An Integrative Review of the Role of Nurses in Fertility Preservation for Adolescents and Young Adults With Cancer

PROBLEM IDENTIFICATION

Adolescents and young adults (AYAs) with cancer commonly report future fertility as an important issue in care. Despite long-standing guidelines on fertility counseling and the trusting relationship between nurses and patients, little is known about the nurse's role in fertility preservation (FP) for AYAs with cancer.

LITERATURE SEARCH

The authors conducted a literature search of articles published through 2020 focused on nursing involvement in FP for AYAs with cancer.

DATA EVALUATION

85 studies were identified. In total, 11 articles met inclusion criteria and were critically appraised in the review.

SYNTHESIS

Although well positioned to improve FP care among AYAs with cancer, nurses currently have a minimal role because of provider, institutional, and patient-related barriers.

IMPLICATIONS FOR PRACTICE

Interventions to enhance nurses' knowledge about FP, improvements in electronic health record documentation, and facilitation of institutional support are needed to support the nurse's role in FP for AYAs with cancer.

Thyroid Hormone and Thyrotropin Regulate Intracellular Free Calcium Concentrations in Human Polymorphonuclear Leukocytes: In Vivo and in vitro Studies

Intracellular free calcium concentrations ([Ca++]1) were studied in polymorphonuclear leukocytes (PMNs) from 13 athyreotic patients who had been previously treated by total thyroidectomy and radioiodine therapy for differentiated thyroid carcinoma, and from age- and sex-matched euthyroid healthy controls. Patients were studied twice, when hypothyroid (visit 1) and after restoration of euthyroidism by L-T4 TSH-suppressive therapy (visit 2). PMNs from patients at visit 1 had significantly lower resting [Ca++]1 levels compared to both visit 2 and controls. Values at visit 2 did not differ from those of the controls. Stimulus-induced [Ca++]1 rise was also significantly blunted at visit 1 and normalized at visit 2, possibly through a differential contribution of distinct intracellular Ca++ stores, as suggested by the response pattern to the chemotactic agent, N-formyl-Met-Leu-Phe (fMLP), to the selective SERCA pump inhibitor, thapsigargine, and to the mitochondrial uncoupler, carbonyl cyanide p-trifluoromethoxyphenyl-hydrazone (FCCP). In vitro treatment of PMNs from healthy subjects with high TSH concentrations impaired intracellular Ca++ store function. Both resting [Ca++]1 levels and fMLP-induced [Ca++]1 rise increased in the presence either of low-concentration TSH or of T4, but effects of TSH and T4 were not additive. T3, rT3, and TRIAC had no effect. In conclusion, this study provides evidence for a direct relationship between thyroid status and [Ca[Ca++]1 homeostasis in human PMNs, mainly related to direct actions of TSH and T4 on these cells.

Quality of life and hormones after sex reassignment surgery

BACKGROUND

Transpeople often look for sex reassignment surgery (SRS) to improve their quality of life (QoL). The hormonal therapy has many positive effects before and after SRS. There are no studies about correlation between hormonal status and QoL after SRS.

AIM

To gather information on QoL, quality of sexual life and body image in transpeople at least 2 years after SRS,to compare these results with a control group and to evaluate the relations between the chosen items and hormonal status.

SUBJECTS AND METHODS

Data from 60 transsexuals and from 60 healthy matched controls were collected. Testosterone,estradiol, LH and World Health Organization Quality of Life (WHOQOL-100) self-reported questionnaire were evaluated. Student’s t test was applied to compare transsexuals and controls. Multiple regression model was applied to evaluate WHOQOL’s chosen items and LH.

RESULTS

The QoL and the quality of body image scores intranspeople were not statistically different from the matched control groups’ ones. In the sexual life subscale,transwomen’s scores were similar to biological women’s ones, whereas transmen’s scores were statistically lower than biological men’s ones (P = 0.003). The quality of sexual life scored statistically lower in transmen than intranswomen (P = 0.048). A significant inverse relationship between LH and body image and between LH and quality of sexual life was found.

CONCLUSIONS

This study highlights general satisfaction after SRS. In particular, transpeople’s QoL turns out to be similar to Italian matched controls. LH resulted inversely correlated to body image and sexual life scores.

A case of inflammatory ascites

CASE BACKGROUND: Ascites appears mainly as a consequence of portal hypertension in patients with liver cirrhosis, or can be caused by several other causes, such us congestive heart failure, peritoneal malignancy, or tuberculosis. In some cases, ascites can pose a diagnostic challenge for clinicians and in some patients, despite thorough and extensive work-up, the origin of this ascites remains unknown.

