The imidazoline site involved in control of insulin secretion: characteristics that distinguish it from I1- and I2-sites

1. The nature of the binding site mediating the insulin secretagogue activity of certain imidazoline compounds remains unclear and the pharmacology of the I1- and I2-imidazoline sites, described in many tissues, does not correlate with the observed responses to imidazolines in islets. In the present paper, we describe further results which support the concept that the islet imidazoline site may represent a novel subtype of imidazoline receptor. 2. Culture of rat isolated islets in the presence of imidazoline secretagogues (either efaroxan or phentolamine) resulted in loss of responsiveness on subsequent re-exposure to these agents. However, culture of islets with either idazoxan or UK14,304 (imidazoline ligands that do not stimulate insulin secretion) did not lead to any loss of response when the islets were subsequently exposed to efaroxan. By contrast, islets cultured with UK14,304 (a potent alpha 2-adrenoceptor agonist), displayed loss of sensitivity to noradrenaline, consistent with down-regulation of alpha 2-adrenoceptors. 3. In order to characterize the imidazoline site further, radioligand binding studies were performed in membranes from RINm5F insulinoma cells using [3H]-RX821002, an imidazoline insulin secretagogue that does not interact significantly with imidazoline sites in other tissues. [3H]-RX821002 labelled alpha 2-adrenoceptors with high affinity (2.01 +/- 0.7 nM) but also labelled a second, non-adrenoceptor site with much lower affinity. 4. Under conditions of alpha 2-adrenoceptor blockade (in the presence of adrenaline), efaroxan displaced [3H]-RX821002 binding to the low affinity site, in a dose-dependent manner. Competition studies employing additional imidazoline compounds of varying secretagogue activity revealed that the pharmacological profile of the low affinity site correlates well with that observed in secretion experiments.5. The results obtained from the down-regulation experiments with isolated islets and from the radioligand binding studies suggest that the low affinity [3H]-RX821002 binding site may represent the functional receptor responsible for the secretagogue activity of imidazoline compounds in the endocrine pancreas and that it has a pharmacological profile distinct from those of I,- and 12-sites.

Screening for planar chlorobiphenyl congeners in tissues of marine biota by high-performance liquid chromatography with photodiode array detection

A rapid method has been developed to screen for planar chlorobiphenyl (CB) congeners, as well as certain other CBs and DDTs, in tissue samples from marine biota. The analytes were extracted from tissue matrices with 1:1 hexane/pentane (v/v) and interfering compounds were separated from the CBs on a gravity-flow column packed with acidic, basic and neutral silica gel eluted with 1:1 hexane/methylene chloride (v/v). Subsequently, the planar CB congeners were resolved from the DDTs and other CBs by HPLC on Cosmosil PYE analytical columns cooled to 9 degrees C and were measured by an ultraviolet (UV) photodiode array (PDA) detector. Two important advantages of PDA over conventional UV detection were the ability to identify individual analytes by comparing their UV spectra to those of reference standards and the ability to establish the spectral homogeneity (purity) of the analytes by comparing spectra within a peak to the apex spectrum. The HPLC/PDA method was tested with tissue samples from fish, shellfish and marine mammals; concentrations of certain CBs and DDTs in samples determined by screening compared favorably with those in the same samples analyzed by a comprehensive method (e.g., gas chromatography/high resolution mass spectrometry). However, the HPLC/PDA method was about an order of magnitude less sensitive than determinations by comprehensive methods.

Chemical contaminants in gray whales (Eschrichtius robustus) stranded along the west coast of North America

The concentrations of selected chlorinated hydrocarbons (e.g. PCBs, DDTs, DDEs, chlordanes) and essential (e.g. zinc, selenium, copper) and toxic (e.g. mercury, lead, arsenic) elements were measured in tissues and stomach contents from 22 gray whales (Eschrichtius robustus) stranded between 1988 and 1991 at sites from the relatively pristine areas of Kodiak Island, AK, to more urbanized areas in Puget Sound, WA, and San Francisco Bay, CA. The majority of animals were stranded at sites on the Washington outer coast and in Puget Sound. The gray whale has the unique feeding strategy among Mysticeti of filtering sediments to feed on benthic (bottom dwelling) invertebrates. Thus, the wide geographical distribution of the stranded whales allowed (1) an initial assessment of whether concentrations of chemical contaminants in these whales exhibited region specific differences and (2) whether toxic chemicals that accumulate in sediments may have contributed to the mortality and stranding of gray whales near the more polluted urban areas. Analyses for chlorinated hydrocarbons in blubber from 22 animals showed no apparent significant differences among stranding sites. The concentrations of sigma PCBs and sigma DDEs in blubber, for example, ranged from 120 to 10,000 and 9 to 2100 p.p.b. (ng/g) wet weight, respectively. Additionally, analyses of chlorinated hydrocarbons and selected elements in liver (n = 10) also showed no apparent significant differences between whales stranded in Puget Sound and whales stranded at more pristine sites (Alaska, Washington outer coast and Strait of Juan de Fuca and Strait of Georgia). For example, the concentrations of sigma PCBs and sigma DDEs in liver ranged from 79 to 1600 and 7 to 280 p.p.b., respectively, and the concentrations of the toxic elements, mercury and lead ranged from 9 to 120 and 20 to 270 p.p.b., respectively. Analyses of stomach contents revealed low concentrations of chlorinated hydrocarbons, but high concentrations (wet weight) of aluminum (1,700,000 +/- 450,000 p.p.b.), iron (320,000 +/- 250,000 p.p.b.), manganese (23,000 +/- 15,000 p.p.b.), and chromium (3400 +/- 1300 p.p.b.), but no significant differences were observed between whales stranded in Puget Sound compared to whales stranded at the more pristine sites. The relative proportions of these elements in stomach contents of stranded whales were similar to the relative proportions in sediments, which is consistent with a geological source of these elements from the ingestion of sediment during feeding. Thus, overall, the concentrations of anthropogenic chemicals in stranded gray whales showed little relation to the levels of chemical contaminants at the stranding sites.(ABSTRACT TRUNCATED AT 400 WORDS)

Relationships between toxicopathic hepatic lesions and exposure to chemical contaminants in English sole (Pleuronectes vetulus), starry flounder (Platichthys stellatus), and white croaker (Genyonemus lineatus) from selected marine sites on the Pacific Coast, USA

