The incidence of interval cancers in the German mammography screening program: results from the population-based cancer registry in North Rhine-Westphalia

BACKGROUND

Cancer screening programs must meet high standards for quality and effectiveness, because many healthy persons need to be screened to detect relatively few cases of cancer. In this study, we use the rate of interval cancers as an important surrogate indicator for evaluating the German mammography screening program (MSP).

METHODS

All first-time participants in the MSP in the German federal state of North Rhine-Westphalia over the period 2005-2008 whose screening mammogram had been read as negative were followed over the next 24 months for the potential development of breast cancer (an "interval cancer" or IC). The screening data in the MSP database were compared in anonymized fashion with reports of cancer that were recorded at the Epidemiological Cancer Registry North Rhine-Westphalia.

RESULTS

Among the 878,764 women with negative screening mammograms in the first screening round, 2036 (23.2 per 10,000) developed an IC in the ensuing 24 months. These ICs accounted for 40% of all T2-T4 breast cancers occurring in first-time participants in the screening program in the 2 years after screening. The relative rate of IC compared to the background incidence of breast cancer before introduction of the MSP was 27% in the first year and 58% in the second. Screening detected 78% of all breast cancers that occurred during a maximum of 2 years after screening.

CONCLUSION

The IC rates in the implementation phase of the MSP agree with those found in other, established European programs. The present study is the first one to assess this important surrogate parameter to characterize the effectiveness of the German MSP among women in North Rhine-Westphalia, Germany's largest state by population.

Digital mammography screening: how many breast cancers are additionally detected by bilateral ultrasound examination during assessment?

OBJECTIVE

To assess the positive predictive values of incremental breast cancer detection (PPV1) in relation to the mammographic breast density and of performed biopsies (PPV3) resulting from supplemental bilateral physician-performed whole-breast ultrasound (US) at recall of a population-based digital mammography screening programme.

METHODS

A total of 2,803 recalled screening participants (50-69 years), who had additional bilateral US with prospectively completed documentation [grading of breast density (ACR 1-4), biopsy recommendation related to US and mammography], were included.

RESULTS

The PPV1 of supplemental cancer detection only by US was 0.21 % (6/2,803) compared to 13.8 % (386/2,803) by mammography. The PPV1 of US-only cancer detection was 0 %, 0.16 % (2/1,220), 0.22 % (3/1,374) and 1.06 % (1/94) for women with breast density of ACR 1, ACR 2, ACR 3 and ACR 4, respectively. The PPV3 of US-only lesion detection was 33.3 % (9/27) compared to 38.0 % (405/1,066) by mammography. The proportion of invasive cancers no larger than 10 mm was 37.5 % (3/8) for US-only detection compared to 38.4 % (113/294) for mammographic detection.

CONCLUSION

Bilateral ultrasound at recall, in addition to the assessment of screen-detected mammographic abnormalities, resulted in a low PPV of incremental cancer detection only by US, without a disproportional increase of false-positive biopsies.

Validation of an optical surface plasmon resonance biosensor assay for screening (fluoro)quinolones in egg, fish and poultry

A surface plasmon resonance biosensor immunoassay has been developed for multi-residue determination of 13 (fluoro)quinolone antibiotics in poultry meat, eggs and fish. The following performance characteristics were determined according to the guidelines laid down for screening assay validation in European Decision 2002/657/EC: detection capability, specificity/selectivity, decision limit, repeatability, ruggedness and stability. The detection capability estimated for norfloxacin, the reference fluoroquinolone, was below 0.5, 1 and 1.5 ng g⁻¹ for poultry meat, egg and fish, respectively. The screening assay proved specific and showed satisfactory sensitivity below the MRL levels even though flumequine and oxolinic acid had lower cross-reactivities. A wide range of non-MRL substances were also detected at concentrations below 10 ng g⁻¹. Repeatability was good with both intra- and inter-assay coefficients of variation 56%; ruggedness was also demonstrated.

Mammography Screening: Evidence, History and Current Practice in Germany and Other European Countries

SUMMARY: In this review, we describe the history, evidence, and current practice of mammography screening in Europe and the newly implemented screening program in Germany. We report results of the first screening rounds in North Rhine-Westphalia and compare these with reference values set by the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis. Finally, we summarize and compare performance indicators of the organized screening program in England, Italy, North Rhine-Westphalia and The Netherlands. Based on results of the first screening rounds, we conclude that the digital mammography screening program in North Rhine-Westphalia performs well and complies with the European guidelines. Besides relatively low attendance rates of approximately 53%, implementation of the German organized breast cancer screening program was successful.

