The association of peri-operative scores, including frailty, with outcomes after unscheduled surgery.

Postoperative hospital stay is longer for frail, older patients, who are more likely to experience prolonged postoperative morbidity and reduced long-term survival. We recorded in-hospital mortality, morbidity and length of stay for 164 patients aged at least 65 years after unscheduled surgery. We evaluated pre-operative frailty with the 7-point Clinical Frailty Scale: 81 patients were 'not vulnerable' (frailty score 1-3) and 83 were 'vulnerable or frail' (frailty score ≧ 4), with mean (SD) ages of 74.7 (7.5) years vs. 79.4 (8.3) years, respectively, p < 0.001. Within 30 postoperative days 8/164 (5%) patients died, all with frailty scores ≧ 4, p = 0.007. Postoperative morbidity was less frequent in patients categorised as 'not vulnerable' on four out of the six days it was measured (days 3, 5, 8, 14, 23, 28). Median (IQR [range]) postoperative stay was 9 (6-18 [2-221]) days for patients with frailty scores 1-3, and 22 (12-33 [2-270]) days for patients with score ≧ 4, p < 0.001. Four variables independently associated with hospital discharge, hazard ratio (95%CI): E-POSSUM, 0.74 (0.60-0.92), p = 0.007; ASA 2, 0.35 (0.13-0.98), p = 0.046, ASA 3, 0.17 (0.06-0.47), p = 0.001 and ASA 4/5, 0.08 (0.02-0.28), p < 0.001; operative severity 'major +', 0.69 (0.41-1.08), p = 0.10 and the Surgical Outcome Risk Tool, 7.75 (0.81-74.40), p = 0.08.

Comparison of sublingual, vaginal, and oral misoprostol in cervical ripening for first trimester abortion.

OBJECTIVES: To compare the effectiveness and tolerability of misoprostol as a cervical ripening agent in first trimester abortion through three different routes of administration before surgical evacuation (SE). MATERIALS AND METHODS: It was a hospital based prospective randomized open labeled parallel study. A total of 150 randomly selected married women were divided in three groups for sublingual (S/L), vaginal and oral 400 µg of misoprostol single dose administration. The drug was administered 3-4 h before SE in the S/L and vaginal groups and 12 h before the procedure in the oral group. Efficacy was assessed on the basis of time taken for ripening, dilatation achieved, duration of the procedure, intra-operative blood loss, and pain score. The tolerability was noted on the basis of side effects. RESULTS: The mean time taken for cervical ripening was less in sublingual administration (3.7±1.2 hr) as compared to the vaginal and oral routes. The S/L group had significant cervical dilatation (P<0.001) and the duration of SE was less as compared to the vaginal and oral routes. However, the mean intraoperative blood loss was more in sublingual as compared to the vaginal and oral groups. The intra-operative pain score of the S/L group was significantly lower (1.9±1.1, P<0.05) as compared to the vaginal (2.6±1.7) or oral route (3.3±1.7). Loose motions and nausea/vomiting were more with the S/L and oral routes while blood loss was more in the vaginal route. CONCLUSION: Administration of misoprostol by the sublingual route is better than the oral and vaginal routes for cervical ripening.

Sodium and potassium excretion in normotensive and hypertensive population in Kashmir.

One hundred thirty five hypertensive patients and equal number of age and sex matched healthy controls were taken up for studying the relationship of 24 hour urinary sodium and potassium excretion, sodium-potassium molar ratio and body mass index (BMI) with blood pressure in normotensive and hypertensive population in Kashmir. There was statistically significant elevated 24 hour urinary sodium excretion (p < .001), increased Na+-K+ molar ratio, significantly higher BMI in hypertensive population as compared to controls whereas there was a lower 24 hour urinary excretion of potassium (p > .20) in patients with hypertension. Thus sodium and potassium excretion, Na+-K+ molar ratio and body mass index has direct bearing in perpetuation or causation of hypertension in Kashmir which may be related to intake of salt tea.

Aflatoxin M1 contamination in commercial samples of milk and dairy products in Kuwait.

