Nucleolar organiser regions (AgNORS) in anal intraepithelial neoplasia and invasive anal squamous cell carcinoma

AIM

To evaluate the usefulness of counting nucleolar organiser region associated proteins (AgNORs) in the management of anal squamous neoplasia.

METHOD

Using a silver staining technique for NOR associated proteins, 32 routinely processed paraffin wax embedded sections of anal epithelium were assessed. These consisted of normal anal epithelium (n = 9), anal intraepithelial neoplasia (AIN) grades I (n = 5), and III (n = 13), and invasive squamous neoplasia of the anus (n = 5).

RESULTS

The median AgNOR counts for every 100 cells are as follows: normal anal epithelium 2.15 (95% CI 1.89-3.94); AIN I 3.21 (95% CI 2.89-7.14); AIN III 4.32 (95% CI 4.00-8.10); and invasive squamous cell carcinoma of the anus 5.51 (95% CI 2.48-10.62). There were significant differences between AgNOR counts in anal cancer and normal epithelium (p < 0.05; Mann-Whitney U test)), AIN III and normal anal epithelium (p < 0.005), and AIN III and AIN I (p < 0.05). No significant differences were observed between AIN I and normal anal epithelium, anal cancer and AIN I, and anal cancer and AIN III. There was a considerable degree of overlap among the different groups.

CONCLUSIONS

Despite the strong association between AgNOR values and degree of dysplasia, the variability within pathological grade may preclude the adoption of this technique on its own as a prognostic indicator. It may, however, be useful in conjunction with other markers of neoplastic growth such as c-myc oncogene amplification or overexpression as a marker of disease progression in AIN and invasive anal squamous cell cancer.

Is there still a place for prolonged bladder distension?

Over a 2-year period, 31 patients underwent prolonged hydrostatic bladder distension for benign and malignant bladder disease in this unit. Of these, 29 patients had benign functional disorders or bladder contracture, and in 2 patients hydrodistension was performed for complications of treatment for bladder neoplasia. Of the 29 patients with benign disease, 6 observed marked improvement and 8 some improvement in their symptoms, and 12 received no benefit. Patients with detrusor hypersensitivity fared better than those with detrusor instability or interstitial cystitis. A patient with malignant bladder disease died soon after the procedure as a result of a myocardial infarction. Problems attributed to the hydrostatic balloon catheter were responsible for 2 failures. The regional anaesthetic technique failed to provide adequate anaesthesia for hydrodistension in 9 procedures and limited the duration to 2 h in 13 others. Following recall of the perished balloon catheters by the manufacturer, and the introduction of continuous spinal anaesthesia, the number of technical failures has been reduced. This technique still has an important role to play in the relief of severe symptoms unresponsive to medical treatment, but it is important that ideal conditions are provided for hydrodistension in order to ensure maximum success, particularly when the alternative is major surgery.

Delay in fixation does not affect the immunoreactivity of proliferating cell nuclear antigen (PCNA)

The effect of delayed fixation on the immunoreactivity of proliferating cell nuclear antigen (PCNA) was investigated using eight breast carcinomas. Topologically shuffled samples of each tumour were immersed in fixative at times of 0.5, 1, 2, 4, 6, 18, and 24 h after surgical removal. In addition to a PCNA index (percentage of positive cells per 1200 tumour cells), a semi-quantitative PCNA grading system was used, based on estimates of more than or less than 50 per cent of positive tumour cells at each time interval. The PCNA index of six tumours increased by a mean of 10 per cent with a fixation delay of 24 h. The PCNA grade of all eight tumours showed no change with delayed fixation.

Radical breast surgery with a contact Nd:YAG laser scalpel

The use of a contact Nd:YAG laser scalpel during radical and modified radical mastectomy was evaluated in 18 patients with carcinoma of the breast. The laser scalpel performed well as a haemostatic tool, the associated mean blood loss for modified radical mastectomy being 132 ml. Operating time, operative blood loss, laser energy required and postoperative wound drainage were all related to patient obesity, correlating significantly with body weight and/or breast weight. The incidence of axillary seroma was not reduced by laser surgery and occurred in 53% of patients undergoing modified radical mastectomy. The Nd:YAG laser scalpel is an excellent haemostatic tool but it does not appear to have any other advantages over conventional surgery for mastectomy.

