Robotic Approach for Perihilar Cholangiocarcinoma IIIA Type: Step-by-Step Procedure

BACKGROUND

Perihilar cholangiocarcinoma is a challenging technique to be performed by minimally invasive approach being the type III among the most complex procedure. Nowadays, the robotic approach is gaining increasing interest among the surgical community, and more and more series describing robotic liver resection have been reported. However, few cases of minimally invasive Bismuth type IIIA cholangiocarcinoma have been reported. Robotic approach allows for a better dissection and suture thanks to the flexible and precise instruments movements, overcoming some of the limitations of the laparoscopic technique. Therefore, robotic technique can facilitate some of the critical steps of a technically demanding procedure, such as the extended right hepatectomy for perihilar cholangiocarcinoma Bismuth IIIA type.

METHODS

In this multimedia video we describe, for the first time in the literature, a full robotic surgical step-by-step technique with some tips and tricks for treating a perihilar cholangiocarcinoma Bismuth IIIA type, performing a radical extended right hemihepatectomy, including segment I combined with regional lymphadenectomy anf left bile duct reconstruction. A 55-year-old woman with obstructive jaundice (10 mg/dl) was referred to our center. The endobiliary brushing confirmed adenocarcinoma, and MRI/CT showed a focal perihilar lesion of 2 cm, including the main biliary duct bifurcation and extending up to the right duct (Bismuth Type IIIA hilar cholangiocarcinoma). After endoscopic biliary stents placement and 6 weeks after right portal vein embolization, the future liver remnant, including segments II and III, reached an enough hypertrophy volume with a ratio of 30%. A right hemihepatectomy with caudate lobe, including standard standard lymphadenectomy and left biliary duct reconstruction was performed.

RESULTS

The operation lasted 670 min with an estimated blood loss of 350 ml. Postoperative pathological examination revealed a moderately differentiated adenocarcinoma pT1N0 with 15 retrieved nodes and free margins. The patient experienced a type A biliary fistula and was discharged on the 21st postoperative day without abdominal drainage.

CONCLUSIONS

Through the tips and tricks presented in this multimedia article, we show the advantages of the robotic approach for performing correctly one of the most complex surgeries.1-7.

Oat-Cell Carcinoma of Primary Location in the Pericardium. A Case Report

A case of oat-cell carcinoma arising in the pericardium of a 51-year-old woman is described. The patient had multiple nodes; the largest was 2 × 1 cm. Two years later the patient presented with a tumor on her lower gum; this measured 2 mm and had similar characteristics to the previous one. The immunohistochemical study showed strong positivity for neuron-specific enolase. From review of the literature, it may be concluded that this is the first report of oat-cell carcinoma occurring in the pericardium.

The homeoprotein SIX1 controls cellular senescence through the regulation of p16INK4A and differentiation-related genes

Cellular senescence is an antiproliferative response with essential functions in tumor suppression and tissue homeostasis. Here we show that SIX1, a member of the SIX family of homeobox transcriptional factors, is a novel repressor of senescence. Our data show that SIX1 is specifically downregulated in fibroblasts upon oncogenic stress and other pro-senescence stimuli, as well as in senescent skin premalignant lesions. Silencing of SIX1 in human fibroblasts suffices to trigger senescence, which is mediated by p16INK4A and lacks a canonical senescence-associated secretory phenotype. Interestingly, SIX1-associated senescence is further characterized by the expression of a set of development and differentiation-related genes that significantly overlap with genes associated with SIX1 in organogenesis or human tumors, and show coincident regulation in oncogene-induced senescence. Mechanistically, we show that gene regulation by SIX1 during senescence is mediated, at least in part, by cooperation with Polycomb repressive complexes. In summary, our results identify SIX1, a key development regulator altered in human tumors, as a critical repressor of cellular senescence, providing a novel connection between senescence, differentiation and tumorigenesis.

[Circulating endothelial progenitor cell levels in treated hypertensive patients]

INTRODUCTION

Most optimally treated hypertensive patients still have an around 50% increased risk of any cardiovascular event, suggesting the possible existence of unidentified risk factors. In the last years there has been evidence of the essential role of circulating endothelial progenitor cells (EPCs) in the maintenance of endothelial integrity and function, increasing the interest in their involvement in cardiovascular disease. In this study, the circulating levels of EPCs and vascular endothelial growth factor (VEGF) are investigated in treated hypertensive patients with adequate control of blood pressure (BP).

