Methodological aspects of crossover and maximum fat-oxidation rate point determination.

AIM: Indirect calorimetry during exercise provides two metabolic indices of substrate oxidation balance: the crossover point (COP) and maximum fat oxidation rate (LIPOXmax). We aimed to study the effects of the analytical device, protocol type and ventilatory response on variability of these indices, and the relationship with lactate and ventilation thresholds. METHODS: After maximum exercise testing, 14 relatively fit subjects (aged 32+/-10 years; nine men, five women) performed three submaximum graded tests: one was based on a theoretical maximum power (tMAP) reference; and two were based on the true maximum aerobic power (MAP). Gas exchange was measured concomitantly using a Douglas bag (D) and an ergospirometer (E). RESULTS: All metabolic indices were interpretable only when obtained by the D reference method and MAP protocol. Bland and Altman analysis showed overestimation of both indices with E versus D. Despite no mean differences between COP and LIPOXmax whether tMAP or MAP was used, the individual data clearly showed disagreement between the two protocols. Ventilation explained 10-16% of the metabolic index variations. COP was correlated with ventilation (r=0.96, P<0.01) and the rate of increase in blood lactate (r=0.79, P<0.01), and LIPOXmax correlated with the ventilation threshold (r=0.95, P<0.01). CONCLUSION: This study shows that, in fit healthy subjects, the analytical device, reference used to build the protocol and ventilation responses affect metabolic indices. In this population, and particularly to obtain interpretable metabolic indices, we recommend a protocol based on the true MAP or one adapted to include the transition from fat to carbohydrate. The correlation between metabolic indices and lactate/ventilation thresholds suggests that shorter, classical maximum progressive exercise testing may be an alternative means of estimating these indices in relatively fit subjects. However, this needs to be confirmed in patients who have metabolic defects.

13-week drinking water toxicity study of hydrogen peroxide with 6-week recovery period in catalase-deficient mice.

A GLP OECD guideline study was conducted to evaluate the subchronic toxicity of hydrogen peroxide (HP) when administered continuously in the drinking water of catalase-deficient (C57BL/6N) mice and reversibility of toxic effects. Groups of mice (15/sex/group) received solutions of 0, 100, 300, 1000 or 3000 ppm HP in distilled water for 13 weeks; five/sex/group continued on untreated distilled water for an additional 6 weeks. Animals drinking 3000 ppm HP exhibited depressed water and food consumption and body weight. Females drinking 1000 ppm HP had reduced water consumption with intermittent effects on food consumption, but no body weight effects. HP administration did not produce any mortality, clinical signs, hematological effects or organ weight effects on brain, liver, kidneys, adrenals, testes, heart or spleen. Total protein and globulin were depressed among high dose males. Mild to minimal duodenal mucosal hyperplasia was noted in animals receiving 1000 and 3000 ppm HP and one male receiving 300 ppm for 13 weeks. There were no other histopathological findings. All effects noted during the treatment period, including the duodenal hyperplasia, were reversible during the 6-week recovery period. Females dosed with 300-3000 ppm HP during the treatment period showed increased water consumption during the recovery period. The no-observed-effect level (NOEL), based on duodenal mucosal hyperplasia, is 100 ppm in drinking water or 26 and 37 mg/kg/day HP, respectively, for males and females.

IRAG working group 5. Other assays. Interagency Regulatory Alternatives Group.

As part of the Interagency Regulatory Alternatives Group (IRAG) program to evaluate the state of the art in the development of alternative (non-whole animal) eye irritation tests, academic and industrial organizations were invited to submit in vitro eye irritation data generated in their laboratories to one of several working groups for review. The assays reviewed in this report (from Working Group 5. "Other Assays") were the EYTEX assay, tissue equivalent assay, a cytotoxicity assay using three-dimensional human fibroblast constructs, the Microtox assay, and other miscellaneous assays. Each submission consisted of raw data for chemicals and products tested, a description of the methodology, and an analysis (generally by regression analysis and Pearson's correlation coefficient) for the performance of the in vitro test relative to its ability to predict individual ocular tissue scores or total ocular score. In vivo data were generated according to the scoring methods proposed by Draize. Working Group 5 evaluated the submissions and commented on the utility of the assays. The variability of the in vivo data made conclusions difficult in many situations. Most of these assays were deemed useful (within limited chemical classes) for screening purposes or for use in conjunction with other toxicological information.

Skin irritation: Reference chemicals data bank.

