Serum CA-15.3 and CEA patterns in postsurgical follow-up, and in monitoring clinical course of metastatic cancer in patients with breast carcinoma

Serum CA-15.3 and CEA levels were longitudinally determined in 307 patients with breast carcinoma during postsurgical follow-up and/or therapy. Of 120 patients with no apparent disease, the specificity of marker levels fluctuating within the normal range (true-negative) was 98% for CA-15.3 alone (P = 0.004) and about 88% for CEA alone or for the tests combined. However, the false-negative levels in patients with progressive cancer reduced the predictive value of the tandem to around 76%, i.e. normal levels of both markers correctly predicted uneventful postsurgical course in only three fourths of the patients. Of 187 patients with active disease, the sensitivity of raised or increasing marker levels was around 70% for CA-15.3 alone or CEA alone, and 82% for the tests combined (P = 0.006). The 11% false-positive rate of CEA in patients with no apparent disease decreased the predictive value of a positive test from 98% for CA-15.3 alone (P = 0.006) to 91% for CEA alone or the tandem. Serum CA-15.3 or CEA paralleled the site of relapse: at least one marker was found elevated in 60% of patients with locoregional disease or with metastases to the lungs or bones exclusively, and in 90% of those with metastases to the lungs and bones or to the liver. A concurrent decrease of both marker levels reflected response to therapy while an increase of at least one marker level reflected treatment failure. It may be concluded that the marker tandem was better than either marker alone for follow-up aimed at detection of relapse, and that the tests were approximately 80% accurate for follow-up and/or monitoring therapy.

Melatonin secretion in vitro from the pineal complex of the lamprey Petromyzon marinus

Melatonin secretion from cultured pineal complexes of the lamprey, Petromyzon marinus, was measured by radioimmunoassay (RIA) for 6 days under either a 12:12 light:dark cycle (L:D) or continuous darkness (D:D) at either 10 degrees or 20 degrees. Under the L:D cycle, melatonin release was completely suppressed during daytime and high during night-time, with larger amplitude at 20 degrees than at 10 degrees. Under D:D conditions, no significant circadian rhythmicity in secretion could be revealed by periodogram analysis at either 10 degrees or 20 degrees. This is the first direct evidence of melatonin secretion in a lamprey, suggesting that both light and temperature can affect in vitro melatonin secretion.

Relations between epidermal growth factor receptor and oestrogen and progesterone receptors in breast cancers of premenopausal and postmenopausal patients in Kuwait

The levels of cell membrane epidermal growth factor receptor EGFR and cytosol (c) and nuclear (n), oestrogen (E) and progesterone (P) receptors (R) were determined in 132 specimens of primary breast cancers. In the tumours of postmenopausal women an inverse significant correlation was demonstrated between the concentrations of EGFR vs. ERc, ERn, and PRc while no such correlation was noted in the tumours of premenopausal women. Premenopausal and postmenopausal EGFR positive tumours (> or = 10 fmol/mg membrane protein) could be regarded as homogenous with respect to the concentration of ER and PR whose mean values were low and without being significantly different. EGFR negative tumours were heterogeneous with respect to the ER and PR concentrations. Postmenopausal EGFR negative (< 10 fmol/mg membrane protein) tumours had evidently higher mean values of ER and PR than premenopausal EGFR negative tumours, but these differences were statistically significant for oestrogen receptors only. The levels of ER and PR of premenopausal EGFR negative tumours were approximated to the corresponding levels of EGFR positive tumours.

Potential and limitations of energy-transfer processes in pulsed and cw dye laser mixtures: comparison of theory and experiments

A comprehensive energy-transfer dye laser (ETDL) simulation model and the premise on which it is based are examined and reviewed. The model permits theoretical predictions of the total transfer efficiency and hence identification of the appropriate mechanisms that are responsible for energy transfer as well as predicting fluorescence spectra of dye mixtures. Using concentration regimes that are generally applicable to laser action, we also show that the model is capable of predicting gain line shapes (and hence tunability) for pulsed ETDL's. An extension of the model also predicts the gain spectrum of cw laser-pumped ETDL's as a function of donor and acceptor concentrations, their spectral data, energytransfer parameters, pump power and wavelength, and dimensions of the active region. Model simulation results are checked against experimental results for pulsed and cw ETDL's with laser outputs in the visible and near-IR spectral regions. The results lead to a better and more detailed understanding of ETDL mec hanisms and the role that the triplet states play in these mechanisms.

