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A muscle cell variant defective in glycosaminoglycan biosynthesis forms nerve-induced but not spontaneous clusters of the acetylcholine receptor and the 43 kDa protein.

Myotubes of the C2 mouse muscle cell line form clusters of ACh receptors (AChRs) at apparently random sites along their length when cultured alone, and near sites of nerve-muscle contact when cocultured with neurons. We find in aneural cultures that myotubes of a C2 variant, S27, which is defective in glycosaminoglycan synthesis, express the AChR on their surface, but do not form clusters. S27 cells in aneural cultures also express the 43 kDa protein but do not cluster it. The altered distribution of laminin and collagen IV on the surface of S27 myotubes suggests that the basal lamina is abnormal. Neither the addition of exogenous proteoglycans or conditioned medium from wild-type C2 cells, nor the growth of S27 cells on substrates rich in basal lamina elements caused clusters to appear on S27 myotubes in aneural cultures. When cultured with primary neurons, however, S27 myotubes formed large clusters of the AChR near sites of neurite contact. The clusters were coincident with patches of the 43 kDa protein. Prelabeling experiments indicate that at least some AChRs in the clusters arise through aggregation. Although Torpedo agrin induces AChR clusters on C2 myotubes, it does not do so on S27 cells. Our experiments suggest that the spontaneous formation of clusters of AChRs and the 43 kDa protein in aneural cultures of myotubes depends upon the normal synthesis of muscle proteoglycans, and that nerve-induced clustering does not. Thus, there appear to be multiple mechanisms for the formation of AChR clusters.

Agrin↗

Multiple endocrine neoplasia type 1 (MEN1): loss of one MEN1 allele in tumors and monohormonal endocrine cell clusters but not in islet hyperplasia of the pancreas.

CONTEXT: The occurrence of multiple small pancreatic endocrine tumors in patients suffering from multiple endocrine neoplasia type 1 (MEN1) represents a unique possibility to study early neoplasms and their potential precursor lesions. To date, it is unknown whether small islet-like endocrine cell clusters found in MEN1 patients are neoplastic or rather hyperplastic. It is also unclear whether microadenomas develop from islets. DESIGN: We hypothesized that monohormonal endocrine cell clusters observed in MEN1 patients are small neoplasms with loss of heterozygosity of the MEN1 locus. Using a technique combining fluorescence in situ hybridization of the MEN1 locus and the centromeric region of chromosome 11q with hormone immunostaining, we examined resection specimens from four MEN1 patients. We focused our investigations on the following: 1) typical microadenomas; 2) monohormonal endocrine cell clusters; 3) endocrine and exocrine structures entrapped in microadenomas; and 4) morphologically normal islets. RESULTS: Loss of one MEN1 allele was found in all 27 microadenomas and 19 of 20 (95%) monohormonal endocrine cell clusters. By contrast, it was absent in islets and ductal or acinar structures. Our results indicate that monohormonal endocrine cell clusters represent a minute form of microadenomas. CONCLUSION: The frequent presence of single nonneoplastic insulin cells in microadenomas and the occurrence of microadenomas in islets suggest an islet origin of microadenomas. Islet hyperplasia does not seem to be an obligatory stage in pancreatic MEN1-associated tumor development.

Adult↗

An open trial of paroxetine in patients with noncombat-related, chronic posttraumatic stress disorder.

