Induction of the Cyp1a-1 dioxin-responsive enhancer in transgenic mice

Cyp1a-1, whose product, aryl hydrocarbon hydroxylase, assists in detoxification of polycyclic aromatic hydrocarbons, is the best characterized of the murine cytochrome P450 genes. The Cyp1a-1 dioxin-responsive enhancer region has been previously analyzed in vitro and found to induce expression of heterologous genes upon exposure of transfected cells to various aromatic hydrocarbons. A 2.58 kbp DNA fragment containing the Cyp1a-1 enhancer elements and promoter region was coupled to the chloramphenicol acetyltransferase (CAT) reporter gene and used to create transgenic mice. CAT assays were performed on tissues harvested from three different lines of transgenic mice following mock-induction or induction using the aromatic hydrocarbon, 3-methylcholanthrene. Basal levels of expression were detected in the spleen and small bowel of non-induced mice, with little or no expression detected in the liver. Treatment with 3-methylcholanthrene increased hepatic expression levels by as much as 10,000-fold. More modest levels of induction were also recorded in the spleen, small bowel, kidney, and lung. The results indicate that the dioxin-responsive enhancer region functions as a strongly inducible promoter in vivo. Differences in the response to induction between male and female mice suggest that Cyp1a-1 expression may be governed in a gender related manner.

Treatment of stephanofilariosis ('earsore') with ivermectin

Thirty-four adult male buffaloes with clinical signs of 'earsore' were used to determine the efficacy of ivermectin against Stephanofilaria zaheeri. On the basis of parasite counts in skin scrapings, ivermectin was effective as a microfilaricide. Adult parasite counts were reduced, but removal of adults was incomplete. Clinical improvement was recorded in more than half of the treated buffaloes, but constant reinfection meant that meaningful interpretations were not possible.

Single agent therapy for infections in cancer patients: a prospective randomized trial comparing three extended-spectrum cephalosporins

Three hundred and twenty patients were enrolled in a prospective randomized trial comparing cefoperazone, ceftizoxime and ceftriaxone for initial therapy of infectious episodes in cancer patients. Patients with neutropenia were excluded. In 286 evaluable episodes, the response rates associated with the three agents were 77% for cefoperazone, 70% for ceftizoxime and 72% for ceftriaxone, with no statistically significant differences between the three treatment groups. The overall response rate for all episodes of pneumonia (64%) was significantly lower than the response rate for all other infections (81%; p = 0.002), and the mortality associated with pneumonia (9%) was higher than that associated with all other episodes (2%; p = 0.01). Patients with infections due to gram-negative organisms responded well to all three agents, whereas patients with gram-positive infections responded more favorably to cefoperazone. Two different schedules of ceftriaxone were used. The clinical response did not differ significantly between patients receiving ceftriaxone once daily and those receiving it twice daily. The incidence of superinfection and relapse was extremely low and all three agents were well tolerated. It is concluded that extended spectrum cephalosporins are effective as single agents for the treatment of infections in cancer patients with adequate neutrophil counts.

Group C streptococcal pleurisy and pneumonia: a fulminant case and review of the literature

A 30-year-old, previously healthy patient developed a pleurisy and pneumonia due to group C streptococcus, with multiple medical complications, including bilateral empyemas. Eight other reported cases of group C streptococcal pneumonia are reviewed.

Ibotenate stimulates glutamate release from guinea pig cerebrocortical synaptosomes: inhibition by L-2-amino-4-phosphonobutyrate (L-AP4)

Ibotenate induced a concentration- and largely calcium-dependent release of endogenous glutamate from guinea pig cerebro-cortical synaptosomes. In the absence of Mg2+, the response to ibotenate was enhanced through a mechanism involving N-methyl-D-aspartate (NMDA) receptors; this component was sensitive to the NMDA antagonist 2-amino-7-phosphonoheptanoate (AP7). In the presence of Mg2+, the ibotenate-induced Ca2(+)-dependent release was abolished by L-2-amino-4-phosphonobutyrate (L-AP4). It is suggested that presynaptic 'L-AP4 receptors' exist in guinea pig cerebral cortex, at which ibotenate acts to facilitate glutamate release. L-AP4 may act as an antagonist, or partial agonist of weak intrinsic activity.

