Higher lung cancer risk for younger African-Americans with the Pro/Pro p53 genotype

A restriction fragment length polymorphism in codon 72 of the p53 gene has been implicated in lung cancer risk, although the functional significance of the polymorphism has not been determined. This association was examined in 109 lung cancer cases (67 African-American and 42 Mexican-American) and 114 controls (74 African-American and 40 Mexican-American) identified from a molecular epidemiological study of lung cancer. The susceptible Pro/Pro genotype was associated with a 1.56-fold higher risk of lung cancer in African-Americans and a 1.95-fold in Mexican-Americans, although neither estimate was statistically significant. In fact, the prevalence of the Pro/Pro genotype was only 2.5% in Mexican-American controls, compared with 20.3% for African-American controls. Patients with the susceptible genotype appeared to have earlier age at diagnosis and lower mean cigarette pack-year exposures than did patients with the Arg/Arg or Arg/Pro genotypes. Risk estimates for the susceptible genotype were 11.29 (1.1, 111.3) for patients < 53 years of age and 14.1 (1.5, 130.6) for patients who reported < 30 pack-years of smoking. The Pro/Pro genotype was not associated with elevated risk in older patients, nor with heavier smokers. If Pro/Pro is a susceptible genotype, the lower prevalence evident in Mexican-Americans may partly explain their lower rates of lung cancer.

Use of exact and adjusted liability scores to detect genes affecting common traits

We used the Haseman-Elston sib-pair test to screen for linkage of markers to genes for disease susceptibility in the simulated data as given in Problem 2 of GAW9. We applied the analysis to the underlying quantitative liability trait (Q1), other covariates of Q1 (Q2-Q4), and the dichotomous affection status trait. In addition, we analyzed the residual Q1 after adjusting for the covariates. Using the sib-pair linkage test, we identified a large region of chromosome 5 affecting the residual value of Q1, a region of chromosome 2 affecting Q3, and a region of chromosome 1 possibly affecting Q2. The analysis of the dichotomous traits did not reveal any regions to be significant. This is likely to be due to lack of information since the families were not selected through affected probands.

Association and linkage with quantitative traits

This paper examines two approaches for the analysis of quantitative traits: (1) association studies and (2) linkage studies. The trait studied was Q1 from simulated Problem 2 data set in Genetic Analysis Workshop 9. Our purpose was to evaluate associations present in the data, to identify nongenetic and genetic predictors of the trait, and to explore the simulated genome for linkage. Through the association study, we found evidence for the primary major gene associated with this trait. The linkage study found evidence of residual genetic effect acting through other traits. Adjustments of Q1 for Q2 and Q3 led to a failure to find significant effects of MG2 and MG3. This supports the suggestion that adjustment for genetically influenced traits for effects of other genetic traits can reduce the power to detect major gene effects. In summary, we detected the major gene directly associated with the trait of interest through association studies. Linkage analysis detected evidence for two other genes associated to a lesser degree with the trait.

Mutagen sensitivity as a risk factor for second malignant tumors following malignancies of the upper aerodigestive tract

BACKGROUND

Second malignant tumors in patients successfully treated for an initial cancer of the upper aerodigestive tract are an important cause of morbidity and mortality. Biologic markers capable of identifying high-risk subgroups of patients who could be targeted for intensive clinical surveillance, therefore, have immense therapeutic and prognostic relevance. We previously demonstrated in a pilot study of 84 patients with cancers of the upper aerodigestive tract that mutagen sensitivity was a significant predictor of risk of developing second malignant tumors.

PURPOSE

We extended the study to include 278 patients diagnosed with previously untreated cancers of the upper aerodigestive tract from 1987 to August 1993.

METHODS

For each patient, base-line (pretreatment) mutagen sensitivity was measured in vitro in 50 metaphases established from peripheral lymphocyte cultures. Patients with an average of more than 1 chromosomal break/cell were deemed mutagen hypersensitive. Cox proportional hazards analysis was used to predict the risk of developing second malignant tumors associated with mutagen sensitivity.

