Accumulation of hexachlorobenzene in humans: a long standing risk

1. Hexachlorobenzene (HCB) internal dose in the general population of Barcelona (Spain) was estimated after new indications of the carcinogenicity of this chemical in humans were recently reported. Hospital blood bank facilities and randomly selected volunteers were used for HCB analyses in serum (n = 100) and cerumen (n = 25). Other main organochlorine residues often found in human tissues and blood (pp DDE, beta-HCH,) were also determined. 2. HCB serum levels currently found (Range 0.7-19.7 ng Ml-1; X +/- s.d.: 4.13 +/- 3.61; GM: 3.05) were compared to those found in a similar survey made in 1986 on the same population. The serum HCB levels showed a significant decrease (P < 0.001) when compared to the former results and correlated with age (P < 0.001) suggesting a progressive preponderance of a stable blood-adipose equilibrium with fewer variations due to recent and variable intake of the chemical. 3. Cerumen analyses revealed detectable concentrations of HCB in all samples (Range: 160-4790 ng g-1 in extractable lipid basis) and confirmed the suitability of this matrix to assess the body burden of residues accumulated in adipose and lipid-rich tissues. The set of results shows that, although HCB exposure has been reduced, the overall population under study still accumulates significant amounts of this possible carcinogen.

Haloperidol: therapeutic window in schizophrenia

Twenty-two schizophrenic inpatients were treated for 3 weeks with three randomly fixed oral doses of haloperidol (10, 20, or 30 mg). Analysis of the results by a nonlinear regression model revealed a curvilinear relationship between haloperidol levels in plasma and clinical response, as assessed on the Brief Psychiatric Rating Scale (pseudo-R2 = 0.85, F = 17.7, p < 0.001, correlation between coefficients ranged from 0.99 to -0.52). This curve defines roughly three drug level ranges (low, < 5.5 ng/ml; optimal, 5.5 to 14.4 ng/ml; and high or toxic, > 14.4 ng/ml), which are significant for clinical practice. Patients with high levels improve to a lesser extent or even worsen in negative symptoms, showing a nonstatistically significant trend to present more extrapyramidal symptoms. Our data thus support the existence of a therapeutic window for haloperidol. Schizophrenic patients with acute exacerbation and drug levels in this range would have a greater probability of global clinical improvement.

Primary central nervous system malignant non-Hodgkin's lymphomas from HIV-infected and non-infected patients: expression of cellular surface proteins and Epstein-Barr viral markers

The increased incidence of primary central nervous system malignant non-Hodgkin's lymphomas (PCNSL) in HIV- and non-HIV-infected patients and the demonstration of Epstein-Barr virus (EBV) in these tumours may indicate relationships between PCNSL and EBV. Consequently expression of EBV-induced antigens and cellular markers were studied in 11 HIV-infected and seven non-infected patients by in situ hybridization (ISH) and immunocytochemistry in monoclonal B cell PCNSL. In HIV-infected patients EBV genome was present in 9/11 cases, LMP in 11/11 cases and EBNA2 in 10/11 cases. The expression of adhesion and activation molecules was low or absent. In HIV non-infected patients, EBV genome was present in 5/7 cases, with LMP in 4/7 cases. EBNA2 was never detected. All these lymphomas expressed LFA1beta. Whatever the population, no lytic cycle EBV markers were detected. Compared with other types of EBV lymphomas, our results suggest a different EBV latency state in primary B cell lymphomas of the CNS from HIV-infected or non-infected patients.

Positive versus negative symptoms in schizophrenia: response to haloperidol

1. Clinical response to treatment with haloperidol was studied in 20 schizophrenic inpatients with acute exacerbation (DSM-IIIR). 2. Patients were assigned to fixed doses of haloperidol (10, 20 or 30 mg/day) for three weeks. Clinical assessment was made using scales SAPS, SANS, BPRS and Simpson-Angus Scale for rating of extrapyramidal side effects. 3. Sixteen patients showed forty per cent or more decrease in positive symptoms assessed by SAPS, being considered the group of responders. Six out of the twenty patients showed improvement in negative symptoms assessed by SANS (improvement above 30%). 4. Clinical predictors of response were only identified for SAPS. The group of responders showed higher basal scores in total scale and formal thought disorder. 5. Negative symptoms responsive to treatment were affective flattening and alogia. Improvement in negative symptoms was independent from that in positive ones. 6. Socio-demographic predictors of clinical response were not found. No differences in clinical response were found in relation to the dose administered. 7. The results of our study suggest that negative symptomatology improves in a scheduled treatment with haloperidol. Assessment of negative symptoms may be useful in the evaluation of treatment of acute schizophrenia.

