A prospective study of tumor markers CA 125 and CA 19.9 in patients with epithelial ovarian carcinomas

In a prospective study, CA 125 and CA 19.9 serum levels were measured in 229 patients with ovarian cancer [121 with active disease, 108 in complete remission (CR)], and in 20 patients with other malignancies. Abnormal levels of CA 125 were found in 90% of patients with active ovarian cancer, in 1.8% of those in CR and in 38% of cases with other malignancies. Abnormal CA 19.9 serum levels were found in 36, 9 and 48% of these groups, respectively. Serum levels of both tumor markers were related to tumor stage and histological type. The highest levels of CA 125 were found in serous adenocarcinoma and the lowest in the mucinous type (p < 0.0001). In contrast, significantly higher CA 19.9 values were found in mucinous carcinoma than in other histologies (p < 0.0001). CA 125 and CA 19.9 were useful for monitoring disease activity in 88.3 and 32%, respectively, while one or other tumor marker was useful in 92% of patients. At the time of the second-look operation, abnormal CA 125 serum levels were found in 32% (6/19) of patients with active disease and in none of those with CR (0/38). CA 125 sensitivity was 83% (5/6) in those patients with residual tumor > 2 cm and in 8% (1/13) in those with tumor < 2 cm. CA 19.9 values were abnormally high in 16% of cases with persistent disease and in 11% of CR patients. In conclusion, our results confirm that CA 125 is a useful marker in ovarian carcinoma. CA 19.9 improves the results obtained with CA 125 alone only in mucinous adenocarcinomas.

Experimental infections of a Phlebotomus perniciosus colony using different procedures

Flies of two colonies of Phlebotomus perniciosus established in Italy and Spain respectively, were infected with a Leishmania infantum isolate from Spain. Only P. perniciosus from Spain was completely found susceptible to the infection. Experimental infections of P. perniciosus from Spain with the same L. infantum isolate were carried out using RPMI or PBS as infective feeding mediums. The results demonstrate that using PBS it is possible to re-feed a great quantity of infected flies.

[Human immunodeficiency virus infection in hemophiliacs: prevalence and current clinical situation]

The prevalence of HIV-antibody was studied in a cohort of 156 haemophiliacs controlled since before 1986. Ninety four patients (60%) were HIV-seropositive, and all of them had been previously treated with non-heated factor concentrates. Seroprevalence was 50% by 1983. Evidence for previous negative results was only available in 19 seropositive patients and all of them seroconverted before 1985. For the 148 patients exposed to non-heat treated factor concentrates, severe haemophiliacs and those with factor consumption greater than 100 x 10(3) had the maximal rate of seropositivity (81% and 75% respectively, p less than 0.005). Fifteen patients developed AIDS (10% of the HIV-positive), 12 of which have died. HIV infection has a high prevalence and it has become the most important cause of death in our haemophiliacs.

Role of tumor necrosis factor in macrophage leishmanicidal activity in vitro and resistance to cutaneous leishmaniasis in vivo

Recombinant human tumor necrosis factor (TNF) and purified murine TNF were both able to activate macrophages to destroy intracellular Leishmania major in vitro. In addition, parasitizing macrophages with L. major markedly increased the ability of the cells to produce TNF. Finally, when mice were vaccinated with an avirulent form of L. major, the animals produced large amounts of TNF but no gamma interferon in response to infection with virulent L. major. Treating these mice with a neutralizing anti-TNF antibody led to partial but not complete inhibition of the resistant state, which suggests that factors other than TNF and gamma interferon contribute to resistance to L. major.

Cancer antigen 125 in serum and ascitic fluid of patients with liver diseases

Serum concentrations of cancer antigen 125 (CA 125) were determined for 373 patients with various liver diseases: 57 with acute hepatitis, 57 with chronic hepatitis, 244 with liver cirrhosis (86 compensated and 158 decompensated), and 15 with primary liver cancer. The antigen was measured simultaneously in the serum and ascitic fluid of 46 of the patients with liver cirrhosis and sequentially in the serum and ascitic fluid of another 25 cirrhotics treated with paracentesis and (or) diuretics. Abnormal results for CA 125 were detected in sera from 4% of the patients with acute or chronic hepatitis, 60% of the patients with liver cirrhosis, and 67% of the patients with primary liver cancer. The main factor associated with abnormal serum concentrations of this antigen was the presence of ascites, with pathological CA 125 values in 94% of patients with ascites without jaundice (mean 566 +/- 528 arb. units/mL), compared with only 40% of patients with jaundice and without ascites (mean 40.1 +/- 28.5 arb. units/mL) (P less than 0.001). High concentrations of CA 125 were mainly associated with spontaneous bacterial peritonitis. The serum concentration of CA 125 decreased after treatment with paracentesis, but increased in patients treated with diuretics rather than paracentesis. The release of this antigen in liver cirrhosis appears to be independent of the liver disorder and, rather, results from peritoneal synthesis of this antigen.