The symptom overlap between posttraumatic stress disorder (PTSD) and other pharmacotherapy-responsive disorders suggests that pharmacotherapy might be effective. Nevertheless, of the eight published placebo-controlled trials investigating the pharmacotherapy of PTSD, only four found statistically significant efficacy for the treatment being studied. This literature possesses a number of methodologic limitations, including the fact that most studies have been conducted with war veterans, who may constitute a more treatment-refractory population. Several open trials and one controlled trial with selective serotonin reuptake inhibitors have reported improvement in some or all core PTSD symptoms (reexperiencing, avoidance, numbing, and hyperarousal). The authors hypothesized that paroxetine might be effective in PTSD, based on findings of its particular efficacy for anxiety and agitation in studies of depressed patients. The study presented here summarizes a 12-week, open-label trial of paroxetine among patients with noncombat-related, chronic PTSD. Outcome was assessed by an independent evaluator, the treating physician, and the patient, with the use of established rating scales for depression, anxiety, general symptoms, and PTSD core symptoms. A repeated-measures analysis of variance revealed highly significant improvement in all three symptom clusters, as well as in associated anxiety, depressive, and dissociative symptoms, with 11 of 17 (65%) patients rated as much or very much improved. The mean reduction in PTSD symptom scores was 48%. Exploratory analyses revealed that cumulative childhood trauma was negatively correlated with pharmacotherapy response (r = -0.52, p = 0.03). There was also significant variation in the time course of response across symptom clusters, which is suggestive of multiple mechanisms of response. Because paroxetine seems a highly promising treatment for all three symptom clusters of PTSD, a placebo-controlled clinical trial is warranted.

Adult↗

Regression analysis of biomedical research data based on a repeated measure or cluster sample.

Research in biology and medicine often entails estimating the effect of an exposure variable X on a response variable Y from a cluster sample, that is, where X and Y may be measured repeatedly from the same subject (cluster), or X and Y may be measured from two or more subjects based on some related grouping such as a litter or household (cluster). Typically, regression analysis of the data is performed ignoring the subject or grouping (cluster) identity. This analytical approach has two drawbacks. First, the statistical inference of the regression coefficient of Y on X (beta) ignored cluster identity will likely be biased. More serious though, is that beta ignored cluster identity will likely be quite discrepant from the average within-cluster beta. It is the latter that is of relevance to the research question. Indeed it is not clear what beta ignored cluster identity really conveys. We describe a multiple regression model for the analysis of data from a cluster sample. The model treats the cluster as a nominal confounding variable to be adjusted. The idea is to represent the cluster by a set of dummy variables to be included as explanatory variables in the regression model. This model gives the average within-cluster beta with valid statistical inference. Numeric examples were used to illustrate the application of the dummy variable multiple regression model. This statistical method can be implemented by any software package that includes multiple regression, and virtually all commercial packages include this procedure.

Cluster Analysis↗

High-throughput protein expression analysis using tissue microarray technology of a large well-characterised series identifies biologically distinct classes of breast cancer confirming recent cDNA expression analyses.

Recent studies on gene molecular profiling using cDNA microarray in a relatively small series of breast cancer have identified biologically distinct groups with apparent clinical and prognostic relevance. The validation of such new taxonomies should be confirmed on larger series of cases prior to acceptance in clinical practice. The development of tissue microarray (TMA) technology provides methodology for high-throughput concomitant analyses of multiple proteins on large numbers of archival tumour samples. In our study, we have used immunohistochemistry techniques applied to TMA preparations of 1,076 cases of invasive breast cancer to study the combined protein expression profiles of a large panel of well-characterized commercially available biomarkers related to epithelial cell lineage, differentiation, hormone and growth factor receptors and gene products known to be altered in some forms of breast cancer. Using hierarchical clustering methodology, 5 groups with distinct patterns of protein expression were identified. A sixth group of only 4 cases was also identified but deemed too small for further detailed assessment. Further analysis of these clusters was performed using multiple layer perceptron (MLP)-artificial neural network (ANN) with a back propagation algorithm to identify key biomarkers driving the membership of each group. We have identified 2 large groups by their expression of luminal epithelial cell phenotypic characteristics, hormone receptors positivity, absence of basal epithelial phenotype characteristics and lack of c-erbB-2 protein overexpression. Two additional groups were characterized by high c-erbB-2 positivity and negative or weak hormone receptors expression but showed differences in MUC1 and E-cadherin expression. The final group was characterized by strong basal epithelial characteristics, p53 positivity, absent hormone receptors and weak to low luminal epithelial cytokeratin expression. In addition, we have identified significant differences between clusters identified in this series with respect to established prognostic factors including tumour grade, size and histologic tumour type as well as differences in patient outcomes. The different protein expression profiles identified in our study confirm the biologic heterogeneity of breast cancer and demonstrate the clinical relevance of classification in this manner. These observations could form the basis of revision of existing traditional classification systems for breast cancer.

