Assembly and intracellular transport of snRNP particles

The assembly of the major small nuclear ribonucleoprotein (snRNP) particles begins in the cytoplasm where large pools of common core proteins are preassembled in several RNA-free intermediate particles. Newly synthesized snRNAs transiently enter the cytoplasm and complex with core particles to form pre-snRNP particles. Subsequently, the cap structure at the 5' end of the snRNA is hypermethylated. The resulting trimethylguanosine (TMG) cap is an integral part of the nuclear localization signal for snRNP particles and the pre-snRNP particles are rapidly transported into the nucleus. SnRNP particles mature when snRNA-specific proteins complex with the particles, in some cases, just before or during nuclear transport, but in most instances after the particles are in the nucleus. In addition, U6 snRNA hybridizes with U4 snRNA to form a U4/U6 snRNP in the nucleus. The transport signals are retained on the snRNP particles and proteins since existing particles and proteins enter the reformed nucleus after mitosis.

Estrogen receptor in primary breast cancer estimated in paraffin-embedded tissue. A study of its usefulness compared to dextran-coated charcoal assay

Estrogen receptor (ER) was estimated immunohistochemically in formalin-fixed and paraffin-embedded tissue from the primary breast cancer in 349 postmenopausal patients with a high risk of recurrence and compared with the results of dextran-coated charcoal assay. There was a highly significant correlation between the ER classification obtained by the two methods (p less than 10(-6)). Patients ER positive according to immunohistochemical estimate had a significantly longer disease-free survival (p less than 0.001) and survival (p less than 0.001) than ER negative patients. The DCC assay showed an advantage of ER positive patients of the same magnitude. The patients, who were followed for a median of 86 months, were a subset of 1,700 patients participating in the Danish Breast Cancer Cooperative Group's randomized trial of adjuvant tamoxifen (TAM) treatment. In the presently analyzed subset of patients there were no statistically significant difference in disease-free survival (p = 0.52) or survival (p = 0.54) between patients who received adjuvant TAM and the controls. The same was true for receptor-defined subgroups regardless if the ER receptor was estimated in paraffin-embedded tissue or by the dextran-coated charcoal method. The analyzed subset might have been too small for demonstrating a positive effect of adjuvant TAM treatment.

Pattern of spread and progression in relation to the characteristics of the primary tumour in human breast cancer

Characteristics of primary breast tumours were related to the extent of dissemination, the anatomical location of metastases, and the rate of progression in 863 patients with recurrent breast cancer. The following features were examined: tumour laterality, location within the breast, size, invasion of skin or fascia, presence of residual cancer tissue (RCT) in the mastectomy specimen, and number of positive lymph nodes. Increasing tumour size, increasing number of nodes, and the presence of local invasion and RCT were all associated with a short duration of survival both from initial diagnosis and from first recurrence. None of the factors were related to either the extent of dissemination or the rate of progression. Patients who had their primary tumours located in the medial or central part of the breast had an increased incidence of mediastinal and pleural recurrences respectively. Primary tumours greater than 5 cm, invasion of skin or fascia, and presence of RCT were all associated with an increased incidence of local recurrences. In addition, both RCT and fascial invasion were associated with increased occurrence of brain metastases. Most differences were explainable on the basis of local and regional lymphodynamics. Since the status of the features examined here all vary with time from tumour inception, it is suggested that the impact on prognosis is related to variations in tumour age from inception to primary diagnosis rather than to qualitative biological differences.

Cavernous haemangioma of the jejunum. Long-standing anaemia in a child

A 15-year-old boy who had been examined for almost lifelong iron deficiency anaemia caused by occult gastrointestinal bleeding was eventually, by abdominal surgery, found to have a cavernous haemangioma of the jejunum. A diagnostic approach is described and the importance of systematic evaluation and subsequent diagnosis in such patients is stressed.

