Malignant ovarian sex cord tumor with annular tubules in a patient with Peutz-Jeghers syndrome: a case report.

The majority of ovarian sex cord tumors with annular tubules (SCTAT) are benign neoplasms that arise sporadically. In patients who have Peutz-Jeghers syndrome (PJS), ovarian SCTAT is often an incidental finding. Malignant behavior in SCTAT has heretofore been reported only in sporadic cases. We report a case of bilateral, malignant SCTAT developing in a 47-year-old woman who had PJS, originally diagnosed as adenocarcinoma on cervicovaginal cytology. Cervicovaginal and peritoneal fluid cytologic preparations were characterized by pseudopapillary clusters and three-dimensional tubes of tumor cells with scanty cytoplasm and high nuclear: cytoplasmic ratio. Examination of surgical resection specimens revealed bilateral, solid ovarian tumors composed of simple and complex annular tubules with hyaline cores, typical of SCTAT. Tumor emboli were present within salpingeal lymphovascular spaces and in both right and left pelvic lymph nodes. Flow cytometry of tumor cells demonstrated a diploid phenotype. This case represents the first documented example of bilateral, malignant SCTAT arising in a patient who had PJS, presenting with an atypical cervicovaginal smear.

Prostaglandin therapy of peripheral occlusive arterial disease.

The mechanism of prostaglandin therapy in man is still poorly understood. We therefore investigated in 57 patients Fontaine stage II-IV the effect of a single intravenous infusion (37 POAD patients aged 36-67 years, mean 55.5) and the effect of a series of 14 therapeutic infusions (20 patients aged 32-77 years, mean 60.6). We employed a broad spectrum of methods including Doppler and photoplethysmographic pressure measurements and plethysmographic flow measurements in the toe, foot and calf, I-131 subcutaneous clearance in the lower leg, oral and skin temperature and blood gas analysis. Walking distances were estimated on a treadmill and compared with calf flows and ankle pressures. After a single infusion, blood flow in the foot and particularly in the toe rose while systemic and local pressures remained constant. Foot venous pCO2 dropped and pO2 rose dose-dependently. I-131 clearance did not change. After a series of infusions, ischaemic rest pain subsided and necroses were improved in all subjects with advanced ischaemia except one. In claudicating patients, a remarkable prolongation of walking distances without change in calf blood flow was found. It is concluded that prostaglandin therapy relaxes toe and foot skin vessels and is of considerable value in therapy of advanced skin ischaemia. It may also improve intermittent claudication. The mechanism of action includes, among other factors, a significant drop of local vascular resistance in the ischaemic areas and probably also an increase in capillary fraction of blood flow.

[The present status of conservative therapy in critical lower limb ischemia]. / Soucasné postavení konzervativní lécby kritické ischémie dolních koncetin.

1. Conservative therapy of critical limb ischaemia either supports the effect of revascularisation procedures (thrombolysis, PTA, surgical reconstruction) or is employed in cases where instrumental intervention is no more possible. As a longterm control programme, the conservative approach reduces the number of local and general vascular complications. 2. The main physiological principles of conservative treatment are as follows: improvement of driving pressure (limb dependency, slow walking, mild temporary hypertension induced by isometric contraction of forearm muscles), decrease of vascular resistance (exercise, reflex dilatation by body heating, pharmacological vasodilators, prostanoids), microcirculatory improvement (oxygen inhalation, full recommended doses of drugs), prevention of oedema (calcium blocking agents not to be administered) and prevention of tissue destruction (anabolic hormones). It is of utmost importance to start vigorous therapy without delay when symptoms or signs of incipient critical ischaemia are detected; this should be followed by a life-long control and treatment programme. 3. Early beginning of therapy makes it usually possible to control incipient critical ischaemia effectively. The long term control and treatment programme contributes to a significant drop of relapses and mortality.

From critical ischaemia to incipient critical ischaemia: a new concept of good hope for salvage of endangered extremities.

1. Although critical limb ischaemia has been clearly defined, in everyday practice the patients are detected too late. This causes poor local and general prognosis despite intensive treatment. 2. A new concept of "incipient critical ischaemia' is advocated. The leading idea is to detect the risk much earlier and secure prompt adequate therapy. To this goal simple clinical tests of sufficient sensitivity and specificity were elaborated and checked for the use of general practitioners. Any single positivity substantiates the diagnosis of incipient critical ischaemia and transport to a vascular centre for therapy. 3. Evidence is presented showing that with the above approach prognosis is remarkably better and many unnecessary amputations can be prevented.