RESULTS

Overall, 44% of the case group exhibited mutagen hypersensitivity. There were no differences in the distribution of mutagen hypersensitivity by site, sex, stage of disease, or smoking status. There were 17 synchronous and 11 metachronous cancers, of which 15 (54%) were smoking-related malignancies. Sixteen (13.1%) of the mutagen-sensitive patients developed second malignant tumors, compared with 12 (7.7%) of the nonsensitive patients. The mean break/cell value (+/- SD) for patients developing second malignant tumors was 1.17 (+/- 0.54), compared with 0.98 (+/- 0.44) for patients with only one cancer (P = .04). Mutagen hypersensitivity conferred a relative risk of 2.67 (95% confidence interval = 1.22-5.79) of developing second malignant tumors.

CONCLUSIONS

Mutagen hypersensitivity increases the risk of developing second malignant tumors.

IMPLICATIONS

Future research should focus on the molecular mechanisms underlying mutagen sensitivity.

NMDA-receptors and potentiation in an area of avian brain essential for learning

The intermediate medial part of the hyperstriatum ventrale (IMHV), part of the avian forebrain, is essential for early learning in the domestic chick. Persistent potentiation (PP) can sometimes be induced in the IMHV in vitro. One can predict success from events which occur during the stimulation (1 min at 5 Hz) which is used for induction: the original response must be transiently replaced by a later, slower response (the LPSR). The LPSR has a comparatively high threshold of activation, its rate of development is inversely related to magnesium concentration and it can be eliminated by NMDA antagonists, as can the induction of PP. PP in the IMHV is therefore dependent upon NMDA receptors and the LPSR represents the activation of these receptors.

Effect of laboratory or clerical error on presymptomatic risk calculations for Huntington disease: a simulation study

Linked markers are useful in prenatal diagnosis as well as presymptomatic diagnosis in late age-of-onset diseases such as Huntington disease (HD). It is widely assumed that most laboratory or clerical errors will be detected because of incompatibility of marker haplotypes within the family. However, errors in marker phenotypes that are compatible but wrong may result in a consultand being given an incorrect risk estimate. We have addressed this issue using simulated marker data in pedigrees similar to those seen in our HD testing program. In Family Structure I (an 11-member, 3-generation family), a particular family was more likely to be detected as inconsistent than incorrectly assigned. In a small nuclear family (Family Structure IV), fewer errors would be detected, and more would appear consistent but give incorrect risk estimates (e.g., low risk misclassified as noninformative or high). Given the presence of tight linkage, risk estimates are often calculated based on a small number of relatives. However, these computer simulations demonstrated that increasing the number of relatives typed decreases the probability that the family will remain consistent with an error present, and, therefore, decreases the probability of an incorrect assignment of risk. It is important to decrease the level of such errors by duplicated readings of raw marker data and validation of computer input.

[Rubber band ligation in the management of hemorrhoids]

During one year from November 1990 to October 1991, 1005 patients of hemorrhoids visited VGH-Kaohsiung. Among different treatments of hemorrhoid, rubber band ligation was most commonly used, with which 66% patients were treated. The follow-up at least one month in duration, discovered much improvement with this ligation in patients symptoms such as prolapse, anal bleeding and anal soiling, etc. The success rate reached higher than 90% for the first, second and third degree of hemorrhoids. About one third of 4th degree hemorrhoid got improved after ligation of their internal hemorrhoids. Except for pain feeling in the anus, the occurrence rate of other complications such as hemorrhage, anal thrombosis, constipation or dysuria was very low. With the exception of hemorrhoid of 4th degree or with large skin tag, this simple and highly successful management is the first choice for the treatment of hemorrhoids.

