Sonographic characteristics of squamous cell cancer and adenocarcinoma of the uterine cervix

OBJECTIVE

The objective of this study was to describe the sonographic characteristics of squamous cell cancer (SCC) and adenocarcinoma (AC) of the cervix using transvaginal ultrasound.

METHODS

Women with early stage cervical cancer undergoing transvaginal ultrasound examination before surgery were prospectively included. The sonographic characteristics were assessed with regard to tumor morphology, vascularization, size, extension and location. Histological assessment of tumor subtype, size, growth pattern, extension and location was performed. Both sonographic and histological assessments were carried out according to a standardized protocol.

RESULTS

Fifty-five women were recruited. Ten were excluded because no tumor was seen on ultrasound examination and five were excluded because radical surgery was aborted as a result of positive lymph nodes, detected using the sentinel node technique. Among the remaining 40 women, 20 had AC and 20 had SCC. At pathological examination, 34 women had tumors confined to the cervix, three had parametrial invasion and three had vaginal invasion. Hypoechogenicity was associated with SCC in 73% (11/15) of the women, while isoechogenicity indicated AC in 68% (13/19) of the women (P = 0.03). Mixed echogenicity (n = 4) showed a non-significant association with larger tumor volume (P = 0.23). Hyperechogenicity was found in two women, both of whom had the less malignant villoglandular AC. Color Doppler signals were found in all cases of AC and in 90% (18/20) of cases of SCC, compared with most normal cervical tissue in which virtually no detectable vascularization was found.

CONCLUSION

We found that the sonographic appearance of SCC and AC differs. This knowledge should be useful in the clinical evaluation of cervical tumors.

Course of Cation Absorption by Plant Tissue

The absorption of rubidium by excised barley roots from solutions containing calcium was a strictly linear function of time for 1 hour and was temperature-sensitive throughout; there was no evidence of an initial nonmetabolic exchange phase of uptake. The rubidium absorbed reached concentrations many times the external concentration without any slackening of the rate of absorption-evidence for a high degree of irreversibility of the overall absorption process. This is discussed in terms of the "enzyme-kinetic" model of ion transport by carriers.

Salt toleration by plants: enhancement with calcium

Bean plants subjected to a sodium chloride concentratioz about onetenth that of seawater for 1 week suffered no damage if the calcium concentration of the nutrient solution was 1 millimole per liter or higher, but at lower calcium concentrations damage was severe and apparently due to a massive breakthrough of sodium into the leaves.

Transport of Sodium in Plant Tissue

Two mechanisms are implicated in the absorption of alkali cations by barley roots. Mechanism 1 has a high affinity for potassium, but its affinity for sodium is so low that, in the presence of even a low concentration of potassium (1 mM), sodium absorption by this mechanism is all but abolished. Mechanism 2 has a much lower affinity for alkali cations and is not highly selective; it transports sodium as well as potassium.

Saline culture of crops: a genetic approach

Increasing salinity of soil and water threatens agriculture in arid and semiarid regions. By itself, the traditional engineering approach to the problem is no longer adequate. Genetic science offers the possibility of developing salt-tolerant crops, which, in conjunction with environmental manipulation, could improve agricultural production in saline regions and extend agriculture to previously unsuited regions.

Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group

The IETA (International Endometrial Tumor Analysis group) statement is a consensus statement on terms, definitions and measurements that may be used to describe the sonographic features of the endometrium and uterine cavity on gray-scale sonography, color flow imaging and sonohysterography. The relationship between the ultrasound features described and the presence or absence of pathology is not known. However, the IETA terms and definitions may form the basis for prospective studies to predict the risk of different endometrial pathologies based on their ultrasound appearance.

Does an active sun exposure habit lower the risk of venous thrombotic events? A D-lightful hypothesis

BACKGROUND

Venous and arterial thrombotic complications exhibit a seasonal variation, with risk peaking in winter and dropping to a nadir in summer. We sought a possible correlation between sun exposure habits and venous thromboembolism (VTE) events.

METHODS

This was a cohort study comprising 40,000 women (1000 per year of age from 25 to 64 years) who were drawn from the southern Swedish population registry for 1990 and followed for a mean of 11 years. Seventy-four per cent answered an inquiry at the inception of the study (n=29,518), and provided detailed information on their sun exposure habits. Cox regression analysis was used with the presence of VTE as a dependent variable and selected demographics as independent variables. The main outcome was the relationship between VTE and sun exposure habits.

RESULTS

Swedish women who sunbathed during the summer, on winter vacations, or when abroad, or used a tanning bed, were at 30% lower risk of VTE than those who did not. Risk estimates did not change substantially after adjustment for demographic variables. The risk of VTE increased by 50% in winter as compared to the other seasons; the lowest risk was found in the summer.

