Recombinant human interferon gamma in the treatment of rheumatoid arthritis: double blind placebo controlled study

Interferon gamma (IFN gamma) has been advocated in open studies as a beneficial remission inducing drug for the treatment of rheumatoid arthritis (RA). The work reported here was designed to assess the therapeutic potential of IFN gamma in the treatment of RA in a double blind placebo controlled study. It was found that patients treated with IFN gamma improved significantly with respect to morning stiffness, grip strength, swelling of an index joint, and erythrocyte sedimentation rate. Furthermore significantly more responders (according to predetermined response criteria) were found in the group treated with IFN gamma. Only minor adverse effects and no significant toxicity with respect to clinical or laboratory parameters were observed.

Changes in cardiac beta 1- and beta 2-adrenoceptor densities after human cardiac transplantation: relation to transplant coronary vasculopathy and pretransplantation disease

In 100 patients 12 to 60 months after cardiac transplantation, the influence of transplant coronary vasculopathy and of the pretransplantation disease (end-stage heart failure caused by coronary artery disease or dilated cardiomyopathy) on the beta-adrenergic receptor (AR) numbers and beta 1/beta 2-AR ratio of right ventricular biopsies was determined. Patients with coronary vasculopathy (CVP) after cardiac transplantation had lower absolute numbers of beta 1-AR compared with patients without CVP. Since patients with CVP had increased left ventricular (LV) end-diastolic pressure and LV muscle mass, it is suggested that decreased beta 1-AR may be the result of an altered hemodynamic situation of the transplanted heart after development of CVP. Patients with dilated cardiomyopathy (DCM) before cardiac transplantation showed a decrease in total beta-AR and of the beta 1/beta 2-AR ratio as a result of an increase in beta 2-AR and a decrease in beta 1-AR numbers. The decreased beta 1/beta 2-AR ratio in patients with previous DCM may indicate that the beta-AR system of the transplanted heart might be influenced (at least in part) by pathophysiologic factors that are characteristic of the pretransplantation disease ultimately leading to cardiac transplantation and persisting after cardiac transplantation.

[Bladder tumors--Magnevist-assisted magnetic resonance tomography]

Magnetic resonance imaging (MRI, Magnetom 0.5 Tesla) using a high-resolution surface coil was performed on 10 healthy volunteers, 16 patients with bladder tumours, 2 patients with cystitis and 15 patients with bladder tumours and cystitis. Lesion delineation versus urine, bladder wall and surrounding organs was evaluated in plain and contrast-enhanced (IV Magnevist, 0.1 mmol/kg) T1-weighted, plain proton-density and T2-weighted spin-echo images. Surface-coil MRI proved very sensitive since all lesions were found in plain scans. Cystitis and 27 of 31 tumours exhibited contrast enhancement, however, differentiation of tumours and cystic lesions was not improved. Plain T2 and contrast-enhanced T1-weighted images demonstrated bladder wall disruption and perivesical tumour spread with equal sensitivity. Post-contrast images permitted unequivocal visualisation of perivesical tumour spread in surrounding peritoneal fat. The authors conclude that T2-weighted imaging may be restricted to non-enhancing bladder tumours thus significantly reducing imaging time.

[Arthroscopy of the wrist and elbow joint]

Arthroscopy of the wrist and elbow is a helpful diagnostic procedure in patients with chronic disability not demonstrated by clinical and radiological examinations. At the wrist, especially triangular fibrocartilage, chondral or ligamentous defects can often not be demonstrated by other tests. Arthroscopy of the wrist allows examination of more than a dozen separate articular surfaces and the function of eight discrete joints. The geometry of the elbow joint limits intra-articular inspection and the use of instruments. The risk of neurovascular injuries is great and depends on exact puncture sites and portals. Its efficiacy is not yet proven.