MATERIAL AND METHODS

Blood samples were collected from treated hypertensive patients with controlled BP. Plasma levels of EPCs CD34+/KDR+ and CD34+/VE-cadherin+ were quantified by flow cytometry. Plasma concentration of VEGF was determined by ELISA. A group of healthy subjects without cardiovascular risk factors was included as controls.

RESULTS

A total of 108 hypertensive patients were included (61±12 years, 47.2% men) of which 82.4% showed BP<140/90 mmHg, 91.7% and 81.5% controlled diabetes (HbA1c <7%) and cLDL (<130 or 100 mg/dL), respectively, and 85.2% were non-smokers. Around 45% of them were obese. Although patients had cardiovascular parameters within normal ranges, they showed significantly lower levels of CD34+/KDR+ and CD34+/VE-cadherin+ compared with healthy control group, although plasma VEGF concentration was higher in patients than in controls.

CONCLUSIONS

Despite an optimal treatment, hypertensive patients show a decreased number of circulating EPCs that could be, at least in part, responsible for their residual cardiovascular risk, suggesting that these cells could be a therapeutic target.

Psychometric validation of the Spanish version of the Dundee Ready Education Environment Measure applied to dental students

AIM

To carry out a psychometric evaluation of the Spanish-language version of the Dundee Ready Education Environment Measure (DREEM) applied to dental students.

METHODS

A total of 1,391 students from nine Spanish public schools of dentistry responded to the DREEM questionnaire. To analyse the reliability of the DREEM questionnaire, the internal consistency was assessed and a 'test-retest' carried out. Validity was evaluated through analysis of item response rate, floor and ceiling effects, corrected item-total and item-subscale correlations and factor structure. A confirmatory factor analysis was performed to analyse the structure of the original DREEM scale.

RESULTS

Cronbach's alpha coefficient for the 'Educational Climate' (EC) global scale was 0.92. In the subscales, the 'observed' Cronbach's alpha coefficients ranged between 0.57 and 0.79 and were higher than the 'expected' ones; except for the Social subscale. In the DREEM questionnaire, all of the corrected correlation coefficients between the items and the EC global scale, and the items and their corresponding subscales, were >0.2; except for items 50 and 17. All goodness-of-fit indices of confirmatory factor analysis showed acceptable values (close to one or zero, depending on the case), and there was consistency in the results.

CONCLUSIONS

The Spanish-language version of the DREEM questionnaire is a reliable and valid instrument for analysing the EC for dental students and its factor structure is supported by the data. Although our findings indicate that the DREEM may be as culturally independent as was originally stated, more research should be directed at verifying the factor structure in various languages and cultural environments.

Analysis of the 'Educational Climate' in Spanish Public Schools of Dentistry using the Dundee Ready Education Environment Measure: a multicenter study

AIM

To analyse the 'Educational Climate' (EC) of dental students in Spain.

METHODS

The study group consisted of 1391 students from nine Spanish Public Schools of Dentistry, who responded to the questionnaire based on 'Dundee Ready Education Environment Measure' (DREEM). This questionnaire has 50 items that are grouped into five domains: Learning, Teachers, Academic, Atmosphere and Social.

RESULTS

The global score on the EC was 123.1 (interpretation: 'EC more positive than negative'). The scores obtained in the different domains were: 28.0 in Learning (interpretation: 'a generally positive perception of learning'), 26.8 in Teachers (interpretation: 'teachers are going in the right direction'), 20.8 in Academic (interpretation: 'feeling more on the positive side'), 29.7 in Atmosphere (interpretation: 'a generally positive atmosphere') and 17.7 in Social (interpretation: 'social perception acceptable'). In seven items (14%), an average of <2 was detected, showing that there are some educational problem areas. Regarding the EC in the different Schools of Dentistry, an average of >100 was achieved in all of them, although there were two centres that showed significantly higher values of EC.

CONCLUSIONS

Spanish dental students felt that their EC was more positive than negative and considered that the different domains were positive and acceptable. However, they pointed out the existence of several educational problem areas associated with the development of a traditional curriculum. Accordingly, and in parallel with the implementation of an innovative curriculum in all Spanish Dental Schools in the coming years, immediate educational goals must address the problem areas identified, thereby further promoting a more positive perception of EC.

