Genetic deletions of glutathione-S-transferase as a risk factor in squamous cell carcinoma of the larynx: a preliminary report

PURPOSE

To test whether genetic deletions of glutathione-S-transferase (GST) are associated with squamous cell carcinoma (SCC) of the larynx. GST are a group of detoxifying enzymes that may help reduce the risk of developing cancer in response to environmental carcinogens. Polycyclic aromatic hydrocarbons, found in high concentration in cigarette smoke, are known carcinogens especially for SCC of the larynx. Individuals with absolute or relative deficiency of the GST enzyme system may therefore be at a higher risk of developing laryngeal carcinoma.

MATERIALS AND METHODS

Genotyping for GST-M1 and GST-T1 was performed using polymerase chain reaction (PCR) assay on fresh frozen tissue specimens of 20 patients with SCC of the larynx and on 20 control subjects with a similar smoking history. Because this assay results in the absence of a PCR product in individuals expressing the GST-M1/GST-T1 null genotype, oligonucleotide primers that amplify a portion of the albumin gene were included in a multiplex PCR as a positive control for DNA quality and PCR conditions. The chi-square test was used for statistical analysis.

RESULTS

GST-M1 gene was deleted in 80% of patients with laryngeal SCC and in 50% of control subjects (P <.05). No statistically significant difference was observed in the incidence of GST-T1 gene deletion in patients with SCC of the larynx and control subjects.

CONCLUSION

GST-M1 gene deletion was significantly associated with SCC of the larynx and may produce a risk for this particular disease.

Role of hysteroscopy in detection and extraction of endometrial polyps: results of a prospective study

OBJECTIVE

The aim of this study was to determine whether hysteroscopy improves the detection and extraction of endometrial polyps in postmenopausal women. This method was compared with curettage complemented by Randall polyp forceps.

STUDY DESIGN

In a prospective study hysteroscopy was performed before and after curettage in postmenopausal women. In addition to curettage, the Randall polyp forceps was used to extract endometrial polyps. Curettage and polyp extraction by Randall forceps were performed by a second surgical team that did not know the results of hysteroscopy.

RESULTS

A total of 83 patients were included in the study because of either postmenopausal bleeding (n = 40) or ultrasonographic abnormal endometrium (n = 37), or both (n = 6). Thirty-two patients received either hormone replacement therapy or tamoxifen. Hysteroscopy revealed endometrial polyps in 51 patients. Polyps were diagnosed by curettage alone in 22 (43%) cases. In 18 of these 22 cases remnants of polyps were extracted by Randall forceps, and in another 23 cases polyps were only found by use of the Randall forceps. Thus in 45 (88%) of 51 patients the detection of endometrial polyps by curettage and Randall forceps was possible. A second hysteroscopy procedure revealed remnants of polyps or polyps in 31 cases. These patients with incomplete curettage predominantly had a preoperative endometrial thickness of > or =10mm.

CONCLUSIONS

Curettage alone in postmenopausal patients is not sufficient for detection and extraction of endometrial polyps. Additional use of Randall forceps improves detection of polyps considerably. However, with both procedures complete extraction of polyps was not achieved in a considerable number of patients. Hysteroscopy-controlled extraction was superior, especially in those patients with an endometrial thickness of >10 mm.

Intrauterine treatment of fetal goitrous hypothyroidism controlled by determination of thyroid-stimulating hormone in fetal serum. A case report and review of the literature

We report a rare case of fetal goitrous hypothyroidism complicated by polyhydramnios and preterm labor in a mother without thyroid gland pathology. The diagnosis was made in the 26th week by ultrasound and cordocentesis [TSH 170 microU/ml, free T(4) 0.2 ng/dl]. The therapeutic regime required repeated fetal blood sampling for determination of thyroid hormones. Five intra-amniotic administrations of 250 microg levothyroxine (LT4) weekly were initiated. Because of the persisting goiter and the elevated level of TSH (128 microU/ml in 32 weeks) in the fetal serum the dosage had to be adjusted to 500 microg LT4 in the next five injections. TSH in fetal serum declined to 49.2 microU/ml in 36 weeks. Normal fetal growth and an uncomplicated course of pregnancy between the 27th and 37th week of gestation were observed. Monitoring of intrauterine therapy by determination of TSH in fetal serum may provide more reliable data than measuring TSH in amniotic fluid. A review of 15 cases of fetal goitrous hypothyroidism in the English literature is presented.

