Increased risk of cancer at multiple sites after gastric surgery for peptic ulcer.

Of 5018 patients who had undergone gastric surgery at St James Hospital, Balham, at least 25 years ago, death certificates have been received for 2768, whilst 1746 patients are still alive and are flagged (Office of Populations, Censuses and Surveys (OPCS) will notify us of their death and its cause) and only 504 could not be traced. Mortality from cancers of various organs has been determined using a 'years at risk' calculation in five year bands. There was no increase in mortality risk from any cancers during the first 15 postoperative years, but from 20 years after operation there was a significant excess risk not only of cancer of the stomach (4.5-fold), but also of the large bowel (1.6-fold), bronchus (3.9-fold), pancreas (4.0-fold), biliary tract (9.1-fold), oesophagus (2.3-fold), bladder (2.4-fold), breast (4.0-fold), and cancer of all sites (3.3-fold). These findings are consistent with the production in the operated-upon stomach of circulating carcinogens with a 20 year latency period.     

Acute ureteral colic from an obstructing renal aspergilloma

Fungus balls of the renal collecting system are rarely of organisms other than Candida. A case of obstructing aspergilloma associated with acute ureteral colic is presented. The clinical features of this case are characteristic of renal aspergillomas in 10 additional cases described in the literature. Ten of the 11 patients were male. Each of the patients had an underlying disease that predisposed to fungal infection. Although all 11 patients were cured, diagnostic evaluation was often protracted as commoner causes of ureteral obstruction were excluded. Successful therapy required evacuation of the obstructing hyphal mass; open surgical procedures were necessary in five instances. Systemic amphotericin B should be reserved for patients with residual infection following removal of the fungus ball. This report emphasizes the need to consider aspergilloma in the differential diagnosis of acute ureteropelvic obstruction in the appropriate patient population.     

Comparison between a swim-up and a Percoll gradient technique for the separation of human spermatozoa

Two methods of separating human sperm were compared using twenty-two semen samples. The sperm were separated by a swim-up technique or by self-migration on a Percoll gradient followed by medium change. After separation, the sperm obtained were assessed for progressive motility, ATP content, energy charge index ([ATP + 0.5 ADP]/[ATP + ADP + AMP]) and morphology. In general, and especially for semen samples containing less than 20 X 10(6) sperm/ml, separation by Percoll gradient selected sperm that were superior to those separated by the swim-up technique. The relatively high energy charge index (greater than 0.8) showed that the sperm tolerated the separation conditions well. It is suggested that self-migration on a Percoll gradient should prove useful for obtaining sperm of high quality.     

Human factors in chemical containment laboratory design

A human factors engineering analysis of a chemical containment laboratory was performed to develop appropriate standards for future laboratory design. In order to perform this evaluation, a state-of-the-art facility was studied in depth. Measurements and observations were made of key operating areas. In addition, technicians were observed and interviewed as they performed various tasks. Compiled data were compared to existing ergonomic standards. The occupational implications of instituting ergonomically developed laboratory design standards are as follows: increased worker health, safety and productivity, improved work quality and reduced stress.     

Multidisciplinary evaluation of rat renal cell carcinoma

The rat renal cell carcinoma system as described by deVere White and Olsson in 1980 is used widely as a model for its human counterpart. The tumor arose spontaneously in a male Wistar Lewis rat and its behaviour has been shown to be stable during multiple passages. We have compared this tumor with the human renal cell carcinoma using a multidisciplinary approach. Light microscopy and electron microscopy showed a great resemblance of this rat tumor to a human renal cell carcinoma of the clear cell type with the ultrastructural presence of desmosomes. With the use of tissue specific antibodies against intermediate filament proteins, it could be shown that their expression is comparable to human renal cell carcinoma, i.e. coexpression of vimentin and different cytokeratins in the tumor cells. The cells could also be shown to contain cytokeratin 18. An aneuploid cell population in the tumor, expressing both vimentin and keratin, could be characterized by DNA flow cytometry in double labeling experiments. Comparison of normal and malignant rat kidney tissue by Northern blot analysis revealed increased levels of vimentin mRNA. In conclusion, this tumor model seems to have several histological and biological properties in common with the human renal tumor.     

Gangliosides of human melanoma: altered expression in vivo and in vitro

The ganglioside composition of human melanoma was analyzed in five sets of tumor specimens obtained directly from surgery, from the autologous tissue culture cell lines, and from the autologous cell lines grown in athymic nude mice. Total gangliosides of these 15 melanoma specimens were isolated and purified, and the amount of each component ganglioside was analyzed by thin-layer chromatography and a thin-layer chromatography scanner. The ganglioside composition of the five surgical melanoma specimens clearly exhibited different patterns from each other. Moreover, none of the autologous cultured melanomas possessed the same ganglioside composition as their original biopsied tumors. However, when these melanoma cell lines were transplanted into nude mice, the ganglioside composition was converted back to the same ganglioside pattern as in the original surgical specimens. The results support the view that changes in the ganglioside composition of melanoma during in vitro growth are caused by the culture environment rather than by selection of melanoma cells with a particular genotype. Reestablishment of the original ganglioside patterns after passage in nude mice provides clear evidence that in vivo expression of gangliosides is a conserved and stable function specified by the human melanoma cells.     

Heterogeneous epithelial expression of class II (HLA-DR) determinants and secretory component related to dysplasia in ulcerative colitis

The intensity and degree of heterogeneous epithelial marker expression were evaluated immunohistochemically in 29 mucosal biopsy specimens from 7 ulcerative colitis (UC) patients with dysplasia. Biopsy specimens from UC patients with mild (n = 7) or severe (n = 6) inflammation and from histologically normal samples (n = 7) served as controls. HLA-DR showed heterogeneous epithelial expression in all lesions with high grade dysplasia and in 6 of 8 with low grade dysplasia. SC was heterogeneous stained in 17 of 21 lesions with high grade dysplasia and in all but two lesions with low grade dysplasia. In histologically normal mucosa, SC was homogeneously expressed and epithelial DR was virtually absent. In mildly inflamed UC lesions, SC exhibited patchy distribution in only one sample and DR in two, whereas both SC and DR showed a slight degree of heterogeneous expression in all lesions with severe inflammation. Moreover, the overall intensity of SC staining tended to decrease with increasing degree of inflammation, whereas the opposite was seen for DR. Decreased SC and increased DR expression thus seemed to be related to intensified inflammatory activity, whereas heterogeneous expression of these markers was significantly more related to dysplasia.