Sequential identification of factors predicting distant relapse in breast cancer patients treated by conservative surgery

BACKGROUND AND METHODS

Predictors of distant relapse following conservative surgery for breast cancer were studied in a review of 425 women. Five steps of breast cancer patient management were defined in which increasing amounts of information, potentially relevant to prognosis for metastasis-free survival (MFS), were available: (1) clinical, (2) biopsy, (3) tumorectomy, (4) axillary dissection, and (5) adjuvant treatment. At each step, a prognosis study based on the Cox model was carried out using all acquired information from the first step.

RESULTS

Among the 21 studied variables, 5 were independent stable risk factors in predicting MFS: (1) clinical node status, (2) modified Scarff-Bloom-Richardson (MSBR) histoprognostic grade, (3) progesterone receptor (PR), (4) anatomic tumor size, and (5) histologic lymph node status. These factors were progressively identified throughout the successive prognostic analyses and kept their significance at the reference step (axillary dissection step where all information is acquired). According to the prognostic score based on the significant variables, a stratification of the patients had been built at each step, identifying three risk groups (low, moderate, high). Even at biopsy step, the mere knowledge of clinical information, such as clinical node status, and biopsy information, such as MSBR grade and PR status, would enable 68% of the patient to be well classified according to the stratification of reference. Knowledge of an additional factor, such as anatomic tumor size, would bring the rate up to 88%. Some subsets of patients with stable prognosis throughout the steps were identified and their profiles were described. It is noticeable that 95% of the patients, classified low risk at the biopsy step, were patients that were stable.

CONCLUSIONS

The early recognition of patients, highly curable by local therapy alone, would obviate aleatoric neoadjuvant treatment.

Ultrastructural study of mouse thymus virus replication

With the exception of thymocytes, no other cell types have been reported to be involved in mouse thymus virus (MTV) infection. The ultrastructure of thymuses of mice infected with MTV were examined. The earliest sign of infection was detected 5 days p.i.; lymphocytes, epithelial and phagocytic (macrophages) reticular cells were shown to be affected. Viral particles and filamentous structures were present in both the nucleus and the cytoplasm of these cells. At more severe stages of cellular necrosis, 6 and 7 days p.i., cytoplasmic granulation as well as loss in definition of cytoplasmic organelles became apparent. This was followed by nuclear degradation and aggregation of cells. After 9 days p.i. necrotic lesions were still observed but viral particles were no longer detectable. This study provides evidence of the susceptibility of macrophages to MTV.

Multiparametric prognostic evaluation of biological factors in primary breast cancer

BACKGROUND

An array of biological features related to tumor cell differentiation status, growth rate, and invasive potential have been identified as potential prognostic factors in breast cancer. We were interested in determining their relative importance in predicting patient survival.

PURPOSE

We evaluated the relative weight of the following four biological factors in predicting survival of patients with breast cancer: tumor cell DNA content (determined by flow cytometry), tumor cell proliferation rate (determined by thymidine kinase activity), expression levels of cathepsin D and urokinase plasminogen activator, and several "classical" clinical and histological factors.

METHODS

Selected from a prospectively updated database, the study population consisted of 319 primary breast cancer patients who received treatment and follow-up care (median, 6 years) in the Centre René Huguenin. To determine the profile of biological factors for each patient, we used frozen tumor specimens and (except for the flow cytometric DNA content assay) commercially available assay kits. We determined by Cox multivariate analysis the relationships of the biological factors to each other, to classical prognostic factors, and to disease-free and metastasis-free survival.

RESULTS

In the overall population, disease-free survival was best predicted by node status (P = .004), clinical tumor size (P = .02), and cathepsin D expression (P = .01), whereas metastasis-free survival was best predicted by node status (P = .0004), clinical tumor size (P = .009), and urokinase plasminogen activator expression (P = .04). In node-negative patients, thymidine kinase activity was the only factor selected for disease-free (P = .04) and metastasis-free (P = .05) survival. In node-positive patients, the number of positive axillary lymph nodes was the only factor selected for disease-free (P = .0008) and metastasis-free (P = .00017) survival.

CONCLUSIONS

Our retrospective analysis has identified protease expression and tumor cell proliferation rate as important biological prognostic factors in breast cancer. Prospective clinical trials should be undertaken to confirm these results.

