Malignant Infantile osteopetrosis

INTRODUCTION

Malignant Infantile Osteopetrosis (MIOP) is a rare and severe genetic disorder due to abnormal osteoclast activity.

OBJECTIVE

To report an infant who presented Malignant Infantile Osteopetrosis, reviewing the most relevant diagnostic and therapeutic aspects.

CLINICAL CASE

A ten- month-old male infant with diagnosis of MIOP confirmed after presenting thrombocytopenia and visceromegaly. He was the first child of non-consanguineous parents, and among the findings, he presented severe hepatosplenomegaly, thrombocytopenia, and anemia; visual and hearing impair ment, and repeated infections. The diagnosis was confirmed by genetic study, which identified two heterozygous mutations in the TCIRG1 gene. Hematopoietic stem cells were transplanted without hematological recovery. The patient died due to occlusive venous disease.

DISCUSSION

MIOP is a rare, severe, and early-onset disease, with a high rate of suspicion necessary in the presence of hepa- tosplenomegaly and bone marrow failure. Early diagnosis and hematopoietic stem cells transplanta tion are the only potentially therapeutic interventions of this lethal entity.

P208 Abnormal coronary flow reserve assessed with stress echocardiography induces a reduction in transmural strain gradient and an increase in heterogeneous myocardial electrical activation

OnBehalf

Echo Lab INC

Background

The integrated quadruple stress echo (IQ-SE) is a state-of-the-art protocol that expands the risk stratification potential of SE. The coronary flow reserve (CFVR) has pronostic implication mainly in the absence of wall motion abnormalities. Longitudinal multilayer strain analysis assesses trasmural strain gradient. The prognostic value of multilayer strain analysis alongside the IQ-SE has not been established. We aim to determine the additive value of multilayer strain analysis during IQ-SE.

Methods

Prospective observational study. We evaluated one hundred twenty intermediate-high risk patients without obstructive coronary artery disease (mean age 61 ± 12 years, female 43%) with IQ-SE dipyridamole at our institution. Abnormal CFVR was defined as CFVR <2. Multilayer strain analysis and mechanical dispersion, were performed during rest and stress, with an automatic frame-by-frame with speckle tracking.

Results

The IQ-SE was feasible in all patients. At rest, mean three-dimensional left ventricular ejection fraction (3D LVEF) was 59% (53-62) without wall motion abnormalities. Abnormal CFVR was seen in 38 patients (32%) and reduced left ventricular contractile reserve (LVCR) in 56 patients (46%). Patients with abnormal CFVR, showed a reduction in EndoLS and transmural strain gradient, and an increase in mechanical dispersion and in lung B-lines during stress. No differences were observed in 3D LVEF and LVCR.

Conclusions

Endocardial ischemia due to microvascular dysfunction leads to a reduction in transmural strain gradient. Adding multilayer strain analysis to IQ-SE might detect myocardial subclinical dysfunction, arrhythmic risk and pulmonary congestion due to microvascular dysfunction.

Left ventricular mechanics analysis CVFR <2 (38) CVFR >2 (81) P Rest EpiLS (%) -14.9 ±4.2 -18 ± 3.7 0.001 EndoLS (%) -20.2 ± 5.9 -23.5 ± 4.5 0.001 EndoLS- EpiLS 5.1 (3.8-6.3) 5.4 (4.2-6.3) 0.27 Mechanical Dispersion (ms) 57.7 (42.2-69) 44.2 (35-54) 0.006 Stress EpiLS (%) -17.2 ± 4.8 -20 ± 4.4 0.003 EndoLS (%) -23 ± 6 -26.6 ± 5.7 0.002 EndoLS- EpiLS 5.6 (4.5-6.7) 6.3 (5.4-7.9) 0.01 Mechanical Dispersion (ms) 47 (39.5 - 59) 39 (30-54.6) 0.007 CVFR: coronary flow reserve; EpiLS: Epicardium longitudinal strain; EndoLS: endocardial longitudinal strain; EndoLS- EpiLS: trasmural strain gradient.

