Potential contribution of screening to cancer mortality reduction

The objective of screening for cancer is to reduce mortality or to improve quality of life. Screening is practiced for several anatomical sites and by several tests. Only cervical cancer screening based on cytological smears has been shown to be effective as a public health policy. Screening for breast cancer based on mammography was shown to reduce mortality in several randomized trials and nonexperimental studies. However, no data are available on its effectiveness at population levels in terms of a public health policy. There are several other valid tests. Application of these tests has failed to demonstrate a reduction in mortality or such an application was never tried and tested. This emphasizes that the prerequisite for effective screening is that the total program is valid and not only the test. At present, knowledge on screening is not fully applied in most European countries. Regular screening for cervical cancer will result in a 90% reduction in the risk of invasive disease. It is likely that the protective effect for breast cancer is about 30%. At the population level, smaller protections are to be expected, and well-organized screening programs are likely to reduce the total cancer death rate by 6 to 10% among females.     

Contrast medium nephropathy--a contribution to the reduction of examination risks

The radiologist is rarely directly confronted with contrast medium-induced renal impairment or even renal failure. In contrast to allergic side effects, the disorders do not become apparent until a few days after the investigation. The relevance of "contrast-medium nephropathy" should not, however, be underestimated: prior contrast medium injections are the initial cause of at least 10% of all cases of acute renal failure. The risk associated with such an investigation can be reduced if the risk factors are known, the patient receives an affective premedication in preparation for the investigation, and if preference is given to non-ionic contrast media.     

Budd-Chiari syndrome: a contribution to surgical therapy

The commonest cause of Budd-Chiari syndrome is stenosis of the inferior vena cava and hepatic veins. Improved venous draining can be achieved by resection of a dorso-cranial portion of the liver and the anterior aspect of the vena cava wall. A complex case is reported.     

The contribution of epidemiology to knowledge of cancer

Epidemiology has contributed to knowledge of cancer in five ways. First, it has demonstrated that all cancers that are at all common anywhere vary in incidence from place to place and from time to time. The amount of variation is large, sometimes several hundred fold, and no cancers are so uniformly common that they would affect as many as 1 per cent of people by 75 years of age, in the absence of other causes of death, in all countries. Studies of migrant groups and the changes that have occurred with time show that this variation is, in large part, due to environmental factors and that most cancers are, in principle, preventible. Secondly it has shown that the incidence of specific cancers can be correlated with the prevalence of factors in the environment that might be suspected of causing the disease. Recent correlations include those between oesophageal cancer in Iran and the consumption of certain locally produced foods, between colon cancer and the presence of certain groups of anaerobic bacteria in the faeces, and between liver cancer and the amount of aflatoxin in the diet. These correlations do not provide direct evidence of causation, but they do suggest ideas for investigation by other methods. Thirdly, epidemiology has provided means for testing hypotheses by relating the occurrence of particular types of cancer to the personal characteristics of individuals, either by studying the past experience of people with and without cancer, or by following up people whose exposure to suspected agents has been previously defined. In this way it has been possible to detect dozens of occupational hazards in industry, which is many more than have been detected by laboratory experiment. Fourthly, epidemiology has confirmed that an agent is a cause of cancer by monitoring the effects of intervention to reduce or prevent exposure. An example is provided by observation in British doctors, who have reduced their consumption of cigarettes to half the national average and have experienced a corresponding reduction in the risk of death from cancers of the lung.     

A contribution to the technology of vanadium recovery from solution by hydrogen reduction

Abstract

The hydrogen reduction of 5-valent Vanadium compounds from aqueous solutions investigated; The reduction precipitates a complex vanadium oxide with the composition mV₂O₃·nV₂O₅·pNa₂O·qH₂O.

The coefficients of components constituting the complex oxide may vary to some extent, but at a reduction temperature below 180°C and with an alkali concentration in the feed solution of less than 50 g/l, constitution of the oxide is V₂O₃·V₂O₅·1.5Na₂O·2H₂O.

The precipitated complex oxide acts as a catalyst in the reaction and the specific activity of the catalyst was 2.1·10^?4 g V/1/h/atm^1/2/m². Equations for the chemical reaction and the reaction rate are given and a basic flowsheet for a recommended process for vanadium recovery from solution by hydrogen reduction using the complex oxide as catalyst is discussed.