Enzyme-linked immunosorbent assay of pS2 in breast cancers, benign tumors, and normal breast tissues. Correlation with prognosis and adjuvant hormone therapy

An enzyme-linked immunosorbent assay using monoclonal and polyclonal antibodies against recombinant pS2 was devised. It was used to measure pS2 concentration in the cytosol of 339 breast cancer, 15 fibroadenomas, 16 cases of benign breast disease, and 6 normal breast tissues. The mean value of pS2 concentration was higher in cancer, but the protein could be detected readily in benign tumors and even in normal breast. The concentration of pS2 was significantly lower in postmenopausal women and tumors of differentiation Grade 3. The pS2 concentration was correlated strongly with the presence of estrogen receptors (ER) and progesterone receptors (PR). No correlation was observed with the size, histologic type of the tumor, and lymph node status. The prognostic value of pS2 appeared relatively limited. It was clear cut only for a relatively small group of patients (approximately 15%), who had low concentrations of pS2 (less than or equal to 0.32 ng/mg of protein). These patients had a shorter disease-free interval and overall survival time. The most striking correlation was observed with the outcome of adjuvant hormone therapy. pS2 concentration was shown to be the most potent prognostic factor, preceding even ER.

Epidermal growth factor receptors and prognosis in primary breast cancer

A retrospective study was performed on 109 human breast tumors stored in liquid nitrogen in order to assess the prognostic value of epidermal growth factor receptor (EGF-R) (median patient follow-up 5 years). A significant inverse relationship was observed between EGF-R and both estrogen (ER) and progesterone receptors (PR). Univariate analysis showed a trend towards a shorter metastasis-free survival both in the overall population and in node-negative patients with EGF-R positive tumors. Multivariate analysis of the overall population showed that lymph-node involvement and PR status were the only significant variables in predicting metastasis-free survival. However, in patients receiving no adjuvant treatment (hormone therapy or chemotherapy). EGF was the only significant variable in the multivariate Cox analysis. No c-erbB-1 amplification was detected in these tumors.

Predicting distant metastases in operable breast cancer patients

Risk factors for distant metastases following mastectomy and axillary node dissection for breast cancer were analyzed in a review of 1022 women. From diagnosis until the end of the adjuvant treatment, six stages were identified that corresponded well to patient data acquisition. At each stage, a prognosis study based on the Cox model was carried out using all acquired information from the first stage. The results demonstrated that tumor size, nuclear pleomorphism, mitotic index, and nodal status at the top of axilla were stable independent risk factors in predicting metastasis-free survival (MFS). These analyses also revealed those factors that were significantly related to MFS at one or several stages and losing their significance at a subsequent stage. This was the case with clinical node status, age, and vascular tumor emboli. Other factors such as estrogen, progesterone, histologic grade, and clinical stage were never identified as independent factors at any stage. The four major stable risk factors were used to define a stratification of reference. The results demonstrated that the mere knowledge of clinical information such as tumor size, clinical node status, and age would enable 51% of the patients to be universally well classified according to that stratification. Knowledge of additional factors, such as nuclear pleomorphism and mitotic index, would bring the rate up to 61%, and then to 64% if supplementary information such as vascular tumor emboli were acquired. These percentages did not appear high enough to claim that the physician may make a reliable prognosis of operable breast cancer patients before acquiring information from the axillary node dissection. However, it was proven that there exist some subsets of patients with stable prognosis, i.e., subsets of patients who will belong permanently to the same risk group through the stages.

The concentration of glucose in the culture medium determines the effect of suramin on the growth and differentiation of the human colonic adenocarcinoma cell clone HT29-D4

Suramin, a drug currently used for advanced malignancy, induces the differentiation of the human colonic adenocarcinoma cell clone HT29-D4 and this process is correlated with a decreased glycolytic activity. We investigated the effects of suramin on HT29-D4 cells in the presence of various glucose concentrations. The main result of this study is that suramin has only an effect on HT29-D4 cell growth and differentiation when the concentration of glucose is above 10 mM. Therefore the efficiency of suramin as an anticancer drug may be greater on poorly differentiated tumoral cells with a high proliferative capacity.

[Epidemiologic and prognostic factors of cancer of the breast]

Breast cancer is the most common of all cancers affecting women in France; its frequency increases in countries with a high standard of living. A family history and certain types of mastosis are unquestionable risk factors, although their weight has not yet been well established, but there is no absolute proof that feeding habits (notably fats and alcohol), which have been blamed by some authors, play a role in the genesis of breast cancer. Among the classical prognostic factors, which are necessary for surgical decisions, the size of the tumour, its histological grade and above all the number of axillary lymph nodes involved are the most important. However, a better knowledge of breast cancer biology has yielded factors that seem to be more promising than hormonal receptors, notably the DNA content of tumoral cells and the presence or absence of a protease, procathepsin 52 K, which reflects tumoral aggressiveness. As for the study of oncogens described elsewhere in this monograph, it will provide a better definition of high risk subjects and more precise information on the progress of the cancer.

