Long term results (greater than 5 years) in patients with peritoneovenous shunting for intractable ascites: liver function and cancer mortality

This report is based on twenty-eight (26%) of 107 patients included in a protocol for prospective evaluation of elective peritoneo-venous shunting for intractable ascites in cirrhosis. These patients had no other procedures and survived more than 5 years after the operation. All patients were free of ascites except one in whom it was mild. One patient refused follow-up. Shunt patency was assessed in 23 patients In 14 patients (60.9%), the shunt was obstructed and the superior vena cava was occluded in 5 of them. In 9 patients (39.1%), the shunt was still functioning. No clinical or biological parameters differentiated these two groups of patients. Of the 24 patients who were alcoholics, 2 abstained completely and 20 significantly reduced their drinking habits. In 25 patients, the Pugh's score improved and was A at the time of the study. Seven patients (25.9%) developed a malignant tumor of the oro-pharynx or digestive tract, all other patients were alive and in good health. This study suggests that patients with intractable ascites treated by a peritoneo-venous shunt may survive for a long period. In patients abstaining from heavy drinking, it may function as a therapeutic bridge permitting spontaneous improvement of liver function. The risk of supervening neoplasms suggests that a continuous follow-up of these patients is warranted.

Pharmacokinetics of ketorolac and p-hydroxyketorolac following oral and intramuscular administration of ketorolac tromethamine

Ketorolac tromethamine (KT), a potent analgesic with cyclooxygenase inhibitory activity, was administered in an open, randomized, single-dose study of Latin-square design to 12 healthy male volunteers. Doses of 30 mg oral (po) and 30, 60, and 90 mg intramuscular (im) KT were administered in solution. Plasma samples were analyzed for ketorolac (K) and its inactive metabolite, p-hydroxyketorolac (PHK), by reversed-phase high-performance liquid chromatography (HPLC). The 30-mg im dose was found to be similar to the 30-mg po dose with respect to total AUC values for both K and PHK. The amount of PHK circulating in plasma was very low as judged by AUC ratios (PHK/K x 100) of 1.9 and 1.5% for the 30-mg po and im doses, respectively. The rate of absorption of K and formation of PHK, as determined by Cmax and Tmax values, was significantly slower following the im doses. Total AUC and Cmax for K and PHK increased linearly with dose after im administration of 30, 60, and 90 mg of KT. The mean plasma half-life of K was remarkably consistent between po and im administration and was independent of dose, ranging from 5.21 to 5.56 hr. The plasma metabolic profile was similar following both routes of administration and graded im doses.

Hashimoto's thyroiditis lacks detectable clonal immunoglobulin and T cell receptor gene rearrangements

The development of B cell lymphoma, predominantly of the large-cell type, in patients with autoimmune diseases such as Hashimoto's thyroiditis or Sjogren's syndrome is well known. In Sjogren's syndrome, it has been recently shown that the benign-appearing lymphocytic infiltrates of the lymphoepithelial lesions in the salivary glands have clonal rearrangements of immunoglobulin genes in their DNA, even in the absence of malignant lymphoma. To investigate whether a similar situation occurs in Hashimoto's thyroiditis, we studied the thyroid glands from four patients with this disease. In all four cases, there was a benign-appearing lymphocytic infiltrate in the thyroid, with eosinophilic changes in the Hurthle cells. In immunologic studies, we determined that the lymphocytes were polyclonal in each case. We extracted DNA from the frozen tissue blocks of these four patients and analyzed it by molecular hybridization for the presence of clonal immunoglobulin (IgH, kappa, and lambda) and T cell receptor beta chain gene rearrangements, and detected none in any case. Therefore, we conclude that the lymphocytes in Hashimoto's thyroiditis are immunologically and immunogenetically polyclonal proliferations of cells, and that the initial lesion of Hashimoto's thyroiditis does not contain a detectable clone of cells that may eventually develop into malignant lymphoma.

Effects of acute hypoxia and reoxygenation in a blood-perfused neonatal heart model

Newborn (less than 4-day old) piglet hearts (n = 7) were isolated and perfused with blood from a support pig. With use of a reservoir and membrane oxygenator, each heart was perfused for 90 minutes with blood at an O2 saturation of 40% and a pH of 7.4-7.5, at a left atrial pressure of 9 mm Hg, and at an aortic root pressure of 80 mm Hg. Blood saturation was increased to 100%, and the left atrial pressure decreased to 6 mm Hg for 60 minutes. Minute work indexes were calculated for each heart before hypoxia, every 30 minutes during hypoxia, and at 30 and 60 minutes of reoxygenation. Control hearts (n = 8) were treated in an identical fashion, but O2 saturation was maintained at 100%. Myocardial function decreased in the neonatal hearts exposed to hypoxia and reoxygenation. Control hearts did not suffer any significant decrease in function. Nucleotide levels were similar in both groups at the completion of the experiment. Anaerobic metabolism was demonstrated in the hypoxic hearts by net release of lactic acid during the period of hypoxia. This model can be used to study methods of intervention in the working hypoxic neonatal heart.

