Foodborne outbreaks surveillance in hospitals and nursery homes: investigation on catering data

Background

Healthcare associated foodborne outbreaks (HA-FBO) can result from exposure to contaminated food in premises where highly vulnerable patients are cared, including hospitals and nursery homes. The probability of developing severe foodborne diseases such as invasive listeriosis is much higher for susceptible populations. There is limited knowledge on the data on food exposures that could be used to investigate HA-FBOs. There is also lack of data relating to specific policies in the health facilities aimed to prevent the administration of potentially risky foods, possibly bringing them from home.

Methods

This study was in the framework of One Health EJP Project NOVA. A semistructured questionnaire was administered to 4 general hospitals, 1 specialist clinic and 3 nursing homes located in the Abruzzo and Molise regions, Italy. The questionnaire included 25 questions in 3 sections (I. General organization of the catering service; II. Food menu data; III. Food from home).

Results

In most facilities (75%) external catering companies used in-house kitchens. Trace-back of food to individual patients was possible in 5 premises out of 8 (62.5%), but only in 1 nursery home out of 3 (33.3%). Data were collected in electronic format (hospitals) or paper (nursery homes) and stored 1-12 months. Food at risk of Listeria monocytogenes were not excluded from the menus, such as pre-sliced cooked meat products (served in 4 out of 8 premises, 50%), smoked fish (20%), soft cheese (20%). The consumption of food brought from home was possible in “special occasions”, mostly in the nursery homes (66.6%).

Conclusions

In case of HA-FBO it could be difficult to trace back the food particularly in the nursery homes where food data are not individually collected and usually on paper. More studies are needed in order to understand the effective exposure to foodborne pathogens, given that some types of foods considered by EFSA as at high risk of microbial contamination are commonly served.

Key messages

Served food could not be traced back to the patient mostly in nursery homes. Foods at risk of Listeria monocytogenes contamination are commonly served to patients and residents.

The NADPH oxidase NOX2 as a novel biomarker for suicidality: evidence from human post mortem brain samples

Recent evidence points towards a role of oxidative stress in suicidality. However, few studies were carried out on the sources of reactive oxygen species (ROS) in subjects with suicidal behaviour. We have previously demonstrated that the NADPH oxidase NOX2-derived oxidative stress has a major role in the development of neuropathological alterations observed in an animal model of psychosis. Here, we investigated the possible increase in NOX2 in post mortem brain samples of subjects who died by asphyctic suicide (AS) compared with controls (CTRL) and subjects who died by non-suicidal asphyxia (NSA). We found that NOX2 expression was significantly higher in the cortex of AS subjects than in the other two experimental groups. NOX2 immunostaining was mainly detected in GABAergic neurons, with a minor presence of NOX2-positive-stained cells in glutamatergic and dopaminergic neurons, as well as astrocytes and microglia. A sustained increase in the expression of 8-hydroxy-2'-deoxyguanosine, an indirect marker of oxidative stress, was also detected in the cortex of AS subjects, compared with CTRL and NSA subjects. A significant elevation in cortical interleukin-6 immunoreactivity in AS subjects suggested an involvement of cytokine-associated molecular pathways in NOX2 elevations. Our results suggest that the increase in NOX2-derived oxidative stress in the brain might be involved in the neuropathological pathways leading to suicidal behaviour. These results may open innovative insights in the identification of new pathogenetic and necroscopic biomarkers, predictive for suicidality and potentially useful for suicide prevention.

Value of real-time gastric juice analysis in upper gastrointestinal endoscopy

AIM

Esophagogastroduodenoscopy (EGDS) cannot identify microscopic lesions. We determined the contribution of real-time gastric juice analysis in detecting lesions non-detectable with the simple endoscopic inspection.

METHODS

Endoscopy, histology and gastric juice analysis were performed in 216 patients. We assessed six diagnostic strategies: EGDS (strategy-1), EGDS with antral biopsies (hematoxylin-eosin staining) in hypochlorhydrics (strategy-2) or all patients (strategy-3), EGDS with antral and fundic biopsies (hematoxylin-eosin staining) in hypochlorhydrics (strategy-4) or all patients (strategy-5), EGDS with antral and fundic biopsies (hematoxylin-eosin + immunohistochemical staining) in hypochlorhydrics (strategy-6). Then, we determined how many of the pathological conditions identified by the complete histological evaluation would have been detected by each strategy.

