Papillomaviruses in lesions of the lower genital tract in Israeli patients

Human papillomaviruses (HPVs) have been strongly associated with benign lesions of the genital tract (condylomata) and with genital cancer of the vulva and cervix. Since the incidence of these lesions in Israel is considered to be low, we have studied the presence of HPV 6, 11, 16 and 18 DNAs in benign, premalignant and malignant tissue samples or gynecological swabs of the lower genital tract. HPV sequences were detected in 48 out of 66 condylomatous lesions (72%), 5/11 grades I-II intraepithelial neoplasia (45%), 4/6 grade III intraepithelial neoplasia (carcinoma in situ) (66.6%) and 8/22 invasive carcinoma (36%). The latter included six cases of vulvar carcinoma which were all negative for HPV sequences. No additional HPV types could be detected in any of the tissue biopsies examined. HPV 18 DNA has been found in one vulvar condyloma where it persisted as an episomal molecule, this being the first report of that specific viral DNA in a condylomatous lesion. In all the benign and premalignant lesions containing HPV, the viral sequences were maintained in an episomal state. In two cases of invasive carcinoma, the HPV 16/18 related sequences were integrated in the cellular genome, but in five cases (three containing HPV 16/18 related DNAs and two containing HPV 6/11 related DNAs) the viral sequences were episomal. HPV 16/18 related sequences detected in one out of three cases of vaginal carcinoma were also found to be episomal. This data indicates that human papillomavirus sequences are indeed found in genital lesions of Israeli patients, although to a lesser extent than in other countries, especially for benign lesions and invasive carcinomas. Although HPVs may have a causative role in the development of genital lesions, also in this low tumor incidence area, other factors should be also considered in the etiology of these lesions.

Nutritional value and safety of methionine derivatives, isomeric dipeptides and hydroxy analogs in mice

Weight gains in mice fed amino acid diets containing methionine and 16 methionine derivatives and analogs were compared at graded dietary concentrations. Linear response was closely approximated for concentrations below those yielding maximum growth. Derivatization of L-methionine generally lowered potency, calculated as the ratio of the slopes of the two dose-response curves. However, the three isomeric dipeptides L-L-, L-D- and D-L-methionylmethionine, N-acetyl- and N-formyl-L-methionine, L-methionine sulfoxide and D-methionine were well utilized. The double derivative N-acetyl-L-methionine sulfoxide reduced potency below 60%. D-Methionine sulfoxide, N-acetyl-D-methionine and D-methionyl-D-methionine had potencies between 4 and 40%. The calcium salts of L- and D-alpha-hydroxy analogs of methionine had potencies of 55.4 and 85.7%, respectively. Several of the analogs were less growth-inhibiting or toxic at high concentrations in the diet than was L-methionine. These results imply that some methionine dipeptides or analogs may be better candidates for fortifying foods than L-methionine. Possible biochemical pathways for the utilization of methionine derivatives and analogs are also described.

Protein reactions with methyl and ethyl vinyl sulfones

Disulfide bonds of bovine serum albumin and wool were reduced by n-tributylphosphine to sulfhydryl groups that were then modified by methyl or ethyl vinyl sulfone in a nucleophilic addition reaction to S-(beta-ethylsulfonylmethyl)-L-cysteine and S(beta-ethylsulfonylethyl)-L-cysteine, respectively. The reductive alkylation was carried out either simultaneously, with both the reducing and alkylating agents present in the reaction mixture, or sequentially, with the reduced proteins first isolated before alkylation. Amino acid analysis studies showed that authentic, synthetic S-(beta-ethylsulfonylethyl)-L-cysteine eluted as a well-resolved peak after serine but that the peak associated with the corresponding methyl derivative overlapped the corresponding peak due to threonine. The extent of alkylation of the sulfhydryl groups of cysteine, epsilon-NH2 of lysine, and NH groups of the imidazole ring of histidine was also measured by amino acid analysis. The results show that alkyl vinyl sulfones have a strong chemical affinity for protein functional groups.

