Applicability of three-dimensional imaging techniques in fetal medicine

Objective

To generate physical models of fetuses from images obtained with three-dimensional ultrasound (3D-US), magnetic resonance imaging (MRI), and, occasionally, computed tomography (CT), in order to guide additive manufacturing technology.

Materials and Methods

We used 3D-US images of 31 pregnant women, including 5 who were carrying twins. If abnormalities were detected by 3D-US, both MRI and in some cases CT scans were then immediately performed. The images were then exported to a workstation in DICOM format. A single observer performed slice-by-slice manual segmentation using a digital high resolution screen. Virtual 3D models were obtained from software that converts medical images into numerical models. Those models were then generated in physical form through the use of additive manufacturing techniques.

Results

Physical models based upon 3D-US, MRI, and CT images were successfully generated. The postnatal appearance of either the aborted fetus or the neonate closely resembled the physical models, particularly in cases of malformations.

Conclusion

The combined use of 3D-US, MRI, and CT could help improve our understanding of fetal anatomy. These three screening modalities can be used for educational purposes and as tools to enable parents to visualize their unborn baby. The images can be segmented and then applied, separately or jointly, in order to construct virtual and physical 3D models.

Associação fitoterápica no tratamento de feridas cutâneas induzidas em equinos

Estudou-se a eficácia do uso tópico de um produto comercial constituído por uma associação fitoterápica como promotor da cicatrização de feridas induzidas em equinos. Uma lesão cutânea em forma de quadrado, com 5cm de lado, foi produzida cirurgicamente em ambos os lados da região glútea de oito cavalos adultos. Aleatoriamente um dos lados foi escolhido como tratado, permanecendo o contralateral como controle. As lesões do lado controle foram lavadas com água e detergente neutro e, no lado tratado, foi realizado o mesmo procedimento, seguido de aplicação tópica da associação fitoterápica. As evoluções macroscópica e microscópica do processo cicatricial foram avaliadas, e a área de cada ferida determinada no decorrer do período experimental. Foram encontradas diferenças significativas entre os lados em relação aos valores de área das feridas. Na última avaliação, o lado controle apresentou valor médio de área de 0,70cm², e o lado tratado de 1,23cm². A contração cicatricial observada em 77 dias de evolução cicatricial foi de 97,57% para o lado controle e de 95,59% para o lado tratado.

Efeitos de detomidina e xilazina intravenosa sobre as variáveis basais e respostas comportamentais em bovinos

Avaliaram-se, durante 60 minutos, 10 bovinos após administração intravenosa de 0,1mg.kg-1 de xilazina ou 10μg.kg-1 de detomidina, quanto às frequências cardíaca e respiratória, movimentos ruminais, pressão arterial média, temperatura retal e respostas comportamentais como ataxia ou decúbito, ptose palpebral, estado de alerta ou sedação e redução da altura da cabeça em relação ao solo, além da presença de salivação, micção e concentração sanguínea de glicose. Observou-se que a xilazina, via intravenosa, em bovinos, ao mesmo tempo que promove sedação mais intensa e prolongada que a detomidina, induz a uma maior quantidade de efeitos indesejáveis, como salivação e decúbito, e redução das frequências cardíaca e respiratória, da pressão arterial média, da motilidade ruminal e da temperatura, sendo estas alterações mais prolongadas. Conclui-se que a detomidina pode ser utilizada com segurança em bovinos na dose de 10μg.kg-1, promovendo sedação e permanência do animal em posição quadrupedal.

[Overactive bladder symptoms in pregnancy and puerperium: is there a relationship between the symptoms score and quality of life?]

INTRODUCTION AND OBJECTIVE

During pregnancy, hormonal change, increase in the body mass index and the pressure caused by the enlarged uterus over the bladder and pelvic floor, are some factors involved in lower urinary tract symptoms (LUTS). This study was made to evaluate the correlation between pregnancy and delivery way with LUTS.

MATERIAL AND METHOD

This open prospective study was carried out using the overactive bladder questionnaire short form (OABq-SF). A total of 60 patients enrolled this study. The mean age was 24 year, raging from 14 to 40 years. The patients were evaluated during the third trimester and 6 months after delivery. Statistical analysis of the OABq-SF scores was made using the Pearson method.