As part of the programme on monitoring of environmental contaminants in food stuff in Kuwait, 54 samples of fresh full cream and skimmed milk, powdered milk, yoghurt, and infant formula were analysed for aflatoxin M1 (AFM1) by HPLC following sample clean up using immuno-affinity columns. Of samples, 28% were contaminated with AFM1 with 6% being above the maximum permissible limit of 0.2 microgl(-1). Three fresh cow milk samples collected from a private local producer showed the highest level of 0.21 microg l(-1) AFM1. There was no contamination with AFM1 in powdered milk and infant formulas. These results show the necessity of a survey involving a larger number of milk and its products and suggest that presently the contamination of milk and milk products with AFM1 does not appear to be a serious health problem in Kuwait. Nevertheless, a continuous surveillance programme may be warranted to monitor regularly the occurrence of aflatoxins in the animal feeds responsible for current limited contamination and to note rapidly and worsening in the situation that may depend on market changes or on unfavourable climatic developments.

Alcohol-stimulated promotion of tumors in the gastrointestinal tract.

Alcohol is a major risk factor for cancers of the upper gastrointestinal tract but the association with cancers of the large bowel is not as clearly established. In recent studies, we have provided experimental support for the associations in the esophagus and oral cavity. Our studies also indicate that the tumor promotion ability of ethanol is related to its ability to generate oxygen free radicals as measured by an increase in indices of lipid peroxidation. This increase in lipid peroxidation was evident in the liver as well as the tissues targeted by the site-specific carcinogens and promoted by ethanol. Studies in mice showed that the increased lipid peroxidation as well as tumor incidence was inhibited by the administration of vitamin E, the potent antioxidant. Determination of fatty acid profiles showed significant alterations when ethanol was used as a tumor promoter after treatment with the carcinogen. Ethanol as a promoter caused an increase in esophageal polyunsaturated fatty acids (PUFA). Ethanol promotion was also evident in increased arachidonate and an exaggeration in PUFA that are involved in eicosanoid production. Thus, these results suggest that ethanol-related promotion may be the result of excessive cell proliferation induced by disordered lipid and eicosanoid metabolism that may cause a selective outgrowth of the carcinogen-initiated cells. Supporting evidence for ethanol-induced hyper-regeneration is also reviewed.

Ethanol-mediated promotion of oesophageal carcinogenesis: association with lipid peroxidation and changes in phospholipid fatty acid profile of the target tissue.

Ethanol consumption is a high risk factor for oesophageal carcinoma and studies indicate that it acts as a promoter of N-nitrosomethylbenzylamine (NMBzA)-induced oesophageal carcinogenesis. The studies described here indicate that ethanol-induced promotion was related with an increase in indices of lipid peroxidation in the target oesophageal tissue and that such an increase was associated with significant changes in the fatty acid profile of phospholipids. Young Sprague-Dawley rats were treated with NMBzA, 2.5 mg/kg body weight, three times a week for 3 weeks, and a week afterwards fed a 7% ethanolic diet that was continued until their death at 10 months. Cumulative ethane exhaled by rats was measured a week before their death and was found to increase significantly with NMBzA treatment but more so when followed by ethanol consumption. Cholesterol, phospholipids, and some indices of lipid peroxidation were measured in the oesophagus and liver. Whereas the levels of cholesterol and phospholipids were not affected in control-fed rats with or without the NMBzA treatment, ethanol consumption by either the untreated or NMBzA-treated rats caused a significant increase in the targeted oesophagus as well as the liver, the major site of ethanol and carcinogen metabolism. Ethanol consumption also increased all the indices of lipid peroxidation, i.e. malondialdehyde, lipid fluorescence, diene- and triene-conjugates; the largest increases were observed in rats that received both NMBzA and ethanol. A comparison of the fatty acid profile of phospholipids from the oesophagus and liver indicated significant alterations both with the NMBzA treatment and ethanol consumption. However, the fatty acid profile with regard to its peroxidability was significantly modified only with ethanol consumption and only in the oesophagus of the NMBzA-treated or untreated rats. Also, hepatic phospholipids showed a substantial increase in linolenate and no change in arachidonate, but the oesophageal phospholipids exhibited a pronounced increase in the levels of C18:3, C20:2, C20:3, C20:3' and C22:6 with a significant increase in arachidonate when use of ethanol followed the NMBzA treatment, suggesting a disorder in lipid and eicosanoid metabolism. We propose that ethanol may promote carcinogenesis through excessive cell proliferation induced by disordered lipid and eicosanoid metabolism that may cause a selective outgrowth of the initiated cells.