Cystic fibrosis patients bearing both the common missense mutation Gly----Asp at codon 551 and the delta F508 mutation are clinically indistinguishable from delta F508 homozygotes, except for decreased risk of meconium ileus

The glycine-to-aspartic acid missense mutation at codon 551 (G551D), which is within the first nucleotide-binding fold of the cystic fibrosis transmembrane conductance regulator (CFTR), is the third most common cystic fibrosis (CF) mutation, with a worldwide frequency of 3.1% among CF chromosomes. Regions with a high frequency correspond to areas with large populations of Celtic descent. To determine whether G551D confers a different phenotype than does delta F508, the most common CF mutation, we studied 79 compound heterozygotes for G551D/delta F508, from nine centers in Europe and North America. Each subject was matched, by age and sex, with a delta F508 homozygote from the same center. A retrospective cohort analysis was performed on the following outcome parameters: age at diagnosis, sweat chloride, meconium ileus at birth, height, weight, weight for height, FVC, FEV1, chest X-ray score, pseudomonas colonization, pancreatic sufficiency, and Shwachman clinical score. There was less meconium ileus among the G551D/delta F508 compound heterozygotes (relative risk 0.33; 95% confidence interval .13-.86), as well as a trend toward later age at diagnosis of pancreatic insufficiency. No statistically significant difference was found between the groups for any other parameter. These results suggest that the CF genotype can be a predictor of pancreatic and intestinal phenotype. Prenatal counseling for the two genotype groups should differ only with respect to probability of meconium ileus. Clinical outcome (after survival of meconium ileus) for G551D/delta F508 compound heterozygotes and delta F508 homozygotes is indistinguishable; therefore, prognostic counseling should not differ.

The technique of percutaneous endoscopic gastrostomy. A safe and cost-effective alternative to operative gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is an attractive method of providing enteral nutrition to patients who are candidates for operative gastrostomy or nasoenteric tube feeding; it is currently the procedure of choice for selected nutritionally compromised patients. PEG may be considered for patients who need short- or long-term enteral support; those unable to swallow or who cannot maintain adequate oral intake are ideal candidates. Several techniques are used to perform PEG; each involves the placement of a gastrostomy tube at a point where the stomach and abdominal walls are in closest contact. PEG can be done at the bedside without general anesthesia. Feeding can begin within 24 hours of PEG placement. Major complications (peritonitis and pulmonary aspiration) occur infrequently.

[Two-phase test of fecal occult blood screening for colorectal cancer]

The detection of colorectal cancer in an early curable stage has become the focus of considerable interest recently. A two-phase test using both guaiac test and Hemolex latex immuno-agglutination test was applied for fecal occult blood screening of colorectal cancer. A total of 4,725 veterans aging 60 to 69 years were registered, and 2,176 persons (average age 66 years) completed the test giving a compliance rate of 46%. The positive rates of both tests were accounted 20.5% and 6.7% respectively. Five hundred and forty five persons had positive reaction for at least one of the tests. Of these, 90 had a follow up diagnosis with colonoscopy or combined with barium enema. Three rectal adenocarcinomas were detected, of which only one was positive by guaiac test, but two by Hemolex test. A rectal carcinoid was found by rectodigital examination. It was negative by both tests. Nineteen cases were detected to have one or more polyps in colon or rectum, of which only 6 were positive by guaiac test, but 18 by Hemolex test. Hemolex test using antibody against human hemoglobin is based on latex agglutination reaction. It is more sensitive and specific than guaiac test. Moreover, no dietary restriction is required. In the view point of cost-effectiveness, mass screening for colorectal cancer in general public is not recommended, but hospital-based screening for high risk group is still worthwhile to study.

Improving a university hospital obstetric clinic: better but not best

The Obstetric Clinic at the Johns Hopkins Hospital was evaluated on four occasions during the past 8 years. In 1980, there were major inefficiencies because of a block patient appointment system and late physician arrival. Clinic goals were largely undefined. The institution of a staggered appointment system, the naming of an on-site physician director who encouraged physicians to arrive on time, and the delegation of specific responsibilities to the nurses and clerks resulted in improved patient transit time. In 1981, 72% of patients had left by 2 hours after their arrival, compared with only 4% in 1980. The departure of the physician director was associated with considerable backsliding in patient transit time because of late physician arrival. There was a corresponding decrease in appointment-keeping from 90 to 78%. Patients were satisfied with their care but very dissatisfied with the waiting time. The return of the physician director and the reaffirmation of the roles of nurses and clerks reversed much of the backsliding. Our study suggests that improvements in teaching-hospital obstetric clinics are difficult to sustain without strong leadership. We believe that further improvement will require a major reorganization of ambulatory care for women. The feasibility of establishing a comprehensive program based on a group practice model is currently being studied.

