bromochloroacetic-acid and Hemorrhage

Primary small cell neuroendocrine carcinoma of the vagina is extremely rare, and its clinical behavior is aggressive. To our knowledge, 22 patients with this tumor have been reported in the English literature to date.. To investigate 3 patients with this tumor clinically and pathologically.. The pathology database at the University of Texas Medical Branch at Galveston was searched, and 3 cases of primary small cell neuroendocrine carcinoma of the vagina were found. The histologic, immunohistochemical, and ultrastructural profiles of the tumors were investigated. The medical charts of the patients were reviewed, and the patients were followed up.. Women with the diagnosis of primary small cell neuroendocrine carcinoma of vagina.. All 3 patients presented with advanced disease, and 2 patients died within 4 months of the initial diagnosis. One 38-year-old patient was newly diagnosed, and her clinical outcome had not yet been determined. The histologic features of all 3 tumors were similar to those of their pulmonary counterpart. All cases were positive for cytokeratin, chromogranin A, and synaptophysin. The expression pattern of thyroid transcription factor 1 was examined in all 3 patients, of whom 2 were negative and 1 was positive with negative clinical and radiologic thyroid or pulmonary findings. Ultrastructural evaluation showed scattered intracytoplasmic electron-dense neurosecretory granules.. Primary small cell neuroendocrine carcinoma of the vagina has histologic, immunohistochemical, and ultrastructural features similar to those of its pulmonary counterpart. Because thyroid transcription factor 1 can be positive, it should not be used to differentiate primary from metastatic disease. The current therapies have usually resulted in poor outcomes, and new therapeutic modalities should be explored.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Brachytherapy; Carcinoma, Small Cell; Chromogranin A; Chromogranins; Cisplatin; Combined Modality Therapy; Etoposide; Fatal Outcome; Female; Hemorrhage; Humans; Keratins; Middle Aged; Neoplasm Proteins; Nuclear Proteins; Radioisotope Teletherapy; Synaptophysin; Thyroid Nuclear Factor 1; Transcription Factors; Vaginal Diseases; Vaginal Neoplasms

Chondrosarcoma of bone is a well recognized, relatively common clinicopathologic entity. Morphologically distinct soft tissue chordoid sarcoma (CS), or extraskeletal myxoid chondrosarcoma, is a relatively rare tumor that has generally been documented in extraosseous soft tissues.. The clinical and pathologic features of two patients with biopsy-proven CS from the pathology files of the Mayo Clinic and St. Thomas's Hospital were evaluated. Routine hematoxylin and eosin-stained slides were reviewed in both cases. Sections from both were examined immunohistochemically using the avidin-biotin-peroxidase technique and employing commercially available antibodies to the following antigens: S-100 protein, cytokeratin (AE1/AE3), epithelial membrane antigen (EMA), CD31, and factor VIII. Appropriate positive and negative controls were utilized throughout these procedures. Cytogenetic analysis was performed on fresh samples obtained from one tumor. Clinical data were obtained from the patients' medical records.. The two cases of primary CS of bone arose from the right distal femur and right scapula, respectively, in 2 men ages 48 and 76 years, respectively. Morphologically, the tumors were lobulated, multinodular, and comprised of a uniform population of rounded to slightly spindled cells. Nuclei were hyperchromatic with inconspicuous nucleoli and surrounded by clear, vacuolated to eosinophilic cytoplasm. Neoplastic cells were arranged in anastomosing chords, strands, and, less often, nests and pseudopapillary structures embedded in an abundant, mostly hypovascular, mucinous matrix. Foci of hemorrhage and cystic degeneration were present in both tumors. No well developed hyaline cartilage or neoplastic osteoid was observed. Immunohistochemically, one neoplasm showed focal positivity for S-100 protein but was uniformly negative for cytokeratin (AE1/AE3), factor VIII, and CD31. The other tumor showed no immunopositivity with cytokeratin, EMA, or S-100 protein. Cytogenetic analysis in the latter tumor revealed a nonrandom reciprocal chromosomal translocation, t(9;22)(q22-31;q11-12). Both patients developed local recurrences and widespread distant metastases. Wide surgical excision was the primary mode of therapy. One patient died of tumor.. Skeletal CS is an extraordinarily rare neoplasm with a distinct morphology. Although follow-up data were limited to only four examples, including two from the literature, the clinical course appears worse than that for usual chondrosarcoma of bone. Wide surgical resection appears to represent the best mode of therapy. The role of chemotherapy and radiation therapy has not been clearly defined.

