Heavy cosmic-ray exposure of Apollo astronauts.

A comprehensive study of the heavy-particle cosmic-ray exposure received by the individual astronauts during the nine lunar Apollo missions reveals a significant variation in the exposure as a function of shielding and the phase of the solar cycle. The data are useful in planning for future long-range missions and in estimating the expected biological damage.

Heavy-particle radiography.

Energetic heavy particles from an accelerator mnay be used to produce radiographs with high contrast and high depth resolution. Small differences in the stopping power of objects can be detected and permnanently recorded by using stacks of plastic track detectors. This method should aid in the diagnosis of soft-tissue abnormalities, including some tumnors, and make possible quantitative reconstruction of the internal density structure of objects.

Radiation measurements aboard Spacelab 1.

The radiation environment inside Spacelab 1 was measured by a set of passive radiation detectors distributed throughout the volume inside the module, in the access tunnel, and outside on the pallet. Measurements of the low-LET (linear energy transfer) component obtained from the thermoluminescence detectors ranged from 102 to 190 millirads, yielding an average low-LET dose rate of 11.2 millirads per day inside the module, about twice the low-LET dose rate measured on previous flights of the space shuttle. Because of the higher inclination of the orbit (57 degrees versus 28.5 degrees for previous shuttle flights), substantial fluxes of highly ionizing HZE particles (high charge and energy galactic cosmic rays were observed, yielding an overall average mission dose-equivalent of about 150 millirems, more than three times higher than measured on previous shuttle missions.

Severe Maternal Pre- and Postpartum Intra-Abdominal Bleeding due to Deciduosis.

The term "deciduosis" is used to describe the severe pregnancy-associated occurrence of ectopic decidua with a usually asymptomatic course. We report on two cases of massive maternal intra-abdominal bleeding due to such symptomatic changes. The complications arose at different time points for the two cases: prepartum (26th week of pregnancy) or, respectively, - reported here for the first time - seven days postpartum. As well as differential diagnostic aspects we describe the management of the disease and its possible effects on subsequent pregnancies.

Frequency and distribution of numerical chromosomal aberrations in prostatic cancer.

Prostatic cancer frequently shows striking morphological heterogeneity and multifocal growth. To better understand the relationship between chromosomal changes and pathological characteristics, 31 routinely processed radical prostatectomy specimens were studied for the presence of numerical chromosomal aberrations by in situ hybridization with centromeric nucleic acid probes specific for chromosomes 7, 10, 17, X, and Y. In 24 of the cases preoperative core biopsy specimens were available and were examined with the probe for the X chromosome. In eight of the prostatectomy specimens chromosome numbers consistent with a normal male karyotype were found. Three cases, besides diploid chromosome numbers, showed a focal doubling of hybridization signals, consistent with tetraploidy. The other 20 cases displayed numerical chromosomal aberrations to a various degree. In this group the appearance of numerical chromosomal aberrations often showed considerable local heterogeneity, generally coinciding with morphological dedifferentiation, and was significantly correlated with tumor stage (P = .0004) as well as primary (P = .0068), worst (P = .0002), and combined (P < .0001) Gleason grades, total tumor volume (P = .0448), and the volume of tumor with Gleason grades 4 or 5 (P < .0001). In four of the 24 core biopsy specimens no residual tumor tissue was left for cytogenetic examination. In the remaining 20 biopsy specimens the presence or absence of numerical changes matched the result obtained on the corresponding prostatectomy specimen. We conclude that in prostatic cancer the presence of numerical chromosomal aberrations is associated with advanced disease. Especially in low differentiated tumors local heterogeneity in 2 chromosome numbers can be very marked. It is possible to forecast the presence or absence of numerical chromosomal changes on preoperative core biopsy specimens.

Heavy-ion radiography: density resolution and specimen radiography.

