The tumour stroma of oral squamous cell carcinomas show increased vascularity compared with adjacent host tissue

For tumours to grow they must acquire an adequate blood supply, and the use of drugs to inhibit tumour vascularization is one promising approach to anti-cancer therapy. Clear information is therefore required on the vascular architecture of human tumours and animal tumour models used for testing anti-angiogenic therapies. Many previous studies on animal tumour models have shown that carcinomas are least vascular in their centres and that host tissues become more vascular with proximity to the tumour. However, we have previously found that many human colorectal carcinomas do not show this pattern. The present study on human oral squamous cell carcinomas (SCCs) again reveals significant differences. Paraffin sections from 24 SCCs were immunostained using the QBEnd-10 monoclonal antibody to demonstrate blood vessels, and these were quantified by interactive morphometry using a Kontron Videoplan system. In most carcinomas, viable tumour tissue was no less vascular in the tumour centre than in the tumour periphery. Although tumours are known to release angiogenic factors, viable tumour tissue was less vascular than adjacent host tissues. However, the tumour stroma, by itself, was more vascular than adjacent host tissues. Host tissue adjacent to tumour showed no obvious increase in vascular density with increasing proximity to the tumour edge, which suggests that tumour-released angiogenic factors are only effective over a short distance.

A polydisperse linear random coil model for the quaternary structure of pig colonic mucin

The distribution of molecular weights for polymeric colonic mucus glycoprotein or "mucin" isolated and solubilised in the presence of protease inhibitors from pig colons is shown to be considerably greater than its "subunit" (thiol reduction product) and papain digested forms using the technique of size-exclusion chromatography coupled to multi-angle laser light scattering, and confirmed by sedimentation equilibrium measurements. The conformation of this mucin is probed by examining the molecular weight-intrinsic viscosity relationship in terms of the Mark-Houwink-Kuhn-Sakurada analysis for its polymeric (or "whole"), reduced and papain-digested forms: an exponent "a" of (1.1 +/- 0.1) is obtained indicating a linear random coil conformation consistent with other mucins. Size-exclusion chromatography coupled to multi-angle laser light scattering is shown to provide a relatively simple complementary technique to sedimentation equilibrium for the molecular weight distribution analysis of polydisperse materials.

Immunophenotypic classification of canine malignant lymphoma on formalin-mixed paraffin wax-embedded tissue by means of CD3 and CD79a cell markers

Canine malignant lymphoma (CML) is a common lymphoid tumour. Identification of the immunophenotype is of prognostic importance: T-cell lymphomas have a worse prognosis than B-cell lymphomas. Until recently, identification of T- or B-cell lymphomas was undertaken by means of flow cytometry or fluorescent immunocytochemistry on frozen sections. Whilst valid in the research field, these methods are impractical for routine diagnostic histopathology in CML. Commercially available CD3 antibody has been successfully employed in T-cell identification in dogs in formalin-fixed paraffin wax-embedded tissue sections, but the lack of a B-cell marker has been a hindrance until the recent introduction of a commercially available pan-B cell marker, CD79a (DAKO M7051), suitable for diagnostic application upon formalin-fixed paraffin wax-embedded material. Antibody markers to CD3 and CD79a show cross-reactivity across species lines for B cells and T cells respectively. In this group of five selected canine cases, two were identified as B-cell and the other three as T-cell lymphoma, by means of CD3 and CD79a. To the best of our knowledge application of CD79a in cases of CML has not been reported.

Hidden impact of paramedic interventions

OBJECTIVE

To examine current patterns of deployment and use of emergency ambulance crews in Nottinghamshire, with particular reference to crew status (technician or paramedic), case mix, interventions performed, and operational times.

METHODS

A retrospective survey of routinely collected computerised ambulance service despatch data, and patient treatment forms for 242 randomly selected emergency callouts in Nottinghamshire, during September 1994. Data were collected on patient demography, broad diagnostic group, crew status and operational times, and paramedic interventions performed.