Loss of 4.5S RNA induces the heat shock response and lambda prophage in Escherichia coli

During depletion of 4.5S RNA, cells of Escherichia coli displayed a heat shock response that was simultaneous with the first detectable effect on ribosome function and before major effects on cell growth. Either 4.5S RNA is involved directly in regulating the heat shock response, or this particular impairment of protein synthesis uniquely induces the heat shock response. Several hours later, lambda prophage was induced and the cells lysed.

Depression in general practice: a comparison of flupenthixol dihydrochloride and dothiepin hydrochloride

A single-blind, parallel group, general practice study was carried out in 153 patients with mild to moderate depression to compare the efficacy and tolerability of flupenthixol dihydrochloride and dothiepin hydrochloride. Patients were allocated at random to receive single daily doses of either 1 mg flupenthixol in the morning or 75 mg dothiepin in the evening, and this dose could be doubled at the end of 2 weeks in the event of inadequate response. Assessments were made on entry and after 1, 2, 4 and 6 weeks of treatment using the Hamilton Depression Rating Scale, a 4-point severity scale and an unwanted symptoms checklist. The results showed that both treatments significantly improved the patients' condition over 6 weeks, and there was a significant difference in favour of flupenthixol at end-point. Both drugs were well tolerated, although persistence of anticholinergic side-effects in the dothiepin group resulted in a trend favouring flupenthixol. One patient in the flupenthixol group attempted suicide by overdose but made a complete recovery.

Non-tuberculous mycobacterial lymphadenitis in children

Eighty-six children (44 males, 42 females) were identified as having non-tuberculous mycobacterial lymphadenitis. The diagnostic criteria were either culture of the organism from the affected lymph node (n = 68), or, when culture was negative, a positive skin test with non-tuberculous mycobacterial antigens and negative skin test responses to tuberculin purified protein derivative (PPD) in association with typical histological features (n = 18). All children had histopathological findings of granulomatous inflammation with caseation and/or acid-fast bacilli. Eighty-two percent of the children were under 5 years of age at presentation and 30% were less than 2 years old. Most (79%) were city dwellers. Lymph node enlargement had been present for less than 6 months in almost all children (97.5%) and was almost exclusively in the face and neck region (97%). Disease was confined to the involved lymph nodes in 56% but had extended beyond the confines of the infected node to form a collar stud abscess in 38% and 6% presented with a skin sinus. Extranodal extension did not show any statistically significant association with the duration of lymphadenopathy. The duration of lymphadenopathy had been greater in those children in whom an organism was not isolated on culture resected tissue (chi 2 = 10.07, P less than 0.01). All children were treated surgically, and recurrence occurred in five patients. This study describes the clinical and demographic characteristics of non-tuberculous mycobacterial lymphadenopathy in children in a population in which tuberculous adenitis is rare. Recognition of these features may allow earlier diagnosis and appropriate surgical therapy.

Disseminated ecthymatous herpes varicella-zoster virus infection in patients with acquired immunodeficiency syndrome

Herpesvirus infections are among the most common and debilitating opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), and they may have atypical clinical features. We describe the cases of three patients with AIDS in whom atypical persistent ulcerative skin lesions developed as a result of varicella-zoster virus infection. Two patients had disseminated infection without a vesicular stage; one patient had underlying asteatotic eczema. All responded well to acyclovir. One patient was treated with azidothymidine, and typical dermatomal herpes zoster subsequently developed. The profound loss of helper T cell function in AIDS may lead to multiple abnormalities in local immune response to cutaneous herpesvirus infections and may be responsible for the atypical morphology and a prolonged course.

