Cytokeratin patterns in the epidermis of human ovarian mature cystic teratomas.

Using a battery of monoclonal antibodies, we investigated the cytokeratin pattern in the epidermides of 12 human ovarian mature cystic teratomas (MCTs) and compared them with those of infant, adult, and fetal skin. Histologically, two types of epidermal layers were identified in the MCTs, a mature layer and an immature layer. The mature layer was similar to the epidermis of infants and adults, while the immature layer resembled stratified nonkeratinizing and metaplastic squamous epithelium. The cytokeratin pattern of the histologically mature epidermis in MCT was either similar to that in infants and adults or was of the fetal type. The cytokeratin expression of the histologically immature epidermis in MCT also showed many similarities to the fetal cytokeratin pattern. We conclude that histologic maturity of the epidermis in MCT is not necessarily expressed by the cytokeratin pattern, which reflects the state of molecular rather than histologic differentiation. Since prognosis in germ cell tumors is usually related to the degree of tissue maturation, our observations raise the possibility that the cytokeratin profile may eventually prove to be a valuable prognostic tool in some of the neoplasms that contain epithelial elements.

Effects of disorder on the wave front depinning transition in spatially discrete systems.

Pinning and depinning of wave fronts are ubiquitous features of spatially discrete systems describing a host of phenomena in physics, biology, etc. A large class of discrete systems is described by overdamped chains of nonlinear oscillators with nearest-neighbor coupling and subject to random external forces. The presence of weak randomness shrinks the pinning interval and it changes the critical exponent of the wave front depinning transition from 1/2 to 3/2. This effect is derived by means of a recent asymptotic theory of the depinning transition, extended to discrete drift-diffusion models of transport in semiconductor superlattices and is confirmed by numerical calculations.

The effect of advanced glycation end-products and aminoguanidine on TNFalpha production by rat peritoneal macrophages.

OBJECTIVE: To evaluate the effect of advanced glycation end-products (AGEs) and the inhibitor of their formation, aminoguanidine, on tumor necrosis factor-alpha (TNFalpha) production (as a functional marker) by rat peritoneal macrophages (PMphi). DESIGN: Charles River rats underwent a daily intraperitoneal injection of peritoneal dialysis solution [(PDS), 4.25 g/dL dextrose; Dialine, Travenol, Ashdod, Israel] for a 2-month period (group E). Another group of rats was subjected to the same protocol with the addition of 25 mg/kg aminoguanidine (group A). Three control groups were utilized: (1) rats that were injected daily with aminoguanidine only (group AO), (2) rats that were injected with Dulbecco's phosphate-buffered saline (group D), and (3) rats in which no intervention was carried out (group C). After 2 months, PMphi were isolated from rat peritoneal effluent and their TNFalpha production measured by ELISA in cell-free culture supernatants, in both the basal state and after 24-hour stimulation with lipopolysaccharide (LPS). The concentrations of AGEs in peritoneal effluent were assayed and correlated to TNFalpha levels. PMphi obtained from normal rats were then incubated for 24 hours with (1) the peritoneal effluent of each of the above respective groups, with or without LPS; (2) increasing concentrations of AGEs (0-250 microg/mL); and (3) increasing concentrations of aminoguanidine (0-7.5 mg/mL), and TNFalpha secretion again determined. RESULTS: After 2 months of daily intraperitoneal injection of PDS, in the basal state, TNFalpha production was significantly higher in PMphi isolated from the peritoneal effluent groups (groups E, A, and AO) compared to controls (group C). Following LPS stimulation, a further increase in TNFalpha secretion was seen, with a significantly greater response in group AO versus groups E, A, and D. Effluent AGEs were markedly elevated only in group E. No correlation was found between TNFalpha secretion by these PMphi and the concentration of AGEs. On incubation with the respective peritoneal effluents (groups E, A, and AO), in both the basal and stimulated state, TNFalpha production by PMphi from normal rats was significantly enhanced compared to group C. Incubation with increasing concentrations of AGEs or aminoguanidine resulted in an increase of TNFalpha secretion by these PMphi. CONCLUSIONS: Following intermittent intraperitoneal administration of glucose-based PDS, rat PMphi are chronically activated, as evidenced by increased basal TNFalpha secretion. The peritoneal effluent of such treated animals is capable of stimulating TNFalpha production by normal rat PMphi. These data suggest that glucose-based PDS acts as a primer of PMphi, which retain their ability to further stimulation by LPS. Although, in vitro, AGEs promote TNFalpha secretion by normal rat PMphi, in vivo, their influence is probably modulated by other factors. Aminoguanidine has a specific inducing effect on rat PMphi, independent of glucose-based PDS.

[Tumor pathology in horseshoe kidney]. / Patología tumoral en el riñón en herradura.

