Life events associated with adolescent pregnancies.

A retrospective study of the life events reported by 121 pregnant adolescents and 261 controls has disproved the null hypothesis that those 2 groups are 2 random samples from the same population. The pregnant girls differ markedly in terms of the events that occurred within their families. Most striking among these events was the greater number of deaths of family members reported by the pregnant girls. Clearly, a prospective study is needed to confirm the findings.

Pathological evaluation of computed tomography images of lungs.

A method is described which allows the features seen in images generated during computed tomography (CT) of lungs previously removed at necropsy to be compared with those seen in corresponding thin sections made from the same lungs. After removal from the body, lungs were inflation-fixed using warm formalin vapour before being x-rayed and then scanned in the inflated state. Slices corresponding to the CT scan images were made and x-rayed. Paper mounted sections were then prepared from each slice. Using these methods pathological correlative studies can be used both to validate the interpretation of CT scans of lungs and to assess the sensitivity of this imaging technique.

Management of screen-detected breast cancer: audit of the first 100 cases in the Southampton and Salisbury breast screening programme.

With the natural history and optimal treatment of a high proportion of screen-detected breast cancers yet to be determined, treatment poses the management team with a number of therapeutic dilemmas. This study surveys the management policy and treatment of a consecutive series of 100 screen-detected cancers treated in a single breast unit. The problems encountered are discussed. There were 87 women with stage Tis or T1 tumours, including 26 women with in situ cancers, four with invasive cancers less than 5 mm in size, and seven with tubular cancers. Sixty-six women were managed with breast-conserving surgery and 36 women underwent localisation biopsy as the sole surgical treatment of the breast. With selection bias for high-grade and lateral tumours, only 2/13 cancers up to 10 mm in size were lymph node positive on axillary clearance. All lymph node positive women received adjuvant therapy. No adjuvant therapy was given in 43 cases, including those with in situ cancer. Thirty-six had extensive intraductal component (EIC). Patient and surgeon choice tends to be a major factor both in type of surgery and adjuvant therapy for screen-detected breast cancer. The optimal treatment for tumours detected by breast cancer screening is debatable and randomised trials on their management need to be expedited.

Primary cerebral lymphoma presenting with bilateral cerebellopontine angle lesions.

A case is described of a primary cerebral lymphoma which presented with bilateral cerebellopontine angle lesions. No similar case has been reported in the English language in the last 25 years. The literature is reviewed and discussed.

Primary neuroblastoma of the facial nerve presenting as a recurrent facial paralysis.

A case is described of a primary neuroblastoma of the facial nerve in a 13-year-old boy presenting with a recurrent facial paralysis. This tumour was excised preserving the nerve and followed with post-operative radiotherapy. The pathology of the tumour is described and facial nerve tumours briefly discussed as a cause of facial palsy. There have been no other cases of a primary neuroblastoma of the facial nerve arising at this site reported in the last 20 years.

Impact of an extensive in situ component on the presence of residual disease in screen detected breast cancer.

This study investigates the histopathological characteristics of a consecutive series of 100 screen detected breast cancers in relation to residual disease. Tumour type, size, grade, resection margins and extent of primary or associated in situ disease were all assessed by one pathologist. Thirty-seven women underwent further surgery (wider excision or mastectomy) and the resected specimen was examined for residual in situ or invasive cancer. In total, 36 cancers had an extensive in situ component, of which 69% were predominantly intraduct carcinoma of comedo type. Of the 37 women who underwent further resection, 21 (57%) women had residual cancer. Of those with initial disease at the resection margin, 16/25 (64%) had residual disease. Five of 12 (42%) with disease close to (within 2-3 mm) but not at the margin had residual disease. Of those with an extensive in situ component, 18/25 (72%) had residual disease, whereas only 2/12 (17%) women with none or some in situ disease had residual cancer. In screen detected breast cancer, residual cancer was present in 72% of women with an extensive in situ component at initial surgery. These women comprise a group in which conservation surgery may be inappropriate if completeness of excision is considered a prerequisite for breast conserving surgery.

A fracture of the sternum in a child.

Fractures of the sternum are seldom seen due to its anatomical structure and supporting structures. The incidence of sternal lesions in children is extremely rare, and the scarcity of published accounts warrants reporting this case, which was treated successfully without surgery.

The effect of emotional factors on football injury rates--a pilot study.

The Life Event Scale for Adolescents (LES A) was used to gather data regarding the events that had occurred during the previous year from 114 high school football players. Injuries during the season were classified according to the National Athletic Injury/Illness Reporting System (NAIRS). The findings indicated that players who experienced more family instability, particularly those who experienced parental illnesses, separations, divorces and deaths, were more likely to sustain a significant injury. It is postulated that a player's mental or emotional state may increase his risk of injury.

