Maxillary Ameloblastoma with Local Recurrence, Orbital Invasion, and Systemic Metastases: A Case Report and Review of the Literature

Introduction

Maxillary ameloblastoma is a rare, slow-growing odontogenic tumor that can recur after surgical excision, be locally aggressive, and rarely develop systemic metastases. We describe the course and management of a patient with recurrent maxillary ameloblastoma with orbital invasion and systemic metastases, the fourth case of its kind to be described in the literature.

Case Presentation

A 50-year-old female presented with left hyperglobus. A diagnosis of maxillary ameloblastoma was made based on biopsy and neuroimaging with MRI and CT. Surgical management included partial maxillectomy with orbital floor reconstruction, given the orbital invasion. Three years later, left hyperglobus recurred, and the patient was found to have orbital recurrence and lung metastases on PET imaging. The lung and orbital lesions have responded well to chemoradiation therapy without surgical intervention.

Conclusion

Maxillary ameloblastoma is a rare tumor that typically arises from odontogenic tissues. Though considered benign, they can recur and in the case of our patient, metastasize. Complete surgical excision with wide surgical margins is associated with a shorter average time to recurrence and a lower incidence of metastasis. Cases of metastasis are managed with chemotherapy with or without adjuvant radiotherapy. Precision medicine may play a role in managing this entity in the future, given the discovery of differing profiles of maxillary ameloblastoma compared to mandibular. Ophthalmologists should be aware of this tumor as it can invade the orbit, resulting in significant ocular morbidity and mortality.

Pathophysiological Role of Genetic Factors Associated With Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is a highly prevalent maternal pathology characterized by maternal glucose intolerance during pregnancy that is, associated with severe complications for both mother and offspring. Several risk factors have been related to GDM; one of the most important among them is genetic predisposition. Numerous single nucleotide polymorphisms (SNPs) in genes that act at different levels on various tissues, could cause changes in the expression levels and activity of proteins, which result in glucose and insulin metabolism dysfunction. In this review, we describe various SNPs; which according to literature, increase the risk of developing GDM. These SNPs include: (1) those associated with transcription factors that regulate insulin production and excretion, such as rs7903146 (TCF7L2) and rs5015480 (HHEX); (2) others that cause a decrease in protective hormones against insulin resistance such as rs2241766 (ADIPOQ) and rs6257 (SHBG); (3) SNPs that cause modifications in membrane proteins, generating dysfunction in insulin signaling or cell transport in the case of rs5443 (GNB3) and rs2237892 (KCNQ1); (4) those associated with enzymes such as rs225014 (DIO2) and rs9939609 (FTO) which cause an impaired metabolism, resulting in an insulin resistance state; and (5) other polymorphisms, those are associated with growth factors such as rs2146323 (VEGFA) and rs755622 (MIF) which could cause changes in the expression levels of these proteins, producing endothelial dysfunction and an increase of pro-inflammatory cytokines, characteristic on GDM. While the pathophysiological mechanism is unclear, this review describes various potential effects of these polymorphisms on the predisposition to develop GDM.

Maintaining bucks over 35 days after a male effect improves pregnancy rate in goats

The ovulation can be induced by the introduction of a male among a group of anovulatory goats, a phenomenon called the ‘male effect’. The objective of this study was to determine whether maintaining bucks over 35 days after the initial introduction of males, improves pregnancy rate in goats. We used sexually active bucks, which were joined (n = 2 each) with three groups of goats (n = 30 each): (i) males remained with females for 15 days (Control group); (ii) males remained with females for 35 days (same buck group); (iii) males were removed at Day 23 and replaced by other males, which were not familiar to the females and which remained with females until Day 35 (new buck group). Percentage of goats ovulating did not differ among groups at Day 19 (≥87%; P = 0.12). Pregnancy rates at Day 35 did not differ between groups (≥70%; P = 0.90). At Day 55, pregnancy rates were similar in the same and new buck groups (96%; P = 1.0), but were higher than that of the Control group (73%; P < 0.05). Therefore, maintaining bucks over 35 days after the onset of the male effect improved pregnancy rate more than 20 points compared with females that remained with the same bucks for 15 days only.

Corticosteroids plus long-acting β2-agonists prevent double-stranded RNA-induced upregulation of B7-H1 on airway epithelium

BACKGROUND

Airway viral infections provoke exacerbations of asthma and chronic obstructive pulmonary disease. B7-H1 is a costimulatory molecule that is implicated in an escape mechanism of viruses from host immune systems. This escape may be associated with the persistence of viral infection and lead to exacerbation of underlying diseases. We have shown that an analog of viral double-stranded RNA, polyinosinic-polycytidylic acid (poly IC), upregulated the expression of B7-H1 on airway epithelial cells, an effect which was corticosteroid-resistant. We investigated the effects of corticosteroids plus long-acting β(2)-agonists (LABAs; fluticasone/salmeterol or budesonide/formoterol) on the expression of B7-H1.

METHODS

BEAS-2B cells and primary airway epithelial cells were stimulated with poly IC or respiratory syncytial virus. The expression of B7-H1 was assessed by flow cytometry.

RESULTS

Poly IC upregulated the expression of B7-H1, which was suppressed by high-concentration corticosteroids but not by LABAs. The upregulation was suppressed by very low-concentration corticosteroids when used in combination with LABAs. Their combination also suppressed the virus-induced upregulation of B7-H1. Poly IC stimulation induced the nuclear translocation of nuclear factor ĸB (NF-ĸB). Inhibitors of NF-ĸB activation prevented the poly IC-induced upregulation of B7-H1. Low-concentration corticosteroids in combination with LABAs enhanced the de novo induction of IĸBα, the endogenous inhibitor of NF-ĸB activation.