Abstract P6-01-08: Keratin 5/14+ Progenitor Cell Concept of Breast Epithelium: Revisited

Background: The role of keratin (K) 5/14+ progenitor cells as precursor cells of the breast epithelium has been demonstrated both in culture and in situ. This cell model opens a new field in which distinct cell subtypes can be evaluated in terms of their functional state and describes how these cells may give rise to either benign or malignant tumors. Material and Methods: In this study, we used modern triple immunofluorescent labeling experiments to visualize directly different cell types and their functional status applying, as a reference, antibodies to basal (K5/14) and glandular (K8/18) keratins and a myoepithelial marker in combination with antibodies to ER-alpha, Ki67, BCL2 and c-kit in normal resting breast epithelium and in 30 cases of ductal neoplasia of low grade pathway and 8 cases of epithelial hyperplasia. Different cell types were quantitatively assayed. Immunolabeling results were supported with quantitative real time PCR.

Results: Basal and glandular keratins in the normal luminal breast epithelium were found to be expressed in highly specific sequential pattern from K5/14+progenitor cells to K8/18+ glandular cells. ER alpha, Ki67, c-kit and BCL2 were found differentially expressed in various subtypes of the breast epithelium, ER-alpha was expressed only in a subset of glandular cells thus subdividing the glandular lineage into ER-alphapositive and negative subcategories. The highest Ki67-proliferation was found in phenotypically glandular cells which are ER-alpha negative. BCL2 was characteristically co-expressed in glandular cells, whereas c-kit was detected mainly in earlier glandular cells. Benign epithelial hyperplasia showed a striking similarity to normal luminal breast epithelium. In terms of functional differentiation these cells disclosed the same ER-alpha, BCL2 and c-kit expression as that observed in normal epithelium. In contrast to UDH, all types of low-grade in-situ neoplasia of ductal type are characterized by expression of only glandular keratins 8/18. The tumour cells co-expressed ER-alpha, BCL2 and Ki67. On the other hand, c-Kit was not expressed in these lesions.

Discussion: From our data, it is evident that basal (K5/14) and glandular keratins (K8/18) are expressed in highly specific hierarchical patterns related to stage of glandular differentiation. This phenotypic hierarchy of cells is furthermore bound to a differential expression of ER, Ki67, c-kit and BCL2 in a very specific manner. Usual ductal hyperplasia disclosed a striking similarity to the resting glandular epithelium. In contrast, all types of low grade intraepithelial neoplasia not only retain the keratin patterns of their (normal) glandular counterpart but show the same functional differentiation with a positive expression of ER and BcL2 and lack of c-kit. This similarity indicates that these lesions may derive from more differentiated glandular cells of the lobular breast epithelium. The data presented here confirm that the K5/14+ progenitor cell concept provides important insight into the functional nature of normal breast epithelium and in proliferative diseases.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-01-08.

Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial

PURPOSE

We investigated the respective contribution (in terms of cancer yield and stage at diagnosis) of clinical breast examination (CBE), mammography, ultrasound, and quality-assured breast magnetic resonance imaging (MRI), used alone or in different combination, for screening women at elevated risk for breast cancer.

METHODS

Prospective multicenter observational cohort study. Six hundred eighty-seven asymptomatic women at elevated familial risk (> or = 20% lifetime) underwent 1,679 annual screening rounds consisting of CBE, mammography, ultrasound, and MRI, read independently and in different combinations. In a subgroup of 371 women, additional half-yearly ultrasound and CBE was performed more than 869 screening rounds. Mean and median follow-up was 29.18 and 29.09 months.

RESULTS

Twenty-seven women were diagnosed with breast cancer: 11 ductal carcinoma in situ (41%) and 16 invasive cancers (59%). Three (11%) of 27 were node positive. All cancers were detected during annual screening; no interval cancer occurred; no cancer was identified during half-yearly ultrasound. The cancer yield of ultrasound (6.0 of 1,000) and mammography (5.4 of 1,000) was equivalent; it increased nonsignificantly (7.7 of 1,000) if both methods were combined. Cancer yield achieved by MRI alone (14.9 of 1,000) was significantly higher; it was not significantly improved by adding mammography (MRI plus mammography: 16.0 of 1,000) and did not change by adding ultrasound (MRI plus ultrasound: 14.9 of 1,000). Positive predictive value was 39% for mammography, 36% for ultrasound, and 48% for MRI.

CONCLUSION

In women at elevated familial risk, quality-assured MRI screening shifts the distribution of screen-detected breast cancers toward the preinvasive stage. In women undergoing quality-assured MRI annually, neither mammography, nor annual or half-yearly ultrasound or CBE will add to the cancer yield achieved by MRI alone.

First epidemiological analysis of breast cancer incidence and tumor characteristics after implementation of population-based digital mammography screening

PURPOSE

To epidemiologically evaluate the impact of digital mammography screening on incidence rates and tumor characteristics for breast cancer.

