POS0006 IDENTIFICATION OF FIBROTIC AND FIBROLYTIC ENDOTYPES IN RHEUMATIC DISEASE COHORTS

Background

Ankylosing spondylitis (AS), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE) are distinct diseases with common molecular features, such as an imbalance in fibrolysis and fibrosis of connective and calcified tissues. Type III, IV and VI collagens are abundant in connective tissue, and type I, II and X of the skeletal tissue. Blood biomarkers are available to measure fibrolysis (C1M, C2M, C3M, C4M, C6M, C10C) and fibrosis (PRO-C1, PRO-C2, PRO-C3, PRO-C4, PRO-C6) of these collagens.

Objectives

To profile AS, PsA and SLE patients (pts) using blood biomarkers of collagen formation and degradation.

Methods

Baseline serum samples from consenting pts of the AS (NCT02437162/NCT02438787), PsA (NCT0315828), and SLE (NCT02349061) studies were included in the analyses. Healthy donor samples were acquired from Discovery LS. Biomarkers were measured by immunoassays. Biomarker levels were compared by Kruskal-Wallis test. Before hierarchical clustering (Ward.D2), biomarker levels were log-transformed and standardized by median centering and scaling by median absolute deviation (MAD).

Results

When compared with healthy individuals, VICM was elevated in all indications (although markedly less so in SLE pts). The fibrosis marker PRO-C3 was elevated in all indications vs. healthy, while PRO-C4 and PRO-C6 were elevated only in AS and PsA. The fibrolysis markers C3M, C4M and C6M were elevated in all indications. The cartilage fibrosis marker PRO-C2, but not C2M, was elevated in AS and PsA, but not in SLE, ps. The bone fibrosis marker PRO-C1 was at the level of healthy for all. The fibrolysis marker C1M was elevated in all, while elevated C10C was seen only in PsA and SLE, pts (Table 1). Four clusters (C) of blood markers were extracted (Figure 1). C1 was characterized by low biomarker levels (68% of healthy, 1% of PsA, 3% of SLE pts). C2 was described by high levels of C10C and median levels of VICM (20% of healthy, 12% of AS, 19% of PsA, 42% of SLE pts). C3 was described by median biomarker levels (8% of healthy, 67% of AS, 48% of PsA, 46% of SLE pts). C4 had high biomarker levels (4% of healthy, 21% of AS, 31% of PsA, 9% of SLE pts).

Conclusion

Fibrosis and fibrolysis blood biomarkers were significantly elevated in AS, PsA and SLE pts. Subsets of pts from each indication were found in clusters with either low (C1/2), median (C3) or high (C4) levels of fibrosis/fibrolysis biomarkers. These findings may provide a first step towards precision medicine for guiding the use of anti-inflammatory vs. anti-fibrotic treatments in pts with rheumatological disorders.

Disclosure of Interests

Anne-Christine Bay-Jensen Shareholder of: Nordic Bioscience A/S, Employee of: Nordic Bioscience A/S, Signe Holm Nielsen Shareholder of: Nordic Bioscience A/S, Employee of: Nordic Bioscience A/S, Peder Frederiksen Employee of: Nordic Bioscience A/S, Morten Karsdal Shareholder of: Nordic Bioscience A/S, Employee of: Nordic Bioscience A/S, Warner Chen Employee of: Janssen Research & Development, Sheng Gao Employee of: Janssen Research & Development

Resting and exercise hemodynamic determinants of daily activity measured by accelerometer in stable heart failure patients

Background

Patient-worn accelerometer is increasingly used in patients with heart failure and reduced ejection fraction (HFrEF) to assess daily activity and and as surrogate endpoint. We examined the association between cardiac physiology and daily activity by patient-worn accelerometer recordings in stable HFrEF patients.

Methods

In this descriptive study, physical average daily accelerometer units (PADA) and total average daily accelerometer unit (TADA) were assessed by a accelerometer recordings. Sixty three stable ambulatory patients with HFrEF, mainly men (92%), mean age 58±10 years, and ejection-fraction 26±4% underwent hemodynamic exercise testing, and accelerometry (Table 1). Patients were divided by PADA in a low and high activity level groups based on counts per minute physical activity.

