Warning: fatal reaction to the use of fibrin glue in deep hepatic wounds. Case reports.

Two cases of severe hypotension following the use of fibrin glue for hemostasis in hepatic injuries are reported. A systemic reaction to bovine thrombin via large venous lacerations is suspected. A preliminary animal study supports this hypothesis. Caution is advised in the use of fibrin glue for hemostasis in deep hepatic wounds.

Sympathectomy for causalgia. Patient selection and long-term results.

Thirty-four sympathectomies were performed for causalgic pain. Overt extremity trauma was the precipitating event in only 26%. In 48%, nerve compression requiring surgical relief preceded the onset of the pain; most common lumbar disk surgery (37%). In the remainder (26%), miscellaneous vascular conditions contributed. Satisfactory immediate relief was obtained in 97% and 61% were completely relieved of pain initially. There were no deaths, 10% wound complication rate, and one instance of Horner's syndrome. Postsympathectomy neuralgia occurred in close to 40%, lasted a little over a month on the average but did not persist beyond ten weeks. In extended follow-up, only one patient failed to sustain satisfactory relief (97% of those relieved, 94% of the total) and 84% continued to enjoy the same degree of relief as they had immediately preoperatively. This frequency, degree, and duration of benefit establishes causalgic pain as one of the best indications for surgical sympathectomy.

Progesterone receptor replenishment in T47D human breast cancer cells. Roles of protein synthesis and hormone metabolism.

T47D are unusual human breast cancer cells that do not require estrogen to synthesize high levels of progesterone receptors. These cells can, therefore, be used to study the mechanisms by which progesterone, freed of estrogen interference, controls the synthesis of its receptors. In a recent paper we described progesterone receptor translocation and a subsequent very rapid nuclear processing step that results in an apparent loss of 60 to 80% of cellular progesterone receptors, 30 to 60 min after progesterone treatment. This paper deals with the replenishment of cellular receptors following processing. If progesterone is removed from cells after 60 min of treatment, cytoplasmic progesterone receptors replenish in 16 to 20 h. However, replenishment occurs even during chronic progesterone treatment; this is an artifact created by the extremely rapid (t1/2 approximately 2 h) metabolism of progesterone in media exposed to cells. If progesterone metabolism is blocked, then replenishment is not seen, probably because the hormone continuously retranslocates the newly replenished sites. There is an early protein synthesis-dependent step; cycloheximide in the first 4 h inhibits replenishment 24 h later, but if cycloheximide is slightly delayed (beyond 4 h), replenishment proceeds normally. In contrast to progesterone, the synthetic progestin R5020 completely suppresses progesterone receptor replenishment even 96 h after its removal from the medium. This compound can bind covalently to receptors and may be very difficult to remove from cells. Clearly, progestin treatment, and by analogy, circulating progesterone, will have profound effects on cytoplasmic and nuclear progesterone receptor levels when these are measured in biopsied human tumors as an adjunct to endocrine therapy.

Progesterone receptors in human breast cancer. Stoichiometric translocation and nuclear receptor processing.

In a subline of T47D human breast cancer cells, progesterone receptors (PR) are synthesized at very high levels, but their synthesis is not estrogen-dependent. Despite the unusual control of synthesis, the physicochemical properties of PR are normal. These are, therefore, ideal cells to study PR regulation by progesterone, free of estrogen effects. In this paper, we show that nuclear translocation of PR is stoichiometric, and that an unusual and very rapid nuclear turnover, or processing step, characterizes receptor-DNA interactions. In intact T47D cells, PR are translocated to the nucleus only by progestins; 70-90% of cytoplasmic receptors are depleted at 37 degrees C within 5 min of progestin addition. After PR are translocated by 0.1 muM progesterone, they can be quantitatively recovered from nuclei only in the first 5 min; thereafter, a rapid nuclear processing step results in loss of 50-80% of the newly translocated sites. Rapid processing may be inherent to PR; it also occurs in PR of MCF-7 cells. The extent of receptor translocation and of nuclear receptor processing is dependent on the progesterone concentration and on the treatment time, and can be masked by endogenous hormones. Proteolytic enzyme inhibitors (leupeptin, antipain) do not prevent nuclear PR loss. G-C specific DNA intercalators that prevent nuclear estrogen receptor processing (actinomycin D, chromomycin A3) also fail to prevent PR loss, but some A-T specific DNA-binding dyes (chloroquine, primaquine, quinacrine) protect 50-75% of nuclear PR. We conclude that translocated nuclear PR can be quantitatively measured only at early time points because the nuclear receptors are rapidly processed. Furthermore, the processing step may involve an interaction of receptors with DNA since it can be partially blocked by DNA-binding agents.