Breast Neoplasms↗

Symptom clusters in oncology patients and implications for symptom research in people with primary brain tumors.

PURPOSE: To provide a critical analysis of the state of the science of research on symptom clusters in the general oncology population, compared to symptom research in the primary brain tumor population. ORGANIZING CONSTRUCT: Symptoms are a multidimensional experience that include perceptions of the frequency, intensity, distress, and meaning as symptoms occur and are expressed. A symptom can influence the occurrence and meaning of other symptoms. METHODS: Literature pertaining to symptom presentation in people with primary brain tumors and the occurrence of multiple symptoms and symptom clusters in patients with cancer was reviewed and analyzed. FINDINGS: Symptoms occur in clusters in general oncology patients, and these clusters have been shown to influence functional status. The potential effect of tumor biology on symptom clusters is shown by the cluster of symptoms theorized to be associated with proinflammatory cytokine production. In patients with primary brain tumors, few researchers have examined the occurrence of symptoms at the time of diagnosis. Studies to date are retrospective and descriptive and were conducted before the use of modern imaging techniques. Studies of symptom clusters have not been reported for patients with primary brain tumors. CONCLUSIONS: Symptom clusters have recently been identified in the general oncology population and might provide a new strategy for assessment and intervention. Neurologic symptoms in patients with primary brain tumors are those related to increased intracranial pressure and those that are location-dependent within the brain. Therefore, application of the symptom cluster paradigm to guide research is warranted.

Activities of Daily Living↗

Cluster of iniencephaly in Miami.

This report details a cluster of 5 cases of iniencephaly with anencephaly and rachischisis occurring over a 4-month period at Jackson Memorial Hospital/University of Miami Medical Center in Miami, Florida. All 5 cases of this rare, lethal, congenital malformation seen in the cluster included diaphragmatic defects with accompanying hernia, omphalocele, small adrenals, renal dysmaturity, gastrointestinal malformations, cleft lip and palate, and hypoplastic lungs. No single causative agent for this cluster was identified. A brief review of the literature regarding categorization of these malformations and as a discussion of the embryological basis for these lesions and possible etiologic factors are included.

Abnormalities, Multiple↗

Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic review.

AIMS: To investigate what patterns of bruising are diagnostic or suggestive of child abuse by means of a systematic review. METHODS: All language literature search 1951-2004. Included: studies that defined patterns of bruising in non-abused or abused children <18 years. Excluded: personal practice, review articles, single case reports, inadequate confirmation of abuse. Two independent full text reviews using standardised data extraction and critical appraisal forms. Studies ranked by study design and definition of abuse used. RESULTS: Twenty three studies included: seven non-abusive bruising, 14 abusive bruising, and two both. Non-abusive: The prevalence, number, and location of bruises is related to increased motor development. Bruising in non-independently mobile babies is very uncommon (<1%). Seventeen per cent of infants who are starting to mobilise, 53% of walkers, and the majority of schoolchildren have bruises. These are small, sustained over bony prominences, and found on the front of the body. Abuse: Bruising is common in children who are abused. Any part of the body is vulnerable. Bruises are away from bony prominences; the commonest site is head and neck (particularly face) followed by the buttocks, trunk, and arms. Bruises are large, commonly multiple, and occur in clusters. They are often associated with other injury types that may be older. Some bruises carry the imprint of the implement used. CONCLUSION: When abuse is suspected, bruising must be assessed in the context of medical, social, and developmental history, the explanation given, and the patterns of non-abusive bruising. Bruises in non-mobile infants, over soft tissue areas, that carry the imprint of an implement and multiple bruises of uniform shape are suggestive of abuse. Quality research across the whole spectrum of children is urgently needed.

