Effects of steroid hormones and antisteroids on alkaline phosphatase activity in human endometrial cancer cells (Ishikawa line)

Alkaline phosphatase activity in human endometrial cancer cells of the estrogen-responsive Ishikawa line was markedly stimulated (3-20-fold in 4 days) by estrogens, 5 alpha-dihydrotestosterone, and dehydroepiandrosterone but not by testosterone, medroxyprogesterone acetate, glucocorticoids, several peptide hormones, prostaglandins, or growth factors. Maximum responses to estradiol were obtained at concentrations between 10(-9) and 10(-7) M; at 10(-8) M estradiol, the highest activity was reached 48-72 h after addition of the hormone. A linear relationship between enzyme activity at 48 h and the length of exposure to the hormone was observed. Dibutyryl cyclic guanosine 3':5'-monophosphate, but not dibutyryl cyclic adenosine 3':5'-monophosphate enhanced alkaline phosphatase activity and acted synergistically with estradiol. trans-4-Monohydroxytamoxifen completely antagonized the stimulatory effect of estradiol and had no agonistic activity. Dihydrotestosterone and dehydroepiandrosterone appear to exert their effects, at least in part, by interacting with estrogen receptors, since the simultaneous presence in the medium of monohydroxytamoxifen abolished their influence on alkaline phosphatase activity. The specific antiandrogen monohydroxyflutamide partially antagonized the effect of these hormones, suggesting that their action involved androgenic mechanisms as well. Exposure to elevated temperature and to specific inhibitors identified alkaline phosphatase of Ishikawa cells as a placental-type isoenzyme, thus contrasting with the nonplacental type found in glandular epithelial cells of normal endometrium and in another human endometrial cancer cell line, HEC-50. This study extends our previous observations of estrogen responsiveness in the Ishikawa cell line. In addition to the previously reported stimulatory effects on growth and progesterone receptor levels, we are now describing the stimulation by estrogens and C19 steroids of an enzyme, alkaline phosphatase, which can be used as a convenient end point to examine mechanisms of hormonal action.     

Interleukin-1α and interleukin-1 receptor antagonist in the urine of children with acute pyelonephritis and relation to renal scarring

Urinary concentrations of interleukin-lα (IL-lα) and interleukin-l receptor antagonist (IL-Ira) standardized to urinary creatinine concentrations were studied. The median standardized IL-1α creatinine quotient in children with first-time acute pyelonephritis was 3.6 pg/μmol, but was non-detectable in children with recurrent pyelonephritis, children with non-renal febrile conditions and children convalescent after acute pyelonephritis ( p < 0.05–0.01). IL-lra levels were also significantly higher in children with acute first-time pyelonephritis (median of 239 pglpmol) compared to these three groups of children ( p < 0.01–0.001). The highest urinary 1L-lra levels, however, were found in the healthy controls (median value 1.019; p < 0.001). Both cytokines were higher among children younger than one year compared to older children. The acute IL-lα creatinine quotients were lowest in children with uptake defects on ^99mTC-dimercaptosuccinic acid (DMSA) scintigraphy both during the acute infection (reflecting the acute inflammation) ( p < 0.001) and 1 year after the acute infection (reflecting permanent kidney scarring) ( p < 0.01). In conclusion, persisting high urinary levels of 1L-lα were associated with less renal inflammation and scarring.     

Endometrial carcinoma: two diseases?

Ninety-five patients diagnosed as having stage I endometrial carcinoma (EC) were divided into two groups, one with associated adenomatous hyperplasia (AH; group 1) and the other without (group 2). Adenomatous hyperplasia results from estrogenic stimulation of the endometrium. Therefore, patients in group 1 are considered to have an estrogen-related EC. Group 1 included 49 patients with an average age of 59; group 2 included 46 patients with an average age of 65. Review of the histologic characteristics of EC showed that group 1 tumors are better differentiated and less invasive and that their morphology is closer to the normal glandular structure of the endometrium. Group 2 tumors are less well differentiated, more often invade the myometrium, and include histologic variants such as papillary, clear cell, and anaplastic carcinoma that are dissimilar from the glandular structure of the normal endometrium. Mucinous adenocarcinomas and the presence of stromal foam cells were found to be associated with group 1 EC. Progesterone receptors (PR) were measured in a sample of 30 patients. They were present in all cases of group 1 ranging from 50 to 2,400 fmol/mg protein and absent or very low (30-190 fmol/mg protein) in group 2. All EC with stromal foam cells had high PR (380-2,400 fmol/mg protein). This study confirms that estrogen-related EC is generally a better differentiated and less aggressive tumor and suggests that there are two types of EC. The tumors not related to estrogens, which are histologically more malignant, were seen in an older age group of patients. In addition to the currently accepted methods of clinical evaluation of EC patients, defining the morphologic and biochemical characteristics of two types of EC may contribute to the management of EC, now the most prevalent cancer of the female pelvis. The patients known to be at risk for endometrial carcinoma, identifiable by abnormal hormonal manifestations (obesity, infertility, and other conditions related to hyperestrogenism) as well as those receiving exogenous estrogens are likely to develop a better differentiated and less aggressive form of neoplasia. It would be important to elaborate a system of early detection of EC in the group of elderly patients with no signs of hyperestrogenism prone to develop the less differentiated and biologically more aggressive tumors.     

