Seguridad y eficacia de la biopsia renal percutánea / Safety and efficacy of percutaneous renal biopsy

Se realizó una evaluación de la seguridad y eficacia del procedimiento de la biopsia renal percutánea BRP de riñones nativos bajo control ecográfico simultáneo. Se revisaron las historias clínicas de todos los pacientes que fueron biopsiados en el período comprendido entre enero de 2005 y diciembre de 2008 en el Servicio de Nefrología del Hospital de Pediatría Juan P. Garrahan. Se excluyeron del análisis los procedimientos realizados bajo anestesia general y en riñón transplantado. Se evaluaron 117 procedimientos realizados en 114 pacientes: 59 varones (50.4%) y 55 mujeres (49.6%). Las indicaciones más frecuentes de BRP fueron: proteinuria masiva o significativa con o sin hematuria 45 (38,6%), Lupus Eritematoso Sistémico 32 (27.4%) y síndrome nefrótico cortico-resistente 23 (20%); otras menos frecuentes estuvieron representadas por: Púrpura de Schönlein-Henoch 7 (6%), insuficiencia renal aguda (IRA) 5 (4%) e insuficiencia renal crónica (IRC) 5 (4%). No se produjeron eventos adversos (EA) en 97 (83%) procedimientos. En 20 (17%), se produjeron EA. Los EA no serios fueron 9: microhematuria (n=3), macrohematuria (n=3) y dolor lumbar (n=3). Los 11 restantes fueron EAS (serios) que correspondieron a hematomas perirrenales de los cuales 2 requirieron transfusión de glóbulos rojos. Las muestras obtenidas fueron suficientes para el diagnóstico en 113 procedimientos (97%), con un número de glomérulos de 30 ± 11. Los resultados demostraron que el procedimiento de BRP con disparador automático, anestesia local y control ecográfico simultáneo es seguro y eficaz. El número de EAS registrados en este estudio es similar o menor según las series analizadas. A diferencia de la publicación internacional en nuestro centro se realiza el procedimiento con el paciente despierto (AU)

In this study we evaluated the safety and efficacy of ultrasound-guided percutaneous renal biopsy (PRB) of native kidneys. The clinical charts of all patients that underwent PRB between January 2005 and December 2008 at the Department of Nephrology of the Pediatric Hospital Juan P. Garrahan were reviewed. Procedures performed under general anesthesia and in transplanted kidneys were excluded from the analysis. We evaluated 117 procedures performed in 114 patients: 59 were male (50.4%) and 55 female (49.6%). The most frequent indications for PRB were: massive or significant proteinuria with or without hematuria 45 (38,6%), systemic lupus erythematosus 32 (27.4%), and steroid-resistant nephrotic syndrome 23 (20%); other less frequent indications were: Henoch-Schönlein purpura 7 (6%), acute renal insufficiency (ARI) 5 (4%), and chronic renal insufficiency (CRI) 5 (4%). No adverse events (AE) were observed in 97 (83%) procedures. AE were seen in 20 (17%). There were 9 minor AE: microhematuria (n=3), gross hematuria (n=3), and lumbar pain (n=3). Serious AE observed were perinephric hematoma in 11 patients of whom 2 required red blood cell transfusions. The sample size was sufficient for diagnosis in 113 procedures (97%), with a number of glomeruli of 30 ± 11. The results show that ultrasoundguided PRB with an automatic trigger and local anesthesia is a safe and effective procedure. The number of serious AE in this study is similar to or lower than reported in previous series. Unlike other international series, at our center the procedure is performed while the patient is awake (AU)

Embryonic chicken trachea as a new in vitro model for the investigation of mucociliary particle clearance in the airways.

