Unique features of the basal cells of human prostate epithelium

The prostate gland is globally composed of epithelium and stroma. The epithelium plays an important role in the development of both benign and malignant disorders while the stroma is involved in benign prostatic hyperplasia. While the prostatic epithelium of the majority of laboratory animals is well recognized as a pseudostratified columnar, the classification of the human prostatic epithelium is controversial. Moreover, the role of the basal cells of the human prostatic epithelium is still uncertain. These cells have been described as undifferentiated cells, precursors of luminal cells, reserve and myoepithelial cells. The objective of the present study was to assess the similarities and/or differences between the epithelium of the human prostate and that of other laboratory animals and thus derive information about the potential functions of basal cells in the human prostate. In the human, basal cells form a continuous layer of cells resting on the basement membrane and upon which rests a layer of luminal cells. This results in a stratified columnar epithelium of two layers of cells, unlike the sporadic appearance of basal cells observed in other species where it results in a pseudostratified epithelium. In addition, the ratio of basal to luminal cells in the human is about 1:1, while the average ratio in the other animal species examined is about 1:7. Furthermore, the gap junctional proteins connexin 26 and 43, are present between basal and luminal cells in the human, thus suggesting that these cells communicate directly with each other. In addition, the ultrastructure of the human basal cells shows morphological evidence of differentiated but not of undifferentiated cells. Moreover, the presence of junction-like structures between adjacent basal cells suggests that these cells form a blood-prostate barrier. In this way, basal cells could prevent substances derived from the blood from directly coming in contact with the luminal cells. Human basal cells could thus regulate functions of the luminal cells by being part of a two-cell mechanism somewhat analogous to thecal and granulosa cells in the ovary.

Tagging of a cryptic promoter that confers root-specific gus expression in Arabidopsis thaliana

 A 2.1-kb sequence was isolated by promoter trapping from an Arabidopsis thaliana transformant (T80) obtained by Agrobacterium-mediated T-DNA insertion. This sequence directed strong β-glucuronidase (GUS) expression specifically in roots. The promoter-gus fusion was used to transform other A. thaliana plants. Most of the transformants obtained exhibited stronger GUS activity in roots than the T80 line and a weak activity in leaves with a root/leaf ratio similar to that of T80. This 2.1-kb promoter sequence possesses a high number of motifs previously described as root-specific or aspecific enhancers. However, this promoter-like sequence is not associated with a detectable transcript and its physiological significance is unclear.

[Late biliary complications after endoscopic sphincterotomy for common bile duct stones in patients older than 65 years of age with gallbladder in situ]

The aim of this retrospective study was to evaluate the nature and the frequency of biliary complications after endoscopic retrograde cholangiography for common bile duct stones in elderly patients with gallbladder in situ.

METHODS

Between 1991 and 1993, 169 consecutive patients with gallbladder in situ, older than 65 years (79 +/- 8) had an endoscopic retrograde cholangiography with sphincterotomy for choledocholithiasis. Information on the early (<1 month) and late biliary complications, treatment and mortality were obtained by mail or phone calls from patients and general practitioners. Long-term data were obtained for 139 patients (82%). Mean follow-up was 56.5 months (80 months for patients still alive at the end of the study).

RESULTS

Early complications occurred in 13 patients (10.8%). Seven patients had acute cholecystitis, present before the procedure in all cases; all were treated by surgery. Other early complications included cholangitis (n =7), mild acute pancreatitis (n =3), bleeding (n =1), perforation (n =1), biliary colic (n =1), pneumopathy (n =1) and bradycardia (n =1), all treated medically. Forty patients underwent early cholecystectomy, and 5 died during the first month without biliary disease. Late complications were thus assessed in 94 patients and occurred in 13 (14%), i.e around 2% per year. Complications were acute cholangitis (n=4), biliary pain (n =4), cholecystitis (n =2), abdominal pain (n =2) and jaundice due to sphincterotomy stenosis (n =1). Five patients had cholecystectomy, 1 a radiological drainage and 7 were treated medically. No death due to a biliary complication was observed. The presence of gallstones, the absence of gallbladder opacification at cholangiography were not prognostic factors for the recurrence of biliary symptoms. 65 patients (50%) died without biliary disease during the follow-up (actuarial death rate 10.5% per year).

