Utilidad de la tomografía computarizada multidetector en la evaluación postoperatoria de cirugías de derivación urinaria / Usefulness of multidetector computed tomography in the postoperative evaluation of urinary diversion surgery

Las cirugías de derivación urinaria son procedimientos que cada vez son más frecuentes, ya que sus indicaciones no son sólo neoplásicas, siendo también útiles en el manejo de otras patologías. Debido a este incremento, no es infrecuente observar complicaciones secundarias, ya sean en el postoperatorio temprano (menos de 30 días después de la cirugía) o tardío (más de 30 días). Dentro de éstas tenemos alteraciones de la motilidad intestinal (íleo paralítico, obstrucción), fugas anastomóticas, colecciones líquidas (linfocele, urinoma, absceso), fístulas, herniación paraestomal, estenosis ureterales, litiasis y recurrencia tumoral. Dada la gran cantidad de técnicas quirúrgicas usadas en estos procedimientos, es importante conocer los cambios anatómicos resultantes, ocasionalmente de difícil valoración. La tomografía computarizada multidetector (TCMD) tiene gran utilidad en el estudio de estos pacientes, especialmente mediante las técnicas de reconstrucción multiplanar, representando adecuadamente las estructuras urinarias y extraurinarias afectadas, y sus relaciones con estructuras adyacentes, permitiendo identificarlas acertada y rápidamente.

Urinary diversion surgeries are procedures that are becoming more frequent, as their indications are not only neoplastic, being useful also in managing other diseases. Due to this increase, it is not uncommon to observe secondary complications, whether in the early postoperative period (less than 30 days after surgery) or later (more than 30 days). Within these are alterations in intestinal motility (paralytic ileus, blockage), anastomotic leaks, fluid collections (lymphocele, urinoma, abscess), fistulas, parastomal herniation, ureteral obstruction, urolithiasis and tumor recurrence. Given the large number of surgical techniques used in these procedures, it is important to know the resulting anatomical changes, occasionally difficult to evaluate. Multidetector computed tomography (MDCT) is of great use in the study of these patients, especially with multiplanar reconstruction techniques, adequately representing the affected urinary and extra-urinary structures, and their relationship to adjacent structures, enabling their accurate and quick identification.

Evaluation of stability of allergen extracts for sublingual immunotherapy during transport under unfavourable temperature conditions with an innovative thermal insulating packaging.

Many pharmaceutical and biotechnological products are temperature-sensitive and should normally be kept at a controlled temperature, particularly during transport, in order to prevent the loss of their stability and activity. Therefore, stability studies should be performed for temperature-sensitive products, considering product characteristics, typical environmental conditions, and anticipating environmental extremes that may occur during product transport in a specific country. Staloral products for sublingual immunotherapy are temperature sensitive and are labelled for maintenance under refrigerated conditions (2-8°C). Given the peculiar climatic context of Italy and the great temperature fluctuations that may occur during transport, this study was aimed at evaluating the impact of a new engineered thermal insulating packaging for Staloral. In particular, the purpose was to assess whether the new packaging could create a container condition able to preserve the stability and immunological activity of the product during the transport phase throughout Italy. The results showed that the range of temperatures that can affect the product, in the area surrounding the product packaging, may reach a peak of 63°C during transport under the most unfavourable climatic conditions, i.e. in a non-refrigerated van during the summer season, from the site of production in France to the patient's house in Catania, the city with the highest temperatures in Italy. However, the highest temperature reached inside the vaccine did not exceed 45°C over a period of about 2 h. The ELISA inhibition test on samples subjected to the extreme temperature conditions previously defined (45°C) showed an immunological activity higher than 75% of that initially measured and was comparable to those obtained with samples stored at controlled temperature (5°C). This means that, even in the worst case scenario, the structure of the allergen extracts is not influenced and the vaccine potency is preserved.

Evaluación de dos métodos rápidos para la determinación de microalbuminuria y de la relación albúmina/creatinina en orina / Evaluation of two rapid tests for the determination of microalbuminuria and the urinary albumin/creatinine ratio