Extraintestinal lymphoma in association with Whipple's disease.

A 45 year old man is described with Whipple's disease who presented with weight loss, lethargy, and ascites. He subsequently developed fever and a mass in the neck, but died despite antibiotic treatment and nutritional support. Necropsy showed extraintestinal lymphoma.

Pyrimidine metabolism in cotyledons of germinating alaska peas.

Cotyledons from Pisum sativum L. cv. Alaska seeds were excised 12, 36, 108, 132, and 156 hours after imbibition in aerated distilled water. They were then incubated under aseptic conditions for 6 hours in solutions containing either uridine-2-(14)C or orotic acid-6-(14)C. Uridine was more extensively degraded to (14)CO(2) at all germination stages than was orotate, and these rates remained essentially constant at each stage. Incorporation of each compound into RNA increased about 2-fold from the 12th to the 156th hour, although the total RNA present decreased slightly over this interval. Paper chromatography of soluble labeled metabolites produced from orotate showed that the capacity to metabolize this pyrimidine increased markedly as germination progressed. Radioactivity in uridine-5'-P, uridine diphosphate-hexoses, and uridine diphosphate increased most, while smaller or less consistent increases in uridine, uracil, uridine triphosphate, and an unidentified UDPX compound were also observed. The data suggest that orotate metabolism was initially limited by orotidine-5'-phosphate pyrophosphorylase or by 5-phosphoribosyl-1-pyrophosphate. Incorporation of uridine into RNA appeared to be limited at the earliest germination periods by conversion of uridine-5'-P to uridine diphosphate. Thus, during the 1st week of germination the orotic acid pathway and a salvage pathway converting uridine into RNA become activated.

Demonstration of oestrogen receptor in symptomatic breast carcinoma, using fine needle aspiration cytology.

Oestrogen receptor immunocytochemical assay (ER-ICA) was used to determine oestrogen receptor (ER) content of cells in fine needle aspirate (FNA) specimens from 88 breast carcinomas. In 49 of these the radioligand binding assay for oestradiol was available for comparison. The predictive value of ER-ICA staining for a positive radioligand binding assay (greater than 10 fmol/mg protein) was 95%. Although the predictive value of negative staining was only 66%, 34 out of 37 ER-ICA negative tumours had radioligand binding assays below 60 fmol/mg protein. ER-ICA staining showed a strong positive correlation with age of the patient, positivity being rare before the menopause. There was a weak inverse correlation with tumour grade but none with tumour size or lymph node status. The assessment of ER by immunocytochemistry using FNA cytology is a rapid technique, which may easily be repeated and provides a pre-operative assessment of ER status. It allows confirmation that tumour cells are present in the sample and an assessment of tumour heterogeneity.

Technique and results of localization biopsy in a breast screening programme.

The techniques of ultrasonographic and hookwire localization biopsy of impalpable breast lesions detected by a large breast screening unit during its first year of operation are described. Hookwire localization (HL) was performed using mammography. Ultrasonographic localization (UL) was used for lesions readily detectable by ultrasonography by marking the skin directly over the lesion and calculating its depth below the surface. UL is not appropriate when microcalcification is the sole mammographic abnormality. Localization was required for 150 of the 191 (78.5 per cent) screen-detected lesions. HL was used for 94 (62.7 per cent) and UL for 56 (37.3 per cent). Four lesions were missed by HL, none by UL; 35 per cent of lesions removed by HL and 39 per cent by UL were malignant, giving benign: malignant biopsy ratios of 1.8:1 and 1.5:1 respectively. Only 22 percent of the patients required overnight hospital stay. Localization biopsy plays a major role in the surgery for screen-detected lesions and, where applicable, UL is the technique of choice.

Determination of Ki67 growth fraction and oestrogen receptors in screen-detected breast cancer using cytological preparations.

Oestrogen receptor (ER) status of 77 cases of screen-detected breast cancer has been determined using cytological preparations. In 48% ER status was positive, which was the same proportion as that formed in a control group of age-matched patients with symptomatic breast carcinoma. Since the screen-detected group contained more low grade tumours, the percentage of ER-positive cases would be expected to be higher. The reasons for the discrepancy are discussed. Ki67 score has been determined for 41 cases of screen-detected cancer. Ki67 score showed a positive correlation with histological tumour grade and a negative correlation with ER status. However, there was no correlation with tumour size or lymph node status. The Ki67 scores in the screen-detected cancers were essentially similar to those found in an age-matched symptomatic group, but the very low scores were only found in the screened group.