Economic costs of minor depression: a population-based study

OBJECTIVE

Although the clinical relevance of minor depression has been demonstrated in many studies, the economic costs are not well explored. In this study, we examine the economic costs of minor depression.

METHOD

In a large-scale, population-based study in the Netherlands (n = 5504) the costs of minor depression were compared with the costs of major depression and dysthymia. Excess costs, i.e. the costs of a disorder over and above the costs attributable to other illnesses, were estimated with help of regression analysis. The direct medical costs, the direct non-medical costs and the indirect non-medical costs were calculated. The year 2003 was used as the reference year.

RESULTS

The annual per capita excess costs of minor depression were US$ 2141 (95% CI = 753-3529) higher than the base rate costs of US$ 1023, while the costs of major depression were US$ 3313 (95% CI = 1234-5390) higher than the base rate. The costs of minor depression per 1 million inhabitants were 160 million dollars per year, which is somewhat less than the costs of major depression (192 million dollars per year).

CONCLUSION

The economic costs associated with minor depression are considerable and approach those of major depression.

TMPRSS2 Fusions with Oncogenic ETS Factors in Prostate Cancer Involve Unbalanced Genomic Rearrangements and Are Associated with HDAC1 and Epigenetic Reprogramming

Translocations fusing the strong androgen-responsive gene, TMPRSS2, with ERG or other oncogenic ETS factors may facilitate prostate cancer development. Here, we studied 18 advanced prostate cancers for ETS factor alterations, using reverse transcription-PCR and DNA and RNA array technologies, and identified putative ERG downstream gene targets from the microarray data of 410 prostate samples. Out of the 27 ETS factors, ERG was most frequently overexpressed. Seven cases showed TMPRSS2:ERG gene fusions, whereas the TMPRSS2:ETV4 fusion was seen in one case. In five out of six tumors with high ERG expression, array-CGH analysis revealed interstitial 2.8 Mb deletions between the TMPRSS2 and ERG loci, or smaller, unbalanced rearrangements. In silico analysis of the ERG gene coexpression patterns revealed an association with high expression of the histone deacetylase 1 gene, and low expression of its target genes. Furthermore, we observed increased expression of WNT-associated pathways and down-regulation of tumor necrosis factor and cell death pathways. In summary, our data indicate that the TMPRSS2:ERG translocation is common in advanced prostate cancer and occurs by virtue of unbalanced genomic rearrangements. Activation of ERG by fusion with TMPRSS2 may lead to epigenetic reprogramming, WNT signaling, and down-regulation of cell death pathways, implicating ERG in several hallmarks of cancer with potential therapeutic importance.

[The prevention of psychiatric disorders]

About 450 million people all over the world suffer from psychiatric disorders. Limitations and handicaps are caused especially by unipolar depression, excessive alcohol consumption, schizophrenia and manic-depressive disorder. It is expected that the importance of psychiatric disorders for public health will increase in the coming decades. Psychiatric disorders are often the cause of death, destroy the lives of both patients and their families, have far-reaching economic consequences and are often complicated by somatic diseases. The advances in the field of treatment are impressive but can have only a limited effect on the consequences of psychiatric disorders for public health. The incidence of psychiatric disorders can be reduced by more than 25%. The greatest effects have been seen with depressive disorders, indicated prevention and the use of cognitive therapy. Indicated prevention has also been found to be effective in psychotic disorders. Debriefing is ineffective in posttraumatic stress disorder. The efficacy of universal prevention has not been investigated. There are still insufficient data to develop evidence-based guidelines for the prevention of psychiatric disorders.

Creative reminiscence as an early intervention for depression: results of a pilot project

Reminiscence may help in resolving conflicts from the past and making up the balance of one's life. Life-review may be further enhanced by the creative expression of memories in stories, poems or drawings. In this way people are encouraged to create and discover metaphors, images and stories that symbolically represent the subjective and inner meaning of their lives. In this article, a new intervention, which combines reminiscence and creative expression aimed at early treatment of depression, is described. A pilot project showed that the intervention Searching for the meaning in life may generate small-sized effects in reducing depression. Additionally, it appears to generate effects of medium size in enhancing mastery. Several possible ways to improve the effectiveness of the intervention are described.