Résumé

La réduction en solution aqueuse de composés de vanadium V par l'hydrogéne a été étudiée. Il en résulte la precipitation d'un complexe d'oxyde de vanadium de composition mV₂O₃·nV₂O₅·pNa₂O·qH₂O.

La valeur des coefficients des composants du complexe peut varier dans une certaine mesure, mais quand la réduction a lieu à températures inférieures à 180°C, et pour des concentrations alcalines dans la solution mère infèrieures à 50 g/l, la composition de l'oxyde est de V₂O₃·V₂O₅·1.5Na₂O·2H₂O.

L'acide complexe précipité agit comme catalyseur de la réaction, et l'activité specifique du catalyseur était de 2.1·10^?4 g V/1/h/atm^1/2/m².

Les équations pour la réaction chimique et la vitesse de réaction sont donnees. On discute du diagramme de fonctionnement d'un procédé recommandé pour récupérer le vanadium de la solution par la reduction d'hydrogène et en employant l'oxyde complexe comme catalyseur.     

Chronic levodopa therapy enhances dopa absorption: contribution to wearing-off

Effects of the chronic administration of levodopa on its peripheral pharmacokinetics and the contribution of the pharmacokinetics to the pathogenesis of the wearing-off phenomenon are re-evaluated. The concentration of plasma levodopa and clinical symptoms were determined 4 hours after oral levodopa (levodopa 100 mg + benserazide 25 mg) administration on 55 parkinsonian patients. Long-term levodopa therapy markedly increased the peak levodopa concentration (Cmax) and the area under the time-concentration curve (AUC); whereas, it decreased time to the peak concentration (Tmax) and the elimination half-life (T1/2). These results suggest that long-term levodopa therapy accelerates the absorption of levodopa. The wearing-off group (n = 23), however, had a markedly higher Cmax and AUC, and a shorter Tmax and T1/2 than the stable group (n = 32). We speculate that the clinical expression of "stable" or "wearing-off" depends on the absorption of levodopa as well as the presynaptic terminal and post synaptic receptors.     

Validation therapy: a review of its contribution to dementia care

There has been a great deal of interest in validation therapy (VT), an interactive technique and group therapy for people who are disoriented. This article reviews the strengths and development of VT and acknowledges Naomi Feil's contribution to the care of those with dementia. Techniques for communicating with people who are dysphasic are described, as are therapeutic interventions which address the devastating effects of memory loss on the sufferers' sense of self and identity.     

Potential contribution of endothelin to renal abnormalities in glycerol-induced acute renal failure in rats

We studied the possible participation of endothelin-1 (ET-1) in the pathogenesis of renal damage in glycerol-induced acute renal failure (ARF). Cortical mRNA expression of ET-1 increased, peaking at 10 hr postinjury, but this did not occur in the medulla, plasma concentration and urinary excretion of ET-1 also increased in this model. There was no change in ETA receptor mRNA, whereas the ETB receptor tended to be down-regulated in the kidney after glycerol administration. In situ hybridization study demonstrated that elevated expression of prepro ET-1 was predominantly localized in cells in the proximal tubules of the nephritic kidney. The administration (30-3 mg/kg) of S-0139, (+)-disodium 27-[(E)-3-[2-[(E)-3-carboxylatoacryloylamino]-5-hydroxyphenl ]acrylayl oxy]-3-oxoolean-12-en-28-oate, an ETA selective antagonist, after initiation of insult offered dose-dependent prevention against ARF, demonstrating preventing of renal function impairment and mortality. These findings indicate that ET-1 participates in the pathogenesis of acute tubular injury in glycerol-induced ARF and that ETA antagonist may be useful in the treatment of some types of human ARF.     

