[Pre- and postoperative irradiation of the mammary carcinoma]

There are different indications for the pre-, per- and postoperative treatment of mammary carcinomas with certain or doubtful operability. Based on clinical examinations, the clinical effect of pre- and postoperative irradiation on the incidence of loco-regional recurrences and distant metastases is explained. The resulting therapy suggestions are discussed. Instead of radical surgery or modified radical surgery in case of subclinical and little carcinomas less than 3 cm, a simple ablation of the tumor with adequate subsequent irradiation is recommended. The therapy results of conservative treatments published hitherto are presented.

Effect of 50 kV irradiation on enzyme activities of growing rat bone. A histopathologic and enzyme histochemical investigation

Young rats were exposed to 2, 5, 8 and 10 Gy 50 kV local irradiation. The epiphyseal region of the proximal tibia was examined with histopathologic, histochemical and enzyme histochemical methods 1 to 90 days after irradiation. One day after irradiation, a decrease in alkaline phosphatase activity was noted and increased activity was found for acid phosphatase, NADH2-diaphorase and glucose-6-phosphate dehydrogenase, especially after 8 and 10 Gy, but also after 5 Gy. Three days after irradiation, all enzymes showed an increased activity and on day 7 the findings resembled those on day 3. Thirty days after irradiation, a return to normal conditions was observed. The most marked morphologic changes were swelling of cells in the hypertrophic cell zone, disturbed order of cells in the zone of proliferation and an increased number of osteoclasts in the metaphyseal bone. These alterations appeared 1 to 3 days after irradiation and normal morphology was seen on day 30 after 2, 5 and 8 Gy and 90 days after irradiation with 10 Gy.

Is occult atrial disorder a frequent cause of non-hemorrhagic stroke? Long-term ECG in 86 patients

To assess the importance of occult atrial disorder with possible embolization as a cause of non-hemorrhagic stroke, 68 patients with neurologic symptoms lasting 24 hours or more and 18 patients with transient ischemic attacks were examined by long-term electrocardiographic recording (LTER). Lacking matched controls we used a reference population of 103 elderly subjects selected at random from the general population for a previous LTER study. Permanent or episodic atrial arrhythmias of types known to cause cerebral embolization were detected by LTER in 32 (47%) of the 68 patients with a clinical diagnosis of cerebral embolization or thrombosis and in 6 (33%) of the 18 patients with transient ischemic attacks. Of the 38 patients with atrial arrhythmia during LTER 17 had such arrhythmias in their standard ECGs. This frequency of atrial arrhythmias during LTER differs from that of the reference population (p less than 0.025). Thirteen of 16 patients with multiple cerebral lesions had signs of atrial arrhythmia during LTER. Patients having occult atrial disorder with episodic atrial arrhythmia may be an important and common risk group for non-hemorrhagic stroke in addition to the previously recognized group of patients with atrial arrhythmia detectable in the standard ECG. LTER may be important in the evaluation of patients with unexplained stroke.

Cellular expression of the non-HLA-DR B-cell antigen 7420: studies on non-lymphoid cells and on lymphocytes from different species

We recently reported on a heterologous antiserum (antiserum 7420), raised against chronic lymphocytic leukaemic lymphocytes, that reacts with B-lymphocyte antigen(s) different from known B-cell markers such as HLA-DR (Ia-like) antigens, surface immunoglobulin, and the Fc receptor. This antiserum is now shown to react also with a C3-receptor-positive population of lymphocytes from the dog, monkey, ox and sheep but not from rodents and avians. The antiserum does not react with the non-lymphoid human cells mature granulocytes, thrombocytes, erythrocytes, or spermatozoa, nor with the cultured cell lines tested, i.e. fibroblasts, melanoma cells, HeLa cells and green monkey kidney cells. This reactivity pattern differs somewhat from that reported for HLA-DR antiserum. The antigen(s) defined by the 7420 antiserum and the C3 receptor are different, since they redistribute independently on the lymphocyte surface.

Irradiation injury of bone tissue. A vital microscopic method

A vital microscopic method using the titanium chamber for observation of bone irradiation injury in situ is described. The subsequent development of bone tissue resorption and replacement with a pathologic immature bone could be observed and recorded.

An IgM monoclonal protein with multiple serological specificities

An IgM lambda M-component with a false Wasserman reaction and 'false' rheumatoid factor activity from a patient suffering from a well-differentiated lymphocytic lymphoma is presented. The monoclonal protein showed antibody activity against cardiolipin and cross-reacted with acryl particles, not with human IgG. Both these activities were found in the Fab fragment. The reduction of the 19S IgM to 7S IgM subunits was responsible for a strong decrease in activity. The importance of the IgM quaternary structure in determining antibody affinity is emphasized.