Results

Patients in the low activity group were older and more frequently treated with diuretics. At rest, the low activity group was characterized by a lower cardiac index (CI) (2.2±0.4 vs. 2.4±0.4 l/min/m2, p=0.01), Stroke volume (SV) (70±19 vs. 81±17 ml, p=0.02) but not pulmonary capillary wedge pressure (PCWP) (12±5 vs. 11±5 mmHg, p=0.3) (Figure 1). Low activity group reached a lower CI (4.8±1.7 vs. 6.6±1.7 l/min/m2, p<0.001) and SV (94±32 vs. 121±29 ml, p<0.001), but not in PCWP (31±12 vs. 27±8 mmHg, p=0.2) or arterial-venous O2 content difference (A-VO2 diff) (13.00±2.32 vs. 12.96±1.65 ml O2/dl, p=0.9) at peak exercise. The attenuated increase was associated with attenuated increase in SV rther than increase in heart rate (42±23 vs. 52±21 bpm, p=0.07). Finally, CI at peak exercise was the only independent variable associated with PADA after adjusting for age, gender, and BMI (p<0.0001). The PADA and TADA were associated to functional assessments using Kansas City Cardiomyopathy Questionnaire, but not with New York Heart Association class or N-terminal pro brain natriuretic peptide (NT-proBNP) (Table 1).

Conclusion

Accelerometer-assessed activity in patients with HFrEF are associated with impairments in LV performance, SV reserve and cardiac output during exercise, to a greater extent than changes in arterial-venous O2 content difference or pulmonary vascular pressures. Accelerometer data may provide information about the functional status that we do not nessecary find in the widely used tools in both research and daily clinical practice.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the Danish Heart Foundation [grant numbers 17-R116-A7714-22076, 18-R124-A8573-22107]; Steno Diabetes Center Odense, Denmark [grant number 3363] and A.P. Møller Foundation for the Advancement of Medical Science [grant number 17-L-0339]. Table 1. Baseline and regression analysisFigure 1. Change in PCWP and CI by exercise

Identification of heterogenous treatment response trajectories to anti-IL6 receptor treatment in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease with fluctuating course of progression. Despite substantial improvement in treatments in recent years, treatment response is still not guaranteed. The aim of this study was to identify variation in Disease Activity Score 28 (DAS28) of RA patients in response to Tocilizumab, and to investigate both molecular and clinical factors influencing response. Clinical and biochemical data for 485 RA patients receiving Tocilizumab in combination with methotrexate were extracted from the LITHE phase III clinical study (NCT00106535), and post-hoc analysis conducted. Latent class mixed models were used to identify statistically distinct trajectories of DAS28 after the initiation of treatment. Biomarker measurements were then analysed cross-sectionally and temporally, to characterise patients by serological biomarkers and clinical factors. We identified three distinct trajectories of drug response: class 1 (n = 85, 17.5%), class 2 (n = 338, 69.7%) and class 3 (n = 62, 12.8%). All groups started with high DAS28 on average (DAS28 > 5.1). Class 1 showed the least reduction in DAS28, with significantly more patients seeking escape therapy (p < 0.001). Class 3 showed significantly higher rates of improvement in DAS28, with 58.1% achieving ACR response levels compared to 2.4% in class 1 (p < 0.0001). Biomarkers of inflammation, MMP-3, CRP, C1M, showed greater reduction in class 3 compared to the other classes. Identification of more homogenous patient sub-populations of drug response may allow for more targeted therapeutic treatment regimens and a better understanding of disease aetiology.

P1533 Early evaluation of global longitudinal strain and biomarkers at initiation of trastuzumab treatment in breast cancer patients

Funding Acknowledgements

The Danish Heart Foundation, Copenhagen (grant number: 14-R97-A5188-22839 and 15-R99-A5940). The Research Fond of the Region of Southern Denmark.

