Blood pressure measurements in the nursing home: are they accurate? To examine the accuracy of blood pressure (BP) measurements in the nursing home, a trained observer (physician) and nursing home staff (NHS) measured BP for 146 nursing home residents on two separate occasions. Using the physician as the reference standard for measuring BP, the NHS: 1) significantly underestimated systolic BP; 2) significantly overestimated diastolic BP; and 3) had a high frequency of terminal digit preference for zero. These errors resulted in the NHS misclassifying hypertension in 21% of patients.


Impact on caregivers of supporting urinary function in noninstitutionalized, chronically ill seniors. In a multivariate study of 148 caregivers of chronically ill older persons, 22% of those caring for a continent senior reported that maintaining continence was a burden, and 75% of caregivers of incontinent seniors reported it as burdensome. The burden of maintaining urinary function was associated with lack of social support, time spent providing care, and care receiver's immobility. Caregivers' depressive symptoms were associated with perceived burden from providing care for urinary function, a confused care receiver, and post-stroke support.


Physicians' acceptance of behavioral treatments and pharmacotherapy for behavioral disturbances in older adults. In response to growing interest in employing behavioral treatments and environmental modification for behavioral disturbances in older adults, we employed vignette methodology to examine physicians' acceptance of two behavioral treatments and haloperidol using Kazdin's Treatment Evaluation Inventory. Physicians assigned the highest acceptability ratings to the behavioral treatments and the lowest ratings to haloperidol. The patient's cognitive capacity, living situation (nursing home vs. community), and the type of behavior problem mediated treatment acceptability ratings.


Enhancing the self-esteem of selected male nursing home residents. This study investigated treatment procedures for enhancing the self-esteem of older adult male nursing home residents. Twenty-one subjects were assigned randomly to either a control group meeting to discuss current news events or an experimental group receiving the intervention. Self-esteem significantly increased for the experimental subjects but not before they experienced a significant decrease in feelings of self-worth. The midtreatment observation of the dependent variable was a vital factor in determining the curvilinear relationship between time and the protocol.


Transportation as outreach, driver as mental health worker. Case finding and early detection and referral of elderly persons with mental problems can be accomplished by trained and supervised drivers as part of a transportation service. Increased access to community programs and services as a result of provided transportation helped clients maintain their independence and self-esteem.


Voting behavior among low-income black elderly: a multielection perspective. We examined voting behavior among 370 low-income older African-American citizens who reside in New Orleans by assessing the impact of various predictors on electoral participation in a series of seven elections. Elders who were active in their community, with a strong sense of citizen duty, who identified themselves as strong Democrats, and with higher levels of education were more likely to vote.


The political behavior of older American blacks. Using a subsample of the National Opinion Research Center's 1987 General Social Survey, this study examined three competing explanations for the political behavior of older black Americans (n = 157, 55 and older). The socioeconomic model was a good predictor of political behavior; ethnic community theory and the empowerment model were, in varying degrees, predictors of alienation but not of political interest or activity. Some comparisons were made between older black Americans, younger blacks, and older and younger whites.


Older voters and the 1992 presidential election. At the core of the so-called "generational equity" construct is the notion that older persons exercise self-interested political power. This article examines what we know about one element of the politics of aging--the voting behavior of older persons in recent presidential elections--and suggests areas of research on the 1992 election that may tell us something about how far, and how soon, proponents of generational equity will be able to move toward dismantling policies that benefit older people.


Women as family caregivers: why do they care? This study was based on in-depth qualitative interviews with 40 francophone Québécois family caregivers of frail elderly or mentally ill relatives and focused on the caregiving relation rather than on the specificities of aging and mental illness. Fourteen factors (love, guilt and duty, women's social identity built around caring, absence of appropriate public or private care alternatives, women's socioeconomic dependence, etc.) emerged from an analysis of informants' accounts of how they came to be the primary caregiver. Data indicate that analyses attempting to understand women's caregiving must take into account the sexual division of labor, its reinforcement through social policy, and how women internalize ideas and norms regarding appropriate gender-role behavior.


A path not taken: a cultural analysis of regrets and childlessness in the lives of older women. This paper explores regrets about childlessness in 90 older women interviewed using qualitative methods. Regrets were discussed in the context of the changing meaning of childlessness over the life course. We found that issues of regret are situated in a cultural system that renders childless women marginal. We argue that regrets should be understood in a wider cultural context that incorporates the cultural construction of the self over time.


The role of animal models in meeting the gerontologic challenge of the 21st century. Animal models play an important role in our quest to understand aging and develop interventions needed for the gerontologic challenge of the 21st century. Results from studies using the dietary restriction rodent model are presented as an example. Dietary restriction slows aging by inhibiting primary aging processes, by enhancing broadly protective mechanisms, or by both. Further study should identify the mechanisms and yield a data base for development of interventions. A threat to attaining these yields is the growing opposition of some to this use of animals.


High-risk profiles for nursing home admission. A statewide probability sample of 1,625 Massachusetts elderly was studied prospectively over a decade to identify risk profiles for long-term care (LTC) institutionalization. Previous admission to a LTC institution, age, basic ADL disability, and restricted outside mobility were the strongest individual predictors of institutionalization. Examining profiles of risk factors dramatically increased the ability to predict 10-year risk of admission.


Functional limitations among home health care users in the National Health Interview Survey Supplement on Aging. A case-control study compared home health care (HHC) users from the 1984 Supplement on Aging to users of other community services and of no community service, matched on age and gender. Examination of specific activities of daily living (ADLs), instrumental activities of daily living (IADLs), and sociodemographic variables showed that HHC users were significantly more limited than controls in every ADL and IADL. In multivariate analyses, HHC use was significantly associated with three ADLs (dressing, going outside, bathing), two IADLs (shopping, heavy housework), and poor health status.


Conflict in Alzheimer's caregiving families: its dimensions and consequences. This paper views conflict in Alzheimer's caregiving families as a multidimensional construct. Three conceptually distinct dimensions of family conflict are described and examined in relation to depression and anger. Regression analyses indicate that conflicts involving family members' attitudes and actions toward the caregiver are associated with increased risk for depression among caregivers, whereas conflicts stemming from family members' attitudes and behaviors toward the patient are most likely to result in anger. Self-concepts and normative expectations are implicated as key explanatory variables.


Caregiving: role engulfment and the loss of self. "Loss of self" was examined in a sample of spouses and adult children caring for a relative with Alzheimer's disease. Defined as a loss of identity that comes about as a result of engulfment in the caregiver role, it was found to be more common among spouses, females, and younger caregivers. Limited social contact and lack of social roles outside that of caregiver were found to be related to greater loss of self. It is associated with lower self-esteem and mastery and with greater depressive symptomatology.


Institutional placement: phases of the transition. The consequences of institutionalization were examined for a sample of caregivers of dementia patients. Consistent with the stress process model, institutionalization was hypothesized to have a large impact on the primary effects of caregiving and lesser influence on secondary effects and well-being. Following placement, relatives experienced relief from primary effects of caregiving (e.g., feelings of overload and tension) and improved well-being, whereas other indicators of stress remained unchanged.


The bereaved caregiver: a prospective study of changes in well-being. This study analyzes short-term bereavement adaptation among caregivers to spouses or parents with a progressive dementia, assessing changes in depression, mastery, overload, and guilt to examine the impact of bereavement on caregivers, and the characteristics of caregiver experience that affect bereavement adaptation. The bereavement group, as compared with active caregivers, dropped substantially in overload and increased in mastery and guilt. Depression showed a curvilinear trend, declining from the time of death and then rising to preloss levels by the end of the year. Caregiver stressors, baseline adaptation, relationship difficulties, and psychological preparation were all related to changes in well-being.


A room of one's own: the SRO and the single elderly. A survey of 485 single-room occupancy housing (SRO) residents in New York City found elderly residents strongly preferred to remain in centrally located neighborhoods where apartment housing was beyond their means; did not wish to share a housing unit; and had little confidence that they could find acceptable housing if they lost their present unit. For many elderly residents, SROs meet needs not easily met by available alternatives. Results suggest the need to maintain this housing option for older persons and replace losses that have accompanied gentrification in many central city areas.


Employer-sponsored postretirement health benefits: not your mother's medigap plan. Using nationally representative data, we report the prevalence of retiree health insurance as a fringe benefit in private and public settings, and take an in-depth look at its content. We examine how it coordinates with Medicare to characterize the "total insurance" of beneficiaries who hold these supplements. Retiree health coverage is now widespread and typical benefits are far more generous than those found in medigap policies, the other major type of Medicare supplement. When a typical retiree plan is overlaid on Medicare, the resulting total insurance benefits are more generous than those held by either the working nonelderly or beneficiaries with a medigap supplement.


Homebound Learning Opportunities: reaching out to older shut-ins and their caregivers. Homebound Learning Opportunities (HLO) represents an innovative health promotion and educational outreach service for homebound older adults and their caregivers. It provides over 125 topics for individualized learning programs delivered to participants in their own places of residence, an audiovisual lending library, educational television programming, and a peer counseling service. Shut-ins are recruited as instructors and as participants in service projects that benefit the greater community. Preliminary assessments reveal high levels of participation and satisfaction with the program.


[Hysteroscopy in infertility].

[Hysteroscopy in infertility]. An evaluation of hysteroscopy as complementary study of the sterile couple, was carried out; the hysteroscopic findings were compared with laparoscopic findings, and with Hysterosalpingography (HSG); it was a longitudinal, retrospective study of 20 patients. In the obstetrical antecedents there were 58 gestations, 50 of which ended in abortion. From de five normal cavities by HSG four were for hysteroscopy. As compared with hysteroscopy, HSG detected only 75% of submucous myomas, 85% of walls, 100% of IUD's fragments and of cervical incompetences. In the case of sinechias it was confirmed by hysteroscopy 80% of the diagnosed by HSG. The only case of endometrial polyp was detected by hysteroscopy. Surgical procedures were carried out in 40%, with complications in 16.6%. It was conclude that hysteroscopy is a complementary method, but necessary, in the study of the sterile couple with the possibility at the same time of being a therapeutic method.