Predicting the onset of major depression in subjects with subthreshold depression in primary care: a prospective study

OBJECTIVE

That subjects with subthreshold depression have an increased probability of developing major depression has been confirmed by many studies. However, the factors which may predict the onset of major depression have yet to be fully examined.

METHOD

We examined the control group of a randomized trial in primary care patients with subthreshold depression (N = 109), of whom 20 had developed major depression 1 year later. Using the vulnerability-stress theory, we examined which factors predicted the onset of major depression.

RESULTS

In both univariate and multivariate analyses, family history and chronic illnesses predicted the onset of major depression.

CONCLUSION

It is possible to predict to a certain degree whether a subject with subthreshold depression will develop major depression within a year.

Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies

OBJECTIVE

In order to examine whether the incidence of major depressive disorder (MDD) is increased in subjects with subthreshold depression, or sD (clinically relevant depressive symptoms, without meeting criteria for a full-blown MDD), we conducted a review of prospective studies examining the incidence of MDD in subjects with sD.

METHOD

A systematic literature search was conducted. For all studies, the relative risk of developing MDD was calculated, based on person-years.

RESULTS

Twenty studies (23 comparisons) were found, based on community samples, general medical patients and high-risk subjects. Most comparisons showed that subjects with sD had a consistently larger chance of developing MDD. The studies differed considerably in the definition of sD, the recency (occurrence of the last sD) and the in-/exclusion of lifetime MDD.

CONCLUSION

The incidence of MDD in subjects with sD is larger than in subjects without sD. Otherwise, the concept of sD is too broad to be used. In future studies, some consensus should be reached regarding the definition of sD.

Guidance for the safety assessment of botanicals and botanical preparations for use in food and food supplements

There is a growing interest by both consumers and industry for the development of food products with 'functional' properties, or health benefits. These products may take the form of dietary supplements or of foods. The health benefits are given by particular ingredients, and in many cases these are derived from botanicals. The variety of plants providing these functions is large, ranging from staple food sources such as cereals, fruits and vegetables, to herbals as used in traditional medicine. The food or ingredient conferring health properties may consist of the plants themselves, extracts thereof, or more purified components. The scientific literature is abundant with articles not only on the beneficial properties, but also on possible adverse health effects of plants and their components. The present report discusses the data required to determine the safe use of these types of ingredients, and provides advice on the development of risk assessment strategies consistent with due diligence under existing food regulations. Product specifications, composition and characterisation of standardised and authentic materials, documented history of use and comparison to existing products (taking into account the effect of industrial processing), description of the intended use and consequent exposure are highlighted as key background information on which to base a risk evaluation. The extent of experimental investigation required, such as in vitro, animal, and/or human studies, depends on the adequacy of this information. A decision tree is presented as an aid to determine the extent of data requirements based on product comparison. The ultimate safety in use depends on the establishment of an adequate safety margin between expected exposure and identified potential hazards. Health hazards may arise from inherent toxicities or contaminants of the plant materials, including the mechanism of the intended beneficial effect. A lower safety margin may therefore be expected than for food ingredients or additives where no physiological effects are intended. In rare cases, post launch monitoring programmes may be envisaged to confirm expected exposures and adequacy of the safety margin. This guidance document was elaborated by an expert group of the Natural Toxin Task Force of the European Branch of the International Life Sciences Institute--ILSI Europe and discussed with a wider audience of scientists at a workshop held on 13-15 May 2002 in Marseille, France.

[Cannabis use as a probable causative factor in the later development of schizophrenia]

OBJECTIVE

To study the role of cannabis use in the onset of symptoms and disorders in the schizophrenia spectrum.

DESIGN

Literature study.

METHOD

Hypothetical explanations of the relationship between cannabis use and subsequent schizophrenia were assessed on the basis of the results of five large longitudinal studies.

RESULTS

Because cannabis use preceded the development of schizophrenia and as a result of statistical control for possible confounders, the following explanations could be rejected: 'cannabis is used as self-medication for schizophrenia', 'schizophrenia is not caused by cannabis but by other drugs that are used concurrently', and 'cannabis use and schizophrenia are both caused by other factors'. Two explanations then remained: 'cannabis use per se contributes in a unique manner to the risk' and 'cannabis use, in interaction with other risk factors, leads to an increase in the risk'.

CONCLUSION

There are strong indications that cannabis use increases the risk of the subsequent development of symptoms and disorders in the schizophrenia spectrum.

