Perineural invasion is a poor prognostic factor for sinonasal squamous cell carcinoma

OBJECTIVES

In this study, our primary objective is to elucidate the correlation between sinonasal squamous cell carcinoma (SCC) and perineural invasion (PNI), a topic that has received limited attention in prior literature. Furthermore, we have undertaken an examination of various other clinicopathological factors.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of patients aged ≥ 20 years with newly diagnosed sinonasal cancer and received treatment and care at a tertiary medical center. We excluded patients who did not have an SCC diagnosis, those who underwent palliative surgery, and individuals with insufficient follow-up data at the study endpoint. Ultimately, a total of 49 eligible participants were included in our further analysis.

RESULTS

PNI and advanced T staging were associated with increased risk of local recurrence (LR). Furthermore, PNI was significantly associated with an adverse prognosis in terms of LR-free survival. Participants with PNI had significantly worse overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS). Patients with LR had significantly worse OS, DFS, and DSS.

CONCLUSION

PNI is associated with an elevated risk of LR and reduced OS, DFS, and DSS in patients with sinonasal SCC. These findings can facilitate the formulation of more targeted and effective treatment strategies for sinonasal SCC in clinical practice.

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

BACKGROUND

Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field.

METHODS

In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication.

RESULTS

The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention.

CONCLUSION

As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.

New Histopathologic Risk Model for Early T-stage Oral Squamous Cell Carcinoma: Focusing on a Modified Worst Pattern of Invasion System and a New Tumor Budding Score

Oral squamous cell carcinoma (OSCC) is treated based on the TNM staging. However, early T-stage OSCC still exhibits substantial nodal metastasis and death rates. Recent literature highlights the independent prognostic value of worst pattern of invasion (WPOI) and tumor budding in OSCC. Nevertheless, WPOI-5 is uncommon in early T-stage OSCC, and the definitions of tumor budding and WPOI-4 overlap. Moreover, WPOI assessment is subjective, and tumor budding evaluation varies across studies. To address these limitations, we aimed to develop a modified WPOI system and a novel tumor budding scoring system that assesses single cells and high-density tumor budding. We also evaluated a new histopathologic risk model for early T-stage OSCC. The study cohort comprised 37 pT1 and 64 pT2 OSCCs. The modified WPOI demonstrated superior interobserver agreement compared with the original system (κ value: 0.98 vs. 0.53). In the multivariate analysis, modified WPOI and tumor budding score were independent prognostic factors for nodal metastasis and disease-free survival, while modified WPOI predicted disease-specific survival. By integrating these factors, our risk model stratified the patients into 3 groups. Notably, the intermediate-risk and high-risk groups exhibited significantly higher rates of nodal metastasis, recurrence, and tumor-related death. Conversely, none in the low-risk group had nodal metastasis or succumbed to the disease. Our model offered simplified scoring and potentially improved prognostic predictions. In conclusion, we've developed a modified WPOI system, a new tumor budding scoring system, and a reliable risk model that classifies early T-stage OSCC patients into distinct risk groups with significant prognostic differences.

Palisading Adenocarcinoma: A Morphologically Unique Salivary Gland Tumor With a Neuroendocrine-like Appearance and a Predilection for the Sublingual Glands of Women

Adenocarcinoma, not otherwise specified (NOS) is a heterogenous group of salivary gland tumors that likely contains distinct tumors that have not yet been characterized. Indeed, in recent years, cases previously diagnosed as adenocarcinoma, NOS have been recategorized into novel tumor designations such as secretory carcinoma, microsecretory adenocarcinoma, and sclerosing microcystic adenocarcinoma. We sought to describe a distinctive, hitherto-undescribed salivary gland tumor encountered in the authors' practices. Cases were pulled from the surgical pathology archives of the authors' institutions. Histologic, immunohistochemical, and clinical findings were tabulated, and targeted next-generation sequencing was performed on all cases. Nine cases were identified, arising in 8 women and 1 man ranging from 45 to 74 years (mean, 56.7 y). Seven tumors (78%) arose in the sublingual gland, while 2 (22%) arose in the submandibular gland. The cases shared a distinctive morphologic appearance. They were biphasic, with ducts scattered among a predominant polygonal cell with round nuclei, prominent nucleoli, and pale eosinophilic cytoplasm. These cells were arranged as trabeculae and palisaded as pseudorosettes around hyalinized stroma and vessels, resembling a neuroendocrine tumor. Four of the cases were well-circumscribed, while the remaining 5 showed infiltrative growth including perineural invasion in 2 (22%) and lymphovascular invasion in 1 (11%). Mitotic rates were low (mean, 2.2/10 HPFs); necrosis was absent. By immunohistochemistry, the predominant cell type was strongly positive for CD56 (9 of 9) and variably positive for pan-cytokeratin (AE1/AE3) (7 of 9) with patchy S100 (4 of 9), but negative for synaptophysin (0 of 9) and chromogranin (0 of 9), while the ducts were strongly positive for pan-cytokeratin (AE1/AE3) (9 of 9) and CK5/6 (7 of 7). Next-generation sequencing did not reveal any fusions or obvious driver mutations. All cases were resected surgically, with external beam radiation also done in 1 case. Follow-up was available in 8 cases; there were no metastases or recurrences after 4 to 160 months (mean, 53.1 mo). A dual population of scattered ducts with a predominance of CD56-positive neuroendocrine-like cells characterizes a unique salivary gland tumor which is often encountered in the sublingual glands of women, for which we propose the term "palisading adenocarcinoma." Although the tumor was biphasic and had a neuroendocrine-like appearance, it lacked convincing immunohistochemical evidence of myoepithelial or neuroendocrine differentiation. Although a subset showed unequivocally invasive growth, this tumor appears to behave in an indolent manner. Moving forward, recognition of palisading adenocarcinoma and its separation from other salivary adenocarcinomas, NOS will facilitate a better understanding of the characteristics of this previously unrecognized tumor.

Sinonasal Adenosquamous Carcinoma - Morphology and Genetic Drivers Including Low- and High-Risk Human Papillomavirus mRNA, DEK::AFF2 Fusion, and MAML2 Rearrangement

BACKGROUND

Sinonasal adenosquamous carcinoma is rare, and there are almost no studies detailing morphology or characterizing their genetic driver events. Further, many authors have termed sinonasal tumors with combined squamous carcinoma and glands as mucoepidermoid carcinoma but none have analyzed for the presence of MAML2 rearrangement.

METHODS

Cases from 2014 to 2020 were collected and diagnosed using World Health Organization criteria. They were tested for p16 expression by immunohistochemistry (70% cut-off), DEK::AFF2 fusion by fluorescence in situ hybridization (FISH) and AFF2 immunohistochemistry, MAML2 rearrangement by FISH, and low- and high-risk HPV by RNA ISH and reverse transcription PCR, respectively. Detailed morphology and clinical features were reviewed.

RESULTS

There were 7 male (64%) and 4 female (36%) patients with a median age of 69 years, most Caucasian (10 of 11 or 91%). Most had tobacco exposure (8/11, 73%) and most presented with epistaxis, a visible nasal mass, and/or facial pain. Several had a precursor papillomas (3 of 11, 27%). The squamous component had variable keratinization, 5 of 11 (46%) of which would be described as keratinizing, 3 non-keratinizing, and 2 with mixed features. All had gland formation, by definition, and 2 of 11 (18%) had ciliated tumor cells. None of the 11 cases had MAML2 rearrangement and one had DEK::AFF2 fusion with associated positive nuclear AFF2 protein immunostaining. Most were p16 positive (7 of 11, 64%) and all 7 of these were hrHPV positive either by RNA ISH or RT-PCR. Two of the p16-negative tumors were positive for lrHPV by RNA ISH. Treatment included surgery alone (4 of 11, 36%), surgery with adjuvant radiation (5 of 11, 45%), and surgery with radiation and chemotherapy (2 of 11, 18%). Four of 11 patients (36%) suffered disease recurrence, two requiring re-operation and who were disease free at last follow-up, one receiving additional chemotherapy and who was alive with disease. The other elected to undergo palliative therapy and died of disease.

