Human papillomavirus is associated with the frequent detection of warty and basaloid high-grade neoplasia of the vulva and cervical neoplasia among immunocompromised women

A total of 158 women who either HIV-infected or under iatrogenic immunosuppression were examined regularly during a 4-year period to evaluate if certain vulvar neoplasms and cervical neoplasia have similar associated risk factors. Patients with CIN were matched prospectively with immunocompetent controls with CIN. Forty-eight cervical lesions were detected among patients, including 2 invasive carcinoma and 15 CIN-3 lesions, compared to 11 vulvar lesions, including 2 invasive carcinoma and 7 VIN-3 lesions. Women who have more than five life-time partners were more likely to have HPV-DNA positive cervical swabs and vulvar scrapes as well as cervical and/or vulvar neoplasia. Compared to 2.7% of controls 15.2% of patients with CIN had coexisting high-grade lesions of the vulva. With 1 exception all patients with vulvar neoplasia either suffered from symptomatic immunodeficiency or received immunosuppressive drugs for more than 10 years. Except for 1 VIN-3 lesions, all vulvar neoplasms were associated with HPV-DNA types 16, 31, and/or 33. Six of nine patients as well as the 2 controls with coexisting vulvar and cervical neoplasia had the same HPV-type associated with both lesions. All vulvar lesions were classified as either "warty" or "basaloid". In conclusion cervical and bowenoid/basaloid vulvar neoplasia seem to have a similar HPV-related genesis. Malfunction of the cellular immune response appears to be a cofactor in the genesis of HPV-associated neoplasia at both sites.

Successful carboxypeptidase G2 rescue in delayed methotrexate elimination due to renal failure

We report on an 18.5-year-old woman with osteosarcoma and delayed methotrexate (MTX) elimination due to renal failure after high-dose MTX, in whom rescue with high doses of folinic acid caused intolerable side effects. In this life-threatening clinical situation, the patients was rescued by the administration of recombinant carboxypeptidase G2, a bacterial enzyme that rapidly hydrolyzes MTX into inactive metabolites. This is the first report on the successful clinical use of this alternative catabolic route for the elimination of MTX.

Complete resection before development of drug resistance is essential for survival from advanced hepatoblastoma--a report from the German Cooperative Pediatric Liver Tumor Study HB-89

Clinical data and tumor histology of 37 patients with advanced and/or metastatic hepatoblastoma (32 stage III and 5 stage IV) treated according to the protocol of the German Cooperative Pediatric Liver Tumor Study HB-89 from 1988 to 1992 were studied for prognostic factors. Twenty-three patients (73%) were free of tumor 9 months to 5 years (median, 36 months) after treatment, whereas 4 experienced progressive disease, 7 had local relapse, and 3 had recurrent metastases. None of 2 patients with primary lymph node involvement or 5 with primary metastases remained disease-free. Chemotherapy with ifosfamide, cisplatin, and adriamycin was effective in reduction of tumor to resectability in 33 (89%) patients. Drug resistance developed in 6 of 11 patients treated with four or more courses of chemotherapy as could be shown by monitoring of serum-alpha-fetoprotein (AFP) and serial investigations of tumor expansion with sonography and computed tomographic (CT) scan. Only 1 of these patients survived after a liver transplantation. Completeness of tumor resection at second- or third-look laparotomy was significantly related to disease-free survival (P < .0001). Patients with initial serum-AFP values < 100 ng/mL or > 1,000,000 ng/mL had a worse outcome than those with immediate levels (P = .044). The rate of decrease of serum-AFP during chemotherapy was significantly related to prognosis (P = .003). Growth pattern of tumor within the liver (ie, defined nodes versus diffusely disseminated) (P = .011) and vascular tumor invasion (P = .026) were valuable prognostic factors, whereas tumor volume, local infiltration of surrounding tissue, histological subtypes, and epithelial differentiation were not significantly related to the outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

[Results of the HB-89 Study in treatment of malignant epithelial liver tumors in childhood and concept of a new HB-94 protocol]

94 children with a primary liver neoplasm were registered in the Cooperative Pediatric Liver Tumor Study HB-89 of the GPOH from 1988 to 1992. 64 of these had a hepatoblastoma (HB), 12 a hepatocellular carcinoma (HCC), 2 a sarcoma and 16 a benign tumor. 51 (80%) patients with an HB were 6 to 36 months of age, 9 with an HCC above 10 years. Initial serum-alpha-fetoprotein (AFP) was elevated in 51 HB patients and exceeded the 3-fold of normal range in 45. Children with low (< 100 ng/ml) and very high (> 1,000,000 ng/ml) levels had a significantly worse prognosis than those with intermediate values (p = 0.0014). AFP was moderately elevated in 9 HCC patients. All other tumor markers were only irregularly above normal range. 48 (77%) of HB patients survived, 45 (73%) are tumor free. All of 18 stage I and 4/5 stage II patients are in remission. After chemotherapy 30/36 stage III HBs and 2/5 stage IV HBs could be resected, 9 of these patients suffered from tumor relapse. Disease-free survival was 100% for stage I, 80% for stage II, 68% for stage III and zero for stage IV HB (p = 0.0005). Surgical complications occurred after 8% of biopsies, 13% of limited primary resections and 25% of extended secondary resections. There was no perioperative death. The completeness of tumor resection at primary or delayed surgery correlated significantly with patients disease-free survival (p < 0.0001). Chemotherapy with ifosfamide, cisplatin and adriamycin was effective in HB. 203 courses were given in 61 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Methotrexate pharmacokinetics and prognosis in osteosarcoma

