8 mM). 3. On glucagon secretion, PACAP and VIP (10(-11) to 10(-8) M) but also secretin (10(-9) to 10(-7) M) caused a concentration-dependent peak shaped response from pancreas perfused with 2.8 mM glucose; PACAP and VIP were equipotent and 20 times more potent then secretin. On the other hand, the peptides did not affect the glucagon release in the presence of 8.3 mM glucose. 4. On pancreatic vessels, in the range 10(-11) to 10(-9) M, the three peptides were equipotent in inducing a concentration-dependent sustained increase in pancreatic flow rate. On the other hand, at the high concentration of 10(-7) M PACAP but not VIP provoked a transient decrease of flow rate. 5. This study provides evidence for PACAP/VIP type II receptors mediating insulin and glucagon secretion as well as vasodilatation in rat pancreas. In addition, the different efficacies of secretin suggest that these effects are mediated by different PACAP/VIP type II receptor subtypes.

Study of behaviour and endurance of Bioapatite implanted in the periodontium of the dog (closed model)

The principle purpose of this study was to quantify endurance of the biomaterial Bioapatite implanted in periodontal structures of the dog (closed model), such quantification being established by means of indices (Endurance Index and Transformed Endurance Index) obtained as a result of data-processed analysis of histologic images. The investigation further aimed at studying the development of new cementum and the reconstruction of an attachment system. The study was conducted on eight dogs and 222 sections. New cementogenesis and the reconstruction of an attachment system are observed both in the test sites and the reference sites. Endurance of the biomaterial is statistically linked with time: the most substantial decrease in the endurance is observed between two and six months. Traces of the material subsist at month 9. The structure of material masses always remains lacunal on a microscopic scale (highest average Endurance Index observed during the investigation: 30.35%). An osteoid deposit can be continually detected as of the second month around crystalline deposits. Further, this type of deposit was noted on the periphery of the deposits implanted in ectopic position in the supracrestal connective tissue.

Low-grade pure and mixed cerebral astrocytomas treated in the CT scan era

From 1974 to 1992, 63 patients diagnosed with low-grade pure or mixed oligo-astrocytoma were seen and treated at our institution. All patients underwent CT scan pre-operatively. There were 20 female and 43 males ranging in age from 12 to 73 years (median age of 33 years). 15 patients had a stereotactic biopsy as the only surgical procedure. 34 had a partial tumor resection and 14 a gross total tumor resection. 43 patients were treated with post-operative radiotherapy whereas 20 patients underwent surgery only as part of the initial management. 50 to 60 Gy (median 59.4 Gy) were given with daily fractions of 1.8 to 2 GY. Tumor volume ranged from 3.4 to 441 cm3. Median tumor volume was larger for radiotherapy treated patients. Median follow-up was 54 months (range of 4 to 240 months). The overall 10 and 15 actuarial survival rates were 37% and 25% respectively. The 5 years survival rate for patients treated at initial diagnosis with surgery alone was 66% and it was 67.3% for patients treated with radiation therapy (P = NS). Prognostic factors having independent significant impact on survival were: extent of surgery, age gender and tumor volume. As well, survival for patients with low-grade astrocytoma in the CT scan era appears to be improved compared to historical controls in the literature.

Glutamate stimulates insulin secretion and improves glucose tolerance in rats

We previously showed in vitro that glutamate stimulates insulin release via an alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor. Here we address a more physiological question concerning the in vivo effect of intravenously or orally administered glutamate on insulinemia and glycemia in fed and fasted rats. In anesthetized fed rats, the intravenous administration of glutamate at 9 and 30 mg/kg transiently increased insulinemia in a dose-dependent manner. The insulin-secretory effect of glutamate (9 mg/kg) was blocked by an antagonist of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors. In anesthetized fasted rats, glutamate at 9 mg/kg was ineffective, but during an intravenous glucose tolerance test (0.5 g/kg), glutamate markedly potentiated insulin release and increased the glucose disappearance rate. In conscious rats, the intragastric administration of glutamate at 200 mg/kg elicited a transient insulin response in fed animals and had no effect in fasted animals but, during an oral glucose tolerance test (1 g/kg), enhanced insulin secretion and reduced the hyperglycemia. Glutamate was effective at plasma concentrations of 200-300 microM. In conclusion, intravenously and orally administered glutamate stimulates insulin secretion in vivo via an excitatory amino acid receptor and improves glucose tolerance.

[Revascularization of supra-aortic trunks from the femoral artery]

A seventy-year-old woman had an occlusion of the left sub-clavian and left primitive, internal and external carotid arteries, combined with a pre-thrombotic stenosis of the brachiocephalic trunk. Lesions were so diffused that a cross extra-anatomic bypass was impossible at the cervical level. There was contraindication for the implantation of a prosthesis on the aortic arch, due to a much extended calcified atheroma which did not allow clamping. Supra-aortic trunk revascularization was done through right femoral-axillary bypass without any post-operative complication. After a four year follow-up, the bypass is still patent. The purpose of this report is to emphasize that such r revascularization, which is rarely reported, must be better known since the implantation of the bypass on the femoral artery leads to patent and durable results.

Activities of roxithromycin against Mycobacterium avium infections in human macrophages and C57BL/6 mice

The activity of roxithromycin against three clinical isolates of Mycobacterium avium was compared with that of clarithromycin both in a model of infection of human monocyte-derived macrophages and in a model of established infection of C57BL/6 mice. In the cell culture model, roxithromycin and clarithromycin were bactericidal for strains MO-1 and N-92159 and bacteriostatic for strain N-93043. For the three strains, the differences between the intracellular activities of roxithromycin and clarithromycin were not singificant after 7 days of treatment. Mice were infected with the MO-1 strain. Drugs were given by gavage at a dosage of 200 mg/kg of body weight 6 days per week for 16 weeks starting 5 weeks after infection. At the end of treatment, clarithromycin was more effective than roxithromycin in lungs; roxithromycin was as effective as clarithromycin in spleens. Thus, the activity of roxithromycin was comparable to that of clarithromycin both in vitro and in vivo.

[Prostate cancer: anatomo-pathological correlation and MRI]

In our study, 50 patients had a prostatic carcinoma stade B. Before the radical prostatectomy we have realised a MRImaging of the prostate. After a precise histopathologic correlation we tried to appreciate the MRI performance for the detection of neoplasic nodes in the peripheral zone and for the loco-regional staging of the carcinoma. In detection of the pathologic nodes, MRImaging is more sensitive from the apex (22.5%) to the base of the prostate (91%), but it is at the same time specificless (apex: 90%, base: 40%). The accurate diagnostic for loco-regional staging in our study is 70%. Extracapsular extension is often underestimated because of the very small size of the invasion. On the other hand the specificity of MRI in seminal vesicles extension is satisfactory (87.5%).

[Breast micro-opacities of lead origin mimicking microcalcifications]

After a surgical excision of focal mammary "microcalcification" we noticed that in fact they represented fine lead deposits (mean diameter: 100 microns) resulting from an attempted suicide (22 long rifle) 10 years previously. The leaded nature of these foreign microbodies was demonstrated by a micro-analysis by energy dispersion on histological slides.