Predictors of first incidence of DSM-III-R psychiatric disorders in the general population: findings from the Netherlands Mental Health Survey and Incidence Study

OBJECTIVE

To investigate determinants of 12-month first incidence of DSM-III-R mood disorder (MD), anxiety disorder (AD) and substance use disorder (SUD) in the general population.

METHOD

Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiologic study in which a representative sample of 7076 adults aged 18-64 years were interviewed with the Composite International Diagnostic Interview. New cases diagnosed 12 months after baseline were compared with never diagnosed controls on sociodemographic and psychosocial variables.

RESULTS

Multivariate, the only demographic variable associated with incidence of MD was female gender. The strongest predictors were negative life events and ongoing difficulties. High level of neuroticism was also associated. Incidence of AD was likewise predicted by female gender. Negative life events and ongoing difficulties were also significant predictors, though weaker than for MD. Incidence of SUD was more common among males, young adults, people not living with a partner and those experiencing positive life events.

CONCLUSION

Incident MD and AD were predicted more strongly by life events, and SUD more strongly by demographic factors.

Underreporting of malaria incidence in The Netherlands: results from a capture-recapture study

The aim of this study was to estimate the completeness of notification of malaria by physicians and laboratories in the Netherlands in 1996. We used a capture-recapture (CRC) analysis of three incomplete, partially overlapping registers of malaria cases: a laboratory survey, the Notification Office and the hospital admission registration. The response of the laboratories was 83.2%. In 1996 the laboratories microscopically identified 535 cases of malaria, 330 patients with malaria were admitted to hospital and physicians notified 311 malaria cases. 667 malaria cases were recorded in at least one register. CRC analysis estimated the total number of malaria cases at 774 (95 % CI of 740-821). This implies a completeness of notification of 40.2% for physicians and 69.1% for the laboratories. It can be concluded that laboratory-based notification can considerably increase the number of officially reported malaria cases as compared to notification by physicians. However, possibly one-third of the cases may still go unreported.

Assessing parental alcoholism: a comparison of the family history research diagnostic criteria versus a single-question method

This study compares two methods of determining parental alcoholism: (1) a single question asking whether one of the subject's parents had alcohol problems; (2) the Family History Research Diagnostic Criteria (FH-RDC), which require at least one alcohol-related problem in addition to parental problem drinking. We sought first to determine the level of agreement between the single-question approach and the full FH-RDC for parental alcoholism, and then to gauge how much bias will be introduced by using the single question rather than the FH-RDC-method in assessing the risk for psychiatric disorders. Data were taken from the National Comorbidity Survey (NCS), a nationwide survey of the noninstitutionalized US civilian population aged 15 to 54. Parental alcoholism was assessed both by the single question and by the full FH-RDC. Psychiatric disorders were assessed with the Composite International Diagnostic Interview (CIDI). Good agreement was found between the single-question approach and the FH-RDC (kappa = 0.83). The single-question method introduces only a small downward bias when it comes to assessing the risk for psychiatric disorders in children of alcoholic probands. This underestimation does not reach statistical significance. When a questionnaire needs to be shortened, a single question on parental problem drinking is a good alternative to checking all individual FH-RDC items.

[HIV-positive drug users in South Limburg: number and characteristics, a capture-recapture analysis]

OBJECTIVE

To estimate the number of HIV positive drug abusers (HDs) in South Limburg, the Netherlands, and to ascertain the characteristics of this group, so that special HIV healthcare can be planned.

DESIGN

Capture-recapture analysis.

METHOD

Capture-recapture analysis was carried out and abuser characteristics were determined using three incomplete, partially overlapping registers of HDs from the regional AIDS hospital, the Regional Institute for Addiction and the Municipal Health Service Centres in South Limburg.

RESULTS

From the 80 HDs included, the Municipal Health Service Centres observed 59 HDs, the Institute for Addiction 45 and the hospital 44. The capture-recapture analysis gave an estimate of 110 HDs (95% CI: 91-164) in South Limburg. Assuming 1100 drug users in South Limburg of which 76% had injected on one or more occasions, the HIV prevalence among injecting drug users was estimated at 13% (110/836). From the observed HDs 80% were male, with a mean age of 38 years (SD: 7) and a mean age at the onset of drug use of 18 years (SD: 5). All HDs currently injected or had previously injected. The first injected drugs were used at a mean age of 21 years (SD: 6). All HDs used heroine, 84% also used cocaine, 54% were homeless, 91% unemployed and 80% had a history of imprisonment. Further, 71% of the female HDs were prostitutes, 37% of the male ones visited prostitutes, 81% had contracted hepatitis B (of which 20% were a carrier) and all HDs were infected with hepatitis C. An estimate based on prevalence data gave 143/836 (17%) and that based on capture-recapture analysis with two registrations was 102/836 (12%).