RESULTS

Mean OABq-SF score during pregnancy was 35.2 and 6 months after delivery decreased to15. Quality of life was 82.9 during pregnancy and increased to 88.4 at 6 month after delivery. Patient's perception, that is correlation, was 55.02 (p=0.0001) during pregnancy and 36.1% (p=0.0046). Clinical correlation index was 6.7%.

CONCLUSIONS

Our study demonstrated that in spite of LUTS being more important during pregnancy, there is no significant clinical correlation in patient's perception.

Flare-up of hand osteoarthritis caused by zoledronic acid infusion

Zoledronic acid is effective for osteoporosis at a single annual intravenous dose. It usually causes few adverse effects; the most common are related to acute phase reactions. We reported the case of a 64-year-old woman who presented flare-up of hand osteoarthritis after zoledronic acid infusions. Despite the fact that arthralgia is a common side effect of intravenous bisphosphonates, development of inflammatory signs in osteoarthritic joints is a rare event. We hypothesized that this side effect is caused by a release of cytokines secondary to activation of gamma-delta T lymphocytes.

Impact of Forpus xanthopterygius (Spix, 1824) (Aves, Psittacidae) on flowers of Handroanthus serratifolius (Vahl.) S. O. Grose (Bignoniaceae)

Handroanthus serratifolius produces flowers during the dry season in the Cerrado biome, and it may be an important food source to some bird species. For Psittacidae species, like Forpus xanthopterygius, flowers are important in their diet. This study intended to characterize the behavior of F.xanthopterygius and evaluate the damage to the flowering and in the reproduction of H. serratifolius. Four individuals of H. serratifolius were observed for 60 hours to register size of groups, the time and duration of visit, and the number of flowers predated by F.xanthopterygius. The groups that visited the plants had between 2 and 12 individuals. The mean time of visits was 60.31 minutes (+/-22.29). The size of groups was correlated to number of flowers predated and was influenced by number of flowers offered. During the flowering, each H. serratifolius individual loses approximately 1,052 flowers per week.

Uso tópico de ketanserina na cicatrização de feridas cutâneas induzidas em equinos

Estudou-se a eficácia do uso tópico de ketanserina como promotor da cicatrização de feridas cutâneas induzidas em equinos. As feridas foram produzidas em ambos os metâmeros na região da garupa de oito cavalos adultos, em formato quadrangular, medindo cinco centímetros de lado. Aleatoriamente um dos metâmeros foi escolhido como tratado, permanecendo o contralateral como controle. As lesões do grupocontrole foram lavadas somente com água e detergente neutro e no grupo tratado foi realizado o mesmo procedimento seguido de aplicação tópica de ketanserina. A evolução macroscópica e microscópica do processo cicatricial foi avaliada e a área de cada ferida determinada no decorrer do período experimental. Não foram verificadas diferenças significativas entre as feridas do grupo-controle e do grupo tratado com ketanserina durante 56 dias de avaliação.

Hemograma e hemogasometria de eqüinos submetidos à obstrução experimental de jejuno

Foram utilizados oito eqüinos distribuídos em dois grupos, submetidos ou não à obstrução experimental do jejuno mediante a colocação de um balão intraluminal. Os animais do grupo 1 foram submetidos à enterotomia com colocação do balão sem distensão suficiente para provocar isquemia e os do grupo 2 à isquemia por obstrução do jejuno durante quatro horas. Para determinação do hemograma e da hemogasometria foram obtidas amostras de sangue venoso em quatro momentos: uma hora antes do procedimento cirúrgico (M1), ao final da obstrução/isquemia (M2) e uma hora (M3) e 18 horas (M4) após o início da reperfusão/desobstrução. Não houve diferença entre grupos nas contagens de hemácias, leucócitos totais, neutrófilos bastonetes, neutrófilos segmentados, linfócitos e monócitos, bem como no teor de hemoglobina. Houve diferença no volume globular em M2 e na contagem de eosinófilos em M3. Na hemogasometria, em ambos os grupos, registrou-se diminuição dos teores de sódio, potássio, cálcio ionizado e cloro, da pressão parcial de oxigênio e da saturação de oxiemoglobina. Os resultados indicam que o hemograma, isoladamente, não fornece informações conclusivas, enquanto a hemogasometria possibilita determinar, precocemente, o volume de reposição hidroeletrolítica a ser administrado em eqüino com abdômen agudo decorrente de obstrução de jejuno, auxiliando no tratamento e no melhor prognóstico da afecção intestinal.

