Ovarian cancer screening

Ovarian cancer will kill more women this year than cancer of the uterine corpus and cervix combined. Outcome is stage dependent. At stage IV, the five year survival rate is about 4.5%, but at stage I it may be well over 90%. Overall, regardless of stage, about 30% of women with ovarian cancer will be alive five years after its diagnosis. The fact that changes in treatment over the past two decades have done little to alter these depressing figures has led to a reassessment of our approach to this problem. It has been proposed that earlier diagnosis of the condition will lead to improved patient outcome. Because the disease is asymptomatic in its earliest stages in the majority of cases, this has prompted the search for a reliable screening test that could be used to detect the cancer when it is still confined within the capsule of the ovary. This paper discusses these issues, assesses the different techniques available to screen for ovarian cancer, and comments on possible future developments.

Effect of variations in peptide sequence on anti-human milk fat globule membrane antibody reactions

Monoclonal anti-mucine antibodies BC1, BC2 and BC3 produced using human milk fat globule membrane react with a synthetic peptide p1-24 (PDTRPAPGSTAPPAHGVTSAPDTR) representing the repeating amino acid sequence of the mucin core protein. The minimum epitope recognized by these three monoclonal antibodies (mAb) in p1-24 was contained in the five amino acids APDTR. To analyse the variation of position of the epitope, various modifications of the APDTR sequence were made by synthesizing peptides and testing by direct binding and inhibition enzyme-linked immunosorbent assays. Firstly, peptides p13-32 and C-p13-32, in which the epitope APDTR was placed in the middle instead of the C-terminal as in p1-24, were examined. These peptides had a greater reaction with mAb BC1, BC2 and BC3 compared with the reaction with p1-24. Secondly, A-p1-24 and TSA-p1-24 were made wherein two APDTR epitopes were present--these peptides were shown to bind two IgG antibody molecules. Finally, the contribution of each amino acid in the APDTR epitope was studied using the pepscan polyethylene rods, making all 20 of the amino acid substitutions in each position for SAPDTR (the minimum epitope APDTR with an adjacent amino acid S). In the 120 peptides examined there were some 'permissible' substitutions in A, D and T but not in P or R for BC1 and BC2; there were more 'permissible' substitutions for BC3; different substitution patterns were found with each antibody and some substitutions gave an increased reaction compared with the native peptide SAPDTR. The studies are of value in analysing the reaction of antibodies with epitopes expressed in breast cancer and in determining the antigenicity of synthetic peptides.

Mechanistic studies of two amino acid racemases of broad substrate specificity from Pseudomonas striata and Aeromonas caviae

The conversion of L-[alpha-2H]alanine in H2O and unlabeled L-alanine in 2H2O into D-alanine, under nearly irreversible conditions, with the amino acid racemase from Pseudomonas striata showed significant internal transfer of the alpha-hydrogen. This result has been interpreted as being indicative of a single base mechanism for the racemization. The relative rates of deuterium incorporation into unlabeled D- and L-methionine by the two amino acid racemases of broad substrate specificity from P. striata and Aeromonas caviae, were measured in 2H2O. The results showed a markedly different pattern, dependent upon the configuration of the initial substrate; with D-methionine as substrate deuterium is incorporated into both enantiomers at approximately the same rate, but with L-methionine as substrate deuterium is incorporated considerably faster into the D than the L enantiomer. These results argue against a single base mechanism of racemization for these enzymes and are best rationalized in terms of a double base model where only one of the bases undergoes proton (deuterium) exchange with the solvent while the amino acid is enzyme-bound. The interpretation of the earlier experiment needs to be considered in light of these results.

Cell-specific expression of the rat oxytocin gene in transgenic mice

Abstract The genes for the posterior pituitary hormones oxytocin (OT) and vasopressin (VP) are expressed in magnocellular neurons of the hypothalamus. Previous attempts to obtain cell-specific expression of OT and VP transgenes in mice have been unsuccessful using constructs containing only the OT or VP genes. As the endogenous genes are located near each other on the same chromosome, we investigated four transgenic mouse lines incorporating a single 5.2 k bp construct of rat genomic deoxyribonucleic acid with 1.63 k bp and 3.55 k bp of the OT and VP genes, respectively. Rat OT transcripts were detected only in transgenic mouse OT neurons of the paraventricular and supraoptic nuclei in two lines. The levels of endogenous and transgene OT transcripts increased in response to 10 days of lactation. Furthermore, rat OT-associated neurophysin immunoreactivity was detected in magnocellular cell bodies as well as in the posterior pituitary of the transgenic but not the control mice. Cell-specific rat VP expression was not detected in these transgenic mice.