Mucociliary clearance (MC) is an important defense mechanism of the respiratory system to eliminate inhaled and possibly noxious particles from the lung. Although the principal mechanics of MC seem to be relatively clear there are still open questions regarding the long-term clearance of particles. Therefore, we have developed a new set-up based on embryonic chicken trachea (ECT) to investigate mucociliary particle clearance in more detail. ECT was placed in an incubation chamber after carbon particles were applied and tracked using optical microscopy. The aim of the study was to validate this model by investigating the impact of temperature, humidity and drugs on particle transport rates. Particles were transported reproducibly along the trachea and clearance velocity (2.39 +/- 0.25) mm/min was found to be in accordance to data reported in literature. Variation in temperature resulted in significantly reduced MC: (0.40 +/- 0.12) mm/min (20 degrees C); (0.42 +/- 0.10) mm/min (45 degrees C). Decreasing humidity (99-60%) had no significant effect on MC, whereas reduction to 20% humidity showed a significant influence on particle clearance. The use of different cilio- and muco-active drugs (propranolol, terbutalin, N-acetylcysteine) resulted in altered MC according to the pharmacological effect of the substances: a concentration dependent decrease of MC was found for Propranolol. From our results we conclude that this model can be employed to investigate MC of particles in more detail. Hence, the model may help to understand and identify decisive physico-chemical parameters for MC and to answer open questions regarding the long-term clearance phenomenon.

[Comparison between 1.5% lidocaine with adrenaline and 1.5% plain mepivacaine in axillary brachial plexus block]. / Comparaison de la lidocaïne 1.5% adrénalinée et de la mépivacaïne 1.5% dans le bloc axillaire du plexus brachial.

OBJECTIVES: To evaluate the distribution of sensory blockade, the onset time and the duration of the axillary plexus block obtained after the administration of 40 mL of 1.5% lignocaine with adrenaline or 40 mL of plain 1.5% mepivacaine. STUDY DESIGN: Prospective, randomised, comparative, double blind study. PATIENTS AND METHODS: One hundred and fifty five patients undergoing hand surgery were randomised into two groups: in group L, 73 patients were given 1.5% lignocaine with 1/200,000 adrenaline and in group M, 82 patients received 1.5% mepivacaine. The entire volume was injected on the first evoked motor activity obtained for a current less than 0.5 mA. Sensory and motor block of each of the four major nerves of the hand and forearm were assessed using light touch and motor strength respectively. The block was considered complete when all nerves were anaesthetised (median, radial, musculocutaneous and ulnar). RESULTS: The percentage of complete sensitive blockade was 22% in group L and 24% in group M. Complete motor blockade was respectively 27% in group L and 40% in group M. The median time required to obtain a complete sensory blockade was 18 min for both group. The median time required to obtain a complete motor blockade was 17 min in-group L and 16 min in-group M. The duration of the sensory blockade was not different for both groups (i.e., 255 +/- 76 min versus 231 +/- 70 min in group L and M respectively. The duration of the motor blockade was longer in group L compared to group M (199 +/- 64 min versus 231 +/- 74 min respectively, p < 0.05). CONCLUSION: Following axillary plexus block, 1.5% mepivacaine improves neither the extension nor the duration of sensory blockade achieved by 1.5% lignocaine with adrenaline.

Sedation with sufentanil and midazolam decreases pain in patients undergoing upper limb surgery under multiple nerve block.

Multiple nerve blocks may be painful and a source of discomfort. We assessed the efficacy of sufentanil 5 microg combined with midazolam 1 mg in decreasing pain in outpatients after a midhumeral multiple nerve stimulation technique. Visual analog scores for pain were significantly lower in those patients who received sedation before the block, both at the time of block performance (14 +/- 1 vs 27 +/- 2 mm, P < 0.0001) and at discharge (11 +/- 1 vs 24 +/- 2 mm, P < 0. 0001). We conclude that the association of sufentanil and midazolam produced minimal sedation while significantly reducing pain experienced by patients undergoing multiple nerve stimulation.

No enhancement of sensory and motor blockade by neostigmine added to mepivacaine axillary plexus block.

