A case-control study of oral contraceptive use and invasive epithelial ovarian cancer

The relation of oral contraceptive use to the risk of ovarian cancer was assessed with data collected during 1977-1991 from patients under 65 years of age in hospitals in Boston, New York, Philadelphia, and Baltimore. We compared 441 women with recently diagnosed invasive epithelial ovarian cancer to 2,065 control women. Logistic regression was used to control risk factors for ovarian cancer. The multivariate relative risk estimate decreased with the increasing duration of oral contraceptive use (p < 0.05): the estimate was close to 1.0 for duration categories of less than 3 years; it was reduced for the categories of 3-4 years of use and greater, but it did not decline further as the duration of use increased. For > or = 3 years of use, the estimate was 0.6 (95% confidence interval 0.4-0.8). The inverse association of risk with > or = 3 years of use was consistently present across categories of age, parity, interview year, and geographic area. It was apparent for as long as 15-19 years after cessation. Many different specific oral contraceptive formulations appeared related to a decreased risk; however, data were sparse for the newer types, particularly phasic preparations, and the ability to assess specific preparations in the context of use of multiple preparations was limited. The present data confirm previous reports of an inverse association of ovarian cancer risk with oral contraceptive use of several years in duration. They also suggest that the association may persist for as long as two decades and that it is not confined to any particular type of oral contraceptive formulation.

An outbreak of phytophotodermatitis due to celery

BACKGROUND

Celery is known to contain psoralens, a group of substances that cause a toxic dermal reaction on exposure to ultraviolet A rays (UVA). An outbreak of phytophotodermatitis amongst 11 workers in a celery harvest in southern Israel is reported.

METHODS

Analysis of the trigger factors was carried out. The patients were questioned regarding their working conditions. Samples of the celery that the workers had been harvesting were analyzed for levels of total psoralens by means of high performance liquid chromatography (HPLC). Levels of UVA were measured.

RESULTS

It was found that the celery harvested in the south of the country contained 84 micrograms/g fresh weight (f.wt.) total psoralens as compared to 35 micrograms/g f.wt. in celery harvested in the north of the country at the same time. The following year the celery harvested in the south contained only 26 micrograms/g f.wt. total psoralens. Other risk factors noted were that the subjects had fair skin, wore no protective clothing, and worked with moist hands. In addition, the days were clear and sunny thus ensuring maximal UV radiation for that time of the year.

CONCLUSIONS

Multiple factors contributed to the outbreak of phytophotodermatitis. A late harvest in the south of the country is incriminated as the cause of the unusually high levels of psoralens in the celery of that year.

The effect of glucose on proteoglycans produced by cultured mesangial cells

Altered proteoglycan metabolism may play a role in the development of diabetic glomerulopathy. This study was conducted to examine the effects of glucose on the production and physical characteristics of proteoglycans generated by rat mesangial cells in culture. Rat mesangial cells were exposed to elevated glucose media (500 mg/dl) or standard glucose media (200 mg/dl) for 8-10 days, and proteoglycan synthesis was determined using 35S-labeling in conjunction with anion exchange and sizing chromatography. Rat mesangial cells generated predominantly chondroitin/dermatan sulfate proteoglycans, with small amounts of heparan sulfate proteoglycans. High glucose did not alter the number of rat mesangial cells after 24 h or after 8-10 days, compared with cells grown under standard glucose conditions. The total amount of glycosaminoglycan generated and the sizes of the major proteoglycans were not different between cultures grown in standard and elevated glucose medium. Levels of mRNA for the proteoglycan, biglycan (as assessed by Northern blot analysis), also were comparable between the standard and elevated glucose conditions. Exposure to media high in glucose did not change the rate of secretion of proteoglycans from the cell layer to the medium, but did result in a greater quantity of radiolabeled proteoglycan deposited in the extracellular matrix. The cell, extracellular matrix and medium proteoglycans isolated from the elevated glucose cultures, consistently eluted from the anion exchange column at a lower [NaCl] compared with those generated under standard glucose conditions, indicating a loss of anionic charges.(ABSTRACT TRUNCATED AT 250 WORDS)

Hormone replacement therapy: the need for reconsideration

Millions of menopausal women are taking hormone supplements. Observational studies suggest that unopposed estrogens reduce the risk of cardiovascular disease and fractures and increase the risk of endometrial cancer and, possibly, breast cancer. In the absence of information from randomized trials, how much of the apparent beneficial effect on heart disease is due to the tendency of healthier women to use these drugs is unknown. The effect on the cardiovascular system of estrogen taken with a progestin is unknown, and this regimen may increase the risk of breast cancer. An approach to health and illness that focuses on a single cause or preventive and on single organ systems is severely limited. Alternative ways to improve cardiovascular and skeletal health that do not increase the risk of cancer are available. A reconsideration of the appropriate use of hormone supplements is needed.

