A comparison of two schedules of cytosine arabinoside used in combination with adriamycin and 6-thioguanine in the treatment of acute myelogenous leukemia

The most effective schedule of cytosine arabinoside (Ara-C) administration remains controversial and is further confused by the use of combination chemotherapy. Two remission induction regimens comprising adriamycin, Ara-C, and 6-thioguanine have been compared in patients with acute myelogenous leukemia. Administration of Ara-C by continuous intravenous infusion resulted in faster clearing of leukemic blasts from the peripheral blood and bone marrow than after administration of the same dose by twice daily intravenous injection. Myelosuppression and gastrointestinal toxicity were, however, more pronounced when Ara-C was given by infusion. The complete remission rate was higher in the patients treated with intravenous infusions. It is too early to assess the duration of remission in the infusion study; however, despite the relatively low remission rate, 80% of patients under the age of 60 in the intravenous bolus study remain in remission with a minimum follow-up of two years.

Chromatographic forms of terminal deoxynucleotidyl transferase in normal lymphoid cells and in leukemia cells at presentation and relapse

Normal thymocyte and bone marrow terminal deoxynucleotidyl transferase (TdT) have distinguishing characteristics by phosphocellulose chromatography in Tris buffer: marrow TdT elutes as a single peak at 0.3 M salt, whereas thymocyte TdT separates into two forms, one at 0.3 M salt and one at 0.4 M salt. Since the majority of TdT-positive acute leukemias are anatomically bone marrow-derived, one would have predicted the presence of a bone marrow TdT-phosphocellulose chromatographic pattern in such patients. However, in 376 consecutive, untreated TdT-positive acute lymphoblastic leukemias (ALL) studied by us we have invariably encountered the two-peak thymocyte-type phosphocellulose pattern. The TdT patterns in the thymic-dependent, TdT-positive lymphoma of AKR mice, and the TdT-positive bone marrow-derived, thymic-independent Abelson virus leukemia of Balb/C mice duplicate the situation in human ALL: a thymocyte pattern is seen in both the marrow-derived and thymus-derived diseases. This chromatographic difference between leukemia-associated and normal marrow-associated TdT in both murine and human leukemia suggested that phosphocellulose-TdT patterns might be useful for monitoring residual marrow tumour cell burden in TdT-positive leukemia. This has not turned out to be the case: in eight patients studied in early relapse the blast cell TdT pattern was the single-peak 0.3 M species. Therefore, leukemic cell TdT cannot reliably be distinguished from normal marrow cell TdT. The chromatographic behaviour of TdT may be regulated by phosphorylation-dephosphorylation, the 0.3 M salt peak can be converted to the 0.4 M salt species by treatment with protein kinase and ATP, and the 0.4 M species can be converted to the 0.3 M form by exposure to alkaline phosphatase. Thus, apparently anatomic compartment-specific forms of TdT may only reflect differing cellular metabolic activity.

A therapeutic comparison of ipratropium bromide and salbutamol in asthmatic patients

A single-blind, crossover study was carried out in 43 asthmatic patients to compare the efficacy and tolerance of inhaled ipratropium bromide with inhaled salbutamol. One or other drug was given 3-times daily (0.04 mg ipratropium bromide or 0.2 mg salbutamol per dose) over a period of 4 weeks. Patients were then crossed over to the alternative medication for a further 4 weeks. The results of lung function tests performed at routine clinic visits and by the patients at home showed similar increases in peak flow and spirometry recordings, although more patients expressed a preference for salbutamol. Unwanted effects were minor with both drugs. It is suggested, therefore, that ipratropium bromide may be a useful alternative to beta-stimulants in some asthmatics.

The 'tumour overkill syndrome'. A potentially lethal complication of cancer chemotherapy

Two cases of acute leukaemia of Burkitt type in whom chemotherapy was associated with the ‘tumour overkill syndrome’ are described. One patient died with severe metabolic derangement which followed chemotherapy. In the other, an intensive programme of allopurinol administration, alkalinization of the urine and forced diuresis was instituted before chemotherapy, thus correcting the initial biochemical abnormalities and modifying those which occurred after chemotherapy. This approach prevented a fatal outcome, allowing the patient to survive to achieve bone marrow remission.

