Are alcohol intake and smoking associated with mycosis fungoides? A European multicentre case-control study

The incidence of mycosis fungoides (MF) is low, and the aetiology of the disease is unknown. The aim of this study was to investigate whether wine consumption protects against the disease and whether smoking constitutes a risk factor. This paper is part of the European Rare Cancers Study that tries to determine the risk factors for seven selective rare cancers, including mycosis fungoides, involved in the development of cancer. A multicentre case-control study was conducted in six European countries. Only incident cases with confirmed histology were included in the analysis which include a total of 76 cases of MF and 2899 controls. Wine intake had no protective effect; on the contrary the consumption of more than 24 g of alcohol per day was associated with a high risk of MF (odds ratio (OR)=3.02, 95% confidence interval (CI), 1.34-6.79), after adjusting for centre, country, age, sex and education. There was a dose-dependent increase in the risk of MF with increased smoking habits, albeit the observed trend was not statistically significant. A combined exposure to high tobacco and alcohol use yielded a significantly increased risk factor for MF (P=0.0073). Alcohol intake was associated with MF.

The possible role of radiofrequency radiation in the development of uveal melanoma

There are few epidemiologic studies dealing with electromagnetic radiation and uveal melanoma. The majority of these studies are exploratory and are based on job and industry titles only. We conducted a hospital-based and population-based case-control study of uveal melanoma and occupational exposures to different sources of electromagnetic radiation, including radiofrequency radiation. We then pooled these results. We interviewed a total of 118 female and male cases with uveal melanoma and 475 controls matching on sex, age, and study regions. Exposure to radiofrequency-transmitting devices was rated as (a) no radiofrequency radiation exposure, (b) possible exposure to mobile phones, or (c) probable/certain exposure to mobile phones. Exposures were rated independently by two of the authors who did not know case or control status. We used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs). We found an elevated risk for exposure to radiofrequency-transmitting devices (exposure to radio sets, OR = 3.0, 95% CI = 1.4-6.3; probable/certain exposure to mobile phones, OR = 4.2, 95% CI = 1.2-14.5). Other sources of electromagnetic radiation such as high-voltage lines, electrical machines, complex electrical environments, visual display terminals, or radar units were not associated with uveal melanoma. This is the first study describing an association between radiofrequency radiation exposure and uveal melanoma. Several methodologic limitations prevent our results from providing clear evidence on the hypothesized association.

[Risk factors and surgery rates in gallstones. Results of a population-based study]

STUDY OBJECTIVE

The prevalence of gallstone disease, time trends in the frequency of cholecystectomies and risk factors for the occurrence of cholelithiasis were examined in a cross-sectional population study.

METHODS

The survey was based on a random sample from the populations of 4 regions in Germany, stratified by region, age and sex. Information on the frequency of gallstone disease and on potential risk factors were collected by standardized interviews. For the statistical analysis, multiple logistic regression was used.

RESULTS

Overall, 1,085 persons were interviewed. The age-standardized prevalence of known gallstones was 4.2% for men and 14.5% for women. The frequency of cholecystectomy almost tripled in women from 1985 to 1994 as compared to 1975 to 1984 despite a decreasing trend in gallstone diagnoses in the same time period. No such trend was apparent in men. In men, age, body weight, changes in body weight, diabetes and use of corticosteroids were identified as risk factors for gallstone disease. In women, gallstone disease was also associated with body weight, changes in body weight and age, and, in addition, the number of births. An inverse association with gallstone disease was found for use of oral contraceptives and level of education in women.

Sorting the hype from the facts in testicular cancer: is testicular cancer related to trauma?

PURPOSE

The rate of testicular cancer is increasing. Trauma severe enough to cause testicular atrophy is a putative risk factor for testicular cancer but the epidemiological evidence is not conclusive. A population based, multicenter case-control study was performed from 1995 to 1997 to investigate potential risk factors for gonadal and extragonadal germ cell cancer.

MATERIALS AND METHODS

The study was done in 5 German regions. Interviews were performed with 269 eligible male patients with a histologically verified diagnosis and 797 controls. Detailed information on medical and family history was collected at personal interviews.

