[Penis carcinoma in a young chimney sweep. Case report 200 years following the description of the first occupational disease]

We report on a 32-year-old patient who, following exposure to soot over a total of 78 weeks as a professional chimney sweep, developed squamous cell carcinoma of the penis. Since the epoch-making description of occupational cancer of the scrotum by Percivall Pott in 1775, soot-related cancer of the scrotum and penis has become anecdotal. As our patient presented with inguinal lymph node metastases, a wide circumcision was performed, followed by preoperative chemotherapy and bilaterial lymphadenectomy. The patient has been free of disease for over 9 years with no functional loss.

[Pheochromocytoma as dominant manifestation of v. Hippel-Lindau syndrome]

A diagnosis of von Hippel-Lindau syndrome was made in two families originating from the same part of the Black Forest but apparently unrelated. Nine affected persons (seven males and two females) had a total of 17 tumours: retinal angioma (4), haemangioblastoma of the CNS (1), and phaeochromocytoma (12). Three of the affected persons and eight of the tumours (six phaeochromocytomas, two retinal angiomas) were diagnosed by family screening. Phaeochromocytoma was diagnosed in eight persons; in four it was the only symptomatic lesion. After extensive diagnostic tests the phaeochromocytoma was the sole tumour in four. Despite severe symptoms the diagnosis of von Hippel-Lindau syndrome had not been made prior to the screening examinations because either the common aetiology of the tumour was not known or there was insufficient exchange of information between the two families.--It is recommended that in each case of phaeochromocytoma von Hippel-Lindau syndrome should be excluded so that lesions can be discovered early in other organs and in other affected family members. If the syndrome is present, annual examinations are indicated because of asynchronous and multi-focal tumour growth.

[Ultrasonic studies of craniocerebral injuries in infants]

This is a report on the sonographic diagnostic possibilities in 46 closed-head injured infants. Cerebral examination via the anterior fontanelle is completed by additional sections of the surface of the brain. The traumatic oedema is limited in most cases and - besides the increase in echogenicity - an increase of the arterial pulsation at the border of the oedema is seen in real-time scanning. The sonographic signs of the epidural and subdural haematomas are described and also the differentiation between both. Surgical treatment was necessary in three cases of subdural haematoma because of increasing ICP. Treatment of extradural and chronical subdural haematomas or effusions is discussed in connection with the sonographic follow-up. Alterations in symmetry and compression of the ventricular system is often caused by intracerebral haemorrhages and-or traumatic local oedema. Parenchymal cysts may occur after liquefaction of cerebral necrosis or clots. The advantage of the cerebral sonographic examination is the uncomplicated follow-up. In connection with the clinical state and with continuous registration of ICP, sonographic findings facilitate the decision if, where and when trepanation must be performed.

Value of ultrasound in the treatment of solitary kidneys in infancy and childhood

Every second patient with a solitary kidney suffers from renal disease. This accumulation of renal diseases of varying origin makes special care for these children necessary. The quality of diagnostic methods is decisive for the choice of therapy. The advantages of primary ultrasound diagnosis and sonographical function tests are described. Sonographical differentiation of disturbances of the urinary transport is possible by means of forced-diuresis ultrasonography, whereas a vesico-ureteral reflux can be detected by means of voiding sonocystography. The value of ultrasound for primary diagnosis, assessment of therapeutic course and postoperative long-term follow-up is discussed.

[Efficacy of recombinant interferon alpha-2 in 34 patients with hairy cell leukemia. Effect of splenectomy and dosage reduction results of therapy]

In a retrospective study of 34 patients with hairy cell leukemia treated with recombinant interferon-alpha 2, we have observed a hematological remission rate of 97%. The true complete remission rate based on bone marrow findings was 17%. Although complete remissions can be obtained only in a few cases, treatment with interferon is justified in cytopenic patients since long-standing clinically meaningful improvement of the peripheral blood values can be attained. If interferon is stopped in the remission phase, the blood values deteriorate in 40% of the patients within 5 months. In contrast, it appears that the remission can be maintained with intermittent administration of interferon weekly or even every other week. As compared to splenectomized patients, granulocyte recovery is delayed in nonsplenectomized patients. However, after several months of treatment there is no difference in peripheral blood values between splenectomized and non-splenectomized patients. In the light of the present results, primary splenectomy remains justified in a selected group of patients for whom the risk of surgery (due to low granulocytes and/or platelets) is low and for whom careful evaluation predicts a high potential for long-standing remission after splenectomy. In the other cases, initial interferon therapy seems justified.