Survival effect of systemic therapy on patients developing metastatic breast carcinoma

A multivariate analysis was performed to assess the effect of post-relapse systemic therapy on a series of patients with metastatic breast cancer who at initial presentation had no detectable metastases (Mo), were less than or equal to 70 years of age, presented with unilateral localized disease and no other associated malignancy, and were treated between 1965 and 1984 with successive protocols for primary disease and subsequently developed distant metastasis. All 760 patients analyzed relapsed with at least one metastasis, and were studied retrospectively with no selection criteria according to any specific protocol. All had recorded clinical data on menopause, stage, clinical tumor aggressiveness (PEV), initial chemo or hormonal therapy, and time to relapse, and had ongoing follow up at our Center, with salvage chemotherapy and/or hormonal therapy having been given to some but not all patients. A brief metastasis-free survival (p less than 0.000001), and factors associated with electing pre-relapse chemotherapy (p less than 0.000001) were associated with shortened post-relapse survival, while post-relapse therapy (chemo p less than 0.0001, and hormonal p less than 0.00001, replacing chemotherapy in the model) apparently increased post-relapse survival in the group overall. This result was similar in the inoperable patient group [with inflammatory breast carcinoma an additional risk factor (p less than 0.0005)], as well as the operable group. However, in the operable group, when the pathologic criteria of histologic grade and nodal status were introduced into the analysis, post-relapse therapy was not seen to be an important factor for survival in any subgroup.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the efficacy of propranolol and amiodarone in suppressing ventricular arrhythmias following myocardial infarction

The purpose of this prospective randomized trial was to compare the efficacy of propranolol and amiodarone in suppressing ventricular arrhythmias during the first 6 months following myocardial infarction (MI). 97 patients were treated with either amiodarone (n = 48) or propranolol (n = 49) starting on the 9th day following MI. Holter monitoring was carried out on four occasions: on D7, D21, D90 and D180. There was no statistical difference in the incidence of 'major' arrhythmias (an average of at least 10 ventricular premature complexes (VPCs) h-1, multiform or paired VPCs or runs) between the two groups on D7. A significant difference in favour of amiodarone became apparent at D180 (P = 0.04). Patients were also classified according to whether treatment failed or was successful. 'Success' was recorded when arrhythmias remained minor or became minor (less than 10 uniform VPCs h-1) and 'failure' when arrhythmias remained major or became major, or when patients were withdrawn because of side-effects, or lost to follow-up. The difference remained in favour of amiodarone (P = 0.03 at D21; P = 0.05 at D90; P = 0.06 at D180). Evaluation of the percentage reduction in the number of VPCs at D21, D90 or D180 compared with D7 showed superiority of amiodarone at D90 (P less than 0.01) and D180 (P less than 0.04). In this study, the overall effect of amiodarone on ventricular arrhythmias following MI was shown to be superior to that of propranolol.

Cathepsin D: an independent prognostic factor for metastasis of breast cancer

122 patients with primary breast cancer were followed-up for a median of 4.6 years after surgery. The concentration of cathepsin D in tumour cytosol was strongly related to both metastasis-free survival and disease-free survival and was independent of nine conventional prognostic indices. Cathepsin D assay may prove particularly useful in identifying women who, though without lymph node involvement at presentation, are at high risk of metastatic disease.

Prognostic value of histologic grade nuclear components of Scarff-Bloom-Richardson (SBR). An improved score modification based on a multivariate analysis of 1262 invasive ductal breast carcinomas

We did a multivariate analysis of 1262 patients with operable, invasive ductal breast carcinoma to assess the prognostic value of the Scarff-Bloom-Richardson (SBR) histologic grading system. Nodal metastasis and SBR were the two most important factors for metastasis-free survival (MFS), P = 10-9 and P = 10-5, respectively, for total study time. In patients who were node negative, the SBR and International Union Against Cancer (UICC) stages were the most important for MFS (P = 4 X 10-4 and P = 0.03). In order to try to improve the SBR prognostic value, we first studied the three components of the SBR separately: ductoglandular differentiation proved the least predictive and nuclear pleomorphism and mitotic index the most predictive. A rearrangement of the two nuclear scores alone produced higher risk values and better risk separation of patient subpopulations than SBR, and eliminated the SBR from the multivariate model. This rearrangement, modified SBR (MSBR), defined five new risk subgroups with statistically different risk ratios for MFS (P = 3 X 10-8). SBR grade II (55% of patients) was separated into three MSBR groups significantly different according to MFS (P = 0.008). In the patients who were node negative, MSBR replaced the SBR and was the most important factor for prediction of relapse of MFS (P less than 0.00001). The MSBR is more accurate and predictive than the standard SBR grade and is particularly useful when the nodal status of the patient is negative or unknown.