CONCLUSIONS

Women with more active sun exposure habits were at a significantly lower risk of VTE. We speculate that greater ultraviolet B light exposure improves a person's vitamin D status, which in turn enhances anticoagulant properties and enhances the cytokine profile.

Gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and vascularity as assessed by color Doppler for discrimination between benign and malignant endometrium in women with postmenopausal bleeding

OBJECTIVE

To determine if gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and endometrial vascular morphology as assessed by color Doppler ultrasonography can discriminate between benign and malignant endometrium in women with postmenopausal bleeding.

METHODS

In a prospective study 95 consecutive women with postmenopausal bleeding and endometrial thickness > or = 4.5 mm as measured by transvaginal ultrasound were included. Gray-scale and color Doppler ultrasound examination of the endometrium was performed. The ultrasound examiner characterized the morphology of the endometrium before and during saline infusion and assessed the endometrial vascular tree using a predetermined classification protocol without suggesting a diagnosis. A histopathological diagnosis was obtained by operative hysteroscopy, dilatation and curettage or hysterectomy.

RESULTS

There were no statistically significant differences in ultrasound findings between benign and malignant endometria of uterine cavities without fluid. Heterogeneous echogenicity, irregular surface, and both heterogeneous echogenicity and irregular surface of a focal lesion (or of the endometrium in the absence of focal lesions) in a uterine cavity filled with fluid (spontaneous or infused) were significantly more common in malignant than in benign endometrium. The sensitivity, false positive rate, positive and negative likelihood ratios of these findings were as follows: heterogeneous echogenicity, 80%, 29%, 2.74, 0.28, P = 0.003; irregular surface, 89%, 33%, 2.70, 0.17, P = 0.002; and both, 78%, 12%, 6.59, 0.25, P < 0.001. Two or more vessels were found in 67% (8/12) of the malignant endometria vs. 51% (40/79) of the benign endometria (non-significant difference). Vascular branching tended to be more common in malignant endometria (10/11; 91%) than in benign endometria (39/61; 64%), P = 0.09.

CONCLUSION

Heterogeneous echogenicity and an irregular surface of a focal lesion or of the endometrium in a fluid-filled uterine cavity are useful ultrasound criteria for predicting endometrial malignancy. Assessment of vascular morphology using color Doppler ultrasound is of limited--if any--value for discrimination between benign and malignant endometrium.

Frequency and type of adnexal lesions in autopsy material from postmenopausal women: ultrasound study with histological correlation

OBJECTIVE

To determine the prevalence and histology of adnexal cysts in autopsy material from postmenopausal women.

METHODS

The study included 104 adnexa from 52 consecutive women with a mean age of 79 (range, 64-96) years, who underwent autopsy and died from causes other than gynecological cancer or intraperitoneal cancer of extragenital origin. The adnexa were removed, put in sterile saline in separate plastic containers and examined sonographically using an 8-MHz transvaginal transducer. Each lesion detected at ultrasound examination was measured with calipers on the frozen ultrasound image and was classified according to its ultrasound morphology. The adnexa were then put in 4% formaldehyde solution and sent for histological examination.

RESULTS

At ultrasound examination, 56% (29/52) of the women had adnexal lesions, cysts being detected in 54% (28/52) and solid lesions in 12% (6/52). At least one adnexal cyst with a largest diameter of 2-10 mm, > 10 mm, > 20 mm, > 30 mm and > 40 mm, respectively, was found in 33% (17/52), 21% (11/52), 12% (6/52), 8% (4/52) and 4% (2/52) of the women. The largest lesion measured 65 mm in diameter. At ultrasound examination we found 36 intra-ovarian cysts (26 inclusion cysts, three cystically degenerated corpora albicantia, five simple cysts, one serous cystadenoma and one 3-mm cyst not confirmed by the pathologist), 19 extra-ovarian cysts (all simple cysts according to the pathologist), five solid intra-ovarian lesions (two fibromas, one cystadenofibroma, one Brenner tumor and one case of dystrophic calcification), and one solid extra-ovarian lesion (fibroma). In addition, the pathologist detected one 20-mm solid corpus albicans, eight extra-ovarian simple cysts of 1-8 mm, and 77 intra-ovarian inclusion cysts of 1-4 mm.

CONCLUSION

Small (< or = 50 mm) benign adnexal cysts and small benign solid tumors are so common in postmenopausal women that their presence may be regarded as normal. Our results support conservative management of adnexal lesions with benign ultrasound morphology incidentally detected at ultrasound examination in postmenopausal women.

Intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women

OBJECTIVES

To determine intraobserver and interobserver reproducibility of ultrasound measurements of endometrial thickness in postmenopausal women.

DESIGN

Forty-eight postmenopausal women underwent transvaginal ultrasound examination by two examiners. Each observer took three replicate measurements of the endometrium in each woman. Intraobserver repeatability was expressed as the difference between the highest and lowest measurement values obtained by one observer, the repeatability coefficient, and the intraclass correlation coefficient. Interobserver reproducibility was expressed as the difference between the mean of the three measurements of each observer, limits of agreement, and interclass correlation coefficient. The repeatability coefficient and the limits of agreement define the range within which 95% of the differences between two measurements are likely to fall. Data were analyzed for all women, as well as separately for women with endometrium < or = 6 mm and > 6 mm. The agreement between observers in classifying women as having endometrium < or = 4.4 mm or > or= 4.5 mm was determined by calculating Cohen's kappa.

RESULTS

In women with endometrium <or = 6 mm the intraclass correlation coefficient was 0.95 for Observer 1 and 0.88 for Observer 2, the median difference between the highest and lowest values being 0.4 mm (range, 0-1.4) for Observer 1 and 0.7 mm (range, 0.1-2.2) for Observer 2, and the repeatability coefficient was 0.8 mm and 1.4 mm, respectively. The corresponding figures for women with endometrium > 6 mm were 0.99 and 0.99, 0.7 mm (0-2.9) and 1.0 mm (0.2-3.4), and 1.7 mm and 1.9 mm. In women with endometrium < or = 6 mm the interclass correlation coefficient was 0.77, and the mean interobserver difference was 0.2 mm +/- 1.8 mm (2 standard deviations), when calculations were based on the mean of three measurements per observer (+/- 1.9 mm when calculations were based on only one measurement per observer). The corresponding figures for women with endometrium > 6 mm were 0.98, 0.2 mm +/- 3.1 mm (+/- 3.2 mm). The agreement between observers in classifying women as having an endometrium < or = 4.4 mm or > or = 4.5 mm was very good (kappa 0.81).

CONCLUSIONS

The reproducibility of endometrial measurements seems to be clinically acceptable and to allow reliable discrimination between postmenopausal women with endometrium < or = 4.4 mm and > or = 4.5 mm. In clinical practice, it is enough to take one endometrial measurement when performing transvaginal ultrasound examination.

An algorithm including results of gray-scale and power Doppler ultrasound examination to predict endometrial malignancy in women with postmenopausal bleeding

OBJECTIVE

To determine if power Doppler ultrasound examination of the endometrium can contribute to a correct diagnosis of endometrial malignancy in women with postmenopausal bleeding and endometrium > or = 5 mm.

METHODS

Eighty-three women with postmenopausal bleeding and endometrium > or = 5 mm underwent gray-scale and power Doppler ultrasound examination using predetermined, standardized settings. Suspicion of endometrial malignancy at gray-scale ultrasound examination (endometrial morphology) was noted, and the color content of the endometrium at power Doppler examination was estimated subjectively (endometrial color score). Computer analysis of the most vascularized area of the endometrium was done off-line in a standardized manner. Stepwise multivariate logistic regression analysis was carried out to determine which subjective and objective ultrasound and power Doppler variables satisfied the criteria to be included in a model to calculate the probability of endometrial malignancy.

RESULTS

Endometrial thickness, vascularity index (vascularized area/endometrial area), and use of hormone replacement therapy (HRT) satisfied the criteria to be included in the model used to calculate the 'objective probability of endometrial malignancy'. Endometrial morphology, endometrial color score and HRT use satisfied the criteria to be included in the model to calculate the 'subjective probability of malignancy'. Endometrial thickness > or = 10.5 mm had a sensitivity with regard to endometrial cancer of 0.88 and a specificity of 0.61. At a fixed sensitivity of 0.88, the specificity of the 'objective probability of malignancy' (0.81) was superior to all other ultrasound and power Doppler variables (P = 0.001-0.02). The 'objective probability of malignancy' detected more malignancies at endometrium 5-15 mm than endometrial morphology (5/7 vs. 1/7, i.e. 0.71 vs. 0.14; P = 0.125) with a similar specificity (49/57 vs. 51/57, i.e. 0.86 vs. 0.89).

CONCLUSION

Power Doppler ultrasound can contribute to a correct diagnosis of endometrial malignancy, especially if the endometrium measures 5-15 mm. The use of regression models including power Doppler results to estimate the risk of endometrial cancer deserves further development.

Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding

OBJECTIVE

To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > or = 5 mm and the extent to which such lesions can be correctly diagnosed by D&C.

