Endometrial cancer and estrogen use. Report of a large case-control study

Our case-control study of the relation between estrogen use and endometrial cancer involved 451 cases and 888 controls. The overall risk of endometrial carcinoma was sixfold for estrogen users as compared with nonusers; long-term users (greater than five years) had a 15-fold risk. Excess risk was present for both diethylstilberstrol and conjugated estrogens. The risk associated with cyclic use was as great as that for continuous use. Increased risk was associated with estrogen use for all histologic grades of the tumor. The risk of advanced-stage carcinoma was fourfold for estrogen users, but rhe confidence interval was wide, and this question requires further study. Finally, this investigation contradicts the speculation that the association between this cancer and estrogen use can be explained by swifter diagnosis for estrogen users, misclassification of estrogen-related hyperplasia or treatment of early symptoms of the tumor with estrogen.

Effects of adenosine 5'-triphosphate (ATP) and beta-gamma-methylene ATP on the rat urinary bladder

1 High concentrations of adenosine 5'-triphosphate (ATP, 100 to 1000 micrometer) were required to cause contraction of the rat urinary bladder, while adenosine and adenosine 5'monophosphate (AMP, 1 to 50 micrometer) produced relaxation. 2 One hundred fold lower concentrations of beta-gamma-methylene ATP, which is resistant to degradation to AMP and adenosine, caused dose-dependent, phasic contractions which mimicked atropine-resistant responses to nerve stimulation. 3 Adenosine and AMP caused dose-dependent inhibition of carbachol-induced contractions; theophylline competitively antagonized this inhibition but not the contractile responses to beta-gamma-methylene ATP, ATP or atropine-resistant nerve stimulation. 4 These results suggest that the insensitivity of the rat bladder to ATP is due to its rapid degradation to AMP and adenosine and support the hypothesis that the bladder receives a purinergic excitatory innervation.

Use of dilute drug solutions for routine cycloplegia and mydriasis

Clinic patients and students were given several regular drops of commercial 10% phenylephrine HCl, and 1.0% cyclopentolate HCl or 1.0% tropicamide HCl. The drops were given three times at five-minute intervals. Mydriasis and cycloplegia were determined and compared with the results obtained by using one of the following: microdrops (0.005 or 0.01 ml) of a mixture of 5% phenylephrine HCl and 0.5% tropicamide HCl, or regular drops of mixtures of 1% phenylephrine HCl, or 0.4% hydroxyamphetamine hydrobromide with 0.1% cyclopentolate HCl, or 0.1% tropicamide in a vehicle of 1.6% or 1.0% methylcellulose 400, or artificial tears or lubricants (Absorbobase, Contique, Isopto Tears, Liquifilm, Lyteers, Ultra Tears). Except for an initial lag in the production of mydriasis with the diluted mixtures, the results were similar for all preparations. The diluted solutions produced little ocular irritation or tearing.

Evaluation of weighted discriminating power calculations as an aid to the selection of chromatographic systems for the analyses of drugs

In toxicological analyses some chromatographic separations are more important than others. Two weighting methods for chromatographic data are described which incorporate the importance of particular separations into discriminating power calculations. The data were abstracted from a publication on the separations of acidic drugs on thin-layer chromatographic systems. When compared with non-weighted discriminating power calculations, those obtained with the weighting procedure did not give any advantage.

Adrenal responses to pharmacological interruption of the renin-angiotensin system in sodium-restricted normal man