RESULTS

In total, 220 pathological conditions were identified. Hypochlorhydria was correlated (r=0.67; P<0.01) with histological lesions (85% lesions were detected in hypochlorhydrics) and high ammonium levels, with H.pylori infection (r=0.69; P<0.01). Strategy-1 identified only 5% conditions, while strategies 3 and 5 detected 68.6% and 83.2% conditions, respectively. Strategies 2, 4 and 6 (based on gastric juice analysis) yielded detection rates (61.4%, 75.5%, 90.9%) similar to or better than those of strategies 3 and 5.

CONCLUSION

Real-time gastric juice analysis provided information about the presence of gastric lesions in an otherwise "normal" stomach at EGDS. It improved the diagnostic yield and optimized resource utilization without any additional effort by the endoscopist.

Functions of TAp63 and p53 in restraining the development of metastatic cancer

Many tumours harbour mutations in the p53 tumour-suppressor gene that result in the expression of a mutant p53 protein. This mutant p53 protein has, in most cases, lost wild-type transcriptional activity and can also acquire novel functions in promoting invasion and metastasis. One of the mechanisms underlying these novel functions involves the ability of the mutant p53 to interfere with other transcription factors, including the p53 family protein TAp63. To investigate whether simultaneous depletion of both p53 and TAp63 can recapitulate the effect of mutant p53 expression in vivo, we used a mouse model of pancreatic cancer in which the expression of mutant p53 resulted in the rapid appearance of primary tumours and metastases. As shown previously, loss of one allele of wild-type (WT) p53 accelerated tumour development. A change of one WT p53 allele into mutant p53 did not further accelerate tumour development, but did promote the formation of metastasis. By contrast, loss of TAp63 did not significantly accelerate tumour development or metastasis. However, simultaneous depletion of p53 and TAp63 led to both rapid tumour development and metastatic potential, although the incidence of metastases remained lower than that seen in mutant p53-expressing tumours. TAp63/p53-null cells derived from these mice also showed an enhanced ability to scatter and invade in tissue culture as was observed in mutant p53 cells. These data suggest that depletion of TAp63 in a p53-null tumour can promote metastasis and recapitulate-to some extent-the consequences of mutant p53 expression.

Perendoscopic real-time assessment of pH improves detection of gastric preneoplastic conditions

AIM

Gastric juice may constitute a precious source of clinicopathological information. We assessed the usefulness of real-time, perendoscopic, gastric juice pH determination in identifying preneoplastic conditions of the stomach, that often escape the mere endoscopic evaluation.

METHODS

The study included 245 patients (115M; 130F; age 47±17). In each of them perendoscopic gastric juice pH was assessed by means of an innovative device, the Endofaster, and the results were correlated with histological evaluation (H&E, immunohistochemistry, argyrophil stains), and gastric acid secretion (BAO-PAO), and serum gastrin levels. The conditions evaluated were: atrophy, intestinal metaplasia, endocrine cell hyperplasia, hypergastrinemia.

RESULTS

A total of 136 pathological conditions were detected and these resulted to be correlated with pH (r=0.67; P<0.01). The rate of pathological conditions was low in normochlorhydric patients (14.1%); most of these conditions were concentrated in patients with hypochlorhydria (85.9%) (P<0.001). Specifically, the number of patients with one or more pathological conditions increased proportionately with the rise in pH levels. An inverse correlation was detected between gastric juice pH and basal acid output (BAO) (r=-0.72; P<0.01). Endoscopic feature was normal/mild in most of patients with pathological conditions.

CONCLUSION

Hypochlorhydria is a sensitive indicator of gastric risk conditions. Perendoscopic real-time assessment of pH can improve and extend optical analysis by allowing the detection of pathological conditions (either preneoplastic or not) that often escape diagnosis because not correlated with specific endoscopic pattern.

Senescence and aging: the critical roles of p53

p53 functions as a transcription factor involved in cell-cycle control, DNA repair, apoptosis and cellular stress responses. However, besides inducing cell growth arrest and apoptosis, p53 activation also modulates cellular senescence and organismal aging. Senescence is an irreversible cell-cycle arrest that has a crucial role both in aging and as a robust physiological antitumor response, which counteracts oncogenic insults. Therefore, via the regulation of senescence, p53 contributes to tumor growth suppression, in a manner strictly dependent by its expression and cellular context. In this review, we focus on the recent advances on the contribution of p53 to cellular senescence and its implication for cancer therapy, and we will discuss p53's impact on animal lifespan. Moreover, we describe p53-mediated regulation of several physiological pathways that could mediate its role in both senescence and aging.

