Human papillomavirus involvement in esophageal precancerous lesions and squamous cell carcinomas as evidenced by microscopy and different DNA techniques

A series of 71 surgically resected esophageal squamous cell carcinomas, including 51 cases of formalin-fixed samples and 20 cases of fresh biopsy specimens derived from the high-incidence area of esophageal cancer in China, were systematically analyzed for the presence of human papillomavirus (HPV) infections by light microscopy, electron microscopy (TEM), in situ DNA hybridization, Southern blot hybridization, and polymerase chain reaction (PCR) techniques. On light microscopy, HPV-suggestive lesions were found in a total of 49.0% (25 of 51) of the specimens, including the flat type (22 of 51) and, less frequently, an inverted one (2 of 51). Of the 51 formalin-fixed, paraffin-embedded specimens, 43.1% (22 of 51) contained HPV DNA sequences by in situ hybridization. Of the positive cases, HPV 6 was present in three (5.9%), HPV 11 in three (5.9%), HPV 16 in eight (15.7%), HPV 18 in six (11.8%), double infections with HPV 11/18 in one (2.0%), and HPV 16/18 in one. In most cases the HPV-positive signals were localized in the hyperplastic and/or dysplastic epithelium adjacent to invasive carcinomas. In two specimens, however, HPV DNA sequences were found in the frankly invasive lesions, one being HPV 6 and the other HPV 18. On TEM, HPV-like particles located in the nuclei of koilocytotic cells were demonstrated in two of the five specimens previously shown to be HPV-positive by in situ hybridization. By means of the PCR technique, all specimens positive for HPV by in situ hybridization also contained amplified HPV sequences. Moreover, three additional samples negative by in situ hybridization were found to contain HPV 11 DNA sequences. Of the 20 DNA samples extracted from the fresh carcinoma samples (containing some surrounding tissues as well) 9 were shown to contain HPV DNA sequences by Southern blot hybridization under low-stringency conditions. Of these, eight samples remained positive when hybridized with the probe cocktail of HPV 11, 16, 18, and 30 DNA under high-stringency conditions. HPV DNA sequences in these carcinoma specimens appeared to be present mainly in an integrated form. The present results confirm the HPV involvement in esophageal squamous cell lesions and suggest that HPV infection might be an important etiologic factor in the pathogenesis of esophageal cancer, most probably acting synergistically with other carcinogenic factors.

Natural history of cervical human papillomavirus lesions does not substantiate the biologic relevance of the Bethesda System

The newly introduced Bethesda System proposes to replace the terms dysplasia, carcinoma in situ (CIS), or cervical intraepithelial neoplasia (CIN) with two terms, low-grade squamous intraepithelial lesion (SIL) or high-grade SIL. We tested the biologic relevance of the Bethesda System (ie, its ability to establish a close correlation between biologic behavior and the different grades of lesions) in a series of 528 women with genital human papillomavirus (HPV)-associated precancerous lesions prospectively followed for 10 years. The cervical biopsies were reclassified as either low-grade or high-grade SIL, and the data obtained by colposcopy, Papanicolaou smear, and HPV typing, as well as the biological behavior of the lesions, were analyzed in these two groups. Altogether, 77.4% (376 of 486) of the lesions were classified as low-grade SIL lesions; the rest (22.6%) belonged to the high-grade SIL category. In the low-grade SIL category, 46.8% of the women were 24 years old or younger, as compared with 37.3% in the high-grade SIL group. The colposcopic appearance was normal significantly more frequently in the low-grade SIL lesions (22.1%) than in the high-grade category (8.5%) (P less than .001). A single Papanicolaou smear was inadequate to distinguish between low-grade and high-grade SIL, as evidenced by almost identical distributions of Papanicolaou smear class I and II cells in both categories. Noteworthy was the discovery of normal Papanicolaou smears in 8.2% of the high-grade SIL lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Phosphorylation of FAR1 in response to alpha-factor: a possible requirement for cell-cycle arrest

Exposure of yeast a cells to alpha-factor causes cells to arrest in the G1 phase of the cell cycle. The FAR1 gene is required for this cell-cycle arrest; its product is necessary for the inhibition of a G1 cyclin, CLN2. Earlier work demonstrated that alpha-factor caused an increase in the transcription of FAR1 severalfold over a measurable basal level. We now show that transcriptional induction of FAR1 from a heterologous promoter is not sufficient to inhibit CLN2 in the absence of alpha-factor. We also show that FAR1 is phosphorylated in response to alpha-factor and propose that this phosphorylation may be required for FAR1 activity.