CONCLUSIONS

Fluticasone/salmeterol or budesonide/formoterol attenuate the virus-associated upregulation of B7-H1 on airway epithelial cells via suppression of NF-ĸB activation.

Allergic inflammatory reaction is involved in necrosis of human pulmonary dirofilariasis

AIMS

To determine whether, in view of the massive inflammatory cell infiltration and the rounded rather than wedge-shaped character of pulmonary lesions in dirofilariasis, the inflammatory response against the worm contributes to the coagulative necrosis, in addition to an ischaemic process.

METHODS AND RESULTS

The histopathological features of 13 resected dirofilariasis cases with well-defined nodules ranged from 10 to 30 mm were analysed. On routine histology and using immunohistochemistry, the peripheral encapsulating wall showed mild to severe infiltration of eosinophils, lymphocytes and plasma cells and a histiocytic reaction in all cases, often with necrotic eosinophils seen within the necrosis (84.6%) and inflammatory changes in the adjacent lung (38.5%). The CD4+ lymphocyte count (80.8 +/- 33.4) was greater than that of CD8+ lymphocytes (24.5 +/- 16.9) in the central necrosis and vice versa in the wall. In the necrotic regions, disruption of the pulmonary artery (61.5%) and extravasation of the torn worm (23.1%) could be seen.

CONCLUSIONS

These findings indicate that an allergic inflammatory reaction, mediated by eosinophils and lymphocytes, is involved in the formation of the dirofilarial necrotizing granuloma rather than infarction caused simply by embolism.

Weekly low dose irinotecan and daily oral anticancer drug chemotherapy for metastatic colorectal cancer (MCRC) patients more than 75 years old

14594

Background: The percentage of CRC patients more than 75 years old is expected to rise in Japan, too. However we have little data on the efficacy and toxicity of chemotherapy in elderly MCRC patients. The aim of this study was to evaluate the objective tumor response rates and toxicities in elderly MCRC patients treated weekly low dose irinotecan and daily oral anticancer drug (UFT or S-1) chemotherapy. Methods: Patients with MCRC were treated on an out-patient treatment basis with irinotecan 60mg/m(2) as an intravenous 90 minutes infusion on weekly plus UFT 300 mg/m(2) or S-1 60 mg/m(2) in 2 divided doses given orally on day 1 to 5 in every week. All the lesions were evaluated with CT and/or MRI scan. Results: From 2001 to 2005, we treated 20 elderly MCRC patients. There were 13 men and 7 women. Fourteen patients were 75∼79 years old and 6 patients were 80 years or more. Chemotherapy was given more than 3 months (3∼30M). To date, 495 cycles (median 24, range 7–98) have been administered. There were 8 PR, 10 SD and 2 PD. The overall response rate was 40% and disease control rate (PR + SD) was seen 90% of pts. Progression free survival time of this regimen is 9.3 months. Median survival time was 16.0 months. One and 2 years survival rates were 72% and 13%. No toxic death was reported. There was no grade III/IV toxicity and all adverse events were manageable. All patients were treated on an out-patient clinic. Conclusions: These results confirmed that this chemotherapy combination is active with acceptable tolerability and QOL maintenance in elderly patients with MCRC. Chemotherapy in elderly patients with MCRC should not be influenced by the chronologic age of the patient.

No significant financial relationships to disclose.

Immunohistochemical detection of ubiquitin-positive intracytoplasmic eosinophilic inclusion bodies in diffuse alveolar damage

AIMS

To clarify the relationship between ubiquitin-positive pneumocytes and intracytoplasmic eosinophilic inclusion bodies (IB) in patients who died of diffuse alveolar damage (DAD).

METHODS AND RESULTS

Eighteen patients with DAD were studied, in whom hyaline membranes were present in one or more out of five sections from each lobe of the lungs and 15 patients with no DAD. Light microscopy revealed hyaline membrane in over 25% of lobes from 18 patients with DAD. The cytoplasm of pneumocytes from six of 18 cases of DAD contained IB. Immunohistochemically, all IBs were characteristically positive for both ubiquitin (Ub) and cytokeratin KL-1. Cytoplasmic granules were also Ub+ in four cases of DAD without IB. IB+ or Ub+ pneumocytes were undetectable in non-DAD patients. We evaluated DAD severity based on hyaline membrane formation; the mean score in DAD with IB (3.60; n = 6) was significantly higher than that in Ub- (2.92; n = 8). Ub+ pneumocytes were found with or without IB among those cases with high DAD scores.

CONCLUSIONS

These findings suggest that disordered proteolysis in the Ub-mediated proteasome system leads to the accumulation of abnormal ubiquitinated protein, which includes cytokeratin, in pneumocytes. This is the first report to suggest that Ub+ pneumocytes are associated with disease severity in patients with DAD.

Red wine raises plasma HDL and preserves long-chain polyunsaturated fatty acids in rat kidney and erythrocytes

The effects of red wine and ethanol on plasma lipoproteins and the fatty acid composition of kidney lipids and erythrocytes phospholipids were studied. Lipid peroxidation is one of the main deleterious effects of oxidant attack on biomolecules, due to the disruption of the structural integrity of membranes. The vulnerability of the kidney to oxidative damage has been partly attributed to its high content of long-chain polyunsaturated fatty acids. Antioxidants, such as flavonoids, would be a means of reducing the risk of oxidative damage to membranes. Nutritional sources rich in antioxidants, including those provided by wine, are expected to attenuate the effects of oxidative challenges. Adult rats were fed red wine rich in flavonols, ethanol (125 ml/l), or alcohol-free red wine. The control group drank water. After 10 weeks, blood samples served to measure plasma lipoproteins and antioxidant capacity. Kidney lipids and erythrocyte phospholipids were extracted. The samples were assayed by GLC. Energy intake did not differ between all the groups, but the weight gain of the ethanol group was less than the other three groups. Blood HDL and triacylglycerols were increased by both ethanol and red wine. Ethanol decreased arachidonic and docosahexaenoic acids in both kidney lipids and erythrocyte phospholipids, as compared with either water, red wine or alcohol-free red wine groups. These results indicate that non-alcoholic components of red wine could contribute to avoiding the unfavourable effects of ethanol on plasma lipoproteins, kidney lipids and membrane erythrocyte phospholipids.

