Radioimmunotherapy of colorectal cancer in small volume disease and in an adjuvant setting: preclinical evaluation in comparison to equitoxic chemotherapy and initial results of an ongoing phase-I/II clinical trial

The 5-year survival of colorectal cancer patients with distant metastases is below 30%, despite the development and use of a variety of chemotherapeutic regimens. Therefore, new therapeutic strategies are warranted. Whereas radioimmunotherapy (RIT) has shown disappointing results in bulky disease, it may be a promising therapeutic alternative in limited and small volume disease. The aim of this study was, therefore, to compare, in a preclinical study, the therapeutic efficacy of RIT in colorectal cancer to equitoxic chemotherapy, as well as to evaluate, in a pilot clinical trial, its efficacy in small volume disease. Nude mice, bearing subcutaneous or metastatic human colon cancer xenografts, were injected either with the unlabeled or 131I-labeled monoclonal antibodies (MAbs), CO17-1A (which is a murine IgG2a directed against a 41-kD membrane glycoprotein) or F023C5 (which is an anti-CEA MAb of murine IgG1 subtype), or were administered 5-fluorouracil/folinic acid (5-FU/LV) at equitoxic doses. In a pilot clinical study, 10 colorectal cancer patients with small volume metastatic disease (all lesions < or = 3 cm) have been entered so far in an ongoing mCi/m2-based dose escalation study with the 131I-labeled F023C5. In the animals, the maximum tolerated activities (MTD) of 131I-labeled CO17-1A and F023C5 were 300 microCi and 600 microCi, respectively, corresponding to blood doses of approximately 15 Gy each. Accordingly, myelotoxicity was dose-limiting. The MTD in the chemotherapy group was 0.6 mg 5-FU/1.8 mg LV, given as intravenous bolus 1 h apart for 5 subsequent days. Whereas no significant therapeutic effects were seen with both unlabeled MAbs or 5-FU/LV chemotherapy, tumor growth was retarded significantly with both radiolabeled antibodies. In the metastatic model, chemotherapy prolonged life for only a few weeks, whereas RIT led to cures in 35-55% of the animals. As was the case in the animals, myelotoxicity seems to be dose-limiting in patients as well. Encouraging anti-tumor effects were observed, lasting for up to more than 12 months. These data suggest that radioimmunotherapy may be a viable therapeutic option in colorectal cancer patients with limited disease. Myelotoxicity is the only dose-limiting organ toxicity. Although most patients were treated below the MTD, anti-tumor effects are encouraging. Further studies are ongoing.

Chondromatosis of the ankle joint (Reichel syndrome)

A case of chondromatosis of the upper ankle joint in childhood is described. It is a monoarticular disease with a good prognosis, frequently without known prior trauma or inflammation, although often free fragments of cartilage are seen in the joint cavities. It originates from the synovium of the joint, and is known in the literature as Reichel syndrome.

Is there a psoriatic osteopathy? -- the activity of bone resorption in psoriatics is related to inflammatory joint process

The aim of this study was to examine former own histomorphological results by using biochemical markers of bone collagen catabolism in patients with psoriasis vulgaris and psoriatic arthritis and to compare these results with those from rheumatoid arthritis. - The diagnosis of PsA was made according to the diagnostic criteria of Moll and Wright modified by Bennet. Urine was collected from 99 patients with PsA, 21 patients suffering from PS without articular manifestations, 154 patients with RA fulfilling the ACR criteria of 1987, and 80 healthy controls. Pyridinoline and deoxypyridinoline in urine were analyzed by HPLC, levels of CrP and ESR were estimated using laboratory assessment. - Both crosslinks show a elevated excretion in PsA (particularly in active PsA / aPsA) as well as in RA. PS and Controls show no significant difference in the elimination of crosslinks. The levels of both crosslinks are higher in females than males in all groups. With the exception of Dpyd levels in urine which only show a tendency to correlate with ESR, there are positive correlations between measured crosslink-levels in urine and markers of inflammation. The Pyd/Dpyd ratio displays a significant correlation with ESR. - An increased breakdown of collagen I and II was found only in active forms of psoriatic arthritis and in rheumatoid arthritis. Our biochemical results do not demonstrate a complete agreement with former scintigraphic or histological investigations of other authors and own histomorphological results.