MATERIALS AND METHODS

The first German digital screening units in the clinical routine were evaluated during the implementation period by using data from the cancer registry to compare the incidence rate of breast cancers and prognostic characteristics. 74 % of women aged 50 - 69 within the region of Muenster/Coesfeld/Warendorf were invited between 10 / 2005 and 12 / 2007 for initial screening; 55 % participated (n = 35 961).

RESULTS

In 2002 - 2004 the average breast cancer incidence rate (per 100,000) was 297.9. During the implementation of screening, the rate rose to 532.9 in 2007. Of the 349 cancers detected with screening, 76 % (265 / 349) were invasive compared to 90 % (546 / 608) of cases not detected with screening during the same period. 37 % (97 / 265) of cancers detected in the screening program had a diameter of <or= 10 mm and 75 % (198 / 265) were node-negative compared to 15 % (79 / 546) and 64 % (322 / 503), respectively, in cancers detected outside the screening program. The distribution of invasive tumor size (pT categories) and the nodal status differed with statistical significance between cancers detected in and outside the program (p = 0.005 and p = 0.004, respectively).

CONCLUSION

Epidemiological data shows that the implementation of a population-based screening program led to a relevant increase in the age-specific breast cancer incidence rate. The characteristics of breast cancers detected in the screening program comply with the requirements of the European guidelines and are significantly favorable compared to tumors diagnosed outside the program. These findings indicate that digital mammography screening fulfills the requirements for an early tumor detection tool.

[Diagnostics of microcalcifications from minimally invasive biopsies in mammography screening: results from the prevalence phase]

BACKGROUND

In mammography screening programmes carried out according to European guidelines, minimally invasive biopsies (MIB) are performed on up to 3% of participants. The aim of this study was to analyse the spectrum of histopathological findings including B categories in MIBs with microcalcifications compared to MIBs without microcalcifications.

MATERIAL AND METHODS

Prospectively collected histological findings of MIBs taken during the period July 2006 to June 2007 were analysed using the Breast Screening Pathology Database of the Reference Centre in Münster.

RESULTS

Of the 4,326 MIBs investigated, 2,161 were benign (B1-B3) whereas 2,165 were malignant (B4-B5) resulting in an overall malignancy rate of 50.04%. Of the MIBs 1,809 contained microcalcifications and 2,517 did not. Cases with microcalcifications showed a different distribution of B categories: B2 was found in 44.5% versus 24.2%, B3 in 18.2% versus 5.5% and the malignancy rate of cases with microcalcifications was 36.8% versus 59.5%. Of all cases of ductal carcinoma in situ (DCIS) detected in the screening programme, 83.35% were diagnosed in MIBs containing microcalcifications.

CONCLUSIONS

MIBs containing microcalcifications showed a different spectrum of diagnoses, especially higher rates of B3 lesions. Even though MIBs without microcalcifications showed a higher overall malignancy rate, most cases of DCIS were diagnosed in MIB containing microcalcifications.

[Immunohistochemistry in breast pathology: differential diagnosis of epithelial breast lesions]

Proliferative epithelial breast lesions include a wide variety of benign hyperplastic and noninvasive neoplastic lesions, as well as invasive carcinomas. Mammographically these lesions may show microcalcifications, architectural distortions or mass lesions. The task of the pathologist begins with a preoperative diagnosis by means of minimally invasive biopsy. His diagnosis forms the basis for not only the radiological-pathological correlation diagnosis, but also for the management of benign proliferative breast disease lesions, as well as therapeutic decisions in the case of malignant lesions.In daily practice, immunohistochemistry is the method of choice for clarifying difficult cases. The aim of this chapter is to describe the relevant markers in breast pathology and to provide an algorithmic approach to different proliferative breast disease lesions.

Development of an optical surface plasmon resonance biosensor assay for (fluoro)quinolones in egg, fish, and poultry meat

The aim of this study was to develop an optical biosensor inhibition immunoassay, based on the surface plasmon resonance (SPR) principle, for use as a screening test for 13 (fluoro)quinolones, including flumequine, used as veterinary drugs in food-producing animals. For this, we immobilised various quinolone derivatives on the sensor chip and tested binding of a range of different antibodies (polyclonal and one engineered antibody) in the presence and absence of free (fluoro)quinolones. The main challenge was to detect flumequine in an assay giving good results for the other compounds. One antigen-antibody combination proved satisfactory: polyclonal antibodies raised against a dual immunogen and, on the sensor chip, a fluoroquinolone derivative. It was the first time that this concept of the bi-active antibody was described in the literature. The assay, optimised for detection in three matrices (poultry muscle, fish, and egg), was tested on incurred samples prepared by liquid extraction followed by two washing steps. This rapid, simple method proved adequate for detecting at least 13 (fluoro)quinolones at concentrations below established maximum residue levels (MRLs). The reference molecule norfloxacin could be detected in the range of 0.1-10 microg kg(-1) in extracts of egg and poultry meat and in the range of 0.1-100 microg kg(-1) in extracts of fish. The determined midpoints of these calibration curves were about 1, 1.5 and 3 microg kg(-1) in poultry meat, egg and fish, respectively.

