Procarbazine, lomustine, and vincristine (PCV) chemotherapy for anaplastic astrocytoma: A retrospective review of radiation therapy oncology group protocols comparing survival with carmustine or PCV adjuvant chemotherapy

PURPOSE

To determine any differences in outcome for patients with anaplastic astrocytoma (AA) treated with adjuvant carmustine (BCNU) versus procarbazine, lomustine, and vincristine (PCV) chemotherapy.

MATERIALS AND METHODS

The Radiation Therapy Oncology Group (RTOG) database was reviewed for patients with newly diagnosed AA treated according to protocols that included either BCNU or PCV adjuvant chemotherapy. All patients were treated with radiation therapy. The outcome analysis included overall survival, taking into account patient age, extent of resection, Karnofsky performance status (KPS), and treatment group (BCNU v PCV). Stratified and nonstratified Cox proportional hazards models were used, as well as an analysis using matched cases between the groups.

RESULTS

A total of 257 patients were treated with BCNU according to RTOG protocols 70-18, 83-02, and 90-06; 175 patients were treated with PCV according to RTOG protocol 94-04. All pretreatment characteristics except KPS were well balanced by treatment group; 61% of the BCNU group had a KPS of 90 to 100 compared with 73% of the PCV group (P =.0075). No statistically significant difference in survival was observed in any age group or by KPS or extent of surgery. The stratified analysis also showed no trends for improved survival by treatment group (P =. 40). The Cox model identified only age, KPS, and extent of surgery as important variables influencing survival, not treatment group. Matching cases between groups using age, KPS, and surgery resulted in 133 matched pairs. No difference in survival was observed (P =. 41). In a Cox model in which each matched pair is a strata, there was no difference between groups (P =.20).

CONCLUSION

Using this retrospective analysis, there does not seem to be any survival benefit to PCV chemotherapy. Future phase III studies for patients with AA may need to consider whether BCNU or PCV is used in the control arm.

Management of ectopic ureterocele associated with renal duplication: a comparison of partial nephrectomy and endoscopic decompression

PURPOSE

We compared the efficacy of primary endoscopic decompression versus partial nephrectomy for treating ectopic duplex ureteroceles.

MATERIALS AND METHODS

We retrospectively reviewed the records of patients with renal duplication and upper pole ectopic ureterocele. Patients were classified according to the initial radiological evaluation. The operation performed was arbitrarily chosen by the surgeon.

RESULTS

A total of 54 patients had unilateral upper or bilateral upper pole ureterocele with no associated vesicoureteral reflux. Partial nephrectomy was performed in 26 patients, of whom 4 (15%) required additional surgery for new onset ipsilateral lower pole reflux. Endoscopic decompression was performed in 28 patients, of whom 18 (64%) required additional treatment due to reflux into the ipsilateral lower pole ureter and ureterocele in 9, reflux into the ureterocele only in 4, ipsilateral lower pole reflux only in 3 and persistent ureterocele obstruction in 2 (p<0.01). An ectopic ureterocele with vesicoureteral reflux into 1 or more moieties was identified in 111 patients, including 56 of 67 (84%) treated with partial nephrectomy and 37 of 44 (84%) treated with endoscopy who have persistent reflux or required further surgery for reflux resolution.

CONCLUSIONS

In patients with an ectopic ureterocele and no vesicoureteral reflux partial nephrectomy should be considered the treatment of choice. However, when the initial cystogram reveals vesicoureteral reflux, partial nephrectomy and endoscopic ureterocele decompression have identical definitive cure rates of only 16%. The majority of the latter patients require continued observation and/or additional surgery for managing persistent reflux.

Amino acids of conserved kinase motifs of cytomegalovirus protein UL97 are essential for autophosphorylation

Thirteen point mutations targeting predicted domains conserved in homologous protein kinases were introduced into the UL97 coding region of the human cytomegalovirus. All mutagenized proteins were expressed in cells infected with recombinant vaccinia viruses (rVV). Several mutations drastically reduced ganciclovir (GCV) phosphorylation. Mutations at amino acids G340, A442, L446, and F523 resulted in a complete loss of pUL97 phosphorylation, which was strictly associated with a loss of GCV phosphorylation. Our results confirm that in rVV-infected cells pUL97 phosphorylation is due to autophosphorylation and show that several amino acids conserved within domains of protein kinases are essential for this pUL97 phosphorylation. GCV phosphorylation is dependent on pUL97 phosphorylation.

Childhood predictors of violent behavior

In this study, prospective childhood data from birth to 7 years of age were used to determine predictors of subsequent violent behavior. The childhood predictors found for the girls accounted for more variance in the reported later violent offenses: 24.9% compared to 3.8% for the boys. This large difference may be due partly to the fact that violent behavior is more unusual among girls; thus, those girls who are violent are more readily differentiated from the others. The only two early childhood variables that were found to predict for both genders were: (a) less normal behavior and (b) presence of deviant or stereotyped behavior. Thus, abnormal behavior in childhood can be considered to be a fairly reliable predictor to greater likelihood of later violent behavior.