Mechanism of acetylcholine action on pacemaker current (i(f)) in canine Purkinje fibers

We have recently reported in canine Purkinje fibers that acetylcholine (ACh) can reverse the positive voltage shift of the pacemaker current (i(f)) induced by beta-adrenergic stimulation while having no direct action of its own. We have now investigated this effect of ACh on the cyclic adenosine monophosphate (cAMP) cascade in more detail. We find that addition of a membrane permeable analogue of cAMP (8-chlorophenylthio cAMP), 0.5-1 mM, increased the amplitude of i(f). This action was not reversed by 1 microM ACh, implying that ACh acts at a step prior to cAMP action. We then looked at the steps controlling intracellular concentration of cAMP. Inhibiting the phosphodiesterase with 100 microM isobutyl-1-methylxanthine (IBMX) increased i(f). This action, however, was reversed by ACh. Finally we investigated whether the action of forskolin, a direct activator of adenylyl cyclase, could be reversed by ACh. Forskolin (10-20 microM) increased i(f), and ACh at 1 microM partially reversed this action of forskolin. These results suggest that, in canine Purkinje fibers, ACh reverses the positive action of beta-adrenergic agents on i(f) via a decrease in cAMP production.

Investigation on the carcinogenic effects of coal tar pitch in rat respiratory tract by intratracheal instillations

The effects of coal tar pitch (CTP) on the tracheobronchial mucosa of Wistar rats were studied. Three groups of animals received 10 weekly intratracheal instillations of CTP at the cumulative doses of 6.48, 136.56 and 200 mg respectively. The control group of rats received 10 weekly intratracheal instillations of charcoal powder at a cumulative dose of 20 mg. The study in which the animals were killed serially revealed that CTP had conspicuous damage on the respiratory system of rats, especially on the bronchiolo-alveolar areas. The lesions induced by CTP ranged from hyperplastic, metaplastic and dysplastic changes to extensive cancers. These lesions were usually multifocal, and were more severe in the rats receiving higher dosages of CTP. The deposition of CTP particles within or adjacent to these lesions could be readily identified. Lung cancers occurred in 12.5% (4/32) and 25% (10/40) of the rats treated with 136.56 and 200 mg of CTP, whereas no tumors were found in control rats and the rats that received 6.48 mg of CTP. The overall cancer incidence significantly related to the cumulative dose of CTP. The histological types of lung cancers consisted of squamous cell carcinomas (10 out of the 14 lung cancers), adenocarcinoma (1/14), and combined squamous and adenocarcinomas (3/14). The development of CTP-induced rat lung cancers appears to derive from the hyperplasias of bronchiolo-alveolar epithelium, and processing stages of squamous metaplasias and/or dysplasias to carcinomas. The present results confirmed the carcinogenic effects of CTP on the respiratory system of rats, and provided experimental evidence for human lung carcinogenesis, particularly in those occupationally exposed to coal tars or tar products.

Study of elasto-gel pads used as surface bolus material in high energy photon and electron therapy

Bolus materials are occasionally used during the high energy photon and electron radiation treatments of head, neck, breast, and chest wall areas in order to deliver the full prescribed dose to the skin surface and underlining tissue. Where skin surface curvatures make uniform contact between the bolus material and skin surface difficult, we have studied a new bolus material called Elasto-gel. Elasto-gel, packed in a sterilized envelope, is routinely used in the treatment of superficial burns and wounds. The adhesive nature of Elasto-gel bolus material provides excellent skin contact without air gaps. The Elasto-gel is made of non-toxic material and is transparent. High dose irradiation has no effect on the appearance and property of the Elasto-gel pad. We are presenting in this note the radiation attenuation and build up effects of the Elasto-gel pads of photon energies of 6 and 18 MV and of electron energies of 6 MeV and 20 MeV. There is little difference between Elasto-gel and Polystyrene in radiation dosimetry.