Topics: Aged; Biopsy; Bone Neoplasms; Cell Nucleolus; Cell Nucleus; Chondrosarcoma; Chromosomes, Human, Pair 22; Chromosomes, Human, Pair 9; Cytogenetics; Cytoplasm; Factor VIII; Femur; Hemorrhage; Humans; Immunoenzyme Techniques; Immunohistochemistry; Keratins; Male; Middle Aged; Mucin-1; Neoplasm Recurrence, Local; Platelet Endothelial Cell Adhesion Molecule-1; S100 Proteins; Scapula; Translocation, Genetic; Vacuoles

Uncontrolled bleeding leads to a higher fatality rate in the situation of surgery, traffic accidents and warfare. Traditional hemostatic materials such as bandages are not ideal for uncontrolled or incompressible bleeding. Therefore, it is of great significance to develop a new medical biomaterial with excellent rapid hemostatic effect. Keratin is a natural, biocompatible and biodegradable protein which contains amino acid sequences that induce cell adhesion. As a potential biomedical material, keratin has been developed and paid attention in tissue engineering fields such as promoting wound healing and nerve repair. Herein, a keratin/chitosan (K/C) sponge was prepared to achieve rapid hemostasis. The characterizations of K/C sponge were investigated, including SEM, TGA, liquid absorption and porosity, showing that the high porosity up to 90.12 ± 2.17 % resulted in an excellent blood absorption. The cytotoxicity test and implantation experiment proved that the K/C sponge was biocompatible and biodegradable. Moreover, the prepared K/C sponge showed better hemostatic performance than chitosan sponge (CS) and the commercially available gelatin sponge in both rat tail amputation and liver trauma bleeding models. Further experiments showed that K/C sponge plays a hemostatic role through the endogenous coagulation pathway, thus shortening the activated partial thromboplastin time (APTT) effectively. Therefore, this study provided a K/C sponge which can be served as a promising biomedical hemostatic material.

Topics: Animals; Bandages; Biocompatible Materials; Chitosan; Gelatin; Hemorrhage; Hemostasis; Hemostatics; Keratins; Rats

Accelerating and regulating collagen formation during wound healing repair is key issues for skin regeneration. Insulin can promote the healing of damaged skin by stimulating cellular migration and angiogenesis. Here, human hair keratin-conjugated insulin was synthesized to enhance full-thickness skin regeneration based on the excellent wound healing and hemostatic effects of keratin and the collagen deposition regulation ability of insulin. The insulin-conjugated keratin (Ins-K) was synthesized through the EDC/NHS reaction, which can supply a sustained release of insulin. The Ins-K hydrogel displayed similar water absorption, porosity and rheology properties to those of the keratin hydrogel. However, the Ins-K hydrogel shows a stronger hemostatic ability than the keratin hydrogel group, with a stronger wound healing effect found for the Ins-K hydrogel in the early regeneration stage (first 2 weeks) than for the keratin hydrogel treatment, resulting in smoother skin tissues at an excision section realized by regulating transforming growth factor β1 (TGF-β1) and hydroxyproline (HYP) expression. The results demonstrate that keratin promotes hemostasis and wound healing after insulin conjugation, which highlights the potential of keratin-based materials in tissue regeneration applications.

