An audit of surgery for seventy-one primary parotid tumours

Seventy-one consecutive patients who presented with lumps in the parotid gland over an eight year period (1981-1989) were analysed. Two-thirds of the patients presented with a history of swelling for over one year, while a quarter (24%) had a parotid mass for over five years at initial referral. The pathology of these masses was diverse, with pleomorphic adenoma being the commonest (64%). Superficial parotidectomy was the commonest procedure employed (50/71) with local excision being performed only in the initial part of our series (15/71). There were five cases of permanent facial palsy, four following radical resection for malignancy. Tumour recurrence rate was 2/15 (13%) in cases treated by local excision while none of the 50 patients treated by superficial parotidectomy had tumour recurrence at a mean follow-up of five years. Only three patients developed Frey's Syndrome. It is recommended that increased community awareness of early referral of a parotid mass is necessary, as surgical treatment in the form of superficial parotidectomy, which is the ideal procedure for such lumps, carries minimal morbidity when performed by a surgeon with a special interest in parotid surgery.

Malignant melanoma lately diagnosed

To assess the clinical impression that patients in Dublin were presenting with late, deep, poor prognosis lesions, a 10 year retrospective review of patients with malignant melanoma was performed. The pathological data on 186 patients was examined and clinical follow-up obtained on 151 of these (80%). The mean period of follow-up was 35 months. Females predominated in a ratio of 3:1. Incidence figures for the two five year periods (1976-80) and (1981-85) indicated a rise in the latter period of over 100%. There was a marked delay in presentation after the onset of symptoms i.e. new pigmented lesions or changes in pre-existing lesions (mean = 21 months). Only 45% of lesions were less than 1.5mm in depth. Females presented with a higher percentage of good prognosis lesions reflected in a superior five year survival figure of 70% compared with 43% for males. The results of this study suggest an increase in incidence and mortality from malignant melanoma in this country. Patients appear to be unaware of the significance of pigmented lesions, presenting late with deep poor prognosis tumours.

Deep venous thrombosis, inflammatory bowel disease, and protein S deficiency

The authors observed a patient with severe inflammatory bowel disease (IBD) complicated by ten episodes of deep venous thrombosis (DVT). Her unusual thrombotic tendency prompted further investigation for primary hypercoagulability. A nonfamilial deficiency of Protein S was documented suggesting the deficiency was acquired. This occurrence suggests that low Protein S levels should be considered as a potential etiologic factor in patients with IBD and recurrent DVT.

Preferential cytotoxicity on tumor cells by caffeic acid phenethyl ester isolated from propolis

The honeybee hive product, propolis, is a folk medicine employed for treating various ailments. Many important pharmaceutical properties have been ascribed to propolis, including anti-inflammatory, antiviral, immunostimulatory and carcinostatic activities. Propolis extracts have provided an active component identified as caffeic acid phenethyl ester (CAPE), which was readily prepared in one step. Differential cytotoxicity has been observed in normal rat/human versus transformed rat/human melanoma and breast carcinoma cell lines in the presence of CAPE.

The effect of the hypoferremic response on iron acquisition by and growth of murine lymphoma cells

The hypoferremic response in C57 black mice during EL4 lymphoma cell growth was followed to determine if a lowered transferrin iron saturation inhibited iron acquisition and growth by these tumor cells. Although the lymphoma induced a strong hypoferremic response, it occurred late in the disease when the tumor burden was high and did not appear to effectively limit tumor cell growth, as all mice subsequently died. The induction of a hypoferremic response early in the disease with subcutaneous injections of turpentine also did not inhibit tumor cell growth. Parallel in vitro cell growth experiments revealed iron to be readily available to the lymphoma cells, regardless of whether the transferrin pool was 100, 50, or 10% saturated with iron. The dynamics of 59Fe uptake by the lymphoma cells from 50% saturated ferritransferrin were followed and saturation of iron uptake was found to occur at 150 nM iron and transferrin, far below physiological levels. Lowering transferrin saturation from 50 to 10% did not result in a proportional decrease in 59Fe uptake. Thus the ability of the EL4 tumor cells to obtain iron appeared to exceed the ability of a vigorous murine hypoferremic response to sequester it, suggesting that the hypoferremic response does not effectively limit EL4 ascites tumor cell growth.