Background

Global longitudinal strain (GLS) is recommended to detect subclinical changes preceding reduced left ventricular ejection fraction (LVEF) in trastuzumab related cardiotoxicity. The possibility to detect signs of acute myocardial deterioration at treatment initiation is not thoroughly investigated. Accordingly, the aim of this study was to assess changes in GLS and biomarkers within the first two weeks of trastuzumab treatment.

Methods

In a prospective cohort study 45 patients with non-metastatic breast cancer (age 54, LVEF 62.8% (SD ± 3.6), GLS -19.9% (SD ± 2.1), 40% hypertension) were included. Examinations including echocardiography and measurement of troponin T and NT-proBrain Natriuretic Peptide were conducted before initiation of trastuzumab, at day 3, 7 and 14 and after 3, 6 and 9 months.

Results

A significant deterioration in LVEF, GLS, s’, e’ septal and s’RV occurred during the 9 months study period and was proceed by significant changes in all these parameters within the first 14 days.

After 14 days 12 patients (27%) had an increase in GLS ≥10 %, which was associated with significantly lower LVEF at nine month at 55.2% (SD ± 4.1) vs. 59.5% (SD ± 3.5) (p = 0.001) compared to patients with &lt;10 % early increase in GLS (Figure 1). No difference in plasma concentrations of cardiac biomarkers was observed between the two groups.

Conclusion

In this cohort study deteriorations in key echocardiographic parameters were detected within the first two weeks of trastuzumab treatment, and an early 10 % increase in GLS was associated with a lower LVEF at nine months.

Abstract P1533 Figure 1

Prenatal exposure to extra vitamin D from fortification and risk of developing coeliac disease

Introduction

Few studies have examined the role of maternal diet in relation to development of autoimmune diseases such as coeliac disease (CD). In Denmark, cancellation of mandatory vitamin D fortification of margarine in June 1985 provides this opportunity. This study examined if prenatal exposure to extra vitamin D from food fortification or season of birth were associated with a decreased risk of developing CD later in life. If low prenatal vitamin D levels are a risk factor, there are immediate, cheap and easy public health implications.

Methods

This register based study has a partially ecologic design. The two entire cohorts were created using information available from the Danish birth registry and development of CD (ICD-8 269 ICD-10 K90) over 30 years was retrieved from the Danish National Patient Register. Logistic regression analysis was used to generate odds ratios and 95% confidence intervals.

Results

There was a lower odds ratio of developing CD (OR: 0.811 95% CI 0.655; 1.003) from the exposed birth cohort adjusting for sex and season of birth. There was a significant season effect particularly for children born in autumn (OR 1.6 95% CI 1.16; 2.21) and born summer (OR 1.5 95% CI 1.1;2.1) when compared to children born in winter.

Conclusions

The results indicate a potential protective effect of a small extra intake of vitamin D from food fortification by pregnant women in relation to the risk of their offspring developing CD. This conclusion is further supported by the results showing that summer born children, where first half of gestation occurred during the dark winter season, had a higher risk of CD. This research lends support for the reconsideration of vitamin-D food fortification in Denmark.

Key messages

Exposure to even a small amount of vitamin D prenatally may protect against developing coeliac disease later in life. Association between season and CD indicates that vitamin D may play an important role in relation to fetal programming.

Prenatal exposure of extra vitamin D from fortification and later risk of inflammatory bowel disease

Introduction

Inflammatory bowel disease (IBD) is a chronic immune-mediated inflammatory disease that can affect the entire digestive tract. Approximately 1% of the Danish population has IBD today. Both the incidence and prevalence of IBD are increasing globally, but the etiology of IBD is still not fully understood. Some, but not all studies find that vitamin D has both protective and therapeutic effects on IBD. To our knowledge, no other study has investigated prenatal exposure to extra vitamin D from either fortified food, diet or supplements in relation to IBD. The aim of this study was to investigate whether a small extra dose of vitamin D from fortification during gestation, was associated with a lower risk of developing IBD in the offspring.