A list of 176 chemicals, all of high or consistent purity and stable on storage, has been developed using available comprehensive in vivo rabbit skin irritation data. No new in vivo testing was conducted to qualify a chemical for inclusion in the list. The chemicals were tested undiluted in in vivo studies, apart from those chemicals where high concentrations could be expected to cause severe effects. The in vivo data were generated in studies carried out since 1981 according to OECD Test Guideline 404 and following the principles of Good Laboratory Practice. The data were obtained from tests normally using at least three rabbits evaluated at the same time, involving application of 0.5 g or 0.5ml to the flank under semi-occlusive patches for 4 hr, and in which observations were made at least 24, 48 and 72 hr after removal of the patch. The chemicals represent a range of chemical classes [acids, acrylates/methacrylates, alcohols, aldehydes, alkalis, amines, brominated derivatives, chlorinated solvents, esters, ethers, fatty acids and mixtures, fragrance oils, halogenated aromatics, hydrocarbons (unsaturated), inorganics, ketones, nitrites, phenolic derivatives, S-containing compounds, soaps/surfactants, triglycerides] and different degrees of irritancy. They are ranked for skin irritation potential on the basis of a 'primary irritation index'. These chemicals could be used in validation tests of promising alternatives to the in vivo rabbit skin irritation/corrosion test. This is an essential step in the progression to regulatory acceptance of alternative procedures.

Genotoxicity studies with chloroethane.

In a recent 2-year inhalation study with F344 rats and B6C3F1 mice conducted as part of the U.S. National Toxicology Program (NTP, 1989), chloroethane (ECl) at an exposure concentration of 15,000 ppm induced a high incidence of endometrial uterine carcinomas only in female mice but not in rats, leading to the conclusion of "clear evidence of carcinogenicity" for the mouse. In order to elucidate whether a genotoxic effect may be a critical factor for the carcinogenicity of ECl in the mouse, we have performed three genotoxicity tests: (1) in vitro HPRT test with CHO cells according to a specially developed gas protocol, (2) in vivo/in vitro UDS with female B6C3F1 mice at an exposure concentration of 25,000 ppm (6 h/day, 3 days), (3) in vivo micronucleus assay with male and female B6C3F1 mice exposed to 25,000 ppm ECl according to the same schedule. In the in vitro HPRT test a mutagenic potential of ECl was detected in the presence as well as in the absence of S9 mix. In contrast, both in vivo test systems failed to detect any indications of genotoxicity of chloroethane at an exposure concentration even higher than that of the NTP study. It is suggested that in vivo the genotoxic potential of ECl is so low that an assumed genotoxic damage is below the detection limit of the test systems used. This leads to the conclusion that genotoxicity may not be a key factor in the induction of the uterine carcinomas in the B6C3F1 mouse.

[Evaluation of locoregional anesthesia in an emergency-traumatology operating room]. / Evaluation de l'anesthésie loco-régionale dans un bloc de traumatologie d'urgence.

Surgical activities concerning traumatic emergencies have been evaluated during 3.5 months. There has been 371 cases. Most of them concerned hand injuries (48%); others concerned limbs, and 5 multiple injuries, one spinal fracture and 30 various injuries. Loco-regional anesthesia has been preferred in 63% of all cases; 80% of all hand injuries, 100% of all femoral neck fractures. The success rate--no addition of morphinics--has been evaluated at 85%, with use of sedatives in 28%.

[Evaluation of ambulatory anesthesia at CHU, Brest]. / Evaluation de l'anesthésie ambulatoire au CHU de Brest.

Outpatient anaesthesia was investigated for a two-month period by means of a questionnaire filled from the preoperative anaesthesia consultation to the surgical procedure and the discharge of the patient. 868 consultations led to schedule 260 ambulatory procedures. ENT (88 patients), paediatric surgery (73 patients) and gynaecology (63 patients) were most frequently concerned. Indications of ambulatory practice could probably be enlarged provided that recovery rooms and surgical schedules were fully adapted.

[Appendiceal carcinoid tumor of systematic detection. When to propose right hemi-colectomy and how to monitor? Thoughts apropos of a case and review of the literature]. / Carcinoïde appendiculaire de découverte systématique. Quand proposer une hémi-colectomie droite et comment surveiller? Réflexions à propos d'un cas et revue de la littérature.

In relation to a case of carcinoid tumor of the appendix discovered after appendectomy and already metastatic, we discuss the prognostic factors of these lesions. Size is the most important one. For tumors less than two centimetres diameter, site, mesoappendix and lymph node involvement do not fully summarize the aggressiveness of the disease. We would like to emphasize the poor prognosis of perineural involvement, especially for young patients, in order to discuss the indication for salvage right colectomy. A positive reaction to Neuron-Specific Enolase allows this enzyme to be proposed as a postoperative serum marker.

