Effects of electromagnetic fields and gender on neurotransmitters and amino acids in rats

Epidemiological studies have linked electromagnetic field (EMF) exposure to certain forms of cancer, however only limited laboratory evidence supports a connection between EMF and biological effects. In the present study we exposed male and female rats to low level, 1000 milli-Gauss (mGs), direct current EMF generated with Helmholtz coils for 1 mo or 4 mo. The effects of these EMF exposures on regional brain neurotransmitter metabolism and circulating amino acid concentrations were determined. After 1 mo of EMF exposure the concentration of serotonin was elevated in the hypothalamus of male rats. Levels of the dopamine metabolite, 3-methoxytyramine, were increased in the corpus striatum of male and female rats that were exposed to EMF for 1 mo. Hypothalamic concentration of norepinephrine was elevated in both groups of male rats, as compared to respective female groups, but was not affected by EMF. Similarly, levels of tyrosine were increased in hypothalamus, corpus striatum and nucleus accumbens of male rats, but were not affected by EMF exposure. Following 4 mo of EMF exposure, no significant effect of EMF was observed. Significant sex differences in plasma amino acid concentrations were observed in both studies, with female rats exhibiting decreases in a majority of the amino acids measured. These results are suggestive that short-term exposure may cause small alterations in neurotransmitter metabolism and in circulating amino acids, which dissipate when exposure duration is increased.

[Experiences after 2 years observation of a chronic alcoholic]

Doctors of legal medicine often have to act as experts when it comes to determining the influence of alcohol or drugs. For this work it would be desirable to have many years of experience in dealing with alcoholics or occasional drinkers. Therefore, drinking experiments have always been part of the training of a doctor of legal medicine, as well as playing an important role in legal practice. It would be wrong if the experience in the legal sense were to be considered sufficient for standardising the judgement of legal responsibility. However, this is often attempted. Too much schematism should be avoided with the so called per mille graduation.

Morphine and morphine glucuronides in serum of heroin consumers and in heroin-related deaths determined by HPLC with native fluorescence detection

A simple, rapid, and sensitive high-performance liquid chromatographic method for the simultaneous determination of serum morphine, morphine-6-glucuronide (M6G), and morphine-3-glucuronide (M3G) based on native fluorescence detection is described. For the extraction of drugs and their metabolites, 200 microL serum was applied to 50 mg of a commercially available octylsilan phase. After isocratic separation in two steps (6.5 min) by reversed phase, the compounds were determined at an excitation wavelength of 245 nm and an emission wavelength of 345 nm (the limit of detection was approximately 5 micrograms/L for each compound). The concentrations of morphine, M6G (with respect to its potential analgesic activity), and M3G were investigated in 20 heroin addicts in police custody and in 10 heroin-associated deaths. The ratios between M6G or M3G and the morphine concentrations and between M6G and M3G are related to the morphine concentration and consequently depend on the time elapsed since the last administration of morphine or heroin. Consequently, the M6G values were found to be higher in cases of death than in the living addicts. By considering the M6G/morphine or M3G/morphine ratios, the narcotic effect of heroin as reflected by morphine and its metabolite concentrations in impaired addicts and cases of fatal poisoning can be better assessed than by use of the morphine concentration alone.

Determination by interphase-FISH of the clonality of aberrant karyotypes in human hematopoietic neoplasias

Interphase-FISH (fluorescence in situ hybridization) studies have been devoted to the determination of clonality of aberrant karyotypes in human leukemia. Various levels of its extent have been examined, including the meaning of a single aberrant karyotype as representing a microclone, the use of FISH to confirm clonality in bi- or multiclonal leukemia, the estimation of the residual (aberrant) clone after contrasexual bone marrow transplantation, and the redetectability in interphase of the abl/bcr rearrangement. The quantitative findings of all these lines of interphase FISH analyses were based on the comparison with data from a large-scale "control" study on normal cells using the same DNA probes which have been chosen for the determination of clonality, i.e. centromeric DNA probes for chromosomes #1, #3, from #6 to #12, from #15 to #18, #20, X and Y, and a specific probe for the abl/bcr rearrangement. In addition, the validity of interphase-FISH analysis on classical bone marrow smears was examined. As a common outcome it was concluded that interphase-FISH technique is a valuable tool for defining clonality of karyotypic changes and, as a consequence, yields additional prognostic information in many human leukemias. It is recommended to perform interphase FISH in routine cytogenetics of leukemia, whenever reasonable.

