Self-management interventions for chronically ill patients with limited health literacy: A descriptive analysis

OBJECTIVES

To support patients with limited health literacy with the challenges they face in the day-to-day management of their disease(s), numerous self-management interventions (SMIs) have been developed. To date, it is unclear to what extent SMIs have been developed for chronically ill patients with limited health literacy. This study aims to provide a description of these SMIs and to provide insight in their methodological components.

METHODS

A secondary analysis of the COMPAR-EU database, consisting of SMIs addressing patients with diabetes, chronic obstructive pulmonary disease, obesity and heart failure, was conducted. The database was searched for SMIs addressing health literacy, including cognitive aspects and the capacity to act.

RESULTS

Of the 1681 SMIs in the COMPAR-EU database, 35 studies addressed health literacy, describing 39 SMIs. The overview yields a high variety in interventions given, with overlapping information, but also lacking of specific details.

DISCUSSION

This descriptive analysis shows that there was a large variety in the extensiveness of the description of intervention characteristics and their justification or explanation. A focus on the broad concept of health literacy, including functional skills, cognitive skills and the capacity to act could improve the effectiveness. This should be taken into account in the future development of SMIs.

Attack politics from Albania to Zimbabwe: A large-scale comparative study on the drivers of negative campaigning

There is little comparative research on what causes candidates in elections across the world to 'go negative' on their rivals - mainly because of the scarcity of large-scale datasets. In this article, we present new evidence covering over 80 recent national elections across the world (2016-2018), in which more than 400 candidates competed. For the first time in a large-scale comparative setting, we show that, ceteris paribus, negativity is more likely for challengers, extreme candidates, and right-wing candidates. Women are not more (or less) likely to go negative on their rivals than their male counterparts, but we find that higher numbers of female MPs in the country reduces negativity overall. Furthermore, women tend to go less negative in proportional systems and more negative in majoritarian systems. Finally, negativity is especially low for candidates on the left in countries with high female representation, and higher for candidates on the right in countries with proportional representation (PR).

Creatine-kinase reference intervals at rest and after maximal exercise in Standardbred racehorses

Due to the high variability of data drawn from the literature, aim of the study was to evaluate the effects of exercise on creatine-kinase (CK) serum activity and to determine CK reference intervals (RIs) at rest and post-exercise in healthy Standardbred racehorses. Data concerning history, physical examination, laboratory evaluation and ECG were collected retrospectively from a population of 258 Standardbred racehorses in training that underwent an incremental-maximal treadmill exercise. Those subjects with alterations potentially influencing CK serum activity were excluded. Finally, a reference sample of 194 horses was selected. Blood samples were collected 1 hour before exercise and 6 hour post-exercise and analysed with a spectrophotometric method. Values were compared by Wilcoxon test for paired samples. The effect of age and sex was evaluated by Kruskal-Wallis and Dunn post-test. Statistical significance was set at P<0.05. RIs were determined following Clinical and Laboratory Standard Institute guidelines (CLSI), approved by the American Society for Veterinary Clinical Pathology. Using a macroinstruction set for Microsoft Excel (RefValAdv), RIs were determined with a non-parametric method. A significant increase (P<0.0001) in CK activity post-exercise was observed. Partition by sex and age did not show any statistical difference, either at rest or post-exercise. In RIs determination no outliers were identified. RIs ranged from 25 to 394 U/l at rest and from 44 to 735 U/l post-exercise. To our knowledge, this is the first study considering CK post-exercise RIs in racehorses using CLSI’s guidelines and specific CK-related exclusion criteria. These RIs could be useful to discriminate between physiological and pathological CK post-exercise increase.

Colorectal cancer guidelines seldom include the patient perspective

OBJECTIVES

This study aimed to describe how colorectal practice guidelines (PGs) incorporate the patient perspective.

STUDY DESIGN AND SETTING

We searched in the Guidelines International Network library, MEDLINE, National Guideline Clearinghouse, NHS Evidence database, and TRIP database. Two authors independently selected the PGs. We considered recommendations rated or worded as weak or conditional or suggesting multiple options, as potentially preference sensitive. Two authors independently evaluated if, in potentially sensitive recommendations, the patient perspective was incorporated.