Nuclear characteristics as indicators of prognosis in node negative breast cancer patients

Nine clinical, biologic and histologic variables were evaluated for their significance in predicting the metastasis free survival (MFS) and the overall survival (OS) of 650 histologic node negative breast cancer patients. The variables studied were: menopausal status, UICC clinical stage of disease, Scarff-Bloom and Richardson (SBR) grade and its 3 components, estrogen and progesterone receptors, and anatomic tumor size. Multivariate Cox analyses revealed that histologic grade and clinical stage were the only significant prognostic factors for both MFS and OS. In the SBR grading system, grades I and III clearly have defined those patients with low and high risk for relapse, respectively. However, it is well known that more than 50% of the patients fall into the intermediate risk category, grade II, which provides essentially no useful prognostic information for those patients. To improve the assignment of patients to specific risk groups, a modified grade (MSBR), with five categories ordered according to the degree of malignancy, has been built from the nuclear pleomorphism and the mitotic index of the SBR grade. In combination with clinical stage, MSBR was found to be a prognostic indicator with high discriminatory power and caused the SBR grade to lose its significance. The first three categories of this MSBR may be gathered to designate low risk patients, whereas the last two categories, once combined, contain all the SBR grade III plus 57% of the SBR grade II tumors, and reliably identify high risk node negative patients. We suggest that a systemic adjuvant therapy should be discussed in this high risk group.

Prognostic value of estrogen and progesterone receptors in primary infiltrating ductal breast cancer. A sequential multivariate analysis of 1262 patients

Nine prognostic variables were evaluated for their significance in predicting the overall survival (OS), the length of disease-free survival (DFS) and the length of metastasis-free survival (MFS) of 1262 patients with primary breast cancer. The variables studied were: UICC clinical stage; menopausal status; histologic grade; number of involved nodes; anatomic tumor size; estrogen and progesterone receptors; local and adjuvant therapies. Three sequential multivariate analyses, at 2, 5 and 10 years, using the Cox proportional hazard regression model, were carried out to identify those variables most highly related to the criteria studied (overall, disease-free, metastasis-free survivals) and especially to fully evaluate the effects of hormonal receptors on prognosis and their stability over time. Our results showed that number of involved nodes and histologic grade were the most significant prognostic factors for all periods of time and whatever the criterion studied; ER had no predictive value while PR was an independent prognostic factor for metastasis-free survival at 2 years (P = 0.01) and 5 years (P = 0.02) but lost its significance at 10 years (P = 0.06). In the subgroup of 261 patients who received prolonged post-operative adjuvant chemotherapies, PR was the main prognostic factor for MFS at 2 years (P = 0.03) and the second at 5 years (P = 0.05) just after number of involved nodes. In the 1001 patients who did not receive prolonged post-operative adjuvant chemotherapies ER was significant for MFS at 5 and 10 years. The present data urge the need for a periodic redefinition of prognostic factors in primary breast cancer.

[Comparative efficacy of amiodarone and propranolol on ventricular arrhythmia in the post-infarction period]

Beta-blockers are known to be effective against post-infarction ventricular arrhythmias and amiodarone has recently been shown to have this property. The purpose of this prospective randomized study was to compare the effects of beta-blockers and amiodarone during the first 6 months following infarction. Nine days after the onset of myocardial infarction, 97 patients were put on either amiodarone (48) or propranolol (49). Holter monitoring was performed on four occasions: on the 7th post-infarction day (baseline), then on the 21st, 90th and 180th days (under treatment). On D7 the two groups were similar in age, sex, risk factors, medical history, characteristics of the infarction and type of arrhythmia. For result analysis purposes the patients were divided into two categories depending on whether their arrhythmia was "moderate" (less than 10 monomorphous and isolated ventricular extrasystoles per hour) or "severe" (at least 10 ventricular extrasystoles per hour, or polymorphous or repetitive ventricular extrasystoles). Concerning the frequency of "severe" arrhythmia, there was no statistical difference between the two treatment groups on D7 (p = 0.53), but differences in favour of amiodarone became increasingly important during the study (p = 0.08 on D21; p = 0.07 on D90; p = 0.04 on D180).(ABSTRACT TRUNCATED AT 250 WORDS)

