Efficacy of restaining prostate needle biopsies with high-molecular weight cytokeratin.

Prostate tissue and lesions obtained by needle biopsy may be scant and not survive cutting into the block; this study examined the efficacy of destaining hematoxylin and eosin-stained sections and restaining the slides using immunohistochemistry with high-molecular weight cytokeratin (high-molecular weight cytokeratin). We identified 105 prostate needle biopsies referred to Johns Hopkins Hospital in an 18-month period (January 1997-June 1998) that had been destained and restained for high molecular weight cytokeratin. The slides were reviewed for the Johns Hopkins Hospital diagnosis (benign, malignant, or equivocal), which had factored in the immunohistochemistry results, and for immunohistochemistry staining quality (optimal, suboptimal, stain failed, or lesion fell off). We obtained data on 96 cases from the referring institutions about the fixative and glass slides used for processing the needle biopsy. In 58% of cases, destaining and restaining with high-molecular weight cytokeratin allowed a definitive benign or malignant diagnosis to be made; in 79% of these cases, the staining was optimal. In only 13% of cases the diagnosis remained equivocal; of these, the stain worked optimally in only 36%. In 19% of cases, the stain failed. In 9% of cases, the lesion fell off; in all 7 cases with available data the tissue had been cut on non-charged slides. All but 3 cases were received in 10% neutral buffered formalin. There was no correlation between the use of charged (plus or lysine coated) or non-charged slides and the staining quality. Furthermore, in 12 instances, we received more than 1 specimen from the same referring institution, and in 6 of these instances there was variable staining in the different cases from the same institution. Destaining hematoxylin and eosin-stained slides and restaining for high-molecular weight cytokeratin is a useful technique that in the majority of cases enables a definitive diagnosis to be made. Tissue may survive the procedure better if originally cut on charged slides, but staining quality is no different for charged or non-charged slides.

Malignant struma ovarii: two case reports and a review of the literature.

Struma ovarii consists of thyroid tissue derived from germ cells in a mature teratoma. Malignant transformation is very rare, with clinically evident metastatic disease reported in approximately 20 cases. The rarity of this disease renders evaluation of treatment modalities difficult. There is evidence that these tumors behave like their thyroid counterparts, and cytoreductive surgery followed by ablation with radioactive iodine has been advocated. We report the diagnosis and treatment of 2 patients with metastatic malignant struma ovarii treated with a combination of surgery and radiation therapy.

Cyclic AMP-mediated growth arrest is associated with increased expression of human T cell leukemia virus type I structural and transforming genes.

The effect of increased intracellular cyclic AMP levels on gene expression of the human T cell leukemia virus type I (HTLV-I) provirus was examined. Induction of infected cells to produce elevated levels of cyclic AMP was associated with specific increases in viral surface antigen expression, protein synthesis, p24 release into the supernatant, and RNA levels. The patterns of HTLV-I proviral gene expression observed support results from transfection experiments regarding the function of Tax, Rex, and cyclic AMP in HTLV-I gene regulation. As evidenced by thymidine incorporation, treatment of the infected cells to produce cyclic AMP caused reversible growth arrest. The data indicate that HTLV-I RNA and protein synthesis can proceed at an elevated level in the absence of cell growth. Sustained increases in the intracellular level of cyclic AMP may represent a method for enriching cell cultures in HTLV-I proteins.

Comparative efficacy of topical hemostatic agents in a rat kidney model.

The efficacies of four topical hemostatic agents were compared in a rat model employing a standardized renal injury. The materials used to effect hemostasis were oxidized cellulose, microfibrillar collagen powder, positively charged modified collagen, and single donor heterologous fibrin glue. Animals that were treated only with surgical gauze served as controls. Hemostasis was achieved by application of one of the topical hemostatic agents plus moderate digital pressure. The time necessary to achieve complete hemostasis was recorded for each animal. Control animals bled profusely and suffered an increased postoperative mortality rate compared with the experimental animals. Microscopic studies demonstrated progressive healing of the injuries with varying degrees of inflammation and scar formation. Fibrin glue was by far the most effective agent in controlling hemostasis. The collagen materials, though effective, required a longer time to control bleeding and did not differ statistically in their activity from one another.