Fatty acid profiles of more than 470 marine species from the Southern Hemisphere

Lipid and fatty acid datasets are commonly used to assess the nutritional composition of organisms, trophic ecology, and ecosystem dynamics. Lipids and their fatty acid constituents are essential nutrients to all forms of life because they contribute to biological processes such as energy flow and metabolism. Assessment of total lipids in tissues of organisms provides information on energy allocation and life-history strategies and can be an indicator of nutritional condition. The analysis of an organism's fatty acids is a widely used technique for assessing nutrient and energy transfer, and dietary interactions in food webs. Although there have been many published regional studies that assessed lipid and fatty acid compositions, many only report the mean values of the most abundant fatty acids. There are limited individual records available for wider use in intercomparison or macro-scale studies. This dataset consists of 4856 records of individual and pooled samples of at least 470 different marine consumer species sampled from tropical, temperate, and polar regions around Australia and in the Southern, Indian, and Pacific Oceans from 1989 to 2018. This includes data for a diverse range of taxa (zooplankton, fish, cephalopods, chondrichthyans, and marine mammals), size ranges (0.02 cm to ~13 m), and that cover a broad range of trophic positions (2.0-4.6). When known, we provide a record of species name, date of sampling, sampling location, body size, relative (%) measurements of tissue-specific total lipid content and abundant fatty acids, and absolute content (mg 100 g^-1 tissue) of eicosapentaenoic acid (EPA, 20:5n3) and docosahexaenoic acid (DHA, 22:6n3) as important long-chain (≥C₂₀ ) polyunsaturated omega-3 fatty acids. These records form a solid basis for comparative studies that will facilitate a broad understanding of the spatial and temporal distribution of marine lipids globally. The dataset also provides reference data for future dietary assessments of marine predators and model assessments of potential impacts of climate change on the availability of marine lipids and fatty acids. There are 480 data records within our data file for which the providers have requested that permission for reuse be granted, with the likely condition that they are included as a coauthor on the reporting of the dataset. Records with this condition are indicated by a "yes" under "Conditions_of_data_use" in Data S1: Marineconsumer_FAdata.csv (see Table 2 in Metadata S1 for more details). For all other data records marked as "No" under "Conditions_of_data_use," there are no copyright restrictions for research and/or teaching purposes. We request that users acknowledge use of the data in publications, research proposals, websites, and other outlets via formal citation of this work and original data sources as applicable.

Chronic lymphocytic leukaemia, synchronous small cell carcinoma and squamous neoplasia of the urinary bladder in a paraplegic man following long-term phenoxybenzamine therapy

STUDY DESIGN

A case report.

OBJECTIVE

To raise awareness among spinal cord clinicians of the possible carcinogenic effect of phenoxybenzamine and of the rare occurrence of small cell carcinoma in the neuropathic bladder.

SETTING

Regional Spinal Injuries Centre and District General Hospital, Southport, Merseyside, United Kingdom.

CASE REPORT

A 28-year-old man sustained a fracture dislocation of L-1 with consequent paraplegia (ASIA impairment scale A). Phenoxybenzamine treatment enabled his indwelling catheter to be discarded in favour of a penile sheath, but it caused unacceptable dizziness and was stopped after 7 years. After 20 years, he developed chronic lymphocytic leukaemia, which was treated with chlorambucil and fludarabine. After 2 years, investigation of bilateral hydronephrosis revealed a primary small cell carcinoma of the bladder with coexistent squamous dysplasia. Uraemia supervened and, declining active treatment, the patient died 3 weeks after diagnosis.

CONCLUSION

Phenoxybenzamine, a known carcinogen in rodents, is likely also to be carcinogenic in humans, and patients with spinal cord injury who have received the drug for any significant period of time, need close follow-up to allow early detection of cancer. Phenoxybenzamine should not be prescribed on a long-term basis, and should instead be replaced with a selective alpha-blocker.

Delayed complications of discontinuation of intrathecal baclofen therapy: resurgence of dyssynergic voiding, which triggered off autonomic dysreflexia and hydronephrosis

STUDY DESIGN

Case report.

OBJECTIVES

To report insidious development of autonomic dysreflexia and hydronephrosis due to dyssynergic voiding following discontinuation of intrathecal baclofen therapy.

SETTING

Regional Spinal Injuries Centre, Southport, UK.

METHODS

A male patient with paraplegia at T-5 (ASIA-A) had implantation of Medtronic Synchromed 8615 s programmable pump to control intractable spasms. After 4 years, the baclofen pump needed replacement because of battery exhaustion. At this time, he was taking oxybutynin 2.5 mg twice a day. He wore a penile sheath and performed intermittent catheterisation three times a day. Intravenous urography showed no dilatation of pelvicalyceal systems or ureters. During the course of the next 4 months, the dose of baclofen had to be increased gradually to 820 microg/day in order to control the spasms. Investigations revealed disconnection of the tube from the pump. The patient decided to undergo explantation of the pump and discontinue intrathecal baclofen therapy altogether. Following removal of the pump, he was prescribed baclofen 20 mg four times a day and diazepam 5 mg twice a day. He continued penile sheath drainage with oxybutynin 2.5 mg twice a day. Although spasms were controlled with oral baclofen and diazepam, he started getting transient, mild headache during reflex voiding. After nearly 2 years, he developed unbearable and pounding headache while passing urine.