Biochemical and biophysical characterization of glucocorticoid receptors in normal lymphoid tissue

3H-triamcinolone acetonide labeled glucocorticoid receptors in normal lymphoid tissues can be resolved into two component by DEAE chromatography: peak I elutes at 0.04 M salt and peak II is 0.22 M salt. By glycerol gradient centrifugation, peak I is 3.5S and peak II 8.5S. Peak I binds to DNA and chromatin, while peak II binds to neither. After heat activation, peak II alters its coefficient of sedimentation to 3.5S and on DEAE rechromatography changes its elution position to 0.04 M salt (peak I area) and acquires affinity for DNA. Glucocorticoid receptors in lymphoblastic leukemia cells can now be characterized using these techniques and compared to receptors in normal lymphoid cells.

A cross-matching procedure for the selection of platelet donors for alloimmunized patients

A platelet cross-matching procedure has been assessed for selecting compatible donors for alloimmunized patients. This confirms the clinical value of combining an indirect platelet immunofluorescence test (PIFT) with a lymphocytotoxicity test (LCT) in predicting the survival of single-donor platelets. There was good agreement between the PIFT cross-match and post-transfusion platelet recovery. Compatibility in the LCT alone was insufficient for platelet donor selection, as this test did not detect all antibodies affecting platelet survival. Positive LCT and PIFT cross-matches indicated the presence of HLA antibodies. Inclusion of an indirect lymphocyte immunofluorescence test (LIFT) helped to classify the platelet antibody when the LCT cross-match was negative. In such cases, parallel positive findings with the LIFT and PIFT suggested a cytotoxic-negative antibody of probable HLA specificity active against platelets. Disparity between the LIFT and PIFT was also observed; a strongly positive PIFT along with a weak reaction in the LIFT suggested that a platelet-specific antibody was responsible for the poor platelet survival in these cases. This study has also shown the presence in multitransfused patients of LIFT-positive antibodies not reacting in the LCT and PIFT, which do not affect the survival of transfused platelets. A positive granulocyte cross-match was demonstrated in patients with febrile rigors associated with compatible platelet transfusions. Splenectomy and steroids may improve the survival of incompatible platelets depending on the nature of the platelet antibody.

Chemotherapy and immunotherapy for acute myelogenous leukemia

Eighty-six consecutive untreated adults with acute myelogenous leukemia were treated with a combination of Adriamycin, vincristine, prednisolone, Cytosine Arabinoside, and BCG. Complete remission was achieved in 39 (45%) patients; these patients were then allocated on an alternate basis to receive BCG and monthly chemotherapy with or without weekly irradiated allogeneic blast cells. The median duration of remission was eight months and was the same for both groups. The median survival of those achieving complete remission was 19 months compared with two months for those not achieving complete remission. Nine patients are still alive without relapse and five of these patients have been disease free for more than three years.

Rupture of pulmonary artery aneurysm associated with persistent ductus arteriosus

Fatal haemopericardium occurred in a 14-year-old boy after rupture of a pulmonary artery aneurysm. Persistent ductus arteriosus with severe pulmonary hypertension was confirmed by cardiac catheterisation when he was 4 weeks old. Attempted closure of the ductus at 4 years had not been possible because of apparent high pulmonary resistance. Exercise tolerance had been good enough to permit competitive horse riding up to the day of death. Light and electron microsocpy showed widespread cystic medionecrosis of the elastic pulmonary arteries.

Isolation, synthesis, and pharmacology of metabolites of 1-(3,4-dichlorobenzyl)-3,4,5,6-tetrahydro-2(1H)-pyrimidone

The metabolism of 1-(3,4-dichlorobenzyl)-3,4,5,6-tetrahydro-2(1H)-pyrimidone, an antianxiety/antidepressant agent, in dogs is reported. Two metabolites, 3-[1-(3,4-dichlorobenzyl)-1-ureido]propanoic acid and 1-(3,4-dichlorobenzyl)uracil, were isolated, characterized, and synthesized. Neither metabolite was acutely toxic, and they did not exhibit antidepressant or antianxiety/anticonvulsant activity.

Book selection for school of radiologic technology libraries

An overview of the process of book selection is given. Methods used in small, average and large institutions are discussed. In addition, specific information concerning the items to be assessed, and practical points on building library collections are presented.

Shock-induced defensive fighting in the rat: evidence for cholinergic mediation in the lateral hypothalamus

Bilateral microinjections of scopolamine into the lateral hypothalamus significantly reduced shock-induced defensive fighting, without altering jump threshold values. Further investigation of the lateral hypothalamus demonstrated that (1) fighting increased in response to bilateral microinjections of physostigmine and carbachol, (2) social attraction remained unaltered following scopolamine treatment, (3) neither motor co-ordination nor motor activity was significantly affected by any of the treatments.