Extraction, characterization and in vivo neuromodulatory activity of phytosterols from microalga Dunaliella tertiolecta

In recent years, a great deal of research has been devoted to identify new natural sources of phytosterols and to improve methods for their recovery and purification. In this regard, unexplored natural sources of bioactive ingredients are gaining much attention since they can lead to the isolation of new compounds or bioactivities. The field of available natural sources has been further increased by including algae and, even more interestingly, microalgae. In the present study, a multidisciplinary approach has been used considering, in an integrated view, extraction, chemical composition and bioactivity of phytosterols from the microalga Dunaliella tertiolecta. A novel methodology to extract, separate and characterize microalgal-derived phytosterols has been developed. In addition, recoverable and reusable eluents have been selected in order to reduce the quantities of employed organic solvents. Finally, we addressed the question whether orally administered phytosterols reach the brain and if those interfere with the major neurotransmitter systems, such as the dopaminergic, serotoninergic and noradrenergic ones, in several brain areas of rats. Flash Liquid Chromatography has been used to separate the Total Sterol (TS) fraction, composed of twelve sterols, with a purity of 97.87% and a recovery percentage of 98%, while the "flash version" of Silver Ion Liquid Chromatography has been used to purify the most abundant phytosterols in TS, (22E,24R)- methylcholesta-5,7,22-trien-3β-ol (ergosterol) and (22E,24R)-ethylcholesta-5,7,22-trien-3β-ol (7-dehydroporiferasterol), with a purity of 97.4%. These two combined methods did not need sophisticated technologies but only cheap laboratory supplies. Moreover, the possibility of recovering and recycling the solvents used as eluents made it a cleaner process. Finally, for the first time, a neuromodulatory action of Dunaliella tertiolecta-derived phytosterols has been found in selective brain areas of rats.

Soluble beta amyloid(1-42): a critical player in producing behavioural and biochemical changes evoking depressive-related state?

BACKGROUND AND PURPOSE

Depression is common in early phases of Alzheimer's disease (AD) and may represent prodromal symptoms of dementia. Recent reports suggest that early memory deficits and neuropsychiatric symptoms are caused by soluble rather than aggregated betaamyloid (Abeta). Thus, we investigated the effects of soluble Abeta(1-42) on working memory and depressive/anxiety-related behaviour in rats and on 5-hydroxytryptaminergic neurotransmission and neurotrophin content in various brain regions.

EXPERIMENTAL APPROACH

Behavioural reactivity to novel object recognition, open field, elevated plus maze and forced swimming test were assessed 7 days after i.c.v. injection of Abeta(1-42) or its vehicle. BDNF (brain-derived neurotrophic factor) and NGF (nerve growth factor) mRNA and protein levels and 5-hydroxytriptamine (5-HT) content were measured in the prefrontal cortex (PFC), striatum (STR) and nucleus accumbens (NAc).

KEY RESULTS

Abeta(1-42) did not affect the ability to distinguish between familiar and novel objects, but Abeta-treated rats exhibited an increase in forced swimming immobility. No differences were revealed between experimental groups in the elevated plus maze test or in self-grooming (evaluated in the open field). In the PFC, but not STR or NAc, Abeta-injected rats exhibited a selective reduction in 5-HT content, BDNF and NGF expression.

CONCLUSIONS AND IMPLICATIONS

Our data suggest that soluble Abeta-treated rats have a depressive, but not anxiogenic-like, profile, accompanied by brain region-dependent alterations in the expression of neurotrophins and 5-hydroxytryptaminergic neurotransmission. Hence, these alterations induced by soluble Abeta might be sensitive indicators of early phases of AD and possible risk factors for the expression of neuropsychiatric symptoms in AD.

