The effects of tamoxifen therapy on the endometrium

From January 1992 to December 1998, 219 women (aged between 30 and 81 yrs; average 55 years) affected by breast cancer were treated. These women in addition to the usual adjuvant therapy, were treated with TAM 20 mg/day, for a period between 24 and 72 months (average 40). In this group there were 84 postmenopausal and 31 premenopausal women. In 8 fertile patients ovarian activity was suppressed with GnRh analogue therapy and one patient underwent attinic castration. Before performing TAM therapy, a hysteroscopic exam was done and patients were followed-up with an annual check-up. None had any endometrial side-effects after the first check-up. After two years, 31 women (26.9%) complained of endometrial alterations (hyperplasia, polyps and endometrial cancer). One women only after 6 years of follow-up, had metrorrhagia; an endometrial adenocarcinoma was found. We would like to point out the necessity of monitoring these patients with an annual check-up (transvaginal sonography and/or hysteroscopy).

Endometrial cancer: preoperative evaluation of myometrial infiltration magnetic resonance imaging versus transvaginal ultrasonography

From January 1996 to December 1998, 33 patients with endometrial carcinoma were preoperatively examined in our department; 30 women underwent transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI), and 3 only TVUS. Diagnosis was obtained by histopathological examination of the tissue removed by hysteroscopically controlled biopsy or by curettage of the uterine cavity. TVUS and MRI were performed a few days before surgery. After surgery the uterus was histopathologically examined by a pathologist in order to evaluate the depth of myometrial invasion. The results were compared with TVUS and MRI data to determine sensibility and specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two methods. According to the results of the present study we conclude that: TVUS is a low cost, easily performed and reliable method in a high percentage of cases if carried out by a skilled ecographist. MRI, is more expensive and has a lower specificity and sensibility index; it is a valid method if the cervical canal is involved and/or myometrial invasion is > 50% (M2) and if lymphatic invasion has to be investigated.

Evaluation of a displacement assay with tamoxifen as prognostic indicator in breast-cancer patients with estrogen-receptor-positive tumors

A displacement assay with tamoxifen, based on the relative binding affinity of tamoxifen and estradiol for the estrogen receptor (ER), was proposed in 1990 as prognostic indicator for breast-cancer patients. Validation of its predictive results in relation to the outcome of 73 patients with ER+ tumors is analyzed. ER, progesterone receptor (PgR) determinations and other conventional prognostic factors in relation to the displacement assay, were considered. Displacement assay results allowed ER+ tumors to be grouped as displaceable (D) or weakly displaceable (WD), with the implication that D tumors should respond better to tamoxifen (Tam) administration. Survival and disease-free interval curves showed highly significant differences between patients with ER+ D and ER+ WD tumors. For survival, including all tumor stages, 73.9% of patients were alive at 9 years after surgery in the group with D tumors and 37.0% in the group with WD tumors (p < 0.005); relative contribution of the different stages is analyzed. Addition of axillary-node number increased the prognostic significance of displacement categories for survival and disease-free interval. PgR determination as another ER functional expression failed to show significant differences for survival and disease-free interval between ER+ PgR+ and ER+ PgR- tumors. Thus, results from the displacement assay and from PgR determinations reflect 2 independent ER functional expressions. Displacement assay data appear as reliable prognostic indicators of breast-cancer outcome, and contribute to more appropriate treatment decisions in this pathology.

Sporadic fundic gland polyps: an immunohistochemical study of their antigenic profile

Fundic Gland Polyps (FGPs) are small sessile (2-5 mm), usually multiple polyps arising in the gastric, acid-secreting mucosa of disputed histogenesis. They have been described in a sporadic form, prevalently in middle aged females, or associated with familial adenomatosis coli-Gardner's syndrome. We performed an immunohistochemical study on 24 sporadic FGPs, using monoclonal antibodies (MAbs) against differentiation markers, class II MHC antigens (HLA-DR), oncofetal and proliferation antigens, aimed to characterize the antigenic profile of the polyps. A preliminary cytogenetic study on five polyps was also done, using an in situ culture method after collagenase treatment. Cytokeratins 8-18 (CAM 5.2 MAb) and 20 (IT-Ks 20.8 MAb), Epithelial Membrane Antigen (EMA) and Chromogranin A were normally expressed by FGPs. FGPs did not express HLA II DR. FGPs did not react with an anti-CEA MAb (F6), but they were frequently positive (22/24, 91.6%) with B72.3 MAb (reacting with the cancer-associated mucin epitope sialyl-Tn). The PC10 MAb (against PCNA or cyclin) showed enhanced expression in the deep glandular-cystic compartment of FGPs; the PCNA index of FGPs was significantly higher than in normal fundic mucosa. The cytogenetic study on the 5 cases analysed, revealed a normal karyotype. We have demonstrated that FGPs express in the paranuclear zone the sialyl-Tn epitope, a side-chain sugar normally masqued in adult gastric mucins, thus revealing an alteration in mucin synthesis; FGPs' higher proliferation index as compared with normal fundic mucosa supports the hypothesis of their hyperproliferative nature.