Estrogen-insensitive progesterone receptors in a human breast cancer cell line: characterization of receptors and of a ligand exchange assay.

In modified culture conditions, T47D human breast cancer cells synthesize extraordinary amounts of progesterone receptors (PgR), but, unlike other progesterone target cells, the PgR are entirely independent of estrogen controls. In the present studies we characterize some physicochemical properties of the PgR in T47D cells. We also describe an exchange assay for cytoplasmic and nuclear forms of the receptors which has enabled us to demonstrate that after progesterone treatment, translocation is stoichiometric. Despite the anomalous regulation of PgR levels, these receptors are typical of steroid receptors; they sediment at 7-8S on sucrose density gradients, they bind ligands with high affinity (Kd approximately 4 nM for R5020; Kd approximately 2 nM for progesterone), they bind only progestins specifically, and they are thermolabile (t1/2 at 37 C is approximately 15 min). Receptor levels range from 15-40 pmol/mg DNA, or more than 300,000 sites/cell. The ability of ligands to dissociate from and rebind to the receptors was measured and used in an exchange assay for nuclear PgR. The synthetic progestin R5020 dissociates readily from receptors (t1/2 approximately 3 h at 0 C and 1.5 h at 10 C), and the dissociation of progesterone is even faster (t1/2 approximately 30 min at 0 C). To quantify steroid exchange, receptor levels were measured in mixtures of hormone-filled and unfilled cytosols. These studies assess ligand dissociation and subsequent ligand rebinding. At 0 C for 4-18 H or at 10 C for 4 h, unlabeled progesterone dissociates from receptors, and R5020 rebinds all sites, resulting in 100% exchange. In contrast, despite the use of a variety of incubation times and temperatures, no more than 50% of receptors previously filled with R5020 can exchange for [3H]R5020. The progesterone to [3H]R5020 exchange assay was used to measure salt-extracted nuclear progesterone receptors. In cells treated for 5 min with 0.1 microM progesterone, all depleted cytoplasmic sites were quantitatively recovered from nuclei. These cells provide a new model system to study the molecular biology of human PgR.

Variant T47D human breast cancer cells with high progesterone-receptor levels despite estrogen and antiestrogen resistance.

In target tissues for estrogen, including breast cancer cells, the synthesis of progesterone receptors (PRs) is controlled by estradiol acting through estrogen receptors (ERs). We describe studies with T47D human breast cancer cells, whose PRs are not regulated by estradiol, though present in extraordinary amounts (300,000 sites per cell). These cells have no ERs sedimenting at 8S on sucrose density gradients, and no unfilled cytoplasmic or nuclear ERs; some apparently hormone-filled nuclear sites, with KD congruent to 0.7 nM, can be demonstrated by exchange. The nuclear ER sites are not processed after estradiol treatment. Nafoxidine, however, doubles nuclear estrogen binding in 6 hr, in a cycloheximide-insensitive step that may represent a reversal of processing. T47D cells are profoundly resistant to estrogens and antiestrogens; estradiol does not stimulate PRs, and nafoxidine concentrations that are cytotoxic to ER-positive cells have no effect on cell growth or on PR levels. Yet the PRs are normal by several criteria, and they can be stoichiometrically translocated to, and extracted from, nuclei in the first 3 min after progesterone addition. If progesterone treatment exceeds 10 min, rapid nuclear turnover prevents quantitative PR recovery. Cytoplasmic PRs are replenished in 10 to 24 hr, and this cycloheximide-sensitive step is also estrogen- and nafoxidine-resistant. However, despite their insensitivity to estradiol or antiestrogen, PRs are not constitutively synthesized; 5-bromodeoxyuridine and sodium butyrate can selectively inhibit PR production. Thus, since PRs retain some characteristics of inducible proteins, the persistent nuclear estrogen-binding sites may be stimulating PRs continuously, even in the absence of exogenous estradiol.