Aging increases the particulate- and leachate-induced toxicity of tire wear particles to microalgae

The toxic effects of tire wear particles (TWPs) on organisms have attracted widespread concerns over the past decade. However, the underlying toxicity mechanism of TWPs, especially aged TWPs to marine microalgae remains poorly understood. This study investigated the physiological and metabolic responses of Phaeodactylum tricornutum to different concentrations of TWPs (Experiment 1), virgin and differently aged TWPs (Experiment 2) as well as their leachates and leached particles (Experiment 3). Results demonstrated that TWPs promoted the growth of microalgae at low concentrations (0.6 and 3 mg L-1) and inhibited their growth at high concentrations (15 and 75 mg L-1). Moreover, aged TWPs induced more profound physiological effects on microalgae than virgin TWPs, including inhibiting microalgae growth, decreasing the content of Chla, promoting photosynthetic efficiency, and causing oxidative damage to algal cells. Untargeted metabolomics analysis confirmed that aged TWPs induced more pronounced metabolic changes than virgin TWPs. This study represented the first to demonstrate that both particulate- and leachate-induced toxicity of TWPs was increased after aging processes, which was confirmed by the changes in the surface morphology of TWPs and enhanced release of additives. Through the significant correlations between the additives and the microalgal metabolites, key additives responsible for the shift of microalgal metabolites were identified. These results broaden the understanding of the toxicity mechanism of aged TWPs to microalgae at the physiological and metabolic levels and appeal for considering the effects of long-term aging on TWP toxicity in risk assessment of TWPs.

Occurrence, Distribution, and Trophic Transfer of Pharmaceuticals and Personal Care Products in the Bohai Sea

The ubiquitous presence of pharmaceuticals and personal care products (PPCPs) in environments has aroused global concerns; however, minimal information is available regarding their multimedia distribution, bioaccumulation, and trophic transfer in marine environments. Herein, we analyzed 77 representative PPCPs in samples of surface and bottom seawater, surface sediments, and benthic biota from the Bohai Sea. PPCPs were pervasively detected in seawater, sediments, and benthic biota, with antioxidants being the most abundant PPCPs. PPCP concentrations positively correlated between the surface and bottom water with a decreasing trend from the coast to the central oceans. Higher PPCP concentrations in sediment were found in the Yellow River estuary, and the variations in the physicochemical properties of PPCPs and sediment produced a different distribution pattern of PPCPs in sediment from seawater. The log Dow, but not log Kow, showed a linear and positive relationship with bioaccumulation and trophic magnification factors and a parabolic relationship with biota-sediment accumulation factors. The trophodynamics of miconazole and acetophenone are reported for the first time. This study provides novel insights into the multimedia distribution and biomagnification potential of PPCPs and suggests that log Dow is a better indicator of their bioaccumulation and trophic magnification.

An electrochemical molecularly imprinted microfluidic paper-based chip for detection of inflammatory biomarkers IL-6 and PCT

Based on surface biomolecular imprinting technology, a rotary microfluidic electrochemical paper-based chip (MIP-ePADs) was proposed for sensitive and selective detection of human interleukin 6 (IL-6) and procalcitonin (PCT). Compared with the traditional method, the sample can be added directly on the MIP-ePAD by rotating the working electrode, which avoids the loss of the liquid to be tested and greatly simplifies the process of electropolymerization imprinting and template elution. Our experimental results show that linear concentration ranges of IL-6 and PCT in the electrochemical molecularly imprinted microfluidic paper-based chip ranged from 0.01 to 5 ng mL-1, with their detection limits being 3.5 and 2.1 pg mL-1, respectively. For the detection of actual serum samples, there was no significant difference between the results of MIP-ePADs and the traditional electrochemiluminescence method used in hospitals, indicating that the paper-based chip can be used for stable and accurate analysis and detection. The chip greatly reduces the cost of clinical trials due to its advantages of easy preparation and low cost. The chip can be used for the analysis of non-antibody inflammation markers and can be widely used in home and hospital treatment detection. This method will not only play an important role in rapid detection, but also provide new ideas for the improvement of rapid detection technology.