Methods

In 1985 mandatory fortification of margarine with vitamin D in Denmark was canceled. To investigate the effect of this policy change we selected all individuals from 2 full year birth cohorts before and after the termination of the mandatory fortification. All individuals were followed for 30 years. By merging data from the Medical Birth Registry with the Danish National Patient Registry, we identified individuals with IBD.

Results

217,249 individuals were included in the analysis. 875 among the exposed and 1102 among the unexposed fulfilled the criteria for being diagnosed with IBD. A lower odds ratio OR = 0.867 (95% CI: 0.792;0.947) for IBD was observed among those who had been exposed to extra vitamin D from fortified margarine during gestation, compared to those who had not been exposed. The analysis was adjusted for sex and season of birth, but results were essentially similar before and after this adjustment.

Conclusions

This study shows, that a small extra dose of vitamin D from fortified margarine during gestation may lower the risk of developing IBD in the offspring, until the age of 30. If these results can be replicated, fortification with vitamin D could be recommended to prevent IBD on a public level.

Key messages

Prenatal exposure of vitamin D from fortified food could lower the risk of IBD later in life. Fortification with vitamin D even at a relatively low level could have public health benefits.

Diagnosis and Treatment of Neuroblastoma Using 131 l-Meta-lodobenzylguanidine

Neuroblastoma is a lethal and not uncommon tumor in childhood. Early detection and display of the spread of the tumor is highly desirable for proper treatment. Nine children suspected of having neuroblastoma were examined by 131l-meta-iodobenzylguanidine (131I-MIBG) scintigraphy. In two recent studies 123l-meta-iodobenzylguanidine (123I-MIBG) was used. A primary adrenal neuroblastoma was correctly identified in 3 cases. In 2 patients additional tumor sites were found. In one patient, who was in complete remission, no pathological accumulation of 131I-MIBG was found. 131I-MIBG scintigraphies were also normal in 4 patients with other types of tumor. In one girl with a large adrenal neuroblastoma high uptake of 131I-MIBG was observed. She received two therapy doses of 131I-MIBG (1300–2800 MBq) with curative intention giving a total absorbed dose in the tumor of approximately 90 Gy. In spite of high retention of radioactivity in the tumor, regression did not appear, but her general condition was improved. In the present study images of superior quality were obtained by 123I-MIBG scintigraphy. It is concluded that scintigraphy with 131I- or 123I-MIBG should be used for primary visualization and control of neuroblastomas.

Effect of health-promoting posters placed on the platforms of two train stations in Copenhagen, Denmark, on the choice between taking the stairs or the escalators: a secondary publication

OBJECTIVE

The purpose of this study was to determine whether posters placed on the platforms of two train stations in Copenhagen, promoting use of the stairs, would encourage people to use the stairs rather than the adjacent escalator. An additional purpose was to see if the effect of the intervention was maintained for a week after the poster was removed.

MEASUREMENTS

The number of people using stairs and escalators at Copenhagen Central Station and Østerport Train Station in Copenhagen was recorded before and during posters promoting stair use were placed on the platforms, and a week after the posters were removed. Two years after the posters were removed, data were collected for 1 week at Østerport Train Station (long-term post-intervention).

RESULTS

At Copenhagen Central Station, the overall stair use increased from 12% before the intervention to 16% (P<0.0001) during the intervention, giving an odds ratio (OR) of 1.5 for stair use. At Østerport Train Station in Copenhagen, the overall stair use increased from 23 to 31% during the intervention (P<0.0001), and dropped to 27% (P<0.0001) after the intervention (during the intervention, OR=1.5 (P<0.0001); after the intervention, OR=1.2 (P<0.0001)). At the long-term post-intervention recording, the overall stair use was 25%, which was not significantly different from the stair use found before the intervention.

DISCUSSION

Posters promoting stair use placed on the platforms of train stations can result in increased stair use, during and after 1 week of intervention, and thereby seem useful only when up and immediately following intervention in changing health-promoting behavior among Danish men and women. These results agree well with results from other countries.

