Age-related change in the number of neurons in the human vestibular ganglion

Dysequilibrium of aging in humans has been speculated to arise from progressive deterioration within anatomical components of the vestibular system. An integral part of this system is vestibular ganglions, which are bipolar neurons that relay peripheral vestibular information to the central nervous system. To assess the effect of aging on the number of human vestibular ganglion neurons, assumption-free stereology in the form of the optical fractionator was used on 20 serially sectioned archival human temporal bone specimens. Donors had no history of vestibular pathology and ranged in age from 2 to 88 years. An average of 25,812 (coefficient of variation = 0.13) vestibular ganglion neurons was found throughout this age range, a significant departure from the results of past studies. Logistics-based regression analysis pointed to a nonlinear pattern of decline in the neuronal population: the number of cells remained roughly constant at about 28,952 cells in youth and then declined gradually between 30 and 60 years of age before leveling off at approximately 23,349 cells in older individuals. This study confirmed the existence of an age-related decline in the primary neurons of the human vestibular system, thus providing one anatomical basis for the increased incidence of imbalance seen with age.

Molecular cloning and high-level expression of G2 protein of hantaan (HTN) virus 76-118 strain in the yeast Pichia pastoris KM71

Hantaan viral G2 envelope gene, which is known to be one of major antigens and induce neutralizing antibodies, was cloned into expression vector pHIL-S1 which consists of AOX1 promoter, PHO1 signal sequence, HIS4 gene and other components. The recombined plasmid was transformed into methylotropic yeast, Pichia pastoris of KM71 and recombinant strains harboring multi-copy of G2 gene were selected. Expression of the cloned G2 gene was confirmed with Western blot analysis using anti-sera of guinea pig immunized with the carboxyl terminal region of G2 protein expressed in Escherichia coli. The expression of G2 gene from the recombinant strain was tightly repressed by dextrose and effectively induced by methanol, an inducer of AOX1 promoter. The highest expression level was observed from 1 day after induction and maintained at the same level for up to 4 days.

Self-reported sleep quality and quality of life for individuals with chronic pain conditions

OBJECTIVE

To determine the sleep quality and quality of life for individuals with degenerative spinal disease or failed back surgery syndrome.

DESIGN

Cross-sectional survey design utilizing standardized instruments. Data were analyzed with use of hierarchical stepwise multiple regression analyses.

PATIENTS

One hundred sixty-seven individuals with degenerative spinal disease or postlaminectomy syndrome who presented to a tertiary care outpatient patient pain center.

OUTCOME MEASURES

The Center for Epidemiological Studies Depression Index measured depressive symptomatology. A modified Pittsburgh Sleep Quality Index (PSQI) measured sleep quality. The arithmetic average of least and usual VAS ratings of pain measured everyday pain. A visual analog scale rating of highest pain during the past 2 weeks measured highest pain. The Epworth Sleepiness Scale measured daytime sleepiness. The Medical Outcome Study-Short Form-Health Survey (SF-36) measured the mental health and general health components of quality of life.

RESULTS

Higher overall sleep quality and lower sleep latency primarily were related to higher ratings of physical functioning and shorter duration of pain. Ratings of the highest pain, but not everyday pain, were independent predictors of overall sleep quality and sleep latency. Daytime sleepiness was associated with younger age and depressed mood. Pain was not associated independently with daytime sleepiness. The quality of life related to mental functioning was associated positively with depressed mood and with the interaction of pain and depressed mood. None of the variables in the model (i.e., pain intensity, sleep quality, depression, and demographic variables) predicted quality of life related to overall general health.

CONCLUSIONS

These data suggest that physical functioning, duration of pain, and age may be more important than pain intensity and depressed mood in contributing to decreased overall sleep quality and sleep latency. The contribution of physical functioning was particularly strong and should be included in subsequent studies of sleep, pain, and mood. The SF-36 should be compared to pain-specific quality-of-life measures to further evaluate the usefulness of this instrument with outpatients with chronic nonmalignant pain conditions.

