Acute disturbed or violent behaviour: principles of treatment.

Acute disturbed or violent behaviour has a number of organic, iatrogenic and psychological precipitants and is commonly encountered. Various models have been used to define such behaviour and to suggest non-pharmacological treatments. However, drugs are frequently used and a wide variety of regimens are employed. Robust research into the use of drugs in acute, disturbed behaviour is scant. Nevertheless a treatment protocol is presented based on primary research, review articles and clinical experience.

Human papillomavirus type 16 DNA in anal cancers from six different countries.

An association between anal squamous cell carcinoma and human papillomavirus (HPV) type 16 DNA has been documented in the UK. If HPV type 16 is an important aetiological factor in the development of this tumour it would be expected to occur in anal cancer tissues from other parts of the world. In this study a series of 173 anal squamous cell carcinoma tissue samples from five centres around the world have been examined by DNA hybridisation for HPV type 16 DNA sequences. HPV type 16 DNA was found in 50 of 173 (29%) of these. The prevalence of HPV associated anal squamous cell carcinoma was significantly lower in tissue from India and South Africa than in the Swiss, Polish, or Brazilian samples. HPV associated anal squamous cell carcinoma does occur in other countries and further investigations of the prevalence of these tumours in association with other HPV types are required.

High frequency mutation in codons 12 and 61 of H-ras oncogene in chewing tobacco-related human oral carcinoma in India.

57 primary tumour samples from Indian oral cancer patients with a 5-15 year tobacco chewing habit, were examined for mutational activation in codons 12, 13 and 61 of the H-ras, K-ras and N-ras oncogenes. The highly sensitive assay based on specific oligonucleotide hybridisation following in vitro amplification of unique sequences by polymerase chain reaction was employed. Mutations were detected in twenty (35%) of the samples and were restricted to H-ras, codons 12, 13 and 61. Two cases had concurrent mutations in codons 12 and 61. The majority of the mutations were at H-ras 61.2 (Glutamine to Arginine) and H-ras 12.2 (Glycine to Valine). Three of the less frequent mutations are apparently novel. Interestingly, eight of the samples with H-ras mutations also showed loss of wild-type H-ras, as judged by absence of signals for wild-type codons 12 or 61 on dot blots. The specific H-ras mutations in these oral malignancies associated with tobacco chewing, may represent an important example of an environmental carcinogen-induced step, in a pathway leading to malignant transformation.

p53 mutations in colorectal cancer.

Immunohistological staining of primary colorectal carcinomas with antibodies specific to p53 demonstrated gross overexpression of the protein in approximately 50% of the malignant tumors examined. Benign adenomas were all negative for p53 overexpression. To determine the molecular basis for this overexpression we examined p53 protein expression in 10 colorectal cancer cell lines. Six of the cell lines expressed high levels of p53 in ELISA, cell-staining, and immunoprecipitation studies. Direct sequencing and chemical-mismatch-cleavage analysis of p53 cDNA by using the polymerase chain reaction in these cell lines showed that all cell lines that expressed high levels of p53 were synthesizing mRNAs that encoded mutant p53 proteins. In two of those four cell lines where p53 expression was lower, point mutations were still detected. Thus, we conclude that overexpression of p53 is synonymous with mutation, but some mutations would not be detected by a simple immunohistochemical analysis. Mutation of the p53 gene is one of the commonest genetic changes in the development of human colorectal cancer.

Ki-ras oncogene mutations in non-HPV-associated anal carcinoma.

Human papillomavirus 16 (HPV 16) DNA is found in a high proportion of anal squamous cell carcinomas in whose genesis it is thought to play an important role. In addition, it can be shown to cooperate in vitro with activated ras oncogenes in cellular transformation. We have therefore screened a series of such tumours for activating mutations of the ras oncogene family using DNA amplified in vitro by the polymerase chain reaction (PCR) and a series of synthetic oligonucleotide probes. Mutations were seen in only two cases (both Ki-ras codon 12), neither of which was HPV-associated. Our results suggest that ras activation is not a common event in the genesis of these tumours and, when it does occur, it does not appear to cooperate with HPV.

Genetic analysis of colorectal cancer.

Adenomatous polyposis, mainly of the colon, (APC) is a rare dominantly inherited susceptibility to colon cancer in which individuals develop hundreds of polyps mainly in their large bowel. The APC gene has been localised to chromosome 5q21 by following up a case report of an individual with an interstitial deletion on chromosome 5q who had multiple developmental abnormalities together with adenomatous polyposis. A DNA marker (D5S71) was found to be closely linked to APC in family studies and localised to 5q21 by in situ annealing. Material from further patients with deletions in this region of chromosome 5 has been used, by a combination of somatic cell hybrid and long-range DNA analysis, to identify new DNA markers close to the APC gene. These and other markers now provide the basis for genetic counselling of nearly all families with APC. These studies are being extended, together with other approaches for analysing DNA clones around the APC gene, in the search for the gene itself. Allele loss in tumour as compared to normal tissue from sporadic cases of colorectal carcinomas has clearly implicated the APC gene in at least 25 to 40% of all cases of colorectal carcinomas. Similar studies by Vogelstein and others as well as ourselves have further implicated recessive changes on chromosomes 17 and 18 in the development of colorectal carcinomas. Following the demonstration by Vogelstein of the role of p53 mutations in connection with the chromosome 17 changes, we have now shown, using monoclonal antibodies to the mutant p53 products and by other approaches, that changes in the p53 gene may occur in up to 50% or more of colorectal carcinomas. Frequent mutations of the K-ras dominant oncogene, as well as changes in the expression of human leucocyte antigen (HLA)-A, B, C determinants, are further genetic changes that appear commonly to be involved in the progression of colorectal carcinomas. The latter have important implications for T cell immune response to tumours and its manipulation for treatment and even prevention of colorectal cancer. We may soon be approaching a situation when it will become possible to identify all the genetic steps and their sequence during tumour progression, as well as their functional significance largely through the induction of inappropriate growth and the suppression of differentiation.

