Metabolic syndrome during gestation and lactation: An important renal problem in dams. selenium renal clearance

BACKGROUND

Metabolic syndrome (MS) in lactating dams leads to several cardiometabolic changes related to selenium (Se) status and selenoproteins expression which produce hypertension. However, little is known about the state of these dams' kidney functions and their Se deposits.

METHODS

Two experimental groups of dam rats were used: control (Se: 0.1 ppm) and MS (Fructose 65 % and Se: 0.1 ppm). At the end of lactation (21d postpartum) kidney weight and protein content, Se deposits, and the activity of the antioxidant selenoprotein glutathione peroxidase (GPx) were measured in dams. Kidney functional parameters: albuminuria, creatinine clearance, serum aldosterone and uric acid levels and water and electrolyte (Na⁺ and K⁺) balance were also evaluated. Systolic blood pressure (SBP) was measured.

RESULTS

In MS dams at the end of lactation Se deposits and GPx activity are higher in the kidney; however, lipid renal peroxidation appears, relative Se clearance increases, and the dams have lost Se by urine. MS dams have polyuria and polydipsia, high uric acid serum levels, albuminuria and high creatinine clearance, implying glomerular renal malfunction with protein loss. They also present hypernatremia, hypokalemia and hyperaldosteronemia, leading to high SBP; however, a natriuretic process is taking place.

CONCLUSION

Since these alterations appear, at least in part, to be related to oxidative stress in renal cells, Se supplementation could be beneficial to avoiding greater lipid renal oxidation during lactation.

The Benefits of Administering Folic Acid in Order to Combat the Oxidative Damage Caused by Binge Drinking in Adolescent Rats

AIMS

An important mechanism in alcohol-induced injury is biomolecular oxidative damage. Folic acid is supplied to chronic alcoholic patients in order to prevent this situation, as this is the main vitamin deficiency that they suffer from. Acute alcohol exposure, such as binge drinking, is one of the most widespread ethanol consumption models practiced by adolescents. However, there is no evidence of folic acid body profiles after this pattern of consumption.

METHODS

Four groups of adolescent rats were used: control, alcohol (exposed to intraperitoneal binge drinking), control folic acid-supplemented group and alcohol folic acid-supplemented group. Folic acid levels, protein, lipid and DNA oxidative damage in serum, and liver glutathione (GSH) and reduced/oxidized glutathione ratio (GSH/GSSG) were measured.

RESULTS

Binge-drinking rats had higher lipids and DNA oxidation levels. They also had lower hepatic GSH levels and GSH/GSSG ratio. Folic acid supplementation to binge-drinking rats does not change the serum protein oxidation but decreases lipid and DNA oxidation. Finally, GSH increased to control levels with folic acid supplementation.

CONCLUSION

Folic acid supplementation is an economic and efficient therapy against the oxidative damage in lipids and mainly in DNA stability caused by binge drinking during adolescence. It has also been demonstrated that folic acid increases GSH levels, improving the antioxidant status and revealing a hepatoprotective effect during binge drinking.

Retroperitoneal schwannoma. A complex surgical treatment of a tumor with uncertain behavior

BACKGROUND

Retroperitoneal schwannoma is a rare nerve sheath tumor; the surgical removal of this tumor is sometimes compromised by its location. The aim of this study is to analyze our experience with the diagnosis and treatment of this type of tumor.

METHOD

We present our experience between 1999 and 2011 in the diagnosis and treatment of retroperitoneal schwannoma. During that time, we diagnosed and treated five female patients (four adults and one infant) with the condition. The tumors appeared sporadically and were not associated with neurofibromatosis or other syndromes. Diagnosis was performed by computed tomography (CT) imaging in four cases and by magnetic resonance imaging (MRI) in one case.

RESULTS

All patients underwent surgical treatment and complete resection of the lesion. An open resection was performed in four cases, and in the most recent case, the excision was conducted laparoscopically. In all of the cases, the histological diagnosis was retroperitoneal schwannoma, and in one case, there was a melanocytic variant that was not associated with Carney syndrome. At the time of this report, there has been no evidence of recurrence.