Mammal teeth from the Cretaceous of Africa

We report here the discovery of two mammal teeth from the early Cretaceous of Cameroon. These, and some jaw fragments, all from Cameroon, are the only fossil evidence of mammalian evolution from Africa between late Jurassic and Paleocene, a span of at least 85 million years. A triangular upper tooth lacks the principal internal cusp of marsupials and placentals and is therefore of a similar evolutionary grade to most Jurassic and early Cretaceous therian mammals, but more primitive than the metatherian-eutherian grade. Early Cretaceous, or older, therian mammals are now known from all southern continents except Antarctica. The new find from Cameroon is consistent with the hypothesis that marsupials, the dominant living mammals of South America and Australia, were not present on any Gondwana continents until after the early Cretaceous separation of Africa by the opening of the South Atlantic.

Flow cytometric study of DNA distribution in cytopunctures of benign and malignant breast lesions

One hundred seventy-eight cytopunctures of mammary lesions were obtained for cytologic diagnosis and flow cytometric (FCM) analysis of the nuclear DNA content. All lesions were excised and evaluated histologically; 106 were carcinomas and 72 were benign lesions. The benign lesions showed a diploid DNA content, with one exception. Among the 106 carcinomas, 35 (33%) were diploid, 14 (13%) were tetraploid and 57 (54%) were aneuploid. For 79 carcinomas, the relationship between ploidy and (1) "T" and "N" of TNM staging, (2) the histologic grading of Scarff, Bloom and Richardson, (3) axillary nodal involvement, (4) the presence of estrogen and progesterone receptors, (5) age and (6) menopausal status was investigated. The percentage of aneuploidy was significantly higher (P less than .05) in grade III tumors as compared to grade I tumors. There was no significant relationship between aneuploidy and the other factors. However, a trend was observed between the lack of steroid receptors and a high probability of the tumor being aneuploid. FCM DNA analysis was also carried out on breast carcinomas obtained at surgery in 40 patients for whom FCM DNA analysis had previously been performed on breast cytopuncture specimens. The FCM DNA analyses were found to be best performed on the samples obtained by cytopuncture, which may increase the yield of tumor cells.

Loss of a c-H-ras-1 allele and aggressive human primary breast carcinomas

The human H-ras protooncogene was shown to be expressed in 16 of 22 invasive ductal carcinomas of the breast. The K- and N-ras protooncogenes were either not expressed or expressed at low levels. No amplification or rearrangement of the three ras genes was detected among the 104 breast carcinoma DNAs tested. These results indicate that the overexpression of H-ras in human breast tumors is not correlated with alteration of the protooncogene. In addition, we did not find any point mutation at the codon 12 of the H-ras or K-ras protooncogenes in 32 and 64, respectively, tumor DNAs examined. However, in tumor DNAs from 14 of 51 patients, heterozygous for H-ras-1 related BamHI restriction fragments, one allele was lost. This allele loss did not alter ras Mr 21,000 protein expression. Correlation with clinicopathological data showed, however, that the loss of one H-ras-1 allele in breast carcinoma DNAs is significantly linked to histological Grade III tumors, the lack of estrogen and/or progesterone receptors, and the subsequent occurrence of distal metastasis. Our results thus indicate that the loss of one H-ras-1 allele correlates with the most aggressive primary carcinomas of the breast.

High frequency of rare alleles of the human c-Ha-ras-1 proto-oncogene in breast cancer patients

The c-Ha-ras-1 locus in 104 breast cancer patients and 56 unaffected individuals was examined for allelic restriction fragment-length polymorphism. Four common and 16 rare alleles were detected in the combined populations. The distribution of common and rare alleles differed significantly between the two populations. The common restriction fragments represented 91% of the allele pool in the unaffected population. In breast cancer patients, these common alleles represented only 59% of the allele pool (P less than .001). More specifically, the frequency of two of the common fragments, the 6.5- and 8.0-kilobase alleles, was significantly diminished in the breast cancer population (P less than .001 and P less than .02, respectively). The frequency of rare c-Ha-ras-1 alleles and hence genotypes composed of two rare alleles was increased in the breast cancer population (P less than .001). One of the rare alleles had a significant (P less than .05) association with these breast cancer patients. These results suggest that genotype analysis of the c-Ha-ras-1 locus, in combination with other clinical parameters, may be of prognostic value in assessing the potential for cancer.

