Correlations between the histopathological alterations in minor salivary glands and the clinically suspected Sjögren's syndrome

In sicca syndrome patients the xerostomia, xerophthalmia and the serological findings may strongly suggest the autoimmune Sjögren's syndrome, but the histological findings in the labial salivary gland biopsies do not always justify the suspected diagnosis. The aim of this study was to compare the histomorphological changes and the clinical findings in patients with pathologically established Sjögren's syndrome and in cases with negative histology. A total of 133 labial biopsies have been retrospectively evaluated from 2015 to May 2022, and the characteristic Sjögren's lesions were found in 67 cases. According to the clinical data, 34 cases proved to be primary, and 33 were associated ("secondary") forms. In 66 cases, the histology did not justify Sjögren's syndrome; a significant acinar loss, fibrolipomatous infiltration, and mild sialadenitis had led to the clinical symptoms. In Sjögren's histologies, the acinar loss was detected in just 31.8% of cases, which might indicate that the diminished saliva production represents immune-mediated hypofunction rather than direct damage of the acini. This is the first systemic study in Hungary investigating the correlation between pathological alterations and clinical findings.

Gross-total resection of malignant gliomas in elderly patients: implications in survival

BACKGROUND

Malignant gliomas in elderly patients are frequently under represented in neuro-oncology trials because of presumed low tolerability of gross-total resection and radiochemotherapy treatments. Thus, the balance of benefit versus adverse response of standard glioma therapy remains controversial. We hypothesized that older patients with malignant gliomas might also take advantage of extensive surgical procedures.

PATIENTS AND METHODS

We analyzed retrospectively 138 consecutive malignant glioma patients. Sixty-two patients were >65 years whereas seventy-six were <or= 65 years. Evaluation consists of clinical features at diagnosis, neurological functional status, surgical procedures, post-operative complications and the predictive value of the former variables for survival.

RESULTS

At diagnosis, elderly patients showed a larger burden of comorbidities but they did not influence outcome significantly. Gross-total resection was associated with a longer survival as compared to biopsy and subtotal resection in both groups of elderly (P=0.05 and 0.001, respectively) and younger patients (P=0.004 and 0.003). Concerning complications, the only difference between both collectives was a higher incidence of psychosyndrome in the elderly group (P=0.016).

CONCLUSIONS

Our results indicate that gross-total resection of malignant gliomas in elderly patients is associated with a survival benefit without increased morbidity.

Enhancement of neutral endopeptidase activity in SK-N-SH cells by green tea extract

Green tea extract (EFLA85942) is able to induce specifically the neutral endopeptidase (NEP) activity and to inhibit the proliferation of SK-N-SH cells; the angiotensin-converting enzyme (ACE) activity is not influenced under the same conditions. The treatment of the cells with arabinosylcytosine and green tea extract results in a strong enhancement of cellular NEP activity whereas cellular ACE activity was not changed significantly, indicating a green tea extract-specific regulation of NEP expression. Because of its role in the degradation of amyloid beta peptides this enzyme induction of NEP by long term treatment with green tea extract may have a beneficial effect regarding the prevention of forming amyloid plaques.

Clinical outcome of sural nerve biopsy: a retrospective study

Sural nerve biopsy is a valuable tool in establishing the diagnosis and investigating the underlying causes of peripheral neuropathies. Few investigations have been carried out in which the sequelae of this procedure have been described systematically. We studied the short-term adverse reactions in 110 patients and the long-term outcome of sural nerve biopsy in a subgroup of 54 patients after 5-32 months. Long-lasting sensory deficits were reported in 93%, dysaesthesia in 19% and mild persistent pain in 33% of the 54 patients. No significant differences were found between patients followed for 1-2 years and those followed for more than 2 years in the frequency and distribution of hypaesthesia and anaesthesia. However, dysaesthesia was less frequent after more than 2 years (6/32 vs 1/16), and persistent pain completely subsided within our observation period. We conclude that disabling sequelae regress and finally subside over time. If we assume that returning for follow-up visits may cause bias towards more severely affected patients, the overall prognosis may be even better.

