Correlation between visualization and size of the areae gastricae and duodenal ulcer

The relationship between the antral mucosal appearance and the incidence of duodenal ulcer was examined by review of 250 double-contrast barium-meal studies. When the mucosal pattern was seen, the areae gastricae were larger in patients with duodenal ulcer. Failure to see the mucosal pattern occurred more frequently in patients without ulcer.

Medico-legal opinion: radiology and vicarious liability

Vicarious liability in Canadian law implies additional responsibilities which parallel the benefits of a partnership, and the benefits of employer--employee relationships. It promotes optimum patient care, together with avenues for loss distribution in situations where negligence occurs. Radiologists, as persons in charge, are expected to exercise due care and skill in maintaining the quality of care which patients receive during all phases of the professional relationship. They are expected to provide the patient with a reasonable standard of care and skill, irrespective of whether the radiologist chooses to deal with the patient directly, or through a partner or employee. This is the same common sense requirement which all of us expect when we contract with a builder or mechanic who employs others to do part of the work. It is not reasonable to expect a patient to entrust his or her health on any other basis.

Histopathological characteristics and oestrogen receptor content in primary breast carcinoma

159 primary breast carcinomas were examined histologically with regard to grade of anaplasia, cellularity, amount of elastic tissue, and whether they were of ductal or lobular origin. Possible correlations between these variables and the oestrogen receptor (OR)-content were investigated. There was a marked tendency toward a greater number of OR-positive tumors in the group rich in elastosis. A significant correlation between the OR-content and the histological grade was found, whereas there was no correlation between either the OR-content or the grade of anaplasia and the cellularity. Furthermore, the group of tumors that were lobular in derivation had a significantly greater number of OER-positive tumors than the group ductally derived.

Treatment of advanced breast cancer with progestins

This paper reviews the theoretical background for the use of progestins in advanced breast cancer and the clinical experience obtained from 13 major studies. The average rate of response is about 30%, with somewhat higher rates when the dominant site of disease is localized to soft tissue and to bones, compared with viscera. Furthermore it seems that cross resistance between progestin therapy and other endocrine therapies is only partial. However, response rates related to previous therapy and to important prognostic variables such as age of the patient, disease-free interval and hormone receptor content of the tumor tissue are poorly elucidated. Only limited data are available concerning response rate in relation to dose and route of administration and data from prospective randomized trials to analyze these relations are still lacking. Considering the only modest side effects of treatment with progestins and the clinical and theoretical evidence favoring a mode of action different from that of other endocrine therapies, progestins are drugs with interesting qualities. Therefore future controlled studies with progestins alone or in combination with other systemic therapies should be carried out to establish the therapeutic efficacy of progestin therapy in primary and advanced disease.

Radiology and the law of negligence

Canadian law expects all persons to behave reasonably in all phases of their lives. An individual who behaves reasonably has nothing to fear from the courts. The determination of what constitutes reasonable behaviour in medicine involves a common-sense approach to the rights and responsibilities of medical and non-medical members of the community. Every day thousands of Canadians trust Canadian radiologists with their lives and livelihoods. That trust demand no less care than the courts ask for. The meeting of this standard requires constant attention. Where there is prudence, forethought, and a good patient-physician relationship, there should be few negligence suits.

The radiologist, the patient and Canadian law

A knowledge of basic medico-legal principles is necessary to the practice of medicine. The professional relationships with radiologists undertake with patients, employees, colleagues and hospitals are all founded on mutual consent and governed by a multitude of laws and regulations. The principal forms of legal proceedings which involve radiologists are criminal, civil and disciplinary actions. The discussion in this article is focused on the law relating to consent. The consent of the patient, which may be expressed or implied, is necessary in all phases of the doctor-patient reltionship. The amount of information which must be provided to allow a patient to give informed consent varies from case to case. It is affected by the risk and potential benefit of the procedure, the demand of the patient for information and many other factors. Obtaining informed consent not only helps protect the radiologist from legal action but also allows for a better doctor-patient relationship.

