SERIAL PROSTATE SPECIFIC ANTIGEN, FREE-TO-TOTAL PROSTATE SPECIFIC ANTIGEN RATIO AND COMPLEXED PROSTATE SPECIFIC ANTIGEN FOR THE DIAGNOSIS OF PROSTATE CANCER

Purpose: The free-to-total prostate specific antigen (PSA) ratio and complexed PSA have been introduced as adjuncts to total PSA for prostate cancer screening. Little data exist on the use of these tests for serial PSA screening. We compared serial total PSA, the free-to-total PSA ratio and calculated complexed PSA in men diagnosed with prostate cancer and matched controls in a population based study.Materials and Methods: We identified 90 men diagnosed with prostate cancer between 1988 and 1996 with at least 3 serial serum samples obtained at 2-year intervals who were participants in the beta-Carotene and Retinol Efficacy Trial for the prevention of lung cancer. Samples were available up to 10 years before diagnosis. A total of 90 age matched men from the same cohort without prostate carcinoma were identified as controls. Free and total PSA was measured by the Abbott AxSYM system.Results: Baseline demographics of cases and controls were similar. At baseline and diagnosis the men with prostate cancer had higher total and complexed PSA, and a lower free-to-total PSA ratio than controls. Mean followup was 5.2 years in cases and 5.5 in controls. The yearly change in PSA parameters in cases versus controls was 20.7% versus 3.5% for total, -3.4% versus 0.2% for free-to-total and 21.5% versus 3.4% for complexed PSA (p <0.0001). At diagnosis PSA alone was estimated to perform with more than 90% specificity in our model.Conclusions: In this population based study total PSA was superior to the free-to-total PSA ratio for predicting the development of prostate cancer. While serial changes in free-to-total PSA ratios with time were statistically significantly different in men diagnosed with prostate cancer and controls, the magnitude of these serial changes were slight enough to render them clinically insignificant.     

The Acridine Orange Viability Test Applied to Bone Marrow Cells I. Correlation with Trypan Blue and Eosin Dye Exclusion and Tissue Culture Transformation

Suspensions of murine bone marrow cells were stained with acridine orange(A-O) and observed under fluorescent microscopy after treatment withvarious injurious agents in order to establish the staining characteristics of"live" and "dead" cells. The percentage of viable cells demonstrated by the"A-O viability test" were correlated with eosin and trypan blue dye exclusionand tissue culture transformation viability tests. In general, the A-O testdemonstrated the viability of cells preserved by freezing as effectively as theother in vitro tests. In addition, the A-O test may be more sensitive indetermining the viability of cells where metabolic processes have been injuredby poisons or change in pH.

Submitted on September 4, 1963 Accepted on October 29, 1963     

Studies in Bisalbuminemia: Binding Properties of the Two Albumins

1. An abnormal serum protein pattern in a patient with Wegener’s granulomatosis and five of his relatives was identified as bisalbuminemia by electrophoretic and immunochemical methods.

2. With the exception of the patient with Wegener’s syndrome, the presenceof bisalbuminemia was not associated with a significant change in total serumproteins, total albumin, serum components other than albumin, or any disease.

3. Addition of I¹³¹-thyroxine to bisalbumin sera resulted in thyroxine binding by albumin B but not by albumin A. The failure of albumin A to bindadded I¹³¹-thyroxine leads to speculation that, in this family, neither albuminA nor B are identical to normal human serum albumin.

Submitted on December 4, 1961 Accepted on April 17, 1962     

Ventricular Tachycardia/Ventricular Fibrillation Ablation in the Setting of Ischemic Heart Disease

Recurrent ventricular tachycardia (VT) in the setting of coronary artery disease is frequently a life-threatening electrophysiologic emergency. Even in patients with an implantable defibrillator, recurrent VT is frequently accompanied by repeated and disabling shock therapy. Catheter ablative therapy offers the ability to provide immediate control of recurrent VT. Long-term elimination of VT should be anticipated in most patients. This article reviews the strategies, tools, techniques, and expected outcome for catheter ablation of stable and unstable ventricular arrhythmias in the setting ischemic heart disease.     