Breast cancer susceptibility gene 1 (BRCAI) is a coactivator of the androgen receptor

In the present study, the role of BRCA1 in ligand-dependent androgen receptor (AR) signaling was assessed. In transfected prostate and breast cancer cell lines, BRCA1 enhanced AR-dependent transactivation of a probasin-derived reporter gene. The effects of BRCA1 were mediated through the NH2-terminal activation function (AF-1) of the receptor. Cotransfection of p160 coactivators markedly potentiated BRCA1-mediated enhancement of AR signaling. In addition, BRCA1 was shown to interact physically with both the AR and the p160 coactivator, glucocorticoid receptor interacting protein 1. These findings suggest that BRCA1 may directly modulate AR signaling and, therefore, may have implications regarding the proliferation of normal and malignant androgen-regulated tissues.

Stratified mucin-producing intraepithelial lesions of the cervix: adenosquamous or columnar cell neoplasia?

BACKGROUND

Squamous (CIN) and glandular (ACIS) intraepithelial lesions often coexist in the same cervical specimen. However, a less common and little studied variant consists of a stratified epithelium resembling CIN in which conspicuous mucin production is present (Stratified Mucin-producing Intraepithelial LEsions (SMILE). This report describes the phenotypic characteristics of the SMILE, its associated lesions, and its immunophenotype.

METHODS

Eighteen SMILEs were identified by the presence of conspicuous cytoplasmic clearing or vacuoles in lesions otherwise resembling CIN. The morphologic spectrum of SMILEs was detailed; including associated intraepithelial and invasive cervical neoplasms. In addition, selected cases were stained for mucicarmine, markers of squamous cell/reserve cell differentiation (keratin-14 and p63), and proliferative activity (Mib-1).

RESULTS

Stratified neoplastic epithelial cells with a high Mib-1 index and a rounded or lobular contour at the epithelialstromal interface characterized SMILEs. In contrast to CIN, in which mucin droplets are confined to surface cells, mucin was present throughout the epithelium, varying from indistinct cytoplasmic clearing to discrete vacuoles. SMILEs were distinguished from benign metaplasia by nuclear hyperchromasia and a high Mib-1 index. All but three coexisted with either a squamous (CIN) or glandular (ACIS) precursor lesion. Nine of nine coexisting invasive carcinomas contained glandular, adenosquamous differentiation, or both. SMILEs stained negative for keratin-14 and variably for p63. When present, staining with p63 was confined to basal areas of SMILEs and was absent in areas of columnar differentiation.

CONCLUSIONS

SMILEs are unusual cervical intraepithelial lesions best classified as variants of endocervical columnar cell neoplasia based on immunophenotype. The distribution and immunophenotype of SMILEs are consistent with a neoplasm arising in reserve cells in the transformation zone. The coexistence of a wide spectrum of intraepithelial and invasive cell phenotypes suggests that SMILEs are a marker for phenotypic instability, emphasizing the importance of identifying SMILEs and ensuring a complete examination of specimens containing this unusual precursor lesion.

The role of exercise training in the treatment of hypertension: an update

Hypertension is a very prevalent cardiovascular (CV) disease risk factor in developed countries. All current treatment guidelines emphasise the role of nonpharmacological interventions, including physical activity, in the treatment of hypertension. Since our most recent review of the effects of exercise training on patients with hypertension, 15 studies have been published in the English literature. These results continue to indicate that exercise training decreases blood pressure (BP) in approximately 75% of individuals with hypertension, with systolic and diastolic BP reductions averaging approximately 11 and 8mm Hg, respectively. Women may reduce BP more with exercise training than men, and middle-aged people with hypertension may obtain greater benefits than young or older people. Low to moderate intensity training appears to be as, if not more, beneficial as higher intensity training for reducing BP in individuals with hypertension. BP reductions are rapidly evident although, at least for systolic BP, there is a tendency for greater reductions with more prolonged training. However, sustained BP reductions are evident during the 24 hours following a single bout of exercise in patients with hypertension. Asian and Pacific Island patients with hypertension reduce BP, especially systolic BP, more and more consistently than Caucasian patients. The minimal data also indicate that African-American patients reduce BP with exercise training. Some evidence indicates that common genetic variations may identify individuals with hypertension likely to reduce BP with exercise training. Patients with hypertension also improve plasma lipoprotein-lipid profiles and improve insulin sensitivity to the same degree as normotensive individuals with exercise training. Some evidence also indicates that exercise training in hypertensive patients may result in regression of pathological left ventricular hypertrophy. These results continue to support the recommendation that exercise training is an important initial or adjunctive step that is highly efficacious in the treatment of individuals with mild to moderate elevations in BP.

Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up

PURPOSE

Fibrin adhesive has been successfully used to treat fistulas-in-ano, but long-term data have been lacking. We report the results of our 18-month study examining the repair of fistulas-in-ano using autologous and commercial fibrin adhesive.

METHODS

A 79-patient, prospective, non-randomized clinical trial was performed in which fibrin adhesive was used to repair fistulas-in-ano. Twenty-six patients were treated with autologous fibrin tissue adhesive made from their own blood, and 53 patients were treated with commercial fibrin sealant. In the operating room the patient underwent an examination under anesthesia, with an attempt to identify the primary and secondary fistula tract openings. The fistula tract was then curetted. Fibrin adhesive was injected into the secondary fistula tract opening until adhesive was seen coming from the primary opening. A petroleum jelly gauze was then applied over both the primary and secondary openings, and the patient was sent home. Follow-up visits occurred one week, one month, three months, and one year later.

RESULTS

Fourteen of 26 (54 percent) patients treated with autologous fibrin tissue adhesive made from their own blood had complete closure of their fistulas after a one-year follow-up, whereas 34 of 53 (64 percent) patients treated with commercial fibrin sealant had closure of their fistulas. Most treatment failures occurred within the first 3 months, but late failures were seen as far as 11 months postoperative.

CONCLUSIONS

Fibrin tissue adhesive offers a unique mode of managing fistulas-in-ano, which is surgically less invasive, but recurrences up to one year later are being seen. Longer follow-up and further research is recommended for improvement.

Unbiased stereological quantification of neurons in the human vestibular ganglion

Vestibular ganglion (VG) neurons are bipolar neurons that relay peripheral vestibular information to the CNS. Neuron counts in normal humans provide a basis for quantitative studies on the effects of aging or pathological conditions in the audiovestibular systems. No prior study has employed unbiased stereological technique to count human VG neurons. This study used unbiased stereology in the form of the optical fractionator to estimate the total number of human VG neurons in archival temporal bone specimens. An average (+/- s.d.) of 27330+/-2593 neurons was found in specimens from five patients with no history of vestibular pathology. This result, a significant departure from results of past studies, provides the first unbiased baseline value to compare with future stereologically based studies on the human VG.

Repair of chronic anorectal fistulae using commercial fibrin sealant

HYPOTHESIS

Commercially produced fibrin sealant can be used to completely close both simple and complex fistulae in ano.

METHODS

A 29-patient prospective nonrandomized clinical trial was performed. In the operating room, the patient underwent an examination with anesthesia and the primary and secondary fistula tract openings were attempted to be identified. The fistula tract was curetted and fibrin sealant was injected into the secondary fistula tract opening until fibrin sealant was seen coming from the primary opening. A petroleum jelly gauze was then applied over the secondary opening and the patient was sent home. Follow-up visits were scheduled for 1 week, 1 month, 3 months, and 1 year later.

RESULTS

Twenty-nine consecutive patients received fibrin sealant injections for their fistulae in ano, with a mean follow-up of 6 months. Two patients had a history of Crohn disease (regional enteritis) and 2 patients had human immunodeficiency virus infection. Overall, 17 (68%) of 25 patients have had successful closure of their fistula with 4 patients lost to follow-up. Two patients required reinjection with fibrin sealant, and neither of these subsequently had closure. One of the 2 patients with Crohn disease had closure, as well as 1 human immunodeficiency virus-positive patient. In addition, there has been no evidence of incontinence or complications related to the use of fibrin sealant in this procedure.

CONCLUSIONS

Initial results in the treatment of chronic anorectal fistulae using commercial fibrin sealant are optimistic, but require further support through longer follow-up data. Fibrin sealant treatment of anorectal fistulae offers a unique mode of management which is safe, simple, and easy for the surgeon to perform. By using fibrin sealant, the patient avoids the risk of fecal incontinence and the discomfort of prolonged wound healing that may be associated with fistulotomy.

Stoma complications: the Cook County Hospital experience

PURPOSE

A retrospective analysis of enteric stomas performed at Cook County Hospital was undertaken to evaluate stoma complications per stoma type and configuration and operating service. In addition, we attempted to identify factors predictive of increased enteric stoma complications.

