Feasibility of a concanavalin A-peroxidase labeling method to detect cancerous and precancerous lesions of the uterine cervix.

For the detection of cancerous and precancerous lesions in cervical cytopathology, the feasibility of a concanavalin A-peroxidase labeling procedure was tested and compared with the Papanicolaou method. To this end, the percentage of labeled flattened epithelial cells with a morphologically normal appearance present in cervical cell suspensions was determined. It was found that the mean labeling percentage of the control group was 71% (SD, 11%). The means for mild, moderate, and severe dysplasia groups were, respectively, 54% (SD, 19%), 48% (SD, 13%), and 44% (SD, 16%). The mean for the carcinoma in situ group was 32% (SD,11%), and for the squamous cell carcinoma group 16% (SD, 5%). It appeared that the labeling percentage gradually decreases with increasing atypia of the epithelium as confirmed by histological observation. A complete dissimilarity was found between healthy individuals and cancer patients. In a follow-up study it was found that the mean labeling percentage did not alter in cases of an unchanged stage of disease. A reestablishment of the normal concanavalin A-peroxidase labeling percentage often appeared once the cancerous or precancerous lesion was treated. In conclusion, the concanavalin A-peroxidase labeling method can be considered as a supplementary technique to the Papanicolaou method for the early detection of cervical cancer. It reduces the effect of sampling and screening errors of the Papanicolaou method, and it allows a more objective cytological diagnosis. In addition, it may possess prognostic significance.

Chemical characterization of glomerular and tubular basement membranes of cattle of different ages.

Glomerular and tubular basement membranes were isolated from fetal, neonatal, young and adult bovine kidneys. An isolation method with sieves for both glomeruli and tubules from the same kidney was developed. A detergent procedure appeared to give purer glomerular and tubular basement membrane preparations than the generally used sonication method. No large differences were found in the composition of glomerular and tubular basement membrane of adult animals. Glomerular and tubular basement membrane preparations of the four age groups showed an increase with age of hydroxylysine and both 3- and 4-hydroxyproline. The most marked increases appeared at different stages of development, that of tubular basement membrane being between fetal and neonatal stages and glomerular basement membrane between 18 weeks old and adult animals. The ratio of 3- to 4-hydroxyproline increased considerably during development. Total imino acid content was higher for both types of basement membrane from adult than from young animals, while total content of hydroxylysine plus lysine remained fairly constant. The increase in hydroxylation of lysine was accompanied by a corresponding change in glucose and galactose content so that the ratio of galactose to hydroxylysine or glucose to galactose remained constant. Fucose content of both types of basement membranes was the same for all age groups but content of aminosugars and mannose gradually increased with age.

Macronodular adrenocortical hyperplasia in long-standing Cushing's disease.

Clinical and biochemical findings in 13 patients (11 women and 2 men) with macronodular adrenocortical hyperplasia (MNH; nodule size, greater than 0.5 to 5.3 cm) were compared with those of 18 patients (15 women and 3 men) with Cushing's disease and diffuse (n = 9) or micronodular (n = 9) hyperplasia (DH). All were bilaterally adrenalectomized for their hypercorticism. The clinical picture was almost identical in both groups, except for greater frequency of hypertension (13 of 13 vs. 10 of 18; P less than 0.05), alopecia (4 of 11 vs. 0 of 15; P less than 0.05), and scintigraphic lateralization (6 of 7 vs. 1 of 7; P less than 0.05) in the MNH group than in the DH group. The sella turcica was enlarged in 30% of the patients in both groups. Patients with MNH were significantly older than DH patients [43.5 +/- 7.8 (mean +/- SD) vs. 31.7 +/- 10.1 yr; P less than 0.005] and had a 3-fold longer duration of disease (7.8 +/- 4.6 vs. 2.0 +/- 1.1 yr; P less than 0.001) than those with DH. The mean plasma ACTH and cortisol levels and urinary 17-hydroxycorticosteroid excretion were elevated in both MNH and DH patients and responded similarly to specific (corticotropin-releasing hormone and metyrapone) and nonspecific (TRH and LHRH) stimuli. However, dexamethasone suppressibility and the stimulatory effect of ACTH on adrenocortical function were less in the MNH than in the DH group or its subgroups, suggesting a greater degree of adrenal autonomy in the former. Adrenal weight in MNH (15.8 +/- 12.1 g each) was almost twice as high as in DH (8.2 +/- 2.0 g) patients and positively correlated with the duration of the disease. The data suggest that MNH may be a result of long-standing Cushing's disease with varying degrees of pituitary dependence and adrenocortical autonomy, which may lead to confusing biochemical and radiological findings. Bilateral adrenalectomy, rather than hypophysectomy, is the treatment of choice in MNH.

