Platelet indices as quality markers of platelet concentrates during storage

The quality of platelet concentrates (PC) is an important issue in transfusion therapy. Recently, platelet indices have been used as markers for the quality control of PCs, as these reflect storage-induced shape changes in platelets. We also analyzed platelet indices such as platelet count, which could be detrimental and influence the rate of pH change during acceptable storage conditions. In the present study, platelet indices (with and without EDTA) were analyzed in stored PC. Forty pooled PRP-PCs were stored for 7 days and various platelet indices were analyzed with and without EDTA incubation. These indices included platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (PLCR). Difference in platelet paramters dPLT, dMPV, dPDW and dPLCR were calculated. Platelet indices correlating with pH changes, as determined by regression analysis, included dMPV and dPDW, while dPLT did not show much correlation (P < 0.05). Mean pH decreased from 7.25 to 6.86 between day 0 and day 7, respectively (P > 0.05). Platelet indices correlating with pH included PDW and MPV, while PLT did not show much correlation with pH. The platelet index dPDW (r = -0.26) and dMPV (r = -0.18) showed maximum, but not perfect, correlation with pH (P < 0.01). The coefficient of determination (R2) was maximum for the platelet indices dPDW and dP-LCR (R2 > 0.6). We conclude that measurements of platelet indices after EDTA incubation have great potential as quality markers of PC, especially when analyzed in combination with pH.

[Kimura's disease on the hard palate in a patient from Martinique]

INTRODUCTION

We report an observation of Kimura's disease (angiolymphoid hyperplasia with eosinophilia) in a Black patient from West Indies, in a rare localisation on hard palate.

EXEGESIS

A 46-year-old male patient from French West Indies (Martinique) presented with a tumor of hard palate evolving from 2 years with locoregional lymph nodes. He had a history of chronic urticaria, prurigo, rhinitis and alopecia areata. Pathological examination of the tumor was consistent with the diagnosis of Kimura's disease. Blood tests showed hypereosinophilia, elevation of IgG and IgE. The serology of Toxocara canis with Western blott was positive. Corticosteroid therapy (0.7 mg/kg/d) and albendazole (800 mg/d) allowed regression of the tumor, lymph nodes, and urticaria. The remaining tumor was surgically excised.

CONCLUSION

Kimura's disease was first described in Japanese young men, between 20 and 40 years old, with subcutaneous nodules on head and neck area. Involvement of oral mucosa is rare, and the occurence in West Indian patients has been rarely reported.

[Obesity persistent scleredema: study of 49 cases]

BACKGROUND

Buschke sclerodema is a very rare disease. Our objective was to show that persistent scleredema is frequent in certain group of patients at risk.

PATIENTS AND METHODS

We studied 49 patients, diagnosed between 1995 and 1999 in dermatology, pneumology and endocrinology departments in Martinique. Diagnosis was performed on classical clinical and histopathological aspects of sclerodema. Data studied were age, sex, mode of occurrence, clinical and histopathological aspects and associated diseases.

RESULTS

The 49 patients presented with cutaneous infiltration of the upper part of the trunk, with thick dermis and large collagen bundles on histopathological examination. Forty-two had mucoid substance deposition, stained with Alcian Blue (this criteria was considered as inconstant by most authors in the literature). Sex ratio H/F was 0.06 (93 p. 100 females). Mediam age at onset was 50 years ranging from 20 to 79 years. The occurrence was insidious in 97 p. 100 of cases. All patients had neck and nuchae involvement. The disease involved the back in 93 p. 100, upper limbs in 50 p. 100 and lower limbs and face in 43 p. 100 of patients. Fifty-six percent of patients had limitation of shoulder movements, 16 p. 100 limitation of mouth opening, 20 p. 100 limitation of eyelid opening, 36 p. 100 had myalgia, 73 p. 100 had pruritus and 66 p. 100 had dyspnea. Obesity was present in 95 p. 100, diabetes in 79.5 p. 100, elevated blood pressure in 81.5 p. 100 and monoclonal dysglobulinemia in 46 p. 100 of patients. Twenty-five patients had a polysomnography showing severe obstructive sleep apnea syndrome.

DISCUSSION

The large number of patients in our study can be explained by the search for sclerodema in patients with obesity, diabetes and high blood pressure. The disease is usually unknown by patients and physicians unless a systematic examination is performed. Association with obstructive sleep apnea syndrome was not previously reported and a larger study is ongoing.

