Factors impacting neurosurgery residents' operative case volume: a nationwide survey

OBJECTIVE

Neurological surgery residency remains one of the most competitive and longest specialties in terms of training in medicine. The Accreditation Council for Graduate Medical Education uses residents' case volume throughout residency as one of its measures for the quality of surgical training. The objective was to study the variability of residency case volume among US training programs and to analyze the factors that potentially influence that case volume.

METHODS

In line with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines, an online survey regarding department size, case volume, number of residents per year, number of dedicated research years, presence of fellows, and resident case volume by the time of graduation was created using Google Forms and distributed to all neurosurgery residency program directors and coordinators in the US.

RESULTS

A total of 97 of the 115 programs (84.3%) responded to the survey. Fifteen programs were excluded due to missing data or incomplete resident cohort at the time of the survey, and a total of 82 programs were included in the analysis. The average number of cases performed by residents as lead or senior surgeons by the time of graduation ranged from 900 to 2250 (median 1600 cases). The resident case volume did not have a significant correlation with the program case volume, number of operating attending neurosurgeons, number of residents, number of research years, or presence of fellows. The only factor that impacted the resident case volume was the number of cases performed per faculty.

CONCLUSIONS

The number of cases performed by residents throughout residency varied significantly between programs. Although other factors play important roles in the quality of training, including autonomy, variation, and complexity of cases, the resident case volume is one of the only measurable factors. This study sheds some light on the factors that potentially influence neurosurgical resident case volume.

Traumatic Subarachnoid-Pleural Fistula with Pneumocephalus

Traumatic subarachnoid-pleural fistula is an uncommon occurrence. We present a case of a patient sustaining a subarachnoid-pleural fistula after a gunshot wound to the neck, which ultimately resulted in substantial pneumocephalus. The patient underwent successful operative repair of the fistula with notable improvement and resolution of pneumocephalus.

Toxoplasma gondii, Herpesviridae and long-term risk of transition to first-episode psychosis in an ultra high-risk sample

BACKGROUND

Ultra high-risk (UHR) criteria were introduced to identify people at imminent risk of developing psychosis. To improve prognostic accuracy, additional clinical and biological risk factors have been researched. Associations between psychotic disorders and infections with Toxoplasma gondii and Herpesviridae have been found. It is unknown if exposure to those pathogens increases the risk of transition to psychosis in UHR cohorts.

METHODS

We conducted a long-term follow-up of 96 people meeting UHR criteria, previously seen at the Personal Assessment and Crisis Evaluation (PACE) clinic, a specialized service in Melbourne, Australia. Transition to psychosis was assessed using the Comprehensive Assessment of the At-Risk Mental State (CAARMS) and state public mental health records. The relationship between IgG antibodies to Herpesviridae (HSV-1, HSV-2, CMV, EBV, VZV) and Toxoplasma gondii and risk for transition was examined with Cox regression models.

RESULTS

Mean follow-up duration was 6.46 (±3.65) years. Participants who transitioned to psychosis (n = 14) had significantly higher antibody titers for Toxoplasma gondii compared to those who did not develop psychosis (p = 0.03). After adjusting for age, gender and year of baseline assessment, seropositivity for Toxoplasma gondii was associated with a 3.6-fold increase in transition hazard in multivariate Cox regression models (HR = 3.6; p = 0.036). No significant association was found between serostatus for Herpesviridae and risk of transition.

CONCLUSIONS

Exposure to Toxoplasma gondii may contribute to the manifestation of positive psychotic symptoms and increase the risk of transitioning to psychosis in UHR individuals.

Traumatic Atlantoaxial Dislocation without Neurologic Deficit

Traumatic atlantoaxial dislocation without associated odontoid fracture or neurologic deficit is rare. We present the case of a 39-year-old male pedestrian who was struck by a vehicle and sustained a traumatic grade 4 C1-2 retrolisthesis. Closed reduction was successful, and the patient underwent posterior occipitocervical fusion. His neurologic status was good throughout the hospital stay, and he was discharged to a rehabilitation facility with full strength.

Natural infections by Cryptosporidium sp. in farm-raised ducks and geese

Modified Ziehl-Neelsen staining and an indirect immunofluorescent assay appeared to be equally useful for monitoring natural infections with Cryptosporidium sp. in farm-raised Pekin ducklings and Danish goslings. In 73 of 128 ducklings, and in 44 of 74 goslings, Cryptosporidium sp. were detected. Tissues from the bursa of Fabricius are most frequently positive in both species. The presence or absence of the parasite could not be correlated with clinical signs or lesions and/or poor performance of the birds. Oocysts from ducklings could not be transmitted to suckling mice but were infectious for ducklings. Oocysts from calves were infectious for mice but not for ducklings. These findings support the view that mammals and birds have different Cryptosporidium spp.

Extraventricular neurocytoma of the spinal cord in a dog

Central neurocytoma is a rare, prognostically favorable neuronal tumor of the human central nervous system, typically located intraventricularly near the foramen of Monro. Extraventricular cerebral neurocytomas and spinal tumors have also been reported. To date, however, neurocytomas have not been documented in domestic animal species. In this report, we describe a spinal cord tumor in a dog. The microscopic examination revealed tumor cells forming loosely packed clusters in some areas and palisades in other areas. In addition, they showed fine fibrillary neuropil-like areas of different sizes, sometimes resembling the "rosettes" of pineocytomas, as well as ependymoma-like perivascular pseudorosettes. The tumor cells had scant eosinophilic cytoplasm, with perinuclear halos, closely resembling the appearance of oligodendroglioma. Immunohistochemical staining showed expression of synaptophysin and neuron-specific enolase by tumor cells and pronounced in fibrillary areas. On the basis of histomorphology and immunohistochemical reactivity, the present tumor was diagnosed as extraventricular neurocytoma.

