The early years of the CARE family planning and reproductive health program were geared primarily toward modern methods of contraception and providing services. However, new and fresh opportunities to address reproductive health awareness and natural family planning are now emerging as important options. In these programs, coordination and collaboration with other sectors such as food and nutrition, children's health and natural resource management, combined with more sophisticated approaches for assessing need and reaching communities with information, has resulted in more people being reached than ever before with appropriate options and opportunities for reproductive health awareness and care. There are examples of CARE projects from India, Peru and Nepal where activities which feature working across development sectors and engaging communities to address their individual and collective RH needs are featured. Ways to disseminate information about reproductive health are being broadened to include creative combinations of interpersonal, mass and folk media', whether it be an informal one-to-one counseling session with flipcharts, a community mobilization event, a multi-media campaign, or any combination thereof. Likewise, the target audience need not always be the women of reproductive age, not should the RH messengers always be the medical and public health professionals. What is critical in all of these instances is to craft strategies based on appropriate research and need, continuously monitor progress, refine approaches as necessary, track results and evaluate the process and impact of interventions leading to behavior change. The challenge is not insignificant, but the rewards to be reaped through the improved programs are clearly worth striving for.

Awareness↗

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Combined effects in toxicology--a rapid systematic testing procedure: cadmium, mercury, and lead.

A testing procedure is described for the assessment of the toxicological response (e.g., acute toxicity or mutagenicity) of any combination and number of chemical, physical, and biological agents, with no more effort for a particular combination than for a single agent. The method provides a simple, sensitive, and quantitative index of synergism, antagonism, and additivity, and it has been demonstrated experimentally in rats by determining the acute lethality of combinations of cadmium, mercury, and lead salts. In a combination of two metal salts, the dose of one metal of the pair was fixed at or near the no-effect level while the dose of the second metal was increased until the entire dose-response curve was obtained. To evaluate interactions of the three metals, the previous pair of metals were kept fixed at their combined extrapolated LD1 level, and the third metal was increased. The statistical treatment of the data employed a computer program that did not involve probit transformations, but rather the approximate linear relationship between the fractional response and the logarithm of the dose. A particular combination could be synergistic, antagonistic, or additive, depending on the relative doses employed. Generally, a combination was synergistic when the most toxic member was present at or near its LD1 dose in the presence of the much less toxic member; the same combination was protective when the least toxic member was present at or near its LD1 dose. The results clarify apparently contradictory reports regarding the biological effects of metal combinations. The application of the testing procedure to combinations of mutagens is described, and an example is cited involving, for a particular bacterial mutagen, a combination of N-methyl-N'-nitro-N-nitrosoguanidine with ethylmethanesulfonate.

Animals↗

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Prognostic significance of mutations in the p53 gene in superficial bladder cancer.

Bladder tumors as the most common urologic malignancy present mostly as superficial transitional cell carcinoma. Many patients with superficial bladder cancer have a good prognosis, however, may develop recurrences or progress to muscle invasive or metastatic disease. It is therefore important to find new markers associated with the biological behaviour of an individual tumor for identifying patients at risk for disease progression. Previous reports on the prognostic significance of p53 alterations in bladder tumors revealed conflicting results. The aim of our study was to evaluate p53 mutation analysis as an effective concept for the characterization of subsets of superficial bladder tumors differing in biological aggressiveness. Screening 66 amplified DNA from micro-dissected tumor cells by direct genomic sequencing p53 alterations were detected in 12%. We found no association between p53 status and tumor stage but a tendency to a higher mutation rate in more malignant tumors (G2 and G3) compared to G1 tumors and a higher recurrence rate in patients with a p53 mutation in the primary tumor after 24 months follow-up. We conclude a general low incidence of p53 mutations in superficial bladder cancer. Detectable p53 damage might be related to a more aggressive phenotype and a higher recurrence risk. Our results are discussed in the context of other studies reviewed from 1995-2000.

DNA Mutational Analysis↗

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Fetal fibronectin: a new screening-marker for bladder cancer?

Early detection of transitional cell carcinoma (TCC) of the urinary bladder is essential for effective treatment. While several serum markers have been evaluated, none have been widely accepted for practical clinical use. Thus, urinary markers have been introduced and investigated to detect the evidence of bladder cancer. But sensitivity and specificity range around 80% respectively. In a prospective study we evaluated fetal fibronectin in the urine of patients with TCC of the urinary bladder. The positivity of oncofetal fibronectin was measured in morning urine samples by membrane immunoassay. This FFN membrane immunoassay is a qualitative test, a solid-phase immunogold assay. A positive sample will result in a single spot after binding of the oncofetal fibronectin-immunogold complex to the membrane containing a monoclonal antibody specific to oncofetal fibronectin (FDC-6, which specifically recognizes III-CS region). The morning urine samples were collected from patients with TCC before they underwent transurethral resection (n=40, 34 non-invasive and 6 invasive carcinomas) and healthy controls (n=20). Oncofetal fibronectin was investigated in the surgical samples by immunohistochemistry (antibody FDC-6, APAAP technique). We found a positive result for oncofetal fibronectin in 38/40 patients with transitional cell carcinoma of the urinary bladder. Two patients with a small pTaG1-TCC showed negative results. In the urine of healthy controls no positive results were detected. Thus, there is a sensitivity of 95% and a specificity of 100%. The TCC was demonstrated as a source of oncfn. To our knowledge this is the first study showing that patients with an evident TCC have a demonstrable amount of oncofetal fibronectin in the urine. We conclude that a positive result is common in TCC-patients. The sensitivity and specificity of this test seems to be extraordinarily high. Because of the small number of cases further studies are required.

