Adolescents and sexually transmitted diseases. Sexually transmitted diseases (STDs) are a serious health problem for adolescents, occurring in an estimated one-quarter of sexually active teen-agers. Many of the health problems--including STDs--result from specific risk-taking behaviors. Determinants of STD risks among adolescents include behavioral, psychological, social, biological, institutional factors. Education is an important component in STD control in adolescents. The goal of education is to increase adolescent self-efficiency in practicing STD prevention and risk-reduction. A comprehensive approach including quality, theory-based education, accessible and effective health clinics, and improved social and economic conditions has the most promise of controlling STDs in adolescents.


Making sexuality education and prevention programs relevant for African-American youth. A demographic and cultural profile of African-American youth is presented. Culturally-based differences in decision-making are reviewed. Attitudes and cultural values related to identity and self-image, gender role socialization, contraception, marriage and parenthood, homosexuality, and HIV/AIDS are described. Recommendations and strategies to make sexuality education and pregnancy prevention programs relevant to African-American youth are offered.


Adolescent pregnancy prevention for Hispanic youth: the role of schools, families, and communities. A sociodemographic profile of Hispanic youth is presented as well as a description of the incidence of adolescent pregnancy and parenting in this population. Strategies and recommendations that should be implemented to provide Hispanic youth with viable options and assistance in delaying early childbearing also are offered.


Creating a safer school environment for lesbian and gay students. Information obtained from clinical experiences of the University of Minnesota Youth and AIDS Project (YAP), a primary AIDS prevention program for gay and bisexual males ages 14-21, is described. More than 300 YAP clients have been interviewed regarding sexual behavior, suicide attempts, drug use, and experiences in disclosing their homosexuality to peers and parents during their high school years. The authors also have drawn from their experiences as support group leaders for gay, lesbian, and bisexual youth in high school and community settings. Constructive and destructive coping strategies employed by gay, lesbian, and bisexual students are described. Roles and responsibilities of school professionals to create a safer school environment also are presented. Key issues include how school professionals support or deny the existence of homosexuality in young people; how adults' biases against homosexuality, as well as institutionalized heterosexism, prevent lesbian and gay students from succeeding in school; how language, behaviors, and environmental cues contribute to school professionals' approachability; how children of lesbian and gay parents suffer when negative attitudes toward homosexuality are not challenged; and what resources and referrals can help lesbian and gay young people.


Sensitivity coefficients, trajectories and graphs of a human head-movement model. With time as the criterion to be optimized, the divergences from optimal head movements show systematic differences in their control signal variables with respect to single behaviours. To clarify these relationships, this study applies manipulation and mathematical analysis of the 6th-order nonlinear head movement model, using the three-fold approach of sensitivity analysis. The sensitivity analysis of the improved and refined head movement model explains the different tasks of the control parameters and their relation to the plant. It shows that width more than height of the agonistic and antagonistic pulses dominate the important behaviours of the movement: acceleration, magnitude and duration.


Analysis of electromagnetic heating patterns inside a cryopreserved organ. Computer analysis of the induced electromagnetic field and heating distribution inside cryopreserved organs subjected to electromagnetic illumination at frequencies of 84 MHz, 434 MHz and 2.45 GHz were carried out using a spherical model for the organ, with special reference to heating in a single-mode resonant cavity. The interaction between the frequency of the incident field and the size and dielectric properties of the sample was investigated. It is shown that uniform heating of organs is likely to be achieved at lower frequencies, as might be expected. However, the ratio between the power penetration depth for plane waves and the size of the organ is not a sufficient basis on which to judge quantitatively the uniformity of the power absorption. Hot or cold spots can occur within the organ even when this ratio is greater than unity; the wavelength in the material is also an important factor. The results from this study indicate that the use of a resonant cavity as a heating applicator has advantages over plane-wave illumination. A sharp upper limit can be set to the frequency suitable for rapid and uniform heating of a given organ.


Finite element stress analysis of simulated metastatic lesions in the lumbar vertebral body. A three-dimensional finite element model of a lumbar vertebral body was developed to study the effects of geometry, material properties and loading conditions on stresses in the presence of metastatic lesions. Parameters studied included location and size of the lesion, modulus of the cortical and trabecular bone within and near the lesion, generalized osteoporosis and load distribution. The results, expressed as ratios of peak values of displacement and stress, relative to a normal baseline case, indicated that the location of a defect which did not penetrate the cortex had a minor influence on the peak displacement and stresses, as did the presence of lesions occupying less than 40% of the volume of the vertebral centrum. A lesion occupying 40% of the centrum volume increased the endplate displacement by 2.9 times, the peak tensile stress in the cortical shell by 2.2 times, and the peak von Mises stress in the endplate by 2.8 times. When this lesion penetrated the cortex, these values increased to 3.8, 3.3 and 4.4 times, respectively. The most severe case involved a defect penetrating the anterior cortex, osteoporotic bone properties and anteriorly eccentric loading. In this case, the peak values increased to 8.4, 3.4 and 5.9 times their baseline values, respectively. The results are consistent with a model of the vertebral body as a stiff frame of cortical bone surrounding a relatively compliant core of trabecular bone. Only variations in geometry and properties large enough to lessen significantly the structural stiffness affect the peak stresses and displacements.(ABSTRACT TRUNCATED AT 250 WORDS)


Performance of a 7-parameter DLT method for the calibration of stereophotogrammetric systems using 1-D transducers. A method is presented for calibrating stereophotogrammetric systems which are based on 1-D cameras, i.e., able to record only one of the two coordinates relative to the projection of the target point onto the image plane of a camera. This procedure is based on the Direct Linear Transformation, DLT, introduced by Marzan and Karara. The present version (7DLT) is different from the standard 11-parameter DLT (11DLT); it avoids certain non-orthogonality problems arising in usual DLT implementations, whose correction can be obtained by modifying the basic algorithm, at the expense of its simplicity (MDLT). The accuracy assessment of the 7DLT method was carried out both by a computer simulation of a two-camera stereophotogrammetric system, and on real data from three 1-D optoelectronic cameras. The computer simulation permitted us to compare the performance of 7DLT with 11DLT and MDLT. The reconstruction accuracies of the three algorithms were quite similar. When using real 1-D data, a reconstruction accuracy of 0.66 mm RMS error was obtained (mean value for X, Y, Z coordinates) for 18 target points used as calibration control points. The extrapolation accuracy was 1.85 mm RMS for 180 target points lying outside the calibration structure.


Three-dimensional finite element modelling of bone: effects of element size. This study quantifies the effects of element size on the stress/strain results of finite element (FE) models of bone that are generated with a previously described automated method. This method uses cube-shaped hexahedral elements, which enabled element shape and aspect ratio to be held constant while the effects of element size were studied. Three models of a human proximal femur, each with a different element size (3.1 mm, 3.8 mm and 4.8 mm), were analysed. Convergence in strain energy of the models had been verified in previous work. The stresses and strains predicted by the models were compared on a pointwise basis using linear regression analysis. There was a general decrease in the level of stress and strain when element size was increased, even though convergence in strain energy had been achieved. An increase in element width from 3.1 mm to 3.8 mm decreased the predicted stresses by 13% to 29% overall; the predicted strains decreased by 4% to 20% for the same increase in element size. These results indicate that linear cube-shaped hexahedral elements must be very small (3 mm on a side or smaller) to represent the sharp variations in mechanical properties that exist in bone, and that use of larger elements decreases the predicted stresses and strains. The elements used in this study are similar to those typically used to represent trabecular bone in conventional (non-automated) FE modelling methods. Therefore, the sensitivity of the stress/strain results to element size that was found for trabecular bone also applies to conventional modelling of such bone.(ABSTRACT TRUNCATED AT 250 WORDS)


Use of uncalibrated biplanar radiography for the measurement of skeletal coordinates around the shoulder girdle. Mechanical modelling of the musculoskeletal system is dependent upon information regarding the bony attachments of the relevant muscles; in order to study the biomechanics of the shoulder girdle the authors have identified the muscle attachments in three embalmed cadavers. A simple biplanar radiographic technique was then used to determine the attachment coordinates using frames of reference defined for each bone. This technique, using hand positioning without special fixtures was believed to be sufficiently accurate, bearing in mind the likely degree of biological variation. In order to test this assumption, the accuracy of the technique has been studied by measuring the agreement between the two measurements of the common coordinate in the pairs of radiographs. It was found that for the trunk, the errors in the common coordinate were always less than the natural variation; for the scapula they were of a similar magnitude but, for the humerus, the measurement errors frequently exceeded the variation in the coordinates of muscle attachments. It was concluded that, in general, uncalibrated biplanar radiography was sufficiently accurate for the determination of the spatial coordinates of muscle attachments.


Development and validation of a new transducer for intradiscal pressure measurement. Potentially damaging tensile stresses in the annulus fibrosus are directly related to the hydrostatic pressure in the centre of an intervertebral disc: the design and development of a miniature strain gauge pressure transducer is described for measuring such pressures. Static calibration tests in bulk liquid demonstrated that measurements made with the transducer were of sufficient accuracy and stability for in vitro and in vivo investigations of spinal mechanics, and a study of the dynamic behaviour of the transducer demonstrated that it had a frequency response suitable for in vitro and in vivo investigations. Tests within loaded cadaveric discs showed that the transducer could be used to make repeatable measurements which were free from significant artefacts, when the disc was subjected to forces of up to 4000 N and when deformed in full flexion/extension.


Design of intramedullary prostheses to prevent bone loss: predictions based on damage-stimulated remodelling. The adaptation of bone around intramedullary fixated prostheses, such as the femoral component of the hip joint or the radial component of the elbow joint, is well documented in follow-up studies. Bone adaptation takes the form of proximal bone atrophy accompanied, in some cases, by distal bone hypertrophy. A mechanistic model has been formulated to predict bone adaptation based on the concept that the continuous processes of damage and repair regulate bone adaptation. We apply the model to investigate the significance of two features of intramedullary prosthesis design on bone adaptation: prosthesis Young's modulus and the presence of a prosthesis collar. Results, as well, as indicating some characteristics of accumulative-damage stimulated bone adaptation, predict that a low Young's modules stem will very much reduce the extent of bone loss whereas the presence of a collar will have no significant effect. The results predict that a collarless low stiffness prosthesis is one possible approach for improving the secondary stability of intramedullary-fixated orthopaedic implants.