METHODS

From 1976 to 1995, data cards on 1,616 patients with stomas were compiled by Cook County Hospital enteric stomal therapists. Data card information included age, gender, weight, early and late stoma complications, emergency status, operating service, type and configuration of the stoma, and whether the patient was seen preoperatively by an enteric stomal therapist. Data were then analyzed using a logistic regression model to identify those variables that influenced the rate of complications.

RESULTS

There were 553 (34 percent) patients with complications. Among the total complications, 448 (28 percent) occurred early (<1 month postoperative), and 105 (6 percent) occurred late (>1 month). The most common early complications were skin irritation (12 percent), pain associated with poor stoma location (7 percent), and partial necrosis (5 percent). The most common late complications were skin irritation (6 percent), prolapse (2 percent), and stenosis (2 percent). The enteric stoma with the most complications was the loop ileostomy (75 percent). The enteric stoma with the least complications was the end transverse colostomy (6 percent). The general surgery service had the most complications (47 percent), followed by gynecology (44 percent), surgical oncology (37 percent), colorectal (32 percent), pediatric surgery (29 percent), and trauma (25 percent). Age, operating service, enteric stoma type and configuration, and preoperative enteric stomal therapist marking were found to be variables that influenced stoma complications.

CONCLUSIONS

Complications from enteric stoma construction are common. Preoperative enteric stoma site marking, especially in older patients, and avoiding the ileostomy, particularly in the loop configuration, can help minimize complications.

Assessment of novel anti-p185HER-2 monoclonal antibodies for internalization-dependent therapies

Novel therapies that require internalization of effector domains may be improved by assessing the efficacy of postbinding receptor-mediated endocytosis. To achieve targeted gene therapy of immunotoxin therapy, natural vector-host tropisms must be altered. Recent improvements in monoclonal antibody (MAb) engineering have expanded the potential range of host cells that can be targeted for therapeutic intervention. However, relatively little is known about cellular responses after binding of a vector construct. We have tested the utility of four novel MAbs recognizing the extracellular domain of p185HER-2, a membrane receptor protein, for use in internalization-dependent therapies. All four antibodies bound to p185HER-2 in a number of immunoassays. Two antibodies recognized accessible epitopes of p185HER-2 on viable cells. Radioimmunoassay demonstrated that antibody-membrane receptor complexes formed by two antibodies were internalized and trafficked through an endolysosomal degradative pathway. Two of the four antibodies evaluated were found to have favorable internalization characteristics suitable for incorporation in a targeting vector. This analytical approach could be applied to antibodies prior to and after fusion with various vectors or toxins to determine the potential utility of the antibodies for targeted therapy.

Tolerance of autologous and allogeneic bone grafts to therapeutic radiation in humans

PURPOSE

To examine the effect of perioperative irradiation on bone graft healing and functional integrity.

METHODS AND MATERIALS

Fifty-five bone grafts (10 autologous and 45 allogeneic) performed between 1978 and 1995 were evaluated retrospectively. Sixteen received preoperative radiation, 11 received postoperative, and 13 were treated with a combination of pre- and postoperative radiation. Fifteen nonirradiated grafts were randomly selected to serve as controls. Twenty-three of the grafts were placed in patients who received chemotherapy in the perioperative period. Functional graft survival and radiographic healing quality were evaluated.

RESULTS

Overall rates of graft survival at 1 year were 89% for autografts and 79% for allografts. Graft survival rates were 86% and 68% at 1 and 5 years for the irradiated group, and 67% and 58% for the control group. No significant difference was seen in the Kaplan-Meier graft survival curves of the two groups. There was a nonsignificant trend toward improved radiographic healing quality in the control group. No significant differences in outcome based on treatment chronology were found with survival rates of 88% for preoperative treatment and 100% for postoperative treatment. No relation between outcome and bone dose (preoperative + postoperative dose), graft dose (postoperative dose), or mean dose/day was found. There was a trend (p = 0.0525) toward worse outcome seen in the Kaplan-Meier curves of patients who received chemotherapy. This difference, however, was not seen in the 1-year survival rates or healing quality. Tobacco use tended toward predicting failure, with 63% graft survival compared to 85% in nonsmokers (p = 0.09). Healing quality was significantly lower in the smoking group.