Profiling of the spatiotemporal distribution, risks, and prioritization of pharmaceuticals and personal care products in coastal waters of the northern Yellow Sea, China

Pharmaceuticals and personal care products (PPCPs) have aroused global concerns due to their ubiquitous occurrence and detrimental effects. The spatiotemporal distributions of 64 PPCPs and their synergetic ecological risks were comprehensively investigated in the seawater of Yantai Bay, and 1 H-benzotriazole (BT), ethenzamide, phenazone, propyphenazone, 4-hydroxybenzophenone and N, N'-diphenylurea were first determined in the seawater of China. Fifty-six PPCPs were detected and their concentrations were 27.5-182 ng/L, with BT contributing around 58.0%. Higher PPCP concentrations were observed in winter and spring, with the concentrations of antioxidants, analgesic/anti-inflammatory drugs and human-used antibiotics significantly higher in winter, while those of aquaculture-used antibiotics and UV filters significantly higher in summer, which was closely related with their usage patterns. Positive correlations were observed for PPCP concentrations between surface and bottom water, except summer, during which time the weak vertical exchange and varied environmental behaviors among different PPCPs resulted in the distinct compositions and concentrations. Terrestrial inputs and mariculture resulted in higher PPCP concentrations in the area located adjacent to the coast and aquaculture bases. The PPCP mixtures posed medium to high risk to crustaceans, and bisphenol A was identified as a high-risk pollutant that needs special attention.

Dissolved oxygen gradient on three dimensionally printed microfluidic platform for studying its effect on fish at three levels: cell, embryo, and larva

A simple and low-cost dissolved oxygen gradient platform of three dimensionally (3D) printed microfluidic chip was developed for cultivating cells, embryos, and larvae of fish. "Christmas tree" structure channel networks generated a dissolved oxygen gradient out of two fluids fed to the device. Polydimethylsiloxane (PDMS) membrane with high biocompatibility was used as the substrate for cell culture in the 3D-printed microfluidic chip, which made the cell analysis easy. The embryos and larvae of fish could be cultured directly in the chip, and their development can be observed in real time with a microscope. Using zebrafish as a model, we assessed the effect of different dissolved oxygen on its cells, embryos, and larvae. Hypoxia induced production of reactive oxygen species (ROS) in zebrafish cells, embryos, and larvae, eventually leading to cell apoptosis and developmental impairment. Hypoxia also increased nitric oxide content in zebrafish cells, which might be a defensive strategy to overcome the adverse effect of hypoxia in fish cells. This is the first platform that could comprehensively investigate the effects of different dissolved oxygen on fish at the cell, embryo, and larva levels, which has great potential in studying the responses of aquatic organisms under different oxygen concentrations.

Surface-enhanced Raman scattering labeled nanoplastic models for reliable bio-nano interaction investigations

Nanoplastics (NPs) have attracted great attention as an emerging pollution. To date, their interaction with biological systems has been studied mostly by using fluorescent-labeled NPs, which suffered from serious drawbacks such as biological autofluorescence interference and false-positive results. Reliable optically labeled NP models are eagerly desired until now. Herein, a novel near-infrared (NIR) surface-enhanced Raman scattering (SERS) labeled NP model was proposed, which gained single-particle ultra-sensitivity, deep tissue detection, multiplex labeling ability, and anti-interference property. More importantly, the NP demonstrated satisfactory in vivo signal stability which completely prevented the positive-false problems. The advantages of the NPs enabled direct, dynamic in vivo behavior imaging study in living zebrafish embryo, adult zebrafish and green vegetable Brassica rapa. It was found for the first time that NPs entered blood circulation system of zebrafish larva via dermal uptake route, which only occurred in a short 48 h-window post-hatch. NPs widely distributed in roots, shoots and leaves of Brassica rapa seedlings germinating and growing in the NP-containing hydroponic culture. Different depths of one root showed varied adsorption capabilities towards NPs with fulvic acid, lipid and sodium dodecyl sulfate eco-coronas. This work provided an ideal tool for reliable bio-NP interaction study for a variety of organisms, which could promote the research of NPs.

Atraumatic acute compartment syndrome - case report

INTRODUCTION

The publishing of our case report on an idiopathic compartment syndrome of both upper limbs after icing a contusion trauma was motivated by another article on the acute spontaneous compartment syndrome of upper limb published in Rozhledy v chirurgii 8/2021.