[Calcium dependence of the contractile response of the aorta in the rat, rabbit and guinea pig and in the human uterine artery]

The influence of extracellular Ca2+ on the contraction produced by noradrenaline (NA) (3 x 10(-6) M), KCl (60 mM) and BaCl2 (30 mM) on human uterine arteries (AUH) and aortic strips from rats, rabbits and guinea-pigs have been studied. The vessels were cut spirally and incubated in Krebs solution containing 2.5 mM Ca2+ (KN), 0 mM Ca2+ (K-0Ca) or 0 mM Ca2+ + 3 mM EDTA (K-EDTA). Both phases (fast and slow) of the response of aortic strips to NA and of the AUH to NA, KCl and BaCl2 were significantly smaller in solutions without Ca2+. Only in rabbit aortic strips the slow phase was significantly more reduced than the fast phase. Overall, the contractions of the rat aortic strips were most resistant to the absence of extracellular Ca2+. These results confirm the variability of the responses of blood vessels from different vascular beds and species to the removal of extracellular Ca2+.

Effects of tyramine on the human uterine artery in vitro

1. We have studied the effects of tyramine on the human uterine artery (HUA) in order to assess its site of action. 2. Tyramine (5 x 10(-5) to 10(-3) M) contracts the isolated human uterine artery. Tachyphylaxis appeared when concentration-response curves were repeated and the contraction was diminished by prazosin (10(-8), 10(-7) and 10(-6) M). The maximal contraction induced by tyramine (10(-3) M) was 25% of the maximal response to noradrenaline (10(-5) M). 3. After 2 hr of tyramine perfusion a decrease of the contractile response to KCl, 30 and 60 mM (15.0 and 12.9%) and noradrenaline 10(-6) M (83.2%) is shown. 4. However, when tyramine was previously added for 3 min to the bath, the response to KCl increased while the response to noradrenaline was lower. 5. A possible postsynaptic antagonistic effect for tyramine in the HUA is suggested in addition to its usual presynaptic effect.

Tumor markers in chronic renal failure and hemodialysis patients

Serum levels and the incidence of elevated levels of several tumor markers were measured in 30 patients with chronic renal failure (CRF) of different degrees, as well as in 36 hemodialyzed (HD) patients without clinical evidence of neoplasia. The tumor markers evaluated were carcinoembryonic antigen (CEA), CA 125, CA 15.3, CA 19.9, CA 50, alpha-fetoprotein, neuron-specific enolase (NSE), squamous cell carcinoma antigen (SCC), prostatic acid phosphatase and prostatic-specific antigen. Serum levels of CEA were above the cutoff limit in 33% of patients with CRF and 47% of HD patients, CA 50 was higher than normal values in 37 and 44% of patients, respectively. SCC was elevated in 43 and 72% of patients, respectively. Serum levels of CA 125 were elevated in 18% of patients with CRF and NSE in 36% of HD patients. In CRF several tumor markers (CEA, SCC, CA 50 and NSE) show a high false positive rate and may be unreliable for monitoring malignancies in uremic patients, while the other markers evaluated appear to maintain their specificity in this situation.

Serum phosphohexose isomerase activities in patients with colorectal cancer

Pretreatment levels of phosphohexose isomerase (PHI) were above the cutoff limit of 107 IU/l in 41% of patients with benign intestinal diseases and in 46% of patients with colorectal cancer. Sensitivity of PHI was related to the presence of distant metastasis and the location of the primary tumor. Patients with rectal tumors presented a lower sensitivity than patients with colonic tumors. Pretreatment levels of PHI had prognostic value and patients with elevated levels of this enzyme showed a shorter disease-free interval in comparison with those patients with normal PHI activities. However, the prognostic significance of PHI was not independent of Dukes' classification. The present study indicates that PHI is not useful in the follow-up of patients with colorectal cancer after curative surgery because of its low sensitivity in the diagnosis of recurrences (47%) and its low specificity in patients without evidence of disease (76%).

