Cigarette smoking accelerates progression of alcoholic chronic pancreatitis

BACKGROUND

Smoking is a recognised risk factor for pancreatic cancer and has been associated with chronic pancreatitis and also with type II diabetes.

AIMS

The aim of this study was to investigate the effect of tobacco on the age of diagnosis of pancreatitis and progression of disease, as measured by the appearance of calcification and diabetes.

PATIENTS

We used data from a retrospective cohort of 934 patients with chronic alcoholic pancreatitis where information on smoking was available, who were diagnosed and followed in clinical centres in five countries.

METHODS

We compared age at diagnosis of pancreatitis in smokers versus non-smokers, and used the Cox proportional hazards model to evaluate the effects of tobacco on the development of calcification and diabetes, after adjustment for age, sex, centre, and alcohol consumption.

RESULTS

The diagnosis of pancreatitis was made, on average, 4.7 years earlier in smokers than in non-smokers (p = 0.001). Tobacco smoking increased significantly the risk of pancreatic calcifications (hazard ratio (HR) 4.9 (95% confidence interval (CI) 2.3-10.5) for smokers v non-smokers) and to a lesser extent the risk of diabetes (HR 2.3 (95% CI 1.2-4.2)) during the course of pancreatitis.

CONCLUSIONS

In this study, tobacco smoking was associated with earlier diagnosis of chronic alcoholic pancreatitis and with the appearance of calcifications and diabetes, independent of alcohol consumption.

Helicobacter pylori, N-methyl-N'-nitro-N'-nitrosoguanidine, and bile modulate gastric cell kinetics in experimental cancer

Helicobacter pylori infection is a risk factor for gastric cancer. How the bacterium contributes to this process is still unclear. We present a new Wistar rat model that was used to evaluate the effect of H. pylori on early preneoplastic events as judged from epithelial cell turnover and histopathological changes. One hundred and four rats were colonized with H. pylori and exposed MNNG (N-methyl-N'-nitro-N'-nitrosoguanidine) and/or taurocholic acid. Inflammation, goblet cell-like metaplasia, atrophy, dysplasia, and adenocarcinoma were scored in a blinded manner. Apoptotic cells were counted after staining with terminal uridine deoxynucleotidyl nick end labeling, and epithelial cell proliferation was determined by means of the Ki-67 labeling index. No early tumor enhancement with H. pylori could be found in ordinary histology. However, H. pylori significantly enhanced the epithelial cell proliferation compared with the control group, and the combination with taurocholic acid appeared to have a synergistic effect. MNNG significantly increased the normal gastric epithelial apoptosis. This increase was reduced in antral mucosa with H. pylori infection. The findings suggest that H. pylori, especially when combined with bile. has an influence on cell kinetics, contributing to the development of gastric cancer. The reduced apoptosis of MNNG also observed in infected animals indicates a dual function of H. pylori.

Effects of Helicobacter pylori and bile on N-methyl-N'-nitro-N'-nitrosoguanidine exposed antral mucosa of C57BU6 mice

The aim of this study was to evaluate the early influence of Helicobacter pylori infection on cell kinetics in the antral mucosa of mice exposed to N-methyl-N'-nitro-N'-nitrosoguanidine (MNNG) and bile alone or in combinations. Four hundred and one C57BL/6 male and female mice were assigned into seven treatment groups and one non-treated control group. The gastric antrums were assessed by histology and immunohistochemistry for studies of cell proliferation and apoptosis at 32 and 44 weeks. One female and one male mouse had developed dysplastic adenomas in the pylorus mucosa and one male animal had dysplastic proliferation in the antrum. Only one of these lesions occurred in a H. pylori colonized animal. H. pylori infection significantly increased the cell proliferation at 32 weeks and promoted the cell proliferation in the MNNG and bile group at 44 weeks. Female mice showed less increase in cell proliferation than did the males. No change in apoptosis was seen in any of the groups. Bile had no promotional effect on cell proliferation. These results indicate that H. pylori infection has the potential to alter epithelial cell kinetics as well as antrum mucosa of an animal species that is regarded as resistant to MNNG. However, this change is not sufficient to promote the early development of neoplastic lesions.

Biliary-intestinal bypass in the treatment of obesity: long term follow up

OBJECTIVE

To evaluate the long term outcome after biliary-intestinal bypass for morbid obesity.

DESIGN

Retrospective study.

SETTING

County hospital, Sweden.

SUBJECTS

120 consecutive patients operated on between 1977 and 1990.

INTERVENTIONS

A variation of jejunoileal bypass in which the excluded bowel was anastomosed to the gallbladder.

MAIN OUTCOME MEASURES

Weight, concentrations of blood lipids and glucose in blood, results of liver function tests, reversal rates, and complications.

