Molecular genetic analysis of easily accessible breast tumour DNA, purified from tissue left over from hormone receptor measurement

In order to establish a large panel of normal and tumour DNA from primary breast cancer patients, we looked for a source of easily accessible, good quality breast tumour DNA. Following routine hormone receptor analysis at the hospital the leftover pellets contained the nuclei from the tumour tissue. We collected 670 pellets over a period of 2 1/4 years and isolated a large amount of DNA (on average 400 microg per pellet). To control the quality of this tumour DNA, we analysed 41 pellets and matching normal DNA for loss of heterozygosity (LOH), with 11 microsatellite markers along chromosome 17. This chromosome is well described for breast cancer. LOH is a sensitive method, requiring good quality and pure tumour DNA. Contamination with normal DNA will blur the results. We found a high rate of LOH, ranging from 33 to 74%, which is in agreement with other reports, and therefore recommend this rich source of breast tumour DNA for molecular biological analysis.

Effect of aclacinomycin A on in vitro cultures of porcine lens epithelial cells

As a potential drug for the prevention of secondary cataract formation (SCF), we investigated the effect of Aclacinomycin A (ACM) on the growth of cultures of porcine lens epithelial cells in vitro. ACM is an anthracycline that has been used in the treatment of acute myeloid leukemia in the human for many years. It has been shown to be non-mutagenic and non-carcinogenic in in vitro and in animal models. Subconfluent cell cultures were exposed to different concentrations of ACM for 5 minutes. The drug effect was evaluated by cell counts after various lengths of culture time (between 1 and 10 weeks). No cells survived the treatment with 12 or 16 microg ml-1. Cultures treated with concentrations between 0.5 and 8 microg ml-1 showed a marked decrease in cell number when compared to controls. However, reproliferation occurred at concentration up to 8 microg ml-1 after 2-6 weeks. Intraocular application of ACM might be suitable in the prevention of SCF. However, with regard to reproliferation, long-term cultures (or long-term animal models, respectively) have to be used in further evaluating the appropriate dosage for this purpose.

[Retinal hemorrhage in the infant as an indication of shaken baby trauma]

BACKGROUND

The shaken baby syndrome is a form of child abuse in young children. Typical are intracranial and intraocular bleedings. As external injuries are often missing, the shaken baby syndrome may easily be overlooked. Intraocular bleeding is a major diagnostic sign and can prove the diagnosis, if child abuse is suspected by the paediatrician. Thus critical family situations can be uncovered and long term help can be initiated.

PATIENTS

Between 1991 and 1997 seven babies (age two to nine months) with intraocular bleedings were examined. Diagnosis, differential diagnosis and prognosis of the shaken baby syndrome are presented with these children.

RESULTS

In two of the seven children a non-accidental trauma and shaken baby syndrome was obvious. In three cases the diagnosis of a shaken baby syndrome was most probable. In one child intraocular bleeding was possibly caused by a fall three months earlier. One child had retinal bleedings after resuscitation. In two cases a vitrectomy was performed. The follow up was two months to six years. In two children intraocular bleeding resolved completely, three children developed mild to severe amblyopia and two children became blind. Vitrectomy could not prevent loss of sight.

CONCLUSIONS

Sudden cerebral symptoms or intraocular bleedings in otherwise healthy young children are suspicious for child abuse. A shaken baby syndrome has to be considered. Thus funduscopic examination in mydriasis is obligatory. The prognosis depends on the severeness of ocular hemorrhages and cerebral lesions.

Refined localization of the pyruvate dehydrogenase E1 alpha gene (PDHA1) by linkage analysis

Pyruvate dehydrogenase (PDH) E1 alpha is a key component in the PDH complex which catalyzes the oxidative decarboxylation of pyruvate to acetyl-CoA. Defects in the gene coding for PDH E1 alpha (PDHA1) are associated with a variety of clinical symptoms, often of a severe character. In the present study, the segregation of three polymorphic CA repeats located in PDHA1 was followed in the 40 CEPH reference pedigrees. Using these data, multipoint linkage analysis was carried out, refining the genetic location of PDHA1. The 16-point map presented locates PDHA1 in an approximately 3-cM interval between DXS999 and DXS365 with odds of more than 1000:1. From known physical localizations of the flanking marker loci, PDHA1 could be regionally assigned to Xp22.1-p22.2. The information provided should be of value in clinical settings.

