Serotonin transporter gene (5-HTT) polymorphisms and compulsive buying.

We examined a panel of 21 patients diagnosed with compulsive buying for two DNA sequence polymorphisms found in the gene that encodes the serotonin transport (5-HTT). One polymorphism, found in the promoter region of the 5-HTT gene, involves a 44-base pair (bp) deletion, and the other, found in the second intron, is due to variable numbers of a repeat sequence. We also typed a panel of 38 psychiatrically normal controls for both 5-HH markers. When compared to this control panel, no significant differences were seen for either 5-HTT marker among the compulsive buyers.

The diagnostic value of silver nucleolar organizer region assessment in breast cytology.

Benign and malignant breast lesions in cytologic preparations can be difficult to distinguish. The authors applied the silver nucleolar organizer region (AgNOR) technique to cytologic preparations obtained from surgical specimens to evaluate its diagnostic usefulness in making this distinction. Sixty-two benign and 36 malignant lesions were examined. AgNORs were counted and evaluated using a subjective scoring technique to examine AgNOR size, shape, and clustering. The benign lesions had a mean count of 4.44 AgNORs/nucleus (95% CI, 2.4-6.5) and the malignant cases, 9.52 AgNORs/nucleus (95% confidence interval, 7.4-11.7; P < .0005). The median score for benign cases was 7 and for malignant cases, 13 (P < .0001). With a few exceptions, cases with high counts had high scores. The diagnostic accuracy of combined counting and pattern assessment was 90%. The likelihood ratio for correct diagnosis using AgNOR counting was 14:1 and for AgNOR scoring, 13:1.

Proliferating cell nuclear antigen counts in formalin-fixed paraffin-embedded tissue correlate with Ki-67 in fresh tissue.

Cell proliferation can be studied by a variety of techniques. However, most require fresh tissue. To evaluate cell proliferation in formalin-fixed paraffin-embedded sections, the authors immunohistochemically studied 35 tumors and 11 samples of normal/hyperplastic tissue with PC10, a monoclonal antibody directed against proliferating cell nuclear antigen. Results were compared with those obtained with Ki-67 on fresh tissues. There was no significant difference between proliferating cell nuclear antigen and Ki-67 counts, which were strongly correlated (r = 0.8). Proliferating cell nuclear antigen positivity was easier to evaluate because morphology was better preserved in formalin-fixed tissue. The authors conclude that PC10 is an alternative to Ki-67 in evaluating cell proliferation and has the advantage of reacting with formalin-fixed paraffin-embedded tissue.

A quantitative immunohistochemical evaluation of lentigo maligna and pigmented solar keratosis.

Pigmented solar keratosis (PSK) is sometimes clinically indistinguishable from lentigo maligna, a form of malignant melanoma in situ. Occasionally histologic diagnosis is also difficult. Accurate diagnosis is essential, as the treatment and prognosis for each condition differs considerably. To determine whether there was a significant overlap in the number of melanocytes in these sun-damaged skin lesions, or whether immunohistochemistry might be helpful in the differential diagnosis, the authors examined skin biopsy specimens from 26 patients with obvious lentigo maligna and 15 patients with PSK using 3 monoclonal antibodies (HMB-45, NK1C3, and vimentin) and 1 polyclonal antibody (S-100 protein). Formalin-fixed paraffin sections were immunostained with each of the above antibodies, and immunopositive cells per mm2 of epidermis were counted. The difference between lentigo maligna and PSK counts was statistically significant at a level of P < .0001; furthermore, there was almost no overlap between the two groups. The sensitivity for the diagnosis of lentigo maligna was high with all antibodies. However, HMB-45 had the highest sensitivity and the lowest false-positive rate and was visually most pleasing. Using a cut-off count of 60 cells per mm2 of epidermis, HMB-45 had a sensitivity of 96% and a 0% false-positive rate. In this study, lentigo maligna was easily differentiated from PSK. The real value of immunohistochemistry in the differential diagnosis of these pigmented lesions should be tested in a prospective study using cases that are difficult to diagnose by routine light microscopy.

The Bal I and Msp I polymorphisms in the dopamine D3 receptor gene display, linkage disequilibrium with each other but no association with Tourette syndrome.