METHODS

In a prospective study, 105 women with postmenopausal bleeding and endometrium > or = 5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty-four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one.

RESULTS

Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy.

CONCLUSION

If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium > or = 5 mm.

Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding

OBJECTIVE

To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > or = 5 mm and the extent to which such lesions can be correctly diagnosed by D&C.

METHODS

In a prospective study, 105 women with postmenopausal bleeding and endometrium > or = 5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty-four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one.

RESULTS

Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy.

CONCLUSION

If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium > or = 5 mm.

Rebleeding and endometrial growth in women with postmenopausal bleeding and endometrial thickness < 5 mm managed by dilatation and curettage or ultrasound follow-up: a randomized controlled study

OBJECTIVE

To compare the frequency of rebleeding and endometrial growth during a 12-month follow-up period between women with postmenopausal bleeding and an endometrial thickness < 5 mm managed by dilatation and curettage, and those managed by ultrasound follow-up.

DESIGN

Consecutive women with postmenopausal bleeding and an endometrial thickness < 5 mm were randomized to ultrasound follow-up after 3, 6, and 12 months (n = 48) or to primary dilatation and curettage with ultrasound follow-up at 12 months (n = 49). At all follow-up examinations, the endometrial thickness was measured and the women were asked about rebleeding. The endometrium was sampled at the 12-month examination, if sampling had not been performed previously because of rebleeding or endometrial growth.

RESULTS

Rebleeding was reported by 33% (16/48) of the women in the ultrasound group and by 21% (10/48) of those in the dilatation and curettage group (P = 0.17). Endometrial growth to >or= 5 mm was found in 21% (10/48) of the women in the ultrasound group and in 10% (5/48) of those in the dilatation and curettage group (P = 0.16). No endometrial pathology was found in women with isolated rebleeding. Endometrial pathology during follow-up was found more often in women with endometrial growth than in those without (33% vs. 4%; P = 0.008).

CONCLUSION

Rebleeding and endometrial growth are common during a follow-up period of 12 months in women with postmenopausal bleeding and an endometrial thickness < 5 mm, irrespective of whether or not dilatation and curettage is primarily carried out. If these women are managed by ultrasound follow-up, endometrial sampling should be performed if the endometrium grows, but not necessarily in the case of rebleeding without endometrial growth.

Charles Bonnet syndrome in glaucoma patients with low vision

PURPOSE

To characterize the nature and frequency of Charles Bonnet syndrome in glaucoma patients with low vision.

PATIENTS AND METHODS

All patients attending the glaucoma clinic during a period of 10 months who had visual acuity of 20/80 or less in both eyes were included in this study. Each patient was questioned about the occurrence of visual hallucinations. Those who responded positively had a thorough interview relating to the characteristics of the hallucinations. Medical history and social history were taken, followed by a complete ocular examination.

RESULTS

Eighty-nine patients met the inclusion criteria. Eleven patients (12.3%), eight men and three women, admitted to having experienced visual hallucinations. Except for one case, the patients did not disclose this experience previously. Eight patients had one repeatable hallucination, and three patients experienced more than one sight. The visions were usually sharp, and the figures were occasionally incomplete. Most hallucinations were chromatic. Frequency of hallucinations varied between daily and weekly, and duration was mostly a few minutes. In addition to glaucoma, nine of the eleven patients had other ocular findings that could have contributed to the reduction of vision.

CONCLUSION

Visual hallucinations are not rare in glaucoma patients with low vision. Patients tend to conceal their experience of visual hallucinations, but a discussion of these phenomena with the patient and assurance of their harmless nature will reduce his or her anxiety and concerns.

Comparison of Endorette and dilatation and curettage for sampling of the endometrium in women with postmenopausal bleeding

MAIN QUESTION: To compare the diagnostic properties of Endorette and D&C in women with postmenopausal bleeding, to relate the properties to endometrial thickness as measured by ultrasound, and to assess the women's experiences of the two methods.

METHODS

In a prospective study, 133 consecutive women with postmenopausal bleeding were examined with transvaginal ultrasound. After measuring the endometrial thickness, Endorette sampling was performed without anesthesia. Dilatation and curettage (D&C) was carried out under general anesthesia within six weeks. After completion of each sampling procedure the women filled in a questionnaire regarding their experience of the sampling.