Lymphoplasmazelluläre Enteritis bei einem adulten Warmblutwallach

Gegenstand: Ein 14-jähriger Hannoveranerwallach wurde wegen seit 4 Wochen zunehmender Abmagerung, Inappetenz, Ödemen und Diarrhö vorgestellt. Der Patient wurde klinisch, endoskopisch, ultrasonographisch, labordiagnostisch sowie pathologisch-anatomisch und histopathologisch untersucht. Ergebnisse: Die klinische Untersuchung ergab Inappetenz, Apathie, Unterbauch- und Präputialödeme sowie Diarrhö. Bei der labordiagnostischen Untersuchung wurde eine Hypoproteinämie (41,3 g/l) mit Hypalbuminämie (17,7 g/l) festgestellt. D-Xylose- und D-Glukose-Resorptionstests ergaben eine hochgradige Aufnahmestörung von Kohlenhydraten. Diegestellte Diagnose lautetechronische Enteritis mitMalabsorption im Dünndarm. Aufgrund der schlechten Prognose wurde das Pferd euthanasiert. Die pathologisch-anatomische Untersuchung ergab im Dünndarm ein mittelgradiges und im Dickdarm ein hochgradiges submuköses Ödem der Darmwand sowie multiple Schleimhautdefekte von etwa 0,5 cm Durchmesser im gesamten Kolon und Zäkum. Histopathologisch ließ sich in Dünndarm und Dickdarm eine hochgradige diffuse Infiltration der Lamina propria und der Submukosa mit Lymphozyten und Plasmazellen nachweisen und es wurde die Diagnose lymphoplasmazelluläre Enterokolitis (LPE) gestellt. Schlussfolgerung: Die lymphoplasmazelluläre Enterokolitis muss bei chronischer Diarrhö mit Abmagerung auch beim Pferd differenzialdiagnostisch erwogen werden. Die sichere Diagnose erfordert eine histologische Untersuchung. Klinische Relevanz: Beimerwachsenen Pferd sind Abmagerung und Diarrhö in seltenen Fällen auf eine Dysfunktion des Dünndarms zurückzuführen. Eine Kohlenhydrat-Aufnahmestörung des Dünndarms lässt sich durch den Xylose-Resorptionstest nachweisen, wobei sich zugrunde liegende morphologische Veränderungen ausschließlich mithilfe histologischer Untersuchung von Darmbioptaten bestätigen lassen.

Gongylonema pulchrum infection and esophageal squamous cell carcinoma in a vari (Lemur macaco variegata; Kehr 1792)

This report describes the morphologic and histologic features of a case of esophageal Gongylonema pulchrum infection and esophageal squamous cell carcinoma in a 17-yr-old, female vari (Lemur macaco variegates). The lemur had lived in a German zoo and had a clinical history of dyspnea, vomiting, and anorexia. At necropsy, a whitish, soft, nodular, centrally necrotic mass was found in the caudal third of the esophagus. In addition, numerous intraepithelial nematodes (G. pulchrum) were observed in the entire esophagus. Results suggest a relation between infection with G. pulchrum and development of an esophageal squamous cell carcinoma.

Influence of different tumour types on natural cytotoxicity (NK cell activity) and mitogen-induced lymphocyte proliferation in isolated blood lymphocytes from 110 dogs with tumours

The cell-mediated immune response of blood lymphocytes from 110 untreated dogs with different tumours was evaluated. The influence of different tumour types on the cellular immune system was examined by assessing the percentage of isolated large granular lymphocytes (LGL), in vitro natural cytotoxicity and mitogen-induced lymphocyte proliferation. Although the overall natural cytotoxicity of dogs with different tumours was decreased, the overall difference from control values was not statistically significant. However, mitogen-induced lymphocyte proliferation was significantly depressed in dogs with tumours in comparison with the controls. Dogs with mammary carcinomas showed significantly lower natural cytotoxicity than controls and dogs with myeloid neoplasms showed significantly lower mitogen-induced lymphocyte proliferation. Abnormalities exist not only in natural cytotoxicity but also in mitogen-induced lymphocyte proliferation. For the dog, this is the first study to assess the influence of different tumours using a combined evaluation of natural cytotoxicity and mitogen-induced lymphocyte proliferation in such a large number of animals.

Induction of apoptosis by canine natural killer cells

Besides a secretory pathway of canine natural killer (NK) cells, which results in necrosis of the target cell, a second pathway was demonstrated, which results in apoptosis of the target cell. Comparing the Chromium Release Assay (CRA) and the Rose Bengal Assay (RBA) for quantification of in vitro canine NK cell activity, a constant 10% higher NK cell activity was found in the RBA compared with the CRA. To find out the mechanism responsible for the different results of both tests, morphological studies of in vitro canine NK cell activity against epithelial and mesenchymal allogenic target cell lines were performed. Most target cells were undergoing necrosis as a result of NK cell killing, which was evidenced by transmission electron microscopy. However, besides necrotic target cells, shrunken target cells with dense cytoplasm, fragmented nuclei and disruption into membrane-bound bodies were detected, which are known as signs of apoptosis. Additionally, using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling (TUNEL) method, 13-23% of target cells presented a positive staining, indicative of apoptosis. These findings give evidence for the ability of canine NK cells to kill their target cells via two different pathways, which results either in apoptosis or necrosis.

