Cancer, vitamins, and plasma lipids: prospective Basel study.

In the Basel study (BS) (1960-73) on cardiovascular and peripheral arterial diseases, a mortality follow-up was completed for the period 1965-80. Of the 4,224 men at risk for these diseases, 531 died. The causes of death were established from the death certificates and classified into 8 groups. For each case 2 age- and sex-matched controls were selected and compared with the corresponding cases with regard to the various variables obtained at the three examinations (1960, 1965, 1971). This report dealth with cancer mortality, plasma lipids, plasma vitamins, alcohol and cigarette consumption, and intake of milk and citrus fruits. The results were all obtained at the second follow-up examination (BS III, 1971-73). Cancer of the lung, stomach, large bowel, and all other sites were treated separately. The average follow-up from BS III until death varied from 3.7 years (other sites) to 4.9 years (cancer of the lung). Of 129 cancer deaths, the highest incidence was found for cancer of the lung (38) followed by stomach (19) and large bowel, (15) and the remainder (57) was for other sites. Plasma lipids did not differ significantly among cases and controls. However, the lowest values were observed in colorectal cancer and gastric carcinoma (mean cholesterol, 213 mg/dl). beta-Carotene was significantly lower in cancer cases of the lung than in controls (14.8 micrograms/dl vs. 23.7; P less than .05). It was also low in gastric cancer cases (13.0 micrograms/dl). Vitamin A was below average only in cases with gastric cancer (difference due to the small number not significant). Vitamin C was consistently lower in cancer cases than in controls. The lowest value was found for cancer of the stomach and corresponded to a below-average consumption of citrus fruits. Vitamin E was low in cancer of the colon. Plasma lipids correlated strongly with vitamin E (tau = 0.5) and to a lesser extent with vitamin A (tau = 0.25). beta-Carotene correlated poorly with beta-lipoproteins (low-density and very low-density lipoproteins) but significantly with total cholesterol. Smoking was inversely related, as was alcohol consumption, to the beta-carotene level. From these results, the conclusion was that vitamins influence carcinogenesis in humans.

Down regulation of the tumor suppressor gene maspin in breast carcinoma is associated with a higher risk of distant metastasis.

BACKGROUND: Maspin (mammary serpin) is a relatively novel serine protease inhibitor with tumor suppressing function in breast cancer. Maspin expression was found in normal breast epithelial cells, but was decreased during tumor progression. Only a few systematic analyses of this phenomenon have been undertaken so far. In this study we developed specific nested reverse transcription polymerase chain reaction (RT-PCR) conditions for the detection of maspin expression in human breast carcinoma and assessed maspin's association with the clinical behavior of primary breast cancers. METHODS: Tumor specimens obtained from 45 primary breast cancer patients were analyzed for maspin expression by a nested RT-PCR assay. Recurrence free survival was evaluated and correlated to maspin expression. RESULTS: The maspin transcript was detected in 29 (64%) breast cancer specimens whereas no expression was found in 16 (36%) cancer specimens. This expression was unrelated to any of the established prognostic factors. However, 6 out of 8 patients who developed distant metastasis (lymph nodes, lung, liver, bone, pleura) within 3 yr after their initial diagnosis showed no maspin expression of the primary breast cancer (p < 0.05). CONCLUSIONS: The lack of maspin expression in breast cancer seems to be associated with a short disease free survival and supports maspin's function as an indicator of tumor aggressiveness and metastatic potential. Nested RT-PCR is a sensitive method to determine maspin expression in human breast cancer tissue.

Odorant source used in Eurasian beaver territory marking.

Mammals use urine, feces, or the secretion of specialized skin glands to mark their territories. These sources can carry different information and, thus, have different functions. Presently it is not known if beavers (Castor spp.) deposit castoreum (primarily a mixture of secondary metabolites from urine) from the castor sacs and secretion from the anal glands (AGS) together or alone when scent marking their territories. We hypothesized that castoreum would be the main scent signal used in the defense of beaver territories during winter and predicted that castoreum would be deposited more often than AGS. A total of 96 scent marks on snow were collected from January 1 to March 31, 1997-1999 in the Bø River, Telemark County, Norway. In order to obtain control material, we chemically analyzed AGS and castoreum from 60 dead beavers collected during January-May 1997-1999. We compared the compounds found in the dead beavers with compounds found in the scent marks on snow. Samples were analyzed by using gas chromatography-mass spectrometry (GC-MS). All 96 scent marks contained compounds from castoreum, whereas compounds from AGS were found in only four scent marks. This suggests that beavers do not specifically deposit AGS on scent mounds as they do with castoreum and that the AGS compounds we found probably were remnants of AGS from the feet or fur following pelt lubrication or coprophagy behavior. We conclude that castoreum is the main scent signal used in the defense of beaver territories during winter.

Decline in the expression of the serine proteinase inhibitor maspin is associated with tumour progression in ductal carcinomas of the breast.

Maspin is an inhibitor of serine proteinases with tumour suppressor activity. Its expression appears to be reduced in advanced stages of breast cancer. A large series of archival breast tissue specimens has been examined, including normal glands (n=7), fibrocystic change (n=22), ductal carcinoma in situ (DCIS, n=12), infiltrating carcinomas (n=128) and their lymph node metastases (n=65), using a specific monoclonal antibody. Myoepithelium invariably showed strong maspin expression. In epithelial cells, the strongest expression was found in normal breast and fibrocystic change. A significant stepwise decrease in maspin expression (p<0.0001) occurred in the sequence DCIS - invasive cancer - lymph node metastasis. However, a subset of infiltrating carcinomas showed strong maspin expression, significantly associated with a lower rate of lymph node metastasis at the time of diagnosis (p<0.01). This was independent of tumour size and grade. The in vivo observations presented here are in keeping with data obtained in prior in vitro experiments. Maspin emerges as an indicator of tumour progression and metastatic potential, and might be exploited to predict breast cancer prognosis. According to in vitro data, its tumour suppressor activity is likely to involve both the modulation of cell motility/invasiveness and the inhibition of angiogenesis.