Competitive prognostic value of clinicopathologic and bioimmunologic factors in primary breast cancer

Fourteen clinical, pathologic, and pretreatment bioimmunologic variables were evaluated for their significance in predicting the survival or the length of disease-free interval of 55 patients with primary breast cancer. The variables studied were: patient age; clinical stage of disease according to the International Union Against Cancer TNM classification; number of involved nodes; sedimentation rate; peripheral lymphocyte, leucocyte, and monocyte counts; serum levels of immunoglobulins IgG, IgA, and IgM; percentages of E-, "active" E-, and EAC-rosettes; and finally, the lymphoblastic transformation test value (PHA-LTT). A multivariate analysis using the Cox proportional hazards regression model was carried out, in a stepwise manner, to identify those variables most highly related to survival or to the length of disease-free interval. The Cox analysis showed that clinical stage, number of involved nodes, percentage of EAC-rosettes, sedimentation rate, and T-lymphocyte reactivity, (i.e., the T-lymphocyte sensitivity to PHA, expressed as the ratio between the PHA-LTT in counts per minute and the percentage of E-rosettes) were the significant prognostic factors for survival, whereas the number of involved nodes and the sedimentation rate were independent of importance in predicting the length of disease-free interval. The results obtained from this analysis proved the importance of some immunologic parameters in the estimation of prognosis. In addition, a prognostic score for summarizing multiple factors with potential use in stratification was derived from the multivariate analysis.

Systemic thromboembolic accidents in the early post-operative period in patients with prosthetic valves

Since 1975, of 2328 patients with prosthetic valves, 61 presented one or many systemic thromboembolic accidents (TEA) between the 12th and the 60th day of the post-operative period: 54 cases involved the brain and 14 involved other areas. Although the embolic accident was clinically detectable, EEG and scanner helped in detecting multiple emboli. Clinical history enables us to select high-risk cases: arrhythmias (47 cases), previous TEA (20), prosthetic dysfunction (4). However, several patients have no specific history. Mitral valves present the highest risk. The preventive value of anticoagulant therapy is unquestionable but it does not always prevent TEA, even the recurring type. One can meet all degrees, from the self-resolutive minor TEA up to massive cerebral emboli with severe sequelae. Warning signs include fever, high fibrinogen and HBDH levels. When TEA occurs in the hospital, early detection favours fibrinolytic treatment if there are no contra-indications. Whenever surgery was imminent, we used urokinase (29 cases). Despite better surgical techniques, efficient prostheses and anticoagulant treatment, TEA remain all too frequent as we do not have ideal methods for biological detection and effective prevention.

Prognostic index for clinical Stage I cutaneous malignant melanoma

Thirteen variables were evaluated for their significance in predicting the survival of 148 patients in a retrospective study with clinical Stage I cutaneous malignant melanoma. The variables studied were histological type, tumor thickness, level of invasion, mitotic activity, pigmentation type, existence of ulceration, presence of lymphocytic infiltration, cell type, sex and age of the patient, site of melanoma, and wide local excision preceded or not by contact radiotherapy and associated or not with lymphadenectomy. When these variables were individualized, only seven were significantly related to survival: histological type; tumor thickness; level of invasion; mitotic activity; pigmentation type; existence of ulceration; and sex of the patient. Multivariate analysis based on Breslow's version of the Cox proportional-hazards model was performed on a group of 110 patients. This analysis demonstrated that 5 of the original 13 variables (i.e., mitotic activity, tumor thickness, sex, lymphadenectomy, and site of primary melanoma) could be used to develop a prognostic model. A Gompertz distribution which provided for an appropriate smoothing of the Breslow model estimates was used to derive a simple prognostic index and to predict the survival of individual patients. Fifty-four patients in a prospective study were subsequently evaluated with the Gompertz model in order to test the prognostic accuracy of the model for the five variables.

[Oogenesis in Centropages typicus (Copepoda, Calanoida)]

We carried out a complete study of oogenesis in Centropages typicus using structural, ultrastructural and cytochemical data. The usual stages of oogenesis, i.e. germinative phase, premeiosis, primary and secondary vitellogenesis, were found. The latter two stages were the most typical. Primary vitellogenesis consisted of endogenous yolk accumulations; these substances, probably of lipoprotein or lipoglycoprotein nature, were produced at the granular endoplasmic reticulum level and then stocked in the reticulum cavities. During secondary vitellogenesis, endogenous yolk production continued, but we mainly observed the development of exogenous yolk accumulation (lipid droplets and protein globules) in the ooplasm. These accumulations resulted from the fusion of very numerous pinocytotic vesicles arising from the oolemma and containing substances probably brought to the oocytes by the hemolymph. The effect of various proteases on the vitellus globules caused a more or less marked digestion of their contents, tending to prove their protein nature. The end of vitellogenesis was marked by the appearance of vacuolar formations with dense lamellae which could correspond to cortical granules.