Human papillomavirus (HPV) infections and their associations with oral disease

More than 65 distinct types of human papillomavirus (HPV) have been identified to date. Several of the HPV types have been proposed as etiologic agents of squamous cell carcinoma. In the oral cavity, HPVs have been found associated with several benign squamous cell proliferations. Evidence from histology and DNA hybridization studies suggests that HPV is also involved in oral carcinogenesis. It is apparent, however, that substantial amount of confusion exists in the diagnosis of oral HPV infections. The keratotic, papillary lesions in the oral cavity are usually small and easily overlooked. The gross appearance of these viral lesions is not distinct enough to be readily diagnosed by the clinicians. Degenerative changes found on oral mucosa frequently simulate koilocytosis. Thus, caution should be exercised to avoid overdiagnosis of HPV infection in the oral cavity. The present review summarizes the current evidence available on HPV infections in general and on oral HPV infections in particular. The diagnostic techniques available as well as the problems encountered in the distinction of these lesions are also discussed in short.

Esophageal squamous cell papillomas. Failure to detect human papillomavirus DNA by in situ hybridization and polymerase chain reaction

Squamous cell papilloma of the esophagus has been regarded as a distinct rarity. After having reviewed the files of the Gastrointestinal Endoscopy Unit of our hospital we found 14 patients diagnosed as having an esophageal papilloma on endoscopy of about 18,000 patients during the period 1985-90. On histologic examination of the biopsy specimens 12 cases showed histologic characteristics typical of a squamous cell papilloma (SQP), 1 was a fibroid polyp, and another showed epithelial dysplasia without the features typical of SQP. To assess the role of human papillomavirus (HPV) recently implicated in the etiology of this tumor, we analyzed all specimens for the presence of HPV types 6, 11, 16, and 18 DNA by in situ DNA hybridization (ISH) and polymerase chain reaction (PCR). No viral DNA was found by either ISH or PCR in any of these lesions. The significance of these findings is discussed in relation to the previous evidence presented on HPV involvement in the development of esophageal squamous cell papillomas and in esophageal carcinogenesis.

Inhibition of glycogen synthesis in Saccharomyces cerevisiae by the mating pheromone alpha-factor

Treatment of the yeast Saccharomyces cerevisiae with the pheromone alpha-factor caused an inhibition of glycogen synthesis in MATa haploid cells but not in MAT alpha cells or MATa/MAT alpha diploid cells. The concentration of alpha-factor required for a half-maximal inhibition was comparable to that required for the induction of the FUS1 gene. Strains containing a disruption in ste2 or ste12 or temperature-sensitive mutations in ste4, ste7, or ste11 continued to divide and to accumulate glycogen in the presence of alpha-factor. In contrast, inhibition of glycogen occurred upon exposure to mating pheromone of far1 mutants which, under this condition, fail to arrest in G1 and continue to divide while simultaneously undergoing the transcriptional induction and morphological changes typical of mating cells. The inhibition of glycogen accumulation by alpha-factor persisted in a strain lacking glycogen phosphorylase (EC 2.4.1.1), which ruled out the participation of this enzyme in the pheromone response. Glycogen synthase (EC 2.4.1.11) from a cells treated with alpha-factor was found primarily in the glucose 6-phosphate-dependent (inactive) form whereas the total activity was unaltered. This indicates that the action of mating pheromone is mainly to inhibit the interconversion of the inactive glucose 6-phosphate-dependent form to the active glucose 6-phosphate-independent form of glycogen synthase without affecting the concentration of the enzyme.

