Isolation of Aspergillus fumigatus from sputum is associated with elevated airborne levels in homes of patients with asthma.

Indoor bioaerosols, such as mold spores, have been associated with respiratory symptoms in patients with asthma; however, dose-response relationships and guidelines on acceptable levels are lacking. Furthermore, a causal link between mold exposure and respiratory infections or asthma remains to be established. The aim of this study was to determine indoor concentrations of Aspergillus fumigatus and a subset of clinically relevant fungi in homes of people with asthma, in relation to markers of airways colonization and sensitization. Air and dust samples were collected from the living room of 58 properties. Fungal concentrations were quantified using mold-specific quantitative PCR and compared with traditional microscopic analysis of air samples. Isolation of A. fumigatus from sputum was associated with higher airborne concentrations of the fungus in patient homes (P = 0.04), and a similar trend was shown with Aspergillus/Penicillium-type concentrations analyzed by microscopy (P = 0.058). No association was found between airborne levels of A. fumigatus and sensitization to this fungus, or dustborne levels of A. fumigatus and either isolation from sputum or sensitization. The results of this study suggest that the home environment should be considered as a potential source of fungal exposure, and elevated home levels may predispose people with asthma to airways colonization.

Tamoxifen induces short-term cumulative DNA damage and liver tumors in rats: promotion by phenobarbital.

Tamoxifen administered in the diet (420 ppm) to Wistar rats (TOX:P) for only 3 months caused cumulative hepatic DNA damage as assessed by 32P-postlabeling, consistent with the proposal that tamoxifen is a genotoxic carcinogen in this species. Promotion of tumor development with phenobarbital after discontinuation of dietary tamoxifen resulted in the formation of liver carcinomas after 9 months. At 12 and 20 months in this study, the majority of these rats had liver carcinomas. Rats treated with tamoxifen for 3 months but not promoted with phenobarbital also developed liver tumors over a longer period of time. These tumors were predominantly adenomas, with one carcinoma, and occurred at a lower incidence than the tumors produced by promotion with phenobarbital. Rats treated with phenobarbital alone did not develop tumors after 20 months. Tamoxifen-induced DNA adducts were relatively persistent, with only a 38% decrease 3 months after tamoxifen treatment had been discontinued. This demonstrates that, in a susceptible species (the rat), tamoxifen can cause initiation of liver cancer after only 3 months exposure. It is proposed that the persistence of such DNA adducts may account for the ability of phenobarbital to promote a high incidence of liver carcinoma, even after discontinuation of tamoxifen treatment. These data are relevant to the concern for women given prophylactic tamoxifen for long periods in that even if there is a relatively small amount of cumulative tamoxifen-induced liver DNA damage, liver tumors could be promoted by other agents, even after the cessation of tamoxifen treatment.

Comparison of the effect of oestradiol, tamoxifen and raloxifene on nerve growth factor-alpha expression in specific neonatal mouse uterine cell types using laser capture microdissection.

Oral dosing of CD-1 mice on days 2-5 after birth with tamoxifen but not raloxifene disrupts the development of the myometrium, resulting in adult uterine adenomyosis. Using laser capture microdissection and RT-PCR we have investigated nerve growth factor (NGF) and cognate receptor expression in uterine cells of 6-day-old pups that may be important in early developmental changes that give rise to adenomyosis. NGF down-regulation is known to occur during terminal myogenic differentiation. NGF was found exclusively in endometrial luminal epithelium of controls. It was up-regulated 18-fold in the luminal epithelium following dosing with tamoxifen but not raloxifene. Western blotting for NGF protein in the whole uterus showed a 25-fold increase after tamoxifen treatment. Expression of the low affinity p75 neutrophin receptor (p75(NTR)) was twofold higher in the myometrium compared with luminal epithelium or stroma. This was not altered following tamoxifen treatment. There was no detectable expression of high affinity tyrosine kinase receptor (trkA(NGFR)). This study shows luminal epithelial cells of the endometrium primarily form NGF. This suggests that NGF normally regulates the differentiation of the mesenchyme into uterine myocytes through paracrine mechanisms and that an early disturbance of this process plays a key role in the subsequent development of adenomyosis.