Objetivo: La detección de microalbuminuria está justificada desde el punto de vista coste-beneficio en aquellos pacientes que presentan riesgo de desarrollar una lesión renal, en una etapa en la cual el proceso es aún reversible. En este estudio se evalúan los analizadores DCA 2000 y Clinitek 50 (Bayer®) que determinan simultáneamente albúmina y creatinina en orina para adoptarlos como métodos rápidos para la detección de microalbuminuria. Métodos Se analizaron 127 muestras de orina de pacientes pediátricos con diferentes enfermedades. Se determinaron la albúmina, la creatinina y la relación albúmina/creatinina en el analizador DCA 2000 y con las tiras Clinitek-microalbuminuria leídas en el analizador Clinitek 50, y se los comparó con los métodos utilizados habitualmente en el laboratorio. Resultados El coeficiente de correlación entre albúmina por nefelometría frente a DCA 2000 fue de 0,914, para creatinina por el método de Jaffe frente DCA 2000 de 0,970 y para la relación albúmina/creatinina calculada frente a DCA 2000 de 0,839. Considerando una concentración de albúmina de 30 mg/l como valor de corte para considerar una muestra como patológica, la sensibilidad, especificidad, los valores predictivos positivo y negativo para la detección de microalbuminuria en el DCA 2000 fueron de 100, 93, 84 y 100 por ciento; y para el Clinitek 50 de 91,7, 86, 55 y 98 por ciento, respectivamente. El análisis de las curvas ROC mostró una mayor utilidad diagnóstica del DCA 2000 para la detección de microalbuminuria. Conclusiones El analizador DCA 2000 muestra una buena correlación para albúmina y creatinina cuando se los compara con los métodos considerados de referencia, siendo la obtención inmediata de los resultados una ventaja importante. Las tiras Clinitek-microalbuminuria representan un método semicuantitativo, sencillo y de bajo coste para ser utilizado como prueba tamiz para la detección de microalbuminuria, no siendo útil para el seguimiento (AU)

[Evaluation of two rapid tests for the determination of microalbuminuria and the urinary albumin/creatinine ratio]. / Evaluación de dos métodos rápidos para la determinación de microalbuminuria y de la relación albúmina/creatinina en orina.

OBJECTIVE: Microalbuminuria screening is justified on the grounds of its cost-benefit ratio in patients at risk of kidney damage while the process is still reversible. The aim of the present study was to evaluate the DCA 2000 analyser and the Clinitek 50 system (Bayer), which simultaneously measure urinary albumin and creatinine levels to adopt them as rapid methods for microalbuminuria detection. METHODS: One hundred twenty-seven urine samples from pediatric patients with various disorders were assessed. Albumin, creatinine, and the albumin/creatinine ratio were determined using the DCA 2000 analyzer and the Clinitek 50 system, which were compared against the usual reference laboratory methods. RESULTS: The correlation coefficient of nephelometric values vs the DCA 2000 analyzer was 0.914 for albumin, 0.970 for creatinine and 0.839 for the albumin/creatinine ratio. At an albumin cut-off concentration of 30 mg/l, the sensitivity, specificity, positive predictive value and negative predictive value were 100 %, 93 %, 84 % and 100 % for the DCA 2000 analyzer and 91.7 %, 86 %, 55 % and 98 % for the Clinitek 50 system. ROC curve analysis showed that the DCA 2000 system was more effective than the Clinitek 50 in microalbuminuria screening. CONCLUSIONS: The data obtained with the DCA 2000 system showed close agreement with those obtained with reference laboratory methods. The immediate availability of results is a great advantage in clinical practice. The Clinitek-Microalbumin dipstick system is a semiquantitative method that is easy to use, low in cost, simple and useful for screening, but it is less reliable as a follow-up method.

An action spectrum for photoinduction of prolonged cutaneous photosensitivity by topical 8-MOP.

Suberythemogenic exposure of human skin treated with aqueous 8-MOP to radiation greater than 380 nm prolongs photosensitization to subsequent UVA from 6 to 24-72 h. One hypothesis for prolonged photosensitization is that greater than 380 nm irradiation forms 8-MOP-DNA monoadducts, which are removed more slowly than free 8-MOP and serve as a substrate for crosslinking by further UVA exposure. Sufficient DNA crosslinking results in erythema. We have examined this hypothesis by measuring the action spectrum for induction of prolonged photosensitization. Skin of normal volunteers was treated with aqueous 8-MOP (0.003%) and immediately received suberythemogenic monochromatic exposures between 334 and 430 nm. twenty-four hours later, the presence of prolonged sensitization was tested by small exposures of UVA. Erythema was evaluated 3 and 5 d later, and an action spectrum for prolonged sensitization was determined. The minimum phototoxic dose (MPD) was also determined at each wavelength. The action spectrum for prolonged photosensitization declined gradually between 334 and 425 nm. The action spectrum for delayed erythema induced by a single exposure of 8-MOP-treated skin declined rapidly from 334-390 nm. These findings are consistent with prolonged binding of 8-MOP in the skin by an initial exposure, possibly as 8-MOP-DNA monoadducts, allowing the second exposure to induce an erythemogenic event, possibly crosslinking of DNA.

Effect of natural beta-interferon on cell proliferation and steroid receptor level in human breast cancer cells.