Hepatic arterial infusion with oxaliplatin, folinic acid, and 5-fluorouracil in patients with hepatic metastases from colorectal cancer: role of carcino-embryonic antigen in assessment of response

BACKGROUND

Therapy for patients with hepatic metastases from colorectal cancer (CRC) remains controversial and may be improved by regional oxaliplatin which proved to be effective when administered systemically to patients with advanced CRC.

METHODS

During the current study, which aims to determine the maximum tolerated dose, the dose-limiting toxicity, and the pharmacokinetics of oxaliplatin applied as hepatic intra-arterial infusion combined with folinic acid and 5-fluorouracil in patients with hepatic metastases from CRC, serial levels of carcino-embryonic antigen were determined and their relationship to response to therapy was assessed.

RESULTS

Toxicity mainly consisted of nausea, pain, mucositis, sensorial neuropathy, diarrhoea, and thrombocytopenia. The results of tumor marker analyses suggest that progressive disease may be detected early by increasing CEA levels and responsive disease may be characterized by low or decreasing values.

CONCLUSIONS

Further analyses are warranted to determine the role of CEA in the assessment of response as compared to imaging techniques.

In vitro activity of human chorionic gonadotropin (hCG)--doxorubicin conjugates against ovarian cancer cells

BACKGROUND

Despite radical surgery and the introduction of novel chemotherapeutic agents, the prognosis of ovarian cancer remains poor. Since in the past the potential role of gonadotropins in the induction and progression of ovarian cancer has been discussed, we conjugated doxorubicin to human chorionic gonadotropin (hCG) in order to specifically target ovarian cancer cells.

MATERIALS AND METHODS

Doxorubicin was conjugated to hCG via glutaraldehyde. 48 hours post seeding, NIH:OVCAR 3 cells were treated with various concentrations of hCG-conjugated and non-conjugated doxorubicin for 2 hours. Cells were cultured for a total of 168 hours. Cell growth was monitored by a crystal violet assay.

RESULTS

Conjugating doxorubicin to hCG resulted in an average specific uptake of 22 mol doxorubicin per mol protein (range 3.0-43.3 mol). Incubating NIH:OVCAR 3 cells for 2 hours with the conjugate led to a more than 8 fold increase of the IC50 values compared to non-conjugated doxorubicin (0.55 microM versus 4.43 microM). The antiproliferative activity of both conjugated and free doxorubicin was detectable up to 168 hours post treatment.

CONCLUSIONS

The present experiments clearly demonstrate a more than 8-fold increase in cytotoxicity of the conjugates compared to free doxorubicin. It was also shown that this effect was not restricted to an acute toxic event but that it resulted in a prolonged antiproliferative activity.

Comparison between critical pathway guidelines and management of deep-vein thrombosis: retrospective cohort study

AIM

To compare the key steps of standard deep-vein thrombosis management with the critical pathway practice guidelines, and to assess the outcome of the treatment after 6 months.

METHOD

This retrospective cohort study (from January 1, 1997 to December 31, 1998) included 172 patients with uncomplicated deep-vein thrombosis of lower extremities, consecutively admitted via emergency room. The data were collected from the entry register in emergency room and medical charts. The outcome of therapy was assessed 6 months after the acute event.

RESULTS

A bolus dose of heparin was administered to 81 (46%) patients. The recommended initial heparin infusion rate at 1250 U/h was employed in only 26 (15%) patients. Time to activated partial thromboplastin time >60 s was met in 29 (17%) patients. All patients but one received heparin therapy longer than 96 h. The recommended time to a therapeutic international normalized ratio of less than 120 h was achieved in 134 (78%) patients, but the average length of a stay in the hospital exceeded the recommended 5. 5 days by 86%. Six months later, compressive ultrasonography revealed 44 (28.9%) cases of complete vein obstruction, 67 (44.1%) cases of partial recanalization and 41 (27%) cases with a normal finding. Recurrent thrombosis developed in 16 patients (10.5%) and acute pulmonary embolism in 4 (2.6%) patients.

