Innovative Sonographie beim Prostatakarzinom

Zusammenfassung Zur Früherkennung und Stadieneinteilung des Prostatakarzinoms wird heutzutage fast ausschließlich die sog. systematische Mehrfachbiopsie eingesetzt. Hierbei tritt das bildgebende Verfahren – der transrektale Ultraschall – als Diagnostikum mehr und mehr in den Hintergrund und dient fast ausschließlich zur Führung der Biopsienadel in spezifische anatomische Regionen. Doch selbst bei multiplen systematischen Biopsien wird eine hohe Zahl klinisch signifikanter Karzinome übersehen. Diese Tatsache hat zu einer drastischen Steigerung der Anzahl von Gewebeproben geführt. So finden sich Zentren, in denen 6, 10, 12, ja bis zu 143 Gewebeproben in einer Sitzung entnommen werden. Diese immer invasivere heterogene Vorgehensweise bestätigt den Bedarf an Verbesserung in der Ultraschalldiagnostik. Neue und innovative bildgebende Verfahren in der Prostatasonographie werden vorgestellt mit dem Ziel, die diagnostische Aussagekraft bei Erstdiagnose sowie in der Stadienvorhersage zu verbessern. Eine verbesserte Bildgebung bei Diagnosestellung und in der Stadieneinteilung würde zu einer erheblichen Verbesserung bei den Therapieentscheidungen führen.Dieser Beitrag ist dem kürzlich verstorbenen Pathologen J. E. McNeal gewidmet, der die zonale Anatomie der Prostata erstbeschrieben hat.     

Preparation of a pure autologous biodegradable fibrin matrix for tissue engineering

Parallel to the growing role of tissue engineering, the need for cell embedding materials, which allow cells to stabilise in a three-dimensional distribution, has increased. Although several substances have been tested, fibrin is thus far the only one that permits the clinical application of cultured tissue. To date, can cause severe immunological side effects. The objective of this study was to explore the practicability of obtaining autologous thrombin from a single patient in an adequate concentration and amount. Fibrinogen was cryoprecipitated from 200 ml of freshly-frozen plasma. Thrombin was isolated from the supernatant through ionexchange chromatography. The thrombin was first bound to Sephadex A-50 and then eluated using 2ml of a salt buffer (2.0M NaCl in 0.015M trisodiumcitrate, pH 7.0). The activity of the thrombin (51 NIH ml⁻¹ to 414 NIH ml⁻¹) reached levels comparable to those in commercially available fibrin glues (4–500 NIH ml⁻¹). The study has shown that it is possible to obtain a sufficient amount of autologous thrombin from a single donor to create a fibrin matrix of high efficiency without the risk of immunological and infectious side effects.     

Temporal profile of potassium channel dysfunction in cerebrovascular smooth muscle after experimental subarachnoid haemorrhage

The pathogenesis of cerebral vasospasm after subarachnoid haemorrhage (SAH) involves sustained contraction of arterial smooth muscle cells that is maximal 6–8 days after SAH. We reported that function of voltage-gated K⁺ (K_V) channels was significantly decreased during vasospasm 7 days after SAH in dogs. Since arterial constriction is regulated by membrane potential that in turn is determined predominately by K⁺ conductance, the compromised K⁺ channel dysfunction may cause vasospasm. Additional support for this hypothesis would be demonstration that K⁺ channel dysfunction is temporally coincident with vasospasm. To test this hypothesis, SAH was created using the double haemorrhage model in dogs and smooth muscle cells from the basilar artery, which develops vasospasm, were isolated 4 days (early vasospasm), 7 days (during vasospasm) and 21 days (after vasospasm) after SAH and studied using patch-clamp electrophysiology. We investigated the two main K⁺ channels (K_V and large-conductance voltage/Ca²⁺-activated (K_Ca) channels). Electrophysiologic function of K_Ca channels was preserved at all times after SAH. In contrast, function of K_V channels was significantly decreased at all times after SAH. The decrease in cell size and degree of K_V channel dysfunction was maximal 7 days after SAH. The results suggest that K_V channel dysfunction either only partially contributes to vasospasm after SAH or that compensatory mechanisms develop that lead to resolution of vasospasm before K_V channels recover their function.     