Reprogramming activity of NANOGP8, a NANOG family member widely expressed in cancer

NANOG is a key transcription factor for pluripotency in embryonic stem cells. The analysis of NANOG in human cells is confounded by the presence of multiple and highly similar paralogs. In particular, there are three paralogs encoding full-length proteins, namely, NANOG1, NANOG2 and NANOGP8, and at least eight additional paralogs that do not encode full-length NANOG proteins. Here, we have examined NANOG family expression in human embryonic stem cells (hESCs) and in human cancer cell lines using a multi-NANOG PCR that amplifies the three functional paralogs and most of the non-functional ones. As anticipated, we found that hESCs express large amounts of NANOG1 and, interestingly, they also express NANOG2. In contrast, most human cancer cells tested express NANOGP8 and the non-coding paralogs NANOGP4 and NANOGP5. Notably, in some cancer cell lines, the NANOG protein levels produced by NANOGP8 are comparable to those produced by NANOG1 in pluripotent cells. Finally, we show that NANOGP8 is as active as NANOG1 in the reprogramming of human and murine fibroblasts into induced pluripotent stem cells. These results show that cancer-associated NANOGP8 can contribute to promote de-differentiation and/or cellular plasticity.

Bacteria involved in sulfur amendment oxidation and acidification processes of alkaline 'alperujo' compost

Eight strains of sulfur oxidizing bacteria were isolated from alkaline 'alperujo' compost, seven being identified as Paracoccus thiocyanatus and one as Halothiobacillus neapolitanus. This was the first time that P. thiocyanatus was isolated from mature compost. Acidification capability of isolated strains was compared with type strains H. neapolitanus CIP104769, Thiobacillus denitrificans CIP104767 and Thiomonas intermedia CIP104401. Indigenous P. thiocyanatus strains were as much as or more efficient for acidifying compost than type strains. Sulfur oxidizing population naturally occurring in compost showed maximum acidification efficiency and no extra effect was found with the help of type strains. pH reduction caused by S○ was paralleled by a decrease in CaCO3 and an increase in CaSO4 and salinity levels. A remarkable increase in cultivable sulfur oxidizing bacteria population along with the acidification process was also recorded. Amended compost showed a range of chemical and biological characteristics suitable for use as container media constituent.

Practical application of seminal plasma

Natural mating deposits a large number of sperm in a high volume of seminal plasma. Semen processed for AI has the seminal plasma greatly diluted, and processing of boar sperm for cryopreservation removes all seminal plasma. Boar sperm were evaluated for the impact of seminal plasma on the functional status of boar sperm. Seminal plasma prevented or reversed capacitation in frozen-thawed boar sperm. However, supplementing frozen-thawed semen doses with 10% seminal plasma did not significantly affect the number of sperm found in the utero-tubal sperm reservoir, nor did it affect farrowing rates.

Impact of millennial mining activities on sediments and microfauna of the Tinto River estuary (SW Spain)

In this paper, we analyze two short cores collected in the Tinto estuary (SW Spain), and describe the palaeoenvironmental evolution of this area during the last two millennia, along with the influence of historical mining activities and recent industrial pollution on sediments and microfauna (foraminifera and ostracoda). Although there were no significant changes in the distribution of microorganisms, a first pollution period (0-150 AD) was recorded in high sediment pollution by Cu in the shallow palaeochannels of the middle estuary. During this period and the following 1700 years, tolerant pioneer species of both foraminifera and ostracoda were found predominantly in the inner, protected areas of the estuary, while the bottom sediments were subjected to high hydrodynamic gradients, and consequently showed lower density and diversity of organisms. In the last 150 years, acid mine drainage processes, introduction of a new mining period, and the polluted inputs derived from two industrial processes resulted in increased heavy metal contamination of the bottom sediments, and corresponding extirpation of ostracodes and restriction of foraminifers to the inner zones of the estuary.

Biological oxidation of elemental sulphur added to three composts from different feedstocks to reduce their pH for horticultural purposes

The biological oxidation of elemental sulphur (S(o)) added to three alkaline composts prepared with a range of organic wastes (CC, melon crop residues; MC, mixed manures; and BC, pine bark) to reduce their pH was studied. The titration curves showed that to achieve an equivalent pH drop, compost CC needed a larger dose of S(o) than did composts MC and BC. The acidification efficiency was high in the three composts (53%), but the pH reduction obtained from the titration curves in MC and BC composts was lower than expected. S(o) oxidation in amended composts was found to be related to pH and CaCO(3) content decreases, and to the rise in CaSO(4) and electrical conductivity levels. A remarkable increase in the autotrophic bacteria population and a slight increase in heterotrophic bacteria along with S(o) oxidation were recorded. Actinomycetes, fungi and yeasts were not affected by the addition of S(o) to composts.