RESULTS

The dose of oxybutynin was increased to modified release formulation, 20 mg, once daily. He was prescribed modified release alfuzosin 10 mg once a day. Indwelling urethral catheter drainage was instituted. Intravenous urography showed dilation of left renal pelvis and calyces, and left ureter. After a fortnight, the dose of modified release oxybutynin was increased further to 25 mg once a day. After a month, he started performing self-catheterisation every 3 h and symptoms of autonomic dysreflexia subsided completely. A follow-up intravenous urography performed 6 months later, showed normal appearances of the left kidney.

CONCLUSION

Spinal cord injury patients, in whom intrathecal baclofen therapy is terminated, need close monitoring of their urological status. Medications, which are prescribed for neuropathic bladder, and the method of bladder drainage, may need suitable changes, as discontinuation of intrathecal baclofen therapy can result in reappearance of detrusor-sphincter dyssynergia in previously susceptible patients.

Pseudo-tumours of the urinary tract in patients with spinal cord injury/spina bifida

OBJECTIVE

To raise awareness of pseudo-tumours of urinary tract, as pseudo-tumours represent benign mass lesions simulating malignant neoplasms. Accurate diagnosis helps to avoid unnecessary surgery in spinal cord injury patients.

SETTING

Regional Spinal Injuries Centre, Southport, UK CASE REPORTS: Pseudo-tumour of kidney: A 58-year-old man with tetraplegia developed a right perirenal haematoma while taking warfarin; ultrasound and CT scanning showed no evidence of tumour in the right kidney. The haematoma was drained percutaneously. After 8 months, during investigation of a urine infection, ultrasound and CT scan revealed a space-occupying lesion in the mid-pole of the right kidney. CT-guided biopsy showed features suggestive of an organising haematoma; the lesion decreased in size over the next 13 months, thus supporting the diagnosis. Pseudo-tumour of urinary bladder: A frail, 34-year-old woman, who had spina bifida, marked spinal curvature and pelvic tilt, had been managing her neuropathic bladder with pads. She had recurrent vesical calculi and renal calculi. CT scan was performed, as CT would be the better means of evaluating the urinary tract in this patient with severe spinal deformity. CT scan showed a filling defect in the base of the bladder, and ultrasound revealed a sessile space-occupying lesion arising from the left bladder wall posteriorly. Flexible and, later, rigid cystoscopy and biopsy demonstrated necrotic slough and debris but no tumour. Ultrasound scan after 2 weeks showed a similar lesion, but ultrasound-guided biopsy was normal with nothing to explain the ultrasound appearances. A follow-up ultrasound scan about 7 weeks later again showed an echogenic mass, but the echogenic mass was seen to move from the left to the right side of the bladder on turning the patient, always maintaining a dependent position. The echogenic bladder mass thus represented a collection of debris, which had accumulated as a result of chronic retention of urine and physical immobility.

CONCLUSION

Recognising the true, non-neoplastic nature of these lesions enabled us to avoid unnecessary surgical procedures in these patients, who were at high risk of surgical complications because of severely compromised cardiac and respiratory function.

Flawed trial of micturition in cervical spinal cord injury patients: guidelines for trial of voiding in men with tetraplegia

STUDY DESIGN

A retrospective study.

OBJECTIVES

(1) To raise awareness of flawed trial of micturition (TOM) in male spinal cord injury (SCI) patients; and (2) to present guidelines for trial of voiding in male SCI patients.

SETTING

Regional Spinal Injuries Centre, Southport, UK.

METHODS

Trial of micturition in male SCI patients refers to discarding indwelling catheters and establishing them on balanced voiding with penile sheath drainage. We describe seven SCI patients, whose trial of micturition was flawed.

RESULTS

Two patients (C-6 and C-4 tetraplegia respectively) developed severe autonomic dysreflexia (headache, sweating, and increase in blood pressure) 2-3 h after removal of urethral catheter. A C-4 tetraplegic developed severe urinary infection after TOM. Four patients with tetraplegia started retaining increasing amounts of urine and developed urinary infections/autonomic dysreflexia/hydronephrosis 1-21 months after they were established on sheath drainage after TOM.

CONCLUSION

During TOM, patients with cervical SCI could develop autonomic dysreflexia, urinary infection, or hold progressively increasing volumes of residual urine. TOM should be guided by videourodynamics. SCI patients need alpha-blockers, and anticholinergics if voiding pressures are >40-50 cm H(2)O. If high urethral resistances are found, sphincterotomy and/or bladder neck incision will help the patients to void by triggering. SCI patients, who had undergone successful TOM, require meticulous follow-up including urodynamics. Intermittent catheterisation without adequate medications based on cystometrogram may be hazardous, and may result in upper tract damage. Facilities for supplementary catheterisation (three to four times a day) should be available in the community if a patient is unable to maintain complete, low-pressure, emptying of bladder.

Detection of early squamous metaplasia in bladder biopsies of spinal cord injury patients by immunostaining for cytokeratin 14

STUDY DESIGN

A prospective, immunohistochemical study of bladder biopsies taken from spinal cord injury (SCI) patients.