Topics: Animals; Hemorrhage; Humans; Hydrogels; Insulin; Keratins; Liver; Liver Diseases; Male; Rats; Rats, Sprague-Dawley; Wound Healing

Effective hemostasis improvements for penetrating traumas remain a research priority for civilian and noncivilian applications. Herein, we fabricated an expandable keratin sponge (EKS) for the hemostatic treatment of a penetrating trauma based on the excellent hemostatic ability of keratin and the expandable property of polyacrylamide (PAM). EKSs with semi-interpenetrating networks were fabricated by radical polymerization of keratin and PAM, and the EKS showed rapid expansion upon blood absorption. This sponge exhibited effective hemostasis on a rat penetrating liver hemorrhage, and the expansion of the EKS was dependent on the bleeding volume. In addition, the results of a shear wave elastography analysis showed that the elasticity of the liver tissue increased from 12.5 kPa to 21.2 kPa after the penetrating liver trauma treated by the EKS, and the mechanical strength of the liver tissue was maintained after 1 h of the EKS application. Further in vivo tests indicated the effectiveness of the EKS for hemostasis in a swine femoral artery transection hemorrhage model. This EKS is promising for hemostatic applications.

Topics: Absorbable Implants; Acrylic Resins; Animals; Bandages; Elasticity Imaging Techniques; Femoral Artery; Hair; Hemorrhage; Hemostasis; Hemostatics; Humans; Keratins; Liver; Male; Rats; Rats, Sprague-Dawley; Swine; Wounds, Penetrating

Uncontrolled bleeding frequently occurs in some emergencies which can result in severe injury and even death. Keratin hydrogel has been found that it had good ahemostatic efficacy in the previous studies. However, an ideal hemostatic agent should not require mixing or preparation in advance, and hydrogel is not easy to store and carry. In the present study, the kerateine was firstly extracted from human hair, and then was prepared nanoparticles by a modified emulsion diffusion method. The synthesized nanoparticles showed spherical morphology with an average diameter of approximately 200 nm. The results of Fourier transform infrared spectroscopy and X-ray diffraction indicated that the chemical structure of kerateine did not change but the crystal form may be transformed in the nanoparticles. In addition, kerateine nanoparticles displayed a faster clotting time in vitro study than the kerateine extracts. Furthermore, kerateine nanoparticles significantly reduced the blood loss and coagulation time in the liver puncture and tail amputation in rat models. Our results indicated that kerateine nanoparticles could quickly form a high viscosity gel onto the wound and accelerate the blood coagulation based on their high specific surface area. Therefore, kerateine nanoparticles have great potential for hemostatic application.

Topics: Animals; Biocompatible Materials; Blood Coagulation; Coagulants; Emulsions; Hair; Hemorrhage; Humans; Keratins; Liver; Microscopy, Atomic Force; Nanoparticles; Rats; Rats, Sprague-Dawley; Spectroscopy, Fourier Transform Infrared; Tail

Traumatic injury is the leading cause of death in people aged 44 or less in the US. It is also estimated that 82% of deaths from battlefield hemorrhage may be survivable with better treatment options. In this study, two biomaterial hemostats having disparate mechanisms were evaluated in a large animal lethal hemorrhage model and compared to a commercial product and standard cotton gauze. We hypothesized that the biomaterial with a biologically active mechanism, as opposed to a mechanical mechanism, would be the most effective in this model. Using a published study protocol, the femoral artery in swine was punctured and treated. KeraStat™ (KeraNetics) and Nanosan®-Sorb (SNS Nano) hemostats were compared to a commercial chitosan dressing (second generation Hemcon®) and cotton gauze. Both KeraStat and Nanosan increased survival, significantly increased mean arterial pressure (MAP), and significantly decreased shock index compared to both controls. The Hemcon dressing was no different than gauze. Platelet adhesion assays suggested that the KeraStat mechanism of action involves β1 integrin mediated platelet adhesion while Nanosan-Sorb operates similar to one reported mechanism for Hemcon, absorbing fluid and concentrating clotting components. The Nanosan also swelled considerably and created pressure within the wound site even after direct pressure was removed.

