Intralesional interferon-alpha and zidovudine in epidemic Kaposi's sarcoma

BACKGROUND

Kaposi's sarcoma (KS) is the most common neoplasm in patients with acquired immunodeficiency syndrome (AIDS). To date, no therapy has proved to be consistently effective.

OBJECTIVE

The purpose of this study was to evaluate the efficacy of intralesional interferon-alpha in patients with epidemic KS who were taking zidovudine.

METHODS

Up to five lesions in each of 14 patients entered into the study were injected with 1 million U of interferon-alpha three times weekly for 6 weeks. Sterile water was used as a placebo control. The median zidovudine dose was 500 mg/day. The median CD4 count was 23/microliters.

RESULTS

Of 14 patients evaluated, 13 of 14 (93%) showed a clinical complete response (CR) or partial response (PR) to therapy. Of 54 lesions injected, 41 (76%) showed a CR and 5 (9%) showed a PR, which resulted in an overall response rate of 85%.

CONCLUSION

Intralesional interferon-alpha produced a high response rate in injected lesions of KS, but it failed to demonstrate superior efficacy over the placebo.

The utility of color flow Doppler examination in penetrating extremity arterial trauma

Recent reports from our institution have demonstrated the safety of nonoperative management of minimal arterial injuries. The purpose of this pilot study was to evaluate whether color flow Doppler (CFD) examination could detect minimal arterial injuries caused by penetrating extremity trauma. Twelve patients with minimal arterial injuries identified by arteriography were treated nonoperatively. Each also underwent color flow examination. Seven of 12 arteriographic abnormalities were detected by color flow examination. Two intimal injuries (brachial artery, superficial femoral artery (SFA)), one small (1 mm) pseudoaneurysm (popliteal artery), and two minor vessel occlusions (interosseous artery, branch off SFA) were not detected. These preliminary data suggest that color flow scans may be less sensitive than arteriography in the detection of clinically insignificant lesions such as small intimal defects or small vessel occlusions. Despite this, CFD examination was successful in detecting more significant lesions such as pseudoaneurysms, arteriovenous fistulae, and major vessel occlusions. This is relevant since these lesions may require immediate intervention. These findings suggest the possibility that color Doppler sonography may be able to sequentially monitor these lesions to determine if they resolve or progress. If progression is documented they may require surgical correction. Further prospective studies must be performed to assess whether color flow Doppler examination can supplant arteriography in patients at low or intermediate risk for arterial injury following penetrating arterial trauma.

Pulmonary migration of coils inserted for treatment of erectile dysfunction caused by venous leakage

Embolization of penile veins by coils and/or detachable balloons has been reported as a possible effective form of treatment of venogenic erectile dysfunction. The major appeal for this avenue of therapy in these patients is the reported low morbidity and negligible rate of complications compared to an open operation. We describe a case of asymptomatic pulmonary migration of a coil placed for venous leakage in a patient in whom the procedure was conducted through the femoral vein rather than the deep dorsal vein. We conclude that patients undergoing coil embolization for venous leakage should be appraised of the potential for coil migration.

Lidocaine prophylaxis in coronary revascularization patients: a randomized, prospective trial

Life-threatening ventricular ectopy can occur after cardiac operations. The actual incidence of ventricular ectopy and the ability to prevent it by the routine prophylactic use of lidocaine hydrochloride have not been established. We performed a double-blind, randomized, prospective trial involving 109 patients undergoing elective coronary artery revascularization. Patients received either lidocaine (n = 54) or a placebo (n = 55) after separation from bypass. A Holter monitor was affixed to each patient for subsequent review, and bedside intensive-care monitors with alarms were used for "real-time" surveillance. The code was broken when potentially malignant ventricular ectopy or side effects attributable to the study drug were noted. Three lidocaine patients and 2 placebo patients were dropped from the study because of hemodynamic instability or bleeding. Of the remaining 104 patients, the code was broken in 12 (24%) of the 51 in the lidocaine group (9 for ectopy and 3 for mental status changes) and 10 (19%) of the 53 in the placebo group (all for ectopy) (p = not significant). Twenty-four-hour Holter monitor evaluation demonstrated occasional ventricular ectopy in all patients and nonsustained ventricular tachycardia in 28% in the lidocaine group and 48% in the placebo group (p = not significant). The mean number of runs of ventricular tachycardia per patient was 0.53 in the lidocaine group and 1.6 in the placebo group (p = 0.035). There were no significant differences in terms of other ventricular ectopy, morbidity, or mortality. No ventricular fibrillation occurred in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of inhibitors of gastric secretion on polarization of gastric potential by voltage clamping