HIV type 1 subtypes B and C from new regions of India and Indian and Ethiopian expatriates in Kuwait.

PIP: HIV-1 subtype B isolates have previously been described in India only in the state of Andhra Pradesh, while subtype C isolates have been reported as widespread in the Bombay and Goa regions of India. Gag subtype was determined in HIV-1 isolates from six Indians and one Ethiopian. One Indian was a native of Goa residing in Kuwait, and the others were natives of Bihar, Haryana, West Bengal, and New Delhi states. Five subjects were males aged 20-26 years. The remaining two subjects were females aged 34 and 40. Four of the men acquired HIV through sexual transmission; the other man was presumably infected through contaminated blood. Six isolates were identified as subtype C and one as subtype B. These preliminary findings obtained by arranging the HIV-1 gag sequences according to their similarity score were confirmed by cladogram and nested analysis. HIV-1 subtype C isolates are therefore present in Bombay and Goa as well as in other regions of northern and eastern India. The subtype has also infected Indian and Ethiopian expatriates living in Kuwait.^ieng

Short-term IgM and IgG antibody responses to hepatitis E virus infection.

53 adult patients with acute hepatitis caused by hepatitis E virus were identified by the presence of IgM antibody to hepatitis E virus, and followed for 12 months to evaluate the kinetics of anti-HEV antibodies. All but 1 female Kuwaiti patient were expatriate workers from the Indian subcontinent, temporarily working in Kuwait. Follow-up samples obtained at 1, 3, 6 and 12 months were evaluated for IgM and IgG antibodies to hepatitis E virus. IgM-class antibodies to hepatitis E virus were detectable in 12/27 (44%) patients at 1 months, in 0/26 at 3 months, in 0/8 at 6 months and 0/6 at 12 months. IgG antibodies to hepatitis E virus were detectable in 46/47 (98%) at onset, 26/27 (96%) at 1 month, in 26/29 (90%) at 3 months, 16/16 (100%) at 6 months and 8/8 (100%) at 12 months of follow-up. This study suggests that IgM antibodies to hepatitis E virus decline rapidly after an acute infection but IgG antibodies to hepatitis E virus persists for at least 1 year in many patients.

Molecular characterization of human T-lymphotropic virus, type 1 (HTLV-1) found in Kuwait: close similarity with HTLV-1 isolates originating from Mashhad, Iran.

Human T-lymphotropic virus, type 1 (HTLV-1) infection was detected in two unrelated Kuwaiti patients with tropical spastic paraparesis (HAM/TSP) and in the asymptomatic mother of one of them. The family roots of these patients were traced to the Najaf region of Iraq. The DNA sequence of three PCR-amplified fragments (env, 512 bp; pol, 140 bp; LTR, 704 bp) was determined for each of Kuwaiti HTLV-1 isolates (KUW-1,2,3). All three Kuwaiti HTLV-1 were identical in env and pol fragments and virtually identical in LTR. Two rare substitutions were found in the env and pol fragments. They were shared only with two isolates from Reunion Island (substitution in env), and two isolates from India and the Caribbean (substitution in pol). The sequences of env and pol fragments of the Middle Eastern HTLV-1 isolates were not available. However, the comparison of Kuwaiti isolates with representative Middle Eastern HTLV-1 was possible for the LTR fragment. The phylogenetic analysis of LTR sequences of KUW and 34 other HTLV-1 isolates has shown that Kuwaiti HTLV-1 belongs to a cosmopolitan "a" subtype of HTLV-1 and tends to cluster together with HTLV-1 originating from the Mashhad region of Iran. These results suggest that common origin of Mashhadi and Kuwaiti (Najafi) HTLV-1 and the possibility of another pocket of HTLV-1 infection in the Middle East, located in the Najaf region of Iraq.

Hepatitis C virus infection in patients on maintenance dialysis in kuwait: epidemiological profile and efficacy of prophylaxis.