Prognostic significance of human papillomavirus (HPV) type and nuclear DNA content in invasive cervical cancer

Eighty-one women treated for an invasive squamous cell carcinoma of the uterine cervix during the period from 1964 to 1987 were studied to assess the prognostic value of human papillomavirus (HPV) types 6,11, 16 and 18, as well as the nuclear DNA ploidy pattern, analyzed using HPV amplification by polymerase chain reaction (PCR) and flow cytometry, respectively. The mean age of the women was 57.7 ± 13.4 years, and the mean follow-up until the patients death or January 1990 was 99 ± 87 months. Altogether, 46 women died; 38 (82.6%) of these deaths were due to cervical cancer. The 5-year survival was significantly correlated with age (P= 0.01), and the FIGO stage of the tumors (P= 0.015), but not with tumor differentiation. Diploid tumor was found in 40 (63.5%) cases, and aneuploid in 23 (36.5%) cases. A DNA index 3= 1.5 was found in 47.8% (11/23) of the cases of aneuploid tumors. The 5-year survival rate in diploid tumors was 60.0% (21/35), as compared to 54.5% (12/22) in aneuploid ones, and in patients with a DNA index of < 1.5, the 5-year survival rate was 58.7% (27/46), as compared to 54.5% (6/11) in those with a DNA index ≥ 1.5. Amplified HPV DNA was found in 30 cases (37.0%) with the pairs of HPV DNA primers for HPV types of 6, 11, 16 and 18. When repeated with the anticontamination primers, only 19 (23.5%) cases remained HPV DNA positive. HPV 16 was the most frequent type present in 57.9% (11/19) of the cases, followed by HPV 18 in 36.8% (7/19). Neither the HPV DNA-positivity nor HPV type proved to be of prognostic significance. The results suggest that despite an intimate association of HPV 16 and 18 in cervical carcinogenesis, the presence of their DNA in cancer biopsies does not seem to have any prognostic value. The most significant prognostic factors are still the age and the FIGO stage at diagnosis. Aneuploid tumors or those with DNA index ≥ 1.5 seem to have a slightly (not statistically significantly) impaired prognosis as compared with the diploid tumors and those with DNA index < 1.5.

Block of the cardiac pacemaker current (If) in the rabbit sino-atrial node and in canine Purkinje fibres by 9-amino-1,2,3,4-tetrahydroacridine

We have investigated the action of 9-amino-1, 2, 3, 4-tetrahydroacridine (THA) on the pacemaker current If in rabbit sino-atrial node myocytes and in canine Purkinje fibers. THA at concentrations in the range 3-300 microM blocked If in a voltage-independent manner, as revealed by measurements on the fully activated I/V relation for If. The dose/response relationship of the If maximal slope conductance (Gf) can be fitted by assuming a cooperative binding reaction where two THA molecules are required to block one If channel. Half-maximal block occurred at 18.2 microM in the sino-atrial node and 36.6 microM in Purkinje fibers. THA also affected the If kinetic properties. This was examined in the sino-atrial node where the current activation curve was shifted in the negative direction on the voltage axis (- 21 mV at 30 microM THA). The delayed rectifier current, IK, was also reduced by THA in sino-atrial node myocytes: at - 40 mV the IK fully activated value was decreased to 37% of its control value by 30 microM THA, with only a minor modification of the position of the activation curve at the same potential. Thus, although THA blocks If at a lower concentration than other known If-channel blockers [DiFrancesco (1982) J Physiol (Lond) 329:485-507], its action on the pacemaker current is not specific.