BACKGROUND: Intrathecal neostigmine induces analgesia but also several side effects. Recently, 500 microg neostigmine administered intraarticularly was shown to produce postoperative analgesia without side effects. The authors' goal was to determine whether 500 microg neostigmine added to mepivacaine in axillary plexus block prolongs postoperative analgesia. In addition, they wanted to determine the incidence of side effects in patients undergoing hand surgery. METHODS: Sixty-nine outpatients scheduled for carpal tunnel syndrome repair with axillary plexus block were randomly assigned to one of three groups that received saline solution in the axillary plexus and subcutaneously (group 1), 500 microg neostigmine in the axillary plexus and saline solution subcutaneously (group 2), or saline solution in the axillary plexus and 500 microg neostigmine subcutaneously (group 3). Sensory and motor block in the four hand nerve distributions were assessed every 5 min for 30 min The duration of the sensory and motor blocks were assessed after operation. Side effects were also recorded. RESULTS: Neostigmine had no effect on sensory and motor block in any of the four nerve distributions, nor did it increase the median duration of sensory block (215 min; range, 120-330 min) compared with group 1 (247 min; range, 190-287 min) or group 3 (236 min; range, 160-280 min). Motor block was slightly shorter (P = 0.045) in group 3 (190 min; range, 135-285 min) compared with group 1 (218 min; range, 145257 min) and group 2 (215 min; range, 105-343 min). Gastrointestinal side effects occurred in 30% of patients in both neostigmine groups but not in group 1 (P < 0.05). CONCLUSIONS: This study suggests that 500 microg neostigmine added to mepivacaine in axillary plexus block does not prolong postoperative sensory block, but it does cause a relatively high incidence of side effects. These two findings raise doubts about the use of neostigmine associated with local anesthetics for plexus neural block.

Touch-preparation cytologic examination of breast core biopsy specimens: accuracy in predicting benign or malignant core histologic results.

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the accuracy of touch-preparation cytologic examination of breast core biopsy specimens in predicting benign or malignant core histologic results. MATERIALS AND METHODS: One hundred two core biopsies were performed on 88 women with stereotactic or ultrasonographic (US) guidance. Slides were prepared by smearing one core sample on each slide, spraying the slides with fixative, and staining them with the Papanicolaou technique. Slides were blindly reviewed by a cytopathologist. Cytologic results were categorized as positive for malignancy, not diagnostic for malignancy, or insufficient for diagnosis. Results were correlated with histologic results from all specimens obtained during the core biopsy. RESULTS: Imaging depicted the lesions sampled for biopsy as masses (n = 70), clustered calcifications (n = 29), focal asymmetries (n = 2), or architectural distortion (n = 1). Touch-preparation slides of 87 (85%) lesions contained sufficient material for diagnosis. Cytologic results correctly identified 12 of 16 (three of five intraductal and nine of 11 invasive) malignancies in 10 of 13 masses and two of three clusters of calcifications. Two false-positive results occurred, both with fibroadenomas. Overall, touch-preparation studies produced 69 true-negative and four false-negative results. Excluding slides with insufficient material, the sensitivity, specificity, and accuracy of touch-preparation results were 75%, 97%, and 93%, respectively. Including insufficient samples, accuracy was 79%. CONCLUSION: Although touch-preparation cytologic examination of breast core biopsy specimens is fairly accurate in prediction of benign or malignant core histologic results, its correlation with histologic results is not sufficient to justify routine use in immediate counseling and treatment planning.

Fine-needle aspiration in the diagnosis of metastatic ovarian cancer to the breast.

Metastatic ovarian cancer to the breast is a rare condition. The diagnosis must be made quickly and efficiently to minimize patients' physical and emotional trauma. Three patients with metastatic ovarian cancer to the breast are presented. Fine-needle aspiration of the breast was used in all patients in an attempt to obtain a diagnosis. Correlation of the cytomorphology from the primary tumor and metastatic lesion allowed proper diagnosis in two of the three patients. This study shows that it is imperative for the clinician to work closely with the cytopathologist to obtain a correct diagnosis.

p53 in endometrial cancer and its putative precursors: evidence for diverse pathways of tumorigenesis.

