Intraarterial 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and systemic chemotherapy for malignant gliomas: a follow-up study

Twenty-five adults who harbored malignant gliomas received 72 courses of intraarterial 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) (100 mg/m2) and 67 courses of systemic vincristine (1.0 mg/m2) and procarbazine (100 mg/m2) as induction therapy (BVP) followed by 106 courses of systemic 1-(2-chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (methyl-CCNU) (130 mg/m2), vincristine, and procarbazine as maintenance therapy (MVP). With a 6-week interval between each treatment, the median and range for the number of courses of BVP were 3 and 1 to 4 and those for MVP were 3 and 0 to 14, respectively. Fifteen patients (60%) responded to both BVP and MVP, and 10 (40%) did not. The overall median survival time was 12.7 months (range, 1.8 to 48.5+ months). Two of 3 patients who had recurrent gliomas responded and survived for 37+ to 45+ months. Seven of 10 who had nonirradiated glioblastomas responded and survived for 9 to 22 months. Four who had nonirradiated anaplastic astrocytomas all responded and survived for 38+ to 48.5+ months. Two who also received radiotherapy (1 glioblastoma and 1 primitive neuroectodermal tumor) benefited and survived for 16.9 and 28.5+ months. All who did not respond favorably died within 8 months. During the infusion of BCNU, complications included transient orbital and head pain, periorbital and scleral erythema in all patients, and a focal seizure in 1 (4%). During the 6-month induction periods, leukopenia and thrombocytopenia occurred in 1 (4%), deep vein thrombosis occurred in 9 (36%), pulmonary emboli occurred in 8 (32%), upper respiratory infections occurred in 6 (24%), pneumonia occurred in 9 (36%), and herpes zoster occurred in 1 (4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Homogeneous immunoassay based on chemiluminescence energy transfer

The chemiluminescent compound aminobutylethyl-isoluminol (ABEI) and its isothiocyanate derivative have been coupled to a range of haptens (progesterone, cyclic AMP, cyclic GMP) and protein antigens (IgG, C9). All the derivatives were chemiluminescent, immunologically active, and stable for more than six months. When the ABEI-labeled antigens bind to their respective fluorescein-labeled antibodies, there is a shift in the ratio of chemiluminescence at 460 nm (blue) to that at 525 nm (green). This nonradiative energy transfer was used to establish homogeneous immunoassays, which require no separation step. These assays were at least as sensitive as the conventional radioimmunoassays and could accurately measure substances in serum (i.e., for IgG, results correlated by r = 0.96 relative to those by 125I assay) and tissue extracts (cyclic AMP, r = 0.91 relative to 3H assay), and also were used to evaluate the kinetics of antibody-antigen binding. Chemiluminescence energy transfer provides a new method for quantifying ligand-ligand interactions in the 10(-15) to 10(-18) mol range without first separating bound and free ligand. This provides a unique opportunity to investigate chemical events in single cells and intact cells.

Homogeneous immunoassay based on chemiluminescence energy transfer

The chemiluminescent compound aminobutylethyl-isoluminol (ABEI) and its isothiocyanate derivative have been coupled to a range of haptens (progesterone, cyclic AMP, cyclic GMP) and protein antigens (IgG, C9). All the derivatives were chemiluminescent, immunologically active, and stable for more than six months. When the ABEI-labeled antigens bind to their respective fluorescein-labeled antibodies, there is a shift in the ratio of chemiluminescence at 460 nm (blue) to that at 525 nm (green). This nonradiative energy transfer was used to establish homogeneous immunoassays, which require no separation step. These assays were at least as sensitive as the conventional radioimmunoassays and could accurately measure substances in serum (i.e., for IgG, results correlated by r = 0.96 relative to those by 125I assay) and tissue extracts (cyclic AMP, r = 0.91 relative to 3H assay), and also were used to evaluate the kinetics of antibody-antigen binding. Chemiluminescence energy transfer provides a new method for quantifying ligand-ligand interactions in the 10(-15) to 10(-18) mol range without first separating bound and free ligand. This provides a unique opportunity to investigate chemical events in single cells and intact cells.

Clinicopathologic features of Chandler's syndrome

The clinicopathologic features of Chandler's syndrome are elucidated based on a study of nine patients. Keratoplasty, trabeculectomy and/or iris specimens were studied by light, electron and, in six cases, specular microscopy. The prominent pathologic features were abnormalities of the endothelially-derived cells lining the posterior corneal surface, the inner surface of the trabecular meshwork, and the anterior iris surface. In all four corneal buttons, the endothelium was diffusely attenuated and focally absent, and posterior collagen layers were present. Extension of the endothelial cell layer and Descemet's membrane deposition over the trabecular meshwork were observed in two trabeculectomy specimens, and similar proliferation onto the anterior surface of the iris was evident in four iris specimens. Other abnormalities of the endothelial cells included increased intracytoplasmic filaments. These pathologic alterations are consistent with the concept of Chandler's syndrome as representing one variant of the iridocorneal endothelial (ICE) syndrome. Interestingly, although both endothelial proliferative and degenerative responses can be observed in Chandler's syndrome, their occurrence within the same eye is apparently not simultaneous.