CONCLUSION

Sinonasal adenosquamous carcinoma is a somewhat heterogeneous tumor not infrequently arising ex papilloma and having various drivers including high- and low-risk HPV and rarely DEK::AFF2 fusion. The prognosis appears favorable when proper treatment is possible.

Tumor-associated tissue eosinophilia promotes angiogenesis and metastasis in head and neck squamous cell carcinoma

Eosinophils are terminally differentiated leukocytes that participate in the process of chronic inflammation and allergy and are able to release multiple cytokines into the surrounding tissue environment. Tumor-associated tissue eosinophilia (TATE) is the presence of eosinophils in the tumor or in the neighboring stroma and has been observed in various types of cancer. In head and neck squamous cell carcinoma (HNSCC), the clinical relevance of TATE has not been concluded yet because of the inconsistent results in different studies. In our study, we focus on the prognostic effects of TATE on HNSCC and how TATE can influence tumor behavior and tumor microenvironment. We first showed that in both the TCGA-HNSC cohort and our cohort of patients with HNSCC who had received curative surgery, TATE is correlated with worse overall survival. To investigate the underlying mechanism of how TATE leads to poor clinical outcomes, we showed that activated eosinophils produce a variety of cytokines and chemokines, and activated TATE-derived culture medium promotes tumor migration mainly through CCL2. We also showed that eosinophils are capable of inducing angiogenesis and that HNSCC samples enriched with TATE are highly correlated with tumor angiogenesis. Furthermore, HNSCC enriched with TATE had more aggressive pathological features, including regional lymph node metastasis, perineural invasion, lymphovascular invasion, and tumor growth. Lastly, we showed that HNSCC enriched with TATE is associated with immunosuppressive tumor microenvironment. Taken together, our results suggest that TATE promotes cancer metastasis and angiogenesis which results in a poor clinical outcomes in HNSCC.

Nuclear expression of AFF2 C-terminus is a sensitive and specific ancillary marker for DEK::AFF2 carcinoma of the sinonasal tract

DEK::AFF2 carcinoma of the sinonasal tract is an emerging entity. The tumor is typically characterized by papillary proliferation of non-keratinizing squamous epithelial cells with monotonous cytologic features, which may mimic other sinonasal tumors. The confirmation of this gene fusion has thus far relied solely on next-generation sequencing, fluorescence in situ hybridization (FISH), or reverse transcription polymerase chain reaction (RT-PCR). This current study aimed to validate an immunohistochemical assay for AFF2 C-terminus as an ancillary marker. We first analyzed publicly available RNA sequencing data of sinonasal tumors from the national center for biotechnology information (NCBI) sequence read archive and identified 3 DEK::AFF2 carcinomas out of 28 sinonasal tumors. The gene expression of AFF2 was significantly higher in the fusion-positive cases compared to the wild-type tumors (p < 0.001), while DEK was not. We then optimized an immunohistochemical assay with an anti-AFF2 C-terminus antibody for ancillary diagnosis. Seventeen DEK::AFF2 carcinomas, including 11 cases with predominantly low-grade morphology and one showing glandular differentiation, as well as 78 DEK FISH-negative sinonasal tumors were evaluated by AFF2 immunohistochemistry (IHC). Sixteen of the 17 DEK::AFF2 carcinomas showed nuclear AFF2 expression in ≥30% of tumor cells, including one decalcified case that failed FISH and RT-PCR confirmation. The one case that was negative for AFF2 IHC in the tumor cells also lacked expression in the internal positive control. It was thus considered a failure of the IHC rather than a truly negative case and was excluded from the statistical analysis. All DEK FISH-negative sinonasal tumors were negative for nuclear AFF2 expression. The nuclear expression of AFF2 IHC showed 100% sensitivity and specificity for DEK::AFF2 carcinoma. Accordingly, AFF2 IHC is a highly sensitive and specific ancillary marker that distinguishes DEK-AFF2 carcinoma from the other sinonasal tumors with overlapping morphological features and may be an especially useful alternative for decalcified specimens.

DEK-AFF2 fusion-associated papillary squamous cell carcinoma of the sinonasal tract: clinicopathologic characterization of seven cases with deceptively bland morphology

A novel DEK-AFF2 fusion has been recently identified in four cases of basaloid to nonkeratinizing squamous cell carcinoma (SCC) in the sinonasal tract and middle ear with high-grade morphology. The exceptional response to immune checkpoint inhibitor in the first reported case highlights the potential clinical importance of identifying tumors with DEK-AFF2 fusions. We herein reported the first series of seven cases of DEK-AFF2 fusion-associated sinonasal SCC with deceptively bland morphology, including four cases of low-grade papillary Schneiderian carcinoma, which is a recently described tumor type with unknown molecular underpinnings. The DEK gene rearrangement was confirmed by DEK break-apart fluorescence in situ hybridization and DEK-AFF2 fusion transcripts were detected by reverse transcription polymerase chain reaction. In contrast to the previously reported DEK-AFF2 fusion-positive high-grade carcinomas, these tumors had a monotonous and bland morphology and were all initially diagnosed as sinonasal papilloma (SP) of various types, with or without dysplasia or carcinoma in situ. The tumor was characterized by mixed exophytic and inverted patterns, broad papillary fronds, acantholytic change, cellular monotony, dense neutrophilic infiltrates, and peripheral palisading. All tumors were diffusely positive for p40 or p63 and negative for NUT and p16. Molecular drivers associated with SP, including EGFR and KRAS mutations and both high and low-risk human papillomavirus infection, were negative in all cases. Although there was no overt stromal invasion or desmoplastic reaction in the initial specimens, these tumors tended to progress locoregionally through a prolonged clinical course and occasionally develop lymph node metastases, high-grade transformation, or extensively local destruction eventually leading to death. These justify more aggressive clinical management. Therefore, we propose the new terminology "DEK-AFF2 fusion-associated papillary SCC of the sinonasal tract" to better describe this clinicopathologically and molecularly distinct entity.

Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences

Background: Invasive fungal rhinosinusitis (IFS) is a rare but often fatal disease. There are limited studies regarding IFS with orbital complications (IFSwOC). The present study aimed to identify the clinical signs associated with IFSwOC and prognosticators of the disease. Methods: A retrospective case series was conducted of patients histopathologically confirmed IFS or fungal rhinosinusitis with clinically apparent neuro-orbital complications who underwent surgery between 2008 and 2018. Demographic data, presenting symptoms and signs, culture data, laboratory results, and patient outcomes were obtained from medical records. Results: A total of 38 patients were identified, including 9 patients with IFSwOC, and 29 patients with IFS without orbital complications (IFSsOC). The clinical signs associated with developing orbital complications include headache, fever, sphenoid sinus, or posterior ethmoid sinus involvement, CRP level ≥ 1.025 mg/dL, or ESR level ≥ 46.5 mm/h. In IFSwOC group, male, posterior ethmoid sinus involvement, WBC count ≥ 9000 μL, CRP level ≥ 6.91 mg/dL, or ESR level ≥ 69 mm/h were correlated with a significantly poorer prognosis. Conclusion: IFS patients with sphenoid or posterior ethmoid sinus involvement, headache or fever as presenting symptoms, elevated CRP, and ESR level were at risk of developing orbital complications. Timely surgical debridement followed by systemic antifungal treatment may improve treatment outcomes.

