Ultrasound features of abdominal thrombosis in COVID 19 patients

PURPOSE

Abdominal thromboses are a poorly characterized thrombotic complication of COVID-19. The aim of this paper is to report multimodality ultrasound imaging findings of the abdomen in evaluation of thrombotic lesions in hospitalized patients with COVID-19.

PATIENTS & METHODS

In this retrospective observational study, patients admitted to a single University Hospital from April 1, 2020 to April 30, 2022, who tested positive for COVID-19 and developed acute abdominal pain over the course of hospitalization were included. Abdominal ultrasound imaging studies performed in these patients were reviewed, including B mode ultrasound (BMUS), color-coded Doppler ultrasound (CCDS) and contrast enhanced ultrasound (CEUS). Thromboembolic findings on contrast enhanced computed tomography (CTA) were also recorded.

RESULTS

Finally, 13 cases of abdominal thrombosis in 226 with COVID 19 infections were included (mean age, 56.69±8.97 years; 10 men, 3 women). Thromboembolic events included: iliac thrombosis (n = 4), portal venous (PV) thrombosis (n = 3), superior mesenteric vein (VMS) thrombosis (n = 2), inferior vena cava (IVC) thrombosis (n = 5) and inferior mesenteric vein (VMI) thrombosis (n = 1). In all cases of abdominal thrombosis, during high resolution BMUS scan, intra-luminary hypoechogenic appositional thrombi could be detected. Meanwhile blood flow with reduced speed less than 20 cm/s could be observed by CCDS. High arterial flow speed was a sign of collateral flow changes with diffuse venous dilatation. On CEUS, changes of the microcirculation of the liver, spleen, kidneys or small bowel by infarctions or micro-emboli could be detected. In 3 cases of PV thrombosis and in 2 cases of IVC thrombosis, catheter interventions were successful performed for recanalization without relevant lumen reduction afterwards. In other cases, without interventional procedure, partial recanalization happened with venous flow speed over 15 cm/s and lumen reduction more than 50%.

CONCLUSIONS

Our study highlights those thromboembolic complications can be seen in hospitalized patients with COVID-19. Multimodality ultrasound examinations is helpful for early and accurate diagnosis of these complications.

Knee and hip joint biomechanics are gender-specific in runners with high running mileage

Female runners are reported to be more prone to develop specific knee joint injuries than males. It has been suggested that increased frontal plane joint loading might be related to the incidence of these knee injuries in running. The purpose of this study was to evaluate if frontal plane knee and hip joint kinematics and kinetics are gender-specific in runners with high mileage. 3D-kinematics and kinetics were recorded from 16 female and 16 male runners at a speed of 3 m/s, 4 m/s, and 5 m/s. Frontal plane joint angles and joint moments were ascertained and compared between genders among speed conditions. Across all speed conditions, females showed increased hip adduction and reduced knee adduction angles compared to males (p < 0.003). The initial peak in the hip adduction moment was enhanced in females (p = 0.003). Additionally, the hip adduction impulse showed a trend towards an increase in females at slow running speed (p = 0.07). Hip and knee frontal plane joint kinematics are gender-specific. In addition, there are indications that frontal plane joint loading is increased in female runners. Future research should focus on the relationship of these observations regarding overuse running injuries.

Polyadenylation of ribosomal RNA by Candida albicans

Candida albicans is the leading fungal pathogen in immunocompromised patients such as those with AIDS and malignancies. It is a polymorphic organism existing as a unicellular yeast or as filamentous forms that include pseudohyphae and true hyphae. While studying the early period of hyphal transformation, comparing cDNAs from yeast to those in early transition, we were surprised to find 25S rRNA represented frequently in our differential display assays, suggesting that our reverse transcription with poly-T primers was copying rRNA with extended poly-A 3' ends. We now report that both the yeast forms and germinating organisms polyadenylate some of their 25S rRNA transcripts. We also found a rapid and transient enhancement of this process upon stimulation with serum. These data indicate that 25S rRNA polyadenylation is part of the biological repertoire of C. albicans and its transient upregulation just prior to hyphal development raises the possibility of a regulatory role in this transition.