CASE REPORT

In the unusual case hereby reported, a 52-year-old man developed severe ascites in a few weeks, in the absence of known liver disease or congestive hearth failure. We performed laboratory analysis, endoscopic, and imaging investigations, including abdominal contrast-enhanced computed tomography and 18-fluorodeoxyglucose-positron emission tomography. Peritoneal fluid analysis showed exudative fluid without neoplastic cells. A diagnostic laparoscopy with multiple diagnostic biopsies was carried out, but no macroscopic cause of the ascites was found; histopathological examination showed minimal aspects of diffuse and non-specific chronic inflammation.

CONCLUSIONS

We decided to empirically treat the patient with steroid therapy (methylprednisolone: 0·5 mg/kg/day). Over a period of 6 weeks, his ascites resolved and at 2 months, he was in remission on low-dose methylprednisolone. Our final hypothesis was reactive inflammatory ascites. The literature on ascites and its management has also been reviewed.

Changes in autonomic modulation to the heart and intracellular catecholamines. A longitudinal study in differentiated thyroid carcinoma during short-term hypothyroidism and thyroid hormone replacement

BACKGROUND

The effects of thyroid deprivation on the autonomic modulation to the heart remain controversial.

METHODS

In this study in patients followed for thyroid carcinoma, we investigated (1) heart rate variability parameters and the baroreflex gain and (2) intracellular catecholamine levels in circulating lymphocytes during short-term hypothyroidism (phase 1) and after reinstitution of TSH-suppressive thyroid hormone replacement (phase 2).

RESULTS

The RR interval value (p < 0.01) and systolic blood pressure (p < 0.05) were higher in phase 1 than in phase 2. The low-frequency/high-frequency (LF/HF) ratio was significantly lower in the hypothyroid state (p < 0.05), with a higher HF component (p < 0.05). After adjusting for mean RR interval in the regression model, the difference between the power of RR interval oscillations calculated in the two states was greater for the LF band (p = 0.005) and it was borderline significant for the HF band (p = 0.052). The baroreflex gain alpha(LF) index was similar in the two phases. The stimulus-induced cellular production of norepinephrine and epinephrine in peripheral blood mononuclear cells was significantly higher in phase 2.

CONCLUSION

The neurally-mediated influences on the sinus node and the study of intracellular catecholamine production suggest a reduced sympathoexcitation in hypothyroidism compared with the treatment phase. The early increase in blood pressure observed after thyroid hormone withdrawal is not due to impaired sensitivity of the baroreflex arc.

Thyroid hormone and thyrotropin regulate intracellular free calcium concentrations in human polymorphonuclear leukocytes: in vivo and in vitro studies

Intracellular free calcium concentrations (Ca++i) were studied in polymorphonuclear leukocytes (PMNs) from 13 athyreotic patients who had been previously treated by total thyroidectomy and radioiodine therapy for differentiated thyroid carcinoma, and from age- and sex-matched euthyroid healthy controls. Patients were studied twice, when hypothyroid (visit 1) and after restoration of euthyroidism by L-T4 TSH-suppressive therapy (visit 2). PMNs from patients at visit 1 had significantly lower resting (Ca++)i levels compared to both visit 2 and controls. Values at visit 2 did not differ from those of the controls. Stimulus-induced (Ca++)i rise was also significantly blunted at visit 1 and normalized at visit 2, possibly through a differential contribution of distinct intracellular Ca++ stores, as suggested by the response pattern to the chemotactic agent, N-formyl-Met-Leu-Phe (fMLP), to the selective SERCA pump inhibitor, thapsigargine, and to the mitochondrial uncoupler, carbonyl cyanide p-trifluoromethoxyphenyl-hydrazone (FCCP). In vitro treatment of PMNs from healthy subjects with high TSH concentrations impaired intracellular Ca++ store function. Both resting (Ca++)i levels and fMLP-induced (Ca++)i rise increased in the presence either of low-concentration TSH or of T4, but effects of TSH and T4 were not additive. T3, rT3, and TRIAC had no effect. In conclusion, this study provides evidence for a direct relationship between thyroid status and (Ca++)i homeostasis in human PMNs, mainly related to direct actions of TSH and T4 on these cells.