RESULTS

170 of 242 callouts (70%) involved a paramedic crew; extended skills were used on 31 of these occasions (18%), predominantly for medical emergencies. Paramedic crews recorded significantly longer on-scene times (median time: 14.0 v 11.5 min, P = 0.04). An examination of the difference between paramedics who performed interventions and those who did not revealed that "intervening" paramedics recorded significantly longer onscene times (median time: 23 v 12 min, P < 0.001), turnaround times (median time: 28 v 18 min, P < 0.001), and total out-of-service times (median time 73 v 51 min, P < 0.001).

CONCLUSIONS

The additional time taken by paramedics at the scene of an emergency incident relates to their performance of an intervention, rather than time spent assessing the patient to decide whether stabilisation or immediate evacuation would be most appropriate. Paramedic interventions were most often performed for medical emergencies. The performance of paramedic interventions also extended turnaround times and total out-of-service times.

Renal dysplasia in a Rhodesian ridgeback dog

A six-month-old Rhodesian ridgeback dog was presented for evaluation of facial swelling. Chronic renal failure was clinically diagnosed based on urinalysis, biochemical changes and ultrasonography. The facial swelling was due to fibrous osteodystrophy, which was evident on survey radiographs of the skull. On post mortem examination, chronic renal failure as a result of renal dysplasia was confirmed. This is the first reported case of renal dysplasia in this breed of dog.

Solitary fibrous tumor of the paranasal sinuses: CT and MR appearance

We describe the CT and MR appearance of a solitary fibrous tumor of the paranasal sinuses with intracranial invasion. The tumor was hypointense on T2-weighted MR images and had a large calcific component that proved to be reactive remodelling of native bone.

The effects of Helicobacter pylori colonization on gastric function and the incidence of portal hypertensive gastropathy in patients with cirrhosis of the liver

OBJECTIVES

To investigate the prevalence of Helicobacter pylori infection in 50 cirrhotic patients with biopsy-proven cirrhosis with and without portal hypertensive gastropathy and to study whether or not the effects of H. pylori colonization of the stomach on gastric acid and pepsin secretion, serum gastrin and pepsinogen I levels, gastric mucus, and gastric emptying contributed to the development of portal hypertensive gastropathy in cirrhotics.

METHODS

All patients underwent an upper GI endoscopy followed by determination of basal and pentagastrin and insulin-stimulated gastric acid and pepsin secretion and serum gastrin and pepsinogen I levels. The gastric biopsies were stained to detect H. pylori infection, portal hypertensive gastropathy, and gastritis. The amount of gastric mucus was estimated by a microanalytical technique. The rate of gastric emptying was assessed by the radionuclide method using a semi-solid meal.

RESULTS

Thirty-three (66%) patients had endoscopic evidence of portal hypertensive gastropathy, 10 with the severe (20%) and 23 with mild form (46%). Twenty (40%) patients had histological evidence of H. pylori infection. Eleven out of 33 (33%) patients with endoscopic portal hypertensive gastropathy had microscopic evidence of H. pylori infection. Eighteen out of 20 (90%) patients with chronic active gastritis had concomitant H. pylori colonization. In contrast, the gastric mucosa was histologically normal in 21 of the 30 patients (70%) not infected with H. pylori. Marked hypochlorhydria and reduced pepsin secretion associated with a tendency to hypergastrinemia were observed in cirrhotic patients colonized with H. pylori compared with those without. However, there was no significant difference in serum pepsinogen I concentrations, the ratio of polymeric to degraded gastric mucus, or the rate of gastric emptying between cirrhotics with and without H. pylori colonization of the stomach. Furthermore, these parameters were not significantly different in patients with portal hypertensive gastropathy with and without H. pylori infection.

CONCLUSION

These observations suggest that H. pylori infection is unlikely to be involved in the pathogenesis of portal hypertensive gastropathy.