Imprecise methods may both obscure and aggravate a relation between fat and breast cancer

Bias in diet reporting may be both random and non-random, and may be found with simpler as well as more advanced dietary instruments. A random bias will contribute to obscure relations between diet and disease. A systematic bias may obscure or aggravate such associations. Underreporting of non-protein energy has been found to be substantial, particularly among those who are obese or have high dietary intakes. Such a non-random bias on the group level would tend to aggravate associations between dietary non-protein and disease. Whether the net result of the random and non-random bias aggravates or obscures relations depends on the relative magnitude of the two.

Arrhythmogenic right ventricular dysplasia as a cause of sudden death

Arrhythmogenic right ventricular dysplasia (ARVD) is a poorly understood and often underdiagnosed disorder of the right ventricle, characterized by replacement of myocardium by fibroadipose tissue, arrhythmic manifestations, and sudden death. The disease occurs in families and is inherited as an autosomal dominant trait. This report describes five cases of ARVD identified by autopsy. In three of the cases, sudden death occurred in the young (16-28 years old) during or shortly after exercise. In another case, a 46-year-old man with no relevant medical history was found dead in his bathroom. In the last case, a 57-year-old woman died from pulmonary thromboembolism. In none of the subjects had the disease been diagnosed or suspected before death. Only one (a 21-year-old man) had previous typical symptoms of the disease. Autopsy examination showed right ventricle dilation and, in four cases, cardiomegaly. The right ventricular myocardium of all hearts was almost replaced by adipose tissue and to a variable degree by fibrous tissue, while the left ventricle myocardium demonstrated no, or only scattered, fibro-fatty infiltration. Postmortem diagnosis of ARVD can be important in identifying possible affected family members in order to initiate treatment.

The reliability of staging and grading of bladder tumours. Impact of misinformation on the pathologist's diagnosis

The influence of misinformation on the reliability of the histopathological classification of bladder tumours was analysed. Four consultant pathologists assessed 40 biopsy specimens of bladder tumours staging invasion and grading the specimens according to the Bergkvist classification. A random sample of 20 specimens was accompanied by systematically distorted information ("bias"-unknown to the pathologists) about previous histological grading of the patient (bias group); the other 20 specimens were used as control group (non bias group). After 6 months a second round with the same specimens was arranged to assess the influence of bias on the intraobserver variation. Using kappa (kappa) statistics the chance corrected interobserver agreement rate was poor both in staging of invasion and grading according to the Bergkvist classification (kappa < 0.50). The kappa values in the intraobserver study ranged from poor to excellent with a tendency towards lower kappa when the observer had been biased. The kappa values in the assessment of malignancy were acceptable to excellent. False information did not affect the pathologists' diagnosis significantly.

Studies of multilayers and thin-foil x-ray mirrors using a soft x-ray diffractometer

A versatile x-ray diffractometer is described in detail. Two applications to the study of x-ray optical elements are presented. The first is a Bragg reflection study of state-of-the-art multilayers deposited both on conventional Si-wafer substrates and on superpolished substrates such as fused quartz and electroless nickel. These data are compared to data previously obtained at FeKα. The second study is a reflectivity and scattering study of various thin-foil x-ray reflectors proposed for up-coming x-ray satellite missions. All the data have been obtained at MgKα = 1.2536 keV.

Diagnostic reliability of combined physical examination, mammography, and fine-needle puncture ("triple-test") in breast tumors. A prospective study

A prospective study of 622 consecutively registered patients with 650 breast tumors was performed to appraise the reliability of combined physical examination, mammography, and fine-needle puncture (triple test) in the preoperative diagnosis of such tumors. All malignant as well as benign test results were confirmed by subsequent histologic examination. The diagnostic accuracy of the triple test at benign changes is comparable to that of histologic examination, but participation of experienced radiologists and cytologists as well as persons skilled in fine-needle puncture is required. Twenty-eight percent of the planned excisional biopsies were made superfluous by the fine-needle puncture, which immediately revealed the tumor as a cyst, abscess, or hematoma. For this reason, too, fine-needle puncture is recommended as a routine procedure.

