Rich and poor: a paradigm of mutual co-existence?

The division of rich and poor in society is unavoidable. In the modern times, the power structure due to wealth is stronger in health care and in environmental projects. The bioethical problems in those areas due to this are discussed. The problem mostly stems from the sense of alienation in both segments of the society, the executor and the user. Some of the ways to minimize this alienation are discussed. Finally arguments have been put forward that the feeling of alienation towards the environment is the root cause for the present environmental degradation.

Production of 15-HETE by cultured smooth muscle cells from cerebral artery.

Hydroperoxyeicosatetraenoic acids (HPETEs) are potent vasoconstrictors which have been implicated in the pathogenesis of the delayed cerebrovascular spasm which follows subarachnoid haemorrhage. We have previously shown that one of their stable breakdown products, 15-hydroxyeicosatetraenoic acid (15-HETE), is the major lipoxygenase product released from isolated cerebral arteries. To investigate the vascular cell type responsible for their production we have established the culture of smooth muscle cells from cerebral arteries and have measured their release of HETEs upon stimulation with arachidonic acid. The cultured cells isolated from bovine cerebral arteries expressed smooth muscle phenotype as they stained positively for smooth muscle alpha-actin and not factor VIII-related antigen. Furthermore, these cells possessed the calcium and potassium conductances characteristic of smooth muscle cells. Upon incubation with arachidonic acid, the major lipoxygenase product was 15-HETE; no leukotrienes were detected. The formation of 15-HETE was concentration-dependent and was attenuated by nordihydroguaiaretic acid, but not by indomethacin. Similar to intact cerebral artery, cultured cerebrovascular smooth muscle cells have lipoxygenase activity, the major product of which is 15-HETE. These results are consistent with a possible role of the HPETEs in the pathogenesis of cerebral vasospasm.

A, B, H, and Lewis-a and Lewis-b blood group antigens in human breast cancer: correlation with steroid hormone receptor and disease status.

Estrogen (ER) and progesterone (PR) hormone receptor status and levels were correlated with blood group antigen (A, B, H, Lewis-a and Lewis-b) expression in 48 cases of human breast cancer. Reduced expression of all the blood group antigens was observed with statistically significant reductions for H, Lewis-a and Lewis-b (P < 0.05). The proportions of ER- and PR-positive breast cancers staining for Lewis-b were greater than in hormone-receptor-negative cancers but the differences were not significant. The loss of Lewis-b antigen in breast cancer increased with tumor grade but did not correlate with axillary lymph node metastases. Loss of Lewis-b antigen is probably not a predictor of local recurrence and survival in the short period of observation. We conclude that the loss of H, Lewis-a and, especially, Lewis-b in breast cancer reflects the invasiveness of breast cancer and that Lewis-a and b expression is probably only marginally and not significantly affected by steroid hormone receptor status and levels.

Ethics in organ donation: contrasts in two cultures.

1. For cadaveric organs in the West, there are many avenues that should be pursued in order to increase the supply. Most of the measures under "giving" in Table 2 are ethical, though we do not accept the implication that those who enroll, in advance, as future organ donors should thereby obtain priority for their own possible future transplant organ needs. 2. "Legislated taking" could be ethically justified if shown to be acceptable to most persons in a society or culture, with provision for opting out for those with minority opinions and beliefs. Such evidence should be sought, and acted upon if found to be present. It certainly warrants a strong public education thrust. 3. Possibilities should be explored for nonmonetary rewarding of families of the decreased, in ways that would not foreclose on families giving authorization for purely altruistic reasons. Direct money payments, "buying," will never outweigh the ethical arguments against the practice, in our opinion. There are other societal avenues by which to pursue the perfectly acceptable goals of indirect altruism. 4. For kidney donations from unrelated living donors in India, a case is made for considering rewarded gifting as being ethically acceptable if it is defined in the way that it is carefully defined for this article, provided it meets the criteria for indirect altruism of a panel of social peers, and also is linked to measures of mandated philanthropy (decided also by a panel of social peers), for the reasons given. This is a balance of societal burden (in allowing rewarded gifting) by the ensured benefit to the seller (to prevent his victimization) plus a required benefit to society by seller's philanthropy. The setting of these balances should be decided by a panel of social peers. Such acceptance would not necessarily pass muster for other cultures than the one for which it is designed. 5. All forms of commerce, included that described in the preceding paragraph, become ethically unacceptable if the regulations governing them cannot realistically be enforced. This is a crucial point, a requirement for ethical cogency.

