"VRA-GlcNAc": novel substrate for N-acetyl-beta-D-glucosaminidase applied to assay of this enzyme in urine

We describe a new chromogenic substrate and assay for determining N-acetyl-beta-D-glucosaminidase (EC 3.2.1.30; NAG) activity in normal and pathological human urine. The novel substrate, ammonium 5-[4-(2-acetamido-2-deoxy-beta-D-glucopyranosyloxy)-3- methoxyphenylmethylene]-2-thioxothiazolidin-4-one-3-ethan oate (VRA-GlcNAc), is prepared by condensation of vanillyl N-acetyl-beta-D-glucosaminide and rhodanine-3-ethanoic acid. The phenol released by enzyme action has an intense absorption peak at 492 nm (epsilon = 37,000 L.mol-1.cm-1). The Km for NAG in urine was 0.5 mmol/L at pH 4.5. The substrate solution may be stored at 4-7 degrees C for one week without any increase in the substrate blank. For optimal assay conditions, we used a substrate concentration of 3 mmol/L and a 15-fold sample dilution at pH 4.5-5.0, with measurement at 505 nm, not significantly different from that at 492 nm. The sensitivity of the assay with VRA-GlcNAc as substrate is twice that of the MNP-GlcNAc [2-methoxy-4-(2'-nitrovinyl)-phenyl GlcNAc] procedure (Clin Chim Acta 1982;124:195-204) and can detect low amounts of minor NAG isoenzymes. This assay is an improvement on previously available colorimetric methods and could be easily incorporated into kits based on either an enzyme calibrant or the molar absorptivity of the phenol.

Treatment of small-cell lung cancer with an alternating chemotherapy regimen given at weekly intervals: a Southwest Oncology Group pilot study

We designed an intensive, weekly treatment regimen for patients with small-cell lung cancer (SCLC) using six of the most active chemotherapeutic agents for this disease (doxorubicin [DOX], cyclophosphamide [CTX], vincristine [VCR], etoposide [VP-16], cisplatin [CDDP], and methotrexate [MTX]). The goal of this program was to gain rapid, repetitive exposure to multiple, active drugs. Treatment was administered weekly for a total of 16 weeks. Seventy-six SCLC patients (limited disease, 34; extensive disease, 42) were treated. The overall complete plus partial response rate was 82%. Complete response rates of 47% and 38% were observed in patients with limited (LD) and extensive disease (ED), respectively. The median survivals for patients with LD and ED were 16.6 and 11.4 months, respectively. Toxicities were tolerable and were primarily hematologic. Twenty-six patients had one or more transient life-threatening toxicities, but only one patient developed a fatal toxicity. Eighty-four percent of the patients received 80% or greater of the intended protocol dosages over the entire 16-week treatment period. We conclude that this intensive, short-duration treatment regimen is at least as good as other "standard" regimens, and we are encouraged aged by the complete response rate and median survival in patients with ED SCLC.

Phase II trial of echinomycin in advanced soft tissue sarcomas. A Southwest Oncology Group study

Thirty-four patients with advanced soft tissue sarcomas were entered in a phase II trial of echinomycin. Patients received 1.2 mg/m2 intravenously (i.v.) weekly times four followed by a two week rest period. There were no objective responses. Dose limiting toxicity was gastrointestinal. Echinomycin given on this weekly schedule is inactive in treating previously treated patients with advanced soft tissue sarcomas.

Raised dopamine metabolites in a case of malignant paraganglioma

This paper describes the case of a malignant retroperitoneal paraganglioma with extensive metastases. The patient presented with a supraclavicular mass and an absence of hypertension. Exclusively raised dopamine metabolites were detected which may be a marker of a malignant process and account for the lack of hypertension.

