Role and mechanism of action of tamoxifen in premenopausal women with metastatic breast carcinoma

Tamoxifen was evaluated as initial hormone therapy for metastatic breast cancer in 85 premenopausal patients. Tamoxifen responders continued on tamoxifen, while tamoxifen failures and initial responders who later progressed were to receive ovarian ablation next. Of 74 evaluable patients, 5 had complete responses (CR) and 15 had partial responses (PR) while 12 remained stable (ST), giving response rates of 27% (CR + PR) or 43% (CR + PR + ST). Of the 23 patients who initially responded (CR + PR + ST) to tamoxifen but then progressed and received ovarian ablation alone, 15 are assessable. Nine (60%) responded (CR + PR + ST) to ovarian ablation. Sixteen patients who failed tamoxifen had ovarian ablation alone, and of 14 assessable patients 2 had ST while 12 progressed. Thus response to tamoxifen strongly predicted response to ovarian ablation (P = 0.021). Serial follicle stimulating hormone, prolactin, and estradiol levels suggested that tamoxifen does not act by induction of a "medical ovariectomy" or by alteration of prolactin levels in premenopausal patients.

Exercise electrocardiographic mapping in normal subjects

To investigate the spectrum of change in multiple-lead exercise electrocardiograms, 120-lead body surface potential maps (BSPM) in normal adult subjects during upright, graded, submaximal exercise testing were recorded. Results showed that in the normal group, exercise was associated with substantial electrocardiographic changes on the body surface, many of which persisted during early recovery. The QRS waveform was minimally altered during exercise. Despite, however, no change in QRS duration, there was significant reduction in QRS potential range with consequent reduction QRS integral value. The ST waveforms changed markedly with exercise, showing abbreviated duration and increased slope. This was reflected by significantly increased ST potential range from rest to immediate cessation of exercise, which returned towards resting value during recovery. The effect of the altered ST-segment waveform was also reflected in torso potential distributions at two time instants during the ST-segment. When a spatially-fixed position on the ST-T waveform was evaluated (ST-segment offset), exercise resulted in small potential changes, especially over the torso area occupied by the standard V1 to V6 chest leads. However, when a temporally-fixed point (80 ms after QRS offset) was evaluated, there were large increases in potential over the precordium with exercise. Isointegral ST-segment maps, which reflect both spatial and temporal ST properties, showed that exercise was associated with substantial decreases in values over the precordium and inferior torso, and although diminished, they tended to persist through five minutes of recovery. Thus, electrocardiographic repolarization parameters are particularly affected by physiological exercise and, although the underlying causes of these changes remain undefined, they should be taken into account when evaluating the population at risk.

The effect of caffeine on cardiac rate, rhythm, and ventricular repolarization. Analysis of 18 normal subjects and 18 patients with primary ventricular dysrhythmia

To determine clinical electrophysiologic effects of a moderate dose of caffeine, we compared prevailing cardiac rhythm and rate, the prevalence and frequency of ventricular dysrhythmia, and Q-T intervals in two populations over an initial 24-hour caffeine-free period and a subsequent 24-hour period in which caffeine was ingested in a dosage of 1 mg/kg of body weight at intervals of one half-life during waking hours. Group 1 was composed of 18 clinically normal subjects; group 2 was 18 subjects with frequent ventricular ectopic beats (VEBs) and no (n = 16) or minor (n = 2) cardiac disease. Sinus rhythm was the prevailing rhythm in all subjects at all times. For group 1, the mean sinus rate during the caffeine-free period was 77 +/- 10 beats per minute, compared to 73 +/- 9 beats per minute during the period of caffeine ingestion (not significant). Similarly, for group 2, the average sinus rate during the caffeine-free period was 76 +/- 11 beats per minute, not significantly different from the average sinus rate during the test period, 76 +/- 10 beats per minute. During abstention from caffeine, four of 18 subjects in group 1 had infrequent (less than 1/hr) VEBs, compared to nine of 18 during caffeine ingestion (not significant). In group 2, some 16 of the 18 subjects had VEBs during the caffeine-free period, with the frequencies varying from less than one VEB per hour to 1,449 VEBs per hour. During the test period, 14 of the 18 subjects in group 2 increased their VEB frequency, and the group's mean frequency rose from 207 +/- 350 VEBs per hour (control period) to 307 +/- 414 VEBs per hour (test period) (p less than 0.01). The Q-T interval in group 1, measured as the corrected Q-T interval (Q-Tc), averaged 0.430 +/- 0.027 during the caffeine-free period, not significantly different from the test period (0.425 +/- 0.019). The comparable Q-Tc values for group 2 were 0.424 +/- 0.018 during the caffeine-free period and 0.433 +/- 0.025 for the period of caffeine ingestion (not significant).(ABSTRACT TRUNCATED AT 400 WORDS)

