Multiple primary tumors.

Multiple primary tumors occur in clinical practice causing diagnostic dilemma. It is not very common, but the incidence has increased gradually since it was first described very many years ago. However, in spite of its increasing incidence, the presence of such primary malignancies in the breast and colon has been rare and far between, as against its presence in breast and lungs, both breasts, colon and stomach, two colonic sites, and endometrium and ovaries. It could be due to genetic disorders such as Li-Fraumeni syndrome in which case the affected individuals develop multiple cancers in childhood or early adulthood. This is, however, very rare. It could be due to metastasis of one cancer to another site. The challenge is making a correct diagnosis and giving the appropriate management. Erroneously handling one as a metastasis of the other and instituting management as such would be inappropriate. It is necessary to make proper clinical and histopathological diagnosis and to institute proper management. We report the case of a woman who had primary cancers involving rare organ combinations of the breast and ascending colon.

Fruits and vegetables diet improves some selected haemorheological parameters predisposing to cardiovascular disease in non insulin dependent diabetes mellitus NIDDM subjects.

Fruits and vegetables have been shown to contain vital components that moderate disease conditions. However, there is dearth of information of these effects in Africans diabetic subjects. Thus, we investigated the relative effect of fruits and vegetables on some selected heamorological factors associated with cardiovascular disease in diabetic subjects. Thirty diabetic subjects were selected at the cardiovascular clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The subjects with mean Fasting Blood Glucose (FBG) level of 7.8 +/- 0.95 mmold L(-1) were placed on 300 g of fruits and vegetables per day, while they continued their normal medication and food intake. A significant difference (p < 0.05) was noticed between baseline and eight week values in all the parameters, Fibrinogen 262.75 +/- 2.64 to 250.57 +/- 3.98 mg dL(-1), Blood viscosity, 5.96 +/- 0.21 to 4.82 +/- 0.23 m Pas; erythrocyte sedimentation rate 49.40 +/- 2.34 to 32.8 +/- 1.26 min h(-1) and haematocrit 38.8 +/- 1.25 to 44.75 +/- 1.05%. At the eight week the fruits and vegetables were withdrawn for two weeks and the above parameters were reassessed (at the 10th week) which were compared with eight week values. Significant difference p < 0.05 was noticed in E.S.R. 32.8 +/- 1.26 to 38.8 +/- 1.23. However no significant difference (p > 0.05) was observed in haematocrit, 44.75 +/- 1.44 to 42.70 +/- 1.24, Fibrinogen, 254.5 +/- 3.98 to 250.57 +/- 3.16 mg dL(-1). The results showed that regular intake of fruits and vegetables by diabetic subjects may reduce cardiovascular risk factors.

Human breast cancer susceptibility to paclitaxel therapy is independent of Bcl-2 expression.

In laboratory studies, ectopic overexpression of the antiapoptotic protein Bcl-2 has been shown to result in resistance to the cytotoxic effects of many chemotherapeutic drugs. Furthermore, posttranslational modification of moderately expressed endogenous Bcl-2 has been correlated with susceptibility to paclitaxel treatment in vitro. To determine whether tumor expression of Bcl-2 protein correlates with response and ultimate outcome in vivo, we quantified Bcl-2 expression by immunohistochemical analysis of archived biopsy specimens from metastatic breast cancer patients treated with single-agent paclitaxel. The statistical association between the degree of Bcl-2 expression, objective tumor response, and clinical outcome was then determined. In patients (n = 39) whose tumors had low (< or = 10% cells positive) Bcl-2 levels by immunohistochemical analysis, the overall response (complete response + partial response) rate was 21% versus an overall response rate of 22% in patients (n = 36) with high (>10% cells positive) Bcl-2 expression (P = 0.92). In patients with low Bcl-2 expression, the median time to progression was 126 days [95% confidence interval (CI), 63-160 days]. This was not significantly different than the 105 days for patients with high tumor Bcl-2 expression (95% CI, 84-214 days). The median survival time from initiation of paclitaxel therapy for patients with low Bcl-2 expression was 663 days (95% CI, 456-1119 days) and was not significantly different than the 450 days (95% CI, 239-1058 days) observed for patients with high Bcl-2 expression. In conclusion, we found that in metastatic breast cancer, there is no significant association between tumor Bcl-2 expression and response to paclitaxel, median time to progression, or survival, suggesting that the main mechanism of paclitaxelinduced cytotoxicity in breast tumors is independent of Bcl-2 expression.