Effect of insemination-ovulation interval and addition of seminal plasma on sow fertility to insemination of cryopreserved sperm

In swine, the use of frozen-thawed (FT) sperm for artificial insemination (AI) is limited because of poor sow fertility, possibly associated with a post-thaw capacitation-like status resulting in fewer fully viable sperm. Sow fertility to AI with FT sperm may improve with deeper deposition of sperm within the female tract, insemination very close to ovulation, or reversal of cryocapacitation by seminal plasma (SP). We performed two experiments to examine these suggestions. In experiment 1, 122 multiparous Yorkshire sows received 600 IU equine chorionic gonadotrophin at weaning and 5 mg pLH 80 h later to control time of ovulation. The predicted time of ovulation (PTO) was 38 h after pLH injection. Thereafter, sows were assigned on the basis of parity to a single AI of FT sperm at 2 h before PTO, or at 12 h before PTO, or FT sperm supplemented with 10% SP at 12 h before PTO. Control sows received fresh semen at 12 h before PTO. All semen doses were adjusted to 3 x 10(9) live cells and deposited into the cervix. Experiment 2 employed 99 multiparous crossbred sows and repeated the treatments of experiment 1 except that all FT inseminations were intrauterine. In both experiments, farrowing rates were lower (p < 0.01) following FT inseminations with no effect of time of insemination or of supplemental SP. In experiment 1, litter size was smaller following FT insemination (p < 0.05), but no effect on litter size was evident in experiment 2. Supplemental SP had no effect on litter size in either experiment. The lack of effect of either SP or timing of FT insemination on sow fertility suggests that the non-lethal sperm cryoinjury affecting fertility involves more than just cryocapacitation.

Effect of sperm numbers and time of insemination relative to ovulation on sow fertility

We examined the effect of inseminating mixed parity sows (n=231) once with fewer sperm at different times relative to ovulation. Lactation length was 19 days and sows received an IM injection of 600 IU equine chorionic gonadotrophin (eCG) 12 h before weaning. At 80 h after eCG injection, sows received an IM injection of 5 mg porcine luteinizing hormone (pLH). Predicted time of ovulation (PTO) was 38 h after pLH injection. Sows were assigned by parity to receive a single transcervical artificial insemination (AI) at either 6 or 24 h before PTO with semen doses containing either 2.5 or 1.25x10(9) sperm. A positive control group of sows (n=49) was subject to conventional AI 24 and 6 h before PTO. Detection of estrus was performed in the presence of a boar and only sows exhibiting estrous behavior at the assigned time of AI were included in the study. Farrowing rate for sows receiving 2.5x10(9) sperm at 6 h before PTO was greater than that for sows receiving 1.25x10(9) sperm at 24 h before PTO (85% versus 61%, P<0.05). All other groups were intermediate. There was no effect of time of AI or sperm numbers on subsequent litter size. These data indicate that single insemination of fewer sperm may compromise sow fertility, even when performed transcervically, if not appropriately timed relative to ovulation.

Effect of sperm cryopreservation and supplementing semen doses with seminal plasma on the establishment of a sperm reservoir in gilts

Frozen-thawed (FT) boar sperm have a reduced fertile life, due in part to a capacitation-like status induced by cooling. Reversal of this cryocapacitation in vitro by exposure to boar seminal plasma (SP) has been demonstrated. The objective of these studies was to determine the effect of SP on the ability of FT sperm to create an oviductal sperm reservoir following artificial insemination (AI). In Experiment one, 35 pre-pubertal gilts were injected (IM) with 400 IU eCG plus 200 IU hCG to induce oestrus. At detection of oestrus, gilts were inseminated with 3 x 10(9) live sperm, either fresh (FS; n = 13), FT (n = 10), or FT supplemented with 10% v/v SP (n = 12). Gilts were killed 8 h later, their reproductive tracts recovered and the uterotubal junctions (UTJs) flushed to recover sperm. Fewer (p < 0.01) sperm were recovered following FT, compared to FS, inseminations, and there was no evident effect of SP. In Experiment two, 30 pre-pubertal gilts received IM injections of 1000 IU eCG followed by 5 mg pLH 80 h later to control time of ovulation. Gilts were inseminated with 3 x 10(9) live FS sperm (n = 6), FT sperm (n = 15) or FT sperm plus 10% SP (n = 9) at 12 h before ovulation and then sacrificed 8 h later. The UTJs were dissected and flushed for sperm recovery. Fewest (p < 0.001) sperm were recovered following FT insemination and there was no evident effect of SP. These data demonstrate that the size of the sperm reservoir is markedly reduced in gilts inseminated with FT sperm. However, the lack of effect of SP suggested that either it did not reverse cryocapacitation or that such a reversal does not impact the in vivo ability to create a sperm reservoir.

