A clinical histologic, and immunologic study of a case of metastatic malignant melanoma undergoing spontaneous remission

A patient with biopsy-proven dermal recurrent malignant melanoma who refused therapy, and who was observed to undergo clinical regression during the period of November 1972 through June 1974 was studied to define the histologic features of spontaneous remission, and to evaluate the immune response as measured by in vitro assays of lymphocyte cytotoxicity and serum effects during the course of regression. Biopsy of regressed areas showed the following histologic features: 1) absence of malignant melanoma cells in basal layers of epidermis with relative increase in basal layer clear cells; 2) dermal inflammatory reaction with lymphocytic infiltrate, melanophages, and degenerate malignant melanocytes; and 3) dermal reactive vascular proliferation and interstitial edema progressing to reparative dermal fibrosis. Using a microcytotoxicity assay with two established allogeneic melanoma cell cultures as target cells, a statistically significant (p less than 0.01) increase in lymphocyte cytotoxicity values was observed over the clinical time course of regression. No significant serum cytotoxic or serum blocking effects were detectable. These findings are consistent with an immunologic basis for the spontaneous remission of the dermal melanoma metastases present in this patient.

Synthesis and biological activity of 10-thia-10-deaza analogs of folic acid, pteroic acid, and related compounds

The 10-thia analogs of pteroic acid, folic acid, their esters, and their 4-amino analogs were synthesized through a reaction sequence involving, as a key step, the condensation of 2-amino-3-cyano-5-chloromethylpyrazine with appropriately substituted thiols. The abilities of the products to inhibit the growth of methotrexate (MTX)-sensitive and MTX-resistant microorganisms were investigated as were their abilities to inhibit dihydrofolic acid reductase and thymidylic acid synthetase. Several compounds had high activity.

Tetrodotoxin: Occurrence in atelopid frogs of Costa Rica

The potent neurotoxin tetrodotoxin, which has previously been found in puffer fish of the order Tetraordontiformes, a goby (Gobius criniger), and the California newt (Taricha torosa), has now been identified in the skins of frogs of the genus Atelopus from Costa Rica.

Triage abilities of nurse practitioner vs pediatrician

The ability of ediatric nurse practitioners (PNPs) to perform triage functions for ill children in a busy pediatric outpatient service was compared to that of a group of pediatricians. One hundred thirteen children were seen separately on arrival by a PNP and by a pediatrician. The PNPs' evaluations agreed with the pediatricians' 84% of the time. Only two significant differences were shown: PNPs were more diligent in recording patient problems, while pediatricians were better able to anticipate the need for roentgenograms and laboratory studies. The results indicate that valuable physician time may be conserved by using the PNP to perform triage in large pediatric outpatient services.

Angiographic evidence of spontaneous closure of nontraumatic arteriovenous fistula of the vertebral artery. Case report

✓ A case is reported in which a congenital arteriovenous fistula of the left vertebral artery closed spontaneously 4 years after becoming symptomatic. The course was followed and confirmed by retrograde left brachial angiography.

EXPERIMENTAL RE-EVALUATION STUDIES ON ISONICOTINIC ACID HYDRAZIDE lN VITRO AND IN VIVO Ⅳ. Experimental Studies on Comparisons of Therapeutic Effects by Administration Modes of Isonicotinic Acid Hydrazide (lNH) in Mice Infected with the H37Rv Strain

In this experiment the writers studied various modes of INH oral administration to the SM-strain mice infected with the H₃₇Rv strain. The results were as follows 1. When doses of INH less than 1.8mg per kg were administered orally to experimental tuberculosis mice, daily twice administration of INH was less effective than daily once administration of the same amount of INH in the antibacterial efficacy and also in development of INH-resistant tubercle bacilli 2. When doses of INH larger than 18mg per kg were administered orally to experimental tuberculosis mice, there was no difference in anti-bacterial effects of INH between daily twice and daily once administration of the same amount of INH, In the mice treated twice daily with INH resistant tubercle bacilli developed more frequently. 3. Intermittant every other day administration of high doses of INH (18mg per kg and 72 mg per kg) were less effective and induced more frequently INH-resistant tubercle bacilli than daily once administration of the same amount of INH in experimental tuberculosis mice. Intermittent impact doses of INH(72mg per kg) were toxic to mice as well as daily once administration of the same doses of INH. 4. The frequency and grade of development of INH-resistent tubercle bacilli in vivo depended on the amount of administration doses, the length of time in contact with the drug and the grades of multiplication of tubercle bacili. 5. Impact therapy with the maximum administrable dose of INH(72mg per kg) is not to be recommended in tuberculosis. 6. We suggest further studies on the modes of administration and suitable effective doses of INH for man.

