The influence of empty body weight and mature weight of the genotype on energy density of empty body gain in growing lambs

From data reported by authors who had serially determined the chemical composition of the empty body of growing lambs of a wide range of genotypes, the energy density of empty body gains (E/G) at intervals from 20 to 50 kg empty body weight (EBW) were estimated. Energy density of empty body gain was related to the EBW of these lambs and to an approximation of the mature weight for the genotype (MW) obtained from a separate data set. The addition of MW to the function relating E/G to EBW increased the r2 from .793 to .940 and reduced the residual standard deviation from .550 to .300 Mcal/kg. Combining EBW and MW as predictors of E/G provided the following function: E/G = 5.718 + .093 (EBW) - .036 (MW). Energy density of empty body gain was approximately constant across all genotypes when comparisons were made at a constant EBW/MW. Thus, both EBW and mature weight of the genotype are closely related to E/G and should be considered important for accurately predicting net energy of gain requirements for growing lambs.

Urachal carcinoma

The clinical and morphologic features in 14 cases of urachal adenocarcinoma are reviewed. The disease occurred more frequently in men than in women. Seven patients (50%) remain alive and currently free of disease at periods ranging from fifteen months to ten years (median: 6 years). Neither the histologic appearance nor the differentiation of the tumor appeared to affect prognosis. It is concluded that the criteria previously recommended to establish the diagnosis of this rare malignancy were too restrictive.

Cyclophosphamide, doxorubicin and cisplatin chemotherapy for patients with locally advanced urothelial tumors with or without nodal metastases

Thirty-eight patients with primary urothelial tumors recurring in the pelvis or nodal presentation were treated with intravenous or intra-arterial cyclophosphamide, doxorubicin and cisplatin chemotherapy. The 38 patients were selected owing to unresectability by local criteria (12 patients) or by virtue of nodal metastases (26 patients). Histologically, the patients either had pure transitional cell carcinoma (29), transformation to a histological subtype of transitional cell carcinoma (7) or pure squamous cell carcinoma (2). An over-all 50 per cent complete remission rate was achieved with an 18 per cent objective pelvic response rate, and 32 per cent failed to respond to chemotherapy. Responses by histological subtype revealed that patients with pure transitional cell carcinoma had a 62 per cent complete remission rate, those with transitional forms had a 14 per cent complete remission rate and none with squamous cell carcinoma responded to chemotherapy. A significant difference in the incidence of responses among patients with transitional carcinoma and those with transition forms was seen (p less than 0.02). Complete remissions were independent of disease site. Nineteen patients achieved a complete remission with a mean duration of 86 weeks and median of 81 weeks (range 33 to 172 weeks). Toxicity of the chemotherapy was moderate with a high incidence of peripheral neuropathy and leukopenic infections. No deaths of chemotherapy were encountered. Patients with locally advanced or metastatic transitional cell carcinoma of the urothelium to lymph nodes can benefit from intravenous and intra-arterial cyclophosphamide, doxorubicin and cisplatin chemotherapy.

Getting started with electronic mail

This paper gives suggestions to librarians on how to get started with electronic mail. It discusses the cost- and time-saving advantages of using electronic mail rather than TWX, United States mail, or telephones for communicating ILL requests and messages. For instance, preliminary cost data show that electronic mail is often half as expensive as TWX and costs no more than a 22 stamp. Key management concerns that must be considered when setting up electronic mail are discussed, including the need for subscribers to agree on one system. Also covered are the types of equipment that can be used with electronic mail, including print terminals.

Potential of imipenem as single-agent empiric antibiotic therapy of febrile neutropenic patients with cancer

Infection remains a major cause of morbidity and mortality for the patient with cancer who experiences episodes of severe granulocytopenia. The search continues for new antimicrobial agents with improved efficacy and lower incidence of toxicity. Imipenem is a new carbapenem antibiotic which possesses a broad antibacterial spectrum with excellent activity against Pseudomonas aeruginosa and the other commonly recovered enteric gram-negative bacilli that infect the granulocytopenic patient with cancer. The combination of imipenem plus an aminoglycoside has shown in vitro synergy against P. aeruginosa and Staphylococcus aureus whereas the combination of imipenem plus piperacillin or the extended spectrum cephalosporins have frequently shown antagonism when tested against P. aeruginosa and Serratia marcescens. The use of a P. aeruginosa-infected neutropenic rat model has provided an in vivo system to evaluate the activity of new antibiotics or antibiotic combinations. Monotherapy with imipenem is as effective in this model as any of the currently available synergistic antibiotic combinations. This degree of activity has not been found with other broad-spectrum antibiotics when used alone. Imipenem provides serum bactericidal activity well above a 1:8 dilution for the four most commonly isolated pathogens: P. aeruginosa, Escherichia coli, Klebsiella species, and S. aureus. In addition, imipenem's post-antibiotic effect against P. aeruginosa may be pertinent. Imipenem is a unique antibiotic, with properties that make it well suited for study as monotherapy for fever and suspected infection in granulocytopenic patients with cancer. A prospective randomized, double-blind study comparing imipenem with a control regimen of piperacillin plus amikacin as empiric antibiotic therapy of febrile granulocytopenic patients with cancer is currently underway at the University of Maryland Cancer Center.