Clinical utility of cytomegalovirus urine cultures for ophthalmic care in patients with HIV

BACKGROUND

The utility of cytomegalovirus (CMV) urine cultures was checked in patients with HIV (a) to identify those at risk for CMV retinitis and (b) to guide clinical decisions on treatment and prophylaxis of CMV retinitis.

METHODS

HIV infected patients were tested for CMVuria by shell vial cell cultures. The prevalence of CMVuria was related to CD4 count, HIV risk group, and time before and after diagnosis of CMV retinitis.

RESULTS

A total of 639 shell vial cell cultures were obtained from 266 HIV infected ophthalmic patients. Only 4% of all patients with a CD4 count > 400 x 10(6)/l shed CMV in their urine compared with 42% with a CD4 count < or = 50 x 10(6)/l. Twenty three of 25 patients with CMV retinitis had a CD4 count < or = 50 x 10(6)/l. Among 130 patients with a CD4 count < or = 50 x 10(6)/l (a) those who were CMVuric had a nearly sevenfold risk (p < 0.0001) of developing CMV retinitis (35%) compared with those who did not shed CMV in their urine (5%), and (b) CMVuria and CMV retinitis were more frequent in homosexuals (58%/25%) than in intravenous drug users (23%/15%). More than 1 year before diagnosis of CMV retinitis 18% of patients were CMVuric compared with 83% of patients who were CMV culture positive in the last 3 months. CMVuria under virustatic maintenance therapy is associated with worsening of retinitis in two thirds of cases.

CONCLUSION

Ophthalmic screening of patients with HIV should include those with a CD4 count < or = 50 x 10(6)/l and focus on the subgroup with additional CMVuria. Screening of other patients can be dropped without undue risk in order to spare AIDS patients unnecessary hospital visits. CMVuria as a single finding, however, does not justify antiviral prophylaxis of CMV retinitis.

Immunological aspects of recombinant factor VIIa (rFVIIa) in clinical use

Patients, receiving rFVIIa for treatment of bleeding disorders, have been followed for specific antibody formation. No antibodies against FVII were demonstrated in 170 patients, with hemophilia, or with acquired inhibitors to clotting factors. Of 6 FVII-deficient patients, one overdosed patient developed antibodies to human FVII. There was no indication of de novo formation of antibodies to potential contaminating foreign protein, which could be correlated to the rFVIIa treatment. Except for the FVII-deficient population, which may represent a risk group, rFVIIa appears to be immunologically safe for use in patient groups with bleeding disorders, including hemophilia A and B patients.

[Indications for eye examination of HIV patients--screening parameters for cytomegalovirus retinitis]

BACKGROUND

To reduce the burden of frequent visits at the physician we have checked (I) for which ocular manifestations in HIV-infection screening of asymptomatic patients is worthwhile and (II) which parameters may indicate patients at risk for CMV-retinitis.

PATIENTS AND METHODS

The clinical data of 215 HIV-infected patients were analyzed retrospectively. Only those ocular manifestations were considered suitable for screening that (a) endanger vision, (b) are treatable, (c) can be diagnosed sufficiently early and (d) are common. Furthermore (1) CDC-stage, (2) CD4+ count, (3) HIV-retinopathy, (4) CMV-uria and (5) CMV-antibodies were checked for their usefulness in indicating patients at risk for CMV-retinitis.

RESULTS

Ophthalmological screening of asymptomatic HIV-patients should focus on cytomegalovirus (CMV)-retinitis because early diagnosis of this common blinding disease improves the visual outcome. 85 of 215 HIV-infected patients had a CD4+ count less than 50 cells/microliters 25% of these patients developed CMV-retinitis (21/85). The risk for CMV-retinitis rose to 38% (13/34) when the low CD4+ count was accompanied by CMV-uria. The proportion of patients with CMV-retinitis did not increase when HIV-retinopathy had been diagnosed earlier (12/48 = 25%). CMV-serology and CDC-classification were not helpful in screening for CMV-retinitis.