[The magnetic resonance tomography of intracranial ependymomas. Their clinical appearance and comparison with computed tomography]

The MRT and CT images of histologically confirmed intracranial ependymomas in 10 patients have been compared. All tumours were demonstrated by CT and MRT. The solid portions of the tumours showed variation in density on CT (hypodense, isodense, hyperdense, or mixed), whereas there was uniform signal intensity on MRT (T1 weighted: hypointense, T2 weighted: hyperintense). Cystic portions of the tumours (6 patients) were shown equally well by both procedures, calcifications were only shown by CT. All ependymomas were related to the ventricles. On unenhanced CT only 3 tumours were clearly delineated, whereas MRT defined all tumours satisfactorily. The significant advantage of MRT is better topographic demonstration of the tumour.

[Reactive enlargement of cervical lymph nodes and cervical lymph node metastases: sonography (M/Q quotient) and computed tomography]

Ranking of sonographic maximum/transverse diameter quotients was compared with the ranking of CT in respect of identification and exclusion of cervical lymph node metastases. Both sonography and CT are distinguished by a high degree of sensitivity in the imaging of cervical lymph node metastases. Sonography, with the assistance of the maximum/transverse diameter quotient, can differentiate between benign enlarged and non-enlarged lymph nodes on the one hand and cervical lymph node metastases on the other, with a safety of 95 per cent. CT can yield definite information regarding the tumour status only after contrast medium administration under the criteria of central hypodensity and peripheral marginal enhancement. CT is much less specific than the sonographic M/T quotient (66% vs 95%). Accuracy of sonography (94%) is clearly superior to that of CT (79%).

[Magnetic resonance tomographic screening studies of the bone marrow with gradient-echo sequences. II. Gadolinium-DTPA-supported studies of plasmocytoma patients]

MR imaging was performed in 19 patients with proven multiple myeloma. Both plain and Gd-DTPA enhanced in-phase and opposed-phase gradient-echo techniques were used (0.1 mmol Magnevist/kg body weight). Plain, opposed-phase imaging demonstrated more lesions than plain in-phase imaging (35 vs. 16); enhanced opposed-phase imaging demonstrated more lesions than plain opposed-phase and enhanced in-phase imaging (47 vs. 35 and 17 lesions). These results suggest that enhanced opposed-phase images which have a high contrast between normal and infiltrated bone marrow are especially suited for MR screening in multiple myeloma.

[Primary humerus head replacement in dislocated proximal humeral fracture. Indications, technique, results]

Displaced three- and four-part fractures of the humeral head detached from their blood supply are at high risk for a poor functional outcome after internal fixation. Primary prosthetic replacement can restore the pretraumatic anatomy, and early function is possible. Head replacement within 2 weeks after trauma, reapproximation of the tuberosities, and reconstruction of the rotator cuff tear establishes early stability and good functional results in up to 80%.

[Border-area cerebral ischemia--3D-SPECT for the imaging of the regional cerebral blood flow]

15 patients with suspected cerebral ischaemia were examined using 99mTc-HM-PAO-SPECT to assess cerebral blood flow. Results obtained from SPECT were correlated with CT and Doppler ultrasound findings. A 3D-display algorithm is proposed to enhance the lesion to non-lesion contrast compared to the standard 2D-image interpretation. In all cases contrast was superior on 3D-display to 2D-display (-0.38 versus -0.09). 3D-display of SPECT-data enhances lesion contrast due to postreconstructive data processing and may improve exact interpretation of cerebral blood flow studies.

[The value of radioimmunoscintigraphy compared to computed tomography in the diagnosis and relapse diagnosis of colorectal tumors]

Radioimmunoscintigraphy (= RIS, scintigraphic "specific" imaging of benign and malignant diseases by means of radioactively marked monoclonal antibodies) has been performed in Germany in clinical studies since 1985 in patients suffering from colorectal cancer. After having been successfully proven in primary studies, RIS is now being used in the early diagnosis of recurrences and metastases. In the prospective study presented here the clinical usefulness of RIS was assessed in comparison against well-tried diagnostic methods including computed tomography in patients suffering from colorectal cancer. It was shown that RIS in SPECT technique (= single photon emission computed tomography) with 99mTc-labelled monoclonal CEA antibodies can visualise local recurrences if diagnostic findings are doubtful, with a sensitivity of 78% versus 50% for CT findings.

