Suppression of acute lymphoblastic leukemia by the human wild-type p53 gene.

Independent mutations in both alleles of the p53 tumor suppressor gene are a frequent finding in human T-cell acute lymphoblastic leukemia (T-ALL) cell lines and in the cells of some T-ALL patients in relapse. One major goal of studying the status of p53 (and other tumor suppressor genes) in human cancer is to facilitate the suppression of the tumorigenic phenotype through the restoration of the expression of the wild-type allele. While the efficient insertion of a suppressor into all cells of solid/metastatic human tumors may at present be impossible, insertion into leukemia cells may be feasible due to the accessibility of the leukemia cells in the body. To examine the feasibility of suppressing the tumorigenicity of human T-leukemia cells, the human T-ALL cell line Be-13, which lacks endogenous p53 protein, was infected with a recombinant retrovirus encoding the wild-type allele of human p53 (hwtp53). Expression of p53 reduced the growth rate of infected Be-13 cells in vitro, suppressed colony formation in methylcellulose cultures, and abrogated their tumorigenic phenotype in nude mice in vivo. These results suggest that suppression of the leukemic phenotype of relapse T-ALL-derived Be-13 cells is feasible. Acute leukemia cell suppression via high-efficiency infection with retroviruses encoding wtp53 may be feasible and beneficial in T-ALL cases as part of a bone marrow transplantation regimen in an effort to reduce the frequency of posttransplantation relapse.     

Regional lymph node and pulmonary metastases after local hyperthermia of melanomas in C57BL/6 mice

The effects of local tumor hyperthermia on regional lymph node metastases are inconclusive. We studied the effects of hyperthermia on the incidence of popliteal, femoral, and abdominal lymph node metastases in C57BL/6 mice with primary B16 melanomas (F10 variant) growing subcutaneously in the left foot. Tumors were heated to 42.3, 43.5, and 44.2 degrees C for 90 minutes either 7 days after inoculation of 5 X 10(4) viable cells (microscopic tumor = mic) or when the tumors were approximately 3 mm in diameter (macroscopic tumor = mac). Femoral lymph node metastases occurred in 0/21 control animals and in 8/22 (36%), 11/19 (58%), and 11/17 (65%) animals whose primary tumors were heated to 42.3, 43.5, and 44.2 degrees C, respectively. For all three treatments, the increase in metastases as compared to controls was statistically significant (p less than 0.004, Fisher's exact test). The incidence of abdominal lymph node metastasis was slightly higher in the treated groups than controls. Twenty of 21 (95%) control mice developed popliteal lymph node metastases and hyperthermia-induced increases could not be demonstrated. Fifteen of 21 control mice killed 3 weeks after amputation of tumor-containing leg had pulmonary metastases with an average of 6 +/- 4 (standard deviation) lesions per affected mouse. Pulmonary metastases occurred in 22/22 (100%), 17/19 (89%), and 13/17 (76%) of mice whose tumors were heated to 42.3, 43.5, and 44.2 degrees C, respectively. The numbers of metastases for affected mice were significantly increased compared to controls for tumors heated to 43.5 and 44.2 degrees C (28 +/- 43, 43 +/- 52, 119 +/- 121, p greater than 0.02, p less than 0.006, p less than 0.002, for two sample T-test). While 0/8 mic tumors were cured 5/9 mac tumors heated to 44.2 degrees C disappeared (p less than 0.03, Fisher's exact test) and there was a growth delay in the remaining mice. Mic tumors, heated to 43.5 degrees C, had an accelerated onset of growth while mac tumors heated to this temperature had a slight growth delay. Growth of both mic and mac primary tumors heated to 42.3 degrees C was similar to controls. These results show that therapeutic and subtherapeutic local hyperthermia increases metastases to regional lymph nodes and to lungs even when primary tumor growth rate is partially or totally controlled.     

Injuries to the liver. Study of 54 cases

The records of 54 consecutively treated patients with hepatic trauma were reviewed. Diagnosis, treatment and results were analyzed. Clinical features and ultra sonography were deciding for diagnosis. Frequent associated injuries are due to mechanism of injury 74% of road accident. 50% of lesions were major. Treatment were hemostasis, by suture and packing. Only 6 major hepatectomy were realised. Total mortality is 15% due to incomplete initial treatment or to extra-hepatic injury. Morbidity is important due to sepsis and hemorrhage. Therapeutic evolution showed decline of resection for conserving operation.     

Prognostic importance of human papillomavirus type 16 DNA in cervical cancer.

Human papillomavirus (HPV) type 16 DNA is frequent in invasive cervical cancers. Among 43 patients with invasive cervical cancer, HPV-16-positive tumors spread to the parametrial and pelvic lymph nodes significantly more often than did HPV-16-negative tumors (P less than 0.05). Demonstration of HPV-16 DNA in invasive cervical cancers may be an additional prognostic factor for this disease.     

Breast Conservation Therapy in Patients with Early-Stage Breast Cancer Who Have Undergone a Second Re-Excision of the Primary Tumor Bed: A Report of Four Cases

Abstract: For the women with early-stage breast cancer who are candidates for breast conservation therapy, re-excision of the primary tumor bed has commonly been used in patients for several indications. These indications include positive margin or uncertain margin status of the primary excision or residual microcalcifications on postbiopsy mammogram. If the pathology from the re-excision does not confirm negative margin status, mastectomy is generally recommended. This article examines patients who have undergone a second re-excision (i.e., a lumpectomy followed by two re-excisions) who have been treated with breast conservation therapy rather than a mastectomy.
From September 1977 to November 1995, 1,562 patients underwent breast conserving therapy at this institution. Seven hundred forty of these patients underwent a re-excisional biopsy because of positive or uncertain margin status or residual microcalcifications after the first excision. Four patients (0.5%) underwent a second re-excision because of positive or uncertain margin status or residual microcalcifications on mammogram after the first re-excision. The final margin status after the second re-excision of all four patients was negative. The radiation dose was 4,600–5,000 cGy to the whole breast followed by a conedown to bring the total dose to 6,400–6,800 cGy to the primary tumor bed.
Follow-up in the four patients was 13 years, 4 years, 14 months, and 8 months respectively. All four patients are clinically without disease and have not had a locoregional recurrence. Cosmesis was excellent in all four patients. One patient had an adriamycin-induced recall reaction causing a cellulitis, which resolved with antibiotics. There were no other complications.
Highly selected patients may undergo breast-conserving therapy after a second re-excision. Good outcome and cosmesis can be achieved for this small subset of patients with avoidance of a mastectomy.     

Clinical aspects of blue nevus and its variants

In a 5-years' study, we investigated the correlation between clinical and histological diagnoses of blue nevi. In 24.7% of the cases, the clinical diagnosis turned out to be false; blue nevus was mostly confused with nevomelanocytic nevus (11.2%). Malignant melanoma was the primary differential diagnosis in 13 out of 89 cases. Differentiation of the histological subtypes identified 76.4% of the tumors as common blue nevi and 15.7% as cellular blue nevi. The remaining 7.9% were combined nevi. The average age of the patients with blue nevi at the time of excision was lower than that of the patients suffering from malignant melanoma during the same observation period. Comparison of the distribution of 89 blue nevi with 196 malignant melanomas revealed the different preferred areas of these tumors. We briefly refer to related dermal melanocytoses, such as Mongolian spot and Ota's nevus.     

Coaching. Developing key players.

Coaching provides nurse administrators with a framework for developing their management team. Middle managers who have been coached can use coaching to provide performance feedback and encourage teamwork within their staff. Coaching as a management strategy should be valued and practiced from the nurse executive on down through the organization.