Relationships between hepatic lesions and chemical contaminant concentrations in sediments, stomach contents, liver tissue, and bile were statistically evaluated in three species of bottomfish, English sole (Pleuronectes vetulus), starry flounder (Platichthys stellatus), and white croaker (Genyonemus lineatus), captured from 27 urban and nonurban sites on the Pacific Coast from Alaska to southern California. Lesions detected were neoplasms, preneoplastic foci of cellular alteration, nonneoplastic proliferative lesions, unique or specific degenerative/necrotic lesions, nonspecific degenerative/necrotic lesions, and hydropic vacuolation of biliary epithelial cells and hepatocytes. In general, lesion prevalences were significantly higher in all three species captured at chemically contaminated urban sites, and certain lesions had significantly higher relative risks of occurrence at urban sites in Puget Sound, San Francisco Bay, the vicinity of Los Angeles, and San Diego Bay. Concentrations of polycyclic aromatic hydrocarbons, polychlorinated biphenyls, DDT and its derivatives, and chlordanes and dieldrin in sediment, stomach contents, liver, and fluorescent aromatic compounds in bile were significant risk factors for the occurrence of neoplastic, preneoplastic, nonneoplastic proliferative, and specific degenerative/necrotic lesions, as well as hydropic vacuolation. Fish age also had a significant influence on occurrence of several hepatic lesions, but gender was rarely a significant risk factor. These relationships provide strong evidence for the involvement of environmental contaminants in the etiology of hepatic lesions in several marine bottomfish species and clearly indicate the utility of these lesions as biomarkers of contaminant-induced effects in wild fish.

Antagonism of the stimulatory effects of efaroxan and glibenclamide in rat pancreatic islets by the imidazoline, RX801080

1. The imidazoline alpha 2-adrenoceptor antagonist, efaroxan, stimulates insulin secretion from rat isolated islets and antagonizes the ability of diazoxide to inhibit glucose-induced insulin secretion. These effects result from closure of ATP-sensitive potassium channels although the mechanisms involved have not been elucidated. 2. In the present work, we have examined the effects of a close structural analogue of efaroxan, RX801080, in rat isolated islets of Langerhans. RX801080 was found to be ineffective as a stimulator of insulin secretion and did not prevent the inhibition of insulin secretion mediated by diazoxide. 3. RX801080 acted as an antagonist of the actions of several imidazolines (efaroxan, phentolamine and midaglizole) in rat islets. It dose-dependently inhibited the ability of efaroxan to antagonize the effects of diazoxide in islets and also completely inhibited the direct stimulation of insulin secretion mediated by efaroxan. 4. RX801080 also antagonized the effects of the non-imidazoline, ATP-sensitive potassium channel blocker, glibenclamide, in rat islets. It inhibited both the capacity of glibenclamide to stimulate insulin secretion and the ability of glibenclamide to overcome the inhibitory effects of diazoxide in rat islets. 5. Antagonism of glibenclamide responses by RX801080 was not due to inhibition of binding of the sulphonylurea to its receptor on the pancreatic beta-cell. 6. The results suggest that imidazoline compounds and sulphonylureas interact with distinct binding sites on islet cells, but that these sites can interact functionally to control islet cell ATP-sensitive potassium channel activity and insulin secretion.

Application of DNA fingerprinting with IS986 to sequential mycobacterial isolates obtained from pulmonary tuberculosis patients in Hong Kong before, during and after short-course chemotherapy

A total of 266 Mycobacterium tuberculosis isolates were subjected to DNA RFLP analysis. They were obtained from monthly sputum cultures from patients treated with short-course chemotherapy and then followed up for 2 years. They originated from 42 patients who relapsed after short-course chemotherapy and from a further 42 patients who yielded a single isolated positive culture after chemotherapy. The isolates consisted of one obtained pretreatment and the last obtained during chemotherapy, together with either two isolates cultured at least 2 months apart during relapse or the single post-chemotherapy isolate. They were coded before DNA RFLP analysis and assigned to groups with identical or near identical band patterns on visual inspection. After decoding, it was evident that almost every patient was infected with a strain with a different band pattern (fingerprint). In 100 comparisons of either the pretreatment isolate against the last positive isolate obtained during chemotherapy, or of the first relapse isolate against the second relapse isolate, 15 had been recorded as different; 4 of these were retrospectively found to be due to reading error (error rate 1.5%), leaving 11 (11%) with marked differences. For 5 (12%) of the 42 patients who relapsed, the fingerprint of the relapse isolate was markedly different from that of the pretreatment isolate. In contrast, the isolated positive culture was markedly different from that initially present in 36 (90%) of 40 comparisons. The relative contributions by clinical mixed infection and laboratory cross-contamination to the remaining 10-12% discrepancy rates could not be assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcome of care. Complications from radiation therapy treatment

This study was undertaken to examine radiation treatment complications. From September 1987 through December 1989, 29,380 patients were screened at their follow-up visits for possible radiation complications. Of these patients, 1,380 were singled out for further study. These 1,380 charts were examined by a radiation oncologist and physicist to determine if there was a radiation complication, the severity of the complication, and whether a calculation or setup error could account for the complications. Of the 1,380 patients studied, 178 (3% of new patients treated each year) were determined to have radiation complications. These complications were divided into four categories of severity and entered into our computerized tumor registry as follows: complication type R1, complete recovery from symptoms, n = 59; R2, injury requiring medications to control injury, n = 104; S1, surgical intervention for one organ, n = 12; and S2, surgical intervention for two organs, n = 3. We believe that a baseline complication rate of 5% is acceptable in radiation oncology practices. However, the examination and documentation of the outcome of care in the form of radiation complications can help improve patient care and keep the radiation oncologist abreast of treatment outcome trends in the department.

Stimulation of insulin secretion by the imidazoline alpha 2-adrenoceptor antagonist efaroxan is mediated by a novel, stereoselective, binding site

We have studied the stereospecificity of three responses mediated by the alpha 2-antagonist efaroxan in rat islets of Langerhans. alpha 2-Adrenergic inhibition of insulin secretion was relieved most effectively by the (+) enantiomer. In contrast, direct stimulation of insulin secretion and antagonism of the inhibitory effects of diazoxide were both preferentially mediated by the (-) enantiomer. Culture of islets in the presence of efaroxan resulted in loss of responsiveness to subsequent re-addition of the drug. On the basis of these results we propose the existence, in islets, of a novel 'non-adrenergic' binding site at which efaroxan acts as an agonist.

