How I do it: a new method of myocardial revascularization with use of the radial loop technique

We report a technique that allows total arterial myocardial revascularization of the left ventricle by the use of the radial artery as a composite graft. The technique includes anastomosis of the distal end of the radial artery to its more proximal part after division of the conduit from the brachial artery. In this way we create an adjustable loop that can be divided and used as a Y-fashioned conduit according to the needs of revascularization. The main advantages of this technique are that it saves time and facilitates complex arterial revascularization of the lateral and posterior parts of the left ventricle, especially during off-pump revascularization. At least 2 coronary targets can be revascularized with the radial artery in a flexible and safe manner. The radial artery also has important potential opportunities for multiple grafting through minimal-access incisions or endoscopic coronary artery bypass grafting when a critical Y anastomosis is needed inside the chest.     

Suppression of tumorigenesis by the breast cancer cell line MCF-7 following transfer of a normal human chromosome 11.

Breast cancer development is associated with several genetic abnormalities. Loss of heterozygosity in the short arm of chromosome 11 has been observed in 30% of tumors. We found homozygosity at five chromosome 11 polymorphic loci in genomic DNA of the MCF-7 breast carcinoma cell line, suggesting a possible loss of one chromosome 11. We have studied the transformed and tumorigenic phenotypes of MCF-7 cells following introduction of a normal human chromosome 11 via microcell fusion. MCF-7/H11 cell hybrids, containing chromosome 11, showed in vitro characteristics similar to the parental cell line. However, tumorigenicity in athymic mice was completely suppressed. Since tumor formation by MCF-7 cells is estrogen dependent, we have analysed the expression of the estrogen receptor and of the estrogen-activated gene pS2. No difference was detected between the parental MCF-7 cells and the derived chromosome 11 cell hybrids, indicating that the mechanism of MCF-7 tumor suppression by chromosome 11-associated functions does not directly involve the estrogen/estrogen receptor molecular pathway.     

Examination of the oncogenic potential of a tumor-associated antigen, intestinal alkaline phosphatase, in HeLa x fibroblast cell hybrids.

An exclusive correlation exists between the ectopic expression of the cell-surface marker, intestinal alkaline phosphatase (IAP), and the tumorigenic phenotype of segregants derived from suppressed, nontumorigenic HeLa x fibroblast cell hybrids. This specific association suggests that loss of tumor suppressor function is closely linked to the re-expression of IAP and, therefore, that IAP may be a critical oncogenic factor in these cells. To address this directly, we have used a HeLa IAP cDNA expression vector (pHIAP) to introduce constitutive IAP expression into a nontumorigenic HeLa x fibroblast cell hybrid. Sequence analysis of the HeLa IAP cDNA revealed 5 separate nucleotide alterations when compared to the native IAP cDNA sequence; however, none of these resulted in amino acid substitutions. Four pHIAP transfectants were analyzed for the presence of the intact integrated IAP cDNA and their relative expression levels of exogenous IAP mRNA and protein. The functional integrity of the cDNA-derived IAP product was confirmed by demonstrating proper enzymatic activity and localization to the extracellular membrane. The tumorigenic potentials of the pHIAP transfectants were assayed by s.c. injection into athymic nude mice. No tumors were observed, even after an 11-week incubation in animals. Therefore, expression of IAP in the nontumorigenic HeLa x fibroblast cell hybrid is not sufficient to confer the tumorigenic phenotype. Although ectopic IAP expression is unlikely to be functionally relevant to tumorigenicity in these hybrids, the significance of IAP as a tumor marker is still evident from its apparent strong association with a tumor suppressor locus.     

Condylomatous lesions of the lower female genital tract

Current views on the aetiology of condylomatous lesions of the lower female genital tract are presented. In addition to the morphology of overt condylomata, the colposcopic, histological and cytological appearances are described, and association with epithelial neoplasia is considered in detail. Problems of nomenclature are discussed.     

Human papillomavirus infection of the lower female genital tract: association with multicentric neoplasia

Fifty-four patients with multiple condylomatous lesions and/or multicentric neoplasia were identified in a consecutive series of 2,627 colposcopic examinations (2%). Forty-one percent presented with condylomata only and 57% exhibited associated intraepithelial or invasive neoplasia in at least one site. Only one patient was found to have multicentric neoplasia with no condylomatous features. There was a significant increase in mean age between patients presenting with multiple condylomatous lesions and those who had intraepithelial neoplasia as well. An association with pregnancy was found in 17% of the cases, and with renal transplant in 5%. Virus particles compatible with human papillomavirus were found in 62% of the cases examined. Evidence for a causative role in the development of neoplasia of the lower female genital tract is considered.     

Paget disease of the anterior tibial tubercle

A study was done of 13 cases of biopsy-proved Paget disease in which the disease involved the anterior tibial tubercle with extension into the metaphysis and diaphysis, but without apparent involvement of the proximal tibial epiphysis. Case data were obtained from archives containing more than 350 cases of Paget disease. Age, sex, symptoms, serum alkaline phosphatase level, and histologic and radiographic appearance of the lesions were evaluated. Patients were young at clinical presentation, averaging 36 years of age. In five of six patients the serum alkaline phosphatase level was normal. The proximal extent of the disease was the anterior tibial tubercle rather than the proximal epiphysis. Radiographic patterns ranged from predominantly lytic to mixed lytic and blastic to predominantly blastic, and the lesion was marginated by a flame-shaped configuration. The radiographic appearance of Paget disease of the anterior tibial tubercle is characteristic and should be sufficient to suggest the diagnosis and preclude biopsy.     

Inhaled corticosteroid aerosols and candidiasis

A three-month controlled study was performed to assess the cumulative incidence of oral Candida carriage and thrush in patients starting to take betamethasone valerate aerosol (800 microgram/day) for control of their asthma. Four of 41 patients on the corticosteroid aerosol developed thrush compared with none of 40 in the control group. However, the number of cumulative saliva culture positives for C. albicans rose by a similar amount (approximately 20%) in each group. A simple mouthwash procedure was shown to have no prophylactic benefit in the aerosol group. Oral candidiasis was not, however, clinically important.     

Alterations in the extracellular matrix organization associated with the reexpression of tumorigenicity in human cell hybrids

The expression of fibronectin on the cell surface was evaluated on a series of intraspecific human cell hybrids formed between HeLa and normal fibroblast strains. Although these hybrids continued to express many of the in vitro transformation properties of their corresponding tumorigenic HeLa parent, they were now unable to form tumors when inoculated into athymic nude mice. From these suppressed hybrid populations, rare tumorigenic segregant subpopulations arose which had regained their tumorigenic capacity. A comparison of the expression of fibronectin on the cell surface was made between these tumorigenic segregant cell lines and their corresponding non-tumorigenic HeLa/fibroblast hybrid. Following specific immunofluorescent staining for fibronectin, a striking alteration in the cell surface organization was observed to correspond with the reexpression of tumorigenicity in these hybrids. Tumorigenic HeLa/fibroblast hybrids were also significantly altered in both their cellular and colonial morphology. Double immunofluorescent staining to simultaneously visualize both surface fibronectin and collagen revealed that these two extracellular matrix proteins displayed an extensive degree of codistribution and expressed a coordinate shift in organization which correlated with the appearance of tumorigenic segregant hybrid populations. These observations are in agreement with the apparently close structural association between fibronectin and collagen and suggest that the organization of these two components in the extracellular matrix may be an important determinant for in vivo growth potential.