The TRANSPARENT TESTA GLABRA1 locus, which regulates trichome differentiation and anthocyanin biosynthesis in Arabidopsis, encodes a WD40 repeat protein.

The TRANSPARENT TESTA GLABRA1 (TTG1) locus regulates several developmental and biochemical pathways in Arabidopsis, including the formation of hairs on leaves, stems, and roots, and the production of seed mucilage and anthocyanin pigments. The TTG1 locus has been isolated by positional cloning, and its identity was confirmed by complementation of a ttg1 mutant. The locus encodes a protein of 341 amino acid residues with four WD40 repeats. The protein is similar to AN11, a regulator of anthocyanin biosynthesis in petunia, and more distantly related to those of the beta subunits of heterotrimeric G proteins, which suggests a role for TTG1 in signal transduction to downstream transcription factors. The 1.5-kb TTG1 transcript is present in all major organs of Arabidopsis. Sequence analysis of six mutant alleles has identified base changes producing truncations or single amino acid changes in the TTG1 protein.

Allele-specific interactions between ttg and gl1 during trichome development in Arabidopsis thaliana.

Trichome development in Arabidopsis thaliana is a well-characterized model for the study of plant cell differentiation. Two genes that play an essential role in the initiation of trichome development are GL1 and TTG. Mutations in either gene prevent the initiation of most trichomes. The GL1 gene encodes a myb-related transcription factor. Mutations in TTG are pleiotropic, affecting anthocyanins, root hairs, and seed coat mucilage in addition to trichomes. Six ttg alleles were examined and shown to form a hypomorphic series. The severity of all aspects of the ttg phenotype varied in parallel in this allelic series. The weakest allele, ttg-10, causes frequent clusters of adjacent trichomes, suggesting a role for TTG in inhibiting neighboring cells from choosing the trichome fate. This allele results from a mutation in the 5'-untranslated region of ttg and creates an out-of-frame upstream AUG codon. The ttg-10 allele shows several unusual genetic interactions with the weak hypomorphic gl1-2 allele, including intergenic noncomplementation and a synthetic glabrous phenotype. These interactions are specific for the gl1-2 allele. The implication of these results for current models of trichome development is discussed.

Risk factors associated with stress reactions in female Marines.

Women have a higher stress fracture rate than men in military studies, although the exact cause of this is not clear. Hyperpronation has been implicated as a potential risk factor for injury. In this prospective observational study, we measured subtalar joint range of motion in 101 women (ages 20-27 years) enrolled in Marine Corps Officer Candidate School in June 1994. The purpose of this study was to identify risk factors for injury in female Marine Corps officer candidates. The primary area of interest was the association between the amount of subtalar joint range of motion and stress reactions. Questionnaires were administered that explored previous physical activities, sports participation, and menstrual history. Anthropometric measurements were performed, including subtalar joint range of motion. During the 10 weeks of physical training, 11.5% of the women (N = 12) had stress reactions compared with 7% of the men (N = 10). There was no statistically significant difference in the means of subtalar joint range of motion in the stress reaction group compared with the non-stress reaction group. Differences in stress reaction rate across quartiles of subtalar joint range of motion were not significant. Those women who ran fewer miles (< or = 2.8 miles per session) before training had a higher rate of stress reactions (p < 0.04). Younger individuals (< 23 years) had a higher rate of stress reactions (p < 0.01). Women with fewer menstrual periods (< 10 per year) had a higher rate of stress reactions (p < 0.02). A narrow pelvis (< or = 26 cm) was associated with a higher rate of stress reactions (p < 0.09). We conclude that an increased subtalar joint range of motion is not a risk factor for stress reactions in women. However, further studies with a larger study population should be performed to confirm these findings.

Recurrent mammary carcinoma after local excision. A segmental problem.