Decompressive craniectomy in patients with uncontrollable intracranial hypertension

There has been controversial discussion about the benefits of decompressive craniectomy in patients with critically raised intracranial pressure (ICP) after severe head injury. The aim of this retrospective study was to analyze the results of secondary decompressive craniectomy in patients with uncontrollable raised ICP after maximum aggressive medical treatment. The data of 28 patients (mean age 22 years, range 8-44 years) with severe head injury and posttraumatic cerebral edema were analyzed retrospectively. Surgery was not indicated in patients with vast primary lesions, hypoxia, ischemic infarction, brainstem injuries and central herniation. The outcome was classified according to the Glascow Outcome Scale (GOS) after one year. The decompressive crainectomy was performed an average of 68 hours after trauma, and ICP (< 25 mm Hg) decreased always while cerebral perfusion pressure (CPP > 75 mm Hg) improved as well as cerebral blood flow and microcirculation to normal values. 15 patients (56%) had a good outcome after one year (GOS 4 + 5). 5 patients (18%) were severely disabled, 4 patients (14%) remained in vegetative state and 3 patients (11%) died. Decompressive craniectomy should be kept in mind as the last therapeutic step, especially in young patients with head injury and raised ICP, which is not controllable with conservative methods.

DNA ploidy and cell-cycle analysis in intracranial meningiomas and hemangiopericytomas: a study with high-resolution DNA flow cytometry

Although various DNA flow-cytometric studies have been performed on meningiomas, the role of DNA ploidy and the S-phase fraction (SPF) in predicting biological tumor behavior remains unresolved. Discrepant results in earlier studies might be due to different preparing, staining and measuring techniques; different quality standards; and lack of sophisticated computer software. In this study, high-resolution DNA flow cytometry using the DNA-specific dye DAPI (4', 6'-diamidino-2-phenylindol) was performed on stored frozen tissue from 128 microsurgically resected meningiomas and 7 hemangiopericytomas, including 17 recurrent meningiomas and 4 recurrent hemangiopericytomas. The computer software Multicycle 2.5 was used to determine the ploidy level and to perform cell-cycle analysis. DNA aneuploidy and SPF were significantly higher in atypical, anaplastic and recurrent meningiomas and correlated well with histopathological features such as focal necrosis, infiltration of dura mater and mitotic activity. Among 128 meningiomas, 42 had additional DNA aneuploid stem lines. No association between hypo- and hyperploidy and either histological subtype or clinical outcome was found. In 7 hemangiopericytomas, SPF was significantly higher compared to the benign meningioma group, while only 1 tumor was aneuploid. In all 42 DNA aneuploid tumors, cell-cycle analysis was performed separately for the euploid and aneuploid stem lines. The proliferation parameters (SPF, G2/M phase) were significantly higher in the DNA aneuploid stem lines. DNA ploidy and SPF are thus useful indicators of different biological behavior within identical histological subgroups in meningiomas.

Saniculoside R-1: a new triterpenoid saponin from Sanicula europaea

A new acylated triterpenoid saponin was obtained from the leaves of Sanicula europaea. The structure has been elucidated from NMR and MS data, and by chemical derivatisation as 21-O-[2-methylbutanoyl]-3 beta, 15 alpha, 16 alpha, 21 beta, 22 alpha, 28-hexahydroxyolean-12-ene 3-O-[alpha-L-arabinopyranosyl (1-->3)] beta-D-glucopyranosyl(1-->2)-beta-D-glucuronopyranoside.

Cloning of a novel transcription factor-like gene amplified in human glioma including astrocytoma grade I

Gene amplification, which is generally considered to occur late in tumor development, is a common feature of high grade glioma. Up until now, there have been no reports on amplification in astrocytoma grade I. In this study, we report cloning and sequencing of a cDNA termed glioma-amplified sequence (GAS41) which was identified recently in a glioblastoma cell line by microdissection-mediated cDNA capture. This technique is tailored to isolate amplified genes from human tumors. An increased copy number of GAS41 was found in glioblastoma multiforme and astrocytoma III, and at a high frequency in astrocytoma grades I and II. Sequence comparison indicates a high homology between the GAS41 protein, the yeast and human AF-9 and the human ENL proteins. Both AF-9 and ENL belong to a new class of transcription factors, indicating that GAS41 might also represent a transcription factor. With GAS41 being the first gene found with increased copy number in low grade glioma, this study provides the first evidence that gene amplification can occur in early tumor development.