Abstract P208 Figure. IQ-SE and Multilayer Strain

Evaluation of the potential of ultrasound technology combined with mild temperatures to reduce cadmium content of edible crab (Cancer pagurus)

The consumption of crustaceans is correlated with certain health risks, particularly due to several highly toxic elements they contain, including cadmium (Cd). Although Cd content in one sole crab generally exceeds the total weekly recommended intake of cadmium as established by EFSA (especially in brown meat), efficient modern strategies to reduce Cd content in crabs still have not yet been developed. The objective of this research was therefore to evaluate the potential use of ultrasound technology in combination with temperature (50°-80 °C) with the purpose of releasing Cd from brown crab (Cancer pagurus), thereby reducing the Cd content in its meat. Female crabs were immersed in a water bath at 50, 65, and 80 °C in presence or absence of ultrasound; Cd concentration in the water was monitored along time. At the end of the process, Cd content in brown and white crab meat was likewise quantified. Treatment temperature did not bear an influence on the release of Cd in absence of ultrasound, but proved to be an important variable when ultrasound assisted the process. Ultrasound increased Cd release rates 8.7-, 2.1- and 2.7-fold in conjunction with the treatments at 50, 65 and 80 °C, respectively. The maximum percentage of Cd extracted (22.8%) was observed at 50 °C for an ultrasound input power of 200 W. These results have demonstrated for the first time that the application of ultrasound during the crab-cooking process could serve as an effective physical procedure for reducing the Cd content of crabs, thereby improving the product's safety for consumers.

An assessment of the application of ultrasound in the processing of ready-to-eat whole brown crab (Cancer pagurus)

This study assesses the potential of incorporating ultrasound as a processing aid in the production of whole cooked brown crab (Cancer pagurus). The FDA recommended heat treatment to reduce Listeria monocytogenes by 6 log₁₀ cycles in this product is a F₇₀^7.5 of 2min. An equivalent F value was applied at 75°C in presence and absence of ultrasound in water alone or in water with 5% w/v NaCl added. Heat penetration, turbidity and conductivity of the cook water and also salt and moisture content of the crab meat (white and brown) were determined. Ultrasound assisted cooking allowed a reduction of the cooking time by up to 15% while still maintaining an F₇₀^7.5 of 2min. Ultrasound also enhanced the rate and total amount of compounds released from the crab, which suggests that crabs cooked in the presence of ultrasound would be expected to be cleaner. Ultrasound also proved to be effective in reducing the salt content but hardly affected the final moisture content of the crab meat.

Osmotolerance provided by the alternative sigma factors σB and rpoS to Staphylococcus aureus and Escherichia coli is solute dependent and does not result in an increased growth fitness in NaCl containing media

The aim of this work was to examine the role of the alternative general stress sigma factors σ(B) and rpoS on the ability of Staphylococcus aureus and Escherichia coli, respectively, to grow in liquid and solid media of different osmolarity. For this purpose, S. aureus strain Newman and its isogenic ΔsigB mutant IK84 and E. coli strain BJ4 and its isogenic ΔrpoS mutant BJ4L1 were grown in media (TSBYE) with different concentrations of NaCl. Growth parameters (lag phase duration, growth rate and maximum number of microorganisms) and limiting growth concentrations (Maximum Non-Inhibitory Concentration - MNIC - and Minimum Inhibitory Concentration - MIC-) were determined. The mechanisms underlying the differences observed between parental and mutant strains were also explored. The absence of the sigma factors σ(B) and rpoS led to a decrease in the MNICs and MICs calculated for S. aureus and E. coli, respectively. Conversely, neither σ(B) nor rpoS provided with increased growth fitness to S. aureus and E. coli cells at NaCl concentrations up to 1.36M and 1M, respectively. The decreased osmotolerance of the σ(B) and rpoS deficient strains, as compared to their parental strains, was compensated by the addition of glycine-betaine (1mM) to the growth medium. It was also observed that the decreased tolerance to NaCl of the mutant strains was coincident with a decreased tolerance to sucrose, KCl, and LiCl but not to glycerol, MgCl2, and CaCl2. Results obtained also demonstrate that the increased osmotolerance of stationary growth phase E. coli cells, as compared to exponential growth phase ones, would be due to the activation of both rpoS-independent and rpoS-dependent mechanisms. This work will help to understand the mechanisms of bacterial resistance to osmotic stress and the role of the alternative sigma factors σ(B) and rpoS in this process.

Bacterial maximum non-inhibitory and minimum inhibitory concentrations of different water activity depressing solutes