Fine-needle aspiration biopsy diagnosis of rhabdomyosarcoma: cytologic, histologic, and ultrastructural correlations

A series of 15 cases of rhabdomyosarcoma diagnosed by fine-needle aspiration biopsy (FNAB) and confirmed by histopathology is reviewed. Cytologically, the tumors were composed of a variable mixture of cells, which according to the degree of differentiation were categorized as early, intermediate, or late rhabdomyoblasts. Histologically, the tumors were divided into embryonal 9, monomorphic round cell 4, and alveolar rhabdomyosarcoma 2. Comparison of histological and cytological features revealed that embryonal types were composed mainly of early rhabdomyoblasts. Recognition of these patterns may be helpful in FNAB diagnosis of rhabdomyosarcoma.

A prospective study to determine the safety of omitting the antiglobulin crossmatch from pretransfusion testing

Transfusion medicine laboratories routinely perform a series of pretransfusion serological tests including: ABO grouping, Rh typing, and investigation of the recipient's serum to detect antibodies against blood group antigens (antibody screen). As a final check, most laboratories also perform a crossmatch in which the recipient's serum is incubated with the donor's red cells followed by the addition of an antiglobulin reagent (antiglobulin crossmatch). The need for the antiglobulin crossmatch when the antibody screen is negative has been questioned because there are few antibodies that are detected by this test. Such antibodies are usually directed against low incidence antigens that are not expressed on the screening cells and in many cases the clinical importance of these antibodies is uncertain. For these reasons, we performed a prospective study in which patients requiring red cell transfusion had a group and screen performed. If the antibody screen was negative the antiglobulin crossmatch was omitted. Following the transfusion of the blood, the antiglobulin crossmatch was performed to look for any potential incompatibility. All patients were monitored both serologically and clinically. Over the 2-year interval of the study 9128 patients were entered. There were 8936 patients (97.9%) with a negative antibody screen and 26.9% (2404 patients) were transfused a total of 10,899 red cell concentrates. The antiglobulin crossmatch performed after the transfusion indicated that 168 red cell concentrates (1.5%) would have been incompatible if the antiglobulin crossmatch had been performed pretransfusion. These 168 red cell concentrates were transfused to 119 patients during 130 transfusion episodes (defined as all transfusions administered within 24 h). Of the 130 transfusion episodes, 79.2% (103/130) were false positive laboratory results. There were 27 transfusion episodes where the antiglobulin crossmatch on blood transfused was positive due to an IgG antibody. Even though these transfused red cell concentrates were designated incompatible by the antiglobulin crossmatch, none of the patients receiving this blood had clinical or serological evidence of haemolysis. We concluded that the antiglobulin phase of the crossmatch can be omitted from pretransfusion testing without putting patients at risk.

Fine-needle aspiration biopsy of Ki-1-positive anaplastic large-cell lymphoma

Five cases of Ki-1-positive anaplastic large-cell lymphoma diagnosed by fine-needle aspiration biopsy are reviewed, and cytologic, histologic, and ultrastructural findings in these cases are correlated. In all cases, the diagnosis of anaplastic large-cell lymphoma was suggested on the basis of the morphological appearance in aspiration smears. This diagnosis was confirmed by immunohistochemistry, which revealed strong positivity of most of the cells by Ki-1 antibody. Two of the lymphomas were T-cell type, one was B-cell type, and the remaining 2 were composed of null cells. In 2 cases, intracytoplasmic inclusions were seen in some of the tumor cells in aspiration smears. These were ultrastructurally correlated with large lysosomal bodies of variable morphology. Fine-needle aspiration combined with immunohistochemistry may be an effective technique for diagnosing this neoplasm.