Lewis blood group antigens (a and b) in human breast tissues. Loss of Lewis-b in breast cancer cells and correlation with tumor grade.

The Lewis blood group antigens (Lewis-a [Lea] and Lewis-b [Leb]) and their precursors are present on various normal human epithelial cell surfaces. The authors examined 35 benign and malignant human breast lesions using mouse monoclonal antibodies to synthetic Lea and Leb carbohydrate antigens. Normal breast lobular and ductal epithelium and benign breast lesions showed Leb staining but only occasional Lea staining. In invasive ductal carcinomas of breast, of all grades, a loss of Leb antigen staining was found in 80% of the breast cancer cases. This reduced Leb antigen expression increased with the grade of malignancy. Therefore, the loss of Leb blood group antigens on breast cancer cell surfaces may suggest altered fucosylation patterns in malignant cells and reflect the degree of malignancy and/or invasiveness.

Striated muscle heteroplasia in the uterine round ligament. A report of 30 cases.

The presence of nonneoplastic mature striated muscle, ie, striated muscle heteroplasia, is described in the proximal stumps of the round ligaments of the uterus. It was an incidental finding in 30 (2.8%) of 1064 surgical specimens studied without clinical or pathologic significance. It is deemed to represent aberrant persistence, differentiation, and maturation of gubernacular rhabdomyoblasts, which normally involute in female fetuses. The reasons for its sporadic occurrence in normal adult women are unknown.

Correlation of blood group antigen expression and oncogene-related proteins in malignant prostatic tissues.

The use of multiple tumor markers could better predict the behavior of malignant tumors. In prostate cancer, there are no reliably predictive markers for metastatic behavior but the histologic grade and clinical stage of tumor do influence prognosis. We have determined the expression of blood group antigens A, B, H, Lewis-a and Lewis-b and the proto-oncogene proteins v-erbB, c-fos and v-H-ras in both benign and malignant prostate tissues by immunohistochemistry. We determined the relationship between these markers and the grade of malignancy and by inference, clinical behavior. There was reduced expression of blood group antigens A, Lewis-a and Lewis-b in all grades of prostatic adenocarcinoma. We also found that the expression of v-erbB was greater in tumors of high grade. We suggest that loss of blood group antigens may be correlated with elevated v-erbB oncoprotein expression (related to epidermal growth factor receptor) and increasing grade of prostatic malignancy.

Effects of advancing age and severe food restriction on pathological processes in the insulin resistant JCR:LA-corpulent rat.

Corpulent rats of the JCR:LA-corpulent strain spontaneously develop atherosclerotic lesions, occlusive thrombi and myocardial lesions. In addition to exhibiting a VLDL hyperlipidemia they are insulin resistant. Young male corpulent rats have significantly impaired rates of clearance of plasma glucose on an intravenous glucose tolerance test in comparison to lean rats (k = 0.94 +/- 0.69 vs 2.06 +/- 0.64 x 10(-2) min-1, p less than 0.01). Food restriction to 60% of the spontaneous intake of lean controls (12 g/day) for 10 days raised the rate of glucose clearance to that of the lean rats (k = 3.01 +/- 0.40 x 10(-2) min-1) and this was highly significant compared to the rate at three months of age (p less than 0.0005). Food restriction significantly lowered the elevated insulin levels of corpulent rats at 3 and 12 months of age. It inhibited, but did not prevent, the development of hyperplasia of the islets of Langerhans. The hypertriglyceridemia was less severe in 12 month old rats (214 +/- 52 vs 282 +/- 19 mg/100 ml while total cholesterol was increased (129 +/- 20 vs 85 +/- 5.5 mg/100 ml). Severe food restriction halved the triglyceride concentration at both 3 and 12 months of age while total cholesterol was unaffected. The food restriction throughout life up to 12 months of age, however, did inhibit the development of advanced myocardial lesions.

Multicentric gastric carcinoids complicating pernicious anemia. Origin from the metaplastic endocrine cell population.