Expression of deoxyuridine triphosphatase (dUTPase) in colorectal tumours

We report the generation of 2 monoclonal antibodies (MAbs), 2B12 and 3E6, suitable for the detection of human dUTPase in routinely processed paraffin sections by immunohistochemistry. Using these MAbs, we observed nuclear expression of dUTPase in the proliferation zones of normal colorectal mucosa as well as in hyperplastic polyps. Colorectal adenomas and adenocarcinomas revealed a wide spectrum of dUTPase expression, ranging from 5 to 63% (median 42%) and from 5 to 71% of tumour cells (median 42%) respectively. Non-parametric correlation of dUTPase expression with proliferation as determined by a Ki-67 antigen-specific MAb revealed a significant and moderately strong correlation between proliferation rate and dUTPase expression in adenomas, but not in adenocarcinomas. This finding was confirmed by double-labelling immunofluorescence. Unexpectedly, we found significantly lower levels of dUTPase expression in primary colorectal carcinomas without lymph-node metastases at the time of surgery (Dukes A and B stages) than in Dukes C carcinomas. While this observation requires confirmation in larger studies, it suggests that dUTPase expression may be a negative prognostic marker in colorectal carcinomas. Moreover, these reagents should prove useful in the context of attempts to develop dUTPase inhibitors for cancer chemotherapy. Since it has been demonstrated that dUTPase expression can mediate resistance to 5-fluorouracil, it is also possible that these MAbs may be helpful in identifying patients with colorectal carcinomas resistant to adjuvant chemotherapy using this and related compounds. Int. J. Cancer (Pred. Oncol.) 84:614-617, 1999.

Intraoperative electrical stimulation of cavernosal nerves with monitoring of intracorporeal pressure in patients undergoing nerve sparing radical prostatectomy

OBJECTIVE

To explore the utility of intraoperative cavernosal nerve stimulation in facilitating atraumatic nerve dissection during radical prostatectomy, and thus help predict postoperative erectile function.

PATIENTS AND METHODS

Fourteen patients (aged 51-72 years) underwent nerve-sparing radical retropubic prostatectomy (NSRRP); 10 were potent before surgery (group 1), and four had erectile dysfunction (group 2). A multi-acquisition system (MacLab/8e) with a Macintosh computer was used for real-time display and recording of intracavernosal pressure (ICP) during surgery. Nerves were stimulated with a bipolar probe (monophasic rectangular pulses, 10 mA, 20 Hz, 0.22 s) before and after removal of the gland. The follow-up consisted of interviews with patients and their partners' 12-18 months after treatment.

RESULTS

The mean (sem) basal ICP of 8. 0 (2.0) cmH2O remained unchanged during nerve dissection. The mean increase in ICP during electrical stimulation was >50 cmH2O in seven potent patients (group 1) and was sustained as long as the nerve was stimulated. Postoperatively, these seven patients reported erections sufficient for sexual intercourse. However, the three remaining patients in group 1 had pressure rises of <30 cmH2O, of whom two reported partial erections and one reported total impotence postoperatively. The recovery time for erectile function was 6-12 months after surgery. Two patients from group 2 had transient increases in ICP to <40 cmH2O; one had an increase to 20 cmH2O and one had no response at all. All four patients remained totally impotent postoperatively. There were no complications.

CONCLUSIONS

Intraoperative electrical stimulation of the cavernosal nerves with ICP monitoring before and after NSRRP is a safe and reliable method for documenting nerve continuity and its functional status. Patients who have normal preoperative erectile function and show an adequate rise in ICP upon electrical nerve stimulation during NSRRP will almost certainly be potent after surgery. This tool may be used to facilitate atraumatic nerve dissection during NSRRP.

Efficient trans-splicing of mutated spliced leader exons in Leishmania tarentolae

Every kinetoplastid mRNA receives a common, conserved leader sequence via the process of trans-splicing. In Leishmania tarentolae the precursor spliced leader RNA is 96 nucleotides, with a 39-nucleotide exon that is 7meG-capped and methylated on the first 4 nucleotides. trans-Splicing was inferred from the presence of tagged leader in the high molecular weight RNA population and confirmed for accuracy by cDNA cloning. Linker scan substitutions within the exon between positions 10 and 39 did not affect trans-splicing. The trans-splicing efficiency for three of the scan exons was proportional to the tagged:wild type ratio in the spliced leader precursor population. Two scan leader RNAs that were efficiently spliced showed reduced methylation. Longer exons showed reduced splicing, whereas 10- or 20-base pair deletions abolished splicing. These results indicate that size, but not content, of the exon is a constraint on the splicing process. These results, in combination with previous data eliminating a role in transcription initiation, suggest that translation may be the selective pressure on the leader content.

Intracavernous pressure responses to physical and electrical stimulation of the cavernous nerve in rats

OBJECTIVES

To better define the techniques of nerve-sparing prostate dissection that would result in preservation of erectile function, we characterize the effects of physical pressure on the prostate and cavernous nerve, electrical stimulation of the cavernous nerve, and pharmacologic manipulations on intracavernous pressure (ICP) in normal and diabetic rats.

METHODS

Fischer-34 rats, both normal and diabetic, underwent dissections that isolated the cavernous bodies and cavernous nerves. Cavernous body pressures were characterized during surgical manipulation, during electrical stimulation of the cavernous nerves, and following papaverine hydrochloride injection.