The Baltimore pregnancy prevention program for urban teenagers. II. What did it cost?

An experimental pregnancy prevention program for junior and senior high school students consisted of classroom lectures, informal discussion groups and individual counseling in the schools and group education, individual counseling and reproductive health care in a nearby clinic. The structure of the program allowed for extensive individual counseling for students who desired it, and the reported costs are thus considered generous. School-based services utilized 40 percent of a total three-year budget of $409,250, and clinic services, 60 percent. The average cost per student served was $122, with the average per female student almost four times that per male and the average per senior high student more than twice that per junior high student. Students who utilized more expensive types of services, such as individual counseling and medical services in the clinic, also used other program offerings more frequently. Services to students who attended only class lectures cost an average of $13.20 to deliver, while students who utilized all services cost the program an average of $546 each.

The Baltimore pregnancy prevention program for urban teenagers. I. How did it work?

Two teams, each consisting of a social worker and a nurse, delivered the bulk of services in an experimental pregnancy prevention program for junior and senior high school students that combined school and clinic components. In-school components were classroom presentations, informal discussion groups and individual counseling; clinic services consisted of group education, individual counseling and reproductive health care. Eight-five percent of the total student enrollment had contact with at least one component of the program. More males than females were among the 15 percent with no contact. When estimates of chronic absenteeism are taken into account, the program is believed to have reached all students in regular attendance. Approximately 22 percent of staff-student contacts occurred in the classroom, and the remaining 78 percent were voluntary on the part of the student. About 68 percent of contacts occurred within the school, with small group discussions especially popular--they represented 41 percent of all contacts. The proportion of contacts that occurred in the clinic was highest among senior high females (46 percent) and lowest among senior high males (12 percent).

Plasmacytoma of the breast. An unusual case of recurrent myeloma

An unusual case of multiple myeloma is presented in which recurrence of the disease after a four-year remission was heralded by an infiltrating plasmacytoma of the breast. The clinical and histologic features of this neoplasm are presented and compared with ten previously reported cases of plasmacytoma of the breast.

Tubal anastomosis: pregnancy success following reversal of Falope ring or monopolar cautery sterilization

The present study reviews pregnancy outcome following tubal anastomosis in 80 previously sterilized women. Thirty of 58 women (52%) sterilized by monopolar cautery techniques delivered a living child as compared to 19 of 22 women (86%) sterilized using the Falope ring method. Cumulative pregnancy curves were calculated for the Falope ring and cautery groups using life-table methods. Following reversal of Falope ring sterilization, the estimated cumulative probability of pregnancy 6, 12, 24, and 36 months after surgery was 28.4%, 48.8%, 69.3%, and 87.2% respectively. The corresponding estimates following reversal of cautery sterilization were lower at 6, 12, 24, and 36 months following surgery: 22.7%, 37.8%, 52.4%, and 57.9%, respectively. The ectopic tubal pregnancy and spontaneous abortion rate were higher among women sterilized with monopolar cautery. A decreased pregnancy rate was associated with ampullary-isthmic anastomosis in the cautery group; however, pregnancy was least likely to occur in women with shortened oviducts of less than 4 cm.

The Johns Hopkins Adolescent Pregnancy Program: an evaluation

The obstetric component of The Johns Hopkins Adolescent Pregnancy Program is described and the pregnancy outcome for adolescents delivering between 1976 and 1981 is compared with that of similar young women who were delivered in the same facilities, by the same staff, but who received their prenatal care in other Hopkins-related programs. The adolescent program is comprehensive, providing intensive psychosocial support and patient education in addition to medical care, using a team approach coordinated by an individual case management system. Enrollees had fewer pregnancy complications and lower perinatal mortality. Between 1979 and 1981, the frequency of birth weight below 2500 g was 9.9%, and below 1500 g, 1.9% for program adolescents, compared with 16.4 and 3.9%, respectively, for controls. Younger adolescents in the program entered prenatal care significantly later than older ones. However, those aged 14 years and below had infants with the highest average birth weight and no greater risk of perinatal death than those of older adolescents.