CASE REPORT

We present the case of a 43-year-old man admitted in the evening for painful massive swelling of both upper extremities. The swelling developed immediately after icing his bruises suffered due to a probable fall on the previous day in a state of inebriety. Compartment syndrome of the left hand and right forearm was diagnosed; subsequently, adequate dermatofasciectomy resulted in normalization of the condition in both upper limbs. The patients condition was cured to a full extent without any disorders of perfusion, mobility or sensation in both upper extremities.

CONCLUSION

Only few reports on the atraumatic compartment syndrome of upper extremity can be found in the literature and it is an acute condition encountered quite rarely at outpatient offices of surgery. Nevertheless, we need to be able to recognize this nosological unit and provide proper treatment in time, otherwise the patient may suffer serious permanent damage.

Three dimensionally printed nitrocellulose-based microfluidic platform for investigating the effect of oxygen gradient on cells

In this article, we present a novel nitrocellulose-based microfluidic chip with 3-dimensional (3D) printing technology to study the effect of oxygen gradient on cells. Compared with conventional polydimethylsiloxane (PDMS) chips of oxygen gradient for cell cultures that can only rely on fluorescence microscope analysis, this hybrid nitrocellulose-based microfluidic platform can provide a variety of analysis methods for cells, including flow cytometry, western blot and RT-PCR, because the nitrocellulose-based chips with cells can be taken out from the growth chambers of 3D printed microfluidic chip and then used for cell collection or lysis. These advantages allow researchers to acquire more information and data on the basic biochemical and physiological processes of cell life. The effect of oxygen gradient on the zebrafish cells (ZF4) was used as a model to show the performance and application of our platform. Hypoxia caused the increase of intercellular reactive oxygen species (ROS) and accumulation of hypoxia-inducible factor 1α (HIF-1α). Hypoxia stimulated the transcription of hypoxia-responsive genes vascular endothelial growth factor (VEGF) and induced cell cycle arrest of ZF4 cells. The established platform is able to obtain more information from cells in response to different oxygen concentration, which has potential for analyzing the cells under a variety of pathological conditions.

Secondary appendicitis in an adult patient with an ascended testicle - case report

Acute appendicitis is one of the most common acute abdomen cases. Although many causes have been described in literature, it is mostly primary affection of the appendix that leads to acute appendicitis. A 57-year-old patient was admitted to our department displaying all usual signs of acute appendicitis, both clinical and laboratory. During laparoscopic appendectomy, we found the inflammation of the appendix in this case appeared secondary, originating in a structure located nearby the appendix, strongly resembling a testicle. We performed appendectomy and removed the suspected structure altogether. The patient recovered completely within a week. Subsequent histological examination confirmed that the suspected tissue was indeed a retained testicle causing se-condary inflammation of the appendix. As we found out later, this condition probably occurred in the patient secondarily in adulthood, most likely due to inguinal hernia repair undergone during childhood.

Hybrid Three Dimensionally Printed Paper-Based Microfluidic Platform for Investigating a Cell's Apoptosis and Intracellular Cross-Talk

In this paper, we first proposed a novel hybrid three-dimensional (3D) printed and paper-based microfluidic platform and applied it for investigating the cell's apoptosis and intracellular cross-talk. The fabrication of a 3D-printed microfluidic chip is much easier than polydimethylsiloxane (PDMS) chip and can be applied in many common labs without soft lithogrophy fabrication equipment. Moreover, 3D printing can be perfectly combined with paper-based chips that can provide 3D scaffold for cell culture and analysis. In addition, these paper chips are disposable after use, greatly reducing the experimental cost. We integrated "Christmas Tree" structure with the top layer of the 3D-printed microfluidic chip to generate a continuous concentration gradient, and the bottom layer contained paper-based chips as cell culture area. The two-layer structure allows the concentration gradient forming layer to be separated from the cell culture layer, which can simplify the planting of cells in the microfluidic chip and make sure the cells stay in the culture chambers and don't clog the microfluidic channels. Applying this hybrid platform, we examined the effect of H₂S on cancer cells. Continuous exposure to a low concentration of H₂S inhibited cancer cell SMMC-7721 proliferation by inducing cell apoptosis. We also found that two gaseous molecules H₂S and NO have cross-talk in cancer cells; they formed bioactive intermediate polysulfides in cancer cells. It is expected that this novel hybrid 3D-printed and paper-based microfluidic platform will have widespread application prospects in cell investigation.