The significance of morphometric methods in cytologic diagnostics: differentiation between mesothelial cells, mesothelioma cells and metastatic adenocarcinoma cells in pleural effusions with special emphasis on chromatin texture.

Opinions differ widely as to the value of morphometric techniques for differentiating between mesothelial cells, mesothelioma cells and metastatic adenocarcinoma cells in pleural effusions. The significance of the changes in the chromatin structure to differentiate between these three cell types was stressed by various scientific groups only qualitatively, and until now no group has used digital methods to quantify chromatin structures. The controversy about the value of morphometric methods was the reason for conducting the following study. We wanted to investigate (i) the importance of various planimetric and texture parameters as well as invariant moments as morphometric discriminators; and (ii) to set up a data structure to make possible the further diagnostic use of the multivariate morphometric analyses method for other applications. The present findings show that nuclear size and form are not the decisive factors in differentiating between reactive cells and mesothelioma cells, but pixel related texture parameters and invariant moments are. All parameter types used showed differences between reactive cells and cells of adenocarcinoma metastases. Invariant moments and shape descriptors, but not texture parameters are used to discriminate between mesothelioma cells and cells of adenocarcinoma metastases.

Digital image analysis in cytological diagnosis: a morphometric analysis on pleural mesotheliomas.

In the course of the last years digital image analysis has become increasingly important in the field of quantitative pathology. This may be due to the technical development of computers which have now reached a high user-friendly standard. In the present paper we present: (1) the development of a simple system for the measurement of digital image analysis; (2) the development of a general data structure applicable to various measurements and classification strategies; and (3) the analysis of the value of invariant moments (IM) as regional descriptors to distinguish mesothelial cells from mesothelioma cells in cytologic smears of pleural fluid. The results show that the invariant moments contain information concerning the geometric distribution of the grey values of the pixels as well as the staining intensity. The invariant moments present combination parameters and are therefore ideal morphometric parameters. With the invariant moments 7 out of 7 patients with mesotheliomas and 8 out of 11 control subjects could be assigned correctly in a nonparametric discriminant analysis procedure.

[Mortality and cause of death in a 20-year follow-up of the Basel study]. / Todesfälle und Todesursachen im 20-Jahres-Follow-Up der Basler Studie.

The results of a mortality follow-up in the Basle Study (BS) for the period 1965-1986 are presented, involving data of 4224 males and 936 females. The autopsy rate was 60% and allowed confirmation of the death certificates. The mortality rate of BS men is considerably higher (22% = 928 male) than that of the - on the average younger-females (9.2% = 87 female). In the male cohort the age-specific 10-year mortality is lower than in the general Swiss population due to a lower incidence of various diseases and accidents with fatal outcome and a lower incidence of cardiovascular death. On the other hand, a higher tumor incidence in the BS cohort from the age of 55 years on can be noted. This is mainly due to a higher frequency of lung cancer. With increasing duration of the follow-up the difference between the mortality of the general Swiss population and the BS participants diminishes. The higher tumor incidence observed could be explained by more accurate diagnoses in the BS group. Consequently, the Basel study cohort could-in relation to mortality data-be considered representative of the Swiss population.

Assessment of telemedicine in surgical education and patient care.

OBJECTIVE: To analyze the value of teleconferencing for patient care and surgical education by assessing the activity of an international academic network. SUMMARY BACKGROUND DATA: The uses of telemedicine include teleeducation, training, and consulting, and surgical teams are now involved, sharing diagnostic information and opinions without the need for travel. However, the value of telematics in surgery remains to be assessed. METHODS: During a 2-year period, weekly surgical teleconferences were held among six university hospitals in four European countries. To assess the accuracy of telediagnosis for surgical cases, 60 randomly selected cases were analyzed by a panel of surgeons. Participants' opinions were analyzed by questionnaire. RESULTS: Seventy teleconferences (50 lectures and 271 case presentations) were held. Ninety-five of the 114 participants (83.3%) completed the final questionnaire. Eighty-six percent rated the surgical activity as good or excellent, 75.7% rated the scientific level as good or excellent, 55.8% rated the daily clinical activity as good or excellent, and 28.4% rated the manual surgical technique as good or excellent. The target organ was identified in all the cases; the organ structure and pathology were considered well defined in 93.3%, and the fine structure was considered well defined in 58.3%. Diagnosis was accurate in 17 cases (28.3%), probable in 25 (41.7%), possible but uncertain in 16 (26.7%), and not possible in 2 cases (3.3%). Discussion among the remote sites increased the rate of valuable therapeutic advice from 55% of cases before the discussion to 95% after the discussion. Eighty-six percent of the surgeons expressed satisfaction with telematics for medical education and patient care. CONCLUSIONS: Participant satisfaction was high, transmission of clinical documents was accurate, and the opportunity to discuss case documentation and management significantly improved diagnostic potential, resulting in an accuracy rate of up to 95%. Teleeducation and teleconsultation in surgery appear to be beneficial.