The NaCl MNICs (maximum non-inhibitory concentrations) and MICs (minimum inhibitory concentrations) for growth of various strains of six bacterial species were determined and then compared with those obtained for seven other solutes. The influence of prior growth conditions on the MNICs and MICs was also evaluated. No significant changes on the MNICs and MICs were found among the strains studied within each species. Among all factors investigated, only growth phase -for Gram-negatives- and growth at high NaCl concentrations led to a change in the NaCl MNICs. Species could be classified depending on its NaCl MNICs and MICs (in decreasing order) as follows: Staphylococcus aureus, Listeria monocytogenes, Cronobacter sakazakii, Enterococcus faecium, Escherichia coli and Salmonella Typhimurium. Similar results were obtained for KCl, LiCl, and sodium acetate, but not for the remaining solutes investigated (sucrose, glycerol, MgCl2 and CaCl2). Results obtained indicate that, in general, Gram-negatives showed lower MNICs and MICs than Gram-positives for all the solutes, S. aureus being the most solute tolerant microorganism. When compared on a molar basis, glycerol showed the highest MNICs and MICs for all the microorganisms -except for S. aureus- and LiCl the lowest ones. NaCl MNICs and MICs were not significantly different from those of KCl when compared on a molar basis. Therefore, the inhibitory action of NaCl could not be linked to the specific action of Na(+). Results also showed that the Na(+) tolerance of some species was Cl(-) dependent whereas for others it was not, and that factors others than aw-decrease contribute to the inhibitory action of LiCl, CaCl2 and MgCl2.

Video endoscopic inguinal lymphadenectomy: surgical and oncological results

INTRODUCTION

We evaluated the reproducibility of video endoscopic inguinal lymphadenectomy (VEIL) and we report our initial experience in the treatment of penile cancer with palpable inguinal lymph nodes.

MATERIAL AND METHODS

From July 2006 to November 2010 were conducted 33 VEIL in 20 patients as complementary treatment for penile cancer in two referral hospitals in Latin America. We analyzed the epidemiological and clinical characteristics of patients and surgical and oncologic outcomes.

RESULTS

Fifty-five percent of the patients included were clinical stage N0 and 45% were N +. Thirteen patients underwent bilateral VEIL and the remaining seven underwent VEIL unilateral and conventional open surgery in the contralateral limb. The average operative time for VEIL was 119 minutes and mean resected lymph nodes was 8 per lymphadenectomy. The overall complication rate was 33.2%. No patient had skin necrosis. The lymphatic complication rate was 27.2%. Of the 6 cases in which the saphenous vein was preserved (18.2%) there were no lymphatic complications (P=,2). The overall survival rate was 80% and cancer-specific survival was 90%. Mean follow-up was 20 months.

CONCLUSIONS

VEIL in the adjunctive treatment of penile cancer is safe, reproducible and may be an alternative to conventional lymphadenectomy. Patients with palpable lymphadenopathy also may benefit from this technique. Oncological results seem to be adequate however require longer follow-up to be confirmed.

Pulsed electric fields cause sublethal injuries in the outer membrane of Enterobacter sakazakii facilitating the antimicrobial activity of citral

AIMS

The objective was to evaluate the relation of sublethal injury in the outer membrane of Enterobacter sakazakii to the inactivating effect of the combination of pulsed electric fields (PEF) treatments and citral.

METHODS AND RESULTS

The occurrence of sublethal injury in the outer membrane was measured using selective recovery media containing bile salts. Loss of membrane integrity was measured by the increased uptake of the fluorescent dye propidium iodide (PI). PEF caused nonpermanent and permanent envelope permeabilization of Ent. sakazakii at pH 4·0. After PEF, most surviving cells showed transient cell permeabilization and sublethal injury in their outer membranes. The simultaneous application of a mild PEF treatment (100 pulses, 25 kV cm(-1) ) and 200 μl l(-1) of citral to cells suspended in pH 4·0 buffer at a final concentration of 10(7) cells per ml showed an outstanding synergistic lethal effect, causing the inactivation of more than two extra log(10) cycles.

CONCLUSIONS

Our results confirm that the detection of sublethal injury in the outer membrane after PEF may contribute to the identification of the treatment conditions under which PEF may act synergistically with hydrophobic compounds such as citral.

SIGNIFICANCE AND IMPACT OF THE STUDY

Knowledge about the mechanism of microbial inactivation by PEF will aid the establishment of successful combined preservation treatments.

Genetic analysis of the early natural history of epithelial ovarian carcinoma

Background

The high mortality rate associated with epithelial ovarian carcinoma (EOC) reflects diagnosis commonly at an advanced stage, but improved early detection is hindered by uncertainty as to the histologic origin and early natural history of this malignancy.

Methodology/Principal Findings

Here we report combined molecular genetic and morphologic analyses of normal human ovarian tissues and early stage cancers, from both BRCA mutation carriers and the general population, indicating that EOCs frequently arise from dysplastic precursor lesions within epithelial inclusion cysts. In pathologically normal ovaries, molecular evidence of oncogenic stress was observed specifically within epithelial inclusion cysts. To further explore potential very early events in ovarian tumorigenesis, ovarian tissues from women not known to be at high risk for ovarian cancer were subjected to laser catapult microdissection and gene expression profiling. These studies revealed a quasi-neoplastic expression signature in benign ovarian cystic inclusion epithelium compared to surface epithelium, specifically with respect to genes affecting signal transduction, cell cycle control, and mitotic spindle formation. Consistent with this gene expression profile, a significantly higher cell proliferation index (increased cell proliferation and decreased apoptosis) was observed in histopathologically normal ovarian cystic compared to surface epithelium. Furthermore, aneuploidy was frequently identified in normal ovarian cystic epithelium but not in surface epithelium.