Developing a novel meatal areolar tissue autograft for minimally invasive tympanoplasty

BACKGROUND

We developed an easy and minimally invasive method of transmeatal tympanoplasty using meatal areolar tissue (MAT) grafts to achieve less postoperative morbidity or surgical scarring. We compared the functional and anatomical results of the developed method with conventional endaural tympanoplasty with a temporalis fascia (TF) graft.

METHODS

In this retrospective cohort study, 58 patients (59 ears) with simple chronic otitis media who underwent type I tympanoplasty between January 2016 and August 2018 were included. All surgeries were performed in a tertiary referral hospital and by the same senior surgeon. The tympanic membrane (TM) was repaired with either a TF or an MAT graft.

RESULTS

Healing of the perforated TM and improvement in a hearing test by air-bone gap (ABG) closure were identified. Postoperative wound conditions were also evaluated. Twenty-eight ears were grafted with MAT, and 31 ears were grafted with TF. Graft success was observed in 26 patients (92.9%) in the MAT group and 28 patients (90.3%) in the TF group. Both groups showed functional improvement compared with the preoperative measurements. The postoperative pure tone audiogram (p = 0.737), ABG closure (p = 0.547), and graft success rate (p = 0.726) were not significantly different between the two groups. Neither wound dehiscence nor keloid formation was observed in our patients.

CONCLUSION

Both MAT and TF grafts revealed satisfactory surgical and functional results. Compared with the conventional endaural approach with TF grafts, the new transmeatal approach method with an MAT graft causes relatively minimal trauma and results in better wound cosmetics. This method represents an easy, minimally invasive surgery and shows comparatively good results.

Metastatic Tumors of the Sinonasal Cavity: A 15-Year Review of 17 Cases

Extranasal cancers that metastasize to the sinonasal cavity are very rare. To date, there are only limited reports regarding this rare condition within the literature. Therefore, we retrospectively reviewed all patients diagnosed with metastatic cancer of the sinonasal tract from 2003 to 2018 at a tertiary academic medical center. Patient demographic data, clinical presentation, treatment modalities, and outcomes were investigated. There were a total of 17 patients (9 males and 8 females) included in the analysis. The mean age was 56.8 years (range 27–80). The most common primary malignancies were hepatocellular carcinoma (n = 3) and gastrointestinal tract adenocarcinoma (n = 3). The most common site of metastasis was the nasal cavity (n = 8). Five patients received radical tumor resection and the others underwent radiotherapy, chemotherapy, or combined chemoradiotherapy. The 2-year survival was 28%. In summary, metastasis to the sinonasal cavity remains extremely rare. A high degree of suspicion regarding the possibility of metastatic spread to the sinonasal region is necessary for patients with a previous history of malignancy who present with new sinonasal symptoms. The treatment strategy of sinonasal metastatic cancer is usually palliative therapy and the prognosis remains poor. However, early detection and diagnosis, coupled with aggressive treatment, may improve patient quality of life.

Sinonasal seromucinous hamartoma

INTRODUCTION

Seromucinous hamartoma (SH) is a rare benign glandular proliferation of the sinonasal tract and nasopharynx. Only few cases have been reported in recent years.

MATERIALS AND METHODS

We performed a retrospective medical record review of seven patients diagnosed with sinonasal SH who underwent endoscopic endonasal surgery.

RESULTS

There were 5 males and 2 females, ranged in age from 40 to 98 years (mean 60 years, SD ± 18.9). Two lesions arise from middle turbinate, two from uncinate process, and 3 (but 4 specimens) from nasal septum. Pathological features revealed a polypoid lesion with submucosal proliferation of seromucinous glands arranged in lobular and haphazard patterns. In immunohistochemical study, the seromucinous glands of SH were reactive for cytokeratin, including CK7, CK19, HMWK, but negative for CK20.

CONCLUSION

Sinonasal SH is a rare diagnosis characterized by a polypoid lesion with a haphazard proliferation of seromucinous glands. The rhinologists should consider it in the differential diagnosis of a polypoid lesion in the nasal cavity.

High neuroendocrine component is a factor for poor prognosis in gastrointestinal high-grade malignant mixed adenoneuroendocrine neoplasms

BACKGROUND

High-grade malignant mixed adenoneuroendocrine carcinoma (MANEC) is a highly malignant combined neoplasm formed by an adenocarcinomatous component and a poorly differentiated (Grade 3) neuroendocrine (NE) carcinoma.

METHODS

Tumors from 21 patients with gastrointestinal high-grade malignant MANECs or tumors with varying percentages of Grade 3 NE component were examined, and the NE component was confirmed by morphological analysis and immunohistochemical staining. Patients were divided into high NE (NE component > 50% in the primary tumor) and low NE (NE component ≤ 50% in the primary tumor) component groups.

RESULTS

High NE component was a poor prognostic factor for patients with high grade MANEC (p = 0.021). Out of 13 patients with high-grade malignant MANEC, eight had a pure NE component, one had a pure adenocarcinomatous component, and four had mixed-type cancer in the metastatic lymph nodes. We further enrolled eight patients who had a Grade 3 NE component in the primary tumor and found that the pure NE component in tumor emboli and distant liver metastases were more frequent in the high NE than in the low NE component group (p = 0.012 and p = 0.046, respectively).

CONCLUSION

The predominant tumor component in primary tumors was a prognostic factor and could predict tumor emboli and liver metastases pathology in high-grade malignant MANECs.

Krüppel-like factor 4 modulates the migration and invasion of hepatoma cells by suppressing TIMP-1 and TIMP-2

Krüppel-like factor 4 (KLF4) plays important roles in development, stemness and tumorigenesis; however limited information is available on the detailed function of KLF4 in hepatocellular carcinoma (HCC). The objective of the present study was to examine the functional roles of KLF4 in the metastasis of HCC cells. KLF4 was overexpressed and knocked down by lentiviral transduction method in highly metastatic HCC cells. KLF4 overexpression in HCC cells led to inhibition of cell migration and invasion. These inhibitory effects were associated with the upregulation of tissue inhibitors of metalloproteinase (TIMP)-1 and TIMP-2 by KLF4. Treatment with recombinant TIMP-1 decreased the migratory ability of HCC cells. Moreover, myeloperoxidase (MPO)-TIMP-1/TIMP-2 inactivator counteracted the KLF4-induced inhibition of cell migration/invasion. Consistently, KLF4 knockdown in HCC cells downregulated TIMP-1 and TIMP-2 expression, consequently promoting cell migration and invasion. Furthermore, we found that KLF4 regulated E-cadherin and epithelial-mesenchymal transition (EMT)-related proteins such as snail, vimentin and Bmi1 to modulate the cell migration ability. These results together demonstrated for the first time that KLF4 plays an important role in inhibiting the aggressiveness of HCC cells via upregulation of TIMP-1 and TIMP-2.

Beneficial effects of dual vascular endothelial growth factor receptor/fibroblast growth factor receptor inhibitor brivanib alaninate in cirrhotic portal hypertensive rats

BACKGROUND AND AIM

Vascular endothelial (VEGF) and fibroblast growth factor (FGF)-induced hepatic stellate (HSCs) and liver endothelial cells (LECs) activation accelerates hepatic fibrogenesis and angiogenesis, and hemodynamic dysarrangements in cirrhosis. VEGF targeting agents had been reported as potential drugs for cirrhosis. However, the evaluation of effects of dual VEGF/FGF targeting agent in cirrhosis is still limited.

METHODS

Using hemodynamic parameters, blood chemistry, primary isolated HSCs and LECs, histology, and digital imaging, we assess the effects of 2-week brivanib alaninate, a dual VEGFR/FGFR inhibitor, treatment in the pathophysiology of bile duct-ligated-cirrhotic rats.