Virtual simulation in the clinical setting: some practical considerations

Virtual simulation departs from normal practice by replacing conventional treatment simulation with 3-dimensional image data and computer software. Implementation of virtual simulation requires the ability to transfer the planned treatment geometry from the computer to the treatment room in a way which is accurate, reproducible, and efficient enough for routine use. We have separated this process into: (a) immobilization of the patient; (b) establishment and alignment of a practical coordinate system for the patient/couch system; and (c) setup of the patient/couch been addressed by the use of hemi- or full-body foam casts, the second by use of an alignment jig on the treatment couch, and the third with the aid of a patient coordinate system referenced to easily located landmarks. Phantom studies and clinical practice have shown these techniques to be practical and effective within reasonable clinical bounds.

The five year school medical--time for change

School medical records of 1000 children born in 1981 were studied retrospectively. They showed that once known medical problems and those screened for by the school nurse (hearing, vision, growth) were excluded, only 17 problems requiring treatment were discovered: speech (n = 10), development (n = 3), undescended testes (n = 3), and phimosis (n = 1). This indicates that routine screening by a nurse, backed up by selective medical examination by the school doctor, is efficient and effective.

Synthetic peptides reactive with anti-human milk fat globule membrane monoclonal antibodies

Mammary mucins are increased in amounts in breast cancer patient sera, and most anti-breast cancer antibodies react with such mucins. One such mucin is found in human milk fat globule membrane and consists predominantly of O-linked sugars and a protein core. Partial complementary DNA clones for the protein core have recently been obtained. The nucleotide sequence is of interest as it contains a 60-base pair repeat, giving rise to a repeated 20-amino acid sequence (PDTRPAPGSTAPPAHGVTSA). Peptides with various lengths were synthesized using this sequence and the adjacent 4 amino acids (PDTR). Three anti-human milk fat globule membrane antibodies produced in our laboratory (BC1, BC2, and BC3) were tested to determine their reactivity with these synthetic peptides. Using three different assays (direct enzyme-linked immunosorbent assay test on peptides, direct enzyme-linked immunosorbent assay test on bovine serum albumin-conjugated peptides, and an inhibition test with the peptides in liquid, rather than solid phase), it was shown that APDTR was the minimum amino acid sequence required to form a reactive epitope with all 3 antibodies, although individual differences in the reactivities of the antibodies were noted. The addition of alanine (A) converted a nonreactive PDTR peptide to a reactive one, and the deletion of arginine (R) did the reverse; thus APDTR is the smallest peptide which reacts with these anti-human milk fat globule membrane antibodies.

Reactivity of anti-human milk fat globule antibodies with synthetic peptides

The nucleotide sequence of partial cDNA clones coding for the core protein of a human polymorphic epithelial mucin has recently been obtained, this mucin consists of a highly conserved 60 bp tandem repeat and the amino acids commonly found are PDTRPAPGSTAPPAHGVTSA. We synthesized three peptides, 1) P1.24 containing the 20 amino acids and four amino acids (PDTR) of the adjoining repeat; 2) P1.15 consisting of the first fifteen (PDTRPAPGSTAPPAH) and P1.09 the second nine amino acids (GVTSAPDTR) of peptide P1.24. The reactivities of the synthetic peptides with mAb known to react with breast cancer (BC1, BC2, BC3, HMFG-1, 3E1.2, and RCC-1) were studied. The synthetic peptide, P1.24, corresponding to the antigenic sequence predicted from the tandem repeat reacted with antibodies BC1, BC2, and BC3 (known to react with human milk mucin and mucin expressed in breast cancer) and the antibody HMFG-1 which was used to select the cDNA clones. In addition, the epitopes recognized by BC1, BC2, and BC3 appear to be in the same region of the molecule represented by their reactions with the nine amino acids in peptide P1.09 (GVTSAPDTR). By contrast, other antibodies such as 3E1.2 which reacts only weakly with components of human milk, and RCC-1 that detects a low Mr component (95 kDa) in breast cancer, had no specific reaction with the synthetic peptides, indicating that their epitopes are distinct from those of BC1, BC2, BC3, and HMFG-1. Inasmuch as the antibodies HMFG-1, BC1, BC2, and BC3 react with the fully processed milk mucin, it is likely that some of the peptide is exposed, even in the fully glycosylated molecule. Identification of the different epitopes could lead to the development of "second generation" mAb with enhanced specificity for breast carcinoma using the appropriate synthetic peptides as immunogens.

