Seventh-grade cigarette, alcohol, and marijuana use: distribution in a north central U.S. metropolitan population

Tobacco, alcohol, and marijuana use were examined in a seventh-grade population from a north central U.S. metropolitan community. Participation exceeded 94% and biological testing was used to increase the disclosure of drug use during the survey. Drug use was related to age, gender, race, family structure, and parental occupation in a series of logit analyses to identify high-risk groups. While univariate analyses uniformly supported earlier studies, the logit analyses revealed patterns not previously reported and at times contrary to previous reports. Significant associations were observed between drug use and each of the demographic factors; the likelihood of drug use increased by as much as 80-fold in subgroups defined by interactions among these variables. Native Americans, Hispanics, Black females, and adolescents whose mothers held white-collar jobs were substantially more likely to report drug use compared to other groups; females were generally similar to males in their level of use after adjustment for other factors. These results suggest that multivariate analyses which consider higher-order interactions may more adequately model the distribution of drug use in adolescent populations, compared to those based on univariate or first-order multivariate techniques.

Bone-marrow plasmocytosis--an immunohistological study

Bone-marrow biopsies and smears from 59 patients with reactive plasmocytosis (22), multiple myeloma (24), solitary plasmocytoma (3) and monoclonal gammopathy of undetermined significance (MGUS) (10) were examined. To demonstrate cytoplasmic immunoglobulin the immunoperoxidase method was applied and evaluated quantitatively. Immunohistology yielded different ranges in kappa/lambda ratio for reactive plasmocytosis (0.4-3.5), multiple myeloma (less than or equal to 0.1 and greater than or equal to 11.2) and MGUS (0.2-3.0). As a result this method seems to be helpful in characterizing a plasmocytosis and distinguishing overt myeloma from monoclonal gammopathy of undetermined significance and reactive plasmocytosis. A differentiation of monoclonal gammopathy of undetermined significance from reactive plasmocytosis is not possible histologically and immunohistologically.

[Tumor-associated antigens and fibrin derivatives as reaction products of ovarian cancer]

The detection of tumour-associated antigens in blood, ascites fluid, and tissue by the use of monoclonal antibodies establishes new aspects for the course control of ovarian cancer therapy and the evaluation of tumour-associated fibrinolysis. Monoclonal antibodies to the cross-linking site of fibrin derivatives in an enzyme immunoassay (D-dimer-ELISA) allow to compare quantitative results of fibrinolysis products with different tumour markers and the clinical tumour situation. In a prospective follow-up-study in 102 patients with epithelial ovarian carcinoma Ca 125, D-dimer, TPA, Ca 19-9, and CEA were investigated as tumour markers. Specificity (control group 61 gynaecologic patients with benign diseases) and sensitivity were compared in sensitivity-specificity diagrams (receiver operating characteristic curves) for different clinical tumour situations (preoperative, S0-S3). Applying a limit value of normal range, indicated in parentheses, the specificity of Ca 125 (greater than 65 mu/ml) amounts to 100%, D-dimer (greater than 700 ng/ml) 100%, TPA (greater than 120 mu/ml) 90%, CEA (greater than 5 ng/ml) 96%, Ca 19-9 (greater than 37 mu/ml) 98%. In the same sequence, sensitivity values came to 91%, 82%, 65%, 8% and 19% in manifest tumour situations. Antigen-concentration levels and frequency of pathological values depend on the degree of tumour disease. The results of seroimmunodiagnostic methods correlate with the clinical tumour situation: In 11 of 12 cases clinical tumour progression or relapse were accompanied by increasing concentrations of Ca 125 and D-dimer. In 21 cases of second-look laparotomies, tumour marker values in the normal range were often found not to be conclusive for diagnosing a tumour-free situation. The predictive value for true negative results amounted to only 18%. Immunohistochemical investigations and plasma-ascites diffusion ratios of antigens indicate that enrichment occurs in ascites. Fibrin deposition often surrounds tumour plugs and is found in interstitional tissue, whereas Ca 125 is expressed mainly at tumour cell surface. The histochemical image reflects fibrin as a tumour surrounding antigen and Ca 125 as a tumour-originated antigen. Clinical relevant serodiagnostic methods for ovarian cancer are brought about by the monoclonal detection of the investigated antigens.(ABSTRACT TRUNCATED AT 400 WORDS)

[Simultaneous determination of Ca 125 and D-dimer in plasma and ascites in ovarian cancer]

In 37 patients with ovarian carcinoma stages Ic to IV the values of preoperatively determined tumour markers and the values of the follow-ups were examined in a trial to observe the course of the disease. The following sensitivity was recorded: Ca 125 92%, D-dimer 100%, TPA 76%, CEA 29%, CA 19-9 15%. Ca 125, D-dimer and TPA are unsuitable as follow-ups. They are also detectable in ascites.

