Differential expression of cytokeratins in follicular variant of papillary carcinoma: an immunohistochemical study and its diagnostic utility

The follicular variant of papillary carcinoma (FVPTC) is characterized by follicular growth pattern and tumor cells with appropriate nuclear features of papillary carcinoma. However, occasionally these lesions may show focal or multifocal instead of diffuse distribution of nuclear features of papillary carcinoma. Such lesions can be underdiagnosed as benign follicular nodule. Previous studies have shown that cytokeratins, especially 19, are helpful in differentiating papillary carcinoma from other benign and malignant follicular patterned lesions. In this study, we applied monoclonal antibodies to CK5/6/18, CK18, CK10/13, CK20, CK17, and CK19 to paraffin sections of formaldehyde-fixed tissue from 26 cases of FVPTC with multifocal distribution of papillary cancer nuclei, 10 cases of usual variant of papillary carcinoma, 1 case of Warthin's tumor-like papillary carcinoma, and 2 cases of the columnar cell carcinoma. CK19 stained strongly and diffusely all cases of papillary carcinoma. FVPTC cases showed strong staining of the areas with papillary cancer nuclei in all cases and moderate to strong staining in areas of tumor without obvious nuclear features of papillary cancer. Normal thyroid parenchyma adjacent to the tumor nodule showed focal staining in most cases; however, tissue away from the tumor nodule failed to show any staining. All cases of usual type of papillary carcinoma, 2 of columnar cell carcinoma, and 1 Warthin's tumor-like papillary carcinoma showed strong and diffuse staining with CK19 and failed to show any staining of adjacent normal thyroid parenchyma. Similar but less intense staining patterns were seen with CK17 and CK20. The control group, consisting of cases of follicular adenoma, follicular carcinoma, and hyperplastic nodule, showed no staining with CK19. We suggest that if one is using immunohistochemistry to aid in the diagnosis of cases of FVPTC with multifocal distribution of nuclear features of papillary cancer, an antibody panel comprising CKs 17, 19, and 20 may prove helpful. In addition, we hypothesize that the staining of adjacent nontumorous thyroid parenchyma with CK19, seen only in cases of FVPTC, suggests that some factors secreted/produced by this particular tumor may lead to modification in keratin expression of surrounding follicular epithelium.

Nasal mucosa and skin of smear-positive leprosy patients after 24 months of fixed duration MDT: histopathological and microbiological study

The skin and nasal mucosa of 10 lepromatous leprosy patients who had completed 24 doses of fixed duration multidrug therapy (MDT) but who continued to be skin-smear positive for acid-fast bacilli (AFB) were examined histopathologically. The nasal mucosa showed granuloma fractions that exceeded those seen in the skin specimens, signifying that activity in this region subsides much more gradually than the activity in the skin. Mouse foot pad studies done using T900r mice with an inoculum from the nasal mucosa biopsy specimens of these patients did not demonstrate any growth of Mycobacterium leprae, indicating that these bacilli were not viable. A skin specimen from one patient grew significant amounts of bacteria in the T900r mouse foot pad. These results show that 2 years of treatment with MDT would prevent dissemination of M. leprae from the nasal mucosa and, therefore, should preclude further transmission of the disease. It also indicates that viable bacteria might persist in the skin of patients, especially those with an initial bacterial index of > or = 4+ who have completed 24 doses of regular MDT. Therefore, a more cautious approach to administering only 12 doses of MDT to highly positive multibacillary patients is suggested.

Research and clinical assessment of eating and exercise behaviour

The Eating and Exercise Examination (EEE-C) is an efficient, self-report, computer-generated and computer-reported examination of eating and exercise behaviour, attitudes and feelings. It is clinically useful for assessment of eating and exercise disorders, as a therapeutic tool to provide feedback to patients and as an instrument to provide standardized data for cost effective and relapse prevention studies.

