Subdermal laterocranial mapping of sentinel lymph nodes in breast cancer as an alternative to the peritumoral mapping.

PURPOSE: Peritumoral injection of blue dye is standard method of sentinel lymph nodes (SLN) biopsy in breast cancer. Applying the marker to different locations will be of great benefit in cases in which the peritumoral mapping is difficult to implement. The aim of this study was to demonstrate that the subdermal laterocranial (SLC) mapping with a dye has similar diagnostic reliability to the peritumoral mapping and is applicable for clinical use. PATIENTS AND METHODS: 254 patients with operable breast cancer (cT

[Total inversion of the uterus].

Non puerperal inversion of the uterus is very uncommon. Patients may present with pelvic pain, vaginal bleeding or hemodynamic shock. We report a fifty five old woman with uterus inversion second stage.

[Endoscopic treatment of pelvic inflamatory disease].

The authors present their own attempt of miniinvasive management of pelvic inflammatory disease. Two groups of patients are compared--in the first one the women are treated only conservatively, while the second one has undergone miniinvasive surgical treatment. The preferences of combined therapy are pointed out.

[Endoscopic treatment of ectopic pregnancy].

The authors show their own experience with endoscopic operative treatment of tubal pregnancy. They describe the different types of operative treatment.

[Sectio ceasarea isthmicolongitudinalis--a forgotten beginning and/or groundless fear?]. / Sectio caesarea isthmicolongitudinalis--zabraveno nachalo i/ili neobosnovan strakh?

A retrospective analysis of the frequency, indications, intra- and postoperative complications in isthmicotansverse (ITS) and isthmicolongitudinal (ILS) cesarean section has been conducted with a view to justifying the wider application of ISL in modern obstetrics. For a five-year period (1996-2000) at the Obstetrics and Gynecology Clinic of St. Ann Hospital-Sofia a total of 522 cesarean section were performed of which 348 (66.7%) with isthmicotansverse incision and 174 (33.3%) with isthmicolongitudinal incision. The data show that ILS were ith less blood loss and with less intra- and postoperative complications and it was applied in all types of obstetric indications and urgent cases. Having in mind the good results and the fact that ILS is a technique which could be performed by every obstetrician familiar with ITS, The authors are convinced that isthmicolongitudinal cesarean section can find a wider application in everyday obstetric practice.

[Residual cavity evacuation following echinococcotomy-methods and results]. / Likvidirane na ostatuchnata kukhina sled ekhinokokektomiia-metodi, rezultati.

The results of operative management of liver hydatid disease are still estimated as unsatisfactory, with evacuation of the residual cavity after echinococcotomy a major problem faced. The study covers 100 patients, aged 15 to 75 years, presenting a total of 146 liver hydatid cysts, operated in the surgical diseases department of the Higher Medical institute--Pleven over the period 1992 through 1998. In 72 cases it is a matter of a solitary formation, and in the remainder (28) two or more cysts are present. A closed method is used in the operative management of 32 cysts, semiclosed (with or without autoplombage, capitonnage respectively)--in 98, and partial resection or pericystectomy--in sixteen. To monitor the residual cavity US imaging and/or CAT are employed. Surgical approaches and methods applied in the various locations, and the respective results obtained are discussed. Emphasis is laid on the safety afforded by the procedure including resection of the prominating fibrous wall (resection du dome saillant) and tight closure around the tubular drain. A maximum reduction of the residual cavity associated with the possibility of simultaneous evacuation of the exudate secreted reduce to a minimum the likelihood of persisting residual formation postoperatively.

The structural integrity of the islet in vitro: the effect of incubation temperature.

The purpose of this study was to examine the effect of incubation temperature on the structural integrity of the islet during culture. Islets were isolated from the pancreas of the Syrian golden hamster and cultured in a collagen gel for < or =12 days at 24 degrees C or 37 degrees C. At 24 degrees C, cells in the islet periphery died, leading to a complete disintegration of the mantle region in 37.4+/-5.6% of the islets. In comparison, at 37 degrees C, few islets exhibited mantle disintegration (p<0.001). Insulin immunoreactivity was distributed nonhomogeneously in islets at 24 degrees C, and the intensity of the staining, by using a semiquantitative scale (0-3), was +1. Islets cultured at 37 degrees C had a normal homogeneous distribution of insulin immunoreactivity with a score of +3. As the pancreas is a complex gland composed of different cell types, and cell-cell interactions are known to be important in the maintenance of cell survival, additional experiments were repeated to include the coculture of islets with duct epithelial cells. The proportion of islets that developed mantle disintegration was now reduced to 2.5+/-0.3% (p<0.001), comparable to that seen at 37 degrees C. Similar results were obtained for islets cultured in the presence of duct-conditioned medium (DCM). Together with the preservation of the islet mantle, islets cultured in the presence of duct epithelial cells or DCM had a normal homogeneous distribution of insulin immunoreactivity, with a staining intensity of +3. We conclude that incubation temperature has a profound effect on the structural integrity of islets, and that the detrimental effects of low-temperature culture can be mitigated by coculture of islets with secretory products derived from pancreatic ductal cells. These data provide evidence for a trophic relation between pancreatic islets and ductal epithelium.

