[Guidelines for health surveillance of health care workers exposed to biological risks set up by the Italian Society for Occupational Health and Industrial Hygiene: application in health facilities of the Regional Health Administration--District No. 7, Ancona]

BACKGROUND

Evidence Based Medicine and the need to achieve better management of health budgets call for verification and, if necessary, revision of the criteria used in Occupational Health, in order to ensure appropriate measures as regards protection of health at the workplace. In December 2003, the Marche Region initiated a process of reform of the regional health service, which will be completed in two years, and will provide a new regional health organization that will improve the quality and appropriateness of health services available to the population. The reform also involves the Occupational Health Services responsible for prevention activities for 20,000 health care workers employed in regional public health facilities. The need was strongly felt to set up a network that would meet the health needs of health care workers, by adopting a common language among occupational health physicians, by eliminating reported criticism, which is due not only to lack of communication between different structures and profiles, but also to the different methods of approach, evaluation and management of occupational risks.

OBJECTIVES AND METHODS

From a historical point of view, the health sector has the biggest as regards prevention of biological risk. Therefore, with a view to harmonizing actions and approach among occupational health physicians in the evaluation of this risk, the publication by the Italian Society for Occupational of Health and Industrial Hygiene of Guidelines for health surveillance of health care workers exposed to biological risks, produced by the working group under the leadership of Prof. Lorenzo Alessio, was considered to offer an interesting opportunity to verify the reproducibility of methods and the quality of results, as applied to health facilities under the Regional Health Administration in Ancona (District No. 7).

RESULTS AND CONCLUSION

The Guidelines fully confirmed the need to plan activities, starting from analysis of epidemiological and occupational data, thus assuring good results both in terms of efficacy and efficiency of the health surveillance programme used. This method also assures a high level of appropriateness of medical measures as regards the "safety" target, at the same time avoiding waste and poor management of human and economic resources, which were till now caused by differences in methods used in assessment of biological risk.

The policy of antenatal corticosteroid administration in Italy vs. other European countries

OBJECTIVE

To describe antenatal corticosteroid policies in Italy in comparison with other European countries, as inferred by the published data of the EURAIL Study Group (1999).

METHODS

The results of a mail survey of departmental policies in Italy and Europe were compared.

RESULTS

The survey response rate was similar in Italy and Europe (86% and 81%, respectively); 70.7% of the respondents in Italy and 84% in Europe started antenatal corticosteroids from 24 to 28 weeks' gestation; however, 5% of respondents in Italy started at a gestational age of >34 weeks. The use of multiple antenatal corticosteroid courses was observed in 81% of the units in Italy and 87% in Europe. Betamethasone was the more frequently used drug in Italy.

CONCLUSIONS

Antenatal corticosteroids are used frequently in Italy and Europe in accordance with international recommendations, although many differences exist in the mode of administration. In 1999 almost all units used multiple courses, although this may not represent the rule 5 years later, following the publication of a prospective randomized trial that questioned the benefits of multiple courses of antenatal corticosteroids.

The web survey network of sudden infant death syndrome and apparent life-threatening events in the Emilia-Romagna region

To survey epidemiology and to study the etiology of sudden infant death syndrome (SIDS) and apparent life threatening events (ALTE) in Emilia-Romagna, a web network was constituted. A regional supervisor and a steering committee plan the action of district and local co-ordinators. They keep contact with the Regional Office of Health Services. District and local co-ordinators collect clinical and laboratory and, in case of SIDS, also autopsy data. Records are communicated to the Regional Supervising Center by on-line software. From these data, future planning of care and of mass information as well as auditing of their efficacy can be carried out. The characteristics of the network that has just started to collect data, as well its future developmental aspects, are discussed.

Inflammatory cells contribute to the generation of an angiogenic phenotype in pancreatic ductal adenocarcinoma

BACKGROUND

Inflammatory cells contribute to the growth and spread of human malignancies by producing molecules that enhance tumour invasiveness.

AIMS

To characterise the inflammatory infiltrate in pancreatic ductal adenocarcinoma and to analyse its contribution to angiogenesis and its prognostic relevance.