Voltage clamping across the frog gastric mucosa, nutrient positive to secretory, results in an increase in the open-circuit potential difference (OCPD). The increase in OCPD, or polarization, induced by voltage clamping could be caused by a redistribution of ions across the plasma membrane or by a polarization of pump electromotive forces, such as the Na(+)-K(+)-adenosinetriphosphatase (ATPase) located in the nutrient (serosal) membrane or the proton pump located in the secretory (luminal) membrane. The polarization induced by voltage clamping was not affected by removing Cl- and Na+ or by increasing the K+ concentration to 79 mM but was markedly reduced by placing in the nutrient solution 10(-3) M famotidine or 10(-4) M omeprazole. These data suggest that there is a strong contribution of the proton pump to the polarization induced by voltage clamping with some contribution of ion redistribution and/or the Na(+)-K(+)-ATPase. The data support the electrogenicity of the proton pump.

Prostate-specific antigen as a measure of disease outcome in metastatic hormone-refractory prostate cancer

PURPOSE

To evaluate the prognostic significance of pretreatment parameters and posttherapy declines in prostate-specific antigen (PSA) in relation to the survival of patients with hormone-refractory prostate cancer.

PATIENTS AND METHODS

One hundred ten assessable patients treated on seven sequential protocols at Memorial Sloan-Kettering Cancer Center (MSKCC) for hormone-refractory prostate cancer were evaluated for 29 different pretherapy and posttherapy parameters, including a posttherapy decline in PSA of 50% and 80% from baseline.

RESULTS

In the univariate analysis, initial Karnofsky performance status (KPS) > or = 80% was associated with a favorable outcome (P = .005), while age, extent of disease on bone scan, and individual sites of metastatic disease were not significant. No difference in survival was observed between patients with measurable or assessable (bone only) disease. Initial hemoglobin (HGB; P = .0012), alkaline phosphatase (ALK; P = .0015), and lactate dehydrogenase (LDH; P = .0002) levels were significant discriminators, while the initial PSA was not. Using a landmark analysis, a significantly longer median survival rate was observed for patients with a > or = 50% decline in PSA (median not reached) versus patients with a less than 50% decline in PSA (median, 8.6 months; P = .0001). Multivariate analysis using the Cox proportional hazards model showed that a > or = 50% decline in PSA (P = .0004) and the natural log of LDH (P = .0001) were the two most significant variables predicting survival. The model was confirmed on an independent data set from the Norwegian Radium Hospital (NRH) in Oslo, Norway.

CONCLUSION

The results suggest that posttherapy PSA declines can be used as a surrogate end point to evaluate new agents in hormone-refractory prostate cancer. The criteria for response need prospective validation in phase III trials.

Axonal regeneration is associated with glial migration: comparison between the injured optic nerves of fish and rats

The central nervous systems of mammals and fish differ significantly in their ability to regenerate. Central nervous system axons in the fish readily regenerate after injury, while in mammals they begin to elongate but their growth is aborted at the site of injury, an area previously shown to contain no glial cells. In the present study we compared the ability of glial cells to migrate and thus to repopulate the injured area in fish and rats, and used light and electron microscopy in an attempt to correlate such migration with the ability of axons to traverse this area. One week after the optic nerve was crushed, both axonal and glial responses to injury were similar in fish and rat. In both species glial cells were absent in the injured area (indicated by the disappearance of glial fibrillary acidic protein and vimentin immunoreactive cells from the site of injury in rat and fish, respectively), while at the same time axonal growth, indicated by expression of the growth-associated protein GAP-43, was restricted to the proximal part of the nerve. In fish, 2 weeks after the crush, GAP-43 staining (i.e., growing axons) was seen at the site of injury, in association with migrating vimentin-positive glial cells. One week later the site of injury in the fish optic nerve was repopulated by vimentin-positive glial cells, and GAP-43-positive axons had already traversed the site of injury and reached the distal part of the nerve.(ABSTRACT TRUNCATED AT 250 WORDS)

