Immunoscintigraphy of colorectal carcinoma utilizing 111In-labeled monoclonal antibody conjugate CYT-103

Twelve presurgical patients with colorectal carcinoma received a single intravenous infusion of 0.5-20.0 mg of the radiolabeled monoclonal antibody conjugate CYT-103. This product is an immunoconjugate of B72.3 labeled with Indium-111 (111In). Patients underwent preoperative gamma camera imaging and computed tomographic (CT) scanning of the abdomen and pelvis. Fifteen intraabdominal sites of tumor were found at surgery. Monoclonal antibody imaging detected 87% of these lesions, whereas CT of the abdomen and pelvis detected 47%. Monoclonal antibody imaging identified tumor in 27% of the patients in which CT did not identify any sites of tumor. The results of this study indicate that monoclonal antibody imaging using [111In]CYT-103 is useful for the preoperative evaluation of colorectal carcinoma patients and the results are complimentary to CT of the abdomen and the pelvis.

Patients' choice of general practitioner: importance of patients' and doctors' sex and ethnicity

The relative importance of sex and ethnicity in patients' choice of doctor is not known. A total of 1633 consultations at a health centre in Bradford, with a mixed ethnic list, were examined over a four week period to test the relative importance of these variables. Patients had the choice to consult any one of: a male Asian, a male white or a female white doctor. Asian patients, irrespective of sex, were significantly (P less than 0.001) more likely to consult the Asian doctor then either of the other two doctors, though a greater proportion of Asian women than men consulted the female white doctor. Although the sex of the doctor was important in patients' choice, for Asian patients the doctor's culture and language were more important.

General practitioners' perceptions of Asian and non-Asian patients

The literature on the health of the population of Asian origin contains little on their interaction with primary care services. This paper reports results of a postal survey of GPs' attitudes towards Asian and Non-Asian patients. The response rate was 78%-141 of the 182 GPs replied. Compared with non-Asian patients, GPs held less positive attitudes towards Asian origin patients who were thought to require longer for consultations, be less compliant, and make excessive and inappropriate use of health services. These perceptions have implications for patient care and the GP workload.

Incidence of cancer in Bradford Asians

STUDY OBJECTIVE

The aim of the study was to investigate the incidence of cancer in Asians living in Bradford.

DESIGN

Cancer registrations were obtained from the Yorkshire Regional Cancer Registry for the six year period 1979-1984. Registrations relating to persons of Asian background were extracted using forenames and surnames. Data were analysed by disease category and age and sex specific incidence rates were calculated. These were compared with expected incidence rates for the non-Asian population and with rates for the Indian subcontinent derived from the Bombay Cancer Registry.

SETTING

Data collection was confined to the Bradford Metropolitan District, population 449,897 (1981).

SUBJECTS

The Asians studied originated from Pakistan (65%), India (28%), Bangladesh (4%), and East Africa (3%). The total Asian population of the Bradford Metropolitan District was approximately 45,000.

MAIN RESULTS

Over the study period there were 178 Asian cancer registrations. The overall standardised registration ratio was 53.7 for males (100 cases, 95% confidence interval 43-64), and 43.5 for females (78 cases, 95% CI 34-53). The standardised registration ratios for cancer of the hypopharynx in males and gall bladder in females were significantly raised. There was a particularly low incidence of cancer of the stomach, large bowel, lung, skin, and bladder in males, and of skin, breast, cervix (in situ), and ovary in females. The analyses suggested that lung and breast cancer incidence may be increasing towards the non-Asian level. In situ cancer of cervix in Asians shows no evidence of the high rates found in younger non-Asian age groups.

CONCLUSIONS

Lower incidence of many cancers in Asians may be due to lower exposure to major risk factors. Demographic change resulting in increased exposure to these risk factors can be expected to result in an increase in cancer incidence in Asians.

Optimization of low-osmolality contrast media for cranial CT: a dose comparison of two contrast agents

A prospective, randomized, double-blind comparative study of 200 patients was made to examine the image quality, safety, and costs of 100 ml of ioversol-320 (32 g iodine) and 150 ml of iohexol-300 (45 g iodine) in patients undergoing cranial CT. We found no statistically significant difference in image quality between the two low-osmolality, nonionic contrast agents at these doses. There was a statistically significant (p = .02) difference in the occurrence of minor to mild adverse effects caused by ioversol (n = 0) as compared with iohexol (n = 5). No patient in either group experienced any major contrast-induced reactions. Contrast media costs were 34% less in patients receiving 32 g of iodine as compared with those receiving 45 g of iodine. This study demonstrates that high-quality cranial CT scans are possible even with a reduced volume of low-osmolality contrast medium, and that the potential cost savings are significant.