Heterologous B-cell antisera may detect non-Ig, non-HLA-DR antigens

A heterologous antiserum (antiserum 7420) against B-lymphocyte antigen(s) was raised in a rabbit by immunization with peripheral blood lymphocytes from a patient with chronic lymphocytic leukaemia (CLL). After absorptions with pooled normal human serum, IgA, IgD, and IgM M-components, the fluorescein isothiocyanate-conjugated F(ab')2 fragments were prepared and further absorbed with normal peripheral blood leucocytes. The F(ab')2 fragments, studied in direct immunofluorescence, reacted with both normal and CLL B lymphocytes but not with T lymphocytes. Comparative studies with an HLA-DR antiserum showed that the antigen(s) detected by 7420 antiserum did not redistribute together with HLA-DR antigens in cocapping experiments, nor did the HLA-DR antiserum block the reaction of 7420 F(ab')2 fragments with B lymphocytes. The 7420 F(ab')2 fragments prcipitated detergent-solubilized B-cell membrane material with a molecular weight of around 40,000 and 150,000 daltons. The conclusion drawn is that the 7420 and HLA-DR antigens are different. The 7420 antigen was also shown to be different from classical HLA antigens, beta 2-microglobulin, surface immunoglobulin, the Fc receptor, and HC protein.

Prednimustine (NSC-134087, Leo 1031) treatment of lymphocytic and lymphocytic-histiocytic lymphomas

Nineteen patients with advanced lymphocytic or lymphocytic-histiocytic lymphomas were treated with Prednimustine (NSC-134087, Leo 1031). The median induction dose was 25 mg/m2 a day by mouth (range 11-42). Ten patients had previously received radiation or chemotherapy, or both. Four patients had a complete remission and eleven a partial remission. The median duration of remission was 12.5+ months for complete responders and 5 months for partial responders. Thirteen patients had a moderate myelosuppression. One patient had urticaria and pruritus and refused further treatment.

Expression of protein HC on the plasma membrane of different human cell types

The surface expression of a recently described plasma glycoprotein called human complex-forming glycoprotein, hetergeneous in charge (protein HC) on a number of different human cell types was investigated. By means of direct and indirect immunofluorescence, protein HC was shown to be associated with the surface of virtually all cells of the investigated normal cell types including erythrocytes, peripheral blood B and T lymphocytes, and the human fibroblast lines HE 81, HE 31, and WI 38. When transformed and malignant cell populations were studied, it was found that some populations (e.g., the T cell line Molt-4) carried protein HC on the surfaces of very few cells, whereas other cell populations (e.g., chronic lymphocytic leukemia lymphocytes) carried the protein on most cells. Malignant cell populations with intermediary percentages of protein HC-positive cells were also found. Protein HC on the cell surface of normal peripheral blood lymphocytes could be redistributed by incubation of the cells with anti-protein HC-antiserum at 37 degrees C, and this reaction could be inhibited by sodium azide.

Prospective studies with the CRE formula of prolonged fractionation schedules

Different dose schedules prospectively calculated with the Cumulative Radiation Effect (CRE) formula were used for irradiation of inoperable breast carcinomas. Fractionation with 2 X 260 rad and 2 X 450 rad twice a week, and total doses corresponding to CRE levels 1900 to 2300, were compared. The results showed that prolonged fractionation increased the tolerance of normal skin and the therapeutic ration with respect to early radiation reactions. Late reactions could not be assessed as yet because their development requires several years. With the prolonged course of treatment and 2 X 260 rad per week, no moist desquamation developed despite dose levels between 6800 and 9400 rad. Skin reactions were milder than those in the rapidly treated areas, indicating that the CRE formula cannot exactly predict acute skin reactions for very prolonged treatment schedules. The tumor regressed continuously during the irradiation schedule.

Control of dose administered once a week and three times a day according to schedules calculated by the CRE formula, using skin reaction as a biological parameter

Patients with breast cancer were irradiated postoperatively to bilateral parasternal fields. The validity of the Cumulative Radiation Effect (CRE) formula for treatment once a week and three times a day was analyzed, and both schedules were compared with treatment once a day (five times a week). The biological radiation effect on normal tissue was studied by reflectance spectrophotometry of skin erythema and pigmentation. Early skin reactions were identical after irradiation daily and once a week, respectively, but were found to be significantly more pronounced after irradiation three times a day than after treatment once a day, corresponding to an overexposure of 7-10%.