[CD44 (HCAM) expression in subserous gallbladder carcinoma]

BACKGROUND

HCAM or CD44 is a multifunctional cell adhesion molecule, related to cell-cell, cell-extracellular matrix interactions and involved in tumor invasion.

AIM

To study the importance of CD44 expression in subserous gallbladder carcinoma.

MATERIAL AND METHODS

One hundred five samples (93 female) of subserous gallbladder carcinoma and 33 non tumoral gallbladder were studied. CD44 was stained using the streptavidine-biotin technique, using human anti CD44 antibodies. Eighty subjects with carcinoma were followed for a period up to 105 months.

RESULTS

Mean age of patients was 62.6 years old, all tumors were adenocarcinoma, all were silent and 13% were well differentiated. CD44 was expressed in all controls and in 91%, the expression was normal. In 57% of cancer samples, CD44 expression was abnormal, in 50% it was less expressed and in 24%, it was not expressed. No differences in CD44 expression was observed between mucosa from control samples and mucosa adjacent to the tumor or superficial or deep tumoral areas. Global five years survival was 40%. No significant differences in survival were observed in those tumors with a lower of absent CD44 expression. Six patients with a higher expression died before 18 months of follow up.

CONCLUSIONS

Nearly 50% of subserous gallbladder carcinomas show an abnormal CD44 expression.

Oxidative stress, microsomal and peroxisomal fatty acid oxidation in the liver of rats treated with acetone

Parameters of oxidative stress, microsomal cytochrome P450 activity and peroxisomal fatty acid oxidation were studied in liver of rats following acetone (1% v/v) consumption for 7 days. Acetone treatment increased the activity of catalase and decreased the activities of superoxide dismutase (SOD) and glutathione peroxidase (GTPx), but did not significantly modify the liver content of malondialdehyde (MDA) and reduced glutathione. Also, acetone increased the total content of cytochrome P450, the microsomal lauric acid hydroxylation, aminopyrine N-demethylation and the peroxisomal beta-oxidation of palmitoyl CoA. These effects were similar to those found previously in starved and ethanol-treated rats, supporting the hypothesis that ketone bodies would be the common inducer of microsomal and peroxisomal fatty acid oxidation in these metabolic states.

Ionizing radiation enhances matrix metalloproteinase-2 production in human lung epithelial cells

Radiation pneumonitis is a major complication of radiation therapy. However, the detailed cellular mechanisms have not been clearly defined. Based on the recognition that basement membrane disruption occurs in acute lung injury and that matrix metalloproteinase (MMP)-2 can degrade type IV collagen, one of the major components of the basement membrane, we hypothesized that ionizing radiation would modulate MMP-2 production in human lung epithelial cells. To evaluate this, the modulation of MMP-2 with irradiation was investigated in normal human bronchial epithelial cells as well as in A549 cells. We measured the activity of MMP-2 in the conditioned medium with zymography and the MMP-2 mRNA level with RT-PCR. Both of these cells constitutively expressed 72-kDa gelatinolytic activity, corresponding to MMP-2, and exposure to radiation increased this activity. Consistent with the data of zymography, ionizing radiation increased the level of MMP-2 mRNA. This radiation-induced increase in MMP-2 expression was mediated via p53 because the p53 antisense oligonucleotide abolished the increase in MMP-2 activity as well as the accumulation of p53 after irradiation in A549 cells. These results indicate that MMP-2 expression by human lung epithelial cells is involved in radiation-induced lung injury.

Diterpenoids from Azorella yareta and their trichomonicidal activities

Diterpenoids with trichomonicidal activity were isolated from the aerial parts of Azorella yareta Hauman. One was 13beta-hydroxyazorellane, together with the known constituents mulinolic acid, mulin-11,13-dien-20-oic acid, azorellanol and 13alpha-hydroxyazorellane. Their structures were determined by spectroscopic and chemical methods.

Side chain-dependent binding of antitumor indoloquinoxaline derivatives to DNA: comparative spectroscopic and viscometric measurements

NCA0424 (1) and its side chain positional isomer, NCA0465 (2), are indoloquinoxaline derivatives with potent antitumor activity. To investigate the effect of side chain position for binding with DNA, the interactions of 2 with various B-form DNAs were studied by spectroscopic (circular dichroism (CD), fluorescence and UV) and viscosity measurements and were compared with those of 1. The binding preference for the base sequence was different in each case. The CD spectra showed that 2 formed an asymmetric binding of indoloquinoxaline ring with adenine in DNA, whereas such a base selectivity was not found with 1. The binding features are discussed based on association constants and thermodynamic parameters, indicating the importance of the side chain position for binding specificity for DNA.

[New cases of Diphyllobothrium pacificum (Nybelin, 1931) Margolis, 1956 human infection in North of Chile, probably related with El Niño phenomenon, 1975-2000]

The effect of El Niño/ENSO on terrestrial atmosphere appears to be extremely clear. However there are outstanding evidences showing its effect on humans and their activities. In fact, prevalence of some parasitic infections have increased during El Niño phenomenon. The reasons for that are the migrations of sylvatic mammals, fishes and birds as well as by environmental contamination. In this report, we show evidence respect of new cases of human infection by Diphyllobothrium pacificum clearly associated with a cyclic manifestation of El Niño in the Chilean Pacific coast during 1975-2000.

