The potential value of (Myo)fibroblastic stromal reaction in the diagnosis of prostatic adenocarcinoma

BACKGROUND: Reactive stromal changes that occur in different human cancers probably are involved in local tumor spreading. The aim of this study was to analyze changes of the stroma in prostatic carcinoma and to establish their possible diagnostic significance. METHODS: For the definition of reactive stroma in prostate cancer Mallory trichrome method and immunohistochemical analysis of vimentin, alpha-smooth muscle actin, and desmin were performed. RESULTS: Compared with adjacent peritumoral tissue and stroma in benign prostatic hyperplasia, reactive stroma in prostate cancer showed increased vimentin expression, and decreased desmin expression (P < 0.05). Mallory method also showed more pronounced desmoplastic reaction in stroma of prostatic adenocarcinoma (P < 0.05). CONCLUSIONS: Our study indicates that a reactive stroma, which occurs in prostatic carcinoma, could be clearly shown by Mallory method and confirmed by immunohistochemistry. We suggest that Mallory trichrome method may be used as a helpful additional diagnostic tool in the diagnosis of suspicious cases of prostatic adenocarcinoma.     

ACE inhibitors and angiotensin II receptor antagonists in acute coronary syndrome

Angiotensin II (AT II) is a final product of the renin-anglotensin-aldosterone system (RAS) and presents one of the most influential factors in the pathogenesis of atherosclerosis, acute coronary syndrome, myocardial dysfunction and heart failure. ACE-inhibitors (ACEI), beside beta adrenergic blockers, are a cornerstone of the current chronic heart failure (CHF) treatment. Evidence based medicine has not yet proved any significant beneficial effects of ACEI in patients with unstable angina pectoris (UAP), although according to the SoLVD study testing the possible effects of ACEI in patients with significant left ventricular dysfunction and/or CHF, there was a significant hospitalization rate reduction as well as less transformation of UAP to myocardial infarction in patients treated with ACEI. In the GISSI 3, ISIS 4 and CCS studies, ACEI was given within the first 24 hours and continued for 4-6 weeks. According to pooled results, ACE inhibitor could save 11/1000 patients with ST-elevation myocardial infarction (STEMI) and only 1/1000 patients with non ST-elevation myocardial infarction (NSTEMI). In the SAVE, AIRE and TRACE studies, ACEI was started later, i.e. 3-16 days after acute myocardial infarction and continued for several years. ACEI therapy resulted in a significantly lower mortality during the first year, and an even 20% relative reduction in the total mortality during the 4-year follow up. The effects of ACEI were even more prominent in more severe myocardial dysfunction, as it was well known that they could slow or stop unfavorable myocardial remodeling. Conclusively, ACEI should be given as early as possible to all patients with acute myocardial infarction, if no contraindications. The HOPE study showed efficacy of ACEI in the primary prevention of ischemic heart disease in high risk individuals, and the EUROPA study showed a favorable effect of ACEI in the secondary prevention of ischemic heart disease in low risk patients. According to these findings, ACEI should be given permenantly following myocardial infarction. These findings suggest the need of a permanent treatment with ACEI in patients having sustaned myocardial infarction. Angiotensin-1 receptor antagonists (AT-1 antagonists) are a newer generation of neurohormonal antagonists, which block the effects of AT II produced not only through a classic, ACE-dependent pathway but also via alternative pathways (non ACE-dependent) and selectively bind to AT-1 receptors for AT II. Therefore, they have some theoretical advances in comparison with ACEI. There are 2 relevant studies elucidating their possible role in treating patients with or post-myocardial infarction. The OPTIMAAL study did not prove losartan to be better than an ACEI (captopril), while the VALIANT study showed that the effects of valsartan vs. captopril were statistically nonsignificantly different. Furthermore, there is no sense to combine AT-1 antagonist and ACEI, while a combination of AT-1 antagonist and a beta blocker is justified. In other words, AT-1 antagonist (the class effect is disputable) should be given to patients with acute myocardial infarction or to post-myocardial infarction patients who cannot take ACEI.     

Exercise and allergic diseases

The aim of this study was to compare exercise-induced bronchial reaction between healthy control subjects and subjects with allergic rhinitis (AR) and allergic asthma (AA). It included 16 controls, 16 subjects with AR and 19 subjects with AA. A skin prick test, pulmonary function test, histamine challenge test and exercise challenge test (ECT) were performed in all subjects. Bronchial reaction to exercise was expressed as the fall index FEV1 (%), AUC(0-30) (min x %), and fall index FEF(25-75) (%). After ECT, subjects with AA had a significantly greater bronchial reaction to exercise than subjects with AR and controls (respective fall index FEV1 8.4, 2.9, and 2.4%, P=0.0083; AUC(0-30) 127.7, 29.6, and 33.1 min x %, P=0.025; and fall index FEF(25-75) 14.6, 0.06, and 1.9%, P<0.001). No difference was found between subjects with AR and controls. In conclusion, ECT induced a significantly greater bronchial reaction in patients with AA and bronchial hyperreactivity to histamine than in patients with AR and bronchial normoreactivity to histamine and controls. This difference was not found between subjects with AR and controls.     