Computer modeling of pole formation in cell division.

The regular position of spindle poles in bi- and multipolar cell divisions is interpreted as the result of expanding caps on the surface of cell nuclei first proposed by Mazia in 1986. In a computer model it is shown that expanding caps position their centers with the maximal distance between them, which is in complete accordance with findings in experimentally influenced cell divisions in which multiple poles are formed.

Medical treatment of critical limb ischaemia: encouraging results if candidates selected early, therapy based on physiological principles and long-term control established.

Medical therapy of CLI is only indicated in patients unsuitable for vascular reconstruction or angioplasty. The approach includes early detection of subjects at risk, observation of physiological principles of therapy and long-term control. The finding of ankle pressure < or = 50 mmHg is of particular value in early detection because of high specificity with respect to CLI. Limb dependency increases skin flow in CLI while in patients with moderate ischaemia vasoconstriction occurs. Positioning of the limb thus contributes to therapeutical effect. Vasodilator substances increase foot blood flow only when administered to patients covered with blankets; improper administration may cause vasoconstriction. When a long-term control programme is established, the number of episodes of CLI decreases as compared to spontaneous course of disease. Rational use of available methods in early diagnosis and therapy considerably improves the prognosis of CLI.

Multipolar mitosis in procaine-treated polyspermic sea urchin eggs and in eggs fertilized with UV-irradiated spermatozoa with a computer model to simulate the positioning of centrosomes.

Procaine-treated eggs can be penetrated by more than one spermatozoon. Supernumerary male pronuclei can fuse with the female one giving raise to multipolar spindles or remain isolated within the egg's cytoplasm forming their own spindle. In all types of multiple mitotic figures (asters and spindles) the distribution of asters is equidistant either uniplanar or at maximum distance like at the apices of a polyhedron. Astral rays are not different from spindle fibers: they can attach to and attract chromosomes of "foreign" mitotic figures. When several mitotic figures are present in one egg, the partner asters are always of the same size, and microtubules of one aster never interdigitate with those of others. The hypothesis that positioning of centrosomes is brought about by spreading of a centrosome organizer in the form of an expanding calotte on the surface of the nucleus (Mazia, D., Int. Rev. Cytol. 100, 49-92 (1987)) is supported by a computer model.

Treatment of intermittent claudication: two different mechanisms.

(1) After surgical reconstruction in patients with isolated arterial occlusions, prolongation of walking distance depends on the increase in blood flow, i.e. the improvement of muscular working capacity is due to a "flow mechanism". (2) After medical therapy, the prolongation of walking distance does not depend on the response of total blood flow. This is most probably attributable to a shift of blood to muscle capillaries, i.e. the improvement of muscular working performance is due to a "distribution mechanism". (3) Combined therapeutic use of both mechanisms may ensure optimal results in the treatment of intermittent claudication.

The effect of hydroxyethylrutoside and its combination with acetylsalicylic acid in patients with obliterative atherosclerosis.

The effect of 7-mono-hydroxyethylrutoside and its combination with acetylsalicylic acid was evaluated in a controlled clinical trial, performed in 105 patients with obliterative atherosclerosis of the lower limbs, and using non-invasive measurement of peripheral haemodynamic parameters--blood flow during reactive hyperaemia and ankle systolic blood pressure. Patients, randomized into three groups, received either placebo or 7-mono-hydroxyethylrutoside alone or in combination with acetylsalicylic acid for 12 months. The placebo group showed a decrease in maximum calf blood flow and a decrease in ankle systolic pressure. Administration of 7-mono-hydroxyethylrutoside did not lead to any significant changes in systolic pressure but there was a decrease in the maximum calf blood flow. There were no statistically significant changes in patients receiving the 7-mono-hydroxyethylrutoside and acetylsalicylic acid combination who, by contrast, showed a tendency to increased values of the parameters measured.

Characteristic of patients surviving over a long-term period after intra-aortic balloon counterpulsation treatment.

Control examination of 21 patients after cardiac surgery which required the application of intra-aortic balloon counterpulsation in order to terminate extracorporeal circulation showed that, in spite of the serious postoperative course, the prognosis and quality of their life is a good one. Objective signs of left ventricular function show rather a moderate deterioration. Patients after myocardial revascularization have at the same time a demonstrable ischaemic disease of the lower extremities. Changes of more serious nature on the arteries of the lower extremities in connection with the earlier application of intra-aortic balloon counterpulsation could not be documented.