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AN APPEAL FOR PEACE
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positives from 7%9 to as much as 48%.10 The false positive reactions are due to uptake of the dye by ulcers, inflamed mucosa, granulation tissue, goblet cells in respiratory epithelium, desquamated keratin, post-irradiation atrophy, or trapping of the dye in crypts, fissures, or papillary keratoses. To reduce unselective staining, a mouth rinse has been substituted for manual application of the dye, or 1% acetic acid has been used as a decolourising agent. The scientific basis for this art remains undecided. Toluidine blue has been regarded as a nuclear stain6 and the highly cellular dysplastic tissue or tumours, having a greater content of nuclei per unit volume and more nucleic acid per cell, 11,12 are believed to take up dye more readily than healthy tissue. After supravital staining, some workers report that toluidine blue colours the nuclei intensely and the cytoplasm to a lesser extent,13 whereas others find the dye between tumour cells.14 Another possibility is that toluidine blue passes easily into the widened intercellular spaces which are a feature of carcinomatous epithelium.15 That between three and five distinct dyes are present in so-called toluidine blue16,17 is a further indication of the empirical nature of the procedure. The present test may detect relative rather than absolute differences between normal and neoplastic cells. Some exclusive marker of neoplastic epithelial cells such as the loss of blood-group substances 18 or the presence of &bgr;2-microglobulin19 might form the basis of an improved invivo test. What is the current status of the toluidine blue dye test? It is not a substitute for biopsy since invasion or dysplasia at deeper levels will not be revealed by a stain which penetrates only superficially.s A small proportion of premalignant or malignant lesions will give a false-negative reaction. In view of the provisos concerning false positives, the existing test is probably unsuitable for the occasional user. The main use of the toluidine-blue test seems to be as an adjunct to biopsy, indicating sinister areas to sample and revealing "satellite" unnoticed tumours. It has been used to mark out the full extent of the dysplastic epithelium or carcinoma when excisions are planned, although normal mucosa undermined by the infiltrating tumour may not stain. Whether the test could be used by paramedical teams to screen large populations has not been looked into. ’
AN APPEAL FOR PEACE IN a time when the arms race shows few signs of abating, and public opinion polls indicate widespread pessimism about the chances that a world war will break out within the next ten years (in a Gallup poll published in the Washington Santesson L. Studies on protein metabolism in the cells of epithelial Acta Radiol 1942; 46: (suppl) 17-18, 82. 12. Gröntoft O, Hellquist H, Ologsson J, Nordstrom G. The DNA content and nuclear size in normal, dysplastic and carcinomatous laryngeal epithelium; a spectrophotometric study. Acta Otolaryngol 1978; 86: 473-79. 13. Sigurdson A, Willen R. Toluidine blue in diagnosing malignancy of the epithelial mucosa Swed Dent J 1975, 68: 117-26. 14. Strong MS, Vaughan CW, Incze JS. Toluidine blue in the management of carcinoma of the oral cavity. Arch Otolaryngol 1968; 87: 101-05. 15. Sugar J An electron microscopic study of early invasive growth in human skin tumours and laryngeal carcinoma. Europ J Cancer 1968; 4: 33-38. 16. Ball J, Jackson DS. Histological, chromatographic and spectrophotometric studies of toluidine blue. Stain Technol 1953; 28: 33-40. 17 Kramer H, Windrum GM. The metachromatic staining reaction. J Histochem Cytochem 1955; 3: 227-37. 18. Dabelsteen E, Fulling HJ A preliminary study of blood group substances A and B in oral epithelium exhibiting atypia. Scand J Dent Res 1971; 79: 387-93. 19. Korthals Altes-Levy Van Vinninghe HR, Neumann HAM. The presence of &bgr;2 microglobulin on the membrane of the keratinocyte in premalignant skin disorders. Br J Dermatol 1981; 104: 515-19.
11
Caspersson T, tumours.