Hipotireoidismo iatrogênico em eqüino decorrente de excesso de iodo: relato de caso

Relata-se o caso de um eqüino com sinais clínicos clássicos e avaliação hormonal compatível com hipotireoidismo primário, decorrente do uso sistêmico contínuo de iodeto de potássio, na dosagem de 60g/dia. O tratamento consistiu na simples remoção da fonte de iodo, o que reduziu, gradualmente, as manifestações clínicas. Este relato de caso contribui com o estudo do hipotireoidismo iatrogênico em eqüinos adultos e, dessa forma, alerta para os possíveis efeitos colaterais indesejáveis de terapias à base de iodo.

Molecular characterization of Portuguese patients with mucopolysaccharidosis type II shows evidence that the IDS gene is prone to splicing mutations

Mucopolysaccharidosis type II (MPS II) is an X-linked recessive lysosomal storage disease caused by a defect in the iduronate-2-sulfatase gene (IDS). Alternative splicing of the IDS gene can occur and the underlying regulatory mechanism may be rather complex. Nevertheless, little information is available on the role of variations at the IDS locus in the splicing process. Here we report that splice mutations at the IDS locus are an important source of MPS II pathogenicity, accounting for almost 56% of Portuguese cases. Among 16 unrelated Portuguese MPS II patients, 15 different mutations were identified: six intronic splice mutations (c.104-2AG, c.241-2A>G, c.241-1G>A, c.418+1G>A, c.880-8AG and c.1181-1G>C); two exonic splice mutations (c.1006G>lC and c.1122C>T); five missense mutations (D269V, D69V, D148N, R88C and P86L); one nonsense mutation (Q465Ter); one total IDS gene deletion; and one rearrangement involving a IDS gene inversion. Furthermore, nine of the 15 detected mutations affected the usual splicing pattern at the locus. Some of them are responsible for dramatic changes in the splicing mechanism. For example, the substitution mutation, c.418+1G>A, revealed the presence of an exonic sequence inside intron 3. Our study provides evidence that the IDS locus is prone to splicing mutations and that such susceptibility is particularly high in exon 3 and neighbouring regions. Consequently, mutation screening of the IDS gene cannot be restricted to gDNA examination. Unless cDNA analysis is also conducted, misclassifications as silent or missense mutations can be produced and even uncharacteristic splice-site mutations can be misinterpreted as classic splicing defects that may generate severe, unconventional splicing alterations.

Intralesional polysulphated glycosaminoglycan as treatment of equine collagenase induced tendinitis: clinical, ultrasonographic and histopathologic evaluation

The effect of intratendineous injections of polysulphated glycosaminoglycan (PSGAG) as treatment of collagenase-induced tendonitis was studied. Two groups (GI and GII) of five Arabian horses each, males and females, two to six year-old, were submitted to experimental tendinitis of the superficial digital flexor tendon of the left thoracic limb by intratendineous injection of 1.0ml of collagenase (2.5mg/ml). Seven days after the induced-lesions were created, the horses of GI received five intralesional injections of 1.0ml (125mg) of PSGAG, every four days. Horses of GII received injections of saline in the same dose and rate. Clinical and ultrasonographic evaluations were performed periodically, during 150 days. All animals showed lameness, increased local pain, heat and swelling 24 hours after the injury was created. All signs, except to swelling, which remained visible by the end of the study, showed regression in all animals. Lesions of variable size, shape and position were evidenced by the ultrasonographic evaluation, reaching maximum severity between the seventh and the 23rd days. By the end of the study, the echogenicity grade ranged from 1 to 2, and the grade of fiber alignment from 0 to 2. The histopathologic analysis demonstrated repair areas with intense fibroplasia and neovascularization, collagen fibers poorly organized, and thickened hypercellular endotenon. The data of this study did not show significant differences between the treated and control groups, therefore leading to the conclusion that the intralesional injection of PSGAG did not have beneficial effects in the treatment of collagenase-induced tendinitis.

