Systemic infection with Trichosporon cutaneum in a patient with acute leukemia: report of a case

A case of disseminated infection with Trichosporon cutaneum, a fungus that causes white piedra, is described. The patient, a 58-year-old barber with acute leukemia, had fever, myalgias and skin lesions. He was receiving cytotoxic drug therapy and prednisone, was severely neutropenic and was being treated with broad spectrum antibiotics. Blood cultures and a biopsy of the skin lesion grew T. cutaneum. He died despite amphotericin B therapy. At autopsy, widespread infection with T. cutaneum was present. T. cutaneum is another fungus capable of causing widespread systemic disease in the immunocompromised host.

Prophylactic trimethoprim-sulfamethoxazole during consolidation chemotherapy for acute leukemia: a controlled trial

We conducted a prospective, controlled, randomized trial of oral trimethoprim-sulfamethoxazole treatment in patients with acute leukemia receiving consolidation chemotherapy. We followed 14 treatment patients during 33 episodes and 15 control patients during 34 episodes of granulocytopenia (less than 1000 granulocytes/mm3). We found no significant difference in the incidence of febrile episodes (13 in treatment group versus 14 in control group), hospitalizations to treat fever or infection (10 versus 12), number of documented infections (eight versus 10), number of septicemias (one versus two), or mean duration of hospital stay to treat fever or infection (8.9 versus 9.2 days) in the two groups. There was little colonization with organisms resistant to trimethoprim-sulfamethoxazole, including Candida, in either group. Prophylactic trimethoprim-sulfamethoxazole did not significantly reduce the incidence of fever, hospitalization, or infection in granulocytopenic patients during consolidation chemotherapy.

Ability of nonpermissive mouse cells to express a simian virus 40 late function(s)

Mouse cells are fully nonpermissive for simian virus 40 (SV40). Infection does not lead to detectable virus replication. In this report, it was shown, first, that spliced 16S and 19S SV40 late mRNA were present in cytoplasmic and polysomal polyadenylated acid+ RNA preparations from SV40-infected baby mouse kidney cells. The 16S and 19S SV40 late mRNA's produced in infected baby mouse kidney cells were identical to or similar to the 16S and 19S SV40 late mRNA's produced in permissive monkey cells as judged by their S1 mapping patterns performed with the late strand of HpaII-BamHI fragment B and by their sedimentation patterns in a sucrose gradient. It was also shown that the 16S late mRNA from infected baby mouse kidney cells could be translated into a polypeptide which was identical to or similar to virion protein VP1 in every aspect examined, including the patter of peptide mapping by limited proteolysis. Second, we reported that mouse kidney cells produced detectable, although low, levels of SV40 virion protein VP1, as shown by the sodium dodecyl sulfate-polyacrylamide gel autoradiogram of [35S]methionine-labeled proteins immunoprecipitated by a rabbit antiserum directed against SV40 virion proteins. Third, it was reported that infected baby mouse kidney cells produced late mRNA's either (i) when the infection was done at a restrictive temperature with the nonleaky tsA58 mutant or (ii) in cells treated with 100 microgram of cycloheximide per ml, in which large T antigen synthesis was inhibited by more than 99.9%. This suggested that large T antigen was not required for the synthesis of late mRNA in mouse cells.

Cytosolic oestrogen receptor content of breast cancer tissue in blacks and whites

We have examined the oestradiol receptor (ER) content of cytosols from 560 Black and White patients. The tumours from the White group contained a significantly lower proportion on ER-negative tumors (35.4%) compared with those from the Black group (46.5%). The proportion of ER-positive tumours is significantly greater in the post- than in th premenopausal White group. The frequencies of ER-positive tumours in the post- and premenopausal Black groups are not significantly different, resembling the situation described by others in Japanese women.

Enhancement of transcription of the SV40 genome in mouse embryo cells by pretreatment with 5-iodo-2'-deoxyuridine

Treatment of mouse embryo (ME) cells with 5-iodo-2'-deoxyuridine (IdUrd) before infection with SV40 virus, enhances T-antigen (T-Ag) production as detected by immunofluorescence and complement fixation. Cellular DNA and RNA synthesis are inhibited in both SV40 and mock-infected cells after IdUrd treatment. The analogue pretreatment significantly increases the amount of radiolabelled nuclear and cytoplasmic SV40-specific RNA and the RNA polymerase activity of the viral transcriptional complexes of the Sarkosyl supernatants, suggesting that the enhancement of SV40 T-Ag production in infected pretreated ME cells results from an increased synthesis of early virus RNA.