RESULTS

We identified a significantly elevated risk for testicular cancer in relation to testis and/or groin trauma (odds ratio 2.5, 95% confidence interval [CI] 1.51 to 4.20). After introducing a lag time by excluding reports of trauma within the last 12 months before diagnosis or interview the corresponding odds ratio was 2.1 (95% CI 1.24 to 3.61). Analysis of the circumstances and the reported types of injury allowed us to restrict the study to testis trauma specifically, which had an odds ratio of 3.49 (95% CI 1.78 to 6.81). To account for a potential reporting bias analysis was restricted to traumatic episodes for which medical attention was sought. This restriction resulted in an odds ratio of 0.70 (95% CI 0.19 to 2.63) after excluding from study trauma reports within the last 12 months.

CONCLUSIONS

The results of our study do not support the hypothesis that testicular trauma is an important risk factor for testicular cancer. The possibility of recall bias should be considered.

Molecular and functional diversity of neural connexins in the retina

Electrical synapses (gap junctions) in neuronal circuits have become a major focus in the study of network properties such as synchronization and oscillation (Galarreta and Hestrin, 1999; Gibson et al., 1999). Despite the recent progress made in unraveling the contribution of gap junctions to network behavior, little is known about the molecular composition of the junctional constituents. By cloning gap junction proteins [connexins (Cxs)] from zebrafish retina and through functional expression, we demonstrate that the retina possesses a high degree of connexin diversity, which may account for differential functional properties of electrical synapses. Three new Cxs, designated as zebrafish Cx27.5 (zfCx27.5), zfCx44.1, and zfCx55.5, and the carp ortholog of mammalian Cx43 were cloned. By in situ hybridization and in situ RT-PCR, we demonstrate that the four fish connexin mRNAs show differential localization in the retina. Transient functional expression in paired Xenopus oocytes and in the neuroblastoma N2A cell line indicate an extreme range of electrophysiological properties of these connexins in terms of voltage dependence and unitary conductance. For instance, the new zfCx44.1 exhibited high sensitivity to voltage-induced closure with currents decaying rapidly for transjunctional potentials >10 mV, whereas zfCx55.5 channels showed an opposite voltage dependence in response to voltage steps of either polarity. Moreover, although zfCx44.1 channels showed unitary conductance as high as any previously reported for junctional channels (nearly 300 pS), zfCx55. 5 and zfCx27.5 exhibited much lower unitary conductances (<60 pS).

Occupation and small bowel adenocarcinoma: a European case-control study

OBJECTIVES

Because of the rarity of small bowel adenocarcinoma (SBA), little is known about the aetiology of this disease. This study aimed to identify occupational clustering of cases SBA as a systematic approach to new hypotheses on the aetiology of this disease.

METHODS

A European multicentre case-control study was conducted in 1995-7, inclusive. Incident cases aged 35-69 years with SBA (n=168) were recruited before acceptance by a pathologist. Altogether 107 cases and 3915 controls were accepted, of which 79 cases, 579 colon cancer controls, and 2070 population controls were interviewed.

RESULTS

The strongest industrial risk factors for SBA taking account of 10 years' exposure lag were dry cleaning, manufacture of workwear, mixed farming (women), and manufacture of motor vehicles (men). A significantly increased risk of SBA (odds ratio (OR) and 95% confidence interval (95% CI)) was found among men employed as building caretakers, OR 6.7 (1.7 to 26.0) and women employed as housekeepers, OR 2.2 (1.1 to 4.9); general farm labourers, OR 4.7 (1.8 to 12.2); dockers, OR 2.9 (1.0 to 8.2); dry cleaners or launderers, OR 4.1 (1.2 to 13.6); and textile workers (sewers or embroiderers), OR 2.6 (1.0 to 6.8). For the last four groups, together with welders OR 2.7 (1.1 to 6.6) (men) an exposure-response pattern was found when calculating the ORs for jobs held 1-5 years and >5 years, with never having held the job as reference. The ORs (95% CIs) for 1-5 years and >5 years were 4.3 (0.4 to 44.0) and 3.5 (0.9 to 13.7), 3.0 (0.3 to 26.2) and 4.3 (0.9 to 21.2), 4.6 (0.4 to 48.1) and 11.0 (2.0 to 60.4), 1.3 (0.2 to 11.0) and 5.8 (2.0 to 17.2), and 2.8 (0.3 to 23.8) and 4.6 (1.3 to 16.6), respectively, for each of these occupations. Among welders, people performing semiautomatic arc welding (MIG/MAG) were identified as a high risk group (OR 5.0 (1.3 to 19.6)).

