Squamous cell carcinoma of the lung: an unusual metastasis to pectoralis muscle.

A 44-year-old man with clinical T2 N0 M0 squamous cell carcinoma of the lung presented 4 weeks after left pneumonectomy with a single metastasis to his right pectoralis major muscle. Three years after excision and chemotherapy he remains in remission. Muscle metastasis of carcinoma is an infrequent occurrence. Further investigation into the incidence and treatment is warranted.

Influence of inflammatory reaction in primary fallopian-tube carcinoma (stage-I and stage-ii).

A retrospective evaluation of 68 Fallopian tube carcinomas (FTC) of a period of ten years (1980-1990) in stage I and II was performed. The aim of this study was to evaluate the prognostic impact of various factors. 68 cases were investigated for the prognostic influence of mitotic activity, degree of nuclear anaplasia and inflammatory reaction. Histological grading (p=0.08), and inflammatory reaction (p=0.003) showed to have a prognostic impact for survival in univariate analysis. Whereas, mitotic activity did not show any statistically significant influence. 47 (69%) tissue samples showed a positive inflammatory reaction which correlated with a significantly better outcome compared with tumors without this feature. However, this influence was proved in multivariate analysis for inflammatory reaction only (p=0.01). Although no data on the influence of the inflammatory reaction on prognosis in FTC has been published up to now, we can state that the determination of this factor can be useful for prognosis in this rare but highly aggressive tumor.

[Placental isoferritin (PLF): early predictor of fetal growth retardation]. / Früherkennung fetaler Wachstumsretardierung durch Bestimmung des plazentaren Isoferritins.

OBJECTIVE: Maternal immunoreaction against the embryo can be responsible for fetal growth retardation. The secretion of PLF during pregnancy could be reliable for a diminished immunoreaction of maternal lymphocytes against the embryo. The aim of the present study was to elucidate a possible correlation between PLF and fetal growth retardation. METHODS: In this study, blood samples of 402 pregnant women were obtained between the 12th and 16th weeks of gestation. The serum levels of PLF were compared with birth weight, percentile of birth weight, and gestational age. RESULTS: Women with children whose birth weight was below or equal to the 10th percentile for gestational age showed significantly lower PLF levels (11.4 U/ml, n = 107) as compared with women whose newborns were of normal weight (19.9 U/ml, n = 295; p < 0.004). CONCLUSION: Determination of the PLF level could serve to identify women at risk of having growth-retarded babies.

3He spin-dependent cross sections and sum rules.

We present a measurement of the spin-dependent cross sections for the 3He over -->(e over -->,e')X reaction in the quasielastic and resonance regions at a four-momentum transfer 0.1< or =Q2< or =0.9 GeV2. The spin-structure functions have been extracted and used to evaluate the nuclear Burkhardt-Cottingham and extended Gerasimov-Drell-Hearn sum rules for the first time. The data are also compared to an impulse approximation calculation and an exact three-body Faddeev calculation in the quasielastic region.

Frequencies of maternal platelet alloantibodies and autoantibodies in suspected fetal/neonatal alloimmune thrombocytopenia, with emphasis on human platelet antigen-15 alloimmunization.