RESULTS

We included 28 PGs that contained 588 recommendations, being 256 potentially preference sensitive. Ten PGs (36%) included patients in the development process, and 12 (43%) provided information about patients' perspectives. Nine PGs (32%) included recommendations in which the patient perspective was explicitly considered, and 13 (46.4%) that recommended a discussion with the patient. From a total of 588 recommendations, 9.7% (25/256) of potentially preference-sensitive recommendations considered the patient perspective. The inclusion of patients in the development process was associated with a more frequent incorporation of the patient perspective in potentially preference sensitive recommendations (70% vs. 0%; P < 0.001).

CONCLUSIONS

Guideline users should be aware that the incorporation of the patient perspective in colorectal cancer PGs is suboptimal. Guideline developers should make efforts to incorporate the patient perspective, especially in preference-sensitive recommendations.

Tissue and Serum TPA in Subjects at Risk for Bladder Cancer

We tested the presence of tumour polypeptide antigen (TPA) in lower urinary tract cells from 59 workers exposed to known bladder carcinogens and from 30 control subjects. We then correlated immunocytological expression and serum TPA levels. Lower urinary tract cells from 31 subjects gave either moderately or strongly positive immunocytological stains. Five also had high serum TPA. The detection of TPA by cytology and in serum differed significantly in workers exposed to cancer agents and the control group.

Cell Kinetics and Tumor-Associated Antigen Expression in Human Mammary Carcinomas

Twenty-six primary breast carcinomas were studied to evaluate cell proliferation as assessed by thymidine labeling index (TLI), and antigenic phenotype, as defined by immunohistochemistry using eight monoclonal antibodies (MAbs) to tumor-associated antigens (TAAs). The majority of tumors had low TLI values. Reactivity to MAbs B72.3, CC49, CC83 (anti TAG 72), COL-12 (anti CEA) and MOv2 (against a tumor-associated mucoprotein) was restricted to < 50% of the tumors studied, while MAbs B1.1 (anti CEA), MBrl and MBr8 (to tumor-associated carbohydrates) reacted with > 50% of the cases. Correlations between expression of TAAs and proliferative activity showed that the tumors could be divided into three groups, two characterized by either high proliferative activity and absence of antigenic expression or low proliferative activity and strong antigenic expression, and the third showing no relation between these two biological features. We defined two antigenic phenotypes associated with specific cellular kinetics: one characterized by negative immunoreaction with MAbs, CC49, CC83 and COL-12 and high proliferative activity; the other characterized by intense immunoreactivity with these antibodies and low proliferative activity. The data suggest that cell proliferation and antigenic phenotype may define biologic subsets of breast carcinomas

Probiotic characterization of lactic acid bacteria isolated from swine intestine

AIM

A study was conducted with the objective to isolate probiotic microorganisms from swine intestine.

MATERIALS AND METHODS

In this study 63 isolates (24 caeca, 24 colon mucosal scrapings, and 15 rectal swab samples) were collected from Large White Yorkshire pigs. The isolates were inoculated and grown in de Man Rogosa Sharpe broth at 37°C with 5% CO2 for 48 h and subjected to morphological identification. Colonies having Gram-positive rods were selected for further physiological and biochemical identification tests, which were conducted in triplicate in two runs for each of the selected isolates using a standard protocol. Probiotic properties among the identified species were determined through the implementation of several tests related with pH tolerance, bile tolerance, and antimicrobial activity.

RESULTS

Morphological identification revealed that only 23 isolates were Gram-positive rods. Physiological tests performed on these 23 isolates further revealed that four of them did not exhibit any growth, at all conditions studied. The rest 19 isolates were, therefore, selected and subjected to biochemical tests. Six isolates were rejected because they were oxidase and nitrate reduction positive. From the 13 isolates subjected to sugar fermentation tests, speciation of only two isolates could be ascertained, one of the isolates showed characteristics for Lactobacillus acidophilus and the other for Lactobacillus plantarum. These two isolates were assessed for the strain possessing maximum probiotic property, and it was inferred that both - L. plantarum and L. acidophilus could tolerate a wide pH range (2-9), a wide bile concentration (0.05-0.3%) and revealed antimicrobial activity toward Escherichia coli, and Enterobacter spp.

CONCLUSION

L. plantarum and L. acidophilus were isolated from swine intestine and were found to have good probiotic properties.

Effect of in ovo supplementation of nano forms of zinc, copper, and selenium on post-hatch performance of broiler chicken

Background and Aim:

Nanoparticles can bypass conventional physiological ways of nutrient distribution and transport across tissue and cell membranes, as well as protect compounds against destruction prior to reaching their targets. In ovo administration of nanoparticles, may be seen as a new method of nano-nutrition, providing embryos with an additional quantity of nutrients. The aim of the study is to examine the effect of in ovo supplementation of nano forms of zinc, copper and selenium on the hatchability and post hatch performance of broiler chicken.