Reduction in HLA-DR antigen density on alveolar macrophages of smokers

The expression of HLA class II genes is essential to the antigen-presenting function of monocytes and macrophages. With a new cytofluorometric method of single-cell analysis we investigated the density of HLA-DR antigen expression on alveolar macrophages (AM) of smokers. Although all AM of nonsmokers (100 +/- 1%) expressed HLA-DR antigens, only 79 +/- 12% of AM from smokers showed positive findings (p less than 0.001). Furthermore, the antigen density of those cells expressing this antigen was significantly reduced in smokers (p less than 0.001). The defective expression of class II genes on AM of smokers might contribute to the impaired antigen-presenting function found by some previous investigators.

[Axis-related spontaneous correction after tibial fractures in childhood]

In the Department of Surgery at the Bergmannsheil University Hospital, a total of 50 children with measurable post-traumatic deformity of the axis after fracture of the lower limb were examined. Clinical and radiological monitoring was carried out 6 years after their accidents, which they had sustained at the age of 3-15 years. The real degree of axis deformity remaining was determined mathematically, and the correction tendency was analysed in three dimensions and projected graphically using sum vectors. This showed better results in the correction of axis deformations of the lower limb visualized on a-p X-ray photographs as varus or valgus than of deformations seen as ante- and recurvation of lateral X-ray photographs. The excentric arrangement of muscles in the dorsal part of the lower limb could be one reason for this. All 50 patients experienced a reliable spontaneous correction of the axis deformity with no complications of stimulatory growth disturbance with showing good functional results. Shaft fractures of the lower limb in children are generally treated conservatively, operative treatment being indicated only in the case of severe lesions of the soft tissue and in adolescent patients.

[A histologically controlled study of the value of sonography and palpation for the detection and exclusion of neck lymph node enlargements and metastases]

Preoperative evaluation of cervical lymph nodes by ultrasound and palpation was compared retrospectively in 123 patients with tumours on the head and neck. The diagnostic accuracy was higher by ultrasound (96.5%) than by palpation (85.5%). Hence, the sensitivity for detecting cervical metastases was also higher for ultrasound than for palpation (96% versus 83%), because of the reduced false negative findings. Specificity, however, was higher for palpation (82%) than for ultrasound (74%). Ultrasound was superior in delineating the relationship of metastases to adjacent tissues (vessels). Major disadvantages of ultrasound were the higher percentage of false positive findings (26%) and absence if delineation of the relationship to bony structures.

[The differential diagnosis of liver metastasis and regional fatty liver: a comparison of CT and MRT]

Differentiation between liver metastases and local fat deposition may be difficult when using CT; the value of MRI was therefore investigated in 18 patients with metastases and ten patients with fat deposits. CT shows both lesions as similar hypodense areas. MRI, however, produces different appearances: T1- and 2-weighted images show marked differences in the signal arising from metastases, whereas local fat collections in both sequences differ little in their signal from normal liver. Quantitative MRI signal intensity of the two types of lesion were also different. Where the differentiation by CT may be difficult, it may be made with certainty by means of MRI.

[Magnetic resonance tomographic screening studies of the bone marrow with gradient echo sequences: (I) the contrast relations of phase-identical and phase-shifted gradient echo sequences. Studies on probands and pathological-anatomical preparations]

Anatomical specimens and normal persons were studied by gradient echo MR imaging to determine the influence of different echo times (TE) on bone marrow contrast. First of all, six normal persons were studied to determine specific echo times for in-phase and opposed-phase states. Using different sequences bone marrow contrast in isolated femoral bones was determined and compared to results of pathological exams. Red bone marrow had no signal on opposed-phase images; contrast between red and yellow marrow was higher on opposed-phase than on in-phase images. Bone marrow lesions can be expected to be visualised with high signal on opposed-phase images; this technique should be especially suited for MR imaging of bone marrow.