A Case Series: Herpes Simplex Virus as an Occupational Hazard

ABSTRACT

Statement of the Problem: Herpes labialis infections are common and present a serious risk to the dental team. Purpose of the Study: The purpose is to make dentists aware of the risks involved with treatment of patients with active herpes labialis. In addition, evidence‐based risk‐management strategies are presented. Methods and Materials: The incidence and natural history of herpes simplex virus type 1 (HSV‐1) are reviewed. Four previously unreported case histories are presented to illustrate the impact common sequelae of HSV‐1 can have on the dental team. The differences between HSV‐1 and the blood‐borne diseases which are the focus of universal precautions are discussed. In particular, the highly contagious, highly transmissible nature of HSV‐1 and its transmission through aerosols are highlighted. Finally, the need to include protection against aerosols in the profession's understanding of universal precautions is noted. Results: The authors suggest limiting the treatment of patients with active lesions to urgent care only, and treating active HSV‐1 lesions to reduce time of healing. For four common clinical situations involving HSV‐1 infections, evidence‐based methods for protecting the dental team and the patient from cross‐contamination are also presented. Conclusion: While it is clear that the treatment of patients with active herpes labialis lesions increases risk of cross‐infection, there are good protocols for controlling this risk.

CLINICAL SIGNIFICANCE

By bringing common vectors of cross‐infection to light and providing evidence‐based protocols for preventing them, this article provides practitioners with positive steps that can be taken for controlling the risk of spreading herpes infections to the dental team. (J Esthet Restor Dent 24:61–67, 2012)     

Megakaryocytopoiesis in Experimentally Induced Immune Thrombocytopenia

The hypothesis that in immune thrombocytopenia, platelet antibody maynot only cause destruction of the circulating platelets but also depress plateletproduction by injuring the megakaryocytes of the bone marrow, was testedexperimentally.

Sustained thrombocytopenia was produced in rats by titrated injections ofa potent heteroimmune antiplatelet serum and megakaryocytopoiesis wasthen studied by the use of tritiated thymidine and bone marrow autoradiography. Rats in which the platelet count was maintained at a lower thannormal level by repeated thrombocytophereses, and other rats injected withplatelet antiserum previously absorbed with rat platelets, served as controls.

Profoundly altered patterns of megakaryocytopoiesis were found in the ratsin which thrombocytopenia was produced by the antiplatelet serum. The dataindicated a severely impaired and depressed megakaryocyte maturation and,possibly, destruction of some of the megakaryocytes during their maturationprocess. In the rats in which the platelet level was maintained low by repeatedthrombocytophereses, the pattern of megakaryocytopoiesis indicated accelerated maturation and there was also an increased megakaryocyte mass. Nodifference from normal was found in the rats receiving the platelet-adsorbed antiserum. It was concluded that the platelet antibody produced aninjurious effect on the megakaryocytes in the bone marrow, thereby depressing platelet production, and that the immune thrombocytopenia was theresult of both increased platelet destruction and defective platelet production.

Submitted on November 22, 1968 Accepted on October 3, 1969     

IMMUNOCYTOCHEMICAL EXPRESSION OF THE 70 kD HEAT SHOCK PROTEIN IN ISCHAEMIC BOWEL DISEASE

Heat shock proteins (HSPs) are a family of polypeptides which are induced in response to diverse forms of cell injury including hyperthermia, anoxia, ethanol, heavy metals, and others, with a presumably protective function. Among several species of HSPs, the 70 kD protein (HSP70) is the most abundant and consistently induced in mammalian cells. Anti-HSP70 monoclonal antibody and a standard immunocytochemical method were used to study the expression of HSP70 in 28 surgical specimens of small and large intestines from patients with ischaemic bowel disease. Strong immunoreactivity was observed in viable, regenerating cells of both the crypt and surface epithelium within or adjacent to the necrotic foci in 86 per cent of the ischaemic bowel specimens. Staining was mostly cytoplasmic, but focally both cytoplasmic and nuclear. Smooth muscle cells of the muscularis mucosae in the ischaemic areas of some cases also showed immunoreactivity. On the other hand, HSP70 was not expressed in control specimens of small and large intestine or in colonic specimens of Crohn's disease, ulcerative colitis, and adenocarcinoma. These findings suggest a possible role of HSP70 in intestinal epithelial and smooth muscle cell response to ischaemic injury, especially in the recovery phase.     

REPEATED DELIBERATE SELF-HARM IN THE ELDERLY

Previous reports on deliberate self-harm (DSH) in old age are reviewed and the lack of any study on repetition in this group is pointed out. The study then describes 39 patients over the age of 60 who presented after repeated self-harm at a district general hospital between 1973 and 1993. They made up 1% of all DSH cases, 28 were female and 11 were male, seven were multiple repeaters. Thirty were suffering from depressive illnesses, six showed significant cognitive impairment, while five (four of them women) gave a history of alcohol abuse. A trend emerged for women to score higher than men on a measure of suicidal intent. Two patients committed suicide during the study period. These findings are discussed together with their implications for the management and prevention of suicidal behaviour in the elderly.