Alterations in gap junction protein expression in human benign prostatic hyperplasia and prostate cancer

PURPOSE

Gap junctions composed of connexin proteins have an essential role in intercellular communication and differentiation. Dysregulation of connexin expression is believed to have a role in carcinogenesis. The human prostate has been reported to express connexin 32 and 43. However, the expression pattern in prostate cancer is controversial, while to our knowledge connexin expression has not been reported in benign prostatic hyperplasia (BPH). To understand the potential involvement in prostate disease connexin 32 and 43 expression was evaluated in a series of normal prostate, BPH and prostate cancer specimens that were surgically removed due to bladder outlet obstruction.

MATERIALS AND METHODS

Frozen sections of 23 normal, 43 BPH and 40 cancer involved prostates were evaluated for the presence, staining intensity and pattern of connexin 32 and 43 by immunocytochemical testing.

RESULTS

In all specimens examined connexin 43 stain was punctate along the borders of the basal epithelial cells, whereas connexin 32 immunolocalized to luminal epithelial cells. In normal prostate connexin 43 and 32 were present in 87% and 65% of specimens, respectively, at low to moderate stain intensity. Importantly none of the normal samples were negative foreach connexin. In BPH specimens there was a marked increase in the incidence and intensity of connexin 43 and 32 immunostaining within epithelial cells. In addition, 23% of BPH samples showed strong connexin 43 expression in stromal cells. In contrast, connexin was decreased in prostate cancer specimens, of which 65% and 38% were negative for connexin 43 and 32, respectively, and 28% were negative for each type. In poorly differentiated tumors connexin 43 and 32 were present in only 10% and 40% of tumors, respectively, at low immunostaining intensity.

CONCLUSIONS

In normal human prostate basal cells communicate via connexin 43 gap junctions, whereas luminal cells communicate via connexin 32 gap junctions. In BPH gap junctional intercellular communication is increased in epithelial and stromal cells, which may have a role in BPH pathogenesis. In prostate cancer gap junctional intercellular communication is decreased, is as indicated by decreased expression of connexin 43 and 32 with severe loss in poorly differentiated prostate cancer. These alterations in connexin expression may have a role in dedifferentiation and tumor progression.

Paclitaxel is more effective than thalidomide in inhibiting LNCaP tumor growth in a prostate cancer model

LNCaP tumors were treated by either administration of paclitaxel, thalidomide or by orchiectomy in order to determine their relationship with markers pertaining to the process of tumor growth, apoptosis or angiogenesis. Forty rats bearing LNCaP tumors were divided into 4 groups of 10 and treated by either paclitaxel (20 mg/kg x 5 days); thalidomide (200 mg/kg x 5 days/week x 5 weeks); or orchiectomy. After 6 weeks serum samples were removed for PSA determination and the animals sacrificed for evaluation of: A) tumor volume; B) tissue bcl-2, cyclin D, PSA and factor VIII immunohistochemically graded (0-5 scale) for marker expression; and C) serum PSA. Comparisons were made to untreated LNCaP tumors. Statistically significant differences were determined using the nonparametric Mann-Whitney test. Paclitaxel produced significant differences in volume (p < 0.001), expression of bcl-2 (p < 0.043), cyclin D (p < 0.023), tissue PSA (p < 0.001) and serum PSA (p < 0.019) levels. Thalidomide altered expression of bcl-2 (p < 0.011) and tissue PSA (p < 0.002). Orchiectomy altered volume (p < 0.002) and bcl-2 expression (p < 0.001). All three therapies have been suggested for prostate cancer and each produced alterations in accepted markers for treatment response (either reduced volume or serum PSA). Paclitaxel significantly influenced the most markers. Of interest was that all treatments, especially thalidomide, a known antiangiogenesis agent, reduced factor VIII, although not significantly. Evidently each treatment evokes different pathways of activity.

Paclitaxel, bropirimine and linomide: effect on growth inhibition in a murine prostate cancer model by different growth regulatory mechanisms

Paclitaxel, bropirimine and linomide therapy was evaluated in a murine prostate cancer model. All drugs were effective in impeding tumor growth but the mechanisms of action varied. Paclitaxel inhibited bcl-2 expression suggesting an apoptotic mechanism. Bropirimine, while inhibiting bcl-2 expression also significantly depressed tumor necrosis factor-alpha (TNF-alpha) expression. In the bropirimine treated group there was also a correlation between angiogenesis and cyclin D expression. Finally, linomide significantly decreased angiogenesis. Since the mechanism of action of these drugs differ, combining them at lower doses might maintain therapeutic efficacy while reducing toxicity.

Comparison of serum prostate-specific antigen levels and PSA density in African-American, white, and Hispanic men without prostate cancer

OBJECTIVES

To determine the influence of race or ethnicity on serum prostate-specific antigen (PSA) levels and PSA density (PSAD) in a population of healthy men without clinically evident prostate cancer.