Effects of protein kinase inhibitors on canine Purkinje fibre pacemaker depolarization and the pacemaker current i(f)

1. The effects of the protein kinase inhibitors H-7 and H-8 were investigated on diastolic depolarization of the action potential with microelectrodes and on the pacemaker current if with the two-microelectrode voltage clamp in canine cardiac Purkinje fibres. 2. Both 200 microM-H-7 and 100 microM-H-8 had no significant effect on the slope of diastolic depolarization but eliminated the actions of isoprenaline (1 microM). 3. We examined the actions of H-7 and H-8 on if in the presence and absence of isoprenaline. H-7 (200 microM) shifted the pacemaker current if in the negative direction on the voltage axis, whereas 100 microM-H-8 had no significant effect by itself. Both 200 microM-H-7 and 100 microM-H-8 can reverse or prevent the actions of isoprenaline (1-5 microM) on if. 4. We applied activators of the cyclic AMP cascade down-stream to the beta-receptor, to further evaluate where H-7 and H-8 might be exerting their effects. When exposing Purkinje fibres to an adenylyl cyclase activator (forskolin, 10-50 microM), a phosphodiesterase inhibitor (IBMX, 100 microM) and a permeable cyclic AMP analogue (8-chlorophenylthio-cyclic AMP, 200 microM-1 mM), the amplitude of if was increased. H-7 and H-8 at 100-200 microM eliminated each of these actions. 5. These results suggest that a phosphorylation process is involved in the modulation of the pacemaker current, if, in Purkinje fibres. The different actions of H-7 and H-8 on basal if suggest the hypothesis that other protein kinases, possibly protein kinase C, might also be involved in regulating basal phosphorylation of if in Purkinje fibres.

Comparison of glycosidase activities in epidermis, palatal epithelium and buccal epithelium

1. beta-Glucosidase, alpha-glucosidase, beta-galactosidase and alpha-mannosidase were measured in epidermis, palatal and buccal epithelium of the pig (Sus scrofa). 2. All three epithelia contained similar alpha-mannosidase activity (1.7-3.2 nmol mg tissue-1 hr-1 at pH 4), and none contained significant alpha-glucosidase. 3. Specific activity of beta-glucosidase was high (9-13 nmol mg tissue-1 hr-1 at pH 4) in epidermis and palate, but activity was low (less than 2 nmol mg tissue-1 hr-1) in buccal epithelium. 4. Only epidermis contained a high level of beta-galactosidase (5.8 nmol mg tissue-1 hr-1). 5. Differences in glycosidase profiles may underlie differences in permeability barrier properties in these epithelia.

Detection of human papillomavirus (HPV) DNA in oral squamous cell carcinomas by in situ hybridization and polymerase chain reaction

A series of 156 formalin-fixed, paraffin-embedded biopsies from 40 patients with surgically-treated oral squamous cell carcinomas was analysed for the presence of human papillomavirus (HPV) infection by histopathological evaluation, in situ DNA hybridization and polymerase chain reaction (PCR). Epithelial changes suggesting a HPV lesion within, or adjacent to, the carcinoma lesions were found in 16 out of 40 patients (40%). Morphological signs of a flat HPV lesion were found in four cases (10%), those of inverted type in three cases (7.5%), and those of papillary type in nine cases (22.5%). HPV DNA was demonstrated in one of the lesions by in situ hybridization with biotin-labelled DNA cocktail probe containing HPV types 6, 11, 16 and 18. With the PCR technique, samples from 11 (27.5%) of the 40 patients proved to contain HPV DNA. Of these, HPV 6 was demonstrated in one case, HPV 16 in ten cases and HPV 18 in one case. HPV DNA was exclusively detected in the biopsies showing carcinoma tissue or its adjacent precancer lesions. No viral DNA was found in the biopsies derived from the tumour-free resection margins. These results provide further evidence to support the concept of HPV involvement in the aetiology of oral squamous cell carcinomas, most probably acting synergistically with other carcinogens.