Retroperitoneal mature teratoma 15 years after initial treatment of testicular mixed germ cell tumor

We present a patient with a retroperitoneal tumor noted 15 years after treatment of a testicular mixed germ cell cancer. The patient initially underwent right-sided orchiectomy and retroperitoneal lymph node dissection for clinical stage I disease. An early relapse indicated by increasing tumor markers shortly after retroperitoneal lymph node dissection was successfully treated with five cycles of combined chemotherapy. However, 187 months after completion of chemotherapy, a symptomatic right-sided iliac mass was diagnosed. Radical surgical excision of the mass was performed and histologic examination revealed differentiated mature teratoma. This represents the longest time interval reported in the literature for a mature teratoma following treatment of a testicular germ cell tumor.     

Late-gestation rat myometrial cells express multiple isoforms of phospholipase A2 that mediate PCB 50-induced release of arachidonic acid with coincident prostaglandin production.

Previous reports have shown that ortho-substituted polychlorinated biphenyls (PCBs) are uterotonic and activate phospholipase A2 to release arachidonic acid (AA) from membrane phospholipids. AA serves as the precursor to various eicosanoids, which, in addition to AA itself, are capable of modulating uterine function. To examine whether PCBs stimulate phospholipase A2 (PLA2) to mobilize arachidonic acid from late-gestation rat uterus, primary cultures of gestation day 20 (gd20) rat myometrial cells (RMC) were labeled with 0.5 microCi 3H-AA prior to a 10-, 20-, or 30-min exposure to 2,2',4,6-tetrachlorobiphenyl (PCB 50) (1-50 microM) or 0.1% DMSO (solvent control). PCB 50 stimulated the release of 3H-AA from gd20 RMC in concentration- and time-dependent manners (p < 0.05). PCB 50 stimulation of RMC was attenuated with ethylene glycol bis(2-aminoethyl ether)-N,N,N'N'-tetraacetic acid (EGTA) and nifedipine, suggesting that AA release was dependent on the influx of extracellular calcium through L-type voltage-operated calcium channels. PCB 50-induced release of AA from RMC was also attenuated with the PLA2-specific inhibitors methyl arachidonyl fluorophosphonate (MAFP), bromoenol lactone (BEL), and manoalide (p < 0.05). Stimulation of PLA2 enzymes in response to PCB exposure occurred via p38 mitogen activated protein kinase (MAPK) activation as indicated by the significant attenuation of PCB 50-induced AA release from RMC in the presence of SB 202190. In addition to stimulating AA release, PCB 50 induced a significant production of prostaglandins from gd20 RMC compared with controls (p < 0.05). These results suggest that myometrial cells express multiple PLA2 isoforms that may serve as a target and effector for ortho-substituted PCB-mediated stimulation of uterine function through arachidonic acid and prostaglandin release.     

Malaria PCR Detection in Cambodian Low-Transmission Settings: Dried Blood Spots versus Venous Blood Samples

In the context of malaria elimination, novel strategies for detecting very low malaria parasite densities in asymptomatic individuals are needed. One of the major limitations of the malaria parasite detection methods is the volume of blood samples being analyzed. The objective of the study was to compare the diagnostic accuracy of a malaria polymerase chain reaction assay, from dried blood spots (DBS, 5 μL) and different volumes of venous blood (50 μL, 200 μL, and 1 mL). The limit of detection of the polymerase chain reaction assay, using calibrated Plasmodium falciparum blood dilutions, showed that venous blood samples (50 μL, 200 μL, 1 mL) combined with Qiagen extraction methods gave a similar threshold of 100 parasites/mL, ∼100-fold lower than 5 μL DBS/Instagene method. On a set of 521 field samples, collected in two different transmission areas in northern Cambodia, no significant difference in the proportion of parasite carriers, regardless of the methods used was found. The 5 μL DBS method missed 27% of the samples detected by the 1 mL venous blood method, but most of the missed parasites carriers were infected by Plasmodium vivax (84%). The remaining missed P. falciparum parasite carriers (N = 3) were only detected in high-transmission areas.     

Two cases of Kallmann syndrome associated with empty sella

Kallmann syndrome (KS) is a developmental disease characterized by the association of isolated hypogonadotropic hypogonadism and anosmia/hyposmia. We report an unusual presentation of two females with KS and empty sella. These females, aged at 20 and 29-year-old, presented primary amenorrhea with prepubertal estradiol and low gonadotropin levels. No other significant clinical signs were observed. Empty sella was observed on MRI in both cases. Sequencing of FGFR1 gene, recently implicated in autosomal form of KS, was performed and one splicing mutation (IVS14 + 1G > A) was identified in one patient.