Investigation of several selected adjuvants regarding their efficacy and side effects for the production of a vaccine for parakeets to prevent a disease caused by a paramyxovirus type 3

The infection with paramyxovirus type 3 (PMV-3) of parakeets can lead to severe illness in small psittacines (Neophema spp. and other parakeets) as well as in passerines (finches). The disease is characterized by acute or chronical pancreatitis and central nervous symptoms, such as torticollis as well as walking in circles and by high mortality rates in the affected flocks. As there is no licensed vaccine for psittacines available to prevent this disease. The aim of the following study was to find a suitable vaccine formulation for parakeets with inactivated PMV-3 and a well-tolerated and effective adjuvant. Seven adjuvants have been examined in ovo and in vivo regarding their efficacy and side effects. In these investigations, the classical Freund's complete Adjuvant (FCA) and Freund's incomplete Adjuvant (FICA) and Alhydrogel, but also the more recent developments TiterMax Gold, Specol, Gerbu Adjuvant 100, and Diluvac Forte have been used. Regarding its efficacy and side effects, the vaccine formulation "PMV-3/Specol" has been evaluated positively and can be recommended for the production of a PMV-3 vaccine for parakeets.

Sonographische Untersuchung von Mammatumoren der Hündin

In der vorliegenden Untersuchung wurden verschiedene präoperativ im zweidimensionalen Sonogramm erhobene Kriterien auf ihre Eignung zur präoperativen Dignitätseinschätzung kaniner Mammatumoren überprüft. Dazu wurden die vor der Operation an 90 Gesäugeneoplasien erfassten sonographischen Eigenschaften mit den postoperativen histopathologischen Befunden verglichen. Bei folgenden Parametern gelang eine statistisch abzusichernde Zuordnung zu den beiden Tumorgruppen benigne und maligne: Form (p < 0,001), Gewebebeziehung (p < 0,001), echogener Randsaum (p < 0,05), Echogehalt (p < 0,001), Echomuster (p < 0,001), Schallverstärkung (p < 0,001), Schallschwächung (p < 0,01) und Randschatten (p < 0,01). Die Daten zeigen, dass mithilfe der Sonographie präoperative Aussagen zur Dignität kaniner Mammatumoren möglich sind. Eine Verbesserung dieses diagnostischen Verfahrens verspricht die Bewertung verschiedener sonographischer Parameter in Kombination, was Gegenstand einer laufenden Untersuchung ist.

Decreasing fibrogenesis: an immunohistochemical study of paired liver biopsies following lamivudine therapy for chronic hepatitis B

BACKGROUND

Activation of hepatic stellate cells is the earliest step in fibrogenesis. Alpha-smooth muscle actin (alpha-SMA), expressed by activated hepatic stellate cells, and C-terminal procollagen alpha1(III) propeptide (PIIICP) are early markers of fibrogenesis and should precede fibrosis.

AIM

Determine if suppression of hepatitis B virus replication with lamivudine would decrease fibrogenesis as measured by immunohistochemical markers.

METHODS

Paired liver biopsies from patients with hepatitis B before and after therapy with lamivudine (n=47) or placebo (n=33) were studied. alpha-SMA and PIIICP were detected in paraffin-embedded tissue by immunohistochemistry and quantified in a blinded manner by video imaging analysis.

RESULTS

Liver biopsies from patients treated with lamivudine showed a significant decrease in alpha-SMA expression (1.06+/-0.23 vs. 0.58+/-0.11, pre vs. post, P<0.05). Placebo recipients had increased levels of alpha-SMA (0.82+/-0.14 vs. 1.32+/-0.21, P<0.05). PIIICP was similarly decreased after lamivudine. Among subjects whose Histologic Activity Index fibrosis score was unchanged or worsened, the mean change in alpha-SMA expression was significantly decreased in the lamivudine group compared with placebo.

CONCLUSIONS

Lamivudine decreased markers of hepatic stellate cell activation and collagen synthesis. Immunohistochemical techniques are sensitive for assessing fibrogenesis and will be useful in trials of antiviral and antifibrotic agents.

An immunoassay for canine pancreatic elastase 1 as an indicator for exocrine pancreatic insufficiency in dogs

The detection of pancreatic elastase 1 in stool samples has become the noninvasive gold standard for the diagnosis of pancreatic insufficiency in humans. Accordingly, the development of a sandwich-ELISA specific for canine pancreatic elastase 1, based on monoclonal antibodies, is presented here. The test has a detection range of 4-240 microg canine pancreatic elastase l/g feces. The intraassay coefficient of variation is 7.4%, and the interassay coefficient of variation is 7.7%. Spiking experiments show that canine elastase 1 is quantitatively detectable in fecal samples. Interestingly, the range of the elastase 1 concentration in canine feces within several days is higher as compared with humans. As the proposed cutoff of 10 microg/g is below this variation range in 96.1% of the tested samples, the effect on the test specificity is negligible. Because the test detects neither human nor bovine and porcine elastase 1, pancreatic function can be monitored without interrupting an enzyme replacement therapy.