Effect of tissue pressure on contact laser insults

The effect of variations in tissue pressure transmitted through contact laser probes during tissue ablation has been investigated. Weights of 10 and 50 g were transmitted through the tip of the probes onto the gastric and colorectal wall. At all laser energies the depth of tissue vaporization was significantly greater at the higher tissue pressure with perforation of the viscus occurring at laser energies above 10 J. The lateral zones of thermal tissue necrosis were not influenced by tissue pressure. Deformation of the wall of the viscus under the pressure of the probe was identified as a sign of excessive tissue pressure likely to result in perforation of any tissue of similar thickness to the normal gastric or colorectal wall.

Preliminary evaluation of a new high power diode laser

A high-powered semiconductor diode laser (805 nm) has recently been developed for medical use. The laser-tissue interactions of this wavelength have been compared with Nd:YAG (1064 nm). When used in the contact mode, the extent of tissue vaporization and zones of thermal necrosis produced by these two lasers were similar. The diode laser was also an effective and haemostatic laser scalpel. This compact laser unit has potential advantages over existing Nd:YAG lasers.

Characteristics and outcome of hospitalized adolescent girls with conduct disorder

Fifty-five adolescent girls with conduct disorder from a psychiatric hospital were examined with a structured interview schedule and then reevaluated 2 to 4 years later. The majority also had depressive or anxiety disorders. The criteria used for conduct disorder were less weighted toward violent crime and differed from the criteria in DSM-III-R. Their outcome was poor; 6% had died a violent death, the majority had dropped out of school, one-third were pregnant before the age of 17, half were rearrested, and many suffered traumatic injuries. Diagnoses of depression or anxiety disorders at the index admission were not associated with a better outcome.

Management of Generalized Faecal Peritonitis-Can We Do Better?

Generalized faecal peritonitis is associated with a mortality of over 50% in most series of cases. Despite great improvements in the standards of intensive care the morbidity and mortality associated with this condition have not improved, in part due to recurrent intra-abdominal sepsis. This preliminary study investigated the role of laparotomy, repeated abdominal lavage and debridement to determine whether such a policy might lead to an improvement in outcome. Of six cases studied three had perforated diverticular disease, two had Crohn's disease. Twenty lavages were performed on these six patients who had a mean ICU stay of 8 days. Five out of the six patients left hospital and remain well, one patient died of septicaemia and pre-existing renal failure. This study found that laparotomy, repeated abdominal lavage and debridement may be effective in reducing the morbidity and mortality of generalized faecal peritonitis and further study of this technique is appropriate.

Loss of monomorphic and polymorphic HLA antigens in metastatic breast and colon carcinoma

MHC class I antigens are intimately involved in intercellular communication, and recognition by cytotoxic T cells. Thus tumour cells that fail to express them may be at a growth or metastatic advantage. A series of ten colorectal and ten breast carcinomas, and their respective lymph node metastases, were examined immunohistologically using monoclonal antibodies (mAb) against both monomorphic and A2 polymorphic determinants, and beta-2-microglobulin (beta 2m). Four colon polypoid adenomas stained positively throughout, but 6/10 primary tumours had partial or complete loss of expression of monomorphic determinants using mAb W6/32: two node and the liver metastasis showed less, four more expression. Similar results were seen for beta 2m. HLA-A2 expression was absent or reduced in 4/4 colon tumours and all their metastases. Among the breast tumours, W6/32 staining was absent or reduced in 2/10, and node deposits showed two with less reactivity than their primary. Beta 2m staining was reduced or absent in 8/10 primaries and all the node metastases; in every case in which beta 2m was detected in the primary tumour their corresponding lymph node metastasis showed a decreased expression. HLA-A2 expression was absent or reduced in 3/4 primary breast carcinomas, and all their metastases. These results show that individual human colon and breast carcinomas often have a reduced HLA class I antigen expression, which apparently confers a metastatic advantage.

Is the grading of breast carcinomas affected by a delay in fixation?

The effect of delay in fixation on the modified Bloom and Richardson grade of eight breast carcinomas was investigated. Topologically shuffled samples of each tumour were immersed in fixative at times of 0.5, 2, 4, 6, 18 and 24 h after surgical removal. The grade of each tumour was assessed at delays of 0.5 and 6 h. The tubule formation and nuclear pleomorphism components of the grade showed no change with a delay in fixation of 6 h. The number of mitotic figures declined by a mean of 53% over the same period and this resulted in a decrease in the histological grade of one of the tumours. The implications of these findings for the handling of breast specimens in a diagnostic histopathological laboratory are discussed.