Effect of n-3 fatty acids from fish oil on hemostasis, blood pressure, and lipid profile of dialysis patients

Dialysis patients have an inordinate risk of cardiovascular events. Fish oils, rich in n-3 fatty acids, are believed to be beneficial in the prevention of atherosclerosis and thrombosis. Hence, the use of fish oils deserves consideration as a preventative or therapeutic intervention in dialysis patients. The suggestion has been made that n-3 fatty acids could increase the risk of bleeding, and thus, the safety of the use of these agents in dialysis patients must be established before long-term studies are undertaken. This study addresses the effect of n-3 fatty acids on the hemostatic profile of dialysis patients. Sixteen patients on chronic dialysis therapy were randomized to fish oil (MaxEPA) or placebo (olive oil) in a double-blind cross-over study. They received 3.6 g of n-3 fatty acids for 4 wk. Bleeding times were 4.8 +/- 0.4 min on MaxEPA and 4.5 +/- 0.3 min on placebo. Platelet aggregation to low-dose ADP or collagen also remained unchanged. There was a trend to lower serum triglyceride levels (2.7 +/- 0.5 versus 3.4 +/- 0.6 mmol/L, fish oil versus placebo) that did not reach statistical significance. Gastrointestinal side effects occurred in 10 of the 16 subjects and were severe in 5 patients. These side effects occurred in both the olive oil and the fish oil groups. The study had a 95% chance of detecting a clinically doubling significant increase in bleeding time, i.e., beta error less than 5%. In conclusion, n-3 fatty acids do not introduce a clinically important risk of bleeding for patients with end-stage renal disease.

Fine-needle aspiration biopsy of pediatric neoplasms: correlation between electron microscopy and immunocytochemistry in diagnosis and classification

A series of fine-needle aspiration biopsies performed in 635 children were reviewed. The diagnoses rendered in these patients included malignant lymphoma in 139 (21.9%); Hodgkin's disease, 25 (3.9%); neuroblastoma, 58 (9.1%); Wilms' Tumor, 37 (5.8%); Ewing's sarcoma, 32 (5.0%); rhabdomyosarcoma, 25 (3.9%); retinoblastoma, 22 (3.5%); leukemia infiltrate, 33 (5.2%); and miscellaneous tumors, 52 (8.2%). In 171 patients (26.9%), the biopsy was nondiagnostic. The cytomorphological characteristics of these lesions are briefly described and illustrated. Salient morphological features are further correlated with histological and ultrastructural appearances. Immunocytochemical patterns of these tumors are also discussed briefly.

Effects of photoperiod and temperature on rhythmic melatonin secretion from the pineal organ of the white sucker (Catostomus commersoni) in vitro

The secretion rate of melatonin from cultured pineal organs of the white sucker was examined for several days under either a 12:12-hr light:dark (LD) cycle or continuous darkness (DD) at either 10 degrees or 20 degrees. The incubation medium was changed at 3-hr intervals and secreted melatonin was measured by RIA. Under a 12:12-hr LD cycle (0800 light on, 2000 light off) melatonin secretion was suppressed during the day and highly active at night, with larger amplitudes at 20 than at 10 degrees. In DD at 10 degrees no circadian rhythmicity in secretion was found in October or January, whereas at 20 degrees a circadian-like pattern was detected in pineals which were derived from animals reared at either 10 degrees or 20 degrees for 1 week prior to the experiment in October or January. The pineals in the DD experiment still responded to an additional 24-hr LD cycle at both temperatures even after 6 or more days. These results clearly reveal the influence of photoperiod and temperature on melatonin secretion of organ-cultured pineal glands. The existence of a circadian oscillator for melatonin secretion in the pineal gland of the white sucker is suggested.

Giant epithelioid leiomyoblastoma of the stomach--a diagnostic dilemma

Epithelioid leiomyoblastoma (ELB) of the stomach is an uncommon slow growing smooth muscle tumour, attaining enormous size and presenting with bizzare symptoms. We report one such case which posed a diagnostic problem to both the clinician and the radiologist; the condition was diagnosed after laparotomy and histological examination.

