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[Transdiaphragmatic shunt with a Roux loop in non-resectable neoplastic processes of the cardia].

On the basis of 26 cases with non-operable primary or secondary neoplastic obstructions of the cardia the authors express the opinion that the best solution is the transdiaphragmatic pontage with a jejunal loop mounted in Y. Enlargement of this indication should not be made on behalf of radical or palleative resections, but on the contrary internal derivations should increase the range of surgical solutions in cancer of the cardia. Making an analysis of the major aspects (death-rate, indications and some technical details) in connection with the by-pass with a Roux loop the authors stress the benignity of this type of surgery and the chances it has to take the place of external derivations, compared with which it provides both nutritional and moral advantages.

Cardia

Editorial: Chromosomes and human neoplasms. Achievements using new staining techniques.

Numerical and structural chromosome aberrations are frequently found in neoplastic cells. As demonstrated by the new chromosome banding techniques these aberrations are not random, but tend to show a specific occurrence. A model example is the leukemias where many cytogenetical investigations have been done to date. In leukemia chromosome analysis serves the following purposes: to identify a neoplastic process, to confirm and strengthen the hematological diagnosis, for the early diagnosis of transformation from a chronic leukemia into its blastic phase and for following up the clonal evolution of a leukemic cell line. In the discussion of chromosomes and neoplasms it must be mentioned that individuals demonstrating chromosomal instability and some trisomic patients show a greater tendency toward the development of a malignancy. Malignancy is primarily a cellular phenomenon caused by a disturbance in cellular regulation, whose fine events are not known. Therefore the exact role of the chromosomes in neoplastic processes cannot be stated. From experimental investigations it appears that the affected chromosomes carry cell growth regulating factors and also that a specific aberration is the result of the action of a specific agent.

Acute Disease

Zinc biochemistry in normal and neoplastic growth processes.

Zinc is essential for the growth of all species. Growth arrest results from its deficiency and presumably reflects important roles for this metal at critical points of metabolism. Studies of zinc metalloenzymes show that zinc serves as a coenzyme to more than 80 enzymes, among which are the reverse transcriptases which cause leukemia in many species. Its role in nucleic acid metabolism is emphasized.

DNA-Directed DNA Polymerase

Persistently abnormal brain scintigraphy after cerebral infarction.

The current literature indicates nuclear brain images typically return to normal within two to three months following an episode of cerebral infarction. In this report, two patients are described who demonstrated no significant change in their brain scan abnormalities 11 and 17 months following their strokes. Computed tomography confirmed the clinical impression that the persistent brain scan abnormalities were due to cerebral infarction rather than to neoplastic process.

Aged

Persistence of nucleolar RNA-rich structures and Ph1 duplication in the blastic crisis of chronic myeloid leukaemia.

Nucleolar persistence in metaphase plates is a feature observed in most of the cells in neoplastic processes. Pathological persistence or fragmentation of the nucleoli is thought to be the cause of some numerical chromosomal aberrations due to non-disjunction of the chromatids, with particular involvement of the satellite chromosomes. Thus, a combined selective staining of both the nucleoli (amido black 10B according to Mundkur and Brauer's cytochemical technique) and the chromosomes (neutral red) was applied to the metaphase plates of patients with chronic myeloid leukaemia in the blastic crisis. Duplicated Ph1 was associated with amido black-stained areas at a very high rate in some cases. Since the blastic crisis in chronic myeloid leukaemia is characterized by the appearance of an increased number of immature, highly nucleolated cells, these findings lend support to the hypothesis that the duplication of the Ph1 represents a feature possibly favoured by the pathological persistence of nucleolar RNA-rich structures in the metaphase.

Adult

Treatment of Paget's disease of bone with mithramycin.

The hypothesis that Paget's disease of bone is a low grade neoplastic process led us to use the cytotoxic antibiotic mithramycin in its treatment. The dramatic effects observed on the serum calcium and alkaline phosphatase, and urinary hydroxyproline are compatible with the concept that mithramycin is primarily toxic to osteoclasts. Subjective and objective clinical effects establish this agent as useful in the treatment of Paget's disease despite its observed toxicity to other organ systems.

Chemical and Drug Induced Liver Injury

[Progressive multifocal encephalitis (PML)].

In four cases of progressive multifocal leucoencephalitis the basic disease was always a malignant lymphogranuloma. Changes in the brain were multifocal, however the frontoparietal area of the white matter was affected most frequently and foci in this part were oldest. In these foci demyelination with atypical astrogliosis predominated, and there was a very small number of scavenger cells. At the periphery of foci always proliferation and enlargement of homogenous oligodendroglia nuclei were found sometimes with inclusions which in immunoassay sometimes had a common antigen with papovirus SV 40 and on electronoptic examination always contained many virions of the papovirus. No direct relationship was found between the duration of the neoplastic process, its type and changes in the CNS.

Adult

Serological and epidemiological considerations of the role of herpes simplex virus type 2 in cervical cancer.