METHODS

Immunohistochemistry was used to identify inflammatory cells and evaluate the expression of proangiogenic and prolymphangiogenic molecules (vascular endothelial growth factor A (VEGF-A), VEGF-C, and basic fibroblast growth factor (bFGF)) by inflammatory and cancer cells in 137 pancreatic cancers. Intratumorous microvessel density (IMD) was assessed using CD34 as an endothelial cell marker.

RESULTS

There were significantly more mast cells and macrophages in pancreatic cancers than in normal pancreas and the number of mast cells directly correlated with the presence of lymph node metastases. However, there was no relation between numbers of infiltrating inflammatory cells and the presence of chronic pancreatitis (CP)-like changes in the parenchyma surrounding the tumour. Double immunostaining revealed that both pancreatic mast cells and macrophages express VEGF-A, VEGF-C, and bFGF. These factors were also expressed in the tumour cells in many cases. The numbers of VEGF-A expressing tumour cells and bFGF expressing tumour and inflammatory cells significantly correlated with IMD. Moreover, tumours with higher IMD had higher numbers of infiltrating mast cells and macrophages.

CONCLUSIONS

Mononuclear inflammatory cells of the non-specific immune response are recruited to pancreatic cancer tissues independent of the presence of CP-like changes, may influence the metastatic capacity of the cancer cells, and may contribute to the development of tumours with high angiogenic activity.

A longitudinal evaluation of the effect of two doses of tibolone on bone density and metabolism in early postmenopausal women

Tibolone, a steroid with tissue-specific activities, can reduce the bone resorption that takes place after the menopause. The present calcium-controlled, 2-year study aimed to evaluate the effect of two doses of oral tibolone, 1.25 mg and 2.5 mg, on bone loss in early postmenopausal women. The subjects were randomly allocated to one of the three groups, namely tibolone 2.5 mg (n = 30), tibolone 1.25 mg (n = 30) and a control group (n = 30). All subjects received 1000 mg of calcium per day. In the control group, vertebral and femur bone mineral density (BMD) decreased significantly (p < 0.05) after 12 and 24 months. In both tibolone groups, vertebral and femur BMD increased significantly (p < 0.05) increased after 12 and 24 months. In the control group, bone turnover markers (urinary excretion of hydroxyproline/creatinine and plasma osteocalcin levels) remained constant, while in both tibolone groups these markers showed similar significant decreases (p < 0.05) after 12 and 24 months. After 24 months, body weight increased in the control group (p < 0.05), while smaller increments were evident in the tibolone groups. Symptom scores in the control group did not show any significant modification during the study. In contrast, the administration of 2.5 mg tibolone was significantly (p < 0.05) effective in reducing hot flushes and other symptoms. The tibolone 1.25 mg group yielded similar results (even if it was proportionally less efficient) to the higher dose. It is concluded that tibolone is effective, even at lower doses, in relieving climacteric symptoms and preventing a decrease in spine and femur BMD in early postmenopausal women.

An observational study of surfactant treatment in infants of 23-30 weeks' gestation: comparison of prophylaxis and early rescue

OBJECTIVE

To test the clinical efficacy of exogenous surfactant for treatment of neonatal respiratory distress syndrome (RDS).

METHODS

In a retrospective multicenter observational study, data were collected on 987 infants of 23-30 weeks' gestation given surfactant for respiratory problems within 3 h of birth. Obstetric, neonatal and short-term outcome data were retrieved from recording charts and analyzed after subdivision of the sample into two treatment groups: prophylaxis (surfactant within 15 min) and early rescue (surfactant at 16-180 min).

RESULTS

A total of 965 infants were eligible for the study: 244 receiving prophylaxis and 721 receiving early rescue. The prophylaxis group had lower gestational ages and birth weights than the early rescue group (p = 0.0001), but were otherwise comparable. Natural surfactants were used in > 90% of infants in both groups. The rates of retreatments and the mean total doses of surfactant were similar in both groups. Babies receiving prophylaxis presented less grade 3-4 RDS than those receiving early rescue (32.4% vs. 53.8%, p = 0.0001). Those requiring prophylaxis also needed lower peak inspiratory pressure and had a shorter duration of oxygen therapy. Mortality and complications were similar between the groups, but babies receiving prophylaxis had less pulmonary interstitial emphysema (p = 0.0006) and periventricular leukomalacia (p = 0.0113) than infants receiving early rescue.