Immunoprecipitation of a pertussis toxin substrate of the G(o) family from rat islets of Langerhans

Rat islets express a pertussis toxin sensitive G-protein involved in receptor-mediated inhibition of insulin secretion. This has been assumed previously to represent "G(i)" which couples inhibitory receptors to adenylate cyclase. Incubation of islet G-proteins with 32P-NAD and pertussis toxin resulted in the labelling of a band of molecular weight 40,000. This band was very broad and did not allow resolution of individual components. Incubation of the radiolabelled proteins with an anti-G(o) antiserum resulted in specific immunoprecipitation of a 32P-labelled band. These results demonstrate that the complement of pertussis toxin sensitive G-proteins in rat islets includes G(o).

Ligand atom partial charges assignment for complementary electrostatic potentials

The design of molecules to fit into the active site of receptors is a rapidly developing area of pharmacology and medicinal chemistry. A good ligand needs a suitable geometry and also appropriate electrostatic properties. The electrostatic properties of the ligand should complement those of the receptor. We present a method for the assignment of atom-centred point charges for a ligand, based on the electrostatic potential of the receptor. These point charges are chosen to give the best possible complementarity to the receptor electrostatic potential over the van der Waals surface of the ligand. We demonstrate that point charges can be chosen to give good electrostatic complementarity, and suggest that a molecule with similar electrostatic properties should bind well to the receptor.

Lung function in relation to silicosis and silica exposure in granite workers

Lung function tests (forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC %) were related to silica exposure and the extent of radiological opacities in a study of 206 active and 132 previously employed granite workers from two quarries. The investigations included detailed personal interviews, spirometric testing and radiographic examination of the chest. The chest X-ray films were read randomly and independently by three readers, using International Labour Office (ILO) standard films. Cumulative exposure to respirable silica (mg.m-3-yr) and total granite dust (million particles per cubic foot (mppcf-yr)) were estimated for each subject based on his years of employment at various jobs and historical and current measurements of quarry-, period- and job-specific exposures. The results suggest that chronic simple silicosis, especially for profusion category 2 and 3, was associated with significant lung function loss. As expected, mixed dust fibrosis was associated with little or no functional disturbance. Massive fibrosis was associated with significant obstructive and restrictive impairment. No additional effect of exposure to respirable silica on lung function loss was found after allowing for the presence of "silicosis". However, exposure to total dust (mppcf-yr) appeared to be associated with some lung function loss independent of silicosis. Our results indicate that chronic simple silicosis is not a benign disease; silica exposure is the primary cause, but the lung function loss in silicotics is directly attributable to the fibrotic lung disease. However, exposure to total granite dust beyond the respirable size range may separately produce additional lung function loss.

Lung function in relation to silicosis and silica exposure in granite workers

Lung function tests (forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC %) were related to silica exposure and the extent of radiological opacities in a study of 206 active and 132 previously employed granite workers from two quarries. The investigations included detailed personal interviews, spirometric testing and radiographic examination of the chest. The chest X-ray films were read randomly and independently by three readers, using International Labour Office (ILO) standard films. Cumulative exposure to respirable silica (mg.m-3-yr) and total granite dust (million particles per cubic foot (mppcf-yr)) were estimated for each subject based on his years of employment at various jobs and historical and current measurements of quarry-, period- and job-specific exposures. The results suggest that chronic simple silicosis, especially for profusion category 2 and 3, was associated with significant lung function loss. As expected, mixed dust fibrosis was associated with little or no functional disturbance. Massive fibrosis was associated with significant obstructive and restrictive impairment. No additional effect of exposure to respirable silica on lung function loss was found after allowing for the presence of "silicosis". However, exposure to total dust (mppcf-yr) appeared to be associated with some lung function loss independent of silicosis. Our results indicate that chronic simple silicosis is not a benign disease; silica exposure is the primary cause, but the lung function loss in silicotics is directly attributable to the fibrotic lung disease. However, exposure to total granite dust beyond the respirable size range may separately produce additional lung function loss.

Predictors of mortality in silicosis

The mortality of a cohort of 1487 male patients with silicosis in a population-based register followed up from 1980 to 1986 was evaluated with reference to the mortality rates of the general male population. A striking excess of deaths from all causes (observed 368, standardized mortality ratio, SMR 3.00) was noted. Seventy-four percent of the deaths were due to respiratory conditions and complications directly or indirectly related to silicosis. The risk of death was especially higher than expected in younger patients under 45 years of age. Patients with simple silicosis of profusion category 1 did not appear to be at any increased risk of death relative to the general population, but increasing excesses of death were associated with greater extent of simple and conglomerate disease. These increased mortality risks were observed in tuberculosis-free patients as well as in those who never smoked. For the same extent of silicotic disease, the risk of death was higher if tuberculosis occurred. There was no evidence, however, that patients who smoked were more likely to suffer a worse mortality outcome than those who did not. Age at diagnosis, extent of silicotic disease and the occurrence of tuberculosis were therefore strong predictors of mortality in patients with silicosis.

The early bactericidal activity of rifabutin measured by sputum viable counts in Hong Kong patients with pulmonary tuberculosis

Previously untreated patients with smear-positive pulmonary tuberculosis were randomly allocated to treatment with 600, 300, 150 or 75 mg doses of rifabutin (LM427, ansamycin), 600, 300 or 150 mg of rifampicin, 300 mg isoniazid or to no drug daily for 2 days. The fall in viable counts of Mycobacterium tuberculosis in sputum collections during the 2 days, termed the early bactericidal activity (EBA), was estimated from counts of colony-forming units (cfu) on selective 7H-11 agar medium. The EBA for rifabutin ranged from -0.039 (an increase in counts) to 0.049 log10 cfu/ml/day whereas the EBA increased from 0.071 for 150 mg rifampicin to 0.293 log10 cfu/ml/day for 600 mg rifampicin and was 0.43 log10 cfu/ml/day for 300 mg isoniazid. The difference between the EBAs for rifabutin and rifampicin just attained significance (P = 0.05) suggesting that rifabutin was inactive or less active than rifampicin against the extracellular bacilli in pulmonary cavities. Peak plasma concentrations of rifabutin after the initial doses were found to be proportional to dose size and were approximately 7 times lower than those after the same dose size of rifampicin. The lower EBA of rifabutin as compared to rifampicin is probably due to the low plasma concentrations which are not fully compensated for by slightly greater antituberculosis activity of rifabutin in vitro.