CONCLUSION

The number of HDs was estimated to be 110. The population had a marginalized existence and there was a risk of HIV spreading.

The structure and stability of common mental disorders: the NEMESIS study

BACKGROUND

We analyzed the underlying latent structure of 12-month DSM-III-R diagnoses of 9 common disorders for the general population in the Netherlands. In addition, we sought to establish (1) the stability of the latent structure underlying mental disorders across a 1-year period (structural stability) and (2) the stability of individual differences in mental disorders at the level of the latent dimensions (differential stability).

METHODS

Data were obtained from the first and second measurement of the Netherlands Mental Health Survey and Incidence Study (NEMESIS) (response rate at baseline: 69.7%, n = 7076; 1 year later, 79.4%, n = 5618). Nine common DSM-III-R diagnoses were assessed twice with the Composite International Diagnostic Interview with a time lapse of 1 year. Using structural equation modeling, the number of latent dimensions underlying these diagnoses was determined, and the structural and differential stability were assessed.

RESULTS

A 3-dimensional model was established as having the best fit: a first dimension underlying substance use disorders (alcohol dependence, drug dependence); a second dimension for mood disorders (major depression, dysthymia), including generalized anxiety disorder; and a third dimension underlying anxiety disorders (simple phobia, social phobia, agoraphobia, and panic disorder). The structural stability of this model during a 1-year period was substantial, and the differential stability of the 3 latent dimensions was considerable.

CONCLUSIONS

Our results confirm the 3-dimensional model for 12-month prevalence of mental disorders. Results underline the argument for focusing on core psychopathological processes rather than on their manifestation as distinguished disorders in future population studies on common mental disorders.

[Considerable underreporting of malaria in the Netherlands; a capture-recapture analysis]

OBJECTIVE

To estimate the completeness of notification of malaria by physicians and laboratories in the Netherlands.

METHOD

Capture-recapture analysis was applied to three incomplete, partially overlapping registers of malaria cases in 1995 and 1996: a laboratory survey, the Notification Office and the hospital admission registration.

RESULTS

The average response of the 107 laboratories approached was 83.6% over both years. In 1995 and 1996 581 and 535 malaria cases respectively were microscopically diagnosed. In each year physicians officially notified 311 patients. 350 and 330 patients respectively were admitted to hospital. Capture-recapture analysis estimated the total number of new malaria cases at 933 (95% confidence interval: 849-1072) in 1995 and at 774 cases (740-821) in 1996. The estimated completeness of notification in 1995 and 1996 was therefore 33.3% and 40.2% for physicians and 62.3% and 69.1% for the laboratories.

CONCLUSION

Laboratory-based notification, introduced in the Infectious Diseases Act, can considerably increase the number of officially reported malaria cases as compared with notification by physicians. However, approximately one-third of the estimated number of cases may still go unreported.

Psychiatric and sociodemographic predictors of attrition in a longitudinal study: The Netherlands Mental Health Survey and Incidence Study (NEMESIS)

This article discusses the effects of sociodemographics and the presence of psychiatric disorders diagnosed in the 12 months before the first interview by using the Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R, third edition, revised, on three types of attrition (failure to locate, refusal to participate, morbidity/mortality) in the second wave (1997-1998) of the Netherlands Mental Health Survey and Incidence Study, a longitudinal, general population survey of psychopathology among 7,076 subjects aged 18-64 years. Compared with those reinterviewed successfully, persons not located at the 1-year follow-up (n = 219) were more often younger, poorly educated, urban, not cohabiting with a steady partner, and born outside the Netherlands. Refusers (n = 923) had a lower educational level. Morbidity/mortality (n = 72) was associated with higher age, lower educational level, not being employed, and somatic disorders. After adjustment for sociodemographics, none of the disorders was positively associated with refusal. Failure to locate was linked to agoraphobia, alcohol abuse, and the categories of mood, substance use, and eating disorders. Morbidity/mortality was linked to dysthymia, agoraphobia, simple phobia, obsessive-compulsive disorder, and the category of anxiety disorders. Overall attrition was only slightly higher among respondents with one or more disorders (odds ratio = 1.20, 95% confidence interval: 1.04, 1.38). Thus, psychopathology has only weak-to-moderate effects on attrition and is mainly related to failure to locate and morbidity/mortality but not to refusal.