Postoperative radiotherapy of NSCLC--outcome after 3-D treatment planning

AIM

To evaluate the benefit of postoperative radiotherapy depending on lymph node involvement in non-small-cell lung cancer (NSCLC).

PATIENTS AND METHOD

Retrospective analysis of patients with NSCLC, who have been treated at the University of Giessen between 1986 and 1996 by surgery (n = 437) or surgery and 3-D planned postoperative radiotherapy with 50-60 Gy (n = 115). Evaluation of survival rates and risk of death depending on postoperative radiotherapy taking into account N-category, tumor stage, completeness of resection and performance status.

RESULTS

With individually 3-D planned postoperative radiotherapy there was a lower risk of death in all stages with lymph node metastases. The relative risks of death and the 95% CI were in pN1 0.64 (0.39-1.03), in pN2 0.31 (0.18-0.56) and in pN3 0.25 (0.10-0.64).

CONCLUSION

Our results suggest that the risk of death in NSCLC with lymph node involvement can be reduced by individually 3-D planned postoperative radiotherapy.

[CD143 expression in testicular germ cell tumors]

CD143 (angiotensin I-converting enzyme) occurs in two isoforms: a testicular form (tCD143) expressed during spermatogenesis, and a somatic form (sCD143) generally found in certain other cell types. To study these isoforms in normal and neoplastic germ cells of humans, we analyzed a broad collective of different testicular germ cell tumors (GCTs) of adults, adjacent intratubular germ cell neoplasms (IGCNs), and testicular tissues representing the regular germ cell development. Different techniques were employed on fresh frozen and formalin-fixed, paraffin-embedded tissues: CD143-mRNAs were analyzed by RT-PCR on selected cells after UV-laser-assisted cell picking and by in-situ hybridization using cRNA probes; the proteins were analyzed by semi-quantitative immunohistochemistry using monoclonal antibodies to CD143, and to PLAP/GCAP as controls. In contrast to normal germ cells bearing only tCD143 during spermiogenesis, both mRNA and protein of sCD143 were detected in neoplastic cells of all IGCNs and in the majority of seminomas. sCD143 expression also was found during testicular development, but was differently regulated in fetal germ cells and in GCTs compared with PLAP/GCAP. Thus, our findings (i) demonstrate profound changes in the expression of both CD143 isoforms during regular germ cell development and maturation, (ii) suspect sCD143 being involved in the regulation of germinal stem cell proliferation, (iii) are in agreement with the concept of an 'embryonic state' of neoplastic germ cells, (iv) indicate a close molecular relationship between IGCN and seminoma and, finally, (v) suggest sCD143 as an appropriate marker in the diagnosis of seminomas in addition to PIAP/GCAP.

Lymphocyte subpopulations in the caecum mucosa of rats after infections with Eimeria separata: early responses in naive and immune animals to primary and challenge infections

This study aimed to characterise the local (intestinal) immune response of rats after primary and challenge infections with Eimeria separata. Naive rats and rats which had been immunised by two moderate infections were exposed to a heavy infection with 100000 oocysts per animal. Necropsies were performed 0, 24 and 48 h after infection and lymphocyte subpopulations were microscopically quantified in the caecum mucosa after marking by immunohistological techniques. There was no difference between naive and immune rats concerning the number of CD45R(+) (B) cells, whereas significantly more CD3(+) (T) cells were found in the caecum wall of the immune rats. CD4(+) T cells predominated in animals after primary infection, whereas CD8(+) T cells represented the major T-cell subset in challenged rats. The proportion of TCRgammadelta(+) T cells did not differ in the mucosa between the groups examined, whereas challenged rats showed significantly increased numbers of TCRalphabeta(+) T cells in the caecum wall when compared with animals after a primary infection. Thus, CD4(+) T cells may be particularly involved in the immune response to a primary infection of rats with E. separata whereas immunity to a challenge infection seems to be mediated predominantly by CD8(+) and TCRalphabeta(+) T cells.

Somatic isoform of angiotensin I-converting enzyme in the pathology of testicular germ cell tumors

Retained fetal expression of angiotensin I-converting enzyme (ACE, CD143) has recently been shown in intratubular germ cell neoplasms (IGCN) and invasive germ cell tumors (GCT), suggesting the somatic isoform (sACE) as a characteristic component of neoplastic germ cells. We analyzed the distribution of sACE in 159 testicular GCT, including 87 IGCN. sACE protein was determined by immunohistochemistry (MAb CG2) on routinely formalin-fixed and paraffin-embedded tissue sections, supplemented by mRNA expression analysis using in situ hybridization. These data were compared with those obtained by germ cell/placental alkaline phosphatases (PIAP; MAbs PL8-F6 and 8A9) employing an uniform score system for the evaluation of immunoreactivity (IRS; possible values from 0 to 12). Expression of sACE and PIAP was found in all 87 analyzed IGCN (IRS > 4, median IRS of 12). Heterogeneous staining patterns were not related to the type of adjacent GCT but correlated with low expression in adjacent seminomas (P =.032 for sACE; P =.005 for PIAP). Both sACE and PIAP often showed a decreased and more heterogeneous but still moderate expression in 91 classic seminomas (median IRS of 8) and were completely absent in tumor cells of spermatocytic seminomas. Despite all similarities, we found sACE and PIAP differently regulated during GCT progression. This was documented by a well-preserved expression of either sACE or PIAP or both in all classic seminomas, low PIAP immunoreactivity in metastasis of seminomas, and completely diverging expression patterns in nonseminomatous GCT. Our findings underline the close molecular relationship between IGCN and seminoma, and suggest sACE as an appropriate marker for seminomatous differentiated tumors. HUM PATHOL 31:1466-1476.

