[The development of a guideline to improve the efficiency and effectiveness of FACT board meetings using a Delphi study]. / Delphi-studie voor de ontwikkeling van een handreiking ter bevordering van een effectief en efficiënt FACT-bordoverleg.

BACKGROUND: The FACTboard meeting structures the multidisciplinary meetings held by FACT teams, held for the 10-20% most care intensive patients. The FACT manual only provides a general outline for the FACTboard meeting, leaving out criteria specifying the methods to structure meetings. Precisely describing these criteria could improve the quality of these meetings. AIM: To develop a more detailed guideline on how to structure a FACTboard meeting by means of a Delphi study. METHOD: The panel of the Delphi study existed of 22 professions working in certified FACT teams and 8 experts in the field of FACT. Panel members individually assessed 113 items according to whether the statement should be included in the guideline. Statements rated important or essential by ≥80% of the panel members were included in the guideline. The panel members' commentary was used to shape and adjust the statements to clarify why they were regarded as important or unimportant. RESULTS: 54 statements were rated essential or important by ≥80% of the panel members. These statements pertained to the organization and structure of the FACTboard meeting and the roles and responsibilities of the team members. CONCLUSION: The developed guideline could be used by FACT and possibly ACT teams to structure the FACTboard meeting.

Immunohistochemical method for detecting lesions in the prostate gland of bulls treated with diethylstilbestrol-dipropionate.

Hyperplastic and metaplastic lesions in the prostate gland of bulls are used as morphological evidence for the illegal administration of oestrogens or compounds with oestrogenic activity, like stilbenes. Exogenous and endogenous androgens can suppress the effects of these drugs, resulting in suspect or negative results. The detection of epithelial changes immunohistochemically with cytokeratin antibodies appeared to facilitate the diagnosis of hyperplasia and metaplasia in the prostate. A specific and sensitive method for detecting such lesions in formalin-fixed, paraffin-embedded prostate samples has been developed with the commercially available cytokeratin monoclonal antibody 34 beta E12, and applied to bulls treated with diethylstilbestrol-dipropionate. The highly reproducible staining pattern of 34 beta E12 can be used for the detection of hyperplasia and metaplasia in the prostate glands of animals treated illegally with oestrogens.

Changing cytokeratin expression patterns in diethylstilbestrol dipropionate-induced metaplastic lesions of the goat prostate.

Five-month-old male goats were treated with 25 mg diethylstilbestrol dipropionate (DES-DP) by a single intramuscular injection, causing characteristic histological alterations in the peripheral glandular epithelium of the prostate, resulting in squamous metaplasia. Using a panel of monoclonal and polyclonal cytokeratin antibodies on frozen tissue sections of control prostates, we were able to immunohistochemically distinguish between the normal secretory cells, which are positive for cytokeratin 18 as detected with the antibody RGE 53, and the scattered basal cells, which could be specifically stained by the antibody RCK 103. Cytokeratins indicating squamous differentiation, i.e., nos 4 and 13, recognised by the antibodies 6B10 and 1C7, respectively, were found in sporadic cells throughout the normal goat prostate. Profound changes in cytokeratin expression were observed in the metaplastic lesions as compared to control peripheral glandular tissue. In this respect three monoclonal antibodies are of special interest. RCK 103 is immunoreactive with resting and all stages of differentiating basal cells. Antibodies 1C7 and 6B10 strongly stain the squamous cells in the metaplastic lesions, with 1C7 staining all the squamous cells in the lesions except the basal cell layer, and 6B10 being immunoreactive with the same suprabasal cells or the more differentiated cells in the upper strata. As a result the number of cytokeratin 18-positive cells is drastically reduced upon metaplasia. The results indicate that the goat system can be used as a suitable model system to further test the applicability of immunohistochemical methods in meat inspection and toxicological pathology.

Application of diethylstilbestrol dipropionate in bulls. I. Excretion of residues in urine and faeces and histological and immunohistochemical changes in the prostate.

In this experiment 20 one year old bulls received a single intramuscular injection of the anabolic preparation diethylstilbestrol dipropionate (DES-DP) (an oil preparation or an emulsion). Four animals received a corresponding placebo. The application of DES-DP to bulls caused characteristic histological alterations in the peripheral glandular epithelium of the prostate, which could be observed until four weeks after treatment. The value of histological investigation as a screening method was, however, limited by the occurrence of only few metaplastic lesions and a rapid recovery. By contrast, immunohistochemistry using a polyclonal cytokeratin antiserum K40 appeared to be a specific and very sensitive method to detect oestrogen-induced lesions in the prostate. In only two animals, six weeks after injection with the DES-emulsion, false-negative results were obtained, demonstrating the potential value of this screening method. The excretion of DES in the urine and faeces was monitored using radioimmunoassay following chromatographic purification of the urine and faeces extracts. The excretion of DES in urine was faster for animals of the oil group. The DES content in urine decreased to the 1 microgram/l level after 42 days (emulsion group) or 70 days (oil group). The excretion in faeces was comparable to that in urine. After day 21 the excretion patterns of the two excreta were indistinguishable.

[Immunohistochemistry of cytokeratins in prostate tissue as a possible sensitive method for the screening of veal calves treated with anabolic estrogens]. / Immunohistochemie van cytokeratines in prostaatweefsel als mogelijk gevoelige methode voor de screening van met oestrogene anabolica behandelde mestkalveren.

For the detection of veal calves treated illegally with oestrogenic anabolics, histological examination of the prostate is carried out in the Netherlands. As a result of the effect of oestrogens, basal cells in the prostate proliferate and develop into (squamous) metaplastic tissue. In the present study, immunohistochemistry using antibodies to cytokeratins was used as a more sensitive and specific method to detect oestrogen-induced lesions. Prostate glands of two young bulls serving as controls and of two oxen treated with 17 beta-oestradiol and trenbolone-acetate were examined by an immunoperoxidase technique. The results suggest satisfactory immunoreactivity of the polyclonal cytokeratin antiserum K40 and particularly of the monoclonal cytokeratin antibody RCK103 for basal cells as well as for metaplastic and even hyperplastic 'suspected' lesions in the prostate of the treated animals. A more detailed study of this promising method is essential.