[The significance of screening studies for the early detection of metastases in curatively operated breast carcinoma]

A retrospective analysis of 80 women with breast cancer operated on with curative intent showed that metastases developed within 8 years. The value of laboratory tests and radiological surveys for the early detection of metastases is considered. In fewer than 50% of the patients was the finding of a single abnormal laboratory result associated with tumor recurrence. However, when several findings were abnormal concomitantly this suggested tumor dissemination in about 90% of women. In 80% of the patients clinical symptoms were present at the time of tumor recurrence. In only 20% of the patients were metastases clinically silent. Since metastatic breast cancer cannot be cured by present treatment modalities, the relevance of detecting early recurrence is limited.

Prognostic significance of agar and liquid cultures in AML patients before treatment, early postinduction and in remission

In the present study, the growth and differentiation capacity of myeloid leukemic cells in agar and liquid cultures have been investigated in relation to their prognostic significance for treatment outcome and early detection of relapse. Prior to induction therapy, leukemic cells failed to differentiate and the colony or cluster number did not correlate with response to treatment. Seventeen to 42 days after induction, patients with BM cells producing greater than 10 colonies or greater than 30 clusters resp. had a high likelihood of achieving a complete remission. Cells from refractory patients had a significantly impaired differentiation capacity. During remission, a colony number greater than 50 was significantly associated with a high probability to remain in further remission for greater than 3 months. An impaired differentiation was significantly associated with the likelihood of relapsing within 3 months. In the light of these results, agar and liquid cultures appear to be useful for monitoring the effect of induction chemotherapy and detecting patients likely to relapse.

[Mycoplasma etiology of acute pancreatitis]

In a 10 year-old girl the clinical and laboratory findings led to the diagnosis of pancreatitis. At the same time an infection by mycoplasma pneumoniae was serologically stated. Since there could not be found another cause for pancreatitis, a relation between pancreatitis and infection by mycoplasms is very probable.

[Effectiveness and toxicity of high-dosage Ara-C. Clinical observations in 10 cases and review of the literature]

Ten patients with acute myeloid leukemia were treated with a high-dose ara-c regimen (3 g twice daily for 6 days). 5 patients (50%) achieved a complete remission lasting for a median duration of 5 months. These patients had all achieved a complete remission following standard treatment with ara-c. High-dose ara-c was ineffective in 2 patients resistant to standard ara-c protocols. The most important side effects of high-dose ara-c were conjunctivitis and cerebellar symptomatology. In one case a severe diffuse encephalopathy with cerebellar predominance set in at a remarkably late stage (45 days after starting treatment). Our results and those of other authors suggest that treatment with high-dose ara-c should be used with caution.

[Sonographic follow-up studies in purulent meningitis and its complications in infancy]

In 29 newborns and 18 infants ill with meningitis the following characteristic signs visible by sonographic examination of the brain mostly indicated complications: increase of the leptomeningeal echogenicity, increase of the periventricular echogenicity in ventriculitis, alterations of the configuration of the ventricles, typical echos in the CNS-fluid by increased cell and protein content, alterations of the Plexus chorioideus caused by inflammation, membranes in the enlarged ventricular system. In the first year of life the sonographic examination of the brain is ideal for early diagnosis of possible complications in meningitis to change the therapeutic management without any loss of time.

Limitations of the salmonella/mammalian microsome assay (Ames test) to determine occupational exposure to cytostatic drugs

Urine samples of nursing personnel working in medical oncology divisions of several Swiss hospitals were examined for mutagenic activity. Urine samples were concentrated 100 times following XAD-2 chromatography and mutagenicity was determined using the Salmonella/mammalian microsome assay (Ames test). Apart from the urine samples of patients treated with cytostatic drugs and urine samples of nurses who are cigarette smokers, no mutagenic activity could be found. Also following exposure to an increased and defined quantity of cytostatic drugs no mutagenicity could be recovered from the urine. Four different nurses worked with cyclophosphamide, methotrexate, 5-fluorouracil, adriamycin and cis-platinum for 3-4 hr without using any protection such as gloves, masks or a vertical laminar airflow hood. Aqueous extracts of filters, through which air was pumped during the whole experiment (a personal air-sampler was fixed near the face of the test persons), were non-mutagenic. Parallel to the mutagenicity test chemical analyses were also done. The methotrexate content was determined in serum samples and the aqueous filter extracts and urine samples were examined for cis-platinum. All chemical determinations were negative. With the aid of urine concentrates of a patient treated with sub-therapeutic doses of cyclophosphamide as well as with normal urine to which single small amounts of different cytostatics (adriamycin, cyclophosphamide, cis-platinum) were added, the detection limits for the corresponding cytostatic drugs were determined and found to be in the range of 2-10 mg for cyclophosphamide and approx. 10 micrograms for adriamycin. Cis-platinum was lost during the passage through the XAD-2 columns. With these results at hand the sensitivity of the hitherto preferably used method (Ames test) for the monitoring of exposure to cytostatic drugs must be seriously questioned.