An automatic method for the identification and interpretation of clustered microcalcifications in mammograms

We investigated a method for a fully automatic identification and interpretation process for clustered microcalcifications in mammograms. Mammographic films of 100 patients containing microcalcifications with known histology were digitized and preprocessed using standard techniques. Microcalcifications detected by an artificial neural network (ANN) were clustered and some cluster features served as the input of another ANN trained to differentiate between typical and atypical clusters, while others were fed into an ANN trained on typical clusters to evaluate these lesions. The measured sensitivity for the detection of grouped microcalcifications was 0.98. For the task of differentiation between typical and atypical clusters an Az value of 0.87 was computed, while for the diagnosis an Az value of 0.87 with a sensitivity of 0.97 and a specificity of 0.47 was obtained. The results show that a fully automatic computer system was developed for the identification and interpretation of clustered microcalcitications in mammograms with the ability to differentiate most benign lesions from malignant ones in an automatically selected subset of cases.

Preliminary experience with interactive guided brain biopsies using a vertically opened 0.5-T MR system

The purpose of our study was to evaluate the feasibility and accuracy of brain biopsies performed within a vertically opened MR system. We worked with the interventional 0.5-T MR "SIGNA SP" (General Electric Medical Systems, Milwaukee, Wis.) with an integrated tracking device "Flashpoint Position Encoder" (Image Guided Technologies, USA). As a holding device for this instrument we constructed a special frame. The whole system allows an exact adjustment of an optimum biopsy direction and guidance of the biopsy in a non-stereotactic, interactive mode in near real-time. As biopsy tools we used MR-compatible aspiration and specially made side-cut needles (Daum, Germany; E-Z-EM, USA). We performed a prospective diagnostic brain biopsy study in 18 patients. Guidance of the needle was carried out using gradient-echo single-slice technique. The sample was taken after controlling the exact position of the needle tip on spin-echo images. In 12 cases an exact neuropathological diagnosis was possible. In 6 cases of negative biopsy (4 aspiration biopsies) the samples were not representative. Our results demonstrate the feasibility of interactive MR-guided minimally invasive brain biopsies in an open MR system. The best results were achieved using cut needles for biopsies of contrast-enhancing lesions visible on T1-weighted gradient-echo guidance sequence.

Application of the ADEPT strategy to the MDR resistance in cancer chemotherapy

New prodrugs consisting of a beta-D-glucuronic acid linked to a MDR reversal agent (verapamil, quinine or dipyridamole) through a self-immolative spacer were synthesized. Four of them were selected for their reduced cytoxicity and beta-glucuronidase enzymatic efficient hydrolysis. Combined use of these prodrugs with a beta-D-glucuronyl-spacer-doxorubicin (HMR1826) according to an ADEPT strategy restored in vitro the sensibility of a MDR resistant strain.

Topotecan-based combination chemotherapy for human malignant glioma

BACKGROUND

Topotecan has been considered a promising agent for the adjuvant chemotherapy of human malignant glioma because of its novel mode of action, its activity against other solid tumors, and its good penetration across the blood-brain barrier. However, the clinical effects of topotecan monotherapy in malignant glioma have been disappointing.

MATERIALS AND METHODS

We sought to identify suitable partners for topotecan combination chemotherapy of malignant glioma using two well-characterized human malignant glioma cell lines, T98G and LN-229. The effects of co-exposure to topotecan and other chemotherapy drugs were assessed in cytotoxic and clonogenic cell death assays.

RESULTS

We found additive, less-than-additive, or occasional antagonistic effects, but never synergistic activity of topotecan with either CCNU, VM26 or vincristine, in acute cytotoxicity or in clonogenic cell death assays, with simultaneous or sequential drug exposure. VM26 or vincristine followed by topotecan yielded the most favourable results. Further, prolonged exposure of the glioma cells to topotecan and either CCNU, VM26, vincristine, cisplatin, doxorubicin or cytarabine resulted in additive but not synergistic growth inhibition.

CONCLUSIONS

The present study fails to identify a specific partner for topotecan-based combination chemotherapy of malignant glioma among the chemotherapeutic drugs examined here. While this does not exclude a possible synergy of the drug combinations examined here in vivo, a focus on novel partners for topotecan or topotecan-based chemoimmunotherapy may be more promising.

[Creatinine and calcium in urine and blood after brief exposure to magnetic fields]

In this experimental study, 35 males were exposed to artificial magnetic fields. The fields were produced by a set of Helmholz coils internally isolated by a Faraday cage which effectively eliminated electrical fields. Each participant stayed inside the coils for 40 minutes on two occasions with an interval of seven days, but was actually only once exposed to a static magnetic field (9.6 mT) and oscillating magnetic fields of variable frequency and strength. Urine and blood samples were taken before and after exposure, and before and after non-exposure. Analysis detected significant changes in serum creatinine level after exposure (p < 0.0001). The changes in serum creatinine level in the nonexposed situation were significantly smaller than the changes found in the exposed situation (p < 0.0001). The changes i urine creatinine after 40 minutes of exposure was also found to be significant (p < 0.01). Exposure to magnetic fields may induce biological reactions.

