Patients' and doctors' perception of long-term morbidity in patients with testicular cancer clinical stage I

Patient-based questionnaires were designed with the aim to identify and rank long-term somatic and psychosocial morbidity in patients with low-stage testicular cancer. A further intention was to compare patients' assessments with experienced doctors' general opinion on quality of life items in cured testicular cancer patients. In pilot study I, 103 tumour-free patients ranked items of physical and psychosocial morbidity after having had various kinds of treatment. Though the ranking procedure appeared to cause some difficulties amongst the patients and subsequently was abandoned, the results indicated considerable differences between the patients' and doctors' evaluations. In pilot study II patients were asked to score the different items. The questionnaire of pilot study II was completed by 107 patients from the Norwegian Radium Hospital (NRH) and 99 relapse-free patients from the Royal Marsden Hospital (RMH) with testicular cancer stage I at least 1 year after infradiaphragmatic radiotherapy (n = 94) or adjuvant chemotherapy (2 cycles,n=26), or patients who had been followed on the surveillance program (n = 86). A total of 93 doctors completed a similar questionnaire, thereby expressing their general opinion on long-term morbidity in comparable testicular cancer patients as seen during routine clinical follow-up. Both the irradiated patients and those on the surveillance program reported slight degrees of Raynaud-like phenomena, neurotoxicity and ototoxicity, most probably representing background morbidity in an age-matched general male population. Doctors tended to underestimate their patients' somatic morbidity, but often overestimated the degree of psychological distress, in particular in patients on the surveillance program. Significant differences between RMH and NRH patients with regard to sexual problems and to leisure time activity may be explained by cultural differences in the two countries. The items presented in the questionnaire used identify important issues for patients cured of testicular cancer which may be used in future multicentre trans-cultural studies assessing these patients' quality of life. This will provide sufficient data for psychometric testing and, together with the findings from patients' free comments, support the final design of a testicular cancer quality of life module.     

Internal and external quality control in the toxicological analysis of blood and urine samples in the Federal Republic of Germany

Summary Due to a technical rule for dangerous agents (TRGS 410), issued by the Ministry of Labor in the Federal Republic of Germany in 1979, toxicological analyses in biological materials must be carried out under conditions of statistical quality control. This quality-control scheme provides internal and external control programmes. For internal quality control, the results of many years of experience with five commercially available control specimens and one home-made control have been evaluated. The control samples showed good, comparable results over a long period. Except in a few cases, there was good agreement between our results and the assigned values. Since 1982, the German Society of Occupational Medicine has offered eight intercomparison programmes for external quality. In samples from 80–90 laboratories, 6 metals in blood and around 20 inorganic and organic parameters in urine in 2 concentration adjustments have been analysed. Successful participation was certified if both results obtained for one parameter were within the tolerance range (assigned] value ± 3 SD). The average success rate was around 60%.     

Exposure to soluble barium compounds: an interventional study in arc welders

Summary Soluble barium (Ba) compounds are well-known toxicants. Intoxications are mainly known in an acute form from casual or suicidal oral ingestion. No scientifically based data are available on possible health effects of inhalative exposure to soluble Ba salts at the workplace. Therefore, we investigated 18 welders in an interventional study over 1 week. They performed welding of Ba-containing stick electrodes and self-shielded flux cored wires under conditions similar to real working conditions. The welding fumes contained 31%–37% Ba, more than 90% of which was soluble in acids. Without appropriate preventive measures, a high rate of measurements exceeded the TLV values for total welding fumes of 5 mg/m³ and for soluble Ba of 0.5 mg/m³. The median fume concentrations were 13.2 mg/m³ in stick electrode welding and 12.3 mg/m³ in flux cored wire welding. The median Ba concentrations were 4.4 and 2.0 mg/m³ respectively. An integrated exhaust system built into the gun proved to be efficient in flux cored wire welding. The internal exposure to Ba reached median urine levels up to 101.7 g/l (normal: below 20 g/l) and median plasma concentrations of up to 24.7 g/l (normal: below 8 g/l). No health impact on the welders could be proven, but hypokalemia may have occurred as a result of the Ba exposure.     

