Comparative analysis of CA 242 and CA 19-9 serum tumor markers in colorectal cancer patients. A longitudinal evaluation

OBJECTIVE

Following the encouraging results obtained on CA 242 as an adjunctive marker for colorectal cancer this study was designed to compare the clinical behavior of CA 242 to that of its related marker CA 19-9.

PATIENTS AND METHODS

Sera from 630 patients with benign (n = 201) or malignant (n = 429) colorectal diseases were evaluated. Moreover, 50 patients with colorectal cancer were longitudinally monitored during. post-surgical follow-up for either a minimum of 5 years or until time of recurrence. Serum CEA, CA 19-9 and CA 242 levels were determined before treatment and at each scheduled follow-up.

RESULTS

The distribution of CA 242 levels in colorectal cancer patients demonstrated a similar positivity rate (32.9%) compared to that of CA 19-9 (29.8%), although both sensitivities were lower than that of CEA (43.8%). Moreover, elevated CA 242 serum levels were found in metastatic disease (58.2%). A longitudinal evaluation demonstrated that serum CEA, CA 19-9 and CA 242 levels were elevated in 63.9%, 63.9% and 66.7% of recurrences. Combined evaluation of CEA, CA 19-9 and CA 242 serum levels in the overall population demonstrated a complementarity of CEA with the latter two markers. Conversely, a highly significant correlation was observed, suggesting that the two assays might recognize the same macromolecular complex.

CONCLUSION

CA 242 determination does not seem to offer a particular advantage over CA 19-9, while CEA remains the marker of choice in monitoring colorectal cancer patients.

Multiple unfolded states of alcohol dehydrogenase I from Kluyveromyces lactis by guanidinium chloride

Inactivation, dissociation, and unfolding of tetrameric alcohol dehydrogenase I from Kluyveromyces lactis (KlADH I) were investigated using guanidinium chloride (GdmCl) as denaturant. Protein transitions were monitored by enzyme activity, intrinsic fluorescence and gel filtration chromatography. At low denaturant concentrations (less than 0.3 M), reversible transformation of enzyme into tetrameric inactive form occurs. At denaturant concentrations between 0.3 and 0.5 M, the enzyme progressively dissociates into structured monomers through an irreversible reaction. At higher denaturant concentrations, the monomers unfold completely. Refolding studies indicate that a total reactivation occurs only with the enzyme denatured between 0 and 0.3 M GdmCl concentrations. The enzyme denatured at GdmCl concentrations higher than 0.3 M refolds only partially. All together, our results indicate that unfolding of the KlADH I is a multistep process, i.e., inactivation of the structured tetramer, dissociation into partially structured monomers, followed by complete unfolding.

Investigation of the simian polyomavirus SV40 as a potential causative agent of human neurological disorders in AIDS patients

Neurological diseases and a variety of neoplasms frequently occur in AIDS patients. Human JC and BK polyomaviruses have been associated with neurological disorders in such patients. SV40 polyomavirus sequences have been detected in human brain tumours, other neoplasms and normal tissues. JCV, BKV and SV40 DNA sequences were investigated in cerebrospinal fluid (CSF) samples from 12 AIDS patients affected by different neurological disorders, by PCR assay and filter hybridisation with specific internal oligoprobes, and DNA sequencing. Three of the 12 CSF samples were positive for JCV (one sample) or SV40 (one) DNA, or both (one). No sample was positive for BKV DNA. JCV- and SV40-specific genomic regions were confirmed by DNA sequencing. CSF samples from the two patients diagnosed clinically as having progressive multifocal leukoencephalopathy (PML) contained either JCV (one sample) or SV40 (one) DNA. The CSF found to contain both JCV and SV40 DNA originated from a patient with a cerebral mass lesion of unknown aetiology. These results suggest that SV40 may be involved in the aetiology of PML in AIDS patients, and raise the possibility that SV40 and JCV may act synergically in vivo to enhance their pathogenicity.