PURPOSE

The influence of methotrexate (MTX) pharmacokinetic parameters on the efficacy of high-dose MTX (HDMTX) in osteosarcoma was analyzed.

PATIENTS AND METHODS

MTX serum peak values from 198 patients in 1,703 treatment courses and more detailed pharmacokinetic data from 185 patients in 1,045 treatment courses from the Cooperative Osteosarcoma Study Group (COSS) studies COSS-80, COSS-82, and COSS-86 were investigated.

RESULTS

A mean threshold peak level of > or = 1,000 mumol/L for the repeated MTX courses of individual patients was found to correlate significantly to prognosis in study COSS-80 (18% v 64% actuarial 10-year disease-free survival [DFS], P = .0001). Six courses of HDMTX per patient who achieved peak values > or = 1,000 mumol/L were found to be sufficient for a full effect to be seen in DFS in COSS-80. The MTX peak level was found to correlate closely to the area under the curve (AUC). However, AUC was a less powerful determinator of prognosis than the mean threshold MTX peak value. In patients who received cisplatin (DDP) as one of the additional drugs to MTX, the peak values and AUC were significantly increased (1,396 v 1,276 mumol/L, P = .011; 6,684 v 5,820 h.mumol/L, P < or = .002) and only a few patients (6%) did not achieve mean threshold MTX peak values. In addition, following restriction of hydration fluid after the MTX infusion from 4.5 to 3.0 L/m2 per 24 hours, the early MTX half-life (t1/2) and the AUC, but not the MTX peak value, were significantly increased (3.4 v 3.05 hours, and 6,760 v 5,998 h.mumol/L, respectively, P < or = .002).

CONCLUSION

MTX pharmacokinetics significantly influence the efficacy of MTX in osteosarcoma. Individual adaptation of the MTX dose to ensure a threshold peak serum level > or = 1,000 mumol/L does not seem necessary at a fixed dose of 12 g MTX/m2, restriction of hydration fluid to 3 L/m2 per 24 hours, and concomitant use of DDP within the drug regimen.

[Results of the HB-89 Study in treatment of malignant epithelial liver tumors in childhood and concept of a new HB-94 protocol]

94 children with a primary liver neoplasm were registered in the Cooperative Pediatric Liver Tumor Study HB-89 of the GPOH from 1988 to 1992. 64 of these had a hepatoblastoma (HB), 12 a hepatocellular carcinoma (HCC), 2 a sarcoma and 16 a benign tumor. 51 (80%) patients with an HB were 6 to 36 months of age, 9 with an HCC above 10 years. Initial serum-alpha-fetoprotein (AFP) was elevated in 51 HB patients and exceeded the 3-fold of normal range in 45. Children with low (< 100 ng/ml) and very high (> 1,000,000 ng/ml) levels had a significantly worse prognosis than those with intermediate values (p = 0.0014). AFP was moderately elevated in 9 HCC patients. All other tumor markers were only irregularly above normal range. 48 (77%) of HB patients survived, 45 (73%) are tumor free. All of 18 stage I and 4/5 stage II patients are in remission. After chemotherapy 30/36 stage III HBs and 2/5 stage IV HBs could be resected, 9 of these patients suffered from tumor relapse. Disease-free survival was 100% for stage I, 80% for stage II, 68% for stage III and zero for stage IV HB (p = 0.0005). Surgical complications occurred after 8% of biopsies, 13% of limited primary resections and 25% of extended secondary resections. There was no perioperative death. The completeness of tumor resection at primary or delayed surgery correlated significantly with patients disease-free survival (p < 0.0001). Chemotherapy with ifosfamide, cisplatin and adriamycin was effective in HB. 203 courses were given in 61 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Imaging methods in diagnosis of cerebrovascular complications with L-asparaginase therapy]