To elucidate the role of p53 abnormalities in endometrial tumorigenesis, a diverse group of endometrial neoplasms and their putative precursors, atypical endometrial hyperplasia, and endometrial intraepithelial carcinoma (EIC) were studied using a conventional immunohistochemical technique. Immunostaining for p53 protein was detected in 24 (86%) of 28 serous carcinomas compared with nine (20%) of 45 endometrioid carcinomas (P < .001). Immunoreactivity was also detected in two (100%) of two clear cell carcinomas, five (83%) of six mixed endometrioid/serous carcinomas, and seven (70%) of 10 malignant mixed mesodermal tumors. Benign endometrial tissue and 12 examples of atypical endometrial hyperplasia were nonreactive. In 27 (79%) of 34 tumors containing EIC, both the tumor and EIC were immunoreactive for p53, whereas in 7 (21%) both were negative. Immunostaining for p53 highlighted small foci of EIC and showed the extent and distribution of the lesions. The strong association and similar p53 immunostaining pattern of EIC and serous carcinoma support the hypothesis that serous carcinomas develop from endometrial surface epithelium that demonstrates abnormal p53 protein expression in conjunction with transformation to EIC. Mutation of p53 seems unrelated to the development of endometrioid carcinoma from atypical endometrial hyperplasia but may be related to dedifferentiation in some of these neoplasms.

Comparison of ThinPrep preparations with conventional cervicovaginal smears. Practical considerations.

This study compared cytologic quality, diagnostic accuracy, detection of endocervical and endometrial cells and yeast, screening times and costs for 128 ThinPrep preparations (TP) to the corresponding conventional cervicovaginal cytologic smears (CCVS). Final diagnoses agreed in 114 (89%) cases. There were four discrepancies between atypical squamous cells of undetermined significance and low grade squamous intraepithelial lesion. The number of abnormal cells was lower in TP than in CCVS. Endocervical and endometrial cells were detected less frequently in TP than in CCVS. Yeast forms were seen rarely but were identified in both CCVS and TP. Inflammation and blood were less prominent on TP. While some CCVS showed artifacts related to fixation, cell preservation was optimal in all TP. Screening times were significantly shorter for TP than for CCVS. The combined cost of reagents, preparation and screening for an average TP was $1.78 higher than for a CCVS. We conclude that the use of TP for cervicovaginal smears reduces screening time and produces better cytologic preparations. However, cost-benefit analyses, readjustments in criteria for diagnosis of dysplasia and improvements in the recovery of glandular cells may be necessary before this method is used instead of CCVS.

Nodular foci in parathyroid adenomas and hyperplasias: an immunohistochemical analysis of proliferative activity.

Samples of normal, hyperplastic, and neoplastic parathyroid tissues were analyzed for proliferative activity to determine (1) whether a higher number of proliferating cells were detectable in adenoma and hyperplasia versus normal tissues; (2) whether there was a difference in the number of proliferating cells in adenoma versus hyperplasia; and (3) whether there was a relationship between nodularity and proliferative rate in both adenoma and hyperplasia. Formalin-fixed, paraffin-embedded tissue from 21 patients with parathyroid adenoma and 10 patients with hyperplasia (two primary, six secondary, and two tertiary) was analyzed by immunohistochemistry with the monoclonal antibody PC10 to proliferating cell nuclear antigen (PCNA) and, in a subset of cases, with Ki-67 (MIB 1) as markers of cell proliferation. The results were that (1) no proliferating cells were found in normal glands or residual rim of "suppressed" parathyroid tissue; (2) the most intense proliferative activity was confined to nodular areas in both adenomas (57% nodular) and hyperplasias (80% nodular); (3) when fields of highest number of labeled nuclei were chosen, PCNA counts were higher in adenomas than in hyperplasia in both nodular and diffuse areas (P < .05); and (4) the number of nuclei immunoreactive for Ki-67 (MIB-1) was consistently and proportionally lower (range, 13% to 45%; mean, 32%) than the number of those immunoreactive for PCNA, although the nodular pattern was maintained. These findings demonstrate that nodules within parathyroid adenomas and hyperplasias contain subpopulations of cells with a consistently higher proliferative rate than nonnodular areas. Cells within these nodules may be more likely to develop genetic abnormalities that have been observed in hyperplastic and neoplastic parathyroid tissues.

p53 tumor suppressor oncogene expression in squamous cell carcinoma of the hypopharynx.