Lymphangiomatosis of the pelvic limb in a Maltese dog

A case of lymphangiomatosis is described affecting the right pelvic limb of an 18-month-old, female Maltese dog. A progressive swelling around the stifle had developed subsequent to a routine tibial crest transposition. The swollen area eventually progressed to involve the entire limb circumferentially, to end abruptly in the mid-metatarsal region. The skin of the affected area was deep red in colour, devoid of hair, and had numerous large, thin-walled vesicles that were easily ruptured and from which a serosanguineous fluid exuded. The swelling pitted on digital pressure and showed fluctuant mobility. The microscopic appearance of biopsied and post mortem material mimicked that of lymphangioma. However, the signalment, clinical presentation and histological features are consistent with a diagnosis of the recently reported variant of human lymphangiomatosis, lymphangiomatosis of the limb.

Characterization of pig colonic mucins

Pig colonic mucins isolated from the adherent mucus gel in the presence of proteinase inhibitors were solubilized by homogenization and the component mucins fractionated by CsC1 density-gradient centrifugation. Polymeric and reduced pig colonic mucin were both largely excluded on Sepharose CL-2B, papain-digested colonic mucin was included. The M(r) values of polymeric, reduced and digested mucins were 5.5 x 10(6), 2.1 x 10(6) and 0.6 x 10(6) respectively. This suggests that pig colonic mucin is comprised of 2-3 subunits, each subunit containing 3-4 glycosylated regions. The intrinsic viscosities of polymeric, reduced and digested mucin were 240 ml.g-1, 100 ml.g-1 and 20 ml.g-1 respectively. Polymeric pig colonic mucin comprised 16% protein per mg of glycoprotein and was rich in serine, threonine and proline (43% of total amino acids). There were approx. 150 disulphide bridges and 53 free thiol groups per mucin polymer. A seventh of the protein content was lost on reduction. This protein was particularly rich in proline and the hydrophobic amino acids. Papain-digested pig colonic mucin contained 11% protein per mg of glycoprotein and was rich in serine, threonine, glutamate and aspartate. All types of amino acids with the exception of aspartate were lost on digestion. The amino acid analysis of the proteolytically digested regions of pig colonic mucin are markedly different to the tandem repeat regions of the human mucin genes shown to be expressed in the colon.

Cutaneous malignant melanotic neurocristic tumors arising in neurocristic hamartomas. A melanocytic tumor morphologically and biologically distinct from common melanoma

Cutaneous neurocristic hamartomas (CNH) are pigmented lesions of neural crest origin that involve the skin and superficial soft tissue. They consist of a complex proliferation of nevomelanocytes, schwann cells, and pigmented dendritic and spindled cells. Malignancies can arise within the lesions, but few studies have dealt with this issue. We studied seven cases of CNH in which malignancy supervened. They included four congenital and three acquired lesions that involved the head and neck (five cases) or back (two cases) in patients aged from 11 to 67 (mean, 32) years. Malignant tumors developed 15 to 67 (mean, 32) years after identification of the pigmented lesion in the congenital CNH and after 1 to 6 (mean 3.5) years in the acquired CNH. The malignant tumors had a deep intradermal or subcutaneous origin and lacked a junctional component. Most were circumscribed, multinodular, melanin-containing tumors composed of bland, small, rounded to spindled cells, focally displaying a trabecular or nested growth pattern. Nuclear palisading and perivascular pseudorosettes were present in several tumors. In two examples, the neoplasm consisted predominantly of large pleomorphic epithelioid cells. Tumors contained immunoreactive S-100 protein (all of seven cases), a melanoma-associated antigen (HMB-45)( five of six cases, neuron-specific enolase (five of seven cases) and vimentin (six of six cases). The four patients with congenital lesions tended to have multiple recurrences and died of disease after 2 to 20 (mean, 9) years, three with metastases, one with direct invasion of the posterior fossa. The three patients with acquired lesions are alive after 1 to 5 years two with persistent disease. In contrast to common melanomas, these tumors have a propensity to recur as bulky nodules and to metastasize after many years or decades. Because these tumors exhibit melanocytic differentiation and arise in hamartomatous lesions composed of neural crest derivatives, we have designated them cutaneous malignant melanotic neurocristic tumors.