Neuromusculoskeletal chest pain

To determine frequency of neuromusculoskeletal etiology of chest pain is performed. By means of a retrospective analysis and on the basis of the history of the patients' disease, data were collected after chest pain had been medically worked out. The causes to chest pain were in 82% of cardial etiology, in 9% of neuromusculoskeletal etiology, in 6% of gastrointestinal etiology and 3% others. All the patients suffering from neuromusculoskeletal causes to chest pain were, besides anti-rheumatic therapy, also treated by certain form of cardiac therapy. The task of a doctor is to accurately recognize serious disorders as possible causes to chest pain. However, the doctor must not make wrong diagnosis of potentially dangerous conditions thus causing unwanted psychological and economical consequences. In order to realize this, adequate diagnostic possibilities are necessary besides the knowledge about all possible causes to chest pain.     

Antibody response and virus tissue distribution in chickens inoculated with wild-type and recombinant fowl adenoviruses

We demonstrated that the long tandemly repeated region (TR-2) is dispensable for in vitro replication of fowl adenovirus 9 (FAdV-9). The TR-2-deleted recombinant FAdV-9 expressing the enhanced green fluorescence protein was further characterized for in vivo effects. Groups of chickens were exposed to recombinant or wild-type FAdV-9 by intramuscular injection, through the feed or drinking water and one group served as a negative control. The antibody (Ab) response, evaluated by ELISA and a plaque reduction test depended on the virus, dosage and the route of inoculation. Although the highest levels of anti-viral Ab were detected in chickens inoculated intramuscularly (i.m.) with wild-type FAdV-9, the deletion of TR-2 did not have a significant effect on the immune response. The tissue distribution of the virus was examined by the polymerase chain reaction (PCR) and was similar for both wild-type and recombinant viruses. Based on these results the TR-2 was dispensable for viral replication in vivo and did not influence virus distribution, and the recombinant FAdV-9 induced the same immune response as the wild-type virus.     

Public stem cell banks: considerations of justice in stem cell research and therapy

If stem cells fulfill their therapeutic promise, moving them from the laboratory into the clinic will raise several concerns about justice. One concern is that, for biological reasons alone, stem cell‐based therapies might not be available for every patient who needs one. Worse, depending on how we address the problem of biological access, they might benefit primarily white Americans. We can avoid this outcome—although at a cost—by carefully selecting the stem cells we make available.     

Prosthetic mesh for infected abdominal wall defects? Report of a patient with a large full thickness abdominal wall defect and colostomy due to a gunshot wound.

Reconstruction of large, infected abdominal wall defects is often difficult. Local factors, such as defect size, presence of infection, adequate skin coverage and presence of enteric fistulae dictate the reconstructive method that can be used. Placement of prosthetic mesh materials into infected defects was generally not recommended due to a high rate of extrusion and fistulae. We present a patient with a large infected abdominal wall defect, exposed intestines and colostomy due to a gunshot wound that was successfully treated with a polypropylene mesh reinforcement and free latissimus dorsi muscle flap coverage. Twelve months following abdominal wall reconstruction with stable soft tissue cover, the patient is without any signs of hernia or infection. We conclude that prosthetic mesh repair of infected abdominal wall defects of such characteristics that preclude other reconstructive procedures can be attempted provided there is coverage with a well vascularised tissue.     

Large complex odontoma of the left maxillary sinus

Odontomas as a group are the most common odontogenic neoplasms. They are mixed lesions containing fully formatted dental tissues, both epithelial and mesenchymal, and are usually found during a routine radiographic examination or as a factor in noneruption. Odontomas can be divided into two types: the complex and the compound odontoma. Both types are composed of enamel, dentin, cementum and pulp tissues, but in complex odontomas the tissues are arranged in a haphazard fashion with no discernible dental structures, whereas in compound odontomas the dental tissues exist in a more regular pattern so that the lesion consists of tooth-like structures. We report a case of a 23-year-old man with a large complex odontoma involving the left maxilla and maxillary sinus with clinical, radiographic and histological findings. Because of the size of the mass and its clinical course, benign neoplasms were considered in the differential diagnosis. Surgery was the treatment of choice, and recurrence of the lesion is not expected.