CONCLUSION

Late biliary complications after endoscopic retrograde cholangiography for choledocholithiasis in patients with gallbladder in situ are rare (2% per year). Prophylactic cholecystectomy after sphincterotomy does not seem warranted in elderly patients, because of rare recurrent biliary symptoms, low mortality rate, and limited life expectancy.

Competitive recruitment of CBP and Rb-HDAC regulates UBF acetylation and ribosomal transcription

RNA polymerase I (PolI) transcription is activated by the HMG box architectural factor UBF, which loops approximately 140 bp of DNA into the enhancesome, necessitating major chromatin remodeling. Here we show that the acetyltransferase CBP is recruited to and acetylates UBF both in vitro and in vivo. CBP activates PolI transcription in vivo through its acetyltransferase domain and acetylation of UBF facilitates transcription derepression and activation in vitro. CBP activation and Rb suppression of ribosomal transcription by recruitment to UBF are mutually exclusive, regulating in vivo PolI transcription through an acetylation-deacetylation "flip-flop." Thus, PolI transcription is regulated by protein acetylation, and the competitive recruitment of CBP and Rb.

Localization of androgen and estrogen receptors in rat and primate tissues

There is now evidence that estrogens and androgens are exerting their effects in different tissues throughout the body. In order to determine the sites of action of these steroids, studies have been performed to identify at the cellular level the localization of androgen receptor (AR) and the two estrogen receptor (ER) subtypes, ERalpha and ERbeta, specially in the rat, monkey and human. In the prostate, AR was observed in the secretory and stromal cells. In the testis, Sertoli, Leydig and myoid cells were labelled. In the epididymis and seminal vesicles, both epithelial and stromal cells contained AR. In the ovary, AR was detected in granulosa and interstitial cells. In the uterus, epithelial, stromal and muscle cells were all immunopositive for AR. In the central nervous system, AR-containing neurons were found to be widely distributed throughout the brain. In the mammary gland, epithelial cells in acini and ducts and stromal cells were demonstrated to express AR. In the skin, AR was detected in keratinocytes, sebaceous and sweat glands, and hair follicles. In addition, AR was also found in anterior pituitary, thyroid, adrenal cortex, liver, kidney tubules, urinary bladder, cardiac and striated muscle, and bone. The ER subtypes are in general differentially expressed. While ERalpha has been predominantly found in anterior pituitary, uterus, vagina, testis, liver and kidney, ERbeta is predominant in thyroid, ovary, prostate, skin, bladder, lungs, gastro-intestinal tract, cartilage and bone. In tissues which contain both receptor subtypes, such as ovary, testis and various regions of the brain, a cell-specific localization for each ER subtype has been generally observed. Altogether, the recent results on the cellular localization of sex steroid receptors will certainly contribute to a better understanding of the specific role of these steroids in different target organs.

The TT8 gene encodes a basic helix-loop-helix domain protein required for expression of DFR and BAN genes in Arabidopsis siliques

The TRANSPARENT TESTA8 (TT8) locus is involved in the regulation of flavonoid biosynthesis in Arabidopsis. The tt8-3 allele was isolated from a T-DNA-mutagenized Arabidopsis collection and found to be tagged by an integrative molecule, thus permitting the cloning and sequencing of the TT8 gene. TT8 identity was confirmed by complementation of tt8-3 and sequence analysis of an additional allele. The TT8 gene encodes a protein that displays a basic helix-loop-helix at its C terminus and represents an Arabidopsis ortholog of the maize R transcription factors. The TT8 transcript is present in developing siliques and in young seedlings. The TT8 protein is required for normal expression of two flavonoid late biosynthetic genes, namely, DIHYDROFLAVONOL 4-REDUCTASE (DFR) and BANYULS (BAN), in Arabidopsis siliques. Interestingly, TRANSPARENT TESTA GLABRA1 (TTG1) and TT2 genes also control the expression of DFR and BAN genes. Our results suggest that the TT8, TTG1, and TT2 proteins may interact to control flavonoid metabolism in the Arabidopsis seed coat.

