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A gas chromatography-mass spectrometry (GC-MS) method was developed for the analysis of 15 polycyclic aromatic hydrocarbons (PAHs) highlighted as carcinogenic by the Scientific Committee on Food (SCF) plus benzo[c]fluorine (recommended to be analysed by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) in fat-containing foods such as edible oils and smoked meat products. This method includes accelerated solvent extraction (ASE) and the highly automated clean-up steps gel permeation chromatography (GPC) and solid-phase extraction (SPE). Using a VF-17ms GC column, a good separation of benzo[b]fluoranthene, benzo[j]fluoranthene and benzo[k]fluoranthene was achieved. Futhermore, the six methylchrysene isomers and the PAH compounds with a molecular weight of 302 Daltons in fat-containing foods attained a better chromatographic separation in comparison with a 5-ms column. The reliability of the analytical method for edible oils was demonstrated by the results from a proficiency test. Measurements with GC-high-resolution mass spectroscopy (HRMS) and gas chromatography-mass selective detection (GC-MSD) led to comparable results. A survey of the 16 PAHs in 22 smoked meat products showed concentrations in the range < 0.01-19 microg kg(-1). The median concentration for benzo[a]pyrene was below 0.15 microg kg(-1).
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Contaminación de Alimentos/análisis , Productos de la Carne/análisis , Aceites de Plantas/química , Hidrocarburos Policíclicos Aromáticos/análisis , Análisis de los Alimentos/métodos , Cromatografía de Gases y Espectrometría de Masas/métodos , HumoRESUMEN
For some foodstuffs, determination of the mycotoxin ochratoxin A (OTA) requires time consuming clean up by means of solid phase extraction (SPE). Therefore a system for automated SPE was tested for cleaning up roasted coffee as a possible way of shortening preparation time. Validation of the method in accordance to the so called "Concept '98" led to a LOD of 0.2 µg/kg and a recovery rate of 92%. By using the described procedure with samples of roasted coffee the OTA contents varied between the LOD and 3.4 µg/kg. This method was also used to determine ochratoxin A in liquorice roots, ginger and valerian.
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The circulation of water masses in the northeastern North Atlantic Ocean has a strong influence on global climate owing to the northward transport of warm subtropical water to high latitudes. But the ocean circulation at depths below the reach of satellite observations is difficult to measure, and only recently have comprehensive, direct observations of whole ocean basins been possible. Here we present quantitative maps of the absolute velocities at two levels in the northeastern North Atlantic as obtained from acoustically tracked floats. We find that most of the mean flow transported northward by the Gulf Stream system at the thermocline level (about 600 m depth) remains within the subpolar region, and only relatively little enters the Rockall trough or the Nordic seas. Contrary to previous work, our data indicate that warm, saline water from the Mediterranean Sea reaches the high latitudes through a combination of narrow slope currents and mixing processes. At both depths under investigation, currents cross the Mid-Atlantic Ridge preferentially over deep gaps in the ridge, demonstrating that sea-floor topography can constrain even upper-ocean circulation patterns.
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Deep-sea hydrothermal vents and cold seeps are submarine springs where nutrient-rich fluids emanate from the sea floor. Vent and seep ecosystems occur in a variety of geological settings throughout the global ocean and support food webs based on chemoautotrophic primary production. Most vent and seep invertebrates arrive at suitable habitats as larvae dispersed by deep-ocean currents. The recent evolution of many vent and seep invertebrate species (<100 million years ago) suggests that Cenozoic tectonic history and oceanic circulation patterns have been important in defining contemporary biogeographic patterns.
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Evolución Biológica , Ecosistema , Invertebrados , Agua de Mar , Animales , Ambiente , Cadena Alimentaria , Genética de Población , Geografía , Sedimentos Geológicos , Invertebrados/clasificación , Invertebrados/genética , Invertebrados/fisiología , Océanos y Mares , Oxidación-Reducción , Filogenia , TemperaturaRESUMEN
This prospective, randomized investigation evaluated the efficacy of cryotherapy on subjective responses after both open and arthroscopic procedures on the shoulder. Seventy patients were randomly assigned to one of two study groups: (1) continuous cryotherapy group and (2) age-matched control group. Visual analog scales were used to assess subjective responses on postoperative days 1, 7, 14, and 21. On day 1, patients receiving cryotherapy reported significantly less pain during sleep and significantly more comfort in bed and rated their sleep as more restful than the control subjects. During days 7 through 21, cryotherapy subjects reported a significant reduction in frequency and intensity of pain, as well as less pain during shoulder rehabilitation, than the control subjects. These results indicate that cryotherapy is an effective method for postoperative pain control because it decreases the severity and frequency of pain and allows a return to normal sleep patterns while increasing overall postoperative comfort and satisfaction.
