Immunohistochemical evidence for mesothelial origin of paratesticular adenomatoid tumour

AIMS

To investigate the histogenesis of paratesticular adenomatoid tumour by use of immunohistochemical markers for a variety of carcinomas and mesothelioma.

METHODS AND RESULTS

Immunohistochemical staining of sections from 12 cases of paratesticular adenomatoid tumour was undertaken using primary antibodies to antigens expressed by benign epithelial cells and carcinoma (cytokeratin AE1/AE3, cytokeratin 34ssE12, epithelial membrane antigen, MOC-31, Ber-EP4, CEA, B72.3, LEA.135, Leu M1), stromal and vascular markers (vimentin, CD34, factor VIII), and mesothelioma-associated antigens (thrombomodulin, HBME-1, OC 125) and p53 protein. There was absence of immunohistochemical expression of epithelial/carcinoma markers MOC-31, Ber-EP4, CEA, B72.3, LEA.135, Leu M1 and to factor VIII and CD34. All tumours expressed cytokeratin AE1/AE3, epithelial membrane antigen and vimentin, with weak expression of cytokeratin 34ssE12 in 25% of tumours. Each tumour showed expression of thrombomodulin, HBME-1 and OC 125 in a membranous distribution. p53 protein expression was not detected.

CONCLUSIONS

The immunohistochemical profile of paratesticular adenomatoid tumour is strongly supportive of a mesothelial cell origin.

Publication bias in meta-analysis: its causes and consequences

Publication bias is a widespread problem that may seriously distort attempts to estimate the effect under investigation. The literature is reviewed to determine features of the design and execution of both single studies and meta-analyses leading to publication bias, and the role the author, journal editor, and reviewer play in selecting studies for publication. Methods of detecting, correcting for, and preventing publication bias are reviewed. The design of the meta-analysis itself, and the studies included in it, are shown to be important among a number of sources of publication bias. Various factors influence an author's decision to submit results for publication. Journal editors and reviewers are crucial in deciding which studies to publish. Various methods proposed for detecting and correcting for publication bias, though useful, all have limitations. However, prevention of publication bias by registering every trial undertaken or publishing all studies is an ideal that is hard to achieve.

Use of laryngeal mask airway in a patient requiring continuous positive airway pressure: a case report

The successful use of a laryngeal mask airway over a 48-hour period is reported in a patient with partial upper airway obstruction who required continuous positive airway pressure.

Unwanted childbearing, health, and mother-child relationships

This paper investigates the relationships among unwanted childbearing, health, and mother-child relationships. We hypothesize that unwanted childbearing affects mother-child relationships in part because of the physical and mental health consequences of unwanted childbearing. Impaired mental health hampers women's interaction with their infants, and these poor neonatal relationships translate into poor mother-adult child relationships. Using the Intergenerational Panel Study of Mothers and Children--a 31-year longitudinal survey of a probability sample of 1,113 mother-child pairs begun in 1961--we demonstrate that mothers with unwanted births have lower quality relationships with their children from late adolescence (age 18) throughout early adulthood (ages 23 and 31). Furthermore, these lower quality relationships are not limited to the child born as a result of the unwanted pregnancy; all the children in the family suffer. Using the 1987-88 wave of the National Survey of Families and Households, a survey of a national probability sample of U.S. households, we show that mothers with unwanted births suffer from higher levels of depression and lower levels of happiness. We also demonstrate that they spank their young children more and spend less leisure time with them. We conclude that experiencing unwanted childbearing reduces the time and attention that mothers give their young children and that these early mother-child interactions set the stage for long-term, lower quality relationships.

Stereotactic proton radiosurgery

The technique of stereotactic proton radiosurgery is discussed in depth in this article. The physics of the proton beam in radiosurgery is explained, and the different factors of beam delivery are examined. These key factors (correspondence to shape, accuracy of delineation of volume, correspondence to volume, and accuracy of delivery vary) with each of the radiosurgical techniques, from Gamma Knife surgery to linear accelerator therapy. Clinical series in the use of proton radiosurgery are also presented, with an emphasis on efficacy and uses.

Luminal epithelial antigen (LEA.135) expression in adenocarcinoma of the colon

BACKGROUND

Luminal Epithelial Antigen (LEA.135) is a cell surface glycoprotein, whose expression has been shown to have prognostic significance in breast carcinoma and transitional cell carcinoma of the bladder, but has not been previously evaluated in adenocarcinoma of the colon.

