Clinical and histopathological tumour progression in ECL cell carcinoids ("ECLomas").

AIMS: The aims of this study were to illustrate the malignant potential of gastric enterochromaffin-like (ECL) cell carcinoids (ECLomas) associated with hypergastrinemia, and the gradual neoplastic progression of such tumours. In addition, we examined whether the tyramide signal amplification (TSA) technique could visualize immunohistochemical (IHC) neuroendocrine (NE) features in the dedifferentiated neoplastic ECL cells which were not detected by conventional methods. METHODS: Conventional histopathological and IHC methods for visualizing ECL cells and cell proliferation were used in addition to the TSA technique. OBSERVATIONS: Our patient was followed for 5 years. During that period, her ECLoma displayed all the signs of classical tumour progression, ultimately with the appearance of metastases in the regional lymph nodes, the liver and the skin. The neoplastic ECL cells became progressively dedifferentiated with an increasing number of Ki-67 immunoreactive (IR) cell nuclei. In addition, there was a substantial decrease in argyrophil and IR NE cells that could be visualized by conventional methods. By applying the TSA technique, however, the number of IR tumour cells increased considerably. CONCLUSIONS: ECLomas secondary to hypergastrinemia should be closely followed for signs of clinical and histopathological tumour progression. Such ECLomas deserve early, active, radical surgical treatment. The TSA technique is a valuable tool for visualizing the characteristic IHC features in dedifferentiated NE cells.

Side effects of cyclosporin A treatment in patients with rheumatoid arthritis.

Cyclosporin A (CyA) and azathioprine (Aza) were compared with respect to renal side effects in an open controlled, randomized study of patients with rheumatoid arthritis. Twelve patients were treated with CyA (mean dose 7.8 +/- 1.2 mg/kg/day) and 12 with azathioprine for 26 weeks. All patients also received prednisolone 5 mg/day. The patients had normal serum creatinine (less than 120 mumoles/liter) and protein-free urine before the trial. CyA increased serum creatinine in nine out of the 11 patients followed for 26 weeks, the mean increase was approximately 50%. Creatinine clearance was reduced by 31%. Mean arterial pressure (MAP) and serum potassium were significantly increased by CyA. Urinary beta 2-microglobulin excretion was significantly increased by CyA, in five of the patients more than ten times. Urinary kallikrein excretion was reduced by more than 50% and urinary albumin excretion was doubled. All these parameters remained normal and unchanged in the azathioprine group. CyA was withdrawn in seven patients after 26 weeks. Urinary beta 2-microglobulin was still increased by 85% nine months after CyA treatment. The other parameters were gradually normalized after three to nine months except for one patient who developed renal failure. Urinary beta 2-microglobulin excretion was a very sensitive parameter for renal tubular damage in this study.

Frequency and prognostic significance of germinal matrix hemorrhage, periventricular leukomalacia, and pontosubicular necrosis in preterm neonates.

The occurrence of germinal matrix hemorrhage (GMH), periventricular leukomalacia (PVL), and pontosubicular necrosis (PSN) was evaluated in a material of 96 preterm infants. All cases were born at less than 38 weeks of gestation, and died within 30 days after birth. The frequency of GMH (50%) and PVL (24%) was within the range of previous observations, but the 59% occurrence of PSN argues against the assertion that intraventricular hemorrhage is the most common neuropathological finding in preterm neonates. However, different combinations of these injuries were found in more than half the cases affected. Of the 48 infants with GMH, 36 (75%) showed either PSN (19 cases), PVL (2 cases), or both lesions (15 cases), and the frequency of additional damage was related to the severity of hemorrhage. Thus, neonatal mortality may be more related to additional hypoxic/ischemic lesions than to the severity of hemorrhage per se. Clinical follow-up studies on subpopulations of preterm infants with and without GMH have shown no difference in frequency of mild and moderate psychomotoric deficiencies. The 35% occurrence of PSN as a solitary lesion in the 48 cases without GMH was similar to the frequency of PSN as a single additional lesion in 48 cases with GMH (40%). This finding makes PSN and not GMH the most likely cause of at least less severe handicaps.

A clinical and phlebographic study of postoperative deep vein thrombosis following knee meniscus extirpation.

To evaluate the risk of deep vein thrombosis, a clinical and phlebographic examination was performed 7 to 16 days after a bloodless knee meniscus operation in 37 male patients aged 20 to 35 years. Anticoagulant prophylaxis was not administered. Phlebography revealed asymptomatic calf vein thrombosis in three patients and these were not treated. In two of these phlebography was repeated after six weeks, and complete regression of the thrombi was noted. The present study may underestimate the frequency of postoperative venous thrombosis, as some thrombi may already have lysed at the time of phlebography. However, our results indicate a low incidence of thrombosis after knee meniscus extirpation.