CONCLUSION

The low failure rate of grafts in irradiated sites, overall and compared to controls from this study and relevant literature, as well as the lack of dose and time effects, does not support significant deviation from the indicated treatment regimen for patients who have received or are expected to receive a graft. The trend toward decreased quality of radiographic bone healing, and data published in relevant literature indicating improved healing when radiation is withheld until 3-4 weeks postoperatively suggest this delay should be attempted when not expected to otherwise compromise patient outcome. A nonsignificant trend only for the effect of chemotherapy on bone grafts was seen, thus we do not recommend changes in its use as appropriate for disease management other than a preference against use during the immediate perioperative period.

Effects of testosterone on the development of a sexually dimorphic neuromuscular system in ciliary neurotrophic factor receptor knockout mice

Motoneurons in the spinal nucleus of the bulbocavernosus (SNB) innervate the perineal muscles, bulbocavernosus (BC), and levator ani (LA). Testosterone regulates the survival of SNB motoneurons and BC/LA muscles during perinatal life. Previous findings suggest that effects of testosterone on this system may be mediated by trophic factors-in particular, by a factor acting through the ciliary neurotrophic factor alpha-receptor (CNTFRalpha). To test the role of CNTFRalpha in the response of the developing SNB system to testosterone, CNTFRalpha +/+ and -/- mice were treated with testosterone propionate (TP) or oil during late embryonic development. BC/LA muscle size and SNB motoneuron number were evaluated on the day of birth. Large sex differences in BC and LA muscle size were present in newborn mice of both genotypes, but muscle volumes were reduced in CNTFRalpha -/- animals relative to same-sex, wild-type controls. Prenatal testosterone treatment completely eliminated the sex difference in BC/LA muscle size in wild-type animals, and eliminated the effect of the CNTFRalpha gene deletion on muscle size in males. However, the effect of TP treatment on BC and LA muscle sizes was blunted in CNTFRalpha -/- females. SNB motoneuron number was sexually dimorphic in oil-treated, wild-type mice. In contrast, there was no sex difference in SNB motoneuron number in oil-treated, CNTFRalpha knockout mice. Prenatal treatment with testosterone did not increase SNB motoneuron number in CNTFRalpha -/- mice, but also did not significantly increase SNB motoneuron number in newborn wild-type animals. These findings confirm the absence of a sex difference in SNB motoneuron number in CNTFRalpha -/- mice. Moreover, the CNTFRalpha gene deletion influences perineal muscle development and the response of the perineal muscles to testosterone. Prenatal TP treatment of CNTFRalpha -/- males overcomes the effects of the gene deletion on the BC and LA muscles without a concomitant effect on SNB motoneuron number.

Fibrin sealant for treatment of cerebrospinal fluid leaks

OBJECTIVE

Persistent cerebrospinal fluid leaks in the human population are rarely found in otherwise healthy individuals, but occur in patients with comorbid illnesses. These leaks are frequently resistant to dural suturing or closure of the defect site with connective tissue, cartilage, or plastic materials. In this study, fibrin sealant (ViGuard Fibrin Sealant was used to adhere muscle grafts to surgically created dural defects to close cerebrospinal fluid leaks in chinchillas. Histologic evaluation of the defect sites were conducted to assess healing and tissue response in the test and control groups.

METHOD

In 20 chinchillas, after a skin incision, a 6 mm X 6 mm window was created in the right superior bulla exposing the underlying bony tegmen. Using a microcutting burr, a 3 mm X 3 mm area of tegmen was drilled out and the exposed dura was resected to create a large cerebrospinal fluid (CSF) leak. In the control group (n = 10), a small muscle graft from the surrounding tissue was placed into the defect site. In the test group (n = 10), the muscle graft was glued into the defect with ViGuard Fibrin Sealant. Bulla and skin were then closed. All animals were killed at 3 weeks into the experiment, and tissue was harvested for histologic examination.

SETTING

The Department of Otolaryngology, Head and Neck Surgery Research Laboratory. University of Illinois, Chicago.

RESULTS

Three weeks after surgery in the test group the tegmen defects were found to be closed by bone or connective tissue or both. Meninges had regrown, and the underlying brain appeared histologically normal. There was no evidence of CSF leak, toxicity, infection or other deleterious tissue reactions. In the control group, again the meningeal and bony tegmen defects were seen to be closed by connective tissue or bone or both. Brain tissues appeared histologically normal. There was no evidence of CSF leak, toxicity, or other deleterious tissue reactions. One animal of the test group died of unknown causes. On autopsy, no signs of meningitis or encephalitis could be detected and the cause of death was unapparent.