Running discrete cosine transform.

Running discrete cosine transform. The discrete cosine transform (DCT) has become an important tool in digital signal processing because its performance is close to the optimal Karhunen-Loeve transform. In this work the running discrete cosine transform (RDCT) is introduced. Using the properties of the discrete Fourier transform kernel W = exp (-2 pi j/N), a fast recursive algorithm was developed for real-time computation of the RDCT coefficients. For N-point RDCT the present algorithm needs only 2N real multiplications. The hardware implementations of the RDCT algorithm and applications in real-time data processing are discussed.


Universal joint slippage as a cause of Hoffmann half-frame external fixator failure [corrected]. Slippage of the universal joints of external fixation devices is known to occur but its significance or incidence is often overlooked. In this study, controlled experiments were used to determine the relationship between joint slippage and the maximum loads a single half-frame could bear for the Hofmann device. The experiments showed that: (a) the joints slipped at minimal loads and (b) frame failure, i.e. loss of initial alignment of the frame components, was determined by joint slippage. The importance of the control of slippage cannot be overstated; the orthopaedic community must educate itself and its patients and guard against the problem in order to avoid complications secondary to slippage.


Correlation algorithm and sampling techniques for estimating the signal-to-noise ratio of the electrocardiogram. An algorithm, based on correlation techniques, is proposed for estimating the signal-to-noise ratio of very low frequency signals contaminated by white and flicker noise. Sampling techniques based on converting a single continuous signal into two time series that satisfy the requirements of cross-correlation functions are proposed. The algorithm has been tested on simulated data and the electrocardiogram transduced from ten patients.


Drug recirculation model with multiple cycles occurring at unequal time intervals. A pharmacokinetic model for enterohepatic recycling has been developed to take into account multiple recirculations likely to occur at various times after intravenous or subcutaneous injection, after infusion, or after a single oral administration of a drug. The times when the gall bladder empties, the duration of infusion and the number of recirculations may be arbitrarily chosen (for simulations) or computed (for optimization) to express the concentration in the central compartment at any time. Without a new theoretical calculation, the area under the concentration curve may be obtained as a function of the model parameters. As an example, the model is applied to an experimental case of four recirculations after oral administration and to a new drug data fitting.


Forces required for dilatation of human cervix in first trimester of pregnancy. Cervical resistance to dilatation was measured in 76 patients undergoing first trimester legal abortion; a specially designed force-sensing instrument was used. No correlation between cervical resistance and patient age or gestational age was found. Increasing parity and earlier legal abortions were significantly correlated with a lowering of the cervical resistance. In patients dilated to 11 mm a lowering of resistance was noted suggesting a tear in cervical tissue.


The relationship between anaerobic running capacity and peak plasma lactate. The purpose of this study was to examine the relationship between anaerobic running capacity and peak plasma lactate. Twelve adult males (mean age +/- SD = 21.9 +/- 1.2 yrs) performed a critical velocity test from which anaerobic running capacity was determined and a maximal treadmill running test from which peak plasma lactate was determined from post-exercise blood samples taken at one minute intervals. The results indicated that anaerobic running capacity (mean +/- SD = 0.18 +/- 0.04 km) was not significantly (r = -0.06, p greater than 0.05) correlated with peak plasma lactate (9.3 +/- 1.8 mM). These findings do not support anaerobic running capacity as an indirect indicator of anaerobic capabilities.


Energy expenditure following a bout of non-steady state resistance exercise. Little is known about the effect of non-steady state resistive exercise on postexercise energy expenditure. Using a counterbalanced design, energy expenditure was measured by indirect calorimetry in six adult males (mean age +/- SD = 24.5 +/- 6.1) for 30 min before and 60 min after a single 42 min bout of weight lifting, and again on a separate day for 30 min before and 60 min after a 42 min control period of quiet sitting. For the exercise condition the subjects performed 4 sets of upper and 3 sets of lower body resistive exercises at weights equivalent to a 12 repetition maximum for each respective lift. Metabolic rate remained significantly elevated at the end of the 60 min recovery period compared to the control condition, although the excess postexercise oxygen consumption accounted for only approximately 19 additional kcal expended. These data suggest that while postexercise metabolic remains elevated for at least one hour following a moderate level of resistive exercise, the caloric cost of this elevation during a one hour recovery period is small and similar to that induced by steady-state exercise of moderate intensity.


Is aerobic dance an effective alternative to walk-jog exercise training? In order to compare the physiological effects of an 8 week aerobic dance program to those of a walk-jog exercise training program, 60 male and female University employees ages 24-48 years were randomly assigned to an aerobic dance program (N = 22), a walk-jog program (N = 24), or a sedentary control group (N = 15). Subjects who had an exercise compliance rate less than or equal to 85% were dropped from the study, as were control subjects who had scheduling conflicts or illnesses precluding post-treatment testing. Thirty-five subjects completed the 8 week period with a compliance rate greater than or equal to 85%, leaving 14 in the aerobics group, 11 in the walk-jog group and 10 in the control group. Significant increases (p less than 0.001) in maximal oxygen uptake occurred in both the aerobics (+3.9 ml/kg-1/min-1) and walk-jog group (+3.4 ml/kg-1/min-1), while no significant change was observed in the control group. Peak heart rate decreased significantly (p less than 0.05) in the aerobics (-4 b/min-1) and walk-jog groups (-3 b/min-1 but was unchanged in the control group (-1 b/min-1) following the treatment period. Body weight, peak respiratory exchange ratio and peak minute ventilation remained the same in the aerobics, walk-jog and control groups throughout the treatment period. It is concluded that aerobic dance programs can result in similar improvements in aerobic power as a walk-jog program. Thus, an aerobic dance program is an effective alternative to a traditional walk-jog training regime.


Biological and performance variables in relation to age in male and female adolescent athletes. To observe the cross-sectional nature of the effect of age, height, and body mass on motor performance during adolescence (13-18 years), 103 boy and 65 girl athletes were measured for motor performance and anthropometric variables. Motor performances included tests of strength, muscular endurance, flexibility, aerobic capacity, anaerobic power, speed, and agility. Anthropometric determinations included height, body mass, lean body mass, %fat, and somatotype. Boys were significantly different from girls in all measurements except endomorphy, while girls were significantly superior to boys only in flexibility. Physical maturation, as reflected by height and body mass, was a major contributor to increases in motor performance. Somatotype did not differ greatly across the age groups. Boys were significantly more mesomorphic than girls, while girls were significantly more ectomorphic than boys. Higher %fat and more endomorphy were significantly related to poorer performance for relative aerobic capacity, 40-yd dash, and agility in boys but only for upper body muscular endurance in girls. Mesomorphy had higher relationships with performance variables among boys than among girls. Growth would appear to contribute significantly to enhanced motor performance with age, and its effect may be different in boys than in girls.


A physiological and nutritional profile of young female figure skaters. This study was undertaken to develop a physiological and nutritional profile of 13 female figure skaters, aged 9-17 years. Compared with previous published data, skaters in this study were younger and smaller with a higher percent body fat. Skaters in this study were less experienced and trained less than skaters in other studies but attained similar levels of maximal oxygen uptake (VO2max), handgrip strength, and vertical jump power. Relative VO2max (ml/kg/min) was significantly negatively correlated (p less than 0.0033) with body weight and percent body fat, while body weight was significantly positively correlated (p less than 0.0003) with handgrip strength and vertical jump power. In terms of nutritional recommendations, skaters in this study consumed comparatively high amounts of fat and protein with low amounts of carbohydrate, calcium, and iron. Despite suboptimal nutrition and a relatively low training volume, skaters in this study exhibited physiological characteristics similar to those reported for female figure skaters in the literature.


Body composition and energy metabolism in resting and exercising muslims during Ramadan fast. Muslims abstain from food and drink from dawn to sunset during Ramadam, the ninth month of the Islamic calendar. The purpose of this study was to examine the changes that occurred in body composition and both resting and exercise metabolism during a 4 week Ramadan fast. Subjects consumed an average of 1220 kcal each day during Ramadan and lost a significant 1.92 kg body weight. The subjects also lost 2.8% fat. Fat-free mass did not change. Serum sodium, chloride, and protein increased during the first week of Ramadan and returned to the pre-fasting levels during the last week. This indicates a state of dehydratation existed during the first week of Ramadan. Consistent with this is first week 1.13 kg body weight loss with no change in percent fat. First week Ramadan tests showed a significant decrease in VO2max with a return to the pre-test levels in the last week. The lower resting afternoon VO2 suggests that during Ramadan the body's metabolism slows down during the day in order to conserve its energy stores, however, exercise economy as measured by submaximal VO2 in mk/kg/min is not affected.


Physiological assessment of Saudi athletes. This study was aimed at assessing the physiological responses of Saudi male athletes to maximal exercise testing. Seventy five national athletes representing nine different sports and fourteen healthy controls were subjected to graded bicycle ergometer tests, during which cardiorespiratory and metabolic functions were monitored and recorded. The results of this study indicate that the maximal oxygen uptake (VO2max) values for the Saudi athletes were not significantly different from those of controls. The cyclists, however, attained the highest VO2max with a mean of 55.05 ml.kg-1.min-1 followed by the middle distance runners (X = 53.17) and the long distance runners (X = 51.19). Comparison of the Saudi athletes with some previously reported international standards revealed that the Saudi athletes had a VO2max that was lower than their respective French, Swedish, Belgian, Norwegian, Italian, Canadian or American athletes.


Effect of body position on the afterload response during sustained exercise. Hemodynamic and cardiovascular responses were studied in 80 males (age: 30 +/- 2 years) at rest, and during separate three minute trials of upright and supine isometric deadlift exercise at 30% of maximum voluntary contraction (MVC). MVC did not differ significantly between supine and upright deadlift exercise. In comparison to values at rest, both forms of isometric exercise resulted in significant increases (p less than 0.05) in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, oxygen uptake, oxygen pulse and double product. In the upright exercise, the values obtained for all of the physiological variables were found to be significantly higher (p less than 0.05) than in the supine exercise. These findings indicate that the upright isometric deadlift produces a higher after-load than the supine maneuver, and that this response may be a good indicator of cardiovascular functioning.