BACKGROUND AND OBJECTIVES: Serological evaluation of maternal sera for platelet antibodies in suspected fetal/neonatal alloimmune thrombocytopenia (FNAITP) discloses in only approximately 30% of individuals a platelet-specific antibody. Transfusion-induced alloimmunization against human platelet antigen-15 (HPA-15) has been reported to be about as common as against HPA-5, the second most common platelet antibody. Thus, anti-HPA-15 may also contribute significantly to yet-unclear cases of FNAITP. MATERIALS AND METHODS: In this retrospective analysis, we provide data on maternal platelet antibodies from 309 mothers who delivered an offspring with suspected FNAITP. RESULTS: Genotyping maternal and paternal samples (together n = 573) revealed a gene frequency of 0.496 for HPA-15a and a gene frequency of 0.504 for HPA-15b. HPA-15 antibodies were detected in 2% of all samples. Anti-HPA-15a and -15b were detected in two and three samples, respectively. One serum reacted equally with HPA-15a and -15b platelets. The most frequent platelet-specific antibodies were anti-HPA-1a (22%), but anti-HPA-5b (8.4%) were more frequent than anti-HPA-15. In addition, panreactive (5.5%) or autoreactive (5.2%) anti-GPIIb/IIIa or anti-GPIb/IX were detectable in maternal samples. CONCLUSIONS: These data indicate that HPA-15 alloimmunization needs only to be considered in subjects with suspected FNAITP if no other platelet-specific antibody is detectable. The presence of panreactive or autoreactive antibodies should also be considered in neonatal thrombocytopenia.

Microcrystalline identification test of some amphetamines and hydrochlorothiazide: collaborative study.

A previously described procedure for the identification of methamphetamine, dl-deoxyephedrine, dextroamphetamine, and amphetamine and a new procedure for hydrochlorothiazide identification have been subjected to collaborative study. The method for the amphetamines depends upon their volatilization from a strongly basic solution into a hanging drop containing gold chloride and the formation of characteristic crystals. The hydrochlorothiazide method is direct: the I2-KI solution is added to an alkaline solution of hydrochlorothiazide to cause the deposition of characteristic crystals. Of the 40 unknown drug dosage form powders supplied to 10 collaborators, 39 were correctly identified. The results indicate that the amphetamine procedure is capable of distinguishing between methampetamine and dl-deoxyephedrine. The age of the gold chloride reagent is important in these tests. The official final action tests for dl-deoxyephedrine and methampetamine were modified and Table 36:04 has been revised to reflect these changes. The hydrochlorothiazide test has been adopted as official first action and added to Table 36:05.

Use of three optical systems to obtain a microscopic profile of asbestos and other nonopaque particulate matter larger than 5 mum in parenteral drugs.

A comparative microscopic study of chrysotile fibers was conducted, using 3 sequential optical systems: plane polarized light (PL), phase contrast (PC), and Nomarski differential interference contrast (NDIC) for complementary image analyses. The introduction of NDIC for qualitative and quantitative analyses of particulate matter greater than 5 mum resolves the problem of diffraction halos encountered in PC microscopy. High optical contrast, the instrumental characteristic of NDIC, is particularly useful for the detection of chrysotile fibers at a magnification of 500 X.

Color Doppler sonography of the lateral thoracic (breast-feeding) arteries: a new approach to the diagnosis of breast disease?

OBJECTIVE: The main arteries to the breast are the lateral thoracic artery and to a lesser extent the internal thoracic artery. In this prospective open diagnostic study involving 94 women, we compared the intraindividual differences of Doppler indices in the lateral thoracic (breast-feeding) artery of breasts affected by cancer with those unaffected by disease. METHODS: Sixty-seven consecutive patients were recruited from an outpatient unit for breast surgery and 27 volunteers were studied who were known to be without any breast disease (controls). In each patient we attempted to obtain Doppler indices from the lateral thoracic artery of both breasts. The difference in Doppler indices in each individual was assessed and statistical analysis was performed to assess whether these differences were significantly altered in women with cancer compared to healthy women. RESULTS: Lateral thoracic arteries could be visualized in 88% of the study population. Significantly lower values for pulsatility and resistance indices and systolic/diastolic ratios were obtained in the lateral thoracic arteries of breasts affected by cancer as compared to the contralateral breasts (1.73 +/- 0.39 vs. 2.05 +/- 0.47, P = 0.003; 0.78 +/- 0.06 vs. 0.84 +/- 0.06, P < 0.0001; 4.71 +/- 1.24 vs. 6.75 +/- 3.38, P = 0.0008, respectively). Using the intraindividual difference of pulsatility index, resistance index and systolic/diastolic ratio to screen for malignancy, sensitivities for breast cancer of 78%, 85% and 83%, respectively, were achieved. Depending on the cut-off level, specificity reached 94%. CONCLUSION: The intraindividual difference in Doppler indices in women with breast cancer may be a useful test for the diagnosis of breast lesions.