A mutation adjacent to the beta cleavage site of factor IX (valine 182 to leucine) results in mild haemophilia Bm

The genetic basis of a mild form of haemophilia Bm has been investigated. The patient under investigation has a mild bleeding disorder and has never experienced spontaneous bleeds. Factor IX coagulant activity (FIX:C) was 0.15 units/ml and factor IX antigen (FIX:Ag) 1.32 units/ml. The prothrombin time performed with an ox brain thromboplastin was 65 s (normal plasma 31 s). Studies of the abnormal factor IX protein in this patient showed a normal molecular weight and normal calcium binding properties. Activation of the mutant factor IX with factor XIa showed normal proteolytic cleavage. DNA sequence from the eight factor IX exons and flanking introns was amplified from this patient using the polymerase chain reaction. The amplified material was subjected to direct chain termination nucleotide sequencing. The only nucleotide sequence alteration found was a G----C transversion at nucleotide 20,524, changing the amino acid encoded at residue 182 from valine to leucine. This residue is one amino acid removed from the beta cleavage site of factor IX. This residue is highly conserved in other vitamin K dependent serine proteases and we propose that its alteration in this patient is responsible for his mild haemophilic phenotype, and for the abnormal interaction of this factor IX protein with the extrinsic system of coagulation.

A past mutation at isoleucine 397 is now a common cause of moderate/mild haemophilia B

Of the factor IX sequence changes that we have identified in 65 consecutive males with haemophilia B, 11 (17%) are the same mutation. This mutation is a T----C transition at base 31311 which substitutes threonine for isoleucine397 (ile397) in the factor IX molecule. The 11 patients are of Western European descent and have the same haplotype: Hinf1 (-), Xmn1 (-), Taq1 (-), BamH1 (+), Malmö allele = thr148. The frequency of this haplotype was estimated and the probability of the same mutation occurring independently 11 times in this haplotype was miniscule. We conclude that these patients have a common ancestor despite the lack of overlapping pedigrees. The clinical symptoms of the disease were consistently moderate/mild in these 11 patients, whereas factor IX coagulation values obtained from the medical records varied more than sixfold between individuals. However, when plasma from five individuals was assayed by the same laboratory concurrently, the values varied less than twofold. Thus, in routine practice, clinical severity may correlate better with the presence of a given mutation than the factor IX coagulant activity. The high frequency of the mutation at ile397 indicates that carrier testing in families of Northern European descent with moderate/mild haemophilia B can be expedited by first determining whether this particular mutation is present. We demonstrate here that the technique of polymerase chain reaction (PCR) amplification of specific alleles (PASA) can be used to rapidly perform carrier testing in families with the ile397 mutation.

Comparative study of automated versus manual extraction of DNA from clinical specimens

The authors have compared an automated method for DNA extraction with an established manual method using routine clinical specimens. The purity, yield, and quality of the extracted DNA was assessed by ultraviolet absorbency measurements, gel electrophoresis, and DNA probe hybridization. The automated DNA extractor can provide high molecular weight DNA equivalent in purity, yield, and quality to that obtained by the manual method with substantial savings in technologist time and overall costs associated with the procedure.

Concurrent chemotherapy/radiotherapy for limited small-cell lung carcinoma: a Southwest Oncology Group Study

The Southwest Oncology Group (SWOG) has conducted a phase II study to explore the efficacy and toxicity of initial, concurrent use of radiation therapy with cisplatin, etoposide (VP-16), and vincristine in limited-stage small-cell carcinoma of the lung. Two courses of cisplatin, VP-16, and vincristine chemotherapy were given with concurrent radiotherapy (XRT) to the primary tumor to a total dose of 4,500 cGy. Elective brain XRT was given to all patients concurrent with a third course of cisplatin/VP-16 therapy. Consolidation chemotherapy consisting of vincristine, methotrexate, and VP-16 alternating with Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) and cyclophosphamide, was given for 12 weeks following the initial induction chemotherapy/XRT program. Patients with a complete response had all therapy discontinued. Among 154 eligible patients treated, the complete response rate was 56%, with a partial response rate of 27%. The median survival is 17.5 months with an estimated 30% survival rate at 4 years from initiation of treatment. Combined modality toxicities were acceptable with the predominant toxicity being moderate to severe leukopenia and mild radiation esophagitis. The results of this treatment program appear superior to any previously reported by our group and compare favorably to those in the literature at large.