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Crioterapia/métodos , Rango del Movimiento Articular/fisiología , Lesiones del Manguito de los Rotadores , Dolor de Hombro/rehabilitación , Análisis de Varianza , Artroscopía/métodos , Femenino , Humanos , Masculino , Dimensión del Dolor , Periodo Posoperatorio , Pronóstico , Estudios Prospectivos , Valores de Referencia , Manguito de los Rotadores/cirugía , Dolor de Hombro/diagnóstico , Dolor de Hombro/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Resultado del TratamientoRESUMEN
Several studies have documented an association between the type III acromion and rotator cuff tears. However, controversy exists as to whether the shape of the acromion is an innate anatomic characteristic. The purpose of this study was to evaluate the prevalence of the type III acromion in young asymptomatic athletes. Bilateral supraspinatus outlet radiographs were obtained in 100 Division 1 collegiate athletes (average age, 19.9 years). Only 4 (2%) of 200 shoulders were found to have a type III acromion by use of the standard subjective Bigliani classification. Eight (4%) acromion were found to be type III by the use of previously published objective criteria for acromial measurement. Our results show the type III acromion to be relatively rare in asymptomatic, young athletes, but the incidence of type III acromion in a general population of both young and older individuals is still not completely understood. However, our results accentuate the possibility that the higher incidence of type III acromion seen in older populations may in fact be related to secondary acromial changes.
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Acromion/anatomía & histología , Acromion/diagnóstico por imagen , Adolescente , Adulto , Humanos , Masculino , RadiografíaRESUMEN
In this investigation, we determined the patterns of valgus laxity and acquired valgus laxity of the ulnar collateral ligament in the elbows of collegiate athletes involved in overhead and nonoverhead sports. Acquired valgus laxity of the elbow is defined as the differential amount of stress valgus opening between the dominant and nondominant elbows. Forty-eight asymptomatic male athletes involved in sports that require overhead arm movements (baseball, tennis, and swimming) and 88 asymptomatic male athletes involved in nonoverhead sports (track, lacrosse, fencing, and wrestling) underwent fluoroscan examination of both their elbows with (13 daN) and without (0 N) valgus stress. There were no statistically significant differences in the amount of valgus stress opening or in acquired valgus laxity between the two groups. In fact, 25% (34 of 136) of the athletes showed an acquired valgus laxity of more than 0.5 mm, and 51.5% (70 of 136) had an acquired valgus laxity that was actually negative. There was also no correlation between the number of years played and acquired valgus laxity. Our results show that acquired valgus laxity does not exist in asymptomatic athletes involved in overhead sports, and there is no threshold value of measurement indicative of acquired valgus laxity.
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Ligamentos Colaterales/fisiopatología , Articulación del Codo/fisiopatología , Inestabilidad de la Articulación/fisiopatología , Deportes , Análisis de Varianza , Articulación del Codo/diagnóstico por imagen , Humanos , Masculino , Radiografía , Estrés MecánicoRESUMEN
Providing intraarticular analgesia with a continuous infusion of local anesthetic via a disposable infusion pump has gained popularity. Despite the prevalence of this technique, data comparing this method of analgesia to conventional regional anesthesia are not available. We present a prospective study that compared a single-dose interscalene block with a single-dose interscalene block plus continuous intraarticular infusion of local anesthetic. Forty patients scheduled for shoulder arthroscopy were entered in this prospective, double-blinded study. All patients received an interscalene brachial plexus block as their primary anesthetic. Patients were randomly assigned to 1 of 2 groups: 1. interscalene block with 1.5% mepivacaine (40 mL) followed by a postoperative intraarticular infusion of 0.5% ropivacaine at 2 mL/h, or 2. interscalene block with 0.5% ropivacaine (40 mL) followed by a postoperative intraarticular infusion of 0.9% saline (placebo) at 2 mL/h. Postoperative infusions were maintained for 48 h. Visual analog scale pain scores and postoperative oxycodone consumption were measured for 48 h. Visual analog scale scores at rest and with ambulation in the Mepivacaine/Intraarticular Ropivacaine group were reduced when compared with the Ropivacaine/Saline group (rest: P = 0.003, ambulation: P = 0.006). Oxycodone consumption was also decreased (28 +/- 21 mg vs 44 +/- 28 mg, P = 0.046), respectively. We conclude that a brachial plexus block with 1.5% mepivacaine and a continuous intraarticular infusion of 0.5% ropivacaine at 2 mL/h provides improved analgesia for minor surgery at 24 and 48 h versus a single-injection interscalene block with 0.5% ropivacaine.