Preparation of cell-free feline oncornavirus-associated cell membrane antigen.

Cell-free feline oncornavirus-associated cell membrane antigen (FOCMA) was prepared from a feline lymphoblastoid cell line of tumor origin (FL-74). Membrane fractions, separated on sucrose density gradients, and papain-solubilized products were found to contain FOCMA as determined by their capacity to inhibit reference cytotoxic cat antisera.     

Die analyse von aluminium im serum und urin zur überwachung emonierter personen

Zusammenfassung Die Einführnung der flammenlosen Atomabsorptionsspektrometrie in die chemische Analytik ermöglicht eine einfache quantitative Bestimmung des Aluminiums im biologischen Material. Die verwendeten Analysen-methoden und deren Zuverlässigkeitskriterien wurden beschrieben. Entsprechend der heute üblichen Verfahren zur Überwachung schwermetallexponierter Personen wurden von uns bei verschiedenen Kollektiven Aluminiumbestimmungen im Blut und Urin durchgeführt. Untersucht wurde ein Kollektiv von 110 Arbeitern eines Korund-herstellenden und -verarbeitenden Werkes. 82 dieser Arbeiter waren durch staubförmigen Korund exponiert, während 28 Personen an den Öfen zusätzlich noch Metalldämpfen ausgesetzt waxen. Die Expositionsdauer betrug im Mittel 6,9 Jahre. Als Vergleichskollektiv dienten 40 männliche nicht aluminiumexponierte Probanden. Zusädtzlich wurden 33 Dialyse-Patienten, die mit Aluminiumhydroxid (Aludrox) therapiert wurden, in die Studie einbezogen.Für die Aluminiumausscheidung im Urin errechnete sich bei den Normalpersonen eine obere Normgrenze von 30 g/l. Die Ausscheidungswerte der aluminiumexponierten Personen lagen mit einem Median von 39 g Al/l signifikant höher als das Normalkollektiv. Erwartungsgemä zeigten die dampfförmig belasteten Personen einen statistisch signifikant höheren Al-Spiegel im Urin als die staubförmig belastete Gruppe.Die Serumanalysen ergaben keine Hinweise für einen signifikanten Unterschied gegenüber Normalpersonen. Aus den Untersuchungen der Seren von nicht aluminiumexponierten Probanden errechnete sich ein oberer Grenzwert von 35 g/l. Der Serum-Aluminium-Spiegel der exponierten Personen war von der Art und Dauer der Exposition nicht beeinflut. Dagegen lagen die Aluminium-Spiegel im Serum der Dialyse-Patienten im Bereich von 6 – 254 g/l. Bei dieser Patientengruppe mit erhöhten Serum-Aluminiumwerten wurden keine klinischen Zeichen einer manifesten Toxicität gefunden. Damit kommt den Aluminiumkonzentrationen im biologischen Material der aluminiumexponierten Arbeiter keine gesundheitsgefahrdende Relevanz zu.Bei der inhalativen Aufnahme von Aluminium scheint die Menge des resorbierten und in die Blutbahn übergehenden Aluminiums gering zu sein. Hinweise für eine Akkumulation des Metalls im Organismus wurde bei Versuchen mit D-Penicillamin nicht gefunden.Aluminiumbestimmungen im Serum oder Harn sind für die Überwachung von Korund-herstellenden und -verarbeitenden Personen nach diesen Ergebnissen nicht notwendig. Bei Substanzen, wie dem Aluminium, mit geringer Resorptions-quote und groer Toleranzbreite für den menschlichen Organismus sowie ohne manifeste signifikante Gesundheitsschäden erscheint ein Biological Monitoring nicht indiziert.D 29     

Sensitised locomotion does not predict conditioned locomotion in cocaine-treated mice: further evidence against the excitatory conditioning model of context-dependent sensitisation.

