Histopathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast--results from the Swedish randomised trial.

AIM: The primary aims were to study risk factors for an ipsilateral breast event (IBE) after sector resection for ductal carcinoma in situ of the breast (DCIS) in a trial comparing adjuvant radiotherapy to no therapy and to assess predictive factors for response to radiotherapy. Secondary aims were to analyse reproducibility of the histopathological evaluation and to estimate correctness of diagnosis in the trial. SETTING: A randomised trial in Sweden (the SweDCIS trial), including 1046 women with a median of 5.2 years of follow-up in a population, offered routine mammographic screening. METHODS: A case-cohort design with a total of 161 cases of IBE (42 of those being members of the subcohort) and 284 sampled for the sub-cohort. Ninety five percent of the participants' slides could be retrieved and were re-evaluated by three experienced pathologists. RESULTS: Low nuclear grade (NG 1-2) and absence of necrosis halves the risk of IBE in both irradiated and non-irradiated patients. Lesion size, margins of excision and age at diagnosis did not modify these associations. The presence of necrosis modified the effect of radiotherapy: relative risk was 0.40 with necrosis present and 0.07 with necrosis absent (p-value for interaction 0.068). In all subsets of prognostic factors, radiotherapy conferred a substantial benefit. The risk factors for in situ and invasive IBE were similar. The agreement between pathologists was moderate (kappa=0.486). Correctness of diagnosis in the subcohort of SweDCIS was 84.8%. CONCLUSION: Although nuclear grade and necrosis carry prognostic information, we could not define a group with very low risk after sector resection alone. Radiotherapy has a protective effect in all substrata of risk factors studied. The interaction between the presence of necrosis and radiotherapy is a clinically and biologically relevant research area.

Primary hyperparathyroidism in Northern Sweden.

Three hundred and eleven patients with presumed hyperparathyroidism were operated upon between the years 1961 and 1983 at the two surgical clinics in Northern Sweden equipped with pathologic facilities. Eighty per cent were women. All of the patients were hypercalcemic. Parathyroid hormone (PTH) levels were elevated in 66 per cent of the patients. The correlation between serum calcium and PTH levels was only 0.38. Serum creatinine levels were normal in 92 per cent of the patients while renal concentrating ability was depressed in 79 per cent. The main patient symptoms were fatigue, mental disturbances and renal stones. Eighteen per cent were asymptomatic at the time of the operation. Most patients were diagnosed during in-hospital investigations. Many were also found to be hypercalcemic at regular outpatient controls. At operation, adenomas were found in 80 per cent, different kinds of hyperplasia in 15 per cent, normal histologic finding in 4 per cent, while cancer was found in less than 1 per cent of the patients. At follow-up study, 79 per cent were normocalcemic while 3 per cent were hypocalcemic and 11 per cent were still hypercalcemic--7.5 per cent were lost to follow-up study. Nine patients had a permanent paralysis of the recurrent laryngeal nerve.

Immobilized-metal affinity chromatography of serum proteins on gel-immobilized group III A metal ions.

A chromatographic adsorbent (TED-Sepharose) capable of chelating various di- and trivalent metal ions was prepared by introducing tris(carboxymethyl)ethylenediamine into agarose. This gel was charged with Al3+, Ga3+, In3+, and Tl3+ to form immobilized-metal affinity adsorbents, and their adsorption behavior toward serum proteins at various pH values was studied. At low pH, these adsorbents behave as ion exchangers. At pH 7 and above, their adsorption behavior shows a high degree of selectivity but with varying affinity profiles for serum proteins. The adsorbents based on Al3+ and Ga3+ thus have negligible affinity for proteins at pH 7.6, whereas that based on In3+ exhibits a low but significantly higher affinity for proteins compared to the previous two. On the other hand, the Tl3+-based adsorbent showed a much higher capacity to adsorb serum proteins. Selective fractionation by affinity elution of human serum proteins adsorbed to an immobilized Tl3+ is also presented.

Quantitative determination of albumin dimer in albumin preparations by combined starch-gel electrophoresis and immunoprecipitation.

A method is described for albumin dimer determination. The method is based upon an electrophoretic separation of albumin dimer from the monomer in starch gel with a subsequent immunochemical diffusion and precipitation of the albumin components in agarose gel containing antibodies. The precipitation zones are measured and compared iwth those of albumin monomer standards. A factor for converting monomer to dimer has furthermore been established.