Verpflichtung zur Ausschreibung des Vertragsarztsitzes nach Erreichen der Altersgrenze

Abstrakt 1. Die Verpflichtung zur Ausschreibung des Vertragsarztsitzes mit Erreichen der Altersgrenze ist grunds?tzlich nicht gem. § 138 BGB i.V. mit Art. 12 GG nichtig. 2. Gegenüber der Ausschreibungsverpflichtung besteht kein Zurückbehaltungsrecht wegen eines Abfindungsanspruchs. (Leits?tze des Bearbeiters)     

Herausgabe von CT- und MRT-Aufnahmen im Original zur Prüfung von Schadensersatzansprüchen

Ohne Zusammenfassung     

Gesamtschuldnerausgleich im Arzthaftungsprozess

Abstrakt 1. Für eine gesamtschuldnerische Haftung für den Tod eines Patienten ist es grunds?tzlich ausreichend, wenn beide ?rzte durch ihre jeweiligen Behandlungsfehler nebeneinander kausal für den Tod des Patienten geworden sind. Es ist nicht erforderlich, dass der Zweitbehandler auf Untersuchungsergebnisse des Erstbehandlers zurückgegriffen hat oder in dessen Behandlungst?tigkeit eingebunden gewesen ist. 2. Einem entscheidungserheblichen Beweisantritt ist in Anlehnung an die in § 244 Abs. 3–5 StPO geregelten Gründe zur Ablehnung eines angebotenen Beweises unter Berücksichtigung der Besonderheiten des Zivilprozesses nicht nachzugehen, wenn das angebotene Beweismittel ungeeignet ist. 3. Von einer Ungeeignetheit des Beweismittels ist auszugehen, wenn die Krankenunterlagen als Begutachtungsgrundlage für die Erstellung eines medizinischen Sachverst?ndigengutachtens im Hinblick auf die ?rztliche Schweigepflicht des auf Schadensersatz in Anspruch genommenen Arztes nicht verwertet werden k?nnen. 4. Nach dem Tod eines Patienten sind mit Blick auf die H?chstpers?nlichkeit der Entscheidung über die Entbindung von der Schweigepflicht hierzu nicht die Erben berechtigt; vielmehr ist mangels einer Willens?u?erung des Patienten zu Lebzeiten dessen mutma?licher Wille zu erforschen. Sofern hierfür keine anderen Indizien zur Verfügung stehen, kann der beweisbelasteten Partei die Vorlage einer Schweigepflichtentbindungserkl?rung der Erben des verstorbenen Patienten aufgegeben werden, um so einen Anknüpfungspunkt für einen Rückschluss auf den mutma?lichen Willen des Verstorbenen zu haben. Kann die Kl?gerseite eine solche Schweigepflichtentbindungserkl?rung nicht vorlegen und liegen auch im übrigen keine hinreichenden Anhaltspunkte dafür vor, dass der verstorbene Patient eine Befreiung des beklagten Arztes von der Schweigepflicht gewünscht h?tte, ist die Klage ohne sachliche Prüfung abzuweisen. (Leits?tze des Bearbeiters)     

The cost of hospital-related care of patients with psoriasis in Italy based on the AISP study

The objective of this study was to assess the cost of caring for patients with psoriasis in Italy according to the AISP study (Associazione Italiana Studi Psoriasi or Italian Association for Studies on Psoriasis), involving 104 university and hospital centres and 7992 patients in 1994. The mean yearly cost of care for a single patient was calculated at 905 Euros. Hospitalization accounted for more than four-fifths of the costs, therapy for about one-eighth (systemic therapies were the most expensive) and office visits and day hospitals for the remainder. In our study series less than 20% of patients accounted for more than 90% of the total costs.