To assess the possible biological significance of the observations that women with cervical cancer tend to be younger at first intercourse than control women, data from 1823 women were analyzed for the relationship between age at 1st intercourse and number of sex partners. Women who were younger at first intercourse had more sex partners than did women who were older at first intercourse. The interdependence of age at first intercourse and number of sex partners does not exlude the possibility that intercourse at an early age represents a biologically significant event in which the neoplastic process is initiated. However, it is equally possible that younger women at first intercourse may have multiple sex partners and be at greater risk of coming in contact with a putative oncogenic agent later in life. In addition, sera from patients with herpesvirus infections were assayed for cross-reacting and type-specific antibodies. Approximately 80% of the total antibody activity was to the cross-reacting antigen and only 20% was to the type-specific antigens in the sera of patients infected with either type 1 or type 2 virus. Among patients infected with both types of virus, less antibody activity to the type-specific antigens and more antibody activity to the cross-reacting antigens were found. These observations are discussed with respect to case-control seroepidemiological studies.

Age Factors

A general concept for molecular biology of cancer.

The demonstrations that "fetal" isozymes and other fetal or "oncodevelopmental" antigens are present in tumor cells has led to the general concept that genes normally silent in adult tissues are activated during the neoplastic process. Recent evidence that some chromatin proteins of tumor cells are fetal antigens has suggested that some of the "switches" involved in gene activation for tumor growth may also be fetal or oncodevelopmental. These results have led to current theoretical concept that fetal gene derepressors interact with the genome to produce messenger RNA for the protein products involved for growth, invasiveness, and metastasis. These processes may not be controllable in adult cells because of the lack of inhibitors, which were present during embryonic development but are not produced in adult tissues.

Animals

Angio-immunoblastic lymphadenopathy. Report of a case with pleural effusion.

A 78-year old man is presented with a characteristic case history and physical and laboratory findings typical of angio-immunoblastic lymphadenopathy with dysproteinemia (AILD). The disease had an acute onset with constitutional symptoms, generalized lymphadenopathy and hepato-splenomegaly. The presence of a large pleural effusion was of particular interest. Histologically the distinctive feature was a pronounced proliferation of small blood vessels and immunoblasts in the lymph nodes. Management of patient with AILD is problematic. Since AILD is a non-neoplastic process, symptomatic treatment with small doses of steroids, if necessary, would seem to be the best therapeutic approach. However, in our patient, as well as in other cases reported in the literature, a rapid and long standing (18 months so far in our case) complete remission was obtained with a short cycle of chemiotherapy.

Aged

Cytochemistry of nucleoproteids and some cathionic proteins in the peripheral blood leukocytes of patients with lung cancer.

In 40 patients with untreated lung cancer cytochemical studies of the peripheral blood leukocytes were conducted by means of a cytological method for the simultaneous staining of nucleoproteids (RNP and DNP) and some cathionic proteins (after Zvetkova and Zvetkov [60]). Changes were detected in the RNP cytoplasmic contents of lymphocytes, of which the most outstanding were the reduction and uneven distribution of RNP granules, their frequent extracellular expulsion by means of microclasmatoses, as well as changes in the staining of cathionic proteins of RNP accompanied by an increased nuclear chromatin condensation in the small and medium-sized lymphocytes. Parellel to reducing of the percentage of these cells in the peripheral blood of patients with advanced neoplastic disease an increased number of lymphoblastoid and monoblastoid cells is established with RNP diffusely stained, but reduced in quantity and localized in the cytoplasmic periphery and projections (compared to Downey type II atypical cells). By means of one of the variants of the method (modified type of Feulgen's reaction) a characteristic distribution and structuring of the nuclear chromatin is established in mono- and polymorphonuclear cells, most clearly expressed in the nuclei of monocytes and monoblastoid cells, as well as in nuclei of neutrophil granulocytes. In these cellular types a more specific nuclear modelling (microhypersegmentation) is observed resulting in multiple irregular nuclear projections on the nuclear surface, probably caused by subkaryolemal distribution of uneven chromatin thickenings. The changes are also recorded in the cathionic protein containing secondary cytoplasmic granules in granulocytes-neutrophils and eosinophils, probably associated with changes in the lysosomal and phagocytic functions of these cells in neoplastic diseases. The authors discuss the importance of the obtained results in connection with data on the participation of lymphocytes and neutrophils in the immune response to tumour antigenic stimuli during the course of the neoplastic process, as well as with data on the suppressive effect of antigenic (serum, viral) factors, possibly affecting the synthesis and the transport of cellular nucleoproteids (RNP and DNP) in leukocytes of cancer patients.

Blood Proteins

Mapping micrometastatic seeds of relapse.

In this issue of Cancer Cell, Liu et al. apply spatial multi-omics to map colorectal cancer micrometastases across primary tumors and matched liver and lung metastases, revealing liver micrometastases as an early evolved, stem-like, immune-suppressed residual disease state linked to a six-gene recurrence signature.

Colorectal Neoplasms

Mouse Prkar1a haploinsufficiency leads to an increase in tumors in the Trp53+/- or Rb1+/- backgrounds and chemically induced skin papillomas by dysregulation of the cell cycle and Wnt signaling.