Materials and Methods:

Nano form of zinc at 20, 40, 60 and 80 µg/egg, nano form of copper at 4, 8, 12 and 16 µg/egg and nano form of selenium at 0.075, 0.15, 0.225 and 0.3 µg/egg were in ovo supplemented (18^th day incubation, amniotic route) in fertile broiler eggs. Control group in ovo fed with normal saline alone was also maintained. Each treatment had thirty replicates. Parameters such as hatchability, hatch weight and post hatch performance were studied.

Results:

In ovo feeding of nano minerals were not harmful to the developing embryo and did not influence the hatchability. Significantly (p<0.05) best feed efficiency for nano forms of zinc (2.16), copper (2.46) and selenium (2.51) were observed, when 40, 4 and 0.225 µg/egg respectively were in ovo supplemented. Except in nano form of copper at 12 µg per egg which had significantly (p<0.05) highest breast muscle percentage there was no distinct trend to indicate that dressing percentage or breast muscle yield was influenced in other treatments.

Conclusion:

Nano forms of zinc, copper and selenium can be prepared at laboratory conditions. In ovo feeding of nano forms of zinc, copper and selenium at 18^th day of incubation through amniotic route does not harm the developing embryo, does not affect hatchability.

Implication of laminin and collagen type IV expression in the progression of breast carcinoma

BACKGROUND

The prognostic variability in breast cancer patients prompted the authors to investigate specific biological markers for the identification of high-risk breast cancer groups. In the present study, attention was focused on the interaction between tumor cells and the extracellular matrix, an important requisite in the metastatic process.

MATERIALS AND METHODS

Fifty-six primary breast carcinoma specimens obtained by mastectomy or quadrantectomy plus axillary dissection were examined with immunohistochemistry, for the determination of laminin, collagen type IV and hormone receptor expression and with static cytometry, for the determination of the DNA content.

RESULTS

Laminin and collagen type IV expression was observed on the membrane and in the cytoplasm of neoplastic cells. Laminin and collagen type IV were present, respectively, in 85.4% and 73.8% of the cases which showed recurrence.

CONCLUSION

The results of this study have shown that high expression of laminin and collagen type IV may have a value in the prognosis of disease free survival and may be linked to other classical clinical, histological and biological parameters in the evaluation of breast cancer patients.

Extended (D2) lymphadenectomy in gastric cancer: a five year experience

The extent of lymph node dissection in stomach adenocarcinoma is currently under debate. Japanese data strongly support the therapeutic value of extended lymphadenectomy (D2 node dissection), whereas in Western countries several prospective trials have recently been completed with contrasting results. During the period May 1993 to May 1998, 164 patients with gastric cancer were observed: 136 patients, treated with a radical surgical procedure including lymph node dissection according to the guidelines of the Japanese Research Society for Gastric Cancer, were eligible for our analysis. Clinical, histopathological, and surgical factors were examined for their influence on long-term survival. Our results on morbidity and mortality rates are similar to Japanese series: we suggest that the experience and training of the surgeon and his personal attitude towards extensive lymph node dissection may, therefore, be a major factor influencing the morbidity associated with the procedure. The relatively high estimated 3-year survival rate (52%) suggests support for extended lymphadenectomy (D2 dissection) in gastric cancer as standard treatment.

BCL2 and BAX expression in hyperplastic and dysplastic rectal polyps

BACKGROUND/AIMS

Members of the gene family that includes BCL2 and BAX are functionally antagonists in the apoptosis process and they have been observed in normal and neoplastic tissues. The aim of this study is to investigate the combined effects of BCL2 and BAX protein in normal mucosa, dysplastic and hyperplastic polyps of the rectum.

METHODOLOGY

We studied BCL2 and BAX protein expression in 40 cases of adenomatous polyps all located in the rectum, with different dysplastic gradings, and the mean time in 10 cases of normal rectal mucosa.

RESULTS

BCL2 expression was found more frequently in hyperplastic and in low dysplastic polyps with moderate and strong positivity compared to moderate and severe dysplasia. BAX expression was found in normal mucosa in hyperplastic and dysplastic polyps, the immunoreactivity was prevalently moderate and strong.

