Allogeneic bone marrow transplantation vs chemotherapy for the treatment of childhood acute lymphoblastic leukaemia in second complete remission (revisited 10 years on)

In 1989 we carried out a trial comparing allogeneic BMT to chemotherapy (CT) in 76 children with relapsed acute lymphoblastic leukaemia (ALL). Ten years on we have clinically revised outcome to firmly establish the role of each treatment, to analyse the importance of length of first remission and to provide long-term actuarial results for disease-free survival (DFS) and relapse rate in each group. For 21 patients within the transplantation group, probability of DFS and relapse are 42.8 +/- 10.8% and 40.2 +/- 11.7% (s.e.), respectively. In the chemotherapy group, probability of DFS is 10.0 +/- 4.74% (P = 0.001) and probability of relapse 87.5 +/- 5.2% (P = 0.0004). These results strongly reflect those at initial analysis, confirming a key role of BMT in the management of ALL in second remission. Moreover, on univariate analysis only two factors influenced DFS: treatment group and length of first complete remission (less or more than 30 months from first CR). Thus, it seems clear that the best therapeutic option in early relapse is BMT, whereas DFS in late relapse is at the limit of significance (P = 0.07), with a higher relapse rate in the CT group. Although encouraging results using intensified rotational combination chemotherapy have been published, prospective randomised studies are needed to assess with certainty the best therapeutic option in these patients.

Substernal goiter: clinical experience of 72 cases

The aim of this work was to study the clinical management and surgical approach of substernal goiters. We studied the clinical data, preoperative evaluation, surgical treatment, histopathologic data, complications, and follow-up of 72 patients found to have substernal goiter over a period of 15 years, from a total of 780 patients with goiter who underwent surgery. In this group, 83% were women, and the mean age was 61 years. The most common symptoms were the existence of a palpable cervical mass (93% of cases) and dyspnea (40%). The most successful study to diagnose substernal goiter was computed tomography (100%), followed by chest radiography (75%), gammagraphy (19%), and ultrasound (15%). All but 7 patients received a Kocher cervicotomy, and 49% of the cases underwent a total thyroidectomy. The histologic study revealed 3 carcinomas (4%). There was 1 permanent unilateral recurrent laryngeal nerve injury (1.4%) and 1 instance of permanent hypoparathyroidism (1.4%). We regard surgery as the most successful treatment for patients with substernal goiter, even in those without compressive symptoms. We base our choice on the low morbidity and zero mortality obtained.

Use of bile cytology for early diagnosis of complications in orthotopic liver transplantation

We conducted a daily analysis of bile cellularity in 25 patients undergoing 29 orthotopic liver transplants (OLT) and correlated the cytological parameters with the clinical outcome of each patient. The 16 patients without complications only showed slides with cells during the first 4-5 postoperative days. The four patients with primary non-function (PNF) of the graft had a high cell density up to the time of the retransplant, with a preponderance of polymorphonuclear (PMN) leucocytes (59.2%) and epithelial cells (29.2%). During the episodes of sepsis (n = 3) and rejection (n = 7) we noted the sudden appearance of high cellularity, almost exclusively PMN leucocytes (96.5%), and a preponderance of PMN leucocytes (84.2%) with appreciable percentages of mononuclear cells and macrophages as well as the early appearance of lymphoblasts in the rejection episodes. Our results show that bile cytology can be a useful method for diagnosing graft complications in liver transplantation.

Insular carcinoma: an infrequent subtype of thyroid cancer

BACKGROUND

Insular carcinoma is a little-known thyroid cancer, characterized by the presence of well-defined nidi of small uniform cells with frequent areas of tumor necrosis and microfollicles with thyroglobulin. It was described by Carcangiu in 1984, but its prognosis is not yet clear.

STUDY DESIGN

Six of 335 patients undergoing surgery for thyroid carcinoma had the insular type. We studied age, gender, treatment, histology (tumor size, coexistence of another tumor, extrathyroid spread, vascular invasion, multicentricity, and metastatic adenopathies), TNM, and followup (recurrences, mortality, and survival). These results were compared with those published in the literature.

RESULTS

Insular carcinoma was more common in women (4 of 6), and mean patient age was 32 years. Three patients had metastatic adenopathies. Four patients presented with other thyroid tumors (2 papillary, 1 follicular, and 1 anaplastic) and 2 were simple. Two patients had vascular invasion, and another 2 were extrathyroid. Only 1 case was multicentric. Three recurrences were detected in 2 patients over 50 years old: 1 lymph node at 60 months, 1 pulmonary at 132 months, and the other a bone recurrence at 8 months. Two patients died at 12 and 140 months.

CONCLUSIONS

Insular carcinoma is a special type of thyroid cancer, and the prognosis is poorer than for the classic differentiated thyroid carcinoma.

