Comparison of 99Tcm-labelled MDP and DMAD bone scanning agents in patients with advanced breast cancer

The detection of focal pathology on a bone scan is dependent on the contrast between uptake in a lesion compared with the affinity of the scanning agent for the surrounding normal bone. Dimethyl-amino diphosphonate (DMAD) has a relatively low uptake in normal bone compared with methylene diphosphonate (MDP). We have compared the bone scan appearance with MDP and DMAD in 11 patients with multiple bone metastases from breast cancer. The median time between scans was 7 days (range 6 to 14). In two patients additional lesions were identified on the DMAD scan. No additional lesions were visible on the MDP scans. In five patients some lesions were visualized more clearly with DMAD and others with MDP. In six patients no differences were seen. Anatomical resolution was generally less clear with DMAD and precise anatomical localization was sometimes impossible. We have demonstrated superior lesion detection with DMAD. The clinical value of this for the detection of early relapse of disease in the skeleton requires further study.     

Risk Factors for Developing Seizures After a Stroke

Summary: We evaluated development of seizures in 219 consecutive patients who had ischemic or hemorrhagic stroke. Subjects with transitory ischemic attacks, sub-arachnoid, subdural, and epidural hemorrhages or those with previous history of epilepsy were excluded. Mean follow-up time was 11.5 months (range 1–72 months). Twenty-two of 219 stroke patients (10.04%) had seizures. Twelve (54.55%) were of early onset (<1 month after the stroke), and 10 (45.45%) were of late onset. No statistically significant differences were evident between the early- and late-onset seizure group in comparisons of type of stroke, localization, and size of the lesion. Six of 22 patients (27%) had seizure recurrence. Seizures developed in (a) 13 of 183 patients with ischemic stroke (7.1%) and 9 of 36 patients with hemorrhagic stroke (25%) (p = 0.01); (b) 16 of 93 patients with cortical lesions (17%) and 6 of 126 patients with subcortical lesions (4.7%) (p = 0.01); and (c) 14 of 66 patients with a lesion comprising more than one lobe (21.2%) and 8 of 153 patients with a lesion comprising less than one lobe (5.2%) (p < 0.01). We conclude that patients with hemorrhagic stroke, cortical lesions, and lesions involving more than one lobe are at higher risk of developing seizures.     

Accuracy of the typical computed tomographic appearances of fibrosing alveolitis.

BACKGROUND--Open lung biopsy is often performed to confirm the diagnosis in patients with suspected fibrosing alveolitis. The superior sensitivity and specificity of high resolution computed tomography (CT) over chest radiography in various diffuse lung diseases suggest that the characteristic appearance of fibrosing alveolitis on high resolution CT might render biopsy confirmation unnecessary. METHODS--The chest radiographs and high resolution CT scans of 86 patients (41 with fibrosing alveolitis and 45 with various other diffuse lung diseases) were examined individually and independently by two observers. No clinical information was given and the observers gave a level of confidence when the diagnosis was thought to be fibrosing alveolitis. RESULTS--The observers correctly and confidently discriminated between fibrosing alveolitis and other diffuse lung diseases on high resolution CT with an accuracy of 88% and on chest radiography with an accuracy of 76%. The false negative rate for fibrosing alveolitis diminished from 29% on chest radiography to 11% on high resolution CT. The false positive rate on chest radiography was 19% and on high resolution CT 13%; the false positive diagnoses on CT were the result of a few conditions (extrinsic allergic alveolitis, sarcoidosis, cryptogenic organising pneumonia, and pulmonary eosinophilia) which mimicked some of the CT features of fibrosing alveolitis. The superficial similarity of the CT patterns of these conditions are discussed. CONCLUSIONS--High resolution CT is superior to chest radiography in establishing the diagnosis of fibrosing alveolitis and the typical CT appearances are virtually pathognomonic. The diagnostic advantages of CT over chest radiography should further reduce the need for open lung biopsy in this condition.     

The use of neoadjuvant chemotherapy to achieve complete surgical resection in recurring supratentorial anaplastic ependymoma

Introduction Ependymoma is a central nervous system neoplasm that is often managed with surgery and radiotherapy. The benefits of chemotherapy in treating this tumor remain poorly defined. Case report The use of a platinum-based chemotherapy as a neoadjuvant treatment to permit complete surgical resection of a supratentorial anaplastic ependymoma recurring for the third time is described.Discussion This paper also discusses the possible use of chemotherapy as a strategy that may allow tumor shrinkage and ease tumor resection in giant recurring ependymomas.     