CONCLUSION

Retroperitoneal schwannoma is a tumor that is difficult to diagnose with imaging techniques, and because of its localization, the tumor is difficult to remove surgically.

Effect of dietary selenite on development and intestinal absorption in offspring rats

AIM

The present study aims to compare selenium (Se) status in offspring rats born to selenium-deficient and selenium supplemented dams and to analyse Se's influence on intestinal parameters and the intestinal absorption of selenomethionine (Se-Met).

MAIN METHODS

Male and female Wistar rats (150-200 g) were randomised in: control (C) (0.1 ppm Se), Se-deficient (SD) (0.01 ppm Se) and Se-supplemented (SS) (0.5 ppm Se) groups; and were mated to obtain their offspring. Se levels in serum, urine and faeces in offspring and in mothers' milk were measured by graphite-furnace atomic absorption spectrometry. Duodenal transport studies in offspring were performed using an in vivo perfusion of different Se-Met concentrations (2, 5, 10, 25, 75 and 150 μM).

KEY FINDING

A Se-deficient diet provoked a decrease in the offspring's body weight and intestinal parameters, while the supplemented diet increased these values. Serum Se levels were similar between Se-deficient and control offspring because the urinary excretion of Se was smaller to compensate for Se homeostasis. Intestinal Se-Met absorption obeys the Michaelis-Menten equation with lower apparent constant (K(m)) and maximal velocity (V(max)) in the SD group. However, the C and SS groups presented similar K(m) and different V(max). The V(max) showed greater values in the following order of rank: SS>C>SD groups.

SIGNIFICANCE

Selenium intake deficiencies in offspring lead to the development of compensatory mechanisms in order to normalise serum selenium levels. These mechanisms, however, do not permit normal body development; nor do they regulate intestinal parameters and Se-Met transport.

Selenium or selenium plus folic acid intake improves the detrimental effects of ethanol on pups' selenium balance

The levels of folic acid and selenium, two nutrients with antioxidant properties, decrease in dams exposed to ethanol during gestation and lactation. This decrease affects their antioxidant balance, and consequently the health of their offspring. In this study we have proved that a supplemented diet with Se (0.5 ppm) or with Se (0.5 ppm) plus folic acid (8 ppm) to ethanol-exposed (20%v/v) dams prevents the ethanol-provoked effects in their offspring's Se deposits. Se levels in milk, serum, urine, faeces and several tissues were measured by graphite-furnace atomic absorption spectrometry. Results show that ethanol decreases Se deposits in pups' heart, liver, kidney and testes. However Se levels in pancreas and in serum were increased by ethanol; it also compromised the weight and the length of the offspring at the end of lactation. Our supplemented diets to ethanol dams increased all of these impaired levels, and restored Se pancreas concentration to a control status. However Se-only therapy mainly displaces Se to serum, kidney and spleen, and co-treatment with Se plus folic acid, mainly displaces Se to liver and brain. This data demonstrate that the qualitative and quantitative Se organ deposits depend on ethanol consumption, Se status, and the presence of other antioxidants.

Dietary selenium plus folic acid as an antioxidant therapy for ethanol-exposed pups

BACKGROUND

Nutrients such as folic acid and selenium are decreased in dams exposed to ethanol during gestation and lactation, affecting their metabolism, antioxidant balance, and the future health of their progeny. We will study whether the supplementation of the maternal diet with folate and selenium can prevent ethanol-induced oxidative liver disorders in the offspring.

METHODS

Dams were randomised into four groups: control, alcohol, alcohol+folic acid+Se, and control+folic acid+Se. We determined selenium by graphite-furnace atomic absorption and antioxidant enzyme activities, lipid peroxidation, and protein carbonyl by spectrophotometry in the offspring.

RESULTS

Alcohol increased serum Se levels and glutathione peroxidase (GPx) activity. However, in the liver of pups from ethanol-exposed dams a decrease in selenium was provoked and GPx activity increased with the double supplementation. Glutathione reductase (GR) and catalase (CAT) activities increased with ethanol, while double supplementation significantly decreased the GR activity. The supplemented diet reduced the protein peroxidation found in ethanol pups.

