Thyroid remnant ablation: questionable pursuit of an ill-defined goal

Ablative therapy with I-131 in 30-mCi doses, directed to postsurgical remnants in patients with differentiated thyroid cancer, reduced visible I-131 uptake to zero or nearly zero in 81% of patients but did not protect against tumor recurrence in six of 69 patients who were followed for 2-5 yr. Recurrences developed within 5-37 mo. Effectiveness of 30-mCi doses of I-131 in producing ablation did not correlate with I-131 uptake by the thyroid remnant, surgeon's estimate of remnant size, or delivered dose to the remnant in rads, calculated using reasonable assumptions. These findings emphasize the difficulty of dosimetric measurements and calculations. The value of postsurgical ablative therapy in diminishing morbidity and mortality in patients with differentiated thyroid cancer has not yet been firmly established, and until this is done we advocate a conservative, economical approach to thyroid ablation with 30-mCi treatment doses of I-131 and 1-mCi neck-scanning doses to check on effectiveness of therapy.

An international collaborative clinical study mechanism for resuscitation research

Recent experimental and clinical studies of cardiac arrest, suggesting a brain damage ameliorating effect of thiopental loading, stimulated the development of an international randomized clinical trial of brain resuscitation. Twelve collaborating hospitals in 9 countries are testing the efficacy of post-cardiac arrest thiopental loading (30 mg/kg body wt). The methodology for assessing insult and outcome data, as well as risk and benefit monitoring, is described. This clinical trial will be completed in 1983 and is expected to provide valuable data about the efficacy of thiopental loading. The study mechanism is now well-established and ready for the evaluation of future promising brain resuscitation therapies.

Demographic, cognitive and experiential predictors of presurgical anxiety

A heterogeneous sample completed a demographic survey, a measure of internal-external locus of control (I-E), the Hospital Stress Rating Scale (HSRS), and a state anxiety measure on the eve of major surgery. Three sets of variables (demographic, cognitive, and experiential) together significantly accounted for one-quarter of the variance in state anxiety. However, only the cognitive set (I-E and the HSRS) was uniquely significant, supporting the view of presurgical anxiety as a patient's response to interpretation of a life-threatening event. Higher levels of anxiety were associated with more anticipated stressful experiences, stronger beliefs that powerful others and chance influence events, and weaker beliefs that events are caused by one's own efforts. Implications are presented for identifying patients at risk for presurgical anxiety and for designing interventions to enhance the patient's sense of control.

Assertiveness training with children

The efficacy of assertiveness training was examined by comparing it to a structured interview/empathic responding procedure and an activity-control procedure. The participants were 48 children and adolescents who were identified as nonproblematic, mildly problematic, or moderately problematic in reference to school performance, classroom behavior, and interpersonal skills. Assertiveness training resulted in enhanced effectiveness of responding on a behavioral role-play test, and these effects persisted after treatment. Generalization to nontrained role-play scenes was established, but there was no evidence of generalization to interpersonal performance in school. Training of social skills was not more effective than the other procedures in reducing self-reported anxiety or anger. The effectiveness of assertiveness training was not dependent upon age or the occurrence of problematic behavior.

Correlative light and electron microscopy of dissociated immature rat testicular cells undergoing morphogenesis in vitro

Immature rat testicular cells undergo morphogenesis in primary culture (Davis, 1978). Depending upon the number of dissociated testicular cells added to the culture dish, spherical or tubular aggregates were formed. Spherical aggregates resulted from movement of cells into centers of aggregation and the detachment of these cells from the substratum; on the other hand, tubular aggregates resulted from detachment and retraction of the cell monolayer at certain points along its outer edge. In this investigation, the different methods of formation of aggregates by immature rat testicular cells in primary culture were examined with the scanning electron microscope (SEM). The cell types involved in such morphogenesis and their associations within completely formed structures were examined by transmission electron microscopy (TEM). In addition, the rates of formation of aggregates were established by time-lapse cinemicroscopy. During formation of spherical aggregates, the rate of recruitment of cells into centers of aggregation (0.4 +/- 0.006 micrometer/min; means +/- S.E.M., n = 78) was much slower than the rate of cell detachment during formation of tubular aggregates (11.7 +/- 1.8 micrometer/sec; means +/- S.E.M., n = 110). Although specific roles for each cell types in formation of aggregates have not been determined, the associations of cells within the two types of reformed aggregates appeared to be similar. Myofibroblast cells were located in outer cell layers and Sertoli cells were observed to underlie the layers of myofibroblasts in both types of aggregates. Germinal cells, however, were found on the outer surface of spherical aggregates, but in tubular aggregates they were located on the inner surface. Since spherical and tubular aggregates are formed by different methods, this observation suggests that rearrangement of cells, within the aggregates takes place and contributes to the internal morphology of newly formed aggregates.

