Subunit interaction and function of clathrin-coated vesicle adaptors from the Golgi and the plasma membrane

Clathrin in coated vesicles is linked to transmembrane receptors by adaptor protein complexes. The Golgi-associated adaptor complex HA1 is a tetramer, made up of beta', gamma, 47-kDa, and 20-kDa subunits, whereas the tetrameric plasma membrane adaptor, HA2, contains alpha, beta, 50-kDa, and 16-kDa subunits (Ahle, S., Mann, A., Eichelsbacher, U., and Ungewickell, E. (1988) EMBO J. 7, 919-929). Here we report on the structural organization of adaptor subunits as revealed by proteolytic dissection. We show that the beta' and gamma subunits of HA1 are cleaved into 60-67-kDa "trunk" and 32-44-kDa "head" fragments. Interactions between adaptor subunits involve the trunk domains only. In overall organization of their domains, the Golgi and plasma membrane adaptors are very similar. The similarity encompasses also the location of phosphorylated serine residues in the alpha a, beta, beta', and gamma subunits, which are found in the head domains in all cases. In the alpha a and beta subunits they probably occur in the proline- and glycine-rich hinge region, which connects the head to the trunk. Identical adaptor fragments were obtained by controlled digestion of clathrin-coated vesicles. Under conditions that did not affect the integrity of the clathrin heavy chain, the adaptor head fragments were always quantitatively released from coated vesicles. The release of the bulk of the adaptors occurred concomitantly with the cleavage of their beta-type subunits (beta and beta') and under buffer conditions that prevent aggregation of adaptors. These observations taken together with the results of reconstitution experiments confirm and extend previous data (Ahle, S., and Ungewickell, E. (1989) J. Biol. Chem. 264, 20089-20093) which suggested that adaptors attach to clathrin through their beta-type (beta and beta') subunits. Moreover, high affinity interaction between adaptors and clathrin requires the participation of regions from both the head and trunk domains of the beta-type subunits.

Immunocytochemical differential diagnosis of diffuse malignant pleural mesotheliomas--a clinicomorphological study of 158 cases

Formalin-fixed paraffin-embedded material of 158 diffuse malignant pleural mesotheliomas (DMPMs) was used in order to determine the differential diagnostic value of immunocytochemical probes against 9 different antigens. While vimentin expression was found in only 50% of cases, regardless of their histological subtype all tumours were found to be cytokeratin-positive when an antibody with broad-spectrum cytokeratin reactivity was used. Conversely, none of the cases was immunostained by antisera against carcinoembryonic antigen (CEA), Leu-M1 antigen, chromogranin, S-100 protein, lysozyme and a T-cell associated antigen. The density of inflammatory cell infiltrates reactive with antisera against the three latter antigens was not associated with the clinical behaviour of the neoplasms examined. Eight DMPM cases showed immunoreactivity with HEA-antibodies against Egp 34, an antigen previously supposed only to be expressed by carcinomas. On the basis of these findings, the consistent cytokeratin reactivity, also of the sarcomatous type of DMPM, may help to exclude metastatic involvement of the pleura by a mesenchymal neoplasm of other origin. CEA and Leu-M1 staining of a given pleural tumour, on the other hand, is indicative of a carcinoma secondarily afflicting the pleura, thus making the diagnosis of primary DMPM unlikely.

The role of a commercial latex agglutination test in the diagnosis of group B streptococcal infection in neonates

An open prospective multicenter study was conducted in order to evaluate the Wellcogen Strep B latex agglutination test in the diagnosis of group B streptococcal (GBS) infections in neonates. Twenty-three (5.9%) of 391 urine specimens and 5 (1.2%) of 404 sera assayed were positive. The results of the urine tests corresponded to a sensitivity of 0.78 for bacteremic, 0.50 for non-bacteremic and 0.53 for all GBS associated (bacteremic, non-bacteremic and suspected) infections. After 20-25-fold concentration of urine specimens the sensitivity increased to 1.0 for bacteremic, 0.67 for non-bacteremic and 0.78 for all GBS associated infections. The specificity of the test was high (0.93 for concentrated urines), and the predictive value of a positive test (Pvpos) was 0.68. A positive latex test was highly predictive of positive surface cultures for GBS (Pv pos = 0.83 after concentration).

Mapping of antigenic epitopes on the alpha 1 subunit of the inhibitory glycine receptor

The inhibitory glycine receptor (GlyR) is a ligand-gated chloride channel protein that occurs in developmentally regulated isoforms in the vertebrate central nervous system. Monoclonal antibodies (mAbs) against the GlyR distinguish neonatal and adult GlyR proteins by identifying distinct alpha subunit variants within these receptor isoforms. Here, bacterially expressed fusion proteins of the rat GlyR alpha 1 subunit were used to localize the major antigenic epitopes of this protein within its N-terminal 105 amino acids. Synthetic peptides allowed further fine mapping of two mAb binding domains. MAb 2b, specific for the adult alpha 1 subunit, bound to a peptide corresponding to amino acids 1-10, whereas mAb 4a, which recognizes both neonatal and adult GlyR isoforms, reacted with a peptide representing residues 96-105 of the alpha 1 polypeptide. These data define unique and common antigenic epitopes on GlyR alpha subunit variants.

Melatonin and the ovulatory luteinizing hormone surge

A newly developed 125I-radioimmunoassay allows for the accurate determination of physiological concentrations of plasma melatonin. Melatonin secretion does not change significantly on the day before and the day of the luteinizing hormone (LH) surge when compared with the early follicular phase. In addition, it was confirmed that the beginning of the LH surge frequently occurs in the morning and is associated with low melatonin values (six of nine women). Supraphysiological melatonin concentrations did not decrease the midcycle LH secretion in four women studied.