[Experience with the management of endometritis in the Instituto Nacional de Perinatalogía]. Endometritis is the most frequent infectious complication of the puerperal period; with the objective to know the clinical characteristics, etiology and evolution of this disease we did a retrospective study of the endometritis cases among the patients of the Instituto Nacional de Perinatología (INPer) from January 1st, 1990 to May 31, 1991. During the revision period were diagnosed 120 cases, but we were able to examine only 90. In the 90% the resolution of the pregnancy was by means of caesarean. A 24.4% of the patients had premature rupture of the membranes. The 10% had diagnose of chorioamniotis. The latency period to develop postpartum endometritis was 120 +/- 66 hours, and post-caesarean 56 +/- 30 hours (p = 0.001). The symptom most frequent were fever (100), foul-smelling lochia (61.1%) and uterine tenderness (60%). The infection was polymicrobial, being the microorganisms most frequent isolated Staphylococcus coagulase negative, Escherichia coli and Peptostreptococcus. A 3.3% developed pelvi-peritonitis. One patient died.


[Simultaneous identification of the nucleolar organizing regions and G bands in obstetrical cytogenetic studies]. An improvement of the silver-staining method of the nucleolus organizer region with simultaneous trypsin-Giemsa-banding is described. The combined demonstration of such regions (which express the transcriptive activity of ribosomal ribonucleic acid genes) and the precise identification of chromosomes, particularly acrocentric chromosomes, should be of value in the investigation of parents with spontaneous abortion in whom abnormal acrocentric chromosomes are often encountered.


[Pregnancy in adolescents. Complications, birth weight, somatometry of the newborn and Apgar score, comparison with the general population]. The objective of this study was to compare pregnancy evolution, newborn's weight, its somatometry and Apgar's qualification of teenagers and the general population in a community where the socio-economic factor is similar among those two groups. Three hundred and two pregnancies in teenagers were analyzed, 69 of 12-15 years and 233 of 16-17 years at the time of pregnancy, against a control group of 304 pregnant patients of 18-39 years. It was a prospective, comparative, longitudinal study. Average age at the first delivery of the 606 patients was 18.1 years. There were no significant difference among the groups as to occupation. There was not significant difference among the three groups as to pre-natal control, weeks of gestation incidence of threatening abortion, toxemia, bleeding of the second half of pregnancy, premature rupture of membranes, proportion of deliveries and cesarean sections, as well as forceps application and newborns' sex. The most common indications of cesarean section in teenagers were CPD and acute fetal suffering, in the control group were CPD and pelvic presentation. There was significant difference comparing the weight, Apgar qualification at one minute and at three minutes in the 16-17 years group, and older of 18 years being greatest in the last group. There was significant difference in size, cephalic perimeter, thoracic perimeter and PC/pa ratio among the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)


[Dermatomyositis and adenosquamous carcinoma of the ovary. Report of a case]. A case of adenosquamous ovarian carcinoma in a 50 years old female is reported. The patient had marked improvement of her symptoms after resection of the tumor and chemotherapy. The knowledge of this association forces to rule out an ovarian carcinoma.


[Molecular systems in cellular interactions. I. Fertilization iin mammals]. Multicellular organisms require diverse mechanisms of cellular recognition in order to work integrally. In the present paper we consider the molecular mechanisms for cell recognition and cell adhesion on fertilization of mammalian egg. Several surface proteins of spermatozoa (galactosyl transferase, proteases, glycosidases and lectins), recognize and bind zona pellucida glycoproteins of egg, a necessary condition prior to fertilization.


[The critical period in natural fertility]. In order to learn the natural expectancy period of first pregnancy as well as the influences of some biosocial variables, a clinical-retrospective study was performed within 1120 gravida I women. All of them attended the major institutes of health care in Mexico City (IMSS, ISSSTE, SS and DDF). Data were obtained by means of predetermined questions from subjects after the first postpartum hours. None of them had previously used any contraceptive method. Results showed age at the first pregnancy: 21.6 +/- 3.8 (years); gestational interval 22.1 +/- 19.9 (months) and a 67% achievement rate the following twelve months of sexual activity. Eutocia was seen in 54% of these population and significant linear correlation was attained between age of the patient and the gestational interval. It seems that this is the first information regarding the fertility critical period within our society.


[The allergologic status of vegetable growers in hothouses]. Studies of the main factors causing allergic diseases, level and structure of allergic morbidity proved the prevalence of contact allergic dermatitis and urticaria among hot-house plant workers. Opportunistic bacteria and Streptococcus pyogenes were found to play an important role in sensitization of vegetable growers. The rational employment of subjects suffering from allergic diseases is recommended.


[Dermatomycoses in workers in enterprises of the microbiological industry]. Mycologic examination of 54 patients with clinical manifestations of dermatomycosis, engaged in glucose oxidase and catalase production has found a producer fungus, Penicillium vitale in 31 (38%); 3 out of 37 people contacting with producers of glucamylase and pectofetidine appeared to be infected by Aspergillus awamori (1.1%) and Aspergillus foetidus (1.1%), respectively. The producers were isolated from the skin of 40 (16.44%) out of 243 workers having no clinical signs of dermatomycosis, mainly in drying, granulating and microbiology lab workers. Dermatophytes (50.9%), yeast fungi (1.8%) and other agents were isolated from the skin of patients with clinical manifestations of dermatomycoses. Age and sex of personnel, length of service and infectious contamination of technological premises were found to influence the skin disorder caused by dermatophytes in combination with producer fungi. Prophylactic measures to prevent the contamination of air and skin by producer fungi and their metabolite are to be developed.


[The cytokinetics of the bronchoalveolar lavage fluid from workers in silicosis-hazardous jobs]. Cytogram of pulmonary lavage fluid was studied in 50 workers al risk of developing silicosis. Workers with long length of service showing no radiographic signs of silicosis had normal cytogram of pulmonary lavage fluid, except for slightly increased neutrophil counts. Cytogram of patients with first recognized silicosis were characterized by elevated lymphocyte count. Neutrophil level increased in chronic silicosis. Cytogram of pulmonary lavage fluid is considered valuable for the diagnosis and prognosis.


[Lipid peroxidation and thrombocyte aggregation in vibration disease]. A three-fold increased level of malonic dialdehyde was found in platelets of patients suffering from the first stage of vibration disease, exposed to local vibration. The changes of the fermentative and nonfermentative lipid peroxidation (LPO) were: increased accumulation of malonic dialdehyde (by 2.5 times in ascorbate-dependent LPO and by 2.6 times in NADRH-dependent LPO). Patients with peripheral vasomotor dystonia of the upper limbs combined with vasomotor spasms of the fingers showed NADPH-dependent and ascorbate-dependent LPO respectively 41% and 29% more activated than in patients having no vasomotor spasms. In patient with vibration disease antioxidant activity was reduced by 39% on average, platelet aggregation, both spontaneous and induced by epinephrine, aggristine or adenosinediphosphoric acid, was increased. Platelet hyperaggregation in vibration disease may be caused by stimulated LPO in platelets, amassed end toxic product of LPO, decreased antioxidant activity.


[Lipid peroxidation in the liver microsomes--a sensitive link in body exposure to vat dyes]. Experiments on male white rats showed that the soluble forms of vat dyes such as red brown 'G' (RBG) and bright green 'G' (BGG) delivered into the stomach in a toxic dose (1 g/kg) activate lipid peroxidation (LPO) in liver microsomes. Chronically inhaled dyes hasten of slow down some LPO stages, the changes depending on the concentration, duration of exposure and chemical structure of a compound. Soluble vat dye RBG increases LPO in concentration 5 mg/m3 whereas RBG shows antioxidant action in high and low concentrations.


[The stability of the hearing function as a problem of otoergonomics]. Hearing stability was measured by the method using physiologic dependence: the better were body possibilities to resist the unfavourable effect of acoustic environment, the higher was the tolerance threshold. Hearing stability measured by the suggested method appeared to be an individual stable characteristic that can be predicted.


[Scientific and technical progress and the problems of protecting the health of workers in water transport]. The influence of scientific and technological progress on the work and life of man in the world ocean is analysed. The main results of investigations and practical solutions are described in details. The drawbacks in the research of some aspects of the problem are shown and the objects of further investigations are outlined.


[The pathogenesis of trichloroethylene poisoning]. Basing on the results of original clinical and experimental studies, as well as on medical literature data, the contributors proposed a hypothesis of the toxic action of trichloroethylene. It was attempted to prove that the trigger links of trichloroethylene intoxications were the energy exchange disorders caused by the nonspecific membranotoxic actions of the substance's molecules and their metabolites, as well as the extra consumption of energy by the metabolic processing of the poison. Involvement of adaptational reactions, such as the catecholamines' discharge, under the conditions of the damaged metabolic system, decreased the cell's potential and aggravated the severity of intoxications.


[Data on the hygienic regulation of benzanthrone-based vat dyes in the air of a work area]. With regard to acute toxicity, the cubosols are attributed to the non-cumulative compounds of low toxicity. Acute inhalation exposure threshold for cubosol "Bright green" is over 140 mg/m3. Subacute poisonings developed following intragastric administrations in concentrations 1 g/kg for 30 days, and were characterized by polymorphism of the signs. Revealed were delayed body mass increment in the laboratory animals, changes in peripheral blood and hepatorenal morphology and function.


[The use of a thin-layer chromatographic method for measuring the concentrations of mixtures of the dyes scarlet 2G and black 2K in the air of a work area]. Scarlet 2G and black 2K dyes were divided and measured by thin-layer chromatography with mixture of acetone and toluene (3:4) used as an eluent for dividing scarlet 2G and a mixture of chloroform, benzene and acetone (3:2:1) for eluting black 2K. The method permits the detection of the aforesaid dyes in the air of working area at the level of 0.5 MAC in the presence of admixtures.


[The industrial environment in the electric-furnace steel smelting, converter and open-hearth furnace methods of manufacturing manganese-alloyed steels]. Inspection of the environment in manganese-alloyed steel production showed inadequate hygienic conditions of the technological processes employed. Air was more polluted by manganese oxides during the oxygen-converter process though their highest concentrations, 38 times exceeding the MAS, appeared during the casting of steel. An electric furnace coated by dust-noise-proof material and gas cleaning is preferable from a hygienic point of view. The influence of unfavourable microclimate, intensive infrared irradiation and loud noise on workers necessitates automation and mechanization of the process in order to improve the working conditions.