The alpha 2-adrenoceptor antagonist efaroxan modulates K+ATP channels in insulin-secreting cells

The actions of efaroxan, a highly selective and potent alpha 2-adrenoceptor antagonist, on insulin secretion, cAMP levels, 86Rb+ efflux and ATP-regulated potassium (K+ATP) channels have been studied using isolated pancreatic islets of Langerhans and RINm5F cells. In the absence of an adrenoceptor agonist, efaroxan (1-100 microM) potentiated glucose-induced secretion over the range 4-10 mM glucose, but was without effect upon the maximal rate of secretion induced by 20 mM glucose. Efaroxan did not affect cAMP levels. Suppression of insulin release by the potassium channel opener diazoxide, was partially alleviated by efaroxan and was associated with an inhibition of the diazoxide-induced increase in the rate of 86Rb+ efflux. Using isolated patches of membrane we found efaroxan to be an effective blocker of K+ATP channels, with a KI value of 12 microM and a Hill coefficient of approximately 1. These data indicate that efaroxan promotes insulin secretion, in the absence of exogenous agonists, by a mechanism that involves inhibition of ATP-regulated K+ channels.

Mechanisms involved in stimulation of insulin secretion by the hypoglycaemic alpha-adrenergic antagonist, DG-5128

The selective alpha 2-antagonist DG-5128 provoked a dose-dependent stimulation of insulin release from isolated rat islets. DG-5128 was only weakly effective as an antagonist of noradrenaline-induced inhibition of insulin secretion but, surprisingly, was able to reverse the suppression of secretion and increase in 86Rb efflux from preloaded islets, mediated by diazoxide. These effects were not reproduced with more effective alpha-antagonists, suggesting that stimulation of insulin secretion by DG-5128 is independent of alpha-receptor blockade.

Factors associated with massive fibrosis in silicosis

Data on 1432 patients with silicosis on a register in Hong Kong were analysed to examine the association of massive fibrosis with possible predisposing factors. Detailed occupational and clinical histories, clinical records, radiographic readings according to the International Standard Classification of Radiographs of Pneumoconioses, and environmental dust measurements from hygiene surveys were used to obtain information for several variables--namely, age at first exposure, relative dust exposure level, duration of exposure, smoking, previous recorded history of tuberculosis, and background profusion of small opacities. The most significant risk factors associated with massive fibrosis were high relative dust exposure level, a history of tuberculosis, and increased background profusion of small opacities.

Nosocomial tuberculosis in hospital staff. The size of the problem in a Hong Kong chest hospital

In the past three decades, among 831 staff (over 6,862 staff-years) under regular chest radiographic survey in the Grantham Hospital, Hong Kong, the cumulative incidence of active pulmonary tuberculosis requiring treatment was 27 (belonging to 23 staff). Number of cases detected per year ranged from 0 to 3. The mean duration from the beginning of employment to the first evidence of disease was 6.43 years. Although this incidence is low, yet the hospital caters for quite a large number of patients with bacteriologically confirmed tuberculosis, we feel that the active screening program for hospital staff should be maintained, and that review of the situation is also recommended.

Serodiagnosis of tuberculosis using an ELISA with antigen 5 and a hemagglutination assay with glycolipid antigens. Results in patients with newly diagnosed pulmonary tuberculosis ranging in extent of disease from minimal to extensive

Hemagglutination tests with three glycolipid antigens, A1, B1, and C, and ELISA with antigen 5 were done on serum from Chinese patients with pulmonary tuberculosis and from normal subjects in Hong Kong. Tests with all four antigens were of similar efficiency, giving positive results in 30 to 52% of 88 smear-positive patients, in 16 to 22% of 37 smear-negative, culture-positive patients, in 5 to 13% of 76 culture-negative patients with radiologically active disease, in 5 to 11% of 217 culture-negative patients with inactive disease, and in 1 to 4% of 140 normal subjects. If tests were combined so that an overall positive was scored when all tests were positive, there was worse discrimination between patients and normal subjects; however, as suggested by the poor correlation between the results with pairs of the tests, better discrimination was obtained if an overall positive was scored when any of the tests was positive. A positive result in any of the four tests was found in 22% of all cases, including 58% of smear-positive patients, 32% of smear-negative, culture-positive patients, and 0.7% of normal subjects.

Stimulation of insulin secretion by efaroxan may involve interaction with potassium channels

The imidazoline alpha 2-antagonist efaroxan was found to stimulate insulin secretion from isolated rat pancreatic islets incubated in glucose concentrations between 4 and 12 mM. This response could not be attributed to interaction of efaroxan with either classical alpha 2-receptors or with a B-cell 'imidazoline receptor', since the effect was not reproduced by the structural analogue idazoxan. Stimulation of insulin secretion by efaroxan correlated with the ability of the drug to reverse the inhibition of secretion mediated by the potassium channel agonist diazoxide. The data suggest that the capacity of efaroxan to stimulate insulin secretion may be related to an interaction with potassium channels in the pancreatic B-cell.

Mortality of a cohort of men in a silicosis register: further evidence of an association with lung cancer

Lung cancer mortality from 1980 to 1986 was studied in a cohort of 1,419 men in a silicosis register who had no previous exposure to asbestos and polyaromatic hydrocarbons. The 28 deaths from lung cancer were statistically in excess of expected (SMR 2.03; 95% CI 1.35-2.93). Excess risks of lung cancer were found in both underground workers (SMR 3.41; 95% CI 1.10-7.97; based on 5 deaths) and surface workers (SMR 1.87, 95% CI 1.18-2.81; based on 23 deaths). All lung cancer deaths were smokers. There was an increase in SMRs with longer latency periods and years of exposure, with the greatest risk found in those who had worked for 30 or more years after more than 30 years since first exposed (SMR 3.07, based on 16 deaths). The risk for lung cancer was higher in those with tuberculosis (SMR 2.52; 95% CI 1.52-3.94) and showed an increasing trend with severity of silicosis, from category 1 to 3 and from category A to C, with highest risk in those with tuberculosis and category 3 (SMR 4.44 based on 3 deaths) or tuberculosis and category C (SMR 7.63 based on 7 deaths). Most of the excess lung cancer risk in silicotics is due to smoking, but a synergistic effect between smoking and silica/silicosis on the risk of lung cancer is also likely. In particular, a possible role of silicosis and tuberculosis as the fibrotic seedbed for malignant growth in the lung is strongly supported.