Lafora's disease. Comparison of inclusion bodies in skin and in brain.

A patient had the clinical and neuropathologic signs of Lafora's disease. Skin biopsy specimens from the midcalf area confirmed earlier findings by showing numerous periodic acid-Schiff-positive inclusion bodies in eccrine sweat gland duct cells. In our patient, however, inclusion bodies were more abundantly present in the apocrine sweat gland duct cells of the axilla skin. In brain biopsy specimens and autopsy material the same periodic acid-Schiff-positive inclusion bodies were found. From these data it can be stated that skin biopsy of the axilla is the method of first choice in confirming the diagnosis.

Leigh's encephalomyelopathy in a patient with cytochrome c oxidase deficiency in muscle tissue.

A patient is described with subacute necrotizing encephalomyelopathy proven by autopsy. A slight increase of blood pyruvate and lactate levels with an increased lactate/pyruvate ratio and frequently increased beta-hydroxybutyrate/acetoacetate ratio suggested a disorder of mitochondrial oxidation. A cytochrome c oxidase deficiency was shown in peripheral muscle tissue with some residual cytochrome c oxidase activity in heart muscle. Normal cytochrome c oxidase activity was present in liver tissue. Because of the markedly higher levels of pyruvate and lactate in CSF compared with blood and an increased lactate/pyruvate ratio in CSF, there may also have been defective activity of cytochrome c oxidase in brain tissue. After a period of apparently normal development, the child's clinical condition gradually deteriorated and she died at age 6 years due to respiratory insufficiency. This study illustrates the fact that Leigh's disease is not linked to a single inherited molecular defect.

Scintigraphic evaluation of experimental colitis in rabbits.

UNLABELLED: Scintigraphic techniques are frequently used for evaluation of inflammatory bowel disease. The radiopharmaceutical of choice is labeled leukocytes. In this study, two new agents, 111In-labeled polyethylene glycol-coated liposomes and 111In-labeled human nonspecific gamma globulin (immunoglobulin G; IgG), were compared with 111In-leukocytes in a rabbit model of colitis. METHODS: In rabbits, acute colitis was induced by colonic instillation of trinitrobenzene sulfonic acid at 25 cm from the anal sphincter. After 24 hr, 15 MBq of the radiopharmaceuticals was injected intravenously in groups of four rabbits. Twenty-four hours after injection, the animals were killed and macroscopic abnormalities were scored in seven consecutive affected colonic segments of 5 cm each (0 = normal, 1 = inflammation, 2 = ulcers). The ex vivo uptake was measured in the normal ascending colon and the affected colonic segments. The colitis index (CI, affected-to-normal colon-uptake ratio) was calculated. RESULTS: Histologically, an acute, patchy, transmural colitis was observed at the site of instillation and the distal colon. The CI of all agents in colitis lesions correlated with the severity of the abnormalities. With increasing severity, the CI for liposomes was 1.86 +/- 0.24, 4.88 +/- 0.42 and 7.42 +/- 0.54 (r2 = 0.68, p < 0.001); for leukocytes 1.77 +/- 0.32, 3.10 +/- 0.58 and 5.54 +/- 0.83 (r2 = 0.31, p < 0.01); for IgG 1.60 +/- 0.29, 2.81 +/- 0.21 and 2.65 +/- 0.21 (r2 = 0.29, p < 0.02). CONCLUSION: Indium-111-labeled-leukocytes, -IgG and -liposomes all show increased uptake in inflamed colonic tissue. Indium-111-liposomes showed the highest CI, which correlates best with the morphological abnormalities. Indium-111-leukocytes and 111In-liposomes are superior to 111In-IgG for this indication.

Double-blind comparison of 5-aminosalicylic acid and acetyl-5-aminosalicylic acid suppositories in patients with idiopathic proctitis.