Data on hepatitis C virus (HCV) infection in patients undergoing maintenance hemodialysis (HD) in Kuwait were collected retrospectively in December 1994. Ninety three of 232 patients (40%) studied had hepatitis C antibodies (anti-HCV) when tested by a second generation enzyme linked immuno-sorbent assay (ELISA-II). Since October 1992, all HD patients who tested positive for anti-HCV were dialysed on separate machines and blood transfusions were limited to acute life-threatening emergencies through regular use of recombinant human erythropoeitin. The prevalence of anti-HCV positivity among dialysis patients who received treatment during the "HCV-prophylaxis period" was 33/163 (20.2%), as compared to 46/55 (83.6%) of those who received HD during the 27 months prior to October 1992 (p< 0.0001), and had similar average duration on dialysis (12 + 7 and 13 + 7 months, respectively). Excluding the 15 patients who had anti-HCV on entry to HD during "HCV-prophylaxis period", the estimated incidence of positive anti-HCV seroconversion was 11.5 per 100 patients per year on HD. In the 93 anti-HCV positive patients, alanine aminotransferase (ALT) levels were elevated for more than six months in 32 (34.4%), elevated in multiple peaks in 22 (23.7%) and showed combined variation of the latter two abnormalities in 16 (17.2%). Histological evidence of chronic active hepatitis was present in five of six patients who manifested persistent ALT abnormalities. Vaccination against hepatitis B virus produced positive seroconversion in 76.1% patients, and those with positive anti-HCV were not at a disadvantage. In conclusion, HCV infection is common in patients undergoing HD in Kuwait.Improvement in screening assays, isolation of anti-HCV positivepatients during dialysis and limitation of blood transfusions may decrease the transmission of this disease in this patient population.

Urinary schistosomiasis associated with hepatitis C virus infection.

We studied 26 adult patients referred for cystoscopy: 13 consecutive patients with schistosome ova on bladder biopsy and antibodies to Schistosoma species in serum were classified as having urinary schistosomiasis, while 13 consecutive patients without schistosome ova on bladder biopsy and who were negative for antibodies to Schistosoma species in serum served as controls. Nine of 13 patients (70%) and none of 13 controls (p < 0.0005) had antibodies to hepatitis C virus in serum (anti-hepatitis C virus). All controls and patients who were negative for anti-hepatitis C virus had normal serum alanine aminotransferase levels, while 2 of 9 (22%) positive for anti-hepatitis C virus had elevated levels. Our study shows that patients with urinary schistosomiasis are at high risk for anti-hepatitis C virus positivity and that some of them may have active liver disease. Therefore, it is imperative to screen patients with urinary schistosomiasis for associated hepatitis C virus infection and liver disease.

Restenosis following subclavian artery angioplasty for treatment of coronary-subclavian steal syndrome: definitive treatment with Palmaz-stent placement.

We report a case of progressive angina pectoris 4 years post coronary bypass surgery, in which the left internal mammary artery (LIMA) was grafted to the native left anterior descending coronary artery. The coronary-subclavian steal phenomenon was proven angiographically with retrograde reflux through the LIMA graft into the distal subclavian vessel, downstream from a critical stenosis at the origin of the subclavian artery. After initially successful angioplasty of the ostial subclavian lesion, restenosis and return of angina prompted repeat dilatation and placement of a Palmaz 154-M stent. Follow-up catheterization has demonstrated persistent patency at the stented site and absence of coronary steal.

Lipid peroxidation and ethanol-related tumor promotion in Fischer-344 rats treated with tobacco-specific nitrosamines.

Male Fischer-344 rats were treated, by gavage, with a total dose of 40 mmol/kg of N'-nitrosonornicotine (NNN) or 20 mmol/kg of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), three times a week for 4 weeks. One week afterwards the rats were fed an isocaloric liquid diet containing 7% (v/v) ethanol and continued on this diet until killed. Cumulative ethane exhaled by a rat by 180 min was measured at 54 weeks of the start of the study and was found to increase significantly (P < 0.001) with either NNN or NNK treatment but more so when followed by ethanol consumption. Other indices of lipid peroxidation, cholesterol and phospholipids were measured in the lipid extracts from the liver, esophagus and lungs at 55 weeks. Ethanol consumption increased the amount of cholesterol and phospholipids per g of tissue in naïve or NNN- and NNK-treated rats. All peroxidative indices measured, i.e. malondialdehyde (MDA), diene- and triene-conjugates and lipid fluorescence, were significantly increased in the liver, the main metabolic and peroxidative site, with ethanol consumption in rats whether they were treated with NNN or NNK or remained untreated. Overall, the indices of lipid peroxidation also showed an increase in other tissues, but the results differed with different indices. The differences in indices may be due to differences in lipid peroxidation products measured or to differences in their rates of production and degradation or conversion to other products. However, the largest increases in indices were seen with ethanol consumption by either NNN- or NNK-treated rats. Incidence of tumors in the tissues was also assessed and showed about a two-fold increase with ethanol consumption in the tumors of esophagus, oral cavity, lungs and liver induced by either NNN or NNK. Ethanol also caused an increase in the mean frequency and mean size of the tumors induced. The results suggest that ethanol-related promotion of NNN- and NNK-induced tumors may result from increased lipid peroxidation in the target tissue.