OBJECTIVES

To investigate whether cytokeratin 14 immunostaining may be useful to detect early squamous metaplasia in bladder biopsies from patients with SCI.

SETTING

Southport, United Kingdom.

METHODS

Biopsy of bladder mucosa was taken from adults with SCI, while they underwent an elective therapeutic procedure in the urinary tract. A total of, 54 biopsies, which showed transitional epithelium only with no evidence of squamous metaplasia on routine H&E staining, formed the study group. In all, 22 biopsies, which showed squamous metaplasia on routine H&E staining, acted as controls. All biopsies were benign with no evidence of dysplasia or malignancy. Immunohistochemical staining for cytokeratin 14 was performed on all biopsies in a single batch, using a standard avidin-biotin complex method.

RESULTS

All control biopsies showed positive immunostaining for cytokeratin 14 in basal and parabasal cells in areas of squamous metaplasia. Of the 54 biopsies, which showed only transitional epithelium on H&E staining, immunohistochemistry for cytokeratin 14 showed no staining in 47 biopsies. The remaining seven biopsies showed positive immunostaining for cytokeratin 14 in the epithelium, in individual cells or clusters of basal cells, revealing unexpected early squamous metaplasia in these biopsies.

CONCLUSION

Immunostaining for cytokeratin 14 identifies an early phenotypic switch from transitional to squamous epithelium in bladder mucosa. Cytokeratin 14 staining is sufficiently sensitive to identify early squamous metaplasia, which is not yet evident on examination of routine H&E stained sections. This early identification may be of use in alerting physicians to change bladder management regimens to prevent predisposition to recurrent urinary infection and progression of squamous metaplasia. A cost/benefit analysis should be performed to assess the feasibility of routine cytokeratin 14 immunostaining of bladder biopsies from SCI patients.

Community-care waiting list for persons with spinal cord injury

OBJECTIVES

To disseminate the concept of community care waiting lists for spinal cord injury (SCI) patients with particular reference to carer support for management of neuropathic bladder by a regime of intermittent catheterisation.

METHODOLOGY

The surgical waiting list focuses only on operative procedures, and ignores the wider requirements for ensuring satisfactory rehabilitation of people with spinal cord injury in the community. A community-care waiting list for individuals with spinal cord injury should include the following aspects of community care: (1) Home adaptation; (2) Provision of appropriate mobility needs (including wheelchair and cushion); (3) Equipment for comfortable living (including provision of hoist, pressure relieving mattress); (4) Psychological support for spinal cord injury patients and their partners; (5) Nursing home or residential care placement where appropriate; (6) Carer support for global management of complex needs associated with spinal cord injury (eg neuropathic bladder and bowel).

RESULTS

Whereas full physical adaptation of the home can wait for some time after discharge, carer support for intermittent catheterisation is required from the first day after discharge from a spinal unit. Lack of such support means that some SCI patients are discharged with long-term indwelling urinary catheters, even though clean intermittent catheterisation is known to be the safest regime for managing the neuropathic bladder. Therefore, the absence of a community care waiting list means that best practice cannot be achieved for some tetraplegic subjects.

CONCLUSION

We believe that a community care waiting list for bladder management will help to provide optimum care for neuropathic bladder and, hopefully, reduce the complications related to long-term indwelling catheters in spinal cord injury patients.

Gastrointestinal autonomic nerve sarcoma presenting as a giant intra-abdominal cyst

Gastrointestinal autonomic nerve sarcomas are rare tumours. A 36-year-old man presented with abdominal pain, distension and constipation. Abdominal ultrasound and CT scanning demonstrated a giant cystic intra-abdominal mass. Laparotomy confirmed a large cystic mass arising from the ileum with multiple metastases. Immunohistochemical staining was positive for vimentin, neuronal-specific enolase and PGP9.5. This is the first reported case to present as a giant intra-abdominal cyst. Specialist histopathological and immunohistochemical analysis is essential to establish the diagnosis of this rare tumour.

Fatal intestinal perforation secondary to fragmentation of a Celestin tube

BACKGROUND/AIMS

Oesophageal intubation remains one of the principal methods of palliation for an obstructing oesophageal carcinoma. We present a case which illustrates a rare but fatal complication of this procedure.

METHODS

A 60-year-old female with oesophageal cancer presented with total dysphagia 9 months following insertion of a Celestin tube for palliation. Oesophagoscopy revealed a bolus obstruction which was successfully cleared. Two days later she developed generalised peritonitis and subsequently died.

RESULTS

A post-mortem examination demonstrated fragmentation and displacement of the distal part of the Celestin tube resulting in perforation of the small bowel.

CONCLUSION

Celestin tube disintegration is a risk associated with long-term use, and routine replacement is indicated in patients with a prolonged survival to avoid this complication.

Xanthogranulomatous funiculitis and epididymo-orchitis in a tetraplegic patient

STUDY DESIGN

A case report of xanthogranulomatous funiculitis and epididymo-orchitis. Xanthogranulomatous inflammation is an uncommon, non-neoplastic process characterised by destruction of tissue, which is replaced by a striking cellular infiltrate of lipid-laden macrophages.