BACKGROUND: Although abnormalities of the p53 tumor suppressor oncogene system are being detected in many human cancers, the frequency and prognostic significance of such events in squamous cell cancer of the head and neck remain unknown. METHODS: Immunohistochemical studies were performed on archival tumor tissue taken from 43 patients with squamous cell carcinoma of the hypopharynx. Statistical analyses examining potential associations between p53 oncoprotein accumulation and various clinicopathologic parameters (including survival) were conducted. RESULTS: Sixteen (37%) tumors demonstrated strong specific staining for p53. Patients whose tumors stained strongly for p53 were significantly younger, presented at a more advanced clinical disease stage, and tended to have increased expression of epidermal growth factor receptor (P = 0.056). There was no correlation between p53 expression and the incidence of multiple primary cancers, tumor grade, DNA ploidy, or percent of S-phase. Median survival times were 11.6 months and 18.0 months for the p53-positive and p53-negative groups (NS). A Cox regression analysis confirmed the lack of significance of p53 in overall survival. CONCLUSIONS: These data suggest that although abnormalities of the p53 oncoprotein are common in this cancer, this finding is of little clinical significance.

Estrogen and progesterone receptor detection in neoplastic and non-neoplastic thyroid tissues.

Previous reports have shown that estrogen and progesterone receptors (ER and PgR) are detectable in neoplastic and non-neoplastic thyroid tissues using a variety of techniques. However, differences in relative expression of ER and PgR according to tumor type have not been emphasized. To determine whether such differences occur and to assess clinicopathologic correlations, we have evaluated ER and PgR expression in sections of 64 thyroid lesions stained by indirect immunoperoxidase. The lesions studied included 39 papillary carcinomas, 3 follicular adenomas, 2 follicular carcinomas, 15 Hürthle cell tumors, 3 medullary carcinomas, and 2 multinodular goiters. Immunostaining was achieved using monoclonal antibodies H222 to ER and JZB39 to PgR. Additionally, the monoclonal antibodies D75p3 to ER and mPRI to PgR were also used in some cases. Overall, ER and/orPgR were detected in 26 of 64 lesions (40%) using any of the above antibodies. ER was identified in eight of 64 (12.5%) tumors that were all papillary carcinomas. No staining for ER was seen in follicular neoplasms, Hürthle cell tumors, or medullary carcinomas. PgR staining was present in 13 of 39 (33%) papillary carcinomas, 8 of 15 (53%) Hürthle cell tumors, 2 of 7 (28%) follicular tumors, and in none of 3 medullary carcinomas. Non-neoplastic thyroid tissue was negative for ER and PgR in all but one case in which weak staining for PgR was present adjacent to a follicular adenoma. There were no correlations between ER and/or PgR staining and age, gender, tumor size, presence of capsular or vascular invasion, or lymph node status in any tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

p53 expression in neoplasms of the uterine corpus.

It has been recognized that mutations in tumor suppressor genes may have an important oncogenic role. Although abnormalities of the p53 tumor suppressor gene have been reported in tumors from various organ systems, p53 expression has not been studied in neoplasms of the uterine corpus. Using a monoclonal antibody to the p53 product, frozen sections of 56 uterine tumors (40 endometrioid endometrial adenocarcinomas, 7 serous endometrial carcinomas, 4 mixed Müllerian tumors, 2 endometrial stromal sarcomas, 1 leiomyosarcoma, 2 leiomyomas) and 2 normal endometria were stained using the immunoperoxidase technique. Staining was evaluated by light microscopic examination; in carcinomas with strong/diffuse reactivity, evaluation was by digitized image analysis. p53 staining of adenocarcinomas was compared statistically to the histologic type, grade, surgical stage, and clinical follow-up. Specific staining was present in the nucleus of malignant tumor cells only. Benign cells did not stain. Strong/diffuse staining was seen in 14 adenocarcinomas and in 2 mixed Müllerian tumors. Weak/focal staining was observed in 14 adenocarcinomas. Serous carcinomas showed strong positivity more frequently than endometrioid endometrial carcinomas. Staining patterns correlated with histologic grade and stage. Image analysis of immunostained p53 correlated with type of adenocarcinoma, but not with grade or stage in the cases measured. p53 was expressed strongly in tumors of five of eight patients who died of adenocarcinoma but in none of five patients with no evidence of disease and a minimum follow-up of 24 months. In addition, 3 of 12 patients with persistent or recurrent disease showed tumors that strongly expressed p53. It is concluded that abnormal expression of p53 occurs frequently in malignant uterine tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Melanotic neuroectodermal tumor of infancy: an important mimicker of paratesticular rhabdomyosarcoma.