Effect of musculoskeletal development on the prediction of body density in females. The purpose of this study was to determine if musculoskeletal development had a significant effect on the prediction of body density in females. Subjects consisted of 156 females aged 17 to 44 years. Subjects were divided into three groups on the basis of musculoskeletal development as determined by the Heath-Carter Anthropometric Somatotype mesomorphy rating. Anthropometric measurements included eight skinfold measures (tricep, subscapula, chest, midaxillary, abdomen, suprailiac, thigh, and calf), body diameters of the humerus and femur, and circumferences at five locations (waist, forearm, upper arm, calf, and gluteal). Residual lung volume was determined by the closed circuit oxygen dilution method prior to the measurement of body density by hydrostatic weighing. A regression equation was developed to predict body density from the sum of seven skinfolds, sum of seven skinfolds squared, age, and mesomorphy rating. A similar regression equation was developed using the sum of three skinfolds, sum of three skinfolds squared, and the other variables. Results indicated that mesomorphy rating did not contribute significantly to the prediction of body density in females. It was concluded that musculoskeletal development did not have a significant effect on the prediction of body density in females.


Serum enzymes activities at rest and after a marathon race. With the purpose of determining the long and short term changes in serum enzyme activities after a marathon race, a survey involving nine healthy male runners was carried out. A basal blood sample was extracted from each 24 hours prior to the race and three further extractions were made immediately after the race, as well as at 1 and a final 24 h after the end of the race. In the enzymes of preferably hepatic origin--alkaline phosphatase (AP), ganna-glutamyltransferase (GGT) and alanine aminotransferase (ALT)--scanty modifications were found and these could be related to the changes observed in the plasma volume. Enzymes such as aspartate aminotransferase (AST) and lactate dehydrogenase (LDH), which are widely distributed in the tissues, were found to have undergone more marked variations and these could not be related to the changes in the volume of the plasma, while in enzymes of muscular origin such as aldolase (ALD), creatine kinase (CK) and its cardiac isoenzyme (CK-MB), notable increases were observed due to the muscular injury suffered. The greatest example of this was the increase found in total CK 24 h after the end of the marathon (414.6%). The high serum percentages found in CK-MB in these endurance-trained runners in relation to total CK activity should be carefully assessed in order to avoid false diagnosis of acute myocardial infarction.


Monitoring training status in professional ballet dancers. Methods of non-invasive monitoring of training status for prevention of staleness in athletes and dancers need to be developed and evaluated. In order to monitor physiologic and psychologic changes which may result from overstraining, we measured urinary excretion of free norepinephrine (NE) and epinephrine (E) and mood states over 5 weeks of an intensive ballet season in 12 (6 men, 6 women) professional dancers. First morning urine voids (AM) were collected at the start of the season and following the only off-day each week with final collection on the last day of the season. Additional urine samples were collected before (pre) and after (post) each dancer's subjectively-rated single most difficult performance. Profile of Mood States (POMS) was completed by and collected from each dancer at the same time as the AM urine samples. NE and E excretions (nanograms per mg creatinine) increased significantly with time (r = 0.91, p less than 0.02, and r = 0.94, p less than 0.01, respectively) from beginning to end of season, and pre to post (51.1 +/- 7.3 to 115.6 +/- 19.7, p less than 0.001 and 19.3 +/- 3.2 to 37.7 +/- 4.2, p less than 0.001, respectively). Women had a significantly higher excretion of NE than did men (F = 9.33, p = 0.014) and no gender differences existed in the excretion of E (F = 0.57, p = 0.484).(ABSTRACT TRUNCATED AT 250 WORDS)


Urinary protein excretion induced by exercise: effect of a mountain agonistic footrace in healthy subjects. Renal function and mountain footrace. The increase in albuminuria induced by exercise in healthy subjects is variably dependent on an increased glomerular filtration and/or to a decreased tubular reabsorption of albumin, in relation to the intensity of muscular work. Membrane anionic charges and haemodynamic changes have been implicated in exercise-induced albuminuria. We evaluated in 12 healthy subjects albumin and beta-2-microglobulin excretion rate and the presence in urine of cationic compounds before and after an agonistic mountain footrace. Albumin excretion rate increased significantly (3.7 +/- 1.3 vs 43.7 +/- 10.0 micrograms/min) (p less than 0.001) and beta-2-microglobulin excretion rate (16.5 +/- 4.4 vs 37.9 +/- 7.4 micrograms/min) (p less than 0.025), too. In 3/4 subjects, urines revealed a peak of highly cationic proteins, sharing antigenic and biological characteristics with platelet-derived cationic proteins. The increase in albuminuria induced by strenuous exercise of an agonistic mountain footrace is of mixed type (both glomerular and tubular) and is associated to the urinary excretion of cationic proteins.


The Kaike triathletes' hematocrit values. With relation to their competition results. The subjects were 20 male triathletes in the 4th Kaike Triathlon, held in Tottori during 1984. The competitors' hemogram values were estimated at rest, during, and after the competition. The results were related to their competition order by methods of rank correlations and cluster analysis, using the average distance method. The first cluster, including an competition order is composed of hematocrit at rest, after swimming, after bicycling, and after the finish. The rank correlation coefficients between competition order and hematocrit values were significant (p less than 0.05) at each of the four periods, especially after swimming, though the probability is the same. We found that lower hematocrit values correlate with excellent competition results, as the competitors' hematocrit values could be elevated during exercise if their hematocrit values are in the low normal density whilst at rest.


Physical activity, physical fitness and mortality in a sample of middle aged men followed-up 25 years. One-thousand-seven-hundred-twelve men aged 40-59, representing two demographic samples of rural areas in Northern and Central Italy, were examined in 1960 and then followed-up for 25 years. Total mortality and coronary mortality were related to the entry measurements of physical activity at work, estimated in three levels by a simple questionnaire and to four possible indicators of physical fitness, ie resting heart rate, the circumference of the right arm cleaned from the contribution of skin and subcutaneous fat, vital capacity and forced expiratory volume in 3/4 sec, the latter two adjusted by height. The four indicators of fitness and the score of physical activity were somewhat related each other in the expected direction. Both all causes and coronary mortality were indirectly related to the score of physical activity. The relative risk for age adjusted rates of sedentary vs heavy workers was 1.23 for all causes of death, and 1.72 for coronary deaths. Direct univariate relationships were found between resting heart rate and mortality (for both all causes and coronary deaths) whereas indirect relationships were found for arm circumference and the two indicators of respiratory function. The age adjusted relative risks between the upper and the bottom quartile of the distribution were, for all causes of death, 0.75 for vital capacity, 0.68 for forced expiratory volume 1.32 for heart rate, and 0.84 for arm circumference. The correspondent relative risks for coronary deaths were 0.71, 0.65, 1.23 and 1.02 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


Trends in sports injuries, 1982-1988: an in-depth study on four types of sport. In this study, we analyzed the records of both inpatients and outpatients which were treated for acute sports injuries in the Trauma Department of the University of Groningen (The Netherlands) during the years 1982 to 1988. We examined whether there was a trend in sports injuries in this time period. The study comprised four types of sports, i.e., soccer, volleyball, gymnastics, and martial arts. The absolutely highest rates of injuries across the seven years were found in soccer, followed by gymnastics, volleyball, and martial arts. Injuries sustained at participating in soccer, volleyball, and gymnastics involved for the major part the lower extremities, followed by injuries of the upper extremities, whereas the reverse pattern was observed for patients who participated in martial arts. For all four types of sport, the ankle and foot were the most frequently site of injury of the lower extremities. Sprains and strains were the major types of injury. Most injuries were seen at ages between 10 and 30 years. The ratio of male to female patients within age groups did not differ significantly across the seven years. We concluded that, except for martial arts, the increased participation in sports in the last decade was not accompanied with a change in the patterns of sports injuries by the patients' age, sex, and number and nature of the injury. This consistency in results can be used to guide the development of prevention programs aimed at a reduction of injuries in specific sports.


The effect of dexamethasone and endotoxin administration on biliary IgA and bacterial adherence. Adherence of bacteria to the intestinal epithelial cell may be the crucial initiating event for invasion and translocation and is normally prevented by both immune (IgA) and nonimmune (mucus, peristalsis, desquamation) mucosal defense mechanisms. The purpose of the present study was to examine the effect of endotoxin administration on mucosal immunity and to define the role of glucocorticoids, commonly released during endotoxicosis, in this process. Thirty female Fisher rats were randomly assigned to three groups of 10 animals each. Group I (CONT), was fed rat chow and H2O ad lib., Group II (DEX) was administered 0.8 mg/kg subcutaneously of dexamethasone, and Group III (ETX) was given 1 mg/kg of endotoxin. Twenty-four hours later animals were sacrificed and mesenteric lymph nodes and vigorously washed stool-free ceca were collected and cultured. Bile was collected and assayed for IgA from 5 animals in each group. A significant decrease (P < 0.05) in secretory IgA was noted in animals treated with either dexamethasone or endotoxin (CONT = 332 +/- 42, DEX = 78 +/- 24, ETX = 68 +/- 16 micrograms/mg protein +/- SEM). No difference in S-IgA between animals in the dexamethasone-treated group and the endotoxin-treated group was noted (P = NS). A statistically significant increase (P < 0.001) in bacteria adherent to the cecal wall in both the dexamethasone-treated rats and the endotoxin-treated rats over that in = 7.5 +/- 0.8, CONT = 6.4 +/- 0.6 cfu/g(log10) +/- SD). Our results suggest that endotoxin or glucocorticoid administration results in significant bacterial adherence to the cecal mucosa and a decrease in IgA.(ABSTRACT TRUNCATED AT 250 WORDS)


Evaluation of a rat model for the study of local regulation of intestinal blood flow: ex vivo asanguineous perfusion of the ileal vascular bed. A new model of ex vivo vascularly perfused, isolated rat ileum was developed and evaluated. Segments of distal ileum (approximately 5 cm) from male Wistar rats were isolated on their vascular pedicles. Perfusion through an aortic cannula with oxygenated (95% O2, 5% CO2) Krebs solution containing 5% bovine albumin, 5.6 mM glucose, and 25 mM mannitol at 37 degrees C was initiated immediately after interruption of blood flow. The bowel preparations, including the abdominal aorta, were then transferred to a perfusion chamber. Perfusion pressure was maintained by gravity at 40 mm Hg. Flow was measured with an electromagnetic flow probe. The portal vein, together with the lymphatics, drained freely into collection tubes. The bowel lumen was perfused at 0.85 ml/min with isotonic modified Krebs solution containing [14C]polyethylene glycol, and the luminal perfusion pressure was monitored. Luminal effluents were collected through a large-bore outlet tubing. As determined by histology, O2 consumption, vascular reactivity, and mucosal permeability, the preparations were viable for at least 60 min of perfusion. With this model, a vasoconstrictor effect of the alpha 2-adrenoceptor agonist clonidine was documented for the first time in isolated rat bowel.


