Absence of seasonal variation of estrogen receptor levels in human breast cancer tissue.

The concentration of estrogen receptors was measured in 979 human primary breast cancer tumors obtained during 4 consecutive years. Of these tumors, 631 were classified receptor positive and originated from 212 premenopausal and 419 postmenopausal patients. A modified EORTC procedure was used to quantify the receptor content. Several statistical analyses were performed on the data from the premenopausal and postmenopausal patients separately and on the combined data. The results of these analyses do not support the existence of any periodicity in the estrogen receptor level which is significant and consistent from year to year.

Magnetic resonance imaging of the cerebral aqueduct. Signal intensity time curves demonstrated by fast acquisition with multiple excitation (FAME).

Using cardiac-gated fast acquisition with multiple excitation (FAME), time curves of the cerebral aqueduct signals were derived in 19 healthy volunteers and 14 patients. A mean curve of the normal subjects was determined during systole. A relatively stable point of time was found at 270 msec after the R-wave supposed to be the reversal of the flow of cerebral-spinal fluid in the aqueduct. Different curves were noticed in complete aqueductal obstruction (n = 2); in other pathologic states, such as cerebral tumor (n = 3), normal pressure hydrocephalus (n = 3), and brain atrophy (n = 1), no different signal time curves were observed. Parameters such as aqueduct diameter, cerebro-spinal fluid volume and brain compliance are probably other important factors in aqueduct liquor flow.

B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma involving bone marrow with an interfollicular pattern.

B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) may involve the bone marrow in nodular, interstitial, diffuse, or mixed patterns. However, B-cell CLL/SLL associated with large reactive germinal centers (the so-called interfollicular pattern) involving the bone marrow is not reported. We describe 2 examples of B-cell CLL/SLL that subtotally replaced the bone marrow with an interfollicular pattern. In both cases, the neoplasms were composed of small round lymphoid cells; proliferation centers also were present. The neoplasms surrounded large reactive germinal centers that were devoid of peripheral mantle zones. The germinal centers were paratrabecular and nonparatrabecular in case 1 and nonparatrabecular in case 2. Flow cytometry immunophenotypic studies done on bone marrow aspiration samples of both cases showed a uniform population of neoplastic cells positive for pan-B-cell antigens and the CD5 and CD23 antigens. Immunohistochemical studies done on bone marrow biopsy sections supported the flow cytometry results and demonstrated that the germinal centers were negative for BCL-2. B-cell CLL/SLL may rarely involve the bone marrow with an interfollicular pattern. Knowledge of this pattern will prevent confusion with follicle center lymphoma and large cell transformation, both of which initially were considered in the differential diagnosis of these cases.

Oral contraceptive use and secondary amenorrhea.

Among 1099 patients seen over an 8-year period for amenorrhea or oligomenorrhea, 115 (10.5%) had developed amenorrhea after ceasing oral contraception. These patients were the subject of a special study. Those who were treated received either clomiphene alone, hMG/hCG therapy, or both. There was no correlation between the incidence of either spontaneous or treatment-induced ovulation and menstruation and the duration of use of oral contraception, previous parity, or the nature of prior menstrual cycles. The incidence of treatment-induced resumption of menses was essentially the same as that for spontaneous resumption. An average duration of 30 months of oral contraceptive use did not significantly affect urinary excretion levels of estrogens and gonadotropins.

Diagnostic value of orthopedic tests in patients with temporomandibular disorders.

For a better definition of diagnostic subgroups of patients with temporomandibular disorders (TMD), clinical orthopedic tests have been developed for the masticatory system, for use together with the commonly used active movement tests and palpation. In the present study, the characteristics and additional diagnostic value of four orthopedic tests--namely, passive opening, the joint play test, compression, and the static pain test--were determined for a patient group, diagnostic subgroups, and a control group. Significant differences among the scores of the tests in the different groups indicated that all six orthopedic tests contributed to the diagnostic process. Because of the close functional relationship of the masticatory system, most information was obtained when patients indicated where pain occurred during the different tests. Logistic regression techniques were used for determination of the relative diagnostic value of each orthopedic test in the diagnostic process. Active movement was the most powerful test for distinguishing the different subgroups. Palpation and passive opening were additionally useful for distinguishing between patients and control subjects and between the subgroups of arthrogenous and myogenous patients. Besides active movement, both compression and the joint play test played a minor role in the distinction of subgroups of arthrogenous patients. It may be concluded that in routine clinical practice, besides history taking and conventional radiography, a functional examination consisting of active movements, passive opening, and palpation provides valuable diagnostic information. In patients with a specific diagnostic problem, one of the other additional tests might be indicated.

