1027 ary cedema does
develop,
it
responds well
to
oxygen and/or
SPHEROTHROMBOCYTOSIS IN DISEASES AND PREGNANCY
a
diuretic. Department of Obstetrics and Gynecology, University of California, Davis, Sacramento Medical Center, Sacramento, California 95817, U.S.A.
P. ROGGE S. YOUNG R. GOODLIN P. ROGGE
TRIALS OF ADJUVANT THERAPY IN BREAST CANCER
SiR,—Mr Blamey and Dr Elston (April 28, p. 920) show concern for their patients with early breast cancer by
laudable
wishing to inflict upon them unnecessary alopecia following the necessity of a mastectomy. Their attitude reflects an enviable certainty in the face of the clinical dilemma of a patient with early carcinoma of the breast. On the one hand, they are certain that the risks of alopecia outweigh the possible benefit of an increase in disease-free survival following adjuvant chemotherapy whereas they obviously are certain that breast conservation carries with it unacceptable risks to the patient. Whilst they are entitled to these certainties they should not be critical of those with reasonable doubts, who feel that the only way of resolving the dilemma is by entering their patients into prospective randomised controlled trials (which it pleases Blamey and Elston to dismiss as "sacred cows"), investigating the value of adjuvant systemic therapy or, for that matter, breast not
conservation. Two controlled trials have been published which demonstrate a more than 10% improvement in survival at ten years by the use of either a short course of cyclophosphamide’ or a combination of ovarian ablation and prednisone,2-neither of which produced alopecia. The two trials for which I am responsible are investigating adjuvant systemic therapy with the antiosstrogen tamoxifen or a chemotherapy regimen of low toxtcity, which again do not produce alopecia. I would be very content if either trial showed a 10% improvement in survival: extrapolated across the country this would lead to the saving of more than a thousand women’s lives a year. I admit that the logistics of running a multicentre trial where you hope to demonstrate a 10% improvement in one arm are extremely difficult and require the collaboration of many surgeons and the recruitment of a thousand patients.3 It is a great pity that the Nottingham group are not prepared to enter their patients into one of these studies as their enormous experience might help us to cut down the recruitment period, and so hasten the answer. Furthermore, it could be argued that collaboration in a protocol-e.g., investigating the value of adjuvant antiosstrogen therapy-might even heighten the significance of their excellent research-work on the oestradiol-receptor status of primary malignant mammary tumours.4 How much more useful t ’tOutd be to discover if the oestradiol receptor of the primary Lumour could be used not only as a prognostic indicator but also as an index of whether or not the patient would be likely to benefit from anti-oestrogen therapy at the time of mastectomy. Such information can only be determined if patients with tumours of known oestradiol-receptor content are randomised between a control group and a group receiving anuoestrogen therapy. I leave it to readers to decide whether they wish their therapeutic decisions concerning early carcinoma of the breast to be decided by the "sacred cow" or the "papal bull".
SIR,-Circulating platelets are now the object of research in to thrombotic or hxmorrhagic conditions.I,2 Platelets (thrombocytes) circulate in their native discoid form.3 This shape is maintained by a circumferential bundle of microtubules and is easily lost during viscous metamorphosis triggered by only slight stimuli, resulting in spiny spheres. In normal man 85% or so of platelets are discs,3-7 but platelet shape has not been studied in clinical conditions, except for a few special diseases such as aplastic anaemia,8 and Bernard-Soulier syndrome.2 We have examined platelet shape in haematological, vascular, or other diseases and in pregnancy by our modification of the method by Zucker and Borrelli5 and found spherothrombocytosis in several conditions. Blood was drawn through a siliconised 18G needle (inner diameter, 1.2mm) connected to a polyethylene tube (2 mm at inner diameter and 15 cm long). The first 2-10 ml of blood relation
from the open end of the tube was discarded and then several drops of blood were fixed in 10 ml of 1% glutaraldehyde, PLATELET SHAPE AND PSEUDOPOD FORMATION IN VARIOUS CLINICAL
Departement of Surgery,
±
S.D.
0-38’r citrate (0.1 molll phosphate buffer, pH 7.4) for 2 h. 200 fixed platelets were classitied’ by light microscopy as discs (D) (thickness/diameter ratio < 1/3), hemispheres (HS) (ratio 1/3-2/3), spheres (S) (ratio > 2/3), bipolar forms (B), or other (0), and were examined for whether they had pseudoor not. Platelet "discoidness" was determined by the index (D—S — (D+HS+S), D, HS, and S being expressed as percentages. Deformed platelets were frequent in disordered hxmatopoiesis, in diseases with intravascular activation of platelets by coagulation, hxmolysis, or, possibly, immune-complex formation, and, unexpectedly, in late pregnancy. As shown in the table,
pods (Ps)
was strong spherification (spherothrombocytosis) (P
develop,
it
responds well
to
oxygen and/or
SPHEROTHROMBOCYTOSIS IN DISEASES AND PREGNANCY
a
diuretic. Department of Obstetrics and Gynecology, University of California, Davis, Sacramento Medical Center, Sacramento, California 95817, U.S.A.
