Diet therapy for rheumatoid arthritis

Although diet therapy for arthritis has received considerable publicity, there is little objective information about its efficacy. We undertook a 10-week, controlled, double-blind, randomized trial of patients with active rheumatoid arthritis (RA). Twenty-six patients completed the study; 11 were on an experimental diet (a specific popular diet free of additives, preservatives, fruit, red meat, herbs, and dairy products) and 15 were on a "placebo" diet. Of 183 variables analyzed, there were no clinically important differences among rheumatologic, laboratory, immunologic, radiologic, or nutritional findings between patients on experimental and placebo diets. Six RA patients on the placebo and 5 on the experimental diet improved by objective criteria. Improvement averaged 29% for patients on placebo and 32% for patients on experimental diets. Two patients on the experimental diet improved notably, elected to remain on the experimental diet following the study period, have continued to improve, and noted exacerbations of disease upon consuming nonexperimental diet foods. Our study failed to provide evidence of objective overall clinical benefit of this diet as followed by a group of patients with longstanding, progressive, active RA. However, our data are not inconsistent with the possibility that individualized dietary manipulations might be beneficial for selected patients with rheumatic disease.

Perineural spread by squamous carcinomas of the head and neck: a morphological study using antiaxonal and antimyelin monoclonal antibodies

Perineural spread has been demonstrated histologically in 65/180 (36%) major surgical resections for squamous carcinomas of the head and neck; the incidence in a smaller necropsy series was 18/20 (90%). Perineural infiltration was observed most commonly in the vicinity of carcinomas arising in the buccal cavity (31/63, 50%) and, at all sites, it was most commonly encountered near tumours less than or equal to 2.5 cm in diameter. Perineural spread near cervical node metastases was, by contrast, uncommon in the surgical series. Tumour within perineural spaces tends to be concentrated at the margin of the nerve and shows only limited extension inwards, but cells may track upwards and downwards within the spaces. Distant spread for greater than 2 cm is unusual, and interval sampling of involved nerves in necropsy material indicates that most perineural tumour cells are confined to the distal 1 cm of the affected nerve. Infiltrated nerves regularly show varying degrees of myelin and axonal degeneration, probably anoxic in origin, and segmental infarction of nerve trunks was observed in three patients. Fine changes in axons and myelin have been regularly demonstrated with two monoclonal antibodies, and the use of these new reagents is described.

Aphasia and speech organization in children

A long-standing controversy concerns whether lateralized cerebral specialization for speech and language is present at the time of language origins (developmental invariance) or whether it gradually develops from initial bilaterality (developmental progression). Thus controversy is complicated by conflicting reports of the incidence of childhood aphasia. The discrepancies are largely due to one early study. When methods for estimating speech organization distributions are applied to later studies, the developmental invariance position is supported.

Calcium phosphate deposition disease in great danes

A new clinicopathologic syndrome, possibly familial, in Great Dane dogs, resembles the familial childhood variant of calcium pyrophosphate dihydrate deposit disease in man, except that the mineral deposits were composed of amorphous calcium phosphate or hydroxyapatite rather than pyrophosphate. The syndrome was characterized clinically by paraplegia and incoordination in very young puppies which was caused by concentric constriction of the posterior cervical spinal cord. Canal stenosis resulted from dorsal displacement of the seventh cervical vertebra and deformation of the vertebral articular processes. Mineral deposition in the diarthrodial joints of the axial skeleton could be seen on radiographs of weanling puppies, and the appendicular skeleton became involved as the dogs matured. Periarticular mineralization of the limbs was associated with shorter bones, a thin cortex, abnormal bone curvature, and increased medullary trabeculae. Bone alterations were associated with abnormalities of the growth plate, which had focal areas of cartilage calcification. Soft tissue mineralization, seen in all dogs, was a primary feature of the disease process. Serum calcium concentrations were within the normal range, but serum phosphorus concentrations were decreased.