CONCLUSIONS

In clinical practice, prophylaxis was preferred in babies with lower birth weights and gestational ages compared to early rescue treatment. Not surprisingly, infants treated with prophylactic surfactant had a lower rate of RDS than the infants treated by early rescue, even though they did not need less surfactant overall.

Can breast-feeding protect against schizophrenia? Case-control Study

BACKGROUND

Human milk, unlike formula feeds, contains long-chain polyunsatured fatty acids, such as docosahexaenoic acid and arachidonic acid which are essential in the development of the central nervous system. If human milk is the optimal food for brain development, and if schizophrenia is a neurodevelopment disorder, might people who become schizophrenic in adult life be less likely to have been breast-fed?

AIMS

To compare the incidence and length of breast-feeding in patients, siblings and normal controls and to examine the relationship between the duration of breast-feeding and age at onset of schizophrenia.

METHOD

113 schizophrenic patients were recruited, as were 140 siblings of the patients and 113 nonschizophrenic controls. The breast-feeding history of the patients, their siblings and controls was obtained through interviews with the mothers of the patients and controls.

RESULTS

There were no significant differences between groups in the incidence of breast- feeding. The duration of breast-feeding was positively correlated with the age at onset of illness (r = +0.25, p < 0.02).

CONCLUSION

Breast-feeding is no less common in those who develop schizophrenia in later life. However, breast milk might postpone the onset of the illness in schizophrenic patients.

Dentin matrix protein 1 is expressed in human lung cancer

We have previously shown that breast and prostate cancers express bone matrix proteins. DMP1 expression was evaluated in 59 human lung cancer samples at the protein and mRNA levels. It was detectable in 80% of the cases, suggesting a potential role for DMP1 in tumor progression and bone metastasis.

INTRODUCTION

Previously, we and others have shown that bone extracellular matrix proteins such as bone sialoprotein (BSP) and osteopontin (OPN) are expressed in various types of cancer that are characterized by a high affinity for bone including breast, prostate, and lung adenocarcinoma. Based on biochemical and genetic features, BSP, OPN, dentin matrix protein 1 (DMP1), and dentin sialophosphoprotein (DSPP) have been recently classified in a unique family named SIBLING (small integrin-binding ligand, N-linked glycoprotein). Therefore, we investigated whether DMP1 could also be detected in osteotropic cancers.

MATERIALS AND METHODS

We first used a cancer array for evaluating the relative abundance of DMP1 transcript in a broad spectrum of human cancer tissues. This screening showed that DMP1 was strongly detectable in lung tumors compared with normal corresponding tissue. In a second step, we used an immunophosphatase technique and a specific polyclonal antibody directed against DMP1 to examine the expression of DMP1 in 59 human non-small cell lung cancer samples, including 29 squamous carcinoma, 20 adenocarcinoma, and 10 bronchioloalveolar carcinoma. Student's t-test was used to determine the statistical significance of immunostaining scores between the lung cancer histological groups studied and between cancer and normal lung tissues.

RESULTS

Our results show that DMP1 is detectable in 90% of the adenocarcinoma and squamous carcinoma analyzed while 8 of 10 bronchioloalveolar specimens were negative. DMP1 immunostaining intensity and extent scores were significantly higher in adenocarcinoma (p = 0.0004) and squamous carcinoma (p < 0.0001) samples compared with adjacent normal lung tissue. In situ hybridization experiments confirmed that DMP1 mRNA is localized in lung cancer cells.

CONCLUSION

In this study, we show that a third SIBLING protein is ectopically expressed in lung cancer. The role of DMP1 in lung cancer is largely unknown. Further studies are required to determine the implication of this protein, next to its sisters SIBLING proteins, in tumor progression and bone metastasis development.