Antenatal phenobarbital for the prevention of periventricular and intraventricular hemorrhage: a double-blind, randomized, placebo-controlled, multihospital trial

To determine whether the neuroprotective properties of phenobarbital would alter the incidence and severity of intracranial hemorrhage in premature infants, we randomly assigned 110 women at less than 31 weeks of gestation to receive 10 mg/kg phenobarbital or placebo in a blinded fashion before delivery. Infants were examined postnatally with real-time ultrasonography for evidence of intracranial hemorrhage. Maternal demographics, pregnancy complications, antenatal management, and route of delivery did not differ between the phenobarbital group (n = 50) and the placebo group (n = 60). The total incidence of periventricular-intraventricular hemorrhage did not differ between the phenobarbital-treated (n = 54) and the placebo-treated (n = 67) infants. However, the frequency of grade 3 and grade 4 hemorrhages was 15% (10 infants) in the placebo group and 3.7% (2 infants) in the phenobarbital group (p less than 0.05). There were no differences in the severity of associated conditions in the babies to explain the difference in the incidence of severe hemorrhage between the study groups. We conclude that antenatal administration of phenobarbital appears to be effective in decreasing the severity of periventricular-intraventricular hemorrhage in infants delivered at less than 31 weeks of gestation.

Tumor markers in patients with chronic renal failure

In order to evaluate the specificity of tumor markers in chronic renal failure, we have determined serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19.9 (CA 19.9), carbohydrate antigen 50 (CA 50), alphafetoprotein (AFP), neuron-specific enolase (NSE), prostatic acid phosphatase (PAP), prostatic specific antigen (PSA), squamous cell carcinoma antigen (SCC), carbohydrate antigen 15.3 (CA 15.3) and carbohydrate antigen 125 (CA 125) in 30 patients with chronic renal failure and in 36 hemodialyzed patients without clinical evidence of neoplasia. CEA, CA 50, NSE and SCC frequently show increased serum levels, suggesting a renal metabolism, while others remain, generally, within the normal levels.

Inhibition of the growth of enteropathogenic bacilli by bacteriocins produced by micro-organisms from the sediment of wells

The bacterial flora of the sediment of 20 wells of water for human consumption in the rural area of the VII Region in Chile was examined. Fourteen strains of bacteria, from different wells, produced bacteriocins which inhibited the growth of Salmonella typhi, Salm. typhimurium, Shigella sonnei and enterotoxigenic Escherichia coli. About 50% of these strains contained plasmids of different molecular weight and a large number of these codified for bacteriocins. The results suggest what is required to implement an efficient, simple and economical biological system for the purification or control of the number of enteropathogenic bacilli of well water in the rural area.

Mononuclear cell subpopulations in human follicular fluid from stimulated cycles

The study of lymphocyte subsets from human follicular fluid (FF) provides an opportunity to evaluate immunological features of the ovary. We investigated the mononuclear cell subsets in FF and peripheral blood obtained at the time of laparoscopy from ten in vitro fertilization (IVF) patients. Midcycle nonpregnant peripheral blood was used as the control. A marked increase in the proportion of monocytes (CD14+) was observed in FF. Although FF was enriched with CD8+ lymphocytes, a decrease in the proportion of CD4+ lymphocytes was observed. "Memory" T cells in FF, identified by the CD4+ CD45R- phenotype, predominated over "naive" T cells (CD4+ CD45R+) at a ratio of 2:1, which differs from the ratio yielded by control blood samples (1:1). The percentage of activated T cells (CD3+ HLA-DR+ cell) increased significantly in FF. When lymphocyte subsets were studied in the peripheral blood of IVF patients, changes similar to but less significant than those in FF were found. These data support the concept that lymphocytes play an important role in ovarian physiology.