During or immediately following L-asparaginase (L-asp) therapy especially intracranial thromboembolic or hemorrhagic complications due to hemostatic imbalance have been observed. We report about 6 children who had intracranial thrombosis or hemorrhage after 3 to 8 doses of L-asp. Initial symptoms of the cerebral events were similar--seizure, coma, hemiparesis and disorientation. All patients were examined by cerebral computerized tomography (CT) or/and magnetic resonance imaging (MRI). Three patients had a dural sinus thrombosis, one had an intracranial hemorrhage and two a hemorrhagic infarction with typical findings in the cerebral CT or MRI. Two other patients were interpreted as having peripheral thrombosis. They showed nontypical hypodense cortical and subcortical areas without any contrast medium enhancement in CT and hyperintense areas in T2-weighted MRI scan. All patients recovered from neurological symptoms, and showed obvious regression of CT and MRI findings which correlate with the good prognosis of these complications. Both CT and MRI are useful in diagnosis and follow-up of cerebrovascular complications of L-asp therapy. The CT and MRI findings of the reported cases seem to reflect different appearances of the same entity, i.e. thrombosis of venous vessels of different size with or without congestive edema and hemorrhagic complication.

Cellular immunodeficiency enhances the progression of human papillomavirus-associated cervical lesions

Most cases of low-grade cervical intraepithelial neoplasia (CIN) associated with oncogenic human papillomavirus (HPV) types regress spontaneously within years. Unknown co-factors seem to be necessary for a progression to malignancy. To determine the possible role of cellular immunodeficiency as such a co-factor in the genesis of genital neoplasia, 48 HIV-infected women and 52 allograft recipients were examined periodically during a 3-year period. Colposcopy, cytology and HPV-DNA typing (ViraType) were performed at each visit. Each cervical lesion was matched prospectively with 2 lesions from immunocompetent controls. In all, 29/100 patients suffered from cervical neoplasms, including 2 advanced cervical cancers and 9 CIN3 lesions. Correlation between grade of lesion and HPV DNA 16/18 was significant. Low-grade lesions among patients progressed more often than among controls and recurrent lesions after destructive treatment were seen more frequently among patients than among controls. All patients with CD4-lymphocyte counts of < 400/microliters or immunosuppression for more than 3 years suffered from progressive lesions. We conclude that malfunction of the cellular immune response following either HIV-induced depletion or iatrogenic inhibition of CD4-lymphocyte activation, enhances the progression of HPV-induced cervical lesions to malignancy.

[Differences in current state and at the beginning of cancer therapy and possible sequelae: a pilot study in pediatric oncology]

The psycho-social and medical care of families with a cancer sick child can be more effective if the team can identify those parents who need help most desperately from the very beginning. In a retrospective study of 20 patients and their families two groups of parents with different levels of stress could be seperated. Highly stressed parents demonstrated already at the time of diagnosis unfavorable coping strategies with the possibility of a cancer disease. They experience a high degree of guilt feelings and believe that they might be responsible for the occurrence of the disease. However they refuse more often than the other parents psycho-social help offered by the professionals. The results suggest to implement special kind of help for the more stressed families already in the early phase of diagnosis and treatment.

[Inpatient psychological management in pediatric oncology: the concept of liaison management]

Concepts for counseling and long term support have been the major interest in the psychosocial care of pediatric oncology patients and their families. Similar methods for psychosocial care on the ward are still rare. This paper presents the psychological care of the oncology patients during their stay on the ward, complimentary to the medical treatment. The concept is based on the process of coping with the phases and specific situations (L.P.; B.M.A.; diagnosis; medication ect.) of the cancer therapy. This process contains on the part of the patients and their parents the need for information, active involvement in treatment regimes and relaxation (before, during and after the stressful situation). The concepts of informed consent, adherence and recovery-counseling are related to the coping methods of the patients and their parents. The aims of our concept are to create and utilize diagnostic tests and psychological methods to enable the families to help themselves. To reach this goal, the technique of semantic and pragmatic information is very important because this kind of social communication helps us to make the medical implications of the treatment understandable and suitable for the patients and families.

[The psychosocial questionnaire for pediatric oncology]

A concept based on empirical data is needed for psychological support of children with cancer and their families. A number of concepts are already available, but a psychological assessment is needed, which controls the feasibility of these concepts. The psychosocial questionnaire is such an assessment, which transforms individual data into the practical psychosocial work during the entire course of cancer treatment. The diagnostical procedure includes aspects of coping with cancer, such as stress, protective and risk factors and health behavior. Data are collected before, during and after the intensive cancer treatment and in a follow-up after 6 or 12 months respectively. The questionnaire has four parts. Each contains a "handbook for parents", which informs the parent in detail on each part. Thus, we enforce the potential of each parent to help him-/herself.