Pharmacokinetics and immune response of 131I-chimeric mouse/human B72.3 (human gamma 4) monoclonal antibody in humans

Chimeric B72.3, composed of the V-regions of murine B72.3 and the constant regions of human immunoglobulin G4 heavy and kappa light chain, was administered as a 131I-labeled conjugate to 12 patients with metastatic colon cancer. Seven of these patients had an antibody response after initial infusion, and the immune response was primarily directed to the murine V-region, although a small proportion of the antibody response was directed to topographical epitopes requiring the presence of both murine V-region and human CH-1 and kappa constant regions (neo-epitopes). The pharmacokinetics included a plasma disappearance curve best fit by a two-compartmental model with an alpha t 1/2 of 18 +/- 7 h and a beta t 1/2 of 224 +/- 66 h. A second infusion of the same dose of 131I-chimeric B72.3 was administered to four of these patients 8 wk after the first infusion. Two patients who had a high antibody response to initial infusion had an anamnestic antibody response, and the infused ch-B72.3 rapidly disappeared from the circulation with associated immune complexes and free 131I in the plasma. One patient with no initial antibody response had no antibody response and identical pharmacokinetics on second infusion. One patient with a modest transient antibody response to initial infusion had no antibody response on second infusion and a modest shortening of plasma circulation. Thus, the human immunoglobulin G4 isotype chimeric B72.3 monoclonal antibody has a plasma half-life 6 to 8 times as long as murine B72.3 and retains considerable immunogenicity in some patients which can adversely affect repetitive infusions.

Cytomegalovirus (CMV)-specific intravenous immunoglobulin for the prevention of primary CMV infection and disease after marrow transplant

Cytomegalovirus (CMV)-specific immunoglobulin (IVIG) was evaluated in a randomized controlled trial in CMV-seronegative marrow transplant patients with seropositive marrow donors for the prevention of primary CMV infection during the first 100 days after transplant. Patients received 200 mg/kg CMV IVIG on days 8 and 6 before transplant, the day after transplant, weekly for the first month, and then every 2 weeks to complete 10 doses. Patients were followed with weekly CMV cultures and serologic studies and for clinical and histologic evidence of CMV disease. Sixty patients were evaluable in each group. There was significantly less CMV excretion (P = .04) and viremia (P = .01) in the treatment group. However, the incidence of CMV disease including CMV pneumonia, CMV enteritis, and CMV syndrome (fever, leukopenia, hepatitis) was not statistically different. There was also no difference in median time of onset of CMV infection or disease, median number of hospital days, or survival between the two groups.

Diagnostic difficulties in patients with a pancreatic mass

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Parameters for and safety of contact Nd:YAG laser irradiation of early gastric cancer: an in vitro study

Early gastric cancers have been treated by endoscopic contact Nd:YAG laser irradiation. The extent of thermal damage produced by this laser system has been inadequately investigated. In an in vitro study we have shown that contact laser probes produce consistent and reproducible thermal lesions in the human stomach wall. Contact laser energies of 40 to 60 joules are optimal for the ablation of early gastric cancer. Energies greater than 90 joules are associated with a high incidence of gastric perforation. Contact laser probes may have advantages over non-contact laser techniques for the endoscopic treatment of early gastric cancer in patients who are unfit for major surgery.

The use of CA15.3 as a serum tumour marker in breast carcinoma

There is, as yet, no tumour marker which is sufficiently specific and sensitive for use in the routine assessment of breast cancer patients. CA15.3 is a recently described tumour marker determined by two monoclonal antibodies. We have estimated CA15.3 by immunoradiometric assay in 187 patients attending a breast clinic. Eighty-one patients with benign disease were used as controls and 32 U/ml was taken as the upper limit of the normal range (means + 3SD = 31.7). Of 58 women with Stage I and II disease, only four had abnormal concentrations of CA15.3 and all are disease-free at a mean follow-up of 31 months. Seven women with normal CA15.3 concentrations developed recurrent disease at a mean of 18.7 months (range 10-25 months). Seven-day postoperative values were significantly lower than pre-operative values. There was no association between the CA15.3 value and the axillary nodal status. The patients with disseminated disease had a wide range of CA15.3 concentrations and there was no association between the CA15.3 concentration and the apparent tumour load.

Reaction of patients on chronic dialysis to discussions about cardiopulmonary resuscitation

A total of 146 patients, 91 on chronic hemodialysis and 55 on chronic peritoneal dialysis, were asked to declare their choice of cardiopulmonary resuscitation (CPR) in cases of cardiopulmonary arrest. Fifty-four patients (37%) declined CPR. The severity of medical disability and the presence of diabetes were independent predictors of refusal of CPR. The pattern of patient reaction to CPR gave valuable information about patients' comprehension of this issue and about patients' ability to cope emotionally with CPR. On the basis of the reaction pattern, approximately 95% of the patients interviewed understood CPR and reacted to it appropriately. Questioning dialysis patients about their CPR preference is feasible and fruitful.

