Morphological analysis of the connective tissue reaction in linear hypertrophic scars treated with intralesional steroid or silicone-gel sheeting. A light and electron microscopic study.

The linear hypertrophic scar has become the most common type of pathologic scarring. Silicone-gel sheeting is the first line therapy while intralesional steroid is the second. A light and electron microscopic analysis was carried out to reveal differences in tissue reaction following the two different treatments. Two groups of 12 patients each were treated for 4 months. For the first group, diluted Triamcinolone acetonide was injected until an inactive state was achieved. The other group of patients was treated with silicone-gel sheeting. The scars were examined every two weeks and their appearance documented. After reaching the expected therapeutic response, inactive scars were removed. The excised scars were evaluated through light microscopic histopathology and electron microscopy. The light and electron microscopic observations revealed marked differences following treatments. The activity of fibroblasts and the numbers of collagen fibers forming bundles decreased and the orientation of the collagen fibers was more variable in the treated scars. The amount of elastic fibers increased after both steroid and silicone-gel sheeting treatment. Vascularization was also slightly changed, with more capillaries and fewer pre-capillary arteries detected in the treated scars. Both treatments resulted in the same decrease in score but steroid treatment was more rapid in onset. We suggest that the two different treatments work through different mechanisms, although the final functional outcome is similar.

Following the goose liver development by means of cross-sectional digital imaging, liver histology and blood biochemical parameters.

A follow-up study was performed to describe characteristic physiological alterations by means of computer tomography, direct chemical analysis and histology of the liver, and blood biochemical parameters during conventional force-feeding of Landes geese. 30 birds were exposed to an 18-day long force-feeding. Sampling was performed at the start and during force-feeding (7th, 11th, 14th, 18th days). Computer tomographic data were plotted in 3D histograms, effectively indicating the volumetric development and the fat deposition of the liver. Applying the so-called fat index, a saturation process was found for the hepatic fat content. Histological sections indicated the appearance of microvesicular fat forms in the hepatocyte cytoplasm, which first turned to a total fatty infiltration, later changing to a macrovesicular form with progressing inflammation; membrane damage was not visualized. In blood metabolites triglyceride, total and HDL cholesterol and uric acid increased measurably, while creatinine concentration decreased. Alanine aminotransferase, aspartate aminotransferase activities increased strongly, while that of lactate dehydrogenase only slightly. Based on the results of macroscopic and microscopic imaging techniques and blood biochemical parameters, a comprehensive follow-up study was performed, elucidating still unknown processes during force-feeding of geese.

Multimodality treatment resulting in long-term survival in hepatocellular carcinoma.

The early detection and complex therapy of the hepatocellular carcinoma (HCC) is one of the most seasonable questions of the gastroenterology-oncology, because of the increasing prevalence of the primary liver cancer. The course of the hepatocellular carcinoma is rapid, untreated patients rarely live over 5-6 months. Combination of different treatment modalities in HCC can offer the best chances for survival. If possible, a surgical resection should be the primary procedure, followed by adjuvant cytostatic treatment and chemoembolisation. The authors report three cases with HCC with extremely long survival. The long-term survival achieved by multimodality therapy, as presented in these cases, seems to justify aggressive therapeutical approaches in HCC. It has been concluded, that early detection and complex, aggressive multimodality treatment--even repeated liver resections and surgical elimination of duplex distant metastases--can result in long-term survival with a good quality of life.

Colorectal cancer risk in relation to genetic polymorphism of cytochrome P450 1A1, 2E1, and glutathione-S-transferase M1 enzymes.

Chemical carcinogens generally require metabolic activation in order to be able to bind to DNA and contribute to cancer causation. Most of the human metabolizing enzymes are genetically polymorphic, and these polymorphisms may affect the enzyme activity or inducibility. In our present study we investigated the connection between genetic polymorphism of cytochrome P450 1A1, 2E1 (phase I enzymes) and glutathione-S-transferase M1 (a phase II enzyme) and colorectal cancer occurrence in a Hungarian population. The CYP 2E1 c2 allele proved to be in significant association with colorectal cancer (OR: 1.91, 95% CI: 1.05-3.52), the CYP 1A1 Val allele was also overrepresented among colon cancer patients (OR: 1.57, 95% CI: 0.90-2.74), and the frequency of GSTM1 homozygous 0 genotype showed only minor difference (OR: 1.19, 95% CI: 0.75-1.35). Combined analysis of the polymorphisms showed that individuals carrying all the three "high-risk" alleles have a strikingly increased risk for sporadic colorectal cancer (OR: 4.62, 95% CI: 1.23-25.68).

Improving diagnostic accuracy of prostate carcinoma by systematic random map-biopsy.