Adrenomedullary hyperplasia and phaeochromocytoma. DNA cytophotometric findings in 47 cases

Fifty adrenalectomy specimens containing normal (n = 3), hyperplastic (n = 4) or neoplastic (n = 43) medullary tissue were subjected to quantitative cytophotometric measurements of DNA content. Differing evaluation schemes were applied for interpretation of DNA distribution patterns. Of the 43 phaeochromocytomas (PCC), 16 were inherited as part of the syndrome of multiple endocrine neoplasia type 2a (MEN 2a). Five of 27 sporadic PCCs followed a malignant course. Three benign and three malignant PCCs lacked endocrine activity. In normal medulla and in adrenomedullary hyperplasia, diploid or euploid DNA distributions were found. In contrast, 87% (33/38) of the benign and all 5 malignant PCCs exhibited non-diploid or aneuploid DNA histograms. No differences in DNA content existed between functioning and non-functioning PCCs or between sporadic and hereditary tumours. In this study, in contrast to earlier communications, DNA cytophotometry did not discriminate between benign and malignant adrenomedullary tumours. In addition, as opposed to the findings in a variety of other endocrine tumours, DNA measurements did not appear to be a useful tool to assess the prognosis of an individual malignant PCC.

Diffuse sclerosing variant of papillary thyroid carcinoma. S-100 protein immunocytochemistry and prognosis

The recently published second edition of the WHO classification of thyroid tumours describes the diffuse sclerosing papillary carcinoma (DSPC) as a specific variant of papillary thyroid cancer (PC). Besides several histological hallmarks, this rare tumour is characterized by its occurrence in young individuals and is thought to have a less favourable prognosis than PC in general. The observations on two examples of this tumour presented herein, however, are at variance at this assumption. The neoplasms occurred in a 10 year old girl and a 34 year old woman. Each time, diffuse involvement of both thyroid lobes and bilateral cervical lymphadenopathy were seen. In one case, the carcinoma extended into the cervical soft tissue. Follow-up disclosed both patients to be without evidence of disease 2 and 13 years, respectively, after thyroid surgery. Immunocytochemically, both thyroid primaries as well as 7 other cases of DSPC reported in the literature showed dense accumulations of S-100 protein positive dendritic/Langerhans cells. Such infiltrations have been demonstrated to be correlated with a benign clinical course of PC. It is thus suggested that DSPC behaves similarly or even less aggressively than PC in general, at least if prominent Langerhans cell infiltration is present.

[A method for recording the network topology of human retinal vessels]

Network analysis of the human retinal vessels must be based on a thorough knowledge of the topology of the network. This derives from the numerical composition of the network's individual components. Using histologic specimens, centrifugal and centripetal ordering methods were compared. It was found necessary to use an ordering system which takes both dichotomous as well as lateral branching into account, and Strahler's centripetal ordering system was found to be suitable. For various representative areas of human retinae it could be shown that the number of segments of each Strahler order forms an inverse geometric sequence which enables the Horton branching quotient RB to be calculated. It is thus possible to predict the number of vessel segments within the individual orders. Although the method ignores detailed vessel morphology, with knowledge of the vessel lengths and diameters determined in the same manner it enables the conductivity and resistance of human retinal vessels to be measured.

Immunocytochemical differential diagnosis of adrenocortical neoplasms using the monoclonal antibody D11

The monoclonal antibody D11 is a valuable aid in the accurate typing of adrenal tumours as, in formalin-fixed, paraffin-embedding material, strong nuclear D11 positivity was observed only in adrenocortical cells in 190 neoplasms (including 100 adrenal tumours). This pattern was demonstrated for all zona glomerulosa cells in 27 normal adrenals and for the neoplastic cells of 15 adrenocortical adenomas derived from that zone, as judged from clinically evident hyperaldosteronism. Normal cells of zona fasciculata and reticularis also showed strong diffuse D11 immunostaining and the same nuclear plus cytoplasmic D11 reactivity was evident in 15 benign and malignant adrenocortical neoplasms derived from these zones, documented by hypercortisolism. Cytoplasmic and/or nuclear D11 staining made topohistogenetic typing possible in 15 non-functioning cortical tumours. D11 immunostaining gave negative results in 50 specimens containing normal, hyperplastic and neoplastic adrenomedullary cells. In addition, absence of D11 reactivity was recorded in 4 adrenal metastases of extra-adrenal carcinomas, 5 paragangliomas, 25 primary renal carcinomas and 59 of 60 primary thyroid carcinomas. D11 immunocytochemistry allows the accurate typing of benign and malignant adrenocortical neoplasms, irrespective of histology and function. With this method, primary adrenocortical tumours can be separated from carcinomas metastatic to the adrenal gland, including secondary tumours of similar phenotype (such as renal carcinomas). By exclusion, D11 negativity provides evidence of the medullary origin of primary adrenal tumours even in the absence of clinical, structural, histochemical and conventional immunohistochemical indicators of phaeochromocytoma.

Sporadic unilateral adrenomedullary hyperplasia with hypertension cured by adrenalectomy

Adrenomedullary hyperplasia (AMH) with increased urinary excretion of epinephrine is regarded as the earliest adrenal manifestation in familial pheochromocytoma; however, pathogenetic mechanisms and morphogenesis involved in the development of sporadic adrenomedullary diseases are unknown as yet. We present 4 patients with clinical, biochemical, imaging, and morphological findings of sporadic unilateral adrenomedullary hyperplasia cured by unilateral adrenalectomy. All patients were hypertensive with intermittent hypertensive crises, and with increased catecholamine concentrations in urine and serum. Correct unilateral localization was achieved by 123-I-BG-scan (planar and SPECT) (n = 2) or cavovenous blood sampling with selective catheterization of both suprarenal veins (n = 2). Histomorphometric analyses revealed diffuse adrenomedullary hyperplasia in all 4 specimens with significant increase of relative volume to 17.6% (controls, 8.7%), and of estimated medullary weight to 0.95 g (controls, 0.45 g); corticomedullary ratio (C:M) was decreased to 5.4 (controls, 11.2). DNA histograms showed euploidy in all cases. In 3 patients, DNA analysis revealed evidence of cell proliferation, but without increase to grade of malignancy indices (0.101-0.523). Adrenalectomy was performed preferentially by a translumbar approach; the operative and postoperative course was uneventful in all 4 patients. Blood pressure without antihypertensive drugs returned to normal in 3 patients, in 1 patient to the upper normal limit.

