When do benefits turn to risks? Impact of a 900 mL whole blood donation on Special Forces performance

BACKGROUND

Special Forces (SF) teams operate in remote environments with limited medical support. As a result, they may need to rely on buddy transfusions to treat bleeding teammates. Considering that 450 mL has no direct impact on their combat performances, it might be tempting to take more blood from a compatible donor to save a hemorrhaging teammate. This study investigates the effect of a 900 mL blood donation on SF operator performance and recovery time following this donation.

STUDY DESIGN AND METHODS

Participants underwent a multifactorial assessment including measures of physiological parameters, vigilance, and physical performance. Results from the day of blood donation were compared with baseline values obtained 1 week earlier (i.e., immediate effect), as well as repeated testing at 7, 14, and approximately 30 days after blood donation (i.e., recovery period).

RESULTS

Hemoglobin levels and heart rate were affected by giving blood. The participants also experienced a significant decrease in physical performance of more than 50% immediately after blood donation. Recovery was slow over the following weeks, remaining significantly different from baseline until full recovery around day 30. However, participants were still able to respond to a simple stimulus and adjust their response, if necessary, even immediately after donating blood.

DISCUSSION

A 900 mL blood donation greatly affects the physical fitness of SF operators. A donation may be worthwhile if it is the only life-saving procedure available and does not endanger the donor's life. The donor would then become a patient and unable to complete the mission.

Chromosome 9 instability and alterations of p16 gene in squamous cell carcinoma of the lung and in adjacent normal bronchi: FISH and immunohistochemical study

AIMS

p16, a tumour suppressor gene located at 9p21 chromosome and involved in cell cycle regulation, is often inactivated in lung carcinoma. Inactivation is also supported by the loss of p16 protein, a strong inhibitor of cyclin-dependent kinase (CDK) 4 and 6. The aim of this study was to examine alterations of p16 both in pulmonary squamous cell carcinoma (SCC) and in morphological normal bronchi contiguous with neoplasia.

METHODS AND RESULTS

p16 gene and chromosome 9 alterations were examined by fluorescence in situ hybridization and the expression of p16 protein by immunohistochemistry in pulmonary surgical specimens from 31 patients with SCC. As controls, surgical specimens from 13 patients with non-neoplastic pathology were examined. Tumours showed molecular alterations for p16 gene and chromosome 9 abnormalities in, respectively, 29/31 and 19/31 cases respectively. p16 protein was unexpressed in 29/31 cases. In morphologically normal bronchi p16 gene and chromosome 9 alterations occurred in, respectively, 13/31 and 4/31 cases respectively; loss of protein immunoreactivity occurred in 14/31 cases. No alterations were seen in any of the control cases.

CONCLUSIONS

Inactivation of p16 gene in histologically normal bronchi could aid the identification of individuals at risk of developing SCC of the lung.

Unusual clear cell variant of epithelioid mesothelioma

Clear cell mesothelioma is an extremely rare neoplasm of the pleura, which can easily be mistaken for a metastasis of clear cell carcinoma to the pleura. We report here the histochemical, immunohistochemical, and ultrastructural aspects of a new case of clear cell pleural mesothelioma in a 52-year-old man with no known asbestos exposure. He was admitted to the hospital for recurrent pleural effusion, which was negative for neoplastic cells at the cytologic examination. A partial decortication of the right pleura was performed. The morphologic, immunohistochemical, and ultrastructural features reported for this case are consistent with the diagnosis of clear cell mesothelioma. The differential diagnosis and immunohistochemical features in comparison with other clear cell neoplasms are discussed.

Surfactant protein A expression in human normal and neoplastic breast epithelium

We studied the presence of surfactant protein A (Sp-A) immunoreactivity and messenger RNA in 62 normal and abnormal breast samples. Sections were immunostained with polyclonal anti-Sp-A antibody. The association between Sp-A immunoreactivity and histologic grade of 32 invasive ductal carcinomas was assessed by 3 pathologists who scored the intensity of Sp-A immunoreactivity times the percentage of tumor immunostained; individual scores were averaged, and the final scores were correlated with tumor grade, proliferative index, and expression of estrogen and progesterone receptors. Strong Sp-A immunoreactivity was present at the luminal surface of ductal epithelial cells in normal breast samples and in benign lesions; carcinomas displayed variable immunoreactivity, inversely proportional to the degree of differentiation. Sp-A messenger RNA was detected by reverse transcriptase-polymerase chain reaction in 3 of 3 normal breast samples and 9 of 9 carcinomas. The significance of Sp-A expression in breast epithelium requires further study; possibly it has a role in native host defense or epithelial differentiation.