Conclusions/Significance

Together, these data indicate that EOC frequently arises in ovarian cystic inclusions, is preceded by an identifiable dysplastic precursor lesion, and that increased cell proliferation, decreased apoptosis, and aneuploidy are likely to represent very early aberrations in ovarian tumorigenesis.

Dissociation of the E-Cadherin-Catenin-Complex (CCC) Is an Early and Progressive Event in Lobular Neoplasia

Recent data suggests that some lobular carcinoma in situ (LCIS) lesions may behave as precursors to invasive lobular carcinoma (ILC). Loss of E-cadherin (E-CD) mediated cell adhesion is characteristic of both LCIS and ILC and is reflected in the dis-cohesive appearance of the individual cells. Subsequent dissociation of the intracellular E-cadherin-catenin-complex (CCC) facilitates tumor progression, invasion and migration. Whether disruption of the CCC plays a role in the progression of select LCIS lesions to ILC remains unclear. The aim of this study was to evaluate the relation between loss of E-CD and dissociation of the CCC in pure LCIS and LCIS with concurrent ILC (LCIS w/ILC). Methods Thirty patients undergoing mastectomy for LCIS alone or LCIS w/ ILC were prospectively enrolled to an IRB-approved protocol. FFPE blocks were retrieved and sections prepared for IHC. 18 cases had LCIS w/ ILC, 12 cases had pure-LCIS. IHC was performed for ER, PR, E-CD, N-cadherin (N-CD), and α-, β- and phospho-β-catenin. ER/PR positivity was scored as any nuclear staining, and E-CD and N-CD by any membranous staining. a- and β-catenin expression was scored by site (membranous/cytoplasmic/nuclear) of staining compared to normal. Dissociation of the CCC was defined by loss of membranous α- and β-catenin expression.Results Median age at surgery was 51yrs (range 40-79); patients with pure LCIS were younger than those with LCIS w/ ILC (median 48yrs vs 57yrs, p=.0002). Among 18 cases of LCIS w/ ILC, the median tumor size was 2cm (range 1.4-5.7), 9 patients had N1 disease and 1 had M1 disease. All pure LCIS, LCIS w/ ILC and ILC lesions were ER/PR positive and E-CD negative. N-CD expression was also absent in all pure LCIS, LCIS w/ ILC and ILC lesions. Normal α-catenin membranous expression was confirmed in all normal epithelial cells but decreased with the transition from in-situ to invasive disease: pure-LCIS lesions 83%; LCIS w/ ILC 28%; ILC 0%. Loss of membranous α-catenin expression was accompanied by cytoplasmic α-catenin expression in all lesions. A similar trend of decreasing membranous staining from in-situ to invasive disease was observed for β-catenin, however in contrast to α-catenin, cytoplasmic β-catenin expression decreased from 67% in pure LCIS to 11% in LCIS w/ ILC and 6% in ILC. Active β-catenin (nuclear staining) was not seen in pure LCIS lesions and was only present in one case of LCIS w/ ILC. Inactive (phospho) β-catenin expression was present in all lesions.Conclusion Loss of E-CD expression is an early event in lobular neoplasia however subsequent dissociation of the intracellular CCC a a ppears to be a progressive process with complete dissociation occurring only in invasive lesions. This finding suggests that complete disruption of the CCC may be required to facilitate maintenance of the invasive phenotype; however, the absence of N-CD expression and predominance of inactive β-catenin in both in situ and invasive lesions suggests that alternate mechanisms are also required to mediate the pro-invasive effects of CCC dissociation. Further studies into the mechanisms of CCC dissociation and downstream events in lobular carcinoma are needed to define the role of this process in the transition from in-situ to invasive disease.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6149.

Observation of muon neutrino disappearance with the MINOS detectors in the NuMI neutrino beam

This Letter reports results from the MINOS experiment based on its initial exposure to neutrinos from the Fermilab NuMI beam. The rates and energy spectra of charged current nu(mu) interactions are compared in two detectors located along the beam axis at distances of 1 and 735 km. With 1.27 x 10(20) 120 GeV protons incident on the NuMI target, 215 events with energies below 30 GeV are observed at the Far Detector, compared to an expectation of 336+/-14 events. The data are consistent with nu(mu) disappearance via oscillations with |Delta(m)2/32|=2.74 +0.44/-0.26 x10(-3)eV(2) and sin(2)(2theta(23))>0.87 (68% C.L.).