RESULTS

Fibrogenic and angiogenic markers in the serum and liver of bile duct-ligated-cirrhotic rats, including hydroxyproline, transforming growth factor-β1, angiopoietin-1, VEGF, FGF-2, endocan and phosphorylated-VEGFR2/VEGFR2, and phosphorylated-FGFR/FGFR together with hepatic CD31/angiopoietin-1 expressions (immunohistochemistry staining), angiogenesis (micro-computed tomography scan), microcirculatory dysfunction (in vivo miscroscopy and in situ liver perfusion study), portal hypertension, and hyperdynamic circulations (colored microsphere methods) were markedly suppressed and ameliorated by brivanib alaninate treatment. In in vitro study, acute brivanib alaninate incubation inhibited the transforming growth factor-β1-induced HSCs contraction/migration and VEGF-induced LECs angiogenesis. Concomitantly, the overexpression of various fibrogenic and angiogenic markers in HSCs and LECs, and in their culture media, was increased in parallel and these changes were suppressed by acute brivanib alaninate incubation.

CONCLUSIONS

This study demonstrated that brivanib alaninate targeting multiple mechanisms and working in the different pathogenic steps of the complications of cirrhotic rats with portal hypertension.

Carcinoembryonic antigen (CEA) level, CEA ratio, and treatment outcome of rectal cancer patients receiving pre-operative chemoradiation and surgery

Background

To investigate serum carcinoembryonic antigen (CEA) as a prognostic factor for rectal cancer patients receiving pre-operative chemoradiotherapy (CRT).

Methods

Between 2000 and 2009, 138 patients with advanced rectal cancer receiving CRT before surgery at our hospital were retrospectively classified into 3 groups: pre-CRT CEA <6 ng/ml (group L; n = 87); pre-CRT CEA ≥ 6 ng/ml and post-CRT CEA <6 ng/ml (group H-L; n = 32); and both pre- and post-CRT CEA ≥ 6 ng/ml (group H-H; n = 19). CEA ratio (defined as post-CRT CEA divided by pre-CRT CEA), post-CRT CEA level and other factors were reviewed for prediction of pathologic complete response (pCR).

Results

Five-year disease-free survival (DFS) was better in groups L (69.0%) and H-L (74.5%) than in group H-H (44.9%) (p = 0.024). Pathologic complete response was observed in 19.5%, 21.9% and 5.3% of groups L, H-L and H-H respectively (p = 0.281). Multivariate analysis showed that ypN stage and pCR were independent prognostic factors for DFS and that post-CRT CEA level was independently predictive of pCR. As a whole, post-CRT CEA <2.61 ng/ml predicted pCR (sensitivity 76.0%; specificity 58.4%). For those with pre-CRT CEA ≥6 ng/ml, post-CRT CEA and CEA ratio both predicted pCR (sensitivity 87.5%, specificity 76.7%).

Conclusions

In patients with pre-CRT serum CEA ≥6 ng/ml, those with “normalized” CEA levels after CRT may have similar DFS to those with “normal” (<6 ng/ml) pre-CRT values. Post-CRT CEA level is a predictor for pCR, especially in those with pre-CRT CEA ≥6 ng/ml.

Trends in prostate needle biopsy diagnosis. A ten year experience of a medical center in Taiwan

Prostate cancer has seen a rapid rise in Taiwanese men. The current study was undertaken to evaluate trends of the disease diagnosed on prostate needle biopsy during a ten-year period at the Department of Pathology, Taipei Veterans General Hospital. The study included 8236 men who underwent a total of 9995 prostate needle biopsies at this institute from 1994 to 2003. Pathologic features pertinent to diagnosis of cancer were reviewed and compared for cases diagnosed before and after 1999. There were statistically significant increases of the overall cancer detection rate (from 17.6% to 19.9%), proportion of cases with a Gleason score ≤ 6 (from 16.6% to 40.9%) and focal adenocarcinoma (from 3.0% to 12.8%) in the latter 5 years. The incidence of high-grade prostatic intraepithelial neoplasia (HGPIN) increased from 0.1% to 1.5%. Patients with HGPIN had a significantly higher risk for subsequent cancer discovered on repeat biopsy than did those with a primary benign diagnosis (29.9% versus 13.7%). Despite a relatively lower incidence of cancer and HGPIN in Taiwanese men compared with that reported in Western studies, in recent years we have found an increase of relevant diagnoses, especially cancer of limited extent and lower grade, which may represent the progress in prostate cancer diagnosis.

Significance of neuroendocrine component in mixed adenoneuroendocrine neoplasms

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Background: Mixed adenoneuroendocrine carcinoma (MANEC) and adenocarcinoma with neuroendocrine differentiation (ADC-NE) are tumors with divergent exocrine and neuroendocrine differentiation. These tumors display variable quantitative extent of the two components. Some studies reported the extent of two components in primary tumor and lymph node are not always the same. The aim of our study is to analyze the neuroendocrine component in primary tumor, angiolymphatic invasion and metastatic lymph nodes.

Methods: Tumor histology of 15 patients with MANEC or ADC-NE was evaluated in this study. Neuroendocrine component was confirmed by morphology and immunohistochemistry for synaptophysin and chromogranin A. The extent of neuroendocrine components in primary tumor, angiolymphatic invasion and lymph node were reviewed by two independent pathologists.

Results: Fifteen patients with MANEC and ADC-NE tumors were evaluated. Of these, pure neuroendocrine component in angiolymphatic invasion was observed in 9; pure adenocarcinoma component was seen in 4; and both components were seen in 2. The components in lymph node metastases were consistent to angiolymphatic invasion (Table), suggesting the tumor component in angiolymphatic invasion may predict pathology in lymph node metastasis. In high neuroendocrine component group (>50% in primary tumor), 83.3% revealed pure neuroendocrine component in lymph node and 88.9% had angiolymphatic invasion. The pure neuroendocrine component in lymph node and angiolymphatic invasion was higher in high neuroendocrine component group compared to the low neuroendocrine component group, (p=0.012 and p=0.01, respectively).

Conclusions: The components of tumor involved in angiolymphatic invasion is consistent with that in lymph node metastasis. High neuroendocrine component predicts the rate percentage of pure neuroendocrine component in lymph node or angiolymphatic invasion.

[Table: see text]

Invasive ductal carcinoma arising in phyllodes tumor with isolated tumor cells in sentinel lymph node

Phyllodes tumor (PT) consists of stroma of variable grading and benign ductal epithelium. Although exceptional, carcinomas that arise from the epithelium in PTs do exist, and seem to behave less aggressively than the usually encountered breast carcinoma. To the best of our knowledge, among the invasive carcinomas that have arisen in PTs, only 1 has been proved to have metastatic carcinoma in the lymph nodes. Here, we describe the youngest woman to have invasive ductal carcinoma that arose in a borderline PT, with isolated carcinoma cells in the sentinel lymph node. Whether such a combined lesion carries a more indolent course is also discussed.

Is the sympathoexcitatory effect of yohimbine determined by brain yohimbine concentration?

Plasma noradrenaline and adrenaline concentrations, plasma renin concentration (PRC), and serum and brain yohimbine concentrations were measured in conscious Sprague-Dawley rats after the s.c. and i.v. injection of yohimbine. The s.c. and i.v. administration of 1 and 3 mg/kg of yohimbine (30 min post-injection) elicited equivalent and dose-related increases in plasma noradrenaline concentration. At 30 min post-injection, the 1 mg/kg dose given s.c. or i.v. did not increase plasma adrenaline concentration or PRC, whereas the 3 mg/kg dose caused comparable increases in plasma adrenaline concentration and PRC when given s.c. or i.v. Brain yohimbine concentration increased in a dose-related manner whereas serum yohimbine concentration was not significantly different 30 min after treatment with the 1 1 and 3 mg/kg doses regardless of the route of injection. Despite the fact that serum yohimbine concentration was 5-fold greater after i.v. injection as compared to s.c. administration (1 and 3 mg/kg doses), brain yohimbine concentrations were comparable after s.c. and i.v. injection and thus not dependent on either the route of administration or serum yohimbine concentration. The fact that the s.c. and i.v. injection of yohimbine lead to comparable dose-related increases in both brain yohimbine concentrations and neuroendocrine responses suggests that increased sympathetic outflow resulted primarily from an action of yohimbine at central, rather than peripheral, alpha 2-adrenoceptors. However, the data also are consistent with a purely peripheral prejunctional action of the 1 mg/kg dose and a combined central and peripheral action of the 3 mg/kg dose.

