Cyclin D1 protein expression and gene polymorphism in colorectal cancer. Aberdeen Colorectal Initiative

Cyclin D1 is a key cell cycle regulatory protein, the expression and subcellular localization of which is often altered in human tumor cells. A common A/G single nucleotide polymorphism (A870G) in exon 4 of the cyclin D1 gene, CCND1, is associated with the presence of 2 distinct mRNA transcripts for this G1/S regulatory protein, and CCND1 genotype has been related to prognosis in lung cancer and head and neck carcinoma. We have investigated both the expression of cyclin D1 protein and the CCND1 A870G polymorphism in 100 colorectal cancer patients. Immunohistochemistry demonstrated cyclin D1 protein expression in 55% of tumors, and while the absence of cyclin D1 protein was not associated with outcome (p=0.81), high levels of protein expression (>50% of tumor cells expressing cyclin D1) correlated with significantly shortened overall survival (p=0.01). Using polymerase chain reaction restriction fragment length polymorphism analysis, we determined the frequency of each genotype and found that CCND1 genotype was not related to overall survival (p>0.05). In addition, genotype was unrelated to the level of expression and localization of cyclin D1 protein, as well as other key G1/S checkpoint proteins (p21, p27, p53, retinoblastoma) and tumor proliferation markers (proliferating cell nuclear antigen). However, higher levels of p27, and to a lesser extent p21, were associated with reduced cytoplasmic cyclin D1 protein (p=0.029 and p=0.054, respectively). In conclusion, we have demonstrated that high levels of cyclin D1 protein expression are related to outcome in colorectal cancer; however, the CCND1 A870G polymorphism is unrelated to either cyclin D1 protein expression or patient survival.

Use of donepezil for the treatment of mild-moderate Alzheimer's disease: an audit of the assessment and treatment of patients in routine clinical practice

There have been a number of randomised, placebo-controlled trials of donepezil in the treatment of mild-moderate Alzheimer's disease and these report significant benefits for a proportion of patients. Little is known about the use of donepezil in routine clinical practice. The aims of this study were to examine the use of donepezil in routine clinical practice and to identify some of the practical and resource implications associated with treatment. A number of areas were examined against published guidelines including assessment, diagnosis, initiation of treatment, monitoring and discontinuation of treatment. This was a retrospective case note study involving patients with mild - moderate Alzheimer's disease over a one-year period. One hundred and seventeen patients were commenced on donepezil and 93 successfully completed three months of treatment. Of these, 47% demonstrated an improvement in cognition, activities of daily living or carer observation (or a combination). Compliance with accepted guidelines with respect to assessment, diagnosis and monitoring requires a standardised approach that has both clinical and resource implications.

Matrix metalloproteinases: molecular aspects of their roles in tumour invasion and metastasis

The matrix metalloproteinases (MMPs) are a family of proteolytic enzymes, whose physiological functions include tissue remodelling and embryogenesis. The importance of this group of proteins in the processes of tumour invasion and metastasis is now widely acknowledged, and has led to the search for MMP inhibitors for use as anticancer treatments in a clinical setting. This review aims to bring the reader up-to-date with current research relating to MMPs, with particular emphasis on emerging mechanisms of regulation of these enzymes, and their interaction with cell adhesion molecules. The therapeutic inhibition of MMPs will also be discussed.

Hypescheme: an operational criteria checklist and minimum data set for molecular genetic studies of attention deficit and hyperactivity disorders

Investigators engaged in mapping the genetic basis of attention deficit hyperactivity disorder (ADHD) currently use a number of measures for the collection of clinical information. This gives rise to difficulties in comparing datasets and research communications between independent groups. This paper describes the development of Hypescheme, which is an operational criteria checklist for ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD), and is proposed as a minimum dataset for those engaged in molecular genetic studies of ADHD. Hypescheme consists of a computerised data checklist system that includes all the operational criteria required for both DSM-IV and ICD-10 diagnostic criteria and a systematic record of information about comorbid psychiatric, developmental, and neurological disorders. Using this data, an algorithm applies both DSM-IV and ICD-10 criteria to generate operational diagnostics under both these systems. Hypescheme is not designed to replace current assessment protocols but to be a final common checklist that can be completed by experienced researchers using all available data.