RESULTS

The mean body mass index was reduced by 39% (from 42 kg/m2 to 26 kg/m2), serum cholesterol and triglyceride concentrations by more than 30%, and fasting blood glucose concentrations by 1 1%. There were no cases of irreversible hepatic failure, diabetes, deaths related to the operation, or progressive renal failure. The incidence of renal calculi increased by a ratio 2.3. The reversal rate/year was 2% (n = 20).

CONCLUSION

We conclude that biliary-intestinal bypass may be used to treat cases of obesity associated with seriously high blood lipid concentrations and where gastric restrictive operations are less suitable.

Mutagenicity from neutrophils after challenge with Helicobacter pylori and bile

OBJECTIVE

To study some mechanisms involved in Helicobacter pylori (H. pylori)-induced gastric carcinogenesis.

DESIGN

In vitro study.

SETTING

Medical centre hospital, Sweden.

INTERVENTIONS

Mutagenicity in Ames' test of neutrophils challenged for 2 hours or more by two different strains of H. pylori. One strain designated NCTC 11637 by the National College of Type Cultures activated neutrophils to an oxidative burst and producing vacuolating cytotoxin, the other strain C-7050 lacked these abilities. Mutagenicity was also studied with sterile human gall bladder bile alone added to neutrophils or in combination with both neutrophils and H. pylori.

RESULTS

There was no increase in the number of revertants with the crude suspension or the supernatant of neutrophils challenged for 1 hour or less with H. pylori, bile, or the combination of both. However, in 5 out of 19 experiments there was significant mutagenicity after challenge of neutrophils for 2 hours or more with either strain of H. pylori, bile, or the combination of the two. The strongest mutagenicity was obtained after challenge over night (18 hours) with the combination of H. pylori and bile.

CONCLUSION

Mutagenicity occurs when neutrophils are challenged with H. pylori and bile. Factors other than reactive oxygen metabolites seem to be responsible.

Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group

OBJECTIVES

The aim of this study was to determine which factors predict mortality in a cohort of patients with chronic alcoholic and nonalcoholic pancreatitis. Patients with chronic pancreatitis are known to have a reduced life expectancy, but the quantitative relationship between various clinical features and survival is unclear.

METHODS

We evaluated survival among 2015 subjects with chronic pancreatitis treated at seven centers located in six countries.

RESULTS

Mean age at diagnosis was 46 +/- 13 yr and mean duration of follow-up was 7.4 +/- 6.2 yr. Overall survival at 10 yr was 70% (95% confidence interval (CI), 68-73%) and at 20 yr was 45% (95% CI, 41-49%). Survival was significantly less than in the background population. There were 559 deaths observed among those with chronic pancreatitis compared with an expected number of 157.4, yielding a standardized mortality ratio (SMR) of 3.6 (95% CI, 3.3-3.9). Older subjects and those with alcoholic pancreatitis had a significant reduction in survival. In a multivariate analysis, mortality of middle-aged and older subjects was 2.3 (95% CI, 1.8-2.8) and 6.3 (95% CI, 4.7-8.3) times greater than subjects less than 40 yr at diagnosis. Smoking (hazard ratio, 1.4; 95% CI, 1.0-1.9), drinking (hazard ratio, 1.6; 95% CI, 1.2-2.2), or development of cirrhosis (hazard ratio, 2.5; 95% CI, 2.0-3.2) increased the risk of death during the observation period, but we observed no survival difference in operated vs. nonoperated patients.

CONCLUSIONS

Age at diagnosis, smoking, and drinking are major predictors of mortality in patients with chronic pancreatitis.

Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group

BACKGROUND

The results of case-control studies and anecdotal reports suggest that pancreatitis may be a risk factor for pancreatic cancer, but there have been no studies of sufficient size and power to assess the magnitude of the relation between these two diseases.

METHODS AND RESULTS

We undertook a multicenter historical cohort study of 2015 subjects with chronic pancreatitis who were recruited from clinical centers in six countries. A total of 56 cancers were identified among these patients during a mean (+/-SD) follow-up of 7.4 +/- 6.2 years. The expected number of cases of cancer calculated from country-specific incidence data and adjusted for age and sex was 2.13, yielding a standardized incidence ratio (the ratio of observed to expected cases) of 26.3 (95 percent confidence interval, 19.9 to 34.2). For subjects with a minimum of two or five years of follow-up, the respective standardized incidence ratios were 16.5 (95 percent confidence interval, 11.1 to 23.7) and 14.4 (95 percent confidence interval, 8.5 to 22.8). The cumulative risk of pancreatic cancer in subjects who were followed for at least 2 years increased steadily, and 10 and 20 years after the diagnosis of pancreatitis, it was 1.8 percent (95 percent confidence interval, 1.0 to 2.6 percent) and 4.0 percent (95 percent confidence interval, 2.0 to 5.9 percent), respectively.

CONCLUSIONS

The risk of pancreatic cancer is significantly elevated in subjects with chronic pancreatitis and appears to be independent of sex, country, and type of pancreatitis.

