Repeated cesarean scar pregnancy - Case report.

Cesarehn scar pregnancy (CSP) is a rare location of an ectopic pregnancy implanted within a scar from previous cesarean section, separated from the endometrial cavity. The prevalence ranges from 1:1,800 to 1:2,226 pregnancies. It is a potential life-threatening condition, and if misdiagnosed, can cause serious maternal morbidity from uterine rupture with massive hemorrhage and even death. Until now, no universal treatment guidelines have been established, with treatment options ranging from systemic or local injection of methotrexate (MTX), suction curettage under ultrasound control to surgical treatment, including hysteroscopy and wedge resection of the ectopic pregnancy, via laparotomy or laparoscopy. The authors present a case of a 42-year old woman with two consecutive CSPs. First CSP was un- successfully treated conservatively, followed by ultrasound guided vacuum aspiration of the uterine cavity. Second CSP was treated by laparotomy and a wedge excision of a CSP and repair of a scar with interrupted sutures. The authors also discuss diagnostic pitfalls and treatment modalities.

Nitric oxide-independent inhibitory effects of L-arginine analog NG-monomethy-L-arginine on the generation of interleukin-2 activated cytotoxic activity in humans.

Nitric oxide (NO) derived intracellularly from L-arginine (Arg) is indispensable for optimalgeneration of lymphokine-activated killer (LAK) cell activity in rodents. Still unclear, however, is its role in humans. To address this question human peripheral blood mononuclear cells (PBMC) from healthy donors were cultured in L-arginine free medium supplemented with recombinant interleukin-2 (rIL-2) and in the presence of exogenous L-arginine analog NG-monomethyl-L-arginine (NMMA), a specific inhibitor of the NO synthetic pathway. Cultured PBMC were tested for cytotoxic activity, proliferative capacity, and expression of phenotypic and activation markers (CD3, CD4, CD8, CD16, CD56 and CD25). Culture supernatants were assayed for nitrite (NO2-) and tumor necrosis factor-alpha (TNF-alpha) production. We found that NMMA inhibits the generation of optimal LAK cell activity when no exogenous Arg is supplied. Similar effects were also observed on proliferation, expression of IL-2 receptor induced upon rIL-2 stimulation and on TNF-alpha production. Sodium nitroprusside (SNP), used as a source of exogenous NO could not overcome this effect of NMMA on LAK cell activity. NO2- production was virtually undetectable in culture supernatants. Thus, NMMA affects in an NO-independent manner rlL-2 induced LAK activity in human PBMC.

Glutathione S-transferase activity as an early marker for malignant tumors of corpus uteri.

Glutathione (GSH) concentrations and glutathione S-transferase (GST) activities were determined in 30 paired malignant human corpus uteri tumor samples and in samples of adjacent normal tissues. For GSH concentrations no difference was found between normal (126.0 +/- 52.4 nmol/mg protein) and tumor tissues (110.1 +/- 46.4 nmol/min/mg protein; p = 0.219). The GST activities were significantly higher in tumor tissues (322.4 +/- 135.54 nmol/min/mg protein) than in corresponding normal tissues (224.6 +/- 95.64 nmol/min/mg protein; p = 0.005). This activities were independent on the pathohistological and clinical factors, except for positive lymphovascular invasion and myometrial invasion (over 50%), where significantly lower GST activities were found. For normal tissues the positive correlation between GSH concentrations and GST activities was found (correlation coefficient = 0.50, p = 0.005), but not for tumor tissue (correlation coefficient = 0.20, p = 0.281). The prognosis of patients (according to the well established prognostic factors, such as tumor type, myometrial invasion and grades) who had lower GSH concentration and GST activity in normal tissue was similar to those with higher GSH concentration and GST activity. In conclusion, higher GST activities found in tumor of corpus uteri suggest, that GST activity could be used as a tumor marker for the early stages of these malignant tumors.

Diazenes: modificators of tumor cell resistance to cisplatin.