No association between low- and high-activity catecholamine-methyl-transferase (COMT) and attention deficit hyperactivity disorder (ADHD) in a sample of Turkish children

Biochemical and genetic studies of attention deficit hyperactivity disorder (ADHD) suggest that regulation of catecholamine neurotransmission is a key factor in the aetiology of the disorder. In particular, it is postulated that an underactive dopamine system is associated with the disorder. In this study we have tested this hypothesis by screening a clinical sample of Turkish children with the combined subtype of ADHD with a functional variant of catecholamine-methyl-transferase (COMT) that codes for high- and low-activity variants of the enzyme. Using within-family tests of association and linkage in a sample of 72 children, we found no evidence for a genetic association or linkage. We conclude that altered regulation of catecholamines due to this polymorphism does not have a significant main effect on the risk for ADHD in this population. However, it remains feasible that more minor effects or interacting effects with other genes or environment exist.

Laser capture microscopy

Human tissues are composed of complex admixtures of different cell types and their biologically meaningful analysis necessitates the procurement of pure samples of the cells of interest. Many approaches have been used in attempts to overcome this difficulty, including a variety of microdissection methods. This review concerns a recent advance in microdissection techniques, namely laser capture microdissection (LCM). The principle underlying this technique is outlined, and practical issues pertaining to LCM are considered. In addition, the literature relating to LCM is reviewed, with examples of research applications of this technique being outlined.

Matrix metalloproteinases in tumour invasion and metastasis

The matrix metalloproteinases (MMPs) are a large family of proteolytic enzymes, which are involved in the degradation of many different components of the extracellular matrix. The MMPs have been classified into different groups including collagenases, gelatinases, stromelysins, and others, particularly membrane-type MMPs, based mainly on the in vitro substrate specificity of individual MMPs. There is increasing evidence to indicate that individual MMPs have important roles in tumour invasion and metastasis. However, the current concept of the role of MMPs in tumour invasion is that they not only have a direct role in tumour invasion by facilitating extracellular matrix degradation, but as a consequence they also have an important role in maintaining the tumour micro-environment and thus promoting tumour growth. Inhibiting the action of MMPs represents a new therapeutic approach for the treatment of individual types of cancer and several broad-spectrum, low-molecular-weight MMP inhibitors are currently being assessed for clinical use. This review examines the role of MMPs in tumour invasion and metastasis, with an emphasis on studies of clinical relevance.

Matrix metalloproteinases in tumour invasion and metastasis

The matrix metalloproteinases (MMPs) are a large family of proteolytic enzymes, which are involved in the degradation of many different components of the extracellular matrix. The MMPs have been classified into different groups including collagenases, gelatinases, stromelysins, and others, particularly membrane-type MMPs, based mainly on the in vitro substrate specificity of individual MMPs. There is increasing evidence to indicate that individual MMPs have important roles in tumour invasion and metastasis. However, the current concept of the role of MMPs in tumour invasion is that they not only have a direct role in tumour invasion by facilitating extracellular matrix degradation, but as a consequence they also have an important role in maintaining the tumour micro-environment and thus promoting tumour growth. Inhibiting the action of MMPs represents a new therapeutic approach for the treatment of individual types of cancer and several broad-spectrum, low-molecular-weight MMP inhibitors are currently being assessed for clinical use. This review examines the role of MMPs in tumour invasion and metastasis, with an emphasis on studies of clinical relevance.

Expression of cell cycle control proteins in primary colorectal tumors does not always predict expression in lymph node metastases

Analysis of tumor markers focuses on expression in primary tumors with the assumption that this is representative of metastatic tumor, against which treatment is targeted. Few studies have compared the expression of such markers in primary and secondary tumors. In this study, several key genes involved in cell cycle regulation were investigated in colorectal tumors and corresponding lymph node metastases. The cell cycle regulators p53, cyclin D1, p21, p27, retinoblastoma protein (Rb), and proliferating cell nuclear antigen (PCNA) were examined in a series of 42 paired samples of primary colorectal and secondary lymph node tumors by immunohistochemistry. Expression of p53, p27, and Rb was similar in virtually all paired samples (p53, 38 of 42; p27, 39 of 42; Rb, 40 of 42), indicating that the pattern of these proteins in colorectal tumors may be used to predict that in lymph node tumors. It also suggests a lack of direct involvement in the metastatic process. A lower concordance for p21 and cyclin D1 staining was observed between primary and secondary tumors (p21, 19 of 42; cyclin D1, 22 of 42). p21 expression was more often observed in primary colorectal cancers, whereas cyclin D1 expression was more frequently seen in lymph node metastases, in keeping with the contrasting roles of these proteins as a cell cycle inhibitor (p21) and activator (cyclin D1). The PCNA-labeling index was found to vary considerably in a number of cases, thus limiting the ability to predict expression of this protein in lymph node metastases from the primary tumor. In addition, PCNA-labeling indices between paired samples were neither consistently higher nor lower, suggesting that the proliferative capacity of tumor cells is not directly related to their ability to metastasize.