CONCLUSIONS

These results suggest that folic acid+Se could be effective in neutralising the damage of ethanol consumption in pups since it prevents peroxidation protein products.

Selenium tissue distribution changes after ethanol exposure during gestation and lactation: selenite as a therapy

Ethanol consumption affects maternal nutrition and antioxidant status together with the future health of their progeny. Selenium (Se) is a trace element with antioxidant activity; we will study the effect of ethanol in dams on Se bioavailability, antioxidant balance and gestational parameters. We also will study if a Se-supplemented diet (0.5 ppm) administered to ethanol-exposed dams avoids the undesirable effects provoked by ethanol. We have used four experimental groups: control (C); chronic ethanol (A); control+Se (CS) and chronic ethanol+Se (AS). Se levels in serum, urine, faeces, and several tissues were measured by graphite-furnace atomic absorption spectrometry. Serum glutathione peroxidase (GPx) activity was determined by spectrometry. Se bioavailability is altered by ethanol, causing a decrease in Se retention, reducing Se levels in cortex, muscle, mammary gland and salivary gland while elevating Se values in heart, liver and spleen. On the other hand, Se supplementation increases some of these parameters. Serum GPx activity was decreased by ethanol, while a Se-supplemented diet restores these values to those found in controls. We have demonstrated that ethanol decreased Se retention in dams, affecting their tissues' Se deposits, decreasing GPx activity in serum, gestational parameters and the weight of their progeny. Selenite supplementation counteracts these decreasing effects, except in cortex.

Molecular analysis of synchronous uterine and ovarian endometrioid tumors

The presence of simultaneous carcinomas involving both the ovary and uterine corpus presents a diagnostic challenge, particularly if the tumors have a similar histology. The classification of these lesions as either two separate primary tumors, or as a single primary tumor with a metastasis has significant implications with respect to patient prognosis and recommendations for therapy. Although several morphologic criteria have been proposed as guidelines for the classification of these lesions, certain cases remain difficult to confidently classify. The application of current molecular biology techniques to pathological specimens can provide genetic information than can be helpful in establishing the relationship between synchronous neoplasms. Specifically, the use of tissue microdissection and polymerase chain reaction (PCR) amplification of DNA can be helpful. In this study we used polymorphic DNA markers on chromosomes 17q21.3-22 and 11q13 to study loss of heterozygosity (LOH) in 13 patients who presented with endometrioid tumors in both the uterus and ovary. Ten of the 13 cases showed LOH in one or both tumors. In eight of the 13 cases the detected LOH either chromosome 17q21.3-22 or 11q13 occurred selectively in only one of the two tumor sites. The results of this study suggest that the eight cases with LOH selective for one tumor site represent patients with two separate primary tumors. Molecular analysis may be useful in determining the relationship of synchronous uterine and ovarian endometrioid neoplasms.

Genetic analysis of synchronous mucinous tumors of the ovary and appendix

The coexistence of mucinous ovarian and appendiceal tumors in association with pseudomyxoma peritonei (PP) is well established. However, it has not been determined whether they represent independent or metastatic neoplasms. The authors analyzed microsatellites on chromosome 17q 21.3-22 (nm23), 3p 25-26 (von Hippel Lindau disease [VHL] gene), and 5q 21-22 (D5S346 locus) in 12 synchronous ovarian and appendiceal mucinous lesions. Loss of heterozygosity (LOH) at the nm23 locus has been shown previously in ovarian carcinomas, and genetic alterations at both the 3p and 5q loci have been reported in colorectal carcinomas. The ovarian lesions consisted of nine mucinous tumors of low malignant potential and three invasive adenocarcinomas, and the appendiceal lesions consisted of eight carcinomas without invasion, two invasive carcinomas, and two mucosal hyperplasias. DNA was extracted from microdissected cells obtained from formalin-fixed, paraffin-embedded tissue sections and amplified by polymerase chain reaction. In three specimens, genetic alterations occurred at 17q 21.3-22 in only the ovarian tumors. One of these cases showed LOH on chromosome 5q 21-22 in only the appendiceal tumor. In three other specimens, LOH at the same locus was found in both tumors. Six specimens did not show LOH at any locus. These results suggest that a subset of synchronous mucinos ovarian and appendiceal lesions showing different LOH patterns in both sites most likely represent patients with two separate primary lesions. Another group of specimens with the same allelic loss in both tumors most likely represent patients with a single primary and metastatic spread. Thus, genetic analysis of these lesions may be useful in investigating the origin of histologically similar synchronous tumors.

