Malignant epithelial tumours in the upper digestive tract: a dietary and socio-medical case-control and survival study.

OBJECTIVE: The aim of the present study was to elucidate the influence of social, dietary and environmental factors on the incidence of malignant epithelial tumours in the upper digestive tract and on the prognosis of patients with these cancers. DESIGN: A population-based case-control study was carried out, and the patients in the study were included in a survival analysis. SETTING: The study was carried out at the Department of Otorhinolaryngology at Ullevål University Hospital, Oslo, Norway. SUBJECTS: In the case-control study, 84 patients and 89 controls were included. Only the patients were included in the survival analysis. RESULTS: Smoking showed the highest odds ratio (OR) for morbidity (OR = 29). The patients had in general a lower social status, and a higher alcohol intake (OR = 6.6). For both beta-carotene and vitamin C, the ORs decreased with increasing intake (OR = 0.2 and 0.3, respectively). Increased ORs were associated with low values for haemoglobin, iron, TIBC, folic acid, magnesium and especially for albumin (OR = 14), and with high values for ferritin, vitamin B12 and thiocyanate (a marker for smoking). Stage of the disease was an important prognostic factor. The relative risk (RR) of dying for disseminated vs localised tumours being 3.2. A poorer prognosis was linked to higher age, to smoking vs no smoking (RR = 2.3), and to lower levels of haemoglobin, albumin, magnesium and thiocyanate. CONCLUSIONS: Strong beer, liquor, consumption of milk and table fat, low social status and smoking seemed to have a negative impact on both disease and survival. Fruit and vegetables might, however, reduce the risk. Whereas low serum albumin, iron and magnesium indicated a high OR for cancer, vitamin C and beta-carotene had the opposite implication. No significant implications on survival could be detected in blood chemistry beyond the stage of disease.

Cardiovascular risk factors: interactive effects of lipids, coagulation and fibrinolysis.

In western societies cardiovascular disease accounts for approximately one of every three deaths, and is a major contributor to chronic debiliation. During the last years our knowledge of factors that contribute to the development and progression of this disease has increased markedly. Elevated serum total cholesterol, hypertension and cigarette smoking are "traditional", well-known risk factors. In addition, low serum levels of high density lipoprotein (HDL) cholesterol predispose to development of disease, whereas in epidemiological studies the role of increased triglycerides is more controversial. During the last years derangements in several haemostatic components in persons who develop cardiovascular disease have been observed. Such alterations include increased plasma concentrations of fibrinogen, Factor VII coagulant activity and plasminogen activator inhibitor-1 (PAI-1). Furthermore, interactions between lipoproteins and haemostatic factors are gradually being disclosed. Serum triglycerides have been shown to correlate both to PAI-1 and to Factor VII. The lipoprotein (a), first described by Berg in 1963, also appears to be a link between lipoprotein metabolism and fibrinolytic function. In addition, linkages are observed between high triglycerides, low HDL cholesterol, reduced glucose tolerance, hyperinsulinemia, obesity, low physical activity, reduced fibrinolytic capacity and increased Factor VII. This clustering of risk factors has been suggested to be a coronary risk syndrome and has been called Reavens syndrome, syndrome X and insulin-resistance syndrome. A more descriptive name, athero-thrombogenic syndrome (ATS), has recently been suggested, thereby indicating that both atherosclerosis and thrombosis contribute to its development.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term effects of doxazosin and atenolol on serum lipids and blood pressure in hypertensive smokers.

On the basis of a 1-year double-blind comparative study of doxazosin and atenolol in hypertensive patients, we have previously described sustained and significantly different drug effects on the blood lipid profile. The present paper presents a retrospective analysis of the smoking subgroups for each drug regimen, for both the original 12-month double-blind period and for a further 12-month open-label period. The changes in blood lipids were qualitatively and quantitatively similar in both the smoking subgroup and in the full study population (smokers and non-smokers). In the hypertensive smokers doxazosin increased high-density lipoprotein (HDL) cholesterol (+9.4%) and decreased triglycerides (-10.9%) whereas atenolol had the opposite effect, decreasing HDL cholesterol (-5.6%) and increasing triglycerides (+20.7%). The antihypertensive effects of doxazosin (n = 24) and atenolol (n = 23) were comparable over 24 months of treatment. Eighteen (75%) doxazosin and 17 (73.9%) atenolol patients reached the blood pressure goal (sitting diastolic blood pressure less than or equal to 90 mmHg with at least a 5-mmHg reduction, or a greater than or equal to 10-mmHg reduction from baseline). As a consequence of the lowered blood pressure and favourable lipid changes, doxazosin decreased the risk of coronary heart disease (as calculated from the Framingham risk equation) by -24.4% (P less than 0.05). However, the calculated risk was not significantly reduced by atenolol (-2.1%). It is concluded that the smoking status of the patient has no obvious implications for the safety, efficacy or metabolic effects of doxazosin.