Phase II trial of intravenous melphalan for metastatic colorectal carcinoma. A Southwest Oncology Group study

Based on the high response rates seen among patients with colon cancer receiving high dose Melphalan with autologous marrow infusion, the Southwest Oncology Group conducted a Phase II trial of the compound at a conventional dose. The initial starting dose of 40 mg/m2 was reduced to 30 mg/m2 after severe myelotoxicity was encountered in the first five patients. Toxicity was primarily myeloid and was moderate to severe in most patients with one treatment related death. There were two complete and one partial response among 43 patients. Melphalan at 30 mg/m2 has little activity among patients with metastatic colorectal carcinoma.

Phase II evaluation of mitoxantrone in advanced pancreatic carcinoma: a Southwest Oncology Group study

Patient with advanced adenocarcinoma of the pancreas and no prior chemotherapy were treated on a Phase II trial of mitoxantrone. Doses were adjusted for hepatic dysfunction as defined by bilirubin. Twenty-four patients with a bilirubin less than or equal to 1.5 mg% received mitoxantrone 12 mg/m2 i.v. repeated every three weeks. Myelosuppression in the form of leukopenia was the major toxicity. There were no responses in twenty-four evaluable patients.

Variation of the non-factor VIII sequences detected by a probe from intron 22 of the factor VIII gene

A severe hemophilia A family has been studied with the factor VIII (F.VIII) intragenic XbaI polymorphism. During this investigation, a new variant hybridization pattern was observed with important implications concerning the non-F.VIII DNA sequences detected by the probe from intron 22, p482.6. Both Southern hybridization studies and direct analysis of amplified DNA demonstrated a variant form of the non-F.VIII sequences. This variant DNA sequence has not been responsible for any detectable phenotypic abnormalities, and likely represents a polymorphic change. In conclusion, this study has shown that the non-F.VIII sequences detected with the probe p482.6 are situated on the X chromosome, they seem to be present in two copies, and either or both copies infrequently possess a polymorphic XbaI site or a partial deletion.

Patterns of sperm allocation across successive ejaculates in four species of voles (Microtus)

This study was designed to determine testes masses, total number of spermatozoa ejaculated per copulatory episode, and the pattern of sperm numbers in successive ejaculates in prairie voles (Microtus ochrogaster), montane voles (M. montanus), pine voles (M. pinetorum), and meadow voles (M. pennsylvanicus). Prairie voles displayed mean totals of 2.7 ejaculations and 30.5 X 10(6) spermatozoa before reaching a satiety criterion; montane voles 3.4 ejaculations and 19.0 X 10(6) spermatozoa, pine voles 2.4 ejaculations and 3.3 X 10(6) spermatozoa, and meadow voles 2.5 ejaculations and 25.5 X 10(6) spermatozoa. In all species the number of spermatozoa decreased in successive ejaculates. Significant species differences were noted for the total number of spermatozoa ejaculated and number of spermatozoa ejaculated in each of the first 3 ejaculates. Species differences also were noted for testes mass, with meadow voles having the largest testes and pine voles having the smallest. These data can be compared to similar data on laboratory rats and deer mice and related to recent theory regarding sperm numbers, testes sizes, and mating systems. In general, the species with large testes appear to ejaculate more spermatozoa. The significance of species differences in testes mass and total sperm numbers remains unclear, but may relate to the occurrence of multiple mating by females during a single receptive period.

