Methotrexate in rheumatoid arthritis: an update

Methotrexate, a folic acid antagonist, is being employed more frequently in an attempt to control rheumatoid arthritis that has not responded adequately to conventional therapies. Systemic administration of 7.5-15 mg weekly in a pulse fashion appears to be effective without precipitating serious adverse effects. Concern over potentially serious adverse effects and lack of well-controlled clinical trials have limited its use to severe, refractory disease. Its use in the future is likely to increase in these patients because of its ease of administration and the high response rate noted in clinical studies.

Improved disease-free survival of children with acute lymphoblastic leukemia at high risk for early relapse with the New York regimen--a new intensive therapy protocol: a report from the Childrens Cancer Study Group

An intensive multimodal therapy was developed for the treatment of a subpopulation of children with acute lymphoblastic leukemia (ALL) who had a predicted event-free survival of less than 40% on previously reported therapeutic regimens (at high risk for early relapse). Induction with multiagent chemotherapy and radiotherapy to bulky disease-bearing areas (peripheral lymph nodes and mediastinum) was followed by consolidation, CNS prophylaxis, and cyclical remission maintenance therapy. Ninety-six (96%) of 100 previously untreated patients, 1 to 17 years of age, attained a complete remission. Seven patients received other maintenance therapy or a bone marrow transplant in remission. Sixty-six of the remaining 89 (74%) are in continuous complete remission at 22+ to 72+ months (median, 44+ months). Marrow relapse occurred in 15 (17%), CNS relapse in 5 (6%), and testicular relapse in one. Sixty-six of the 93 evaluable patients (71%) (including the induction failures) are event-free survivors. Two patients died of infection during the induction phase. No patient died during consolidation or maintenance without recurrent disease. The patients spent a median of 19, 0, and 0 days hospitalized during induction, consolidation, and maintenance, respectively. The most common complications were bacteremia and mucositis during induction and mucositis and fever during periods of neutropenia in consolidation. Maintenance was well tolerated. We conclude that the treatment protocol is intensive, but the inherent toxicities are manageable with adequate supportive care. The life table--projected event-free survival of 69% +/- 5% 48 months from diagnosis is encouraging.

Hb Bicêtre or alpha 2 beta(2)63(E7)His----Pro in a white male: clinical observations over a period of 25 years

A description is given of clinical observations over a period of 25 years for a 26-year-old white male with a heterozygosity for the beta-chain variant, Hb Bicêtre, in which beta 63His is replaced by Pro. The variant was identified through analysis of tryptic peptides from a digest of the beta X-chain isolated by PCMB precipitation and purified by chromatography. Similarity between the clinical histories of the first (French) heterozygote and our patient was most striking, including improvement after splenectomy.

Electrophoretic characteristics of macro creatine kinase type 2 in serum

We have studied the electrophoretic characteristics of a creatine kinase (CK, EC 2.7.3.2) isoenzyme, macro creatine kinase type 2 (MCK-2), in the serum of 42 patients with carcinoma of the colon. The patients could be divided into three subgroups by the intensity of the MCK-2 band (nine high, nine medium, and 24 low intensity), but we detected no correlation between the isoenzyme activity and the stage of the cancer. Inhibition of the activity of the CK-M subunit by antibody to CK-M allowed more sensitive detection of MCK-2 in serum and revealed that MCK-2 may be obscured by CK-MM. Moreover, there may be major discrepancies between the amount of MCK-2 seen on electrophoresis and the apparent total CK.

Electrophoretic characteristics of macro creatine kinase type 2 in serum

We have studied the electrophoretic characteristics of a creatine kinase (CK, EC 2.7.3.2) isoenzyme, macro creatine kinase type 2 (MCK-2), in the serum of 42 patients with carcinoma of the colon. The patients could be divided into three subgroups by the intensity of the MCK-2 band (nine high, nine medium, and 24 low intensity), but we detected no correlation between the isoenzyme activity and the stage of the cancer. Inhibition of the activity of the CK-M subunit by antibody to CK-M allowed more sensitive detection of MCK-2 in serum and revealed that MCK-2 may be obscured by CK-MM. Moreover, there may be major discrepancies between the amount of MCK-2 seen on electrophoresis and the apparent total CK.