CASE REPORT

A 21-year male sustained complete tetraplegia at C-6 level, after a fall in 1998. The neuropathic bladder was managed with an indwelling urethral catheter. He had many unsuccessful trials of micturition. Sixteen months after the cervical injury, he noticed swelling of the left side of the scrotum following removal of a blocked catheter. He was prescribed antibacterial therapy. Four weeks later, physical examination revealed a hard and irregular swelling encompassing the testis, epididymis and spermatic cord. The clinical diagnosis was epididymo-orchitis progressing to pyocele. Through a scrotal incision, the swollen testis, epididymis and diseased segment of the spermatic cord were removed en masse. Histopathology showed extensive areas of necrosis, with xanthogranulomatous inflammation in the spermatic cord and to a lesser extent in the testis/epididymis.

CONCLUSION

Repeated episodes of high-pressure urinary reflux along the vas deferens during dyssynergic voiding, and subsequent interstitial extravasation of urine together with chronic, low-grade, suppurative infection possibly led to development of xanthogranulomatous inflammation in the testis and the epididymis. Since tissue destruction is a feature of xanthogranulomatous inflammation, the definite and curative treatment is either complete (or, where applicable, partial) excision of the affected organ in most of the cases.

Parathyroid hormone-related protein (1-34) and urothelial redifferentiation in the neuropathic urinary bladder

STUDY DESIGN

A comparative study of immunostaining for parathyroid hormone-related protein (1-34) (PTHrP (1-34)) in the vesical epithelium of biopsies obtained from patients with non-neuropathic bladder and those with neuropathic bladder.

OBJECTIVES

To investigate the immunostaining for PTHrP (1-34) in the control cases and in neuropathic bladders showing (1) normal transitional epithelium, (2) hyperplastic transitional epithelium, and (3) squamous metaplasia.

SETTING

Regional Spinal Injuries Centre, and Department of Cellular Pathology, Southport & Ormskirk Hospitals NHS Trust, Southport, Department of Pathology, Royal Liverpool University Hospital and the Departments of Clinical Chemistry and Cell Biology, The University of Liverpool, Liverpool, England.

METHODS

Cold cup biopsies of bladder mucosa were taken from patients suffering from neuropathic urinary bladder when they were undergoing a therapeutic procedure in the urinary tract. Immunohistochemistry was performed on these biopsy specimens using a rabbit polyclonal antibody raised to a synthetic peptide corresponding to human PTHrP (1-34). Control group (n=10) consisted of archival biopsies taken from non-neuropathic bladders.

RESULTS

In the control group, the transitional epithelium showed no immunostaining, or at the most, very faint positive staining was seen in the transitional epithelium of non-neuropathic bladder. Positive immunostaining to PTHrP (1-34) was seen in the normal transitional epithelium of neuropathic bladder in nine of 13 cases. Hyperplastic transitional epithelium showed positive immunostaining for PTHrP (1-34) in 11 of 13 biopsies from patients with neuropathic bladder. Immunostaining for PTHrP (1-34) was observed in the metaplastic squamous epithelium in 14 of 17 cases with neuropathic bladder.

CONCLUSION

The transitional epithelium of non-neuropathic bladder showed no immunostaining, or at the most, very faint positive staining for PTHrP (1-34). In contrast to this, positive immunostaining for PTHrP (1-34) was observed more frequently in the vesical epithelium of neuropathic bladder. This observation opens up avenues for innovative therapy with PTHrP or its analogues for possible modulation of urothelial differentiation in the neuropathic bladder.

Immunohistochemical study of parathyroid hormone-related protein in vesical transitional epithelium of patients with spinal cord injury

INTRODUCTION

Parathyroid hormone-related protein (PTHrP), in addition to the well-established role in endochrondral bone development, is believed to be an important mediator of cellular growth and differentiation in a number of non-bony tissues.

OBJECTIVES

To compare the immunohistochemical staining of vesical transitional epithelium to antibodies raised to synthetic peptides of PTHrP composed of amino acid sequences 43 - 52 and 127 - 138 in patients with spinal cord injury (SCI) and neuropathic bladder (n=14), and control patients with intact neuraxis and no history of bladder cancer (n=10).

SETTING

Male SCI patients registered with Regional Spinal Injuries Centre, Southport, England.

INTERVENTION

Endoscopic cold cup biopsy from the trigone of the urinary bladder was taken from patients with SCI while they were undergoing a therapeutic procedure in the urinary bladder. The control samples of bladder biopsies were taken from the archives of the Department of Histopathology, District General Hospital, Southport. Immunohistochemistry was performed using rabbit antibodies raised against synthetic peptides of human PTHrP (43 - 52) and PTHrP (127 - 138). The biopsies were examined for immunostaining of transitional epithelium.

RESULTS

Of the 14 biopsies of SCI patients, positive immunostaining using antibodies to both the PTHrP peptides was found in four cases; five biopsies showed positive immunostaining only to anti-PTHrP (43 - 52); and five biopsies showed no immunostaining with either of the PTHrP peptides. In contrast, transitional epithelium in the biopsy specimens of ten control subjects with no history of bladder cancer showed no immunostaining with either of the PTHrP peptides.