The impact of ergotamine-induced headache and ergotamine withdrawal on information processing

Ergotamine abuse and subsequent ergotamine-induced headache is a common problem in the pharmacological treatment of migraine and other headache types; often, withdrawal therapy is necessary. This study investigated whether ergotamine abuse affects information processing and whether withdrawal therapy can lead to an improvement of information processing. We designed a standardized neurophysiological retrospective (ergotamine abuse) and prospective (ergotamine withdrawal) study in a supraregional headache outpatient clinic. Seventy-one patients abusing ergotamine derivatives with subsequent daily headache were enrolled and compared to 36 migraine patients without ergotamine intake and 36 healthy subjects. Information processing was evaluated by latencies and amplitudes of visually evoked event-related potentials (ERP) before and after ergotamine withdrawal therapy. P3 latency of the ERP was significantly increased in ergotamine abuse (442 +/- 45 ms) versus migraine (415 +/- 40 ms) and healthy subjects (410 +/- 33 ms), there was no difference between ergotamine tartrate and dihydroergotamine abuse. The migraine specific loss of habituation in information processing as measured by P3 latency could not be observed in migraine patients with ergotamine abuse. After successful withdrawal therapy in 36 patients, the abnormally prolonged P3 latency was significantly shortened (452 +/- 47 ms versus 433 +/- 30 ms; P < 0.004). Our findings imply that information processing is impaired by ergotamine abuse and can be improved but not normalized after withdrawal therapy. Furthermore, our data provide strong evidence that ergotamine, besides its peripheral effects, has a central mode of action.

Hypertension-induced end-organ damage : A new transgenic approach to an old problem

Angiotensin (Ang) II-induced organ damage has fascinated students of hypertension since the work of Wilson and Byrom. We are investigating a double transgenic rat (dTGR) model, in which rats transgenic for the human angiotensinogen and renin genes are crossed. These rats develop moderately severe hypertension but die of end-organ cardiac and renal damage by week 7. The heart shows necrosis and fibrosis, whereas the kidneys resemble the hemolytic-uremic syndrome vasculopathy. Surface adhesion molecules (ICAM-1 and VCAM-1) are expressed early on the endothelium, while the corresponding ligands are found on circulating leukocytes. Leukocyte infiltration in the vascular wall accompanies PAI-1, MCP-1, and VEGF expression. The expression of TGF-beta and deposition of extracellular matrix proteins follows, which is accompanied by fibrinoid vasculitis in small vessels of the heart and kidneys. Angiotensin-converting enzyme inhibitors and AT1 receptor blockers each lowered blood pressure and shifted pressure natriuresis partially leftward by different mechanisms. When combined, they normalized blood pressure, pressure natriuresis, and protected from vasculopathy completely. Renin inhibition lowered blood pressure partially, but protected from vasculopathy completely. Endothelin receptor blockade had no influence on blood pressure but protected from vasculopathy and improved survival. We show evidence that Ang II stimulates oxidative stress directly or indirectly via endothelin 1 and that NFkappaB is upregulated in this model. We speculate that the transcription factors NFkappaB and AP-1 are involved with initiating chemokine and cytokine expression, leading to the above cascade. The unique model and our pharmacological probes will enable us to test these hypotheses.

Monocyte infiltration and adhesion molecules in a rat model of high human renin hypertension