Ethyl glucuronide: an unusual ethanol metabolite in humans. Synthesis, analytical data, and determination in serum and urine

Ethyl glucuronide (ethyl beta-D-6-glucosiduronic acid), a minor ethanol metabolite in serum or urine, was determined by gas chromatography-mass spectrometry. Prior to this, ethyl glucuronide was synthesized by the reaction of acetobromo-glucosiduronic acid with ethanol. For the determination of ethyl glucuronide, serum samples were precipitated with acetone, and urine specimens were analyzed after evaporation to dryness. The residues were derivatized with acetic anhydride. Capillary gas chromatography was used to find a retention index value of 1920 for the triacetyl derivative. The mass spectrum of the acetylated ethyl glucuronide was recorded. The calibration is linear in the range investigated (0.1-150 mg/L), and the detection limit is 0.1 mg/L. In individual specimens containing between 0.1 and 4 g ethanol per liter serum, ethyl glucuronide could be detected at concentrations between 3 and 14 mg/L and in the corresponding urine specimens at concentrations between 3 and 130 mg/L.

[Results of the 75selenium homotaurocholic acid retention test (SeHCAT test) in diagnosis of diarrhea]

PATIENTS AND METHOD

For that reason absorption of bile acids was investigated using the 75Se-homotaurocholate (SeHCAT) in 239 patients with diarrhoea. SeHCAT retention time was measured as 7 day retention time in a whole body counter. An intact bile acid absorption (negative SeHCAT test) was confirmed in 23 healthy volunteers within the range of 11 to 50% (mean +/- double standard deviation).

RESULTS

In 135 patients with a possible type I bile salt malabsorption the SeHCAT test was positive in 78%, thus indicating bile salt malabsorption. The test is very sensitive detecting bile salt malabsorption in Crohn's disease, identifying ileal disease more precisely than radiology. The SeHCAT test ascertained type II primary bile salt malabsorption in 7 patients, as well as type III bile salt malabsorption in patients (9 out of 28) with cholecystectomy, vagotomy, partial gastrectomy and chronic pancreatitis. In addition, a positive SeHCAT test indicating bile acid malabsorption was found in 5 out of 11 patients with irritable syndrome, diarrhoeic form, and in 4 out of 12 patients with lactose intolerance.

CONCLUSION

SeHCAT retention should be measured routinely in patients with chronic diarrhoea for which the cause is not obvious.

[Contraception in patients with type I diabetes: a survey of 808 women of reproductive age]

In-depth advice about contraception is important for type I diabetic women since special medical aspects have to be considered and because pregnancy should be planned. The actual contraceptive practice in diabetic women living in Germany had not been investigated before.

METHODS

In December 1992 type I diabetic women of 16 to 46 yrs of age who had consecutively participated in a diabetic treatment and teaching programme (n = 1028) were mailed a multiple-choice questionnaire about reproductive and contraceptive issues. 409 non-diabetic women were also questioned and served as a control group.

RESULTS

808 diabetic women (age 32[7] yrs, duration of diabetes 14[8] yrs) returned the questionnaire. The percentage of women using a method of contraception was comparable between diabetic and control women (76 vs. 72%). Of these, fewer diabetic women used oral contraceptives (OC) (33 vs. 57%). The OC-using diabetic women were younger than those using other methods (27[5] vs. 33[7] yrs), however 63% had at least one of the contraindications for OC-use (smoking, hypertension, proteinuria, retinopathy, poor metabolic control) and 18% were using high-dose preparations. More diabetic than control women used IUDs (19 vs. 12%) and more diabetic women were sterilised (19 vs. 9%). Compared to controls diabetic women had had sterilisation at a younger age (31[5] vs. 36[4] yrs) and more sterilised women were childless (29 vs. 14%). Methods of lower efficacy (condom, diaphragma, spermatocides) were used by 26% of diabetic women (controls 20%), p < 0.05. Nearly half of the diabetic women had received contraceptive advice exclusively by gynaecologists. 22% of all pregnancies were unplanned (controls 17%); 0 > 0.05).