CONCLUSION

Our results considerably differ from the critical pathway guidelines due to the lower initial heparin doses and longer diagnostic assessment of thrombosis etiology. Our approach to deep-vein thrombosis treatment was a combination of the critical pathway guidelines and the conventional regimen. The clinical outcome in our series did not differ significantly from the outcome after the conventional way of treatment.

The patterns of expression of an apoptosis-related CK18 neoepitope, the bcl-2 proto-oncogene, and the Ki67 proliferation marker in normal, hyperplastic, and malignant endometrium

Expression of a neoepitope on cytokeratin 18, recognized by the monoclonal antibody M30, is an early indicator of apoptosis in epithelial cells. The aim of this study was to determine the equilibrium between apoptosis (M30), anti-apoptosis (bcl-2), and proliferation (Ki-67) in different endometrial conditions. Paraffin-embedded samples (n = 107), representing proliferative endometrium (18), secretory endometrium (19), postmenopausal endometrium (15), disordered proliferative endometrium (6), simple hyperplasia (12), complex hyperplasia (8), and endometrial adenocarcinoma (29), were evaluated immunohistochemically. The indirect streptavidin-biotin-horseradish peroxidase technique, with 3-amino-9-ethylcarbazole as the chromogen, was used to visualize the reactions. Proliferative endometrium showed high bcl-2 and Ki-67 expression levels with no M30. In the secretory phase, the balance was tipped in favor of M30 with a decrease of bcl-2 and Ki-67. Postmenopausal endometrium revealed high Ki-67 and bcl-2 expression levels and no M30. In complex hyperplasia, M30, bcl-2, and Ki-67 showed increased expression. In endometrial carcinoma, an increasing reactivity for M30 and Ki-67 was seen as the grade progressed. bcl-2 reacted weakly and only in grade 1 cancer. Immunohistochemistry facilitates the study of the expression of proteins related to cyclic endometrial activity. Interruption of these cyclic events is associated with specific disturbances in the expression patterns of these proteins.

Nitric oxide synthase activity and Doppler parameters in the fetoplacental and uteroplacental circulation in preeclampsia

OBJECTIVE

We investigated the hypothesis that changes in blood flow in the uteroplacental and fetoplacental circulation in preeclampsia are associated with an abnormality of placental or uterine placental bed nitric oxide (NO) synthesis.

METHODS

We measured pulsatility indices on Doppler waveform analysis from uterine and umbilical arteries in 20 patients with preeclampsia and 14 healthy pregnant controls before elective cesarean section. During cesarean section, biopsies from the uterine placental bed and the placenta were taken and the nitric oxide synthase (NOS) activity was measured by the [3H] L-arginine-[3H] L-citrulline conversion assay in these samples.

RESULTS

The NOS activity was significantly lower in the uterine placental bed in comparison to the placental tissue (p < 0.01). Placental NOS activity was similar between patients with preeclampsia and healthy controls and in the groups with either a pathological or a normal Doppler flow in the umbilical artery. In the uterine placental bed however, NOS activity from patients with preeclampsia was significantly lower (p < 0.01), whereas the blood flow resistance in the uterine arteries was elevated (p < 0.01) in comparison to healthy controls.

CONCLUSIONS

Our data show that pathological Doppler waveforms in the uterine arteries of patients with preeclampsia are paralleled by diminished NOS activity in the uterine placental bed. Therefore, the compromised NO production in the uterine placental bed may play an important role in the impaired uteroplacental blood flow and potentially in some pathological features of preeclampsia such as intervillous thrombosis formation and fetal growth retardation.

Distribution and concordance of N-acetyltransferase genotype and phenotype in an American population

