Morphological abnormalities of the terminal neuromuscular apparatus in recent juvenile diabetes

Summary Muscle biopsies from eight cases of acute juvenile diabetes (a few weeks after the beginning of the disease) revealed well marked degenerative changes combined with vigorous regeneration of the terminal neuromuscular apparatus. This observation is in accordance with previous demonstrations of neurophysiological disturbances at this early stage of diabetes.

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Morphologische Anomalien der neuromuskulären Endplatte bei frisch entdeckten juvenilen Diabetikern

Zusammenfassung Muskelbiopsien von 8 Patienten mit akutem juvenilem Diabetes (einige Wochen nach Krankheitsausbruch) zeigten ausgeprägte degenerative Veränderungen mit kräftigen Regenerationserscheinungen an der neuromuskulären Endplatte. Diese Befunde stimmen mit früher mitgeteilten Beobachtungen neurophysiologischer Störungen dieses Frühstadiums des Diabetes überein.

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Anomalies morphologiques de l'appareil neuro-musculaire terminal dans le diabète juvénile récent

Résumé Dans huit cas de diabete juvénile aigu (quelques semaines après le début de la maladie) des biopsies musculaires ont révélé des modifications dégénératives bien marquées, associées á une puissante régénération de l'appareil neuro-musculaire terminal. Cette observation est en accord avec les démonstrations précédentes de troubles neurophysiologiques à ce stade précoce du diabète.

     

Incidence of breast cancer in Norwegian female radio and telegraph operators

Exposure to electromagnetic fields may cause breast cancer in women if it increases susceptibility to sex-hormone-related cancer by diminishing the pineal gland's production of melatonin. We have studied breast cancer incidence in female radio and telegraph operators with potential exposure to light at night, radio frequency (405 kHz-25 MHz), and, to some extent, extremely low frequency fields (50 Hz). We linked the Norwegian Telecom cohort of female radio and telegraph operators working at sea to the Cancer Registry of Norway to study incident cases of breast cancer. The cohort consisted of 2,619 women who were certified to work as radio and telegraph operators between 1920 and 1980. Cancer incidence was analyzed on the basis of the standardized incidence ratio (SIR), with the Norwegian female population as the comparison group. The incidence of all cancers was close to unity (SIR=1.2). An excess risk was seen for breast cancer (SIR=1.5). Analysis of a nested case-control study within the cohort showed an association between breast cancer in women aged 50 + years and shift work. In a model with adjustment for age, calendar year, and year of first birth, the rate ratio for breast cancer associated with being a radio and telegraph operator-in comparison with all Norwegian women born 1935 or later-analyzed with Poisson regression, was 1.5 after adjustment for fertility factors. These results support a possible association between work as a radio and telegraph operator and breast cancer. Future epidemiologic studies on breast cancer in women aged 50 and over, should address possible disturbances of chronobiological parameters by environmental factors.Mssrs Tynes, Andersen, and Haldorsen are with the Cancer Registry of Norway, Oslo, Norway. Authors are also affiliated with the Radiation Protection Authority, Østerås (Ms Hannevik, Mr Tynes), and the University of Oslo, Physics Department, Oslo, Norway (Dr Vistnes). Address correspondence to Mr Tynes, Norwegian Radiation Protection Authority, Pilestredet 46, N-0167 Oslo, Norway.     

Mortality from lung cancer in workers exposed to sulfur dioxide in the pulp and paper industry

Our objective in this study was to evaluate the mortality of workers exposed to sulfur dioxide in the pulp and paper industry. The cohort included 57,613 workers employed for at least 1 year in the pulp and paper industry in 12 countries. We assessed exposure to SO(2) at the level of mill and department, using industrial hygiene measurement data and information from company questionnaires; 40,704 workers were classified as exposed to SO(2). We conducted a standardized mortality ratio (SMR) analysis based on age-specific and calendar period-specific national mortality rates. We also conducted a Poisson regression analysis to determine the dose-response relations between SO(2) exposure and cancer mortality risks and to explore the effect of potential confounding factors. The SMR analysis showed a moderate deficit of all causes of death [SMR = 0.89; 95% confidence interval (CI), 0.87-0.96] among exposed workers. Lung cancer mortality was marginally increased among exposed workers (SMR = 1.08; 95% CI, 0.98-1.18). After adjustment for occupational coexposures, the lung cancer risk was increased compared with unexposed workers (rate ratio = 1.49; 95% CI, 1.14-1.96). There was a suggestion of a positive relationship between weighted cumulative SO(2) exposure and lung cancer mortality (p-value of test for linear trend = 0.009 among all exposed workers; p = 0.3 among workers with high exposure). Neither duration of exposure nor time since first exposure was associated with lung cancer mortality. Mortality from non-Hodgkin lymphoma and from leukemia was increased among workers with high SO(2) exposure; a dose-response relationship with cumulative SO(2) exposure was suggested for non-Hodgkin lymphoma. For the other causes of death, there was no evidence of increased mortality associated with exposure to SO(2). Although residual confounding may have occurred, our results suggest that occupational exposure to SO(2) in the pulp and paper industry may be associated with an increased risk of lung cancer.     

