[Prognostic significance of clinic pathological and selected immunohistochemical factors in endometrial cancer]

OBJECTIVE

To assess the immunohistochemical expression of p53, bcl-2, c-erbB-2, Ki-67, estrogen (ER) and progesterone (PR) receptors in endometrial cancer patients. To assess the relation between steroid receptors positivity and other markers. To evaluate the prognostic significance of clinicopathologic and immunohistochemical markers on patient disease free survival.

DESIGN

Experimental prospective study.

SETTING

Department of Obstetrics and Gynaecology, Institute of Human Genetics, Department of Pathology, Department of Biophysics, Palacky University Medical School and University Hospital, Olomouc.

METHODS

We studied 144 cases of primary untreated endometrial carcinoma in which the p53, bcl-2, c-erbB-2, Ki-67, ER and PR antigens were investigated with the use of an immunohistochemical method. In a group of 122 patients we assessed disease free survival (DFS) in relation to clinicopathologic and immunohistochemical factors.

RESULTS

From the total group of 144 patients, 122 were included for survival analysis. We found 15 (12.3%) patients with recurrence of the disease. Mean age was 64,5 (34-88) years. Immunohistologic expression was p53 positive in 29 (23.8%), bcl-2 positive in 87 (71.3%), c-erbB-2 positive in 34 (27.9%), Ki-67 positive in 56 (45.9%), ER positive in 97 (79.5%) and PR positive in 106 (86.9%) of cases. In the survival analysis significantly shorter DFS was present in tumours with poor differentiation (G3), deep myometrial invasion (M2) and positive lymphoinvasion (N).

CONCLUSION

Only poor differentiation (G3) and deep myometrial invasion (M2) are significant independent factors for the length of DFS.

[Immunohistochemical markers expression in hysteroscopy and hysterectomy specimens from endometrial cancer patients: comparison]

OBJECTIVE

To assess the immunohistochemical expression of p53, bcl-2, c-erbB-2, Ki-67, estrogen (ER) and progesterone receptors (PR), MMP-7, MMP-26 in samplex from diagnostic hysteroscopy and therapeutic hysterectomy in endometrial cancer patients.

DESIGN

Experimental prospective study.

SETTING

Department of Obstetrics and Gynecology, Institute of Human Genetics, Department of Pathology, Palacky University Medical School and University Hospital, Olomouc.

METHODS

We studied 43 cases of primary untreated endometrial carcinoma in which the grade and immunomarkers assessed by histoscore were investigated in specimens obtained at hysteroscopy and hysterectomy.

RESULTS

Based on hysterosopy, 31 (72.1%) patients were classified as G1, G2 7 (16.3%) and G3 5 (11.6%) respective. In grade 1 the concordance rate was 77.4% of cases, in grade 2 it was in 14.3% of cases and in grade 3 it was in 80.0% of cases. In hysterosocpy samples the p53 expression was found in 23 (53.5%), bcl-2 in 37 (86.0%), c-erbB-2 in 20 (46.5%), Ki-67 in 29 (67.4%), ER in 37 (86.0%), PR in 36 (83.7%), MMP-7 in 25 (58.1%) and MMP-26 in 23 (53.5%) cases. Expression in hysterectomy specimens was p53 positive in 13 (30.2%), bcl-2 positive in 33 (76.7%), c-erbB-2 positive in 24 (55.8%), Ki-67 positive in 25 (58.1%), ER positive in 36 (83.7%), PR positive in 40 (93.0%), MMP-7 positive in 27 (62.8%) and MMP-26 positive in 23 (53.5%) of total 43 cases.

CONCLUSION

We found high concordance in expression of p53, bcl-2, PR and MMP-7 in hysteroscopy and hysterectomy samples which could be of importance for therapeutic algorithm in endometrial cancer patients.

Immunohistochemical evaluation and lymph node metastasis in surgically staged endometrial carcinoma

OBJECTIVE

To assess the expression of immunohistochemical markers in surgically staged endometrial cancer patients.

METHODS

We studied 107 cases of primary untreated endometrial carcinoma in which the p53, bcl-2, her-2/neu, Ki-67, estrogen receptor (ER) and progesterone receptor (PR) antigens were investigated by an immunohistochemical method. In the last 50 consecutive patients immunoreactivity for MMP-7 and MMP-26 was assessed as well. We evaluated the correlations among the immunohistochemical staining assessed by histoscore, and the age, grading, depth of invasion, stage of the neoplasia and extrauterine disease.

RESULTS

Mean age was 65 years (range 34-88). All patients were submitted to total abdominal or modified radical vaginal hysterectomy plus bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy; p53, bcl-2, her-2/neu, Ki-67, MMP-7, MMP-26, estrogen and progesterone receptors were positive in 36 (43%), 71 (86%), 13 (16%), 80 (96%), 65 (78%), 80 (96%), 61 (73%) and 71 (86%) patients, respectively. p53 overexpression was found to be related to poor grade of differentiation and deep myometrial invasion. Immunostaining for ER was inversely related to the histopathological differentiation of the tumors. Decreased expression of PR was related to advanced stage, poor histopathologic differentiation and extrauterine spread of disease.

CONCLUSION

The overexpression of p53 seems to indicate more malignant phenotype, while PR expression correlates with parameters of better clinical outcome.

Sulphates of 3beta-hydroxy-5-ene steroids in women with epilepsy

Epilepsy is associated with various reproductive disorders and some antiepileptic drugs also influence the steroid metabolism. There is only limited data concerning the role of steroid sulphates in human epilepsy. Moreover, the substitution treatment with therapeutic substances also improves cognitive functions in humans. Therefore, we evaluated the balance between free and Delta5 sulphated steroids in women with epilepsy on various antiepileptic drugs. The study included 28 patients (17.0-51.0 years), with generalized (n=16) or catamenial epilepsy (n=12) followed in the follicular (FP) and luteal (LP) phases of menstrual cycle. Fifteen patients were on monotherapy and 13 were on polytherapy with 2 or 3 drugs. RIA was used for the steroid analyses. Statistical evaluation was done by Mann-Whitney tests and multivariate regression with reduction of dimensionality (Orthogonal Projections to Latent Structures, O2PLS). The final O2PLS model found a single significant predictive component extracting the variability shared between carbamazepine therapy, age of the subjects, and steroid levels and correlating with the variables as follows pregnenolone sulphate (PregS)-FP: R= -0.844, p<0.01; DHEAS-FP: R= -0.923, p<0.01; PregS-LP: R= -0.876, p<0.01; DHEAS-LP: R= -0.902, p<0.01; carbamazepine therapy: R=0.441, p<0.01; age of the participants (R=0.584, p<0.01). Carbamazepine significantly decreased DHEAS in both FP (p=0.02) and LP (p=0.003) and PregS in LP (p=0.03) and tended to decrease the PregS levels in FP (p=0.10), while primidone decreased DHEAS in both FP and LP (both p=0.05) and did not significantly change the levels of PregS. In conclusion, carbamazepine and primidone therapies significantly suppressed the sulphated steroids in serum.

