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THF1 AXc£T,'SErTLtsF_tt 10,7.983! PA'SSME SMQMG AND LUNG OAMCER PELXYCD CORStErt' 1.IIoDA W11.UabnS'3atCkGLE E'LtZMS1:TH FOYixAN[ YtDUPINC, LSAr Whi1A.M',H4EX= Depar<nrosrq/Aavhahag2; Loufitmsa S}au UnisKrsiry,hArd+m!' Cotrer. Ntso tjrtTaon/, Zodiimra, Err~r+vr~tesal ept~larriolap ' Bnsrsoti, NorJdrlal CetnonlRSl dVatiunaJJxw~;4a of lfacirh+. C~i'aogv. Btthala, Mal lJlltb:r Conrsr Cormll L1yumG, USJl. Su+mrtary Qutws[fotts about the srsoking habits of . parmta and apoauct vcrc aaked in a tase- eoratrol atudr in.olving 1338 htng eancer pstieou'and 1393 eompaarison subjaxs in J,~,onLsiunai USA. 1`7on-omokers mutsned to heavy smolters had an iecraased rusk of lung ©nter, and'so did eubjeats whose mothers smoked. There was no assodttion betwotn lung cancer risk astd patcrnai smakieg. The usoeiition with'mat'ernal smoking was ficurtd oniy in'smokars and persisted!e.ltes opntt:oUing,For rariablks iadieative ofictivc smoking.It'is nor clearwhetber'the resu]ts ra`tect a blolo¢ic-.l efFecs assodaeediwith maternal smoking or the tnability'te-eontrol adeqaatelp for confounding factors's rehtell acriwtstaoknna; Tttis pratimirr.rs 8ndinb deser.fes further investugatfon. Int2,oduedon THF posaibiiuy of passire'or involuntars smoltiag being a cauatnve factor in lung' taneer has been invextigatad in severel eouavies.t'3 This report describes a.c2se-controt studj+ of lung canaor in1 I:aulsiana io Wlutb qnarjona were asked abobt the smokiag habits of tne spaouen end'parenu of 1!33P ;ung eaneer patierrts and'' 1393 comparison subjkctx (controls). Materialx ssrd Methods Gi:rre^.c prima.ry, :unF ancer twses were i6nr'tAed hom ldmiss:oc:and parhology records ofall pa.ui.7,iating boapitall in r.cnry-nin_ lavielena parishes (ulundes), r.hick iaaudcd' all southerni ane oe;ltral I(A:apide.), P.ndYioro nortbern parisnes(Cliddo and'Sossttrl. Patients with ibronOhiaBtYeolar nrancmai(32'rases) ara no: taduded in the present repo;s: A:D'tmtjor bospitals in the study arm parriQpated ercepc some si:'tlie ciry, of New Or,lclnt .herc, for to&ic rca.monseJflttr9iitwurd wss dxL'bt»ata(y iimited to teo largt ho!pitelt set'vinQ the medieatly unia:urec p*punsrion and rao)argc pnra:ahosp,tals. Por cacb.ubiect a eoAthd *oas rnadoauY selected from parjcxrra atte,,7dinQ the aaate hospital and mazched b;- n+": sex, aad ags (wrthm 5 yaars). Pal whose main diav,nostt, was em, hysczris, c2troair brmcMtisi cbronic o)2struCttMe' pulaon ari diraase, or rineer of tba uarynx; orai taa; ty, pesophsgus, , or bladd:r mcre ezrJvdcd from the eontrol selection pracednres. The admtssicn d'ugnores'of the eontrol3 were d;stributed in che foIIal ategories: ea:diovascular 1'5•3"%e; gascain¢el 13%a; musc:foskeleta. 