Susceptibility to lung cancer in light smokers associated with CYP1A1 polymorphisms in Mexican- and African-Americans

The gene-environment associations between potential carcinogenic agents modified by polymorphisms in the cytochrome P450 1A1 (CYP1A1) gene and lung cancer risk were assessed in a hospital-based case-control study composed of African- and Mexican-Americans. The study involved 171 cases and 295 controls identified from the greater Houston and San Antonio metropolitan areas. Both the exon 7 and MspI polymorphisms were analyzed by RFLP of PCR-amplified DNA, and in addition, the African-American-specific polymorphism was assayed for subjects who reported that they were African-American. Logistic regression analysis was performed to assess the association between each of the CYP1A1 polymorphisms and lung cancer, adjusting for the matching variables (age, sex, ethnicity) and other potential risk factors. Interactions between pack-years smoked, CYP1A1 genotypes, and case status were also evaluated. The variant allele frequencies did not differ by case status, but the distributions of genotypes were strikingly different by ethnicity. In addition, both the exon 7 and MspI polymorphisms, but not the African-American-specific polymorphism, were modified by the amount of cigarette consumption measured in pack-years. An approximate 2-fold increase in lung cancer risk among individuals with one or more of the variant alleles was observed among light smokers (defined as having smoked < or = 30 pack-years). The respective risk ratios for the exon 7 and MspI polymorphisms were 2.26 (95% confidence interval, 0.82-6.26) and 2.03 (95% confidence interval, 1.03-4.01) at low smoking dose. No such increase in risk was found among heavy smokers (> 30 pack-years). This phenomenon at low smoking dose was also observed when the two common polymorphisms were combined, which resulted in was a progressive increase in risk with an increasing number of variant alleles. These results indicate that at low smoking levels, the MspI and exon 7 CYP1A1 genetic polymorphisms confer susceptibility to lung cancer.

Recombinant human interferon-beta in the treatment of condylomata acuminata

The number of clinic consultations for condylomata acuminata (genital warts) has increased substantially during the last 30 years. Most infections produce benign lesions but a few types may be associated with cervical and penile cancers. Interferons (IFN) have shown antiviral properties to these infections and IFN-beta in particular has demonstrated a specific cytopathic effect in humans. A total of 124 patients with condylomata acuminata, the majority of whom had failed previous therapy, were treated intralesionally with either recombinant human interferon-beta la (r-hIFN-beta-1a) or placebo. Up to 6 lesions were treated in each patient, and injections were made 3 times per week for a total of 9 injections. The patients were then followed up for 3 months. Efficacy assessments at all time points (day 19, week 6 and month 3) showed a clear advantage for the r-hIFN-beta-1a interferon-beta treatment. Patients receiving r-hIFN-beta-1a showed a greater proportion of treatment success in terms of the complete or partial reduction (at least 50%) of the total area of the treated lesions. The treatment was also well tolerated. Headache, flu-like symptoms and asthenia were more common in patients receiving r-hIFN-beta-1a, but these adverse events were generally mild in severity and rarely led to patient withdrawal. It was concluded that r-hIFN-beta-1a has good efficacy in condylomata acuminata, and therefore presents a useful therapeutic alternative in this hard-to-treat condition.

Nitric oxide inhibition of coxsackievirus replication in vitro

Nitric oxide is a radical molecule with antibacterial, -parasitic, and -viral properties. We investigated the mechanism of NO inhibition of Coxsackievirus B3 (CVB3) replication in vitro by determining the effect of NO upon a single replicative cycle of CVB3 grown in HeLa cells. Transfection of inducible NO synthase cDNA into HeLa cells reduces the number of viral particles produced during a single cycle of growth. Similarly, a noncytotoxic concentration of the NO donor S-nitroso-amino-penicillamine reduces the number of viral particles in a dose-dependent manner. To explore the mechanisms by which NO exerts its antiviral effect, we assayed the attachment, replication, and translation steps of the CVB3 life cycle. NO does not affect the attachment of CVB3 to HeLa cells. However, NO inhibits CVB3 RNA synthesis, as shown by a [3H]uridine incorporation assay, reverse transcription-PCR, and Northern analysis. In addition, NO inhibits CVB3 protein synthesis, as shown by [35S]methionine protein labeling and Western blot analysis of infected cells. Thus, NO inhibits CVB3 replication in part by inhibiting viral RNA synthesis by an unknown mechanism.