We report a case of a paratesticular tumor in a 6-month-old infant. This tumor was originally believed to represent a poorly differentiated sarcoma of the cord but upon further pathological consultation it was recognized as a rare melanotic neuroectodermal tumor of infancy involving the epididymis. Since the former is a highly aggressive lesion and the latter an indolent tumor, treatment of these 2 entities differs markedly. Therefore, although the histological distinction between these lesions is often difficult, it is of critical importance.

Estrogen receptor immunohistochemistry in carcinoma in situ of the breast.

Although estrogen receptor (ER) content and its clinical significance have been extensively evaluated in invasive breast cancer, ER expression in carcinoma in situ (CIS) of the breast and its correlates are less well understood. Thus, using an indirect immunoperoxidase technique and paraffin-embedded tissue, the authors studied ER expression in 100 breast tumors containing CIS with or without invasive carcinoma. The percentages of positive and of strongly positive nuclei were compared among histologic categories of CIS and between CIS and invasive carcinoma. The relationships between histologic features of CIS (cell size, nuclear pleomorphism, necrosis, extent of CIS) the patient's age, and the ER status of CIS also were evaluated. ER expression in pure CIS was compared with that of CIS with adjacent invasive carcinoma. Significant differences were observed between comedo CIS, which was frequently ER negative, and non-comedo and lobular CIS, which usually were positive. A predominance of large cells, independently from other features, was the best morphologic predictor of ER negative status in CIS. ER in CIS correlated with ER in invasive carcinoma in 98% of cases (r2 = 0.677). CIS without invasive carcinoma was more frequently ER weak or negative than CIS associated with invasive carcinoma. There was no difference in the overall percentage of nuclear staining in CIS of women of premenopausal versus postmenopausal age; however, a higher proportion of strongly positive cells occurred in the postmenopausal group. The authors conclude that the ER expression in CIS correlates with pathologic features of differentiation and is similar to that of invasive carcinoma.

White blood cell aplasia associated with thymoma.

A limited number of cases of acquired hypoplastic neutropenia or pure white blood cell aplasia (PWCA) associated with thymoma have been reported, in contrast to the well-documented association of pure red blood cell aplasia and thymoma. The mechanism of the aplasia in these disorders is unclear. The authors report a case of PWCA (with total absence of all granulopoietic elements in the bone marrow) in a patient with metastatic spindle cell thymoma, in which suppression of autologous granulocyte-macrophage colony-forming units by the patient's serum could be demonstrated. This finding suggests a humoral autoimmune mechanism for the pathogenesis of PWCA in this patient and lends support to the possibility that all hematologic phenomena associated with thymoma may have an autoimmune basis.

Estrogen receptor localization in formalin-fixed, paraffin-embedded endometrium and endometriotic tissues.

Monoclonal estrogen receptor (ER) antibody and indirect immunoperoxidase techniques were used to study the immunohistochemical localization of ER in paraffin sections of 20 surgical specimens containing foci of endometriosis. The eutopic endometrium, available in 16 of 20 cases, was dated histologically and stained for ER. Specific nuclear staining was observed in glandular and stromal cells of the endometrium during the proliferative and early secretory phases. Mid and late secretory phase endometria showed only focal staining. Dating of the endometriotic tissues using morphologic criteria revealed that these were in phase with the endometrium in nine of 16 cases. In these cases the ER staining of both the endometriotic tissues and endometrium was similar. The endometriotic tissues could not be dated as either proliferative or secretory in seven cases and stained variably for ER. Diffuse nuclear staining for ER was present in the endometriotic glands of three of these cases in which the endometriotic glands morphologically resembled glands of the basalis contrasting with weak, focal staining in the corresponding eutopic secretory endometria. The majority of endometriotic tissues examined mimicked the cyclic ER expression of the eutopic endometrium and thus appeared to correspond to the morphologic appearance of the endometriotic glands. Immunohistochemical staining with monoclonal estrophilin antibodies may be helpful in supporting the histopathologic diagnosis of endometriosis.