RESULTS

In normal rats, baseline cavernous pressures ranged from 5 to 15 cm H2O (mean 12.29). In diabetic rats, the baseline pressure was significantly lower (3 to 7.5 cm H2O). Lateral nerve displacement caused ICP to rise to approximately 35 cm H2O in normal rats, but only to 20 cm H2O in diabetic rats. Electrostimulation resulted in cavernous pressure increases of 10-fold from baseline in normal rats and sevenfold from baseline in diabetic rats. ICPs were not disturbed appreciably with nerve-sparing dissection techniques. Neurotomy resulted in declines in baseline cavernous pressures in all rats. Electrostimulation of the distal end of a severed nerve resulted in pressure rises to 50% of those observed in rats with intact cavernous nerves. Intracavernous papaverine injection before or after nerve stimulation masked subsequent (expected) pressure changes.

CONCLUSIONS

A change in cavernous pressure is a sensitive indicator of cavernous nerve manipulation. Both cavernous pressure measurements and electrostimulation of cavernous nerves may aid surgeons during radical prostatectomy.

Biologic response modifiers in the management of superficial bladder cancer

For the treatment of existing transitional-cell carcinoma or for prophylaxis of recurrent disease, intravesical therapy should be chosen according to stage. Papillary disease (stages Ta, Tl) may be treated effectively either with an alkylating agent or with bacillus Calmette-Guérin (BCG). BCG is the agent of choice for the treatment of Hat carcinoma in situ (Tis), with the recommended treatment course comprising 12 weekly and 12 monthly instillations. Intravesical interferon and many of the other biologic response modifiers mentioned herein may be effective for patients with Ta disease who have failed BCG therapy.

Intravesical bacille Calmette-Guérin therapy for muscle invasive bladder cancer

OBJECTIVES

This investigation attempted to determine whether the degree of fibronectin expression in the bladders of patients with invasive transitional cell carcinoma correlated with their clinical response to intravesical bacille Calmette-Guerin (BCG) therapy.

METHODS

Following transurethral resection of all invasive disease, 13 patients with Stages T2-T4 bladder cancer were administered intravesical BCG (fo 6 weeks followed by monthly instillations). Fibronectin expression in the patients' resected tumors and normal mucosa was determined by immunohistochemical staining techniques. Minimum disease-free follow-up was 60 months.

RESULTS

Only 1 of 13 patients had neither local nor systemic disease recurrence; 10 of 13 patients developed systemic disease and 7 patients died from metastases. Fibronectin expression was not correlated with the clinical response to BCG.

CONCLUSIONS

Intravesical BCG therapy for the treatment of muscle invasive transitional cell carcinoma of the bladder is ineffective. Fibronectin expression in the bladder of patients with invasive disease is variable and does not correlate significantly with the clinical response to BCG therapy.

Dental treatment considerations for the pre- and post-organ transplant patient

Organ transplantation is a viable treatment for individuals whose quality of life is significantly impaired. There has been a dramatic increase in the number of whole organ transplants being performed over the past few years; and although somewhat limited by donor availability, these numbers have continued to increase as success rates improve and more medical centers perform them. The number of solid organ transplants performed throughout the world has grown from 35,628 (1980-1990) to 285,561 (1989-1991). The number of patients on the waiting list for organs has increased by 59.4 percent from 1988 to 1993. As this patient population grows, the community-based dental practitioner will be faced with a special set of concerns. Understanding the diverse precautions for treatment of pre- and post-organ transplant patients will help the practitioner adequately treat the dental needs of this patients population.

Cytoreductive surgery for stage IV renal cell carcinoma

To facilitate the regression of extra renal disease in response to systemic therapy, cytoreductive surgery has been advocated as step 1 in the treatment of stage IV renal cell carcinoma. To determine the effect of surgery on subsequent clinical course, we reviewed the treatment records of 30 patients with known stage IV carcinoma of the kidney who underwent nephrectomy or additional procedures in preparation for systemic therapy. Of 30 patients only 7 (23%) underwent systemic therapy postoperatively. Progression of the disease, surgical morbidity and mortality were the factors preventing 77% of our patients from continuing with treatment. Since regression of extra renal lesions is the goal of systemic therapy, our data suggest that nephrectomy and most other cytoreductive operations in preparation for systemic therapy are not efficient treatment strategies.

Renal cell carcinoma: considerations for nephron-sparing surgery

OBJECTIVES

The performance of nephron-sparing surgery in patients with a normally functioning contralateral kidney is controversial. To explore the risk factors that may contribute to the success or failure of nephron-sparing surgery, we examined the radiology and pathology reports of 278 patients who underwent radical nephrectomy for the treatment of clinically localized renal cell carcinoma.