We assessed the role of the renin-angiotensin system in the control of aldosterone secretion in response to sodium restriction in 62 normal subjects. Both saralasin, an angiotensin II antagonist, and SQ 20881, a converting enzyme inhibitor, induced a dose-related decrease in plasma aldosterone levels when the renin-angiotensin system was activated by restriction of sodium intake. Two types of experiments were performed with saralasin. In the first set, a dose-response relationship was established 20 min after beginning infusions ranging from 0.03-1.0 microgram/kg/min. The optimal dose was 0.1 microgram/kg/min, with a reduction in aldosterone levels of -10.1 +/- 3.8 ng/dl (P less than 0.025). Higher doses induced smaller reductions in aldosterone levels. In the second set, a 3-h infusion was given. The results were qualitatively similar but the magnitude was greater (-15 +/- 4 ng/dl; P less than 0.01). The aldosterone response 20 min after administration of SQ 20881 paralleled the angiotensin II response, with the first significant decrement (-6.5 +/- 1.5 ng/dl; P less than 0.01) occurring at 0.1 mg/kg and maximum (-10 +/- 3 ng/dl) occurring at 0.3 mg/kg. Thus, both agents produced qualitatively similar changes in aldosterone secretion in sodium-restricted normal subjects. However, neither reduced sodium restricted aldosterone levels to that measured in sodium-loaded subjects because of the intrinsic limitation of each agent. Saralasin is a partial agonist. SQ 20881 induces an increase in plasma renin activity via interruption of the short feedback loop, which probably limits its action. Yet, these data do support the hypothesis that angiotensin mediates the adrenal's response to sodium restriction in normal man.

Physical examinations in inner-city preschools

This paper describes the physical examination program started in March 1974 and carried out by the Anacostia Headstart Program in Washington DC. Annual totals of 362, 274, and 458 preschool children were examined in 16 schools during the 1973-1974, 1974-1975, and 1975-1976 school years, respectively. For these years, 8, 9, and 12 percent, respectively, had heart murmurs. The rates for abdominal hernias were higher, 11, 17, and 16 percent, respectively. Eczema was also a common problem. Parents had easy access to counseling from health professionals who worked in the program.

Modified peptidoglycan transpeptidase activity in a carbenicillin-resistant mutant of Pseudomonas aeruginosa 18s

A carbenicillin-resistant mutant of Pseudomonas aeruginosa 18s was found to possess peptidoglycan transpeptidase activity significantly more resistant to inhibition by benzyl penicillin, ampicillin, carbenicillin, and cephaloridine than that of the parent strain. The mutant was more resistant than the parent strain to all of the beta-lactam antibiotics tested, and 50% inhibition values for these compounds against membrane-bound model transpeptidase activity paralleled this increase. The resistance of the mutant to kanamycin, streptomycin, and chloramphenicol was unchanged.

Development of information processing in normal and disabled readers

8- and 11-yr-old reading-disabled children were compared in two experiments with controls matched on intelligence and age. Exp. 1 measured duration of visual information store by means of a separation threshold technique. Exp. II determined the rate of transfer from visual information store to short-term memory using a backward masking technique. Results from Exp. I showed that at each age specific reading-disabled children had significantly longer durations of visual information store than controls. The difference between the reading ability groups decreased with increasing age. Exp. II demonstrated that rate of transfer of information was significantly slower for specific reading-disabled children than for controls at both age levels. In contrast to Exp. I, this difference increased with increasing age. The results are considered in terms of their possible relevance to developmental lag theories. The evidence indicates that the development of visual information processing in reading-disabled children is similar to that in controls but occurs at a slower rate.

A study of five year old children born after elective induction of labour

A controlled retrospective study of some short-term and long-term effects of elective induction of labour was conducted. There did not appear to be any increase in the incidence of maternal complications during labour, or of neonatal problems in the induced-labour group compared with the remainder of the mothers in the hospital. In the follow-up phase of the study, two treatment groups of children who were delivered after amniotomy and amniotomy plus the administration of oxytocin were compared with each other, and with a control group of children born after spontaneous labour. The children were assessed at the age of five years on verbal and non-verbal subtests of a standardized intelligence scale, tests of gross motor and fine motor coordination, and auditory and visual tests. A full physical examination was also performed. No statistically significant differences nor trends of clinical interest were found between the groups on any measure.