Most studies indicate that modulation of glutathione metabolism may be one of the most promising means of reversing clinical drug resistance. Five new diazene compounds have been synthesized: JK-279, JK-835, JK-913, JK-925 and LV-57 that should, according to their structure and biochemical properties, lower the GSH concentration. In the present study, we examined the influence of diazenes on cisplatin resistance in human cervical (HeLa) and laryngeal carcinoma (HEp2) cells as well as in their cisplatin-resistant sublines (HeLaCA and CK2, respectively). Intracellular GSH content was examined spectrophotometrically by the procedure developed by Tietze. The cell sensitivity to drugs was determined using a modified colorimetric MTT assay. Results show that all examined diazenes lowered GSH concentration. This decrease was insignificant for JK-835 and JK-925 in HeLa and HeLaCA cells, and JK-925 in CK2 cells. In human cervical carcinoma HeLa and HeLaCA cells, JK-279 was mostly active in sensitizing the cells to cisplatin, especially in drug-resistant cells. JK-913, JK-835 and LV-57 reverted partially resistance to cisplatin in HEp2 cells, while none of the diazenes was active in CK2 cells. In conclusion, diazene JK-279 may be useful in the combined treatment (cisplatin + diazene) for the certain type of cancer.

Characterization of human breast adenocarcinoma SK-BR-3 cells resistant to doxorubicin.

Doxorubicin shows a wide spectrum of activities in solid tumors, especially against breast carcinoma. The aim of this study was to examine if doxorubicin, when given at lower concentrations than applied in clinic, may induce changes in treated cells. With this purpose we developed human breast adenocarcinoma SK-BR-3 cell line resistant to doxorubicin. The sensitivity of these cells to doxorubicin and to some other cytostatics used in cancer treatment was determined by colorimetric MTT assay. Some parameters which may be of importance as prognostic factors in treatment of breast cancer were analyzed as well. The expression of genes involved in mitotic signal pathway (EGF, TGF alpha, EGF-R, erbB-2, erbB-3, c-myc and c-H-ras) was determined immunocytochemically. The concentrations of cathepsins were determined using quantitative immunoreactive assays (cathepsins B and L) or immunoradiometric assay (cathepsin D). The results revealed that even low doses of doxorubicin can induce numerous changes in treated cells: they become resistant to doxorubicin, and cross-resistant to several other cytostatics. The expression of the above mentioned genes involved in mitotic signal transduction, as well as cathepsins D and L, was similar in both parental and doxorubicin treated cells.

Relationship of gastric metaplasia and age, sex, smoking and Helicobacter pylori infection in patients with duodenal ulcer and duodenitis.

Gastric metaplasia is one of the factors in duodenal ulcer appearance. The aim of this study was to investigate the frequency of gastric metaplasia and its connection with age, sex, cigarette smoking and H. pylori infection. In the study 216 patients were included. There were 98 patients with duodenal ulcer, 60 with duodenitis, and 58 healthy control subjects. There was no statistically significant difference in gastric metaplasia frequency according to age and sex. Gastric metaplasia was statistically more significant in patients with duodenal ulcer (p < 0.01). In all the subjects cigarette smoking did not significantly influence gastric metaplasia. In smokers with duodenal ulcer, and those who besides duodenal ulcer and smoking had H. pylori infection gastric metaplasia was more frequent (p < 0.01). However, in patients with duodenal ulcer, there was no statistically significant difference of gastric metaplasia related to H. pylori presence. It may be suggested that H. pylori infection is not of indispensable significance for gastric metaplasia appearance.

Features of uremic neuropathy in long-term dialysis.

In order to assess the influence of long term hemodialysis on progression of uraemic neuropathy (UN), 16 different electroneurographic (ENG) parameters on 158 dialysis patients were performed. The ENG parameters were compared in three groups of patients of different dialysis age. Group I: high dialysis age (HDA) comprising of, 31 patients being more than 10 years on dialysis; Group II: intermediate dialysis age (IDA) comprising of 53 patients between 5 and 10 years on HD and group III: low dialysis age (LDA) comprising of 74 patients being less than 5 years on dialysis. The influence of sex and age was also analyzed. All sixteen tested parameters were altered in uremic patients when compared to 140 healthy controls (p < 0.01). HDA pts compared to LDA pts and the older group versus the younger had 11 and 9 out of 16 ENG parameters significantly worsened, respectively (p < 0.01). The most profound and reproducible lesion was in prolongation of evoked potential of tibialis posterior and peroneus nerve (FWt, HWt, FWp). HDA, especially after 10 yrs and the age but not the sex is clearly associated with a further progression of UN. However, for unknown reasons, the progression of UN in dialyzed patients is not followed by a parallel worsening of clinical symptoms (p > 0.05).