Identification of a gene necessary for cell cycle arrest by a negative growth factor of yeast: FAR1 is an inhibitor of a G1 cyclin, CLN2

alpha factor is a negative growth factor and differentiation factor that induces G1 arrest and increases transcription of mating genes in S. cerevisiae a cells. We have identified a gene, FAR1 (for "factor arrest"), which is necessary for cell cycle arrest but not for other responses to alpha factor: far1- mutants are insensitive to arrest despite having an intact signal transduction pathway. FAR1 is a nonessential gene whose expression is induced 4- to 5-fold in a cells by alpha factor. The sequence of FAR1 indicates no significant similarities to known proteins. A null mutation in the CLN2 gene, which codes for a G1 cyclin, reverses the effect of a far1 null mutation: far1- cln2- strains arrest in response to alpha factor. We thus propose that FAR1 contributes to cell cycle arrest by inhibiting CLN2. The behavior of far1- cln2- strains indicates that products other than FAR1 are responsible for inhibiting the other G1 cyclins, CLN1 and CLN3.

Verrucous carcinoma of the anus containing human papillomavirus type 16 DNA detected by in situ hybridisation: a case report

Verrucous carcinoma of the anus is a distinct and rare variant of well-differentiated squamous cell carcinoma. A case of anal verrucous carcinoma in a 35 year old man was studied by light microscopy and in situ DNA hybridization. Human papillomavirus (HPV) type 16 DNA sequences were demonstrated in the tumour cells, as well as in cells showing koilocytotic and dyskeratotic changes. The possible viral (HPV) aetiology of verrucous carcinoma is considered with a review of the previous literature.

Detection of human papillomavirus (HPV) in genital warts and carcinomas by DNA in situ hybridization in Chinese patients

A series of 51 genital biopsies from normal epithelium, condylomata acuminata, leucoplakia and squamous cell carcinoma from Chinese male and female patients were analysed for the presence of human papillomavirus (HPV) types 6, 11, 16 and 18 by DNA in situ hybridization. All of the nine genital condyloma acuminata were positive for HPV DNA, in which HPV 6 was found in six cases, HPV 11 in two cases and HPV 18 in one case. Twelve out of the 21 cases (57.1% of the total) of cervical squamous cell carcinoma were shown to contain HPV DNA; HPV 16 was found in nine cases, HPV 18 in two cases and HPV 16/18 in one case. Present results support the earlier concept that HPV 6/11 are closely associated with benign genital lesions, and HPV 16/18 are mostly confined to higher grade of intra-epithelial neoplasias and carcinoma.

CDC36 and CDC39 are negative elements in the signal transduction pathway of yeast

Mutations in either the CDC36 or CDC39 gene cause yeast cells to arrest in G1 of the cell cycle at the same point as treatment with mating pheromone. We demonstrate here that strains harboring temperature-sensitive mutations in CDC36 or CDC39 activate expression of the pheromone-inducible gene FUS1 when shifted to nonpermissive temperature. We show further that cell-cycle arrest and induction of FUS1 are dependent on known components of the mating factor response pathway, the STE genes. Thus, the G1-arrest phenotype of cdc36 and cdc39 mutants results from activation of the mating factor response pathway. The CDC36 and CDC39 gene products behave formally as negative elements in the response pathway: they are required to block response in the absence of pheromone. Epistasis analysis of mutants defective in CDC36 or CDC39 and different STE genes demonstrates that activation requires the response pathway G protein and suggests that CDC36 and CDC39 products may control synthesis or function of the G alpha subunit.

Detection of human papillomavirus DNA in cytologic specimens derived from esophageal precancer lesions and cancer

A series of 80 esophageal cytologic specimens derived from the same number of patients with previously diagnosed squamous cell dysplasia of the esophagus were examined for the presence of human papillomavirus (HPV) infection by filter in situ hybridization (FISH), using a mixed DNA probe containing HPV types 11, 16, and 18. All the patients came from an area at high risk for esophageal cancer in China. A total of 53 cases (66.3%) were demonstrated as HPV-DNA-positive. HPV DNA was detected in 22.2% (2 of 9) of the patients without cytologic atypia, in 50% (3 of 6) with mild dysplasia, in 80.6% (25 of 31) with moderate dysplasia, in 67.9% (19 of 28) with severe dysplasia, and in 66.7% (4 of 6) with an invasive squamous cell carcinoma. The present results confirm the recent findings on HPV involvement in esophageal squamous cell lesions. They support the hypothesis that HPV is a possible etiologic agent in esophageal carcinogenesis, most probably acting synergistically with physical, chemical, and/or nutritional factors that have previously been related with this malignancy in the high-risk areas of China.

