Positive immunostaining for thyroid transcription factor-1 in primary and metastatic colonic adenocarcinoma: a note of caution

Immunohistochemistry for thyroid transcription factor-1 (TTF-1) is considered an important ancillary technique for distinguishing primary pulmonary adenocarcinomas from metastases. A case of metastatic colonic adenocarcinoma in a bronchial biopsy specimen that showed focal positive nuclear staining for TTF-1 is reported here. The primary colonic adenocarcinoma was retrieved from the file and immunostaining also showed focal nuclear positivity for TTF-1. This confirmed the morphological and clinical impression of colonic metastases in the bronchial biopsy specimen. To investigate this apparent aberrant TTF-1 expression, further sections from primary colonic adenocarcinoma were immunostained for TTF-1 using the SPT24 antibody clone. Three of the six cases studied showed focal nuclear positivity with the SPT24 clone. All six cases were subsequently shown to be negative with the 8G7G1 clone. It is concluded that the SPT24 antibody to TTF-1 may show focal nuclear positivity in adenocarcinomas of colorectal origin such that focal staining in small biopsy specimens should be interpreted with caution.

A genetic linkage map of a cichlid fish, the tilapia (Oreochromis niloticus)

We have constructed a genetic map for a tilapia, Oreochromis niloticus, using DNA markers. The segregation of 62 microsatellite and 112 anonymous fragment length polymorphisms (AFLPs) was studied in 41 haploid embryos derived from a single female. We have identified linkages among 162 (93.1%) of these markers. 95% of the microsatellites and 92% of the AFLPs were linked in the final map. The map spans 704 Kosambi cM in 30 linkage groups covering the 22 chromosomes of this species. Twenty-four of these linkage groups contain at least one microsatellite polymorphism. From the number of markers 15 or fewer cM apart, we estimate a total map length of approximately 1000-1200 cM. High levels of interference are observed, consistent with measurements in other fish species. This map is a starting point for the mapping of single loci and quantitative traits in cichlid fishes.

The ability of the chemiluminescence test to predict clinical outcome and the necessity for amniocenteses in pregnancies at risk of haemolytic disease of the newborn

The chemiluminescence test measures the ability of anti-D to sensitise red cells for recognition by monocytes. It predicts clinical outcome in haemolytic disease of the newborn with greater precision than quantification of anti-D levels by AutoAnalyzer. However, whether or not the chemiluminescence test can, or should, affect clinical management is not clear. Of 56 alloimmunised women referred to a single fetal medicine unit, 30 underwent a total 63 amniocenteses to establish the extent of fetal haemolysis. Overall, chemiluminescence test results were a better predictor of amniocenteses with elevated bilirubin levels than the AutoAnalyzer (P < 0.01). Chemiluminescence results > 30% were always associated with elevated bilirubin levels. The chemiluminescence test might be used to prompt the direct evaluation of fetal haemolysis in patients with borderline levels of anti-D (5-15 IU/mL). However, the ability of the test to predict amniocenteses with normal bilirubin levels was less clear.

Comparison of extradural fentanyl, bupivacaine and two fentanyl-bupivacaine mixtures of pain relief after abdominal surgery

Fentanyl 50 micrograms, bupivacaine 50 mg and two mixtures containing fentanyl 50 micrograms and bupivacaine 25 mg or 12.5 mg (0.25 and 0.125%), respectively, in a volume of 10 ml were administered via thoracic extradural catheters to 24 patients after major abdominal surgery. All patients received all four treatments, in a randomized order, so that each patient received one of the 24 possible combinations of the four treatments. Pain relief was assessed by a linear analogue pain scale and the Prince Henry Hospital pain score. The duration of pain relief, effects on ventilatory frequency, heart rate, arterial pressure and central venous pressure were also recorded. Mean reductions in the analogue pain scale for fentanyl, bupivacaine, and fentanyl in 0.25% and 0.125% bupivacaine were 80 (SEM 5) %, 87 (4) %, 86 (5) % and 77 (5) %, respectively (ns). Pain scores decreased by 62 (6) %, 83 (5) %, 77 (6) % and 72 (6) %, respectively (ns). Mean arterial pressure decreased to 90 (2) %, 70 (2) %, 81 (2) % and 82 (3) %, respectively, of pretreatment values. In this respect, bupivacaine alone was significantly different from the three other treatments (P < 0.001). Hypotension (reduction in arterial pressure greater than 25% of pretreatment mean arterial pressure) was also more frequent after bupivacaine alone (P < 0.01). Effects on ventilation, heart rate and central venous pressure did not differ between the four treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Patients', parents', and oncologists' perceptions of informed consent for bone marrow transplantation

Bone marrow transplantation (BMT) is gaining increasing acceptance as a therapeutic treatment modality and is being offered to patients even in the early stages of disease in the presence of minimal debilitating symptoms. Despite this, little is known regarding patients' and physicians' perceptions of the process in which informed consent for this controversial and potentially lethal procedure is obtained. Thirty-nine adult BMT patients and the parents of 61 children undergoing BMT and each of their physicians completed a questionnaire concerning their perceptions of the discussion in which consent for BMT was obtained and their evaluation of the consent document. In addition, the factors influencing patients' and parents' decision to accept BMT and the nature and amount of BMT information retained by patients and parents were assessed. The results indicate that on the whole patients and parents evaluated the BMT consultation and consent document favorably, were motivated by their trust in the physician and their belief in BMT as a cure, retained information regarding major points of informed consent from both the consent document and physician discussion, and had considerable difficulty with recall of the specific toxic side effects associated with BMT. Physicians' perceptions, on the other hand, reflected a less positive view of the extent to which patients and parents were actively involved in the consent process and the readability of the consent document. Perceptions of the informed consent process on the part of oncologist-investigators and patients which could impede the goals of informed consent and implications for facilitating the process are discussed.