The molecular epidemiology of human immunodeficiency virus type 1 in six cities in Britain and Ireland

We have sequenced the p17 coding regions of the gag gene from 211 patients infected either through injecting drug use (IDU) or by sexual intercourse between men from six cities in Scotland, N. England, N. Ireland, and the Republic of Ireland. All sequences were of subtype B. Phylogenetic analysis revealed substantial heterogeneity in the sequences from homosexual men. In contrast, sequence from over 80% of IDUs formed a relatively tight cluster, distinct both from those of published isolates and of the gay men. There was no large-scale clustering of sequences by city in either risk group, although a number of close associations between pairs of individuals were observed. From the known date of the HIV-1 epidemic among IDUs in Edinburgh, the rate of sequence divergence at synonymous sites is estimated to be about 0.8%. On this basis we estimate the date of divergence of the sequences among homosexual men to be about 1975, which may correspond to the origin of the B subtype epidemic.

Optimal selective sentinel lymph node dissection in primary malignant melanoma

OBJECTIVE

To determine the optimal approach of selective sentinel lymph node (SLN) dissection in primary malignant melanoma.

DESIGN

Consecutive patient study. Prior to selective SLN dissection and wide local excision of the primary melanoma biopsy site, technetium Tc 99m sulfur colloid was injected intradermally around the primary melanoma or biopsy site to mark the SLN. Isosulfan blue (Lymphazurin, Hirsch Industries Inc, Richmond, Va) was injected at the primary biopsy site immediately before the surgical procedure.

SETTING

Teaching hospital tertiary care referral center.

MAIN OUTCOME MEASURES

Successful identification of SLNs being defined as positive for microscopic metastatic melanoma by blue dye staining, radioisotope uptake, or both.

RESULTS

Selective intraoperative mapping by gamma probe and visualization of blue dye-stained SLN(s) resulted in a 98% (160/163) successful identification rate. Thirty patients (18.4%) had microscopic metastatic melanoma of the SLN(s), 22 of whom had subsequently completed lymphadenectomy. In 4 (18.2%) of these 22 patients, further microscopic metastatic disease was found in 1 of 8 nodes, 1 of 8 nodes, 1 of 28 nodes, and 1 of 9 nodes. No notable complications were encountered. Five recurrent cases from patients with SLNs without microscopic metastatic melanoma (3.8%) and 2 from patients with SLNs with microscopic metastatic melanoma (6%) were found during a median follow-up period of 463 days. A second primary melanoma developed in 2 patients; neither had no local recurrence.

CONCLUSIONS

Sequential combination of preoperative lymphoscintigraphy and intraoperative mapping is a reliable way to identify regional SLN. The frequency of microscopic metastatic melanoma of the SLN(s) is 18.4%. Gamma-probe--guided resection minimizes the extent of lymph node dissection. Further follow-up is needed to assess the outcome of this group of patients for regional and systemic recurrences.

Azithromycin and erythromycin resistant Neisseria gonorrhoeae following treatment with azithromycin

A pre-treatment and a 3-week post-treatment isolate of Neisseria gonorrhoeae from a 13-year-old boy treated with azithromycin in a single 1 g oral dose were characterized microbiologically. Both isolates were of the same serovar/auxotype (1B6/non-requiring) and had similar antibiograms apart from erythromycin and azithromycin: the pre- and post-treatment MICs (minimum inhibitory concentrations) were: 1 mg/L and 32 mg/L to erythromycin and 0.125 mg/L and 3 mg/L to azithromycin. The finding that both isolates were 1B6/NR, had similar antibiograms (other than azithromycin and erythromycin), and no other 1B6/NR isolates were resistant to erythromycin supports the view that macrolide resistance developed following treatment. A high overall level of azithromycin susceptibility was confirmed by testing 67 clinical isolates: MIC90 0.5 mg/L (range 0.023-0.75 mg/L). We conclude that the long half-life of azithromycin which is beneficial in treating chlamydial infection may result in increased selective pressure for resistance in gonococci. This report also highlights the importance of antibiotic susceptibility surveillance of gonococci and stresses the need for appropriate treatment of gonococcal infection, particularly when it is prescribed outwith departments of genitourinary medicine.

