Periodic health examinations. Why? What? When? How?

Pulmonary blastoma is now accepted as a distinctive neoplasm. It remains rare, and only 28 cases have been reliably recorded. A further two cases are now reported, and the previous literature is reviewed. There are no specific clinical or radiological features of pulmonary blastoma. The presentation can be that of any other pulmonary tumour although a peripheral situation is usual and a large size is often attained before detection. Pulmonary blastoma is a mixed tumour with malignant epithelial and connective tissue components with a distinctive resemblance to fetal lung. The treatment of choice is surgical excision but the overall prognosis is poor. It is doubtful whether the tumour has a true blastomatous origin.     

Posttraumatic Budd-Chiari syndrome treated with thrombolytic therapy and angioplasty

In this study we compared the frequency and pattern of p53 mutations in 34 bladder tumors from people with high-level occupational exposure to arylamines to those in 30 bladder tumors from people without such exposure. No differences were observed for p53 mutations between the two groups. The frequency of mutation was similar at 47% for arylamine-exposed individuals and 53% for unexposed individuals and showed a similar pattern of mutation, with GC to AT transitions accounting for the majority of the mutations in both groups. This finding suggests that arylamine exposure does not leave a mutational "footprint" in the p53 gene. However, compared to other tumors, bladder tumors from both exposed and unexposed individuals had a high frequency of multiple mutations and it is interesting that these mutations were highly concordant. We suggest that one explanation of this pattern of mutations could be from decreased DNA repair fidelity within tumor cells. The frequency of mutation in p53 is closely linked to tumor grade and stage and so may be a late event in the development of bladder tumors.     

pH in human tumor xenografts and transplanted rat tumors: effect of insulin, inorganic phosphate, and m-iodobenzylguanidine

Various strategies to improve the therapeutic index of anticancer agents aim at inducing, by stimulation of aerobic glycolysis, temporary pH differences between malignant and normal tissues which can be exploited to activate cytotoxic agents selectively in tumors. We have investigated whether the pH reduction induced by glucose, the "drug" commonly used to increase lactic acid production in malignant tissues, can be augmented by pharmacological manipulation of tumor cell glycolysis. At normal plasma glucose concentration (6 +/- 1 mM), inorganic phosphate, a modifier of hexokinase and phosphofructokinase activity, had no effect on pH in two transplanted rat tumors and a human tumor xenograft line (average pH, 6.80; range, 6.65-6.95). When plasma glucose concentration was raised to 30 +/- 3 mM by i.v. infusion of glucose, inorganic phosphate reduced the pH in those tumors which exhibited only a moderate pH response to glucose per se (mean pH, 6.60) to an average value of 6.20 (range, 6.05-6.35). In the same setting, insulin, continuously infused at dose rates up to 600 milliunits/kg body weight/min, did not result in acidification of tumor tissue exceeding that induced by glucose alone. However, the H+ ion activity in both transplanted rat tumors and human tumor xenografts was increased by m-iodobenzylguanidine (MIBG), an inhibitor of mitochondrial respiration. For example, at normoglycemia, MIBG reduced the mean pH in a human mesothelioma xenograft from 6.90 to 6.70. This pH value was further reduced to 6.20 by simultaneous low-dose i.v. glucose infusion (plasma glucose concentration, 14 +/- 3 mM). The acidosis induced by inorganic phosphate and MIBG was tumor specific. Normal tissues of tumor-bearing hosts were only marginally sensitive to hyperphosphatemia or MIBG administration. These results indicate that the known stimulatory effect of exogenous glucose on lactic acid production in malignant tumors in vivo can be further accentuated or, as in the case of MIBG, partially replaced by pharmacological manipulation of aerobic glycolysis using clinically established drugs.     

Dependence of rates of lipolysis, esterification, and free fatty acid release in isolated fat cells on age, cell size, and nutritional state

Rates of lipolysis, esterification, and free fatty acid release were estimated in isolated epididymal fat cells prepared from rats fed either ad lib. or with a restricted caloric intake. Basal and epinephrine- or theophylline-stimulated rates of lipolysis correlated positively with cell size in the ad lib.-fed group only. Rates of esterification, both basal and epinephrine-stimulated, correlated positively with cell size in the ad lib.-fed group but negatively in the caloric-restricted group. These findings indicate that nutritional factors can modify any possible influence of adipose cell size on lipolysis and esterification. On the other hand, in both groups of rats, epinephrine- and theophylline-stimulated rates of lipolysis correlated positively with the basal rates of lipolysis. Also, rates of esterification in the presence of epinephrine correlated positively with the basal rates of esterification, suggesting that stimulated rates of lipolysis and esterification are at least partly determined by the basal rates regardless of nutritional status. The activity of glycerokinase measured in homogenates of isolated fat cells, if applicable to intact fat cells, was sufficient to cause considerable underestimations of the basal rates of lipolysis (using glycerol production as an index). When lipolysis was stimulated, the potential errors of estimating lipolysis by glycerol production alone were negligible.     

Culture change and mental illness

A study of the relationship of culture change to the frequency of mental illness in the outpatient clinic in the city of Cairo indicates that rapid industrialisation tends to produce significantly higher rates of patients who were judged to have serious symptoms of depression especially among village migrants who moved from their villages to work in the city's factories. A suggestive explanation is that the higher rates of depression are a factor of the social disorganisation associated with moving from the village to the city.     

Hemodialysis in the treatment of severe hypercalcemia

Severe hypercalcemia is a life-threatening problem that requires prompt therapy. With the exception of diuresis, most forms of therapy are either ineffective, slow in action, or have major serious disadvantages. In some instances diuresis is relatively ineffective. As shown in this case report, hemodialysis with a dialysate low in calcium is rapidly effective in such instances and should be considered for patients with severe hypercalcemia while they are being prepared for surgery or while diagnostic studies are being performed.