The Holocene occurrence of Acipenser spp. in the southern North Sea: the archaeological record.

Archaeological sturgeon remains from the southern North Sea basin used to be automatically attributed to Acipenser sturio, since this was the only acipenserid species believed to occur there. These species identifications, however, were in need of revision after a growing number of indications were found for the historical presence of Acipenser oxyrinchus in western Europe. In this study, morphological and genetic data on sturgeon remains from archaeological sites along the southern North Sea are revised. A large number of Dutch, Belgian, British and some French archaeological sturgeon remains, dating from the Mesolithic up to Late Modern times, are morphologically examined and fish sizes are reconstructed. This study of >7000 acipenserid bones proves the sympatric occurrence of European sturgeon A. sturio and Atlantic sturgeon A. oxyrinchus in the southern North Sea at least since the Neolithic (fourth millennium BC onwards), with A. oxyrinchus remains always outnumbering those of A. sturio. Human influence is documented by the decrease in finds through time, but no clear evidence was found for a diachronic change in fish lengths that could possibly be related to fishing pressure.

Expression of epidermal growth factor receptor in breast carcinoma.

A series of 90 patients with primary operable breast cancer and with up to 36 months of follow up were investigated for expression of epidermal growth factor receptor (EGFR) in their tumours by immunocytochemical staining with the monoclonal antibody EGFR 1. Tumour samples were snap frozen in liquid nitrogen immediately after resection and subsequently stained using a standard indirect immunocytochemical method. Tumour staining was assessed by two observers and scored on a four point scale (0-3). Thirteen (14%) tumours showed positive immunoreactivity. A strong correlation between distinct EGFR expression and short disease free interval was observed. Significant correlations were also shown with oestrogen and progesterone receptor expression and tumour nuclear size. No significant association was found with tumour size, lymph node stage, and histological grade. The association with disease free interval remained significant in multivariate analysis.

A prospective study of patient choice in treatment for primary breast cancer.

One hundred and sixty-three patients with primary breast cancer were prospectively studied. Using recently developed selection criteria 91 patients were offered a choice of treatment. Forty-one chose to undergo conservation treatment and 47 chose to undergo simple mastectomy. In those women who were offered a choice of treatment there was a significant tendency for younger patients to choose breast conserving treatment.

In situ carcinoma of the breast.

The optimal management of ductal carcinoma in situ of the breast is controversial. With the introduction of the National Mammographic Breast Screening Programme the condition will be encountered more frequently. We have reviewed 76 patients from a 12-year period treated by one surgeon (R.W.B.) at the Nottingham City Hospital. Fifty-nine patients had either ductal carcinoma in situ or lobular carcinoma in situ; 17 patients had Paget's disease. The mean age at diagnosis was 54 years and the commonest mode of presentation was with a palpable breast lump. Pre-operative mammography was performed in 31 patients with ductal carcinoma in situ and 28 were reported as showing malignancy. Patients with a lesion in the breast parenchyma were treated either by mastectomy (simple, subcutaneous or 'wedge'--see text) or by lumpectomy and radiotherapy. Patients with Paget's disease were treated by simple mastectomy, wedge mastectomy or a cone excision of the nipple and underlying tissue. The mean follow-up period was 65 months. Patients treated by any of the procedures less than simple mastectomy had a significant chance of developing local recurrence. A detailed histological review was made and grade, microinvasion, calcification, necrosis and completeness of excision were assessed for each tumour. None of these factors was correlated with subsequent local recurrence.

An evaluation of differences in prognosis, recurrence patterns and receptor status between invasive lobular and other invasive carcinomas of the breast.

One-hundred-and-seventy-one patients with invasive lobular carcinomas have been matched with 342 patients with non-lobular invasive carcinomas for lymph node stage, tumour differentiation and patient age on a one to two basis. The two groups were investigated for differences in prognostic factors, survival, disease-free interval, metastatic patterns, receptor status, response to endocrine therapy after distant metastases and bilateral cancer rates. Patients with lobular carcinomas survived significantly longer than patients with carcinomas of no specific type, particularly in survival from the time of diagnosis of distant metastases; lobular carcinomas more often responded to endocrine treatment for systemic disease. Lobular cancers had a significantly higher rate of local recurrence, particularly after treatment by excision and breast irradiation. No differences were found between the two groups with respect to regional or distant recurrence rates, distant organ involvement patterns, distant metastatic free intervals and receptor status. Bilateral cancer was more frequent in patients with lobular carcinoma.

Ki67 immunoreactivity in breast carcinoma: relationships to prognostic variables and short term survival.