Factors influencing the establishment of tumour-infiltrating lymphocyte cultures from human breast carcinoma and colon carcinoma tissue

Tumour-infiltrating lymphocytes (TIL) were obtained from breast and colon tumour tissue and cultured in vitro in the presence of recombinant human interleukin-2. Seven of 35 breast tumours and five of 41 colon TIL cultures were established in vitro: proliferation rates of greater than 10(3) were achieved. The cytotoxic capacity of these cells was determined against the cell lines K562 and SW742, and percentage cytotoxicity levels of greater than 97% and 79%, respectively, were seen. An inverse relationship between the ability of TIL to kill and their proliferative capacity was observed in all cultures. The prominent phenotype was CD3 positive, with greater than 55% of TIL expressing this antigen; there was no expression of CD16. The expression of CD56 and CD25 varied, being maximumly expressed on 64% and 38% of TIL, respectively. When greater than 90% of TIL expressed CD3, the ability of the culture to kill the target cell lines was low; only when there was an increase in the proportion of cells expressing CD56 and a decrease in the expression of CD3 was there high cytotoxicity. This study indicates that the TIL which proliferate in vitro in the presence of interleukin-2 are not necessarily the mediators of cytotoxicity.

The value of assessing cell proliferation in breast cancer

Using three methods to measure cell proliferation, namely DNA cell cycle; anti-proliferating cell monoclonal antibody (MAb) (Ki67, P145) analysis by flow cytometry; and the histological silver (argyrophilic) staining technique to visualize nuclear-organizing regions (AgNOR), twenty-two paired samples of primary breast tumour and axillary lymph node were analysed. The results showed variable levels of correlation between the methods used for the tumour group (r = 0.915, P less than 0.001 for Ki677 versus P145; r = 0.42, P less than 0.005 for percentage S/G2/M-phase versus P145; r = 0.16, P less than 0.5 for percentage S/G2/M-phase versus AgNOR; r = 0.400, P less than 0.1 for Ki67 versus AgNOR). The lymph-node group showed slightly poorer correlations, yet involved nodes showed a consistently higher level of proliferation than non-involved nodes by all methods used. Overall, MAb binding of Ki67 or P145 was seen to be a good indicator of cycling cells, detecting G1-phase cells in addition to S/G2/M-phase cells identified by the other methods used. However, no advantage was found over the usual DNA flow cytometric analysis of cells, which had clear prognostic value. AgNOR scores were found to be able to discriminate between diploid and aneuploid; and dividing and non-dividing cells, but areas of score overlap limited the application of this technique to that of a positive discriminator only.

Evaluating understanding of popular press reports of health research

This research assessed the ability of a sample of persons on a college campus to understand media reports of health research. Three or four articles on each of five contemporary health topics (dietary cholesterol and heart disease, treatment for breast cancer, starch blockers, drug treatment for heart disease, test tube skin) were selected from widely circulated newspapers (e.g., New York Times) and magazines (e.g., Newsweek). A sample of 144 college students responded to content-based and application-based questions derived from photocopies of these popular press articles. The overall rate of reader misunderstanding approached 40% and generally fell between one third and one half for each of 16 articles representing five health topics. Several strengths and weaknesses of the research are considered as they relate to the accuracy of estimated error rates and to the generality of study findings. The implications of these findings for other areas of health (e.g., AIDS risk factor research) are also discussed.

Initial evaluation of a human immunoglobulin M monoclonal antibody (HA-1A) in humans

A human monoclonal antibody (HA-1A) directed against bacterial endotoxin was administered to 15 patients with incurable malignant disease. No adverse effects were noted following single intravenous infusions of 0.05 to 100 mg. Pharmacokinetics were evaluated in nine patients receiving 10 mg (n = 3), 25 mg (n = 3), and 100 mg (n = 3). Seven of these patients had initial peak serum concentrations greater than 80% of predicted values with plasma disappearance curves fitting a one-compartment system and a plasma half-life of 31.5 h (range of 20.3-44.6 h). The peak serum concentrations and area under the curve values were proportional to the dose of HA-1A administered. One patient had a hypercatabolic state with low levels of serum albumin and IgM. He achieved 65% of the predicted value for peak serum concentration of HA-1A with a plasma half-life of 12.3 h. A second patient had detectable serum HA-1A for only 15 min following infusion without an adequate technical or biologic explanation. We were unable to demonstrate antibody to HA-1A in sera from these nine patients either prior to therapy or during 28 days postinfusion using a "double-antigen" radiometric assay. This study suggests that HA-1A human monoclonal antibody administration is well tolerated by patients. Phase I trials will need to be carried out to characterize further the pharmacokinetics and toxicity of HA-1A in patients with gram-negative sepsis.

