Faculty Bibliography

Studies were performed to define the immunologic status of various groups of homosexual men including homosexual men with Kaposi\'s sarcoma, healthy homosexual men who were of similar ages to the homosexual patients with Kaposi\'s sarcoma and homosexual men with hyperplastic lymphadenopathy. Heterosexual men with Kaposi\'s sarcoma were also studied. Immunologic parameters which were examined included serum immunoglobulin levels, enumeration of B cells, T cells, and T-cell subsets, and quantitation of lymphocyte responsive to phytohemagglutinin (PHA) and pokeweed mitogen (PWM). Significant immunologic abnormalities were observed in all three groups of homosexuals studied. These were most severe in the homosexuals with Kaposi\'s sarcoma, somewhat less severe in homosexual men with lymphadenopathy, and least marked but still significant in healthy homosexual men. Heterosexual men with Kaposi\'s sarcoma displayed essentially normal immunologic profiles. The possible etiologic factors underlying the immunologic abnormalities in the male homosexual population studied and the role of an altered immune system in the development of and the fulminant course of Kaposi\'s sarcoma in these patients are discussed.

Nineteen cases from an epidemic of disseminated Kaposi\'s sarcoma in homosexual men were studied by clinical, virologic, immunologic, and genetic methods. The patients were all male homosexuals ranging in age from 29 to 52 years, with histories of multiple sexually transmitted diseases and exposure to both prescription and recreational drugs. Sites of disease included skin (16 of 19 patients), lymph nodes (13 patients), gastrointestinal tract (12 patients), spleen (three patients), and lung (one patient). Most patients had elevated levels of serum immunoglobins, positive antibody titers to hepatitis A and B virus, cytomegalovirus and Epstein-Barr virus, and impairment of cell-mediated immunologic reactions. The frequency of HLA-DR5 in these patients was significantly elevated. Two of the 19 patients died. Although the precise cause of this epidemic is unknown, it is likely that a genetic predisposition, an acquired immunoregulatory defect, and one or more infectious agents and drugs may be involved.

An investigation of 20 homosexual men with histologically confirmed Kaposi\'s sarcoma and 40 controls revealed significant associations between Kaposi\'s sarcoma and use of a number of drugs (amyl nitrite, ethyl chloride, cocaine, phencyclidine, methaqualone, and amphetamine), history of mononucleosis, and sexual activity in the year before onset of the disease. Patients with Kaposi\'s sarcoma also reported substantially higher rates of sexually transmitted infections than did controls. Multivariate analysis indicated independent significant associations for amyl nitrite and sexual activity and showed use of phencyclidine, methaqualone, and ethyl chloride to be non-significant. Evaluated at the median exposure for patients, the analysis yielded risk-ratio estimates of 12.3 for amyl nitrite (95% confidence limits 4.2, 35.8) and 2.0 for sexual activity (95% confidence limits 1.3, 3.1).

A case-control study of spontaneous diabetes mellitus in dogs was undertaken, using 2 veterinary data bases. The Veterinary Medical Data Program (VMDP) contained records of 1,019 cases of canine diabetes from 14 university-affiliated veterinary hospitals. The Animal Medical Center (AMC), a private veterinary hospital which has not participated in the VMDP, contained records of 449 diabetes cases. Each data base was analyzed separately, control groups being chosen from all admissions, excluding diabetic animals. Summary odds ratios by sex adjusted for age and breed indicated significantly (P less than 0.05) elevated risks for entire females and neutered females compared with that for entire males. The VMDP data indicated a significantly elevated risk for castrated males, whereas the risk derived from AMC data was not significantly different from 1. Analysis of risks by breed adjusting for age and sex identified Poodles as being at significantly excess risk, and German Shepherd Dogs, Cocker Spaniels, Collies, and Boxers at significantly decreased risk in both data sets. The male-female risk ratio changed with age from 1 at less than 1 year of age to a predominance of females at older ages. In the AMC data base, diabetes was significantly associated with cataracts in dogs of both sexes combined. Diabetes was also significantly associated with benign mammary tumors in female dogs.

Publication of the \'Atlas of Cancer Mortality for U.S. Counties, 1950-1969\' caused a great deal of concern in counties shown in the Atlas to have had high cancer mortality rates in relation to the United States as a whole. An analysis was made of temporal trends of cancer mortality in Bergen County, a \'high-rate county\' in northeastern New Jersey, by calculating age-adjusted cancer mortality rates by sex and site for Bergen County residents for the period 1962-75. Mortality rates and time rates of change in mortality rates were compared to those in the United States as a whole. Male and female rates for respiratory cancer and male rates for all sites combined increased significantly more quickly in the United States than in Bergen County during the study period. The authors discuss these trends and recommended that recent time-specific mortality rates be furnished to county health commissions on a regular basis.

Serum and urinary levels of iodine were determined in six cats before and after oral administration of Gastrografin. Iodine was identified by gamma spectrometry after the specimens had been subjected to neutron activation. Peak serum iodine levels, compared to undetectable preadministration levels in five of the six cats, ranged from 8.0 to 50.7 micrograms/ml 1 to 2 hours after Gastrografin administration. Twenty-four hour cumulative urinary excretion of iodine represented 0.9 to 4.08% of this element calculated to be in Gastrografin. Pharmacokinetic analysis of the serum concentrations using the one-compartment open model resulted in an estimate of ka, the fraction of Gastrografin dose absorbed per unit time, of 2.24 hr-1 (95% CL = -5.4, 7.7) and an estimate of ke, the fraction of the dose eliminated per unit time, of 0.10 hr-1 (95 % CL = -0.01, 0.21). Analysis of urinary elimination rates also yielded ke = 0.10 hr-1 (95% CL = 0.01, 0.18). At necropsy the gastrointestinal tract of each cat was normal.

Patterns of mortality in 11 air-conditioned and 9 un-air-conditioned nursing homes in New York City have been investigated to determine the impacts of heat waves on nursing home occupants and the efficacy of air conditioning in reducing these impacts. During each of four heat waves in 1972 and 1973, the number of deaths in un-air-conditioned nursing homes was significantly greater than the number of deaths expected on the basis of mortality during cooler control periods. In contrast, deaths in air-conditioned nursing homes were not significantly different from expected. The age- and sex-adjusted ratio of relative death rates was 2.29 (95% confidence interval = 1.75-2.98). Approximately 94 excess deaths occurred in the un-air-conditioned nursing homes. On the basis of this research, it is recommended that nursing homes and other institutions for the elderly located in climates like that of New York City be required to provide air conditioning