CONCLUSIONS

We recommend the following ophthalmological screening scheme for HIV-patients without ocular symptoms: (1) patients with a CD4+ count < 100 cells/microliters should be checked every third month and (2) those with a CD4+ count < 50 cells/microliters and CMV-uria every sixth week.

Effect of gossypol on cultured TM3 Leydig and TM4 Sertoli cells: 31P and 23Na NMR study

The effects of gossypol on glucose metabolism, ATP levels and intracellular sodium levels in murine TM3 Leydig and TM4 Sertoli cell lines were investigated, and their response compared. Relative ATP levels and sodium ion levels in the two cell lines were determined by 31P and 23Na NMR spectroscopy. Short-term effect of gossypol on phosphate metabolism in immobilized and perfused cells was apparent in 31P NMR spectra only with relatively high concentrations of gossypol, corresponding to about 40 times IC50. However, incubation with low gossypol concentrations markedly affected the energetic status of the cells, especially of the TM3 cells. Although inhibition of proliferation by gossypol was stronger with the TM4 cells, the decrease of intracellular ATP level and increase of sodium ion concentration were more pronounced in the TM3 cells. The growth-inhibitory effect of (-)-gossypol was stronger than that of (+)-gossypol, with the eudesmic ratio of 2-2.5. The enantioselectivity of the effect of gossypol on the energy metabolism of TM3 and TM4 cells was low, in contrast to the in vivo antispermatogenic effect, which was reported to be solely associated with (-)-gossypol. Inhibition of energy production in somatic testicular tissue is thus unlikely to be major cause of the antispermatogenic effect of gossypol.

Pattern, flicker, and flash electroretinography in human immunodeficiency virus infection: a longitudinal study

To study electroretinographic (ERG) changes in the course of human immunodeficiency virus (HIV) disease, 42 eyes without retinitis were examined twice or more. During 9.6 months of mean observation time the visual acuity did not change. We found progressive functional impairment for the first, second, and third neurons of the visual pathway: the pattern-ERG amplitude (retinal ganglion-cell function) decreased by 11%, the b-wave amplitude (bipolars mediated by Müller cells) decreased by 13%, and the a-wave amplitude (dominated by rods) diminished by 21%. The flicker amplitude (dominated by cones) decreased by 20%. All of the latter four changes were significant (P < 0.02). Damage to the retina in HIV infection cannot solely be explained by visible changes in HIV retinopathy.

Sensitive and fast mutation detection by solid phase chemical cleavage

We have developed a solid phase chemical cleavage method (SpCCM) for screening large DNA fragments for mutations. All reactions can be carried out in microtiterwells from the first amplification of the patient (or test) DNA through the search for mutations. The reaction time is significantly reduced compared to the conventional chemical cleavage method (CCM), and even by using a uniformly labelled probe, the exact position and nature of the mutation can be revealed. The SpCCM is suitable for automatization using a workstation to carry out the reactions and a fluorescent detection-based DNA sequencing system to analyze the cleaved fragments.

[Reproducibility of measurements with the Heidelberg retina tomograph in fundus elevations]

PURPOSE

The Heidelberg Retina Tomograph (HRT) was intended to evaluate the optic nerve head. It is, however, also possible to measure retinal elevations. There are no systemic data on the reproducibility of HRT measurements of retinal elevations. We now provide such data.

METHODS

117 measurements in patients with diseases which are characterized by retinal elevations were analyzed with the HRT. We measured the "volume above surface" of the retinal elevations. Each patient was analyzed three times, and the coefficient of variation was calculated.

RESULTS

The coefficient of variation was between 0.55% and 40.5%. Some 42% of the coefficients of variation were between 0% and 10%, 31% between 5% and 10%, 21% between 10% and 20%, and 6% larger than 20%.

CONCLUSION

The reproducibility of the HRT measurements in retinal elevations is clinically sufficient. The relation between sufficient reproducibility and accuracy is discussed.

[Motility and binocular function after radial episcleral buckle]

BACKGROUND

The incidence of motility disturbances induced by episkleral buckle operations for retinal detachment has been reported to range between 7 and 77%. We anticipated a relation between the buckle size and the incidence and extent of motility disturbances.