[Possibilities of pre-, intra- and postoperative sonography in hydrocephalus]

Short-term repeat sonographic examinations of the brain were performed in 90 newborn and infants with ventricular dilatation. Changes in the ventricular configuration are pointers to the intracranial pressure. Measurement of the ventricular system must be performed in the same way as for estimating progressive ventricular dilatation. If a shunt is necessary, the ventricular tube can be positioned in the anterior horn of the lateral ventricle under ultrasound guidance. This will help to avoid complications which are due to a wrong position near the plexus or in a clot. Complications like overdrained ventricles, haemorrhages, shunts blocked in proximal or distal areas may be visible even before the appearance of clinical signs or symptoms. Comparative postoperative examinations allow an assessment of shunt function.

Leukemic samples characteristics associated with clonogenic growth

In this study, we attempted to delineate readily assessable characteristics from 100 leukemic samples associated with in-vitro growth. Successful growth defined as production of greater than 30 clusters and/or colonies per culture dish was obtained in 68% of samples. More than 10 colonies were found in 59% and greater than 30 colonies in 51% of cultures, respectively. Leukemic cells from patients previously treated with aggressive cytotoxic chemotherapy grew significantly better than cells from untreated patients, independently of the above definitions of cloning success. Cells from peripheral blood had a weak, albeit significant growth advantage over bone marrow cells (p = 0.032) when cluster growth was taken into account for growth success. When colony growth alone was used as criterium, no growth advantage was found. The morphological subtype and the proliferation kinetics prior to cell plating did not affect cloning success. A high labeling index had predictive value for subsequent growth, but only in bone marrow cells. By multivariate analysis, we found that treatment status was the most important factor correlated with in-vitro growth.

Hairy cell leukemia: an interferon deficient disease?

rIFN-alpha 2 is an effective substance in the treatment of HCL. Although the complete eradication of hairy cells from the bone marrow is rarely possible, a dramatic improvement of profound cytopenias can be obtained in most patients, 12 out of 13 in this study. The response can be seen after a median treatment duration of about 2 months and appears to be independent of the presence of the spleen. Once a stable improvement of the peripheral blood values is achieved, one dose of rIFN-alpha 2 every other week may be sufficient to maintain the cell counts. The mechanism(s) by which IFN acts remain unclear. We speculate, that HCL is an IFN deficient syndrome because monocytes which are the major source of IFN-alpha are severely depressed in this lymphoproliferative disorder. Following this hypothesis, the IFN therapy would be comparable to the substitution of insulin in diabetic patients.

[Diagnostic value of sonography in vesico-ureteral reflux in infancy and childhood]

The direct demonstration of reflux by filling of the urinary bladder using real time sonography is a new method avoiding radiation exposure. Since 1979 we use this technique (Miktions-Cysto-Sonographie, MCS) as routine procedure. In 117 cases with 163 radiologically diagnosed refluxes we could demonstrate, that refluxes of grad II or higher gave a positive sonogram. As a consequence it is proposed, that for children with urinary tract infections the first examinations should be the sonography of kidneys and the sonographic evaluation of reflux. In the cases of conservatively treated refluxes the check-up of the reflux is carried out only sonographically. The same is valid for the control after antireflux surgery. Thus radiological examinations are necessary only for sonographically suspicious findings. The urinary tract obstruction after antireflux operations is detected sonographically, too. In 99 cases of antireflux operations it could be shown, that the urinary flow came back to the normal state within 3 months post operation.

Effects of leukocyte interferon (E. coli) on human bone sarcoma growth in vitro and in the nude mouse

Effects of highly purified human leukocyte interferon (rIFN-alpha 2) on colony formation, DNA synthesis and proliferation in nude mice of tumor cells from eight bone sarcomas have been studied. rIFN-alpha 2 produced a dose-dependent inhibition of [3H]thymidine incorporation by sarcoma cells. Even at high doses (10(4) U/ml), however, [3H]thymidine uptake could not be completely blocked by rIFN-alpha 2. In a cloning assay three established sarcoma cell lines and five other sarcoma samples obtained after short-term in vitro culture were found to be sensitive to various degrees to rIFN-alpha 2, complete inhibition being seen only at 10(4) U/ml. Three sarcomas were sensitive in the nude mouse model. Scheduling experiments revealed that rIFN-alpha 2 produces a delay in tumor growth only when administered either before or shortly after tumor implantation. Therefore rIFN-alpha 2 appears to be most active when tumor size is small and growth not exponential, indicating that rIFN-alpha 2 may play a role in an adjuvant setting. Growth sarcomas strongly suppressed by rIFN-alpha 2 in the cloning assay was markedly inhibited in the nude mouse. One sarcoma which was only moderately sensitive in the cloning assay was resistant in the animal experiment, confirming the predictive value of the clonogenic assay. Although the present findings demonstrate strong antitumor activity of rIFN-alpha 2 against human bone sarcoma cells they should be interpreted with caution mainly because the high rIFN-alpha 2 levels used in the experiments cannot be maintained in patients over a prolonged period.