Value of repeated fine-needle aspiration cytology and cytologic experience on the management of thyroid nodules

Although fine-needle aspiration is being currently accepted as the most reliable method to select patients with thyroid nodules for surgery, controversy remains about the accuracy in distinguishing benign nodules. We present our results from 636 fine-needle aspirations performed from 1984 to 1989. Our article focuses on the value of cytologic expertise and repeated punctures for follow-up of benign nodules. We found annual figures for specificity and positive predictive value to increase steadily from 1984 to 1989, thus suggesting that the power of the test is proportional to the experience of the cytologist. We also state that the value of performing repeated punctures for the follow-up of unselected benign nodules is low.

Design and implementation of the United States National Animal Health Monitoring System 1995 National Swine Study

The United States Department of Agriculture's National Animal Health Monitoring System 1995 National Swine Study was designed to estimate management, health and productivity parameters on pig operations in the United States. Sixteen major swine-producing states that accounted for nearly 91% of June 1, 1995 swine inventory and nearly three-fourths of United States swine producers were included in the study. In the initial phase of the study, National Agricultural Statistics Service enumerators collected information from 1477 producers involved in all phases of swine production (farrowing, nursery, and grower/finisher). Of these, 405 operations with > or = 300 finisher pigs (with at least one finisher pig > or = 54 kg) participated in the subsequent component of the study, which involved on-farm visits by state and federal veterinary medical officers and animal health technicians, and which concentrated on the grower/finisher phase of production. Of those eligible to take part in the second phase of the study, participation was higher among independent producers (48.3%) than among contract producers (15.3%). Participation was also higher among operations that used advanced record-keeping systems (such as record cards for individual breeding hogs or a computer-based record-keeping system). Thus, study results could have been influenced by response biases. As a biosecurity measure, 40.5 +/- 2.1% of operations restricted entry to employees only. For operations that permitted non-employees to enter the premises, relatively few enforced other biosecurity measures on visitors (0.4 +/- 0.1% required feed-delivery personnel and livestock handlers to shower before entering the premises; 3.3+/- 0.9% required a footbath; and 7.0 +/- 1.5% required feed-delivery personnel and livestock handlers not to have visited another operation with pigs on that day). The most common method of waste storage (used by 49.9 +/- 3.8% of operations with > or = 300 finisher pigs) was below-floor slurry or deep pit.

Differences between sporadic and multiple endocrine neoplasia type 2A phaeochromocytoma

OBJECTIVES

Phaeochromocytoma may be either sporadic or part of a familial cancer syndrome. We have investigated whether there are differences between sporadic and MEN 2A phaeochromocytomas.

DESIGN

A retrospective study. We analysed age at presentation, sex, mode of presentation, clinical data, laboratory and imaging techniques, treatment, pathology and follow-up.

PATIENTS

Forty-six patients diagnosed with phaeochromocytoma between 1979 and 1995 (23 sporadic and 23 familial) at the Hospital Universitario Virgen de la Arrixaca (Murcia, Spain), a tertiary referral centre.

RESULTS

Mean age at presentation was 47 +/- 16 years for sporadic and 38 +/- 11 years for familial phaeochromocytoma (P < 0.05). The most common clinical feature and the presenting feature in cases of isolated phaeochromocytoma was hypertension. Of the MEN 2A patients, 52% were asymptomatic at diagnosis and only 35% presented with hypertension. Levels of adrenaline, noradrenaline, dopamine and metanephrines in a 24-hour urine connection confirmed the diagnosis in 95% of the isolated and 91% of the familial phaeochromocytomas. Computed tomography located 100% of the sporadic and 76% of the familial phaeochromocytomas (P < 0.02). All the MEN 2A phaeochromocytomas were bilateral compared with none of the sporadic phaeochromocytomas (P < 0.001). All the patients with familial phaeochromocytoma underwent bilateral adrenalectomy. The patients with sporadic phaeochromocytoma had the affected gland or the tumour, if extraadrenal, removed.

CONCLUSIONS

In comparing sporadic and MEN 2A phaeochromocytoma we found differences in age at presentation, mode of presentation, clinical data, duration of clinical features, imaging findings bilaterality and type of surgical treatment required.

High-resolution ultrasound associated with aspiration biopsy in the follow-up of patients with differentiated thyroid cancer

OBJECTIVE: To assess the value of ultrasound in the follow-up of patients undergoing surgery for differentiated thyroid carcinoma.

SUBJECTS: The study included 89 patients (70 women and 19 men) with differentiated thyroid carcinoma (76 papillary and 13 follicular cancer).

METHODS: High-frequency ultrasound (US) was used in the evaluation of 89 subjects who underwent surgery for thyroid carcinoma. Fine-needle aspiration was performed in cases with positive US. In addition, determinations of thyroglobulin (Tgb) in serum, scintigraphy with 131I, and cervical palpation were evaluated. We determined sensitivity, specificity, and overall accuracy for each of these diagnostic methods.

RESULTS: Ultrasonography was positive in 22 subjects, 16 in the nodal area and 6 in the thyroid bed. Twenty-two subjects received fine-needle aspiration with US control; 13 (59%) of 22 were positive for cancer. The results of the US for detecting neoplastic disease showed a sensitivity of 65%, specificity of 86%, and overall accuracy of 82%. The overall accuracy for scintigraphy was 88% and for Tgb, 91%.

