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BACKGROUND: Organic acids on the surface of human hands contribute to the barrier against transient pathogens. This is the first study to explore the synergistic contribution of lactic acid and other hand environment-related features on the antibacterial properties of the hand surface. MATERIALS AND METHODS: We estimated the contribution of fingerprint depth, skin pH, stratum corneum water content, skin temperature, and sweat rate of the hands to the infection barrier using an observational survey of 105 subjects. The relationship between each factor and the antibacterial activity of the hands was analyzed using Pearson's correlation coefficient. We performed molecular dynamics simulations to study the interaction between lactic acid and bacterial membranes. RESULTS: The amount of lactic acid on the hands and skin temperature contributed positively to the antimicrobial activity (r = 0.437 and P = 3.18 × 10-6 , r = 0.500 and P = 5.66 × 10-8 , respectively), while the skin pH contributed negatively (r = -0.471, P = 3.99 × 10-7 ). The predicted value of the combined antimicrobial effect of these parameters was [antimicrobial activity] = 0.21 × [lactic acid] - 0.25 × [skin pH] + 0.26 × [skin temperature] + 0.98. The coefficient of determination (R2 ) was 0.50. CONCLUSION: The increase in the amount of non-ionic lactic acid due to lower pH and improvement in the fluidity of the cell membrane due to higher temperatures enable the efficient transport of lactic acid into cells and subsequent antimicrobial activity. The proposed mechanism could help to develop an effective hand infection barrier technology.
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Mãos , Ácido Láctico , Epiderme , Humanos , ÁguaRESUMO
BACKGROUND: Pancreas divisum (PD), the most common pancreatic anomaly, is caused by the failure of pancreatic bud fusion in the embryo. Although most cases are asymptomatic, it can cause pancreatitis or epigastric pain. We report an unusual case of PD in an infant. CASE PRESENTATION: The patient was a 9-month-old girl with no pertinent medical history. She had suffered vomiting and diarrhea for 1 week before transfer to our hospital. Her general condition was poor, and abdominal distention was noted. Blood tests revealed microcytic anemia with normal chemical markers. The parents reported no episode of pancreatitis. Ultrasonography revealed massive ascites, which was later found to be bloody. Enhanced computed tomography and magnetic resonance imaging depicted a cystic lesion, approximately 2 cm in size, anterior to the second portion of the duodenum. During exploratory laparotomy, a pinhole was identified on the cyst wall, which was mistakenly identified as a duodenal perforation, and direct closure was performed. Postoperative levels of serum amylase and inflammation markers were elevated, and the amount of ascites increased, impairing oral feeding. The level of pancreatic enzymes in the ascites was high. Imaging studies were repeated, but the cause of pancreatic fistula was not identified. Conservative therapy, including administration of total parenteral nutrition, antibiotics, and octreotide, was initiated, but the situation did not improve. Three months after admission, endoscopic retrograde cholangiopancreatography showed a thick dorsal pancreatic duct communicating with a hypoplastic ventral duct, which was indicative of PD. Contrast medium leaking from the dorsal duct near the minor ampulla revealed the presence of a pseudocyst. Stenting via the minor papilla was impossible because the minor papilla was obstructed. Instead, a stent was inserted into the ventral pancreatic duct. Endoscopic transgastric drainage of the cyst was effective, and the patient was discharged, 7 months after admission. The patient is healthy, but the gastric stent needs to be replaced regularly. CONCLUSION: In children, PD can manifest with pancreatic pseudocyst that causes pancreatic ascites, even in the absence of pancreatitis. This may be a previously unrecognized manifestation of PD in children, and clinicians need to be aware of it.