The role of cell death and cell proliferation in the promotion of rat liver tumours by tamoxifen.

Administration of tamoxifen to rats results in liver tumours with a latency time that is dependent on the strain of rat used. Wistar and Lewis rats develop liver tumours more rapidly than Fischer rats. Significant increases in the number of apoptotic hepatocytes were found in the Wistar and Lewis strains of rats after they were fed tamoxifen for up to 6 months, but not in Fischer rats. By 6 months of exposure to tamoxifen there were liver tumours in the Wistar and Lewis rats, but not the Fischers. Sustained elevations of the PCNA labelling index were found in the livers of tamoxifen-treated Wistar and Lewis rats, over the first 6 months of tamoxifen treatment, but not Fischers. It is proposed that sustained cell death by apoptosis may play a role in the mechanism of promotion of tamoxifen-induced liver tumours, by causing liver hyperplasia. To support this concept it has been shown that cyloheximide, which causes apoptosis but not necrosis in the rat liver, causes DNA synthesis and cell division in hepatocytes.

The quantitative distinction of hyperplasia from hypertrophy in hepatomegaly induced in the rat liver by phenobarbital.

A histological method utilizing the optical dissector principle has been developed for determining the absolute numbers of rat hepatocytes in the liver after treatment with phenobarbital (PB). The optical dissector is a technique derived from the "new stereology" used to measure the number of features, in this case hepatocyte nuclear profiles, that are present in a reference volume of tissue. The method has been applied to distinguish between the hepatomegaly that commonly occurs in rodents after treatment with chemicals, due to an increase in the number of cells caused by cell division (hyperplasia), rather than the size of cells (hypertrophy). In the case of PB treatment, the hepatomegaly was found to be partly due to hypertrophy and partly to hyperplasia after 2 weeks of treatment. While the increase in the absolute number of hepatocytes was not significant after 2 weeks, after 12 weeks of treatment with PB the number of hepatocytes was significantly increased, compared to the controls at that time point. PCNA labeling index measurements of liver hepatocytes confirmed that there was a significant increase in the growth fraction of hepatocytes during PB treatment. The induction of hyperplasia can be associated with an increased risk of eventual liver tumor formation, and the distinction of hyperplasia from hypertrophy, using a purely histological method, for the determination of increases in absolute hepatocyte cell numbers, will be useful in assessing whether treatment-related sustained hyperplasia is occurring in the liver, although this methodology could be applied to any organ.

Compartmentalized uterotrophic effects of tamoxifen, toremifene, and estradiol in the ovariectomized Wistar (Han) rat.

The comparative uterotrophic responses of ovariectomized Wistar (Han) rats to tamoxifen, toremifene, and 17beta-estradiol have been determined over a period of 72 h. Uterine wet weight; luminal epithelial cell hypertrophy; and BrdU labeling index in the different tissue compartments of the uterus, and the immunohistochemical expression of nuclear estrogen receptor alpha (nERalpha), and nuclear progesterone receptor (nPR) were examined. Luminal epithelial cell hypertrophy was produced by all three compounds to a similar degree. 17beta-Estradiol produced an increase in uterine wet weight due to fluid imbibition over the 3-day period, and an increase in DNA synthesis in the endometrial stromal and myometrial compartments of the uterus, as measured by increased BrdU incorporation. Estradiol increased the expression of nERalpha and nPR in the myometrium with time and decreased nERalpha levels from the overexpressed levels in control ovariectomized rat luminal epithelial cells. Tamoxifen and toremifene caused a smaller increase in uterine weight and the BrdU labeling index in the endometrial stroma and myometrium than did estradiol, and they increased the expression of nERalpha and nPR in the myometrium. Tamoxifen and toremifene differed from estradiol in that they did not decrease the expression of nERalpha in the luminal epithelial cells of the uterus. The response of PR expression was the same for tamoxifen, toremifene, and estradiol, and was therefore considered to be the most reliable indication of an estrogen-agonist effect in this study. The ability to distinguish differential, compartmentalized effects for agonists of estrogen action in the uterus will allow a better risk assessment for new pharmaceuticals that are used as breast cancer chemotherapeutic agents, especially where their use may also be associated with an increased risk of uterine cancers, in particular.

