Imprint cytology of the sentinel lymph node in the assessment of axillary node status in breast carcinoma.

BACKGROUND: Intra-operative assessment of the sentinel lymph node (SLN) status may allow the surgeon to complete the breast cancer surgery in most patients in one sitting. We have studied the role of imprint cytology in the assessment of SLN status. PATIENTS AND METHODS: Imprint cytology of the SLN in 132 patients with invasive breast carcinoma was correlated with the histopathological assessment of the SLN and overall axillary nodal status. In 26 patients, the cytology was reported intra-operatively. RESULTS: Imprint cytology reflected the status of the parent node well (sensitivity 86%, specificity 97%, positive predictive value (PPV) 92%, negative predictive value (NPV) 93%). Its ability to reflect the axillary status was also good (sensitivity 70%, specificity 97%, PPV 95% and NPV 83%) but somewhat diminished by the relatively high number of false-negative SLN in the study. Intra-operative assessment (sensitivity 86%, specificity 100%, PPV 100% and NPV 95%) did not reduce the accuracy of imprint cytology in predicting the SLN status and took a mean of 24.5 min. CONCLUSIONS: Imprint cytology is an accurate and relatively simple method for the assessment of the SLN and can be a useful intra-operative tool.

Is massage following dye injection necessary in sentinel node biopsy in breast cancer?

In sentinel node biopsy of breast cancer, massaging of the dye injection site following subdermal injection of blue dye does not improve sentinel node detection rate or the time needed for sentinel node biopsy. It may reduce the number of false negative sentinel nodes.

Iatrogenic gastrocolic fistula associated with non-steroidal anti-inflammatory drug administration.

An unusual case is presented of a benign gastrocolic fistula occurring in a 70-year-old man treated with piroxicam for arthritis for a period of only two months. This report illustrates that significant upper gastrointestinal complications can occur, even with short-term treatment, with non-steroidal anti-inflammatory drugs (NSAIDs).

In situ hybridisation and S1 mapping show that the presence of infiltrating plasma cells is associated with poor prognosis in breast cancer.

In order to identify potential markers of prognosis in breast cancer, representative cDNA libraries were constructed using RNA isolated from primary breast tumour tissue associated with good and poor prognosis. Cross-screening of these libraries repeatedly identified cloned mRNA species associated with the immune system, in particular B-cells, in libraries derived from tumours of poor prognosis. We have used one of these a kappa IV light chain cDNA probe, in two complementary studies to investigate the relationship between immunoglobin gene expression and prognosis. The results obtained using a combination of S1 mapping, RNA blotting and in situ hybridisation demonstrate that the presence of plasma cells, as defined by infiltrating cells which express high levels of immunoglobulin kappa-chain mRNA, is associated with a poor prognosis.

An aetiology for fistula in ano.

Four cases of superficial peri-anal fistula occurring in early infancy are described. They were all successfully treated by complete excision of the fistula. Histological examination of the excised fistulae revealed a mixture of columnar, transitional and stratified squamous epithelium lining the tracts in three cases and non-specific connective tissue in the fourth. It is postulated that the presence of these inappropriate types of epithelium (columnar and transitional) along the length of the fistulous tract is evidence of a congenital origin for peri-anal fistulae presenting in the first few months of life.

Delayed mouth-caecum transit of a lactulose labelled liquid test meal in patients with steatorrhoea caused by partially treated coeliac disease.

Mouth-caecum transit time (M-CTT) of a lactulose labelled liquid test meal has been measured in 27 coeliac patients and 10 healthy controls using the breath hydrogen technique. Although all patients were urged to maintain a gluten free diet, not all did, and there was, therefore, a wide range in the severity of fat malabsorption within the patient group. Gastric emptying of a 113Indium DTPA-labelled liquid test meal was also assessed in separate studies on six healthy controls and 11 of the coeliac patients. Fasting breath hydrogen concentrations and the response to lactulose, as assessed both by the rate of rise, and the peak breath hydrogen concentration reached, showed no difference between coeliacs and controls, regardless of the presence or absence of steatorrhoea. Mouth-caecum transit time in the 16 coeliac patients with steatorrhea (faecal fat greater than 7 g/24 h) was, however, significantly prolonged being 158 +/- 18 minutes (mean +/- SEM), compared with 70 +/- 9 minutes for the controls (p less than 0.02), and 83 +/- 15 minutes for the 11 coeliacs without steatorrhoea (p less than 0.002). Mouth-caecum transit time in the coeliac patients was linearly related to the 24 hour faecal fat excretion, r = 0.55, n = 27, p less than 0.01. Slow mouth-caecum transit in the coeliacs with steatorrhoea was not caused by delayed gastric emptying as the t1/2 for coeliacs with steatorrhoea was within the normal range. Coeliacs with delayed mouth-caecum transit had impaired insulin release but the postprandial profiles of the other peptides measured (cholecystokinin, GIP, secretin, motilin, neurotensin, enteroglucagon, and peptide YY) were all within the normal range in this group of partially treated coeliac patients.