Precision of the measurements of periprosthetic bone mineral density in hips with a custom-made femoral stem

Our aim was to determine the precision of the measurements of bone mineral density (BMD) by dual-energy x-ray absorptiometry in the proximal femur before and after implantation of an uncemented implant, with particular regard to the significance of retro- and prospective studies.

We examined 60 patients to determine the difference in preoperative BMD between osteoarthritic and healthy hips. The results showed a preoperative BMD of the affected hip which was lower by a mean of 4% and by a maximum of 9% compared with the opposite side. In addition, measurements were made in the operated hip before and at ten days after operation to determine the effect of the implantation of an uncemented custom-made femoral stem. The mean increase in the BMD was 8% and the maximum was 24%. Previous retrospective studies have reported a marked loss of BMD on the operated side.

The precision of double measurements using a special foot jig showed a modified coefficient of variation of 0.6% for the non-operated side in 15 patients and of 0.6% for the operated femur in 20 patients.

The effect of rotation on the precision of the measurements after implantation of an uncemented femoral stem was determined in ten explanted femora and for the operated side in ten patients at 10° rotation and in 20 patients at 30° rotation. Rotation within 30° influenced the precision in studies in vivo and in vitro by a mean of 3% and in single cases in up to 60%.

Precise prediction of the degree of loss of BMD is thus only possible in prospective cross-sectional measurements, since the effect of the difference in preoperative BMD, as well as the apparent increase in BMD after implantation of an uncemented stem, is not known from retrospective studies. The DEXA method is a reliable procedure for determining periprosthetic BMD when positioning and rotation are strictly controlled.

Precision of the measurements of periprosthetic bone mineral density in hips with a custom-made femoral stem

Our aim was to determine the precision of the measurements of bone mineral density (BMD) by dual-energy x-ray absorptiometry in the proximal femur before and after implantation of an uncemented implant, with particular regard to the significance of retro- and prospective studies. We examined 60 patients to determine the difference in preoperative BMD between osteoarthritic and healthy hips. The results showed a preoperative BMD of the affected hip which was lower by a mean of 4% and by a maximum of 9% compared with the opposite side. In addition, measurements were made in the operated hip before and at ten days after operation to determine the effect of the implantation of an uncemented custom-made femoral stem. The mean increase in the BMD was 8% and the maximum was 24%. Previous retrospective studies have reported a marked loss of BMD on the operated side. The precision of double measurements using a special foot jig showed a modified coefficient of variation of 0.6% for the non-operated side in 15 patients and of 0.6% for the operated femur in 20 patients. The effect of rotation on the precision of the measurements after implantation of an uncemented femoral stem was determined in ten explanted femora and for the operated side in ten patients at 10 degrees rotation and in 20 patients at 30 degrees rotation. Rotation within 30 degrees influenced the precision in studies in vivo and in vitro by a mean of 3% and in single cases in up to 60%. Precise prediction of the degree of loss of BMD is thus only possible in prospective cross-sectional measurements, since the effect of the difference in preoperative BMD, as well as the apparent increase in BMD after implantation of an uncemented stem, is not known from retrospective studies. The DEXA method is a reliable procedure for determining periprosthetic BMD when positioning and rotation are strictly controlled.

gammadelta T-cell anergy in human immunodeficiency virus-infected persons with opportunistic infections and recovery after highly active antiretroviral therapy