A prospective study examining the association between the symptoms of anxiety and depression and severity of urinary incontinence

OBJECTIVE

To investigate the association of the presence or absence of the symptoms of anxiety and depression compared with the 48 h pad test as an objective measure of incontinence.

DESIGN

Prospective study.

SETTING

Urodynamics clinic in a large teaching hospital.

SUBJECTS

All patients with urinary incontinence attending for urodynamic assessment from 23.4.96 to 29.10.96.

INTERVENTIONS

48 h pad test, Hospital Anxiety and Depression scale (HAD scale).

MAIN OUTCOME MEASURES

Urodynamic diagnosis of cause of incontinence. Urinary loss over 48 h as measured by weight change in pads. Presence of symptoms of anxiety or depression as defined by HAD scale score of 8 or more.

RESULTS

Urodynamic investigation was performed for incontinence on 133 patients. Of these 127 (95.4%) completed the HAD scale questionnaire. Of the 43 patients (32.2%) who returned the pads 18 (41.8%) patients were found to have symptoms of anxiety and six patients (13.9%) had symptoms of depression. Patients with symptoms of anxiety had lower mean measured urinary loss over a 48 h period compared to women with no symptoms of anxiety (median loss 44.2 ml range 6.8-622.4 versus 97.1 ml range 8.2-4384.4 ml) (P=0.05). There was no significant association between symptoms of depression and pad test results.

CONCLUSIONS

Patients presenting with incontinence who have symptoms of anxiety are on average less incontinent compared to than those without symptoms of anxiety. It suggests that anxious patients present with a lesser degree of incontinence than nonanxious patients.

Psychopathology 8 1/2 years post parasuicide

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8 1/2 years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five and died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

Matrix metalloproteinases in tumour invasion and metastasis

The matrix metalloproteinases (MMPs) are a large family of proteolytic enzymes, which are involved in the degradation of many different components of the extracellular matrix. The MMPs have been classified into different groups including collagenases, gelatinases, stromelysins, and others, particularly membrane-type MMPs, based mainly on the in vitro substrate specificity of individual MMPs. There is increasing evidence to indicate that individual MMPs have important roles in tumour invasion and metastasis. However, the current concept of the role of MMPs in tumour invasion is that they not only have a direct role in tumour invasion by facilitating extracellular matrix degradation, but as a consequence they also have an important role in maintaining the tumour micro-environment and thus promoting tumour growth. Inhibiting the action of MMPs represents a new therapeutic approach for the treatment of individual types of cancer and several broad-spectrum, low-molecular-weight MMP inhibitors are currently being assessed for clinical use. This review examines the role of MMPs in tumour invasion and metastasis, with an emphasis on studies of clinical relevance.

Selecting an antidepressant for use in a patient with epilepsy. Safety considerations

Depression is a common and disabling condition and is especially disabling for patients who also have epilepsy. Antidepressants, particularly the tricyclic antidepressants are well known to be associated with seizure activity, but this is a very neglected area of research. Most of the data on the proconvulsive effects of antidepressants come from either work in animal models or from research into the effects of antidepressants in overdose. Both of these situations may tell us little about the behaviour of antidepressants in patients with epilepsy. The selective serotonin [5-hydroxytryptamine; 5-HT] reuptake inhibitors have a low seizure propensity, are well tolerated in overdose and have a favourable adverse effect profile, making them suitable as first line treatments for depression in patients with epilepsy. Other antidepressants, e.g. trazodone, moclobemide, mirtazepine, are also likely to have minimal proconvulsive effects, but adverse effects, interactions with other drugs, especially anticonvulsants, or the lack of clinical data may make their use less attractive. Although this review has focused on these clinically important issues it is clear that considerably more research needs to be undertaken on the seizure propensity and clinical efficacy of antidepressants in patients with epilepsy.