Tamoxifen and hypercalcaemia. A case report

A patient is reported in whom hypercalcaemia developed when adjuvant hormonal treatment with tamoxifen (Nolvadex) was instituted. The response to withdrawal of the drug and the recurrence of hypercalcaemia on rechallenge with tamoxifen make a causal relationship between hypercalcaemia and tamoxifen therapy probable. Some of the mechanisms of development of hypercalcaemia in cases of breast carcinoma are discussed, and the literature on hypercalcaemia and tamoxifen therapy is reviewed.

In situ study of SV40 virus DNA in lytic infection by mild loosening of nucleoproteins

We have studied SV40 (simian virus40) nucleoprotein in permissively infected monkey kidney cell cultures (CV1) by a procedure which does not require the isolation of the SV40 chromosomes. Treatment of the cells by a low ionic strenght medium containing Photo flo produces a mild loosening of nucleoproteins, and permits the in situ study in ultrathin sections of virus components and their relationships with host cell chromatin. RNP and DNP could be distinguished by uranyl-EDTA-lead staining (for RNP) and by DNase digestion. SV40 DNA was observed as circular molecules, either free or connected with either RNP fibrils or virus capsids. These three aspects were interpreted, respectively, as viral minichromosomes, transcription of virus genome and partially encapsidated virus DNA. During encapsidation a few virus particles appear to be bound to host chromatin. Many, if not all, seemingly mature viruses, singly or in small linear clusters, are also aligned on host chromatin. Some of these observations were corroborated by the Miller spreading technique. They are consistent with a role for the host cell chromatin in the production of nuclear viruses.

Correlation between prognosis and bone marrow chromosomal patterns in children with acute nonlymphocytic leukemia: similarities and differences compared to adults

The chromosomal complement of 28 children with the diagnosis of acute nonlymphocytic leukemia (ANLL) were examined. An abnormal cytogenetic pattern was found in 50% of these patients, which is similar to the results in adults with ANLL. Unlike the reports in adult patients, however, no specific chromosomal changes were found. This observation may imply that the etiology and mechanisms by which abnormal clones develop in ANLL could differ significantly between children and adults. Those patients with chromosomal abnormalities in their initial bone marrow sample had a median survival of 7.1 mo, whereas those with a normal diploid pattern in their bone marrow had a median survival of 20.5 mo (1-sided, p = 0.04). If all metaphases were abnormal, the median survival was only 3 mo.

Combination chemotherapy of metastatic breast cancer: a randomized trial comparing the use of adriamycin to that of Vinblastine

Two regimens of chemotherapy for metastatic breast cancer were compared in a randomized controlled fashion. Regimen 1 consisted of cyclophosphamide, vinblastine, methotrexate and 5-fluorouracil (CVMF). Regimen 2 consisted of cyclophosphamide, adriamycin, methotrexate and 5-fluorouracil (CAMF). The patient population consisted of both black and white postmenopausal females who had not received any prior chemotherapy. Objective responses were observed in 25/57 patients treated with CVMF and in 28/51 patients treated with CAMF. Neither race nor choice of chemotherapeutic regimen affected prognosis, although there were differences in the pattern of metastatic involvement between the two racial groups. The median duration of survival of patients who responded to therapy has not yet been reached but will be in excess of 12 months.

Effects of ethidium bromide on the production of ribosomal RNA in cultured mouse cells

A treatment of primary mouse kidney cell cultures with 5 microM Ethidium Bromide (Eth Br) reduces the transcription of nuclear-coded genes and especially of ribosomal RNA genes. This effect was consistently observed when comparing drug-treated and control cells for (i), the incorporation of 3H uridine into total nuclear and B RNA polymerases as determined in isolated nuclei. It became more pronounced with exposure time; however, after removal of the drug, there was a progressive recovery of RNA synthesis culminating in the complete reversal of the drug effect. That this effect is probably not due only to the suppression of mitochondrial protein synthesis by the drug, is shown by a comparative study of the effects of chloramphenicol treatment. In addition, in the cytoplasm Eth Br depresses the labeling of 28 S rRNA more than that of 18 S whereas no abnormal accumulation of 28 S rRNA is observed in the nucleus. It is suggested that Eth Br may affect either the stability of the 28 S rRNA or its rate of formation from the 32 S precursor.

