Inhibitory effect of nuts on iron absorption

The effects on iron absorption of nuts, an important source of dietary protein in many developing countries, were measured in 137 Indian women. When the absorption from bread and nut meals (walnuts, almonds, peanuts, and hazelnuts) was compared with that from bread meals, the overall geometric mean absorption from the nut meals (1.8%) was significantly less than from the bread meals alone (6.6%, t = 9.8, p less than 0.0005). In contrast, coconut did not reduce absorption significantly. All the nuts tested contained significant amounts of two known inhibitors of Fe absorption (phytates and polyphenols) but the amounts in coconut were significantly less than in the other nuts. Fifty milligrams ascorbic acid overcame the inhibitory effects of two nuts that were tested (Brazil nuts and peanuts). This is different from that found previously for soy protein, another potent inhibitor of Fe absorption.

Neutrophil lactoferrin content in viral infections

In an attempt to elucidate the previously observed decrease in plasma lactoferrin-neutrophil ratio in subjects with acute viral infections, a study of the neutrophil lactoferrin content in such infections was undertaken. With the use of an immunoperoxidase stain for lactoferrin, neutrophils in viral illness were shown to have reduced lactoferrin content (mean score 97.9 +/- SD [38.0] per 100 neutrophils) as compared with normal subjects (mean score 196.4 +/- SD [3.6] per 100 neutrophils) (t = 7.69; P less than 0.0005). This suggests an acquired defect of neutrophil lactoferrin synthesis in viral infection. This finding is of importance when seen against the well-recognized increased risk of bacterial superinfection in subjects who have recently had a viral infection.

Platelet parameters. Part II. Platelet volume-number relationships in various normal and disease states

The relationship between mean platelet volume (MPV) and platelet count was evaluated in 259 patients with rheumatoid arthritis and 311 patients with various haematological disorders. Platelet volume-number relationships determined in a previous study on normal subjects were used as a reference range. There was a significant inverse relationship between MPV and platelet count in patients with rheumatoid arthritis (r = -0.49; P less than 0.0001), which by interval analysis was shown to be non-linear. In the patients with haematological disorders, the platelets were found to be disproportionately small for number in patients with aplastic anaemia, chemotherapy-induced marrow suppression and some cases of acute idiopathic thrombocytopenic purpura (ITP). In subjects with chronic ITP followed longitudinally, the inverse platelet volume-number relationship was retained. MPV was appropriate for platelet number in myelodysplastic syndromes, variable in iron deficiency anaemia and disproportionately large in myeloproliferative syndromes, most notably in agnogenic myeloid metaplasia. The observation that the MPV was disproportionately large in comparison with the platelet count was used in establishing the diagnosis of an hereditary giant platelet syndrome in a family of British origin.

Ocular reticulum cell sarcoma. A case report

A case of ocular reticulum cell sarcoma (RCS) is described. Its relationship to systemic and central RCS and the eye signs, pathology and treatment are discussed. The importance of early diagnosis is stressed and vitreous biopsy should be considered in any unexplained vitritis in patients over the age of 40 years. Chemotherapy should be added to the usual dosage of radiation and may improve the survival period.

Platelet parameters. Part I. Platelet counts and mean platelet volume in normal and pregnant subjects

Platelet counts and mean platelet volume (MPV) were studied in 564 normal subjects and 297 pregnant women using a Coulter Model S-Plus electronic counter. The reproducibility of these measurements both intra- and inter-sample was documented. The mean platelet count in the normal group was 283 x 10(9)/l while the mean MPV was 9.32 fl. An inverse correlation between platelet volume and platelet number was documented (r = -0.38; P less than 0.0001). By interval analysis, this inverse relationship was shown to be non-linear. In the pregnant subjects there appeared to be a progressive decrease in platelet count with advancing gestation; this reached a significant level when the first and third trimesters were compared with each other (P less than 0.05). The MPV was unchanged. The fact that the platelet count decreased in proportion to the red cell count suggested that a common factor, such as haemodilution, was in part responsible. There was again an inverse relationship between MPV and platelet number (r = -0.39; P less than 0.0001) shown to be non-linear by interval analysis.

Lectin binding in human breast cancer: clinical and pathologic correlations with fluorescein-conjugated peanut, wheat germ and concanavalin A binding

Cell surface glycoconjugates of human breast cancer tissue were investigated using FITC peanut (PNA), wheat germ (WGA) and jackbean (concanavalin A; Con A) agglutinins. Although PNA and WGA binding patterns differed when normal and malignant breast tissues were compared, the specificity of this finding was poor and neither PNA nor WGA binding correlated with oestrogen receptor status or clinical outcome. Con A binding on the other hand was not seen in normal breast tissue. The percentage of Con-A-positive (Con A+) tumours increased progressively with advancing stage (16% Con A+ in stage I, 40% Con A+ in stage III) and there was a trend towards longer disease-free survival of patients with Con A- as compared to those with Con A+ tumours. However, in a multivariate analysis it was found that these differences were explained by the association with the stage of the disease.

Subacute myelopathy: an unusual paraneoplastic complication of Hodgkin's disease

We report a case of Hodgkin disease presenting with a subacute myelopathy without evidence of metastatic involvement of the spinal cord. The systemic disease responded to conventional chemotherapy, but the myelopathy only improved after intrathecal dexamethasone was added to the treatment program, beta-2-microglobulin levels in the cerebrospinal fluid were elevated at presentation. Following the use of intrathecal corticosteroids there was a decrease of CSF beta-2-microglobulin levels. The possible significance of these findings is discussed.