Diffuse leiomyosarcomatosis of the colon

Smooth muscle cell tumors of the large bowel excluding the rectum are extremely rare. The case of a 30-year-old patient, who had ulcerative colitis for 5 years, is reported. Because of uncontrollable bleeding a proctocolectomy was performed. Along the whole colon the authors found more than 50 polypous tumors with a diameter up to 5 cm. Histologically all of these tumors were classified as leiomyosarcomas. The authors believe this to be the first reported case of multicentric leiomyosarcoma of the colon and of such a tumor associated with a history of ulcerative colitis.

[Leu-M1, CEA and intermediate filament proteins in histochemical differential diagnosis of malignant pleural mesothelioma]

The differential diagnosis "pleuramesothelioma" vs "metastatic adenocarcinoma" can mostly not be decided clearly by conventional histological methods in malignant pleuraneoplasias. Leu-M1 is employed in immunhistochemical diagnosis of lymphomas in Hodgkin's disease but it also reacts with adenocarcinoma cells. Pleuramesotheliomas are Leu-M1 negative. Intermediary filament proteins, CEA and Leu-M1 are important "markers" in the diagnosis of malignant pleuraneoplasias. 25 pleura biopsies of malignant pleura processes were subjected to immunhistochemical examination.

Medullary carcinoma of the thyroid

The results of our study may be summarized as follows: 1. Medullary carcinomas of the thyroid are derived from the C cells of the gland and are characterized by strong histologic and cytologic pleomorphism with inconstant stromal amyloid deposits. 2. The decisive morphodiagnostic criterion is immunohistochemical evidence of calcitonin coinciding with negative TG reactivity. 3. In addition to obligatory calcitonin expression, MCs may show variable synthesis of several polypeptids and biogenic (?) amines. 4. The varying immunoreactivity patterns are not related to the clinical behavior of the respective tumors. 5. Leu-M-1 antigen, a monocyte-granulocyte marker known to express in Reed-Sternberg cells and in certain nonhemopoietic neoplasms, can also be demonstrated in MCs. Leu-M-1 immunoreactivity was found to correlate significantly with an unfavorable course. Thus, the introduction of immunostaining for Leu-M-1 in cases of thyroid carcinoma may provide significant prognostic information for these patients.

A case of tularemia meningitis in Sweden

Tularemia meningitis occurred in a previously healthy 64-year-old man from Northern Sweden. The patient was immunocompetent and recovered without sequelae. The bacterial isolate conformed by most criteria with the Euro-Asian biovar Francisella tularensis var. palaearctica. Tularemia meningitis may mimic meningitis caused by Mycobacterium tuberculosis.

[T-cell oriented therapy concept in the treatment of rejection following liver transplantation]

Since 1984 32 liver transplantations were performed at the University of Hamburg in 29 patients. 2-year survival rate of electively grafted patients is 71.4%. Immunosuppression is performed with ciclosporin A, steroids and azathioprine. The diagnosis of rejection episodes or viral infections is established by determination of activated lymphocytes, lymphoblasts or LGL-cells in the peripheral blood or in the graft (aspiration cytology). Additional liver biopsy gives information regarding the extent and kind of a white blood cell infiltrate and furthermore allows a differentiation of T-lymphocytes by immunohistological staining. Rejection episodes are primarily treated with ATG (Fresenius), non responding cases either with ATG (Stanford) or OKT 3. Successful treatment with ATG results in an elimination of T3, T4 and T8-lymphocytes. A sufficient result of OKT 3 treatment is stated after elimination of T3 cells.

[Pharmacokinetics of cefotaxime during late pregnancy]

Examining serum level values and urinary concentrations taken from nonpregnant control persons and pregnant women suffering from urinary tract infections (UTI) during the third trimenon, the pharmacokinetic dates after single application of 1 g cefotaxime have been evaluated. We used a computer program based on the two-compartment model. It is shown that during pregnancy complicated by UTI the elimination half-life will be prolonged, the distribution volumes and clearance values will be increased. The results discussed with the dates given by literature allow us to state that it is not necessary to change dosage and application interval of cefotaxime during pregnancy.

[Pharmacokinetic studies of cefotiam in late pregnancy]

Examining blood level values and urinary concentrations taken from pregnant women during the third trimester and nonpregnant female volunteers, the pharmacokinetic dates of cefotiam (a second generation's cephalosporin) have been evaluated. We used a computer program of an open two-compartment model for intravenous injection. We found an increase of some pharmacokinetic parameters (elimination half-life, distribution volume, clearance) during pregnancy. Because the serum levels were yet effective and nearly equal 6 hours after intravenous injection we state that it is not necessary to change the dosage and the application interval of cefotiam during pregnancy.

[The hall--reflections on the site of open interaction between patients and the therapeutic team]

Starting from an apparent every-day situation in daily clinic life--the encounter between patients and therapeutic team in a sojourn chosen by the first ones--reflections are made about patterns of relations shown there. These contain partly complicated transference - and counter-transference-mechanisms and represent an always new challenge for the team to deal with the own professional role and the engagement toward the mentally sick.