Body mass index and mortality: the influence of physical activity and smoking

PURPOSE: To study the association between body mass index (BMI) and mortality, and to evaluate the effect of physical activity during leisure time and smoking on this association in a general male population. METHODS: During 1974-1978, all men aged 35-49 yr living in three Norwegian counties were invited to a cardiovascular screening, and 87.1% attended and had their weight and height measured. Men with recognized cardiovascular diseases, diabetes mellitus, or cancer at screening were excluded. The cohort (N = 22,304) was followed for an average of 16.3 yr with respect to total and cause-specific mortality. RESULTS: During follow-up, 1909 men died. We found a J-shaped association between BMI and total mortality, and the form of association was similar for death from cardiovascular diseases. Although not statistically significant, a J-shaped association was also suggested in never-smokers. Irrespective of BMI level, ex- and never-smokers had lower mortality than current smokers. Obese smoking men had a relative risk of dying of 2.01 (95% CI: 1.29-3.11) compared with obese never-smokers, and a relative risk of 4.55 (95% CI: 3.34-6.20) compared with normal weight never-smokers (BMI 22-24.9 kg x m(-2)). Within each category of physical activity during leisure time, obese men had a similar increased relative risk of death compared with normal-weight individuals. However, the U- to J-shaped association between BMI and mortality seemed to disappear by increasing level of physical activity, but this finding was not significant. CONCLUSION: This study suggests a J-shaped association between BMI and total mortality, also when stratified on smoking habits and physical activity. The suggested linear trend in the most physical active men needs to be reassessed.     

A phase II study of ifosfamide, carboplatin and cisplatin in advanced and recurrent squamous cell carcinoma of the uterine cervix

BACKGROUND:: Discouraging response durations and long-time survivals haveso far been the result of cisplatin-containing combination chemotherapyagainst advanced or recurrent squamous cell carcinoma of theuterine cervix. In order to increase the platinum-based effectupon this tumor without an increase in the specific toxicityof cisplatin, we combined it with carboplatin, added ifosfamide,which has been shown to possess a comparable degree of single-agentactivity. PATIENTS AND METHODS:: Thirty-six patients with advanced or recurrent squamous cellcarcinoma of the uterine cervix not curable by radiation orsurgery were treated with a combination of ifosfamide 1.5 gr/m²i.v. days 1–3, carboplatin 200 mg/m² i.v. day 1, and cisplatin50 mg/ml² Thirty-one patients were evaluable for response and34 patients for toxicity. RESULTS:: Twenty-three patients responded (64%), 11 (31%) of them completely,and 12 (33%) partially. Median response duration was 23 weeks(range 8–107 weeks), reaching 27 weeks and 21 weeks patientswith and without disease in previously irradiated areas, respectively.Median survival is 40 weeks (range 1–114 weeks). Toxicityconsisted mainly of moderate to severe myelosuppression, resultingin 2 toxic deaths. CONCLUSION:: The response rate, also for earlier irradiated areas, comparesfavorably with other known cisplatin-containing regimens. Thecombination deserves investigation in a randomized setting. Uterine cervical cancer, advanced, recurrent, chemotherapy     

Vascular decompression surgery for severe tinnitus: Selection criteria and results