METHODS

We collated patient data from the records of 278 patients with Stage III renal cell carcinoma entered into the Eastern Cooperative Oncology Group protocol EST 2886 and compared preoperative clinical staging with postoperative pathologic results. Patients were considered potential candidates for nephron-sparing surgery if their preoperative radiographic studies indicated that the carcinoma was a single polar lesion 5 cm or less in diameter.

RESULTS

Of 278 radical nephrectomy specimens, 36 had primary lesions 5 cm or less in diameter. Preoperative radiographic studies showed 14 of 36 would not have been considered eligible for nephron-sparing surgery. Of the remaining 22 potential candidates, pathologic studies showed multifocal lesions in 11, renal vein disease in 4, and nodal disease in 2. Only 5 of 22 patients might have had specimen-confined disease (T3a lesion).

CONCLUSIONS

Capsular-penetrating (T3a) renal cell carcinoma is not often appreciated preoperatively and is associated frequently with multifocal lesions, renal vein or nodal disease. Frozen section studies to rule out T3a disease at the time of nephron-sparing surgery may help determine which patients need radical surgery.

Management of recurrent penile cancer following partial or total penectomy

The initial management of localized penile carcinoma determines the probability of recurrence. Although potentially disfiguring, the management of recurrent carcinoma of the penis requires aggressive surgical resection of both the primary lesion and nodal sites to effect the best chance for long-term survival.

Expression of the Leishmania tarentolae ubiquitin-encoding and mini-exon genes

To develop models for transcription and trans-splicing in kinetoplastid protozoa, we have characterized ubiquitin (Ubi) gene organization and mRNA processing in Leishmania tarentolae (Lt). Three ubi loci were characterized: two discrete Ubi-extension protein 52 (EP52)-encoding genes (ubiA and ubiB) and a polymorphic polyubiquitin-encoding gene (ubiC). The three loci resided on chromosomes of 2.05 Mb, 630 kb and 2.9 Mb, respectively. On the basis of upstream flanking gene identity, ubiB appears to be the homologue of the tandemly repeated ubi-EP52/1 and 2 in Trypanosoma brucei (Tb). Similar to Trypanosoma cruzi, Lt did not contain a homologue of the ubi-EP76 that has been found in Saccharomyces cerevisiae and multicellular organisms. All three Lt ubi loci were transcribed. The primary transcripts from the ubi loci were processed at the 5'-end by trans-splicing with the mini-exon. A Lt mini-exon gene (min) that gave rise to a 95-nt primary transcript, which is the second template in the trans-splicing reaction, was also characterized.

Combined laparoscopic pelvic lymph node dissection and modified belt radical perineal prostatectomy for localized prostatic adenocarcinoma

OBJECTIVE

Despite many known advantages, the radical perineal prostatectomy (RPP) had fallen out of favor because of the need for a second incision for the regional lymph node dissection. Laparoscopic lymphadenectomy, however, provides an accurate and minimally invasive alternative to open lymph node dissection. Herein are reported the practical advantages of combining laparoscopic lymph node dissection (LPLND) with RPP.

METHODS

Forty-nine patients with clinically localized carcinoma of the prostate were considered candidates for RPP using a modified Belt technique. Thirty-five patients underwent attempted LPLND and 31 of these patients subsequently underwent RPP; 14 patients underwent RPP alone. Variables examined included total operative time, transfusion requirement, length of hospital stay, continence, and potency.

RESULTS

The mean operative time for LPLND combined with RPP in 31 patients, including time for repositioning, was 4.5 hours (range 3.0 to 7.0 hours). Only 26 percent of the patients who underwent the combined approach required blood transfusions of which 75 percent received autologous units. Mean length of stay was six days, and laparoscopy did not contribute significantly to postoperative morbidity. Eighty-four percent of the patients are completely continent. Of 27 potent patients who underwent nerve-sparing surgery, 22 percent are potent and an additional 30 percent are sexually active with intracavernous pharmacotherapy. There were no perioperative deaths, 2 major complications, and 5 minor complications.

CONCLUSIONS

Laparoscopic techniques now permit the urologist to utilize the perineal approach, and its many advantages, to radical prostatic extirpation without the need for a formal abdominal incision. The minimal blood loss and low morbidity associated with laparoscopic pelvic lymphadenectomy combined with the radical perineal prostatectomy make this procedure an attractive alternative to the open retropubic approach for clinically localized prostatic adenocarcinoma.