Dietary gossypol suppressed postprandial TOR signaling and elevated ER stress pathways in turbot (Scophthalmus maximus L.)

Gossypol is known to be a polyphenolic compound toxic to animals. However, its molecular targets are far from fully characterized. To evaluate the physiological and molecular effects of gossypol, we chose turbot (Scophthalmus maximus L.), a carnivorous fish, as our model species. Juvenile turbots (7.83 ± 0.02 g) were fed diets containing gradient levels of gossypol at 0 (G0), 600 (G1), and 1,200 (G2) mg/kg diets for 11 wk. After the feeding trial, fish growth, body protein, and fat contents were significantly reduced in the G2 group compared with those of the G0 group (P < 0.05). Gossypol had little impact on digestive enzyme activities and intestine morphology. However, gossypol caused liver fibrosis and stimulated chemokine and proinflammatory cytokine secretions. More importantly, gossypol suppressed target of rapamycin (TOR) signaling and induced endoplasmic reticulum (ER) stress pathway in both the feeding experiment and cell cultures. Our results demonstrated that gossypol inhibited TOR signaling and elevated ER stress pathways both in vivo and in vitro, thus providing new mechanism of action of gossypol in nutritional physiology.

Correlations between intratumoral vascular network and tumoral architecture in prostatic adenocarcinoma

The authors made a preliminary assessment of possible correlations between the intratumoral vascular density (IVD) and the architectural tumoral patterns described by Gleason. The studied material consisted of samples obtained by transurethral resection from 34 patients diagnosed with prostatic adenocarcinoma. Ten fields, five for dominant and five for secondary identified patterns of each case, with no necrosis were selected randomly from CD34 immunomarked sections using ×20 objective. IVD increased with Gleason pattern both for the entire group, but also for "solid" phenotype group of subtypes up to pattern 4, respectively subtype 4B. In "necrotizing" phenotype group of subtypes, IVD had a decreasing trend from the better-differentiated subtypes to the poorest one. These preliminary data showed that the intratumoral vascular network reacts differently to the loss of tumoral differentiation in the two groups of Gleason subtypes suggesting the existence of two different populations of malignant cells.

Correlations between intratumoral interstitial fibrillary network and tumoral architecture in prostatic adenocarcinoma

The authors made a preliminary assessment of possible correlations between the amount of intratumoral stromal fibrillary components (ISFC) and the architectural tumoral patterns described by Gleason. The studied material consisted of samples obtained by transurethral resection from 34 patients diagnosed with prostatic adenocarcinoma. Ten fields, five for dominant and five for secondary identified patterns of each case, with no necrosis were selected randomly from Gömöri stained sections using ×20 objective. ISFC-ratio increased with Gleason pattern both for the entire group but also for "Necrotizing" phenotype patterns and "Solid" phenotype patterns, excepting the subtype "4A" where the stromal compartment was reduced by the expansion of tumoral ducts enlarged by growing tumoral intraductal cribriform masses. These preliminary data showed that stromal microenvironment try to adapt to the loss of tumoral differentiation by increasing the amount of fibrillary components of intratumoral stromal compartment.

Clinical significance of the plasminogen activator system in relation to grade of tumor and treatment response in colorectal carcinoma patients