Paracoccidioidomycoses: a sequential histopathologic study of lesions in experimentally infected rats

Foram utilizados ratos albinos, fêmeas, para o estudo histopatológico sequencial da paracoccidioidomicose experimental. Os animais foram inoculados intraperitonealmente com uma cepa de Paracoccidioides brasiliensis na fase leveduriforme e sacrificados, em determinados intervalos, a partir de 1 a 168 dias pós-infecçäo;cada animal recebeu um inóculo de 4 x 10 células em 0,8 ml de salina. Os animais controles receberam salina contendo raspado do meio de cultura. Foram estudados tecidos correspondentes à área de inoculaçäo. Analisou-se pela microscopia óptica o processo inflamatório granulomatoo em todo o seu conjunto, estudando a populaçäo celular, a matriz extracellular e apresença e características do fungo. Os resultados possibilitaram desmembrar a cinética da resposta inflamatória em três fases: 1) neutrofílica ou macrofágica-neutrofílica; 2) pré-granulomatosa; 3) granulomatosa. A síntese de matriz extracelular iniciou=se pela deposiçäo de material fibrinóide, intensificando-se de modo gradativo com depósito de colágeno, de proteoglicanos e glicoproteínas. Os parasitos estavam presentes em todas as fases estudadas. Períodos de reativaçäo da doença eram nitidamente evidenciados através da concomitância de granulomas recém-formados com granulomas mais antigos, indicando que o processo granulomatoso neste modelo näo resolve a doença, nem täao pouco consegue limitar a disseminaçäo do fungo por um período prolongado

Connective matrix organization in chronic granulomas of experimental paracoccidioidomycosis.

The histological and ultrastructural aspects of chronic granulomas from rats infected intraperitoneally with Paracoccidioides brasiliensis are described with special emphasis on the composition of the extracellular matrix. The granulomas were structurally arranged in two zones, one central containing fungi, and the other peripheral. The extracellular matrix was composed of collagen types I and III, proteoglycans, glycoprotein, and an undefined amorphous substance. The main cellular population was represented by macrophages, epithelioid cells, and giant cells in the central zone, and fibroblasts in the peripheral zone. The fibrotic process was a critical event in this stage of the infection, and showed a centrifugal direction. This might be provoked by direct stimulus from the fungi or by macrophage-fibroblastic interaction.

Paracoccidioidomycosis in nude mice: presence of filamentous forms of the fungus.

Congenitally athymic nude mice (nu/nu) and their phenotypically normal littermates (nu/+) were intraperitoneally infected with yeast cells of a strain of Paracoccidioides brasiliensis. The nude mice developed a severe and generalized infection with an intense parasitism of several organs, accompanied by a low-grade of tissue reaction. The lesions were characterized by abundant yeast-like cells of the fungus, and in some animals, numerous hyphal forms could be well visualized. In control animals, infection was moderate, almost exclusively restricted to the area of inoculation, and the lesions presented few parasites surrounded by an inflammatory response. Filamentous forms of the fungus were never encountered in these animals.

Intrinsic vascularization of granuloma in experimental paracoccidioidomycosis.

Rats infected with Paracoccidioides brasiliensis exhibited vascularized granulomas during the granulomatous stage, with more intensity on the 49th day after infection. These data change the classical belief that the granuloma is always an avascular structure. The authors suggest that the granuloma is under the balanced influence of angiogenic or angiostatic factors, with the usual predominance of the latter, with the consequent advantage of limited antigen diffusion to the vascular system.

Isolation and preliminary characterisation of cDNA clones representing mRNAs associated with tumour progression and metastasis in colorectal cancer.

We have constructed cDNA libraries from the poly(A)+ RNA of normal colonic mucosa and a liver metastasis from a colonic adenocarcinoma. Differential screening of these libraries using 32P-labelled cDNAs transcribed from poly(A)+ RNAs isolated from specimens of four normal colonic mucosae, five adenocarcinomas, and three liver metastases by Grunstein-Hogness and dot-blot hybridization has identified a number of recombinant cDNA clones homologous to mRNAs that appear to differ significantly in abundance between normal and neoplastic colon and metastases. These cDNA clones, and others identified in the libraries, may be of considerable importance both as diagnostic tools and in defining the phenotypic changes associated with tumour progression and metastasis.

Intrinsic vascularization of granuloma in experimental paracoccidioidomycosis

Rats infected with Paracoccidioides brasiliensis exhibited vascularized granulomas during the granulomatous stage, with more intensity on the 49 th day after infection. These data change the classical belief that the granuloma is always an avascular structure. The authors suggest that the granuloma is under the balanced influence of angiogenic or angiostatic factors, with the usual predominance of the latter, with the consequent advantage of limited antigen diffusion to the vascular system

Immunocytochemical demonstration and significance of p21 ras family oncogene product in benign and malignant breast disease.

It has been suggested that the immunocytochemical demonstration of the p21 ras oncogene product is a useful marker of malignancy in breast disease. We have studied the reactivity of a series of specimens of benign and malignant breast disease with the anti ras p21 monoclonal antibody Y13-259, and shown widespread positive staining in both benign and malignant (including metastatic) disease as well as in adjacent 'normal' epithelium. In addition some staining of stromal cells as well as nerve fibres was observed. Our results suggest that the presence of ras p21 protein as demonstrated by this antibody is not a useful marker of malignancy or of proliferating epithelium but is rather a normal feature of certain cell types.