gammadelta T lymphocytes recognize non-peptidic microbial antigens without antigen processing and major histocompatibility complex (MHC) restriction, representing an early defence mechanism against invading pathogens. As a defective response to non-peptidic antigens was observed in human immunodeficiency virus-positive (HIV+) persons, the aims of this study were twofold: to analyse the incidence of gammadelta T-cell anergy in HIV+ positive patients with opportunistic infections/co-infections (HIV-OIC), and to investigate the role of highly active antiretroviral therapy (HAART) on gammadelta T-cell functions. Peripheral gammadelta T-cell distribution and in vitro reactivity to a non-peptidic mycobacterial antigen, isopentenyl pyrophosphate (IPP), were analysed. gammadelta T-cell subset distribution was altered more in HIV-OIC patients than in asymptomatic HIV+ subjects (HIV-ASY). Specifically, the Vdelta2/Vdelta1 ratio was inverted as a consequence of a decrease in Vdelta2 T-cell number. Moreover, IPP-stimulated Vdelta2 T cells from the HIV-OIC group displayed a major defect in interferon-gamma (IFN-gamma) production. Interestingly, HAART induced a sustained recovery of naive CD45RA+ and CD62L+ T cells and restored gammadelta T-cell function. Accordingly, in vitro CD45RA depletion resulted in gammadelta T-cell hyporesponsiveness. Altogether, the incidence of gammadelta T-cell anergy was increased in HIV-OIC patients and dependent on CD45RA helper function. Moreover, HAART was able to restore gammadelta T-cell reactivity, extending the immune recovery to non-peptide microbial antigens.

Soluble P-selectin and proinflammatory cytokines in patients with polygenic type IIa hypercholesterolemia

Plasma soluble P-selectin (sP-selectin), beta-thromboglobulin (beta-TG), von Willebrand Factor (vWF), prothrombin factor 1+2 (F1+2), IL-6 and IL-1beta levels were analyzed in 35 consecutive patients with polygenic type IIa hypercholesterolemia (HC) and 35 age- and sex-matched healthy subjects. sP-selectin (p < 0.005), beta-TG (p < 0.05) and IL-1beta (p < 0.02) levels were higher in HC patients than healthy subjects whereas no significant difference was observed for vWF. sP-selectin directly correlated with beta-TG (p < 0.05) and IL-1beta levels (p < 0.005), but not with the other variables analyzed. A direct correlation was observed between F1+2 and IL-6 (p < 0.05), total cholesterol (p < 0.05) or LDL cholesterol (p < 0.05). We conclude that HC is associated with an increase of plasma sP-selectin levels, and that sP-selectin may be considered as a marker of in vivo platelet activation in type IIa polygenic HC. The correlations observed among the variables analyzed in the study suggest that proinflammatory cytokines might play a role in the prothrombotic state often associated with HC.

CA 19-9 monosialoganglioside content of human colorectal tumor cells correlates with tumor cell-induced platelet aggregation

BACKGROUND

Gangliosides are involved in tumor cell-induced platelet aggregation (TCIPA). CA 19-9 is a monosialoganglioside detected in colon carcinoma cells. Therefore, this study was designed to evaluate whether there was any correlation between the CA 19-9 monosialoganglioside content and TCIPA.

MATERIALS AND METHODS

The CA 19-9 content was determined on gangliosidic extracts of human colorectal tumor cells (GEO, WiDr, DLD-1, MIP) in comparison with the degree of TCIPA.

RESULTS

CA 19-9 was detected in all cell lines, except MIP. The mean CA 19-9 content was 10.2, 30.2 and 82.6 U/microgram of sialic acid for GEO, DLD-1 and WiDr, respectively. CA 19-9 content directly correlated with TCIPA (p < 0.0001). Furthermore, incorporation of exogenous gangliosides in GEO cells resulted in an increase of CA 19-9 content, paralleled by a concomitant increase of TCIPA.

CONCLUSIONS

The CA 19-9 monosialoganglioside may be involved in platelet/tumor cell interactions, thus playing an important role in the haematogenous metastases of colorectal cancer.

