Wandering spleen associated with ß-Thalassemia: a case report.

The clinical entity 'Wandering spleen' is an uncommon presentation and it is more often diagnosed in children than in adults, mostly women of reproductive age. Here is a case of a young woman who presented with generalized weakness and fever, and a painless mobile lump in her central abdomen. The laboratory evaluation revealed a haemolytic state and Haemoglobin electrophoresis showed ß-Thalassemia trait (Hb A2 5.1%). Ultrasonography and Computerized Tomography (CT) scan confirmed that the mass is spleen and spleen is not present in its normal anatomical location. Abdominal CT described a well-defined, homogenous pediculated mass with echo texture comparable to spleen. Radioisotope scanning could be used as an alternative for confirmation of diagnosis of this rare condition, but was not done in our case. Colour Doppler sonography of the splenic circulation revealed no infarction and intact splenic vasculature. Wandering spleen should be considered in the differential diagnosis of idiopathic abdominal or pelvic lumps. The authoritative opinion for the treatment of such a case is splenectomy or splenopexy especially in children and here, in this case splenectomy was done.

Distribution and expression of beta-lactamase genes among Aeromonas spp.

Clinical and environmental isolates of Aeromonas spp. (20 Aeromonas caviae, 33 Aeromonas veronii and 21 Aeromonas hydrophila) were examined for their ability to yield mutants derepressed for beta-lactamase production and for the distribution of the three chromosomally encoded beta-lactamase genes, ampS and cepS from A. veronii bv. sobria and cphA from A. hydrophila. Of these isolates, 100% and 96% of the isolates from A. hydrophila and A. caviae, respectively, yielded beta-lactamase derepressed mutants but only 38% of A. veronii isolates yielded the resistant phenotype at 37 degrees C. However, when tested at 30 degrees C, all isolates gave rise to the derepressed mutants, indicating a temperature effect on the control mechanism. All mutants had significantly higher beta-lactamase activity against ampicillin, oxacillin, cephaloridine and imipenem. Hybridization studies with cloned aeromonas beta-lactamase genes indicated that the cephalosporinase gene, cepS, is almost ubiquitous for the three species tested. The cphA gene cross-hybridized with all isolates of A. veronii and A. hydrophila but not to A. caviae isolates. In contrast, hybridization studies using ampS revealed that only 25% of A. caviae, 45% of A. veronii and 38% of A. hydrophila tested carried the ampS gene or one closely homologous to it. Nonetheless, strains that failed to hybridize with ampS showed two serine beta-lactamases when analysed by isoelectric focusing.

Diagnosis of breast carcinoma with radiolabeled monoclonal antibodies (MoAbs) to carcinoembryonic antigen (CEA) and human milk fat globulin (HMFG).

The current study attempted to assess the potential proficiency of radioimmunodetection (RAID) of primary, residual, multicentric, and recurrent breast carcinoma using two radiolabeled murine monoclonal antibodies (MoAbs), anti-human milk fat globulin (HMFG1) labeled with iodine (123I) and anti-carcinoembryonic antigen (CEA) labeled with technetium (99Tc). Thirteen patients with suspicious clinical and/or mammographic primary or recurrent breast carcinoma were studied in a phase I-II prospective, consecutive, nonrandomized, noncontrolled study. Five patients received intravenous infusion with 0.5-2.0 mg anti-CEA MoAb type CYT 380 labeled with 99Tc [13-22 millicurie (mCI)] and 8 patients received intravenous infusion with 0.25-1.0 mg anti-HMFG1 MoAb (Unipath, U.K.) labeled with 123I (4-17 mCI). Both MoAbs used in this study demonstrated ability to bind specifically to breast cancer lesions, resulting in successful RAID in 10 of 12 of studied patients (5 of 5 patients in the anti-CEA-99Tc and 5 of 7 in the anti-HMFG-123I group--accuracy 83.3%). One patient was excluded due to protocol violation. Seven patients had true-positive scans when correlated with surgery (sensitivity 87.5%). The MoAb scans accurately diagnosed lesions in 3 of the 4 primary invasive breast carcinomas confirmed histologically. Presence of residual carcinoma following wide excision was established in 1 of 2 patients and presence of soft tissue metastases in 3 patients. Three patients had true-negative scan (specificity 75%): 2 patients presented with suspicious mammographic recurrence postlumpectomy and 1 patient had questionable soft tissue recurrence. One patient with primary breast carcinoma had a false-negative scan and another had a false-positive scan in the presence of fibrosis following lumpectomy and radiation therapy. No adverse reactions were noted in the patients studied. RAID findings were confirmed by immunohistochemistry in 6 of 9 cases studied. Our data suggest that radiolabeled MoAbs used in this study are potentially useful diagnostic agents for evaluation of primary or recurrent breast carcinoma, particularly in the areas where conventional methodology is limited.