Fasting urinary hydroxyproline: creatinine ratios in silicosis

Fasting urinary hydroxyproline: creatinine (HOP:C) ratios were measured in 74 patients with suspected (borderline) silicosis (10), simple silicosis (46) and complicated silicosis (9 silicotuberculosis, 4 massive fibrosis, and 5 combined silicotuberculosis and massive fibrosis) and in 18 healthy subjects (controls). There was no statistically significant difference in urinary HOP:C ratios between control subjects (mean 13.8, SD 3.6) and suspected silicotics (mean 18.0, SD 7.6); however, urinary HOP:C ratios were significantly higher in both simple silicosis (mean 25.0, SD 9.9, p less than 0.001) and complicated silicosis (silicotuberculosis and progressive massive fibrosis) (mean 28.6, SD 11.3; p less than 0.001). Urinary HOP:C ratios appeared to show a graduated increase to their highest levels in category 2 silicosis and thereafter remained constant or declined slightly in category 3 silicosis and massive fibrosis. The results support the suggestion that urinary hydroxyproline might be useful as an indicator of disease progression in established silicosis. However, further longitudinal studies are needed to confirm its predictive value.

Effects of phenoxybenzamine on insulin secretion from isolated rat islets of Langerhans

In isolated rat islets the alpha 2-adrenergic antagonist phenoxybenzamine was found to be only partially effective at relieving the inhibition of glucose-induced insulin secretion mediated by noradrenaline. Further experiments revealed a direct inhibitory effect of phenoxybenzamine itself on the secretory response to glucose. At concentrations above 1 microM the antagonist inhibited insulin secretion in a dose-dependent manner, with greater than 50% inhibition at 50 microM. The inhibition of secretion developed rapidly in perifused islets, and was not altered when islets were also incubated with idazoxan or benextramine, suggesting that it did not reflect binding of phenoxybenzamine to the alpha 2-receptor. Paradoxically phenoxybenzamine significantly increased the basal secretion rate in the presence of 4 mM glucose. The results demonstrate that phenoxybenzamine can exert direct effects on insulin secretion which are unrelated to its alpha-antagonist properties.

Effects of benextramine on the adrenergic inhibition of insulin secretion in isolated rat pancreatic islets

Insulin secretion from isolated rat islets of Langerhans in the presence of 4 mM glucose averaged 2.26 +/- 0.20 (S.E.M.) ng/islet per 90 min and was significantly (P less than 0.001; n = 30) increased to 3.28 +/- 0.21 ng/islet per 90 min by the covalent alpha-adrenoceptor antagonist benextramine (10 microM). Glucose (20 mM) also increased the secretion rate (to 6.24 +/- 6.0 ng/islet per 90 min) but, under these conditions, the response was not further enhanced by benextramine. Clonidine and noradrenaline (1 nM-10 microM) each caused dose-dependent inhibition of glucose-induced insulin secretion which was maximal at 1 microM. Benextramine, when added simultaneously with the agonist, relieved, in a dose-dependent manner, the inhibition of secretion induced by either clonidine or noradrenaline with similar sensitivity. Even after a 30-min preincubation with benextramine the antagonist failed to differentiate between noradrenaline, adrenaline and clonidine with respect to inhibition of insulin secretion. In contrast to its effects on adrenergic responses, short-term treatment with benextramine did not significantly affect muscarinic-cholinergic receptor-mediated 45Ca2+ efflux from rat islets of Langerhans perifused in Ca2+-depleted medium. These data suggest that benextramine does not differentiate between clonidine and noradrenaline in rat islets of Langerhans but that it does show preference for alpha-adrenoceptors in this tissue.

HLA typing in the Hong Kong Chest Service/British Medical Research Council study of factors associated with the breakdown to active tuberculosis of inactive pulmonary lesions

As part of a multifactorial study of the causes of breakdown to active tuberculosis of inactive pulmonary lesions, HLA-A, -B, and -DR typing was performed on 256 Hong Kong Chinese patients and 100 healthy control subjects. Patients were classified into those with smear-positive, active pulmonary tuberculosis (n = 103), those with inactive disease (n = 113), and those with breakdown to active disease after 6 months or more of inactivity (n = 40). Separately, 21 multiple-case families comprising 38 available parents and 93 offspring were examined for HLA haplotype segregation in relation to infection. Results of both studies indicate that among Hong Kong Chinese there is no statistically significant association between HLA and susceptibility to pulmonary tuberculosis.

Benefits of dual chamber pacing in sick sinus syndrome

The effects of DDD (fully automatic) and VVI (ventricular demand) pacing modes on exercise tolerance, symptom diary cards, and Holter monitoring were investigated in a randomised double blind crossover study of 16 patients who had had DDD pacemakers implanted because of frequent syncope. Eight patients presented with sick sinus syndrome and, with one exception, retrograde atrioventricular conduction and eight age and sex matched patients presented with 2:1 or complete atrioventricular block. Maximal symptom limited exercise in those with atrioventricular block was significantly higher after one month of DDD pacing than after VVI pacing. In those with sick sinus syndrome, however, maximal effort tolerance was not significantly different for the two pacing modes. In all but one patient with sick sinus syndrome sinus rhythm developed during exercise in VVI pacing. For both VVI and DDD modes maximal atrial rates were significantly lower in those with sick sinus syndrome. Palpitation and general wellbeing were significantly improved during DDD pacing in the eight patients with sick sinus syndrome. Shortness of breath was improved by DDD pacing in the eight patients with atrioventricular block but not in those with sick sinus syndrome. Holter monitoring showed that sick sinus syndrome patients remained in paced rhythm, either DDD or VVI, for most of the 24 hour period. DDD pacing was better than VVI pacing in sick sinus syndrome with retrograde atrioventricular conduction. Despite their ability to show sinus rhythm and inhibit their pacemakers on exercise patients with sick sinus syndrome are just as likely to have symptomatic benefit from DDD pacing as patients with atrioventricular block.