Pain and Dysphagia in Patients with Squamous Carcinomas of the Head and Neck: The Role of Perineural Spread

Clinical and pathological features of perineural spread have been investigated in patients with squamous carcinomas at several sites in the head and neck. In 100 surgical cases, the clinical and pathological findings were congruent in 76%. Combined clinical and histological evidence of perineural invasion was recorded in 33% and the overall incidence of nerve involvement detected morphologically was 44%. Perineural infiltration was demonstrated histologically in 51% of major excisions from the buccal cavity and in 34% of resections from the oropharynx, hypopharynx and cervical oesophagus. The neurological findings were dominated by hypoaesthesia, dysaesthesia and referred pain — Mainly in the territories of cranial nerves V and IX. Multiple and/or sequential nerve involvement was occasionally seen. No correlation was established between nerve invasion and metastasis to regional lymph nodes. Long-distance infiltration of nerve trunks, and multiple involvement, are grave prognostic features.

In 17 terminal patients submitted to autopsy, 65% had combined clinical and pathological evidence of perineural spread and the overall incidence of nerve involvement detected morphologically was 88%. Sensory changes again predominated. Multiple nerve involvement was observed in 35%. An apparently new ‘dysphagia syndrome’ is described in 4 patients with oropharyngeal carcinomas in whom gross mechanical obstruction was simulated by a combination of perineural spread of tumour into the ipsilateral vagal trunk, sometimes accompanied by segmental infarction, variable invasion of the sympathetic chain, and ‘splinting’ of the pharynx by local fibrosis and tumour in the soft tissues of the neck. Short-term palliation was achieved in these patients with high-dose steroids.

Decay of colostral antibodies to bovine leukemia virus with application to detection of calfhood infection

An estimated weighted-regression method was used to describe the decay of colostral bovine leukemia virus (BLV) antibodies in the calf, as measured by agar-gel immunodiffusion with glycoprotein antigen. The prediction equation, based on 473 observations from 130 animals, was log10 inverse titer = 1.29 -0.012 age (days). The half-life of BLV antibodies was estimated to be 25.8 days. Ages at which colostral antibodies were last detected were between 51 and 187 days. Normal limits of antibody decay were estimated and used to identify virus-induced active antibodies in calves during the colostral antibody period. Calves known to be infected were identified between 2 and 180 days of age, using 95% limits. Application of this procedure for the early serologic detection of BLV-infected calves in eradication or control programs is discussed.

Framework invasion by laryngeal carcinomas

The accuracy of standard clinical and radiologic methods in detecting invasion of the laryngeal framework or the presence of a transglottic tumor was examined by comparing clinical and pathologic findings in a series of 50 randomly selected laryngectomies for squamous carcinoma. Forty-two of the patients had received radiation therapy as primary treatment. The presence of pain referred to the ear immediately before laryngectomy indicated invasion of the laryngeal framework or spread into the extralaryngeal soft tissues in 11 of 12 patients. Transglottic tumors were correctly identified in 10 of 14 patients from laryngeal tomograms, but seven additional tumors were incorrectly designated as transglottic. Both transglottic tumors and infraglottic extension were seriously underdiagnosed by direct laryngoscopy. Framework invasion was seen to be a feature of transglottic tumors 2 cm or more in diameter. The morphology of this process is described. Limited follow-up has already shown a pattern of early recurrence, frequently as cervical node metastases, that is significantly more common in patients with framework invasion.

An immunocytochemical study of the distribution of epithelial membrane antigen in normal and disordered squamous epithelium

Using immunocytochemical techniques, we have investigated the distribution of epithelial membrane antigen (EMA) in human squamous epithelium. The antigen is not demonstrable in normal adult tissues although it is present on the surface membrane of normal foetal epidermis before keratinization takes place. It may be expressed strongly in the adult, however, in in situ and infiltrative squamous carcinomas as well as in a variety of non-neoplastic states. Present evidence suggests that EMA may protect exposed surfaces. The lack of demonstrable antigen on malignant melanomas and basal cell carcinomas highlights the histogenetic differences between these tumours and squamous carcinomas, and suggests a possible role for EMA in the differential diagnosis of malignant skin tumours.