Treatment of hairy cell leukaemia with recombinant alpha-interferon

Of 10 patients with hairy cell leukaemia treated with 3 mU recombinant alpha-interferon daily, 9 showed clinical haematological response--including 2 patients who achieved complete remission. Unmaintained responses have continued for as long as 18+ months after completion of therapy. There was no significant toxicity associated with this treatment schedule.

Metastases of prostate cancer to breast. A case report

A case of carcinoma of the prostate metastasising to the breast and mimicking breast cancer in a male is presented. The possibility of this diagnosis should always be considered. The usefulness of cytochemical staining for prostate-specific acid phosphatase is illustrated.

Use of mitoxantrone-based combination chemotherapy regimens as first-line treatment for advanced breast cancer

Three first-line combination chemotherapy regimens which included mitoxantrone were studied for the treatment of advanced breast cancer. The first combination, consisting of methotrexate, mitoxantrone (Novantrone) and 5-fluoro-uracil (MNF), gave a response rate of 17/48 (35%). Cyclophosphamide + mitoxantrone (CN) gave a response rate of 20/31 (64%) while cyclophosphamide + mitoxantrone + vincristine (CNV) gave a response rate of 28/39 (72%). The response durations for the three regimens were 6 months for MNF, 7.5 months for CN and 11.5 months for CNV. The regimens were well tolerated with an approximately equal frequency of side-effects. Cardiotoxicity was infrequent, occurring in only 2 patients out of 118 studied.

Immunologic investigation of recurrent pregnancy loss and consequences of immunization with husbands' leukocytes

A significant association was found between absence of cytotoxicity to husbands' lymphocytes and of MLC suppression, both of which were absent more commonly in primary than secondary abortion. Following immunization with husbands' leukocytes, systemic side effects were common and cytotoxicity became positive in all but two of eight women tested, both of whom also failed to develop MLC suppression.

Breast cancer in men. Clinical features, hormone receptor status, and response to therapy

Stage, estrogen receptor status, treatment and survival of 29 men with breast cancer attending the Breast Clinic of the Johannesburg Hospital between 1976 and 1985 are reviewed. Most patients had locoregionally advanced disease at presentation. Estrogen receptors (ER) were detected in significant concentration in 15/23 (65%). Local control was achieved in the majority, 19/26 (73%), by either surgery or radiation therapy alone or by combined modality treatment. Fifteen of 23 patients tested (65%) were ER-positive (greater than 10 fmol/mg protein). For patients with metastatic disease hormone receptor status was predictive of response to hormonal manipulation. Tamoxifen was the most acceptable and frequently used form of hormone therapy with 7/12 patients responding. Combination chemotherapy gave a response rate comparable to that seen in women with breast cancer.

Apotransferrin receptors and the delivery of iron from cultured human blood monocytes

A study was done to find out whether apotransferrin receptors are involved in the release of iron from reticuloendothelial cells. To this end, human macrophages which had been obtained by culturing blood monocytes for 7 days were incubated with either diferric or apotransferrin at the physiological pH of 7.4 or at an acidic pH (6.0). While specific diferric transferrin receptors (Kd 1.3 X 10(-8) M) were demonstrated at pH 7.4, no apotransferrin receptors were found. In contrast, both diferric receptors (Kd 2.1 X 10(-8) M) and apotransferrin receptors (Kd 6.8 X 10(-9) M) were found at pH 6.0. The findings of specific apotransferrin binding at acidic pH fits in with the current understanding of iron uptake by cells, in which the iron-transferrin complex is endocytosed and the iron is released at acidic pH. The present results suggest that the apotransferrin remains attached to its receptor in the endocytosed vesicle at this acidic pH but that it becomes detached at the cell surface where the pH is neutral. No evidence was found to indicate that iron is transported out of macrophages via apotransferrin receptors at the physiological pH.

Radioisotopic flow scanning for portal blood flow and portal hypertension

The use of a simple, noninvasive, isotope scanning technique for the determination of relative portal blood flow and detection of portal hypertension is described. Using this technique the presence of portal hypertension was demonstrated in seven of nine patients known to have elevated portal venous pressure. By contrast, esophageal varices were demonstrated in only five of these patients, illustrating the potential value of the method. Furthermore, this technique has been adapted to the study of portal blood flow in patients with myeloproliferative disorders with splenomegaly but without disturbances in hepatic architecture. Results demonstrate that the high relative splenic flow resulting from the presence of splenomegaly may in turn be associated with elevated relative portal blood flow and portal hypertension. The theoretic reasons for the development of flow-related portal hypertension and its relationship to splenic blood flow are discussed.

Use of aminoglutethimide for the treatment of advanced breast cancer. Clinical correlations with previous treatment, oestrogen-receptor and menstrual status

In a study of 118 patients with advanced breast cancer treated with aminoglutethimide plus hydrocortisone replacement the overall objective response rate was 42 (36%). Response was not determined either by the nature or the extent of previous treatment, including endocrine therapy and/or chemotherapy, nor by oestrogen-receptor status. The vast majority of patients who responded were postmenopausal but a complete response was seen in a premenopausal patient with skin metastases. Aminoglutethimide is useful in the second-line treatment of postmenopausal subjects with advanced breast cancer.