Influence of liver fibrosis on hepatic artery Doppler resistance index in chronic hepatitis of viral origin

BACKGROUND

Hepatic arterial Doppler sonography is increasingly being used in liver diagnostics. The determinants of the elevation of hepatic artery impedance indexes in chronic liver disease, however, have still not been fully clarified. The aim of the present study was to investigate the relationship between histological alterations and liver circulation in chronic hepatitis.

METHODS

Hepatic artery resistance index and portal flow velocity were measured using Doppler sonography in 47 patients with chronic hepatitis of viral origin diagnosed at histopathology. The patients were divided into two groups, those with mild and those with severe alterations, in accordance with the various histological parameters of the Knodell scoring system.

RESULTS

Hepatic artery resistance index and age were higher in patients with more severe liver fibrosis (respectively 0.638 +/- 0.084 and 39.0 +/- 10.9 (years) in mild fibrosis versus 0.687 +/- 0.060 and 49.4 +/- 14.4 (years) in severe fibrosis; P < 0.05 for both), whereas no difference between the two groups was found for the other histological features (degeneration, inflammation and necrosis), nor for portal flow velocity.

CONCLUSIONS

The increase in hepatic artery resistance index appears to be influenced by the extent of fibrous tissue deposition in the liver, determined by chronic inflammation and repair and, secondly, by ageing.

Time trends of major coronary risk factors in a northern Italian population (1986–1994). How remarkable are socioeconomic differences in an industrialized low CHD incidence country?

BACKGROUND

The goals are to estimate time trends (1986-1994) of major coronary risk factors in an industrialized low CHD incidence population and to assess education class (EC) differences in risk factor prevalence and in time trends.

METHODS

Three population surveys were conducted in 1986-1987, 1989-1990 and 1993- 1994 on independent and two-stage age- and gender-stratified random samples (1906 men and 1941 women) of 35-64 year old residents of Brianza, an affluent region of northern Italy. The protocol for data collection, clinical measurements and biochemical determinations adhered to the WHO MONICA manual and underwent repeated quality control assessments. EC were identified according to gender- and 5-year birth-cohort specific tertiles.

RESULTS

In the initial, middle and final surveys 1258, 1259 and 1330 subjects were enrolled, corresponding to participation rates of 70.1%, 70.3% and 74.3%, respectively. Over the 8-year period, in men systolic blood pressure and smoking habits declined, body mass index and serum total cholesterol increased. In women systolic blood pressure showed a constant reduction, total cholesterol and BMI increased and the prevalence of smokers remained stable. Overall inverse associations with EC were found for body mass index, for prevalence of cigarette smokers in men and for systolic blood pressure in women. Decreases in blood pressure were more evident in the lowest EC. Cigarette smoking was on the decline in the higher EC in men. BMI and total cholesterol increased in all EC with the notable exception of the 'low' EC in women.

CONCLUSIONS

Favourable changes of the risk factor profile in the low socio-economic classes may have contributed to reduce CHD rates in this population. Specific policies oriented to lowest socio-economic classes are needed to continue to combat the smoking epidemic.

Transient amnesia triggered by acute marijuana intoxication

We report an unusual case of sudden isolated transient amnesia triggered by acute marijuana use. The memory disorder, apart from the long duration, had the characteristics of a transient global amnesia-like episode. Acute marijuana intoxication can affect memory more globally and severely than previously reported.

Results of a pilot study of endoscopic screening of first degree relatives of colorectal cancer patients in Italy

STUDY OBJECTIVE

Screening recommendations for colorectal cancer include sigmoidoscopy in asymptomatic, average risk persons aged 50 and over and colonoscopy every three to five years in high risk groups. Little is known about the eligible population's compliance with endoscopic screening. This is the first Italian report of an endoscopic screening programme for colorectal cancer patients' relatives.

DESIGN

In 1986, a pilot project for colorectal cancer screening by endoscopy in high risk subjects was started in the Desio (Milan, Italy) public health service region. The results obtained after seven years are described.

SETTING

The names of 536 inhabitants with colorectal cancer diagnosed between January 1975 and December 1984 and their relatives' addresses were obtained from the Regione Lombardia Health System records and from the municipal registry offices respectively.

PARTICIPANTS

From October 1986 to October 1993, 778 first degree relatives aged 20-75 were offered colonoscopy.

