COMMENTS

The epidemiology of testicular germ cell cancer is relatively well understood, but less is known about the epidemiology of ovarian germ cell cancer. Cases of testicular (7910) and ovarian (453) germ cell cancer diagnosed 1960-1999 were extracted from the Thames Cancer Registry. The incidence rate in males doubled in the period from 2.0 to 4.4 per 100,000. In females the rate was much lower but the rate of increase over the period was similar to the increase in males. In both sexes the incidence increased sharply around the age of onset of puberty and decreased in older age groups. The biological mechanism of initiation of germ cell carcinogenesis is similar in males and females and probably occurs with roughly the same frequency in the two sexes. In males, the initiated cell population is promoted by the normal action of adult sex hormones to form carcinoma in situ, consisting of many millions of cells. The incidence of testicular cancer is rate limited by the development of carcinoma in situ. The key difference between males and females, which may explain the different levels of incidence, is the much lower number of susceptible cells in females at the time of puberty.     

DIURNAL VARIATIONS IN PLASMA PROLACTIN, GROWTH HORMONE, CORTISOL AND BLOOD GLUCOSE IN LABILE DIABETES MELLITUS

In labile diabetes mellitus wihout ketoacidosis we have studied plasma prolactin levels and a possible causal connection between fluctuation in blood glucose concentration and plasma prolactin, growth hormone and cortisol levels. The hormone concentrations in plasma and blood glucose concentration were determined at 20 min intervals for a 24 h period in six male patients with insulin treated diabetes mellitus. Prolactin varied within the normal range but without any significant rise in relation to sleep in five out of the six patients. Growth hormone levels were low with superimposed secretory peaks. Plasma cortisol showed a normal diurnal rhythm. Blood glucose fluctuated as expected, but the variations and especially the falls in blood glucose to non-hypoglycaemic levels were not followed by increases in plasma hormone concentrations. No relationship could be demonstrated between the changes in the plasma concentration of prolactin, growth hormone and cortisol.     

Effect of vein pump activation upon muscle blood flow and venous pressure in the human leg

The effect of vein pump activation upon superficial venous pressure and blood flow in human skeletal muscle tissue was studied in 7 healthy subjects. Blood flow was measured in the anterior tibia muscle by the local ¹³³Xe washout technique. The subjects were placed on a steeply tilted couch in nearly erect position. The vein pump in gastroenemius-soleus muscles was activated by heel-raisings. and the anterior tibial muscle remained relaxed during this procedure. Blood flow in the resting anterior tibial muscle was constant before, during and after 20 heel-raisings per min. A more heavy exercise with 40 heel-raisings per min increased blood flow about 100%. This increase in blood flow was absent during venous stasis (40 mmHg), and in areas infiltrated with lidocaine. It is concluded, that intense dynamic exercise in gastrocnemius-soleus muscles, in erect humans, increased blood flow considerably in another crural muscle remaining in the resting state. The present study strongly suggests, that the observed increase in blood flow, was associated with a decrease in regional subfascial venous pressure to below the threshold level of the local sympathetic veno-arteriolar reflex.     

Posture-Dependent Chronotropic Effect of Carotid Sinus Massage

The hypertensive carotid sinus can be divided into cardioinhibitory (chronotropic) and vasodepressor components; the former can be evaluated by carotid sinus massage performed in the supine position. We present the case of a patient in whom the abnormal cardioinhibitory response could only be demonstrated while in the sitting position.     

Connexin abundance in resistance vessels from the renal microcirculation in normo‐ and hypertensive rats

The expression of connexins in renal arterioles is believed to have a profound impact on conducted responses, regulation of arteriolar tonus and renal blood flow. We have previously shown that in renal preglomerular arterioles, conducted vasomotor responses are 40% greater in spontaneously hypertensive rats (SHR) than in normotensive Sprague–Dawley (SD) rats. Because conducted vasomotor responses depend on the cell–cell communication mediated through gap junctions, we hypothesized that the increased magnitude of conducted vasomotor response in SHR is associated with an increased amount of connexins in renal arterioles. To test this hypothesis, the amount of connexin 37 (Cx37), Cx40 and Cx43 was assessed in renal arterioles from normo‐ and hypertensive rats using quantitative immunofluorescence laser confocal miscroscopy. To account for differences in genetic background, we included both normotensive Wistar–Kyoto (WKY) and SD rats in the study. In all three strains of rats, and for all three isoforms, the expression of connexins was predominantly confined to the endothelial cells. We found a significantly increased abundance (240 ± 17.6%, p<0.05) of Cx37 in arterioles from WKY compared with SD and SHR. This high abundance of Cx37 was not related to blood pressure because normotensive SD demonstrated a level of Cx37 similar to that of SHR. Additionally, we found no evidence for an increased abundance of Cx40 and Cx43 in renal arterioles of SHR when compared with normotensive counterparts.     