Isolation and characterization of the promoter of the human prostate cancer-specific DD3 gene

Recently, we have described a novel gene, DD3, which is one of the most prostate cancer-specific genes described to date (Bussemakers, M. J. G., van Bokhoven, A., Verhaegh, G. W., Smit, F. P., Karthaus, H. F. M., Schalken, J. A., Debruyne, F. M. J., Ru, N., and Isaacs, W. B. (1999) Cancer Res. 59, 5975-5979). The prostate cancer-specific expression of DD3 indicates that the DD3 gene promoter is a promising tool for the treatment of prostate cancer. To identify the promoter elements that are responsible for the prostate cancer-specific expression of DD3, we have isolated and characterized the DD3 promoter. Sequence analysis of the DD3 5'-flanking region was performed and several promoter-human growth hormone reporter constructs were prepared, which were transiently transfected in the DD3-positive cell line LNCaP and several DD3-negative cell lines. Using a 500-base pair DD3 promoter construct, we could detect promoter activity in LNCaP cells, which was not affected by increasing the size of the constructs. Truncated constructs, however, showed an increased transcriptional activity, suggesting the presence of a silencer that negatively regulates the expression of DD3. DNase-I footprint analysis, using nuclear extracts from LNCaP cells, revealed the presence of three DNase-I-protected areas within the DD3 proximal promoter. We show that the high mobility group I(Y) protein binds to one of the DNase-I-protected areas and recruits another, yet unidentified, protein to the DD3 promoter in LNCaP cells.

Accessibility of government-run sheltered workshops to people with psychiatric histories

Government-run sheltered workshops in the Netherlands are not as easily accessible to people with psychiatric histories as they are to other groups, such as those with physical and intellectual disabilities. This was found in a large-scale nationwide study in 21 such workshops, commissioned by the Dutch Ministry of Social Affairs and Employment. The workshops varied in their degree of accessibility. The more accessible ones placed stronger emphasis on social objectives and had shorter waiting periods and more lenient admission policies.

Body perception index: benefits, pitfalls, ideas

Estimates of body size are often expressed as a ratio of actual size [body perception index or BPI = (estimated size/actual size) x 100%]. In this article, we examine the possibility that overestimation of body size in patients with anorexia nervosa, as measured by the BPI, is due to their smaller body size rather than to their being anorexic. Using 50 mean body sizes derived from seven studies we investigated whether the error of estimation is a constant proportion of the body size to be estimated, as the use of the BPI assumes. A negative linear relation between BPI and actual body size was found, confirming that smaller size is associated with greater overestimation. However, although both groups showed a strong tendency to overestimate smaller sizes, anorexic subjects showed even greater overestimation than controls. Hence, overestimation of body size in AN can only partially be accounted for by the smaller body size of anorexic patients. Recommendations for future use of the BPI are put forward.

The influence of methodological differences on the outcome of body size estimation studies in anorexia nervosa

A major problem that has dogged research into body image disturbance in anorexia nervosa concerns the diversity of measurement procedures employed in studies of body size estimation. Many researchers believe that results obtained with different procedures cannot meaningfully be compared with each other, because the methods used measure different aspects of the body image. A meta-analysis of 33 body size estimation studies was conducted to investigate whether methodological differences do indeed influence outcome. This analysis revealed a general overestimation of body size among anorexia patients. Although a difference in mean effect size was found between studies using Body Part and Whole Body methods, this difference was absent when only the most commonly used Body Part method, the visual size estimation procedure, was considered. Among Whole Body methods, silhouette methods could not be distinguished from the rest in terms of effect size. It was concluded that Whole Body methods and the visual size estimation procedure assess correlated aspects of the body image.