Primary intrathoracic meningioma: histopathological, immunohistochemical and ultrastructural study of two cases

Meningiomas are common, usually benign slow-growing neoplasms of the central nervous system thought to arise from meningocytes capping arachnoid villi. Primary ectopic meningiomas are exceedingly rare extracranial and extraspinal tumors of controversial origin; they are usually limited to the head and neck region or to the paravertebral soft tissues. Only one mediastinal ectopic meningioma and few pulmonary ectopic meningiomas have been described in the literature until now. Because of their rarity and their intriguing pathogenesis, we report here a second case of primary mediastinal meningioma and an additional case of primary pulmonary meningioma. Their possible origin and differential diagnosis are discussed.

[Surfactant protein and thyroid transcription factor 1 in pleuro-pulmonary neoplasia. Immunohistochemical study]

Aim of this work was to investigate the ability of the antibodies against Surfactant proteins (SP) and Thyroid transcription factor 1 (TTF-1) to distinguish primary neoplasms of the lung from metastatic carcinomas to the lung and pleural mesotheliomas. We evaluated the immunohistochemical expression of the antibodies anti SP-A, SP-B, pro SP-C, SP-D, and TTF-1 in a series of 56 primary lung carcinomas, 9 metastatic carcinomas to the lung, 5 pleural mesotheliomas and 8 non-pulmonary carcinomas. Among primary lung neoplasms, only adenocarcinomas immunostained for all SP (specificity = 1; total sensitivity = 0.52). TTF-1 had an excellent specificity (= 1), but a weak sensitivity (= 0.34) in recognizing primary lung carcinomas. TTF-1 was present in lung adenocarcinomas which were negative for SPs; however it failed to distinguish the subtypes. Pleural mesotheliomas, pulmonary metastases and non-pulmonary carcinomas were not immunoreactive for SP-A, SP-B, SP-D, and TTF-1. Pro SP-C was positive also in the adenocarcinomas of the large bowel and in their pulmonary and nodal metastases. These results demonstrate that the combined use of antibodies anti SP-A, SP-B and TTF-1 is the best association in distinguishing primary lung carcinomas from metastatic carcinomas to the lung and pleural mesotheliomas.

Peripheral papillary tumor of type-II pneumocytes: a rare neoplasm of undetermined malignant potential

Peripheral papillary adenomas of the lung are uncommon neoplasms (only ten cases have been described so far in the English literature) composed predominantly of type-II pneumocytes and generally considered benign. We describe here two additional cases of this lung tumor. In both cases histological examination revealed an encapsulated papillary neoplasm with invasion of the capsule and, in one case, invasion of the adjacent alveoli and visceral pleura too. The proliferative index (Ki67) was less than 2% and the epithelial cells were positive for cytokeratins, surfactant apoproteins (SP), and nuclear thyroid transcription factor-1 (TTF- 1). Ultrastructurally, the epithelial cells showed the characteristic surface microvilli and cytoplasmic lamellar inclusions of type-II cells. Review of the literature has revealed two other cases of peripheral papillary adenoma of type-II pneumocytes with infiltrative features. Thus, we propose replacing the term peripheral papillary adenoma with peripheral papillary tumor of undetermined malignant potential.

Evaluation of new small barium alginate microcapsules

Microencapsulation of islets of Langerhans has been proposed in order to prevent immune rejection and possible recurrence of autoimmune disease. This study introduces a fast simple one-step microencapsulation procedure which allows the production of small sized barium-alginate beads. The volume of the microcapsules produced was approximately that of the encapsulated islets. Consequently, the insulin kinetics and the oxygen diffusion were favoured, while the transplanted tissue volume was reduced. Electron microscopy and immunoisolating testing were performed to evaluate the molecular cut-off, the physical and chemical characteristics of these microcapsules. Immunohistochemical staining and perifusion experiments of microencapsulated pancreatic islets showed their viability after the encapsulation procedure as well as in vivo experiments. In fact, microencapsulated porcine islets were implanted intraperitoneally into streptozotocin-diabetic rats. The xenografts reversed the hyperglycemic state and functioned for a period ranging from 9 to 385 days. The low mannuronic acid concentration and the purity grade of the alginate, exerted a combined influence on the capsule biocompatibility as in vivo studies showed.

Congenital hepatic dysplasia from cytomegalovirus

The Authors report on a case of liver dysplasia in a four-month-old infant affected by prenatal cytomegalovirus infection. Immunologic, histologic and ultrastructural studies suggest an embryopathic origin of the lesions.