A statistical approach to the determination of the fertile period

17 beta-Estradiol (E2), basal body temperature (BBT) and luteinizing hormone (LH), were measured in normally menstruating women. The preovulatory E2 observations were characterized by variations about a constant level during the preovula-peak. The BBT observations typically varied about a constant level during the preovulatory phase then about a higher constant level during the postovulatory phase. The change points in E2 and BBT were detected using a Bayesian detection rule and a midcycle 'fertile period' was marked off. The midcycle 'fertile periods' appear to bracket the ovulation event and the method shows promise as a natural family planning method. Several practical limitations of the method are discussed.

Fetal death in utero: effect on estrone, estradiol-17 beta and progesterone levels in the ewe

Polyvinyl catheters were placed in the maternal femoral artery (MA) and maternal uterine vein (UV) of 11 near-term ewes and in the umbilical vein of their fetuses. 1-5 days postoperatively 100 ml of air were injected into the umbilical vein of 7 fetuses. 4 fetuses served as controls. Samples of blood from MA were taken 15 min prior to air embolism and every 15 min for 3 h, then at +4, +5 and +6 h after air injection. Plasma levels of estrone (E1) estradiol (E2) and progesterone (P) were determined by radioimmunoassay. In MA and UV of treated ewes there was a significant decrease in P, but not in E1 or E2 after fetal death compared to control ewes. Control levels of P in MA were 9.6 ng/ml; values at 1, +2, +4 and +6 h were 8.8, 3.3, 2.3 and 1.2 ng/ml, respectively.

A Bayesian change-point problem with an application to the prediction and detection of ovulation in women

Under the assumptions of independent normally distributed and sequentially observed responses, a Bayesian rule for detecting a change from a constant mean response is derived. It is known that both basal body temperature (BBT) and preovulatory estrogen values undergo such a change in mean value at some random time during the menstrual cycle. The Bayesian rule is applied to estrogen to predict ovulation and to BBT to detect ovulation. Data from an aggregate of women are used to obtain prior information about the change-points and the parameters that define the changes in estrogen and BBT. A method is proposed by which the accumulation of information for a specific women can be incorporated into the aggregate prior information.

Reliability and validity of the 24-hour recall

The reliability and validity of the 24-hour dietary recall method was tested statistically by comparing observed with recalled intakes of kilocalories and protein. Data on observed intake of 28 children, aged 10 through 12, with asthma, cystic fibrosis, or diabetes, participating in a summer camp program, were obtained by unobtrusive observation. The same subjects were interviewed within 24 hours after the observation. Intakes of kilocalories and of protein were computed for both observed and recalled data. The two sets of data were compared by paired t-test and regression analysis. A large and significant difference was found between mean recalled and mean observed intakes for both kilocalories and protein. This coupled with a low but significant coefficient for reliability limits the usefulness of this dietary assessment tool in the age group studied.

Five human tumour cell lines derived from a primary squamous carcinoma of the tongue, two subsequent local recurrences and two nodal metastases

Five tumour cell lines have been derived from a primary squamous carcinoma of the tongue, from 2 subsequent local recurrences, and from 2 lymph-node metastases--all from the same patient. While the cell lines shared many morphological and biochemical characteristics, those derived from recurrences and metastases appeared to be less differentiated, were less well organized in culture, and displayed fewer desmosomes and tonofilaments than cells in the primary tumour line. A recurrent line showing greatest morphological divergence from the primary tumour line also demonstrated the greatest differences at the ultrastructural level, in increased production of plasminogen activator and in the composition of cell-surface glycoproteins.

The diagnosis and surgical management of olfactory neuroblastoma: the role of craniofacial resection

The diagnosis and clinical management of olfactory neuroblastoma are discussed. Computerized tomography is a valuable means of assessing the pre-operative extent of disease and the efficacy of subsequent major surgery. The tissue diagnosis is facilitated by electron microscopy, demonstrating the presence of dense core vesicles and cytoplasmic filaments. Radiotherapy followed by craniofacial resection is the treatment of choice for olfactory neuroblastomas that are locally extensive at presentation.