Vaccination with human papillomavirus type 16-derived peptides using a tattoo device

Tattooing has been shown to be very efficient at inducing immunity by vaccination with DNA vaccines. In this study, we examined the usability of tattooing for delivery of peptide vaccines. We compared tattooing with subcutaneous (s.c.) needle injection using peptides derived from human papillomavirus type 16 (HPV16) proteins. We observed that higher peptide-specific immune responses were elicited after vaccination with the simple peptides (E7(44-62) and E7(49-57)) and keyhole limpet hemocyanin-(KLH)-conjugated peptides (E7(49-57), L2(18-38) and L2(108-120)) with a tattoo device compared to s.c. inoculation. The administration of the synthetic oligonucleotide containing immunostimulatory CpG motifs (ODN1826) enhanced the immune responses developed after s.c. injection of some peptides (E7(44-62), KLH-conjugated L2(18-38) and L2(108-120)) to levels close to or even comparable to those after tattoo delivery of identical peptides with ODN1826. The highest efficacy of tattooing was observed in combination with ODN1826 for the vaccination with the less immunogenic E6(48-57) peptide and KLH-conjugated and non-conjugated E7(49-57) peptides which form the visible aggregates that could negatively influence the development of immune responses after s.c. injection but probably not after tattooing. In summary, we first evidenced that tattoo administration of peptide vaccines that might be useful in some cases efficiently induced both humoral and cell-mediated immune responses.

Reconstruction of defect after radical vulvectomy by the use of four-flap local transfer--a case report

Malignant vulvar tumors must be treated by radical removal of the tumor as well as a sufficient amount of surrounding healthy tissue. The resulting defects can be resolved by skin transplants, local transfers, skin flaps, muscle flaps or free tissue transfers. We describe the case history of a patient who underwent radical vulvectomy for a malignant tumor with immediate reconstruction by local flaps from the area of inner thighs and mons pubis. The advantages and disadvantages of this method are compared to other reconstructive surgery methods.

Finasteride treatment and neuroactive steroid formation

Finasteride is the 5alpha-reductase inhibitor that received clinical approval for the treatment of human benign prostate hyperplasia and androgenetic alopecia. The 5alpha-reductase is enzyme responsible for the reduction of testosterone to dihydrostestosterone, progesterone to dihydroprogesterone and deoxycorticosterone to dihydrodeoxycorticosterone, steroids modulating the action of gamma-aminobutyric acid on GABA receptors. These neuroactive steroids possess anticonvulsant, antidepressant and anxiolytic effects. The objective of the study was to determine the effect of finasteride therapy on a broad steroid spectrum in men with benign prostate hyperplasia. A group of 20 men with benign prostate hyperplasia was involved in the present study. Finasteride in the daily dose of 5 mg/day was administrated for 4 months. In all individuals, their hormonal profile of steroid hormones was determined before and after 4 months lasting finasteride treatment. Finasteride treatment resulted in a significant decrease all alpha-reduced and increase of most 5beta-reduced metabolites of testosterone and progesterone as well as in an increase of 7alpha-hydoxyderivatives, which are known as neuroactive steroids acting by modulation of GABAA and NMAD receptors in the brain. In the course of finasteride treatment the decrease of the concentration of circulating steroids with known inhibitory activity on GABA-ergic excitation in the brain is very probably an important factors contributing to the development of the symptoms of depression seen in some isolated cases of finasteride administration.

Enhancement of T cell-mediated and humoral immunity of beta-glucuronidase-based DNA vaccines against HPV16 E7 oncoprotein

Therapeutic DNA vaccines against oncogenic infection with human papillomavirus type 16 (HPV16) are mostly targeted against viral oncoproteins E7 and E6. To adapt the E7 oncoprotein for DNA immunization, we have previously reduced its oncogenicity by modification of the Rb-binding site and enhanced immunogenicity of the modified E7GGG gene by the fusion with the 5'-terminus of the gene encoding E. coli beta-glucuronidase (GUS). In this study, we attempted to improve immunogenicity of the GUS-based anti-E7 vaccines by increasing the steady-state level of fusion proteins. We fused deletion mutants of E7GGG and codon-optimized E7GGG with the 5'-terminus of GUS and unaltered E7GGG with the 3'-terminus of GUS. Furthermore, we mutated the initiation codon of the GUS gene in the E7GGG.GUS construct, as GUS alone was produced from this fusion gene. We found that only the fusion of E7GGG with the 3'-terminus of GUS (GUS.E7GGG) and deletion mutants of E7GGG with the 5'-terminus of GUS increased the steady-state level of fusion proteins in transfected human 293T cells. Analysis of immune reactions induced in mice by vaccination via a gene gun showed that the increased steady-state level of fusion proteins resulted in augmented production of E7-specific antibodies, but did not enhance cell-mediated anti-tumor immunity. Finally, we joined the signal sequence of the adenoviral E3 protein with GUS.E7GGG. This modification led to the predominant localization of the fusion protein in the endoplasmic reticulum and enhancement of CD8+ T-cell response, while antibody production was reduced. In conclusion, we found modifications of the E7GGG.GUS fusion gene that augmented either humoral or cell-mediated immune responses.

[Expression of p53, Ki-67, bcl-2, c-erb-2, estrogen, and progesterone receptors in endometrial cancer]

OBJECTIVE

To assess the immunohistochemical expression of p53, bcl-2, c-erb-2, Ki-67, estrogen and progesterone receptors in endometrial cancer patients.

DESIGN

Experimental study.

SETTING

Department of Obstetrics and Gynecology, Institute of Human Genetics, Department of Pathology, Palacky University Medical School and University Hospital, Olomouc.

METHODS

We studied 103 cases of primary untreated endometrial carcinoma in which the p53, bcl-2, c-erb-2, Ki-67, estrogen and progesterone receptor antigens were investigated by an immunohistochemical method. We evaluated the correlations among the immunohistochemical staining assessed by histoscore, and the age, grading, depth of invasion, stage of the neoplasia and extrauterine disease.