Clinical pharmacokinetics of mitoxantrone in hyperthermic, isolated perfusion of the leg

The clinical pharmacokinetics of mitoxantrone in hyperthermic, isolated perfusion of the leg were studied in five patients exhibiting solitary, localized malignant melanoma. Mitoxantrone was given as four 1-min infusions at 15-min intervals into the arterial line of the perfusion system at a total dose of up to 14 mg/m2. The mean half-lives for mitoxantrone in the blood circulation of the leg were: t1/2 alpha (distribution phase), 25.5 s, and t1/2 beta (elimination phase), 14.9 min. The mean volume of distribution at steady state in the leg was 25.6 1. In the arterial part of the perfusion, the mean AUC was 155.9 mg min l-1, and that in the corresponding venous part was 91.6 mg min l-1. Leakage of the drug from the leg into the systemic circulation amounted to 1.2% of the total delivered dose; 91% of the delivered dose remained in the leg after the perfusion had been completed. The mean elimination half-life of mitoxantrone in the systemic circulation was 123 min and the corresponding AUC for systemic concentrations was 8.59 mg min l-1. The present data revealed a high uptake of mitoxantrone into the leg and low systemic drug concentrations due to minor leakage, suggesting that mitoxantrone might be a good candidate for use in isolated, hyperthermic limb perfusion.

[Visceral leishmaniasis. Personal observation and review of epidemiology, clinical aspects and therapy]

A 5 year old German girl contracted visceral leishmaniasis during a vacation in Spain, either 32 or 20 month prior to the manifestation of disease. She presented with fever, hepatosplenomegaly and pancytopenia. A bone marrow aspirate proved the diagnosis. Therapy with a pentavalent antimony drug brought about immediate improvement. Visceral leishmaniasis has to be suspected in individuals with fever, hepatosplenomegaly and pancytopenia who have resided in endemic areas (Mediterranean countries, India, East Africa, South America) during the previous years. If untreated, visceral leishmaniasis runs a fatal course. Therefore, early diagnosis by morphological and serological means and specific therapy with pentavalent antimony drugs are mandatory.

[Results of treatment in primary disseminated osteosarcoma. Analysis of the follow-up of patients in the cooperative osteosarcoma studies COSS-80 and COSS-82]

Since the long-term disease-free survival rate in adjuvantly treated osteosarcoma has nowadays reached a level of about 70%, increasing interest is also being directed towards primarily disseminated forms of the disease. Primary metastases, which were confined to the lungs in 42 cases, were detected in 59 out of 421 patients from the prospective therapy trials COSS-80 and COSS-82. The primary tumors were more frequently localized in the proximal femur and flat bones as compared to patients without detectable metastases at diagnosis. Following chemotherapy and surgery of the primary tumor, 15/31 (48%) patients whose metastases were excised have survived for 4-8 years, in contrast to only 1/22 (5%) of those patients whose metastases could not be removed for a variety of reasons. Clinical or histological evidence of tumor response after primary chemotherapy significantly influenced the outcome of the metastasectomized patients.

[Tolerance of intraoperative, intraperitoneal chemotherapy in advanced gynecologic malignancies]

Assuming that cells and portions of tumor may remain in the abdominal cavity after surgery to reduce tumor size in cases of ovarian carcinoma, and that a change in cell kinetics could result in accelerated growth in the event of a recurrence, 23 patients with advanced tumors were given local (intraperitoneal) treatment intraoperatively. The treatment consisted of 15 mg Mitomycin C or 30 or 40 mg of Mitoxantron, in 1000 ml normal saline. Since the observation time was so short, the tolerance and side effects of this form of treatment were of primary interest, rather than remission quotas and survival times. The principal abdominal complaints included two subileus conditions which responded well to therapy and the problem of postoperative nausea. Four patients reacted to the treatment described with temperatures of over 38 degrees C. Chemical changes detected in the laboratory included 18 cases of leukopenia, which in one case reached WHO Grade 4. Intermittent changes in liver values and electrolytes were observed in isolated cases. Wound-healing impairments occurred in three cases. In one of them, a patient who sustained a prolapse of the small intestine with tumor growth into the abdominal wall, reoperation was necessary. Taken overall, the side effects of the intraoperative, intraperitoneal cytostatic therapy were acceptable. In view of the courses observed and with the idea of employing a form of therapy to combat aggressive growth of tumor cells remaining after surgery, it appears justified to continue with this form of treatment.

[Continuous doxorubicin infusions. A pilot study in young patients]

Eleven young patients with relapsed childhood malignancies received continuous infusions of 5-10 mg/m2/day doxorubicin. 30 infusions were given via a central venous access until signs of mucositis showed up (7-52 days). Other toxicity was low, both bone marrow depression and fever and neutropenia occurred in 7/30 and 5/30 courses of therapy, respectively. No signs of liver or cardiac toxicity were seen in these heavily pretreated patients. In 8/11 patients tumor regression was documented, though only two partial remission were noted. Continuous infusions of doxorubicin are an effective and relatively non-toxic treatment for relapsed childhood malignancies. Since this form of therapy enables good quality of life and medical care on ambulatory basis, a phase II-study of low-dose doxorubicin for relapsed tumors is justified.