[Gadolinium-DTPA as an oral contrast medium for magnetic resonance tomography of the pancreas]

52 patients with normal pancreas, pancreatitis and pancreatic tumors were examined by magnetic resonance imaging (Magnetom 0.5 T). Using T1-, proton density- and T2-weighted spin-echo sequences images were obtained before and after oral administration of Gadolinium-DTPA (Gd-DTPA, 1 mM, 15 g/l Mannit, 5-13 ml/kg). Gd-DTPA resulted in hyperintense labeling of small bowel in all sequences and improved visualization of pancreatic head, body and tail in 15, 14 and 7 of 27 patients with normal pancreas and in 17, 8 and 6 of 25 patients with diseased pancreas. Better delineation of pseudocysts and tumorous gut wall invasion were diagnostically profitable. With regard to motion artifact reduced MRI of the intestine using fast sequences Gd-DTPA may be a suitable oral contrast agent to improve the imaging of the pancreas.

[Prepontine artifacts due to cerebrospinal fluid pulsation in the T-2 weighted coronal MRT picture. Clinical significance, frequency, technique for artifact suppression]

Coronal T2-weighted MRI is the most sensitive imaging modality to detect temporal lobe pathology. However, prepontine artifacts resulting from pulsation of cerebrospinal fluid occasionally simulate temporal lobe lesion. To characterize this artifact we studied 30 patients without temporal lobe pathology in conventional T2-weighted spin-echo technique (0.5 T, SE 1600/70, coronal, horizontal phase encoding). Visual analysis revealed high-intensity artifacts simulating a lesion in five of 30 cases. The present study shows that prepontine artifacts due to pulsation of cerebrospinal fluid are quite frequent (17%) and that these artifacts may result in misinterpretation in the evaluation of temporal lobe epilepsy. By a repeat examination in identical methodology while using vertical phase encoding, all artifacts could be identified and an artifact-free representation of the temporal lobes was achieved.

Silver-stained structures in prostatic carcinoma: evaluation of diagnostic and prognostic relevance by automated image analysis

The comparison of the diagnostic and prognostic significance of histology, immunohistochemical parameters (PSA, PSP), and silver-stained nucleolar organizer regions (AgNORs) was estimated in paraffin sections taken of 63 prostatic carcinomas prior to therapy. AgNORs were visualized with a one-step silver staining technique with the appropiate staining time determined by preliminary staining-time series. The mean AgNOR number per cell (n) and the mean AgNOR area per silver-stained dot (A) were determined by means of an automatic image analysis system. Thereby prostatic carcinomas exhibited multiple small AgNORs within their nuclei (n = 4.7, A = 0.09 micron 2), whereas benign prostatic epithelium showed few but large silver-stained particles (n = 1.8, A = 0.27 micron 2; p less than 0.001). This relationship was then calculated as a quotient of AgNOR number and area (NQ = n/A) which provided additional information for the diagnosis of malignancy as well as survival. Univariate survival analysis disclosed a set of four variables predicting death from prostatic cancer; cribriform growth pattern, AgNOR quotient, histological grade, and PSA immunoreactivity. Of these parameters, immunoreactivity of PSA failed to prove its prognostic significance in multivariate survival analysis (Cox model). No relation to prognosis was found for the number as well as the area of AgNORs alone. Therefore, image analysis proved to be a prerequisit for the feasibility of this promising technique by providing objective and reproducible results.

Increased rCBF in gray matter heterotopias detected by SPECT using 99mTc hexamethyl-propylenamine oxime

Imaging findings of morphology and regional cerebral blood flow in two patients suffering from epileptic seizures are presented. CT and MRI revealed heterotopic gray matter as a probable structural correlate, causing the seizure disorder. 99mTc hexamethyl-propylenamine oxime (HM-PAO) SPECT demonstrated focally increased regional cerebral blood flow in both patients in the areas of their heterotopic lesions. Heterotopic and orthotopic gray matter seem to have similar features in terms of regional perfusion. A focally increased brain perfusion in interictal epileptic patients may indicate an underlying migration anomaly.

