Endovascular treatment of AICA flow dependent aneurysms. A report of three cases and review of the literature

Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare, accounting for less than 1% of all cerebral aneurysms. To our knowledge 34 flow-related cases including the present study have been reported in the literature. Three patients harbouring four flow dependent aneurysms were referred to our institution. Two patients presented with subarachnoid hemorrhage, one presented with cerebellar manifestations. They were all treated by endovascular embolization of the aneurysm as well as the parent artery using liquid embolic material. Two cases were embolized using NBCA, Onyx was used in the third case. No bleeding or rebleeding were encountered during the follow-up period which ranged from five to nine months. One patient developed facial palsy, cerebellar symptoms and sensorineural hearing loss. The remaining two cases did not develop any post treatment neurological complications. Endovascular management of flow-dependent AICA aneurysms by parent artery occlusion is feasible and efficient in terms of rebleeding prevention. Post embolization neurological complications are unpredictable. This depends upon the adequacy of collaterals from other cerebellar arteries.

Correction of dorsally-malunited extra-articular distal radial fractures using volar locked plates without bone grafting

Malunion is the most common complication of the distal radius with many modalities of treatment available for such a problem. The use of bone grafting after an osteotomy is still recommended by most authors. We hypothesised that bone grafting is not required; fixing the corrected construct with a volar locked plate helps maintain the alignment, while metaphyseal defect fills by itself. Prospectively, we performed the procedure on 30 malunited dorsally-angulated radii using fixed angle volar locked plates without bone grafting. At the final follow-up, 22 wrists were available. Radiological evidence of union, correction of the deformity, clinical and functional improvement was achieved in all cases. Without the use of bone grafting, corrective open wedge osteotomy fixed by a volar locked plate provides a high rate of union and satisfactory functional outcomes.

The initial experience of safety and efficacy of argon plasma coagulation (APC) in the primary prevention of variceal bleeding

BACKGROUND AND STUDY AIMS

The well-known complications of variceal bleeding together with the high mortality rate mandate effective prophylaxis. Because of the intolerance, failure of response and lack of compliance related to B blockers and because of the high incidence of variceal recurrence after endoscopic variceal ligation (EVL), other alternatives should be investigated. As APC provides coagulation at a shallow depth, it has been considered an ideal procedure to promote mucosal fibrosis for oesophageal varices. This study aims to investigate the safety and effectiveness of APC application to the oesophagus post-variceal obliteration in an attempt to decrease variceal recurrence and bleeding, as compared to EVL.

PATIENTS AND METHODS

This study included 60 patients with chronic liver disease and portal hypertension referred to the Gastrointestinal Endoscopy Unit, Kasr Al-Aini Hospital, Cairo University, during the period from August 2008 till January 2010. Patients had to have large-sized varices (F3), without history of bleeding, portal hypotensive drugs or intervention. Patients were allocated into either group I that included 30 patients for whom EVL was performed and sequentially followed by one session of APC or group II that included 30 patients for whom EVL alone was done. Patients underwent surveillance endoscopy at 3 and 6months to evaluate variceal recurrence (F1 or more).

RESULTS

Both groups were comparable in terms of the demographic features, hepatic functional reserve and endoscopic findings. Post-APC, fever was reported in 6.7%, dysphagia in 3.3%, procedure-related bleeding in 0% and stricture in 3.3%. At 3 and 6months follow-up, both groups were comparable in terms of variceal recurrence and none of the patients in both groups developed variceal bleeding.

CONCLUSION

Although, APC application to the oesophageal mucosa is a safe technique, its additive benefit in terms of variceal recurrence and re-bleeding is comparable to EVL alone. This is encountered when only a single session of APC is applied. A more beneficial effect of multiple sessions of APC awaits further studies.

Traumatic pseudoaneurysms of the common carotid and vertebral artery in a four-year-old child

Pseudoaneurysms of the neck arteries are rare lesions usually traumatic and less frequently infectious in origin. They are often described as case reports. We describe here an unusual occurrence of pseudoaneurysms in the common carotid and vertebral artery in a four-year-old child victim of a stab wound in the neck treated by parent artery occlusion of the vertebral and common carotid arteries.

Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss

Ununited fractures of the scaphoid with extensive bone resorption are usually treated by bone grafting and internal fixation, using either an open or a minimally invasive technique. We studied the feasibility of percutaneous fixation without bone grafting in a consecutive series of 27 patients with established nonunion of an undisplaced fracture of the scaphoid and extensive local resorption of bone. They were treated by a single surgeon with rigid fixation alone, using a headless cannulated screw inserted through a volar percutaneous technique. Clinical examination, standard radiographs and CT confirmed that the fracture had united in all patients at a mean of 11.6 weeks (8 to 16), and that their functional scores had improved.

We concluded that extensive resorption at the fracture site is not an absolute indication for bone grafting, and that percutaneous fixation alone will eventually produce healing of ununited undisplaced fractures of the scaphoid regardless of the size of the gap.

First measurement of Bose-Einstein correlations in proton-proton collisions at √s=0.9 and 2.36 TeV at the LHC

Bose-Einstein correlations have been measured using samples of proton-proton collisions at 0.9 and 2.36 TeV center-of-mass energies, recorded by the CMS experiment at the CERN Large Hadron Collider. The signal is observed in the form of an enhancement of pairs of same-sign charged particles with small relative four-momentum. The size of the correlated particle emission region is seen to increase significantly with the particle multiplicity of the event.

Transverse-momentum and pseudorapidity distributions of charged hadrons in pp collisions at square root of s = 7 TeV

Charged-hadron transverse-momentum and pseudorapidity distributions in proton-proton collisions at square root of s = 7  TeV are measured with the inner tracking system of the CMS detector at the LHC. The charged-hadron yield is obtained by counting the number of reconstructed hits, hit pairs, and fully reconstructed charged-particle tracks. The combination of the three methods gives a charged-particle multiplicity per unit of pseudorapidity dN(ch)/dη|(|η|<0.5) = 5.78 ± 0.01(stat) ± 0.23(syst) for non-single-diffractive events, higher than predicted by commonly used models. The relative increase in charged-particle multiplicity from square root of s = 0.9 to 7 TeV is [66.1 ± 1.0(stat) ± 4.2(syst)]%. The mean transverse momentum is measured to be 0.545 ± 0.005(stat) ± 0.015(syst)  GeV/c. The results are compared with similar measurements at lower energies.

Reversal of Hepatic Fibrosis by Human CD34(+) Stem/Progenitor Cell Transplantation in Rats

Human umbilical cord blood (UCB) cells have many advantages as grafts for cell transplantation. Here, we transplant UCB cells into injured liver fibrosis, investigated the hepatic potential of UCB cells both in vitro and in vivo. a CCl4 rat model with liver fibrosis was prepared. Human (UCB) CD34(+) stem cell was separated with MACS (magnetic cell sorting). Cells were cultured with and without hepatic differentiation medium. Rats were divided into 3 groups; group (1): control healthy, group (2): CCl4 injected rats and group 3: CCl4/CD34(+)injected rats with human differentiated and undifferentiated cells through intrahepatic (IH) and intravenous (IV) routes. A significant elevation was detected in serum albumin in CCl4/CD34(+) compared to the CCl4 group (p<0.001). Serum ALT, had a significant decrease of its level after administration of stem cells compared to the CCl4 group (p<0.001). However, it was still significantly higher than control (p<0.001) with no significant difference between the groups that received stem cells. Histopathological examination of liver tissue showed that stem cells have a significant antifibrotic effect. Concerning gene expression, the collagen gene (rat) was highly expressed in the CCl4 group whereas its expression was significantly decreased after administration of stem cells. Human albumin and matrix metalloproteinase (MMP2) genes were expressed in liver tissues in the groups that received stem cells. Highest expression was in the group that received un-differentiated cells I.V. human UCB CD34(+) stem cells can ameliorate liver fibrosis in rats.