Glutamate suppression of feeding and the underlying output of effector neurons in Helisoma

This study tested the consequences of 3 stress conditions on feeding consumption in the freshwater snail Helisoma. Two stresses (placement in a hypotonic environment and body wall incision) were without effect on food consumption. In contrast, placement of animals in a hypertonic environment (20% seawater) caused a transient suppression of feeding. Since the osmolarity and composition of molluscan blood is known to be altered under conditions of osmotic stress, we reasoned that a blood-borne agent might be responsible for the observed suppression of feeding. We tested this hypothesis by chromatographic analysis of blood and, based on this analysis, subsequent assay of putative neuromodulatory agents on the patterned motor activity (PMA) expressed by effector neurons of the buccal ganglion. Our analysis shows that a rise and fall of blood acidic amino acids corresponds to the suppression of feeding. Furthermore, bath application of glutamate at its elevated physiological level (100-150 microM) to buccal ganglia caused complete and prolonged suppression of PMA in effector neurons. This suppression is attributable to activation of chloride and potassium currents which shunt patterned synaptic inputs to the effector neurons. We conclude that glutamate, in an endocrine-like fashion, can exert a powerful neuromodulatory action on the feeding effector neurons of Helisoma.

Induction of proteins in response to low temperature in Escherichia coli

When the growth temperature of an exponential culture of Escherichia coli is abruptly decreased from 37 to 10 degrees C, growth stops for several hours before a new rate of growth is established. During this growth lag the number of proteins synthesized is dramatically reduced, and at one point only about two dozen proteins are made; 13 of these are made at differential rates that are 3 to 300 times increased over the rates at 37 degrees C. The protein with the highest rate of synthesis during the lag is not detectably made at 37 degrees C. The identities of several of these cold shock proteins correlate with previous observations that indicate a block in translation initiation at low temperatures.

Sacrococcygeal teratoma: has chemotherapy improved survival?

Case records of 57 patients (50 female, 7 male) with sacrococcygeal teratoma who were treated at the Royal Children's Hospital in Melbourne between 1948 and 1986 were reviewed. There were 40 benign and 19 malignant tumors; two patients had malignant recurrence following excision of a benign tumor. The majority of the benign lesions were readily excised; 80% of these patients presented under the age of 6 months. In contrast, 16 of the 19 patients with malignant disease presented after 6 months of age and 12 of these died. Before 1975, malignant lesions were treated with surgery or irradiation, and in a few patients, single-agent chemotherapy. No patients survived. In 1970, intensive multiagent chemotherapy was introduced, with planned delayed surgical resection, with or without postoperative irradiation. Three of five patients treated between 1976 and 1980 survive disease-free and are almost certainly cured. Modern therapy is with cisplatin-containing regimens, and while initial responses in six patients with extensive disease are impressive, it is too early to evaluate the impact of these newer programs on cure.

Ceftizoxime plus ticarcillin: double beta-lactam therapy for infections in cancer patients

Eighty-one febrile episodes in cancer patients with adequate neutrophil counts (greater than 1000/microliter) were treated with a double beta-lactam combination of ceftizoxime plus ticarcillin. Fifty-four episodes were microbiologically documented and 27 were clinically documented. The overall response rate was 75% (61 of 81). The response rate in 38 episodes where a single organism was identified was 71%. Polymicrobial infections were associated with a high response rate of 87%. Responses occurred in six of eight Gram-positive and 21 of 30 Gram-negative infections. Pneumonia was the most frequent infection and was associated with a response of 61%. Septicaemia and urinary tract infections also occurred commonly and had response rates of 76% and 89% respectively. All but one organism were susceptible to at least one of the antibiotics. No resistant organisms emerged during therapy. Side-effects included rash (1), phlebitis (3), and coagulation abnormalities without bleeding (3). Four patients developed superinfections (three bacterial, one fungal). The double beta-lactam combination of ceftizoxime plus ticarcillin was safe and effective therapy for infections in non-neutropenic cancer patients.