[Arthrolysis of post-traumatic stiff elbow. Which factors influence the end result]

In a retrospective study of 59 patients the results obtained with elbow arthrolysis performed for the treatment of posttraumatic stiffness were analyzed. The intraoperative functional result was classified as excellent in all cases, while an average of 27 months after the operation the range of movement was decreased again to varying extents. This deficit correlated with the type of injury, timing of arthrolysis, duration of metal implants and timing and type of postoperative rehabilitation program. The relative increase in function was better after simple fractures, with 47%, than after fracture dislocations, with 35%. After arthrolysis within 3 months of onset of posttraumatic stiffness the range of improvement was 55%, compared with an increase of only 30% after 10 months' stiffness. When arthrolysis was combined with metal removal and the implants had been in place for longer than 9 months the increase achieved was only 15%. Patients mobilized on the 1st day postoperatively lost only 15% of their intraoperative function. If mobilization was delayed to between the 2nd and 5th days, 30% was lost. Changing splints for maximal joint flexion and extension at 4-h intervals resulted in a 35% loss of range of movement postoperatively. In contrast there was a loss of only 17% in the group with combined additional physiotherapy and continuous passive motion. The results show that the prognosis of elbow arthrolysis is determined by optimal operative planning and a meticulous rehabilitation program. The time to arthrolysis should be as short as possible, as should the time to removal of metal implants. The aim of the rehabilitation program is immediate postoperative mobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bronchial carcinoma associated with pulmonary osteoarthropathy (Marie-Bamberger)]

Hypertrophic pulmonary osteoarthropathy (HPO) is characterised by clubbed, or drumstick, fingers and a painful periostitis of the extremities, and occurs most frequently as paraneoplastic symptom in association with bronchial carcinoma. Much rarer are inflammatory pulmonary changes such as lung abscesses. Curative treatment of the underlying disease will always also alleviate the pain in the extremities. This article reports on a case of a bronchial carcinoma masked by a pulmonary abscess. Despite the treatment of the abscess the patient developed the typical pattern of signs and symptoms of hypertrophic pulmonary osteoarthropathy for the bronchial carcinoma which was identified only later and which had been masked by the abscess. Persistence of hypertrophic pulmonary osteoarthropathy in case of a successfully treated pulmonary abscess should, therefore, always be regarded as a possible pointer towards an undetected bronchial carcinoma.

[Simplified storage procedure of cryopreserved human parathyroid tissue]

Parathyroid tissue that is stored for replantation purposes is usually kept in a special tank containing fluid nitrogen at -196 degrees C. Our studies demonstrate that storage is also possible in a deep-freezer at -70 degrees C without any loss of quality. Most hospitals own such freezers for storing bone marrow cells at the same temperature. Parathyroid tissue of 11 patients who were operated on because of primary hyperparathyroidism was stored in this way. After six months the tissue showed 75.7% morphologically intact cells. The control group's tissue was stored in liquid nitrogen according to the common method; after the same period of time it showed 76% histologically normal cells.

Nude mouse xenografts as in vivo models for lung carcinomas

Eighty-eight primary and secondary lung tumor specimens were subcutaneously transplanted into athymic nude mice. One third of all carcinoma specimens yielded tumor growth. Success rates were highest if fresh tumor pieces or fresh or frozen cell suspensions were implanted or injected. More than half of squamous cell and adenocarcinoma xenografts showed a lower degree of differentiation than the original tumor. The degree of dedifferentiation led to the diagnosis of large cell carcinoma by light microscopical criteria in 4 of these cases. All small cell carcinoma xenografts showed intermediate-cell type morphology irrespective of the cell type of the original tumor, and all large cell carcinoma xenografts showed features similar to the original tumor. Tumor latent periods were approximately twice as long during the first nude mouse passage than subsequent passages, and tumor doubling times remained stable during serial passages. We conclude that the large cell lung carcinoma subtype is a mixed bag of tumors and includes highly undifferentiated squamous cell and adenocarcinomas, that the small cell carcinomas remain in that histologic subtype during xenotransplantation, and that lung carcinoma xenografts display stable morphologic and kinetic features during serial xenotransplantation. Nude mouse xenografts may serve an in vivo model to study the biologic relationship of non-small cell lung carcinomas.