CONCLUSION: We concluded that US can be included in the follow-up protocol for patients undergoing surgery for differentiated cancer of thyroid, as a valuable tool to localize the recurrence. This technique is particularly useful in the evaluation of patients who are found to have elevated Tgb levels.

The treatment of differentiated thyroid cancer includes surgery and, in some cases, the ablation of residual thyroid tissue with therapeutic doses of iodine 131I. 1 The posttreatment search for recurrence or metastases is based on periodic body scanning with 131I and determination of serum thyroglobulin (Tgb) levels. 2,3

High-resolution ultrasound (US; 10 MHz) has been found to have a high sensitivity in diagnosing nonpalpable cervical masses. 4–6 Thus the possibility exists that including it in the protocols for follow-up of differentiated thyroid cancer may be valuable.

The aim of our study was to assess the value of high-resolution US (associated with directed fine-needle aspiration [FNA] biopsy) in the follow-up of patients undergoing surgery for papillary and follicular thyroid cancer.

Design and implementation of the United States National Animal Health Monitoring System 1994-95 Cattle on Feed Evaluation, and an evaluation of the impact of response biases

The 1994-95 Cattle on Feed Evaluation was a cooperative project (sponsored by the United States Department of Agriculture) involving Washington State University, state agricultural departments, and several agencies of the United States Department of Agriculture). The project focused on cattle-on-feed operations in 13 states that accounted for over 85% of the United States cattle on feed inventory. Participants were selected from National Agricultural Statistics Service list frames. Questionnaires were administered by telephone to operations with a one-time capacity of fewer than 1000 cattle; larger operations were visited twice to administer questionnaires. The participation rate for the first phase of the study was 56.7%. Ninety-one percent of eligible operations completed the second phase of the study. Data summarized from this national study can be used to profile management practices on cattle-feeding operations in the United States. Differences between participants and non-participants did not appear to be great. However, one does need to be mindful of the fact that a small percentage of the producers accounted for the vast majority of feedlot cattle marketed when interpreting the results.

The influence of coffee with milk and tea with milk on the bioavailability of tetracycline

The effect of milk added to coffee or black tea on the bioavailability of tetracycline was evaluated in 12 healthy volunteers according to a crossover design. Results showed that even a small volume of milk containing extremely small amounts of calcium severely impair the absorption of the drug, so that the presence of this metal ion should be carefully controlled in order to avoid decreasing the available tetracycline.

Detection of animal pathogens by using the polymerase chain reaction (PCR)

The polymerase chain reaction (PCR) is a nucleic acid-based technique that enables the rapid and sensitive detection of specific micro-organisms. Although this technique is widely used in veterinary research, it has not yet found applications in routine microbiological analysis of veterinary clinical samples. However, advances in sample preparation together with the increasing availability of specific gene sequences will probably lead to the more widespread diagnostic use of PCR in the future. PCR is likely to have a strong impact in the epidemiology, treatment and prevention of animal infectious diseases.

Papillary thyroid microcarcinoma: clinical study and prognosis

OBJECTIVE

To study the anatomical and prognostic characteristics of papillary thyroid microcarcinomas (10 mm or less in size).

DESIGN

Retrospective review.

SETTING

Community hospital, Spain.

SUBJECTS

36 patients with papillary microcarcinomas diagnosed over a period of 20 years from a total of 158 papillary carcinomas with complete follow-up.

MAIN OUTCOME MEASURES

Symptoms, treatment, histopathological confirmation and follow-up compared with those of papillary carcinomas more than 10 mm in size.

RESULTS

Six of the patients with microcarcinomas presented with adenopathy, the remaining 30 being admitted for treatment of associated thyroid diseases. In 15 cases the tumour was 5 mm or less in size. Thirty were well-differentiated, 2 were follicular, and 2 showed signs of diffuse sclerosis. Three had recurred after total thyroidectomy, but no patient died. When the results were compared with those of the patients with larger tumours, we found differences in histological type (p = 0.001), the incidence of adenopathy (p = 0.03), TNM stage (p = 0.001) and mortality (p = 0.04).

CONCLUSIONS

There are clinical, histopathological, and prognostic differences between microcarcinomas (which do well) and larger papillary tumours.

