Gene transfer of human heme oxygenase into coronary endothelial cells potentially promotes angiogenesis

Heme oxygenase (HO-1) is a stress protein that has been suggested to participate in defense mechanisms against agents that induce oxidative injury such as hemoglobin/heme, hypoxia-ischemia and cytokines. Overexpression of HO-1 in endothelial cells (EC) might, therefore, protect against oxidative stress produced under these pathological conditions, by generation of CO, a vasodilator, and bilirubin, which has antioxidant properties that enhance blood vessel formation to counteract hypoxia-induced injury. A plasmid containing the cytomegalovirus promoter (pCMV) neomycin human HO-1 gene complexed to cationic liposomes, lipofectin, was used to transfect rabbit coronary microvessel EC. Cells transfected with human HO-1 gene demonstrated a twofold increase in HO activity and maintained a similar phenotype as in the nontransfected cells. Cell number in transfected cells with human HO-1 gene increased by about 45%, as compared to nontransfected or those transfected with control pCMV. Transfected and nontransfected EC revealed a similar response to basic fibroblast growth factor (bFGF) in capillary formation. However, transfected cells with the human HO-1 gene exhibited a twofold increase in blood vessel formation. The angiogenic response of EC to overexpression of HO-1 gene provides direct evidence that the inductive form of HO-1 following injury represents an important tissue adaptive mechanism for moderating the severity of cell damage produced in inflammatory reaction sites of hemorrhage, thrombosis and hypoxic-ischemia. Thus, HO-1 may participate in the regulation of EC activation, proliferation and angiogenesis.

Gene transfer of human heme oxygenase into coronary endothelial cells potentially promotes angiogenesis

Heme oxygenase (HO-1) is a stress protein that has been suggested to participate in defense mechanisms against agents that induce oxidative injury such as hemoglobin/heme, hypoxia-ischemia and cytokines. Overexpression of HO-1 in endothelial cells (EC) might, therefore, protect against oxidative stress produced under these pathological conditions, by generation of CO, a vasodilator, and bilirubin, which has antioxidant properties that enhance blood vessel formation to counteract hypoxia-induced injury. A plasmid containing the cytomegalovirus promoter (pCMV) neomycin human HO-1 gene complexed to cationic liposomes, lipofectin, was used to transfect rabbit coronary microvessel EC. Cells transfected with human HO-1 gene demonstrated a twofold increase in HO activity and maintained a similar phenotype as in the nontransfected cells. Cell number in transfected cells with human HO-1 gene increased by about 45%, as compared to nontransfected or those transfected with control pCMV. Transfected and nontransfected EC revealed a similar response to basic fibroblast growth factor (bFGF) in capillary formation. However, transfected cells with the human HO-1 gene exhibited a twofold increase in blood vessel formation. The angiogenic response of EC to overexpression of HO-1 gene provides direct evidence that the inductive form of HO-1 following injury represents an important tissue adaptive mechanism for moderating the severity of cell damage produced in inflammatory reaction sites of hemorrhage, thrombosis and hypoxic-ischemia. Thus, HO-1 may participate in the regulation of EC activation, proliferation and angiogenesis.

Lymphoid myelofibrosis associated with high grade B cell lymphoma of the liver: morphological, cytogenetic, and clinical features

Severe pancytopenia associated with moderate hepatosplenomegaly, increased serum lactic dehydrogenase (LDH) levels, and hypogammaglobulinemia were found in a young male patient. Bone marrow histology showed extensive fibrosis, hypoplasia of erythro- and granulocytopoiesis, and hyperplasia of megakaryocytopoiesis associated with histiocytic fat cell phagocytosis and infiltration of abnormal lymphocytes, compatible with lymphoid myelofibrosis. Striking chromosomal aberrations indicating karyotype evolution were also demonstrated by cytogenetic analyses (47, XY, +3 / 47, XY, +3, 1p+ / 46, XO, +3, 1p+, -Y). The clinical course was characterized by cyclic febrile episodes accompanied by excessive increase of serum LDH levels and leukocyte counts, and decrease of platelet counts, followed by spontaneous regression. Further diagnostic procedures, including two liver biopsies and computed tomography, did not detect any manifestation of lymphoma. Eventually, the patient developed rapidly progressive, lethal pulmonary aspergillosis. At autopsy, high grade B cell lymphoma of the liver was found. In this case, the lymphoid myelofibrosis seen on bone marrow biopsy may be considered as a manifestation of "discordant" bone marrow histology related to high grade lymphoma. With respect to the cyclic clinical course, a possible role of apoptotic mechanisms in the physiopathology of this disorder is reviewed.