Hypertension and kidney damage in the double transgenic rat (dTGR) harboring both human renin and human angiotensinogen genes are dependent on the human components of the renin angiotensin system. We tested the hypothesis that monocyte infiltration and increased adhesion molecule expression are involved in the pathogenesis of kidney damage in dTGR. We also evaluated the effects of long-term angiotensin-converting enzyme (ACE) inhibition, AT1 blockade, and human renin inhibition on monocyte recruitment and inflammatory response in dTGR. Systolic blood pressure and 24-hour albuminuria were markedly increased in 7-week-old dTGR as compared with age-matched normotensive Sprague Dawley rats. We found a significant monocyte/macrophage infiltration in the renal perivascular space and increased expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in the interstitium, intima, and adventitia of the small renal vessels. alphaLbeta2 integrin and alpha4beta1 integrin, the corresponding ligands for ICAM-1 and VCAM-1, were also found on infiltrating monocytes/macrophages. The expression of plasminogen activator inhibitor-1 and fibronectin in the kidneys of dTGR were increased and distributed similarly to ICAM-1. In 4-week-old dTGR, long-term treatment with ACE inhibition (cilazapril), AT1 receptor blockade (valsartan), and human renin inhibition (RO 65-7219) (each drug 10 mg/kg by gavage once a day for 3 weeks) completely prevented the development of albuminuria. However, only cilazapril and valsartan were able to decrease blood pressure to normotensive levels. Interestingly, the drugs were all equally effective in preventing monocyte/macrophage infiltration and the overexpression of adhesion molecules, plasminogen activator inhibitor-1, and fibronectin in the kidney. Our findings indicate that angiotensin II causes monocyte recruitment and vascular inflammatory response in the kidney by blood pressure-dependent and blood pressure-independent mechanisms. ACE inhibition, AT1 receptor blockade, and human renin inhibition all prevent monocyte/macrophage infiltration and increased adhesion molecule expression in the kidneys of dTGR.

Medical audit after 26,711 breast imaging studies: improved rate of detection of small breast carcinomas (classified as Tis or T1a,b)

BACKGROUND

Patients with breast carcinomas 1 cm or smaller are known to have the highest long term survival rates. This pathologic measurement was used as a quality indicator of the performance of different reporting radiologists.

METHODS

A total of 26,711 diagnostic breast imaging studies were performed over a period of 5 years. Within the first 18 months, several general radiologists reported mammograms, whereas during the rest of the evaluated period only 1 radiologist was responsible for all mammography reporting. Radiologic findings leading to open biopsy were correlated with the histologic results. The cancer sizes from the histologic reports were recorded, and the number of Tis, T1a, and T1b cancers were correlated with all cancers found at open biopsy. The change in the relative percentage of small cancers was evaluated, along with the positive predictive value (PPV).

RESULTS

Between 1991 and 1995, 26,711 breast imaging studies were performed. This resulted in 2698 open biopsies with 620 breast carcinomas detected. In the first 2 years, the percentages of small cancers detected (Tis or T1a,b) were 27.2% and 25.7%, respectively. In the third, fourth, and fifth years, the percentages increased to 38.8%, 34.5%, and 38.8%, respectively. At the same time, the PPV increased slightly, from 0.23 in 1991 to 0.27 in 1995.

CONCLUSIONS

The detection of curable early stage breast carcinomas requires the dedication and commitment of a small group of radiologists who are willing to spend most of their time on this single subject. This will increase considerably the number of early stage cancers found and reduce the number of false-positive diagnoses. [See editorial counterpoint on pages 2430-1 and reply to counterpoint on pages 2432-3.]

DNA quantification and ploidy patterns in human adrenocortical neoplasms

The determination of DNA ploidy and the study of the cell cycle in adrenocortical tumoral cells could help in the distinction between benign and malignant lesions and also in the prediction of the biological behaviour of these tumors. We analysed 32 cases of adrenal tissue (8 normal adrenals--N, 12 benign adenomas--A and 12 carcinomas--C). DNA was quantified by image analysis of Feulgen stained sections (Ahrens System) employing ACAS3 software. The DNA content was considered to be diploid in 70% of the N and in 67% of the A groups and in none of C. In this latter group nearly 90% were triploid or tetraploid while this did not occur in any of the A cases. The percentage of cases with a 5c-exceeding rate (5cER) above 5% was nil in the N and A groups and 100% in C. In what concerns the distribution in the cell cycle we found a very distinctive pattern between the groups as the percentage of cases in which the S-phase fraction exceeded 33% was nil in the normals, 8% in A and 83% in the C cases. In conclusion, there was a good correlation between the analysed parameters and the clinically defined groups of adrenal cortex tumors.

Relapse of pulmonary Mycobacterium kansasii disease associated with large-cell cancer of the lung: a case report

A 43-year-old caucasian male diabetic presented with purulent cough and a history of weight-loss, elevated temperature, night-sweat and dyspnea. Four years previously, the patient had undergone a 12-month antimycobacterial regimen because of pulmonary mycobacterium kansasii (MK) disease of the left upper lobe (LUL). Treatment had led to complete recovery with the exception of minor fibrous residuals in the involved pulmonary segments. Chest radiograph and computed tomography (CT), performed on recent admission, revealed a dense infiltration of these residual-containing segments. Microbiological evaluation of bronchial brushings, aspirates and histology of the transbronchial biopsies indicated a relapse of pulmonary MK disease. Although antimycobacterial treatment was started immediately, therapeutic effects were only minimal and remained to be limited to the initial phase of the treatment. After four weeks of treatment, the patient's general condition worsened again. Follow-up CT of the lung showed a marked increase of the infiltration in the left apicoposterior lobe and re-bronchoscopy showed a tumorous protrusion of the bronchial wall involving the apicoposterior segment ostium, a finding which was not seen in the previous bronchoscopy. Histology of the transbronchial biopsies revealed a carcinoma mainly from large-cell type.