Renal vascular response to interruption of the renin-angiotensin system in normal man

We assessed the role of the renin-angiotensin system in the response of the renal circulation to restriction of sodium intake in 38 normal patients. Both saralasin (10 to 30 ng/kg/min), an angiotensin antagonist, and SQ 20881 (30 to 300microgram/kg), a converting enzyme inhibitor, induced a dose-related increase in renal blood flow (xenon 133 washout) only when the resin-angiotension system was activated by restriction of sodium intake to 10 MEq/day. Increasing doses of saralasin (100 to 1,000 ng/kg/min) reduced renal blood flow, presumably due to the angiotensin-like action of this partial agonist. The renal vascular response to SQ 20881 paralleled the endocrine response: An identical threshold dose (30 microgram/kg) increased renal blood flow and reduced plasma angiotensin II concentration, which fell despite a progressive rise of plasma renin activity. Plasma bradykinin concentration did not change in response to SQ 20881, which also blocks kininase II. Both agents also induced a small but consistent and statistically significant reduction in arterial blood pressure, which will be important in assessing the pathogenetic significance of a blood pressure reduction in patients with hypertension. This study indicates that angiotensin mediates the renal vascular response to restriction of salt intake in normal man and provides an approach to assessing the role played by angiotensin in the pathogenesis of functional renal disease.

Tests for homogeneity of effect in an epidemiologic investigation

A test for homogeneity of the effect of a factor in inducing disease in the various strata of a population should relate to the scaling in which homogeneity is anticipated. Popularity, it is the multiplicative effect on the odds ratio in which homogeneity is anticipated. An asymptotic test by M. Zelen (Biometrika 58:129-137, 1971) for homogeneity in this scaling is indicated to be invalid. Further, a test by J. L. Fleiss (Statistical Methods for Rates and Proportions. NY, Wiley, 1973) for homogeneity of the standardized difference is shown to be the same as the Zelen test, to be invalid in any case, and not to correspond to any scaling. The examples given include one in which results of two studies are apparently inhomogeneous by the test even though they give effectively identical results. It is advised that tests for homogeneity be conducted with care, and that thought be given to how effects might be made homogeneous rather than to trying to demonstrate the existence of heterogeneity.

Release of Escherichia coli DNA from membrane complexes by single-strand endonucleases

Treatment of gently prepared lysates of Escherichia coli with single-strand-specific endonuclease (SI or from mung beans) results in the release of about 90% of the DNA from membranes, as determined by the M band technique. The released DNA has an average molecular weight of about 1.2 X 10(8). Data obtained with endonuclease S1 fit a mathematical model in which substrate sites are at or near membrane attachment sites. Data obtained with pancreatic deoxyribonuclease or x-rays fit a model for double-strand breaks at random sites along the DNA. Fitting data to these models, we estimate that there are 18+/-5 membrane attachment sites. The DNA remaining after S1 nuclease treatment is enriched for the region near the origin of chromosome replication. Therefore, attachment at this region near the origin of chromosome replication. Therefore, attachment at this region appears to be chemically different from that at the other sites along the DNA.

Polyurethane foam (Bentley) micropore blood transfusion filter: filtration characteristics

Stored human blood of varying age was passed through polyurethane foam (Bentley) micropore blood transfusion filters. Passage through these filters resulted in decreased screen filtration pressure (SFP) of the blood and increased filter weights. Numerous microaggregates were removed and SFP returned to normal after filtration. Occlusion of the filter occurred after passage of only 2 units of whole blood. On the basis of this research, we conclude that polyurethane foam (Bentley) micropore blood transfusion filters are effective in removal of microaggregates from stored human blood. Because the filtering capacity is not great, it is recommended that when these filters are used during transfusion a new filter be used for each unit of blood administered.

Vertical fissure line in a normal adult

The major fissure when directed in the sagittal plane is visualized on a frontal roentgenogram. It is reported in infants and children as the vertical fissure line and may occur with cardiomegaly and/or respiratory infection which rotates or partially collapses the lower lobe. Its presence in a normal adult chest is presented. It is believed to represent a congenital positional variant.