Distribution of putative primordial germ cells in equine embryos

Eighteen equine embryos, 3 each on Days 20, 22, 24, 26, 28 and 30 post ovulation, were collected transcervically by uterine lavage, fixed in 4% paraformaldehyde and embedded in paraffin wax. Ten micron serial sections were stained to determine alkaline phosphatase (AP) activity in the cells. Positive cells were counted and their approximate location determined. The cells were approximately 8 microm in diameter and the entire cell, except the nucleus, stained strongly with many small round areas of intense staining in the cytoplasm. The cells varied from round to elongated in shape and pseudopodia were often present. Thus, they were similar in shape and staining pattern to primordial germ cells described in other species. A total of 2 AP-positive cells were found in the 3 Day 20 embryos and the mean number of AP-positive cells changed (P<0.05) over the succeeding days as follows; Day 20 = 1; Day 22 = 251; Day 24 = 1484; Day 26 = 2385; Day 28 = 3267; Day 30 = 2424. AP-positive cells present in the liver were not included in the calculations. In the Day 22 embryos, 10% of the putative primordial germ cells were found within the vascular system, including the heart chambers, and only 4% were found along the genital ridge. The percentage of cells found in the vascular system decreased from 10% on Day 22 to 1% on Day 30, although not significantly. The percentage of cells found along the genital ridge changed (P<0.05) over gestational age as follows; Day 22 = 4%; Day 24 = 10%; Day 26 = 28%; Day 28 = 28%; Day 30 = 16%. Once the putative primordial germ cells reached the developing gonads they were no longer AP-positive and nor was the gonadal stroma. The rest of the cells were distributed along the dorsal mesentery (range, 14-24%), near the dorsal aorta (16-29%), in the mesonephros (1-3%) and in other areas of the embryo (27-44%). Large numbers were in the cranial portion of the embryo. Although it is likely that the population of AP-positive cells counted included the primordial germ cells, other cells, such as haematopoietic precursor cells, could not be ruled out. The AP reactivity, the appearance of the cells and their migratory pattern through the dorsal mesentery to the gonadal ridge were consistent with descriptions of primordial germ cells in other species. Their distribution throughout the embryo, especially its cranial aspect and their location within, or in close proximity to, blood vessels suggested that the equine embryo is unusual among mammals in that some of its primordial germ cells migrate through the blood.

M-mode ultrasonic assessment of equine fetal heart rate

Embryonic heart rate was studied during 87 examinations in 56 mares on Days 25 to 174 post ovulation. Real-time B-mode using a stopwatch and M-mode ultrasonography were compared. For analyses of heart rates, data were grouped into weeks or months. For the stopwatch and M-mode techniques, respectively, heart rates averaged 123 and 133 beats per minute during Month 1, peaked during Month 3 at 172 or 196 beats, then gradually decreased over the duration of the study to 126 and 130 beats during Month 6. There was a significant increase in heart rate from Months 1 to 2 and Months 2 to 3 and a significant decrease from Months 3 to 4 and Months 5 to 6 for both techniques. There was a tendency for a difference (P<0.08) between techniques during Month 1 and a significant difference between techniques for each of Months 2 and 3. The lower heart rate values for the stopwatch technique during Months 1, 2 and 3 may have reflected the difficulties associated with maintaining the transducer field on the fetal heart continuously for an adequate period of time (Months 1 and 2) and difficulty counting fast enough to keep up with the fetal heart (Months 2 and 3). When data were grouped weekly, the largest increase in fetal heart rate occurred between Weeks 4 and 5.

Effect of paroxetine on seizure length during electroconvulsive therapy

This study reports the effect of paroxetine, a selective serotonin reuptake inhibitor, on seizure length during electroconvulsive therapy. Seven inpatients taking paroxetine were compared with 7 controls taking tricyclic antidepressants. The mean seizure length of the paroxetine group was approximately twice that of the control group.

The impact of a media campaign on public action to help maltreated children in addictive families

Developed because of the need to promote public understanding of the link between addictions and child maltreatment, a multimedia campaign helped to increase by 62% the average monthly number of people who called a telephone service for information about how to aid abused and neglected children. The campaign was supported by market research and professional experience that indicated the campaign should focus on easy action a citizen could take, avoid inducing fear or blame, and target third party helpers and younger families-at-risk. Campaign exposure was promoted through the support of corporate partners. A random household survey found that 61% of the general population had seen or heard the campaign slogan. The average monthly calls to the child maltreatment information service regarding alcohol and other drug abuse tripled and the requests regarding at-risk children almost doubled. An auxiliary project provided interprofessional education to increase the probability that people seeking help would get it when referrals were made. The project yielded several lessons for future public awareness campaigns: focus on helping action rather than the problem; use of client-based market research; a strategic plan to assure necessary exposure; reliance on public-private-nonprofit sector partnerships; preparation of the service system; promotion of personal ways of helping.