Reactive thrombocytosis in pulmonary tuberculosis

The incidence of reactive thrombocytosis in active pulmonary tuberculosis was studied in 122 patients. Thrombocytosis was common, platelet counts often exceeding 1 X 10(12)/1. A significant inverse correlation was noted between the mean platelet volume and the platelet count (r = -0.54, p less than 0.0001). Interval estimation suggested that this relation was non-linear. Further studies were done in a small group of six patients. Platelet survival was considerably shortened, the platelets aggregated excessively in vitro, serum concentrations of thrombopoiesis stimulating activity were raised, and serotonin uptake and release were within normal limits. The degree of thrombocytosis correlated significantly with the degree of inflammation measured by the erythrocyte sedimentation rate (r = 0.40, p less than 0.003) and serum C-reactive protein concentration (r = 0.35, p less than 0.008).

Idiopathic haemochromatosis. Family studies and results of a pilot prevalence survey

HLA typing for the A and B loci was carried out in conjunction with measurements of iron status on 38 of the first-degree relatives of 8 patients suffering from idiopathic haemochromatosis (IHC). Seven of the 8 probands had the A3 allele, 2 in the homozygous form. Seven had the B7 allele and in 5 it was present with the A3 allele on the same chromosome. Six family members were diagnosed as homozygous for the HLA-linked iron-loading gene on the basis of genotype assessment, while 27 were assessed as being heterozygous. Five of the 6 homozygous subjects had developed significant iron overload. In contrast, disturbances of iron metabolism in the heterozygotes were mild and present in only 33%. Pseudodominant inheritance of IHC was noted in one family, presumably as the result of a homozygous/heterozygous mating. A pilot epidemiological survey was carried out on 222 Afrikaans-speaking men in an attempt to find affected individuals using the serum ferritin concentration as the screening test. One homozygous subject was identified (genotype A3, B7/A3, B7) and further family studies confirmed the presence of the HLA-linked iron-loading gene. These preliminary results suggest a disease frequency of about 4-5/1,000 in the Afrikaner population.

The effects of fruit juices and fruits on the absorption of iron from a rice meal

The effects of the chemical composition of fruit juices and fruit on the absorption of iron from a rice (Oryza sativa) meal were measured in 234 parous Indian women, using the erythrocyte utilization of radioactive Fe method. The corrected geometric mean Fe absorptions with different juices varied between 0.040 and 0.129, with the variation correlating closely with the ascorbic acid contents of the juices (rs 0.838, P less than 0.01). Ascorbic acid was not the only organic acid responsible for the promoting effects of citrus fruit juices on Fe absorption. Fe absorption from laboratory 'orange juice' (100 ml water, 33 mg ascorbic acid and 750 mg citric acid) was significantly better than that from 100 ml water and 33 mg ascorbic acid alone (0.097 and 0.059 respectively), while Fe absorption from 100 ml orange juice (28 mg ascorbic acid) was better than that from 100 ml water containing the same amount of ascorbic acid (0.139 and 0.098 respectively). Finally, Fe absorption from laboratory 'lemon juice' (100 ml orange juice and 4 g citric acid) was significantly better than that from 100 ml orange juice (0.226 and 0.166 respectively). The corrected geometric mean Fe absorption from the rice meal was 0.025. Several fruits had little or no effect on Fe absorption from the meal (0.013-0.024). These included grape (Vitis vinifera), peach (Prunus persica), apple (Malus sylvestris) and avocado pear (Persea americana). Fruit with a mild to moderate enhancing effect on Fe absorption (0.031-0.088) included strawberry (Fragaria sp.) (uncorrected values), plum (Prunus domestica), rhubarb (Rheum rhaponticum), banana (Musa cavendishii), mango (Mangifera indica), pear (Pyrus communis), cantaloup (Cucumis melo) and pineapple (Ananas comosus) (uncorrected values). Guava (Psidium guajava) and pawpaw (Carica papaya) markedly increased Fe absorption (0.126-0.293). There was a close correlation between Fe absorption and the ascorbic acid content of the fruits tested (rs 0.738, P less than 0.0001). There was also a weaker but significant correlation with the citric acid content (rs 0.55, P less than 0.03). Although this may have reflected a direct effect of citric acid on Fe absorption, it should be noted that fruits containing citric acid also contained ascorbic acid (rs 0.70, P less than 0.002).(ABSTRACT TRUNCATED AT 400 WORDS)

Factors influencing the absorption of iron from soya-bean protein products

The absorption of iron from soya-bean (Glycine hispida)-based and milk-based infant formulas was assessed in 138 multiparous Indian women, using the erythrocyte utilization of radioactive Fe method. Fe absorption was significantly greater from the basal milk formula (1.5 g protein) than it was from the basal soya-bean formula (2.3 g protein), with geometric mean values of 0.083 and 0.044 respectively. Ascorbic acid markedly increased Fe absorption from the milk-based formula in a dose-dependent fashion. The increase was fivefold when the ascorbic acid:Fe ratio on a weight-for-weight basis was 6:1 and over tenfold when it was 20:1. In contrast, ascorbic acid had a less-marked effect on the absorption of Fe from the soya-bean-based formula, with only a two- to threefold increase at an ascorbic acid:Fe ratio of 20:1. The geometric mean Fe absorption from the soya-bean formula (1.27 mg Fe, 2.3 g isolated soya-bean protein (ISP] was somewhat less than that from the same amounts of ISP and ascorbic acid made up in milk (0.075 and 0.113 respectively). However, a direct comparison between the soya-bean formula in milk and in water showed no significant difference (0.043 and 0.060 respectively). Fe absorption from a drink containing 10 g ISP and 30 mg ascorbic acid was significantly better than that from a similar drink containing the soya-bean flour from which ISP is extracted (0.044 and 0.027 respectively). Heating ISP to 200 degrees for 2 h before its use had no effect on Fe availability.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma C-peptide and insulin responses to intravenous glucagon stimulation in idiopathic haemochromatosis

