Nontumorous vascular malformations in the liver: color Doppler ultrasonographic findings.

OBJECTIVE: To investigate color Doppler and spectral wave characteristics of nontumorous vascular malformations in the liver. METHODS: From September 1995 to January 2001, 32 cases of vascular malformations were identified by means of color Doppler ultrasonography and spectral wave analysis. Computed tomography, angiography, or both were performed in all cases. RESULTS: Five arterioportal and 14 portovenous malformations, 1 arteriovenous malformation, and 4 portoportal and 8 venovenous shunts were detected. Associations with Rendu-Osler-Weber syndrome in 6 cases and with cirrhotic liver in 12 cases were found Fourteen patients were liver disease free. In 3 cases, interventional procedures were necessary to reduce portal hypertension or cardiac dysfunction. The incidence of finding vascular malformations in 12,000 patients was 0.1%. CONCLUSIONS: Nontumorous vascular malformations are rare disorders in the liver. They may appear in patients with healthy livers and in patients with portal hypertension. Color Doppler ultrasonography and spectral wave analysis are capable of showing and differentiating different types of hepatic vascular malformations.     

Alveolar granulocyte colony-stimulating factor and alpha-chemokines in relation to serum levels, pulmonary neutrophilia, and severity of lung injury in ARDS

OBJECTIVES: To determine granulocyte colony-stimulating factor (G-CSF), epithelial neutrophil-activating peptide (ENA)-78, and interleukin (IL)-8 in BAL fluid (BALF), epithelial lining fluid (ELF), and serum for establishing the concentration gradient of G-CSF, ENA-78, and IL-8 between the blood and the alveolar space in ARDS and acute lung injury (ALI); and to evaluate the relationship of G-CSF, IL-8, and ENA-78 to pulmonary neutrophilia and severity of lung injury. DESIGN: Prospective study. SETTING: An adult trauma/surgical ICU. PATIENTS: Nineteen patients with ARDS and 10 patients with ALI. INTERVENTIONS: None. Measurements and main results: BAL and blood sampling simultaneously within 12 h and 24 h after onset of ARDS/ALI; G-CSF was detected in BALF in 18 of 19 patients with ARDS, in 7 of 10 patients with ALI, and in all serum samples. G-CSF in BALF and serum was significantly higher in ARDS than in ALI. ENA-78 was detected in BALF in 14 of 19 patients with ARDS, in 8 of 10 patients with ALI, and in serum of all patients. Levels in BALF and serum were not different between ARDS and ALI. IL-8 was detected in all patients; concentrations in BALF in ARDS were significantly higher than in ALI. Concentrations of G-CSF, ENA-78, and IL-8 in ELF were significantly higher than in serum. G-CSF in BALF and serum and IL-8 in BALF correlated positively with pulmonary neutrophilia. G-CSF in serum and IL-8 in BALF correlated negatively with PaO(2)/fraction of inspired oxygen (FIO(2)) ratio. However, ENA-78 did not show a correlation with neutrophil count or with PaO(2)/FIO(2) ratio. CONCLUSIONS: G-CSF may be pathophysiologically important for accumulation and activation of neutrophils in ARDS. Local G-CSF production is the likely driving force for neutrophils rather than elevation of circulating levels. In comparison to ENA-78, IL-8 seems to be the predominant neutrophil chemoattractant in the early phase of ARDS.     

Isolation and characterisation of Ralstonia solanacearum strains from Solanaceae crops in Ethiopia

Eighty one isolates of Ralstonia solanacearum -like bacteria on triphenyl tetrazolium chloride (TTC) medium were collected from different Solanaceae crops (i.e. potato, tomato and pepper plants and potato tubers) at various sites in Ethiopia. Of these, 62 strains were identified as R. solanacearum based on their cultural characteristics on TTC medium, tomato pathogenicity bioassay, carbon source utilisation patterns and a specific PCR-based assay. By Hayward's classification method, based on carbon source utilisation, 19 of the 62 R. solanacearum strains were identified as biovar I and 43 strains were identified as biovar II. The biovar I strains exhibited a high growth rate at high temperatures (37 degrees C). Whereas the growth rate of biovar II strains was greatest at lower temperatures (22 degrees C). Biovar I strains had broader host range than biovar II strains, which were limited to potato, tomato, and eggplant. To our knowledge, this is the first report of R. solanacearum biovar I in Ethiopia. The existence of biovar I strains in Ethiopia raises concerns because they have a broader host range than biovar II strains.     

Increased angiogenesis in the bone marrow of patients with systemic mastocytosis

Recent data suggest that angiogenesis in the bone marrow (BM) is augmented and associated with growth of neoplastic cells in various hematological malignancies. Systemic mastocytosis (SM) is a neoplasm affecting multilineage and mast cell (MC)-committed hemopoietic progenitors. In the present study, we have assessed the BM microvessel density (MVD) by CD34 immunohistochemistry in 21 patients with SM, 5 with cutaneous mastocytosis (no BM infiltrates), and 5 control cases (normal BM). The median BM MVD was significantly higher in SM compared to cutaneous mastocytosis or controls (P < 0.05). In addition, a significant correlation (r = 0.74) between the BM MVD and grade of MC infiltration (percent tryptase(+) BM infiltrates) was found in SM. Moreover, the MVD was higher in MC infiltrates compared to the nonaffected adjacent marrow (P < 0.05). Immunohistochemical staining revealed expression of vascular endothelial growth factor in MC infiltrates. The notion that SM is associated with increased BM angiogenesis and vascular endothelial growth factor expression may have implications for the biology of disease and development of new treatment strategies.     