[Therapeutic results in spinal tumor metastases involving neurologic deficit]

Between 1976 and 1982 primary or secondary intraspinal malignant lymphomas and metastases of solid tumours with neurologic defects were found in 118 hospitalised patients. A total of 126 episodes of spinal and caudal compressions were observed. Nearly half of all tumour diagnoses were breast and prostatic carcinomas. Segments Th 3-6 were mainly involved. Symptoms of compression were the first objective hints of malignant disease in every third patient. Local and (or) radicular pains were reported as first symptoms by 80% of patients. Therapeutic success was considered satisfactory (group A) if patients were able to walk freely 3 months after initiation of treatment or isolated loss of sensitivity or defects of urination or defaecation could not be demonstrated any longer. Results were classified as unsatisfactory (group B) if the above-mentioned aims of treatment could not be achieved within this time. After individualised carefully monitored treatment, survival of patients of group A was significantly longer after 12 and 24 months than in patients of group B. Probability of survival is mainly influenced by rapid response to treatment, by tumour histology, by severity of neurologic defects and by the chosen treatment regime.

[Malignant testicular tumor treated with cytostatic drugs in a case of kidney transplantation for familial cystic kidney]

The case is presented of a 29-year-old male who developed embryonal testicular carcinoma two months after successful transplantation of a cadaver kidney because of end stage renal disease due to polycystic disease. After surgical removal of the carcinoma and 3 courses of chemotherapy with bleomycin and vinblastine, complete remission was induced which has now lasted for 14 months. In addition to the usual toxicity of cytotoxic therapy, transplant function decreased intermittently but renal function recovered under close monitoring and dose-adaptation of immunosuppressive medication with cyclosporin and prednisolone.

Agranulocytosis associated with semisynthetic penicillins and cephalosporins. Report of 7 cases

Within one year we observed in the same intensive care unit seven severely polytraumatized patients with agranulocytosis (AG) associated with treatment by semisynthetic penicillins or cephalosporins combined with aminoglycosides. Antibiotics were given because of severe bacterial respiratory or generalised infections. Five patients died, four of them without haematological remission. Bone marrow aspirates showed hypoplasia of granulopoiesis due to a lack of mature cells. Leukocyte and granulocyte counts in the blood declined continuously over a period of 8 to 11 days. In average, minimal granulocyte counts occurred after 21 days of hospitalisation and 14 days of antibiotic drug exposure. Beside the incriminated antibiotics all patients were treated sporadically with other agents of which may cause AG. Granulocyte kinetics and serial bone marrow examinations of one patient suggest a phenothiazine type of AG, which is caused by a toxic damage of granulopoiesis. Declining absolute granulocyte counts in the blood together with persisting high temperatures during antibiotic treatment should give rise to the suspicion of a beginning AG.

[Head and neck cancers. What's new in clinical oncology for the practicing ENT physician?]

An interdisciplinary evaluation is made of the most common forms of head and neck cancer, with emphasis on certain aspects.--In the field of x-ray diagnostics, computed tomography dominates varying importance being given to the individual organs. Nuclear medicine pays particular attention to skeletal scintigraphy and gallium scintigraphy. In radiation therapy, progress has been made especially through the use of optimal radiation planning as well as the use of the after-loading technique and neutron radiation. Antineoplastic chemotherapy is currently being used as palliative treatment, adjuvant chemotherapy and as the first step towards a curative therapy.