The effects of human immunodeficiency virus infection on macrophage phagocytosis of Candida

The effects of infection by human immunodeficiency virus (HIV) on phagocytic function towards Candida pseudotropicalis were tested using monocytotropic and nonmonocytotropic HIV strains on peripheral blood monocytes. There were no differences in either quantitative phagocytic activity or efficacy between the two infected and control mock-infected monocytes. Immunofluorescence for cytoplasmic p24 antigen and in situ hybridization for detection of HIV-specific RNA sequences revealed that very few cells (10(-4)) exhibit productive infection. Occasional cells with active infection as defined by microscopically detectable fluorescence labelling contained phagocytized yeasts.

Calcium channel antagonists in the treatment of interstitial cystitis

The calcium channel antagonist nifedipine has shown efficacy in the treatment of interstitial cystitis and the urethral syndrome. The optimal daily dose of nifedipine can be determined with the use of a nifedipine titration test. To complete the repair of damaged bladder and/or urethral mucosa, nifedipine therapy should be used for a minimum of 3 months. Patients who do not respond well to nifedipine are those with the pelvic floor muscle spasm syndrome variant of interstitial cystitis.

Management of superficial transitional cell carcinoma of the bladder

Intravesical therapy for the treatment of existing bladder cancer or for prophylaxis of recurrent disease should be chosen according to the stage of transitional-cell cancer. Papillary disease (stages Ta, T1) may be treated effectively with either an alkylating agent or with BCG. BCG is the agent of choice for the treatment of Tis, provided that the treatment course includes 12 weekly and 12 monthly instillations.

Identification of a gp63 surface glycoprotein in Leishmania tarentolae

The promastigote stage of most if not all Leishmania species possesses an abundant surface glycoprotein of 63 kDa (gp63) that has protease activity. We show that the lizard parasite Leishmania tarentolae appears to lack the surface protease activity. L. tarentolae does, however, possess an approximately 63-kDa molecule that is antigenically cross-reactive with the L. major gp63. Additionally, the genome of L. tarentolae contains sequences that hybridise at high stringency to a L. major gp63 gene probe.

Marketing CT and MR imaging services in a large urban teaching hospital

A three-phase marketing program was implemented to increase referrals for examination with computed tomographic (CT) or magnetic resonance (MR) imaging and improve services in an academic radiology department. In the research phase, a data base of 135 referring physicians was developed, and a questionnaire was mailed to 130 physicians. The market research identified three key issues: waiting time to get an appointment, scheduling procedures, and communication of findings. In the implementation phase, additional equipment was installed and a program of expanded appointments, service improvements, and public relations was introduced. In the evaluation phase, 1 year after the completion of phase 2, the effect of the marketing program was measured. The average number of physicians who made referrals per month increased from 609 to 653 (an increase of 7.2% over baseline); the average number of CT and MR examinations performed each month increased by 57.3% and 45.2%, respectively. Referrers' ratings of 10 imaging services improved significantly (P = .02). It is concluded that a well-designed marketing program can boost the productivity of a teaching hospital department.

Benign fibrous tumor of the tunica vaginalis testis. Report of a case with light, electron microscopic, and immunocytochemical study, and review of the literature

Benign fibrous tumor of the tunica vaginalis testis is an uncommon lesion of unknown pathogenesis and histogenesis, frequently described as fibrous pseudotumor. We describe a case of a fibrous tumor of the tunica vaginalis testis studied with light, immunocytochemical, and electron microscopy in a 64-year-old man who also developed a metachronous renal cell carcinoma. To our knowledge, this is the first such case to be presented. We describe the cell of origin of this rare entity and its similarity to fibrous tumors of pleura and extrapleural sites, with a review of the English-language literature and emphasize that not all intrascrotal tumors are malignant.

Human immunodeficiency virus causes mononuclear phagocyte dysfunction

There is compelling clinical evidence for dysfunction of the mononuclear phagocyte system in patients with AIDS, which is believed due in part to loss of T-cell cooperativity. The direct consequences of human immunodeficiency virus infection on macrophage function are unknown. To address this question we infected normal human macrophages in vitro with a monocytotropic strain of human immunodeficiency virus and performed assays to quantify their extra- and intracellular killing ability. Human immunodeficiency virus-infected macrophages were significantly less effective than control cells in mediating antibody-dependent cell-mediated cytotoxicity against leukemic cell targets and intracellular killing of Candida pseudotropicalis. The functional defects were profound, related temporarily to active virus production by the macrophages, and could not be overcome by granulocyte-macrophage colony-stimulating factor. Treatment of macrophages with 3'-azido-3'-deoxythymidine (AZT) 6 days after infection caused a marked decrease in virus production and prevented development of the intracellular killing functional defect. The results suggest that early antiviral therapy may be useful in preventing or mitigating some virus-induced mononuclear phagocyte dysfunction.