PATIENTS AND METHODS

This study examines LEA.135 expression in 134 archival cases of colon adenocarcinoma obtained from Wellington Hospital Pathology Department between 1985 and 1990 inclusive. The findings were compared with tumor grade, stage and survival, to determine whether LEA.135 could serve as a useful indicator of the progression of colonic adenocarcinoma.

RESULTS

Analysis of results showed that LEA.135 expression was not related to depth of invasion (p = 0.097), grade (p = 0.14) or clinical outcome (p = 0.27). Both luminal and cytoplasmic labelling of LEA.135 was seen in tumor cells however there was no association between LEA.135 distribution and either tumor grade or patient survival.

CONCLUSION

The results suggest that the expression of LEA.135 does not provide a useful indication of clinical progression or outcome in patients with colonic adenocarcinoma.

The long-term impact of parents' childbearing decisions on children's self-esteem

We examine the long-term impact of parents' childbearing decisions on children's self-esteem. We focus on subjective aspects of the home environment in the creation of children's internalized sense of self-worth. Unique 23-year family panel data combining measures of mothers' childbearing, mothers' childbearing intentions, and children's self-esteem allow us to examine the overall links between parents' childbearing and children's self-esteem. The results demonstrate that parents' childbearing intentions can have a significant long-term impact on their children's self-esteem. Children who were unintended by their mothers have significantly lower self-esteem 23 years later. Our findings indicate that giving birth to an unintended child can have a long-term negative impact on subjective aspects of the child's well-being, at least in terms of self-esteem. Unintended childbearing has received an increasing amount of research attention in recent years.

T lymphocyte-mediated control of autoimmunity

Autoreactive T cells can be readily identified in the peripheral lymphocyte pool of both humans and experimental animals. Peripheral tolerance may be maintained by regulatory/suppressor T cells which prevent the activation of autoantigen-specific cells. Mice thymectomized on day 3 of life (d3Tx) develop a wide spectrum of organ-specific autoimmune diseases. Reconstitution of d3Tx mice with CD4+ CD25+ T cells from normal mice prevents the development of disease. Similarly, CD4+ CD25+ T cells prevent the transfer of disease by autoantigen-specific cloned T cells derived from d3Tx mice. Thus, regulatory T cells can prevent both the induction and effector function of autoreactive T cells. In vitro, the CD4+ CD25+ population is anergic to stimulation through the T cell receptor (TCR) and suppresses the proliferative responses of normal CD4+ CD25- cells by a contract-dependent mechanism. Suppression is not MHC-dependent, but requires activation of the CD4+ CD25+ population. The mechanism of suppression in vivo and the target antigen(s) of this unique regulatory population remain to be characterized.

Netting in Nepal: social change, the life course, and brideservice in Sangila

"Using survey and ethnographic data gathered in Nepal, this paper examines the implications of change in work, living experiences, and the marriage process for subsequent inter-familial relationships exemplified by cross-cousin marriage and the provision of brideservice. Hypotheses are developed which consider the impact of community context on these behaviors; these are tested in logistic regression analyses for the first marriages of all 430 ever-married women in the community. Cross-cousin marriage and brideservice are shown to be related to prior familial characteristics, life-course experience, and elements of the marriage process in ways that are significantly conditioned by community history and proximity to urban centers."

Would thyroid and breast shielding be beneficial in CT of the head?

Contrary to common perception, the advent of third- and fourth-generation scanners has lead to a significant increase in radiation dose to the patient per computed tomography (CT) head scan. With that in mind, a pilot study was designed with the objective of assessing the effectiveness of a dental-style protective bib in reducing the dose to the radiosensitive organs of the neck and thorax. Radiation doses over the thyroid gland and breast were measured with thermoluminenscent dosemeters and an ionization chamber respectively in 110 patients undergoing routine head scans. Half the patients wore the protective bib and collar. With lead protection, the thyroid measurements were reduced by an average of 45 % and the breast measurements by an average of 76 %. Similar results were seen in phantom measurements.

Prognostic significance of microscopic vascularity for clear cell renal cell carcinoma

OBJECTIVE

To investigate the association between tumour vascularity and patient survival in a series of clear-cell renal cell carcinoma (RCC), which often metastasizes via the vascular route and frequently has a prominent vascular network.

