Mice deficient for the secreted glycoprotein SPARC/osteonectin/BM40 develop normally but show severe age-onset cataract formation and disruption of the lens

SPARC (secreted protein acidic and rich in cysteine, also known as osteonectin/BM40) is a secreted Ca2+-binding glycoprotein that interacts with a range of extracellular matrix molecules, including collagen IV. It is widely expressed during embryogenesis, and in vitro studies have suggested roles in the regulation of cell adhesion and proliferation, and in the modulation of cytokine activity. In order to analyse the function of this protein in vivo, the endogenous Sparc locus was disrupted by homologous recombination in murine embryonic stem cells. SPARC-deficient mice (Sparctm1Cam) appear normal and fertile until around 6 months of age, when they develop severe eye pathology characterized by cataract formation and rupture of the lens capsule. The first sign of lens pathology occurs in the equatorial bow region where vacuoles gradually form within differentiating epithelial cells and fibre cells. The lens capsule, however, shows no qualitative changes in the major basal lamina proteins laminin, collagen IV, perlecan or entactin. These mice are an excellent resource for further studies on how SPARC affects cell behaviour in vivo.

A patient's perspective on the management of peptic esophageal stricture: experience and results in 113 consecutive cases

A retrospective analysis of 113 consecutive cases of benign esophageal stricture, all secondary to gastroesophageal reflux, 100 treated conservatively, 13 treated surgically, has been carried out in conjunction with a postal questionnaire of patients. Patients were requested to grade both their swallowing ability and the acceptability of their treatment. Of those responding to questionnaire, 88% of patients treated conservatively found their treatment acceptable or better, and 72% were left with either no or minimal restriction of diet. There was no correlation between either the total number or frequency of dilatations and the result achieved. Similarly, patient satisfaction appears largely independent of these variables. Doctors should be wary of taking recurrence of a stricture after initial dilatation as indicating a poor eventual outcome or a dissatisfied patient. There was no difference in terms of either the result or patient satisfaction between conservatively treated and surgically treated patients.

Natural choice in nonhuman primates

In 5 experiments, 4 monkeys and 1 ape chose between 2 food sources, each held in 1 of the experimenter's hands while he stood in front of a cage. When choosing between 2 sources of the same food that differed in amount, preference for the larger amount decreased as the size of each good proportionately increased. A second finding was that subjects were indifferent between a 2-food mixture and a single food that was part of the mixture if the single food was the preferred food of the mixture, a result suggesting the less preferred food had no value. Experiment 6 replicated these effects in 4 additional monkeys. These effects may be incompatible with previous theorizing about animal choice and may reflect a cognitive difference between nonhuman primates and humans.

Proliferation and cell death in oligodendrogliomas

The rates of cell proliferation and of cell loss influence the growth rate of a tumour and reflect genetic changes. We studied proliferation and apoptosis in oligodendrogliomas and their relationship to progression of the tumours. Thirty-two cases of oligodendroglioma were retrieved spanning a 10-year period. The diagnosis and grade were reviewed and follow-up data obtained. Mitotic index (MI) and apoptotic index (AI) were determined from haematoxylin and eosin (H & E) stained sections. A labelling index (LI) of proliferating cells was obtained using the MIB1 antibody to the Ki-67 antigen. A further index of apoptosis was obtained using in situ end-labelling of DNA strand breaks (TUNEL index, TI). Fourteen cases were graded as II, 18 as III (1993 WHO). LI was significantly higher in grade III than in grade II tumours (P < 0.01) but the difference in apoptotic indices between grades was not significant. There was a significant (P = 0.036) positive correlation between the logarithms of TI and LI. Construction of survival curves demonstrated a significant difference in survival according to histological grade (P < 0.05). Stratification of cases by LI alone did not predict significantly different survival outcomes, and apoptotic indices did not demonstrate a relationship to survival. A positive relationship was demonstrated between proliferation and apoptosis in oligodendrogliomas. The levels of apoptosis observed indicate that this phenomenon may have an important influence on the overall rate of tumour growth.

Pointing, withholding information, and deception in capuchin monkeys (Cebus apella)

Brown capuchin monkeys, like 4-year-old children and human-socialized chimpanzees, showed communicative and deceptive pointing in experiments in which they benefited by indicating, accurately or falsely, the location of hidden food. All 3 capuchin monkeys tested (13, 19, and 26 years old) pointed communicatively in the presence of a cooperative trainer. One human-reared monkey pointed without any training and frequently gazed at her human respondent; as with apes, extensive exposure to humans may promote some human-like responses in monkeys. Another capuchin withheld pointing when beneficial, whereas the 3rd learned to obtain the hidden food by pointing deceptively in the presence of a competitive trainer. Such deceptive pointing by one monkey and withholding of information by another suggest that primates' deceptive pointing in an experimental situation is explainable in terms of response inhibition and conditional discrimination learning.

Self-recognition in Saguinus? A critical essay

No abstractCopyright 1997 The Association for the Study of Animal BehaviourCopyright 1997The Association for the Study of Animal Behaviour.

A second dose of a CFTR cDNA-liposome complex is as effective as the first dose in restoring cAMP-dependent chloride secretion to null CF mice trachea

Phase I clinical trials have provided encouraging data suggesting that gene transfer could provide a treatment for cystic fibrosis (CF). However, for all the current viral and nonviral vectors used to deliver the cystic fibrosis transmembrane conductance regulator (CFTR) gene, the duration of CFTR expression is limited, necessitating a repeat dosing regimen to provide a long-term treatment. This study was performed to determine whether a second delivery of a CFTR cDNA-liposome complex could result in a similar level of functional CFTR expression observed after a single delivery and to assess whether the deliveries produced adverse inflammatory responses. CFTR functional expression was assessed by short circuit current measurements of tracheas taken from CF null mice (Cftrtm1Cam) treated with a CFTR cDNA-liposome complex in the upper airways. Mice receiving two deliveries of this complex, the second after the response to the first had declined, showed cAMP-stimulated chloride currents which were not significantly different from normal tracheas or tissues assayed after a single dose of the complex. This double treatment was well tolerated with no discernible inflammation of lung tissue.