[The effect of industrial factors on specific functions and the course of pregnancy and labor in workers of the Orgsintez Manufacturing Association]. Women engaged in the production of chlorine, divinyl and propylene oxide are exposed during the working shift to unfavourable occupational factors: gas, dust, noise, emotional and physical stress, inadequate microclimate. All that disorders the specific functions and health status. Diseases in women working for 'Orgsintez' enterprise are closely connected with the length of service. Occupational factors of this chemical enterprise influence the course of pregnancy and labor, condition of fetus and newborn.


[Industrial hygiene problems in reclamation constriction operations]. Workers engaged in reclamation construction are exposed to dust and chemical agents, appearing in the air during the work. Vibration, noise, meteorologic conditions overmatch the normal parameters. Immunologic status is changed, transitory disablement incidence is high, occupational diseases occur. Hygienic measures for this population are recommended and put into practice.


[The central hemodynamics of participants in the cleanup of the sequelae of the accident at the Chernobyl Atomic Electric Power Station 4 years after the accident]. Investigations of the central haemodynamics and myocardial contractility in 73 men, who took part in repairing after the Chernobyl accident in 1986, in 4 years after the accident have shown the hyperkinetic type of circulation in 60.2%, eukinetic in 23.2%, hypokinetic in 15.6% of the examinees. Such changes of the central haemodynamics, increased frequency of the hyperkinetic type are due to the regulatory disorders decreasing the vascular tone in the major and minor circles, amplifying the venous return to heart and increasing the myocardial contractility.


[The evaluation of the work regimens of miners in the gold-extracting placers of the north]. Results of field physiologic and hygienic investigations of borer's work schedule during the subterranean gold extraction in the Chukot Range [correction of Chukotka] are presented. Methods and models of rational work schedule in conditions of the extreme north are suggested based on the dose approach.


[A comprehensive assessment of the working conditions for workers in vibration-hazardous jobs]. Comprehensive evaluation of work conditions of workers of different occupational groups (bulldozer, excavator and boring machine operators, embroideresses) helped create a new parameter of occupation harmfulness evaluation: mean arithmetic value and root-mean-square digression. The main parameters of transitory disablement morbidity were found connected with the integral parameter of harmful environmental factors, which helped define the morbidity increase per 1 harmfulness grade for men and women and predict the morbidity levels of workers depending on their work conditions.


[The criterial approach to the diagnosis of changes in the osteoarticular apparatus of persons in vibration-hazardous jobs]. A criterial approach to the diagnosis of the skeletal system changes in individuals exposed to industrial vibration, involving the use of the X-ray diagnostic criteria (gerontologic, manual, vertebral) and the criterion based on the absorbed dose of vibration energy (exposure criterion) together with the data on the vibration disease manifestations (clinical criterion), makes it possible to estimate the risk of vibration disease.


[The working conditions and morbidity with temporary loss of work capacity for those engaged in the manufacture of household chemical preparations]. Workers engaged in production of household chemical goods (paints, synthetic detergents, aerosols) are exposed to harmful factors (noise levels higher than the maximal allowable ones, concentration of chemical agents in the air surpassing the MACs). Such work conditions are estimated as unfavourable according to the hygienic classification. The total morbidity and some nosologic forms (respiratory, digestive, locomotor systems and skin) are growing in number especially in workers of aerosol production. Statistic analysis revealed that the length of service was directly related to the level of total morbidity and the incidence of gastrointestinal diseases in the workers engaged in manufacture of household chemical goods.


[Magnesium sulfate as an industrial poison]. The article provides information on the hygienic assessment of the labour conditions in magnesium sulphate processing, along with the experimental data on the toxicity of this chemical compound at different ways of its penetration into human body, and describes the damaging mechanisms of its action. The toxicity parameters were related to the 4th class of hazardousness (GOST 12.1.007-76). The acute inhalational action threshold was determined at 112.7 mg/m3. The chemical substance did not exhibit any irritating action on the skin and mucosae, but was capable of penetrating through the undamaged skin and cause some functional disorders. The chronic inhalational action threshold was assessed at 10.2 mg/m3. Magnesium sulphate did not display any specific cardiotoxic or gonadotrophic action. MAC in the air in working zone areas was established at 2 mg/m3. Lesions of the liver were the major factor in the pathogenesis of intoxications.


[Skin pathology from exposure to the lubricating coolant fluid MR-7]. The article narrates on pathologic developments in the skin caused by the lubricating cooling liquid MP-7. 63 workers, including machine operators and adjusters, were medically examined, as a result of which it was established that the MP-7 liquid manifested marked irritating properties and less expressed allergenic characteristics. Oil-induced folliculitis, allergic dermatitis and eczema cases constituted 85.4 +/- 4.6% rate, which confirmed the occupational origin of the lesions. Ample supply of hygienic clothes, other hygienic procedures, weekly change of overalls did not fully eliminate contact with the MP-7 liquid.


[The epidemiology, diagnosis and prevention of dermatoses in workers manufacturing alumina from different aluminum ores]. Studies of dermatological morbidity in the workers of alumina enterprises showed a lowered incidence of skin lesions caused by common chemical harmfulness and increased incidence of allergic occupational dermatoses. Different types of such dermatoses are related to the ore used. The total level dermatologic morbidity mainly depends on the technology stage of the process but not on the type of raw material. Dermatologic screenings have shown that skin mycoses were the most incident among the dermatoses, whereas analysis of sick-leave records indicates the highest incidence of pyoderma; this necessitates adequate preventive measures.


[The clinical characteristics of the early stages of occupational fluorosis under the combined and joint action of production factors]. Over 1000 workers of hydrofluoric and cryolite enterprises and electrolysis shops of aluminium enterprises were examined. Subjects exposed to soluble hydrofluorides presented in the early stage of chronic intoxication with a variety of syndromes, that was characteristic of intoxication with poisons of general toxic action with involvement of hepatobiliary, digestive, circulatory and autonomic nervous systems. Combined exposure to fluoric compounds, heating microclimate and electromagnetic fields results in a graver involvement of the circulatory and autonomic nervous systems. Clinical and experimental data show, that osteoarthrosis deformans of the major joints (primarily elbow joint) must be regarded as one of the symptoms of fluorosis, when other intoxication signs are present.


[The membranogenous action of occupational hazards from the manufacture of black copper on older individuals]. Many-year investigations of health status, aging process and occupational diseases in rough copper production workers, including elderly individuals, revealed the occupational factors (sulphur dioxide, industrial dust, etc.) harmful for membranes. Lowered share of phospholipids containing polyunsaturated fatty acids, that changes the physical and chemical properties of membranes and cellular receptors and enzymes, was found harmful for membranes. The most severe changes were seen in the workers exposed to sulphur dioxide.


[The fitness for shift work of operators working according to schedules with a rapid shift rotation]. Integral parameter of professional capacity for work in day and night shifts were studied in 52 operators of heat electric power stations and compared with the results of sociopsychologic questioning. 19% of the operators having higher work capacity in the night shift than in the day one (according to integral parameter) were characterized by lower anxiety, better mood and sleep, and lesser fatigue during the night shift than 19% of examinees, whose night working capacity was lower in comparison with the day shift. The rest 62% of the operators showed a stable level of capacity for work during day and night shifts, their position according to the sociopsychologic parameters is intermediate.


[The dependence of the degree of visual fatigue on the shift duration in work with video terminals and an assessment of the efficacy of preventive measures]. Dynamic studies of visual capacity for work in individuals working with displays revealed decreased accommodation volume after the long concentration on the display. The total time of work with the display of more than 2h a day involved a decrease of the accommodation volume by 0.42-0.49 diopters and transitory myopia of 0.15-0.21 diopters, as well as increased self-appraisal of fatigue. The system of prophylactic measures including rest breaks, special exercises, massage was worked out and put into practice. Repeated study has proved the effectiveness of suggested measures.


[The pathomorphological changes in the internal organs in experimental chronic red phosphorus poisoning]. Experiments on 76 rats of both sexes exposed to red phosphorus revealed the morphologic changes in the body. Chronic red phosphorus poisoning (15 days, 1, 2, 3, 4 months) induces dystrophic changes and hyperemia in the examined viscera and brain. The first pathomorphologic changes appeared in the liver, stomach, small intestine, and as the intoxication period was prolonged they appeared in other internal organs and brain.


[The cytotoxic action of metal stearates and its correlation with the toxicity for animals]. Toxic effects of lead, cadmium, barium, silver, zinc and calcium stearates on the Rh-type cells culture have been revealed. The expressiveness of the cytotoxic action correlated with the toxicity degree for laboratory animals. The strongest (r = 0,98; p less than 0,01) was the correlation between cytotoxicity parameter (the minimal cytoclastic concentration) and the inhalation toxicity parameter in animals (lim(ac)). The results permitted deriving formulae for predicting some toxicity parameters (intraperitoneal LD50, lim(ac)), hygienic regulations (MAC), and showed that the prediction based on cytotoxicity data is more reliable, than that based on toxicometric parameters in short-term experiments used for such purpose.


[Experimental data on the hygienic regulation of dimethyl phosphite in the air of a work area]. Dimethylphosphite, being a semiproduct of chlorophosphonium synthesis, is a moderately toxic substance according to the criterion of acute toxicity. It is characterized by marked cumulative properties, absorption from skin and local irritative action. Acute and chronic poisoning induces disorders of the nervous system. MAC in the air is 0.5 mg/m3 as established by Ministry of Health.


[A method for performing single-factor dispersion analysis with the transformation of the initial values into relative ones]. Initial data can be transformed into relative to check conclusion about the influence of studied factor on resulting variable. Examples of dispersion analysis on orthogonal and nonorthogonal complexes are given.


[The function of mono-oxygenase system in exposure to tricresol (experimental research)]. Studies of monoxygenase system in rat liver exposed to tricresol showed, that the microsomal enzymes status depends on the route of tricresol administration and on the exposure intensity. Monoxygenase system status compared with the serum enzymes activity characterizing the function of the liver showed that changes in microsomal system are more marked, appear earlier and after lower levels of exposure. Changes of cytochrome P-450 enzyme system are the main principle of tricresol harmful action.


[The late sequelae of body exposure to phosphorus, fluorine and their derivatives (a review of the literature)]. Presents data on mutagenic, gonadotoxic, embryotoxic and teratogenic activities of phosphorus, fluorine and their derivatives. The investigations have revealed the mechanisms of these chemical substances toxic action on the genetic apparatus, reproductive organs, progeny. The problem is interesting and needs further investigations.