Holmium: YAG laser-induced aseptic bone necroses of the femoral condyle

In laser-controlled cartilage-ablation arthroplasties, the attention focuses more and more on the depth effects of the various lasers, especially as heat necroses of the cartilage and even in places of the bone were found in animal experiments. For the first time, two cases of holmium: YAG laser-induced aseptic bone necrosis of the femoral condyles after cartilage ablation are described.

GM-CSF activates regenerative epidermal growth and stimulates keratinocyte proliferation in human skin in vivo

Granulocyte/macrophage-colony-stimulating factor (GM-CSF), an immunomodulator of hematopoietic cells, has also been shown to stimulate human keratinocyte proliferation in vitro and speed healing of wounds in the skin of lepromatous leprosy patients. In this study we have examined the in vivo effects of recombinant human GM-CSF on epidermal keratinocyte proliferation and on expression of proteins marking regenerative epidermal growth. Skin biopsies from GM-CSF injected cutaneous sites were obtained between 1 and 6 d following administration of 7.5 or 15 micrograms of the growth factor. Activation of keratinocyte proliferation, quantified as the expression of the Ki67+ nuclear antigen, was noted 1 d following GM-CSF administration. A regenerative epidermal phenotype, demonstrated by immunohistochemical staining of cellular proteins involucrin, filaggrin, and keratin 16, was similarly noted as early as 1 d following GM-CSF injection. This phenotype persisted as late as 6 d post-injection. These results suggest that GM-CSF injection into human skin induces keratinocyte proliferation as well as regenerative differentiation of the epidermis. To date no other cytokine has been shown to be mitogenic for human keratinocytes both in vivo and in vitro or to alter keratinocyte differentiation along the "alternate" or regenerative pathway.

Brucellosis: differential diagnosis of acute abdominal pain

A 34-year-old Turkish woman presented with septic fever, sweats, arthralgia, and abdominal pain. Further examination revealed generalized lymphadenopathy, hepatosplenomegaly, pancytopenia, and multiple caseous granulomas. Microbiological diagnosis revealed Brucella melitensis type 3 as causative agent. This case report demonstrates that abdominal pain can be a symptom in brucellosis, and caseous granulomas may occur. In our mobile society Brucella infection should be considered as possible differential diagnosis in patients with fever, lymphadenopathy, hepatosplenomegaly, and pancytopenia, although human brucellosis is rare in Germany and other Western countries.

Endoscopic ultrasonography in the diagnosis of regional lymph nodes in esophageal and gastric cancer--results of studies in vitro

A total of 90 regional lymph nodes (43 benign/47 metastatic) from 16 surgical resection specimens of patients with esophageal and gastric carcinoma were examined in vitro by endosonography. The validity of endosonographic criteria of lymph node dignity (size, echogenicity, internal echo pattern and margin structure) was assessed using computer-supported B-mode analysis and compared to histopathological results. Of 26 lymph nodes with a diameter of more than 10 mm, 19 were metastatic (72%). The subjective assessment of the internal echo pattern (homogeneity) and the node margins by an experienced observer allowed the diagnosis of metastatic lymph nodes, but there was a high proportion of false positives (52%). Lymph node echogenicity, assessed either subjectively or by computer analysis, did not permit the differentiation between benign and metastatic lymph nodes.

[Endosonography of esophageal cancer. Results of a clinical study and in vitro analysis]

From April 1989 to June 1991 63 patients with esophageal cancer were investigated by endosonography with the object of ascertaining the depth of intrathoracic tumor infiltration and lymphnode involvement. The sensitivity in diagnosing tumor infiltration amount to 0.74; the sensitivity for involvement of regional lymphnode was 0.84, specificity 0.44. In an in-vitro analysis endosonographic criteria for the assessment of regional lymphnodes are proved. Echogenic structure seems not to be a valuable criterium.