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Currently, there are no detailed reports on the effects of vitamin E-bonded polysulfone (PS) membrane dialyzers on intradialytic hypotension (IDH) in diabetic hemodialysis (HD) patients. This study was designed to evaluate changes in intradialytic systolic blood pressure (SBP) using "VPS-HA" vitamin E-bonded super high-flux PS membrane dialyzers. The subjects were 62 diabetic HD patients whose intradialytic SBP fell by more than 20%. Group A comprised patients who required vasopressors to be able to continue treatment or who had to discontinue therapy due to their lowest intradialytic SBP being observed at 210 min (28 patients). Group B comprised patients who showed no symptoms and required no vasopressors but showed a gradual reduction in blood pressure, with the lowest intradialytic SBP seen at the end of dialysis (34 patients). The primary outcome was defined as the lowest intradialytic SBP after 3 months using VPS-HA. Secondary outcomes included changes in the following: lowest intradialytic diastolic blood pressure, pulse pressure, pulse rate, plasma nitric oxide and peroxynitrite, serum albumin, and hemoglobin A1c. Group A's lowest intradialytic SBP had significantly improved at 3 months (128.0 ± 25.1 mm Hg vs. 117.1 ± 29.2 mm Hg; P = 0.017). Group B's lowest intradialytic SBP had significantly improved at 1 month (134.4 ± 13.2 mm Hg vs. 121.5 ± 25.8 mm Hg; P = 0.047) and 3 months (139.1 ± 20.9 mm Hg vs. 121.5 ± 25.8 mm Hg; P = 0.011). We conclude that VPS-HA may improve IDH in diabetic HD patients.
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Pressão Sanguínea/efeitos dos fármacos , Nefropatias Diabéticas/terapia , Hipotensão/tratamento farmacológico , Diálise Renal/métodos , Vitamina E/uso terapêutico , Idoso , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/complicações , Feminino , Humanos , Hipotensão/sangue , Hipotensão/complicações , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/sangue , Ácido Peroxinitroso/sangue , Polímeros/química , Albumina Sérica/análise , Sulfonas/química , Vasoconstritores/uso terapêutico , Vitamina E/químicaRESUMO
OBJECTIVES: To elucidate clinicopathological risk factors for intravesical recurrence (IVR) in patients undergoing nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC). METHODS: We identified a study population of 151 consecutive patients without previous or concurrent bladder cancer who underwent nephroureterectomy for UUT-UC. IVR was assessed in relation to tumor location, size, and multifocality, operation modality and time, stage, grade, lymphovascular invasion, regional lymph node metastasis, preoperative urinary cytology, and perioperative chemotherapy. The median follow-up time was 24 months. RESULTS: Of 151 patients, 51 (34%) developed IVR after nephroureterectomy, and 50 (98%) of the patients presented with IVR within 2 years. Tumor multifocality and site (located in ureter) were determined as risk factors for IVR by univariate analysis. In a multivariate analysis, only tumor multifocality (relative risk: 4.024, p = 0.001) was an independent predictor of IVR. Ten-year cancer-specific survival rates for the patients with and without IVR were 68 and 52%, respectively (p = 0.06). CONCLUSIONS: Tumor multifocality is a significant risk factor in developing IVR after surgery for UUT-UC. These results indicate that despite most IVR occurring within 2 years of treatment, it is necessary to follow such patients more closely using cystoscopy. However, IVR is unlikely to indicate a poorer prognosis.
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Carcinoma/secundário , Carcinoma/cirurgia , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefrectomia , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/secundário , Distribuição de Qui-Quadrado , Cistoscopia , Humanos , Japão , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Metástase Linfática , Análise Multivariada , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas , Nefrectomia/efeitos adversos , Nefrectomia/mortalidade , Razão de Chances , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Neoplasias Ureterais/mortalidade , Neoplasias da Bexiga Urinária/mortalidade , Urotélio/patologia , Urotélio/cirurgiaRESUMO
Although the surface of the human hands contains high antimicrobial activity, studies investigating the precise components involved and the relationship between natural antimicrobial activity and morbidity in infectious diseases are limited. In this study, we developed a method to quantitatively measure the antimicrobial activity of hand surface components. Using a clinical survey, we validated the feasibility of our method and identified antimicrobial factors on the surface of the human hand. In a retrospective observational study, we compared the medical histories of the participants to assess infectious diseases. We found that the antimicrobial activity on the surface of the hands was significantly lower in the high morbidity group (N = 55) than in the low morbidity group (N = 54), indicating a positive association with the history of infection in individuals. A comprehensive analysis of the hand surface components indicated that organic acids, especially lactic acid and antimicrobial peptides, are highly correlated with antimicrobial activity. Moreover, the application of lactic acid using the amount present on the surface of the hand significantly improved the antimicrobial activity. These findings suggest that hand hygiene must be improved to enhance natural antimicrobial activity on the surface of the hands.