Multiple sebaceous neoplasms and visceral carcinomas: Torre's syndrome

The association of sebaceous neoplasms with visceral carcinomas is recognized as Torre's syndrome. A classical example of this interesting syndrome is reported. The familial predisposition to colorectal carcinoma is emphasized.

The influence of interferon alpha and gamma, singly or in combination on human natural cell mediated cytotoxicity

The influence of interferon alpha and gamma alone or in combination on the augmentation of human natural cytotoxicity was studied. Treatment of peripheral blood lymphocytes with IFN- alpha led to a rapid augmentation of NK activity, in contrast to IFN-gamma where target cell killing was observed only following 18 hrs exposure of lymphocytes to IFN-gamma. The results of the single cell assay paralleled those obtained using the Chromium release test, but neither interferon type caused an increase in the number of target binding lymphocytes. The combined effect of IFN-alpha and IFN-gamma in stimulating human natural cytotoxicity demonstrated individual lymphocyte responses to be variable. Exposure of lymphocytes to IFN-alpha and IFN-gamma for 18 hrs prior to assay for cytotoxicity usually decreased the level of cytotoxicity compared with control values, whereas other treatment regimes gave an additive and sometimes synergistic effect. Only treatment with IFN-alpha for 18 hrs and IFN-gamma for one hr produced a synergistic response in the majority of individuals tested. We conclude from this study that individual responses to IFN-alpha and IFN-gamma alone or in combination are variable and dependent upon timing of exposure of lymphocytes to individual interferon types, and possibly reflects the donor status at the time of sampling.

Mouse/human chimeric monoclonal antibody in man: kinetics and immune response

A mouse/human chimeric monoclonal antibody (mAb) composed of the variable regions of murine 17-1A mAb and the constant regions of human IgG-1K immunoglobulin was administered to 10 patients with metastatic colon cancer. Four patients received single infusion of 10 mg (n = 2) or 40 mg (n = 2). Six patients received three infusion of 10 mg (n = 3) or 40 mg (n = 3) at 2-week intervals. The pharmacokinetics were similar at both dose levels and at the second and third infusions. The plasma disappearance curves were best fit by a two-compartment model having a mean alpha T1/2 of 17.5 hr (range 13-23 hr) and a mean beta T1/2 of 100.5 hr (range 65-139 hr). One patient who received three 40-mg doses of chimeric IgG-1K 17-1A mAb (day 0, 14, and 28) was the only patient to exhibit a detectable but modest antibody reactivity to chimera on days 63 and 84. The antibody reactivity was inhibited by murine 17-1A mAb, indicating that the antibody response was directed to the murine variable region of the chimera. The patients had no toxic or allergic reactions. This chimeric form of 17-1A mAb has an approximate 6-fold longer circulation time and appears to be substantially less immunogenic than its murine counterpart. These characteristics may provide an advantage in the clinical application of such chimeric molecules in therapeutic trials in humans.

Cardiac transplantation: University of South Florida--Tampa General Hospital experience

Cardiac transplantation has evolved from an experimental procedure to an accepted mode of therapy that prolongs life in patients with severe heart failure. The University of South Florida-Tampa General Hospital began performing cardiac transplantation for the treatment of end-stage cardiac disease in June 1985. Since then 42 heart transplantations have been performed and 30 patients are alive and well. The one-year actuarial survival is 78.73% and the two-year actuarial survival is 72.15%. Multiple complications have been encountered most notably rejection and infection. The recent approval of the USF/TGH program as a Medicare funded cardiac transplantation center is expected to greatly expand the number of potential recipients and will provide the residents of Florida, and the Southeastern United States, with an additional health care resource.