Total skin electron irradiation for mycosis fungoides: relationship between acute toxicities and measured dose at different anatomic sites

From June 1978 to June 1986, 50 patients with primary and recurrent mycosis fungoides were treated with total skin electron irradiation (TSEI), using the Stanford technique, to a total dose of 3600 cGy. TSEI was used alone, or in combination with low dose total body photon irradiation, or MOPP. Thermoluminescent dosimeter (TLD) measurements of the prescribed skin dose were obtained on twenty patients. The dorsum of the foot was 24% higher. The axillae, the bottom, and the arch of the foot were significantly underdosed. Frequencies of acute toxicities noted at 2000 cGy were: Skin, Grade I-II (RTOG) 80%. Partial epilation: scalp, 100%; eyebrows and at eyelashes, 20%. Nail dystrophy, 48%. Edema: hands and feet, 44%. Bullae: dorsum of feet, 8%; hands, 4%; and 3600 cGy: Skin, grade III 22%. Total epilation: scalp, 66%; eyebrows and eyelashes, 56%. Nail loss, 38%. Edema: hands and feet, 76%. Bullae: dorsum of feet, 34%; hands, 12%. Conjunctivitis, 4%. Large bullae, were more significant on the dorsum of the feet. Severe moist desquamation occurred in eight patients who had ulcerated lesions on initial presentation. Three patients were hospitalized due to ulceration and skin infection. All patients completed treatment after a short to moderate break. No patient developed skin necrosis, or corneal ulceration. No correlation exists between dose level, degree and onset of toxicity with previous chemotherapy or TBI. We conclude that the overall toxicity of TSEI is well tolerated.

Male infertility: diagnosis and treatment

The evaluation of the subfertile male starts with the basic history and physical examination, which often provide indication of probable cause. Aside from analysis of properly collected semen, most cases require very few tests. Etiology can be classified as pretesticular, testicular, and post-testicular. Treatment can be more specific if a definite cause is found. Unfortunately, about 25% of patients are idiopathic, and non-specific treatments generally yield unacceptably low conception rates. Improvement will occur as more becomes known, through animal research and clinical application, about the physiology of spermatogenesis and the pathological processes that can affect it.

High-performance liquid chromatographic method for isolating organic contaminants from tissue and sediment extracts

Interest in the assessment of the anthropogenic contamination of the marine environment has accelerated in recent years. Existing methods to analyze environmental samples (e.g., sediments or tissues) for trace amounts of organic contaminants such as aromatic hydrocarbons and chlorinated compounds are tedious and costly. We report a rapid, efficient high-performance liquid chromatography (HPLC) procedure which uses a size-exclusion column to separate the analytes of interest from interfering compounds in the sample matrix. Analytical results from the HPLC method were, in general, comparable to a gravity-column method which had been used for several years. The HPLC method had several other advantages: improved precision; the ability to monitor chromatographic conditions; the potential for automating analyses; and reduced consumption of solvents and other materials.

The importance of genetics for the optimization of radiation therapy. A hypothesis

There is growing evidence that a fraction of cancer patients, perhaps as high as 15%, is radiation sensitive because of the action of specific genes. It seems likely that in the near future we shall be able to identify these patients by DNA probes. Therefore, we have calculated the impact on radiation therapy of removing these patients and treating the rest more aggressively. In particular, we assumed that the radiation oncologist will treat with an effective therapeutic dose corresponding to a 5% risk of serious normal tissue injury. Our results, in several instances, show a considerable increase in local control when the 5, 10, or 15% of the most radiosensitive patients are removed from the treated group. This is so, even if we assume that the tumor cells, as well as the normal cells, in radiosensitive patients are more radiosensitive than the tumor cells in patients of normal radiosensitivity.

Radiological progression and lung function in silicosis: a ten year follow up study

Chest radiographs and spirometric tests were performed on 81 patients who had silicosis from two granite quarries in 1975, 73 of whom were followed up for two to 10 (mean 7.2) years. Each patient's initial and most recent chest radiographs were assessed independently by three experienced readers, and the yearly declines in forced expiratory volume in one second and forced vital capacity were estimated from two to four (mean 3.45) serial spirometric readings. Estimates of individual dust exposure were based on extensive historical data on hygiene. All but 11 patients were no longer exposed to dust by the start of follow up, but 24 (45%) of 53 patients who had simple silicosis and 11 (55%) of 20 who had the complicated disease showed radiological evidence of disease progression. In patients who had simple silicosis and showed no radiological progression the yearly declines in forced expiratory volume in one second and forced vital capacity were modest (64 ml/year and 59 ml/year, respectively), whereas significantly greater declines in lung function were seen in those who showed radiological evidence of progression (97 ml/year and 95 ml/year, respectively). In addition to radiological progression the previous average dust concentration to which patients had been exposed also influenced declines in both forced expiratory volume in one second and forced vital capacity after allowing for the effects of age, smoking, duration of exposure, history of tuberculosis, initial state of disease, and baseline lung function. The probability of radiological progression was most strongly influenced by the average dust concentration previously exposed to. The progression of simple silicosis is thus accompanied by appreciable declines in lung function and is strongly affected by previous levels of exposure to dust.

A survey of the respiratory health of silica-exposed gemstone workers in Hong Kong

Respiratory symptoms and radiographic and lung function alterations were studied in a cross-sectional survey of gemstone workers in Hong Kong. The study population included a group of grinders, polishers, and buffers who were heavily exposed to dust (principally free silica) and a less exposed group of cutters and carvers. Among all 218 male workers who answered the respiratory questionnaire, heavily exposed workers reported significantly higher prevalence of respiratory symptoms suggestive of mucus hypersecretion. Radiological pneumoconiosis defined as opacities with profusion of 1/0 and above was found in 27% of 157 workers who accepted radiographic and lung function examination. Radiological opacities were significantly related to increasing years of employment in both groups of workers after taking into account age and smoking habits. Decline in forced vital capacity (FVC) was significantly related to increasing years of employment in both groups after allowing for the effects of age, height, and smoking. A modest decline in forced expiratory volume in one second (FEV1) was related to dust exposure which was of borderline statistical significance in polishers and buffers who smoked. Radiological pneumoconiosis did not have an independent effect on lung function when allowance was made for dust exposure.