[The hygienic bases of laser safety].

[The hygienic bases of laser safety]. Exploitation of laser devices exposes the workers to reflected low-intensity radiation and concomitant physical and chemical factors. Clinical and experimental studies revealed the structural and functional disorders in the organs and body systems exposed to long and constant action of the stated factors, which let the changes be considered as a criterion of the harmful action and serve to base the maximal allowable conditions and assure the safe work conditions when handling laser devices. Harmful and dangerous factors produced by laser device and used materials necessitate the creation of laser equipment of different types and purposes, that will be safe for the personnel handling it.


[The correction of hemodynamic disorders with low-intensity infrared laser radiation in agricultural machinery operators with borderline arterial hypertension]. Data on the influence of low-intensity infrared laser on the central and peripheral hemodynamics in 76 agricultural machine operators facing transitory arterial hypertension are presented. Analysis revealed that low-intensity laser is more effective at the early stages of cardiovascular diseases. Low-intensity infrared laser exposure of reflexogenic zones can be effectively used to correct hemodynamic disorders in subjects facing transitory arterial hypertension.


[Industrial hygiene in the modern manufacture of synthetic detergents]. Work conditions in the synthetic detergents production according to the new technology created by Sumitomo (Japan) were evaluated from hygienic point of view. The main unfavourable factor is the contamination of air by initial products (aerosols of sodium tripoli phosphate, carboxy methylcellulose, optic bleacher, enzymes et al.) and dust of the final product. Sulphur oxides appear in the air of the sulphating unit. Levels of noise and vibration are surpassed. At the same time the studied technology is more profitable than the current ones. Parameters of the cardiovascular, central nervous and neuromuscular systems do not indicate the physical and neuropsychic fatigue.


[The mechanisms of the formation of pneumoconiosis under high-altitude conditions]. Lipid peroxidation parameters, such as malonic dialdehyde and antioxidant defense (superoxide dismutase and catalase activities) were studied in healthy individuals, miners of different occupations, working at mines of different altitudes. The studies showed that increased lipid peroxidation and decreased antioxidant defense are connected with the altitude of work and exposure to the quartz-containing dust combined with hypobaric hypoxia. Malonic dialdehyde, the final toxic product of peroxidation, is accumulated as a result of it. Increased membranous lipid peroxidation results in death and lysis of cells. It becomes the principal pathogenetic component of pneumoconiosis formation and clarifies the mechanism of its early development, comparatively fast progressing, frequency of nodular forms in miners from the high and middle altitudes. That testifies the ability of hypobaric hypoxia to produce silicosis.


[The role of the sweat glands in excreting antimony from the body in people living in the biogeochemical provinces of the Fergana Valley]. The features of antimony excretion by sweat glands were studied in normal subjects and patients with chronic bronchitis, chronic gastritis, chronic nephritis and calculous pyelonephritis, visceral leishmaniasis, living in some biogeochemical provinces of Fergana Valley. A micromethod based on the coloured reaction of the element with brilliant green was worked out to detect antimony in sweat. Sweat antimony elimination was proved to play a significant role in health and disease. The workers engaged in antimony production, the inhabitants of antimony biogeochemical regions should have their sweat excretion tested to score the Sb level. It is recommended as an additional test for screening and controlling the effects of visceral leishmaniasis chemotherapy by solusurmine in patients with kidney disorders.


[The immune reactivity characteristics of persons engaged in the manufacture of protein-vitamin concentrates]. Immunologic studies in 130 protein-vitamin concentrate production workers of Angarsk showed the characteristic changes in clinically healthy individuals, suffering from allergic conditions. The changes are: increased levels of T lymphocytes, T killers, T helpers, B lymphocytes, decreased levels of T suppressors and IgA. Immunologic reactivity predisposing to allergic conditions and chronic course of inflammations was found to appear in the workers engaged in protein-vitamin concentrate production.


[Dosimetry in setting practical hygienic standards for radio-wave irradiation]. In dosimetric approach to the hygienic norm setting of radio waves adequate metrological basis is required. Joint investigations, carried by physicists and hygienists helped solve the new medical and technical problems, connected with the creation of individual dosimeters and indicators, monitor the hygienic norms of superhigh frequency electromagnetic waves. The devices are small, light, with autonomic power supply and digital indication of current exposure dose. The devices are supposed to give signals (light, sound) if the individual hygienic levels of superhigh frequency electromagnetic waves are surpassed.


[The characteristics of the reactions of excitable tissue to combined exposure to microwaves and low-intensity ultrasound]. Isolated pacemaker of the frog's heart served as a sensitive model to study the combined action of the low intensity electromagnetic and mechanic factors. Critical energy levels of factors, their relative efficiency in direct action on the cell were estimated. Additive effects of microwaves and ultrasound were examined. The data can be valuable for the further investigations concerning the effects of different nonionizing rays.


[Pathology of the joints of the hand and periarticular tissues in exposure to local vibration and functional overload of the hands]. The hand joint is a multi-joint formation, including the wrist, carpal, intercarpal, carpometacarpal, intermetacarpal, distal radioulnar joints. Features of hand joint and periarticular tissue disease were studied in 536 workers exposed to local vibration and functional overstrain. The most prevalent diseases are arthroses with deformation of the wrist, radiocarpal, carpometacarpal joints, often with involvement of the triangular fibrous disk and carpals, periarthroses of the hand joint with compression neuropathy of the median and ulnar nerves.


[The clinical manifestations of chronic exposure to a heating microclimate in metal and forge workers]. Comprehensive examination of 177 workers and screening of more than 2000 workers exposed to heating microclimate revealed the possibility of chronic overheating in some workers and provided the description of its clinical manifestations. Vasoneurosis, myocardiodystrophia and metabolic disorders are the keys to developing of the disease characterized by a rotative course.


[Changes in the serum enzymo- and proteinograms of workers in enzyme production suffering from skin diseases (the validation of the diagnosis and of the therapeutic-preventive measures)]. Clinical and epidemiologic examinations of 260 workers engaged in enzyme production revealed the structure of skin disease incidence: mycoses--31%, atopic dermatitis--19%, contact dermatitis--9%, allergic, dermatitis--5%. The majority of these skin diseases were associated with hyperphosphatemia and monoaminoxidase (MAO) depression. Changes of alkaline phosphatase and MAO activities, serum albumins and gamma-globulins may be considered as sensitive markers of disease.


[The results of clinico-hygienic research in the region of the Mozyr industrial center following the accident at the Chernobyl Atomic Electric Power Station]. The dose of radioactive irradiation received by the workers of the Mozyr industrial area after the Chernobyl power plant accident cannot result in specific lesions, but a nonspecific effects of low radiation doses, chemical substances of low intensity and other occupational factors are possible. A possible radiation origin of the astheno-depressive and astheno-somatic disorders developing by nonspecific stress mechanisms is to be investigated.


[Cytochemical research on the peripheral blood erythrocytes and neutrophils of coal miners]. A total of 140 miners, divided into 4 groups were studied. The first group consisted of 25 practically healthy people, newly employed, examined at a health center of the mine, the second of 21 patients with anthracosilicosis, the third of 36 with anthracosilicosis confirmed by X-ray, the fourth included 58 facing the first stage of anthracosilicosis. Erythrocyte histidine and catecholamine levels, myeloperoxidase and beta-glucuronidase activities, data of lysosomal cation (LC) and NBT tests in neutrophils were under study. The miners of groups 2, 3, 4 showed the increased beta-glucuronidase activity (by 47-73%) and NBT test values (37-96%), lowered levels of catecholamines (57-67%), histidine (48-60%), results of LC-test (29-32%) and myeloperoxidase activity (21-31%) in comparison with normal subjects. The findings will help diagnose the latent forms of anthracosilicosis comparatively early, when the structural changes cannot be detected by X-ray.


[R proteins as an integral index of the action on the body of industrial allergens in an experiment on white rats]. P proteins were just obtained from white rats and a method to testify them with the help of highly stable anti-P serum was worked out. Normal titres of P proteins are 1:1600 and 1:3200. Different models of sensitisation to the industrial allergens (delivered intracutaneously, by inhalation, into trachea in various doses and concentrations) were used in trials of the method. P protein level appeared to correlate with the sensitisation degree estimated by specific allergy tests. The highest P protein titer is due to the toxic allergic conditions (up to 1:102400), the minimal to sensitization of threshold (up to 1:12800) level. Provocative inhalation test in sensitized rats induced an increase of P protein titer as delayed hypersensitivity was forming.


[The establishment of the MPEL for carboxylic acid derivatives in the air of a work area by using mathematical models]. Reports of MACs for carboxylic acid derivatives as sodium methoxyacetate (SMOA), methyl chlorpropionate (MCP) and acetoacetic ether (AAE). SMOA shows low toxicity, no cumulation and specific action MCP demonstrates moderate toxicity, low cumulation no specific action in concentrations close to Limac. AAE presents toxicity low in oral usage and moderate when inhaled, low cumulation, no irritation and sensitization. Tentative safe level of injury and MAC estimated for the aforesaid substances together with toxicity parameters compared with the substances studied before allowed the authors to set the MAC of SMOA--10, MCP--2, AAE--10 mg/m3.


[The toxicokinetics of low-solubility substances (exemplified by 2 boron compounds)]. Multichamber toxicokinetic model studies of the resorption, distribution and excretion properties of poorly soluble substances in subchronic action of suspensions administered intragastrically can be the first step in prognosing the toxicokinetic properties of the inhaled aerosols of the substances mostly discharged from the respiratory into the gastrointestinal tract (GIT). The generally accepted quantitative characteristics of the particles' deposition and translocation into GIT can provide a further application of the model for a mathematical description of a prolonged inhalational exposure to some substances. This technique was tested with the boron compounds characterized by low solubility and revealed a good correlation between the prognosed and actual deposits of the substance in the organ and excretions. At the same time, detected were some qualitative and quantitative differences in the boron toxicokinetics influenced by magnesium deboride and hexaborate, which were explained by differences in their solubility.


[Improved medical care for miners with ischemic heart disease]. The article is devoted to coronary disease in miners of deep Donbass mines. Data of its prevalence, chemical and functional features are given. Rapid progress of the disease was found to correlate with unfavourable factors of occupational environment. Mechanisms of dangerous heart rythm disorders formation during the work are shown. The main points of the programme improving the health care of miners suffering from coronary heart disease are described.


