[Comprehensive Preoperative Evaluation of Patients with Lung Cancer]

Surgical resection continues to be a mainstay of curative treatment of patients with non-small cell lung cancers stages I - III and some small cell lung cancers. Reported rates of complications and mortality vary considerably. Therefore, a thorough and comprehensive preoperative evaluation of lung cancer patients is crucial in order to select appropriate surgical candidates and to determine their individual risk, including the extent of resection possible. Following available data and guidelines, such evaluation should include: ECOG-scoring, cardiac risk assessment, cerebrovascular assessment, pulmonary risk assessment, including split function analysis, and additional initiation or adjustment of treatment where appropriate; in patients aged ≥ 70 years: functional scoring (IADL). Risk stratification results in three groups: patients at low risk for complications and mortality, patients at increased risk, and patients who usually are not candidates for surgical resection. Finally, in order to support autonomous decisions of patients on optimal treatment based on defined risks, physicians must be familiar with values and preferences of patients as well as their familial and social situation.

[Application of artificial intelligence in thoracic surgery]

BACKGROUND

The application of artificial intelligence is a relatively new option to enable improved patient treatment in modern medicine and is therefore currently the focus of many research projects. In the clinical practice the application of artificial intelligence so far seems to be confined to the analysis of medical imaging.

OBJECTIVE

In which form is the use of artificial intelligence possible in routine daily work in thoracic surgery and is already being practiced?

MATERIAL AND METHODS

A search of the currently available literature was performed.

RESULTS

Under current conditions artificial intelligence can best be used as part of diagnostics and treatment planning; however, in order to enable a comprehensive use standardization and evaluation of the centralized data collection are necessary.

CONCLUSION

At the present time promising study results are available but the implementation into the surgical routine has so far been very difficult.

[Comprehensive Preoperative Evaluation of Patients with Lung Cancer]

Surgical resection continues to be a mainstay of curative treatment of patients with non-small cell lung cancers stages I - III and some small cell lung cancers. Reported rates of complications and mortality vary considerably. Therefore, a thorough and comprehensive preoperative evaluation of lung cancer patients is crucial in order to select appropriate surgical candidates and to determine their individual risk, including the extent of resection possible. Following available data and guidelines, such evaluation should include: ECOG-scoring, cardiac risk assessment, cerebrovascular assessment, pulmonary risk assessment, including split function analysis, and additional initiation or adjustment of treatment where appropriate; in patients aged ≥ 70 years: functional scoring (IADL).Risk stratification results in three groups: patients at low risk for complications and mortality, patients at increased risk, and patients who usually are not candidates for surgical resection.Finally, in order to support autonomous decisions of patients on optimal treatment based on defined risks, physicians must be familiar with values and preferences of patients as well as their familial and social situation.

[Lobectomy of Right Lower Lobe Eight Years after Foreign Body Aspiration]

A young man presented with haemoptysis, eight years after foreign body aspiration. The initial evaluation took place in the emergency department of a general hospital. However, neither chest x-ray nor bronchoscopy were performed. Bronchoscopy performed in our hospital revealed a foreign body in right lower lobe bronchus. Extraction failed because it was embedded in granulation tissue. The chronic atelectasis of right lower lobe and recurrent bronchopulmonary infections during the last years were the indication for lobectomy.

Video-Assisted Thoracoscopic Surgery of Parapneumonic Empyema - a 10-year Single-Centre Experience

OBJECTIVES

 Evaluation of a standardised management for the treatment of patients with parapneumonic empyema.

METHODS

 A retrospective 10-year single-centre analysis of all patients with parapneumonic empyema undergoing a standardised thoracoscopic treatment approach. We describe referral and age patterns, microbiological results, overall and stage-dependent success rates, conversion rates, 30-day and in-hospital mortality.