Early changes of gene expression during cerulein supramaximal stimulation.

Administration of supramaximal doses of cerulein results in acute interstitial pancreatitis. To understand the pathogenesis of this disease, it would be of great importance to elucidate the changes during the early phase of the process. We report changes of gene expression in the pancreas during the first 6 h of cerulein supramaximal stimulation. The expression of genes, including the secretory enzyme amylase, the lysosomal enzyme cathepsin B, as well as the housekeeping genes beta-actin and glyceraldehyde-3-phosphate dehydrogenase (GAPD), was investigated in this study. The most prominent alteration in gene expression is beta-actin messenger RNA (mRNA), which increased continuously after cerulein infusion. Immunostaining for beta-actin was observed along the membrane of large cytoplasmic vacuoles in pancreatic acinar cells. The level of amylase mRNA decreased during the first 30 min of cerulein infusion, recovered to the control level at 1 h and increased twofold at 2 h. An obvious increase in cathepsin B mRNA was observed after 3 h of cerulein infusion and reached sixfold of the control at 6 h. A significant increase of GAPD mRNA level was observed at 6 h of cerulein stimulation. In conclusion, this study provides direct evidence that the changes in gene expression, such as cathepsin B and amylase, after supramaximal cerulein stimulation, are regulated at the transcriptional level. It also suggests that beta-actin is involved in the formation of cytoplasmic vacuoles during supramaximal cerulein administration. Finally, this study indicates that beta-actin and GAPD may not be appropriate as RNA-loading controls for Northern blot analysis of pancreatic tissue.

Pancreatic islet cell survival following islet isolation: the role of cellular interactions in the pancreas.

The purpose of this study was to characterize the trophic effect of pancreatic duct cells on the islets of Langerhans. Ductal epithelium and islets were isolated from hamster pancreata. In addition, duct-conditioned medium (DCM) was prepared from primary duct cultures that had been passaged twice to remove other cellular elements. Three experimental groups were then established: Group 1, 100 islets alone; Group 2, 100 islets+80 duct fragments; and Group 3, 100 islets in 25% DCM. All tissues were embedded in rat tail collagen for up to 12 days and the influence of pancreatic ductal epithelium on islet cell survival was examined. By day 12, 20.6+/-3. 0% (S.E.M.) of the islets cultured alone developed central necrosis, compared with 6.7+/-2.0% of the islets co-cultured with ducts and 5.6+/-1.5% of the islets cultured in DCM (P<0.05). The presence of apoptotic cell death was determined by a TdT-mediated dUTP-biotin nick end labelling (TUNEL) assay and by a specific cell death ELISA. DNA fragmentation in islets cultured alone was significantly increased compared with islets cultured either in the presence of duct epithelium or in DCM (P<0.05). More than 80% of TUNEL-positive cells were situated in the inner 80% of the islet area, suggesting that most were beta-cells. DCM was analysed for known growth factors. The presence of a large amount of IGF-II (34 ng/ml) and a much smaller quantity of nerve growth factor (4 ng/ml) was identified. When the apoptosis studies were repeated to compare islets alone, islets+DCM and islets+IGF-II, the cell death ELISA indicated that IGF-II produced the same beneficial result as DCM when compared with islets cultured alone. We conclude that pancreatic ductal epithelium promotes islet cell survival. This effect appears to be mediated in a paracrine manner by the release of IGF-II from cells in the ductal epithelium.

Melatonin effects on glucocorticoid receptors in rat brain and pituitary: significance in adrenocortical regulation.

1. The effects of chronic melatonin treatment on glucocorticoid binding sites in hippocampus, hypothalamus and pituitary were investigated in rats, subjected to long-term manipulation of circulating corticosterone concentrations. 2. Melatonin treatment decreased the affinity of glucocorticoid receptors. 3. The effect of melatonin was apparent in the presence of normal or enhanced systemic corticosterone levels, but not in long-term adrenalectomized animals.