[The measurement of the characteristics of x-ray radiation generated by video display terminals by using thermoluminescent detectors]. Exposure doses of X-rays generated by video displays were measured by means of highly sensitive TLD-500K type detector based on thermoluminophore Al2O3 and DTG-4 type detector based on thermoluminophore LiF. Individual human doses and doses accumulated on the display's surface can be measured. Trials showed efficiency of the method to evaluate the efficacy of protective screens for reducing the irradiation exposure.


[Methodological approaches to the analysis of morbidity with temporary loss of work capacity]. The morbidity with temporary disablement (MTD) was studied with the help of Pearson's [correction of Pirson's] criterion in 689 empiric rows. The effect of work conditions on such morbidity was scored by dispersion analysis, demanding to take into account not only intergroup parameters connected with work conditions, but also intragroup ones, depending on casual circumstances, that is why the results should be regarded as preliminary data. The estimated effect of work conditions on the MTD shows unjustified high results for the year, because intragroup parameters were levelled.


Pain threshold in humans. A study with the pressure algometer. Pain perception threshold (PPT) in the head was assessed with a pressure algometer in 40 control individuals (24 females and 16 males). Threshold was assessed at 11 symmetrical points on each side. The average threshold for each side was calculated, and differences between two sides were evaluated with an asymmetry index. Subjects were studied in relation to age and sex, and any difference in the symmetrical perception of pain on the head was registered. The deltoid muscle was chosen as a reference point, since it is rarely a site of trigger points. The reproducibility of the method was satisfactory. A significantly positive correlation was found between PPT value of the head and the deltoid muscle. There was no tendency to rise or fall in PPT during the same "session", which consisted of 3 separate complete measurements. The mean of mean values showed that there was little asymmetry as for the thresholds pertaining to the head in the total material. Age and sex apparently played little role as for the outcome of the test. The assessment of PPT in the head might be a useful tool in the study of lateralization of pain in unilateral headache syndromes.


Laterality of pain and other migraine criteria in common migraine. A comparison with cervicogenic headache. Patients diagnosed as suffering from common migraine according to the "Ad hoc committee" criteria of 1962 have been studied as for type of unilaterality of headache. Patients, with trauma to the face, head, and neck were excluded, together with patients with the faintest suspicion of aura and those with chronification of the headache. Common migraine criteria, as stipulated by the IHS and Vahlquist, were counted in every patient (n = 32), except the laterality which was a free variable (a total of 8 variables remaining). For comparison, as far as the number of migraine criteria is concerned, a group of cervicogenic headache patients was also studied (n = 30). Unilaterality with side shift of pain was present in 75% in the common migraine group; in 34% of the patients, a combined pattern, i.e. bilateral headache + unilaterality with sideshift was present. Common migraine, therefore, just as classic migraine, seems to be a headache characterized by unilaterality with side alternation of pain. Common migraine criteria were present to a high degree in common migraine patients selected in this way, i.e. ca. 6.8 of a maximum of 7. In cervicogenic headache, the corresponding figure was ca. 3.8 (of a maximum of 7). These figures are statistically significantly different (p < 1.3 10(-11), Mann-Whitney test). Still, the level of criteria is relatively high in cervicogenic headache, and 6 of 30 patients would fulfil the IHS common migraine criteria.


Length of Barrett's oesophagus: an important factor in the development of dysplasia and adenocarcinoma. In a 15 year prospective study of endoscopic surveillance of columnar lined oesophagus, 102 patients with a mean follow up of 54 (12.5) months and total follow up of 462 years have been evaluated. Of all the sets of biopsies taken, 59 in 21 patients were found to exhibit dysplasia or carcinoma. Four male patients had carcinoma of the oesophagus, indicating a 30 times increased risk of development of adenocarcinoma in columnar lined oesophagus. The length of columnar lined oesophagus in subjects with dysplasia was significantly longer as compared with the whole group (p = 0.01) and when compared with the patients without dysplasia (p = 0.005). None of the patients with dysplasia had a columnar lined oesophagus of less than 8 cm. Length of columnar lined oesophagus therefore seems to be a significant risk factor in the development of dysplasia and subsequent carcinoma and intensive follow up of patients with columnar lined oesophagus greater than 8 cm in length is recommended.


Apomorphine test in de novo Parkinson's disease. We administered apomorphine, a powerful dopaminergic agonist, subcutaneously to 25 untreated patients with parkinsonian features and evaluated motor response with the aim of discriminating idiopathic Parkinson's disease (IPD) from multiple system atrophy and progressive supranuclear palsy. The response to apomorphine was strongly predictive of responsiveness to subsequent levodopa follow-up and of the final diagnosis, made on the basis of both clinical and instrumental evaluation. Our data confirm that the apomorphine test is helpful in the differential diagnosis of IPD.


Length of social deprivation differently affects free-choice morphine consumption in C57BL/6J mice. The effects of social deprivation on morphine consumption in C57BL/6J mice were investigated. Social or isolated animals (length of isolation: 7, 12, 17 days) were submitted to a free-choice between water and morphine hydrochloride solution (0.5 mg/ml). Isolation affects morphine consumption, with solitary housed mice drinking more morphine solution than socially housed animals. Moreover the amount of morphine intake depends on the duration of the isolation period to which mice are subjected. The importance of environmental factors on opiate consumption may be considered in terms of the possible implications of drug addiction in humans.


Comparison of endoscopic injection therapy versus the heater probe in major peptic ulcer haemorrhage. One hundred and twenty patients presenting with major peptic ulcer haemorrhage were randomised in a clinical trial comparing endoscopic injection and heater probe therapy. The two groups were well matched with regards to age, admission haemoglobin concentration, the presence of shock, non-steroidal anti-inflammatory drug usage and endoscopic findings. Permanent haemostasis was achieved in 87% of the injection group and 85% of the heater probe group. Hospital mortality, transfusion requirement and duration of admission were similar in both groups. Endoscopic injection and the heater probe represent equally effective therapy for peptic ulcer bleeding.


Mucosal peptic activity during Helicobacter pylori infection in pediatric patients. Intramucosal peptic activity may participate in the genesis of acute and chronic superficial gastritis. The proteolytic activity of homogenates of gastric mucosa (antrum and body) and duodenum were measured at pH 2.0 (total peptic activity) after exposure to pH 8.0 (pepsinogen) and the activated pepsinogen (pepsin) was calculated in pediatric patients investigated for the presence of Helicobacter pylori (H pylori), 122 antral, 77 stomach body, and 74 duodenal biopsies were examined in 43 H pylori positive patients, 51 controls, and 28 H pylori negative gastritis patients. Activated pepsinogen was significantly reduced in the stomach of H pylori positive patients only. Pepsinogen values were similar in all the anatomical areas tested in all patients. In 13 H pylori positive patients reinvestigated three months after antibiotic therapy, antral mucosal activated pepsinogen activity increased significantly (mean pretreatment 1.56 (1.0) U/mg protein versus mean post-treatment 2.72 (1.7) U/mg protein) and reached values comparable with controls. The decreased activated pepsinogen activity in association with normal pepsinogen content observed in the antrum of H pylori positive gastritis patients indicate local pepsin inactivation or alternately enhanced removal into the gastric lumen or backflow into the circulation.


Effect of acute cigarette smoking on gastric secretion. The effects of smoking one cigarette on a plateau of submaximal gastric secretion induced by histamine acid phosphate (16 nmol kg-1 h-1 (0.005 mg kg-1 h-1)) were measured in eight normal volunteers and in eight duodenal ulcer subjects. The rate of secretion in both groups fell by 25% without any statistically significant change in pyloric loss or duodenogastric reflux. It is concluded that smoking reduces gastric secretion. The possibility that relative antral hypoacidity induced by regular smoking produces an increase in parietal cell mass via a feedback mechanism mediated by gastrin is discussed: such a mechanism would explain the previously reported positive correlation between maximal gastric secretion of acid and the total dose of cigarettes.


Effect of cholera toxin on the human jejunum. In order to develop a model for secretory diarrhoea and to confirm the in vitro effects of cholera toxin in man in vivo the effect of intrajejunally administered cholera toxin was investigated in healthy volunteers. An intestinal perfusion technique with an occluding balloon proximal to the infusion site was used. The jejunum was perfused under steady state conditions with a plasma like electrolyte solution containing polyethylene glycol as a non-absorbable volume marker. After two control periods of one hour each, during which water was absorbed at a rate of 104 (14) (mean (SEM), n = 15) and 94 (15) ml/30 cm/h, respectively, three different doses of cholera toxin (6.25 micrograms, 12.5 micrograms, 25 micrograms) were administered by bolus into the lumen of the jejunum. Cholera toxin reduced absorption of water and electrolytes progressively over four hours and induced secretion in a dose dependent fashion. In the fourth hour net secretion amounted to 22 (23), 36 (24), and 88 (40) ml/30 cm/h (each n = five) with doses of 6.25, 12.5, and 25 micrograms cholera toxin, respectively. The movement of sodium, chloride, and bicarbonate paralleled water movement. Our results suggest that cholera toxin may serve as a secretory model in the human jejunum which might allow testing of new antisecretory agents.


Cow's milk provocation induces an immune response to unrelated dietary antigens. The activation of immune mechanisms was evaluated by the solid phase enzyme linked immunoassay of immunoglobulin and specific antibody secreting cells in 27 patients (aged from nine to 69 months), subjected to a diagnostic cow's milk challenge or a rechallenge. A significant rise in the total number of immunoglobulin secreting cells was associated with clinically positive (n = 17), but not a negative (n = 10) cow's milk challenge in all immunoglobulin isotypes. The number of specific antibody secreting cells against beta lactoglobulin, mean (95% confidence interval), increased from 4.8 (1.4, 15.8) to 16.9 (5.5, 52.7) specific antibody secreting cells/10(6) cells, p = 0.02, and against casein from 2.2 (0.8, 6.1) to 7.5 (2.5, 22.5) specific antibody secreting cells/10(6) cells, p = 0.01, in patients positive to challenge in the IgM class only, indicating defective immune elimination of milk antigens. In addition to the specific immune response to cow's milk antigens, an increase in IgM specific antibody secreting cells against an unrelated dietary antigen, gliadin, from 8.2 (2.1, 31.1) to 31.0 (14.2, 67.6) specific antibody secreting cells/10(6) cells, p = 0.01, was observed. These results indicate that cow's milk challenge, in patients who have cow's milk allergy, induces a strong non-antigen specific immune response that includes a response against unrelated antigens concomitantly present in the intestinal lumen. Activation of such immune mechanisms may hence reflect increased antigenic load caused by the immune mediated lesion in the gut mucosa.


