Patients treated in hospital for infectious mononucleosis and risk of cancer

The risk of cancer was evaluated in a cohort of 1,234 patients with severe infectious mononucleosis between 1954 and 1983. The diagnosis of mononucleosis was confirmed by reviewing patient records. The observed numbers of cancer cases up to 1988 were obtained through record linkage from the Finnish Cancer Registry, which is nationwide and population-based. There were 11 cases of cancer in the cohort, as against 17.4 expected on the basis of the 24,288 person-years at risk and of incidence rates specific for age, sex and period in the area. This gives a standardized incidence ratio of 0.6 (95% confidence interval 0.3-1.1). There was only 1 lymphoma case. No malignancies were diagnosed during the first 5 years after infectious mononucleosis. The results indicate that infectious mononucleosis with severe symptoms does not imply an increased risk of cancer.

Tympanometry in patients with insulin-dependent diabetes mellitus

Tympanograms were studied in 53 patients with insulin-dependent diabetes mellitus (IDDM) and 42 randomly selected non-diabetic control subjects, aged between 20 and 40 years, using the Madsen Model ZO 73 Impedance Bridge. Subjects with abnormal tympanic membrane, conductive hearing loss and known reason for hearing impairment (e.g. noise damage) were excluded from the study. The mean tympanogram amplitudes in diabetic patients were significantly lower in both ears than those of control subjects. The duration of diabetes and microvascular complications (nephropathy and retinopathy) were associated with decreased amplitudes. These findings indicate that decreased tympanogram amplitudes in patients with IDDM are probably caused by diabetes of long duration and the microvascular complications associated with it.

Effect of sucrose rinses on the oral microflora and on salivary sucrase activity

The effect of sucrose rinses on the salivary microflora and on bacterial sucrose cleaving, i.e., sucrase activity, was studied in 11 dental students with high salivary counts of mutans streptococci (> or = 10(5) CFU/ml). The subjects rinsed for 1 min with a 10% (w/v) sucrose solution every 4-h during waking hours on 2 consecutive days. Four paraffin-stimulated saliva samples were collected as follows: one before the rinses and then 12 h and 5 and 8 days after the rinses. Commercial dip-slide methods were used to determine viable counts of mutans streptococci, lactobacilli, and yeasts; mutans streptococci were also enumerated using MSB agar, while blood agar was used to recover the total facultative and anaerobic bacteria. The sucrase activity was determined using both whole (mainly cell-associated) and centrifuged (extracellular) saliva samples. The proportions of facultative bacteria (p = 0.007) and mutans streptococci (p = 0.001) increased as a result of the sucrose rinses. No changes were detected in the number of lactobacilli or yeasts. The sucrose rinses increased both the cell-associated (p = 0.049) and the extracellular (p = 0.011) sucrase activities. The measurement of sucrase activity may be of value in assessing dietary habits and sucrose consumption.

Lung cancer following Hodgkin's disease: a case-control study

It is recognized that survivors of Hodgkin's disease are at a substantially increased risk of lung cancer. A collaborative group of population-based cancer registries and major treatment centers carried out a case-control study, in which 98 cases of lung cancer were identified in patients who had survived at least 1 year following a diagnosis of Hodgkin's disease. A total of 259 matched controls were selected from patients with Hodgkin's disease who did not develop subsequent lung cancer, and for both cases and controls detailed information was abstracted from medical records concerning stage and treatment of Hodgkin's disease. Patients treated with chemotherapy alone had about twice the risk of developing lung cancer than those treated by radiotherapy alone or both modalities. There was no increase in risk with cumulative number of cycles of chemotherapy. Among patients treated with radiotherapy alone, there was an increase in risk related to estimated radiation dose to the lung. There was also a strong association between cigarette smoking and the risk of lung cancer. The finding of a higher risk following chemotherapy than following radiotherapy was unexpected, but could not be explained by any identified methodological flaws. A plausible inference from the study is that all forms of Hodgkin's disease therapy are carcinogenic to the lung and that, in particular, chemotherapy is associated with an increase in risk which is at least comparable to and perhaps higher than the risk produced by radiotherapy.