Fever and malnutrition: endogenous pyrogen/interleukin-1 in malnourished patients

The effect of protein-calorie malnutrition on the release of endogenous pyrogen/interleukin-1 (EP/IL-1), the protein responsible for the induction of fever, was investigated in 18 hospitalized patients with chronic malnutrition. Monocytes from the 18 patients and from 19 healthy controls were cultured overnight after stimulation with Staphylococcus epidermidis. The presence of EP/IL-1 was tested by injecting culture supernatants into rabbits and measuring the maximum febrile response (delta Tmax). Malnourished patients produced significantly less EP/IL-1 than controls (delta Tmax = 0.27 +/- 0.04 degrees C for patients vs 0.49 +/- 0.03 degrees C for controls, p less than 0.001). The poor febrile response in the malnourished patients was related to low serum albumin and retinol-binding protein, but not to thyroxine-binding albumin or lymphocyte number. This abnormality may help explain the poor febrile response often noted in hospitalized debilitated patients.

Hereditary multiple glomus tumours

A 9 year old girl presenting with multiple glomus tumours is reported. Multiple glomus tumours are rare, often asymptomatic lesions, with a familial tendency and found in a more proximal location than their solitary counterparts. In our report four close relatives had similar lesions. Indications for surgical excision are discussed.

Aztreonam therapy in neutropenic patients with cancer

Combinations of aztreonam/vancomycin, aztreonam/vancomycin/amikacin, and moxalactam/ticarcillin were compared in a prospective randomized trial as empiric therapy for febrile neutropenic cancer patients. Vancomycin was added to aztreonam to provide coverage against gram-positive organisms. Of 535 febrile episodes included in the study, 455 were evaluable. The aztreonam/vancomycin and aztreonam/vancomycin/amikacin combinations were both more effective than the moxalactam/ticarcillin combination in a total of 244 episodes of documented infection. The difference was due to the fact that both aztreonam-containing combinations were more effective than the moxalactam/ticarcillin combination in documented gram-positive infections. The three regimens were equally effective in 67 documented infections due to a single gram-negative bacterial species. (The response rates were 87, 86 and 94 percent for the aztreonam/vancomycin, aztreonam/vancomycin/amikacin, and moxalactam/ticarcillin combinations, respectively.) Aztreonam was effective as the single active antibiotic in the treatment of gram-negative infections in neutropenic patients; however, it must be used in combination with another antibiotic to provide gram-positive coverage.

Imipenem-cilastatin as initial therapy for febrile cancer patients

Imipenem-cilastatin was used to treat 79 febrile episodes in 71 cancer patients, most of whom had neutropenia. The overall response rate was 67%, and 76% of the 45 documented infections responded. The response rates for septicemias and pneumonias were 79 and 62%, respectively. Only 1 of the 17 infections caused by gram-negative bacilli failed to respond to this therapy. The most common side effects were skin rash, nausea, and diarrhea. Eight superinfections were detected during therapy.

Influence of age, sex, duration of symptoms and dehydration of serum electrolytes in hypertrophic pyloric stenosis

A review was conducted of 234 consecutive patients with hypertrophic pyloric stenosis (HPS) proven at operation. The relationship of age, sex, the duration of symptoms and the clinical degree of dehydration to the severity of metabolic derangement as reflected by alterations in serum electrolytes and acid-base status, was analysed statistically. The length of history and the degree of dehydration was found to have predictive value in identifying those likely to have major metabolic disturbances. Where severe vomiting has persisted for more than 1 week, major derangements of the biochemical parameters should be anticipated; and where clinical assessment of dehydration is estimated as being greater than 5%, there is almost always some major biochemical abnormality present. Nevertheless, variation in individual cases necessitates that all patients with suspected HPS should have serum electrolytes and acid-base estimations performed.