Manual versus image analysis estimation of PCNA in breast carcinoma.

OBJECTIVE: To compare manual to image analysis estimation of proliferating cell nuclear antigen (PCNA) expression in paraffin sections of breast carcinomas. STUDY DESIGN: Paraffin sections of 51 breast carcinomas were stained with primary antibody to PCNA. Nuclear PCNA expression in 100 randomly selected tumor cells from marked areas was manually graded from 0 to 3. Antigen expression was also calculated by a cell analysis system (CAS-200, Becton Dickinson, Elmhurst, Illinois, U.S.A.) from marked and random microscopic fields. Obtained proliferative index (PI) from both methods was compared. RESULTS: Manually calculated PI correlated strongly with the CAS-200-calculated PI (P < .01). The highest correlation was seen between the CAS-200 PI value and manually calculated PI value using grade 2 and 3 nuclei. A particularly high correlation was noted between the number of positive nuclei and antigen staining area (P < .01) as estimated by the CAS-200. CONCLUSION: Nuclear expression of PCNA and other nuclear antigens can be accurately evaluated by an image analysis system. The speed and objectivity of such machines allow the evaluation of larger parts of tissues and provide more-representative antigen expression profiles.

Overexpression of BCL-x protein in primary breast cancer is associated with high tumor grade and nodal metastases.

PURPOSE: Dysregulation of genes that control apoptosis can contribute to tumor progression and increased drug resistance. The BCL2 gene and its family member BCL-x as well as the TP53 genes regulate apoptosis and have been shown to have a direct effect on the sensitivity of cancer cells to radiation and chemotherapeutic agents. METHODS: The expression of BCL-x, a BCL2-related protein that is a potent inhibitor of apoptosis, was investigated by immunohistochemical and immunoblot methods in 43 primary untreated breast carcinomas, in conjunction with BCL2 and TP53. RESULTS: BCL-x protein was overexpressed in 18 of 42 (43%) invasive breast cancers when compared with adjacent normal breast epithelium. Western blot analysis of eight primary breast cancers and five breast cancer cell lines indicated that BCL-xL was the predominant BCL-x protein expressed. Overexpression of BCL-x protein in these tumors was associated with higher tumor grade and increased number of positive nodes. In contrast, BCL2 protein was overexpressed in 19 of 42 tumors (45%) and was strongly correlated with estrogen receptor positivity, lower tumor grade, smaller tumor size, and lower stage. TP53 protein immunostaining was detected in 12 of 40 tumors (29%) and was inversely correlated with BCL2 expression and ER positivity. There was no correlation between the level of BCL-x protein expression and age, tumor size, ER status, and TP53 status. At a median follow-up time of 216 weeks, there was a trend toward decreased overall survival in patients with tumors overexpressing BCL-x. CONCLUSIONS: These findings suggest that expression of BCL-x protein is increased in a significant fraction of invasive breast cancers. In contrast to BCL2 expression, up-regulation of BCL-x protein may be a marker of tumor progression. Additional data including larger numbers of patients, more uniform treatments, and longer follow-up are needed to define the prognostic significance of overexpression of BCL-x during breast cancer progression.

Prevention of injuries in excessive pronators through proper soccer shoe fit.