CONCLUSION

More diabetic women should use methods of contraception with high efficacy. However, when prescribing OCs more attention must be payed to special contraindications. Sterilisation should be recommended more cautiously to diabetic women without advanced diabetic complications. Contraceptive advice to diabetic women must be given by gynaecologists and diabetologists.

The role of adjuvant treatment in endometrial cancer

PURPOSE

Divergent opinions exist on the value of adjuvant treatment in endometrial cancer. This paper aims at clarifying the indications for adjuvant radiotherapy by reviewing the literature and presenting own data.

METHODS

For endometrial cancer 5-year survival data are analysed with respect to the value of adjuvant radiotherapy and/or chemo-/hormone therapy.

RESULTS

Adjuvant radiotherapy in FIGO stage I and II tumors reduces pelvic recurrence rates from 15 to 20% to 1 to 5%. In high risk stage I patients the 5-year survival rate is increased by 30 to 40% using pre-operative high dose endocavitary brachytherapy or postoperative external beam therapy. In stage II disease the 5-year survival rate is increased to 60 to 80% when applying 50 to 60 Gy post surgery. In stage III and IV tumors primary radiotherapy results in 5-year survival rates of 16 to 40%.

CONCLUSIONS

In stage I and II endometrial cancer primary treatment consists of surgery followed by radiotherapy in eligible cases. In stage III and IV tumors primary radiotherapy is generally advocated. No properly randomized trials are available to date on the value of adjuvant treatment. There is a great demand for such trials in order to confirm the available data. According to the extent of the disease and the discrimination of certain risk groups these trials should include external beam pelvic irradiation, brachytherapy, para-aortic irradiation as well as systemic chemo-or hormone therapy.

Carboplatin and radiotherapy in the treatment of head and neck cancer: six years' experience

Between 1987 and 1991, 103 patients with advanced head and neck carcinoma were treated with radiochemotherapy plus carboplatin. Tumors were located in the oral cavity in 33 patients, the oropharynx in eight, and the hypopharynx in seven. Four patients had a tumor of the epipharynx and three, tumor of the larynx. In 48 patients tumor involvement included two or more compartments. Radiotherapy was performed with cobalt-60 rays or 8-MeV photons in a fractionation of 5 x 2 Gy/wk to a dose of 50 Gy. Carboplatin 60 to 70 mg/m2/d was administered days 1 through 5 and 29 through 33. For inoperable patients radiotherapy was continued to a dose of 70 to 74 Gy. To date, 103 patients have entered the study and 100 have completed treatment; three patients died during the treatment period. Actuarial 1- and 2-year survival rates are 77% and 53%, respectively, for all patients; comparable figures for patients with interposed surgery are 93% and 69%, and for the patients treated with radiotherapy alone, 71% and 47%. In a pilot study conducted between 1990 and 1991, 15 patients with advanced head and neck carcinomas underwent hyperfractionated accelerated radiotherapy (2 x 1.6 Gy/d 5 days per week; total dose, 64 to 67.2 Gy) and simultaneous intravenous carboplatin (60 mg/m2, days 1 through 5 and 29 through 33). Eleven patients had T4 and four had T3 tumors. At the end of the treatment period, 12 patients had achieved a complete tumor remission and all others attained a partial tumor involution. Although acute side effects were more pronounced compared with conventional irradiation, this treatment regimen is feasible and the initial complete remission rate of 80% is encouraging. As a result of the encouraging results achieved with hyperfractionated accelerated radiotherapy, we initiated a multicenter randomized study in November 1991. Patients with advanced head and neck carcinomas are either randomized for conventional radiotherapy plus carboplatin or hyperfractionated accelerated irradiation plus carboplatin. As of July 1994, 178 patients have been entered in the study. Results will be evaluated after the study is completed.