Potential of the histoculture drug-response assay to contribute to cancer patient survival

The histoculture drug-response assay (HDRA) was recently evaluated in a retrospective clinical trial and was found to correlate to drug sensitivity, resistance, and patient survival. To further investigate the potential of HDRA to contribute to patient survival, 215 patients with gastric cancer from 45 medical centers were tested with the HDRA in a blinded study after resection of the primary lesion. One hundred sixty-eight patients received at least 20 mg/m2 of mitomycin C and a minimum of 30 g UFT, a mixture of tegafur and uracil at a molar ratio of 1:4, thereby making them eligible for the study. Of these cases 128 were evaluable by the HDRA. The evaluable patient tumors were tested by the HDRA with the [3H]thymidine incorporation end point measured by microautoradiography to be drug "sensitive" or "resistant." The in vitro conditions for distinguishing sensitivity and resistance that matched the response rates for historical controls for gastric carcinoma were 90% inhibition rate and 0.12 microgram/ml for mitomycin C and 70% inhibition rate and 1 microgram/ml for 5-fluorouracil, respectively. Most importantly in the blinded study, the overall and disease-free survival rates of the HDRA-sensitive group were found to be significantly higher than those of the HDRA-resistant group tested under the above conditions. The data further indicate the importance of three-dimensional tumor culture for obtaining accurate clinical information. The results demonstrate that the HDRA response correlates to patient survival, which suggests the potential of the HDRA to contribute to patient survival in gastric cancer when used prospectively.     

Excess hepatobiliary cancer mortality among munitions workers exposed to dinitrotoluene

This study was conducted to determine the sex of buffalo embryos produced in vitro by amplifying male specific DNA sequences using the polymerase chain reaction (PCR). This method uses three different pairs of bovine Y-chromosome specific primers and a pair of bovine satellite specific primers. Buffalo in vitro fertilized embryos at the 4-cell to blastocyst stage were collected at days 3, 4, 6, and 8 postinsemination, and the sex of each embryo was determined using all three different Y-chromosome specific primers. The bovine satellite sequence specific primers recognize similar sequences in buffalo and are amplified both in males and in females. Similarly, Y-chromosome specific primers amplify the similar Y-chromosome specific sequences in male embryos of buffalo. Upon examining genomic DNA from lymphocytes of adult males and females, and embryos, the results demonstrate the feasibility of embryo sexing in buffaloes. Furthermore, sex determination by PCR was found to be a rapid and accurate method.     

Importance of heart failure as a cause of death. Changing contribution to overall mortality and coronary heart disease mortality in Scotland 1979-1992

AIMS: As heart failure is a syndrome arising from another condition, such as coronary heart disease, it is rarely officially coded as the underlying cause of death regardless of the cause recorded by the physician at the time of certification. We sought to assess the true contribution of heart failure to overall mortality and coronary heart disease mortality and to examine how this contribution has changed over time. METHODS AND RESULTS: We carried out a retrospective analysis of all death certificates in Scotland between 1979 and 1992 for which heart failure was coded as the underlying or a contributory cause of death. From a total of 833622 deaths in Scotland between 1979 and 1992, heart failure was coded as the underlying cause in only 1.5% (13695), but as a contributory cause in a further 14.3% (126073). In 1979, 28.5% of male and 40.4% of female deaths attributed to coronary heart disease (coded as the underlying cause of death) also had a coding for heart failure. In 1992 these percentages had risen significantly to 34.1% and 44.8%, respectively (both P<0.001). Mortality rates for heart failure as the underlying or contributory cause of death, standardized by age and sex, fell significantly over the period studied in all ages and in both sexes: by 31% in men and 41% in women <65 years and 15.8% in men and 5.1% in women > or =65 years, respectively (P<0.01 for all changes). CONCLUSIONS: Death from heart failure is substantially underestimated by official statistics. Furthermore, one third or more of deaths currently attributed to coronary heart disease may be related to heart failure and this proportion appears to be increasing. While the absolute numbers of deaths caused by heart failure remains constant, this study is the first to show that standardized mortality rates are declining.     