[Key aspects of sexual behavior and safer sex practice among men in the city of São Paulo]

Heterosexual relations currently constitute the predominant route of HIV transmission to women in Brazil. Few studies have approached male sexual behavior taking women into account. This study included 597 men ages 21 to 50 in São Paulo city and explored several aspects pertaining to safer sex, such as sexual partners, knowledge of sexually transmitted diseases (STDs)/AIDS, risk perception, and protective practices aimed at AIDS prevention. The results showed that, similar to other countries, the proportion of men who have sex with men is low (5%), that younger men adopt more protective behavior than older men regarding multiple partners and condom use, that knowledge of AIDS is widespread (but that there is still a lack of knowledge concerning STDs in general), and that although risk perception increases protective behavior, presumption of the partner's behavior influences this perception, placing men and women in a vulnerable situation.

Cloning and sequence analysis of the gene encoding Methylophilus methylotrophus cytochrome c", a unique protein with a perpendicular orientation of the histidinyl ligands

Cytochrome c" from Methylophilus methylotrophus is an unusual monohaem protein that undergoes a major redox-linked spin-state transition: one of the two axial histidines bound to the iron in the oxidised form is detached upon reduction and a proton is taken up. A 3.5-kb DNA fragment, containing the gene encoding cytochrome c" (cycA), has been cloned and sequenced. The cytochrome c" gene codes for a pre-protein with a typical prokaryotic 20-residue signal sequence, suggesting that the protein is synthesised as a precursor which is processed during its secretion into the periplasm. The C-terminus of cytochrome c" has homology with the corresponding region of an oxygen-binding haem protein (SHP) from phototrophically grown Rhodobacter sphaeroides. SHP is similar in size and in the location of its haem-binding site. Immediately downstream from cytochrome c" a second open reading frame (ORF) codes for a 23-kDa protein with similarity to the cytochrome b-type subunit of Ni-Fe hydrogenase. The possibility of coordinated expression of cycA and this ORF is discussed.

Virtually all methicillin-resistant Staphylococcus aureus (MRSA) infections in the largest Portuguese teaching hospital are caused by two internationally spread multiresistant strains: the 'Iberian' and the 'Brazilian' clones of MRSA

OBJECTIVE: To determine the nature (clonal type and antibiotic resistance pattern) of methicillin-resistant Staphylococcus aureus (MRSA) strains recovered from the largest teaching hospital in Portugal and to detect temporal trends in clonal types during three consecutive surveillance periods in 1992--93, 1994--95 and 1996. METHODS: MRSA strains were characterized by chromosomal SmaI macrorestriction patterns using pulsed-field gel electrophoresis (PFGE) and by DNA fingerprints---applied to ClaI digests---capable of probing two specific areas of the staphylococcal chromosome: (1) the vicinity of the mecA gene, and (2) the attachment site(s) and copy number of transposon Tn554. The combination of these methods can generate 'clonal types' useful for epidemiological tracking of MRSA strains. RESULTS: During the 1992--93 collection period, 65% of MRSA strains carried the mecA polymorph I, Tn554 pattern E and PFGE pattern A (I::E::A)---a clonal type that was used to define the 'Iberian MRSA', which is widely spread throughout southern Europe. The representation of this clone decreased to 42% in 1994--95 and to 20% in 1996. At the same time, a second multiresistant MRSA strain carrying mecA polymorph XI, Tn554 type B and PFGE pattern B (XI::B::B)---a clonal type characteristic of the so-called 'Brazilian MRSA'---increased from 5% in 1992--93 to 36% in 1994--95 and 29% in 1996. CONCLUSIONS: Throughout the four years of surveillance, the Iberian and Brazilian MRSA types and their single subtype variants together have been responsible for the overwhelming majority (close to 90%) of all MRSA infections in the largest teaching hospital of Portugal. The mechanism of epidemicity of these two multiresistant international MRSA clones remains to be elucidated.