Progression and resolution of changes in pulmonary function and structure due to pulmonary microembolism and blood transfusion

It was the purpose of this research to define the progression over several days of changes in pulmonary function and structure and to document the phases of recovery following transfusions to dogs of sublethal quantities of stored blood containing microaggregates. Ten dogs underwent partial exchange transfusions averaging 60% of blood volume through standard blood transfusion filters. Average screen filtration pressure (SFP) of the blood was 85 mm Hg. Pulmonary hypertension did not develop, but there were striking decreases in O2 consumption, increases in Qs/Qt and decreases in Do2. Changes became progressively more marked over the first 48 to 72 hours after the transfusions. Pulmonary function of surviving animals returned nearly to normal by the sixth day after transfusions. Pathologic examinations of the lungs of animals sequentially sacrificed over 6 days showed intravascular microemboli, alveolar cell hyperplasia and interstitial and alveolar pulmonary edema. Progressive recovery was associated with progressive resolution of all detrimental changes. In 6 animals exchange transfused 100% of their blood volumes through dacron wool (Swank) filters and in three control animals that were not transfused, there were no significant changes in pulmonary function or structure. These experiments define the progression of deterioration and recovery over 6 days of pulmonary function in dogs after sublethal pulmonary microembolism occurring during blood transfusion.

Gastric cancer in Colombia. III. Natural history of precursor lesions

The premalignant process in the gastric mucosa was studied by gastroscopic surveys of Colombian populations, and the prevalence of superficial gastritis, chronic atrophic gastritis, and intestinal metaplasia was calculated for population samples having a very high gastric cancer risk (Nariño), very low risk (Cartagena), and intermediate risk (Cali). The prevalence of individuals with normal mucosa in successive age groups was used to estimate "depletion" curves, which were taken as indicators of the dynamics of the premalignant process in each community. Differences corresponding to the geographic variation in stomach cancer risk were found: In the high-risk areas of Nariño, around 75% of the population developed some type of gastritis by 45 years of age, whereas in the low- and intermediate-risk population of Cartagena and Cali, the proportion of such lesions did not exceed 50% at age 45 or thereafter. The effect of environmental factors in early life seemed to be important in determining the prevalence of lesions in each population.

Gastric cancer in Colombia. I. Cancer risk and suspect environmental agents

A case control study of patients discharged from hospitals revealed fourfold differences in geographic variation in stomach cancer risk within the Department of Narino (Colombia). Data from gastroscopic surveys of population groups, samples of water supplies, and urine and saliva in Narino also indicated a generally positive correlation among the following parameters: 1) gastric cancer risk, 2) prevalence of chronic atrophic gastritis and intestinal metaplasia, 3) nitrate content of well waters, and 4) nitrate excretion by the population. Urinary excretion reflected the ingestion of nitrates, and this implied a higher average intake of nitrates in the populations at high risk for stomach cancer. The Narino data could be construed as presumptive epidemiologic evidence for the role of nitrate availability in the etiology of stomach cancer.

Anterior approach to the thoracolumbar spine: technical considerations

Forty-five patients, of whom most were children, underwent extensive exposure of the thoracolumbar spine to correct serious orthopedic abnormalities. The spine was exposed through a combined thoracotomy and retroperitoneal approach that gave excellent access with minimal morbidity. The diaphragm was opened circumferentially after the peritoneum had been dissected from its muscular portion. This permitted repair of the diaphragm with no detectable loss of function. Although this approach was developed for exposure of the spine, it can also be utilized to expose the entire aorta, both kidneys and their blood supply, and the retroperitoneal area for possible excision of large tumors.