Candidiasis. A diagnostic and therapeutic challenge

Candida infections are becoming more common for a number of reasons. Diagnosis of local infections is relatively simple, and therapy with topical antifungal drugs or ketoconazole (Nizoral) is usually adequate. However, diagnosis of disseminated candidiasis is more difficult, frequently requiring biopsy confirmation. Amphotericin B (Fungizone Intravenous), often in combination with flucytosine (Ancobon), may be appropriate. In catheter-induced fungemia, antifungal therapy may be necessary to avoid deep-seated infection with Candida.

Hypoprothrombinemia in patients with cancer receiving cefoperazone and mezlocillin

Forty-one patients with cancer who were receiving cefoperazone sodium plus mezlocillin sodium were prospectively followed up for the development of abnormal bleeding or hypoprothrombinemia. Ten of 41 patients developed an increased prothrombin time, three with a hemorrhagic episode. Serum transport proteins and serum carotene were measured in 18 patients, six of whom developed hypoprothrombinemia. Low serum prealbumin and low serum carotene levels were associated with the development of hypoprothrombinemia. Patients with cancer are especially predisposed to the development of antibiotic-associated hypoprothrombinemia. This is probably a result of protein-calorie malnutrition and low vitamin K stores.

Semiquantitative cultures of intravascular catheters from cancer patients

Three-hundred seventy-nine catheter tips were prospectively cultured by both a semiquantitative method and by broth culture, over a 2-month period. One hundred eleven of the catheters were culture-positive in broth, and 47 of these were also culture-positive by the semiquantitative method. Clinical signs of infection were reviewed for the 111 culture-positive catheters and for 50 of the 268 culture-negative catheters. Both culture-positive and culture-negative catheters were infrequently associated with local signs of infection (10% and 12%, respectively). Culture-positive catheters, however, were more likely to be associated with systemic signs of infection than were culture-negative catheters (15% and 2%, respectively). Among the culture-positive catheters, those that yielded greater than or equal to 15 colonies on semiquantitative culture were more likely to be associated with septicemias than were those with less than 15 colonies (22% and 6%, respectively). Nevertheless, there were five catheter-related bacteremias that were associated with catheters which were culture-negative on semiquantitative culture but culture-positive in broth. The proportion of patients with culture-positive and culture-negative catheters who were febrile was similar (30% and 42%, respectively). Semiquantitative cultures of catheters from cancer patients are useful, but the result should be interpreted with some caution.

Use of mercurochrome in the management of the large exomphalos

The topical application of solutions containing mercury has remained popular in the conservative management of the large exomphalos, despite recent reports of high organ mercury levels occurring in neonates who have died following this type of treatment. There are few reports of mercury poisoning being recognized in survivors. This report records blood and urine mercury levels in four patients with no apparent sequelae after treatment with Mercurochrome and provides guidelines for the safer use of mercurial solutions in the conservative management of exomphalos: one thin application of 1% Mercurochrome be applied to the intact sac; thereafter, Mercurochrome be applied sparingly only to areas that remain moist; blood and urine levels of mercury be monitored routinely; and applications ceased whenever mercury levels exceed the minimum toxic level. Only with this sparing and judicious use of mercurial solutions is the hazard to the infant kept to a minimum.

Fever in uremia: production of leukocytic pyrogen by chronic dialysis patients

Uremic patients frequently have low baseline temperatures and a blunted febrile response to infection. We investigated the first step in the generation of a febrile response, the production of leukocytic pyrogen (LP) by blood monocytes, in 12 patients on chronic hemodialysis, five patients on continuous ambulatory peritoneal dialysis (CAPD), and 17 control subjects. No significant differences were found in the amount of LP produced by hemodialysis patients, CAPD patients, and control subjects. Uremic serum did not decrease LP production by monocytes from control subjects. Hemodialysis patients who were consistently hypothermic (mean oral predialysis temperature less than or equal to 35.6 degrees F) produced as much LP as those with more normal oral temperatures (mean oral predialysis temperature greater than or equal to 36.8 degrees F). Decreased production of LP does not explain the blunted febrile response noted in patients with chronic renal failure.