Acute effects of recombinant human interleukin-6 on endocrine and central nervous sleep functions in healthy men

Interleukin-6 (IL-6) is a proinflammatory cytokine that has been shown to mediate, in addition to immune reactions, various endocrine and central nervous components of the acute phase response. In this context, the present study aimed to specify the contributions of IL-6 to the regulation of pituitary-adrenal secretory activity and GH and TSH secretion, as well as to the regulation of central nervous sleep and mood in healthy men. Effects of a low dose of IL-6 (0.5 microgram/kg body weight) were assessed, inducing plasma IL-6 concentrations closely comparable with those typically observed after infectious challenge. Each of the 16 male subjects participated in two 14-h sessions (between 1800 and 0800 h), receiving either placebo or human recombinant IL-6 sc at 1900 h. Blood was collected repeatedly to determine plasma hormone levels, serum concentrations of cytokines, and C-reactive protein. Moreover, mood was assessed, and sleep recordings were obtained between 2300 and 0700 h. The cytokine induced a prolonged increased in plasma concentrations of ACTH and cortisol (P < 0.001), but led to a decrease in TSH concentrations (P < 0.01). In response to IL-6, subjects reported fatigue and felt more inactive and less capable of concentrating than after placebo. Sleep architecture was altered significantly by the cytokine. Slow-wave sleep was decreased during the first half and increased during the second half of sleep. Rapid eye movement sleep during the entire nocturnal sleep time was significantly decreased. After IL-6, body temperature rose slightly. C-reactive protein concentrations were dramatically increased 12.5 h after substance administration (P < 0.001). IL-6 did not affect serum concentrations of IL-2, IL-8, interferon-alpha, and interferon-gamma. The results underscore the importance of IL-6 in the cascade of cytokines for the neuroendocrine response during the acute phase reaction. In addition, IL-6 appears to be involved in changes of sleep and behavior accompanying infection and inflammatory disorders.

[New method of MR-guided mammary biopsy]

PURPOSE

With a recently installed new open MR tomograph (Signa SP, General Electric MS) it is possible for the first time to examine patients with obscure lesions of the mamma by MR imaging in a sitting position, similar to mammography.

METHOD

The newly developed positioning device with integrated surface coil permits in combination with the vertical gap in the new magnet and imaging of the mamma with a "real time" sequence a biopsy procedure within a short time and in a manner that is acceptable for the patient. By means of an integrated interactive scan plane guiding system ("flash point tracking system") and special MR-compatible needles and wires tissue samples can be taken, or marking by a wire can be carried out within a short time.

RESULTS

Phantom experiments and first in vivo experience (10 patients) show that by means of the new mamma fixation and biopsy device a MRI of one breast in a sitting position for detecting an enhancing lesion and a MR-guided biopsy of this lesion is possible. The whole procedure takes about 25-35 minutes, comparable to the conventional stereotactic method.

CONCLUSION

Direct patient access and the interactive guided biopsy allow in future both new diagnostic information (histological results after biopsy or after wire-guided open biopsy of a lesion only visible in MR) and the development of minimal invasive therapeutic procedures, e.g. MR-guided and -controlled interstitial thermotherapy.

[Operation of multidisciplinary, interventional 0.5 Tesla magnetic resonance tomograph. Technical and logistic problems and initial clinical results]

Multidisciplinary usage of a MRI system with a superconducting 0.5-T magnet (Signa SP, General Electric) with a vertical gap suited for diagnostic and therapeutic interventions raises complex problems. The MR equipment, including a special localizing system and the instruments for diagnostic and therapeutic interventions, is described. Before putting the system into operation tests were necessary to check MR compatibility of various materials and instruments and to build some auxiliary equipment. We report on the coordinating activities of the radiologist in the context of MR use by different medical specialities. Within the course of 12 months, 428 examinations/interventions of different kinds were carried out, among them 75 functional examinations of the spine or of joints, 31 diagnostic biopsies, 23 cerebral biopsies, and 23 operations. The special design of the Signa SP allows the whole scale of functional examinations, up to complete neurosurgical interventions, in the sitting position and under nearly real-time imaging control.

