[Infiltration of the skull by dedifferentiated cutaneous leiomyosarcoma]. / Infiltration der Schädelkalotte durch ein dedifferenziertes kutanes Leiomyosarkom.

We present a brief report of an 81-year-old man with a pretreated leiomyosarcoma of the skull. Histologically the diagnosis of a dedifferentiated cutaneous leiomyosarcoma with an infiltration of the skull was confirmed. In an interdisciplinary approach together with the University Clinic for Neurosurgery, complete removal of the tumour was performed. Cutaneous leiomyosarcoma are rare tumors of the skin and typically present as slowly growing erythematosus nodes. Because of the risk of metastatic spread, complete micrographically confirmed resection is necessary.

Transurethral ultrasonography-guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence.

In the last years preclinical studies have paved the way for the use of adult muscle derived stem cells for reconstruction of the lower urinary tract. Between September 2002 and October 2004, 42 women and 21 men suffering from urinary stress incontinence (age 36-84 years) were recruited and subsequently treated with transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were injected into the urethral submucosa, while the myoblasts were implanted into the rhabdosphincter. In parallel, 7 men and 21 women (age 39-83 years) also diagnosed with urinary stress incontinence were treated with standard transurethral endoscopic injections of collagen. Patients were randomly assigned to both groups. After a follow-up of 12 months incontinence was cured in 39 women and 11 men after injection of autologous myoblasts and fibroblasts. Mean quality of life score (51.38 preoperatively, 104.06 postoperatively), thickness of urethra and rhabdosphincter (2.103 mm preoperatively, 3.303 mm postoperatively) as well as contractility of the rhabdosphincter (0.56 mm preoperatively, 1.462 mm postoperatively) were improved postoperatively. Only in two patients treated with injections of collagen incontinence was cured. The present clinical results demonstrate that, in contrast to injections of collagen, urinary incontinence can be treated effectively with ultrasonography-guided injections of autologous myo- and fibroblasts.

Molecular characterization of the human protein kinase C theta gene locus (PRKCQ).

Members of the protein kinase C (PKC) family of serine/threonine kinases, in particular PKCtheta, play critical roles in the regulation of differentiation and proliferation of T lymphocytes. In this study the genomic structure of the human PRKCQ gene that encodes PKCtheta was determined. Two genomic P1 clones were isolated from human P1 libraries using the PKCtheta cDNA as a probe and have been used to confirm the assignment of the single PRKCQ locus to chromosome 10p15 by FISH analysis. The PRKCQ locus, the first mammalian PKC gene locus characterized so far, spans approximately 62 kb and is composed of 15 coding exons and 14 introns, varying in size between 98 and 16000 bp. All exon-intron boundaries have been determined by long-range PCR and subsequent DNA sequence analysis. Comparison with other known genomic PKC genes reveals a high degree of homology to the genomic organization of the Drosophila melanogaster dPRKC gene. Alignment of the intron positions in the PRKCQ gene with the intron locations in the dPRKC gene indicates that the sites of seven of the 14 PRKCQ introns are exactly conserved. Exons 5 (32 bp), 11 (174 bp) and 12 (92 bp) share highest similarity in size, organization and primary structure with their counterparts in the Drosophila gene. On the basis of this knowledge of the genomic PRKCQ locus, a directed search for potential genetic polymorphisms and/or genetic abnormalities involved in human genetic disease(s) can now be initiated.

Immunohistochemical evaluation of cathepsin D expression in colorectal cancer.

Determination of cathepsin D has been proven to be prognostically relevant in breast cancer. Cathepsin D, a lysosomal proteinase, is suggested to be causally involved in tumor invasion. In this study we investigated cathepsin D expression immunohistochemically in 106 colorectal adenocarcinomas with the intention to evaluate its prognostic significance in this type of cancer. The majority of colorectal adenocarcinomas (93/106) stained positive for cathepsin D, while normal colon was almost completely negative. A trend toward stronger staining intensity was found in Dukes' stage C and D tumors (p < 0.1), but cathepsin D expression was found to have no influence on survival in this tumor type nor did it correlate with other known prognostic factors, e.g., histological differentiation, lymph vessel invasion, or rate of proliferation. Staining of lymph node metastases did not differ significantly from that of their primary tumors. Stronger staining intensity of tumor tissue in the neighborhood of inflammatory cells may be due to paracrine activation.

[Epidemiology of heart wall rupture in myocardial infarct]. / Epidemiologie der Herzwandruptur bei akutem Myokardinfarkt.

In a retrospective study including 1888 consecutive patients (pts) with acute myocardial infarction (AMI) admitted in the years 1989-1993 to the CCU, the relationship between sex, age, history of angina, location of infarction and heart wall rupture has been studied in a multivariate regression model. Female sex (p = 0.0013), older age (p = 0.0001), first angina during the AMI (p = 0.001) were indicative for significantly higher risk of rupture. Women are at higher risk only with anterior wall AMI (p = 0.0393). This risk increases continually with age, more in pts with inferior wall AMI than anterior wall AMI (p = 0.339). Females over the age of 75 with anterior wall AMI and first AP, and males and females over 83 with inferior wall AMI and first AP are at the highest risk of rupture (48.6% of deaths). We conclude that the defined high risk pts should be carefully monitored concerning the signs of impending heart wall rupture.