CONCLUSION

Fibrin Sealant, made from pooled donor blood and treated with viral elimination procedures, was found in combination with muscle grafts to securely close induced CSF leaks in the chinchilla model. Inflammation, infection, or toxic reactions were not observed. We believe that ViGuard Fibrin Sealant has stronger bonding power compared with available autologous fibrin tissue adhesives.

Late presentation of a unilateral sporadic retinoblastoma in a 16-year-old girl

BACKGROUND

Retinoblastoma is the commonest intraocular tumour of childhood with the majority of cases being diagnosed before 5 years of age. Late presentation of retinoblastoma is rare.

CASE HISTORY

A healthy 16-year-old Caucasian girl presented with a 1-day history of blurred vision in the left eye. Examination revealed an inferonasal mass in the left retina with an overlying haemorrhage and vitreous seeding. Imaging studies revealed a 5-mm densely calcified opacity. Other investigations, including cerebral spinal fluid examination, bone marrow aspirate trephine, toxocara serology and serum protein studies, were normal. After considering the differential diagnoses such as toxocariasis and Coat's disease, a diagnosis of late-presenting retinoblastoma was made. The patient subsequently underwent enucleation with a primary orbital implant. The diagnosis was confirmed histopathologically.

CONCLUSION

Late presentation of retinoblastoma is uncommon but can be a cause of acute visual impairment in the non-paediatric age group. Retinoblastoma should be considered in the differential diagnosis of a fundal mass in any age group.

Endoscopic retrograde pancreatographic findings of pancreatic lipomatosis

Pancreatic lipomatosis is characterized by fatty infiltration or replacement of the pancreas, and has been associated with many conditions. We recently experienced two cases of pancreatic lipomatosis in patients with pancreatic pseudocyst and a case of lipomatosis in diabetes mellitus. In these patients, abrupt obstruction of the main pancreatic duct with smooth tapering is a typical endoscopic retrograde pancreatography (ERP) finding of pancreatic lipomatosis and must be differentiated with pancreatic carcinoma.

Atypical immature metaplastic-like proliferations of the cervix: diagnostic reproducibility and viral (HPV) correlates

Although some immature squamous lesions (papillary immature metaplasias) of the cervix have been described and associated with human papillomaviruses (HPV), nonpapillary atypical immature squamous proliferations (AISPs) are a poorly defined entity and range from atypical reactive metaplasias to squamous intraepithelial lesions resembling immature metaplasia. This study examined the diagnostic reproducibility of AISPs and their relationship to HPV nucleic acids. Forty-four diagnostically problematic AISPs were studied. Based on nuclear density (crowding), chromasia, variation (anisokaryosis) in nuclear size, and surface cytoplasmic maturation, cases were independently scored by 2 observers as (1) probably reactive (Rx), (2) not otherwise specified (NOS), and (3) squamous intraepithelial lesion (SIL). Extracted archival DNA was scored for HPV by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Interobserver reproducibility (kappa statistic) and HPV correlates (chi square) were computed. Approximately one third of cases were classified in each category by the observers. Interobserver reproducibility was excellent (0.80), poor (0.23), and fair to good (0.41) for a diagnosis of Rx, NOS, and SIL, respectively. Differences in HPV DNA positivity between Rx and SIL were significant for both observers (5.8% to 6.7% v 38.4% to 50.0%, respectively); however, differences between NOS and SIL (30.7% to 42.8% v 38.4% to 50.0%) were not, even when cases were limited to those in which both observers agreed (28.6% v 37.5%). By light microscopy, AISPs exceeding the threshold for presumed reactive changes (NOS or SIL) are a morphologically heterogeneous group that defy precise classification. Furthermore, their histopathologic appearance, even when there is diagnostic agreement, does not consistently correlate with their HPV status. The laboratory management of AISPs should take into account the uncertainty of this diagnosis.

Technical manual for manufacturing autologous fibrin tissue adhesive

PURPOSE

The aim of this article is to provide a concise and simple technical manual for manufacturing autologous fibrin tissue adhesive derived from the precipitation of fibrinogen using a combination of ethanol and freezing for surgery.

METHODS

All materials and equipment needed to manufacture ethanol-based autologous fibrin tissue adhesive are listed. In addition, step-by-step instructions are provided to allow for easy and rapid fibrin adhesive production.