[Non-Hodgkin lymphoma with infiltration of the optic nerve (author's transl)]

Infiltration of the optic nerve is very rarely found in any form of malignant lymphoma. We report on a 24-year-old male patient suffering from non-Hodgkin lymphoma of the stomach. While recovering after treatment of the primary tumor by chemotherapy he developed papilledema in both eyes and almost total loss of vision. Radiotherapy resulted in restitution of vision within a few days. Later there was a transient acute detachment of pigment epithelium. Malignant cells in the CSF could not be detected until three months after the onset of ophthalmological symptoms. Histopathological sections revealed meningeosis sarcomatosa with infiltrations into the optic chiasm, tracts and nerves.

[Diagnosis of pulmonary embolism: lung perfusion scintigraphy and thoracic roentgenography. Comparison of results in 472 patients with suspected pulmonary embolism]

Although lung-perfusion scintigraphy has been proved to be the most helpful method in the diagnosis of suspected pulmonary embolism, especially in comparison with actual chest-X-ray or ventilation studies, sometimes problems occur in interpreting the scan. The aim of the present retrospective study in 472 patients with suspected pulmonary embolism was to reevaluate the reliability of direct and indirect radiological findings typical for pulmonary embolism. Out of 155 patients with confirmed pulmonary embolism 41% showed those signs in chest-X-ray (true-positive). 59% cases were found to be false-negative. Patients without pulmonary embolism (84%) did not demonstrate any radiological symptoms typical for pulmonary embolism (true-negative) but 16% did (false-positive). Physicians should pay more attention to X-ray findings despite the fact, that their sensitivity and specificity are low, because radiological symptoms represent important additional information, helpful especially in controversial clinical results.

[Closed intramedullary nailing of femur shaft fractures - experiences in 245 cases (author's transl)]

A follow-up study is given of 245 femoral shaft fractures, treated 1961-1975 with closed reduction and intramedullary nailing. 141 patients were examined personally 19-5 years after operation. The results were excellent in 75,9%, fair in 20,6%, and poor in 3,5%. Deep infections occurred in 2,4%. The number of patients was also subdivided in regard to indication, concomitant injuries, postoperative fatalities, pathologic fractures etc.

[Report concerning 20 open wounds of the heart (author's transl)]

It will be reported about 20 open wound of the heart, which were observed between 1964 and October 1980 at the II. Univ. Clinic of Traumatology in Vienna. 17 of them could be operated and 10 could be discharged healed. In 14 cases the cause was a stab, in 5 cases a gun-shot and in one case an explosion. The right and the left ventricle were wounded in equal numbers. Six patients were resuscitated successfully after admission but died after operation. In three cases the reanimation was not successful. Except in one case the anterolateral thoracotomy was chosen for entering. An experienced, well trained team is absolutely necessary to provide such wounds.

[Skeletal scintigraphy for the observation of course and treatment of carcinoma of the prostate ]

Serial skeletal scintigraphy was carried out on 259 patients with carcinoma of the prostate; 5-10% developed bone metastases each year. Isotope uptake was measured in 79 patients receiving treatment; in 60.6% (48 patients) there was a reduction or disappearance of the areas of uptake, in 16.6% (13 patients) they were stationary and 22.8% (18 patients) the metastases progressed. Skeletal scintigraphy is therefore useful during the course of the disease in showing its extent and the effect of treatment.

[Lingual goiter with special regard to diagnosis and therapy]

Starting with a case report, epidemiology, diagnosis, therapy and prognosis of lingual thyroid are discussed with special reference to the decisive value of scintigraphy. The usual 99mTc-scan often fails in detection of ectopic thyroid tissue because of tracer accumulation in salivary glands and its excretion into the oral cavity. Another disadvantage is the relatively high tissue absorption of 99mTc-photons. According to the low sensitivity and specificity of usual 99mTc-scintigraphy, all patients with suspected ectopic thyroid tissue and especially in case of suspected tumor in the retrolingual region should be examined by radio-iodine-imaging (123I, 123I). The decision between conservative and surgical therapy depends on subjective complaints, regional iodine uptake and growth behaviour of the lingual thyroid, and especially on cytological findings of fine needle biopsy, which is not dangerous in expert hands.