Systematic random rectal ultrasound directed map-biopsy of the prostate was performed in 77 RDE (rectal digital examination) positive and 25 RDE negative cases, if applicable. Hypoechoic areas were found in 30% of RDE positive and in 16% of RDE negative cases. The score for carcinoma in the hypoechoic areas was 6.5% in RDE positive and 0% in RDE negative cases, whereas systematic map biopsy detected 62% carcinomas in RDE positive, and 16% carcinomas in RDE negative patients. The probability of positive diagnosis of prostate carcinoma increased in parallel with the number of biopsy samples/case. The importance of systematic map biopsy is emphasized.

Immunohistochemical assessment and prognostic value of hepatitis B virus X protein in chronic hepatitis and primary hepatocellular carcinomas using anti-HBxAg monoclonal antibody.

Hepatitis B virus (HBV) is the most meaningful risk factor in chronic hepatitis, cirrhosis and primary hepatocellular carcinoma (PHC). The hepatitis B virus X protein (HBxAg) is a multifunctional protein with many important functions in hepatocellular carcinogenesis. A monoclonal anti-HBxAg antibody was developed in our laboratory and characterized by different methods. Using this antibody HBxAg was detected in formaldehyde fixed paraffin embedded tissue sections of 72 liver biopsies from patients with acute hepatitis, chronic hepatitis, cirrhosis and primary hepatocellular carcinoma. The co-expression of hepatitis B surface antigen (HBsAg), hepatitis B core antigen (HBcAg) and HBxAg was compared. The histological and cytological localization of the detected HBxAg showed a characteristic distribution in different stages of HBV infection. Strong and diffuse nuclear reaction was detected in PHC cases in contrast to the focal, cytoplasmic and nuclear labeling in the acute and chronic B hepatitis cases. Our antibody seems to be a suitable prognostic marker for routine pathohistological diagnosis and for comparative pathological and epidemiological research on the development of PHC.

Cytophotometric investigations on a chronic tubular nephropathy simulating preneoplastic condition.

Cytophotometric investigations were performed on the atypical renal tubular epithelium of a young man who died of renal failure, possibly due to chronic lead exposure. The aim of this analysis was to determine whether nuclear atypia indicates incipient malignancy or is a type of so-called "benign atypias". DNA histogram, showing euploid polyploidy supports the latter view and the dysplastic epithelial lesion is not even considered to be a preneoplastic condition.

Differential detection of N-heterocyclic compounds and their N-methylated derivatives by immunoanalysis.

Competitive enzyme-linked immunosorbent assay (ELISA) systems are proposed for the indirect monitoring of formaldehyde by the parallel detection of its N-methylated precursors and the corresponding demethylated compounds. As an example for such immunoanalytical differentiation between an N-heterocyclic compound and its N-methylated derivative, the quantitative detection of the systemic triazole fungicide, myclobutanil, is discussed. Antibodies recognizing the non-zwitterionic structure of 2-(4-chlorophenyl)-2-[(1,2,4-triazol-1-yl)-methyl]-hexanonitril e (myclobutanil) showed only minor binding to corresponding N-alkylated derivatives of myclobutanil. And vice versa, literature data indicate that antibodies raised against the pyridilium ionic structure of the herbicide paraquat, displayed only mediocre reactivity towards the corresponding dealkylated derivatives. Thus, both experimental and literature data suggest that immunoanalytical methods for differential detection of N-methylated heterocycles (potentially including formaldehyde precursors) and their non-methylated counterparts are possible to develop.

[Pathology of alcoholic liver disease]. / Az alkoholos májbetegség patológiája.

The history of alcohol consumption has been nearly as long as the history of mankind. Alcohol-related diseases represent a serious problem all over the world and they show a gradually increasing tendency. It can be stated that the frequency of occurrence, severity and mortality of alcohol-related hepatic diseases are in direct correlation with the amount of alcohol consumed. The direct hepatotoxic effect of alcohol and its metabolites has become obvious by now. In addition to this, other mechanisms also play a part in the development of hepatic diseases: their occurrence and severity are significantly influenced by genetic and environmental factors. The rather wide spectrum of alcohol-related hepatic diseases includes steatosis, perivenular fibrosis, alcohol-related hepatitis, occlusive venous lesions, cirrhosis and hepatocellular cancer. All of these disorders are characterized by clearly defined, characteristic but non-specific changes, which need to be supplemented by histological diagnostic criteria. Cirrhosis, which must still be regarded as an irreversibly lethal condition, is thought to develop in two ways. A well-known and widely accepted assumption is that episodes of alcohol-related hepatitis aggravated by progressive fibrosis sooner or later lead to cirrhosis. Another possible explanation is that steatosis facilitating the development and spreading of perivenular fibrosis--even without episodes of hepatitis--may lead to cirrhosis. Thus, alcohol-related hepatic conditions have characteristic pathohistological features, none of which, however, are pathognomonic at the same time. Therefore, the definitive diagnosis of any form of alcohol-related hepatic disorders needs to take evidence of alcohol consumption into account.