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Controle de Doenças Transmissíveis/métodos , Desinfecção das Mãos/métodos , Mãos/microbiologia , Ácido Láctico/metabolismo , Pele/metabolismo , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/microbiologiaRESUMO
Ribosome biogenesis and turnover are processes necessary for cell viability and proliferation, and many kinds of proteins are known to regulate these processes. However, many questions still remain, especially in the Archaea. Generally, several ribonucleases are required to process precursor rRNAs to their mature forms, and to degrade rRNAs for quality control. Here, we found that FAU-1, which is known to be an RNA binding protein, possesses an RNase activity against precursor 5S rRNA derived from P. furiosus and T. kodakarensis in the order Thermococcales in vitro. An in vitro analysis revealed that UA sequences in the upstream of 5S rRNA were preferentially degraded by addition of FAU-1. Moreover, a fau-1 gene deletion mutant of T. kodakarensis showed a delay of exponential phase, reduction of maximum cell number and significant changes in the nucleotide sequence lengths of its 5S, 16S, and 23S rRNAs in early exponential phase. Our results suggest that FAU-1 is a potential RNase involved in rRNA stability through maturation and/or degradation processes.
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Proteínas Arqueais/metabolismo , Pyrococcus/enzimologia , Estabilidade de RNA , RNA Arqueal/metabolismo , Proteínas de Ligação a RNA/metabolismo , Ribonucleases/metabolismo , Thermococcus/enzimologia , Sequência de Bases , Sobrevivência Celular/efeitos dos fármacos , Íons , Magnésio/farmacologia , Mutação/genética , Pyrococcus/citologia , Estabilidade de RNA/efeitos dos fármacos , RNA Ribossômico 5S/genética , Análise de Sequência de RNA , Thermococcus/citologiaRESUMO
PURPOSE: To determine whether laparoscopic nephrectomy (LN), open nephrectomy (ON), or observation (OB) is most efficient for managing multicystic dysplastic kidney (MCDK). METHODS: We performed a retrospective review of the management of our 12-year clinical experience of 32 MCDK patients to analyze the estimated total cost (ETC) of various treatment options and compare them with respect to survival, development of hypertension, and postoperative cosmetic appearance, to determine the most efficient treatment option. RESULTS: There were 12 cases in the LN group, 6 in the ON group, and 14 in the OB group. ETC was lower for ON than for LN. But the length of preoperative observation and length of follow-up after spontaneous regression greatly affected ETC. If MCDK cases were observed > 5 years with standard investigations performed regularly, ETC was higher for the OB group than for the LN group. In 6/14 (42.9%) of OB cases, MCDK resolved within 5 years, and this subgroup had the lowest ETC up to the time of this review. Six cases initially in the OB group were managed surgically (4 by LN and 2 by ON) in accordance with parental requests, and ETC in these cases was highest. All cases are well after a mean follow-up of 5.7 years, without any impairment of renal function, or hypertension. CONCLUSION: The decision to operate after lengthy observation increases costs. Overall, the most efficient surgical technique for managing MCDK was LN because of greater patient satisfaction with postoperative cosmesis. We recommend MCDK be treated by LN after a short period of observation.
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Laparoscopia/economia , Rim Displásico Multicístico/cirurgia , Nefrectomia/economia , Custos e Análise de Custo , Seguimentos , Humanos , Hipertensão/etiologia , Tempo de Internação , Rim Displásico Multicístico/economia , Rim Displásico Multicístico/mortalidade , Satisfação do Paciente , Complicações Pós-OperatóriasRESUMO
Lactate is considered an alternative substrate that is capable of replacing glucose in maintaining synaptic function in adult neurons. But, we found recently that lactate could be utilized for maintenance of synaptic potentials only after the activation of NMDA and voltage-dependent-calcium channel during glucose deprivation. To clarify more on the relationship between glycolysis and induction of lactate utilization, we tested lower concentration of glucose with hypoxia to induce a relative shortage of anaerobic energy production. Population spikes are not maintained with lactate following hypoxia in 10 mM glucose medium, but are maintained at their original levels with lactate after exposure to hypoxia in lower concentration (5 mM) of glucose. Hypothermia during low glucose-hypoxia, bath application of the NMDA channel blocker and the voltage-sensitive calcium channel blocker, as well as the omission of extracellular calcium prevented the induction of the lactate-supported population spikes. ATP levels in the tissue slices are relatively preserved in the conditions that block the induction of lactate-supported population spikes. From these observations, we propose that the energy source for maintenance of synaptic function in adult neuron changes from adult form (glucose alone) to immature one (glucose and/or lactate) after short of glucose supply.