METHODS

This retrospective study was conducted between January 1988 and January 1993. The serum PSA levels were measured in 859 men (586 African Americans, 142 whites, and 131 Hispanics) who were participants in a prostate cancer screening program or had urinary symptoms suggestive of prostate gland pathology. All men underwent a detailed clinical examination, including digital rectal examination, serum PSA determination, and transrectal ultrasound (TRUS). None of the subjects included had clinical or TRUS evidence of prostate cancer (furthermore, 283 men were pathologically proved to be cancer-free by prostate biopsies). Serum PSA levels and PSA densities as a function of each individual's ethnic background were determined.

RESULTS

The mean serum PSA level in African Americans was 2.1 ng/mL, which was significantly higher than that of whites (mean PSA of 1.53 ng/mL) and Hispanics (mean PSA of 1.83 ng/mL) (P = 0.003). Similar differences among the three groups were observed in PSA density (the mean PSAD was 0.078, 0.057, and 0.065 for African Americans, whites, and Hispanics, respectively). A separate analysis for the biopsy-negative men was performed, and the findings were consistent with the observations for the entire study group. After adjustment for age and prostate volume, the differences remained statistically significant.

CONCLUSIONS

Among men without evidence of prostate cancer, African Americans have higher serum PSA levels and PSA densities than do whites or Hispanics. Race or ethnicity was an independent factor that affected serum PSA levels even after adjustment for age and prostate volume.

Long-term clinical performance of Sorin tilting-disc mechanical prostheses in the mitral and aortic position

OBJECTIVE

Analyzing the long term performance of sorin tilting-disc mechanical prostheses.

EXPERIMENTAL DESIGN

Retrospective patient-oriented study. The total follow-up was 460.2 patient-years. Follow-up data was obtained from the patients themselves or from their relatives.

SETTING

Department of Cardiovascular Surgery in a general community hospital.

PATIENTS

Seventy four patients undergoing valve replacement with Sorin tilting-disc mechanical prostheses between May, 1982 and July 1991.

INTERVENTIONS

Thirty one of those patients underwent isolated mitral valve replacement (MVR) and 43 isolated aortic valve replacement (AVR).

MEASURES

The incidence of the different complications is expressed as linearized rates. Actuarial analysis was performed with the Kaplan-Meier method.

RESULTS

Linearized rates for MVR and AVR for the different complications (events per 100 patient-years) were, respectively: Late mortality: 4.5 +/- 1.6 and 1.8 +/- 0.8; Thromboembolism: 3.4 +/- 1.4 and 1.1 +/- 0.6; Anticoagulant-related hemorrhage: 2.8 +/- 1.3 and 0.3 +/- 0.3; Prosthetic endocarditis: 1.1 +/- 0.8 and 0.7 +/- 0.5; Non-structural dysfunction: 0.5 +/- 0.5 and 1.1 +/- 0.6; Reoperation: 1.1 +/- 0.8 and 0.3 +/- 0.3. Actuarial probabilities of freedom from the different complications were, respectively, at 13 years follow-up for MVR and 12 years follow-up for AVR, the following: Late mortality: 45.7 +/- 12.4% and 70.3 +/- 7.9%; Thromboembolism: 74.6 +/- 10.8% and 90.7 +/- 5.1%; Anticoagulant-related hemorrhage: 79.4 +/- 11.6% and 97.3 +/- 2.7%; Prosthetic endocarditis: 92.7 +/- 4.9% and 91.2 +/- 6.4%; Non-structural dysfunction: 95.6 +/- 4.3% and 88.2 +/- 6.6%; Reoperation: 83.6 +/- 11.8% and 97.3 +/- 2.7%. All valve-related mortality and morbidity: 42.2 +/- 11.0% and 56.7 +/- 8.6%. There was no instances of prosthetic structural failure.

CONCLUSIONS

The Sorin mechanical prosthesis presents a good durability and its performance in the long term is comparable to other tilting-disc devices of the same generation.

The effect of androgen deprivation on malignant and benign prostate tissue

The purpose of this research was to describe the changes in marker expression and histologic morphology following androgen deprivation in malignant and benign human prostates. Fourteen patients receiving pre-radical prostatectomy total androgen deprivation had pre- and post-androgen deprivation evaluation of marker expression and histologic morphology (both malignant and benign). Marker expression was significantly reduced for serum (p < 0.0001) and tissue (p < 0.004) PSA as well as bcl-2 expression (p < 0.008). There were significant histologic increases in vacuolization (p < 0.001), pyknosis (p < 0.04), fibrosis (p < 0.01) and lymphocytic infiltration (p < 0.008) in the malignant tissue. There were significant increases in squamous metaplasia (p < 0.0002), fibrosis (p < 0.0005), basal cell hypertrophy (p < 0.0005) and lymphocytic infiltration (p < 0.0002) in the benign tissue. Androgen deprivation therapy produces significant changes in marker expression and morphology in prostate specimens. At times these iatrogenic changes can be confusing. Clinicians and pathologists must be aware of these changes.