RESULTS

Ethanol-based autologous fibrin tissue adhesive can be manufactured in under 60 minutes. Furthermore, at our institution the startup cost for manufacturing ethanol-based autologous fibrin tissue adhesive was under $2,500.00.

CONCLUSION

Ethanol-based autologous fibrin tissue adhesive is a safe, reliable, and easily manufactured autologous fibrin tissue adhesive that can be made by a trained technician in any blood bank, pharmacy, or surgical laboratory.

Cytotoxicity of 2,2':6',2' '-terpyridineplatinum(II) complexes against human ovarian carcinoma

2,2':6',2''-Terpyridineplatinum(II) complexes are shown to possess cytotoxicity against a number of human ovarian tumor cell lines. Many of the complexes show similar activity against cisplatin- and doxorubicin-resistant cell lines as the parental cells suggesting that there is little or no cross-resistance with cisplatin or doxorubicin. The cytotoxicity of bis[2,2':6',2''-terpyridineplatinum(II)] complexes is strongly dependent on the nature of the linker. Bis[2,2':6',2''-terpyridineplatinum(II)] complexes with a flexible linker at the 4'-position show poor cytotoxicity; by contrast bis[2,2':6',2''- terpyridineplatinum(II)] complexes with rigid and short linkers at platinum(II) are strikingly effective. Several of the compounds show greater cytotoxicity against human ovarian cell lines than carboplatin, the therapeutic agent currently advocated for the treatment of human ovarian cancers.

Intracerebroventricular infusion of the galanin antagonist M40 attenuates heterosexual partner preference in ferrets

Gonadectomized, estradiol-treated male and female ferrets (Mustela furo) received intracerebroventricular (i.c.v.) infusions of 4 doses of the galanin receptor antagonist M40 or galanin and were allowed to approach breeding male or female ferrets that were placed behind wire mesh barriers in the goal boxes of a T maze. After i.c.v. infusion of saline, subjects strongly preferred to approach stimulus ferrets of the opposite sex. Male and female subjects approached these preferred stimulus animals on significantly fewer trials after i.c.v. infusion of the 2 highest doses of M40, whereas this drug failed to affect males' coital behavior in separate tests with an estrous female. Endogenous galanin may facilitate neural reward mechanisms that control heterosexual partner preference in both sexes.

Repair of fistulas-in-ano using autologous fibrin tissue adhesive

PURPOSE

Our goal was to determine if autologous fibrin tissue adhesive derived from the precipitation of fibrinogen using a combination of ethanol and freezing, could be used to completely close both simple and complex fistulas-in-ano.

METHODS

A 26-patient pilot study was performed in which 100 ml of a patient's blood was drawn 90 minutes before surgery. Autologous fibrin tissue adhesive was prepared. In the operating room the patient underwent an examination under anesthesia, and the primary and secondary fistula tract openings were attempted to be identified. The fistula tract was curetted, and autologous fibrin tissue adhesive was injected into the secondary fistula tract opening until fibrin glue was seen coming from the primary opening. A petroleum jelly gauze was then applied over the secondary opening, and the patient was sent home. Follow-up visits were scheduled for one week, one month, three months, and one year later.

RESULTS

Twenty-six patients received autologous fibrin tissue adhesive fistula injections, with a mean follow-up of 3.5 months. Initial results were encouraging. Twenty-one of 26 patients (81 percent) had successful initial closure of their fistulas. Two of five failures were injected a second time, and one closed, giving an overall successful closure rate of 85 percent (22/26 patients). Of five patients who failed, mean time to failure was 3.8 weeks. In addition, there was no evidence of infection or complications related to the procedure.

CONCLUSION

Our initial results are optimistic and require further support through longer follow-up data. Fibrin glue treatment of anorectal fistulas offers a unique mode of management that is safe, simple, and easy for the surgeon to perform. By using autologous fibrin tissue adhesive the patient avoids the risk of anal incontinence and the discomfort of prolonged wound healing which may be associated with fistulotomy.