Localization of the antigenic sites and intrinsic protein kinase domain within a 300 amino acid segment of the ribonucleotide reductase large subunit from herpes simplex virus type 2

The 140-kDa ribonucleotide reductase (RR1) protein of herpes simplex virus type 2 (HSV-2) functions as the large subunit of virus-specified RR1 and exhibits an intrinsic protein kinase (PK) activity at its unique NH2-terminal region. The N-terminal half of RR1 contains the protein and DNA functions of the morphological transforming region III (mtrIII) of HSV-2. In the present study, we have expressed a number of truncated RR1 derivatives in a mammalian expression vector containing NH2-terminal RR1 gene fragments and amber mutants generated by site-specific mutagenesis. These derivatives, synthesized in transient expression assays, were used as test antigens to localize the epitopes of a panel of HSV-2 RR1-reactive monoclonal antibodies and to fine-map the PK catalytic domain. Our data show that the epitope for HSV-2-specific monoclonal antibody 6A-6 is located in a region of RR1 protein spanning aa 72-350. The epitopes for cross-reactive antibodies to HSV RR1, i.e., 48S and 51S, are formed predominantly by a stretch of amino acid residues specified by aa 350-376 of the RR1 molecule. The 6A-6 antibody utilized in conjunction with the RR1 amber mutants has allowed us to define a 278 aa domain within the NH2-terminal half of the 140-kDa RR1 (aa 72-350) that is sufficient for PK activity.

The protective effect of vitamin E on the hemolysis associated with dapsone treatment in patients with dermatitis herpetiformis

OBJECTIVE

This study looked at whether oral vitamin C and vitamin E would protect the erythrocyte from oxidant damage caused by dapsone in patients with dermatitis herpetiformis.

DESIGN

Fifteen consecutive patients with dermatitis herpetiformis taking dapsone therapy received, in addition, 800 U/d of vitamin E for 4 weeks; then 1000 mg of vitamin C per day for 4 weeks, and, finally, combined vitamin E and vitamin C therapy for 4 weeks. Hemolysis indexes were assessed at baseline and after each 4-week period.

RESULTS

Statistical analysis of the results suggests that oral administration of 800 units of vitamin E daily for 4 weeks confers partial protective effect against dapsone-induced hemolysis in patients with dermatitis herpetiformis.

CONCLUSION

Partial protection against dapsone-induced hemolysis by orally administered vitamin E, if confirmed as being clinically relevant by further trials, may allow clinicians to continue dapsone therapy orally in patients who develop significant hemolysis. Prophylactic vitamin E to minimize potential hemolysis at the initiation of dapsone therapy may also be appropriate.

Immunohistochemical study of the development of serotoninergic neurons in the brain of the brook trout Salvelinus fontinalis

Serotonin is believed to play an important role in the neuronal development of various invertebrates and mammals, but only one study has yet investigated the development of serotoninergic neurons in the brain of a teleost. In the present study, we investigate the development of serotoninergic neurons in the brain of the brook trout, Salvelinus fontinalis, by immunohistochemistry, from fertilisation to the resorption of the yolk sac and in juveniles for reference. Maintaining trout embryos and larvae in 9L:15D or in complete darkness made no difference in the appearance and distribution of serotonin immunoreactive (5-HTir) neurons. On day 56, the first 5-HTir perikarya, indicative of the primordia of the nuclei raphe medialis/dorsalis, have stained in the presumptive isthmus region. At hatching time (days 95-115), all the 5-HTir nuclei reported in the juvenile are present, except for the population observed in the lobus inferior hypothalami. We observed that the nucleus recessus lateralis stained on day 58, the raphe caudal nucleus on day 60, the nuclei raphe pallidus and obscurus on day 65, the area praetectalis on day 80, and the nucleus recessus posterioris and the anterior group of the nucleus recessus lateralis on day 92. At the complete resorption of the yolk sac (days 175-190), the nucleus reticularis paragigantocellularis, the nuclei raphe pallidus and obscurus and the caudal raphe of the brainstem are very weakly immunoreactive, and in juveniles, only one caudal immunoreactive nucleus is still present. A comparison of our result with those previously reported in the three-spined stickleback, Gasterosteus aculeatus, suggest a similar distribution of 5-HTir neurons in the brain of both species but also reveal species differences in the sequence of appearance of 5HT immunoreactivity in the different neuronal populations.