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Metabolismo Energético/fisiologia , Glicólise/fisiologia , Hipocampo/metabolismo , Ácido Láctico/metabolismo , Neurônios/metabolismo , Transmissão Sináptica/fisiologia , Potenciais de Ação/fisiologia , Trifosfato de Adenosina/biossíntese , Animais , Cálcio/metabolismo , Cálcio/farmacologia , Bloqueadores dos Canais de Cálcio/farmacologia , Hipóxia Celular/fisiologia , Giro Denteado/metabolismo , Antagonistas de Aminoácidos Excitatórios/farmacologia , Glucose/metabolismo , Cobaias , Hipoglicemia/metabolismo , Hipotermia Induzida , Técnicas de Cultura de Órgãos , Terminações Pré-Sinápticas/metabolismo , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Receptores de N-Metil-D-Aspartato/metabolismoRESUMO
Background: hepatic functional reserve is determined by the function and number of hepatocytes, as well as hepatic blood flow. In Japan, endoscopic injection sclerotherapy is often performed prophylactically in patients with high-risk esophageal varices. We examined the effects of blocking portosystemic shunts by this treatment on hepatic circulation and hepatocyte function as evaluated by 99mTc-GSA scintigraphy (HH15, LHL15), an examination via asialoglycoprotein receptors on hepatocytes. Methods: forty-nine patients who underwent prophylactic treatment of esophageal varices were divided into two groups; one having esophageal varices alone and the second having other collateral circulation in addition to esophageal varices. Asialoscintigraphy and general liver function tests were performed both before and after treatment in each group and the data were statistically analyzed. Results: In the group having esophageal varices alone, serum total bile acid significantly decreased at 62.2% and ICGR15, HH15, and LHL15 were slightly improved at -10.9, -3.0, and +4.7%, respectively, after sclerotherapy (P<0.01). However, Child-Pugh's score was not changed after sclerotherapy. In the group having additional collaterals, no parameters were changed after sclerotherapy. Conclusion: we demonstrate that HH15, LHL15, and ICGR15 are partially influenced by hepatic circulation but are mainly determined by the function of hepatocytes, whereas serum total bile acid is markedly influenced by hepatic circulation.
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OBJECTIVE: To examine blood-flow change and recovery of sensibility in the dental pulp of maxillary incisors in patients undergoing a single-segment Le Fort I osteotomy. STUDY DESIGN: Fifty-four maxillary incisors in 14 patients were examined preoperatively and at 1 to 7 days, 14 days, 3 months, 6 months, and 12 months postoperatively. The pulpal blood flow (PBF) was measured by laser Doppler flowmetry, and the pulpal sensibility (PS) was investigated by electrodiagnostics. RESULTS: The mean PBF dropped to its lowest value at 1 day postoperatively and subsequently increased except for a temporary drop on day 4. The PS was negative in all the examined teeth from 1 day to 14 days after surgery. Subsequently, the rate of the teeth with positive PS increased. At 3 months postoperatively, the PS recovered in half of the examined teeth. The PBF value on day 1 was significantly higher in the teeth with positive PS at 3 months postoperatively than in those with negative PS at 3 months postoperatively. CONCLUSION: These results suggest that the decrease of the PBF in the maxillary incisors on 1 day after a single-segment Le Fort I osteotomy may affect the recovery of the PS in the short term after surgery.