Preoperative radiation therapy produces an early and persistent reduction in colorectal anastomotic blood flow. Preoperative external beam radiation therapy (RT) is an increasingly popular form of adjunct therapy for rectal cancer; however, little is known about its effects on healing of colorectal anastomoses. We serially evaluated colorectal anastomotic healing following moderate dose RT. Twenty-four adult female pigs were administered 4250 centiGrays (cGy) of external beam pelvic RT over 4 weeks followed by rectosigmoid resection with handsewn or circular stapled anastomosis. Groups of animals were then sacrificed at 5, 11, 60, and 120 days postoperatively. A control group (N = 24) was studied similarly but not irradiated. Perianastomotic blood flow was measured using laser doppler velocimetry at each time interval. Nonirradiated anastomoses demonstrated significantly higher blood flows compared to irradiated anastomotic segments at each study interval. In addition, early (Days 5 and 11) postoperative gross inflammatory scores and microscopic inflammatory score (all intervals) were significantly higher for irradiated animals. Anastomotic complications were more frequent in irradiated animals (7/24) vs controls (2/24, P < 0.05). These results indicate that a preoperative dose of 4250 cGy results in an early and persistent decrease in colorectal mural blood flow independent of anastomotic technique. This is the first experimental study which attempts to quantitate the effects of preoperative pelvic radiation therapy on anastomotic blood flow.


The effect of temporary hepatic artery or portal vein occlusion in obstructive jaundice. Hepatic hemodynamics before vascular occlusion and the effect of transient hepatic artery or portal vein occlusion on the liver were investigated in normal dogs and dogs with experimentally induced obstructive jaundice by measurement of hepatic tissue blood flow (HTBF), index of hemoglobin concentration (IHb), oxygen saturation (ISO2), serum glutamic pyruvic transaminase (SGPT) concentration, and malonaldehyde (MDA) concentration in liver tissue. Livers with obstructive jaundice had increased blood flow and a lower hemoglobin concentration compared with normal livers at baseline before vascular occlusion. Percentage change of ISO2 from baseline was higher than percentage change of HTBF after reperfusion in both normal and obstructive jaundiced liver, although they were decreased to almost similar proportions during vascular occlusion. MDA concentration in obstructive jaundice after reperfusion following vascular occlusion was higher than in normal liver. Furthermore, MDA concentration after reperfusion following hepatic artery occlusion was increased compared with after reperfusion following portal venous occlusion in obstructive jaundice. There was no evidence of massive liver necrosis which was newly developed by transient vascular occlusion. These results represent the pathological condition in the liver before transient vascular occlusion and after reperfusion in obstructive jaundice.


The vascular supply of splenic autotransplants. The close opposition of blood to phagocytic cells lining the pulp cords and marginal sinus has been proposed as a contributing factor in the clearance mechanism of the spleen. The vasculature of splenic autotransplants was investigated in rats using microcorrosion casts. Six-month-old splenic autotransplants and unoperated control spleens were selectively perfused and a methyl methacrylate cast was made. Scanning electron microscopy of these corroded casts was performed. In autotransplants, the marginal zone capillary network was abnormal with the fine network of capillaries replaced by dilated blood vessels. The red pulp cords were also found to be abnormal with increased diameter and loss of the fine saccular dilations found in normal spleens. The abnormally dilated capillaries and cords in the autotransplants may decrease antigen contact with these cells and hence explain previous reports of reduced phagocytic function.


Limiting oxygen delivery attenuates intestinal reperfusion injury. Since free radical-mediated injury is dependent on the reintroduction of oxygen into ischemic tissues, restriction of oxygen content in the initial reperfusate has therapeutic potential. The degree to which oxygen must be restricted is crucial since hypoxic injury would continue if reperfusion O2 delivery remained below the ischemic threshold of the tissue. We examined this treatment strategy in 20 pump-perfused intestinal preparations subjected to 30 min of flow interruption. The oxygen content of the reperfusate was varied by utilizing arterial (A) or venous (V) blood; as a further modification, we also performed experiments in which hemodiluted arterial blood (HD) was the reperfusate at normal (NHD) and high (HHD) flow rates. The flow rates and O2 contents of the reperfusates were adjusted to produce either high (approximately 12 ml O2/min/100 g) or low (approximately 8 ml O2/min/100 g) levels of O2 delivery. Histologic sections, obtained after ischemia and after 1 hr of reperfusion, were blindly evaluated for mucosal injury (1 = normal to 5 = severe injury). Immediately after 30 min of ischemia, all groups had comparable histologic grades (A 2.0 +/- 0.3, V 1.8 +/- 0.3, NHD 1.6 +/- 0.3, HHD 2.3 +/- 0.3). One hour after reperfusion, intestines reperfused with blood with high O2 content and hence high O2 delivery showed significantly more damage (P < 0.001) than those with exposed to low O2 delivery during reperfusion: A 3.9 +/- 0.5 and HHD 4.4 +/- 0.4 versus V 2.7 +/- 0.5 and NHD 2.9 +/- 0.3.(ABSTRACT TRUNCATED AT 250 WORDS)


Reversal of gelatin-impaired wound healing in rats by exogenous fibronectin. Animal experiments have shown that administration of gelatin results in a deprivation of plasma fibronectin (FN) and impaired wound healing. For further elucidation of these findings a therapy study with purified human FN was performed in rats. Fifty animals received a standard burn injury of 1% body surface and were divided into five experimental groups. Positive controls given no further treatment or treated with solvent only served for estimation of normal healing. For a negative control, 10 animals received three intraperitoneal injections of gelatin (58 mg/kg body wt) on Days 0, 1, and 2 after injury. They exhibited a striking lack of plasma FN (Day 1) and a significant delay of wound contraction (Days 7 and 14). In the therapy groups each administration of gelatin was followed by an intraperitoneal or intracardiac injection of FN (58 mg/kg body wt) 1 hr later. In these animals the negative effect of gelatin upon plasma FN and wound contraction was prevented. According to this study wound healing is menaced by FN deficiency and can be optimized by substitution of exogenous FN.


Peri-insular presence of collagenase during islet isolation procedures. Reportedly, higher islet yields are obtained by ductal collagenase administration and subsequent digestion of the pancreas than by the chopped tissue collagenase digestion technique. However, the exact mechanism of islet isolation is not known. This study aims to understand the underlying mechanism of a favorable effect of ductal collagenase administration. To this end, we investigated if the higher yields can be explained by a different distribution of the collagenase enzymes in the pancreatic tissue after ductal application as compared to during chopped tissue digestion. India ink was used to mimic and visualize the distribution of collagenase in histological sections of pancreases of several species. Ink particles were seen around and even within the islets both after ductal application and during chopped tissue collagenase digestion. Thus, collagenase enzymes are not restricted to the exocrine tissue compartment with either technique. In view of this observation, we compared the efficacy of both techniques in islet isolation procedures in paired experiments in rats. Both techniques gave similar islet yields to those reportedly obtained with the ductal collagenase method. However, with either technique, the islet yield was only approximately 50% of the endocrine volume of the pancreas, indicating that a substantial loss of islet tissue had occurred. We conclude that, irrespective of the route of collagenase administration, collagenase enzymes are present in the peri-insular space during islet isolation procedures. This is pertinent in view of the finding that both methods have similar islet yields in rats and that collagenase digestion, as such, is associated with loss of islet tissue.


The effects of endothelin-1 on human dermal fibroblast growth and synthetic activity. Endothelin-1 (ET-1) is the most potent vasoconstricting substance known, and is believed to have a fundamental role in the regulation of blood flow. It is a peptide produced and secreted by endothelial cells in response to hypoxia and injury, as well as by macrophages. These properties suggest that ET-1 may play a role during tissue repair. In this study, we have examined the effects of ET-1 on the growth and synthetic activity of human dermal fibroblasts. ET-1 stimulated DNA synthesis in serum-deprived cultures: this effect reached a mean value of 64% more than control (P < 0.01) at 2.5 ng/ml (10(-9) M) of ET-1. In contrast, the addition of ET-1 to fibroblasts at different densities and in 0, 3, or 10% fetal bovine serum (FBS) failed to increase cell counts. In 1% FBS, a 41% mean increase in cell counts compared to control values was observed in cultures treated with 2.5 ng/ml of ET-1 (P < 0.01). Incubation of dermal fibroblast cultures at 37 degrees C for 1 hr with increasing concentrations of 125I-ET-1 resulted in saturable binding and a half-maximal specific binding of 27.5 pM. Scatchard plot analysis of the binding showed a Kd of 224 pM and 11,400 high-affinity binding sites per cell. ET-1 had no effect on [14C]-glucosamine incorporation by fibroblasts and caused no increase in collagen synthesis, as measured by collagenase-sensitive [3H]proline incorporation and by salt precipitation of 3H-labeled collagen at acid and neutral pH successively.(ABSTRACT TRUNCATED AT 250 WORDS)


A simple method for bile duct anastomosis and interval bile collection in the liver-transplanted rat. A mini T-tube is introduced for the bile duct anastomosis of rat liver transplantation as well as interval bile collection. The validity of the T-tube was evaluated in 14 liver-transplanted rats and compared to 14 rats using traditional stent for bile duct anastomosis. Changes of biliary tree after the T-tube anastomosis were examined by T-tube cholangiography on sample rats at 4 days and at 4 months after liver grafting. Additionally, bile volumes and rates of bile salt secretion were compared in the continuously flowing cannula and the chronic T-tube fistula in normal rats. The results show that the mini T-tube facilitates bile duct anastomosis and study of bile secretion after liver transplantation in rats without increase in surgical difficulty or interference of biliary enterohepatic circulation.