BACKGROUND: The acceptance of local operative therapy for mammary carcinoma has stimulated scrutiny of specific techniques with the goals of minimizing the incidence of local recurrence while optimizing the cosmetic result. Intraductal spread of carcinoma has been established as a major factor in determining the rate of local recurrence after breast-conserving therapy for mammary carcinoma. The relationship of the anatomic location of a recurrent neoplasm to that of the primary tumor is likely to be instructive in evaluating the effectiveness of various proposed approaches to primary excision. METHODS: Using the tumor registry of a tertiary care medical center, the authors reviewed all patients with mammary carcinoma treated with primary local excision during a 9-year period (1984-1992; n = 86), and identified all patients who subsequently experienced local recurrence (n = 5). The pathologic anatomic findings in each case were reviewed carefully and correlated with clinical and mammographic data. RESULTS: The rate of local recurrence in this series was 5.8%, similar to that of Veronesi's "lumpectomy" group (7%). In all five patients, the recurrent lesion was located in the same breast quadrant, along a radius from the nipple to the edge of the breast disc that crossed the site of the initial lesion. CONCLUSION: Local recurrence of mammary carcinoma after breast-conserving operative therapy most often occurs within the same segment; it is therefore proposed that its incidence may be substantially reduced with the use of a primary excision technique (based on normal breast anatomy) that removes en bloc the dominant tumor mass and the associated (possibly diseased) duct system.

Use of algorithmic pathways to develop quality, cost-effective clinical care.

STUDY OBJECTIVES: To analyze the cost of diagnosis and treatment associated with hydrosalpinges and pelvic adhesions using algorithmic pathways. DESIGN: Analysis of six pathways: (1) Chlamydia IgG antibody titer -> hysterosalpingogram -> diagnostic laparoscopy -> in vitro fertilization (IVF); (2) Chlamydia IgG antibody titer -> diagnostic laparoscopy -> therapeutic laparoscopy -> IVF; (3) hysterosalpingogram -> diagnostic laparoscopy -> therapeutic laparoscopy -> IVF; (4) diagnostic laparoscopy -> therapeutic laparoscopy -> IVF; (5) no treatment; and (6) IVF only. SETTING: A tertiary care practice at a university-associated hospital. PATIENTS: Patients were retrospectively chosen on the basis of availability of results of Chlamydia IgG titers, operative notes from laparoscopy, and hysterosalpingograms (HSGs). All patients identified with these three results available were included. INTERVENTIONS: Determination of results of laparoscopic treatment, IVF, and no therapy (observation only), based on the literature. MEASUREMENTS AND MAIN RESULTS: The theoretical cost to achieve pregnancy for each pathway was calculated by mathematical modeling. The greatest number of pregnancies for the least cost ($18, 883/pregnancy) was from the diagnosis and treatment of adhesions at laparoscopy with no previous screening. The least costly approach to pregnancy for blocked tubes ($26,614/pregnancy) was to start with an HSG. All pathways for adhesions and any screening pathway using HSG for hydrosalpinges were more cost effective than IVF. CONCLUSIONS: These pathways are limited, as they require several assumptions and are based on a tertiary care population. Although HSG and laparoscopy appeared to be the most cost-effective approaches to pregnancy, a primary care group may have a more cost-effective response to the use of Chlamydia trachomatis IgG antibody screening.

Clinical correlates of false-negative fine needle aspirations of the breast in a consecutive series of 1,005 patients.

Fine needle aspiration (FNA) of the breast is a useful diagnostic tool in the management of lesions of the breast. However, false-negatives invariably occur and can detract from the usefulness of the technique. The current study of 16 patients with false-negative FNA of the breast from a consecutive series of 1,005 patients was undertaken in an attempt to better understand the clinical correlates most often associated with false-negative diagnoses. Pre-FNA physical examination and mammographic findings were correlated with the gross and microscopic features of these 16 patients. All 16 patients had palpable findings. Mammographic abnormalities were divided into three categories--highly suspicious for malignant tumor (n = 7), indeterminate (n = 3) and negative (n = 4). Mammograms were not available for two patients. The carcinomas ranged in size from 0.8 to 6.5 centimeters (mean of 1.9 centimeter). Thirteen of 16 carcinomas were 2 centimeters or less. Of the small tumors, histologic factors revealed no special type (NST) in six patients and special type carcinoma in seven patients. The notably large tumor (6.5 centimeters) was of high grade and demonstrated an unusual diffusely infiltrative pattern histologically extending between normal mammary lobules. Overall, special type carcinomas comprised seven of 16 patients. All of these carcinomas, as well as six of nine NST were paucicellular, that is, more than 20 percent area containing tumor cells. The current study supports the findings of others that small tumor size, paucicellularity and special type histologic factors contribute to false-negative diagnoses of FNA of the breast.

