Prophylaxis for CMV should now replace pre-emptive therapy in solid organ transplantation.

Cytomegalovirus is a significant cause of morbidity and mortality in transplantation. Controversy exists concerning whether prophylactic or pre-emptive therapy is the optimal strategy for preventing CMV disease. In addition, CMV impacts the transplanted graft, transplant recipient and transplant programme beyond just causing CMV disease; thus questioning whether 'asymptomatic' CMV replication should also be prevented. In this Forum article, prophylactic therapy is advocated as the preferred approach for preventing CMV disease. Prophylactic therapy has a large body of supportive controlled clinical studies demonstrating its efficacy and cost effectiveness. In addition, prophylactic therapy has the benefit of preventing other herpes viruses and other opportunistic superinfections by reducing the immunosuppressive effects of CMV. Moreover, a small but growing body of information suggests that prophylactic therapy may also have a beneficial effect on organ outcomes, including rejection. In contrast, pre-emptive therapy is limited by its reliance on intensive surveillance, which presents logistical difficulties and requires perfect patient compliance. Ambiguity still exists concerning the best surveillance method and its effect on patient-care costs. Each proposed diagnostic approach has limitations, which are affected by the prevalence of CMV in the population studied, the particular assay employed, and the frequency of surveillance. The suggested benefits of pre-emptive therapy, such as decreased cost, fewer adverse medication effects and less antiviral resistance have not been adequately proven in head-to-head clinical studies. We therefore support the proposition that transplant patients at risk for any level of CMV replication will significantly benefit from effective antiviral prophylaxis.

A cell line derived from a clinically benign phyllodes tumor: characterization and implications.

Phyllodes are uncommon tumors of the breast. Improved understanding of their behavior is hampered by the paucity of good laboratory models. We have developed two cell lines, by both xenograft and direct cell culture, derived from a histologically benign phyllodes tumor. Both cell lines have the same characteristics and growth kinetics. They grow as monolayers of spindle-shaped cells, with surface markers consistent with a mesenchymal origin. They do not express either estrogen or progesterone receptors. The cells have a relatively short doubling time of just over 1.5 days, and show a stimulatory effect with the addition of insulin. Karyotype analysis reveals the absence of one X chromosome.

Growth and metastasis of human breast carcinomas with Matrigel in athymic mice.

Immunodeficient athymic mice with human tumor xenografts provide an important in vivo experimental model for cancer research. However, only a limited number of tumor types grow in these animals. For human breast carcinomas, the incidence of tumor-take is 6-15%. Recently, increased incidence of xenograft development in mice has been reported for various human tumors when the tumors were coinjected with Matrigel. We studied the development of human breast carcinoma xenografts in athymic mice with and without coinjection of Matrigel. Tumors developed in only 7.3% of enzyme-dispersed tumors injected subcutaneously in saline solution alone. None of these tumors metastasized to distant sites. On the other hand, 50% of enzyme-dispersed tumors coinjected with Matrigel developed xenografts; four out of five of these tumors metastasized to distant sites. Our data from the recent study suggest that, in athymic mice, Matrigel not only enhanced breast tumor growth but also facilitated tumor metastasis.

Human breast carcinoma cell lines: ultrastructural, genotypic, and immunocytochemical characterization.

Two new breast carcinoma cell lines, designated as UISO-BCA-1 and UISO-BCA-2, have been established from pleural effusions of postmenopausal women. Both cell lines show properties of mammary epithelial cells, such as positive immunoreactivity to cytokeratins and human milk fat globulin, presence of desmosomal junctions, numerous microvilli, intracytoplasmic duct-like vacuoles and tonofilaments. UISO-BCA-1 and UISO-BCA-2 cells differ from each other with respect to cellular morphology, ultramicroscopic details, immunoreactivity to Her-neu oncogene protein, chromosomal mode and in vivo and in vitro growth rates. UISO-BCA-1 cells are well-differentiated (as evident from their morphology and ultrastructural details) and hyperploid (42-114 chromosomes). In vitro, UISO-BCA-1 cells are fast growing, with a population doubling time of 31.2 +/- 9.6 hrs (n = 4), and are tumorigenic (100%) in athymic nude mice. In contrast, UISO-BCA-2 cells are poorly differentiated, but are also hyperploid, with 54-64 chromosomes. UISO-BCA-2 cells are slow growing in vitro (population doubling time: 56.0 +/- 5.0 hrs [n = 4]) and have limited tumorigenic potency (20-40%). Both these cell lines are estrogen and progesterone receptor (less than 10 fmol/mg protein) negative.

Cellular retinol binding protein and breast carcinoma.

Cellular retinol binding protein (C-RBP) levels were measured in 87 malignant and 18 non-malignant breast cancer tissues. C-RBP, sedimenting in the '2S' region on 5-20% sucrose density gradients, was detectable in 70% of malignant tissues examined. None of the non-malignant tissues contained detectable C-RBP. No significant association between tumour steroid receptors status, patients' obesity or menopausal status and C-RBP contents was observed. However, patients with stage IV disease had higher C-RBP levels than patients at stages II and III (P less than 0.0001), which suggested altered intracellular mobilization of retinol in the tumour, probably as an indirect consequence of inadequate nutrient intake.

Mycobacterium chelonei: report of a case of septicemia and review of the literature.

Mycobacterium chelonei was originally included in group IV of Runyon's classification of "anonymous" or "atypical" mycobacteria. Although a frequent contaminant without clinical significance, this organism has definite pathogenic potential. A compromised host with M. chelonei septicemia and disseminated candidiasis is described. A review of the literature on M. chelonei human infections is also presented.

Blood group testing of ancient material with particular reference to the mummy Nakht.

An international multidisciplinary team performed an autopsy on the mummy of Nakht, a 16-year-old Egyptian boy who died 3200 years ago. Excavation records and translation of hieroglyphics provide a positive identification. The histological techniques, both at the light and electron microscope levels, demonstrate remarkable preservation of normal and diseased structures. Splenic material and dark brown substance obtained from the inside of the sigmoid sinus of Nakht, during the examination of the contents of the cranial cavity, were tested using the SMM and IAT procedures. Repeated testing of the splenic material using SMM produced no agglutination and was complicated by hemolysis of the absorbed group O cells due to contaminating bacteria and fungi. However, when used in the IAT, splenic material gave a positive result for blood group B. The sigmoid sinus material produced a positive reaction for blood group B when used with the SMM and with the IAT. The blood cells recovered from Nakht are believed to be the oldest known preserved human red and white blood cells. The authors also believe that the testing techniques employed in this study are reliable and hence feel confident that the Egyptian boy Nakht, who is 3200 years old, was blood group B.

Antagonistic action of Streptococcus salivarius and Streptococcus faecalis to Mycobacterium tuberculosis.

Streptococcus salivarius and Streptococcus faecalis were found to inhibit the growth of Mycobacterium tuberculosis on Löwenstein-Jensen and Middlebrook 7H11 agars, but not on the latter medium when antibacterial drugs were added. S. faecalis was found to be more inhibitory than S. salivarius to 15 strains of M. tuberculosis. S. salivarius produced little or no inhibition of growth of Runyon group III organisms but was very antagonistic to Runyon group I mycobacteria.