Pulmonary carcinomas with a sarcomatoid element: an immunocytochemical and ultrastructural analysis

Eight primary carcinomas of the lung with a prominent spindle-cell sarcomatoid component were studied by immunocytochemical staining and electron microscopy. The eight tumors were indistinguishable by conventional light microscopy, with the exception of one unusual neoplasm that followed multiple pathways of differentiation with elements of squamous cell carcinoma, rhabdomyosarcoma, chondrosarcoma, and an undifferentiated spindle-cell population. Reticulin fiber production by individual spindle cells and a sharp demarcation of the carcinomatous and sarcomatoid domains by light microscopy were not useful differentiating features. Three of the eight tumors exhibited keratin expression in both the carcinomatous and spindle-cell components. Both immunocytochemical and electron microscopic analyses were required to detect epithelial differentiation, as in one case keratin was identified only by immunocytochemical staining and in another only by ultrastructural examination. Epithelial differentiation was undetectable in the sarcomatoid component of five tumors, and in one case immunoreactive myoglobin was identified in spindle cells; skeletal muscle differentiation was confirmed ultrastructurally. We propose that pulmonary carcinomas exhibiting evidence of epithelial differentiation in a sarcomatoid component be termed spindle-cell carcinomas and that those biphasic tumors exhibiting mesenchymal differentiation into specific tissues, such as neoplastic bone, cartilage, or striated muscle, or lacking epithelial differentiation by light microscopy, immunocytochemistry, and electron microscopy be classified as carcinosarcomas. This distinction may ultimately be unnecessary, because these two tumors may represent different points along a morphologic and biologic continuum.     

Microvascular function in skin windows.

The dermal microvasculature is an integral component of skin windows. However, in spite of the obvious dependence of the skin window model on vascular function, its almost exclusive application has been the study of leukocyte function and recovery of the cellular components of inflammatory exudates. In the studies reported here, skin window chambers were employed for assessment of function of the underlying microvasculature in rats given intravenous infusions of Evans blue dye or colloidal carbon. Increased vascular permeability was documented by photometric measurement of Evans blue dye, and vascular labeling of dermal vessels with colloidal carbon was assessed histologically. Zymosan-activated serum elicited accumulation of both leukocytes and Evans blue dye in chamber fluid overlying skin windows, confirming the responsiveness of the preparations. With serotonin as a model vasoactive substance, both increased vascular permeability and vascular labeling were directly related to serotonin concentration in the chamber fluid. It is estimated that plasma exudates were distributed as approximately 10% in the fluid and 90% in the dermis. Finally, serotonin-induced exudates recovered from the 0.3-ml chambers were estimated to be up to 3 microliter of plasma based on Evans blue dye measurement or up to 70 micrograms of protein based on Lowry assay. Thus, soluble components of skin window exudates were recovered for examination, and the dermal microvasculature was shown to be an important functional component of the skin window model that was directly accessible for study.     

The usefulness of growth hormone treatment for psychological status in young adult survivors of childhood leukaemia: an open-label study

Background  

To reduce the risk of brain damage children with acute lymphoblastic leukaemia (ALL) are nowadays mainly treated with intrathecal chemotherapy (ITC) instead of central nervous system (CNS) radiation therapy (CRT) to prevent CNS relapse. However, chemotherapy may also lead to cognitive deficits. As growth hormone deficiency (GHD) or impaired growth hormone secretion are frequently found in ALL patients treated with cranial radiation therapy and/or chemotherapy, we hypothesized that GH therapy may reduce cognitive deficits in these patients.     

Immunological Unresponsiveness in Guinea Pigs: II. The Effect of Unresponsiveness on the Development of Delayed Type Hypersensitivity to Protein Antigens

Guinea pigs were rendered incapable of making circulating antibody against bovine serum albumin (BSA) or human gamma globulin (HGG), by prenatal and/or neonatal contact with these antigens. They were then treated with a water in oil emulsion of picryl BSA, or with HGG in Freund's adjuvant, or with HGG precipitated with excess rabbit antibody and suspended in a water in oil emulsion, such as to produce a state of delayed hypersensitivity to BSA or HGG respectively in control animals. The guinea pigs which would not make antibody failed to become hypersensitive to these antigens. In one group of unresponsive animals treatment with HGG in Freund's adjuvant resulted in antibody production, but no phase of delayed hypersensitivity was observed.     

High maternal vitamin E intake by diet or supplements is associated with congenital heart defects in the offspring

Objective  To study associations between maternal dietary and supplement intake of antioxidants vitamin E, retinol and congenital heart defects (CHDs).
Design  Case–control study.
Setting  Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Population  Participants were 276 case mothers of a child with CHD and 324 control mothers with their children.
Methods  Food frequency questionnaires covering the intake of the previous 4 weeks were filled out at 16 months after the index pregnancy. Data were compared between cases and controls using the Mann–Whitney U test. Risk estimates for the association between CHD and dietary intake of vitamin E and retinol were estimated in a multivariable logistic regression model.
Main outcome measures  Medians (5–95th percentile) and odds ratios with 95% CI.
Results  Dietary vitamin E intake was higher in case mothers than in controls, 13.3 (8.1–20.4) and 12.6 (8.5–19.8) mg/day ( P = 0.05). CHD risk increased with rising dietary vitamin E intakes ( P -trend = 0.01). Periconception use of vitamin E supplements in addition to a high dietary vitamin E intake above 14.9 mg/day up to nine-fold increased CHD risk. Retinol intakes were not significantly different between the groups and not associated with CHD risk.
Conclusions  High maternal vitamin E by diet and supplements is associated with an increased risk of CHD offspring.     

How and why the health insurance system will collapse

The advocates of defined-contribution health plans extol the virtues of consumer-driven health care, consumer choice, and empowered consumers as solutions to the problems--particularly the rapidly growing costs--of employer-sponsored health benefits. This paper argues that the widespread use of defined-contribution plans, with more consumer choice and more knowledgeable consumers, will lead to the erosion of the social contract on which health insurance must be based, with healthier employees subsidizing the care of older and sicker ones, and a death spiral of adverse selection. If unchecked by government intervention, these trends will lead to the collapse of employer-sponsored health insurance.     

Remission induction in acute myelogenous leukemia using cytosine arabinoside synchronization: a Southwest Oncology Group Study.

The use of cytosine arabinoside (Ara-C) infused at kinetically suggested intervals is reported in 40 pediatric patients with acute myelogenous leukemia (AML) and its subtypes. Response was observed in 17 of the 34 evaluable patients. However, the severe, often fatal effects of the regimen prevent its recommendation as a standard induction regimen in AML in children.