Bone conduction thresholds in patients with otosclerosis

PURPOSE

Sensorineural hearing loss in patients with otosclerosis is commonly encountered. This study was conducted to determine if surgery on the otosclerotic ear had an effect on the sensorineural hearing.

METHODS

A cohort of 262 patients subjected to operation in 311 ears were evaluated. All patients had a minimum of 5 years follow-up and patients over 60 years of age were excluded. Audiograms obtained 1 day before surgery were compared with those obtained 1 year postoperatively and at the last follow-up examination in the study. Results were evaluated using the Student's t test for statistical analysis of hearing results.

RESULTS

The mean follow-up was 9.6 years. Deterioration of bone conduction scores occurred in 6.4% of 311 operated ears. Deterioration of bone conduction threshold occurred in the speech frequency in 6 ears (1.9%).

CONCLUSIONS

Bone conduction scores of operated ears remained quite stable compared with the otosclerotic ears not subjected to operation. Patients with bilateral otosclerosis may benefit from surgery performed on both ears when indicated.

Physiologic variation of sucrase activity and microbial counts in human saliva

Quantitation of salivary sucrase activity has been proposed as a method for the estimation of the level of sucrose consumption. The purpose of the present study was to investigate the physiologic variability of the sucrase activity and microbial counts in paraffin-wax-stimulated saliva of subjects with sound sucrose consumption habits. Variation was analyzed by repeated sampling studies. Intraday variability was investigated by serial analyses of 16 individuals who gave eight samples at 2-h intervals on a single day. Interday variation was studied by analyzing the morning value of 24 individuals on three consecutive days. Interday variability of salivary mutans streptococci, lactobacilli, and yeasts was tested using semiquantitative commercial test kits. The diurnal variation of sucrase activity revealed that the activity in the morning was significantly higher than at noon or at later sampling times of the day. Interday variation was considerable in subjects with high sucrase values. The day-to-day variability of the salivary microbes was considerable for lactobacilli and relatively small for yeasts. A weak positive correlation ranging from 0.732 to 0.741 was found between high sucrase activity values and salivary lactobacilli. Salivary samples should be collected in the morning to differentiate between subjects with high and low sucrase activities.

Cancer risk among workers at a copper/nickel smelter and nickel refinery in Finland

A total of 1,388 workers employed for at least 3 months at a copper/nickel smelter and nickel refinery were followed up for cancer from 1953 to 1987 through the Finnish Cancer Registry. There were 1,339 male and 49 female workers, making a total of 27,130 and 706 person-years, respectively. All of the women worked in the refinery, which opened in 1960, the same year the smelting of nickel began. A total of 67 cancers were diagnosed among the men, the standardized incidence ratio for all cancers being 1.0. No cancer was found among the women (1.8 expected). The risk of cancer among men was analysed according to primary site, exposure to nickel, type of work, years since first exposure and age at diagnosis. In the subcohort of nickel refinery workers, one case of sinonasal cancer was observed, against 0.02 expected, but otherwise no significantly increased risks of cancer were found. In addition to the small size of the cohort, the non-positive finding concerning lung cancer might be related to the relatively low arsenic exposure and, perhaps, to the late commencement of nickel production.