The D3-dopamine receptor gene, DRD3, has been considered as a candidate gene in several disorders in which the dopaminergic system has been implicated including Tourette syndrome and schizophrenia. The DRD3 studies to date have all used as the gene marker a Bal I polymerase chain reaction restriction fragment length polymorphism (PCR RFLP). There have been recent reports on a second marker, an Msp I PCR RFLP, that lies 40 kb downstream. We have typed a sample of 16 Tourette syndrome families with both markers and observed significant linkage disequilibrium between the two markers but no apparent association of either marker with Tourette syndrome.

Secretory (juvenile) carcinoma of the breast.

A case of secretory (juvenile) carcinoma of the breast is reported in a 26-year-old multiparous woman who had been taking oral contraceptives for 7 months. The tumour recurred 8 months after local resection and axillary metastases were found at radical mastectomy. No further recurrence has been detected but the follow-up period is only 8 months. It is emphasized that secretory carcinoma of the breast originally described in children occurs also in adults. Early reports stressed the slow rate of growth, often with intervals of many years before recurrence, and the small risk of metastatic spread, many cases being cured by local resection. However, axillary metastases have been found in approximately 15% of the recorded cases. Consequently it is recommended that the initial treatment should be simple mastectomy with at least a low axillary resection.

Persistent Tardive Dyskinesia and Other Neuroleptic-Related Dyskinesias in Tourette's Disorder.

ABSTRACT Two new cases are reported of persistent tardive dyskinesia associated with neuroleptic treatment of patients with Tourette's disorder. Previously, 44 cases were described in 8 published reports, including 36 children and adolescents, but diagnostic criteria were infrequently specified. In our review of these cases, using the criteria of Schooler and Kane but modified by Gualtieri's more conservative duration criteria of 16 weeks, only 2 of these cases were consistent with a diagnosis of persistent tardive dyskinesia. The 2 new cases are reported here. A 12-year-old, who was treated with haloperidol 4 mg daily since the age of 8, developed fine vermicular movements of the tongue of moderate severity. Despite discontinuation of the neuroleptic, symptoms of tardive dyskinesia still persisted at age 15 and were associated with difficulty in speech production. A 42-year-old, who was treated with haloperidol 1 mg three times daily for 7 years, developed jaw movements and lip smacking that persisted for more than 2 years. Abnormal involuntary movement scale (AIMS) ratings supported a diagnosis of tardive dyskinesia in both patients with Tourette's disorder. The identification of tardive dyskinesia in the setting of a preexisting movement disorder is discussed. Features that helped distinguish the movements of tardive dyskinesia and Tourette's disorder in these patients included the premonitory urges of Tourette's symptoms and a differential response of the symptoms to distracting voluntary motor tasks. Clinicians should be attentive and thorough in searching for symptoms of tardive dyskinesia following treatment with relatively low doses of haloperidol in patients with Tourette's disorder.

Comparison of oestrogen receptor assessment in frozen and paraffin sections.

Estimation of oestrogen receptors (ER) in breast carcinoma has important therapeutic and prognostic implications. The dextran-coated charcoal (DCC) biochemical technique is being replaced in many institutions by immunohistochemical techniques. The aim of this study was to assess the level of agreement between ER counts in frozen and paraffin sections. Ninety-seven infiltrating breast carcinomas were studied immunohistochemically, for ER in frozen and paraffin sections. Cases were classified as ER-positive if > or = 10% of the tumor cells were positive. Both techniques gave a high level of correlation and agreement. There was complete agreement in classifying cases as ER-positive or ER-negative. ER estimation on only one case was outside 2SD of complete agreement. Oestrogen-receptor content can be assayed satisfactorily in paraffin sections and offers many advantages over the frozen section technique.

Evaluation of Ki-67 reactivity in neuroblastoma using paraffin embedded tissue.