Relationship of benzyl alcohol to kernicterus, intraventricular hemorrhage, and mortality in preterm infants

Intraventricular hemorrhage and death in preterm neonates has been associated with the use of fluid containing benzyl alcohol, a bacteriostatic agent, to flush intravascular catheters. The hospital and autopsy records of infants admitted to a nursery during the last 18 months that benzyl alcohol was in use (218 patients) were reviewed and compared with those of infants admitted in the first 18 months after benzyl alcohol was withdrawn (232 patients). The volume of flush solution administered to each patient was estimated. Exposure to benzyl alcohol was significantly associated with the development of kernicterus (P less than .005), and intraventricular hemorrhage (P less than .000,000,5). Kernicterus did not develop in any patient after benzyl alcohol was withdrawn. Many patients with kernicterus or intraventricular hemorrhages received small daily volumes of fluid containing benzyl alcohol. Withdrawal of benzyl alcohol from clinical use had no demonstrable effect on mortality. Medications intended for neonatal use should not contain benzyl alcohol. Our data indicate that patients not exposed to benzyl alcohol have a greatly reduced risk of kernicterus. If this finding is confirmed by other investigators, present indications for exchange transfusions in preterm infants with moderate elevations of serum bilirubin should be reconsidered.

Immuno-electron microscopy of chondrocyte-derived cells in the rheumatoid cartilage-pannus junction

Immuno-electron microscopy has been utilised to examine the cartilage-pannus junction in seven patients with rheumatoid arthritis. Using a monoclonal antibody, keratan sulphate was localised to cells with the ultra-structural appearance of fibroblasts within a transitional fibroblastic zone in the pannus in two cases. This confirms previous light microscopy evidence that this area (which is clearly separate from articular cartilage) contains cells which produce keratan sulphate, and strengthens the hypothesis that these cells are derived from cartilage rather than from the adjacent synovial membrane.

Tuberculosis: a surgical viewpoint

Over the past 15 years, 32 cases of tuberculosis have been seen and diagnosed in the surgical and gynaecological departments of the Northern General Hospital, Sheffield. The average age of patients was 42.8 years. Of the sites affected, 17 had head, neck or axillary swellings, 6 affected the female genital tract, 3 had intra-abdominal tuberculosis, 2 presented with soft tissue swellings on the trunk or limbs, 2 affected the male genitourinary system, whilst the remaining cases presented with an ischiorectal and psoas abscess. The time delay between initial consultation and diagnosis being established was between 1 and 8 months. In only 7 (21.8%) cases was a correct preoperative diagnosis made, with only 8 patients being clinically unwell at presentation. Twenty-three received antituberculous chemotherapy and there was one death. Tuberculosis will not be diagnosed or correctly treated unless it is considered in the differential diagnosis and appropriate specimens sent for bacteriology and histology. We conclude that tuberculosis is still prevalent in the surgical departments and both general surgeons and gynaecologists should consider the diagnosis more frequently than is currently the case.

Loss of polymorphic A and B locus HLA antigens in colon carcinoma

In the present study we have confirmed that approximately one third of human colorectal carcinomas fail to express the HLA - A,B,C monomorphic determinant reactive with the W6/32 MAb, and 44% express class II HLA antigens as shown by reactivity with NFK-1 MAb. Reduced staining with the W6/32 MAb was not always associated with the loss of beta 2m. In addition, the expression of HLA-A2 and Bw4 class I specific haplotypes on normal colon epithelium and tumour biopsy tissue was assessed. All normal colonic epithelia stained positively with MAb against A2 and Bw4 antigens, but a loss of these determinants was shown on tumour biopsies from patients tissue typed for the respective specificities. Loss of the A2 haplotype was shown in 4 of 15 tumour tissue samples, and loss of Bw4 specificities in 5 out of 7 tissue samples. The failure to detect specific loci determinants was not necessarily associated with loss of reactivity with W6/32 MAb.

Immunohistological demonstration of progesterone receptor in breast carcinomas: correlation with radioligand binding assays and oestrogen receptor immunohistology

The validity of determining the progesterone receptor status of breast carcinomas with a monoclonal antibody was investigated by comparison with data from a radioligand binding assay on adjacent cryostat sections of 103 tumours. Significant nuclear staining for progesterone receptor was observed in 37 (36%) of the tumours studied and this showed a close correlation with the results of radioligand binding assays for progesterone receptor. In three progesterone receptor positive tumours there was an apparent paradoxical absence of oestrogen receptor; progesterone receptor normally depends on the presence of oestrogen receptor, but these rare tumours may be essentially progesterone receptor positive. It is concluded that this monoclonal antibody is an appropriate reagent for use in the immunohistological determination of progesterone receptor status of breast carcinomas; that it advantageously identifies both the occupied and unoccupied receptor sites; and that it provides information about tumour cell heterogeneity with respect to receptor status.

