Nicotinic acetylcholine receptor immunohistochemistry in Alzheimer's disease and dementia with Lewy bodies: differential neuronal and astroglial pathology

Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are common forms of dementia in the elderly. The neuropathology of AD and DLB is related to cholinergic dysfunctions, and both alpha4 and alpha7 nicotinic acetylcholine receptor (nAChR) subunits are decreased in several brain areas in both diseases. In this immunohistochemical study, we compared neuronal and astroglial alpha4 and alpha7 subunits in AD, DLB and age-matched controls in the hippocampal formation. The numbers of alpha4 reactive neurons were decreased in layer 3 of the entorhinal cortex of AD and DLB, whereas those of alpha7 reactive neurons were decreased in layer 2 of the subiculum of AD and DLB and in layer 3 of the entorhinal cortex of DLB. In contrast, the intensity of alpha7 reactive neuropil was significantly higher in AD than in controls or DLB in a number of areas of the hippocampus (CA3/4 and stratum granulosum), subiculum and entorhinal cortex. An increase in alpha7 immunoreactivity in AD was also associated with astrocytes. The number of astrocytes double-labelled with alpha7 and glial fibrillary acidic protein (GFAP) antibodies was increased in most areas of the hippocampus and entorhinal cortex in AD compared with controls and DLB. Increased astrocyte alpha7 nAChRs in AD may be associated with inflammatory mechanisms related to degenerative processes specific to this disease.     

Comparison of two groups of patients with serous and mucinous types of borderline ovarian tumors

OBJECTIVE: The retrospective comparison of two groups of patients with the most common types of borderline ovarian tumors (BTO): serous and mucinous. METHODS: All patients were treated between 1978 and 2000 at the 2nd Department of Obstetrics and Gynecology Medical University of Gdańsk. The first group consisted of 58 patients with serous BTO. The second group consisted of 48 patients with mucinous BTO. These groups were compared according to such parameters: age at diagnosis, parity, clinical symptoms, localization of tumor, tumor size, type of operation, stage of disease, utilization of adjuvant therapy, presence of recurrence and 5-year survival. Statistical comparisons were made by the chi 2 test. The clinical life table analysis was performed to determine 5-year survival and comparisons were made by means of the Long Rank tests. RESULTS: The mean age of serous BTO was 53.1 +/- 12.8 and of mucinous BTO 43.3 +/- 17.9 (p = 0.0000). In the first group 15.5% and in the second 43.8% women were nullipara (p = 0.0602). The main symptom of serous BTO was pain--53.5% patients and that of mucinous BTO increasing girth--47.9% patients (p = 0.0456). The mean size of serous BTO was 13.7 +/- 6.9 cm and that of mucinous BTO was 20.3 +/- 9.5 cm (p = 0.004). 43 patients (89.6%) with mucinous and 28 patients (48.3%) with serous BTO were at I A stage and 9 patients (15.5%) with serous and only one (2.1%) with mucinous were at III stage (p = 0.0008). The mucinous BTO--affected were more frequently treated conservatively than serous BTO--ones which were rather treated radically with using adjuvant therapy (p = 0.003). Residual disease was observed mainly in patients with serous BTO. 5-years survival was better in patients with mucinous BTO, 87.7% and 85.2% respectively (p = 0.0001). CONCLUSIONS: 1. The mucinous BTO occurred more frequently than serous BTO in women of the childbearing age. 2. The extraovarian disease was observed more often with serous BTO than the mucinous BTO. 3. The mucinous BTO was usually bigger than serous BTO and mainly affected only one ovary. 4. The mucinous BTO was more frequently treated conservatively than serous BTO which were rather treated radically with use of adjuvant therapy. 5. The recurrence rate was higher and the 5-year survival was worse in patients with serous BTO.     

Sonoangiography and logistic regression analysis in the preoperative differentiation of ovarian tumors

OBJECTIVE: To apply logistic regression analysis for several clinical and sonographic data for the construction of a predictive model that could be helpful in the preoperative differentiation of adnexal masses. MATERIALS AND METHODS: Two hundred and eight women with tumors thought to be of adnexal origin were examined preoperatively. Initial analysis included age and menopausal status, ultrasound derived morphological features of adnexal masses (unilateral/bilateral tumors, papillae, septae, tumor size and volume) as well as color Doppler criteria such as PI, RI, Peak Systolic Velocity, PSV assessment. In all examinations we used B&K 2002 ADI (Denmark) and Kretz Voluson V730 (Austria) scanners with transvaginal probes 5-9 MHz. Stepwise logistic regression analysis was used to construct a predictive model that would allow probability of malignancy calculation for individual patient. RESULTS: There were 159 benign and 49 malignant masses. Seven cancers were in FIGO stage one. Statistical analysis revealed that only 5 of initially tested 14 variables had significant influence on the regression equation. These were: age, bilateral mass, presence of septa > 3 mm, papillary projections > 3 mm in the tumor wall and subjective color scale assessment according to Timmerman et al. (1999). Sensitivity and specificity at the 50% probability level of malignancy in the studied tumor were 77.5% and 96.8%, respectively. When 25% cut-off probability level was used, sensitivity increased to 87.7% and specificity dropped to 89.9%. Prospective testing in a new group of 30 patients (5 ovarian cancers) gave sensitivity of 80% and specificity of 100%. CONCLUSIONS: The use of logistic regression analysis can help in modeling clinical and sonographic data. Our model had better predictive value than individual tests and allowed to calculate true probability figure of ovarian malignancy for any given patient with adnexal mass.     

Gastrointestinal surgery in patients with ovarian cancer

OBJECTIVES: The objectives were to assess indications as well as outcome and morbidity of gastrointestinal surgery in patients with ovarian cancer. METHODS: The study included 74 patients with primary ovarian cancer who had debulking surgery (bowel surgery) from 1987 to 2001. RESULTS: In our group postoperative residual tumor was--R0 in 15 cases (20.3%) and < or = 2 cm (R2) in 33 patients (44.6%). CONCLUSION: Gastrointestinal surgery is frequently indicated during operation in ovarian cancer. Gynecologic cancer surgeons should be trained accordingly.     

Pregnancy and delivery after conservative treatment of borderline ovarian tumor with FIGO stage III C--a case report

This study presents a case of pregnancy after conservative surgical treatment of borderline ovarian tumor with III C stage according to FIGO classification. The caesarean section in 37 week of pregnancy was performed and connected with very precise staging. In normal-appearing both ovaries the foci of borderline ovarian tumor were found. There were no foci of borderline ovarian tumor or foci of invasive carcinoma in tissues routinely sampled during the second look operation. All benefits and costs of conservative surgical approaches to very young, childless women with advanced borderline ovarian tumor were exactly estimated.     

Diagnostic difficulties in neuroendocrine carcinoma of the larynx

The rare case of the large cell neuroendocrinic carcinoma of larynx was described. 66 years old man was treated by total laryngectomy because of melanoma. Postoperative, immunohistochemical study shoved large cell neuroendocrinic carcinoma. A special emphasis was put on the preoperative misdiagnose, limiting neck dissection. The authors point out, however, the difficulties of the pathologic differentiation caused by similarity of these tumors. The treatment and prognosis are discussed.     

Amniotic fluid embolism in a 24-year-old female after caesarean section - a case report

A case of a 24-year-old female with amniotic fluid embolism following an urgent caesarean section is presented. Medical treatment was effective. Prognosis in this condition and differential diagnosis are discussed.