Factor IX Cardiff: a variant factor IX protein that shows abnormal activation is caused by an arginine to cysteine substitution at position 145

Crude barium chloride eluates prepared from 12 unrelated patients with cross-reacting material positive (CRM+) haemophilia B were activated with celite eluate, the reaction products resolved after reduction by 13% SDS-PAGE, and factor IX antigenic material detected by probing with radiolabelled immunopurified rabbit anti-factor IX antiserum followed by autoradiography. Out of the 12, one sample showed faulty activation with the production of a stable reaction product with a MW compatible with that of a putative light chain-activation intermediate. In order to confirm this, two oligonucleotide primers that bracketed exon 6 of the factor IX gene were constructed and used to prime a polymerase chain reaction on DNA isolated from the patient's peripheral blood leucocytes. A single 489 nucleotide DNA fragment was obtained, gel purified, subcloned into M13, and DNA sequencing carried out on both strands. A single C to T transition was discovered that changed the Arg residue at position 145, the first residue of the first bond in the activation peptide, to a Cys, a result that confirmed the inferences drawn from the activation studies.

Sexual activity and satiety over an extended observation period in prairie voles (Microtus ochrogaster)

This study was designed to delineate the course of sexual satiation in prairie voles (Microtus ochrogaster). Fourteen male-female pairs were allowed to copulate freely for 24 hr under continuous observation. Copulations occurred predominantly during the first few hours and decreased in frequency thereafter. The mean number of ejaculations per pair was 5.6 (range, 2-9). Two thirds of the ejaculations occurred during the first 3 hr, and over 90% took place within the first 7 hr after the first intromission. No ejaculations were observed during the last 8 hr. These results suggest that male capacity to deliver ejaculations to a female is limited and that direct observations reveal a more limited capacity than observations made with time-lapse videotape.

Whole brain irradiation and intrathecal methotrexate in the treatment of solid tumor leptomeningeal metastases--a Southwest Oncology Group study

From 1981 through 1985 the Southwest Oncology Group (SWOG) conducted a study evaluating the natural history and the effectiveness of standard therapy in those patients with leptomeningeal carcinomatosis from non-hematologic malignancies. Twenty-six patients were evaluated for the effectiveness of treatment; those who responded to therapy by one month exhibited a median additional survival of 5.7 months and those who were not responders at one month exhibited a median additional survival of 1.8 months. We were unable to identify pre-treatment clinical characteristics which would predict for a favorable response to therapy. Aggressive treatment in some patients may be indicated, as those patients who respond to treatment may have a survival benefit. The overall prognosis in this patient group remains exceedingly poor.

A complete deletion of the factor IX gene and new TaqI variant in a hemophilia B kindred

We report a hemophilia B kindred in which the proband has a complete deletion of the factor IX gene extending a minimum of 80 kilobase pairs (kb) 3' of the gene. This individual has severe factor IX deficiency with no detectable circulating factor IX protein. In common with one previous report, despite a total deletion of the factor IX gene, this patient has not developed antibodies to factor IX. The mother of the proband was found to have a new TaqI variant of the factor IX gene on the nondeletion-bearing X chromosome. The location of the altered TaqI site was found to be 5' of exon IV between residues 9731-9734 and does not affect the function of the factor IX protein. The familial natures of both the variant allele and the deletion were established. In addition a study of this kindred at the DXS99 locus demonstrated the first reported recombination event between this site and the factor IX gene.

Effects of experience and available cues on estrous versus diestrous preferences in male prairie voles, Microtus ochrogaster

Male prairie vole preferences for estrous versus diestrous females and associated stimuli were investigated. The role of sexual experience in engendering preferences proved more complex than reported for other species. Naive males did not display preferences. Neither males receiving sexual experience through monogamous cohabitation, nor males housed with two females displayed preferences. Males exposed to both estrous and diestrous females, and males housed with other males and females in a semi-naturalistic setting, displayed preferences. Thus, preferences seem to be "tuned" by experiential manipulations. Cues available for discrimination also influenced the display of preferences, as different results were obtained using apparatus that differed in cue availability. The observed pattern of responsiveness to sex odors may be related to the social organization and mating system of the prairie vole, a mammal that is believed to be monogamous.