The quality of psychiatric residency : the assessment of programs and options for distributing psychiatric residents in the service of health care reform

Recent health care reform initiatives proposed training fewer medical specialists, including psychiatrists, and determining the size and location of training programs via centralized regulatory mechanisms. Facing such potential future developments, the American Association of Directors of Psychiatric Residency Training appointed a Task Force on the Quality of Residency Programs to develop informed recommendations for the field. This paper describes the Task Force's considerations and recommendations concerning how the least damaging and most effective decisions could be made regarding the distribution of residency positions, program size, and the future funding of training stipends. The recommendations emphasize voluntary decisions, feedback from local and regional stakeholders regarding perceived needs and demands for psychiatrists, and Federal or regional funding of postgraduate training stipends that are not primarily tied to providing clinical services.

Sprouty: a common antagonist of FGF and EGF signaling pathways in Drosophila

Extracellular factors such as FGF and EGF control various aspects of morphogenesis, patterning and cellular proliferation in both invertebrates and vertebrates. In most systems, it is primarily the distribution of these factors that controls the differential behavior of the responding cells. Here we describe the role of Sprouty in eye development. Sprouty is an extracellular protein that has been shown to antagonize FGF signaling during tracheal branching in Drosophila. It is a novel type of protein with a highly conserved cysteine-rich region. In addition to the embryonic tracheal system, sprouty is also expressed in other tissues including the developing eye imaginal disc, embryonic chordotonal organ precursors and the midline glia. In each of these tissues, EGF receptor signaling is known to participate in the control of the correct number of neurons or glia. We show that, in all three tissues, the loss of sprouty results in supernumerary neurons or glia, respectively. Furthermore, overexpression of sprouty in wing veins and ovarian follicle cells, two other tissues where EGF signaling is required for patterning, results in phenotypes that resemble the loss-of-function phenotypes of Egf receptor. These results suggest that Sprouty acts as an antagonist of EGF as well as FGF signaling pathways. These receptor tyrosine kinase-mediated pathways may share not only intracellular signaling components but also extracellular factors that modulate the strength of the signal.

Synthesis and activity of sulfonamide-substituted 4,5-diaryl thiazoles as selective cyclooxygenase-2 inhibitors

A series of sulfonamide-substituted 4,5-diarylthiazoles was prepared via three synthetic routes as selective COX-2 inhibitors. Recently in the synthesis of selective COX-2 inhibitors we have discovered that the sulfonamide moiety is a suitable replacement for the methylsulfonyl moiety yielding compounds with activity both in vitro and in vivo.

[Evaluation of the antinociceptive effect of systemic and epidurally applied xylazine in general anesthesia with isoflurane in dogs and the effect of atipamezole infection on postoperative analgesia]

The alpha 2-selective adrenergic agonist xylazine has a long lasting antinociceptive effect (> 4 hours) after lumbosacral injection in dogs (Rector, 1996). The present study was performed to find out if epidurally administered xylazine acts locally as well as systemically. In a clinical investigation 30 dogs anesthetized with isoflurane in oxygen (1.9 Vol.% ET) were examined before and after epidural and intramuscular injection of xylazine (0.25 mg/kg) during surgery and over a 240-minute postoperative period. All dogs underwent surgery caudal the costal arch. The surgical patients were divided into three groups: group I: xylazine (0.25 mg/kg) epidural and aqua pro injectione i.m. (n = 10 dogs); group II: aqua pro injectione epidural and xylazine (0.25 mg/kg) i.m. (n = 10 dogs); group III: aqua pro injectione epidural and aqua pro injectione i.m. (n = 10 dogs). The division of xylazine epidural or i.m. or aqua pro injectione only was randomized. Prior to surgery, in all three groups somatic stimuli were exerted by pressure on the nailbed of a hind- and a forelimb before and after the epidural injection under general anesthesia. Heart rate, mean arterial pressure and rate of ventilation were used to determine the analgesic effect. During surgery, heart rate and mean arterial pressure were measured every 15 minutes. At the end of the operation, all patients were treated with the (alpha 2-selective adrenergic-antagonist atipamezole. During a 240 minute post operative examination heart rate, mean arterial pressure, rate of ventilation and reaction to pressure on the surgery site were used to determine the analgesic properties of xylazine. In this study it could be shown, that the concurrent epidural (group I) or intramuscular injection (group II) of xylazine in isoflurane anesthetized dogs leads to a better analgesic effect than isoflurane alone (group III) after somatic stimulation of a hind- and forelimb. From the antinociceptive effect in the forelimb after epidural administration of xylazine it was concluded that xylazine acts both locally as well as systemically. This was also confirmed by the hemodynamic changes, which were similar in group I (xylazine epidurally) and group II (xylazine i.m.). In the two groups treated with xylazine (group I and II), bradycardia and AV-blocks I and II were observed in three dogs during the first 30 minutes after epidural and intramuscular injection of xylazine. Hemodynamic changes were seen at the time of maximal plasma xylazine concentrations. One dog in the control group also had a bradycardia in connection with an AV-block II. During surgery no hemodynamic differences could be observed between the three groups. Heart rate was within normal limits and mean arterial pressure showed a slight hypotension. In agreement with the investigation of Rector (1996) it was shown in this study that xylazine has a long lasting (> 4 hours) antinociceptive effect after lumbosacral injection in the epidural space (group I). This analgesic effect is of local, spinal cord origin, as it was impossible to antagonize the analgesia by systemic application of atipamezole. In contrast to this, atipamezole reversed all analgesic properties totally after systemically administered xylazine in group II. However, sufficient analgesic plasma xylazine concentrations could only be detected in group II up to 180 minutes after injection. After this time period, an analgesic effect could not be expected anyway, even without antagonization. It can be concluded that the epidural administration of xylazine offers advantages in contrast to a systemic administration, as a longer lasting analgesic effect can be observed (after the epidural application), and systemic side effects can be reversed without effecting spinal analgesia.