[Use of a virtual immersion computer simulator as a model for basic training in laparoscopic urology]

BACKGROUND

to date, it has not been defined the best method for teaching urologic laparoscopy, however it is well recognized that it involves a steep learning curve.

METHODS

A course of Laparoscopic Urology was done in our Institute. The program included skill practices in a virtual immersion simulator which evaluated, the score and time to complete each activity. This was done in a group of residents with previous experience with this virtual simulator (group 1) and another group of residents with no experience (group 2). Four different basic tasks were performed in the virtual simulator, which included: coordination, cutting, clip application and performing a simple suture.

RESULTS

When we compared the scores between both groups the mean scores for each task were superior in group 1 compared to the group 2, with no statistically significant difference, however when we compared the time to complete each task, it was shorter in group 1 compared to group 2 with a statistically significant difference.

CONCLUSIONS

The performance of residents without experience in a virtual simulator was similar to that of previously trained residents, however it takes less time to complete each task as the resident gains experience in these simulators. The use of virtual simulators for laparoscopy training are useful when learning basic techniques allowing the surgeon to improve hand dexterity and coordination in laparoscopic surgery.

[Frequent users and difficult patients: how do they feel about their treatment by doctors?]

BACKGROUND

To determine the opinions and expectations of difficult, frequent user, patients about their relationship with their GP.

MATERIAL AND METHODS

Qualitative design. Discussion groups. Invitation to a meeting at the Chantrea Health Centre (Pamplona). The participants were frequent users of the health centre in the year 2003, who had been defined as "difficult"--according to previously defined criteria--by each of the 12 doctors of the health centre. Excluded were patients with mental retardation, severe hearing problems, severe mental illness, difficulties in mobility and travelling, and over 70 years of age. Groups were formed from amongst the 112 preselected patients. Four groups were designed: "older" persons (GMA) of 46 to 70 years (14); "women" (GMU) of 31 to 45 years (14); "men" (GHO) of 31 to 45 years (13) and "youths" (GJO) of 16 to 30 years (12). The patients were invited by letter and by a subsequent telephone confirmation to a meeting, the content of which was not specified. Sessions of 2 hours duration were held with each of the groups formed. Audio recording, with prior authorization, and verbatim transcription of sessions. Discussion and content analysis by the research group resulting in lines of consensus.

RESULTS

The three groups of older patients were formed with a total of 16 participants. The group of youths was not formed since the figure for attendance did not reach the number of 3 or more after three appointments.

CONCLUSIONS

From the perspective of the patient it is very important that there should be efficient communication with the doctor. Awareness of a state of frequent use was not detected in those attending. They feel themselves to be chronic patients who need frequent attention. Satisfaction at the treatment received was observed as well as an understanding attitude towards the organisational limitations of the health centre. They did not give verbal expression to the existence of conflictive relations with their GPs.

Precision measurement of the weak mixing angle in Møller scattering

We report on a precision measurement of the parity-violating asymmetry in fixed target electron-electron (Møller) scattering: A(PV) = [-131 +/- 14(stat) +/- 10(syst)] x 10(-9), leading to the determination of the weak mixing angle sin2(thetaW(eff) = 0.2397 +/- 0.0010(stat) +/- 0.0008(syst), evaluated at Q2 = 0.026 GeV2. Combining this result with the measurements of sin2(thetaW(eff) at the Z0 pole, the running of the weak mixing angle is observed with over 6sigma significance. The measurement sets constraints on new physics effects at the TeV scale.

Increased progesterone receptor expression in benign epithelium of BRCA1-related breast cancers

The study of pathologically normal breast epithelium of BRCA mutation carriers may yield insights into the early natural history of breast tumorigenesis. Hormone receptor expression was assessed in 24 cases of invasive breast cancer associated with a mutation in BRCA1 (n = 15) or BRCA2 (n = 9) and in 39 sporadic cases matched for patient age and tumor hormone receptor status. Expression of progesterone receptor was significantly (P = 0.0003) more common in normal breast epithelium adjacent to invasive breast carcinoma in BRCA1-linked cases compared with sporadic cases. The wild-type BRCA allele was retained in normal epithelium of all cases tested. We conclude that deregulation of progesterone receptor expression, as a result of BRCA1 haploinsufficiency, may represent an early event in BRCA1-linked breast tumorigenesis.