CONCLUSIONS

This explorative study suggests an increased occurrence of SBA in certain occupations, which needs further evaluation.

Is there an association between alcohol intake or smoking and small bowel adenocarcinoma? Results from a European multi-center case-control study

OBJECTIVE

To discover whether tobacco smoking and intake of different types of alcoholic drinks are associated with small bowel adenocarcinoma (SBA).

METHODS

A population-based European multi-center case-control study was conducted from 1995 to 1997.

RESULTS

After a histological review using uniform diagnostic criteria, 47 (33%) of the 142 identified cases of SBA were excluded due to reclassification as either tumors of the papilla of Vater (n = 22), stromal tumors, or metastases; 95 cases were accepted for study. In all, 70 cases of SBA together with 2070 controls matched by age, sex, and region were interviewed. A high intake (more than 24 g alcohol per day) of beer or spirits was associated with SBA, an odds ratio (OR) of 3.5 and 95% confidence intervals (CI) of 1.5-8.0 and 3.4 (95% CI 1.3-9.2), respectively). There was no association with wine intake or total alcohol intake. Tobacco smoking was probably unrelated to SBA.

CONCLUSIONS

A high intake of beer or spirits seems to be a risk factor for SBA. Since this association was not seen for wine drinkers, protective components of wine may counterbalance a carcinogenic effect of alcohol on the small bowel. Alternatively, the result may be confounded by other factors, e.g. dietary factors.

The prognostic value of cyclin D1, p53, and MDM2 protein expression in uveal melanoma

Malignant uveal melanoma is the commonest primary intraocular tumour in adults. It metastasizes frequently and 50% of patients die within 10 years of diagnosis. The expression of cyclin D1, p53, and MDM2 in uveal melanoma and their relationship to metastasis-free 5-year survival was determined, in order to investigate whether these proteins help to distinguish those patients with a favourable prognosis from those with a poorer one. Ninety-six eyes enucleated for uveal melanomas were immunohistochemically analysed for the protein expression of cyclin D1 and related cell-cycle markers, p53 and MDM2. The evaluation of the specimens was undertaken by two independent pathologists without knowledge of the outcome. Statistical analysis of clinical, morphological, and immunohistological features was performed. A 'favourable outcome' was defined as survival of at least 5 years after diagnosis, without metastases (n=57). An 'unfavourable outcome' was defined as death from metastases within the first 5 years after diagnosis of uveal melanoma (n=39). Cyclin D1 positivity (>15% positive tumour cells) as well as p53 positivity (>15% positive tumour cells) was associated with an unfavourable outcome (for cyclin D1: odds ratio=4. 2, 95% confidence interval 1.5-11.8, p=0.006; for p53: odds ratio=3. 2, 95% confidence interval 1.1-9.3, p=0.03). In addition, cyclin D1 positivity was associated with the presence of extraocular extension of the tumour (p=0.01), with the mixed or epithelioid cell type (p=0. 02), and with the tumour cell MIB-1 positivity (p=0.0001). MDM2 immunoreactivity of the tumour cells showed a potential correlation with clinical outcome (odds ratio=2.1, 95% confidence interval 0.8-5. 8, p=0.13). Multiple logistic regression models showed that cyclin D1 positivity is an independent prognostic factor after control for other prognostic markers. The expression of cyclin D1 in uveal melanoma is associated with a more aggressive course and histologically unfavourable disease. This could serve as a further independent prognostic factor in uveal melanoma.