[Local excision of rectal tumors. Indications, preoperative diagnosis, surgical technique and results]

Between January 1986 and October 1991 255 patients with rectal tumors were treated by local excision. In 239 patients local excision was performed by transanal endoscopic microsurgery, 16 tumors were removed with the retractor developed by Parks. Operative mortality was 1% in 189 local removed adenomas, complications were observed in two patients (2.1%), local recurrences in seven patients (3.7%). 66 rectal carcinomas were treated by local excision (operative mortality 1%, complication rate 3%). In one of 28 local excised "low risk" T1-carcinomas a recurrence was observed. Five of eleven local treated patients with "high risk" tumors developed a recurrence. Endosonography was of utmost importance in preoperative staging of rectal tumors. Between June 1987 and October 1991 204 patients with rectal tumors (92 sessile adenomas, 30 T1-carcinomas and 82 advanced carcinomas) were examined preoperatively by endosonography. The diagnosis of an adenoma or a T1-carcinoma was made with a sensitivity of 0.9, although no differentiation was possible between adenomas and T1-carcinomas. Results of digital examination were comparable to endosonography, under condition that digital examination was complete. Insufficient information was obtained from the endosonographic detection of lymph-node metastatic spread.

[Obstructive jaundice: its histological diagnosis by percutaneous endoluminal bile duct biopsy]

32 forceps biopsies were performed in 30 patients with obstructive jaundice during percutaneous transhepatic biliary drainage procedures. In one patient an adequate specimen could not be obtained. In 25 of the remaining 31 cases diagnosis was confirmed histologically (malignant tumours: n = 22, benign stricture: n = 3). In 6 patients false-negative results were obtained. Transluminal biopsy is an easily performed adjunct to percutaneous transhepatic diagnostic interventions with minimal additional discomfort for the patient. In many cases percutaneous needle biopsy can be avoided. Forceps biopsy enables nonoperative histological diagnosis of small carcinomas of the bile ducts.

[High-resolution thin-section CT in the preoperative staging of rectal tumors: a comparison with endoluminal sonography and histology]

Rectal carcinomas are amongst the most common malignant tumours. The aim of this work was to determine whether high resolution CT with thin sections (1 mm) can provide satisfactory delineation of perirectal tumour infiltration. Correct determination of local tumour spread was possible in four out of nine patients and distinction between those tumours confined to the rectal wall and those infiltrating the perirectal tissues was possible in four out of eight patients.

[Endosonographic staging of rectal tumors]

Pre-operative staging was performed in 81 patients with rectal tumours by means of endorectal sonography. In 87% of cases (70 out of 81), the endosonographic findings corresponded with the histopathological appearance; the recognition of T0 and 1 tumours, which is important in deciding surgical procedures, was possible in 94% (51 out of 54). Differentiation between T0 and T1 tumours (i.e. between adenomas and carcinomas infiltrating the submucosa) was not possible. Five out of ten of T2 and 14 out of 16 T3 tumours were staged correctly. One T4 tumour was placed in too low a stage. A comparison of the echo structure of adenomas and carcinomas in 76 patients showed that 28 out of 43 adenomas (65%) have homogeneous echoes, while 24 out of 33 carcinomas (73%) showed inhomogeneous low intensity echoes.

[Prevalence of tongue anomalies in children]

The prevalence of grooved tongue, geographic tongue, and ankyloglossia, was investigated in 660 children, 3 to 13 years old, which attended the Out patient Clinic of the University Hospital of Buenos Aires for unrelated complaints. The figures obtained are at variance--by far--from those published by other people engaged in the same line of research. Probably, further studies with a much larger amount of patients are called for.