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Polpa Dentária/irrigação sanguínea , Maxila/cirurgia , Osteotomia de Le Fort/classificação , Sensação/fisiologia , Adulto , Polpa Dentária/fisiopatologia , Eletrodiagnóstico , Feminino , Seguimentos , Humanos , Incisivo/irrigação sanguínea , Incisivo/fisiopatologia , Fluxometria por Laser-Doppler , Masculino , Dor/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Fluxo Sanguíneo Regional/fisiologiaRESUMO
This is the first report of a primary mucinous cystadenoma (MCA) arising from behind the posterior peritoneum of the descending colon in a paediatric patient. A large intra-abdominal cystic lesion was found incidentally during renal ultrasonography in a 14-year-old girl. Imaging studies showed a 13 x 9 x 15 cm homogeneous cystic lesion with mild contrast enhancement of the wall. The cyst appeared to originate from the retroperitoneum, but was separated from the left kidney, ovary, and pancreas. At laparotomy, there was a cyst behind the posterior peritoneum of the descending colon. The cyst was successfully excised, and histopathology showed MCA. Although primary MCA in the retroperitoneum is extremely rare in children, it should be considered in the differential diagnosis of an intra-abdominal cyst, since it needs to be excised to eliminate the risk of infection, recurrence, and malignancy.
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Colo/patologia , Cistadenoma Mucinoso/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Adolescente , Biópsia por Agulha , Cistadenoma Mucinoso/cirurgia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Laparoscopia/métodos , Laparotomia/métodos , Imageamento por Ressonância Magnética/métodos , Espaço Retroperitoneal , Medição de Risco , Resultado do TratamentoRESUMO
Carcinomatous meningitis from urothelial carcinoma of the bladder and ureter is rare. A 77-year-old man with invasive bladder cancer and right ureter cancer had been treated with 3 courses M-VAC (methotrexate, vinblastine, epirubicin, cisplatin) chemotherapy. After chemotherapy we performed radical cystectomy and right nephroureterectomy (ileal-neobladder) (TCC, G3, pT3, N0, M0). Sixteen months after operation, patient complained of anorexia, muscular weakness, stiff neck. CT of chest and abdomen, and bone scintigraphy showed no metastasis. Brain CT and MRI showed hydrocephalus but no evidence of parenchymal metastasis. Because we suspected carcinomatous meningitis, we performed lumbar puncture. Cerebrospinal fluid cytology revealed class V (urothelial carcinoma). Patient died 6 days after diagnosis of carcinomatous meningitis.
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Carcinoma de Células de Transição/secundário , Neoplasias Meníngeas/secundário , Meningite/etiologia , Neoplasias Ureterais/patologia , Neoplasias da Bexiga Urinária/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/cirurgia , Cisplatino/administração & dosagem , Terapia Combinada , Cistectomia , Doxorrubicina/administração & dosagem , Humanos , Masculino , Metotrexato/administração & dosagem , Nefrectomia , Ureter/cirurgia , Neoplasias Ureterais/tratamento farmacológico , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia , Vimblastina/administração & dosagemRESUMO
We describe a rare case of congenital sternal cleft. Multidetector computed tomography showed the counterclockwise rotation of the heart. Primary surgical correction was successfully performed using the Sabiston technique when the patient was 20 days old. Although the circulatory and respiratory status was unstable in the immediate postoperative period, this abated, and the patient was discharged without complications on the 13th postoperative day. Postoperative multidetector computed tomography showed that the heart approached the normal position.
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Anormalidades Musculoesqueléticas/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Esterno/cirurgia , Humanos , Recém-Nascido , Masculino , Tomografia Computadorizada Multidetectores , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Esterno/anormalidades , Esterno/diagnóstico por imagemRESUMO
We report the case of a 31-year-old woman who suffered lipiduria after selective transcatheter arterial embolization for renal angiomyolipoma (AML). Computed tomography confirmed cystic liquefactive necrosis with fat-fluid level in AML. Although the process by which AML fat tissue excretion occurs is not clear, we speculated that the infarcted AML was connected to the urinary collection duct system and subsequently its adipose component was excreted into the urine.