The effect of natural beta-interferon (beta-IFN) on cell proliferation and steroid receptor level was investigated in CG-5 human breast cancer cell line. beta-interferon determines an appreciable diminution of cell growth, at concentrations ranging from 100 to 1000 IU/ml, which is enhanced when serum content of the culture medium is lowered. Low concentrations of beta-IFN (10-100 IU/ml) produce, after a 5-day treatment, an increase in estrogen receptors (ER) and progesterone receptors (PR). No variation of ER and PR levels is observed when beta-IFN is added directly to the cell homogenate before the assay. Our data suggest that beta-IFN could affect hormone sensitivity through a modification of ER and PR in neoplastic mammary cells.

Estrogen responsive creatine kinase in human breast cancer cells.

The brain type (BB) isoenzyme of creatine kinase (CK) is a very sensitive marker of estrogen action in rat uterus and in experimental mammary tumors. In order to detect useful markers for estrogen dependent human breast cancer cell proliferation we measured CK levels and isoenzyme composition in the CG5 cells, an estrogen supersensitive variant of the MCF-7 human breast cancer cell line. Under basal conditions, CK-BB accounted for 10%-15% of total enzymatic activity, while the MM isoenzyme represented the overwhelming component. In cells cultured in the presence of 5% charcoal-treated fetal calf serum, physiological concentrations (0.1-1 nM) of estradiol increased CK-BB levels in a dose- and time-related fashion. The effect was specific for estrogens and was prevented by antiestrogens. Our results show that CK-BB is estrogen regulated in the CG5 cells and suggest a possible role for this enzyme as an additional marker of the hormonal responsiveness of breast cancer.

A monoclonal antibody (AB/3) reactive with human breast cancer.

Monoclonal antibody AB/3 was produced from a fusion of spleen cells of a human breast cancer cell-primed BALB/c mouse with the murine myeloma cell line P3-NS1-Ag4-1. The antibody reacted strongly with the plasma membrane of human breast cancer cells. Tissue sections of both malignant and benign human mammary carcinomas and tumors of non-breast origin as well as apparently normal tissues were tested with immunoperoxidase. Ninety-six of 124 (77%) primary human breast cancers, 12 of 14 (86%) metastatic breast lesions, and 12 of 44 (27%) benign breast lesions reacted positively. Little or no appreciable reactivity was observed with apparently normal human tissues and carcinomas of non-breast origin, with the exception of colon carcinoma. Antibody AB/3 did not immunoprecipitate any identifiable protein from radiolabeled extracts of the immunizing cell line.

Estrogen stimulates cell proliferation and the increase of a 52,000 dalton glycoprotein in human breast cancer cells.

In an estrogen supersensitive variant of the MCF-7 cell line, CG-5, estrogen was found to stimulate the labelling of a glycoprotein released into the culture medium which has the same electrophoretic migration pattern as that previously reported in MCF-7 cells (Biochem. Biophys. Res. Commun., 90: 410-416, 1979). To test the possibility that the 52 K is a marker of estrogen-dependent breast cancer cell proliferation, we have correlated the effect of estrogen and antiestrogen on protein labelling and cell proliferation under different experimental conditions. In cells cultured in the presence of 5% charcoal-treated fetal calf serum, physiological concentrations (0.1-1 nM) of estradiol stimulated in a dose- and time-related fashion both 52 K labelling and cell proliferation. However at high concentrations (10-100 nM) estrogen decreased 52 K labelling while it still stimulated cell proliferation. Concentrations of the tamoxifen derivative, 4-hydroxytamoxifen, which effectively prevented estrogen-stimulated cell proliferation also blocked estrogen-stimulated increase of 52 K labelling. Time-course experiments suggest that the estrogen-stimulated increase of 52 K labelling (detectable after 22 h of hormone exposure) precedes the effect of cell proliferation (detectable after 3 days of hormone exposure). In cells cultured under serum-free conditions there was no effect of estradiol at any of the concentrations and times used on either 52 K labelling or cell proliferation.

Presence and steroid inducibility of glutamine synthetase in human leukemic cells.

Glutamine synthetase (EC 6.3.1.2; GS) is present in lymphoblasts from patients with acute lymphoblastic leukemia (ALL) as well as in normal peripheral blood lymphocytes. In 16 out of 20 ALL patients studied exposure of the cells to physiological concentrations of dexamethasone in vitro increased enzyme activity above the control levels. The increase was specific for glucocorticoid receptor ligands. A direct correlation was found between the magnitude of glucocorticoid-mediated increase of GS activity and the cellular levels of specific glucocorticoid receptors assayed in the same cell specimen. Moreover, the basal levels of the enzyme measured in cells prior to exposure to dexamethasone correlated negatively with receptor density. It is suggested that the presence of steroid-inducible GS in ALL cells may prove to be a marker for functional receptor sites.