Adult↗

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Differentiation of multifocal renal cell carcinoma by comparative genomic hybridization.

Multifocality occurs in 12-22% of all renal cell carcinoma (RCC) cases. In order to differentiate multifocal RCC, we performed comparative genomic hybridization (CGH) and correlated the results with histopathological and clinical data. After histopathological examination of multifocal tumors, tumor areas were dissected from histopathological sections. Isolated DNA was amplified by DOP-PCR. CGH was performed according to standard protocols. Twenty cases were analyzed. In eight cases, at least one identical aberration was detected in the related tumors. Another eight cases showed different chromosomal changes in tumors of the same kidney. In the small additional clear cell tumors typical genetic alterations of clear cell carcinomas were detected whereas in the chromophilic tumors aberrations characterizing both adenomas and carcinomas were found. From these results we conclude that multifocal RCC represents a heterogeneous group of tumors. The malignant potential of small additional tumors in multifocal RCC cannot be excluded.

Carcinoma, Renal Cell↗

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The histopathological heterogeneity of small renal cell carcinoma.

BACKGROUND: Renal tumors resembling renal cell carcinoma but less than 3 cm in diameter historically have been regarded as adenomas because of their low frequency of metastases. However, this concept has been challenged, and it seems that all of these lesions should be considered carcinomas. Thus, the extent of radical surgery of these findings have been reconsidered, in view of the uncertainty regarding their malignant or benign nature. MATERIALS AND METHODS: 107 tumors 40 mm or less in diameter were accordingly divided into three groups and clinico- and histopathological criteria were correlated: group 1: 20 mm or less (n = 33), group 2: 21-30 mm (n = 28) and group 3: 31-40 mm (n = 43). RESULTS: Both lymph node metastases and distant metastases were well correlated with tumor size. Grade 1 renal cell carcinomas decreased in their frequency with an increasing tumor diameter. In grade 3 carcinomas an opposite result was found. With an increase of tumor size the frequency of venous involvement increases as well. Significant more multifocal malignant renal cell carcinoma were seen in renal cell carcinoma between 21-40 mm compared to tumors 20 mm or less in diameter. CONCLUSION: Although the metastatic potential and the biology of small renal tumors are not yet known, it seems that nephron-sparing surgery in patients with renal cell carcinoma more than 20 mm in diameter should only be performed when there is an absolute indication, such as bilateral carcinomas, single kidney or renal failure. The problem is that a long-term follow-up study is mandatory to justify partial nephrectomy as a nephron-sparing operation for renal cell carcinoma more than 20 mm in patients with normal function of the contralateral kidney.

Adrenal Gland Neoplasms↗

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Are renal cell carcinoma cells able to modulate the cytotoxic effect of tumor infiltrating lymphocytes by secretion of interleukin-6?

BACKGROUND: Interleukin (IL)-6 can suppress the cisplatin-induced induction of apoptosis in renal cell carcinoma (RCC) in vitro. There are reports on IL-6 secretion by tumor cells. MATERIALS AND METHODS: In supermatants of RCC cultures we measured IL-6 levels by a bioassay. In a videomicroscopic microcytotoxicity assay the immunomodulating effect of secreted cytokines on the cytotoxicity of tumor infiltrating lymphocytes (TIL) was studied. RESULTS: The IL-6 concentrations in 17 supematants of healthy renal cells tended to be higher than in the supernatants of tumor cell cultures. By immunostaining we detected IL-6 in 3/6 cell cultures from healthy renal tissue, in 12/22 tumor tissue samples, and in 8/18 tumor cultures respectively. Supernatants suppressing cytotoxic activity of TIL showed higher IL-6 concentrations in tendency. Suppression of cytotoxicity could also be induced by adding discrete concentrations of IL-6. CONCLUSIONS: IL6 secreted by tumor cells seems to be tumor protecting against cytotoxic TIL. Blocking this mechanism could be an additional approach in immunotherapy of RCC.

Apoptosis↗

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Educating the community.

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Acquired Immunodeficiency Syndrome↗

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[Results of perioperative antibiotic prophylaxis in orthognathic surgery].

Intraoral approaches are commonly used for the surgical correction of dysgnathia. Because of the massive contamination of these wounds, antibiotic therapy is considered necessary. In a study on an unselected patient population the benefit of perioperative short-term prophylaxis is compared with that of postoperative long-term treatment. The results have shown perioperative short-term prophylaxis with penicillin to be extra-ordinarily effective vis à vis long-term treatment with oxytetracycline. Inflammatory complications did not occur, whereas in a control group they were observed in almost one fifth of the patients. In addition, this form of short-term prophylaxis is far more economical. The differences are statistically significant.

Humans↗

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Comparing the grief reactions of a rehabilitation patient and a psychiatric patient.

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Attitude to Death↗

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[Mathematic principles for lip reconstructions].

Anthropometric measurements of the orofacial region were performed in 240 probands of 6 different age groups. The mean width of the orifice of the mouth was approximately equal to the interpupillary distance. The normal length of the lip arch was 6.6 cm and increased by a factor of 1.5 (10 cm) with the lips stretched. From these measurements a mathematic equation was derived and represented as a diagram. Thus, the amount of tissue required for the reconstruction of lip defects can be readily assessed.

Humans↗