Heavy-ion radiography is performed by the passage of a beam of nuclei accelerated to energies of several hundred MeV/nucleon through an object. The technique of recording transmitted nuclei in a downstream stack of plastic sheets affords excellent resolution of density by recording the nuclei only at their stopping points. Imaging of a phantom--which stimulated tumors of low density contrast in a body part--by conventional radiography, computed tomographic scanning and the heavy-ion technique indicated superior density resolution for heavy-ion imaging at radiation dose. Superior imaging of tumors in pathologic specimens was demonstrated for heavy-ion imaging compared to conventional radiography. Values of stopping power for various tumors and normal tissues were determined by a computer-aided technique. Heavy-ion radiography shows promise for superior imaging of low contrast tumors at relatively low radiation low levels.

Numerical chromosomal aberrations in papillary renal cortical tumors: relationship with histopathologic features.

Previous studies have indicated that a combined trisomy of chromosomes 7 and 17 is a constant finding in papillary renal cortical adenomas and that papillary renal cell carcinomas are marked by additional trisomies such as trisomy 12, 16, and 20. The aim of our study was to compare this cytogenetic classification of papillary renal cortical tumors with conventional histopathologic classification. We performed interphase cytogenetics with enumeration probes for chromosomes 7, 12, 16, 17, and 20 on 41 papillary tumors found in 21 nephrectomy and 10 autopsy kidneys. A total of 38 tumors harbored gains of chromosomes 7 or 17, and most of these showed a trisomic signal distribution. The three tumors with normal copy numbers for chromosomes 7 and 17 were a papillary grade-2 carcinoma, a small adenoma (both with distinctive oxyphilic cytoplasm), and a papillary carcinoma with focally clear cells. Gains for chromosomes 12, 16, or 20 were found in 21 tumors and were significantly associated with the presence of histologic criteria of malignancy ( P<0.0001). Histopathologic and cytogenetic features of malignancy were found in eight tumors smaller than 10 mm. There is a good agreement of cytogenetic and histopathologic criteria of malignancy in papillary renal cell tumors. Interphase cytogenetics might give useful additional information in cases of doubt or when only small biopsy specimens are available.

Systematic biopsies and digital rectal examination to identify the nerve-sparing side for radical prostatectomy without risk of positive margin in patients with clinical stage T2, N0 prostatic carcinoma.

OBJECTIVES: Systematic biopsies and digital rectal examination were used to identify the nerve-sparing side for radical prostatectomy without risk of positive margin in patients with clinical Stage T2, N0 prostatic carcinoma. METHODS: We studied specimens from 73 consecutive radical prostatectomies by the 3 mm step-section technique for clinical Stage T2a, T2b (n = 57), and T2c (n = 16) tumors to see whether digital rectal examination or the use of 6 systematic biopsies could identify the side where nerve-sparing could be used without risk of positive margin. RESULTS: In 39 of the 57 (68%) patients with clinical Stage T2a, T2b 3 contralateral biopsies were negative. Only in these 39 patients was unilateral nerve-sparing done on the biopsy-negative side. None of these 39 specimens had a positive margin at this nerve-sparing side. The other 18 (32%) of the 57 patients with clinical T2a, T2b tumors had positive biopsies on the contralateral side of the palpable tumor; no nerve-sparing was done in this group. Of the 18 specimens, only 5 (28%) had full capsular penetration on the contralateral side in the area of the nerve bundle and thus the potential risk of positive margins if contralateral nerve-sparing would have been done. That could mean that 13 patients of these 18 (23% of the whole group of the 57 patients with T2a, T2b lesions) were unnecessarily excluded from the unilateral contralateral nerve-sparing. CONCLUSIONS: We conclude that unilateral contralateral nerve-sparing can be done safely in patients with T2a, T2b lesions without risk of positive margins when three biopsies on the contralateral side are negative. We calculate that by such strict selection criteria for unilateral contralateral nerve-sparing technique only one of five patients with clinical unilateral tumors will be excluded unnecessarily from the nerve-sparing technique.

Incidence of positive surgical margins after biopsy-selected nerve-sparing radical prostatectomy.

