Shoulder arthroplasty in patients with prior mastectomy for breast cancer.

Twenty women, all of whom had undergone mastectomy for breast cancer and 11 of whom had undergone radiation therapy, underwent shoulder arthroplasty. Two of these patients subsequently underwent resection arthroplasty for delayed infection and uncontrollable instability. Seventeen patients were available for follow-up, which averaged 4.6 years (range, 23 months to 13 years). There was significant improvement in pain (P < .0001), with no pain in 8, slight pain in 7, occasional moderate pain in 1, and moderate pain in 1 of the patients. A significant improvement in active motion occurred only in external rotation. Active elevation increased 7 degrees, from 92 degrees to 99 degrees; external rotation increased 17 degrees, from 25 degrees to 42 degrees; and internal rotation increased 1 level, to L3. All patients were pleased with their results. Complications were frequent. Apart from the 2 patients who underwent reoperation, 5 patients with preoperative lymphedema experienced exacerbation of their edema and 2 others developed new lymphedema. The edema returned to prearthroplasty levels or resolved in all patients by 5 months. In addition, antecubital vein thrombosis occurred in 1 patient, delayed long head of biceps rupture in 2 patients, and late rotator cuff tearing in 3 patients. In carefully selected patients, shoulder arthroplasty can be effective in pain reduction, but little increase in range of motion should be expected. Complications (often involving soft tissues) are frequent. New or increased arm edema can occur; however, edema resolved or returned to prearthroplasty levels in our patients.

The effects of growth factors associated with osteoblasts on prostate carcinoma proliferation and chemotaxis: implications for the development of metastatic disease.

The extensive mortality and morbidity associated with prostate cancer is caused by the high prevalence of metastatic disease at the time of diagnosis. The area most frequently involved in metastatic prostate cancer is the skeleton. Unlike other cancers, which metastasize to bone and destroy the bone matrix, prostate cancer is unique in that it is osteogenic, resulting in the formation of dense, sclerotic bone with high levels of osteoblastic activity. We proposed that factors produced by bone cells may be responsible for the development of prostate carcinoma metastasis. We studied the effects of these growth factors on prostate cell proliferation by [3H]thymidine incorporation and chemotaxis by the double-filter chamber method. Three prostate carcinoma cell lines were studied, LNCaP (androgen responsive) and PC-3 and DU-145 (androgen unresponsive). The bone-associated growth factors tested were: insulin-like growth factors I and II (IGF-I, IGF-II), transforming growth factor beta, interleukin (IL)-1 beta, IL-6, and tumor necrosis factor alpha (TNF-alpha), IGF-I and IGF-II significantly increased proliferation in all three cell lines, whereas IL-6, TNF-alpha, and IL-1 beta significantly decreased proliferation. Transforming growth factor beta induced a biphasic response in proliferation in DU-145 and PC-3 cells and produced no response on LNCaP cells. Increased cell chemotaxis occurred in the presence of IGF-I and IGF-II, and decreased cell chemotaxis occurred with the addition of TNF-alpha and IL-1 beta. These data indicate that growth factors produced by bone cells alter prostate carcinoma cell proliferation and chemotaxis and suggest that modulations of the production of these factors may be a potential therapeutic intervention in deterring the metastasis of prostate carcinoma to bone.

Effects of the calciotrophic peptides calcitonin and parathyroid hormone on prostate cancer growth and chemotaxis.

BACKGROUND: The most common site of metastases in prostate cancer is the skeleton and occurs in 70-80% of patients with prostate carcinoma. Calciotrophic peptides are important in the growth and development of normal bone matrix. METHODS: Three human prostate carcinoma cells lines, DU-145, PC-3, and LNCaP, were exposed to varying concentrations of parathyroid hormone (PTH) or calcitonin (CT). Cell proliferation and chemotaxis were assessed. RESULTS: Proliferation increased in LNCaP cells in a dose-dependent manner following treatment with PTH. Proliferation was not altered in PC-3 cells in response to PTH. Proliferation was decreased in DU-145 and PC-3 cells and increased in LNCaP cells after treatment with CT. Cell chemotaxis was increased in the presence of PTH in DU-145 and PC-3 cells compared to vehicle-treated controls. CONCLUSIONS: The combined proliferation and chemotaxis data suggest that PTH has a dual role in prostate carcinoma resulting in an increase in the number and migration of selected prostate cancer cells. With CT, chemotaxis was unchanged in the DU-145 and PC-3 cells and significantly elevated in the LNCaP cell line. The calciotrophic hormones, PTH and CT, may play an integral role in the regulation of prostate cell growth and metastases.