Cavernous artery obstruction following blunt trauma to the penis

Erectile dysfunction following blunt trauma to the erect penis usually is associated with an injury to the tunica albuginea of the corpus cavernosum. We recently identified 2 patients with erectile dysfunction following bending of the penis during coitus whose only abnormality after a complete evaluation, including penile angiography, was a deep cavernous artery injury. We suggest that during examination of patients with erectile dysfunction following blunt injury to the erect penis a complete vascular evaluation, including penile angiography, may be necessary to detect an unrecognized injury to the deep cavernous arteries.

cDNA clones from fish optic nerve

1. The present review describes the results of a cloning that was successfully employed in the study of optic nerve regeneration in fish. 2. Three intermediate filaments (IFs) expressed by the glial fish optic nerve were cloned. 3. By the use of this approach it was possible to resolve the controversial question of whether glial fibrillary acidic protein (GFAP) is expressed in the fish optic nerve. 4. Moreover, as a result of the information that emerged from the cloning, it was possible to raise well-characterized monospecific antibodies and successfully exploit them in order to determine glial cell maturation, lineage and plasticity, monitor the glial cell response to injury of the fish optic nerve, and compare it to that of a non-regenerative system.

New light on nerve regeneration in the mammalian nervous system

It has long been known that while damaged nerves of the peripheral nervous system in mammals are able to regenerate, this does not occur in the central nervous system. Recent studies have shown that a chemical factor present in regenerating fish optic nerves facilitates regeneration of nerve axons in rodents. Further research encourages the hope that this may ultimately lead to the successful treatment of nerve damage in humans.

Rehabilitation of patients with Hallervorden-Spatz syndrome

Hallervorden-Spatz Syndrome is an infrequently occurring disorder involving pigmentary degeneration of the globus pallidus, red nucleus, and substantia nigra. Resultant corticospinal and extrapyramidal signs and symptoms predominate early in the course of the disease, with concomitant intellectual deterioration paralleling the developing muscular disorder. To date, there have been no reports in the literature of rehabilitative intervention in patients with this disabling pathology. We report the case of a 43-year-old man whose illness spanned 20 years. He was referred for rehabilitation after a precipitous decline in function over the course of six months. An interdisciplinary team approach was implemented and various medical strategies were used, including the initiation of carbidopa-levodopa. An improvement in functional skills, communication, and the ability to use cognitive strategies was observed. We conclude that a multidisciplinary team approach and in selected cases, the use of carbidopa-levodopa are valid methods for the rehabilitation of patients with Hallervorden-Spatz Syndrome.

Immune-mediated thrombocytopenia secondary to suramin

The authors report a case of suramin-induced immune-mediated thrombocytopenia occurring in a patient on a Phase II protocol for treatment of metastatic renal cell carcinoma. On withdrawal of suramin, the acute and severe thrombocytopenia did not respond initially to plasmapheresis; subsequently, it resolved promptly and dramatically during the administration of intravenous gamma globulin, also coinciding with a decline in suramin blood levels. Results of immunologic and coagulation studies are reported and clinical implications discussed.

Diabetes mellitus in cystic fibrosis: genetic and immunological markers

Family history, as well as genetic and immunological markers of diabetes mellitus, were studied in cystic fibrosis (CF) patients with and without diabetes mellitus. Positive family history of diabetes mellitus in first-degree relatives was found in only 6 of 210 (3%) CF patients, with no difference between non-diabetic and diabetic patients. The frequency distributions of the HLA types DR3, DR4 and DR3/4, which normally confer susceptibility to insulin-dependent diabetes mellitus and of HLA-DR2, which normally confers resistance to insulin-dependent diabetes mellitus, were not different in non-diabetic CF patients, diabetic CF patients and normal subjects. The genotypic frequencies of tumor necrosis factor-beta and of heat shock protein 70, located within the HLA region on chromosome 6, in CF patients with diabetes were not different from those in patients with insulin-dependent diabetes mellitus, while non-diabetic CF patients and normal subjects shared other patterns. The frequencies of the interleukin-1 beta alleles, located on chromosome 2, were not different in non-diabetic and diabetic CF patients, insulin-dependent diabetic patients and normal subjects. Islet cell cytoplasmic antibodies, measured before, at and after the diagnosis of diabetes in 33 diabetic CF patients and in 32 matched non-diabetic CF patients, were detected in only 2 of 236 (0.8%) serum samples: in a pre-diabetic patient and in a non-diabetic control patient. Birth weights were not different in diabetic and non-diabetic CF patients, arguing against the importance of the intrauterine environment as a determinant in the transmission of diabetes mellitus in CF patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Benign schwannoma of the liver