RESULTS

 From May 2003 to April 2013, 248 patients with parapneumonic empyemas were treated in our centre. Most patients were referred at weekends, and younger patients had advanced stages. The cure rate in stage I was 97.6 % and reached 80.3 % in stage II and 63.1 % in stage III. 6 patients (2.4 %) (all stage III) needed conversion to an open procedure. A revision was required in 19.7 % of cases in stage II and 27.7 % in stage III. 30-day mortality was 4.8 %, in-hospital mortality was 8.1 %.

CONCLUSION

 A standardised approach, including VATS, is associated with a high cure, low revision and moderate conversion rates. In view of a still considerable mortality, a higher index of suspicion and detection of advanced stages, especially in younger patients, is required to improve outcomes.

Severe Complications of Ultrasound Guided Transbronchial Needle Aspiration--A Case Series and Review of the Literature

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has become essential for the workup of patients with lung cancer and other pulmonary diseases. The emphasis of currently available literature is related to the diagnostic yield of EBUS-TBNA which was found to be high. Complications seem to be rare but such data are scant. We report three cases of complications including mediastinitis, pneumothorax and bleeding and provide a review on the existing literature.

Zur Chemie des Phorbols, XII

Dehydration of phorbol-20-monoacetate or phorbol-20-tritylether with phosphoroxychloride/pyridin yields phorbobutanon-20-monoacetate or -20-tritylether (1) respectively. From 1 phorbobutanon (2) is prepared. 2 is one of the products obtained from the reaction of phorbol with 0,02 N sulfuric acid (Flaschenträger reaction). From NMR- and CD-measurements of 2 and its derivatives and from mechanistic considerations of the pinacol rearrangement involving the α- [hydroxy-cyclopropyl]-carbinol group the structure and stereochemistry of phorbobutanon is derived. 2 is a 4,9,20-trihydroxy-14 (13 → 12) abeo-tigliadien- (1,6) -dion- (3,13).

Structure-Activity Relationships of Polyfunctional Diterpenes of the Tigliane Type, V / Preparation and Irritant Activities of Amino Acid and Peptide Esters of Phorbol

Tho synthesis of a series of 12-O-amino acyl- and 12-O-peptidyl-13-acetate and -13,20- diacetate esters of the tetracyclic diterpene alcohol phorbol is described. These esters, which include amino acid moieties with both N-protected and free amino functions, were all tested for irritant activity on mouse ear. The highest activities were observed for esters with N-9-fluorenylmethyloxycarbonyl-protected leucine and 11-aminoundecanoic acid.

On the Chemistry of Resiniferonol. I. Preparation of Resiniferonol, Synthesis of Homologous Aliphatic Resiniferonol-9,13,14-orthoesters and Some of their Bioactivities

The preparation of the daphnane prototype polyfunctional diterpene resiniferonol from resiniferatoxin (1) contained in latex from Euphorbia unispina or E. poisonii was modified to convert in an `early’ fraction of the acetone extract the extremely irritant 1 to the much less irritant 9,13,14-ortho(phenylacetate) 2 by transesterification. 2 was obtained in good yields and can be handled conveniently to prepare resiniferonol as reported previously. By esterification of resiniferonol with homologous straight chain aliphatic acids from C2 to C18 resiniferonol-14,20-diacylates were prepared. Treatment of the diacylates with perchloric acid/methanol yielded by intramolecular formation of the orthoester function the corresponding 9,13,14-orthoester-20-acylates. They were cleaved selectively by base catalysed transesterification to obtain the resiniferonol-9,13,14-orthoacetate (3), -hexanoate (4), -decanoate (5), -tetradecanoate (6) and -octadecanoate (7). On the mouse ear, unexpectedly they exhibit only weak irritant activity and on the mouse back skin practically no tumor promoting activity.