The intracellular fate of Histoplasma capsulatum in human macrophages is unaffected by recombinant human interferon-gamma

Human alveolar, peritoneal, and cultured macrophages were exposed in vitro to human recombinant interferon-gamma (rHuIFN-gamma) and were tested for their ability to inhibit intracellular replication of yeast-phase Histoplasma capsulatum. Exposure at various concentrations, and for different time periods, failed to activate the macrophages to inhibit multiplication of intracellular yeast. Macrophages were, however, activated by rHuIFN-gamma as shown by their ability to inhibit intracellular replication of Trypanosoma cruzi and by their enhanced production of superoxide when stimulated by phorbol myristate acetate. These data indicate that rHuIFN-gamma by itself does not activate human macrophages to inhibit intracellular proliferation of yeast-phase H. capsulatum.

Seasonal rhythm of platelet 3H-imipramine binding in normal controls

The densities of platelet 3H-imipramine sites were determined by repetitive measures of 11 normal controls over the course of 1 year. A significant seasonal variation was found, with a circannual peak on February 17 and a nadir on August 18. The estimated amplitude of this rhythm was +/- 599.54 fmol/mg, which fluctuated about a yearly mean of 2647.5 fmol/mg. The present results underscore the importance of including seasonally matched controls in the evaluation of potential patient differences in platelet binding.

Biologic response modifiers and urologic malignancies

Biologic response modifiers represent a new generation of immunotherapeutic agents. Although biologic response modifiers such as interferon have been moderately successful in treating B-cell malignancies, they have not been as successful for the management of advanced genitourinary malignancies. The measurement of biologic response modifiers in the urine may prove useful for directing intravesical BCG therapy for the treatment of superficial bladder cancer or for directing the use of prophylactic antibiotics for the management of urinary tract infections.

Granulocyte-macrophage colony-stimulating factor enhances neutrophil function in acquired immunodeficiency syndrome patients

We conducted a clinical trial of human recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF) in leukopenic patients with acquired immunodeficiency syndrome (AIDS) and analyzed neutrophil function before, during, and after in vivo administration of rGM-CSF. Prior to GM-CSF infusion, AIDS patients' neutrophil superoxide generation and neutrophil antibody-dependent cell-mediated cytotoxicity were enhanced normally by in vitro exposure to GM-CSF. Neutrophil phagocytosis and intracellular killing of Staphylococcus aureus were also normal in the majority of these patients. Two patients, however, had discrete neutrophil functional defects: one in phagocytosis and one in intracellular killing. During the period of GM-CSF infusion, these abnormalities were corrected. The number of circulating neutrophils increased in all patients treated with GM-CSF in a dose-dependent manner. Neutrophils produced in vivo in response to GM-CSF administration functioned normally and there was evidence for neutrophil priming and activation in vivo. We conclude that GM-CSF treatment of AIDS patients leads to the production of functionally active neutrophils, suggesting therapeutic potential for GM-CSF in the treatment of patients with impaired host defense.

Granulocyte-macrophage colony-stimulating factor enhances phagocytosis of bacteria by human neutrophils

In order to determine whether human granulocyte-macrophage colony-stimulating factor (GM-CSF) can enhance phagocytosis, neutrophils were combined with Staphylococcus aureus (S aureus), and both the number of bacteria per neutrophil and the percent of neutrophils phagocytizing were assessed in the absence and presence of GM-CSF. Exposure to GM-CSF did not enable neutrophils to ingest unopsonized bacteria. When bacteria were opsonized with serum, both the number of bacteria per neutrophil and the percent of cells phagocytizing were increased by treatment with GM-CSF. Digestion of extracellular organisms by lysostaphin was used to substantiate phagocytosis. These results indicate that another effect of GM-CSF on the mature neutrophil is the enhancement of phagocytosis.

Clinicopathologic correlation of lipidization and detachment of the retinal pigment epithelium

A 49-year-old woman had a few small drusen-like lesions and one larger area of depigmentation in the right fundus. The pin-point lesions corresponded to single enlarged retinal pigment epithelial cells with lipid accumulation and the larger area represented a small, localized retinal pigment epithelial detachment (soft druse). Lipoidal degeneration of individual retinal pigment epithelial cells may be a mechanism of nodular drusen formation. The soft druse was associated with thickening of the basement membrane of the retinal pigment epithelium.

