Assessment of non-palpable mammographic abnormalities: comparison between screening and symptomatic clinics.

A retrospective study found that a breast screening clinic generated fewer localization biopsies for non-palpable mammographic abnormalities than a symptomatic clinic (3.36 versus 9.89 per 1000 mammograms, respectively) and that a greater proportion of such biopsies were malignant. This study determined the reason for this difference. There were 108 of 304 (35.5 per cent) and 17 of 130 (13.1 per cent) carcinomas in women attending the screening and breast clinics respectively (relative risk 2.72 (95 per cent confidence interval 1.70-4.34)). This difference was regardless of age. The characteristics of the mammographic abnormality, the Wolfe pattern, a family history of breast carcinoma, parity and age at first pregnancy were similar in both groups. Women attending the screening clinic were referred for localization biopsy after assessment by clinicians and radiologists at a joint clinic; there was no joint assessment for patients attending the breast clinic. The same staff attended both clinics, although the proportion of time spent at each varied. This study suggests that all women with a non-palpable mammographic abnormality should be reviewed at a joint assessment clinic before localization biopsy is recommended.

Outcome of surgery for non-palpable mammographic abnormalities.

Four hundred and ninety-three women underwent 515 localization biopsies for non-palpable mammographic abnormalities. The mammographic abnormality was located with a hooked wire in 509 cases. Specimen radiology was performed on all excised tissue. The mammographic abnormality was visualized in the first piece of tissue excised in 402 (78.1 per cent) cases and complete excision was achieved in 476 (92.4 per cent). A palpable nodule was removed in 38 (7.4 per cent) cases and in 17 (44.7 per cent) was shown to contain a carcinoma. The mammographic abnormality was missed in 14 (2.7 per cent) cases or only partly excised in 13 (2.5 per cent). Overall 144 (28.0 per cent) localization biopsies were malignant. The mammographic abnormality was not visualized on the specimen radiograph more frequently in women aged under 55 years, in women with dense breast (Wolfe grade DM or DY) or in those whose mammographic abnormality contained only microcalcification. The 27 women in whom the mammographic abnormality was not visible on the specimen radiograph underwent repeat mammography 2 months later. Only two women required a further localization biopsy and the mammographic abnormality was recovered in the first piece of tissue excised. Women with a carcinoma underwent mastectomy or wide local excision, and residual carcinoma at the localization biopsy site was found in 64 (44.4 per cent) cases. Oestrogen receptor analysis by ligand binding assay was possible in only 71 (49.3 per cent) carcinomas. If the specimen radiograph does not show the mammographic abnormality within pieces of tissue excised and there is no palpable nodule it may be best to conclude the biopsy. In this series these missed lesions were usually benign. Only rarely is a second localization biopsy required and this is performed without difficulty.

Effects of medium quality on the expression of human interleukin-2 at high cell density in fermentor cultures of Escherichia coli K-12.

We examined the ability of transformed Escherichia coli cells in fermentor cultures to accumulate interleukin-2 (IL-2) intracellularly under temperature-regulated control of the phage lambda pL promoter. Induction of expression was undertaken at different culture optical densities, and specific IL-2 accumulation was found to decrease with increasing cell density at induction. Induction at higher culture optical densities was also accompanied by decreased growth during induction and increased acetate accumulation in the culture medium. Experiments were undertaken to study the effect of replacing spent medium by perfusion with fresh medium both before induction and during IL-2 expression at high cell density. Improved IL-2 expression was seen only when perfusion was continued past 1.6 h after the start of induction, and it was accompanied by a significant reduction in acetate buildup. Further improvements were not seen when perfusion was continued beyond hour 3 of induction. Replenishing medium components and decreasing the concentration of diffusible inhibitors before induction did not alleviate acetate buildup, growth limitation, or limitation of IL-2 synthesis. These results suggested that accumulation of diffusible inhibitors such as acetate during induction may be a significant factor limiting IL-2 expression in high-density cultures, but other factors intrinsic to the organism or the protein also played a major role.

The Scottish First Episode Schizophrenia Study. VI. Computerised tomography brain scans in patients and controls.

This is the initial report of a prospective study by computerised tomography brain scan of first episode schizophrenia. Twenty-seven patients who met Research Diagnostic Criteria for schizophrenia were compared with volunteer controls on ventricular:brain ratio, sulcal:brain volume ratio, and the widths of third ventricle and Sylvian and interhemispheric fissures. The results provide evidence that sulcal enlargement, but not ventricular abnormalities, may be detected at first admission for schizophrenic illness, and are discussed in relation to findings from other studies.

Prevalence of spina bifida occulta in patients with functional disorders of the lower urinary tract and its relation to urodynamic and neurophysiological measurements.