OBJECTIVES: The selection criteria for a nerve-sparing radical prostatectomy (NSRP) are not thoroughly investigated and are based mainly on preoperative digital rectal examinations and intraoperative findings. At our institution NSRP is performed only on patients whose preoperative systematic sextant biopsy of the prostate showed only unilateral cancer. To prove the safety of these criteria, we analyzed the incidence of positive surgical margins and tumor progression rate in patients who were selected for an NSRP only by the result of the biopsy. METHODS: Preoperative systematic sextant biopsies revealed unilateral cancer in 69 preoperatively potent men of 289 consecutive prostatic cancer patients (23.9%); contralateral NSRP was performed on these 69 patients. The prostate specimens were investigated by using a 3-mm step-section technique to identify positive surgical margins. Tumor progression was defined as a prostate-specific antigen (PSA) level greater than 0.4 ng/mL in the native and greater than 0.025 ng/mL in the suprasensitive postoperative blood test. Mean follow-up was 15 months (range 6 to 24). RESULTS: In 69 patients who underwent NSRP, 11 positive margins (15.9%) were found. Only 3 patients (4.3%) had a positive margin on the nerve-sparing side. In 220 patients who underwent non-NSRP 59 positive margins (26.8%) were detected. PSA recurrence rate after 12 months was similar in patients with NSRP and non-NSRP. Analysis of systematic sextant biopsies gives safe selection criteria because in approximately 95% the surgical margin on the nerve-sparing side will be negative. CONCLUSIONS: Basing the indication for an NSRP on the results of preoperative systematic biopsies was safe according to margin status and postoperative PSA, when all patients with tumor in one of the three biopsy cores of each side of the prostate were excluded from an NS technique on that side. Such a strict approach will exclude approximately 30% of patients from NSRP unnecessarily because of tumor findings on a prostate side where the cancer is still organ-confined. Less strict criteria, including patients with only well-differentiated cancer and a maximum of one positive biopsy on the evaluated side, seem to be as safe as the described selection. However, data on these patients need further evaluation.

Microsatellite alterations at chromosomes 9p, 13q, and 17p in nonmuscle-invasive transitional cell carcinomas of the urinary bladder.

The clinical behavior of bladder cancer is difficult to predict and prognostic markers applicable to routinely processed tumor specimens clearly are needed. We screened 40 primary Ta and T1 bladder cancers for microsatellite alterations at 9p, 13q, and 17p with PCR, using nine polymorphic microsatellite markers. DNA was prepared after microdissection of paraffin-embedded transurethral resection specimens. PCR products were separated on sequencing gels, and allelic loss as well as band shifts was assessed by comparing alleles of control and tumor tissue. The results were correlated with grade, stage, and clinically documented tumor recurrence. Overall, allelic loss at 9p, 13q, and 17p was present in 35.1%, 25%, and 27.5% of cases, respectively. Whereas the frequency of allelic loss at 9p was nearly equally distributed throughout all tumor grades and stages, the occurrence of allelic loss at 13q and 17p correlated statistically significantly with higher grades and stage. Band shifts were observed in three cases. Of the 40 patients, 16 had tumor recurrence during a follow-up period of 3-49 months (median, 23 months). Kaplan-Meier analysis did not show any statistically significant correlation between allelic loss at either locus and tumor recurrence. The results confirm the role of alterations at 13q and 17p in the progression of bladder cancer. Allelic loss at 9p seems to be an early event in tumor development. However, the detection of alterations at the three chromosomal loci studied did not have any prognostic value regarding tumor recurrence in this group of patients.

Analysis of molecular isoforms of PSA and their ratios in men with PSA-relapse after radical prostatectomy.

BACKGROUND: The aim of this study was the longitudinal comparison of % f-PSA in patients before radical prostatectomy and after PSA relapse. Is % f-PSA a consistent tumor specific parameter or does this ratio change during untreated tumor progression? MATERIALS AND METHODS: In this study 41 out of 420 patients with untreated increasing PSA-progression (> 0.5 ng/ml) were analysed. Patients with neoadjuvant or adjuvant hormonal therapy were excluded. T-PSA were f-PSA were analyzed by Immulite DPC (Diagnostic Products Coop., CA) and Abbott Axsym (Abbott Park, Il, USA). RESULTS: Pre-operative % f-PSA ratio was 10.6% (range 4.6-22%; Std. dev.: 4.9); T-PSA concentration was 26.4 ng/ml (range 5.5-10.2 ng/ml Std. dev.: 20.3). In men with PSA relapse after radical prostatectomy % f-PSA ratio was 14.73% (range 2.2-4.5% Std. dev.: 9.7). Repeated post-operative % f-PSA measurements resulted in 12.94% f-PSA (range 2.7-3.8% Std. dev.: 9.9%) with a regression of R = 0.57. All men with pre-operative elevated % f-PSA (> 15%) had post-operative elevated % f-PSA. CONCLUSIONS: The data indicates that post-operative % f-PSA is a constant tumor specific parameter in men with untreated PSA relapse after radical prostatectomy. Post-operative % f-PSA was higher compared with pre-operative % f-PSA concentrations. No correlation with Gleason score or pathological stage was found.