CONCLUSION

This study revealed that the transitional epithelium of neuropathic urinary bladder exhibits increased predilection for positive immunohistochemical staining for PTHrP (43 - 52), and to a lesser extent, to PTHrP (127 - 138), as compared to the vesical transitional epithelium of able bodied individuals with no history of vesical malignancy. The possible role of PTHrP in the cellular differentiation of urothelium of neuropathic bladder, and thereby, in the pathogenesis of cystitis in SCI patients, needs to be explored.

A review of the readmissions of patients with tetraplegia to the Regional Spinal Injuries Centre, Southport, United Kingdom, between January 1994 and December 1995

Patients with chronic tetraplegia are prone to develop unique clinical problems which require readmission to specialised centres where the health professionals are trained specifically to diagnose, and treat the diseases afflicting this group of patients. An appraisal of the readmission pattern of tetraplegic patients will provide the necessary data for planning allocation of beds for treatment of chronic tetraplegic patients. Hospital records of patients with tetraplegia readmitted to the Regional Spinal Injuries Centre, Southport, UK between 1 January 1994 and 31 December 1995 were analyzed to find out the number of tetraplegic patients who required readmission, reasons for readmission, duration of hospital stay, and mortality among patients readmitted. During the 2-year period, 155 tetraplegic patients were readmitted and 44 of them (28.4%) required more than one readmission (total readmission episodes: 221); these patients occupied 4.5 beds which is equivalent to 11.5% of the total bed capacity of the spinal unit. Among the reasons for the readmissions, evaluation and care of urinary tract disorders topped the list with 96 readmission episodes (43.43%) involving 70 patients; the median hospital stay was 3 days, and 18 patients (26%) required more than one readmission during this period. One hospital bed was occupied by the tetraplegic patients requiring treatment/evaluation of urinary tract disorders. Assessment and treatment of cardio-respiratory diseases was the second most common reason for readmission with 51 readmission episodes pertaining to 27 patients having a median hospital stay of 6 days; 13 patients (48%) were readmitted more than once within this 2-year period. Treatment of cardio-respiratory diseases in chronic tetraplegic patients required 1.2 hospital beds yearly. Only five tetraplegic patients were readmitted for treatment of pressure sore(s); however they had a prolonged hospital stay (median duration: 101 days). Social reasons accounted for 13 readmission episodes concerning nine patients who stayed in the hospital for varying periods (median: 6.5 days; mean: 35 days). Four tetraplegic patients readmitted with acute chest infection expired. An 81 year-old tetraplegic died of myocardial infarction. Urinary sepsis, renal insufficiency, respiratory failure and intra-cerebral haemorrhage accounted for the demise of a 41 year-old tetraplegic patient following surgical removal of a large, impacted stone at the pelviureteric junction. A tetraplegic patient who was admitted with haematuria subsequently underwent cystectomy for squamous cell carcinoma of the urinary bladder; he developed secondaries and expired 5 months later. As more patients with high cervical spinal cord injury survive the initial period of trauma, and as the life expectancy of tetraplegic patients increases, it is likely that greater numbers of tetraplegic patients will be requiring readmission to spinal injuries centre. Although it may be possible to prevent some of the complications of spinal cord injury and hence the need for a readmission, progress in medicine and rehabilitation technology will create additional demands for readmissions of chronic tetraplegic patients in order to implement the newer therapeutic strategies. Thus a change in the pattern of readmission of chronic tetraplegic patients is likely to be the future trend and this should be taken into account while making plans for providing the optimum care to chronic tetraplegic patients.

p75 nerve growth factor receptor in the vesical urothelium of patients with neuropathic bladder: an immunohistochemical study

INTRODUCTION

Nerve growth factor (NGF), apart from its role as a growth factor, appears to be involved in neuroimmune interactions and in tissue inflammation. Low-affinity nerve growth factor receptor (p75 NGFR), if demonstrated in the urothelium, could provide the means for (1) NGF-mediated modulation of the urothelial response to inflammation; (2) NGF-mediated autocrine/paracrine regulation of urothelial proliferation; and (3) p75 NGFR-mediated induction of apoptosis.

OBJECTIVES

To investigate the presence of p75 NGFR in the vesical urothelium of patients with neuropathic bladder by immunohistochemical methods.

SETTING

A hospital-based study of consecutive, unselected, adult patients of either sex with neuropathic bladder, undergoing procedure on the urinary tract in a Regional Spinal Injuries Centre located in the north-west of England.

INTERVENTION

Cold cup biopsies were taken from the trigone of the neuropathic urinary bladder of 26 patients with neuropathic bladder. Immunohistochemical studies were performed using antiNGF-receptor human monoclonal antibody which reacts with the low affinity receptor (p75 NGFR).

RESULTS

Both neural and epithelial structures showed positive immunostaining for p75 NGFR. The basal layer of the transitional epithelium showed strongly positive immunostaining for p75 NGFR in all the 26 cases. The luminal layer of transitional epithelium showed varying degree of positive immunostaining in 12 patients. The nerve fibres showed positive immunostaining for p75 NGFR. In many cases, the positively-stained nerve fibres were coursing very close to the basal layer of the urothelium almost entering the urothelium; however, no NGFR-positive intra-epithelial terminals could be seen. The positively-stained single nerve fibres and positively-stained thicker nerve bundles were seen in abundance in the submucosa but they were present in a sparse manner in the muscularis layer.