CONCLUSIONS

These preliminary data suggest that BCL2 and BAX confirm a probably different role in apoptosis. Nevertheless, it is important to know the relation between the molecular pathways of apoptosis, the defective mismatch repair and the tumor suppressor genes associated with an increased mutation rate in cancerogenesis of the colorectum.

Immunohistochemical expression of p53, nm23-HI, Ki67 and DNA ploidy: correlation with lymph node status and other clinical pathologic parameters in breast cancer

BACKGROUND

The different clinical evolution of breast cancer with similar pathological characteristics prompted the authors to investigate the prognostic significance of different biological markers.

METHODS

Seventy-one primary breast carcinoma specimens obtained by mastectomy or quadrantectomy were examined for the determination of the p53, nm23 and Ki67 expression, with immunohistochemistry, and the DNA content, with static cytometry.

RESULTS

p53 protein was expressed as nuclear staining in 58% of the cases and was associated with high levels of Ki67, non-diploid lesions and lymph-node status. Positive staining for nm23 was significantly correlated only with histologic grading. A predictive role in disease recurrence was demonstrated only in patients with a high Ki67 nuclear expression.

CONCLUSIONS

From these data, we may conclude that, besides all the other traditional clinical morphological parameters, a panel of different biological markers, such as Ki67 and the determination of p53 expression, may be utilized to further characterize breast cancer and its biological behavior.

Cytological and immunocytochemical analysis of laterocervical lymph nodes in patients with previous thyroid carcinoma

BACKGROUND

In the follow-up of patients with a history of thyroid carcinoma, an enlarged cervical lymph node may indicate metastatasis is underway. Various methods may be utilized in the differential diagnosis between cancer metastasis of thyroid origin and aspecific lymphoadenitis. The aim of the present study was to evaluate the sensitivity and specificity of fine needle aspiration biopsy (FNAB) and the additional diagnostic value of immunocytochemical thyroglobulin staining on FNAB of neck nodes.

METHODS

We evaluated cytologically 38 samples obtained by ultrasound-guided FNAB on laterocervical nodes from patients with a history of thyroid carcinoma. One smear for each case was selected for the immunocytochemical stain.

RESULTS

Twenty-eight of those samples were adequate (16 positive for metastasis of thyroid origin and 12 negative) and 10 inadequate. Two of the cytologically positive samples from poorly differentiated neoplasia showed no reaction to thyroglobulin (Tg). In ten of the 11 cases classified as lymphoadenitis, no immunoreaction was present; in the last case, blastic-like cells showed a scanty cytoplasmic rim which was immunoreractive to Tg. Therefore, this case was reclassified as a metastatic tumor.

CONCLUSIONS

Based on our results, we would recommend that FNAB be routinely performed in the diagnostic evaluation of neck masses. If the FNAB is inconclusive, aspiration should be repeated, while immunoperoxidase stain to evidence Tg, may be an adjunctive diagnostic tool in cytologically negative cases.

[Evaluation of cellular proliferative activity and DNA ploidy as a prognostic factor in breast cancer]

BACKGROUND

In the past years, morphological indexes and kinetic parameters have been introduced to characterize breast cancer in order to select breast cancer patients for adjuvant therapy. The alterations of the proliferative activity of neoplastic cells and DNA ploidy may provide important information about the aggressiveness of the lesion and may be used as powerful prognostic factors. In fact, prognostic information based on the classic clinico-pathologic parameters such as histotype, stage and grade are no longer sufficient to select patients for long term follow-up. The aim of this study was to evaluate the malignant potential of neoplastic cells through the determination of modifications of the proliferative index and the evaluation of DNA ploidy.

METHODS

Forty-five breast cancer patients, 32 to 80 years of age, were studied. Proliferative indexes and DNA ploidy, besides the other clinical-pathologic parameters have been evaluated. The proliferative index was assessed with the immunocytochemical determination of Ki67 and quantified with the CAS 200: 31 cases had a high proliferative index, 12 medium and 2 low. DNA ploidy was analyzed on cytologic preparations with static cytometry utilizing an image analyzer CAS 200: 13 cases were diploid, 32 non-diploid.

RESULTS

A close relationship was found between Ki67 expression and DNA ploidy. In fact, lesions with a high proliferative index were all non-diploid, whereas, those with a low proliferative index were all diploid. Lesions with a medium proliferative index were 2 diploid and 1 non-diploid. Among the 45 cases, studied in a follow-up period of 36 months, 12 showed disease recurrence; 3 showed a medium Ki67 expression and were diploid, 9 a high Ki67 expression and were all non-diploid.