CA 50 and CA 19-9 antigen expression in normal, hyperplastic, and neoplastic thyroid tissue

The occurrence of the tumor-associated carbohydrate antigens defined by the monoclonal antibodies (moabs) C 50 and 19-9 has been studied by immunoperoxidase staining of formalin-fixed and paraffin-embedded tissue specimens from normal, hyperplastic, adenomatous, and carcinomatous thyroid tissues. Epithelial expression of these antigens was observed neither in normal nor in hyperplastic thyroid tissue. The antigens were expressed in only 1 of 26 follicular adenomas and the staining in this case was weak and restricted to a few cells. In contrast, the expression of this antigens is marked and progressive in carcinomatous tissues. A high proportion, 48 of 52 papillary carcinomas demonstrated C 50 reactivity, whereas 25 of these tumors expressed the CA 19-9 antigen. Of 25 follicular carcinomas, 15 gave a positive staining for the CA 50 and 6 for the CA 19-9 antigen. CA 50 antigen expression was still detected in tumor cells lacking the CA 19-9 antigen and C 50 reactive material was found in all tissue specimens from medullary carcinomas tested, whereas CA 19-9 antigen staining was consistently negative. This indicates that the moab C 50 which reacts, like the moab 19-9, with the sialylated Lewisa (Lea) blood group determinant also binds to other antigens apart from the sialylated Lea in CA 19-9 antigen negative tumor cells. Although, the functional significance of CA 50 and CA 19-9 antigen expression remains to be investigated, these results suggest that the demonstration of these antigens could provide additional differential diagnostic parameters for the characterization of hyperplastic and neoplastic lesions of the thyroid gland. Further clinical studies will show whether these carbohydrate antigens are useful serum markers for the monitoring of thyroid carcinomas.

[Avulsion of a calcified leaflet as a complication of aortic valvuloplasty]

Valvuloplasty was recently introduced as a palliative treatment of calcific aortic stenosis in elderly patients. Embolisation of valvular material has not been described as complication yet. We describe the detachment of a large calcific fragment resulting in acute, severe aortic incompetence in a 76-year-old patient. During immediate operative valve replacement the calcific embolus was recovered from the abdominal aorta.

Percutaneous catheter ablation at the mitral annulus in canines using a bipolar epicardial-endocardial electrode configuration

For potential application in ablating left free-wall accessory AV pathways with direct current shocks, a new epicardial-endocardial electrode configuration, designed to focus the current field across the mitral annulus, was tested in dogs. A catheter electrode in the coronary sinus (epicardial electrode) was used as the cathode, and a catheter electrode in the left ventricle (endocardial electrode) placed beneath the mitral valve, high against the mitral annulus and directly across from the epicardial electrode formed the anode. Two shocks, each of 30, 40, or 50 joules (J) were delivered in nine, three, and four dogs, respectively. The first shock was applied to the anterior or lateral wall and the second shock to the posterior wall, except in one dog which received one anterior and one lateral shock. Two dogs receiving 50 J shocks died acutely, one due to rupture of the coronary sinus and cardiac tamponade and the other had unexplained electromechanical dissociation. The remaining 14 dogs tolerated the two shocks well and were sacrificed 3-5 days later for pathological examination of the heart. Shocks in the anterior and lateral regions produced atrial necrosis (height 1.5-11 mm, width 1.5-12 mm and depth 1-3 mm) in 10 of 14 dogs and ventricular necrosis (height 4-27 mm, width 4-33 mm, and depth 5-14 mm) in all 14 dogs. Ideal lesions with atrial necrosis extending down to the annulus and ventricular necrosis extending to the epicardial aspect of the ventricular crest occurred in five dogs in which the endocardial electrode was positioned high against the annulus. In the other nine dogs, the endocardial electrode was located 6-18 mm below the annulus, as estimated by the center of ventricular necrosis. In these dogs, the ventricular lesions did not extend to the epicardial aspect of the crest and, in four dogs, no atrial necrosis was found. Shocks delivered to the posterior wall produced no atrial or ventricular necrosis except in one dog receiving a 50 J shock. It is concluded that, using the epicardial-endocardial electrode configuration with the LV catheter positioned high against the annulus, shocks of less than 50 J in dogs safely produce atrial and ventricular necrosis adjacent to the mitral annulus in the anterior and lateral regions but not in the posterior regions. Similar lesions in man may be capable of interrupting left anterior and lateral accessory AV pathways.

Leu-M1 immunoreactivity and prognosis in medullary carcinomas of the thyroid gland

Leu-M1 antigen is a monocyte/granulocyte-related marker known to be consistently expressed in the Reed-Sternberg cells of patients with Hodgkin's disease and to be present in tumour cells of a variety of non-haematopoietic neoplasms, most of them adenocarcinomas. The biological significance of this aberrant reaction has not yet been clarified. Recently, however, we have demonstrated that marked epithelial Leu-M1 immunoreactivity significantly correlated with an unfavourable clinical course in papillary carcinomas of the thyroid gland. The findings of the present study obtained from surgical specimens of 39 tumours suggest that Leu-M1 immunostaining also provides significant prognostic information in patients with medullary carcinoma (MC) of this organ. Irrespective of other morphological and clinical features, local recurrences occurred 2.9 times (P less than 0.005) and death resulting from tumour occurred 4.3 times (P less than 0.03) more frequently among MCs with marked Leu-M1 positivity (greater than 15% tumour cells positively stained) in comparison to tumours with only slight or absent immunoreactivity. A significantly higher recurrence rate of intense Leu-M1-positive MCs was even evident when comparing only tumours of stage pT1-3N0M0 (P less than 0.005). Our findings infer that Leu-M1 immunostaining might be of clinical relevance to the selection of different aggressive adjuvant therapeutic procedures to be used in MCs with high or low malignant potential.

Influence of moxaverine hydrochloride on membrane curvature and microsieve filterability of red cells after exposure to hyperosmolarity and lactacidosis

Using a combination of novel techniques to assess quantitatively the shape and the filterability of red blood cells (RBC) after exposure to stress conditions (400 mosmol/l, lactacidosis, pH 6.8), the effects of 1-benzyl-3-ethyl-6,7-dimethoxy-isoquinoline hydrochloride (moxaverine-HCl, Kollateral) were tested. The shape of freely suspended RBC was quantified using the tangent count procedure. The filterability (microrheological performance) of leukocyte-free RBC suspensions was determined by computer-assisted conductometry using novel precision metal microsieves with uniform pore diameter of 4.2 micron. Moxaverine, when present in doses between 10(-5) und 10(-2) mol/l while the RBC are stressed, restored both the normal discoid red cell configuration and the microrheological performance when tested under low shear stresses. The data show that moxaverine, a papaverine derivative, hitherto considered as a classical vasodilator exerts protective effects on RBC membrane curvature and whole cell microrheological behavior (performance). The protective effects manifest themselves when the RBC's are exposed to abnormal biochemical conditions such as they might occur in poststenotic areas, where hypoxic ischemia is known to lead to a combination of hyperosmolarity and lactacidosis which modify the RBCs.