The TT8 gene encodes a basic helix-loop-helix domain protein required for expression of DFR and BAN genes in Arabidopsis siliques

The TRANSPARENT TESTA8 (TT8) locus is involved in the regulation of flavonoid biosynthesis in Arabidopsis. The tt8-3 allele was isolated from a T-DNA-mutagenized Arabidopsis collection and found to be tagged by an integrative molecule, thus permitting the cloning and sequencing of the TT8 gene. TT8 identity was confirmed by complementation of tt8-3 and sequence analysis of an additional allele. The TT8 gene encodes a protein that displays a basic helix-loop-helix at its C terminus and represents an Arabidopsis ortholog of the maize R transcription factors. The TT8 transcript is present in developing siliques and in young seedlings. The TT8 protein is required for normal expression of two flavonoid late biosynthetic genes, namely, DIHYDROFLAVONOL 4-REDUCTASE (DFR) and BANYULS (BAN), in Arabidopsis siliques. Interestingly, TRANSPARENT TESTA GLABRA1 (TTG1) and TT2 genes also control the expression of DFR and BAN genes. Our results suggest that the TT8, TTG1, and TT2 proteins may interact to control flavonoid metabolism in the Arabidopsis seed coat.

The Arabidopsis AtEPR1 extensin-like gene is specifically expressed in endosperm during seed germination

Screening of 10 000 Arabidopsis transgenic lines carrying a gene-trap (GUS) construct has been undertaken to identify markers of seed germination. One of these lines showed GUS activity restricted to the endosperm, at the micropylar end of the germinating seed. The genomic DNA flanking the T-DNA insert was cloned by walking PCR and the insertion was shown to be located 70 bp upstream of a 2285 bp open reading frame (AtEPR1) sharing strong similarities with extensins. The AtEPR1 open reading frame consists of 40 proline-rich repeats and is expressed in both wild-type and mutant lines. The expression of the AtEPR1 gene appears to be under positive control of gibberellic acid, but is not downregulated by abscisic acid during seed germination. No expression was detected in organs other than endosperm during seed germination. The putative role of AtEPR1 is discussed in the light of its specific expression in relation to seed germination.

Intracrinology: role of the family of 17 beta-hydroxysteroid dehydrogenases in human physiology and disease

In women and men, an important proportion of estrogens and androgens are synthesized locally at their site of action in peripheral target tissues. This new field of endocrinology has been called intracrinology. In postmenopausal women, 100% of active sex steroids are synthesized in peripheral target tissues from inactive steroid precursors while, in adult men, approximately 50% of androgens are made locally in intracrine target tissues. The last and key step in the formation of all estrogens and androgens is catalyzed by members of the family of 17beta-hydroxysteroid dehydrogenases (17 beta-HSDs) while different 17 beta-HSDs inactivate these steroids in the same cell where synthesis takes place. To date, seven human 17 beta-HSDs have been cloned, sequenced and characterized. The 17 beta-HSDs provide each cell with the means of precisely controlling the intracellular concentration of each sex steroid according to local needs.

The maternal chromosome set is the target of the T-DNA in the in planta transformation of Arabidopsis thaliana

In planta transformation methods are now commonly used to transform Arabidopsis thaliana by Agrobacterium tumefaciens. The origin of transformants obtained by these methods has been studied by inoculating different floral stages and examining gametophytic expression of an introduced beta-glucuronidase marker gene encoding GUS. We observed that transformation can still occur after treating flowers where embryo sacs have reached the stage of the third division. No GUS expression was observed in embryo sacs or pollen of plants infiltrated with an Agrobacterium strain bearing a GUS gene under the control of a gametophyte-specific promoter. To identify the genetic target we used an insertion mutant in which a gene essential for male gametophytic development has been disrupted by a T-DNA bearing a Basta resistance gene (B(R)). In this mutant the B(R) marker is transferred to the progeny only by the female gametes. This mutant was retransformed with a hygromycin resistance marker and doubly resistant plants were selected. The study of 193 progeny of these transformants revealed 25 plants in which the two resistance markers were linked in coupling and only one plant where they were linked in repulsion. These results point to the chromosome set of the female gametophyte as the main target for the T-DNA.