Cross-cultural use of socio-medical indicators with British Asians

Socio-medical measures of health are increasingly being used as adjuncts to traditional clinical and epidemiological investigations. Such instruments can potentially make a significant contribution to research on inequalities in health between different ethnic groups and in planning health service delivery. However, care must be taken to ensure that the cross-cultural adaptation has conceptual, semantic and linguistic equivalence with the original and cultural differences in the meanings of health and illness must be closely considered. The use of some such instruments with Britain's Asian populations is reviewed and issues in adapting the Nottingham Health Profile for use with these populations, and some preliminary results are discussed.

The effects of single doses of X rays on the mechanical properties of pig skin in vivo

Changes in the mechanical properties of pig skin have been studied in vivo, using a dermal extensometer, after irradiation with a single dose of 18 Gy of X rays. There was no significant change in the stiffness of irradiated skin, when compared with unirradiated skin, until 9 weeks after irradiation when the irradiated skin was significantly stiffer. This effect was also found at 12 and 15 weeks after irradiation. When the increase in skin thickness, as a consequence of oedema, was taken into account a significant increase in the unrelaxed elastic modulus of irradiated skin was only seen at 12 and 15 weeks after irradiation. There were no significant changes in force relaxation, after extension of the skin, over this time period. After the resolution of oedema, which was associated with a significant 20% reduction in the thickness of irradiated skin relative to unirradiated skin, the mechanical properties of irradiated skin were not markedly different from those of unirradiated skin. However, between 30 and 39 weeks after irradiation there was a further wave of dermal thinning, resulting in a total reduction in the thickness of irradiated skin relative to unirradiated skin of 26%. This was associated with a rapid rise in the skin stiffness and unrelaxed elastic modulus by approximately 65 and approximately 140%, respectively. It was only at these late times after irradiation that the force relaxation of the skin was modified significantly. At 9 and 12 weeks after irradiation the reduction in skin stiffness and the unrelaxed elastic modulus were dose related. Based on the percentage of fields showing a significant reduction in these biomechanical parameters, ED50 values of between 12 and 14.5 Gy were established. This would appear to be a sensitive method for assessing radiation-induced dermal changes since few gross changes are observed in this dose range.

Influence of ethnicity and unemployment on the perceived health of a sample of general practice attenders

Published research shows people of Asian origin to be less healthy than the white population. Most of the studies have not taken account of differences in employment between populations of white and Asian origin. Also, little research has been carried out on the patients' perceived health. This study, based on 215 patients from an inner-city general practice in Bradford, looks at the influence of ethnicity and unemployment on the perceived health of the sample. The Nottingham Health Profile was used as the measure of perceived health. In the study population, twice as many Asians as white people were unemployed, and significant differences in perceived health were observed between the employed and the unemployed. After controlling for employment, Asian males had significantly better perceived health than white males in the 16-34 age group. Perceived health of Asian and white females was similar on most morbidity dimensions.

Patients' choice of general practitioner: influence of patients' fluency in English and the ethnicity and sex of the doctor

Asian patients' use of general practitioner services and, in particular, their interaction with doctors is not well researched. However, difficulty in communication and in the case of women, reluctance to be examined by a male doctor has been reported. This study, based on interviews with 241 Caucasian, Pakistani and Indian patients attending a general practice in Bradford, examined the relationship between choice of general practitioner and the patient's fluency in English and the general practitioner's ethnicity and sex. Both Pakistani and Indian patients, particularly women, had poor fluency in English and the use of interpreters was confined to women (11% of Pakistani women and 4% of Indian women). The linguistic and broad cultural concordance between the patient and the general practitioner was more important in the choice of doctor than the sex of the general practitioner. It was also found that while 62% of Pakistani women objected to being examined by a male doctor, this was true for only 21% of Indian women.

Health of British Asians; a research review

About 2.5 per cent of United Kingdom residents are of Asian (or Indian subcontinent) origin though the term 'Asian' hides their internal diversities of languages, religions and national origins. The research on the health of these populations is heavily concentrated in areas of rickets and osteomalacia, tuberculosis, maternal and child health, and mental health, and is mainly dependent on analysis of routinely available morbidity and mortality data. Little has been published on the use of primary care services, racism in health service delivery, quality of care and doctor-patient communication. Also, few of the studies have attempted to interpret their findings against the disadvantaged background of Asian communities. It is implied that differences in health status are due to linguistic and cultural factors alone. The research literature on the health of Asian populations is critically reviewed.