Numerical chromosomal changes in high-grade prostatic intraepithelial neoplasia (PIN) and concomitant invasive carcinoma.

Prostatic intraepithelial neoplasia (PIN) is regarded as a precursor lesion of at least some prostatic cancers. Using interphase cytogenetics, an in situ hybridization technique with chromosome specific probes, we investigated 15 prostatectomy specimens containing both invasive carcinoma and PIN for the presence of numerical changes of chromosomes 7, 8, 10, 17 and X. The results were correlated with tumor stage and Gleason grade as well as with morphological features of PIN. Of the 15 carcinomas, four were disomic, five displayed at least focal chromosomal gains and six were found to be aneusomic. A non-disomic chromosomal status correlated well with a higher tumor stage and grade. Although the majority of PIN glands showed an eusomy, focal chromosomal gains within single glands or parts of a gland could be observed in 12 of the 15 cases. All but one specimen with non-disomic carcinomas also harboured areas of PIN with numerical chromosomal aberrations, often laying directly adjacent to tumorous glands. Additionally, focal non-disomies of PIN could also be detected in two cases with eusomic cancer. With regard to numerical changes in PIN and cancer, no significant preponderance could be observed for the five chromosomes tested. We conclude that numerical chromosomal aberrations are a frequent, but mostly focal event in PIN. This karyotypic instability is further evidence for the premalignant nature of this lesion.

Radiation exposures during space flight and their measurement.

The paper reviews radiation exposures recorded during space flights of the US and USSR. Most of the data are from manned missions and include discussion of absorbed dose and dose rates as a function of parameters such as altitude, inclination, spacecraft type and shielding. Preliminary data exist on the neutron and HZE-particle component, as well as the LET spectra. For low Earth-orbit missions, the dose encountered is strongly altitude-dependent, with a weaker dependence upon inclination. The doses range from about 6 millirad per day for the Space Transportation System No. 3 flight to about 90 mrad per day for Skylab. The effective quality factor (QF) for the near-Earth orbits and free space has been estimated to be about 1.5 and about 5.5 respectively. Complete shielding from the galactic cosmic rays does not appear practical because of spacecraft weight limitations.

[Kidney cancer and angiomyolipoma in lymphangiomyomatosis]. / Nierenkarzinom und Angiomyolipom bei Lymphangiomyomatose.

Lymphangiomyomatosis is an extremely rare benign disease characterized by extensive proliferation of smooth muscle cells within lymphatic vessels and lymph nodes. While 10-15% of all patients show concomitant renal angiomyolipomas, no association so far has been reported with renal cell carcinoma. We present a case with coincident lymphangiomyomatosis, renal cell carcinoma and renal angiomyolipoma. The possible underlying pathogenesis is discussed. Classifying lymphangiomyomatosis as a "forme fruste" of tuberous sclerosis allows postulation of a common pathogenesis for all three entities.

[Preoperative assessment of tumor aggressiveness in localized prostatic carcinoma]. / Präoperative Abschätzung der Tumoraggressivität beim lokalisierten Prostatakarzinom.