Mutation and expression of the TP53 gene in early stage epithelial ovarian carcinoma

OBJECTIVE

The early natural history of epithelial ovarian carcinoma remains poorly understood. Mutation of the TP53 gene is common in advanced-stage (III-IV) ovarian cancers, but less well described in early stage (I-II) tumors. The purpose of this study was to perform a comprehensive analysis of TP53 mutation and p53 expression status in early stage ovarian carcinomas.

METHODS

Seventy-three cases of various histologic types, including 46 stage I and 27 stage II tumors, were subjected to direct sequence analysis of the entire TP53 coding region and exon-intron junctions as well as immunohistochemical assessment of p53 expression.

RESULTS

Overall, mutations were identified in 24 of 73 (34%) cases. However, a significant difference in the distribution of mutations among histologic types was observed; TP53 mutations were present in 14 of 21 (67%) serous cancers and 11 of 52 (21%) non-serous cancers (P = 0.0002). Mutations were equally common between stage I and stage II tumors of serous histology. With respect to the correlation between TP53 mutation and p53 immunopositivity, the sensitivity (58%), specificity (71%), positive predictive value (64%), and negative predictive value (83%) were not sufficiently robust to justify use of p53 expression as a surrogate or screen for mutation.

CONCLUSIONS

These data indicate that TP53 mutation is common in early stage ovarian carcinomas of serous histology, with a mutation frequency comparable to that reported for advanced-stage tumors, and is therefore likely to occur early in the progression of the most common histologic variant of ovarian carcinoma.

Observation of parity nonconservation in møller scattering

We report a measurement of the parity-violating asymmetry in fixed target electron-electron (Møller) scattering: A(PV)=[-175+/-30(stat)+/-20(syst)] x 10(-9). This first direct observation of parity nonconservation in Møller scattering leads to a measurement of the electron's weak charge at low energy Q(e)(W)=-0.053+/-0.011. This is consistent with the standard model expectation at the current level of precision: sin((2)theta(W)(M(Z))((-)MS)=0.2293+/-0.0024(stat)+/-0.0016(syst)+/-0.0006(theory).

Weekly trastuzumab and paclitaxel therapy for metastatic breast cancer with analysis of efficacy by HER2 immunophenotype and gene amplification

PURPOSE

This phase II study evaluated weekly trastuzumab and paclitaxel therapy in women with HER2-normal and HER2-overexpressing metastatic breast cancer. Efficacy was correlated with immunohistochemical and fluorescent in situ hybridization (FISH) assay results.

PATIENTS AND METHODS

Eligible patients had bidimensionally measurable metastatic breast cancer. Up to three prior chemotherapy regimens, including prior anthracycline and taxane therapy, were allowed. Trastuzumab 4 mg/kg and paclitaxel 90 mg/m2 were administered on week 1, with trastuzumab 2 mg/kg and paclitaxel 90 mg/m2 administered on subsequent weeks. HER2 status was evaluated using four different immunohistochemical assays and FISH.

RESULTS

Patients received a median of 25 weekly infusions (range, one to 85 infusions). Median delivered paclitaxel dose-intensity was 82 mg/m2/wk (range, 52 to 90 mg/m2/wk). The intent-to-treat response rate for all 95 patients enrolled was 56.8% (95% confidence interval, 47% to 67%). A response rate of 61.4% (4.5% complete response, 56.8% partial response) was observed in 88 fully assessable patients. In patients with HER2-overexpressing tumors, overall response rates ranged from 67% to 81% compared with 41% to 46% in patients with HER2-normal expression (ranges reflect the different assay methods used to assess HER2 status). Differences in response rates between patients with HER2-overexpressing tumors and those with normal HER2 expression were statistically significant for all assay methods, with CB11 and TAB250 antibodies and FISH having the strongest significance. Therapy was generally well tolerated, although three patients had serious cardiac complications.

CONCLUSION

Weekly trastuzumab and paclitaxel therapy is active in women with metastatic breast cancer. Therapy was relatively well tolerated; however, attention to cardiac function is necessary.

[Infection of ascending aortic graft: treatment with surgical cleaning, graft preservation and transposition of muscle flaps. Report of two cases]

Mediastinitis with graft infection is a serious complication of ascending aorta replacement. We report two cases of graft infection, treated with surgical cleaning, graft preservation and transposition of muscle flaps. A 62 years old male was admitted 34 days after an ascending aortic grafting due to a sternal dehiscence and mediastinitis. Antimicrobial treatment was started and a surgical cleaning performed, leaving an open sternotomy. Three days later, the thoracic cavity was closed with a rectus abdominis muscle flap. After 23 months of follow up, the patient is well and without evidence of infection. A 74 years old male was subjected to an aortic valve and ascending aorta replacement and a myocardial revascularization. In the postoperative period, the patient developed septic signs, and a purulent drainage. A CAT scan showed a liquid collection surrounding the aortic graft. On tW Sixteenth postoperative day, a surgical cleaning was performed and the thorax was closed with the pectoralis major muscle. After 10 months of follow up, the patient is in Good condition and without evidence of infection.