Lack of toxicity associated with the systemic administration of antisense oligonucleotides for treatment of rats bearing LNCaP prostate tumors

Antisense oligonucleotides (oligos) are now in clinical trials for the treatment of a variety of diseases. However, concern is sometimes expressed as to the toxicity of such compounds, particularly those with phosphorothioated backbones. We have previously reported (J. Surg. Oncol. 62, 194, 1996) our experience in treating nude mice bearing human PC-3 prostate tumors with phosphorothioated antisense oligos directed against mRNA encoding transforming growth factor-alpha (TGF-alpha) and the epidermal growth factor receptor (EGFR). This therapy resulted in a 75% (9/12) response rate for the intralesional treatment and a 100% (3/3) response rate for the systemic administration utilizing Alzet diffusion pumps. In the current study, athymic nude rats bearing orthotopically implanted LNCaP tumors, whose establishment was confirmed by the expression of human PSA, were implanted subcutaneously with Alzet diffusion pumps and treated systemically for 14 days with a total of 1 mg of each oligo (2 mg total). Controls consisted of five untreated rats similarly inoculated with LNCaP cells, but which did not receive antisense oligos. After 2 weeks the rats were sacrificed and serum samples were evaluated for BUN, creatinine, LDH and SGOT. Lungs, kidneys, livers, spleens and prostates were also removed for pathologic evaluation. There were no serum marker differences between groups nor was there histologic evidence of oligo toxicity seen in any evaluated tissue. Of interest was the observation that the livers and spleens, as well as prostates, of treated animals revealed mild lymphocytic infiltration compared to controls. We conclude that at this level of administration, there is no toxicity associated with 14-day oligo treatment.

Suramin as adjuvant therapy with radical prostatectomy

Suramin is a newer agent employed in the management of prostate cancer. One suggested method of action is growth factor inhibition. While suramin has been employed to treat advanced disease its adjuvant role remains unexplored. To address this question we have employed a new model: the orthotopic placement of the Dunning AT-3 tumor. The purpose of this research was to assess the efficacy of adjuvant therapy in controlling residual disease. The method consisted of the injection of 2.4 to 2.6 x 10(6) AT-3 cells (harvested from flank tumors) into the ventral prostates of 29 Copenhagen X Fischer rats. The animals were then divided into four groups: 1) untreated controls (6 rats); 2) ventral prostatectomy only (10 rats); 3) ventral prostatectomy plus suramin (300mg/Kg) on post-op day 3 (5 rats); and 4) ventral prostatectomy plus cytoxan (50 mg/Kg) on post-op day 3 (8 rats). Prostatectomies were performed 10-12 days following AT-3 cell inoculation. Animals were sacrificed 10 days following prostatectomy, autopsied, and residual diseased weighed. All operating procedures: tumor cell inoculations, ventral prostatectomies, and necropsies were performed microsurgically employing a Zeiss operating microscope. The results (in mean tumor weights) were: Group 1, 20 +/- 1.4 gms; Group 2, 6.7 +/- 11.5 gms; Group 3, 2.7 +/- 3.8 gms; and Group 4, 2.2 +/- 2.5 gms. The differences between control and all treatment groups were significant: Group 1 vs. Group 2, P < 0.02; and Group 1 vs. Groups 3 and 4, P < 0.001. We conclude that prostatectomy resulted in a diminished weight of residual disease. Of more importance was the fact that adjuvant therapy further reduced residual disease. The orthotopic placement of the Dunning tumor may serve as a model to evaluate the place of suramin following radical prostatectomy.

Nevomelanocytic proliferations in the central nervous system of children

BACKGROUND

Melanocytic proliferations affecting the central nervous system (CNS) of children may be classified as meningeal melanocytosis, primary melanoma, or metastatic melanoma. Meningeal melanocytosis often is associated with giant congenital pigmented nevi (preferentially involving the midline, the head and neck) representing the lethal condition neurocutaneous melanocytosis. Primary or metastatic melanomas, although extremely rare in children, can occur in the brain and its coverings and are associated with a poor prognosis.

METHODS

A retrospective study of five patients with nevomelanocytic proliferations of the CNS was performed.

RESULTS

There was characteristic enhancement in the magnetic resonance imaging (MRI) with gadolinium contrast, abnormal cerebral spinal fluid (CSF) cytology with neoplastic cells showing cytoplasmic prolongations, and nevomelanocytic proliferation in the meninges expressing HMB45 positivity and exhibiting ultrastructural features of melanocytes.