Expression of integrin alpha5beta1 and MMPs associated with epithelioid morphology and malignancy of uveal melanoma

PURPOSE

Altered expression of the alpha5beta1 integrin and matrix metalloproteinases (MMPs) is recognized as a hallmark of invasive tumor cells. The purpose of the present study was to investigate the expression of integrin subunit alpha5, its corresponding ligand fibronectin (FN), and the expression pattern for MMPs in four highly proliferative human choroidal melanomas (TP17, TP31, SP8.0, and SP6.5) to evaluate whether any correlation can be established between these markers and cell tumorigenicity.

METHODS

Cell tumorigenicity was evaluated by subcutaneous injection of uveal melanoma cell lines in immunodeficient nude mice. Anchorage dependency was evaluated by growth assays in soft agar. The invasive ability of each cell type was also determined using a modified Boyden chamber. Expression of both the alpha5 integrin subunit and FN was determined at the mRNA level by RT-PCR. The protein level (for alpha5) was determined by flow cytometry and inhibition of adhesion assays by using an antibody directed against the alpha5 subunit. Expression of MMPs was determined by standard gelatin zymography.

RESULTS

Assays in nude mice provided evidence that the cell lines possess a range of tumorigenic ability of TP17>TP31>SP8.0>SP6.5. Antibody inhibition of cell adhesion and flow cytometry demonstrated that TP17 cells have no detectable membrane-bound alpha5beta1, whereas low levels are found in primary cultured melanocytes, as well as in SP6.5, SP8.0, and TP31 cells. RT-PCR analyses provided evidence that both FN and alpha5 expression may be regulated at the transcriptional level. Gelatin zymography revealed that all cell lines, as well as normal melanocytes, express MMP-2 at varying levels but that only the highly invasive TP17 cell line secretes a distinctive MMP with a high molecular weight of 117 kDa.

CONCLUSIONS

Among the four melanoma cell lines selected for the completion of this study, TP17 exhibited the most aggressive phenotype, which also correlated with the mostly epithelioid morphology of these cells. The cell morphology of the TP17 cell line could be related to the loss of alpha5beta1, whereas its invasive properties are more likely related to the expression of the 117-kDa MMP.

In vivo evidence for the production of sulfated steroids in the frog brain

It is well established that sulfated neurosteroids are potent regulators of neuronal activity but the biosynthesis of sulfate esters of steroids in the central nervous system (CNS) has received little attention. In particular, the localization of hydroxysteroid sulfotransferase (HST), the enzyme which is responsible for the formation of sulfated steroids, has never been determined in the brain. We took advantage of the availability of an antiserum raised against rat liver HST to investigate the distribution of this enzyme in the CNS of the frog Rana ridibunda. Two populations of HST-positive neurons were localized in the anterior preoptic area and the magnocellular nucleus of the hypothalamus. Numerous HST-immunoreactive fibers were visualized throughout the telencephalon and the diencephalon. Reversed-phase high performance liquid chromatography (HPLC) analysis of frog telencephalon and hypothalamus extracts combined with radioimmunoasssay (RIA) detection showed the presence of substantial amounts of DHEAS-immunoreactive material which coeluted with synthetic DHEAS. The concentrations of DHEAS detected in the telencephalon and hypothalamus were respectively eight and five times higher than in the serum. The present study demonstrates the occurrence of HST-immunoreactive material in neurons of the frog telencephalon and diencephalon. This report also provides evidence for the presence of HST bioactivity, in vivo, in the frog brain.