Investigation of the pathogenesis of massive hemolysis in a case of Clostridium perfringens septicemia.

Massive hemolysis is a rare, usually fatal complication of Clostridium perfringens septicemia. Of all toxins produced by the bacterium, phospholipase C (PLC) is believed to be the most likely cause of hemolysis. An influence of neuraminidase has often been suspected. In the present study, a case of C. perfringens septicemia with acute massive intravascular hemolysis is described. It led to death within 4 h of admission to the hospital. While the course of events was comparable to previously reported cases, we succeeded in gaining deeper insight into the pathogenesis by monitoring serum anti-T titer and quantifying serum PLC activity during the course of the disease. We excluded an effect of neuraminidase by a negative direct antiglobulin test, a negative anti-T lectin test, and a steady serum anti-T titer of 1 in 32. Serum PLC activity, on the other hand, showed a nearly fivefold increase (6.0 to 27.3 U/l), which is consistent with the hypothesized dominant role of this enzyme.

The prognostic significance of proliferating cell nuclear antigen, epidermal growth factor receptor, and mdr gene expression in colorectal cancer.

BACKGROUND: Proliferating cell nuclear antigen (PCNA), a proliferation marker, epidermal growth factor receptor (EGFR), a glycoprotein that plays a role in tumorigenesis by binding the mitogenic epidermal growth factor, and P-glycoprotein, the mdr gene product, are considered to be of prognostic relevance in different tumor types. Parameters that allow prediction of the course of disease in colorectal cancer would aid the development of improved treatment strategies. METHODS: Immunohistochemical staining was performed on paraffin-embedded sections of 82 colorectal adenocarcinomas and 18 lymph node metastases. EGFR and P glycoprotein expression was evaluated semiquantitatively; PCNA expression was analyzed quantitatively. RESULTS: An inverse relationship between the percentage of PCNA-positive cells and survival times could be demonstrated, survival differed significantly among the quartiles (P < 0.02). The median and range of the percentage of PCNA-positive cells in primary tumors and lymph node metastases were similar. The extent of EGFR expression also revealed significant differences concerning survival times; patients with more than 50% stained tumor cells had a poorer prognosis than those with less than 50% stained cells. P-glycoprotein expression was found to have no influence on survival. CONCLUSIONS: Knowledge of the percentage of PCNA-positive cells could be especially helpful in deciding whether to treat patients with localized disease further because adjuvant chemotherapy affects mainly dividing cells and should, therefore, be more successful in tumors with high proliferative activity.

[The high autopsy rate in Vienna]. / Zur hohen Autopsierate in Wien.

In 1983 34% of all persons who died in the Republic of Austria were autopsied. We examined the frequency of postmortem examinations in the capital city, Vienna, between 1983 and 1987 in view of this high overall autopsy rate. The annual autopsy rate in all 9 pathology institutes and the department of legal medicine of the University of Vienna was on average 51 to 53%. There was a slight statistically verifiable decline in 1987. The reason for this high necropsy rate is that Austrian law permits the autopsies without the consent of next of kin if it appears indicated for medical, scientific or educational reasons; further more the fact, that the chairman of the department is at the same time the coroner for the hospital. A high autopsy rate is necessary to maintain a high standard of diagnostic accuracy even in modern medicine. The diagnoses were inaccurate or incomplete in 15% of all cases. The high autopsy rate is the basis for extremely accurate mortality and morbidity statistics and provides the basis for long range public health planning. Medical students develop an insight in disease patterns, which cannot be gained in any other way. The pathology departments of Vienna introduce a new city-wide computer-supported diagnostic file system, which will provide a baseline for comparative scientific studies.

[Pigmented neurofibroma]. / Pigmentiertes Neurofibrom.

In a 24-year-old male melanin synthesis was demonstrated in a neurofibroma by light and electron microscopy. Although it is unclear whether the tumor cells are pigment-synthesizing Schwann cells or whether they originate from a coexisting melanocytic tumor, this tumor again demonstrates the close relationship between peripheral nerve sheath tumors and melanocytic malformations, as for example cellular blue nevi.

[Intravaginal treatment of colpitis maculosa with an oestriol-containing vaginal cream (author's transl)]. / Intravaginale Behandlung der Colpitis maculosa mit einer östriolhaltigen Vaginalcreme.