[Prognostic histopathological features of malignant melanoma. New statistical approaches (author's transl)]

The records of 203 patients with cutaneous malignant melanoma treated at the Centre René Huguenin, Saint-Cloud, from october, 1959 to december, 1978 were reviewed. Histological data from 155 patients were retained after re-examination. The melanomas, which had previously been classified according to Clark's system of histological type and degree of invasiveness, were re-evaluated according to the thickness, were re-evaluated according to the thickness of the tumour as measured by Breslow's ocular micrometric method. Other histological data, as well as clinical and therapeutic data, were gathered together. One hundred and fifty cases were found to be suitable for standard single and multifactorial analysis, and 96 records contained sufficient information to be analyzed by the new "similarly aggregation" method developed by IBM. Two significant results emerged from the study: the thickness of the tumor is the single most important prognostic factor, as it correlates with the incidence of recurrences, metastases and deaths; by using a small number of clinical and histological variables, it seems possible to draw a profile of every new patient, to classify him in a well-determined prognostic category and, consequently, to institute a complementary treatment when needed.

Relationship of presence of progesterone receptors to prognosis in early breast cancer

The presence of progesterone receptors was found to be associated with a favorable prognosis in 98 patients with primary breast cancer. The occurrence of metastases was 3.6 times less probable in patients with progesterone receptor-positive tumors than in patients with progesterone receptor-negative tumors. There was also an inverse relationship between the concentration of progesterone receptor and the frequency of metastases. However, there was no statistical correlation between frequency of local recurrences and progesterone receptor content of the tumor. In patients displaying clinical or histological criteria of gravity, the presence of progesterone receptors allowed us to define subgroups with good prognosis. Thus, in women with progesterone receptor-positive cancers, metastases had occurred at 18 months, in only 5% of the 39 Grade III cancers and in none of the 25 cases with invaded axillary nodes. Measurement of estradiol receptor (105 patients including the previous 98 patients) was found to be less effective for guiding the prognosis of early breast cancer. Combined evaluation of estradiol and progesterone receptors did not provide any more information than did the determination of progesterone receptor alone.

[Detachment of Descemet's membrane in cataract surgery]

Six cases are reported of detachment of Descemet's membrane as a complication of the extraction of 1253 cataracts--a frequency of 0.5%. In two of the cases faulty surgical technique was thought to be the cause of the detachment. There appears to be an anatomic predisposition for detachment in the elderly. In two patients Descemet's membrane reattached itself without postoperative sequelae. On the other hand, in spite of complete clinical reattachment of the membrane in three patients and partial reattachment in another, stromal and epithelial edema at the level of the detachment persisted and progressed to stromal opacity.

[Results of a survey of the risk factors involved in the incidence of female breast cancer (author's transl)]

A survey of the risk factors involved in the incidence of female breast cancer was conducted in the Hauts-de-Seine and Yvelines departments, near Paris. Two hundred and fifty thousand questionnaires were sent out; 18000 women replied. The family risk factor appeared in 15% of the replies, including 6% which concerned the closest relatives (mother and/or sister). Correlations are established between the various factors, and conclusions are drawn about the possibility of cancer detection according to graded risks.

[Mortality due to carcinoma of the stomach between 1954 and 1974. Changes in France (author's transl)]

A study of changes in mortality due to carcinoma of the stomach in France between 1954 and 1974 was undertaken on the basis of probable levels standardised on the French population in 1968. There was a marked fall in this mortality for both sexes. In the male, the initial level in 1954 was 54.8/100 000 and the decrease was of the order of 1.35 deaths per 100 000 per year, i.e. an annual fall of -3.21%. This phenomenon was more marked during the second period (1965--1974): - 3.88%, than during the first period (1954--1963: - 2.38%. In the female, with an initial mortality rate of 31.25/100 000, the annual decrease was 31.25/100 000, i.e. an annual fall of - 3.49%. This fall was - 3.09% for the first ten year period and - 4.80% for the second period. Thus in France, in common with many other countries, there has been a marked decrease in mortality due to carcinoma of the stomach, for both sexes, and this phenomenon became progressively more notable during the period of the study.