SCC antigen measured in malignant and nonmalignant diseases

SCC antigen was measured in the serum of 214 patients with benign diseases and in 251 patients with various cancers. With 2.5 micrograms/L as the upper normal limit for serum, values were positive in 2.9% of 69 healthy subjects (I), 29.0% of 214 patients with benign pathologies (II), and 41% of 217 patients with active cancer (III). The highest values in group II were for patients in renal failure (64%) or with lung diseases (40%) or head-and-neck diseases (21.2%). Specificity of SCC increased (91.1%) when we excluded patients in renal failure or with creatinine values greater than 133 mumol/L. In group III, SCC values were abnormal in 57.7% of patients with squamous cell carcinoma, but in only 9.3% of those with other histological types (P less than 0.001). In squamous cell carcinoma of the lung, cervix, or head and neck, SCC values were related to tumor stage, values being highest in patients with metastases.

Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with continuous 5-fluorouracil infusion

The limiting toxicity of low dose continuous infusion 5-fluorouracil (200-300 mg/m2/day) is often palmar-plantar erythrodysesthesia (PPE). PPE developed in 16/25 patients (exact 95% confidence interval of 42%-82%) with metastatic colon cancer enrolled in a phase II trial. In this trial, 5-FU was given continuously at a dose of 200 mg/m2/day until toxicity or progressive disease forced discontinuation. The first signs of the syndrome developed at a median of 2 months following infusion initiation and, unless treatment was interrupted, became progressively worse. The incidence of moderate to severe PPE was 71% in the 14 previously untreated patients (exact 95% confidence intervals of 42-92%). Seventy-eight percent of the responders in the no prior treatment group developed PPE. The incidence of moderate to severe PPE was only 27% in the 11 previously treated patients (exact 95% confidence intervals of 6-61%). The higher incidence of PPE in the previously untreated patients probably resulted from a longer total infusion time (median = 7.3 months) than the previously treated (median = 4.5 months). The longer infusion time in turn was a result of the higher response rates (64 vs 18%) in the previously untreated versus treated groups. Five previously untreated patients who developed PPE received 50 or 150 mg of pyridoxine/day when moderate PPE changes were noted. Reversal of PPE without interruption of the 5-FU was seen in 4/5 patients. Four of these patients who received pyridoxine had responded to 5-FU treatment. No adverse affect of pyridoxine on clinical response was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

SCC antigen measured in malignant and nonmalignant diseases

SCC antigen was measured in the serum of 214 patients with benign diseases and in 251 patients with various cancers. With 2.5 micrograms/L as the upper normal limit for serum, values were positive in 2.9% of 69 healthy subjects (I), 29.0% of 214 patients with benign pathologies (II), and 41% of 217 patients with active cancer (III). The highest values in group II were for patients in renal failure (64%) or with lung diseases (40%) or head-and-neck diseases (21.2%). Specificity of SCC increased (91.1%) when we excluded patients in renal failure or with creatinine values greater than 133 mumol/L. In group III, SCC values were abnormal in 57.7% of patients with squamous cell carcinoma, but in only 9.3% of those with other histological types (P less than 0.001). In squamous cell carcinoma of the lung, cervix, or head and neck, SCC values were related to tumor stage, values being highest in patients with metastases.

Immunosuppressive properties of human follicular fluid

Human preovulatory follicular fluids (FF) obtained in the course of stimulated cycles were analyzed for their possible immunologic functions. Different concentrations of FF (20%, 2%, 1%) inhibited the mitogenic response of normal human lymphocytes to concanavalin A (Con A). Lymphocytes were assessed for immunosuppressor activity after preincubation with FF. Lymphocyte mitogenic response to Con A was only suppressed by cells preincubated with FF at concentrations of 2% and 1% for at least 48 hours. No evidence of suppressor cell induction was seen following incubation of lymphocytes with 20% FF, nor was any significant relationship between FF immunosuppressor activity and the outcome of in vitro fertilization observed. We conclude that some factor(s) in FF may be capable of directly inhibiting lymphocyte response and inducing immunosuppressor cell activity in vitro.

c-myc proto-oncogene expression in peripheral blood mononuclear cells from patients with primary Sjögren's syndrome