Post on Dec. 31 the proportion reckoning the chance less than 50-50 varied from only 36% to 69% in 26 nations of Europe, North and South America, and Asia), one of the heartening signs is the growing popular movements of protest against the arms race and especially against the proliferation of nuclear weapons. Doctors have become particularly active in the U.S.A., U.S.S.R., and some countries of Europe, including Britain, in trying to make clear to the public what would be the medical consequences of a nuclear war, and the danger of regarding nuclear weapons as instruments of policy. Although all these protests from many groups have not yet caused a single nuclear weapon to be removed from the arsenals of the East or the West, they may have helped to encourage the leaders of the U.S.A. and the Soviet Union to enter into discussions (at present somewhat half-heartedly) about reducing nuclear armaments. One reaction in ruling circles to protest movements in Western Europe has been to imply that, consciously or unconsciously, they weaken the West’s defences against Soviet aggression. In East European countries peace and disarmament councils enjoy official approval but they limit their protests to the waste and horror of war, while accepting their own countries’ preparations for war as no more than a reaction to threats of aggression from the United States. Attitudes in East and West tend to be mirror images of one another. In these circumstances, opportunities for persons of influence from Eastern and Western countries to discuss together the problems freely and honestly become especially important. The Pugwash Conferences on Science and World Affairs have for many years provided such opportunities and
their discussions greatly assisted the conclusion of the Partial Test Ban Treaty. A similar body in the medical field is International Physicians for the Prevention of Nuclear War, founded in 1980 by two cardiologists, Prof. Bernard Lown, of Boston, and Prof. Eugene Chazov, of Moscow. IPPNW held its first congress in March, 1981.1 The agreed conclusions of this congress about the medical effects of nuclear war were given wide publicity in the United States and in the Soviet Union, and continue to attract the support and interest of physicians everywhere. The second congress, to be held in Cambridge, England, oh April 3-7 this year, will concentrate on the effects of nuclear war in Europe. It will be attended by some 200 physicians and other specialists from most European countries, with large contingents from the U.S.A. and the U.S.S.R., as well as persons from Japan and the near and far East. Its programme includes workshops not only about the short-term and long-term medical consequences of nuclear weapons but also about risks of nuclear war arising from human error, about the psychological effects of living under its threat, and about the barriers to understanding arising out of preconceived attitudes and the stereotyping of adversaries. If the participants can reach agreed conclusions at these workshops which are not merely anodyne, and obtain publicity for them in their own countries, this would be a significant medical contribution to preventing what has been described as the Final Epidemic. To organise a congress of this kind is a considerable and costly undertaking. We understand that the organisers have raised some L40 000 but are still £30 000 short of the sum needed. This is a cause which we commend to our readers for support.2
1. International Physicians for Prevention of Nuclear War. Lancet 1981; i: 790-91. 2. Donations may be sent to: The Treasurer, IPPNW Congress ’82, 9 Great Russell Mansions, 60 Great Russell Street, London WC1B 3BE.
positives from 7%9 to as much as 48%.10 The false positive reactions are due to uptake of the dye by ulcers, inflamed mucosa, granulation tissue, goblet cells in respiratory epithelium, desquamated keratin, post-irradiation atrophy, or trapping of the dye in crypts, fissures, or papillary keratoses. To reduce unselective staining, a mouth rinse has been substituted for manual application of the dye, or 1% acetic acid has been used as a decolourising agent. The scientific basis for this art remains undecided. Toluidine blue has been regarded as a nuclear stain6 and the highly cellular dysplastic tissue or tumours, having a greater content of nuclei per unit volume and more nucleic acid per cell, 11,12 are believed to take up dye more readily than healthy tissue. After supravital staining, some workers report that toluidine blue colours the nuclei intensely and the cytoplasm to a lesser extent,13 whereas others find the dye between tumour cells.14 Another possibility is that toluidine blue passes easily into the widened intercellular spaces which are a feature of carcinomatous epithelium.15 That between three and five distinct dyes are present in so-called toluidine blue16,17 is a further indication of the empirical nature of the procedure. The present test may detect relative rather than absolute differences between normal and neoplastic cells. Some exclusive marker of neoplastic epithelial cells such as the loss of blood-group substances 18 or the presence of &bgr;2-microglobulin19 might form the basis of an improved invivo test. What is the current status of the toluidine blue dye test? It is not a substitute for biopsy since invasion or dysplasia at deeper levels will not be revealed by a stain which penetrates only superficially.s A small proportion of premalignant or malignant lesions will give a false-negative reaction. In view of the provisos concerning false positives, the existing test is probably unsuitable for the occasional user. The main use of the toluidine-blue test seems to be as an adjunct to biopsy, indicating sinister areas to sample and revealing "satellite" unnoticed tumours. It has been used to mark out the full extent of the dysplastic epithelium or carcinoma when excisions are planned, although normal mucosa undermined by the infiltrating tumour may not stain. Whether the test could be used by paramedical teams to screen large populations has not been looked into. ’
