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The Malignant Fibrous Histiocytoma is a very rare cancer and rather exceptional when located in bladder diverticulum. it occurs in men in their sixties, manifests itself through haematuria and/or irritative micturition. There is not a causal association. An immunohistochemical analysis is necessary to establish a differential diagnosis. It is aggressive, with a high rate of local recurrence and remote progression, thereby requiring early treatment that consists of radical cystectomy with pelvic lymph node dissection followed by adjuvant therapy, predominantly radiotherapy on the surgical wound. Close follow-up is crucially important. Poor survival rate even when patients undergo multimodal therapy.

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A 35-year-old male patient was admitted to our hospital for urachal carcinoma with oligometastatic bone disease. He received a surgical resection through the umbilical area, urachal ligament and bladder dome (partial cystectomy) and adjuvant chemotherapy based on cisplatin-gemcitabine regimens together zoledronic acid with a good tolerance, no toxicity. Nine months after surgery, our patient presented no symptoms and the metastasis had been brought under control with no apparent signs of recurrence as assessed in a follow-up CT. To our knowledge, is the first case report of a urachal carcinoma with oligometastatic bone disease who received multimodal therapy, including surgery resection.

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BACKGROUND: Plasma levels of proinflammatory cytokines, including tumor necrosis factor (TNF)-alpha and interleukin (IL)-6, are elevated in patients with congestive heart failure (CHF). Recent studies suggest that the failing human heart is a source of proinflammatory cytokines in the end-stage failing heart. However, the relevance of plasma levels to those of the myocardium remains undefined. We sought to compare cytokine expression in early and end-stage CHF, and to evaluate the correlation of tissue expression to plasma levels. METHODS: Two patient populations were studied: patients with recent-onset CHF, all with symptoms less than 6 months (n = 17, duration of symptoms 2.1 +/- 1.6 months, range of New York Heart Association (NYHA) 1 to 3), and end-stage heart-failure patients (n = 7) who underwent left-ventricular assist-device (LVAD) implantation (Duration of symptoms 47.1 +/- 28.0 months, all NYHA class 4). Plasma levels of TNF-alpha and IL-6 proteins were evaluated by an Enzyme-Linked Immuno-Sorbent Assay (ELISA), while myocardial levels of cytokine transcripts were assessed by ribonuclease (Rnase) protection assay. RESULTS: In patients with end-stage heart failure, TNF-alpha and IL-6 were increased in the plasma as well as in the myocardium (plasma: TNF-alpha = 7.7 +/- 2.3 pg/ml, IL-6 = 45.0 +/- 47.1 pg/ml; myocardium: TNF-alpha = 0.31 +/- 0.15% of glyceraldehyde 3-phosphate dehydrogenase (GAPDH) expression, IL-6 = 1.56 +/- 1.54% ). In contrast, despite elevated plasma levels of TNF-alpha and IL-6, the myocardium of patients with the recent onset of symptoms demonstrated minimal expression of TNF-alpha and IL-6 messenger ribonucleic acid (mRNA) (plasma: TNF-alpha = 4.3 +/- 1.7 pg/ml, IL-6 = 3.3 +/- 1.8 pg/ml; myocardium: TNF-alpha = 0.13 +/- 0. 04%, IL-6 = 0.02 +/- 0.04%). Plasma levels of TNF-alpha were significantly correlated with those in the myocardium when both populations were combined. (r = 0.69, p < 0.001). CONCLUSIONS: Cytokines are expressed in the myocardium in end-stage heart failure to a much greater degree than in patients with the recent-onset of symptoms. This suggests that induction of cytokines in the myocardium is a relatively late event in the pathogenesis of CHF. Furthermore, plasma levels of TNF-alpha correlates with mRNA expression in the myocardium and thus may serve as an appropriate marker of myocardial cytokine activation. Whether the production of cytokines in the failing human heart precedes the elevation of cytokines in the plasma remains undefined. Therefore, we studied expression of TNF-alpha and IL-6 in the myocardium as well as in the plasma in patients with early and end-stage CHF. The results have demonstrated that cytokines are expressed in the myocardium in end-stage heart failure to a much greater degree than in patients with the recent onset of symptoms. This suggests that induction of cytokines in the myocardium is a relatively late event in the pathogenesis of CHF.

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Congestive heart failure (CHF), one of the few cardiovascular conditions increasing in incidence and prevalence, is characterized by high morbidity and mortality. Up to 50% of the mortality is attributable to dysrhythmic sudden death. Risk stratification to identify those most susceptible to sudden death remains imperfect. The advances in CHF therapeutics and management over the past 16 years have had a favorable impact on CHF mortality including sudden death. The role of amiodarone and implantable cardioverter-defibrillator intervention is evolving and discussed in the context of current CHF management and available trials.