Suppositories containing 300 mg 5-aminosalicylic acid (1.96 mmol) or 425 mg acetyl-5-aminosalicylic acid (1.96 mmol) were used in 40 patients with idiopathic proctitis to determine the efficacy of acetyl-5-aminosalicylic acid in treating this bowel inflammation. Each patient was treated with 5-aminosalicylic acid or acetyl-5-aminosalicylic acid suppositories twice daily for 4 weeks in a double-blind trial. Four patients were included twice in the trial. The second time they were treated with the alternative regimen. Six patients in the acetyl-5-aminosalicylic acid group did not complete the trial, four of them because of diarrhoea. Complete clinical remission with normal rectal mucosa on sigmoidoscopy was achieved in 10 out of 18 patients on 5-aminosalicylic acid and in only two out of 15 in the acetyl-5-aminosalicylic acid group (P = 0.03). A favourable histological improvement was demonstrated with 5-aminosalicylic acid suppositories, but the difference with acetyl-5-aminosalicylic acid was not significant (P = 0.059). Three of the four patients who received both drugs recovered with 5-aminosalicylic acid; in none of them was acetyl-5-aminosalicylic acid effective. The results from this study and from previous investigations show that acetyl-5-aminosalicylic acid is not superior to placebo.

Hemihepatectomy and transfer of the portal inflow tract of the retained hemiliver in the dog.

The results of resection of cancers arising from the biliary tract or hilar portions of the liver might be improved by concomitant resection of all potentially involved regional lymphatics and vessels in the hepatoduodenal ligament. A method to replace the portal vein before its resection in combination with a hemihepatectomy was developed in 15 dogs. A second hepatic inflow tract for the portal blood was constructed by transposition of the splenic vein to an intrahepatic portal vein branch spared during hemihepatectomy. When this paraportal bypass had been shown to function well, the portal vein could be cut safely. Under the influence of the initially raised portal blood pressure, the bypass expanded in the next several weeks to a vessel almost as wide as the former portal vein, with concomitant normalization of the portal pressure and normal liver regeneration. Replacement of the portal vein as such by an adequate paraportal bypass enhances the resectable area of the liver hilus.

Leiomyosarcoma of spermatic cord.

A case of leiomyosarcoma of the spermatic cord is presented, bringing the total number of reported cases to 39. A review of diagnostic and therapeutic approaches along with our experiences stress the need for a uniform treatment schedule.

Pharmacokinetics and toxicology of sparsomycin in beagle dogs.

Sparsomycin is a cytotoxic drug exhibiting a broad spectrum of in vitro activity against murine tumors and many tumor cell lines. It also appears to be a potent stimulator of the antitumor activity of cisplatin against L1210 leukemia in vivo. However, because of its toxicity, the antitumor activity of sparsomycin on murine tumors in vivo has been disappointing. The purpose of our study was to investigate the pharmacokinetics of this drug as well as the possible mechanisms that produce sparsomycin toxicity. Tests on beagle dogs revealed that about 60% of the drug is eliminated by metabolic clearance, while 40% is eliminated by the kidneys. After a single bolus injection of 0.1 mg/kg sparsomycin without narcosis, sparsomycin was eliminated with a t beta 1/2 of 0.6-0.7 h, the AUC being 0.32-0.38 mg.h.l-1, and the volume of distribution (Vd) 0.26 l/kg. In addition to being subject to glomerular filtration, sparsomycin is probably also actively excreted and actively reabsorbed by the renal tubuli. Sparsomycin itself may inhibit its active tubular excretion, thus resulting in a decrease in the drug's renal clearance and its accumulation in the plasma. Sparsomycin appeared to be toxic primarily in the liver, disturbing its function and the synthesis of plasma proteins. Two out of five dogs developed hemorrhagic diathesis due to hypofibrinogenemia and deficiency of other blood-coagulation factors. Sparsomycin was not toxic to the bone marrow.

Features of a syndrome with congenital cataract and hypertrophic cardiomyopathy.

We studied 12 patients from six unrelated families with a syndrome that has an autosomal recessive pattern of inheritance and can be diagnosed from clinical, histologic, and biochemical characteristics. The four major symptoms are congenital cataract, hypertrophic cardiomyopathy, mitochondrial myopathy of voluntary muscles, and exercise-related lactic acidosis. The patients had bilateral and total cataract in the first weeks of life, underwent cataract surgery, and developed nystagmus and strabismus. Corrected visual acuity was lower than 20/40 in aphakic eyes. Patients were mentally normal, and at school age they visited a school for blind and visually impaired children. The majority of the patients developed axial myopia with myopic fundus changes; aphakic refraction usually was lower than 10.0 diopters after the first decade. The cardiac myopathy was progressive and the cause of premature death. Three of the 12 patients died in the neonatal period and six patients died in early adulthood.