10°7sp •gmirtturinary 7• 3%; oph'helmology- aad ororhinmlar}ngology6.62a; other nsmoui!546; diabcces 5cle; trzumr 3'•7°h; perlphe.rsi' vasCular 3•7rla; trjlmonary 2-717R; eerebrooas.:.Ur 1• 5°7s; tad infeaions 2% t;ocel profeasional inter.icw-ars, tralned fot this investigac:on end tborouPtitly,fam3lia w;b loC2i Ct1lCnte; inter:•Scwed subje•res(76%,of the'nscs and Wfa ollbe eont-e1s) iortheir ncx:ofirin.l?bequastions covere,d o=apat,on, residencs, dle:, "oktaganC dhiokiaghabits; beahh, water st:pply, snd osbcr related lterpR: loformatull etietted on the srnakinS hablts of the gpovae or pstent'inriuded type'of tnrrsizl smoKed, dunr9on of seaokint; habit, and daily amounr. QumonQ oe parenta; hrbtts rekrred'to the penod"'durirg most of your ehildbood". Histoloaical conGrnptio:•t was ob-uned fo- 97% of the'caseE: ; tissinE data were e8e:uded'r otn tse ::b1es:,Sraicarc unmaturied Fvr r~cthods'TVetrt usa: to esti-nsre xelitive ris14. Nl p calucs ve bssed lor, 2-eided'x' tests: Resalts SPoUre S'mok0e' Wc idcndfied noaxmokers with IuAg caDt:er and oompatmd' ehe smoltiAg himrfcs ol spousa o>;!h thos e afspouscs of non~tnokin; ooaorols, Only 10 out of 1036 male easa were non-aqtokerf: 2 repottlod ooaapational exfrosttre to 1 dust (ntrcet-vpeepa,log-ateser); I vas a stdarrel fitter; 2 li!aad In'r1f f. immcdists rddnit7 of industrial pS9ars (grain elevtttor and ccnent, oi1'refaery,y; i was married to a heavy smoker, snd 4were IonY-iimc chewers ofrobaao-Theae lrere 15 oon- smo'kin& 1 eLerYnarried'.rozucn with lung cancer out of 302 . feroaie coes= 2 of tb!rae chewed tobacco'tegttlarlly. For 1 fetttaic and 2 male Aon-smoki4pstdeaa no informaion +vas z-cailbble on, the smoking hiscors of the spottse. 2 fanalct ptdents' busbends wcre smokets' bot the araotr;:t and duration aas unlmown. Table I distritatues the non-smoking, e9e: rmsrried'meu utd' -omen acoording to total llfrrino-epatlt-rears imokedlbytheir spouses at'rhx'time oftbc interrievo. The stlative ,ri3kof htng cancer is r aised vcheII'the spouse is a heavy s'rnoker. Similar tabulations for smoking suble= did notsho>w'an ]nerrzscd risk assotriated with'srpohirig of spouses, exceptfor, light smoking men (lcis thae 20 paekwcarf): who bad a relative risk of !'• S when mar riad'to b+eaw smokers (41 pack- years or more). Casc•control comparisons bascd on currcnt daily number of cigarettes smoktw by the spouse yielded almost idboticai fi:-idings, Including neistire risk eataima;ea, w'sth tltose prrsenrcd'' in teble' 1. The apparent passive cxpostue efr®; t was presem in W+omon orer and under 60 yeets of age, although smaa numbers madc the aubgtnup. ,qrtdings not starosrotaliy.y sigaiFicant,ll,rtalyses 3imimd'to t:a.sss and controls inter4e-ed in person indicated that systerLatic b;as in persortai versus ntxt-of:kia rtsporses can vc ruled out . aF a potentiai explanapion for the ttndings. The same conclus;on wss reached wmen relative risks were race sdiustedi lncliu;on ofbroncbroziveolar carcinomas resulted in s,'i,ri-tt;y Iowc: odia ratios: males 1'69. jftales 1• i 7, both s6SeS. Pdrrr•tr' Sr+lohing f77brls. Smoking habits;of rbe parents's;rongly" influertcEd smaking hsbits :n of5pribg (table rI): Heavy smolters were more iikelV than :5a other patients to hs.e nad smoking parents. Thc smcking historis of rhe pareets'in our seriiCs were assocititcd, wit'h eac%h othe:. Tn:rc were 201 spotrse pairs of s;nol compared with 136 expcr,cd if the s.atus of each p'rrent was TABiR:-1+Oti•sMClt''.vc;. d:Z+SRJA.tRRI$0 ~LtlNG.rANGbRC1SES wN[D Ci9`.aF.OiS `:S~n'r_r~,ray,~~co;~SL+~SP?:CIri~oFGfiA@Rrr'TrESZY'.THR/!.' SFOu3r.5 CJb.rznes sncud r•v xf~nvse (pz ~•yesrr)' 595 Wor.o t~0.