No correlation between radiosensitivity or double-strand break repair capacity of normal fibroblasts and acute normal tissue reaction after radiotherapy of breast cancer patients

The aim was to study the relationship between cellular radiosensitivity or double-strand break (dsb) repair capacity of skin fibroblasts and the extent of acute reaction after radiotherapy for breast cancer. The study was performed with 25 breast cancer patients submitted to the radiotherapy unit of the Egyptian National Cancer Institute after conserving surgery. Dermal fibroblasts, established from skin biopsies, were used to determine the cellular radiosensitivity via colony assay and the capacity of dsb repair by constant-field gel electrophoresis. Acute reactions were scored using the Radiation Therapy Oncology Group (RTOG) classification. The spectrum of acute reactions varied from grade 1 to 4, whereby most patients developed a grade 1 reaction after total doses ranging between 46 and 70 Gy. Skin fibroblasts showed a pronounced variation in both cellular radiosensitivity expressed as the mean inactivation dose (Dbar) (coefficient of variation, CV=25%) as well as in the number of residual dsb (CV=33%) with no significant correlation between these two endpoints (r2=0.20, p=0.14). Both parameters did not correlate with the extent of acute reaction of the respective patient. The data obtained indicate that the sensitivity of fibroblasts measured either by colony assay or by dsb repair capacity is not a major parameter determining the extent of acute reaction after radiotherapy of breast cancer patients.

Transdermal patch incorporating salbutamol sulphate: In vitro and clinical characterization

Eudragit patches containing salbutamol sulphate were prepared and evaluated as a rate-controlling membrane for transdermal use. The effect of different Eudragit polymers and various plasticizers on the permeability and mechanical properties of the prepared patches were studied. Drug patches of Eudragit polymers were prepared by a casting method employing methanol as a solvent and dibutylphthalate, polyethylene glycol 400, Propylene glycol, and triacetin as plasticizers. These patches were evaluated for weight and thickness uniformity, swelling index, tensile strength, percentage of elongation, and moisture absorption capacity. In vitro release characteristics of these patches were studied and analyzed. The patches were found to have a uniform thickness. Patches prepared using Eudragit RS 100 (T(8)) as well as RS100 + L100 in a ratio of 3:1 (T(15)) plasticized with triacetin were found to have a tensile strength lower than that of other patches. Permeability characteristics of selected patches were studied. Patch formulations T(8) and T(15) containing 10% oleic acid and 5% dimethyl formamide as penetration enhancers, respectively, displayed the highest permeability to salbutamol sulphate. These two formulations were selected for further clinical investigation and although both resulted in improvement in respiratory function tests, only the first formulation resulted in significant improvement.

Vertebral artery stump syndrome

After occlusion of flow in an artery, further ischaemic episodes are not expected due to lack of a flow conduit to carry the embolus. In the carotid stump syndrome, ongoing ischaemic events may continue due to collateral flow via the external carotid artery. We report two patients presenting with posterior circulation strokes after documented vertebral artery occlusion, due to a vertebral stump syndrome. Their presentation, the pathophysiology of cervico-vertebral anastomoses and management are described.

Diagnosis and management of galactosemia: an Egyptian experience

OBJECTIVE

To screen normal and high risk Egyptian neonates for galactosemia.

SUBJECTS AND METHODS

The study included 2238 neonates classified into two groups. Group I included screening of 1794 normal newborns. Group II included 374 high risk neonates (jaundice, hepatomegaly and failure to thrive). Group III 70 prematures. Total galactose was determined by enzymatic colourimetric method in dried blood spot (Quantase). The enzymes activities (uridyltransferase and epimerase) were measured using C14.

RESULTS

One case of galactosemia was found in the first group and 26 cases in the second group. 19 patients suffered from uridyltransferase deficiency, the parents of 16 (88.8%) of this classic form were consanguineous and 5 (27.7%) parents had history of a previously affected child. Mean age of diagnosis was 3.8 month with a mean total gal value of 52.9 mg/dl. 10 (55.5%) of them have cataract. The other 8 affected neonates were epimerase deficiency patients. 5 (62.5%) of them born to consanguineous parents. Parents of the epimerase deficiency neonates have no previously affected children. Mean age of diagnosis was 7.2 month with a mean total gal of 17.5 mg/dl. All eight patients have cataract.

CONCLUSION

Mass screening program is not available yet in Egypt. Screening of the high risk neonates is a priority. Diagnosis of different galactosemia forms is mandatory to structure the management strategy accordingly. (Fig. 4, Ref: 26.)