Biotransformation of chloroform by rat and human liver microsomes; in vitro effect on some enzyme activities and mechanism of irreversible binding to macromolecules

The effects of chloroform on some rat microsomal enzyme activities were studied in vitro. Maximum inhibition of oxygen consumption, NADPH oxidase and NADPH-cytochrome c reductase was observed at 0.5 mM chloroform; prior metabolization of CHCl3 by microsomal monooxygenases increased inhibition by about 50% at 0.2-0.5 mM chloroform. Higher concentrations produced a paradoxical reversal of inhibition, whereas p-nitroanisole demethylase was steadily inhibited by about 50% up to 10 mM chloroform. Irreversible binding of 14CHCl3 was confirmed to depend on chloroform metabolization by monooxygenases. The increased irreversible binding due to phenobarbital induction is accompanied by a diminished affinity towards chloroform as shown by increased KM of irreversible binding, and a higher spectral dissociation constant KS. Aminoacids with nucleophilic functions (histidine, cysteine) partially prevented the irreversible binding of chloroform metabolites to microsomes; non-volatile radioactive derivatives were recovered in trichloracetic acid supernatants when microsomes were incubated with cysteine, but not with histidine. Phosgene has been demonstrated as a biological metabolite of chloroform: its possible reactions with nucleophilic groups of macromolecules, water and added aminoacids partly explain these experimental data. Similar results were obtained with human microsomes, showing that chloroform hepatotoxicity in man could involve the same mechanisms.

Xerographic parenchymal patterns and breast cancer

The xerographic mammography records of 3,002 patients with breast disease were reviewed and classified according to the criteria of Wolfe. The parenchymal P2 pattern occurred in 59% of patients with cancer and in only 16,9% patients under the age of 40 without cancer, but the incidence of the DY pattern was much the same in patients with cancer and in those without cancer in almost all the age groups studied. The incidence of the P2 pattern tended to rise slightly in patients without cancer, whereas the incidence of the DY pattern tended to remain the same in all groups. The findings of Wolfe and others have been confirmed by this study, which also supports the suggestion that women under the age of 40 undergo a baseline xerographic examination of the breasts for cancer and that subsequent screening be based on the presence of a P2 pattern. This will involve a selection of 16,9% of the under 40-year-old subjects without cancer who might, on screening be expected to show 60% of the cancers in each decade after the age of 40. This information coupled with other factors indicating a high risk for the development of breast cancer, such as florid epithelial dysplasia, a previous history of breast cancer or a family history of breast cancer, should increase the yield of early carcinomas at a preclinical stage and reduce costs of a screening programme.

Infective endocarditis in heroin addicts: epidemiological observations and some unusual cases

The total number of cases of heroin-induced endocarditis occurring over a four-year period were reviewed in order to explain an increase in the number of cases in the last year studied (1975). Brown heroin was noted to be used more frequently by addicts during the period of increased incidence. Cultures of "street samples" of brown and white heroin as well as cocaine were obtained in order to elucidate a possible relationship between the increased use of brown heroin and the increased number of endocarditis cases. Despite frequent contamination of both white and brown heroin, none of the common endocarditis-causing pathogens were isolated from the samples. Staphylococcus aureus, the most common etiological agent, frequently resulted in tricuspid endocarditis. That the accepted criteria for tricuspid endocarditis may be present without actual cardiac valve involvement is demonstrated by a most unusual case of hepatic vasculature infection.

Oestrogen receptors in tumours of breast cancer patients

Oestrogen receptors were measured in the cytoplasmic fraction of tumours from patients with breast cancer. Receptors were detected in 48% of patients, and 52% showed no receptors. A follow-up study of a small group of patients on hormone therapy is reported.

Death-producing hemoptysis in tuberculosis

Massive hemoptysis in patients with tuberculosis is reported infrequently and then virtually always in association with cavitary disease or aspergilloma. In contrast, we describe herein five cases characterized by hemoptysis on admission, bilateral pulmonary disease, samples of sputum positive for acid-fast bacilli by Ziehl-Neelsen stain, and no obvious cavitary disease. In each, hemoptysis subsided and then suddenly recurred in prodigious amounts, leading to death, probably from asyphyxiation. In patients hospitalized with tuberculous hemoptysis of any amount, with or without an obvious cavity, aggressive diagnostic evaluation, including bronchoscopic examination, may define the site of bleeding, thus permitting rapid surgical intervention if the hemoptysis increases.