MAIN RESULTS

After seven years, 233 (29.9%) had undergone endoscopic examination, mostly up to the splenic flexure. Being > 60 in age at the start of the programme negatively affected the participation (p < 0.05). Two cancers were detected and adenomatous polyps were found in another 24 of those screened (frequencies 0.9% and 10.3% respectively). Male gender (p < 0.05), increasing age in males (p < 0.01), and two or more affected relatives in females (p < 0.01) positively affected the frequency of polyps detection.

CONCLUSION

These results suggest that about 30% of the eligible population would comply at least with sigmoidoscopic screening. The collaboration of family doctors and more widespread public information about the ability to cure colorectal cancer are necessary for better compliance.

Alterations in circulating fatty acids and the compartmentation of selected metabolites in women with breast cancer

The presence of the tumor in women with breast cancer provokes a profile of biochemical change characterized by hypoglycemia, hyperuremia and high levels of free fatty acids and ketone bodies in plasma. The total circulating levels of amino acids and lactate are slightly higher in patients with breast cancer. Moreover, alterations in the circulating levels of free and total fatty acids are associated with enhanced levels of total free fatty acids and significantly lower levels of esterified arachidonic acid. This profile may indicate a state of moderate catabolic activation in breast cancer patients and may also be associated with a slight mobilization of proteins and fatty acids by some of the peripheral tissues in order to cover the needs of the host and the tumor. However, the alteration in the distribution of different fatty acids (saturated, mono-unsaturated and poly-unsaturated) and the different behaviour of the free and esterified fractions may be the result of a greater release of only specific fatty acids by tumor or other host tissues, rather than a higher release of the whole spectrum of free fatty acids. Thus, it is proposed that some of the alterations may be directly related to localized tumor activity.

[Multiple jejuno-ileal metastasis of malignant schwannoma from the leg. Report of a case presenting anemia symptoms and review of the literature]

A case of jejunal-ileal metastasis from a left leg malignant schwannoma in a 73 year old woman is described. The patient was affected by progressive anemization without signs of bleeding. A colonoscopy performed during hospitalization revealed an ulcerative lesion at the ileo-colonic junction which at histologic examination was suspected for sarcomatous proliferation arising in peripheral nerve tissue. At operation multiple ileal resections of numerous polypoid formations were performed. Histological examination of polypoid masses revealed the presence of malignant proliferation of spindle cells consistent with a malignant schwannoma. Differential diagnoses are discussed with a review of the literature.

Enzymatic determination of carbon (14C)-labeled glycerol in biological samples

A method for determination of glycerol-specific-radioactivity in biological samples is presented. It is based on the following steps: (a) enzymatic conversion of glycerol to dihydroxyacetone-phosphate, (b) quantitative trapping of dihydroxyacetone-phosphate in SPE amino (NH2) columns, (c) eluation with HCl 0.5 N of dihydroxyacetone-phosphate followed by radioactivity counting and (d) estimation of the radioactivity thus trapped compared with that of enzymatically untreated aliquots of the same samples. No interferences from other 14C-labeled materials tested such as D-glucose, L-alanine, L-glutamine and D-beta-hydroxybutyrate were observed. This inexpensive and high-speed method can be applied in routine multiple estimations of glycerol-specific-radioactivity in biological samples in tracer metabolic studies.

Human CYP2A6 activation of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK): mutational specificity in the gpt gene of AS52 cells

The tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanone (NNK) is a potential human carcinogen that is known to be metabolized to DNA-reactive intermediates by the cytochromes P450. We have examined the nature of NNK's DNA damaging effects in a mammalian cell system expressing a specific human cytochrome P450 (2A6) and containing a target gene for mutagenesis. Human CYP2A6, which is known to activate NNK to a mutagen, was lipofected via a retroviral vector into the Chinese hamster ovary AS52 cell line, which contains the bacterial gpt gene and can be mutated to 6-thioguanine resistance. AS52 cells expressed negligible CYP2A6-specific coumarin 7-hydroxylase activity (0.7 pmol/mg protein/min), while a CYP2A6 transfected clone (AS52-E8) expressed 30 pmol/mg protein/min. Both cell lines were equally sensitive to the cytotoxic and mutagenic effects of the direct-acting mutagen ethylmethanesulfonate; however, only the AS52-E8 cells exhibited a dose-dependent increase in cytotoxicity and mutant frequency upon treatment with NNK. At the highest NNK dose (1200 micrograms/ml), the mutant frequency in AS52-E8 cells was 14-fold (339 x 10(-6)) greater than the spontaneous frequency of 24 x 10(-6). Ninty-eight mutant clones were isolated following NNK treatment. Based on PCR analysis, 21 clones contained deletions/rearrangements and 77 were putative point mutants. Sequencing potential point mutants showed that 81% contained G:C to A:T transitions. Four of six G:C to A:T hotspots were at the second G of the GGT motif, which is the motif and major mutation found in codon 12 of Ki-ras from NNK-induced lung tumors in strain A mice. Since NNK may be metabolized via different pathways to pyridyloxobutylate or methylate DNA, the data suggest that methylation damage causes the major mutagenic events in AS52-E8 cells when NNK is activated by human CYP2A6.