Decreased CD95 expression on naive T cells from HIV-infected persons undergoing highly active anti-retroviral therapy (HAART) and the influence of IL-2 low dose administration. Irhan Study Group

The functional recovery of the immune system in HIV-infected persons receiving HAART and the role of adjuvant immune therapy are still matters of intensive investigation. We analysed the effects of HAART combined with cytokines in 22 naive asymptomatic individuals, randomized to receive HAART (n = 6), HAART plus a low dose (1000 000 U/daily) of rIL-2 (n = 8), and HAART plus rIL-2 after previous administration of granulocyte colony-stimulating factor (n = 8). After 3 months of therapy, increased CD4+ T cell counts and diminished viral loads were observed in all patients, independently of cytokine addition. A decreased expression of CD95 (Apo 1/Fas) was evident in all groups when compared with values before therapy. The percentages of peripheral blood mononuclear cells (PBMC) expressing CD95 after therapy decreased by 15%, 22% and 18% in the three treatment groups, respectively (P < 0.05). Analysis of PBMC subsets demonstrated that CD95 expression was significantly reduced on CD45RA+CD62L+ naive T cells (25.3%, 22.4%, and 18.6%, respectively; P < 0.05) in each group, after therapy. Accordingly, all patients showed a reduced rate of in vitro spontaneous apoptosis (P < 0.05). Another effect induced by HAART was a significant increase in IL-2Ralpha expression on total PBMC (P < 0.05), independently of cytokine addition. Altogether, our results suggest that very low dose administration of rIL-2 (1000 000 U/daily) may be not enough to induce a significant improvement in the immune system as regards HAART alone. The employment of higher doses of recombinant cytokines and/or different administration protocols in clinical trials might however contribute to ameliorate the immune reconstitution in patients undergoing HAART.

[Inpatient and follow-up nosocomial wound infection in orthopedics]

SUBJECT

This study was designed to determine if direct documentation (in-patients) and questionnaire (out-patients) are reliable follow-up methods to record nosocomial wound infections (NWI) after orthopedic surgery. Furthermore if postdischarge NWI were also detected without this project.

MATERIAL AND METHODS

1664 patients after orthopedic surgery were evaluated over 20 month. In-hospital infections were directly documented. Later infections were recorded by questionnaire 3 months following patient's discharge. Data of all cases with NWI were retrospectively evaluated as a control.

RESULTS

A total of 18 NWI (1.1%) were recorded. 2 of these were deep wound infections after hip or knee arthroplasty, no re-operation was required. 6 NWI (33.3%) occurred after discharge. All of these post-discharge NWI were detected in our out-patient clinics.

CONCLUSION

This study demonstrate, that postoperative wound infections surveillance must be continued after discharge. 33.3% NWI occurred after discharge and all cases were detected at our out-patient clinics. We conclude that questionnaires to record post-discharge NWI are not necessary in hospitals with routinely follow-up in out-patient clinics.

Soluble P-selectin as a marker of platelet hyperactivity in patients with chronic obstructive pulmonary disease

A comparative analysis between soluble (s) P-selectin and von Willebrand Factor (vWF) was performed in 40 patients with chronic obstructive pulmonary disease (COPD) and 20 healthy subjects, with the aim of investigating whether the occurrence of elevated levels of sP-selectin may reflect activation of platelets, endothelial cells, or both. Plasma sP-selectin levels were significantly higher in patients compared to controls (P < 0.01). Similarly vWF levels were elevated in patients compared to healthy subjects, although the difference did not reach statistical significance. Lipoprotein (a) [Lp(a)] levels were lower in COPD patients than controls (P < 0.0001). The analysis of the correlation among all the variables demonstrated that plasma sP-selectin did not correlate with vWE. Conversely, plasma sP-selectin levels significantly correlated with either oxygen (rho = -0.41, P < 0.05) or carbon dioxide (rho = 0.47, P < 0.05) tension. An inverse correlation between serum Lp(a) and plasma sP-selectin levels (rho = -0.35, P < 0.05) was also observed. Moreover, increasing levels of sP-selectin in COPD patients significantly correlated with the impairment of blood gas tensions. In conclusion, the results obtained indicate the prominent platelet origin of circulating sP-selectin, suggesting that sP-selectin might be considered a marker of in vivo platelet activation in patients with COPD.