Flavonoids protect against T-2 mycotoxins both in vitro and in vivo

Quercetin was able to reduce the cytotoxic effect of T-2 mycotoxin on cultured murine thymocytes. When given to mice immediately before challenge with T-2 mycotoxins, quercetin significantly reduced mortality.

In vitro toxicity of T-2 mycotoxin in mouse lymphoid cells

The in vitro toxicity of T-2 toxin towards mouse lymphoid cells prepared from spleen, thymus, peritoneal lavage and bone marrow cells was studied. Bone marrow cells were more resistant to damage by T-2 toxin than thymus, spleen and peritoneal cell preparations.

Depression in hospitalized cancer patients

The study of depression in cancer patients has been hampered by difficulty in establishing diagnostic criteria, since neurovegetative signs and symptoms may be attributable either to depression or physical illness. Confusion has also arisen in defining the boundary between "normal" grieving with illness, and "abnormal" clinical depression. We studied 62 oncology inpatients applying DSM-III diagnostic criteria, patient self-report, and interview report rating scales. Forty-two percent met criteria for nonbipolar major depression: 24% with severe and 18% with moderately severe symptoms. Fourteen percent of the sample had depressive symptoms that did not meet criteria for a major depression. Forty-four percent had no depressed affect. Medical and demographic variables were evaluated for relationship to depression; only greater degree of physical disability was clearly associated. Other negative life events and poor quality of social supports were additionally associated with depression in the less disabled patients. The use of clearly defined criteria for diagnosis of depression in cancer patients provides a basis for the study and implementation of specific therapeutic interventions.

The prevalence of psychiatric disorders among cancer patients

Two hundred fifteen randomly accessed cancer patients who were new admissions to three collaborating cancer centers were examined for the presence of formal psychiatric disorder. Each patient was assessed in a common protocol via a psychiatric interview and standardized psychological tests. The American Psychiatric Association's DSM-III diagnostic system was used in making the diagnoses. Results indicated that 47% of the patients received a DSM-III diagnosis, with 44% being diagnosed as manifesting a clinical syndrome and 3% with personality disorders. Approximately 68% of the psychiatric diagnoses consisted of adjustment disorders, with 13% representing major affective disorders (depression). The remaining diagnoses were split among organic mental disorders (8%), personality disorders (7%), and anxiety disorders (4%). Approximately 85% of those patients with a positive psychiatric condition were experiencing a disorder with depression or anxiety as the central symptom. The large majority of conditions were judged to represent highly treatable disorders.

Development of brief measures of psychological adjustment to medical illness applied to cancer patients

The interrater reliability and validity of brief interview rated measures of psychosocial adjustment were examined in four sequential studies. A total of 25 videotaped interviews with cancer patients were rated by 105 social workers, nurses, physicians, and specialists in psychosocial oncology. The Rating of Psychosocial Function (RPF), Coping Adequacy Rating (CAR), and Global Adjustment to Illness Scale (GAIS) were used by various rating groups with an indication of interrater agreement. Agreement on ratings was not influenced by the length of interview (15 vs. 30 minutes) but appeared to the affected by the structure of the interview and profession of the raters. All three instruments showed a measure of matching with clinical impressions in addition to demonstrating a measure of both convergent and divergent construct validation. The GAIS was chosen as most adequately reflecting their clinical impression by a majority of raters. With a degree of training, any of the three instruments could be used to assess psychosocial adjustment with some measure of confidence in the validity of the rating.

A survey of psychotropic drug prescriptions in an oncology population

The present study examined the prescription practices concerning psychotropic drugs in 5 major oncology centers over a 6 month period. During the survey period 1579 patients were admitted to the collaborating institutions, and 51% of them were prescribed at least one psychotropic medication. Hypnotics were the most frequently prescribed drugs, accounting for 48% of total prescriptions, followed by anti-psychotics at 26% and anti-anxiety agents at 25%. Anti-depressant drugs accounted for only 1% of psychotropic prescriptions. Analysis of prescription rationales revealed that 44% of the psychotropic prescriptions were written for sleep, while 25% were given for nausea and vomiting; approximately 17% were attributed to psychological distress, and 12% were associated with diagnostic medical procedures. The overall rate of prescription was approximately 2 psychotropic drugs per patient per admission, with only 2% of prescriptions resulting in chart-documented side effects. At the level of individual compounds, 3 distinct drugs accounted for 72% of total prescriptions--flurazepam (33%), prochlorperazine (21%), and diazepam (17%).