ERPs and behavioral inhibition in a Go/No-go task in children with attention-deficit hyperactivity disorder

In order to study the behavioral responses and the brain inhibition process in children with attention-deficit hyperactivity disorder (ADHD), Event-Related Potentials (ERPs) were recorded from 30 scalp electrodes in 21 ADHD and 21 normal boys during performing a Go/No-go task. ADHD children made fewer correct responses to both Go and No-go stimuli than normal controls. The frontal N2 amplitude was larger for No-go stimuli than Go stimuli in both groups, reflecting inhibition of responding. Smaller N2 amplitudes to No-go stimuli were found in ADHD children, but only when the Go/No-go task was performed after a first stimulus-response compatibility (SRC) task. In addition, the controls exhibited a prolonged N2 only when the Go/No-go task was performed second. However, the ADHD subjects exhibited this prolonged N2 when the task was first, but not when it was second. These results suggest an inhibitory regulation problem rather an inhibition deficit in ADHD children.

Stimulus-response incompatibility effects on event-related potentials in children with attention-deficit hyperactivity disorder

In order to test the hypothesis of a response choice deficit in attention-deficit hyperactivity disorder (ADHD) children, event-related potentials (ERPs) were recorded from 30 scalp electrodes in 21 ADHD and 21 normal boys during a spatial stimulus-response compatibility (SRC) task. ADHD children made fewer correct responses than control children, but did not show a larger incompatibility effect on response speed and accuracy. In ERPs, ADHD children had longer N1 latency and larger condition effect on the frontal N2, which would reflect a greater frontal involvement for the correct responses. The ADHD group who performed the SRC task first showed a larger condition effect on an early occipital P3 only, while the ADHD group who performed the SRC task second showed a larger condition effect on a later central P650 component and on a late parietal NSW, as compared with normal controls. These results suggest strategic differences in information processing in ADHD children, rather than a specific deficit.

Ten-year follow-up of critically ill patients undergoing heart transplantation

BACKGROUND

The long-term result following heart transplantation appears very good despite complications of coronary atherosclerosis and cancer. Critically ill patients supported with mechanical devices remain a growing and difficult group in which long-term results need to be defined. The objective of this study was to review the 10-year follow-up of critically ill patients who underwent heart transplantation after support with mechanical devices.

METHODS

We retrospectively analyzed all patients who underwent heart transplantation from 1986 to 1999 at the Montreal Heart Institute.

RESULTS

Twenty-two patients (22/199, 11%) underwent heart transplantation after support with intra-aortic balloon pumps (n = 17) and total artificial hearts (n = 5). One hundred seventy-seven patients (177/199, 89%) underwent heart transplantation without pre-operative mechanical assistance. Patients with pre-operative mechanical assistance were younger (41 +/- 12 vs 48 +/- 10 years old, p = 0. 002), underwent a shorter waiting time to transplantation (2 +/- 2 vs 19 +/- 27 weeks, p = 0.004), and donor hearts had longer ischemic time (166 +/- 63 vs 137 +/- 49 minutes, p = 0.002) compared with patients without pre-operative mechanical assistance. One-month, 1-, 5-, and 10-year survival averaged 86% +/- 7%, 67% +/- 10%, 67% +/- 10%, and 59% +/- 12%, respectively, in patients with pre-operative mechanical assistance compared with 95% +/- 2%, 88% +/- 2%, 81% +/- 3%, and 74% +/- 4%, respectively, in patients without assistance, a significant difference (p = 0.04) that is mainly related to higher operative mortality in the former group. Although, we found no difference between the 2 groups in the 10-year freedom rate from acute rejection, infection, cancer, and coronary atherosclerosis, sepsis was the cause of 4 early deaths among patients with pre-operative mechanical assistance.

CONCLUSION

Early and long-term survival was significantly decreased in critically ill patients with pre-operative mechanical assistance compared with other patients without pre-operative assistance. Sepsis is a dominant threat among patients who underwent heart transplantation with pre-operative mechanical assistance, and the lower survival is due mainly to the increased early mortality.