Dendritic/Langerhans cells and prognosis in patients with papillary thyroid carcinomas. Immunocytochemical study of 106 thyroid neoplasms correlated to follow-up data

Paraffin sections of 106 primary thyroid carcinomas were the subject of an immunocytochemical study to determine the density of infiltrates of S-100 protein-positive dendritic/Langerhans cells (LC), lysozyme-positive histiocytes, and LCA-positive lymphocytes. Evidence of dense infiltrates of LCs was found only in the majority of papillary thyroid carcinomas (PCs). The determination of the quantity of LCs proved to be a highly effective means of assessing the prognosis of these tumors. Irrespective of other morphologic and clinical features, no single instance of death resulting from cancer occurred among 23 PCs with dense LC infiltrates (including 6 tumors of stage pT4), while 9 of 53 (17%) of the remaining patients ultimately died from thyroid cancer. On the other hand, the degree of histiocytic and lymphocytic infiltrations was not associated with a distinct biologic behavior neither among PC nor among the remaining thyroid carcinomas. These findings suggest that LCs may play an important role in the immunologic defense mechanisms of the host against the tumor only in the papillary type of thyroid cancer.

Prognostic factors in medullary thyroid carcinomas. Survival in relation to age, sex, stage, histology, immunocytochemistry, and DNA content

Patients with medullary thyroid carcinomas (MTC) were analyzed according to age, sex, and tumor stage. In addition, the MTC were screened for the predominant histologic pattern, immunocytochemical spectrum (60 tumors), and DNA content (DNA cytophotometry and DNA flow cytometry, 25 tumors). These findings were correlated with follow-up data available for 45 of these patients. Forty-eight percent of the tumors revealed a polygonal cell pattern, whereas 22% showed spindle-cell predominance. All tumors contained cytokeratin, chromogranin A, and calcitonin (CT). Calcitonin gene-related peptide (CGRP) was present in 92%, carcinoembryonic antigen (CEA) in 77%, neuron-specific enolase (NSE) in 75%, and vimentin in 53% of cases. Positivity for neurotensin, somatostatin, neurofilaments, bombesin, and alpha human chorionic gonadotropin (a-hCG) and serotonin ranged between 3% and 27%. All MTC were negative for substance P, adrenocorticotropic hormone (ACTH), thyroglobulin (TG), or S-100 protein. Local recurrences and regional lymph node metastases revealed identical staining patterns as the primaries. Prognosis of MTC was found not to be related to histologic features (dominant architectural pattern, cellular shape, presence of amyloid deposits) or immunocytochemical pattern. Instead, survival was significantly correlated to age, sex, and stage of disease. The best prognosis was seen in women younger than 40 years and revealing an early stage of disease. DNA measurements added valuable information in assessing the prognosis of MTC.

DNA cytophotometry in malignant thyroid tumors--use of different evaluation schemes for prognostic statements

Quantitative evaluation of nuclear DNA has been found to provide information on diagnosis and prognosis in a number of malignant tumours and borderline lesions. Using 53 carcinomas of the thyroid with varying differentiation we examined the prognostic information obtained by DNA cytophotometry with respect to clinical outcome, applying three different evaluation schemes. DNA cytophotometry allowed the discrimination of euploid carcinomas with good prognosis from aneuploid tumours with bad prognosis and a generally shortened life span. However, the encapsulated variants of follicular and papillary thyroid carcinomas, with their generally excellent prognosis, exhibited DNA histograms similar to those of their widely invasive counterparts. Thus, the favourable prognosis of these minimal invasive subtypes may primarily be related to the tumours' encapsulation and cannot be ascribed to a particular DNA content. We conclude that DNA cytophotometry can provide additional prognostic information for the individual patient suffering from thyroid carcinoma and may probably lead to an individualization of the therapeutic strategies.

[Prognostic criteria of papillary thyroid cancer. Morphologic clinical analysis of 202 cases of tumor]

A retrospective study of 202 papillary thyroid carcinomas was conducted to determine the prognostic value of different morphological and clinical features. The biological behaviour was primarily influenced by tumor type: Among encapsulated (n = 28) and occult lesions (n = 34), each time recurrence-free survival was seen, whereas 22% of patients with widely invasive tumours (n = 140) died from carcinoma (mean observation period: 9.6 years). In the latter group, dismal prognosis was demonstrated for older patients (greater than 52 years) and oxyphilic or poorly differentiated tumours; the same effect was shown for presence of distant haematogenous spread and tumour invasion of cervical soft tissue. Since lethal outcome was seen even in cases lacking the aforenamed unfavourable criteria, total thyroidectomy should be performed for all widely invasive neoplasms regardless of cellular or histological differentiation, stage of disease and age at diagnosis. The same applies for the two prognostically excellent subtypes in the case of regional metastases. As opposed to this, hemithyroidectomy and life-long TSH-suppressive oral hormone replacement therapy is regarded to be sufficient in encapsulated and occult papillary tumours not accompanied by regional or distant metastases.