Immunohistochemical detection of bromodeoxyuridine-labeled nuclei for in vivo cell kinetic studies.

The classical technique for identifying cells engaged in DNA synthesis is by their uptake of [(3)H]-thymidine, detected using autoradiography. However, this method can be inconvenient, as specialized darkroom and radioisotope facilities are required, with the potential health hazard that handling isotopes entails. Bromodeoxyuridine (BrdU), the halogenated 5-substituted derivative of deoxyuridine, is a thymidine analog specifically incorporated into the DNA of proliferating cells during S phase. This is now a well-established alternative to (3)H thymidine, since it has been shown that labeling indices for the two molecules are the same (1,2). The development of a monoclonal antibody (3) that recognizes BrdU incorporated into single-stranded DNA has resulted in several techniques using immunocytochemical staining to detect incorporated BrdU in frozen, paraffin- and plastic-embedded sections of tissue by light microscopy. It has also proved extremely valuable for studies in conjunction with flow cytometry and even, for in vivo studies of human tumor cell kinetics (see this vol., Chapter 43 ). We describe here a method to detect DNA synthesis by in vivo labeling of nuclei with BrdU, followed by indirect immunological detection in paraffin-embedded tissue (4).

Immunohistochemical detection of bromodeoxyuridine-labeled nuclei for in vivo cell kinetic studies.

The classical technique for identifying cells engaged in DNA synthesis is by their uptake of [(3)H]-thymidine, detected using autoradiography. However, this method can be inconvenient, as specialized darkroom and radioisotope facilities are required, with the potential health hazard that handling isotopes entails. Bromodeoxyuridine (BrdU), the halogenated 5-substituted derivative of deoxyuridine, is a thymidine analog specifically incorporated into the DNA of proliferating cells during S phase. This is now a well-established alternative to (3)H thymidine, since it has been shown that labeling indices for the two molecules are the same (1,2). The development of a monoclonal antibody (3) that recognizes BrdU incorporated into single-stranded DNA has resulted in several techniques using immunocytochemical staining to detect incorporated BrdU in frozen, paraffin- and plastic-embedded sections of tissue by light microscopy. It has also proved extremely valuable for studies in conjunction with flow cytometry and even, for in vivo studies of human tumor cell kinetics (see this vol., Chapter 43 ). We describe here a method to detect DNA synthesis by in vivo labeling of nuclei with BrdU, followed by indirect immunological detection in paraffin-embedded tissue (4).

New approaches to the quantitation of hypertrophy and hyperplasia in hepatomegaly.

A histological method utilizing the optical dissector principle has been developed for determining the contribution of hypertrophy and hyperplasia to the hepatomegaly induced by the peroxisome proliferator gemfibrozil. The optical dissector is a technique derived from the 'new stereology' and has been used to estimate the number of hepatocyte nuclear profiles, that are present in a reference volume of tissue. The overall changes due to hypertrophy and hyperplasia in the rat liver after gemfibrozil treatment, did not reach significance, although the zonal hypertrophy change did. This indicated that although there was a 20% increase in liver weight with treatment, the hepatomegaly was caused by a combination of hypertrophy and hyperplasia, neither of which, on its own, was significantly different from the control values. The distinction of hyperplasia from hypertrophy, using a purely histological method, will be useful in assessing whether treatment related sustained hyperplasia is occurring in the liver.

Hepatic fibrosis and iron accumulation due to endotoxin-induced haemorrhage in the gerbil.

This study reports the findings of hepatic fibrosis and the accumulation of iron in the livers of 12 gerbils. The primary lesion was a haemorrhagic necrosis of the liver that was identical to that produced experimentally in the gerbil by administration of E. coli endotoxin lipopolysaccharide. The resulting extravasation of blood caused focal histiocytic reactions. The number of lesions increased with age, eventually resulting in a micronodular cirrhosis after 9 to 12 months owing to repeated episodes of endotoxin-induced haemorrhages in the liver. The accumulation of iron occurred in perisinusoidal cells, Kupffer cells and hepatocytes. The perisinusoidal cells were responsible for the subsequent hepatic fibrosis. The fibrosis associated with this condition appears to result from iron accumulation in the liver, following haemorrhage caused by endotoxin lipopolysaccharide. The gerbil is the first recorded rodent species to develop hepatic fibrosis in response to hepatic iron overload.