OBJECTIVE: Properly fitting shoes are important in the prevention of injuries. When it involves the lower extremity and pronation, proper fitting of shoes is considered as a treatment for gender variations in shoe fit and excessive pronators. The purpose of the study therefore, is to compare static and dynamic foot tracings in excessive pronators to determine if there were differences between right and left feet of male and female soccer athletes. DESIGN AND SETTING: Multivariate analysis with static and dynamic foot tracing measurements of foot length, first metatarsal length, fifth metatarsal length, metatarsal width, and heel width as the dependent variables and male and female (gender) as the effect. Interscholastic soccer players who were excessive pronators were used in the study. SUBJECTS: Volunteers were solicited from a boys and girls interscholastic soccer team (level C to varsity). From this pool of 40 subjects, a group of 20 (10 males and 10 females, n = 40 feet), with excessive pronation were used in the study. Criteria for selection was based on navicular height (? 10 mm) and arch index (? .26). MEASUREMENTS: Static and dynamic foot tracings were determined. From these tracings, foot length, first metatarsal length, fifth metatarsal length, metatarsal width, and heel width were determined. Multivariate analysis of variance (MANOVA; p < .05), one-way repeated measures analysis of variance (ANOVA; p < .05), and pairwise comparisons (p < .05) were performed to determine significance, as well as intraclass correlation coefficients for intraclass reliability of the measurements. RESULTS: For between genders, male foot tracings for static and dynamic right and/or left feet were statistically greater in all foot parameters except heel width. Comparison of same side static and dynamic measurements for the right or left foot indicated differences for foot length, metatarsal width, and heel width for males, and foot length, fifth metatarsal width, metatarsal width, and heel width for females. There were no significant differences between static and dynamic foot measurements for either foot between genders and within genders. CONCLUSIONS: Foot length should not be the only consideration used for determining proper shoe fit. Static and dynamic measurements for the right or left foot, as well as metatarsal width, fifth metatarsal length, and heel width should also be included.

Hodgkin's disease associated with chronic lymphocytic leukemia. Eight additional cases, including two of the nodular lymphocyte predominant type.

Several reports of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) and of coexisting or subsequent Hodgkin's disease (HD) have raised the question how these two disorders are related. The authors have identified eight new cases of B-cell low-grade lymphoproliferative disorders (LGLPD) and HD. Six of these cases were similar to those previously reported on by others in that the HD were mixed cellularity, nodular sclerosing, and lymphocyte depleted subtypes. The morphology in these cases was typical of HD, as was the immunohistochemical profile. However, the two remaining cases were notable in that the HD was of the nodular lymphocyte predominant type (NLPHD). To our knowledge, this association has not been well documented previously. In the two cases in this study, CLL and NLPHD were found simultaneously when each patient presented with lymphadenopathy and a lymphocytosis that was comprised of small monoclonal B lymphocytes coexpressing CD5. Lymph node biopsies in each case revealed typical NLPHD, with large, indistinct nodules containing scattered lymphocytic-histiocytic (L&H) cells. Focal, but distinct areas of CLL/SLL were also present. Immunostaining of the lymph node biopsy specimens showed the L&H cells to be CD20- and CD45 positive, and to lack CD15 or evidence of light chain restriction. In one of these patients, a NLPHD-associated large cell lymphoma developed 8 months later. The large cells were CD20- and CD45 positive, with lambda light chain restriction. In contrast, the original CLL cells in this patient expressed kappa light chains. This report indicates that LGLPD can be associated with all subtypes of HD, including the NLP type. The discordant light chain restriction between the CLL and the NLPHD-associated large cell lymphoma in one of these cases indicates that the CLL and HD were probably not derived from the same clone.

Detection of CDKN2 deletions in tumor cell lines and primary glioma by interphase fluorescence in situ hybridization.

