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Objectives: To examine the effects of aging on the ability of contrast baths to increase the circulation in the skin of the foot compared with immersion in a continuous warm water bath of the same temperature as the warm component of the contrast bath. Methods: A laser Doppler flow meter was used to assess skin blood flow on the dorsal and plantar aspects of the foot during immersion in a warm bath (100 degreesF (37.8 degreesC)) compared with contrast baths with a ratio of 3 minutes of warm (100 degreesF (37.8 degreesC)) and 1 minute of cold (60 degreesF (15.6 degreesC)); the cycle was repeated for 16 minutes. Fourteen participants whose average age was 55.1 +/- 9.1 years were examined and compared with 12 younger participants whose average age was 23.9 +/- 5.8 years. Results: For both groups of participants, the use of alternating hot and cold bath temperatures elicited an increase in skin blood flow above that which was found with warm water immersion alone. The greatest response was in the younger participants. For the older participants, skin blood flow was approximately one-third less than that seen in the younger participants with either continuous warm water immersion or contrast baths. These same results were seen on the dorsal and plantar aspects of the foot, indicating diminished circulation in both areas with aging. Conclusion: We conclude that contrast baths do increase circulation in the skin in the foot of older individuals but the response was less than that of younger people. [ABSTRACT FROM AUTHOR]

Contrast baths have been used for therapy for over 2,000 years. The basic concept is to alternate warm and cool water baths during a treatment session. It is believed that this will increase circulation better than just placing the limb in a warm water bath. However, there is little supportive evidence for this assertion. Further, for subjects with diabetes, with underlying impairments in their circulation, this may not work at all. Fourteen people with type 2 diabetes were compared to 14 age-matched controls. Skin blood flow of the foot (BF) was measured during 16 minutes of contrast baths at two different intervals: 3 minutes warm and 1 minute cold and 6 minutes warm and 2 minutes cold. In control subjects, warm and cold contrast baths with the ratio 3 minutes warm to 1 minute cold elicited significantly (p < 0.01) greater BF than placing the limb continuously in warm water or using a 6:2 ratio of warm to cold bath time. In control subjects, there was also a greater plantar than dorsal BF. For subjects with diabetes, there was no statistical difference between BF with contrast baths versus warm whirlpool; but in both cases BF was significantly less than that seen in control subjects under similar circumstances. There was also very little difference between BF on the plantar and dorsal aspects of the foot in the subjects with diabetes. Patients with diabetes do not show a vascular response to contrast bath therapy. The BF response to contrast temperatures may be a good diagnostic test for diabetic vascular impairment.

Background: Contrast baths (CB) have been used for over two thousand years. But it only was recently that CB were shown to improve limb circulation to a greater extent than that which can be seen after continuous exposure to a warm, constant temperature, bath. However, other studies show that this type of response to temperature can be impaired if the sympathetic nervous system applies vasoconstriction to the blood vessels. Therefore the purpose of the present investigation was to examine the relationship between sympathetic outflow on the magnitude of the change of blood flow (BF) during contrast baths in controls and with people diabetes. Sympathetic vasoconstriction activity was altered by global heating., Material/methods: Fourteen patients with type 2 diabetes were compared to 14 age-matched controls. BF was measured during 16 minutes of serial contrast baths of the foot following 3 minutes of warm water and 1 min of cold immersion at 2 different room temperatures, 19 and 32 deg C., Results: When subjects were exposed to global heating (warm room) there is a greater response to CB than when subjects were initially in a cooler room. However, for both temperatures, subjects with diabetes had a response that was over 50% less than that seen in control subjects., Conclusions: Removing sympathetic vasoconstrictor tone by global heating benefits subjects with diabetes and control subjects in their response to CB. For subjects with diabetes, global heating may be necessary to increase blood flow to acceptable levels for effective therapy.

This entity consists of a chronic inflammatory process of the peritenon of the tendo Achilles (usually bilateral) at variable points of the tendon itself but usually near the insertion in the Achilles. Its occurrence, not only in runners but in relatively sedentary individuals of both sexes, seems to be the result of microtrauma with insidious onset of local pain in increasing degree with physical activity. Clinically, in the advanced cases, fibrillation, modulation, and "yellowing" of the edematous tendon occur and probably are a precursor to later ruptures. Pathological changes consist of one or more of the following: a myxomatous degeneration of collagenous tissue; fibrosis; round cell inflammatory infiltrate; and proliferation of fibrovascular connective tissue. The use of steroid injections seems to be of no help and probably is contraindicated. Surgery consists of excision of the entire pseudosheath, allowing the tendon to assume a new, nonconstricting alignment. All but one of the nine patients with a follow-up of at least one year went on to clinical, painless recovery, with unrestricted future activity, in just a few months.