Diagnostic imaging techniques in thyroid cancer

With the refinement of fine-needle aspiration, the specific applications of thyroid imaging techniques need to be reevaluated for efficiency and cost containment. No thyroid imaging test should be routinely obtained. Radionuclide scanning is most beneficial in evaluating the functional status of thyroid nodules when fine-needle aspiration is inadequate, the findings are benign, or when there is no discrete nodule that is palpated in an enlarged gland. When fine-needle aspiration is unavailable or unreliable, radionuclide scanning becomes a first-line diagnostic tool. Ultrasonography should be used primarily for identifying a solid component of a cystic nodule, determining the size of nodules on thyroxine suppression that are not easily palpable, or for performing guided fine-needle aspiration. Computerized tomography and magnetic resonance imaging both have a definite role in the evaluation of thyroid tumors. Magnetic resonance imaging is superior to computerized tomography for the evaluation of metastatic, retrotracheal, or mediastinal involvement of large thyroid tumors or goiters. Careful selection of the diagnostic techniques will ensure more accurate diagnosis and reduce unnecessary patient costs in the treatment of thyroid cancer.

The application of a two-stage design for clinical trials in patients with recurrent head and neck cancer

Cytotoxic chemotherapy produces modest benefits for patients with recurrent and metastatic squamous cell carcinoma of the head and neck (SCCHN). Prospective randomized clinical trials have failed to demonstrate unequivocal superiority of aggressive multidrug regimens over single agents. Despite this, phase II trials frequently result in encouraging preliminary observations that compare favorably to historical single-agent data. While providing for a useful method of screening for anti-tumor activity, phase II studies have limited use in determining the relative value of a new treatment program. Results of phase II studies are considerably influenced by patient selection factors and criteria used to establish therapeutic benefits (responses). Furthermore, estimations of true levels of efficacy (response rates) are dependent on sample sizes, which are usually limited in such trials. We propose that newly developed combinations containing at least one known active agent in this disease should be tested in a controlled setting after their toxicity pattern has been well established. The conduct of the usual phase II study in these situations will probably not provide useful new information, since responses are likely to be observed. We describe a two-stage design applied to terminate a trial if at the first stage there is no evidence of improvement over the control arm. This method allows for early termination of studies involving relatively inefficient treatment regimens and, at the same time, continuation of those with a high likelihood to result in significant therapeutic improvements over a control arm. Loss of power is negligible and sample sizes can be reduced significantly. The rationale behind this method and its simplicity are attractive features for a widespread application for new drug development strategies in this and other diseases.

Medical treatment of hepatocellular carcinoma

Hepatocellular carcinoma is a rapidly fatal disease in most patients. In addition, many patients have underlying liver disease complicating their treatment. Prognostic factors have been found that identify a subset of patients who could benefit from therapy; though to date, chemotherapy, administered either intravenously or intra-arterially, has not altered the survival of patients who have advanced or recurrent disease. Patients with unfavorable prognostic factors, such as poor performance status, jaundice, or overt liver failure, should be offered only supportive care. Treatment with intravenous doxorubicin may be considered in better risk patients outside a clinical trial, although it has limited activity (less than 20 per cent response rate). Good performance status patients should be placed in clinical trials exploring both new ways to deliver therapy and promising new drugs.

Multiple potential of etched porcelain laminate veneers

In many clinical situations, the etched-porcelain veneers can provide a restoration that looks natural with a minimum of tooth preparation. Application has been equally successful on mandibular and maxillary teeth. Periodontal response to the veneers, when properly placed, has been excellent.

Ozone inhibits endothelial cell cyclooxygenase activity through formation of hydrogen peroxide

We have previously demonstrated that a 2H exposure of cultured pulmonary endothelial cells to ozone (0.0-1.0 ppm) in-vitro resulted in a concentration-dependent reduction of endothelial prostacyclin production (90% decrease at the 1.0 ppm level). Ozone-exposed endothelial cells, incubated with 20 uM arachidonate, also demonstrated a significant inhibition of prostacyclin synthesis. To further examine the mechanisms of the inhibition of prostacyclin synthesis, bovine pulmonary endothelial cells were exposed to 1.0 ppm ozone for 2H. A significant decrease in prostacyclin synthesis was found within 5 min of exposure (77 +/- 36% of air-exposed control values, p less than 0.05). Endothelial prostacyclin synthesis returned to baseline levels by 12H after ozone exposure, a time point which was similar to the recovery time of unexposed endothelium treated with 0.5 uM acetylsalicylic acid. Incubation of endothelial cells, previously exposed to 1.0 ppm ozone for 2 hours, with 4 uM PGH2 resulted in restoration of essentially normal prostacyclin synthesis. When endothelial cells were co-incubated with catalase (5 U/ml) during ozone exposure, no inhibition of prostacyclin synthesis was observed. Co-incubation with either heat-inactivated catalase or superoxide dismutase (10 U/ml) did not affect the ozone-induced inhibition of prostacyclin synthesis. These data suggest that H2O2 is a major toxic species produced in endothelial cells during ozone exposure and responsible for the inhibition of endothelial cyclooxygenase activity.