Malignant eccrine poroma with lymph node metastasis followed by multiple basal cell carcinomas in a young female patient.

A case of metastasizing malignant eccrine poroma is described. This case is unique because a relatively young patient presented later on with multiple basal cell carcinomas. Our observation is compared with a review of the literature.

Glutathione S-transferases in gastric carcinomas and in adjacent normal gastric epithelium: immunohistochemical and biochemical analyses.

Glutathione S-transferases (GSTs) are enzymes involved in the detoxification of xenobiotics and are divided into four subclasses. Alpha, Mu, Pi and Theta. Most human gastrointestinal tumors contain increased amounts of GST Pi. In order to compare data on the expression of GSTs obtained by biochemical as well as immunohistochemical methods, we characterized the presence of GST Alpha and Pi by Western blot analysis and immunohistochemistry in 22 samples of human gastric carcinoma and adjacent non-neoplastic mucosa. Biochemical analyses revealed the presence of GST Alpha and Pi in 95% and 91% of normal tissues and in 82% and 100% of tumor specimens, respectively. Immunohistochemically all cases of normal gastric tissue stained for both GST Alpha and Pi, whereas immunostaining for GST Alpha and Pi was seen in 36% and 100% of the gastric tumor specimens, respectively. No statistically significant correlation however was observed between biochemical and immunohistochemical determination of GST Alpha and Pi both in normal as well as in malignant tissue. The absence of a statistically significant correlation between biochemical and immunohistochemical determination of GST Alpha and Pi implies that a high degree of caution must be taken in interpretating data derived solely from biochemical or immunohistochemical assays.

Immunohistochemical determination of glutathione S-transferases in gastric carcinomas and in adjacent normal gastric epithelium.

Glutathione S-transferases (GSTs) are a family of isoenzymes that play an important role in protecting cells against cytotoxic and carcinogenic agents. The distribution and levels of GST Alpha and Pi in normal and malignant gastric tissue of 34 patients with gastric cancer were examined immunohistochemically. Expression of GST Alpha and Pi was observed in 47 and 100 percent of the tumors, respectively. In normal mucosa both enzyme classes were present in 100 percent of the specimens. Mucous cells showed staining for GST Alpha and Pi in 88 and 97 percent, parietal cells in 93 and 67 percent, and chief cells in 82 and 30 percent, respectively. No correlation was observed between the amount or pattern of GST Alpha or Pi in carcinomas and the clinical and pathological characteristics of the patients. So it can be concluded that both GST Alpha and Pi cannot be considered as prognostic factors for gastric cancer.

Undefined malabsorption syndrome with villous atrophy successfully reversed by treatment with cyclosporine.

A 47-year-old man with a flat jejunal mucosa complicated by malabsorption, diarrhoea and lymphocytic colitis is presented. There was no response to gluten withdrawal alone, combination of a gluten-free diet and prednisone therapy, or total parenteral nutrition. Complete clinical remission was only achieved after simultaneous treatment with cyclosporine and a gluten-free diet. Rechallenge with a gluten-containing diet while cyclosporine treatment continued resulted in a relapse of diarrhoea and malabsorption. We conclude that cyclosporine may be an effective agent for the treatment of undefined, refractory forms of malabsorption.

The usefulness of an endomyocardial biopsy in heart disease of unknown etiology.

Light-, electron microscopic and enzyme histochemical examinations (phosphorylase, LDH, NADH:TR, SDH and 3-HBDH) were performed on endomyocardial biopsies of 26 patients with heart diseases of unknown etiology. On the basis of the clinical findings the patients were grouped into hypertrophic cardiomyopathy patients), dilated-congestive cardiomyopathy (8 patients), latent cardiomyopathy and small vessel disease (11 patients) and myocarditis (4 patients). Morphologic changes which might characterize the pathogenesis, were found in 7 patients: small vessel disease in 3 patients, nonspecific myocarditis in 1, iron storage disease in 1, adriamycin cardiomyopathy in 1 and cardiomyopathy with inclusions typical of Fabry's disease in 1 patient. In the other patients the morphologic changes were not sufficiently characteristic to be indicative of an etiopathogenesis. Several pathologic alterations did, nonetheless, appear to have a certain prognostic value such as endocardial and interstitial fibrosis, myofibrillolysis, myolysis, mitochondrial degeneration and increased lipid content in the muscle fibers. The frequency of these changes was evaluated partly semiquantitatively, partly by means of the point-counting method and graded with 1-3 points. Three patients with congestive cardiomyopathy scored at least 7 points. Two of them died within 8 weeks, 1 patient with adriamycin cardiomyopathy recovered after discontinuation of the therapy but he died 4 years after the biopsy. Six to 50 months after the biopsy (mean 31.5, median 6.5) the score was less than 7 in the other patients and all these patients were still alive. The histochemical changes manifested as an increase and/or a decrease of the enzymatic activities, involving scattered muscle fibers or their segments. A decrease of the activities of all dehydrogenases examined appeared to be prognostically ominous, correlating with a score of 7 or higher. A decrease of SDH activity in 7 cases, in combination with a decrease of the HBDH activity in 4 of them, was indicative of a disturbance in the Krebs cycle and lipid metabolism in the absence of ischemic damage. The alterations in the phosphorylase activity did not, however, appear to have a prognostic significance. Normal activity of the phosphorylase seemed to be prognostically favorable.