Scintigraphic detection of gastric and pancreatic carcinomas with In-111 ZCE 025 monoclonal antibody.

We have evaluated the role of In-111 anti-CEA (carcinoembryonic antigen) monoclonal antibody ZCE 025 in 8 patients. Three patients had a confirmed diagnosis of gastric carcinoma. Three had a confirmed diagnosis of pancreatic carcinoma. Two patients had elevated serum levels of CEA with no known primary. Each patient received 5.5 mCi In-111 ZCE 025 infused at doses of 10-80 mg. Planar and single photon emission computed tomography (SPECT) imaging at 3 and 7 days after infusion detected 9 of 12 known tumor sites and all 5 of the previously identified sites of metastasis. In-111 ZCE 025 MoAb imaging also found 6 previously unsuspected tumor sites and changed the preoperative evaluation in 50% of the patients studied. It changed the clinical management in 2 patients and established the site of primary involvement in 2 others. There were no clinical or biochemical reactions. In-111 ZCE 025 monoclonal antibody scintigraphy is a useful adjunct in the evaluation of patients with either gastric or pancreatic carcinoma. It may have a beneficial impact on the surgical decision making in these patients.

Human placental insulin binding in normal and well-controlled diabetic patients.

Previous studies of insulin binding to placentas of both insulin-dependent and untreated gestational diabetic patients have described placentas from diabetics to contain fewer insulin receptors than placentas from nondiabetic gravidas. However, these studies were done using membrane fractions prepared from the placentas and at a time when adequacy of antepartum glycemic control in the diabetic patients was not routinely evaluated by self blood sugar measurement or hemoglobin A1 assay. The current study compares specific 125I-insulin binding in vitro to intact placental villi from 15 normal patients with insulin binding to intact villi obtained from 15 insulin-dependent diabetic mothers whose fasting and postprandial blood sugars and hemoglobin A1 levels were maintained in a range normal for term pregnancy. We demonstrate that insulin binding to intact placental villi is the same in this group of diabetic patients as in the nondiabetic patients.

Clinical experience with intra lymphatic administration of 111In-labelled monoclonal antibody PAY 276 for the detection of pelvic nodal metastases in prostatic carcinoma.

The ability of 111In-PAY 276 (anti prostatic acid phosphatase antibody) in detecting pelvic lymph node metastasis following bipedal intra lymphatic administration was studied in five patients with carcinoma of the prostate. The labeled antibody was injected directly into the lymphatics of each foot. Planar and tomographic images radioactivity content of lymph nodes resected during staging pelvic lymphadenectomy were compared to the histologic and immunoperoxidase findings. Radioactivity in pelvic lymph nodes was prominently seen within 20 min of injection and was present 16 days later. Persistent accumulation of tracer in the lymphatics of the lower extremities was also observed in all patients 16 days post injection. Radioactivity counts in tumor-free lymph nodes were higher than in tumored lymph nodes resected. Our results demonstrate that intra lymphatic administration of 111In-labeled PAY 276 monoclonal antibody has major technical limitations, and that further research directed at the causes of tracer accumulation in the lymphatics and tumor-free lymph nodes is required.

Colorectal tumors: scintigraphy with In-111 anti-CEA monoclonal antibody and correlation with surgical, histopathologic, and immunohistochemical findings.

A prospective clinical study of 17 patients with a histologic diagnosis of colorectal carcinoma proved at colonoscopy and surgery was performed with indium-111 anticarcinoembryonic-antigen (CEA) monoclonal antibody (MoAb), ZCE-025. MoAb scanning depicted nine of 16 primary colorectal carcinomas on planar scintigrams (true-positive findings = 56%) and ten of 16 lesions on single-photon emission computed tomography (SPECT) scans (true-positive findings = 62%). Liver metastases were detected in three of three patients, and lymph node metastases were detected in one of four patients. Immunohistochemical examination for CEA in resected colorectal cancer tissues demonstrated a positive correlation between MoAb imaging of primary lesions and cytoplasmic-stromal intracellular CEA distribution. There was no correlation between CEA serum levels and lesion detectability with MoAb scanning.

Morphology and glycoprotein synthesis of uterine glandular epithelium in human basal plate at term: an ultrastructural and autoradiographic study.

