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Mancini immunodiffusion method7 ~vhlch has a sensitivity of 1-2 mgfl, a value four times greater than that ofmaxlmally concentrated normal urine. The results were recorded as either positive or negative. 35% (8/23) of patients who ever lived in BN endemic villages> 35% (I0/29) of the patients from non-endemic rural areas, and 1 of the 2 patients belonging to the indigenops urban non- endemic population were positk'e for p2M. Thus, in a large series ofpatlents, an ordinarily rare tumour was more than 18 times as frequent in a population at risk of BN than in a non-exposed population. The difference may be even greater than ..reported here ifthe exact endemic population could be determined. " 35% of the patients had, at fellox~up> fl2M in their urine, but • positivit3; w~ not related to place of residence. In an age matched .. control populati.on the frequency of pzM positivity would be • expected to be zero %./J2M may ~cur transiently after surg,.i'y? but this is unlikely to account for thc mlcrogiobulinurla seen in I. P~vle $. Gec~raphlea! dlsu|bulton of,argel oflbe urot~li~ in Yugmbvh: a ." ~u~iclon oft s~ci~ ~rel~gcnle ~grnt. lm ] L'z,d ~u419~; ~: 1-9. . 2. R~a~v;~ ~ Kra~v~ S. ~c Balkan e~mic ~ro~th)" and urinal- lra~ tumou~ d~ Gt~mh~or~ 19~9; 4~¢ 4~4-47. . 3. Chcrnozdm~y IN, Pctkova.8~h~o~a T, Nikdav IG, Sto)~v IS. Familhl ~g~n ef urln=~ ~ys~rm augurs in a r~g~ w~h endem~ ac~ro~by. 4 ~tt~TA+Dimluo~T, lta)l ~. Rd=i~n~Jae~n ¢~d~;c(~R~) nephrepa~hy pancreas) has beeh rising steadily, and it is.now about the fourth • most common cause of cancer death in western sodedesfl'~.Yet insights into its aetiology are few and seeming])' disconueded. Empirical risk factors 9ore epidemiological studies include~ with varying consistency~ cigarette smoking~ diabct~, mellitus> alcohol, the "affluent diet", migration from low to high risk env.h'onmenrs, and coffee consuraption.TM Unlike epithelial tissues of,, for example, the oroph'aryngeal, respiratory, and gastrointestinal tracts, the exocrine pancreas is not • in immediate - contact with exogenous environmental "carcinogens". How then might the above-mendoned~ disparate, • collection ofeaupirical risk Factors impinge upon the pancreas? "" ". " Various ad hoe mechanisms have ken postulat~ .for. th~se" individual risk factors; most have focused on the search for chemical cardnogen,t Howeveh $,pcctor st,gge~ts, and he is ' snpported by experiments in rats,L*tbat certain dietary factors promote pancreatic carcinogen esis. This notion, I suggest, could be extended to a more general hypothesis tha~ the well-known trophic " (especiallyhypetplastlc) effects of certain gastrolnteminal hormones . " upbn the eso,.'rine pancreas* ndght medlate~ at least h part, th~ " 49 -~+ " "+ " " 0031. Tt05280085

T10~280088