RESULTS

Endorette sampling failed in 16% (21/133) of the women. More than half (56%) of the women experienced moderate or strong pain during Endorette sampling, and the doctor underestimated the pain in 62% of the women. Endorette failed to diagnose two of seven (29%) endometrial cancers found at D&C. In one of these two cases, the examiner suspected that the Endorette device had not reached the uterine fundus. In women with endometrium < 7 mm, Endorette and D&C showed similar results with regard to obtaining a sufficient endometrial sample and to distinguishing normal endometrium, benign pathological endometrium and malignancy. In women with endometrium > or =7 mm, Endorette yielded insufficient samples significantly more often than D&C (23% vs 6%, p=0.02; the McNemar test) and missed all polyps and most (77%) hyperplasias diagnosed by D&C.

CONCLUSION

Endorette and D&C have similar diagnostic properties in women with postmenopausal bleeding and endometrium < 7 mm. D&C is superior to Endorette in women with endometrium > or =7 mm.

Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm

OBJECTIVES

To determine the ability of transvaginal ultrasound, with or without saline infusion, to detect focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > 5 mm, and to determine the accuracy of conventional ultrasound, saline contrast sonohysterography and diagnostic hysteroscopy under general anesthesia to diagnose endometrial polyps, submucous myomas and uterine malignancy.

DESIGN

In a prospective study, 105 women with postmenopausal bleeding and endometrium > 5 mm underwent conventional ultrasound examination and saline contrast sonohysterography. Diagnostic and operative hysteroscopy under general anesthesia was then performed. The presence of focally growing lesions and the type of lesion (endometrial polyp, submucous myoma, malignancy or unclear focal lesion) were noted at ultrasound examination and at hysteroscopy.

RESULTS

There was almost perfect agreement (96%) between saline contrast sonohysterography and hysteroscopy in the diagnosis of focally growing lesions. Saline contrast sonohysterography and hysteroscopy both had a sensitivity of approximately 80% with regard to diagnosing endometrial polyps (false-positive rates of 24% and 6%, respectively), whereas conventional ultrasound missed half of the polyps (sensitivity, 49%; false-positive rate, 19%). Hysteroscopy was superior to both saline contrast sonohysterography and conventional ultrasound with regard to discriminating between benign and malignant lesions (sensitivity, 84%, 44%, and 60%; false-positive rate, 15%, 6% and 10%, respectively). The risk of malignancy was increased seven-fold (odds ratio, 7.3; 95% confidence interval, 1.9-27.8) in women with distension difficulties at saline contrast sonohysterography, and two thirds of the women with a poorly distensible uterine cavity had a malignant diagnosis.

CONCLUSION

Saline contrast sonohysterography is as good as hysteroscopy at detecting focally growing lesions in the uterine cavity in women with postmenopausal bleeding. However, neither hysteroscopy nor saline contrast sonohysterography can reliably discriminate between benign and malignant focal lesions. Distension difficulties at saline contrast sonohysterography should raise a suspicion of malignancy.

A role of PDGFRalpha in basal cell carcinoma proliferation

Activation of the hedgehog pathway, through the loss of patched (PTC) or the activation of smoothened (SMO), occurs frequently in basal cell carcinoma (BCC), the most common human cancer. However, the molecular basis of this neoplastic effect is not understood. The downstream molecule Gli1 is known to mediate the biological effect of the pathway and is itself up-regulated in all BCCs. Gli1 can drive the production of BCCs in the mouse when overexpressed in the epidermis. Here we show that Gli1 can activate platelet-derived growth factor receptor alpha (PDGFRalpha) in C3H10T(1/2) cells. Functional up-regulation of PDGFRalpha by Gli1 is accompanied by activation of the ras-ERK pathway, a pathway associated with cell proliferation. The relevance of this mechanism in vivo is supported by a high level expression of PDGFRalpha in BCCs of mice and humans. In the murine BCC cell line ASZ001, in which both copies of the PTC gene are inactivated, DNA synthesis and cell proliferation can be slowed by re-expression of PTC, which down-regulates PDGFRalpha expression, or by downstream inhibition of PDGFRalpha with neutralizing antibodies. Therefore, we conclude that increased expression of PDGFRalpha may be an important mechanism by which mutations in the hedgehog pathway cause BCCs.

Overcoming the language barrier in visual field testing

PURPOSE

To evaluate the effect of using recorded instructions in patients' native language compared with interpreter-assisted instructions on the reliability and duration of the visual field test.

PATIENTS AND METHODS

Sixty patients referred for visual field testing were included in the study. Thirty-five had limited or no knowledge of the Hebrew language, and 25 control patients were fluent in Hebrew, the native language. None had previous experience with automated perimetry. Patients were randomized to receive recorded instructions on the visual field test in their native language or translator-assisted instructions by the technician before performing the test. For each patient, the time required for instructions and test performance and the reliability indices were documented.