CONCLUSIONS

In conclusion, proliferative indexes and DNA ploidy may be considered additional prognostic parameters which may potentially influence the clinical behaviour of breast cancer and may be utilized besides all the other clinico-pathologic data to assess these lesions.

Nm23-H1 protein, DNA-ploidy and S-phase fraction in relation to overall survival and disease free survival in transitional cell carcinoma of the bladder

OBJECTIVES

To explain the overall survival (OS) and disease free survival (DFS) in relation to nm23-H1 protein, DNA-ploidy and S-phase fraction (SPF) in transitional cell carcinoma of the bladder.

PATIENTS AND METHODS

Ninety-four samples were obtained from patients with transitional cell carcinoma of the bladder examined between 1994 and 1996. The patients were underwent cistectomy or surgical biopsy and the material was histologically evaluated according to World Health Organization classification. Nm23-H1 protein expression in immunohistological staining and DNA ploidy, S-phase fraction by flow cytometric were performed.

RESULTS

The correlation between OS and staging, grading, DNA-ploidy and S-phase was significant; whereas the overall survival and nm23-H1 protein, was not significant. The relationship between DFS and stage, DNA-ploidy and S-phase had a significant value. The correlation between DFS and age, sex, grading and nm23-H1 protein was not significant. There was no significant difference in age, sex, stage, grading, DNA-ploidy and SPF distribution between patients with nm23-H1 positive bladder cancer and those with nm23-H1 negative tumours.

CONCLUSION

In our study, multivariate analysis showed that stage, ploidy and SPF were the strongest prognostic factors in predicting disease-free survival and prolonged survival, while nm23-H1 expression was not related to disease progression and/or prolonged survival. This expression, therefore, does not appear to be an independent prognostic factor in bladder cancer, although a still larger number of patients and a longer follow-up period are now needed for a definitive assessment of the prognostic significance of nm23-H1 expression.

Analysis of p53 expression in precancerous and malignant gastric mucosa

P53 overexpression, detected by immunohistochemical analysis, has been reported in about 50% of gastric cancers whereas scarce data are available on the p53 oncoprotein in precancerous gastric lesions. This study focused on the p53 expression in gastric cancerous and precancerous lesions. One hundred gastric specimens obtained during endoscopy were analyzed: 14 cases of normal gastric mucosa, 53 of chronic gastritis with intestinal metaplasia and/or dysplasia and 33 gastric tumors. An immunoperoxidase technique and monoclonal anti-p53 antibodies were employed. Eleven out of 31 gastric carcinomas overexpressed p53. No correlation was observed between p53-positivity and histological type and grade of tumors. All precancerous lesions were p53-negative. Our results suggest that p53 overexpression is a relatively late event in gastric carcinogenesis.

Early stage human colorectal cancer: prognostic value of nm23-H1 protein overexpression

Nm23 gene codifies for a nucleoside diphosphate kinase allowing the intracellular transduction of the signals. In colorectal cancer nm23 protein expression seems related to the progression of the disease. By immunohistochemistry we have studied the intracytoplasmatic nm23 H1 protein expression in 20 patients affected by colorectal cancer at initial stage. In 12 cases it resulted elevated and in four the disease recurred. The overexpression was not correlated with other prognostic factors. Nm23 H1-positive patients affected by colorectal cancer at initial stage could be considered at risk for disease recurrence and included in a more frequent follow-up protocol.

nm23 and p53 expression

Breast cancer is a common malignancy and the modalities and the aggressiveness of treatment strategies are variable and depend on information regarding the biological characteristics and behavior of an individual tumor. Therefore, to improve overall survival it is important to identify and select lymph node negative patients at high risk who would benefit from adjuvant therapy. Besides prognostic factors such as lymph node status, hormone receptor status and histopathologic parameters, nm23 antimetastatic gene and the p53 protein were studied in 32 breast cancer patients. Positive staining for nm23 was inversely associated with lymph node involvement in 82.4% of the cases. Most of the non-diploid lesions (70.8%) showed a high protein expression. Positive immunostaining for p53 was present in 28.1% of the cases and was strongly correlated with prognostic indicators such as necrosis and histologic grading. Tumor grade, DNA ploidy and lymph node metastasis were not significantly correlated with p53 protein expression. In this study, all the prognostic indicators studied, satisfactorily explain the important characteristics of the biologic behaviour of breast cancer, but the detection of lymph node metastasis is still the most accurate prognostic factor utilized for a predictive role in disease recurrence.