Recommendations for the biopsy procedure and assessment of skeletal muscle biopsies

Muscle biopsy has a valuable diagnostic role in many neuromuscular diseases, but it is an invasive investigation that should not be undertaken lightly. Furthermore, the biopsy procedure and subsequent laboratory processing of the specimen may significantly influence the results. The following guide is designed to optimise the diagnostic information that can be obtained from muscle biopsy. It covers the whole procedure, from selection of the biopsy site and technique of biopsy, progressing through freezing of the specimen for histochemistry, and the role of immunocytochemistry and electron microscopy. Finally, the contents of a model biopsy report are considered.

Pretreatment TNM staging of childhood rhabdomyosarcoma: a report of the Intergroup Rhabdomyosarcoma Study Group. Children's Cancer Study Group. Pediatric Oncology Group

BACKGROUND

The Intergroup Rhabdomyosarcoma Study Group (IRSG) studies began in 1972 and initially used a clinicopathologic system to place patients into prognostic groups. Because of interest in the development of a pretreatment staging system for assessing the posttreatment outcomes of patients with this disease, potential staging elements were retrospectively evaluated in a subset of 505 patients who participated in IRS-II, an IRSG clinical trial.

METHODS

Using the IRS-II data, a TNM pretreatment staging system was developed and used to stage prospectively the patients who were entering IRS-III, a subsequent treatment protocol of the IRSG. Failure free survival and overall survival were compared by pretreatment stage in IRS-III as a means of evaluating this TNM staging.

RESULTS

The TNM staging system described the tumor (T) in terms of lesion size (< 5 cm or > or = 5 cm) instead of invasiveness, because these two features were not independent of each other. The clinical status of regional lymph nodes (N) was included in the staging system, as was the presence or absence of metastatic disease (M). The latter feature was extremely important, as expected. The anatomic site of the primary tumor also proved to be an important staging element. Classification of patients by tumor size, clinical status of regional lymph nodes, presence or absence of metastatic disease, and location of the primary tumor (at a favorable or unfavorable anatomic site) created four prognostically distinct staging categories that were relatively equal in size. In a prospective evaluation of this staging system with IRS-III patients, the pretreatment staging lost some prognostic impact. The survival of patients with smaller lesions at unfavorable anatomic sites without clinically involved lymph nodes (Stage II) was similar to that of patients with primary tumors at favorable anatomic sites (Stage I).

CONCLUSIONS

A pretreatment TNM staging system for childhood rhabdomyosarcoma, developed with data from IRS-II, was not as predictive of patient outcome when applied prospectively to patients treated in the IRS-III trial. These findings could be due to differences in the management strategy used for IRS-III or the statistical variability in the model-fitting process used to develop the staging system. This demonstrates the need for continual reevaluation of staging systems as patient evaluation and treatment innovations are developed.

The role of examples and rules in the acquisition of a cognitive skill

In 3 experiments, participants memorized 8 examples, each exemplifying a different rule. Participants were asked to extend these rules to new examples. They practiced applications of the rules to examples over a period of 4 days (Experiment 1) or 5 days (Experiments 2 and 3). Although these rules were bidirectional, an asymmetry gradually built up such that participants became more facile in using the rules in the practiced direction. Participants also showed an advantage when the initial study example was repeated or when test examples were repeated. It is argued that skill acquisition involves development of a complex set of strategies based on use of rules and retrieval of examples. Four overlapping stages of skill acquisition are described.

The role of examples and rules in the acquisition of a cognitive skill

In 3 experiments, participants memorized 8 examples, each exemplifying a different rule. Participants were asked to extend these rules to new examples. They practiced applications of the rules to examples over a period of 4 days (Experiment 1) or 5 days (Experiments 2 and 3). Although these rules were bidirectional, an asymmetry gradually built up such that participants became more facile in using the rules in the practiced direction. Participants also showed an advantage when the initial study example was repeated or when test examples were repeated. It is argued that skill acquisition involves development of a complex set of strategies based on use of rules and retrieval of examples. Four overlapping stages of skill acquisition are described.

Congenital myopathy with excess of thin myofilaments

Three unrelated young children are reported to have suffered since birth from muscle hypotonia and two of them from fatal respiratory insufficiency. Muscle tissues were found to contain large masses of thin myofilaments, immunologically identified as containing actin, but without further morphological features. These masses of thin filaments were found in different muscles at different occasions in the three children, suggesting a disease-specific morphological and possibly nosological feature all of them justifying classification as congenital myopathy with excess of actin or actin myopathy. The lesions were dissimilar to hyaline bodies in that the latter consist of granular material which is faintly positive for ATPase activity whereas the masses of thin filaments are devoid of ATPase activity. Two of our three patients also had intranuclear rods with virtually no sarcoplasmic rods suggesting the term of this congenital myopathy as actin myopathy with intranuclear rods.

Allogeneic-blood stem-cell collection following mobilization with low-dose granulocyte colony-stimulating factor

PURPOSE

The optimal dose of granulocyte colony-stimulating factor (G-CSF) for mobilization of allogeneic-blood stem cells (AlloBSC) has yet to be determined. As part of a prospective trial, 41 related human leukocyte antigen (HLA)-matched donors had blood cells mobilized with G-CSF at 5 micrograms/kg/d by subcutaneous administration. The purpose of this trial was to monitor adverse effects during G-CSF administration and stem-cell collection, to determine the optimal timing for stem-cell collection, and to determine the cellular composition of stem-cell products following G-CSF administration.

PATIENTS AND METHODS

The median donor age was 42 years. Apheresis began on day 4 of G-CSF administration. At least three daily 12-L apheresis collections were performed on each donor. A minimum of 1.0 x 10(6) CD34+ cells/kg (recipient weight) and 8.0 x 10(8) mononuclear cells/kg were collected from each donor. All collections were cryopreserved in 5% dimethyl sulfoxide and 6% hydroxyethyl starch.

RESULTS

Toxicities associated with G-CSF administration and the apheresis process included myalgias/arthralgias (83%), headache (44%), fever (27%), and chills (22%). The median baseline platelet count of 242 x 10(4)/ mL decreased to 221, 155, and 119 x 10(6)/mL on days 4, 5, and 6 of G-CSF administration, respectively. Median numbers of CD34+ cells in collections 1, 2, and 3 were 1.99, 2.52, and 3.13 x 10(6)/kg, respectively. The percentage and total number of CD4+, CD8+, and CD56+/CD3- cells remained relatively constant during the three collections. Median total numbers of cells were as follows: CD34+, 7.73 x 10(6)/kg; and lymphocytes, 6.93 x 10(8)/kg.