Association between self-concept and body weight, gender, and pubertal development among male and female adolescents

This study examined the effects and interactions of gender, pubertal status, and body weight on the self-concept of 462 young adolescent Australian students from two different schools. All students enrolled in Years 7 and 8 completed the Self-Perception Profile for Adolescents, which includes several self-concept subscales and ratings of the importance of each subscale. The self-concept subscales ranked as most important by male and female students were Close Friendship, Scholastic Competence, and Job Competence. Females rated their ability to form close friendships significantly higher and of greater importance than did males. Standard body weight was related to students' Physical Appearance subscale scores, with higher weight students having lower self-concept, and postmenarcheal females having the poorest opinion of their physical appearance. Higher body weight males had lower scores on Athletic Competence, Job Competence, and Behavioral Conduct than did other males. Overweight females and normal weight males considered athletic competence to be more important than did other students. Pubertal status was related to students' scores on Athletic Competence, with postpubertal males who were not overweight scoring highest, and on Physical Appearance, with postmenarcheal females having the lowest opinion of their appearance. The mean self-concept score was significantly related to students' standard body weight, and there was an interaction between gender and puberty, with postpubertal males having the highest and postmenarcheal females the lowest self-concept score. The discrepancy score suggested that females felt they had failed to meet their ideal self-concept significantly more than did males. The results suggest that school programs should be implemented to provide exercise and job skill training suitable for all students, especially those who are overweight. These programs, while taking into account students' pubertal status, should aim to improve self-image without resulting in feelings of failure.

Composite co-activator ARC mediates chromatin-directed transcriptional activation

Gene activation in eukaryotes is regulated by complex mechanisms in which the recruitment and assembly of the transcriptional machinery is directed by gene- and cell-type-specific DNA-binding proteins. When DNA is packaged into chromatin, the regulation of gene activation requires new classes of chromatin-targeting activity. In humans, a multisubunit cofactor functions in a chromatin-selective manner to potentiate synergistic gene activation by the transcriptional activators SREBP-1a and Sp1. Here we show that this activator-recruited cofactor (ARC) interacts directly with several different activators, including SREBP-1a, VP16 and the p65 subunit of NF-kappaB, and strongly enhances transcription directed by these activators in vitro with chromatin-assembled DNA templates. The ARC complex consists of 16 or more subunits; some of these are novel gene products, whereas others are present in other multisubunit cofactors, such as CRSP, NAT and mammalian Mediator. Detailed analysis indicates that the ARC complex is probably identical to the nuclear hormone-receptor cofactor DRIP. Thus, ARC/DRIP is a large composite co-activator that belongs to a family of related cofactors and is targeted by different classes of activator to mediate transcriptional stimulation.

Pharyngeal transport dysfunction consequent to an organ-sparing protocol

OBJECTIVE

To investigate the effects of a protocol of concomitant intravenous hydroxyurea and hyperfractionated, accelerated, external-beam radiation therapy on the swallowing mechanism of patients with advanced-stage head and neck cancer.

DESIGN

Posttreatment videofluoroscopic swallow function studies, using images of single-bolus swallows of low-density liquid barium, were analyzed in real time, slow motion, and frame by frame using an integrated system that allows objective analysis of video recordings through image processing and digitization (Kay Elemetrics Computerized Swallowing Station). Radiological descriptors were used for pharyngeal transport abnormalities, and temporal measures were obtained of structural movements.

SETTING

Academic, tertiary care, referral medical center.

PATIENTS

Fifteen consecutive patients with previously untreated, stages III and IV, nonmetastatic squamous cell carcinoma of the head and neck who underwent a phase 1 study of prolonged infusion hydroxyurea therapy in combination with hyperfractionated, accelerated external-beam radiation therapy for their disease.

RESULTS

All patients had anterior pharyngeal segment dysfunction, characterized by no epiglottic movement and slowed laryngeal motility (1.011 +/- 0.379 seconds [mean +/- SD). Anterior pharyngeal dysfunction was more severe in patients with primary tumors of the hypopharynx than in those with cancer of the oropharynx. Twelve (80%) of our patients demonstrated posterior pharyngeal segment dysfunction characterized by impaired pharyngeal constrictor motility. All 15 patients displayed pharyngeal stage abnormalities that limited bolus transport and clearance.

CONCLUSIONS

Severe pharyngeal physiological abnormalities were present that led to impaired bolus transport and that were frequent and debilitating consequences of this organ-sparing protocol. Long-term follow-up of this group will be required to assess the permanence of the abnormalities.

Measles vaccination before nine months

OBJECTIVE

To measure the protective effect of measles vaccine administered before 9 months of age and compare overall mortality of children vaccinated at 6-8 months and at 9-11 months.

METHOD

Non-concurrent cohort study involving all 13 134 children born between 16 January 1986 and 31st December 1991 in Kaniyambadi block near Vellore who had not left the area by six months of age. Main outcome measures were risk of disease and death among the under-five-year-olds according to age at measles immunization.