Intercellular communication and maintenance of islet cell mass--implications for islet transplantation

BACKGROUND

The major emphasis in islet transplantation has been the development of methods to enhance islet purity. This focus assumes that islets do not require support from other cellular elements of the pancreas. We chose to examine a possible duct-islet interaction because of the embryologic origin of islets from ductal epithelium.

METHODS

Duct and islet cells were prepared by collagenization of hamster pancreas and purified on a bovine serum albumin gradient. Primary duct cultures were passaged twice. Duct-conditioned medium was collected from the tertiary cultures. Three groups of cultures were established: group 1, 100 islets/plate in minimal medium (Dulbecco's modified Eagle medium/F12); group 2, 100 islets + 40 duct fragments/plate in Dulbecco's modified Eagle medium/F12; and group 3, 100 islets/plate+duct-conditioned medium. After a 3-day incubation, tritiated thymidine (1 microCi/ml) was added for 24 hours. The islets were separated from the ducts by handpicking and then sonicated. DNA was measured (microgram) fluorometrically and tritiated thymidine incorporation, a measure of cell proliferation, was determined in trichloroacetic acid-precipitated material by liquid scintillation. Data (mean +/- SEM) were compared by two-tailed Student's t test.

RESULTS

Tritiated thymidine incorporation into islet cells in minimal medium (81.1 +/- 24.6 disintegrations per minute [dpm]/microgram DNA [n = 8 plates]) was less than 25% (p < 0.001) of that of islet cells cocultured with ducts (323.2 +/- 54.5 dpm/micrograms DNA [n = 6]) or with duct-conditioned medium (389.7 +/- 27.6 dpm/micrograms DNA [n = 5]).

CONCLUSIONS

Pancreatic duct epithelium can stimulate islet cell proliferation in a paracrine manner.

Cyclosporine and islet mass--implications for islet transplantation

Cyclosporine (CsA) is an inhibitor of ornithine decarboxylase (ODC), a key enzymatic step in cell proliferation. The purpose of this study was to determine the effect of CsA on islet cell mass. Partial obstruction (PDO) of the hamster pancreas is an established model of islet cell differentiation and proliferation in which regeneration is mediated by the induction of trophic activity (TA) that can be extracted from the pancreas. In Part 1 of these studies, hamsters were randomized to (i) Control (n = 5); (ii) PDO alone (n = 5); (iii) PDO + CsA (20 mg/kg ip daily) (n = 5); (iv) CsA alone (n = 5). On Day 21, 1 hr prior to sacrifice, animals received tritiated thymidine, 2 microCi/g body wt ip. Pancreata were excised for analysis of islet cell mass (No. islets/mm2) by morphometry and of cell proliferation (islet cell labeling index) by autoradiography. In Part 2 of these studies, hamsters were randomized to receive CsA (n = 34), as in Part 1, or saline (n = 30). After 7 days, animals received 1 ml of TA ip and were sacrificed after 0, 6, 8, and 10 hr. The pancreata were excised and determinations made of organ weight, DNA content, and ODC bioactivity (pmole/CO2/hr/mg DNA). Data (mean +/- SEM) were analyzed by ANOVA. In Part 1, the number of islets/mm2 in the PDO group was increased two-fold compared to control animals, those receiving CsA, and those undergoing PDO with CsA (2.4 +/- 0.1 vs 1.1 +/- 0.0, 1.4 +/- 0.2, 1.2 +/- 0.1, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro stimulation of hamster pancreatic duct growth by an extract derived from the "wrapped" pancreas

Partial obstruction of the hamster pancreas in the cellophane wrap model leads to the induction of duct and ductular proliferation followed by endocrine cell differentiation. This effect appears to be mediated by the local action of a growth factor. The purpose of the present study was to determine if cytosolic extract prepared from the wrapped pancreas had trophic activity on purified hamster pancreatic ductal epithelium in tissue culture. Cultures of purified pancreatic ducts were prepared by digestion of the hamster pancreas using a solution of collagenase type XI and chymotrypsin infused directly into the pancreatic duct. The ducts were separated and purified by a series of steel mesh filtrations. Ducts were embedded in 1.5% Seaplaque agarose and fed a liquid medium containing serum-free Dulbecco's Modified Eagle Medium/Nutrient Mixture F-12 Ham (DME/F-12), 12.5% cytosol extract+DME/F-12, or 25% cytosol extract+DME/F-12. The trophic effect of the extract on the tissue in culture was evaluated by the incorporation of tritiated thymidine ([3H]TdR) into DNA. Duct fragments cultured in medium supplemented with 12.5% cytosol showed no difference in their [3H]TdR uptake compared with control ducts (908 +/- 147 vs. 913 +/- 151 dpm/micrograms DNA). The incorporation of [3H]TdR by ducts maintained in medium supplemented with 25% cytosol extract was increased 78% over serum-free controls (1,632 +/- 386 vs. 913 +/- 147 dpm/micrograms DNA; p < 0.025). We conclude that a cytosol extract prepared from the partially obstructed cellophane-wrapped pancreas contains a factor(s) trophic for pancreatic ductal cells.