Macro creatine kinase type 2 in human colonic tissues

Macro creatine kinase type 2 (MCK-2) is a promising new tumour marker for carcinoma of the colon. We have purified it from tumour tissue, from serum and, for the first time, from normal colonic epithelium and identified it in a tissue culture line of colon cancer cells. The molecular weight of each preparation, regardless of the source, was similar. Its consistent presence in tumours and in normal colon, contrasted to its variable appearance in serum, implies that there are other factors affecting its release into, or removal from, the circulation.

Collaborative Behavioral Teratology Study: preliminary research

Prior to the beginning of the Collaborative Behavioral Teratology Study (CBTS), extensive preliminary experiments were conducted. Several experiments were conducted to permit the selection and verification of dosage levels of d-amphetamine sulfate and methylmercuric chloride to be used in the CBTS. These studies included evaluations of any teratogenic effects produced by selected concentrations of the chemicals, the potential pathology produced in the dams and offspring, and the postnatal behavioral consequences of the prenatal exposures. This preliminary research allowed the determination of the most appropriate experimental design for the CBTS, verified the practicality of the schedule of work, assured that all necessary procedural details were specified, and provided a database for the determination of the most appropriate statistical techniques for the analyses of the data. This paper presents the details and results of the preliminary research performed prior to beginning the CBTS.

Large saccular aneurysm and A-V fistula of the brachial vessels

This paper reports a 39-year-old patient who developed an unusually large saccular false aneurysm and A-V fistula of the brachial vessels following a neglected penetrating wound. Rapid enlargement to 15 cm appeared after one year and the aneurysm was then stable for the six months prior to operative repair. The aneurysm was excised and lateral closure of the vessels restored continuity with uneventful recovery.

Evidence for an increased risk of Crohn's disease in oral contraceptive users

The risk of Crohn's disease in relation to oral contraceptive use was evaluated in a hospital-based, case-control study of 57 women with Crohn's disease and 2189 controls with other conditions. The relative risk for oral contraceptive users compared with women who had never used these drugs was 1.9 (95% confidence interval 1.0-3.5). The magnitude of the relative risk estimate was related to the timing and duration of oral contraceptive use. For use within the year before admission to a hospital (recent use), the relative risk estimate was 4.3 (2.1-8.7); the estimate dropped to 1.2 (0.5-2.6) 4 yr after discontinuation of oral contraceptive use. The relative risk estimate for recent use that lasted greater than or equal to 5 yr was 8.0 (3.1-21). The findings are in accordance with earlier reports of an increased risk of Crohn's disease in oral contraceptive users.

Prognostic implications of blast cell morphology in childhood acute lymphoblastic leukemia: a report from the Childrens Cancer Study Group

The Childrens Cancer Study Group (CCSG) has evaluated French-American-British (FAB) morphology in newly diagnosed children with acute lymphoblastic leukemia (ALL) since 1975. A modification of the FAB system was used in which individual lymphoblast cells were scored and designated as either L1 or L2 on the basis of distinctive morphologic characteristics. L1 ALL was defined as less than 10% L2 cells and greater than 90% L1 cells; L2 ALL was defined as greater than or equal to 10% L2 cells and less than 90% L1 cells. FAB morphology was an independent predictor of overall survival (P = 0.02) in CCSG-141 and a highly significant predictor of successful induction of complete remission and event-free survival in the CCSG-160 series (P = 0.00001). These studies involved nearly 3900 patients. Two concordance studies have been performed. In the first (1981) study, overall concordance between the FAB reference laboratory and member institutions was 76% using a two-category system (L1, non-L1), 86% for L1 cases, and 47% for non-L1 cases. In the second (1984) concordance study, the use of more stringent, semiquantitative definitions of L1 and L2 lymphoblasts did not improve overall (75%), L1 (89%), or non-L1 (46%) concordance. The results of reference laboratory classification more powerfully predicted event-free survival than did member institutions (P = 0.016 vs P = 0.125). Quality control factors (slide preparation, cellularity, staining quality, and discipline of the reviewer) did not influence concordance. These results justify the continued assignment of patients to protocols of the CCSG-100 series on the basis of the modified FAB classification. The biological significance of the FAB morphologic variants remains to be determined.