CONCLUSION

The presence of p75 NGFR was demonstrated in the urothelium of neuropathic bladder of all the 26 patients with neuropathic bladder. This observation may have potential therapeutic implications.

Audit of 6 years' experience of breast fine needle aspiration (FNA) cytology using the cytospin method; improvement through multidisciplinary clinical audit

A breast FNA cytology service for palpable breast lumps was commenced in 1989 using the cytospin method. Over the following 6 years 2314 aspirates were received. The results were audited in detail in 1990, 1991/1992 and 1994. Multidisciplinary clinical audit meetings followed each audit cycle. Practice change was agreed after each audit. Each audit cycle was followed by demonstrable improvement in the complete sensitivity of the technique, being respectively 79%, 88% and 96%. The cytospin method is a viable alternative to the conventional smear method.

Blood pressure and myocardial perfusion in hypertensive patients with and without left ventricular hypertrophy

To evaluate the effect of acute blood pressure (BP) changes on the myocardial perfusion in hypertensives, 10 patients with and 10 patients without left ventricular hypertrophy (LVH) were examined with 99TCm-Sestamibi scintigraphy at rest and after acute pharmacological BP reduction using nifedipine and captopril. Signs of LV ischaemia was quantified as the size of the hypoperfused area defined as isotope uptake below 70% of maximum LV uptake, and LVH was defined as ventricular mass (LVM) > 125 g/m2 BSA by use of echocardiography. Not significant relations between BP and size of the hypoperfused area was found at rest. During BP reduction patients with LVH had negative correlations (r = -0.58) between the size of the hypoperfused area and the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) (r = -0.49) while patients without LVH showed positive correlations (SBP r = 0.60, DBP r = 0.48). The differences in correlation coefficients were significant (P < 0.01) for both. Thus, in hypertensives with LVH, ischaemia may develop at low BP providing a possible mechanism for the observed increased risk of cardiovascular events in some hypertensive patients with low achieved BP during follow-up. Until treatment goals are defined on scientific grounds, BP should not be decreased below 90 mm Hg in subjects with LVH.

[Quantification of aortic insufficiencies. Comparison between Doppler echocardiography and qualitative angiographic methods: apropos of a series of 60 consecutive patients]

Many doppler echocardiographic indices have been described for quantifying aortic regurgitation, posing the problem of the relative value of each. Therefore, the authors assessed the severity of aortic regurgitation in 60 consecutive patients (16 women and 44 men, mean age 56.7 years, range 7 to 84 years) by the four grades of Seller's classification with selective aortography. These results were compared with Doppler echocardiographic measurement of anterograde cardiac output (Qao), the pressure half time (PHT), diameter of the jet at its origin in M mode colour Doppler (DTM) and calculation of the regurgitant fraction (RF) by comparison of flow at the different cardiac orifices by a method previously described and validated in the author's laboratory with an interorifice correlation of 0.91 to 0.96 and confidence intervals at 95% of the order of 12%. The feasibility of doppler echocardiographic methods was good: 87.8% for PHT (58/66 patients), 90% for DTM (36/40 patients), 90.9% for Qao and RF (60/66 patients). The correlation with aortography was -0.65 (p < 0.01) for PHT; 0.91 (p < 0.01) for DTM, 0.80 (p < 0.01) for Qao and 0.92 (p < 0.005) for RF. However, there was a number of overlaps between Grades I and II and Grades III and IV.(ABSTRACT TRUNCATED AT 250 WORDS)

[Feasibility and accuracy of pulmonary blood flow measurement by Doppler echocardiography. Apropos of 100 consecutive cases]

One of the main advantages of Doppler echocardiography is the possibility of non-invasive measurement of blood flow at each valvular orifice. This method enables quantification of valvular regurgitation, the measurement of Qp/Qs in cardiac disease with atrial or ventricular shunts, and the interpretation of gradients and functional surface areas in valvular stenosis or prosthesis with respect to the underlying haemodynamics. In each of these application, the measurement of pulmonary blood flow is valuable as the reference blood flow, and even indispensible in cases of shunts. The authors' objective was to study the feasibility and accuracy of pulmonary flow measurement in 100 consecutive patients (40 women and 60 men, average age 56.7 +/- 17.5 years) with cardiac disease (82%) or healthy hearts (18%). A grading from A to D was accorded depending on the technical difficulty of the examination, each grade having three degrees: 1) difficulty of recording and poor quality Doppler spectrum, 2) difficulty of measuring orifice diameter by 2D echocardiography, 3) necessity of analysis of color coded anterograde flow to measure the pulmonary valvular orifice. Grade A was distributed to easily recordable measurements with no difficulty; grade B for measurements with one difficulty; grade C for measurements with 2 difficulties and grade D for investigations judged to be impossible or unreliable (3/3 criteria). The feasibility of measurement of the cardiac output at the pulmonary orifice was 88% (A:55%, B:25%, C:8%). The correlation between the pulmonary flow and reference measurements at the aortic and/or mitral valve and/or mitral annulus was 0.96. The average difference between the pulmonary and reference flow was 51 +/- 273 cc/min.(ABSTRACT TRUNCATED AT 250 WORDS)