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Angiomiolipoma/terapia , Embolização Terapêutica/métodos , Neoplasias Renais/terapia , Lipídeos/urina , Adulto , Angiografia , Angiomiolipoma/diagnóstico por imagem , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
We report a case of bile duct stones in which piezoelectric extracorporeal shockwave lithotripsy (ESWL) was highly effective for the clearance of stones. A 16-year-old girl, who had undergone excision of a choledochal cyst when she was 3 years old, presented a spiking fever and colic abdominal pain. Radiological investigations showed two large stones incarcerating to the proximal end of hepatico-jejunostomy anastomosis. Massive debris was also present in intrahepatic bile duct proximal to the anastomosis. She underwent piezoelectric ESWL with an EDAP LT02 lithotripter. An average of 40 min ESWL session was repeated at intervals of 2 or 3 days. Neither anesthetic nor sedative treatment was required. By the end of the sixth session, the stones incarcerated were fragmented and the debris in the intrahepatic bile duct was completely eliminated. We conclude that piezoelectric ESWL is a less invasive, effective and repeatable method, therefore, it could be a treatment of choice for bile duct stone formation after choledochal cyst excision.
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Ductos Biliares Intra-Hepáticos , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Cisto do Colédoco/cirurgia , Cálculos Biliares/etiologia , Cálculos Biliares/terapia , Litotripsia/métodos , Adolescente , Colangiopancreatografia por Ressonância Magnética , Feminino , Seguimentos , Cálculos Biliares/diagnóstico , Humanos , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To examine the immunoreactivity of tumors for matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), tissue inhibitors of metalloproteinases 1 and 2 (TIMP-1, TIMP-2), and membrane type MMP 1 (MT-MMP-1), to evaluate the optimum assessment of incidental renal cell carcinoma. METHODS: Tumor samples from 120 incidental clear cell renal cell carcinoma (ICRCC) patients without distant metastasis or invasion beyond Gerota's fascia were obtained by surgery. They were immunohistochemically stained for MMP-2, MMP-9, TIMP-1, TIMP-2, and MT-MMP-1. Immunoreactivity for these factors was analyzed by semiquantitative multivariate analysis for cancer-specific survival. RESULTS: The cancer-specific 5 and 10-year survival rates were 91.4% and 91.4%, respectively. Univariate analysis revealed that nuclear grade (P = 0.0064) and TIMP-2 (P = 0.034) were significant prognostic factors. Matrix metalloproteinase 9 has a significant relationship with high nuclear grade RCC (P = 0.017) and was found to be an independent prognosticator by Cox multiple regression analysis (P = 0.0028). CONCLUSIONS: Nuclear grade and TIMP-2 were significant prognostic factors of ICRCC. Multivariate analysis showed that a nuclear grade greater than 3 was associated with a 566% significant increase in the odds of cancer death. Strong expression of MMP-9 was associated with a 774% increase in the odds of high nuclear grade, with statistical significance. Although ICRCC is well known for having a favorable prognosis, patients with tumors having a high nuclear grade and strongly expressed MMP-9 and TIMP-2 should undergo strict postoperative follow-up.
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Carcinoma de Células Renais/metabolismo , Neoplasias Renais/metabolismo , Metaloproteinase 9 da Matriz/biossíntese , Inibidor Tecidual de Metaloproteinase-2/biossíntese , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Carcinoma de Células Renais/patologia , Feminino , Humanos , Imuno-Histoquímica , Neoplasias Renais/patologia , Masculino , Metaloproteinase 14 da Matriz/biossíntese , Metaloproteinase 2 da Matriz/biossíntese , Pessoa de Meia-Idade , Prognóstico , Inibidor Tecidual de Metaloproteinase-1/biossínteseRESUMO
Long-term histopathologic changes after bladder augmentation (BA) in rats using living-related partial bladder transplantation (LPBTx) or conventional ileocystoplasty (ICP) were compared. In this study, BA (n = 37), LPBTx (n = 18), and ICP (n = 19) were performed in 16-wk-old Lewis rats. Five donors and seven nontransplanted normal Lewis rats (controls) were also studied. Rats that survived >10 mo after BA were killed after blood biochemistry and neobladder imaging. Harvested bladders were examined with hematoxylin and eosin and proliferating cell nuclear antigen (PCNA). When the rats were killed, there were 16 rats in the LPBTx group and 12 rats in the ICP group; ICP rats were significantly smaller than LPBTx rats (p < 0.05). Mean duration of follow-up for the LPBTX group was 17.3 mo, for the ICP group was 13.7 mo, for the donor group was 16.1 mo, and for the control group was 19.7 mo. Mean serum pH in the LPBTx group was 7.41 +/- 0.78 and in the ICP group was 7.25 +/- 0.38. Mean base excess in the ICP group was significantly lower than in the LPBTx group (p < 0.05). Incidence of bladder calculi in the LPBTx group (6.3%) was significantly lower than in the ICP group (33.3%; p < 0.05). There was no dysplasia/malignancy/increase in PCNA in the LPBTx group. PCNA increased in the ICP group, compared with controls (p < 0.05); two (16.7%) of 12 of ICP rats had dysplasia with mitosis. Bladder capacity increased in LPBTx and ICP compared with controls (both p < 0.05). We hope to show that BA using LPBTx may result in a neobladder with fewer complications than BA using ICP; LPBTx may also decrease the risk for malignancy.