We examined peripheral blood mononuclear cells (PBMC) from 16 patients with Sjögren's syndrome (SS) and 7 normal control subjects for the expression of the c-myc proto-oncogene. Patients with SS were found to have a significantly increased expression of c-myc messenger RNA compared with normal individuals. No abnormal forms of c-myc RNA were detected in the SS patients. DNA analysis did not show deletion, rearrangement, or amplification in the c-myc proto-oncogene. The methylation status of the c-myc gene in patients with SS was found to be comparable with that of the control subjects. Nuclear run-off assays showed increased transcription of the c-myc gene in some patients but normal transcription in others, suggesting that posttranscriptional mechanisms are also involved in the increased c-myc messenger RNA observed in these patients. Two patients with primary SS and B cell lymphomas were found to have normal c-myc expression in their PBMC. These results demonstrate the presence of activated PBMC in patients with primary SS and delineate some of the mechanisms that are involved at the molecular level. We speculate that increased c-myc expression may represent an early permissive event in the progression toward neoplasia in these patients.

Clinical usefulness of prostate-specific antigen and prostatic acid phosphatase in patients with prostatic cancer

Serum prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) levels were measured in 70 patients with benign prostatic hypertrophy (BPH) and in 70 patients with prostatic cancer. PSA was increased above the cutoff level of 10 ng/ml in 13% of patients with BPH and in 87% of patients with prostatic cancer. In contrast, abnormal PAP levels were found in 14 and 76% of patients, respectively. We concluded that, due to its high specificity, PSA is a useful marker in the management of patients with prostatic carcinoma and that it surpasses PAP in this regard.

MCA in patients with breast cancer: correlation with CEA and CA15-3

MCA serum levels were determined in 27 healthy subjects, 136 with benign pathology (42 breast) and in 289 patients with cancer (247 active). The last group includes 223 patients with breast cancer (96 without metastases, 89 with metastases and 38 no-evidence of disease). CEA and CA15-3 serum levels were determined in all the patients with breast diseases. The mean levels of MCA were 4.7 + 2.4 U/ml in the control group, considering less than 11 U/ml as normal. MCA values were abnormal in 15.4% of patients with benign pathology, mainly in those with liver cirrhosis (8/20) and lung diseases (4/20). In the majority of these cases, the rise was only moderate, lower than 15 U/ml in 97.5% of patients. In malignant diseases, important increments were found in breast cancer (19.8% Mo, 77.5% M1) and ovarian cancer stages III-IV (44.4%). When we compared MCA serum levels with CA15-3 and CEA in breast pathology, a similar specificity was observed: 92.3%, 92.3% and 100% in cases with benign pathology and 92.1%, 94.7%, and 97.4% in NED patients, respectively. MCA and CA15-3 sensitivity was similar in breast cancer without metastases (19.8%) and lower for CEA (16.7%). In patients with breast cancer without metastases, we found a relation between positivity of these tumor markers and prognostic factors (tumor size, nodal involvement). The disease free interval in patients with locoregional breast cancer was shorter in cases with abnormal presurgical levels of some of the tumor markers, but only the difference from MCA was significant (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

[Normal term placentae: type of collagen and its disposition around fetal blood vessels detected with the Picro sirius technique]

The chorionic villi tissue of normal term human placentae is made of a highly fibrous extracellular matrix. An increasing amount of fibrous tissue is seen as gestation advances, phenomenon referred as organ aging. Electron microscopy reveals many collagen fibrils close to fibroblasts between the trophoblast and the fetal capillary vessels. A characteristic 67 nm transverse striation produced by the intermixing of tropocollagen and collagen types 1 and 3 is observed. Picrosirius staining under polarized light allowed us to detect abundant type 1 collagen fibers. These were randomly distributed in the stroma but concentrically order around the blood vessels.