Polymorphic arylamine N-acetyltransferase 2 (NAT2) status varies widely between individuals and ethnic groups and has been associated with susceptibility to several cancers. Few studies have reported the distribution of NAT2 status for Caucasian-American populations or evaluated the concordance between methods of assessment for cancer cases and controls. In our study, distribution of NAT2 status was classified by genotype and phenotype measurements in PANCAN, a population-based case-control study of pancreatic cancer, and concordance between measurements was evaluated for 33 cases and 222 controls. Major genotypes and alleles among controls were *5B/*6A, *5B/*5B, *4/*6A, and *5B/*4. One putative new allele was found in a single individual. Genotypes and phenotypes were classified as rapid or slow, according to a bimodal model. Presence of the *4 (wild-type) allele defined a NAT2 genotype as rapid. The NAT2 phenotype was analyzed by the caffeine assay. Ratios of 5-acetylamino-6-formylamino-3-methyluracil to 1-methylxanthine were determined, and individuals with values of > or =0.66 were identified as having a rapid phenotype. In our population, 58.1 and 59.5% of control subjects were classified as slow acetylators by phenotype and genotype, respectively. Concordance of NAT2 genotype and phenotype classification was 97.8% in the bimodal model. A similar analysis was completed for a trimodal model. Concordance of genotype and phenotype was high in cases (90.9%) and similar to controls; genotyping alone provided an efficient, accurate method of analysis for acetylator status. A comparison with two previous reports revealed subtle differences in genotype and allele distribution but exhibited overall similarity with other Caucasian-American populations.

Prognostic relevance of soluble interleukin-2 receptors in patients with ovarian tumors

Soluble interleukin-2 receptors (sIL-2R) are measurable in the sera of patients with ovarian cancer and several other benign and malignant diseases. However, the function of these sIL-2R is still unclear. Since high levels of sIL-2R are thought to be an indicator of an activated immune system we investigated the correlation of sIL-2R concentration and prognosis of ovarian cancer patients. sIL-2R measurement was performed on the preoperative sera of 130 patients with benign, and 119 patients with malignant ovarian tumors. The IMMULITE sIL-2R assay by DPC Biermann, Bad Nauheim, Germany was used. In ovarian cancer patients sIL-2R concentrations were significantly higher than in those with benign tumors. By defining the 95th percentile of the sIL-2R concentration distribution in patients with benign diseases as the cut-off (1200 U/ml) 35% of the ovarian cancer patients had elevated concentrations. Concentrations of sIL-2R increased with FIGO stage. FIGO-III patients with highly elevated sIL-2R concentrations tended to have better prognosis than those with sIL-2R levels within normal range in contrast to FIGO IV patients. Since sIL-2R concentrations indicate an immunological activation in ovarian cancer patients our data give hints of the possible role of sIL-2R in the assessment of the risk of recurrence in ovarian cancer patients.

IMMULITE OM-MA assay: a useful diagnostic tool in patients with benign and malignant ovarian tumors

Measurement of CA125 is well established in the diagnosis and follow-up of ovarian cancer. CA125 determination is usually performed with the monoclonal antibodies OC125 and M11. For the IMMULITE OM-MA chemoluminsence assay (DPC Biermann, Bad Nauheim, Germany) the monoclonal antibody OV185 is used. We analysed CA125 serum concentrations of patients with benign and malignant ovarian tumors with the IMMULITE OM-MA assay by defining a cut-off at 90% specificity level. Sera of 130 patients with benign and 119 patients with malignant ovarian tumors at different FIGO stages were analysed. By calculating a cut-off of 46 U/ml, in 87 ovarian cancer patients, elevated CA125 concentrations were detected (78% sensitivity). There were no significant differences between CA125 concentrations of tumors of different histological type. The measurement of CA125 by IMMULITE OM-MA is a simple and sensitive procedure.

Prognosis of children born to mothers with HELLP-syndrome

In literature there have been differences in the assessment of the outcome of children born to mothers with HELLP syndrome. In a retrospective study we investigated six annual groups (1989-1994) at the Perinatal Center in Erlangen (11,235 births, 68 children of mothers with HELLP syndrome), 53 children were treated in our neonatal intensive care unit (NICU). The control group (n = 219) consisted of a complete age group in our NICU. The gestational age (mean 33 weeks, p < 0.003) and the birth weight (mean 1671 g, p < 0.001) were significantly lower in the HELLP group. No significant differences were detected with respect to the frequency of leucocytopenia (p = 0.518) and thrombocytopenia (p = 0.215). Despite a relatively high rate (37.7%) of RDS there was only a significant tendency to the disadvantage of HELLP children (p = 0.075). There was no difference in frequency of intracranial hemorrhage (ICH) (p = 0.566). Infections were diagnosed less frequently in HELLP children (p = 0.042). Mortality in the control group was higher only as a tendency (p = 0.07). The follow-up examinations of the neurological development covered 31 of the 53 treated children. After 6-72 months (median 24 months), 90.3% of these children showed normal development or only minor disabilities. The prognosis of children of mothers with HELLP syndrome is not as bad as has been assumed so far.