Digital mammography screening: average glandular dose and first performance parameters

PURPOSE

The Radiation Protection Commission demanded structured implementation of digital mammography screening in Germany. The main requirements were the installation of digital reference centers and separate evaluation of the fully digitized screening units. Digital mammography screening must meet the quality standards of the European guidelines and must be compared to analog screening results. We analyzed early surrogate indicators of effective screening and dosage levels for the first German digital screening unit in a routine setting after the first half of the initial screening round.

MATERIALS AND METHODS

We used three digital mammography screening units (one full-field digital scanner [DR] and two computed radiography systems [CR]). Each system has been proven to fulfill the requirements of the National and European guidelines. The radiation exposure levels, the medical workflow and the histological results were documented in a central electronic screening record.

RESULTS

In the first year 11,413 women were screened (participation rate 57.5 %). The parenchymal dosages for the three mammographic X-ray systems, averaged for the different breast sizes, were 0.7 (DR), 1.3 (CR), 1.5 (CR) mGy. 7 % of the screened women needed to undergo further examinations. The total number of screen-detected cancers was 129 (detection rate 1.1 %). 21 % of the carcinomas were classified as ductal carcinomas in situ, 40 % of the invasive carcinomas had a histological size <or= 10 mm and 61 % < 15 mm. The frequency distribution of pT-categories of screen-detected cancer was as follows: pTis 20.9 %, pT1 61.2 %, pT2 14.7 %, pT3 2.3 %, pT4 0.8 %. 73 % of the invasive carcinomas were node-negative.

CONCLUSION

The average glandular dose for all three digital screening units was below the AGD of the analog mammography screening units (1.7 mGy) used in the German trial projects. Nevertheless, the performance indicators of the European guidelines were fulfilled with respect to the prevalent tumor detection rate and tumor size distribution while meeting an acceptable recall rate. This first evaluation of a digital screening unit in Germany demonstrates that the quality standards are met at lower radiation dosage levels than in screen-film mammography.

Maintenance immunotherapy by repetitive low-dose donor lymphocytes infusions in a child with relapse state aml after allogeneic stem cell transplantation

The treatment of a child with a relapsed state acute leukemia after allogeneic stem cell transplantation (allo-SCT) is a challenge. The authors report about a child with an acute myelogenous leukemia (AML), which relapsed after allo-SCT despite immunological intervention. It was further treated with a second line chemotherapy followed by an infusion of stem cells and donor lymphocytes. Because of an immense risk for a further relapse, an immunological maintenance therapy was also performed, consisting of repetitive infusions of low doses of donor lymphocytes combined with low-dose chemotherapy. Presently, the child is in continuous complete remission and has a good quality of life.

Androgen-binding protein is co-expressed with oxytocin in the male reproductive tract

Androgen-binding protein (ABP) and the posterior lobe hormone oxytocin (OT) were co-localized in male rat reproductive organs. Immunostaining of serial semi-thin sections revealed a high rate of coexistence of both antigens in Sertoli cells and in the epithelial cells of the prostate. There was a considerably less co-localization of OT and ABP in epithelial cells of the epididymis, and in the different tissues of the ductus deferens. In situ hybridization with synthetic oligonucleotides complementary to a fragment of ABP mRNA showed specific staining in the same sites that were immunostained for ABP. ABP was isolated by affinity chromatography from homogenates of testis, epididymis, prostate and the content of the prostate lumen. Identical protein patterns could be shown with surface-enhanced laser desorption/ionization time-of-flight mass spectrometry in all samples except for the epididymis indicating that ABP structure is similar in all these tissues. ABP seems to be expressed in specified cells throughout the male rat reproductive tract. Most of these cells appear to be oxytocinergic. ABP and OT have previously been detected in the ejaculate. The observed epithelial cells are likely to be their source.

[The "EVA" Trial: Evaluation of the Efficacy of Diagnostic Methods (Mammography, Ultrasound, MRI) in the secondary and tertiary prevention of familial breast cancer. Preliminary results after the first half of the study period]

PURPOSE

To investigate the respective diagnostic accuracies of the different breast imaging modalities, i. e., mammography (Mx), high-frequency breast ultrasound (US), and dynamic contrast-enhanced breast (MRI) regarding the early diagnosis of familial (hereditary) breast cancer.