Sequence and organization of the left multigene family 110 region of the Vero-adapted L60V strain of African swine fever virus

Sequencing of the left variable region of the L60V Vero cell-adapted strain of African swine fever virus (ASFV) showed the presence of three genes belonging to multigene family 110 (MGF110) and of a fourth unrelated gene. This gene was separated from the MGF110 genes by a region rich in direct repeats. The first MGF110 gene, V1L, with 104 codons, was only moderately related to the other two, W1L and W2L, with 124 and 80 codons, respectively. These two genes were closely related, W2L being a truncated duplication of W1L. Homology matrix analysis of the sequence against itself showed the existence of a repeated block corresponding to the central conserved domain of the three genes, flanked by two other repeated blocks in W1L and W2L. The comparison of the organization of the left variable region of ASFV L60V with that of field isolates and other adapted viruses revealed that adaptation of unrelated viruses resulted in similar large deletions that map, in their right boundaries, exactly at the same positions in the intergenic repeat-rich region.

[Multicenter study of isolated micro-organisms resistant to antimicrobials in 10 Portuguese hospitals in 1994]

In 1994, Microbiology Laboratories of ten Portuguese hospitals analysed isolated microorganisms found in blood and urine samples and studied antimicrobial susceptibilities of the most frequent bacterial pathogens. From 63780 blood samples, the most frequent were Staphylococcus spp. and from 69189 urine samples significant numbers of Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa and Candida spp. were isolated. Escherichia coli strains (c.7000) revealed a low percentage of resistance to antibiotics with the exceptions of ampicillin (48%) and co-trimoxazol (25%). Klebsiella pneumoniae isolates (c.2000) revealed important resistance to ampicillin (98%), cephalotin (31%), co-trimoxazol (38%) and gentamicin (28%), while values for 3rd generation cephalosporins varied among hospitals, with several strains showing phenotype of extended-spectrum beta-lactamase. A great variation in resistance values of P. aeruginosa (c.4000) was found in relation to the antibiotics as well as to the hospitals. Resistance to methicillin in S. aureus (c.6000) was high, reaching an average of 47%, and it was even higher with S. epidermidis (c.3000) and S. haemolyticus (c.650). Only vancomycin was always active against these strains. In E. faecalis (c.2500) resistance was of 2% to ampicillin, 35% to gentamicin, 45% to streptomycin and 1% to vancomycin. E. faecium isolates (c.300) showed the most worrying results with 70% resistance to ampicillin, 42% to gentamicin, 59% to streptomycin and 9% (30 strains isolated in 5 hospitals) to vancomycin. Vancomycin resistant strains were also resistant to all other antibiotics.

Prenatal diagnosis of GM2-gangliosidosis B1 variant

Prenatal diagnosis in a pregnancy at risk for a juvenile B1 variant of GM2-gangliosidosis was carried out. The biochemical study of the cultured amniocytes and the affected fetal brain is reported. The results obtained show that the sulphated artificial substrate can be used in the diagnosis of B1 variant, but not the neutral one. The accumulation of GM2-ganglioside in the fetal brain of the B1 juvenile form and an infantile form of GM2-gangliosidosis (0 variant) was compared.

Genetic identification and nucleotide sequence of the DNA polymerase gene of African swine fever virus

The DNA polymerase gene of African swine fever virus (ASFV) was mapped by marker rescue experiments using a phosphonoacetic acid-resistant mutant and hybridization with an oligonucleotide probe designed from the most conserved motif of family B DNA polymerases. Viral DNA fragments mapping in this region were cloned and sequenced. An open reading frame coding for a 1244 amino acid long peptide with a molecular mass of 142.5 kDa was determined from the sequence. A unique feature of ASFV DNA polymerase is the presence of 13 tandem repeats of the sequence Ala-Gly-Asp-Pro near the carboxyl end of the molecule. Comparison with 30 sequences of alpha-like DNA polymerases of cellular and viral origin showed that ASFV DNA polymerase has all the conserved motifs of family B DNA polymerases. A 3.9 kb transcript was detected by Northern hybridization and the transcription initiation and termination sites were mapped by S1 analysis and primer extension. Late transcription was initiated at a site different from the early transcription initiation site. A 145 kDa protein, consistent with the size of the gene, was identified by an in situ enzyme assay after gel electrophoresis of infected cell extracts.