[Pain therapy in dogs and cats--clinical experiences with buprenorphine (Temgesic)]

Buprenorphine was used as a post-operative analgesic drug in 40 dogs and 30 cats. The analgesic properties of buprenorphine failed in 20% (dogs) respectively 23.3% (cats) of the cases even after high doses of 0.1 mg/kg in dogs and 0.01 mg/kg in cats. The unsatisfactory results were seen in fracture-patients with a concurrent severe tissue damage. Side effects even after high doses were of no clinical relevance.

[Perioperative anesthesia management in small mammals]

In anaesthesiology rabbits and rodents are considered being high risk patients as about 30% of the anaesthetized patients die intra- or postoperatively. Due to the anatomic structures many anaesthetic techniques and patient monitoring are very difficult of even impossible to perform in these animals. For this reason anaesthesia of rabbits and rodents confronts the veterinarian with great problems. The main complications during anaesthesia are discussed and principles of the perioperative anaesthetic management, of anaesthetic techniques as well as patient monitoring are presented.

sprouty encodes a novel antagonist of FGF signaling that patterns apical branching of the Drosophila airways

Antagonists of several growth factor signaling pathways play important roles in developmental patterning by limiting the range of the cognate inducer. Here, we describe an antagonist of FGF signaling that patterns apical branching of the Drosophila airways. In wild-type embryos, the Branchless FGF induces secondary branching by activating the Breathless FGF receptor near the tips of growing primary branches. In sprouty mutants, the FGF pathway is overactive and ectopic branches are induced on the stalks of primary branches. We show that FGF signaling induces sprouty expression in the nearby tip cells, and sprouty acts nonautonomously and in a competitive fashion to block signaling to the more distant stalk cells. sprouty encodes a novel cysteine-rich protein that defines a new family of putative signaling molecules that may similarly function as FGF antagonists in vertebrate development.

A framework for assessing communication in mental illness

Many studies support the notion of semantic and/or pragmatic difficulties in people with mental illness. This paper describes a framework (based on a discourse analysis model) for the assessment and reassessment of communication in mentally ill persons.

'Confabulation' in narrative discourse by schizophrenic patients

There are many clinical reports of confabulation by schizophrenic patients. This study provides evidence of a form of confabulation by schizophrenic patients in tasks which do not include a memory component. It uses a linguistic framework to analyse the components of this confabulation.

[Pediatric and geriatric small animal patients as risk groups in anesthesia management]

In the first 12 weeks of postnatal life puppies and kittens are defined by the term pediatric, because of their immature organ systems. In anaesthesiology they are considered as high risk patients. Dogs and cats can be defined by the term geriatric when they have completed 80% of their expected life spans. These patients show age-related decline in organ functions or in their mechanisms of compensation. Physiological and pathophysiological characteristics of pediatric and geriatric patients are discussed and principles of the perioperative anaesthetic management and of pediatric and geriatric anaesthetic techniques are given.

Home health nurse patient care and coordination time. Health maintenance organization versus fee-for-service

Home health nurse visit and care coordination time were compared between Medicare patients enrolled in an health maintenance organization (HMO) and in the traditional Medicare fee-for-service program. In home nurse visit time did not differ for the two groups. Coordination time per episode of care was approximately 40 minutes longer for an HMO patient. When home health administrators develop discounted visit rates for HMO contracts, they must include the extra coordination time in the rates.

[Evaluation of the antinociceptive effect of xylazine after epidural administration in dogs under general anesthesia with isoflurane]

Seven dogs anaesthetized with isoflurane in oxygen (1.9 Vol.-% ET) were examined before and after lumbosacral injection of xylazine (0.25 mg/kg) into the epidural space. Over a 240 minute period the dogs were first stimulated in a visceral manner (extension of the colon descendens by a balloon-catheter) every 15 minutes. In a second part, the dogs were stimulated somatically by pressure to the interdigital skin of a hindlimb. Heart rate and mean arterial pressure were used to determine the analgesic properties of epidurally injected xylazine. Furthermore, plasma xylazine concentration was controlled in both series. Before epidural anaesthesia, heart rate and mean arterial pressure increased during stimulation significantly in both groups. After epidural injection of xylazine, hemodynamic reactions were distinctly diminished, in the somatically stimulated group more than in the viscerally stimulated group. Up to 30 minutes after epidural injection, plasma xylazine concentrations of about 100 ng/ml were found in both groups. Up to 60 minutes after epidural injection, plasma xylazine concentrations of more than 60 ng/ml still were found. From the 120th minute on, xylazine concentration decreased below 30 ng/ml. From these results, it can be concluded that there is a well-suited analgesic effect of epidurally applicated xylazine for approximately 240 minutes.