Acetylcholine reverses effects of beta-agonists on pacemaker current in canine cardiac Purkinje fibers but has no direct action. A difference between primary and secondary pacemakers

We have investigated the actions of acetylcholine in the absence and presence of the beta-agonist isoproterenol in cardiac Purkinje fibers. beta-Agonists, like isoproterenol, increase the magnitude of the pacemaker current (If) in cardiac myocytes by shifting its activation voltage more positive on the voltage axis. We find that acetylcholine has no effect on If in the absence of isoproterenol. However, if If is first increased by beta-agonist stimulation, acetylcholine can then return If to control levels. This effect on If is exerted through muscarinic receptors since atropine prevents this action of acetylcholine. Functionally, this action of acetylcholine can guarantee the maintenance of ventricular pacemakers when there is high parasympathetic tone but can also prevent extra ventricular beats when sympathetic and parasympathetic tone are both high.

Human papillomavirus (HPV) DNA in esophageal precancer lesions and squamous cell carcinomas from China

A series of 51 biopsies derived from the same number of patients with established invasive squamous-cell carcinoma of the esophagus in Linxian, a high-risk area for esophageal cancer in China, were analyzed histologically and by in situ DNA hybridization to demonstrate human papillomavirus (HPV) infection. Epithelial changes suggesting HPV infection within or adjacent to the carcinoma lesions were found in 25 cases (49.0%). Esophageal lesions with HPV morphology showed both flat (25 cases) and inverted condylomas (2 cases) resembling those found in the genital tract. HPV 6, 11, 16 or 18 DNA sequences were detected in 22/51 (43.1%) of the esophageal specimens. HPV DNA was most frequently localized in epithelium adjacent to carcinomas in areas showing either epithelial hyperplasia (36.1%) or dysplasia (22.2%). Of the lesions with morphological HPV changes, 64% (16/22) were shown to contain HPV DNA. In 2 specimens, HPV DNA was found in frankly malignant cells. High-risk types HPV 16 and/or 18 DNA sequences were found in 16 of the 22 HPV DNA-positive cases (72.7%). Our results confirm previously reported HPV involvement in esophageal squamous-cell lesions, and support the hypothesis of HPV as a possible etiological agent in esophageal carcinogenesis.

Metastatic breast cancer complicating pregnancy. A case report

An 18-year-old patient at 15 weeks' gestation was hospitalized for a high fever and delirium secondary to a presumed viral syndrome. She had massive hepatomegaly, and a small breast lump was noted incidentally. Abnormalities in the differential blood count and liver function tests were found in addition to thrombocytopenia. Bone marrow biopsy revealed metastatic breast cancer.

Effect of exercise training and sucrose feeding on insulin-stimulated glucose uptake in rats with streptozotocin-induced insulin-deficient diabetes

The effect of exercise training and a sucrose-rich diet on insulin-stimulated glucose disposal was studied in rats with streptozotocin-induced insulin deficiency. Rats were injected with streptozotocin (40 mg/kg), and 3 days later divided into three groups with equal degrees of hyperglycemia. One group of rats was allowed to run spontaneously on exercise wheels, another group remained sedentary but ate a sucrose-rich diet (66% sucrose), and the third also remained sedentary but consumed conventional rat chow. Three weeks later, we determined the effect of these various programs on postabsorptive plasma glucose and insulin levels, as well as on the ability of exogenous insulin to stimulate disposal of a glucose load during a period in which endogenous insulin was suppressed by epinephrine and propanolol. Basal plasma insulin levels were the same in all three groups, but plasma glucose levels were significantly lower (P less than 0.001) in exercise-trained rats, and significantly higher (P less than 0.05) in sucrose-fed rats, than in chow-fed diabetic rats. The inference that exercise training markedly enhanced insulin action in rats with insulin deficiency was borne out by direct estimation of insulin-stimulated glucose disposal. In contrast, sucrose-fed diabetic rats seemed to be more insulin-resistant than chow-fed diabetic rats. These results provide direct evidence that spontaneous exercise can dramatically attenuate the severity of diabetes in insulin-deficient rats by enhancing insulin action. DIABETES 32:165-168, February 1983.