[Vaginal colonization of Streptococcus B in pregnancy]

In the last few years the importance of GBS as the cause of serious neonatal sepsis has become more evident. The number of cases of this infection clearly exceeds the number of other congenital infections, for which antenatal screening is performed. Asymptomatic colonization of the genital tract of the pregnant woman has the most important role in transmission of GBS and several risk factors are connected to neonatal infection. In order to assess the epidemiological situation in Tuscany, 5079 pregnant women have been recruited by the Obstetrical Department of 16 Hospitals and evaluated for the vaginal colonization by GBS. 3654 couples mother-neonate have also been studied to ascertain the transmission of this germ to the neonate. A vaginal swab was collected at the admission to the Hospital at delivery-time and swabs from several sites of the neonate were obtained just after birth. A blood-agar culture and a latex agglutination test were employed to detect the GBS. GBS was present in 6.6% of the vaginal cultures, with a wide variation in colonization rates. 2.2% of the neonates were positive. The transmission of GBS from the positive mother to the neonate occurred in 20% of the cases. Furthermore one positive neonate out of three was born from a negative mother. No correlation between GBS positivity and preterm delivery was found. The rates of prevalence of GBS in our population, both mother and neonates, suggest a situation that can no longer be neglected. Our data are probably underestimated because of the low sensibility of the culture method. A preventive strategy has to be employed to avoid serious neonatal sepsis. An antenatal screening that provides a vaginal culture at the 36th week of gestation and a chemoprophylaxis intra-partum in the positive cases appears to be the most effective approach.

[Serum pancreatic enzymes in patients with chronic renal failure on hemodialysis and in transplant patients]

OBJECTIVE

The aim of this study was to evaluate which of serum pancreatic enzymes was less influenced by chronic renal failure (CRF).

MATERIALS AND METHODS

40 patients with CRF undergoing hemodialysis (A group) and 24 renal transplant patients (B group) were considered. None of these patients showed clinical and instrumental findings of exocrine pancreas disease. Total amylase (T Amy), pancreatic isoamylase (P Amy), lipase (L) and Elastase-1 (E-1) were measured (in A group immediately before hemodialysis).

RESULTS

In A group T Amy and P Amy showed a significant correlation with serum creatinine level. In A group T Amy serum levels were increased in 65% of cases, P Amy in 72.5%, L in 47.5%, E-1 in 10%; in B group T Amy serum levels were increased in 41.6%, P Amy in 20.1%, L in 8.3% and E-1 in 4.1%. Statistical comparison showed a significantly lower percentages in B group considering P Amy (p < 0.001) and L (p = 0.003).

CONCLUSIONS

Our data suggest that E-1 is the only pancreatic enzyme whose specificity is not limited by CRF and thereby may be of value in the diagnosis of the exocrine pancreatic disease in patients with CRF on hemodialysis.

Oxytocin reduces the activity of N-methyl-D-aspartate receptors in cultured neurons

N-Methyl-D-Aspartate(NMDA)-sensitive glutamate receptors, are critically involved in the induction of the learning process. Activation of NMDA receptors by glutamate lead to massive influx of extracellular Ca2+, with ensuing activation of a variety of Ca(2+)-dependent enzymes, including protein kinase C. This triggers a cascade of intracellular reactions which is essential for memory formation. In culture neurons, high concentrations of oxytocin (> 1 microM) attenuate the stimulation of 45Ca2+ influx promoted by glutamate through the activation NMDA receptors. In addition, the hormone reduces glutamate-stimulated [3H]4-beta-phorbol 12,13-dibutyrate (PdBu) binding in intact cells, a parameter that reflects the translocation of protein kinase C from the cytosol to the cell membrane. Taken collectively, these results indicate that oxytocin reduces the activity of NMDA receptors, thus impairing one of the major substrates for the induction of learning and memory.