Chemiluminescence energy transfer: a new technique applicable to the study of ligand--ligand interactions in living systems

Chemiluminescent molecules can be readily detected in the range 10(-15) to 10(-18) mol, and potentially at least down to 10(-20) mol reacting/s. The chemiluminescent compound aminobutylethylisoluminol (ABEI) and its isothiocyanate derivative have been synthesized. The ABEI was coupled to rabbit immunoglobulin and cyclic AMP. These labeled antigens were stable for at least 9 months and were used to establish chemiluminescent immunoassays. When these chemiluminescent-labeled antigens bound to their respective fluorescein-labeled antibodies, a wavelength shift towards the green was detected in the chemiluminescence. This was due to chemiluminescence energy transfer and used to establish an homogenous immunoassay which could measure these antigens in biological samples at least as sensitively as conventional radioimmunoassays.

[Acute primary infection due to slow-growing anaerobes after total hip arthroplasty (author's transl)]

Most early post-operative infections in total hip arthroplasty are due to aerobic bacteria. Anaerobes infections are less common and less easy to diagnose since the organisms are growing slowly. In the three patients reported the responsible organisms were detected by a strict bacteriological technique including cultures lasting more than 48 hours. Treatment consisted of re-operation and appropriate antibiotic therapy. The slow development of anaerobic bacteria makes antibiotic sensitivity tests particularly difficult to read. The need for cultures prolonged beyond 48 hours partly explains the frequency of overt suppuration in cases where standard bacteriological methods had given negative results.

Fractures of cervical spine with neurological lesion treated by reduction and fixation with plates

A series of 61 cases of cervical spine fracture and dislocation with neurological deficit treated operatively were reviewed. All were reduced and internally fixed with plates and screws. The operative technique was not easy and required a great deal of care and experience. Surgery did not significantly alter the neurological recovery in 12 cases with root involvement and 23 cases with complete tetraplegia. Neurological recovery seemed to be better after surgical intervention in the case of incomplete tetraplegias; 18 out of 26 being able to walk eventually. The main value of surgical fixation of these injuries was to allow early rehabilitation without any external cervical support. However, intensive care of the neuro-cardio-respiratory complications in the post-operative period was necessary to evert the high risk of mortality and morbidity from surgery.

Treatment of infected pseudoarthrosis of limbs

It was not difficult to treat an infected pseudoarthrosis without loss of bone substance by "excision-decortication-drainage" in one stage. Union was obtained in 90% of the cases. The rest required additional bone grafts. In only one case out of 41 was there persistent infection. The problem of infected pseudoarthrosis with loss of bone substance and a sizeable defect was more difficult to solve. None of the several methods of treatment employed were without complications. When the overlying skin defect was large and impossible to close in the presence of persistent sepsis at the pseudoarthrosis defect, Papineau's two stage technique of wide excision first followed by insertion of spongious autologous grafts through the granulating defect, appeared secure with minimal risk of residual osteitis in nearly 90% of the cases. 15% of the cases had poor skin healing, requiring further treatment and 20% (nearly one in five) had a stress fracture through the grafted area. One out of 35 cases had persistent pseudoarthrosis and two had persistent infection. In ten selected cases of infected pseudoarthrosis of the tibia with large skin and bone defect, a one stage method of excision, bone grafting and primary skin cover with a local gastrocnemius flap was attempted. In seven cases, primary skin healing and bone union was achieved, one patient required further bone grafting and two had recurrence of sepsis. If properly planned, this one stage method may be indicated in selected cases of infected pseudoarthrosis of the tibia.

A comparison of fluorescent and nonfluorescent light sources for phototherapy

We have compared fluorescent and nonfluorescent light sources for phototherapy for newborn infants with hyperbilirubinemia. Phototherapy was provided by a tungsten halogen lamp and conventional fluorescent light with identical radiant flux of 6 microW/sq cm. For 22 infants treated with the nonfluorescent lamp the mean duration of phototherapy was 33.77 hours and the mean reduction of bilirubin was 3.84 mg/100 ml/day. This did not differ significantly from infants treated with conventional fluorescent lights. The nonfluorescent light can be utilized for infants in incubators or on radiant warmers. These results provide additional support for the relationship between radiant flux as a practical measure of phototherapy dose and the clinical response of a reduction in serum bilirubin.

[Total hip prosthesis. Current indications (author's transl)]

The various problems posed by total hip prosthesis are first described. The authors then analyse the various parameters which should guide the choice of this technique which must be used only when all other solution have failed. The recent development of prostheses without cement has made it possible to widen the application of this surgery to younger patients. Two special cases are finally reported: the role of total prostheses in the treatment of sequelae of fractures of the acetabulum, and in disarthrodesis of the hip with insertion of a total prosthesis.