~ y41 N.a:~r I I ~ ~ I C. . Ctses ~, 6' Gr.c c:: '( ,St 20 I L I GW!S RLG II 1 •0 2•0 re.N>n C40 , a canarol'f 21 064 n:.e, B :r8 : ": Od'u rai,o ~ ?.5`. f,idtue:eefvr•rxl j ;-4 ;•45 )F1,. •cc6•eK. I I I

: c 5!9b TNML'8::-CIChRE:7E tt6x OF COL'rROL 3G 9JE< :'S iY Sa.OI;,vQ :,lt': FOCBtr'hF UCtk' Piti.R.^rPS , Fjrber waksr 1lol~'nn~st ^ I Ycf' No Yu ~o M 1 ~ r_ t•Jarn I }(er-ssa:en, ~ 13°•i i }Z/15 ~ 5% f 3-~5 Fat-sPio[e:1 ! 234. ' zea ~ 3fi*, , 29k E,- Currtnl imOkcn ~ ib?h i :295' { 6g~3' 4T. Tool cuaoer 475 i ~' e94 J 'a~ 5 sQ fimdd i I l Non+uwt<n 37'/ . I ba!s; rrs; aes: I Ea,t®o"n , YGCt, 14% , li~ !Tb Cuntnrxaokcn 4!~ 20% sass ~ 2796 TasGcumber , 130, ~ I ti{, ~ }4 7 So indcpendcatl$ disuibutcd. CkissiGcatioa of thc stemts of one rne.mber; parricularlry~. thc a.otber, it+ditcct~i yitcctiy eonm-ys informasion on the status ~of tbrrcarital ,rartnar. When tbe smoking sts~n~s of eacb, parcnt is cLissified, seperately the relativc raaks!of lung caoocr for persons (b>atb 3caas, arnokers a~d aoa-saiokers) with a positi9epsterngl and matennai~history!'of snsoki,u~ ,oki,u~ ,, ~c:l -0~i'auid 1 i• 66, rrspeciively. (tatb:e 11t,. Silrutiny of thc daze shows that ti:c increased ri'sk associated wuh maternal smoking ir~signt~Fre2ra tn srr.okin5 males(o~dds ratio 1-9) but not ~sigatifrant tnsmolr.ng'ferat~lee (4dds~ratio 1~•'~)~ A7o signitcant ibcreasas ir.ril~k were:found in non-srnoke.rs but amall numbers prtt:ltsde adeq~txtc analysis (tbene was oruy one non-susoleiny lung cartecr pacicat ahose mothcr was a smoker), To reuiove the confounds,ng,cCfrect'of the other parent, a'e considered each snbscr of cases ana coatrols for which' only one of the parents smoked. T'ncc rvspect~iv espect~iv eive relative riwks, controLedi for spouse-smoki, status, for positive patcraal andlrr.ate:rtal histories ofs;mokmg were 0•95 and 1•4i, rc3pecuvely,; Thus, smo+cing sritus of' tdzc mother increas~cs the relative risz of lung; cancer, but smoi~ang,'starus of the father dots not. "Ilic ePiect of iaate.-nai i smokiag did not seem to bc dose rrl4tcd; our quezioararre did aor cover this point escrut3i-;ely beeause we, dot:bted wher3rer children could adetluately qua,ntitatc their ?arents' sznok~g;hatory: Taerelative risk of:h:ng rar.eer wlzen both parents s:noked *as 1 r ob; tnere is thus ao evidence of sr: additionel contrisatioa to tVsla aorrt paccr~eal crpostse, ower and abo~~e that contribucad~by rnaternal es:pos.ue. Given ::he cnhanci ; zffoct of pa;cntal smo;cing on ;be.; smokir.g 'r,abiisi of t.he oFFspring„ the affar zz of pxrentxl smokiag ort relativr rts••c of'lutig cr~cer colild'rrt7ect a,subCle tridlrectdssoc`.ar3on' wiitlacLive s.