T-cell-rich lymphoproliferative disorders. Morphologic and immunologic differential diagnoses

To differentiate peripheral T-cell lymphomas (PTCL), the authors evaluated the results of T11 monoclonal antibody studies on consecutive cell suspensions prepared from 509 lymph nodes from various lymphoproliferative disorders (LPD). They used T11 (CD2) positivity to identify those LPD in which the content of T cells was high. There were 266 (52%) cell suspensions which contained more than 50% T11-positive cells. More than 75% of the following non-Hodgkin's lymphomas had over 50% T11-positive cells: diffuse mixed cell (DM), diffuse atypical poorly differentiated lymphocytic and lymphoblastic lymphomas; mycosis fungoides; and true histiocytic lymphoma. Eleven cell suspensions had more than 90% T11-positive cells; four were involved by B-cell lymphomas. The cell suspensions prepared from nine of 14 diffuse large cell lymphomas of the T-cell type had more than 50% T11-positive cells. Of these, three of five cases of the polymorphous subtype had fewer than 50% T11 cells, but six of seven lymph nodes of the clear-cell type had more than 50% T11-positive cells. Each of seven DM samples of the T-cell type contained over 50% T11 cells; none had a polymorphous appearance. In the 112 cases of reactive LPD studied, more than 75% of cases of necrotizing lymphadenitis, dermatopathic lymphadenitis, angioimmunoblastic lymphadenopathy, and those with lymph nodes with no specific reactive pattern had more than 50% T11-positive cells. The authors' findings indicate that T11 positivity is a reliable T-cell marker in reactive and neoplastic LPD except for those cases of PTCL with a polymorphous appearance; these tend to lose T11-expression. A multi-parameter diagnostic approach is required in the following LPD: (1) PTCL which are T11-negative; (2) PTCL of small lymphocytic type having an unremarkable T-cell phenotype; (3) SIg-negative B-cell lymphomas which are rich in nonneoplastic T cells; (4) non-Hodgkin's lymphomas with minimal disease which are rich in reactive T cells; and (5) polymorphous large cell proliferations.

Effect of gold shielding on the dosimetry of an 125I seed at close range

Radioactive 125I plaques with gold shields have been used for the treatment of choroidal melanoma. The effect of the gold shield on the dosimetry of a single 125I seed (model 6711) has been investigated in this paper. Increases in dose at close range due to the presence of the shield are observed. Such enhancement is in agreement with Williamson's Monte Carlo calculations.

Cardiolipin from ethanol-fed rats confers tolerance to ethanol in liver mitochondrial membranes

In rats chronically consuming ethanol, the liver mitochondrial membranes develop resistance to the disordering effects of ethanol in vitro, so-called "membrane tolerance". To investigate the molecular basis of this tolerance in the inner mitochondrial membrane, multilamellar vesicles were produced by recombining the mitoplast phospholipids (quantitatively separated by preparative HPLC) from control and ethanol-fed animals in various combinations. The effect of in vitro ethanol on the physical properties of these vesicles was determined by electron spin resonance. Vesicles composed of all mitoplast phospholipids from control rats were disordered by 50-100 mM ethanol, whereas those made of the phospholipids from ethanol-fed animals were resistant. When phosphatidylcholine (46 mol %) or phosphatidylethanolamine (42 mol %) from ethanol-fed rats replaced the corresponding phospholipids of control rats, the vesicles were disordered by ethanol. By contrast, when as little as 2.5 mol % of cardiolipin (one-fourth the naturally occurring amount) from ethanol-fed rats replaced that phospholipid from control rats, vesicles were rendered entirely resistant to disordering by ethanol. The same amount of cardiolipin from ethanol-fed rats also conferred membrane tolerance to vesicles composed of bovine phospholipids, demonstrating that this effect is not restricted to rat mitoplast phospholipids. In vesicles composed of a single mitoplast-phospholipid class, only vesicles composed of cardiolipin from ethanol-fed rats resisted disordering. Phosphatidylinositol from liver microsomes of ethanol-fed rats also confers membrane tolerance and was the only microsomal phospholipid that formed tolerant vesicles. Thus, in livers of rats chronically fed ethanol, anionic phospholipids are selectively converted into potent promoters of membrane tolerance in both mitochondrial and microsomal membranes.