Implications of a pre-existing tumor hypoxic fraction on photodynamic therapy. The presence of oxygen in tissue is a requirement for photodynamic therapy (PDT)-induced destruction of solid tumors, otherwise no cell death occurs. Since many tumors have been shown to have significant populations of hypoxic cells, it is of clinical interest to determine if pre-existing tumor hypoxia limits phototherapy. This question was examined using RIF tumors where tumor response to PDT of completely oxygenated tumors was compared to tumors with an induced hypoxic fraction. Tumor hypoxia was induced by using vasoactive drugs (epinephrine, chlorpromazine, or isoproterenol), given 30 min prior to PDT, or by a surgical method. PDT consisted of 5 mg/kg Photofrin II ip 24 hr prior to treatment and 135 J/cm2 630-nm light. The administration of the various vasoactive agents induced hypoxic fractions of 2.2 to 10%. The surgical method induced hypoxic fractions of 35%. Tumor response and cure in animals given vasoactive agents did not differ from controls, suggesting that low levels of pre-existing tumor hypoxia do not limit photodynamic therapy in this tumor model. Animals with tumors made hypoxic by a surgical method showed significantly reduced tumor response to PDT. Only 14% of these animals had tumors which became flat and necrotic by the day following PDT, compared to nearly 100% for animals given vasoactive drugs or controls. Furthermore, no tumor cure was observed in animals treated by this method. The higher level of tumor hypoxia in these animals likely represents one point where large proportions of PDT-resistant cells can survive after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)


Skeletal muscle fiber type does not predict sensitivity to postischemic damage. Because the three distinct fiber types of skeletal muscle have significant metabolic differences, the predominant fiber type in a muscle may influence its sensitivity to injury from ischemia and reperfusion. The few studies to address this issue have been conflicting. We explored possible differences in the sensitivity of fiber types to ischemia/reperfusion injury with an isolated rat hindlimb preparation perfused with an albumin-enriched Krebs buffer. Following 120 min of ischemia and 60 min of reperfusion, the tibialis anteriorwhite, tibialis anteriorred, soleus, and plantaris muscles were assessed for injury by examining three parameters: skeletal muscle injury (via 99Tc-pyrophosphate), microvascular injury (via 125I-albumin), and tissue water content. There was no consistent correlation between fiber type and sensitivity to postischemic injury. Both the soleus (slow twitch) and plantaris (fast twitch) muscles sustained similar significant injury: muscle damage was 133 and 167% greater than controls, and microvascular damage 96 and 91% greater than controls, respectively. However, other fast twitch muscles (tibialis anteriorwhite and tibialis anteriorred) exhibited no significant injury. Both injured muscles were in the posterior compartment while the uninjured muscles were in the anterior compartment. Regional flow as measured by microspheres revealed no correlation between postischemic flow and muscle injury, microvascular injury, or compartmental location. Skeletal muscle fiber type was not consistently predictive of its sensitivity to ischemia/reperfusion-induced injury. Compartmental location may have played an as yet unknown role in modulating vulnerability to postischemic damage.


Modulation of peritoneal re-epithelialization by postsurgical macrophages. The studies reviewed here show that postsurgical macrophages are capable of modulating the proliferation of TRC. That is, macrophages either suppress or enhance the proliferation of TRC depending on the culture time and the medium used as a comparison, i.e., culture medium with only serum or spent medium from cultures of resident peritoneal macrophages. Postsurgical macrophages also modulate the morphology of (spindly or rounded appearance) and the secretion of extracellular matrices by TRC. The responsivity of TRC to control by postsurgical macrophage-spent media or growth factors changes as a function of postsurgical and/or culture time. In addition, cells harvested from the site of peritoneal trauma (TRC) did not respond to growth factors in a fashion entirely the same as fibroblasts. This indicates that cells harvested from the site of peritoneal injury are unique. Lastly, after removal of a suppressive factor from postsurgical macrophage-spent media by dialysis, the factors secreted by postsurgical macrophages are more potent in enhancing TRC proliferation than growth factors individually.


Traumatic disruption of the cervical trachea. Treatment of a case of traumatic disruption of the cervical trachea has been described. This injury is not common but must be suspected in blunt chest trauma patients, with evidence of possible tracheal obstruction as in this patient. Massive subcutaneous emphysema, large air leaks, and persistent pneumothorax are more common signs of tracheobronchial disruption. Diagnosis can be made with fiberoptic bronchoscopy, and primary repair is the treatment of choice.


Learning alcohol tolerance by mental or physical practice. Five groups of six male social drinkers learned a psychomotor task (Tracometer) and subsequently attended five sessions to perform the task after drinking. On each of the first four sessions, subjects received 0.62 g/kg alcohol. On session 5, a placebo was administered when alcohol was expected. During treatment sessions 1-3, two groups performed the task with a valuable consequence for drug-compensatory performance: either information (IO) or information plus money (MI). This MI experience was mentally rehearsed by a third group (MR). Two control groups performed the task, either with no outcome (N), or with money for compensatory performance but no information about earnings until the study concluded (MO). Sessions 4 and 5 assessed the effect of the prior treatments when all groups performed the task with money and information. Groups MI, IO and MR displayed comparable and significantly more tolerance and a stronger compensatory response to placebo than control groups MO and N. The evidence indicates that mental or physical practice associating drug-compensatory performance with some valuable outcome enhances tolerance to moderate doses of alcohol.


The effect of alcohol on emotional response to a social stressor. Social drinkers were administered either an alcoholic, placebo or no-alcohol control beverage. Subjects were next informed that they were to give a self-disclosing speech about their body and physical appearance. Subjects' heart rate and videotapes of their facial expression were recorded during this instruction. Facial reactions to the stressor were analyzed using a system based on the Maximally Discriminative Facial Coding System (Izard, 1979). Subjects who were intoxicated showed significantly less negative emotion, as measured by the facial expression analysis, than those subjects consuming either the control or placebo beverage. We attribute this effect of alcohol to its actions on subjects' appraisal of anxiety-inducing information.


Neuropsychological efficiency measures in male and female alcoholics. The role of time in performance on many neuropsychological tests has been relatively neglected in the literature to date. Neuropsychological functioning in 90 male and female alcoholics and 65 peer controls was examined using both accuracy and time measures for four basic types of neuropsychological functioning: verbal skills, learning and memory, problem-solving and abstracting, and perceptual-motor skills. Alcoholics had significantly lower efficiency ratios (accuracy/time) than controls in each of the four areas, and had significantly lower overall accuracy and time scores. There were no significant Group x Gender interactions for efficiency, speed or accuracy scores, indicating that male and female alcoholics have similar deficits as a result of chronic alcoholism. The study is the first to apply systematically an empirical measure of neuropsychological efficiency to different areas of cognitive function; the results have implications for neuropsychological testing procedures.


The relationship between three subtypes of the flushing response and DSM-III alcohol abuse in Japanese. This study examined the relationship between the flushing response and drinking patterns and DSM-III alcohol abuse among Japanese using data collected in the joint U.S.-Japan collaborative study. The flushing response was classified into the following three subtypes: typical flushing (always flushed in the face after drinking), atypical flushing (sometimes) and nonflushing (never). This study of male current drinkers showed that typical flushers drank less alcohol than did atypical and nonflushers, but there was no observed difference between the drinking patterns of atypical flushers and nonflushers. Although the relationship was less pronounced, a similar association was found for female current drinkers. The 12-month prevalence of DSM-III alcohol abuse was estimated to be highest among atypical flushers and lowest among typical flushers, with nonflushers in between for both genders. When daily alcohol consumption and other pertinent sociodemographic variables were controlled, logistic regression analyses revealed that the risk for alcohol abuse by men was approximately 3.0 times higher among atypical flushers and 1.7 times higher among nonflushers than among typical flushers. The corresponding risks for abuse by women were 7.8 (atypical flushers) and 2.8 (nonflushers) times higher. Possible explanations for these differences in drinking patterns and the risk for alcohol abuse among the three flushing subtypes and between genders are discussed.


The reliability and stability of the Mortimer-Filkins test. The Mortimer-Filkins test has been used widely as an instrument for detecting problem drinkers among drink-driving offenders. While extensive psychometric testing has been undertaken by the developers of the test, few independent validation studies have been conducted, and few studies have used the Mortimer-Filkins test with general populations. The present study investigated the test-retest and internal-consistency reliability of the instrument, and the stability of problem drinking, as measured by the instrument. The test was administered to moderate and heavy drinkers at an industrial workplace on three occasions. The results indicated that the Mortimer-Filkins test has high test-retest and internal-consistency reliability, and problem drinking, as measured by the test, appears to be a stable characteristic across time.


Changing the legal minimum drinking age: results of a longitudinal study. Alcohol consumption patterns of samples of college students were examined before and after legislation to raise the minimum drinking age for "weak" beer (3.2% or less alcohol content by weight). Sampling was completed just before and immediately after inception of the law, and then each semester for a total of 4 years. These samples were compared with baseline data obtained 2 years before the legislative action. Quantity and frequency of consumption showed an increase in the sampling period just before the law change and a decrease immediately following. Overall, the quantity-frequency index remained constant, and reports of problem drinking changed very little. Some adjustments were found in drinking locations with students reporting less drinking in public places, such as bars or restaurants, and more drinking in private places, such as residence halls or homes. Policy implications of legislation designed to control drinking are discussed.