nm23-H1 protein immunohistochemical expression in human breast cancer

A series of 76 patients undergoing surgery for primary breast carcinoma has been prospectively studied in order to evaluate the relative weight of nm23-H1 protein expression in disease-free survival. Expression of nm23 protein was immunohistochemically assessed. In all, 39% (29/74) of the turners showed positive staining for nm23-H1 protein expression. Negative nm23-H1 expression was found in poorly differentiated, tumors (p<0.02). There was no significant relationship between nm23-H1 and the other clinicopathological and biological features examined. In the univariate statistical analysis, node positivity, G3 histological grade and high flow cytometric S phase fraction (SPF) value proved to be significantly related to risk of relapse. In the multivariate analysis, only histological grade (G3) and high SPF values (>10.6) proved to be independently related to risk of relapse, with a hazard ratio of 9.84 and 7.98 respectively. Our preliminary study suggests that immunohistochemical nm23-H1 expression should not be considered a marker for predicting tumor progression and patient prognosis.

Overexpression of NDP kinase nm23 associated with ploidy image analysis in colorectal cancer

The nm23 gene was originally identified by differential hybridization between two murine melanoma cell sublines with low and high metastatic potential. Nm23 is localized on chromosome 17q21.3-22. Allelic deletions of chromosome 17 have been related to the progression of colorectal carcinomas. We have evaluated and compared the expression of nm23 NPD kinase protein using an immunohistochemical method and DNA ploidy evaluation with image analysis. This study was performed on 20 patients, who underwent surgery for colorectal carcinoma. Patients were followed up during the period from 1992 to 1994. Results have shown an association between the parameters obtained for the nm23 NPD kinase protein expression, and aneuploid DNA and neoplastic progression. The expression of nucleoside diphosphate (NDP) kinase mm23 has been reported to be inversely related to the metastatic potential of experimental cells in human breast cancer. A relationship between the positivity in protein expression of gene product in the allele nm23 H1 and the state of the lymph nodes has also been found.

Correlation between ploidy status, Erb-B2 and p53 immunohistochemical expression in primary breast carcinoma

In the present study we evaluated the prognostic significance and correlation between ploidy status, lymph node status, estrogen-progesterone receptor status and the expression of Erb-B2 and p53 protein in 77 primary breast carcinomas. Quantitation of DNA ploidy was determined on Feulgen-stained touch imprints with an image analyzer, whereas localization of the immunohistochemical reaction of Erb-B2 and p53 protein was evaluated in paraffin-embedded tumor specimens with microscopy. The DNA histogram was diploid in 17 cases, poly/tetraploid in 24 and aneuploid in 36. We observed no correlation between ploidy status and hormone receptor content or lymph node status. The expression of Erb-B2 protein was observed exclusively in the membrane and in the cytoplasm of neoplastic cells and was uniformly distributed. Overexpression was observed in 89.2% of cases. Aneuploid tumors intensively expressed the oncogene in 20.3% of cases. A statistically significant correlation was observed between lymph node metastasis and Erb-B2 overexpression. The expression of p53 protein was expressed as nuclear staining in 17.6% of the cases, with variable intensity, mainly in ductal histotypes. Among these, 62% were aneuploid. Lymph node status and steroid receptor status did not correlate significantly with p53. From these data we conclude that DNA ploidy and Erb-B2 and p53 expression correlate with cell proliferation and differentiation and therefore may identify breast carcinoma patients with more aggressive disease.

p53 expression and genetic evidence for viral infection in intraepithelial neoplasia of the uterine cervix

Infections with high-risk strains of human papillomaviruses (HPVs) and with herpes simplex virus type 2 (HSV 2), as well as inactivation of the p53 tumor suppressor gene, are important cofactors in cervical carcinogenesis. We analyzed 41 paraffin-embedded cervical intraepithelial lesions, including 25 cases of low-grade cervical intraepithelia neoplasia (CIN), and 16 cases of high-grade CIN for the presence of HPV 16/18 and HSV 2 genomic sequences and for the nuclear accumulation of the p53 protein. HPV 16 DNA was detected in 24.% of low-grade CINs and in 43.7% of high-grade CINs. HPV 18 was found only in 8.% of low-grade CINs. None of the cases tested scored positive for HSV 2 DNA. Nuclear accumulation of p53 was found in 4% of low-grade CINs, and in 31.2% of high-grade CINs, including 57.1% of the lesions that were positive for HPV 16. These results indicate that HPV 16 infection was over sixfold more common than HPV 18 infection and that p53 overexpression was significantly associated with high-grade lesions.