OBJECTIVE: To determine the relation between neurophysiological abnormalities and the radiological detection of spina bifida occulta in patients with dysfunction of the lower urinary tract. DESIGN: Blind assessment and subsequent decoding of mixed batch of abdominal radiographs from patients with and without urological symptoms for evidence of spina bifida occulta and comparison of results with those of previous control series. SETTING: Review study among tertiary referrals to an incontinence clinic of a city hospital. PATIENTS: One hundred and thirty eight adults with proved urodynamic abnormalities in whom neurophysiological measurements were available. INTERVENTIONS: None. END POINT: Correlation of neurophysiological abnormalities in lower urinary tract dysfunction with presence and type of spina bifida occulta and level of opening of posterior sacral arcs. MEASUREMENTS AND MAIN RESULTS: On decoding radiographs those from patients without urological symptoms showed a similar prevalence of spina bifida occulta to that in the control series (631/2707 controls; 23%). By contrast, patients with urological symptoms had a significantly increased prevalence of spina bifida occulta at S1 and S2 and a higher level of opening of posterior sacral arcs. The increased prevalence of the bony defect was particularly striking in men with urgency and instability and in women with stress incontinence. No significant correlation was found between any particular neurophysiological abnormality and the presence of spina bifida. CONCLUSIONS: In patients with dysfunction of the lower urinary tract neurophysiological abnormalities may be associated with congenital dysraphic lesions in the lower lumbar spine and sacrum. There appears to be no direct causal relation between the radiological and neurophysiological abnormalities but the findings suggest a common aetiological factor.

Neurological defects of the voiding reflex arcs in chronic urinary retention and their relation to spina bifida occulta.

A group of 37 patients (24 female and 13 male) with chronic urinary retention and without demonstrable mechanical obstruction had neurophysiological measurements of their lower urinary tracts to detect any neurological abnormality which might relate to the disorder. These consisted of measurements of the electrosensitivity of the dorsal nerve of the penis/clitoris and of the urethra, measurement of the sacral reflex latencies (SRL) from dorsal nerve to urethra and to anus and between urethra and anus and EMG studies of the urethral and anal sphincters. The results suggest that female patients in particular have significant neurogenic defects in the voiding reflex arcs which find their clinical expression in detrusor underactivity with urinary retention. Plain X-rays of the renal tracts (KUB films) were also studied for the presence of spina bifida occulta. The prevalence of this defect was significantly higher than in normal controls, suggesting that in some of these patients the nerve defect might be related to a tethered cord in association with spina bifida occulta.

Neurophysiological measurements in patients with genuine stress incontinence of urine and the relation of neurogenic defects to the presence of spina bifida occulta.

Neurophysiological measurements comprising surface electromyography (EMG) of the urethral and anal sphincters, measurement of the sensory thresholds of the dorsal nerve (DN) of the clitoris and the urethra and sacral reflex latencies from the dorsal nerve to urethra and anus and from the urethra to anus were performed in 44 females with genuine stress incontinence, in order to detect any relationship between the clinical disorder and a neurogenic defect in the innervation of the muscles involved in maintaining continence. Plain X-rays of the renal tracts (KUB films) were also studied to establish whether the prevalence of spina bifida occulta was increased in this group of patients and was a likely explanation for the nerve defects. Forty-three patients were found to have abnormal neurophysiological responses and the prevalence of spina bifida occulta was 50%, which compares with a prevalence of 17% in normal female controls. Genuine stress incontinence appears to be at least partly associated with defective innervation of the lower urinary tract and it is likely that in some cases the defect may be related to the presence of spina bifida occulta.

Prevalence and patterns of spina bifida occulta in 2707 normal adults.

Plain radiographs of the urinary tract on 2707 normal volunteers were reviewed to establish the prevalence and patterns of spina bifida occulta in the normal population. Abnormalities in the formation of the posterior arch were identified in 23%, and four different patterns are described. In this group of subjects the condition was twice as common in males as in females (P less than 0.001) and commoner in younger adults. The commonest defects were either in S1 alone or involved S1 and S2 together. Isolated defects at L5 or S2 were rare. The level of opening of the posterior sacral arcs was assessed and a high level of opening was shown to correlate with the presence of spina bifida occulta.

Brain water measured by magnetic resonance imaging. Correlation with direct estimation and changes after mannitol and dexamethasone.

Brain water content was measured in tissue samples taken at operation from 19 patients with intrinsic cerebral tumours imaged preoperatively by magnetic resonance. A high correlation (r = 0.94, p less than 0.0001) between white matter water content and the longitudinal relaxation time (T1) enabled water content to be estimated from T1 to within 4%. 11 patients received dexamethasone and improved clinically but their T1, and thus brain water content, was unchanged an average of 6 days later. Intravenous infusion of 20% mannitol in 11 patients significantly reduced T1 in oedematous white matter and tumour within 15 min of administration, and by 30 min the T1 of oedematous white matter had fallen to a mean of 32.4 (SEM 7.1) ms, corresponding to a reduction in water content of 1.4 (0.3)%.

Correlation of human NMR T1 values measured in vivo and brain water content.

A relationship has been demonstrated between nuclear magnetic resonance (NMR) longitudinal relaxation times (T1 values) obtained in vivo in both normal and oedematous (peritumoral) brain tissue, and measurements of brain water obtained by gravimetric analysis of operative samples. Significant correlations were found in seven patients in both cortex (r = 0.97, P less than 0.001) and white matter (r = 0.92, P less than 0.001). These findings suggest that NMR may prove a useful technique for monitoring brain oedema.