Intracellular coexpression of epidermal growth factor receptor, Her-2/neu, and p21ras in human breast cancers: evidence for the existence of distinctive patterns of genetic evolution that are common to tumors from different patients

Multiparameter flow cytometry studies were performed on cells from the primary tumors of 94 patients with breast cancer. Correlated cellular measurements of cell DNA content, Her-2/neu, epidermal growth factor receptor (EGFR), and p21ras levels were performed on each of 5,000 to 100,000 cells from each tumor. When criteria for positivity were matched with those in common use for immunohistochemical studies, 28 of 94 (30%) breast cancers were classified as positive for Her-2/neu overexpression. When similar criteria were applied to the EGFR measurements, 23 of 94 (24%) cases were classified as positive for EGFR overexpression. Similarly, 23 of 94 (24%) cases were classified as positive for p21ras overexpression. By conventional flow cytometric criteria for DNA ploidy, 24 cases were diploid, 28 were tetraploid, and 42 were aneuploid. When the measurements were treated as separate sets of data, the only statistically significant correlations noted were the high frequency of diploid tumors, which did not overexpress any of the three oncogenes studied (P < 0.05), and an association between Her-2/neu overexpression and aneuploidy (P < 0.03). When the data were treated as correlated intracellular measurements, 90 of the 94 tumors studied contained a population of cells in which the intracellular levels of Her-2/neu expression were directly correlated with the levels of EGFR expression in the same cells. The ratio of Her-2/neu molecules to EGFR molecules in the same cells exceeded 1 in the majority of tetraploid and aneuploid cases and was close to or less than 1 in the majority of diploid cases. In nearly all tumors, p21ras overexpression was observed only in cells that overexpressed Her-2/neu, EGFR, or both, and p21ras levels per cell were more closely correlated with levels of EGFR per cell in the same cells than with Her-2/neu levels per cell. The data are consistent with a model in which heterodimerization of Her-2/neu and EGFR in individual cells is achieved by one of several genetic evolutionary pathways, all of which commonly lead to p21ras overexpression. The two major genetic evolutionary pathways identified in this study are an aneuploid, Her-2/neu overexpression-driven pathway seen in 59 of 94 tumors, and a diploid, EGFR overexpression-driven pathway seen in 19 of 94 tumors. All tumors with Her-2/neu:EGFR ratios greater than 2 contained an infiltrating ductal carcinoma component, whereas all infiltrating pure lobular carcinomas had Her-2/ neu:EGFR ratios that were less than 2. All of the genetic evolutionary pathways identified in this study were represented among the 11 tumors from patients who experienced early tumor recurrences.

Three computational systems for disclosing medical data in the year 1999

Today most organizations release and receive medical data with all explicit identifiers, such as name, address, and phone number, removed in the incorrect belief that patient confidentiality is maintained because the resulting data look anonymous. We examine three computer programs that do maintain patient confidentiality when disclosing electronic medical records: the Scrub System which locates personally-identifying information in letters between doctors and notes written by clinicians; the Datafly System which generalizes data within the record based on a profile of the recipient at the time of access; and, the mu-Argus System which is becoming a European standard for disclosing public use data. The techniques presented in these systems help protect confidentiality in the face of a changing globally-networked society with immediate access to volumes of personal data.

Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training

Elementary school children with mild-to-moderate depressive symptoms were randomly assigned to a control group or an 8-session Primary and Secondary Control Enhancement Training program. The program focused on (a) primary control (changing objective conditions to fit one's wishes; e.g., through activity selection and goal attainment) and (b) secondary control (changing oneself to buffer the impact of objective conditions; e.g., altering depressogenic thinking, practicing mood-enhancing cognitions). At immediate posttreatment and 9-month follow-up, the treatment group showed greater reductions than the control group in depressive symptomatology on the Children's Depression Inventory and the Revised Children's Depression Rating Scale, and treated children, more than controls, shifted from above to within the normal range on both measures. Future research is needed to test treatment effects with severely depressed youths.

Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training

Elementary school children with mild-to-moderate depressive symptoms were randomly assigned to a control group or an 8-session Primary and Secondary Control Enhancement Training program. The program focused on (a) primary control (changing objective conditions to fit one's wishes; e.g., through activity selection and goal attainment) and (b) secondary control (changing oneself to buffer the impact of objective conditions; e.g., altering depressogenic thinking, practicing mood-enhancing cognitions). At immediate posttreatment and 9-month follow-up, the treatment group showed greater reductions than the control group in depressive symptomatology on the Children's Depression Inventory and the Revised Children's Depression Rating Scale, and treated children, more than controls, shifted from above to within the normal range on both measures. Future research is needed to test treatment effects with severely depressed youths.

Guaranteeing anonymity when sharing medical data, the Datafly System

We present a computer program named Datafly that maintains anonymity in medical data by automatically generalizing, substituting, and removing information as appropriate without losing many of the details found within the data. Decisions are made at the field and record level at the time of database access, so the approach can be used on the fly in role-based security within an institution, and in batch mode for exporting data from an institution. Often organizations release and receive medical data with all explicit identifiers, such as name, address and phone number, removed in the incorrect belief that patient confidentiality is maintained because the resulting data look anonymous; however, we show the remaining data can often be used to re-identify individuals by linking or matching the data to other databases or by looking at unique characteristics found in the fields and records of the database itself. When these less apparent aspects are taken into account, each released record can be made to ambiguously map to many possible people, providing a level of anonymity determined by the user.