Pacing in a Patient with Ebstein''s Anomaly

We report a case of Ebstein's anomaly in which ventricular pacing was achieved by positioning a pacing lead in the enlarged right atrium. By placing the electrode in the atrialization of the right ventricle, an aggravation of tricuspid regurgitation that may result from catheter displacement of the valve leaflets is avoided.     

Tumor volume of colon carcinoma is related to the invasive pattern but not to the expression of cell adhesion proteins

Tumor volume increases during growth and due to tumor progression various mutations appear that may cause phenotypic changes. The invasive pattern may thus be affected resulting in a more disorganized growth. This phenomenon might be due to mutations in the genome of the adhesion proteins, which are responsible for the structural integrity of epithelial tissue. Tumor volume was assessed in whole mount sections of 33 colon carcinomas using Cavalieri's principle. Images from the entire invasive border were captured and used for calculating the irregularity of the border (Complexity Index). The expression of the adhesion proteins E‐cadherin, β‐catenin, Claudin 2 and Occludin was assessed after immunohistochemical staining of two randomly selected areas of the invasive front of the tumor. Statistical significance for differences in volume was obtained for tumor Complexity Index, tumor stage (pT) and lymph node status (pN). Expression of adhesion proteins was significantly perturbed in the tumors compared with normal mucosa but only infrequently correlated to tumor differentiation or invasive pattern. The results show that when tumor volume increases the invasive pattern becomes more irregular which is compatible with tumor progression. A direct contribution of adhesion protein derangement to this process appears to be insignificant.     

Paroxysmal Dysarthria and Raynaud's Phenomenon in the Tongue

ABSTRACT Three patients suffering from systemic scleroderma and Raynaud's phenomenon in the digits as well as the tongue are reported. Following exposure to cold, a vasospasm was observed in the digits and the tongue accompanied by severe dysarthria. These striking oral symptoms had been overlooked for years in the medical ward. It is recommended to question all patients with Raynaud's phenomenon about visceral manifestations during the digital attacks.     

Effect and stage models in community intervention programmes; and the development of the Model for Management of Intervention Programme Preparation (MMIPP)

Recent years have seen the development of a number of diagrammatic‘models’ bearing on community intervention programmes.There have been two basic types, one involving actual or hypotheticalcausal relationships (effect, or how-it-works models) and theother, sequences of activities or events (stage, or how-to-do-itmodels). A selection of such models, with their roots in differenttheories of social change, health education and health promotion,are reviewed in the light of this distinction. Both types ofmodel are important. Existing stage models for health promotion programmes implyan ordered or cyclical set of activities, in which preparationis followed by implementation, maintenance, evaluation and revision.In the second part of the paper a new and more detailed typeof stage model is presented for the preparatory phase. In practice,this phase involves a series of parallel but interdependentactivity streams. These add up to a complex process that needsto be carefully planned and managed. In such circumstances itis important to be able to convey to the various people andorganisations involved how their different contributions meshtogether. The new model is designed to help with this. It hasbeen developed in the light of experience of planning community-baseddisease prevention programmes in Stockholm and elsewhere, withthe objective of making the lessons learned available for othersin a compact and accessible form.     

VASOACTIVE INTESTINAL POLYPEPTIDE (VIP) IN CHILDREN WITH NEURAL CREST TUMOURS

ABSTRACT. The concentration of vasoactive intestinal polypeptide (VIP) in plasma was measured in 22 children with neural crest tumours (NCT) during a 5-year period; the mean concentration of VIP in plasma was 22.5 pmol/l (interval 2.0-95.0 pmol/l). To establish a reference interval the plasma concentration of VIP was measured in 41 children without tumours; the mean concentration of VIP in plasma was 6.2 pmol/l (interval 0.5-19.0 pmol/l). Of the 22 children with NCT 16 had a plasma concentration of VIP within the normal range while 6 children (27%) had elevated plasma concentration of VIP between 28 and 95 pmol/l. Only one child, whose plasma concentration of VIP was 95 pmol/l had diarrhoea. Elevated plasma concentration of VIP in children with NCT but no diarrhoea has not previously been described. The urinary excretion of vanillylmandelic acid (VMA) was increased in 18 of the children with NCT (82%). In 2 of the children with normal excretion of VMA the concentration of VIP in plasma was elevated. Thus, the plasma concentration of VIP may be a supplement to VMA as a tumour marker in some cases of NCT.