RESULTS

Unimmunized children had a higher risk of developing measles compared to the immunized (P < 0.05). There was no significant difference in risk of measles among those vaccinated prior to and after nine months of age. Unvaccinated children were at significantly higher risk of death than vaccinated children (P < 0.001). There was no difference in risk of death between infants vaccinated between 6 and 8 months and those vaccinated between 9 and 11 months. There was no difference in the risk of death between boys and girls vaccinated between 6 and 8 months with standard-titre Edmonston-Zagreb vaccine.

CONCLUSION

Administration of standard-titre Edmonston-Zagreb measles vaccine at 6-8 months is an effective and safe preventive measure for measles, especially where the age-specific attack rate for children < 9 months is high.

Effects of prolonged ACTH-stimulation on adrenocortical cholesterol reserve and apolipoprotein E concentration in young and aged Fischer 344 male rats

Changes in the morphology of rat adrenal cortex with age include increased accumulations of lipid droplets and lipofuscin granules. Because glandular concentrations of cholesteryl esters (CE) and apolipoprotein (apo) E are also increased in parallel, the utilization or metabolism of lipid-droplet stored CE for steroidogenesis might be altered in aging cells. To explore this possibility, adrenocortical cholesterol storage and utilization were studied in 3-6 months-old (mo) (Y) rats and 20-23 mo (O) Fischer 344 male rats. Both groups received either adrenocorticotropin (ACTH1-39, Acthar gel) or gelatin alone daily for seven consecutive days. We found that: (a) the CE concentration in O rats, but not Y animals, was diminished by ACTH. The depleted CE in stimulated-O rats was replenished within five days post stimulation. Failure to deplete CE in stimulated-Y rats was not associated with an insufficient dose of the hormone, since stimulation of Y animals with higher doses of ACTH actually increased the CE concentration. In contrast, adrenocortical free cholesterol concentration remained constant during stimulation regardless of age. (b) The depleted CE in stimulated-O rats was principally comprised of cholesteryl adrenate, cholesteryl arachidonate and cholesteryl cervonate. The accumulated CE in stimulated-Y animals was primarily comprised of cholesteryl adrenate, cholesteryl arachidonate and cholesteryl oleate. (c) Whereas in stimulated-Y rats adrenal apoE concentration declined, the concentration in stimulated O animals was well maintained. (d) In vitro, adrenal homogenate or cytosolic fraction from stimulated-O rats displayed a higher capacity to hydrolyze exogenous CE than its Y counterpart. However, cholesterol esterification with external fatty acid substrates in adrenal homogenate or microsomal fraction was comparable in the two age-groups. Our findings revealed altered adrenocortical cholesterol reserve in O rats to cope with prolonged ACTH-stimulation. Changes in apoE levels and CE hydrolysis activity may be factors associated with this alteration. Depletion and accumulation of adrenocortical CE are reflected in parallel changes in cholesteryl adrenate and cholesteryl arachidonate, suggesting physiologic importance of these polyunsaturated fatty acids during sustained steroidogenesis.

Epidemiological significance of first skin lesion in leprosy

The epidemiological significance of monolesions in leprosy and the possible inferences on the mode of entry by Mycobacterium leprae into the body are presented based on data from the clinical records of the Leprosy Control Programme of Gudiyatham Taluk in India; 660 children with monolesions (335 males, 305 females) younger than 15 years of age and detected during the period 1990-1995 were included in the study. Detailed investigations on the location of monolesions were carried out and compared with a random sample of 669 normal rural children matched for age and sex. A large majority of the leprosy monolesions were in the uncovered parts of the body, with special predilection for the posterior aspects of the upper extremities and the anterior aspects of the lower extremities. Based on observation of normal children, these happen to be precisely the sites vulnerable for trauma since they are exposed to the environment where M. Leprae could enter through abraded skin and manifest as a patch. The need for further studies is emphasized.

Nail changes in systemic diseases : A clinical study of 435 cases

Nail changes often are reflectors of an internal disease. Four hundred and thirty-five patients admitted in the Medical, Surgical and Obstetric and Gynaecology wards were studied. Nail changes were seen in 134 which included clubbing (21.3%) longitudinal melanonychia (17.2%) and platonychia (14.2%). In patients with HIV associated pulmonary tuberculosis, clubbing was associated with an unique red "crescent sign".