Integrated human T-cell leukemia virus II genome in CD8 + T cells from a patient with "atypical" hairy cell leukemia: evidence for distinct T and B cell lymphoproliferative disorders

We previously reported isolation of human T-cell leukemia virus II (HTLV-II) from a second patient (N.R.A.) with atypical hairy cell leukemia. Follow-up analysis of the characteristics of the patient's HTLV-II infection over a 2-year period has revealed that the patient had two coexistant lymphoproliferative disorders. Oligoclonally integrated HTLV-II was detected in DNA extracted from the patient's peripheral blood mononuclear cells on separate occasions greater than 1 year apart, similar to integration of HTLV-I seen in adult T cell leukemia/lymphoma. Although integrated provirus was readily detected, no HTLV-II viral RNA expression was seen in fresh peripheral blood lymphoid cells. Although the patient's peripheral blood consistently contained a majority of atypical lymphoid cells with a T cell antigenic phenotype, he ultimately developed extensive pleural, hepatic and soft tissue infiltration with malignant Tac+, tartrate-resistant, acid phosphatase-positive (TRAP+) B cells of clonal origin. To further characterize the role of HTLV-II, the patient's peripheral blood mononuclear cells were fractionated into four enriched subpopulations at autopsy. Oligoclonally integrated HTLV-II was detected in DNA from a T cell-enriched fraction and a CD8+ T cell-enriched fraction, but not in a CD4+ T cell-enriched fraction, a non-T cell fraction, or in B cells obtained from the malignant pleural effusion. We conclude that the patient harbored two distinct lymphoproliferative disorders, a TRAP+, Tac+ B cell malignancy consistent with hairy cell leukemia that did not contain HTLV-II and a Tac-, CD8+ lymphoproliferative syndrome with oligoclonally integrated HTLV-II.

A dose homogeneity index for evaluating 192Ir interstitial breast implants

To evaluate and optimize dose homogeneity of 192Ir interstitial breast implants, we define a quantity, the dose homogeneity index (DHI), as follows: DHI = [V(TDR)--V(HDR)]/V(TDR), where V(TDR) denotes the total treatment volume enclosed by the prescribed treatment dose rate (TDR) and V(HDR) denotes the volume enclosed by high-dose rate (HDR), which is 1.5 X TDR or greater. We have used the DHI to examine and compare 192Ir double-plane implants of various sizes planned by the Memorial system or the Tufts system. Criteria have been suggested for the number of planes required for implants in a given treatment volume. Anderson's volume-dose histogram with inverse square suppression is adopted for illustration.

Stability of heating temperature on cytotoxicity

Chinese hamster V79 cells were used to test the cytotoxic effect of heat which alternates between high and low temperatures during the treatment period. This type of temperature fluctuation is often encountered in clinical hyperthermia. Two sets of heating protocols were used in the experiments: Temperature alternates (a) between 42 and 43 degrees and (b) between 42 and 44 degrees in cycle with equal total "thermal dose," that is heating temperature X heating time. The effectiveness of these heating protocols expressed in average percentage of cell survival depend on the initial temperature attained and the length of the time of this temperature alternation. If the period of temperature change is short such as every 5 or 10 minutes, the cytotoxicity shows very little difference whether the initial treatment temperature is low or high. However, when the period is longer than 20 minutes, the difference in cell survival between the initial temperature at 42 degrees and at higher temperatures is substantial. Cells obtained from logarithmic or plateau phases of growth yield the same result. The difference is likely resulted from a combination of thermotolerance and step-down heating mechanisms. In addition, the effects of heating temperature fluctuation on cytotoxicity is not altered by a 500 cGy of gamma-ray radiation applied either immediately before or after the heat treatment.

Rearrangement of kappa-chain and T-cell receptor beta-chain genes in malignant lymphomas of "T-cell" phenotype

Detection of immunoglobulin gene rearrangements by molecular hybridization is considered to be a highly sensitive approach to the evaluation of clonality of B-cell-derived neoplasms. Like monoclonal surface immunoglobulin in B cells, which serves as a reliable immunophenotypic marker for clonality, rearrangement of the genes encoding immunoglobulin light chains has been accepted as a reliable genotypic marker for the presence of a clonal expansion of B lymphocytes. The authors now report 3 cases of non-Hodgkin's lymphoma that were immunologically classified as having a T-cell phenotype and in which, in addition to rearrangements of the T-cell receptor beta-chain gene, a rearrangement of an immunoglobulin light-chain gene was clearly identified by Southern blot hybridization. The results demonstrate that the data obtained by molecular hybridization should be interpreted with caution when the immunogenetic findings do not correlate with immunophenotypic expression, and that the results of molecular genetics studies should be interpreted in conjunction with morphologic and immunologic findings.