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Amidas , Anestésicos Locales , Plexo Braquial , Bloqueo Nervioso , Adulto , Analgésicos Opioides/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Bombas de Infusión , Inyecciones Intraarticulares , Masculino , Mepivacaína/uso terapéutico , Oxicodona/uso terapéutico , Dimensión del Dolor , Estudios Prospectivos , RopivacaínaRESUMEN
PURPOSE: Improper lifting techniques may increase injury risks and decrease performance. The aim of this study was to compare and contrast biomechanical parameters between sumo and conventional style deadlifts and between high- and low-skilled lifters who participated in the powerlifting event during the 1999 Special Olympics World Games. METHODS: Two synchronized video cameras collected 60 Hz of data from 40 subjects. Parameters were quantified at barbell liftoff (LO), when the barbell passed the knees (KP), and at lift completion. RESULTS: Compared with the conventional group, the sumo group had a 100% greater stance width, 20% smaller hand width, 10% less vertical bar distance, a more vertical trunk at LO, a more horizontal thigh at LO and KP, a less vertical shank at KP, and greater forefoot abduction. The sumo group generated ankle dorsiflexor, knee extensor, and hip extensor moments, whereas the conventional group produced ankle plantar flexor, knee flexor and extensor, and hip extensor moments. Compared with low-skilled lifters, high-skilled lifters had a 40% greater barbell load, 15% greater stance width (sumo group only), greater knee flexion at LO (conventional group only), greater knee extension at KP, a less vertical shank position at LO (sumo group only), 15% less vertical bar distance, less first peak bar velocity between LO and KP (conventional group only), smaller plantar flexor and hip extensor moment arms at LO and KP, and greater knee extensor moment arms at LO. CONCLUSIONS: The sumo deadlift may be more effective in working ankle dorsiflexors and knee extensors, whereas the conventional deadlift may be more effective in working ankle plantar flexors and knee flexors. High-skilled lifters exhibited better lifting mechanics than low-skilled lifters by keeping the bar closer to the body, which may both enhance performance and minimize injury risk.
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Traumatismos en Atletas/etiología , Levantamiento de Peso/fisiología , Adulto , Tobillo/fisiología , Fenómenos Biomecánicos , Humanos , Rodilla/fisiología , Masculino , Factores de Riesgo , Grabación en VideoRESUMEN
OBJECTIVE: To determine whether MRI can identify instability of the long head of the biceps tendon (LBT) in the rotator interval. DESIGN AND PATIENTS: A retrospective review was carried out of 19 patients, all arthroscopically examined, nine of whom had surgically confirmed instability of the LBT. RESULTS: A LBT perched on the lesser tuberosity correctly indicated all nine cases of instability with one false positive. In six of seven cases where the LBT was oval in shape, no instability of the biceps tendon existed, whereas LBT instability was present in eight of 12 patients with a flat long head of the biceps tendon. In seven of eight acutely angled intertubercular sulci there was no instability of the LBT while eight of 11 obtusely angled sulci were associated with LBT instability. By consensus impression, instability of the LBT could be determined with 67% sensitivity, 90% specificity, 86% positive predictive value, and 75% negative predictive value. CONCLUSIONS: A flat LBT perched on the lesser tuberosity with an obtusely angled intertubercular sulcus suggests the diagnosis of instability of the LBT in the correct clinical setting.