Beta-cell reserve was investigated in 15 patients with proven idiopathic haemochromatosis (IHC) (7 normoglycaemic haemochromatotic patients, 4 non-insulin-requiring diabetics and 4 insulin-requiring diabetics) by measuring the response of plasma C-peptide, insulin and glucose to a 2 mg intravenous bolus of glucagon, and compared with that in 5 lean normal subjects. The corresponding C-peptide/insulin molar ratios were also calculated. Despite the significant fasting hyperglycaemia in the insulin-requiring haemochromatotic diabetics, mean fasting C-peptide concentrations were similar in all four groups. However, after glucagon stimulation the C-peptide response was significantly reduced in the insulin-requiring group over the whole period of observation. A trend in insulin response to glucagon was noted, with the highest values in the non-diabetic haemochromatotic patients, followed by the controls and then by the non-insulin-requiring diabetics, although there were no significant differences. In contrast, C-peptide/insulin molar ratios after glucagon were significantly reduced in the normoglycaemic IHC group. These results suggest the presence of at least two abnormalities of insulin metabolism in IHC--a progressive reduction in beta-cell function and a diminished rate of removal of insulin by the liver.

B-cell chronic lymphatic leukemia in Hodgkin's disease. A report of two patients with unusual chromosome features

The development of B-cell chronic lymphatic leukemia in two patients who had previously been treated for Hodgkin's disease is described. In both cases aneuploidy and multiple chromosome aberrations of hemopoietic cells were evident. In one patient these changes included a clonal 14q + abnormality in association with other complex rearrangements, interpreted as translocation abnormalities involving t(6;14), 5(1;15), and t(17;19). Although the chromosome abnormalities in the other patient were nonclonal, a 14q abnormality also was detected, namely t(14q+;18q-). Other chromosome abnormalities (all nonclonal) in the two patients included translocations involving chromosome 5 and deletion of 7q in one patient and trisomy of chromosome 8 in the other. Although these abnormalities have been associated with the presence or development of non-Hodgkin's lymphoma, acute nonlymphoblastic anemia, or myelodysplastic disorders, the findings in these patients suggest that the detection of clones and potential clones with these abnormalities may be only one stage in the development of secondary malignancy.

Hematologic and iron-related measurements in rheumatoid arthritis

The hematologic status of 265 patients with rheumatoid arthritis was assessed. In the group as a whole, a mild depression in the hemoglobin concentration and mean cell volume (MCV) was associated with an increase in the red blood cell distribution width (RDW), erythrocyte sedimentation rate (ESR), and platelet count. Bone marrow trephine biopsies and further measurements of iron status and disease activity were done in [a further] 38 more anemic patients, and the findings in those with absent marrow iron (iron deficiency) were compared with those having stainable stores (anemia of chronic disorders). The RDW was raised in both, and there was no significant difference between the two groups. The concentrations of nonheme iron in the marrow and of serum ferritin were significantly lower in the iron-deficient group, but the geometric mean serum ferritin of 34 micrograms/L was still a good deal higher than that associated with uncomplicated iron deficiency. This was presumably because of the fact that the serum ferritin, which was significantly correlated with the ESR (r 0.55; P less than 0.0004) and C-reactive protein (CRP) r 0.41; P less than 0.01), was also functioning as an acute phase protein. While there was a weak correlation (r 0.37; P less than 0.04) between the marrow nonheme iron and the serum ferritin concentrations, it disappeared when nonactive patients with normal CRP concentrations were excluded. The absence of a correlation is unlike the findings that have previously been noted in other chronic inflammatory conditions and in neoplasia. This raises the possibility that serum ferritin concentrations in rheumatoid arthritis may reflect, in part at least, another store of iron located in affected joints.

Hematologic, iron-related, and acute-phase protein responses to sustained strenuous exercise

This study was undertaken to gain insight into the mechanisms responsible for the hypoferremia occurring after severe exercise. To this end, 18 athletes who were competing in a 160-km triathlon involving canoeing, cycling, and running were evaluated before the race, immediately after the finish, and thereafter at 30 min, 24 h, and 48 h. The evaluation included plasma iron, total iron-binding capacity, lactoferrin, ferritin, haptoglobin, cortisol, various enzymes, and white cell count. The cortisol, white cell count, and lactoferrin were significantly increased immediately after the race, while the plasma iron and transferrin saturation were significantly decreased. There was a 40% but nonsignificant rise in the plasma ferritin at the completion of the race, while the C-reactive protein was raised by nearly 300% at 24 h. In contrast, haptoglobin declined significantly by 24 h but was normal again 24 h later. Quantitative considerations suggested that the lactoferrin was not responsible for removing transferrin iron from circulation and hence causing the hypoferremia. Instead, it seemed more likely that the iron-related changes were occurring as part of an acute phase response initiated by muscle injury.