Adjuvant tamoxifen for male breast cancer (MBC)

A study was started in 1976 whereby patients with Stage II and operable Stage III MBC were given adjuvant Tamoxifen for 1 year, increasing to 2 years from 1988. All patients had axillary nodal involvement. Primary treatment consisted of a radical mastectomy or simple mastectomy with radiotherapy. The rarity of the disease precluded a randomised trial. Thirty-nine patients are available for analysis at a median follow-up of 49 months. The actuarial survival of the Tamoxifen treated patients is 61% (range 42-80%) at 5 years compared to 44% (range 35-53%) for historical controls (P = 0.006). Disease-free survival was 56% (37-75%) vs 28% (17-33%) at 5 years (P = 0.005). There were no serious side-effects recorded. The conclusion from this, the first reported series on adjuvant Tamoxifen therapy for MBC, is that significant improvement in disease-free survival can be achieved with minimal upset to the patients. Recruitment to the study continues.

In vitro DNA replication by cytoplasmic extracts from cells infected with African swine fever virus

A cell-free system that catalyzes DNA replication was prepared from cytoplasmic extracts of Vero cells infected with African swine fever virus (ASFV). The cells were permeabilized with lysolecithin and disrupted by mild mechanical action and the nuclei were removed by low-speed centrifugation. Extracts prepared from infected cells at the time of maximal DNA replication incorporated [alpha-32P]dTTP into acid-insoluble material that was sensitive to DNase and resistant to RNase. The reaction was inhibited by phosphonoacetic acid, an inhibitor of ASFV-specific DNA polymerase. Extracts from mock-infected cells had a negligible activity. Micrococcal nuclease-treated extracts were able to replicate added virion DNA or viral replicative DNA. An increase in the mass of DNA detected by ethidium bromide staining and by dot blot hybridization with ASFV DNA showed that the incorporation was due to true replication. Plasmid DNA was also replicated, which indicates that ASFV-specific DNA polymerase does not require a virus-specific origin of replication. The pattern of fragments generated by EcoRI digestion of the in vitro product was characteristic of viral replicative DNA. Hybridization with a recombinant plasmid containing a terminal fragment of ASFV DNA confirmed the presence of dimer terminal ASFV fragments presumably generated from concatemeric replicative intermediates.

Juvenile GM2 gangliosidosis variant B1: clinical and biochemical study in seven patients

We describe seven patients from five different families with GM2 gangliosidosis, variant B1. To our knowledge these are the first juvenile cases reported in the literature.

The Christie hospital adjuvant tamoxifen trial--status at 10 years

From November 1976 to June 1982, a randomised clinical trial was carried out at the Christie Hospital, Manchester, to test the clinical efficacy of tamoxifen (TAM) as an adjuvant to surgery for patients with operable breast carcinoma. Following surgery, premenopausal women were randomly allocated to have either TAM 20 mg day-1 for one year or an irradiation menopause (the previous standard treatment). Postmenopausal women had TAM 20 mg day-1 for one year or no further treatment (Controls). A total of 1005 patients were entered into the trial of whom 961 are evaluable at 10 years from the inception. At 10 years the analysis shows no significant difference in overall and disease free survival between premenopausal women given TAM or an irradiation menopause. For premenopausal node negative patients there would appear to be a trend in favour of the TAM treated patients with a 93% ten year survival vs. 82% for the irradiation menopause group (P = 0.09). When the disease free survival of all 961 patients is analysed, allowing for node status, then there is a marked trend in favour of the TAM treated patients (P = 0.07). Of the patients originally allocated to TAM 47% had an irradiation menopause on relapse and 73% of the postmenopausal control patients had TAM on relapse. The incidence of side effects and second primary tumours is discussed as well as the possible effects of varying the length of time over which adjuvant TAM is administered.