Anti-tumor ribonuclease, combined with or conjugated to monoclonal antibody MRK16, overcomes multidrug resistance to vincristine in vitro and in vivo

Onconase, a ribonuclease isolated from Rana pipiens oocytes and early embryos, is a member of the RNase A superfamily. Onconase has anti-neoplastic properties both in vitro and in vivo, and is undergoing clinical evaluation. In the present study, Onconase was combined with or conjugated to MRK16, an anti-P-glycoprotein (Pgp) monoclonal antibody. The interaction of these combinations with vincristine (VCR) against parental and multidrug resistant (MDR), Pgp expressing, human colon carcinoma cells caused increased VCR cytotoxicity in vitro and enhanced survival of athymic nude mice given transplants of drug resistant HT-29(mdr1) cells in vivo. The results suggest that combination treatment with Onconase and other agents that modulate the chemosensitivity of Pgp-expressing human tumor cells has the potential to overcome MDR.

Immunity to Mexican H5N2 avian influenza viruses induced by a fowl pox-H5 recombinant

The presence of highly pathogenic H5N2 avian influenza in domestic poultry in Mexico that is not being eradicated by conventional depopulation methods constitutes an imminent problem for poultry producers and agricultural authorities in the United States. The present report considers the candidate vaccines available to H5N2 influenza virus and establishes that a fowl pox-H5 recombinant can provide protection from lethal Mexican H5N2, and prevent shedding in the feces and transmission to contact birds. Inactivated and recombinant vaccines may be useful adjuncts to eradication if the H5N2 influenza virus spreads to the United States or the countries in Central America.

Dopamine-beta-hydroxylase and tyrosine hydroxylase immunoreactive neurons in the human brainstem

Immunohistochemistry of dopamine-beta-hydroxylase in the human hind brain indicates that neuronal cell bodies containing the antigen form prominent populations in the nucleus tractus solitarius and nearby medial and dorsal edge of the medial vestibular nucleus. They are frequent in and around the periphery of the dorsal motor nucleus of the vagus and in an oblique band extending from that region to the ventrolateral aspect of the reticular formation, where they are most numerous at the mid medullary levels. Dopamine-beta-hydroxylase immunoreactive neurons are also closely packed in the nuclei coeruleus and subcoeruleus. Concomitant immunohistochemistry for tyrosine hydroxylase demonstrates small numbers of neuronal cell bodies that are reactive only for this antigen, and which do not contain detectable dopamine-beta-hydroxylase. Such neurons are present in the nucleus tractus solitarius, the pontine lateral parabrachial nucleus and within the core of the rostral pontine reticular formation. Some medullary and pontine axon bundles similarly stain for tyrosine hydroxylase but not for dopamine-beta-hydroxylase. These differential staining patterns suggest, among other possibilities, that in humans some neurons of the caudal brainstem are dopamine (if they contain the second step catecholamine synthesizing enzyme, aromatic L-aminoacid decarboxylase) rather than noradrenaline or adrenaline containing catecholamine neurotransmitters.

Adrenal secretion and major depression in 8- to 16-year-olds, II. Influence of co-morbidity at presentation

The association between high evening cortisol and low morning DHEA and the pattern of co-morbid diagnoses in 82 cases of major depressive disorder in 8- to 16-year-olds has been analysed. There was a significant association between the presence of high evening cortisol and co-morbid dysthymia. This was independent of age or sex. No positive association was found between the presence of low morning DHEA and any co-morbid diagnosis. However, co-morbid panic or phobic disorder was significantly associated with the absence of this endocrine abnormality. These findings suggest that specific endocrine disturbances may be associated with different patterns of co-morbidity during an episode of major depression in this age group.