Breast MR imaging screening in eight women proved or suspected to be carriers of BRCA1&2 gene mutations

The aim of this study was to evaluate the efficacy of MR imaging for the early detection of breast tumor in women at high genetic risk compared to conventional strategies such as ultrasonography and mammography. This study included 8 women, 5 of which had undergone surgery for breast cancer. BRCA germ line mutations were detected in 7 women, one patient was enrolled for more than 50% probability to be carrier of BRCA mutation. RM imaging screening was negative in 7 patients and strongly indicative of a malignant lesion in one. The gold standard was surgery for the suspicious cases and follow-up with clinical examination and conventional imaging every six months for the others. MR imaging proved itself to be a reliable technique in familial breast cancer high risk women.

The Italian multi-centre project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk

This report presents the preliminary results of the first phase (21 months) of a multi-centre, non-randomised, prospective study, aimed at evaluating the effectiveness of contrast-enhanced magnetic resonance imaging (MRI), X-ray mammography (XM) and ultrasound (US) in early diagnosis of breast cancer (BC) in subjects at high genetic risk. This Italian national trial (coordinated by the Istituto Superiore di Sanità, Rome) so far recruited 105 women (mean age 46.0 years; median age 51.0; age range 25-77 years), who were either proven BRCA1 or BRCA2 mutation carriers or had a 1 in 2 probability of being carriers (40/105 with a previous personal history of BC). Eight cases of breast carcinomas were detected in the trial (mean age 55.3 years, median age 52.5; age range 35-70 years; five with previous personal history of BC). All trial-detected BC cases (8/8) were identified by MRI, while XM and US correctly classified only one. MRI had one false positive case, XM and US none. Seven "MRI-only" detected cancers (4 invasive, 3 in situ) occurred in both pre- (n = 2) and post-menopausal (n = 5) women. With respect to the current XM screening programmes addressed to women in the age range 50-69 years, the global incidence of BC in the trial (7.6%) was over ten-fold higher. The cost per "MRI-only" detected cancer in this particular category of subjects at high genetic risk was substantially lower than that of an XM-detected cancer in the general women population. These preliminary results confirmed that MRI is a very useful tool to screen subjects at high genetic risk for breast carcinoma, not only in pre-, but also in post-menopausal age, with a low probability of false positive cases.

Quality control for biomarker determination in oncology: the experience of the Italian Network for Quality Assessment of Tumor Biomarkers (INQAT)

Biomarker analysis and evaluation in oncology is the product of a number of processes (including managerial, technical and interpretation steps) which need to be monitored and controlled to prevent and correct errors and guarantee a satisfactory level of quality. Several biomarkers have recently moved to clinical validation studies and successively to clinical practice without any definition of standard procedures and/or quality control (QC) schemes necessary to guarantee the reproducibility of the laboratory information. In Italy several national scientific societies and single researchers have activated -- often on a pilot level -- specific external quality assessment protocols, thereby potentially jeopardizing the clinical reality even further. In view of the seriousness of the problem, in 1998 the Italian Ministry of Health sponsored a National Survey Project to coordinate and standardize the procedures and to develop QC programs for the analysis of cancer biomarkers of potential clinical relevance. Twelve QC programs focused on biomarkers and concerning morphological, immunohistochemical, biochemical, molecular, and immunoenzymatic assays were coordinated and implemented. Specifically, external QC programs for the analytical phase of immunohistochemical p53, Bcl-2, c-erb-2/neu/HER2, and microvessel density determination, of morphological evaluation of tumor differentiation grade, and of molecular p53 analysis were activated for the first time within the project. Several hundreds of Italian laboratories took part in these QC programs, the results of which are available on the web site of the Network (www.cqlaboncologico.it). Financial support from the Italian Government and the National Research Council (CNR) will guarantee the pursuit of activities that will be extended to new biomarkers, to preanalytical phases of the assays, and to revision of the criteria of clinical usefulness for evaluating the cost/benefit ratio.