AN APPEAL FOR PEACE IN a time when the arms race shows few signs of abating, and public opinion polls indicate widespread pessimism about the chances that a world war will break out within the next ten years (in a Gallup poll published in the Washington Santesson L. Studies on protein metabolism in the cells of epithelial Acta Radiol 1942; 46: (suppl) 17-18, 82. 12. Gröntoft O, Hellquist H, Ologsson J, Nordstrom G. The DNA content and nuclear size in normal, dysplastic and carcinomatous laryngeal epithelium; a spectrophotometric study. Acta Otolaryngol 1978; 86: 473-79. 13. Sigurdson A, Willen R. Toluidine blue in diagnosing malignancy of the epithelial mucosa Swed Dent J 1975, 68: 117-26. 14. Strong MS, Vaughan CW, Incze JS. Toluidine blue in the management of carcinoma of the oral cavity. Arch Otolaryngol 1968; 87: 101-05. 15. Sugar J An electron microscopic study of early invasive growth in human skin tumours and laryngeal carcinoma. Europ J Cancer 1968; 4: 33-38. 16. Ball J, Jackson DS. Histological, chromatographic and spectrophotometric studies of toluidine blue. Stain Technol 1953; 28: 33-40. 17 Kramer H, Windrum GM. The metachromatic staining reaction. J Histochem Cytochem 1955; 3: 227-37. 18. Dabelsteen E, Fulling HJ A preliminary study of blood group substances A and B in oral epithelium exhibiting atypia. Scand J Dent Res 1971; 79: 387-93. 19. Korthals Altes-Levy Van Vinninghe HR, Neumann HAM. The presence of &bgr;2 microglobulin on the membrane of the keratinocyte in premalignant skin disorders. Br J Dermatol 1981; 104: 515-19.
11
Caspersson T, tumours.
Post on Dec. 31 the proportion reckoning the chance less than 50-50 varied from only 36% to 69% in 26 nations of Europe, North and South America, and Asia), one of the heartening signs is the growing popular movements of protest against the arms race and especially against the proliferation of nuclear weapons. Doctors have become particularly active in the U.S.A., U.S.S.R., and some countries of Europe, including Britain, in trying to make clear to the public what would be the medical consequences of a nuclear war, and the danger of regarding nuclear weapons as instruments of policy. Although all these protests from many groups have not yet caused a single nuclear weapon to be removed from the arsenals of the East or the West, they may have helped to encourage the leaders of the U.S.A. and the Soviet Union to enter into discussions (at present somewhat half-heartedly) about reducing nuclear armaments. One reaction in ruling circles to protest movements in Western Europe has been to imply that, consciously or unconsciously, they weaken the West’s defences against Soviet aggression. In East European countries peace and disarmament councils enjoy official approval but they limit their protests to the waste and horror of war, while accepting their own countries’ preparations for war as no more than a reaction to threats of aggression from the United States. Attitudes in East and West tend to be mirror images of one another. In these circumstances, opportunities for persons of influence from Eastern and Western countries to discuss together the problems freely and honestly become especially important. The Pugwash Conferences on Science and World Affairs have for many years provided such opportunities and
their discussions greatly assisted the conclusion of the Partial Test Ban Treaty. A similar body in the medical field is International Physicians for the Prevention of Nuclear War, founded in 1980 by two cardiologists, Prof. Bernard Lown, of Boston, and Prof. Eugene Chazov, of Moscow. IPPNW held its first congress in March, 1981.1 The agreed conclusions of this congress about the medical effects of nuclear war were given wide publicity in the United States and in the Soviet Union, and continue to attract the support and interest of physicians everywhere. The second congress, to be held in Cambridge, England, oh April 3-7 this year, will concentrate on the effects of nuclear war in Europe. It will be attended by some 200 physicians and other specialists from most European countries, with large contingents from the U.S.A. and the U.S.S.R., as well as persons from Japan and the near and far East. Its programme includes workshops not only about the short-term and long-term medical consequences of nuclear weapons but also about risks of nuclear war arising from human error, about the psychological effects of living under its threat, and about the barriers to understanding arising out of preconceived attitudes and the stereotyping of adversaries. If the participants can reach agreed conclusions at these workshops which are not merely anodyne, and obtain publicity for them in their own countries, this would be a significant medical contribution to preventing what has been described as the Final Epidemic. To organise a congress of this kind is a considerable and costly undertaking. We understand that the organisers have raised some L40 000 but are still £30 000 short of the sum needed. This is a cause which we commend to our readers for support.2
1. International Physicians for Prevention of Nuclear War. Lancet 1981; i: 790-91. 2. Donations may be sent to: The Treasurer, IPPNW Congress ’82, 9 Great Russell Mansions, 60 Great Russell Street, London WC1B 3BE.