MATERIALS AND METHODS

A prospective, non-randomized controlled clinical multi-center trial is performed at 4 academic tertiary care centers in Germany (Ulm, Munchen/Grosshadern, Munster and Bonn) for a total period of 4 years, sponsored by the German Cancer Aid. The protocol consists of semiannual clinical visits and breast ultrasound, and annual bilateral two-view Mx, US and MRI. Imaging studies were first analyzed independently, then Mx was read in conjunction with US, followed by Mx combined with MRI, and finally, all three imaging modalities were read in synopsis. We present the concept and first results of this trial.

RESULTS

So far, 748 screening rounds are available for analysis in 613 women. A total of 12 breast cancers have been identified, with 11/12 cases in the pTis or pT1/N0 stage. The mean size of detected invasive cancers was 7 mm. A total of 19 benign lesions were biopsied due to false-positive imaging diagnoses. The breast cancer detection rates were: Mx: 5/12 (42 %), US 3/12 (25 %), MRI 10/12 (83 %), and the positive predictive values: Mx 5/17 (29 %), US 3/15 (30 %), and MRI 10/23 (43 %).

CONCLUSION

The preliminary data suggest that early diagnosis of familial breast cancer is feasible by intensified surveillance, in particular with the addition of MRI.

Lethal subarachnoid bleeding under immunosuppressive therapy due to mycotic arteritis

A subarachnoid haemorrhage (SAH) occurred 67 days after cardiac transplantation in a 10-year-old girl with consecutive immunocompromising therapy. Neither digital subtraction angiography (DSA) nor computed tomographic angiography showed signs of intracranial vascular malformations. One month before the lethal SAH occurred, she had developed arterial hypertension and attacks of severe headache with cerebrospinal fluid (CSF) pleocytosis while CT scans showed an infarct of the left thalamus. Pathologic findings established the rare diagnosis of SAH due to aspergillosis-related mycotic arteritis. Imaging characteristics are presented.

Lethal subarachnoid bleeding under immunosuppressive therapy due to mycotic arteritis

A subarachnoid haemorrhage (SAH) occurred 67 days after cardiac transplantation in a 10-year-old girl with consecutive immunocompromising therapy. Neither digital subtraction angiography (DSA) nor computed tomographic angiography showed signs of intracranial vascular malformations. One month before the lethal SAH occurred, she had developed arterial hypertension and attacks of severe headache with cerebrospinal fluid (CSF) pleocytosis while CT scans showed an infarct of the left thalamus. Pathologic findings established the rare diagnosis of SAH due to aspergillosis-related mycotic arteritis. Imaging characteristics are presented.

Thoracic aortic stent graft: comparison of contrast-enhanced MR angiography and CT angiography in the follow-up: initial results

The objective of this study was to compare contrast-enhanced magnetic resonance angiography (CE MRA) and multislice computed tomographic angiography (MS CTA) in the follow-up of thoracic stent-graft placement. The CE MRA and MS CTA were performed following nitinol stent-graft treatment due to thoracic aneurysm ( n=4), intramural bleeding ( n=2) and type-B aortic dissection ( n=5). Corresponding evaluation of arterial-phase imaging characteristics focused on the stent-graft morphology and leakage assessment. Stent-graft and aneurysm extensions were comparable between both techniques. Complete exclusion (aneurysm, n=4; dissection, n=2) was assessed with high confidence with CE MRA and MS CTA. Incomplete exclusion (intramural bleeding, n=2; dissection, n=3) was assigned to lower confidence scores on CE MRA compared with MS CTA. On CE MRA the stent-graft lumen demonstrated an inhomogeneous signal, the stent struts could not be assessed. The CE MRA can be used as alternative non-invasive imaging for follow-up of nitinol stent grafts. Arterial-phase leak assessment can be less evident in CE MRA compared with MS CTA studies; therefore, the use of late-phase imaging seems to be necessary. The diagnostic gap of stent-graft fracture evaluation using MRA may be filled with plain radiographs.

Revealing in-stent stenoses of the iliac arteries: comparison of multidetector CT with MR angiography and digital radiographic angiography in a Phantom model

OBJECTIVE

Our objective was to evaluate the detectability of in-stent stenoses in iliac artery stents using multidetector CT angiography in comparison with MR angiography and digital radiographic angiography.