A history of radiology and radiation oncology at Thomas Jefferson University

The Departments of Radiology and Radiation Oncology have evolved during the last 100 years from a small combined facility into two large comprehensive departments characterized by the highest quality of patient care. Both departments, now under the direction of David C. Levin and Walter J. Curran, Jr., are leaders in graduate education and research productivity. As a result, both departments clearly represent another golden age in the history of radiology at Thomas Jefferson University.

Clinical comparison of medetomidine with xylazine/l-methadone in dogs

Seventy-two healthy dogs required sedation and analgesia for a variety of procedures causing discomfort or pain. They were treated either with the alpha 2-agonist medetomidine at 40 micrograms/kg (15 intravenously and 17 intramuscularly), or 80 micrograms/kg (15 intravenously and 15 intramuscularly) or with xylazine plus l-methadone (1.0 mg)(10 intravenously). The levels of sedation, analgesia and safety were compared clinically and by measurements of the effects on the electrocardiogram (ECG) and blood gases, body temperature, haematology and clinical chemistry. Sedation was achieved reliably with both medetomidine and xylazine plus l-methadone but its onset, depth and duration were influenced by the dose and route of administration. In the medetomidine-treated dogs, intravenous administration resulted in more rapid sedation and the effects of the higher dose were deeper and longer lasting. The small dogs receiving 40 micrograms/kg may have been underdosed. The initial analgesic effects in response to a pin prick to the body surface were sufficient and similar for both drugs, except for the intramuscular dose of 40 micrograms/kg medetomidine. Analgesia for the clinical procedures was less reliable with medetomidine and was not always adequate even at the high dose, but xylazine plus l-methadone assured analgesia in almost every case. Medetomidine resulted in marked bradycardia, lasting as long as the sedation and the ECG revealed a sinus arrhythmia with sinoatrial and atrioventricular blocks grade I and II as a sign of interference with transduction. The bradycardia with xylazine plus l-methadone was less pronounced. A decrease in respiratory rate accompanying sedation had no influence on blood gases and blood acidity in the dogs treated with medetomidine but caused a respiratory acidosis with xylazine plus l-methadone. Body temperature decreased with all treatments for the duration of the period of sedation. Blood glucose concentration increased to a similar extent in all treatment groups, but all other haematological and clinicochemical variables remained unchanged. Treatment with the specific alpha 2 antagonist, atipamezole, reversed the sedation and cardiovascular and pulmonary effects due to medetomidine within minutes.

Home health resource utilization. Health maintenance organization versus fee-for-service subscribers

A commonly held belief is that patients enrolled in health maintenance organizations (HMOs) are authorized fewer home health services than patients enrolled in fee-for-service (FFS) plans. This study compared home health resource utilization patterns between patients enrolled in a cost HMO and in FFS plans. Although no significant differences were found, the cost HMO subscribers actually received more services. Despite these similarities, home health administrators need to carefully craft contracts with cost HMOs.

The relationships of substance abuse to illegal and violent behavior, in a community sample of young adult African American men and women (gender differences)

In a longitudinal study of an African American young adult community sample (N = 380), prospective data on lifetime substance use/abuse from childhood up to age 24 were used as control variables in analyses to predict illegal and violent behavior during the ensuing 2 1/2-year period. Frequent earlier use of drugs predicted subsequent violent behavior for both men and women. Frequency of earlier use of alcohol predicted subsequent violent behavior for men but not for women. A weaker relationship was found between degree of psychopathology and degree of engaging in either illegal or violent behavior than between degree of psychopathology and degree of substance use/abuse. Comorbidity (the combination of earlier use/abuse of drugs with earlier psychopathology) was a stronger predictor, for women than for men, of later illegal and violent behavior.

Home health quality outcomes. Fee-for-service versus health maintenance organization enrollees

Quality outcomes were compared between home health patients enrolled in the traditional Medicare fee-for-service (FFS) program versus a health maintenance organization (HMO) with a Medicare cost contract with the federal government. The quality outcome scores were similar between the two patient groups. However, other home health research showed superior quality outcomes for patients enrolled in the traditional Medicare FFS program versus an HMO with a risk contract with the federal government. Before signing contracts with HMOs, home health administrators will want to identify the type of Medicare contract the HMO has with the federal government.

Cell fate control in the Drosophila retina by the orphan receptor seven-up: its role in the decisions mediated by the ras signaling pathway

Drosophila seven-up is an orphan receptor of the steroid receptor family that is required to specify photoreceptor neuron subtypes in the developing compound eye. Expression of seven-up is confined to four of the eight photoreceptor precursors, R3/R4/R1/R6. We show that misexpression of seven-up in any of the other cell types within the developing ommatidium interferes with their differentiation. Each cell type responds differently to seven-up misexpression. For example, ectopic expression in the non-neuronal cone cells using the sevenless promoter/enhancer (sev-svp) causes the cone cells to take on a neuronal identity. Ectopic expression of seven-up in R2/R5 using the rough enhancer (ro-svp) causes these neurons to lose aspects of their photoreceptor subtype identity while remaining neuronal. Each cell type appears to have a different developmental time window that is sensitive to misexpressed seven-up. The temporal order of responsiveness of each cell type to misexpressed seven-up is similar but not identical to the order of neuronal differentiation. This suggests that there are processes of specification that are distinct from the specification to become a photoreceptor neuron. We have identified members of the ras signaling pathway as suppressors of the cone cell to R7 neuron transformation caused by sev-svp. Suppression of the sev-svp phenotype can be achieved by decreasing the gene-dosage of any of the members of the ras-pathway. This suggests that the function of seven-up in the cone cells requires ras signaling. However, a decrease in ras signaling results in enhancement of the phenotype caused by the ro-svp transgene. We discuss the relationship between decisions controlled by seven-up and those controlled by ras signaling.