This study describes the morphologic features of uterine glandular epithelium in human basal plate at term and identifies this epithelium as an active site of glycoprotein synthesis. Wedge biopsies were obtained from the basal plate at the time of repeat cesarean section from 11 normal pregnant patients at term. Biopsy specimens were either processed immediately for microscopic examination or incubated in vitro with 25 microCi/cc of 3H-galactose or 3H-leucine. Tissues incubated with tritiated compounds (2-hour pulse +/- 3-hour chase in nonradioactive medium) were either processed for light microscopic autoradiographic analysis or extracted for determination of trichloroacetic-acid-precipitable tritiated macromolecules in tissues and medium. Profiles of cuboidal-columnar glandular epithelium were identified in the decidual component of the basal plate region adjacent to spiral arterioles and perpendicular to the inner layers of myometrial muscle. Autoradiographic and biochemical studies identified the glandular epithelium, as well as large decidual cells, to be major sites of incorporation of both 3H-galactose and 3H-leucine and to be prime sources for secretion of tritiated macromolecules that appeared in the medium during in vitro incubation of basal plate tissue. Ultrastructurally, the glandular epithelium was noted to rest on a basal lamina, to have lateral cell membranes with numerous desmosomes, and to exhibit an apical surface with microvilli projecting into a luminal space. Cytologic features of the cells included abundant profiles of rough endoplasmic reticulum, multiple mitochondria with lamellar cristae, a well-developed perinuclear but nonpolarized Golgi apparatus,and nuclei containing predominantly euchromatin.(ABSTRACT TRUNCATED AT 250 WORDS)

Differentiation and secretory activities of cultured human placental cytotrophoblast.

Ultrastructural, autoradiographic, immunofluorescent and biochemical techniques were used to characterize primary cultures of term placental cytotrophoblast in order to gain insight into the differentiation and secretory capacities of the cellular component of human trophoblast. Trypsin treatment of placental villi allowed isolation of a predominantly cytotrophoblast cell population that maintained viability up to 13 weeks in monolayer culture. Autoradiographic studies of tritiated thymidine incorporation identified a smaller diameter mononucleated cell population that was mitotically active and developed into larger diameter mononucleated cells and into multinucleated cells during culture. Ultrastructurally, cultured cells formed desmosomes, had an extensive network of cytoplasmic microfilaments and contained the organelles for hormone synthesis and secretion. These cells secreted steroid hormones, secreted Schwangerschafts protein I, actively incorporated tritiated glycoprotein precursors and expressed surface immunoreactivity for the beta-subunit of human chorionic gonadotrophin (hCG). However, medium concentrations of hCG and human placental lactogen dropped rapidly to undetectable levels after 14 days in primary culture. Cells grown beyond confluence differentiated into 1 to 2 mm structures with a villus-like histology. Our studies indicate that cytotrophoblast can secrete steroids, cytotrophoblast differentiation occurs in vitro in the absence of maternal tissues, hCG synthesis occurs in cultured cytotrophoblast and medium concentrations of placental protein hormones are not the best indicators of cell viability for cultures of cytotrophoblast.

Glycosylated serum protein levels in diabetic and nondiabetic pregnant patients: an indicator of short-term glycemic control in the diabetic patient.

Measurement of the level of nonenzymatic glycosylation of blood proteins with more rapid turnover times than hemoglobin has been suggested as an indicator of time-averaged glucose control in nonpregnant diabetic patients. Using affinity chromatography, we have measured the levels of glycosylated serum proteins during pregnancy in 14 normal volunteers and 15 insulin-dependent diabetic patients. No relationship was noted between the percentage of glycosylated serum proteins in serum from normal patients and the gestational age at the time of sampling in the second and third trimesters of pregnancy. When the relative frequency distribution of glycosylated serum protein levels in normal patients was compared with that in diabetic patients, a significant difference was noted between the two groups, with a higher percentage of glycosylated serum protein levels in diabetic patients being at elevated values compared to those in normal patients. Normal patients had measured glycosylated serum protein levels of 12.5% +/- 2.2% whereas diabetic patients had glycosylated serum protein levels of 14.0% +/- 3.6%. When peak fasting serum glucose and high Chemstrip glucose levels were compared with glycosylated serum proteins in the diabetic population, a significant correlation for each was noted. The best correlation resulted from a comparison of an average Chemstrip glucose level (mean of 49 glucose values during the previous week) and the glycosylated serum protein value obtained at the end of that week. This inexpensive assay can be adapted to any clinical laboratory and should provide an objective means to evaluate short-term glycemic control, complementing the evaluation provided by self-glucose monitoring (immediate control) and intermittent assay of glycosylated hemoglobin (long-term control).