Long-Term Effects of Syrup Medications for Recurrent Otitis media on the Dental Health of 6- to 8-Year-Old Children

The dental response to repeated antimicrobial and antihistamine medications was studied by comparing the dental health of 64 adenoidectomized children 5 years after surgery to that of 212 untreated controls. Annual dental recordings starting from the age of 3 years were obtained from health care centers. As expected, the proportion of children who had several (> or = 11) syrup medications was significantly higher (p < 0.001) in the adenoidectomized than in the control group. Sucrose-containing syrup medications were prescribed twice as often for the children of the adenoidectomized as for the control group (p < 0.001). However, the average amount of antimicrobial syrup medications prescribed was 19.2 +/- (SD) 13.0 per child for the adenoidectomized as compared to 8.5 +/- 8.3 for the control children (p < 0.001). The dmf value of the adenoidectomized children at the age of 3 years (mean +/- SEM: 0.5 +/- 0.1) was significantly (p < 0.005) lower than that of the controls (1.1 +/- 0.2). The difference was still significant (p < 0.01) at the age of 4 years, but disappeared thereafter. In conclusion, the antibacterial syrup medication seemed to be associated with a significant decline in dental caries at first. The simultaneous use of antihistamines was, however, thought to delay normal tooth maturation, so that after discontinuation of the antimicrobial medication, accelerated formation of new carious lesions took place.

Effect of repeated sampling and prestimulation on saliva buffer capacity and flow rate values in children

Great variations reported in the frequency distribution of buffer capacity values may partly be due to methodological differences in saliva sampling. In this study we wanted to see to what extent these variations are due to repetition and prestimulation. 9-yr-old schoolchildren (n: 41, 23 girls and 18 boys), who had never had saliva samples taken before, participated in the present study. The repetition tests were carried out between 9 and 11 a.m. on three subsequent days. The effect of prestimulation was tested 4 days later with the same subjects. The buffer capacity of the samples was determined electrometrically immediately after sampling using the commercial Dentobuff-test. The intraindividual analysis revealed a significant increase in flow rate but not in buffer capacity along with repetition of the sampling. The analysis further showed that the buffer capacity of children accustomed to saliva sampling increased significantly through prestimulation of 1 min. The use of prestimulation resulted in substantial changes also in the frequency distribution of the buffer capacity values. Our results emphasize the importance of proper sampling conditions in saliva collection when screening children for high caries risk.

A population-based study on the incidence and survival rates of 3857 glioma patients diagnosed from 1953 to 1984

Intracranial glioma was diagnosed during the patient's life and histologically verified in 3857 patients between 1953 and 1984 in Finland. Their survival up to the end of 1987 was analyzed, the follow-up being complete. The treatment was by operation in 1193 cases, radiation in 459 cases, both operation and radiation in 1486 cases, and neither operation nor radiation in 719 cases. The 1-year, 5-year, 10-year, and 15-year cumulative relative survival rates were 0.53, 0.29, 0.20, and 0.18, respectively. The newborn to 14-year-olds lost 56% of their life expectancy; the 15-year-olds to 44-year-olds, 71%; the 45-year-olds to 64-year-olds, 88%; and the 65-year-olds to 99-year-olds, 91%. According to the model with the best fit in regression analysis the prognosis was significantly better among young, recently diagnosed patients who had undergone both operation and radiation.

Perilymph fistula--a diagnostic dilemma

A retrospective series is presented of 51 cases operated on for suspected perilymph fistula. In 26 ears a fistula was identified at surgery. A positive fistula test was found to strongly indicate a perilymph fistula but was more often negative than positive in surgically demonstrated fistula ears. Other vestibular tests were found to be of little value in the pre-operative diagnosis. Ears with a surgically demonstrated fistula and sensorineural hearing loss had either flat or downward-sloping audiograms. Difficulties in diagnosing a perilymph fistula at tympanotomy are discussed. At follow-up, vestibular symptoms were found to be eliminated or improved in 96 per cent of cases with surgically demonstrated fistulae and in 68 per cent of cases in which no fistula was detected at tympanotomy but hearing improved significantly in only one ear (4 per cent) of the former group and in five ears (20 per cent) of the latter group.

Geographical variation in cancer patient survival in Finland: chance, confounding, or effect of treatment?

STUDY OBJECTIVE

The aim was to determine whether survival of cancer patients in Finland varies with their place of residence, and if so, what proportion of the variation might be due to health services rather than to confounding variables.