Hairy cell leukemia: kinetics and intercellular relationships of cells in leukemic colonies grown in a semisolid medium

We examined cellular relationships and cytokinetics of hairy cells in colonies formed in an in vitro cloning system. Cells in small colonies and at the periphery of larger ones were separated by wide, irregular intercellular spaces. Cells in the core of large colonies were elaborately intertwined by their cytoplasmic processes and so densely packed that their intercellularity was greatly reduced. Cell labeling with 3H-thymidine revealed indices ranging from less than 1% to 35%. The combination of autoradiography with a stain for tartrate-resistant acid phosphatase showed that the enzyme was not expressed by cells in S-phase. The cellular relationships of hairy cells in colonies grown in this system closely mimic those of their in vivo counterparts in the spleen and bone marrow.

[Is the use of adriamycin (doxorubicin) limited by its cardiotoxicity?]

Adriamycin (doxorubicin), one of the most active cytotoxic antineoplastic agents, can cause heart failure. This side effect is dose-dependent, the frequency of heart failure being 3% at a cumulative Adriamycin dose of 400 mg/m2 and 18% at 700 mg/m2. It is assumed that Adriamycin, or other anthracycline derivatives, are still active when the cardiotoxic level is reached. In this retrospective study of 171 patients with various metastatic malignant tumors, the total dose of Adriamycin given to the patients and the reasons for withholding the treatment have been analyzed. Overall, among the 171 patients treated by Adriamycin-containing combination chemotherapy, 54 objective remissions (31%) were observed. Remissions were more frequent in untreated patients (52%) than in previously treated patients (20%). In 36 of 54 patients the disease progressed before the cumulative cardiotoxic level was reached. Adriamycin could be discontinued in only 18 patients still in remission. 8 of 171 patients received more than 450 mg/m2 Adriamycin without cardiotoxic side effects being observed. Among the 171 patients, cardiotoxicity probably related to anthracyclines developed in 5 cases (3%), in all cases at a level below 450 mg/m2. These results suggest that in most cases Adriamycin becomes inactive before the dose-limiting cumulative cardiotoxic level is reached.

[Effect of interferon-alpha 2 (E. coli) in hairy cell leukemia]

Recombinant interferon-alpha 2 (E. coli) produced a clinically significant improvement in hemoglobin, granulocytes and platelets in 7 of 8 patients with hairy cell leukemia. Response to treatment was already noticeable in the fourth treatment week. In one case without improvement after 120 days, treatment was stopped. So far only one complete remission has been documented. Because of the remarkable improvement in the peripheral blood values, the induction of a complete remission may not be the ultimate goal of interferon treatment. The side effects of this subcutaneous low-dose treatment consisted mainly of mild flu-like symptoms of short duration. The results obtained with recombinant interferon-alpha 2 confirm the initial observation by Quesada et al. with partially purified leukocyte-interferon. In our experience, these results are superior to those obtained in similar conditions with chlorambucil.

Hairy cell leukemia. Ultrastructural and cytochemical evaluation of leukemic colonies grown in a semi-solid medium

We examined the fine structure and enzymatic activity of cells composing colonies grown from blood and/or spleen of eight patients with hairy cell leukemia. Mononuclear cells (MNC) were plated over an agar layer in a medium containing methylcellulose and leukocyte-conditioned medium. After 7-10 days incubation colonies were harvested for cytologic study. Colony cells possessed a euchromatic nucleus with an occasional nucleolus. Their cytoplasm contained a prominent Golgi region, numerous mitochondria and small vesicles, many short strands of rough endoplasmic reticulum (RER) and an infrequent phagosome. Well-developed ribosome-lamella complexes and what may have been their intermediate forms appeared in colony cells from three patients. Strong activity for tartrate-resistant acid phosphatase, localized in the RER, nuclear envelope and some Golgi vesicles, was evident in 50-95% of all colony cells. Our results indicate that a high proportion of MNC forming colonies in this culture system maintain the characteristic morphology and cytochemical activity of hairy cells.