[Antineoplastic effectiveness and toxicity of idarubicin (4-demethoxy-daunorubicin) in recurrent acute leukemias in childhood]

11 patients with refractory acute leukemia of childhood were treated with idarubicin per os. Bone marrow toxicity which was observed at a dose level of 60 mg/m2 p.o. (3 x 20 mg q 24 hrs p.o.) per 3 weeks was found to be the dose limiting factor. In contrast to the first phase I study of Tan et al. (16) the maximal tolerated dose in the present study was found to be lower at a level of 90 mg/m2 p.o. (3 x 30 mg/m2 p.o. q 24 hrs) per 3 weeks. Therefore, we recommend a dosage of 60 mg/m2 p.o. (3 x 20 mg/m2 p.o. q 24 hrs) per 3 weeks as a starting dose for phase II/III studies. 2 out of the 11 anthracycline pretreated patients (91-880 mg/m2) with acute leukemia reached a complete remission undergoing idarubicin p.o. as a single therapy.

Change of thymic size during and following cytotoxic therapy in young patients

In a retrospective study, 108 thoracic CT-scans of 18 patients aged 5-25 who had received cytotoxic treatment for solid tumors were evaluated. The thymic size decreased in 15/17 patients during treatment and increased in 14/15 after the end of therapy. In 5/5 patients, the change could also be detected with relapse therapy. These changes have to be considered in the evaluation of a mediastinal mass suspected of metastasis during and following cytotoxic therapy.

[Langerhans cell histiocytosis in childhood--results of the DAL-HX 83 study]

Owing to the unclear and mostly unknown etiology of Langerhans' cell Histiocytosis (LCH) and the unsatisfactory results in treating disseminated LCH a prospective multicentric study DAL-HX 83 was commenced, including 45 different clinics of West-Germany, Austria and Netherlands. From June 1st, 1983 to October 31st, 1986, 97 patients (pts) were involved in this study. 35 pts (9 females, 26 males, medium age 6 2/12 years, age range 0/12-14 2/12 years) suffering from localized disease (28x unifocal bone, 6x isolated skin, 1x isolated lymphnode involvement) were treated by surgery and/or radiation or were just kept in observation. 2 children (1 pt with primary localized bone lesion, 1 child with isolated skin rash) developed a new bone lesion after 1/2 year and 1 1/2 years respectively. 62 pts (33 females, 29 males, medium age 2 years, range 0/12-17 1/2 years) with previously untreated disseminated disease were assigned to 3 different risk groups (A, B and C) and were treated according to a standardized induction and risk adapted maintenance protocol. The whole treatment period was limited to 1 year. 19 pts with multifocal bone involvement (group A, medium age 6 1/2 years) were allocated to regimen A, 30 pts with bone and soft tissue involvement or soft tissue involvement alone (group B, medium age 1 8/12 years) to regimen B and 13 pts with dysfunction of the liver, lungs and/or haematopoietic system (group C, medium age 1 year) to regimen C. So far, 1 pt of group A (19 available pts) developed a new bone lesion after 10 months, another pt a suspicious bone involvement 16 months after diagnosis. A 4 months old girl of group B (27 available pts) died 11 months after diagnosis with progressive organ dysfunction, 2 pts are still alive with recurrent multifocal bone lesions and 1 pt achieved stable 2nd clinical remission after a local relapse (mediastinum). 4 pts of group C (11 available pts) died because of progressive disease between 5 days and 3 years after diagnosis, 3 pts are in partial remission after persistent and recurrent disease episodes. All the others are in clinical remission. The medium observation time of the whole group of pts with disseminated LCH is 1 9/12 years (range 0/12-3 5/12 years). The worst prognostic criteria were found to be the presence of organ dysfunction at diagnosis or its development during the course of disease and the age under two years.(ABSTRACT TRUNCATED AT 400 WORDS)

[High dosage ARA-C in combination with mitoxantrone in therapy of acute myeloid leukemia in childhood. Initial results of the AML BFM-85 recurrence study]

19 children with AML were treated using the combination of high dose cytosine-arabinoside and mitoxantrone. All children were initially treated according to protocol AML-BFM-83. 6 children with refractory AML, 9 children with bone-marrow relapse during or after maintenance therapy and 4 children with residual blasts (5-25%) after remission induction and consolidation therapy AML-BFM 83 were treated with the relapse protocol. 6 of 15 children with refractory AML and all 4 children with residual blasts achieved a complete remission. 2 children died in bone-marrow aplasia and 1 child did not respond. One child died after further mitoxantrone treatment due to toxic cardiomyopathy. All children went into severe bone marrow aplasia, which lasted in median 27 days. These data indicate a high antileukemic activity of HD-ARA C/mitoxantrone in childhood AML.