Activated eosinophils in adult coeliac disease: evidence for a local release of major basic protein. The eosinophil population is increased in the jejunal mucosa of patients with coeliac disease. Eosinophils may participate in the mucosal damage by releasing their granule components that have cytotoxic properties such as eosinophil cationic protein (ECP) and major basic protein (MBP). This study aimed to assess the presence of ECP and MBP in the jejunal mucosa of 10 adult patients with active coeliac disease who presented with villous flattening. Endoscopic jejunal biopsy specimens were obtained from macroscopically flattened jejunal mucosa and were processed for ultrastructural study and immunogold labelling using anti-MBP, anti-ECP, and anti-IgA antibodies. Numerous eosinophils were found in the upper part of the lamina propria and showed two types of morphological change: some were lytic and others exhibited ultrastructural signs of activation, containing altered granules with fading of the central core. IgA plasma cells were intermingled with eosinophils and had dense deposits on the external side of their cytoplasmic membrane. MBP was detected in central cores of granules but also diffusely in their matrix and in tight association with dense extracellular deposits. Conversely, ECP was detected only in the matrix of eosinophil granules. This study showed that numerous eosinophils are in an activated state in the mucosa of patients with active coeliac disease and release cytotoxic proteins such as MBP, which could contribute to the mucosal damage. The observation that eosinophils and IgA plasmocytes were closely associated in the mucosa supports a role for IgA in eosinophil recruitment and activation in coeliac disease.


Non-invasive assessment of gastrointestinal motility disorders in diabetic patients with and without cardiovascular signs of autonomic neuropathy. Twenty six patients with insulin dependent diabetes mellitus underwent a gastric emptying test, a gall bladder contraction test, an orocaecal transit study, and a colon transit test. Eleven patients had signs of cardiovascular autonomic neuropathy, 15 patients were without signs of cardiovascular autonomic neuropathy. Mean gastric clearance of radioopaque markers ingested with a meal averaged 29.5 (2.3) markers per six hours in subjects without cardiovascular autonomic neuropathy compared with 17.8 (2.3) markers per six hours in patients with cardiovascular autonomic neuropathy (p < 0.02). Gall bladder emptying in response to graded CCK8 stimulation was impaired in five of 11 patients with cardiovascular autonomic neuropathy, whereas it was normal in the patients without cardiovascular autonomic neuropathy (p < 0.01). Oral caecal transit times were not significantly different in the two patient groups, whereas colonic transit was slower in the patients with cardiovascular autonomic neuropathy compared with the group without cardiovascular autonomic neuropathy (p < 0.02). There was no correlation between disturbed gastric clearance, impaired gall bladder contraction, and prolonged colonic transit time in the patients with cardiovascular autonomic neuropathy nor was there a correlation between any disturbed motor function and age or duration of diabetes. It is concluded that autonomic neuropathy can affect motor functions throughout the gastro-intestinal tract. Any disturbed motor function in the gut could therefore be one of the numerous expressions of diabetic neuropathy affecting the cardiovascular, the endocrine or the gastrointestinal system.


Metronidazole reduces intestinal inflammation and blood loss in non-steroidal anti-inflammatory drug induced enteropathy. This study assessed the effect of metronidazole on the gastroduodenal mucosa, intestinal permeability, blood loss, and inflammation in patients on non-steroidal anti-inflammatory drugs (NSAIDs). Thirteen patients were studied before and after 2-12 weeks' treatment with metronidazole 800 mg/day, while maintaining an unchanged NSAID intake. Intestinal inflammation, as assessed by the faecal excretion of indium-111 labelled neutrophils, and blood loss, assessed with chromium-51 labelled red cells, were significantly reduced after treatment (mean (SD) 111In excretion 4.7 (4.7)% v 1.5 (1.3)% (N < 1.0%), p < 0.001, 51Cr red cells loss 2.6 (1.6) ml/day v 0.9 (0.5) ml/day (N < 1.0 ml/day), p < 0.01). Intestinal permeability assessed as the 5 hour urinary excretion ratio of 51CrEDTA/L-rhamnose did not change significantly (0.133 (0.046) v 0.154 (0.064), p > 0.1) and there were no significant changes in the endoscopic or microscopic appearances of the gastroduodenal mucosa. These results suggest that the neutrophil is the main damaging effector cell in NSAID induced enteropathy. The main neutrophil chemo-attractant in this enteropathy may be a metronidazole sensitive microbe.


Polymerase chain reaction detection of Mycobacterium paratuberculosis and Mycobacterium avium subsp silvaticum in long term cultures from Crohn's disease and control tissues. Thirty one cultures were established in MG3 medium from the intestinal tissues of 29 patients, including 18 with Crohn's disease, five with ulcerative colitis, and six non-inflammatory bowel disease controls. All cultures grew either acid fast bacilli or uncharacterized spheroplasts. Pellets from these cultures were coded and assayed blind for M paratuberculosis and M avium subsp silvaticum using IS900- and IS902-PCR (polymerase chain reaction) assays, respectively. IS900 and IS902 are multicopy DNA insertion elements specific for these two organisms. Six Crohn's disease cultures and a single non-inflammatory bowel disease control were positive for M paratuberculosis. A further six cultures were positive for M avium subsp silvaticum, of which two each were from Crohn's disease, ulcerative colitis, and non-inflammatory bowel disease controls. The intensity of the IS900-PCR signals indicated very low numbers of M paratuberculosis organisms and bore no relation to visible spheroplastic or bacillary mycobacterial growth. The results suggest that M paratuberculosis isolated from man exists in a form which hardly replicates if at all when cultured in MG3 medium in vitro, and are consistent with the involvement of this known animal enteric pathogen in a proportion of chronic enteritis in man.


Detection of mRNAs for macrophage products in inflammatory bowel disease by in situ hybridisation. In situ hybridisation has been used to detect mRNAs to the macrophage secretory products, lysozyme, interleukin 1 beta and tumour necrosis factor-alpha. Sections of paraformaldehyde fixed, frozen colonoscopic biopsies from patients with ulcerative colitis, Crohn's disease or normal controls were hybridised with specific radiolabelled probes and the signal detected by autoradiography. Lysozyme mRNA expression was more common in ulcerative colitis (22/27) and Crohn's disease (eight of eight) compared with controls (17/27). Positive cells were found mainly in the subepithelial region in normal colon, while in inflammatory bowel disease they also appeared in the deeper lamina propria. Immunocytochemistry in parallel sections showed that lysozyme mRNA was expressed only in macrophages or in metaplastic Paneth cells in longstanding inflammatory bowel disease. Tissue neutrophils did not express the lysozyme mRNA, though they have large stores of the protein. Tumour necrosis factor mRNA was detected in four of nine controls compared with 11/15 inflammatory bowel disease patients. For interleukin 1 beta, three of eight controls were positive compared with 10/13 with ulcerative colitis. The tumour necrosis factor signal was located mainly in the deeper lamina propria whereas the interleukin 1 beta was seen in subepithelial macrophages. These results confirm increased macrophage activation in inflammatory bowel disease and suggest functional heterogeneity within the intestinal macrophage population.


Raised concentrations of platelet activating factor in colonic mucosa of Crohn's disease patients. Platelet activating factor (PAF-ACETHER or PAF) and precursors of platelet activating factor were investigated in 26 patients with acute Crohn's disease and in 10 healthy controls. Platelet activating factor, lyso platelet activating factor, and alkyl acyl glycerophosphocholine, were determined in colonic mucosal biopsies in patients with acute Crohn's disease, during prednisolone therapy, and in remission. Biopsy specimens were submitted to histopathology examination and to phospholipid extraction. Platelet activating factor, lyso platelet activating factor, and alkyl acyl glycerophosphocholine were found in patients with acute Crohn's disease and in remission as well as in controls. Whatever the site of the biopsy, the level of platelet activating factor in colonic mucosa was higher (p < 0.01) in Crohn's disease than in controls. There was no correlation between the level of colonic PAF-ACETHER and age, sex, Crohn's disease activity index, and biological parameters in sera. Although concentrations of colonic platelet activating factor content were higher (p < 0.01) when colonic mucosa displayed cell infiltration, they were neither related to the severity nor the type of inflammatory cells. Platelet activating factor decreases with prednisolone therapy and might return to normal concentrations in quiescent patients. Lyso platelet activating factor and alkyl acyl glycerophosphocholine were not significantly higher in Crohn's disease than in controls. These data suggest that platelet activating factor may be involved in the pathogenesis of Crohn's disease and that it could be used as a marker of the mucosal activity of the disease.


Mortality from Crohn's disease in Leicestershire, 1972-1989: an epidemiological community based study. Mortality among 610 people with Crohn's disease identified in a population based study from 1972-89 was assessed. In Europeans the overall mortality was not increased, the standardised mortality ratio (SMR) was 71.8 (95% confidence interval (CI) 49 to 101). The SMR in South Asians was 0, (95% CI 0 to 1590). The SMR varied with the site of disease (chi 2 (4) = 10.5, p < 0.05) and was highest in those with duodenal and jejunal involvement (SMR = 210, 95% CI 44 to 621). Survival curve comparisons showed that colonic disease carried a worse prognosis than terminal ileal disease (chi-2 = 9, p < 0.01) or mixed site disease (chi-2 = 4.7, p < 0.05). Mortality was particularly high during the first six years. It was increased in patients who had undergone more than one resection (SMR = 137, 95% CI 28 to 401) or an ileoanal anastomosis (SMR = 357, 95% CI 9 to 1070), although no difference was significant. Mortality did not change significantly during the study. Such information needs to be made available, not just to patients, their families, and their doctors, but perhaps more importantly, to actuaries, insurers, and those advising employers.