Reactivity of anti-human milk fat globule antibodies with synthetic peptides

The nucleotide sequence of partial cDNA clones coding for the core protein of a human polymorphic epithelial mucin has recently been obtained, this mucin consists of a highly conserved 60 bp tandem repeat and the amino acids commonly found are PDTRPAPGSTAPPAHGVTSA. We synthesized three peptides, 1) P1.24 containing the 20 amino acids and four amino acids (PDTR) of the adjoining repeat; 2) P1.15 consisting of the first fifteen (PDTRPAPGSTAPPAH) and P1.09 the second nine amino acids (GVTSAPDTR) of peptide P1.24. The reactivities of the synthetic peptides with mAb known to react with breast cancer (BC1, BC2, BC3, HMFG-1, 3E1.2, and RCC-1) were studied. The synthetic peptide, P1.24, corresponding to the antigenic sequence predicted from the tandem repeat reacted with antibodies BC1, BC2, and BC3 (known to react with human milk mucin and mucin expressed in breast cancer) and the antibody HMFG-1 which was used to select the cDNA clones. In addition, the epitopes recognized by BC1, BC2, and BC3 appear to be in the same region of the molecule represented by their reactions with the nine amino acids in peptide P1.09 (GVTSAPDTR). By contrast, other antibodies such as 3E1.2 which reacts only weakly with components of human milk, and RCC-1 that detects a low Mr component (95 kDa) in breast cancer, had no specific reaction with the synthetic peptides, indicating that their epitopes are distinct from those of BC1, BC2, BC3, and HMFG-1. Inasmuch as the antibodies HMFG-1, BC1, BC2, and BC3 react with the fully processed milk mucin, it is likely that some of the peptide is exposed, even in the fully glycosylated molecule. Identification of the different epitopes could lead to the development of "second generation" mAb with enhanced specificity for breast carcinoma using the appropriate synthetic peptides as immunogens.

Prolongation of heterotopic heart allograft survival by local delivery of continuous low-dose cyclosporine therapy

The effectiveness of local versus systemic low-dose CsA (2 mg/kg/day) therapy delivered by osmotic pump for a 14-day continuous infusion was examined in the rat model. Systemic subtherapeutic CsA treatment of WFu recipients either by oral gavage or intravenously using an osmotic pump resulted in quick rejection of BUF heart allografts within a median survival time (MST) of 8 days in comparison with untreated controls (MST = 7 days). In contrast, direct local subtherapeutic CsA delivery to BUF heart allografts produced significantly (P less than 0.01) prolonged heart allograft survivals up to MST of 40 days. Splenic T cells, isolated on days 10 to 12 from locally immunosuppressed WFu recipients, revealed a nonspecifically reduced proliferative response toward alloantigens. Coculture experiments demonstrate that these T cells have the capacity to inhibit normal T cell proliferative responses in a nonspecific fashion either by their suppressor function or more likely by carrying CsA to the culture plate. In contrast, T cells isolated from WFu recipients three weeks after transplantation and tested in vitro demonstrated the presence in alloantigen specific T suppressor cells that coincided with a decreased frequency of alloantigen-specific T cytotoxic cells and may explain the extended heart allograft survival beyond the time of CsA delivery. CsA therapy delivered directly to the graft resulted in high CsA levels within the heart graft (1108 ng/0.1 g) but subtherapeutic levels in other tissues. These results demonstrate that local drug delivery is effective in inhibiting the rejection process within the graft itself, as manifested by prolonged heart allograft survival. Further, subtherapeutic CsA therapy facilitates development of Ts cells that may be responsible for the survival of heart allografts beyond the CsA delivery time.