Inter-laboratory quality control of estrogen and progesterone receptor assays in breast cancer tissue using lyophilised cytosols

In 1981 a quality control (QC) program for estrogen and progesterone receptor assays was organized among six laboratories in Ontario, Canada. Twenty-three vials of lyophilised cytosol prepared from human breast tumor tissues were analysed by each laboratory over a two-year period. Samples of each batch of QC material were analysed at least twice: either in the same batch or on separate occasions. The present study demonstrates the stability of the QC material, defines the relative accuracy of the receptor assays, and provides estimates of within-batch and between-batch precision of the receptor assays.

Clinical observations on the response of equine hoof defects to dietary supplementation with biotin

Horses with weak hoof horn, which becomes misshapen and crumbles around the lower parts of the hoof walls, pose problems for treatment in practice. The effects of dietary supplementation with a high level of the B-group vitamin biotin (which has proved successful in the treatment of the similar condition in pigs) were investigated in more than 40 cases. Varying degrees of improvement in the hardness, integrity and conformation of the hoof horn were observed in all cases. The signs and progress seen in three typical cases are described. It is concluded that dietary supplementation with 10 to 30 mg biotin/day (depending on bodyweight) for not less than six to nine months is a useful treatment to support other remedial measures in such cases.

Body weight and prognosis in breast cancer

We have examined the relationship between risk factors for breast cancer incidence and the subsequent prognosis of breast cancer among patients in a randomized controlled trial of adjuvant ovarian ablation. Body weight was the only risk factor found to be associated with statistically significant differences in survival. This finding could not be explained by a disproportionate number of anatomically more advanced tumors in the heavier women. In premenopausal women aged 45 years or more, the only group to benefit from adjuvant ovarian ablation, there was an interaction of treatment and weight, suggesting that weight exerts its influence on prognosis by a hormonal mechanism. The prognostic effect of weight was generally most marked in patients with tumors whose prognostic characteristics were favorable, and in these patients weight loss as an adjuvant treatment may reduce the frequency of disease recurrence.

Distribution of heavy metals and radionuclides in sediments, water, and fish in an area of Great Bear Lake contaminated with mine wastes

The concentrations of heavy metals and radionuclides in the sediments and water of Great Bear Lake were determined during 1978 near an operating silver mine and an abandoned uranium mine. Additional information on the level of mercury in fish tissues were also collected. The mines, situated on the same site, deposited tailings and other waste material directly into the lake. The concentrations of mercury, lead, manganese, and nickel in the sediments were highest near the tailings deposit and decreased significantly as the distance from the mine increased. Although there were also significant positive correlations between these metals and the organic content of the sediments, water depth and slope of the bottom had no impact on metal distribution. Since the concentrations of arsenic, cobalt, copper, 226radium, 210lead and 230thorium varied inconsistently throughout the study area, the distribution of these substances could not be related to any of the environmental factors that were measured. There were, however, significant negative correlations between the concentrations of 232thorium and 228thorium and distance from the mine and organic content of the sediments. Heavy metal and radionuclide levels in water were generally below detectable limits, reflecting the strong chemical bonding characteristics of the sediments. The low concentrations of mercury in the tissues of lake trout Salvelinus namaycush were probably related to low uptake rates and the ability of this species to move into uncontaminated areas of the lake.

Chemotherapy for adenocystic carcinoma

Seventeen patients with adenocystic carcinoma have received 34 adequate trials of chemotherapy at Princess Margaret Hospital since 1969. There have been five objective responses to chemotherapy in 4 cases, lasting from five to 24 months, and 3 other patients have had stabilized disease for a period of five to seven months. Responding and stabilized patients all had symptomatic improvement. Most responses were to 5-fluorouracil, the preferred drug for initial treatment of metastatic disease or locoregional disease that cannot be controlled by means of surgery or radiation therapy.