Correlative light and electron microscopy of dissociated immature rat testicular cells undergoing morphogenesis in vitro

Immature rat testicular cells undergo morphogenesis in primary culture (Davis, 1978). Depending upon the number of dissociated testicular cells added to the culture dish, spherical or tubular aggregates were formed. Spherical aggregates resulted from movement of cells into centers of aggregation and the detachment of these cells from the substratum; on the other hand, tubular aggregates resulted from detachment and retraction of the cell monolayer at certain points along its outer edge. In this investigation, the different methods of formation of aggregates by immature rat testicular cells in primary culture were examined with the scanning electron microscope (SEM). The cell types involved in such morphogenesis and their associations within completely formed structures were examined by transmission electron microscopy (TEM). In addition, the rates of formation of aggregates were established by time-lapse cinemicroscopy. During formation of spherical aggregates, the rate of recruitment of cells into centers of aggregation (0·04± 0·006 μm/min; x±S.E.M., n = 78) was much slower than the rate of cell detachment during formation of tubular aggregates (11·7 ± 1·8 μm/sec; x±S.E.M., n = 110).

Although specific roles for each cell type in formation of aggregates have not been determined, the associations of cells within the two types of reformed aggregates appeared to be similar. Myofibroblast cells were located in outer cell layers and Sertoli cells were observed to underlie the layers of myofibroblasts in both types of aggregates. Germinal cells, however, were found on the outer surface of spherical aggregates, but in tubular aggregates they were located on the inner surface. Since spherical and tubular aggregates are formed by different methods, this observation suggests that rearrangement of cells within the aggregates takes place and contributes to the internal morphology of newly-formed aggregates.

Glomerular deposition of complement-control proteins in acute and chronic glomerulonephritis

Acute poststreptococcal glomerulonephritis (AGN) differed from membranoproliferative glomerulonephritis (MPGN) and lupus nephritis (SLE) in that two of the proteins that control the C3b-dependent convertase, beta 1H and the C3bC4b-inactivator cofactor (C3bC4bICo), were frequently absent from the glomerular deposits. In addition, factor B was distributed with C3 in the capillary walls in hypocomplementemic AGN patients. From this, it can be assumed that C3bBb is in the deposits, uninhibited by control proteins as would be predicted for alternative pathway activation. Factor B could not be found in normocomplementemic AGN, was rarely present in MPGN, but was usually present in SLE, most often in the mesangium. In MPGN and SLE, the control proteins were nearly always present in the glomeruli in a distribution like that of C3; IN MPGN they were particularly abundant. Complement profiles indicated an occasional transient reduction in serum C4 level early in AGN. Thus, although there is occasional evidence of early classical activation in AGN, more characteristic is a long period of alternative activation. Serum levels of control proteins did not deviate greatly from normal except for reduced serum beta 1H levels in MPGN type I.

A new test of visual acuity using a holographic phase grating and a laser

A new visual acuity testing device is able to determine a specific visual acuity of the retina even in the presence of opacities of the ocular media, such as a cataract. This is achieved by forming two spatially coherent, quasimonochromatic point sources near the nodal point of the eye. The two spherical waves that emanate from the point sources interact to produce a pattern of stripes on the retina. The intensity of the pattern is easily varied. More importantly, the pattern can be projected over different-sized retinal areas corresponding to visual fields of 0.5 to 15 degrees in diameter. The device may be useful for vision research and preoperative assessments of visual potential.

Culture of human pituitary prolactin and growth hormone cells

Fragments of pituitary tissue obtained from a total of 37 patients with either breast cancer, diabetic retinopathy, galactorrhea, or acromegaly were dissociated into single cell suspensions prior to cell culture. Release of human growth hormone (hGH) and human prolactin (hPRL) into the culture medium was measured by radioimmunoassay. During a 3-week culture period, prolactin cells released 9--13 times the intracellular levels of hPRL at the time of seeding, whereas hGH release from growth hormone cells was only 1--2 times that of their initial intracellular level during this same time. Both growth hormone and prolactin cells retained distinctive ultrastructural features during culture. The prolactin cells responded to TRH stimulation by elevated release of PRL into the medium. No evidence for mitotic division of prolactin cells in vitro was found.