Adjuvant chemotherapy with 5-fluorouracil, vincristine and CCNU for patients with Dukes' C colorectal cancer. The Swedish Gastrointestinal Tumour Adjuvant Therapy Group

A prospective controlled randomized trial testing adjuvant postoperative combination chemotherapy (5-fluorouracil, lomustine (CCNU) and vincristine) versus no adjuvant therapy in patients operated on for Dukes' C colorectal cancer is reported. In total 334 patients aged less than 70 years were recruited: 205 patients with colonic and 99 with rectal cancer, but there were three protocol violations and these cases are excluded from further consideration. Twenty-seven patients had a limited resection of their cancer. After 5 years' follow-up there was no significant difference in the tumour-free survival rate or in the survival rate between the treated and control groups. Twenty-nine of the 147 patients who started chemotherapy discontinued this treatment because of side-effects, mainly from the gastrointestinal tract. In 30 patients treatment was discontinued because of recurrent disease. The conclusion is that systemic administration of combination chemotherapy for colorectal cancer after operation is not worthwhile in routine clinical practice.

Cystadenocarcinoma of the pancreas 9 years after a pancreatic cyst operation: report of a case

A patient case with cystadenocarcinoma of the pancreas in a middle-aged woman is described. Nine years prior to the pancreatic malignancy she underwent cystogastrostomy due to a pancreatic cyst presumed to be of non-neoplastic nature. The malignancy occurred at the site of the previous cystogastrostomy and was radically resected. Five years later the patient was well without signs of recurrence. The possibilities of incorrect primary diagnosis or development of a rare pancreatic malignancy in a previous cystogastrostomy are discussed.

Gallstone growth, size, and risk of gallbladder cancer: an interracial study

To investigate gallstone size, growth, and the relation between stone size and gallbladder cancer we have used cholecystectomy reports from 1676 female subjects (169 Whites, 531 Blacks, and 976 Native American Indians). Although the prevalence of gallstones differs markedly in these groups it appears that the estimated growth rate of gallstones in younger subjects, 2.0 mm per year (95% confidence interval: 1.7-2.3 mm) is homogeneous for all three groups. In both Indian and non-Indian populations the proportion of small stones diminished and the proportion of large stones increased over time. We found a strong relationship between gallstone size and gallbladder cancer. Large stones (greater than or equal to 3 cm) were found in 40% of patients with gallbladder cancer but in only 12% of all subjects of similar age. The relative risk for gallbladder cancer in subjects with stones greater than or equal to 3 cm was 9.2 compared with subjects with stones less than 1 cm. (95% confidence interval: 2.3-37). We estimate that one-third of all gallbladder cancers in subjects with calculi will be associated with large (greater than or equal to 3 cm) stones. We believe that stone size might be used to determine the risk of gallbladder cancer in patients with gallstones.

Effect of therapeutic concentrations of anthracyclines on monocyte phagocytosis of yeast cells

The effect of therapeutic concentrations of doxorubicin, epirubicin, and mitoxanthrone on mature leukocyte function has been examined by measuring phagocytosis of yeast cells by surface-bound monocytes, using a fluorescence-quenching method. There was a 10% inhibition of monocyte phagocytosis by doxorubicin, but epirubicin and mitoxanthrone had no effect on monocyte phagocytosis. Anthracyclines may have a major immunosuppressive effect due to bone marrow depression. The lack of interference with mature monocyte function by epirubicin and mitoxanthrone provides a potential advantage in comparison with the parent compounds.

Pharmacokinetics and central haemodynamic effects of doxorubicin and 4'epi-doxorubicin in the pig

The relationship between the cardiotoxicity and the haemodynamics/pharmacokinetics of clinical concentrations of doxorubicin and 4'epi-doxorubicin was studied. Twelve pigs were randomized to receive i.v. infusions of either drug of 50 mg/m2 over 3.0 min. Aortic, pulmonary arterial, coronary sinus and central venous plasma concentrations of the agents were determined until 180 min after the infusion. The V5 ECG, left ventricular dP/dT, aortic, pulmonary arterial and right atrial pressures were recorded continuously, cardiac output and coronary sinus blood flow were recorded intermittently. No haemodynamic changes were recorded after administration of either drug. Pharmacokinetic data indicated myocardial extraction, followed by myocardial release of both drugs. This release was higher after administration of 4'epi-doxorubicin than after doxorubicin, within the range 2-4 min and 20-40 min after the infusion. The tendency of greater myocardial release of 4'epi-doxorubicin may explain its lower cardiotoxicity.