Skin reaction as a biologic parameter for control of different dose schedules and gap correction

In patients with mammary carcinoma, irradiated postoperatively on the parasternal regions, prospective dose calculations for different fractionation schedules have been performed with the CRE formula. The biologic radiation effect on normal tissue was recorded by reflectance spectrophotometry of skin erythema and pigmentation. The right side received 4 050 R in 25 days, the left side 4 390 R in 47 days with a gap of 3 weeks. A compensation for the gap with 8 per cent of the total exposure was found to be adequate. The smallest exposure difference that could be clearly discriminated visually and with spectrophotometry was recorded in a special series and was found to be 6 to 7 per cent.

Skin reaction as a biological parameter for prospective studies of different dose schedules with the CRE formula

The validity of the CRE formula for prospective calculation of biologically equivalent radiation doses with different fractionation schedules has been investigated. Patients with breast cancer were irradiated postoperatively on bilateral parasternal fields. The biological radiation effect was studied by reflectance spectrophotometry of skin erythema and pigmentation. The results from daily irradiation in comparison with twice-a-week, once-a-week, 3-times-a-day and "split-course" irradiation indicate that the formula is a very good predictor of the acute skin erythema and pigmentation.

Lymphocyte subpopulations in the cerebrospinal fluid and peripheral blood in patients with multiple sclerosis

The cerebrospinal fluid (CSF) and blood of patients with multiple sclerosis (MS) were studied with respect to the frequency of lymphocytes with intracellular immunoblobulins of different Ig classes as well as the relative frequency of B and T lymphocytes. An increased number of Ig-postive cells were found in CSF (mean, 0.52%) when compared with blood (mean 0.18%). In CSF there was a striking dominance of IgG-postive cells, very few IgA-postive cells, and almost no IgM-postive cells. The distribution in blood was approximately normal. The ratios between chi- and lambda-postive cells in CSF were all outside the range in blood. In CSF there were fewer B cells (mean, 4.7%) and more T cells (mean 74.2%) when compared with blood (mean, 11.5%) and 61.8%, respectively). The values for MS blood were approximately the same as for normal controls. The increased number of IgG-containing cells in the CSF are in agreement with earlier studies, which showed a local immunoglobulin synthesis. The increased proportion of T lymphocytes in CSF of MS patients may indicate that these cells play a role in the pathogenesis of MS.

Skin reactions after different fractionation schedules giving the same cumulative radiation effect

The CRE formula was used for calculation of biologically equivalent radiation doses with different fractionation schedules. The early radiation effects, skin erythema and pigmentation were measured with a reflectance spectrophotometer at wavelengths 578 and 660 nm. The course and maximum for both erythema and pigmentation agreed well with the two types of fractionation. The results seem to justify further use of this simple formula.

Coagulation and platelet adhesion-inducing factor in the endothelium of the retinal vessels

By means of an immunofluorescent technique, we found factors promoting blood coagulation and platelet adhesion in the intima of retinal vessels. These factors coexisted with other agents causing the opposite process, fibrin dissolution. The components of this vascular hemostatic balance are possibly involved in the thrombotic occlusion of the retinal vessels, their canalization, and in the pathogenesis of diabetic retinopathy.

Gaucher's disease and benign monoclonal gammapathy. A case report with immunofluorescence study of bone marrow and spleen

A case of chronic non-neuronopathic Gaucher's disease is presented. The diagnosis was based on the finging of typical Gaucher cells in the bone marrow spleen. The patient also had a benign monoclonal gammapathy. Immunofluorescence studies of bone marrow and spleen were performed using monospecif antisera against immunoglobulin heavy and light chains. The results indicate a monoclonal plasma cell proliferation in the bone marrow, whereas the distribution of plasma cells in the spleen was polyclonal. The combination of chronic Gaucher's disease and monoclonal gammapathy was also found in the patient's brother.

Nucleolar size in benign and malignant plasma cell proliferation;

Nucleolar and nuclear size of bone marrow plasma cells has been studied in 26 cases of myeloma, 19 of benign essential monoclonal gammapathy (BEMG) and 9 without an M-component. Bone marrow smears were Feulgen-stained to visualize nucleoli and nuclei. Nucleolar area, nuclear area and the ratio nucleolar area/nuclear area were calculated. The myeloma group differed from the other two groups in having plasma cells with larger nucleoli, larger nuclei and an increased ratio nucleolar area/nuclear area. No difference was found between the BEMG group and the cases without an M-component. In some cases--in which the absence of osteolytic lesions at X-ray examination, a low plasma cell percentage in bone marrow smears or a low M-component concentration initially made the diagnosis of myeloma uncertain--the observation of enlarged nucleoli could help to establish the diagnosis. Three cases were observed in which the onset of myeloma was preceded by a long period of essentially unchanged M-component concentration. In these cases a sudden increase of M-component concentration was accompanied by an increase of mean nucleolar size of bone marrow plasma cells.