Breast cancer risk associated with proliferative breast disease and atypical hyperplasia.

BACKGROUND: Women with proliferative breast disease (PD) have been observed to have an increased risk of breast cancer. The authors evaluated the effect of PD on breast cancer risk in a case-control study among participants of the Breast Cancer Detection Demonstration Project (BCDDP). METHODS: More than 280,000 women were screened in the BCDDP at 29 centers. Study subjects were selected from BCDDP participants who underwent biopsy that revealed benign breast tissue. There were five BCDDP centers for which histologic slides were available on more than 85% of the benign biopsy specimens. Case patients for this study were the 95 women from these five centers who had breast cancer develop during follow-up. Two matched control patients who did not have breast cancer develop were selected for each case. The biopsy slides were reviewed by two pathologists who were blinded with regard to cancer outcome. RESULTS: Women with atypical hyperplasia (AH) had 4.3 times the breast cancer risk of women without PD (95% confidence interval [CI], 1.7-11). In women with PD lacking AH, the relative risk was 1.3 (95% CI, 0.77-2.2). A family history of breast cancer (FH) increased breast cancer risk 2.4 times (95% CI, 1.4-4.3). The joint occurrence of FH and AH had a strong synergistic effect on breast cancer risk. CONCLUSIONS: AH is a reliable marker of increased breast cancer risk among women undergoing breast biopsy.

Selective fallopian tube canalization.

Infertility is an increasingly common problem. Occlusion of the fallopian tubes is one of the principal causes, and until recently surgery was the only available treatment. The success rate of surgery is often low, particularly with occlusion of the proximal tube. Selective fallopian tube canalization under fluoroscopic guidance has been successful in alleviating proximal tubal obstruction. This procedure may be performed in the outpatient setting and is a safe, cost-effective alternative to surgery.

Effects of contrast agents on the fallopian tube in a rabbit model.

The authors evaluated the effect of different iodinated contrast agents on the fallopian tube and adnexal tissue in 15 rabbits. Ethiodized oil, an oil-soluble agent, was used in five rabbits. The following water-soluble agents were used: iothalamate meglumine 30% (n = 3), iothalamate meglumine 60% (n = 3), and ioxilan (n = 4). The agents were injected through catheters placed in the fallopian tubes. Fallopian tubes and peritoneal cavities were histologically evaluated. The contralateral tube served as a control. Ioxilan and iothalamate meglumine 30% produced no pathologic response in the tube or peritoneal cavity. Iothalamate meglumine 60% was associated with mild inflammatory infiltrate, mucosal edema, giant cell reaction, and periovarian adhesions that were bilateral but more pronounced on the injected side. Use of ethiodized oil resulted in papillary fibrous adhesions on the ovarian surface, and fat granulomas were seen in the periovarian tissues. The safety of oil-based contrast agents for use in hysterosalpingography is therefore questioned. No significant differences were found among the water-soluble contrast agents.

American Cancer Society's Breast Cancer Detection Awareness Program: the 1988 middle Tennessee experience.

In an effort to augment public awareness of the benefits of screening mammography and to encourage the use of screening mammograms, the Tennessee Division of the American Cancer Society initiated the Breast Cancer Detection Awareness Program in March 1988. As a result of the initiative, 3,473 women telephoned for information, and 3,123 were found to be eligible for a screening mammogram. Of the 2,248 mammograms actually obtained, 1,764 (78%) were interpreted as normal, whereas 484 (22%) were classified as abnormal. Of the 484 women with abnormal mammograms, 277 (57%) were advised to have follow-up mammograms and 57 (12%) had excisional biopsy. The 55 biopsies reported showed benign changes in 83.6% and malignancy in 16.4%. Thus, nine malignancies were discovered from 2,248 screening mammograms (four malignancies per 1,000 mammograms). No malignancies were found in women between 35 and 39 years old.