The present environmental scenario of the Nador Lagoon (Morocco)

In this paper, we present a multivariate approach (waters, sediments, microfauna) concerning the environmental state of the Nador Lagoon (NE Morocco). The normal water quality parameters (salinity, pH, nutrients) of the dominant marine flows are altered by local fecal water effluents, urban discharges, sewages derived from a water treatment station, and residues originated in a slaughterhouse. The geochemical analyses carried out in surficial sediment samples show very high concentrations of all metals studied near an old iron mine and moderate contents between Nador and its treatment station. Ostracods are good bioindicators of these environmental impacts, with the presence of a highly brackish assemblage in the quieter, more confined areas or the appearance of opportunistic species under hypoxic conditions. In addition, these microcrustaceans are absent in polluted bottom sediments or areas with high hydrodynamic gradients, whereas they decrease in both density and diversity if the subaerial exposure increases.

Neuregulin (NRG) expression modulates clinical response to trastuzumab in patients with metastatic breast cancer (MBC)

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Background: ErbB2 overexpression is the major determinant of response to trastuzumab (Herceptin, H). Recently, some authors have reported the potential role of the expression of NRG on ErbB2 activation in breast cancer cells, and its consequences in response to treatment with H. In the present study we analyze the relationship between response to H and expression of ErbB2 and NRG in patients (pt) with MBC. Methods: Data and frozen tissue samples from 30 consecutive pt with MBC and positive ErbB2 at diagnosis [Immunohistochemistry (IHC)] were collected. All pt were treated with an Herceptin-based regimen. Central Pathologic review of ErbB2 expression was performed in all samples (Herceptest and FISH). NRG expression was studied by IHC on paraffin embedded material and by Western blotting on frozen tissue using an antibody raised against the intracellular domain of NRG. NRG expression by IHC was evaluated using a semiquantitative scoring system that assesses both extension and intensity of cytoplasmic staining. Correlation between ErbB2 and NRG expression and its influence in response to H was analyzed. Characteristics of pt: Median Age: 54; Median mts sites: 2; Treatment: H alone:1 pt; H+Taxol:15 pt; H+Taxol+Carbo: 4 pt; H+Taxol+Lip.Doxorub:2 pt, H+Vinorelbine:7 pt; H+CDDP:1 pt. Results: ORR: 76% (CR:23%, PR:53%). Median TTP: 7.8 m. After central Pathologic review, a total of 20 tumors showed ErbB2 amplification by FISH and 19 of them were Herceptest 3+. A positive correlation was observed between ErbB2 amplification and NRG expression. All complete responses (n=7) were seen in pt with ErbB2 amplification. Interestingly, in the group of tumors without ErbB2 amplification (n=10), 7 had high NRG expression levels, as assessed by IHC. Six out of these 7 tumors having high levels of NRG expression, exhibited partial responses. NRG expression, in turn, did not have impact on response among ErbB2 amplified tumors. Conclusions: These preliminary results suggest that responses to H regimens in pt with MBC can be seen in pt lacking ErbB2 amplification in presence of high levels of expression of transmembrane ligand NRG. This suggests that the group of pt that may benefit from treatment with H could be broader than currently established. A confirmatory study is ongoing in a larger series.

No significant financial relationships to disclose.

Ostracoda and foraminifera as short-term tracers of environmental changes in very polluted areas: the Odiel Estuary (SW Spain)

The analysis of 17 cores collected in the Odiel Estuary (SW Spain) permits delimiting the recent evolution of this zone during the past decades and the influence of natural and anthropogenic factors on the distribution of Ostracoda and Foraminifera. In the upper estuary, the coincidence of acid waters, prolonged subaerial exposure, and coarse sediments may explain the absence or the disappearance of these microorganisms during the industrial period (1966-1985) in the major part of this area. In the lower estuary, sedimentary evolution and industrial wastes are the main factors influencing both the distribution and trends of the populations of these two groups. Finally, the main changes observed in the marine estuary are due to the sedimentary effects of the construction of two banks and the dredging of the main estuarine channel.