Immunity in rats against Eimeria separata: oocyst excretion, effects on endogenous stages and local tissue response after primary and challenge infections

The aim of the study was the characterization of the local immune response of Lewis rats to Eimeria separata, a caecum-dwelling coccidium. Rats infected twice at 10-day intervals with 5,000 oocysts developed a high degree of immunity to a heavy challenge with 100,000 oocysts, reducing the oocyst production by > 98% when compared with naive recipients. Histopathological investigations performed over a period of 0-72 h post-infection (pi) showed that 1st generation schizonts, developed within 24 h pi, represented the major target stages, although later stages were also affected. Preinfected animals showed significantly more lymphocytes in the caecum wall than naive animals. An increase in lymphocyte numbers after challenge observed in both groups was enhanced in challenged animals up to 36 h pi. The number of lamina propria lymphocytes predominantly was increased after primary infection whereas in repeatedly infected animals the increase also concerned intraepithelial lymphocytes. In addition, the numbers of plasma cells were enhanced in the caecum wall of immune animals. Macrophage infiltration in the caecum wall followed a similar time course in both groups up to 36 h pi. A subsequent further rise up to 48 h pi was enhanced in naive rats. Tissue infiltrations with eosinophils and mast cells were observed predominantly in the repeatedly infected rats. No obvious changes occurred with intestinal neutrophils and goblet cells. In conclusion, caecum tissue alterations suggest an early local immune response, which is related to development and maturation of the parasite.

Evaluation of canine lymphocyte proliferation: comparison of three different colorimetric methods with the 3H-thymidine incorporation assay

To evaluate canine lymphocyte stimulation the radioactive thymidine incorporation assay is still the method of choice. In order to find a suitable non-radioactive alternative to the standard 3H-thymidine incorporation assay, proliferation of canine peripheral blood lymphocytes (PBL) was measured with three different colorimetric assays, using the two tetrazolium salts MTT and XTT and 5-bromo-deoxyuridine (BrdU). Isolated canine PBL were stimulated with two different mitogens, Concanavalin A (Con A) and Phytohemagglutinin (PHA), using different culture conditions. Applying statistical analysis we found that BrdU and MTT showed a high correlation to the 3H-thymidine incorporation assay, although the BrdU assay proved to be more sensitive than the MTT assay. No significant correlation between the XTT assay and the radioactive method was demonstrated. Consequently, the BrdU assay is the most suitable alternative to the radioactive method.

[Cystic testicular anomaly with subsequent stenosis of the small intestine in an emerald tree boa (Corallus caninus L., 1758)]

A case report with emphasis on diagnostic procedures and differential diagnoses is given. The etiology is discussed in comparison to similar malformations in mammals and other reptiles. The literature is reviewed with emphasis on differential diagnostic aspects.

Primary cancer of the fallopian tube. Treatment and results of 37 cases

OBJECTIVE

A collective of 37 patients with primary cancer of the fallopian tube treated at the Gynecologic Clinic of the Justus Liebig University of Giessen, between 1976 and 1995 was retrospectively evaluated for stage, histo-pathology, treatment and results.

PATIENTS

Median age was 61.5 years, FIGO stages: I 17 (45.9%), II 7 (18.9%,. III 12 (32.4%), and IV 1 (2.7%). Histopathology: adenocarcinoma 45.9%, papillary adenocarcinoma 27%, solid carcinoma 8.1%, undifferentiated carcinoma 5.4%, and others 13.6%.

TREATMENT

24 patients (64.9%) underwent complete bilateral salpingo-oophorectomy and hysterectomy (BSOH); 13 (35.1%) had incomplete surgery. POSTOPERATIVE TREATMENT: 31 patients (83.8%) had chemotherapy (since 1982 with platinum), 28 (75.7%) intraperitoneal radionuclides, 23 (62.2%) percutaneous irradiation, and 6 (16.2%) additional vaginal brachytherapy.

RESULTS

The cumulative survival rates were 40% for the total of 37 patients, stage I 68%, stage II 29%, stage III 10%, stage IV 0%. From 1976 to 1985 the cumulative survival rate was 25%, from 1986 to 1995, 54%. Stage was a significant prognostic factor (p = 0.0001), surgery, age, chemotherapy and irradiation were not. Severe complications occurred in 7 patients (18.9%): 4 fistulas, 1 myelosuppression, 1 ileus, 1 peritonitis.

CONCLUSION

Due to the long period of time and alterations in the mode of treatment the benefit of single treatment modalities could not be evaluated, but prognosis-dependent multimodality treatment (radical surgery, irradiation, platinum-containing chemotherapy) has resulted in higher 5-year survival rates for the last decade.