Ten human carcinoma cell lines derived from squamous carcinomas of the head and neck

Ten cell lines of human squamous carcinomas of the tongue and larynx have been established from surgical specimens removed from 36 unselected patients, in order to provide systems for investigating the invasive and tissue-destructive capacity of squamous carcinomas of the head and neck. The morphology, ultrastructure and growth characteristics of the 10 lines are described. Detailed cytogenetic analysis of the first 4 lines indicates that each is karyotypically unique, with no evidence of cross-contamination. Nine of the 10 cell lines secrete immunoreactive beta human chorionic gonadotrophin (beta-hCG) in the culture medium. No correlation was demonstrated between the ability of the cell lines to secrete plasminogen activator and their capacity to grow in soft agar or as xenografts in immune-deficient mice.

Some mechanisms of local bone destruction by squamous carcinomas of the head and neck

An in vitro osteolysis assay with 45Ca-labelled mouse calvaria has been used to investigate mechanisms of direct bone invasion by squamous carcinomas of the head and neck. Short-term (3-day) organ cultures of 8 fresh squamous carcinomas showed varying degrees of in vitro bone-resorbing activity which was blocked by indomethacin, an inhibitor of prostaglandin synthesis. Supernatant media from 6 established cell lines also induced bone resorption in vitro and evoked an osteoclastic response in the cultured calvaria. Osteolysis by supernatant media was not blocked by indomethacin in all the tumour-cell lines, and the production of non-prostaglandin osteolysins by the indomethacin-resistant lines is postulated. The two principal findings that emerge are: (1) Stimulants for osteoclastic activity are derived from both squamous-carcinoma cells and from host cells in the tumour stroma. (2) These stimulants are diverse. Indomethacin-sensitive agents, presumed to be prostaglandins, are most convincingly demonstrated in the fresh tumours. Indomethacin-resistant agents, presumably not prostaglandins, are more characteristic of the carcinoma cell lines.

An unexpected fungal infection in a patient with leukaemia

A 58-year-old man, who was entering remission from acute monocytic leukaemia, died unexpectedly after five days of fever. Cultures of necropsy material grew the yeast Trichosporon beigelii, and subsequent histological examination showed a widely disseminated infection. This fungus usually causes a localised lesion of the hair shaft (piedra). Deep-seated infections due to Trichosporon spp. have been recorded infrequently and disseminated infections on only five previous occasions. None of these has been from the United Kingdom. This case report describes some of the difficulties of diagnosis.

The irradiated radical neck dissection in squamous carcinoma: a clinico-pathological study

A preliminary clinico-pathological survey is presented of radical neck dissections from 50 patients with advanced (T3, T4) squamous carcinomas of the head and neck, previously treated by irradiation and combination chemotherapy. The total yield of lymph nodes (1411) from these dissections was high--mean of 28 nodes/dissection, range 8-60; the proportion of nodes containing metastatic carcinoma was low--100 (7%)--with only 1 or 2 nodal masses/dissection in most instances. The involved nodes tended to be concentrated in 1 or 2 anatomical groups, principally in the upper anterior neck, with apparent sparing of nodes in the posterior triangle. There was a high incidence (88%) of transcapsular spread. Keratin granulomas, with or without intact metastatic carcinoma, were commonly found; on occasions they formed large masses simulating nodal metastases. The morphological patterns in uninvolved lymph nodes were shown to be of no prognostic significance. Initial data on postoperative follow-up indicated a crude survival of 52% (24 patients) at 30 months. Most deaths (80%) occurred within 12 months of major surgery; the majority (72%) died with residual malignant disease; and uncontrolled primary tumour, particularly in the oral cavity and oropharynx, was found more frequently than metastatic disease in the neck or elsewhere. Clinical implications are discussed with reference to the use of modified radical neck dissection in the surgical salvage of this poor-risk group of previously irradiated patients.