Objective: To characterize the extent and sources of imprecision in histologic dating of the endometrial biopsy., Design: Duplicate endometrial biopsies from 25 women were dated by five evaluators on two separate occasions to evaluate the overall precision of the measure. Using variance component analysis, estimates of intrauterine, intraevaluator, and interevaluator variability were determined., Setting: Samples were obtained during outpatient fertility testing. Evaluators were colleagues at the same institution., Patients, Participants: Women presenting with infertility undergoing routine evaluation., Interventions: None., Main Outcome Measure: Variability in histologic dating of the endometrium., Results: Inconsistencies between evaluators accounted for 65% of the observed variability, whereas 27% was because of inconsistencies in duplicate readings by the same evaluator. Regional differences in the uterus accounted for only 8% of the total variability., Conclusions: The overall error from these sources have the potential to result in a substantial false-positive rate for diagnosis of luteal phase defect.

We investigated differences in lung cancer care and outcome between academic and community settings for all lung cancer patients diagnosed during 1973-1976 in New Hampshire and Vermont. Trained abstracters reviewed hospital charts to record personal, diagnostic, and clinical information, and survival was determined for all patients through the end of 1979. Patients diagnosed in university hospital cancer centers underwent more staging procedures and tended to be assigned to a higher stage than similar patients diagnosed in community hospitals. When tumor stage was considered as a covariable in a survival analysis, these patients appeared to have a lower mortality rate both for non-small cell tumors (mortality rate ratio, 95% confidence interval = 0.81, 0.71-0.91) and for small cell tumors (0.71, 0.55-0.91). When functional status rather than tumor stage was used to adjust for disease severity, there was no apparent survival advantage for university patients with non-small cell cancer (0.96, 0.85-1.09) and the lower mortality for small cell cancers (0.76, 0.59-0.97) was attenuated, although still statistically significant. We conclude that inconsistently-collected data on clinical stage can complicate comparisons of prognosis between cancer patients from different types of hospitals and that measures of performance status may be more useful indicators of disease severity in population based studies.

This entity consists of a chronic inflammatory process of peritenon of the tendo Achilles (usually bilateral) at variable points of the tendon itself but usually near the insertion in the Achilles. Its occurrence, but not only in runners but in relatively sedentary individuals of both sexes, seems to be the result of microtrauma of stress with insidious onset of local pain in increasing degree with physical activity. Clinically, in the advanced cases, fibrillation, nodulation, and "yellowing" of the edematous tendon occur and probably are a precursor to later ruptures. Pathological changes consist of one or more of the following: a myxomatous degeneration of collagenous tissue; fibrosis; round cell inflammatory infiltrate; and proliferation of fibrovascular connective tissue. The use of steroid injections seems to be of no help and probably is contraindicated. Surgery consists of excision of the entire pseudosheath, allowing the tendon to assume a new, nonconstricting alignment. All but one of the nine patients with a follow-up of at least 1 year went on to clinical, painless recovery, with unrestricted future activity, in just a few months.

The technique and application of fine-needle aspiration cytology in the management of gynecologic cancer are discussed. The authors report 90 cases that have been evaluated by means of fine-needle technique. The technique has been applied both for primary diagnosis and for follow-up evaluation. Among the 90 cases reported, there was two false negatives and one false positive and three cases in which the histologic findings were false negative.

Report is made of the first two cases in which psammoma bodies were detected in peritoneal washings. The significance of psammoma bodies in a cytologic specimen is reviewed. These case reports and review of the literature make it clear that the cytologic detection of psammoma bodies should be a stimulus for further investigation but that the diagnosis of malignancy cannot be based on their presence alone.

Twelve cases of stenosing tenosynovitis about the ankle (eight posterior tibial and four peroneal), with at least 2 to 4 years of follow-up, have been successfully relieved of their symptoms and returned to increased activity by utilizing a simplified comprehensive surgical technique. Surgery consists of: 1) appropriate treatment to the tendon itself whether intact, partially ruptured, or completely ruptured; 2) deepening of the constricted groove; 3) fashioning of new pulleys from available sheath and retinaculum; and 4) construction of a new sheath from regional deep fascia. Postoperative management includes non-weightbearing, soft bandages, and home exercise therapy for 1 month, followed thereafter by intensive home therapy buildup of the involved muscle and orthoses. Pathology findings included thickening of the tendon sheath, varying degrees of fibrosis of the tendon itself, with or without rupture, and reactive hypertrophy of the bone at the involved groove.