A case-control study of baldness in relation to myocardial infarction in men

OBJECTIVE

To examine the relationship between male pattern baldness and the risk of myocardial infarction in men under the age of 55 years.

DESIGN AND PARTICIPANTS

A hospital-based, case-control study was conducted in eastern Massachusetts and Rhode Island. Cases were men admitted to a hospital for a first nonfatal myocardial infarction (n = 665); controls were men admitted to the same hospitals with noncardiac diagnoses (n = 772). Extent of baldness was assessed using the 12-point modified Hamilton Baldness Scale; other information was obtained by personal interview. Among the controls, the prevalence of any baldness was 34%, while the prevalence of baldness involving the vertex scalp was 23%.

RESULTS

After allowing for age, the relative risk estimate for frontal baldness compared with no hair loss was 0.9 (95% confidence interval, 0.6 to 1.3), for baldness involving the vertex scalp it was 1.4 (95% confidence interval, 1.2 to 1.9). Risk of myocardial infarction increased as the degree of vertex baldness increased (P < .01); for severe vertex baldness the relative risk was 3.4 (95% confidence interval, 1.7 to 7.0). The relationship between vertex baldness and myocardial infarction was consistent within strata defined by age and other risk factors for coronary artery disease.

CONCLUSION

These data support the hypothesis that male pattern baldness involving the vertex scalp is associated with coronary artery disease in men under the age of 55 years.

Basal cell carcinoma of the male nipple. Case report and review of the literature

BACKGROUND

Basal cell carcinoma (BCC) of the nipple is a very unusual occurrence, often mistaken for Paget's disease.

OBJECTIVE

By reporting a further case of BCC of the nipple in a 57-year-old man and by reviewing the sixteen previously reported cases, we mean to characterize further a common lesion arising at an unusual site. We also wish to stress the lack of agreement regarding the treatment of BCC of the nipple.

METHODS

Review of the literature was based on a search in Medline.

CONCLUSIONS

We appeal to compile all cases of BCC arising at unusual locations in order to gain a better understanding of these lesions.

A case-control study of myocardial infarction in relation to use of estrogen supplements

Observational epidemiologic studies suggest that the incidence of cardiovascular disease is reduced by about 50% in users of unopposed estrogens, but the reduction may have been overestimated because of a greater tendency for women at lower risk to use estrogens. To minimize bias due to such behavior, the authors conducted a case-control study of first myocardial infarction among Massachusetts women aged 45-69 years during 1986-1990, in which each of 858 cases was age-matched with a control from the same geographic area, and important correlates of estrogen use and myocardial infarction were controlled by conditional logistic regression. The estimated relative risk was 0.9 for ever use of unopposed estrogen (95% confidence interval 0.7-1.2); the estimate decreased with increasing duration of use to 0.6 for 5 or more years of use (p for trend = 0.08). The association with long-term use was stronger for recent use (p for trend < 0.05) than for past use (p for trend = 0.86). There were insufficient data to evaluate estrogens taken together with progestins. The results suggest that unopposed estrogen use may reduce the risk of first myocardial infarction, that the reduction is related to the duration and recency of use, and that it may be smaller than previously believed. Despite efforts to control confounding, observational studies cannot rule out the possibility that a tendency for women at lower risk for myocardial infarction to use estrogens has contributed to the reduced risk in estrogen users, and randomized trials are needed.

The house of difference: gender, culture, and the subject-in-process on the American stage

A lesbian woman of color is often defined by her multiple differences as "other" and/or "object." Yet these very differences can also allow her to challenge culturally held notions of gender, subjectivity, and representation. This article examines one such example, Cherríe Moraga's teatro Giving Up the Ghost where, for the first time, the issue of Chicana lesbian sexuality is addressed on the stage.

A case-control study of the risk of breast cancer in relation to oral contraceptive use

The relation of oral contraceptive use to the risk of breast cancer was evaluated in a case-control study of women under the age of 70 years, conducted in Toronto, Canada, from 1982 through 1986. A total of 607 breast cancer cases identified in a cancer hospital were compared with 1,214 controls matched to the cases on neighborhood and decade of age. Information on oral contraceptive use and risk factors for breast cancer was collected in home interviews. Conditional logistic regression was used to control multiple confounding factors. For women aged 40-69 years (527 cases, 1,054 controls), the results suggest that oral contraceptive use does not increase the risk of breast cancer. Multivariate relative risk estimates were close to or below 1.0 for long durations of use overall and in various categories of parity status and other factors. For women under the age of 40 years, the data were sparse (80 cases, 160 controls). Although there were some elevated relative risk estimates, most were not statistically significant, and there were no consistent patterns across duration of use. The present data add to the body of evidence that indicates that oral contraceptive use does not adversely affect the risk of breast cancer in older women; the data are inadequate to clarify the effect in younger women.