Aspergillus Peritonitis complicating perforated appendicitis in adult acute leukemia

A 38-year-old male with terminal transferase positive acute lymphoblastic leukemia experienced fever, polymicrobial bacteremia, gastrointestinal bleeding, abdominal pain during induction therapy, and remission. Cecal perforation, Aspergillus peritonitis, and subsequent disseminated aspergillosis were successfully managed with colon resection, drainage, and antibiotic and antifungal therapy. Serologic tests for antibody to Aspergillus were repeatedly negative.

Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions

Four homosexual men presented with gradually enlarging perianal ulcers, from which herpes simplex virus was cultured. Each patient had a prolonged course characterized by eight loss, fever, and evidence of infection by other opportunistic microorganisms including cytomegalovirus, Pneumocystis carinii, and Candida albicans. Three patients died; Kaposi's sarcoma developed in the fourth. All were found to have depressed cell-mediated immunity, as evidenced by skin anergy, lymphopenia, and poor or absent responses to plant lectins and antigens in vitro. Natural-killer-cell activity directed against target cells infected with herpes simplex virus was depressed in all patients. The absence of a history of recurrent infections or of histologic evidence of lymphoproliferative or other neoplastic diseases suggests that the immune defects were acquired.

Anabolic profiles in late-stage cancer patients responsive to hydrazine sulfate

The anabolic profiles of 59 late-stage cancer patients responsive to hydrazine sulfate were examined; the drug had been given either as a sole agent or added to preexisting therapy to which the patients had become refractory. Most of the patients (79.7%) responded which Indicated Appetite Improvement (IAI), expressed by protocol-code, clinical evaluation and/or direct quantitation. In those patients receiving hydrazine sulfate alone the IAI was 86.1%; in those in whom hydrazine sulfate was added to pre-existing therapy the IAI was 69.6%. Of those cases expressed in direct quantitation the average weight gain for patients receiving hydrazine sulfate alone was 8.2 lbs, whereas the average weight gain for those with pre-existing therapy was 0.6 lbs (p = 0.01). The results suggest the use of hydrazine sulfate as a specific chemotherapy for cancer cachexia, and implicate ineffective concurrent or prior therapy as an apparent negative factor in the generation of anabolic response.

Seasonal variation in spontaneous abortions

Using a national sample of hospital discharges, we found identical seasonal patterns for spontaneous abortions and conceptions but no significant seasonal variation in the rate of spontaneous abortions per 1,000 conceptions. The differences between our findings and those of previous investigators of spontaneous abortion may reflect our more comprehensive definition of spontaneous abortion, our more complete estimate of the monthly number of conceptions, and our more rigorous statistical analysis. The periodic regression analysis (PRA) reported in our study may be useful in other studies that monitor short-term trends.

Fatal ectopic pregnancy after attempted legally induced abortion

From 1973 through 1978, the Center for Disease Control identified ten deaths caused by ruptured ectopic pregnancy after attempted legal abortions for those pregnancies. The women ranged in age from 18 to 31 years, seven were black, three were white, and five were nulliparous. The estimated gestational age was 16 menstrual weeks or earlier. In seven cases tissue obtained at abortion was sent for outside microscopic pathological examination; attempts to contact four of the patients when no products of conception were found were unsuccessful. An important factor in preventing fatal ectopic pregnancy for women who have legal abortions is the identification of products of conception at the time of the abortion procedure while the patient is still available for reexamination and recurretage.