Patterns of expression of cytoskeletal proteins in human thyroid gland and thyroid carcinomas

By two-dimensional gel electrophoresis of proteins insoluble in detergents and high-salt buffer and immunofluorescence microscopy with a panel of polypeptide-specific antibodies to proteins of intermediate filaments (IF) and desmosomes, we have characterized the cytoskeletons of normal human thyroid gland, several kinds of benign lesion (goiter, Hashimoto's and Graves' diseases, adenomas), and the major thyroid carcinomas (follicular, papillary, medullary, and anaplastic). In all these tissues, desmoplakins and cytokeratins 7, 8, 18, and 19 were identified. While cytokeratins 8 and 18 occurred in all epithelial cells and cytokeratin 7 was also rather widespread, cytokeratin 19 occurred in amounts variable between the different types of tissues and in normal thyroid gland was restricted to certain clusters of follicular epithelial cells. Of all samples studied, in none did we detect cytokeratins commonly associated with stratified epithelia such as cytokeratins 4-6, 10, and 13-17, indicating that these are infrequent, if at all present, in such tissues. Coexpression of cytokeratins with vimentin appears to occur constitutively in follicular epithelial cells of normal thyroid gland and is also frequent in the diverse carcinomas, though to various degrees. Medullary carcinomas are exceptional, not only because they express neuroendocrine markers, but also because they coexpress combinations of cytokeratin IFs with neurofilaments and/or vimentin IFs in some cases, but not all. The results are discussed in relation to states of cell differentiation in normal and diseased thyroid gland and with respect to their value in tumor diagnosis.

[Metastases of the thyroid gland--morphology and clinical aspects of 25 secondary thyroid neoplasms]

Morphological and clinical findings in 25 secondary tumours of the thyroid are described. The most common sources of such lesions were the kidneys (32%), lung (28%) and breast (20%). In the majority of cases, thyroidectomy was performed prior to identification and treatment of the primary cancer. Conversely, among renal cell carcinomas, the metastatic lesion frequently appeared many years after resection of the primary tumour. This suggests that secondary thyroid tumours occasionally may be the only important malignant disease remaining. Hence, adequate surgical treatment may prove to be life-prolonging or life-saving.

[Morphology and prognosis of follicular thyroid cancer--a clinico-pathologic and DNA cytometric study of 95 tumors]

A retrospective study of 95 follicular thyroid carcinomas was conducted to evaluate the prognostic value of different morphological and clinical features. The biological behaviour of these tumours was primarily influenced by presence or absence of a capsule type of confinement: the frequency of lethal outcome among widely invasive carcinomas was six times higher than among encapsulated neoplasms. Furthermore, dismal prognosis could be demonstrated for tumours occurring in older patients (with a sharp break in the prognosis at the age of 52 years) and for those lesions which displayed oxyphilic metaplasia. The same effect was shown for presence of lymph node metastasis, tumour invasion of the cervical soft tissue and, for the case of encapsulated carcinomas, distant haematogenous spread. Conversely, the degree of differentiation and the patients' sex proved to have no significant influence on prognosis. In 22 carcinomas, cytophotometric and flow-cytometric determinations of DNA values were performed. These procedures revealed to have only limited diagnostic value, since for the majority of the tumours, benignancy or malignancy could not be judged from the DNA histograms. However, DNA measurements proved to contribute valuable information for the prognosis in individual cases of widely invasive follicular carcinomas. The discussion focuses on the diagnostic, therapeutic and prognostic relevance of these findings and on their impact on subclassification of follicular thyroid carcinomas.

Carcinoembryonic antigen and nonspecific cross-reacting antigen in thyroid cancer. An immunocytochemical study using polyclonal and monoclonal antibodies

The expression of carcinoembryonic antigen (CEA) and related antigens in formalin-fixed paraffin-embedded tissues of 200 primary thyroid carcinomas and 22 nonmalignant thyroid lesions was studied immunocytochemically by using three monoclonal antibodies recognizing different epitopes on CEA and related antigens. The monoclonal antibody 431/31 defined epitope (present only on CEA) was found exclusively on 77% of the medullary thyroid carcinomas and on 100% of hyperplastic C-cell nodules adjacent to infiltrating C-cell carcinomas. The monoclonal antibodies 374/14 and 250/183, defining epitopes present on CEA and the nonspecific cross-reacting antigens 95 or 55, reacted with 88% and 82%, respectively, of the medullary carcinomas, but labelled also many nonmedullary thyroid carcinomas (follicular 34% and 18%, papillary 42% and 30%, anaplastic 18% and 13%), follicular adenomas, and nonneoplastic follicle-cell lesions. Similar results were obtained by using a polyclonal CEA antiserum preabsorbed with lyophilized spleen tissue. The findings suggest that nonspecific cross-reacting antigens can be expressed by all types of thyroid carcinoma, while CEA is present only in C-cell tumors of this organ.

Prognostic significance of Leu-M1 immunostaining in papillary carcinomas of the thyroid gland

Leu-M1 antigen is a monocyte/granulocyte-related marker known to be consistently expressed in the Reed-Sternberg cells of patients with Hodgkin's disease. Recently, however, the presence of Leu-M1 has also been noted in tumour cells of a variety of non-haematopoietic neoplasms, most of them adenocarcinomas. The biological significance of this aberrant reaction has not been clarified. We have been able to demonstrate marked epithelial Leu-M1 immunoreactivity (greater than 15% tumour cells positively stained) in 24 out of 76 (32%) papillary carcinomas of the thyroid gland (PC). This phenomenon was more frequently observed among PCs at an advanced stage of disease (pT4 vs. pT1-3 and M1 vs M0 p less than 0.05). The degree of epithelial Leu-M1 positivity was also shown to be significantly correlated to the clinical course of PC. Irrespective of other morphological and clinical features, death resulting from cancer occurred 17 times more frequently among PCs with marked Leu-M1 positivity (8/24) when compared with tumours with only slight or absent immunoreactivity (1/52) (p less than 0.00005). These findings suggest that Leu-M1 immunostaining provides significant prognostic information for patients with papillary carcinoma of the thyroid gland.

[The concentration of oxacillin and ampicillin (Penstabil) in serum and mother's milk in puerperal mastitis]

In 23 women in childbed suffering from mastitis puerperalis the transport of oxacillin and ampicillin into the milk was investigated. Moreover the concentration of the antibiotics in the urine of babies nursed during therapy of their mothers with antibiotics was measured. After a regular taking (good compliance) the drug-concentrations in the serum and the milk of the mothers are higher than the minimal inhibiting concentrations necessary against the number of bacteria found in the milk. In the urine of suckling babies drug concentrations were differently high or undetectable as well. During the therapy of nursing mothers with antibiotics the milk should be misplaced.