Eine einfache Trennfunktion zur Gegenstromverteilung und ihre Bedeutung für die Praxis

Die Theorie der Gegenstromverteilung wird vervollständigt durch Ableitung einer Trennfunktion, die mit einem Minimum an Experimenten den günstigsten Weg und den zu erwartenden Erfolg einer Gegenstromverteilung vorausberechnen läßt. Für die Auswahl der Lösungsmittelsysteme und des günstigsten Volumenverhältnisses ergeben sich daraus wichtige Hinweise. Durch die Trennfunktion wird ein quantitativer Vergleich des Trenneffektes der Gegenstromverteilung mit dem anderer Trennverfahren möglich.

On the Chemistry of Resiniferonol, II [1] Preparation and Bioactivities of 15,16-Dihydrosimplexin and Methods for its Tritium Labeling

Excoecaria factor O 1 -the daphnane type polyfunctional diterpene ester 5 β-hydroxy-6 α,7 α-epoxyresiniferonol-9,13,14-orto-(2,4,6-decatrienoate) -may be obtained in reason­ able amounts from the latex of Excoecaria oppositifolia from South East Asia. O 1 was partially hydrogenated with H2-Pd/C to yield, by saturation of the three double bonds in the orthoester, and of ⊿15,16 in the diterpene moiety, the new 15,16-dihydro derivative of simplexin. The latter is the well known daphnane prototype of polyfunctional diterpene esters occurring in Euphorbiaceae and Thymelaeaceae. 15,16-Dihydrosimplexin (DHS) showed pro­nounced irritant and tumor promoting activities. By analogous hydrogenation of O1 with a mixture of 1H2/3H2 a selectively labeled [3H]DHS was obtained that exhibited a particularly high specific activity of 30 Ci/mmole. Thus it is considered most appropriate for use to study the toxicokinetics and -dynamics of daphnane type diterpene esters. To device an alternative of 3H-labeling of DHS or simplexin (SIM) in position 20 of the diterpene moiety DHS-5-benzoate was oxidized by pyridinium chlorochromate. The resultant 20-aldehyde was reduced by sodium borohydride to reconstitute DHS-5-benzoate and, after deprotection, DHS. This route appears appropriate to prepare similarly [20-3H]DHS as well as [20-3H]SIM using sodium [3H]borohydride.

On the Active Principles of the Euphorbiaceae, IXa Ingenane Type Diterpene Esters from Five Euphorbia Species

Investigations of E. antiquorum, E. helioscopia, E. palustris, E. peplus and E. quadrialata for irritant and tumor promoting constituents afforded several new ingenane type diterpene esters derived from the parent alcohols ingenol and 20-deoxyingenol and from the hitherto unknown 20- deoxy-16-hydroxyingenol and 20-deoxy-13.16-dihydroxyingenol. The irritant activities of the natural compounds are reported together with some aspects on structure activity relationships

Zur Chemie des Phorbols, XI

Reaction of phorbol-13,20-diacetate with mesylchloride/pyridin induces a homoallyl rearrangement of the α- [acetoxycycloproyl] -carbinol group yielding crotophorbolone-enol-13,20-diacetate (7) and acetoxy-crotophorbolone-20-acetate (10). By alkali catalysed transesterification 7 may be converted to crotophorbolone (8). 7 is the 4,9-dihydroxy-13,20-diacetoxy-13,15-seco-tigliatetraene-(1,6,12,15) -one- (3) whereas 10 is the 4,9-dihydroxy-15,20-diacetoxy-13,15-tigliadiene- (1,6) -dione-(3,13), generated by an intramolecular migration of the acetyl group in 13-position.

A comparison of percutaneous dilatational tracheostomy versus conventional surgical tracheostomy

BACKGROUND

Percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) are widely accepted techniques and frequently performed in clinical practice. We compared PDT with ST tracheostomies in view of the benefits and drawbacks, time of duration, indication and complication rate of the respective procedures.

METHODS

The evaluation was based on data from 378 tracheostomies. 209 of these tracheostomies were performed at bedside as PDT in the intensive care unit. These were compared to 169 ST tracheostomies performed in the operating room. All interventions were performed by the same team of surgeons or intensivists, however, at different training levels.