Pharmacokinetics of intra-arterial mitomycin C with or without degradable starch microspheres (DSM) in the treatment of non-resectable liver cancer

The effects of degradable starch microspheres (DSM) on mitomycin C pharmacokinetics and bone marrow toxicity were studied in a phase II multicenter study. Sixty-three patients with non-resectable primary or secondary liver cancer were randomized to receive either i.a. mitomycin C 15 mg/m2 first, followed 5 weeks later by mitomycin C 15 mg/m2 plus DSM 360 mg administered into the hepatic artery (group I) or the same treatments in the opposite sequence (group II). In 36 out of 47 patients who received at least 2 treatments, peripheral venous blood samples were analyzed for mitomycin C pharmacokinetics on a minimum of 2 paired courses. In all patients, the area under the concentration time curve (AUC) was significantly lower when the drug was co-administrated with DSM, but the terminal half-life (t1/2) of mitomycin C was unchanged. In group I the addition of DSM resulted in a significantly lowered AUC, but not in group II. The discrepancy between the 2 groups is probably due to differences in DSM-induced intra-hepatic shunting. The addition of DSM resulted in significantly higher platelet nadir values, but unchanged white blood cell count nadir value. In conclusion, DSM reduce the systemic exposure of mitomycin C and seem to lessen the haematologic toxicity judged from a less pronounced decrease in platelets.

The effects of omeprazole and cimetidine on duodenal ulcer healing and the relief of symptoms

In a Swedish double-blind multicentre study, omeprazole (30 mg o.m.) was compared with the H2-receptor antagonist cimetidine (400 mg b.d.) in 152 patients. Clinical assessments and laboratory investigations were carried out at 2 and 4 weeks, and again at 6 weeks in unhealed patients. Endoscopy was performed at 2 weeks, and again at 4 and 6 weeks in unhealed patients. The patients in the two groups were well-matched prior to treatment. Omeprazole was superior to cimetidine in ulcer-healing rate after 2, 4 and 6 weeks. After 2 weeks of treatment, 66% of the omeprazole- and 45% of the cimetidine-treated patients were healed (P = 0.02), after 4 weeks 97 and 84% (P = 0.01), and after 6 weeks 100 and 92% (P = 0.02), respectively. There was a more pronounced improvement in the patients' symptoms in the omeprazole group after 2 weeks (P = 0.05). Both drugs were well-tolerated, but there was a high prevalence of patients with adverse events in the cimetidine group (51%, compared to 30% of the omeprazole group; P = 0.02). A total of 125 patients were followed for 6 months after healing. The patients were investigated by endoscopy after 6 months, or whenever symptoms occurred. There was no significant difference in the rate of relapse within 6 months between the two treatment groups: 54% relapsed in the omeprazole group and 52% in the cimetidine group. In conclusion, 30 mg of omeprazole, given once daily, is superior to 400 mg of cimetidine twice daily in duodenal ulcer healing; but ulcer relapse in the two groups appears to be equivalent.

A cytostatic drug (taxol) which does not inhibit monocyte phagocytosis

Taxol is a new cytotoxic agent which arrests cell division in the G2 and the M phases, due to its unique property of inhibiting microtubule function by stabilization. In contrast to other microtubule antagonists except griseofulvin, taxol did not inhibit monocyte phagocytosis. It is suggested that lack of interference with the function of mature leukocytes may reduce the immunosuppression induced by a cytotoxic agent.

Splenic release of amino acids in man assessed by arterial and venous blood sampling in situ

The splenic arteriovenous differences in plasma amino acid concentrations were assessed in situ by peroperative sampling in 11 patients undergoing splenectomy because of benign and malignant hematologic diseases. The total difference was about 250 mumol/l, which suggests that the spleen contributes about 11 mumol/100 g spleen/min of amino acids to the portal vein. This means that the liver extraction of amino acids may be at least 10% greater than previously believed.

Therapeutic concentrations of melphalan do not affect yeast cell phagocytosis by monocytes

The effect of melphalan on monocyte phagocytosis was assessed by studying the uptake of fluorescent yeast cells by glass-adherent monocytes (a fluorescence-quenching technique). In contrast to several other cytotoxic agents, melphalan did not inhibit monocyte phagocytosis. Although the main immunosuppressive side effect of most cytotoxic drugs appears to be due to bone marrow depression with reduction of leukocyte counts, it is reasonable to assume that lack of interference with the function of mature leukocytes is a favourable feature of an antineoplastic drug.