Deletions of chromosomal band 9p21 have been detected in various tumor types including melanoma, glioma, lung cancer, mesothelioma, and bladder cancer. Recently, the CDKN2 gene (p16INK4A, MTS I, CDK41) has been proposed as a candidate tumor suppressor gene because it is frequently deleted in cell lines derived from multiple tumor types. We performed fluorescence in situ hybridization (FISH) with interphase cells using yeast artificial chromosome clones and a cosmid contig of the CDKN2 region. In 10 cell lines (4 glioma, 2 melanoma, 2 non-small cell lung cancer, 2 bladder cancer) with 9p alterations detected by molecular or cytogenetic analysis, interphase FISH with the CDKN2 cosmid contig detected all 9p deletions previously identified by molecular analysis. Using this probe, FISH analysis of primary glioblastoma tumors revealed homozygous deletions of the CDKN2 region in 6 of 9 tumors (67%) whereas a yeast artificial chromosome probe containing the interferon type I (IFN) gene cluster was deleted in only 4 cases (44%). Thus, it is likely that the CDKN2 region is the target of 9p deletions in gliomas. Interphase FISH will play an important role in defining the clinical significance of 9p deletions in primary tumors because it is especially applicable to clinical samples which may be contaminated by normal cells.

Ultrasonically guided fine-needle aspiration biopsy of portal vein thrombosis: a cytomorphological study of 14 patients.

Portal vein tumor thrombosis is an important and consistent prognostic indicator in hepatocellular carcinoma. We reviewed 14 cases of ultrasonically guided fine-needle aspiration biopsy (FNAB) of the portal vein. All the patients had clinical evidence of portal vein thrombosis (PVT). Twelve of these patients had a preliminary diagnosis of hepatocellular carcinoma while the remaining two, initially, had a clinical diagnosis of end-stage liver disease. The mean age of the patients was 60 years. An average of 1.7 passes per case was made. No clinical complications were encountered. The cytomorphologic features of the aspirated materials were reviewed. Twelve of the 14 cases (85.7%) were judged neoplastic or thought to have probable neoplastic involvement of the portal vein while two were clearly benign. The cell block was found to be the most useful in diagnosis. We conclude that FNAB of the portal vein is a feasible method in evaluating PVT, especially in patients already known to have hepatocellular carcinoma.

Incontinentia pigmenti achromians (Ito) in a West African.

Incontinentia pigmenti achromian is a very rare cutaneous disorder of pigmentation which has been reported from Japan, the United States of America, the Caribbean countries, Mexico and India. A case with coarse hair and associated with atopic dermatitis in a West African girl is presented in this brief report. The case, to the authors' knowledge, is the first documented in Africa.

Public knowledge, attitudes, and behavior toward Kansas mandatory seatbelt use: implications for public health policy.

State law and policies established by legislative bodies represent an important machinery for amplifying the effects of behavior change efforts in individuals and groups. This study shows the inter-relationships of public health policy, behavior, attitude, knowledge of the general public and how their outcomes can affect health and safety, policy formulation, enactment, implementation, policy evaluation and its revision or repeal. Observational and interview surveys of the driving public were conducted over an eighteen month period (1987-1989) in Kansas. Results showed major differences in the public's knowledge, attitudes, and behavior toward the new mandatory seatbelt law across different geographic locations of metropolitan, urban and suburban areas. The new law had the support of more than half of those interviewed. The public's knowledge and attitude on the seatbelt use and law were far from being ideal. Much work is needed to convince about 27% of the driving public who declared they never use their seatbelts and would ignore any law/policy that would force them to comply.

Adolescent health status, behaviors and cardiovascular disease.

This study tracked levels of risk indicators over a four-year period in 356 matched high school students in central Illinois. Selected clinical measures of health status (height, weight, triceps skinfold thickness, body mass index, blood pressure and pulse) and self-reported behavior were assessed. From these measures, subjects were identified as potentially at risk if their scores equaled or exceeded the 75th percentile for their age, sex, and race. Results indicated that 54% of this at-risk group also had negative health behaviors (smoking, physical inactivity, high salt, red meat and fat consumption, and alcohol intake). Some of these behaviors demonstrated strong, positive correlations with health status as shown by chi-square, t test, analysis of covariance, and Pearson product-moment correlation statistics. Thus, those students warranting preventive intervention and referral follow-up programs before adulthood were identified.