Separation of macromolecules in isotachophoresis systems involving single or multiple counterions

The isotachophoresis principle provides unique opportunities for rational designs of fractionation procedures involving molecules. Theoretically any two charged molecules that are soluble under the experimental conditions involved can be physically separated if their electrophoretic net mobilities differ only slightly in the electrophoresis medium used. A theoretical and practical outline is presented that enables the reader to set up this fractionation system and on a rational basis develop fractionationprocedures for a given set of charged macromolecules by isotachophoresis with simple and well characterized ampholytes as spacer substances. The planning of preparative experiments in this approach is based on results obtained from rapid analytical screens on a microgram scale. The report includes an appendix containing the theoretical basis for computation of buffer compositions in the isotachophoretic steady state with mono/polyvalent constituents in systems involving one or more counterions and controlled amounts of interfering ions.

Labeling of histamine H1-receptors in the brain of the living mouse

Labeling of cerebral H1-receptors is obtained following i.v. administration of [3H]mepyramine in tracer dose as shown by saturability, stereospecificity, regional distribution and pharmacological specificity. Cerebral H1-receptors are occupied following administration of most H1-antihistamines at low therapeutic dosage, which probably accounts for the sedative side-effects of these agents.

Effects of an insertion mutation in a locus affecting pyridine nucleotide transhydrogenase (pnt::Tn5) on the growth of Escherichia coli

The effects of a pnt::Tn5 insertion mutation on the growth of strains lacking phosphoglucoisomerase or glucose 6-phosphate dehydrogenase were examined. The results support the idea that the energy-linked transhydrogenase is an important source of reduced nicotinamide adenine dinucleotide phosphate for Escherichia coli under some conditions.

Therapeutic effect of tamoxifen related to estrogen receptor level

Cytoplasmic oestrogen receptor (ER) determinations were performed in 59 postmenopausal patients with metastatic breast cancer. Fifty percent of the patients were found to be ER+. Forty patients were treated with tamoxifen (TAM) and 19 patients were treated with tamoxifen plus medroxyprogesterone acetate (MPA). The response rate of TAM-treated patients was 30% (12/40). Of the 21 ER+ patients, ten (48%) responded to therapy. The ER values of these patients were significantly higher than the ER values of nonresponders (P less than 0.01). No correlation could be found between the ER value and the duration of remission in TAM-treated patients.

Acute non-lymphocytic leukemia in patients with ovarian carcinoma following long-term treatment with Treosulfan (= dihydroxybusulfan)

Acute non-lymphocytic leukemia occurred in eight women following long-term treatment with Treosulfan (= dihydroxybusulfan) for ovarian carcinoma. The leukemia developed from 21 to 58 months (median 50 months) after the institution of chemotherapy. At the time when the leukemia appeared seven of the patients were in complete, and one in partial, remission as regards the ovarian carcinoma. Seven of the eight cases of acute leukemia occurred in a series of 553 patients treated with Treosulfan for ovarian cancer in the period from 1970 to 1977 and followed closely for a total of 1159 patient-years up to February 1978. As compared with an expected number of 0.04 cases of acute myeloblastic leukemia based on patient-years, the observed seven cases correspond to a 175-times increased risk. Although the cumulative probability of acute non-lymphocytic leukemia among surviving patients at five years using life-table statistics was 7.6%, the survival curve for the 553 patients with ovarian carcinoma was only slightly affected by death from leukemia. The probability of developing acute leukemia in this study was not significantly correlated to the total cumulative dosage of Treosulfan. Cytogenetic studies of the bone marrow performed after the development of acute leukemia showed chromosome abnormalities in all five patients examined, with hypodiploidy and loss of B and C group chromosomes.