[Acute eosinophilic pneumonia induced by cigarette smoking: positive lymphocyte stimulation test of a cigarette extract]

A 21-year-old man was admitted to our hospital with high fever, general fatigue and dyspnea. Chest radiography on admission showed diffuse bilateral infiltrate shadows with Kerley's B lines, and a CT scan showed patches of infiltrates with thickened interlobular septa in both lungs. Examination of the bronchoalveolar lavage fluid and the clinical course led to a diagnosis of acute eosinophilic pneumonia. The patient improved without steroid therapy. We suspected that the disease was related to smoking because the patient had started smoking seven days before the onset of the symptoms. Because a lymphocyte stimulation test gave a positive reaction to a cigarette extract, a challenge test was done. After this, the patient had fever and hypoxemia. These findings suggest that cigarette smoking induces acute eosinophilic pneumonia.

Bradykinin stimulates IL-6 and IL-8 production by human lung fibroblasts through ERK- and p38 MAPK-dependent mechanisms

Bradykinin (BK) is a major kinin with well-documented pharmacological properties including vascular leakage and induction of a variety of cytokines. However, the intracellular signalling mechanisms by which BK induced proinflammatory cytokine production have not been fully elucidated. This study investigated the role of the extracellular signal-regulated protein kinase 1/2 (ERK 1/2) and p38 mitogen-activated protein kinase (p38 MAPK) in the BK-induced interleukin (IL)-6 and IL-8 production by human lung fibroblasts. Lung fibroblasts were stimulated with BK in the presence or in the absence of PD98059, a specific MAPK/ERK kinase-1 inhibitor, or SB203580, a specific p38 MAPK inhibitor, and IL-6 or IL-8 production and their gene expression was examined. BK-induced ERK 1/2 or p38 MAPK phosphorylation was also analysed by Western blot analysis. BK at nanomolar concentrations stimulated lung fibroblasts to produce IL-6 and IL-8 along with increased ERK 1/2 and p38 MAPK phosphorylation. BK-induced IL-6 and IL-8 synthesis was inhibited by a B2-type BK receptor antagonist. Furthermore, PD98059 or SB203580 significantly suppressed BK-induced IL-6 and IL-8 production and their gene expression. These results indicate that bradykinin-induced interleukin-6 and interleukin-8 production are at least partly mediated through the extracellular signal-related protein kinase 1/2 and p38 mitogen-activated protein kinase pathway-dependent activation in human lung fibroblasts, and suggest that bradykinin appears to be involved in the inflammatory reaction leading to acute lung injury through stimulating interleukin-6 and interleukin-8 production by lung fibroblasts.

Neoadjuvant intra-arterial infusion chemotherapy combined with hormonal therapy for locally advanced breast cancer

To determine the efficacy of combined neoadjuvant intra-arterial infusion chemotherapy and hormonal therapy for treating locally advanced breast cancer, we compared the outcomes of patients with or without this therapy, and also assessed histologic response. Ninety-four patients with locally advanced breast cancer (stage IIIa, 56; stage IIIb, 38). Nineteen stage IIIa and 17 stage IIIb patients received intra-arterial plus hormonal therapy while 37 stage IIIa and 21 stage IIIb patients with similar ages and follow-up durations did not. Treated patients received intra-arterial epirubicin plus oral medroxy-progesterone. Five-year disease-free survival rates were 77.5% for intra-arterially treated and 33.0% for other patients in stage IIIa, and 70.5% for intra-arterially treated and 38.1% for other patients in stage IIIb. Five-year overall survival rates were 94.4% for intra-arterially treated and 61.7% for other patients in stage IIIa, and 90.9% for intra-arterially treated and 56.3% for other patients in stage IIIb. Ten-year overall survival rates in stage IIIb were 90.9% for treated and 22.5% for other group patents. All differences were statistically significant (p<0.05). Good histologic response to intra-arterial therapy was seen in 75% of the primary tumors and 71% of involved lymph nodes. Neoadjuvant intra-arterial therapy with hormonal therapy yielded better survival rates than no intra-arterial therapy or our previous intra-arterial regimen.

[P53 gene mutation in gallbladder cancer]

BACKGROUND

Gallbladder cancer frequency and mortality renders it one of the most important neoplastic diseases in Chile. P53 tumor suppressor gene has been studied in most types of cancer, but there is scarce information about it in gallbladder cancer.

AIM

To study the frequency of P53 gene mutation in gallbladder cancer in the ninth region of Chile.

MATERIAL AND METHODS

In 25 pathological samples of gallbladder cancer, the direct amplification and sequencing of p53 gene exons 5,6,7,8-8 was possible.

RESULTS

Seventeen punctual mutations were observed in 13 cases (52%). There were 10 transitions, 5 transversions, one insertion (codon 194) and one deletion (codon 186). Eight cases had mutations in exon 5, six had mutations in exon 6, two had mutations in exon 7 and one had mutations in exons 8-9. In 14 of 25 cases, gene p53 protein was positive. When immunohistochemical expression of gene p53 protein was positive in more than 20% of cells, there was a high correlation between genetic alterations and immunohistochemical expression of the protein, with a specificity, sensitivity, positive and negative predictive values over 80%.

CONCLUSIONS

P53 gene mutation is observed in a high proportion of gallbladder cancers at it can be accurately detected with conventional immunohistochemical techniques. The importance of this gene in the genesis of this carcinoma should be determined studying preneoplastic lesions and early carcinomas.

