Effects of 13-cis retinoic acid and Ara-C on differentiation and proliferation of non-promyelocytic acute myelogenous leukemia

An alternative to a cell-kill strategy for eradication of acute myelogenous leukemia, is to restore normal differentiation. Vitamin A derivatives demonstrate differentiation-inducing activity both in vitro and in vivo on promyelocytic leukemic cells. We tested the ability of 13-cis retinoic acid to reduce proliferation and induce differentiation in 10 samples from patients with acute non-promyelocytic leukemia. DNA synthesis and leukemia colony formation were affected to varying degrees by a prolonged exposure to the vitamin A compound. Morphologically and cytochemically no differentiation was determined either after 48 h in suspension cultures or 7 additional days in semi-solid cultures. Alkaline leukocyte phosphatase, a biochemical marker of differentiation, was significantly increased in five samples. DNA synthesis in these samples was significantly reduced as compared to samples failing to express alkaline leukocyte phosphatase following 13-cis retinoic acid treatment. DNA synthesis of these same 5 samples was also strongly inhibited by Ara-C. Expression of alkaline leukocyte phosphatase following 13-cis retinoic acid exposure may be a useful indicator for cells amenable to 13-cis retinoic acid or Ara-C treatment.

[Sonographic evaluation of drainage relations following antireflux operations in childhood]

The judgment of the passage conditions after operations on the ureter and the kidney is of great importance. The sonography as "diagnostics of choice" allows an exact, non-invasive continuous control of the passage of urine in the early postoperative phase and in the kidney dispensary. On a larger number of patients is examined, which value this method obtains in the postoperative diagnostics. With the help of a subdivision of the disturbances of the transport of urine according to sonographic criteria an exact judgment is possible and restricts the use of radiological methods to cases with pathological sonographic findings.

Clinical experience with preoperative chemotherapy for osteosarcoma

Since 1978 preoperative chemotherapy has been administered to 15 consecutive patients with osteosarcomas in Zurich. Preoperative chemotherapy was acceptably well tolerated and did not impair surgical procedures. Our retrospective analysis confirmed that the extent of necrosis after preoperative chemotherapy is of biological importance for the further course of the disease. Patients with extensive necrosis had better relapse-free survival and longer overall survival than those with little necrosis.

Ultrasonic diagnosis of the spleen

The sonographic presentation of the spleen may be difficult and is seldom requested. Main indications for special investigation are traumatic lesions, malignant diseases, such as Hodgkin's or non-Hodgkin's lymphomas, and changes in portal hypertension.

Drug selection for perioperative chemotherapy

A wide variety of tumor types can be successfully grown with the clonogenic assay. However, few tumor types perform adequately for routine drug sensitivity testing, e.g., ovarian carcinoma and malignant melanoma. Because of insufficient in vitro growth, the cloning system cannot help substantially in indicating active substances for epidemiologically frequent tumors that usually have a poor prognosis, such as colorectal cancers and non-small cell lung and breast cancers. The degree of in vitro cell kill that would correspond to complete eradication of micrometastases is unknown. The identification of individual patients sensitive to a given antineoplastic agent becomes more difficult as the tumor becomes more refractory to treatment. At this moment, the clonogenic assay appears most promising for trials dealing with the treatment of ovarian adenocarcinoma.

The expression of human interferon alpha genes

We have determined the levels of mRNAs for IFN-beta, IFN-gamma and various alpha-IFNs (IFN-alpha 1, -alpha 2, -alpha 4, -alpha 5, -alpha 6, -alpha 7, -alpha 8 and -alpha 14) in normal and leukaemic human blood leucocytes and several cell lines induced in different fashions. The ratio of alpha to beta IFN transcripts varied greatly, depending on the cell type. The levels of the individual IFN-alpha RNAs were very different: IFN-alpha 1, -alpha 2 and -alpha 4 RNAs constituted the major fraction of the IFN-alpha transcripts measured, while IFN-alpha 6, -alpha 7, -alpha 8 and -alpha 14 were minor components in normal, induced leucocytes. Moreover, there was a striking difference in the proportion of individual IFN-alpha mRNA species in different cell types, in particular between normal and leukaemic cells; for example all cases of myeloblastic leukaemia examined showed a high expression of IFN-alpha 14. Use of different induction protocols did not significantly affect the proportion of IFN mRNAs. Analysis of the human IFN-alpha 1 gene by reversed genetics led to the identification of a segment of 5' flanking sequence between positions 117 and 68 upstream of the cap site which is required for inducibility by virus.