Symptomatic bucket handle tear of the lateral meniscus after knee arthroplasty

We report on a 67-year-old women who had pain after a knee arthroplasty in the region of the lateral meniscus. The arthroscopy showed the remainder of the posterior horn of the lateral meniscus, which luxated as a bucket handle tear into the joint. The resection led to an immediate relief. This case show the importance of meticulous removal of the entire menisci during bicondylar surface replacement.

[Influence of osteoarthrosis, osteoporosis, and rheumatoid arthritis at precision of osteodensitometry of lumbar spine and proximal femur]

Precision of osteodensitometric measurements using dual energy X-ray absorptiometry (DEXA) depends on various known factors, such as positioning, aortic calcification or vertebral fractures. The purpose of this study was to investigate the influence of various diseases or bone density on the reproducibility of measurements in the lumbar spine and the proximal femur. Measurements in the LWS p.a. , LWS lat. and at Ward's triangle were made in a total of 100 patients. The subjects were repositioned between measurements. In order to be able to determine the influence of various diseases, four groups of 25 patients each were formed: three with the diagnosis osteoarthrosis, osteoporosis and rheumatoid arthritis and one control group. The mean percentual difference and coefficient of variation were calculated as the measure for reproducibility. Mean percentual differences of 0.18 to 2.6% were found in the four groups at the three measurements sites. After calculation of coefficient of variation, a value between 1.2 and 2.7% was found for LWS p.a., between 7.1 and 15.7% for LWS lat. and between 4.1 and 9.9% at Ward's triangle. It was also conspicuous that the difference in coefficient of variation in osteoporosis patients was nearly double that in the control group in all measured areas.

CONCLUSION

Lateral lumbar spinal measurements using DEXA cannot presently be recommended. LWS p.a. measurements and, with limitations, measurements at Ward's triangle have good precision and could be used for course documentation of bone density.

Muscular fatigue, maximum strength an stress reactions of the shoulder musculature in paraplegics

In paraplegic patients, shoulder complaints attributable to muscle dysbalances arising from the particular daily form of exercise are often observed. The goal of therapy is to correct these imbalances through muscular training, whereby eccentric exercise might offer advantages due to lower fatigue with concurrent higher maximum strength. This study therefore examines muscle fatigue, maximum strength, and suitability for paraplegics of eccentric exercise of the shoulder. Muscle fatigue, isokinetic peak torque, and EMG activity were determined eccentric (Ecc) and concentric (Con) in 41 paraplegic subjects (13 early rehabilitants; 16 trained in wheelchair sports; 12 untrained). Serum CK, myoglobin, and subjective pain were collected for one week after exercise. In eccentric exercise, there was less muscle fatigue in all groups. Highest Ecc/Con peak torque ratio was found in trained subjects in all movements, followed by the untrained and the early rehabilitants. EMG-activity was lower in eccentric compared to concentric exercise (Ecc/Con ratio <1). CK and myoglobin concentrations, like pain symptoms, showed a marked increase after exercise. It is concluded that the Ecc/Con strength patterns among paraplegics are altered. Eccentric exercise offers advantages on the basis of lower muscular fatigue independent of training status and lesion time and higher maximum strength with increasing duration of paraplegia and additional athletic training. However, due to structural damage and subjective pain eccentric exercise can only be recommended with reservations in therapy and training.

Phosphoantigen-reactive Vgamma9Vdelta2 T lymphocytes suppress in vitro human immunodeficiency virus type 1 replication by cell-released antiviral factors including CC chemokines