Non-cultural detection of rectal and pharyngeal gonorrhoea by the Gen-Probe PACE 2 assay

OBJECTIVE

To assess the sensitivity and specificity of the Gen-Probe PACE 2 assay, which uses a chemiluminescent labelled single-stranded DNA probe to detect gonococcal ribosomal RNA (rRNA), for the non-cultural detection of rectal and pharyngeal gonorrhoea in homosexual men.

SUBJECTS

161 homosexual men attending the Department of Genitourinary Medicine, Edinburgh Royal Infirmary during the latter half of 1995 and the first quarter of 1996.

METHODS

Duplicate rectal and pharyngeal swabs were collected for culture on modified New York City (MNYC) medium and detection of gonococcal nucleic acid by the Gen-Probe assay. Repeatedly reactive Gen-Probe specimens from culture negative patients were also tested by the Gen-Probe competition assay (PCA).

RESULTS

Of the 161 patients, 23 (14.3%) gave a positive culture at one or both sites (rectum 10, throat 8, rectum and throat 5) compared with 28 (16.7%) who gave a positive Gen-Probe result at one or both sites (rectum 9, throat 11, rectum and throat 8). After resolution of discrepant results by PCA the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Gen-Probe was 94.1%, 100%, 100% and 99.3% for rectal specimens while the corresponding values for pharyngeal specimens were 86.4%, 100%, 100%, and 97.9%. The sensitivity and NPV of rectal culture were 88.2% and 98.6% while the corresponding values for pharyngeal culture were 59% and 93.9%. Gen-Probe was significantly more sensitive than throat culture (p < 0.05) but not rectal culture (p > 0.2). The average Relative Light Units (RLU) value for the cut-off was 386 (range 351-450) while the average for a positive result was 20306 (range 403-110104): this was, however, significantly higher (p = 0.019) in rectal specimens 31325 (range 1705-110104) than in throat specimens 10447 (range 403-15633).

CONCLUSIONS

Gen-Probe PACE 2 assay is a sensitive and specific method for the detection of rectal and pharyngeal gonorrhoea. As the Gen-Probe assay may detect nucleic acid from non viable gonococci the clinical significance of a probe positive culture negative specimen from a patient without culture evidence of gonorrhoea at another site is uncertain and requires further consideration. Nevertheless a positive result does indicate exposure to infection and could be important in ensuring appropriate partner notification action. If non-cultural methods are used to screen for gonococcal infection cultures should be obtained from patients with positive results in order that the antibiotic susceptibility and molecular epidemiology of the gonococcal population can be monitored.

Lung cancer in Mexican-Americans and African-Americans is associated with the wild-type genotype of the NAD(P)H: quinone oxidoreductase polymorphism

Age-adjusted incidence rates for lung cancer are significantly lower for Hispanics compared with non-Hispanic whites or African-Americans; differences in genetic susceptibility have been postulated as one explanation for these ethnic differences. Recently, a polymorphism of the gene encoding NAD(P)H quinone oxidoreductase (NQO1) has been described. NQO1 is a cytosolic enzyme catalyzing the two-electron reduction of quinone substrates, which is thought to be involved in both metabolic activation and detoxification of carcinogenic agents that could be involved in lung carcinogenesis. The polymorphic variant of the gene (a C-to-T transition at base pair 609) is associated with reduced NQO1 activity and resistance to anticancer agents requiring reductive activation. We studied 177 untreated lung cancer cases and 297 community controls, examining the prevalence of the NQO1 wild-type and variant alleles to assess whether the polymorphism was associated with lung cancer. Cases and controls were individuals of Mexican-American (n = 222) or African. American (n = 252) ethnicity recruited from the Houston and San Antonio areas. Overall cases were more likely to carry two copies of the wild-type NQO1 allele compared with controls (odds ratio, 1.79; P = 0.002). When cases and controls were stratified by ethnicity, the wild-type genotype was found to be approximately 2-fold more common among African-Americans (P < 0.001) than among Mexican-Americans. Multivariate analyses indicated a significant association of the wild-type genotype with lung cancer risk after controlling for the effects of age, gender, ethnicity, and smoking status (odds ratio, 1.80; 95% CI:1.09-2.97; P = 0.02). These results indicate a significant ethnic variation in the occurrence of the NQO1 base pair 609 transition and demonstrate an association of the wild-type genotype with lung cancer risk. Given the known role of NQO1 in the activation of potential lung carcinogens, the NQO1 polymorphism should be investigated further as a possible genetic risk factor for lung cancer among minority populations.