Primary Candida meningitis and chronic granulomatous disease

The occurrence of two rare entities in a single patient can be fortuitous or may signify some deeper relationship. A young boy was recently treated for primary Candida meningitis. Autopsy findings suggested to an experienced pathologist the presence of chronic granulomatous disease (CGD), unrecognized during his life. The patient's identical twin brother was tested and found to have the typical laboratory features of CGD. The literature on Candida meningitis was reviewed and 15 cases were discovered that apparently arose in the absence of recognized predisposing causes. All but one of these cases occurred in males, and most occurred during the first three decades of life. The case reports and literature review presented herein suggest that CGD should be suspected when a case of "primary" Candida meningitis is encountered.

Human renal cell carcinoma xenograft: morphology, growth and chemosensitivities

A primary human renal clear cell carcinoma has been developed as a xenograft (JDF-1). Passage 7 of the JDF-1 tumor retained the microscopic morphology of the primary tumor, electron micrographs have confirmed its epithelial characteristics and karyotyping of a subsequent passage has proved it is not a murine hybrid. Immunoperoxidase studies using a panel of murine monoclonal antibodies demonstrate an antigenic phenotype specific for human renal cancer. In vitro chemosensitivities of the JDF-1 tumor were determined by the double-layer soft-agar clonogenic assay method. JDF-1 showed no significant sensitivities to several standard chemotherapeutic agents, but alpha-2-interferon and difluoromethylornithine in combination synergistically inhibited its growth by 74 per cent.

Opsonic activity of MCP-1 and MCP-2, cationic peptides from rabbit alveolar macrophages

MCP-1 and MCP-2, cationic peptides derived from rabbit alveolar macrophages, enhanced the ability of these cells to ingest Staphylococcus aureus, Klebsiella pneumoniae, Bordetella bronchiseptica, and Candida albicans in vitro. The opsonic effect of MCP-1 was potentiated by Ca++ and Mg++ and was associated with binding of the peptide to alveolar macrophages and microorganisms. MCP-1 and MCP-2 may contribute to the ability of alveolar macrophage to ingest microorganisms that gain entry to the lower respiratory tract.

Effects of alpha-difluoromethylornithine and recombinant interferon-alpha 2 on the growth of a human renal cell adenocarcinoma xenograft in nude mice

The effects of human recombinant interferon-alpha 2 (IFN-alpha 2) and alpha-difluoromethylornithine (DFMO) as single agents and in combination were studied for efficacy against the renal cell adenocarcinoma (JDF-1) in an in vitro clonogenic assay and in vivo as xenografts in nude mice. In vitro studies showed dose-dependent inhibition of JDF-1 colony formation by IFN-alpha 2. DFMO alone did not significantly inhibit colony formation even though ornithine decarboxylase activity was significantly inhibited. The combination of IFN-alpha 2 and DFMO synergistically inhibited JDF-1 colony formation. The synergism was more readily observed at low IFN-alpha 2 concentrations. In vivo studies showed a similar tumor growth inhibition pattern. JDF-1 tumors were implanted s.c. in nude mice, and drugs were administered continuously by Alza minipumps (IFN-alpha 2) and in drinking water (DFMO) for 28 days. IFN-alpha 2 alone significantly inhibited JDF-1 growth, while DFMO alone had no significant inhibitory effect. The combination of IFN-alpha 2 and DFMO inhibited tumor growth in an apparent additive manner at the doses used. This was reflected in the mean tumor weights obtained at the termination of the experiment: control, 1484 +/- 187 (S.E.) mg; DFMO only, 1106 +/- 129 mg; IFN-alpha 2 only, 941 +/- 186 mg; and DFMO plus IFN-alpha 2, 620 +/- 109 mg. Assessment of mouse natural killer cell activity at the time of sacrifice showed that DFMO inhibited natural killer cell activity, while IFN-alpha 2 had no effect. DFMO was observed to inhibit ornithine decarboxylase activity in JDF-1 tumors by 78%, IFN-alpha 2 by 18%, and the combination by 78%. In addition, the drugs individually and in combination had similar inhibitory effects on JDF-1 spermidine content. One of the unexpected findings was the alteration in the spermine:spermidine ratio in the tumors treated with the combination of DFMO and IFN-alpha 2. The ratio in this group decreased to 0.44, while ratios for control, IFN-alpha 2 only, and DFMO only were 0.99, 0.66, and 0.88, respectively. These results clearly show that combined therapy with DFMO and IFN-alpha 2 is more effective than is single-drug therapy. The mechanism by which these drugs coordinately inhibit tumor growth is unclear but appears to be associated with direct inhibition of tumor cell proliferation, possibly by modulation of polyamine metabolism.