Topics: Animals; Biocompatible Materials; Disease Models, Animal; Extremities; Female; Hemorrhage; Hemostasis; Keratins; Polyurethanes; Swine

Topics: Actins; Adenoma; Adult; Biomarkers, Tumor; Biopsy; Breast Neoplasms; Carcinoembryonic Antigen; Cell Nucleus; Female; Glial Fibrillary Acidic Protein; Hemorrhage; Humans; Keratins; Neoplasms, Multiple Primary; Nipples; Skin Ulcer

Metastatic clear cell renal cell carcinoma (CCRCC) should be considered in differential diagnosis of intraoral clear cell tumors, including mucoepidermoid carcinoma (MEC).. We compared the clinical, histologic, histochemical, and immunohistochemical characteristics of 9 oral metastatic CCRCCs and 8 intraoral clear cell MECs.. Oral metastatic CCRCC affected salivary-gland containing tissues in 7 cases (78%). Microscopically, oral metastasis revealed a proliferation of neoplastic clear cells arranged in an alveolar pattern with central blood vessels, features that were not seen in any intraoral clear cell MEC. Mucicarmine staining was positive only in clear cell MEC. Immunohistochemistry showed similarities in cytokeratin expression; vimentin and CD10 were expressed in all oral metastatic CCRCCs but in only 1 clear cell MEC each.. Besides clinical history, the alveolar pattern, vessel distribution, absence of mucicarmine staining, and vimentin and CD10 immunoexpression are useful in histologic differential diagnosis of CCRCC and clear cell MEC.

Topics: Adenocarcinoma, Clear Cell; Adult; Aged; Aged, 80 and over; Carcinoma, Mucoepidermoid; Carcinoma, Renal Cell; Carmine; Cell Nucleus; Coloring Agents; Cytoplasm; Diagnosis, Differential; Female; Hemorrhage; Histocytochemistry; Humans; Immunohistochemistry; Keratins; Male; Microvessels; Middle Aged; Mouth Neoplasms; Neprilysin; Salivary Gland Neoplasms; Vimentin

Many women using progestogen (P)-only contraceptives experience uterine bleeding problems. In clinical trials, a single low dose of mifepristone, given to Implanon users at the beginning of a bleeding episode reduced the number of bleeding days by approximately 50% compared with controls. In this study, a single dose of mifepristone was administered to etonogestrel (ENG)-exposed pseudo-pregnant mice, 5 days after artificial decidualization was induced when the endometrium showed signs of bleeding. Control mice received vehicle alone. Mice were culled 12-, 18-, 24- and 48-h post-treatment. In the continued presence of ENG, a single dose of mifepristone stimulated tissue breakdown followed by very rapid repair: most treated tissues were fully restored to the pre-decidualized state by 48 h post-treatment. During repair, proliferating cells (Ki67 immunostained) were localized to a band of cells around the basal area in breaking down tissues and to the repairing luminal epithelium and glands. Progesterone receptor-positive cells were largely localized to the basal area of the breaking down tissue in treated mice compared with decidual cells in controls. Oestrogen receptor-positive cells were observed in the repairing luminal epithelium and glands compared with the decidua and the basal region in control tissues. It is concluded that mifepristone treatment stimulates rapid restoration of luminal epithelial integrity: such action may be a key event in reducing the number of bleeding days observed in women using Implanon who were treated with a single dose of mifepristone.

Topics: Animals; Contraceptives, Oral, Synthetic; Endometrium; Estrogen Receptor alpha; Female; Hemorrhage; Humans; Immunohistochemistry; Injections, Subcutaneous; Keratins; Mice; Mice, Inbred C57BL; Mifepristone; Models, Animal; Progestins; Pseudopregnancy; Receptors, Progesterone; Stimulation, Chemical; Wound Healing