Captopril increases norepinephrine spillover rate in conscious spontaneously hypertensive rats

These experiments were designed to test the hypothesis that the antihypertensive action of the converting enzyme inhibitor captopril in conscious spontaneously hypertensive rats is associated with an inhibition of norepinephrine release from peripheral sympathetic neurons. Radiotracer techniques were used to measure norepinephrine clearance and spillover rate into plasma. A single 30 mg/kg (s.c.) dose of captopril elevated norepinephrine spillover rate by 20 to 25 and 45 to 60% at 0.5- and 2-hr postinjection, respectively. At 2-hr postinjection, captopril (10 and 30 mg/kg s.c.) produced a dose-related fall in mean arterial pressure (MAP) and dose-related increase in norepinephrine spillover rate. The 30-mg/kg dose was more effective in decreasing MAP when given s.c. as compared to i.v. dosing. When equivasodepressor doses of captopril, hydralazine and prazosin were compared at 2-hr postinjection, the increases in norepinephrine spillover rate produced by captopril (44%) and hydralazine (68%) were not different. However, prazosin elevated norepinephrine spillover rate by 137%. Norepinephrine clearance was not altered by captopril. When MAP was lowered to the same extent (-17 to -23%) by 5 days of continuous treatment with captopril, enalaprilat and minoxidil, the increases in norepinephrine spillover rate (50-65%) were not different in the three treatment groups. In conclusion, these data do not support the hypothesis that captopril lowers blood pressure by inhibiting the neuronal release of norepinephrine.

[Clinical experience of nerve-sparing radical prostatectomy]

A total of 18 patients underwent nerve-sparing radical prostatectomy for clinical stage B1 or B2 prostatic cancer. An operation was performed according to the modified technique originally described by Walsh and associates. The operative technique involved three steps: 1) accurate ligation of dorsal vein complex, which makes a relatively bloodless field and makes it possible to dissect the lateral pelvic fascia from the prostate; 2) the incision in the lateral pelvic fascia is made anterior to the neurovascular bundle; 3) the lateral pedicle is divided close to the prostate. There were no major intraoperative complications such as rectal perforation or ureteral injury. The mean blood loss was 802 g (340-1600 g) and the average duration of surgery was 173 minutes. Eleven patients had no blood transfusions. Postoperatively, there was a wound infection in one case. Mild bladder neck contracture in one case responded to single dilatation. Sexual function was evaluated in 16 of the patients who have been followed for more than three months and who had not received hormone therapy postoperatively. Of 16 patients 6 (37%) had return of erectile function. Return of erections required 3-15 months (average 9 months). Patients under 70 years old had a higher incidence (80%) of return of erections than those over 70 years old. Four of the 6 patients had tumor involvement confined to the prostate. Initially most patients had significant amounts of stress incontinence. This resolved within the first or second postoperative month. Finally 4 had slight stress urinary incontinence but no patients had total incontinence. The results suggest that nerve-sparing radical prostatectomy is an anatomically safe approach. It can contribute to the quality of life in men at a stage when it is still curable.

[Clinical experience with the Kock continent ileal urinary reservoir]

From May 1985 through July 1987, 22 patients underwent Kock continent ileal reservoir for urinary diversion. There were 19 males and 3 females, between 38 and 82 years old (mean age 63.1 years). A one-stage radical cystectomy and Kock pouch construction were performed in 21 patients. One patients was converted from standard ileal conduit to this new reservoir. The keys to success of the Kock pouch are creation and maintenance of the nipple valve to prevent reflux and to ensure continence. Mesenteric fat is removed with CUSA for 8 cm along the afferent-efferent limbs of the pouch and exclusion of mesentery is limited for only 3-4 cm. This important modification will ensure adequate ileal intussusception and vascular supply to the valves. To prevent eversion and prolapse, the nipple valve is anchored to the wall of reservoir. A strip of sauvage filamentous Dacron serves as a collar to fix the afferent-efferent limbs to the pouch. There were 2 postoperative deaths and two major early complication: 1 acute renal failure and 1 intestinal fistula, both of which were treated conservatively. Late complications occurred in 6 patients. Of these 6 patients, 1 required reoperation and revision of the continence valve mechanism and 1 required hospitalization for entero-pouch fistula. Serum electrolytes and vitamin B12 remained normal in all patients. Patients perform self-catheterization every 4-6 hours during the day and once at night for volumes ranging up to 1,000 ml. The end result in 19 of 20 patients was excellent.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transurethral ureterolithotripsy using a rigid ureteroscope]

Eighty patients with ureteral stones underwent transurethral ureterolithotripsy using a rigid ureteroscope. In 68 of the patients (85%), the stones were removed successfully. Most of the 12 failures were removed by a percutaneous approach. The main complications of transurethral ureterolithotripsy were high fever (35%), ureteral injury (10%) and ureteral stricture (1.6%). Ureteroscopic procedures are thought to be useful in stone removal and diagnostic evaluation of abnormality of upper urinary tract.

[Penile implantation surgery for organic impotence due to radical cystectomy or prostatectomy]

Implantation surgery was performed twelve times in eleven patients with organic impotence, mainly due to radical cystectomy and prostatectomy against malignancy, between March, 1982 and April, 1987. A self-contained type prosthesis (AMS Hydroflex(TM] was used in 7 cases, reservoir type inflatable prosthesis (AMS 700TM) in 2, malleable semirigid type (ESKA-Jonas Silicon Silver(TM) Trimming Tip Version) in 2, and nonmalleable semirigid type (Fuji system Finney type) in 1 case. In the last case, the prosthesis was replaced by AMS Hydroflex 4.5 years later at patient's wish. Excellent results and good patients' acceptance were gained with inflatable-type prosthesis (AMS 700 and Hydroflex) in 7 out of 8 cases (88%), whereas concealment problems were produced by semirigid type prosthesis (Finney and Jonas). Experience with AMS Hydroflex penile implantation is reported for the first time in the Japanese literature. Intraoperatively, it was sometimes difficult to implant a pair of Hydroflex rods into both of the corpus cavernosum. Postoperative perineal pain was almost constantly seen and in one patient, penile edema continued for three weeks and subsided spontaneously in two months. In another patient, the length of the prosthesis (15 cm) was short, and exchange to the longer one (17 cm) was necessary. In this patient, the longer Hydroflex caused erosion of the glans to necessitate its removal on one side. From our experience, the diameter (11 mm) of the Hydroflex seems to be too big for the average Japanese patient. The operative procedures and results of each kind of the prostheses are briefly discussed.

Nonprotein sulfhydryl compounds in canine gastric mucosa: effects of PGE2 and ethanol

By use of an in vivo canine chambered stomach preparation in which the gastric mucosa was partitioned into two equal halves, the effect of topical 16,16-dimethyl PGE2 (DMPGE2) (1 microgram/ml of perfusate) and 8% and 40% ethanol on tissue levels of nonprotein sulfhydryl compounds was assessed. Both DMPGE2 and 8% ethanol significantly increased (P less than 0.005) mucosal levels of nonprotein sulfhydryls when compared with corresponding mucosa bathed with saline alone. In contrast, mucosa bathed with 40% ethanol showed significantly decreased levels. If mucosa was bathed with DMPGE2 or 8% ethanol prior to exposing the stomach to 40% ethanol, this depletion in sulfhydryl compounds was not observed. Since other experimental observations have shown that exogenously administered prostaglandins and mild irritants (such as low-dose alcohol) can prevent gastric mucosal damage by necrotizing agents (such as high-dose alcohol), our findings are consistent with the hypothesis that nonprotein sulfhydryls may play a role in mediating gastric mucosal protection.