Ectomycorrhizal mediation of competition between coniferous tree species

To test the effect of ectomycorrhizal fungi (EMF) on interactions between host plants, Pseudotsuga menziesii (Mirb.) Franco and Pinus ponderosa Dougl. ex. Laws., seedlings were grown in replacement series in pasteurized soil with (a) no EMF added, (A) two EMF species added - Rhizopogon vinicolor Smith (specific to Douglas-fir) and R. ochraceorubens Smith (specific to pine), and (c) tour EMF species added - the two Rhizopogon species plus two host generalists, Laccaria laccata (Scop, ex Fr.) Bk. & Br, and Hebeloma crustuliniforme (Bull.) Quel. A replacement series in unpasteurized forest soil also was included. Seedlings without added EMF were colonized by the greenhouse contaminant, Thelephora terrestris. Without added EMF (but with T. terrestris), the tree species mutually inhibited one another, producing Relative Yield Totals significantly < 1; with EMF added, mutual inhibition disappeared. With four EMF species added, Pseudotsuga menziesii seedlings were significantly larger in mixture than in monoculture, with no corresponding decrease in the size of Pinus ponderoso seedlings; this was due solely to seedlings with L. laccata, which apparently enhanced nitrogen (N) and phosphorus (P) uptake by Pseudotsuga menziesii at the expense of luxury consumption by Pinus ponderosa. Graphical analysis suggested that better growth of Pseudotosuga menziesii in mixture with EMF added was related to improved P nitrogen. Both N and P nutrition of Pinus ponderosa was better in mixture with two than no EMF species added; there was no clear nutrient effect with four EMF species added. Results indicate that EMF can reduce competition between plant species and perhaps increase overall community P uptake. However, patterns were specific to both EMF and tree species and were quite different in unpasteurized soils. Hence generalizations about the effects of EMF on plant-plant interactions must be made cautiously.

Monthly injectable steroid contraceptives and cervical carcinoma

The World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives is a large multinational hospital-based case-control study of steroid contraceptives and gynecologic, hepatobiliary, and mammary neoplasms. Monthly injectable steroid contraceptives which contained the long-acting progestogen dihydroxyprogesterone acetofenide plus a shorter-acting estrogen (usually estradiol enanthate) were used by women in two of the countries (Chile and Mexico) from which data were collected. In preliminary analyses of data from Chile (1979-1983), a strong association was observed between use of these products and invasive cervical cancer. Therefore, three additional data sets from these two countries were analyzed in further detail for this report. Analyses of additional data from Chile on invasive cervical cancer (1983-1985) and cervical carcinoma in situ (1979-1986) and of data on invasive cervical cancer from Mexico (1979-1986) failed to confirm the initially observed association. The original finding was probably due to chance, but a causal interpretation cannot be confidently ruled out, and additional studies are warranted.

Alpha-fetoprotein in the early diagnosis of hepatocellular carcinoma

Increased AFP levels in patients with hepatocellular carcinoma are mainly related to tumor size and in a lesser degree, to AST levels. Abnormal and/or diagnostic AFP levels will be observed in a reduced proportion of patients with small HCC (less than 5 cm). Therefore, AFP measurement is of little value in the early detection of HCC.

Luteal cytoplasmic estradiol and progesterone receptors in human endometrium: in vitro fertilization and normal cycles

Luteal cytoplasmic estradiol (E2) and progesterone (P) receptor levels were measured from the 22nd to the 25th days of the menstrual cycle in endometrial samples obtained from seven patients in an in vitro fertilization (IVF) program who received no embryo replacement after ovarian stimulation with clomiphene citrate/human menopausal gonadotropin/human chorionic gonadotropin, and from seven normally menstruating women. Serum levels of E2, P, follicle-stimulating hormone, luteinizing hormone, and prolactin (PRL) were measured in blood samples collected at the time of biopsy. The E2 (P less than 0.01) and PRL (P less than 0.001) levels were higher in stimulated than in spontaneous cycles. The level of cytoplasmic P receptor was decreased in endometrium in stimulated cycles, but cytoplasmic E2 receptor remained unchanged. These alterations in the luteal phase of cytoplasmic P receptor in the endometrium could be involved in the low rate of success following the IVF program.

[Immaturity of syncytial trophoblast in maternal malnutrition. Ultrastructural analysis]

We studied the placental membrane at term in normal females and females with malnutrition not related to associated pathologic processes of pregnancy. Both groups belonged in the low socioeconomic stratum. The fetal aspect of placenta from malnourished females showed signs of immaturity in relation to gestational age, as evidenced by transitional cytotrophoblastic cells in different stages of maturation. The latter appear as a third intermediata layer between cytothropoblast and syncitiotrophoblast.

Empyema caused by Kingella denitrificans and Peptostreptococcus spp. in a patient with bronchogenic carcinoma

Empyema caused by Kingella denitrificans and Peptostreptococcus spp. was diagnosed in a patient with bronchogenic carcinoma. This appears to be the third report providing evidence of a pathogenic role for K. denitrificans, and the first concerning infection in the pleural space and in a patient with underlying immunosuppressive disease. K. denitrificans should be added to the list of fastidious gram-negative bacteria associated with opportunistic infections in the compromised host.