micF RNA binds to the 5' end of ompF mRNA and to a protein from Escherichia coli

micF RNA regulates the levels of outer membrane protein F (OmpF) in Escherichia coli in response to temperature increase and other stress conditions by decreasing the levels of ompF mRNA (Andersen et al., 1989). A 93-nucleotide micF RNA was synthesized in vitro directly from polymerase chain reaction generated DNA which was designed to contain a functional T7 RNA polymerase promoter upstream of the micF RNA gene and an appropriate restriction site for transcription termination. A transcript (150 nucleotides) containing the ribosomal binding domain of ompF mRNA messenger was synthesized in vitro from the ompF gene cloned into a T7 expression vector. A stable duplex was formed between micF RNA and the 150-nucleotide 5' transcript of ompF mRNA after incubation at 37 degrees C in a physiological buffer. The melting curve of the duplex formed by micF RNA and 150-nucleotide transcript revealed a Tm of 56 degrees C and a delta Tm that spans about 20 degrees C; both are consistent with the proposed structure for the micF/ompF duplex. In addition, as determined by competition studies and UV cross-linking/label-transfer analyses, an E. coli protein was found to bind specifically to micF RNA. The protein also bound weakly to the 150-nucleotide ompF transcript. The data are the first to demonstrate the complex between micF RNA and the 5' end of ompF mRNA and suggest that in vivo a micF ribonucleoprotein (RNP) particle may participate in the destabilization ompF mRNA during thermoregulation of OmpF porin.

A technique for screening of achlorhydria and hypochlorhydria during upper gastrointestinal endoscopy

Measuring of the intragastric pH during upper gastrointestinal endoscopy examination was performed perendoscopically with a monocrystalline antimony electrode, which was passed through the biopsy channel of the endoscope. The procedure was easily performed, resulting in only a few minutes' delay. If the pH found was 3.5 or above, the patients were later sent for a subcutaneous pentagastrin aspiration test. There was a close correlation between the lowest intragastric pH measured via the endoscope and the lowest pH measured in the gastric juice aspirated under basal conditions (r = 0.673, p less than 0.0001). An endoscopically assessed pH of 4.0 was the lowest level above which patients with achlorhydria or hypochlorhydria were found, according to the subsequent pentagastrin test. Fifty-five per cent of the patients with a perendoscopically assessed pH of 4.0 or above were achlorhydric.

Identification and characterization of the small nuclear ribonucleoprotein particle D' core protein

The addition of urea to sodium dodecyl sulfate (SDS)-polyacrylamide gels has allowed the identification and characterization of the small nuclear ribonucleoprotein particle (snRNP) D' protein and has also improved resolution of the E, F, and G snRNP core proteins. In standard SDS-polyacrylamide gels, the D' and D snRNP core proteins comigrate at approximately 16 kilodaltons. The addition of urea to the separating gel caused the D' protein to shift to a slower electrophoretic mobility that is distinct from that of the D protein. The shift to a slower electrophoretic mobility in the presence of urea suggests that the D' protein has extensive secondary structure that is not totally disrupted by SDS alone. Both N-terminal sequencing and partial peptide maps indicate that the D and D' proteins are distinct gene products, and the sequence data have identified the faster moving of the two proteins as the previously cloned D protein (L. A. Rokeach, J. A. Haselby, and S. O. Hoch, Proc. Natl. Acad. Sci. USA 85:4832-4836, 1988). In the cytoplasm, the D protein is found primarily in the small-nuclear-RNA-free 6S protein complexes, while the D' protein is found primarily in the 20S protein complexes. Like the D protein, the D' protein is an autoantigen in patients with systemic lupus erythematosus and is recognized by some of the Sm class of autoimmune antisera.

micF RNA in ompB mutants of Escherichia coli: different pathways regulate micF RNA levels in response to osmolarity and temperature change