Sterol composition of gonad, muscle and digestive gland of Pecten maximus from Málaga (South Spain)

Sterol composition and content and their seasonal variations over 18 months were investigated in adductor muscle, digestive gland and gonads of Pecten maximus. Sterols were isolated by Silicagel 60 thin layer chromatography and identified by gas chromatography/mass spectrometry. Eleven sterols were identified, with cholesterol, brassicasterol, 24-methylenecholesterol and 22-trans-dehydrocholesterol being the principal components. The same sterols were found in all three tissues independent of season. The relative amounts of each sterol present in each tissue differed. Total sterol levels in gonad and muscle were higher than in digestive gland. Statistically significant differences (P<0.05) were found between the concentrations of each of the sterols isolated from the gonad or muscle and digestive gland. The seasonal variations in the sterol content of the gonad seem be related to the reproductive cycle, while the sterol content of the digestive gland appears to be linked to diet, mainly diatoms or dinoflagellates. The muscle sterol content showed minor changes throughout the year.

The microstructure of coconut coir dusts for use as alternatives to peat in soilless growing media

The microstructure of the mesocarp pithy tissue and short-length fibres of 2 differently processed coconut coir dusts from Mexico and Sri Lanka was studied using scanning electron microscopy and compared with that of a Sphagnum moss peat. Selected physical properties of these materials were also determined for their use in potting media. The 2 coir dusts did not significantly differ in the microstructural parameters studied, whereas they differed remarkably in their particle size and therefore in their physical properties. Pithy tissue was the major constituent of coir dust. Coarse pithy tissue particles (larger than 1 mm) were highly porous, with an internal porosity of 41.0% by volume. These particles exhibited round-shaped external pores which ranged in diameter from 30 to 80 μm, with an average of 44.3 μm, and which accounted for a relative surface porosity of about 40.9%. By contrast, the cells of Sphagnum peat moss leaves showed oval-shaped pores of 20.1 × 11.5 μm, which accounted for a relative surface porosity of only 12.0%. The internal porosity of peat moss leaves was 51.1% by volume. The retting process (soaking in water) applied to the coconut husks in Sri Lanka partially degraded the pithy tissue and coir fibres. Coir dust from Mexico showed lower water-holding capacity and higher aeration than peat, whereas air–water relationships in coir dust from Sri Lanka were similar to those in peat. Although differences observed in microstructure and porosity characteristics could explain the differential physical properties of the three materials studied, the major reason was the different size distribution of their constituent particles.

National inventory of organic wastes for use as growing media for ornamental potted plant production: case study in Spain

An inventory of materials suitable for use as growing media for ornamental potted plant production in Spain has been prepared. Special attention has been paid to solid organic wastes generated by production, industrial and consumer activities. Information obtained from this study has been organised into two data bases. Data base 1 contains the "General Characteristics" file of more than 105 materials. In this file, data are available regarding generation points, material availability, uses, cost, disposal expenses, etc. Data base 2 is comprised of the "Specific Properties" file of 63 materials selected from data base 1. The main physical, chemical and biological properties of these materials as container media have been characterised, and the results obtained have been compiled. Finally, a computerised data bank has been created which can be found in the home page of the Spanish Ministry of Agriculture, Fisheries and Food (http://agritel2.mapya.es/sustratos/).

DNA aneuploidy by flow cytometry is an independent prognostic factor in gastric cancer

In the present study the prognostic value of both DNA ploidy and the proliferative activity of tumour cells were studied in a series of 76 consecutive patients suffering from gastric tumours. DNA ploidy and the proliferative index (as measured by the percentage of S-phase cells) were determined by flow cytometry using fresh tumour specimens. The presence of DNA aneuploid clones by flow cytometry was detected in 62% of the cases (mean DNA index of 1.63 +/- 0.46; range 1.08-2.92), the mean proportion of S-phase cells being of 18.4 +/- 11.5%. In comparison with diploid cases, aneuploid tumours showed a higher proliferative activity (cases with more than 15% S-phase cells: 18.4% versus 6.1%, p = 0.0001) as well as a higher incidence of node involvement (95% versus 68%, p = 0.001). By contrast, no significant differences were detected with respect to sex, age, histologic grade and type, clinical stage, tumour size and the incidence of extranodal involvement. Upon grouping the patients according to the proportion of S-phase cells no significant differences were observed for the clinical and biological parameters explored except for an association between a high percentage of S-phase cells and the presence of DNA aneuploidy (40% versus 96%, p = 0.0001). Regarding survival the presence of DNA aneuploidy was significantly associated with poor outcome as compared to the diploid cases (median of 15 versus 26 months, p = 0.005). By contrast, the proportion of S-phase cells did not predict patients's outcome. Multivariate analysis of prognostic factors showed that the presence of DNA aneuploidy (p = 0.003) together with the histologic type (p = 0.03) and the existence of extranodal metastases (p = 0.05) were the best combination of prognostic factors for survival prediction.