[Interventional methods in breast diagnosis. Histological vs. cytological evaluation of core cut biopsies of the breast]

High speed core cut biopsies of breast tumors, sonographically or stereotactically guided, allow an histological examination of the tumor without surgery. It can be used prior to operation for the confirmation of a breast cancer and it can avoid unnecessary breast surgery in benign tumors. Unfortunately, only some centers are equipped with a pathology unit that allows an immediate histological examination. But often these institutes are provided with an experienced cystologist. Thus, the question arises if a cytology taken from the core cut biopsy is as reliable as an histological examination. In a prospective study we performed unroll-cytologies in core cut biopsies of 173 breast tumors in 169 patients consisting of 122 malignant and 51 benign tumors. Histology of core cut biopsies was proven by operational histology in all malignant and in 5 benign tumors. Histology of core cut biopsies could not be judged in 2 cases (lymphoma, gallert carcinoma). Cytological slide preparations were technically inadequate in 4 cases. The false negative rate of histology was 1/120 and 27/120 in cytology. Histology compared with cytology showed the following results: sensitivity 99.2% versus 77.5%, specificity 100% versus 95.9%, positive predictive value: 100% vs. 97.8%, negative predictive value: 98.1% vs. 63.5%, and accuracy: 99.4% vs. 82.8%. The sensitivity of cytology was much worse than that of histology of core cut biopsies. Thus, in our opinion cytology can provide a quick diagnostic orientation, but it cannot replace the more reliable histological examination. Diagnostic or therapeutic decisions should be based upon the more reliable histological results.

Increase of serum tumor marker concentrations by interferon-alpha

Since it has been shown that the addition of interferon-alpha to ovarian cancer cells in vitro leads to an increase of CA125 in the cell culture supernatant it was the aim of our study to investigate whether the CA125 serum concentrations of patients with ovarian tumors could also be increased by injection of interferon-alpha in vivo. Nine patients with cystic ovarian tumors received 6 million IU interferon-alpha subcutaneously. CA125, CA15-3, and CEA were measured in defined time intervals during the following three days after interferon-alpha injection. In one patients with T1a N0 M0 ovarian cancer with normal serum levels of all markers before interferon-alpha application a massive increase of CA125 serum concentration was detected three days after injection. In the other 8 patients (5 benign tumors, 3 ovarian cancers) no marker increase was observed. In concordance with observations in cell cultures an increase of CA125 serum concentration after interferon-alpha injection was seen in one patient with early ovarian cancer and initially normal CA125 levels. If by the injection of interferon-alpha an increase of CA125 could regularly be induced in ovarian cancer patients, earlier detection of ovarian cancer seems possible.

[Pelvic wall recurrence of cervix carcinomas. Combined surgical-radio-chemotherapeutic procedure (CORCT)]

PURPOSE

The prognosis of patients with pelvic wall recurrences after primary therapy of cervical cancer is bad. In selected patients treated exclusively by surgery as primary therapy the 5-year survival rate was between 5 and 25%. Additionally the combination of operation and radiotherapy (CORT) improved the survival so far. We developed a new concept for the treatment of pelvic wall recurrences. This concept includes the combination of radical surgery, interstitial radiation and chemotheray--CORCT (combined operative- and radiochemotherapy).

PATIENTS AND METHODS

After radical surgery, interstitial HDR (Ir-192) brachytherapy in afterloading technique (2.5 Gy, 2 fractions/day in 5 days) was performed. Additionally a chemotherapy with cisplatin 25 mg/m2/day in 5 days and 5-fluorouracil 1000 mg/day in 5 days was applicated.

RESULTS

After combined operative- and radiotherapy 3 of 3 patients died after treatment within 8 months (median) because of distant metastases. After additive radiochemotherapy 3 of 4 patients had no evidence of disease (NED) after a follow-up period of 14 (12 to 30) months.

CONCLUSION

The first treatment results of the new designed combined operative- and radiochemotherapy concept (CORCT) led us to expect an improvement of the prognosis of patients with recurrences of cervical cancer at the pelvic wall.