A prospective analysis of immunohistochemically determined hormone receptors and nuclear features as predictors of early recurrence in primary breast cancer.

The immunohistochemically determined receptor status, as well as first-generation risk factors (tumor size, lymph node status, histologic grading including subfactors, tumor histology, and biochemically determined receptor status) were prospectively analyzed in 288 cases of primary breast cancer for their impact on recurrence-free survival (RFS) and overall survival (OS) after a median observation period of 41 months. Immunohistochemically (ER-ICA) and biochemically determined estrogen receptors (ER-DCC), as well as tumor size, lymph node status, histologic grading, mitotic rate, and nuclear polymorphism, were of prognostic value for recurrence-free survival and/or overall survival. In multivariate analysis, lymph node status, tumor size, and mitotic rate proved to be independent prognosticators; ER-ICA showed significance in the univariate analysis which dropped, however, when multivariate analysis was applied. The prognostic power of histologic grading in our series seemed to depend mainly on the subfactors which relate to nuclear features.

Comparison of immunohistochemical and biochemical measurement of steroid receptors in primary breast cancer: evaluation of discordant findings.

Tumor samples of 240 patients with primary breast cancer were biochemically and immunohistochemically investigated for estrogen receptors (ER) and, in 130 of the samples, for progesterone-receptors (PgR) in order to examine reasons for discordant findings. The biochemical (DCCA) and immunohistochemical assays (ICA) yielded positivity in 71% for ER, and in 44% for PgR. Concordant ER-DCCA and ER-ICA results were obtained in 84%; two thirds of the discordant ER-findings manifested as DCCA-neg/ICA-pos. Concordance in the case of PgR amounted to 72%, and of the discordances 60% were DCCA-neg/ICA-pos. Significant association with postmenopausal status existed only for ER positivity in ICA (p = 0.01), whereas ER-DCCA, PgR-DCCA and PgR-ICA were all more or less independent of the menopausal status. The frequency of discordances was independent of menopausal status. Discordance for ER-assays increased significantly near the respective cut-off point; this was not unequivocally true for PgR-assays. The correlation of tumor types of sparse cellularity, as well as prominent stroma content ('scirrhous carcinoma') with increased frequency of the constellation DCCA-neg/ICA-pos was of borderline significance for PgR (p = 0.06), but not for ER. The percentage of discordant ER-findings, figuring as DCCA-neg/ICA-pos, was statistically significantly increased in locally advanced breast cancer (p = 0.03). Fibrocystic disease in peritumoral breast tissue had no impact on receptor-assay discordance. In any case, the models derived from theoretical thought, laboratory data and singular observations can only in part explain the discordance in steroid receptor values measured with different methods.

[Axillary metastases of unknown primary carcinoma]. / Axilläre Metastasen eines primär unbekannten Karzinoms.

S.R., a 66-year old woman, was referred to our department because of an axillary mass in the right side. The patient had observed an increasing, painless swelling in the right axilla for the last two months. In the region of the right axilla in the middle axillary line an ovoid and solid tumour of 3 cm in diameter, quite well distinguishable, moving against the skin and the surrounding tissue, could be palpated. A subsequent mammography yielded an unsuspicious visualisation of both breasts and the left axilla. In the right axilla a circular solidification was detected, which then turned out on ultrasound examination to be a 2.6-cm diameter axillary lymph node. In the course of the lymph node extirpation of the right axilla two lymph nodes were dissected with histological evidence of metastatic nodes of a solid tumour, most likely in accordance with a breast carcinoma. Several immunohistochemical methods had been applied to determine the origin of the tumour cells and were thus identified as breast cancer cells. To detect primary causative carcinoma, different examinations were performed postoperatively without identifying any cancerous lesions. At least accurate research concerning the history of the patient was required to reexamine the histologic material of an operation of the right breast in 1989. The histological diagnosis of the dissected node of that time had been defined as a benign intracanaliculary papilloma in the right side without evidence of malignancy. The reexamination of the paraffin-embedded material from the operation of the right breast in 1989 revealed a lobular carcinoma of the right breast. The "occult" (undetectable) carcinoma of the breast occurs in less than 1% of all breast carcinomas. Thus it represent a rare clinical event and hence no standardised therapy schemata exist. To confirm the diagnosis of an occult carcinoma of the breast efficient reexamination of histological material from earlier breast operations indicated.