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Imagen por Resonancia Magnética , Traumatismos de los Tendones/diagnóstico , Tendones/patología , Adulto , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Manguito de los Rotadores , Sensibilidad y Especificidad , HombroRESUMEN
The purpose of this study was to delineate, through electromyographic analysis, the function of the long head of the biceps at the shoulder. Ten shoulders were examined with dynamic electromyography. The long head of the biceps was instrumented with thin wire electrodes. The supraspinatus, infraspinatus, deltoid, brachialis, and brachioradialis were instrumented as controls. Because the biceps functions primarily as a forearm supinator and elbow flexor, a long arm brace was used to lock the elbow in extension with the forearm in neutral pronation/supination. Each motion was tested in a full arc at fast (170 degrees per second) and slow (36 degrees per second) speeds and repeated with and without a 5-pound weight attached to the distal end of the brace. No electrical activity was identified in the long head of the biceps muscle in response to isolated shoulder motion with the elbow and forearm position controlled. The data demonstrate that the long head of the biceps is not active in isolated shoulder motion when the elbow and forearm are controlled. Thus, any hypothesis on bicipital function at the shoulder must be based on either a passive role of the tendon or tension in association with elbow and forearm activity.
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Articulación del Codo/fisiología , Movimiento , Músculo Esquelético/fisiología , Articulación del Hombro/fisiología , Adulto , Fenómenos Biomecánicos , Electromiografía , Antebrazo/fisiología , Humanos , Masculino , Valores de ReferenciaRESUMEN
OBJECTIVE: We describe the MR imaging findings of focal articular cartilage lesions of the superior humeral head and the clinical features in seven patients. CONCLUSION: Focal articular cartilage lesions of the superior humeral head are rare lesions that may cause clinical symptoms and may be easily overlooked on MR imaging. These lesions occur in a particular location (along the superior surface of the posterior humeral head, medial to the expected location of a Hill-Sachs lesion), are caused by trauma, and do not seem to have a specific mechanism of injury. Because of improvements in MR imaging of cartilage, this area of the shoulder should be inspected for this lesion.
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Cartílago Articular/patología , Húmero/patología , Imagen por Resonancia Magnética , Articulación del Hombro/patología , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Instability in the athlete presents a unique challenge to the orthopaedic surgeon. A spectrum of both static and dynamic pathophysiology, as well as gross and microscopic histopathology, contribute to this complex clinical continuum. Biomechanical studies of the shoulder and ligament cutting studies in recent years have generated a more precise understanding of the individual contributions of the various ligaments and capsular regions to shoulder instability. An understanding of the underlying pathology and accurate assessment of degree and direction of the instability by clinical examination and history are essential to developing appropriate treatment algorithms.
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Traumatismos en Atletas/patología , Traumatismos en Atletas/fisiopatología , Inestabilidad de la Articulación/patología , Inestabilidad de la Articulación/fisiopatología , Lesiones del Hombro , Algoritmos , Traumatismos en Atletas/etiología , Traumatismos en Atletas/terapia , Fenómenos Biomecánicos , Árboles de Decisión , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/terapia , Anamnesis , Examen Físico , Presión , Rango del Movimiento Articular , Factores de RiesgoRESUMEN
Radiographs of the shoulders of 84 asymptomatic individuals aged between 40 and 83 years were evaluated to determine changes in 23 specific areas. Two fellowship-trained orthopaedic radiologists graded each area on a scale of 0 to II (normal 0, mild changes I, advanced changes II). Logistic regression analysis indicated age to be a significant predictor of change (p < 0.05) for sclerosis of the medial acromion and lateral clavicle, the presence of subchondral cysts in the acromion, formation of osteophytes at the inferior acromion and clavicle, and narrowing and degeneration of the acromioclavicular joint. Gender was not a significant predictor (p > 0.05) for radiological changes. Student's t-test determined significance (p < 0.05) between age and the presence of medial acromial and lateral clavicular sclerosis, subchondral acromial cysts, inferior acromial and clavicular osteophytes, and degeneration of the acromioclavicular joint. Radiological analysis in conditions such as subacromial impingement, pathology of the rotator cuff, and acromioclavicular degeneration should be interpreted in the context of the symptoms and normal age-related changes.