In 106 consecutive patients with localized prostate cancer digital rectal examination (DRE), preoperative prostate-specific antigen (PSA) determination and results of systematic sextant biopsies (TRUS 6Bx) of the prostate were analyzed for their value in the estimation of the aggressivity of tumors. In all patients with negative pelvic lymph nodes radical retropubic prostatectomy was performed. Tumor aggressiveness was defined as capsular penetration (pT2 versus pT3) or positive surgical margins in patients with pT3 tumors. Neither DRE nor preoperative PSA level was helpful in predicting capsular penetration or positive surgical margins. However, the number of positive core biopsies and the identification of Gleason 4 or 5 tumors within positive biopsy specimens correlated with capsular penetration and positive surgical margins. These results can be used to create a score, based on DRE, PSA, TRUS 6Bx, and Gleason 4 or 5, that might be helpful in predicting tumour aggressivity in patients with localized prostate cancer.

[Morphologic results of 106 consecutive radical prostatectomy specimen of patients with clinical stage B1-B3 (T2a-c) and histologically negative lymph nodes in the fossa obturatoria]. / Morphologische Ergebnisse von 106 konsekutiven radikalen Prostatektomiepräparaten von Patienten mit klinischem Stadium B1-B3 (T2a-c) und histologisch negativen Lymphknoten in der Fossa obturatoria.

The morphologic results recorded in 106 consecutive radical prostatectomy specimens from patients with clinical stage B1-B3 (T2a-c) are presented. All specimens had inked margins and were subjected to morphometric work-up using a 3-mm step section technique. In only 39 (37%) was the tumour confined to a single organ (pT2); 67 (63%) were stage pT3; 40 (37.7%) had only capsular penetration; and 27 (25.4%) had seminal vesicle invasion. In 33 (31.1%) the surgical margin was positive. None of those with pathological stage pT2 had a positive margin. Of the 40 patients with pathological stage pT3a+b, 19 (47.5%) had a positive margin. Of the 27 patients with seminal vesicle invasion (pT3c), 14 (51.8%) had a positive margin. Specimens with only unilateral seminal vesicle invasion or none at all had positive surgical margins in only 25% and 24% of cases, in contrast to those with bilateral seminal vesicle invasion, in which the rate for positive margins was 73%. The mean tumour volume was 8.1 cm3 (0.12-50.13 cm3). There were 9 (8.4%) tumours with a volume < 0.5% cm3 while 62 specimens contained > 0.5 cm3 Gleason 4 and Gleason 5 tumours. Our analysis shows a good correlation of the positive margin rate with tumour volume and especially with volume of the high-grade tumor.

[Development of tumor selection based on pathological stage in clinically localized prostate carcinoma]. / Entwicklung der Tumorselektion anhand des pathologischen Stadiums beim klinisch lokalisierten Prostatakarzinom.

Four hundred and eighty-eight radical retropubic prostatectomies (RRP) were performed on clinically localized prostate cancer at one institution within 5 years (1992-1996). These were then analyzed regarding the migration of pathological tumor stages towards more localized stages. Within the observation period, the annual rate of RRP increased by 81% from 69 to 125 cases. The authors noted a decline in the occurrence of advanced tumor stages (65.0% to 39.2%) and small cancers (< 0.5 cc: 7.2% to 1.6%) and an increase in pathological T2 tumors (30.4% to 55.2%). The rate of positive surgical margins declined from 34.7% to 12.8% (for all pathological stages). These data confirm trends which were observed in the USA with increasing detection and treatment of localized prostate cancer.

Recurrent neck abscess due to a bronchogenic cyst in an adult.

BACKGROUND: Neck abscesses can originate from congenital cervical cysts. Cervical cysts of bronchogenic origin are rare and often asymptomatic. Common symptoms of bronchogenic cysts are stridor, dyspnoea and dysphagia. The reported patient represents the second published case of a bronchogenic cyst causing a neck abscess in an adult. CASE REPORT: We report a case of a cervical bronchogenic cyst presenting as a recurrent supraclavicular abscess in a middle-aged woman. During extirpation, a fistula was demonstrated to the right upper lobe of the lung, suspected because the cyst inflated synchronously with respiration. DISCUSSION: The symptoms of bronchogenic cysts are due to the effects of compression or fistulas. In the majority of these cysts, a thorough investigation involving history, examination and radiological imaging does not clearly demonstrate a fistula. Therefore, extirpation is both diagnostic and therapeutic. CONCLUSION: A bronchogenic cyst is a very rare cause of a recurrent deep neck abscess. Total extirpation is the treatment of choice.