Salicylates and renal function in rheumatoid arthritis

The effect of salicylate treatment on the kidney, particularly medullary function, was investigated. In a retrospective analysis patients with rheumatoid arthritis (RA) treated with high doses of salicylates were shown to have inferior urinary concentrating power and increased excretion of N-acetyl-beta-D-glucosaminidase (NAG) when compared with patients who had not received salicylate treatment. A prospective study of renal funcition in healthy people and patients with RA starting salicylate in therapeutic doses showed that while epithelial cell excretion was only transiently raised in both groups the excretion of NAG was increased in all cases at three days and this increase was sustained at 10 days, all values being much higher in the patients than in the healthy subjects. Thus salicylate treatment does cause renal tubular damage but this damage results in only minimal impairment of function and does not constitute a reason for withholding salicylate treatment.

A system for processing by digital computer spirograms acquired in field surveys

Instrumentation and techniques are described for recording expiratory spirograms in the field and analysing them with a digital computer in the laboratory. A commercially available spirometer is modified, to give an oscillating electrical output signal which is recorded on a cassette tape recorder. The computer displays the spirogram, calculates the forced vital capacity, one-second forced expiratory volume, maximum mid-expiratory flow, and time to expire 25%, 50%, 75%, and 90% of the vital capacity.

Further surgical management of gastric ulcer with unsuspected malignant change

This paper considers the further surgical management of patients who have had a gastric ulcer removed which was apparently benign but which on subsequent histological examination has proved to be a carcinoma. A retrospective review of 59 such patients has been undertaken. A non-radical partial gastrectomy was performed in the first instance on all these patients; 24 of them had a second operation once the correct diagnosis had been reached and 35 had no further surgery. These two groups are compared. The overall 5-year survival in the non-revisional group was only 23% compared with 56% in those treated by a second operation. It is thought that revisional surgery should be undertaken within 6-8 weeks, provided the age and general condition of the patient are satisfactory. Since 1970 the routine use of fibreoptic endoscopy and biopsy has virtually eliminated the problem.

The simultaneous determination by selected ion monitoring of the levels of homovanillic, isohomovanillic, 3,4-dihydroxyphenylacetic and 3-methoxy-4-hydroxymandelic acids in single biological samples

Methods for the determination and quantitation of homovanillic, isohomovanillic, 3,4-dihydroxyphenylacetic and 3-methoxy-4-hydroxymandelic acids in single samples of biological material by gas chromatography, gas chromatographic mass spectrometry and selected ion monitoring during gas chromatographic mass spectrometry are described. Examples of the levels of these four acid metabolites of catecholamines in serum and CSF of untreated dog, cat and human, in urine of parkinsonian subjects treated with varying doses of L-DOPA and in CSF of dogs which had received 1 g of L-DOPA per day for 7 weeks are presented.

Quantitative and Qualitative Studies of Bacteria Isolated from Sea Water Used in the Laboratory Culture of the American Oyster, Crassostrea virginica

Quantitative and qualitative bacteriological studies were conducted on sea water utilized in laboratory culture of American oyster larvae (Crassostrea virginica).The generic diversity of bacteria isolated from a laboratory seawater storage tank did not change during a 15-day sampling period, although bacterial numbers increased substantially. The mean number of bacteria in ultraviolet light-irradiated sea water was less than that in nonirradiated sea water, although individual samples varied considerably. Over a 10-day sampling period during which oyster larval cultures were sampled repetitively, bacteria were more numerous at 24 h and 48 h than at 0 h.Pseudomonas was the dominant genus present in stored sea water, irradiated sea water, and sea water from oyster larval cultures.

A Test of the Zucherman Heterosexual Scales

Female and male undergraduate students enrolled in the introductory psychology course were administered the Zuckerman heterosexual scale as part of a larger battery of tests. The ordering of items for males was very similar to Zuckerman's with two minor exceptions. Female subjects, on the other hand, reported more sexual experiences of all kinds than did Zuckerman's sample, and two major differences in ordering Were noted. The coefficients of reproducibility for males and females were .928 and .954 respectively which were almost identical to those of Zuckerman. The rank-order correlation between the ranking of the items in the male and female scales was .958.

