The use of the Multi-Tabs vitamin and mineral complex to prevent influenza

Two cases of small bowel tumour, resected and considered as benign leiomyomas, are reported. Both developed late hepatic metastases, 6 and 8 years after surgery respectively, diagnosed as leiomyosarcoma. Emphasizing the difficulties in assessing malignancy of these tumours and considering local and far dissemination, a long-term follow-up is recommended after surgical resection.     

Recurrent left-sided heart leiomyosarcoma: should heart transplantation be legitimate?

Leiomyosarcoma of the heart is an uncommon primary malignant tumor with poor postoperative survival that may be measured in months. A leiomyosarcoma of the left atrium was diagnosed in a 47-year-old man. Initial admission was for acute pulmonary edema requiring emergency surgery. The tumor involved the left atrial cavity, and a radical resection was performed. Six months later an isolated myxomatous recurrence was detected. Heart transplantation was then performed. The patient is in good health 20 months after operation with no evidence of residual disease or recurrence. The literature has been reviewed. Surgical resection is not an adequate treatment for leiomyosarcoma of the left atrium and early heart transplantation probably offers the only hope for these patients.     

The stepchild of intestinal diagnosis. Evaluation of radiologic methods in the diagnosis of leiomyoma of the small intestine

PURPOSE: Various radiological methods to diagnose small bowel neoplasms and problems of differential diagnosis specially considering leiomyomas are discussed. PATIENTS AND METHODS: Two patients with leiomyoma of the ileum underwent enteroclysis, computed tomography of the abdomen, intra-arterial DSA and colour Doppler sonography. Another patient with leiomyosarcoma just underwent CT of the abdomen with CT-guided biopsy. RESULTS: Due to the homogenous density and the smooth surface of the tumors in computed tomography and respectively enteroclysis and the presentation of the tumor vascularisation in the angiography and Colour Doppler sonography in both patients a leiomyoma of the small bowel was diagnosed. Postoperatively this diagnosis was histologically confirmed. The CT-findings of the patient with leiomyosarcoma were not suspicious of a malignant tumor. CONCLUSION: Radiologically it is not possible to determine the dignity of smooth muscle cell tumors safely. That is the reason why the diagnosis has to be achieved operatively. But the histopathological diagnosis based on the mitotic rate may be difficult. Therefore the after care has to be carried out thoroughly.     

Glaucoma surgery in the patient undergoing anticoagulation

Gastrointestinal stromal tumour (GIST) is the designation used here to identify the most common subset of gastrointestinal mesenchymal tumours specific to those sites. These tumours have unique histological, immunophenotypic and molecular genetic features that set them apart from typical smooth muscle tumours and schwannomas; however, by tradition, they have been classified as GI-smooth muscle tumours, or stromal tumours/smooth muscle tumours. GISTs occur predominantly in persons over 40 years of age with an equal sex incidence. Benign GISTs outnumber the malignant ones by a margin of 10:1. GISTs occur throughout the gastrointestinal tract, but are most common in the stomach (60-70%) and small intestine (30%). GISTs are rare in esophagus, colon and rectum. Histologically they may show a spindle cell or epithelioid pattern (the former largely corresponds with the designation of cellular leiomyoma and the latter with that of leiomyoblastoma). Immunohistochemically most GISTs are positive for CD34 and c-kit protein (CD117); the latter is quite specific for GISTs among mesenchymal tumours. Genetically GISTs commonly show DNA losses in the long arm of chromosome 14, and c-kit gene mutations occur at least in some cases. c-kit is also expressed in the interstitial cells of Cajal, the gastrointestinal pacemaker cells, and relationship of GISTs to these cells has been proposed recently. GISTs differ histologically, immunohistochemically and genetically from typical (esophageal) leiomyomas that are negative for c-kit and CD34 and neither show DNA-losses in 14q nor c-kit mutations. Evaluation of malignancy of GISTs is based on mitotic count, tumour size and extra-gastrointestinal spread. Tumours with mitotic counts higher than 5/10 high power fields or larger than 10 cm have a significant risk for recurrence and metastasis and are considered histologically malignant; however, some tumours with mitotic activity < 1/10HPF may metastasize indicating some uncertainty in malignant potential of GISTs, especially those larger than 5 cm.     