RESULTS

Mean age was 67 years (range 35-90). p53, bcl-2, c-erb-2, Ki-67, estrogen and progesterone receptors were positive in 49 (48%), 81 (79%). 18 (17%), 99 (96%), 73 (70%) and 87 (84%) patients respectively. There was no clear association between immunohistochemical parameters and the age of patients. p53 and Ki-67 overexpression was found to be related to poor grade of differentiation, deeper myometrial invasion, advanced stage of neoplasia and extrauterine spread of disease. Immunostaining for bcl-2 correlated inversely with FIGO stage, while c-erb-2 was overexpressed in tumors with deeper myometrial invasion. Estrogen and progesterone receptor positive tumors showed a statistically significant association with clinicopathological parameters of better clinical outcome.

CONCLUSION

The overexpression of p53 and Ki-67 seems to indicate more malignant phenotype, while bcl-2 and c-erb-2 may have a limited role in the identification of high-risk tumors.

Live cell vaccines expressing B7.1, monocyte chemoattractant protein 1 and granulocyte-macrophage colony stimulation factor derived from mouse HPV16-transformed cells

One of the gene therapy strategies in oncology is immunization with cancer cells that express various cytokines. We used a thymidine-kinase deficient (cTK-) cell line designated 123IA, which had been derived from HPV16-transformed mouse (C57BL/6) cells MK16/I/III/ABC (MK16). To obtain genetically modified cells, 123IA cells were transfected with bicistronic plasmid vectors carrying the herpes simplex type 1 thymidine kinase (HSV TK) gene and either the gene for the mouse B7.1 (CD80) co-stimulatory molecule or the gene for the monocyte-chemoattractant protein 1 (MCP-1). For control purposes, a plasmid vector carrying only the HSV TK gene was used. The transfected cells were cultivated in medium supplemented with hypoxanthine, aminopterin and thymidine. For comparative purposes we also used B9 cells, which express the granulocyte-macrophage colony stimulation factor (GM-CSF) and had been derived from 123A cells by transduction with the recombinant adeno-associated virus carrying the HSV TK gene and the mouse GM-CSF gene. All of the cell lines isolated were found to be sensitive to minute amounts of ganciclovir, revealing the production of HSV TK, and to express the respective transgenes. When inoculated into 5-week-old female syngeneic mice, cells expressing either GM-CSF or B7.1 were non-oncogenic. On the other hand, nearly all mice inoculated with MCP-1-producing cells developed tumours, though considerably later than animals inoculated with the same dose of the parental MK16 cells. Animals injected with GM-CSF- or B7.1-producing cells were protected against challenge with the parental MK16 cells. When another mouse (C57BL/6) HPV16-transformed oncogenic cell line, TC-1, which differs from the MK16 cells in a number of properties such as MHC class I and B7.1 expression, was used for the challenge, the protective effect was much less pronounced.

Clinical anatomy of the dorsal venous network in fingers with regard to replantation

The arterial system of fingers is anatomically well described, and so, usually no difficulties arise during its preparation and the making of anastomoses in replantation surgery. Difficulties may occur, however, during manipulation in the dorsal vascular bed of fingers, known only as a random venous network. There are minimal references to its existence and the location of its valvular apparatus. Using a microscopic preparation, a contrast staining, and a histological assessment, topographic relations and the course of veins of the dorsal venous network, as well as the existence and location of their valvular apparatus, was investigated on 72 three-phalanx fingers. The specimens were either harvested from fresh cadavers or traumatically amputated. We found that veins of rather significant caliber predominantly run along the dorsal aspect of the finger on both the radial and ulnar sides above the proximal phalanx of three-phalanx fingers. Proximally, venous systems of respective neighboring fingers connect in the interdigital space. The valvular apparatus was found at all levels ranging from metacarpophalangeal joints to the distal phalanx. The valves were always located distally from the confluence of two veins. Aside from this confluence, the existence of valves was not observed. The exact description of architecture of this venous system, in practice, contributes to faster orientation, better preparation, and the creation of safer anastomoses of these structures, and thus, to an increased success of replantation.

[The polycystic ovary syndrome and its male equivalent]

BACKGROUND

The polycystic ovary syndrome is multifactorial disease. The autosomal genetic transfer of the disease predisposition is the basis for hypothesis that there can exist a male equivalent of PCOS. Androgenetic alopecia has been suggested as the symptom of the male phenotype of PCOS.

METHODS AND RESULTS

A group of 30 men with premature hair loss was involved in the present study. In all individuals, their hormonal profile was determined and insulin tolerance test was made. Robust Mann-Whitney test and Fisher's exact test were used for statistic analysis. Based on the laboratory findings two subgroups of individuals were shown. The first one revealed similar hormonal changes as women with PCOS, namely lower SHBG, lower FSH and elevated free androgen index. The other had either no anomaly in steroid spectrum. Both subgroups did not differ in either BMI or age. The subgroup with hormonal changes resembling those of PCOS, showed a significantly higher insulin resistance than the group without these changes.

CONCLUSIONS

Based on our results it can be concluded that men with premature alopecia and hormonal changes partially resembling those typical for female PCOS, might probably represent the male equivalent of PCOS.

The existence of a male equivalent of the polycystic ovary syndrome--the present state of the issue

The polycystic ovary syndrome (PCOS) in women belongs to the most frequent endocrinopathies. This syndrome is characteristic by a hormonal and metabolic imbalance. It seems to be a kind of an oligogenic disease resulting from the interaction among several key genes and environmental effects. Considering the genetic basis of this syndrome there is no reason why the syndrome could not occur in men as well, be it with a different symptomatic expression. Premature baldness before the age of thirty used to be suggested as a symptom of the male PCOS equivalent. Yet there still seems to be rather a meagre attention devoted to the endocrinological changes in men in the specialised literature, although there do exist genealogical studies on the occurrence of alopecia or glucose metabolic disorder in male members of the families where a considerable number of females were affected by PCOS.

[Histological grade in management of carcinoma of endometrium]

OBJECTIVE

To correlate histological differentiation of endometrial cancer assessed from material obtained at diagnostic operation (hysteroscopy and targeted biopsy or curettage) and definitive radical surgical treatment.

DESIGN

A prospective multicentric study.

SETTING

Department of Obstetrics and Gynaecology, Institute of Pathology, Palacký University Medical School and University Hospital, Olomouc.

MATERIAL AND METHODS

237 patients with endometrial adenocarcinoma diagnosed between 1997-2001 were enrolled into this study. Histopathologic differentiation of tumoral tissue obtained at diagnostic and definitive radical operation were compared.

RESULTS

Discrepancies in histopathologic differentiation of tumoral tissue obtained at diagnostic and definitive operation were found to be present in 42.2% of grade 1 (G1), 34.8% of grade 2 (G2), and 25.6% of grade 3 (G3) samples. When divided into subgroups, we observed discrepancies in 37.1% of G1, 31.5% of G2, and 26.7% of G3 tumors diagnosed at hysteroscopy and targeted biopsy. In patients with D&C the discrepancies were present in 53.1% of G1, 41.4% of G2, and 23.1% of G3 tumors.

