Flow Cytometry Role of DNA Analysis

We analyzed the results obtained by flow cytometry DNA analysis in prostatic cancer. We considered the diagnostic role of this investigation and the prognostic value observed from correlating the DNA analysis with usual diagnostic and prognostic factors such as staging, grading, PSA, size, etc. Results in literature suggest that further studies are necessary to explain both the biological and cytometrical heterogeneous aspects of this neoplasm.

Controversy regarding Diagnosis and Staging of Prostatic Carcinoma: The Role of Rectal Exploration and Imaging Methods

Although rectal examination (RE) represents the most utilized diagnostic tool, its reliability is limited by the large number of false positive results (low sensitivity) which” limit its use as a screening method. Transrectal ultrasound (TRUS) is very useful in the diagnosis of prostatic neoplasms, as the hypoechoic lesions are very likely to be cancerous and should be biopsied. Nevertheless tumoral hypoechogenicity is not specific and at most only 1 of 3 hypoechoic areas in the peripheral and central zones will prove to be cancer. Of palpable stage B cancers in the peripheral and central zones, 21% are reported to be isoechoic. Moreover cancers that arise in the transitional zone cannot ever be detected as hypoechoic tumors because of the heterogenic echo texture of this zone filled with diffuse hypoechoic nodules of BPH. The integration between RE, TRUS and PSA improves diagnostic accuracy. As far as neoplasm staging is concerned the proper evaluation of the Gleason score and spatial distribution of the tumor are referred by some authors to be assured only by means of “systematic” biopsies of the two prostatic lobes, independently of the echographic support. RNM and CT do not assure a better diagnostic or staging reliability, while endorectal RM is considered to afford, in comparison with TRUS, a better visualization of periprostatic structures and therefore a more reliable evaluation of neoplastic extracapsular extension.

Functional analysis of Mel-14+ and Mel-14- early precursor cells in the adult mouse thymus

The earliest T-cell precursor population in the adult mouse thymus (low CD4 precursors) may be divided into 85% of cells expressing surface Mel-14 (LECAM-1, the lymphocyte homing receptor) and 15% of cells which are Mel-14. To date, this is the only surface marker for which we have found this population to be heterogeneous. The precursor activity of the Mel-14+ and Mel-14- subpopulation was assessed by both intrathymic and intravenous transfer of sorted cells into Ly5 congenic irradiated recipient mice. On both a cell-for-cell and a total activity basis, almost all precursor activity was associated with the Mel-14+ cells. No segregation was seen between T-cell, B-cell and dendritic cell precursor activity of the low CD4 population, all activities being concentrated in the Mel-14+ fraction. This strengthens the hypothesis that one precursor cell has the potential to form all three lineages.

The Endoscopy and Endourology registers

Computerised archives of endoscopic and endourologic procedures can be obtained by a common data base. Computerised archives are significantly advantageous compared to traditional filing methods if they succeed in achieving the following aims: improvement of data registration, automatic description of the procedures, fast searches of data for clinic and scientific purposes.

The use of clinical parameters in an interactive statistical package to predict pathological features associated with local failure after radical prostatectomy for prostate cancer

The capability of an interactive statistical package (ISP) to predict the patients whose pathologic findings at the time of radical prostatectomy for prostate cancer would require postoperative radiation therapy to prevent local failure is investigated. A retrospective review of the clinical pretreatment factors and pathologic findings of 174 patients with adenocarcinoma of the prostate treated from 1989 to 1993 with radical retropubic prostatectomy was performed and served as a knowledge base of the ISP. The pathologic findings of seminal vesicle involvement, gross transcapsular disease, and positive surgical margins are defined as outcomes associated with a high risk of local failure after radical prostatectomy and, thereby, requiring postoperative radiation therapy to decrease this risk. By using the pretreatment clinical factors including prostate-specific antigen (PSA), Gleason score, clinical stage, and endorectal magnetic resonance imaging (MRI) findings as input to the ISP, patients are identified from a test group of 50 cases with known pathologic outcome who would require postoperative radiotherapy to decrease local failure. Low- (0% to 33%), intermediate- (34% to 67%), and high-risk groups (68% to 100%) for pathologic features associated with local failure were predicted accurately (r > .95) by the ISP for the 50 test cases. Factors identified on univariate analysis by the ISP as significant predictors of local failure postoperatively include PSA > 20 (p < .001), clinical stage (p < .001), MRI finding of gross transcapsular disease (p < .001), MRI finding of seminal vesicle involvement (p < .001), and Gleason score (p < .003).(ABSTRACT TRUNCATED AT 250 WORDS)

Prostatic-specific antigen doubling times in patients with prostate cancer: a potentially useful reflection of tumor doubling time

PURPOSE

This study was undertaken to investigate the relationship of prostatic specific antigen doubling time with disease progression in irradiated patients whose only sign of failure was an abnormal prostatic specific antigen.