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Articulación Acromioclavicular , Envejecimiento/patología , Artritis/diagnóstico por imagen , Lesiones del Manguito de los Rotadores , Síndrome de Abducción Dolorosa del Hombro/diagnóstico por imagen , Articulación del Hombro , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Artritis/clasificación , Artritis/etiología , Artritis/fisiopatología , Sesgo , Distribución de Chi-Cuadrado , Diagnóstico Diferencial , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Radiografía , Valores de Referencia , Índice de Severidad de la Enfermedad , Caracteres Sexuales , Síndrome de Abducción Dolorosa del Hombro/clasificación , Síndrome de Abducción Dolorosa del Hombro/etiología , Síndrome de Abducción Dolorosa del Hombro/fisiopatología , Método Simple CiegoRESUMEN
Continuous interscalene brachial plexus blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from a continuous peripheral nerve block, with a reliable method of catheter insertion, and a self-contained infusion system would be a valuable asset for short-stay care. We compared the efficacy of single injection interscalene brachial plexus blockade to a continuous peripheral nerve block, with an insulated Tuohy system and a disposable infusion pump. Forty adult patients scheduled for open rotator cuff repair were entered in this randomized, double-blinded, placebo-controlled study. Patients received an interscalene brachial plexus blockade and a continuous peripheral nerve catheter as their primary anesthetic and then, were assigned to receive one of two different postoperative infusions: either 0.2% ropivacaine at 10 mL/h via a disposable infusion pump or normal saline at 10 mL/h via a disposable infusion pump (n = 18-20 per group). Visual analog pain scores and postoperative morphine consumption were measured for 24 h. The ropivacaine group showed less pain than the placebo group (P: = 0.0001) between 12 and 24 h after the initial injection of local anesthetic. In addition, initial interscalene blockade was successful in all patients and all redosed catheters were functional after 24 h with the continuous catheter insertion system. We conclude that it is possible to achieve a high rate of successful catheter placement and analgesia by using the continuous catheter insertion system and a disposable infusion pump in the ambulatory setting. This method of analgesia may offer improved pain relief after outpatient rotator cuff repair.
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Plexo Braquial , Bloqueo Nervioso/instrumentación , Adolescente , Adulto , Amidas/sangre , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/sangre , Cateterismo/instrumentación , Cateterismo/métodos , Método Doble Ciego , Femenino , Humanos , Bombas de Infusión , Masculino , Morfina/administración & dosificación , Morfina/uso terapéutico , Procedimientos Ortopédicos , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Ropivacaína , Hombro/cirugíaRESUMEN
A rapid and single multimethod was developed to determine substances of different pesticide classes in whole blood in the event of acute human intoxications, as required by EU Commission Directive 96/46. The method was validated by an in-house and an independent laboratory validation. Whole blood is hemolyzed and then deproteinized. After extraction of the supernatant, blood levels are determined by gas chromatography-mass spectrometry. The method, which can be performed within 120 min, covers 15 active substances (8 organophosphate pesticides, 2 carbamates, 3 pyrethroids, 1 azole, and 1 organochlorine pesticide) classified as toxic or very toxic. These compounds can be identified down to concentrations between 100 and 1000 ng/mL by comparison of their mass spectra to those in a commercial pesticide mass spectra library. Using the standard addition method, they can be quantitated down to concentrations between 30 and 200 ng/mL. These limits of quantitation are considered to be sufficient in comparison to respective LD50 values.
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Cromatografía de Gases y Espectrometría de Masas/métodos , Plaguicidas/sangre , Medicina Legal/métodos , Humanos , Dosificación Letal Mediana , Plaguicidas/envenenamiento , Sensibilidad y EspecificidadRESUMEN
PURPOSE: Strength athletes often employ the deadlift in their training or rehabilitation regimens. The purpose of this study was to quantify kinematic and kinetic parameters by employing a three-dimensional analysis during sumo and conventional style deadlifts. METHODS: Two 60-Hz video cameras recorded 12 sumo and 12 conventional style lifters during a national powerlifting championship. Parameters were quantified at barbell liftoff (LO), at the instant the barbell passed the knees (KP), and at lift completion. Unpaired t-tests (P < 0.05) were used to compare all parameters. RESULTS: At LO and KP, thigh position was 11-16 degrees more horizontal for the sumo group, whereas the knees and hips extended approximately 12 degrees more for the conventional group. The sumo group had 5-10 degrees greater vertical trunk and thigh positions, employed a wider stance (70 +/- 11 cm vs 32 +/- 8 cm), turned their feet out more (42 +/- 8 vs 14 +/- 6 degrees). and gripped the bar with their hands closer together (47 +/- 4 cm vs 55 +/- 10 cm). Vertical bar distance, mechanical work, and predicted energy expenditure were approximately 25-40% greater in the conventional group. Hip extensor, knee extensor, and ankle dorsiflexor moments were generated for the sumo group, whereas hip extensor, knee extensor, knee flexor, and ankle plantar flexor moments were generated for the conventional group. Ankle and knee moments and moment arms were significantly different between the sumo and conventional groups, whereas hip moments and moments arms did not show any significantly differences. Three-dimensional calculations were more accurate and significantly different than two-dimensional calculations, especially for the sumo deadlift. CONCLUSIONS: Biomechanical differences between sumo and conventional deadlifts result from technique variations between these exercises. Understanding these differences will aid the strength coach or rehabilitation specialist in determining which deadlift style an athlete or patient should employ.