The excitatory conditioning model of contextual sensitisation proposes that the progressive emergence of the locomotion-activating effect of cocaine (or any other stimulant drug) characterising that phenomenon is due to a growing conditioned response (the test context cues) that mimics the unchanging unconditioned response (the drug effect). The present study aimed at verifying whether the relationship between the amplitude of sensitisation and the size of the conditioned response was positive, a direct implication of that view. Sensitisation to the locomotion-activating effect of cocaine (10 mg/kg, s.c.) was firstly generated over 10 daily sessions in 25 mice (strain C57Bl/6J), another lot of 25 mice receiving the same dose of cocaine outside of the testing context. Conditioned locomotion was assessed 24 h later. No significant linear correlations were found between the magnitude of the conditioned response and the magnitude of the sensitised response (delta scores), the rate of sensitisation (individual regression coefficients) or the magnitude of the initial unconditioned response to cocaine (scores in the first session of sensitisation treatment). Accordingly, there was no significant correlation between the magnitude of the initial unconditioned response and the magnitude of the sensitised response or that of the initial unconditioned response. Therefore, the conditioned response is neither necessary nor sufficient for the development of context-dependent sensitisation of the locomotion-activating effect of cocaine, a conclusion that refutes the excitatory conditioning model of that chronic effect.     

Hospital-related differences in breast cancer management

A retrospective review is presented of 1353 consecutivepatients with histopathologically confirmed invasive breast carcinoma treatedradically with curative intent during the decade 1980–89.None had received adjuvant systemic therapy with hormonesor prolonged chemotherapy. The distribution of lymph-node negative(N–) and lymph-node positive (N+) patients was 75%and 25%, respectively.The treatment and outcome were analysed as regardsconventional prognostic parameters, in particular considering the axillarylymph-node status and the responsible hospital category (GeneralMunicipal Hospitals (MH)) versus Comprehensive Cancer Center (CC)).The most striking difference was detected as regardsthe number of examined lymph nodes. The mediannumber of nodes described at the MH was7, as compared to 14 at the CC(p < 0.001). In patients with pT1 tumoursthe highest rate of lymph-node positivity was observedwhen 10 or more axillary nodes were removed.Adjuvant radiotherapy reduced the loco-regional recurrence rate inthe N– patients, whereas only the regional recurrenceswere reduced among the N+ patients. The five-and 10-year tumor-related survival rates were 86% and76%, respectively, with no difference between the MHand the CC.As life-prolonging adjuvant hormone therapy and chemotherapy isnow available for patients with axillary lymph nodemetastases, it is important that patients with breastcancer are operated adequately with the aim toremove at least 10 axillary lymph nodes. Athorough examination of the axillary content should beperformed by the pathologist, and the number ofresected lymph nodes and metastases should be reported.The establishment of nation-wide standard criteria for themanagement of breast cancer is recommended.     

Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.

OBJECTIVE: To assess the impact of introducing clinical practice guidelines on acute coronary syndrome without persistent ST segment elevation (ACS) on patient initial assessment. DESIGN: Prospective before-after evaluation over a 3-month period. SETTING: The emergency ward of a tertiary teaching hospital. PATIENTS: All consecutive patients with ACS evaluated in the emergency ward over the two 3-month periods. INTERVENTION: Implementation of the practice guidelines, and the addition of a cardiology consultant to the emergency team. MAIN OUTCOME MEASURES: Diagnosis, electrocardiogram interpretation, and risk stratification after the initial evaluation. RESULTS: The clinical characteristics of the 328 and 364 patients evaluated in the emergency ward for suspicion of ACS before and after guideline implementation were similar. Significantly more patients were classified as suffering from atypical chest pain (39.6% versus 47.0%; P = 0.006) after guideline implementation. Guidelines availability was associated with significantly more formal diagnoses (79.9% versus 92.9%; P < 0.0001) and risk stratification (53.7% versus 65.4%, P < 0.0001) at the end of initial assessment. CONCLUSION: Guidelines implementation, along with availability of a cardiology consultant in the emergency room had a positive impact on initial assessment of patients evaluated for suspicion of ACS. It led to increased confidence in diagnosis and stratification by risk, which are the first steps in initiating effective treatment for this common condition.