Urokinase (uPA) plays an essential role in the activation of plasminogen to plasmin, and together with its receptor (uPAR), tissue activator (tPA) and urokinase inhibitors (PAI 1, PAI 2, PAI 3 and protease nexin) forms the plasminogen activator system (PAS), a component of metastatic cascade importantly contributing to the invasive growth and angiogenesis of malignant tumours. In our project we examined the expression of uPA, uPAR, PAI 1 and PAI 2 in tumor tissue and we also studied the plasma levels of PAI 1 before and after the initiation of therapy in patients with colorectal carcinoma in relationship to grade of tumor and the treatment response. In our prospective evaluation we included 80 patients treated for adenocarcinoma of the colon and rectum. Analysis of collected data revealed statistically significant evidence of a relationship between the level of PAI 1 in plasma before treatment and grade of the tumor, which increases with tumor grade (p=0.025). We demonstrated that there exists a statistically significant relationship between the expression of PAI 2 (p<0.001) and uPAR (p=0.031) and grade of tumor. We also confirmed a statistically significant relationship between soluble levels of PAI 1 before treatment and therapeutic response (p=0.021). In our group of patients the expression of uPA, uPAR, PAI 1 and 2 in tumor tissue in relation to response to treatment was also assessed. Our results suggest that the greater expression of these parameters in tumor tissue is linked to a worse response to therapy. In conclusion, PAS factors help as a prognostic indicators and could also act as a predictive factor in colorectal carcinoma.

[Radiofrequency ablation of pancreatic neuroendocrine tumor]

BACKGROUNDS

Pancreatic neuroendocrine tumors (PNETs) include a broad range of neoplasms spanning from relatively benign to malignant. Radical resection has been advocated as the only curative method. Debulking (R2) resection can be indicated for locally unresectable PNETs. Debulking surgery improves the quality of life and prolongs overall survival. The disadvantages of this approach include bleeding, pancreatic fistula and tumor spread. No alternative method that would eliminate these complications has been published yet. Considering the encouraging results of the studies describing radiofrequency ablation (RFA) of locally advanced pancreatic cancer, a question arises, whether it might be possible to use RFA as a R2 resection alternative in PNETs.

CASE

A 73-year-old gentleman had been admitted due to abdominal pain and hyperglycaemic syndrome. Contrast-enhanced CT showed a tumor of pancreatic head invading portal vein (PV) and superior mesenteric vein (VMS). A surgery was indicated on the basis of EUS-guided FNAB that verified a PNET of uncertain biological behaviour. The surgery confirmed a locally advanced tumor of pancreatic head invading the PV and SMV. Due to the polymorbidity, radical pancreatoduodenectomy with SMV resection was not indicated. Because of the presence of symptoms, RFA of the PNET using ValleyLab generator with cooltip cluster electrode, was performed. Postoperative course was uneventful. Final immunohistochemical examination verified a well-differentiated grade 1 PNET. The patient was regularly monitored during a three-year follow-up. The quality of life was evaluated using standardized EORT QLQ-30 questionnaire. Pain was assessed by a ten-point visual analogue scale (VAS). Ablated area was evaluated annually by contrast-enhanced CT. Postoperatively, abdominal pain ceased (pain decrease from 2 to 0 on VAS). Insulin dose was reduced from 46 IU (international units) to 20 IU of Humulin-R per day. CT verified tumor regression according to RECIST (response evaluation criteria in solid tumors). During the three-year follow-up, no local progression or tumor dissemination was observed.

CONCLUSION

We present the first case report of a patient with locally advanced symptomatic pancreatic neuroendocrine tumor successfully treated by intraoperative radiofrequency ablation. More clinical studies are needed to evaluate the clinical relevance of this cytoreductive method in the PNET indication.

[Outcomes of pancreatic resections in the elderly and geriatric patients]

As a result of the population aging, we are confronted with the problematics of geriatric patients more and more frequently. The aim of this retrospective study was to compare outcomes of pancreatic resections in patients of three different age groups. During 2000-2007, 150 pancreatic resections were performed in our clinic, including 34 (22.7%) patients aged 65 and over at the time of the procedure and 5 (3.3%) patients over 75 y.o.a. The procedures were heterogenous, including indications for oncologic diagnoses, as well as for chronic pancreatitis. Our assessment demonstrated no significant differences in the 30-day postoperative mortality between the group of subjects over 65 y.o.a, geriatric group (i.e. over 75 y.o.a) and the group of subjects below 54 y.o.a. (8.8% vs. 0% vs. 5.2%). Furthermore, the postoperative morbidity showed no statistically significant differences between the all three groups (30.2% vs. 29.4% vs. 20%). The commonest postoperative complications included secondary healing of the surgical wound (7.8%) and pancreatic fistules (6.9%) in the group of subjects below 65 y.o.a., and insufficiency of the pancreatic-jejunal anastomosis (5.8%) and hepatic- jejunal anastomosis (5.88%) in the group aged 65 and over. Pancreatic-jejunal anastomosis insufficiency, complicated by consecutive bleeding, contributed to postoperative mortality most significantly. Significant increase in postoperative complication rates connected to proximal pancreatoduodenectomies and total pancreatoduodenectomies, was recorded in patients over 65, compared to those in the young patient group (p = 0.014). No statistically significant relation was found between a particular comorbidity and onset of postoperative complications or deaths in patients over 65 or geriatric patients. Based on the results, the authors do not consider the patient's age a contraindication for pancreatic resection procedures. Radical resections can be performed with acceptable mortality and morbidity rates in geriatric patients.