[Primary amyloidosis with nephrotic syndrome: 5 year follow-up under polychemotherapy. A case report (author's transl)]

A patient with primary amyloidosis had infiltration of liver, bone and bone marrow and a nephrotic syndrome with massive proteinuria. In addition, there was evidence for a plasma cell dyscrasia with an increased number of plasma cells and other lymphoreticular cell elements in the bone marrow and an impairment of immunoglobulin synthesis without M-gradient. The course of disease was observed over a period of five years. The patient was treated intermittently with a combination of penicillamine, melphalan, fluocortolone and fluoxymesterone. Under treatment the nephrotic syndrome disappeared and liver size decreased. Hemopoiesis remained sufficient but bone marrow infiltration by amyloid did not respond to therapy and massive osteoporosis developed. Comparison of our with other reported cases treated with the same regime suggests that response to this treatment may be influenced by factors such as sex and clinical manifestation of the disease.

[Chronic hypophosphatemic osteopathy (author's transl)]

The process of chronic hypophosphatemic vitamin D-resistant rickets--observation of two cases. With the male patient--our first case--the disease was sporadic and had not been recognized for a long time. In his early adulthood it manifested itself as Umbauzonen (pseudofractures) in the larger context of active osteomalacia. It was possible to observe the pseudofractures before and while the patient was treated with drugs. High doses of vitamin D 3 and dosage of phosphate mitigated the complains although with respect to the radiological, scintigraphic, humoral and histological findings there was only slow improvement or no improvement at all.--The patient's daughter is affected by the disease as well. In her case the pathological signs of her bones became better when treated with vitamin D 3.

[Intestinal endometriosis as a surgical problem]

6 cases of colonic endometriosis, treated by surgery, are presented. The average age was 50 years. All patients also had concomitant genital endometriosis and 5 of these 6 women have had previous pregnancies. Pathological findings were intramural colonic growth leading to stenosis and tumor like endometriomas. 3 times a sigma resection, once an ileo-cecal and once an anterior resection was carried out, there is in one instancy the stenosis could be overcome by enucleation. Postoperative course was uneventful, but one case later on developed a rectal carcinoma--first mistaken as recurrence of intestinal endometriosis.

[Unilateral pulmonary artery aplasia with special reference to lung scintigraphy (author's transl)]

In a case of unilateral aplasia of one Arteria pulmonalis, i.e. proximal interruption, the diagnostic value of perfusion and ventilation scintigraphy is shown to be simple and non-invasive, exposing the patient to a lower radiation dose than other diagnostic screening methods. When an interruption of a main pulmonary artery is radiologically suspected the scintigraphic examination allows to distinguish between vascular and/or parenchymatous pulmonary diseases, thus clarifying the diagnosis of primary pulmonary malperfusion. The results of other examinations, the relevant literature, the pathogenesis and pathophysiology of unilateral pulmonary artery aplasia as well as therapeutical and prognostic aspects are reviewed.

[Application of computer tomography (CT) as an additional means of follow-up gynecologic neoplasms-a case documentation (author's transl)]

The application of CT represents an important progress not only in diagnostic and therapeutic planning, but also in the evaluation of the effectiveness of follow-up procedures in gynecologic cancer therapy. The evaluation of the results of some follow-up procedures in a case of leiomyosarcoma uteri shows significance and importance of CT as a new radiologic method. Inspite of preliminary negative results of extensive radiologic, myelographic, laboratory investigations and of technetium- and gallium-scintigraphy, CT proved a solitary metastasis located at S-1 in the os sacrum. The diagnostic aspects of follow-up examinations in patients undergoing cytoreductive surgery or radiotherapy are discussed. CT should not be placed at first rank position, but be considered as an helpful additional means for special cases.

Die einseitige Lungenarterienaplasie unter besonderer Berücksichtigung der nuklearmedizinischen Lungendiagnostik

Am Beispiel eines Falles einer unilateralen Aplasie der Arteria pulmonalis (sog. proximal interruption) wird der Stellenwert der Lungenperfusions- und Ventilationsszintigraphie als technisch einfache und nicht-invasive Methode mit vergleichsweiser geringer Strahlenbelastung in der Vorfelddiagnostik aufgezeigt. Beim röntgenologischen Verdacht erlaubt ihr Einsatz durch die mögliche Unterscheidung zwischen vaskulärer und/oder parenchymatöser Lungenerkrankung bereits die Klärung in Richtung einer primären pulmonalen Perfusionsstörung herbeizuführen. Unter gleichzeitiger Berücksichtigung der übrigen Untersuchungsergebnisse und der einschlägigen Literatur werden auch Pathogenese und Pathophysiologie der einseitigen Lungenarterienaplasie sowie therapeutische und prognostische Gesichtspunkte besprochen.