CONCLUSIONS

Low correlation between histopathologic differentiation of tumoral tissue obtained at diagnostic and definitive surgery supports the necessity of surgical staging in all patients with endometrial cancer. Primary radiotherapy should be reserved only for patients, in which the surgery is contraindicated.

Characteristic of two mouse bcr-abl-transformed cell lines: I. General properties of the cells

In an effort to develop an experimental system suitable for immunological studies in which Bcr-Abl-positive cells are to be used as antigens, we examined the properties of two mouse (Balb/c) established cell lines that express the Bcr-Abl protein and are oncogenic for syngeneic animals. Under standard conditions the two cell lines, viz. Ba-p210 (B210) and 12B1, expressed comparable amounts of the Bcr-Abl protein. However, they differed in a number of characteristics. From the morphological point of view, B210 cells were the more homogeneous, being mainly represented by leukaemic blastic cells with a large number of AgNORs as markers indicating a high proliferative activity. 12B1 cells were more polymorphic and giant cells were detected within their populations. Many 12B1 cells exhibited nuclear segmentation and "band-like" structures. Markers of proliferation were less frequent in 12B1 and the tendency for aging was more pronounced in these cells. The 12B1 cells were slightly more sensitive to imatinib mesylate than B210 cells. In B210 cells, the expression of MHC class I was downregulated, which was not the case with 12B1 cells. Both cell lines induced leukaemia-like disease in mice after intravenous application but, as compared with B210, 12B1 cells were about 100 times more oncogenic and the disease they induced was more aggressive. Moreover, 12B1, but not B210, induced tumours after subcutaneous or intraperitoneal inoculation.

Degloving injury--the use of a combination of free fasciocutaneous sensitive flap and pedicle flaps for reconstruction

The authors present a case report of reconstruction after a degloving injury to hand by a combination of microsurgery and standard pedicle flaps. Degloving injury high on the hand was solved by free sensitive fasciocutaneous flap transfer from the radial forearm (Chinese flap), which covered the defect in the palm, while finger defects were covered by pedicle flaps from the abdomen. Dorsum of the hand was treated with a mesh skin graft. The authors also describe techniques of treatment and the relevant results prior to the time of microsurgery and compare them to the possibilities offered by microsurgery today, and they include comprehensive illustrations.

Combined immunization with fusion genes of mutated E7 gene of human papillomavirus type 16 did not enhance antitumor effect

BACKGROUND

The E7 oncoprotein of human papillomavirus type 16 (HPV16) is frequently used as a model tumor-associated antigen. Its immunogenicity has been substantially enhanced by fusion with several proteins of various origins and functions. Different mechanisms have been responsible for increased vaccination efficacy of fusion proteins.

METHODS AND RESULTS

We linked E7 and its mutated form (E7GGG) with the mouse heat-shock protein 70.1 (HSP70.1). Enhanced immunogenicity of both fusion genes administered via a gene gun was demonstrated by protection of C57BL/6 mice against oncogenic MHC class I positive TC-1 cells producing the HPV16 E7 oncoprotein but not against the MHC class I negative TC-1/A9 subline. To assess if the efficacy of E7-based DNA vaccines could be increased by combination of various fusion genes, we combined the HSP70.1 fusion genes (i.e. E7HSP or E7GGGHSP) with the fusion construct linking E7GGG with targeting signals of lysosome-associated membrane protein 1 (Sig/E7GGG/LAMP-1). Treatment of mice 4 days after TC-1 cell inoculation showed moderately higher immunization potency of HSP70.1 fusion genes in comparison with the Sig/E7GGG/LAMP-1 gene. Any combination of two fusion genes given in the same gene gun shot neither was more effective compared with single genes nor protected mice against TC-1/A9 cells. As fusion of E7GGG with E. coli glucuronidase (E7GGG.GUS) had been previously proven to provide partial protection from TC-1/A9-induced tumors, we also combined E7GGGHSP with E7GGG.GUS. The genes were inoculated either in mix in two gene gun shots or separately each gene in one shot into opposite sides of the abdomen. Neither mode of combined immunization induced higher protection than E7GGG.GUS alone. However, doubling the DNA dose considerably enhanced the antitumor efficacy of E7GGG.GUS.

CONCLUSIONS

We constructed highly immunogenic fusions of HPV16 E7 and E7GGG with mouse HSP70.1. Furthermore, we substantially enhanced protection against TC-1/A9 cells with downregulated MHC class I expression by doubling the pBSC/E7GGG.GUS dose, but we failed to demonstrate a beneficial effect of any combination of two fusion genes with different mechanisms causing enhancement of HPV16 E7 immunogenicity.

Chemotherapy and immunotherapy of tumours induced by gene-modified HPV16-transformed cells

HPV16 E6/E7 transformed mouse kidney cells designated MK16/1/IIIABC (MK16) were modified by the insertion of a suicide gene, viz. the thymidine-kinase gene of herpes simplex virus (HSV TK). Tumour induction by these cells, designated N2A, was suppressed by ganciclovir (GCV). The growth of already established tumours was partially inhibited by GCV. This effect was markedly potentiated by a single dose of cyclophosphamide (Cy). Ganciclovir- or GCV+ Cy-cured mice were not protected against challenge with MK16 cells. N2A tumour growth was suppressed by simultaneous administration of MK16-derived, non-oncogenic B9 and 181 cells, which express either mouse GM-CSF or mouse IL2, respectively, in addition to HSV TK. The animals treated were protected against challenge with MK16 cells. Animals with already established N2A tumours were treated with GCV and/or repeated doses of B9 or 181 cells. Ganciclovir treatment alone and immunotherapy alone resulted in partial suppression of tumour growth but not in tumour cure. On the other hand, combined chemo- and immunotherapy resulted in tumour rejection by nearly all animals. Similar results were obtained if the immunotherapy with homologous gene-modified cells was substituted by treatment with anti-CD4 antibody. The animals cured of tumours with GCV combined with cell-based vaccine therapy but not those cured by GCV and anti-CD4 antibody treatment were found resistant to challenge with MK16 cells. The present results suggest that combined specific and non-specific chemo- and immunotherapy of tumours induced by appropriately gene-modified cells might provide a special advantage in the treatment of established tumours.

Hormonal profile of men with premature balding

OBJECTIVE

Premature androgenic alopecia has been suggested as a feature of the male equivalent of the syndrome of polycystic ovary. However, the hormonal pattern of men with premature balding has been investigated in only a few studies with inconsistent results.