[Preventative tail amputation in fattening bulls]

In 5 cattle fattening farms with 900 to 3000 bulls tail docking was practised prophylactically in consequence of losses due to tail necrosis. Following detailed consultations in the farms temporary exceptional permission of the ban of amputation according to article 6 of the German Animal Welfare Law was given to 4 of the 5 farms, associated with real instructions to improve the housing conditions. By that means communication between farmer and veterinary authority was intensified and the contrariety between legislation and practice was pointed out clearly. The farmers were concerned with consequences of the ban of tail docking intensively. A process of understanding began, resulting in renunciation of prophylactic tail docking in 4 of the 5 farms.

Tympanometric screening in elementary school children

The revised ASHA (American Speech Language Hearing Association, 1990) hearing screening guidelines were developed to decrease over-referrals for middle ear disorders through amended tympanometric measurements. These guidelines also recommended a large-scale normative study be done with tympanometric measures to further reduce the over-referral rate. Seven hundred and fifty ears from 392 kindergarten through third-grade children were tested. Normative values of Peak Ytm and tympanometric width were calculated by grade. For increasing grade level, there was an orderly increase in the mean Peak Ytm and a decrease in the mean tympanometric width. Sensitivity and specificity were calculated at 65 and 80% respectively, with a prevalence of 11%. Suggestions for improving sensitivity and specificity are discussed.

Long-term results of pediatric and adult craniopharyngiomas treated with combined surgery and radiation

From 1958 to 1982, 58 patients with craniopharyngioma were treated with external beam radiation, 56 post surgery. Nineteen were pediatric (< 16 years) and 39 were adult. Forty patients underwent primary treatment while 18 (7 pediatric and 11 adult) were treated for recurrence. Median follow-up is 17 years. Tumor dose and 'maximum dose' (i.e. dose to smallest isodose > 1 cm) were recorded. The mean tumor and maximum dose for pediatric patients was 5588 and 5870 cGy vs. 6243 and 6542 cGy, respectively for adults. The actuarial 5- and 10-year survivals for pediatric patients were 84% and 72%, respectively and were significantly better than the 54% and 51% for adults (p = 0.01). However, overall disease recurrence rates were 26% (5/19) for pediatric patients and 18% (7/39) for adults. Of the multiple patient and treatment parameters analyzed, initial disease type (i.e. primary vs. recurrence) in pediatric patients, surgical extent, tumor dose, maximum dose, age of adults and use of pretreatment CT evaluation appeared to impact on patient outcome. Pediatric patients treated for primary disease showed improved survival over those treated for recurrence. The same was not observed in adults and appeared to be due to treatment toxicity. Surgical morbidity correlated with extent of surgery. All patients who underwent total resection developed surgical sequelae. Forty-four percent (4/9) of patients receiving tumor doses of < or = 5400 cGy developed recurrences vs. 16% (8/49) in those receiving > 5400 cGy. Nine of the 12 recurrences were in patients who did not undergo pretreatment CT evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Pediatric craniopharyngiomas: long term results of combined treatment with surgery and radiation

From 1961 to 1981, 19 pediatric patients with craniopharyngiomas were treated with external beam radiation post surgery. Twelve underwent primary treatment while seven were treated for recurrence. Median follow-up is 21 years (range 8-28 years) with an overall 20-year survival of 62%. Twenty-six percent (5/19) developed disease recurrence following radiation. Of the multiple patient and treatment parameters analyzed, only initial disease status (i.e., primary vs recurrence), surgical extent, radiation dose, and treatment prior to routine use of CT scans (1961-1974) appeared to have major influence on patient outcome. The 20-year survival for those treated for primary disease was 78% versus 25% for those treated for recurrence. Fifty percent (3/6) of patients receiving tumor doses of < or = 5400 cGy developed recurrences versus 15% (2/13) in those receiving > 5400 cGy. Four of the five recurrences occurred in patients treated during the pre-CT era. Long term effects of treatment were analyzed. Surgical morbidity correlated strongly with extent of surgery. All patients who underwent total resection developed surgical sequelae. Radiation morbidity correlated strongly with radiation dose. The incidence of vascular or neurologic complications attributable to radiation were minimal, occurring in only two patients. Both received doses higher than that given with modern therapy. Long-term results from this series are better than those reported with surgery alone. Use of modern surgical and radiation equipment/technique along with CT/MRI imaging should yield improved treatment results both in terms of lower recurrence and lower toxicity rates.