Attachment site specificity and the tapeworm assemblage in the spiral intestine of the blue shark (Prionace glauca)

The parasite assemblage in the scroll-type spiral intestine of 24 specimens of the blue shark Prionace glauca collected off of Montauk, Long Island, New York was investigated. When opened with a longitudinal incision to the right of the ventral blood vessels, the internal mucosal spiral of the spiral intestine of the blue shark could be unrolled into a flat sheet of double-sided mucosal tissue. Attachment sites and parasite assemblages were studied on both sides of the sheet in 12 sharks and on either the inside or the outside of the sheet in 12 additional sharks. Assemblages within host individuals were composed of up to 4 species of tetraphyllidean cestodes including the onchobothriid Platybothrium auriculatum, and the phyllobothriids, Prosobothrium armigerum. Paraorygmatobothrium prionacis, and Anthobothrium laciniatum. Each individual shark hosted 1-4 tapeworm species (mean = 3.7 +/- 0.65). The 12 sharks in which both sides of the mucosal scroll were examined hosted 156-2,382 (mean = 929.1 +/- 818) individual tapeworms. The assemblage consisted of 4 core species. Sharks were not found to host all of the possible combinations of species in their assemblages; the most common combination (17 out of 24 individuals) was the occurrence of all 4 parasite species. A chi-square test revealed no evidence that the 4 species did not occur independently. Regression revealed a significant relationship between shark total length and spiral intestine area. Analysis of covariance (ANCOVA) revealed a significant difference between the surface areas of the 2 sides of the mucosal sheet when shark total length was taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Equine fetal kinetics: entry and retention of fetal hind limbs in a uterine horn

Transrectal ultrasonic examinations were made in 31 pregnant pony mares once a week during Months 6 to 11. Each uterine horn was divided into 3 approximately equal segments (caudal, middle, cranial). The percentage of examinations with cranial fetal presentation increased (P<0.05) progressively from 58% at Month 6 to 99% at Month 9 and was followed in all mares by entry of the fetal hind limbs into one uterine horn. The mean number of uterinehorn segments with limb parts increased (P<0.05) between each set of consecutive months from Month 6 to Month 10. Initially (Months 7 and 8), retraction of limbs after entry into the caudal and middle segments of the horn was common (31% incidence). The mean day of final entry of the limbs without detection of subsequent retraction was Day 230 +/- 2.2. Both uterine horns were closed during the examination preceding final entry of the hind limbs into one horn in 25 of 29 (86%) mares. The limbs reached the cranial segment in most examinations by Months 9 and 10 (73% and 98%). The cross-sectional height, as seen on the ultrasound screen, of both uterine horns increased (P<0.05) progressively during Months 7 to 10. Between Months 10 and 11, the height of the horn containing the limbs decreased (P<0.05); this result was attributable to a flattening of the horn and thinning (P<0.05) of the horn wall above a hoof and metatarsal bone. Apparent placental fluid (nonechogenic areas >5 mm in height) between the hind limbs and the cornual wall was detected in 0, 10, 25, and 63% (P<0.01) of examinations for Months 8 to 11, respectively. Results indicated that entry of the fetal hind limbs into a uterine horn was initially tentative and became final during a mean of Month 8. The apposition between the cornual wall and limbs was close during Months 7 to 11. By Month 11, the fetal-limb horn became flatter and thin-walled and usually contained placental fluid.

