Interstitial cell tumor and Sertoli cell tumor in the testis of a cat.

Testicular tumors are rarely reported in cats. We describe a case of interstitial cell tumor and Sertoli cell tumor in a cat that developed aggressive behavior and inappropriate urination 7 years after it was obtained from a shelter as an allegedly castrated 2 year old. At physical examination, the urine odor and the presence of penile papillae implied testosterone production. Testes were not palpable, but the left testis was found in the scrotum by surgical exploration and was mostly replaced by the 2 tumors. The interstitial cell tumor, but not the Sertoli cell tumor, was immunohistochemically positive for Melan-A, consistent with steroid production. Behavior improved after excision of the testis and penile papillae began to regress, but the cat was euthanatized 3 1/2 months after castration at the owner's request. Neither tumor had metastasized. The right testis was never found and was presumed to have been removed during the reported castration procedure.

Heparin-induced thrombocytopenia as the cause of gluteus muscle necrosis: a case study describing the benefits of multidisciplinary physical and psychosocial interventions.

Heparin-induced thrombocytopenia, an increasingly recognized aspect of heparin therapy, occurs in 0.6% to 30% of patients receiving heparin. Approximately 1% of those patients develop the more severe heparin-induced thrombocytopenia II, also called white clot syndrome, in which synchronous venous and arterial thrombi impede blood flow in central vessels. Mortality (as high as 25%) and morbidity are related to the site and extent of thrombi formation. Following vascular surgery, one patient manifested an unusual consequence of heparin-induced thrombocytopenia II when thrombotic blockage of the vessels supplying the bilateral gluteus maximus and minimus muscles resulted in tissue ischemia and death. Supporting the patient through numerous complications and managing the extensive wound healing process required multidisciplinary skills and innovative technology, including use of vacuum-assisted closure therapy, platelet-derived growth factors, parenteral and enteral nutritional support, and spirit-restoring favorite foods. This article describes the patient's life-threatening and long-lasting effects from an allergic reaction to heparin therapy. In addition to information about the diagnosis of heparin-induced thrombocytopenia, this article also describes management of the wound and other aspects of care and comforting that occurred over a 9-month hospitalization.

Maturation and lineage-specific expression of the coxsackie and adenovirus receptor in hematopoietic cells.

Adenovirus vectors have been used to transfer genes into both hematopoietic progenitor cells and tumor cells, including carcinoma cells that have metastasized to bone marrow (BM). However, the relative susceptibility of different subsets of hematopoietic cells is unknown. In permissive cells adenoviral-mediated gene transfer is mediated by the coxsackievirus and adenovirus receptor (CAR) protein and alpha(v) integrins expressed on the cell surface of the target cells. This prompted us to investigate the expression of CAR on subpopulations of hematopoietic cells, determine whether this protein played a role in adenovirus-mediated gene transfer of hematopoietic cells and whether we could modulate CAR to enhance gene transfer efficiency. In this report we show that CAR is expressed on approximately 40% of all human BM cells, including erythroid and myeloid cells, but not lymphoid cells. Of the CD34(+) cells, 10%-15% expressed CAR, but this did not include most colony-forming progenitor cells, nor the most primitive CD38(-) subpopulation. The presence of CAR correlated well with gene transfer efficiency, but we were unable to induce CAR expression on immature, noncommitted progenitor cells. In conclusion, our results show that primitive hematopoietic progenitor cells lack CAR expression, but that expression is acquired during erythroid and myeloid differentiation.

Essential role for the p55 tumor necrosis factor receptor in regulating hematopoiesis at a stem cell level.

Hematopoietic stem cell (HSC) self-renewal is a complicated process, and its regulatory mechanisms are poorly understood. Previous studies have identified tumor necrosis factor (TNF)-alpha as a pleiotropic cytokine, which, among other actions, prevents various hematopoietic progenitor cells from proliferating and differentiating in vitro. However, its role in regulating long-term repopulating HSCs in vivo has not been investigated. In this study, mice deficient for the p55 or the p75 subunit of the TNF receptor were analyzed in a variety of hematopoietic progenitor and stem cell assays. In older p55(-/-) mice (>6 mo), we identified significant differences in their hematopoietic system compared with age-matched p75(-/-) or wild-type counterparts. Increased marrow cellularity and increased numbers of myeloid and erythroid colony-forming progenitor cells (CFCs), paralleled by elevated peripheral blood cell counts, were found in p55-deficient mice. In contrast to the increased myeloid compartment, pre-B CFCs were deficient in older p55(-/-) mice. In addition, a fourfold decrease in the number of HSCs could be demonstrated in a competitive repopulating assay. Secondary transplantations of marrow cells from primary recipients of p55(-/-) marrow revealed impaired self-renewal ability of p55-deficient HSCs. These data show that, in vivo, signaling through the p55 subunit of the TNF receptor is essential for regulating hematopoiesis at the stem cell level.