RESULTS

The method of instruction (recorded or interpreter-assisted) did not affect the time required for patient instructions (66 +/- 24 seconds and 57 +/- 30 seconds, respectively), the time for test performance (7.2 +/- 1.5 minutes and 7.8 +/- 1.8 minutes, respectively), and test reliability as measured by the rate of fixation losses. Regardless of the method of explanation, the time required for instructions and for performing the test were significantly shorter for Hebrew speakers than for non-Hebrew speakers.

CONCLUSION

The use of a recorded explanation in the patient's native language before visual field testing is an applicable method for patient instruction. Clinics in areas with multilingual populations may use this method to save technicians time, without adversely affecting the time required for performing the test and its reliability.

Genetic determinants of basal cell carcinoma risk

Basal cell carcinomas are can be induced by ionizing radiation, in particular in patients with the rare autosomal dominant basal cell nevus syndrome (BCNS). These patients also are prone to medulloblastomas, and curative ionizing radiation therapy for the latter is followed soon by the development of sheets of basal cell carcinomas in the overlying skin. Positional cloning of the gene mutant is BCNS patients has identified the hedgehog signaling pathway as crucial to the development of all basal cell carcinomas and presumably to this susceptibility to post-ionizing radiation carcinogenesis. Thus this pathway is a candidate for susceptibility to second, post-therapy cancers in the broader population.

Potassium/sodium selectivity in wheat and the amphiploid cross wheat X Lophopyrum elongatum

The early response of K(+) and Na(+) net fluxes to different external NaCl and KCl levels has been studied in wheat (Triticum aestivum L.) and the amphiploid cross wheat X Lophopyrum elongatum (Host) Löve in culture solution experiments. We found that during the first 24 h of exposure to 100 or 200 mM NaCl, at low K(+) levels, the amphiploid absorbed, translocated and allocated to the youngest leaf less Na(+) than the wheat parental line. During that period, the amphiploid retained more K(+) than wheat. Short-term uptake studies with 86Rb and 22Na showed that K(+)(86Rb) and Na(+) influxes were not involved in genotypic differences in K(+)(86Rb) and Na(+) net uptake observed after 6 h of exposure to salt stress. Differences in K(+)(86Rb) net uptake could be attributed to differences in K(+)(86Rb) efflux and/or to K(+)(86Rb) accumulation by root vacuoles. The possibility that differential shrinkage of protoplast volume plays a role in the genotypic difference in K(+) retention cannot be ruled out. On the other hand, Na(+) efflux did not contribute significantly to differences in Na(+) net uptake between these genotypes. Hence, differences in Na(+) net uptake were attributed to differences in the transport of Na(+) to the shoot. The presence in the amphiploid of fast acting mechanisms able to enhance Na(+)/K(+) selectivity at different plant levels minimizes the early build-up of Na(+) concentration, and K(+) substitution by Na(+), in the growing tissue of the leaf.

Characterization of auxin conjugates in Arabidopsis. Low steady-state levels of indole-3-acetyl-aspartate, indole-3-acetyl-glutamate, and indole-3-acetyl-glucose

Amide-linked indole-3-acetic acid (IAA) conjugates constitute approximately 90% of the IAA pool in the dicot Arabidopsis, whereas ester-linked conjugates and free IAA account for approximately 10% and 1%, respectively when whole seedlings are measured. We show here that IAA-aspartate Asp, IAA-glutamate (Glu), and IAA-glucose (Glc) are present at low levels in Arabidopsis. Nine-day-old wild-type Arabidopsis seedlings yielded 17.4 +/- 4.6 ng g(-1) fresh weight IAA-Asp and 3.5 +/- 1.6 ng g(-1) fresh weight IAA-Glu, and IAA-Glc was present at 7 to 17 ng g(-1) fresh weight in 12-d-old wild-type seedlings. Total IAA content in 9-d-old Arabidopsis seedlings was 1, 200 +/- 178 ng g(-1) fresh weight, so these three IAA conjugates together made up only 3% of the conjugate pool throughout the whole plant. We detected less than wild-type levels of IAA-Asp and IAA-Glu (7.8 +/- 0.4 ng g(-1) fresh weight and 1.8 +/- 0.3 ng g(-1) fresh weight, respectively) in an Arabidopsis mutant that accumulates conjugated IAA. Our results are consistent with IAA-Asp, IAA-Glu, and IAA-Glc being either minor, transient, or specifically localized IAA metabolites under normal growth conditions and bring into question the physiological relevance of IAA-Asp accumulation in response to high concentrations of exogenous IAA.