RESULTS

The mean duration of the operation was shorter for PDT than for ST (18.2 ± 10 min versus 38.2 ± 14.2 min, p = < 0.001). The PDT was a simpler procedure and performed predominantly by physicians in postgraduate training. The rate of complications was low in both groups (8.6 % PDT, 8.3 % ST, p = 0.909).

CONCLUSION

Although both interventions are safe and achieve comparable results, PDT can be applied in a shorter time. PDT is easier to perform and seems particularly suitable for physicians in postgraduate training.

Tracheal perforation by an oesophageal stent

In a 63 year-old female patient with oesophageal carcinoma a tracheal perforation by an oesophageal stent was diagnosed. A first attempt of tracheal stenting was not successful due to spontaneous dislocation of the stent. Therefore, a shorter stent was chosen and correctly placed in a second session. This case report on an oesophagotracheal fistula provides a summary of this complication in advanced oesophageal cancer.

[Pleural empyema and lung abscess: current treatment options]

Parapneumonic pleural empyema has been classified into different stages and classes. While the American Thoracic Society (ATS) classification is based on the natural course of the disease, Light has classified pleural empyema according to the radiological, physical and biochemical characteristics, and the American College of Chest Physician (ACCP) has categorised the patients with pleural empyema according to the risk of a poor outcome. According to this classification the management of the pleural empyema is based on the stage of the disease. Therapeutic strategies include chest tube, chest tube with fibrinolysis, thoracoscopic debridement and decortication in open or minimally invasive techniques. Primary lung abscesses develop in previously healthy lung parenchyma and are caused by aspiration. In addition, abscess formation can occur without aspiration, and important differences relate to community-acquired, nosocomial abscesses and those in the immunosuppressed host. 90 % of all lung abscesses can be cured with antibiotic treatment alone, 10 % have to be treated with an interventional catheter or chest tubes and only 1 % require thoracic surgery because of complications independent of the former conservative or interventional treatment strategies.

[Successful risk management in flexible bronchoscopy]

Flexible bronchoscopy is one of the most important diagnostic procedures in respiratory medicine. The investigator operates in a vital organ and therefore must face a broad range of potential complications. This article provides an overview of all important complications associated with flexible bronchoscopy. It is further discussed how this risk can be minimized. A skillfull team, close monitoring and readily available resuscitation facilities are mandatory to avoid and to deal with major complications.

Co-carcinogens of the initiation-(or tumor)promoter type as environmental risk factors of cancer in man, experimental analysis of an etiologic model situation of life style cancer and current problems of assessment of cancer risk in multifactorial carcinogenesis

The identification of so-called co-carcinogens i.e. "per se essentially non-carcinogenic amplifiers" of carcinogenesis - especially promoters of initiation(or tumors) - as a new, non-classical group of risk factors has added a new dimension to the etiology of cancer in man. Indeed, in real human life, multifactorial causation of cancer may be considered the rule and classical unifactorial causation the exception. This comprehensive and current concept of the etiology of cancer in man and certain prototype experimental models of multifactorial carcinogenesis allow for proposals of a standardized terminology which may be adequate for common use in both, experimental and epidemiological oncology. On the background of a recent experimental analysis of life style esophageal cancer the current situation regarding the scientific basis of classification and grading of carcinogenic risk factors will be reviewed. It may be helpful in legislation aiming at more environmental safety.

[Video-assisted thoracoscopic surgery (VATS) for the management of parapneumonic pleural empyema]

Parapneumonic pleural empyema has been classified by international societies and by pleural diseases experts into different stages and classes. While the American Thoracic Society (ATS) classification is based on the natural course of the disease, Light has classified pleural empyema according to radiological, physical and biochemical characteristics, and the American College of Chest Physicians (ACCP) has categorised patients with pleural empyema according to the risk of a poor outcome. According to these classifications, the management of the pleural empyema is based on the stage of the disease. The recommended treatment options in (ATS) stage I disease (Light classes I-III, ACCP categories I and II) are therapeutic thoracentesis or tube thoracostomy and antibiotics when necessary. In (ATS) stage II disease (Light classes IV-VI, ACCP category III), thoracoscopy (VATS) is the treatment of choice because it has a higher efficacy than treatment strategies that utilise tube thoracostomy or catheter-directed fibrinolytic therapy alone, whereas in (ATS) stage III disease (Light class VII, ACCP category IV), decortication via thoracoscopy or thoracotomy is the treatment of choice.