Acute sporadic hepatitis E in Kuwait.

Fifty-seven adult patients with acute hepatitis and 34 comparison patients without liver disease were evaluated using a newly developed Western blot assay for IgM antibody to hepatitis E virus. The mean age of patients with hepatitis was 32 years (range, 18-55 years); 88% were male. Among patients with acute hepatitis, hepatitis A (anti-HAV IgM positive) was diagnosed in two (4%), hepatitis B (anti-HBc IgM positive) in three (5%), and hepatitis E (anti-HEV IgM positive) in 34 (60%). One hepatitis patient had CMV IgM, another had EBV IgM, and 16 others (28%) were negative for all serologic markers of acute viral hepatitis. No patient with acute hepatitis A or B and none of the comparison patients without acute hepatitis had anti-HEV IgM. All but one case of acute hepatitis E were found among expatriates of Asian origin, and acute hepatitis E was associated significantly with recent travel to the Indian subcontinent. These data suggest that acute hepatitis E is common among foreign workers in Kuwait but that little HEV transmission is occurring directly in Kuwait.

Alcohol, immunomodulation, and disease.

Recent research findings point to a spectrum of alcohol-induced immune dysfunctions in animal models and humans. Use of alcohol in vivo causes abnormalities in the function and/or structure of a broad array of cells involved in humoral and cellular immunity, including lymphocytes, Kupffer cells and other macrophages, as well as the endothelium of blood vessels and lymphatics. Regulatory cytokines and neuroendocrine factors can mediate some of these immunomodulatory effects which may be further re-phased, exaggerated or unbalanced by other drugs of misuse. A variety of animal models is available to study acute and chronic alcoholism, non-alcohol drug misuse, AIDS as well as other opportunistic infections, and neoplasias, which hold promise of clarifying the role of alcohol as an immunomodulator.

Comparison of two immunization schedules with recombinant hepatitis B vaccine and natural immunity acquired by hepatitis B infection in dialysis patients.

In a prospective study over a 2-year period we compared two practical dosage schedules to vaccinate dialysis patients against hepatitis B virus (HBV) infection using a yeast-derived recombinant hepatitis B vaccine (Engerix-B). In addition, the natural history of this acquired immunity was compared with that developed through HBV infection in dialysis patients and healthy subjects. Patients on dialysis treatment (haemo or peritoneal) who were tested to be negative for hepatitis B surface antigen (HBsAg), anti-HBs and anti-HB core were allocated at random to receive HB vaccine according to one of the two schedules. The two groups receiving the vaccine were matched for age, sex, mean duration on dialysis and the form of dialysis treatment received. The group of patients who received a four-dose schedule (at 0, 1, 2 and 6 months) of 40 micrograms of HB vaccine each time (group 2) achieved a seroconversion rate of 79% 1 month after the last dose (at month 7) compared with a seroconversion rate of 55% in those who received three doses (at 0, 1 and 6 months) of 40 micrograms each (group 1). Healthy controls who received half the amount of vaccine on a three-dose schedule (group 3) attained 100% seroconversion (p < 0.05). When retested at 24 months, 30% of seroconverters in group 1 had lost their protective immunity, compared with only 6% in group 2 and 15% in group 3. The magnitude of antibody response (total and anti-(a)-specific) was assessed in the vaccinees at 24 months and compared with that of two other control groups, dialysis patients (group 4) and healthy volunteers (group 5), who had acquired immunity from HBV infection. In general, the total and anti-(a)-specific HBs titres in the dialysis patients (groups 1, 2 and 4) were lower than in their corresponding healthy controls (groups 3 and 5), irrespective of whether the protective immunity was acquired by vaccination or HBV infection. However, the anti-HBs titres in dialysis patients who received four doses were significantly higher than in those who received only three doses (p < 0.05), which indicated a better protective immunity in favour of the former regime. The magnitude of antibody response in the vaccinees of groups 2 and 3 compared well with their respective controls, groups 4 and 5, who had acquired their immunity through HBV infection. This implied that the yeast-derived vaccine was sufficiently immunogenic and provided lasting protection in patients and healthy subjects vaccinated by an appropriate dosage schedule.(ABSTRACT TRUNCATED AT 400 WORDS)

Alcohol-associated generation of oxygen free radicals and tumor promotion.