Ultrasonic determination of fetal gender in horses and cattle under farm conditions

Accuracy of transrectal ultrasonic diagnosis of fetal gender by identifying and locating the genital tubercle was assessed in 85 horses and 102 dairy heifers and cows. Examinations were made once (horses and cattle) under farm conditions (cattle) on approximately Days 50 to 100. Definite diagnosis was made by removal of fetuses (horses) or after calving or abortion (cattle). In both species and both parities, accuracy was 100% (109 109 totaled over both species) when the certainty level recorded at the time of examination was 95 or 99%. At the lower levels of certainty (65 to 80%, 85 to 90%), the accuracy was 89% (57 64 totaled over both species). A diagnosis was not obtainable in 10 horses (12%) and 5 cattle (5%); this was especially due to inadequate viewing of the fetus when the fetus was beyond Day 64. The time from completion of evacuation of the rectum to diagnosis of gender averaged 1 minute 17 seconds in horses (range, 15 seconds to 3 minutes 55 seconds). The corresponding figure in cattle was 1 minute 53 seconds (range, 16 seconds to 8 minutes 30 seconds).

Effects of topical administration of levocabastine on psychomotor and cognitive function

The possible central nervous system effects of topical administration of levocabastine, a new H1-antagonist, were investigated in a double-blind, placebo-controlled, crossover study using a battery of objective and subjective tests. These were carried out in 12 volunteers up to five hours postapplication. Neither the recommended (0.5 mg/mL) nor the four times higher (2.0 mg/mL) concentration level was found to be distinguishable from placebo, while the verum (triprolidine 10 mg) was significantly worse, on both objective and subjective measures.

Pharmacodynamic effects of buspirone and clobazam

1. The pharmacodynamic effects of buspirone and clobazam were compared in two volunteer studies. Acute doses of buspirone 5 mg, 10 mg and clobazam 10 mg were contrasted with placebo and a verum (lorazepam 1 mg), in a repeated measures design with 10 subjects assessed on a battery of psychometric tests at 1.5, 3.5, and 5.5 h post dose. For the combined results clobazam and the lower dose of buspirone (5 mg) were significantly contrasted with lorazepam on measures of subjective sedation, memory and choice reaction time (CRT). The higher dose of buspirone was not statistically different from lorazepam for all measures except memory; whilst contrasting significantly with placebo and clobazam on movement and total reaction time components respectively. Though failing to achieve significance, a similar trend was seen for critical flicker fusion (CFF) with buspirone 10 mg and lorazepam producing the lowest scores indicative of increased sedation. 2. Repeated doses of buspirone 5 mg twice daily, clobazam 10 mg twice daily, or placebo twice daily for 8 consecutive days were compared on the same battery of psychometric tests in a repeated measures design. Nine subjects were assessed on days 1, 3, and 8 of the study. Overall, memory performance significantly decreased with buspirone 5 mg in contrast to both clobazam and placebo whilst the opposite trend was seen with CFF. Clobazam significantly improved TRT in contrast to both placebo and buspirone. 3. These results indicate improved reaction time and memory performance with repeated dosing of clobazam in contrast to buspirone. Impairment following acute administration of buspirone appears limited to the higher (10 mg) dose.

Accuracy of ultrasonography for pregnancy diagnosis on days 10 to 22 in heifers

Two operators independently conducted ultrasonic pregnancy examinations on nulliparous Holstein heifers on Days 10, 12, 14, 16, 18, 20 and 22, and assigned a diagnosis (pregnant or nonpregnant) and a score for degree of certainty in the diagnosis (1, 2 or 3 for low, intermediate or high, respectively). Pregnancy was retrospectively confirmed by the ultrasonographic detection of an embryo proper and embryonic heartbeat on Day 24 in 20 25 bred heifers; the five nonpregnant heifers were excluded from the analyses. Eleven nonbred heifers were included as an unequivocal source of nonpregnant heifers. Accuracy was not significantly greater than a guess (50%) before Day 18, but reached 100% on Days 20 and 22. Mean accuracy was higher (P<0.005) for nonpregnant (65 77 , 84%) than pregnant heifers (91.5 140 , 65%). For certainty score, there were main effects of day (P<0.0001), reproductive status (pregnant or nonpregnant, P<0.003), and an interaction of day and reproductive status (P<0.0001). The certainty score increased in all heifers among days and was higher (P<0.05) in pregnant than nonpregnant heifers on Days 16 to 20. For luteal area (area of corpus luteum, excluding area of fluid filled center, if present), there were significant main effects of day, reproductive status and a day by status interaction (P<0.0001 for each). Luteal area was approximately constant in pregnant heifers, but in nonpregnant heifers it was lower (P<0.05) on Days 16 to 22 than on Days 10 to 14. Uterine echotexture was scored on a scale of 1 to 3, characteristic of a diestrus, intermediate and estrus uterus, respectively. There were main effects of day and reproductive status (P<0.0001 for each) and an interaction of day and reproductive status (P<0.025). Uterine echotexture was approximately constant in pregnant heifers, but in nonpregnant heifers it was higher (P<0.05) on Days 16 to 22 than on Days 10 to 14. Pregnancy diagnosis on Days 10 to 14 was based on detection of the conceptus; however, detection of the conceptus was not accurate prior to visualization of the embryo proper (mean Day 22, range Days 20 to 24). In nonpregnant heifers, a correct diagnosis with high certainty was made when a small corpus luteum and uterine echotexture characteristic of estrus were detected. In the absence of these changes on Days 18 to 22, a diagnosis of pregnancy was made with high accuracy and intermediate or high certainty.