Selective alpha 1 inhibition with doxazosin in hypertensive smokers and non-smokers: haemodynamic and metabolic effects.

Hypertensive cigarette smokers have an especially high risk of coronary heart disease. Doxazosin, which has beneficial effects on haemodynamic factors and lipid metabolism, may be suitable for treating these patients. The haemodynamic and metabolic effects of doxazosin were investigated in a 16-week open, parallel, comparative study of 64 heavy cigarette smokers and 69 non-smokers after a 4-week placebo period. Of the 133 patients who entered, six patients (one smoker and five non-smokers) withdrew due to adverse events. Doxazosin significantly reduced blood pressure without reflex tachycardia in both the smokers and the non-smokers. The therapeutic success rates (reduction in sitting diastolic blood pressure to less than or equal to 90 mmHg and greater than or equal to 5 mmHg reduction, or greater than or equal to 10 mmHg reduction from baseline) were similar for the smokers (93.3%) and the non-smokers (92.5%). Doxazosin significantly decreased total cholesterol and low-density lipoprotein (LDL) cholesterol, but increased high-density lipoprotein (HDL) cholesterol and the HDL:total cholesterol ratio in both smokers and non-smokers. Doxazosin corrected the reduction in HDL cholesterol caused by smoking; compared with baseline, doxazosin increased HDL cholesterol by 19% in hypertensive smokers. The beneficial effects of doxazosin on blood pressure and the lipid profile were apparent in the change in the 10-year probability of developing coronary heart disease as calculated by the Framingham equation; the calculated risk of coronary heart disease decreased by 39% in smokers and by 33% in non-smokers. Plasma fibrinogen and plasminogen activator inhibitor, which independently contribute to atherosclerosis, were significantly reduced by doxazosin in the non-smokers but not in the smokers.

[Routine determination of both hemoglobin and hematocrit is not necessary]. / Unødvendig med rutinemessig bestemmelse av både hemoglobin og hematokrit.

It is a well known fact that the haemoglobin concentration and haematocrit vary in proportion to one another in most clinical situations. Therefore routine, simultaneous measurement should not be necessary. In 400 consecutive patients' blood samples, a strong correlation between the two variables is demonstrated. Routine, simultaneous measurement of the haemoglobin concentration and haematocrit increases the workload and should be avoided.

[Chemical determination of blood in gastric contents]. / Kjemisk påvisning av blod i mageinnhold.

The chemical tests used to determine blood in faeces and urine have not been recommended for determining blood in gastric contents, since highly acidic samples may give false-negative reactions. Based on model studies this article states that, in most cases, ordinary chemical tests for faecal blood may also prove useful for determining blood in gastric materials.

The early follow-up of 131I-treatment of thyrotoxicosis.

No general agreement exists concerning the optimal time for the first control of patients treated with 131I for thyrotoxicosis. Ten consecutive cases were followed clinically, and current laboratory thyroid tests were frequntly performed during a 14 week period to point out the optimal control time and the best setup of control parameters for such patients. It is concluded that clinical examination, supplied with T4, T3, T3-test, and TSH determinations 12--14 weeks after therapy seems rational as a first step in the lifelong follow-up of these patients.

Rapid diagnostic tests for glucosuria are still influenced by ascorbic acid.

The influence of ascorbic acid on commercial rapid diagnostic tests for glucosuria is demonstrated in vitro. Although much work has been done to stabilize the tests against such interference, and although manufacturers of tests trips declare their products now to be fairly stable against ascorbic acid 'at higher glucose levels', all the investigated commercial rapid diagnostic tests for glucose at the lower pathological range of glucosuria were substantially influenced by ascorbic acid at potentially physiological concentrations.

Ascorbic acid and test strip reactions for haematuria.

The inhibitory effect of ascorbic acid on commercial test strip reactions for haematuria is demonstrated in vitro. A new test strip containing iodate is shown to be insensitive to even high ascorbic acid concentrations in the same in vitro experiments.

A 5-year comparison of doxazosin and atenolol in patients with mild-to-moderate hypertension: effects on blood pressure, serum lipids, and coronary heart disease risk.