Effects of Fasting and Sedation on Gastrointestinal-Tract Function in 2 Potoroine Marsupials

Radiographic techniques were used to follow the movement of barium sulfate given orally, either as a suspension or incorporated into feed pellets, through the gastrointestinal tract of two potoroine marsupials, Aepyprymnus rufescens, the rufous rat-kangaroo; and Potorous tridactylus, the long-nosed potoroo. Compared with previously reported results from fed animals, fasting for 12-15 h delayed the passage of contrast medium into the small intestine, but sedation with ketamine hydrochloride visibly increased gastrointestinal tract activity and significantly reduced retention times of contrast medium in the stomach. A daily cycle of ingesta movements within the potoroine stomach, consequent upon the discontinuous feeding pattern and nature of the diet of these small marsupials, is proposed. In this proposal the sacciform region of the forestomach plays a primary role in storage of ingesta for later digestion in the intestine, and fermentative digestion of fibre is of secondary importance.

The effect of dexamethasone on tissue water distribution and proton relaxation in Panc02 tumors

The present experiments were conducted to determine the effects of dexamethasone mediated changes in tumor water distribution on proton relaxation times (T1, T2) in a murine pancreatic adenocarcinoma (Panc02). Spin lattice (T1) and spin-spin(T2) relaxation times were determined by ex vivo methods (10 MHz) and by in vivo imaging techniques (6.25 MHz) at various intervals after single or multiple dexamethasone treatments. In complementary studies, dexamethasone mediated changes in tumor capillary permeability, tumor water distribution, relative tumor blood flow and tumor cell proliferation were also determined. Proton spin lattice (T1) and spin-spin (T2 relaxation times for Panc02 tumors shortened within two hours of a single dexamethasone treatment. The time course and magnitude of this response was dexamethasone dose dependent. The time dependent changes in T1 and T2 after dexamethasone were similar at 10 MHz (ex vivo) and 6.25 MHz (in vivo imaging). Although dexamethasone produced little or no change in total tumor water content and tumor cell proliferation, transient changes in the physiologic distribution of tumor water were clearly demonstrated. The data supports the idea that dexamethasone induced changes in the distribution of tumor water were mediated by changes in capillary permeability and tumor blood flow. These physiologic responses produced serial changes in tumor extracellular extravascular water content that were consistent with the observed changes in tumor T1 and T2. The results from these experiments might imply that therapy associated changes in tumor proton relaxation times may not only reflect changes in tissue water content, but may also reflect physiologic responses which alter the distribution of tissue water and solute.

Biological implications of androgen dependent changes in proton-NMR relaxation times in rat ventral prostate

The present studies were conducted in rat ventral prostate to determine if proton nuclear magnetic resonance (1H-NMR) might be a useful tool to monitor physiologic changes in an androgen-dependent target tissue after ablation and reconstitution. Ventral prostate mass and blood flow (86RbCl distribution) decreased markedly after castration. Although prostate water content was not affected by androgen ablation, 1H-NMR spin-lattice (T1) and spin-spin (T2) relaxation times determined on excised prostate tissue were reduced by 10% and 50%, respectively. Testosterone propionate (Tp) reconstitution resulted in a prompt but transient increase in total water content, marked increases in prostate blood flow, and regrowth of the gland. 1H-NMR studies indicated that although T1 lengthening after Tp was temporally related to changes in prostate water content, T1's remained prolonged after total prostate water content returned to control levels. Increased Gd-DTPA-dimeg modification of prostate T1 by Gadolinium-DTPA-dimethyl glucamine in androgen reconstituted rats implied that prostate extracellular water volumes were markedly increased during intervals of increased T1. Recovery of prostate T2 relaxation times after Tp was delayed with respect to changes in T1, water content, and prostate blood flow, but was temporally correlated with increase in prostate dry mass. Studies to assess Gd-DTPA-dimeg T2 modification showed that prostate T2 changes after androgen depletion and replacement reflected spin-spin relaxation of water protons outside the in vivo Gd-DTPA-dimeg distribution volume. The results from these studies indicate that 1H-NMR and paramagnetic probes may be useful to noninvasively monitor biologically relevant changes in cellular and extracellular water in androgen-dependent target tissues during hormonal manipulations.