Hyperkalemia with cardiac arrhythmia. Induction by salt substitutes, spironolactone, and azotemia

In two patients, severe hyperkalemia and serious cardiac arrhythmia developed after excessive use of potassium-containing salt substitutes. Both had impaired ability to handle and excrete additional potassium load due to chronic congestive heart failure, azotemia, and administration of spironolactone. Prompt recognition of the arrhythmia and immediate restoration of the cardiac rate and rhythm by pacemaker support followed by intensive regimen to lower the serum potassium prevented a potentially fatal outcome. These cases emphasize the potential danger of salt substitutes when used by patients who are predisposed to retain potassium.

Exchange transfusion in the neonate: a controlled study using frozen-stored erythrocytes resuspended in plasma

During a nine-month period 43 consecutive infants who needed exchange transfusions for the management of their hyperbilirubinemia randomly received whole blood less than 5 days old (control group) or frozen erythrocytes diluted in plasma (experimental groups). There was no different prior to and after exchange transfusions in total protein, albumin, globulin, immunoglobulins, bilirubin, and hematocrit in the control group versus the experimental group. The efficacies of bilirubin removal, as measured by delta bilirubin, were the same in the two groups. Advantages of exchange transfusion with freeze-preserved erythrocytes suspended in type-specific plasma are discussed.

[Thrombo-embolitic complications due to total hip prostheses. Results of preventive treatment using low-dose heparin therapy]

Our experience of the prevention of thrombosis and embolism by the use of low doses of calcium heparinate in total hip replacement, with individual variations, shows that this method is efficacious, convenient and has a low complication rate both locally and generally.

[Aortic ruptures in traffic accident traumatology]

8 cases of rupture of the aorta seen in a series of 62 autopsies were studied in the context of a multidisciplinary enquiry into road accidents. In the light of these cases, the literature and experimental findings, different mechanisms are described, an essential step in the prevention of this lesion which is the main cause of death in 15 p. cent of cases.

[Circular fractures of the skull base during traffic accidents]

With reference to 5 cases of circular fracture of the base of the skull occurring in relation to road accidents, the literature is reviewed. Two different types may be distinguished: --"compression" fractures, --"hyperextension' fractures, the latter being special on the basis of the site of the fracture line and the application of forces via the face or chin. Reconstruction of trajectories during accidents, on the basis of the anatomical lesions and the damage caused to vehicles, as well as the study of films made during the experimental reproduction of similar lesions, make it possible to explain the mode of production of these hyperextension fractures. Such understanding is essential to the study of safety precautions for vehicle occupants.

[Abdominal emergencies in the daily practice of a traumatology center]

This study analyses 57 cases of abdominal trauma occurring in patients with multiple injuries admitted to the accident unit in Garches, over a period of four years. After a few remarks concerning the use of a safety belt, the authors discuss in particular: -- 25 hepatic lesions; -- 20 splenic lesions. These lesions were operated on by the surgeons on the unit with the exception of 9 cases where a specialised surgeon was called in. In the vast majority of cases, we consider the patient should not be transferred to the other units but, if possible, all lesions should be treated simultaneously in one centre.

[Sequelae of acetabulum fractures treated by total hip prosthesis]

The authors have treated by total prosthesis 39 cases of fractures of the acetabulum, at the stage of severe sequellae. 21 of them had been initially treated conservatively, and 18 had been previously operated on. 23 times they used conventional prosthesis anchored with cement. 8 cases became loose and had to be re-operated on. 16 times an original prosthesis made of highly porous metal was used with no complication at the present time.

[Early detection of venous thromboses of the lower limb in traumatology by labelled fibrinogen]

In emergency traumatology, the iodine 125 labelled fibrinogen test is useful in the early detection of phlebitis in patients in whom the routine use of heparin is not possible--fractures of the cervical spine, severe cranial trauma, elderly subjects. It makes possible the institution of appropriate heparin therapy, without waiting for clinical signs to become evident. We noted that isotopic venous thromboses occured very frequently and very early, and that clinical signs, when present (50 p. cent of cases) occurrer 24 to 48 hours after the appearance of isotopic signs.

Restoration of normal red cell size after treatment in megaloblastic anaemia

The return of the MCV to normal after treatment in megaloblastic anaemia follows a biphasic pattern. The initial more rapid decline in MCV is due to disappearance of pretreatment macrocytes from the circulation and the rate of fall is determined by their mean cell life. The second slower component is probably due to a mixture of pretreatment macrocytes and new macrocytes, the result of a young red cell population. The MCV often returned to normal most rapidly in the most severely megaloblastic patients due to a very short mean red cell life span. However, there was no significant correlation between either initial MCV or red cell count and the time after treatment for a return of a normal MCV.

Neutral-lipid storage disease: a new disorder of lipid metabolism

Images