PATIENTS AND METHODS

We examined 45 patients 2 to 4 years after successful retinal detachment surgery with a radial buckle. The buckle diameter was 3-11 mm. Patients were examined for diplopia and heterophoria in the primary position and in 20 degrees secondary and tertiary gaze deviations. Stereopsis was determined using the TNO plates. Refractive error and visual acuity were also measured.

RESULTS

Heterophoria measurements in the various directions of gaze revealed a hypermotility in 22/45 cases. A hypomotility was encountered only in one of the 45 cases. In 40 of the 45 cases the field of binocular single vision had a radius of at least 20 degrees. 39 of the 45 patients had stereopsis (after macular detachment 17/22, without macular detachment 22/23). 7/32 patients with a buckle of > or = 5 mm reported on diplopia, but none of the 13 patients with a buckle of < or = 4 mm. Heterotropia in the primary position was found in one of the 45 cases. He had three buckles, a 10.5 mm buckle under the superior rectus muscle of one eye and a 4 and 7.5 mm buckle under the inferior oblique and rectus muscles of the other eye. The resulting vertical deviation was successfully treated with prisms. Motility disturbances in the upper field of gaze were found in 2 of 45 cases with buckles of 5 and 7.5 mm. Diplopia was not permanent in these cases.

DISCUSSION

Hypermotility towards the position of the buckle may be explained by a deviation of the adjacent rectus muscles, after sharp preparation and shrinkage of the intermuscular septum.

CONCLUSION

Since motility disturbances were encountered only with buckles of > or = 5 mm, small buckles (< or = 4 mm) should be applied whenever possible.

[Computer controlled analysis of the optic papilla in patients with anterior ischemic optic neuropathy]

BACKGROUND

In patients with non-arteritic anterior ischaemic optic neuropathy disc parameters have been measured with a largely objective method (Optic Nerve Head Analyzer). We wanted to find out, whether the measurements of different disc parameters allow an assertion of predisposition to AION.

METHODS

Measurements have been done with the Optic Nerve Head Analyzer (ONHA). In 25 patients with AION disc area and neuroretinal rim area was measured in the nonaffected fellow eye. The results were compared to those of 19 healthy subjects. In 12 of the 25 patients the disc structure of the AION-eye was measured over time with an average of 4 measurements in 16 months.

RESULTS

1) Disc area and neuroretinal rim area of the AION-eyes do not differ significantly from those of the healthy subjects. 2) Disc area and neuroretinal rim area of the healthy fellow eyes of the AION patients were not significantly different from those of the healthy subjects. 3) Measurements of disc parameters over time did not show significant differences between the parameters of the beginning of AION and after 16 months.

CONCLUSIONS

Measurements of disc area and neuroretinal rim area with the Optic Nerve Head Analyzer do not allow assertions of predisposition to AION.

[Risk factors of pseudophakic detachment]

The increase of pseudophakic retinal detachments has raised the question about its risk factors. According to the literature, complicated cataract surgery rarely contributes to pseudophakic retinal detachment. Nevertheless, we noted a high proportion of defects in the capsular barrier among our patients. We therefore reevaluated our charts for perioperative and epidemiologic risk factors for pseudophakic retinal detachment.

PATIENTS

Seventy-six patients with pseudophakic retinal detachment after extracapsular cataract operation with intraocular lens implantation were referred to the Ophthalmology Department of Freiburg University between 1986 and 1991. Their case records were analyzed for possible risk factors for retinal detachment.

RESULTS

When retinal detachment developed, posterior lens capsule was not intact in 52/76 eyes (68%), the highest rate published so far. In 37 eyes capsular rupture occurred during cataract surgery, in 16 eyes followed by vitreous prolapse and in 9 eyes with persistent vitreous incarceration. Three eyes had vitreous prolapse via zonula. In 10 eyes YAG laser capsulotomy preceded detachment, and in 2 eyes capsular rupture occurred during an aspiration procedure for secondary cataract. The high proportion of intraoperative capsular ruptures is understandable if we assume a 2% risk of intraoperative capsular rupture, followed by a 20-fold increase in retinal detachment. The latency between cataract surgery and retinal detachment was 22 months after uncomplicated surgery, after YAG laser capsulotomy 13.5 and after intraoperative capsular rupture 10 months (medians).