MATERIALS AND METHODS

Ten different metallic stents (made of steel, nitinol, tantalum, or cobalt) were implanted in plastic tubes (8 mm). The stent lumina were partially obstructed by wax (CT density, -30 H) resulting in 50-60% in-stent stenoses. The tubes were filled with diluted contrast material (25 mmol/L of gadopentetate dimeglumine or 6 mg I/mL of iodinated contrast material) and placed in a plastic container filled with oil or water, respectively. CT angiography was performed on a four-detector CT scanner (detector collimation, 4 x 1 mm; slice thickness, 1.25 mm; table feed, 4 mm per rotation). MR angiography was performed on a 1.5-T system with a three-dimensional gradient-echo sequence (TR/TE, 4.6/1.8; flip angle, 30 degrees; slice thickness, 1.88 mm). Axial and longitudinal reformations of CT and MR imaging data were evaluated regarding the in-stent attenuation and signal intensity, the visible lumen diameter inside the stent, and the delineation of the stenoses. For comparison, digital radiographic angiography was performed as the gold standard.

RESULTS

The degree and character of stent-related artifacts differed in CT angiography and MR angiography. In CT angiography, only the tantalum stent caused artifacts that obscured the stenosis; in all other cases, the stenoses were visible. In MR angiography, depiction of stenoses was impaired in two steel stents but possible in the tantalum and most nitinol stents.

CONCLUSION

CT angiography is suited for detection of relevant stenoses in steel, cobalt-based, and nitinol stents. MR angiography is superior only in tantalum products.

Bioassay-directed chemical analysis of River Elbe surface water including large volume extractions and high performance fractionation

A bioassay-directed fractionation and identification (toxicity identification evaluation procedure) was performed on extracts of 10 1 River Elbe water samples. The experimental method included a SDB-1 solid phase extraction followed by RP-HPLC fractionation and subfractionation. Chemical analysis by GC-MS as well as acute toxicity testing using a luminescent bacteria assay were conducted in the respective fractions. Many substances were identified, among which were pesticides and pharmaceuticals, but many compounds remained unknown.

New method for rapid solid-phase extraction of large-volume water samples and its application to non-target screening of North Sea water for organic contaminants by gas chromatography-mass spectrometry

A method has been developed that allows the solid-phase extraction of microorganic compounds from large volumes of water (10 l) for non-target analysis of filtered seawater. The filtration-extraction system is operated with glass fibre filter candles and the polymeric styrene-divinylbenzene sorbent SDB-1 at flow-rates as high as 500 ml/min. Recovery studies carried out for a couple of model substances covering a wide range of polarity and chemical classes revealed a good performance of the method. Especially for polar compounds (log Kow 3.3-0.7) quantitative recovery was achieved. Limits of detection were between 0.1 and 0.7 ng/l in the full scan mode of the MS. The suitability of the method for the analysis of marine water samples is demonstrated by the non-target screening of water from the German Bight for the presence of organic contaminants. In the course of this screening a large variety of substances was identified including pesticides, industrial chemicals and pharmaceuticals. For some of the identified compounds their occurrence in marine ecosystems has not been reported before, such as dichloropyridines, carbamazepine, propyphenazone and caffeine.

Intensive chemotherapeutic regimens against acute leukemia transiently suppress asthma symptoms but do not lead to long-term relief

In some very rare cases children suffer from a combination of asthma and a malignant disease. This study investigated whether intensive chemotherapy might have a positive effect on asthma in these special cases and whether asthma generally relapses after completion of chemotherapy. The authors monitored clinical outcome and lung function of 43 children with acute lymphoblastic leukemia and non-Hodgkin lymphoma who received chemotherapy at the University Children's Hospital of Greifswald between 1993 and 1998. Cytostatic chemotherapy was administered according to the German treatment protocols. Two of the 43 patients had asthma before leukemia was diagnosed. During the course of chemotherapy, asthma symptoms diminished promptly after beginning of chemotherapy but asthma was rediagnosed after completion of chemotherapy in both cases. The third patient developed asthmatic symptoms shortly after completion of chemotherapy for the first time. It can be stated that chemotherapy does not essentially cure asthma. Therefore, it seems mandatory to perform follow-up lung testings after chemotherapy, especially in patients with asthma.

Ectopic cervical thymus in a 12-year-old boy: a case report

The case of a 12-year-old boy with ectopic cervical thymus is reported. This is a rare differential diagnosis in cervical tumors in childhood. The clinical symptoms might present as complications; in rare cases malignant transformations have been reported. The diagnosis ectopic cervical thymus can be achieved only histologically. Due to possible malignant transformation, it is mandatory to excise this thymus tumor totally.

