The New England journal of medicine
-
Because the nation's health is so greatly influenced by cigarette smoking, this report examines current trends in cigarette advertising and marketing. According to the Federal Trade Commission, total cigarette advertising and promotional expenditures reached $2.1 billion in 1984. From 1974 through 1984, total expenditures increased approximately sevenfold, or threefold after adjustment according to the consumer price index. ⋯ The fastest growing markets are discounted cigarettes and brands containing 25 cigarettes per pack. Several advertising campaigns have targeted women, minorities, and blue-collar workers. The study of these marketing trends should assist health officials in identifying and predicting patterns of cigarette use and in developing health promotion programs that counteract the influence of advertising by incorporating similar, effective techniques.
-
Although several studies have reported that the use of oral contraceptives decreases the risk of ovarian cancer, it is not clear whether the effect varies according to the oral-contraceptive formulation or the histologic type of cancer. To characterize this association more fully, we used data from a case-control study, the Cancer and Steroid Hormone Study. ⋯ Women who had used oral contraceptives had a risk of epithelial ovarian cancer of 0.6 (95 percent confidence interval, 0.5 to 0.7) as compared with those who had never used them. This protective effect was seen in women who had used oral contraceptives for as little as three to six months, and it continued for 15 years after use ended; it was independent of the specific oral-contraceptive formulation and of the histologic type of epithelial ovarian cancer. (We could not adequately assess the association with nonepithelial ovarian cancers because of an insufficient number of cases.) We conclude that the use of oral contraceptives decreases the risk of epithelial ovarian cancer.
-
Case Reports
Treatment of adenosine deaminase deficiency with polyethylene glycol-modified adenosine deaminase.
We treated two children who had adenosine deaminase deficiency and severe combined immunodeficiency disease by injecting bovine adenosine deaminase modified by conjugation with polyethylene glycol. The modified enzyme was rapidly absorbed after intramuscular injection and had a half-life in plasma of 48 to 72 hours. Weekly doses of approximately 15 U per kilogram of body weight maintained plasma adenosine deaminase activity at two to three times the level of erythrocyte adenosine deaminase activity in normal subjects. ⋯ Clinical improvement was indicated by absence of infection and resumption of weight gain. We conclude that from the standpoints of efficacy, convenience, and safety, polyethylene glycol-modified adenosine deaminase is preferable to red-cell transfusion as a treatment for adenosine deaminase deficiency. Patients with other inherited metabolic diseases in which accumulated metabolites equilibrate with plasma could benefit from treatment with the appropriate polyethylene glycol-modified enzyme.
-
To search for a genetic marker for type 2 Gaucher's disease (acute neuronopathic form), we compared the nucleotide sequence of a cloned glucocerebrosidase gene from a patient with Gaucher's disease with a normal gene. We found only a single base substitution (T----C) in exon X. This mutation results in the substitution of proline for leucine in position number 444 and produces a new cleavage site for the NciI restriction endonuclease. ⋯ Only 4 of 20 patients with type 1 Gaucher's disease had the mutant allele and were heterozygous for it. None of the 29 normal controls had the mutant allele. The high frequency of this mutation (444leucine----proline) in patients with neuronopathic Gaucher's disease, detectable by the NciI RFLP, may be of value in the identification of patients who will have the neurologic sequelae of Gaucher's disease.