Isolation, characterization, and organ-specific expression of two novel human zinc finger genes related to the Drosophila gene spalt

The region-specific homeotic gene spalt (sal) of Drosophila specifies head and tail as opposed to trunk segments. During later stages of ontogenesis, sal is also expressed and required in a small number of tissues and organs in the developing embryo. sal encodes a zinc finger protein of unusual but characteristic structure. We made use of these unique features to isolate sal-like genes from humans. Here we report the isolation and molecular characterization of two sal-like transcription units, termed Hsal1 and Hsal2, which are located on chromosomes 16q12.1 and 14q11.1-q12.1, respectively. Their transcripts are expressed in a limited number of adult organs, including the brain. While Hsal2 is evenly expressed in different brain areas, Hsal1 transcripts preferentially accumulate in the corpus callosum and the substantia nigra. In the fetal brain, transcripts of both genes were detected in neurons. The arrangement of sal-like zinc finger domains and their high degree of sequence similarity suggest a novel and conserved subfamily of human zinc finger transcription factors that is closely related to the Drosophila gene product encoded by the gene sal.

A new colorimetric method for measuring cell-mediated cytotoxicity in dogs

In order to replace the radioactive 51chromium release assay (CRA), a colorimetric method for the determination of cell-mediated cytotoxicity of natural killer (NK) effector cells of dogs and adherent target cells was developed using the dye Rose Bengal (RB). After a 14 h incubation period of leucocytes isolated from the peripheral blood (PBL) of dogs and a natural killer cell-sensitive canine adenocarcinoma cell line (CTAC), effector and lysed target cells were removed by washing, and the surviving adherent target cells were stained with RB. The optical density (OD) of the remaining target cells was measured in a microspectrophotometer (ELISA reader) and was found to correspond to the number of surviving cells, and thus was inversely correlated to the cytotoxic activity. The RB assay revealed almost identical cytotoxic values when compared with the CRA. In contrast to this assay the RBA is quick and easy to perform, inexpensive and avoids radioactive materials and waste. However, the method is restricted to adherent target cells.

Round cell sarcomas of possible myelomonocytic origin localized at the lip of aged dogs

Four round cell tumors, situated at the lip of dogs older than 4 years of age, which could not be further classified, were examined light and electron microscopically, immunocytochemically and in part functionally and cytochemically. Immunocytochemically they were positive for vimentin, but negative for cytokeratin, desmin, neurofilament, synaptophysin, S-100 protein, neuron specific enolase, lysozyme, IgG and a pan-T-cell marker. Cell lines were established from two malignant neoplasms. In vitro, neoplastic cells had morphological, functional and cytochemical properties of myelomonocytic cells. A tumor cell-specific polyclonal rabbit antiserum reacted immunocytochemically positive with primary and recurrent tumors and metastases of the original and the three other round cell tumors. Immunoblotting demonstrated a main band with approximately 65-75 kDa. All four tumors were present in aged dogs and metastasized. They most likely represent a distinct group of malignant tumors among the canine round cell tumors.

[Two mesenchymal tumor cell lines for the determination of natural killer (NK) cell activity in the peripheral blood of dogs]

The two mesenchymal cell lines K1 and K6 were established from round cell tumours located at the lips of two dogs. Both cell lines were characterized as being of myelomonocytic origin by morphological, cytochemical, immunocytochemical and functional criteria. In the 51chromium release assay (effector/target cell ratio 100/1) the K6-cell line revealed a mean cytotoxic sensitivity of 53.6% and thus showed a susceptibility similar to that of the epithelial CTAC line (57.8%). The K1-cell line exhibited less cytotoxic activity (41%) when incubated for 14 h, but showed results comparable to the K6-cell line, when the incubation time was reduced to 8 h.

A human cDNA coding for the Leydig insulin-like peptide (Ley I-L)

cDNA clones for the human Leydig insulin-like peptide (Ley I-L) have been isolated and characterized. The nucleotide sequence of the 743-bp cDNA includes an incomplete 7-bp 5'-noncoding region, an open reading frame of 393 bp, and a 343-bp 3'-noncoding region. By primer extension analysis, the transcription start site was determined as being 14-bp upstream of the translation start site. The underlying gene is expressed in the testis but not in other organs. From the cDNA sequence, it can be deduced that the Ley I-L protein is synthesized as a 131-amino-acid (aa) preproprotein and that it contains a 24-aa signal peptide. Comparison of the pro Ley I-L protein with members of the insulin-like hormone superfamily predicts that the biologically active hormone, after proteolytic processing of the C peptide, consists of a 31-aa long B chain and a 26-aa long A chain, and that it has a molecular weight of 6.25 kDa.

Structural organization of the porcine and human genes coding for a Leydig cell-specific insulin-like peptide (LEY I-L) and chromosomal localization of the human gene (INSL3)

Leydig insulin-like protein (LEY I-L) is a member of the insulin-like hormone superfamily. The LEY I-L gene (designated INSL3) is expressed exclusively in prenatal and postnatal Leydig cells. We report here the cloning and nucleotide sequence of porcine and human LEY I-L genes including the 5' regions. Both genes consist of two exons and one intron. The organization of the LEY I-L gene is similar to that of insulin and relaxin. The transcription start site in the porcine and human LEY I-L gene is localized 13 and 14 bp upstream of the translation start site, respectively. Alignment of the 5' flanking regions of both genes reveals that the first 107 nucleotides upstream of the transcription start site exhibit an overall sequence similarity of 80%. This conserved region contains a consensus TATAA box, a CAAT-like element (GAAT), and a consensus SP1 sequence (GGGCGG) at equivalent positions in both genes and therefore may play a role in regulation of expression of the LEY I-L gene. The porcine and human genome contains a single copy of the LEY I-L gene. By in situ hybridization, the human gene was assigned to bands p13.2-p12 of the short arm of chromosome 19.