[Experimental and clinical studies on calcium urolithiasis: (I) Animal model for calcium oxalate urolithiasis using ethylene glycol and 1-alpha (OH) D3]

As calcium oxalate stones are the most important component in urolithiasis, an experimental model has to be designed to clarify the pathogenesis and aid in their prevention. Hyperoxaluria as well as hypercalciuria were produced in rats by administering ethylene glycol (0.5%, in drinking water administered ad libitum) and 1-alpha (OH) D3 (0.5 micrograms/rat given every other day), respectively, for three to four weeks. Neither drug alone produced stones efficiently as did the combination regimen of these two compounds. The occurrence of stones was 77.3%, and with only a moderate degree of renal functional impairment. Biochemical and histological data were obtained using this model.

Failure of 16,16-dimethyl PGE2 to prevent inhibitory effect of ethanol on sodium transport in canine gastric mucosa

By use of an in vitro canine gastric mucosal preparation, we evaluated the effects of ethanol (2, 4, 6, and 8%, vol/vol) and indomethacin (2.2 X 10(-4)M), with and without 16,16-dimethyl PGE2 pretreatment, on net sodium transport (JNanet) (mucosal to serosal) across gastric epithelium. Although administration of 2 or 4% ethanol to the mucosal bathing solution had no appreciable inhibitory effects on sodium transport, 6 and 8% ethanol and indomethacin significantly inhibited JNanet when compared with untreated control mucosa. This effect was accompanied by inhibition of transmucosal potential difference (PD) and short-circuit current (Isc). In other mucosae exposed to dimethyl PGE2 (8 X 10(-6) M) in the serosal bathing solution, significant increases in JNanet, PD, and Isc were noted when compared with control mucosa. Addition of 6 or 8% ethanol to the mucosal solution of dimethyl PGE2-pretreated tissue resulted in significant decreases in PD, Isc, and JNanet below control values that were not significantly different from mucosa exposed to 6 and 8% ethanol without PG pretreatment. When indomethacin was added to the mucosal solution following dimethyl PGE2 pretreatment, only slight decreases in PD and Isc below control levels were observed, and the inhibitory effects on JNanet induced by indomethacin without such treatment were abolished. These findings suggest that stimulation of JNanet by prostaglandin may play a role in its ability to prevent indomethacin damage to gastric epithelium but does not appear to be of importance in mediating protection against ethanol damage.

Sodium transport in Rana pipiens gastric mucosa

The transport properties of frog gastric mucosa in vitro have been reexamined in conditions analogous to those used in studies on mammalian systems in which net movements of sodium were observed. Net transport of sodium across frog gastric mucosa was not observed to occur when the mucosal surface was bathed with a well-buffered solution of near neutral pH, indicating that failure to demonstrate sodium transport across frog stomach in previous work could not be ascribed to the low pH value of the solution usually used as the mucosal fluid. Addition of 5 X 10(-4) M amphotericin B to the mucosal solution elicited net transport of sodium and an increase in short-circuit current. These findings indicate that sodium transport may contribute to the electrolyte physiology of frog gastric mucosa in some experimental conditions, and may limit the utility of the three-variable model proposed by Hogben.

[Ultrasound-guided renal cyst puncture and 95% ethanol instillation. Part 2: Morphological and functional alterations]

Ultrasound-guided renal cyst puncture was performed on 22 cysts which were then 95% ethanol instilled to prevent recurrence of cystic fluid. Cystic lesions disappeared on the ultrasonogram in the follow-up period of 3 to 28 months. On CT, cystic lesions became smaller size but did not disappear. Average CT numbers of the cyst were 8.75 +/- 3.83 before and 12.96 +/- 3.27 after ethanol instillation. The cystic wall became thicker. Caliceal distortion and/or pelvis compression by cystic lesions improved on IVP 2 to 3 days after ethanol instillation. The renal image on Tc-99m-DMSA scintigram showed morphological improvement and DMSA renal uptake rate increased slightly but significantly 2 to 4 weeks after ethanol instillation. There were no major complications with this procedure except for one case in which the tip of the catheter became stuck in the cyst and broke off when the catheter was removed. A slight local irritable pain was noticed in all cases. Half of the patients had hot flushes and/or somewhat drunken sense but these symptoms were only temporary. Antabuse phenomenon appeared in one case with concomitant use of a cephem antibiotics after ethanol instillation. This method of therapy is a safe non-surgical approach to treat renal cysts. 95% ethanol instillation in the cyst seems to prevent recurrence of cystic fluid.

Prevention of the inhibitory effects of aspirin on sodium transport in canine gastric mucosa by prostaglandin. Correlation with mucosal morphology

Using an in vitro canine gastric mucosal preparation, this study evaluated the effects of 1 mM aspirin in a buffered Ringer solution (pH = 7.4), with and without concomitant prostaglandin (PG) treatment, on net sodium transport (mucosa to serosa) across gastric epithelium. Administration of aspirin to the mucosal bathing solution for 2 hr significantly decreased the potential difference (PD), short circuit current (Isc), and net sodium transport (net J-Na+) when compared with untreated control mucosa. In mucosa treated with 16,16-dimethyl PGE2 (8 X 10(-6) M) in the serosal bathing solution 40 min after aspirin exposure and for 80 min thereafter, the initial inhibitory effects on PD, Isc, and net J-Na+ induced by aspirin were completely reversed within 40 min of PG treatment, having returned to control values. Histologically, mucosa exposed to aspirin alone showed evidence of diffuse cellular injury involving 50-60% of the surface epithelium. In contrast, mucosa treated with prostaglandin in conjunction with aspirin exposure demonstrated damage involving only 20-30% of the epithelium. These findings suggest that stimulation of sodium transport by PG may play a role in mediating the cytoprotective effects of PGs against aspirin-induced gastric mucosal injury.

Effects of 16,16-dimethyl prostaglandin E2 on alkaline secretion in isolated canine gastric mucosa

An isolated fundic mucosal preparation of dog stomach which is capable of exhibiting an alkaline secretion is described. A stable secretion was established 40 min to 1 hr after the mucosa was pretreated with the H2-antagonist cimetidine to block spontaneous acid output. Alkaline secretion decreased when Ca2+ was removed from the nutrient solution. This secretion was stimulated by dibutyryl cyclic GMP, but was not altered by acetylcholine, carbachol, or 16,16-dimethyl PGE2. Alkaline secretion from a similar antral mucosal preparation was stimulated by 16,16-dimethyl PGE2. We conclude that the 16,16-dimethyl PGE2-stimulated bicarbonate secretion previously demonstrated in in vivo canine fundic mucosa is not the result of a direct effect of PG on gastric mucosal cells and that an intact blood circulation or cholinergic innervation is required for this action to occur.

Parathyroid cysts with primary hyperparathyroidism: report of a case

Cysts of the parathyroid glands are uncommon, and, moreover functioning parathyroid cysts that cause primary hyperparathyroidism are rare. Herein is reported a 53-year-old female with primary hyperparathyroidism accompanied by 2 parathyroid cysts, in one of which adenoma was noticed. Forty-two cases of parathyroid cysts were found in the Japanese literature. Twelve of them were in the hyperparathyroid state, but infarction of the adenoma lead to cystic degeneration in most of such cases and so the cyst wall were lined with adenoma cells. In only 2 cases including our case were the cyst walls lined with cuboid cells and the adenoma evident in the wall. The pathogenesis of our case seems to be a common embryonic defect or dilatation of vestigial remnants rather than a degenerative change of the adenoma.