A cluster of septic complications associated with illegal induced abortions

Between August 7 and October 14, 1977, Clostridium perfringens organisms were isolated from endometrial and/or blood specimens from 3 women who had been hospitalized in McAllen, Texas, after having had illegal induced abortions. One of the women died of clostridial septicemia. A single abortionist was suspected in these 3 cases. The authors investigated the illnesses of these 3 women and those of 6 other women who were hospitalized at some time from January through October 1977 after having had illegal abortions but did not identify a common abortionist. The patient who died was a Medicaid-eligible woman who had had an abortion performed by a nonphysician after public funding of abortion was restricted in Texas as of August 5, 1977. The authors examined the medical records of all 230 women hospitalized in McAllen General Hospital with abortion complications from 1977 through January 1978. The local effect of restriction of public funds for abortion was to be studied. The incidence of women admitted to the hospital with febrile abortion complications after August 5, 1977, did not differ from that of women admitted from January 1 through August 4, 1977. However, the incidence of hospitalization of Medicaid-eligible women with abortion-related complications was greater after August 5 than it was in the earlier period.

Ultrasound demonstration of anicteric dilatation of the biliary tree

This report presents eight patients with dilatation of the biliary tree, six of whom had no clinical or laboratory evidence of biliary tract disease except for elevated levels of serum alkaline phosphatase. In two patients, dilatation was caused by obstruction of only one hepatic duct; in three, it was caused by a pancreatic tumor; and in three, it was associated with gallstones which exercised a ball-valve effect, producing intermittent obstruction. The elevation of the alkaline phosphatase level in six of these patients suggests that it is a more sensitive indicator of biliary tract obstruction than the serum bilirubin level is. The recognition of biliary dilatation in one or both lobes of the liver should lead to a careful examination, with ultrasound or another modality, of the porta hepatis, common bile duct, and pancreas.

The histiocytoid hemangiomas. A unifying concept embracing several previously described entities of skin, soft tissue, large vessels, bone, and heart

The proposal is made that a number of previously described entities of skin, soft tissue, large vessels, bone, and heart actually constitute different manifestations of the same basic process, characterized by the proliferation of a highly distinctive type of cell descriptively identified as a "histiocytoid endothelial cell." The entities in question are angiolymphoid hyperplasia with eosinophilia and related cutaneous and subcutaneous disorders, atypical vascular proliferation of large vessels, hemangioendothelioma of bone, and endocardial benign angioreticuloma of the heart. The main cell that proliferates in all these conditions has the basic features of an endothelial cell, but also exhibits histochemical and ultrastructural characteristics that are more akin to those of a histiocyte. These unusual features could be the expression of a morphologic abnormality or represent an overgrowth of a specific and as yet undefined subpopulation of endothelial cells, such as Majno's "contractile endothelial cell." Whether this group of proliferative diseases is of a reactive or a neoplastic nature is not immediately apparent, although the latter seems more likely. However, it is clear that the behavior of these lesions, as a group, is quite indolent and even self-limited, in contrast to the aggressive behavior and often fatal outcome of the true angiosarcomas that they so closely resemble on microscopic grounds. The term "histiocytoid hemangioma" is suggested for this group of disorders.

Response of low income women and abortion facilities to restriction of public funds for abortion: a study of a large metropolitan area

During the first five months after the restriction of public funds for abortion, a large percentage of low-income women seeking abortions in a metropolitan area in Texas obtained abortion that were partially subsizied using a combination of reduced clinic fees and public funds for ancillary non-abortion services. Their own personal funds made up the difference between the subsidy and the full cost of the procedure.

The health impact of restricting public funds for abortion. October 10, 1977--June 10, 1978

The Center for Disease Control (CDC), Atlanta, Georgia implemented an eight-month prospective surveillance system in 24 hospitals distributed among states with and without public funding for abortion. Out of 3,157 visits for abortion-related complications, only 10 women gave a history of non-physician or self-induced abortion and none were Medicaid recipients. The small number of hospitals located in non-funded states and the smaller numbers of women served in these hospitals than in the funded states limited the power of out study. Women living along the Texas-Mexico border appeared more likely to have complications after illegal abortions than women from other areas of the country.

Day treatment as an aid to mainstreaming troubled children

Problem children who are diverted from public school programming into a private psychoeducational day facility in a community mental health center are followed up in a 10-year study to determine the rate of return to regular classes. The evidence points to a successful reintegration into public schools for the great majority of students. A philosophy for mainstreaming which supports the need for proper preparation of children for public school reentry is basic to effective management.