Cloning of a cDNA for a novel insulin-like peptide of the testicular Leydig cells

We have isolated complementary DNA clones coding for a novel member of the insulin-like hormone super-family from a boar testis cDNA library. Northern blot analysis and in situ hybridization revealed that the gene is expressed exclusively in prenatal and postnatal Leydig cells. We have tentatively proposed the name Leydig insulin-like (Ley I-L) for the gene and its encoded protein. The Leydig insulin-like protein is synthesized as a 131-amino acid preproprotein, which contains a 24-amino acid signal peptide. Comparison of the deduced amino acid sequence of pro-Leydig insulin-like protein with members of the insulin-like hormone superfamily predicts that the biologically active protein, after proteolytic processing of the C-peptide, consists of a 32-residue-long B-chain and a 26-residue-long A-chain and has a molecular size of 6.25 kDa.

Endocardial pacing, cardioversion and defibrillation using a braided endocardial lead system

The clinical efficacy and safety of a second-generation braided endocardial pacing, cardioversion and defibrillation lead system was evaluated in 25 patients with ventricular tachycardia (VT) or ventricular fibrillation (VF). The lead system consisted of two 8Fr active fixation endocardial leads each with pacing and defibrillation electrodes and a thoracic patch electrode. Monophasic and biphasic shocks were delivered using a triple-electrode configuration with a right ventricular common cathode and right atrial and thoracic patch anodes. VT and VF were electrically induced. Rapid VT (rate > or = 180 beats/min) and VF were initially terminated by 20 J (550 V) shocks and slow VT (rate < 180 beats/min) by 10 J (400 V) shocks. One hundred fourteen episodes (rapid VT/VF 73, slow VT 41) were treated with 128 shocks (monophasic 80, biphasic 48). Mean ventricular pacing threshold was 0.7 +/- 0.5 ms before and 0.9 +/- 0.5 ms after endocardial shock delivery (p > 0.2). Mean ventricular electrogram amplitude in sinus rhythm was 11.9 +/- 5.7 mV before and 11.4 +/- 5.1 mV after shock delivery (p > 0.2). Simultaneous monophasic endocardial shocks terminated 53% of VF episodes at < or = 20 J. Simultaneous biphasic shocks terminated 94% of all VF episodes at < or = 20 J (p < 0.03). Efficacy of > or = 10 J shocks for rapid VT/VF was greater for biphasic (92%) versus monophasic (74%) shocks (p < 0.05) at lower average shock energy (15 +/- 7 J vs 19 +/- 7 J, respectively, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective comparison of biphasic and monophasic shocks for implantable cardioverter-defibrillators using endocardial leads

Bidirectional shocks using 2 current pathways have been used in endocardial lead systems for implantable cardioverter-defibrillators, but the optimal shock waveform for endocardial defibrillation is unknown. The clinical efficacy and electrical characteristics of bidirectional monophasic and biphasic shocks for endocardial cardioversion-defibrillation of fast monomorphic or polymorphic ventricular tachycardia (VT), or ventricular fibrillation (VF) were evaluated. Thirty-three patients (mean age 60 +/- 12 years, and mean left ventricular ejection fraction 34 +/- 13%) were studied. Defibrillation catheter electrodes were located in the right ventricular apex and superior vena cava/right atrial junction. A triple-electrode configuration including the 2 catheter electrodes and a left thoracic patch was used to deliver bidirectional shocks from the right ventricular cathode to an atrial anode (pathway 1) and the thoracic patch (pathway 2). The shock waveforms examined were sequential and simultaneous monophasic, and simultaneous biphasic. The efficacy of 580 V (20 J) shocks for fast monomorphic VT were comparable for the 3 waveforms (73% for sequential monophasic, 73% for simultaneous monophasic, and 100% for simultaneous biphasic). However, for polymorphic VT and VF, 580 V sequential monophasic shocks had a significantly lower efficacy (25%) than did simultaneous monophasic (75%; p = 0.01) or biphasic (89%; p less than 0.001) shocks. Single-shock defibrillation thresholds with simultaneous biphasic shocks were significantly lower (9 +/- 5 J) than were those with simultaneous monophasic shocks (15 +/- 4 J; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Germ cell-specific expression of a proacrosin-CAT fusion gene in transgenic mouse testis

Acrosin is a serine proteinase located in a zymogen form, proacrosin in the acrosome of the sperm. It is released as a consequence of the acrosome reaction and is believed to be the most important enzyme in the fertilization process. In the mouse, the proacrosin gene is transcribed premeiotically in spermatocytes, but protein biosynthesis starts in haploid spermatids and is restricted to the emerging acrosome. Four lines of transgenic mice harboring 2.3 kb of 5' untranslated region of the rat proacrosin gene fused to the CAT-reporter gene were generated by microinjection of fertilized eggs. The chimeric gene was found to be present in 10-100 copies per genome in the different strains. The 5' untranslated region of rat proacrosin gene could properly direct CAT-gene expression to spermatocytes and CAT-mRNA translation to round spermatids as it is known for mouse proacrosin gene. However, CAT protein is not restricted to the acrosome; rather, it is distributed in the spermatid cytoplasm. This could be due to the lack of DNA sequences for a hydrophobic leader peptide that have been found in all mammalian proacrosins studied until now but that was not present in transgene. It can be concluded from our results that cis-acting sequences required for tissue specific proacrosin expression reside on a 2.3-kb restriction fragment and are conserved in the proacrosin genes of mouse and rat.