[The significance of clinical prodromes for dosage estimation after whole-body radiation exposure]

BACKGROUND

The triage of victims after radiation injury is complicated by missing dose values and the fact that most tissues react after a latency period.

PATIENTS AND METHODS

We evaluated 63 patients undergoing total body irradiation as conditioning regime before bone marrow transplantation in order to find a relation between prodromal symptoms and dose.

RESULTS

Emesis after radiation exposure hints to doses greater than 1.5 Gy. A rise of body temperature above 37 degrees C up to five hours after exposure is related to doses exceeding 2.5 Gy, while an acute onset of diarrhoea is an indicator of a severe accident with more than 9 Gy.

CONCLUSION

Besides blood counts and chromosome analyses a careful evaluation of prodromal symptoms can help to classify the severity of radiation accidents.

Trial of intravesical versus extravesical ureteroneocystostomy in renal transplant recipients

We carried out a trial to evaluate the complication rate of intravesical (LP) versus extravesical (Lich) ureteroneocystostomy in recipients of renal transplantation. Ureteric stenosis was the predominant complication in the LP technique, which was more difficult to correct. Complications by the Lich technique were urinary leaks, which were managed successfully by prolonged bladder drainage. We conclude that the Lich technique is simpler to perform and avoids the complication of ureteric stenosis, and should therefore be the procedure of choice for ureteric implantation in recipients of renal transplants.

[Suicide with prothipendyl]

The distribution of prothipendyl (Dominal) in two cases of fatal poisoning are reported. The highest concentration of prothipendyl were found in liver (1.2 g/kg to 1.8 g/kg) and kidney (0.6 g/kg). Prothipendyl concentrations in these organs far exceeded those in blood. In the first case we found a blood concentration 200 times over the therapeutic range. Prothipendyl was detected in all specimens tested including: lung, muscle and stomach. These results are in agreement with limited, previously reported data and indicate that more then 4 g of prothipendyl is fatal overdose. In this report the survival time and dose are discussed.

A retinoic acid receptor alpha antagonist counteracts retinoid teratogenicity in vitro and reduced incidence and/or severity of malformations in vivo

The role of retinoic acid receptors (RAR) in retinoid-induced teratogenesis is mainly unknown. The aim of the present studies was to demonstrate the effect of a RAR alpha antagonist on retinoid-induced teratogenic effects in vitro and in vivo. In micromass cultures of rat limb bud cells a RAR alpha antagonist was able to counteract differentiation inhibiting effects of a RAR alpha agonist. In mouse studies, the selective RAR alpha antagonist reduced frequency and/or severity of major malformations. Our observations indicate the potentiality of selective RAR agonists and antagonists in dissecting the function of nuclear receptors and in particular cases of retinoid teratogenesis, to assign to the different receptors a primary role in determining one or another of the multiple malformations.

Dosimetry of large, irregularly shaped fields by the circle method. A feasibility study

The Circle Method is an algorithm for dose calculation in an irregularly shaped field. The algorithm is based on measurements of circle fields at the therapy machine in use. A separation into primary and scattered radiation components is not necessary. Clarkson's sector-integration method and an off-axis correction are embodied. Experimental and calculated dose values agree within +/- 2.8% in the treatment field and under block shieldings.

Combined radiochemotherapy with carboplatin in the treatment of advanced head and neck carcinomas