Increased susceptibility of aged rats to haemorrhage and intravascular hypercoagulation following endotoxin administered in a generalized Shwartzman regime.

Ageing rats are known to have an increased incidence of myocardial fibrosis and dyspnoea caused by pulmonary intravascular coagulation. In order to determine whether endotoxin can be responsible for such responses in ageing rats we have exposed rats of differing ages (2 months, 16 months and 24 months) to single or repeated (two doses 24 h apart; generalized Shwartzman regime) intravenous doses of endotoxin (E. coli 0111 B4). Only the 2-year-old rats reacted adversely. Two doses of endotoxin produced death, with focal myocardial necrosis, haemorrhage and pulmonary and hepatic intravascular coagulation. The increased susceptibility of aged rats to the toxic effects of endotoxin explains some of the changes found in the tissues of old rats. The sporadic nature of both cardiac failure and dyspnoea as a cause of morbidity and mortality in ageing rats may be related to the need for two endotoxin episodes in a period of 24 h to provoke a generalized Shwartzman reaction, an occurrence likely to be relatively uncommon under natural conditions.

The immunotoxicity of tributyltin oxide (TBTO) does not increase the susceptibility of rats to experimental respiratory infection.

1. The dietary exposure of rats to tributyltin oxide at a concentration of 150 ppm for 6 weeks is known to lead to a significant reduction in relative thymic weight. 2. To determine whether this reduction in thymic weight also leads to an impairment of function sufficient to alter the host response to micro-organisms, we have examined the development of virus- and mycoplasma-induced pneumonia in TBTO-exposed rats. 3. Using a quantitative histopathological method for measuring both the extent and duration of lung lesions in TBTO-exposed rats, no statistically significant increase in the extent or persistence of virus-induced lung lesions was found in rats exposed chronically to TBTO. 4. The susceptibility of rats to Mycoplasma pulmonis infection, alone, or in conjunction with viral pneumonia, was also not increased by dietary exposure to TBTO.

Immunotoxic effects of hexachlorobenzene on the pathogenesis of systemic, pneumonic and hepatic virus infections in the mouse.

A quantitative histopathological method has been developed for the evaluation of the effects of hexachlorobenzene (HCB) on the pathogenesis of three virus infections in the mouse. Hexachlorobenzene was selected because a substantial amount of immunotoxicological data already exists with which we could compare our results. To establish the validity of the method a systemic virus infection (mouse cytomegalovirus, MCMV), a pneumonia causing virus (pneumonia virus of mice, PVM) and a hepatitis virus (mouse hepatitis virus, MHV) were used. We have compared the existing data with the actual pathological effects of hexachlorobenzene on virus disease processes, to gain a more realistic idea of the value of the risk assessment to be derived from extrapolating the in-vitro data in particular, to the in-vivo situation. The results show that the data derived from previous studies on the immunotoxicity of HCB were accurate in predicting the exacerbation of the viral hepatitis, especially in immunodeficient athymic 'nude' mice. It is proposed that this histopathological technique could be a useful technique in the evaluation of host resistance changes following exposure to potentially immunotoxic compounds, but caution will have to be exercised in interpretation in relation to human disease.

A comparison of the acute pathology induced by 3-phenylamino-1,2-propanediol (PAP) and its mono-oleoyl ester in rodents with the toxic oil syndrome in man.