Counteracting effect of papaverine on morphine inhibition of gastrointestinal transit in mice

Oral papaverine has been shown to be capable of antagonizing the constipation induced by a single dose of oral morphine. The primary aim of the present study was to ascertain whether papaverine is also capable of counteracting morphine-induced decrease of upper gastrointestinal transit (UGT) after repeated parenteral administration of the opioid. We next investigated the mechanisms(s) responsible for the counteracting effect of papaverine, by analysing whether this effect was changed by pretreatment with N(G)-nitro-L-arginine methyl ester (L-NAME), dexamethasone, indomethacin or capsaicin. Papaverine, co-administered with morphine, counteracted the morphine-induced decrease in UGT in mice pretreated with morphine for 3 days but did not do so in naive animals. The counteracting effect of papaverine was antagonized by L-NAME, but not by indomethacin. In mice pretreated with both morphine and dexamethasone, papaverine failed to antagonize the effect of morphine. Capsaicin pretreatment completely abolished the effect of a single dose of morphine, the effect being partially restored by the 3 days pretreatment with morphine. In mice pretreated with both capsaicin and morphine, the UGT decrease elicited by morphine was lower than in the other experimental groups and was not modified by papaverine. Our results show that papaverine can counteract the morphine inhibition of UGT in mice repeatedly exposed to the opioid. Papaverine exerts its action through a nitric oxide synthase-mediated mechanism; this mechanism is only effective after repeated morphine administration and does not operate when capsaicin-sensitive afferent neurones are ablated.

Synthesized esters of ferulic acid induce release of cytochrome c from rat testes mitochondria

Ferulic acid plays a chemopreventive role in cancer by inducing tumor cells apoptosis. As mitochondria play a key role in the induction of apoptosis in many cells types, here we investigate the mitochondrial permeability transition (MPT) and the release of cytochrome c induced by ferulic acid and its esters in rat testes mitochondria, in TM-3 and MLTC-1 cells. While ferulic acid, but not its esters, induced MPT and cytochrome c release in rat testes isolated mitochondria, in TM-3 cells we found that both ferulic acid and its esters induced cytochrome c release from mitochondria in a dose-dependent manner, suggesting a potential target of these compounds in the induction of cell apoptosis. The apoptosis induced by ferulic acid is therefore associated with the mitochondrial pathway involving cytochrome c release and caspase-3 activation.

Real-time detection of Helicobacter Pylori infection and atrophic gastritis: comparison between conventional methods and a novel device for gastric juice analysis during endoscopy

BACKGROUND AND STUDY AIMS

Gastric juice may represent a valuable source of clinicopathological information if properly analyzed. We evaluated the reliability and clinical validity of data obtained using an innovative device (the "Mt 21-42") that analyzes gastric juice, thus allowing the identification of Helicobacter pylori infection and atrophic gastritis of the oxyntic mucosa during endoscopy.

METHODS

Validation studies were carried out to evaluate the measuring performance of the device. In addition, the H. pylori status and the presence of atrophic gastritis were assessed in 150 patients undergoing upper gastrointestinal endoscopy. In all these patients the Mt 21-42 device was used to assist endoscopy. Conventional tests (involving histology, urease testing, urea breath testing, anti- H. pylori IgG, serum gastrin, pepsinogen, intrinsic factor and parietal cells autoantibodies, vitamin B12, and folate) were also performed for comparison with the Mt 21-42 results.

RESULTS

The measuring performance of the Mt 21-42 was good; for pH, the relative percent error and the coefficient of variation were 1.9 % +/- 4.2 and 1.3 %, respectively, and for ammonium they were 0.1 % +/- 0.2 % and 2.1 %. For the detection of H. pylori infection, the sensitivity and specificity of the device (96.7 % and 94.3 %) were similar to those of the urea breath test (90.5 % and 93.3 %) and serology (87.1 % and 88.8 %), and higher than those of the urease test (78.6 % and 98.7 %; P < 0.01) and routine histology (94.3 % and 76.3 %; P < 0.05). When compared with the currently available standard methods, use of the Mt 21-42 was found to be the most sensitive technique for the detection of atrophy (94.7 % vs. 5.3 % - 47.4 %; P < 0.001); the device failed to detect the disease in only one case (5 %), whereas failure rates of 53 % - 95 % were reported with the conventional methods.

CONCLUSION

Atrophic gastritis of the oxyntic mucosa is a risky condition that often goes undetected in current clinical practice. The Mt 21-42 is an effective, useful, and desirable tool that may help to overcome this diagnostic limitation; it produces time and cost savings and also allows the detection of H. pylori infection.