Estrogen receptor localization in the female genital tract.

The authors have used monoclonal estrophilin antibodies and the peroxidase antiperoxidase technique to characterize the distribution of estrogen receptor in the human vagina, uterus, and fallopian tubes. Exclusively nuclear localization of estrogen receptor was observed in epithelial cells, stromal cells of the lamina propria, and smooth muscle cells with both immunohistologic studies and immunoelectron-microscopy studies. The endometrium in various regions of the uterus (uterine isthmus, corpus, and fundus) was stained for estrogen receptor, with similar staining intensities in each of the respective cell types. There was no systematic regional variation in the staining intensity or distribution of cells with stained nuclei. The functionalis of the endometrium showed distinctive variation in the intensity of the staining for estrogen receptor with the menstrual cycle. The staining intensity of both endometrial epithelium and stroma was greatly reduced in the functionalis during the secretory phase. The vaginal epithelium did show some variation with the menstrual cycle, but it was much less than that observed in the functionalis of the endometrium. The basal cells of the vaginal stratified squamous epithelium, strongly stained during the proliferative phase, were less strongly stained during the secretory phase. No variation in the staining intensity for estrogen receptor was observed in different regions of the fallopian tube (isthmus, ampulla, and infundibulum), and the staining intensity varied only minimally with the menstrual cycle. The serosa of the female reproductive tract, connective tissues in the muscularis and in the vicinity of blood vessels, as well as neutrophils, eosinophils, mast cells, and lymphoid cells in the female genital tract were not stained for estrogen receptor.

Lectin binding to human gastric adenocarcinomas and adjacent tissues.

The binding of lectins to paraffin sections of nine gastric carcinomas and adjacent mucosa was examined by fluorescence microscopy. A battery of nine lectins was employed, and both intestinal and diffusely infiltrating tumors were tested. Wheat germ agglutinin and Ricinus communis agglutinin I appeared to bind to both mucus and nonmucus glycoproteins; these lectins labeled tumor cells, benign epithelial cells, and nonepithelial tissues strongly and consistently. Peanut agglutin, soybean agglutinin, Dolichos biflorus agglutinin, Bandeiraea simpifolica agglutinin, and Ulex europaeus agglutinin I bound extensively to mucosubstances in vacuoles and apices of benign epithelial cells but often bound to tumor cells focally and in some cases not at all. Neuraminidase digestion enhanced lectin staining in some tumors; but in others, especially those of the diffusely infiltrating type, neuraminidase digestion did not enhance the staining of tumor cells. The results suggest that the decrease in the proportion of tumor cells labeling with lectin relative to superficial epithelial cells can be due either to the oversialylation of mucoproteins or to the loss of glycosylating enzyme activity. Concanavalin A did not bind to mucosubstances in the vacuoles or apices of benign epithelium, but bound to mucus vacuoles of metaplastic epithelium and to coarse cytoplasmic granules in two of the tumors examined. This suggests either the abnormal addition of mannose to mucus glycoprotein or the production of a distinct glycoprotein by some gastric tumors.

Impaired B-lymphocyte reactivity in patients with Hodgkin's disease and non-Hodgkin-lymphomas.

The generation of immunoglobulin-secreting cells upon stimulation with pokeweed mitogen was studied in patients with Hodgkin's Disease (HD) and non-Hodgkin lymphomas (NHL) using a reverse hemolytic plaque assay. The experiments revealed that the majority of the patients in both groups had greatly diminished responses of their peripheral B-lymphocytes. Whereas in NHL patients an intrinsic B-cell defect is the most likely explanation for the impaired B-cell reactivity, the situation in HD appears to be more complex. In some patients with an active stage of the disease, suppressor cells were found to cause the unresponsiveness: in other patients, an intrinsic B-cell defect as well as a defect of the T helper cells were responsible for the diminished responses. The results further suggest that the immune defect in patients with HD is reversible and can be corrected by therapy.