Parathyroid hormone related protein (PTHrP) gene expression in fetal and extra-embryonic tissues of early pregnancy

Parathyroid hormone related protein (PTHrP) is an important humoral factor in hypercalcaemia of malignancy. In addition there is increasing evidence that this peptide has a physiological role in fetal development, especially in cellular growth and differentiation. Both in-situ hybridization and immunohistochemistry were used together and for the first time to identify sites of PTHrP gene expression and peptide in fetal and extra-embryonic tissues of first trimester human pregnancy. PTHrP mRNA and peptide were identified in the avascular amnion and the syncytiotrophoblast while mRNA alone was expressed in the cytotrophoblast. Its expression in these extra-embryonic tissues is consistent with postulated roles for PTHrP in implantation, relaxation of endometrial muscle and regulation of vascular tone. Expression of both mRNA and peptide occurred in endo-, meso- and ectodermal structures of the fetus, consistent with local production of the peptide rather than cellular uptake from amniotic fluid and supporting a role for PTHrP in cellular growth and differentiation.

[Evaluation of prognosis and myocardial ischemia using thallium in myocardial tomoscintigraphy]

Thallium scintigraphy holds a unique position amongst the methods available for evaluating the prognosis of coronary patients: it enables quantification of underperfused myocardium and evaluates already constituted ventricular damage (irreversible necrosis) and areas at risk of future coronary events (viable but ischemic myocardium). In a series of 1,926 patients who underwent exercise stress or dipyridamole Thallium myocardial scintigraphy for angina pectoris and followed up fort an average of 34 months, the following features were observed: the long-term prognosis in patients with normal myocardial scintigraphy (715 patients) was identical to that of a normal population of the same age (0.11% cardiovascular deaths per year) whereas the cardiovascular mortality was 15 times higher in cases with a pathological scintigraphy: finally, the long-term prognosis (cardiovascular deaths, infarcts or secondary revascularisation) was directly related to the severity of the initial lack of Thallium uptake. This method was used to assess the prognosis and evaluate the myocardial ischaemia in 75 patients who underwent complete surgical revascularisation fort ischaemia, 50 of whom had previous myocardial infarction: all patients had at least one arterial bypass graft: 39% of the myocardium was underperfused before revascularisation; this procedure reduced by 80% (p < 0.0001) the zones of reversible underperfusion but also zones of irreversible underperfusion by 17% (p = 0.04). The results were particularly impressive in patients who underwent revascularisation with an arterial pedicle (left and right internal mammary, gastroepiploic alone or in association) as 91% of the ischemic territories recovered on average 13 days after revascularisation.(ABSTRACT TRUNCATED AT 250 WORDS)

Low blood pressure levels and signs of myocardial ischaemia: importance of left ventricular hypertrophy

To clarify a possible relationship between the level of BP and signs of myocardial ischaemia, two groups of treated hypertensive patients with (n = 12) and without (n = 18) increased left ventricular mass defined by echocardiography were investigated with 24h ambulatory BP and ECG monitoring. It was found that hypertensive patients with increased left ventricular mass had the following. (1) Higher systolic BP, heart rate (HR) and SBP x HR product during the night indicating a higher ventricular work load than hypertensives without increased LVM in this period. (2) This increased left ventricular work load during the night was concomitant with a lower DBP consistent with a lower perfusion pressure of the left ventricular myocardium. (3) Significantly depressed ST segment levels throughout the 24 hours with a significant positive correlation between BP and the level of the ST segment indicating increased ischaemic metabolic changes within the myocardium the lower the BP. (4) A higher ratio between the systolic SBP x HR product and DBP during sleep than in hypertensives without increased left ventricular mass, further corroborating that low DBP during the night might cause ischaemia through an imbalance between left ventricular work load and coronary perfusion pressure. We conclude that low BPs in hypertensive patients with increased left ventricular mass seem to induce ischaemia of the left ventricle. These findings provide a possible mechanism for the increased risk of ischaemic heart disease in hypertensive patients with low achieved BP.

Ceruminous gland tumours: a reappraisal

Ceruminous glands should no longer be regarded as purely apocrine glands, but as apoeccrine glands with both apocrine and eccrine modes of secretion. We present two cases of pleomorphic adenoma of ceruminous glands, among the rarest of such tumours. The use of such terms as 'ceruminoma' and 'hidradenoma' should finally be abandoned, and 'ceruminous gland tumour' used instead as a generic term. Classification should be based on Wetli's prototype (adenoma, pleomorphic adenoma, adenoid cystic carcinoma and adenocarcinoma), with the addition of benign eccrine cylindroma and syringocystadenoma papilliferum; the inclusion of mucoepidermoid carcinoma should await full validation. Wide local excision is necessary for all tumours, with only follow-up for histologically benign neoplasms. Malignant tumours need early aggressive surgery and radiotherapy. If marginal invasion cannot be assessed histologically, then adenoma and adenocarcinoma cannot be distinguished and we suggest that the tumour be reported as 'of uncertain malignant potential'. Long-term studies are needed to confirm or refute the view that all ceruminous gland tumours are potentially malignant.