Theory and application of passive SAW radio transponders as sensors

Surface acoustic wave (SAW) radio transponders make it possible to read identification codes or measurement values from a remote location. The decisive advantage of these SAW transponders lies in their passive operation (i.e., no power-supply), and in the possibility of wireless installation at particularly inaccessible locations. The passive SAW transponders are maintenance free. Identification marks respond to an interrogation signal with their nonchanging identification pattern. In wireless SAW sensors the physical or chemical properties to be detected change the propagation characteristics of the SAW. SAW radio transponders are advantageously placed on moving or rotating parts and in hazardous environments such as contaminated or high voltage areas. They also can be used for contactless measurements in high vacuum process chambers, under concrete, extreme heat, or strong radioactive radiation, where the use of conventional sensors is complicated, dangerous, or expensive. In this paper we discuss the principles of wireless passive SAW transponders and present a radio frequency interrogation unit and several passive radio SAW sensors developed for noncontact measurements of temperatures, pressures, torques, and currents.

[Radiologic imaging of MALT lymphoma. (Comparison between stomach roentgen image, computerized tomography and magnetic resonance tomography]

The new classification of primary lymphomas of the stomach according to the MALT concept is very promising in therapy planning and prognostic estimation. This new classification sets strict requirements for imaging diagnostics. Besides endosonography which allows the determination of the infiltration depth in stages E I1 and E I2 in an excellent manner, computed tomography and, possibly, magnetic resonance tomography are indispensible for evaluation of higher stages and of the resectability of a lymphoma. Further MRI examinations are recommended.

[Value and importance of magnetic resonance tomography]

After 14 years of clinical practice, magnetic resonance imaging (MRI) has gained an important place among the imaging methods. For a physician not permanently occupied with these problems, the differential indications of MRI compared to ultrasound and computertomography (CT) are difficult to understand. Knowledge of capabilities and limitations, benefits and drawbacks, contraindications, future trends, and, in an era of shortage of financial resources, knowledge of some essential economic aspects will be helpful. This publication tries to present these aspects in a compact form were singular problems of MRI diagnostics can only partly be dealt with.

[Mercury and creatinine in urine of employees exposed to magnetic fields. A study of a group electrolysis-operators in Norzink A/S in Odda]

The results described are based on a study of 26 male cell house employees. They were exposed to a combination of static magnetic fields (3-10 mT) and low frequency oscillating magnetic fields of variable frequency and strength for eight hours a day over a period of four weeks. Every fifth week was spent off work. Urine samples collected at the end of the four weeks of exposure were compared with samples collected at the end of the week off work. The results show that the cell house workers excreted significantly more mercury in their urine after exposure to magnetic fields (p = 0.01). The mercury/creatinine ratio was also significantly higher after exposure (p < 0.01). These results support findings by Schmidt in a study from 1992 when the levels of mercury and creatinine in the urine of cell house workers were compared with the levels in office personnel.

[Nuclear magnetic resonance tomography examinations of the urogenital diaphragm in comparison with corresponding histomorphologic findings (the controversy concerning the musculus transversus perinei profundus)]

The transversus perinei profundus muscle is a well known structure in found anatomical textbook. Fibers of this muscle are believed to form the so-called external urethral sphincter (musculus sphincter urethrae). Recently histomorphologic investigations have shown that there is no muscular connection between the musculus sphincter urethrae (external sphincter) and the muscle system of the pelvic floor. Furthermore, the external sphincter was found to be divided into parts: the transversely striated part (musculus sphincter urethrae transversostriatus) and the smooth part (musculus sphincter urethrae glaber). Similar to histomorphologic investigations, contrast-enhanced MR imaging has shown the musculus sphincter urethrae to be surrounded by fatty and connective tissue only. Neither in MRI nor in anatomical slices can any connection between the urethral sphincter and the muscle system of the pelvic floor to be found. Thus, on the basis of the results presented in this work it is concluded that the musculus transversus perinei profundus does not exist in the form described in textbooks.

[Mammography]

Today mammography represents the only imaging modality that decreases with the help of screening programs the mortality rate of breast cancer patients. This becomes increasingly necessary because already every tenth woman in Austria will get this tumor during her lifetime. There is conclusive evidence that the patients chance for survival depends on the clinical status of breast cancer at the time of diagnosis. Therefore every woman should undergo a yearly mammogram starting at 40 years of age. If sensitivity and specificity of mammography is under consideration one must differentiate its role during a screening program versus the situation of a symptomatic patient.