Potential pathogens in the environment: cultural reactions and nucleic acid studies on Klebsiella pneumoniae from clinical and environmental sources

The phenotypic and nucleic acid properties of Klebsiella pneumoniae have been studied on cultures obtained from six different habitats (humans, vegetables, seeds, trees, rivers, and pulp mills). The 19 cultural reactions of 107 isolates varied significantly only in tryptophanase activity and dulcitol fermentation. The percentage of guanine plus cytosine base composition of 41 isolates varied from 53.9 to 59.2%. The range of percentage of guanine plus cytosine base composition for environmental klebsiellas was broader than that for the cultures of human origin. The range of deoxyribonucleic acid relative reassociation (homology) to the human K. pneumoniae reference strain extended from 5% to 100% and the chromosome molecular weights ranged from 2,200 x 10(6) to 3,000 x 10(6). The species of K. pneumoniae is thus molecularly more heterogeneous than previously thought and most isolates of human, pulp mill, and river origin are genetically indistinguishable. The presence of K. pneumoniae therefore represents a deterioration of the microbiological quality of the environment and should be considered of public health significance. At the present time the health significance of the molecularly more divergent strains, primarily of vegetable and seed origin, their relationship to klebsiellas of human origin, or to other genera of the Enterobacteriaceae is unclear.

Operative biopsy of the pancreas

A review has been undertaken of the 47 patients who have had open pancreatic biopsy performed at the Royal Free Hospital between 1967 and 1972. It is concluded that not only is the procedure safe when using the technique described but also it is a valuable and accurate diagnostic procedure.

Changes in the ribosome content, principal microsomal protein composition, and secretory character of mammary epithelial rough endoplasmic reticulum during differentiation. Evidence that messenger RNAs specific for milk proteins are incorporated into rough endoplasmic reticulum formed de novo after parturition

The equilibrium density distribution, protein composition, and secretory character of mouse mammary epithelial rough microsomes have been determined during differentiation. The density range exhibited by the rough microsomes broadens during mammary development; rough microsomes within the 1.25-1.29 g/ml density range appear soon after conception and then within the 1.30-1.34 range after the onset of lactation. The appearance of these denser microsomes represents the progressive increase of the average ribosome content of the rough endoplasmic reticulum (ER) during gestation and lactation. Fractionation of rough microsomal proteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis reveals that two proteins, having molecular weights of 57,000 and 76,000, occur to a significant extent only during lactation and are then most prominent in the very dense rough microsomes of the 1.30-1.34 range. Nascent polypeptide chains discharged (by incubation with puromycin) from 17-days lactation rough microsomes in either the 1.21-1.29 or 1.30-1.34 density range are distributed equally between the intra- and extravesicular compartments. Whereas 36% of the chains are discharged intravesicularly from 1-day lactation rough microsomes in the 1.30-1.34 range, only 25% are so discharged from those in the 1.21-1.29 range. The results indicate (a) that there is no correlation between the relative levels in lactation rough microsomes of the two microsomal proteins which become prominent during lactation and the extent of secretory activity and (b) that for a short period after parturition the rough ER elements bearing high surface densities of ribosomes have a greater proportion of ribosomes synthesizing milk proteins than the rough ER elements with moderate ribosome densities.

The experimental production of gastric ulcers by induced muscle spasm

A new technique is described for the experimental production of gastric ulcers in dogs. It depends on producing an intermittent but severe localized increase in the contractility of the stomach by means of electrodes implanted in the gastric muscle. A suitable stimulator is attached to the animal's back. Following some early technical, failures an adequate stimulus was applied for 2–3 weeks in 16 animals. In 13 cases macroscopic lesions developed in the stimulated area, varying from frank perforation to superficial erosions. Confirmation by barium meal examinations and histology is provided.

It is suggested that the responsible mechanism may be a localized ischaemia, due to the increased muscle spasm, predisposing to the necrosis and ulceration of the mucosa followed by the more superficial layers of the stomach wall.