[Radiofrequency ablation (RFA) of pancreatic tumors]

The authors refer about their first experience with radiofrequency ablation of locally advanced pancreatic tumors. They put forward the prospective study of five patients (four with ductal adenocarcinoma of the head and one with malignant neuroendocrine tumor of pancreatic body), who either because of local advanced disease or performance status, were not able to undergo radical curative surgery. All patients underwent peroperative radiofrequency ablation of pancreatic tumors. In the case of pancreatic head localization, posterior retrocolic gastro-enterostomy and hepatico-jejunostomy to Y Roux jejunal loop were performed. There was no perioperative mortality. In one case duodenal leak apeared in the fourth postoperative day. This was healed conservatively by drainage. At one patient the subfascial absces developed. This was solved by drainage reoperation at the fourteenth postoperative day. After consolidation, all patients were released to home care.

CONCLUSION

According to our early experience, radiofrequency ablation of inoperable pancreatic tumors is relatively save cytoreductive procedure.

[Krukenberg tumors of gastric origin versus Krukenberg tumors of colorectal origin]

The aim of this study was to analyze the incidence and origin of Krukenberg tumors in our region to determine their clinical behavior and to compare some anatomo-clinical features of Krukenberg tumors of gastric origin versus those of colorectal origin. This is a retrospective, descriptive and comparative study of Krukenberg tumors diagnosed and treated in the IV-th Surgical Clinic of Cluj-Napoca. The epidemiologic features concerning global incidence, age, and menopausal status overlap the data from literature. Characteristic for our series of cases were the higher incidence of Krukenberg tumor of colorectal origin compared with those of gastric origin , significantly more frequent bilaterality of lesions of gastric origin and the prevalence of the unilateral left ovarian localization for Krukenberg tumors of colorectal origin. The differences in anatomo-clinical behavior between the Krukenberg tumors of gastric and colorectal origin may indicate different pathways of metastasizing and seeding.

An association study of 43 SNPs in 16 candidate genes with atorvastatin response

Variation in individual response to statin therapy has been widely studied for a potential genetic component. Multiple genes have been identified as potential modulators of statin response, but few study findings have replicated. To further examine these associations, 2735 individuals on statin therapy, half on atorvastatin and the other half divided among fluvastatin, lovastatin, pravastatin and simvastatin were genotyped for 43 SNPs in 16 genes that have been implicated in statin response. Associations with low-density lipoprotein cholesterol (LDL-C) lowering, total cholesterol lowering, HDL-C elevation and triglyceride lowering were examined. The only significant associations with LDL-C lowering were found with apoE2 in which carriers of the rare allele who took atorvastatin lowered their LDL-C by 3.5% more than those homozygous for the common allele and with rs2032582 (S893A in ABCB1) in which the two groups of homozygotes differed by 3% in LDL-C lowering. These genetic effects were smaller than those observed with the demographic variables of age and gender. The magnitude of all the differences found is sufficiently small that genetic data from these genes should not influence clinical decisions on statin administration.

Brown tumor of the spine and progressive paraplegia in a hemodialysis patient

STUDY DESIGN

Case report.

OBJECTIVE

To describe the radiographic features and management of spinal brown tumor and to document tumor mineralization after parathyroidectomy.

SUMMARY OF BACKGROUND DATA

Brown tumors are classic skeletal manifestations of hyperparathyroidism usually seen in severe forms. They are increasingly rare because hyperparathyroidism is now diagnosed and treated at an early stage.