Assessment of nucleolar organizer regions by automatic image analysis in breast cancer: correlation with DNA content, proliferation rate, receptor status and histopathological grading

The value of automatic image analysis in the investigation of nucleolus regions (AgNOR) has been examined in tissue sections of 52 malignant and 30 benign breast lesions. Determination of the AgNOR number per cell alone revealed a considerable overlap between benign (range 1.2-3.8) and malignant specimens (range 1.5-16.2). They differed however, highly significantly (P less than 0.001) in their AgNOR sizes. In benign breast disorders the mean AgNOR area per tumour ranged from 0.22 microns2 to 1.07 microns2 (mean 0.39 microns2), whereas in carcinomas AgNOR sites ranged from 0.05 microns2 to 0.22 microns2 (mean 0.09 microns2). AgNOR counts showed a good correlation with histopathological grade (P less than 0.05), aneuploidy (P less than 0.01), proliferation rate as determined by Ki67 immunostaining (P less than 0.01), as well as oestrogen and progesterone receptor content (P less than 0.01). Image analysis proved to be advantageous over AgNOR counting alone as it facilitated the standardization of the AgNOR technique itself and thus, significantly improved its diagnostic specifity.

Multiple myeloma of the bladder and vagina

A case is described of multiple myeloma with involvement of the urinary bladder and vagina. The patient was admitted with hematuria and postrenal obstruction. She was treated successfully with local radiotherapy and combination chemotherapy with vincristine, Adriamycin (doxorubicin), and dexamethasone (VAD).

Differentiation capacity of human non-small-cell lung cancer cell lines after exposure to phorbol ester

Three cell lines of squamous-cell carcinoma and 3 of large-cell carcinoma origin were investigated for the expression of differentiation markers and functional parameters (proliferation, morphology, cornified envelope formation, involucrin staining, transglutaminase activity, adhesiveness and migration) under normal cell culture conditions and after treatment with the tumor promoter phorbol-12-myristate-13-acetate (PMA). Although all original tumors had been described as poorly differentiated by histological grading, we found significant heterogeneity in the expression of differentiation markers in cell culture. A systematic grading of the cell lines became possible only after PMA stimulation. PMA generally increased expression of differentiation markers in cell lines of comparably low grades of differentiation, as indicated by dose-dependent inhibition of proliferation and cloning efficiency, induction of squamous markers, and decreased adhesiveness and cell motility. In contrast, cell lines of apparently higher differentiation by these criteria showed little response to PMA. The results presented show that the assessment of differentiation capacity by comparison of differentiation markers under normal cell culture and PMA-stimulated conditions in established NSCLC cell lines allows for a refined cell culture grading, which might advance the classification and characterization of such cell lines which, otherwise, appear to be very heterogeneous. It may also help to correlate cellular functions with various states of differentiation in vitro.

Establishment of rat endometrial cell lines by retroviral mediated transfer of immortalizing and transforming oncogenes

To study hormone responsive genes in differentiated epithelial cells and as a model for endometrial carcinoma, lines were established from primary rat endometrial cells by infection with replication-defective retroviruses carrying oncogenes and the selectable gene neo. The initial step involved immortalization through the large T antigen of SV40 to generate a line we designate RENT4, or with the E1a gene of adenovirus to generate lines referred to as RENE1 and RENE2. Additionally, lines generated by large T antigen of SV40 were superinfected with a replication-defective retrovirus harboring the v-Ha-ras oncogene and selected by the ability to form colonies in soft agar. The latter cell lines appeared fully transformed and were designated RENTR01 and RENTR03. Five established lines were characterized for steroid hormone receptors, alkaline phosphatase activity and their complement of the intermediate filaments vimentin and cytokeratin. With the exception of the RENE1 cells all other lines have normal levels of glucocorticoid receptor, whereas only RENE1, RENE2 and RENT4 were positive for the progesterone receptor. RENTR01, RENTR03 and, to a lesser extent, RENE1 exhibited differential expression of cytokeratins dependent upon whether the cells were grown on a substrata of NIH3T3 cells. When grown on formalin-fixed NIH3T3 cells, RENTR01 and RENTR03 cells appeared to differentiate or rearrange themselves in culture. Individual islands of cells showed a heterogeneous pattern of intermediate filaments with vimentin-positive cells localized to the outer portion of the islands whereas cytokeratin-positive cells are seen on the insides of these structures.