[A microbiological evaluation of the use of roxithromycin in oral odontogenic infections]

Odontogenic infections are the primary infections caused by indigenous oral bacteria, when a factor changes their perfect equilibrium. We studied 30 samples from patients with odontogenic infections that were submitted to therapy with roxithromycin. Our results showed that 79% of aerobic and 71% of anaerobic bacteria, responsible for odontogenic infections, were sensitive to roxithromycin.

[Splenic arteriovenous fistula (a clinical case)]

A splenic arteriovenous fistula is a situation often presenting with signs of portal hypertension and with a characteristic murmur. Though rare, the possibility of a splenic arteriovenous fistula must be borne in mind in differential diagnosis, since it can be corrected surgically by resolving the portal hypertension.

The use of bone scan to evaluate total hip prostheses. A preliminary study

The authors conducted a clinical and radiographic study on a group of 43 patients with hip arthroprostheses selected from the three-year period from 1984 to 1987, characterized by no immediate postoperative complications, no positional defects on X-ray examination, and with a Renther test greater than 1. Prostheses were cemented, cementless and combined. Scintigraphy was evaluated for areas of subdivision in the proximal end of the femur and acetabulum, making a semi-quantitative comparison of the intensity of captation of each area with that of the skull and sacroiliac synchondrosis. The authors emphasize that this procedure is both reliable and easy for the early determination (pre-clinical and pre-radiographic) of any complications. A scintigraphic examination of the single areas was also capable of revealing the site and entity of prosthetic bone-to-implant interactions. According to the results reported, PCA prostheses seem to be characterized by better biocompatibility.

[Evaluation of the efficacy of haloperidol decanoate in the treatment of chronic psychotic hospital patients]

The purpose of our experience was to determine the efficacy of haloperidol decanoate during the treatment of chronic psychotic in-patients. So we included, in an open study, 30 patients hospitalized in the Esquirol and Magnan Departments of the National Hospital of Mental Health "Dr. Braulio A. Moyano". As a result of this study, we have observed that to the already known properties of this drug, it may be added, because of its new depot formulation, the following advantages: a) it replaces effectively the daily intake of neuroleptics; b) it allows the reduction of the dose of oral neuroleptics as well as the number of drugs combination; c) it diminishes the incidence of extrapyramidal symptoms, allowing the reduction of the dose or the interruption of antiparkinsonian drugs; d) it facilitates the nurse's labor; e) it allows the physician to be sure of the fulfillment of his prescription.

Hemodynamic effects of molsidomine vasodilatory therapy in acute myocardial infarction

The hemodynamic effects and duration of action of 4 mg of intravenous molsidomine (M), a new peripheral vasodilator antianginal agent, were evaluated and compared to those of 10 mg sublingual isosorbide dinitrate (ISDN) in 12 patients with uncomplicated acute myocardial infarction (AMI). Both M and ISDN produced marked decreases in mean right atrial pressure (RAP), mean pulmonary capillary wedge pressure (WP), and mean pulmonary arterial pressure. The maximal decreases in RAP (-56%) and WP (-35%) with intravenous M intended to be more pronounced than with sublingual ISDN (RAP-35% and WP-29%). Physiologic modest declines in systemic vascular resistance, cardiac output, and arterial pressure were similar with the both drugs. The duration of action of M was longer (average 5 hours) than that of ISDN (2 hours). No patient experienced hypotension, tachycardia, or other adverse responses following M, suggesting that M is well isolated by patients with normotensive AMI.

Iatrogenic hyperstimulation of the ovary with ascites. Report of a case and considerations and management

The authors describe a case of iatrogenic hyperstimulation of the ovary with ascites in a patient with primary amenorrhea and hypogonadotropic hypogonadism. They present the results of total urinary estrogen assays stressing the advisability of a technical check in the presence of an apparently abnormally high estrogen excretion during HMG therapy. The patient's biochemical and hematological data during the stage of clinical hyperstimulation are set out and management is discussed. Finally, the usefulness of timely and adequate albumin administration under CVP control is stressed and the possibility of clinical application of the result of recent experimental research (viz. antihistamines is discussed.