Polyunsaturated fatty acid inhibition of fatty acid synthase transcription is independent of PPAR activation

Polyunsaturated fatty acids (PUFA) of the (n-6) and (n-3) families inhibit the rate of gene transcription for a number of hepatic lipogenic and glycolytic genes, e.g., fatty acid synthase (FAS). In contrast, saturated and monounsaturated fatty acids have no inhibitory capability. The suppression of gene transcription resulting from the addition of PUFA to a high carbohydrate diet: occurs quickly (< 3 h) after its addition to a high glucose diet; can be recreated with hepatocytes cultured in a serum-free medium containing insulin and glucocorticoids; can be demonstrated in diabetic rats fed fructose; and is independent of glucagon. While the nature of the intracellular PUFA inhibitor is unclear, it appears that delta-6 desaturation is a required step in the process. Recently, the fatty acid activated nuclear factor, peroxisome-proliferator activated receptor (PPAR) was suggested to be the PUFA-response factor. However, the potent PPAR activators ETYA and Wy-14643 did not suppress hepatic expression of FAS, but did induce the PPAR-responsive gene, acyl-CoA oxidase (AOX). Similarly, treating rat hepatocytes with 20:4 (n-6) suppressed FAS expression but had no effect on AOX. Thus, it appears that the PUFA regulation of gene transcription involves a PUFA-response factor that is independent from PPAR.

Eating behavior and pregnancy outcome

The association between clinical eating disorders, maternal body weight, shape, and eating concerns, and the birth of low-birth-weight infants (LBW; less than 2500 g) was investigated using a retrospective case-control study. Eighty-eight women delivering LBW infants were interviewed and then divided into two groups--those delivering term, small-for-gestational-age infants (SGA; 37 or more completed weeks, n = 34) and those delivering premature infants (less than 37 completed weeks, n = 54). There were 86 reference women (CTRL) matched for age, parity, and health insurance status, who delivered babies with birth weights greater than 2500 g. In the week postpartum, women delivering term SGA, premature (PREM), and CTRL infants were interviewed using a semistructured interview. One section of this interview included a modified version of the Eating Disorder Examination (EDE), which retrospectively generated, over the previous 12 months, diagnosis of an eating disorder and maternal "normative" weight and shape concerns. In the 3 months before pregnancy, 32% of SGA women, 9% PREM women, and 5% of reference women were diagnosed as having a clinical eating disorder. Women with a past history of an eating disorder had no greater risk of delivering a low-birth-weight infant. Women delivering SGA infants, reported elevated eating disorder psychopathology postdelivery (Eating Disorders Inventory, EDI) and more disturbances in eating behavior before and during pregnancy. Unique predictors for delivery of a LBW term SGA infant were: low maternal prepregnancy body weight, smoking, low maternal weekly weight gain, and elevated EDI (Bulimia subscale). Unique predictors for delivery of a LBW premature infant were: lower maternal occupational status, vomiting in pregnancy, and lower dietary restraint. Women with disordered eating were shown to be at greater risk of delivering term SGA infants. Predictors of term growth retardation are partly determined by maternal behavior.

Sexuality and reproduction in bulimia nervosa patients over 10 years

The reproductive and sexual histories of women who had recovered or were recovering from bulimia nervosa were examined. Of 48 consecutive female patients, 43 were studied 10-15 years after first presenting for treatment. At follow-up, 74% were considered recovered and 26% still had an eating disorder. Only 2 women fulfilled the criteria for bulimia nervosa. A history of amenorrhea was common (81% of women), 63% of women being without their menstrual periods for more than 12 months. Menstruation was present in women at a body mass index of 19 or more who were no longer using the weight loss practices of self-induced vomiting, laxative abuse, and starvation. Bulimia nervosa women are more likely to be investigated for infertility when their eating disorder is active. Bulimia sufferers are sexually active, but have times of withdrawing from their partners and ceasing sexual behavior. They associate their sexual feeling with body weight, pregnancy, breastfeeding, and status of their relationships. Marital breakdown is also more common but only if the eating disorder was active at the time of marriage. Forty-five percent left their relationship had a negative effect on their eating disorder. Short-term episodes of bulimic-free behavior are associated with pregnancy and breastfeeding in some pregnancies. Termination of pregnancy occurs more often. The prevalence of miscarriage, hyperemesis gravidarum, and postnatal depression was greater among women who had not recovered from their eating disorder at the time of their pregnancy. Recovery from eating disorder behavior before attempting conception reduces the prevalence of the gynecologic, obstetric, and psychiatric problems associated with eating disorder behavior.