Route of ethanol administration and gastric acid output during chronic conditions

The effect of intravenous or intragastric ethanol on gastric secretion was determined in chronic ethanol-fed and matched control rats. In vivo, basal and histamine-stimulated acid outputs were inhibited by acute intragastric ethanol to a greater extent in chronic control rats than in ethanol-fed rats. In contrast, intravenous ethanol stimulated basal and potentiated histamine (H)-stimulated acid output (blocked by cimetidine but not atropine) in ethanol-fed rats but not in chronic control rats. Serum gastrin levels were not significantly altered by ethanol. In vitro, mucosal ethanol inhibited basal and H-stimulated acid secretion by mucosae from chronic control and ethanol-fed rats, but serosal ethanol did not significantly alter acid secretion. In conclusion, chronic ethanol intake results in higher acid outputs following acute exposure to intravenous or intragastric ethanol or in vitro exposure to mucosal ethanol as compared to studies using matched control rats.

Inhibition of active sodium transport by cytochalasin B in rat jejunum in vitro

The effects of cytochalasin B on electrophysiological properties and sodium transport in rat jejunum in vitro are described. Stripped paired rat jejunal segments were maintained in Ussing chambers with Leibovitz's (L-15) tissue culture medium bubbled with 100% oxygen. L-15 medium contains galactose as the only sugar, and an assortment of amino acids and cofactors to nourish the tissue. Electrophysiological parameters of short-circuit current (Isc) and transepithelial potential difference could be maintained for up to 4 h in control tissues. Upon application of cytochalasin B (20 micrograms/ml), on the mucosal side, Isc and potential difference fell within 1 h from 1.93 +/- 0.12 to 1.09 +/- 0.14 (mean +/- S.E.) muequiv./cm2 per h and from 5 to 2.5 mV. Tissue resistance remained unchanged at approx. 110 omega X cm2 for up to 4 h. 22Na net flux was 4.1 +/- 0.9 muequiv./cm2 per h during the last control period and fell to zero within 1 h after cytochalasin B treatment. Transmission electron micrographs revealed no gross morphological changes at this dose. Absorptive junctional morphology was apparently not altered by cytochalasin B treatment, a finding which was consistent with the stable transepithelial electrical resistance observed during exposure to this drug. Active sodium transport processes coupled to hexose, amino acid, and chloride movements are all possible in L-15 medium. However, following exposure to 20 micrograms/ml cytochalasin B, all net sodium transport is completely inhibited. The data are consistent with the hypothesis of a common regulator for active sodium transport processes which is modulated through structural changes in cytoskeletal organization.

Acute effect of ethanol on metabolite concentrations of dog pancreas in vivo

Sections of dog pancreas were freeze-clamped before and 1 hr after oral administration of 1 g/kg of ethanol in anesthetized, respirated, 24-hr-fasted animals, and multiple metabolites were determined in the perchloric acid extract of the frozen tissue. In spite of the fact that the pancreas contained little or no alcohol dehydrogenase activity (less than 0.01 IU/g of tissue), significant metabolite changes did occur. Although arterial oxygenation was constant and adequate (pO2 = 100 +/- 7 mM Hg) there was a significant 1.7-fold rise in L-lactate and fall in the cytoplasmic free [NAD+]/[NADH] ratio from 719 +/- 87 to 453 +/- 88 after ethanol. Except for a tendency for L-malate and L-alpha-glycerolphosphate to parallel the rise in L-lactate, there was little consistent disturbance in the remainder of the glycolytic metabolites (glucose, glucose 6-phosphate, pyruvate, 2-ketoglutarate, citrate, 3-phosphoglycerate, etc.) or in high energy intermediates and related compounds (ATP, creatine phosphate, ADP, Pi, creatine). There was, however, an unexpected and significant fall in the levels of the major transaminating amino acids, L-glutamate, L-aspartate, and L-alanine. The results can be only partially explained by an influence of blood-borne metabolites and imply significant effects of ethanol on the metabolism of the pancreas in vivo not directly mediated through alcohol dehydrogenase. Evidence is presented suggesting that both L-alanine and L-aspartate aminotransferases are functioning near equilibrium in the pancreas in vivo.

Effects of cyclic AMP, ouabain and furosemide on ion transport in isolated canine gastric mucosa

1. Cyclic AMP (10 mM), present in the serosal solution of isolated dog gastric mucosa, increased potential difference (p.d.), short-circuit current (ISC), net flux of Na+ from the mucosal to serosal side, and the unidirectional flux of K+ from the mucosal to serosal side. Cyclic AMP did not stimulate H+ or Cl- secretion. 2. Dibutyryl cyclic AMP (DBcAMP, 1 mM) or theophylline (2 mM), present in the serosal solution, stimulated H+ and Cl- secretion, decreased p.d., ISC and electrical resistance. These compounds had no effect on Na+ transport. The stimulatory effect of DBcAMP on H+ secretion was still present after pretreatment with cimetidine or atropine. 3. Ouabain abolished both the p.d. and ISC of the histamine-stimulated gastric mucosa. The mucosal to serosal flux of Na+ and the serosal to mucosal flux of Cl- were significantly decreased in the presence of ouabain. Ouabain caused an increase in the serosal to mucosal flux of K+ and high concentrations caused a significant reduction in H+ secretion. 4. Furosemide (10(-4) M) decreased p.d., ISC and net flux of Na+. Higher concentrations inhibited the net flux of Cl- from the serosal to mucosal side. 5. These results suggest that in isolated dog gastric mucosa, (1) both DBcAMP and theophylline may increase intracellular cyclic AMP to stimulate H+ and Cl- secretion, (2) cyclic AMP, outside the serosal membrane, stimulates active transport of Na+; in contrast, ouabain inhibits this active process predominantly, (3) the selective action of furosemide on Na+ transport indicates that Na+ and Cl- move via separate transport pathways across the serosal border.

Direct effect of ethanol on acid secretion in isolated canine gastric mucosa

The direct effects of ethanol on resting and secreting (histamine = H, pentagastrin = G, and acetylcholine = A) gastric mucosa were determined using an in vitro chamber preparation. Ethanol (E) produced no effect on acid (H+) secretion during resting conditions but concentrations above 2% (4% and 8%) decreased electrical potential difference (PD), short-circuit current (Isc) and resistance (R). With H-induced H+ secretion, E at 8% on mucosal side decreased H+ secretion (4.11 +/- 0.34 to 0.64 +/- 0.45 microEq/cm2hr), Pd (32 +/- 2 to 4.9 +/- 0.6 mV), Isc (5.0 +/- 0.3 to 1.1 +/- 0.1 microEq/cm2hr), and R (237 +/- 15 to 174 +/- 68 hm . cm2). Washout of E produced recovery in all parameters. With P-induced H+ secretion, E decreased H+ secretion (1.63 +/- 0.11 to 0.51 +/- 0.18), PD (42 +/- 5 to 13 +/- 3), Isc (5.71 +/- 0.38 to 2.22 +/- 0.45), and R (274 +/- 21 to 218 +/- 13). With A-induced H+ secretion, E decreased H+ secretion (1.16 +/- 0.06 to 0.45 +/- 0.23), PD (38 +/- 1 to 12 +/- 1), Isc (5.69 +/- 0.40 to 1.94 +/- 0.09) and R (253 +/- 22 to 226 +/- 22). When E was placed on the serosal side, 10% was necessary to inhibit H+ secretion and all the electrical parameters increased. Hypertonic sucrose (695.6 mM in mucosal side) produced an immediate decrease in H+ secretion, PD and Isc but increased R. These data indicate that the direct action of E is not to stimulate but rather to inhibit secretagogue-induced gastric H+ secretion.