Intracerebroventricular infusion of the galanin antagonist M40 attenuates heterosexual partner preference in ferrets

Gonadectomized, estradiol-treated male and female ferrets (Mustela furo) received intracerebroventricular (i.c.v.) infusions of 4 doses of the galanin receptor antagonist M40 or galanin and were allowed to approach breeding male or female ferrets that were placed behind wire mesh barriers in the goal boxes of a T maze. After i.c.v. infusion of saline, subjects strongly preferred to approach stimulus ferrets of the opposite sex. Male and female subjects approached these preferred stimulus animals on significantly fewer trials after i.c.v. infusion of the 2 highest doses of M40, whereas this drug failed to affect males' coital behavior in separate tests with an estrous female. Endogenous galanin may facilitate neural reward mechanisms that control heterosexual partner preference in both sexes.

In vivo cyclin E expression as a marker for early cervical neoplasia

Identification of human papillomavirus (HPV)-related early cervical neoplasia and its distinction from benign epithelial alterations is based on either subjectively applied morphologic criteria or on identification of associated papillomaviruses. The direct and indirect consequences of HPV infection, however, potentially include upregulation of some host genes. We investigated one candidate, cyclin E, as a possible marker for HPV-related early squamous lesions. Serial paraffin sections from 92 archival cervical biopsy specimens were analyzed, including 19 non-neoplastic biopsy specimens, 30 low-grade and 31 high-grade squamous intraepithelial lesions (SILs), and 12 invasive carcinomas. Four parameters (histologic diagnosis, cyclin E staining, HPV status and, in selected cases, Ki-67 staining) were scored, and their relationship(s) were evaluated by the chi2 independence test. Twenty-one, 73, 79, and 75% of nonlesional epithelia, low-grade SILs, high-grade SILs, and invasive squamous cell carcinomas, respectively, were HPV positive (P < .001 for HPV status vs. diagnosis). Cyclin E staining was nuclear in distribution, and the frequency of positive staining, ie., moderate or strong intensity, was significantly higher (P < .001 for cyclin E staining vs. diagnosis) in all of the lesional epithelia (92.3, 51.6, and 50% of low-grade and high-grade SILs and carcinomas, respectively) compared with nonlesional epithelium (5.9%). Cyclin E positivity and/or HPV positivity was seen in 100% of the low-grade SILs. Epithelial Ki-67 and cyclin E staining were strikingly different in frequency and distribution. Cyclin E was undetectable in basal cells of normal mucosa (which were positive for Ki-67) and limited to suprabasal epithelium in noninvasive lesions. Cyclin E expression correlates strongly with morphologic features of HPV-related preinvasive and invasive cervical disease. This correlation is most pronounced in low-grade SILs. The possibility that in vivo cyclin E staining is a generic marker for HPV infection in low-grade SILs merits additional study.

Large somal size is associated with the expression of galanin but not with neuronal birthdate in the sexually dimorphic male nucleus of ferret's preoptic area/anterior hypothalamus

Using Nissl and Golgi stains, a sexually dimorphic male nucleus (MN) comprised of a cluster of large cells with large dendritic arbors has been identified in the dorsal preoptic area/anterior hypothalamus (POA/AH) of male ferrets. The MN-POA/AH is formed only in males by the action of estradiol derived from the neural aromatization of testosterone during the last quarter of a 41-day gestation. The ferret's dorsal POA/AH is also characterized by a sex difference in the expression of the neuropeptide galanin which first arises in males around embryonic day (e) 34. We asked whether the male-typical phenotype of large somal size is related to birthdate and/or the capacity of dorsal POA/AH neurons to express galanin. In experiment 1 we labeled cohorts of cells born on E20, E24, or E28 by injecting the amniotic sacs of individual fetuses with the thymidine analogue bromodeoxyuridine (BrdU). On postnatal day 20, BrdU-immunoreactive cells were visualized immunohistochemically, counterstained with cresyl violet, and their somal sizes were measured. BrdU-immunoreactive cells were significantly larger in the males' MN-POA/AH than in a comparable region of females, regardless of when they were born between E20 and E28. In experiment 2 galanin-immunoreactive cells in the dorsal POA/AH of adult ferrets were visualized immunohistochemically, and their somal sizes were measured. Somal areas of galanin-immunoreactive cells were significantly larger in the MN-POA/AH of intact, breeding, or castrated and testosterone-treated males than in the corresponding area of females. Our results suggest that cells in the males' MN-POA/AH are more likely to be larger than cells in females' corresponding region, regardless of birthdate. Finally, in adulthood the male-typical phenotype of large Nissl-stained somal areas of MN-POA/AH cells may, in part, reflect their increased galanin expression.