DESIGN

Patients with breast and prostatic cancer diagnosed in Finland between 1970 and 1981 were classified by place of residence (from 21 hospital districts), and area specific 5 year relative survival rates were estimated.

SETTING

This was a population based survey of the whole of Finland.

PATIENTS

16,754 cases of breast cancer and 9483 cases of prostatic cancer were identified. Of these, 0.5% of breast cancers and 4.1% of prostatic cancers were excluded because diagnosis was based only on necropsy findings or because the only information available was from the death certificate.

MEASUREMENTS AND MAIN RESULTS

There was a large variation in rates, ranging from 59% to 76% for breast cancer, and from 30% to 65% for prostatic cancer. However, after accounting for age of patient and extent of disease, the standardised differences for prostatic cancer closely followed random distribution, indicating equal results of treatment in different areas. For breast cancer there was more variation than expected by chance and patients resident in any of the university central hospital districts with modern radiotherapy equipment survived better than other patients.

CONCLUSIONS

There is little indication that large variations in crude mortality rates from these two cancers in different parts of Finland are due to inequalities of medical care, though a small effect on breast cancer survival which might be care related was shown.

Social class as a prognostic factor in breast cancer survival

The effect of social class on survival of female breast cancer patients was studied by linking the patient files of the Finnish Cancer Registry (FCR) with the information on patient's social status, obtained from the 1970 Population Census of Finland. The material consisted of 10,181 patients 25 to 69 years of age at diagnosis, whose cancer was diagnosed between 1971 and 1980. The classification of social class was based on occupation. The effects of social class, age, period of diagnosis, and stage of disease on survival were evaluated using the Cox proportional hazards model; mortality from causes of death other than breast cancer was taken into account using the exact causes of death. Those in the lowest social class had about 1.3 times higher relative excess risk of dying than those in the highest social class. The older the patients, the greater was the difference in survival by social class. Differences in stage distribution explained only a minor proportion of the variation in survival by social class. The Finnish legislation guarantees everyone fairly equal accessibility to health care. The results suggest that more determined efforts should be undertaken to reduce inequity in survival.

Comparative study on mineralization-related intraoral parameters in periodontitis-affected and periodontitis-free adults

The parameters related to an intraoral mineralization tendency in periodontitis-affected (P+) and periodontitis-free (P-) study subjects (16 adults, 46-74 yr, matched for sex and age) were compared. For this purpose the calcium (Ca) and phosphate (P) concentration of both plaque and saliva, resting pH and the acidogenic response of interdental plaque, plaque wet weight, salivary flow rate, buffering capacity and sucrase activity, interdental plaque, plaque S. mutans levels as well as salivary lactobacilli and yeast levels were estimated. Plaque Ca (micrograms/mg protein, P less than 0.025) and P (micrograms/mg protein, P less than 0.05), saliva Ca (micrograms/ml, P less than 0.005) and the saliva Ca:P ratio (P less than 0.005) were higher in the P+ than in the P- group. The resting pH values were higher (P less than 0.025) and the acidogenic response of the interdental plaque was lower (P less than 0.025) in the P+ group than in the P- group. The P+ group had lower S. mutans levels in saliva and interdental plaque. No differences were found in the wet weight of plaque and in the flow rate, buffering capacity or sucrase activity of saliva between the groups. The findings of the mineralization-related parameters in the two "extreme" groups of periodontal status suggest a higher intraoral mineralization tendency in periodontitis-affected persons than in periodontitis-free subjects. Ca and P accumulation of supragingival plaque seem to be connected with low acidogenicity of plaque and high salivary Ca concentration.