Within renal aberrations, the most frequent one is the horseshoe kidney. Adenocarcinoma is the most common primary renal neoplasia. The association of tumour and horseshoe kidney is uncommon, with only 135 cases described in the literature. Presentation of 4 patients with tumours in horseshoe kidney: 3 adenocarcinoma and one urothelial tumour of renal pelvis. As a result of our experience we consider that arteriography is a key imaging technique for pre-operative study of these patients, medial laparotomy being the choice access for approach, and prognosis depending on tumour staging, with no influence from the malformation.

[Cerebral metastasis as first manifestation++ of a bladder carcinoma]. / Metástasis cerebral como primera manifestación de un carcinoma vesical.

The infiltrant vesical carcinoma shows a tendency to become metastatic in a high percentage of cases, so that the preferred sites are usually the retroperitoneal lymph nodes, liver and bone. CNS metastasis is an uncommon fact, but it is even less common to find CNS affectation symptoms even before the appearance of any signs and symptoms related to the vesical affectation itself. Contribution of one case of infiltrant vesical carcinoma which presented with focal neurological symptomatology as its first manifestation.

[Tuberculous prostatic abscess in a patient with AIDS]. / Absceso prostático tuberculoso en paciente con SIDA.

Despite of prostate abscesses having become an uncommon disease, a number of cases has been described lately specially in immunodepressed patients caused by infrequent agents, such as Mycobacterium tuberculosis. This paper describes the case of one HIV-positive patient, diagnosed with a prostate abscess within a tuberculous dissemination. The best diagnostic method is considered to be the transrectal ultrasound (TRU), the choice therapy being drainage by ultrasound-guided transperineal percutaneous puncture.

[Intradiverticular bladder tumors]. / Tumores vesicales intradiverticulares.

Retrospective study conducted on 58 patients with vesical diverticulum seen in our unit between 1975 and 1992, of which a total of 11 (18.9%) patients had vesical tumours. Of these, 6 (10.3%) were intradiverticular and 5 (8.6%) extradiverticular. Sixty-six percent of patients with intradiverticular tumours also had prior or concurrent history of extradiverticular vesical tumours. The most frequent clinical presentation was gross haematuria. The abdomino-pelvic CT is the most sensitive morphological examination although in 33% cases it resulted in overstaging. Curative treatment was only possible in the 4 patients with urothelial tumours, in whom 3 partial cystectomies with pelvian lymphadenectomy (2 pT1 G2 and 1 pT3 G3) and 1 TUR (T1 G2) were performed. The 2 (33%) remaining patients had advanced locoregional epidermoid carcinoma (T4 N+). All patients with urothelial carcinoma are alive with follow-up ranging between 6 months for the one infiltrant case and 136 months for a surface tumour undergoing partial cystectomy. Prognosis for both epidermoid carcinoma was ominous with mean survival time of 9 months. Review of the literature and discussion of epidemiological, clinical, diagnostic, therapeutic and prognostic issues.

[Genitourinary malacoplakia]. / Malacoplaquia genitourinaria.

Malacoplakia is a chronic inflammatory disease the etiology of which remains obscure. It has a very low incidence and affects primarily the genitourinary tract, although it has been described in some other organs. This paper presents a historic insight of the clinical cases diagnosed in this centre, and includes a review and update of several issues related to this entity such as pathogenesis, pathological anatomy and treatment. Also, the peculiarities related to the involvement of each separate organ with regard to diagnosis, prognosis and treatment are described.

[Diagnostic comparison of diuretic isotopic renogram and diuretic Doppler ultrasonography in pediatric hydronephrosis]. / Comparación diagnóstica entre el renograma isotópico diurético y el Eco Doppler diurético en las hidronefrosis infantiles.

UNLABELLED: Due to the high frequency of asymptomatic pyelocaliceal dilatations, most of them with prenatal diagnosis, the diagnosis of obstruction remains a major chance. Isotopic diuretic renogram (IDR) remains the basic diagnostic tool, although it has some pitfalls and undetermined diagnosis. To obviate them, several others tests have been used, such as diuretic Doppler ultrasound (DDU). The object of this paper is to determine its validity. METHODS: All the patients with hydronephrosis and with grade II dilatation or bigger were studied wit DDU. The results were compared with those obtained by IDR, obtaining 2 x 2 tables to analyze specificity and sensibility. RESULTS: 37 patients were studied, 9 of them bilateral, with a total of 46 dilated kidneys. There were 22 males and 15 females. 59 percent had prenatal diagnosis and 57 percent were asymptomatic. 22 percent had grade IV dilatation, 37 percent grade III and 41 percent grade II. 2 cases had contralateral vesicoureteral reflux. IDR showed 15 obstructed kidneys, 7 of them with a regular renal function. 16 were operated, one more due to abdominal pain despite a non-obstructed IDR. Only 7 of the 15 kidneys presented an obstructive pattern in the DDU. Comparing both tests, DDU had a 46 percent of sensibility and 100 percent of specificity and a negative predictive value of 79% for a 95% interval. Kramer index was 0.54 representing a very low association. CONCLUSIONS: In our institution, DDU is not better than IDR to diagnose obstruction. We consider its use as a second line test in cases of doubtful IDR.