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Transplante Heterotópico/métodos , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Anastomose Cirúrgica/métodos , Animais , Feminino , Modelos Animais , Antígeno Nuclear de Célula em Proliferação/metabolismo , Ratos , Ratos Endogâmicos Lew , Fatores de Tempo , Coleta de Tecidos e Órgãos/métodos , Transplante Isogênico , Resultado do Tratamento , Bexiga Urinária/patologia , Cálculos da Bexiga Urinária/metabolismoRESUMO
The purpose of this study was to further define the immunohistochemical and ultrastructural characteristics of neuroendocrine (NE) differentiated prostatic carcinomas. Seventy-seven specimens were obtained from prostatic carcinoma tumors during prostatectomy, transurethral resection of prostate or biopsy in 77 prostate cancer patients, and analyzed by immunohistochemical staining for chromogranin A (CgA). Nine of these tumors were also studied by elctron microscopy and 4 were examined by pre-embedding immunoelectron microscopy. CgA-stained cells were detected in 36 tumors (47%). Clinically advanced tumors or tumors with higher histological grades were associated with increased NE differentiation. Three of the tumors studied by electron microscopy contained cells showing unequivocal NE differentiation revealed by the presence of neurosecretory granules, while the poorly NE-differentiated malignant cells contained pleomorphic granules, which were lysosomal-like rather than NE-type granules. Immunoelectron microscopy demonstrated the presence of CgA immunoreactivity on the pleomorphic granules in the poorly differentiated malignant glands. This study suggests that NE-differentiated malignant cells in prostate cancer tissues may induce aggressive behavior in adjacent proliferating neoplastic cells via a paracrine mechanism.
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Carcinoma Neuroendócrino/metabolismo , Neoplasias da Próstata/metabolismo , Idoso , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/ultraestrutura , Diferenciação Celular , Cromogranina A , Cromograninas/análise , Citoplasma/patologia , Citoplasma/ultraestrutura , Humanos , Imuno-Histoquímica , Masculino , Microscopia Imunoeletrônica , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia , Neoplasias da Próstata/ultraestrutura , Vesículas Secretórias/metabolismo , Vesículas Secretórias/ultraestruturaRESUMO
BACKGROUND: No significant differences in gross and light- microscopic features have been reported between preclinical and overt Cushing's adenomas. In this study, the ultrastructural differences between the two syndromes was attempted to be clarified. METHODS: Two preclinical Cushing's syndrome adenomas and two overt Cushing's syndrome adenomas obtained from surgical extirpation were examined in an electron microscopic study. RESULTS: Light microscopically, the adenomas of both syndromes were composed predominantly of clear cells, with few compact cells. Ultrastructurally, the prominent differences were of development in each organelle: the preclinical Cushing's adenomas had undeveloped mitochondria, which were smaller in size and had sparse cristae, lysosomes and polysomes, whereas the overt Cushing's adenomas contained well-developed mitochondria which were larger in size and were filled with abundant cristae, smooth endoplasmic reticulum (SER), lysosomes and polysomes. CONCLUSIONS: Preclinical Cushing's syndrome adenomas were ultrastructurally characterized by a reduced number of cellular organelles such as mitochondria and SER, which are necessary to synthesize glucocorticoid hormones. However, examination of a greater number of adenomas will be required to be able to draw conclusions on the ultrastructural differences between the two syndromes.