Empyema caused by Kingella denitrificans and Peptostreptococcus spp. in a patient with bronchogenic carcinoma

Empyema caused by Kingella denitrificans and Peptostreptococcus spp. was diagnosed in a patient with bronchogenic carcinoma. This appears to be the third report providing evidence of a pathogenic role for K. denitrificans, and the first concerning infection in the pleural space and in a patient with underlying immunosuppressive disease. K. denitrificans should be added to the list of fastidious gram-negative bacteria associated with opportunistic infections in the compromised host.

Transitional cell carcinoma of the urethra in men after radical cystectomy for bladder cancer. Is prophylactic urethrectomy indicated?

A retrospective study of the incidence and clinical course of transitional cell carcinoma of the urethra is reported. Of 110 consecutive male patients who underwent cystectomy during a 9-year period, 9 had or developed a urethral tumour. Five patients undergoing radical cystectomy had known or suspected urethral involvement which was confirmed at urethrectomy. All 5 had deeply invasive (T3 or T4) transitional cell carcinomas of the bladder and subsequently died of metastatic disease. Four patients underwent urethrectomy because of signs or symptoms of urethral recurrence at an average interval of 2.5 years after cystectomy. There were two deaths in this group, neither of which appeared to be due to urethral recurrence. Six additional patients had undergone prophylactic urethrectomy because of prostatic urethral involvement or diffuse carcinoma in situ in the cystectomy specimen, and none had identifiable tumour in the anterior urethra. The residual urethra is a potential focus for recurrent tumour and this necessitates careful follow-up with serial cytology, but the low incidence of urethral recurrence (3.5% in this series) does not appear to warrant routine urethrectomy at the time of cystectomy.

Oral contraceptives and cervical carcinoma in situ in Chile

A case-control study of cervical carcinoma in situ was conducted in Santiago, Chile, to determine whether risk of this condition is altered by use of oral contraceptives. Responses to a standardized questionnaire were compared in 133 hospitalized cases and 254 age-matched controls selected from the same screening program through which the cases were detected. After controlling for the possible confounding influence of a variety of indices of sexual behavior, socioeconomic status, and prior cytological smears, no increase in risk was found in women who ever used oral contraceptives. No trend of increasing or decreasing risk was seen in relation to duration of use, up to more than 6 years of exposure, or with the passage of time from either initial or most recent exposure. An observed increase in risk in current users of oral contraceptives was not considered likely to represent a causal relationship.

Expression of genes for platelet-derived growth factor in adult human venous endothelium. A possible non-platelet-dependent cause of intimal hyperplasia in vein grafts and perianastomotic areas of vascular prostheses

Neointimal fibromuscular hyperplasia (NFH) in vein grafts and perianastomotic zones of vascular prostheses has been attributed to the effects of platelet-derived growth factor (PDGF) released by platelets interacting with bypass conduits. But inhibition of platelet aggregation often fails to prevent NFH, and recurrent growth of intact, platelet-free endothelium over perianastomotic areas where NFH occurs is inconsistent with the concept of sustained PDGF release from platelets causing NFH progression at late times after surgical procedures. Cultured bovine aortic endothelial cells (ECs) and human umbilical vein ECs have been shown to release a PDGF-like molecule. We report that confluent cultured fourth passage adult human saphenous vein ECs (AHSVECs) grown in the presence of heparin (100 micrograms/ml) and retina-derived growth factor (RDGF) studied by Northern blotting transcribed a messenger ribonucleic acid (mRNA) of 3.9 kb, strongly hybridizing to PDGF B chain probes, and two species of 2.0 and 2.6 kb hybridizing to PDGF A chain probes. Withdrawal of RDGF and heparin from these cultures for 48 hours before mRNA extraction amplified the scanning densitometric mRNA signal per cell by 8.0 +/- 7.6 fold (mean +/- SD) (N = 4 cultures) for B chain mRNA and 5.2 +/- 3.6 fold (N = 3 cultures) for A chain mRNA. In addition, AHSVEC cultures released a PDGF-like substance, because 50% vol/vol AHSVEC-conditioned serum-free medium increased tritiated thymidine uptake elevenfold in PDGF receptor-bearing 3T3 cells whereas an excess (50 micrograms/ml) of nonspecific goat anti-human-PDGF antibody significantly reduced this increase by a mean of 30% to 7.0 +/- 3.4 fold (N = 6 trials, p less than 0.001). Flow cytometry determined AHSVEC cultures to be proliferating with a mean of 6.2% +/- 1.9% (N = 3 culture lines) of ECs in S phase even at confluence when deprived of EC mitogens for 48 hours. Adult human ECs, which proliferate on bypass conduits and host vessels after perioperative injury, may play a role in causing NFH by stimulating proliferation of adjacent smooth muscle cells. Prevention of NFH may require not only antiplatelet agents but also ways to prevent EC release of smooth muscle cell mitogens in response to perioperative EC injury.