Phenylamino-1,2 propanediol (PAP) and its mono-oleoyl ester have been identified in samples of the cooking oil thought to be responsible for the Toxic Oil Syndrome (TOS) which occurred in Spain in 1981. The acute toxicity of PAP and its mono-oleoyl ester have been examined in rats and mice, after daily administration for periods of up to 14 days to determine whether these compounds could produce any of the pathologies of TOS. Even at the highest dose, the 1-mono-oleoyl ester of 3-phenylamino-1,2 propanediol did not cause any toxicity in rats or mice when given intraperitoneally. 3-Phenylamino-1,2 propanediol, however, was toxic when administered to rats by this route. After 6-10 consecutive daily doses of PAP, at the highest dose administered (350 mg kg-1), all of the rats became unwell. Postmortem examination showed that the major pathology present was massive pulmonary thromboembolism. Further investigations of the toxicity of PAP after intravenous administration showed that it was not directly vasotoxic. The pulmonary thromboembolism seen with intraperitoneally administered PAP was due to the toxic effect of PAP on the mesenteric tissue and blood vessels, causing thrombosis which subsequently embolised the blood vessels in the lung. Intra-gastric administration of PAP caused no toxicity in rats. Comparatively, the pathology seen after intraperitoneal administration of PAP was not thought to be representative of the pathology of the toxic oil syndrome in man.

Intrapleural administration of fibres induces mesothelioma in rats in the same relative order of hazard as occurs in man after exposure.

1. The dose-response data for the induction of mesothelioma, in rats, by the intrapleural administration of the fibrous zeolite, erionite, has been compared to the published data for the crocidolite and chrysotile forms of asbestos. Erionite is more than two orders of magnitude more carcinogenic than either of the two forms of asbestos examined. 2. The relative sensitivity of the intrapleural and intraperitoneal routes of injection were also examined. The sensitivity of the intraperitoneal over the intrapleural route of administration was considerably greater for all the forms of asbestos examined but not for erionite. 3. The relationship for different fibres, between the number of fibres required to give animals mesothelioma, at the 50% or 10% observable tumour effect level (OTEL) was examined, and a ranking of relative carcinogenicity was made. 4. This showed that the data derived from the dose responses obtained by the intrapleural administration of fibres to rats ranked the relative carcinogenicity of erionite, crocidolite and chrysotile in accord with the known clinical mesothelioma induction in man after exposure to these fibres. Examination of the carcinogenicity ranking from data derived from intraperitoneal injections of fibres was not in accord with the known clinical mesothelioma induction in man for the various asbestos types examined.

Intrapleural administration of vitreous high duty ceramic fibres and heated devitrified ceramic fibres does not give rise to pleural mesothelioma in rats.

In order to determine whether they are potentially carcinogenic to the pleural mesothelium, three samples of ceramic fibre have been administered to rats by the intrapleural route. These samples were a high-duty grade refractory ceramic fibre (manufactured by Thermal Ceramics Ltd) in the as-manufactured vitreous state and two devitrified samples produced by heating the same fibre for 2 weeks at 1200 degrees C and for two weeks at 1400 degrees C. The mean lifespans of the groups of rats treated with vitrified and devitrified ceramic fibres were not significantly different from that of the control rats. In these studies none of the treated or control rats developed pleural mesothelioma, making it unlikely that ceramic fibres of this type, whether vitreous or devitrified, are potentially carcinogenic to the pleural mesothelium.

Use of the Nd-YAG laser improves quality of life and economic factors in the treatment of hemorrhoids.

PURPOSE: Hemorrhoidal disease may benefit from the use of Nd-YAG laser to decrease surgical recovery time, postoperative hospital stay and complications. METHODS: Fifty patient charts from 1993 to 1998 were reviewed retrospectively to evaluate postoperative complications and overall patient satisfaction following hemorrhoidectomy. We used the Nd-YAG laser from Surgical Laser Technologies CL60 with the ERP4 sapphire tip and the setting of 20 watts on continuous wave mode. Coagulation posthemorrhoidal excision of the remaining tissue was done using 60 watts pulse wave setting of 0.3 seconds. RESULTS: Laser treated hemorrhoidectomy patients experienced less pain than the standard hemorrhoidectomy patients. One week after surgery, the laser treated patients had 65% less pain than the standard hemorrhoidectomy patients. Painless defecation occurred earlier in the laser treated patients by five days and postoperative drainage was less than standard surgically treated patient. Surgical and hospital costs were lower by 27% and 11% respectively in the laser treated group. 88% of the laser treated patients vs 44% of the standard patients resumed work at one week after surgery. CONCLUSIONS: Nd-YAG laser treated hemorrhoid surgery patients had a quicker recovery and earlier return to work.