Interleukin-10 reduces natural killer (NK) sensitivity of tumor cells by downregulating NK target structure expression

We examined the effect of exogenous IL-10 on the sensitivity of rat W14 and W31 tumor cells to natural killer (NK) cell-mediated cytotoxicity in relation to previously identified NK target structure (NKTS) expressed on these cells. We also examined the effect of endogenous interleukin-10 (IL-10) on rat IL-10 cDNA-introduced W31 cells (W31T-H, a high-IL-10-producer clone; W31T-L, a low-IL-10-producer clone). Both exogenous and endogenous IL-10 had no effect on the proliferative activity of these cells, but incubation of cells with recombinant human (rh) IL-10 resulted in a dose-dependent decrease in the expression of NKTS recognized by mAb 109. The expression level of NKTS on W31T-H cells was dramatically decreased compared with that on W31T-L cells and parental W31 cells. In addition, treatment of W31 cells with the culture supernatants of W31T-H cells could downregulate the expression of the NKTS. Moreover, NK sensitivity of W31T-H was suppressed down to a level equivalent to that of W31 cells pretreated with exogenous rhIL-10, and cytolysis could no longer be inhibited by mAb 109. We previously demonstrated that IL-10 downregulated MHC class I expression in this model. Nevertheless, NK susceptibility was also decreased. Taken together, these results suggest that the IL-10-mediated decrease in NKTS expression has a larger effect than decreased MHC class I expression on NK sensitivity. Thus, our data reveal a novel mechanism for an IL-10-mediated escape of tumor cells from host immune surveillance by downregulation of NKTS expression.

Neoadjuvant intraarterial high-dose chemotherapy and autologous peripheral blood stem cell transplantation for advanced breast cancer

Eight locally advanced breast cancer patients were treated with neoadjuvant intraarterial high-dose chemotherapy (epirubicin) plus MPA combined with autologous PBSCT. All patients completed the scheduled treatment, and there were no toxic deaths. Patients were treated with an escalating dose of epirubicin (370-480 mg) and cyclophosphamide (0-6000 mg). The rate of clinical response was 100%. The rate of good histologic response was 87.5% in the main tumor and 75% in diseased lymph nodes. The 2-year survival rate was 100%. Six patients were disease-free at the time of writing. This treatment resulted in higher rates of clinical and histologic response when compared with standard-dose intraarterial chemotherapy.

[Microbiological study of gallbladder bile in a high risk zone for gallbladder cancer]

BACKGROUND

Gallbladder cancer is frequent in Chile and there is sparse information about the association between this type of cancer and the presence of bacteria in the gallbladder bile.

AIM

To determine the presence of aerobic bacteria in gallbladder bile in patients with and without gallbladder cancer.

MATERIAL AND METHODS

A microbiological analysis of bile and pathological study was performed in 608 gallbladders, obtained during to cholecystectomies performed to 513 women and 95 men aged 44 years old as a mean.

RESULTS

Pathological study showed a chronic cholecystitis in 468 cases (77%), an acute cholecystitis in 140 (33%), cancer in 24 (3.9%) and dysplasia in 5 cases (0.8%). A positive culture was obtained in 22.5% of women and 28.5% of males. Twenty seven percent of women over 30 years old had positive cultures compared with 10% of younger women (p < 0.001). Thirty two percent of acute cholecystitis had positive cultures, compared with 24% of chronic cholecystitis (p = 0.03). E Coli was isolated in 51% of positive cases, Streptococci-Enterococci in 24%, Enterobacter sp in 9%, Klebsiella and Proteus in lower proportions. Salmonella sp was isolated in 4 cases, being all women with chronic cholecystitis. Thirteen of 29 cases with cancer or dysplasia had positive cultures (45%), compared with 25% of patients with inflammatory gallbladder diseases (p = 0.02). Streptococci-Enterococci were isolated in 7 cases and Enterobacter sp in three.

CONCLUSIONS

The presence of Salmonella sp in gallbladder bile was not frequent in the studied patients. Its role in the pathogenesis of gallbladder cancer must be reassessed.

Reactive oxygen intermediates stimulate interleukin-6 production in human bronchial epithelial cells

Reactive oxygen intermediates (ROIs) play an important role in the initiation and progression of lung diseases. In this study, we investigated whether ROIs were involved in the induction of interleukin (IL)-6 in human bronchial epithelial cells. We exposed normal human bronchial epithelial cells as well as a human bronchial epithelial cell line, HS-24, to ROIs. We measured the amount of IL-6 in the culture supernatants using ELISA and the IL-6 mRNA levels using RT-PCR. Superoxide anions (O-2), but not hydrogen peroxide (H2O2), increased IL-6 production. To examine whether it is a cell type-specific mechanism of airway epithelial cells, the experiments were also performed in human lung fibroblasts, WI-38-40. In WI-38-40 cells, neither O-2 nor H2O2 increased IL-6 production. In contrast, tumor necrosis factor (TNF)-alpha (200 U/ml) induced IL-6 at the protein and mRNA levels in both airway epithelial cells and lung fibroblasts. This cytokine-induced IL-6 production was significantly suppressed by several antioxidants, including dimethyl sulfoxide (DMSO), in airway epithelial cells. In WI-38-40 cells, DMSO was not able to suppress IL-6 production induced by TNF-alpha. Pretreatment with DMSO recovered the TNF-alpha-induced depletion of intracellular reduced glutathione in HS-24 cells. These findings indicate that oxidant stress specifically induces IL-6 production in human bronchial epithelial cells and that in these cells ROIs may be involved in IL-6 production after stimulation with cytokines such as TNF-alpha. Presumably, ROIs participate in the local immune response in lung diseases via IL-6 release from bronchial epithelial cells.

Heat-shock protein-73 protects against small intestinal warm ischemia-reperfusion injury in the rat

BACKGROUND

The protective effects of heat-shock protein (hsp) in rat small intestinal warm ischemia-reperfusion (I/R) injury are poorly understood.