Role of dietary sulphate in the regulation of methanogenesis in the human large intestine. Hydrogen produced during colonic fermentation may be excreted, or removed by H2 consuming bacteria such as methanogenic and sulphate reducing bacteria. In vitro, sulphate reducing bacteria compete with methanogenic bacteria for hydrogen when sulphate is present. In this study the hypothesis that sulphate in the diet could alter CH4 production in vivo has been tested. Six methane excreting volunteers were fed a low sulphate diet (1.6 mmol/d) for 34 days with the addition of 15 mmol sodium sulphate from days 11-20. Breath methane was measured and viable counts and metabolic activities of methanogenic bacteria and sulphate reducing bacteria determined in faeces. Whole gut transit time and daily stool weight were also measured. When sulphate was added to the diet, breath methane excretion decreased in three of the subjects while faecal sulphate reduction rates rose from 7.5 (0.5) to 20.3 (4.3) nmol SO4 reduced/h/g faeces. Sulphate reducing bacteria, which were not detected during the control diet, were found and viable counts of methanogenic bacteria fell from 10(7)-10(9)/g faeces to 10(6)/g. Methanogenic counts and breath CH4 recovered after sulphate addition was stopped. No change was found in the other three subjects. Faecal weights and transit times were not different between study periods. It is concluded that methanogenesis is regulated by dietary sulphate if sulphate reducing bacteria are present. Dietary sulphate may allow growth of sulphate reducing bacteria which inhibit the growth of methanogenic bacteria. This may explain the absence of CH4 in the breath of many people in western populations.


Faecal unconjugated bile acids in patients with colorectal cancer or polyps. The unconjugated faecal bile acid profiles of 14 patients with colorectal cancer, nine patients with polyps and 10 controls were compared using gas liquid chromatography, controlling for such confounding variables as cholecystectomy, gall stones and hepatic function. Patients with adenomatous polyps had a higher concentration of faecal bile acids (5.23 mumol/g, 2.16-13.67 (median, range) v 1.96, 0.91-6.97; p = 0.016) lithocholic acid (2.41, 0.88-3.22 v 1.07, 0.38-2.03; p = 0.013) and total secondary bile acids (5.23, 2.16-13.4 v 1.96, 0.73-6.63; p = 0.02) compared with control subjects. Patients with colorectal cancer had an increased (p = 0.029) proportion of secondary faecal bile acids (mol%) compared with controls (100, 96.5-100 v 95.19, 81.73-100) and the ratios of the primary bile acids, cholic and chenodeoxycholic acid, to their respective derivatives (secondary bile acids) were significantly lower in cancer patients compared with control and patients with polyps (p = 0.034 to 0.004). This study lends further support to the theory that bile acids may play a role in the development of polyps and colorectal cancer.


Effects of alpha-glucosidase inhibitors on mouth to caecum transit time in humans. The alpha-glucosidase inhibitors acarbose and miglitol have been successfully used to control postprandial hyperglycaemia in diabetics. They probably work by slowing carbohydrate digestion and absorption, but their effect on mouth to caecum transit time has not been studied. The effect acarbose (100 mg), miglitol (100 mg), and placebo on mouth to caecum transit time (380 kcal breakfast with 20 g of lactulose) was investigated in 18 normal volunteers using breath hydrogen analysis. Both miglitol and acarbose significantly increased breath hydrogen excretion (F2,34 = 6.31, p = 0.005) and shortened the mouth to caecum transit time (F2,34 = 3.49, p = 0.04) after breakfast compared with placebo. There was a significant negative correlation between breath hydrogen excretion and mouth to caecum transit time suggesting that with shorter transit times significantly more carbohydrates were spilled into the colon. These results indicate that alpha-glucosidase inhibitors accelerate mouth to caecum transit time by inducing carbohydrate malabsorption.


Portal and peripheral blood short chain fatty acid concentrations after caecal lactulose instillation at surgery. The major end products of fermentation, short chain fatty acids (acetate, propionate, butyrate) were measured in portal and peripheral venous blood after the caecal instillation of lactulose at surgery in patients undergoing elective cholecystectomy. Blood samples for short chain fatty acid measurement were taken before and at 15 minute intervals up to 60 minutes after caecal instillation of either 20 ml sterile saline or 6.7 g or 10 g lactulose. Fasting concentrations (n = 28) were (mumol/l, mean (SD)); portal acetate 128.0 (70.8), propionate 34.4 (23.3), butyrate 17.6 (18.4); peripheral acetate 67.0 (23.0), propionate 3.7 (1.2), butyrate traces only. After lactulose there was a rapid rise in portal short chain fatty acids with peak concentrations being reached in 15 to 45 minutes. Mean peak concentrations (mumol/l (SD)) after 10 g lactulose were acetate 240.9 (142.2), propionate 39.0 (17.8) and butyrate 26.9 (17.6). The changes in acetate concentrations seen in portal blood were reflected in peripheral blood acetate measurements. In contrast with portal blood, only small amounts of propionate and traces of butyrate were found in peripheral blood.


Selection, management, and early outcome of 113 patients with symptomatic gall stones treated by percutaneous cholecystolithotomy. Between January 1988 and December 1990, 283 patients with symptomatic gall stones were referred for non-operative treatment. After ultrasound scanning including a functional assessment, 220 (78%) patients were found to be suitable for percutaneous cholecystolithotomy. Of these, 113 underwent the procedure including 10 in whom extracorporeal shock-wave lithotripsy or methyl tert-butyl ether therapy had failed. Forty four patients underwent extracorporeal shockwave lithotripsy, methyl tert-butyl ether therapy or rotary lithotripsy, 46 chose laparoscopic cholecystectomy or minicholecystectomy and 27 declined treatment. Percutaneous cholecystolithotomy was successfully performed in 100 patients. Thirty four patients were a high operative risk and 14 presented with an acute complication of gall stone disease. Complications developed in 15 patients, all of whom were managed conservatively and most occurred during development of the technique. Outcome has been assessed clinically and by ultrasound scanning in 92 patients with a median follow up period of 14 months (six to 37 months). Seventy nine per cent were completely cured of their symptoms. Ninety three per cent of gall bladders were shown to be functioning and nine (9.8%) contained stones, although five of these are believed to have developed from residual fragments. Percutaneous cholecystolithotomy is a safe, non-operative treatment for symptomatic gall stones and enabled the patient to fully recover within two to three weeks; it has a definite role in the management of the elderly and high risk patient but its use for the treatment of other groups is likely to remain controversial.


Role of interleukin-6 in acute pancreatitis. Comparison with C-reactive protein and phospholipase A. Plasma values of immunoreactive interleukin-6, C-reactive protein and phospholipase A have been determined in serial samples from 24 patients with acute pancreatitis ('mild' pancreatitis nine, 'severe' pancreatitis 15). Median plasma concentrations of interleukin-6, C-reactive protein, and phospholipase A activity were significantly higher in patients with 'severe' illness (p < 0.001) than those with 'mild' illness. A particularly marked increase in interleukin-6 was found in two patients with necrotising pancreatitis and fatal outcome. Significant correlations between plasma concentrations of interleukin-6 and phospholipase A (p = 0.0218) and C-reactive protein and phospholipase A activity (p < 0.0001) were found in patients with 'severe' disease. These findings in a limited number of patients with acute pancreatitis are promising in that raised interleukin-6 correlated with clinical severity and with two other established markers, C-reactive protein, and phospholipase A activity.


Familial and idiopathic colonic varices: an unusual cause of lower gastrointestinal haemorrhage. A patient is described presenting with an acute lower gastrointestinal haemorrhage as a result of extensive colonic varices. Further investigation revealed that there were no oesophageal varices or splenomegaly. Liver biopsy showed grade II fatty change only, with no other specific or significant pathological features. Transhepatic portography showed a raised portal pressure (20 mm/Hg) but the portal system was patent throughout. There was an abnormal leash of vessels in the caecum thought to represent a variceal plexus. This patient was diagnosed as having idiopathic colonic varices. This case is discussed together with nine other reports of idiopathic colonic varices from the published literature. Four of these reports describe idiopathic colonic varices in more than one member of the same family. Possible modes of inheritance, aetiology of variceal change, natural history, and prognosis are discussed.


Intraperitoneal therapy of malignant ascites associated with carcinoma of ovary and breast using radioiodinated monoclonal antibody 2G3. A phase I/II study of intraperitoneal (ip) radioimmunotherapy was conducted in ovarian or breast cancer patients with symptomatic chemotherapy-resistant ascites using a novel anti-mucin monoclonal antibody (mAb) 2G3 labeled with 131I. Tracer doses of 2 mCi [131I]2G3 were given by ip injection to 11 patients, followed by increasing therapeutic doses up to 150 mCi (cumulative) in 9 patients. There was no serious toxicity. Temporary palliation of ascites was observed in 3 of 4 patients who received doses greater than 50 mCi. Total body elimination half-life of the radiolabeled antibody assessed by gamma scintigraphy ranged from 95 to 250 hr, longer than data previously reported in patients without ascites treated with ip administered radiolabeled antibodies. However, uptake of radiolabel by tumor nodules was small and variable (2 x 10(-4) - 2 x 10(-2) % ID/g), and preferential uptake by tumor compared to normal peritoneum was observed in only 2 of 5 patients in whom biopsies were obtained. These results suggest that the observed palliation of ascites is due to prolonged retention of radiolabeled antibody in the peritoneal cavity even in the absence of specific targeting.


Hip disarticulation for recurrent vulvar cancer in the groin. A patient with squamous cell carcinoma of the vulva treated with a radical vulvectomy and bilateral inguinal and femoral lymphadenectomies utilizing separate groin incisions, subsequently developed a recurrence in the skin bridge between the vulvar and groin excisions. Following groin irradiation with chemosensitization, the tumor progressed to involve the superior public ramus and femoral vessels. A left hip disarticulation and resection of a portion of the superior pubic ramus was performed. The patient has been free of disease for 3 years. The advantages of this procedure over a hemipelvectomy include shorter operative time, reduced blood loss, better fascial closure of the abdomen, and the creation of a stump which is more amendable to prosthetic fitting.


Spontaneous internal jugular vein thrombosis associated with leiomyosarcoma of the omentum. A case of spontaneous internal jugular vein thrombosis associated with distant malignancy is presented. This unusual manifestation of a hypercoagulable state was associated with a low-grade epithelioid leiomyosarcoma of the omentum. It was discovered on a gynecologic oncology service in a patient explored for a pelvic abdominal mass.