Expression of the cell adhesion molecules ICAM-1, VCAM-1 and NCAM in uveal melanoma: a clinicopathological study

To investigate the relationship between the expression of the cell adhesion molecules intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and neural cell adhesion molecule (NCAM) in uveal melanoma and the metastatic spread in the first 5 years after diagnosis, we performed a hospital-based case-control study with human tissue from 90 patients who underwent enucleation for primary uveal melanoma (iris melanoma excluded). Thirty-five patients developed metastasis within the first 5 years, and 55 patients lived metastasis-free for at least 5 years after enucleation. The paraffin-embedded and formalin-fixed globes were studied by immunohistochemistry with monoclonal antibodies for ICAM-1, VCAM-1 and NCAM. A strong ICAM-1 positivity (more than 75% of the tumor cells stained positive) was detected in 73 tumors (81%). The expression of 75% or less ICAM-1 positive cells in tumors was strongly associated with the development of metastases (odds ratio: 7.5, p = 0.001). Multiple logistic regression models showed that ICAM-1 is an independent risk factor for metastasis even after control for important prognostic markers like extraocular growth, ciliary body involvement, scleral infiltration and cell type. VCAM-1 was expressed in 24 out of 88 tumors (27.3%) and NCAM only in 14 out of 87 tumors (16%). Only spindle cells stained positive with anti-NCAM. NCAM and VCAM-1 expression was not related to metastasis. Our results show that the loss of ICAM-1 expression is associated with an increased risk of metastasis within the first 5 years after diagnosis.

New contraceptive eligibility checklists for provision of combined oral contraceptives and depot-medroxyprogesterone acetate in community-based programmes

Community-based services (CBS) have long used checklists to determine eligibility for contraceptive method use, in particular for combined oral contraceptives (COCs) and the 3-month injectable contraceptive depot-medroxyprogesterone acetate (DMPA). As safety information changes, however, checklists can quickly become outdated. Inconsistent checklists and eligibility criteria often cause uneven access to contraceptives. In 1996, WHO produced updated eligibility criteria for the use of all contraceptive methods. Based on these criteria, new checklists for COCs and DMPA were developed. This article describes the new checklists and their development. Several rounds of expert review produced checklists that were correct, comprehensible and consistent with the eligibility requirements. Nevertheless, field-testing of the checklists revealed that approximately half (48%) of the respondents felt that one or more questions still needed greater comprehensibility. These findings indicated the need for a checklist guide. In March 2000, WHO convened a meeting of experts to review the medical eligibility criteria for contraceptive use. The article reflects also the resulting updated checklist.

Descriptive epidemiology of small intestinal malignancies: the German Cancer Registry experience

In the first population-based analysis of certain epidemiologic features of primary malignancies of the small intestine in Germany, we used data from the Saarland Cancer Registry (1982-1993) and from the former National Cancer Registry of the German Democratic Republic (1976-1989). The age-standardized incidence rates for ages 0-74 years is 3.3-6.2 per million per year. The average incidence rates of the federal state Saarland are for men about 1.3 times and for women about 1.4 times the rate of the former German Democratic Republic. After the age of 30 years, the incidence rates increased with increasing age. Incidence rates for carcinoids levelled off after the age of 54 years. Rates for men were 35-40% higher than for women after adjusting for age. The risk for carcinomas, malignant carcinoids and malignant lymphoma were higher for men than for women.

Perspectives of clinical epidemiology in Germany

The aim of this article is to discuss the perspective of clinical epidemiology in Germany. The following statements are discussed: (1) There is some confusion about the definition of clinical epidemiology. (2) There is a latent and growing need for clinical epidemiology in Germany. (3) Clinical epidemiology is an interdisciplinary field and not simply clinical medicine, epidemiology, biometry, or medical informatics. (4) We must continue with the education of clinicians and nonclinical methodologists in clinical epidemiology to develop the field of clinical epidemiology in Germany, Biometry, medical informatics, and epidemiology will play an essential role for this purpose. (5) The German scientific community urgently needs clinicians and scientists with experience in methodological research to specialize in the methods of clinical epidemiology. (6) The starting point for the development of clinical epidemiology in Germany, clear deficits in the past notwithstanding, is promising. However, we will only be able to develop the field if the egoism of the different disciplines can be tamed.