P. ROGGE S. YOUNG R. GOODLIN P. ROGGE
TRIALS OF ADJUVANT THERAPY IN BREAST CANCER
SiR,—Mr Blamey and Dr Elston (April 28, p. 920) show concern for their patients with early breast cancer by
laudable
wishing to inflict upon them unnecessary alopecia following the necessity of a mastectomy. Their attitude reflects an enviable certainty in the face of the clinical dilemma of a patient with early carcinoma of the breast. On the one hand, they are certain that the risks of alopecia outweigh the possible benefit of an increase in disease-free survival following adjuvant chemotherapy whereas they obviously are certain that breast conservation carries with it unacceptable risks to the patient. Whilst they are entitled to these certainties they should not be critical of those with reasonable doubts, who feel that the only way of resolving the dilemma is by entering their patients into prospective randomised controlled trials (which it pleases Blamey and Elston to dismiss as "sacred cows"), investigating the value of adjuvant systemic therapy or, for that matter, breast not
conservation. Two controlled trials have been published which demonstrate a more than 10% improvement in survival at ten years by the use of either a short course of cyclophosphamide’ or a combination of ovarian ablation and prednisone,2-neither of which produced alopecia. The two trials for which I am responsible are investigating adjuvant systemic therapy with the antiosstrogen tamoxifen or a chemotherapy regimen of low toxtcity, which again do not produce alopecia. I would be very content if either trial showed a 10% improvement in survival: extrapolated across the country this would lead to the saving of more than a thousand women’s lives a year. I admit that the logistics of running a multicentre trial where you hope to demonstrate a 10% improvement in one arm are extremely difficult and require the collaboration of many surgeons and the recruitment of a thousand patients.3 It is a great pity that the Nottingham group are not prepared to enter their patients into one of these studies as their enormous experience might help us to cut down the recruitment period, and so hasten the answer. Furthermore, it could be argued that collaboration in a protocol-e.g., investigating the value of adjuvant antiosstrogen therapy-might even heighten the significance of their excellent research-work on the oestradiol-receptor status of primary malignant mammary tumours.4 How much more useful t ’tOutd be to discover if the oestradiol receptor of the primary Lumour could be used not only as a prognostic indicator but also as an index of whether or not the patient would be likely to benefit from anti-oestrogen therapy at the time of mastectomy. Such information can only be determined if patients with tumours of known oestradiol-receptor content are randomised between a control group and a group receiving anuoestrogen therapy. I leave it to readers to decide whether they wish their therapeutic decisions concerning early carcinoma of the breast to be decided by the "sacred cow" or the "papal bull".
SIR,-Circulating platelets are now the object of research in to thrombotic or hxmorrhagic conditions.I,2 Platelets (thrombocytes) circulate in their native discoid form.3 This shape is maintained by a circumferential bundle of microtubules and is easily lost during viscous metamorphosis triggered by only slight stimuli, resulting in spiny spheres. In normal man 85% or so of platelets are discs,3-7 but platelet shape has not been studied in clinical conditions, except for a few special diseases such as aplastic anaemia,8 and Bernard-Soulier syndrome.2 We have examined platelet shape in haematological, vascular, or other diseases and in pregnancy by our modification of the method by Zucker and Borrelli5 and found spherothrombocytosis in several conditions. Blood was drawn through a siliconised 18G needle (inner diameter, 1.2mm) connected to a polyethylene tube (2 mm at inner diameter and 15 cm long). The first 2-10 ml of blood relation
from the open end of the tube was discarded and then several drops of blood were fixed in 10 ml of 1% glutaraldehyde, PLATELET SHAPE AND PSEUDOPOD FORMATION IN VARIOUS CLINICAL
Departement of Surgery,
±
S.D.
0-38’r citrate (0.1 molll phosphate buffer, pH 7.4) for 2 h. 200 fixed platelets were classitied’ by light microscopy as discs (D) (thickness/diameter ratio < 1/3), hemispheres (HS) (ratio 1/3-2/3), spheres (S) (ratio > 2/3), bipolar forms (B), or other (0), and were examined for whether they had pseudoor not. Platelet "discoidness" was determined by the index (D—S — (D+HS+S), D, HS, and S being expressed as percentages. Deformed platelets were frequent in disordered hxmatopoiesis, in diseases with intravascular activation of platelets by coagulation, hxmolysis, or, possibly, immune-complex formation, and, unexpectedly, in late pregnancy. As shown in the table,
pods (Ps)
was strong spherification (spherothrombocytosis) (P