Fetal malignant melanoma: ultrasound presentation and review of the literature

Malignant melanoma is an infrequently described type of congenital neoplasm. We report a case of primary fetal malignant melanoma. A review of the literature yielded six previous cases, four of which were due to metastasis from advanced maternal disease, and two of which were fetal (primary) in origin. Recommendations are discussed for management of this rare fetal malignancy.

Sonography of pelvic masses in children: diagnostic predictability

The usefulness of sonography in determining the location and internal consistency of a pelvic mass and in predicting a specific diagnosis was assessed in 70 girls ranging in age from neonate to 19 years. Sonography was correct in determining the site of origin in 39 of 40 surgically proven cases. Among the various sonographic patterns observed, cystic uterine masses and cystic adnexal masses were the most specific, representing hydrometrocolpos or intrauterine pregnancy and benign ovarian cysts, respectively. A nonspecific sonographic pattern was encountered with complex or solid adnexal masses, which were proven to be ovarian teratomas, hemorrhagic ovarian cysts, and pelvic abscesses. Occasionally, a specific diagnosis of ovarian teratoma could be made when echogenic foci produced shadowing in a complex adnexal mass. Our results indicate that sonography in girls is reliable in determining the site of origin of a mass and can suggest a specific diagnosis of hydrometrocolpos, benign ovarian cyst, or intrauterine pregnancy.

Concurrent presence of two clonal populations in small lymphocytic lymphoma of the lung

In a patient with small lymphocytic proliferation (SLP) involving the right middle and right lower lobes of the lung, immunophenotypic studies showed that the neoplastic lymphoid cells in the right middle lobe expressed kappa light chains, whereas those in the right lower lobe expressed lambda light chains on their surface. Gene rearrangement studies with Southern-blot hybridization confirmed the disparate surface immunoglobulin expression, and showed that the SLPs in the two lobes were derived from separate clones. The findings indicate that even morphologically identical lymphomas in the same organ may be immunophenotypically and genotypically heterogeneous. Our findings demonstrate that immunologic and DNA gene rearrangement analyses may complement each other in the study of lymphomas. This case is unique in that it is the first reported case of the concurrent presence of two immunologically distinct clonal populations in an extranodal site.

Performance characteristics of a helical microwave interstitial antenna for local hyperthermia

A helical microwave antenna has been designed to improve heat deposition by interstitial applicators used for clinical hyperthermia. Iso-specific-absorption-rate (SAR) curves of the helical antenna as well as a conventional monopole antenna were measured and compared in both muscle and brain tissue phantoms. The heating pattern of the helical antenna is more uniform along the length of the antenna which has important implications for multiarray implant configurations.

Single intravenous dose and steady-state oral dose pharmacokinetics of nicardipine in healthy subjects

Nicardipine HCl oral doses (10-40 mg) were administered sequentially to six healthy subjects. For each regimen the capsule dose was administered every 8 hours (q 8 h) for 3 days and the plasma profiles of nicardipine and its pyridine analogue (M5) were determined following the last dose on day 4. Steady-state plasma concentrations of nicardipine for each subject were fitted very well by the Michaelis-Menten equation. An intravenous tracer dose (0.885 mg nicardipine HCl) was administered simultaneously with the final oral dose on the fourth day of the 30 mg q 8 h regimen. The steady-state bioavailability of nicardipine was shown to be dose-dependent and averaged 19 per cent (10 mg), 22 per cent (20 mg), 28 per cent (30 mg), and 38 per cent (40 mg). Nicardipine undergoes linear first-pass metabolism to M5. Other metabolic pathways are responsible for the saturable first-pass metabolism observed for nicardipine.

Antineoplastic drug cytotoxicity in a human bladder cancer cell line: implications for intravesical chemotherapy

The clonogenic survival of MGH-U1 human bladder carcinoma cells treated with melphalan, cisplatin, mitomycin-C, adriamycin, vincristine and 5-fluorouracil was measured to determine the relative contribution of drug concentration and duration of exposure to cytotoxicity and to measure the relative cytotoxic effects of these agents used in intravesical chemotherapy. The survival curves were plotted as a function of log (C X T) and were fitted using a linear least squares analysis. The survival was the same for any given C X T whether this was determined by varying concentration or by varying the duration of exposure in the cases of melphalan, cisplatin, adriamycin, mitomycin-C and 5-fluorouracil. However, duration of exposure was more important than was drug concentration in the case of vincristine cytotoxicity. By utilizing the slope of the log (survival fraction) as a function of log (C X T), the relative cytotoxicity of each agent was determined. Mitomycin C, melphalan, adriamycin and cisplatin had comparable activity in this cell line, whereas vincristine and 5-fluorouracil demonstrated much lower cytotoxicity. We conclude that: mitomycin-C, adriamycin and melphalan were the agents with the greatest cytotoxic efficacy; determination of survival as a function of C X T can be used to separate the relative importance of concentration and of duration of exposure. the cytotoxicity of 5/6 drugs studied was equal when the C X T was kept constant but concentration and exposure times were varied.