Distribution and metabolism of N'-nitrosonornicotine in the miniature pig

The distribution and metabolism of [5-3H]N'-nitrosonornicotine ([5-3H]NNN) was studied in three 18-day-old miniature pigs. [5-3H]NNN was administered by intracardiac administration into the right ventricle of the heart to mimic uptake by the lung. Whole body autoradiograms taken 15-220 min after treatment showed high levels of radioactivity in the mandibular and parotid salivary glands, Harder's gland, lacrimal glands, glands of the snout and respiratory part of the nasal cavity, and the melanin of the eyes and skin. Bound radioactivity was most abundant in the nasal mucosa and liver. Analysis of tissues by h.p.l.c. showed the presence of high levels of [5-3H]NNN in the mandibular glands and Harder's gland. Levels of [5-3H]NNN and its metabolites were determined in arterial and venous serum, 0.5-220 min after injection. The disappearance of [5-3H]NNN from serum was biphasic. 4-Oxo-4-(3-pyridyl) butyric acid, a metabolite of [5-3H]NNN resulting from 2'-hydroxylation, which is a suspected activation pathway, was detected 0.5 min after injection and appeared to reach a steady state 2-220 min after injection. 4-Hydroxy-4-(3-pyridyl)butyric acid, from 5'-hydroxylation of [5-3H]NNN, and norcotinine, from denitrosation, were also rapidly formed. These experiments are the first in which the appearance of NNN metabolites in blood has been measured. The ratio of 2'-hydroxylation to 5'-hydroxylation varied from 0.27 to 0.60 in arterial serum and from 0.33 to 0.49 in venous serum in the period from 2-220 min. [5-3H]NNN accumulated in the stomach contents such that its levels were greater than those in arterial or venous serum, 60 min after injection. The results of this study demonstrate that the miniature pig is a useful model for the investigation of nitrosamine metabolism and indicate some similarities and differences in metabolism and distribution compared with the rat.

Effects of partial hepatectomy on plasma fibronectin concentrations in the rat

Rats were subjected to 60% partial hepatectomy. In the immediate postoperative period, there was a small decline in plasma fibronectin concentrations, which was normalized already 12 h post-operatively. Metabolic labelling of fibronectin with 35S-methionine showed that the rate of incorporation of label was unchanged after partial hepatectomy. However, when the abdominal viscera were excluded from the circulation, no incorporation of label was found. These results show that the rate of fibronectin biosynthesis has the rapid regulation characteristics of an acute phase reactant. Peripheral tissues do not contribute significantly to the plasma fibronectin concentration. Intra- or retro-peritoneal viscera, most likely the liver, are responsible for the synthesis of rat plasma fibronectin.

Response of human monocyte phagocytosis to FAM (fluorouracil, adriamycin, mitomycin)

The immunosuppressive effect of chemotherapy associated with surgery is poorly understood. The effect of combination chemotherapy--fluorouracil, adriamycin and mitomycin (FAM)--on monocyte phagocytosis was tested in patients operated on for gastric cancer. The adherence, engulfment and total phagocytic process were studied with a fluorescence-quenching technique 1 hour, 24 hours and 1 week after 19 FAM treatments in nine patients. The engulfment of yeast cells and the total phagocytosis were significantly impaired 1 hour post-treatment (p less than 0.05 and less than 0.01, respectively). These functions had normalized after 24 hours, but after 1 week the engulfment step was significantly depressed (p less than 0.05). Significantly increased adherence of yeast cells (p less than 0.05) was found at the same time. The initial, transient depression of monocyte phagocytosis probably was related to inactivation of cell-surface receptors. The late (1 week) depression probably was due to bone-marrow toxicity. This functional impairment of the blood monocytes was not reflected as clinical liability to infections.

Cardio-pulmonary elimination of 5-fluorouracil after bolus injection in the hepatic artery

Theoretically, administration of 5-fluorouracil (5-FU) into the hepatic artery should improve the clinical response rate by high tumor cell extraction of the drug. However, previous studies in animals and man have also found a major extrahepatic elimination route for 5-FU. In the present study of 7 patients with primary and secondary liver cancer, we have found indications that a considerable elimination of 5-FU takes place in the cardio-pulmonary circuit. Thus, the mean AUC in the hepatic vein was 7185 mumol X min X l-1 and 3792 in a peripheral vein.

Phagocytosis of yeast cells by monocytes: effects of fluorouracil, doxorubicin and mitomycin

The drugs in the FAM combination (fluorouracil, doxorubicin, mitomycin) were tested for a possible effect on monocyte function by means of a glass-surface fluorescence-quenching technique of monocyte phagocytosis. The individual drugs significantly inhibited monocyte phagocytosis. The inhibition was located at the engulfment phase of phagocytosis and in an order of magnitude of 20-30%. The FAM combination did not suppress monocyte phagocytosis more than each one of the individual drugs. It is suggested that a slight inhibition of monocyte phagocytosis is a cost of cytotoxic treatment.

Effects of fluorouracil, doxorubicin and FAM combination on human peritoneal macrophages

The effects of fluorouracil and adriamycin as single drugs and in combination with mitomycin (FAM) on the phagocytosis of tissue macrophages were studied in vitro. Human peritoneal macrophages (HPM) from cancer patients or uremic patients on peritoneal dialysis were incubated with the test drugs. No apparent inhibition of the adherence, engulfment or total phagocytosis of yeast cells was found with the fluorescence quenching technique. This is in contrast to our previous findings on blood monocytes. Thus the heterogeneity in sensitivity to anticancer drugs is probably related to cell maturity and cell surface characteristics.