We report a case of benign schwannoma presenting as a rapidly enlarging liver mass in a 67-year-old man and review the literature on nerve sheath tumors of the hepatobiliary system. Such tumors, which may occur in patients with and without neurofibromatosis, are very uncommon in the liver. The case reported herein, to our knowledge, is the first well-documented benign schwannoma of the liver occurring in a patient without neurofibromatosis.

Biliary cystadenocarcinoma arising in a liver with fibropolycystic disease

Intrahepatic cholangiocarcinoma associated with fibropolycystic disease of the liver and biliary cystadenocarcinoma are rare tumors that are considered distinct entities. We present a case of a malignant tumor with features of hepatic cystadenocarcinoma arising in a background of fibropolycystic disease.

[Cystic fibrosis. From clinical diagnosis to a mutation specific test]

By use of classical linkage analysis and modern DNA technology the gene for cystic fibrosis (CF) was mapped to the long arm of chromosome 7 in 1985. Cloning of the entire gene (CFTR = Cystic Fibrosis Transmembrane Conductance Regulator) was published in 1989. The most common mutation (delta F508) is a three base pair deletion in exon 10, which results in a protein without the amino acid phenylalanine at position 508. The frequency of this mutation varies among different populations, ranging from 45% in the Mediterranean countries to a height in Denmark of 88% of the disease genes. More than 150 different mutations have been identified so far, most of which are very rare. CF is one of the most common severe inherited diseases, but the cloning of the gene and identification of the mutations give great possibilities for prevention permitting both carrier and prenatal diagnosis. The function of the CFTR protein is still not fully known. However, the amino acid sequence of the protein is highly homologous to those of several membrane proteins. In vitro transfection experiments indicate that it constitutes a chloride channel. Recently in vivo experiments involving somatic gene therapy on rats have been successful.

Growth factor dependency and gene expression in preneoplastic mouse mammary epithelial cells

The TM preneoplastic mammary outgrowth lines were established in vivo from mammary epithelial cell lines and have been characterized with respect to their tumorigenic, morphological, and functional properties. The TM outgrowth lines were then established as in vitro cell lines. A comparison of the growth factor dependencies of the TM preneoplastic lines and their progenitor cell lines grown in monolayer cell culture indicated that the TM preneoplastic cell lines exhibited a decreased dependence on epidermal growth factor for growth in vitro. The exception to this result was the TM3 cell line which still exhibited a marked dependence on epidermal growth factor for growth. An examination of several genes for mRNA levels indicated that the expression of c-neu, c-H-ras, c-myc, and retinoblastoma was not elevated in those TM preneoplasias which exhibited a decreased dependence on epidermal growth factor. Additionally, there was no evidence that c-H-ras was activated in the preneoplastic outgrowths or tumors. In contrast, mouse mammary tumor virus long terminal repeat mRNA was increased in preneoplasias and tumors, whereas gelsolin mRNA was decreased in tumors but not in preneoplasias. The down-regulation of gelsolin mRNA is consistent with recent reports in human breast cancers. These results together with those reported in another paper (D. Medina et al., Cancer Res., 53: 663-667, 1993) indicate that the TM3 outgrowth line is a minimally deviated preneoplasia which does not share many of the molecular alterations exhibited in tumorigenic TM preneoplastic outgrowth lines. These data, along with other recent data, are interpreted in a hypothesis which views the three essential characteristics of the mammary preneoplastic state as independent and dissociable genetic alterations. Importantly, each of the three characteristics is independently isolated in one or more of the in vivo outgrowth populations. These outgrowth lines should allow identification of the nature and function of the molecular alterations associated with each stage of mammary preneoplasia.