Age specific sensitivity and sojourn time in a breast cancer screening programme (DOM) in The Netherlands: a comparison of different methods.

STUDY OBJECTIVE: To estimate age dependent sensitivity and sojourn time in a breast cancer screening programme by different methods. POPULATION AND METHODS: The study population comprised women participating in the DOM project--the Utrecht screening programme for the early detection of breast cancer. Breast cancer screening prevalence data and incidence rates after a negative screen were used to estimate age specific sensitivity and mean sojourn time by different methods. MAIN RESULTS: Maximum likelihood estimates of the mean sojourn time varied from one year for women aged 40-49 years to three years for women over the age of 54. Sensitivity was calculated by two different methods. Both pointed to a high sensitivity (around 100%) in the age groups 40-49 and over 55 years. For women aged 50-54, the sensitivity varied from 63% to 100%, depending on the method used and the value of the baseline incidence rate. CONCLUSIONS: Different methods of estimating sensitivity pointed at an acceptable level in women over and under 50 years of age. Sojourn time, and thus the tumour growth rate, seemed to be age dependent. This could mean that the until now disappointing screening results in women under 50 years of age are not so much a result of low sensitivity as of a relatively high tumour growth rate in younger women.

Distribution of tumors in the retina in hereditary retinoblastoma patients.

We have compared the location of the ocular tumors in hereditary retinoblastoma in relation to the age of the patients at time of diagnosis. Eighty fundus drawings were analyzed from 59 hereditary patients containing I 59 tumors. At the time of diagnosis, indirect ophthalmoscopy was performed under general anaesthesia in all patients and standard drawings of the retina were made depicting the number and relative location of all tumors. The distance between the center of the tumor and the center of the macula was measured and plotted against the age of the patients at time of diagnosis. The results show that the distance between the center of the tumor and the center of the macula at time of diagnosis increases with age during the first seven months after birth.

Outpatient exercise training in children with cystic fibrosis: physiological effects, perceived competence, and acceptability.

Exercise training is currently advocated as part of the treatment of patients with cystic fibrosis (CF). However, data are few that document physiologic benefits or changes in patients' perceptions of long-term training programs in children with CF. The aim of this study was to investigate the effects and acceptability of a home cycling program in children with CF. Fourteen patients (9 boys, 5 girls) with CF, mean (SD) age 14.1 (2.0) years, with mild to moderate impairment of lung function (forced expiratory volume in 1 s, mean (SD) 58.3 (16.3)% of predicted) were studied for 1 year. The first half of the study year was used to obtain baseline values at 0 and 6 months. During the second half of the year, a cycle program was carried out 5 times a week, for 20 min each day at a level of work that resulted in a heart rate of 140-160 beats/min. Once a week the cycle program was supervised by a physiotherapist. Measurements were repeated at 12 months. Effects of the exercise program were measured in terms of lung function, nutritional status, growth, muscle strength, exercise performance, perceived competence, and attitude towards the training program. Differences between the changes during the 6-month training period as compared to the 6-month control period were analyzed by multivariate statistics and nonparametric tests. Statistically significant differences (P < 0.05) between the two periods were found with respect to muscle strength of knee extensors and ankle dorsiflexors, and with respect to maximal oxygen consumption per kg body weight as well as per kg fat free mass. All changes were positive. No adverse effects were found. Perceived competence showed significant positive changes in feelings about physical appearance, general self-worth, and Total Perceived Competence Score. Scores concerning perceived acceptability of the program were significantly lower at the end of the training period; however, patients reported that they did want to continue with other sorts of training. We conclude that an exercise training program in the home can produce beneficial effects on oxygen consumption, muscle force, and perceived competence in children with CF. However, acceptability of the program was low, suggesting that long-term adherence would be poor, and hence, other sorts of training need to be identified.

The small-cell variant of mycosis fungoides. A clinicopathological and quantitative electron microscopic study on 14 patients.