Characterisation of suppressor cells generated following cryosurgery of an HSV-2-induced fibrosarcoma

Cryosurgery of a primary HSV-2-induced hamster fibrosarcoma resulted in the generation of a population of suppressor cells. These cells were detectable in the spleen 1-10 days post-cryosurgery by their ability to suppress the proliferation of immunocompetent splenic T-lymphocytes following exposure to concanavalin A (Con A). The spleens of tumour-bearing (t.b.) animals which received cryosurgery 3 days previously displayed gross splenomegaly due to the generation of large numbers of highly proliferative erythroblasts. The erythroblast cells were unlikely to be the source of suppression since time course studies have demonstrated the presence of suppressor cells before and after their appearance in the spleen. The erythroblasts therefore probably reflected a response by the host to regenerate the erythrocytes lost during surgery and their presence was independent of the appearance of suppressor cells. Characterisation of the suppressor cell has revealed it to be non-adherent and esterase negative making it unlikely to be of macrophage (MO) lineage. This was confirmed by the ability of splenic MOs from day 3 t.b. cryosurgery-treated animals to completely restore Con A-dependent T-lymphocyte proliferation following MO depletion. As nylonwool column-eluted cells are able to suppress Con A-dependent T-lymphocyte proliferation, it seemed unlikely that B-lymphocytes play a role in cryosurgery-induced immunosuppression. These findings suggest that cryosurgery of a t.b. animal results in the generation of a population of T-lymphocytes capable of suppressing Con A-dependent T-lymphocyte proliferation, and infers that these cells contribute to the inferior prognosis following cryosurgery as compared to excision of a metastatic tumour.

Comparison of excision versus cryosurgery of an HSV-2-induced fibrosarcoma. I. Survival, extent of metastatic disease and host immunocompetence following surgery

Cryosurgery and excision were used to treat primary tumours of HSV-2-transformed hamster tumour sublines, and post-operative survival and the extent of metastatic disease were compared in the two groups. An inferior prognosis was observed following cryosurgery although the extent of metastatic disease was similar in both groups. Using this model it would appear that cryosurgery enhances the development of micrometastases rather than affecting the number of cells shed from the primary tumour during surgery. To investigate the underlying causes of the decrease in survival following cryosurgery, in vitro assays were used to monitor host immunocompetence following surgery. The results showed that whilst natural killer cell cytotoxicity was only marginally depressed, mitogen responsiveness and lymphocyte participation in a mixed lymphocyte reaction were severely reduced 3-7 days post-cryosurgery. In parallel with immunosuppression, extensive cell proliferation in the spleen of cryosurgically treated tumour-bearing animals was observed. Histological examination of the spleen demonstrated the presence of large numbers of transformed cells which correlated with the loss of mitogen responsiveness and the ability to participate in a mixed lymphocyte reaction. Further studies (manuscript submitted for publication) have demonstrated that spleen cells from animals whose tumour is treated by cryosurgery are capable of suppressing immunocompetence in vitro, implying they have a role in the uncontrolled growth of micrometastases in vivo.

Immunohistology of oestrogen receptor and D5 antigen in breast cancer: correlation with oestrogen receptor content of adjacent cryostat sections assayed by radioligand binding and enzyme immunoassay

Two monoclonal antibodies recognising epitopes associated with oestrogen receptor protein were evaluated against the assayable soluble oestrogen receptor concentration in a series of 149 breast carcinomas. One antibody (anti-ER) recognises the hormone binding unit of oestrogen receptor and gives nuclear staining; the other antibody (anti-D5) was raised to a component of soluble oestrogen receptor and gives cytoplasmic staining. To minimise variations attributable to tumour heterogeneity and sampling error immunohistology using the two monoclonal antibodies, radioligand binding assays, enzyme immunoassays, and quantitative histology were done on adjacent frozen sections. Thirty nine per cent, 48%, 54%, and 43% of the tumours were found to be oestrogen receptor positive by radioligand binding assay, anti-ER and anti-D5 immunohistology, and enzyme immunoassay, respectively. Strong correlations (p less than 0.0005) were found between anti-ER immunohistology and the radioligand binding assay. Only weak correlations were found between anti-D5 immunohistology and the results of other assay methods for oestrogen receptor. Nuclear staining of human breast cancers with the anti-ER monoclonal antibody thus seems to be an acceptable alternative to biochemical assays, with the additional advantage of showing intercellular and regional heterogeneity for oestrogen receptor content.