METHODS AND MATERIALS

Post irradiation patients whose only sign of failure was an elevated prostatic specific antigen were followed without treatment. The prostatic specific antigen doubling time was determined and compared to original characteristics of disease, time to elevation of prostatic specific antigen after treatment and time to a second sign of failure.

RESULTS

The prostatic specific antigen doubling times varied from 1.2 months to 36 months. The original grade and stage correlated with the doubling time as did the intervals to elevation of prostatic specific antigen and to a second sign of failure.

CONCLUSION

We recommended delaying intervention until the prostatic antigen doubling time can be calculated for patients with prostatic specific antigen elevation as the only sign of failure. Patients with short doubling times (< 9 months) can be promptly treated while those with longer doubling times (> 1 year) may have androgen suppression delayed avoiding the cost and morbidity of that treatment.

[The complications of lumbotomies]

After having described the surgical anatomy of the lumbar region, with particular regard to the relationships with pleura and peritoneum, as well as to the course of the nervous structures of the region (12th intercostal, ileohypogastric and ileoinguinal), the authors describe the possible complications related with the surgical approaches to the lumbar region. Pathogenesis of post-operatory pains and parietal hypotonies is especially evaluated; these complications may be caused by section, ligature or compression of one or more nervous trunks. The authors conclude that the respect of the anatomic structures located in the lumbar region represents the best way in order to prevent most complications related to lumbotomies.

[Transitory postoperative anuria after transvesical prostatic adenomectomy: review of the literature, description of new clinical cases and physiopathological considerations]

Anuria is a rare complication after prostate adenomectomy. Three cases of complete bilateral anuria and one case of monolateral anuria are reported following transvesical prostate adenomectomy, characterized by immediate onset without any apparent cause and by spontaneous resolution within 48 hours. After a thorough review of the literature, the authors analyze the pathophysiological and clinical aspects of post-prostate-adenomectomy anuria and postulate an "obstructive" aetiology for the anuria cases observed in their series.

Imaging for deep venous thrombosis

The diagnosis of DVT is a perplexing clinical challenge for the emergency physician. The algorithm depicted in Figure 9 from Hobson et al represents a logical strategy for the application of noninvasive studies. Positive studies in the proper setting that are reliably interpreted can dictate anticoagulant therapy, but equivocal or uninterpretable tests must be followed by invasive testing to exclude clot. Negative tests require close follow-up and serial evaluation to detect potentially silent early clot formation.

Extracorporeal lithotripsy to remove ureteral stent calcifications

In this report the Authors present their experience regarding two cases of calcification of the renal end of a ureteral double J catheter treated by ESWL. The shock waves can easily fragment this type of calcification: for this reason ESWL represents the treatment of choice of such complications.

Stones in horseshoe kidney treated by ESWL

In this report the Authors present their experience regarding 11 patients (in all 12 renal units) with stones in horseshoe kidney treated by ESWL. Horseshoe kidney is a frequent malformation that in about one out of five cases is complicated by lithiasis with a marked tendency to recurrence. In these cases, because of anomalous seat, rotation and vascularization, percutaneous lithotripsy appears to be dangerous. 66.6% of treated renal units were stone-free after one or more treatments (maximum 3). The lithotriptor was a Dornier MFL 5000. On the basis of these data ESWL represents the treatment of choice for stones with dimensions less than 25 mm in horseshoe kidney.