Effect of exercise and diet on triglyceride metabolism in rats with moderate insulin deficiency

The ability of exercise and diet to modify the effects of moderate streptozotocin-induced insulin deficiency on triglyceride metabolism has been studied in the rat. Insulin-deficient rats allowed to run spontaneously in exercise wheel cages had significantly lower (P less than 0.001) plasma glucose levels (187 +/- 19 mg/dl) than either sedentary (374 +/- 24 mg/dl) or sucrose-fed (450 +/- 13 mg/dl) diabetic rats, despite the fact that plasma insulin levels were comparable in all these groups. Plasma triglyceride (TG) levels in exercise-trained rats with diabetes (51 +/- 5 mg/dl) were actually lower than in control rats with normal glucose tolerance (90 +/- 14 mg/dl). In contrast, plasma TG levels were higher than control levels in diabetic sedentary rats (128 +/- 11 mg/dl), and severe hypertriglyceridemia developed in sucrose-fed diabetic rats (369 +/- 35 mg/dl). The ability of exercise training to attenuate diabetic hypertriglyceridemia, which was observed in both chow-fed and sucrose-fed rats, was secondary to a decrease in TG secretion, and appeared to be related to lower plasma FFA concentrations. In contrast, the accentuation of diabetic hypertriglyceridemia seen in sucrose-fed rats was related to a defect in TG catabolism. Adipose tissue lipoprotein lipase (LPL) activities were essentially identical in all diabetic rats, suggesting that the observed difference in TG kinetics could not be attributed to concomitant increases or decreases in adipose tissue LPL activity. These results emphasize the powerful impact of exercise and diet on TG metabolism in rats with moderate degrees of insulin deficiency.

Benign ulceration of the cecum presenting with massive hemorrhage: report of a case and review of the literature

Massive gastrointestinal hemorrhage secondary to benign cecal ulceration is a rare occurrence. The diagnosis of bleeding from this benign condition is rarely entertained and is often a finding on a pathologic examination. A case of massive hemorrhage from a cecal ulcer is presented, and the literature is reviewed. The role of angiographic demonstration of the lesion, if angiography is readily available, is emphasized, but surgery is the definitive therapy.

Effect of exercise-training on the metabolic manifestations of streptozotocin-induced diabetes in the rat

Streptozotocin-induced insulin deficiency of a moderate degree was produced in exercise-trained and sedentary young rats, and determinations made of subsequent changes in plasma glucose, triglyceride, and insulin concentrations. Exercise-training attenuated the rise in both plasma glucose and triglyceride concentrations associated with insulin deficiency. Plasma insulin levels were, if anything, lower in exercise-trained rats. Thus, the beneficial effects of exercise-training on plasma glucose and triglyceride concentrations could not be due to the preservation of endogenous insulin secretion, and appear to be secondary to enhanced insulin sensitivity.

Markedly raised synovial fluid leucocyte counts not associated with infectious arthritis in children

Synovial fluid leucocyte counts greater than 50 000 cells/mm3 (50 X 10(9)/1) are usually associated with infectious arthritis. Six children, 3 of whom meet the criteria for juvenile rheumatoid arthritis (JRA), are described with synovial fluid white blood cell counts greater than 88 000 cells/mm3 (88 X 10(9)/1). Two had synovial fluid leucocyte counts greater than 100 000 cells/mm3 (100 X 10(9)/1). The diagnosis of infectious arthritis was unlikely in these 6 children since the synovial fluid smears and cultures for infectious agents were negative and their histories atypical for infection. While in most instances such markedly raised synovial fluid leucocyte counts indicate infection, this finding is not diagnostic of septic arthritis.