Colobus type C virus: molecular cloning of unintegrated viral DNA and characterization of the endogenous viral genomes of Colobus

The unintegrated viral DNA intermediates of colobus type C virus (CPC-1) were isolated from infected human cells that were permissive for viral growth. There were two major species of DNA, linear molecules with two copies of the long terminal repeat and relaxed circles containing only a single long terminal repeat. In addition, there was a minor species (approximately 10%) composed of relaxed circles with two copies of the long terminal repeat. A restriction endonuclease map of the unintegrated DNA was constructed. The three EcoRI fragments of circular CPC-1 DNA were cloned in the EcoRI site of lambda gtWES . lambda B and then subcloned in the EcoRI site of pBR322. Using these subgenomic fragments as probes, we have characterized the endogenous viral sequences found in colobus cellular DNA. They are not organized in tandem arrays, as is the case in some other gene families. The majority of sequences detected in cellular DNA have the same map as the CPC-1 unintegrated DNA at 17 of 18 restriction endonuclease sites. There are, however, other sequences that are present in multiple copies and do not correspond to the CPC-1 map. They do not contain CPC-1 sequences either in an altered form or fused to common nonviral sequences. Instead, they appear to be derived from a distinct family of sequences that is substantially diverged from the CPC-1 family. This second family of sequences, CPC-2, is also different from the sequences related to baboon endogenous type C virus that forms a third family of virus-related sequences in the colobus genome.

Dacron bypass grafting in the relief of obstructive jaundice

A new technique using a 'Dacron' tube bypass graft for relief of obstructive jaundice due to malignant disease is described. This method is applicable when a conventional bypass operation is technically impossible. Good palliation was achieved in all seven patients who survived the immediate postoperative period.

Effect of lysolecithin on gastric mucosal structure and potential difference

The effect of lysolecithin (100 mg%) on the guinea-pig gastric mucosa was studied by instilling a solution for 30 minutes, preceded and followed by 100 MN HCl into 10 total gastric pouches. Ten control animals had HCl throughout. Lysolecithin produced a significant change in transmucosal potential difference, macroscopic erosions, and mucosal damage on histology and electron scanning microscopy. None of these changes was seen in the control animals. This is further evidence that the reflux of lysolecithin from the duodenum is an important factor in causing active gastritis and gastric erosions.

Asymptomatic infection with EB virus

Evidence of asymptomatic EB virus infection was sought in healthy medical students and nurses following the observation that 1.4% possessed heterophile antibodies. The proportion of subjects with EB virus antibodies rose with age and there was evidence of recent infection in 19%. Smooth muscle antibodies were detected in 13 individuals and recent infection with EB virus was probable in six of these. Subclinical EB virus infections, in some cases associated with some disturbance of immunological function, may therefore be not uncommon in young adults.

Immunoglobulins and EB virus antibodies in infectious mononucleosis

Antibodies to EB virus capsid, EB virus complement-fixing antibodies and IgM, IgA and IgG immunoglobulins were estimated in sera from seventy-four patients with infectious mononucleosis, eighty-nine control patients (mostly with infectious diseases) and 232 healthy medical students and nurses. Complement fixing (but not virus capsid) antibodies were much lower in patients tested during active infectious mononucleosis than in patients tested during late convalescence or in controls, a disparity which could form the basis of a diagnostic test. Immunoglobulin levels were higher in patients with active infectious mononucleosis than in controls and, when tested 6 months to 2 yr later, were still higher than those in healthy individuals.

Influenza infection causing manic psychosis

Although depression is well known as a sequel to influenza, mania is not. We describe a patient with a severe psychotic illness who first showed features of a confusional state but then developed a manic psychosis. The occurrence of functional affective psychoses during or following systemic physical illness has been well described (Bonhoeffer, 1909; Kraepelin, 1921; Kiloh, 1961; Post, 1965), but the nature of the relationship has never been clear. In some instances, the physical illness may simply act as a form of non-specific stress precipitating the mental disorder; evidence for a more direct patho-physiological relationship has been lacking. When, in addition to a background of physical illness, a patient shows disorientation and clouding of consciousness together with signs of a manic psychosis, the diagnostic problem is especially difficult, particularly so since a confusional state can occur as part of a severe manic illness (Maudsley, 1895; Kraepelin, 1921). Conversely, hypomanic symptoms can occur in an organic psychosis (Bonhoeffer, 1909).