Squamous carcinoma arising in dermoid cysts and associated with hypercalcemia: a clinicopathologic study of six cases

Six cases of squamous carcinoma arising in dermoid cysts are reported. In four out of five cases in which serum calcium was measured hypercalcemia was present and increased pari passu with increases of tumor size. The presence of hypercalcemia in association with an ovarian tumor may therefore point to the possibility of this background. In all cases survival was short, ranging from 3 to 17 months. Five patients were treated with cisplatin, etoposide, and bleomycin but without great benefit. These cases, together with a review of the literature, suggest that a new treatment will be needed to improve survival in all but a few stage I cases.

DNA-binding proteins specified by African swine fever virus

[35S]Methionine-labeled proteins from total or cytoplasmic extracts of Vero cells infected with African swine fever virus were chromatographed on native and denatured DNA-cellulose and DNA-binding proteins were analyzed by SDS-polyacrylamide gel electrophoresis (SDS-PAGE), by DNA binding to Western blots, or by two-dimensional electrophoresis. Thirteen virus-specific DNA-binding proteins were detected by one-dimensional analysis. Major species have molecular mass 44,000 (44K), 38K, 20K, 18K, 14K, 13K, and 12K. The remaining DNA-binding proteins are proteins with molecular mass 130K, 110K, 35K, 33K, 17K, and 14.5K. When viral DNA used in the binding assay the results were very similar but the 13K protein did not bind viral DNA. Seven other minor virus-specific DNA-binding proteins could be detected by two-dimensional analysis. This technique also enabled the assignment of virus-specific proteins. Seven of the virus-specific DNA-binding proteins are structural proteins. Twelve are late proteins, the remaining being early proteins synthesized before viral DNA replication. Most of the virus-specific DNA-binding proteins bind both to double-stranded and to single-stranded DNA. The 110K, 29K, and 18K DNA-binding proteins bind only to single-stranded DNA. Two virus-specific enzymatic activities, DNA polymerase and RNA polymerase, were present in the fractions separated by DNA-cellulose chromatography. The virus-specific single-stranded DNA nuclease did not bind to DNA.

Carcinoma of the breast associated with pregnancy

A series of 178 patients in whom carcinoma of the breast was associated with pregnancy has been analysed. In 121 patients the carcinoma was diagnosed during pregnancy (CP group) and in 57 patients the pregnancy occurred subsequent to definitive treatment for primary breast carcinoma (SP group). Patients presented with more advanced disease in the CP group, 72 per cent being axillary node positive. Only 37 per cent of the 121 patients survived 5 years, although 79 per cent of the node negative patients survived 5 years. Survival was not affected by age, nor by the phase of pregnancy during which the carcinoma was diagnosed or treated. The majority of pregnancies (79 per cent) ended in the delivery of a normal child. The 5 year survival of the 57 patients in the SP group was 69 per cent. However only 26 per cent of the patients who had positive nodes at the time of primary surgery were disease free 10 years later. This fact should be borne in mind when considering the continuation of the pregnancy.

The Christie Hospital tamoxifen (Nolvadex) adjuvant trial for operable breast carcinoma--7-yr results

The Christie Hospital Tamoxifen Trial was a randomised trial to assess the efficacy of tamoxifen (Nolvadex) as an adjunct to surgical treatment for operable breast carcinoma. From 1 November 1976 to 1 June 1982 1005 patients were registered, of whom 961 are evaluable. Following surgery, premenopausal women were randomly allocated to either tamoxifen (TAM) 20 mg/day for 1 yr or to have an irradiation menopause. Postmenopausal women had TAM 20 mg/day for 1 yr or no further treatment (controls). The analysis at 7 yr shows that there is no statistically significant difference in the overall survival for premenopausal women between those given TAM and those given ovarian irradiation. Similarly for the postmenopausal women there was no significant difference in overall survival between the TAM and control groups. However, if the series of 961 patients is analysed as a whole and allowance is made for node status then the TAM-treated patients show a significant survival benefit (P = 0.05). There was also a statistically significant delay in first relapse for the TAM-treated patients (P = 0.04); with a particularly marked reduction in distant metastases in postmenopausal patients (P = 0.06). TAM was extremely well tolerated, with very few side-effects.