Tamoxifen therapy in premenopausal patients with metastatic breast cancer

Tamoxifen was evaluated in a phase II trial as initial hormonal therapy in premenopausal patients with metastatic breast cancer. The study design was such that responders remained on tamoxifen therapy; those who initially or subsequently progressed went on to ovarian ablation either by surgery or irradiation. Of 42 evaluable patients treated with tamoxifen, three had complete responses (CR), ten had partial responses (PR), and four remained stable (ST), giving total response rates of 32% (CR + PR) or 41% (CR + PR + ST). Among the 18 patients with positive estrogen (ER) or progesterone (PgR) receptors, there were eight responders, but only one responder (ST) in the nine patients with negative ER or PgR. Of the 25 patients who failed to respond to tamoxifen, 13 underwent ovarian ablation; all failed to respond. These 13 included four patients who were ER positive or equivocal and PgR positive or unknown. Nine tamoxifen responders (CR + PR + ST) have subsequently progressed; of these, eight have gone on to ovarian ablation. Six of these eight have responded (five PR and one ST) to ovarian ablation, and one has failed to respond. Thus, steroid receptors generally predicted a patient's response to tamoxifen therapy, but response to tamoxifen also strongly predicted a patient's subsequent response to ovarian ablation.

Plasminogen-activating activity: association with steroid binding by cytosols of human breast cancers

Plasminogen-activating activity (PAA) was determined on cytosols prepared from human breast cancers. Coincident assays of steroid-binding proteins were obtained for 119 patients. Significant positive correlations were found between PAA and binding of: 1) estrogen (P less than 0.01), 2) progestin (P less than 0.001), and 3) triamcinolone (P = 0.01). Stepwise regression analysis indicated that variations in the levels of progestin binding accounted for 17% (P less than 0.01) and variations in the levels of triamcinolone binding for 3% (P = 0.05) of the variation observed in PAA. Use of the median value of each assay to discriminate positive from negative values accentuated the positive correlation between PAA and binding of 1) estrogen (P = 3.9 X 10(-5), 2) progestin (P = 1.9 X 10(-4), and 3) triamcinolone (P = 6.1 X 10(-5). Preliminary results suggested that values of PAA equal to or greater than the median correlated positively with response to treatment by hormone manipulation (P = 0.0549). Possible significance of these observations was discussed.

Carcinoembryonic antigen in breast cancer

Carcinoembryonic antigen (CEA) levels were determined in 742 postoperative patients with breast cancer. Within this group the percentage of elevated (greater than or equal to 4.0 ng/ml) assays increased with UICC clinical stage and was 14.8% (12/81), 23.7% (27/114), 73.1% (190/260) and 20.0% (49/245) for stages I, II, III, IV and X (unstagable due to insufficient data) patients. We have now followed the above 482 stages I, II, III and X patients in whom CEA was performed less than or equal to 3 months after initial surgery at a time when there was no evidence of residual disease, for an average interval of 255 days from date of diagnosis. At present 16.2% (17/105) of patients with elevated CEA values compared to only 4.8% (18/377) of patients with normal values have developed recurrent disease (p less than .0005). There is an association of elevation of CEA postoperatively with different clinical stages of breast cancer. Elevated CEA levels postoperatively are associated with an increased risk of development of recurrent disease in breast cancer patients.

Rapid assays for evaluating the drug sensitivity of tumor cells

Assays that assess the ability of cells to incorporate labeled precursors into acid-precipitable material in the presence of adriamycin, daunorubicin, puromycin, vinblastine, melphalan, or methotrexate were investigated as an approach to the detection of resistant cells in human tumor samples. Each assay was evaluated with suitable drug-resistant Chinese hamster ovary cell lines and normal human fibroblasts to determine whether the assays reflected the drug sensitivity of these lines. Moreover, the ability to detect the presence of drug-resistance cells in a mixed population was evaluated. Validated assays were then used to measure the drug sensitivity of cell samples from pleural and peritoneal effusions of patients, mainly with carcinoma of the breast or ovary. Though the responsiveness of the majority of the samples in these assays was similar to that of a human fetal lung fibroblast line, 37 of 142 samples displayed responses consistent with the presence of a significant proportion of drug-resistant cells. Of these 37 nonresponsive samples, 12 displayed nonresponsiveness to three drugs.