Effects of pancreastatin (24-49) on growth of normal pancreas and pancreatic cancer

In the present study, the effects of pancreastatin on growth are evaluated in two human pancreatic cancer cell lines, in vivo and in vitro, and on athymic nude mouse pancreas. SW-1990 and MIA PaCa-2 pancreatic cancer cell lines were grown in serum-supplemented and serum-free medium in the presence of pancreastatin (10(-11)-10(-6) M), or cholecystokinin (CCK) (10(-11)-10(-8) M) or combinations thereof. Growth was evaluated by [3H]thymidine incorporation and cell counts. Pancreastatin significantly inhibited DNA synthesis in both cell lines, and cell counts in SW-1990 on days 3 and 5 but not 7. CCK-stimulated cell growth was inhibited in both cell lines and mouse pancreas by pancreastatin. Pancreastatin had no effect in the presence of fetal bovine serum. In the in vivo experiments, pancreastatin (15 micrograms/kg) did not affect growth of SW-1990 xenografts to nude mice, but inhibited CCK-stimulated growth transiently. Pancreastatin (100 micrograms/kg) transiently decreased volumes of MIA PaCa-2 xenografts to nude mice and significantly decreased weight, protein, and DNA of mouse pancreas. Fasting glucose levels of mice treated with pancreastatin 100 micrograms/kg for 35 days were significantly lower than controls. Our results demonstrate that pancreastatin not only inhibits CCK-stimulated pancreatic growth but also has inhibitory effects by itself.

Organ specific cytokine therapy. Local activation of mononuclear phagocytes by delivery of an aerosol of recombinant interferon-gamma to the human lung

In the context of the central role of the alveolar macrophage in host defense of the respiratory epithelial surface, and the ability of IFN-gamma to activate mononuclear phagocytes, we have evaluated strategies to use rIFN-gamma to activate human alveolar macrophages in vivo. To accomplish this, rIFN-gamma was administered to nonsmoking normals, the amounts of IFN-gamma quantified in serum and respiratory epithelial lining fluid (ELF) and the status of IFN-gamma related activation of blood monocytes and alveolar macrophages was evaluated by quantifying the expression of mRNA transcripts of IP-10, a gene induced specifically by IFN-gamma. Systemic administration (subcutaneous) of maximally tolerated amounts of rIFN-gamma (250 micrograms) was followed by detectable levels of IFN-gamma in serum but not ELF, the expression of IP-10 transcripts in blood monocytes but not alveolar macrophages, and multiple systemic adverse effects. To circumvent the inability of systemic administration to reach respiratory ELF and activate alveolar macrophages, rIFN-gamma (250-1,000 micrograms) was inhaled as an aerosol once daily for 3 d. Strikingly, while IFN-gamma was not detected in serum it was detectable in respiratory ELF in a dose-dependent fashion. Further, alveolar macrophages, but not blood monocytes, expressed IP-10 mRNA transcripts and, importantly, inhalation of aerosolized rIFN-gamma was not associated with local or systemic adverse effects. Thus, it is feasible to use rIFN-gamma to activate alveolar macrophages by targeting the cytokine directly to the lung. These data suggest a potential strategy for targeted cytokine therapy, without systemic side effects, to augment respiratory tract defenses in individuals at risk for or with lung infection.

Expression of neu protein, epidermal growth factor receptor, and transforming growth factor alpha in breast cancer. Correlation with clinicopathologic parameters

The major objectives of this study were twofold: to determine 1) if growth factors or growth factor receptors were expressed similarly or differently in a clinically well-characterized group of breast cancer patients and 2) if these phenotypic characteristics were associated with any of the commonly used prognostic parameters. Formalin-fixed paraffin-embedded tumor tissue from 51 node-positive breast cancer patients were analyzed for the expression of neu, epidermal growth factor-receptor (EGF-R), and transforming growth factor alpha (TGF alpha) using immunoperoxidase staining. Positive membranous staining for neu was observed in 15 (29%) tumors. Over-expression of neu was observed in high-grade, estrogen-receptor-negative tumors (P less than 0.05). Epidermal growth factor receptor was expressed in 22 (43%) of the tumors analyzed and found to a greater degree in estrogen-receptor-negative and high-grade tumors (P less than 0.025). A significant correlation between neu and EGF-R expression was also noted. Tumors expressing membranous staining of neu had a greater than 70% chance of expressing EGF-R (P less than 0.01). Expression of TGF alpha was found in 68% of tumors and TGF alpha was detected in grade 1 and 2 tumor to a greater degree than EGF-R. The authors conclude that assaying tumors for these antigens may give additional phenotypic characteristics that can give further insight into the biology of breast cancer.