Field and laboratory studies of the etiology of liver neoplasms in marine fish from Puget Sound

A series of field studies was conducted between 1979 and 1985 in Puget Sound, Washington State, to investigate etiological relationships between prevalences of hepatic neoplasms in bottom-dwelling marine fish species, with emphasis on English sole (Parophrys vetulus), and concentrations of toxic chemicals in sediments and affected fish. Statistically significant (p less than or equal to 0.05) correlations have been found between the prevalences of hepatic neoplasms in English sole and the following parameters: sediment concentrations of aromatic hydrocarbons, and concentrations of the metabolites of aromatic compounds in the bile of affected sole. A significant difference (p less than 0.001) was also found between the relative concentrations of aromatic free radicals in the liver microsomes of English sole with liver lesions compared to sole without liver lesions. Laboratory studies designed to evaluate the etiology of the liver neoplasms in English sole have also yielded evidence that is consistent with the view that high molecular weight aromatic hydrocarbons, e.g., benzo[a]pyrene (BaP), are hepatocarcinogens in English sole. The current status of a series of long-term (up to 18 months) exposures of English sole and rainbow trout (Salmo gairdneri) to selected fractions of Puget Sound sediment extracts, enriched with aromatic hydrocarbons and nitrogen-containing aromatic compounds, and to individual carcinogens (e.g., BaP) is discussed.

The bioavailability of isoniazid, rifampin, and pyrazinamide in two commercially available combined formulations designed for use in the short-course treatment of tuberculosis

The bioavailability of isoniazid, rifampin, and pyrazinamide in 2 combined formulations of the 3 drugs (Rifater) for use primarily in the short-course chemotherapy of tuberculosis has been studied in Chinese patients in Singapore and Hong Kong. One formulation, containing 50 mg isoniazid, 120 mg rifampin, and 300 mg pyrazinamide per tablet is suitable for daily use, whereas the other, containing higher proportions of isoniazid and pyrazinamide, is designed for intermittent treatment, each tablet containing 125 mg isoniazid, 100 mg rifampin, and 375 mg pyrazinamide. Appropriate dosages for the Chinese patients, whose average weight was approximately 50 kg, were 5 and 6 tablets, respectively. Plasma concentrations of the 3 drugs after giving such dosages of the 2 combined formulations were compared in 16 patients, 8 in Singapore and 8 in Hong Kong, by means of a crossover study, with the concentrations obtained when identical doses of the 3 drugs were given using standard separate drug formulations. The concomitant urinary excretions of the drugs and their major metabolites were also estimated. Very similar results were obtained whether the drugs were given as the combined preparations or in their standard separate formulations, demonstrating the excellent bioavailability of all 3 drugs in each of the 2 combined formulations.

Toxic chemicals in sediments and biota from a creosote-polluted harbor: relationships with hepatic neoplasms and other hepatic lesions in English sole (Parophrys vetulus)

High prevalences of idiopathic hepatic lesions, including neoplasms (e.g., hepatocellular carcinomas, cholangiocellular carcinomas) (27%, 20 of 75 fish) and foci of cellular alteration (putative 'preneoplastic' lesions) (44%, 33 of 75 fish), were found in English sole (Parophrys vetulus) exposed to creosote-contaminated sediments in Eagle Harbor, Puget Sound, WA. Sediments from the contaminated region of the harbor contained particularly high concentrations of aromatic hydrocarbons (e.g., benzo[a]pyrene and benz[a]anthracene), and a variety of nitrogen-containing aromatic compounds (e.g., carbazole and acridine). The composition of the aromatic compounds was characteristic of creosote. Dramatically lower concentrations of aromatic compounds were found in sediments from a reference site in which the bottom-dwelling fish examined were free of detectable neoplastic or 'preneoplastic' hepatic lesions. Food organisms in the stomachs of the English sole from Eagle Harbor contained substantially higher concentrations of aromatic hydrocarbons than comparable organisms from the reference site. The concentrations of individual aromatic hydrocarbons in muscle and liver from the Eagle Harbor fish were low; however, high concentrations of metabolites of aromatic compounds were present in the bile. The findings strongly suggest an association between exposure to creosote and the prevalence of hepatic lesions, including neoplasms, in the bottom-dwelling fish, and furthermore support the putative role of aromatic hydrocarbons in liver carcinogenesis in fish.

Toxic chemicals in marine sediment and biota from Mukilteo, Washington: relationships with hepatic neoplasms and other hepatic lesions in English sole (Parophrys vetulus)

High prevalences of idiopathic liver lesions, including 7.5% hepatic neoplasms (e.g., hepatocellular and cholangiocellular carcinomas) and 16.7% foci of cellular alteration (putative preneoplastic hepatic lesions), were found in English sole (Parophrys vetulus) from waters near Mukilteo, a small community on Puget Sound in Washington State. Sediments from the sampling sites contained particularly high concentrations of aromatic hydrocarbons. Substantially lower concentrations of these compounds were found in sediments from another Puget Sound (reference) site in which fish showed no evidence of hepatic neoplasms or foci of cellular alteration. Stomach contents from the fish at Mukilteo contained substantially higher concentrations of the chemicals than did stomach contents of fish from the relatively uncontaminated site. High concentrations of metabolites of aromatic compounds were measured in the bile of fish from Mukilteo. These findings support previously observed relationships between sediment chemicals (e.g., aromatic hydrocarbons) and high prevalences of liver lesions in English sole from Puget Sound. In addition, a dietary route of uptake by English sole of environmental chemicals, including known carcinogens, was documented.