Phosphatidylinositol from ethanol-fed rats confers membrane tolerance to ethanol

The presence of ethanol disorders (fluidizes) biological membranes, but its chronic administration confers resistance to this perturbation (membrane tolerance). The latter effect has been invoked as an explanation for behavioral tolerance in alcoholics, but the molecular basis for membrane tolerance is obscure. To study the molecular mechanisms of this acquired resistance to disordering, we fed rats ethanol (36% of total calories) for 35 days, after which we quantitatively separated the phospholipids of hepatic microsomal membranes by high-performance liquid chromatography. Multilamellar vesicles were prepared from the recombined phospholipid classes, and their physical properties were examined by electron spin resonance. Vesicles composed of phospholipids from untreated rats were disordered (fluidized) in the presence of ethanol, whereas those made from phospholipids of ethanol-fed rats were resistant to this effect. When phosphatidylcholine (66.5 mol %), phosphatidylethanolamine (21 mol %), or phosphatidylserine (4.0 mol %) from ethanol-fed rats replaced their corresponding phospholipids in vesicles prepared from microsomal phospholipids from untreated rats, the membranes were still disordered by ethanol. In contrast, when 2.5-8.5 mol % phosphatidylinositol from ethanol-fed rats replaced phosphatidylinositol from untreated rats, the reconstituted membranes were rendered resistant to ethanol-induced disordering. Liver microsomal phosphatidylinositol (2.5-8.5 mol %) from ethanol-fed rats also conferred membrane tolerance to vesicles composed of bovine liver and brain phospholipids, an effect which demonstrates that the ability of phosphatidylinositol to confer membrane tolerance is not restricted to the microsomal membrane.

Immunoglobulin and T-cell receptor beta-chain gene rearrangement analysis of Hodgkin's disease: implications for lineage determination and differential diagnosis

The lineage and clonality of Hodgkin's disease (HD) were investigated by analyzing the organization of the immunoglobulin and T-cell receptor beta-chain (T beta) gene loci in 18 cases of HD, and for comparison, in a panel of 103 cases of B- and T-cell non-Hodgkin's lymphomas (NHLs) and lymphoid leukemias (LLs). Sizable clonal B- or T-cell populations, representing greater than or equal to 10% of the pathologic sample, were readily detectable by immunogenotypic analysis in all 103 NHLs and LLs but not in any of the 18 cases of HD. However, extremely minor clonal populations (less than or equal to 1%) were detectable in 3 of 18 cases of HD. We demonstrated that these minor clonal populations do not correspond to Reed-Sternberg (RS) cells since clonal immunoglobulin or T beta gene rearrangements are not detectable in cases of HD containing greater than 25% RS cells. The number of RS cells present in these samples appeared to correlate directly with the pattern of gene rearrangements characteristic of polyclonal T cells. These studies demonstrate that Southern blot hybridization analysis for clonal immunoglobulin and T beta gene rearrangements represents an accurate, objective tool in the differential diagnosis between HD and NHL; that HD is predominantly composed of polyclonal B and T cells; that minor clonal B- or T-cell populations unrelated to RS cells occasionally can be found in HD; and that RS cells do not represent clonal B- or T-cell expansions. Finally, our data preliminarily suggest that RS cells may represent polyclonal T-cell populations.

Membrane tolerance to ethanol is rapidly lost after withdrawal: a model for studies of membrane adaptation

The structural properties of liver microsomes and erythrocytes obtained from rats that had been chronically administered ethanol were examined by electron spin resonance (ESR) following ethanol withdrawal for 1-10 days. Membranes obtained from control animals exhibited considerable molecular disordering upon the addition of ethanol in vitro (50-100 mM). Conversely, microsomal and erythrocyte membranes from alcoholic animals were resistant to this disordering by ethanol (membrane tolerance). These membrane properties were also apparent in lipid bilayers comprised of either total lipids or phospholipids isolated from the control and alcoholic animals. While several weeks of ethanol administration were required for both erythrocytes and microsomes to develop membrane tolerance, erythrocytes from alcoholic animals were disordered by ethanol in vitro after the animals had been withdrawn from ethanol for only 1 day. The same rapid loss of tolerance was observed in microsomes after 2 days of withdrawal. The same time course for the loss of tolerance was observed in lipid bilayers prepared from the total lipid and phospholipid extracts. No significant differences in the cholesterol/phospholipid ratio were observed between the microsomal or erythrocyte membranes isolated before and after withdrawal. Thus, alterations in the microsomal and erythrocyte phospholipids, and not cholesterol content, were responsible for conveying membrane tolerance. Membrane structural properties can be rapidly adjusted in a mammalian system in response to the withdrawal of the external membrane perturbant ethanol. The withdrawal model, which begins with established membrane tolerance and leads to rapid and complete loss of tolerance, provides a model to analyze the compositional changes responsible for this tolerance to disordering by ethanol.