Homozygous deletions of p16(INK4) occur frequently in bilharziasis-associated bladder cancer

We have studied p16(INK4) mutation (by PCR-SSCP) and deletion (by Southern blotting and/or multiplex PCR) in a series of 47 bilharziasis-associated tumors from Egypt and compared the results with those obtained on a series of 17 established bladder cell lines and non-bilharziasis-associated bladder cancers from the Netherlands. In the cell lines we found 9 homozygous deletions and 1 mutation (59% of p16(INK4) alterations in cell lines), whereas in cases from the Netherlands deletions were found in 4 of 22 samples. No mutations were detected in the 46 samples screened. Interestingly, in bilharziasis-associated bladder cancer, deletions were present in 23 samples and mutations in a further 2 cases (53% of p16(INK4) alteration in bilharziasis-associated bladder cancer). No correlation was found between p16(INK4) alteration and histopathological data. Likewise, the same frequency of alteration was found in tumors with different differentiation patterns (squamous, transitional or adenocarcinoma). Three conclusions can be drawn from our findings: (i) p16(INK4) alterations are more frequent in cell lines than in primary tumors; (ii) in primary bladder tumors (bilharziasis-associated or not), p16(INK4) deletions are much more frequent than p16(INK4) mutations; (iii) p16(INK4) alterations are more frequent in bilharziasis-associated bladder tumors than in other bladder tumors. This high frequency of deletion is not related to a specific histological type but to the specific etiology of these tumors.

p16 mutations/deletions are not frequent events in prostate cancer

Cyclin-dependent kinase-4 inhibitor gene (p16INK4) has recently been mapped to chromosome 9p21. Homozygous deletions of this gene have been found at high frequency in cell lines derived from different types of tumours. These findings suggested therefore, that p16INK4 is a tumour-suppressor gene involved in a wide variety of human cancers. To investigate the frequency of p16INK mutations/deletions in prostate cancer, we screened 20 primary prostate tumours and four established cell lines by polymerase chain reaction (PCR) and single-strand conformation polymorphism (SSCP) analysis for exon 1 and exon 2. In contrast to most previous reports, no homozygous deletions were found in prostate cancer cell lines, but one cell line (DU145) has revealed to a mutation at codon 76. Only two SSCP shifts were detected in primary tumours: one of them corresponds to a mutation at codon 55 and the other one probably corresponds to a polymorphism. These data suggest that mutation of the p16INK4 gene is not a frequent genetic alteration implicated in prostate cancer development.

Characteristics of wheeze during histamine-induced airways obstruction in children with asthma

BACKGROUND

An automated system has been developed for the detection of sound patterns suggestive of airways obstruction in long term recordings. The first step, presented here, was tracheal sound recording during histamine-induced airways obstruction.

METHODS

The tracheal sounds of 29 children aged 8-19 years with asthma were recorded during airways obstruction caused by histamine inhalation using a system for continuous respiratory telemetry and computer analysis. Sound patterns were analysed, classified, and related to airways obstruction measured by lung function tests based on the forced expiratory volume in one second (FEV1).

RESULTS

Five sound patterns were identified, one dominant sensitive and four specific to a fall in FEV1 of > 20%. The presence of at least one of three specific sound patterns during unforced respiration predicted a fall in FEV1 of > 20% in 87.5% of the subjects. The inspiratory and expiratory sound patterns were almost equally informative of airways obstruction.

CONCLUSIONS

Wheezes can be differentiated with more precision than is currently accepted. Tracheal sound patterns are sensitive and specific predictors of histamine-induced airways obstruction. These patterns are neither invariably nor proportionally related to the results of lung function testing. However, they can be used for detection of airways obstruction on the basis of their presence or absence.

Phenylalanine ammonia-lyase from cotton (Gossypium hirsutum) hypocotyls: properties of the enzyme induced by a Verticillium dahliae phytotoxin