Immunohistochemical expression of tissue polypeptide specific (TPS) antigen in normal and neoplastic tissues

TPS was determined by immunohistochemistry in 44 different tissues (normal and pathological) from various organs such as cervix, endometrium, breast, stomach, bowel and bladder. TPS was expressed in several physiologic situations: in different phases of the endometrial cycle and in cervical metaplasia. In other organs such as the breast and the bladder this antigen shows its highest expression in invasive neoplasias. Therefore, it could be utilized in the follow-up of these neoplasias.

[Diarrhea, erythema nodosum, arthralgia]

Following antibiotic treatment of febrile tonsillitis, a 20-year old man developed watery diarrhea during military service. He was admitted to the infirmary by the medical officer. During the last year the patient had traveled to Spain. The history of recent food intake was not remarkable. The clinical investigation revealed a slightly tender liver. A markedly elevated ESR, a consecutively developing erythema nodosum on both lower legs and arthralgias opened a broad spectrum of differential diagnoses that are discussed here. Stool cultures grew salmonella typhimurium. The clinical picture, the treatment and possible complications of this salmonellosis are discussed.

Regional heterogeneity and complementation in the expression of the tumor-associated glycoprotein 72 epitopes in colorectal cancer

We analyzed the immunohistochemical expression of three epitopes of the tumor-associated glycoprotein 72 (TAG-72) in whole cross-sections of primary colorectal carcinomas and in regional lymph node metastases using monoclonal antibodies (MAbs) B72.3, CC-49, and CC-83, which recognize distinct carbohydrate antigenic determinants. B72.3, CC-49, and CC-83 reacted with 13 of 27 (48%), 25 of 27 (92%), and 21 of 27 (77%) carcinomas, respectively. The immunoreactivity with lymph node metastases followed a similar pattern; MAb CC-49 was again the most reactive of the three antibodies, since it labeled 13 of 15 metastatic lesions. Positive reactions of the MAbs with the primary tumors were not always predictive of the immunorecognition of their metastases. Distinct areas within whole cross-sections of TAG-72-positive primary carcinomas demonstrated marked differences in the expression of the three epitopes. CC-49 tended to react with the highest number of areas and with the highest percentages of carcinoma cells within each area. In no instances did B72.3 demonstrate reactivity superior to that of either CC-49 or CC-83. Tumors negative for the CC-49 epitope in any area also did not express the other two TAG-72 epitopes. However, the comparison of the immunostaining obtained with each MAb in TAG-72-positive primary lesions revealed areas where CC-83 was clearly more reactive than CC-49. Moreover, one lymph node metastasis, negative for CC-49, was recognized by CC-83. Thus, the combined use of MAbs CC-49 and CC-83 resulted in additive immunostaining of primary and metastatic colorectal carcinoma cells. The study provides evidence of intratumoral heterogeneity in the glycosylation pattern of the TAG-72 antigen in colorectal cancer and emphasizes the advantages of cocktails of anti-tumor-associated antigen MAbs in the immunodetection of colorectal tumor cells.

Immunohistochemical evidence of immune responses to tumor-associated antigens in lymph nodes of colon carcinoma patients

The authors investigated by immunohistochemical study the drainage of three tumor-associated antigens in unaffected regional lymph nodes of colon cancer patients. The study was conducted using monoclonal antibodies (MoAb) directed against different epitopes of the tumor-associated glycoprotein, TAG-72 (CC-49, CC-83, B72.3), of the carcinoembryonic antigen (CEA) (COL-4, COL-12), and of the colon-associated antigen, CAA (anti-CAA). The authors detected immunohistochemical reactions of MoAb CC-49 and anti-CAA with antigen-presenting cells (APC), such as peritumoral and sinus macrophages and lymphatic endothelial cells and with specific areas of germinal centers in lymph nodes draining 11 of 24 colorectal carcinomas studied. The corresponding primary tumors expressed the TAG-72 and CAA antigens. No immunostaining was detectable in lymph nodes using the anti-CEA MoAb, even when the primary tumors strongly expressed the specific epitopes. In germinal centers of regional lymph nodes, the immunostaining was often distributed at the periphery with a characteristic crescentic or circular pattern, which strongly suggested the exposure of the specific epitopes defined by MoAb CC-49 and anti-CAA on follicular dendritic cells. This would indicate that these epitopes are selectively recognized and presented to germinal center B-cells. This phenomenon may have clinical and diagnostic implications.