PRKAR1A inactivation leads to dysregulated cAMP signaling and Carney complex (CNC) in humans, a syndrome associated with skin, endocrine and other tumors. The CNC phenotype is not easily explained by the ubiquitous cAMP signaling defect; furthermore, Prkar1a(+/-) mice did not develop skin and other CNC tumors. To identify whether a Prkar1a defect is truly a generic but weak tumorigenic signal that depends on tissue-specific or other factors, we investigated Prkar1a(+/-) mice when bred within the Rb1(+/-) or Trp53(+/-) backgrounds, or treated with a two-step skin carcinogenesis protocol. Prkar1a(+/-) Trp53(+/-) mice developed more sarcomas than Trp53(+/-) mice (P < 0.05) and Prkar1a(+/-) Rb1(+/-) mice grew more (and larger) pituitary and thyroid tumors than Rb1(+/-) mice. All mice with double heterozygosity had significantly reduced life-spans compared with their single-heterozygous counterparts. Prkar1a(+/-) mice also developed more papillomas than wild-type animals. A whole-genome transcriptome profiling of tumors produced by all three models identified Wnt signaling as the main pathway activated by abnormal cAMP signaling, along with cell cycle abnormalities; all changes were confirmed by qRT-PCR array and immunohistochemistry. siRNA down-regulation of Ctnnb1, E2f1 or Cdk4 inhibited proliferation of human adrenal cells bearing a PRKAR1A-inactivating mutation and Prkar1a(+/-) mouse embryonic fibroblasts and arrested both cell lines at the G0/G1 phase of the cell cycle. In conclusion, Prkar1a haploinsufficiency is a relatively weak tumorigenic signal that can act synergistically with other tumor suppressor gene defects or chemicals to induce tumors, mostly through Wnt-signaling activation and cell cycle dysregulation, consistent with studies in human neoplasms carrying PRKAR1A defects.

Animals

A new computed tomographic sign of pancreatitis.

Computed body tomography has become useful in the diagnosis of pancreatic disease. Pancreatitis frequently results in lateral and posterior extension of inflammatory tissue into the pararenal fat planes, which can be visualized by CT. In our series it was associated with clinically diagnosed pancreatitis. Of 100 cases studied for abdominal pathology where pancreatic visualization was optimum, 10 had enlargement of the pancreas with destruction of soft tissue planes extending into the left pararenal space and clinical findings of pancreatitis. Carcinoma of the pancreas was identified in 12; no abnormality was identified in 49; the remaining cases were mixed intraabdominal and retroperitoneal pathology. The value of this sign lies in separating inflammatory processes from neoplastic disease; the sign was not found in normals.

Acute Disease

The fine structure of neoplastic invasion: invasion of liver, skeletal muscle and lymphatic vessels by the Rd/3 tumour.

Neoplastic invasion as seen in the rat Rd/3 neoplasm has been studied electron microscopically in three sites: abdominal wall, footpad and liver. This neoplasm invades by peripheral cell division and active cell migration. Neoplastic cells protrude many fine processes and compress host cells. Neoplastic cells invade lymphatic vessels in a way similar to that in which white blood cells penetrate them - by the protrusion of fine cytoplasmic processes and passage, sometimes in clumps through open cell junctions. There is no ultrastructural evidence of secretory phenomena.

Abdominal Muscles

[A report on studies on the child's adaptation to school and family environment after neoplastic disease].

The objective of this study was to learn the course of child's adaptation process to school and family environment following the neoplastic disease. The study also aimed select the environment and personality factors influencing adaptation effect. The study pertains to the child's personality and how it works at home and at school. It also tries to get to know the child's environment. 65 children of different social environment were studied. Motor functions of these children were limited as the result of tumour disease. Special scale of adaptation was prepared when the research was over. By means of this sale two groups of children were distinguished: those who were well adapted to the environment and those who were not. Statistical analysis was used to compare the groups on account of the following factors: health factors including: a kind of tumour, duration of the disease, prevalence of pain, manipulation and locomotive abilities, visibility of handicap; sociological factors including: age and sex of studied persons, the place of residence and education of parent's, living standard of the family, a degree of family participation in cultural life of the society, mother's attitude towards the insane child. These factors allow to formulate the following dependences: The more a level of the child's locomotive functions, following neoplastic disease approaches to the standard, the more favourable course takes the process of child's adaptation to the family and peers. If a neoplastic disease leaves permanent and always visible handicap then child's adaptation effect to the environment is not favourable. An active participation of the family in socially life is beneficial for regular adaptation of a child. Personality development as the result of participation in cultural life allows socially accepted defence mechanism to work in stress situations connected with the disease. Parent's rational attitude towards an insane child correlates with a beneficial child's adaptation to an environment. Other factors did not differentiate the two groups statistically. During clinicalontgenetic analysis concerning particular studied cases, 3 models of nonfunctional adaptation were distinguished: maladjustment of aggressive type prevailing among the children with permanent physical handicap coming of families characteristic for socially nonaccepted standard of behaviour; maladjustment of neurotic type prevailing among the children coming of compliant families whose adult members manifest neurotic vegetative reactions in difficult situations.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living