Recombinant DNA approaches for the development of metabolic systems used in in vitro toxicology

In the past few years there has been considerable progress in the development of mammalian cell systems for use in genetic toxicology by the stable transfer of genes/cDNAs coding for drug metabolizing enzymes directly into the target cell. Alternative approaches have also been developed in which mammalian cells are transiently transfected with cDNAs coding for drug-metabolizing enzymes and S9 preparations expressing a single metabolizing enzyme isolated and used for metabolic activation. Progress in these areas is reviewed here and the relative merits of the different approaches are discussed. Work to date has focused primarily on the cytochrome P450 family of enzymes, although other enzyme systems involved in xenobiotic metabolism have been used. The central theme of this review is the transfer of genetic information to improve the metabolic capability of cell systems used in genetic toxicology. However, a basic philosophy of the review is that genetic manipulation of cultured mammalian cells has the potential for developing systems to be used to better understand chemically induced toxicological effects.

[Association of biliary calculosis and portal cavernomatosis]

This paper reports the case of a woman, who underwent surgery because of cholelithiasis, with intraoperative finding of prehepatic portal hypertension from portal vein thrombosis ("portal cavernoma") with healthy liver, later confirmed by angiographic studies. This rare pathologic association carries a higher risk of major operative complications; therefore the Authors agree with the general belief that, for these cases, biliary tract surgery should be as simple and safe as possible. In the case of preoperative diagnosis of biliary disease associated with portal cavernoma, should a surgical approach on the biliary tract be required, we agree on the advisability of performing a shunting procedure before any kind of biliary surgery. In case of variceal bleeding endoscopic sclerotherapy will be the first choice; surgical procedures (shunting) should be seen as a second choice in case of rebleeding after sclerotherapy.

[Prolapse of the vaginal vault complicated by ileal evisceration. Possible role of dacron mesh in emergencies. Technical notes]

The prolapse of vaginal vault after hysterectomy is a rather common event, whereas ileal evisceration and intestinal occlusion following a complete rupture of an inverted vaginal vault is extremely rare. The Authors report a case successfully treated using a modified Feldman and Birnbaum colposacropexy. The technique, which takes into account pathophysiologic mechanisms of vaginal prolapse, is described in detail and involves the use of a Dacron mesh.

Four year treatment with a long acting somatostatin analogue in a patient with Verner-Morrison syndrome

The case is described of a woman with a Verner-Morrison syndrome of extreme severity, caused by an occult VIPoma. Administration of SMS 201-995 (Sandoz) (SMS) at the dose of 150 and subsequently of 250 micrograms daily, decreased plasma levels of vasoactive intestinal polypeptide (VIP) from about 500 to 100 pg/ml (highest normal limit 60 pg/ml). This was associated with complete regression of the diarrhea and normalization of serum potassium levels and hence with the return of the patient to a fully normal life. After 36 months of clinical remission, watery diarrhea recurred together with elevation of VIP plasma levels and appearance of liver metastases. Laparotomic exploration led to the removal of a pancreatic VIPoma and its liver secondarisms, which was followed by a second remission. Reappearance of the symptoms and development of new liver metastases 8 months later required reinstitution of SMS therapy, which allowed once again to control the clinical picture. Anterior pituitary function, assessed by dynamic testing, was unaffected by chronic SMS administration with the exception of the stimulated growth hormone secretion that was inhibited. Glucose tolerance and insulin secretion remained normal during treatment. Glucose intolerance ensued after pancreatectomy and was not worsened by reintroduction of SMS. Treatment with SMS may allow long-lasting remission of Verner-Morrison syndrome associated to VIPoma, though it does not arrest the progression of the tumor.