Effect of changes in the CD44 gene on tumour cell invasion in gliomas

Cell adhesion is a critical factor in the multistep process of tumour invasion. CD44 is one of the cell surface adhesion molecules responsible for interaction with hyaluronic acid, a component of the CNS extracellular matrix. The aim of the present study was to demonstrate whether alterations in the CD44 gene might account for different invasive behaviour. EcoRI restriction analysis by Southern blot hybridization revealed several additional hybridization signals in tissue specimens of two out of 16 patients with glioblastoma, indicating DNA rearrangements or point mutations, respectively, within the region of the CD44 gene. Expression patterns of CD44 isoforms in these two rearranged gliomas and in 28 other patients with malignant gliomas were analysed by RT-PCR. All cases displayed only the splice variant CD44H, which acts as hyaluronic acid receptor in glioma tumour cells. Tumour cell invasion was studied with Boyden chamber assays using hyaluronic acid as ligand and functional CD44H blocking antibody. Invasion of cells derived from those gliomas carrying the rearranged CD44 gene locus was decreased by about 50% compared with gliomas without rearrangement, indicating that the altered hybridization patterns in the two glioma samples influenced CD44H mediated glioma cell invasion through hyaluronic acid in vitro. Our results on CD44 isoform expression suggest that, in contrast to other solid tumours, gliomas seem to express only the CD44 variant. Genetic alterations within the CD44 gene might alter the binding domain of the receptor and thus account for different invasive behaviour in glioblastomas.

Comparative amplification analysis of human glioma tissue and glioma derived fragment spheroids using reverse chromosome painting (RCP)

Tumor fragment spheroids (TFS) represent an organotypic in vitro model with preserved cytoarchitecture and matrix components of the native tumor in situ. In order to determine whether DNA amplifications within gliomas remain stable in spheroid culture, tumor fragment spheroids were established from 15 human gliomas including 14 glioblastoma and one anaplastic astrocytoma. Native tumor tissue, monolayers as well as TFS were evaluated for DNA amplification using reverse chromosome painting (RCP). A modified protocol for DNA isolation from TFS was established. Amplifications in the original tumor tissue were found on chromosomes 12q13-15, tel, 4q12-13 and 11p12-13, an amplification on 11p12-13 is reported for the first time. By RCP we could demonstrate that amplified domains on 12q13-15 and 4q12-13 in three tumors were maintained in TFS whereas the amplification on 11p12-13 could not be confirmed in TFS. In monolayer cultures, all amplifications which were detected in primary culture were lost until passage 5. The results of this first comparative study of DNA amplification in glioma by analyzing native tumor tissue and tumor fragment spheroids enables us to conclude that TFS seems to be a promising in vitro model for the study of DNA amplification under cell culture conditions.

Prognostic significance of nuclear DNA content in human meningiomas: a prospective study

Flow cytometric DNA analyses were performed to study the correlation between alterations of nuclear DNA content and clinical aggressive tumour behaviour in 134 cranial meningiomas. Forty-one meningiomas revealed an aneuploid DNA content with a distribution of n = 24 in benign, n = 12 in atypical and n = 5 in anaplastic tumours. Aneuploid DNA content was correlated with a significantly higher amount of histomorphological criteria like evidence of mitoses, necrosis, infiltration and increased cellularity. There was a significantly higher Ki 67 proliferation index in the aneuploid meningiomas in comparison to the diploid tumour group. The rate of aneuploid cell-lines was increased in recurrent tumours. No tumour recurrence could be found in diploid meningiomas during follow up (mean 37 months, range 22-46 months). However eight of forty-one aneuploid tumours showed meningioma recurrence. Nuclear DNA content has an important significance in predicting risk of recurrence and poor clinical outcome after benign meningioma surgery.