METHODS

Hsp-73 expression was induced in rat small intestine with use of sodium arsenite injected (6 mg/kg) through a catheter cannulated into the left common carotid artery 24 hours before ischemia (group 1). In the control group an equal volume of phosphate-buffered saline solution was injected (group 2). To block the induction of hsp-73 expression, sodium arsenate and quercetin (5 mg/kg) were injected (group 3).

RESULTS

The mean peak plasma levels of tumor necrosis factor-alpha and cytokine-induced neutrophil chemoattractant after reperfusion were lower in group 1 than in group 2. The tissue myeloperoxidase activity after reperfusion was lower in group 1 than in group 2. The mean peak plasma level of interleukin-10 after reperfusion was higher in group 1 than in group 2. The induction of hsp-73 expression reduced the synthesis of nitric oxide and the magnitude of the small intestinal warm I/R injury. The results in group 3 were similar to those in group 2.

CONCLUSION

Hsp-73 protects against small intestinal warm I/R injury by inhibiting the synthesis of inflammatory cytokines and the activation of neutrophils and by accelerating the synthesis of anti-inflammatory cytokines.

[Human diphyllobothriasis by Diphyllobothrium pacificum. A new case in Antofagasta, Chile]

We report a 26 years old asymptomatic female that expelled spontaneously a 39 proglottid strobila. The taxonomic study of proglottids and eggs found in the stool examination concluded that the patient was infected by Diphyllobothrium pacificum. This infection was probably acquired by the ingestion of raw fish (Sciaena deliciosa) with lemon in a traditional plate called "cebiche". She was treated with a single dose of praziquantel in a dose of 10 mg/kg body weight. After 24 h of treatment there were no scolices on feces. The patient did not have anemia. All eight family members studied, did not have the infection. A follow up stool examination three months later remained negative.

[Severe pneumococcal pneumonia with acute respiratory failure and neutropenia]

Severe pneumococcal pneumonia may precipitate both respiratory failure and neutropenia. The prognoses are considered to be very poor in such cases. We encountered three patients with pneumococcal pneumonia presenting respiratory failure and neutropenia, and successfully treated two. All three patients showed disseminated intravascular coagulation, and respiratory failure requiring mechanical ventilation. Neutropenia was treated with granulyte-colony stimulating factor (G-CSF), with methylpredonisolone administered by pulse therapy for 3 days to treat severe respiratory failure during the clinical course. All 3 patients were relieved of their respiratory failure at least for a few days following treatment. As a result of treatment with antibiotics and G-CSF, pneumococci disappeared from the patients' sputum. However, it has been reported that disintegration of the bacterial cell walls can release inflammatory components capable of causing secondary inflammatory reactions in the lung tissue. This suggested that the worsening respiratory failure experienced by our patients during their clinical course was a result of such reactions, and that methylpredonisolone was effective as the treatment of inflammation.

[Polymyositis-induced respiratory failure in the presence of antecedent pleural effusion]

Pulmonary involvement is generally recognized to be an important determinant of the clinical course in cases of polymyositis. A patient with bilateral pleural effusion as an initial symptom developed respiratory failure due to muscle weakness. Polymyositis was diagnosed on the basis of a muscle biopsy. A chemotherapy regimen consisting of methyl prednisolone (1 g/day for 3 days) followed by prednisolone (60 mg/day) alleviated, the pleural effusion and respiratory failure. Though pleural complications in polymyositis have been described mostly in association with concomitant interstitial lung disease, our patient exhibited only bilateral pleural effusion. Given that pleural effusion can be an initial symptom of polymyositis, it seems necessary that polymyositis be taken into consideration by differential diagnoses of pleural effusion of unknown etiology.

Early gastric cancer and Helicobacter pylori: 34 years of experience at Charity Hospital in New Orleans

Good survival rates have been reported for resected early gastric adenocarcinoma (EGC) in patients found via screening procedures. However, the prevalence of Helicobacter pylori in EGC in unscreened populations is unclear. The major purpose of this investigation was to analyze the clinical experience and incidence of H. pylori in unscreened patients presenting with EGC at Charity Hospital over a 34-year period. From 1963 through 1997, the tumor registry at Charity Hospital compiled data on 2497 patients evaluated for gastric carcinoma. Of these patients, 26 (1%) had lesions that were confined to the mucosa or submucosa, i.e., T1N0M0 (American Joint Commission on Cancer classification). Pathology specimens and medical records were retrieved for confirmation of diagnosis and retrospective analysis for H. pylori. H. pylori was analyzed by Steiner staining and immunohistochemistry using a polyclonal antibody. EGC was detected in 12 men and 14 women with a mean age of 62 years. Upper gastrointestinal X-ray studies were performed on 19 of the 26 patients and failed to conclusively demonstrate a lesion in any case. Endoscopy was performed on 22 patients, and preoperative biopsies were positive in 95 per cent of these. Operative procedures included 2 local excisions and 22 subtotal and 2 total gastrectomies. No extended nodal dissections were performed. Microscopic evaluation revealed lesions limited to the mucosa in 63 per cent of cases and involving the submucosa in 37 per cent of the cases. Of the 14 patients evaluable of H. pylori, 79 per cent were positive for the bacterium. The status of 2 patients is unknown, and only 1 patient died of the original gastric cancer, for a disease-free survival of 96 per cent. The 5-year and 10-year overall survival rates were calculated to be 50 per cent and 21 per cent, respectively, when all causes of death were taken into consideration. Median follow-up of the survivors was 64 months. Resection of early gastric carcinoma in unscreened patients without extended lymphadenectomy yielded excellent results. H. pylori was present in 79 per cent of cases. These data suggest an association between H. pylori and EGC. Whether H. pylori infection is an etiologic factor in gastric cancer remains an area of active research.