Cancer risk among health care personnel in Finland, 1971-1980

Standardized incidence ratios were calculated for the assessment of cancer risk among Finnish health care personnel in 1971-1980. The overall relative cancer risk among the men was low when compared with that of all economically active men, mainly due to the low relative risk of lung cancer. The cancer risk of female health care personnel was increased when compared with that of all economically active women. The relative risk of breast cancer among registered nurses was high, being twice that of practical nurses, who had an average risk. In contrast, the risk of lymphomas, leukemia, and primary liver carcinoma was low among registered nurses and high among practical nurses. Although specific occupational exposures could not be assessed, the results did not imply any alarming major hazards related to health care work itself.

Sucrase activity in relation to other salivary factors and DMFS values of dental students

Samples of stimulated whole saliva were collected from 176 dental students, and their teeth were examined both clinically and radiographically. Salivary flow; buffering capacity; numbers of lactobacilli, yeasts, and Streptococcus mutans; and DMFS and DS values were correlated to sucrase activity. The high flow-rate group had a lower (p = 0.0201*) sucrase activity than the low flow-rate group. The proportion of high (greater than or equal to 10 mumol/min x mg x 10(-3] sucrase activities among the highest density category of lactobacilli was 67%, whereas the corresponding proportion in the whole material was only 28%. Men had significantly (p = 0.0169*) higher sucrase activities than women. The other variables measured did not seem to have any significant effect on the sucrase activity values. In addition to sucrose consumption, other factors like the rate of salivary flow and the density of lactobacilli seem to influence the level of salivary sucrase activity.

Glass ionomers in proximal cavities of primary molars

Proximal cavities with or without a dovetail were prepared in primary molars of 5-7-yr-old children. The cavities were filled with either a traditional glass ionomer (Ketac-Fil) or a cermet (Ketac-Silver). A total number of 199 treated teeth were available for evaluation 5-14 months after placement of the fillings. The percentage of success was 84% for Ketac-Fil and 77% for Ketac-Silver. There was no clear difference in rate success between the two different types of cavities.

Leukemia following chemotherapy for ovarian cancer

An international collaborative group of cancer registries and hospitals identified 114 cases of leukemia following ovarian cancer. We investigated the possible etiologic role of chemotherapy, radiotherapy, and other factors, using a case-control study design, with three controls matched to each case of leukemia. Chemotherapy alone was associated with a relative risk of 12 (95 percent confidence interval, 4.4 to 32), as compared with surgery alone, and patients treated with both chemotherapy and radiotherapy had a relative risk of 10 (95 percent confidence interval, 3.4 to 28). Radiotherapy alone did not produce a significant increase in risk as compared with surgery alone. The risk of leukemia was greatest four or five years after chemotherapy began, and the risk was elevated for at least eight years after the cessation of chemotherapy. The drugs cyclophosphamide, chlorambucil, melphalan, thiotepa, and treosulfan were independently associated with significantly increased risks of leukemia, as was the combination of doxorubicin hydrochloride and cisplatin. Chlorambucil and melphalan were the most leukemogenic drugs, followed by thiotepa; cyclophosphamide and treosulfan were the weakest leukemogens, and the effect per gram was substantially lower at high doses than at lower doses. The extent to which the relative risks of leukemia are offset by differences in chemotherapeutic effectiveness is not known.

A mineral-related feature of young plaque characteristic to periodontitis-affected adults

The calcium concentration of 3-day-old total supragingival plaque in periodontitis-affected adults (n = 12) and their age and sex-matched periodontitis-free pairs was compared. The young plaque of the periodontitis-affected adults contained more calcium per protein (P less than 0.025, sign test) than that of the periodontitis-free pairs. The findings of the present study may suggest that high Ca-content of supragingival plaque is connected to the development of adult periodontitis.

Progressive hearing loss in Usher's syndrome

In 18 patients with Usher's syndrome, progressive hearing loss was verified audiologically in eight cases. Despite poor auditory threshold values and low speech discrimination scores, there was only one patient who could not communicate with speech. The possibility of hearing impairment being mainly progressive in Usher's syndrome is discussed.