Early Doppler echocardiographic dysfunction is associated with an increased mortality after orthotopic cardiac transplantation

BACKGROUND

Doppler echocardiographic (DE) diastolic dysfunction has been correlated with rejection after orthotopic cardiac transplantation (Tx). However, the relationship of early diastolic dysfunction to late outcome is unknown. The purpose of this study was to assess the correlation between early DE diastolic dysfunction and outcome after heart Tx.

METHODS AND RESULTS

Of 133 patients undergoing heart Tx between October 1990 and April 1994, 83 were identified with > or = 4 routine DE performed during the first 6 months. Assessment of diastolic function included measurement of isovolumic relaxation time (IVRT), pressure half-time (PHT), and peak early mitral inflow velocity (M1). Diastolic dysfunction was defined as a decrease of 15% from baseline (IVRT and PHT) or an increase of 20% (M1). A mean dysfunction score (MDS) was calculated for each patient (number of episodes of dysfunction by Doppler total number of echocardiograms performed). The population diastole MDS was determined and two groups established (group 1, MDS < mean; group 2, MDS > mean). Actuarial survival, rejection, and transplant coronary artery disease (TxCAD) were compared between groups. Actuarial survival was significantly reduced in patients with greater early diastolic dysfunction (P < .05). There were 17 deaths overall: 5 in group 1 (mean, 786 days) and 12 in group 2 (mean, 384 days). There were no significant differences in treated rejection episodes, actuarial freedom from rejection or TxCAD, immunosuppression, sex, donor age, donor ischemic time, or cytomegalovirus between the two groups.

CONCLUSIONS

Diastolic dysfunction within 6 months of transplant was associated with an increased late mortality.

Characterizing patients with multiple sexually acquired infections: a multivariate analysis

It has long been recognized that sexually transmitted diseases (STDs) may occur concurrently hence necessitating screening in individuals attending Genito-Urinary Medicine (GUM) clinics. However there are few data on individuals with more than one concurrent STD. Individuals attending the GUM Department in the Royal Infirmary of Edinburgh between 1990 and 1994 with the diagnosis of HIV infection, genital warts, genital herpes, non-specific genital infection (NSGI), gonorrhoea and syphilis were included in the study. A multivariate comparison was made between those presenting with multiple concurrent STDs and a control group comprising individuals with a solitary STD with respect to year of attendance, social class, location of acquisition of infection, sex, sexual orientation and age using a logistic regression model. A total of 680 of 9265 patients in the study period had more than one concurrent STD. Individuals in lower socio-economic class were at higher risk and older individuals at lower risk of multiple concurrent STDs. Multiple sexually acquired infections are common in individuals who attend GUM clinics. Age and socio-economic class were the only significant variables. Identification of populations at highest risk for multiple infection can direct interventions against all STDs.

Regulation of endothelial nitric-oxide synthase during hypoxia

The mechanism by which nitric-oxide (NO) production increases during hypoxia is unknown. To explore the effect of hypoxia upon endothelial nitric-oxide synthase (ecNOS) activity and expression, we exposed bovine aortic endothelial cells (BAEC) to hypoxia (1% O2) for 0-24 h and measured levels of ecNOS mRNA, protein, and activity. The amount of ecNOS mRNA increases to more than twice the basal level after 6 h of hypoxia. Incubation of BAEC with actinomycin D during hypoxia prevents this increase, demonstrating that higher levels of mRNA observed during hypoxia are due to increased synthesis, not to increased stability of ecNOS mRNA. Levels of ecNOS protein increase throughout 24 h of hypoxia to more than twice normoxic levels. Although ecNOS expression increases within 2 h of hypoxia, total activity remains unchanged. To explore the transcriptional regulation of ecNOS, we constructed a reporter plasmid containing the ecNOS promoter region upstream of the luc gene and transfected this reporter plasmid into BAEC. In this system, hypoxia induces a linear increase over time in the expression of luciferase driven by the ecNOS promoter. It is concluded that hypoxia induces an increase in transcription of ecNOS in endothelial cells, activating the regulatory region of ecNOS by undefined transcription factors.