Bombesin-, calcitonin-, and serotonin-immunoreactive pulmonary neuroendocrine cells in acute and chronic neonatal lung disease

Bombesin-, calcitonin-, and serotonin-immunoreactive pulmonary neuroendocrine cells (PNEC) were quantitated in the lungs of infants dying of hyaline membrane disease (HMD) and bronchopulmonary dysplasia (BPD). When compared with the lungs of age-matched control infants dying of noncardiopulmonary causes, infants who had HMD demonstrated a decrease in the numbers of bombesin-, calcitonin-, and serotonin-immunoreactive PNECs, while infants who had BPD demonstrated an increase. This difference was most pronounced at 2 months of age, when infants with BPD had a threefold increase in bombesin-, a tenfold increase in calcitonin-, and a 34-fold increase in serotonin-immunoreactive cells. In both control infants and infants who had acute and chronic lung disease, a consistent relationship was found between numbers of the three cell types: bombesin greater than calcitonin greater than serotonin. Radioimmunoassay of lung tissue from infants dying of HMD and BPD confirmed low levels of bombesin immunoreactivity in HMD and increased levels in BPD. Circulating plasma bombesin levels in neonates, as measured by radioimmunoassay, were significantly higher than levels found in adults. Though these findings are intriguing, the documentation of a causal relationship between observed alterations in PNEC and the vascular and gas exchange abnormalities known to be associated with HMD and BPD must await further studies.

Benign retroperitoneal neurilemoma without von Recklinghausen's disease: a rare occurrence

We describe a rare case of a primary retroperitoneal neurilemoma that was confused initially on ultrasonography and computerized tomography for a renal carcinoma. These tumors vary in vascularity on arteriography, are more often solid than cystic and usually are benign in the absence of von Recklinghausen's disease. The preferred treatment is wide surgical excision.

Improved survival with cyclic chemotherapy for nonseminomatous germ cell tumors of the testis

Forty-eight patients with advanced nonseminomatous germ cell tumors of the testis received a combination of cyclophosphamide, doxorubicin, and cisplatin (CISCAII) and a modified combination of vinblastine and bleomycin (VBIV) cyclic chemotherapy. Forty-four (92%) have achieved a complete remission. No patient in complete remission has relapsed with a mean follow-up of 139.0 weeks (SEM 7.0 weeks). The patients were stratified according to the modified Samuels clinical staging criteria. Thirty-seven (77%) had advanced disease (stage III-B3 to III-B5), ten of whom had advanced visceral non-lung disease (stage III-B5). Chemotherapy was individualized by tumor volume and response to therapy. Two courses were delivered after complete remission or the development of a stable mass with negative serum biomarkers. Twenty-four patients (50%) were explored for a persistent and stable mass. No viable cancer was found; 15 (62%) had mature teratomas and nine (38%) had scar. No patients suffered from doxorubicin cardiotoxicity, clinical pulmonary bleomycin toxicity, or persistent cisplatin renal failure. Four patients died. One patient, an unrecognized drug abuser, died of toxicity. Three with far-advanced tumors died of progressive disease. CISCAII/VBIV cyclic chemotherapy is superior to chemotherapy with vinblastine, bleomycin, and cisplatin, resulting in a 92% complete remission rate and a significant reduction in long-term toxicity.