Biomarkers in styrene-exposed boatbuilders.

14 fiberglass-reinforced plastics (FRP) boatbuilders were compared with 9 unexposed controls with respect to several chemical specific and nonspecific biomarkers measured in peripheral blood. Biomarkers included styrene-hemoglobin adducts (styrene-Hb), sister-chromatid exchanges (SCEs), micronuclei (MN), single-strand breaks (SSBs) and N-acetoxy-2-acetylaminofluorene-induced DNA binding (NA-AAF binding) as a measure of susceptibility to DNA damage. Workers' exposures averaged 11 ppm (8-h TWA; geometric mean) and ranged from 0.6 to 44 p.p.m. Mandelic acid levels were measured in end-of-shift urine samples and reflected an average styrene exposure equivalent to 15 p.p.m. There was a large though not significant difference in levels of styrene-Hb adducts among exposed workers and controls, largely the consequence of a single heavily-exposed individual with an extremely high level of adducts. Significant differences between biomarker levels in exposed workers and controls were observed with MN, SSBs and NA-AAF binding. No significant differences were seen in mean levels of SCEs nor in the incidence of cells with a high frequency of SCEs. The data suggest that exposure to levels of styrene in occupational settings near or below the current OSHA standard (50 p.p.m.) can induce damage at the cellular/molecular level. Appropriately-selected panels of biomarkers can be useful in identifying potentially harmful exposures.

Sick-hospital syndrome.

An outbreak of complaints consisting primarily of eye and respiratory tract irritation accompanied by headache, dizziness, fatigue, and nausea occurred among the operating room personnel of a large metropolitan hospital. This initially was attributed to infiltration of diesel exhaust emissions into the ventilation system. However, following correction of this problem and subsequent unrevealing air monitoring, symptoms persisted and were noted in personnel in adjacent areas of the hospital as well. An industrial hygiene and medical evaluation was undertaken. Monitoring for carbon monoxide, formaldehyde, and anesthetic gases and review of medical records and patient examinations were unrevealing, and the problem resolved gradually over several weeks. This outbreak represents a case of building-associated illness among health professionals in a hospital setting that was triggered by a single, identifiable noxious exposure but was sustained despite any apparent ongoing noxious exposures.

Polycyclic aromatic hydrocarbon (PAH) residues on skin in relation to air levels among roofers.

To assess the utility of skin wipes as an index of exposure to polycyclic aromatic hydrocarbons (PAHs), simultaneous skin wipe and breathing zone air samples were obtained for 10 roofers. Samples were obtained during removal of an old coal-tar pitch roof and application of a new asphalt roof. Skin wipes were obtained immediately before and after the workshift. Anthracene was present in air but not skin samples. In air samples, the relative concentrations of seven PAHs were fluoranthene greater than pyrene greater than benzanthracene greater than benzo[a]pyrene greater than benzo[b]fluoranthene greater than benzo[ghi]perylene greater than benzo[k]fluoranthene. A similar pattern, or rank concentration, was observed in matching skin wipe samples. The amount (ng) of PAH (either total or individual compounds) found in skin wipes taken after the workday was significantly correlated with that in air samples (micrograms/m3, time-weighted average) for 8 of the 9 cases with air and skin samples taken the same day (r = 0.99 for total PAH). Skin wipe PAH residues were not significantly correlated with air samples taken 4 d earlier. These findings suggest that skin wipes can provide a useful measure of exposure to PAH.

Acute respiratory effects of short-term exposures to nitrogen dioxide.

Eleven study subjects with asthma and 12 normal controls were monitored for 5 days with a portable continuous nitrogen dioxide (NO2) monitoring instrument held at breathing level before, during, and after cooking dinner on a gas cooking range. Forced expiratory volume in 1 sec (FEV1.0), forced expiratory volume (FEV25-75), peak expiratory flow, and a tracing of the entire flow curve was monitored before the gas stove was turned on, during a break in cooking, immediately after, and 1 hr after cooking was completed. Study design for detection of health effects of the acute exposures to NO2 described above and a method of validating findings in an exposure chamber are discussed in this paper.