Multivariate analysis of bcl-2, apoptosis, P53 and HER-2/neu in breast cancer: a short-term follow-up

BACKGROUND

Several molecular genetic alterations in breast cancer, including aneuploidy, altered apoptosis, aberrant expression of p53, HER-2/neu and Bcl-2, have been associated with poor prognosis in breast cancer patients. To determine the importance of molecular-genetic factors relative to more traditional surgical-pathological prognostic factors, multivariate analysis was performed.

PATIENTS AND METHODS

Ninety-four fresh tissue samples of primary breast carcinoma were studied with flow cytometry for DNA ploidy. On the same specimens, steroid hormone receptors (ER and PR) were measured in the cytosol fraction using Abbott ELISA assays. HER-2/neu was determined in the membrane fraction and mutant p53 protein in the nuclear fraction, both, by Oncogene Science ELIZA procedures. Bcl-2 and apoptosis (cell death) were measured in cell lysates by Oncogene Science & Boehringer Mannheim ELISA assays. In addition, information regarding surgical-pathological features of the tumor was obtained. Multivariate analysis using an unconditional logistic regression model was done to identify variables predictive of poor prognosis.

RESULTS

Using univariate analysis, histological grade, tumor stage, lymph node status, HER-2/neu and mutant p53 were predictive of poor short-term prognosis. By multivariate analysis, tumor stage, lymph node status and HER-2/neu were independent factors. Grade subgroup analysis versus time of relapse, illustrated a predictive value of Bcl-2 in only low-grade tumors while apoptosis was significant in high-grade type.

CONCLUSION

Among a panel of molecular-genetic factors investigated, HER-2/neu was the most strongly predictive of poor short-term prognosis in breast cancer. Patients with HER-2/neu-positive tumors can benefit from Herceptin therapy.

Pattern of meningitis in Al-Ain medical district, United Arab Emirates--a decadal experience (1990-99)

OBJECTIVES

Haemophilus influenzae vaccine was introduced in the United Arab Emirates in 1999. Our objective was to describe the pattern of meningitis in a health district in the decade before the introduction of the vaccine and compare it with the data from elsewhere.

METHODS

For this retrospective study we included 128 meningitis cases reported from 1990 to 1999. Information on the cases was abstracted from the case notification forms and clinical and laboratory data from the hospital case notes.

RESULTS

H. influenzae was the most common cause of bacterial meningitis (n=59, 46.1%) followed by Streptococcus pneumoniae (n=20, 15.6%). Meningitis was a disease primarily of infants and children and the median age was 15 months. One fifth of the patients (n=27) had neurological sequelae of which 33.3% had seizures and 25.9% developed deafness. 18.9% (10 out of 53) of H. influenzae isolates were resistant to ampicillin compared with 5.9% (3 out of 51) to chloramphenicol. 78.9% (15 out of 19) of S. pneumoniae isolates were susceptible to penicillin.

CONCLUSIONS

The epidemiology of meningitis in our health district is similar to the epidemiology of meningitis during the pre-vaccine era in other countries.

Rectus sheath haematoma: an unusual diagnosis

Rectus sheath haematoma is a very rare occurrence. There were four cases in this hospital within a three month period. In this article, these cases, their investigation and management arc reported. A review of the literature was undertaken to ascertain how best to diagnose and treat this condition.

Corticosteroid prophylaxis for neurologic complications of intravenous immunoglobulin G therapy in childhood immune thrombocytopenic purpura

To assess in a retrospective analysis if there is evidence suggesting corticosteroids can prevent the neurologic complications of intravenous immunoglobulin (IVIG) therapy in children with immune thrombocytopenic purpura (ITP). From March 1985 to September 1997, 112 children received IVIG (1 g/kg/day for one or two dosages) for the treatment of ITP. During the years 1990 to 1997, 23 children nonrandomly received a short course of prednisone (2 mg/kg/day during and for 3 days after the completion of IVIG therapy) as a prophylaxis against the neurologic complications of IVIG therapy. The authors analyzed the data of all 112 children and compared the incidence of neurologic complications in those who received prednisone prophylaxis with those who did not. The severity of the complications was assessed as follows: grade 1, headache only; grade 2, headache plus vomiting; grade 3, headache, vomiting, and fever; grade 4, headache, vomiting, fever, and meningeal signs (aseptic meningitis). Of the 23 children who received prednisone prophylaxis, 2 (8.7%) experienced headache and vomiting after the completion of prednisone prophylaxis. Of the 89 children without prednisone prophylaxis, 27 (30.3%) experienced neurologic symptoms of varying severity, including one patient with aseptic meningitis proven by examination of the spinal fluid. Twelve of these patients needed additional hospital care for the complications. Children receiving prednisone had a 78% lower risk of neurologic complications (OR = 0.22; CI = 0.05-0.90; P = 0.036). This retrospective study shows a short course of prednisone therapy, given during and until 3 days after the completion of IVIG infusion, is likely to decrease the incidence and severity of neurologic complications of IVIG in children with ITP.