^.So.Ci37P~Cy the:'suG!eci:. T o. control SorJCRiveslCok':nQ; alb$i3tic.reP~ressi0n anSiyslswns danc, takicg mro 3ccount aU the active smoking varia3!es which ;ncreas: hutg;cantxr, ri.skr aoe sr, wktich casc srancud smoking, tarconteat of usual brand, degree pi irl slatiott~ use of hand-ro~~rd~ cigeretras, years of amakit•,g„ rau~uc; arsount smoked.,3y this tnethod of analysis the rolatit~c ;is:c associated with maternal sraoking was: l'•3E (pC0•02) for ecth sexcs and -'-i (p<'0•OT) for malcs: No i_lcrea<e in t^;k Tt.B'L'tn-Ltr'NG C:1.\GtaUGiiE9.~N~ ~ CCvTL2tj ,90TH S~"c5COS?.8I?iED) ACC3R'DI V4 "'O.:'A'CFJCV: YA.Yr1:14.ATT<.L'~ett. SNtO!CR~G NsroRY LueZ c~nxcr Cmuot O''.d+ r.na-csvde Od rd taw uffttwed f r y.~ve :mo nz; !~~sue rt;ressra,-soe:ezq .~0.05, tpcTDh "1'JiE I:AetiCE;T,SEpPE.~sBBx 10,,1'983' wasstiuadlin t:his mod'el~£or;fomaiv subiaev or for subjects +boi. athtrs staoked. Tbertslt was stgnifsc•rntty raised only, :n ma:e smokcrs wbo3e mothers str.oked. Discussicst Spcrrre-; moklnT, EJ'fecr Qur daze stre4gchen th=cotucntioa that bc.tvysmok'i_g by onc member of the spousepair inereases'she lusg;cance-. _isk of the non-srnoking partncr: Hcavy smoYing by wiv;zs may :hcrcasethe nsk of tha light smoltiaShusbaodbutt:his 1Snding, requires Rtrthnr analysis and eonttrmation in la:gcr series. Smoking by husbands did n'os;alffsct sbd,risk oflung aaccs'in women, who smoked (relative risk s- 09), a finding that aup,gata tivf active smokizK Is so powrrldl thst' it oNetshatiqrvs aay µ+ssible additlonat ell;'xt &om concornitaat passive eacposttre. 'T'ae proporsion of lwsg carcinosaas tkut were adenonreinornaa in non•smoksag' women was; 54%. compared with 22% for r_nolazaa uromcs.'Ibc association of' ad:nocardnwm w}th smoking is weakisr than tor other histological types. The risk of'squ:lcrous sn& saull cdl carcinomaa atnoag euwk-errf rs)azive to a unit risk for non- amokers„has aatareporwd to bt 1!S-4„compared with S-1 for adanocarciaorr:a.' Tamiti'nsaythrreforc'reL+ect dt7ttctomof site rclasion by titclusion of adcooarcir.amas_ Escltssibn of' sdcnoorcinotaas produeed: sigaifsEseu linaartrend ini-isk; a> found by Tricnopolot:s at aL=' The pofaibility- tmat di!''fceaccs in Ihe chctatcat nompositson of mainstram (active) twdsirirstrestr,(passive) sznoke asay produce difftifeat proportions of biaologieal types of rumours sliould be considered. Tue nizro:amir,c cootent'in sideszream stnoke is rrpoftcd to be approximatclS 50 times g;eatcr nhan,::hat in minartam ~saacke.s flic e!1•eci of the smok5ag;fsabits of the spouse on lung cancer risc aras fust reported by Hirayama in a Tapanese cohort statdy: • A cobort'study In the Ubited Svtes reponed s posiuve but not significant is:crew in risk for rAn-ss-r:okicg w-o:r•en married to smn]cn'g husbaeds.s A' csse.cor<trol stndy of nunsmakin; womcni diavtosed as :navicg lung cancer in Grecee : eported!rr'ativc risa of approYimatzy 2• 5 for those married :o modcratesmokers aad'3 forthose marriad to heavy smokcrs; 46th a.;i; ificant linear treu3.r tTsr numbers arr .mall bat we :hink that the sunila.