Comparison of health Status of International and American University Students: Implications for Health Education.

The study examined the differences between a sample of 311 international and 251 American university students relative to their self-perceived health status, health attitudes, behaviors, and locus of control using the International Student Health Inventory (ISHI). More specifically, the study compared demographics, current health history, health care obtained by students within the university milieu, health locus of control, wellness attitudes and behaviors. The study addressed the rationale for student health care professionals to improve health services for the international students. Data were analyzed using both descriptive and inferential statistics. Results indicated that sociocultural (external) and self-perceived (internal) stressors may influence both groups' health status and care. American students experienced more common minor stress-related illnesses/ailments than international students. Both groups indicated they functioned more from an internal health locus of control. Healthiest and poorest wellness attitudes were reported by the international male and American male students respectively. No observed differences were noticed on the groups' wellness behaviors.

Predicting adolescent blood pressure: implications for health education practice.

The study was set up to potentially determine if a stepwise multiple regression model composed of such factors as sociodemographics, attitudes, and behaviors in combination with selected biomedical measures can be used to predict adolescent at risk health conditions such as hypertension and to examine the implications for health education practice. The study population consisted of 650 ninth grade (14-16-year-old) students in the baseline survey (1981) and 606 twelfth grade students in the final survey of 1985. Data collected included clinical measures of height, weight, triceps skinfold thickness, blood pressure, body mass index (BMI), resting pulse, and percent ideal body weight (PIBW). Self-reported health behaviors, attitudes, and sociodemographic variables were also assessed. Principal factor analysis with varimax rotation was employed to determine the grouping of the behavioral/attitudinal test items. Stepwise multiple regression analysis was used to determine the variables' potentials as predictors of blood pressure in adolescents. Significant potential predictors of male diastolic blood pressure included smoking, alcohol intake habits, obesity, pulse, race, age and parents' socioeconomic status; while predictors for the females focused on smoking, alcohol intake habits, stress, obesity, pulse and race. Potential indicators for male systolic blood pressure were smoking, alcohol habits, weight, height, race, parent's socioeconomic status; while smoking, alcohol habits, stress, obesity, pulse and race for the females. Community health promotion, prevention and educational programs directed at these potential predictors need to be implemented to encourage healthful lifestyles in the younger generation.

The relationship among attitudes, behaviors, and biomedical measures of adolescents "at risk" for cardiovascular disease.

This study monitored trends in health behavior and attitudes of 93 adolescents who, according to clinical measures, were classified "at risk" for cardiovascular disease and determined the relationship among their health status, behavior, and attitude over a four-year period. Data collected included biomedical measures and self-reported health behaviors and attitudes. A greater proportion of "at risk" students reported negative health behavior changes in smoking, diet, alcohol, and stress. However, a positive health behavior trend was noted with respect to smokeless tobacco use declining from a high of 14% as freshmen to 8% as seniors. Also, students appeared sensitive to the potentially harmful effects of smoking. In general, a positive relationship existed among health status, health attitudes, and behavior. The findings justify screening to identify students "at risk" and beginning early intervention to prevent chronic disease in later life.

A three-year study of obesity and its relationship to high blood pressure in adolescents.

A sample of 356 matched cases were tracked for three years during high school. Measures taken included self-reported behavior and clinical measures of height, weight, skinfold, blood pressure, and body mass index. Data were analyzed by ethnic group, age, and sex groups. Three year (1981-1982 to 1984-1985) trends for students who were overfat, overweight, and obese revealed: a relatively greater proportion of female to male students were overfat as seniors; overweight trends for each of the four groups (ethnic group and gender) were stable over the study period; a sharp increase of obesity trends among black females was observed; and significant positive relationships existed between Percent Ideal Body Weight, skinfold thickness, Body Mass Index, and blood pressure among females of both ethnic groups. The hypothesis that the early onset of obesity is an indicator of obesity in older adolescents was supported. Students classified at risk as freshmen are more likely to remain at risk as seniors.