Six-year results of a controlled trial of tamoxifen as single adjuvant agent in management of early breast cancer

A randomized controlled trial of tamoxifen as a single adjuvant agent after mastectomy for early breast cancer, reported on at an average follow-up of almost 2 years in 1983, has now been followed up to a maximum of 6 years. One thousand two hundred eighty five patients aged 75 or less were entered into the trial. Premenopausal women with positive axillary nodes and postmenopausal women with both positive and negative axillary nodes were randomized to receive either tamoxifen 10 mg twice daily for 2 years or to the untreated control group with systemic therapy reserved until the time of relapse. Forty-six percent of the trial population had primary tumor specimens assayed for estrogen receptor (ER) content. There has been a highly significant reduction in death rate, with 45 (34%) fewer deaths observed in the treated group than in the control group. This benefit appeared to be independent of menopausal, nodal, or ER status.

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Resumen Un estudio prospectivo y al azar con tamoxifen como agente adyuvante único en cáncer mamario temprano, el cual fue informado en 1983, cuando el período de seguimiento era apenas de un promedio de casi 2 años, ha sido seguido ahora hasta un máximo de 6 años. Mil doscientos ochenta y cinco pacientes con edades de 75 años o menos fueron incorporadas al ensayo clínico. Mujeres premenopáusicas con ganglios axilares positivos y mujeres postmenopáusicas con ganglios tanto positivos como negativos fueron adjudicadas al azar para recibir tamoxifen 10 mg dos veces al día por 2 años, o al grupo control libre de tratamiento sistémico, el cual sólo fue administrado en el momento de un relapso. El 46% de las pacientes tuvieron determinaciones del contenido de receptores de estrógeno en los especímenes del tumor primario. Se observa un incremento en el período libre de enfermedad y una reducción altamente significativa en la tasa de mortalidad, con 45 muertes menos (34%) en el grupo que recibió tratamiento que en el grupo control. Tal beneficio parece ser independiente del estado menopáusico, del estado ganglionar o de los receptores de estrógeno.

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Résumé L'association du seul tamoxifen à la mastectomie pour traiter le cancer du sein décelé à un stade précoce a donné lieu à un essai controlé randomisé. Les résultats du traitement à 2 ans ont été publiés en 1983. Ceux qui ont été constatés après une survie de 6 ans font l'objet de ce rapport qui concerne 1285 malades âgées de moins de 75 ans. Les malades traitées avant la période qui précède la ménopause et qui présentaient un envahissement ganglionnaire de l'aisselle et celles traitées après la ménopause qui présentaient ou non une atteinte des ganglions ont été réparties au hasard en deux groupes. Les patientes du premier ensemble ont reçu 10 mg de tamoxifen 2 fois par jour pendant 2 ans, celles du second ont été soumises au traitement classique jusqu'au moment ou une récidive se manifestait. Quarante-six pour cent des malades incluses dans cet essai ont bénéficié du dosage du contenu récepteur oestrogénique de la tumeur (ER). L'essai a permis de constater une réduction hautement significative du taux de la mortalité concernant le groupe traité, 45 malades (34%) ayant échappé à la mort, par rapport au groupe de contrôle. Ces résultats paraissent indépendants de la ménopause, de l'état des ganglions et de la teneur en récepteur oestrogénique.

     

Lymphocyte subsets identified by monoclonal antibodies in healthy children

The distributions of lymphocyte subsets and monocytes in the peripheral blood mononuclear leukocytes of 72 normal children from 2 months to 13 5/12 yr were examined using quantitative immunofluorescence analysis with monoclonal antibodies. Distinct decreases with age were found in the total leukocyte counts, the percentages and the absolute numbers of peripheral blood mononuclear leukocytes. The percentages of Leu-2a+ cells, Leu-7+ cells, and Leu-M3+ cells significantly increased with age, whereas the percentages of Leu-3a+ cells, Leu-4+ cells, and 2H7+ cells significantly decreased with age. As a result, ratios of Leu-3a+/Leu-2a+ decreased with age. No prominent differences with age were found in the proportions of Leu-10+ cells and HLA-DR+ cells.