Cooling rate and ice-crystal measurement in biological specimens plunged into liquid ethane, propane, and Freon 22

Specimens sandwiched between copper planchettes were plunged up to a depth of 430 mm into coolants used for cryofixation. Hydrated gelatin containing a miniature thermocouple was used to mimic the behaviour of tissue during freezing. Gelatin and red blood cells were used for ice-crystal analysis. Ethane produced the fastest cooling rates and the smallest ice-crystal profiles, and Freon 22 produced the slowest cooling rates and the largest crystal profiles. Smaller crystal profiles were often seen in the centre of the specimens than in subsurface zones. The results show that ethane, rather than propane, should be used for freezing metal-sandwiched freeze-fracture specimens by the plunging method, and probably also in the jet-cooling method. They further suggest that good cryofixation could occur at the centre of thin specimens rather than only at their surfaces. Comparison between theoretical and experimental ice-crystal sizes was satisfactory, indicating that where the experimental parameters can be defined then realistic predictions can be made regarding cryofixation results.

A cytofluorometric method to quantify membrane antigens on individual alveolar macrophages

An immunofluorescence method for assaying membrane-bound antigens on individual alveolar macrophages (AM) collected by bronchoalveolar lavage (BAL) is described. Cells were labelled with FITC-conjugated anti-HLA-DR antibodies in a single (direct) step. Quantification of the fluorescence was performed by computer-assisted cytophotometry. Alveolar macrophages, especially when obtained from cigarette smokers, exhibited an autofluorescence which interfered with the measurement of specific fluorescence. The specific fluorescence was calculated by determination of total fluorescence in the wave-length optimal for FITC and the non-specific fluorescence in a different wavelength during a second measurement. Specificity and reproducibility testing confirmed the reliability of the method.

[Infection of the knee joint--an arthroscopic challenge?]

Unlike previous forms of surgical treatment, operative arthroscopy of the septic knee can prevent in most cases severe functional deficit or even ankylosis provided that arthroscopy is done within 1 week after the onset of the infection and that consistent and continuous passive motion is then carried out. In all other cases, open subtotal synovectomy is preferable to closed-irrigation suction drainage. In three-quarters of the cases presented, the functional results can be considered good. Reoperations have only been necessary when arthroscopy has been delayed by more than 1 week.

Prognostic significance of nucleolar organizing regions (NORs) in carcinomas of the sigmoid colon and rectum

The prognostic significance of silver-binding nucleolar organizing regions (AgNORs) has been evaluated in tissue sections of biopsies taken from 70 primary adenocarcinomas of the colon sigmoid (n = 25) and rectum (n = 45) prior to their curative resection. A significant correlation between five-year survival rate and the mean AgNOR number per tumour cell (p less than 0.001) and the mean size of silver stained dots (p less than 0.05) was found according to the univariate Kaplan-Meier survival analysis. There was no significant relationship between AgNOR content and grade of malignancy, pT categories or pN categories. Multivariate survival analysis of covariates (Cox regression model) revealed a set of five variables that significantly influenced the patients' outcome: pN categories, AgNOR content, pT categories, maximum grade of malignancy and number of inflammatory cells. From the clinical and pathological parameters studied, pN and pT categories as well as the mean AgNOR number were the most important variables predicting death from colorectal carcinoma. Since the analysis of AgNORs can be performed on routinely processed paraffin-embedded tissue, this method may be of potential use in pretherapeutic assessment of the biologic aggressiveness of the disease.

Tetanus toxin as a marker for small-cell lung cancer cell lines

Tetanus toxin labeling of human lung cancer cell lines was investigated using direct and indirect immunofluorescence and immunohistochemical staining. Cells of characterized permanent cell lines, eight small-cell lung cancer (SCLC) cell lines of classic subtype, six SCLC cell lines of variant subtype and seven non-small-cell lung cancer (NSCLC) cell lines, were incubated with a saturating concentration of tetanus toxin. For staining, fluorescein-isothiocyanate-(FITC)-conjugated anti-(tetanus toxin) antibodies were used or a mouse monoclonal anti-(fragment C) antibody with subsequent binding of FITC-conjugated anti-(mouse Ig) antibody or peroxidase-anti-peroxidase complex. Only SCLC showed an intense fluorescence/immunoreactivity restricted to the cell membrane. Quantitative analysis of tetanus toxin labeling by flow cytometry revealed the percentage of positive cells to be between 35% and 95% in SCLC without obvious differences between the classic and variant subtypes of SCLC. In NSCLC the percentage of positive cells was lower than 10%. These results demonstrate that SCLC in contrast to NSCLC can be labeled with tetanus toxin, emphasizing the neuroendocrine properties of this tumor, and that tetanus toxin labeling may become a useful diagnostic marker for SCLC cells in cytology.