Chlamydia trachomatis infection during pregnancy: can it cause an intrauterine infection?

In an attempt to prove the presence of intrauterine fetal chlamydial infection, sera from 26 laboring women, who tested positive for cervical chlamydial antigen in the first half of their pregnancies, and from 43 laboring women with no evidence of such infection, and sera from the cord of their delivered infants were tested for chlamydial IgA-, IgG- and IgM-specific antibodies. Nine (34.6%) of the 26 women with positive cervical infection and 5 (11.6%) of the 43 women with no identifiable cervical infection had significant antibody levels at the time of the delivery. Three of the 26 (11.5%) babies born to the mothers with positive cervical chlamydial infection early in the pregnancy and high antibody titer at delivery were found to have anti-chlamydial antibodies in their cord serum, indicating intrauterine infection; cord sera from the other 43 babies were negative for these antibodies. These findings suggest a low but possible risk of intrauterine infection in the presence of lower genital infection during pregnancy.

Alpha smooth muscle actin (alpha-SM actin) in normal human ovaries, in ovarian stromal hyperplasia and in ovarian neoplasms.

An immunohistochemical investigation of alpha-smooth muscle actin (alpha-SM actin) using the monoclonal anti-alpha-SM-1 antibody was carried out in 15 normal ovaries, in three ovaries with stromal hyperplasia and in 27 neoplastic ovaries. In selected cases the pattern of actin isoforms was examined by means of 2 D-gel electrophoresis. In addition, the tissues were stained for vimentin and desmin. In normal ovaries alpha-SM actin was found in the inner cortex and in the theca externa. In ovarian stromal hyperplasia expression of alpha-SM actin was minimal or absent. In primary and metastatic epithelial tumors there was positive stromal staining for alpha-SM actin, especially in the vicinity of epithelial elements. This tended to be more widespread in malignant neoplasms. Thecomas did not express alpha-SM-actin and could thus be differentiated from leiomyomas which stained intensely for alpha-SM actin. Only focal stromal staining of alpha-SM actin was observed in granulosa and germ cell tumors. In all the tissues studied blood vessels were strongly positive for alpha-SM actin. Desmin, although present in the stroma of most of the specimens, was less abundant than alpha-SM actin. We concluded that alpha-SM actin is a component of the normal human ovary where it may contribute to the contractility of its stroma. Its absence in the normal outer cortex and theca interna, and in stromal hyperplasia and thecoma implies that sex hormones do not constitute a stimulus for alpha-SM actin production in the ovary. Among neoplasms it is most widely represented in the stroma of epithelial tumors in which it may reflect stromal stimulation mediated by neoplastic epithelium.

[Clinical usefulness of free PSA/total PSA ratio in the early diagnosis of prostatic cancer]. / Utilidad clínica de la ratio PSA libre/PSA total en el diagnóstico precoz del cáncer de próstata.

OBJECTIVES: To determine the clinical utility of free/total PSA ratio and PSA density in the early diagnosis of prostate cancer (patients with serum PSA between 4 and 10 ng/ml) and to determine the differences, if any, in the free/total PSA ratio in patients with cancer and those with benign prostatic hyperplasia (BPH). METHODS: A prospective and descriptive study was conducted on 61 patients with low grade obstructive symptoms and total serum PSA between 4 and 10 ng/ml (group 1), and 42 patients who underwent prostate surgery and had an anatomopathologically confirmed diagnosis of BPH (group 2). Free and total PSA were determined, as well as prostate volume by transrectal US, in all cases. Prostate biopsy was performed in all patients with a total PSA value between 4-10 ng/ml. The sensitivity, specificity, positive and negative prognostic values of free/total PSA ratio and PSA density were analyzed. RESULTS: The mean age of the patients in group 1 was 67.7 years and 68.3 years in group 2. The mean prostate volume by US was 55.2 and 47.1, respectively (n.s.). The mean total PSA was 6.39 ng/ml for group 1 and 5.73 ng/ml for group 2 (n.s.). No significant difference was found between the mean free PSA values of both groups. However, the free/total PSA ratio and PSA density were significantly different (p < 0.000). In group 1 (total PSA 4-10 ng/ml), prostate biopsy was positive in 32.8% of the patients. In this group of patients, there were no significant differences in the parameters analyzed. Application of different cutoffs for both tests showed a higher clinical utility for the 0.24-0.30 range. CONCLUSIONS: At similar mean prostate volume and mean total PSA, significant differences were found in the free/total PSA ratio and PSA density of patients submitted to surgery for BPH and those with a total PSA value of 4-10 ng/ml. However, these results were not observed when patients with PSA of 4-10 ng/ml were analyzed for presence or absence of evidence of malignancy in the prostate biopsy.