42-hour methotrexate infusions as relapse therapy for childhood malignancies: toxicity and efficacy of 109 infusions

Thirty-six children and adolescents received 42-h methotrexate (MTX) infusions in doses of 5.5-22 g/m2 as a single drug or as part of a combination chemotherapy for relapsed childhood leukemias or solid tumors. In a total of 109 courses serum MTX concentrations were maintained at 2 x 10(-5) -2 x 10(-4) M for 42 h before leukovorin rescue was started. There were responses in one of two hemangiopericytomas, two of five Ewing's sarcomas, and six of eight rhabdomyosarcomas. In ALL, NHL, and neuroblastomas, responses were seen with 42-h MTX infusions as part of a combination chemotherapy. The major toxicities were mucositis in 45%, nausea and vomiting in 35%, and hepatic toxicity in 25% of the courses. Bone marrow depression as well as neuro- and nephrotoxicity were rare. Long-term MTX infusions in high doses are strongly recommended for the treatment of relapsed childhood malignancies because of their efficacy and mild toxicity.

[Immunoglobulin administration as infection prevention in oncologic patients]

Children receiving cytotoxic drugs were given 7 S IgG or placebo before the period of neutropenia (less than 500/mm3 neutrophils) in a double-blind study. Though the IgG levels differed significantly, fever as the most reliable sign of infection occurred not less often than in the placebo-group. There is no indication for the routinely prophylactic administration of immunoglobulins to oncological patients. The therapeutic benefit of immunoglobulin substitution in cancer patients needs verification.

[Acute encephalopathy following cranial irradiation of previously treated meningeal leukemia]

The sudden occurrence of an encephalopathic symptomatology within a day following commencement of radiotherapy is demonstrated by a case report of a small child suffering from CNS leukemia. Former intrathecal chemotherapy appears to be a prerequisite for this toxicity. In spite of diuretic therapy the patients condition may worsen initially, but recovery is possible within days. Patient characteristics and disease course identify a new toxicity syndrome, which is not yet familiar.

[Fluorescence cytophotometric DNA studies of Ewing and osteosarcomas]

The single-cell fluorescence cytometric data presented in this study basing on measurements on 6 osseous Ewing's-Sarcoma and 17 classical osteosarcoma are showing a mirrorlike behaviour to cytological and histological appearance. The cellular monotony in Ewing's-Sarcoma and the polymorphic appearance of osteosarcoma are represented by typical aneuploid DNA-histograms. Ewing's-Sarcoma histogram's show a large peak between the diploid and tetraploid region and little deviation to the octoploid value. The conventional osteosarcomas are characterised by a very polyploid and changeable DNA-histogram with variable blocks and peaks and deviation up to 34c. Special trends in the subtypes are remarkable, but depend on further investigations. DNA-measurements support objectivization of histological appearance on the one hand and the controlling of therapeutical responses on the other hand.

[Clinical application of a totally implantable catheter system]

A central-venous, totally implantable catheter system was used in 56 patients, aged 7 months to 75 years, predominantly for cytostatic treatment. The observation period was maximally 22 months. Infections occurred in four patients with leukaemia and severe agranulocytosis (after faulty puncture, and after rupture of the connection between catheter and injection port). Long period of usability with low complication rate distinguishes the system from the conventional central-venous catheter one.

Five coping styles in families of children with cancer: a retrospective study in thirty families

This retrospective study concerned the coping behavior of 30 children with cancer and their families. Fifteen families with children who were considered "cured" and 15 families with children who had died of their disease were questioned in partly structured interviews. In accordance with the coping model of Lazarus, the following five different styles of coping by the family were identified: experiencing the disease as challenge, as probation, as misfortune, as fate, and as punishment. The evaluation of patient's, parents', and siblings' attitudes toward the disease and the treatment allows early predictions of their coping behavior. The criteria of the classification of coping styles are described and the implications of their prognostic value for medical compliance are discussed.

[Permanent central venous access in chronically-ill children]

15 patients aged 8 months to 18 years received implanted venous access catheters. Blood sampling and continuous infusions up to 52 days were performed via these devices. The systems were used for 18-166+ days and implanted for 18-635+ days. The complication rate was low and seems to be dependent on the experience of the caretaker. The systems are a valuable addition in the care of chronic sick children and offer new perspectives of therapy.

[Mediastinal liposarcoma in a 14-year-old girl]

Liposarcomas are not frequently found in children or adolescents. An unusual localisation of this tumor was seen in a 14 year old girl. The prognosis of this disease is good in young patients. Surgical resection is the treatment of choice, chemo- and radiotherapy are additional therapeutic modalities.

[Acute isoniazid poisoning]

Acute isoniazid intoxication is characterised by high mortality and vomiting, seizures, coma and metabolic acidosis as main symptoms. Besides isoniazid, its metabolites may also cause neurotoxicity, as demonstrated in a patient. Delayed onset of neurotoxicity should be considered. The therapy of intoxication with special emphasis on high-dose vitamin B6 application is discussed.

[Granuloma formation following intracutaneous administration of procaine-polyvinylpyrrolidone]

After intracutaneous application (dermojet) of procaine polyvinylpyrrolidone (PVP) because of backpain in a 60-year-old woman, multiple brownish-red nodules developed at the injection site within a few days. The histology showed signs of a sarcoid granuloma. There was no clinical evidence for sarcoidosis in this patient. An allergic reaction of the granulomatous type is suspected.