Carcinoembryonic antigen as differentiation marker for small cell lung cancer in vitro and its clinical relevance

Fifteen small cell lung cancer (SCLC) cell lines and 249 histopathological specimens from patients with SCLC were investigated for carcinoembryonic antigen (CEA) expression. Quantitative determinations of CEA in cell line homogenates correlated significantly (p less than 0.001) with L-DOPA decarboxylase (DDC) activities and population doubling times (PDT). Using monoclonal antibodies specific for CEA (BW 431/31) and crossreactive with non-specific crossreacting antigens (NCA) 55 and 95 (BW 250/183 and BW 374/14), the CEA-reactive moiety in SCLC was immunologically identified as CEA. In vivo studies demonstrated CEA by immunohistochemistry in 57% (141/249) of newly diagnosed SCLC. The presence of CEA and the degree of immunostaining did not correlate with clinical parameters.

[Dislocation and subluxation of the patella]

Subluxations or dislocations are present in adolescents and young adults, they are caused by malalignments of the leg (rotation, axis, extensor mechanism). In subluxation, functional therapy is the method of choice, dislocations with haemarthrosis are an indication for arthroscopy. After the first dislocation without chondral lesion, consequent functional treatment has a recurrence rate of only 5 per cent. Recurrent dislocations need a reconstruction of the extensor mechanism to prevent chondral damage.

Clinical relevance of histologic subtyping in small cell lung cancer

Histopathologic specimens from 249 patients with small cell lung cancer (SCLC) were reviewed and classified into oat cell-type, pure intermediate cell-type (excluding specimens with mixed small cell/large cell features), and small cell/large cell-type. One hundred seventy (68%) specimens displayed oat cell features (including 30 with mixed oat cell/intermediate cell features), 66 (27%) displayed intermediate cell features, and 13 (5%) displayed mixed small cell/large cell features. No differences among these subtypes were found with respect to stage of disease, sex, age, performance status, and number and distribution of metastases. Complete and partial remission rates for the oat cell-type were, respectively, 31% and 38%, for the intermediate cell-type 20% and 45%, and for the small cell/large cell-type 38% and 31%. Two-year survival rates were 7%, 11%, and 15%, respectively. These data were all statistically insignificant, and comparisons of log-rank analyses of survival curves for these SCLC subtypes also showed no statistically significant differences. We thus conclude that histologic subtypes of SCLC are not distinct entities of clinical relevance, and that prognostic as well as therapeutic decisions cannot be based on histologic subtyping.

[Central pontine myelosis. Morphology and forensic importance]

Central pontine myelinolysis (CPM) evidently occurs more frequently than had been assumed up to now owing to the cases that have been substantiated solely on the basis of pathological anatomy. Its genesis is still unclarified. Computed tomography and magnetic resonance methods allow detection of the foci while the affected person is still alive. They are clearly capable of regression and are not automatically accompanied by a poor prognosis. Since an iatrogenic factor (forced compensation of hyponatremia) is increasingly under discussion as the cause of CPM, the condition also has substantial significance from a forensic point of view. On the basis of a prospective study on CPM confirmed in 100 brains of alcoholics, as well as 4 further cases from the forensic autopsy material, it is shown that hyponatremia is not likely to be the sole triggering factor. The course of the condition in the cases investigated shows that the capacity for action may be preserved up to death (which has occurred for other reasons) in not very pronounced CPM. In questionable violent and other unclear deaths, CPM must also be considered a possible cause of death. The various hypotheses on its etiology in the extensive literature are compared with the findings in our own cases and discussed.