The changing spectrum of cystic pulmonary lesions requiring surgical resection in infants

Congenital labor emphysema and cystic adenomatoid malformation have been the most common surgically treatable cystic lesions of the lung. With the successful treatment of newborn respiratory distress syndrome, an increased frequency of an acquired form of cystic disease, interstitial pulmonary emphysema, has been observed. Some degree of interstitial pulmonary emphysema is relatively common, and during the years 1980 to 1983 this disease was diagnosed in 372 infants. Seven of these infants, all premature, underwent resection of relatively localized areas of persistent cystic interstitial pulmonary emphysema. Lobectomy or wedge resection was performed in five patients because of their inability to be weaned from the ventilator. A sixth patient with this disease underwent lobectomy for recurrent pneumothoraces. A seventh patient underwent lobectomy because the cystic interstitial pulmonary emphysema produced atelectasis and recurrent infections. All seven patients were extubated by the fourth postoperative day, have been discharged, and are showing respiratory improvement. Within the same period, four infants had congenital lobar emphysema and two had congenital cystic adenomatoid malformation. They were gestational age 36 weeks or older and, although respiratory distress was present to some degree in all six, only one was ventilator dependent at operation. All underwent lobectomy and one infant had a left upper lobe resection and right middle lobectomy on separate occasions for bilateral congenital cystic adenomatoid malformation. All patients with congenital labor emphysema and congenital cystic adenomatoid malformation have been discharged and are doing well. Our results suggest the following conclusions: Persistent interstitial pulmonary emphysema is now the most common indication for pulmonary resection in the newborn period. The anatomic distribution of resected interstitial pulmonary emphysema is similar to that of congenital lobar emphysema. Although only a small fraction (less than 2%) of patients with interstitial pulmonary emphysema require operation, the development of relatively large discrete cystic areas that (1) significantly decrease effective lung volume and produce respirator dependence, (2) produce atelectasis and recurrent infections, or (3) lead to pneumothoraces may make pulmonary resection beneficial. Finally, despite the presence of generalized lung disease in patients with interstitial pulmonary emphysema, these patients can be expected to improve significantly after resection, and the long-term outcome is generally good.

Chemotherapy of extragonadal germ cell tumors

Forty-nine patients with histologically proven germ cell tumors arising in extragonadal sites were retrospectively reviewed. Included in the review were an additional seven patients with undifferentiated tumors with a pathologic appearance compatible with that of a germ cell tumor and elevated levels of serum biomarkers (beta subunit of human chorionic gonadotropin [beta-HCG] +/- alpha-fetoprotein [AFP]. Nineteen patients had a pure seminoma arising in an extragonadal site, whereas 30 patients had nonseminomatous germ cell tumors. Seven patients had primary undifferentiated tumors with elevated levels of serum biomarkers. Sixteen (84%) of the 19 patients with pure extragonadal seminomas with normal levels of serum AFP are alive and free of disease. Eighteen of these 19 patients received platinum-containing regimens and four had received prior chemotherapy that failed. Of the patients with nonseminomatous germ cell tumors, 12 (40%) of the 30 are alive and free of disease with vinblastine/bleomycin +/- cisplatin (13 patients) or CISCAII (cisplatin, cyclophosphamide, and doxorubicin) (nine patients) alternating CISCAII/VBIV (eight patients) chemotherapy. None of the seven patients with undifferentiated germ cell tumors are alive and free of disease. Three of the five patients with pure anterior mediastinal endodermal sinus tumors treated with chemotherapy remain alive and free of disease. Of the seven patients with choriocarcinomas arising in extragonadal sites, three are alive and free of disease. A classification for patients with extragonadal germ cell tumors incorporating site of origin, histology, and likelihood of being truly extragonadal is proposed. The implications of this classification are discussed.

Verrucous carcinoma of the penis

We reviewed 13 cases of verrucous carcinoma, accounting for 5 per cent of the penile cancers seen during a 25-year interval. Although the typical verrucous pattern predominated minute foci of invasive squamous carcinoma were identified in 3 patients. All patients were followed for at least 6 years and none has died of the malignancy. Wide surgical excision, usually requiring partial or total penectomy, is the treatment of choice.

Bladder leiomyosarcoma: a review of 10 cases with 5-year followup

Of 10 patients with leiomyosarcoma of the bladder followed for a minimum of 5 years 4 remain free of disease at 5, 6, 6 and 9 years, respectively, following partial cystectomy. An additional patient who was treated sequentially by radiation, radical cystectomy and chemoimmunotherapy survived for 10 years before death of metastatic disease. Wide surgical extirpation (partial or radical cystectomy) remains the curative treatment of choice.

Squamous cell carcinoma of renal pelvis

Squamous carcinoma of the renal pelvis was diagnosed in only 11 of 2,166 renal tumors (0.5%) seen over a twenty-seven-year period. The combination of an insidious onset and a prolonged duration of symptoms (median: 5 months) resulted in all patients having invasive disease at diagnosis. Ten patients died two to twenty-eight months after diagnosis (median survival: 5 months), and only 1 patient is currently alive at nine months. We conclude that the treatment of choice is radical nephrectomy followed by adjuvant chemotherapy.