Role of the cholinergic system and of apamin-sensitive Ca2+-activated K+ channels on rabbit jejunum spontaneous activity and on the inhibitory effects of adrenoceptor agonists

1. One reason why rabbit jejunum is suitable for studying the mechanisms underlying the actions of the various neurotransmitters and their interactions is its spontaneous motility. The main regulator of spontaneous motility is the cholinergic system. How the cholinergic system regulates the spontaneous activity in the rabbit jejunum and how it affects the inhibitory action of alpha- and beta-adrenoceptor agonists remains unclear. 2. We studied the influence of the cholinergic system and apamin-sensitive Ca2+-activated K+ channels on spontaneous contractions in the rabbit jejunum and on the inhibitory effects of alpha1- and beta-adrenoceptor agonists. 3. In naïve tissues, atropine (ATR, 7.4 x 10(-8) m) and tetrodotoxin (8 x 10(-8) m) almost completely inhibited - to a similar extent - the amplitude of spontaneous activity. Despite the presence of ATR or TDX, tissue contraction gradually recovered to about 50% of the baseline amplitude within 5-10 min. When ATR or TDX, respectively, were added to the TDX- or ATR-treated tissues, the recovered activity decreased weakly but significantly. After washout and a 45-min rest the contraction amplitude returned to baseline values. A further exposure to ATR or TDX reduced the contraction to a level significantly lower than the one obtained after TDX or ATR added 5 min after ATR or TDX, respectively. In preparations prestimulated for 10 min with acetylcholine (ACh), ATR abolished the TDX-resistant recovered spontaneous activity. 4. Adrenaline (ADR, 0.5-5 x 10(-7) m) and phenylephrine (PHE, 1-10 x 10(-7) m) inhibited tissue motility in naïve and in ATR- and in TDX-exposed preparations. But whereas in naïve preparations the alpha1-adrenoceptor antagonists completely antagonized inhibition induced by both drugs, in ATR- and TDX-exposed tissues they did so only partially for ADR. Agonist-induced inhibition had a rapid onset but rapidly faded; pendular movements took significantly longer to recover in ATR- and TDX-treated tissues than in naïve tissues. In tissues exposed for 2 min to ADR (0.5-5 x 10(-7) m) or PHE (1-10 x 10(-7) m), washout or addition of alpha1-adrenoceptor antagonists caused an immediate short-lasting increase in contraction amplitude. 5. Apamin (APAM, 5 x 10(-9) m) caused a rapid and persistent increase in the amplitude of contractions. It also blocked the inhibitory responses to ADR and PHE, and removed washout-induced contractions. The APAM-induced increase in the contraction amplitude correlated with the increase obtained by washing out ADR or PHE. 6. Isoprenaline (at concentrations up to 2.8 x 10(-7) m) produced no inhibitory response in naïve tissues, but it invariably blocked (at a concentration of 0.7 x 10(-7) m) the recovered spontaneous activity (and sometimes depressed muscletone) in tissues exposed to ATR or TDX. Neither propranolol (3.4 x 10(-7) m) nor APAM (5 x 10(-9) m) counteracted these inhibitory effects. 7. These results indicate that spontaneous motility in the rabbit jejunum is predominantly mediated by neuronal release of ACh and by some other unidentified neuronal activity. Released ACh inhibits myogenic activity and strongly antagonizes beta-adrenoceptor-induced APAM-insensitive inhibition but leaves alpha1 agonist-induced APAM-sensitive inhibition unchanged.

Interactions between A-9THC and capsaicin on isolated lamb bladder detrusor

A number of studies have demonstrated that capsaicin, a capsicum alkaloid, can affect isolated bladder tissue with either a relaxation or a contraction, depending on the species, by acting on VR1 receptors. In a previous work on isolated lamb detrusor, we demonstrated that capsaicin generally produces a relaxation of the tissue; this relaxation seems to be mediated by CGRP. Endogenous cannabinoids, such as anandamide, produce some of their actions by stimulating VR1 receptors and this seems to cause the release of peptides, e.g. CGRP. The aim of this work was to ascertain whether a cannabinoid, delta-9-tetrahydrocannabinol (delta-9THC), was able to interfere with the response of the isolated lamb detrusor to capsaicin. A-9THC, at concentrations between 1.6 x 10(-7) and 1.3 x 10(-6) M, displayed no activity on tissues. Instead, following delta-9THC, most of the tissues responded to capsaicin with a contraction that was abolished by atropine (9.0 x 10(-7) M). It has been reported that cannabinoids can inhibit the release of CGRP by stimulation of CB1 and CB2 cannabinoid receptors. Delta-9THC could act stimulating these receptors and thus inhibiting CGRP release and vesical relaxation. The muscle relaxing component removal could favour the contracting component, usually not active.