Multifocal adenomatous oncocytic hyperplasia of the parotid gland (unusual clear cell variant in two female siblings.)

The same variant of an extremely rare tumorous lesion of the parotid gland in two sisters is reported. The clinical and histological features of this pathological condition and related lesions are discussed.

Palpable breast tumours: "triple diagnosis" and operative strategy. Results of a prospective study

A prospective study of 292 consecutive patients with 303 tumours was performed to appraise the combination of physical examination, mammography and fine-needle puncture (triple test) in the diagnosis of breast tumours. The diagnostic accuracy of the triple test was 100%. Because of its relative smallness, however, the series does not permit the conclusion that a benign result of triple test makes excisional biopsy unnecessary. It is emphasized that a follow-up regimen with participation of radiologists and cytologists is required. Fine-needle puncture with cytologic examination of the aspirate is recommended as a routine procedure in the diagnosis of breast tumours.

Clinical value of percutaneous intrathoracic fine-needle aspiration biopsy. An analysis of 500 cases

The clinical value of percutaneous pulmonary aspiration biopsy was assessed in 500 patients. Conclusive information was obtained in 53.6% (i.e. with decisive value in 27.4 and supportive value in 26.2%). Inconclusive results were reported in 44.8% of the cases and in 1.6% the cytologic report was misleading. Pneumothorax occurred in 25% of the series and required intubation in 4.4%. Percutaneous transthoracic fine-needle aspiration biopsy provides a simple means of obtaining positive diagnostic information of pulmonary lesions suspected to be malignant.

Cytogenetic analysis and flow cytometric DNA measurement of a human tumor with pronounced hypodiploidy

A case of malignant choroid plexus papilloma of the brain with severe hypodiploidy is presented. The hypodiploidy was estimated by means of flow cytometric measurements of the nuclear DNA content in two investigations with an interval of 21 months. The latter investigation was supplemented with chromosome analyses including quinacrine bonding. A modal chromosome number of 34 to 35 was found with a consistent loss of one chromosome Nos. 2, 3, 4, 5, 10, 13, 14, 15, 17, and 18, and no major structural changes. The corresponding calculated DNA content per nucleus correlated very well with the measured content, which was found to be 75% of the male diploid amount. The paper briefly discusses cell survival in extreme hypodiploidy and provides a comparison with cases from the literature in which banding analysis gives comparable information.

Glucose-6-phosphate dehydrogenase activity in human breast cancer. Lack of association with oestrogen receptor content

The correlation between glucose-6-phosphate dehydrogenase activity and different tumour characteristics was investigated in human breast cancer tissue. The enzyme activity was measured by a histochemical method and the oestrogen receptor content by a dextran-coated charcoal assay. The proliferative activity of the tumours correlated positively with the glucose-6-phosphate dehydrogenase activity. No correlation was found between enzyme activity and tumour type and menopausal status, age, TNM-class nor oestrogen receptor content. Based on this investigation it is concluded that the activity of glucose-6-phosphate dehydrogenase reflects the proliferative status of the tumour but not the hormone dependency of the tumour.

Diagnostic aid of aspiration biopsy cytology in brain lesions

In a series of 28 neurosurgical cases we tried to assess the value of aspiration biopsy cytology from brain lesions during the operation. Cytological aspirates during craniotomy were compared with simultaneously performed frozen section biopsies. Cytology was correct in 24 out of 28 cases (86%). It is concluded that aspiration cytology permits a safe microscopic diagnosis provided the specimens are cellular and representative. Cases are mentioned where this technique can be very useful and/or the only way to obtain microscopic evidence of a malignant tumour before treatment.

DNA content of meningiomas

Flow cytometric DNA analysis was carried out in 35 meningiomas. Thirty-three had diploid stem lines while two were aneuploid having a triploid DNA mode. Both aneuploid meningiomas were grossly huge nodular tumours and one had malignant histologic features. Flow cytometry in meningiomas is a rapid means of determining the DNA modes and adds objective information to microscopy. Appropriate cases may be selected for further cytogenetic studies.