Long-term, continuous (twice per week) administration of CCl4 to male mice resulted in a high incidence of liver nodules which appeared to be resistant to the necrotizing effects of CCl4 but showed no features of malignant neoplasia. Liver nuclear DNA synthesis was compared in mice given CCl4 and in mice subjected to partial hepatectomy (PH). Mice were given by gavage corn oil or CCl4 in corn oil for periods of 2 to 25 weeks and several mice were subjected to PH after 12 and 25 weeks of corn oil treatment. Mice were given [3H]TdR during liver regeneration and newly synthesized liver nuclear DNA was isolated and separated by BND-cellulose chromatography. Greater than 85% of the labeled DNA from PH mice eluted from BND-cellulose columns as double-stranded (ds) DNA with single-stranded (ss) regions or ends and less than 15% as ds DNA. When mice were treated with CCl4 for 8 weeks or longer a significantly greater portion of liver nuclear DNA eluted as ds DNA. Administration of HU and 5-FU with [3H]TdR decreased [3H]TdR incorporation into DNA to low levels incompatible with unscheduled DNA synthesis. Single doses of CCl4 given to mice treated with corn oil for 2 to 12 weeks provided newly synthesized DNA which was primarily (greater than 80%) ds DNA with ss regions or ends, but after 25 weeks of corn oil administration, a single dose of CCl4 resulted in newly synthesized DNA with a greater proportion of ds DNA. The high labeling of ds DNA in mice treated with CCl4 may have resulted from an alternate pathway of DNA synthesis catalyzed by the enzymes or enzyme complexes associated with semiconservative DNA synthesis or from proliferation of nonparenchymal cells with a rapid turn-over rate.

The concept that squamous carcinoma arises with any frequency from common skin cysts is examined. We believe this to be extremely rare and suggest that many of the previously reported cases are pilar tumors or proliferating trichilemmal cysts, a benign but clinically impressive lesion occurring most commonly in the scalps of older women. An illustrative case is presented.

One hundred and thirty-four cervical and vaginal smears were obtained from 51 patients receiving cyclophosphamide, doxorubicin, and cis-platinum. These drugs do not appear to cause dysplasia or significant atypia. Additionally, the Pap smear was not useful for the diagnosis of unexpected persistent or recurrent carcinoma of the ovary.

We report a previously unrecognized hand dermatosis, pulling boat hands (PBH), occurring in thirteen participants at the Outward Bound School on Hurricane Island, Maine. Painful and pruritic macules, plaques, and vesicles developed exclusively while subjects lived aboard a pulling boat, the school's open rowing/sailing craft. Nine of those affected were women and eight had Raynaud's phenomenon or vasospasm. These subjects experienced thirty episodes of PBH during May through October, 1978 to 1982. Histopathology revealed a superficial and deep lymphohistiocytic perivascular infiltrate, subepidermal blister formation, red blood cell extravasation, and dermal capillary thrombosis compatible with cold injury to the skin. All patients experienced prolonged percussion to their hands while rowing as well as a continuous environmental exposure to cold air, wind, humidity, ocean spume, and precipitation. These clinical, histopathologic, and environmental findings suggest a unique syndrome that combines the vascular effects of mechanical trauma from rowing with those of nonfreezing cold injury.

Identified were 1,906 cases of confirmed lung cancer that occurred among all residents of New Hampshire and Vermont over a 4-year period. Medical records, pathologists' reports, and, when possible, pathology slides were obtained and reviewed to assign cases to a specific histologic diagnosis. The diagnosis made by the original pathologist was generally confirmed upon review, except for the large cell undifferentiated cell type which appeared to be an unreliable classification. Among men at all ages incidence rates for squamous cell cancer far exceeded those for adenocarcinoma and small cell undifferentiated carcinoma, and the three age-incidence curves showed a similar pattern, rising until the eighth decade of life and then declining. Among women these three major cell types occurred about equally often, but the age-incidence curves differed in shape with adenocarcinoma reaching a peak incidence at an earlier age.

1. A microspectrophotometric apparatus was used to measure nuclear absorption in fixed and stained human bone marrow smears. 2. The validity of the measurements was established. 3. The total and polymerized desoxyribose nucleic acid (DNA) of erythroblast nuclei were measured in relative units, and a gradual loss of DNA from the red cell nucleus during maturation was noted. 4. The loss in DNA is comparable quantitatively to that occurring during pathological pyknosis in sarcoma cells. 5. The continual loss of nuclear material during erythropoiesis supports the conception that the nucleus disappears by intracellular dissolution, not by extrusion in the intact form.