[Granular cell tumour in a patient with pulmonary tuberculosis]

Primary tracheal tumours are rare and often only cause symptoms at a late stage, when the tumour obstructs most of the tracheal lumen. We report the case of a 45-year-old woman with pulmonary tuberculosis and a tumour in the trachea, which had been interpreted as a tuberculous lymph node perforating the tracheal wall. Bronchoscopy revealed a white, glossy, papillomatous lesion in the ventral wall of the trachea, which was identified by histology as a granular cell tumour. After culture conversion of the underlying tuberculosis, which led to the detection of the lesion, the tumour was surgically removed. Granular cell tumours rarely appear in the trachea, they may be multifocal and sometimes follow a malignant course. Complete resection is the treatment of choice and recurrence rates are low.

[Peripheral neuropathic pain relieved by somatosensory rehabilitation]

The femoral neuralgia is a rather frequent and invalidating clinical disorder. It takes on many clinical forms because of the anatomical variations of the cutaneous branches of saphenous and femoral nerves. The neuroplasticity of the somato-sensory system has now been determined which allows for a better understanding of the techniques of somatosensory rehabilitation. The authors precisely explain the various stages necessary in the care of patients suffering from femoral neuralgia. The various strategies of somatosensory rehabilitation are mentioned. The authors also present a brief review of the pharmacological treatments of peripheral neuropathic pain. Lastly, the result of the somatosensory rehabilitation of femoral neuralgia (NNT = 1.8) is documented on the basis of a prospective study done on 59 patients.

12-O-retinoylphorbol-13-acetate (RPA) behaves like a retinoid-derivative in binding to retinol-binding-protein: a correlation with its specific action as an incomplete tumor promoter?

12-O-retinoylphorbol-13-acetate (RPA), an incomplete tumor promoter of the phorbol ester type and protein kinase C (PKC) activator, consists of two characteristic structural elements: the phorbol body and the retinoyl ester chain. Therefore, possible binding of the incomplete tumor promoter RPA to the human transport protein retinol-binding-protein (RBP) has been examined by molecular modeling methods and experimental binding studies. The calculated prediction of binding properties was primarily based on a comparative geometrical approach. It was shown that the beta-ionone-ring of RPA was not altered within the binding pocket of RBP (molecular modeling) compared to retinoic acid (X-ray crystallographic data). The torsion angle C5'-C6'-C7'-C8', determining the conformation of the RBP-beta-ionone-ring relative to the isoprene tail, is rotated by 42 degrees for RPA compared to retinol and to retinoic acid, respectively. Combining all the results from force field calculations, MD simulations and geometrical comparisons, the conclusion could be drawn that RPA should be able to bind to RBP. This interaction should be less strong than that with its natural ligand retinol or with retinoic acid. This prediction was proven experimentally. RPA was able to compete with retinoic acid for binding at RBP in human plasma. The binding properties were investigated using 3H-labeled retinoic acid in homologous and heterologous competition studies in a one-dimensional native polyacrylamide gel electrophoresis system. An approximately 2000-fold weaker binding of RPA to RBP as compared to retinoic acid was determined experimentally, confirming the prediction of the molecular modeling approach. The characteristic behaviour of RPA as an incomplete promoter, due to possible binding to PKC and RBP, is discussed.

Thymolipom

This report is on a 37-year-old female patient with an extraordinary large intrapleural tumor on the left, macroscopically originating from mediastinal structures. The tumor was completely removed via transpleural approach without compromising the left lung. It was identified as a thymolipoma with a weight of 2400 g.