Geographic information systems. A new tool in environmental epidemiology

PURPOSE: Geographic Information Systems (GIS) are useful tools for identifying populations with potential exposure to environmental contaminants. Using a GIS, features of the local environment around an individual's home, work, or school can be described. We present two examples illustrating methods and issues in identifying populations potentially exposed to agricultural pesticides and to toxic releases from the Toxic Release Inventory (TRI).METHODS: We used USDA Farm Service Agency records as ground reference data to classify a late summer 1984 satellite image into crop species in 3 counties in Nebraska. We located residences from a case-control study of non-Hodgkin's lymphoma (NHL) on the crop maps and calculated the distance to crop fields. Residences from a 4-center study of NHL were mapped and the distance to TRI sites was determined.RESULTS: Twenty-two percent of residences had crop fields within 500 meters of the home, an intermediate distance for the range of drift effects from pesticide applications. After accounting for the extent of primary drift from ground applications of pesticides, we estimated that 30 percent of residences were potentially exposed to crop pesticides. In the 4-center study, residence locations determined by address-matching methods and by a global positioning system were compared; the population 1 mile from specific TRI sites is described.CONCLUSIONS: These examples demonstrate the utility of a GIS in environmental epidemiology studies. A GIS can be a useful addition to questionnaire and other methods of exposure assessment in health studies.

Antibiotic sequential therapy for febrile neutropenia in pediatric patients with malignancy

Children suffering malignant diseases can experience phases of bone marrow depression during intensive chemotherapy. The influence of antibiotic sequence therapy on the course of diseases was examined in 41 pediatric patients with malignant diseases. Inclusion criteria were neutropenia (ANC < 500/microL), rectal body temperature over 38.5 degrees C, and increased C-reactive protein (CRP, cutoff > 5.0 mg/L). The first stage of therapy comprised the following antibiotics: piperacillin, teicoplanin, and gentamicin. In stage 2 imipenem, teicoplanin, and tobramycin were administered. Fluconazole was the antifungal drug of choice in stages 1 and 2. In the first level of antibiotic therapy 68% of the patients showed a positive reaction. The C-reactive protein was a sensitive parameter, which significantly decreased with 3 days of therapy. A total of 72% of the bacteriological smears were sterile. All patients survived the septic phase.

The nuclear export signal within the E4orf6 protein of adenovirus type 5 supports virus replication and cytoplasmic accumulation of viral mRNA

During the late phase of adenovirus infection, viral mRNA is efficiently transported from the nucleus to the cytoplasm while most cellular mRNA species are retained in the nucleus. Two viral proteins, E1B-55 kDa and E4orf6, are both necessary for these effects. The E4orf6 protein of adenovirus type 5 binds and relocalizes E1B-55 kDa, and the complex of the two proteins was previously shown to shuttle continuously between the nucleus and cytoplasm. Nucleocytoplasmic transport of the complex is achieved by a nuclear export signal (NES) within E4orf6. Mutation of this signal sequence severely reduces the ability of the E1B-55 kDa-E4orf6 complex to leave the nucleus. Here, we examined the role of functional domains within E4orf6 during virus infection. E4orf6 or mutants derived from it were transiently expressed, followed by infection with recombinant adenovirus lacking the E4 region and determination of virus yield. An arginine-rich putative alpha helix near the carboxy terminus of E4orf6 contributes to E1B-55 kDa binding and relocalization as well as to the synthesis of viral DNA, mRNA, and proteins. Further mutational analysis revealed that mutation of the NES within E4orf6 considerably reduces its ability to support virus production. The same effect was observed when nuclear export was blocked with a competitor. Further, a functional NES within E4orf6 contributed to the efficiency of late virus protein synthesis and viral DNA replication, as well as total and cytoplasmic accumulation of viral late mRNA. Our data support the view that NES-mediated nucleocytoplasmic shuttling strongly enhances most, if not all, intracellular activities of E4orf6 during the late phase of adenovirus infection.

Inactivation of p53 but not p73 by adenovirus type 5 E1B 55-kilodalton and E4 34-kilodalton oncoproteins

The adenovirus E1B 55-kDa and E4 34-kDa oncoproteins bind and inactivate the p53 tumor suppressor gene product, resulting in cell transformation. A recently discovered cellular protein, p73, shows extensive similarities to p53 in structure and function. Here we show that the simultaneous transient expression of E1B 55-kDa and E4 34-kDa proteins is sufficient to drastically shorten the intracellular half-life of p53, leading to strongly reduced steady-state p53 levels. Concomitantly, the E1B 55-kDa and E4 34-kDa proteins act synergistically to inactivate the transcriptional activity of p53. Mutational analysis suggests that physical interactions between the E1B 55-kDa protein and p53 and between the E1B 55-kDa and E4 34-kDa proteins are both required for p53 degradation. In contrast, the ability of p53 to interact with the cellular mdm2 oncoprotein or with its cognate DNA element appears to be dispensable for its destabilization by adenovirus gene products. The adenovirus E1B 55-kDa protein did not detectably interact with p73 and failed to inhibit p73-mediated transcription; also, the E1B 55-kDa and E4 34-kDa proteins did not promote p73 degradation. When five amino acids near the amino termini were exchanged at corresponding positions between p53 and p73, this rendered p53 resistant and p73 susceptible to complex formation and inactivation by the E1B 55-kDa protein. Our results suggest that while p53 inactivation is a central step in virus-induced tumor development, efficient transformation can occur without targeting p73.