Sex-dependence of the relative number of elastic fibres in human heart valves.

The aim of the current study was to find out whether there are sex-dependent differences in the relative number of elastic fibres in human heart valves. Twenty-six aortic valves, 26 mitral valves, 33 pulmonary valves and 28 tricuspid valves of both sexes were obtained at autopsy from newborn to 89-year-old patients who died of noncardiac diseases. The quantitatively morphometric investigations were carried out on conventionally stained (Resorcinfuchsin) histological sections. The results were qualitatively examined with immuno-histochemically marked (anti-elastin antibodies) histological sections. Earlier examinations by Leutert [1976. Z. Gesamte Inn. Med. 31, 97-104] showed that the atrioventricular valves have the following layers: endothelium, atrial fibroelastic tissue (S1), fibrous tissue, ventricular fibroelastic tissue (S2) and endothelium. In our study, the ventricular side of the semilunar valves corresponds to side S1, whereas the vessel side corresponds to side S2. Three regions of interest were examined on each side of the valves: base, mid and tip. The number of elastic fibres per measuring area for all four human heart valves was significantly higher (p < 0,001) in fibroelastic tissue of side S1 than in fibroelastic tissue of side S2. Neither on side S1 nor on side S2 were there significant gender-related differences in the relative number of elastic fibres per measuring area. The results suggest a characteristic distribution of the elastic fibre system which is not sex-dependent but closely related to the function of the heart valves.     

Transient receptor potential canonical channel 1 impacts on mechanosignaling during cell migration

Cell migration is crucial for many important physiological and pathophysiological processes ranging from embryogenesis to tumor metastasis. It requires the coordination of mechanical forces generated in different regions of the migrating cell. It has been proposed that stretch-activated, Ca²⁺-permeable channels are involved in mechanosignaling during cell migration. To date, the molecular identity of these channels is only poorly defined. Here, we investigated the contribution of TRPC1 channels to mechanosignaling during cell migration. We used primary cultures of synovial fibroblasts from TRPC1^?/? mice and the wild-type littermates or Madin?CDarby canine kidney (MDCK-F) cells with increased or decreased TRPC1 expression. TRPC1^?/? fibroblasts have the same migratory phenotype as siTRPC1 MDCK-F cells, with a largely increased projected cell area and impaired directionality. Measurements of the intracellular Ca²⁺ concentration ([Ca²⁺]_i) were combined with time-lapse video microscopic cell migration experiments. Cells were seeded on elastic silicone membranes. Uniaxial stretch elicits a graded elevation of the [Ca²⁺]_i in TRPC1-expressing cells. In contrast, TRPC1^?/? fibroblasts or siTRPC1 MDCK-F cells do not react to 0.4?%, and the response to 4?% stretch is attenuated. Similarly, siTRPC1 MDCK-F cells do not alter their direction of migration upon mechanical stimulation, which contrasts the behavior of TRPC1-overexpressing cells which turn into the direction of stretch. Impaired mechanosignaling in siTRPC1 MDCK-F cells leads to accelerated lamellipodial protrusions. Finally, artificially decreasing membrane tension with the detergent deoxycholate impairs the migration of TRPC1-overexpressing cells, but not of siTRPC1 cells. Taken together, our findings indicate that TRPC1 channels are linked to mechanosignaling during cell migration.     

Osteoporosis in Transplant Recipients

Osteoporosis is a frequent and severe complication of transplantation that substantially reduces the recipient's quality of life. However, strategies to prevent or to treat osteoporosis have as yet not been established. Determination of bone mass and density is the basis for interventions following transplantation. Therefore, bone mineral density should be measured in all patients awaiting transplantation to assess their individual risk of fracture. Prophylaxis should be considered in patients at high risk in view of the rapid initial bone loss after transplantation. Treatment of acute rejection with corticosteroids induces more bone loss than maintenance therapy with corticosteroids. Once manifest osteoporosis has occurred, treatment with a triple therapy consisting of calcium, vitamin D and either calcitonin or bisphosphonates is possible without negative effects on graft function. Therapy should be initiated according to the general guidelines for osteoporosis therapy, but several aspects specific for this patient group have to be considered. The present recommendations for the management of osteoporosis after transplantation need to be proven by further intervention studies.     

Urothelial carcinoma of the upper urinary tract: inverted growth pattern is predictive of microsatellite instability

Urothelial carcinoma of the renal pelvis and ureter may develop as a manifestation of hereditary nonpolyposis colorectal cancer syndrome (HNPCC), a disorder characterized by mutation or inactivation of a number of DNA mismatch repair genes and detectable as microsatellite instability (MSI). Some urothelial carcinomas display areas of endophytic, or inverted, growth. In this study, urothelial cancers of the upper urinary tract (n = 132) from patients treated at 2 tertiary care centers were studied to identify an association between growth pattern and MSI. Thirty-five neoplasms were microsatellite unstable (26.5%), and MSI was more frequent in papillary lesions than in sessile urothelial cancers (P = .033). The amount of inverted growth was estimated as a percentage of the total tumor. The interobserver and intraobserver concordance in recognizing inverted growth was good, and 65.7% of microsatellite-unstable tumors exhibited at least 20% of an inverted growth component, compared with only 17.5% of microsatellite-stable tumors (P < .0001). In this series, inverted growth predicted MSI with a sensitivity and specificity of .82. Inverted growth in urothelial carcinomas of the upper urinary tract may serve as a marker lesion for MSI and may help identify patients who should be offered testing for HNPCC.