A new method for D-glucaric acid excretion measurement that is suitable for automated instruments

Urinary excretion of D-glucaric acid (uGA) is an index of type II hepatic microsomal enzyme induction, indirectly revealing possible organic effects of some drugs and environmental pollutants. However, its determination is often cumbersome. We suggest a new, fast microanalytical method for uGA determination in which beta-glucuronidase (BG; EC 3.2.1.31) activity inhibition produced by uGA-derived 1,4-D-glucarolactone is measured. With use of purified BG, the method is suitable for centrifugal analyzers, allowing assay of greater than 100 samples per day. Moreover, the method measures uGA more accurately than other enzymatic methods based on BG inhibition. The within-day CV ranges from 7.9% to 4.6% (uGA 31.55-121.31 mumol/L); the between-day CV ranges from 11.5% to 5.0% (uGA 26.09-124.10 mumol/L). The detection limit is 6.0 mumol/L. The standard curve is linear from 10 to 200 mumol/L. Mean analytical recovery is 100%. Comparison with the method of Simmons et al. (Clin Chim Acta 1974;51:47-51) gave a correlation of r = 0.978, y = 1.40x-2.81. Reference intervals were established in a healthy population sample of 369 people (165 under 14 y), and uGA, expressed in micromoles per gram of creatinine, was higher in women than in girls or in males.

A new method for D-glucaric acid excretion measurement that is suitable for automated instruments

Urinary excretion of D-glucaric acid (uGA) is an index of type II hepatic microsomal enzyme induction, indirectly revealing possible organic effects of some drugs and environmental pollutants. However, its determination is often cumbersome. We suggest a new, fast microanalytical method for uGA determination in which beta-glucuronidase (BG; EC 3.2.1.31) activity inhibition produced by uGA-derived 1,4-D-glucarolactone is measured. With use of purified BG, the method is suitable for centrifugal analyzers, allowing assay of greater than 100 samples per day. Moreover, the method measures uGA more accurately than other enzymatic methods based on BG inhibition. The within-day CV ranges from 7.9% to 4.6% (uGA 31.55-121.31 mumol/L); the between-day CV ranges from 11.5% to 5.0% (uGA 26.09-124.10 mumol/L). The detection limit is 6.0 mumol/L. The standard curve is linear from 10 to 200 mumol/L. Mean analytical recovery is 100%. Comparison with the method of Simmons et al. (Clin Chim Acta 1974;51:47-51) gave a correlation of r = 0.978, y = 1.40x-2.81. Reference intervals were established in a healthy population sample of 369 people (165 under 14 y), and uGA, expressed in micromoles per gram of creatinine, was higher in women than in girls or in males.

The mutagenic activity of selected compounds at the TK locus: rodent vs. human cells

The mutagenic (TFT resistance) and toxic responses of mouse lymphoma (MOLY) L5178Y cells and human lymphoblast (HULY) TK6 cells were compared for 13 chemicals. The mutagenic activities of 8 of the 13 chemicals (62%) examined in the HULY and MOLY assays are in agreement - the results being judged positive in both assays. However, a dramatic difference is observed when the two conditions of metabolic activation are considered separately; the overall concordance of 8/13 has been achieved by combining a 13/13 (100%) agreement in the absence of S9 with a 1/6 (17%) agreement in the presence of S9. In the absence of S9, the concentration ranges, lowest significant doses, and shapes of the concentration-response curves for both toxicity and mutagenicity were similar in spite of the differences in exposure times (4 h for MOLY, 20 for HULY) and expression times (2 days for MOLY, 3 days for HULY). The general agreement observed in the absence of S9 contrasted with the differences manifested in its presence. 6 compounds which were negative in the absence of S9 were tested in both the MOLY and HULY assays in the presence of S9. Of the 6 chemicals, only 1 was positive in both MOLY and HULY under the latter condition; 4 others were positive in MOLY and negative in HULY whereas 1 was positive in HULY and negative in MOLY.

Expression of cytoskeleton components in various Epstein-Barr virus infected cell lines

It has been shown that viruses can induce alterations in the content and distribution of cytoskeleton structures, particularly actin microfilaments and microtubules. An immunomorphologic study of the cytoskeleton components of various EBV-infected cell lines with expression of different functions of EBV genome has been performed using antibodies to each of its three major components. Intermediate filaments and microtubules were similarly represented in all examined lymphoblastoid cell lines. The distribution of actin microfilaments, on the contrary, differed significantly from cell line to cell line. It is concluded that the morphologic expression of actin might depend on the expression of EBV genome. Furthermore, some of these cell lines might represent a useful substrate for the identification of anticytoskeleton antibodies, mainly anti-actin antibodies, in human sera.