Psychologic response of the edentulous patient after primary surgery for oral cancer: A cross-sectional study

STATEMENT OF PROBLEM

Edentulous patients can have difficulty in tolerating dentures and this may lead to psychologic disturbance. The problem is potentially more severe for edentulous patients after primary surgery for oral cancer, where treatment can include composite resection and reconstruction, followed by adjuvant radiotherapy.

PURPOSE

This study investigated the psychologic response and oral satisfaction of edentulous patients treated by surgery for oral squamous cell carcinoma, and to make a comparison to edentulous noncancer counterparts.

METHODS AND MATERIAL

The cross-sectional study included patients who were alive and disease-free 2 to 3 years after primary surgery. Seventy patients underwent surgery at the Regional Maxillofacial Unit, Liverpool, in 1993 and 1994. Twenty-eight patients were disease-free; 26 completed questionnaires that included a general health questionnaire (GHQ), a body satisfaction scale, a self-esteem scale, an oral symptom checklist, and a denture satisfaction questionnaire. Comparison was made with 98 noncancer edentulous patients from the same unit.

RESULTS

There were similarities in psychologic and oral satisfaction scores between the noncancer and cancer edentulous patients. Cancer patients reported lower self-esteem (P <.02). Cancer patients who were not rehabilitated with either conventional or implant-retained prostheses had significant psychologic morbidity as measured by the GHQ, self-esteem, and body satisfaction scales. Cancer patients with implant-retained overdentures reported greater satisfaction with their dentures compared with their counterparts who wore conventional dentures (P <.05).

CONCLUSION

Edentulous cancer patients who do not achieve oral rehabilitation after surgery for oral cancer exhibited significant psychologic morbidity. Patients with implant-retained overdentures exhibited a tendency to adopt the same psychologic response with improved denture satisfaction as edentulous patients with conventional dentures, despite the former having more extensive disease that would otherwise make the provision of dentures much more difficult if implants were not used.

Human immunodeficiency virus-associated diarrhea and wasting in Zambia: selected risk factors and clinical associations

A significant association was observed among human immunodeficiency virus (HIV)-positive adult cases in Lusaka, Zambia compared with HIV-negative controls for chronic diarrhea (68% versus 22%; P < 0.05), weight loss (54% versus 30%; P < 0.05), lymphadenopathy (44% versus 15%; P < 0.05), and skin eruption (33% versus 7%; P < 0.05). Among the HIV-positive children, a higher proportion had clinical evidence of tuberculosis when compared with HIV-negative children (8% versus 1%; P < 0.05). The study demonstrated an association between weight loss in HIV-positive adults and children and chronic diarrhea (odds ratio [OR] = 12.7, 95% confidence interval [CI] = 6.4-25.5; P < 0.001), persistent cough (OR = 7.2, 95% CI = 2.9-14.5; P < 0.001), and an age of 31-45 years (OR = 3.8, 95% CI = 1.8-8.3; P < 0.01). The factors associated with mortality in HIV positive patients included chronic diarrhea (OR = 7.4, 95% CI = 1.6-34; P < 0.01), and lymphadenopathy (OR = 3.89, 95% CI = 1.2-12.2; P < 0.04).