CONCLUSION

Vitreal complications in cataract surgery facilitate the development of retinal detachment. The incidence of defect posterior capsules and vitreal complications among patients with pseudophakic retinal detachments can be explained by assuming a 10- to 20-fold increase in retinal detachments after these complications. In cases of capsular or zonular rupture, all means, including prophylactic vitrectomy of vitreal strands, should be used to avoid permanent vitreous traction. However, the rate of retinal detachments after YAG laser capsulotomies only minimally surpassed the rate after uncomplicated cataract surgery. The risk for retinal detachment is not determined so much by the capsular defect itself. It is determined rather by the circumstances in which it occurred and by the grade of vitreal disturbance.

[Isovolemic hemodilution in central retinal vein occlusion in patients less than 50 years of age]

AIM--Aim of the study was investigation of the effect of isovolemic hemodilution in patients younger than 50 years on the course of central retinal vein occlusion (CRVO) and to compare these results with those of older patients with CRVO. PATIENTS AND METHODS--We performed a prospective study on 35 patients younger than 50 years who were suffering from a central retinal vein occlusion. These patients were all treated by isovolemic hemodilution and compared to a group of older patients with CRVO with the same treatment. RESULTS--About 66% of the younger patients were men compared to only 46% in older patients. At least two cardiovascular risk factors were present in 8.5% of the younger and 54% of the older patients. 16 eyes showed the ischemic, 19 the nonischemic type of CRVO, a similar distribution as in older patients. The course of the disease was more favourable in younger patients, although ocular complications may occur in ischemic CRVO. Isovolemic hemodilution did not change the initial visual acuity of eyes with nonischemic CRVO, but led to an improvement in 56% of the eyes with ischemic CRVO. This means only a minor difference to the course of CRVO in hemodiluted older patients. CONCLUSION--In general, there is no principal difference between the CRVO in younger and older patients, but the course is more favourable in younger patients. On the basis of these findings we recommend isovolemic hemodilution in younger patients with ischemic CRVO.

Method for determination of intracellular sodium in perfused cancer cells by 23Na nuclear magnetic resonance spectroscopy

Changes of intracellular sodium concentrations are often an indication of disease or malfunction. In this work, shift reagent-aided 23Na NMR spectroscopic determination of intracellular sodium was adapted to measurements with perfused cells embedded in agarose gel threads. Ehrlich ascites tumor cells (EHR2) and their multidrug-resistant counterparts (EHR2/DNR+) were immobilized and perfused until the metabolic steady state had been reached as shown by 31P NMR spectroscopy. Subsequent addition of 5 mM dysprosium(III) bis(tripolyphosphate) to the perfusion medium caused a separation of extracellular and intracellular 23Na NMR signals, making quantification of the intracellular sodium possible. The dysprosium shift reagent was apparently nontoxic to the cells, as shown by the unchanged level of ATP and other intracellular phosphates. NMR visibility of the intracellular sodium was determined in suspensions of EHR2 and EHR2/DNR+ cells by treatment with digitonin; the increase of intensity of the extracellular sodium resonance observed after the digitonin treatment corresponded well (97 +/- 3%) to the sum of intracellular and extracellular sodium observed with intact cells prior to the digitonin treatment. The resistant EHR2/DNR+ cells contained a moderately higher intracellular sodium level than the wild-type EHR2 cells, 1.02 +/- 0.10 and 0.77 +/- 0.07 mumol Na/mg protein, respectively. Closely similar levels of intracellular sodium were found by flame photometry. Thus, 23Na NMR offers a reliable method for noninvasive quantification of intracellular sodium in perfused cancer cells.

[Do scars grow despite successful laser coagulation of subretinal neovascularization?]

After successful laser coagulation of subretinal neovascularization, we examined 9 patients to see if laser scar growth (which can be expected according to the literature) is accompanied by an increase in associated scotoma. We used a specially designed visual field program. Laser scars had grown by 23% 107 days after therapy and by 32% after 409 days. The changes in our patients were at the lower range of the data reported in the literature. The increase in the laser scar was statistically significant in just one patient. Mean sensitivity and two further parameters for describing visual fields, which we introduced, all hinted at an improvement in the central visual field, although the laser scars had grown. The mean sensitivity increased by 4.9% and 7.5% after 107 and 409 days, respectively.