Defects in protein-folding and -degradation machinery have been identified as a major cause of intracellular protein aggregation and of aggregation-associated diseases. In general, it remains unclear how these aggregates are harmful to normal cellular function. We demonstrate here that, in the developing placenta of the mouse, the absence of the Mrj (Dnajb6) co-chaperone prevents proteasome degradation of keratin 18 (K18; Krt18) intermediate filaments, resulting in the formation of keratin inclusion bodies. These inclusions in chorionic trophoblast cells prevent chorioallantoic attachment during placental development. We show further that keratin-deficient embryos undergo chorioallantoic attachment and that, by genetically reducing keratin expression in Mrj(-/-) conceptuses, chorioallantoic attachment was rescued. Therefore, the chorioallantoic attachment phenotype in Mrj mutants is not due to a deficiency of the normal keratin cytoskeleton, but rather is cytotoxicity caused by keratin aggregates that disrupt chorion trophoblast cell organization and function.

Topics: Allantois; Animals; Chorion; Cytoskeleton; Female; Hemorrhage; HSP40 Heat-Shock Proteins; Inclusion Bodies; Keratins; Male; Mice; Molecular Chaperones; Placenta; Proteasome Endopeptidase Complex; Trophoblasts

Twenty-five cases of thymoma with prominent cystic and hemorrhagic changes and areas of necrosis and infarction are presented. The patients were 11 women and 14 men between the ages of 18 and 73 years (median 45.5 years). Clinically, nine patients were asymptomatic and their mediastinal tumor was discovered on routine chest radiograph. Sixteen patients presented with symptoms of chest pain and cough. All patients underwent surgical resection of their tumor. Grossly, the tumors were described as well circumscribed and encapsulated, with the exception of two that showed infiltration of pleura and pericardium. The tumors measured from 4 to 13 cm in greatest dimension. On cut surface they showed prominent cystic areas and foci of hemorrhage and necrosis. Histologically, the tumors contained solid areas showing an admixture of round to oval epithelial cells devoid of atypia admixed with small lymphocytes in varying proportions. Cystic changes with areas of necrosis, infarction, and hemorrhage were present in all cases and comprised extensive areas of the tumors. The areas of infarction showed features of ischemic necrosis and were always intimately associated with vaso-occlusive and thrombotic phenomena and with cystic and hyperplastic changes of adjacent thymic epithelium. Clinical follow-up in 14 patients showed that 11 were alive and well from 1 to 18 years after surgery (median follow-up 9 years). Three patients died: one of complications during the immediate postoperative period, one because of colonic adenocarcinoma 9 years after diagnosis of the mediastinal tumor, and one because of pneumonia 6 years later. The two patients with invasive tumors were lost to follow-up. The present study appears to indicate that areas of hemorrhage and necrosis in well encapsulated, noninvasive thymomas do not portend an adverse prognosis.

Topics: Adolescent; Adult; Aged; Cysts; Female; Follow-Up Studies; Hemorrhage; Humans; Immunoenzyme Techniques; Infarction; Keratins; Male; Middle Aged; Necrosis; Retrospective Studies; Thymoma; Thymus Neoplasms

Keratin 8 (mK8) and its partner keratin 18 (mK18) are the first intermediate filament proteins expressed during mouse embryogenesis. They are found in most extraembryonic and embryonic simple epithelia, including trophectoderm, visceral yolk sac, gastrointestinal tract, lungs, mammary glands, and uterus. We report that a targeted null mutation in the mK8 gene causes mid-gestational lethality. Mutant embryos are growth retarded and suffer from internal bleeding, with an abnormal accumulation of erythrocytes in fetal livers. The mK8- phenotype has 94% penetrance, with a few mice surviving into adulthood. We suggest that mK8/mK18 filaments are important for the integrity of the fetal liver, like specialized human epidermal keratins for the integrity of the epidermis. This phenotype in mice differs from the reported function of simple epithelium keratins in Xenopus at the gastrulation stage. In mice, mK8 fulfills a vital function at 12 days postcoitum.

Topics: Animals; Epithelium; Erythrocyte Aggregation; Fetal Death; Gene Deletion; Genes, Lethal; Hemorrhage; Intermediate Filaments; Keratins; Liver; Mice; Mice, Inbred C57BL; Mutagenesis, Site-Directed