Hepatic Morphological alterations induced by zidovudine (ZDV) in an experimental model

Zidovudine (AZT) inhibits HIV replication. Many studies have demonstrated its toxic myopathic effect in both HIV-positive patients treated with the drug and experimental animal models. So far hepatic lesions induced by AZT have not been reported. In our study, an experimental rat model was used in which the rats were administered AZT (1 mg/ml) in drinking water; histological and ultrastructural alterations were observed in the liver of treated animals and compared with the findings in control animals. The histological alterations detected were turbid swelling, vacuolar degeneration and microvacuolar fatty degeneration of panlobular distribution; these lesions were progressively greater as the duration of treatment increased. The ultrastructural alterations detected involved the mitochondria (similar to those described in cardiac muscle), smooth and rough endoplasmic reticulum (SER and RER), and the accumulation of fat and glycogen in the hepatocytes of treated animals. The histopathological and ultrastructural findings in our experimental model suggest hepatotoxicity induced by AZT or its catabolites in treated, as compared to control animals.

[Deep cystic enteritis in Peutz-Jeghers syndrome (pseudoinfiltrating lesions in a patient with enteric polyps)]

We report a case of enteritis cystica profunda observed in a patient who, owing to both his personal and familial history, had been diagnosed and suffering from Peutz-Jeghers syndrome. The patient was operated because of a clinical picture of intestinal invagination. Together with hamartomatous polyps, anatomopathological study of the segment of the small intestine removed revealed the presence of lesions typical of Enteritis cystica profunda consisting in the presence of benign encysted glands and pools of mucous in the deep layers of the intestinal wall. The main characteristics of this interesting and rare entity are briefly commented.

[Capillary testicular hemangioma: a case report]

Testicular tumors in infants are rare and most of them are malignant. Hemangioma of the testis is an extremely rare tumor in infants. We report on an intratesticular capillary hemangioma that appeared in a 10 month-old child subsequently undergoing orchidectomy and on the patient's evolution at 4 years. The histological characteristics showed proliferation of small blood vessels, lined with endothelial cells. Mitoses and atypias were not found. Permitting differential diagnosis with other vascular tumors: Masson's vegetant intravascular hemangio-endothelioma and angiosarcoma.

Flow cytometric DNA analysis of fine-needle aspirates of prostatic benign lesions

Fine-needle aspiration samples from 54 consecutive patients suffering from prostatic benign lesions were analyzed for both cytological diagnosis and DNA cell content, by means of standard cytological criteria and flow cytometry, respectively. Of these patients, 13 displayed prostatitis: three being classified as acute prostatitis, 7 as chronic and 3 as granulomatosous prostatitis. All cases had a diploid DNA cell content, with a mean percentage of S-phase cells of 1.8 +/- 2.7%. Although no major differences were detected between patients with and without prostatitis, the former group had a slightly higher proportion of S-phase cells (1.4 +/- 2.2% vs 2.7 +/- 3.7%). Moreover, within those patients with prostatitis, acute prostatitis cases showed the highest proliferation rates although differences did not reach statistical significance.

Pilomatrixoma: a description of two cases diagnosed by fine-needle aspiration

The present work reports on the findings obtained by fine-needle aspiration of two pilomatrixomas located on the upper limbs whose diagnosis was confirmed histologically. In both cases, the cytology disclosed a proliferation of small round basaloid cells that were dispersed and grouped in clusters together with squamous cells and abundant multinucleate giant cells. The differential diagnosis with other neoplasms is discussed.

Diagnosis of genital infection caused by human papillomavirus using in situ hybridisation: the importance of the size of the biopsy specimen

AIM

To determine the size of a cervical biopsy specimen with human papillomavirus (HPV) infection required to enable in situ hybridisation to be carried out with a guarantee of a reliable result.

METHODS

In situ hybridisation was carried out in 142 cervical uterine biopsy specimens classified histologically as low grade and high grade squamous intraepithelial lesions. Epithelial length at the level of the basal membrane was measured by image analysis. The specimens were divided into 10 groups based on epithelial length.

RESULTS

Of the biopsy specimens, 61.2% were HPV positive. In specimens with an epithelial length below 5 mm 31.9% were HPV positive; in those between 5 and 9 mm in length 67.5% were HPV positive; and in those greater than 9 mm in length 81.8% were positive for HPV. For low grade squamous intraepithelial lesions (n = 90), 68.4% of specimens with an epithelial length greater than 5 mm were HPV positive. For high grade squamous intraepithelial lesions (n = 52), 86.8% of specimens with an epithelial length greater than 5 mm were HPV positive.