Seasonal changes in the activities of glycolytic enzymes from liver and skeletal muscle of Rana perezi

Glycogen phosphorylase (GP), Hexokinase (HK), Phosphofructokinase (PFK), Pyruvate kinase (PK) and Lactate dehydrogenase (LDH) activities from skeletal muscle and liver were measured in Rana perezi for the four seasons of the year. Skeletal muscle showed a decrease in PFK, PK and LDH activity during winter and summer. Liver displayed an increase in GP activity in spring and in PK and LDH in autumn.

Diagnostic interest of the monoclonal antibody CA1 in malignant pleural effusion

The Ca1 antibody was used in an immunohistochemical procedure on smears of cells from 40 patients with malignant pleural effusion. The control group consisted of 25 benign pleural effusions with a high percentage of reactive mesothelial cells. The Ca1 Mc Ab was positive in 19 (79%) of the 24 pleural effusions with positive malignant cytology. In all the benign cases the Ca1 Mc Ab was negative (100% specificity). The Ca1 Mc Ab detected malignant mesothelial cells in two cases and was negative with reactive mesothelial cells and other nucleated cells present in the pleural effusion. We conclude that the Ca1 antibody offers a useful diagnostic method for malignant pleural effusions, when the morphological interpretation is doubtful.

Use of charcoal hemoperfusion with sequential hemodialysis to reduce serum methotrexate levels in a patient with acute renal insufficiency

Acute renal failure induced by methotrexate can be complicated by prolonged high serum levels of methotrexate, resulting in pancytopenia and severe mucositis. The role of dialysis in these patients has not been well elucidated. Serum methotrexate levels were successfully lowered in a patient with methotrexate-induced acute renal failure by charcoal hemoperfusion and sequential hemodialysis. No rebound in serum methotrexate levels was observed after perfusion, a phenomenon previously reported as limiting the usefulness of this procedure.

Continuous arterio-venous ultrafiltration in cirrhotic patients with ascites or renal failure

To assess whether continuous arteriovenous ultrafiltration (CAVU) might constitute a useful alternative to hemodialysis in the management of patients with advanced liver failure, we carried out CAVU in 3 patients with decompensated Laennec's cirrhosis. CAVU was utilized in two patients with acute renal failure and pulmonary edema to stabilize renal function and facilitate administration of large amounts of fluid. In the third case, CAVU was successfully utilized to mobilize fluid in a patient refractory to conventional diuretic regimens. We conclude that CAVU may constitute an appropriate alternative to traditional hemodialysis in patients with advanced liver disease and renal functional impairment.

New method for quantitative evaluation of esophageal sensibility

A method for quantitating esophagus sensibility by an electric stimulation test is described. Square stimulus waveform at different voltages and durations were transmitted to the esophagus, three series of electric stimuli being used in successive durations (0.5, 1, 2, 4, 8 and 16 ms); in each series the voltage discharge was increased progressively from 0 mV, until the subject noted the first sensation. This procedure was carried out at all esophageal levels. The following parameters were analyzed: sensitive threshold along the esophagus; the relation of threshold sensibility (mV) duration of stimulus (ms), and reobase and cronaxia for each esophageal level. At all esophageal levels, the sensitive threshold was regular and coherent; in the middle esophagus a zone was found having higher sensitive threshold than the proximal and distal esophageal zones. The relationship between sensitive threshold and inverse of the stimulus duration indicated that esophageal sensibility follows the basic law of excitation of WEISS, at least with this type of stimulus, reobase and cronaxia being representative of the sensibility threshold along the esophagus. Quantitative esophageal sensibility, therefore is concluded to be particularly suited to evaluation by electric stimulation.