A prospective trial of the effect of vitamin D supplementation on metacarpal bone loss in elderly women

The effect on cortical bone loss of treating elderly women with 15,000 IU vitamin D2 weekly was evaluated by sequential radiographic morphometry of the metacarpals. One hundred nine randomly selected women aged 65-74 yr were studied for 2 yr. The women were randomly allocated to control or treated groups taking placebo or vitamin D2 capsules. Hand radiographs and blood samples were obtained at the beginning and end of the trial. Plasma 25-hydroxyvitamin D was measured by radio-competitive protein binding assay. Comparing the treated and control groups, vitamin D treatment significantly raised the plasma 25-hydroxyvitamin D levels (p less than 0.001) and reduced the rate of cortical bone loss (p less than 0.01). The placebo had no measurable effect on the plasma levels.

Differences in rate of uptake of immunisation among ethnic groups

In the Bradford health district ethnic origin is associated with appreciable differences in morbidity and mortality. In view of these differences a study was undertaken to determine whether there were differences among the ethnic groups in utilisation of the National Health Service, as reflected in the rate of uptake of immunisation, which is offered to all children. Significant differences were found between the British group and some other ethnic groups--notably Pakistani, Indian, and half Negro groups. The rate of uptake of immunisation was nearer the optimum in the Indian group than in the British group. The most unsatisfactory rate of uptake of immunisation overall was found in the half Negro group. No clear explanation of the differences has been shown, they are likely to be due to various factors in the National Health Service and in the community.

Femoral neck fractures--two populations

A survey of 128 patients with femoral neck fractures has emphasised the difference in physical condition and clinical behaviour between those with cervical fractures and those with trochanteric fractures. The latter group of patients manifest advanced biological ageing and present a greater health care problem. Maintenance of mobility in the elderly may alleviate this situation.

The decline in vitamin D status with age

A cross-sectional study of plasma 25-hydroxy-vitamin D (250HD) concentrations in healthy women in the age range 20-96 years is reported. Mean values decline with increasing age while abnormally low levels of plasma 250HD are more common in the elderly. The decline in vitamin D status with age is probably the result of lack of sunlight exposure associated with social factors and physical immobility.

Two cases of the nephrotic syndrome with a reversible coagulation defect

Two cases of the nephrotic syndrome with an apparently identical defect of blood coagulation, discovered during preparation for renal biopsy are described. Plasma from both patients showed prolongation of thrombin and kaolin cephalin times which was probably due to abnormally slow polymerization of fibrin monomer. Corticosteroid therapy reversed the abnormal times in one case. One of the patients showed seasonal relapses which occurred in relation to episodes of hay fever associated with allergy to grass pollen. The other patient showed some similar features, but on renal biopsy was found to have proliferative glomerulonephritis.

Redescription of Camallanus ancylodirus Ward and Magath 1916 (nematoda: Camallanidae) from freshwater fishes of North America

Camallanus ancylodirus Ward and Magath 1916 is redescribed, based on examination of syntypes. This species differs from C. oxycephalus Ward and Magath 1916, the only other camallanid described from freshwater fishes of North America, in the size of male worms, number and arrangement of caudal papillae in males, shape of the male caudal end, position of the vulva, and length and shape of the female tail. The host range of C. ancylodirus is not clear from literature reports because the species may have been confused with C. oxycephalus.

Seasonal changes in abomasal worms (Ostertagia spp.) in white-tailed deer (Odocoileus virginianus) at Long Point, Ontario

Three species of nematodes were recovered from the abomasa of white-tailed deer (Odocoileus virginianus) collected at Long Point, Ontario, from September 1972 to August 1973. Ostertagia odocoilei was recovered from 45 deer (96%), O. mossi from 31 (66%), and O. dikmansi from 30 (64%). Abundance of adult stages of all three species was greatest in summer and least in winter. O. odocoilei was the most abundant species, especially during winter. Females were more abundant than males at all times of the year, particularly during winter.Numerous inhibited early fourth-stage larvae were recovered during winter and early spring, while few were found in July and August. The decrease in numbers of inhibited larvae in spring was coincident with a corresponding increase in abundance of adult worms. This is the first indication of the existence of inhibition (previously reported in domesticated animals) in species of Ostertagia parasitizing deer. Inhibition was not related to host age, indicating that the phenomenon is probably not due to development of immunity by the host over the grazing season.

The maintenance of liver cells in vitro for virological and other studies

Cells from the livers of rats and monkeys were dispersed by enzyme treatment and maintained for weeks in roller tube cultures. Rat liver cells were shown to synthesize urea and monkey cells apparently synthesized RNA and protein—rat cells supported the growth of Sendai virus and monkey cells supported yellow fever virus. Organ cultures of human embryo liver supported the growth of adenovirus type 5 and herpes simplex virus. The Australia antigen serum hepatitis agent failed to grow in human or monkey liver cultures.