EXPERIMENTAL RE-EVALUATION STUDIES ON ISONICOTINIC ACID HYDRAZIDE lN VITRO AND IN VIVO Ⅲ. Experimental Studies on Comparison of Therapeutic Effects with Various Doses of Isonicotinic Acid Hydrazide (INH) in Mice Infected with the H37 Rv Strain

It is well known that proper treatment with INH alone is effective, as sell as combined therapy Recently high doses of INH have been recommended by many investigators. For the purpose of studying therapeutic effects of anti-tuberculous drugs the mouse is an useful experimental animal. If the experiments are performed properly, the results from experimental tuberculosis in mice offers valuable information applicable to man. Many investigators determine the efficacy of anti-tuberculous drugs by examining multiplication of viable tubercle bacilli recovered from the spleen of mice. But, as it requires quite a long period of observation to evaluate the effectiveness of anti-tuberculous drugs in the experimental animals, in our opinion the lung is the only suitable organ for the above mentioned purpose. The following results were reached in our experiments in the SM-strain mice infected with H₃₇Rv strain for comparisons of the therapeutic effects with various oral doses of INH and development of INH resistant tubercle bacilli: 1. The therapeutic effects of INH to tuberculous mice depend on the amounts of INH, large dosage offers better therapeutic efficacy. But, the differences in anti-tuberculous effects of INH were only slight between larger than optimal dose and optimal dose. 2. Even though the tubercle bacilli in vivo do not multiply by INH treatment, the dosage is the more the development of INH resistant was the more frequent. 3. If we expect the best therapeutic effect of INH and protect the development of INH resistant tubercle bacilli, higher than optimal doses of INH should be criticized. 4. Toxicity of INH is not the only problem to be considered in determining the high therapeutic amount of INH. 5. The present usual dosage of INH should be re-evaluated and also the term and concept of high dosage of INH in chemotherapy of tuberculosis should be reviewed. We propose the routine doses of INH should be increased from the present doses for the effective treatment of tuberculosis.

EXPERIMENTAL RE-EVALUATION STUDIES ON ISONICOTINIC ACID HYDRAZIDE lN VITRO AND IN VIVO Ⅰ. In vitro Inhibitory Effects of Isonicotinic Acid Hydrazide (INH) Against Tubercle Bacilli

Of course, it is importanat to discover new antituberculous drugs, but it is also very important to know how present anti-tuberculous drugs should be used for tuberculosis control. It is well known that isonicotinic acid hydrazide(INH) is the most widely used effective drug in chemotherapy of tuberculosis. It seems that a new drug more effective than INH will not be discovered in the near future. From this view point, many investigators are still continuing their efforts to know the best way of using INH, part icularly in optimal dose and mode of administration. In Korea, much of the treatment of pulmonary tuberculosis depends on the use of INH alone, therefore suitable therapeutic methods using INH for control of tuberculosis in this country are urgently required. Under the above mentioned circumstances the authors have made a series of experimental studies on re-evaluation of INH in vitro and in vivo. Two human strains, H₃₇Rv and Kurono, and one bovine strain, Ravenel, were used. Ten day old cultures from Ogawa media were used as inocula throughout the experiments. Proskauer-Beck medium with the addition of 10 percent horse serum was used for determination of inhibitory effects of INH against the above three strains. The following conclusions were reached: 1. Non-contaminated INH solution was obtained by using ten fold dilution or twice dilution methods with sterilized distilled water or Proskauer-Beck medium without autoclaving or Seitz-filtration. 2. Minimum completely inhibitory concentration o INH to human H₃₇Rv strain and Kurono strain was between 0.02mcg per ml. and 0.04 mcg per ml. but to bovine Ravenel strain was around 0.04 mcg per ml. 3. Slide culture method with petroleum ether suspension of the tubercle bacilli is a rapid quantitative method for measuring inhibitory effect of INH against the tubercle bacilli. 4. Under the constant conditions, minimum completely inhibitory concentration of INH against the same strain of tubercle bacilli is always constant. The deep cultures should be observed at least within one week. 5. Microscopic examination of stained slides by slide culture method should be made at three or four days cultivation, because INH activity begins to decrease.