CONCLUSION

Relatively low doses of G-CSF can mobilize sufficient numbers of AlloBSC safely and efficiently.

Long-term results of coronary artery surgery

The management of coronary artery disease is constantly being refined and, as a consequence, the long-term results of coronary artery surgery are under intense and continuous scrutiny. An appreciation of the long-term results of different surgical strategies in selected subgroups of patients with ischaemic heart disease is important in deciding which is the most appropriate treatment option between surgery, angioplasty, and continued medical treatment. It also permits the patient to make an informed choice when that choice may influence the treatment. Interventional cardiology is encroaching onto traditionally surgical territory, and what effect these changes have on long-term results remains to be seen. Operative management continues to improve, and the use of arterial conduits may have a survival advantage; however, attention to the secondary prevention of cardiac risk factors will have the most influence on the long-term results of surgery. A clearer understanding of the importance of risk-factor management, in particular lipid reduction by drug treatment, will improve the long-term results for patients undergoing operations, probably both in late mortality and in clinical events, including the need for further intervention.

Doppler index perfusion in the detection of hepatic metastases secondary to gastric carcinoma

BACKGROUND

The early detection of liver metastases in patients with gastric carcinoma is important for determining the appropriate therapy; however conventional imaging techniques are limited for detecting "occult" liver metastases. Previous studies have shown that the measurement of the Doppler perfusion index (DPI)-ratio of hepatic arterial to total liver blood flow-can detect the presence of even small hepatic tumors. In this study, we compared the measurement of DPI with computed tomography (CT) for detecting gastric liver metastases.

METHODS

At presentation, 43 patients with gastric carcinoma underwent CT scanning of the liver and after 12 hours of fasting, DPI measurement was carried out using Doppler sonography.

RESULTS

Both techniques detected overt liver metastases in 9 of the 43 patients. Of the 34 remaining patients with an apparently disease-free liver on the basis of CT, laparotomy, or laparoscopy, 14 subsequently develop liver metastases over a follow-up period of 4 years, 13 of which had been predicted by DPI at the time of presentation.

CONCLUSION

The data suggest that the measurement of the DPI is more sensitive than a CT scan for detecting liver metastases secondary to gastric carcinoma.

Ewing's sarcoma of soft tissues in childhood: a report from the Intergroup Rhabdomyosarcoma Study, 1972 to 1991

PURPOSE

One hundred thirty of 2,792 patients (5%) registered on three Intergroup Rhabdomyosarcoma Study clinical trials (IRS-I, -II, and -III) from 1972 to 1991 had an extraosseous Ewing's sarcoma (EOE). We report here the results of multimodality therapy for this tumor.

PATIENTS AND METHODS

The 130 patients were less than 21 years of age; 70 (54%) were males. Primary tumor sites were on the trunk in 41 patients, an extremity in 34, the head/neck in 23, the retroperitoneum/pelvis in 21, and other sites in 11. One hundred fourteen patients had no metastases at diagnosis. In 21 patients, the tumor was completely resected; in 30, the localized or regional tumor was grossly resected, and in 63 patients, grossly visible sarcoma was left behind. Sixteen patients (12%) had distant metastases at diagnosis. All patients were given multiagent chemotherapy and most received irradiation (XRT); none were treated with bone marrow transplantation.

RESULTS

One hundred seven patients (82%) achieved a complete response. At 10 years, 62%, 61%, and 77% of the patients were alive after treatment on IRS-I, IRS-II, or IRS-III therapeutic protocols, respectively, similar to figures obtained in all IRS patients. At last follow-up evaluation, 42 patients had died of progressive tumor and one of infection. Survival at 10 years was most likely for patients with tumor that arose in the head and neck, extremities, and trunk, and for those who underwent grossly complete tumor removal before initiation of chemotherapy. For patients with localized, gross residual tumor, adding doxorubicin (DOX) to the combination of vincristine, dactinomycin, cyclophosphamide (VAC), and XRT did not significantly improve survival in 39 patients (62% alive at 10 years) compared with that of 24 patients treated with VAC and XRT without DOX (65% alive at 10 years, P = .93).

CONCLUSION

This series indicated that EOE in children is similar to rhabdomyosarcoma (RMS) in its response to multimodal treatment. No benefit was apparent from the addition of DOX to VAC chemotherapy in patients with gross residual EOE.

The combination of laser recanalization and endoluminal intubation in the palliation of malignant dysphagia

Laser recanalization and endoluminal intubation have been combined to optimize the palliation of malignant dysphagia in 37 patients. Nine patients with an endoluminal tube in situ presented with secondary dysphagia due to tumour overgrowth. Patency of the prosthesis was restored in all patients by laser recanalization with no complications. Twenty-eight patients treated initially by laser recanalization required subsequent intubation. The indications were dysphagia secondary to external compression (n = 3), significant angulation (n = 9), tracheo-oesophageal fistula (n = 3), failure of laser recanalization (n = 8), poor palliation (n = 3) or a combination of these (n = 2). There were no complications associated with the insertion of the tube and all patients subsequently reported improved swallowing. Laser recanalization or endoluminal intubation in isolation provide adequate palliation in the majority of patients with malignant dysphagia. We have shown that the appropriate timed combination of these two modalities may optimize the palliation of dysphagia in patients in whom the primary treatment modality fails.

High-dose therapy with autologous hematopoietic rescue for follicular low-grade non-Hodgkin's lymphoma

PURPOSE

This study evaluated the results of high-dose therapy followed by autologous bone marrow or peripheral-blood stem-cell transplantation for patients with follicular low-grade non-Hodgkin's lymphoma.

PATIENTS AND METHODS

We performed a retrospective review of 100 patients undergoing autologous transplantation for follicular low-grade lymphoma between April 22, 1983 and December 31, 1993.