43 patients with colpitis maculosa (average age 60.2 years) were selected for an open control therapeutic study with Ortho-Gynest vaginal cream (Ortho-Cilag). The cream contains 0.5 mg of oestriol per single applicator filling. The treatment lasted from 3 to 4 weeks, success being evaluated by clinical documentation and cytological evaluation of vaginal smears before and after treatment. 10 patients (23.3%) were treated successfully, 29 (67.4%) showed a distinct improvement both clinically and cytologically, whilst the remaining 4 (9.3%) showed only moderate improvement. Hence, 39 patients (90.7%) were classified as having been successfully or partly successfully treated. Severe symptoms disappeared completely or were greatly alleviated in 91.4% cases. Moderate symptoms vanished in 59.7%. 58.1% showed a complete normalisation of the former atrophic vaginal skin. Blood spotting and reddening of the vaginal wall vanished completely. A change from dry to moist vagina occurred in 77.3% patients. Discharge vanished completely in 80.6% cases. No untoward side effects were recorded.

[Histological findings following preoperative catheter embolization in hypernephroid renal carcinoma (author's transl)]. / Histologische Ergebnisse nach präoperativer Katherembolisation beim hypernephroiden Nierenkarzinom.

The authors investigated the histological findings in various embolization materials and at various interval before operation in 11 hypernephroid renal carcinoma patients who had been subjected to a preoperative transfemoral catheter embolization of the renal artery. The embolization materials used were fibrin-thrombin, pieces of gelatine sponge, collagen and GAW-spirals. The periods at which nephrectomy was carried out ranged from immediately after the embolization to six weeks later. From the histological point of view, total necrosis of the tumour did not occur in any case; only in three cases could a subtotal necrosis be achieved and in all the other cases the tumour-free parenchyma showed greater damage as a result of more pronounced ischemic infarction than did the tumour. A complete and lasting elimination of a tumourous kidney cannot be achieved by embolization of the renal artery. The obvious reasons for this are the tendency towards recurrence of canalization and the formation of collateral circulation.

[Clinical and immunological studies with OK-432 (Streptococcus pyogenes) on immunotherapy in cancer patients]. / Klinische und immunologische Untersuchungen mit OK-432 (Streptococcus pyogenes) zur Immuntherapie bei Krebspatienten.

In a phase I study, the bacterial vaccine OK-432 (streptococcus pyogenes) was investigated in eight patients with advanced malignant tumors. Besides a fever reaction after i.v. application no toxic side effects were observed. Additionally, its therapeutic effectiveness could be demonstrated by i.v. and local therapy. There was also observed an increase of lymphocyte blastogenesis response in patients under treatment with OK-432.

[The so-called transitional-cell carcinoma of the prostate and its oncogenesis]. / Zur Frage des sogenannten Ubergangszellkarzinoms der Prostata und seiner Onkogenese.

Report on two cases of so-called transitional cell carcinoma of the prostate. Clinically important differences to adenocarcinoma (above all ineffectivity of estrogen therapy and orchiectomy), histological differential diagnosis and therapeutic possibilities are reported on. Micromorphological similarities to the carcinoma of the cervix uteri allow for conclusions regarding histogenesis and oncogenesis, thereby possibly explaining marked differences of local growth and individual prognosis.

[Morphology versus prognosis in renal cell carcinoma a statistical approach]. / Statistische Untersuchungen zur Frage der Beziehungen zwischen Morphologie und Prognose bei Nierenparenchymcarcinomen

In a group of 102 selected cases of renal cell carcinoma which at various periods after nephrectomy terminated fatally, age, sex, and 23 gross and/or histologic tumor characteristics were examined, subclassified, and evaluated. An attempt was made to correlate these parameters statistically to postoperative survival time. A newly developed and programmed statistical method, i.c. "dichotomic variance analysis", proved to be superior to both multiple regression and cluster analysis. Using infiltrative-destructive tumor growth, polymorphy, and chromatin density of tumor cell nuclei, extension of renal vein invasion, age and sex, as the only 6 required out of 25 distinguished tumor parameters, this statistical multivariate method comprised 7 distinctive groups of different mean geometrical postoperative survival time, obviously corresponding to 7 tumor types of increasing degree of malignancy. By step-wise dichotomic splitting of tumor groups it therefore was possible to delinate schematically some of the complex connections between the criteria or variables of prognostic significance. Conceivable sources of errors possibly influencing reproducibility and practical applicability of the presented dichotomic variance analysis in evaluating prognostic criteria in renal cell carcinoma are discussed.

[Sulfametrol-trimethoprim in the treatment of chronic urinary tract infections]. / Sulfametrol-Trimethoprim in der Behandlung der chronischen Harnwegsinfektion

Thirtyeight patients with a chronic urinary infection (definitions see methods) were treated for 3 months with Trimethoprim-Sulfametrol. During therapy in 19 (70%) out of 27 patients without obstruction in the urinary tract infection could be eliminated. In 3 (27%) out of 11 patients with obstruction in the urinary tract infection was also eliminated. In 2 (18%) of these 11 patients the causative organisms changed to resistant strains. In 2 patients (10%) resp. in one patient without obstruction and one with obstruction in the urinary tract the infection recurred within the follow up of 3 months.