MATERIAL AND METHODS

We examined 37 men with premature balding (defined as frontoparietal and vertex hair loss before the age of 30 years with alopecia defined as grade 3 vertex or more on the alopecia classification scale of Hamilton with Norwood modification). The plasma concentrations of total testosterone, dihydrotestosterone, epitestosterone, androstenedione, cortisol, 17-OH-progesterone (17OHP), estradiol, LH, FSH, prolactin, SHBG and TSH and free thyroxine were measured.

RESULTS

The frequency of subnormal values in SHBG, FSH, testosterone and epitestosterone (but not in free androgen index) was significant in the balding men. A borderline significant trend was recorded with respect to increased levels in 17OH-P and prolactin.

CONCLUSIONS

The hormonal pattern of a substantial number of men with premature balding resembles in some respects the hormonal pattern of women with polycystic ovary syndrome.

Solitary intracranial metastasis of follicular carcinoma of the thyroid gland clinically mimicking a meningioma

We describe a rare case of solitary metastasis of follicular carcinoma of the thyroid gland into the petroclival region in a 58-year-old woman. The metastasis was the first and only manifestation of the disease. The histology of the tumor, differential diagnosis and clinical course are discussed. In a few similar cases described so far the tumor was always a well or moderately differentiated follicular carcinoma located in the petroclival region. As in this presentation, these cases also clinically mimic a meningioma. The differential diagnosis includes adenoma of the thyroid gland and thyroid gland dystopia. We demonstrated the primary focus of carcinoma within the thyroid after its detailed examination initiated by our finding. The clinical outcome of such rare cases is usually excellent, much better than in metastases of papillary carcinoma into the brain.

History of upper extremity replantation in the Czech Republic and worldwide

Replantation surgery is a specialization in plastic surgery which, in comparison with other disciplines, has a relatively short history of only forty years. Replantation surgery developed due to experience with macrovascular anastomosis and to the evolution of the operative microscope, special micro-instruments and ultra delicate suturing material. Due to these advances, it is possible to implement anastomosis of blood vessels with a diameter smaller than 1-2 mm. Each of the three pillars of microvascular surgery has its own history. This work outlines their use and the contribution of each to the development of microsurgery. Finally, it compares the development of replantation surgery in the Czech Republic and worldwide within a specific time frame.

What may be the markers of the male equivalent of polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS), the most common endocrinopathy in women (with a prevalence of 5-10 %), is characterized by hormonal and metabolic imbalance. Complexity of symptoms of close relatives of women with PCOS and genetic autosomal trait initiated a hypothesis about the existence of a male equivalent of PCOS. Premature alopecia was suggested as one of the signs of a male phenotype of this syndrome. The present study investigated a group of 30 men, in which premature hair loss started before 30 years of age. In all patients, their hormonal profile was determined. It was possible to form two subgroups. The first one showed similar hormonal changes as women with PCOS, the other had either no anomalies in steroid spectrum or just only lower level of sexual hormones binding globulin (SHBG). Both subgroups did not differ in either BMI or age. In all men with premature alopecia insulin tolerance test was also carried out and the occurrence of allele 3 INS VNTR was investigated, which is one of the candidate genes for PCOS. The subgroup with hormonal changes resembling those of women with PCOS showed a significantly higher insulin resistance than the group without these changes. About one third of the premature balding men showed the combination of hormonal shifts and higher insulin resistance. This frequency corresponds to the prevalence of PCOS in women. There was no significant difference between the two subgroups in the occurrence of allele 3 INS VNTR.

Reconstruction of maxilla alveolus for application of dental implant in patients with cleft defect

The prospective study of dental implant application into the reconstructed maxilla alveolus of cleft patients was started in 2001. Its aims are to specify precisely the indications, conditions and techniques, as well as the factors justifying the assumption that the results will be successful. Indication was based on an examination by a multidisciplinary therapeutic team (plastic surgeon, dental surgeon, orthodontist, and prosthetist), with the proviso that the patient should have a positive approach. Successful orthodontic treatment of intergnathic relation and shape of the dental arches served as the basis. It was followed by a reconstruction of the defective alveolus using autologous cancellous bone grafts, harvested from an iliac crest. Dental implants were inserted 12-15 weeks after the transplantation and subsequently a prosthetic component was applied with a time delay of at least 2 months. After the orthodontic preparation, reconstruction of the alveolus has so far been performed in 38 patients. Their age was at least 14 years, i.e. the age when growth of the orofacial region was finalised or already complete. The crucial tasks at this stage are to form a stable, three-dimensional voluminous alveolar crest, and to cover the grafts with a sufficient amount of quality soft tissue. We needed an average amount of 3.7 ccm of cancellous bone graft for the reconstruction. This amount can be harvested only from an enchondral bone. For soft tissue shell the mucoperiosteal shift of flap from cleft segment was used. In more serious cases contralateral or even bilateral shift was performed. The relief of tissue tension was performed by double cut-back. Using the approach described we attained a 84.2% success rate. Our results and experience derived within this project show that the success rate of this procedure depends on the continuous flow of the alveolar arch with a good intergnathic relation, with a length of defect between crowns of border teeth of at least 8 mm. The original osseous walls of the defect must definitely be of suitable height. On-lay augmentation does not work in these cases. A subsequent pitfall lies in resorption of transplanted bone, which may be reduced due to an early load by a dental implant. During the three months after the reconstruction a spongy osseous graft matures enough to ensure the primary stability of a fixture. We emphasise the necessity of close co-operation of the therapeutic team in such cases.

[Diagnosis of lymphoproliferative diseases from bone marrow biopsies]

The cytological, histological and immunophenotypical markers of lymphoproliferative diseases are evaluated in the collection of 950 trepanobiopsies, and correlated with types of extramedullary malignant lymphoma. The diagnostic significance of tumor infiltrates topography and basic rules of the differential diagnoses of malignant lymphomas in the bone marrow biopsies are discussed.

Rhinomanometry in patients with a cleft deformity of the nose

A typical cleft deformity of the central facial area is very frequently associated with impaired patency of the nose. Rhinomanometry makes it possible to assess objectively and quantitatively the patency of these airways. For objective assessment of the disorder this examination was made closely before secondary rhinoplasty in 36 patients with complete unilateral (81%) or bilateral cleft (19%). Using the method of active anterior rhinomanometry, values of nasal flow and nasal resistance were assessed. Subsequently the degree of obstruction of the nasal airways and the lateral ratio of the nasal flow were evaluated. The mean value of the total nasal flow was 239.9 cm3/s, and the mean value of nasal resistance for individual nasal vents was 3.55. The results were compared with normal values according to Bachmann. It was revealed that patients with clefts suffer in 88% of casesfrom significant obstruction of the nasal airways and In the remaining 12% of cases from mild obstruction. The lateral ratio can be evaluated as normal only in 19% and 14% of patients with unilateral and bilateral clefts respectively. Although the great majority of patients ask for secondary correction because they want to improve their appearance, It is an advantage to express objectively the functional disorder of nasal patency before surgery--thus defining the indication more accurately--and to explain to the patient the possible benefit of the operation.