Autoimmune-resistance in Graves' disease tissues indication of a structural and functional heterogenicity

Out of 256 patients with Graves' disease and a characteristically low echogenic ultrasound appearance of the thyroid gland, 12 patients (4.7%) showed additionally one single or several intrathyroidal focal alterations with high echogenicity. Their volume was 0.2 to 7.0 cm (X +/- SD: 1.75 +/- 2.24 cm). A common characteristic of the 12 patients was a longstanding history of Graves' disease and antithyroid treatment with thiamazol or carbimazol and a mean age of 55 +/- 9 (SD) years (range 42-75 years). The foci with high echogenicity had a normal or macrofollicular histological structure (mean follicle lumen diameter 119.7 micron, as proven by histology in 4 cases) which was significantly higher than follicle lumina of the surrounding Graves' disease tissue (mean follicular lumen diameter 38.3 micron; P greater than 0.001). The height of follicle epithelium and the nuclei cross-section area of such foci was similar to corresponding normal tissue parameter in 5 out of 7 foci. The 99mTc-uptake of the foci amounted to 40 to 80% in comparison with Graves' disease tissue. 131-iodine autoradiography, thyroglobulin immunochemistry and 125-iodine-TSH binding analysis performed in selected cases confirmed the heterogenicity of these foci. The data provided evidence that the foci were unresponsive to TSH-receptor mediated stimulation through Graves' immunoglobulins. It is concluded that longstanding Graves' disease can be associated with tissue foci which are in a functional sense resistant to immunogenic stimulation by TSH-receptor autoantibodies.

[Occult papillary thyroid carcinoma. Clinical significance and morphology of a common tumor]

In a systematic analysis of surgical specimens of 388 carcinomas of the thyroid 34 occult papillary tumours were revealed. In 18 of the 34 patients cervical lymph-node metastases were demonstrated, which in 16 had been the indication for operation. In 15 patients the tumour was a chance finding in a thyroid resected for other reasons. Postoperative follow-up over an average of ten years demonstrated a uniformly favourable course in all, regardless of tumour size or type, age, sex or lymph-node status. There were no local recurrences or metastases beyond those known at time of thyroidectomy.

[Emission of microorganisms from sewage treatment plants depending upon construction differences of single structural parts]

In order to examine the influence exerted by the differing design of individual water treatment plant units on the emission rate of micro-organisms and the associated degree of exposure to which plant personnel is subjected, measurements were taken at three different types of treatment plants. Measurements were made using "Biotest" RCS Air Samplers. The total count of colonies was determined by means of Agar Strips GK-A (tryptic soy agar). Enterobacteriaceae were quantitatively ascertained using Agar Strips C (MacConkey agar), particular attention being paid to the determination of the coliform bacteria as faeces indicators. Agar Strips S (mannitol salt agar) were used to measure the count of staphylococci using Agar Strips HS (rosa Bengal streptomycin agar). Before taking measurements, the prevailing climatic conditions were recorded. It could be ascertained that the enclosure of the inflow area (screw conveyor pump station and aerated grit removal tank) lead to a considerable increase in the concentration of microorganisms in the air within the housing. The values dropped however, when adequate ventilation was provided. Differing oxygen in the activated sludge tanks - finebubble aeration at the tank bottom or the blowing in of air via centrifugal blowers - lead to large variations in the emission rates. However, the less the waste water is agitated, the lower the emission rates. In the case of fine-bubble aeration, rates which are also normally to be found in the "non-burdened" outside air were even recorded close to the aeration tank. In cases of centrifugal blower, the aeration tank should be covered with a shield. With this type of aeration the waste water is emitted radially towards the walls of the tank. The use of a sprinkler unit on an aeration tank equipped with centrifugal blower - to avoid foam formation on the surface of the water - does not lead to an increase in the already high emission rate. An increase in air pollution through mould fungi from waste water treatment plants could not be found. In conclusion, it can be said that different individual plant unit designs have a large influence on the concentration of micro-organisms in the ambient air of places of work of waste water treatment plant personnel. Emission rates can be limited to such a degree that, even in the immediate vicinity of the plant units, a decrease of micro-organism concentrations can be attained as comparable to the area outside the treatment plant.

Bone metastases of differentiated and medullary thyroid gland carcinomas. Usefulness and limitations of immunohistology performed on undecalcified plastic-embedded tissue specimens

Undecalcified methylmethacrylate(MMA)-embedded biopsies and surgical specimens from 20 bone metastases of differentiated or medullary thyroid carcinomas or prostate carcinomas were investigated immunohistologically for the presence of thyroglobulin, cytokeratin, vimentin, and CEA. The immunoreactions on MMA-sections revealed the same staining patterns as those demonstrated using paraffin sections of the primary lesions. Conversely, immunohistological examination of decalcified paraffin-embedded specimens of the same metastases yielded either false-negative results or results that did not allow an exact evaluation. The findings demonstrate the usefulness and limitations of immunohistology when performed on undecalcified plastic-embedded material.

Clear-cell carcinomas of thyroid gland: a clinicopathological study of 13 cases

Thirteen primary thyroid clear-cell carcinomas and eight thyroid metastases of renal carcinomas are described. A broad variety of features is shown to be responsible for this follicle cell phenotype, some of which also occur in renal carcinomas. In biopsy specimens these two conditions can only be distinguished by immunohistochemistry. Clinical follow-up disclosed that in the papillary and follicular categories of thyroid cancer the biological behaviour of clear-cell tumours exhibits no significant difference to their non clear-cell counterparts. In the case of eight follicle cell carcinomas, various samples were available for study. These revealed some striking variations in histology at different stages, and even during the same stage, of disease. Both reversal of clear cell change and transitions towards other kinds of metaplasia occurred. Morever, maintenance of follicle cell function was documented in several of these lesions by estimations of serum thyroglobulin levels and radioiodine scans. On the basis of these findings the concept of regarding the clear-cell variant as a distinct subtype of thyroid cancer is refuted. Previous statements on the causal mechanism of clear-cell change are discussed and it is suggested that metaplastic transformation accounts for this phenomenon in at least some instances of this heterogeneous condition.