Vgamma9Vdelta2 T lymphocytes are broadly reactive against various intracellular pathogens and display both lytic and proliferative responses to human immunodeficiency virus (HIV)-infected cells. HIV infection of peripheral blood mononuclear cell cultures led to absolute increases in Vgamma9Vdelta2 T cells accompanied by decreased p24 levels. Strong gammadelta T cell activation with nonpeptidic mycobacterial phosphoantigens (TUBAg1 extract or synthetic isopentenyl pyrophosphate) resulted in potent inhibition of HIV replication through soluble released factors. Subsequent analyses showed that phosphoantigen-activated gammadelta T cells produced substantial amounts of beta-chemokines (macrophage inflammatory protein [MIP]-1alpha, MIP-1beta, and regulated-on-activation, normal T-cell-expressed and -secreted beta-chemokine [RANTES]), which represent the natural ligand for the CCR5 HIV coreceptor. Accordingly, anti-beta-chemokine antibodies neutralized the inhibition of monocytotropic HIV strains by gammadelta T cell-released factors. Moreover, a T-tropic HIV strain using the CXCR4 coreceptor for virus entry was potently inhibited. Together, these data reveal that phosphoantigen-activated gammadelta T cells are an important source of CC chemokines and may suppress HIV replication through cell-released antiviral factors.

Bone mineral density of the proximal femur after unilateral cementless total hip replacement

It was the aim of this study to examine bone mineral density changes in the non-operated contralateral femur of patients undergoing total hip replacement. Bone density in the contralateral femur of 45 patients with an average age of 54 years was measured with the aid of the DEXA technique at one week, 3 and 6 months after total hip replacement. Within the first 3 months there was an average reduction of bone density of 3.9% (3.0%-5.9%). After a further 3 months the average difference was 2.5%.

[Effect of diclofenac on human osteoblasts and their stromal precursors in vitro in relation to arthroplasty]

INTRODUCTION

Results of animal experiments have demonstrated that the osseous integration of non-cemented prostheses can, at the very least temporarily, be impaired by the application of non-steroidal antiphlogistic agents (such as diclofenac). It is the objective of this study to examine whether there is a direct influence of diclofenac used in usual clinical dosages (3 times 50 mg daily) on bone cells and their progenitor cells which would explain the observed slow integration of the prostheses.

METHODS

To investigate this, cultivated human in vitro osteoblasts and stromal bone marrow cells were incubated with increasing doses of the medications. Our study focused on the effect of diclofenac application on proliferation and functional metabolism in both cell lines. The measurable maximal plasma concentration 2 h after the application of one tablet Voltaren 50 reached 1.6 micrograms/ml. This correlated with diclofenac concentrations between 1 and 10 ml found in our experiments. The detected values were correlated to the control group (0 microgram/ml diclofenac).

RESULTS

The drug effect upon osteoblasts was higher than on progenitor cells. The proliferation of in vitro stromal bone marrow cells, compared to untreated cells, was found to be decreased. We observed a decrease to 82% at a diclofenac concentration of 1 microgram/ml, Osteoblasts exhibited a decrease to 97.5% at the same concentration. The DNA synthesis increased to 118% in stromal bone marrow cells, in osteoblasts to 144%. In contrast, we detected a neglectible decrease to 92% in the collagen synthesis of osteoblasts compared to untreated cells. The synthesis of osteocalcin by osteoblasts increased to 119%. The alkaline phosphatase activity was found to be decreased to 88% in stromal bone marrow cells and increased in osteoblasts to 111%.

CONCLUSION

Temporary inhibiting effects on osseous integration in non-cemented prosthesis by diclofenac could be caused by a disturbance in the anabolic bone metabolism, exhibited by an increase of osteoblastic osteocalcin expression. Osteocalcin as a known negative regulator of the osteoneogenesis is most likely inhibiting the collagen matrix deposition.