Dynein light chain binding to a 3'-untranslated sequence mediates parathyroid hormone mRNA association with microtubules

The 3'-untranslated region (UTR) of mRNAs binds proteins that determine mRNA stability and localization. The 3'-UTR of parathyroid hormone (PTH) mRNA specifically binds cytoplasmic proteins. We screened an expression library for proteins that bind the PTH mRNA 3'-UTR, and the sequence of 1 clone was identical to that of the dynein light chain LC8, a component of the dynein complexes that translocate cytoplasmic components along microtubules. Recombinant LC8 binds PTH mRNA 3'-UTR, as shown by RNA electrophoretic mobility shift assay. We showed that PTH mRNA colocalizes with microtubules in the parathyroid gland, as well as with a purified microtubule preparation from calf brain, and that this association was mediated by LC8. To our knowledge, this is the first report of a dynein complex protein binding an mRNA. The dynein complex may be the motor that is responsible for transporting mRNAs to specific locations in the cytoplasm and for the consequent is asymmetric distribution of translated proteins in the cell.

Indole glucosinolate and auxin biosynthesis in Arabidopsis thaliana (L.) Heynh. glucosinolate mutants and the development of clubroot disease

Mutants and wild type plants of Arabidopsis thaliana were analysed for differences in glucosinolate accumulation patterns, indole-3-acetic acid (IAA) biosynthesis and phenotype. A previously identified series of mutants, termed TU, with altered glucosinolate patterns was used in this study. Only the line TU8 was affected in shoot phenotype (shorter stems, altered branching pattern). Synthesis of IAA and metabolism were not much affected in the TU8 mutant during seedling development, although the content of free IAA peaked earlier in TU8 during plant development than in the wild type. Indole glucosinolates and IAA may, however, be involved in the development of clubroot disease caused by the obligate biotrophic fungus Plasmodiophora brassicae since the TU3 line had a lower infection rate than the wild type, and lines TU3 and TU8 showed decreased symptom development. The decline in clubroot formation was accompanied by a reduced number of fungal structures within the root cortex and slower development of the fungus. Indole glucosinolates were lower in infected roots of TU3 and TU8 than in control roots of these lines, whereas in wild-type plants the differences were not as prominent. Free IAA and indole-3-acetonitrile (IAN) were increased in infected roots of the wild type and mutants with normal clubroot symptoms, whereas they were reduced in infected roots of mutants TU3 and TU8. These results indicate a role for indole glucosinolates and IAN/IAA in relation to symptom development in clubroot disease.

How often does oral treatment of toenail onychomycosis produce a disease-free nail? An analysis of published data

OBJECTIVE

To analyze studies on oral treatment of toenail onychomycosis so as to aid clinicians and patients in making informed decisions.

DATA SOURCES

Studies dealing with treatment of toenail onychomycosis were identified by means of 2 MEDLINE search strategies. One was a title search using the word "toenail"; the other search used the combined Medical Subject Headings "onychomycosis" and "therapy".

STUDY SELECTION

Articles were read to ascertain that they (1) described results in toenails, (2) used both culture and microscopy, and (3) included a clinical evaluation. Not included were case reports, series of fewer than 15 subjects, reports that combined fingernail onychomycosis and toenail onychomycosis in their statistics, and articles reporting only the total number of toenails cured without providing data as to how many subjects were cured.

DATA EXTRACTION

This elimination process left 26 articles, which were then analyzed by means of a checklist that included a morphologically normal nail, mycological findings, and methodological items including recurrence rate, intent-to-treat analysis, placebo group, and whether terms were defined.

DATA SYNTHESIS

When there was sufficient data, the frequency with which the treatment achieved normal mycological results, a clinically normal nail, and a disease-free nail (normal-appearing nail plus normal mycological results) was calculated. Confidence intervals were calculated for disease-free nail results.

CONCLUSIONS

Standard courses of terbinafine achieved a disease-free nail in approximately 35% to 50% of patients. For itraconazole, the relevant disease-free nail rate was about 25% to 40%. Disease reappearance is an important issue; unfortunately data are lacking as to its frequency.

Do treatment process factors mediate the relationship between type A-type B and outcome in 12-Step oriented substance abuse treatment?

AIMS

One underutilized strategy for enhancing treatment research is to examine intervening factors that link client characteristics to endpoint outcomes. This study tested the hypothesis that Type B substance abusers would demonstrate difficulties engaging in the treatment process, and that these problems would mediate their poorer outcomes.

DESIGN

Longitudinal naturalistic study.

SETTING

Two intensive 12-Step substance abuse treatment programs.

PARTICIPANTS

A sample of 115 men and women seeking treatment.

MEASUREMENT

Empirical clustering techniques were used to divide the sample, and the link between type, process factors, and 12-month outcomes was examined.