[Endobronchial ultrasound for local tumour and lymph node staging in patients with centrally growing lung cancer]

AIM

Lung cancer is a common disease and exact staging is of extreme importance in order to plan therapy. A frequent problem in assessing the extent of tumour spread is the question of infiltration versus compression of central airways by central tumours and a correct lymph node staging. Chest CT as the general imaging procedure of choice is often not helpful with these questions. Endobronchial ultrasound (EBUS) has been available for several years, and we were interested to find out if the addition of EBUS to regular bronchoscopy can help to differentiate between airway infiltration and external compression and improves the yield of transbronchial needle aspiration (TBNA).

METHOD

Patients with central tumour growth and enlarged lymph nodes were examined with EBUS and CT, classified according to local tumour invasion, and a needle biopsy of the lymph nodes was performed after EBUS detection.

RESULTS

50 patients were examined and subsequently operated. Relative to the local T-staging EBUS resulted in a sensitivity of 89 % and a specificity of 100 %. The results were highly improved statistically compared to the CT results (sensitivity 25 %, specificity 80 %). With EBUS-guided TBNA the results of correct N-staging could be improved to 86 %.

CONCLUSION

Our study suggests that EBUS, if performed by experienced endoscopists for the detection of airway wall infiltration or compression is highly accurate and superior to chest CT in assessing potential airway infiltration by a malignant tumour. Furthermore, the results of the lymph node staging could be improved through the additional use of EBUS. It is easily performed within the context of a standard bronchoscopy and may spare many patients unnecessary surgical biopsies.

Life-threatening complications of hepatitis B virus-related polyarteritis nodosa developing despite interferon-alpha2b therapy: successful treatment with a combination of interferon, lamivudine, plasma exchanges and steroids

Polyarteritis nodosa (PAN) is a rare vasculitis associated with hepatitis B virus (HBV) infection in a significant proportion of cases. When used to treat HBV-related PAN, immunosuppressive agents may enhance viral replication and relaspes are frequent. In recent years the use of antiviral drugs has been proposed. We report the case of a patient with HBV-related PAN who, despite 6 weeks of interferon-alpha2b (IFN-alpha2b) monotherapy, developed life-threatening complications with bowel perforation. He was thereafter successfully treated with a combination of IFN-alpha2b, lamivudine, plasma exchanges and short-term steroids. In contrast to IFN-alpha2b, lamivudine is effective in rapidly suppressing viral replication. This may be valuable in the treatment of HBV-related PAN by contributing to a faster diminution of circulating immune complex levels. This case report highlights the importance of aggressive combined therapy in patients with HBV-related PAN.

Dietary cancer risk from conditional cancerogens (tumor promoters) in produce of livestock fed on species of spurge (Euphorbiaceae). IV. Toxicologic and pathophysiologic observations in lactating goats and their suckling kids fed on the irritant herbs Euphorbia nubica and Euphorbia helioscopia: an etiologic model for investigations on the putative risk of cancer by consumption of food p

The feeding of lactating goats on usual green fodder, contaminated with Euphorbia helioscopia or E. nubica, results in poisoning of the dams as well as their suckling kids. General signs of toxicity were emaciation, depression, shedding of body hair, arching of back, and possible death. Post-mortem changes of dams and dead suckling kids included congestion and hemorrhage in cardiac muscle, lung, liver, and kidneys. Blood analyses of goats exposed to these contaminants showed an increased level of serum alanine amino transferase compared to control samples, indicating cellular destruction in the liver. The latter was confirmed by histopathological changes in the organ which include severe congestion, necrosis, and degenerative changes. The goats also suffered from deterioration of renal function as indicated by increased blood urea nitrogen and creatinine levels. In histopathologic inspections of kidney, severe congestion, hemorrhage in the cortex and medulla, as well as necrosis of epithelial cells of kidney tubules were noticed. Considerable degenerative changes were also observed in heart and lung. The pathophysiological appearances indicate that by feeding on the Euphorbia species mentioned above, the goats are poisoned in a way similar to the case of E. peplus reported previously. Such intoxication most likely is due to irritant and hyperplasiogenic diterpene ester (DTE) toxins, usually present in the aerial parts of Euphorbia species and well known as tumor promoters in mouse skin. After ingestion of the toxic plant parts by the goats, the DTE toxins might be metabolized and thereby partially detoxified. Yet, at least in part, they may show up in the milk of the goats, as indicated by severe poisoning of their suckling kids. As discussed previously in lactating goats fed on fodder contaminated with E. peplus, tumor promoters of the DTE type may enter the human food chain via this source of milk. Such milk may be considered a valuable etiologic model for the investigation of economic, ecologic, and public health problems raised by human diet polluted with tumor promoters, i.e., conditional (non-genotoxic) cancerogens.