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OBJECTIVES: We sought to evaluate the effect of therapy with intravenous immune globulin on recovery of left ventricular function in women presenting with peripartum cardiomyopathy. BACKGROUND: Peripartum cardiomyopathy is a rare complication of pregnancy that results in significant morbidity and mortality in women of childbearing age. Intravenous immune globulin has been reported to improve left ventricular systolic function in patients with acute dilated cardiomyopathy and myocarditis, but its effectiveness in peripartum cardiomyopathy is unknown. METHODS: In this retrospective study, we compared the clinical outcomes of six women with peripartum cardiomyopathy treated with intravenous immune globulin (2 g/kg) with those of 11 recent historical control subjects. All women in the study were referred between 1991 and 1998 with class II to IV heart failure and a left ventricular ejection fraction of <0.40. Left ventricular ejection was reassessed during early follow-up (6.1+/-2.9 months). RESULTS: The two groups did not differ in terms of baseline left ventricular ejection fraction, left ventricular end-diastolic diameter, months to presentation, age or multiparity. The improvement in left ventricular ejection fraction in patients treated with immune globulin was significantly greater than in the conventionally treated group (increase of 26+/-8 ejection fraction units vs. 13+/-13, p = 0.042). CONCLUSIONS: In this small retrospective study of women with peripartum cardiomyopathy, patients treated with immune globulin had a greater improvement in ejection fraction during early follow-up than patients treated conventionally. Given the poor prognosis of women with peripartum cardiomyopathy who do not improve, this therapy merits further study.

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BACKGROUND: The purpose of this study was to determine which patients on a cardiac transplantation list required a ventricular assist device. METHODS AND RESULTS: In a preliminary study, 26 patients with decompensated severe New York Heart Association class IV chronic heart failure were studied. Blood levels for sodium, hemoglobin, cytokines, neurohormones, and hemodynamics were obtained. During short-term follow-up of 40 days, 12 patients had undergone emergent implantation of a ventricular assist device (range 1-27 days, mean 5 days), 4 died (range 14-38 days, mean 26 days), and 5 were alive and receiving only medical therapy while waiting for a transplantation. In addition, five patients had undergone transplantation (range 5-29 days, mean 18 days, excluded from further analysis). Survival curves were constructed by comparing the incidence of death and the implantation of an emergent ventricular assist device in patients with values of a variable above or below the mean value (or median for nonnormally distributed data). There was a significantly greater incidence of death or need for a ventricular assist device in patients with higher levels of tumor necrosis factor-alpha (P = .008), lower levels of serum sodium and hemoglobin (P = .02 and P = .03, respectively), higher heart rates (P = .03), and higher plasma norepinephrine levels (P = .01). The Cox proportional hazards model demonstrated that only serum sodium (P = .03) independently predicted those patients who died or who required emergent left ventricular assist device. CONCLUSION: Numerous variables, particularly serum sodium, need to be considered when evaluating which patients on the transplant list require early assist device implantation or urgent transplantation. These preliminary observations merit confirmation in a larger patient population.

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Endothelial cells provide an antithrombotic and anti-inflammatory barrier for the normal vessel wall. Dysfunction of endothelial cells has been shown to promote atherosclerosis, and normalization of previously dysfunctional endothelial cells can inhibit the genesis of atheroma. In normal arteries, endothelial cells are remarkably quiescent. Acceleration of the turnover rate of endothelial cells can lead to their dysfunction. Apoptosis is a physiological process that contributes to vessel homeostasis, by eliminating damaged cells from the vessel wall. However, increased endothelial cell turnover mediated through accelerated apoptosis may alter the function of the endothelium and therefore, promote atherosclerosis. Apoptotic endothelial cells can be detected on the luminal surface of atherosclerotic coronary vessels, but not in normal vessels. This finding links endothelial cell apoptosis and the process of atherosclerosis, although a causative role for apoptosis in this process remains hypothetical. Estrogen metabolites have been shown to be among the most potent anti-atherogenic agents available to date for post-menopausal women. The mechanism of estrogen's protective effect is currently incompletely characterized. Here we show that 17beta-estradiol, a key estrogen metabolite, inhibits apoptosis in cultured endothelial cells. Our data support the hypothesis that 17beta-estradiol's anti-apoptotic effect may be mediated via improved endothelial cell interaction with the substratum, increased tyrosine phosphorylation of pp125 focal adhesion kinase, and a subsequent reduction in programmed cell death of endothelial cells. Inhibition of apoptosis by estrogens may account for some of the anti-atherogenic properties of these compounds.