Different patterns of HLA-DR antigen expression in normal epithelium, hyperplastic and neoplastic malignant lesions of the breast

Fifteen samples of non-tumoural breast tissue, 24 cases of benign lesions, four biopsies of inflammatory carcinomas and 94 tumour samples of primitive mammary carcinomas were analysed for HLA class II expression. We found, first, that HLA class II antigens were detectable in all cases of non-neoplastic breast tissue. Secondly, HLA class II antigen expression was notably increased in benign neoplasms and hyperplastic lesions. In contrast, only 32 out of 94 carcinomas showed expression of HLA-DR antigens, 17 tumours had HLA-DP antigens and 11 carcinomas were positive for the presence of DQ molecules. The expression of class II antigen was associated with the degree of histological differentiation (P < 0.05) but was independent of stromal leucocytic infiltration. Thirdly, HLA-DR was very strongly expressed in intravascular tumoural thrombi, especially in the 'inflammatory carcinomas'. The immunophenotype of inflammatory infiltrate was analysed in benign and malignant lesions. In malignant lesions the mean number of inflammatory cells was significantly higher than in benign lesions. Interestingly, we found no differences in the amount and composition of inflammatory infiltrate between HLA-DR positive and negative tumours.

Detection of HPV DNA by in situ hybridization in benign, premalignant and malignant lesions of the oral mucosa

Evidence has accumulated in recent years that relates certain types of human papillomaviruses (HPV) to the development of some tumors. We use in situ hybridization to study DNA from HPV 6/11, 16/18 and 31/33/35 in 6 squamous papillomas, 18 hyperkeratotic/acanthosis lesions with and without dysplasia (5 and 13 cases respectively) and 27 squamous cell carcinomas of the oral mucosa. HPV DNA was found in 66% of squamous papillomas, 38.4% of hyperkeratotic/acanthosis lesions without dysplasia, 60% of epithelial dysplasia and 37% of squamous cell carcinomas. HPV DNA 6/11 was the most common type found, and in squamous cell carcinomas HPV DNA appear more frequently in well differentiated tumors.

Adenocarcinoma of the urachus showing extensive calcification and stromal osseous metaplasia

We report a case of adenocarcinoma of the urachus showing extensive calcification and stromal osseous metaplasia, arising in the bladder dome of a 51-years-old man. The patient underwent partial cystectomy, including in block excision of the entire urachus and umbilicus, and remains well, free from symptoms after a 22-month follow-up period. Main pathologic and clinical characteristics of urachal calcified tumors are reviewed. To our knowledge, this is the first report in the English literature on urachal carcinoma showing both extensive scattered calcification and massive stromal osseous metaplasia.

Hyaline globules in uterine malignant mixed müllerian tumours. A diagnostic aid?

In order to evaluate the presence of hyaline globules (HGs) in uterine malignant mixed müllerian tumours (MMMT), and its possible diagnostic value in haematoxylin & eosin stained sections, a retrospective microscopic study of 38 cases (13 homologous and 25 heterologous) was carried out. Intra- and extracellular HGs were found in 31 MMMT (81.6%), 8 homologous (61.5%) and 23 heterologous (92%). In addition, strong alpha-1-antitrypsin immunoreactivity was also noted in the HGs of 10 cases out of 13 investigated. In initial diagnostic curettage material, HGs were observed in 18 of 22 cases (81.8%), 6 of 9 homologous (66.7%) and 12 of 13 heterologous (92.3%). In view of the high incidence of HGs in curettage specimens, their finding in haematoxylin & eosin stained sections could orientate a histopathologic preoperative diagnosis of MMMT, specially of heterologous type, and may be considered a diagnostic tool in order to indicate an early, planned therapy and staging in these neoplasms of poor prognosis.