CONCLUSIONS

For a diagnosis of HPV infection using in situ hybridisation, the minimum length of epithelium in a cervical biopsy specimen should be 5 mm. For high grade squamous intraepithelial lesions, specimens over 5 mm in length are suitable. For low grade squamous intraepithelial lesions, to minimise the number of false negative results, the ideal minimum length is 10 mm.

Transrectal fine needle aspiration biopsy of the prostate combining cytomorphologic, DNA ploidy status and cell cycle distribution studies

Fine needle aspiration (FNA) cytology of the prostate is becoming a common diagnostic procedure, and DNA flow cytometry (FCM) data have been shown to correlate with the pattern of evolution of prostatic carcinoma, thus emphasizing the importance of assessing both parameters together. The aim of the present paper is to analyze the presence of DNA aneuploidy, cell cycle distribution and their relationship with the cytologic grade in transrectal fine needle aspiration prostate biopsies from 78 consecutive patients. Herein we studied the DNA ploidy status, the cell cycle distribution and their relationship with cytologic grade in transrectal FNA biopsies of the prostate from 78 consecutive patients -47 benign hyperplasias and 31 carcinomas- as analyzed by a reproducible FCM method for single cell suspension preparations, data acquisition and analysis. The presence of DNA aneuploidy was detected in 39% of the carcinomas and it was found to be a specific marker for prostatic carcinoma since all benign hyperplasia cases were diploid. Moreover, the incidence of DNA aneuploidy increased progressively from well-differentiated to moderately-differentiated and poorly-differentiated carcinomas (p = 0.005). Regarding cell cycle distribution, carcinomas displayed a higher proportion of both S-phase (p = 0.0003) and G2/M-phase (p = 0.0006) cells with respect to benign hyperplasias. Aneuploid cases also showed a greater proliferation rate as compared to the diploid carcinomas, regardless of their cytopathologic grade (p = 0.00001). Despite the fore-mentioned results, these correlations were far from being absolute, suggesting that combined assessment of these parameters should give additional information for the clinical management of prostatic disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippine experience

From March to September 1990 the Philippine Department of Health, with the assistance of the HEALTHCOM Project, carried out a national mass-media communication campaign to support routine vaccination services. The essential elements of the campaign strategy were as follows: focusing on measles as a way to get mothers to bring their children to the health centre; emphasizing logistic knowledge in the mass-media messages, in particular popularizing a single day of the week as "vaccination day" and giving clear information about the age for measles vaccination; and focusing on urban areas, which had lower vaccination rates than rural areas. Evaluation of the effects of the campaign indicates an increase in vaccination coverage and a substantial increase in the timeliness of vaccination that can be attributed to improvement in carers' knowledge about vaccination. Furthermore, most of the observed increase in knowledge was related to exposure to the mass-media campaign. There was no evidence of any programmatic change that could account for the increase in vaccination or evidence that increased health education efforts at health centres could account for the change in knowledge. These results indicate that when countries meet certain conditions--a high level of access to the media, sufficient expertise and funds available to develop and produce high-quality radio and television advertisements, and a routine system that is able to serve the increased demand--a mass communication campaign can significantly improve vaccination coverage.

Masson's vegetant intravascular hemangioendothelioma. Fine needle aspiration cytology, histology and immunohistochemistry of a case

Masson's vegetant hemangioendothelioma is a benign intravascular tumor, sometimes confused with such malignant vascular tumors as angiosarcoma, whose clinical appearance is nonspecific and whose diagnosis can only be established through microscopic examination. The fine needle aspiration (FNA) cytologic findings together with the histologic and immunohistochemical findings of such a tumor in a 22-year-old man are presented. Cytologically, the material obtained by FNA consisted of two distinct populations of cells. One type of cell had large nuclei (sometimes displaced towards the periphery), finely granular chromatin, prominent nucleoli and abundant globular cytoplasm. The second type of cell had spindle-shaped or oval nuclei, granular chromatin and scanty eosinophilic cytoplasm. Although these findings may permit the cytologic recognition of this entity, the aspirate in this case was interpreted as showing a vascular mesenchymal tumor of probable malignancy. Histologic examination of the excised tumor, aided by immunoperoxidase studies for factor VIII antigen that revealed the endothelial nature of the proliferating cells, established the correct diagnosis.