The repressor RNA, micF RNA, is regulated by temperature, osmolarity, and other stress conditions during growth of Escherichia coli. Northern (RNA) blot analyses showed that levels of micF RNA differ widely in various ompB mutant strains when cells are grown at 24 degrees C in LB broth. For example, relative to the parental strain MC4100, the ompR101 mutant strain (which contains no functional OmpR) had about a 10-fold reduction in micF RNA, whereas the envZ11 strain showed about a 5-fold increase. At 37 degrees C, however, micF RNA levels in the ompR101 and envZ11 strains and other ompB mutants differed by less than two-fold compared with the level in strain MC4100, thus indicating that a factor(s) independent of the ompB locus regulates micF RNA expression with temperature increase and that there is an additional control mechanism(s) which maintains the levels of micF RNA in these mutants close to that of the wild type during growth at high temperatures. In a plasmid strain containing the micF gene but without the upstream OmpR-binding site, steady-state levels of micF RNA increased with temperature increase but did not change with osmolarity increase. This showed that osmolal regulation but not temperature regulation of micF depends on these upstream sequences and suggested that while osmolal regulation of the micF gene depends on OmpR, thermal regulation does not.

[Breast carcinoma in situ. Diagnostic and therapeutic aspects with special reference to growth patterns]

The probability of developing in situ carcinoma has been calculated at about 25%, while the cumulative risk of having the diagnosis established is estimated at less than 1%. In situ carcinoma in its pure form constitutes up to about 6% of all newly diagnosed breast cancers in clinical series, whereas its share in the most thorough mammographic screening series ranges from 8 to 16%. This excess in diagnosis comprises, in particular, the ductal type, primarily its most aggressive forms. To-day in situ cancer occurs chiefly as non-palpable lesions demonstrated by mammography or as minor changes discovered accidentally by the pathologist. A more recent classification based upon histological growth patterns is described. The advantage of classifying according to growth pattern bears a good correlation to clinical presentation, extent of surgery and prognosis. The treatment of in situ carcinoma lacks a rational basis. Therapy should therefore be kept within the framework of prospective protocols. Various treatment modalities are described with reference to the most important multicenter trials.

Perioperative blood transfusion and recurrence and death after resection for cancer of the colon and rectum

Several reports have claimed that perioperative blood transfusion promotes recurrence and death after cancer surgery. We studied the effect of transfusion in 315 patients who had radical resection for carcinoma of the colon and rectum. The disease recurred in 113 (42%) of 268 transfused patients, versus in 15 (32%) in 47 non-transfused patients (P = 0.2). Of the transfused patients 102 (38%) died of colon cancer, versus 13 patients (28%) in the non-transfused group (P = 0.2). The 5-year recurrence-free survival rate was 0.59 in the transfused patients and 0.72 in the non-transfused group (P = 0.10). When differences in confounding background variables were accounted for by Cox multiple regression analysis, the significance of transfusion was even less. The study does not support the hypothesis that perioperative blood transfusion promotes recurrence after operation for colorectal cancer.

[District psychiatry in the Naestved region. Consequences of a reorganization]

Community psychiatry was introduced in the Naestved region on 1.1.1987. Anticipating that the number of admissions would be reduced as a result of this, the hospital services were altered: a day ward was inaugurated and a district team was organized and, simultaneously, the total number of psychiatric beds was reduced. In order to investigate the effects of these conversions, the patterns of admission were reviewed retrospectively and compared for the years 1986 and 1987. This investigation revealed that the number of admissions was reduced but that this occurred at the expense of many alcoholics and drug addicts, many of whom have disappeared from the psychiatric therapeutic system. The only group which it proved possible to retain in their own environment consisted of the group of schizophrenics. The question is raised of whether this group gains by this.

A double blind comparative multicentre study of remoxipride and haloperidol in schizophrenia

Seventy-two patients fulfilling the DSM-III criteria for schizophrenia and schizophreniform psychosis were admitted to a multicentre, double-blind controlled study to evaluate the efficacy and safety of remoxipride in comparison to haloperidol. The mean daily dose of remoxipride at the end of treatment was 353 mg and of haloperidol, 11 mg. Patients were assessed each week on the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) and the symptoms checklist. No significant differences in efficacy were found between the two treatments. The median total BPRS score in the remoxipride group was 25 at start of active treatment and 17 at the last valid rating (n = 31). For the haloperidol group the corresponding figures were 24 and 15 (n = 29). According to the CGI, 40% of remoxipride patients and 50% of haloperidol patients were much or very much improved. Treatment-emergent extrapyramidal symptoms, such as akathisia and rigidity, occurred significantly more frequently, and were more severe during treatment with haloperidol than with remoxipride (p = 0.012 and 0.024, respectively). Haloperidol-treated patients reported significantly more drowsiness and increased sleep during treatment (p = 0.026 and 0.012, respectively). No statistically significant differences were seen in endocrine or autonomic symptoms. Remoxipride seemed to be as effective as haloperidol, had a lower frequency of side effects, and was used safely in the dose range 150-600 mg/day.