[Increased rate of spontaneous version in breech presentation by Indian bridge? A prospective, randomized study]. / Erhöhung der Rate von Spontanwendungen bei Beckenendlagen durch die Indische Brücke? Eine prospektive, randomisierte Studie.

BACKGROUND: The effectiveness of Indian version to convert fetuses from breech to vertex presentation was evaluated. METHODS: One hundred and nine pregnant women presenting between 30 and 32 weeks of gestation with singleton breech infants were included in our prospective randomized open study making an interim analysis recruitment to estimate the sample sizes after one year. The spontaneous version rate of fetuses in breech presentation was compared with the version rate in women performing Indian version. Indian version is a maternal positioning exercise that consists of raising the pelvis, abduction of the thighs, and relaxed abdominal breathing. Clinical parameters that could influence the result were assessed. RESULTS: In primiparous women, the version rate was 70% in the Indian version group and 63% in the comparison group. In multiparous women, 89% Indian versions and 87% spontaneous versions were observed. Parity was the only clinical parameter found to be related to outcome. CONCLUSION: Indian version does not significantly improve the rate of spontaneous version of breech to vertex presentation.

Axillary metastases of an occult primary carcinoma of the breast-discovered only by 99mTc-tetrofosmin scintigraphy.

Recent reports consider 99mTc-tetrofosmin scintigraphy to be a powerful new diagnostic tool for discriminating malignant from benign breast disease. We report on a woman suffering from histologically confirmed axillary metastases of a primary unknown, occult carcinoma, whose origin was suspected within the breast. All the diagnostic procedures performed to discover any lesion failed or were inconclusive. The primary cancer was clearly visualized, however, in the right breast by means of 99mTc-tetrofosmin scintigraphy. Conclusion. We suggest that 99mTc-tetrofosmin scintigraphy is a powerful method to detect breast cancer, especially when other diagnostic imaging procedures are inconclusive.

Quantification of uPA receptor expression in human breast cancer cell lines by cRT-PCR.

The conversion of plasminogen to active plasmin is thought to be a crucial step in the process of extracellular matrix degradation associated with metastatic spread. Activation of plasminogen is initiated by urokinase plasminogen activator (uPA). The binding of uPA to the uPA cell surface receptor (uPA-R) accelerates plasmin generation from plasminogen and localizes uPA activity to the cell surface. We investigated the mRNA-expression of uPA-R in 19 different human breast cancer cell lines. In a competitive reverse transcription polymerase chain reaction (cRT-PCR) we simultaneously co-amplified two different RNA templates bearing the same primer recognition sequences, the cell line RNA and a known amount of an in vitro synthesized uPA-R-RNA internal standard. We analyzed the two PCR products differing 50 bp in size by agarose gel electrophoresis and calculated the initial uPA-R-RNA template concentration from the relative intensities of the bands quantified by video densitometry. We grouped the investigated cell lines according to their in vitro invasiveness according to literature. Cell lines with a high potential of invasiveness showed a higher expression of uPA-R compared to those with a low potential of invasiveness (Student's t-test, p 0.04). In addition to that we compared the uPA-R mRNA levels with uPA-R, uPA, and PAI-1 protein levels in culture supernatants and cell lysates. The obtained results in breast cancer cell lines with different invasiveness and in benign epithelial cell lines revealed the complex cooperation of the urokinase type proteolytic pathway. uPA, uPA-R, and PAI-1 are to be considered as a diagnostic tool rather than assaying a particular molecule alone. Our findings support the hypothesis that the urokinase proteolytic pathway plays a central role in the acquisition of an invasive phenotype and favors its potential use as a prognostic marker in patients with breast cancer.

