A positive family history of breast cancer. Does it effect diminish with age?

To determine whether the influence of family history on the incidence of breast cancer diminishes with age, we studied data from 9000 women: 2712 with breast cancer, 2972 with benign breast disease, and 3316 control subjects. Patients were divided into eight cohorts by age; for each, odds ratios were computed to compare cancer patients with patients who have benign disease and with control subjects for positive family history of breast cancer. For both sets of comparisons, odds ratios are highest for subjects from 30 to 34 years old. After the age of 45 years, odds ratios decline, and after age 60 years the odds of breast cancer occurring in women with a positive family history are no greater than it is in women without such a history. These results suggest that a family history of breast cancer is a determinant of breast cancer only for women under age 60 years. The mechanism through which this is effected needs to be studied.

Comparison of image analysis of imprints with flow cytometry for DNA analysis of solid tumors.

Quantitative analysis of cellular DNA content may be clinically useful for several solid tumors. The technology for this analysis by flow cytometry or image analysis has existed for several years but has not been widely used, except in a handful of specialized research institutions. Recently, however, relatively inexpensive image analyzers intended for use by hospital pathologists have been introduced that can analyze DNA content from cytology or imprint specimens which are readily obtainable from solid tumors. We report here an assessment of this technology for analysis of tumor imprint specimens, using flow cytometry of tissue blocks as the standard for comparison. We used image analysis equipment on Feulgan-stained imprint preparations from 31 tumors and compared the histograms with those obtained by flow cytometric analysis of archival tissue blocks from the same tumors. The ploidy descriptors (diploid, tetraploid, and aneuploid) were concordant for the two methods in 27 specimens, with three specimens yielding discordant results and one specimen considered unevaluable by image analysis. The image analysis method using imprints appeared to have several advantages over flow cytometry, including lower instrument cost, no need to dissociate paraffin blocks or fresh tissue, and ability to analyze very small samples. Somewhat lower resolution of the histograms, extremely localized tissue sampling, and possibly greater risk of occasionally obtaining unevaluable preparations were disadvantages. Microcomputer-based image analysis performed on imprints appeared to be a viable alternative to flow cytometric analysis of tissue blocks for quantitative DNA analysis of tumor specimens.

Carcinoma of the breast: detection with MR imaging versus xeromammography.

Detectability of breast cancer with magnetic resonance (MR) imaging versus xeromammography was quantitatively compared. MR images were obtained of breasts of 120 women who underwent xeromammography. T1 values were determined for masses larger than 2 cm. Cancer was histologically confirmed in 39 breasts and was considered excluded from 81 due to results of biopsy, cyst aspiration, or sonography or absence of change in xeromammographic findings over time. Images were blindly interpreted by three observers, and results were expressed as receiver operating characteristic curves. Detectability of breast cancer was substantially better with xeromammography than with MR imaging for all observers (P less than .03, 10(-6), and .001). On MR images, spiculation of a mass, distorted architecture, skin thickening, and nipple or skin retraction were specific but relatively insensitive indicators of cancer. Masses with smooth, distinct margins and signal intensity greater than that of fat on T2-weighted images were always benign. Other findings and T1 values were not diagnostically useful. The authors conclude that xeromammography is superior to MR imaging in detection of breast cancer.

Pheochromocytoma: operative strategy.

We studied 28 patients who had undergone 30 operations for pheochromocytoma since 1964. The tumor types included bilateral, extra-adrenal, malignant, recurrent, and multiple endocrine neoplasia, with 20 tumors confined to the adrenal gland. The preoperative studies used to localize the tumor included ultrasonography, intravenous urography, angiography, and computed tomography. Patients underwent exploratory operations via flank, subcostal, bilateral subcostal, midline, or thoracoabdominal approaches. In one case, that of a recurrence after bilateral adrenalectomy, surgical exploration discovered a tumor that had not been localized during the preoperative workup. Two patients underwent splenectomy because of injury incurred during operative exploration. Our experience suggests that preoperative localization is highly reliable, and therefore the benefits of extensive surgical exploration may be outweighed by its risks. We believe that with the exception of tumors that occur in association with childhood or pregnancy, multiple endocrine neoplastic syndromes, or recurrent disease, a direct approach to the tumor, possibly via the flank, is justified. Our results suggest that exploration of the contralateral adrenal or periaortic area is not so important as to be worth jeopardizing the spleen or other organs by a complex or extensive dissection.

Cytoprotective effect of prostaglandin E2 in irradiated rat ileum.