^:ty between'our nnd:ags and'tnost ofTriw oy^,olosa =r ala'strczg~.hens +he slupicicn that passive s:rwYing may contribute to lung c33rcer mk. pIIttn[4l:..SrrMk:rta: ~Jl:kr Asfazes Fe'srew,oursistheflrstµse-conuolstudyoflLr,g cancer reporting on parental smcking history. ParFnts' stnoking' be6a'+i01ur i.'si'.uen.eesthe: smoking babiis of ttuirofasprn.z„',7 but we found that z3se'smoking behsv)oL of t4e, fsiricr doa';noti~.Ltiuenae tht3uag cu ce risk ofhis orTspring,, whereas the b:5avicur of tHe mother does.,ThSs differceee mayxeae.tT the closer and~s.ore prolonged eontact th,zi infants and young Child:en•irave with tbrir;taothers thart u'::h their fatilers. The rsk of'broncuitis aud ~r.rlamottia is increased in cUltlren wbnac motvlers smnke. This effacris dose relued: and is greatcr 1n rha seiaW, strongly-suggcstLIIg thar q9Ssive smoking bythe iofitnr'is esiisalv related to risk ofiespirntori` snFectiion. The excess of bronchitis oceurs atter 6 rcoe:ths of age„suggcscrag that ttre paasiwe imrnuniry er=€ferrcd. from mother to child'-prevenrs Sacrezial eoloniaati.oa of bronciaial ~ mucosa. Tbr af?rect ofpasaive smoking onbrotechitia mayba independent of the matagcnic e!'1'xt ofute-to'oaceo :mok.,' and it is prolubly'satetoassume that the child is cxpm.d to

. FRON, j'aFMSI$~ LIBRARY bothi the irritrot and the muta;er.ie i;asults' carried by eidaves:m cmokc. Tbe obtcsration' thft tbc bronchicr taffiibatablc'to'panlare smoking oeeurs mosiy'durusg rbe $rst' •7eat of life stad l!s fndtpm dent ofbirtb veight'm as refiect the iatimac7 ofr>yother4hild connet in t2iat period ,ortLe ebiJd's. IIfe.11 Sronchitis in infants map bare'a )ong-l>arung effect on the respinrory tnct as suggesred, by the inaease' ia thee prevaiena of covgh a't age 20 in subje .rs Who have had a i rapiratory, ilibes.during t8e firat2'ytars oflife, independent of btu~rrttt smoking babita. s vVhetber broneliitis is a csusadbrfactor m lung eaneer is eonfounded"by thefactitbat smok3ng'inducos both canou and' bronchitis: Cobvrt'sevdics have concludod itbao °pcraomq wbo stnokeuprettn rtta a Isigher'risk ofchronie bronchitis than non-smokere and'tb.osc'who develop bronchiris run a hiEhcr risk of deselopiag lung cancerr':rs. How matcrwl amtrkin g caDSCs lung eanccr ean iat tlii.s sexgc only be a matter of speculation. By ;rsel.;,passive smil during', childhood may not bz suffcieut stimulus for carr.nogpnesis. HoSaeverl, laboratorf work has shown titat: transplaeet}tai cxposure to caricinogrns iitcrmases the carernogenie responle to post-DatyIicaposu rc to the ssmc or to a different csreinogen;'"'u bienzo(s)pyrene, a nutagenic mrcinogto found in tobacco smok:, Kb'ert Er.jecred' into pregnant mioe, induces csncer of t,he lung and Other orgsns or the offl 7°'atmours develop iin 33s'ro of u} e offspriag of pregttantharnsters treated with hijzFh doscs ofdg3tetre smorc condensare;Tr end smaL' doses of'carcinogens can induce tUr.D©UIC in fttall t36Fueab. • The effeeta of raaternail smoitiag are ont;v significant in males. e6pxl the hassT s*nokers. 