Timing of exogenous surfactant administration in clinical practice. Report of a multi-center Italian Observational Study

We now have convincing data that surfactant administration in newborns with the respiratory distress syndrome (RDS) is effective in reducing the need for respiratory supports and improves the clinical outcomes. To evaluate the different strategies adopted in clinical practice for the surfactant use we performed an observational multicenter study. All newborns with gestational age (g.a.) between 24-32 wk. with RDS and that were in need of mechanical ventilation and treated with exogenous surfactant from 1994 to 1996 in twelve Neonatal Intensive Care Units have been evaluated. The patients have been divided into two groups: one includes babies that were given surfactant within the first 15 minutes of life (very early -VE- treated) and the other includes those that received the treatment at age 16- 180 minutes (early -E- treated). The analysis concerned 246 cases, 54 VE treated and 192 E treated. The two groups were comparable with regards to sex, Apgar score at one and five minutes, maternal treatment with steroids and multiple pregnancy. Mean birth weight and g.a. were significantly lower and the rate of caesarean sections was higher in the VE than in the E. Almost 80% of the VE newborns had a g.a. equal or less than 28 wks. One single dose of surfactant was administered in 77.8% of VE babies and 45.3% in the E group, while 18.5% VE and 36.8% E received two doses, 3.7% VE and 16.3% E were given three doses. The mean number of doses used per patient was 1.3 in VE and 1.7 in E. 62.5% of cases with g.a. equal to or less than 26 wks and 80.8% of those with g.a. 27-28 wk. received a single dose if VE, compared to 31.9% and 49.1% respectively if E treated. Prenatal prophylaxis of RDS with steroids, considering only the mothers that received a complete course between 48 hrs and 7 days before the delivery, did not modify the number of doses of surfactant required in both groups. The main outcomes did not differ in the two groups: mortality at 28 days of life, age at death, pneumothorax, intraventricular haemorrhage grade 3-4, retinopathy of prematurity grade 3-4, patent ductus arteriosus and oxygen dependency at 36 wks post-conceptional age.

CONCLUSIONS

Very early surfactant administration in clinical practice reserved for newborns with the lowest g.a., improves the outcome and does not increase surfactant consumption.

Normal values of reactive oxygen metabolites on the cord-blood of full-term infants with a colorimetric method

The main end-point of the study was to evaluate the normal values of reactive oxygen metabolites (ROMs) in healthy full-term babies. Secondary end-points were differences between groups related to modality of delivery, Apgar score, birth weight, gestational age and sex. All apparently healthy babies born at our institution between 8 a.m. and 8 p.m. Monday to Friday with gestational age 37-42 weeks, delivered both vaginally or by caesarean section and without foetal distress and perinatal asphyxia. ROMs were evaluated by a colorimetric method (d-ROM test) on cord-blood immediately after birth. The values are reported as arbitrary unit U. Carr. Statistical analysis was performed by t-test and by multiple and stepwise regression analysis. We have analyzed 80 babies with mean birth weight 3301 +/- 446 g. and mean gestational age 39.5 +/- 1.0 weeks. The male:female ratio was 1.56 and the median (range) Apgar score was 9 (7-10) at 1' and 10 (9-10) at 5'. The babies born by vaginal delivery were 37 out of 80 while the remaining 43 were delivered by cesarean section. Because the two groups did not differ for the clinical characteristics they were considered together for the determination of the mean value of ROMs and indicated as "total". The mean value +/- SD of ROMs of the "total" was 115.5 +/- 32.6 U. Carr. Significant differences in the mean value of ROMs were not found related to type of delivery, birth weight, gestational age, and Apgar score at 1' and 5'. Instead the female infants had a significantly lower mean value of ROMs than the male babies (respectively 104.4 +/- 32.2 vs 120.2 +/- 30.6 U. Carr.; p = 0.031). Multiple and stepwise regression analyses both demonstrated that the sex of the neonate is able to independently influence the value of ROMs (respectively p = 0.025 and p = 0.035). The main end-point of the study was to determine the standard reference values for this method in the healthy full-term infant at birth: the values of ROMs we found in the "total" population are lower than those of healthy adults (between 250-300 U. Carr.) and similar to those of adults treated with steroids or antioxidant drugs. The finding that the female sex is able to independently determine lower values of ROMs at birth compared to the male sex, lets speculate that the female infants are less prone to oxidative stress in the first moments of life.