Delivery of fertility control services by male and female obstetrician-gynecologists

Sex differences in the delivery of fertility control services were explored in a national survey of 1420 recently trained obstetrician-gynecologists in active practice. Women were found to be more likely than men to provide abortion services but less likely than men to provide amniocentesis and certain infertility services. Women were found to contribute less than their proportionate share of two services for which volume was measured: artificial inseminations and sterilizations. Physician gender, however, was a less important predictor of volume of sterilizations delivered than were a set of practice-related variables. Overall our findings suggest that the increased representation of women among obstetrician-gynecologists could influence the delivery of a few specific services.

Sex differences in the practice patterns of recently trained obstetrician-gynecologists

Sex differences in practice patterns, as modified by family roles, are investigated in a national survey of 1420 active obstetrician-gynecologists who graduated from medical school between 1974 and 1979. Women are more likely than men to be practicing in multispecialty groups, and men are more likely than women to be practicing in obstetrics-gynecology partnerships. On average, men and women report working over 60 hours per week. In all practice arrangements except academic medicine, women work fewer total hours per week, although the differences are small and translate into significantly fewer patient encounters than men in only two practice arrangements: partnerships and multispecialty groups. When marital status and presence of children under age 18 are controlled, significant sex differences in hours worked remain only for married respondents with children. Family roles have an opposite effect on hours of work reported by men and women, decreasing the number of hours worked by women and increasing the number worked by men.

Thyrotropin-releasing hormone-induced contraction of urethral and vaginal muscle

Pressure studies were carried out in 10 women to determine whether TRH stimulates muscular contractions in the genitourinary system. TRH (500 micrograms) or saline was administered iv as a bolus injection. Whereas saline had no effect, TRH increased intraurethral pressures in all women, vaginal pressure in 7, and bladder pressure in none. These findings suggest that TRH, acting centrally, peripherally, or both, may play a role in initiating muscular contractions in the female genitourinary tract.

Use of osmotic dilators to facilitate induced midtrimester abortion: clinical evaluations

A number of studies evaluating an osmotic cervical dilator consisting of polyvinyl foam saturated with magnesium sulphate in women undergoing midtrimester abortion with intra-amniotic hyperosmolar urea plus prostaglandin F2a were completed. Comparisons with women receiving no pre-treatment with a laminaria tent or with one laminaria indicate that their use appears to shorten injection-abortion intervals, particularly in parous women, and reduce risk of endometritis and cervical laceration compared to women not receiving any type of device. The data suggests that two osmotic dilators may be more effective than one. Also, magnesium toxicity does not appear to be a substantial risk with their use.

Morbidity risk among young adolescents undergoing elective abortion

A cohort study comparing risks of morbidity at the time of elective abortion between 399 young adolescents aged 17 years or less matched to 399 women aged 20 to 29 years was completed. The study matched for duration of gestation, types of procedure, parity, race, month of procedure, and insurance status. Results indicated a relative risk of post-abortal endometritis for adolescents compared to older women of 2.5 (95% C.L. 1.48, 3.85). The reasons for this difference are unclear.

Comparative effects of intrauterine instillation of analogues of quinacrine and tetracycline on uterine morphology in the rat

Currently, intrauterine instillation of quinacrine hydrochloride is used to induce closure of the uterotubal junction in women, thus constituting a chemical method of sterilization. Questions regarding the safety of this drug have been raised. The purpose of the present study is to screen other drugs for their sterilizing potential by comparing quinacrine-induced changes in uterine morphology in the rat which have previously been correlated with decreased fertility with the changes induced by other drugs. The drugs tested include quinacrine-like compounds, namely chloroquine, primaquine and trimethoprim; and tetracycline and its analogues which are known sclerosing agents. The quinacrine-like drugs were relatively ineffective in producing uterine lesions similar to those of quinacrine, but like quinacrine, chloroquine and primaquine showed some toxicity. Tetracycline and its analogues produced quinacrine-like morphologic changes in the rat uterus and showed no toxicity for the doses tested. These results prompt further testing of tetracycline and its analogues as sterilizing agents.