Quantitative and qualitative analysis of stability for 16 serum immunoregulators over 50 freeze-thaw cycles.

OBJECTIVES: To evaluate the reliability of data from the assay of bio-archived specimens, a 50-freeze-thaw-cycle (FTC) degradation study of fresh sera was conducted to test the stability of 16 immunoregulators. METHODS: Twenty de-identified serum specimens were obtained from volunteers at United Health Services-Wilson Memorial Hospital. Specimens were stored at -20°C and underwent daily 1 h thawing and subsequent freezing for each FTC over 50 consecutive days. Immunoregulator concentrations were assessed via enzyme-linked immunosorbent assay (ELISA) in participant samples at 2 FTC (baseline), 25 FTC, and 50 FTC. Specific immunoregulators observed in the study were C-reactive protein (CRP), interleukin (IL)-1α, 4, 6, 8, 10, monocyte chemoattractant protein-1 (MCP-1, CCL2), monocyte chemoattractant protein-2 (MCP-2, CCL8), eotaxin-1, thymus-and-activation-regulated chemokine (TARC, CCL17), regulated on activation normal T-cell expressed and secreted (RANTES, CCL5), growth-regulated oncogene-alpha (GRO-α, CXCL1), small inducible cytokine A1 (I-309, CCL1), interferon-gamma (IFN-γ), interferon-gamma inducible protein-10 (IP-10, CXCL10), and tumor necrosis factor-alpha (TNF-α). RESULTS: Quantitative stability of serum immunoregulators: Serum CRP, IL-8, IL-10, IFN-γ, IP-10, and eotaxin-1 levels appear to be statistically equivalent from baseline to 50 FTC (p ≤ .05). Retention of patterns in serum immunoregulators: patterns across FTC were retained for TARC (age) and CRP, IFN-γ, and MCP-2 (sex). CONCLUSIONS: While the effect of multiple FTC on serum immunoregulator levels may not replicate prolonged freezer storage, the results of this study provide valuable information on the robustness of immunoregulators for research using bio-archived sera.

Tubular carcinoma of the breast: association with multicentricity, bilaterality, and family history of mammary carcinoma.

Seventeen tubular carcinomas occurred among 211 consecutive mastectomies (7.6%). The relative frequencies of multicentric involvement in the ipsilateral breast (56%), history of bilateral mammary cancer (38%) (P less than .01), and family history of mammary cancer in a first-degree relative (40%) (P less than .05) were all significantly greater in patients with tubular carcinomas than among patients with other carcinomas studied in a review of serial subgross examined mastectomy specimens. Patients with tubular carcinomas also tended to be somewhat younger (56 vs. 59 years) than those with other forms of mammary cancer. These features suggest that tubular carcinoma may be a histologic marker for a subpopulation of patients with mammary carcinomas strongly associated with multicentricity, bilaterality, and familial history of mammary carcinoma.

Development of mammography and breast services in a community hospital.

The growth and development of mammography and related breast services in one community hospital are chronicled and described. With mammography providing the initial stimulus, substantial growth, diversification, and sophistication in diagnosis and treatment of breast disease have developed. The achievement of a cooperative and mutually supportive relationship among radiologists, pathologists, and surgeons committed to the goal of early detection of potentially curable breast cancer has succeeded in identifying increasing numbers of such lesions. The more frequent employment of breast-sparing surgical procedures and the encouraging survival rates in patients detected and treated for these early lesions represents an important contribution to the care of these women. Improvement in the detection of early breast cancer can be achieved by community radiologists, whether in private hospitals or office-based practices.

Mission possible: community health.

VHA Health Foundation and the AHA's Health Research and Educational Trust surveyed 15 national community health award winners to learn how they have sustained their community health programs in a challenging economic environment.

Needle localization guided excisional biopsy for mammographically identified nonpalpable breast lesions.

The capability of high-quality mammography to discover early, preclinical breast cancer has demanded the development of a new relationship between radiologists, surgeons, and pathologists. It is only through mutual understanding and appreciation of the technical requirements and interpretive difficulties involved in the successful identification, preoperative localization, and excision of these lesions that the full benefits of this method of early cancer detection can be brought to all of our patients.

Detecting early breast cancer. Experience in a community hospital.