AIMS: To examine the pattern of reactivity of Ki-67 in neuroblastoma and correlate this with a) clinical prognostic criteria and b) cell cycle statistics (using flow cytometry). METHODS: Four micron sections of paraffin embedded (PE) tissue from 55 patients (25 pre chemotherapy and 30 post) were placed on to aminosialinised slides, dewaxed and rehydrated. Slides were pretreated in a microwave oven, endogenous peroxidase activity blocked using 3% hydrogen peroxide and Ki-67 reactivity investigated using a streptavidin/biotin/peroxidase technique. DNA ploidy was also performed from an immediately adjacent section on the same block using a FACScan and Cellfit software. RESULTS: Ki-67 reactivity was well defined and highly reproducible. Eighteen out of 30 post chemotherapy samples were totally negative, despite evidence of proliferation on flow cytometry and all subsequently died of disease. As interpretation post chemotherapy was therefore deemed unreliable, this group was excluded from analysis. Reactivity in pretreatment samples ranged from 0% to 67%; staining was restricted to the nucleus with a distinct pattern noted in the nucleolus. Ki-67 positivity was lower in aneuploid compared with diploid tumours (mean 26% vs 36%, NS). Among diploid tumours, a lower percentage positivity was noted in those patients with better clinical prognostic parameters. Correlation however between Ki-67 and SG2M phases of cell cycle was poor (RS = 0.39, NS). CONCLUSION: Assessment of proliferation in neuroblastoma by Ki-67 reactivity in paraffin embedded tissue is reliable in pretreatment samples and can be incorporated into routine immunohistochemical evaluation. Larger multicentre studies are required to further evaluate Ki-67 reactivity as a prognostic indicator.

Sudden cardiac death in the young: a 1-year post-mortem analysis in the Republic of Ireland.

AIMS: A retrospective post-mortem analysis was undertaken to determine the aetiology of sudden cardiac death (SCD) amongst individuals aged

Maternal care and altered social phenotype in a recently collected stock of Astatotilapia burtoni cichlid fish.

For over 30 years, the African cichlid fish, Astatotilapia burtoni, has been an important model system for studying the mechanisms underlying socially mediated behavioral change, with the focus being the dominance behavior of males. A recently collected wild-stock (WS) of this species invigorates interest in parallel studies of females' behavior. Here, we describe a robust 'good-mother' phenotype, increased maternal affiliation in fry, and subtle differences in males' behavior that are exhibited by this new stock. While the females of both the laboratory-stock (LS) and the WS brood the developing fry in their buccal cavity, only the WS continues to provide maternal care after initial release of the fry while the LS engage in filial cannibalism. We show that weight loss during starvation, either during brooding or with restriction of food, is greater in the LS than in the WS; thus, the observed behavioral differences may be tied to metabolic differences. The WS also exhibits a robust androgen response to challenge during the maternal care phase. Given the increasing power of genomic tools available for this species, the comparison of these two stocks will offer the opportunity to investigate the genetic and genomic basis of behavioral differences.

Social and ethnic differences in attendance for antenatal care in England.

OBJECTIVES: Evidence about sociodemographic factors associated with late attendance for antenatal care in the UK is of poor quality. This study aimed to identify any social or ethnic differences in access to antenatal care, and to quantify the effect of any such differences using data collected in a survey of women's experiences of antenatal screening. STUDY DESIGN: Cross-sectional survey using a postal questionnaire. METHODS: A stratified clustered random sampling strategy was used. Hospitals in England were stratified according to ethnic mix. In order to ensure inclusion of an adequate number of women from Black and Minority Ethnic (BME) backgrounds, hospitals with >or= 15% of women of BME origin were oversampled. Pregnant women aged >or= 16 years, receiving care in 15 participating hospitals, were sent a postal questionnaire at 27-31 weeks of gestation. Logistic regression was used to estimate odds ratios (ORs) comparing social and ethnic groups for attendance for antenatal care, adjusting for sociodemographic and clinical factors. RESULTS: In total, 839 women (57%) returned completed questionnaires. Compared with all women giving birth in 2005 in England and Wales, the survey sample contained fewer women aged <20 years (5.8% vs 6.9%), more women aged >35 years (24.1% vs 19.6%) and fewer women who were born outside the UK (14.8% vs 20.8%). Five percent of responders were late attenders for their first antenatal appointment. The odds of late initiation of antenatal care were higher for women born outside the UK [OR 4.37, 95% confidence interval (CI) 2.25-8.52; P=0.0004] and for women living without a husband/partner (OR 2.74, 95% CI 1.81-4.16; P=0.0002). In total, 2.5% of women were late attenders for their booking appointment. The odds of late booking were higher for Black women (OR 5.92, 95% CI 2.97-11.83) and women living without a husband/partner (OR 1.95, 95% CI 0.97-3.93; P=0.06). CONCLUSIONS: A small proportion of women initiate and/or book late for antenatal care. This study provides recent, good-quality evidence that women born outside the UK and those living without a husband/partner may be at particular risk of late attendance for antenatal care.