Radiation injury to the gastrointestinal tract is an infrequent but major clinical problem. Results of previous studies have shown that prostaglandins provide cytoprotection of the gastrointestinal mucosa against a variety of noxious agents, although, prior to this study, the protection against radiation exposure had not been documented. Exteriorized segment of Sprague-Dawley rat ileum was radiated with 10 and 15 Gy (137Cs). One group of rats was pretreated with prostaglandin E2 one hour before and 24 hours after radiation injury. The rats were sacrificed three and five days following radiation injury. Morphometric measurement of mucosal thickness, villous height, crypt of Lieberkühn height and number of mitosis per square millimeter swath of tissue were analyzed. Also, 125IUdR and 3HTdR were injected in a group of rats radiated with 15 Gy (137Cs). 125IUdR counts per minute per milligram of dry weight and 3HTdR labeled cells were counted and analyzed. The morphometric measurements and radioactive labeled tissue counts suggest that prostaglandin E2 has a cytoprotective effect upon irradiated rat ileum. Speculations about the possible mechanism and usefulness of this observation are included.

Hickman catheter placement simplified.

A simplified technique to place the Hickman indwelling right atrial catheter has been devised. This involves securing the catheter to a trocar, which is easily advanced to the cutdown site of the selected vein. Experience in more than 75 patients shows this technique to be associated with less discomfort and fewer complications than seen with standard techniques.

Gas-like radiolucencies in a popliteal cyst.

A 71-year-old man with rheumatoid arthritis complained of pain and swelling in the left calf. X-ray examination of the calf disclosed radiolucencies suggestive of soft tissue gas; however, subsequent investigation revealed no evidence of infection and an arthrogram showed a dissected popliteal cyst in the area of the gas. Gas-like radiolucencies in a popliteal cyst are an unusual finding which has not been previously reported.

Staging of carcinoma of the colon and rectum.

Commonly used modifications of the Dukes' system for staging carcinomas of the colon and rectum are inaccurately presented in many current textbooks and articles. These modifications divide Dukes' Stage B category into B1 and B2, depending upon whether or not the lesion has invaded or penetrated the muscularis propria. The term muscularis propria has been incorrectly interpreted to mean muscularis mucosa; as a result, A, B1 and B2 lesions, according to the modified systems all correspond to Dukes' Stage A category, and there is no modified stage corresponding to Dukes' Stage B. It is suggested that the term "modified Dukes" be discarded and that modified systems be given the eponyms of their describers. If the modified systems are to be continued, they must be correctly understood and presented. The simple and unambiguous nature of the original Dukes' system, however, favors its widespread use.

Postoperative abdominal infections.

Infectious complications remain an important source of postoperative morbidity and mortality. The prevention, diagnosis, and treatment of these problems can be extremely taxing, and skillful clinical judgment and surgery can frequently make the difference between survival or death.

Peritoneovenous shunting in the management of malignant ascites.

The incapacitating, malignant ascites of 37 patients were treated with peritoneovenous shunt using the LeVeen valve. Palliation of ascites was achieved in 27 of 37 patients until they died of their underlying diseases. In ten of the 37 patients, no long-term palliation was accomplished. Complications relating to the shunt procedure were noted in six patients. No evidence of abnormal malignant dissemination was noted. We concluded that the peritoneovenous shunt can be used with relative safety to manage progressive malignant ascites.

Microvascular techniques for polar artery reconstruction in kidney transplants.

The complications of ureteral ischemia make revascularization of polar vessels attractive in cadaver and live-related transplants. Thirty-two patients underwent reconstruction of polar vessels of 1.2 to 2.5 mm, in diameter after revascularization of the major vessels as follows: (1) inferior epigastric artery to polar artery, ten patients - six cadaver transplants, four living-related transplants (The vessels are spatulated and sutured precisely by microvascular techniques with Nos. 7-0 or 8-0 Tevdek); (2) polar vessel with a patch of aorta to iliac artery, one patient - living relative donor; (3) polar artery to the main renal artery or branch, 17 patients - 14 cadaver transplants, three living-related transplants [A Waters "MOX"-100 machine is used with cryoprecipitated plasma (800 mg. of SoluMedrol and 80 U. of insulin added) for preservation.]; (4) autogenous saphenous vein graft, two patients - one child receiving on adult live-related kidney and one cadaver transplant with three arteries and a stenosis of the inferior polar vessel; (5) polar artery to vein patch in iliac artery, two patients - cadaver transplants. Follow-up was done by arteriography (18 patients), direct observation (two patients), and by use of ultrasound (one patient). The remaining 11 patients have exhibited no evidence of occlusion. Twenty of 21 patients exhibited patent vessels; one thrombosed at the time of the transplant operation. Long-term patency in those patients studied was 95%. We advocate small-vessel reconstruction in human renal transplantation, either during ex vivo preservation (workbench surgery) or at the time of transplantation.