One-day ex vivo culture allows effective gene transfer into human nonobese diabetic/severe combined immune-deficient repopulating cells using high-titer vesicular stomatitis virus G protein pseudotyped retrovirus.

Retrovirus-mediated gene transfer into long-lived human pluripotent hematopoietic stem cells (HSCs) is a widely sought but elusive goal. A major problem is the quiescent nature of most HSCs, with the perceived requirement for ex vivo prestimulation in cytokines to induce stem cell cycling and allow stable gene integration. However, ex vivo culture may impair stem cell function, and could explain the disappointing clinical results in many current gene transfer trials. To address this possibility, we examined the ex vivo survival of nonobese diabetic/severe combined immune-deficient (NOD/SCID) repopulating cells (SRCs) over 3 days. After 1 day of culture, the SRC number and proliferation declined twofold, and was further reduced by day 3; self-renewal was only detectable in noncultured cells. To determine if the period of ex vivo culture could be shortened, we used a vesicular stomatitis virus G protein (VSV-G) pseudotyped retrovirus vector that was concentrated to high titer. The results showed that gene transfer rates were similar without or with 48 hours prestimulation. Thus, the use of high-titer VSV-G pseudotyped retrovirus may minimize the loss of HSCs during culture, because efficient gene transfer can be obtained without the need for extended ex vivo culture.

Utility and reproducibility of semiquantitative analysis of sestamibi breast images.

UNLABELLED: Technetium-99m-sestamibi scintimammography has been shown to be a useful diagnostic test in the detection of breast cancer. The purpose of this study was two-fold to: (a) evaluate semiquantitative indices of tracer uptake in lesions and determine if they are helpful in distinguishing benign from malignant breast lesions; and (b) test the reproducibility of these measures of sestamibi uptake in breast images. METHODS: Prone lateral planar imaging was performed on 27 patients after intravenous injection of 20-30 mCi 99mTc-sestamibi. Data were analyzed by creating three regions of interest (ROIs) over designated areas: lesion, normal breast and right chest wall. Lesion-to-normal (L:N) and lesion-to-chest wall (L:CW) ratios were calculated for each patient. Reproducibility was assessed by having two independent observers draw ROIs (interobserver) and one observer draw two independent sets of ROIs (intraobserver). RESULTS: L:N and L:CW ratios were significantly different for malignant versus benign lesions (p < 0.001 for both ratios). Intraobserver and interobserver reproducibility showed good correlation with r = 0.98 (L:CW ratio). CONCLUSION: Semiquantitative analysis of sestamibi breast imaging results in reproducible uptake ratios that may be helpful in objectively interpreting imaging results.

Samarium-153-EDTMP biodistribution and dosimetry estimation.

Fifty-two patients were treated with single doses of 153Sm-EDTMP in a Phase I escalating dose protocol for palliation of bone pain from metastatic prostate carcinoma. Samarium-153 (T1/2 46.3 hr), maximum beta-particle energies 810 keV (20%), 710 keV (30%), 640 keV (50%), gamma photon 103 keV (28%), was complexed to the tetraphosphonate chelate, EDTMP. Five groups of patients were treated at doses of 1.0, 1.5, 2.0, 2.5, and 3.0 mCi/kg to evaluate toxicity from treatment. Patients were screened prior to treatment and followed after treatment with 99mTc-MDP bone scans. Biodistribution data on this group of patients were acquired and showed rapid uptake of 153Sm-EDTMP into bone with complete clearance of nonskeletal radiotoxicity by 6-8 hr. Also included are complete sets of dosimetry estimations on an additional seven patients who received 0.5 mCi/kg 153Sm-EDTMP Ca++ as part of a multiple dose therapy trial. Estimated radiation absorbed doses to bone surfaces averaged 25,000 mrad/mCi (6686 Gy/MBq), and urinary bladder doses averaged 3600 mrad/mCi (964 Gy/MBq).