[Essential fatty acid content of maternal erythrocyte phospholipids. A study in preterm and full-term human newborns]

BACKGROUND

A high concentration of arachidonic acid in maternal erythrocytes and trophoblast could have a role in pre term deliveries.

AIM

To study the fatty acid composition of long chain fatty acids from erythrocytes of mothers who gave birth to pre term and full term infants.

PATIENTS AND METHODS

Thirty three healthy women that gave birth to healthy newborns in a public hospital were studied. Twenty two had pre term (34 weeks) and 11 full term (40 weeks) deliveries. The fatty acid profile of phospholipids isolated from erythrocytes of these women was analyzed by gas-liquid chromatography.

RESULTS

Compared to women giving birth to full term infants, phospholipids of women giving birth to pre term infants had a higher content of arachidonic acid (20:4 omega 6) and all the species of omega 6 fatty acids. They also had a lower concentration of palmitic and eicosapentanoic (20: 5 omega 3) acids and thus a higher arachidonic acid/eicosapentanoic acid ratio.

CONCLUSIONS

A high arachidonic acid content in phospholipids of erythrocytes could be a risk factor or predictive marker for pre term deliveries.

[Activity of Dipernoids isolated from Azorella compacta (Llareta) on Trypanosoma cruzi amastigotes]

The trypanocidad activity against amastigote forms of SPA-14, Tulahuen and G strains and CL Brener clone of Trypanosoma cruzi of diterpenoids isolated from Azorella compacta, Phil. (Llareta), a plant with ethnomedicinal prestige from prespanish age, was investigated. Amastigocidal activity was shown in azorellanol (2), diterpene isolated by first time, with an inhibitory concentration 50 (IC50) that varied between 60 M (CL Brener clone) and 84 M (SPA-14 strain), and in mulin -11,13 -dien-20-oico acid (5) with IC50 between 41 microM (G strain) and 87 mM (CL Brener clone). The cytotoxicity levels of both compounds against Hela and Vero cells and macrophages J144 are lower than nifurtimox and similar to gentian violet.

Characterization of an interspersed repetitive DNA element in the genome of Trypanosoma cruzi

We report the molecular characterization of a middle repetitive DNA sequence, named C6, isolated from the Trypanosoma cruzi genome. C6 appears to be a composite repeated element since 3 subregions may be defined within it on the basis of sequence similarities with other T. cruzi genomic sequences. Sequences homologous to C6 are interspersed in the genome and can be mapped out on most chromosomal bands of different T. cruzi. strains. The copy number of the C6 element is about 1000 per haploid genome. Given the species specificity and different genomic distribution of C6 homologous sequences among the T. cruzi strains the C6 element could be a useful probe for diagnosis and typing of parasites. C6 is a polymorphic marker with potential as a tool for physical mapping of the T. cruzi genome.

p53 tumour suppressor gene protein expression in early and advanced gallbladder carcinoma

AIMS

Gallbladder carcinoma is one of the most frequent malignant tumours occurring in Chile and the mortality rate in both sexes ranks among one of the highest in the world. Mutation of p53 tumour suppressor gene has been demonstrated in many tumours. Our aim was to determine protein expression of p53 gene in early and advanced gallbladder carcinoma.

METHODS AND RESULTS

Protein expression of gene p53 was studied by immunohistochemical means in 191 gallbladder carcinomas (157 primary tumours, 34 metastases) and 25 controls. In 86 out of 191 cases (45%), protein expression of gene p53 was observed. Differences related to sex, age, or race were not observed. All gallbladder controls were negative. Twenty-five per cent of well-differentiated tumours were p53 positive, while moderate or poorly differentiated carcinomas reached 50% (P = 0.04). p53 expression was observed in 23.5% of early carcinomas and in 48.2% of advanced carcinomas (P = 0.01). No differences between primary tumours and metastasis were demonstrated.

CONCLUSIONS

Protein expression of p53 tumour suppressor gene is observed in 45% of gallbladder carcinomas. The absence of expression in controls and in normal mucosa adjacent to tumours suggests its utility in differentiating atypical gallbladder epithelia from neoplastic lesions.

[Epidemiological study of pediculosis capitis and scabies in schoolchildren from Antofagasta, Chile, 1995]

In order to contribute to a better knowledge of the pediculosis capitis and scabies during March-December 1995, 1122 primary schoolchildren under 14 years of age in the city-port of Antofagasta in northern Chile (20 degrees South lat.), were examined. A total of 285 (25.4%) were found to be infested with Pediculus humanus capitis and only 20 (1.8%) with Sarcoptes scabiei. In general the rates of infestation to both ectoparasitic diseases were higher in groups of younger schoolchildren, also higher in women than in men and in those groups with high indexes of crowding and ignorance of the transmission mechanism of pediculosis capitis and scabies.

[Effect of pregnancy and lactation on the nutritional status of essential fatty acids in rat]

BACKGROUND

Pregnancy and lactation could be high risk situations for the development of essential fatty acid deficiencies.

AIM

To study the effect of pregnancy and lactation on red blood cell phospholipids percentual fatty acid composition of virgin, pregnant and lactating rats.

MATERIALS AND METHODS

Twenty four pregnant rats of 50 +/- 1 days of age were supplement with soy and 24 with fish oil during 21 days. Twelve rats of each group were sacrificed after 18 days of lactation, twenty four non pregnant rats received soy oil and acted as controls of pregnant and lactating rats. Red blood cell phospholipid fatty acid composition was analyzed by gas chromatography.