From 1987 to 1991, 100 evaluable patients with advanced head and neck carcinomas (T2-4, N0-3) were treated with radiotherapy and simultaneous carboplatin. Tumors were located in the oral cavity in 33 patients, oropharynx in 8 patients, and hypopharynx in 7 patients. Four patients had a tumor of the epipharynx, 3 of the larynx, and 45 had involvement of two or more compartments. Radiotherapy was performed in a fractionation of 5 x 2 Gy/week up to a dose of 50 Gy. Carboplatin was administered in a dose of 60 or 70 mg/m2 from days 1-5 and 29-33. After a 2-week interval, tumor involution was evaluated and a decision was made on the patients' operability. In cases of inoperability, radiotherapy was continued up to a dose of 70-74 Gy. Thirty patients underwent surgery after 50 Gy. Eight patients showed a histologically complete remission (CR), 7 showed microscopic residual tumor, and 15 showed macroscopic tumor. Seventy patients were treated with radiotherapy and concomitant carboplatin only. Thirty-nine of them achieved a CR and 30 a partial remission (PR). The residual tumor was operable in 8 of the latter patients. Only a minor response was achieved in the remaining patient. At the end of the treatment 77 patients achieved a CR with this combined modality. From 1990 to 1992, 20 patients with locally advanced head and neck carcinomas underwent hyperfractionated accelerated radiotherapy (2 x 1.6 Gy/day, 5 days per week: total dose, 64-67.2 Gy) and simultaneous intravenous carboplatin (60 mg/m2, days 1-5 and 29-33) in a pilot study. Fifteen patients had T4 and 5 had T3 tumors. Six weeks after the end of treatment, 16 patients (80%) had CR, and PR was seen in the other 4 patients (20%). Overall and disease-free survival at 1 year was 82 and 81%, respectively. Although acute side effects were more pronounced compared with conventional irradiation, this treatment regimen is feasible and the initial CR rate of 80% is encouraging. Because of the results achieved with hyperfractionated accelerated radiotherapy, we initiated a multicenter randomized study in November 1991. Patients with advanced head and neck carcinomas are either randomized for conventional radiotherapy with carboplatin or hyerfractionated accelerated irradiation with carboplatin. Results will be forthcoming.

Sex differences and the effects of alcohol on immune response in male and female rats

Although it is clear that both alcohol and sex hormones impact immune function, very little information is available on the effects of alcohol on immune response in males versus females. We decided to determine if the alterations in immune response resulting from alcohol feeding might be expressed differently in males and females. To accomplish this we utilized pair-fed male and female Sprague-Dawley rats. Animals were fed a liquid diet for 60 days containing 30% of their calories as ethanol, and after 1 week this concentration was increased to 45% ethanol. Controls received liquid control diet of the same caloric and nutritional composition, and immune status was monitored with in vivo and in vitro techniques. Ethanol feeding significantly reduced the phytohemagglutinin skin response in males (p = 0.020) and females (p = 0.012). The concanavalin A blastogenic response of spleen cells prepared from female rats fed ethanol was significantly depressed with respect to spleen cells prepared from female rats fed the control diet (p = 0.0071). Alcohol also appeared to depress spleen cell blastogenic response in males, but this trend did not quite reach significance (p = 0.071). Spleen cells from groups of ethanol and control male and female rats were labeled with fluorescent monoclonal antibodies and run on a Fluorescent-Activated Cell Sorter. Ethanol significantly increased the percentage population of CD4 (T-helper cell) in males (p = 0.017), but not in females, and promoted an apparent, although nonsignificant, increase in the CD4/CD8 ratio in both sexes. An ELISA was used to measure IgM and IgG antibody elaborated by pokeweed mitogen-stimulated spleen cells in cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of radiotherapy in the management of small cell lung cancer (SCLC)

In the past decade the management of small cell lung cancer (SCLC) has undergone substantial changes with respect to surgery, chemo- und radiotherapy. Due to combined chemotherapy regimens survival rates increased and the role of radiotherapy has been reevaluated. Despite this, the majority of patients treated with chemotherapy alone failed at the primary site. Several randomized studies have shown that irradiation (35 to 40 Gy) following chemotherapy has increased locoregional control rates. There is no uniform opinion about the treatment volume, fractionation schedule or optimal dose of radiotherapy. Recent reports have demonstrated better local control rates with radiation doses in excess of 45 Gy. Prophylactic cranial irradiation with 20 to 40 Gy is widely used in patients with SCLC and generally accepted in patients with complete remission after chemotherapy. Randomized studies have proven that prophylactic cranial irradiation reduces central nervous system relapses, however, no author has reported so far a significant improvement in survival.