Selective fallopian tube cannulation: initial experience in an infertile population.

We have studied a group of 19 patients presenting with proximal tubal occlusion. Seventy-three percent (22/30) of tubes attempted were successfully cannulated. Sixty-two percent (5/8) of tubes remained patent in limited follow-up at 3 to 6 months. We conclude that selective fallopian tube cannulation may provide an alternative to microsurgical tubal anastomosis in selected patients.

Diagnostic imaging of fertility disorders.

It is estimated that as many as 15% of married couples are affected by fertility disorders. The number of such couples seeking medical help has increased dramatically in the past 10 years due to both relative and absolute factors. The increase in population, the rising rate of sexually transmitted diseases, and the reduced availability of adoptable infants all contribute to the magnitude of this problem. The role of diagnostic imaging in the effective and compassionate care of couples desiring offspring is the subject of this review. Infertility is a disorder of a couple, not of two individuals. The diagnostic evaluation, therefore, must include both partners. Hysterosalpingography and ultrasound constitute the mainstay of the evaluation of the female member. The various techniques and complications of hysterosalpingography are reviewed. The normal appearance of the uterine cavity together with a review of the numerous anomalies and variations that might be encountered are presented. Along similar lines, the possible filling defects, synechiae, postoperative changes, and other alterations that may be encountered in imaging the uterine cavity are described. Evaluation of the fallopian tubes is of paramount importance, primarily to assess patency but also to assess the possibility of patent but diseased salpinges or disease of the surrounding peritubal tissue. Recently, interventional techniques using radiographic and sonographic control have been developed and are beginning to demonstrate promising results in the management of fallopian tube obstruction. These procedures, adapted from previously established radiographic interventive techniques, are discussed. The role of diagnostic imaging of the male partner is of lesser magnitude. Clinical assessment and semen evaluation generally permit adequate assessment of the male factor. Occasionally, however, vasography and seminal vesiculography are called into play. More frequently, sonographic evaluation to establish the presence of varicoceles is necessary. Such techniques are reviewed, as well as the interventional approaches for ablating varicoceles. The application of conventional and transvaginal sonography in the management of gynecologic fertility disorders is reviewed. Follicular monitoring, guided follicle aspiration, assessment of the status of the endometrium, guided embryo transfer and tubal cannulation, and evaluation of other pelvic disorders are significant factors in the appropriate management of the infertile couple.(ABSTRACT TRUNCATED AT 400 WORDS)

Ioversol for intravenous urography: a comparison study.

A new nonionic, low-osmolar iodinated contrast media, ioversol, was compared with another low-osmolar, nonionic contrast media, iohexol, in 80 patients undergoing intravenous urography. There were 40 patients in each contrast group. Patients were assessed for changes in vital signs, patient tolerance (heat and pain), and other adverse effects. Double-blind evaluation was also performed for comparison of the urogram image quality. There were no severe, life-threatening reactions for either contrast group. Ten patients (25%) receiving ioversol and seven (17.5%) receiving iohexol perceived body heat related to the injection of contrast material. Two patients (5%) in each group experienced mild nausea. Two patients (5%) of each group experienced noted unpleasant taste, and two patients (5%) of the iohexol group complained of headache. Vital signs remained stable without significant change in both groups, and image quality was considered equivalent. The results indicate that the two contrast agents are equivalent in image quality, safety, and incidence of adverse effects.

Adenocarcinoma in a sigmoid conduit: case report.

The increased risk of developing adenocarcinoma in the sigmoid colon after ureterosigmoidostomy has been acknowledged for some time. Development of adenocarcinoma in colonic conduits isolated from the fecal stream is rare. We report a case of adenocarcinoma arising in a sigmoid conduit that probably represents a metachronous adenocarcinoma of the colon.

Peritoneal reaction resulting from iodinated contrast material: comparative study.