Metastatic gastric cancer arising from breast carcinoma: endoscopic ultrasonographic aspects

Linitis plastica of the stomach was diagnosed in four patients. Endoscopic ultrasonography (EUS) was performed in four cases; they were monitored by EUS and had their treatment adapted accordingly. According to the present study, the typical criteria of gastric linitis at EUS are: (a) rigidity of the gastric wall; (b) a wall thickness exceeding 6 mm; (c) a second enlarged layer marginally more echogenic than the fourth hypoechogenic layer (muscularis propria); (d) a third hyperechogenic enlarged layer; and (e) a poor demarcation between layers. Gastric linitis appears more likely to be specific metastasis from lobular breast carcinoma. In most of the follow-up cases, EUS showed correlation with a subsequent decrease of the CA15.3 level. At present, EUS seems to be the most effective and least invasive examination for clinical diagnosis and treatment surveillance of secondary gastric linitis arising from infiltrating lobular carcinoma (ILC) of the breast.     

Gastric leiomyosarcoma mimicking a cystic tumor at the pancreatic tail--one case report

A 73 year-old female patient suffered from anemia and a palpable abdominal mass. Abdominal ultrasonography and magnetic resonance imaging revealed a lesion with papillary excrescences at the pancreatic tail. Endoscopic retrograde cholangiopancreatography showed a normal pancreatic duct, but a small submucosal tumor was found in the stomach incidentally. Laparotomy disclosed an exophytic tumor arising from the submucosal layer of the stomach. Pathology revealed a gastric leiomyosarcoma with remarkable liquefaction and cystic change. Gastric leiomyosarcoma can be so necrotic as to be mistaken for a cystic tumor. It is critically important to differentiate the peripancreatic cystic lesion because the treatment strategy is totally different.     

Pharmacologic characteristics of rabbit esophageal muscularis mucosae in vitro

The aim of this study was to investigate in vitro the pharmacologic properties of rabbit esophageal muscularis mucosae. Stimulation of its motor innervation elicited only atropine-sensitive excitatory responses. This tissue was not refractory to histamine but appeared to be rapidly desensitized to its effects. Responses to adrenoreceptor agonists were produced by excitatory alpha1 and beta1 adrenoreceptors, inhibitory beta3 receptors but not alpha2 receptors. The esophageal muscularis mucosae was only weakly stimulated by neurokinins and bradykinin, and these responses were mediated via NK2, NK3, B1, and B2 receptors, respectively. Adenosine diphosphate and adenosine triphosphate produced approximately 40% maximal contractions through the activation of P2 receptors, whereas adenosine monophosphate and adenosine were without effect. Responses to prostaglandins E2 and F2alpha were < or =10% of the tissues' maximum response to acetylcholine. These data demonstrate that rabbit esophageal muscularis mucosae has a simple excitatory innervation and is only weakly stimulated by a variety of pharmacologic agents. For these reasons it is distinct from muscularis mucosae found elsewhere in the rabbit gastrointestinal tract.     

Uterine leiomyosarcoma with subsequent pregnancy]

Leiomyosarcoma are malignant tumors showing smooth muscle differentiation, they are rare, representing only about 25 percent of all uterine sarcomas and mixed malignant tumors and slightly more than 1 percent of all corporeal malignant tumors. Usually they arise in postmenopausal women and are not known to be related to the known risk factors for endometrial carcinoma (nulliparity, obesity, diabetes mellitus, hypertension, etc.) or carcinosarcoma (prior radiation therapy). They may occur in uteri that also bear typical benign leiomyomas, but leiomyosarcoma rarely can be proven to have arisen in or from benign leiomyomas. We report on two premenopausal women with leiomyosarcoma--out of totally 31 cases in our clinic from 1975-1995 who got pregnant after surgical treatment preserving the uterus. The patients are alive without evidence of disease 3 and 6 years after surgical resection.     

Ultrasonic endoscopy of superficial epidermoid cancer of the esophagus

Superficial squamous cell carcinomas of the oesophagus are defined as cancers confined to the mucosa or involving the submucosa but sparing the muscularis mucosae, with or without lymph node extension. Although lymph node involvement is rare (less than 5%) in tumours confined to the mucosa, it is frequent (30 to 45%) in tumours involving the submucosa, which have a prognosis similar to that of the usual obstructive tumours. Endoscopic ultrasonography is the most accurate examination (diagnostic accuracy greater than 95%) to distinguish between superficial and advanced cancers. The absence of visualization of the muscularis mucosae with the currently available transducers limits the decision-making value of such a distinction except in the case of flat tumours in which the absence of ultrasonographically detectable parietal thickening indicates the presence of a cancer confined to the mucosa, with an excellent prognosis.     

Cysts of the prostate. Apropos of 2 cases

An unusual case of nodular fasciitis, arising from the splenius muscle, is presented. This uncommon lesion is always benign, but a local spread in the surrounding muscular tissue is possible. Through a Literature review, the main pathological, clinical and therapeutic features are discussed.     