Adolescent↗

Cluster B and C personality traits, symptom correlates, and treatment utilization in postacute schizophrenia.

Unusually high levels of Cluster B and C personality traits have been observed in schizophrenia. While these have been linked to poorer function, less clear is the association of these personality traits with symptoms and service utilization. To examine this issue, 46 participants with schizophrenia or schizoaffective disorder were administered the Millon Clinical Multiaxial Inventory, Third Edition, and the Positive and Negative Syndrome Scale, and an inventory was taken of medical and psychiatric service utilization. Two sets of multiple regression analyses using Cluster B and C traits to predict treatment utilization and symptoms revealed that emotional discomfort symptoms were significantly related to level of borderline traits. Higher levels of positive symptoms were linked with more avoidant traits and fewer dependent traits. Higher levels of negative symptoms were linked with greater avoidant traits. Service utilization was predicted by borderline, antisocial, and avoidant traits. Implications for rehabilitation and treatment are discussed.

Ambulatory Care↗

The human natural killer cell immune synapse.

Inhibitory killer Ig-like receptors (KIR) at the surface of natural killer (NK) cells induced clustering of HLA-C at the contacting surface of target cells. In this manner, inhibitory immune synapses were formed as human NK cells surveyed target cells. At target/NK cell synapses, HLA-C/KIR distributed into rings around central patches of intercellular adhesion molecule-1/lymphocyte function-associated antigen-1, the opposite orientation to mature murine T cell-activating synapses. This organization of protein was stable for at least 20 min. Cells could support multiple synapses simultaneously, and clusters of HLA-C moved as NK cells crawled over target cells. Clustering required a divalent metal cation, explaining how metal chelators inhibit KIR function. Surprisingly, however, formation of inhibitory synapses was unaffected by ATP depletion and the cytoskeletal inhibitors, colchicine and cytochalsins B and D. Clearly, supramolecular organization within plasma membranes is critical for NK cell immunosurveillance.

Actins↗

A recent fixation of cfiA genes in a monophyletic cluster of Bacteroides fragilis is correlated with the presence of multiple insertion elements.

Small-subunit ribosomal DNA sequences of 16 strains of Bacteroides fragilis were determined and compared with previously published sequences. Three phylogenetic methods (the neighbor-joining, maximum-likelihood, and maximum-parsimony methods) as well as a bootstrap analysis were used to assess the robustness of each topology. All phylogenetic analyses demonstrated that the B. fragilis strains were clearly divided into two robust monophyletic units which corresponded to the cfiA-negative and cfiA-positive groups. Strains of two previously identified DNA homology groups separated similarly into the two monophyletic units. According to the intensity of the hybridization signal with a cfiA probe, the cfiA-positive cluster could be further divided into two groups. This difference might reflect the existence of two, probably closely related cfiA-type genes. In the strongly hybridizing cfiA-positive strains, the gene is capable of conferring high-level resistance to the carbapenems and to most beta-lactamase inhibitors as well, while in the weakly hybridizing cfiA-positive strains, only the latter type of resistance is known to occur. The presence of the cfiA-type genes within a monophyletic cluster of B. fragilis that apparently represents only a minority of the species B. fragilis is suggestive of a recent acquisition. The fact that this cluster is also the predominant pool of all known B. fragilis insertion elements, which have been found to play an important role in the expression of carbapenem resistance, raises the possibility that both genetic determinants, i.e., the resistance gene(s) and insertion elements, may have coevolved.

Bacterial Proteins↗

Multidrug-resistant transport proteins in yeast: complete inventory and phylogenetic characterization of yeast open reading frames with the major facilitator superfamily.