CONCLUSIONS

Because of the rarity of these lesions, awareness of their existence is crucial for their recognition. Clinical, radiologic, and cytologic, correlation may allow an opportune diagnosis, which would allow avoidance of brain biopsy. Melanin production is not restricted to melanocytic neoplasms, and other CNS tumoral lesions occasionally may feature melanin as part of their histologic findings.

Variation in DNA polymorphisms of the short arm of the human X chromosome: genetic affinity of Parsi from western India

Four DNA probes (L754, p99-6, pERT87-1 and pERT87-15) from the short arm of the human X chromosome were studied in two European (English and Spanish) and two Asiatic Indian (Maratha and Parsi) populations. All four RFLPs showed conclusive heterogeneity among the four populations. Nei's genetic distance (d) matrix shows an affinity between the Parsis and the population from southern Europe. There is an interesting suggestion of a west to east clinic for allele *2 detected by probe L754. Genetic heterogeneity found for the X-linked RFLPs prove that these markers are a useful tool for population genetics studies.

Papanicolaou smear abnormalities in ambulatory care sites for women infected with the human immunodeficiency virus

OBJECTIVE

We attempted to determine the prevalence of cervical dysplasia in human immunodeficiency virus-infected women in ambulatory care settings and to correlate Papanicolaou smears with demographic and clinical variables.

STUDY DESIGN

Papanicolaou smears of 135 women attending three ambulatory care clinics were reviewed. Chart review identified demographic and clinical variables, including CD4 count. Prevalence of abnormal smears was compared with baseline community rates. Demographic and clinical variables were correlated with Papanicolaou results with the chi 2 test.

RESULTS

Fivefold to eightfold increased rates of abnormal smears in human immunodeficiency virus-infected women were observed. Prevalence of abnormal smears increased from 21% in women with CD4 counts greater than 600/mm3 to 45% in women with CD4 counts less than 400/mm3. Age, ethnicity, or mode of human immunodeficiency virus transmission was not significantly correlated with Papanicolaou smear findings.

CONCLUSION

Increased rates of abnormal Papanicolaou smears and significant correlation with CD4 counts were observed in human immunodeficiency virus-infected women at ambulatory care sites. We recommend comprehensive gynecologic care, including semiannual Papanicolaou smears, for all human immunodeficiency virus-infected women.

Malignant granular cell tumor

We report a case of malignant granular cell tumor of the chest wall that recurred in the right breast with axillary lymph node metastases. The recurrent tumor clinically and grossly mimicked a breast carcinoma. Electron microscopy and immunohistochemical techniques were used to confirm the cytologic and histologic diagnosis of granular cell tumor. The importance of true metastases in the diagnosis of malignant granular cell tumor and their differential diagnosis are discussed.

Prevalence of hepatitis B surface antigen (HBsAg) in blood donors from Bombay

Analysis of serum samples from 3104 blood donors from Bombay screened for hepatitis B surface antigen (HBsAg) by ELISA. HBsAg was detected in 4.7% of the subjects. Relatives showed a significantly higher prevalence of HBsAg than volunteer donors. There was no significant association between HBsAg positivity and a particular blood group.

Characterization of cellular infiltrates in the rat urinary bladder following BCG and thiotepa intravesical therapy

We examined rat urinary bladders following intravesical administration of BCG and thiotepa. BCG administration resulted in a relatively greater increase in the mucosal infiltration of mononuclear cells relative to polymorphonuclear cells (P less than 0.01) compared to the thiotepa treated bladders. This finding suggests that the mode of action of the therapeutic effects of these agents may be different. These results may also suggest that the mechanism of action of BCG might be immunologic in nature.

An immunohistologic characterization of human prostatic atypical hyperplasia

In an effort to better distinguish the morphologic relationship of atypical hyperplasia of the prostate to benign prostatic hypertrophy and prostatic cancer, 43 prostate specimens were analyzed with ten immunohistologic markers. Two cytokeratin antibodies appeared useful (Cyto M and Cyto P, with the latter slightly more discriminatory). In summary, it appears that atypical hyperplasia is immunohistopathologically related to both benign prostatic hypertrophy and prostatic cancer, having characteristics of both.