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Articulaciones/fisiología , Levantamiento de Peso/fisiología , Adulto , Fenómenos Biomecánicos , Humanos , Cinética , Masculino , Postura , Soporte de PesoRESUMEN
PURPOSE: Longitudinal split tears of the peroneus brevis tendon have been increasingly reported as a source of lateral ankle pain and disability. MR imaging is useful in identifying the appearance of longitudinal split tears of the peroneus brevis tendon to differentiate this entity from other causes of chronic lateral ankle pain. We observed variations in anatomy associated with these tears. MATERIALS AND METHODS: Twenty-two patients (eleven males, eleven females) were identified as having longitudinal split tears of the peroneus brevis tendon. These cases were reviewed retrospectively to evaluate for the following: shape of the peroneus brevis tendon, high signal in the peroneus brevis tendon, tendon subluxation, appearance of the superior peroneal retinaculum, presence of osseous changes in the ankle, lateral ankle ligaments, presence of a bony fibular spur, flattening of the peroneal groove of the fibula and presence of a peroneus quartus. A control group consisted of twenty ankles imaged for reasons other than lateral ankle pain. The same structures were assessed in this group. A Fisher's exact P-value was used to determine the significance of each finding in the two groups. RESULTS: Statistically significant associated findings were chevron shaped tendon (p = .0001), high signal in the peroneus brevis (p = .0017), bony changes (p = .0001), flat peroneal groove (p = .0001), abnormal lateral ligaments (p = .0004), and lateral fibular spur (p = .0006). CONCLUSIONS: MR imaging is useful in differentiating longitudinal split tears of the peroneus brevis tendon from other lateral ankle disorders. It can show the extent of the abnormality in the tendon and the associated findings of soft tissue and/or bone variations which must be addressed at the time of surgery.
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Tobillo , Imagen por Resonancia Magnética , Traumatismos de los Tendones/diagnóstico , Tendones/patología , Adolescente , Adulto , Anciano , Traumatismos del Tobillo/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , RoturaRESUMEN
It has been suggested that cyproterone acetate (CPA) has a mutagenic potency. It has been postulated that a threshold dosage of CPA has mutagenic effects, but in the same way data have been published documenting that a continuous low dosage of cyproterone acetate leads to a reduction of mutagenic episodes. Despite published data about higher levels of DNA adduct creations due to CPA an international multicentre study analysing 2,506 patients with 7,971 patient-years that used CPA could not find any liver cell cancers, even if due to epidemiological data 6 liver cell cancers should have occurred upon this study group. The present study deals with the evaluation of 57 women which received CPA in combination with EE2 11-13 years before. The daily dosage was 2 mg CPA in combination with 35 mg or 50 mg EE2. In Germany these drugs were registered under the name of Diane 35 or Diane 50. Long-term follow-up evaluation concerning side effects, especially the appearance of liver cell carcinomas, were the aim of this study. With the records of 32% (18/57) of the above mentioned patient group the following long-term follow-up side effects could be observed: 1) weight gain, 2) headache, 3) migraine, 4) gastrointestinal disorders, 5) mood affections/depressions, 6) oedema of the legs, 7) skin affections, 8) mastodynia. No benign liver tumor or liver cell carcinoma was detected upon our group of investigated patients. In conclusion we can affirm that the use of CPA in a dosage of 2 mg per day does not lead to serious side effects under long-term follow-up observation conditions and that it's use does not correlate with a higher appearance of liver cell carcinomas.