Role of mast cells in the pathogenesis of postburn inflammatory response: reactive oxygen species as mast cell stimulators

Thermal trauma has a direct effect on mast cells, triggering the secretion of histamine. This secretion leads to an enhanced xanthine oxidase activity and an increased production of reactive oxygen species (ROS), the latter being produced after burns through differing mechanisms. As ROS have been shown to have deleterious effects on cellular membranes, a lesion of the mast cell membrane could close the circle of autoinjury due to the vasoactive actions of mast cell mediators. Our studies were designed to assess the potentiality of ROS as stimulators of mast cell degranulation after burns by comparing two groups of rats treated, respectively, with SOD and saline solution after a scald injury. Plasma levels of tryptase and histamine were analyzed as markers of mast cell activity. A comparison of the mean increases of tryptase between baseline and 3-h postburn levels in the two groups shows significant differences (p < 0.001) (control: 0.13+/-0.04, SOD: 0.03+/-0.01). When comparing the mean increases between the baseline and 3 h postburn levels of histamine in the two groups, significant differences were also found (p < 0.001) (control group: 2.70+/-0.57. SOD group: 1.22+/-0.32). The lower levels of histamine and tryptase induced by SOD provides indirect evidence that ROS are involved in the process, causing the release of such mediators by mast cells, which may in turn suggest that ROS can act as stimulators of mast cell degranulation in burns.

Improved branching ratio measurement for the decay K(0)(L) --> &mgr;(+)&mgr;(-)

We report results from Experiment 871, performed at the BNL AGS, of a measurement of the branching ratio K(0)(L)-->&mgr;(+)&mgr;(-) with respect to the CP-violating mode K(0)(L)-->pi(+)pi(-). This experiment detected over 6200 candidate &mgr;(+)&mgr;(-) events, a factor of 6 more than that seen in all previous measurements combined. The resulting branching ratio gamma(K(0)(L)-->&mgr;(+)&mgr;(-))/gamma(K(0)(L)-->pi(+)pi(-)) = (3. 474+/-0.057)x10(-6) leads to a branching fraction B(K(0)(L)-->&mgr;(+)&mgr;(-)) = (7.18+/-0.17)x10(-9), which is consistent with the current world average, and reduces the uncertainty in this decay mode by a factor of 3.

[Popliteal vein aneurysm]

The popliteal vein aneurysm is a rare condition that can lead to local symptoms, thrombosis and pulmonary embolism. We report the case of a 67 years old, otherwise healthy white male, who presented to us with localised swelling and pain in the left popliteal fossa. Duplex ultrasound and venography were obtained, confirming the diagnosis of popliteal vein aneurysm. The patient underwent tangential aneurysmectomy and lateral venorrhaphy, recovery was uneventful remaining asymptomatic. The reconstruction was demonstrated patent on a duplex scan. The popliteal vein aneurysm is a potentially fatal condition for which surgical treatment is recommended.

High-performance liquid chromatography analysis of Bobel-24 in biological samples for pharmacokinetic, metabolic and tissue distribution studies

A rapid and simple HPLC method is described for the determination of Bobel-24 (2,4,6-triiodophenol) and other iodinated derivatives in biological samples. The sample preparation was liquid-liquid extraction before injection onto the HPLC system. 2,6-Diiodo-4-methylphenol was used as internal standard. Separation was obtained using a reversed-phase column under isocratic conditions. The mobile phase consisted of water-acetonitrile (62:38). 2,4,6-Triiodophenol was detected at 277 nm. This method was used for Bobel-24 determination in plasma, urine, synovial liquid and different tissues. The assay was applied to pharmacokinetic studies in dog and horse plasma and different dog tissues for tissue distribution profiles toxicological and metabolic studies. In addition, this method for biological samples can be applied to non-biological samples such as pharmaceutical formulations in stability studies and quality control assays.

Simple and robust high-performance liquid chromatographic method for the determination of ranitidine in microvolumes of human serum

A simple robust high-performance liquid chromatographic method is described for the determination of ranitidine in microvolumes of human serum. The drug of interest was isolated using liquid-liquid extraction with dichloromethane and back-extraction with 0.1% phosphoric acid and separation was obtained using a reversed-phase column under isocratic conditions, with ultraviolet detection at 313 nm. Intra-day and inter-day coefficients of variation ranged from 1 to 6% and 3 to 10%, respectively. Accuracy of the assay was less than 10% at all concentrations. The limit of detection and the limit of quantitation were 2 and 7 ng/ml, respectively. The linearity was assessed in the range 10-1000 ng/ml. It was shown that a group of common drugs co-administered with ranitidine did not interfere with its determination. The applicability of this method for the pharmacokinetic study of ranitidine following i.v. infusion in patients was demonstrated using only 100 microl of serum. The ruggedness of the assay was demonstrated over a three-year period.