We report three cases of multicentric carcinoid tumors of the stomach in patients with long-standing pernicious anemia and severe atrophic gastritis (type A). The tumor nodules arose in nonantral gastric mucosa showing marked intestinal metaplasia. Diffuse endocrine cell hyperplasia was present in both fundus and antrum. Antral G-cell hyperplasia was observed. A widely accepted pathogenesis of this syndrome suggests that the proliferating cell type is the argyrophilic, enterochromaffinlike cell native to the gastric body and fundus. Our findings conflict with this view, in that focal argentaffin staining was also present within tumor cells, as well as immunoreactivity for serotonin and substance P (more characteristic of small-intestinal enterochromaffin or Kulchitsky's cells and small-intestinal carcinoids). Findings in these cases at least suggest an alternative possibility: the tumors may derive from small-intestinal-type metaplastic endocrine cells within the atrophic mucosa, rather than the hypertrophic native endocrine cell population.

Prevention of myocardial disease in JCR:LA-corpulent rats by running.

The JCR:LA-corpulent rat is a congenic strain that, if homozygous for the cp gene, is obese with a very low-density lipoprotein hyperlipidemia and is insulin resistant. The male corpulent rats develop atherosclerotic lesions of the major arteries and myocardial lesions. Corpulent and lean male rats were induced through mild food restriction to run intensively (approximately 6,000 m/day) from 6 wk to 6 mo of age. Food restriction, especially when coupled with running, lowered all classes of lipids in the whole serum of corpulent rats. The principal changes in lipid concentrations were in the very low-density lipoprotein fraction. Food restriction caused a significant drop in fasting insulin levels of corpulent rats and decreased beta-cell hyperplasia. Both effects were more marked in the running animals. There was a significant decrease in myocardial lesion frequency in the food-restricted corpulent rats and an absence of lesions in the running rats. The results indicate that intensive physical activity can largely correct the lipid abnormalities and insulin resistance of this atherosclerosis-prone strain, and these changes are associated with inhibition of the disease process. However, moderate food restriction has similar effects, and the greater effects seen with intensive running may simply reflect an effectively more severe metabolic restriction in the presence of the exercise.

Effects of chronic ethanol consumption in atherosclerosis-prone JCR:LA-corpulent rat.

Rats of the atherosclerosis-prone JCR:LA-corpulent strain were subjected to long-term low (0.5% wt/vol) or high (4% wt/vol) consumption of ethanol from 1 to 12 months of age. The corpulent rats are hyperphagic, obese, and insulin-resistant; exhibit a marked very low density lipoprotein hyperlipidemia; and develop both vascular and myocardial lesions while eating a normal rat chow. The total lipid profile of the rat sera showed only limited changes with ethanol consumption. There were also no significant effects on high density lipoprotein lipids. Ethanol consumption was associated with elevated fasting glucose concentrations in both lean and corpulent rats and a strong decrease in fasting insulin levels and pancreatic B-cell volume density in the hyperinsulinemic corpulent rats. The relative frequency of myocardial nodules of chronic inflammatory cells was increased in the ethanol-consuming rats, both lean and corpulent. In contrast, old organized lesions (scars) were absent in the ethanol-consuming corpulent rats. Thus, ethanol consumption had no major effect on serum lipids or lipoproteins in the corpulent rat but was associated with a reduction in insulin resistance and islet cell hyperplasia, with an associated decreased incidence of myocardial lesions.

Insulin resistance and impaired glucose tolerance in the atherosclerosis-prone LA/N corpulent rat.

The LA/N-cp rat is, when homozygous for the cp gene, hyperphagous, hyperlipidemic, and corpulent. The corpulent males develop atherosclerotic disease and myocardial lesions while corpulent females and lean rats do not. The fasting plasma glucose concentrations of corpulent rats are in the normal range, but insulin concentrations are mildly elevated in corpulent females and markedly elevated in corpulent males. Glucose tolerance testing reveals a glucose intolerance in corpulent rats in the presence of very high insulin concentrations, and this deficiency is more severe in the male rats. Glucagon concentrations are higher in corpulent rats than lean rats at 3 months of age and decrease progressively with age. In contrast, glucagon concentrations increase with age in lean rats and are higher than those in corpulent rats at 9 months. The islets of Langerhans of corpulent rats exhibit marked hyperplasia that increases with age. The hyperplasia is less extreme in corpulent female rats. The abnormalities suggest that this strain of rats has an insulin resistance leading to impaired glucose tolerance and progressive pancreatic disturbance. This process may be related to an accompanying defect causing elevated concentrations of very low density lipoproteins and correlates with the development of atherosclerotic disease.