Screening of the complete genome sequence from the yeast Saccharomyces cerevisiae reveals that 28 open reading frames (ORFs) are homologous to each other and to established bacterial members of the drug-resistant subfamily of the major facilitator superfamily. The phylogenesis of these protein sequences shows that they fall into three major clusters. Cluster I contains 12 ORFs, cluster II contains ten ORFs and cluster III contains six ORFs. Hydropathy analyses indicate that in cluster II and III ORFs, 14 transmembrane spans are predicted whereas only 12 transmembrane spans are predicted in cluster I ORFs. Three ORFs that have known functions as multidrug-resistance pumps in other yeast species such as Schizosaccharomyces pombe (CAR1), Candida albicans (BMRP) or C. maltosa (CYHR), also fall into cluster I. Two S. cerevisiae ORFs of known multidrug-resistance function (ATR1, SGE1) fall into cluster II. Cluster III consists exclusively of ORFs of unknown function but binary sequence comparisons show homology to ORFs from cluster II. Analysis of the multiple alignment for these proteins leads to the identification of characteristic signature sequences for each of the three clusters.

Amino Acid Sequence↗

Structural, functional, and evolutionary relationships among extracellular solute-binding receptors of bacteria.

Extracellular solute-binding proteins of bacteria serve as chemoreceptors, recognition constituents of transport systems, and initiators of signal transduction pathways. Over 50 sequenced periplasmic solute-binding proteins of gram-negative bacteria and homologous extracytoplasmic lipoproteins of gram-positive bacteria have been analyzed for sequence similarities, and their degrees of relatedness have been determined. Some of these proteins are homologous to cytoplasmic transcriptional regulatory proteins of bacteria; however, with the sole exception of the vitamin B12-binding protein of Escherichia coli, which is homologous to human glutathione peroxidase, they are not demonstrably homologous to any of the several thousand sequenced eukaryotic proteins. Most of these proteins fall into eight distinct clusters as follows. Cluster 1 solute-binding proteins are specific for malto-oligosaccharides, multiple oligosaccharides, glycerol 3-phosphate, and iron. Cluster 2 proteins are specific for galactose, ribose, arabinose, and multiple monosaccharides, and they are homologous to a number of transcriptional regulatory proteins including the lactose, galactose, and fructose repressors of E. coli. Cluster 3 proteins are specific for histidine, lysine-arginine-ornithine, glutamine, octopine, nopaline, and basic amino acids. Cluster 4 proteins are specific for leucine and leucine-isoleucine-valine, and they are homologous to the aliphatic amidase transcriptional repressor, AmiC, of Pseudomonas aeruginosa. Cluster 5 proteins are specific for dipeptides and oligopeptides as well as nickel. Cluster 6 proteins are specific for sulfate, thiosulfate, and possibly phosphate. Cluster 7 proteins are specific for dicarboxylates and tricarboxylates, but these two proteins exhibit insufficient sequence similarity to establish homology. Finally, cluster 8 proteins are specific for iron complexes and possibly vitamin B12. Members of each cluster of binding proteins exhibit greater sequence conservation in their N-terminal domains than in their C-terminal domains. Signature sequences for these eight protein families are presented. The results reveal that binding proteins specific for the same solute from different bacteria are generally more closely related to each other than are binding proteins specific for different solutes from the same organism, although exceptions exist. They also suggest that a requirement for high-affinity solute binding imposes severe structural constraints on a protein. The occurrence of two distinct classes of bacterial cytoplasmic repressor proteins which are homologous to two different clusters of periplasmic binding proteins suggests that the gene-splicing events which allowed functional conversion of these proteins with retention of domain structure have occurred repeatedly during evolutionary history.(ABSTRACT TRUNCATED AT 400 WORDS)

Amino Acid Sequence↗

Genetic susceptibility to the development of autoimmune disease.