Protein selectivity in IgA nephropathy

The protein selectivity index was measured in 68 patients (53 males, 15 females) with proteinuria due to IgA nephropathy to determine whether it bore any relationship to other clinical and pathological features of known prognostic significance. The mean age of the patients was 25 +/- 8 years with a follow-up period of 42 +/- 35 months. Forty-six presented with asymptomatic haematuria and proteinuria, 17 with macroscopic haematuria and 5 with the nephrotic syndrome. Twenty-three (34%) patients had selective proteinuria and 45 (66%) had non-selective proteinuria. Patients with non-selective proteinuria had more glomerulosclerosis (29% +/- 20 vs. 16% +/- 20, p less than 0.02), higher serum creatinine (1.47 mg/dl +/- 0.70 vs. 1.17 mg/dl +/- 0.33, p less than 0.02), lower creatinine clearance (79 ml/min +/- 28 vs. 95 ml/min +/- 25, p less than 0.02), and higher incidence of hypertension (chi 2 = 3.84, p less than 0.05) when compared to those with selective proteinuria. The protein selectivity was measured at the end of the study. Of the 5 patients with the nephrotic syndrome, 1 had poorly selective proteinuria and failed to remit and 4 had highly selective proteinuria who either remitted spontaneously (1 patient) or with treatment (3 patients). The results suggest that patients with IgA nephropathy and poorly selective proteinuria are more likely to have other features indicating a poor prognosis such as glomerulosclerosis, renal impairment and hypertension.

Phospholipid spin probes measure the effects of ethanol on the molecular order of liver microsomes

Ethanol, in vitro, is known to perturb the molecular order of the phospholipids in biological membranes, while chronic ethanol exposure, in vivo, leads to resistance to disordering. Such changes have usually been measured by electron spin resonance, utilizing fatty acid spin probes. The use of such probes is controversial, since their orientation in the membrane may not accurately represent that of individual phospholipids. We, therefore, compared ethanol-induced structural perturbations in the membranes of rat hepatic microsomes measured with the spin probe 12-doxylstearic acid (SA 12) with those assayed with various phospholipid spin probes. With SA 12, the addition of increasing amounts of ethanol (50-250 mM) in vitro caused a progressive decrease in the membrane molecular order, as measured by electron spin resonance (ESR). By contrast, microsomes obtained from rats chronically fed ethanol were resistant to the disordering effect of ethanol. Microsomes labeled with the phospholipid spin probes 1-palmitoyl-2-(12-doxylstearoyl)phosphatidylcholine, -phosphatidylethanolamine, or -phosphatidic acid also exhibited increased disordering with the addition of increasing amounts of ethanol. However, the effect noted with phospholipid spin probes was less than that observed with the fatty acid probe. Microsomes obtained from the livers of chronically intoxicated animals labeled with the phospholipid probes were also resistant to the disordering effects of ethanol in vitro. These results suggest that fatty acid spin probes are qualitatively valid for measuring membrane perturbations in biological membranes, ethanol affects all microsomal phospholipids, regardless of chemical dissimilarities (e.g., head-group structure), in a qualitatively similar fashion, and the fluidization of fatty acyl chains in microsomal membranes is comparable in different membrane phospholipids.

Colorectal cancer in Chinese and Chinese-Americans

Rationale and plans are described for a collaborative case-control study of large bowel cancer among Chinese-Americans in Los Angeles and the San Francisco Bay Area and among Chinese in Zhejiang Province, People's Republic of China. A common protocol and questionnaire will be used during personal interviews of approximately 400 Chinese and 300 Chinese-American patients with histologically confirmed adenocarcinoma of the colon or rectum and 2,100 Chinese and Chinese-American controls. Controls will be matched to patients on age, sex, and community of residence. The information requested from subjects will permit testing of hypotheses relating colorectal cancer risk to: dietary factors, including intake of fat (saturated and unsaturated), animal protein, fiber, and vitamins A and E and ascorbic acid; physical activity levels and body mass index; reproductive factors among women; history of bowel disease; and family history of cancer. The information requested of Chinese-American subjects will also permit testing of hypotheses relating cancer risk to such migrant factors as United States versus Chinese nativity, duration of residence in the United States, and Chinese province of ancestry. These factors will be tested for associations with cancers of the colon and rectum separately and with cancers of the large intestine as a whole. We will examine sex and geographic differences in relative risks for etiologic factors, location of tumors within the large bowel, histologic subtype of adenocarcinoma, and frequency of accompanying polyps.