Suppression of canine antral gastrin secretion by urine

Distention of the gastric antrum with an alkaline fluid normally results in the secretion of gastrin. Following gastrocystoplasty in humans, however, hypergastrinemia has not been observed. We explored the possibility that a component of urine may suppress antral gastrin activity in the dog. Partial cystectomy and antral transposition to the bladder (ATB) was performed in five animals and antral transposition to the colon (ATC) was performed in five other dogs to serve as a hypergastrinemic controls. At four and eight weeks after surgery the mean serum gastrin levels in the ATC dogs were significantly greater than the mean preoperative levels (p less than 0.05). In contrast, at four and eight weeks after surgery the mean serum gastrin levels in the ATB animals were significantly less than the mean preoperative levels (p less than 0.05). The antral G-cell density as determined by immunohistochemical study at eight weeks after surgery was greater than normal in the ATC dogs but less than normal in the ATB dogs; but the differences did not achieve statistical significance. In another series of experiments using four other dogs a 4% aqueous peptone solution and a 4% peptone solution in concentrated dog urine were instilled into exteriorized antral pouches. The mean serum gastrin levels at 60 and 90 minutes after instillation of the former were significantly increased (p less than 0.05), but there was little or no change after instillation of the latter. Urine, or a component of urine, appears to suppress canine antral gastrin secretion and may explain the absence of hypergastrinemia following gastrocystoplasty in humans.

BCG in management of transitional cell carcinoma invasive to prostate

Transitional cell carcinoma invading the prostate is a difficult problem to manage. Transurethral resection of the bladder neck followed by intravesical bacillus Calmette-Guerin (BCG) is one suggested option.

Evaluation of cytokeratin markers to differentiate between benign and malignant prostatic tissue

Cytokeratins are intermediate filaments found within basal and secretory epithelial cells. Antisera raised against cytokeratins are available but frequently differ in specificity. Many are incompletely characterized for their reactivity against epithelial components. Cytokeratin (Cyto) P is a polyclonal antisera specific for 56 and 64 kd cytokeratins. Cyto M is a pool of monoclonals reacting against 40, 46, 50, 52, 58, and 65-67 kd cytokeratins. Initially, utilizing immunohistologic techniques, we evaluated these two antisera for their ability to distinguish between prostatic tissues of benign (benign prostatic hypertrophy [BPH]) or malignant (carcinoma of the prostate [CAP]) origin in the 34 cases evaluated. Specimens were analyzed for both Cyto P and Cyto M reactivity, as well as for the degree of reactivity. Lastly, in an effort to determine the morphologic relationship of atypical hyperplasia (AH) with either BPH or CAP, nine additional prostate specimens were analyzed. Cyto P was reactive in 8 of 8 (100%) BPH specimens and in 2 of 26 (8%) CAP specimens. Mean Cyto P degree of reactivity in the positive specimens was greater in BPH than in CAP (2.6 vs. 1.0). Cyto M reactivity was present in 8 of 8 (100%) BPH specimens and in 23 of 25 (92%) CAP specimens. Mean Cyto M degree of reactivity in the positive specimens was greater in CAP than in BPH (3.6 vs. 2.8). Cyto P was reactive in 3 of 9 (33%) AH specimens, with a mean degree of reactivity of 2.7. Cyto M was reactive in 9 of 9 (100%) AH specimens, with a mean degree of reactivity of 3.9. Cyto P reacted with only the basal cells, whereas Cyto M reacted with basal as well as secretory cells. These differences appeared to be the result of the differential reactivity of basal cells, which are present in BPH but absent in CAP. In summary, Cyto P and Cyto M are potentially useful markers in differentiating BPH from CAP, and it appears that AH is immunohistopathologically related to both.

Möbius and Möbius-like syndromes (TTV-OFM, OMLH)

There exists a spectrum of syndromes characterized by cranial nerve palsies, limb anomalies, and craniofacial malformations. Criteria based on type and severity of limb anomaly or presence or absence of cranial nerve palsy may alter the syndrome nomenclature due to a selection bias but do not appear to benefit syndrome delineation to any extent. Patients with seventh nerve palsy and abduction weakness are usually diagnosed as having Möbius syndrome by ophthalmologists. The observed ocular motility findings range from primarily abduction deficiencies to patients who have a Duane or gaze palsy pattern of horizontal movements. Some cases previously described as "sixth nerve and partial third" may better fall into one of the latter groups, since an isolated adduction deficit as a manifestation of third nerve involvement is rare. The presence of clinical appearance of Duane syndrome in these Möbius-type patients raises the possibility of abnormal innervation of the lateral rectus as an explanation of some patterns of motility observed.