RESULTS

Sixty-seven patients remained alive and 48 were failure-free. The median follow-up duration of surviving patients was 2.6 years (range, 1.0 to 11.7). There were eight (8%) deaths within 100 days of transplantation. Six additional patients died of nonrelapse causes up to 912 days after transplantation. Overall survival at 4 years was estimated to be 65% (95% confidence interval [CI], 54% to 75%) and failure-free survival was estimated to be 44% (95% CI, 33% to 55%). There was no definite evidence of a plateau in the failure-free survival curve. The only factor significantly associated with overall survival and failure-free survival was the number of chemotherapy regimen received before transplantation. No significant differences in outcome were observed between patients with follicular small cleaved-cell lymphoma and follicular mixed lymphoma, or between patients who received peripheral-blood stem-cell transplants and unpurged autologous bone marrow transplants.

CONCLUSION

Prolonged failure-free survival is possible following high-dose therapy and autologous hematopoietic rescue for follicular low-grade lymphoma. It is unclear whether patients are cured with this therapy or if survival is prolonged.

Prospective comparison of laparoscopy, ultrasonography and computed tomography in the staging of gastric cancer

A total of 103 consecutive patients with gastric adenocarcinoma was assessed for intra-abdominal spread of malignancy using ultrasonography, computed tomography (CT) and laparoscopy under general anaesthesia. Histologically proven metastases were to the liver in 27 patients, lymph nodes in 49 and directly to peritoneum in 13. All modalities showed a high specificity (92-100 per cent) for each type of metastasis. Laparoscopy was more sensitive in detecting hepatic, nodal and peritoneal metastases; the relative performance of laparoscopy was best with regard to hepatic metastases. Ultrasonography and CT were particularly poor at detecting nodal and peritoneal metastases. There was no significant morbidity and no mortality associated with laparoscopy, which was more accurate in preoperative staging of gastric cancer than ultrasonography or CT.

Preschoolers' perception of other people's looking: photographs and drawings

Children aged 3-4 years were tested for their ability to decide which of two photographs or drawings of a face depicted the act of fixating on a target object; in each control photograph or drawing the same face and object were present without fixation. Performance was above chance on both stimulus types, but low enough to call into question conclusions from previous research. The same children were also tested on their ability to discriminate between photographs/drawings depicting two faces fixating the same object (joint visual attention) and the same two faces fixating different objects. While discrimination of joint visual attention depicted in drawings was as good as discrimination of fixation in the single-face tasks, the ability to reliably choose between a photograph of two people attending to a common object and a control photograph was significantly poorer. The results suggest that, while young infants and children may be highly sensitive to face-on gaze, even well into the fourth year of life children are unable consistently to interpret (1) direction of non-self-directed gaze in static faces and (2) joint visual attention by others.

Skeletal muscle weakness and dysphagia caused by acid maltase deficiency: nutritional consequences of coincident celiac sprue

BACKGROUND

A 30-year-old woman with celiac sprue had progressive weight loss, myalgia, limb-girdle weakness, and dysphagia.

METHODS AND RESULTS

Barium swallow showed an atonic esophagus, and scintigraphic study confirmed esophageal dysmotility. Skeletal muscle biopsy showed characteristic appearances of acid maltase deficiency, which was confirmed by a reduction of leukocyte acid alpha-glucosidase activity.

CONCLUSIONS

Nutritional factors may have accelerated the presentation of the lysosomal storage disorder. This is the first reported case of dysphagia caused by esophageal motor weakness in acid maltase deficiency.

Training chemical dependency counselors to treat nicotine dependence

To test the effectiveness of providing chemical dependency (CD) staff with a knowledge-and-skills-building workshop on treatment of nicotine dependence, we employed a nested cross-sectional design with six outpatient CD programs in Nebraska (3 intervention, 3 control sites). Data on tobacco counseling provided by CD staff were obtained by telephone from sequential samples of smokers currently receiving alcohol treatment at each participating site. Intervention site clients with clinic visits after the staff training workshop were no more likely than intervention-site clients with clinic visits before the workshop to report having been counseled about their smoking (OR = 0.95, 95% confidence interval (CI): 0.74-1.21). However, control-site clients were significantly more likely to report having been counseled about smoking during the second half of the study (OR = 2.15, 95% CI: 1.49-3.08), even though staff training was not provided at control sites until data collection had been completed. These findings suggest that in some alcohol treatment programs simple monitoring of staff counseling practices may be sufficient to increase the frequency of attention to tobacco. In others, more intensive efforts might be needed to shift CD staff toward more consistent treatment of nicotine dependence.

Paravertebral muscles in disease of the cervical spine

OBJECTIVES

Cervical spine disorders are common in the older population. The paravertebral muscles are essential to the support and stabilisation of the cervical spine but have been little studied. The aim was to determine whether pathological changes develop in these muscles in patients with severe cervical spine disease, which, if present, might contribute to the pathogenesis and symptomatology of their disorder.

METHODS

Open biopsies of superficial and deep paravertebral muscles were obtained during the course of surgical procedures to alleviate cervical myelopathy. Most of these patients had cervical spondylosis or rheumatoid arthritis involving the cervical spine. The biopsies were compared with muscle obtained at necropsy from patients without a history of cervical spine or neuromuscular disorder.

RESULTS

Muscle from both the study and control groups showed a similar range and severity of abnormalities. In several patients, grouped fibre atrophy suggested chronic partial denervation. Most biopsies showed type 1 fibre predominance and selective type 2 fibre atrophy. Ragged red fibres were a frequent finding and electron microscopy disclosed accumulations of mitochondria, a small proportion of which contained rounded, or longitudinally oriented, single osmiophilic inclusions. Fibres containing core-like areas were also frequent. These pathological features were seen with increasing severity and frequency with increasing age.

CONCLUSIONS

The paravertebral cervical muscles develop pathological abnormalities with increasing age with both neurogenic and myopathic features, the pathogenesis of which is probably multifactorial. Such a muscle disorder would be expected to be accompanied by functional impairment which may contribute to the development and symptomatology of cervical spine disease with increasing age.