Radial cortical and trabecular bone densities of men and women standardized with the European Forearm Phantom

We previously showed that it is possible to cross-calibrate peripheral bone densitometers using the European Spine Phantom (ESP). We have now performed a multinational study of cross-calibrated radius bone density based on normal subjects of both sexes in eight European centers. Six centers were equipped with machines made by Scanco or Stratec for determining distal radial trabecular bone density by quantitative computed tomography (QCT) and two were equipped with Lunar SP2 single photon absorptiometry (SPA) equipment for measuring midshaft cortical bone density. Subjects recruited ranged from 20 to over 80 years of age. Over one hundred and fifteen men were studied by QCT and a different cohort of 104 men were studied with SPA; the equivalent figures for women were 235 and 123. Reference ranges were derived for bone density against age for each of the four groups, and their applicability is discussed in relation to between-center differences in the results obtained. There were insignificant differences (P > 0.05 with Bonferroni correction) between centers in the values obtained by QCT in the different populations. However, there were considerably larger and highly statistically significant differences between midshaft cortical bone density values of about 10% of overall means between subjects from eastern Finland and central Belgium (P < 0.001), with higher Finnish values. Women had considerably lower radial trabecular bone density values than men at all ages, a result that differentiates the radius from the spine. This sex difference widened after menopause. These results have important implications for understanding the contribution of bone density to the differential risk of Colles' fracture in the two sexes and suggest that further work is needed to establish young normal reference ranges for radial bone density in Europe.

Adrenal secretion during major depression in 8- to 16-year-olds, I. Altered diurnal rhythms in salivary cortisol and dehydroepiandrosterone (DHEA) at presentation

The association between basal cortisol, dehydroepiandrosterone (DHEA), its sulphate (DHEAS) and major depression was investigated in 8- to 16-year-olds. Eighty-two subjects with major depression, 25 non-depressed psychiatric cases and 40 community controls were systematically assessed for current mental state and hormone levels at 08.00, 12.00 and 20.00 h, assayed from salivary samples collected over a 48 h period. The average mean of the two time points was compared between the three groups. Evening cortisol hypersecretion and morning DHEA hyposecretion were significantly, and independently, associated with major depression. High evening cortisol (> 0.594 ng/mL) and low morning DHEA (< 0.200 ng/mL) identified subgroups of depressives with different types of adrenal hormone dysregulation. The association between high evening cortisol or low morning DHEA and MDD was not affected by either age or gender.

Cell-to-cell signaling in the symbiotic nitrogen-fixing bacterium Rhizobium leguminosarum: autoinduction of a stationary phase and rhizosphere-expressed genes

The Sym plasmid pRL1JI encodes functions for the formation of nitrogen-fixing pea root nodules by Rhizobium leguminosarum. Some of the nodulation genes are involved in recognition of chemical signals produced by the plant root, and others are required for production of chemical signals recognized by the plant. pRL1JI also contains a regulatory gene, rhiR, that is homologous to luxR, the transcriptional activator of luminescence genes in Vibrio fischeri. LuxR requires a signal compound, an autoinducer, for its activity. We have identified an R. leguminosarum autoinducer that, together with RhiR, is required to activate both the rhizosphere-expressed rhiABC operon and a growth-inhibiting function encoded by pRL1JI. This intercellular signal is an N-acylated homoserine lactone structurally related to the V. fischeri and other autoinducers. These findings indicate a new level of intercellular communication in root nodule formation.

Information for patients with cancer. Does personalization make a difference? Pilot study results and randomised trial in progress

Although there are a number of groups working on the provision of personalized patient information there has been little evaluation. We have developed and piloted a method of giving patients on-line access to their own medical records with associated explanations. We are comparing, in a randomised trial, personalized with general computer based information for patients undergoing radiotherapy for cancer. We present results from the pilot study and the evaluation methods to be employed.