Ultrastructure in the differential diagnosis of pulmonary histiocytosis and pneumocystosis

A child with histiocytosis X initially diagnosed at the age of 4 months had a series of pulmonary biopsies later in the course of the disease. The specimens were examined by light and electron microscopy. The primary disease was complicated by Pneumocystis carinii pneumonia. This study demonstrates the limitation of light microscopy and the necessity of ultrastructural examination to verify the simultaneous occurrence of an infiltrative disorder such as histiocytosis X in the presence of an infection.

Hemangiosarcoma of the spleen: report of a case and review of previously reported cases

Splenic hamangiosarcomas are rare tumors, usually discovered at autopsy. In a few instances the diagnosis was made premortem, at the time of splenectomy for spontaneous rupture. The tumors usually present with abdominal pain, left upper guadrant mass and tenderness, and occasionally with a microangiopathic type of anemia. The histogenesis of the tumor is in dispute. Some authors feel that they are degenerations of hemangiomas. Others feel that they arise de novo in the spleen. There is not proven association of thorotrast administration or vinyl chloride exposure to the development of hemangiosarcomas in the spleen. The prognosis of the tumor is uniformly poor and most of the patients surviving laparotomy have followed a uniformly fatal clinical course. In a few cases treated with chemotherapy there has been no evidence of clinical benefit. The case report in this article presented with essentially all the features enumerated above.

Antiviral activity of cyclooctylamine hydrochloride in cell culture and mouse systems

Calcium elenolate inactivates all myxoviruses so far tested. The pH of the reaction mixture is less critical for myxovirus inactivation than that required for coxsackie A-21 virus; the myxoviruses are inactivated at a broad spectrum of pH with the maximum activity occurring at a pH below 7.0. The infectivity of the virus is more susceptible to the action of calcium elenolate than is either the neuraminidase activity or the hemagglutinin. The inactivation of Newcastle disease virus by calcium elenolate also destroys the ability of the virus to induce interferon formation in cell culture and in mice.

Enhancement by hydrazine sulfate of antitumor effectiveness of cytoxan, mitomycin C, methotrexate and bleomycin, in walker 256 carcinosarcoma in rats

Use of hydrazine sulfate potentiates the antitumor action of Cytoxan (cyclophosphamide), Mitomycin C, methotrexate and bleomycin against Walker 256 intramuscular carcinosarcoma in in vivo short-term studies in rats. Experimental data suggest this potentiation by hydrazine sulfate to result from a mechanism of action other than direct cytotoxicity, and further, that combination chemotherapy with hydrazine sulfate and a cytotoxic agent may be useful in the treatment of human cancer.

Use of hydrazine sulfate in terminal and preterminal cancer patients: results of investigational new drug (IND) study in 84 evaluable patients

In a series of 84 various evaluable disseminated cancer patients treated with hydrazine sulfate as a result of a pharmaceutical-sponsored investigational new drug (IND) study, it was found that 59/84 or 70% of the cases improved subjectively and 14/84 or 17% improved objectively. Subjective responses included increased appetite with either weight gain or cessation of weight loss, increase in strength and improved performance status and decrease in pain. Objective responses included measurable tumor regression, disappearance of or decrease in neoplastic-associated disorders and long-term (over 1 year) 'stabilized condition'. Of the overall 59 subjective improvements 25 (42%) had no concurrent or prior (within 3 months) anticancer therapy of any type. Of the 14 objective improvements 7 (50%) had no concurrent or prior anticancer therapy. Of the remaining cases in which there was either concurrent or prior anticancer therapy, improvements occurred only after the addition of hydrazine sulfate to the treatment regimen. Duration of improvement was variable, from temporary to long-term and continuing. Side effects were mild, comprising for the most part low incidences of extremity paresthesias, nausea, pruritus and drowsiness; there was no indication of bone marrow depression.