Long-term survival in advanced chronic myelogenous leukemia following bone marrow transplantation from haploidentical related donors

From 1987 to 1991, 26 patients with CML and a median age of 31 years received allogeneic BMT from a partially mismatched related donor (PMRD) who shared at least one haplotype with the recipient. Nine patients were in accelerated phase (AP), and 11 patients were in blast crisis (BC) at the time of BMT. Patients were mismatched either in graft-versus-host or host-versus-graft directions for one antigen in 3 patients, two antigens in 14 patients, and three antigens in 9 patients. All patients were prepared with a regimen consisting of total body irradiation, etoposide, cytosine arabinoside, cyclophosphamide and methylprednisolone. All marrows were treated ex vivo with T10B91.A-31, a monoclonal antibody directed toward the alpha beta heterodimer of the CD3 receptor, and rabbit complement. Additional GVHD prophylaxis included either the anti-CD5 immunoconjugate XomaZyme-H65, cyclosporine, or both in combination with methylprednisolone. Eight patients did not have sustained engraftment. The 100-day survival was 42%. The incidence of > or = grade II acute GVHD was 29%. The incidence of chronic GVHD was 50% and was limited in all cases. The median survival at 4 years for all 26 patients was 27%. Seven patients (CP 1, AP 3, BC 3) remain in hematologic remission 1297-2241+ days after transplantation. AlloBMT from a PMRD may be considered for patients with advanced CML who lack a matched sibling or unrelated donor.

Trapping oestrid parasites of reindeer: the response of Cephenemyia trompe and Hypoderma tarandi to baited traps

At 340-360 km North of the Arctic Circle in Norway, Hypoderma tarandi (L.) and Cephenemyia trompe (Modeer) females were caught in baited traps from 10 July to 21 August. During three summers, adverse climatic conditions inhibited flight activity of these oestrids on 56-68% of the days. Flies were not caught prior to or after these dates, nor at winds above 8 m/s, temperatures below 10 degrees C, light intensities below 20,000 lux, or during periods of rain or snow. CO2-baited insect flight traps caught significantly more H.tarandi females than non-baited traps. However, neither a white reindeer hide or reindeer interdigital pheromone glands enhanced the attraction of CO2 to H.tarandi or C.trompe. Hypoderma tarandi females also were attracted to mobile people, but not to stationary individuals. There were no significant differences in the number of C.trompe or H.tarandi caught in CO2-baited traps in a birch/willow woods, on the treeless vidda (= tundra-like biome), or at woods:vida ecotone sites. Flies were caught in traps on days when the nearest reindeer herds were 25-100 km away. Significantly more H.tarandi and C.trompe were caught from 09.30 to 14.30 hours than from 14.30 to 19.30 hours; no flies were caught from 20.00 to 07.00 hours (Norwegian Standard Time = NST). Because of CO2-baited traps caught from hundreds to thousands of mosquitoes, blackflies and Culicoides midges, when climatic conditions inhibited oestrid activity, reindeer aggregations and movements attributed to insect attacks during warm sunny days may be largely in response to attacks by H.tarandi and C.trompe.

Molecular epidemiology of deletions and mutations of the latent membrane protein 1 oncogene of the Epstein-Barr virus in posttransplant lymphoproliferative disorders

Latent membrane protein 1 (LMP1) is a protooncogene of the Epstein-Barr virus (EBV) that is expressed in most EBV-positive posttransplant lymphoproliferative disorders (PTLD). Small deletions in the carboxy-terminal domain of LMP1 have been recently described in Hodgkin's disease, nasopharyngeal carcinoma, and non-Hodgkin's lymphoma. We characterized the deletions and point mutations of LMP1 in 32 PTLD and 8 reactive lymphoid cases found to contain EBV by one or more methods, including LMP1 immunohistochemistry, EBV-encoded RNA in situ hybridization, LMP1 DNA amplification, or Southern blot analysis. Our goal was to study the relationship of LMP1 deletions and mutations with the PTLD morphology, clonality, EBV strain subtype, and survival of patients. We found a 30-bp deletion (Del-LMP1) in 13 of 32 (41%) PTLD cases and a similar incidence of Del-LMP1 and point mutations in 3 of 8 (38%) reactive EBV cases (rho = 0.87). The presence of the Del-LMP1 in the PTLD cases was not highly associated with a high-grade morphology or clonal immunoglobulin gene rearrangements compared with the wild-type LMP1. We found that 100% of B-strain isolates, compared with 30% of A-strain isolates, harbored the Del-LMP1. There was no significant difference in the survival of PTLD patients with or without Del-LMP1 (rho = 0.83). We conclude that the incidence of Del-LMP1 in PTLD may be reflective of the incidence of this EBV substrain in the regional population and that the Del-LMP1 sequence has no prognostic significance in PTLD.

Trapping oestrid parasites of reindeer: the relative age, fat body content and gonotrophic conditions of Cephenemyia trompe and Hypoderma tarandi females caught in baited traps

Dissection of flies caught in northern Norway revealed that only mated, gravid females of H.tarandi (L.) and larviparous C.trompe (Modeer) were caught in host-mimicking CO2-baited traps. Trapped females had the same gonotrophic and fat body (FB) conditions as females caught on and around reindeer. Most trapped females of both species were of middle to old age, having only one-half to no FB reserves left and only a few to moderate numbers of eggs or larvae remaining. Most young females trapped also had previously oviposited or larviposited at least once, and some newly eclosed, mated females were present throughout the fly season. Based on the known location of reindeer herds, it was evident that trapped flies that had recently oviposited or larviposited had dispersed into the trapping area from 25-100 km away. Declining FB reserves sustained wild-caught C.trompe females (and in utero larvae) in the laboratory for 14 days and H.tarandi females for 18 days. Reserve FB also was depleted during long flights. Females of both species that flew for the longest times (5.1-11.7 h) on a laboratory flight mill had low FB reserves, but nearly maximum numbers of eggs or larvae. Conversely, most females that flew for less than 5 h on the light mill had little or no FB remaining, and few eggs or larvae. The large FB reserves accumulated as larvae feed in the vertebrate host enable the non-feeding adults to survive and infect their hosts even after prolonged periods of flight-inhibiting climatic conditions.

Single-photon emission computed tomography gallium imaging versus computed tomography: predictive value in patients undergoing high-dose chemotherapy and autologous stem-cell transplantation for non-Hodgkin's lymphoma

PURPOSE

To evaluate the predictive value of computed tomography (CT) scanning and single-photon emission computed tomography (SPECT) gallium (Ga) scanning in the disease-free survival of patients receiving high-dose chemotherapy and autologous stem-cell transplantation for non-Hodgkin's lymphoma (NHL).

PATIENTS AND METHODS

One hundred forty-three patients undergoing transplant for NHL underwent CT scanning of chest, abdomen, and pelvis, and a SPECT Ga scan before transplantation and at day + 100 after transplant. The failure-free survival (FFS) by scan result was analyzed.