Simian-virus-40 footprints in human lymphoproliferative disorders of HIV- and HIV+ patients

SV40 sequences were investigated by PCR DNA amplification followed by filter hybridization in a series of human lymphoproliferative disorders obtained from human-immunodeficiency-virus (HIV)-seronegative and HIV-infected patients. Our PCR and filter-hybridization conditions enabled us to detect SV40 sequences in the range of 10(-4) to 10(-2) genome equivalents per cell. In non-Hodgkin's lymphomas (NHL) from HIV- patients, SV40 footprints were found in 11 out of 79 (13.9%) samples, while in NHL from HIV+ patients SV40 DNA sequences were detected in 2/16 (12.5%). In Hodgkin's disease (HD), SV40 sequences were found in 7/43 (16.3%) and 1/12 (8.3%) in HIV- and HIV+ patients respectively. A slightly higher prevalence of SV40 footprints was observed in reactive lympho-adenopathies both in HIV- (3/9, 33.3%) and in HIV+ (6/17, 35.3%) patients. Sequence analysis of 2 NHL and 2 HD DNA samples established that the amplified PCR products belong to the SV40 sequences. SV40 prevalence and load were similar in samples from HIV-seronegative and HIV-infected individuals, suggesting that SV40 probably does not undergo strong reactivation phenomena in the context of HIV-related immunosuppression. Moreover, the large T-antigen(Tag) expression was detected by immunohistochemistry in 5/18 SV40-DNA-positive samples analyzed; however, few tumor cells (<1%) in 3/5 samples displayed positivity for SV40 Tag, while this viral oncoprotein was revealed in several reactive histiocytes present in all 5 SV40-positive tissues. These results suggest that the lymphoid tissue could represent a reservoir for SV40 and may constitute the first step in understanding whether this DNA tumor polyomavirus has a role in the pathogenesis of human lymphoproliferative disorders.

The suppression of heterotopic ossifications: radiation versus NSAID therapy--a prospective study

This prospective, randomized study compares the effect of postoperative irradiation and nonsteroidal anti-inflammatory drug (NSAID) therapy on the prevention of heterotopic ossifications after the implantation of a total hip endoprosthesis. A total of 154 operations were performed; one group of patients underwent radiation treatment of 3 x 3.3 Gy, and the other group took 3 x 50 mg of diclofenac per day over a period of 3 weeks. Average age, sex, preoperative diagnosis, and risk factors were similar in both groups. Postoperative radiation began on average 2.9 days after operation, and the radiation therapy was finished on average within 3.8 days. NSAID prophylaxis was begun on the first postoperative day. Heterotopic ossifications occurred in two of the patients who had undergone postoperative prophylaxis by radiation. In both cases, the ossification was Brooker I, and there was no functional impairment. There were no ossifications of Brooker II-IV in this group. One patient had a Staphylococcus epidermidis infection, and fistula revision had to be carried out; the prosthesis could be left in place. In the group treated with NSAID, 16 heterotopic ossifications stage Brooker I and 2 stage Brooker II could be detected. Eleven patients stopped the treatment because of gastrointestinal problems. Both postoperative radiation and NSAID therapy have proved to be effective prophylactic methods. In direct comparison, radiation prophylaxis by 3 x 3.3 Gy proved to be slightly more successful than NSAID prophylaxis.

[Quantification of shoulder power in trained and untrained paraplegic wheelchair athletes]

Shoulder complaints are frequently observed to result from the increased stress to the upper extremities of wheelchair users. The cause may be muscle dysbalances of the stressed musculature, whereby the changed situation in the wheelchair during everyday and athletic exercise is important. To demonstrate the different importance of altered shoulder stress in the wheelchair situation and in additional athletic stress, maximum strength in the dominant shoulder was recorded in 14 trained and 13 untrained paraplegics. The goal was to examine the differences between the groups during concentric (60 degrees/s) and eccentric (60 degrees/s) shoulder exercise. Based on the strength/velocity curve, differentiation was also made between the shoulder movements in dependence on various movement velocities. Finally, a comparison was to be made with the test results of untrained and trained, non-paralyzed subjects examined by the same test methods in earlier studies. The results show higher maximum torques in both groups under eccentric stress (p < 0.001), more expressed in trained paraplegics (p < 0.001). In group comparison, there are only slight differences in concentric exercise. The comparison between untrained paraplegics and untrained normal persons (non-paralyzed) show hardly any differences. Trained paraplegics attain values comparable to those of non-paralyzed athletes in eccentric and isometric shoulder exercise. It is concluded, that objective data for determination of the strength situation in the shoulder musculature can be obtained by isokinetic strength measurements in paraplegics. Obviously, eccentric forms of exercise are particularly important. Valuable information can be obtained by determining shoulder strength in dependence on work mode and comparison with non-paralyzed subjects; the information must be interpreted according to the movement.