[Prevention of perinatal infection caused by group B beta-hemolytic streptococcus]

Streptococcus agalactiae strains or group B streptococci (GBS) are the leading cause of bacterial pneumoniae, sepsis and meningitis in neonates. GBS is also a major cause of bacteriemia in pregnant women. Colonization of the human rectovaginal tract with GBS is a risk factor associated with chorioamnionitis and transmission of the infection to the infant. Neonatal exposure to high concentrations of GBS, mainly during vaginal delivery, leads to colonisation of the lung airways and subsequent onset of severe diseases like pneumonia, sepsis and menigitis. GBS is present in the genitourinary tract of 10% to 40% of pregnant women, about 50% of the newborns of these mothers will be colonised during delivery and of these neonates, 1% to 2% present a severe invasive disease. The early-onset disease, appear in the neonates within 7 days of life and more than 90% occur within the first day of life. Fatal infection is associated commonly with fulminat and overwhelming early-onset disease. Maternal-intrapartum chemoprophylaxis is able to prevent the transmission of GBS to the newborn and to reduce the frequency and the severity of early onset disease. In many countries, in particular in US, several recommendations have been proposed to prevent the perinatal GBS infection. In this paper some recommendations to prevent GBS disease of the newborn, performed in collaboration with Italian Society of Perinatal Medicine, are presented. The most important problem in the prevention programme is the identification of the cases to treat, since it is not possible to give antibiotics to all the women. We combine two strategies for the identification of the women to be treated, one risk based and the other screening based. Intra-partum administration of ampicillin or penicillin is recommended for the women with one or more risk-factors (labour < 37 weeks of gestation, duration of ruptured membranes > = 18 hours, intrapartum temperature > = 38 degrees C, previous infant with invasive GBS disease, diabetes) and for women with collect vaginal and rectal swab for GBS culture at 36-38 weeks' gestation, positive for GBS. No treatment is required for the babies of women intrapartum treated or with negative culture performed near term. Treatment with ampicillin is necessary, only in the new-borns of women with incomplete or unknown results or not done cultures and in those born from mothers with positive cultures, but not intrapartum treated. Collection of swabs for GBS is recommended before antibiotic administration. If the culture is negative, we suggest to stop the antibiotic therapy, otherwise the treatment must be continuated for 5-7 days. In conclusion, a written protocol for prevention of GBS infection in new-born must be adopted in every delivery centre and one possible protocol is proposed in this paper.

Failure of primary breast cancer neoangiogenesis to predict pattern of distant metastasis

In the present study, the primary tumor neoangiogenesis characteristics of 81 stage IV previously untreated breast cancers with synchronous metastasis to different distant sites (10 patients with soft tissue metastases, 31 with bone metastases, and 40 with visceral metastases) were analyzed. The primary intratumor microvessel density was assessed by immunohistochemical assay on paraffin-embedded primary tumor samples, using a monoclonal anti-CD34 antibody. The mean primary intratumor microvessel density (at 400x fields) was 78 +/- 39 (SD) microvessels per field. The microvessel density was not significantly related to the main clinical/pathological features of the tumor (age, cytohistological grade, DNA ploidy, diameter, and receptor status). The percentage of tumor cases with high primary intratumor microvessel density (cut-off median value of the series 73 +/- 39 microvessels/field) did not significantly differ in patients with bone, soft tissue, or visceral metastatic disease. Analysis of clinical outcome showed a significantly shorter time to progression and overall survival for patients with visceral metastases (P<0.001 and P<0.0002 by log-rank, respectively). Presence of visceral metastases was confirmed to be the only independent prognostic factor related to a worse TTP (hazard risk 2.15, 95% confidence interval 1.14-4.03, P<0.02) and overall survival (hazard risk 1.81, 95% confidence interval 0.98-3.35, P<0.06) by multivariate analysis. In conclusion, the assessment of neoangiogenesis of primary breast cancer by CD34 expression does not provide information predictive of different distant sites of metastasis.