Chloride, sodium, potassium and hydrogen ion transport in isolated canine gastric mucosa

1. The fluxes of isotopically labelled Na+, Cl- and K+ in each direction and H+ secretion across isolated dog gastric mucosa were measured under short-circuit conditions. 2. In the non-stimulated state, the net flux of Na+ was 6.61 micronequiv/cm2.hr from mucosal (luminal, secretory) to serosal (nutrient, blood) side, whereas the net flux of Cl- was only 0.79 micronequiv/cm2.hr, and the direction was from serosal to mucosal side. 3. There was a positive correlation between the net flux of Cl- and acid secretion, however, net flux of Na+ was not correlated with acid secretion initiated by secretagogue treatment. 4. With ion substitution studies, only replacement of mucosal Na+ with choline produced a highly significant decrease in potential difference (p.d.). This indicates that active transport of Na+ from the mucosal to the serosal side is the most important source for the generation of the gastric p.d. in dog gastric mucosa. 5. From ion substitution studies, it was also observed that Cl- in either mucosal or serosal solution is necessary for maintaining acid secretion; whereas only serosal Na+ and K+ are essential for acid secretion. Removal of either Na+ or K+ from the mucosal solution had no effect on acid secretion. 6. Substitution of SO2-(4) for Cl- had no effect on active transport of Na+, but choline substitution for Na+ diminished active transport of Cl-.

Acid secretion by isolated canine gastric mucosa

1. An isolated gastric mucosal preparation from the dog stomach which is capable of acid secretion is described. Average values for normal resting potential difference (p.d.) was 49 +/- 2 mV (mucosal side negative with respect to the serosal side), short-circuit current (Isc) was 172 +/- 4 muA and resistance (R) was 285 +/- 6 omega.cm2. Low rates of spontaneous acid secretion (0-0.58 muequiv/cm2.hr) were present initially but following short-circuiting of the tissue these values decreased to low levels (less than 0.1 muequiv/cm2.hr) within an hour. 2. Histamine in doses exceeding 10(-6)M stimulated acid secretion, increased Isc and decreased R. Concentrations ranging from 10(-5) to 8 X 10(-4)M produced maximal secretion. The maximal secretory rate achieved was 4.24 +/- 0.35 muequiv/cm2.hr. 3. Pentagastrin (10(-8)M) and acetylcholine (10(-6)--10(-5)M) also stimulated acid secretion with a lower maximal secretion as compared to histamine stimulation. These concentrations of pentagastrin and acetylcholine did not alter histamine stimulated acid secretion. Higher concentrations of pentagastrin (10(-6)M) and acetylcholine (10(-4) M) reversibly inhibited acid secretion of histamine stimulated mucosa. 4. These results demonstrate that there are many similarities between in vitro and in vivo findings on the dog stomach, indicating the great potential of the in vitro dog gastric mucosa for studies on the mechanism of action and interaction of gastric secretagogues.

Effects of ethanol on sodium, 3-O-methyl glucose, and L-alanine transport in the jejunum

Effects of ethanol on Na+, Cl-, 3-O-methyl glucose (3-O-MG), and L-alanine fluxes were studied in the isolated rattit jejunal mucosa. Ethanol (3% v/v present on both sides of the mucosa) decreased electrical potential difference (PD), short-circuit current (Isc) and inhibited active transport of Na+, 3-O-MG, and L-alanine. This concentration also increased the permeability of the mucosa for Cl-, 3-O-MG, and L-alanine. Ethanol at 5.4% potentiated the effects on PD, Isc, and the permeability for electrolytes and organic substances. These effects of ethanol could not be fully explained by an osmotic action.

Acute effects of N-methyl-N'-nitro-N-nitrosoguanidine on canine gastric mucosa

The electrophysiological effects of the chemical gastric carcinogen N-methyl-N'-nitro-N-nitrosoquanidine (MNNG) were determined in an in vivo chambered canine stomach and in an in vitro canine gastric mucosal preparation. In the in vivo stomach, the topical application of 2.5 mg MNNG/ml decreased the transmural electrical potential difference, and the systemic blood pressure was essentially unchanged. In the in vitro preparation, exposure of the mucosal side of the isolated canine gastric mucosa to 0.25 and 2.5 mg MNNG/ml for 1 hour sequentially or exposure of the serosal side to 2.5 mg MNNG/ml for 2 hours inhibited net Na+ and Cl- fluxes. With longer duration, the undirectional fluxes of Na+ and Cl- increased, indicating an increase in permeability. These findings suggested that inhibition of active transport in the gastric mucosa may have an important function in the gastric carcinogenicity of MNNG.

Inhibition of ion transport by bile salts in canine gastric mucosa

Studies were conducted with in vivo and in vitro canine stomach preparations. Instillation of 5, 10, and 20 mM bile salts in TES bufer (pH 7.4) into the nonsecreting stomach in vivo caused a progressive decrease in electrical potential difference (PD) and an increase in electrical resitance (R). The rate of acid secretion, determined by the pH-stat method in the histamine-stimulated stomach, decreased with 5 and 20 mM bile salts. Mucosal adenosine triphosphate (ATP) content of the nonsecreting or secreting stomach was reduced by bile salts. In vitro flux studies demonstrated that within the first hour after 1 mM bile salts were added to the mucosal side of the chamber, PD decreased, R increased, and net sodium transport decreased. In the second hour, unidirectional fluxes of sodium increased, indicating an increase in permeability of the gastric mucosa to sodium. These results demonstrate that the initial action of bile salts is inhibition of ion transport, which is followed by an increase in permeability.

Mechanism of action of aspirin on canine gastric mucosa

Using an in vivo chambered canine stomach preparation, exposure of the gastric mucosa to 5, 10, and 20 mM aspirin(pH 3.0) resulted in a decrease in electrical potential difference (PD) and in an increase in resistance (R) within 30 min. In vitro, exposure of the mucosal side of the isolated canine gastric mucosa to 5, 10, and 20 mM aspirin (pH 3.0) for 1 h or of 1 mM aspirin (pH 3.0) for longer than 1 h resulted in marked permeability changes, i.e., increases in the undirectional fluxes of Na+ and Cl-, as well as inhibition of net ion fluxes. These concentrations of nonionized aspirin (pH 3.0) also reduced the R and PD. However, 1 mM aspirin (pH 3.0) or 20 mM ionized aspirin (pH 7.4) depresses the active transport of ion, increases R, but does not increase the ionic permeability. Mucosal adenosine triphosphate (ATP) content is reduced by mucosal instillation of aspirin (pH 3.0). These results demonstrate that the initial action of aspirin is inhibition of ion transport which is followed by an increase in permeability.

Electrophysiological effects of burimamide and 16,16-dimethyl prostaglandin E2 on the canine gastric mucosa

The electrophysiological effects of two potent inhibitors of gastric acid secretion, burimamide and 16,16-dimethyl prostaglandin E2 (dm-PGE2), were determined in an in vivo histamine-stimulated canine stomach preparation and an in vitro canine gastric mucosal preparation. In the in vivo stomach preparation, intravenous burimamide caused a decrease in acid secretion, an increase in transmucosal potential difference (PD) and the relative resistance (R) was essentially unchanged. Intravenous dm-PGE2 also inhibited acid secretion and increased PD but, in contrast to burimamide, increased R. In the in vitro preparation, the unidirectional flux of sodium from mucosa to serosa increased after dm-PGE2 but not after burimamide. Passive sodium fluxes and unidirectional chloride fluxes were not altered after either agent. These findings suggest that increased active transport of sodium from mucosa to serosa is at least partially responsible for the observed increase in transmural PD with dm-PGE2, an agent which also decreases hydrogen ion transport. With burimamide the increased PD was due primarily to inhibition of hydrogen ion secretion.