Phenylalanine ammonia-lyase (EC 4.3.1.5), induced by a Verticillium dahliae phytotoxin, has been purified to electrophoretic homogeneity from cotton hypocotyls by differential ammonium sulfate fractionation and hydrophobic interaction chromatography, with a yield of 52%. The enzyme is a tetramer with a molecular weight of 332,000 to 337,000. The isoelectric point is 4.6, and no isoforms were observed. The subunits of the enzyme are unstable and breaks down to fragments with M(r)'s of 69,000 and 49,500. The enzyme exhibited only activity with L-phenylalanine as substrate. Deamination was optimal at pH 8.9 and the activation energy was calculated as 100.6 kJ mol-1. Non-Michaelian kinetics were observed with a KmL = 10.0 microM and KmH = 75.0 microM describing the binding of the substrate to the enzyme. Negative cooperative interactions occurred between the substrate binding sites with a Hill coefficient of 0.87. The inhibitors AOPP (S)-2-amino-oxy-3-phenylpropanoic acid), APEP (R)-1-amino-2-phenylethylphosphonic acid) and 2-AIP (2-aminoindan-2-phosphonic acid) strongly inactivated the enzyme, as did various analogues of L-phenylalanine and t-cinnamate. The induced enzyme is also sensitive to inhibition by phenylpropanoid intermediates and precursors involved in lignification such as 4-hydroxycinnamate and 3,4-dihydroxycinnamate.

Uni- and multivariate analysis of eight indications for post-operative radiotherapy and their significance for local-regional cure in advanced head and neck cancer

Eighty consecutive patients with advanced head and neck cancer were treated with combined therapy of radical surgery and post-operative radiotherapy. Indications for post-operative radiotherapy were pathological staging of the primary tumour (pT3 or pT4), poorly differentiated or undifferentiated carcinoma (G3, G4), tumour thickness, tumour invasion in the surrounding tissues with slender tumour strands and solitary tumour cells, perineural spread, lymphangio-invasive tumour growth, multiple positive neck nodes or extranodal spread, and microscopical irradicality of the surgical margins. The contribution for prognosis of these indications for post-operative radiotherapy were retrospectively calculated in an univariate and multivariate analysis. Of all investigated parameters, the mode of tumour invasion and lymphangio-invasive growth were independent prognostic factors. If these unfavourable prognostic signs are present, post-operative radiotherapy has to be intensified to at least curative doses of 66 Gy or more to the areas at risk.

Oral immunization with polyvalent bacterial lysate and infection with Streptococcus pneumoniae: influence on interferon-gamma and PMN elastase concentrations in murine bronchoalveolar lavage fluid

We recently demonstrated that oral immunization with a polyvalent bacterial lysate (Paspat oral) significantly reduces mortality rates in mice, infected with Streptococcus pneumoniae or influenza A virus. In this study it is demonstrated that oral immunization with the same bacterial lysate reduces the intrapulmonary inflammatory reaction to infection with S. pneumoniae, assessed by measurement of PMN elastase in bronchoalveolar lavage fluid. Furthermore, it is demonstrated that oral immunization with Paspat oral increases intrapulmonary IFN-gamma concentrations.

The status of the resection margin as a prognostic factor in the treatment of head and neck carcinoma

The value of the status of the resection margin as a prognostic factor after surgical treatment was investigated in 80 patients with squamous cell carcinoma of the oral cavity, oropharynx and laryngohypopharynx. The relation of locoregional recurrence with the presence or absence of tumour at the surgical margin was analysed together with other indications for postoperative radiotherapy. Locoregional recurrence was observed in 20% and was correlated with tumour thickness over 5 mm, spidery growth and tumour-positive margins. Tumour-positive margin as a single indication for postoperative irradiation was not related to an increased recurrence rate. When however occurring together with other indications for postoperative irradiation, the recurrence rate was higher than in the patient group with the same number of indications for postoperative radiotherapy but without tumour at the surgical margins.

Early recognition of pulmonary dysfunction during intramedullary orthopaedic surgery

Peri-operative partial arterial oxygen tension (PaO2) was monitored in 20 patients undergoing total hip replacement. Three distinct groups emerged on analysis of the arterial oxygen tensions. In group I there was no initial decrease in PaO2 but it rose above baseline level towards the end of the procedure. In group II there was a distinct fall in PaO2 during the acetabular and femoral stages of the operation. On termination of the procedure PaO2 had returned to baseline levels. In group III PaO2 values were significantly lower than those in group II during the acetabular and femoral stage s and decreased further at the end of the procedure. One patient in group II and 6 in group III developed postoperative pulmonary dysfunction. A progressive deterioration in PaO2 during hip replacement without recovery at end of the procedure indicates that the patient is likely to develop postoperative pulmonary dysfunction.

Minocycline versus doxycycline in the treatment of acne vulgaris. A double-blind study

16 patients with acne vulgaris were treated with either minocycline or doxycycline. Both drugs appear to have about the same effect when given for 3 months.