The long-term efficacy and safety of once-daily treatment with doxazosin or atenolol were compared in a 5-year study in patients with mild-to-moderate hypertension. The study consisted of a 1-year, multicenter, double-blind, parallel-group phase, followed by a 4-year, open-label extension phase. Of the 228 patients enrolled, 100 patients (54/111 doxazosin and 46/117 atenolol) completed the 5-year study. Both treatments were similarly efficacious in controlling blood pressure. As assessed by the Framingham risk equation, which incorporates lipid parameter values, patients receiving doxazosin had significantly less chance of developing coronary heart disease (CHD) within 10 years compared with those patients receiving atenolol (p < 0.05). Doxazosin significantly (p=0.0005) reduced the mean CHD risk from baseline to final visit by 12.3%; whereas, atenolol produced essentially no change in mean risk (0.2% increase). In patients receiving doxazosin, statistically significant (p < 0.05) increases from baseline were observed in serum concentrations of high-density lipoprotein (HDL) cholesterol and the HDL/total cholesterol ratio during the first 2 and 3 years of treatment, respectively. In contrast, significant (p < 0.05) percent reductions from baseline in both these lipid parameters were seen in atenolol-treated patients during most of the 5-year trial. Between-group differences were statistically significant (p < 0.01) at all time points. Decreases in total cholesterol were similar between the two treatment groups. Triglycerides, however, significantly increased with atenolol treatment (p < 0.0001 vs baseline) while remaining essentially unchanged with doxazosin treatment. The safety profiles of doxazosin and atenolol were comparable. Thus, while demonstrating similar antihypertensive efficacy and safety during this 5-year study, once-daily treatment with doxazosin produced a significantly greater beneficial effect on both 10-year CHD risk and serum lipid parameters compared with atenolol.

A comparison between haematological parameters in 'capillary' and venous blood samples from hospitalized children aged 3 months to 14 years.

In 16 hospitalized children aged 3 months to 14 years EDTA-blood samples were taken simultaneously from an anticubital vein and from a finger tip. Haematological measurements were subsequently performed in an Ortho ELT 800/WS analyzer. The thrombocyte count and the red cell indices were nearly identical in the two sets of samples. The 'capillary' erythrocyte count, haematocrit and haemoglobin values exceeded those of venous blood by 2%, and the mean 'capillary' total leukocyte count by about 20%. The relative frequency of lymphocytes, granulocytes and mononuclear cells did not alter between the two sets of samples. The significant differences demonstrated may in certain clinical settings be of medical importance. Their possible explanations are discussed.

[New, simple and sensitive urinary and blood pregnancy tests. A market study with special reference to the diagnosis of extra-uterine pregnancies]. / Nye, enkle og følsomme svangerskapstester for urin og serum. En "markedsundersøkelse" med tanke på diagnostikken av extrauterin graviditet.

PIP: There has been a tremendous development in the area of simple pregnancy tests. Generally, the new products possess increased sensitivity, shorter analysis times and, not least, the tests can be used on serum samples. Since a number of early pregnancies end up being aborted (up to 65%), there is a continuing need for sensitive tests for detecting ordinary pregnancy with urine tests. These tests, which are preferably of the "plate type," should have a sensitivity of around 500 IE/1. They will show positive after 1-2 weeks following a missing menstruation cycle, when the greatest risk of abortion is over. These types are not further discussed here, since the emphasis in this study is on detecting ectopic pregnancy. The diagnostics/differential diagnostics regarding the increasing number of ectopic pregnancies have become a serious problem for surgical and gynecological wards, since serious medical emergencies can arise if detection is not made. Since pathological pregnancies often have abnormally low HCG production, there is great interest in finding sensitive, rapid and reliable tests for such situations. A trial was made in 1986 using 37 women in Aker Hospital, Norway for treatment of acute abdominal pains, and with possibly ectopic pregnancy. Their urine and serum was immediately deep frozen in portions and then tinted for examination. Final diagnosis was done with the aid of clinical observations, histology and HCG findings in the urine and serum samples using the reference method. Analysis was based on RIA, radio immunoassay. 5 Norwegian products were compared as to sensitivity, method of testing and cost. Results showed serum values for 10 non-pregnant subjects of between 10 and 23 IE/1, while corresponding serum values were around 5 or 6 IE/1. The HCG values of 5 patients with normal pregnancies showed a close correspondence between urine and serum values, with some individual variation. The HCG values of 10 patients with ectopic pregnancies had a much wider variation between corresponding urine and serum values, showing 7-10 for urine positive and 3-10 for serum positive. It was also found that the most sensitive urine tests gave positive readings with all the patients having ectopic pregnancy, while the less sensitive tests failed to the degree sensitivity declined. No false reactions were given with any of the tests, nor were there any false negatives because of the prosone phenomenon. The most sensitive brands tested were Neo-Pregosticon 75 Duoclon and Tandem Icon HCG.^ieng

[Correct handling of serum separating gel tubes is of significance]. / Viktig med korrekt bruk av "gelrør" til blodprøver.

We review the construction, handling, advantages and drawbacks of serum separator tubes. A study is reported, which demonstrates that serum potassium measurements are less reliable when gel-barrier sampling tubes are used incorrectly. We give guidelines for correct use of such equipment.