The prognostic value of immunohistochemical estrogen receptor analysis in paraffin-embedded and frozen sections versus that of steroid-binding assays

Estrogen receptors (ER) were independently analyzed using dextran-coated charcoal assays (ER-DCC) and immunohistochemical assays in frozen (ER-ICA) and paraffin-embedded tissue (ER-PAR) from 130 human breast cancer specimens drawn from postmenopausal high-risk patients registered in the Danish Breast Cancer Cooperative Group. ER was best detected with the ER-DCC assay followed by the ER-ICA (relative sensitivity 87%) and the ER-PAR assays (relative sensitivity 71%). The semiquantified staining features of the immunohistochemical assays were statistically significantly correlated with each other and with ER-DCC. Analysis of disease-free interval (DFI) and overall survival (OS) showed that all assays allowed statistically significant discrimination between a high risk and a low risk group, although the sensitivity differences tended to be reflected as small differences in clinical discriminatory power. The patient groups were then stratified according to adjuvant treatment [radiotherapy (RT) versus radiotherapy and tamoxifen (RT + TAM)]. The survival advantage was tied primarily to the receptor status itself in the steroid-binding assays, but was linked to both the receptor status and the adjuvant treatment in the immunohistochemical assays. Thus, the relative risks in terms of DFI and OS were of the same relative magnitude in the RT and RT + TAM groups for ER-DCC assays using a cut-off level of 10 fmol/mg cytosol protein, while there were large differences in the relative risks between RT and RT + TAM groups for ER-ICA and ER-PAR assays. We conclude that an ER assay in fresh tissue should be given first priority, but if there is no fresh tissue, an ER assay in paraffin-embedded tissue offers a reasonably good alternative as a prognosticator and an equivalent alternative as a predictor of the response to endocrine treatment.

Intravenous omeprazole: effect of a loading dose on 24-h intragastric pH

To determine the effect of three times daily dosing with intravenous omeprazole on intragastric acidity, 24 h intragastric pH was measured continuously with a monocrystalline antimony electrode system in II patients with inactive duodenal ulceration during fasting conditions. After a baseline investigation, two different dosage regimens of intravenous omeprazole were compared in a double-blind crossover study, with regard to their ability to keep the pH greater than or equal to 4 for as long as possible. Success in the individual patient was defined as pH greater than or equal to 4 for at least 90% over the 24-h period. Two doses of omeprazole [40 mg t.d.s. (120 mg) and 80 mg + 40 mg + 40 mg (160 mg)] were compared. Omeprazole (120 mg) increased the median of individual median intragastric 24-h pH from 1.49 to 6.67. The pH was greater than or equal to 4 for greater than or equal to 90% of the 24 h in three of the 11 patients. With omeprazole, 160 mg (a loading dose of 80 mg), the median of individual median intragastric 24-h pH increased to 7.33. The pH was greater than or equal to 4 for greater than or equal to 90% of the 24 h in seven of the 11 patients. Median time to reach pH 4 was 39 min after 40 mg and 20 min after 80 mg omeprazole. An initial loading dose of 80 mg omeprazole seems preferable to 40 mg to achieve a fast and sustained increase in intragastric pH to above 4 in the fasting patient.