Baroreflex sensitivity measured by the phenylephrine pressor test in patients with carotid sinus and sick sinus syndromes

Baroreflex sensitivity was measured by the heart rate response to the transient rise in blood pressure induced by phenylephrine, in 11 patients with carotid sinus syndrome, 6 patients with sick sinus syndrome and nine age and blood pressure matched controls. Patients with carotid sinus syndrome were divided into those with a hypersensitive carotid sinus reflex manifest as sinus arrest (n = 9) and those with a reflex manifest as atrioventricular block (n = 2). The mean gain of the baroreflex sensitivity was significantly increased (p less than 0.001) in patients with carotid syndrome manifest as sinus arrest (12.7 +/- 5.1 ms . mmg-1) compared to that in patients with sick sinus syndrome (3.8 +/- 2.6 ms . mmHg-1) and controls (4.2 +/- 2.1 ms . mmHg-1). Patients with carotid sinus syndrome manifest as atrioventricular block did not have increased baroreflex sensitivity measured by their sinus node response (2.1 +/- 0.5 ms . mmHg-1). There was significant correlation (p less than 0.001) between the corrected carotid sinus inhibitory response to carotid sinus massage and the measurement of baroreflex sensitivity in the carotid sinus syndrome patients. Patients with carotid sinus syndrome manifest as reflex sinus arrest have an increased gain in baroreflex sensitivity for their age, which is not seen in patients with symptomatic sinoatrial disease. This study provides further evidence of a different mechanism of bradycardiac symptoms in patients with carotid sinus and sick sinus syndromes.

The management of urinary tuberculosis--a logical approach

The chemotherapy of urinary tuberculosis is controversial as far as choice of drug regimen and duration of treatment are concerned. We propose a course of treatment that is tailored to the pathological state of infection and the type of surgical procedure performed. One hundred and ten patients with tuberculous infection were divided into three groups. Group I comprised 27 patients in whom surgery was not necessary; Group II contained 48 patients where ablative surgery was carried out; Group III consisted of 35 patients who underwent reconstructive surgery. Anti-tuberculous drugs (rifampicin, pyrazinamide, isoniazid and ethambutol) were given according to this tailored regimen. Patient compliance and results of treatment were excellent.

Deoxyribonucleic acid (DNA) flow cytometry: a new modality for quantitative analysis of testicular biopsies

Methods currently in use for quantification of spermatogenesis are not widely accepted clinically because they are time-consuming and open to subjective interpretation. This study explores the use of flow cytometry as a rapid and objective modality for quantitative analysis of testis biopsies.

The treatment of urinary tuberculosis

During the last 7 years we treated 92 patients with tuberculosis of the urinary tract. Patients with tuberculous infection were divided into 3 groups according to treatment: group 1--no surgical treatment (18 patients), group 2--ablative surgery (45 patients) and group 3--reconstructive surgery (29 patients). Antituberculous drugs, consisting of rifampin, pyrazinamide, isoniazid and ethambutol, were given according to the severity and extent of the infection process. The results of medical and surgical treatment were most gratifying. Surgical morbidity was low and there was no immediate mortality.

Sustained improvement in exercise tolerance following physiological cardiac pacing

Fifty-three patients have received 'physiological' pacemakers, 37 with atrioventricular (AV) block having atrial synchronous units (VAT or VDD) implanted and the remaining 16 patients with both AV block and sick sinus syndrome having 'universal' (DDD) pacemakers. Effort tolerance was assessed by serial bicycle ergometry and in 16 patients direct comparisons between ventricular pacing and atrial synchronous pacing could be made acutely. Physiological pacemakers were found to increase maximum effort tolerance by 43% compared to pre-pacing values (P less than 0.01). The increase was sustained over a mean of 33 months post pacing. The atrial synchronous mode increased maximum effort tolerance by 34% acutely compared to ventricular inhibited pacing. Dual chambered 'physiological' pacemakers represent a significant therapeutic advance over standard ventricular inhibited pacemakers.

The role of rate hysteresis pacing in the hypersensitive carotid sinus syndrome

The ability of rate hysteresis programming with the escape interval longer than the automatic interval to reduce the hypotensive response to carotid sinus massage at the onset of ventricular pacing was studied in six patients paced for carotid sinus syndrome. Rate hysteresis significantly reduced this hypotensive response and abolished spontaneous symptoms in two patients and symptoms reproduced by carotid sinus massage in four patients.

Randomised controlled trial of physiological and ventricular pacing

Thirteen patients have completed a randomised double blind cross over study to compare the effects of chronic ventricular and atrial synchronous pacing on exercise capacity and symptoms. Maximal symptom limited exercise was significantly increased after one month of atrial synchronous pacing compared with ventricular pacing. Symptomatic assessment (by diary card and monthly symptom scores) of "shortness of breath", "palpitation", and "general well-being" was significantly improved during the physiological pacing mode. Atrial synchronous pacing has been shown to be superior to ventricular pacing.

Physiological benefits of atrial synchrony in paced patients

Over a five-year period, hemodynamic exercise capacity studies and a randomized controlled trial have been performed in a total of 50 patients. DVI vs. VVI pacing showed an increase in stroke work index (P less than 0.005) and a fall in left ventricular filling pressure (P less than 0.05) in 17 patients. VDD/DDD pacing vs. VVI showed an exercise capacity benefit in 44 patients (P less than 0.01) including 8 patients with sinus node disease and a lower peak heart rate (P less than 0.02). Maintenance of benefit was also shown of VDD/DDD pacing in the longer term (13 months) vs. acute (P - NS). The controlled trial VDD/DDD vs. VVI showed benefit in shortness of breath (P less than 0.01) and general well being (P less than 0.01). It is concluded that atrial synchronous ventricular pacing (VDD/DDD) is the mode of choice in suitable patients.

Carotid sinus syncope treated by pacing. Analysis of persistent symptoms and role of atrioventricular sequential pacing

Seventy patients have been paced for carotid sinus syndrome over four years. Twelve patients had persistent symptoms despite adequate ventricular pacing. Patients with persistent symptoms were found to have a significant vasodepressor response, a significant hypotensive response to ventricular pacing (pacemaker effect), and a severe hypotensive response to carotid sinus massage with introduction of ventricular pacing, which reproduced symptoms in all patients. A group of 14 asymptomatic paced carotid sinus patients was found to have a significantly lower vasodepressor response, pacemaker effect, and combined vasodepressor response plus pacemaker effect than the group with persistent symptoms. Atrioventricular sequential pacing was shown to eliminate the hypotensive effect of ventricular pacing and is considered to be the treatment of choice for patients with carotid sinus syndrome who have both cardioinhibitory and significant vasodepressor responses.