Problems in brain death determination

During the last decade there has been philosophical acceptance of the concept that the state of brain death is equivalent to total patient death. The application of this concept to clinical medicine has been associated with major problems in both the diagnosis of brain death and the medical management of the brain dead patient. In our experience with 176 consecutive cases of suspected brain death over a seven-year period, we have found that a standardized protocol applied by experienced clinicians will minimize these problems.

Carcinoembryonic antigen (CEA) plasma levels in Michigan and Wisconsin dairy farmers

Carcionogenic embryonic antigen (CEA) titers were determined for 611 Michigan farmers exposed to PBB and a control nonexposed population of 139 Wisconsin farmers. The overall prevalence of elevated CEA titers was slightly higher in the Michigan study group, but the difference was not statistically significant. Smoking and/or significant past or present conditions (inflammatory bowel disease, ulcers, polyps, liver disease, chronic lung disease, or malignancies) were found to result in higher prevalence of elevated CEA titers, in both the Michigan study group and the Wisconsin control group, thus confirming previous reports. In addition, serum PBB concentrations appeared to be positively correlated with CEA titers. The possibility that the effect of PBB concentrations appeared to be positively correlated with CEA titers. The possibility that the effect of PBB may be additive to that of other factors which are known to result in an increased prevalence of elevated CEA titers is discussed.

Unit gravity sedimentation separation of cells comprising the caput epididymidis of the rat

Cells from the rat caput epididymidis were separated by unit gravity sedimentation. Purest 12-ml fractions contained 88-95% basal cells or 64-76% principal cells. Ultrastructure of separated cells was similar to that of cells in intact tissue. Viability of separated cells was excellent as determined by dye exclusion tests and cellular ATP content. By combining fractions pools containing 4.0 +/- 0.9 X 10(6) cells (86 +/- 8% basal cells) and 1.4 +/- 0.4 X 10(6) cells (56 +/- 7% principal cells) were obtained. Thus, studies on the function of basal and principal cells from the rat caput epididymidis should be possible.

Functional heterogeneity in somatotrophs isolated from the rat anterior pituitary

Somatotrophs in suspensions of anterior pituitary cells from adult male rats can be separated into 2 fractions by density gradient centrifugation. In addition to their different densities, somatotrophs in these 2 fractions can be distinguished morphologically by their staining characteristics and ultrastructure. Somatotrophs of lesser density (type I; approximately 1.068 g/cm3) have fewer secretory granules and a more extensive Golgi apparatus than the somatotrophs of greater density (type II; approximately 1.073 g/cm3). Responsiveness of type I and type II cells to secretory agents (i.e., dibutyryl cyclic adenosine monophosphate, somatostatin, thyroxine, and hydrocortisone) was evaluated by GH radioimmunoassay. Type I cells were consistently more responsive (% GH release) than type II cells. During 7 days in culture, type I cells produced more (approximately 200%) GH than they initially contained, whereas type II cells did not show evidence of increased GH production. Hydrocortisone significantly stimulated GH production in type I, but not type II cells. These results support the hypothesis that at least 2 functionally distinct populations of somatotrophs are present in the anterior pituitary gland of the adult male rat.

Characterization of mammotrophs separated from the human pituitary gland

Human pituitary tissues from 27 patients and 7 persons post mortem were dissociated into single cell suspensions. On the average, 23% of the cells were mammotrophs. The concentration of prolactin in these suspensions averaged 3.8 ng/1,000 cells. After cell separation by velocity sedimentation at unit gravity, mammotrophs and other cell types were enriched twofold to threefold. The separated mammotrophs retained structural integrity at light and electron microscopic levels. In eight separation experiments, cells recovered from different gradient regions were assayed for intracellular prolactin levels. In cells from "normal" subjects, 8.5% of the prolactin recovered from the gradient was associated with large mammotrophs, whereas in patients with breast cancer, 28% of the hormone was associated with large mammotrophs. The number of mammotrophs recovered from this gradient region (beyond fraction 6) was doubled in breast cancer (2 expts). These mammotrophs showed areas of hypertrophied Golgi and endoplasmic reticulum. Culture of the separated cells from 1 patients with diabetes and 2 patients with breast cancer for 21 days showed that mammotrophs in the upper gradient fractions (diabetic) secreted seven times more hormone than those in the lower regions, whereas those mammotrophs from patients with breast cancer that fell to the lower gradient regions secreted 15 times more prolactin than did those in the upper regions. These data suggest that pituitaries of patients with breast cancer contain a small pool (10-20%) of hypertrophied mammotrophs that have the potential for significant secretory activity in vitro.