[Intra-abdominal desmoplastic small-cell tumor of the peritoneum]

The authors described three cases of intraabdominal desmoplastic small round cell tumour of the peritoneum (IDSRT). In one case the patient was a woman, and in the other two men. The age ranged from 20-29 years. Common of all the cases was a rapid onset of clinical symptoms during the period of twelve to eighteen months. In one case, a 22-year-old woman presented with a symptomless course of disease documented by medical examination one month ago. Intensive chemotherapy was applied but two patients died of generalisation. The 22-year-old woman is alive but with clinical evidence of generalisation in the abdominal cavity. The "classical" type of IDSRT was found in all the cases. Sharply demarcated groups of tumour cells of different size were surrounded by dense fibrous stroma. In some regions desmoplastic areas prevailed. In one case the tumour consisted of round and oval cells resembling a lymphoma. In the other two cases, the slightly elongated cells were present. Immunohistologically, the small round cells were positive for cytokeratins with antibody AE1-AE3. Membrane and dot-like paranuclear positivity were found. In 2 cases the reaction to desmin was seen in a dot-like paranuclear distribution, whereas the reaction to smooth muscle actin (MSA) was negative. In all the cases positivity to vimentin and neuron specific enolase (NSE) were apparent. Negative reactions were found for WT-1 antibody in all three cases. In one of the cases the RT PCR reaction for chimeric gene EWS/WT1 was performed, and found to be negative. Many different tumour types, such as lymphoma, Ewing sarcoma/PNET, neuroblastoma, alveolar rhabdomyosarcoma, malignant mesothelioma must be excluded. Cytogenetic examination should be performed on tumours with a "non-typical" histological pattern and uncommon immunohistological examinations.

[Complications of axillary dissection in breast carcinoma ]

OBJECTIVE

The objective of the work was to evaluate the incidence and type of postoperative complications after radical exenteration of the axilla in conjunction with an implemented surgical operation.

DESIGN

Retrospective clinical study.

SETTING

Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital Prague, Apolinárská 18, Prague.

METHOD

The authors made a retrospective analysis of postoperative complications in 116 selected patients, who underwent partial breast surgery or ablation of the breast with dissection of the axilla at the Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital in Prague in 1994-2000 on account of breast cancer stage I and II according to FIGO. The group comprised patients where radiotherapy or chemotherapy of the axilla was not used. The patients were at least 12 months after operation without signs of locoregional relapse of the disease and in the dissected axillary tissue at least 10 lymph nodes were found. The operations were implemented by nine different surgeons. Early (infection, seroma, haematoma) as well as late (oedema, paraesthesia, stiffness, pain, weakness of the upper extremity) complications were also evaluated. The authors compared the incidence of complaints in relation to age, the number of dissected nodes and extent of the breast surgery. The statistical significance of the phenomena was evaluated by Fisher's exact test.

RESULTS

At least one complication was recorded in 65% of the patients. In early complications (haematoma, infection, seroma) neither the correlation with the patient's age nor with the number of removed nodes was significant. There was a statistically significant relationship (P < 0.05) between the incidence of infection and the extent of the breast surgery which probably was associated with the wound area. As to late complications (oedema, paraesthesia, stiffness, pain and weakness of the upper extremity) a significant relationship was found with lower painfulness in patients above 55 years (P < 0.05) and lower sensation of weakness and paraesthesias in patients with partial breast operations (P < 0.05). The more frequent complaints of younger patients were probably due to their greater everyday physical activity as compared with older women. The higher number of subjective complications in patients after ablation of the breast is explained not only by the size of the wound area but also by psychosocial reasons.

CONCLUSION

Dissection of the axilla is part of standard surgical treatment of breast cancer. The surgical operation without radio- or chemotherapy is associated in 65% cases with long-term morbidity of the patients. With regard to the shift of diagnosis of breast cancer to earlier stages it is important to seek a less invasive staging method which will reduce the patient's morbidity. The sentinel node biopsy method seems perspective.

The role of plastic surgery in the complex treatment of breast tumours (review of indications and operations)

The indications and possibilities of plastic surgery are detailed for the treatment of benign and malignant breast tumours and precancerous. The necessity of perfect surgical technique and results is emphasized with regard to the somatopsychosocial response of these operations.

Advantages and disadvantages of endoscopically assisted front-lift

Reduced surgical risk, a diminution of visible scars, rapid recovery, long-termed results and reduced costs are at present the most important demands on development in aesthetic plastic surgery. Endoscopically assisted front-lift meets perfectly the need of reduced invasiveness. It is technically simple and associated with a minimum of complications. It brings minimal scars beyond the hairline with a favourable effect after eliminating the drop of the brows, and wrinkles on the forehead. The duration of the effect in the aging face depends, however, similarly as other methods, on the characteristics of the skin, changes in other parts and the individual disposition. A marked disadvantage is the high initial, cost of special equipment. Their recovery ensues from the reduced time of surgery, reduced consumption of material, lower number of complications and more rapid return to normal life.

[Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) leading to the diagnosis of Wilson's disease]

Authors describe the case of a patient suffering from Thrombotic Thrombocytopenic Purpura--Hemolytic-Uremic syndromee. Any cause of the disease was not found, except signs of liver injury. The etiology of indefinite liver disease that had been diagnosed several years before was examined. Wilson's disease was considered as a final eventuality. The finding of 488 micrograms of copper in the dry liver tissue confirmed the diagnosis of Wilson's disease in the end.

[Risks in hysteroscopy in patients with endometrial carcinoma--a prospective clinical study]

OBJECTIVE

The evaluation of the risk of hysteroscopy (HSC) in patients with endometrial carcinoma with regard to the dissemination of disease and the deterioration of its prognosis.

DESIGN

A prospective multicentric study.

SETTING

Department of Obstetrics and Gynaecology and Institute of Pathology of the Palacky Univerzity Medical School and University Hospital, Olomouc; Obstetrical and Gynecological Departments of collaborating hospitals.

METHODS

Two groups of patients with endometrial carcinoma were compared on the basis of cytological examinations from the peritoneal cavity. The study group (n = 156) consisted of patients whose diagnosis was made on the base of HSC and targeted biopsy. The control group (n = 71) included patients with the classical D&C. Both groups were comparable as to the distribution of clinical stages of the disease (P < 0.05). Cytological examinations were performed from the fluid obtained by the puncture of the cul de sac at the end of the HSC procedure and from the peritoneal lavage at the beginning of the following operation. Results of both groups were compared and statistically evaluated.