Carcinoid of the larynx: a report of three cases and a review of the literature.

Carcinoid tumors are among the exceptional neoplasms of the larynx. The laryngeal carcinoid was first described in 1969 by Goldman, et al. Only 16 cases could be traced from the literature. This paper describes three additional cases. In one patient, the tumor infiltrated the laryngeal tissues and metastasized to the cervical lymph nodes breast. In the second case, the polypoid lesion could be excised completely. The third case was initially diagnosed as undifferentiated squamous cell carcinoma. The diagnosis of carcinoid was made a few years later when a metastasis was removed. The presence of intracellular membrane bound neurosecretory granules and positive argyrophilia in the Grimelius stain are characteristic. In half of the cases described in the literature, the tumor was initially misdiagnosed as undifferentiated carcinoma. The treatment of choice is surgical removal which may be curative. The literature is reviewed.

Primary carcinoid tumors of the middle ear. Report on four cases and a review of the literature.

Carcinoid tumors are rare in the middle ear. To our knowledge, only 17 cases could be found in the literature, the first of which was described in 1980. In addition to enlarging on a previous observation we present three new cases. The neoplasms showed a striking, heterogeneous aspect ranging from solid trabecular to tubuloglandular growth patterns resembling the classic carcinoid tumor and adenomatous middle ear tumor, respectively. Based on immunohistochemistry and electron microscopy, three cell types were found. A review was made of our four patients and the cases described in the literature. The medical histories ranged from 1 month to 9 years. Presenting symptoms and signs were not characteristics, but hearing loss predominated. In two patients, the eardrums were perforated, in all the others it was intact and often bulging. Surgery, usually radical mastoidectomy, was performed in all cases. Often the tumor encased the ossicular chain, without infiltration. In two patients, local recurrence occurred that was treated successfully with surgery. All the cases showed an indolent biological course and the tumors were clinically nonfunctional, despite the recognition of biogenically active products by immunohistochemistry. To our knowledge, regional or distant metastases have never been reported. Conservative surgery with radical removal of the primary or recurrent tumor is the treatment of choice.

Chemical properties of glomerular basement membrane in congenital nephrotic syndrome.

Glomerular basement membranes have been isolated from kidneys of three children presenting with a congenital nephrotic syndrome. The histology of renal tissue was characterized by an increase of the mesangial area mainly due to matrix. Immunofluorescent studies showed no positive staining. After isolation, the glomerular basement membranes contained no more cellular contaminants than normal membranes. Isolated abnormal membranes exhibited, as normal preparations, less than 1% DNA, RNA, phospholipids or glycosaminoglycans. Since the protein content of both membrane preparations was comparable, significant contamination by non-proteic material did not seem likely. Although the amino acid and carbohydrate composition of both normal and abnormal membranes was very similar, the folowing statistically significant differences were observed: diseased membranes exhibited an increased number of hydroxylysine, 3- and 4-hydroxyproline residues, and an increased content of glucosyl-galactosyl-hydroxlysine units. The data suggest that, in the congenital nephrotic syndrome, the production of disaccharide-rich glomerular basement membrane subunits is enhanced, which could interfere with the packing of the peptide chains and therefore account for the altered permeability of the membrane observed in this disease.

A solitary metastasis in the heart from Ewing's sarcoma.

We present a patient with a solitary metastasis in the heart 8 years after treatment for Ewing's sarcoma. Exploratory thoracotomy was performed and biopsies were taken. Despite high dose ifosfamide, the patient died a few weeks after surgery.