Genetic mapping of a mutation affecting pyridine nucleotide transhydrogenase in Escherichia coli

A mutation, pnt-1, causing loss of pyridine nucleotide transhydrogenase activity in Escherichia coli, was mapped by assaying for the enzyme in extracts of recombinant strains produced by conjugation, F-duction, and P1 transduction. The site of this mutation was near min 35, counterclockwise from man, and it co-transduced 59% with man. The mutation was associated with loss from the cell membrane fraction of energy-independent and adenosine 5'-triphosphate-dependent transhydrogenase activities, but reduced nicotinamide adenine dinucleotide dehydrogenase activity was not affected. Strains were constructed which lack phosphoglucoisomerase (pgi-2) and which carry either pnt+ or pnt-1. Although such strains, when grown on glucose, are expected to produce a large excess of reduced nicotinamide adenine dinucleotide phosphate, the growth rate was not affected by the pnt-1 allele.

Theophylline toxicity

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Therapeutic effect of tamoxifen versus tamoxifen combined with medroxyprogesterone acetate in advanced breast cancer in postmenopausal women

Postmenopausal patients, those less than 68 years of age resistant to chemotherapy and those greater than 68 years of age with or without resistance to chemotherapy, entered this trial. Among 101 eligible patients, 46 were randomized to treatment with tamoxifen at a dose of 10 mg 3 times daily and 55 were randomized to treatment with tamoxifen at a dose of 10 mg 3 times daily plus medroxyprogesterone acetate at a dose of 100 mg once daily. Remission (partial plus complete) was obtained in 20 patients (45%) with tamoxifen compared to 14 patients (26%) with tamoxifen plus medroxyprogesterone acetate; however, this difference is not significantly different. The median duration of remission was also not significantly different between the two treatments: 10 months for the single drug compared with 9 months for the combined treatment. Response rates correlated with the presence of estrogen receptor, with no differences between the two treatment groups. Side effects occurred in 12 patients and in only one patient did they cause discontinuation of treatment. In conclusion, these results and theoretic considerations indicate that combined treatment with tamoxifen and medroxyprogesterone acetate is not better than treatment with tamoxifen alone.

An assessment of the Alabama Smile Keeper school dental health education program

An evaluation of the Alabama Smile Keeper Dental Health Education Program was necessary to determine if educating teachers to teach preventive dentistry improved the oral hygiene and knowledge of dental health of elementary schoolchildren. Four hundred seventy-five students at the Maxwell Air Force Base elementary school in grades 1 through 6 were tested using a series of written examinations and scores from a plaque index (Greene's OHI-S Index) before and after the education program. Levels of plaque were significantly reduced immediately after instruction and retention test scores were significantly lower four months later than preinstruction test scores. Written examinations proved that knowledge increased immediately after instruction and retention test scores were significantly better than preinstruction test scores.

Synthesis and release of histamine studied on slices from rat hypothalamus

In slices from rat hypothalamus, incubated in the presence of 3H-L-histidine (3H-L-His), the aminoacid was rapidly taken up by a saturable process, and partially converted into 3H-histamine (3H-HA). The overall conversion was prevented either by inhibitors of L-histidine decarboxylase or by aromatic aminoacids competing with L-His uptake. The synthesis process exhibited Michaelis--Menten kinetics with an affinity of the aminoacid not different from that for the decarboxylase in homogenates; however the Vmax in homogenates was more than 10 times higher than in slices. Depolarization of the slices by 50 mM potassium resulted in: (a) a calcium-dependent release of 3H-HA which was more marked than that previously reported for endogenous HA, (b) a significant acceleration in the rate of 3H-HA synthesis, which was characterized by an unchanged Km but a significantly elevated Vmax. The regulation of HA synthesis did not appear to depend on end-product inhibition since it was not midified by the addition of exogenous HA. The release of 3H-HA was followed by the accumulation of 3H-methylhistamine, which was enhanced by a monoamine oxidase inhibitor. Aminoguanidine, a diamine oxidase inhibitor, had no effect on catabolism. The involvement of mast-cells in the storage of a fraction of endogenous HA in hypothalamic slices was assessed by the significant releasing effect of compound 48/80. Hence, the data support the existence of two distinct HA stores in the brain: depolarization relases the amine and increases its synthesis, probably in neurones, whereas compound 48/80 releases it from a slowly turning-over store, probably in mast-cells.

A DICEPHALOUS FOETUS

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