Combination chemotherapy of hepatocellular cancer. Comparison of adriamycin + VM 26 + 5-fluorouracil with mAMSA + VM 26 + 5-fluorouracil

Forty-seven patients with hepatocellular cancer were treated in a randomised trial comparing adriamycin + VM 26 + 5-Fluorouracil (5-FU) to mAMSA + VM 26 + 5-FU. Thirteen patients had a partial response to treatment (28%) and another 6 (13%) showed disease stabilisation. There were no significant differences in the response rates between the two treatment regimens. Patients who responded to treatment showed significant prolongation of survival (48 weeks) when compared to non-responders (5 weeks).

Relationship between absorption of inorganic and food iron in field studies

Food iron absorption data on 853 Indian women were compared to the haemoglobin concentrations, other iron-related measurements and the absorption of a reference dose of 3 mg iron given as ferrous ascorbate. The serum ferritin concentration was identified as the best predictor of the absorption of the reference dose (r = -0.54, p less than 0.0001). These two measurements were then compared in terms of their relative ability to predict the absorption of iron from 10 individual meals. Results were comparable, with correlations for the pooled data of -0.50 (p less than 0.0001) for the serum ferritin and 0.47 (p less than 0.0001) for the reference dose. Since serum ferritin is a simple and non-invasive test, it may represent the more satisfactory way of standardising food iron absorption results to a common iron status in field studies. However, the value of such an approach is limited by the wide confidence limits of the relationship between food iron absorption and both the other measurements.

Correlation of breast tumour aromatase activity and response to aromatase inhibition with aminoglutethimide

Tumour aromatase, oestrogen (E) and progesterone (P) receptor (R) measurements were carried out in biopsies from 29 patients with advanced or recurrent breast cancer. Patients were then treated with aminoglutethimide according to one of two dosage regimens: (a) aminoglutethimide 1000 mg/day + hydrocortisone 20 mg/day, and (b) aminoglutethimide 250 mg/day. Tumour aromatase values varied from 0.05 to 2.07 pmol ER produced/mg protein/h and ER and PR values from less than 1 to 249 and less than 1 to 132 fmol of steroid bound/mg protein, respectively. There was no correlation between aromatase values and either ER or PR and also no correlation between ER and PR and response to aminoglutethimide. Tumour aromatase values did however correlate with response to treatment. Mean aromatase levels for responders (1.18 +/- 0.64 pmol E produced/mg protein/h) were significantly higher than those of non-responders (0.34 +/- 0.27) (t = 5.20, DF 27; p less than 0.005). Ten out of fourteen patients with aromatase values greater than 0.5 pmol ER produced/mg protein/h responded, whereas 0 out of 15 patients with tumour aromatase values less than this responded. Responses were seen at both dosages of aminoglutethimide. It is concluded that tumour aromatisation will be a useful measurement in predicting response to aromatase inhibitors.

Aromatisation of androstenedione by human breast cancer tissue: correlation with hormone receptor activity and possible biologic significance

The conversion of 1 beta [3H] androstenedione to estrone in the presence of NADPH by breast cancer homogenates was assessed in tumors from 35 subjects together with estrogen and progesterone receptor concentration. Breast cancers from post menopausal women had significantly higher aromatase activity than those from premenopausal women. Although in many instances the local production of estrogens was sufficient to the capable of exerting a biologic effect, there was, however, no correlation with tumor estrogen or progesterone receptor content. Further studies of the biological significance of tumor aromatisation will depend on direct observation of tumor aromatase and response to suitable doses of aromatase inhibitors.

Bone marrow involvement in anaplastic small cell lung cancer. Diagnosis, hematologic features, and prognostic implications

The hematologic changes and prognostic implications of bone marrow involvement in small cell lung cancer (SCLC) were examined in 133 patients undergoing staging procedures including bone marrow aspiration and trephine biopsy. Bone marrow involvement was found to be present in 27 of 133 (20%) at diagnosis. In most instances bone marrow involvement was associated with the presence of other metastases but in five patients (4%) the bone marrow was the sole site of metastasis. Bone marrow biopsy proved superior (14%) to bone marrow aspiration (5%) in detecting marrow infiltration. Peripheral blood hematologic changes were infrequent even in patients with positive bone marrow biopsy results. Although patients with bone marrow involvement had a shorter median survival (9 weeks) than bone marrow-negative patients (33 weeks) the adverse effect on survival appears to have been mainly due to the presence of concomitant metastases at other sites. Intensive chemotherapy was tolerated to the same degree by bone marrow-positive and bone marrow-negative patients.

The use of mitoxantrone plus cyclophosphamide as first-line treatment of metastatic breast cancer

Thirty-two patients with metastatic breast cancer who had not received prior chemotherapy for metastatic disease were entered into a trial of mitoxantrone 12 mg/m2 plus cyclophosphamide 600 mg/m2 given at three weekly intervals. Thirty-one patients are eligible for assessment. Response was seen in 65% (4/31 complete regression; 16/31 partial regression). Median duration of response was 6 months and median duration of survival was 10 months. Mitoxantrone + cyclophosphamide appears to be an active combination in treatment of metastatic breast cancer.

A survey of human T-cell leukaemia virus type I antibodies in patients with malignant disease in the Witwatersrand area

The prevalence of antibodies to human T-cell leukaemia virus type I in Africa ranges from 2% to 21% according to the geographical area surveyed. Most studies suggest that the background infection rate in children is low. In paediatric patients with malignant disease in the Witwatersrand area the prevalence is low (1%), whereas a seemingly high rate is found in healthy black children from a restricted rural area (7%). Further, the antibody prevalence in adult whites with lymphoproliferative disease is low (1%) compared with that in blacks with malignant disease (6%). There also appears to be a higher prevalence of positive results in black women (7%) than in black men (4%).