FINDINGS

Hypotheses were not supported. Type Bs did not demonstrate difficulties with the treatment process, but had greater problems sustaining gains posttreatment. Contrary to prediction, Type Bs were better matched to self-help affiliation than Type As.

CONCLUSIONS

Findings argue for a more optimistic perspective on treating Type Bs, and for the utility of Type A-Type B in informing treatment research.

Determinant capture by MHC class II DR3 during processing of mycobacteria leprae 65kD heat shock protein by human B cells

Using T cell immunoblotting we have characterised the immunogenic fragments derived from the Mycobacteria Leprae 65kD heat shock protein that become associated with MHC class II DR3 during processing by a human B cell line. After 5 h incubation with antigen, a peptide of approximately 12kD (approximately 110 amino acids) was the only major fragment found associated with the class II MHC. The association of this oligopeptide was abolished if an excess of a synthetic peptide representing the minimal epitope was included in the culture or when cells were incubated at 4 degrees C. This suggests that the generation of this moiety is dependent on cell metabolism and that its binding to MHC is specific. This large fragment may represent an intermediate in the processing pathway, directly demonstrating the role of MHC in determinant capture during antigen degradation.

Does intermittent "pulse" topical 5-fluorouracil therapy allow destruction of actinic keratoses without significant inflammation?

BACKGROUND

Topical 5-fluorouracil (5-FU) is effective in removing actinic keratoses but causes unsightly and painful erosions. Intermittent "pulse" 5-FU therapy has been described as being an effective and comfortable technique for destroying actinic keratoses.

OBJECTIVE

The purpose of this study was to determine the efficacy and cutaneous side effects of intermittent 5-FU therapy.

METHODS

Efficacy of treatment was evaluated by three experienced dermatologists separately comparing randomly arranged before and after photographs. Degree of skin reaction was graded from photographs taken during treatment.

RESULTS

Of 13 patients treated with intermittent 5-FU, two had an excellent result, three a good result, but eight failed to show discernible improvement. Efficacy was linked to the degree of skin irritation.

CONCLUSION

Pulse 5-FU failed to clear actinic keratoses in most patients. Intermittent 5-FU treatment does not dissociate its therapeutic efficacy from its undesirable erosive effects. Pulse therapy is a less intensive way of employing 5-FU and may be of value in patients unwilling to accept the erosions and discomfort that accompany the traditional course of daily 5-FU applications.

Linkage studies in erythrokeratodermias: fine mapping, genetic heterogeneity and analysis of candidate genes

Erythrokeratodermias are a clinically heterogeneous group of rare autosomal dominant disorders of cornification with overlapping features including hyperkeratosis and erythema. We ascertained five extended pedigrees with different phenotypes for a linkage study. Three families presented with localized erythrokeratodermia variabilis, and one with erythrokeratodermia and ataxia. Another family had Greither disease associated with variable hyperkeratotic plaques. Despite their phenotypic differences, both erythrokeratodermia variabilis and erythrokeratodermia with ataxia map to a common region in 1p34-p35. Multipoint linkage and haplotype analyses place erythrokeratodermia variabilis between the marker D1S496 and D1S186 with a maximum LOD score of 12.88. Our linkage results provide compelling evidence for genetic homogeneity among families of mixed European and French-Canadian origin. In contrast, results excluded Greither's disease from the established erythrokeratodermia variabilis gene region indicating genetic heterogeneity of erythrokeratodermias. Based on recombinations, two genes assigned to 1p34-p35 were excluded: cartilage matrix protein and avian myelocytosis viral oncogene. Connexin-37 (GJA4), a member of the connexin gene family, maps within the erythrokeratodermia variabilis region and is an attractive candidate gene. Direct sequencing of the coding region of GJA4 in four patients revealed several variations, including a novel polymorphism within the 5' cytoplasmic domain, but no pathogenic mutations were found, thus excluding Connexin-37 as a candidate. There is evidence, however, that other epidermally expressed connexins cluster in this region, and one may yet be determined to play a role in the pathogenesis of erythrokeratodermia variabilis.

Physical mapping of the 5 Mb D9S196-D9S180 interval harboring the basal cell nevus syndrome gene and localization of six genes in this region

The basal cell nevus syndrome (Gorlin syndrome) is characterized by multiple basal cell carcinomas and diverse developmental defects. The gene responsible for this syndrome has been mapped previously to a 2 cM interval between D9S196 and D9S 180 at 9q22.3, and very recently mutations of a candidate gene in this region--the human homolog of the Drosophila patched gene have been identified. We report here on physical mapping studies integrating a contig of yeast artificial chromosomes and bacterial artificial chromosomes with a long-range map spanning approximately 5 Mb between the recombination-determined flanking markers. Six genes have been mapped to this interval.