Cytoskeleton organization of normal and neoplastic lymphocytes and lymphoid cell lines of T and B origin

An anomalous organization of the cytoskeleton has been described in lymphocytes from chronic lymphatic leukaemia and in only few cell lines. We have now studied normal and neoplastic lymphocytes and lymphoid cell lines of both T and B lineage in order to detect morphological differences in the expression of microfilaments and intermediate filaments. Microfilaments appear to be well expressed by all the B cells, whereas a rich network of intermediate filaments is present in T cells and plasma cells. Most prominent changes occur in the latter system, which is almost lacking in cells of B chronic lymphatic and hairy cell leukaemia. Although the significance of the present findings is not yet clear, one might speculate that such alterations account for some of the aberrant functions and peculiar biologic properties of neoplastic lymphocytes.

An autoantibody profile in primary sclerosing cholangitis

A high frequency of a variety of autoantibodies has been found in sera from patients with primary sclerosing cholangitis (PSC). The prevalence of all types of autoantibodies in PSC was significantly higher than that in healthy controls and patients with isolated inflammatory bowel disease. The titres of the antibodies were rather elevated, particularly in females, and most of them were IgM. The most frequent type of antinuclear antibody was the 'homogenous' type, which is a marker of many autoimmune diseases. The overall prevalence of the antibody was 35%, whereas in female patients it reached 67%. No correlation was found between autoantibody positivity and any clinical parameter. The present findings support the hypothesis that immunological factors may be relevant in PSC.

Close association between antibodies to cytoskeletal intermediate filaments, and chronic graft-versus-host disease

Chronic graft-versus-host disease can mimic various autoimmune disorders, although autoantibodies are rarely detected in the sera of affected patients. Antibodies to cytoskeleton are a frequent finding in patients affected by autoimmune disorders. In all the sera of 16 patients who were submitted to allogeneic bone marrow transplantation, we have found antibodies against cytoskeletal intermediate filaments. Moreover, the titer of such antibodies is quite elevated when compared with those reported in autoimmune disorders. A statistically significant difference between the titers found in patients without and with cGVHD (median 1:40 vs. 1:256, P less than 0.05) has been found. This would suggest that such antibodies might be relevant in monitoring clinical course. Furthermore, since certain cytoskeleton antigens have been shown to be expressed also on cell membrane, antibodies against intermediate filaments might also play a more important role by interfering with such surface structures.

Autoimmunity in chronic liver disease caused by hepatitis delta virus

Recent evidence shows that chronic liver disease induced by hepatitis delta virus is closely associated with production of autoantibodies. To verify this sera from patients with hepatitis delta virus and from those with hepatitis B virus mediated chronic liver disease were tested for a panel of autoantibodies. Although the traditional non-organ specific autoantibodies were similarly distributed in the two groups, a considerably higher prevalence of IgG basal cell layer antibodies, IgM anti-intermediate filaments, and IgG antimicrotubule antibodies was found. Although these phenomena might be secondary to hepatitis delta virus infection, they might be the serological markers of underlying immune events.

Role of target and effector cell structures in natural killer-mediated cytotoxicity

An analysis of target and effector cell structures involved in the in vitro natural killer (NK)-mediated cytotoxicity has been performed. The degree of surface expression of transferrin receptor (TR) was only in part correlated with that of cell lysis. Moreover, the lysis could not be blocked by treating target cells with two anti-TR monoclonal antibodies. Finally, cell lines poorly affected by NK cells express TR only at the cytoplasmic level. As to the effector cells, the integrity of cytoskeleton components (especially microtubules) was found to be essential for the occurrence of cell lysis. In fact, vinblastine, an anti-microtubule agent, was able to significantly reduce the percentage cell lysis. This effect was not due to a selective depletion in NK cells induced by the drug. It is concluded that the mechanisms underlying NK activity are complex and involve both target and effector cell structures.

Immunofluorescent detection of anti-cytoskeleton antibodies using vinblastine-treated mononuclear cells

A reliable and reproducible immunofluorescence method is described for the detection of anti-cytoskeleton antibodies in human sera, based on the use of vinblastine-treated peripheral blood mononuclear cells as substrate. Three immunofluorescence patterns associated with antibodies to microfilaments, intermediate filaments and microtubules are readily identified.