Plasma lactoferrin content: differential effect of steroid administration and infective illnesses: lack of effect of ambient temperature at which specimens are collected

The effect of parenteral hydrocortisone on plasma lactoferrin concentration, neutrophil count and lactoferrin:neutrophil ratio was assessed in 10 volunteer subjects. Administration of a single dose of corticosteroid was followed by a significant rise in the circulating neutrophil count, a significant but proportionately smaller rise in the plasma lactoferrin concentration and a significant fall in the lactoferrin:neutrophil ratio. Acute viral infections were found to be associated with a disproportionately low plasma lactoferrin concentration relative to the circulating neutrophil count. The relatively low lactoferrin concentrations in both these situations could be of significance in regard to the propensity to bacterial infection and superinfection which these 2 groups of subjects display. Compared to patients with viral infection, those suffering from Plasmodium falciparum malaria showed a significantly elevated lactoferrin:neutrophil ratio, although this ratio was not significantly different when malarial patients were compared to normal individuals. These findings suggest that the pathogenesis of relative neutropenia in viral and protozoal illnesses is fundamentally different. Finally, it was found that the temperature at which specimen collection takes place does not appear to be a significant variable determining the plasma lactoferrin concentration.

Iron and folate status of pregnant black women in Gazankulu

A limited nutritional survey was carried out in 229 first attenders at an antenatal clinic in Gazankulu during the winter of 1984. Haemoglobin concentrations equal to or less than 11 g/dl were found in 33% of these women, the prime reason being folate deficiency. Serum folate concentrations were less than a 3.5 ng/ml in 60% of subjects and less than 3.0 ng/ml in 48%. A mean corpuscular volume of 100 fl or more, which reflects a defect in red cell DNA synthesis, was present in 35%. Iron related measurements indicated that only 17% were also iron deficient but the figure is certainly an underestimate, since the presence of folate deficiency tends to mask concomitant iron deficiency. The findings underline the need for folate and iron supplementation in pregnancy; the very high prevalence of significant folate deficiency also indicates that serious consideration should be given to the fortification of maize meal with folic acid.

Failure of transferrin to enhance iron absorption in achlorhydric human subjects

There is evidence in experimental animals that transferrin, produced either by gastrointestinal cells or derived from bile, mediates the luminal absorption of iron. The applicability of these findings to human subjects was tested by administering diferric transferrin labelled with 3 mg 59Fe to seven patients with pernicious anaemia. Achlorhydric subjects were chosen to ensure that the iron transferrin complex did not dissociate in the stomach. The geometric mean absorption of 1.4% was similar to that of 3 mg iron given as ferric chloride (1.9%) and much less than that of ferrous ascorbate (18.9%). These findings suggest that transferrin does not play a physiological role in the absorption of iron in human subjects.

Isolation and characterisation of lactoferrin separated from human whey by adsorption chromatography using Cibacron Blue F3G-A linked affinity adsorbent

A new one-step procedure for isolating lactoferrin from human whey using Cibacron Blue affinity chromatography is described. Characteristics of the isolated lactoferrin include pI 5.5-6.1 and differential migration on SDS-polyacrylamide gel electrophoresis of apo and iron saturated lactoferrin. The concentration of lactoferrin in breast milk varies with time after parturition but the iron saturation remains relatively constant with time.

Haematological and iron-related measurements in active pulmonary tuberculosis

59 patients with active pulmonary tuberculosis were evaluated in terms of haematological indices, iron-related measurements and markers of inflammation. The variables evaluated included the Hb, mean cell volume (MCV), serum iron, total iron-binding capacity, percentage saturation, serum ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein. In addition, marrow iron stores were assessed both histologically and chemically. Among the changes noted was a raised S-Ferritin, which appeared in part to be a component of the acute phase response, since it correlated with C-reactive protein concentration (r 0.59, p less than 0.0001). In addition, there was a good correlation between the S-Ferritin and the concentrations of non-haem iron in the marrow, as assessed chemically on trephine biopsies (r 0.78, p less than 0.0001) and histologically on aspirated and biopsy material (rS 0.78, p less than 0.0001 and rS 0.68, p less than 0.0001, respectively). Furthermore, the quantitative relationship between the S-Ferritin and the chemical concentrations of non-haem iron in the marrow was similar to that found previously in a heterogeneous group of subjects without infections. While the present findings confirm that iron is diverted into reticuloendothelial stores in active pulmonary tuberculosis, no evidence was found to suggest that the anaemia which was present in 45 of the 59 patients was secondary to iron-deficient erythropoiesis; the percentage saturations in the 2 groups were 30.3 and 31.1 respectively. In a final analysis, the present findings were compared with previous ones obtained in a group of patients with Hodgkin's disease. The degree of rise in the S-Ferritin for a given marrow non-haem iron concentration was significantly less in the patients with tuberculosis (p less than 0.0001).