Schizophrenia-specific basic symptoms. A successful replication

Several investigations showed that the Frankfurt Complaint Questionnaire (FCQ) has no diagnostic specificity. However, in a preceding study two new FCQ subscales were developed: FCQ-S, sensitive to schizophrenia, and FCQ-A, sensitive to alcoholism. The aim of the present study was to replicate the diagnostic sensitivity of those subscales. Four groups were considered: schizophrenics with marked negative symptoms (n = 25); schizophrenics with no or mild negative symptoms (n = 25); alcoholics (n = 25); patients with obsessive-compulsive disorder (n = 15). FCQ original subscales and total score did not differ between groups. As expected, in FCQ-S both schizophrenic groups had significantly higher scores than the other groups; FCQ-A failed to show group differences but was significantly related to alcoholism markers.

Hypoglycemia following insulin and proinsulin. A comparison

The counterregulatory hormonal response to proinsulin-induced hypoglycemia was investigated in eight volunteers. Proinsulin cleared slower from the circulation than insulin. Hypoglycemia occurred slower (2P less than 0.005) and was prolonged, while the overall hypoglycemic activities were comparable. The antilipolytic effect of proinsulin was also prolonged (2P less than 0.001). The response of epinephrine to hypoglycemia was less pronounced after proinsulin (2P less than 0.05). The amount of epinephrine was correlated to the rate of fall in plasma glucose (P less than 0.005). The production of lactate induced by beta-stimulation was also correlated to the fall of glucose (P less than 0.005). The responses of prolactin (2P less than 0.02), norepinephrine (2P less than 0.02), cortisol, and growth hormone were attenuated following proinsulin. The decreases of serum potassium and serum phosphate (2P less than 0.05) were less pronounced. Symptoms like sweating (2P less than 0.01) and dizziness (2P less than 0.01) were milder after proinsulin. It is concluded that the rate of fall in glucose concentration determines the differing counterregulatory responses. We don't relate the differing counterregulatory responses to special insulin-like properties of proinsulin, but to the slower kinetics which is emphasized by the intravenous bolus injection.

Postnatal methyl mercury exposure: effects on ontogeny of renal and hepatic ornithine decarboxylase responses to trophic stimuli

The effects of postnatal methyl mercury exposure on the ontogeny of renal and hepatic responsiveness to trophic stimuli were examined. Increased ornithine decarboxylase (ODC) activity was used as an index of tissue stimulation. In the rat, renal ODC responsiveness to growth hormone, angiotensin, vasopressin, isoproterenol, and serotonin was absent at birth and matured 3 to 4 weeks later. However, pups exposed to methyl mercury showed marked, ODC responses to these same agents as early as 10 to 19 days of postnatal age, accompanied by a significant renal hypertrophy. In contrast to the kidney, the liver of normally developing rats was responsive to trophic factors even in the neonate. In this tissue, there was no consistent effect of neonatal methyl mercury treatment on ODC responses at any developmental stage tested; although absolute liver weights were reduced, liver/body weight ratio was not affected. These results demonstrate that postnatal methyl mercury exposure causes a precocious onset of ODC responses to trophic agents specifically in the kidney. Altered responsiveness may mediate some of the effects of this organomercurial on overall renal development and function.

Organ specificity of neonatal methyl mercury hydroxide poisoning in the rat: effects of ornithine decarboxylase activity in developing tissues

To determine the organ specificity of neonatal mercury hydroxide (CH3HgOH) exposure on biochemical development of its potential target tissues, effects on rat brain, liver, heart and kidney were compared utilizing the ontogenetic pattern of ornithine decarboxylase (ODC) activity, an early index of perturbation of cellular maturation. CH3HgOH was given daily beginning at birth for up to 21 days, using three dose levels (1, 2.5 or 5 mg/kg s.c.). In the brain, CH3HgOH treatment resulted in an initial reduction in ODC followed by a subsequent elevation of activity, a maturational pattern known to be associated with delayed cellular development. In contrast to the effects of CH3HgOH on brain, the pattern obtained in the liver, an initial elevation followed by a subsequent decline, is usually associated with compression of the time couse of cellular development. In the heart and kidney, CH3HgOH produced sustained elevations of ODC representing prolongation of the developmental period of rapid tissue growth and development; these patterns were associated with tissue hypertrophy which was sustained through the preweaning stage for both tissues and well into the postweaning period for the kidney. The results obtained with ODC clearly demonstrate that neonatal CH3HgOH poisoning causes organ-specific biochemical lesions which can play a role in subsequent effects on overall tissue development.