Hepatitis C virus infection in chronic haemodialysis patients, a clinicopathologic study

Fifty-two patients on regular haemodialysis at our institution were evaluated for the presence of HCV infection. Evaluation included detailed history, clinical examination, and monthly screening for anti-HCV antibody, liver enzymes (ALT, AST), serum iron and ferritin. Also, three-monthly screening for other viral markers, HBV (HBsAg, HBsAb, HBcAb), CMV (IgG and IgM), EBV, and HIV. Anti-HCV antibody was found in 21 patients (40.4%). There was a significant (P less than 0.05) relationship between presence of anti-HCV antibody and proportion of patients who received blood transfusion. During a 12-month follow-up, four (11.4%) patients seroconverted to be Anti-HCV positive while one case (4.8%) seroconverted to be anti-HCV negative. The frequency of elevation of liver enzymes was significantly higher in Anti-HCV positive cases (14/18) than in negative cases (11/28, P = 0.01). Evaluation of liver biopsies of 13 patients showed chronic persistent hepatitis in six and chronic active hepatitis in seven cases. We concluded that hepatitis C is a common problem among chronic haemodialysis patients at our institution; HCV infection is documented in 70% of all clinically diagnosed NANB hepatitis. Presence of anti-HCV antibodies cannot differentiate between active and past infection and cases with early HCV infection can be missed when relying on the mere detection of anti-HCV antibodies.

Histochemical classification of human minor labial salivary glands according to their glycoprotein content

There is debate about the nature of the secretory cells in human labial salivary glands. Histologically two types of acinar cells were observed. The predominant mucous acini, few basophilic serous acinar cells were detected. Histochemical differentiation of these cells according to their neutral and acidic mucopolysaccharides content using PAS, AB pH 1 and AB pH 2.5 stain revealed the presence of three types of acinar cells: 1. Cells rich in both neutral and acidic mucopolysaccharides. 2. Cells rich in either neutral or acidic mucopolysaccharides. 3. Cells contain neither neutral nor acidic mucopolysaccharides. The first type constitute the major component of the gland.

Effects of photoperiod and different intensities of light exposure on melatonin levels in the blood, pineal organ, and retina of the brook trout (Salvelinus fontinalis Mitchill)

Daily variations in the melatonin concentration in the blood, pineal organ, and retina of the brook trout, Salvelinus fontinalis, were investigated in July under constant photoperiod (16 h L: 8 h D) and temperature (12 °C). Diel variations in melatonin levels in the blood and pineal organ showed similar patterns, with higher values during the night, whereas melatonin concentrations in the retina increased slightly in the first half of the light period. Light exposure of 1 h duration at mid-dark decreased melatonin levels in the blood and pineal organ in an intensity-dependent manner, whereas retinal melatonin levels increased with increasing light intensities. The minimum light intensity causing significant effects on the melatonin concentrations was 2 lx for the serum and 20 lx for the pineal organ and the retina. The parallelism between pineal and circulating melatonin patterns suggests that the lateral eyes of the trout have no significant endocrine function as far as the melatonin rhythm in the blood is concerned. Supporting evidence comes from the reversed response of retinal melatonin to light exposure at mid-dark, and from the low retinal melatonin concentrations found in this study. Thus, the serum melatonin rhythm of the brook trout seems to be mainly the result of rhythmic melatonin secretion from the pineal organ.

Malignant mesothelioma: King Faisal Specialist Hospital and Research Centre experience

Ten cases of malignant mesothelioma were diagnosed and treated at the King Faisal Specialist Hospital and Research Centre over a ten year period from 1977 to 1987. Seven of these cases were referred from the Southern Province and were clustered in the Al-Baha and Najran districts. In only one case (a plumber from Taif) was there the likelihood of occupation exposure. None of the patients had interstitial changes or pleura plaques on chest x-ray. Epidemiological studies are warranted to establish the etiology of mesothelioma in the Southern region of Saudi Arabia.