The successful development and implementation of a mammography program at one community hospital is described. A substantial reduction in the size of breast mammography to change the diagnosis and treatment of breast cancer in one community hospital. As the vast majority of American women receive their medical care in community facilities, the more widespread development and implementation of community hospital-based mammography programs for early breast cancer detection has the potential to significantly improve survival rates for patients in whom these early lesions are found. Substantial improvement in the rate of early breast cancer detection can be achieved by community radiologists whether in private hospital or office-based practices.

Pneumonia of atypical measles.

Infection with rubeola virus after previous immunization with killed measles virus vaccine produced abnormal chest radiographs in 9 patients. Variable pneumonic consolidation occurred in all cases and was mainly lobar or segmental in distribution. Four patients had hilar adenopathy, 3 pleural effusion, and in 1 instance a pulmonary nodule remained 9 months after clearing of the acute pneumonia. Atypical measles pneumonia is a presumed hypersensitivity response in incompletely immunized patients.

Polypoid lipomatosis of the small bowel.

An unusual case of multiple polypoid, benign lipomatous tumors in the ileum of a 53-year-old female with vague gastrointestinal symptoms is described. The pertinent literature is reviewed, and a technique which could have allowed definitive preoperative diagnosis is suggested.

Ductal carcinoma in situ: the mammographer's perspective.

Ductal carcinoma in situ represents a heterogeneous group of lesions now most commonly discovered by mammography. The biological behavior of ductal carcinoma in situ ranges from indolent, essentially benign lesions to obligate precursors of invasive carcinoma. This article reviews the natural history of this disorder, its mammographic and pathologic features, and current considerations in patient management, including the role of mammography. The results of recent clinical trials are summarized.

Mammographic detection of early breast cancer. Ten years' experience in a community hospital.

Mammography is currently the most effective method for detecting early breast cancer. In one community hospital during the decade 1974 through 1983, 35% of 415 cases of breast cancer were discovered by xeromammography alone, with a false-positive interpretation rate of 65% and a false-negative rate of 11.1%. Mammography was responsible for detecting an increasing number of smaller cancers with fewer axillary metastases. Such lesions have the most favourable five- and ten-year survival rates. Much lower detection rates of preclinical breast cancer have been reported from other community hospitals.

Computed tomography of posterior lumbar apophyseal ring fractures.

Lumbar apophyseal fracture is an uncommon injury that occurs during adolescence. We described two cases in young adults with back pain. The radiographic findings were distinctive. In both cases CT demonstrated characteristic bony fragments displaced posteriorly into the spinal canal and a corresponding defect in the posteroinferior aspect of the vertebral body rim. Recognition of this entity is important in evaluating back pain in both adolescents and adults.

Impact of mammographic screening on the size and the relative frequency of invasion in breast cancers seen in a community hospital from 1975-1988.

At CPMC routine mammographic screening was introduced in late 1975. The total volume of breast cancers, other than outside consultations, seen in the department increased from 71 in 1975 to 164 by 1988, an increase of 230%. This expansion in volume was due largely to surgical removal of mammographically detected occult, in situ duct and relatively small invasive duct carcinomas. In 1974, prior to routine mammographic screening, in situ carcinomas represented only 4% of all breast cancers seen in the Department of Pathology at CPMC. However, after the introduction of mammographic screening, the proportion of in situ cancers increased steadily. By 1988, 45% of all breast cancers seen in our hospital were found by mammography. While data on the size distribution of invasive breast cancers are not available at our hospital prior to 1976, an appreciable effect of mammography is still evident when the numbers of relatively small invasive cancers detected in 1976 are compared with those detected in 1988. Invasive breast cancers 10 mm in diameter or less represented only 6% of all cancers in our series in 1976, but 33% in 1988. These findings confirm observations made by Gibbs on the pathology of breast cancers found in mammographically screened and unscreened populations. The detection of increasing numbers of relatively small invasive duct carcinomas produced an overall reduction in the average diameters of invasive cancers seen at CPMC. The average dropped from 30 mm in 1975 to a low of 14.8 mm in 1987. Mammography did not appear to be effective in the early detection of invasive lobular cancers and had no impact on reducing their size. The implications of early discovery of in situ duct and relatively small invasive duct carcinomas are for improved patient survival through: (1) preventing progression of in situ duct to invasive duct cancers, and (2) the removal of invasive duct cancers before reaching a size where there is a high risk of metastasis.