The carotid artery in head and neck surgery.

Involvement of the carotid artery by malignant disease may present the surgeon with a dilemma. An aggressive approach to the problem may improve results in some cases that have not developed distant metastases. Adequate assessment in the planning of a curative surgical procedure is necessary and some of the problems in dealing with involvement of the artery are discussed.

Late rupture of knitted velour Dacron arterial prostheses.

Rupture of a Dacron arterial prosthesis is a most unusual complication, although it has been reported previously. Three further such cases are reported with a brief review of the relevant literature.

Peripheral arterial embolism: 1961-1985.

A review of arterial embolism to upper and lower limbs from 1961 to 1985. During this period 253 patients were treated for 269 episodes of embolus at the Princess Alexandra Hospital. The period was divided into 5 year intervals and analysis showed significantly increasing age for the population over this period. Similarly a decreasing mortality rate was noted during this period although limb salvage did not change after the initial 5 year period. There was a rising incidence of atherosclerotic ischaemic heart disease and a decreasing incidence of rheumatic heart disease. The overall mortality rate was 15.6% while the overall amputation rate was 8.2%. Factors significantly related to survival were acute myocardial infarction and level of occlusion. Factors significantly relating to morbidity were pre-operative heparin administration and performance of completion angiography. The performance of completion angiography was shown to improve the result from embolectomy without having adverse influence on the mortality rate. The results of this review indicate that preoperative heparinization, the performance of completion angiography, and the flexibility to explore multiple levels of the limb circulation, are essential factors in the management of peripheral arterial embolism.

Aortocaval fistula as a complication of leaking aortic aneurysm.

The successful management of 2 patients is reported, each involving the closure of a fistula into the inferior vena cava as a sequel to the rupture of an atherosclerotic aortic aneurysm. It is an uncommon complication which should be suspected in the presence of an aortic aneurysm with a loud machinery bruit. Associated peripheral cyanosis and venous pulsation in the accessible proximal veins of the lower extremity and priapism afford strong supporting evidence.

Atherosclerotic popliteal aneurysms with particular regard to the contralateral side.

A retrospective analysis of 75 patients with 103 atherosclerotic popliteal aneurysms, seen at Princess Alexandra Hospital, Brisbane, was undertaken to assess the results of management and the most appropriate approach to the contralateral popliteal aneurysm. These patients were seen between January 1968 and December 1985. There were no females, the mean age was 66.3 years and 36% of the patients had bilateral popliteal aneurysms. There was a high incidence of other associated aneurysms, abdominal aortic (21), femoral (12) and isolated iliac (3). Thrombosis in a popliteal aneurysm was the most common reason for presentation initially (48%), followed by detection of a lump in the popliteal fossa (22.6%), embolic phenomena (10.6%) and ruptured popliteal aneurysm (four cases). The most common presentation for contralateral aneurysms was detection of a lump in the popliteal fossa. Management of the contralateral popliteal aneurysm was classified as early, elective repair (n = 14) and no surgery or surgery delayed until the development of symptoms (n = 14). Outcome was classified as successful, retained and fully functional limb at follow-up; or failure, amputation or debilitating ischaemia. There was one failure among those undergoing early elective repair and seven failures among those undergoing no or delayed surgery (P = 0.033, Fisher's Exact Test). There were 79 reconstructions. Bypass and ligation (n = 54) resulted in two amputations and two long-term occlusions, interposition augmented vein graft (n = 15) in two amputations and no long-term occlusions and interposition Dacron grafts (n = 10) with no amputations and three long-term occlusions.(ABSTRACT TRUNCATED AT 250 WORDS)