Small-cell variants of Sézary syndrome and mycosis fungoides (MF) have been described. However, in these studies the nuclear area of the small-cell variant of MF (SC-MF) as compared to histological classical MF (CL-MF) was not characterized objectively by quantitative electron microscopy. In a 14-year follow-up period, of a total of 76 patch/plaque stage MF patients seen in the Department of Dermatology of the University Hospital Utrecht, 14 (18%) had an infiltrate composed of atypical lymphocytes characterized by a distinctly smaller cell diameter and smaller, hyperchromatic, deeply indented nuclei as compared to the usual cell type of MF. The aim of the investigation was to confirm this observation objectively using quantitative electron microscopy (morphometry) and to define SC-MF as compared to CL-MF. The study was performed on the 14 patients with SC-MF, and 10 patients with clinical and histological CL-MF and 4 patients with chronic eczema. Electron micrographs of sections obtained from each biopsy were analysed by computer to produce the following data: a nuclear contour index (NCI), the mean nuclear area (MNA), the mean nuclear area of the cells above the 75th percentile (P75NA) and the percentage of cells larger than 30 microm2. The values of MNA differed significantly between patients with SC-MF and those with CL-MF (17.6 vs 23.2 microm2; P = 0.02), as did the values of P75NA (20.7 vs 27.9 microm2; P = 0.01). The NCI of the SC-MF and CL-MF patients were similar. These results are consistent with our observations that SC-MF does indeed exist.

Recurrent syncope and quadriplegia.

A 72-year-old man had posturally induced syncopal episodes, followed by quadriparesis, coma, and death. Neuroimaging studies supported the clinical diagnosis confirmed by neuropathological findings.

Fate of the aortic root after arterial switch operation.

OBJECTIVE: Concerns have been voiced about possible dilation and insufficiency of the neo-aortic valve after the arterial switch operation (ASO). AIMS: To determine growth of the neo-aortic valve and the aortic anastomosis after ASO and the prevalence of insufficiency or stenosis. PATIENTS AND METHODS: Since 1977, 144 consecutive patients (pts) underwent ASO for transposition of the great arteries (TGA). Median follow-up was 8.65 years (0.1--22.5 years). Simple TGA was present in 97 pts and 47 had TGA with ventricular septal defect (VSD). Detailed echocardiography included measurements of aortic diameter at four levels. The 608 measurements were compared with published normal values. RESULTS: The mean aortic valve z-score was 1.5, without significant change with age (P=0.75). Under 4 months, mean valve z-score was 0.63+/-2.20, between 5 and 12 months 2.56+/-2.30 (P<0.0001). Gradual growth occurs thereafter. The aortic sinus follows an identical growth pattern. The aorta at the anastomosis, is initially smaller than normal (z-score -0.64). After 4 months the z-score is 0.83, followed by continued growth of 0.1 z-score per year. At the last visit, the aortic valve z-score was above 2 in 51 patients, between -2 and 2 in 72 and less than -2 in six patients, none of whom had a flow velocity above 2 m/s. z-score of patients with VSD remained above those without VSD (P<0.0001). Aortic insufficiency was grade 2/4 in three patients, grade 3/4 in one and grade 4/4 in one. No patient developed aortic stenosis. CONCLUSION: After ASO the neo-aortic valve and sinus are larger than normal, representing the natural size difference in the prenatal situation and influence of associated cardiac malformations. In the first year of life, rapid dilatation of the new aorta is observed, followed by growth towards normalization of the valve and sinus size. Stenosis at the anastomosis was not observed. Aortic dilatation by itself is rarely associated with significant insufficiency.

Effects of calcium and magnesium intakes and feeding level during the dry period on bone resorption in dairy cows at parturition.

A study was made of the influence of low and high calcium intakes at two feeding levels (experiments 1 and 2), and of different magnesium intakes (experiment 3) during the dry period, on the cellular resorptive activity in bone of dairy cows at parturition. In experiment 1 (26 cows) the feed intake was 1.12 times maintenance and the calcium intake was either 13.0 g d-1 or 83.5 g d-1. In experiment 2 (33 cows) the feed intake was 1.9 times maintenance and the calcium intake was either 26.4 g d-1 or 87.2 g d-1. In experiment 3 the cows feed intake was 1.4 times maintenance, the calcium intake was 71 to 72 g d-1 and the magnesium intake was either 16.6 g d-1 or 71.0 g d-1. Bone biopsies were taken from the tuber coxae between three and eight hours after parturition. In experiment 1 the cellular resorptive activity in bone from older cows was higher in the cows receiving the low calcium diet. In experiment 2 the differences between the bone resorptive activities of the two groups were small. In experiment 3 the bone resorptive activity was lower in the cows with a deficient supply of magnesium. There were significant relationships in young cows, but not in older cows, between the cellular resorptive activity in bone and the rate of calcium mobilisation measured biochemically. These results suggest that in older dairy cows bone resorption makes only a minor contribution to the total rate of calcium mobilisation at parturition and is therefore of minor importance for the prevention of periparturient hypocalcaemia.