In situ carcinomas of the female breast. Diagnostic and therapeutic aspects with special reference to histological growth patterns. Clinical review

There is a disparity between the autopsy prevalence and the clinical incidence of in situ carcinoma of the breast without co-existing invasive carcinoma. The probability of developing in situ carcinoma is about 25%, while the cumulated risk of having the diagnosis established is less than 1%. In situ carcinoma in its pure form constitutes roughly 6% of all newly diagnosed breast cancers whereas in the most thorough mammographic screening series the incidence ranges from 8 to 16%. This excess in diagnosis comprises the ductal type in particular, primarily in its most aggressive forms, while the lobular type is no more common than in clinical series. Today in situ cancers occur chiefly as non-palpable lesions shown on mammography or as small changes accidentally discovered by the pathologist in a meticulous examination of an otherwise benign specimen. This survey also describes the traditional histopathological classification and presents in more detail a new classification based on histological growth patterns. The advantage of classifying in situ cancer according to its growth pattern is that it shows a good correlation with its clinical presentation. Moreover, the growth pattern can indicate the extent of excision. In addition, the method also seems to be applicable to prognosis. The treatment of in situ carcinoma has not been worked out scientifically, so treatment should be kept within the framework of prospective clinical trials. This is the only way to collect useful data about the biological behaviour of such lesions. In several countries large multicentre studies are being conducted to extend our knowledge about carcinoma in situ and to create a rational basis for treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Estrogen receptors appear undetectable in the C-cells of the human thyroid gland

An attempt was made to explain the bone-preserving effect of estrogen by analysis of estrogen receptors (OER) in the calcitonin-producing C-cells of the human thyroid gland. Thyroid tissue from twenty patients with benign hyperthyroidism and three patients with medullary thyroid carcinoma was used. The C-cells were identified immunohistochemically using a polyclonal antibody to calcitonin, and by a similar staining technique the adjacent sections were stained for the OER protein using a monoclonal antibody (H 222-ABBOTT, USA). In spite of an intense nuclear staining of the positive control tissue (an OER positive breast carcinoma) no specific OER-staining was identified in C-cells or any other cells of the thyroid gland. Neither a dextran-coated charcoal assay nor a solid-phase immunoenzyme assay revealed any quantitative OER activity in tissue homogenates. Various observations point to a regulating mechanism between calcitonin and estrogen. The nature of this mechanism is not known, but according to our study it is unlikely to be a direct one.

Phase III trial of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) versus cisplatin, etoposide, bleomycin and prednisone (CisEBP) for the treatment of advanced non-Hodgkin's lymphoma of high grade malignancy. The Danish Lymphoma Study Group

The trial included 85 previously untreated patients (median age 61 years) with stage III or IV non-Hodgkin's lymphoma (NHL) of the subtypes centrocytic lymphoma, diffuse centroblastic lymphoma, immunocytoma, immunoblastic lymphoma, or unclassified lymphoma of high grade malignancy. The patients were randomized to 9 monthly treatment cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CisEBP (cisplatin, bleomycin, etoposide, prednisone). Patients who had failed to achieve even a partial response (PR) after the completion of 2 cycles were switched to the alternative regimen. Complete response (CR) on primary treatment was obtained in 70% (55-83%) of CHOP-treated patients and in 25% (13-41%) of CisEBP-treated patients (p = 0.0004). Secondary CHOP treatment produced CR in 7 (30%) of 24 patients and secondary CisEBP treatment led to CR in 2 (15%) of 14 patients. The median survival was 3.4 years in the CHOP arm and 2.6 years in the CisEBP arm (p = 0.78). Hematologic toxicity was mainly leukocytopenia and anemia in both treatment arms. Non-hematological toxicity was slight, and late toxicity was insignificant. Three treatment-related deaths were noted. We conclude that CHOP induces more remissions than CisEBP in advanced lymphomas of high grade malignancy.

Elephantiasis-like cutaneous metastases from signet-ring cell carcinoma of the stomach

We report the clinical features and course of a 66-year-old patient with gastric carcinoma, in whom multiple cutaneous metastases occurred one year after he underwent subtotal gastrectomy. Although internal malignancies rarely metastasize to the skin, when they do this may have profound diagnostic, therapeutic, and prognostic significance. Cutaneous metastases are usually synonymous with a rapidly progressive disease and a poor prognosis. This case, in which cutaneous metastases were found in the lower limbs, is notable since usually less than 4 percent of cutaneous metastatic lesions are found in this region. Moreover, the case seems unique because of the predominating dermiotrophic metastases, with only minor internal involvement.