MATERIALS AND METHODS

Vessels were labelled in sections from 150 cases of clear cell RCC by factor VIII immunohistochemistry. The mean microvessel density (MMD), expressed as the number of vessels per 10 high-power fields (HPFs, x400, aggregate field area 1.452 mm2) and tumour microvessel area (TMA), expressed as the percentage of the total tumour area within 10 HPFs, were measured for each case. The relationship between MMD and TMA, tumour stage and grade, and patient survival over a 5-year follow-up was determined.

RESULTS

Tumour MMD ranged from 1 to 238 vessels per HPF, while the TMA was 1.2-60.8%. There was a weak but significant difference for MMD between tumour grades (P < 0.01) and stages (P < 0.05). There was no significant association between TMA and either tumour stage or grade. Division of cases according to MMD < or = 40 and > 40 per HPF showed a significant difference in survival curves between both groups, with a higher MMD being associated with longer patient survival. The significant association between MMD and survival was retained for stage 3 tumours only when cases were stratified according to Robson's stage at presentation. TMA did not correlate with survival.

CONCLUSIONS

The assessment of tumour vascularity is of prognostic significance for clear cell RCC. The significant inverse relationship between MMD and patient survival suggests that for tumours with a poor prognosis, decreased MMD is associated with tumour fibrosis and the development of large diameter vascular channels.

Orthographic analogies and developmental dyslexia

Goswami (1986, 1988) has demonstrated that children can use orthographic analogies (particularly at the onset-rime level) between the spelling patterns in words to help to decode new words (e.g. using 'beak' to read 'peak'). This strategy has been shown in children as young as six years old. Since it is known that children with developmental dyslexia find it particularly difficult to read words that they have not been specifically taught (Lovett, Warren-Chaplin, Ransby & Borden, 1990), the present study investigated whether dyslexic children might be unable to use analogies. Employing a design similar to that used by Goswami (1988), it was hypothesized that dyslexics would find it difficult to transfer spontaneously knowledge of a 'clue' word to decode new words that could be read by analogy with the clue word. The results of Expt 1 indicated that the dyslexic readers read significantly fewer of the analogous words than a reading age-matched comparison group of younger children. Furthermore, none of the nine dyslexic children read as many of the analogous words as the lowest scoring control child. In a second experiment, a design similar to that of Muter, Snowling & Taylor (1994) was used with a new and larger sample of dyslexic children. In this experiment, all the children were brought to criterion in reading the clue words before the analogous words were presented. Once again, the dyslexic children read significantly fewer words that were analogous with the clue words than did a reading age-matched comparison group. The number of analogous words that the dyslexic children read was significantly correlated with their performance on a test that is sensitive to the ability to detect rhyme. It is argued that a failure to make analogies may be one of the main causes of the reading impairment experienced by children with developmental dyslexia.

Motor and cognitive function in Lewy body dementia: comparison with Alzheimer's and Parkinson's diseases

OBJECTIVE

Motor and cognitive function were compared in patients with Lewy body dementia, Parkinson's disease, or Alzheimer's disease, to identify features that may be clinically useful in differentiating Lewy body dementia from Alzheimer's disease and Parkinson's disease.

METHODS

A range of neuropsychological function and extrapyrimidal signs (EPS) was assessed in 16 patients with Lewy body dementia, 15 with Parkinson's disease, 25 with Alzheimer's disease, and 22 control subjects.

RESULTS

The severity of total motor disability scores increased in the following order: controls approximately = Alzheimer's disease << Parkinson's disease < Lewy body dementia. Compared with patients with Parkinson's disease, patients with Lewy body dementia had greater scores for rigidity and deficits in the finger tapping test, but rest tremor and left/right asymmetry in EPS were more evident in Parkinson's disease. Patients with Lewy body dementia were also less likely to present with left/right asymmetry in EPS at the onset of their parkinsonism. "Sensitivity" to neuroleptic drugs was noted in 33% of patients with Lewy body dementia. Alzheimer's disease and Lewy body dementia groups had greater severity of dementia compared with the Parkinson's disease group and controls. Neuropsychological evaluation disclosed severe but similar degrees of impaired performances in tests of attention (digit span), frontal lobe function (verbal fluency, category, and Nelson card sort test) and motor sequencing in both Lewy body dementia and Alzheimer's disease groups, than Parkinson's disease and controls. In the clock face test, improved performance was noted in the "copy" compared to "draw" part of the test in controls, patients with Alzheimer's disease, and those with Parkinson's disease, but not in the patients with Lewy body dementia, who achieved equally poor scores in both parts of the test.