[Lipoma of the hypopharynx: role of computerized tomography in the diagnosis protocol]

A case of hypopharyngeal lipoma is reported and the fundamental role of C.T. in the diagnosis of laryngo-pharyngeal neoplastic pathologies is emphasized. Laryngoscopy made it quite easy to detect the lesion, showing the smooth surface of a large tumor, although it proved difficult to explore the lower portion because of the narrowing of the larynx. Thermography showed a hypothermia area in the right neck region but did not offer any further information. Only C.T. made correct identification of the site and extension of the lesion possible. It was also possible to identify its fat composition, as suggested by the typical density pattern. The tumor presented a homogeneous hypodense structure and its limits were well defined throughout their entire extension. Furthermore, it was possible to rule out any macroscopic infiltration of the adjacent cartilaginous surfaces of the larynx. The latter feature was confirmed by the C.T. images obtained after intravenous administration of an iodine contrast medium and was consistent with the hypothesis of a benign lesion. Thus the lesion could be considered a lipoma; a highly uncommon non-epithelial tumor of the hypopharyngeal region but which occurs more frequently than liposarcoma. Nonetheless, such C.T. tissue characterization requires histological support so as to prevent distinguishing a well differentiated liposarcoma only after recurrence. The greatest likelihood for accurate diagnosis lies in complete utilization of the data derived from the entire diagnostic procedure. The direct laryngoscopy of the lesion is very important as it makes it possible to inspect the surface and first evaluate any anatomo-pathological alterations. Nonetheless, the most extensive information is provided by C.T.(ABSTRACT TRUNCATED AT 250 WORDS)

Nature of the thymocytes associated with dendritic cells and macrophages in thymic rosettes

Thymic rosettes, structures consisting of 3-30 thymic lymphoid cells attached to a central macrophage or dendritic cell, were released from mouse thymus tissue by collagenase digestion. They were shown to be preexistent structures within the thymus, but to be subject to extensive exchange with free thymocytes under certain conditions. An isolation procedure was developed, using a new technique of zonal unit-gravity elutriation, which minimized exchange and produced a completely pure sample of the larger rosettes. The rosette-associated thymocytes were analyzed by two- and three-color immunofluorescent staining and flow cytometry. The dominant cell type was a small, CD4+CD8+, cortical-type thymocyte. However, all of the established thymus subpopulations defined by CD4 and CD8, including CD4-CD8+ and CD4+CD8- mature thymocytes and CD4-CD8- early thymocytes, were also present in rosettes. Very few of the cells present were of an intermediate or transitional phenotype. Rosette-associated thymocytes were somewhat enriched in large dividing thymocytes, in CD4-CD8- thymocytes, and in mature thymocytes expressing the T-cell antigen receptor-CD3 complex. Their most striking characteristic was a marked depletion in small thymocytes lacking surface H-2K expression, a major population among free thymocytes. The physiological role of the rosette structure is discussed, and it is suggested that the heterogeneity of the associated thymocytes in part reflects the existence of different types of rosettes in different areas of the thymus.

Sensorineural hearing loss in chronic otitis media

A statistical study was done on the sensorineural component in hearing loss, using 595 patients suffering from Chronic Otitis Media (COM); of these, 195 with monolateral COM were taken into consideration. They presented criteria of valuation which excluded other possible causes of sensorineural hearing loss, such as exposure to acoustic trauma, ototoxic drugs, cardiovascular disease, past head injury and hereditary causes. The contralateral (healthy) ear served as a control. We determined the average sensorineural component in the hearing losses in relation to the age of onset and duration of the disease, examining it in relation to other eventual aural complications such as cholesteatoma. On the basis of the data obtained, we believe that the sensorineural component in hearing loss does not change with respect to the age of onset of COM, but the duration of COM does exert a significant influence.

Developmental status and reconstitution potential of subpopulations of murine thymocytes

In this chapter we have summarized our view of the subsets of murine CD4- CD8- thymocytes which can be identified with a range of monoclonal antibodies. We have shown the division rate and turnover time of the main subsets and have listed what we know of the TcR gene rearrangement, and expression at the RNA and protein levels. We have been unable to completely segregate gamma delta-TcR-expressing cells from alpha beta-TcR-expressing cells by any of the markers we have used, although the proportions of the two receptor forms vary widely in the different subsets. Experiments involving intrathymic transfer of the CD4- CD8- subsets are described, which indicate that all the TcR- subsets of the CD4- CD8- thymocytes display some precursor activity and which suggest a progression of at least five stages through the TcR- subpopulations of CD4- CD8- cells. The earliest precursor is a Thy 1 low, HSA low, Pgp-1 high cell which has unrearranged C beta and is non-dividing and which closely resembles the bone marrow prothymocyte. The later precursors are Thy 1 high, HSA high, Pgp-1 low, have rearranged C beta and are rapidly dividing. We tentatively conclude that none of the TcR+ CD4- CD8- cells are precursors of the major thymocyte subsets or of typical peripheral T cells, and we have found no evidence so far of separate precursors for the different mature subsets of thymocytes or peripheral T cells.