Problems in deterrence: a comparison of the driving histories of DUII and non-DUII drivers. Driving records of subjects arrested for driving under the influence of intoxicants (DUII), both recidivists and nonrecidivists, were compared with records of an age- and sex-matched random sample of non-DUII drivers. Major differences were found between DUII and non-DUII groups in the incidence of traffic violations but some differences also existed between nonrecidivist and recidivist DUII subjects. Rehabilitative diversion programs for first-time DUII offenders did not affect recidivism rates in the study population. Findings in this study suggest that general deterrence directed at the non-DUII population should receive emphasis equal to specific deterrence directed at DUII offenders.


Relationship of family history, antisocial personality disorder and personality traits in young men at risk for alcoholism. Studies examining possible risk factors for the development of alcoholism have focused recently on a variety of personality factors, including those associated with risk-taking behaviors. Alcohol-seeking behavior leading to the abuse of alcohol may be associated with a variety of risk-taking behaviors that derive from certain personality traits. Further, there is evidence that personality traits are transmitted across generations. This study examined the relationship of a family history of alcoholism, antisocial personality disorder (ASP) and alcohol use to several personality traits including the Tri-dimensional Personality Questionnaire (TPQ) in a sample (N = 91) of nonalcoholic, young male volunteers. The men with ASP scored higher than the non-ASP men on the Novelty Seeking Scale of the TPQ, but not on the Harm Avoidance or Reward Dependence subscales. In addition, ASP men scored higher than non-ASP men on a measure of impulsivity and tended to score higher on measures of sensation seeking, psychopathy and monotony avoidance. A family history of alcoholism did not differentiate the young men on any of the childhood behavior problems, personality measures or alcohol-related variables.


A high-risk community study of paternal alcohol consumption and adolescents' psychosocial characteristics. A prospective community study looked at drinking behavior and biopsychosocial correlates of adolescents (in years 9 and 10 and again in years 11 and 12 at 23 high schools) and their parents. Heavy drinkers were compared to nil/low drinkers. Sons were more likely to drink heavily if fathers drank heavily and mothers who drank heavily were more likely to cohabit with heavy drinkers. Differences in psychological characteristics and home environment were defined in regard to heavy drinking fathers and drinking sons. Difficulty in settling disagreements and reduced time spent with family were the main correlates associated with drinking by both boys who did not necessarily have a heavy drinking father and those who did.


The characterization of inconsistencies in self-reports of alcohol and marijuana use in a longitudinal study of adolescents. The reliability of self-reported measures remains an important issue for research on adolescent alcohol and drug use. Many studies have concluded that adolescents' self-reports are valid and reliable, but few studies have excluded consistent nonusers from their reliability estimates, and no study has examined in detail the reliability of reported age at first use of substances. This study explores the consistency of self-reports of frequency of use and age of first use of alcohol and marijuana in a sample of 5,770 secondary school students in a southeastern U.S. county. Two waves of data were collected between 1985 and 1988 using state-of-the-art data collection procedures and self-administered instruments. Consistency of reports was examined by comparing reports at T1 and T2, approximately 1 year apart. Results showed that when consistent nonusers were dropped from the analysis, consistency rates of lifetime frequency of use dropped from 82.7% to 74.7% for alcohol and from 95.6% to 83.2% for marijuana. Reports were more consistent for lifetime marijuana use than for alcohol use, but these results must be interpreted with caution given differences in the measures for the two substances. Reliability of reported age of first use was very low for both substances. When consistent nonusers were dropped from the analysis, only 27.8% of respondents made consistent estimates of their age at first alcohol use and 34.4% for their age at first marijuana use. Implications and recommendations for this area of research are discussed.


The changing role of the surgeon in the management of cancer in the university setting and its impact on resident training. A retrospective review was performed of 22,168 cancer cases registered by the Tumor Registry between 1965 and 1990. Eighty-six percent of these cases involved solid tumors; this number remained fairly constant throughout the study period. There was a significant trend toward more advanced disease at the time of presentation, most marked in the last 10 years; prior to 1980, 63.7% had localized or in situ cancer as opposed to only 49.4% since 1980 (P < 0.001). This suggested that more advanced cases were being submitted for treatment. As expected, more disseminated disease at the time of presentation was coupled with an overall decrease in the number of cases in which surgery comprised part of the treatment: 43.6% prior to 1980 vs. 38.1% after 1980. This trend has reversed, however, in the last 5 years. Though the number of cases in which surgery was the only treatment modality remained constant prior to and after 1985 (26.8% and 27.1%, respectively), the number of cases in which surgery was part of a multimodality treatment plan significantly increased (39.9% prior to 1985; 45.3% after 1985). This was coupled with a significant decrease in the number of cases treated with nonsurgical modalities alone (60.1% prior to 1985; 54.7% after 1985). Therefore, not only has the surgeon been called upon to operate on more advanced disease for cure in the last 5 years, but he or she has also become increasingly involved in multimodality treatment. Since 40.4% of university departments of surgery (as of 1990) did not provide specific training in surgical oncology, it is suggested that these departments reevaluate the objectives of their educational programs in view of the changing, increasingly complex role of the surgeon in the multidisciplinary approach to the care of the cancer patient.


Prognostic markers of colorectal cancer: an evaluation of DNA content, epidermal growth factor receptor, and Ki-67. Between January 1989 and August 1991, 62 patients undergoing resection for colorectal adenocarcinoma were assessed in a prospective fashion on the basis of various tumor characteristics that are thought to indicate prognosis. Parameters measured included epidermal growth factor receptor (EGFr) expression, a cell membrane receptor known to be overexpressed in a variety of tumors, Ki-67, a monoclonal antibody marker of cell proliferation, as well as flow cytometry and standard histologic examination. Statistical analysis included chi square with Yates correction when appropriate, Wilcoxon W, and multivariate logistic regression. EGFr positive tumors were associated with worse Dukes' stage (27% of EGFr negative tumors were Dukes' C or D vs. 58% of EGFr positive tumors, P = 0.03), as well as more aneuploid characteristics by flow cytometry (48% EGFr negative = aneuploid vs. 82% EGFr positive = aneuploid, P = 0.01). Lymphatic invasion was more frequent in EGFr positive tumors (P = 0.03). These factors proved to be independent of each other by multivariate analysis. Ki-67 did not correlate with any of the measured parameters and was of extremely limited use in the evaluation of the study population. Multivariate analysis indicated that aneuploid tumors were associated with worse Dukes' stage than diploid tumors. Histologic parameters such as lymphatic and vascular invasion as well as histologic grade are compared to the other parameters involved with prognosis.


Accurate specimen preparation and examination is mandatory to detect lymph nodes and avoid understaging in colorectal cancer. Lymph node involvement in colorectal cancer, one of the most important prognostic factors, can be sometimes underestimated. In this study the authors report the results of two different techniques of specimen preparation and examination. In 240 patients (Group I), histologic examination was performed using a conventional procedure. In Group II (60 cases) the resected bowel and its mesentery were separately stretched, pinned on to a cork board, and fixed. The mesentery was divided according to node location (intermediate and principal) and evaluated by sight and palpation to identify lymph nodes. The bowel segment was divided from 5 cm proximally to 5 cm distally to the tumor every 10 mm in serial 3 mm slices. Three and 10 mm slices were then carefully examined by sight and palpation. Isolated lymph nodes embedded in groups (10-12 per paraffin block) were stained and investigated for neoplastic involvement. The specimen examination procedure used in Group II resulted in identification of a higher number of lymph nodes (mean = 41.1) and nodal metastases (mean = 10) compared to the standard technique used in Group I (mean = 11.3 and 2.4, respectively--P < .05). The percentage of N+ cases also was increased in Group II (48.3%) when compared to that in Group I (30.4%; P < .05). The new technique is simple, inexpensive, and efficacious for the detection of lymphatic metastases in colorectal cancer.


Prognostic assessment of superficial squamous cell carcinoma of the esophagus using karyometric analysis and nucleolar organizer regions. To investigate prognostic values for squamous cell carcinoma, we measured nuclear area (NA), nuclear shape factor (NSF), DNA content and mean number of nucleolar organizer regions (NOR), using formalin-fixed, paraffin-embedded tissue sections from 39 patients with superficial squamous cell carcinoma of the esophagus. NA and DNA content were significantly higher in patients with lymph node metastasis than in those without metastasis. NA and the NOR number were also significantly higher in patients with recurrence than in those surviving for more than 3 years without recurrence. To determine the optimal combination of these parameters for prognostic assessment, we used a stepwise discriminant analysis to obtain two linear discriminant functions. One (f = 0.331 x NA + 6.64 x NSF + 9.85) gave an accuracy of 87.2% in predicting lymph node metastasis, and the other (f = -0.071 x NA - 2.34 x NOR + 13.0) yielded an overall accuracy of 88.9% in classifying patients into two groups with a better and worse prognosis. These results suggest that karyometric analysis and determination of the NOR number are useful for the prediction of disease outcome in patients with superficial squamous cell carcinoma of the esophagus.


Breast masses in adolescent females.

Breast masses in adolescent females. In a retrospective study of 38 adolescent females operated on for mammary masses, 42 fibroadenomata (FA), 2 fibrous scars around abscesses, and one papilloma were found. All were postmenarchal. Clinical and pathological features were reviewed and the patients reexamined or interviewed. FA were mostly asymptomatic and removed a few weeks after incidental discovery. They were often seen in Jewish girls of parents born in North Africa and the Middle East, and were more frequently located in the outer superior quadrant of the left breast. New FA appeared in almost half of the cases later on in the same breast, as well as in the other breast, or bilaterally. Necrosis occurred in three FA and was unrelated to the size of the tumor. There was no correlation between the size of FA, multiplicity, or necrosis, nor between increased stromal or epithelial atypia, cellularity, or mitotic activity. One explanation for the high rate of multiplicity might be related to this neoplasm occurring in an actively developing organ under hormonal control. There was no increased breast carcinoma apparent in the family history. Therefore, except in cases of fast-growing tumors, a conservative approach is recommended because of the frequency of multiple FA as well as aesthetical postoperative complications.


Colorectal carcinoma in young patients.