Cigarette smoking and the risk of endometrial cancer

Because of evidence of reduced estrogen excretion in the urine of women who smoke cigarettes and evidence linking estrogen levels to the risk of cancer of the female reproductive system, we evaluated the risk of endometrial cancer in relation to cigarette use in a hospital-based case-control study of 510 women with endometrial cancer (cases) and 727 women with other cancers (controls). The rate-ratio estimate (relative risk) for current smokers as compared with women who had never smoked was 0.7 (95 per cent confidence interval, 0.5 to 1.0), and for former smokers the estimate was 0.9 (0.6 to 1.2). For women currently smoking 25 or more cigarettes per day, the rate-ratio estimate was 0.5 (0.3 to 0.8). The effect of current smoking of at least 25 cigarettes per day appeared to be confined to postmenopausal women, among whom the estimate was 0.5 (0.2 to 0.9). Among premenopausal women the estimate was 0.9 (0.4 to 2.2), but the difference between these two estimates could have been due to chance. The data suggest that women who smoke heavily may have a lower risk of endometrial cancer than nonsmokers. The present findings do not have direct public health importance since cigarettes, overall, have serious deleterious effects. However, if these results are confirmed, elucidation of the underlying mechanisms whereby smoking reduces the risk would be of interest and might be useful in the development of strategies for preventing endometrial cancer.

Breast cancer and the consumption of coffee

The hypothesis has been raised that coffee consumption may increase the incidence of breast cancer, based on the report that fibrocystic breast disease, a risk factor for breast cancer, regresses after abstention from coffee and other methylxanthines. The relation between recent coffee consumption and the risk of breast cancer was evaluated in a case-control study, based on interviews conducted 1975-1982 at several mainly eastern US teaching and community hospitals. The responses of 2,651 women with newly diagnosed breast cancer were compared with those of 1,501 controls with nonmalignant conditions and 385 controls with cancers at other sites. The relative risk estimates for levels of coffee drinking up to seven or more cups daily, relative to none, approximated 1.0 with narrow 95% confidence intervals. After allowance for confounding, the relative risk estimate for drinking at least five cups a day was 1.2 (95% confidence interval, 0.9-1.6) using the noncancer controls and 1.1 (0.7-1.6) using the cancer controls. Coffee consumption was not associated with an increase in the risk of breast cancer among women with a history of fibrocystic breast disease, nor were tea or decaffeinated coffee associated with an increase in the risk of breast cancer. The results suggest that the recent consumption of coffee does not influence the incidence of breast cancer.

Management of pancreatic and duodenal trauma

Eighty-four patients were treated for pancreatic or duodenal injuries or both over a 13 year period. Isolated contusion of the duodenum was managed by drainage only, and disruption was managed with primary closure, coverage of the closure with a serosal patch, and drainage. Patients with distal pancreatic injuries that involved the body or tail of the pancreas and were total or near-total transections underwent distal pancreatectomy and splenectomy. The difficult areas of management continue to be the type III and IV pancreatic and duodenal injuries. Extensive pancreatic resection should be reserved for those situations in which the pancreas has been devitalized and it is not expected that resolution will occur with drainage. The mortality in combined severe pancreatic and duodenal injuries was 64 percent with death related to associated injuries in most cases; however, extensive resection (Whipple procedure) in two cases led to death because of leakage from the anastomosis with subsequent retroperitoneal infection. Postoperative management of patients with pancreatic and duodenal injuries should always include careful attention to nutrition.

Mondor's disease associated with metastatic axillary nodes

Mondor's disease, superficial thrombophlebitis of the breast, is customarily associated with benign conditions of the breast. This article reports a patient in whom an early manifestation of recurrent axillary metastasis from carcinoma of the breast was a symptom of ipsilateral superficial thrombophlebitis of the breast, an unusual association.

DNA and RNA determination in 111 cases of childhood acute lymphoblastic leukaemia (ALL) by flow cytometry: correlation of FAB classification with DNA stemline and proliferation

Flow cytometry with acridine orange was used in 111 cases of childhood acute lymphoblastic leukaemia (ALL) to determine simultaneously DNA index, cell cycle distribution and cellular RNA content in bone marrow samples. The overall incidence of DNA aneuploidy in the population was 40%. Significantly higher incidence of DNA aneuploidy was present in the L2 (70.6%) as compared to the L1 (34.1%) group (P = 0.007), using the FAB classification. No difference in the frequency of normal and abnormal DNA stemlines was found between newly diagnosed and relapsed patients. The L2 group had significantly higher proliferation (S phase = 12.4%) than L1 (S phase = 5.8%) (P = 0.01), but RNA content was not significantly different. The aneuploid group had significantly more (P = 0.01) cases with L2 morphology (28.6%) compared to the diploid group (8%) and proliferation was higher in DNA aneuploid (S-phase = 9.5%) compared to DNA diploid (S-phase = 4.7%) leukaemias. Likewise, RNA content was significantly higher in aneuploid than in diploid ALL (P = 0.006). These correlations between morphology, cell kinetics and DNA index elucidate biological properties of leukaemic cells with potentially prognostic value.