RESULTS

In the diffuse aggressive lymphoma patients, the 1-year FFS for patients having a positive SPECT Ga scan at day + 100 was 15% compared with a 3-year FFS of 47% for those with a negative scan (P < .001). Patients with a positive CT scan at day + 100 had a 36% 3-year FFS, and those with a negative CT scan had a 39% 3-year FFS (P = not significant [NS]). An analysis of the combination of CT scan and SPECT Ga scan results at day + 100 posttransplant demonstrated a 3-year FFS of 14% if they were both abnormal; if the CT was positive and Ga was negative, the 3-year FFS was 68%; positive Ga with a negative CT was 25%; and both negative was 34% (P = .0015). For the patients with follicular NHL, those with a positive SPECT Ga at day + 100 had a 14% 1-year FFS compared with those with a negative scan, who had a 45% 3-year FFS (P < .001). In the follicular NHL patients, the 3-year FFS of those with a positive CT was 17% compared with a 64% 3-year FFS for patients with a negative CT scan (P < .001).

CONCLUSION

The use of SPECT Ga scan at day + 100 posttransplant for evaluation of disease activity in patients with diffuse aggressive NHL was highly predictive of eventual outcome and was more predictive than the CT scan results. However, for patients with follicular NHL, the addition of SPECT Ga scanning to CT scanning did not add substantially to the evaluation of transplant outcome.

Discrimination learning and multiple reversals in young adult and older monkeys (Macaca arctoides)

Two groups of five young adult an older stumptailed macaques (Macaca arctoides) were tested on a visual discrimination task followed by a reversal upon attainment of criterion; task and reversal were repeated until 20 reversals with the same pair of objects had been completed. Both groups required more trials to learn the first reversal than the original discrimination, with no significant difference between the groups. Older monkeys tended to show more perseverative errors on early reversals, but a striking improvement in their scores across successive blocks of reversals culminated in performances virtually indistinguishable from those of the young group by the end of testing.

Abnormal cerebral glucose metabolism in HIV-1 seropositive subjects with and without dementia

This study was undertaken in order to extend our previous finding of relative basal ganglia hypermetabolism in AIDS dementia complex (ADC) and to develop clinically useful metabolic indices of CNS involvement in HIV-seropositive (HIV+) subjects.

METHODS

Twenty-one HIV+ subjects (11 with AIDS) underwent FDG-PET scanning; 12 had a follow-up scan at 6 mo and 4 had a third scan at 12 mo. Forty-three age-matched heterosexual volunteers served as controls. FDG-PET scanning was performed with arterial blood sampling, and scan data were analyzed using the Scaled Subprofile Model (SSM) with principal component analysis.

RESULTS

SSM/principal component analysis of the combined (HIV+ and controls) FDG-PET dataset extracted two major disease-related metabolic components: (a) a nonspecific indicator of cerebral dysfunction, which was significantly correlated with age, cerebral atrophy and ADC stage and (b) the striatum, which was heavily weighted (relatively hypermetabolic) and appeared to provide a disease-specific measure of early CNS involvement.

CONCLUSION

FDG-PET scans provide quantitative measures of abnormal functional connectivity in HIV-seropositives-with or without AIDS or ADC. These measures, which are robust across centers with respect to instrumentation, scanning technique and disease severity, appear to track the progression of CNS involvement in patients with subclinical neurologic or neuropsychologic dysfunction.

Adjuvant chemotherapy of childhood posterior fossa ependymoma: cranio-spinal irradiation with or without adjuvant CCNU, vincristine, and prednisone: a Childrens Cancer Group study

In 1975, members of The Children's Cancer Group (CCG) initiated a trial for patients with infratentorial medulloblastomas and ependymomas. Patients, all of whom received post-operative cranio-spinal irradiation (CSI), were randomized to receive or not receive adjuvant chemotherapy (CT) with lomustine (CCNU), vincristine, and prednisone for 1 year. Thirty-six of the 42 patients with ependymoma entered on study were suitable for analysis; 22 received combined modality therapy and 14 irradiation (RT) alone. The failure-free survival (FFS) for the entire sample at 10 years is 36% and overall survival (OS) 39%, with no difference in outcomes between the two regimens. Survival was better for females (73%) than males (21%) and for those older than 10 years (51% vs. 31%). There were two toxic deaths in the group receiving CT. We conclude from this study with long-term follow-up that the CT used was not effective in improving the outcome in children with ependymoma.

Working memory: activation limitations on retrieval

Two experiments which require subjects to hold a digit span while solving an equation and then recall the digit span are performed. The size of the memory span and the complexity of the equation are manipulated as well as whether the subject is required to substitute items from the digit span for constants in the equation. As either task (digit span recall or equation solving) gets more complex there are performance decrements (accuracy or latency) not only in that task but also in the other task. It is also shown that the majority of the errors are misretrievals. These results are consistent with the proposal that working memory load has its impact on retrieval from memory. These results are fit by the ACT-R theory (Anderson, 1993) which assumes that there is a limit on source activation and that this activation has to be divided between the two tasks. As either task increases in complexity there is less activation for retrieval of information from declarative memory. Subjects' misretrievals of associatively related information could be predicted by assuming a partial matching process in ACT-R.

Acute epididymitis: a work-related injury?

Occupational medicine physicians frequently are presented with requests by employers to determine the work-relatedness of medical illnesses or injuries. Occasionally, this involves a sudden onset of acute epididymitis in the male employee after strenuous activity in the workplace. Because the vast majority of acute epididymitis cases have an underlying sexually transmitted disease component, this poses a real dilemma for the consulting physician. This article discusses the etiology and pathogenesis of acute epididymitis along with its epidemiologic significance and reviews workers' compensation and its possible legal interpretation when acute epididymitis occurs at the worksite.

p53 mutations in mantle cell lymphoma are associated with variant cytology and predict a poor prognosis