The effect of the full bladder on vasopressin secretion in healthy young adults

Interactions between the central nervous system, bladder and kidneys have been investigated for many years in animal studies and have shown that bladder distension, in animals, leads to decreased urine production. The objectives of the current study were to determine the effect of a full bladder on urinary output, vasopressin secretion and urine osmolality in humans. The study involved healthy volunteers. They were studied for a period of 48 hours. This period included two 24-hour studies, one involving regular and frequent voidings (to produce a minimal bladder filling) and the other voiding postponement (to produce maximal bladder distension). In contrast to enuresis studies a circadian rhythm of vasopressin secretion was observed in the males involved in this study, whereas no significant rhythm of vasopressin secretion could be detected in the female subjects. However, this study was unable to confirm that, in humans, a full bladder causes a decrease in urine production, an increase in vasopressin secretion or an increase in urine osmolality.

Long-term home studies of water balance in patients with nocturnal enuresis

A 2-week, home-based study was conducted on 75 children with nocturnal enuresis to monitor the frequency of enuretic episodes and the volume of nocturnal urine production. The objectives of the study were to correlate nocturnal urine production to the occurrence of nocturnal enuresis and response to desmopressin (Minirin, DDAVP) treatment. Furthermore, patient compliance was evaluated. Enuresis episodes and nocturnal urine production was recorded every night during two base-line weeks without treatment and during 2 weeks with 20-40 micrograms desmopressin at bedtime. During both periods fluid intake and micturition volumes were recorded for 2 days. Desmopressin response was defined as > 50% reduction in wet nights during treatment. It was found that patient compliance was acceptable in most patients. Regarding urine output it was found that base-line nocturnal urine production was significantly higher during nights when enuresis occurred than during "dry" nights and significantly higher in desmopressin responders compared with desmopressin non-responders. During treatment with desmopressin, nocturnal urine production in desmopressin responders decreased to levels similar to those of non-responders. The results confirm inpatient circadian studies of urine output and emphasise the importance of nocturnal polyuria in patients with monosymptomatic enuresis. The response to desmopressin was found to correlate with the occurrence of nocturnal polyuria. Home studies were considered to be a useful tool in the characterisation of patients with nocturnal enuresis.

Comparison of mammographic image quality in various methods of reconstructive breast surgery

The purpose of our study was to evaluate mammographic image quality of various methods of reconstructive breast surgery with specific reference to the possibility of diagnosis of recurrent tumors. A total of 39 patients who underwent breast reconstruction following modified radical mastectomy were subject to clinical and mammographic examination. Three groups were formed: (a) autonomous tissue reconstruction (TRAM-flap; n = 9), (b) submuscular silicon gel prostheses (n = 21), and (c) supramuscular silicon gel prostheses (n = 9). Mammographic image quality of the groups was compared by two radiologists working together using a point system where five specific criteria were valued and scored. The result was tabulated into three quality levels: good, acceptable, and limited. Mammograms were assessed as good, acceptable, or limited, respectively, as follows: group I: 7 (77.8%), 1 (11.1%), 1 (11.1%); group II: 4 (19%), 11 (52.4%), 6 (28.6%); group III: 3 (33.3%), 4 (44.5%), 2 (22.2%). The TRAM-flap method of reconstruction displays a high degree of mammographic image quality and therefore is preferable with respect to early diagnosis of recurrent tumors.

The impact of data-analysis methods on cumulative research knowledge: statistical significance testing, confidence intervals, and meta-analysis

The methods of data analysis used in research have a major effect on the development of cumulative knowledge. Traditional methods based on statistical significance testing have systematically retarded the growth of cumulative research by making it virtually impossible to discern the real meaning of research literatures. Meta-analysis makes it possible to demonstrate graphically the high price the research enterprise has paid for its reliance on significance testing. But in addition to these demonstrations, reform will require that researchers come to understand that the benefits they see as flowing from the use of significance tests are illusory. In research practice and in training of researchers, we must use and teach appropriate data analysis methods: point estimates of effect sizes and confidence intervals within individual studies, and meta-analysis in the integration of multiple studies to produce final conclusions. These reforms are essential to the progress of cumulative research knowledge.

An examination of the dental state of an Egyptian mummy by means of computer tomography: a contribution to 'dentistry in Ancient Egypt'

In 1991 mummies from Leipzig collections were investigated by means of conventional X-ray techniques and by computer tomography. The dental state of one of these mummies prompted a re-examination of the question of whether a dental profession actually existed in Ancient Egypt or not. To answer this question, different types of source material are discussed.