The Marrara syndrome: a hypersensitivity reaction of the upper respiratory tract and buccopharyngeal mucosa to nymphs of Linguatula serrata

The Marrara syndrome, like Halazoun in Lebanon, is a hypersensitivity reaction of the upper respiratory tract and buccopharyngeal mucosa to nymphs of Linguatula serrata. The condition follows the consumption of Marrara which consists of raw liver, lungs, trachea and rumen of goats and sheep infected with larvae of L. serrata. The adult worm is found in the nasal passages of dogs. Sheep and goats are infected by eggs from infected dogs. A survey that included 240 adult individuals in a village of endemic L. serrata infection in the Sudan showed that 20% experienced symptoms of allergic nasopharyngitis (Marrara syndrome) following the consumption of raw viscera of goats or sheep at least once in their life. In a prospective study of 24 patients who reported to hospital with the Marrara syndrome, the clinical features included itching in the throat and nose, unilateral conductive deafness, tinnitus and facial palsy. Secondary bacterial infection caused suppurative otitis media. Adult L. serrata parasites were found in the nasal passages of 56 and 47% of male and female dogs in the endemic area. Nymphs were recovered from the mesenteric lymph nodes, lungs and livers of goats in the area.

Topical treatment of erectile dysfunction: randomised double blind placebo controlled trial of cream containing aminophylline, isosorbide dinitrate, and co-dergocrine mesylate

OBJECTIVE

To examine the effectiveness in treating impotence to topically applied cream containing three vasodilators--aminophylline, isosorbide dinitrate, and co-dergocrine mesylate--which act by different mechanisms.

DESIGN

Randomised double blinded placebo controlled crossover trial over two weeks.

SUBJECTS

36 men with erectile dysfunction randomly allocated to two equal groups.

INTERVENTIONS

Active cream containing aminophylline 3%, isosorbide dinitrate 0.25%, and co-dergocrine mesylate 0.05% for one week and placebo for another.

MAIN OUTCOME MEASURES

Patients' reported experience of penile responses and side effects of treatment in questionnaires. Penile tumescence and arterial flow in the laboratory.

RESULTS

21 patients reported full erection and satisfactory intercourse with the active cream. Three men reported full erection and satisfactory intercourse with either cream. The active cream was more effective in psychogenic than organic impotence (eight out of nine men with psychogenic impotence achieved a full erection upsilon four out of eight with neurogenic impotence and two out of seven with arterial insufficiency). No major side effects were reported. In the laboratory the active cream increased penile arterial flow (0.19 (SD 0.08) m/s upsilon 0.02 (0.15) m/s with placebo) and induced tumescence in 24 patients.

CONCLUSIONS

Topical treatment with a cream containing three different vasodilators might be considered before intracavernous injection of vasoactive agents, particularly in psychogenic impotence.

Myelo-ablative therapy with peripheral blood progenitor cell (PBPC) support in patients with haematological malignancy

BACKGROUND

Myelo-ablative therapy with peripheral blood progenitor cell (PBPC) support is increasingly being used in patients with haematological malignancy considered to be at high risk for recurrence. The results of this approach, in comparison with the previous experience at St. Bartholomew's Hospital (SBH) using autologous bone marrow transplantation form the basis of this report.

PATIENTS AND METHODS

42 patients (age range 18-63 years, median 42 years), deemed to have a poor prognosis with conventional therapy received myelo-ablative therapy with PBPC support. Diagnoses comprised: non-Hodgkin's lymphoma (NHL): 16 patients, Hodgkin's disease (HD): 9, Multiple Myeloma (MM): 12, and solid tumours (ST): 5. PBPC were mobilised using adriamycin: 35 mg/m2 i.v. on day 1 and etoposide 100 mg/m2 orally, days 1-5, followed by G-CSF: 5 micrograms/kg, subcutaneously, for a median of 7 days (range 6-9 days).

RESULTS

A total of 67 PBPC collections were performed, 1 being 'sufficient' (i.e. mononuclear cells > or = 1.5 x 10(8)/kg and CD34+ cells > or = 1 x 10(6)/kg) in 21 of the 42 patients. The median time to haematological recovery following reinfusion of PBPC was 13 days for both neutrophils > 0.5 x 10(9)/l and platelets > 20 x 10(9)/l (ranges: 8-27, and 8-48 days, respectively) which is significantly shorter than for patients in the historical control group. Supportive care requirements were also significantly reduced, as was the duration of hospital stay i.e., median 19 days (range 12-73 days) compared with 29 days (range 9-180 days).

CONCLUSION

These results confirm rapid blood count recovery following myelo-ablative therapy with PBPC support and the feasibility of this approach.