ERP differences in visual attention processing between attention-deficit hyperactivity disorder and control boys in the absence of performance differences

Event-related potentials (ERPs) were recorded during a visual two-choice reaction time (RT) task in attention-deficit hyperactivity disorder (ADHD) and control boys selected using strict inclusion and exclusion criteria. No group differences were found in mean RT and correct responses. Although early occipital ERPs were not affected in the ADHD group, the peak latency of early anterior ERPs (N1, P1, N2) was significantly delayed. ADHD showed a larger effect of stimulus type on the frontal negativity (N530) and the posterior late negativity (nSW) and a smaller effect of stimulus type on anterior N2 and posterior P3b amplitude. The development of N530 and P450 amplitude across blocks of five trials was analyzed using orthogonal polynomial trend analysis of variance software. In the control group, P450 amplitude to "frequent" stimuli reduced across blocks. In the ADHD group, N530 amplitude increased for "rare" stimuli across blocks. It is suggested that the ADHD group showed a lack of automatization of the categorization process with increasing time on task for which they compensated by controlled attentional processes.

Localization of oestrogen receptor alpha, oestrogen receptor beta and androgen receptors in the rat reproductive organs

There is now evidence that oestrogens and androgens can influence male and female reproductive systems. In order to accurately identify the sites of action of oestrogens and androgens, we have proceeded to the histological localization of the two oestrogen receptor (ER) subtypes, ERalpha and ERbeta, and the androgen receptor (AR) in the reproductive tissues of adult rats of both sexes. AR was detected by immunocytochemistry, while ERalpha and ERbeta were localized by both immunocytochemistry and in situ hybridization. In the pituitary gland of animals of both sexes, ERalpha was found in the majority of nuclei of secretory cells in the anterior pituitary. The intermediate and posterior lobes did not show any staining. ERbeta was not found to be expressed in any of the pituitary lobes. Using AR antibodies, nuclear staining was detected in about 50% of secretory cells of the anterior lobe, the intermediate and posterior lobes being completely unstained. In the testis, ERalpha was localized in nuclei of Leydig cells as well as in round spermatocytes and spermatids, while ERbeta could only be detected in Sertoli cell nuclei. AR immunoreactivity was found in nuclei of Sertoli, peritubular myoid and Leydig cells. In the prostate, ERbeta was observed in epithelial cells of tubulo-alveoli, while the stroma was unlabelled. ERalpha was not found to be expressed in any prostate cells. In the prostate, AR was detected in nuclei of epithelial, stromal and endothelial cells. In seminal vesicles, staining of ERalpha was found in nuclei of epithelial and stromal cells. Similar findings were observed using AR antibodies. While ERbeta mRNA could not be detected by in situ hybridization, weak staining for ERbeta was localized in epithelial cells of seminal vesicles. In the ovary, both ERalpha and ERbeta were found to be expressed. ERbeta mRNA was found in granulosa cells of growing follicles, while ERalpha was present in theca cells, interstitial gland cells and germinal epithelium. AR immunoreactivity was detected in granulosa cell nuclei in growing follicles and also in scattered interstitial cells. In the oviduct and uterus, ERalpha was observed in nuclei of epithelial cells as well as of stromal and muscle cells. Similarly, AR immunoreactivity was present in nuclei of epithelial cells, stromal and muscle cells in both the oviduct and uterus. ERbeta was not detected in the oviduct and uterus. The present findings indicate a cell-specific localization of ERalpha, ERbeta and AR in reproductive tissues in rats of both sexes. By establishing the precise sites of action of oestrogens and androgens they contribute to a better understanding of the respective role of these steroids in reproduction function.