Male breast carcinoma--a review of 301 cases from the Christie Hospital & Holt Radium Institute, Manchester

A series of 301 cases of male breast carcinoma has been analysed; of these, 292 have been treated at The Christie Hospital, Manchester and followed-up for a maximum of 15 years. The mean age was 63 years. The corrected survival was 52%, 38% and 36% at 5, 10 and 15 years respectively. For clinical Stage I, the 15 year survival was 61%. Since 1976, adjuvant Tamoxifen for one year has been administered to patients with operable Stage II (path) and Stage III disease following surgery and radiotherapy. Twenty-three patients so treated have a corrected survival of 55% at 5 years compared to 28% previously. Of 22 tumours assayed for oestrogen and progesterone receptors, 86% showed a positive result. For recurrent/metastatic disease, the drug Tamoxifen is recommended as the treatment of choice.

Adjuvant tamoxifen for operable carcinoma of the breast: report of clinical trial by the Christie Hospital and Holt Radium Institute

A large controlled clinical trial with the admission of 1005 patients was carried out using tamoxifen as adjuvant treatment for women with operable carcinoma of the breast. Results were analysed for the first 906 evaluable patients randomised up to December 1981. After mastectomy premenopausal women were randomised to receive either an irradiation menopause or tamoxifen 20 mg daily for one year. Postmenopausal women were randomised to receive either tamoxifen 20 mg daily for one year or no systemic treatment (controls). Analysis at five years suggested that for premenopausal women there was no significant difference between an irradiation menopause and tamoxifen in terms of survival, local recurrence, or distant metastases. Tamoxifen had no appreciable side effects. For postmenopausal women there was a trend in favour of tamoxifen with regard to survival and incidence of distant metastases, and the difference became statistically significant for those patients with four or more positive axillary nodes. If long term results of these studies show only an improved quality of remaining life with tamoxifen, then this drug could be an important contribution to adjuvant treatment.

Clinical pharmacology of tamoxifen and N-desmethyltamoxifen in patients with advanced breast cancer

Serum concentrations of tamoxifen and its metabolite, N-desmethyltamoxifen (DMT) were determined in six post-menopausal patients with advanced breast cancer. Following a single 10-mg dose PO parent drug was detected in the serum, with a peak concentration of 17.5 ng/ml. Concentrations of the N-desmethyl metabolite were below the limit of detection (less than 2.5 ng/ml). After 21 days' oral therapy with 10 mg b.i.d. the serum concentration of tamoxifen had increased ten fold, while DMT was now present in comparable amounts. Two patients were further studied for a longer time period. There was little change in the serum concentration of tamoxifen, while the DMT increased two fold above its value at 21 days.

Use of a glucose controlled insulin infusion system (artificial beta cell) to control diabetes during surgery

An artificial beta cell has been used to achieve and maintain a preset plasma glucose concentration in five diabetic patients undergoing surgery. These subjects were compared to control groups of normal subjects receiving either saline or glucose, and diabetics receiving glucose intraoperatively. Hyperglycaemia during surgery was seen in normals (mean plasma glucose +/- SEM: 185 +/- 16 mg/dl) and, to a greater degree, diabetics (247 +/- 36 mg/dl) receiving glucose. Insulin and C-peptide levels did not increase during 2 hours of operation in any of the control groups, suggesting beta cell suppression during surgery. As C-peptide levels declined similarly in normal subjects whether they received saline or glucose, the hyperglycaemia seems to be due to an inability to use exogenous glucose. This is confirmed by a correlation of maximal plasma glucose to glucose infusion rate (r = 0.78, p less than 0.01). The artificial beta cell was able to achieve the same plasma glucose after 2 hours of operation (128 +/- 21 mg/dl) as normal subjects receiving saline (110 +/- 7 mg/dl). The artificial beta cell proved to be a safe, convenient and effective way of monitoring and controlling the hyperglycaemia seen in diabetic patients undergoing surgery.