Effects of natural tachykinins on ovine lower urinary tract smooth muscle

1. Numerous studies have demonstrated that the urinary bladder is particularly sensitive to tachykinins; rat, rabbit and guinea pig bladders, besides human detrusor, have been the most extensively studied, whereas very little is known about most large animal detrusors. The aim of this work was to study natural tachykinin activity on the lower urinary tract of ovine to make a comparison with data obtained in laboratory animals. 2. As in other animal species, tachykinins are also able to contract ovine bladder smooth muscle. 3. The results reported in this study indicate that in ovine bladder, neurokinin 2 (NK2) receptors are expressed most. In fact, on lamb and sheep bladder neurokinin A (NKA), a NK2- almost selective peptide, was shown to be > 100% more active than the natural tachykinins kassinin (KASS) and eledoisin (ELED). Eledoisin was shown to be 50% less active than KASS, which is typical behaviour for an almost exclusively NK2 receptor population. Moreover, NK1- preferential peptides, namely substance P (SP) and physalaemin (PHYS), showed a lack of activity even when applied at high concentrations. 4. The results reported in this study show that lamb and sheep detrusor represent a good alternative model for the characterization of NK2-selective tachykinins.

Effect of an electric field on the motility of Entamoeba histolytica examined by multiple-beam interference microscopy

A recently developed multiple-beam interference microscopic technique has been used to visualize submicroscopic structures of Entamoeba histolytica and their movements in applied external electric fields. The movements were videorecorded and it was found that at low current (120 microA) pseudopods are filled with hyaline ectoplasm. At slightly higher current (about 150 microA), the amoeba stops extending the pseudopods and loosens its attachment to the surface. At higher currents (200 microA), it forms a cyst and remains immobile for a time. Before this stage is reached a narrow ring is formed around the nucleus due to alterations in the proteins to protect it.

Toxicological evaluation of commercial mineral water bottled in polyethylene terephthalate: a cytogenetic approach with Allium cepa

The aim of this study was to ascertain the possible toxicological effects of chemicals released into mineral water packaged in polyethylene terephthalate (PET) bottles. Two commercial mineral waters, bottled both in PET and glass and stored under different conditions, were examined using the Allium cepa test. The influence of the water samples on macroscopic (root length, colour and form) and microscopic (root tip mitotic index, chromosome aberrations) parameters was examined. The water samples were analysed after: (A) controlled-condition storage (no direct light exposure and 18 +/- 2 degrees C), (B) storage at 40 degrees C for 10 days, in the dark (migration test in accordance with 82/711/EEC), and (C) exposure to sunlight and varying temperatures (18-38 degrees C, mean temperature 25 +/- 3 degrees C). The two water samples bottled in PET induced cytogenetic aberrations regardless of the storage conditions. These signs of toxicity were evident even only 8 weeks after bottling, which is well within the recommended expiry date. Storage conditions were very important, as is suggested by the finding that chromosomal aberrations were particularly apparent after exposure to direct sunlight. However, as plant systems are not considered as primary screening tools by current international guidelines for mammalian systems, extrapolation of the results from this test system to other systems and, eventually, to human beings should be based on results from a battery of assays covering various metabolic pathways.

Effects of natural tachykinins on porcine lower urinary tract smooth muscle

1. The aim of our study was to ascertain the possible differences and/or similarities in natural tachykinin activity in vitro on lower urinary tract of large-sized animals as compared with data obtained in laboratory animals. 2. Besides tachykinins normally present in mammals, namely substance P (SP), neurokinin A (NKA) and neurokinin B (NKB), we tested non-mammalian tachykinins, such as eledoisin (ELED), physalaemin (PHYS), kassinin (KASS) and PG-kassinin II (PG-KASS II). 3. NKA, KASS and ELED were found to be the most potent peptides in contracting detrusor strips from porcine bladder. In particular, NKA showed a pD2 of 7.14, whereas KASS and ELED showed pD2 values of 7.20 and 7.22, respectively. The activity of NKB and PG-KASS II corresponded to 72.4 and 55.0% respectively of that of NKA. SP and PHYS activity corresponded to only 2% of that of NKA. 4. NKA (pD2 7.92) was the most active peptide in contracting bladder neck tissues as well. ELED and KASS were found to have lower, similar pD2 values (7.62 and 7.70, respectively), whereas NKB and PG-KASS II were much less active (pD2 7.12 and 6.74, respectively). Moreover, SP and PHYS showed an activity range lower than 2% of that of NKA. 5. The reported results confirm that, on pig vesical neck and detrusor, NK1 receptors represent a minority as compared with NK2 and NK3 receptors. By contrast, the presence of NK2 receptors is demonstrated by a greater potency of NKA. The presence of NK3 receptors both on detrusor and neck is evidenced by NKB activity and by results achieved with PG-KASS II.