Seventy-four patients were operated on within a period of 10 years to treat incapacitating tinnitus; 72 underwent microvascular decompression (MVD) of the intracranial portion of the auditory nerve, and 2 underwent section of the eighth nerve close to the brain stem. Of those who underwent MVD, 2 had no change in symptoms and later also underwent section of the eighth nerve near the brain stem. Two patients did not return for follow-up. Of the 72 remaining patients, 13 (18.1%) experienced total relief from tinnitus, 16 (22.2%) showed marked improvement, 8 (11.1%) showed slight improvement, 33 (45.8%) had no improvement, and 2 (2.8%) became worse. The patients who experienced total relief and those who showed marked improvement had experienced their tinnitus for an average of 2.9 years and 2.7 years, respectively; those who showed slight improvement and those who had no improvement had experienced their tinnitus for a longer time before the operation (mean, 5.2 and 7.9 years, respectively). Of the 72 patients who were operated on and followed, 32 were women. Of these, 54.8% experienced total relief from tinnitus or marked improvement, while only 29.3% of the men showed such relief or improvement. Selection of the patients for operation was mainly based on patient history and, to some extent, on auditory test results (brainstem auditory evoked potentials [BAEP], acoustic middle ear reflexes, and audiometric data).     

Precise antrectomy

A follow-up study of 108 patients 2–8 years after precise antrectomy for gastric ulcer showed no ulcer recurrences. The frequency of complications was similar to that following conventional resections. Biopsies taken at gastroscopy at the time of follow-up showed permanent removal of all functioning antral mucosa; no gastrin-producing cells could be recovered from any part of the gastric remnant. There was a close relationship between gastric acid secretion and the incidence and spreading of chronic atrophic gastritis in both resected specimens and biopsies. Following precise antrectomy alone, acid secretion was reduced considerably 3 months postoperatively, and the reduction was unchanged at the time of follow-up. In patients with a high preoperative insulin-stimulated acid secretion, precise antrectomy plus vagotomy reduced acid secretion significantly more than precise antrectomy alone. Besides producing a decrease in acid secretion, the advantage of precise antrectomy appears to be that the target area for recurrent gastric ulcer is permanently removed.

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Résumé Nous n'avons observé aucune récidive chez 108 malades suivis pendant 2–8 ans après une antrectomie à limites précisées pour ulcère gastrique. La fréquence des complications a été comparable à celle des résections usuelles. Des biopsies prélevées par gastroscopie lors du follow-up ont montré que toute la muqueuse antrale fonctionnelle avait bien été réséquée: elles n'ont jamais révélé aucune cellule productrice de gastrine. Les pièces opératoires et les biopsies ont montré une corrélation étroite entre sécrétion chlorydrique, fréquence et étendue de la gastrite chronique atrophique. Après antrectomie à limites précisées, la sécrétion d'acide est considérablement réduite au 3ème mois postopératoire, et cette réduction persiste dans le follow-up. Chez les malades qui ont, avant l'opération, une riposte sécrétoire importante à la stimulation insulinique, la réduction est plus marquée après vagotomie et antrectomie qu'après antrectomie seule. Un avantage de cette antrectomie à limites précisées semble être, outre la réduction de la sécrétion chlorydrique, la résection de toute la zone de muqueuse où une récidive ulcéreuse est susceptible de se produire.

     

Cancer of the gastrointestinal tract and exposure to asbestos in drinking water among lighthouse keepers (Norway)

Objective Previous studies of predominantly ecological design have indicated a possible elevation of gastrointestinal cancer risk in population groups exposed to drinking water contaminated with asbestos from natural sources or asbestos–cement containing water pipes. In the present study the possible effect of ingested asbestos fibers on gastrointestinal cancer risk was investigated in an occupational group where a proportion of the employees was exposed to asbestos in their drinking water.Method A cohort of 726 lighthouse keepers first employed between 1917 and 1967 were followed up for cancer incidence from 1960 to 2002. The standardized incidence ratio (SIR) was calculated as the number of new cancer cases divided by the expected number based on five-year age and sex specific incidence rates in the general rural population of Norway. A 95% confidence interval (CI) was calculated for all SIR values assuming a Poisson distribution of the cancer cases.Results Risk of stomach cancer was elevated in the whole cohort (SIR: 1.6, CI: 1.0–2.3), in the subgroup with definite asbestos exposure (SIR: 2.5, CI: 0.9–5.5), and when the group was followed for 20 years and more after first possible exposure (SIR: 1.7, CI: 1.1–2.7). Less consistent results were found for colon cancer; SIR was 1.5 (CI: 0.9–2.2) overall, 0.8 (CI: 0.1–2.9) among the exposed, and 1.6 (CI: 1.0–2.5) twenty years and more after first possible exposure.Conclusion The results support the hypothesis of an association between ingested asbestos and gastrointestinal cancer risk in general and stomach cancer risk specifically.