Comparative ultrastructure and opsin immunocytochemistry of the retina and pineal organ in fish

The pineal organ and retina were compared in developing charr and cisco, further in adult cisco, eel, creek chub, dace, zebrafish and black moli by opsin immunocytochemistry. In prehatching charr embryos, retinal rods and cones and pinealocytes displayed well-developed outer segments and formed synapses. Differentiation of the retina started centrally but was more advanced in the dorso-caudal retina than rostroventrally. The pineal organ differentiated earlier distally than proximally. In the cisco, the pineal organ and retina differentiated around hatching. In charr embryos, further in the larval and adult species studied, opsin immunoreactivity was found in retinal rods, accessory cones and many "rod-like" pinealocytes, a result indicating the presence of rhodopsin and/or porphyropsin. Retinal principle cones, long and short cones and some "cone-like" pinealocytes were opsin-immunonegative; they are thought to represent red- and/or u.v./violet-sensitive elements. The pineal organ may be involved in negative phototaxic behavior. Both the retina and pineal organ appear to be suitably differentiated to detect light in the larval and embryonic charr.

Efficacy of therapeutic suggestions for improved postoperative recovery presented during general anesthesia

There have been claims that the postoperative course of patients may be improved by presentation during general anesthesia of therapeutic suggestions which predict a rapid and comfortable postoperative recovery. This study evaluated the effectiveness of such therapeutic suggestions under double-blind and randomized conditions. A tape recording predicting a smooth recovery during a short postoperative stay without pain, nausea, or vomiting was played during anesthesia to about half the patients (N = 109), while the remaining, control patients were played a blank tape instead (N = 100). The patients were primarily undergoing operations on the fallopian tubes, total abdominal hysterectomy, vertical banding gastroplasty, cholecystectomy, and ovarian cystectomy or myomectomy. The anesthesia methods consisted of either isoflurane with 70% nitrous oxide in oxygen to produce end-tidal concentrations of 1.0, 1.3, or 1.5 MAC; or 70% nitrous oxide in oxygen combined with high or low doses of opioids. Assessments of the efficacy of the therapeutic suggestions in the recovery room and throughout the postoperative hospital stay included: the frequency of administration of analgesic and antiemetic drugs; opioid doses; the incidence of fever; nausea, retching, and vomiting; other gastrointestinal and urinary symptoms; ratings of pain; ratings of anxiety; global ratings of the patients' physical and psychological recoveries by the patients and their nurses; and length of postoperative hospital stay. There were no meaningful, significant differences in postoperative recovery of patients receiving therapeutic suggestions and controls. These negative results were not likely to be due to insensitivity of the assessments of recovery, as they showed meaningful interrelations among themselves and numerous differences in recovery following different types of surgery. Widespread utilization of therapeutic suggestions as a routine operating room procedure seems premature in the absence of adequate replication of previously published positive studies.

Congenital hepatic fibrosis in Saudi Arabia

Congenital hepatic fibrosis (CHF) is a recognized cause of portal hypertension with oesophageal varices, gastro-intestinal haemorrhage and cholangitis in children without significant impairment of hepatic or renal function. This report describes the varied clinical presentation of CHF as seen at King Faisal Specialist Hospital and Research Centre (KFSH & RC) and emphasizes the clinical patterns that should enable a pediatrician to consider the diagnosis. Fourteen children with CHF were diagnosed between 1981 and 1988. The age at presentation ranged from 1.8-14 years (mean: 7.5 years); clinical manifestations at diagnosis were splenomegaly (12), hepatomegaly (11), failure to thrive (10), marked abdominal distention (4), and fever (4). Liver function tests were normal except for high alkaline phosphatase. Eight patients had polycystic kidneys confirmed on ultrasound examination. Upper gastro-intestinal endoscopy showed oesophageal varices of variable severity in all eight patients examined. Splenoportography revealed splenic vein occlusion in one patient. One patient died within days of admission with convulsions, coma, and aspiration pneumonia. One patient was lost to follow-up. The remaining 12 patients are all alive and receive regular follow-up. Two patients required splenorenal shunt. In view of the prevalence of consanguinity in Saudi Arabia, the diagnosis of CHF should be considered in children with hepatomegaly despite normal liver function tests, and particularly in those with renal abnormalities and/or evidence of portal hypertension.