[Compliance and long-term prognosis in hypertensive patients. Case series in a specialized hospital outpatient service]

In this study of ambulatory patients who had their first visit at the hypertension Unit of the Ospedale San Carlo Borromeo in Milan during the years 1979-1983, we report some data regarding compliance and long-term prognosis of mild hypertension. In these 5 years, 445 mild hypertensives (mean DBP: 103.3 +/- 13.2 mmHg) came to our facilities at least once: of these, 57 (12.9%) have been in constant touch with the outpatient clinic until today; 310 (69.6%) have been lost to follow-up after less than 1 year; 78 (17.5%) had an irregular pattern of attendance with a mean length of follow-up of 3.49 +/- 1.8 years. These data indicate a less than ideal compliance especially for patients who were older, smokers, not married and with no previous pharmacological treatment at the first visit. Index of morbidity and mortality for all causes and for cardiovascular disease and blood pressure control were better, although without reaching statistical significance, in the 57 patients with the best compliance. Altogether our data point to a reevaluation of the approach to the problem of mild hypertension through specialised hospital facilities.

Effects of daylength on androgen metabolism and pulsatile luteinizing hormone secretion in male golden hamsters

In an effort to understand the potential neuroendocrine mechanisms underlying photoperiodic control of fertility in seasonally breeding species, we monitored the intracellular processing and nuclear uptake of [1 alpha, 2 alpha-3H]testosterone (3H-T) within the brain-pituitary complex as well as the patterns of episodic luteinizing hormone (LH) secretion in male golden hamsters exposed to long day (14 h light:10 h dark) and short day (10 h light:14 h dark) photoperiods. Target tissue specific patterns of nuclear 3H-androgens and estrogens were observed in castrated, T-replaced hamsters exposed to long and short days for 7 weeks or longer. Significantly, 3H-T metabolism or receptor-mediated nuclear uptake in the hamsters in short days was not influenced in any manner that would explain their increased responsiveness to androgen feedback suppression of LH release. Comparable patterns of episodic LH secretion were observed in acutely catheterized hamsters castrated for 7 weeks prior to exposure to 8 weeks of long or short days. Similar patterns were also observed in animals maintained in long days and castrated 1 or 2 weeks prior to blood collection. However, such a pattern was not seen in acutely castrated hamsters maintained in the short-day photoperiod. The data suggest that steroid-independent mechanisms play an important role in suppressing gonadotropin release in short days in this species. However, such mechanisms appear to be most effective when the animals are or have recently been exposed to circulating androgens.

Comparison of immunochemical and radioligand binding assays for estrogen receptors in human breast tumors

We have compared a new enzyme immunoassay (EIA) for estrogen receptors (ER) with our conventional radioligand binding assays (multipoint dextran-coated charcoal assay for cytoplasmic ER and hydroxylapatite exchange assay for nuclear ER). Cytoplasmic ERs were measured in 76 human breast cancer specimens by EIA and by five-point Scatchard analysis. The correlation between the two assays yielded a straight line with a slope of 0.92 (r = 0.95; P less than 0.001); conversely, in 31 nuclear salt extracts, linear regression analysis of hydroxylapatite exchange assay data with EIA showed a clear correlation (r = 0.93; P less than 0.001) but a slope of 1.7, demonstrating that EIA detects more ER sites. The binding of the antibody to the cytoplasmic ER molecules was investigated by sucrose density gradient analysis, which showed that EIA recognizes both cytoplasmic forms (9 and 3S), but does not distinguish between them. Advantages and drawbacks of this method are discussed with respect to its application for routine receptor determination for clinical management of breast cancer patients.

Relationship between ER-ICA and conventional steroid receptor assays in human breast cancer

We applied a new immunocytochemical assay for estrogen receptors (ER-ICA) to 82 human breast tumors. Results were correlated with cytosolic estrogen receptors (ERc) and nuclear ER (ERn) determined on the same sample respectively by the radioligand binding assay and by an ER enzyme immunoassay (ER-EIA). All ER-ICA-positive tumors contained more than 10 fmol/mg of protein of ERc and were therefore considered as ERc positive. In contrast, 15.4% of ERc-positive cases were ER-ICA negative. Comparison of ER-ICA results with ERn showed extensive agreement of negativity (92%), whereas 38% of ER-ICA-positive tumors were ER-EIA negative. However, the latter had ERc levels above the positivity threshold. Quantitative features of the immunocytochemical staining such as intensity and percentage of labelled cells, considered separately, did not reflect the amount of ERc or ERn. Cellularity was not significantly correlated with ER-ICA and biochemical results.