Application of immunohistologic staining to develop a malignant index to aid in distinguishing benign from malignant prostatic tissue

The development of antisera with reactivities against intermediate filaments, differentiation antigens, and secretory products has aided in identification and characterization of tissue specimens. Such evaluations may assist pathologists in distinguishing between benign (BPH) and malignant (CAP) tissue of prostatic origin. However, attempts to employ this technique are thwarted by 1) the use of frequently incompletely characterized antisera, 2) the use of both paraffin- and frozen-sectioned materials, and 3) a lack of quantitation in the degree of antisera immunoreactivity. To overcome these shortcomings, a mathematical approach was evaluated using eight BPH and 23 CAP specimens. These were sectioned and stained using commercially prepared antisera against cytokeratin (Cyto P, Cyto M), epithelial membrane antigen (EMA), NK cells (Leu-7), prostatic acid phosphatase (PAP), and prostate specific antigen (PSA). Reactivity was quantitated on a scale of 0-5. Mean values for markers elevated in CAP (relative to BPH) were placed in the numerator; those elevated in BPH (relative to CAP) were placed in the denominator: Malignant index = PSA + EMA + Leu-7 + Cyto M/PAP + Cyto P. This malignant index was significantly greater (P less than .001) in CAP tissues than in BPH regardless of Gleason grade (3.2 +/- 0.9 vs 1.6 +/- 0.9). It was also significantly elevated (3.0 +/- 0.8; P less than .01) in nine specimens representing prostatic atypical hyperplasia. These data suggest that immunohistologic staining may be applied as an aid in distinguishing between BPH and CAP.

X chromosome restriction fragment length polymorphisms in five racial groups: rare variant detected with the RC8 (DXS9) probe in the Marathi population, India

Restriction fragment length polymorphisms were investigated in five racial groups using the X chromosome probes DXS9 and DXS7. The allele frequencies of these polymorphisms showed significant differences and both DNA fragments were found to be highly polymorphic in the populations of south and southeast Asia. In the Marathi population of India, a rare allele B*3 (3 kilobases; kb) and an altered 7-kb fragment instead of the 6.6-kb constant band were found with DXS9. This is the first time that the rare B*3 allele is found in a non-European population.

Persistent müllerian duct syndrome in a man with transverse testicular ectopia

A 33-year-old Pakistani man with transverse testicular ectopia underwent surgery for repair of a left inguinal hernia. At operation a uterine structure with attached vasa deferentia was found in the left inguinal area and it was removed. Transverse testicular ectopia has been reported previously in association with the persistent müllerian duct syndrome. A deficiency of activity of a müllerian inhibiting substance during gestation is believed to be responsible for this syndrome. Most patients usually are sterile. Cloning of the gene for a müllerian inhibiting substance should permit studies of the pathogenesis of the persistent müllerian duct syndrome.

Human immunodeficiency virus antibody screening in blood donors from India, Nigeria and Thailand

Screening for human immunodeficiency virus (HIV) (LAV/HTLV-III) antibodies in 3 blood donor populations from India (n = 1,000), Nigeria (n = 500) and Thailand (n = 650; sampling in 1982) with a sensitive enzyme immunoassay (EIA; Abbott) yielded seropositivity rates of 0.5, 2.2 and 1.7%, respectively. Two EIAs with control antigens prepared from uninfected cell cultures ('ELAVIA', VIRGO'), a recombinant Escherichia coli DNA EIA ('ENV/CORE'), Western blot, an immunofluorescence assay and a radio-immunoprecipitation assay confirmed none of the EIA-reactive specimens as truly positive. The lack of specificity of the screening test was also attributable to monochromatic evaluation of the test trays at 492 nm only, and to reactivities against determinants of H9 cells used to grow HIV (HLA antibodies).

Chemical carcinogens. A review and analysis of the literature of selected chemicals and the establishment of the Gene-Tox Carcinogen Data Base. A report of the U.S. Environmental Protection Agency Gene-Tox Program

The literature on 506 selected chemicals has been evaluated for evidence that these chemicals induce tumors in experimental animals and this assessment comprises the Gene-Tox Carcinogen Data Base. Three major sources of information were used to create this evaluated data base: all 185 chemicals determined by the International Agency for Research on Cancer to have Sufficient evidence of carcinogenic activity in experimental animals, 28 selected chemicals bioassayed for carcinogenic activity by the National Toxicology Program/National Cancer Institute and found to induce tumors in mice and rats, and 293 selected chemicals which had been evaluated in genetic toxicology and related bioassays as determined from previous Gene-Tox reports. The literature data on the 239 chemicals were analyzed by the Gene-Tox Carcinogenesis Panel in an organized, rational and consistent manner. Criteria were established to assess individual studies employing single chemicals and 4 categories of response were developed: Positive, Negative, Inconclusive (Equivocal) and Inconclusive. After evaluating each of the individual studies on the 293 chemicals, the Panel placed each of the 506 chemicals in an overall classification category based on the strength of the evidence indicating the presence or absence of carcinogenic effects. An 8-category decision scheme was established using a modified version of the International Agency for Research on Cancer approach. This scheme included two categories of Positive (Sufficient and Limited), two categories of Negative (Sufficient and Limited), a category of Equivocal (the evidence of carcinogenicity from well-conducted and well-reported lifetime studies had uncertain significance and was neither clearly positive nor negative), and three categories of Inadequate (the evidence of carcinogenicity was insufficient to make a decision, however, the data suggested a positive or negative indication). Of the 506 chemicals in the Gene-Tox Carcinogen Data Base, 252 were evaluated as Sufficient Positive, 99 as Limited Positive, 40 as Sufficient Negative, 21 as Limited Negative, 1 as Equivocal, 13 as Inadequate with the data suggesting a positive indication, 32 as Inadequate with the data suggesting a negative indication, and 48 Inadequate with the data not suggesting any indication of activity. This data base was analyzed and examined according to chemical class, using a 29 chemical class scheme.(ABSTRACT TRUNCATED AT 400 WORDS)