RESULTS AND CONCLUSIONS

The comparison of the cytological findings from the punctures of the cul de sac after the HSC and from the lavages at the following operation did not show an increased penetration of malignant cells from the uterus into the abdominal cavity. Similarly, the comparison of cytological findings from the peritoneal lavages after HSC and probatory curettage did not show a statistically significant difference between both groups. We assume that HSC does not increase the risk of dissemination of tumour cells into the peritoneal cavity and does not deteriorate the prognosis of the disease.

Spindle cell myoepithelial tumours of the parotid gland with extensive lipomatous metaplasia. A report of four cases with immunohistochemical and ultrastructural findings

We report four cases of parotid gland tumours composed predominantly of spindle-shaped myoepithelial cells and mature adipocytes. The central portion of one tumour showed extensive adipose differentiation, whereas in the peripheral parts there were small foci of ductal epithelium arranged in cords and tubules within an abundant myxoid stroma. The other cases were adipose spindle cell myoepitheliomas without an obvious glandular component. Under high-power examination, a transition between modified spindle-shaped myoepithelial cells and adipocytes was observed, and this was confirmed with immunohistochemistry. Ultrastructurally, the modified myoepithelial cells showed intracytoplasmic tonofilaments, bundles of actin microfilaments and lipid droplets. A possible pathogenesis is proposed of true metaplastic transformation of myoepithelial cells to adipocytes. This lesion is important to identify correctly, as inadequate surgery can lead to recurrence.

Peri- and post-operative course of cytokines and the metabolic activity of neutrophils in human liver transplantation

Peri- and post-operative (up to day 7 after surgery) neutrophil chemiluminescence and the plasma concentrations of interleukin 6 (IL-6), IL-8, IL-10 and tumour necrosis factor alpha (TNF-alpha) were evaluated in the blood of patients undergoing liver transplantation. IL-6, IL-8 and IL-10 levels increased during early reperfusion and then returned to normal mostly within the first post-operative day. TNF-alpha was increased during the whole period observed. Spontaneous as well as activated neutrophil chemiluminescence was depressed in early reperfusion and remained low during the whole period followed. Samples collected during early reperfusion provided positive correlation for IL-6 vs IL-8 as well as for IL-6 and IL-8 vs chemiluminescence. The data were also evaluated with respect to the outcome of transplantation. Since IL-8, IL-10 and TNF-alpha levels increased significantly during the first post-operative week, mainly in a group of patients who developed serious complications within the first month after surgery, we proved a connection between peri- and early post-operative induction of cytokine release and the outcome of liver allograft transplantation.

Breast reconstruction as an integral part of breast carcinoma therapy (a self-present final report of a research project IGA MZ CR)

This comparative prospective study elucidates whether breast reconstruction that is not associated with systemic oncological treatment may trigger a tumour relapse, and if there is any difference between the evaluated reconstruction methods, a simple procedure using an implant versus a TRAM flap, on this hypothetical influence. The study group of 95 patients suffered from stage I-II of breast carcinoma. As regards the available reconstruction procedures, the study group was divided into two subgroups, the first using an implant (n1 = 33) and the second using a TRAM flap (n2 = 62). All oncological problems manifesting during the subsequent 12 months were considered as a response to the reconstruction. The oncological course was compared with two control groups. The first control group (k1 = 82) corresponded to the study group in terms of tumour stage (I-II), average age, time of initial diagnosis, type of primary surgery, i.e. mastectomy with axilla exenteration, and subsequent oncological treatment. The second control group (k2 = 19,625) was based on the National Oncology Register data. It was formed from all patients with breast carcinoma stage I-II from 1985-1994. The disease development in terms of the relative number of relapses and deaths was compared to the number of healthy and living patients, respectively, in the preceding year. The working hypothesis of late breast reconstruction (i.e. not associated with oncological treatment) being a possible trigger effect on the subsequent course of breast cancer has not been confirmed. No statistically significant differences at the 5% significance level were found between individual reconstruction methods and control groups in terms of the number of local relapses and survival length.

Immunohistochemical analysis of the functional status of estrogen receptor cascade in breast cancer

Hormone receptor expression in human breast cancer cells does not always reflect tumor response to therapy. Thus, relations between hormone receptor status and other parameters need further examination. The aim of this study was to test the ability of estrogen receptors (ER) to induce progesterone receptor (PR) synthesis as well as to test their role in the regulation of cell proliferation. Measurement of the relation between expressions of ER and the estrogen receptor related protein p29 (ERRP) was a further goal. The results show that some hormone receptor phenotypes are closely related to tumor proliferative activity: in the ER-group, especially ER-PR-phenotype, proliferative activity shows no obvious relationship to phenotype status, suggesting that proliferation in this group probably is not under estrogen control, while in the ER+ group, PR expression was related to reduced proliferation. There was no clear association between ERRP and nuclear ER but the highest ERRP expression was most closely related to ER negative (ER-) or slightly positive (ER +/-) hormone receptor statuses. Tumors with these phenotypes are known to have a poorer prognosis. The conclusion drawn is that simultaneous estimation of proliferative activity, ERRP p29 expression and a comparison with ER/PR hormone receptor phenotype, could provide pathologist with a valuable tool for predicting hormone response and prognosis in breast cancer patients.

Capsular contracture in augmentation mammaplasty

In a group of 331 augmentation mammaplasties performed at the Clinic of Plastic Surgery in Prague from 1994-1998, capsular contracture was recorded in 6% cosmetic and 12% of reconstruction operations. The main cause was, in particular, the quality of tissue surrounding the implants along with individual disposition. The incidence of this complication did not differ significantly in relation to the placement of the prosthesis beneath the muscle or gland. Based on histological analysis and the clinical finding, it is obvious that disintegration of the prosthesis does not always lead to severe grades of capsular contracture. It is despite the presence of foreign bodies in the connective tissue.

[Large volume tumors with uncertain biological activity located in the pleural cavity]

The authors discuss specific problems of an exact diagnosis and indication for surgical treatment in patients with large tumours in the pleural space. Our series includes even some rare tumours of varied histogenesis. The biological activity of those tumours is frequently uncertain and causes an unpredictable prognosis. The prognostic conclusion is based on a bioptic diagnosis, established by histological examination. Complete extirpation is essential.

