Pathogenesis and biological significance of seminal vesicle invasion in prostatic adenocarcinoma

Seminal vesicle invasion and the percentage involvement by cancer of each seminal vesicle were related to cancer volume, quantitative histological grade and presence or absence of lymph node metastases in 243 radical prostatectomy specimens. There were 47 prostates with seminal vesicle invasion. Frequency and extent of seminal vesicle invasion were strongly correlated with cancer volume, with minimal invasion noted in only 6% of the cases less than 4 cc. The relationship of seminal vesicle invasion to lymph node metastasis was statistically significant but cancer volume and histological grade were much stronger predictors of lymph node metastasis. The route of invasion from the prostate in 46 cases involved direct tumor spread into the midbase region near the ejaculatory ducts. Seminal vesicle invasion often may not be identified if the tissue nearest the ejaculatory ducts at the prostate base is not sampled.     

Selection of the method of operation on the stomach in the complex treatment of esophageal and gastric burns

The results of treatment of 317 patients with concurrent burn of the esophagus and stomach are generalized. Various restorative operations were carried out in 214 of them. The pyloroplasty-type plasty with local tissues was performed in short strictures of the pylorus, cardioesophageal junction, duodenum, and the initial portion of the small intestine. Resection of the stomach after Billroth I was conducted in cicatricial affection of the distal part of the stomach. The Billroth II operation or gastroenterostomy is indicated in subtotal burn and combined cicatricial stenosis of the stomach and duodenum. Enterostomy with subsequent restorative operation is indicated in total burn of the stomach. Preoperative management with consideration for the operative risk, elaboration of a rational therapeutic tactics and improvement of operative techniques with the use of laser and microsurgical techniques facilitated a decrease in the number of complications and in the mortality rate.     

Increase in survival time of liver transplants by protease inhibitors and a calcium channel blocker, nisoldipine

Kupffer cells are activated by calcium and release a variety of toxic mediators, including proteases. The purpose of these studies, therefore, was to determine if protease inhibitors and a calcium channel blocker could increase survival time in the rat model of orthotopic liver transplantation. Survival for 30 days was greater than 90% in this model when livers were stored for 1 hr in Ringer's solution (survival conditions)--however, grafts stored for 4 hr in Euro-Collins solution or 8 hr in University of Wisconsin (UW) solution survived postoperatively only 1.2 and 0.7 days, respectively (nonsurvival conditions). When livers were stored for 4 hr in Euro-Collins containing a cocktail of protease inhibitors (leupeptin, pepstatin A, phenylmethylsulfonyl fluoride, 20 ng/ml each; diisopropyl fluorophosphate, 100 microM) and subsequently transplanted, however, survival time was increased significantly to 11.5 days. Inclusion of a calcium channel blocker, nisoldipine (1.4 microM), in the protease inhibitor cocktail increased survival time to 23 days. Actually, nisoldipine alone increased survival time to 25 days. Nisoldipine alone also increased survival time in livers stored for 8 or 16 hr in UW solution to between 15 and 20 days. Serum transaminase levels reached peak values greater than 2400 U/L one day postoperatively in the nonsurvival groups, and liver injury assessed histologically was apparent. Under these conditions, pulmonary infiltration of inflammatory cells was observed in about 60% of the lungs examined and was associated with massive bleeding. Inclusion of the protease cocktail, nisoldipine, or both in the storage solutions decreased maximal SGOT levels and injury to both liver and lung significantly by about 50% postoperatively. Nisoldipine also decreased phagocytosis of carbon particles by the perfused liver 2- to 3-fold following storage under nonsurvival conditions (half-maximal effect = 0.3-0.4 microM nisoldipine). Moreover, nisoldipine improved hepatic microcirculation. It accelerated blood flow into the liver, as indexed by hemoglobin reflectance from the liver surface. These data support the hypothesis that Kupffer cells are activated early in the sequence of events that causes graft failure leading to endothelial cell-mediated alterations in the microcirculation. This work demonstrates clearly that dihydropyridine-type calcium channel blockers such as nisoldipine may be clinically useful in storage solutions for liver prior to transplantation.     

A true hermaphrodite with some unusual features

A fifteen-month-old boy with ambiguous external genitalia was found to have a 46XX karyotype, an ovotestis in the right labioscrotal fold, and an absent left gonad. He also had a rudimentary uterus and fallopian tubes and a blind-ending vagina lined with squamous epithelium. These features are compared with those more commonly found in true hermaphroditism.     

Small-cell neuroendocrine carcinoma of the ampullary region. A clinicopathologic, immunohistochemical, and ultrastructural study of three cases.

We report the clinicopathologic, immunohistochemical, and ultrastructural features of three small-cell neuroendocrine carcinomas of the ampullary region of the duodenum. All patients were men; their ages were 51, 62, and 66 years. The therapy consisted of pancreatoduodenectomy. All patients died of the disease; median survival was 10 months from the diagnosis. The histological appearance was identical to pulmonary and extrapulmonary small-cell carcinoma. The neuroendocrine differentiation was demonstrated ultrastructurally by the presence of dense-core granules, and by the positive immunoreaction for neuron-specific enolase and Leu-7 in each case. One case expressed a focal positivity for chromogranin A (PHE-5) and argyrophilic granules. The same case showed the presence of neurofilaments on frozen material. Neurofilament proteins could not be demonstrated in any case in paraffin sections. Neoplastic cells exhibited cytoplasmic immunostaining for cytokeratins (CAM 5.2) in all cases. In one case, a large number of neoplastic cells (60-70%) exhibited nuclear Ki-67 positivity. We postulate that the disease's histogenesis was from epithelial stem cell expressing both epithelial and neuroendocrine characteristics. The clinical behavior of small-cell neuroendocrine carcinomas of the ampullary region appears to be extremely aggressive, with early metastases and fatal outcome.