1'crhap.', matc; ,al' smoletns enl7anees scriNe smoking by tbe ii in rubrlc -ays not detected bpy conventionat :echniques: if' our rnerbods for eontroliing, for active smokmg, are cot sufflicientiv refined, thc: incrcasc in risk assprietcd vri.h maternal snioking wcula'nor be aa efiar of pessiwe'smakine_ buo one of enhanccmcnt' of ec.Li+e smoking behaviourai par,eras. This is a reat possibi.ury a.,d l we wouid' !ike .e cmCOUragc furthcc research on thc .ubjecr. Cona4irio" 1fie difTr.rences'betweezthe effects e; passive eaFosure to spouse and imaternal smoking =rc p- ;zzling: I?assiie cltpo?ur c to spouse amnkinF ie mostly detected in ton-srzokcrs, and light smokut'g maies;, atsrernal pzssive s!r,okirg' eflccM: are seer. mostly' in smoiferS: PasSOve s.'ne<iag, 1Ar.. stUOuS'S a introduced in adr,:i: lifa'a.zd in sa:oke:s is'conl vciri: cfFc,c; their own aertae tmoksng; Tye megn:of sur}i arp mx y bc lo.c.,<hen campared -xith nctitieco^_ccmirlLZt smok!:.g anC'it ma}= not be de:ee;iSle Kherr'both ;ra; ':of smok>.ng arc preseat~. Maternal'sr,oking, on the or}:er Sand, exer¢s its infisuenoes 00riy in li.°e and in tt e'sbsence of active smoh,ng is probabi'y insufficient', .o produce c2rcinogcn!c mTccts: Our flndingss ind;cate that ttt:zte.^nallsmok!ngress?ts in a s;i,4htincreate;ne lung,csr.ccr ri:k but do notindiZWe +vhether the effect !s'dU:. tn erLhaleed'aa:ve smCk'in3' of'tl c a~s; : ing cr tc'er,:^..na^1 s:aiceptitiiJiry to lung cancer iddueiior.:rr-er *.::e,cisallcnoe o= active ttnokin3',:7rrr in 1!fc. Ou: f3ndings aoint ro the need'.or .:,o.c r:scerch on _hc svblcc of passiye smokiag and cancer. Since iarge r.umoers o'fMes may bt needa- fvr'3dcGu.accpir,~cml a na:yss; nlulti*irrirutionai coaabozation :`say be ndlc:xd. Tfli eos nl by conana ~o! CFAI~r?;~CCP,,S.r,il' ranCAr tix,c~n ~ioonrilinnlrunetatiiet.!h(Scacc 1~:'iruasisnd'o3asr.a:f.ron Itse'_m::rvni Otap?cr C."thr Ahlerior. Gnca Sbcn r(`1a :.h t:o.:mona} 597 r.nrrupce~doace sLn•riC.bc a.drxcedtorr. C.r.1Dmr,men; orA9rboloU, iae,lilsrs Suce' U,vvc-aLty lrttdreal Can:.r, Nc.. Oflmns, ;.euiusn. LA 70)12, c:SiL: r.MAa..ca^s i'. Huspnu~.1';M..nsY.uill:.+hcs" tndarchan.ihiFbetnsRaNu'neranev,l tn,dfmJtFasE.MdJIfEL.~siAal.a5;.rd'aaL IP067. Tfktapdbe n; Rrhedl A.lpsmos'., J~tarMslqe E. UYfKsuaoc l pmkn MIK". JM JiGnr-193)j 27: 1^4.. s: QC'rNil Tt/0l~Rqbt,MIWi('a/1>lerm0.4Li17*.aYlae@n+lrMt.YfIaOd LCORO yew.ctoador jN.r6enstrler,t9ataii IoGi-oG . nnnK.R,stasefal>!',Haepar.lell rcpxtlotLts.r.[roa'Gve.l'.~Ae.wr. CtF+sHCm.onSmaldat'toe2:nL•t;: L'v.Sruokina*nl.HaldlTISDKEW 'Iil Ha~J1: iv.tCS Po!•4utlen nt :103. ott.l:nGm tSC,.196<7 ~! 75:.. 6:k6ek'.tL-ac[ptpt'dWt,+'c:sis.o~.rcaz rreon:9aO.n•1C52 6:YS~Ltoarrro~eortido~oon. TeMaaeaex„k~r;;/rs~INA~tsbEleaC.ernxcvnz n>lER.?itlrcalllnflrSWed.L'ti=nan;ar.:lunrooDL 1979„76/:, t Lumm R1` Wukl Flt„xelltr.MA: S,r•olv'ill bib'l m s rem.p popdnlae• suvdh.rrisre~sooeeyewl s,~oro.eti,.te J'Psl ,1971:tl: I!C7-a SHv!ac.S;D.da,LrL Lrl.nl, s!