Determination of imipenem in plasma by high-performance liquid chromatography for pharmacokinetic studies in patients

A rapid and simple HPLC method is described for the determination of imipenem in human plasma. After blood collection, plasma was separated by centrifugation and immediately stabilized with 3-morpholinopropanesulfonic acid (MOPS) and ethylene glycol solution (1:1). The sample preparation, before injection into HPLC, was ultrafiltration. The mobile phase was boric acid buffer. The imipenem was detected at 300 nm and cilastatin sodium, coadministered, did not interfere. Calibration curves in human plasma were linear from 0.1 to 100 microg/ml. The limit of detection was 0.030 microg/ml. Inter-day precision at 0.1 microg/ml, determined as the coefficient of variation, was 6.26%. Only 250 microl of plasma was required in our assay. Due to the limited stability of imipenem [G.B. Smith et al., J. Pharm. Sci., 79 (1990) 732], stability studies in plasma were done to establish appropriate storage conditions. The assay was applied to pharmacokinetic studies in patients.

Determination of captopril in plasma by high-performance liquid chromatography for pharmacokinetic studies

A high-performance liquid chromatographic method is described for the determination of free captopril in human plasma N-Acetyl-L-cysteine (NAC) was used as an internal standard. Plasma samples were immediately derivatized with N-(1-pyrenyl)maleimide (NPM) and stabilized with 11 M HCl. The drug of interest was isolated using a liquid-liquid extraction with ethyl acetate and separation was obtained using a reversed-phase column under isocratic conditions with fluorescence detection. The sample volume was 150 microliters plasma. The intra- and inter-day accuracy and precision, determined as relative error and coefficient of variation respectively, were less than 10%. The lower limit of quantitation, based on standards with acceptable coefficients of variation, was 25 ng/ml. No endogenous compounds were found to interfere. The linearity was assessed in the range of 25-600 ng/ml. This method has been demonstrated to be suitable for pharmacokinetic studies in humans.

Melanocyte reservoir in vitiligo

BACKGROUND

Dopa-negative, inactive melanocytes, present in the middle portion of the hair follicle, but also in hair bulbs, have been reported as a source of pigment cells, when repopulation of epidermal melanocytes occurs. A melanocyte reservoir in these anatomical sites has been suggested. Our objective was to investigate the ability of the lower third of the hair follicle (hair bulb) to repigment achromic skin in vitiligo.

METHODS

Scalp hair bulbs were transplanted within leukodermic areas in 10 patients with vitiligo.

RESULTS

Repigmentation around the grafts was suitable for evaluation in four cases. Dopa-positive (+) cells were seen in the epidermal basal cell layer of the repigmented areas.

CONCLUSIONS

Although these findings were observed only in a few patients, they suggest that melanocytes from the implanted lower third portion of the hair follicle (hair bulb) act as a reservoir in this anatomic location and are able to migrate and repigment achromic areas in vitiligo.

Selective attention and brainstem frequency-following responses

In the auditory system, cortical event-related potential amplitudes are enhanced during selective attention within the auditory channel. In the case of brainstem responses, however, the results are less clear since only a few studies have reported attention effects. Nearly all of these studies have used click stimuli to elicit the brainstem auditory evoked response (BAER). In the present study, pure tones (200 and 400 Hz) elicited the brainstem frequency-following response (FFR) in a task that maximized channel separation by presenting different frequencies to each ear. Twelve male and 12 female subjects participated. Perceptual sensitivity (d') showed an overall right ear advantage (REA) that did not depend on gender or stimulus frequency. FFR averages were enhanced by digital filtering, the 25 ms response was partitioned in half, and quantified by fast-Fourier analysis. Results of the statistical analysis showed a significant Attention x Frequency x Half interaction. Thus, whether or not component amplitudes were larger during attention depended on the particular stimulus and temporal location within the FFR. These results are more complex and time variant than would be predicted by the hypothesis that attention only enhances evoked response amplitudes. Nevertheless, these results suggest that some form of attention-related modulation may be occurring at the level of the brainstem. The present results provide additional support for a peripheral gating mechanism in humans, which has been claimed in a minority of BAER studies. The FFR may provide additional useful information since it presumably depends on phase-locking neural elements, rather than on-units activated by acoustic transients.