Sequential studies of skin tumorigenesis in phosphoglycerate kinase mosaic mice: effect of resumption of promotion on regressed papillomas

Most mouse skin papillomas induced by 7,12-dimethylbenz(a)-anthracene initiation followed by 12-O-tetradecanoylphorbol-13 acetate (TPA) promotion are benign promoter-dependent papillomas which regress after cessation of promotion, but some benign tumors (promoter-independent papillomas) do not regress, and a few carcinomas seem to develop from progressive growth of these tumors. We have tested whether a second course of TPA promotion induces regeneration in regressed promoter-dependent papillomas and advances them to malignancy. The regression and regeneration of these papillomas were determined by serial photographs, measurements of coordinates, histopathological evaluation, and X-chromosome-linked phosphoglycerate kinase enzyme cellular markers. Most of the regressed promoter-dependent papillomas did not regenerate. However, the second course of TPA promotion induced rapid development of many new papillomas, some of which advanced to promoter-independent papillomas and a carcinoma. This finding suggests that there are more abnormal cells in the initiated mouse skin than those detected with a single course of TPA promotion.

Studies of skin tumorigenesis in PGK mosaic mice: many promoter-independent papillomas and carcinomas do not develop from pre-existing promoter-dependent papillomas

The induction of mouse skin papillomas in two stages by initiation-promotion protocols has been studied extensively. On the basis of kinetics of induction and morphological observations of apparent progression to carcinomas, it has been argued that the papillomas sequentially advance to carcinomas through promoter-dependent and promoter-independent premalignant stages. Although this hypothesis has been widely accepted, the step-wise development of the same cell population from papilloma to carcinoma has not been established at the cellular level. We show here that some carcinomas which morphologically appear to result from progression of promoter-dependent papillomas do not develop from sequential progression of the same cell population as was found in the original papillomas. Other initiated cells also participate during the growth of these tumors and may replace the original papilloma cells. We also present evidence that some tumors develop directly as promoter-independent papillomas without going through an apparent promoter-dependent papilloma stage.

Relaxation training and response to cardiac catheterization: a pilot study

This pilot study evaluated the effects of relaxation-via-letting-go training on patients' state anxiety, observer-reported distress, and self-reported distress during cardiac catheterization. The sample consisted of 30 adults, 15 subjects in the relaxation training group and 15 subjects in the control group. A comparison of the control and relaxation training groups on the demographic variables of age and education, the preintervention variables of state anxiety and worry about the procedure, and number of days in the hospital prior to catheterization showed no differences between the groups. Relaxation training subjects did not indicate less anxiety prior to catheterization nor were they seen as less distressed during the procedure than control subjects. In addition, relaxation subjects did not report having less distress than control subjects.

Macrophage interaction with skeletal muscle: a potential role of macrophages in determining the energy state of healing wounds

A decrease in ATP and creatine phosphate (CP) is characteristic of local injury to skeletal muscle. Recent data have suggested adequate potential for high-energy phosphate production in the wounded tissue. Thus, an adequate explanation for the deficit in the high-energy tissue content in wounds was lacking. Since the wound has multiple components (muscle + cellular infiltrate), the tissue content represents the summation of these components. Therefore, a technique to separate these components was designed. Using a 0.5% solution of lambda-carrageenan as the wounding agent, the extensor digitorum longus muscles (EDL) of male Fisher rats were unilaterally wounded with intramuscular injections. Five days later, both wounded and contralateral nonwounded muscles were incubated in a standardized fashion. The groups of EDL were: wounded as described, contralateral nonwounded, or contralateral nonwounded with the addition to the incubate of 6 X 10(6)/ml lambda-carrageenan elicited peritoneal macrophages. Following incubation, the individual component parts of the system (muscle and macrophage) were rapidly frozen and assayed for high-energy phosphate and DNA content. Examination of the high-energy phosphate content of the separate components of a wound demonstrated that macrophages increased the ATP and CP content of normal skeletal muscle. Yet when total high-energy phosphate content was normalized for total DNA (muscle + macrophages) in the reconstituted system, the values approximated those of wounded muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Tumor effects on gluconeogenesis in the isolated perfused rat liver