Measurement and application of uranium isotopes for human and environmental monitoring

An improved method is described utilizing extraction chromatography, anion exchange, and alpha spectroscopy for measurement of uranium isotopes in human and environmental surveillance studies. These methods provide a sensitivity of approximately 0.7 mBq per isotope per sample and are generally accurate within the precision of the measurements. The extraction chromatography methods greatly simplify separation of uranium from iron in silicate matrices and provide increased sample throughput and data quality for water, soil, and air filter samples. For bioassay samples, the coprecipitation/anion exchange/alpha spectrometric methods provide rapid throughput and sufficient sensitivity to meet new analytical performance standards in human monitoring studies. In addition, the 234U:238U data can be used as a fingerprint of natural vs. anthropogenic sources of uranium. For 1995 data from our laboratory, a large percentage (79-94% by matrix) of samples appear to be of natural 234U:238U isotopic composition. For all matrices, samples with higher uranium concentration generally have more depleted isotopic composition (smaller 234U:238U). A small percentage of soil (11%), air filter (3%), urine (3%), and water (3%) samples have depleted isotopic signatures at the 95% confidence interval, indicating anthropogenic contributions of uranium to these samples.

Cytogenetic analysis in human bone marrow transplantation

Bone marrow transplantation (BMT) is a therapeutic process used to treat a variety of hematologic diseases. After BMT, the documentation of engrafting with the use of genetic markers is obligatory. C-band polymorphism is an excellent genetic marker because it occurs with high frequency in all populations studied and shows a high stability in vitro and in vivo. We studied a total of 36 patients: 15 with myeloid leukemia and 21 with severe aplastic anemia (SAA), submitted to BMT. The majority of the patients with chronic granulocyte leukemia (CGL; 10/15, 67%) and with SAA (17/21, 81%) showed a frequency of host cells around 15% (CGL) and 8% (SAA) in the first period analyzed (day +30 post-BMT); with a decrease in the others (+90, +180 to CGL and SAA and +365 only to CGL). In our study, the persistence of host cells in these proportions did not imply an unfavorable prognosis. On the contrary, some patients with myeloid leukemia (5/15 33%) and SAA (4/21, 19%) showed high proportions of host cells in one or more periods analyzed. If compared to the first group, these patients had, in general, a poor clinical evolution, with rejections, relapses, and deaths in greater numbers. These results show the important contribution of cytogenetic analysis in the follow-up of patients submitted to BMT.

Encapsulated papillary neoplasm of the thyroid: retrospective clinicopathological study with long term follow up

OBJECTIVE

To study the clinical course of patients with the encapsulated variant of papillary thyroid carcinoma, in which there is a well-defined fibrous wall completely separating the tumour cells from the adjacent tissue.

DESIGN

Retrospective review.

SETTING

University hospital, Spain.

SUBJECTS

Of a total of 163 patients whose papillary thyroid carcinomas were treated surgically between 1975 and 1985, there were 25 encapsulated tumours.

MAIN OUTCOME MEASURES

Clinicopathological features and survival rate compared with those of non-encapsulated papillary thyroid carcinomas.

RESULTS

Mean follow up was 9 years (range 7-17), and 42 were excluded because follow up was incomplete. Encapsulated tumours differed from the earlier age of other types in that they presented earlier (mean age 36 years compared with 45), they were significantly less likely to have symptoms of compression (1/25 compared with 24/96, p = 0.024), or nodal metastases (3/25 compared with 43/96, p = 0.002), or to recur (0/25 compared with 33/96, p = 0.002). No patients died in the encapsulated group compared with 11/96 in the other group.

CONCLUSIONS

Encapsulated papillary carcinomas have an excellent prognosis, and can be cured by operation.

Isolation and characterization of pediocin L50, a new bacteriocin from Pediococcus acidilactici with a broad inhibitory spectrum

Lactic acid bacteria were isolated from Spanish dry-fermented sausages and screened for bacteriocin production. About 10% of the isolates produced antimicrobial substances when grown on solid media, but only 2% produced detectable activity in liquid media. Strain L50, identified as Pediococcus acidilactici, showed the strongest inhibitory activity and was active against members of all of the gram-positive genera tested. The strain produced a heat-stable bacteriocin when grown at 8 to 32 degrees C but not at 45 degrees C. The bacteriocin was purified to homogeneity. Its mass was determined to be 5,250.11 +/- 0.30 by electrospray mass spectrometry. The N terminus of the bacteriocin was blocked for sequencing by Edman degradation, but a partial sequence of 42 amino acids was obtained after cleavage of the peptide by cyanogen bromide. The sequence showed no similarity to those of other bacteriocins. Pediocin L50 appears to contain modified amino acids but not lanthionine or methyl-lanthionine.

Primary hyperparathyroidism in patients who have received radiation therapy and in patients who have not received radiation therapy

BACKGROUND

Primary hyperparathyroidism (HPT) occurs more frequently in persons who have been exposed to low-dose therapeutic radiation. Little information is available concerning whether or not the clinical, metabolic, and pathologic manifestations, as well as outcome, differ in these patients when compared with patients with sporadic HPT.

STUDY DESIGN

Records from 438 unselected patients with primary HPT, who were treated from 1982 to 1993 were retrospectively analyzed. All patients prospectively received a standard questionnaire preoperatively and postoperatively concerning clinical manifestations and a history of radiation exposure. Forty-nine patients had a history of radiation exposure (rHPT), whereas 389 did not have sporadic HPT (sHPT).