[Angiocentric T-cell lymphoma of the lung]. / A tüdö angiocentrikus t-sejtes lymphomája.

Angiocentric T-cell lymphoma of the lung. The case history of a patient with primary angiocentric T-cell lymphoma of the lung having an unusually long survival period (> 10 years) is presented. Attention is paid to the possibilities of differential diagnosis that should be taken into account in the analysis of certain lymphocytic infiltrates of the lung. In accordance with relevant data of the literature, this case shows that pleiomorphic small cell T-lymphomas may have a protracted course, and the disease free periods repeatedly achieved in this patient by irradiation and chemotherapy are thought to be noticeable. Authors refer to some recent findings which may give new insights in the pathobiology of extranodal T-cell lymphomas, and result in recognition of new disease entities.

[Adenocarcinoma (Klatskin tumor) of the hepatic duct simulating viral hepatitis]. / Virushepatitis képében megjelenö ductus hepaticus adenocarcinoma (Klatskin tumor).

The authors review the experiences obtained during investigation of a patient with Klatskin tumor and whose clinical syndromes were developing as of virus hepatitis. In the first two weeks of the illness the clinical symptoms, the chemical laboratory findings and among the virus investigations the positive (experimental) Non-A Non-B hepatitis virus antigen suggested the existence of virus hepatitis. Later the laboratory investigations and the symptoms showed on obstructive icterus. The subsequent performed investigations as ultrasonography and PTC--showed the Klatskin tumor, which was proven by the operation performed and histology. The patient is free from the complaints more than 1 year after the operation, moreover recidivation or metastasis was not indicated by the investigations performed in the latest time.

[Repeated resection of hepatocellular carcinoma and its recurrences and removal of pulmonary metastases]. / Hepatocellularis carcinoma és recidíváinak ismételt resectiója tüdömetastasisok eltávolításával.

A case of a 67 year old male successfully treated local recurrence of previously radically resected hepatocellular carcinoma with distant metastases of the lung is reported. Two years after a complete removal of the primary liver malignoma a local recurrence was resected which was followed by selective intraarterial cytostatic treatment and chemoembolisation. A three-year disease-free interval was achieved, then recurrence in the liver and lung metastases were detected at the regular check-up. All of the malignant focuses were eliminated by parenchyma sparing surgical resections, then a postoperative adjuvant chemotherapy (FAM scheme) has been followed. After eight months the patient remained symptom-free. The long-term survival seems to justify the aggressive approach of this kind of malignancies.

The rubber hand illusion increases heat pain threshold.

BACKGROUND: Accumulating evidence shows that manipulations of cortical body representation, for example, by simply viewing one's own body, can relieve pain in healthy subjects. Despite the widespread use of the rubber hand illusion (RHI) as an effective experimental tool for the manipulation of bodily awareness, previous studies examining the analgesic effect of the RHI have produced conflicting results. METHOD: We used noxious heat stimuli to induce finger pain in 29 healthy subjects, and we recorded the participants' pain thresholds and subjective pain ratings during the RHI and during the control conditions. Two control conditions were included in our experiment - a standard one with reduced illusion strength (asynchronous stroking control) and an additional one in which the participants viewed their own hand. RESULTS: Raw data showed that both the RHI and the vision of the own hand resulted in slightly higher pain thresholds than the asynchronous stroking control (illusion: 47.79 °C; own-hand: 47.99 °C; asynchronous: 47.52 °C). After logarithmic transformation to achieve normality, paired t-tests revealed that both increases in pain threshold were significant (illusion/asynchronous: p = 0.036; own-hand/asynchronous: p = 0.007). In contrast, there was no significant difference in pain threshold between the illusion and the own-hand conditions (p = 0.656). Pain rating scores were not log-normal, and Wilcoxon singed-rank tests found no significant differences in pain ratings between the study conditions. CONCLUSION: The RHI increases heat pain threshold and the analgesic effect of the RHI is comparable with that of seeing one's own hand. The latter finding may have clinical implications.

Intra-abdominal desmoids observed after total proctocolectomies.

Two cases of mesenteric desmoids observed after colectomy are reviewed. In one of them the familial polyposis had been known, in the other familial history could not be proved. Fibrous change prevented making of the planned Kock reservoir.

[Pseudosarcoma of the esophagus]. / Az oesophagus pseudosarcomája.

Authors describe pseudosarcoma, a rare esophageal tumour in a 52-year-old male patient. The tumour of complex histological appearance has characteristic macroscopic, microscopic and clinical features. Although its histogenesis is unclear, it can be well distinguished from the real carcinosarcoma and represents an independent class of tumours.