During a survey of young subjects not receiving treatment for hypertension in Tecumseh, Michigan, clinic and self-monitored blood pressures taken at home (14 readings in 7 days) were obtained in 737 subjects (387 men, 350 women, average age 31.5 years). Hypertension in the clinic was diagnosed if the clinic blood pressure exceeded 140 mm Hg systolic or 90 mm Hg diastolic. In the absence of firm criteria for what constitutes hypertension at home, subjects whose average home blood pressure was in the upper decile of the whole population were considered to have hypertension at home. By these criteria, 7.1% of the whole population had "white coat" hypertension (i.e., high clinic but not elevated home readings). The prevalence of "sustained" hypertension (i.e., high readings in the clinic and at home) was 5.1%. Subjects with white coat and sustained borderline hypertension in Tecumseh were very similar. Both groups showed, at previous examinations (at ages 5, 8, 21, and 23 years), significantly higher blood pressure readings than the normotensive subjects. As young adults (average age 333 years), the parents of both hypertensive groups had significantly higher blood pressure readings than the parents of normotensive subjects. Both hypertensive groups had faster heart rates, higher systemic vascular resistance, and higher minimal forearm vascular resistance. Both hypertensive groups were more overweight, had higher plasma triglycerides, insulin, and insulin/glucose ratios than normotensive subjects. The white coat hypertensive group also had lower values of high density lipoprotein than the normotensive group. White coat hypertension is a frequent condition. In regards to excessive risk of hypertension (past blood pressures, parental blood pressures, weight, and heart rate), excessive risk for atherosclerosis (triglycerides and insulin), and hemodynamic parameters (vascular resistance and minimal forearm resistance), the white coat and sustained hypertensive groups are similarly different from the normotensive group. These findings do not support the accepted practice of using home blood pressure determination to distinguish groups of borderline hypertensive subjects with a lesser or greater clinical problem. (Hypertension 1990;16:617-623) T he clinical usefulness of ambulatory blood pressure monitoring rests on the original report of Sokolow et al 1 on patients with moderately severe hypertension. They found a strong correlation between cardiovascular morbidity and the average ambulatory blood pressure, whereas the correlation with the casual clinic blood pressure and morbidity was weaker. This finding in moderate sustained hypertension has been extrapolated to much milder forms of hypertension. It is assumed that patients with borderline blood pressure elevation who have "white coat" hypertension (i.e., show high office readings but normal values outside of the physician's office) have a less serious problem. We advocated the technique of home blood pressure readings by self-determination 2 -4 as a simple, reproduci...

Cyclophosphamide is a well established cytotoxic drug used in the treatment of lymphoproliferative disorders, certain solid tumors, and nonneoplastic disorders such as nephrotic syndrome, systemic lupus erythematosus and rheumatoid arthritis. Hemorrhagic cystitis can be a complication of this drug varying between two and 40 per cent. Misoprostol, which is a synthetic prostaglandin E1 analog, was found to significantly decrease the histological damage to the bladder from cyclophosphamide. Male rats receiving misoprostol in conjunction with cyclophosphamide were found to have a reduction in ulceration, inflammation and edema of the bladder walls as compared to those treated with cyclophosphamide alone.

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Morphologic features (abnormal mitoses, necrosis, vascular and capsular invasion, broad fibrous bands, cellular pleomorphism, size) previously suggested to be predictors of malignant behavior in adrenal cortical tumors were assessed individually in 23 (17 benign, 6 malignant) pediatric and 42 (29 benign, 13 malignant) adult tumors. Of these features, size was the only predictor of malignancy in pediatric tumors. All pediatric tumors weighing more than 500 g were malignant and all but one weighing less than 500 g were benign. The remaining features were present in both benign and malignant pediatric tumors, and pediatric benign tumors were significantly more likely to have mitoses (P < 0.01), necrosis (P < 0.001), broad fibrous bands (P < 0.005), and moderate to severe pleomorphism (P < 0.01) than were adult benign tumors. The authors conclude that pediatric tumors are more likely to be benign than previously thought, and that size is the only morphologic predictor of their biologic behavior.Cancer 57:2235-2237, 1986.OST STUDIES of the morphologic criteria for malig-M nancy in adrenal cortical tumors have not separated pediatric from adult tumors. As a result, the literature often advocates using the same morphologic criteria for malignancy for both,'-3 and there remains a persistent tendency for the majority of pediatric adrenal cortical tumors to be classified as We undertook a retrospective multi-institutional study to determine long-term prognosis in a series of pediatric adrenal cortical tumors. Morphologic features suggested in the literature as predictors of malignant behavior in adrenal cortical t u m~r s~,~-l were assessed individually in the childhood tumors and in a control series of adult tumors. Reliability of these features as criteria for biologic behavior was then compared between the two series. Materials and MethodsThe original hematoxylin and eosin (H & E) histologic sections of 23 cases of childhood adrenal cortical tumors resected between 1953 and 1983 were collected from the collaborating centers. The slides were examined, without prior knowledge of the outcome of the patient, for his- The authors thank Mrs. Lillian ONeil for her secretarial support. Accepted for publication August 19, 1985. tologic features that have been suggested to predict malignancy in such tumors. The presence or absence of the following features was noted in each case: necrosis, calcifications, broad fibrous bands, abnormal mitoses, vascular invasion, and capsular invasion. Cytologic pleomorphism was graded as absent, mild, moderate, and severe. Mitoses were considered significant when they numbered more than one per high-power field.3The age and sex of the patient, the symptoms at presentation, the subsequent clinical history, the original pathologic diagnosis, and the weight of each tumor at the time of resection were obtained from the clinical records and pathology reports. Malignant tumors were defined clinically as those producing metastases and/or resulting in death from direct effects of tumor. The relations...