Mutations of the p53 tumor suppressor gene have been described in several subtypes of non-Hodgkin's lymphoma, but the incidence of p53 mutations in mantle cell lymphoma (MCL) is unknown. We hypothesized that cases of MCL with a variant or high-grade cytology would have a higher likelihood of p53 mutations than typical MCL. We were also interested in the prognostic significance of p53 mutations in MCL. Therefore, a series of 53 well-characterized cases of MCL with DNA from 62 tissue samples were analyzed by the polymerase chain reaction with denaturing gradient gel electrophoresis for exons 5-8 of p53. Immunoperoxidase studies with the antibody DO-7 to p53 protein were also performed on frozen sections. We found mutations of the p53 gene in 8 of the 53 cases (15%) of MCL. Missense mutations predominated, and 50% of the mutations occurred at known p53 hotspot codons. Of 21 cases with variant cytology (ie, anaplastic or blastic), 6 (28.6%) had p53 mutations as compared with only 2 of 32 cases (6.3%) with typical MCL cytology (P = .05), and p53 mutations preceded the development of variant cytology in 2 patients. Overexpression of p53 protein was observed in 6 of the 8 cases (75%) with p53 mutations and in none of the 45 wild-type cases. The median survival of the cases with mutant p53 was only 1.3 years (all died), whereas the median survival of cases with germline p53 was 5.1 years (P = .023). These results suggest that mutations of p53 may be one mechanism involved in the development of variant forms of MCL and indicate that p53 mutations in MCL predict a poor prognosis.

Occurrence of the t(2;5)(p23;q35) in non-Hodgkin's lymphoma

Primary CD30(Ki-1)-positive anaplastic large-cell lymphoma (ALCL) is considered by some to be a distinct clinicopathologic entity associated with the t(2;5) (p23;q35). However, the specificity of t(2;5) for ALCL has not been carefully studied. Therefore, we performed a detailed analysis of all cases of ALCL with abnormal cytogenetics results in the Nebraska Lymphoma Study Group registry, as well as all other cases of non-Hodgkin's lymphoma with t(2;5) in the registry. We found the t(2;5) in only five of 10 cases of ALCL, four of whom were young patients. However, we also found the t(2;5) in 11 other cases of nonanaplastic lymphoma, including eight children with typical peripheral T-cell lymphomas of various types. The t(2;5) was also found in three older adults with B-cell lymphomas of various types. Thus, the t(2;5) was not specific for CD30+ ALCL. However, t(2;5) may define a clinicopathologic entity in children and young adults characterized by variable morphologies with a T-cell or indeterminate phenotype, CD30-positivity, nodal disease with frequent extranodal involvement, advanced stage, and an excellent response to therapy, including bone marrow transplantation for relapsed disease. The clinical relevance of the t(2;5) in older patients requires further study.

Training surgeons and safeguarding patients

Surgical trainees need exposure to a wide variety of operations and a chance to operate under supervision. At the same time there is the over-riding responsibility to do the best for our patients. Cardiac surgery is dominated by coronary bypass surgery and the tendency has been to delegate easy coronary cases to trainees and to neglect their experience in other areas. This paper is an audit of trainee exposure and supervision in a training centre. During a 20-month period, 35.2 per cent of cases were delegated; 20.6 per cent to the senior registrar and 14.6 per cent to the registrars. Senior registrars were assisted by the consultant in 19.1 per cent of their cases and registrars were assisted by more senior colleagues in 28.5 per cent of theirs. Most cases delegated to trainees were of low perioperative risk and operations were performed with commensurate low morbidity and mortality. The delegation of valve surgery was disproportionately low in comparison to overall case mix. On the basis of this study, the delegation of cases is being reviewed in the knowledge that with appropriate selection, trainees can gain valuable operative experience without compromising patient-safety.

Mitochondrial abnormalities in oculopharyngeal muscular dystrophy

This report describes a 56-yr-old man with a dominantly inherited disorder affecting four generations and characterized by bilateral ptosis and dysphagia. Muscle biopsy showed only minor light microscopic abnormalities but electron microscopy revealed fibres containing paracrystalline mitochondrial inclusions. Southern analysis of mitochondrial DNA obtained from muscle did not reveal mitochondrial gene deletions. An extensive search eventually identified the characteristic intranuclear filaments of oculopharyngeal muscular dystrophy (OPMD). Abnormal mitochondria are non-specific epiphenomena in OPMD but a potential source of confusion with a late-onset mitochondrial cytopathy. This case further emphasizes the necessity for a diligent search for the diagnostic intranuclear filaments when oculopharyngeal muscular dystrophy is suspected clinically.

Cardiopulmonary function and autologous bone marrow transplantation: results and predictive value for respiratory failure and mortality. The University of Nebraska Medical Center Bone Marrow Transplantation Pulmonary Study Group

Cardiopulmonary complications are a major cause of morbidity and mortality in patients undergoing high-dose therapy with stem cell transplant support. Since exercise tolerance testing (ETT) assesses the cardiopulmonary reserve of an individual, we hypothesized that ETT performed prior to transplant would predict respiratory failure and mortality and would be a superior predictor over resting cardiopulmonary function tests. We performed a retrospective study of 191 lymphoma patients who underwent ETT prior to transplant between 1 June 1990 and 31 December 1992 and compared the results of ETT with resting pulmonary function tests (PFT) and resting cardiac ejection fraction (EF). ETT revealed that cardiac, pulmonary and combined cardiopulmonary limitation were observed in 31, 20 and 16% of the patients, respectively, with a gas diffusion-type limitation being the most common exercise limitation. Resting PFT were abnormal in 58% of patients with a diffusion defect being the most common abnormality. Low EF was observed in 6.8% of patients. Twelve patients eventually required mechanical ventilation post-transplant with only the resting diffusion PFT predictive of this complication. There were five early deaths that were attributable to respiratory failure and neither resting nor ETT studies were predictive of these deaths. ETT and EF performed prior to transplant in lymphoma patients undergoing autologous transplant do not predict for either respiratory failure or short-term mortality. Our findings may be due to the rather low incidence of respiratory failure (6.3%) and low early mortality from cardiopulmonary complications (2.6%) seen in our patient population.

Categorization and sensitivity to correlation

Three categorization experiments were run in which participants saw a set of stimuli that varied on 4 continuous dimensions. Participants first categorized the stimuli and tried to predict some of the dimensions, given the values of others. Experiment 1 used iris-like stimuli based on the descriptions of R. A. Fisher's (1936) taxonomic descriptions. It showed that having participants categorize the stimuli was essential to being able to perform the prediction task and that merely observing the stimuli was not sufficient. It also indicated that participants could use within-category as well as between-category correlations for predictions. Experiments 2 and 3 used stimuli with artificial variations of values. Participants processed categories that had different within-category correlations. Participants' behavior could be predicted as a combination of sensitivity to within-category correlation and bias about the sign of the correlations. These results were fit to the rational model of categorization (J. R. Anderson, 1991) and to an exemplar model (R. M. Nosofsky, 1988).