The effects of interferon on granulopoiesis in vitro

Colony formation by myeloid progenitor cells (CFU-c) in agar was inhibited to the same extent by heterogeneous human leucocyte IFN (IFN-Le) and 2 different cloned IFN-alpha 2 preparations, but approximately 10 times less by cloned IFN-alpha 1; cluster formation remained unaffected by any of the interferons. An anti-proliferative effect is suggested by both lower cell yield and DNA synthesis in IFN containing liquid cultures. Incubation of cells with IFN for 18 h prior to plating with colony stimulating factor (CSF) reduced colony formation, indicating an altered responsiveness of CFU-c to CSF. In IFN treated cultures no consistent block of morphological differentiation occurred, but granulocyte alkaline phosphatase activity was reduced. Thus, IFN may play a modulatory role on functional markers. Our results indicate that the effects observed with heterogeneous preparations are due to IFN and not to impurities and that various differentiation parameters are unequally affected by IFN.

Phase II study of doxifluridine in advanced colorectal adenocarcinoma

Doxifluridine, a new fluoropyrimidine derivative, was tested in a cooperative phase II trial by the Swiss Group for Clinical Cancer Research in advanced measurable colorectal cancer. The drug was given in a five consecutive day schedule by a bolus intravenous injection at a dose of 4 g/m2 per day and repeated every three to four weeks. Of 42 eligible patients, 40 had no previous chemotherapy. Response was defined in 27 patients having received two or more courses of doxifluridine. Seven responses (26%) were observed. Responses were seen only in sigmoid and rectum primary tumors. Toxicity consisted mainly of leukopenia (53% of the evaluable patients), nausea and vomiting (38%). Other toxicities such as dermatitis, myocardial injury, and hair loss were also observed. Doxifluridine has therapeutic activity, albeit limited, in advanced rectosigmoid adenocarcinoma.

[Prenatal ultrasonic diagnosis of malformations and their surgical consequences--a new chapter in pediatric surgery]

The importance of antenatal diagnosis of malformations for the paediatric surgeon is highlighted on the basis of the authors' own studies. Among 34000 examinations of pregnant women we found 40 malformations (0.1%), 12 of which were surgically corrected postnatally: 6 malformations of the urinary tract, 3 intestinal atresias, 2 ovarian cysts and 1 hydrocephalus. 6 cases are described in greater detail in consideration of the special problems involved. It is stated that today practically all gross malformations can be recognised prenatally. There are three groups as follows, with their pertaining consequences: non-viable, immediate surgical correction, and postponed need for immediate intervention. The necessity of close co-operation between gynaecologist, neonatologist and paediatric surgeon is stressed, as well as the need for including the parents in the consultations. Prognosis of correctable malformations can be improved by termination of birth and immediate interdisciplinary care of the newborn.

[The Zurich experience with preoperative high-dose methotrexate in osteosarcomas]

15 consecutive patients with osteosarcoma underwent preoperative chemotherapy with high dose methotrexate (HDMTX) containing regimens according to the T7 or T10 protocols of ROSEN, Preoperative chemotherapy was well tolerated and did not impair surgical procedures. 67% of the patients responded clinically with reduction of pain and tumor size. Histologic examination of the tumor after preoperative chemotherapy revealed extensive necrosis in 53% of patients. In a retrospective analysis, patients with extensive necrosis (group B) were compared with those with little or no necrosis (group A). Patients from group B had a longer relapse free and overall survival period than group A. In addition, patients of group A had significantly higher initial levels of alkaline phosphatase than group B. The incidence of a 2.5-fold increase of the transaminases 2-3 days after HDMTX was significantly greater in patients of group B compared to group A. In the absence of documented necrosis after chemotherapy according to the T7 or T10 protocols, further use of HDMTX is not indicated. New aspects on the treatment of osteosarcoma, derived from recent publications, are discussed.

Repeated occurrence of skin necrosis twice following coumarin intake and subsequently during decrease of vitamin K dependent coagulation factors associated with cholestasis

A female patient is described who developed skin and subcutaneous fat necrosis on two occasions after intake of acenocoumarol. Several months later identical skin changes occurred during an episode of cholestasis associated with a prolongation of the prothrombin time to an extent comparable with therapeutic anticoagulation; intake of oral anticoagulants could be excluded. This association gives new insights in the pathogenetic mechanisms responsible for the so-called coumarin necrosis and indicates that it may be not due to drug toxicity or allergy.

[Monoclonal gammopathies of undetermined significance]

In the majority of monoclonal gammopathies it is not possible to demonstrate an association with an underlying disease related to multiple myeloma, Waldenström's macroglobulinemia, malignant lymphoma or amyloidosis. After a lapse of months to years, however, some patients will develop one of the diseases mentioned. Since no test can identify patients at risk, periodic controls of the M-component are necessary.

Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high-dose intravenous gamma globulin

Since recent observations indicate that treatment with high-dose intravenous polyvalent intact immunoglobulin leads to a rapid reversal of thrombocytopenia in the idiopathic thrombocytopenic purpura (ITP) of childhood, we decided to apply this treatment to adults with ITP and to test the possibility that the effect of the immunoglobulin might be attributable to transient blockade of the reticuloendothelial system. Using sequential clearance studies of autologous 99mTc-labeled and anti-Rh(D)-sensitized erythrocytes in four adults with ITP who were treated with total doses of 1 to 1.5 g of immunoglobulin per kilogram of body weight, we found that a transient rise in platelet counts to normal levels within four to five days was accompanied by a marked temporary prolongation of the immune-particle clearance time. These data suggest that commercial intravenous immunoglobulin preparations may interfere with phagocyte Fc-receptor-mediated immune clearance. Since platelets in ITP treated with immunoglobulin were fully hemostatic, this type of therapy may allow surgical procedures to be performed safely in patients with this disease.

Fibrin aggregation before sol-gel transition

Fibrinogen solutions (concentrations 2 mg/ml, 0.15-M Tris-NaCl buffer, pH 7.4) were incubated at 20 degrees C with quantities of reptilase or thrombin that were so small that the polymerization process could be followed for several hours by means of static and dynamic light scattering. The scattered intensity and its correlation function were recorded at scattering angles between 30 degrees and 150 degrees. The measured data were compared with model calculations based on the Flory-Stockmayer distribution, which predicts a sol-gel phase transition. This distribution is characterized by a parameter, lambda, that indicates the extent of aggregation. lambda = 0 corresponds to the monomeric solution, and lambda = 1 indicates the sol-gel transition. Good agreement was found for monomeric units of 75-nm length aggregating (a) end-to-end in the early stage (0 less than or equal to lambda less than or equal to 0.3), and (b) in a staggered overlap pattern for the progressing polymerization (0.3 less than or equal to lambda less than 1). Before the gel point was reached, no systemic difference was observed between the data obtained after activation with thrombin which releases both fibrinopeptides A and B from fibrinogen, and reptilase, which exclusively releases the fibrinopeptides A. This confirms that the release of the fibrinopeptides A is the essential prerequisite for the aggregation process.

[Ultrasonographic (B-scan) studies of the skull in childhood (author's transl)]

The technical and diagnostic possibilities of two-dimensional echoencephalography in newborns and infants are described. The technique is simple, easy to carry out and avoids irradiation. Real-time ultrasound gives a quick general view of the ventricular system while the details are best performed with a compound scan procedure, 310 investigations in 93 patients are analysed and presented. Sonography should now be the first investigation in infants with possible intracranial lesions. The investigation is particularly valuable in the post-operative control and follow-up of treated hydrocephalus. The most important limitation of the technique is the increasing sound deflection as the ossification of the skull proceeds.

Drug resistance in multiple myeloma associated with high in vitro incorporation of 3H-thymidine

In multiple myeloma, tumor cell mass and labeling index correlate with subsequent survival duration, but do not predict for response to treatment. In the present study was have autoradiographically measured the incorporation of 3H-thymidine as determined by the number of grains over the myeloma nuclei in bone marrow aspiration samples. In 33/37 patients with less than 50% tumor regression or progressive disease, the pretreatment grain count was greater than or equal to 20/myeloma nucleus. Conversely, values of less than 20 were found in 27/29 patients who had greater than or equal to 50% cell mass reduction. Survival duration was significantly better than (p less than 0.001) in patients with grain counts less than 20. Sixty percent of the patients with both a low labeling index (less than or equal to 3%) and grain count (less than 20) were alive at 48 mo, whereas 15/17 patients with a high labeling index and grain count had a median survival of less than 6 mo. In a subset of 22 patients, there as a significant correlation between in vitro resistance to melphalan, adriamycin, and vincristine as tested in the myeloma stem cell colony assay system and a grain count of greater than 20. We can only speculate as to the reasons for the increased 3H-thymidine uptake by myeloma cells resistant to treatment, however, it could be associated with accumulation of excess DNA and /or increased unscheduled DNA synthesis following injury from alkylating agents.

[Ultrasonic diagnosis of vesico-ureteral reflux in children]

The ultrasound diagnostics in the vesico-ureteral reflux makes possible: 1. The exact determination of various parameters of the reflux kidney (breadth of parenchyma, size of the kidney, pyelon). 2. In cases of reflux 3.--5. degrees the direct representation by filling of the bladder. 3. The full postoperative judgment of the condition of defluxion, which is of great value in risk patients. 4. The long-term control within the renal dispensary for the exclusion of late stenosations and the morphological judgment of the further development of the kidney. The postoperative intravenous urogramme is restricted to those cases which are sonographically conspicuous. The control MCU of the reflux recidivation will further be necessary.