Flow cytometric DNA analysis in fine needle aspiration biopsies from patients with prostatic lesions. Diagnostic value and relation to clinical stages

Transrectal fine needle aspiration biopsy was carried out in 59 patients with cancer of the prostate, benign prostatic hypertrophy and prostatis for cytomorphological examination and flow cytometric DNA analysis. One major single peak in the DNA histogram was observed in patients with benign hyperplasia, prostatitis and in some patients with carcinoma. A DNA histogram with a second or third peak was always compatible with carcinoma and was found both in patients with carcinoma in stage I--II and stage III--IV. It is suggested that patients with hyperploid cancers in stage I--II could benefit from early treatment.

Experimental infection of the genital tract of female grivet monkeys by Mycoplasma hominis

Mycoplasma hominis, a common inhabitant of the mucosae of the genitourinary tract of human and nonhuman primates, was inoculated directly into the uterine tubes of five laparotomized grivet monkeys. A self-limiting acute salpingitis and parametritis developed within a few days in all animals. Although there were no clinical signs of overt disease, the gross pathology was characterized by pronounced oedematous swelling and hyperaemia of the tubes and parametria. Microscopically, cellular infiltrations of lymphocytes and some polymorphonuclear leukocytes were found in the acute phase in the subserosa and muscularis of the tubes and in the parametria. Granulation tissue and fat necrosis appeared at a later stage in the parametria. The infection was associated with a marked antibody response and a moderate rise of the erythrocyte sedimentation rate and leukocyte counts. The capability of M. hominis to produce salpingitis and parametritis in a nonhuman primate would seem to add rather significantly to the available evidence suggesting an etiological role of this organism in inflammatory diseases of the internal female genitals of humans.

Flow cytometry in tumours of the brain

Flow cytometry was used for studying the distribution of single cell DNA content in biopsy material from 85 patients with benign and malignant lesions of the brain and spinal cord. In inflammatory lesions and in most benign tumours, cells with diploid DNA values were observed, sometimes with additional smaller amounts of tetraploid DNA. Cells from malignant tumours were characterized by marked hyperploid DNA values. Flow cytometry is found a rapid and valuable method adding important information to the biological nature of tumours of the central nervous system.

Endoscopic retrograde cholangio-pancreatography in pancreatic cancer and chronic pancreatitis. Differences in morphologic changes in the pancreatic duct and the bile duct

The radiological findings in ERCP in 49 patients (ERP 49 patients and ERC 24 patients) with pancreatic diseases were evaluated blindly (24 patients with chronic pancreatitis and 25 patients with pancreatic cancer as a final diagnosis). Obstructions of the main pancreatic duct were found in 16 out of 24 patients with chronic pancreatitis and in 24 out of 25 patients with pancreatic cancer. Irregularity of obstructions was seen significantly more often in patients with cancer. Cholangiography demonstrated obstructions of the distal part of the common bile duct in both groups of patients, but irregularity of obstructions was exclusively seen in the cancer group. Though characteristic radiological features were demonstrated, a safe diagnosis must probably still rely on biopsy.

Histiocytosis X. III. Clinical value of serial biopsies

In a retrospective review of sequential biopsies in 8 cases of histiocytosis X, 2 developed xanthomatous or fibrous lesions, 3 remained unchanged, whereas 3 developed malignant disease, one Hodgkin's disease and 2 malignant histiocytosis. A possible progression from benign, well differentiated to malignant histiocytic lesion is discussed, and the importance of achieving a microscopic diagnosis is emphasized.

Histiocytosis X. IV--Immunologic response assessed by lymphocyte transformation tests

Eight children with histiocytosis X were investigated with reference to immunologic reactivity in vitro (PHA, PWM, Con-A and MLC testing). No significant impairment of immune function was detected, but a subnormal (statistically insignificant) response in the MLC test may suggest some abnormality of the T lymphocytes reacting against allogeneic cells. In a patient who relapsed a marked, but insignificant, increase in lymphocyte reactivity in vitro was observed.