Potential use of cytokine therapy in poultry

The time course of incorporation of [14C]arachidonic acid and [3H]docosahexaenoic acid into various lipid fractions in placental choriocarcinoma (BeWo) cells was investigated. BeWo cells were found to rapidly incorporate exogenous [14C]arachidonic acid and [3H] docosahexaenoic acid into the total cellular lipid pool. The extent of docosahexaenoic acid esterification was more rapid than for arachidonic acid, although this difference abated with time to leave only a small percentage of the fatty acids in their unesterified form. Furthermore, uptake was found to be saturable. In the cellular lipids these fatty acids were mainly esterified into the phospholipid (PL) and the triacyglycerol (TAG) fractions. Smaller amounts were also detected in the diacylglycerol and cholesterol ester fractions. Almost 60% of the total amount of [3H]Docosahexaenoic acid taken up by the cells was esterified into TAG whereas 37% was in PL fractions. For arachidonic acid the reverse was true, 60% of the total uptake was incorporated into PL fractions whereas less than 35% was in TAG. Marked differences were also found in the distribution of the fatty acids into individual phospholipid classes. The higher incorporation of docosahexaenoic acid and arachidonic acid was found in PC and PE, respectively. The greater cellular uptake of docosahexaenoic acid and its preferential incorporation in TAG suggests that both uptake and transport modes of this fatty acid by the placenta to fetus is different from that of arachidonic acid.     

Pneumonia mortality reduction and quality improvement in a community hospital

Certain enveloped viruses are known to assemble on membranes of the Golgi complex. Intracellular budding is facilitated by targeting of the viral glycoproteins to this organelle. It is likely that these viral glycoproteins are retained in the Golgi by the same means as are endogenous Golgi proteins. Consequently, the study of Golgi-specific viral proteins has provided important clues to the nature of Golgi retention signals.     

Radiation therapy with neoadjuvant hormonal therapy for prostate cancer confined to pelvis

Neoadjuvant endocrine treatment prior to radical prostatectomy for prostate cancer confined to pelvis has of some value to prevent progression although there are many controversies. In order to improve the prognosis of locally advanced prostate cancer (stage B2 and C), definitive radiotherapy with neoadjuvant endocrine therapy has been investigated. Endocrine therapy reduces the volume of prostate, thus reduces the amount of side effect via reducing the area of irradiated normal tissue. Effect of radiation and that of endocrine therapy to induce apoptosis might be synergistic. The result is favorable although the follow-up period is too short. Further studies are needed to make conclusion.     

Increased cancer mortality following a history of nonmelanoma skin cancer

CONTEXT: Cancer registries have reported an increased incidence of melanoma and certain noncutaneous cancers following nonmelanoma skin cancer (NMSC). Whether these findings were attributable to intensified surveillance, shared risk factors, or increased cancer susceptibility remains unclear. OBJECTIVE: To determine whether a history of NMSC predicts cancer mortality. DESIGN: Prospective cohort with 12-year mortality follow-up adjusted for multiple risk factors. SETTING: Cancer Prevention Study II, United States and Puerto Rico. PARTICIPANTS: Nearly 1.1 million adult volunteers who completed a baseline questionnaire in 1982. MAIN OUTCOME MEASURE: Deaths due to all cancers and common cancers. RESULTS: After adjusting for age, race, education, smoking, obesity, alcohol use, and other conventional risk factors, a baseline history of NMSC was associated with increased total cancer mortality (men's relative risk [RR], 1.30; 95% confidence interval [CI], 1.23-1.36; women's RR, 1.26; 95% CI, 1.17-1.35). Exclusion of deaths due to melanoma reduced these RRs only slightly. Mortality was increased for the following cancers: melanoma (RR, 3.36 in men, 3.52 in women); pharynx (RR, 2.77 in men, 2.81 in women); lung (RR, 1.37 in men, 1.46 in women); non-Hodgkin lymphoma (RR, 1.32 in men, 1.50 in women); in men only, salivary glands (RR, 2.96), prostate (RR, 1.28), testis (RR, 12.7), urinary bladder (RR, 1.41), and leukemia (RR, 1.37); and in women only, breast (RR, 1.34). All-cause mortality was slightly increased (adjusted men's RR, 1.03 [95% CI, 1.00-1.06]; women's RR, 1.04 [95% CI, 1.00-1.09]). CONCLUSIONS: Persons with a history of NMSC are at increased risk of cancer mortality. Although the biological mechanisms are unknown, a history of NMSC should increase the clinician's alertness for certain noncutaneous cancers as well as melanoma.