Categorization and sensitivity to correlation

Three categorization experiments were run in which participants saw a set of stimuli that varied on 4 continuous dimensions. Participants first categorized the stimuli and tried to predict some of the dimensions, given the values of others. Experiment 1 used iris-like stimuli based on the descriptions of R. A. Fisher's (1936) taxonomic descriptions. It showed that having participants categorize the stimuli was essential to being able to perform the prediction task and that merely observing the stimuli was not sufficient. It also indicated that participants could use within-category as well as between-category correlations for predictions. Experiments 2 and 3 used stimuli with artificial variations of values. Participants processed categories that had different within-category correlations. Participants' behavior could be predicted as a combination of sensitivity to within-category correlation and bias about the sign of the correlations. These results were fit to the rational model of categorization (J. R. Anderson, 1991) and to an exemplar model (R. M. Nosofsky, 1988).

Effect of capacitive coupled electrical stimulation on regenerate bone

An in vivo study was carried out to determine if capacitive coupled electrical stimulation increased the rate of recovery of strength of regenerate bone produced as a result of lengthening by the Ilizarov technique. Thirty-four adult male beagles underwent a right tibial mid-diaphyseal corticotomy, followed by a 5-day delay, and then 21 days of lengthening (1 mm/day). At the start of the post-distraction period (day 27), stimulation (3-6.3 V peak to peak, 5-10 mA root-mean-square at 60 kHz) was applied for 28 days to one group. The nonstimulated group (n = 17) underwent a 28-day period with no stimulation. From each group, four tibiae were prepared for histology; both ends of the remaining bones were embedded in polymethylmethacrylate and tested in torsion (internal rotation at 4.7 degrees/sec) until failure. Statistically significant changes included a 37% lower maximum torque capacity and a 40% decrease in strain energy to failure in the stimulated group compared with the nonstimulated group. The findings are supported by measured trends to a lower modulus of rigidity (37% decrease) and a smaller percentage of active osteoid perimeter (20% decrease) for the stimulated group. The experimental data suggest that when this dose of capacitive coupled electrical stimulation is applied to the regenerating bone created during distraction osteogenesis, it delays the recovery of bone strength compared with an untreated control.

High-dose chemotherapy followed by autologous hematopoietic rescue for Hodgkin's disease patients following first relapse after chemotherapy

BACKGROUND

The best results of conventional-dose salvage chemotherapy for Hodgkin's disease have been reported after first relapse. We evaluated the results of high-dose chemotherapy and autologous hematopoietic rescue for Hodgkin's disease patients who had relapsed from an initial chemotherapy-induced complete remission.

PATIENTS AND METHODS

Eighty-five patients received high-dose cyclophosphamide, carmustine, and etoposide (CBV) followed by autologous bone marrow or peripheral blood stem cell transplantation.

RESULTS

Actuarial survival at five years was 51%, and failure-free survival was 40%. Failure-free survival at five years was 90% for patients who received no conventional-dose salvage chemotherapy prior to CBV. Failure-free survival of patients treated initially with a four-drug regimen was not significantly different than patients treated with seven/eight-drug regimens.

CONCLUSION

These results appear to be better than those reported for conventional-dose salvage chemotherapy. High-dose therapy followed by autologous bone marrow or peripheral blood stem cell transplantation should be considered for any patient with relapsed Hodgkin's disease, regardless of the length of initial remission, or type of initial chemotherapy. Certain patients, especially those with minimal disease, may benefit by proceeding directly to transplantation after relapse, without first receiving conventional-dose salvage chemotherapy.

Phase I/II trial of PIXY321 to enhance engraftment following autologous bone marrow transplantation for lymphoid malignancy

PURPOSE

A phase I/II study of PIXY321 following high-dose therapy (HDT) and autologous bone marrow transplantation (ABMT) was conducted to evaluate the safety and clinical potential of this agent.

PATIENTS AND METHODS

Fifty patients with Hodgkin's disease or non-Hodgkin's lymphoma (NHL) undergoing HDT and ABMT received PIXY321 post-ABMT in doses that ranged from 50 to 1,000 micrograms/m2/d either as intravenous (i.v.) or subcutaneous (SC) dosing until engraftment was reached.

RESULTS

If all doses are considered together, the median time to reach an absolute neutrophil count (ANC) > or = 500/microL was 18 days and the median time to platelet transfusion independence was 21 days. At the estimated optimum dose of 750 micrograms/m2/d by SC injection once daily, the median time to reach an ANC > or = 500/microL was 15 days and the median time to platelet transfusion independence was 16 days. Historical control patients who received granulocyte-macrophage colony-stimulating factor (GM-CSF) had a median time to an ANC > or = 500/microL of 19 days and a median time to platelet independence of 26 days.

CONCLUSION

The administration of PIXY321 post-ABMT was generally well tolerated and resulted in prompt engraftment in the majority of patients who underwent HDT and ABMT for lymphoid malignancies. The optimum dose and route of administration of PIXY321 suggested by this trial was 750 micrograms/m2/d by once-daily SC injection. Compared with historical control patients who received 2-hour i.v. GM-CSF, patients who received PIXY321 at 750 micrograms/m2/d by SC injection once daily had an improvement in the median days to neutrophil and platelet engraftment by 4 and 10 days, respectively.

Transhiatal oesophagectomy: a comparison of alternative techniques in 68 patients

Over a 7-year period 68 patients with oesophageal carcinoma underwent transhiatal oesophagectomy, utilizing blunt dissection in 42 cases and eversion stripping in 26. The effects of the alternative techniques on mortality and morbidity have been analysed. There was no significant difference between the two techniques in terms of operative blood loss or time or the number of patients requiring post-operative ventilatory support. Stripping of the oesophagus was associated with significantly fewer cardiorespiratory complications and a shorter hospital stay. There was no significant difference in either 30-day or 3-month survival. Eversion stripping should become the preferred method of oesophageal resection once the primary tumour has been mobilized.