Polyglycolic acid mesh in experimental renal trauma

We investigated the efficacy of kidney wrapping with polyglycolic acid (PGA) mesh for control of hemorrhage and preservation of renal function following extensive potentially lethal kidney lacerations in the dog. Wrapping of lacerated kidneys resulted in reapposition of the renal parenchyma and prompt, sustained hemostasis. At 21 days following injury the renal lacerations were well healed. Among five dogs with lacerations involving the entire surface of one kidney, the mean of the ratios of the creatinine clearance of the affected kidney divided by the creatinine clearance of the uninjured contralateral kidney was 0.83 +/- 0.14. Among ten dogs with lacerations confined to the lower pole of one kidney, five were treated by mesh wrapping and five by partial nephrectomy. The mean of the ratios of the creatinine clearance of the affected kidney divided by the creatinine clearance of the uninjured contralateral kidney was 0.93 +/- 0.17 for the former group and 0.58 +/- 0.06 for the latter group. Perirenal infection following kidney wrapping developed in only one dog who had an E. coli bacteriuria at the time of injury. Blood pressure was monitored in eight dogs treated with mesh wrapping. None became hypertensive. These data suggest that PGA mesh may have clinical utility in the management of selected renal injuries in humans.

Histopathology of BCG and thiotepa treated bladders

In an effort to characterize the pathophysiological differences between the modes of action of BCG and thiotepa in the treatment of superficial bladder cancer, normal female rats received weekly intravesical instillations of both agents. The animals were sacrificed and their bladders were examined pathologically to determine if there were histological differences between the cellular infiltrates found in the BCG and thiotepa treated bladders. Mononuclear cells, particularly T-cells, predominated in the BCG treated bladders whereas polymorphonucleated cells predominated in the thiotepa treated bladders suggesting that there may be an immune aspect to the former therapy. The presence of T-cells following BCG therapy suggest a T-cell mediated immune response.

Percutaneous identification and removal of fungus ball from renal pelvis

Fungus balls in the upper urinary tract are uncommon infectious processes that usually occur in diabetic patients. We report a case of an obstructing fungus ball of the renal pelvis, which was identified and removed successfully by percutaneous techniques.

Staging errors in prostatic cancer

There is some question on the accuracy of staging in large epidemiological studies of prostatic cancer that rely on hospital tumor registry data. In an effort to assess the accuracy of tumor registry information in our institution registry staging was compared to surgical staging in 100 consecutive prostatic cancer patients. The tumor registry data had a 30 per cent understaging error. Other institutions may have the same problems.

Evaluation of gleason classification system in prostate cancer

To compare the relative prognostic accuracy of the Gleason classification, the Whitmore staging, and the Broder grading systems, 111 patients with prostate cancer undergoing radical surgery were assessed utilizing these systems. The assessments were correlated with the presence or absence of disease six months to eight years after surgery. Of the three systems the Gleason classification system was the least accurate.

Evaluation of cytologic techniques for diagnosis of prostate cancer

Two hundred forty-eight male patients seen on a urology service were diagnostically screened using four different cytologic tests for cancer of the prostate. The tests included voided urine cytology, prostate massage cytology, aspiration cytology, and postmassage urine cytology. The aspiration cytology was the most efficient screening test for the diagnosis of prostate malignancy.

Agglutination of granulocytes from chronic myeloid leukaemia by concanavalin A

Peripheral blood leucocytes from chronic myeloid leukaemia (CML) patients previously untreated or in relapse are agglutinated by concanavalin A (Con A) at concentrations of 25-400 microgram/ml. Leucocytes from normal subjects, from CML patients in remission and from patients with granulocytosis are not agglutinated by Con A. Normal bone marrow cells which contain immature and mature myeloid cells are not agglutinated either by Con A. These results suggest that an alteration occurs in the cell surface of myeloid cells in CML due to leukaemic change and results in the agglutination of these cells by Con A. If peripheral blood leucocytes of CML patients in relapse are separated into immature and mature fractions, both these fractions are agglutinated by Con A suggesting that this alteration occurs in the cell surface of both the immature and the mature myeloid cells.