1. Autoimmune diseases are common conditions which appear to develop in genetically susceptible individuals, with expression of disease being modified by permissive and protective environments. Familial clustering and data from twin studies provided the impetus for the search for putative loci. Both the candidate gene approach in population-based case-control studies and entire genome screening in families have helped identify susceptibility genes in a number of autoimmune diseases. 2. After the first genome screen in type 1 (insulin-dependent) diabetes mellitus it seems likely that most autoimmune diseases are polygenic with no single gene being either necessary or sufficient for disease development. Of the organ-specific autoimmune diseases, genome screens have now been completed in insulin-dependent diabetes mellitus and multiple sclerosis. Furthermore, the clustering of autoimmune diseases within the same individuals suggests that the same genes may be involved in the different diseases. This is supported by data showing that both HLA (human leucocyte antigen) and CTLA-4 (cytotoxic T-lymphocyte-associated-4) appear to be involved in the development of insulin-dependent diabetes mellitus and Graves' disease. 3. Genome screens have also been completed in some of the non-organ-specific autoimmune diseases including rheumatoid arthritis, inflammatory bowel disease and psoriasis. Many candidate genes have also been investigated although these are predominantly in population-based case-control studies. 4. Substantial progress has been made in recent years towards the identification of susceptibility loci in autoimmune diseases. The inconsistencies seen between case-control studies may largely be due to genetic mismatching between cases and controls in small datasets. Family-based association studies are being increasingly used to confirm genetic linkages and help with fine mapping strategies. It will, however, require a combination of biology and genetics, as has been necessary with the major histocompatibility complex in insulin-dependent diabetes mellitus, to identify primary aetiological mutations.

Abatacept↗

[Multivariate statistical analysis in stabilometry in human upright standing (the first report)--age-related factor].

Posturography is not a clearly defined examination. Recently a number of parameters can be obtained in stabilometry by means of computers. To evaluate each parameter and to decide its normal range, subject's age must be considered. The age-related factors found in stabilometry were studied in terms of both multiple regression analysis and cluster analysis. The parameters used in this study were as follows: the area of an ellipse for rejection and of the figure displayed on an X-Y recorder, the maximum width on both the X axis (left and right direction) and the Y axis (anterior and posterior direction), the total length and the sum of excursion in each direction, the root mean square, the velocity, the acceleration, and the averaged frequency of body sway in both X and Y directions. One hundred normal subjects, aged from the second to sixth decade, including 10 males and 10 females in each decade, were tested. Each subject was asked to stand on a platform in Romberg's position for 60 seconds with both eyes open and closed. The significant parameters to predict age, which were determined by multiple regression analysis, were as follows (P less than 0.05): the averaged frequency in the Y direction with eyes closed, the maximum width in the X direction with eyes open, the area of the ellipse for rejection and of the figure with eyes closed, the maximum width in the Y direction and the area of the ellipse and the velocity in the X direction with eyes open. All test subjects were successfully classified into two groups by cluster analysis. One was the younger group aged less than 40 years and the other was the older group not younger than 40-year-old. However, the difference between with eyes open and with eyes closed was not significant (P less than 0.01) as regards the parameters of root mean square and averaged frequency in both sexes and at every decade. The difference between both sexes was supposed to be significant in the Y direction in the younger group and in the X direction in the older one.

Adult↗

Ultrastructure of unit fragments of the skeleton of the human erythrocyte membrane.