Alterations in metabolism in the tumor-bearing host can be explained by: 1) alterations of metabolic processes in the tumor itself, and/or 2) tumor effects on host metabolism. Tumor effects on host liver metabolism were studied using an isolated perfused rat liver preparation. The livers of fasted female Lewis Wistar rats with and without transplanted subcutaneous mammary tumors were perfused for 1 hr with medium containing 5 mM glucose and physiological levels of amino acids. The rate of gluconeogenesis, as measured by conversion of 14C-lactate to 14C-glucose, showed a significant increase in the rate of glucose production from lactate in tumor-bearing rats (2.40 vs 2.00 mumol/min/100 gm). Hepatic glycogen and 14C-glycogen content were not significantly different between the two groups. In order to evaluate whether this tumor model exhibits characteristic changes in metabolism previously reported in other animal tumor models, serum lactate, triglyceride, glucose, and blood urea nitrogen were measured in non-perfused animals. The serum concentration of lactate and triglycerides were significantly higher in tumor-bearing rats (0.9 mM vs 2.7 mM lactate; 244 mg % vs 365.5 mg % triglycerides). Serum glucose and blood urea nitrogen were not significantly different in the two groups. An effect of tumor on host energy metabolism and serum metabolite levels is demonstrated. A method for the study of host-tumor metabolic interactions is described.

Assessment of maternal nutrition

A booklet, "Assessment of Maternal Nutrition," has been published by the American College of Obstetricians and Gynecologists in cooperation with The American Dietetic Association as a useful guide for physicians, nurses, dietitians, and nutritionists. Nutritional risks during pregnancy are clearly outlined. Clinical, dietary, and biochemical factors, as well as medical, obstetric, and social factors, are delineated as components of nutritional assessment. An A.D.A. Liaison Committee had major responsibility for the development of the "Eating Habits Questionnaire," a tool to screen dietary intake for major deficits and excesses, which is included in the booklet. It should be useful also as a starting point for nutrition education. Additional evaluation of the use and reliability of the screening tool is recommended.

Use of sodium nitroprusside and dopamine hydrochloride in the postoperative cardiac patient

Effective postoperative nursing care of the cardiac surgery patient receiving combined drug infusion of dopamine HCl and SNP requires awareness of many critical factors. Among these are: (1) understanding of cardiac physiology with emphasis on the concepts of myocardial oxygen consumption vs. availability; (2) basic pharmacologic functions of dopamine HCl and SNP, both singly and combined; (3) importance of maintaining intravascular volume at optimum levels; and (4) awareness that constant nursing observations and reassessments are essential.

Cytochemical localization of adenylate cyclase in broken cell preparations of the cerebral cortex

Broken cell preparations derived from rat cerebral cortical grey matter were studied cytochemically to localize adenylate cyclase (AC) activity in subcellular organelle membranes. AC activity was localized by visualizing reaction product in brain particulate fractions by electron microscopy. Activity was found in the endoplasmic reticulum, on the inside of the inner mitochondrial membrane and on both leaflets of the nuclear membrane. Reaction product was found in the postsynaptic density area of most synapses. The reaction product tended to be more prominent in the presence of fluoride. A synaptosome-rich fraction was shown to have NE stimulated AC activity which was blocked in vitro by both a alpha- and an beta-blocker and in vivo by propranolol.

Leaf anatomy of species in some dicotyledon families as related to the C3 and C4 pathways of carbon fixation

Species in the families Amaranthaceae, Aizoaceae, Chenopodiaceae, Convolvulaceae, Euphorbiaceae, Nyctaginaceae, Portulacaceae, and Zygophyllaceae were examined for leaf anatomy typical of plants having the C4 type photosynthetic carbon fixation pathway. They are assembled by families into three groups: genera in which all species possess the specialization; genera in which some but not all species possess the specialization; and genera in which no species possess the specialization. The specialization in leaf anatomy was noted in species of 24 genera. Its presence is highly correlated with a habitat of limited water availability and (or) with a tropical origin. The carbon dioxide compensation points of nine species in the Chenopodiaceae family were measured. Low values were obtained only for those species that possess a form of specialized leaf anatomy (Atriplex confertifolia (Torr. & Frem.) Wats., A. falcata (M. E. Jones) Standl., Halogeton glomeratus (Bieb.) Meyer, Salsola kali L. var. tenuiflora Tausch.). The latter two species, having centric leaves, do not possess the more typical differential bundle sheath chlorenchyma but do possess two, individually distinct, single-cell layers of chlorenchyma, adjacent and external to the peripheral veins.

Energized configurations of heart mitochondria in situ

Changes in the configurational state of the cristal membranes of rat heart mitochondria within the living cell can be induced by imposing energizing conditions. An exact correlation has been established between the configurational states of the cristal membrane and the energy states of the mitochondrion. The configurational changes observed in mitochondria in situ are comparable to those established for beef heart mitochondria in vitro and are consistent with the postulate of the conformational basis of energy transductions in membrane systems. The formation of paracrystalline arrays is one of the noteworthy features of configurational changes of mitochondria in situ.