Immunological identification and distribution of parathyroid hormone-like protein polypeptides in normal and malignant tissues

Monoclonal and polyclonal antibodies recognizing human parathyroid hormone-like protein (PTHLP) have been produced using a series of recombinant and synthetic PTHLP peptides. These antibodies have been used to develop a two-site immunometric enzyme immunoassay which detects PTHLP[1-87] and PTHLP[1-141] but not PTH. The immunoassay detected PTHLP in extracts of squamous carcinomas and normal tissues at concentrations from 7-515 ng PTHLP[1-87]/mg protein. Immunoblotting of the extract which showed the highest immunoreactivity, a squamous carcinoma of the lung from a patient with hypercalcemia, revealed a major band having an apparent mol wt of 26,500 and several other higher mol wt bands. Similar polypeptides were observed by immunoblotting cell extracts from a cell line, SCaBER, which secretes immunoreactive PTHLP into its medium and also from tumors in nude mice derived from this cell line. Chaotropic agents did not alter the immunoblotting pattern, and antibodies to three different epitopes of PTHLP recognized these bands, indicating PTHLP expression in the extracts. Immunohistochemical staining of normal human tissue with these antibodies revealed several PTHLP-containing tissues and confirmed the results of the immunoassay, suggesting a paracrine role for PTHLP. Staining was observed in several neoplastic tissues including squamous cell carcinomas, lung carcinoma, bladder carcinoma, osteogenic sarcoma, and adenocarcinoma of the colon.

Cholecystokinin stimulates growth of human pancreatic adenocarcinoma SW-1990

The effect of a synthetic analogue of CCK (Thr4,Nle7CCK-9) on growth of SW-1990 human pancreatic cancer was examined in two experimental models. Nude mice bearing SW-1990 pancreatic cancer xenografts were injected with CCK (5, 15, or 25 micrograms/kg) or vehicle twice daily for 20 days. Animals were then sacrificed and tumor volume, weight, protein, and deoxyribonucleic acid (DNA) content were evaluated. SW-1990 cells were grown in vitro and the effects of CCK, secretin, vasoactive intestinal peptide (VIP), and proglumide (a CCK-receptor antagonist) on cell number and DNA synthesis were determined. The highest dose of CCK, 25 micrograms/kg, significantly increased tumor weight, protein content, and DNA content (P less than 0.005). In vitro, CCK caused significant increases in cell counts of up to 47% at six days and 66% at 12 days compared to control. Graded concentrations of CCK had a biphasic effect on DNA synthesis with significant increases of up to 65% (P less than 0.005). CCK-induced cell proliferation was inhibited by proglumide. Secretin slightly increased cancer cell growth, although not as potently as CCK, VIP or secretin in combination with CCK did not show potentiation. These results indicate that growth of some human pancreatic cancers may be influenced by gastrointestinal peptides, of which CCK is the most potent.

Effects of a high-fat diet and L364,718 on growth of human pancreas cancer

The effects of a high-fat diet and the CCK-receptor antagonist, L364,718, were examined on growth of human pancreas cell line SW-1990 xenografted to nude mice. Sixty animals were fed either low-fat (4.3%) or high-fat (20.25%) diet. Fifteen mice in each diet group were treated with L364,718 (2 mg/kg) subcutaneously twice daily for 23 days. On day 24 the animals were sacrificed. Tumor and animal pancreases were dissected and evaluated for weight, protein, and DNA content. When comparing within each diet group, L364,718 significantly decreased tumor volume, weight, protein, and DNA content compared to untreated mice (P less than 0.005). Tumor volume and protein content were significantly larger in untreated animals on the high-fat diet (P less than 0.05) compared to the low-fat diet. Mouse pancreatic weight, protein, and DNA content per kilogram of animal weight were all significantly lower (P less than 0.005) in mice on the low-fat diet treated with L364,718. Pancreatic DNA content was also decreased in both groups of animals on the high-fat diet compared to untreated mice on the low-fat diet. These findings suggest that diets high in unsaturated fat promote the growth of human pancreatic cancer. Since both tumor and pancreas growth are inhibited by the specific CCK-antagonist, L364,718, it is possible that endogenous CCK promotes the growth.

Neuroblastoma and parental occupation

A matched case-control study of neuroblastoma investigated parental occupational risk factors. Cases diagnosed in 1970-1979 were identified through tumor registries in the Greater Philadelphia area. Controls were selected by random digit dialing and were matched to cases on race, birth date, and telephone exchange. Parents of 104 matched pairs were interviewed by telephone. In contrast to results of a previous study, no significant associations were noted for paternal employment in a job cluster of occupations in electricity, electronics, insulation, utility, and printing; in jobs with electromagnetic field exposure; or in jobs as workers in electronics. Six cases and one control, however, had a father or mother who worked in electrical or electronic products assembly.

The treatment of medulloblastoma. Results of a prospective randomized trial of radiation therapy with and without CCNU, vincristine, and prednisone

In a prospective randomized trial designed to study the effectiveness of adjuvant chemotherapy following standard surgical treatment and radiation therapy, 233 eligible patients with medulloblastoma were treated by members of the Children's Cancer Study Group and the Radiation Therapy Oncology Group. Eligible patients were randomly assigned to receive radiation therapy with or without adjuvant chemotherapy consisting of 1-(2-chloroethyl)-3-cyclohexyl-nitrosourea (CCNU), vincristine, and prednisone. The estimated 5-year event-free survival probability was 59% for patients treated with radiation therapy and chemotherapy and 50% for patients treated with radiation therapy alone, a difference which is not statistically significant. The 5-year survival probability was 65% for both groups. Although the treatment difference was not statistically significant when all patients were combined, in the small number of patients with more extensive tumors, event-free survival was better in the group receiving chemotherapy (48% vs. 0%, p = 0.006). In these latter patients the survival time is also significantly prolonged. Extent of disease (as measured by the M staging criteria described by Chang) and age at diagnosis were significantly associated with outcome; advanced disease and young age had a worse prognosis. The extent of tumor resection was not an independent prognostic factor. It is concluded that chemotherapy does not benefit patients with low-stage medulloblastoma, but may benefit those with more advanced stages of disease.