Age-related qualitative and quantitative changes in the endocrine pancreas of the LA/N-corpulent rat.

Islets of Langerhans in sections from the tail of the pancreas of corpulent LA/N-cp rats and lean controls aged 1, 3, 6 and 9 mo were examined by immunocytochemistry and morphometrically using an automatic image analyzer. The corpulent rats had significantly greater islet volumes at all ages, although islet hypertrophy tended to plateau after 6 mo. By 12 mo age the architecture of the islets was disrupted with large islets fused and showing areas of fibrosis and deposits of hemosiderin. The volume density (v/v, %) of islets in the parenchyma was significantly increased at each age step in corpulent rats reaching over 20% at 9 mo, and was greater in corpulent than in lean rats at all ages. In the corpulent rats, B-cell volume density dramatically with age and at all ages was significantly greater in corpulent than in lean rats. A-cell volume density was significantly greater in the corpulent rats than in lean rats at 1 and 9 mo. The mean B:A cell ratio was greater in corpulent than in lean rats at 3, 6 and 9 mo. There were more D cells per islet in corpulent than in lean rats up to 9 mo. These changes in cell populations were paralleled by qualitative changes in islet morphology and cellular topography such as increasingly irregular islet shape in corpulent animals and by variations in plasma levels of insulin and glucagon. In this strain of rats, obesity is associated with major changes in pancreatic morphology and this correlates strongly with the susceptibility of the strain to atherosclerosis.

Immunolocalization of alpha and beta chains of human chorionic gonadotropin, placental lactogen and pregnancy-specific beta-glycoprotein in term placenta by a touch preparation method.

Touch preparations of human placenta yield cells retaining antigenic reactivity to immunoperoxidase stains for alpha and beta chains of human chorionic gonadotropin, placental lactogen, and pregnancy-specific beta glycoprotein. This method is a rapid and simple alternative to conventional frozen and paraffin-embedded sections for detection of placental peptides.

The osteoclast-type giant cell tumor of the pancreas.

We present a case report of osteoclast-type giant cell tumor of the pancreas and review the literature concerning this rare neoplasm, the histogenesis of which is uncertain. Electron microscopic features have suggested stromal, histiocytic, and epithelial origins to different investigators. Analysis of the present case supports and epithelial origin, with positive immunocytochemical staining for carcinoembryonic antigen and for low molecular weight keratin in the mononuclear and in some osteoclastlike giant cells. These tumor cells did not stain for mesenchymal markers (lysozyme, alpha 1-antitrypsin, alpha 1-antichymotrypsin, S100 protein). Zymogen granules, desmosomes, and zonulae occludentes were identified ultrastructurally and further support an epithelial derivation.

Malignant fibrous histiocytoma of prostate gland.

The English language medical literature does not contain any definitive reports of malignant fibrous histiocytoma (MFH) arising in the prostate gland. A case of prostatic MFH is described, characterized by rapid local tumor progression and pulmonary metastases. The histologic diagnosis was supported by immunohistochemical and electron microscopic studies.

Papillary cystic tumor of the pancreas.

We studied three cases of papillary cystic tumor of the pancreas and reviewed the literature concerning this uncommon neoplasm. This tumor almost always behaves in a benign fashion and occurs predominantly in young women. The histogenesis remains uncertain, but results of electron microscopic and immunocytochemical studies are consistent with an origin from a primitive cell capable of differentiating along both acinar and endocrine lines.

Phylogeny of functional humoral transplantation immunity: comparative studies in amphibians and rodents.

Remarkably comparable observations from parallel experiments in salamanders and mice utilizing three related model systems (implant-induced immunomanipulation; passive transfer; and putative B cell suppression) argue directly that functional humoral transplantation immunity is highly developed at the phylogenetic level of Amphibia and that it plays a major role in regulating graft survival in these species (Fig. 4). Although it is still conjectural whether such humoral immunity and weak H-antigens evolved concurrently, the argument that enhancing atibodies evolved exclusively in viviparous species to protect the fetus from potential rejection by the maternal immune system no longer seems tenable (1).