Dietary cancer risk from conditional cancerogens (tumor promoters) in produce of livestock fed on species of spurge (Euphorbiaceae). V. Skin irriitant and tumor-promoting diterpene ester toxins of the tigliane and ingenane type in the herbs Euphorbia nubica and Euphorbia helioscopia contaminating fodder of livestock

Irritant diterpene ester toxins were isolated from Euphorbia nubica and E. helioscopia, which are contaminants of the green fodder of livestock in Egypt. Fractionations of methanol extracts of aerial parts of both plants were monitored by the irritation unit on the mouse ear. Plant extracts were subjected to multiplicative distribution methods, yielding irritant hydrophilic fractions that were further purified by column chromatography. Final purification of the materials was achieved by TLC (silica gel) followed by HPLC, or by TLC alone. In this way, from E. nubica, five Euphorbia factors (Nu1-Nu5) were isolated and characterized as short-chain polyfunctional diterpene esters of tigliane-type parent alcohols. The two weak irritants Nul and Nu3 were triesters of 4-deoxy(4alpha)phorbol. Nu2 was shown to be a triester of the stereoisomeric tigliane-type parent alcohol 4-deoxyphorbol. Weak irritant Nu4 probably is a positional isomer of Nu2. Nu5 was characterized as a short-chain triester of 4,20-dideoxy-5xi-hydroxyphorbol. From E. helioscopia, six short- to medium-chain polyfunctional diterpene esters of the ingenane type, generally containing unsaturated acids were obtained, i.e., four irritant esters of ingenol (Euphorbia factors H1, H2, H5, and H6) and two esters of 20-deoxyingenol (non-irritant Euphorbia substance HS4, and irritant Euphorbia factor H8). All irritant Euphorbia factors of the tigliane and ingenane diterpene ester type described in this investigation are considered to be more or less active tumor promoters, i.e., conditional (non-genotoxic) cancerogens. The Euphorbia factors assayed exhibited moderate (H1) to low (H8) relative tumor-promoting potency in comparison to the ingenane prototype DTE tumor promoter 3-TI.

A novel polypeptide p10 expressed in tumor-promoter-treated murine epidermis and in untreated neonatal murine epidermis

12-O-Tetradecanoyl-phorbol-13-acetate (TPA) has been shown to induce a broad variety of morphological and metabolic changes in mouse skin. These include gross changes in cell growth as well as subtle changes regarding gene expression. Changes in the induction of specific proteins have been described, but it is not yet clear, if there exists a strict causal correlation between the induction of expression of specific proteins and the phenomenon of tumor promotion. At least some of these proteins might also be correlated with an accompanying hyperproliferative effect. This has been shown for protein p10, a 10 kDa protein not found in untreated adult mouse epidermis. The expression of this protein can be induced de novo after the topical administration of TPA. It is also shown, that p10 is expressed in untreated neonatal murine epidermis. Due to the induction of this protein by irritation, hyperproliferation-causing tumor promoters and due to the observable abundance in neonatal epidermis, this protein seems not strictly related to tumor promotion, but rather to proliferation and differentiation.