A beam-edge modifier for abutting electron fields

Abutment of unmodified electron fields to irradiate large areas can lead to significant dose inhomogeneities in the region of junction of the fields. In this paper we describe the design and dosimetric characteristics of a device developed to broaden the electron beam penumbra and thereby to improve the dose uniformity in the overlap region. The device is a high-density triangular-toothed comb capable of reducing the beam intensity without seriously degrading the beam energy. The effect of the comb is such that a single device will generate a beam penumbra which is broad and very nearly linear at all depths for all clinically used beam energies. Results are shown for various field configurations and energies. With a gap of 5.0 cm between the treatment cone and phantom surface the dose "ripple" in the region beneath the teeth was found not to exceed +/- 5% at 0.5-cm depth.

Cytotoxicity of cisplatin and cisdiammine-1,1-cyclobutane dicarboxylate in MGH-U1 cells grown as monolayers, spheroids, and xenografts

The cytotoxicity of cisplatin and cisdiammine-1,1-cyclobutane dicarboxylate (CBDCA) was examined using the MGH-U1 human bladder carcinoma cell line, grown as monolayer cultures, multicellular tumor spheroid(s) (MTS), and xenografts in immune-deprived CBA/CaJ mice. The cell survival of exponentially growing monolayers and MTS treated with cisplatin declined in a monoexponential fashion with a concentration of drug resulting in 10% colony survival (D10) of 7.75 micrograms/ml and 9.5 micrograms/ml, respectively. MTS growth delay determination demonstrated a drug concentration-dependent increase in growth delay and a correlation between decreasing surviving fraction and increasing growth delay. In vivo treatment of MGH-U1 xenografts with cisplatin caused a modest decrease in surviving fraction although the xenografted cells treated in vitro demonstrated the same sensitivity to cisplatin as those cells maintained continuously in vitro. The D10 for CBDCA treatment was 246 micrograms/ml for exponentially growing monolayer cells and 196 micrograms/ml for MTS. Growth delay studies with CBDCA showed a concentration-dependent increase in spheroid growth delay and a correlation between decreasing surviving fraction and growth delay similar to cisplatin. The conclusions were that: 1) cisplatin and CBDCA did not have any difficulty penetrating into spheroids, 2) both agents appeared to be active against the noncycling poorly nourished cells found near the necrotic center of spheroids, 3) both cisplatin and CBDCA were cytotoxic toward MGH-U1 cells but cisplatin was 20-30 times more effective, and 4) the limited cytotoxic effect of cisplatin in vivo may be due to the low area under the concentration times the time curve achieved in vivo and not due to intrinsic cell resistance.

Peak temperature influences on heating rate effect in hyperthermic cytotoxicity

Exponentially growing Chinese hamster V79 cells were heated from 37 degrees C up to 42 degrees C or 43 degrees C at four different heating rates: immediate exposure, 1/2 hour, 1 hour, and 2 hours. The D0's of the heat survival curves for both 42 degrees C and 43 degrees C were determined for the different heating rates. The results show that the decrease in toxicity to cells at 43 degrees C resulting from a slower heating rate appears to be less pronounced than that at 42 degrees C. However, the thermotolerance ratio is found to depend on the specific heating time (the reciprocal of the heating rate), in a linear fashion and it does not seem to depend on the peak temperature. We propose that the difference in the heat exchange on cell membranes at different rates of heating may contribute to the causes for the difference in cell sensitivity to hyperthermia.

Effective wedge angles for 6-MV wedges

Measurements were undertaken with 30 degrees and 45 degrees large wedges on a 6-MV linac to determine the effective wedge angle for various combinations of open and wedged fields. The validity of Tatcher's equation, relating effective wedge angle to maximum dose weightings, was examined over a range of field sizes from 5 X 5 to 20 X 20 cm. An alternative equation involving only central axis quantities was also investigated. The results obtained from an analysis of point dose measurements indicate that, for these wedges, either equation yields sufficient accuracy for clinical purposes.

Tumor dose specification of I-125 seed implants

A new calculation procedure for interstitial implants with I-125 seeds is presented. The total activity of I-125 seeds required to deliver a net minimum dose of 1 Gy is also given as a function of implant volume for various seed spacings. This will permit clinicians to prescribe a specific dose for patients as a primary or boost treatment. Elongation and shape corrections are studied. Discussions and comparisons with other dosimetric calculations such as "matched" peripheral dose, average minimum dose, and minimum peripheral dose are made. The results indicate that for a fixed total activity the net minimum dose is relatively insensitive to variations in seed spacing and individual seed activity.