Myocardial infarction and cigarette smoking in women younger than 50 years of age

The modifying influence of individual risk factors on the relation between myocardial infarction (MI) and cigarette smoking was evaluated in a case-control study of women younger than 50 years of age. Data from 555 women who survived first MIs were compared with those of 1,864 hospital controls of similar ages. The risk of MI increased with the number of cigarettes smoked, both in the presence and absence of factors that predispose to an infarction. In particular, the association was apparent at all ages, at all levels of total serum cholesterol and high-density lipoprotein cholesterol, and in the presence and absence of oral contraceptive use, hypertension, diabetes mellitus, blood group A, tendency to type A behavior, and family history of MI. The relative increase in risk was generally greater the lower the underlying predisposition to MI. There was clear evidence, however, that recent oral contraceptive use substantially augmented the increased risk for smokers, and hypercholesterolemia may have had the same effect.

Microstructures of duplex (beta + gamma) silver-tin alloys

The microstructures of (beta + gamma) silver-tin alloys are especially influenced by both homogenization temperature and subsequent heat treatment. When the alloy is cooled from homogenization temperatures above approximately 200 degrees C, lenticular regions of the ordered orthorhombic gamma phase precipitate from within the disordered h.c.p. beta phase on three structurally equivalent planes, (1210), (1120), and (2110), to form a Widmanstatten structure. When the duplex alloys were homogenized at temperatures below approximately 200 degrees C, where the beta/(beta + gamma) phase boundary is vertical, these structures were not observed.

The use of methotrexate in rheumatoid arthritis

The use of methotrexate in rheumatoid arthritis is reviewed. Methotrexate, a folic acid antagonist, is sometimes employed in an attempt to symptomatically control patients whose disease does not respond adequately to conventional therapies. Systemic administration of 7.5-15 mg/wk in a "pulse" fashion appears to be effective without precipitating severe adverse effects. However, concern over potentially serious side effects and a lack of well-controlled clinical trials have limited its use to severe, refractory disease. Further studies are needed before its role in rheumatoid arthritis can justifiably be expanded.

Terminal deoxynucleotidyl transferase activity in childhood leukemia

The activity of terminal deoxynucleotidyl transferase (Tdt) was measured in mononuclear cells of 70 children with acute leukemia, in whom raised levels of Tdt were noted at diagnosis, relapse, or during remission. Serial measurements of Tdt activity were related to the percentage of blasts in the bone marrow and the clinical course of children both during therapy and after its completion. The Tdt values did not predict relapse in children with acute lymphoblastic leukemia nor did the quantitative determination correlate with the percentage of blasts in the bone marrow.

The use of ellipsometry to study adsorption on hydrogels

This paper discusses the application of ellipsometry to film thickness measurements of materials deposited on hydrogel surface. The fundamentals of ellipsometry and modelling of ellipsometric readings are presented. A system of buffer/protein/hydrogel/metallic substrate is analysed in detail; the effects of optical properties of buffer, protein, polymer and thickness of protein film on ellipsometry readings are discussed. Cell window effects on ellipsometric results may also be quite important.

Interactions of calcium, copper, iron, and zinc with methylmercury and selenium in guinea pig tissues

Female guinea pigs were exposed to 10 doses of 3 mg/kg body weight of methylmercuric chloride with or without concomitant equimolar doses of sodium selenite. Tissue concentrations of calcium, copper, iron, and zinc were determined 1, 14, and 28 d after the final dose, in red blood cells, plasma, pancreas, spleen, kidney, liver, cerebrum, and cerebellum. Various alterations were observed, most notably a marked depression in cerebellar calcium levels, a change that did not take place in the presence of selenium. The alterations are discussed in terms of their possible relevance to mechanisms of methylmercury toxicity and selenium protection against it.