Adjuvant medroxyprogesterone acetate and steroid hormone receptors in category M0 renal cell carcinoma. An interim report of a prospective randomized study

From July 1, 1979 to June 30, 1983, 136 consecutive patients with category M0 renal cell cancer who had undergone transperitoneal radical nephrectomy at 5 centers entered a prospective randomized trial to compare 500 mg. adjuvant medroxyprogesterone 3 times a week for 1 year to no treatment. Sex steroid hormone receptors also were studied in the renal tumor and in the surrounding healthy parenchyma with the dextran-coated charcoal technique. After a median followup period of 3 years (range 13 to 60 months) 30 of 121 evaluable patients (24.8 per cent) experienced relapse, usually in the lung or bones. Relapses occurred in 15 of 58 evaluable patients in the adjuvant treatment group (25.8 per cent) and 15 of 63 evaluable controls (23.8 per cent). The disease recurred more frequently (35.1 per cent) in the 57 patients with no receptors in the tumor than in the 45 with at least 1 receptor (17.8 per cent). These results were independent of adjuvant therapy. After a median 3-year followup, adjuvant medroxyprogesterone acetate was of no therapeutic benefit in patients who had undergone radical nephrectomy and the side effects of the therapy were evident in more than 50 per cent of the patients.

Effect of medroxyprogesterone acetate on the growth of mouse transplanted tumors: relation with hormone sensitivity

The effect of high and low doses of medroxyprogesterone acetate (MPA) was investigated on three transplanted murine tumors (MXT mammary carcinoma, colon 38, and colon 26) in relation to receptor status and sensitivity of the tumors to ovariectomy and treatment with dexamethasone. MPA had no inhibitory activity on the growth of these tumors. It had no effect on the ovarian-sensitive MXT tumor; it significantly enhanced the growth of an MXT tumor line, selected through serial transplantations, which was stimulated also in ovariectomized animals. MPA, as well as ovariectomy, stimulated the growth of the colon 38 tumor, but this hormone sensitivity was lost during serial transplantations. No correlation was found between the effects of MPA and ovariectomy and the steroid receptor status of these tumors. MPA effects on these tumors do not seem contingent upon a glucocorticoid-like action since dexamethasone was highly effective on all the tested tumors. The combined treatment of the colon 26 tumor with a cytotoxic drug, 4'-deoxydoxorubicin, and MPA, which administered alone stimulated tumor growth and increased life span, caused a slight increase in the life span compared to single agents alone.

Steroid hormone receptors in normal and malignant human renal tissue: relationship with progestin therapy

Documented hormone dependence of renal tumors in animal models, hypothetical hormonal environment of human kidney neoplasms and their controversial response to endocrine therapy prompted us to undertake a prospective multicentric cooperative study to evaluate the hormone-dependence/responsiveness of renal tumors. Patients with renal carcinoma were stratified according to the TNM classification and after nephrectomy were treated with high-dose medroxyprogesterone acetate (MPA). Specimens of tumor and healthy surrounding kidney tissue were studied for titration of steroid receptor proteins (78 for androgen, AR, 89 for estrogen, ER, and progestin, PgR). Their true receptor nature was estimated. Very low titers (on an average less than 10 fmol/mg protein) were found, especially for ER and PgR in neoplastic samples. Occurrence rate of AR was low for both tissues (less than 20%), whereas ER and PgR were detected at a higher frequency in healthy parenchyma than in tumor tissue (42.2 vs 23.3% and 30.7 vs 11.2%, respectively). AR was moderately affected by metastatic status of the disease and by sex. All three steroid receptors were simultaneously detected in normal tissue in 11.7% of cases and in tumor tissue in only 3.8%. No significant correlation between receptor status in the tumor and clinical response to hormone therapy was found. In 27 cases who received adjuvant MPA therapy, relapses were respectively 43.8 and 18.2% in the patients with negative receptors or with at least one detectable receptor. In metastatic renal carcinoma, stabilization of the disease with MPA was achieved more frequently in receptor-negative patients. Therefore, we conclude that the receptor assay is not a valid tool to select renal carcinoma patients for therapy with MPA.