Colorectal carcinoma in young patients. Utilizing Tumor Registry records dating from 1935 to 1988, 50 patients diagnosed with colorectal adenocarcinoma at the age of 40 years or younger were retrospectively studied with respect to sex, race, family history, delay in diagnosis, primary tumor location, tumor differentiation, mucin production, stage at presentation, and the effect of these factors on 5-year survival. This younger group of patients was compared to a computer-generated, randomly selected group of 50 patients 40 years of age or older. There was no difference with respect to sex, racial distribution, family history, symptoms at presentation, or expediency of physician diagnosis between the two groups. Younger patients waited significantly longer to seek medical attention than did their older counterparts. However, those patients who delayed presentation had no higher incidence of advanced disease than those patients who presented earlier. Younger patients had a higher incidence of poorly differentiated, advanced, right-sided tumors. This is in contrast to a predominance of well-differentiated, less advanced, rectosigmoid lesions in the older patients. There was no age-related difference in the incidence of mucin-producing tumors. Overall 5-year survival was 75% in older patients, in contrast to only 51% in younger patients (P = 0.01). We conclude in this study that it is advanced stage at presentation that is the most significant prognostic indicator in patients of all ages. The high incidence of poorly differentiated, right-sided tumors is responsible for the majority of young patients presenting with advanced disease, resulting in their poorer prognosis.


Long-term right atrial catheters in patients with malignancies: an Indian experience. Ninety-eight single lumen and two double lumen silicone right atrial Hickman/Broviac catheters inserted in 91 patients with various malignancies over a period of 36 months were prospectively studied. The average duration of use for all Hickman/Broviac catheters was 7,460 days with an average of 74.6 days. A total of 41 episodes of catheter-related infections were documented in all patients (0.5 per 100 access days). Catheter related bacteremia was the most frequent type of infection (31 out of 41, 75%). Majority of the bacteremias could be controlled with routine antimicrobial therapy. Exit site infections were seen in 5 Hickman/Broviac catheters. Two catheters had to be removed because of catheter tunnel infections. Gram negative bacteremic infections were the most common, with Pseudomonas aeruginosa being the major pathogen. Silicone rubber Hickman/Broviac catheters proved to be convenient, reliable, and easily manageable devices in our experience.


Synergistic effects of intratumor administration of cis-diamminedichloroplatinum(II) combined with local hyperthermia in melanoma bearing mice. The synergistic effect of local hyperthermia (LHT) with intratumor injection (i.t.) of cis-diamminedichloroplatinum (II) (DDP) was studied using a rodent model with implanted B16 melanoma tumors. The hindfoot of the C57BL/6 mouse bearing the tumor was placed in a water bath at 42.5 +/- 0.2 degrees C (intratumor temperature was at 42.3 +/- 0.1 degrees C) for 30 minutes just after local (i.t.) or systemic (intraperitoneal;i.p.) administration of DDP (1-3 mg/kg once in experiment I and 1-3 mg/kg three times in experiment II). The tumor growth ratio (TGR) at 7 days after treatment in the group given DDP 3 mg/kg (i.t.) with LHT was 1.1 in experiment I and 0.5 in experiment II, and there was a statistically significant difference in both experiments compared to findings in other groups (P < 0.01). The mean survival time was 42.1 days in experiment I and 50.2 days in experiment II, with a significant difference in the latter (P < 0.001). Thus regional injection chemotherapy given concomitantly with local hyperthermia promotes the anticancer effects and improves the prognosis without either severe renal injury or the promotion of hematogenic metastasis.


Biological monitoring of cancer chemoprevention. A major limiting factor in the successful implementation of cancer chemoprevention trials has been the determination of endpoints to measure efficacy and success. The use of the ultimate goal of such trials, namely, cancer incidence, as an endpoint has serious feasibility problems, including the need for large numbers of participants, long follow-up periods, and high costs. The application of biological markers as intermediate endpoints to reveal responses to chemopreventive agents within a short time and to act as surrogates for cancer is an attractive concept worthy of intense investigation. This study reviews some potential biological markers, including genetic, cellular, biochemical, and immunological, as well as their possible application to cancer chemoprevention.


Surgical treatment of colon and rectum adenocarcinoma in elderly patients. The results are presented of disease-free interval and overall survival in 53 elderly patients with colon or rectum adenocarcinoma treated with curative surgery. The average age was 75.3 years (median = 75.0); 21 patients were male and 32 were female. Tumor location was as follows: rectum 18 (34%), sigmoid 17 (32.1%), right colon 14 (26.4%), and transverse colon 4 (7.5%) All patients were surgically treated following the classical patterns for tumor resection. After pathological examination, which included the histological grade differentiation, the disease stage was reevaluated following the pTNM system. Overall and disease-free survival at 5 years, for all patients, independent of histological grade differentiation and disease stage, were 75.3% and 55.5%, respectively. Overall survival at 5 years for patients with grades I and II histological differentiation was 74.1% and 85.0%, respectively. None of the grade III patients (2 cases) survived more than 1 year. The 5 years disease-free survival for patients with histological grade differentiation I and II was 56.8% and 60%, respectively. There was no statistically significant difference in overall survival for patients with stages SI, SII, and SIII, but the disease-free survival at 5 years by stages was found to be significant with rates of 100%, 67.6%, and 22.6%. Postoperative mortality was 4 (7.5%). The postoperative mortality and survival rates obtained in this group of patients encourage us not to consider age as a limiting factor for curative surgical treatment.


Mucinous biliary cystadenoma: a case report and review of the literature. Mucinous biliary cystadenomas are rare neoplasms with protean manifestations. In most cases the mucinous material is retained within the cyst itself. We describe an asymptomatic case of a mucin secreting biliary cystadenoma in which the mucin presented as an amorphous intraluminal filling defect in the common hepatic duct on endoscopic retrograde cholangiopancreatography (ERCP). The neoplasm itself was confined to the posterior segment of the right hepatic lobe and was treated by formal right hepatic lobectomy. This case prompted a review of mucinous biliary cystadenomas.


Metastatic breast carcinoma presenting as persistent diarrhea. Patients with breast carcinoma metastatic to the colon generally present with multiple symptoms, usually pain, vomiting, nausea, and ascites. We describe a patient who presented only with persistent diarrhea, underwent surgery for colon cancer, and, on pathological evaluation of the surgical specimen, was found to have metastatic breast cancer affecting the colon. Metastatic breast cancer should therefore be suspected in patients with a history of breast cancer and diarrhea of unknown cause that is not accompanied by other symptoms. Evaluating such patients by colonoscopy and biopsy would provide important information relevant to choosing between colon surgery and systemic therapy.


Staging invasive bladder tumors.

Staging invasive bladder tumors. Staging of bladder tumors is based primarily on the depth of tumor invasion (T-category). Stage is important to treatment planning and prognosis. The problem is that clinical evaluation by T-category alone often understages the pathologic extent of disease and does not reliably predict treatment results. The current analysis shows that the presence of a mass palpable on bimanual examination is of prognostic value. Incorporating tumor volume with microscopic tumor invasion may enhance the usefulness of clinical staging.


Noncurative resection for advanced gastric cancer. Between 1965 and 1985, 489 patients with advanced gastric cancer who were treated with gastric resection and in whom tumor cells remained after the operation were defined as cases of a "noncurative resection." The clinicopathological features and prognosis of these patients were examined and two groups were prepared: locally advanced cancer and cancer with a distant metastasis. In locally advanced cancer cases, tumor cells remained in the neighboring organs, lymph nodes, and/or resected margins; in those with distant metastasis, peritoneal dissemination and/or liver metastasis were present regardless of whether or not the metastasis was removed, with or without locally noncurative factors. Serosal invasion was prominent and high rates of lymph node metastasis and lymphatic involvement were evident in both groups. The survival rate for patients with locally advanced gastric cancer was better than that of patients with distant metastasis (P < 0.01). Survival time in patients with locally advanced cancer can be lengthened by resecting all of the primary tumor and as much of the metastatic lesions as possible, even if the surgical management is "noncurative." Aggressive postoperative chemotherapy for patients with distant metastasis from a gastric cancer is to be recommended.


Gamma probe location of 111indium-labeled B72.3: an extension of immunoscintigraphy. Eight colorectal and 5 ovarian cancer patients were evaluated with preoperative immunoscintigraphy and intraoperative gamma probe detection of 111indium-labeled monoclonal antibody B72.3. Immunoscintigraphy detected the presence of tumor in every patient shown to have tumor at surgery. There was one false-positive scan. A total of 21 pathologically verified lesions were identified at surgery in the 11 patients with tumor. Immunoscintigraphy localized 12 (57%) and intraoperative gamma probe detection located 17 (81%) of the lesions. Intraoperative probe detection located 6 of 8 lesions smaller than 1 cm and 3 lesions that were not identified on initial surgical exploration. The gamma probe offers information that is complementary to immunoscintigraphy in that (1) it aids the surgeon in locating intra- and extra-abdominal lesions previously identified by immunoscintigraphy, (2) it locates lesions too small to be seen by immunoscintigraphy alone, (3) it locates lesions that otherwise might be missed at surgery, and (4) it provides objective evidence for adequacy of surgical resection of cancer in the abdominal cavity.


Clinicopathologic comparisons between estrogen receptor-positive and -negative gastric cancers. We report that a modified dextran-coated charcoal (DCC) assay, including the addition of sodium molybdate and 5% DCC stripping of endogenous hormone, detected higher estrogen receptors (ERs) than those by the conventional assay. ERs in 21 gastric adenocarcinoma were determined by the modified DCC assay; 13 patients had ERs of 2.5 to 520.2 fmol/mg protein with a mean dissociation constant of 1.9 x 10(-10) M. The remaining 8 patients had no detectable amount of the receptor. There were no differences between the ER-positive and ER-negative groups in clinico-pathologic characteristics such as age, sex, tumor size, location, gross appearance, invasive depth, invasion of lymph vessel or vein of stomach wall, nodal involvement, peritoneal dissemination, liver metastasis, and curability. Histological analysis, using Japanese, Lauren's, or Ming's classifications, all revealed no differences between the ER-positive and -negative groups. The survival rate was identical for the 2 study groups. These results suggest that the presence or absence of ERs in gastric adenocarcinoma does not correlate to either biologic or clinicopathologic characteristics of this tumor; the role of ERs in human gastric cancer remains to be elucidated.