Ocular squamous cell carcinoma in Simmental cattle in Zimbabwe.

In Zimbabwe, ocular squamous cell carcinoma (OSCC) was frequently observed in 5 breeding herds of Simmental cattle, a Bos taurus breed originating from Switzerland. In these herds, initial signs of OSCC were already noticeable in cattle about 3 years old. Gradually, OSCC prevalence increased, and 36 to 53% of cattle over 7 years old had 1 or more tumors. More tumors developed in Simmental cattle with periorbital white skin than in cattle with periorbital pigmented skin. Other breeds of cattle (eg, Friesian) also are partly white-faced and live in Zimbabwe in a comparable environment; yet, OSCC prevalence was lower in those breeds.

Effects of low and high calcium intake prepartum on calcium mobilization rate around parturition in dairy cows.

Forty-one dairy cows were fed a low (LCa-13 g/d) and a high (HCa-83.5 g/d) calcium ration in the 8 weeks prior to parturition and the effect on the Ca mobilization rate around parturition was studied. Plasma Ca values were stable in the LCa group around parturition. In the older cows of the HCa group a very slight decrease in the mean plasma Ca was observed: 2.58 mmol/l at 12-36 h ante partum decreased to 2.38 mmol/l at parturition. Hypocalcaemia, which commonly occurs around parturition, did not occur in 40 of the cows. A subclinical hypocalcaemia (1.8 mmol/l) occurred in one cow (parity 10) from the HCa group. To assess the efficiency of Ca mobilization, a severe hypocalcaemia (1.0 mmol/l) with clinical signs was induced by means of Na2EDTA infusion (0.90 mmol/min), starting at 10 h post-partum. The older cows in the LCa group required more Na2EDTA than those in the HCa group. Higher urinary hydroxyproline excretion in the week before parturition in the LCa than in the HCa group suggested a higher bone turnover. Plasma PTH levels around parturition were not significantly different between the groups. The amount of colostrum milked out in the first 10 h post-partum did not influence Ca homeostasis around parturition. The results contradict those of many other experiments in which hypocalcaemia was observed in cows ingesting high levels of Ca. It is concluded that the restricted feed intake prepartum possibly had a favourable effect on Ca homeostasis.

[The usefulness of the refractometer in the assessment of colostrum and various factors affecting serum gamma globulin levels in newborn calves]. / Een onderzoek naar de bruikbaarheid van de refractometer bij de beoordeling van de biestverstrekking en naar een aantal factoren die van invloed zijn op het serum-gammaglobulinegehalte bij pasgeboren kalveren.

The effects of a number of factors on the concentration of gamma globulins in the serum of newborn calves were studied in 181 calves from six different dairy farms as was also the use of the refractometer test in controlling the ingestion of colostrum. The refractometer test was found to be reliable in controlling the concentration of gamma globulins in the serum of calves up to the sixth day of life. The factors 'time the first colostrum was ingested', 'amount of first colostrum ingested' and the 'concentration of gamma globulins in the colostrum' were found to account for 23.5 per cent of the variations in serum gamma globulin concentration; this became 42.4 per cent when the 'system of administration' and the 'farm-bound factors' were also taken into account. The first colostrum is best ingested when it is offered in a pail or bottle provided with a nipple. Calves of heifers were found to show a lower concentration of gamma globulins in the serum than did calves of older cows.

Prediction of independence and intelligence at birth in meningomyelocele.

OBJECTIVE: The aim of this research is to compute a prediction of the future intelligence of every neonate with a meningomyelocele (MMC) on the day of birth to inform the parents. Earlier research revealed that the variables ventricle size, open arch above vertebra lumbar 3, a very small or a very large head can be attended by an IQ below 85 points: the turning point between dependence and independence. METHODS: Until now no research has been done combining the values of influencing variables in one equation. Our study used the equation of multiple longitudinal linear regression. For reference, data from the files of 148 neonates born in the years 1960-1980 were compared with those of Dutch children sampled by Verger. The working hypothesis that the IQ level is directly related to congenital deformities of the nervous system needs to be tested. As standard the values of variables at birth, the head circumference and length, the size of the ventricles and the highest open vertebral arch, are to be used. RESULTS: The Wisc-R of the MMC cohort had a mean of 84 points and 55% had an IQ above 85. The correlation computation of the values of all available variables with the values of the measured Wisc-R revealed the significance of the neuroanatomical variables, size of ventricle and level of the highest open vertebral arch and for the anthropomorphic variables Length and Length/Circumference. To establish the relationship between the Wisc-R value and the values of the significant variables an equation with the multiple linear regression method was used. The measured IQ is made dependent on the significant variables size of ventricle, level of highest open arch and quotient Length by Circumference. This equation produces a value called predicted IQ. The predicted IQ was 92%, the same or nearly the same as the measured Wisc-R IQ. CONCLUSION: This conformity of the measured IQ and the predicted IQ proves the possibility of using these birth data for prediction.