Red blood cell distribution width in the anemia secondary to tuberculosis

A study was done to explore the claim that anisocytosis as measured by the red blood cell volume distribution width (RDW) is raised in iron-deficiency anemia, but is normal in the anemia of chronic disorders. Measurements were done on 283 normal patients, 22 iron-deficient patients, and 102 tuberculotic patients, using a model S plus Coulter Electronic Counter with standard calibration. Mean (+/- SD) values for RDW were as follows: normals, 7.36 (+/- 0.57); untreated iron deficiency, 10.39 (+/- 1.37); and 15 untreated anemic patients with tuberculosis, 10.44 (+/- 0.63). Mean values remained above 10.4 in 69 patients with tuberculosis during treatment, irrespective of whether or not the patients were anemic, but had fallen towards the normal mean (8.49 +/- 0.8) in the 18 subjects in whom it was measured at the end of therapy. By this time the mean corpuscular volume (MCV) and hemoglobin concentrations had risen to normal. It is concluded that RDW values in the chronic inflammatory disorder tuberculosis are not significantly different from those occurring in iron-deficiency anemia.

Mitoxantrone, methotrexate, and 5-fluorouracil combination chemotherapy as first-line treatment in stage IV breast cancer

Fifty patients with Stage IV breast cancer were entered into a prospective Phase II trial of combination chemotherapy that consisted of mitoxantrone (10 mg/m2), methotrexate (40 mg/m2), and 5-fluorouracil (600 mg/m2) given in a 3-weekly schedule. Objective response to treatment was seen in 18 of 48 assessable patients (38%). Responses were seen predominantly in the lung and pleura and the node and soft tissue sites of disease. The median duration of response was 7 months. Toxicity from treatment consisted predominantly of reversible leukopenia. Other toxicities such as nausea and alopecia occurred in less than one half of the patients in the study group. The combination was well-tolerated, and appears to be moderately effective.

Treatment of advanced ovarian cancer: a randomised trial comparing adriamycin or 4'epi-adriamycin in combination with cisplatin and cyclophosphamide

Fifty-one patients with ovarian cancer were entered in a randomised trial comparing treatment with cisplatin + adriamycin + cyclophosphamide (PAC) to cisplatin + 4'epi-adriamycin + cyclophosphamide (PEC). Complete response rates for the two treatment arms were similar (9/27 PAC, 14/24 PEC). Patients with less than 2 cm residual disease had significantly higher rate of complete remission than those with greater than 2 cm residual disease. Cardiotoxicity was significantly less in the PEC-treated group (0/24) as compared with the PAC-treated group (6/27, chi2 = 4.09, p less than 0.05).

Treatment of metastatic and recurrent cervix cancer with chemotherapy: a randomised trial comparing hydroxyurea with cisdiamminedichloro-platinum plus methotrexate

In a randomised trial comparing single-agent chemotherapy (hydroxyurea) to combination chemotherapy in advanced cervix cancer, response was seen in 57% (including 13% CR) of patients receiving the combination (DDP + MTX) regimen. Responding patients survived significantly longer (11 months) than either those receiving hydroxyurea or those not responding to combination chemotherapy (4 months). Two patients remain in complete remission for 14+ and 17+ months.

Relationship of plasma lactoferrin content to neutrophil regeneration and bone marrow infusion

Plasma concentrations of lactoferrin were measured in immediately separated EDTA samples from 5 subjects who had received HLA identical bone marrow transplants for leukaemia or aplastic anaemia and from 7 subjects who were leukopenic as a consequence of chemotherapy for a variety of malignant conditions. Plasma lactoferrin concentrations were found to closely parallel the leucocyte count and were not found to either predict or to antedate leucocyte regeneration. Serial measurements of plasma lactoferrin in a subject with no circulating neutrophils who received a bone marrow graft revealed that the clearance of lactoferrin followed an exponential pattern and had an initial half time of 2.2 h.

Estrogen receptor from human breast cancer and from normal human uterus: isolation and characterization of similar binding complexes

Estrogen receptor from human breast cancer tissue and from normal human uterus was isolated and characterized by a combination of physical separation methods including ammonium sulfate precipitation, gel permeation chromatography, isoelectric focusing and gel electrophoresis. After incubation with 3H-estradiol-17 beta (3HE2) followed by gel permeation chromatography, specific estrogen-binding activity was found to be present in a 160,000-dalton molecular weight component which had a pI of 7.1-7.3. On polyacrylamide gel electrophoresis this estrogen-binding protein migrated as a single band which could however be dissociated into two subunits with molecular weights of +/- 60,000 and +/- 75,000 daltons. 3HE2 binding was to the 75,000-dalton component.

Lack of correlation between iron stores and plasma lactoferrin concentration

Plasma lactoferrin concentration and indices of iron nutrition including P-Ferritin, P-iron, total iron binding capacity and percentage saturation were measured in 75 otherwise normal females. This was done in order to evaluate previous reports that neutrophil lactoferrin content was altered by variations in iron storage status. Since P-Lactoferrin is derived from and hence reflects neutrophil lactoferrin content it would seem reasonable to assume that P-Lactoferrin would vary in accordance with iron stores. However, there was no statistically significant difference in P-Lactoferrin concentration between iron deficient subjects and those who were iron replete. Furthermore, there was no statistically significant correlation between any iron related parameter and P-Lactoferrin concentration.

Acute megakaryoblastic leukaemia with 3q inversion and elevated thrombopoietin (TSF): an autocrine role for TSF?

A patient with acute megakaryoblastic leukaemia is described in whom exactly the same paracentric inversion of 3q was detected as in three previously documented cases. The patient's serum thrombopoietin (TSF) was significantly raised. Based on these findings we postulate a role for a gene (? oncogene) on chromosome 3q in thrombopoietin production. Abnormalities of 3q may assist in delineating a subgroup of acute nonlymphocytic leukaemia, namely acute megakaryoblastic leukaemia.