Spontaneous chromomycosis in the marine toad (Bufo marinus)

Post-mortem examinations were performed on two marine toads, one animal showing neurological disorders and the other multifocal dermatitis. In one case, lesions consisted of a severe granulomatous encephalomyelitis and in the other of multiple granulomas in the nasal cavity, lungs, heart, bone marrow, ovaries and skin. Histologically, the lesions revealed varying amounts of dark brown fungal elements, predominantly sclerotic bodies indicative of a mycotic infection due to a pigmented fungus.

[Recurring oral aphthae, genital ulcers, erythema nodosum, arthralgias]

A 37-year-old Turkish patient suffered from recurrent oral aphthosis, genital ulcers, skin lesions and inflammatory eye disease. Because of typical history, physical findings and absence of laboratory abnormalities Morbus Behçet was diagnosed. Under treatment with prednisone and azathioprine his symptoms disappeared and there was no recurrence of Behçet disease for three months.

Paleoenvironmental distribution of microfossils and stromatolites in the Upper Proterozoic Backlundtoppen Formation, Spitsbergen

The Upper Proterozoic (ca. 700-800 Ma old) Backlundtoppen Formation, northeastern Spitsbergen, preserves an abundant and varied record of ancient microbial life. Five distinctive microfossil assemblages occur in five equally distinct sedimentary settings; differences among the assemblages appear to reflect original ecological heterogeneity, although taphonomic circumstance may contribute to some distinctions. Microfossil assemblages occur in: oncolites, oolites, and pisolites; stratiform stromatolites and associated intraclastic rudites; partially silicified micrites; and siltites interbedded with quartz arenites. Individual assemblages contain one to eight differentiable taxa; a minimum of 17 distinct populations is present in the formation as a whole. Additional microbial community diversity an be inferred from the presence of domal, columnar, pseudocolumnar, and coniform stromatolites, none of which contains microfossils. On the basis of macrostructure, four stromatolite types appear to be present, but only three distinct mat-building communities can be inferred from microstructural features. Eohyella elongata n. sp., a euendolithic cyanobacterium found in silicified pisolites, is described as new.

Susceptibility of chicken blood lymphoblasts and monocytes to infectious bursal disease virus (IBDV)

PHA-M stimulated lymphoblasts obtained from peripheral blood and separated from small lymphocytes by X 1 g velocity sedimentation, unstimulated blood lymphocytes, monocytes and cells isolated from the bursa of Fabricius of chickens, were infected in vitro by the pathogenic strain CU-1 of infectious bursal disease virus (IBDV). Six hours after infection 32.5 per cent of the bursal cells reacted immunocytologically with IBDV antiserum and had high infectivity titers in plaque assays. Separated lymphoblasts showed a marked lower degree of virus replication and only 2.5 per cent reacted positively when studied by immunocytology, while monocytes ranged between these two cell types with regard to both the degree of virus replication and the positive reaction with IBDV antiserum. Small lymphocytes, however, were found to be totally resistant to IBDV infection. When studied by electron microscopy, virus particles arranged in a crystalloid pattern could only be detected in bursal cells. The results of this study indicate that proliferating lymphoid cells at a certain stage of cellular differentiation are the target cells for IBDV, and that in infected chickens monocytes may play a role in the spreading of the virus.

Monoclonal antibodies directed towards the two major cell populations in the bursa of Fabricius of the chicken

Two mouse monoclonal IgM antibodies, B.1 and B.2, have been produced using the mouse myeloma cell line Sp2/0-Ag 14 and spleen cells from mice immunized with chicken bursa cells. The binding of the monoclonal antibodies to cells in suspension or tissue sections was demonstrated by means of the unlabeled peroxidase-antiperoxidase method. B.1 recognizes 61% of the bursa cells, 10-14% of the cells of spleen and of the peripheral mononuclear blood leukocytes and 1% of the thymus cells. The B.1+ cells are regarded as B cells. Their location in tissue sections corresponds with the known B-dependent areas of lymphoid organs. Competitive binding and double marker experiments proved that the B.1 antigen is distinct from surface immunoglobulin (Ig). In the bursa all B.1+ cells are also Ig+, whereas in the thymus, spleen and blood only about 90% of the B.1+ cells show this conformity. B.2 mainly recognizes so called reticular epithelial and reticular cells of the bursa (36%), thymus (20%) and spleen (13%). The B.2+ cells represent the second major cell population of the bursa.

[Cerebrospinal fluid diagnosis of meningeal cryptococcosis]

Cryptococcosis must be taken into account as a cause of basal meningitis. Along with a case report, clinical signs and guiding cerebrospinal fluid findings are evaluated. Special attention is paid to CSF-cytology, which provides important information in terms of identification and clinical course of the disease. For the first time C. neoformans, yielded from CSF-samples, was investigated by means of scanning electron microscopy, and compared with yeast cultured in laboratory.