Bioceramics as an option in correction of facial skeleton deformities

The removal of certain deformities of facial bones is a prerequisite to a restoration of function, stability, and appearance. Synthetic bone substitutes are beneficial in cases where other operative technique would represent an inadequate burden for a patient. A result is achieved in one surgical intervention with low costs and low demands on technical equipment. Biocompatible nonresorbable glass-ceramics based on oxyfluoroapatite and wollastonite presenting osteoconductivity permits osteointegration, i.e., direct physicochemical bonds between live bone tissue and the implant without formation of a fibrous capsule. It presents better durability to stress in simulated body fluid than the usually used hydroxyapatite. It was used for restoration of facial skeletal framework contour in 14 cases under conditions where prior solutions were doubtful. Good results were reached in all patients. The mean time of observation was 18 months. During that period, the rate of complications was 14.3%. This approach may be found to be a suitable technique, especially for patients exhausted by prior unsuccessful treatment but still not acquiesced in a result.

Suction lipectomy

Suction lipectomy is a very effective and safe method, if performed by an experienced plastic surgeon. The authors demonstrate using a group of 284 patients operated on at the University Clinic of Plastic Surgery in Prague between 1994-1998, indications, the method and complications.

Is there a borderline between reconstructive and aesthetic surgery?

Plastic and reconstructive surgery is frequently mistaken for aesthetic and cosmetic surgery. At present, plastic surgery is a very broad discipline in which aesthetic surgery is an integral part. The majority of reconstructive operations, in particular on the body surface, include an aesthetic component. Their purpose is not only the restoration of function but also the achievement of optimal aesthetic results. The authors demonstrate examples on the vague borderline between functional and aesthetic reconstruction and present their views on the medical indication for these operations.

Orally administered proteases in aesthetic surgery

Increasing demand for shortening the sequel period after aesthetic surgery has led to comparative testing of optional approaches. Systemic enzyme therapy with its pharmacological effects represents a preventive and curative option for inflammatory process including healing. Excellent results were presented, namely, in the treatment of secondary lymphoedema. The incidence of hematoma, edema, and pain was followed, and the results were compared in a randomized group of 20 patients with upper eyelid blepharoplasty treated with proteases (Wobenzym drg) and in a similar group treated with systemic antiedema and hemostyptic therapy (Dicynone drg and Reparil drg). No undesirable side effects were observed. In addition, proteases apparently have no limitation for patients with the risk of concurrent cardiovascular, hepatic, or renal diseases.

Total antioxidant capacity of serum increased in early but not late period after intestinal ischemia in rats

The ischemia of small intestine was induced in anesthetized Wistar rats by occluding the superior mesenteric artery for 45 min and then the reperfusion was set. Serum samples were obtained at the end of the ischemic period and also during early (1 to 4 h) and late postischemic period (1 to 4 d). The total antioxidant capacity (TRAP) of serum samples was evaluated using luminol enhanced chemiluminescence. The increased mobilization of phagocytic cells and the release of reactive oxygen species into the circulation was observed from the first and second hour of the postischemic period, respectively. Nevertheless, the activity of natural antioxidant mechanisms of serum was already elicited at the end of the ischemic period. Furthermore, the TRAP of serum increased with the increasing duration of early postischemic period. Among the antioxidants studied, urate and ascorbate concentrations exerted the highest correlation with TRAP, but 31.6% of the total antioxidant capacity remained for the activity of an unidentified antioxidant(s). After being exhausted, the TRAP of serum oscillated around the preoperation level at days 1-4 of the postischemic period. The increase in total antioxidant capacity of serum induced by oxidative stress was sufficient to prevent lipoperoxidation both in serum and intestinal tissue.

[Hodgkin's disease with epithelioid granulomatous reaction]

Hodgkin's disease with a conspicuous presence of epithelioid-histiocytic elements was described as a particular subvariant of mixed type Hodgkin's disease. The authors presented four new cases. An additional increase of Langerhan's and interdigitating cells was observed in two cases, sarcoidosis-like granulomas with epithelioid and big multinucleated cells in the third. This female died and granulomas were found in several other organs. A prognostic relevance of this conspicuous reaction has not been clear for the time being. The mentioned patient deceased one year after the diagnosis had been settled, other three patients have been clinically well surviving 2-5 years.

Leukocyte mobilization, chemiluminescence response, and antioxidative capacity of the blood in intestinal ischemia and reperfusion

Intestinal ischemia and reperfusion elicits changes in leukocyte counts and increased production of reactive oxygen species (ROS). The purpose of this study was to investigate whether these changes were followed by and/or connected with changes in the extracellular antioxidative capacity in a rat superior mesenteric artery (SMA) occlusion/reperfusion model. The SMA was occluded for 45 min and then allowed to be reperfused. Changes of leukocyte, polymorphonuclear (PMN), and lymphocyte counts, chemiluminescence (CL) of whole blood samples as a marker of ROS production, and the total antioxidative capacity of the serum were quantified at the end of ischemia and in 1 h intervals during the postischemic period up to 4 h. The myeloperoxidase (MPO) activity in the serum and intestinal tissue samples was also determined. The MPO activity in the intestinal tissue samples was significantly elevated at the end of ischemia, and this elevation lasted for the whole postischemic period. The oxidative challenge to the body induced a fast mobilization of extracellular antioxidative mechanisms already at the end of ischemia, which was followed by a significant increase in PMN counts and whole blood CL starting at the 2nd hour after reperfusion. The increased CL activity of whole blood was attributed to the increase of the circulating PMNs. No significant changes were observed in leukocyte and lymphocyte counts. It is concluded that compensatory mechanisms of the oxidative-antioxidative balance of the body react very quickly if challenged.

Determination of phagocyte activity in whole blood of carp (Cyprinus carpio) by luminol-enhanced chemiluminescence

In this study, the phagocytic capacity of fish peripheral blood leucocytes was studied using the luminol-enhanced chemiluminescence (CL) method. Suspensions of rice starch (1%) or opsonized zymosan particles-OZP (0.2%) were used as activators. The level of CL was detected at 25 degrees C in various whole blood volumes (100, 50, 20 a 10 microliters) during the mixed or unmixed measurement mode. The peak of CL in all starch-activated samples was between 2.0-4.0 mV, regardless of blood volume or a mode of measurement. Similar results were obtained for OZP activated CL when measured in the mixed mode. On the other hand, the peak of OZP activated CL in unmixed samples was much higher and it showed positive correlation with the increasing volume of blood in a sample. In contrast, no significant differences between the reaction curve areas were found for different blood volumes. After correction for phagocyte number the highest CL activity per cell was observed in the samples containing 10 microliters of blood. It can be concluded that 10-20 microliters of blood are optimal volumes for the measurements of respiratory burst activity in the whole blood of carp and opsonized zymosan particles should be used as an activator. At the same time, the unmixed mode of measurement seems to give better results than the mixed one.