We discuss evidence indicating how ethanol could generate oxygen free radicals. Recent use of techniques such as spin trapping and EPR spectroscopy have demonstrably confirmed that both acute and chronic alcohol use by laboratory animals would generate free radical intermediates. These radicals are of biological origin and presumably involve lipids. However, an exact identification of the intermediates produced has not been worked out with the currently available methodologies. Also not known is the mechanism whereby ethanol could initiate free radicals. The relationship between generation of free radicals and cell toxicity or carcinogenesis is also not understood. Using a variety of systems that included different species, strains and gender (male Sprague-Dawley and Fisher-344 rats, female C57BL/6 mice, male Syrian golden hamsters) and carcinogens (NMBZA, NNN, NNK, DMBA and LP-BM5 retrovirus) we have shown an association of lipid peroxidation with ethanol tumor promotionability. However, the process of tumor promotion in general is not very clear and the role played by ethanol in this process is still more unclear. Here we are reviewing evidence that could possibly be involved in such promotion processes.

Anti-HCV-positive cirrhosis associated with schistosomiasis.

Hepatosplenic schistosomiasis is occasionally associated with cirrhosis and progressive hepatic decompensation. The aim of the present study was to determine the prevalence of antibody to hepatitis C virus in patients with schistosomiasis and cirrhosis. The prevalence of anti-HCV was studied in 12 consecutive cases of schistosomiasis associated with biopsy proven cirrhosis. All patients had a past history of schistosomiasis and high titers of schistosomal antibodies in serum (1:32 to 1:4096). Five of the 12 patients had hepatic catheterization and were found to have sinusoidal involvement with corrected sinusoidal pressures ranging from 19 to 23 mm Hg. Four had ascites, six had pedal edema, and eight had peripheral signs of chronic liver disease in the form of palmar erythema, spider nevi, and/or gynecomastia. Ten of the 12 cases (83%) were repeatedly positive for anti-HCV/ELISA. These results suggest that when patients with schistosomiasis develop cirrhosis, associated hepatitis C virus infection should be suspected.

Ethanol-mediated promotion of oral carcinogenesis in hamsters: association with lipid peroxidation.

Pouches of male Syrian Golden hamsters were painted with 1% 7,12-dimethylbenz[a]anthracene (DMBA) three times for one week. One week after DMBA treatment, hamsters were fed an ethanolic diet and continued on this diet until they were killed 22 and 35 weeks after the start of the experiment. Phospholipids, cholesterol, indexes of lipid peroxidation (malondialdehyde, diene and triene conjugates, lipid fluorescence), and the antioxidants glutathione and vitamin E were determined in the buccal mucosa, as was the incidence of tumors. At 22 weeks, the relative proportion of cholesterol to phospholipids in ethanol-consuming hamsters was significantly increased. At 35 weeks, most of the treatments showed a return of cholesterol vs. phospholipids toward that of untreated mucosa at 22 weeks. Ethanol consumption also increased the indexes of lipid peroxidation at 22 weeks; the largest increases occurred when ethanol use was combined with DMBA treatment. However, at 35 weeks such increases in lipid peroxidation had either returned to intermediate levels or were not different from the untreated controls at 22 weeks. Glutathione decreased in pouches of hamsters fed ethanol diets at 22 weeks, but at 35 weeks there was no appreciable difference. However, vitamin E increased significantly with ethanol consumption at 22 weeks, which increased further when combined with DMBA treatment, but at 35 weeks these values were intermediate. No tumors were seen at 22 weeks. At 35 weeks, DMBA-treated ethanol-fed hamsters had a significantly higher incidence of tumors, more multiple tumors per hamster with tumors, and more of the larger tumors than DMBA-treated control-fed hamsters. The results suggest that an increase in lipid peroxidation occurs with ethanol-related tumor promotion processes, but this lipid peroxidation declines when tumors appear to be preceded by increases in cholesterol relative to phospholipids and increases in vitamin E.