Therapeutic concentrations of griseofulvin do not affect yeast cell phagocytosis by monocytes

The effect of griseofulvin on monocyte phagocytosis was assessed by studying the uptake of fluorescent yeast cells by glass-adherent monocytes (a fluorescence-quenching technique). In contrast to other microtubule antagonists, griseofulvin did not inhibit monocyte phagocytosis. It is suggested that the lack of griseofulvin interference with essential leukocyte functions is a possible explanation for the fact that the microtubule antagonist griseofulvin serves as a comparatively safe and harmless drug.

Effects of CCNU on monocyte phagocytosis

The effect of CCNU on human monocyte phagocytosis of yeast cells was measured in vitro. 'Therapeutic' CCNU concentrations had no measurable effect on monocyte phagocytosis. Higher concentrations of CCNU had a slight but statistically significant effect on the engulfment phase of monocyte phagocytosis. The results suggest that CCNU treatment is of minor importance for monocyte function.

A pharmacokinetic study of adriamycin and 4'epi-adriamycin after simultaneous intra-arterial liver administration

The plasma pharmacokinetics of adriamycin and 4'epi-adriamycin were studied in patients with malignant tumors of the liver after simultaneous regional administration of equal amounts of the two anthracyclines by the arterial route. The use of a highly selective liquid chromatographic analytical method permitted quantification of plasma concentrations of the two drugs as well as their corresponding 13-hydroxy metabolites. The plasma concentrations of each drug followed a three-compartment open model. On average the area under the plasma concentration time curve (AUC) and the maximum plasma concentration (Cmax) were 2.1 and 1.7 times larger for adriamycin than for 4'epi-adriamycin, respectively. 4'Epi-adriamycin was eliminated faster than adriamycin, the terminal half-life time being on the average 1.5 times higher for adriamycin. These findings are in agreement with what has previously been observed after intravenous administration. The plasma concentrations of the 13-hydroxy metabolites did not exceed 30 ng ml-1. The AUC values of these metabolites were on average 20% of the AUC values of the intact drugs.

The phagocytic process of human peritoneal macrophages in cancer or uremia

The ingestion and adherence components of the overall phagocytic process have been studied in human peritoneal macrophages (HPM) from cancer or uremic patients and compared with HPM from healthy controls. No difference was found in the studied functions between cancer patients and controls. However, HPM from uremic patients showed a highly significant impairment in the overall phagocytosis and the studied components of this function. In all groups the ingestion phase was significantly depressed after 24 hours of culture. Despite this functional impairment, the total phagocytic process was unchanged, owing to a significant increase in the adherence of test particles.

The effect of an oral therapeutic single dose of doxycycline on subsequent monocyte phagocytosis in vitro

Doxycycline has been reported to depress leukocyte functions. The effect of peroral administration of 400 mg doxycycline was evaluated after 24 hours in 18 healthy persons. No inhibitory effect on monocyte phagocytosis was found. There is no evidence that therapeutic concentrations of doxycycline depress leukocyte functions to a degree of clinical significance.

Observer variability in upper gastrointestinal fiber endoscopy

The reliability of esophagogastroduodenoscopy (EGD) was evaluated in 71 patients. The study was designed as a comparison between the separate protocols written by two endoscopists at each EGD. The results showed an over-all disagreement of 32% between observers. When the results were correlated with endoscopical experience, a significantly higher proportion of false-negative results was found among endoscopists with experience of less than 500 EGDs compared with a more experienced group of investigators. No difference was found between residents in training (less than or equal to 200 EGDs) and those with intermediate experience (200-500 EGDs). The implications with regard to repeated training programs and authorization of endoscopists are discussed.

Nitrosamide-induced sarcomas in the gastric pylorus of hamsters. A histological and ultrastructural survey on the histogenesis

A histological and ultrastructural survey on the histogenesis of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced gastric sarcomas in hamsters was attempted. Within 3 months after the beginning of oral administration of MNNG, simple spindle cell proliferation in the submucosal zone of the pyloric region of the glandular stomach was evident. By 5-6 months, the cells had acquired a sarcomatous appearance. Ultrastructurally, the spindle cells in the early stage, were divided into 3 types, i.e., angiogenic cells, fibroblastic cells, and primitive mesenchymal cells. Similarly, those in the late-appearing sarcomatous tumors were also classified into different types of angiogenic, fibroblastic, histiocytic and miscellaneous cells. Among the cell population of the 2 major groups, angiogenic cells were the most predominant cell type. Some morphological transition appeared to occur between the corresponding cell types at the early and late stages. DNA content of cell nuclei of the representative forms of the nitrosamide-induced sarcomas was higher than that of early appearing spindle cells. Thus, the evidence suggests that the early appearing spindle cells are precursors for the gastric sarcomas.