RESULTS

The percentage of total omega-6 fatty acids of red blood cell phospholipid was 37.8 +/- 5.9, 32.6 +/- 0.6 and 38.3 +/- 3.5% in non pregnant, pregnant and lactating rats respectively (p < 0.001). The figures for total omega-3 fatty acids were 6.33 +/- 1.52, 4.31 +/- 0.39 and 2.7 +/- 0.46 respectively (p < 0.001). There was no change in eicosatrienoic fatty acid percentage. Supplementation with fish oil reverted the decrease in omega-6 and omega-3 fatty acid percentage of pregnant and lactating rats.

CONCLUSIONS

Pregnancy and lactation decrease the capacity to transform precursors of essential fatty acids in long chain polyunsaturated fatty acids.

[Current human and canine seroprevalence of Chagasic infection in San Pedro de Atacama County, II Region of Antofagasta, Chile, 1995]

In order to assess the impact of a control program against Triatoma infestans launched in 1988, based on insecticide spraying of dwellings, a serological survey for chagasic infection was carried out during 1995 in three localities from San Pedro de Atacama County (22 degrees 55' South lat., 68 degrees 12' West long.), II Region of Antofagasta in northern Chile. Blood samples from 531 children and adolescents and 65 dogs were subjected to ELISA test and indirect immunofluorescent test for Chagas' disease respectively. Tests resulted positive in 12 (2.3%) persons, all above 5 years old, in contrast with the 16.8% serological positivity observed in 1985. Three (4.6%) dogs (two 0-12 months old) resulted positive. These results indicate that dwelling sprayings with long-term activity insecticides against T. infestans is a good tool to prevent new human infections with T. cruzi. However, active vector transmission among domestic animals (canines) could be recently acquired.

[Modification of the lipid profile of human placenta by moderate maternal undernutrition]

The lipid composition of human placenta phospholipids, coming from 9 undernourished women that gave birth to low weight newborns and 9 well nourished women, was analyzed using gas-liquid chromatography. Phospholipids of placentas coming from undernourished women, when compared to well nourished women, had significantly lower amounts of w-6 and w-3 fatty acids (40.1 +/- 1.5 vs 42.4 +/- 1.4 and 6.0 +/- 0.7 vs 7.1 +/- 1.3% respectively). The calculated mean melting point was higher in plancetas coming from undernourished women. It these women, the low content of polyunsaturated fatty acids and its replacement by short chain fatty acids was not able to balance the high mean melting points. The relative deficiency of essential fatty acids, the low saturation index and the high mean melting point of undernourished women's placental phospholipids, may suggest a lower membrane fluidity and a subnormal essential fatty acid content of fetal organs, that are essential for normal growth and development.

[Effect of a diet supplemented with soybean oil or fish oil on the reversibility of docosahexaenoic acid deficiency (22:6w3) in the brain and erythrocytes of rats]

This study was undertaken, to evaluate the effects of dietary supplements containing either soybean oil (19:3w3; ALA), or fish oil (22:6w3; DHA), added to the lactating rat dam diet, on the levels of DHA in brain and erythrocytes of DHA deficient pups. Pregnant rats fed omega 3 deficient diets were divided at parturition into three groups. One group was kept on the same diet fed during pregnancy. The two remaining groups received the above mentioned omega 3 supplements. These feeding regimens were maintained during 18 days. Supplementation of diet with 114 mg DHA/100g diet, increased significantly the concentration of DHA in brain and erythrocytes of the suckling rats. In contrast, the effects of the supplementation with ALA (700 mg/100g diet), were limited to the increase of DHA content in the brain. This increase however, was partial, reaching only 50% of the normal. Results suggest that newborn rat has a limited capacity to convert DHA from ALA, becoming dependent of preformed DHA supply to cover DHA requirements at the cellular level.

Proliferating cell nuclear antigen in gallbladder carcinoma

Proliferating cell nuclear antigen (PCNA) expression was studied in 103 gallbladder carcinomas and 23 metastatic lesions as well as in 25 control non-neoplastic gallbladder specimens. Positive nuclear staining was observed in 88% of controls, in 92% of carcinomas and in 70% of metastases. The mean number of positive cells was 21.2% in controls, 44.1% in primary carcinomas and 32% in metastatic cancer cells. Differences which were significant were control v. primary tumour, P < 0.000001; control v. metastasis, P < 0.01 and primary tumour v. metastasis, P < 0.006. In 57 (60%) of the primary tumours there was positive staining in over 40% of tumour cells. We were not able to demonstrate any relationship between macroscopic or microscopic features and PCNA expression. However, tumours confined to the mucosa expressed PCNA more frequently than did more advanced tumours.

[Exclusion of alpha-linolenic acid from diets for rats during several generations. I. Effect on reproduction and postnatal growth]

The effects of a dietary alphalinolenic acid (18: 3w3) deficiency on reproduction and post natal growth in rats during 3 successive generations were studied. Female rats received respectively a diet with sunflower oil at 10% (deficient diet) or a diet with soya oil at 10% (control diet). The results showed that in our experimental conditions deficient diet affects: fecundity, fertility, post natal growth and cause a high rates of perinatal mortality from birth to post partum day 3: Perinatal mortality increased with successive gestation from 14.6% to 18.6% compared with the survival of control. The fatty acid composition of placenta phospholipids and milk lipids reflected the nature of the dietary oil. The possibility that 18: 3w3 might function in a way different from the EFA role of 18: 2w6 in reproduction at least in rats has been discussed.

[Intestinal amebiasis in Antofagasta, Chile]

In January 1989--December 1991 period we verified 35 cases of symptomatic intestinal amebiasis in Antofagasta, the main city of the North of Chile. Out of the total number of studied patients 23 were adults (77.1% males and 22.9% females) and all of them were permanent residents of Antofagasta. E.histolytica was frequently detected in association with other parasites and/or commensals, and observed alone in only seven cases. The clinical and epidemiological aspects of these 35 cases are discussed.