Adjunctive medroxyprogesterone acetate to radical nephrectomy in category M0 renal cell carcinoma. Preliminary report of a prospective randomized trial

From July 1979 to December 1981, 83 patients from 6 centers in the Lombardy underwent radical nephrectomy for category M0 renal cell carcinoma. Postoperatively they were randomly allocated to adjunctive medroxyprogesterone acetate (MPA) or to a control group. After the first year of follow-up, the relapse rate was 13% in the controls (5 of 38 evaluable patients) versus 28% in the MPA treatment group (9 of 32). Sex steroid receptors were studied in both the tumor and in the surrounding healthy parenchyma by the dextran-coated charcoal technique in 52 of 70 clinically evaluable patients. There was no significant correlation between receptor studies and the relapse rate. Besides, receptors were more often detected in the healthy than in the neoplastic tissue, and values rarely exceeded 10 fmol/mg protein. Due to the negative trend in the MPA treatment group, the admittance of patients to this study was stopped after 120 patients had been accepted.

Estrogen receptors in renal carcinoma

The presence of estrogen receptors was determined in 31 cases of renal carcinoma by use of the charcoal absorption technique. In 26 of these cases, the 'normal' counterpart of the same kidney was also studied. In 13 normal and in 19 neoplastic samples, the values were undetectable; in the other cases, the values were very low. Progesterone and dihydrotestosterone receptors were also studied in four cses (both normal and neoplastic tissue) by use of a gel-filtration assay: all the samples were negative. These findings do not support the presence of significant amounts of estrogen receptors in kidney carcinoma.

An assay for estradiol preceptors using a staphylococcal protein-A--estradiol antibody adsorbent

Antiestradiol antisera were raised in rabbits by immunization with a steroid-protein conjugate Whole antisera and purified antiestradiol antibodies were reacted with heat-killed and formalin-fixed bacteria from the protein-A-bearing strain of Staphilococcus aureus (Cowan I, NCTC 8530). The bacterial immunoadsorbent was used to estimate the estrogen-receptor proteins contained in several specimens from human breast carcinoma. Since the affinity constant for estradiol of antiestradiol antibodies is about 10(8) M-1 while those for breast estrogen-receptor complexes are about 10(9) to 10(10) M-1, it is possible to remove the free steroid from a reaction mixture containing tissue cytosol, radio-labelled estradiol, and the antiestradiol bacterial adsorbent by pelleting the bacteria at low-speed centrifugation. The radiolabelled estradiol molecules bound to their receptors remain in the supernatant and can be easily counted by liquid scintillation counting. The results obtained by this technique on specimens of human breast carcinomas compared more than satisfactorily with those obtained, on separated aliquots from the same specmens, by the dextran-coated charcoal method, according to the EORTC group (1973). The versatility, specificity and stability of the antiestradiol bacterial immunoadsorbent recommend its use, rather than that of charcoal-coated dextran and other non-specific steroid adsorbents, in the mass screening of patients with breast carcinoma which could be amenable to hormonal therapy.

Evaluation of cardiac activity and pharmacokinetic analysis of 3H-adriamycin in patients pretreated with beta-methyldigoxin

The consequences at the cardiac level of adriamycin treatment alone or in association with the cardiac glycoside beta-methyldigoxin, were evaluated with reference to the PEP/LVET ratio, heart rate, and minimum blood pressure. The variation usually seen in the PEP/LVET ratio when adriamycin is administered alone was not observed when pretreatment with beta-methyldigoxin was also given. A similar situation is found with variations in blood pressure and heart rate. From a pharmacokinetic point of view, this treatment scheme does not seem to affect the general behavior of the antibiotic.

[Critical observations on changes in gamma-glutamyl-transpepdidase in hepatopathies]

The behaviour of gamma-glutamyl transpeptidase was compared with other serum enzyme activities and functional parameters in a carefully selected and relatively extensive series of patients with liver disease, including alcoholics, in an investigation of the underlying pathogenesis and its clinical expression. Reference. to the literature and to personal data showed that increased gamma-glutamyl transpeptidase levels could be attributed to enzyme induction (caused by drugs or alcohol), liver damage in the broad sense, and intra- or extrahepatic cholestasis. These causes were individually predominant, or nearly so, on occasions, though their concomitance was more common. High levels, however, were not pathognomonic for a given disease. In alcoholism, they were highly indicative, especially if accompanied by GLD changes. They were a virtually constant, early, and typical finding in intra- and extra-hepatic cholestasis, and tended to persist for a time after the resolution of icterus. Lastly, they were an aid in the early diagnosis of aggressive hepatitis and liver cancer.