Effects of smoking and Helicobacter pylori on prostaglandin concentrations in gastric and duodenal mucosa of patients with duodenal ulcer and duodenitis.

The aim of this study was to determine the level of endogenous prostaglandin E2 (PGE2), prostaglandin F1 alpha (6-keto-PGF1 alpha) and thromboxane B2 (TXB2) in the gastric and duodenal mucosa of patients with duodenal ulcer and duodenitis. Besides, the investigation aimed at determining the effect of smoking and infection by Helicobater pylori on prostaglandin synthesis. The investigation comprised 62 patients with duodenal ulcer, 46 patients with duodenitis and 44 controls. The results of our investigation indicate that the decreased prostaglandin synthesis in gastric and duodenal mucosa determined in patients with duodenal ulcer may have a considerable role in development of duodenal ulcer. Furthermore, the harmful effects of smoking on the gastric and duodenal mucosa may be mediated by the decreased prostaglandin synthesis in the gastric and duodenal mucosa. However, Helicobacter pylori seems to affect the development of duodenal ulcer through other mechanisms.

The characterization of two human cervical carcinoma HeLa sublines resistant to cisplatin.

Human cervical carcinoma HeLa cells were made resistant to cisplatin by one of two schedules; "acute" (cells repeatedly treated with cisplatin for 1 h in serum-free medium--CA cells) or "continuous" (cells treated repeatedly for 24 h in complete medium--CK cells). The sensitivity of CA and CK sublines to cisplatin and various other antineoplastic drugs was determined by the modified MTT staining procedure. The possible involvement of glutathione (GSH), glutathione S-transferases (GST) and metallothioneins (MT) in cisplatin resistance was examined. The results show that acutely treated CA cells became more resistant to cisplatin than CK cells. The resistance to cisplatin does not involve either glutathione or glutathione transferase. The increased levels of metallothioneins might be involved in the development of resistance. The sensitivity of CA and CK sublines to the selected drugs was different from that of the parent cells. Both sublines became cross-resistant to vincristine and methotrexate, but only CA cells exhibited cross resistance to etoposide doxorubicin and 5-fluorouracil. Thus, the development of resistance to cisplatin is a consequence of numerous intracellular alterations that are reflected in cell response to a variety of anticancer drugs. The response depends on the schedule of resistance development and on the nature of the secondary agent.

Tyrosine kinase-dependent and -independent events induced by interleukin-2 stimulation: interleukin-2-mediated NO production required for the induction of lymphokine-activated killer cell activity in rat splenocytes is tyrosine kinase independent.

Nitric oxide (NO) has recently been shown to be an indispensable co-factor in the generation of lymphokine-activated killer (LAK) cells induced by interleukin-2 (IL-2). Upon stimulation with IL-2, cells endowed with specific receptors undergo phosphorylation of substrates mediated by protein tyrosine kinases (PTK). In this work we utilized a well-characterized PTK inhibitor, genistein (GEN), to address the role of PTK on NO-dependent LAK cell generation. The effects of GEN were tested on the expression of the inducible NO synthase (iNOS) gene, proliferation, generation of cytotoxic activity and production of NO upon IL-2 stimulation of rat splenocytes. We report here that GEN displays profound inhibitory effects on recombinant (r)IL-2 induced proliferation and on LAK cell generation, while only marginally affecting NO production, measured as NO2-. In contrast, a specific inhibitor of the NO synthetic pathway (NG-monomethyl-L-arginine; NMMA) blocked generation of LAK cells and NO production without affecting cell proliferation. If added directly to the cytotoxicity tests, GEN exerted minor inhibitory effects, not exceeding 25% of control tests, while NMMA was completely ineffective. Sodium nitroprusside (SNP), a non-enzymatic NO-releasing substance, restored LAK cell generation in cultures performed in the presence of NMMA, but not in those performed in the presence of GEN. These results indicate that IL-2-induced NO production is a PTK-independent event. IL-2-stimulated LAK cell generation obligatorily requires the concurrent activation of PTK dependent and independent signal transduction pathways.