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Ethmoid mucocele, a condition that usually affects adults, can be found in both children and infants with cystic fibrosis. We have cared for two patients with cystic fibrosis and ethmoid mucoceles. Because we could find no references to the prognosis or any long-term follow-up data for this disorder, we contacted the physicians and families of six of the seven patients with this condition previously reported in the English literature to determine how they were managed surgically and the incidence of recurrence. Regardless of the mode of therapy, none of the mucoceles recurred.

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OBJECTIVE: To present an uncommon but startling case of a urinary tract infectious disease such as renal emphysematous pyelonephritis. METHOD/RESULTS: We report the case of a decompensated diabetic female patient who presented an intrarenal infectious picture with gas formation compatible with emphysematous pyelonephritis that showed good evolution following medical treatment and simple nephrectomy surgery. CONCLUSIONS: Emphysematous pyelonephritis is a serious infective disease that occurs almost exclusively in diabetic patients and requires a fast and correct diagnosis differentiating between diffuse from focused processes in order to advise conservative or aggressive therapy on the renal unit (percutaneous drainage/nephrectomy), based on immediate hemodynamic and antibiotic medical support, due to its serious prognosis such as is described in the literature.

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Adhesion-independent growth is a neoplastic phenotype that is inducible in Rat 1a fibroblasts by enforced MYC expression. The c-Myc protein has been well characterized as a transcription factor, yet the molecular basis of c-Myc-induced neoplastic transformation has remained elusive. In this report, we demonstrate a link between ectopic MYC expression, deregulated cyclin A levels, and adhesion-independent growth.

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Fibroblasts in parenchymal organs potentially contribute extracellular matrix to local fibrogenic processes. This contribution, in some circumstances, may be initiated by cytokines disseminated from inflammatory lesions. Different populations of fibroblasts, however, might respond distinctively to this cytokine bath depending on the microenvironment in which they reside. We have begun to explore this issue using syngeneic, low-passage fibroblasts cultured in serum-free media that were derived originally from the dermis (DFBs) and from tubulointerstitium (TFBs) of the kidney. Our findings indicate that, while fibroblasts from each compartment appear similar at the ultrastructural level, there are a variety of functional differences which distinguish their proliferative response, and their collagen secretory response (types I, III, IV, and V) following challenge with various doses of immune-relevant cytokines (TGF beta, EGF, IL-1, IL-2 and gamma IFN) in culture. DFBs, for example, express more surface EGF receptors than do TFBs, and, as a consequence, exhibit a more robust proliferative response to EGF in serum-free media. Unstimulated DFBs also secrete more collagen types I and III than TFBs, while unstimulated TFBs secrete more types IV and V. The expression of these collagens in TFBs was confirmed by Northern blot hybridization. When these sets of fibroblasts were further stimulated by cytokines, some of the cytokines not only differentially effect the secretion of various species of collagens within the same group of cells, but also between cells from populations which are anatomically distinct. DFBs, furthermore, at mid-level doses of cytokine, demonstrated a general trend towards less secretion of all types of collagen (particularly for TGF beta, EGF, and IL-2), while TFBs seemed less repressive. In TFBs the cytokine-induced responses for collagen types I and III tended to be discordant, and for types I and IV EGF inhibited, while TGF beta stimulated the secretory process. These findings speak collectively for the presence of a functional heterogeneity among organ-based populations of syngeneic fibroblasts in normal tissues.

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Tubulointerstitial changes in the diabetic kidney correlate closely with the decline in glomerular filtration. In this study, we used a cell culture system of mouse proximal tubule epithelial cells to test the effects of glucose on cell growth, size, and matrix biosynthesis. [3H]thymidine incorporation was significantly inhibited in cells grown in 450 mg/dl glucose, compared with cells grown in 100 mg/dl glucose. The cells grown in the higher glucose concentration were slightly larger, their protein content and the total protein synthetic rate were significantly increased, and they secreted approximately twice as much procollagens type IV and type I. Concordantly, steady-state procollagen mRNA levels were also increased: 2.6-fold for the alpha 1(IV) and 2.2-fold for the alpha 2(I) procollagens. Additionally, nuclear run-off studies demonstrated that procollagen gene transcription rate was stimulated approximately 50%; beta-actin transcription rate was not altered. We used chloramphenicol acetyltransferase (CAT) reporter gene constructs to determine whether the increased transcription rate of alpha 2(I) gene was associated with activation of its enhancer sequence. Cells transfected with the enhancer demonstrated more than fivefold increase in CAT activity when cultured in the high-glucose medium. These studies demonstrate a multitude of effects of high ambient glucose concentrations on proximal tubule cell growth and collagen biosynthesis; cell proliferation is decreased although cell hypertrophy occurs. Procollagen gene transcription rate is stimulated and this response contributes to the observed increase in procollagen mRNA content. Activation of an enhancer sequence may be one possible mode through which high glucose levels increase the transcription of procollagen type I, presumably involving trans-acting factor(s).