A randomized trial of oral 5-fluorouracil versus placebo as adjuvant therapy in colorectal cancer Dukes' B and C: results after 5 years observation time

A double-blind randomized trial of daily oral 5-fluorouracil (5 mg kg-1 bodyweight) for 3 months versus placebo as adjuvant therapy to surgical treatment of colorectal cancer Dukes' B and C was conducted. In total 421 patients were randomized; 198 patients with Dukes' B, 159 with Dukes' C and 64 were referred to a limited resection group. The distribution of prognostic variables was similar in both groups indicating the absence of any bias and the efficacy of the randomization. Disease-free interval and survival time were analysed as end points. After 5 years of follow-up of all patients there was no significant difference between treatment or placebo group in the total material or the subgroups regarding either of the end points. There was no difference in localization of first recurrence between treated and control group. A high withdrawal of therapy was found in the 5-FU group (40 per cent) and in the placebo group (13 per cent).

The phagocytosis of yeast cells by blood monocytes. Effects of therapeutic concentrations of Vinca alkaloids

The role of cytoplasmic microtubules in the phagocytosis of yeast cells by blood monocytes was studied by means of therapeutic concentrations of the Vinca alkaloids vincristine, vinblastine, and vindesine. Phagocytosis was measured in a monolayer of glass-adherent monocytes fed with fluorescein-labelled yeast cells. Phagocytosis was composed of two sequential processes, yeast cell adherence to the monocyte and yeast cell engulfment by the monocyte. Monocyte phagocytosis was significantly inhibited by the Vinca alkaloids, mainly due to inhibition of engulfment but probably also due to inhibition of adherence. Since the Vinca alkaloids are microtubule antagonists it is reasonable to assume that monocyte phagocytosis, both adherence and engulfment, are partially microtubule-dependent processes. It is suggested that Vinca alkaloid inhibition of monocyte phagocytosis is of value in the treatment of type II-III autoimmune disorders, such as idiopathic thrombocytopenic purpura and autoimmune haemolytic anaemia.

Prevalence of gallstones in Finland: an autopsy study in the Helsinki area

The prevalence of gallstones in Helsinki (Uusimaa county) was determined in an autopsy sample consisting of 1102 males and 768 females. The crude prevalence of gallstone disease in men was 15.3%, as compared with 34.5% in women. The age-adjusted rates for men and women were 8.7% and 15.9%, respectively. The prevalence of gallstone disease appears to be significantly lower in Finland than in Sweden. However, cholecystectomy rates appear to be higher in Finland than in reports from Sweden and Norway. No significant association with neoplastic disease was found.

Adherence and phagocytosis of yeast cells by blood monocytes. Effects in vitro of a therapeutic doxycycline concentration

The effect of a therapeutic doxycyline concentration on yeast-cell phagocytosis by blood monocytes was studied in vitro by means of a fluoresence assay. This method allows discrimination between monocyte-adherent yeast cells and ingested yeast cells. The adhesive and phagocytic capacity of 50 monocytes was measured in 16 healthy donors. Yeast-cell adherence was not influenced by doxycycline. In contrast, a slight depression of phagocytosis by doxycycline was suggested. The median difference between doxycyclin-treated and control monocytes was 30% (p = 0.07). It is reasonable to assume that a possible inhibitory effect of doxycycline on monocyte phagocytosis is negligible in healthy individuals. However, a clinically significant effect cannot be excluded in severely immuno-compromised patients.

Effects of long-term combination chemotherapy on the reticuloendothelial system

The phagocytic and metabolic functions of the reticuloendothelial system (RES) were studied in 20 postoperative cancer patients undergoing long-term combination chemotherapy. Each course included vincristine, methyl-CCNU (day 1) and 5-fluorouracil (days 1-5) every sixth week. The RES-test was performed prior to each course, using 125I-labeled microaggregated human serum albumin. Total leukocytes, mononuclear cells and platelets were monitored before, during and after each treatment. A significant, initial impairment of the catabolic function of the RES was found (2P = 0.006). A similar, nonsignificant trend was observed in the phagocytic function. The normalization may mirror the large metabolic capacity of the RES. This is further demonstrated by the fact that splenectomized (N = 9) and nonsplenectomized patients did not differ. A significant decrease was also found in total leukocytes and mononuclear cells (2P less than 0.001). Combination chemotherapy induced a similar myelosuppression in both groups, but did not further reduce the mobile RES in asplenic individuals.