[The incidence of 1,2-dimethylhydrazine-induced colonic neoplasms in the rat: the effect of constipation]

The authors studied the role of slow bowel transit in the development of colonic neoplasias in rats treated with 1,2-dimethylhydrazine (DMH). Forty Sprague-Dawley male rats, weighing 400 g, were used in the experiment and were divided into 4 groups of 10 rats each. The first and the second group were given, weekly, subcutaneous injections of DMH at a dose of 25 mg/kg for 25 and 27 weeks respectively; in these groups constipation was obtained by reducing water intake throughout the period of the experiment. The third and the fourth group (control groups) received DMH at the dose of 25 mg/kg for 25 and 27 weeks respectively and water "ad libitum". The rats were weighed once a week and stool output, weight, and number of scybala/day were recorded once every four weeks. Rats were sacrificed one week after the final injection of DMH and every intestinal lesion macroscopically identified was histologically examined. All rats showed weight loss from the 22nd week to the sacrifice. The mean stool weight/day was 21.2 g +/- 1.47 in the groups A and B; while for the groups C and D it was 23.6 g +/- 1.81 (p = 0.019). The number of scybala/day was 26 +/- 3 in the groups A and B, whereas in the groups C and D was 34 +/- 4 (p = 0.05). An increased number of cancers per rat was recorded in the groups A and B compared to control groups, respectively from 0.66 to 1.4 at 25 weeks (p = 0.02) and from 0.9 to 2.44 at 27 weeks (p = 0.07). A corresponding increase in the number of polyps after 25 weeks was demonstrated, taking into account the possible polyp-cancer sequence. Our study suggests that the slow bowel transit induced an increased number of colonic neoplasia in relation to the prolonged contact of the carcinogen with the mucosa or to its greater concentration in the colonic lumen due to the fecal output reduction.

Pseudomesotheliomatous carcinoma of the lung. An immunohistochemical and ultrastructural study of three cases

The authors report immunohistochemical and electron microscopic studies on three new cases of pseudomesotheliomatous carcinoma of the lung. Although the distinct clinical and histopathologic features of this peripheral lung cancer were described many years ago, its recognition as a distinct variety of lung carcinoma has not gained wide acceptance. Little is known of its incidence and only few cases have been reported until now. In the current study the authors demonstrate the epithelial nature of this tumor by its positive immunohistochemical reactions for epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), Leu-M1, B 72.3, and surfactant apoprotein. The ultrastructural features and staining of nuclear inclusions with surfactant apoprotein indicate differentiation into type II cells as found in other forms of peripheral lung adenocarcinoma. Despite these morphologic similarities, pseudomesotheliomatous carcinoma is characterized by extensive invasion of the pleura and rapidly fatal course. Because of this biologic behavior it deserves recognition as a distinct variant of peripheral lung carcinoma.

[Acute disseminated histiocytosis X. Presentation of a case]

The AA. report a case of acute, diffuse histiocytosis X with an unfavourable course observed in a child of 33 months. The histological diagnosis, formulated on the basis of specimen taken from a skin nodule, was confirmed by ultrastructural observation of Birbeck bodies in the cytoplasm of proliferating Langerhans cells.

[Osteoclastoma-like giant cell tumor of the lung]

Osteoclastoma-like giant cell tumor of lung. A case of osteoclastoma-like giant cell tumor of the lung is reported. This is an unusual tumor too described in the heart, thyroid, skin, soft tissues and pancreas. AA. studied the tumor's structure and are of opinion that it concerns a primitive nonepithelial neoplasm of the lung.

[Osteomatosis of the skin. Presentation of 2 cases]

Osteomatosis cutis. Report of two cases. The AA. reported two cases of osteomatosis cutis in a child three years old and in a girl sixteen years old. In both cases there was no history of previous trauma and acne. Microscopic study revealed islands of true bone, having lamellar configuration, periosteum, marrow cavities with endosteum, lacunae and canaliculae. No other calcified tissue and cartilage were seen.

Sipple's Syndrome: Description of One Case

The case reported involves a young woman with a medullary thyroid carcinoma. Only during autopsy was it possible to show a pheochromocytoma of the left adrenal gland; multiple foci of atypical proliferation were observed, only microscopically, also in the adrenal gland. The authors emphasize the difficulty of a correct diagnosis during life and outline the necessity of an accurate screening of family members of a patient with Sipple's syndrome.

[Experimental research on the toxicity of PVC administered orally]

The AA. report the results of two experiments carried out on 24 rats Wistar treated with PVC dust ingestion. A group received 1 g of PVC dust in distilled water for only 15 days; the second group received PVC dust mixed with standard food almost 5 months till to 15 months. Pathological findings consist in marked hyperplasia of gastro-enteric mucosa, with polipoidfigures, and in a marked activation of pulmonary linforeticular tissue with cellular atipias. In one case a subcutaneous histiocytic lymphoma was observed.