Gallstones and duodenal atresia

Two children with cholelithiasis several years after relief of a duodenal atresia are reported. A survey of the literature on duodenal atresia suggests that there may be associated abnormalities in the biliary tract in this condition, and raises the possibility of cholelithiasis developing in these patients many years after successful relief of the duodenal obstruction by some form of by-pass procedure.

Novel preparation for studying excitation-secretion coupling in the isolated single cell

Cellular mechanisms of secretion in exocrine and endocrine glands are technically difficult to study. We present here a model which offers fundamental advantages for studying excitation-secretion coupling at the level of the isolated single cell. The salivary gland of the leech Haementeria ghilianii possesses a unique combination of unusual properties which greatly facilitate research in this area. Its cells are exceptionally large (up to 1 mm in diameter), clearly visible and easy to penetrate with microelectrodes. They do not form a homogeneous population but consist of five distinct histochemical types, secreting a number of identified products such as the fibrinolytic enzyme hementin (for which there is a sensitive assay). The cells generate overshooting calcium-dependent action potentials up to 90 mV in amplitude and with a duration of 200-1,000 ms. One of their most useful and unusual features is a lack of electrical coupling which means that individual cells can be studied in an intact gland without interference from neighbouring cells.

Pulmonary disease caused by rapidly growing mycobacteria in patients with cancer

Five patients with microbiologically documented pulmonary infection caused by rapidly growing mycobacteria (Mycobacterium fortuitum and M chelonei) in patients with malignant diseases are described. These cases occurred over a seven-year period (1976 to 1983) and were found in patients with solid tumors and hematologic malignancies. Colonization (40 patients) with these organisms was far more frequent than true infection (five patients). Factors predisposing to infection were (1) antineoplastic chemotherapy and (2) previous pulmonary involvement with malignant disease. Mortality in these patients was due primarily to the underlying tumor. Although pulmonary infection caused by rapidly growing mycobacteria in patients with cancer is relatively uncommon, it might become an important diagnostic consideration in the presence of pulmonary infiltrates, especially in patients treated with intensive chemotherapeutic regimens.

Effect of aztreonam on throat and stool flora of cancer patients

Eighteen patients with hematological malignancies received aztreonam in one of two dosing regimens, 1 or 2 g every 8 h for a total of 7 to 9 days. Throat and stool cultures were obtained before and during treatment with aztreonam. Aztreonam had little effect on the predominant throat flora. In contrast, facultatively anaerobic gram-negative bacilli were markedly decreased in stools during the administration of aztreonam. Strict anaerobes in the stool were variably affected by aztreonam.

Clinical pharmacokinetics of aztreonam in cancer patients

The pharmacokinetics of aztreonam were studied in 25 adult patients with hematological malignancies. Two groups of nine patients each received aztreonam (1 or 2 g every 8 h) prophylactically, and seven infected patients received a therapeutic regimen of aztreonam (1.5 g every 4 h). The mean peak serum concentration after a 1-g dose of aztreonam (given over 0.5 h on day 1) was 75.5 micrograms/ml; after a 2-g dose it was 177.2 micrograms/ml. The mean peak serum concentration after a 1.5-g dose of aztreonam (given over 2 h on day 1) was 68.5 micrograms/ml. The serum half-life ranged between 1.7 and 2.0 h for all regimens studied. The urinary concentration of the metabolite of aztreonam, SQ 26,992, increased during 1 week of administration of the drug; however, serum levels of the metabolite were barely detectable.

Septic arthritis due to Histoplasma capsulatum in a leukaemic patient

A case of septic, histoplasmal monoarthritis of the knee in a leukaemic patient is described. Ketoconazole therapy failed to eliminate the infection, but after histoplasmosis was diagnosed prolonged therapy with amphotericin B was curative.