METHODS

A case of brown tumor of the spine in a 37-year-old woman on chronic hemodialysis is described. The imaging findings before and after parathyroidectomy are discussed.

RESULTS

In a woman on chronic hemodialysis, a brown tumor of T8 caused acute spinal cord compression with paraplegia. Magnetic resonance imaging provided an accurate evaluation of the lesion, and needle biopsy confirmed the diagnosis. Emergent surgery was needed to relieve the spinal compression and stabilize the spine. The vertebral lesion underwent remineralization after parathyroidectomy.

CONCLUSION

Brown tumor is a benign tumor that resolves after parathyroidectomy. When brown tumor arises in the spine, surgery may be needed to preserve neurologic function.

[Role of mini-invasive surgery in the treatment of patients with neoplasms, particularly in colorectal carcinoma]

Laparoscopic surgery has found its firm position in the treatment of benign diseases. Yet, oncologic laparoscopy remains a controversial technique. Its indication is discussed, especially its specific complication in oncologic diseases--recurrence of malign tumors within the scar after the trocar. The authors have performed an extensive recherché on the incidence of local recurrences of malign tumors after laparotomy or laparoscopy. They compare the functional results of both techniques, radical measure of intervention and their technical limits. They analyse the causes of local recurrences as well as possibilities of their reduction. They evaluate also their own experience in laparoscopy performed in coincidence with malign diseases, especially in palliative surgery. They suggest indications of laparoscopy in cases with colorectal carcinoma which is currently, as well as prospectively the most frequent malign disease of the gastrointestinal tract in our region.

[Gastroesophageal reflux disease from the viewpoint of the surgeon]

Surgical treatment of patients with gastroesophageal reflux disease (GERD) represents an alternative approach in relation to the long-term pharmacologic therapy of prokinesis, and secretoinhibitory therapy. It must be considered in cases where the conservative approach has failed. The success of surgical treatment depends on an individual approach to the patient. The factors determining the surgical indication and especially the type of surgery, include age, anatomy of the hiatus and the results of pre-operational examinations of the esophagus. The type of operation depends on the ability of the esophagus to contract and to transfer the propulsion activity. According to the authors, the key examination is represented by the detection of esophageal contractility by use of esophageal manometry. The alternative option is represented by scintigraphic measurement of esophageal transit time by use of a tagged bolus. The patients with disappeared contractility are preferentially treated by conservative therapy due to the high risk of post-operational dysphagia. 80% of patients are treated by the standard procedure of laparoscopic fundoplication by a 360-grade cuff. The cases with decreased contractility or esophageal dysmotility are preferentially treated by partial fundoplication in Toupet's modification. The shortening of the esophagus requires consideration as to chest approach, or Collis' operation. Intestinal metaplasia of the esophagus requires specific procedures. Severe dysplastic changes require the consideration of resection treatment. The gained therapeutic results are evaluated by both, the subjective point of view of the authors, as well as by standard pH measurement and manometry of the esophagus performed 6 weeks after surgery.

Clinicopathological significance of p16 gene expression in the surgical treatment of head and neck squamous cell carcinomas

AIMS

To evaluate the clinicopathological significance of p16 expression in the surgical management of squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx, and larynx.

METHOD

p16 expression in 225 head and neck squamous cell carcinomas (HNSCCs) was studied using an immunohistochemical method and paraffin wax embedded tumour tissues. Associations between p16 expression and clinicopathological features were investigated.

RESULTS

Decreased p16 expression was found in 48% of the tumours. There was a higher frequency of decreased p16 expression in tumours of the larynx compared with those from the pharynx and oral cavity. There was a significant correlation between decreased p16 expression and more advanced T stage. There was no significant correlation between p16 expression and sex, age, tumour grade, nodal metastasis, recurrence, or survival.

CONCLUSION

There was a high frequency of downregulation of p16 expression in HNSCC. Tumours of the larynx had a significantly higher frequency of weak p16 expression compared with tumours of the oral cavity and pharynx. Downregulation of p16 contributed to cellular proliferation, resulting locally in a more advanced tumour. It had no prognostic significance for nodal metastasis and survival.