Bandage lenses: collagen shield vs. hydrogel lens.

We compared the behavior of a 70% water content hydrogel lens to a 24-hour collagen shield in 11 healthy volunteers. Corneal swelling was measured by means of ultrasound pachymetry. After 24 hours of continuous wear, mean corneal thickness increased 26.4 microns (4%) with the hydrogel lens and 17.9 microns (3%) with the collagen shield, a difference that was not significant at the P less than 0.05 level. Both the hydrogel lens and the corneal shield were well tolerated. Ocular discomfort was slightly greater with the collagen shield. We assume that this is related to the reduction in visual acuity and subsequent loss of binocular vision with the collagen shield. The development of a fully transparent collagen shield would enhance patient compliance and facilitate assessment of the corneal and intraocular status in eye disease.

Renography: prediction of blood pressure after dilatation of renal artery stenosis.

In 60 patients with hypertension and unilateral renal artery stenosis (URAS) radio-hippuran renograms were performed before and 6 weeks after anatomically adequate percutaneous transluminal angioplasty (PTA). Two characteristics of the renographic curves have been analyzed: the difference in time to peak (DTP) between the affected and contralateral kidneys, which would be expected to be positive in blood flow impairment, and the relative hippuran uptake (RHU) in the second minute by the affected kidney as compared with the total uptake by both kidneys: this would be less than 50% in the case of stenosis. Before PTA, both variables were predominantly abnormal. The DTP did not predict the blood pressure response to PTA. The group of patients with a RHU between 25 and 45% comprised all cured patients and predicted a more favorable response of the blood pressure than a RHU of less than 25% and especially more than 45% which group contained 83% patients whose blood pressure failed to respond after PTA. After PTA the DTP did normalize in the majority of patients, but this was not related to the blood pressure response. The RHU increased in patients in whom it had been low initially, but frequently remained low (less than 45%). The increase of the RHU was significantly higher in patients with a favorable blood pressure response. Pretreatment with captopril did intensify the abnormal curves of hippuran and of DTPA renograms in 6 patients with URAS who did respond favorably to PTA. There was no such deterioration in 2 patients whose blood pressure did not change sufficiently after PTA or in 4 patients without renal artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Symptomatology of patients with oligodontia.

The aims of the present study were: (i) to identify the association of patterns of congenitally missing teeth with combinations of ectodermal symptoms occurring in patients with oligodontia; and (ii) to propose a diagnostic scheme for the general practitioner. For this study 167 patients with oligodontia, both isolated and as part of a syndrome, and 135 healthy controls were interviewed and documented. Chi-square tests, logistic regression and correspondence analysis were used to evaluate and test differences between the groups and associations between the congenitally missing teeth and ectodermal symptoms. No significant differences were found between the control group and the patients with isolated oligodontia with exception of the skin. It could be concluded from the present study that there were no clear associations between congenitally missing teeth, either individually or patterns, and the ectodermal symptoms or combinations of ectodermal symptoms. However, it could be concluded that if the most stable teeth are missing, or if the number of missing teeth is large the patient should be examined carefully for symptoms of ectodermal dysplasia. Using logistic regression a patient could be classified as having isolated oligodontia or oligodontia as part of a syndrome with a specificity and sensitivity of 88.2%.

Intracranial spaces in childhood macrocephaly: comparison of length measurements and volume calculations.

CT scanning was done to calculate the volume of intracranial spaces in children with the purpose of developing a reliable method of differentiating the various causes of macrocephaly. The technique has been applied to the CT scans of 60 apparently normal children, and the resulting graphs show the normal relationship between intracranial volumes and age from birth to 15 years. The measurements for 25 children with macrocephaly and normal rate of growth of head circumference were then compared with the reference values. It was possible to make accurate differentiations between megalencephaly, extraventricular hydrocephalus and communicating hydrocephalus. The advantage of this technique in relation to length measurements on CT scans is discussed. The authors advocate the estimation of the product of head circumference and head height as a much more reliable indication of normal and deviant head-size than head circumference alone.