RESULTS

There was no difference in gender (36 women and 13 men versus 289 women and 100 men) or age (mean of 52 +/- 12 versus 57 +/- 16 years) in patients with rHPT or sHPT. Fatigue, neuropsychiatric disorders, memory loss, nocturia, and polyurea were more common in patients with sHPT (p < 0.05), whereas pain in joints was more common in patients with rHPT (63 versus 52 percent; p < 0.001). Serum calcium levels were similar (11.1 +/- 0.8 versus 11.2 +/- 0.8 mg per dL), but serum parathyroid hormone levels were higher in rHPT (448 +/- 14 percent of upper limit of normal versus 371 +/- 12 percent upper limit of normal). The parathyroid pathology was similar in the two groups (single adenoma 74 versus 72 percent, hyperplasia 14 versus 16 percent, and double adenoma 12 versus 12 percent in rHPT versus sHPT, respectively). Thyroid pathology was more common in the rHPT group (multinodular goiter 27 versus 7 percent and papillary thyroid carcinoma 14 versus 0.3 percent). Seven (1.8 percent) of patients not receiving radiation therapy treated by us had persistent HPT, but no patients receiving or not receiving radiation therapy had recurrent HPT during the follow-up period (six years).

CONCLUSIONS

Patients who have HPT after radiation treatment have more thyroid neoplasms but are otherwise quite similar to other patients with primary hyperparathyroidism.

VACOP-B chemotherapy for high grade non-Hodgkin's lymphoma in pregnancy

A patient presenting with high grade non-Hodgkin's lymphoma in the second trimester of pregnancy was treated with combination chemotherapy, with successful outcome for both mother and foetus.

Combined chemotherapy and radiotherapy in diffuse large cell immunoblastic lymphoma: a phase II study of CHOP/bleomycin/methotrexate alternating with ifosfamide/methotrexate/etoposide

The clinical outcome of 23 patients with high grade diffuse large cell immunoblastic lymphoma (Working Formulation, category H) treated by an intensive shortened schedule regimen of chemotherapy is described. Alternating cycles of cyclophosphamide, doxorubicin, vincristine, bleomycin and prednisolone, and ifosfamide, etoposide and methotrexate were given over an 18-week (range 16.0-20.8) period. External beam radiotherapy was administered as consolidation therapy to sites of original bulky disease in 17 patients. Treatment was well tolerated, though there were two toxic deaths. A 90% response rate was obtained. Sixteen of 18 patients followed for a minimum of 36 months are alive and in complete remission, representing a disease free survival of 69.5%; two further patients are alive following autologous bone marrow transplant. The 3-year disease free survival was 73% (+/- 9%) and the overall 3-year survival 78% (+/- 9%).

Characterization and molecular basis of heterogeneity of the African swine fever virus envelope protein p54

It has been reported that the propagation of African swine fever virus (ASFV) in cell culture generates viral subpopulations differing in protein p54 (C. Alcaraz, A. Brun, F. Ruiz-Gonzalvo, and J. M. Escribano, Virus Res. 23:173-182, 1992). A recombinant bacteriophage expressing a 328-bp fragment of the p54 gene was selected in a lambda phage expression library of ASFV genomic fragments by immunoscreening with antibodies against p54 protein. The sequence of this recombinant phage allowed the location of the p54 gene in the EcoRI E fragment of the ASFV genome. Nucleotide sequence obtained from this fragment revealed an open reading frame encoding a protein of 183 amino acids with a calculated molecular weight of 19,861. This protein contains a transmembrane domain and a Gly-Gly-X motif, a recognition sequence for protein processing of several ASFV structural proteins. In addition, two direct tandem repetitions were also found within this open reading frame. Further characterization of the transcription and gene product revealed that the p54 gene is translated from a late mRNA and the protein is incorporated to the external membrane of the virus particle. A comparison of the nucleotide sequence of the p54 gene carried by two virulent ASFV strains (E70 and E75) with that obtained from virus Ba71V showed 100% similarity. However, when p54 genes from viral clones generated by cell culture passage and coding for p54 proteins with different electrophoretic mobility were sequenced, they showed changes in the number of copies of a 12-nucleotide sequence repeat. These changes produce alterations in the number of copies of the amino acid sequence Pro-Ala-Ala-Ala present in p54, resulting in stepwise modifications in the molecular weight of the protein. These duplications and deletions of a tandem repeat sequence array within a protein coding region constitute a novel mechanism of genetic diversification in ASFV.

Multigene families in African swine fever virus: family 505

Sequencing of restriction fragment EcoRI A-SalI C of African swine fever virus has revealed the existence of a multigene family, designated family 505 because of the average number of amino acids in the proteins, composed of seven homologous and tandemly arranged genes. All the genes of family 505 are expressed during infection. Primer extension analysis showed that transcription is initiated a short distance (3 to 62 nucleotides) from the start codon of the corresponding open reading frame. The proteins of family 505 showed similarity to those of family 360 from African swine fever virus. In particular, a striking conservation of three regions at the amino terminus of the polypeptides was observed.