Changes in gene expression in established human mammary tumor cell lines when compared with normal breast and breast tumor tissue.

RNA complexity analyses of total cellular polyadenylate-containing RNA isolated from lactating human breast tissue, human breast tumor tissue, and a mixture of established cell lines of mammary origin demonstrate extensive homology between the tissue RNA populations but suggest a decrease in the complexity of cell line nuclear RNA populations, with the exception of an early-passage MCF-7 cell line. Cell-free protein synthesis and two-dimensional gel electrophoresis also show quantitative and qualitative differences in gene expression between human mammary tumor tissue and reduction mammoplasty or established mammary cell lines of early and late passage number. The results demonstrate a major role for transcriptional and posttranscriptional mechanisms in the regulation of gene expression in the human mammary gland and show that studies on mammary gland gene expression using established cell lines of mammary origin reflect only in part gene expression in normal lactating human breast or breast tumor tissues.

Colonic tuberculosis presenting with massive rectal bleeding.

Colonic tuberculosis manifests in many diverse ways, of which massive rectal bleeding is a rare feature requiring surgical treatment by resection. We report such a case and review the literature of the last 15 years.

Early discharge despite postoperative pyrexia after inguinal herniorrhaphy in unselected patients.

Although shown to be suitable for selected patients with subsequent community medical and social support early discharge from hospital after inguinal hernia repair is apparently not well established. The application of such a policy may also be inhibited by postoperative pyrexia even though the cause of this is not evident. We report a series of 103 unselected patients presenting consecutively to an inner London hospital for hernia repair in whom early discharge was proposed in 95 per cent and achieved in 79 per cent irrespective of clinically unaccountable postoperative pyrexia and without special community health provision. This discharge policy placed no additional burden on the community health services and did not affect adversely patients' welfare, satisfaction or time off work.

The synthesis of 16 alpha-[131I]iodo-oestradiol and evaluation of its use as a radiotracer for oestrogen receptor positive breast tumours.

16 alpha-Iodo-oestradiol binds with high affinity to the oestrogen receptor and has been shown to accumulate in oestrogen sensitive tissues in many test systems. We have prepared the compound labelled with 131I at four specific activities. Using these preparations we have attempted to image human primary and metastatic breast cancer deposits at various times from 15 min to 24 h post injection by external gamma scintigraphy. Clinical studies were conducted on 10 post-menopausal patients. The receptor status was determined in seven cases, four were positive and three negative. The imaging results were very poor, in only two cases were images obtained, these were very faint and only of the primary, never of the metastatic deposits. The oestrogen receptor status was only available in one of these cases, it was positive. Dynamic studies in vivo revealed that the compound is cleared rapidly from the circulation during the first 5 min and thereafter undergoes extensive enterohepatic recycling. Studies of the radiochemical identity of the circulating species revealed that the injected compound was extensively metabolised. Neither an increase in specific activity of injected radiotracer nor imaging at shorter times after injection improved the results.

Effect of intravenous 3-hydroxybutyrate on postoperative nitrogen balance.

Thirty-two patients routinely admitted for cholecystectomy were allocated randomly to receive a post-operative fluid regimen containing either 18 g/d of sodium DL-3-hydroxybutyrate, or isoenergetic glucose, each for 3 d. The difference in the post-operative mean daily urinary nitrogen excretion between the control (median 8.3 g/d) and the 3-OH-butyrate groups (median 8.3 g/d) was not statistically significant, nor was there any difference when allowances were made for patient's surface area or for changes in blood urea during the course of the study.

Effect of pectin on gastric emptying and gut hormone release in the dumping syndrome.

The effect of pectin on gastric emptying, gut hormone release, and symptoms was studied in four patients with dumping syndrome and in two healthy volunteers after ingestion of a hypertonic glucose meal with and without addition of pectin. The initial fraction emptied from the stomach was reduced in the patients, whose symptoms of dumping were abolished or alleviated by pectin. This change of the emptying seems to be caused by a prolonged stomach transit, probably due to the viscous nature of the pectin meal. Pectin had no effect on the gastric emptying of the volunteers. The motor activity of the stomach was not altered by pectin in either the patients or volunteers. In the patients insulin, enteroglucagon, neurotensin, and gastric inhibitory polypeptide rose to higher levels after the glucose meal than after the glucose-pectin meal. The individual differences in the hormone release were considered secondary to the altered gastric emptying produced by pectin.

Is the undeniably palpable liver ever 'normal'?

A study of whether the lower border of the normal liver, if it extended below the costal margin, could be reliably identified by clinical examination was undertaken in 42 patients in whom there was no clinical, biochemical or scintographic evidence of liver disease. Two clinical observers independently agreed that in 10 of these patients the liver extended infracostally. However, scintiscanning demonstrated that 30 patients had livers extending below the costal margin and that 2 of the 10 livers clinically identified did not in fact lie infracostally. Thus whilst the normal liver commonly extended below the costal margin, recognition of this extension by clinical methods occurred no more frequently than would be expected by chance. It is concluded that the confident clinical finding of a liver projecting below the costal margin should suggest that the organ is abnormal.