We have examined fragments of the filamentous network underlying the human erythrocyte membrane by high-resolution electron microscopy. Networks were released from ghosts by extraction with Triton X-100, freed of extraneous proteins in 1.5 M NaCl, and collected by centrifugation onto a sucrose cushion. These preparations contained primarily protein bands 1 + 2 (spectrin), band 4.1 and band 5 (actin). The networks were partially disassembled by incubation at 37 degrees C in 2 mM NaPi (pH 7), which caused the preferential dissociation of spectrin tetramers to dimers. The fragments so generated were fractionated by gel filtration chromatography and visualized by negative staining with uranyl acetate on fenestrated carbon films. Unit complexes, which sedimented at approximately 40S, contained linear filaments approximately 7-8 nm diam from which several slender and convoluted filaments projected. The linear filaments had a mean length of 52 +/- 17 nm and a serrated profile reminiscent of F-actin. They could be decorated in an arrowhead pattern with S1 fragments of muscle heavy meromyosin which, incidentally, displaced the convoluted filaments. Furthermore, the linear filaments nucleated the polymerization of rabbit muscle G-actin, predominantly but not exclusively from the fast-growing ends. On this basis, we have identified the linear filaments as F-actin; we infer that the convoluted filaments are spectrin. Spectrin molecules were usually attached to actin filaments in clusters that showed a preference for the ends of the F-actin. We also observed free globules up to 15 nm diam, usually associated with three spectrin molecules, which also nucleated actin polymerization; these may be simple junctional complexes of spectrin, actin, and band 4.1. In larger ensembles, spectrin tetramers linked actin filaments and/or globules into irregular arrays. Intact networks were an elaboration of the basic pattern manifested by the fragments. Thus, we have provided ultrastructural evidence that the submembrane skeleton is organized, as widely inferred from less direct information, into short actin filaments linked by multiple tetramers of spectrin clustered at sites of association with band 4.1.

Cell Fractionation↗

Consensus review: A method of assessment of calcifications that appropriately undergo a six-month follow-up.

RATIONALE AND OBJECTIVES: Breast calcifications seen on mammography may be associated with benign conditions or malignancies. Accurate characterization of these calcifications is crucial to providing optimal care that may spare women unnecessary biopsies and appropriately allow interval mammography. The purpose of this study is to determine if consensus characterization of calcifications by two breast imaging experts using standardized criteria can establish that follow-up is a safe option. MATERIALS AND METHODS: For this retrospective study, our breast imaging database was reviewed and the cases imaged between the years 1999 and 2001 were used to identify patients with calcifications who were recommended for a six-month follow-up or biopsy. All cases had been prospectively assessed by at least two expert breast imagers using standardized features to assess the findings before a recommendation for follow-up or a biopsy was made. A retrospective chart review examining the radiology reports was done to determine the percentage of women from each of the two groups who developed malignancies. RESULTS: Of 744 patients who had mammographically identified clusters of calcifications, 490 clusters (409 single and 81 multiple) were diagnosed as probably-benign, and a short-interval 6-month follow-up was recommended. Of these calcifications followed for three years, only two (0.5%) of the single clusters proved to be malignant, and malignancy was diagnosed at the 12-month follow-up examination. In both cases, the women were diagnosed with ductal carcinoma in situ (DCIS). Of 254 clusters recommended for biopsy, 242 (215 single and 27 multiple) underwent biopsy. A total of 70 cancers were diagnosed: 54 (77.1%) were DCIS and 16 (22.9%) were primary invasive mammary carcinoma (10 cases of invasive ductal carcinoma, 3 cases of invasive lobular carcinoma, 2 cases of invasive ductal carcinoma with DCIS, and one case of invasive mucinous carcinoma with DCIS). Twenty-nine percent of women who had a biopsy performed had calcifications associated with malignancy. In contrast, in the women whose calcifications were followed by mammography, only 0.5% went on to develop malignancies. CONCLUSION: Consensus review of calcifications by two breast imagers using standardized criteria is a safe follow-up option.

Breast Diseases↗

Significance of migrainous features in cluster headache: divalproex responsiveness.

Two patients with cluster headache and prominent migrainous features are described and a shared migraine and cluster headache pathophysiology is discussed. Both patients failed routine cluster headache pharmacotherapy, one failed multiple operative interventions; however, both remitted on divalproex. It is suggested that migrainous features be assessed in cluster headache and divalproex initiated before pursuing invasive procedures.

Adult↗