Subpopulations of early thymocytes. A cross-correlation flow cytometric analysis of adult mouse Ly-2-L3T4-(CD8-CD4-) thymocytes using eight different surface markers

Putative early thymocytes, the Ly-2-L3T4-(CD8-CD4-) cells representing 3 to 4% of adult CBA mouse thymic lymphocytes, were isolated in high purity (99.5%). They were then stained by using mAb and analyzed by flow cytometry for the expression of six additional surface antigenic markers. Cross-correlation of the data obtained from a complete series of successive two-parameter analyses revealed the existence of about 11 discrete subsets, falling into four-main groups, within the Ly-2-L3T4- population. All subsets consisted of relatively large lymphoid cells. The most numerous group of Ly-2-L3T4- cells was Ly-1 low B2A2-M1/69 high Thy-1 high Pgp-1 low and by these markers resembled Ly-2+L3T4+ cortical blasts. Many of the cells in this group were positive for the IL-2R and/or for MEL-14. A second major group of Ly-2-L3T4- cells was Ly-1 high B2A2-M1/69 low Pgp-1 high, and resembled in some respects activated mature T cells. This group had previously been shown to be absent from the embryonic thymus. The group could be divided into Thy-1 high and Thy-1 low subsets. None of the cells in this group were positive for the IL-2R and very few expressed MEL-14. A third group, 13% of the Ly-2-L3T4- population, was Ly-1 low B2A2-M1/69 low Pgp-1 high, and could also be divided into Thy-1 high and Thy-1 low subsets. A final minor group, 9% of the Ly-2-L3T4- population, was Ly-1 high B2A2-M1/69 high Pgp-1 low Thy-1 high. The particular pattern of markers on these subsets, combined with subsequent information on their properties, makes it unlikely that they all represent sequential steps in one continuous developmental stream, and indicates that complex developmental steps have occurred, even at this supposedly early stage of T cell differentiation.

Subpopulations of early thymocytes. A cross-correlation flow cytometric analysis of adult mouse Ly-2-L3T4-(CD8-CD4-) thymocytes using eight different surface markers

Putative early thymocytes, the Ly-2-L3T4-(CD8-CD4-) cells representing 3 to 4% of adult CBA mouse thymic lymphocytes, were isolated in high purity (99.5%). They were then stained by using mAb and analyzed by flow cytometry for the expression of six additional surface antigenic markers. Cross-correlation of the data obtained from a complete series of successive two-parameter analyses revealed the existence of about 11 discrete subsets, falling into four-main groups, within the Ly-2-L3T4- population. All subsets consisted of relatively large lymphoid cells. The most numerous group of Ly-2-L3T4- cells was Ly-1 low B2A2-M1/69 high Thy-1 high Pgp-1 low and by these markers resembled Ly-2+L3T4+ cortical blasts. Many of the cells in this group were positive for the IL-2R and/or for MEL-14. A second major group of Ly-2-L3T4- cells was Ly-1 high B2A2-M1/69 low Pgp-1 high, and resembled in some respects activated mature T cells. This group had previously been shown to be absent from the embryonic thymus. The group could be divided into Thy-1 high and Thy-1 low subsets. None of the cells in this group were positive for the IL-2R and very few expressed MEL-14. A third group, 13% of the Ly-2-L3T4- population, was Ly-1 low B2A2-M1/69 low Pgp-1 high, and could also be divided into Thy-1 high and Thy-1 low subsets. A final minor group, 9% of the Ly-2-L3T4- population, was Ly-1 high B2A2-M1/69 high Pgp-1 low Thy-1 high. The particular pattern of markers on these subsets, combined with subsequent information on their properties, makes it unlikely that they all represent sequential steps in one continuous developmental stream, and indicates that complex developmental steps have occurred, even at this supposedly early stage of T cell differentiation.