Doxorubicin and dose-escalated cyclophosphamide with granulocyte colony-stimulating factor for the treatment of hormone-resistant prostate cancer

PURPOSE

The goals of this study were to define the efficacy and toxicity of doxorubicin and dose-escalated cyclophosphamide (Cy) along with granulocyte colony-stimulating factor (G-CSF) in the treatment of hormone-refractory prostate cancer (HRPC), to determine the maximal-tolerated dose (MTD) of Cy in this regimen, and to evaluate the impact of prior pelvic irradiation (XRT) on MTD and toxicity.

PATIENTS AND METHODS

Thirty-five patients were treated every 21 days with fixed-dose doxorubicin (40 mg/m2) and Cy 800 to 2,000 mg/m2 (in a cohort dose-escalation schema) along with G-CSF.

RESULTS

Five of 15 patients (33%) with measurable disease obtained an objective response. Sixteen of 35 patients (46%) had a greater than 50% decrease in prostate-specific antigen (PSA) level (95% confidence interval [CI], 28.8% to 63.4%). Ten of 35 patients (28.6%) had a greater than 75% decrease in PSA level. The median survival time was 11 months. The median survival duration of patients with a greater than 50% decrease in PSA level was 23 months, versus a median survival time of 7 months in patients without a PSA response (P = .02). Although 33% of cycles were associated with grade 4 neutropenia, febrile neutropenia occurred in only 7.8% of all cycles. Thrombocytopenia and anemia were rare. Nonhematologic toxicity was minimal. Patients who had received prior pelvic XRT had a lower Cy MTD, but their hematologic toxicity was not appreciably different.

CONCLUSION

This is a well-tolerated, active regimen for the treatment of HRPC. Toxicity was not different in patients with prior pelvic XRT, although these patients had a lower MTD.

BEAM chemotherapy and autologous bone marrow transplantation for patients with relapsed or refractory non-Hodgkin's lymphoma

PURPOSE

To evaluate the outcome of patients with relapsed or resistant non-Hodgkin's lymphoma (NHL) undergoing high-dose chemotherapy and autologous bone marrow transplantation (ABMT) and to determine the main prognostic factors.

PATIENTS AND METHODS

One hundred seven patients with relapsed or resistant intermediate-/high-grade NHL underwent high-dose carmustine, etoposide, cytarabine, and melphalan (BEAM) chemotherapy and ABMT at University College Hospitals between September 1981 and February 1993. The minimum follow-up duration of all patients is 6 months.

RESULTS

At 3 months, the overall response rate to BEAM and ABMT was 73% (41% complete response and 32% partial response). The 5-year actuarial overall survival and progression-free survival rates were 41% and 35%, respectively. The early procedure-related mortality rate was 7% (eight of 107 patients). On multivariate analysis, the main prognostic factor was disease status at the time of ABMT. Patients with chemosensitive disease had an actuarial 5-year survival rate of 49% at 5 years compared with 13% for those with chemoresistant disease (P < .001). For patients considered to have chemosensitive disease at the time of transplantation, there is a significant difference in the actuarial progression-free survival rates for those who received high-dose therapy after attaining a partial response to first-line therapy (69% at 5 years) as compared with those with sensitive but relapsed disease (32% at 5 years) (P = .003).

CONCLUSION

Patients with chemosensitive disease benefit most from high-dose chemotherapy, and those who receive such therapy early after achieving a partial response to first-line therapy have a high rate of cure.

Temporal changes in the sensitivity of Neisseria gonorrhoeae to penicillin in Edinburgh, Scotland

Increased resistance of Neisseria gonorrhoeae to penicillin has been reported from many centres around the world since the introduction of antibiotic therapy in the 1940s. This study reports the temporal changes in gonococcal penicillin sensitivity over a 3-year period. All patients with a diagnosis of gonorrhoea in the city of Edinburgh, Scotland between 1990 and 1992 were included in the study. Penicillin sensitivity of isolates was analysed in relation to the sex and sexual orientation of the patient and the antibiotic therapy given. Four hundred and twenty-seven new patient episodes of infection occurred of which penicillin sensitivities were available in 426. Eleven episodes of PPNG infection occurred. Chromosomally mediated penicillin resistance did not increase over the study period. No differences were evident in the sensitivity of isolates from homosexual and heterosexual patients. Unlike many other areas the relative resistance of N. gonorrhoeae is not increasing in Edinburgh at present. This may relate to local antibiotic policies combined with intrinsic characteristics of N. gonorrhoeae itself. Unlike previous reports there did not appear to be any increased resistance to penicillin in isolates from gay men.