[Radioimmuno-assay of TSH before and after TRH in 350 patients with previous resection of euthyroid goiter (author's transl)]

Radioimmuno-Assay (RIA) of Thyroid-Stimulating-Hormone (TSH) was performed before and after i.v.-injection of Thyrotropin-Releasing-Hormone (TRH) in 350 patients subsequent to previous resection of euthyroid goiter to find out the optimal treatment schedule for preventing recurrent goiter. In patients without recurrent goiter the dosis of thyroid hormone was considered to be sufficient, if the difference in TSH-levels before and after TRH (delta-TSH) was equivalent to or less than 10 microunits/ml. In patients with recurrent goiter the optimal suppressive dosis of thyroid hormone was accepted for a delta-TSH less than or equal to 2,5 microunits/ml. 126 out of 135 patients, who were set on an immediate and continuous postoperative treatment were free of goiter, 58 presented a delta-TSH less than or equal to 10 microunits/ml (average interval of treatment = 2,5 years), 68 patients had elevated delta-TSH (average interval of treatment 2,1 years) as a sign of insufficient treatment. In 9 patients recurrent goiter was detected in spite of "adequate" treatment. 41 out of 57 patients, set on delayed and partly continuous, partly discontinuous treatment had recurrent goiter (in average after 10 years). delta-TSH was not indicative. 158 patients without any treatment had borderline or slightly increased delta-TSH (in average after 10 years). 122 of these 158 patients had recurrent goiter, 36 were free of goiter. The results favor the necessity of treatment with thyroid hormones starting immediately after operation and with continuous treatment. The combined use of TSH-RIA and TRH-test reliably informs about the individual thyroid hormone dosis necessary for prevention or treatment of recurrent goiters.

[Fractures of the distal end of the femur and their management using condyle plates]

Forty-one patients with fractures of the distal end of the femur are investigated and the importance of the angular plate designed by the AO group for stabilization of these fractures is discussed. For good results it is necessary to have the complete set of instruments and to consider biomechanical principles for stable osteosynthesis, so that early active exercises can be performed. The operation is not always simple but is indicated considering the poor functional and anatomical results after conservative treatment or inadequate fixation.

[A rare cumulation of vena cava catheter complications in the same patient (author's transl)]

Two complications that occurred in connection with the use of CVP catheters in the SVC and IVC in one patient are described: 1. Extravascular injection in the superior mediastinum and in the extrapleural space. 2. Massive thrombosis of the IVC. The differential diagnosis of a wedening of superior mediastinum is discussed. Recommendations are made to prevent these complications.

[Pulmonary edema due to unilateral pneumothorax (unilateral shock lung) (author's transl)]

Unilateral pulmonary edema due to chest drainage is reported in the present paper. Drainage was carried out, because of pneumothorax. The disorder could be treated successfully with differenciated mechanical respirator therapy and additionally with methylprednisolon, heparin, spirolactone and dopamin. Based upon clinical symptoms and on present literature we suggest to account this so called "pulmonary edema exvacuo" to the main complex of acute respiratory insufficiency (unilateral shock lung).

[Osteogenic sarcoma combined with non-ossifying fibroma in one bone (author's transl)]

In a 15 year old girl a combination of osteogenic sarcoma and non-ossifying fibroma in the distal shaft of femur is reported and discussed.

[Complications in modern treatment of posttraumatic osteomyelitis (author's transl)]

Several conditions must be accomplished for successful treatment of posttraumatic osteomyelitis, as there are stability in fracture region, surgical debridement, wound irrigation, cancellous bone transplantation and skin grafting. All this surgical methods involve possibilitis of complications. The most of them can be avoided observing certain rules of management.

[The effectiveness of autologous transplantation of spongy tissue of bone in accident surgery (author's transl)]

The use of autologous transplants of spongy tissue of bone has attained a standard place in the treatment of pseudoarthroses and of depressed fractures in the vicinity of joints. On the basis of experience gained during the implementation of this form of treatment at the Professorial Casualty Unit of the 2nd Department of Surgery, University of Vienna, during the years 1671--1974, guide lines are laid down for the achievement of a successful outcome of transplantation with a minimal complication rate.