Cystoid macular oedema after excimer laser photoreactive keratectomy

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[Retinal diseases in AIDS]

Retinal diseases are the most frequent and most important ocular manifestations in AIDS. Electrophysiological changes can already be found in early stages of AIDS without funduscopic lesions and are a sign of damage to the retinal receptors and ganglion cells. HIV retinopathy (cotton-wool spots, retinal hemorrhages, microaneurysms) seldom occurs in the early stages with normal T-helper cell counts, but is present in about 40% of patients with AIDS-related complex and even in 70% of patients with full-blown AIDS. The cause of this microangiopathy is not known, but patients with lower T-helper cell counts of comparable stages more often have signs of HIV retinopathy. Infections of the retina and the choroid are always part of full-blown AIDS and represent the most important ophthalmological problem in AIDS, as these may lead to blindness if not treated. The specific diagnosis mainly relies on the ophthalmoscopic appearance, as antibody studies are of little help in final-stage AIDS patients. The amplification and proof of virus DNA particles by polymerase chain reaction seem to be more promising ways of obtaining an early laboratory diagnosis of viral retinal infections, but an intraocular specimen is required. Most (90-95%) of the retinal infections in AIDS are caused by the cytomegalovirus. In the final stage 11-40% of AIDS patients develop cytomegalovirus retinitis. Without treatment blindness can occur within a few weeks. Intravenous ganciclovir or foscarnet can prevent or postpone blindness in these patients, but the agents have to be given lifelong in a maintenance dose. Foscarnet offers a survival advantage over treatment with ganciclovir, although the patients may not tolerate foscarnet as well as ganciclovir. Another important infection is toxoplasmic retinochoroiditis, whereas acute retinal necrosis/herpes simplex retinitis, myotic and bacterial infections as well as Pneumocystis carinii choroiditis are seldom seen.

Measurement of basal levels of factor VIIa in hemophilia A and B patients

Previous results, presented in abstract form, indicate that replacement of thromboplastin with a mixture of phospholipid and truncated soluble tissue factor apoprotein results in a coagulation assay that can directly measure plasma factor VIIa levels without interference from zymogen factor VII (Atherosclerosis Thromb 11:1544a, 1991 [abstr]). We have exploited the specificity and sensitivity of such a factor VIIa specific coagulation assay to directly assess the in vivo relationship of factor VIII and factor IX on the production of factor VIIa levels under nonthrombotic and nonstimulatory conditions. Normal individuals (n = 20) were found to possess an average circulating factor VIIa level corresponding to 4.34 +/- 1.57 ng/mL, or approximately 1% of their total factor VII antigen. Severe factor VIII deficient patients (n = 13) possessed a slightly lower but statistically significant (P less than .01) decrease in their basal factor VIIa levels (2.69 +/- 1.52 ng/mL), corresponding to approximately 60% of that observed in normal individuals. On the other hand, severe factor IX deficient patients (n = 7) were found to possess even lower levels of factor VIIa corresponding to 0.33 +/- 0.15 ng/mL, or less than 10% of that observed in normal individuals. Measurement of total factor VII antigen levels shows that the variation in basal factor VIIa levels stems from differences in the degree of factor VII activation as opposed to differences in factor VII antigen levels. Our present data are consistent with the hypothesis that factor IXa is the principal in vivo activator of factor VII under basal conditions.

Haemorheological parameters in patients with retinal artery occlusion and anterior ischaemic optic neuropathy

The haemorheological parameters haematocrit (Hct), plasma viscosity (PV), red cell aggregation (RCA), red cell filterability (RCF), apparent whole blood viscosity (WBV), and fibrinogen were measured in 31 patients with retinal artery occlusion (RAO), 25 patients with anterior ischaemic optic neuropathy (AION), and 19 patients with giant cell arteritis (GCA). The patient groups were compared with controls of same age and similar prevalence of cardiovascular risk factors. Patients with RAO and AION have a significantly decreased RCF in comparison with controls. All other parameters showed no differences. Patients with GCA had significantly decreased Hct and RCF and increased PV and fibrinogen. After 2 weeks of systemic treatment with high dose steroids in patients with GCA the plasma viscosity had returned to normal and was even lower than in controls, and the Hct and fibrinogen had reached normal levels.