Weaving technology and policy together to maintain confidentiality

Author demonstrates that removing all explicit identifiers from medical data does not guarantee medical record confidentiality. She examines three new software systems that do help maintain anonymity, but warns that systems' limitations demand complementary policies.

Lymphangioma circumscriptum associated with paravesical cystic retroperitoneal lymphangioma

A boy with long-standing congenital cutaneous lymphangioma circumscriptum (LC), presented at the age of 6 years with an episode of painless haematuria, subsequently attributed to bladder wall involvement of a paravesical cystic retroperitoneal lymphangioma. Magnetic resonance imaging demonstrated this lymphangioma to be in communication with the cutaneous lesions. Deep lymphatic and visceral involvement is an extremely unusual occurrence in association with LC. This is the first report of an association between LC and cystic retroperitoneal lymphangioma. LC occasionally heralds a deeper, more clinically significant lymphangioma which may not become apparent until many years after the initial dermatological presentation. We report this case to raise awareness of this potential association and to demonstrate the usefulness of magnetic resonance imaging in the assessment of the deep component of cutaneous lymphangiomas.

Replacing personally-identifying information in medical records, the Scrub system

We define a new approach to locating and replacing personally-identifying information in medical records that extends beyond straight search-and-replace procedures, and we provide techniques for minimizing risk to patient confidentiality. The straightforward approach of global search and replace properly located no more than 30-60% of all personally-identifying information that appeared explicitly in our sample database. On the other hand, our Scrub system found 99-100% of these references. Scrub uses detection algorithms that employ templates and specialized knowledge of what constitutes a name, address, phone number and so forth.

Control-related beliefs and self-reported depressive symptoms in late childhood

Research thus far links depressive symptoms in children to one type of control-related belief: low levels of perceived personal competence. However, child research, unlike adult research, has not supported a linkage between depressive symptoms and another theoretically important control-related belief: perceived noncontingency of outcomes. Here we reexamined the issue, adjusting for limitations in previous methodology by using (a) psychometrically stronger measures of control beliefs, and (b) a general population sample rather than children being treated in mental health clinics. In contrast to previous results, we found that both perceived incompetence and perceived noncontingency were strongly related to children's depression, together accounting for 40% of the variance in Child Depression Inventory scores. We also found, as in previous research, that depressive symptoms were correlated with uncertainty as to the causes of outcomes, especially successes. The findings suggest that children may be susceptible to both "personal helplessness" and "universal helplessness" forms of depression.

Control-related beliefs and self-reported depressive symptoms in late childhood

Research thus far links depressive symptoms in children to one type of control-related belief: low levels of perceived personal competence. However, child research, unlike adult research, has not supported a linkage between depressive symptoms and another theoretically important control-related belief: perceived noncontingency of outcomes. Here we reexamined the issue, adjusting for limitations in previous methodology by using (a) psychometrically stronger measures of control beliefs, and (b) a general population sample rather than children being treated in mental health clinics. In contrast to previous results, we found that both perceived incompetence and perceived noncontingency were strongly related to children's depression, together accounting for 40% of the variance in Child Depression Inventory scores. We also found, as in previous research, that depressive symptoms were correlated with uncertainty as to the causes of outcomes, especially successes. The findings suggest that children may be susceptible to both "personal helplessness" and "universal helplessness" forms of depression.

Minitek urea disk test, a sensitive and cost-effective method to screen for Campylobacter pylori in gastric biopsies

One hundred fifty-five biopsy specimens from the gastric mucosa of 81 patients undergoing routine endoscopy procedures were tested for the presence of Campylobacter pylori by three methods: Gram stain, culture, and modified Minitek, a rapid urea disk test (BBL Microbiology Systems, Cockeysville, Md.). Twenty-nine patients were infected with C. pylori. Sensitivities and specificities of detection were 100 and 94% with the Minitek test and 93 and 100% with Gram stain, respectively. Rapid testing by the urea disk is a simple, cost-effective, and accurate method for detecting the presence of C. pylori in gastric biopsy specimens.

99mTc DTPA scanning with diuretic washout. Is it useful in the investigation of obstruction in the presence of gross renal tract dilatation?

Diuretic-enhanced 99mTc DTPA renal scanning aims to determine whether or not a kidney is obstructed. In the presence of gross renal tract dilatation the validity of this technique is questioned. Twenty-eight patients (51 kidneys) with the prune belly syndrome, characterised by gross dilatation and tortuosity of the ureters, were studied. These patients underwent diuretic 99mTc DTPA scanning at the time of diagnosis and at yearly intervals thereafter. Long-term clinical follow-up (3 years) with serial serum creatinine was available in all children. In all cases renal function remained stable and on this basis urinary tract obstruction was excluded. Analysis of the first 99mTc DTPA scan included differential function, whole kidney mean transit time (WKMTT) and the time taken for tracer activity to fall to 75% of peak activity after diuretic stimulus (T75). Using the 99mTc DTPA scan, obstruction can be excluded if the WKMTT is less than 5 min or, in the presence of a prolonged WKMTT, if the diuretic stimulus results in a T75 of less than 5 min. A T75 of between 5 and 10 min is considered equivocal and a T75 exceeding 10 min means that obstruction cannot be excluded. 99mTc DTPA scanning, using these criteria for diagnosis, provided false positive information in 22 kidneys (43%). There were no false negatives. 99mTc DTPA scanning with diuretic washout, using WKMTT and T75 criteria, is not appropriate for the detection of renal tract obstruction in the presence of marked upper renal tract dilatation, since the false positive rate of 43% is unacceptably high.