Immunoreactivity of the monoclonal antibody Ki67, which recognizes an antigen expressed in cells active in the cell cycle, has been investigated by immunocytochemistry in a series of 67 primary breast cancers. The percentage of tumour cell nuclei stained by Ki67 (labelling index) was related to tumour histological grade, mitotic frequency, oestrogen receptor status and tumour type. No correlation was found with patient age, tumour size or lymph node stage. A high Ki67 labelling index was significantly associated with diminished patient survival and disease-free interval, which demonstrates an important role for this monoclonal antibody as a prognostic marker in breast cancer.

Agricultural machinery injuries in Ontario, 1985-1996: a comparison of males and females.

Males and females on farms perform different types of work. This study investigated whether certain injuries experienced by women and men on farms also differed. Gender-based comparisons were made of fatal and hospitalized agricultural machinery injuries that took place in Ontario, Canada, between 1985 and 1996. Data compiled by the Canadian Agricultural Injury Surveillance Program (CAISP) were used. Comparisons were based on 2,333 injury records and six descriptors: age group, time period, agricultural season in which the injury occurred, machinery involved, mechanism of injury, type of machinery, and admission category (where applicable). Distributions of injuries between males and females were statistically different by age group, agricultural production season, and mechanism of injury. These and other differences suggest that gender-specific injury patterns exist. Future studies should examine thefactors contributing to these differences, including degree and duration of exposure to agricultural machinery.

The Nottingham breast self-examination project.

The Nottingham breast self-examination (BSE) project forms a part of the British Trial of Early Detection of Breast Cancer which compares mammographic screening, BSE and control areas. Presented here is an analysis of the Nottingham figures. A total of 89,000 women aged 40-64 were invited for lectures in BSE and 28,000 attended (42%); the corrected attendance allowing for register inaccuracies is around 55%. In women invited for education since the scheme began in 1979 (study) 751 cancers have been diagnosed. The 751 cancers occurring in the same health district and age group, working chronologically backwards from 1979 have been identified (control). Prognostic factors (size, node involvement and grade) are improved in the study group; however, at the present time of follow-up the case survival curves do not separate. A case control study shows that women aged 50-65 who attended for education have a relative risk of death from breast cancer of 0.66 (0.45-0.97) in comparison with those who did not attend (p = 0.025). The figure for women aged 40-49 is 0.85 (0.50-1.46). A programme of BSE is cheap to run, may give a survival advantage and should be added to mammographic screening programmes, especially when the interval is beyond 18 months.

Mammography in symptomatic breast disease.

The contribution of mammography to the diagnosis of breast cancer was examined in 5080 patients with various breast symptoms. There were 562 breast cancers within this group. The sensitivity of mammography was 88%. Only 18 cancers were detected by mammography alone, and of these 3 were in the other breast. 7 of the remaining 15 cancers had clinical signs which would have been pursued to open biopsy in the absence of mammography. Clinical examination is of paramount importance in the management of patients with symptomatic breast disease. Mammography is most useful when applied in specific situations rather than to screen every patient with breast symptoms.

DNA ploidy in fibroadenomas (abstract).

There is now a considerable body of literature reporting DNA quantification in a variety of malignancies. There have been few reports, however, of such measurements in benign lesions.

The action of Solcoseryl on two glycolytic enzymes of several organs of the irradiated mouse.

The blood extract Solcoseryl (SO), when administered daily in i.p. injection to mice adapted to ambient temperature of 32.5 degrees C enhances within a period of 5 days the activities of the enzymes LDH and G-6-PDH of liver, kidney, testes and thymus in an oscillatory way. The changes of enzyme activity resulting from whole body irradiation with gamma-rays and exhibiting mostly a tendency towards diminution are abolished and the activities restored to values lying in between those obtained with sole SO treatment or irradiation alone, respectively, when following irradiation SO is again applied for a period of 3 days.

Enzyme histochemical, biochemical and metabolic effects of Solcoseryl in connection with its radioprotective capability.

The lethal irradiation with gamma-rays (LD 100/30) of adult mice at ambient temperature of 32.5 degrees C heavily alterates the pattern of LDH in liver. In close correspondence with the radioprotective effect of Solcoseryl on the survival rate of irradiated mice -- which amounts to 100% as compared with 40% survival of solely heat adapted animals -- Solcoseryl normalizes the LDH distribution both histochemically and biochemically. Since Solcoseryl alone generally enhances enzyme activity the normalization observed is obviously attributable to an intrinsically regulatory property of this natural compound.

Blood transfusion and survival in colorectal cancer.