Electron contamination due to Lucite in a 45-MV photon beam

The presence of the Lucite blocking tray in a 45-MV betatron beam leads to a considerable loss in the skin-sparing properties of this unit. Measurements conducted with a parallel-plate chamber show that the surface dose is approximately doubled (up to 58% of the maximum absorbed dose) and the depth of maximum dose is reduced by as much as 1.5 cm by the Lucite. These results suggest that separate dosimetry data should be kept for blocked and unblocked fields. The penetration of the electron contamination to the open field depth of maximum dose can lead to erroneous results if attenuation measurements are made at that depth. Studies of the effect of the lead sheet and leaded acrylic on the surface dose showed that under normal circumstances the presence of high-Z materials increases the surface dose, hence these materials cannot in general be used as electron filters on very high energy x-ray units. A Luciteless blocking tray with universal triangular corner blocks has been designed for use in special cases requiring a reduced surface dose.

Dosimetry characteristics of large wedges for 4- and 6-MV x rays

Two sets of newly designed large wedge filters for field sizes up to 20 X 20 cm2 have become commercially available for use with 4- and 6-MV linear accelerators. Such field sizes are sometimes required to ensure adequate coverage in certain treatment techniques. This work reports base line data resulting from an investigation of the dosimetric properties of these wedges. Measurements of wedge angles, transmission factors, and beam hardening effects are described, and comparisons are made with the smaller standard wedges.

Rationale for the use of hypnotic agents in a general hospital

A survey at a teaching hospital found that 46% of medical patients had prescriptions written specifically for sleep and 31% received a hypnotic agent at least once during hospitalization. Physicians for 96% of surgical patients ordered hypnotic agents and 88% received such a drug. The rationale for prescribing hypnotic agents was not well documented. Administration did not correlate with requests by patients, with previous use of hypnotic agents, or with recorded indications of sleep disturbance; however, the chance of receiving a hypnotic agent was greater if the patient was on a private instead of a ward service and if nurses were more inclined to fill as-needed prescriptions. Patients who received a hypnotic agent did not rate the quality of their sleep as being any better than those who did not, and they complained of as many awakenings during the night. Further studies are necessary to ascertain the indications and efficacy of hypnotic agents for hospitalized patients.

Generation time of leukaemic blast progenitor cells

Previous studies have indicated that the generation time of human leukaemic cells is longer than that of normal haematopoietic cells. We have employed a modification of the thymidine (TdR)-suicide technique to measure directly the generation time of leukaemic progenitor cells capable of colony formation. The results obtained with two human leukaemic cell lines (KG-1 and HL-60) and with blast progenitor cells from two patients with acute myelogenous leukaemia indicate generation times ranging from 9 X 0-22 X 0 hr and S-phase durations ranging from 5 X 5-8 X 0 hr. Using the same technique, the generation time of normal bone marrow CFU-c was determined to be 9-11 hr. These findings suggest that the proliferation rate of human leukaemic blast progenitor cells is similar to that of normal haematopoietic stem cells.

UV-induced second readout of LiF thermoluminescent dosimeters in the therapeutic dose range

A previously developed technique for reading out LiF thermoluminescent dosimeters (TLD) a second and subsequent time by means of ultraviolet (UV)-induced repopulation of dosimetry traps was studied to determine the feasibility of maintaining a second readout capability in a radiotherapy clinical setting. It was found that with grouping of the TLDs according to second readout sensitivity, the UV-induced readout attained a precision comparable to that of the initial readout. However, the UV-induced TL response retained a strong previous dose memory following a standard high-temperature anneal, and routine calibration before each reuse is recommended.

The effects of halothane on sympathetic ganglionic transmission

The effects of halothane on ganglionic transmission were studied in the stellate ganglion of the guinea pig using intracellular recordings in vitro. Depression of synaptic transmission is one of the actions common to many general anesthetics. The aim of this study was to investigate which of the processes involved in synaptic transmission are affected by halothane in concentrations comparable to those used during surgical anesthesia. The neurons of the stellate ganglion were depolarized using preganglionic nerve stimulation, postganglionic nerve stimulation, and intracellular stimulation before ad after introduction of halothane (vaporizer settings of 0.75% and 1.5% produced bath concentrations of 8 and 18 mg/dl, respectively). Halothane at both concentrations depressed sympathetic ganglionic transmission which was induced by stimulation of preganglionic nerves. Axonal transmission and the excitability of the postganglionic neurons to direct intracellular stimulation was far less sensitive to halothane than synaptic transmission. The depression of ganglionic transmission seen in the present study was most likely due to a decrease in transmitter release although alterations in postsynaptic receptor properties could have been involved as well. The decrease in sympathetic activity resulting from depression of ganglionic transmission probably contributes to the arterial hypotension seen during halothane anesthesia, along with direct myocardial depression, inhibition of catecholamine release from the adrenal medulla, direct action on vascular smooth muscle, and central sympathetic depression.