Gynaecological examination: a teaching package integrating assessment with learning (693)

A self-directed learning package which includes assessment was developed to allow students to acquire the psychosocial and motor skills needed to conduct a gynaecological examination with sensitivity. The package integrates assessment with learning and uses the Assessment Form as an educational instrument. The introduction, including a video of a vaginal examination and pap smear, is followed by five learning stations for groups of 3 or 4 students to visit. At each station a series of tasks are given which enable the objectives of the station to be fulfilled. The materials necessary to complete the tasks are provided. Gynaecological assistants, themselves trained by participation in the learning sessions, guide the students throughout the session and act as adviser 'patients' to help students acquire the necessary motor skills. In the assessment, students are required to integrate what they have learnt in the learning stations. The students assess themselves and the 'patient' and an observer assesses the student using the same Assessment Form. The form assesses and gives examples of the psychosocial, including legal and motor skills required. The assistants-observers give feedback to the students about their performance and make suggestions for future improvement. Of the 232 medical students completing their clinical terms in Obstetrics and Gynaecology in 1995, those students receiving the learning package rated their practical experience as significantly better. They rate the learning method, content, enjoyment and package overall very highly (median 4, 5 point scale 1-5). Open-ended comments by students confirmed these findings.

Ulnar nerve abscess in a multibacillary patient during post-multidrug therapy surveillance

An old borderline-lepromatous leprosy patient, treated initially with DDS monotherapy followed by MDT, 11 years later during surveillance presented with 3-month-old asymptomatic cystic swelling, arising from the right ulnar nerve without exhibiting any evidence to document relapse of the disease. It responded promptly to corticosteroid therapy. This unusual clinical presentations of ulnar nerve abscess has not been reported elsewhere.

Diffuse alopecia of the scalp in borderline-lepromatous leprosy in an Indian patient

A case of borderline-lepromatous leprosy exhibiting alopecia of the scalp along with lepromatous lymphadenitis of suboccipital lymphnode is reported. To our knowledge generalized leprous alopecia of the scalp with lepromatous lymphadenitis of the suboccipital node is a rare occurrence in female Indian patients.

The Mattis Dementia Rating Scale in nursing home octogenarians and nonagenarians: effects of age and education

Despite their increasing representation in the population, little is known about the neuropsychological test performance of the oldest old, particularly those who live in residential settings. Limited published data and clinical experience suggest that this group is more likely to perform in the impaired range on standardized tests when cut-offs developed with younger groups are used. We examined the Dementia Rating Scale (DRS) performance of 82 nondemented nursing home residents, aged 80 to 99, with a mean education level of 11 years. Using published norms and cutoffs, a large percentage of this sample performed in the impaired range, particularly on the initiation and conceptualization subtests and on the total score. Education, but not age, was significantly related to performance in this sample. Percentages of patients misclassified were substantial in all groups, but were higher in those with less than 13 years of education. Using a lower total-score cutoff of 110 reduced the percentage of misclassifications markedly. We recommend the development and use of revised cutoff scores for the evaluation of very elderly nursing home residents.

KC8851, a tedisamil analogue with mixed channel blockade, exhibits antiarrhythmic properties against ischemia- and electrically-induced arrhythmias

KC8851, a structural analogue of tedisamil, has previously been found to exhibit mixed blockade of K+ and Na+ currents in isolated rat ventricular myocytes. We have now investigated the antiarrhythmic actions of this compound in the anaesthetized rat and isolated rat heart. In the rat, KC8851, at concentrations as low as 0.2 micromol kg(-1) min(-1), widened the QT intervals of the ECG and prolonged the effective refractory period in a dose-dependent manner. Such actions were consistent with blockade of repolarizing K+ currents. At relatively higher doses (above 0.5 micromol kg(-1) min(-1)), KC8851 increased RSh amplitude suggesting blockade of Na+ currents. The compound was found to be effective against occlusion-induced arrhythmias at doses of 0.5 to 2 micromol kg(-1) min(-1). In isolated hearts, the effects of KC8851 on PR and QRS intervals were potentiated by elevated concentrations of K+ and H+. Overall, KC8851 was found to exhibit antiarrhythmic actions consistent with inhibition of both K+ and Na+ currents.