First place winner of the Conrad Jobst Award in the gold medal paper competition. Nitric oxide synthase inhibitors N-monomethylarginine and aminoguanidine prevent the progressive and severe hypotension associated with a rat model of pancreatitis

The objective of this study was to determine whether the observed vascular collapse and other pathologic features of severe pancreatitis may be related to the induction of nitric oxide synthase (NOS). The rat model of pancreatitis reported by Schmidt et al. was employed. Rats in the experimental groups received pretreatment with known NOS inhibitors, N-Monomethylarginine (NMMA) or Aminoguanidine (AG). Controls included sham-operated rats without pancreatic insult and a diseased control group which received pretreatment with normal saline (NS). Arterial blood pressure was continuously recorded with a femoral arterial catheter connected to a transducer and monitor. Fluid resuscitation for hypotension followed a strict protocol with the administration of 5.0 cc NS for sustained decreases in systolic blood pressure (SBP) below 90 mm Hg at 5-minute intervals. Laboratory parameters and histopathology confirmed the induction of pancreatitis, with 6 to 15-fold increases in serum amylase levels and an average of approximately 20% decrease in serum ionized Ca++ levels. Immunohistochemical studies of the pancreas revealed that pancreatic insult resulted in the induction of NOS. Rats in the saline control group (n = 5) became hypotensive (SBP less than 90 mm Hg) between 3 and 4 hours post pancreatic insult and required an average of 110.0 cc (3-4 x blood volume) of NS fluid resuscitation. Rats which were not resuscitated (n = 5) did not survive.(ABSTRACT TRUNCATED AT 250 WORDS)

Urethral stricture and urethritis in men in Scotland

OBJECTIVES

To examine the incidence of urethral stricture in men in Scotland during the years 1982-1991 in relation to the changing incidence of gonococcal and non-gonococcal urethritis (NGU) over the past 20 years.

DESIGN

Retrospective study of incidence of urethral stricture in Scotland.

METHOD

The number of new men in whom a diagnosis of urethral stricture was made for the years 1982-1991 was obtained using the new Scottish Record Linkage system, and the number of cases of gonorrhoea and NGU was obtained from Communicable Diseases (Scotland) Unit. Age-specific rates of urethral stricture were calculated and the Poisson regression model was used to test if there was a trend of rate with age or time change.

RESULTS

There was a highly significant increase in the incidence of urethral stricture with age but only a slight increase in incidence over the study period within each age group.

CONCLUSION

As the interaction between age and time was not significant, it is concluded that urethritis associated with sexually transmitted organisms is an uncommon cause of urethral stricture in Scotland.

Development of new coronary atherosclerotic lesions during a 4-year multifactor risk reduction program: the Stanford Coronary Risk Intervention Project (SCRIP)

OBJECTIVES

This study attempted to determine whether an intensive multifactor risk reduction program conducted over 4 years would reduce the rate of development of new coronary artery lesions.

BACKGROUND

Recent angiographic trials have generally demonstrated that normalization of plasma lipoprotein profiles reduces the rate of progression of established coronary lesions, but limited data exist on how these treatments influence the development of new lesions.

METHODS

Three hundred men and women with coronary artery disease were randomized to multifactor risk reduction or usual care. Highly significant improvements in risk factors were achieved by the risk reduction group compared with minimal changes by the usual care group. Quantitative coronary angiography was performed on entry and after 4 years under identical conditions. A decrement in the minimal diameter of visually normal segments > 0.2 mm was considered to indicate new lesion formation.