Effect of pentoxifylline on the inhibition of surfactant synthesis induced by TNF-alpha in human type II pneumocytes

Tumor necrosis factor alpha (TNF-alpha) seems to play an important role in the pathogenesis of the adult respiratory distress syndrome (ARDS). This study was designed to determine the effect of TNF-alpha and pentoxifylline (PTXF) on surfactant synthesis by isolated human type II pneumocytes. In order to isolate the pneumocytes, lungs obtained from both previously healthy multiple organ donors (n = 11) and patients who underwent surgical excision for lung cancer (n = 8) were used. Surfactant synthesis was measured by the incorporation of labeled glucose into the two most important phospholipid components of surfactant: phosphatidylcholine (PC) and phosphatidylglycerol (PGL). The pneumocytes of the donor group showed a greater degree of PC synthesis than those from the cancer group (3.44 +/- 0.19 versus 2.15 +/- 01.5 pmol/micrograms protein, p < 0.001). The synthesis of PC by pneumocytes in both the donor (1.13 +/- 0.19 versus 3.44 +/- 0.19 pmol/micrograms protein, p < 0.01) and cancer (0.99 +/- 0.11 versus 2.15 +/- 0.15 pmol/micrograms protein, p < 0.01) groups was decreased by TNF-alpha (100 ng/ml). This effect was blocked by PTXF (100 micrograms/ml), a substance that also increased PC production in the control-group pneumocytes from cancer patients, the final PC levels being similar to those of the donors in the absence of TNF-alpha. These results suggest that one of the mechanisms of TNF-alpha participation in the pathophysiology of ARDS is inhibition of surfactant synthesis, and support the hypothesis of in vivo production of TNF-alpha in lung-cancer patients, with subsequent chronic exposure of the lung epithelial cells to this cytokine.(ABSTRACT TRUNCATED AT 250 WORDS)

T-cell receptor gene rearrangements in lymphoid and non-lymphoid leukaemias

Rearrangements of delta-, tau-, and beta- T-cell receptor (TcR) chain genes were analysed in 64 haematologic malignancies comprising T- and B-lineage acute lymphoblastic leukaemias (ALL), B-chronic lymphocytic leukaemias (CLL), acute myeloid leukaemias (AML) and acute undifferentiated leukaemias AUL). The TcR genes were rearranged in 5/6 T-ALL. In non-T-leukaemias the frequency of TcR gene rearrangements was higher in B-lineage ALL (8/11), although they were all detected in B-CLL (5/29), AML (1/16) and AUL (2/4). Immunoglobulin (Ig) gene rearrangements were observed in 1/6 T-ALL and 2/14 AML. The analysis of these gene configurations has a diagnostic application since it allows the definition of the clonality of malignant proliferation and although they are not lineage specific such configurations represent a further parameter to evaluate, together with the immunophenotype and morphology, in the assignment or exclusion of the differentiation lineage of the haematologic malignancies.

Elevated CA125 levels in association with Ki-1 anaplastic lymphoma

CA125 is a tumour marker usually associated with epithelial ovarian malignancy. A case history is reported of a patient with Ki-1 anaplastic large cell lymphoma associated with grossly elevated CA125 levels which reflected the clinical course of the disease. Expression of this tumour marker by lymphoma has not been previously described.

Rearrangement of the N-myc oncogene in acute leukemias: a case report

Rearrangements of the N-myc oncogene have not been described in the literature. The authors present a case of ANLL with the N-myc gene rearranged out of 16 ANLLs and 11 ALLs. While the proportion of the blast cells in the case reported was 85%, the rearranged gene gave a hybridization band which was less intense than that of the germline band, making it probable that this gene rearrangement is present in a leukemia subclone. The c-myc oncogene as well as Ig and TcR genes were in germline configurations. The presence of the rearranged N-myc in the reported case could imply an alternative mechanism of mutation of this oncogene in the pathogenesis of hematological malignancies.

Bioequivalence study of nalidixic acid tablets: in vitro-in vivo correlation

The USP dissolution test was used to select seven products with a wide range of dissolution characteristics for in vivo examination. The bioequivalence of seven (500 mg) products was evaluated in two crossover urinary excretion experiments. In each study three products were compared with the innovator product (Negram-Winthrop-Breon) in 12 subjects according to a 4 x 4 latin square design. Significantly different, lower bioavailability was observed in two products in relation to that of the innovator product. Linear in vitro-in vivo correlations were found between the cumulative amount excreted at 24 h and the log of the amount dissolved at 30 min and between log of the cumulative amount excreted up to 24 h and the log of the amount dissolved at 45 min.