-!.r,..tola.p=.L..a: Wic,n•liaaaidiq Leere. Ir...~~ss<-z, C;, 4 lt1o:. W.a r. Relh,w>~Fofflourmu n~ne>sL'~ n.erbitn7 snd ne^.bkr oetfe rbdt i .prs..n tril ,AaSir*: '19'!!;'iia 671 -S I1. 1e OdWEea EA,CS3er.u.xruea.I..Su;.wue: T. C.rEsrrtRrllA u-~74 Meac. nfR7 M:ten.r. P. r. 1979, 445, ~ i: -6! :1 Ca13qJRT, IioGmd ~,Carutl'.'RT, leh,xa.af psm+rc onwvsat.•n: parcavl. pHlKra m~~+aroma. ;e b; jvcyuii ro es!adildhoe!rouv L!71a.r 1e31-r!. :1 falewJtiT.IY.w~IuJ~L,RidDD 11r.:ntiD.+r[qe~.eirt.YOUnRk.Jir.iaGuwuorecr.p,ebdSA?.:IOW-. ttr.tivsa.g ttae dinsw..~i'cdv'.'ie pl .ne s~okac. FrMd)'1975::Ur !Si-.6. i: P.cnL-Fmi.Smcd~t,ch'roa,ctir.x~cbMa,'~.ior~.~nc:r8rhr':dJ1f7!i4~37i-73:.. iK vcC7=^•etSo.Gcmia orrzm-&can,pertraaoreaoFl tn- .TanstMt.,. Meill Truap!.cTrs; cr. e~ nei<u!Sks.~ 1F~ 1Mf!on+r/+rneY fr. F,esereE os . Gaev.lac~CrieLMOb!,a;i0-.ce~i, :.<en:.ls711,1t-22MNr.qs,jr ptp., 5ir,.; scntrr' mas:daansn aa . r!e probylrl of tnns-.LasTa:, nraas2erak tll T".ry. L, .Motu v, eKs. Tnill a.elnesenau . lo:c.t..owrl A;,.llm~ =w Rr.rcb an C.MU r.taniCc qui .K 4. ;,yy% i6'vYYscnZ':Tnrcax~:d.:cr:oerf~nzqqp„vreneumdiFyne~e 9al;£:Fieroll ' 2,77; sa: !CY-17. .7 Naae. !G, Gr.,cccrnakrrN. Tn>mer:an- n~~l.r~c 5s,moz~..SYriaf D•nrsxn rdli. Y{crusoGzen:~inonwn:;tetaul.vlwpV,wtiC~e1r,lnokccondeassre.J. fi...r. Rn Cr:e Onml 7 f791249-5l. !!., CVSOa. RR.. :nJ•IiW14.fAiXpIMSp9}:r(xPj,rG , e:4.crn.: ,z.okm. my, be r. .c;!c.,.t thm nd .c sevii t!c La::n l??G: dl ! 2s'-Er' A.`iA1'IiYI.AGTOM REACTIONS TO NRCiRQNlUSCULA.R BI:UCKING A/("iEhTS: A C•OMu'`i Q.'yI.Y LTPID'IA GNC>'S£D COD+lDIITIOI\? P. R'. YOidhiCuN4A:\' K. M. TAYLOR J. D. wLtsor. Dqdrt»r*asaNftdlnr.cOJt„jpha rT=Iof,y, L`mi r/A i,dJvr.d' 5-koad oflfediarre, .f urelVnn: *r-7,errlcnc Summary A group of 7.6 patients ..i li cx:reme: life. thr~te ung Fll to' suxamethoniutu was identified'and 15 were srudied in de;zii iq,v skus-tclsting. The femaldr.)ale rapio was 611. Sensiuvity may be present widtout prMious esrposu:-e'to suxamettlor.::>m;,ia 3 pat6cnts rcncpons occurred during,thc firsr exposure to anaestiiff-is_ Mosr patients showed ont or more, cross-sensitiriiacs to alcuromtin, rubocu..rine. and gallartiae. Signs of esruulatory,eollapse +ae:e :be soie'prescn5ngfeature in 80% of thc paticn;K. HiEtataine r9ieast i'r.di:ced'bv the i in v!tro was demcns::a!ed ',n some inszar,ecs. Intxoctttctp.oo D>:vGs o: .hc' musclc-reiatan: g:oup a:e commonly i1tpliCar.ei i1 svSCet'nic reFtiiora: .So.T.fi3mc5 iiiC-t'u4reaterLL~F- . Ki;ic-'i oc:ur ducng',genera: waesr':esra. Since 1977 paticnts ~: ou- hospital whn Faxe had sever• anaesthede'r`aetio=j iYdke ~Ce° ec: ,o.:etel drug scns::;vu;~:,After'tu'o dstha art:i't:+aed to suxamc'noniu.^i ?r.A1.clJand ir. _9E2; a brL'dR ot KntlUw1set:3aive :]attenes waljiundertrtker•, inla0RV'tR•. de;e:ar.ine whether `;;rhvcholine'% the on17 .uxatnetltonlum cblar6de :vaillible in Aear Zet:and, Zif*ere,d. u i I