Endocarditis as a complication of indwelling right atrial catheters in leukemic patients

Three patients with acute leukemia who had chronic indwelling right atrial catheters developed endocarditis. In all cases, the infection was cured with antibiotics only after removal of the infected catheter. Although infective endocarditis has been rarely noted in leukemic patients, the use of chronic indwelling catheters may lead to an increased incidence of this infection in these patients.

Effect of therapy with latamoxef (moxalactam) on carriage of Clostridium difficile

Twenty-seven patients receiving latamoxef (moxalactam) as a single antimicrobial agent were studied prospectively for Clostridium difficile carriage and development of diarrhoea or colitis. Stools were available prior to therapy from only seven patients, one of whom (14.3%) was an asymptomatic carrier. None of twelve patients studied during therapy were carriers. Seven of 27 patients (25.9%) were colonized with Cl. difficile after completion of latamoxef therapy, and three patients had cytotoxin positive stools. Two patients with cytotoxin grew Cl difficile from stools and one patient was culture negative. Only one patient, who had both culture and cytotoxin positive stools, had profuse diarrhoea. Cl. difficile clinical isolates were only moderately susceptible to latamoxef in vitro. Hamsters given moxalactam developed caecitis. Patients receiving latamoxef, or third generation cephalosporins, may be at increased risk of development of Cl. difficile associated diarrhoea and should be followed closely for this complication, especially after therapy has been discontinued.

Efficacy of ketoconazole v nystatin in prevention of fungal infections in neutropenic patients

A prospective randomized study was undertaken in neutropenic patients to evaluate the efficacy of prophylactic ketoconazole v nystatin in reducing yeast infections. Eighteen patients received 500,000 units of nystatin suspension four times daily, and 18 patients received 200 mg of ketoconazole daily. The nystatin group experienced nine local yeast infections (four thrush, three esophagitis, and two vaginitis); three patients receiving ketoconazole had thrush. No cases of disseminated candidiasis occurred in either group. Ketoconazole was better tolerated than nystatin and neither drug caused toxic effects. In addition to being nontoxic and better tolerated, ketoconazole appeared to be slightly more effective than nystatin in reducing locally severe yeast infections.

Fever in the elderly. Production of leukocytic pyrogen by monocytes from elderly persons

In an attempt to explain the diminished febrile response of the elderly, we studied the first step in fever generation, that of production of leukocytic pyrogen (LP) by monocytes. Monocytes from 25 healthy elderly volunteers (ages 65-91) and 24 healthy young volunteers (ages 17-38) were stimulated with Staphylococcus epidermidis to release LP; LP activity in the culture supernatants was assayed by measuring the pyrogenic response in rabbits and rats and the fall in plasma iron and zinc in rats. Monocytes from elderly volunteers produced slightly less LP than monocytes from young volunteers, but the difference was not statistically significant. The amount of LP produced was not correlated with age. Therefore, the diminished febrile response of the elderly is not the result of an intrinsic defect in the monocyte's ability to make LP. Other explanations relating to the central effect of LP and the effector response to LP in the elderly should be sought.

Disseminated histoplasmosis, invasive pulmonary aspergillosis, and other opportunistic infections in a homosexual patient with acquired immune deficiency syndrome

A homosexual man with the acquired immune deficiency syndrome had an unusually wide array of opportunistic infections. Despite antibiotic treatment over a period of two and a half years, the patient died. Perianal herpetic ulcers, oral candidiasis, cytomegalovirus infection, and disseminated infections with both Histoplasma capsulatum and Mycobacterium avium-intracellulare were diagnosed during illness. An autopsy revealed invasive pulmonary aspergillosis and a cerebellar lesion caused by cytomegalovirus. The latter was probably responsible for the patient's gait disturbance.