Distribution of GAD-immunoreactive neurons in the diencephalon of the african lungfish Protopterus annectens: colocalization of GAD and NPY in the preoptic area

The distribution of GABAergic neurons was investigated in the diencephalon of the African lungfish, Protopterus annectens, by using specific antibodies directed against glutamic acid decarboxylase (GAD). A dense population of immunoreactive perikarya was observed in the periventricular preoptic nucleus, whereas the caudal hypothalamus and the dorsal thalamus contained only scattered positive cell bodies. Clusters of GAD-positive cells were found in the intermediate lobe of the pituitary. The diencephalon was richly innervated by GAD-immunoreactive fibers that were particularly abundant in the hypothalamus. In the periventricular nucleus, GAD-positive fibers exhibited a radial orientation, and a few neurons extended processes toward the third ventricle. More caudally, a dense bundle of GAD-immunoreactive fibers coursing along the ventral wall of the hypothalamus terminated into the median eminence and the neural lobe of the pituitary. Double-labeling immunocytochemistry revealed that GAD and neuropeptide tyrosine (NPY)-like immunoreactivity was colocalized in a subpopulation of perikarya in the periventricular preoptic nucleus. The proportion of neurons that coexpressed GAD and NPY was higher in the caudal region of the preoptic nucleus. The distribution of GAD-immunoreactive elements in the diencephalon and pituitary of the African lungfish indicates that GABA may act as a hypophysiotropic neurohormone in Dipnoans. The coexistence of GAD and NPY in a subset of neurons of the periventricular preoptic nucleus suggests that GABA and NPY may interact at the synaptic level.

Prolonged distress and clinical deterioration before pericardial drainage in patients with cardiac tamponade

OBJECTIVE

To determine whether patients with cardiac tamponade are subject to delays and clinical deterioration before undergoing echocardiography and pericardial drainage.

DESIGN

Retrospective study.

SETTING

The Montreal Heart Institute, Montreal, Quebec, a cardiology referral centre.

PATIENTS

The charts of 50 patients who presented with tamponade were reviewed. Intervals between the appearance of symptoms, consultation, echocardiography and drainage were noted. The presence of clinical deterioration before drainage was evaluated. Causes for delays were investigated.

RESULTS

Previous cardiac surgery (74%) was the most common etiology of tamponade. Symptoms were present 6.6+/-5.8 days before consultation. The delay between consultation and echocardiography was 1.2+/-2.0 days (range 0 to 12), and that between echocardiography and drainage was 0.8+/-0.9 days (range 0 to four). Patients underwent drainage 1. 9+/-2.5 days (range 0 to 16) after the initial consultation. Deterioration of the clinical status was noted in 34% of patients before pericardial drainage. An error in the initial diagnosis was present in 36% of patients; the majority of these were incorrectly diagnosed with heart failure. Another 44% of patients had no mention of either a working diagnosis in the chart at admission or the desire to rule out tamponade on the request for echocardiography.

CONCLUSION

The proper diagnosis does not appear to be initially considered in up to 80% of patients who present with cardiac tamponade. Clinical deterioration occurs in approximately a third of patients during the interval between consultation and pericardial drainage.

Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures

BACKGROUND

Magnetic resonance cholangiography (MRC) is currently under investigation for non-invasive biliary tract imaging.

AIM

To compare MRC with endoscopic retrograde cholangiography (ERC) for pretreatment evaluation of malignant hilar obstruction.

METHODS

Twenty patients (11 men, nine women; median age 74 years) referred for endoscopic palliation of a hilar obstruction were included. The cause of the hilar obstruction was a cholangiocarcinoma in 15 patients and a hilar compression in five (one hepatocarcinoma, one metastatic breast cancer, one metastatic leiomyoblastoma, two metastatic colon cancers). MRC (T2 turbo spin echo sequences; Siemens Magnetomvision 1.5 T) was performed within 12 hours before ERC, which is considered to be the ideal imaging technique. Tumour location, extension, and type according to Bismuth's classification were determined by the radiologist and endoscopist.

RESULTS

MRC was of diagnostic quality in all but two patients (90%). At ERC, four patients (20%) had type I, seven (35%) had type II, seven (35%) had type III, and two (10%) had type IV strictures. MRC correctly classified 14/18 (78%) patients and underestimated tumour extension in four (22%). Successful endoscopic biliary drainage was achieved in 11/17 attempted stentings (65%), one of which was a combined procedure (endoscopic + percutaneous). One patient had a percutaneous external drain, one had a surgical bypass, and in a third a curative resection was attempted. Effective drainage was not achieved in six patients (30%). If management options had been based only on MRC, treatment choices would have been modified in a more appropriate way in 5/18 (28%) patients with satisfactory MRC.