Antibodies to the cytoskeleton components and other autoantibodies in inflammatory bowel disease

A high prevalence of antibodies to cytoskeleton components (anti-CYTO) and of anti-smooth muscle (SMA) and antinuclear (ANA) antibodies has been found in inflammatory bowel disease (IBD). In particular, a significant correlation has been documented between anti-CYTO and activity of the disease in ulcerative colitis and anti-fibroblast intermediate filaments (anti-vimentin) antibodies and Crohn's disease. The antibodies are detectable in the three major immunoglobulin classes, including IgA. While titres of anti-CYTO did not exceed 1:40, ANA and SMA were of high titres (up to 1:1,280). Antibodies to epithelial cells intermediate filaments (anti-cytokeratin) were detected only occasionally. The significance of these findings in IBD is discussed.

Close association between basal cell layer antibodies and hepatitis B virus-associated chronic delta infection

Antibodies reacting in immunofluorescence with the basal cell layer of rat forestomach (BCLA) have been detected in 36 of 121 (30%) hepatitis B virus (HBV)-mediated chronic liver disease (CLD), in 1 of 30 (3%) HBV-negative CLD, in 3 of 36 (8%) alcoholic liver disease (with no correlation with serum HBV markers), in 1 of 25 (4%) primary biliary cirrhosis, in none of 19 HBV-related HBsAg-negative CLD and 60 healthy blood donors. Of 352 hospitalized patients with miscellaneous diseases (including immunological conditions), the antibodies were found in four (1%). In the 36 BCLA positive cases from HBV-mediated CLD, evidence of chronic delta infection was found in 34. The overall prevalence of BCLA in 68 delta cases was 50% (58% in chronic active hepatitis, 46% in cirrhosis), and in 28 delta negative cases was 4% (p less than 0.00002). BCLA of delta cases were mainly of the IgG class (38 of 41 sera), and high titers (up to 40,960) were found in the majority (66% greater than or equal to 1:640). The high titer BCLA has to be considered a marker of chronic delta infection in HBV cases.

A simple method for purification of human monocytes and evaluation of IgG Fc-receptor-mediated phagocytosis

A simple and reproducible, although not completely original method for purification of human monocytes and evaluation of IgG Fc-receptor-mediated phagocytosis has been set up and is described here. The purity of monocyte preparations obtained by the use of this method is quite elevated (over 95%), but the yield, although satisfactory for this purpose, is rather poor. As to the test of phagocytosis, a time-response curve using opsonized sheep erythrocytes showed that 10-min incubation gives the best and most reproducible results. A peroxidase reaction is suggested in order to obtain a better evaluation of erythrocytes within monocytes. The test has been proved suitable for evaluation of Fc-receptor function of monocytes in primary biliary cirrhosis, an immunological liver disease, and might be also useful in immune complexes-mediated conditions.

Evaluation of serum rosette inhibitory factors in chronic liver disease

Serum rosette inhibitory factors (IF) were detected in 61% of 18 sera from HBsAg negative and in 78% of 14 sera from HBsAg positive chronic active liver disease (CALD) patients, who were not under immunosuppressive treatment. In CALD patients, who were under treatment for at least 6 months, IF were detected in 66% of the HBsAg positive patients and only in 18% of the HBsAg negative ones. After precipitation of the serum gamma-globulins by ammonium sulphate, IF were found in the supernatant only in HBsAg positive sera, while completely disappeared in HBsAg negative ones. A significant correlation between serum IF and factors reacting in immunofluorescence (IFL) with a T enriched preparation of lymphocytes was documented only in HBsAg negative cases. No correlation was found between serum IF and circulating immune complexes (IC) or lymphocytotoxins in any of the sera tested. From all these data it is concluded that serum IF detectable in HBsAg negative CALD cases are probably immunoglobulins. Our data would favour the hypothesis that they are anti-T lymphocytes antibodies, since no correlation was found between serum IF and circulating IC. Similar factors, detectable in HBsAg positive sera, are, at least in part, different. The role of such factors in the modulation of the immune response in CALD patients is discussed.

[2 cases of biliary ileus]

Two cases of gallstone ileus are reported. Treatment of the occlusion and the underlying bilio-digestive fistula should be carried out in one surgery session. Careful preoperative preparation of these patients from the hydric, electrolytic and metabolic viewpoints is the indispensable premise for single session treatment.

[Acute torsion of the greater omentum. 3 new cases]

Three cases of acute torsion of the greater omentum two unipolar in two 5-yr-old children and one bipolar in a man of 46 are reported. Correct diagnosis was impossible and never suspected in any of the patients and was only made during surgery. The postoperative course was normal in all three cases.