Placental isoferritin in pregnancies with small-for-gestational age fetuses.

The secretion of placental isoferritin (PLF) during pregnancy could be responsible for the diminished immunoreaction of maternal lymphocytes against the embryo. In this study, serum levels of PLF in 335 pregnant women were correlated with birth weight, percentile of birth weight, gestational age, and pulsatility index of the uterine artery, as well as with diastolic notching. Women with small-for-gestational age (SGA) infants (birth weight below or equal to the tenth percentile) showed significantly lower PLF levels (11.7 U/ml) compared with women whose newborns were of normal weight (19.4 U/ml) (P < 0.05). In line with this finding, a strong correlation was observed between PLF levels and the percentile of birth weight, pulsatility index of the uterine artery, and the presence of diastolic notching. The strong correlation of low PLF values and SGA newborns suggests that determination of PLF could serve as a marker to identify women at risk of having such babies.

Maternal alloimmunization against fetal platelet antigens: a prospective study.

Neonatal alloimmune thrombocytopenia (NAIT) is induced by maternal alloantibodies to fetal platelet antigens. This prospective study was carried out to evaluate the incidence of anti-platelet antibodies in 933 mother-child pairs where the mother and child were typed for the human platelet antigens (HPA)-1, -2, -3, -5. Sera from mismatched mother-child pairs were screened for anti-platelet antibodies, anti-HLA class I and blood group ABO IgG antibodies. Platelet-specific antibodies were anti-HPA-3a in one and anti-HPA-5b in 17 neonates, respectively. All these neonates had normal platelet counts. One woman had autoreactive antibodies. Anti-HLA class I and anti-blood group A IgG antibodies were detected in five and four neonates, respectively, born with a platelet count < 150 x 10(9)/l. None of the 11 homozygous HPA-1b mothers became immunized against their heterozygous offspring. The maternal HLA-allotypes HLA-DR52 and -DR6, typically found in individuals immunized against HPA-1a and -5b, respectively, were found in three of 11 HPA-b/b nonresponders and eight of the anti-HPA-5b responders. The results indicate that a risk for NAIT due to HPA-2 and -3 alloimmunization is low. The HLA allotypes do not predict the risk for NAIT due to HPA-1 or -5 alloimmunization. Maternal anti-HPA-5b antibodies do not correlate with the platelet count in the neonate.

Prognostic factors in primary fallopian tube carcinoma. Austrian Cooperative Study Group for Fallopian Tube Carcinoma.

A retrospective nationwide evaluation of primary fallopian tube carcinomas for a period of 10 years (1980-1990) was performed to evaluate the prognostic impact of various factors. Sixty-six cases were investigated for the prognostic influence of estrogen (ER) and progesterone (PgR) status, mitotic activity, degree of nuclear anaplasia, and inflammatory reaction. ER and PgR receptors were detected by immunohistochemistry from paraffin sections. Forty-two percent were PgR-positive and 26% were ER-positive. However, no correlation of steroid receptors with survival could be found. Ninety-two percent of all tumors showed a moderate and high degree of nuclear anaplasia and only 8% showed a low degree of nuclear anaplasia. Thirty-four (52%) samples from all patients revealed low mitotic activity compared to 32 (48%) with an intermediate and high mitotic rate. Twenty-four (37%) tissue samples showed a positive inflammatory reaction which correlated with a significantly better outcome compared with tumors without this feature. This finding was also confirmed in multivariate analysis as an independent prognostic factor.