Control response proportions in population-based case-control studies in Germany

We investigated the methods of recruitment, levels and determinants of response, and the calculation method of response proportions in population-based case-control studies in Germany. We identified 26 eligible studies. The pooled analysis showed that the response proportion was 68% among controls and 80% among cases. Response proportions among controls without telephones were about 50% lower than for controls with telephones. We propose a new measure that indicates the efficacy of the recruitment strategy.

Cancer occurrence in the elderly: agreement between three major data sources

PURPOSE

To explore agreement on cancer occurrence and site among Medicare Part A, Massachusetts Cancer Registry, and death certificates.

METHODS

We linked these data sources with the cohort of the population-based East Boston Senior Health Project, a component of the National Institute on Aging's Established Populations for Epidemiologic Studies of the Elderly. The cohort consists of 905 subjects dying between January 1986 and December 1990.

RESULTS

We detected the following agreements on cancer occurrence: hospitalization data and death certificates (kappa = 0.70), hospitalization and cancer registry data (kappa = 0.59), and cancer registry and death certificate data (kappa = 0.50). Measures of agreement changed little when the analyses were stratified by age, sex, calendar year and place of death, autopsy performance, cigarette smoking or alcohol consumption. Site-specific agreements were higher for colorectal and respiratory tract cancer compared to breast and prostate across all three comparisons.

CONCLUSIONS

The results should assist epidemiologists to better understand the strengths and limitations of these data sources.

Expression of connexin43 mRNA in adult rodent brain

The expression of connexin43 mRNA was detected in adult rat brains by in situ hybridization methods. Specific digoxigenin riboprobes were generated by in vitro transcription of two PCR-amplified fragments of connexin43 cDNA which lack homology with any other published connexin. Following immunohistochemical detection, the digoxigenin cRNA was found to occur in various neuronal populations including Purkinje cells of the cerebellum, pyramidal cells of the neocortex and the hippocampal formation, as well as granule cells of the dentate gyrus and various neurons of diverse hindbrain nuclei. This ubiquituous expression of connexin43 mRNA in adult neurons, in particular in neocortical pyramidal cells, is surprising insofar as gap junction communication in adult bains has been considered to be confined to specific subpopulations of neurons revealing a high incidence of synchronized electrical activities in contrast to the postnatal brain where interneuronal coupling via gap junctions precedes the formation of chemical transmission. In addition, connexin43 is regarded as being preferentially expressed in astrocytes, although its presence in adult neurons has not definitely been excluded. We propose that adult neurons preserve their capability of expressing functional gap junctions more frequently than presently considered and that connexin43 is a most likely neuronal gap junction protein candidate.

One heart transplanted successfully twice

We report the first successful reuse of a previously transplanted heart after perioperative brain death of the first recipient. The second recipient was a 66-year-old man suffering from end-stage ischemic cardiomyopathy. The intra- and postoperative course of the retransplantation was completely uneventful. At the time of writing, more than 2 years after reuse of the graft, the patient remains in New York Heart Association class I. This procedure, which proved to be possible under certain optimal conditions, should be considered in the case of brain death of a graft recipient, particularly with regard to the ongoing donor shortage.

Elevated lipoprotein(a) levels in patients with acute myeloblastic leukaemia decrease after successful chemotherapeutic treatment

Twenty-two patients with acute myeloblastic leukaemia (AML) were studied to investigate disease-associated changes in lipid metabolism. Lipoprotein (a) [Lp(a)] levels were found to be elevated at the time of diagnosis (median 23 mg/dl; 41% of patient group had levels greater than 25 mg/dl) and diminished after successful chemotherapeutic treatment in 9 of 10 cases, with a maximum decrease from 56 to 10 mg/dl. In contrast, reduced levels of total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) (medians 137, 87 and 20 mg/dl, respectively) were observed at the time of diagnosis. Cholesterol and HDL levels increased in all 10 and LDL in 9 cases in which complete remission was achieved. These data suggest that the catabolism of LDL-cholesterol might be even more enhanced than assumed to date. Furthermore, it indicates that the Lp(a) level in acute myeloblastic leukaemia is influenced either directly or indirectly by the leukaemic blasts.