Response to isoprenaline of rabbit detrusor muscle following exposure to 5, 8, 11, 14 eicosatetraynoic acid. Role of prostanoids on beta-adrenergic-evoked response

1. Incubation with indomethacin or ibuprofen causes a fall in basal tone and inhibits isoprenaline-evoked response in rabbit detrusor muscle strips. To ascertain whether this is due to cyclo-oxygenase inhibition, we investigated the influence on beta-adrenoceptor response of 5, 8, 11, 14 eicosatetraynoic acid (ETYA) which, unlike nonsteroidal anti-inflammatory drugs, has no action in vitro other than cyclo-oxygenase inhibition. 2. Incubation of detrusor strips with ETYA (7 or 14 microM) for 60 min significantly reduced tissue response to isoprenaline by an extent similar to that induced by indomethacin, but only slightly affected basal tone. 3. In tissues preincubated with indomethacin, the addition of PGE2 or PGE1 to restore basal tone, completely re-established isoprenaline-evoked responses. 4. Our findings in rabbit detrusor strips show that inhibition of cyclo-oxygenase and of prostanoid production is the main mechanism involved in lowered beta-adrenoceptor evoked response. 5. In addition, these findings strengthen the conviction that ibuprofen and indomethacin act largely through mechanisms other than inhibition of prostanoid production.

Response to isoproterenol of rabbit detrusor strips following exposure to NSAIDs

To ascertain whether NSAIDs affect the physiological mechanisms involved in bladder detrusor muscle motility we investigated the influence of indomethacin, ibuprofen and acetyl salicylic acid on the beta-adrenergic-evoked response in isolated male-rabbit detrusor strips. Incubation with indomethacin for 60 min significantly reduced the tissue response to isoproterenol (up to 10.8+/-4.9%), entirely abolished spontaneous contractions and caused a fall in basal tone. Ibuprofen significantly inhibited the tissue response to isoproterenol (up to 25.5+/-5.8%), abolished spontaneous contractions and caused a fall in basal tone. After the spasmogen KCl had been added to restore basal tone, the highest indomethacin and ibuprofen concentrations still significantly inhibited the isoproterenol-evoked response, indomethacin being the most active compound. Acetyl salicylic acid, at the doses used, neither inhibited spontaneous contractions nor changed basal tone whereas it significantly inhibited tissue response to isoproterenol (up to 69. 6+/-4.6%). Our findings in rabbit detrusor strips show that NSAIDs affect the beta-adrenergic-evoked response. They probably do so mainly through mechanisms other then inhibition of prostaglandin production.

Carcinoma in female urethral diverticulum: case reports and review of management

We report on 4 women ages 31 to 65 years with adenocarcinoma of urethral diverticulum. One patient presented with metastatic disease and died after refusing post-radiation surgery. The other 3 women were without evidence of disease 9 to 44 months after diverticulectomy with radiation (1) or radical surgery (2). Review of our 4 cases and 64 cases documented in the literature showed that irritative voiding symptoms and hematuria were the most common findings. A palpable urethral mass was described in only 56% of reported cases but was observed in all of our patients, with the smallest mass measuring 2 x 2 cm. Urethroscopy with biopsy is the most important diagnostic test. Aggressive treatment is appropriate in most patients, since local recurrence has been documented in 44% of those treated by diverticulectomy and/or radiation.

Multiple penile horns: case report and review

We report a case of unusually large multiple penile horns following removal of condylomata acuminata. Penile horns can grow rapidly, although malignant degeneration is uncommon. Wide excision with deep biopsy of skin at the base of the lesion probably is appropriate treatment.

Renal vein ligation in absence of vena caval obstruction

This is a report of a patient whose left renal vein was ligated in the course of a right nephrectomy for a large Wilms tumor, in the presence of an unobstructed vena cava and without established venous collateral circulation. It would appear that even with sudden obstruction to venous outflow the left kidney can develop an adequate network of collateral venous drainage capable of supporting normal renal function.