CONCLUSION

MRC should be considered for planning treatment of malignant hilar strictures. Accurate depiction of high grade strictures for which endoscopic drainage is not the option of choice can preclude unnecessary invasive imaging.

Cellular localization of estrogen receptor beta messenger ribonucleic acid in cynomolgus monkey reproductive organs

There is now evidence that the recently identified estrogen receptor (ER) beta is more widely distributed in the body than is ER-alpha. In order to gain more information about the role of ER-beta in reproduction, we have investigated by in situ hybridization the localization of mRNA expression of this ER subtype in adult monkey reproductive organs. In the pituitary gland of animals of both sexes, in both the anterior and intermediate lobes, a large number of cells were positive. No specific signal was observed in the posterior lobe. In the ovary, granulosa cells in primary and growing follicles highly expressed ER-beta mRNA. The theca interna cells were also strongly labeled. In some corpora lutea, the luteal cells were strongly labeled, while in other ones, the signal was weak. A hybridization signal was also detected in the ovarian surface epithelium. In the uterus, ER-beta mRNA was found in high concentration in glandular epithelial cells and stromal cells of the endometrium, while weaker labeling was consistently observed in smooth muscle cells. In the mammary gland, labeling was detected in the epithelial cells of acini and interlobular ducts as well as stromal cells. In the testis, specific labeling was detected in the seminiferous epithelium whereas the interstitial Leydig cells were unlabeled. Although it was not possible to clearly identify all the positive cell types, it appears that Sertoli cells as well as the vast majority of germinal cells express ER-beta mRNA. In the prostate, the secretory epithelial cells exhibited a specific autoradiographic reaction while the stromal cells did not show mRNA expression. The epithelial cells of the prostatic urethra showed a strong labeling. No hybridization signal was detected in the seminal vesicles. It then appears quite clear that ER-beta is expressed in a cell-specific manner in all the monkey reproductive organs studied. In the female, the wide distribution of these receptors in the ovary and uterus suggests that ER-beta may play an important role in the mediation of the known effects of estrogen in reproduction functions. In the male testis and prostate, ER-beta has been found in cells that contain very little or no ER-alpha. The role of circulating or locally produced estrogens in the male reproductive system remains to be clarified.

Conversion of cyclosporine A to tacrolimus following heart transplantation

BACKGROUND

Cyclosporine A (CyA) is ususally the immunosuppressive drug of choice in organ transplantation; however, some side effects have limited its use. Tacrolimus is a novel immunosuppressive drug that is more potent than CyA, and has been used as a rescue agent following heart transplantation when the use of CyA is undesirable or inefficient.

PATIENTS AND METHODS

Since 1996, 14 heart transplant recipients under CyA were switched to tacrolimus therapy, for refractory rejection or intolerance, to conventional immunosuppression.

RESULTS

After a mean of 35+/-7 months of treatment, tacrolimus was substituted for CyA therapy. The reason for substitution was refractory rejection in six patients, gingival hypertrophy in five patients, hypertrichosis in one patient, severe arterial hypertension in one patient and hepatotoxicity in one patient. Five patients underwent a successful rescue therapy and one patient died of refractory rejection despite the use of tacrolimus. All patients with CyA side effects recovered with tacrolimus. After conversion from CyA to tacrolimus, the number of episodes of acute rejection decreased from a mean of 0.42+/-0.17 to 0.14+/-0.09 episodes/patient/month under CyA and tacrolimus therapy (P=0.11), respectively. The mean dose of prednisone was 0.18+/-0.06 mg/kg/day before compared with 0.06+/-0.01 mg/kg/day after conversion from CyA to tacrolimus (P=0.09). Creatinine serum levels averaged 124+/-7 mmol/L under CyA treatment compared with 113+/-7 mmol/L with tacrolimus therapy (P=0.002).

CONCLUSION

In patients with refractory rejections or intolerance to CyA after heart transplantation, conversion to tacrolimus-based immunosuppression is safe and effective.