Malignant schwannoma of the breast

Malignant schwannoma (MS) is a tumor of the Schwann or nerve sheath cells, most frequently occurring in the lower and upper extremities, trunk and head region. We report the third known case of MS of the breast, which occurred in a 27-year-old woman. The palpable tumor, about 1.2 cm in diameter, was localized in the upper inner quadrant of the right breast. After ultrasonography, mammography and fine needle aspiration cytology, the tumor was removed surgically.

Serotonin acts as a radical scavenger and is oxidized to a dimer during the respiratory burst of human mononuclear and polymorphonuclear phagocytes

Isolated human mononuclear and polymorphonuclear phagocytes were stimulated in the presence and absence of serotonin (5-HT), the major secretory product of activated platelets, and the release of reactive oxygen metabolites during the respiratory burst was assessed by luminol-enhanced chemiluminescence. In the presence of 5-HT, a dose-dependent suppression of the chemiluminescence signal occurred, irrespective of the stimulus used to elicit the respiratory burst. A similar suppression of luminol-enhanced chemiluminescence was also seen in a radical generating cell free system. 5-HT was found to be oxidized by the reactive oxygen species released by stimulated phagocytes. This oxidation is prevented in the presence of other antioxidants. The major 5-HT oxidation product was isolated by gel chromatography and identified by mass-spectrometry as a 5-HT dimer, probably 5,5'-dihydroxy-4,4'-bitryptamine. It is concluded that the 5-HT released from activated thrombocytes at sites of inflammation and endothelial cell damage acts as a true scavenger of reactive oxygen species generated during the respiratory burst of stimulated phagocytes and may thus modulate various aspects of cell-mediated defence reactions.

Heavy metal mediated inhibition of rBAT-induced amino acid transport

rBAT, a protein which is located in the brush border membranes of intestine and renal proximal tubule cells, was recently shown to induce electrogenic countertransport of neutral and dibasic amino acids after its expression in Xenopus oocytes. Here, we studied the effects of heavy metals on rBAT induced amino acid transport in Xenopus oocytes to clarify a possible involvement of rBAT in heavy metal-induced aminoaciduria. The heavy metals Hg2+ and Pb2+ inhibited rBAT-induced amino acid transport with a different profile of action. The Pb2+ mediated inhibition occurred rapidly upon superfusion and was readily reversible upon washout. The maximal inhibition caused by Pb2+ was about 50% of the amino acid-induced currents at an apparent affinity (Km) of about 10 microM. In contrast, the Hg(2+)-mediated inhibition occurred rather slowly, depending on its concentration, and was not reversible during washout with control solution. However, the Hg(2+)-mediated amino acid transport inhibition could be reversed with Hg2+ chelating agents and reducing compounds. Other oxidative agents, such as the membrane permeable 2,2'-Dithio-bis(5-Nitropyridine) (DTNP), but not the membrane impermeable 5,5'-Dithio-bis (2-Nitrobenzoic acid) (DTNB), mimicked the effect of Hg2+, and their effect could similarly be reversed with 2,3-Dihydroxybutane-1,4-dithiol (DTE). In conclusion, Pb2+ and Hg2+ inhibit rBAT-induced amino acid transport in a noncompetitive, allosteric fashion. Blockade of rBAT-induced amino acid transport may be involved in aminoaciduria following mercury or lead intoxication.

[Mammography of the reconstructed breast--a comparison of different methods of reconstruction]

The choice of a breast reconstruction technique is considerably influenced by the possibility of detecting recurrence. Mammography is the most important diagnostic aid in detecting a tumor. We have compared the mammographic evaluation of different reconstruction methods. 41 patients were investigated and divided into three subgroups: Group I (n = 10): Reconstruction with autologous tissue (TRAM-flap); group II (n = 22): Reconstruction with silicone gel-filled implants, muscle and soft tissue replacement (latissimus flap or submuscular expander technique and silicone gel prostheses); group III (n = 9): Reconstruction with silicone gel-filled implants. Evaluation was performed employing a scoring system. The mammographic appearance of autologous breast reconstructions consisting of skin, subcutaneous fat and muscle is comparable to involuted breasts. One mammography in this group was of poor, one of acceptable, and eight of good quality. Autologous reconstruction is associated with the highest chance of recurrence detection. Within group II and III, parts of the reconstructed breast are covered by the X-ray absorbing silicone gel prosthesis. In group II, seven mammographies were considered poor, 14 acceptable, and one good; in group III it was two, four und three respectively. The interpretation depended on the implant soft tissue ratio. If thin soft tissue layers cover the prosthesis, inspection and palpation become increasingly important, nevertheless it is not possible to achieve comparable data as with mammography.