Determination of soluble interleukin-2 receptor in human seminal plasma

Following lymphocyte activation a soluble form of TAC antigen is released. This soluble molecule (soluble interleukin-2 receptor, SIL-2R) seems to corresponds to a truncated extracellular part of the membrane-bound TAC antigen, being smaller than its cellular counterpart. SIL-2R was determined and correlated with PMN elastase levels in the seminal plasma of 79 adult men having different concentrations of PMN elastase (0-700 micrograms/L). The normal level of SIL-2R was detected in the seminal plasma of 15 healthy men. The mean +/- SEM was 101 +/- 29 units/mL. The relation between PMN elastase in human seminal plasma as an index for the state of lymphocyte activity and the sperm motility is also investigated.

The relationship of plasminogen activators and oncogenes to tumour invasion

Accruing evidence suggests an association between increased activity of plasminogen activators and transformed cells, and urokinase activity with tumour aggressiveness. The PIP2 pathway seems to provide a link between oncogene-associated transformation, cellular proliferation, plasminogen-activator expression and tumour invasion and metastasis.

Plasminogen activators in experimental colorectal neoplasia: a role in the adenoma-carcinoma sequence?

An important step in the transition from adenomatous polyp to invasive carcinoma is the degradation of the epithelial basement membrane. By the generation of plasmin, plasminogen activators may play an important role in regulating the extracellular protease activity required for this event to occur. The production of biofunctional urokinase and of tissue plasminogen activator was therefore investigated in the dimethylhydrazine induced rat model of colorectal neoplasia. Both adenomatous polyps (p values less than 0.001) and colorectal carcinomas (p values less than 0.001) were demonstrated to produce a significant excess of both urokinase and tissue plasminogen activator when compared with macroscopically normal colon. There was, however, no increased production of either enzyme by macroscopically normal preneoplastic colon when compared with control colon. This enhanced capacity of colorectal tumours to produce plasminogen activators and generate plasmin is thus a feature of both the premalignant as well as the malignant phenotype. These enzymes may contribute to the malignant potential of adenomatous polyps and to the invasive capacity of established carcinomas.

Role of urokinase in colorectal neoplasia

The biofunctional activity of the plasminogen activators urokinase and tissue plasminogen activator has been measured in extracts from 50 colorectal carcinomas and 21 adenomas using a bioimmunoassay. Compared with control mucosa urokinase activity was significantly elevated in adenomas (P less than 0.001) and carcinomas, levels being significantly higher in carcinomas (P less than 0.05). In contrast tissue plasminogen activator activity was reduced in adenomas (P less than 0.01) and carcinomas, levels being significantly lower in carcinomas (P less than 0.01). Although enzyme activity did not relate to Dukes' stage or histological grade urokinase activity was higher in carcinomas with venous invasion (n = 17, P less than 0.05), in those with moderate or extensive local spread (n = 27, P less than 0.05) and in cases where a palliative resection only was feasible because of advanced disease (n = 8, P less than 0.05). Urokinase has been implicated in tissue degradation as well as fibrinolysis and may play a role in tumour invasion and metastasis in human colorectal neoplasia.

Tissue plasminogen activators in breast cancer

Increased levels of tissue fibrinolytic activity have been detected in some malignant tumours and they have been implicated in metastatic spread. We have investigated tissue plasminogen activator (tPA) and urokinase (UK) in 26 breast carcinomas and 13 benign breast biopsies. Tissue extracts were analysed for overall fibrinolytic activity on fibrin plates and by fibrin-overlay zymography after electrophoresis on SDS-PAG. Supernatants of the extracts were analysed by an antigenic immunoassay (ELISA) and a functional bioimmunoassay (BIA) using polyclonal antibodies. Total ELISA and BIA results correlated (P less than 0.001) and all the tissues contained similar tPA levels. Malignant extracts contained significantly increased UK compared with benign extracts (1.60 +/- 0.37 iu, 0.36 +/- 0.16 iu; P less than 0.002). Zymography showed no high molecular weight inhibitor complexes and UK was almost exclusively confined to the malignant tissues (P much less than 0.02). The results suggest that malignant transformation of breast tissue is associated with the significantly increased production of UK. This may be responsible for the characteristics of malignancy or it may be a growth factor.