RESULTS

A total of 1,605 segments, representing 257 patients, were considered normal at baseline, with 804 and 801 disease-free segments in the usual care and risk reduction groups, respectively. Ninety-nine segments (6.1%) were identified by follow-up quantitative angiography and two angiographic observers as having new lesion formation (usual care 7.6%, risk reduction 4.7%, p = 0.05). New lesion formation was observed in 41 (31%) of 131 patients in the usual care group and in 29 (23%) of 126 patients in the risk reduction group (p = 0.16), with a mean number of new lesions/patient of 0.47 in the usual care group and 0.30 in the risk reduction group (p = 0.06). Multiple regression analysis identified on-study dietary fat intake as the best correlate with new lesion formation.

CONCLUSIONS

These data indicate that intensive multifactor risk reduction tends to diminish the frequency of new coronary lesion formation.

Use of biological markers in risk assessment

Measurements of intermediate end points in the carcinogenic process may reduce uncertainty in human risk assessment from bioassay data, by identifying sources of interspecies variation and dose nonlinearity. This paper describes desirable properties of such markers: persistence, predictive power, temporal relevance, and consistency across dose rate and species. We illustrate these properties by evaluating markers for squamous cell nasal carcinoma in rodents exposed to formaldehyde. We also discuss design issues for bioassays that evaluate markers and tumors simultaneously at necropsy.

Suppurative epididymo-orchitis in young "high risk" patients--a new problem?

During a 4-year period we have treated 3 young patients with severe epididymo-orchitis which progressed to suppuration (despite treatment with a range of antibiotics) and necessitated orchiectomy. All gave a history of "high risk" activity (2 homosexual, 1 sexual partner of intravenous drug user). One patient was suffering from acquired immune deficiency syndrome and another presented during seroconversion to HIV-positive status. Cytomegalovirus was the infective organism in one patient, but the pathogenesis in the others remains obscure. Investigations for atypical pathogens should be performed when young patients present with refractory epididymo-orchitis. These patients should also be counselled with regard to HIV testing.

Use of a commercial PCR kit for detecting Chlamydia trachomatis

AIMS

To evaluate a commercial polymerase chain reaction (PCR) kit for the detection of Chlamydia trachomatis.

METHODS

Two hundred and fifty seven genital specimens, which had been submitted in 2SP medium for chlamydial isolation and subsequently stored at -70 degrees C, were retrospectively examined by a commercial PCR kit which detects chlamydial plasmid DNA. Culture negative, PCR positive specimens were examined by immunofluorescence and an in-house major outer membrane protein (MOMP)-PCR.

RESULTS

All 49 specimens which were culture positive were also PCR positive. Another 14 specimens were also PCR positive. After resolution of these results by immunofluorescence and a PCR assay for MOMP the sensitivity for PCR was 98.4% and that of culture 79%. The specificities were 99.5% and 100%, respectively.

CONCLUSIONS

This kit, which is highly sensitive and specific, is straightforward to use and has a built-in safeguard against cross contamination. The role of this test in the examination of routine genital specimens from patients with uncomplicated chlamydial infection is questionable due to its expense. It may have a place in the investigation of trachoma or infertility, however, where it has been shown that DNA can be detected when culture is unsuccessful.

An open, comparative, study of the efficacy of 0.5% podophyllotoxin lotion and 25% podophyllotoxin solution in the treatment of condylomata acuminata in males and females

The efficacy and safety of topical treatment for external condylomata acuminata with either self-applied 0.5% podophyllotoxin (PT) or hospital-applied 25% podophyllin (PODO) solution was compared in 138 males and 67 females in an open multicentre study. After one week of treatment, wart clearance was observed in 53% of males and 37% of females in the PT group as compared with 19% of males and 19% of females in the PODO group (P < 0.001 in males; P = 0.13 in females). At 5 weeks after commencing treatment, clearance of warts had been achieved in 86% males and 72% females in the PT group as compared with 78% of males and 62% females in the PODO group (P = 0.08 in males; P = 0.14 in females). Treatment had cleared 81% of 180 treated sites in all PT recipients as compared with 61% of 95 treated sites in all PODO recipients (P < 0.001). The increased speed of action of PT was associated with an increased incidence of symptoms and signs of inflammation at treatment sites in both males and females (P < 0.001). These were generally mild, did not interfere with continuing treatment, and were more frequent in those patients whose warts were eradicated most rapidly. Home-based treatment with 0.5% podophyllotoxin lotion in appropriately instructed patients of either sex is superior in efficacy to outpatient applied 25% podophyllin and has the potential to reduce the number of hospital attendances required in genital wart eradication.