Serum ferritin and Hodgkin's disease

The haemoglobin, serum iron, transferrin saturation, serum ferritin, erythrocyte sedimentation rate (ESR), splenic weight and non-haem iron concentration in the marrow, liver and spleen were measured prior to treatment in 35 patients with Hodgkin's disease who underwent staging laparatomy. The Hb, serum iron and transferrin saturation showed a significant decrease with increasing stage of the disease. In contrast, there was a significant increase in the serum ferritin, ESR, splenic weight and in all the tissue non-haem iron concentrations. The calculated total iron content of the body remained relatively constant throughout at about 2 g but with increasing stage there was an internal redistribution of iron, with a progressive drop in Hb iron and a reciprocal rise in storage iron, especially in the liver. Serum ferritin concentrations, which rose with progression of the disease, were inappropriately high in relation to the size of body stores at all stages but especially in patients with 4B disease and hepatic involvement. It was concluded that the serum ferritin concentrations are raised for several reasons in Hodgkin's disease. They reflect an increase in body iron stores, ferritin's role as an 'acute phase' protein in the inflammatory response and hepatic damage in patients with advanced disease.

Effect of natural killer cells on syngeneic bone marrow: in vitro and in vivo studies demonstrating graft failure due to NK cells in an identical twin treated by bone marrow transplantation

Bone marrow transplantation for severe idiopathic aplastic anemia was undertaken in a patient, using his monozygotic twin brother as the donor. In spite of the use of syngeneic bone marrow, failure of engraftment occurred on two occasions. In vitro studies demonstrated that natural killer (NK) cells from the recipient markedly inhibited the growth of donor bone marrow granulocyte progenitor cells. On a third attempt, successful bone marrow engraftment was achieved following high-dose cyclophosphamide, which has previously been shown to be inhibitory to NK cells. We conclude that NK cell activity may play an important role in bone marrow failure as well as being responsible for at least some cases of aplastic anemia.

Enzyme linked immunosorbent assay for lactoferrin. Plasma and tissue measurements

Highly purified lactoferrin was obtained from human breast milk by sequential use of affinity chromatography and isoelectric focusing. IgG antibody to purified lactoferrin was used to develop a sensitive and reproducible enzyme linked immunosorbent assay. Characteristics of the assay included linearity over a wide range of lactoferrin concentration (3.125-200 micrograms/l) and sensitivity (lower range less than 1 microgram/l). The assay can be adapted for use on tissue cytosol as well as plasma. Healthy subjects showed plasma lactoferrin levels ranging from 187.5-450.1 micrograms/l. Pulmonary tuberculosis and acute pneumonia are associated with a 2-3-fold increase in plasma lactoferrin content while neutropenic subjects have markedly depressed lactoferrin concentrations. The assay will be useful for further delineation of lactoferrin and neutrophil function and turnover.

Treatment of neutropenic infection: a randomized trial comparing latamoxef (moxalactam) with cephradine plus tobramycin

Sixty neutropenic patients with infection were studied in a randomized trial comparing treatment with latamoxef (moxalactam) alone or with cephradine and tobramycin. The two treatment groups were comparable in respect to their clinical sites of infection, degree of neutropenia underlying malignancy, and organisms. Forty-two bacterial isolates were obtained from various clinically infected sites. All but two of these isolates were sensitive to latamoxef (30 highly sensitive, ten moderately sensitive). In contrast 29 of the isolates were resistant to cephradine and eight were resistant to both cephradine and tobramycin. Control of infection was achieved in 72% of patients treated with latamoxef and 55% treated with cephradine plus tobramycin. Latamoxef appears to be an effective antibiotic for the treatment of neutropenic patients with infection.

Iron absorption from red and white wines

Iron (3 mg) was added as ferrous sulphate to 2 dl red wine, white wine and 7% alcohol and its absorption was then measured in 38 fasting male subjects. (The original concentrations of iron in the two wines were low, being 1.01-1.08 mg/l (red wine) and 0.13-0.20 (white wine]. The geometric mean absorption from red wine was only 20% of that from the alcohol solution whilst more than 4 times as much was absorbed from white wine as from the alcohol. Direct comparison showed greater absorption from white wine (10.4%) than from red wine (4.4%). Removal of about 80% of the polyphenols in red wine increased the geometric mean iron absorption from 1.9% to 3.6%. In vitro experiments indicated that iron was less soluble and less dialysable in red wines than in white wines. This was possibly due to the binding of iron to polyphenols in red wines. Electrophoretic studies suggested that the iron in white wines was complexed to hydroxycarboxylic acids.

Relative value of oestrogen receptor assay, lactoferrin content, and glucose-6-phosphate dehydrogenase activity as prognostic indicators in primary breast cancer

Oestrogen receptor content, lactoferrin, hexokinase, and glucose-6-phosphate dehydrogenase levels were measured in cytosol from 25 primary breast cancers and 3 fibroadenomas. Both hexokinase and glucose-6-phosphate dehydrogenase activity were higher in malignant tissue as compared to benign breast lesions. Oestrogen receptor concentration and lactoferrin content failed to predict the development of metastatic disease, while glucose-6-phosphate dehydrogenase activity was significantly higher in cytosol from those tumours which subsequently metastasized compared to those which remained localized.