Septic shock in the oncology patient.

Septic shock is an infrequent but not uncommon oncologic emergency. An understanding of the risk factors, pathophysiology, and current issues in the management of septic shock can contribute to better patient care through early recognition and prompt and knowledgeable intervention. This article reviews the epidemiology, predisposing risk factors, causative organisms, and pathophysiology of septic shock. Medical and nursing interventions illustrate the necessary teamwork involved in managing this life-threatening problem. Investigational approaches are discussed as well as the importance of identifying at-risk patients and initiating preventative measures.

Radionuclide and angiographic assessment of the right heart.

Although the pleomorphic nature of the human right ventricle makes wall motion assessment a challenge, it is a worthy challenge in terms of recognizing clinical infarction, ischemia, and primary contractile abnormalities of the right heart. As for the left ventricle, contrast angiography provides the best frame of reference, but will hopefully make way for noninvasive radionuclide ventriculographic methods after systemic evaluation has been carried out.

John Henryism and blood pressure differences among black men.

A community probability sample of southern working-class, black men (N = 132) between 17 and 60 years of age was administered a scale to measure the degree to which they felt they could control their environment through hard work and determination. Since the legend of John Henry--the famous, black steeldriver of American folklore--can be understood as a cultural statement about how black Americans must often attempt to control behavioral stressors through hard work and determination, items for the scale were developed to reflect the theme of John Henryism. It was hypothesized that men scoring below the median on education but above the median on John Henryism would have higher blood pressures than any other group. The data were in line with the prediction, in that men who scored low on education and high on John Henryism had significantly higher diastolic blood pressures than men who scored above the median on both measures. Study findings are discussed in terms of the meaning that education and John Henryism may have for raising or lowering autonomic arousal when individuals encounter behavioral stressors in everyday life.

The family routines inventory: development and validation.

This report builds upon pertinent theoretical considerations regarding the nature and importance of routinization within families and describes the development and validation of a standardized inventory to measure family routines. The Family Routines Inventory (FRI) measures 28 positive, strength-promoting family routines, those observable, repetitive behaviours which involve two or more family members and which occur with predictable regularity in the daily life of a family. The 28 routines were selected from an extensive list of 104 routines obtained through family interviews. Scoring options for the inventory were identified based on their face validity and consistency with the underlying theoretical construct. The inventory was subsequently administered to a diverse group of families for reliability and validity testing. This testing identified an optimal scoring method (frequency score) for the inventory and revealed that the Family Routines Inventory, which measures the extent and importance of routinization within a given family, appears to be a reliable and valid measure of family cohesion, solidarity, order and overall satisfaction with family life.

Effects of hunger on aggression, approach, and avoidance by juncos (Junco hyemalis).

The aggressive tendencies of male dark-eyed juncos Junco hyemalis did not differ significantly following deprivation from food for 20 and 60 min. Tendencies to approach opponents at food, in contrast, increased with longer deprivation. Acute hunger and aggression are thus not competing behavioral systems. Nor do differences in rates of approach by subordinates affect aggressive tendencies of dominant birds.

Effects of interactions with older males on behavior and reproductive development in first-year male red-winged blackbirds Agelaius phoeniceus.

Male red-winged blackbirds Agelaius phoeniceus in their first year normally do not establish territories or breed. To investigate the possibility that interactions with older males might inhibit reproductive development of young males, we compared the behavior of first-year males in the presence and absence of older males. For three months during the first half of the breeding season, we studied mixed- and single-age groups of three males in standardized outdoor aviaries: two groups of three first-year males (FFF groups), two groups of one older and two first-year males (AFF groups), and one group of three older males (AAA group). In all groups one male established clear dominance, invariably the older male in AFF groups. The dominant male in FFF groups displaced subordinates less frequently than did the dominant older male in AFF groups early in the season, but equally frequently later. In May the largest testies weights of males in FFF groups were significantly lower than those of dominant older males in AFF groups. First-year males in the absence of direct interactions with older males can achieve levels of aggressive behavior comparable to those of a dominant older male in similar social environments but the seasonal development of their aggressive behavior occurs later and their testes in May are smaller than dominant adults'. This delay in the seasonal development of aggressive behavior in first-year males, independent of the immediate social environment, suggests that the age-dependent territoriality of males in this species is not strongly regulated by effects of older males on the development of younger males.