Effect of oral administration of 1,3-diphenylguanidine on sperm morphology and male fertility in mice.

An oral testicular toxicity and male fertility study was carried out in CD-1 mice with 1,3-diphenylguanidine (99.9% purity). 1,3-Diphenylguanidine was administered to male mice by daily gavage at dose levels of 0, 0.06, 0.25, 1, 4 and 16 mg/kg body wt. per day during an 8-week premating period. Females were not dosed at any time during the study. Sperm abnormality evaluation was performed in approximately half the males, randomly selected from the control and 16-mg/kg dose group on completion of dosing. The remaining males in the control, 4- and 16-mg/kg body wt per day groups were mated with non-dosed females. Reproductive performance, necropsy findings and litter data were recorded. No differences were found between control and dosed groups in body weight gain during the dosing period, macroscopic observations and organ weights at necropsy. Microscopic examination of the testes and determination of the frequency of total sperm abnormalities in the 16-mg/kg body wt per day group, did not show any effect due to 1,3-diphenylguanidine dosing when compared to the control group, except for a slight increase in sperm with folded tails but normal heads. Male and female fertility as well as reproduction performance were comparable in the groups examined (0, 4 and 16 mg/kg body wt per day). Maternal necropsy findings and litter data did not reveal any dose-related effect. It was concluded that under the conditions of the present study, 1,3-diphenylguanidine did not exert any significant adverse effects on fertility, reproductive capacity or embryonic/fetal development in CD-1 mice when administered to males at levels up to 16 mg/kg body wt per day.

Clinical and electrophysiologic effects of flecainide in patients with refractory ventricular tachycardia.

The electrophysiologic effects and antiarrhythmic efficacy of flecainide were evaluated by electrophysiologic study (EPS) in 20 patients with ventricular tachycardia (VT) refractory to an average 2.9 drugs. In 19 patients EPSs were performed with patients not receiving antiarrhythmic medications and receiving oral flecainide therapy at steady state (mean dose, 235 +/- 67 mg/day). Flecainide significantly increased the QRS complex duration (27%, P less than .001), PR interval (17%, P less than .001), and right ventricular effective refractory periods 8.5% and 21.1% (P less than .01) for the first and second extrastimuli, respectively. During baseline EPS, 17 patients were induced into VT and two were noninducible. Flecainide prevented EPS-induced VT in five patients and the induced VT became slow and hemodynamically stable in three. Two patients who failed flecainide monotherapy were induced into slow hemodynamically stable VT with flecainide in combination with amiodarone. The two noninducible patients, during baseline EPS, had suppression of spontaneous VT with flecainide. Overall, 13 of 20 patients received flecainide either alone or in combination with amiodarone for chronic therapy. Side effects encountered during the study consisted of blurred vision, dizziness, weakness, lethargy, nausea, worsened heart failure and bradyarrhythmias. After a mean 9-month follow-up (3 to 16 months) nine patients remain on flecainide therapy. There were three recurrences of slow, hemodynamically stable VT and no episodes of sudden death. Low-dose flecainide, either alone or in combination with other agents, is effective therapy for certain patients with refractory VT but heart failure remains a significant concern in patients with depressed left ventricular function.

A nonradioactive iothalamate method for measuring glomerular filtration rate and its use to study the renal handling of cibenzoline.

A high-pressure liquid chromatographic method was developed to measure nonradioactive iothalamate in serum and urine for use in estimating glomerular filtration rate (GFR). This method was used to study the renal handling of cibenzoline, an experimental antiarrhythmic drug. The mean cibenzoline clearance was 3.5 +/- 2.5 (SD) times the glomerular filtration rate. The clearance of non-protein-bound cibenzoline was seven times GFR, indicating excretion by the renal tubular secretory pathway for organic bases. This drug, at the doses used, did not lower creatinine clearance, indicating that the effect of basic drugs competing with creatinine for the base secretory pathway appears to be dose and drug dependent.

Epoprostenol sodium (prostacyclin) infusion in acute myocardial infarction.