Complications of radical vulvectomy and inguinal lymphadenectomy for the treatment of carcinoma of the vulva. Forty-two patients with invasive carcinoma of the vulva, subjected to radical vulvectomy and inguinal lymphadenectomy, were evaluated retrospectively. The mean age of patients was 61.6 years. Fifteen patients (35.7%) had complicating medical diseases, the histopathological diagnoses were squamous carcinoma (n = 39), undifferentiated carcinoma (n = 1), and malignant melanoma (n = 2). The postoperative morbidity and mortality rates were found to be 73.8% and 11.6%, respectively.


Cystic neoplasms of the pancreas: a heterogeneous disorder. Cystic neoplasms of the pancreas are rare tumors with a relatively better prognosis as compared to other pancreatic cancers. They may be mistaken for pseudocysts. Seventeen patients who underwent surgical resection were analyzed. Seventy percent of the patients were females and 76.7% of the tumors were located in the tail of the pancreas. Preoperative diagnosis was made on the basis of ultrasonography and/or computed tomography findings in 60% of patients. Retrospective review of the imaging modalities revealed one or more findings suggestive of cystic neoplasms in 90% of the patients. These included multiloculated cysts, thickened cyst wall, intracystic mass or calcifications, and presence of liver metastasis. All the tumors were completely or partly excised. The final histopathological diagnosis was microcystic adenoma in 2, mucinous cyst adenoma in 1, papillary cystic neoplasm in 3, cystic neuroendocrine tumor in 5, and cystadenocarcinoma in 6. Of the 17 patients, 10 had malignant tumors. Seven patients with benign tumors and 3 patients with malignant tumors are disease free 12-30 months after resection. Cystic neoplasm must always be considered as a possibility when dealing with cystic lesions of the pancreas and a careful evaluation of ultrasonography and computed tomographic scan may give a clue to the diagnosis.


Transhiatal and transthoracic esophagectomy: a comparative study. From January 1981 to December 1990, 55 consecutive patients underwent esophageal resection by either the transhiatal (THE, 26 patients) or transthoracic (TTE, 29 patients) approach. Patient age, tumor size, and tumor stage were similar in the two groups. THE patients had a significantly worse mean preoperative American Society of Anesthesiologists (ASA) risk class assigned by the anesthesiologist. Patients who underwent THE had a significantly lower operative mortality and rate of cardiopulmonary complications, significantly shorter intensive care unit and hospital length of stay, and a significantly better postoperative survival when operative deaths are included in the analysis. Operative deaths in the TTE group were concentrated among patients > 65 years of age (4 of 9 died), in an ASA risk class > or = III (3 of 7 died) or with moderate or severe cardiac or pulmonary impairment preoperatively (4 of 6 died).


Antitumor effect of triphenylethylene derivative (TAT-59) against human breast carcinoma xenografts in nude mice. The antitumor activity of a newly synthesized triphenylethylene derivative [(E)-4-[1-[4-[2-(dimethylamino)ethoxy-phenyl]-2-(4-isopropyl)phenyl-1- butenyl] phenyl monophosphate] (TAT-59) was investigated against human breast carcinoma xenografts in nude mice with reference to the changes of hormone receptors. Five strains (MCF-7, Br-10, R-27, ZR-75-1, and T-61) used for the experiments possessed cytosol estrogen receptor (ER), and their growth was estradiol dependent. Five mg of TAT-59 and tamoxifen citrate (TAM) per kg were administered p.o. daily except Sunday. TAT-59 showed a positive antitumor effect against MCF-7 and R-27, whereas TAM was effective on MCF-7, and their adverse effects detected by mortality rate, body weight loss, and spleen weight loss were similar to each other. The reduction of ER and production of progesterone receptor (PgR) after the treatment with TAT-59 were more potent than after TAM, suggesting that TAT-59 exerts its antitumor effect through binding to ER. These findings suggest that TAT-59 might merit use in clinical trials with breast cancers.


Management of long-term postirradiation periclavicular complications. Four cases of periclavicular postirradiation sarcoma and two cases of clavicular osteoradionecrosis with pathologic fractures are reported. All six cases presented more than 10 years after irradiation for breast cancer (five) or nasopharyngeal carcinoma (one). A review of radiotherapy received showed that they were subjected to unconventional radiation schedules (hypofractionation or high dose per fraction treatment). An approach to diagnosis and management of periclavicular lesions arising long after therapeutic irradiation is presented and the unique problems encountered with periclavicular surgery are discussed.


Early drain removal following modified radical mastectomy: a randomized trial. The dilemma of increasing costs of medical care and shrinking health budgets has stimulated attempts to implement stricter control on expenditure without affecting the quality of care. This study shows that in patients with operable breast cancer, a policy of early discharge after a mastectomy did not have deleterious effects on wound healing and was well accepted by patients. In a randomized trial, drains were removed after either 3 or 6 days postmastectomy, and in both groups of patients there was no difference between the mean volumes of seromas aspirated or the number of aspirations and return visits to the hospital. This suggests that a policy of early discharge is safe, acceptable, economical, and may improve bed utilization.


Primary gastrointestinal lymphomas in Turkey: a retrospective analysis of clinical features and results of treatment. Thirty-three patients with primary gastrointestinal lymphoma (GIL) followed at Ankara University Medical School have been evaluated. The most frequent locations of the disease are the small intestine (48.4%) and the stomach (39.3%). The intermediate and high grade lymphomas constitute 84.8% of the cases. The mean age of the patients with small intestinal lymphoma is 28.7 years and 47.1 years for those with gastric lymphoma. The patients treated with surgery and chemotherapy (S+CT) have a longer survival than those treated with chemotherapy (CT) alone. 1) Small intestinal lymphoma occurs more frequently than gastric lymphoma in our study. 2) The median age of the Turkish patients with primary GIL is approximately 10 years less than those in the Western countries. 3) The therapeutic results of S+CT are superior to those of CT in the early stages of the disease.


Experimental chemotherapy for xenograft cell lines of human bile duct and gall bladder cancers in nude mice. Most biliary tract cancers are advanced and inoperable when first diagnosed. Even if surgery can be performed, the postsurgical prognosis of these diseases is poor. In the present study, we investigated effective chemotherapies for a human bile duct cancer xenograft cell line (undifferentiated carcinoma, BDC-SN) and a gall bladder cancer xenograft cell line (well-differentiated adenocarcinoma, GBC-GN), which were transplanted into nude mice. Eight anticancer agents (CDDP, 5-FU, VDS, MMC, ADR, EPIR, CQ, and VP-16) and their various combinations were evaluated at 2-4 times the clinical dose. When used singly, CDDP, 5-FU, and VDS were effective against BDC-SN, and only CDDP was effective against GBC-GN. Among the various 2-agent combinations, CDDP + 5-FU was the most effective against both BDC-SN and GBC-GN. However, 3-agent combinations consisting of CDDP + 5-FU + another agent were less effective than the CDDP + 5-FU double regimen and caused significant loss of weight as well as high mortality. These results suggest that CDDP + 5-FU may be the most useful regimen against biliary tract cancers in clinical application.


The effect of vagotomy and pyloroplasty on colorectal tumor induction in the rat. Epidemiologic studies have suggested that vagotomy increases subsequent colorectal cancer risk. This hypothesis was investigated in the rat 1,2 dimethylhydrazine (DMH) colorectal carcinogenesis model. Eighty-five rats were divided into four groups having either truncal vagotomy and Heineke-Mickulicz pyloroplasty, pyloroplasty alone, laparotomy alone, and anesthesia alone. After recovery from the procedures, colon tumors were induced with five injections of DMH. Results of carcinogenesis show a trend towards increased incidence and yield of colorectal and duodenal tumors after vagotomy, though this was not statistically significant, perhaps because the high postoperative mortality from vagotomy diminished the power of the study.


Bowel perforation due to metastatic lung cancer. Lung cancer infrequently metastasizes to the bowel. When this occurs, the symptoms may vary from mild to emergent in nature. Three patients are presented illustrating the life threatening complications that may occur due to bowel metastases of lung carcinoma. A review of the literature reveals that only four of 24 reported patients have survived bowel perforation due to metastatic lung carcinoma. One of the three patients presented herein survived to be discharged home. Patients with known lung carcinoma who develop abdominal complaints should be investigated aggressively to prevent life-threatening complications by early intervention.


A method for investigating hepatocyte polyploidization kinetics during postnatal development in mammals. A method for investigating weakly-proliferating cell populations of liver parenchyma on the basis of a quantitative analysis of hepatocyte polyploidization during postnatal development is described. The method uses a mathematical model which characterizes the hepatocyte polyploidization process, and incorporates data concerning the time course for relative frequencies of hepatocytes in different ploidy classes. As a result of these measurements and calculations for rat liver, transition rates of hepatocytes (the relative number of cells during a given time unit) from one ploidy class to another, and a coefficient for the reduction of hepatocyte mitotic activity with an increase in its ploidy class were obtained. Calculated curves show a good correspondence with the real process of hepatocyte frequency changes as they relate to changes in the age of the animals. To check this method, experiments investigating time changes of autoradiographic label content in the different ploidy classes of hepatocytes were carried out. By mathematically modeling the label diluting process resulting from cell proliferation and polyploidization, transition rates of hepatocytes were calculated, and they reflect values calculated from the model according to changes in occurrence frequencies.


Phenotypic evolution under gene-culture transmission in structured populations. I consider a simple model for the evolution of a quantitative character is structured populations when an offspring's phenotype is determined partly by his or her genetic constitution and partly by cultural transmission of the parental phenotype. Analysis of the model indicates that when individual and group selection are in the same direction, phenotypic evolution always proceeds faster under gene-culture vs. purely genetic transmission. When individual and group selection are countervailing, altruistic characters evolve faster under gene-culture transmission when individual selection is weak and migration among groups is limited, with increased individual selection and migration tending to decrease the advantage of gene-culture transmission over purely genetic transmission. Given the prevalence of cultural transmission in higher species, these results suggest that contrary to what is often assumed, group selection may indeed by a potent evolutionary force in the evolution of altruistic characters.