EXPERIMENTAL RE-EVALUATION STUDIES ON ISONICOTINIC ACID HYDRAZIDE lN VITRO AND IN VIVO Ⅱ. Toxicity of isonicotinic Acid Hydrazide (INH) Against Mice

The results of toxicity test of drugs in animals may not be fully applied to human beings, but generally toxicity and therapeutic doses of chemotherapeutic drugs in man are based on the results of experiments in animals. It is well known that the mouse is a useful animal for the purposes of estimation of antituberculous drugs. The following results were determined in our studied for the toxicity of INH in the uniform SM-strain mice: 1. Minimum lethal dose was 240mg per kg; by this dose of INH the average time of death was 52 minutes by oral administration and 32 minutes by subcutaneous injection. It seems that the direct cause of death comes from difficulty of breathing after toxic convulsions. 2. When the mice survived more than one hour after drug administration, in most cases of the experiment the mice did not die by acute intoxication of INH and completely returned to a normal healthy situation. 3. An administrable maximum dose once daily was 45mg per kg without causing loss of body weight of mice.

EXPERIMENTAL RE-EVALUATION STUDIES ON ISONICOTINIC ACID HYDRAZIDE lN VITRO AND IN VIVO V. Influences of Glutamic Acid Against Toxicity and Therapeutic Effects of Isonicotinic Acid Hydrazide (INH) in Mice

An account of neutralization of toxicity or administration of high doses of INH many INH derivatives and neutralizing substances against INH toxicity are still under study. Particularly, vitamin B6 is Reported. as one fo the most effective substances against chronic INH toxicity, but this vitamin neutralizes the inhibitory activity of INH to tubercle bacilli in vitro according to some investigators. Glutamic acid has been reported as a substance which antagonizes the toxic properties of INH without destroying its potency. The authors studied the influences of glutamic acid against toxicity and therapeutic effects of INH on mice and the following conclusions have been reached 1. Daily administered maximum dose of glutamic acid was more than 2,400mg. per kg in the uniform SM-strain mice. 2. 240gm per kg and 480 mg per kg of INH which were acute lethal dose were antagonized by glutamic acid pre-treatment in volume of ten-time dose of INH in mice and markedly prolonged time of death of mice. 3. When 2,400mg per kg of glutamic acid was combined in simultaneously daily administrations of 240mg per kg of INH the acute lethal dose could not kill the mice during six days. 4. Absorbtion of glutamic acid administered orally into blood stream may antagonize the lethal toxicity of INH administered subcutaneously in mice. 5. Anti-tuberculous efficacy of INH did not decrease by simultaneous administration of glutamic acid to mice. 6. In administration of high doses of INH, simultaneous administration of glutamic acid in volume of 10 time of INH dosage neutralized INH toxicity and also inhibited development of INH-resistant tubercle bacilli in mice. 7. Combined therapy of INH with glutamic acid can be recommended as one of the effective chemotherapeutic methods against tuberculosis.

Result on the sensitivity test of the pulmonary tuberculosis patients treated with antituberculous drugs

In the treatment of the tuberculosis, the due consideration must be paid for the good knowledge of resistance of the tuberculous bacilli against the antituberculous agents. In this study, we observed the relationship of the emergence of resistance to the length of medication in each antituberculous agent separately, and also evaluation of the reliability of the results of sensitivity test to clinical manifestation has been checked.1) For 56 pulmonary tuberculosis patients, mostly far advanced, and with cavitation have been under the combined chemotherapy for considerable duration, the sensitivity of the SM, PAS and INH of each calculated in the length of its medications. This ablation revealed that a) In early stage of medications, tendency of emergence of resistance is definitively less in PAS compared with those in SM and INH.b) But at last, after months medication all of three agents gained resistance in 100% of cases.2) For the evaluation of reliability test in clinical manifestation, 56 patients divided insensitive and resistant groups, and each group was checked in subjective symptoms and X-Ray findings and tabulated by the scales of improve, no change and deterioration. From this observation, we found that.a) Insensitive group, about 50% improve, 5% deteriorated and 45% no change.b) In resistant group, about 10% improve, 25% deteriorate and 65% no change.