Recurrent consecutive partial molar pregnancy

Gestational trophoblastic disease (GTD) is rare. Recurrent GTD, though occurring in only 0.6-2.6% of subsequent pregnancies, has significant clinicopathological implications. These include risk of malignant sequelae and subsequent poor reproductive performance. The cytogenetics and histopathology of complete and partial moles differ, yet there are several clinicopathological similarities. Although complete hydatidiform moles are known to recur, very little is known about recurrent partial vesicular moles in world literature. We report here on a patient with four consecutive recurrent partial hydatidiform moles who is yet to achieve a normal pregnancy. Her third molar pregnancy was further complicated by severe thyrotoxicosis. The unusual histology and the progressively more aggressive clinical course are discussed. The small risk of malignant sequelae and the need for close endocrinological monitoring are highlighted, as are her chances of yet another recurrent GTD.

Terminal parotid duct carcinoma

Terminal duct carcinoma of salivary glands is an uncommon, histologically distinctive, low grade malignant neoplasm arising from the intercalated salivary duct. We present a case arising eight years after removal of a parotid tumour reported as a pleomorphic adenoma. We describe the clinico-pathological features of the present tumour, illustrate the difficulties that may be encountered in differentiating it from other salivary gland tumours, and discuss the possible significance of the previous tumour.

[Pulse wave velocity and arterial distensibility. Changes during rest and exertion]

The measurement of pulse wave velocity (PWV) is one of the oldest methods of evaluating the dynamic properties of the arterial wall and also one of the most simple. Its value has been proven clinically by epidemiological studies as its value is directly related to changes in arterial structure with aging and hypertension. However, clinical measurement of PWV is an indirect method, and although simple in theory it may provide diverging results because of the large number of structural and functional parameters which influence the transmission of the pressure wave. This explains the difficulties encountered in determining a representative reference value for PWV. Nevertheless, for interpretation of the results, the data provided by PWV measurement about arterial distensibility underline the importance in all measurements of arterial compliance of taking into account the site and conditions of measurement in order to evaluate the variability and physiological role of the arterial segment under study.

Lack of prognostic value of nucleolar organizer region enumeration in transitional cell carcinoma of the bladder

Enumeration of silver-stained nucleolar organizer regions is of limited use in grading transitional cell tumors of the bladder. We attempted in this article to establish whether or not such a technique would be helpful in predicting the prognosis of such tumors within rather than between grades. In the study population of 11 high-grade transitional cell carcinomas of the bladder, no correlation was found between clinical outcome and mean nucleolar organizer region count.

T cell non-Hodgkin's lymphoma with uveitis, pancreatitis, digital gangrene and multiple chromosomal abnormalities

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[Reproducibility at 3 different points of the pulse wave velocity at rest]

The study was aimed to search in which site the pulse wave velocity (PWV), is the most reproducible at rest, and determine the best site for measurement. The 3 sites habitually employed carotid-femoral (CF), femoral-dorsalis pedis (FP), subclavian-radial (SCR) were studied twice running at 24 hours interval (D1/D2) at rest after 10 minutes in dorsal decubitus, in 20 borderline hypertensive subjects (mean age 50 +/- 14), treated (n = 7) or non-treated (n = 13). Pulse transit time (dt) was measured with a continuous doppler velocimeter according to the ECG, the PWV calculated from the artery length on each site (dl) according to the formula PWV = dl/dt (m/s).

STATISTICAL ANALYSIS

Wilcoxon test for paired series and correlation coefficients. Whatever the site, no significant difference between measurements 24 hours apart. For each measurement, the variability and standard errors at each site appear greater for CF and FP (24%), than for SCR (14%). Study of the correlations between measurements at each site: the measurements SCR and CF are correlated (r = 0.43, p less than 0.05); those at the other sites are independent of each other.

CONCLUSION

at rest and 24 hrs apart in the hypertensive subject, the PWV is reproducible in the three measurement sites. The CF and FP sites give less consistent results. The SCR site seems to be the most practical: it is the site of BP measurement, it is correlated with the CF site, and its variability and standard error are low.

[Arterial compliance during exertion in hypertensive and normal subjects of the same age]

In order to improve the reproducibility of arterial compliance measurements, normally taken at rest, we performed these measurements during exercise under stable conditions. Our aim was to determine, in both normotensive and hypertensive subjects, those parameters which condition changes in arterial compliance during exercise, and in particular age, systolic/diastolic arterial pressures and heart rate. The study involved 59 normotensive and 31 hypertensive subjects. Compliance was evaluated by measuring pulse wave velocity in the upper limbs at three levels of exercise: 50, 75 and 100 watts. Pulse wave velocity measured in different age-groups gradually increased at each exercise level, but age made no significant difference in values. Only one correlation appeared at recovery, with a significant (p less than 0.05) difference between normotensive and hypertensive subjects. As regards arterial pressures, there was only one correlation with diastolic pressure reflecting an increase in mural tension during exercise. A correlation with heart rate appeared during exercise, probably due to the vasomotor effect of a higher adrenergic tone. The diversity of vascular repercussions and haemodynamic regulation modes during exercise accounts for the variability of arterial compliance measurements taken during exercise, irrespective of age and blood pressure level. However, these measurements remain of interest for their reproducibility and their correlation with the adrenergic tone. This may be useful for the choice of an antihypertensive therapy.