Localization of metallothionein in breast carcinomas. An immunohistochemical study

Metallothionein (MT) is a cysteine-rich, low molecular weight protein that binds zinc, copper, and cadmium. It is present in a number of normal cells including hepatocytes particularly during fetal and early postnatal life. It has been suggested that developmental profile of MT is similar to other oncofetal gene products and hence, it could be used as a marker for aggressive tumour behaviour. In order to test that hypothesis, we used a monoclonal antibody to MT and immunohistochemically evaluated formalin-fixed, paraffin-embedded tissues from 79 breast carcinomas. In non-neoplastic breast tissue, a strong nuclear and cytoplasmic staining was observed in myoepithelial cells. Positive staining for MT was present in 35 (44%) of breast carcinomas. In most positive cases, nuclear, or both nuclear and cytoplasmic staining was seen. All positive tumours were invasive ductal carcinomas, including a medullary and a metaplastic carcinoma. None of the mucinous, lobular, or intraductal papillary carcinomas reacted for MT. A statistically significant association was found between MT immunostaining and histological grade (P < 0.01) as well as with nuclear grade (P < 0.01). We also observed an inverse relationship between MT staining and oestrogen receptor content of tumours (P < 0.01). Similarly, a statistically significant association was found between moderate and strong MT immunostaining and decreased overall survival and shorter disease-free survival (P < 0.01). MT immunostaining was also predictive of a worse prognosis in the subgroup of lymph node negative (P < 0.001) and oestrogen receptor negative patients (P < 0.01). No statistically significant association was found between MT staining and size of tumour or the presence of lymph node metastasis. We conclude that MT staining may be a useful marker of less differentiated and more aggressive carcinomas of the breast.

[Multiple endocrine neoplasia II A syndrome: relationship between age of the patient, levels of basal calcitonin and size of the thyroid tumor]

This paper presents our experience in four families having the multiple endocrine neoplasia (MEN) II-A syndrome, with a total of 19 affected patients. All had medullary thyroid carcinoma (MTC), 6 also had pheochromocytoma (PH) and 3 had hyperparathyroidism. The screening of the members of the families to measure basal and pentagastrin response calcitonin (CT) serum levels allowed an early diagnosis of medullary thyroid carcinoma, when lesions were only 1 mm in diameter. Measurement of vanillymandelic acid, catecholamines and metanephrines in 24-hour urine collections allowed the diagnosis of pheochromocytoma in patients, some of whom were asymptomatic. A clear relationship was found between the age of the patients, the basal serum calcitonin level and size of the MTC.

The treatment of periocular basal cell carcinomas by radiotherapy

Experience in the treatment of periocular basal cell carcinoma is described. Excellent local control rates and minimal morbidity have been achieved in a series of 128 tumours occurring in 127 patients with a minimum 3 year follow-up.

A fully automated method for mononuclear bone marrow cell concentration

We describe our experience in processing 40 bone marrow aspirates harvested for autotransplantation from patients with several hematological diseases using the CS-3000 blood cell separator. The bone marrow of the first 30 patients was processed by a semiautomated method, and a fully automated procedure was used for the remaining 10 cases. Both procedures were developed in our laboratory and yielded a similar average mononuclear cell recovery of 87.78% and 86.98%, respectively, and similar nucleated cell recovery (27.39% and 27.11%). The cloning efficiency of hematopoietic progenitor cells, measured as the total CFU-GM colony recovery in the in vitro cultures, did not differ between processed and recovered mononuclear cells. On the other hand, all the patients with transplants showed complete hematologic recovery, and the time to engraftment was similar to that described for other procedures. The automated procedure resulted in an average red cell removal of 97.81%, similar to the semiautomated procedure (94.19%), though with a narrower range (96.31-98.6% vs. 80.34-98.34%). The time taken to process a similar amount of bone marrow cell suspension was very different for each method: 1 hour for the fully automated vs. 2 1/2 hours for the semiautomated method to process 1,000 ml. Furthermore, the semiautomated procedure required the addition of homologous or irradiated plasma in a laminar air flow chamber, while the automated method is performed in a closed sterile system. We conclude that our procedure using the CS-3000 processor is an efficient method for fully automated large-scale processing of human bone marrow cells.

Genes homologous to ubiquitin-conjugating proteins and eukaryotic transcription factor SII in African swine fever virus

The nucleotide sequence of the 6004-bp EcoRI I fragment of African swine fever virus DNA has been determined. Translation of the sequence revealed eight closely spaced open reading frames (ORFs), three of them reading rightward and five leftward. Northern blot hybridization analysis indicated that ORFs I73R and I78R were transcribed early in infection, whereas ORFs I177L, I196L, and I329L were expressed at late times. Transcripts for ORFs I215L, I226R, and I243L were detected at low levels in early RNA and at higher levels in late RNA. The intergenic regions between genes I73R/I329L and I78R/I215L were characterized by the presence of direct repeats in tandem. Direct repetitions were also found within ORF I196L. The protein encoded by ORF I329L contained a putative cleavable signal peptide and an internal transmembrane domain, and that encoded by ORF I177L had an amino-terminal hydrophobic region with the characteristics of a "start-stop" sequence. ORF I243L encoded a protein similar to the eukaryotic elongation factor SII. The protein encoded by ORF I215L was homologous to the family of ubiquitin-conjugating proteins.