Factors influencing morbidity and mortality after cranial meningioma surgery--a multivariate analysis

In a retrospective analysis 385 patients with a histologically defined cranial meningioma were studied to analyze the impact of characteristic factors on morbidity and mortality after modern cranial meningioma surgery. Mortality was 4.2% one month and 7.3% six months after operation. 15.6% of the patients stayed more than one month in the hospital (defined as criteria of operative morbidity). Age, poor preoperative clinical condition (ASA score), intra- and postoperative bleeding and CSF disturbances were significantly associated with a subsequent decrease of quality of life. First symptoms like intracranial hypertension, seizures, aphasia and hemiparesis were correlated with an increase of postoperative Karnowsky index. Postoperative quality of life decreased in patients with optic and other cranial nerve disturbances significantly. Tumour size, location (exception: medial sphenoid wing) and histological diagnosis did not influence surgical outcome. This information may be useful in management decisions regarding asymptomatic meningiomas in elderly and high risk patients.

Lack of isodisomy for chromosome 22 in disomic meningiomas

Loss of one copy of chromosome 22 is the most prevalent chromosomal change in meningioma, indicative of a tumor suppressor on chromosome 22. Meningioma retaining both copies of chromosome 22 could be possibly be explained by isodisomy for a meningioma suppressor gene. To investigate whether the chromosomal situation in meningioma is consistent with this hypothesis, we studied 53 cases, using polymorphic probes localized on chromosome 22. loss of one copy of chromosome 22 was found in 14 cases when polymorphic DNA markers were used. Thirty-nine meningiomas studied by karyotyping and molecular probes retained both copies of chromosome 22. The majority of cases (30/39, or 77%) displayed heterozygous banding patterns, indicating the presence of heterologous copies of chromosome 22. Hence, our data provide no evidence for duplication of one parental homolog as a general mechanism in diploid meningioma.

[Importance of germ cell mosaic for genetic counseling of families with Duchenne and Becker muscular dystrophy]

Germ cell mosaics were demonstrated in Duchenne's and Becker's muscular dystrophy by molecular genetic methods. These findings affect risk estimates in these x-chromosomal muscular diseases. The mutation-selection equilibrium for x-chromosomally lethal inheritance for determining the a priori probability for risk estimate according to the Bayes theorem must therefore be redefined to take the germ cell mosaic problem into account. Taking Duchenne's and Becker's progressive muscular dystrophy as an example, the article explains how the estimation of the heterozygote risk in women seeking advice changes in different family situations.

Evidence for linkage of the central core disease locus to the proximal long arm of human chromosome 19

Central core disease of muscle (CCD; MIM 117000) is a rare inheritable myopathy that is frequently found in association with susceptibility to malignant hyperthermia (MHS). This observation has prompted us to perform a linkage study in CCD families using various chromosome 19q probes that are linked to the MHS locus and map close to the ryanodine receptor gene (RYR1), a strong MHS candidate gene. Our genetic linkage data support a location of the CCD gene on proximal 19q13.1 and thus suggest that CCD and MHS may be allelic.

Evidence supporting tight linkage of X-linked Emery-Dreifuss muscular dystrophy to the factor VIII:C gene

In a large German family with Emery-Dreifuss muscular dystrophy (EDMD) linkage analysis was performed using the factor IX gene (F9), the factor VIII:C gene (F8), the anonymous DNA probe DXS52, and DXS15 as markers. Tight linkage was found between the EDMD locus and the F8 probe (Zmax = 1.19; theta max = 0.00), DXS15 (Zmax = 1.75; theta max = 0.00) and DXS52 (Zmax = 2.26; theta max = 0.00). Weak linkage was found to F9 (Zmax = 0.02; theta max = 0.43). The data from the literature and our results suggest that the gene locus of EDMD is close to F8 (confidence interval theta = 0-0.07). The new linkage data are useful for carrier detection and diagnosis of EDMD patients before onset of major clinical signs.

Theoretical considerations on germline mosaicism in Duchenne muscular dystrophy

A newly formulated mutation selection equilibrium for lethal X linked recessive traits such as Duchenne muscular dystrophy is presented, which allows for both male and female germline mosaicism. Estimates of the additional parameters used are given, thus allowing the incorporation of germline mosaicism into the calculation of genetic risks.