Origin and molecular changes associated with emergence of a highly pathogenic H5N2 influenza virus in Mexico

In October of 1993, there was decreased egg production and increased mortality among Mexican chickens, in association with serologic evidence of an H5N2 influenza virus. First isolated from chickens in May of 1994, after spreading widely in the country, the virus caused only a mild respiratory syndrome in specific pathogen-free chickens. Because eradication of the virus by destruction of infected birds posed major obstacles to the poultry industry in Mexico, we were able to conduct a "field experiment" to determine the fate of an avirulent virus after repeated cycles of replication in millions of chickens. By the end of 1994, the virus had mutated to contain a highly cleavable hemagglutinin (HA), but remained only mildly pathogenic in chickens. Within months, however, it had become lethal in poultry. Nucleotide sequence analysis of the HA cleavage site of the original avirulent strain revealed R-E-T-R, typical of avirulent viruses and unlike the K-K-K-R sequence characterizing viruses responsible for the 1983 outbreak in poultry in the United States. Both mildly and highly pathogenic isolates contained insertions and a substitution of basic residues in the HA connecting peptide, R-K-R-K-T-R, which made the HA highly cleavable in trypsin-free chicken embryo fibroblasts. Phylogenetic analysis of the HA of H5 avian influenza viruses, including the Mexican isolates, indicated that the epidemic virus had originated from the introduction of a single virus of the North American lineage into Mexican chickens. This sequence of events demonstrates, apparently for the first time, the stepwise acquisition of virulence by an avian influenza virus in nature.

The effects of heparin on lipoproteins in high-resolution electrophoresis of serum

Sera from heparinized patients commonly display anodal slurring of both the alpha and beta lipoproteins when they are examined by high-resolution electrophoresis (HRE). In this study, the authors examined the effect of heparin and lipoprotein lipase on the electrophoretic migration of alpha and beta lipoproteins in sera. The addition of 10 to 1,000 units of heparin/mL to normal sera resulted in a concentration-dependent anodal slurring of the beta lipoproteins. At 40 units/mL, the beta lipoprotein band was not visible when the Paragon blue protein stain was used. The beta lipoprotein could be seen as a wide, faintly staining band with lipoprotein stain. The alpha lipoprotein band on the same gel was unaffected by the added heparin. High-resolution electrophoresis of other sera from patients who were therapeutically heparinized demonstrated anodal slurring of both alpha and beta lipoproteins independent of heparin concentration. Immunofixation electrophoresis (IFE) studies confirmed that apolipoproteins A and B were slurred within their respective bands. Heparin activates lipoprotein lipase with release of free fatty acids (FFA) from very low density lipoproteins and chylomicrons. To test this effect on migration, sera were incubated with lipoprotein lipase in vitro. The anodal slurring of both the alpha and beta lipoprotein was associated with the amount of FFA production. Individuals interpreting electrophoretic patterns should be aware that both the alpha and beta lipoproteins can migrate and slur anodally in heparinized patients. In addition, when the beta lipoprotein band interferes with the identification of monoclonal gammopathies, its migration can be selectively altered by the addition of 40 units/mL heparin to the sample.

Household family structure and children's aggressive behavior: a longitudinal study of urban elementary school children

The relationship between contemporary household family structures at fourth-grade and sixth-grade parent- and teacher-rated aggression was examined in an epidemiologically defined population of urban school children. The relationship between family structure and aggression varied by child gender and by parent and teacher ratings in the home and school, respectively. After taking into account family income, urban area, and fourth-grade aggressive behavior, boys in both mother-father and mother-male partner families were significantly less likely than boys in mother-alone families to be rated as aggressive by teachers. No significant relations between family structure and teacher- or parent-rated aggression were found for girls.