Endometrial carcinoma with trophoblastic differentiation. An aggressive form of uterine cancer

Three cases of poorly differentiated endometrial adenocarcinoma showing trophoblast-like differentiation are reported. The multinucleated, syncytiotrophoblast-like cells were strongly positive for beta-human chorionic gonadotropin (beta-HCG) by immunohistochemical study. High levels of beta-HCG were also present in the patients' serum, but dropped significantly after treatment. The patients had an unusually rapid and progressive clinical course with widespread dissemination and death by tumor.

Fibrolamellar hepatocellular carcinoma. An immunohistochemical and ultrastructural study

Two cases of fibrolamellar carcinoma of the liver are reported in young female patients of 12 and 21 years of age. Small amounts of perinuclear alpha-fetoprotein were found, unrelated to hyaline globules, as well as alpha 1-antitrypsin in a periglobular fashion in isolated cells. Ferritin was present in a large number of cells. Ultrastructurally, the well differentiated nature of the neoplasm was substantiated by previously unreported findings such as intercellular lumina analogous to bile canaliculi and peroxisome-like bodies containing a central crystalloid. Filamentous material resembling Mallory's type of hyaline was also found. We conclude that both immunohistochemical and ultrastructural features reflect a high degree of differentiation.

The fine structure of choroid plexus carcinoma

The ultrastructural findings of two cases of choroid plexus carcinoma occurring in infants 11 and 24 months old are discussed. Both had a similar ultrastructural pattern which demonstrated a clear polygonal cytoplasm, cell polarity towards the lumina, junctional complexes and evidence of a basement membrane, all of which point to an epithelial origin for the proliferating cells. Abundant immature cellular characters such as polyribosomes, glycogen granules and hypertrophied rough endoplasmic reticulum were found. The importance of the differential diagnosis from ependymoblastoma and benign choroid plexus papilloma is emphasized. In the former, the major differentiating features are the existence of abundant glial neuropil and cellular characters of glial differentiation, whilst in the latter, cytoplasmic features demonstrate cellular maturity.

Extragenital endometrioid cystadenofibroma

We present a case of extragenital endometrioid cystadenofibroma, whose rare pelvic localization is the motive for its publication, as no similar case had been described previously. Its possible histogenesis from a pelvic mesothelium, as well as the differential diagnosis from pelvic endometriosis is discussed.

[Renal biopsy in the hemolytic-uremic syndrome in infancy. A study of three cases (author's transl)]

The hemolytic-uremic syndrome, although clearly described from the clinical and morphological points of view, has uncertain etilogy and pathogenesis for which various hypotheses have been advanced. In the immunohistochemical study of three recent infantile cases, whose clinical description and analysis follow those described in the literature, we found fibrinogen deposits, C3 and immunoglobulins in the walls and glomerular capillary vessels in two from which biopsies were taken early; while in the third case, in which the biopsy was taken a month after the process had begun, only fibrinogen was found. These findings suggest a pathogenesis of lesions involving an immunocomplex reaction with ulterior development of secondary intravascular coagulation. On the other hand, the presence or absence of C3 and immunoglobulins could be related to the timing of the biopsy, disappearing in the more developed cases. In the ultrastructural study performed in one of the case, besides other lesions habitually referred to, the presence of virus-like particles in the glomerular capillary endothelium was observed. Although having been seen in multiple locations and circumstances, this has not previously been described in the hemolytic-uremic syndrome, and it probably represents the morphological expression of degenerative glomerular processes.

Carcinoma in situ of the Fallopian tube associated with cervical carcinoma. Case report

A case of carcinoma in situ of the fallopian tube in a 55-year-old woman, associated to cervical carcinoma is described. The necessary criteria for the diagnosis of pre-invasive carcinoma of the fallopian tube, among which the number of mitoses seems to be of great importance, are discussed. This previously unreported association of carcinoma in situ of the fallopian tube, with carcinoma of the uterine cervix, emphasizes the notion of the multicentric neoplastic possibilities of the müllerian tract derivatives.