Review of a hospital experience of breast abscesses

A retrospective review of breast abscesses during a 10-year period was performed. Only 8.5 per cent (6/72) of patients were in the puerperium. Peripherally sited abscesses were predominantly staphylococcal in origin, incision and drainage was effective treatment in all. By contrast, a subareolar abscess yielded a higher proportion of anaerobic bacteria and 46 per cent (13/28) of these patients had duct ectasia. We conclude that in present day practice a breast abscess is more likely to be related to duct ectasia than to the puerperium, and that patients with anaerobic infection or subareolar abscesses should be assumed to have duct ectasia and may require excision of the major duct system (Hadfield's procedure).

Treatment of cytomegalovirus gastrointestinal ulceration in a heart transplant patient

A 62-year-old man developed cytomegalovirus gastrointestinal infection associated with moderate cardiac rejection. The patient was successfully treated with a new therapeutic agent 9-(1,3-dihydroxy-2-proproxymethyl) guanine during maximal immunosuppression. The medication was well-tolerated, and the patient had an excellent response to therapy. We believe this has significant implications for cytomegalovirus-induced gastrointestinal disease in the heart transplant patient.

Gastric enzymes as a screening test for gastric cancer

Levels of lactic dehydrogenase and beta-glucuronidase were measured in gastric wash samples obtained from 445 patients over 40 years old attending a routine diagnostic endoscopy clinic. An index was derived from the two levels and used as a test for the presence of gastric cancer. Of the 24 patients with an endoscopic diagnosis of gastric cancer, 21 (91.3%) proved positive on this test, including all four cases of early gastric cancer, which were found at repeat endoscopy. The specificity of the test for gastric cancer was 81.3%. Among those patients with false positive results who had endoscopic biopsy were four out of the five cases of severe dysplasia, and four out of the 13 cases of type 2B intestinal metaplasia. Atrophic gastritis alone or with intestinal metaplasia was found in 95.9% of the false positives who were biopsied.

Male choriocarcinoma of the spleen: a case report

The success with treatment of extragonadal germ cell tumours is well recognized and emphasizes the need for an early diagnosis. In young men presenting with undifferentiated carcinoma a non-testicular germ cell tumour should be considered. We report a case of choriocarcinoma involving the spleen.

Cardiovascular effects of and interaction between calcium blocking drugs and anesthetics in chronically instrumented dogs. IV. Chronically administered oral verapamil and halothane, enflurane, and isoflurane

Dogs were chronically instrumented to measure aortic and left atrial blood pressures, left ventricular maximal rate of tension development (dP/dt), cardiac output, and carotid, coronary and renal blood flows. Measurements were taken with the animals awake and during steady-state low and high concentrations of halothane (1.2%, 2.4%), enflurane (2.4%, 4.0%), and isoflurane (1.6%, 3.0%) with and without at least 2 weeks of oral verapamil, 120 mg, three times per day. Plasma verapamil levels varied widely, with means of 500-700 ng X ml-1 in awake animals and lower (300-400 ng X ml-1) at the time of hemodynamic measurements during anesthesia. Chronic oral verapamil in awake dogs produced predominantly tachycardia. The hemodynamic effects of low-dose halothane and isoflurane before and after oral verapamil were unchanged except for decreased renal blood flow after oral verapamil and no coronary vasodilation nor tachycardia. However, left atrial pressure was increased and cardiac output and coronary blood flow were decreased by low concentrations of enflurane with oral verapamil compared to without. The combination of oral verapamil with low (clinical) doses of enflurane was more depressant to the cardiovascular system of healthy dogs than was the combination of verapamil and halothane or isoflurane.

Beta-glucuronidase, LDH and LDH isoenzyme levels and screening for gastric cancer

Lactic dehydrogenase (LDH) and beta-glucuronidase (bGLU) levels are elevated in the gastric juice of patients with gastric cancer, and these enzymes have been used as a screening test for gastric cancer. False positives are common, however, and we have measured enzyme levels, including LDH isoenzyme fraction, in tissue homogenates from resected stomach specimens and compared these with histological features. Increases in bGLU were found in carcinoma and chronic gastritis, an increase in LDH was found in carcinoma, whilst mLDH fraction was increased in chronic gastritis, carcinoma and intestinal metaplasia, particularly the sulphomucin variant. These findings indicate the basis for the screening test, and also the reason for the false positives. An elevated mLDH fraction may be a useful marker of a group at increased risk of developing gastric cancer, and worthy of long-term follow-up.