Comparison of fixed-ratio versus variable-ratio regular and NPH semisynthetic human insulin in insulin-requiring diabetic patients

The efficacy and safety of a fixed combination of semisynthetic human insulin (Novolin) providing a 70:30 ratio of NPH to regular insulin versus a varying ratio of semisynthetic human insulin, regular and NPH (control group), were compared in adult insulin-dependent and noninsulin-dependent diabetic patients whose glycemic control had been stable on customized split-mix regimens of animal insulin. Seventy-eight patients were enrolled, of whom 72 were evaluated for efficacy of the respective regimens. Although the baseline fasting serum glucose concentrations were significantly higher in the fixed-ratio group than in the control group, mean serum glucose and glycosylated hemoglobin values throughout the 12 weeks of experimental treatment were not significantly different between groups. The mean serum glucose and glycosylated hemoglobin values in the fixed-ratio group also did not differ significantly from baseline; however, statistically significant increases were observed in the control group at weeks 4 and 8, but not at week 12. Total daily insulin dosages were comparable between the two groups, and body weight did not change significantly in either group. At the end of the study, the investigators judged 90% of the patients in the fixed-ratio group and 88% of the patients in the control group to be either improved or unchanged with respect to glycemic control. The frequency of hypoglycemic episodes and other clinical events did not change significantly from baseline in either group or differ significantly between the two groups at any time. The results of this study suggest that stable diabetic patients receiving animal insulin can safely be transferred to semisynthetic human insulin and that the majority of patients can maintain acceptable glycemic control with a fixed 70:30 ratio of NPH to regular semisynthetic human insulin.

Clinical results of transanal endoscopic microsurgery

Using the "transanal endoscopic microsurgery" technique, 140 patients were treated at the Department of Surgery in Cologne and Mainz. Of the patients with adenomas, 68.2% had typical symptoms preoperatively. The postoperative hospital attendance was 8.7 days, with an average resection size of 14.4 cm2. The postoperative complication rate was 5%, and there were no deaths related to the technique. In a prospective controlled trial, 2.2% of the patients with adenomas treated endoscopically in Mainz showed recidivation, requiring reoperation. The follow-up rate was 100%. In 30 cases, microscopic examination revealed carcinoma. Radical reoperation in 8 pT1 tumours showed neither remaining tumour nor lymph node metastases. Twelve patients with pT1 carcinoma treated by local surgery alone were recurrence-free with an average follow-up period of 12.3 months. So far, there have been no late results.

[Endorectal sonography in rectal cancer]

35 patients with rectal cancer were examined in a prospective trial by endorectal ultrasound. In 27 patients the sonographic diagnosis of tumour penetration was correct as compared with histologic findings, in 7 patients infiltration depth was overestimated, and in one case underestimated. In 21 resected specimens, examined postoperatively in a water tank with the same equipment, ultrasonic examination was correct in 17; in no case was the infiltration depth underestimated. The different technical approaches in local sonographic staging of rectal cancer are discussed.

Endoscopic microsurgery of rectal tumors

Seventy-five patients with sessile adenomas or early carcinomas of the rectum or rectosigmoid were operated on with the new technique "transanal endoscopic microsurgery" Employing a newly developed complex endoscopic operating system, complete removal of sessile adenomas can be accomplished up to a distance of 25 cm from the anal verge, accurately and non-invasively. Complications occurred in three cases, with no resulting mortality. In the follow-up period we discovered only one adenomatous recurrence that required operative treatment. The superior accuracy of preparation, a short average stay in hospital, and low recurrence and complication rates are the advantages of this transanal endoscopic operative technique.

Idiopathic syndrome of inappropriate antidiuretic hormone secretion possibly related to advanced age

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a cause of hypotonic hyponatremia is well recognized. The syndrome is commonly associated with cranial and thoracic infectious disease or malignancy. An idiopathic form of the syndrome has been reported, but poorly documented. Our patient, an 88-year-old man without any associated disease, had SIADH confirmed by a standard water load test. The pattern of antidiuretic hormone release corresponded to the "vasopressin leak" pattern. A review of ten cases of "idiopathic" SIADH showed that each of these cases has been associated with neuropsychiatric or other medical disturbances. We conclude that idiopathic inappropriate antidiuresis does exist and is a discrete category of SIADH. Data suggest that advanced age may be a risk factor for this disease. This syndrome may account for the increased susceptibility to hyponatremia among older patients.