The disposition of saquinavir in normal and P-glycoprotein deficient mice, rats, and in cultured cells

Protease inhibitors are very effective in treating patients infected with HIV. However, many drugs in this class penetrate poorly into the central nervous system (CNS) and may permit this site to be a sanctuary from which resistant virus can emerge. Previous studies have shown that the protease inhibitor saquinavir (SQV) interacts with the multidrug transport system, P-glycoprotein (P-gp), expressed in epithelial cells in the gut mucosa and at the blood-brain barrier, and thus might affect both the oral absorption and the penetration of SQV into the CNS. To determine whether SQV is a substrate for P-gp, its uptake was determined in cancer cells, which do (Dx5) and do not (MES-SA) express P-gp. The distribution of SQV between brain tissue and plasma was also investigated in rats and in normal and P-gp-deficient mdr1a(-/-) mice. The distribution ratio of SQV in plasma:brain:cerebrospinal fluid was approximately 100:10:0.2 in rats. The accumulation of SQV was enhanced in MES-SA cells (P-gp-negative) versus Dx5 cells (P-gp-positive). Bolus i.v. injection of [(14)C]SQV (2 and 5 mg/kg) into mdr1a(-/-) and normal mice (n = 3 or 4) resulted in 3-fold higher radioactivity in brains from mdr1a(-/-) mice. Similarly, oral administration of [(14)C]SQV (500 mg/kg) resulted in a 5-fold increase in systemic exposure and a 10-fold increase in brain levels in mdr1a(-/-) mice. These data demonstrate that saquinavir is a substrate for P-gp and that this transport system may play a role in limiting oral absorption and CNS exposure to this protease inhibitor.

[Breast tuberculosis--a case report]

The authors report a case of breast tuberculosis in a 58-year-old patient in which the diagnosis was made with difficulty, initially the case being interpreted as a neoplastic process. This diagnosis should be considered in such cases. In our area, in the present tuberculosis endemic, the cases of tuberculosis with extrapulmonary localisation are more and more frequent.

[Gangliocytic paraganglioma of the duodenum]

Gangliocytic Paraganglioma of the duodenum is rare neuroendocrine tumor. This type of the tumor can cause bleeding into the gastrointestinal tract and epigastric pain in this region. It can be difficult to differentiate this tumor from the primary tumor of the head of the pancreas growing secondary to the duodenum. The authors describe one such misdiagnosed case treated finally successfully by hemipancreatodecodenectomy.

Acromioclavicular dislocations: treatment by coracoacromial ligamentoplasty

We did a retrospective review of 32 patients who had undergone acute treatment for acromioclavicular joint dislocation (mean follow-up period 46 months) and 24 patients who had undergone surgery for chronic joint dislocation (mean follow-up period 51 months). All patients had a ligamentoplasty performed using the coracoacromial ligament. With the shoulder functional score described by Patte, we obtained 81% satisfactory results for the patients who underwent acute treatment and 79% satisfactory results for those who underwent late treatment. Because results in both groups were similar, we now treat only the more severe form of acute dislocation with surgery. Delayed surgery is indicated in those patients who have an unsatisfactory result after functional treatment.

Entrapment and compartment syndromes of the upper limb in haemophilia

17 patients with haemophilia have been treated for a neurological deficit of the upper limb. Four of the five entrapment neuropathies have been operated upon, and only two patients recovered completely. Only two of the 12 patients with a compartment syndrome have been operated upon, and only two had sequelae. Clotting factor replacement is always indicated as primary treatment. Surgical release is indicated if the condition fails to improve. Late treatment was responsible for incomplete recovery, whatever the cause of the nerve compression.

Isotope dilution technique for the estimation of l-alpha-[2-3H]-acetylmethadol and its metabolites in biological samples

An isotope dilution technique for the determination of l-alpha-(2-3H)-acetylmethadol and its metabolites from biological samples is described. The parent drug and metabolites were extracted from biological samples with chlorobutane after the addition of unlabeled internal standards. The extracts were purified by two-dimensional thin-layer chromatography for quantification by gas-liquid chromatography and scintillation counting. Dinoracetylmethadol (NNAM) was found to be converted to 6-acetamido-4,4-diphenyl-3-heptanol (AMIDE) during the extraction procedure. The conversion of NNAM to AMIDE was confirmed by gas chromatography-mass spectrometry.