The development of diverticulosis and diverticulitis (author's transl)

The cause of colonic diverticula is myostatic spasm. A low-residue diet contributes to this state as transit time through the bowel is slowed. Information gathered in 102 cases was analysed. The smooth muscle architecture of specially prepared operative specimens of diverticulosis were examined. In every case an asymmetric contracture of the smooth musculature led to the formation of gaps. Here the mucosa and muscularis mucosae can protrude through the bowel wall. The muscular spasm is responsible for incarceration of the diverticula. Inflammatory diverticulitis is compared to appendicitis.     

Distribution of several gut neuropeptides and their effects on motor activity in muscularis mucosae of guinea-pig proximal colon

The distribution of peptide-containing nerve fibers and the effect of their neuropeptides on motor activity were studied in the muscularis mucosae of the guinea-pig proximal colon. In the immunohistochemical study, it was shown that the tachykinin (TK)-containing nerve fibers densely innervated the muscularis mucosae. In the superfusion study, three kinds of TKs, i.e., neurokinin A (NK-A), neurokinin B (NK-B) or substance P (SP), enhanced the spontaneous activity on the strips of muscularis mucosae with a tetrodotoxin (TTX)-insensitive manner. Their potency was in the rank order of NK-A > SP. This suggests that the muscle has a predominant NK2 receptor. Calcitonin gene-related peptide (CGRP)-immunoreactive fibers were commonly observed in the muscle. CGRP induced a potent inhibition on spontaneous activity and a concentration-dependent inhibition on the NK-A-elicited excitation in the presence of TTX, indicating its direct effect on the receptor in the muscle. On the other had, gastrin releasing peptide (GRP), galanin, neuropeptide Y or somatostatin were more or less immunopositive in nerve fibers, but they had no effect on the motility of the muscle except that GRP sometimes showed a faint increase in spontaneous activity. Neither methionine-enkephalin nor gastrin-17/cholecystokinin was immunoreactive and had any effect on the muscle. These neuropeptides other than TKs and CGRP do not seem to be neuromediators of motor activity of muscularis mucosae. The results suggest the possibility that TK-, especially NK-A- and CGRP-containing neurons, participate in the regulation of motor activity of the muscularis mucosae in the guinea-pig proximal colon.     

Distribution of the interstitial cells of Cajal in the human anorectum

The interstitial cells of Cajal are proposed to have a role in the control of gut motility. The aim of this study was to establish the distribution of interstitial cells of Cajal in the wall of the normal human anorectum. Interstitial cells of Cajal express the proto-oncogene c-kit. Interstitial cells of Cajal were identified in the colon by immunohistochemical staining, using a rabbit polyclonal anti-c-kit antibody. Anorectal tissue was obtained at surgical resection for carcinoma of the colorectum. Density of interstitial cells of Cajal was graded. Statistical analysis was performed using chi2 tests. In the longitudinal and circular muscle layers of the rectum interstitial cells of Cajal were seen in the bulk of the muscle layer. In the intermuscular plane interstitial cells of Cajal encased the myenteric plexus. Interstitial cells of Cajal were found at the inner margin of the circular muscle and in association with neural elements of the submuscular plexus. Within the internal anal sphincter interstitial cells of Cajal were infrequently scattered among the muscle fibres. The density of interstitial cells of Cajal in the internal anal sphincter was significantly lower than that observed in the circular muscle layer of the rectum (P = 0.014). In conclusion, interstitial cells of Cajal are evenly distributed in the layers of the muscularis propria of the rectum, but have a lower density in the internal anal sphincter.     

Cardiovascular, respiratory, and panic reactions to epinephrine in panic disorder patients

Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. With minimal discussion in the surgical pathology literature, appropriate evaluation may be challenging because the differential diagnosis includes other uncommon uterine disorders such as intravenous leiomyomatosis, diffuse leiomyomatosis, myxoid leiomyosarcoma, endometrial stromal sarcoma, angiofibroma, and angiomyxoma. We describe such a diagnostic challenge in a 42-year-old woman with a left adnexal mass discovered during an annual examination. With only three cases of perinodular hydropic degeneration previously reported, this case is the first with extrauterine extension and was initially concerning for a more aggressive process.     

Antiretroviral treatment with nucleoside analogs does not decrease the viremia of the hepatitis C virus in patients with HIV-1 infection

Leiomyosarcoma is an uncommon malignant tumour of the pancreas. Many retroperitoneal leiomyosarcomas grow silently and are extremely large when diagnosed. We report a 45 year old lady who presented with abdominal lump and haemoptysis. Ultrasound guided biopsy of the mass revealed a pancreatic leiomyosarcoma. The patient had lung metastasis and received chemotherapy. She is alive with disease at last followup.     