Epoprostenol (prostacyclin) is a potent inhibitor of platelet aggregation and causes relaxation of vascular smooth muscle. These effects may be beneficial in patients with acute myocardial infarction. The effect of epoprostenol infusion in patients with acute myocardial infarction was evaluated in a randomised double blind study of 45 patients with evidence of myocardial infarction of less than 16 hours' duration. The patients were given a 72 hour infusion of epoprostenol (23) or placebo (22). The maximum dose was 5 ng/kg/min. The mean time to treatment was 8.3 hours (range 3.8-15.9 hours). The mean dose was 4.9 ng/kg/min. The patients were followed until day 30. No significant differences were found between the groups in mortality, development of congestive heart failure, cardiogenic shock, arrhythmias, recurrent chest pain, reinfarction, peak creatine kinase concentration, or the time taken to attain peak creatine kinase concentration. No significant difference in baseline ejection fraction was noted between groups, and no significant change in ejection fraction occurred within each group or between groups. The only significant side effect was the development of facial flushing in the epoprostenol group. In this pilot study epoprostenol was well tolerated by patients with acute myocardial infarction. No benefit from epoprostenol could be demonstrated at the dose range used when the drug was administered within 16 hours of the onset of symptoms.

[Spontaneous regression of regressive pulmonary metastases from kidney cancer. Myth or reality? Apropos of 2 cases]. / Régression spontanée de métastases pulmonaires régressives de cancer du rein. Un mythe ou une réalité? A propos de deux cas.

The authors report two cases of regression of lung metastases from renal cell cancer with cytological and histological proof. They present a complete review of the literature and analyse the theories proposed to explain this phenomenon.

Compliance and policy issues and recommendations related to revision of the National Interim Primary Drinking Water Regulations for Radionuclides.

This paper summarizes the deliberations and conclusions of the Compliance and Policy Committee of the National Workshop for Radioactivity in Drinking Water. Prior to and during the workshop the committee considered a total of 32 possible compliance and policy issues and determined that 22 were valid. The committee developed positions on seven of these and these positions are presented herein. The remaining 25 issues are also listed with the committee's evaluation of each.

[The anterior and transperitoneal approach in the surgery of the kidney and ureter]. / La voie d'abord antérieure et transpéritonéale dans la chirurgie du rein et de l'uretère.

Because of the variety of situations encountered in surgery of the kidney and ureter, the methods of approach to these organs need to be diversified. In this context, the authors discuss the place of the anterior and transperitoneal approach, based on a series of 573 cases. Its principal indications are: excision of large kidney tumours or pseudo-tumours, conservative treatment of hydronephrosis, removal of pelvic calculi, staged operations or operations on bilateral lesions, re-operations resulting in secondary nephrectomy or repair of the collecting system. The modalities, advantages and disadvantages are discussed and the authors stress the complications which may result from opening of the peritoneum. Overall, the anterior and transperitoneal approach, in the situations in which it is indicated, is an easy and safe operative technique, superior to the usual sub-peritoneal approaches. Its results are very satisfactory; they should overcome reservations which have surrounded this technique for so long and should give it a definite place beside the classical approaches, which nevertheless remain supreme.

Blue Cross/Blue Shield-sponsored prepaid individual practice.

The HMO is no longer a fledgling idea in the Blue Cross/Blue Shield System. There are 45 Blue Cross/Blue Shield Plans throughout the country which sponsor a total of 54 HMO programs with about 1,040,000 members. Among those 54 programs are staff models, group models, Individual Practice Associations (IPAs), and other structures. This analysis is confined to the Minnesota affiliate corporation, "HMO Minnesota."

Failure in passive transfer of immunoglobulin G1 to lambs: measurement of immunoglobulin G1 in ewe colostrums.

Concentrations of immunoglobulin (Ig) G1 were measured in 590 sera from 24- to 36-hour-old lambs, and failure in passive transfer (FPT), less than 6 mg/ml, occurred in 20 lambs. Of the 20 FPT lambs, 45% died before 3 weeks of age, whereas only 5% of the 570 lambs with adequate passive transfer died before 3 weeks of age. The low percentage of FPT was attributed to management practices ensuring suckling by the lambs and possibly to influences from several years of selecting ewes on the basis of weaned lamb production. The correlation between the concentration of IgG1 in 257 postpartum, presuckle ewe colostrum samples and the IgG1 concentrations in 362 lamb sera from those ewes was low (r = 0.32). However, the mean serum IgG1 concentration in 20 lambs from ewes with the lowest postpartum, presuckle colostrum IgG1 concentrations (less than 30 mg/ml) was significantly lower (P less than 0.001) than mean serum IgG1 concentration in 24 lambs from ewes with the highest postpartum, presuckle colostrum IgG1 concentrations (greater than 110 mg/ml). Postpartum, presuckle colostrum IgG1 was measured in 7 ewes whose lambs had FPT, and the IgG1 values varied throughout the colostrum IgG1 range. Colostrum IgG1 concentrations could not be used to explain FPT or to identify ewes likely to have lambs with FPT.