False-positive elevation of CA-125 in papillary serous carcinoma of the endometrium treated with postoperative whole abdominal radiation. Two patients with Stage I papillary serous carcinoma of the endometrium treated with postoperative whole abdominal radiation developed elevated CA-125 levels. In neither patient was evidence of recurrent disease identified. Hepatic veno-occlusive disease, a known complication of whole abdominal radiation and certain chemotherapy regimens, was confirmed by liver biopsy in both cases. CA-125 levels may not be reflective of disease status in this setting.


Synchronous radiation and cytotoxic chemotherapy for locally advanced or recurrent squamous cancer of the vulva. Between July 1987 and September 1991 a program of external beam radiation and synchronous, radiopotentiating chemotherapy was employed to treat 25 women with locoregionally advanced or locoregionally recurrent squamous cancer of the vulva. Of 18 previously untreated patients, 1 was Stage II, 10 were Stage III, 6 were Stage IVA, and 1 was Stage IVB. Reasons for patient referral for nonsurgical management included the presence of initially unresectable disease (5 patients), disease extent which would have necessitated partial or total exenteration if treated surgically (9 patients), disease extent predictive of inadequate surgical margins (less than 1 cm gross margin) if treated by less than exenterative surgery (8 patients), and severe comorbid illness precluding surgical management (3 patients). Complete clinical response was obtained in 16 of 18 previously untreated patients (89%) and in 4 of 7 patients with recurrent disease following vulvar surgery (57%). Of 20 patients achieving a complete clinical response, 3 patients have relapsed within the irradiated volume at 11, 38, and 48 months following completion of treatment. Fourteen patients remain alive and continuously cancer free from 2-52 months after completion of treatment (median follow-up 24 months). This experience suggests that initial management with radiation and chemotherapy may offer some patients with locally advanced squamous cancer of the vulva an alternative to exenterative surgery and may hold curative potential for some patients with surgically unresectable or medically inoperable disease.


Bulky stage IB cervical carcinoma managed by primary radical hysterectomy followed by tailored radiotherapy. The management of bulky, stage IB cervical carcinoma remains controversial. The present study reports the outcome of 84 women treated by radical hysterectomy, in which the surgical specimen revealed a lesion measured to be 4 cm or greater in size following formalin fixation. Of the 84 women, 42 (50%) received postoperative radiotherapy based on additional surgical findings beyond tumor size suggesting a high risk for pelvic recurrence including lymph node metastasis, parametrial spread, and compromised margins. Despite the bulky nature of these lesions, major operative and early postoperative complication rates were low (6%). Delayed complications including fistulae and bowel obstructions occurred in only 2.4% of patients treated with surgery alone and in 14.2% of women treated with combined therapy. Corrected 5-year survival in this series was 70.4% (75.6% in the surgery only group and 65.0% in the surgery plus radiotherapy group). Recurrence and mortality rates were related to lesion size, with most recurrences and deaths occurring in women with lesions measuring 6 cm or greater. Comparison of these data utilizing primary radical hysterectomy followed by tailored radiotherapy with previously published data on similar groups of high-risk patients treated with either radiotherapy alone or with radiotherapy followed by simple hysterectomy suggests comparable survival and morbidity.


The effects of cyclosporin A on the lysis of ovarian cancer cells by cisplatin or adriamycin. The major limitation to curative therapy for ovarian cancer is the development of drug resistance. Cyclosporin A (CsA), an immunosuppressive agent that has been used extensively in organ transplantation, also has been shown to decrease the resistance of cancer cells to some chemotherapeutic agents. Since cisplatin (CDDP) is the most common drug used for the treatment of ovarian cancer, we evaluated the potential of CsA to decrease resistance to CDDP in ovarian cancer cells selected for resistance to CDDP (A2780-CDDP). Although CsA significantly increased the sensitivity of A2780-CDDP cells to cytolysis by CDDP it did not increase CDDP sensitivity in the CDDP-sensitive parent cells (A2780), that is, CsA did not decrease basal resistance to CDDP. Both A2780-CDDP and A2780 are sensitive to cytolysis by Adriamycin (ADR). CsA significantly decreased the basal resistance of both cell lines to ADR. Interestingly, the effect of the protein synthesis inhibitors, emetine and cycloheximide, was similar to that of CsA, suggesting that CsA decreased selected resistance to CDDP and decreased basal resistance to ADR by affecting a protein synthesis-dependent resistance mechanism(s). In contrast to CsA and protein synthesis inhibitors, buthionine sulfoximine, an inhibitor of glutathione synthesis, decreased basal resistance of both cell lines to cytolysis by CDDP but not ADR, while verapamil, an inhibitor of P-glycoprotein, had no effect on cytolysis in either cell line. These results suggest that CsA may not decrease resistance to CDDP or ADR-mediated cytolysis by reducing glutathione or by inhibiting P-glycoprotein.


A comparison of staging systems for squamous cell carcinoma of the vulva. A review of 172 patients with squamous cell cancer of the vulva treated at the University of Michigan Medical Center from 1975-1989 was performed to compare the 1988 FIGO Staging System to the 1970 FIGO Staging System. The stage distribution according to the 1970 FIGO Staging System was stage I, 65; stage II, 44; stage III, 50; and stage IV, 13. The cumulative 5-year survival under the old system was stage I, 94%; stage II, 91%; stage III, 36%; and stage IV, 26%. The distribution changed under the 1988 FIGO system to stage I, 58; stage II, 36; stage III, 49; stage IVA, 16; and stage IVB, 13. The cumulative survival also changed to stage I, 94%; stage II, 89%; stage III, 71%; stage IVA, 19%; and stage IVB, 8%. The new FIGO stage distribution shifted for the worse due to the influence of positive lymph nodes found at the time of surgery. The survival was then analyzed for death from all causes. This was markedly decreased when compared to the cumulative corrected survival. This relates to the high number of other primary malignancies and the age of the patients. Among these 172 patients, other primary malignancies included squamous cell cancer of the cervix (11), squamous cell cancer of the vagina (2), endometrial cancer (3), squamous cell cancer of the lung (2), colon cancer (3), and others (6). An additional 5 patients died from myocardial infarction within 2 years of diagnosis. The new 1988 FIGO Staging System provides for better discrimination of survival between stages than the 1970 FIGO Staging System.


The role of laparoscopic lymphadenectomy in the management of cervical carcinoma. Laparoscopic lymphadenectomy was performed on 18 patients with invasive carcinoma of the cervix prior to definitive radiation therapy and/or radical hysterectomy. Ten patients underwent pelvic and para-aortic lymphadenectomies prior to planned radiotherapy. Two of these patients had grossly positive pelvic nodes, and one had a microscopically positive para-aortic node. Eight patients with early disease were considered candidates for radical hysterectomy and underwent laparoscopic lymphadenectomy. Three of these patients were found to have positive pelvic lymph nodes and the hysterectomy was abandoned. Five patients underwent radical hysterectomies immediately following their laparoscopic procedures. The average number of lymph nodes removed laparoscopically in these patients was 31.4; the average number of additional lymph nodes resected at laparotomy with the radical hysterectomy was 2.8. A single microscopically positive parametrial lymph node was found on permanent section in 1 patient with radical hysterectomy. No significant complications were associated with the laparoscopic lymphadenectomies. Nine of the 13 patients who underwent laparoscopic procedures only were discharged on Postoperative Day 1. The ability to perform pelvic and para-aortic lymphadenectomy allows for complete surgical staging of carcinoma of the cervix laparoscopically.


Description of a spheroid model for the study of radiation and chemotherapy effects on hypoxic tumor cell populations. The presence of poorly oxygenated cells in solid tumors may account for clinical resistance to ionizing radiation and some chemotherapy in many cancers. Studies of the presence and spatial distribution, sensitivity to cancer therapies, and other physiological characteristics of hypoxic cells are hindered by the lack of markers specific for hypoxia and a relevant yet easily manipulated model system. We have chosen to use multicellular spheroids composed of murine EMT6 (fibrosarcoma) tumor cells as a model system and have applied an immunohistochemical marker specific for hypoxic cells with the ultimate goal of determining how cell populations change in response to radiation and/or chemotherapy. Large spheroids (500-700 microns in diameter) were selected and incubated in the presence of a hexafluorinated 2-nitroimidazole derivative, designated CCI-103F, which undergoes reductive metabolism and irreversibly binds to cellular macromolecules only under low oxygen tensions. A rabbit polyclonal antibody raised against a CCI-103F/protein adduct was used to visualize hypoxic cells using standard streptavidin-biotin-peroxidase immunohistochemical methods. Investigations using this spheroid model system promise to further our understanding of hypoxic cell resistance to cytotoxic therapies and of hypoxic cell biology in general.


The specialty of gynecologic oncology as perceived by the public. The purpose of this study was to obtain information about the public's awareness and perception of the discipline of gynecologic oncology. The marketing of cancer care and related services has resulted in substantial funding being allocated to market individual institutions. However, little has been done to educate patients to the fact that there are physicians specifically trained who possess special expertise in the care of specific types of malignancy. The members of The Division of Gynecologic Oncology at The Hospital of the University of Pennsylvania asked each new patient to complete an anonymous questionnaire hoping to learn more about her prior knowledge of the specialty of gynecologic oncology and her perceptions of our discipline. Presented is the analysis of the answers provided by the 200 participants. The conclusion is that the public in general is poorly informed of gynecologic oncology as a specialty and consequently may not be taking advantage of optimal cancer care already available. Thus, as a specialty we must institute programs to educate and enlighten patients.


Transition from benign to malignant epithelium in mucinous and serous ovarian cystadenocarcinoma. The slides of all patients with ovarian cystadenocarcinoma treated at the University of Kentucky Medical Center from 1966-1990 were reviewed. Fifty-four serous tumors and 42 mucinous neoplasms were identified for further study. Benign epithelium adjacent to an area of borderline or malignant epithelium was observed in 74 tumors (79%) and a site of epithelial transition was noted in 38 cases (40%). The presence of associated benign epithelium was more common in borderline or well-differentiated lesions and in patients with early-stage disease. These findings are consistent with epidemiologic and molecular genetic data and suggest that certain benign serous or mucinous ovarian tumors have the potential for malignant transformation. Removal of these tumors, particularly in postmenopausal women, should result in a subsequent reduction in the frequency of ovarian cancer.