Leiomyosarcoma of the inferior vena cava

BACKGROUND: The inferior vena cava is an uncommon location for leiomyosarcoma, a malignant tumor which develops from the smooth muscle tissue of the media. CASE REPORT: A 76-year-old woman was hospitalized for swelling of the lower limbs. Ultrasonography, computed tomography of the abdomen and magnetic resonance imaging showed tumoral invasion of the inferior vena cava extending to the atrium. Histology examination of a tumoral fragment obtained by transjugular catheterism affirmed the diagnosis of leiomyosarcoma. DISCUSSION: Prognosis of leiomyosarcoma of the inferior vena cava is very poor. No medical or surgical treatment has given satisfactory results. Two factors would explain the poor prognosis: the tumoral localization and the low degree of tumoral differentiation. Clinical presentation and imaging findings suggest the diagnosis which must be confirmed by pathology examination of a tumoral biopsy specimen.     

Malignant mesenchymoma arising in an incisional scar of the abdominal wall

A case of malignant mesenchymoma of the anterior abdominal wall, composed of leiomyosarcoma, chondrosarcoma and osteosarcoma is described. The tumour, arising in the old scar of a previous operation, was completely removed surgically. Eleven months after the operation the patient is well with no evidence of recurrence. There have been no previous reports of malignant mesenchymoma developing in operation scars. We believe that this traumatic factor played a significant role in the aetiology of this rare soft-tissue neoplasm.     

Manipulation of knee extensor force using percutaneous electrical myostimulation during eccentric actions: effects on indices of muscle damage in humans

In Hirschsprung's disease (HD), certain intestinal nervous plexuses are absent. Sprouting nerve endings contain different amounts of synaptophysin (SY), a protein and main constituent of acetylcholinesterase (AChE) storage compartments. Due to the lack of specific markers for synapses, a qualitative analysis of nerve endings of intestinal segments affected by HD has not yet been undertaken. For this study, resected colorectal specimens from patients with HD (n = 8, mean age 2.1 years) were investigated in parallel for AChE, SY, and content of small synaptic vesicles by biochemical, immunohistochemical, and electronmicroscopic means. In the microdissected muscular layer, reduced SY (1.4 microgram/mg total protein, normal 24 +/- 0.3) was observed. Immunohistochemistry showed in affected tissues reduced numbers of SY-positive nerve fibers and nerve endings, which in turn were thickened and distorted, in both the muscle proper and the muscularis mucosae. Combining both morphologic and biochemical findings, in HD the number of cholinergic vesicles in the remaining nerve endings seems to be increased as measured by SY, a marker molecule specific for synaptic vesicles. Our data also suggest that nerve endings in HD may contain high concentrations of cholinergic vesicles, paralleling the known high amounts of acetylcholine and AChE found in intestinal segments of patients with HD.     

Ochratoxin A disturbs pH homeostasis in the kidney: increases in pH and HCO3- in the tubules and vasa recta

The aim of this study was to ascertain whether apoptotic counts have prognostic significance in colorectal cancer and if such counts are related to the expression of proteins implicated in cell cycle regulation. Material from a cohort of patients aged 45 years or less with colorectal carcinoma was re-examined to determine apoptotic and mitotic counts by light microscopy, in addition to assessing p53, c-myc, and bcl-2 protein status by immunohistochemistry. The apoptotic index in the 74 patients who were alive or who had died of colorectal carcinoma ranged from 1.2 per cent to 12.3 per cent and exhibited independent prognostic significance, with high counts predicting better survival (P = 0.02). Mitotic counts were not related to survival, despite a close correlation with apoptosis (r = 0.85). Tumours regarded as not staining with the CM1 antibody for p53 protein demonstrated higher apoptotic counts, compared with those that stained (medians 5.2 and 4.0 per cent, respectively; P = 0.03), but p53 expression was found not to be related to survival. The 68 tumours which stained for c-myc appeared to exhibit higher mitotic counts than those that did not. bcl-2 was detected in only four tumours. The latter two proteins exhibited no apparent relationship to the apoptotic index or survival. Although these results indicate a potential role for apoptotic counting in prognostic prediction in colorectal tumours, this is an uncommon group of patients who exhibited some atypical features. The likelihood of a proportion of cases arising within hereditary non-polyposis colorectal cancer syndrome may limit the application of the findings to a more general population with cancer of the colon and rectum. Further work is required, including critical measurement of reproducibility and assessment of the relative impact of this parameter compared with 'traditional' prognostic markers.