Hepatitis C in liver allografts

Recurrent or intercurrent hepatitis C represents significant problems in patients with liver transplants and must be differentiated from hepatic allograft rejection and other conditions affecting allografts. Often, the currently available anti-hepatitis C virus (HCV) tests are not helpful in the differential diagnosis, because preexisting anti-HCV may persist after transplantation or its development may be delayed. We determined the presence of HCV RNA by the reverse double polymerase chain reaction in biopsy specimens of liver allografts from nine patients with acute or chronic hepatitis of uncertain origin and from three patients with cellular allograft rejection. The NS3 region sequences of HCV were detected in seven of nine liver allograft biopsy specimens 6 weeks to 20 months after transplantation. Hepatitis C virus RNA was not detected in two patients. One of these patients was anti-HCV positive, showing mild acute hepatitis 5 weeks after transplantation. Anti-HCV was present in three patients with detectable HCV RNA in the liver but was absent from four other patients with HCV RNA. These findings suggest that HCV is a major cause of acute and chronic hepatitis following liver transplantation, that detection of HCV RNA by polymerase chain reaction in the liver biopsy specimen represents a reliable method for the diagnosis of hepatitis C in liver allografts, and that in some patients HCV may be acquired during transplantation while in others it may represent a recurrent infection.

Morphological and functional properties of TM preneoplastic mammary outgrowths

The TM series of preneoplastic mammary outgrowth lines was derived from the transplantation of the FSK mammary cell lines into the cleared mammary fat pads of syngeneic female BALB/c mice. The tumor-producing capabilities of the 6 TM outgrowth lines varied from high (TM2, -4, -6) to low (TM9, -10) to nil (TM3). Outgrowth lines 2, 4, and 6 each segregated into sublines of high and low tumor potential. The majority of the outgrowth lines exhibited a moderate to dense alveolar hyperplasia typical of mouse mammary hyperplasias. The exceptions to this picture were lines TM2H and TM10 which exhibited a unique ductular morphology. The ductular morphology was not correlated with tumor potential of the outgrowth lines but was correlated with the expression of K6 and K14 keratins in luminal epithelial cells. In an examination of the growth and hormonal responsiveness properties of the TM outgrowth lines, the TM3 line stands as distinct from the other lines and from any other lines previously characterized in BALB/c mice. The TM3 line grew very slowly and failed to fill the fat pad by 12 months of age. At 12 months of age, the alveolar hyperplasia had regressed so that only bare ducts were present. The TM3 outgrowth was ovarian hormone dependent for growth and alveolar differentiation. TM3 outgrowth represents a minimally deviated mammary hyperplasia which has acquired the immortal phenotype but not the other phenotypic characteristics of mammary preneoplasias. This outgrowth line will be useful for examining the essential molecular changes important for the preneoplastic state, some of which are reported in an accompanying paper (D. Medina et al., Cancer Res., 53: 668-674, 1993).

[Psychiatric manifestations in Wilson's disease]

Wilson's disease is an inherited, autosomal recessive disease characterized by progressive hepatic and neurological symptoms. Clinical features usually start between the ages of 10 and 40. Psychiatric disturbances are present in almost all patients. In about a third of them psychiatric symptoms are present early in the disease and in almost 20% they precede hepatic and neurological dysfunction. In these cases the diagnosis of Wilson's disease is often difficult, as a result of which treatment is begun when the illness is already advanced. We report 3 patients with Wilson's disease in whom the psychiatric manifestations preceded neurological symptoms and necessitated admission for psychiatric treatment.

Identification of mutations in Danish choroideremia families

We have searched for mutations in the choroideremia gene (CHM) in patients from 12 Danish families in which CHM is segregating. Employing polymerase chain reaction (PCR), single strand conformation polymorphism (SSCP) analysis, and direct DNA sequencing, different mutations have been identified in 6 patients. All the mutations will interfere with the correct translation of the mRNA predicting a truncated protein or no gene product at all.