Detection of four new TaqI alleles with probe St14-1

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Effect of oxidants on proteases of the fibrinolytic system: possible role for methionine residues in the interaction between tissue type plasminogen activator and fibrin

Evidence has recently been presented that activated macrophages (M phi) express both urinary (u-PA) and tissue type (t-PA) plasminogen activator. Major cell products of M phi and polymorphonuclear neutrophils (PMN) are reactive oxidants of the HOCl/chloramine type. Since PMN and M phi are involved in inflammatory and fibrinolytic processes, we were interested in the interaction of u-PA, t-PA, and plasmin with oxidants of the leukocyte type. The enzymes were treated with chloramine-T, which at pH 8.5 is a selective oxidant for methionine residues. Oxidation by chloramine-T of t-PA abolishes about 40% of both stimulation susceptibility of t-PA by fibrinogen degradation products (FDP) and affinity of t-PA to FDP. However, the plasminogenolytic and amidolytic activity of unstimulated t-PA as well as the plasminogenolytic activity of u-PA and the amidolytic activity of plasmin are not impaired. Identification of the amino acid residues in the t-PA responsible for the interaction with fibrin might be of great importance in order to understand the mechanism of the clot- selectivity of t-PA. The present study gives evidence that fibrin specificity of t-PA partly depends on chloramine oxidizable amino acids, presumably methionine residues. Hence, experimental data on the interaction between t-PA and fibrin, using oxidized and labelled t-PA should be interpreted with caution. It may be suggested that oxidants of the leukocyte type might regulate t-PA activity and selectivity for fibrin.

Single chain-urokinase binds to oxidized fibrin(ogen) derivatives

Single chain- urokinase (scu-PA), in contrast to two chain urokinase, is a physiological plasminogen activator of fibrin selectivity. The mechanism of selective fibrinolysis of scu- PA has not been clarified up to now. This study has shown that fibrin selectivity might involve oxidative processes. Binding studies with immobilized oxidized fibrinogen degradation products (FDP) demonstrated higher affinity of scu-PA to oxidized than to unmodified FDP. The fibrin(ogen) domain responsible for this oxidant mediated increase of scu-PA affinity is localized in the D-subunit of fibrin(ogen). Thus, experimental data upon the interaction of scu-PA with fibrin(ogen) using oxidized and I- labelled fibrin(ogen) might be interpreted with caution: the oxidized product may behave in a distinct manner than the unoxidized, native, one. Activated leukocytes release large amounts of scu-PA and of oxidants of the chloramine type. The oxidants could contribute significantly to fibrinolysis and proteolysis in areas of inflammation, preparing fibrin for its specific degradation. The present data support the concept of an involvement of oxidative processes in the fibrinolytic pathway.

Concentrations of cefmetazole in plasma and tissue resulting from peri-incisional administration before appendectomy

The levels of cefmetazole in plasma and tissue were determined after injection of a dose of 30 mg/kg into the zone of the wound of each of 15 patients undergoing appendectomy. The mean plasma levels of cefmetazole at the start and end of surgery (8.9 +/- 2.4 and 31.7 +/- 6.4 min after dosage) were 21.1 and 59.0 micrograms/ml, respectively; concentrations of the drug were 14.6 and 4,486.9 micrograms/g in skin, 9,165.0 and 1,756.4 micrograms/g in subcutaneous tissue, and 8,669.6 and 2,022.9 micrograms/g in muscle.

Escape of Hydrogen from Venus

Recombination of O(2)(+) represents a source of fast oxygen atoms in Venus' exosphere, and subsequent collisions of oxygen atoms with hydrogen atoms lead to escape of about 10(7) hydrogen atoms per square centimeter per second. Escape of deuterium atoms is negligible, and the ratio of deuterium to hydrogen should increase with time. It is suggested that the mass-2 ion observed by Pioneer Venus is D(+), which implies a ratio of deuterium to hydrogen in the contemporary atmosphere of about 10(-2), an initial ratio of 5 x 10(-5) and an original H(2)O abundance not less than 800 grams per square centimeter.

Differential effects produced by an anticholinergic on the neuroleptic inhibition of motor behaviour and self-stimulation of the prefrontal cortex in the rat

A specific dopamine receptor blocker, spiroperidol (0.016, 0.032, 0.064 and 0.128 mg/kg) alone or in combined treatment with the centrally acting anticholinergic, dexetimide (0.5, 1.0 mg/kg) was given intraperitoneally to rats pressing a lever for brain self-stimulation through electrodes implanted in the medial prefrontal cortex. The same treatment was also given to rats in which the spontaneous motor behaviour was measured. Spiroperidol produced a dose-related inhibtion of both self-stimulation and spontaneous motor activity. Dexetimide, given to spiroperidol treated rats, was able to antagonize the motor impairment produced by spiroperidol, but prefrontal cortex self-stimulation remained decreased. These data support the suggested role for dopamine in self-stimulation of the prefrontal cortex in the rat.