Patient age as a factor in radiotherapy. Data from the patterns of care study

We studied the effect of patient age on treatment decisions related to radiation therapy using data obtained through the Patterns of Care Study. Definitive treatment given for breast cancer (191 patients) and palliative therapy given for a variety of symptoms (784 patients) were investigated using data collected from 49 facilities selected on a random basis to reflect fairly the national practice of radiotherapy. Elderly (aged 70 or older) patients accounted for 28.6% of the palliatively treated patients and 19.5% of the definitively treated breast patients. No correlation was found between patient age and the dose or number of days used in palliative therapy. Older patients were more likely to have the "boost" dose of radiation to the tumor bed delivered through external rather than implant techniques. While statistically significant, this difference is not felt to be clinically important. We conclude that once a patient is selected for a course of radiation therapy, age per se, is not a basis for prejudicial treatment.

Surgical quality control in head and neck cancer. Study 73-03 of the Radiation Therapy Oncology Group

The measurement of quality of medical care has always been a topic of concern to physicians and other health care professionals. During an age of increasing competitiveness in the health care environment, the ability to assess accurately the quality of the care delivered has become increasingly important. The head and neck surgeons within the Radiation Therapy Oncology Group have examined this problem and have developed an evaluation tool that was then applied retrospectively in an attempt to evaluate the quality of surgery performed in a randomized study. The analysis of the results suggested that the retrospective approach to surgical quality control is fraught with hazards and is unlikely to fulfill the goals set for it.

Parental occupation and Wilms' tumor: results of a case-control study

Parental occupational exposures for Wilms' tumor were investigated in a pair-matched case-control study. The timing of the exposures in relation to the child's conception and birth was studied, as were the two forms of Wilms' tumor: genetic (prezygotic origin) and nongenetic (postzygotic origin). Cases who were under 15 yr of age at diagnosis during 1970 to 1983 were identified through the registries of three main hospitals treating childhood cancer in the Greater Philadelphia area. Controls were selected by random digit dialing and were matched to cases on race, birth date, and telephone area code and exchange. Because of a low participation rate among blacks, results are reported only for the 88 white matched pairs whose parents participated in telephone interviews. Children whose fathers held jobs in a job cluster that consisted mostly of machinists and welders were at significantly increased risk. The increase was highest for preconception exposure (odds ratio = 5.3, P = 0.006). The effect of preconception exposure was higher for the 26 genetic cases than for the 42 nongenetic cases. The other 20 cases were excluded from the subgroup analyses for various reasons. Further analyses did not elucidate an exposure common to machinists and welders that might explain the findings.

Synthesis of a gene encoding parathyroid hormone-like protein-(1-141): purification and biological characterization of the expressed protein

PTH-like proteins (PTHLP), which are associated with humoral hypercalcemia of malignancy, have recently been purified. Isolation of their corresponding cDNAs has revealed that they are derived from a single gene. In this report a synthetic gene encoding PTHLP-(1-141), a 141-amino acid protein corresponding to the most abundant PTHLP cDNA detected in human tumors, was expressed in bacteria and purified to homogeneity. Recombinant (r) PTHLP-(1-141) migrates with an aberrantly high mol wt on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, presumably as a result of its unusually basic pI. rPTHLP-(1-141), like PTH, induced hypercalcemia in rats, caused release of 45Ca from fetal rat bones, and stimulated the synthesis of cAMP by rat osteosarcoma cells and canine renal membrane preparations. A comparison of the abilities of rPTHLP-(1-141) and bovine PTH-(1-34) to stimulate cAMP synthesis indicated rPTHLP-(1-141) to be 5-fold more potent in the osteosarcoma assay, while nearly 30-fold less active in the renal membrane adenylate cyclase assay. Although 100-fold less potent than bovine PTH-(1-34) in promoting bone resorption, rPTHLP-(1-141) was a potent calcemic factor in vivo, inducing a rise in serum calcium from 10.4 to 14.5 mg/dl when infused into rats at 1.3 micrograms/h. These results support previous assumptions that PTHLP is the humoral factor responsible for humoral hypercalcemia of malignancy. In addition, they suggest substantial differences between PTHLP and PTH in the regulation of calcium homeostasis.

The developmental context of internalized preoedipal object relations. Clinical applications of Mahler's theory of symbiosis and separation-individuation

Mahler's theory of symbiosis and separation-individuation demonstrates the essential unity of drive, ego, and object relations psychologies. By highlighting the role that early dyadic relations play in psychic structure formation, her theory expands the understanding of human psychic development and its failures. This paper reviews Mahler's propositions and underscores their clinical importance by describing two cases where much preoedipal reconstructive work preceded the emergence of an analyzable oedipal transference neurosis.