Intermediate-filament expression in thyroid gland carcinomas

Paraffin-embedded specimens of 200 primary thyroid carcinomas were examined immunohistologically for the expression of intermediate-filament (IF) protein of the cytokeratin, vimentin and neurofilament type. In 36 cases, snap-frozen tissue was available, and double label immunofluorescence microscopy was performed in 23 of them. Cytokeratin reactivity was found in all cells of all follicular, papillary and medullary carcinoma cases examined. Using a monoclonal vimentin antibody, positive staining was found in many, though not all cells of the papillary tumours and in approximately 50% of the follicular and the medullary carcinomas. Among anaplastic carcinomas, some tumours were positive for cytokeratins, with or without coexpression of vimentin. Neurofilaments could only be demonstrated in approximately 13% of medullary tumours which in general also exhibited vimentin positivity. The differences of IF expression in follicle and C-cell thyroid carcinomas and the broad variation of cytokeratin and vimentin immunoreactivity among anaplastic tumours of this organ is discussed in relation to the possible intrinsic heterogeneity of these tumours and the diagnostic value of these markers.

Morphological demonstration and quantification of TSH binding sites in neoplastic and non-neoplastic thyroid tissues. An autoradiographic study using 125I-labelled thyrotropin

We have developed a morphological method to portray TSH binding sites in intact tissue specimens. Frozen sections were incubated with 125I-labelled TSH so as to localise binding sites by autoradiography. The proof of specificity was substantiated by: the competitive inhibition of 125I-TSH-labelling with cold TSH, the lack of binding in non-target tissues and a lack of binding in TSH target tissues after incubation with 125I-hCG or free 125I. In applying this method to a total of 22 surgical specimens of thyroid, striking differences came to light in respect of the degree to which 125I-TSH binding occurred in the various thyroid disorders. When compared with histologically normal tissue, labelling was generally decreased in toxic adenomas, non-functioning adenomas (cold nodules), and thyroids affected by Graves' disease, whereas non-toxic colloid goitre cases clearly exhibited denser binding. Medullary and anaplastic carcinomas exhibited no specific labelling whilst binding varied in the differentiated carcinomas between no effective binding or a level resembling that found in normal thyroid tissue.

Immunohistochemical demonstration of carcinoembryonic antigen (CEA) in 120 mammary carcinomas and its correlation with tumor type, grading, staging plasma-CEA, and biochemical receptor status

Antisera to CEA were used for the immunohistochemical localization and quantification of this antigen in 120 Bouin-fixed, paraffin embedded mammary carcinomas. These results were compared to tumor type, grading, staging, biochemical receptor status, cytosolic CEA-levels of the same tumors, and preoperative plasma CEA-levels. Mammary carcinomas were usually characterized by a low percentage of CEA-positive tumor cells: 50.9% of the cases contained more than 5% CEA-positive tumor cells and were therefore defined as being CEA-histopositive in this study. A relation could be shown between CEA-histopositivity and the histologic tumor type. The majority of invasive lobular carcinomas, tubular, and cribriform carcinomas was CEA-negative (72%). Conversely, 70% of invasive ductal carcinomas were CEA-positive. There was a significantly higher percentage of CEA-histopositivity in grade III tumors than in grade I/II carcinomas. The results obtained by quantification of the immunohistochemical staining of CEA were positively correlated with the results obtained by cytosolic CEA-assay. The overall concordance between tissue and plasma determinations of CEA was found to be 57.1%. A positive trend could be found between CEA-positivity and staging. However, no correlation was observed between CEA-positivity and estrogen receptor status.

Signet-ring-cell thyroid tumors. Follicle cell tumors with arrest of folliculogenesis

This study describes three carcinomas and three benign follicle-cell lesions that consisted of vacuolated thyrocytes. In five of these tumors the neoplastic cells, wholly or in part, had the same unique signet-ring-cell feature as recently described for a mucinous microfollicular thyroid adenoma case. On electron microscopy, however, intracellular lumina that were bordered by microvilli were shown. Serial sections of the epon-embedded material and the results of mucin stains and thyroglobulin-immunostaining excluded primary mucin-producing tumors of the thyroid and in each of our six thyroid lesions gave evidence of an arrest of folliculogenesis.

Sonographic tissue characterisation in thyroid gland diagnosis. A correlation between sonography and histology

Punch biopsy was carried out in 32 cases in which thyroid gland changes were sonographically classified as being of homogeneously normal or of homogeneously low echogenicity. Mean follicle lumen size was morphometrically determined from the histological sections. This produced a significant, positive correlation between echogenicity and follicle size. The mean follicle lumen diameter in so-called echonormal structures was 67 microns (SD +/- 23 microns), and 25 microns (SD +/- 8 microns) in low-echogenic lesions. Thus normal echogenicity represented a normofollicular or macrofollicular structure, while a low echogenicity pattern indicated a microfollicular or solid tissue structure. The structure of thyroid carcinomas is not homogeneously normofollicular or macrofollicular; in exceptional cases they are such only focally. Therefore the significance of these findings lies in the exclusion of malignancy in the event of homogeneously normal echogenicity.

[B-mode sonography of the neck. Comparison of results of sonography, computer tomography and pathomorphology]

High-resolution B-scan sonography has so far been hardly utilized in the investigation of neck tumours. The results of B-scan sonography, computed tomography, and anatomic pathology are compared and discussed. Lymph node tumours of the neck are easily and precisely recognized by ultrasonography. The rate of false positive tumours diagnoses is higher in B-scan sonography than by computed tomography. The rate of false negative diagnoses is the same with both methods. The technical development of B-scan sonography will widen its application in E.N.T. surgery.