[Role of chemotherapy in the treatment of malignant liver tumors in childhood]

Primary liver tumors in childhood should be resected totally whenever possible. The chances of long term survival of these patients improved considerably since postoperative chemotherapy has become obligatory. In the treatment of primarily inoperable tumors, initial chemotherapy is given to decrease the size of the tumor and thus achieve conditions for complete resection. For hepatoblastomas, chemotherapy should consist of vincristine, cyclophosphamid, adriamycin and actinomycin-D whereas the hepatocellular carcinoma responds best to anthracyclines. The most effective form of their application will have to be established.

Further characteristics of the ATP-stimulated uptake of calcium into chromaffin granules

The ATP-stimulated uptake of 45Ca2+ [and [3H](-)-noradrenaline ([3H]NA)] into chromaffin granules and that into mitochondria are driven by a protonic gradient delta mu H+, composed of the components delta pH (concentration gradient of protons) and delta psi (electrical potential difference). The granular ATPase pumps protons into the matrix (delta pH inside acid, delta psi positive), but the mitochondrial ATPase ejects protons from the matrix (delta pH alkaline, delta psi negative inside). To show different driving forces of uptake, the rate of the ATP-stimulated uptake of 45Ca2+ (and [3H]NA) into chromaffin granules was compared with the rate of the ATP-stimulated uptake of 45Ca2+ into mitochondria (adrenomedullary or rat liver). In the presence of nitrate, the rate of the ATP-stimulated uptake of 45Ca2+ into chromaffin granules is higher than in the presence of acetate, because the lyotropic anion nitrate stimulates the granular ATPase and increases delta pH (acid inside). Compared with nitrate, the rate of the ATP-stimulated uptake of 45Ca2+ into mitochondria is higher in the presence of the proton-carrying anion acetate, which, after permeation, provides protons for ejection by the ATPase. In the absence of ATP, a valinomycin-mediated potassium influx (delta psi inside positive) stimulates the granular uptake of [3H]NA, which has an electrogenic component, but not the granular uptake of 45Ca2+, which is electroneutral. The electrogenic uptake of 45Ca2+ into mitochondria is stimulated by a valinomycin-mediated potassium efflux (delta psi negative inside). The ATP-stimulated uptake of 45Ca2+ into chromaffin granules is sensitive to ruthenium red, suggesting a carrier-mediated mechanism of uptake, and it is sensitive to atractyloside, indicating the simultaneous uptake of ATP. After collapse of delta pH by ammonia, the ATP-stimulated uptake of 45Ca2+ into chromaffin granules is abolished, but not that into mitochondria. In the presence of ammonia, the rate of the ATP-stimulated uptake of [3H]NA is very low, and an ATP-independent uptake of 45Ca2+ into chromaffin granules is observed which is similar to the ATP-independent Ca2+/Na+ exchange at the granular membrane.

Überempfindlichkeitsreaktion gegen VM-26

Life-threatening anaphylactic reactions to VM-26 are rare. In this report two patients with anaphylactic reactions after the first VM-26 applications in the German neuroblastoma therapy protocol GPO-NB-82 are described. After combination of VM-26 with dexamethasone, repetition of these reactions did not occur any more.

Changes in the translational activity of polyadenylated messenger RNA of HL60 promyelocytic leukemia cells associated with myeloid or macrophage differentiation

In order to characterize the events which commit the HL60 human promyelocytic leukemia cell line to differentiate into macrophages or mature myeloid cells, we have analyzed the in vitro [35S]methionine-labeled translational products obtained from polyadenylated messenger RNA of the HL60 cells before and after exposure to: (a) dimethylformamide (DMF), an inducer of myeloid differentiation; (b) 12-O-tetradecanylphorbol-13-acetate (TPA), an inducer of macrophage differentiation; or (c) a combination of the two inducers. Exposure of the HL60 cells to either TPA or DMF results in decreases in the relative abundancy of translational products with molecular weights of 20,000, 17,000, and 15,000. Exposure of the HL60 cells so as to generate macrophage differentiation results in elevations of translational products with molecular weights of 60,000, 47,000, 42,000, 32,000, 27,000, 14,000, and 12,300, while DMF-induced myeloid differentiation is associated with increases in the abundancy of translational products with molecular weights of 60,000, 42,000, 35,000, 32,000, 27,000, 13,000 and 12,300. The addition of the macrophage inducer TPA to HL60 cells previously exposed to the myeloid inducer DMF results in changes in the relative abundance of several translational products, yielding a pattern which differs quantitatively from that obtained from cells treated with DMF or TPA alone. These changes in the relative abundancies of the HL60 translational products suggest that the steady state levels of several different populations of mRNA or the ability of these mRNAs to be translated are being modified during the induction of myeloid or macrophage differentiation in the HL60 promyelocytic leukemia cell line.