Histiocytosis X. II. Histologic appearance correlated to prognosis and extent of disease

Specimens from 27 bone lesions of histiocytosis X were analysed semiquantitatively before treatment. Eosinophilic granulocytes seemed to be the only significant prognostic cell type. Absence of eosionphils or only slight eosinophilia in the initial bone lesions were found predominantly in widespread disease with fatal outcome. A moderate or severe degree of eosinophilia dominated in solitary bone lesions with good prognosis.

Needle aspiration biopsy in the diagnosis of lytic bone lesions in histiocytosis X, Ewing's sarcoma and neuroblastoma

Cytologic smears obtained by needle aspiration biopsy of lytic bone lesions in 15 patients with histiocytosis X, Ewing's sarcoma and neuroblastoma were reviewed. After conventional staining, histiocytosis X could be diagnosed and differentiated from small cell tumours such as Ewing's sarcoma and neuroblastoma. The need for sampling material for cytochemical and ultrastructural analysis of these small cell tumours by needle aspiration is emphasized.

Pancreatitis and pancreatic carcinoma, diagnosed by peroperative fine needle aspiration biopsy

Thirty-seven cases of fine needle aspiration biopsies from the pancreas with histologic control are reviewed. The different cell types are described and illustrated. The cytologic/histologic correlation was very high. Only cells from very highly differentiated cancers were difficult to distinguish from atypical ductal cells. The clinical implications of the cytologic findings are briefly discussed.

Flow microfluorometry and transrectal fine-needle biopsy in the classification of human prostatic carcinoma

Flow microfluorometry (FMF) and transrectal fine-needle biopsy were used for obtaining DNA histograms from 50 patients suffering from various prostatic lesions. Based on the cytomorphological pattern, the material was classified as benign prostatic hyperplasia (29 cases), suspected carcinoma (1 case), well-differentiated carcinoma (6 cases), moderately differentiated carcinoma (12 cases) and poorly differentiated carcinoma (2 cases). The biopsy material was prepared for FMF analysis according to a new detergent technique. It was observed that increasing anaplasia paralleled an increasing occurrence of cell populations in the tetraploid and octoploid DNA region. According to the DNA histograms the moderately differentiated carcinomas could be divided into two groups: one with no or a few tetraploid cells (similar to the well-differentiated carcinomas), and another with a high percentage of tetraploid and octoploid cells (similar to the poorly differentiated carcinomas). FMF analysis in combination with fine-needle biopsy is therefore proposed as a valuable addition to the cytomorphological classification of human prostatic carcinoma.

Primary leiomyosarcoma of bone

A case of primary leiomyosarcoma of bone in the femur of an 18-year-old girl is described. Light and electron microscopy showed characteristic changes with cytoplasmic myofilaments, dense bodies, pinocytic vesicles and basal lamina fragments. Clinically, the patient is well and without evidence of tumor 9 months after the femur amputation without further treatment.

Fine needle aspiration biopsy of bone lesions: clinical value

The clinical value of cytological aspiration biopsy in 85 patients with lytic bone lesions was studied. In 71 cases cytology was of diagnostic value, but in 14 cases it was inconclusive or misleading. The method is considered a simple primary diagnostic procedure especially in lytic bone lesions of uncertain nature.

Fine needle aspiration biopsy of the pancreas

Fine needle aspiration biopsy from the pancreas was carried out peroperatively in 60 patients. A suspicion of malignancy due to a palpaple mass in the pancreas was raised in 45 cases and confirmed by cytology in 27 cases. Of the remaining 18 cases in which malignancy was suspected, the majority were caused by penetrating gastroduodenal ulcers or pancreatitis. There was only one false negative cytological report among the 37 patients with available histological control. There were no complications due to the aspiration biopsy.

Pemphigus vulgaris following D-penicillamine

A 54-year-old woman with systemic sclerosis developed clinical, histo-pathologic and immunopathologic findings consistent with pemphigus vulgaris after 8 months treatment with D-penicillamine. The course of the bullous disease required sustained steroid treatment.