[SV40 as a possible cofactor in the etiopathogenesis of mesothelioma and other human tumors]

Simian virus 40 (SV40) has been introduced into the human population with contaminated polio vaccines between 1955 and 1963. Previous research conducted by southern blot hybridization and recent analysis by PCR have shown the presence of SW0 sequences in human brain tumors, mesotheliomas and osteosarcomas as well as in normal tissues such as blood and sperm fluids. SV40 RNA and T antigen were detected in the same tissues. All the samples were coinfected by BK Virus (BKV), suggesting that BKV may have a helper function for SV40 replication in human cells. The presence of SV40 in human tumors suggests that the virus may be a cofactor in the etiopathogenesis of human neoplasia. In addition, blood and semen may represent the vectors for transmission of SV40 by horizontal infection in the human population.

Diazepam reduces ultrastructural changes induced by noise stress in rat adrenal gland

Male rats were exposed to noise for 6 running hours and the effects of pretreatment with the benzodiazepine diazepam on the adrenal gland were evaluated. Ultrastructural examination showed that, after noise exposure, zona reticularis cells resulted the more affected, exhibiting areas of diluted cytoplasm, disarranged endoplasmic reticulum, membrane vestigia and some altered mitochondria; diluted cytoplasmic areas appeared in noradrenaline-storing cells, too. On the contrary, zona reticularis cells from diazepam-pretreated and noise-exposed rats resulted significantly less altered, as well as the noradrenaline-storing cells. The present findings indicate that diazepam is able to exert some protective action on adrenal gland alterations due to noise exposure.

bcl-2 automated and quantitative immunocytochemical assays in breast carcinomas: correlation with 10-year follow-up

PURPOSE

bcl-2 protein is detectable in human cancers and may be involved in the response to antineoplastic drugs or endocrine therapy in breast carcinomas. In a previous study, we had developed optimal technical conditions for bcl-2 immunodetection. The aim of the present report was to determine the prognostic significance of bcl-2 expression in breast carinomas by the use of a similar immunocytochemical procedure.

METHODS

bcl-2 immunocytochemical assays were performed on frozen sections by automated immunoperoxidase technique (Ventana) and computer-assisted analysis of digitized colored microscopic images (SAMBA) in a series of 170 breast carcinomas. The results of automated quantitative immunocytochemical assays were correlated with patient follow-up (120 months).

RESULTS

Intense bcl-2 immunocytochemical expression in tumors (cutpoint, 15%) significantly correlated with longer disease-free survival and longer recurrence-free survival in the entire cohort of patients (P = .028 and P = .035, respectively) and also in node-negative subgroups of patients (P = .028 and P = .01; Kaplan-Meier long-rank test; NCSS 6.0.1 software). But bcl-2 immunostained surfaces (cutpoint, 15%) did not correlate with overall survival. In multivariate analysis (proportional hazards regression, Cox model), bcl-2 prognostic significance in terms of disease-free survival was only independent of the tumor size and grade and histoprognostic index (Nottingham prognostic index [NPI]).

CONCLUSION

bcl-2 immunohistochemical expression is a significant indicator of favorable outcome only in terms of disease-free and local recurrence-free survival. However, bcl-2 expression in tumors is an independent weakly prognostic indicator in breast carcinomas. bcl-2 immunodetection assessed in optimal technical conditions (frozen samples, automation, quantitative analysis, scatter diagram cutoffs) may have some limited practical clinical relevance for the management of patients with breast carcinomas.