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Los objetivos del presente estudio consistieron en determinar y cuantificar la presencia de bovinos reaccionantes al antígeno VIA en poblaciones ganaderas estables de las sabanas del departamento del meta; definir su distribución geográfica; realizar un muestreo en bovinos desembarcados en el municipio de Puerto López y efectuar una encuesta de opinión, consultando sobre la presencia o no de enfermedades vesiculares.

The purpose of this study was to determine and quantify the presence of VIAA reactors in the stable cattle population on the Savannas of the Department of Meta, to define their geographic distribution, to perform a blood sampling of cattle unloaded in Puerto López, and to conduct an opinion survey about the presence or absence of vesicular diseases in the referred region.

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Tostones (fried plantains) are consumed by a large segment of the Latin population in Florida. In addition, their use in specialty restaurants is on the increase. However, little is known about the microbial and nutritional quality of this product, particularly as affected by processing. Tostones are prepared by peeling and cutting the plantains into slices; soaking slices in a salt brine; frying, drying and flattening the slices; and refrying them until golden brown. Protein, ash, crude fiber and carbohydrate content increased during preparation as a result of moisture loss during processing. Fat content increased due to uptake during frying. Phosphorus, Na, Hg, Se and Zn content also increased, whereas that of K and Fe decreased. Changes in water activity and pH were not significantly pronounced. Bacillus and Penicillium species were the only organisms isolated from laboratory-prepared samples. The finished product contained 48.0% carbohydrate, 26.5% moisture, 21.5% fat, 2.5% protein, 1.0% ash, 0.5% crude fiber and 395 Kcal/100 g.

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Selected biochemical and microbial changes in Penaeus shrimp inoculated with Planococcus citreus were examined to determine the potential of this organism to contribute to spoilage of shrimp. Biochemical and microbial studies were conducted following storage of Penaeus shrimp at 5 C for 0, 4, 8, 12 and 16 days. Three samples, a control (raw shrimp), an irradiated (600 Krad) control and an irradiated (600 Krad) sample inoculated with P. citreus , were analyzed for changes in aerobic plate count, pH, total volatile nitrogen/amino acid nitrogen (TVN/AA-N) ratio, trimethyl amine-nitrogen (TMN) and total extractable protein (TEP). P. citreus counts increased in the inoculated shrimp from 3.0 × 103 bacteria/gram at 0 day to 1.5 × 108 bacteria/gram at the 16th day. By the 16th day of storage, the pH of the inoculated shrimp was significantly higher than the pH of the other samples. P. citreus inoculated onto irradiated shrimp was able to produce a TVN/AA-N ratio of 1.3 by the 10th day of storage, about the same time as that developed by the natural flora on raw shrimp. The increase in TMN content of the control (raw shrimp) and the inoculated sample were not significantly different. P. citreus was also able to bring about a significant decrease in the percent TEP of shrimp during storage. These changes indicate the capabilities of P. citreus in lowering the overall quality of Penaeus shrimp.

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To determine the effect of delayed heading on shrimp quality, shrimp were stored on ice with and without heads for 10 days. Some shrimp were delay-headed after 5 days and returned to ice for the remainder of the storage period. Microbiological studies were conducted at 0, 5 and 10 days of storage. Total aerobic plate counts were done using Standard Plate Count agar with an added 0.5% NaCl. Incubation was at 20 C for 5 days. Analyses indicated similar counts on shrimp tails stored with or without heads and those delayed-headed. Counts ranged from 2.4 × 106 bacteria/gram at 0 day to 1.6 × 109 bacteria/gram on the 10th day. Identification of the flora present revealed that the same major groups of organisms predominated on shrimp tails subjected to the different storage treatments and the head did not alter development of the usual flora. Flavobacterium , Pseudomonas , Planococcus , Moraxella and the Vibrio/Aeromonas group were the major genera encountered. A shift in bacterial populations was observed during storage. Flavobacterium species predominated during the first 5 days of storage; however, after the fifth day Pseudomonas species predominated. Sensory panel data revealed no differences in acceptability between shrimp tails stored with or without heads and those delay-headed.