CONCLUSIONS

EPS in Lewy body dementia resemble those seen in idiopathic Parkinson's disease, although less rest tremor and left/right asymmetry but more severe rigidity favours a diagnosis of Lewy body dementia. The unique profile of patients with Lewy body dementia seen in the clock face test suggests that this simple and easy to administer test may be useful in the clinical setting to differentiate Lewy body dementia and Alzheimer's disease.

Polyclonal Ki-67 expression in transitional cell carcinoma of the bladder

The proliferation kinetics of 101 cases of transitional cell carcinoma (TCC) and seven cases of transitional cell carcinoma-in-situ of the bladder were assessed following staining with polyclonal Ki-67 antibody (pKi-67). Labeling indices ranged from 49% to 60.2% with a mean value of 22.2% for all cases. A significant association between pKi-67 indices, tumor grade and tumor stage was observed, with significant differences between pKi-67 indices of Grade 1 and 3 tumors and Grade 2 and 3 tumors. Significant differences in labeling indices were also found between superficial (Ta) tumors and both musculoinvasive (T2/T3a) tumors and those infiltrating the perivesical fat (T3b). pKi-67 indices for carcinoma-in-situ were similar to those noted for Grade 1 TCC. No difference in pKi-67 index was found when tumors were classified according to the morphology of the tumor invasion front. It is concluded that pKi-67 index is a useful marker for tumor progression for vesical TCC and that this immunohistochemical stain may assist clinical assessment of the potential behaviour of tumors in individual cases.

Luminal epithelial antigen (LEA.135) expression correlates with tumor progression for transitional carcinoma of the bladder

Luminal epithelial antigen (LEA.135) expression has been shown to have prognostic significance in breast carcinoma, however its relationship to tumor progression in other forms of malignancy is unknown. This study evaluates LEA.135 expression in bladder transitional cell carcinoma (TCC) and compares the findings with tumor stage and grade, and polyclonal Ki-67 derived cell cycle activity. LEA.135 expression was evaluated by immunohistochemical staining using the streptavidin-biotin method. Staining distribution was graded 0 to 4 and the results were compared with World Health Organisation tumor grade, UICC TNM stage and fraction of actively cycling cells showing positive pKi-67 immunohistochemical staining. In normal bladder epithelium, LEA.135 staining was confined to the luminal surface of superficial epithelium. In lower grade, superficial TCC LEA.135 overexpression was noted and there was a progressive loss of expression in tumors of higher grade (p = 0.0001) and advanced stage (p = 0.0001). No LEA.135 staining was seen in carcinoma-in-situ. Loss of LEA.135 expression correlates with tumor progression for bladder TCC.

Infiltration by immunocompetent cells in early stage invasive carcinoma of the uterine cervix: a prognostic study

In various tumor types dentritic cell, infiltration and the presence of tumor-infiltrating lymphocytes have been associated with an improved clinical outcome. In the uterine cervix these immunocompetent cells have been associated with improved prognosis in high stage disease. The current study examines the significance of stromal and tumor T-lymphocyte infiltration together with S-100 positive dendritic cell infiltration in a series of 73 women with low stage (FIGO 1b) invasive squamous and adenosquamous cervical carcinoma. Thirty four percent of cases contained S-100 positive dendritic cells. These were under-represented in cases showing pelvic recurrence or distant disease (1 of 11 compared to 24 of 62 free of recurrence, P = 0.05) and over-represented in cases showing lymphatic/capillary space involvement (12 of 23 compared to 13 of 46 without vascular space invasion, P = 0.05). The women were followed up for an average of 5.2 years and the five-year survival for women whose tumors contained S-100 positive dendritic cells was 92% compared to 73% for negative cases (P = 0.04). There was a significant association between a low density of tumor infiltrating T-cells and risk of pelvic lymph node spread and subsequent local or distant disease control failure (P = 0.008). A five year survival advantage was seen with five or more CD 3 positive tumor infiltrating T-lymphocytes per high power field (90%) compared to a lower count (68%) (P = 0.04). A similar advantage could not be demonstrated for a high stromal infiltrate of T-cells. As yet neither the specific mechanisms that induce these cells to infiltrate some cervical carcinomas nor the nature of the immunological injury that the cells co-ordinate in tumor tissue are well understood.