A consensus does not exist as to the optimal contrast agent for hysterosalpingography. This study was undertaken to evaluate the early and delayed inflammatory responses of the peritoneal surfaces to various types of iodinated contrast media. Guinea pigs received intraperitoneal injections of lactated Ringer solution, iothalamate meglumine, diatrizoate sodium, ioxilan, or ethiodized oil. The inflammatory response of the peritoneal surfaces was assessed at 1,7, and 30 days. Five animals were studied at each time point for each agent. No animals that received Ringer lactate or iothalamate meglumine had inflammation at any time. Ioxilan produced inflammation in two of five animals at 7 days and no inflammation at 1 or 30 days. Ethiodized oil produced no inflammation at 1 day; however, three animals had inflammation at 7 days, and all five had inflammation at 30 days. The 30-day group showed striking inflammatory response with granulomatous features. The authors recommend the continued use of meglumine-based water-soluble ionic contrast material for hysterosalpingography.

Written informed consent for i.v. contrast-enhanced radiography: patients' attitudes and common limitations.

In a multiinstitutional study, we surveyed 902 patients who were undergoing IV contrast-enhanced CT or IV urography; the purpose of the study was to determine patients' reactions to being given a written description of some of the risks associated with radiographic contrast material just before undergoing the examination. Ninety percent of the patients who responded said they would rather receive this information than not receive it. Ten percent said they preferred not to be given the information. Limitations in obtaining a truly informed consent were not rare and occurred in patients with medical emergencies (3% of cases) and in those with a limited understanding of risk disclosure (11% of cases). Patients in the latter category included those who were comatose or semicomatose (2%), those with dementia (1%), those with aphasia (0.8%), those who had psychiatric problems (0.8%), those who were sedated (0.6%), those who were unable to read (2%), those who were unable to understand English (2%), and those who perceived the information as too technical (0.9%). Two percent of the patients were minors. Our survey shows that practical limitations in obtaining adequate risk disclosure are common, but most patients want and accept information about the risks of having IV contrast-enhanced CT or IV urography before undergoing the procedure.

Exploration of factors affecting mammography behaviors.

Of an estimated pool of 1,700 potential participants, only 382 (22%) eligible women participated in a low-cost breast cancer screening program offered to university and medical center employees. Because most women were still available and data were needed to understand why the opportunity to participate was refused by so many, a survey was done to determine factors related to mammography behavior. Three distinct groups of women were identified according to health beliefs, mammography behaviors, and modifying factors. Women who participated in the mammogram program were predominantly well-educated working women who were aware of mammography and its relationship to the breast cancer trajectory; they were affected by cost and convenience issues. One group of women did not participate in the program offered because they had had a recent mammogram; these women were at high risk for breast cancer and perceived mammography to be beneficial. The women who did not participate for other reasons were in nonprofessional jobs, had lower levels of education, and tended not to participate in the health care system as readily as women in the other groups; they perceived themselves less susceptible to breast cancer, valued mammography less, and knew less about breast cancer.

Carcinoma of the fallopian tube.

Primary adenocarcinoma of the fallopian tube is a rare neoplasm that constitutes less than 1% of gynecologic malignancies. Although the triad of menorrhagia, leukorrhea, and pain is said to be pathognomonic, preoperative diagnosis of this lesion is most unusual. The radiographic appearance at hysterosalpingography has only rarely been described in the English literature previously. This therefore is an unusual documentation of the preoperative appearance of fallopian adenocarcinoma by hysterosalpingography and sonography.

Observer variation in quantitative assessment of rheumatoid arthritis Part II. A simplified scoring system.

A new and more comprehensive simplified scoring system to provide quantitative assessment of radiographic findings in rheumatoid arthritis was studied by six observers with different levels of expertise. Since the observers, film set, and joints scored were the same as in a prior study of a more detailed scoring method, a precise comparison of the results was made. Interobserver variation with the simplified scoring system was small; there were highly significant correlations of the total radiographic scores for all observers (R = .898-.978, P less than .001). There were highly significant correlations between scores obtained with the simplified scoring system and those obtained with the more detailed method (R = .920-.955, P less than .001). When the same joints were evaluated by the two methods, a significantly greater number of possible observations could be scored with the simplified scoring system than with the more detailed method (X2 = 131.07, P less than .001). The simplified scoring system required 2.3 times less time to use in the hands of experienced observers.