PURPOSE: This study examined the effect of blood transfusion on the prognosis of patients undergoing surgery for colorectal cancer. METHODS: Potentially curative resections for colorectal cancer were performed in 266 patients who were followed prospectively, with a minimum follow-up of 41 months. They were divided into transfused (n = 121) and nontransfused (n = 145) groups according to their perioperative blood transfusion requirements. RESULTS: There were significantly more rectal tumors (chi 2 = 9.5, df = 1, P = 0.002) and fixed tumors (chi 2 = 4.5, df = 1, P = 0.03) in the transfused group. There was no statistically significant difference between the two groups with regard to recurrence-free survival (chi 2 = 1.1, df = 1, P = 0.3) and overall survival (chi 2 = 2.8, df = 1, P = 0.09). CONCLUSION: In this study we have found no statistically significant effect of perioperative blood transfusion on the prognosis of colorectal cancer patients.

Factors influencing local recurrence after excision and radiotherapy for primary breast cancer.

Between November 1979 and December 1986, 263 patients were treated for primary breast cancer by local excision and radiotherapy at the City Hospital, Nottingham. Local recurrence within the treated breast occurred in 56 patients (21 per cent), in 18 (6.8 per cent) of whom it was gross and uncontrollable. An analysis of clinicopathological features shows patient age, nodal status, tumour size, presence of definitive vascular invasion, adjacent ductal carcinoma in situ and grade to be predictive of local recurrence. A Cox's multivariate analysis of these factors shows the first four to be independently significant. The factors can be combined as a prognostic index which allows identification of patients at high risk of local recurrence. On the basis of these findings we have altered our selection policy for patients suitable for breast conservation.

Results from a seven-year programme of breast self-examination in 89,010 women.

This report presents the results of a study into the effect of breast self-examination (BSE) in a large defined population within the City of Nottingham since 1979. We have examined the effect of breast self-examination in a group of patients invited to attend for education in BSE compared with a group of historical controls. No overall survival advantage has been demonstrated for the study group but within the latter group patients who had attended for instruction in BSE had a significantly better actuarial survival at 13 years than those who did not (P less than 0.001). Patients in the study group presented with significantly smaller tumours which were more likely to be of better histological grade and lymph node stage. A case-control study has demonstrated the value of attendance for BSE particularly in post-menopausal women. Although BSE is not as sensitive as mammographic screening, patients who practise it present with more favourable tumour characteristics and its value in post-menopausal women supports its use as an adjunct to mammographic screening.

Microdochectomy for single-duct discharge from the nipple.

Microdochectomy has been the accepted treatment for single-duct nipple discharge. Review of 97 consecutive patients undergoing microdochectomy between 1980 and 1987 revealed a total of eight patients with ductal carcinoma in situ. All of these had pre-operative mammography, results of which were highly suspicious of malignancy in six patients. Tiny foci of ductal carcinoma in situ were found in the two patients with normal mammograms. We suggest an expectant policy in cases where the mammogram is normal, omitting routine microdochectomy.

Cytological grading of breast carcinoma--a feasible proposition?

Fine needle aspiration cytology (FNAC) of the breast is widely used in the diagnosis of breast carcinoma. In some centres this is sometimes the only diagnostic procedure performed prior to definitive treatment. A grading system based on cytology would be helpful in the selection of patients for appropriate therapy. The aim of this study, therefore, was to devise such a system for grading breast carcinoma based on cytological features alone. The features assessed were the degree of cell clustering, nuclear pleomorphism, nuclear diameter, the presence of multiple, easily visible nucleoli and necrosis. Cytological features were compared to the histological grade of the tumours following excision. Discriminant analysis showed that the features with the closest correlation with histological grade were nuclear diameter, nuclear pleomorphism and the presence of nucleoli. A scoring system based on these three parameters enabled the classification of tumours into high and low cytological grades which showed a close correlation with histological grade.

Evaluation of the prognostic value of triple node biopsy in early breast cancer.

The prognostic information obtained by triple node biopsy (low axillary, apical axillary and internal mammary nodes) in 693 patients with early breast cancer has been reviewed. Results show that tumour site within the breast influenced which nodal groups were involved. The low axillary node contributed the most useful prognostic information. The involved apical node carried the worst prognosis. Either the internal mammary node or a low axillary node when positive alone carried the same prognostic weight. When both nodes were positive the prognosis declined to the level associated with apical node positivity. A double node biopsy of the low axillary node and either the apical or the internal mammary node gave the same maximum prognostic information as a triple node biopsy. The triple node biopsy technique can be used to divide patients into groups with vastly different prognoses.