[Esophageal obstruction in tube feeding: a result of protein precipitation caused by antacids?]

A complication of tube feeding, i.e. thickening of nutrient solution in the presence of an antacid leading to obstruction of the esophagus, is reported. Three patients on artificial breathing where fed by tube with Fresubin liquid. At intervals, Alucol liquid was given for stress ulcer prevention through the tube. After 2, 4, and 50 days respectively, reflux of nutrient solution into the mouth occurred. On removal of the tube a compact, yellowish-white substance was extracted. Endoscopically, residual particles were found in the upper part of the esophagus and in the hypopharynx which obstructed the esophagus completely and in one case could only be extracted through a rigid esophagoscope. In vitro studies showed that thickening of the nutrient solution was due to interaction with antacids administered simultaneously with the nutrient.

Measurement of mesenteric blood flow by duplex scanning

Ultrasonic imaging combined with a pulsed Doppler unit (duplex scanning) allows the noninvasive assessment of blood flow of the superior mesenteric artery. The changes in mesenteric blood flow associated with a standardized (1000 kcal) food load were measured and the results were compared with blood flow of the left common carotid artery. Twenty healthy subjects (aged 30.1 +/- 5 years) were studied fasting (12.4 +/- 2.6 hours' duration) and six times with a 15-minute interval after the test meal. The diameters of the superior mesenteric artery (0.60 +/- 0.09 mm) and of the common carotid artery (0.61 +/- 0.05 mm) were measured from the B-mode image. The Doppler frequency spectra were used to determine peak systolic, late systolic, and end-diastolic velocity and to compute the mean velocity. Although the flow parameters of the common carotid artery were virtually unaffected by food intake, a steep increase in mesenteric blood flow velocity and volume flow was observed. At rest, blood flow through the mesenteric artery was 6.3 +/- 2.6 ml/sec and 9.5 +/- 2.1 ml/sec in the carotid artery. After the test meal, mesenteric artery blood flow increased significantly (p less than 0.0001) and reached maximal hyperemia (20.3 +/- 7.4 ml/sec) after 45 minutes. The measurement of mesenteric blood flow before and after a test meal characterizes intestinal hemodynamics and should be suitable to evaluate ischemic disease and other disorders that lead to changes of mesenteric blood flow.

[Aorto-intestinal fistulas. 4 case reports]

Four cases of aorto-enteric fistula are reported. The two primary types occurred after rupture of an aneurysm of the abdominal aorta into the duodenum and as a consequence of tumor infiltration of both the aorta and the intestinal wall in a woman with metastatic ovarian cancer. The two secondary types developed as a late complication of reconstructive surgery of the abdominal aorta. The condition was diagnosed or suspected on the basis of endoscopic findings in two cases. The pathogenetic role of graft infection in the development of secondary aorto-enteric fistula is emphasized. The generally poor prognosis can be considerably improved if prompt resection of the graft is combined with axillo-bifemoral anastomosis.

[Aortic valve replacement with simultaneous aorto-coronary bypass operation 1969-1980]

Between 1969 and 1980, 62 patients underwent aortic valve replacement with simultaneous aorto-coronary bypass implantation. Three patient groups were formed, namely patients with predominant aortic valve disease, patients with predominant coronary heart disease and patients with simultaneous severe aortic valve disease and coronary heart disease. The results were analyzed separately for the three patient groups. The operative risk of patients with severe aortic valve disease was not greatly increased by the simultaneous implantation of aorto-coronary bypass. On the other hand, patients with predominant coronary disease and aortic valve replacement for mild to moderate aortic valve disease had an increased operative mortality and rate of perioperative infarctions. The unfavorable results in the latter patient group can most probably be explained by patient selection. Late mortality appears to increase with the severity of coronary heart disease. Prognosis of the total patient group was less favorable than that of isolated aortic valve replacement or aorto-coronary bypass operation. The implantation of aorto-coronary bypass did not completely prevent the reappearance of angina pectoris or myocardial infarction in the late postoperative follow-up. Several risk factors for a less favorable course were identified.