Multiple agent chemotherapy including bleomycin of non-Hodgkin's lymphoma during pregnancy

The association of non-Hodgkin's lymphoma and pregnancy is a rarely reported occurrence. We describe the case of a female patient in which a wide-spread lymphoma of mixed lymphohistiocytic diffuse type was diagnosed in the second trimester of the pregnancy. Combination chemotherapy (cyclophosphamide, vincristine, prednisone and bleomycin) was started at approximately the twenty-first week of fetal life. A prompt remission was obtained and a normal full term infant was born. Chemotherapy of progressive lymphoma in women late in pregnancy appears to be rational with little risk of fetal malformation or morbidity.

Multiple agent chemotherapy including bleomycin of non-Hodgkin's lymphoma during pregnancy

The association of non-Hodgkin's lymphoma and pregnancy is a rarely reported occurrence. We describe the case of a female patient in which a wide-spread lymphoma of mixed lymphohistiocytic diffuse type was diagnosed in the second trimester of the pregnancy. Combination chemotherapy (cyclophosphamide, vincristine, prednisone and bleomycin) was started at approximately the twenty-first week of fetal life. A prompt remission was obtained and a normal full term infant was born. Chemotherapy of progressive lymphoma in women late in pregnancy appears to be rational with little risk of fetal malformation or morbidity.

Gonadal function abnormalities in sickle cell anemia. Studies in adult male patients

Thirty-two adult patients with sickle cell anemia were evaluated endocrinologically. Secondary sex characteristics were abnormal in 29, and eunuchoidal skeletal proportions were present in all except one. The age at which different stages of pubic hair growth were attained in these patients was delayed in comparison to normals (P less than 0.005). Hormonal assays were carried out in 14 patients. Basal serum testosterone, dihydrotestosterone, and androstenedione values were lower (P less than 0.02) in patients than controls. Serum LH and FSH levels before and after stimulation with gonadotropin-releasing hormone were consistent with primary testicular failure. Erythrocyte and hair zinc concentrations were significantly decreased, and there was positive correlation between erythrocyte zinc and serum testosterone (r = 0.61, P less than 0.01) in sickle cell anemia. Our study shows that androgen deficiency in this disease is a result of primary rather than secondary hypogondadism. Further studies are required to establish the role of zinc in the pathogenesis of testicular failure in sickle cell anemia.

Trace elements in sickle cell disease

Trace elements in 84 adult patients (38 men and 46 women) with sickle cell disease (SCD) were reflected in clinical and biochemical data. Height was retarded in six men and five women. Eighty percent of the SCD patients in this sample were below the 50th percentile from the normal mean for weight. Twenty-eight men showed a lack of facial and body hair, and five additional subjects showed only scanty facial hair. Whereas zinc in plasma, red blood cells, and hair was decreased, the excretion of zinc in urine was increased in SCD patients as compared to the controls. We believe that one of the mechanisms accounting for zinc deficiency in SCD may be hyperzincuria and that growth retardation and hypogonadism in men so commonly seen in SCD may be related to zinc deficiency.

L-asparaginase reinduction and maintenance therapy in previously treated acute lymphocytic leukemia

Four patients with acute lymphocytic leukemia previously treated with conventional chemotherapy received intramuscular L-asparaginase in combination with other chemotherapy for reinduction and maintenance therapy. These patients received the L-asparaginase for 8, 14, 27, and 34+ months without demonstrating any significant adverse effects. Only 1 of the 4 was clearly resistant to the other chemo-therapy, and 3 of 4 had recurrence of their disease while receiving L-asparaginase. L-asparaginase can be added to reinduction and maintenance regimens of patients resistant to other chemotherapy and is well tolerated for long periods when given intramuscularly weekly with other immunosuppressant agents.

Intensive chemotherapy as primary treatment for rhabdomyosarcoma of the pelvis

Twenty-six cases of childhood rhabdomyosarcoma involving the pelvis were treated at Childrens Hospital of Los Angeles between 1950 and 1972. The median survival of 17 patients treated up to 1970 was 6 months. Of a group of 9 patients treated with intensive chemotherapy (ICG) prior to surgery and/or x-ray therapy, 5 are surviving from 12 to 60 months and have a relative survival rate of 4.5 times that of the mixed therapy group (MTG) (p = 0.01). Deaths have occurred only in patients with Stage IV disease. The use of preoperative chemotherapy with or without x-ray therapy followed by local surgical excision when necessary can be as effective in prolonging the survival of children with pelvic rhabdomyosarcoma as those obtained with more traditional approaches; this limitation in use of surgery is likely to preserve the quality of life, should the child live to adulthood.

Zinc deficiency in sickle cell disease

Clinical similarities between patients with sickle cell anemia and zinc-deficient subjects suggested a secondary zinc deficiency in sickle cell anemia. Zinc was assayed in various biological fluids and tissues by atomic absorption spectrophotometry. Zinc in the plasma, erythrocytes, and hair was decreased and urinary zinc excretion was increased in anemia patients as compared to controls. Erythrocyte zinc and daily urinary zinc excretion were inversely correlated in the anemia patients (r equal to minus .63, P smaller than 0.05), suggesting that hyperzincuria may have caused zinc deficiency in these patients. Carbonic anhydrase, a zinc metalloenzyme, correlated significantly with erythrocyte zinc (r equal to plus 0.94, P smaller than 0.001). Plasma RNase activity was significantly greater in anemia subjects than in controls. We administered zinc sulfate, 660 mg per day, orally, to seven men and two women with sickle cell anemia. Two 17-year-old males gained 5 cm and 7 cm in height during 49 and 42 weeks of zinc therapy, respectively. All but one patient gained weight (0.5 kg to 4.1 kg). Five of the males showed increased growth of pubic, axillary, facial, and body hair, and in one a leg ulcer healed in six weeks on zinc and in two others some benefit of zinc therapy on healing of ulcers was noted.

[Left atrio-ventricular parachute valve. Clinical, angiocardiographic and anatomic study, presentation of 6 cases]

Report of 6 cases of parachute left atrio-ventricular valve, combined with complex malformations in 4. Age ranged from 24 hours to 9 years, five of them being less than 3 months old. Four girsl and two boys. All were examined post-mortem and two had angiography and chateterization. This series was compared with those described in the world literature.

An unusual hemoglobin anomaly and its relation to alpha-thalassemia and hemoglobin-H disease

A Chinese family with hemoglobin H in the propositus has been reinvestigated. Although the original propositus is now deceased, a sister has the same hematological manifestations. Her hemoglobin, like that of the deceased sister, contains hemoglobins A, H, and Bart's. In addition, however, two minor components have been detected. These minor components appear to have abnormal alpha-chains and are also present in the maternal grandmother, the mother, a maternal aunt, and three other siblings but only in about one-tenth the amount. One of the minor components may be the same as Hb-Thai (25). The father has the characteristics of classical alpha-thalassemia. These results are discussed in relation to current concepts of alpha-thalassemia as they relate to "silent" and "classical" alpha-thalassemia and to possible multiple alpha-chain loci.

Studies of tubular alterations in diffuse renal disease. II. Quantitative evaluation of cellularity and length of proximal convoluted tubules in the kidney of lupus nephritis

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