Bleeding as a complication to endoscopic biopsies from the gastric remnant after ulcer surgery

Bleeding is a potential but rare complication after endoscopic biopsies of the gastric mucosa in non-operated patients. The resected stomach, however, seems to run an increased risk of this complication. In a retrospective study comprising 1843 consecutive biopsy examinations of the gastric remnant, 15 bleeding episodes were recorded (0.8%). The frequency of bleeding was 1.1% for the Billroth-II-resected stomach and 0.2% for the Billroth-I-resected stomach. In two patients the bleeding was excessive, requiring emergency surgery. Six other patients required blood transfusions. The observed frequency of bleeding was probably a minimal estimate, suggested by a 20% occult bleeding found in a small prospective study. When planning follow-up examination of patients who have had a gastrectomy, the risk of bleeding should be taken into account, and the patients should be appropriately informed and supervised.

Cholelithiasis, cholecystectomy, and cancer: a case-control study in Sweden

To study the relationship between gallstone disease (cholelithiasis and cholecystectomy) and cancer, a case-control study was performed in two Swedish hospitals comparing the prevalence of gallstone disease discovered at necropsy in 1422 subjects who died of cancer and 1205 subjects who did not die of cancer. Gallstone disease was more prevalent in the group of 131 women less than 50 yr of age who died of various cancers: odds ratio = 2.2, p less than 0.01. When the analysis was restricted to 89 younger women who died of cancers that have been suggested to be related to diet (breast, reproductive system, gastrointestinal), the results became more significant: odds ratio = 3.3, p less than 0.001. No such relationship was detected in older women or in men of any age. It seems likely that gallstone disease and several common cancers in younger Swedish women share similar epidemiologic and perhaps metabolic features.

Effect of bile acid gavage or vagotomy and pyloroplasty on gastrointestinal carcinogenesis

Possible promotion of MNNG-induced gastrointestinal carcinogenicity was evaluated in male Wistar rats exposed to unconjugated bile acid given as gavage or as obtained through truncal vagotomy plus pyloroplasty. No significant difference was found compared with the relevant control groups. Even though gastroduodenal erosions were found more frequently in the bile acid gavage and MNNG groups than in MNNG-treated controls, secondary deconjugated bile acids apparently did not reach optimal promoting concentrations. In contrast to partial gastrectomy, vagotomy and pyloroplasty does not increase the tumor yield in the rat.

Enhancing effect of vagotomy and pyloroplasty on gastro-intestinal carcinogenesis induced by nitrosamide in hamsters

The possible promoting effect of vagotomy and pyloroplasty on N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced carcinogenesis in the gastrointestinal (GI) tract was studied in Syrian golden hamsters on high fat diet (10% corn oil). After truncal vagotomy and pyloroplasty or sham operation, 50 micrograms/ml of MNNG was given for 4 months in drinking water. Similarly operated or non-operated animals without carcinogen administration served as controls. Spindle cell sarcomas were frequently seen in the MNNG-treated hamsters as well as spindle cell proliferation. After vagotomy and pyloroplasty, a small number of hamsters also developed adenocarcinomas and rosette-forming neurogenic tumors. The tumor development in the glandular stomach or small intestine was significantly increased after truncal vagotomy and pyloroplasty. The data suggest that this operation has an enhancing effect on the MNNG carcinogenesis in the hamster.

Microflora and deconjugation of bile acids in alkaline reflux after partial gastrectomy

It has been postulated that reflux of bile into the stomach promotes gastric carcinogenesis. Bile-stained aspirates from 50 asymptomatic patients, partially gastrectomized more than 10 years earlier, were examined bacteriologically and with regard to conjugated and deconjugated bile acids. Endoscopic biopsies showed atrophic gastritis in all patients, cancer in two and severe dysplasia in another two. pH in the reflux aspirates was 7.3 +/- 0.4 (mean +/- standard deviation). Bacterial cultures were positive in all patients studied. Fecal type flora, mostly E. coli, klebsiella and Clostridium perfringens, was found in 85% of the patients. Total bile acids were found to be 2.6 +/- 2.0 mg/ml, 23% of which were deconjugated. Deoxycholic acid, known to promote carcinogenesis in animals, amounted to 27% of total bile acids and deconjugated deoxycholic acid was 5% of total bile acids. The mostly anaerobic microflora and the presence of mainly free secondary and primary bile acids may contribute to the high incidence of cancer in the gastric remnant observed after Billroth I or II operations.

Influence of cancer chemotherapy treatment on the reticuloendothelial system in the rat

The phagocytic function of the reticuloendothelial system (RES) in the rat has been studied after the administration of cyclophosphamide, 5-fluorouracil or a combination of these drugs and vincristine. No impairment in the elimination of 125I-labelled microaggregated human serum albumin was found. A significant reduction in relative and total spleen weight was not paralleled by a decreased splenic uptake of the RES test substance per gram tissue. A significant increase in the relative weight of the lungs was paralleled by a significant increase in the uptake of test substance on a per gram basis. No correr. A general reduction in the cell population of the haematopoietic system has to be assumed. If this reduction is more pronounced in subpopulations of T lymphocytes (suppressor T cells) has to be further tested.