mRNA markers of breast cancer nodal metastases: comparison between mammaglobin and carcinoembryonic antigen in 248 patients

Histological detection of axillary lymph node metastases is still the most valuable prognostic parameter for breast cancer, but about 30% of node-negative patients relapse within five years, suggesting that current methods are inadequate for identifying metastatic disease. More sensitive, PCR-based methods for the detection of metastatic cells are now available, enabling the amplification of cancer cell-specific mRNA messages by the RT-PCR assay. An ideal tumour marker, consistently expressed in tumour samples and not at all in normal lymph nodes, remains to be identified. The present study first investigated the expression of seven mRNA markers, CEA, CK19, c-Met, mammaglobin, MUC-1, beta1-->GalNAc-T and p97, selected on the basis of their previously reported specificity for breast cancer cells. Eighteen lymph nodes were examined from patients without tumours. Only mammaglobin mRNA and CEA mRNA were not expressed in normal nodes. All of the other markers showed a band of expression in 17%-55% of cases, indicating that they are not breast cancer-specific. CEA mRNA and mammaglobin mRNA expression could be detected in 15/20 (75%) and 19/20 (95%) primary breast carcinomas, respectively. The expression of mammaglobin mRNA and CEA mRNA was then compared in axillary lymph nodes from 248 consecutive breast cancer patients, 89 with histologically documented lymph node metastasis and 159 without histological evidence of metastatic disease. Ninety-seven per cent of the patients with histologically involved nodes showed expression of mammaglobin mRNA, whereas CEA mRNA was expressed in 79% of these cases. In the group of patients with histologically negative lymph nodes, 46 (29%) and 32 (20%) were found to be positive for mammaglobin and CEA expression, respectively, indicating the presence of metastases not detected by routine histological examination of one lymph node section. These results show that both mammaglobin RT-PCR and CEA RT-PCR are useful tools for the detection of breast cancer metastases in axillary lymph nodes. The detection sensitivity of the mammaglobin RT-PCR is far superior to that of the CEA RT-PCR, allowing the diagnosis of occult metastases in nearly one-third of cases.

Bcl-2 expression in pancreas development and pancreatic cancer progression

Apoptosis is important for both tissue development and differentiation; its deregulation may contribute to tumourigenesis. In order to clarify the role of Bcl-2, an apoptosis-inhibiting protein, in pancreatic morphogenesis and tumour progression, its immunohistochemical expression was evaluated in 12 samples of fetal pancreas, in 10 samples of adult pancreas with ductal hyperplastic lesions, in 120 cases of primary pancreatic ductal adenocarcinoma, and in 43 synchronous metastatic lymph nodes. To evaluate the role of apoptosis in pancreatic cancer, p53 expression was also studied in tumour samples. Bcl-2 cytoplasmic acinar and ductal immunostaining was found in all fetal and adult tissue samples; ductal hyperplastic lesions were constantly negative. Thirty out of 120 (25%) tumours and 3 out of 43 (7%) lymph nodes expressed Bcl-2, whereas 67 out of 120 (56%) expressed nuclear p53. Well-differentiated tumours (G1) were more frequently Bcl-2-positive (p=0.002); furthermore, there was an inverse correlation between Bcl-2 and p53 expression in primary tumours (p=0.02). Neither Bcl-2 nor p53 influenced patients' prognosis, which was instead affected by N (p=0.02) and M (p<0.0001) status and stage of the disease (p=0.002). It is concluded that Bcl-2 regulates pancreatic morphogenesis and tissue homeostasis from early fetal to adult life and can be considered a phenotypic marker of normal exocrine pancreas. On the other hand, the lack of expression in preneoplastic lesions and the low positivity found in primary tumours and lymph node metastases suggest that Bcl-2 does not play a centralrole in pancreatic tumourigenesis and cancer progression.