Plasma haloperidol and clinical response: a role for reduced haloperidol in antipsychotic activity?

Seventeen hospitalized psychotic patients were treated with a fixed oral dose of haloperidol, 5 mg twice daily for 28 days. Most were chronic schizophrenics with an acute exacerbation of their illness. All patients also received benztropine 3 mg twice daily during the last 11 days of the study, regardless of the presence or absence of extrapyramidal side effects. No significant linear or curvilinear relationship was found between steady state plasma levels of haloperidol and clinical response measured by total Brief Psychiatric Rating Scale score. At 28 days, the correlations between plasma levels and percent improvement were rs = 0.187 (not significant) for haloperidol and rs = 0.582 (p = 0.04) for the hydroxymetabolite, reduced haloperidol. The correlation for the sum was rs = 0.511 (p = 0.078). Metabolite levels were substantially higher than plasma haloperidol, on the average 2.7 times greater. Eleven days of benztropine treatment had no significant effect on haloperidol or metabolite plasma levels or on clinical status. At the end of the study, nine of 17 patients (53%) had recovered as judged by discharge readiness. Within the limitations implied by the small number of patients, these data suggest that reduced haloperidol is an important component of plasma antipsychotic activity and cannot be neglected in correlative studies, and that a substantial proportion of patients--about half--can be successfully treated with only 10 mg of haloperidol. The routine use of large doses is thus not necessary for many patients.

Carcinomatous features of cervical chordoma in a fine needle aspirate

A cartilaginous tumor of the cervical spine in a 31-year-old man is described, with discussion of the differential diagnostic problems both in aspiration biopsy cytology and in histopathology. The tumor mass caused nasopharyngeal swelling and infiltrated the base of the skull and the spinal canal. Aspiration biopsy cytology of the tumor demonstrated mostly papillary epithelial groupings, causing differential diagnostic problems with thyroid and salivary gland carcinomas. Most of the tumor mass was resected, with postoperative radiation performed. Immunohistochemical staining for type II procollagen on the histologic sections confirmed the presence of cartilage. The epithelial components of the tumor appeared to be cytokeratin-positive. Immunohistochemical staining for laminin and type IV collagen revealed positivity only in the blood vessel walls. The diagnosis of cervical chordoma was established by the histologic examination. The patient is without symptoms two years after removal of the tumor.

Ultrasonographic appearance of the bovine conceptus from days 20 through 60

The ultrasonographic appearance of the conceptus on days 20 to 60 was determined by daily examinations in 15 heifers. The mean length of the embryo proper increased from the day of first detection (day 20.3 +/- 0.3; 3.8 +/- 0.3 mm) to day 60 (66.1 +/- 1.7 mm). The growth curve was quadratic, with an increasing growth rate after approximately day 50. The embryo initially had the appearance of a short, straight line and developed a C shape on day 25.4 +/- 0.8 and an L shape on day 32.7 +/- 1.1. The average day of first detection of various structures was as follows: allantois, 23.2 +/- 0.3; spinal cord, 29.1 +/- 0.5; forelimbs, 29.1 +/- 0.3; amnion, 29.5 +/- 0.5; optic area, 30.2 +/- 0.4; hindlimbs, 31.2 +/- 0.3; placentomes, 35.2 +/- 1.0; optic lens, 40.0 +/- 0.6; split hooves, 44.6 +/- 0.7; fetal movements, 44.8 +/- 0.8; and ribs, 52.8 +/- 0.5. Embryonic death, as indicated by cessation of heartbeats, occurred in one heifer on day 26. The embryonic mass increased in echogenicity and was maintained with a gradually decreasing fluid volume until the occurrence of estrus 17 days after death.