Keloid scars as a result of CO2 laser for molluscum contagiosum

Molluscum contagiosum is an infectious disease of the skin, found primarily on the thighs and genitalia. It is a sexually transmitted disease of increasing prevalence. The traditional treatment of this condition is surgical ablation, although CO2 laser has been advocated recently as an alternative mode of therapy. Six patients with molluscum contagiosum were treated by either continuous or intermittent CO2 laser. Four of the six have developed severe keloid scars. Removal of lesions by cold knife, however, was not followed by keloid scars. In the same patient, areas affected by human papillomavirus that were treated with CO2 laser did not develop keloid scars. Our results question the use of CO2 laser therapy for molluscum contagiosum.

Problem-based clinical confrontation modules planned and conducted by students

A course has been described which attempts to introduce clinical relevancy to the basic science knowledge. It has been demonstrated how senior students' feedback about curricular shortcomings can be redirected to their constructive participation in the educational process. The described Clinical Confrontation course develops problem-solving skills and self-learning habits in the learners while they are processing and rearranging prior knowledge. At the same time, both the scientific base of medicine and the internal logic of the disciplines are preserved.

Pharmacokinetic analysis of sustained-release dosage forms of theophylline in humans: comparison of single and multiple dose studies

A pharmacokinetic analysis of two sustained-release dosage forms of theophylline (Theo-Dur and Theotrim) was carried out following single and multiple dose administrations of the two formulations in five healthy subjects. Despite the prolonged absorption after administration of the two sustained-release formulations, theoretical predictions of theophylline steady-state levels following multiple dosages based upon data obtained from the single dose study, correlated with the data of the multiple dose study. This study shows that the recommended dose and dosage regimen of new sustained-release formulations of theophylline can be based upon single dose studies. In the population studied, repetitive doses of 450 mg b.i.d. of Theo-Dur and Theotrim maintain steady-state concentrations of theophylline within the drug's therapeutic window.

Treatment of spastic dysphonia without nerve section

Spastic dysphonia is a disorder characterized by strained, constricted phonation with excessively adducted vocal cords. Despite initial success with recurrent laryngeal nerve section, the search for other treatment continues. Our clinical study involved inserting a needle electrode percutaneously into the region of the recurrent laryngeal nerve in five patients with spastic dysphonia. Electrical stimulation resulted in dramatic improvement in three patients and minimal improvement in two. Our experimental study was designed to create an animal model for an implantable nerve stimulator to be used on a long-term basis. A Medtronic spinal cord stimulation system was implanted into a dog, and a cuff electrode was positioned around the recurrent laryngeal nerve. Vocal cord position could be altered by varying the stimulus frequency. Long-term stimulation of the recurrent laryngeal nerve was relatively safe and effective. Eventually, we plan to implant nerve stimulators into spastic dysphonia patients who respond well to percutaneous stimulation.

Effect of discontinuance of type A behavioral counseling on type A behavior and cardiac recurrence rate of post myocardial infarction patients

Three hundred post infarction participants who had received type A behavioral counseling in the Recurrent Coronary Prevention Project, (RCPP) agreed to be followed for 1 additional year after stopping 4.5 years of continuous type A behavioral counseling. One hundred fourteen participants who had served for 4.5 years as controls in the RCPP Study, thus receiving no type A behavioral counseling, volunteered to receive such counseling for 1 year. Eleven of the 300 previously type A counseled RCPP participants were lost to follow-up at the end of the additional year. The remaining 289 subjects at risk were found to have maintained their previously reduced intensity of type A behavior. Their previously observed relatively low cardiac recurrence rate during the additional year also did not significantly change. Ten of the 114 previous control RCPP participants were lost to follow-up at the end of the additional year. The remaining 104 subjects who had received a year's type A behavioral counseling showed a significantly reduced intensity of type A behavior and a similar significant decrease in both the cardiac mortality and morbidity rate. These results suggest that the decline in the intensity of type A behavior and also in the cardiac recurrence rate previously observed in post infarction subjects exposed to type A behavioral counseling persists for at least 1 year after cessation of such counseling.