Expression of human and mouse nonhistone chromosomal proteins in hybrid mouse erythroleukemia cells containing a single human chromosome

The nonhistone chromosomal proteins of a series of hybrid mouse erythroleukemia cell lines containing human chromosome 16 were investigated by two-dimensional gel electrophoresis to determine if such cells contained nonhistone chromosomal proteins of both human and mouse origin. Comparison of the two-dimensional gel electrophoretograms of the nonhistone chromosomal proteins of mouse and human cell lines showed 400 and 280 chromosomal proteins, respectively, of which about 75% were electrophoretically identical. The two-dimensional gel electrophoretogram of a cloned hybrid mouse erythroleukemia cell line that retained a tetraploid complement of mouse chromosomes and human chromosome 16 (as the only human chromosome) displayed a nonhistone chromosomal protein of pI 6.2 and Mr 65,000. This protein, which comigrates with a nonhistone chromosomal protein present in the human cell line used to produce this hybrid cell and which is also present in two additional human cells lines studied, could not be detected in the mouse erythroleukemia parent before fusion. This polypeptide also was shown by similar techniques to be associated with the presence of human chromosome 16 in four out of five other independently derived hybrid mouse erythroleukemia cell lines that contained a near tetraploid complement of mouse erythroleukemia chromosomes.

Donor toxicity in granulocyte collections: association of lichen planus with the use of hydroxyethyl starch leukapheresis

A normal male volunteer developed lichen planus in association with leukapheresis, with HES used to increase granulocyte yield. Although there is no direct proof of a causative relationship, the temporal association of the onset of initial symptoms and HES infusion strongly supports such a conclusion.

[Kerion celsi. Clinical aspects and pathogenesis of deep trychophytosis of the scalp]

Kerion Celsi (scalp ringworm) is a highly inflammatory, suppurative fungal infection of the scalp caused by zoophilic dermatophytes transmitted from animals to man. The clinical picture extends to patchy infiltrated suppurative lesions in which hairs are broken or eliminated completely. Diagnosis is performed by detection of the organisms in or around the hairs involved and through culture. Kerion Celsi is treated with griseofulvin orally in combination with local symptomatic and antimycotic therapy. In the beginning systemic glucocorticoids might possibly be of help reducing the risk of scar formation and irreversible alopecia.

Active transport of methotrexate from cerebrospinal fluid in humans

The cerebrospinal fluid (CSF) efflux kinetics of methotrexate (MTX) were studied in three patients with indwelling Ommaya reservoirs. A small dose of MTX was injected intraventricularly several hr after the start of a high-dose continuous i.v. infusion of MTX. In all patients, the CSF antifolate concentration returned to the preinjection level before the end of the i.v. infusion. This result indicated that the efflux of MTX from CSF in humans is independent of plasma drug concentrations. Efflux kinetics were further characterized in one patient. Serially obtained CSF samples after intraventricular injections demonstrated a biphasic disappearance curve with alpha- and beta-phase half-disappearance times of 1.7 and 6.6 hr, respectively. Prolongation of the beta-phase half-time was associated with oral acetazolamide medication and with increased intracranial pressure, indicating that inhibition of CSF production slows MTX clearance. CSF MTX concentration, however, declined more rapidly than that of simultaneously administered diethylenetriaminepentaacetic acid, an extracellular marker substance excreted by bulk flow, indicating that bulk flow excretion alone is insufficient to account for MTX efflux from human CSF. Evidence that there is an active transport component was provided by probenecid pretreatment which also prolonged the CSF MTX half-life. These findings suggest that both passive and active mechanisms govern MTX efflux from the CSF in humans and that they can be inhibited by acetazolamide and probenecid, respectively.

Isolation of hybrid cell clones that contain deletion and non-deletion defects of alpha-thalassemia in man

We have succeeded in isolating hybrid mouse erythroleukemia cell clones from a patient with hemoglobin H disease, which exhibit either deletion or nondeletion mutations of the human alpha-globin genes. Analysis of one of these hybrid clones that had retained a human chromosome 16 from the patient's cells showed that both human alpha-globin had been deleted. Several clones of another hybrid cell had retained a human chromsome 16 from the patient's cells, which contained both human alpha-globin genes on an EcoRI fragment of 23 kilobases (kb). These latter hybrid clones showed the presence of human alpha-globin chains at detectable but low levels. These studies show that there are two different types of human chromosome 16 in this patient and that the nondeletion mutation of human alpha-globin genes leading to hemoglobin H diseases in this patient acts in cis to the two alpha-globin genes remaining in his cells. The close correlation between the pattern of human alpha-globin gene expression in the patient and in the hybrid cells suggests that this method of transfer of human globin genes to rodent cells will be a useful one for study of mutations affecting the expression of differentiated genes that lead to disease in man.