Renal cell carcinoma and the clonogenic assay

The clonogenic assay is an in vitro chemosensitivity test performed on tumor specimens and has had limited success in predicting or confirming patient response to chemotherapy. We investigated this assay system, using a 1-hour method, in 37 renal cell carcinoma specimens to determine its clinical usefulness. These specimens also were graded independently by a pathologist with respect to cell type, mitotic figures and degree of differentiation. Only 22 specimens formed at least 50 colonies per 500,000 cells plated and few specimens displayed any chemosensitivities. Marked variations of colony counts among duplicate controls or drug-treated samples demonstrated further the unreliability of the assay. Of several factors responsible for the poor performance of the assay the 2 outstanding problems were losses of clear cells in variable amounts (unique to renal cell carcinoma), and the inability to generate and maintain single cell suspensions. Pathologic correlations confirmed that predominantly clear cell carcinomas did not form colonies as well as granular cell carcinomas. Owing to these problems in its present form the clonogenic assay is not useful clinically and is unsuited particularly for renal cell carcinoma.

Antibacterial activity of microbicidal cationic proteins 1 and 2, natural peptide antibiotics of rabbit lung macrophages

Microbicidal cationic proteins 1 and 2, peptides derived from rabbit lung macrophages, were tested for bactericidal activity against various bacterial species. Both were highly active against diverse gram-positive and gram-negative organisms under conditions of near-neutral pH (between 7 and 8) and relatively low ionic strength. Susceptible species included Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Listeria monocytogenes, Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenzae, Escherichia coli, and Serratia marcescens. Streptococcus agalactiae, type 1A, was less susceptible than the aforementioned organisms or S. agalactiae, type 3. Bordetella bronchiseptica, a common commensal and pathogen of the rabbit respiratory tract, was completely resistant to both peptides.

Successful treatment of spinal arachnoiditis due to coccidioidomycosis. Case report

An unusual case is reported of a patient with spastic paraparesis who was found to have severe spinal arachnoiditis due to Coccidioides immitis. Despite an obstructive hydrocephalus and a spinal subarachnoid block, the patient was treated effectively with surgery (shunting) and antifungal therapy (amphotericin and ketoconazole). He remains asymptomatic 3 years after diagnosis. Aggressive surgical and medical treatment of coccidioidal infection of the central nervous system can be beneficial, even in patients with the worst prognosis.

Pelvic lymph node status as predictor of extracapsular tumor extension in clinical stage B prostatic cancer

To examine the accuracy of normal pelvic lymph node status in identifying patients with clinical stage B prostatic cancer not having extracapsular tumor extension we reviewed 63 consecutive patients (39 stage B1 and 24 stage B2) treated with radical prostatectomy. Ten per cent of the patients with stage B1 lesions (tumor involving 1 lobe) and 38 per cent with stage B2 lesions (tumor involving both lobes) had extracapsular extension. Extracapsular tumor extension was more common in patients with larger, less differentiated lesions. The results suggest that a negative pelvic lymphadenectomy does not exclude with a high degree of confidence extracapsular tumor extension in patients with clinical stage B2 prostatic cancer.

Lack of value of radioimmunoassay for prostatic acid phosphatase as a screening test for prostatic cancer in patients with obstructive prostatic hyperplasia

We examined the incidence of prostatic cancer in patients with an elevated radioimmunoassay for prostatic acid phosphatase and clinical benign prostatic hyperplasia on digital rectal examination. Of 295 patients screened with prostatic acid phosphatase tests 17 fulfilled the criteria of having an elevated prostatic acid phosphatase, clinically benign prostate and histological examination of the prostatectomy specimen. None of the 17 patients had histological evidence of prostatic cancer. The results confirm the predictions of mathematical models that prostatic acid phosphatase is of no practical value as a screening test for prostatic cancer in patients with clinical benign prostatic hyperplasia.

Increased content of microbicidal cationic peptides in rabbit alveolar macrophages elicited by complete Freund adjuvant

We measured the microbicidal peptides MCP-1 and MCP-2 in rabbit alveolar macrophages (AM), comparing rabbits pretreated with complete Freund adjuvant with untreated control animals. Levels of MCP-1 increased from 4.7 +/- 0.6 microgram/10(7) resident AM to 13.2 +/- 0.1 microgram/10(7) complete Freund adjuvant-elicited AM. MCP-2 levels rose from 1.8 +/- 0.1 microgram/10(7) resident AM to 7.3 +/- 0.4 microgram/10(7) complete Freund adjuvant-elicited AM. The activities of five lysosomal hydrolases (beta-D-glucuronidase, beta-D-galactosidase, acid phosphatase, N-acetyl-beta-D-galactosaminidase, and N-acetyl-beta-D-glucosaminidase) were 44 to 96% higher in complete Freund adjuvant-elicited AM, and lysozyme activity was three- to fourfold higher. As MCP-1 and MCP-2 are major constituents of rabbit AM and exhibit potent antibacterial and antifungal properties, they may contribute to the expression of microbicidal activity in both resident and activated states.