Uptake of the mosquito larvicide Temefos by the salt marsh snail, New Jersey--1973-1974

Uptake of the mosquito larvicide temefos (Abate) by the salt march snail (Melampus bidentatus Say) in New Jersey was measured by gas-chromatographic analysis. Measurable quantities of temefos were found in the snails within 1 day after the first treatment with a 2% granular formulation but 3 weeks elapsed before uptake occurred following treatment with a temefos emulsion. Residues in the snails exposed to the granular formulation were generally more than 10 times higher than those in snails exposed to the emulsion although application rates of the granular formulation were only about three times higher than those of the emulsion. Residues in snails exposed to the emulsion fell below detectable levels less than 3 weeks after cessation of treatments although measurable amounts were found in snails exposed to the granular formulation for more than 5 weeks after the last treatment. The persistence of temefos in M. bidentatus suggests the potential for its movement through food webs exposed to the granular formulation.

Androgen-dependent fibrinolytic activity in a murine mammary carcinoma (Shionogi SC-115 cells) in vitro

Physiological concentrations of dihydrotestosterone (DHT) can specifically induce the release of fibrinolysin from androgen-dependent mammary carcinoma (Shionogi SC-115) cells in vitro. No fibrinolytic activity was observed in cells cultured either in the absence of DHT or presence of pharmacological concentrations of estrogen. Furthermore, an autonomous tumor derived from the Shionogi SC-115 cells produced fibrinolytic activity independent of added DHT or estrogen. These observations suggest a close correlation between fibrinolytic activity of a tumor and its ability to grow in vivo.

Androgen receptors: relationship to growth response and to intracellular androgen transport in nine variant lines of the Shionogi mouse mammary carcinoma

Aspects of the biological significance of androgen receptors have been studied in nine variant lines of the Shionogi carcinoma, two of which are androgen dependent and seven of which are autonomous. The dependent lines, and two of the seven autonomous lines, contain androgen receptors; this finding demonstrates that the presence of receptors is not an accurate marker of hormonal dependence in vivo. Since the ability to transport androgens into the nucleus, as judged from the relative maximal rates of transport, is virtually restricted to dependent and autonomous lines which possess cytoplasmic receptors, it is clear that such receptors may play a role in regulating the intranuclear concentration of androgens. The absence of cytoplasmic receptors and the comparative lack of perceptible transfer of androgens across the nuclear membrane are features peculiar to the autonomous condition.

The influence of testosterone on the endogenous levels of prostaglandin F in the accessory reproductive glands of the adult male rat

Orchidectomy increased the endogenous concentration of prostaglandin F (PGF) in the prostatic and vesicular glands of adult rats. A single intramuscular dose of free testosterone (5.0 mg/100 g) was able to reverse the effects of castration on PGF concentration of the accessory reproductive organs. In the case of seminal vesicles, administration of testosterone to castrate rats markedly reduced the PGF levels within 144 h of hormone treatment.

Persistence of cadmium-induced metabolic changes in liver and kidney

Daily intraperitoneal injection of cadmium chloride (1 milligram per kilogram) for 45 days enhanced gluconeogenesis as evidenced by significant increases in the activities of liver and kidney cortex pyruvate carboxylase, phosphopyruvate carboxylase, hexosediphosphatase, and glucose-6-phosphatase, the quartet of key, rate-limiting enzymes involved in the biotransformation of noncarbohydrate precursors into glucose. Whereas cadmium treatment decreased the level of hepatic glycogen, the concentration of blood glucose and urea was significantly elevated by this heavy metal. Discontinuation of the heavy metal treatment for 28 days, in rats previously injected with cadmium for 45 days, failed to restore the observed biochemical alterations in hepatic and renal carbohydrate metabolism to control values. Evidence indicates that cadmium augments the glucose-synthesizing capacity of liver and kidney cortex and that various metabolic changes persist even after a 4-week period of withdrawal from exposure to the heavy metal.