Phase I trial of aggressive weekly chemotherapy in small-cell carcinoma of the lung

We have treated 10 patients with small-cell carcinoma of the lung with an aggressive weekly chemotherapy regimen. Treatment consisted of cyclophosphamide and doxorubicin (Adriamycin) on day 1, methotrexate on day 8, followed by leucovorin on days 9, 10, and 11 cis-platinum on day 15, VP-16 on days 15, 16, and 17, vincristine on days 1, 8, 15, and 22, and trimethoprim/sulfa twice daily. Cycles were repeated every 28 days. The primary toxicity was hematologic. One treatment-related death occurred. All other patients tolerated treatment without irreversible toxicity. There have been three complete responses and seven partial responses. This very active regimen is tolerated with acceptable toxicity even in patients with poor performance status.

Concurrent chemotherapy and radiation therapy in advanced head and neck cancer

A combination of radiation therapy and cis-platinum (25 mg/m2 i.v.) day 1, vincristine (1 mg i.v.) day 2, and bleomycin (15 U i.v.) day 4 was given concomitantly to 14 patients with advanced inoperable head and neck cancer and one patient with local recurrence. Radiation therapy consisted of 70 Gy to the involved areas and 50 Gy to adjacent uninvolved areas at 1.8 Gy per fraction. The overall response rate was 100%. Nine patients (60%) achieved a complete response, and six patients achieved a partial response. One patient appeared to have increasing disease, but biopsies have shown only fibrosis. The survival is 8 of 15 (53%), with a median follow-up time of 24 months. Most significant toxicity was anorexia and weight loss. Other toxicity consisted of peripheral neuropathy (1 patient), mild transient elevation of creatinine (1 patient), hypothyroidism (1 patient), and mild pulmonary toxicity (2 patients). Mucositis occurred in all patients, requiring interruption of therapy (2-14 days).

Mixed bacterial meningitis

Two recent cases of mixed bacterial meningitis at the Kansas City Veterans Administration Medical Center were studied. A review of the literature suggests that 1% of all cases of meningitis are caused by more than one bacterial species. Before 1950 such cases occurred predominantly in children and were caused by combinations of bacteria commonly associated with meningitis. Since 1950 a largely adult population has been affected by mixed bacterial meningitis, with a higher incidence of gram-negative bacillary organisms cultured from the cerebrospinal fluid. Common predisposing factors in this older group of patients include infection at contiguous foci, tumors in close proximity to the central nervous system, or fistulous communications with the central nervous system. Mortality was 26% for cases occurring before 1950 and 63% for those occurring after 1950. Failure to recognize one of the organisms present in the cerebrospinal fluid may result in the initiation of inadequate therapy in as many as 67% of cases. Empiric broad-spectrum antimicrobial therapy is indicated in symptomatic patients predisposed to mixed bacterial meningitis until culture results become available.

Renal effects of gastrin C-terminal tetrapeptide (as pentagastrin) and cholecystokinin octapeptide in conscious rabbit and man

Pentagastrin and cholecystokinin octapeptide (CCK8) were infused i.v. at three different doses in two sets of 4 conscious rabbits following a repeated measurements design (130, 1,300 and 13,000 pmol kg-1 min-1 pentagastrin; 5, 50 and 450 pmol kg-1 min-1 CCK8). In man, two different doses of pentagastrin (13 and 65 pmol kg-1 min-1) were infused in two groups of 6 subjects, and CCK8 (2 pmol kg-1 min-1) in a third group. According to published human postprandial levels, plasma CCK8-like immunoreactivity concentrations were supraphysiological at all doses infused. In the rabbit, pentagastrin produced a dose-related fall in urine flow and free water clearance, but no significant change in systemic and renal haemodynamics, electrolyte excretion and measured plasma constituents; however, in human subjects, pentagastrin increased renal sodium excretion and reduced potassium excretion but did not change glomerular filtration rate. In the rabbit, CCK8 produced a dose-related fall in plasma renin activity, plasma calcium concentration and mean arterial blood pressure; dose-dependent increases in effective renal plasma flow, glomerular filtration rate and renal sodium excretion. In man, changes in sodium and potassium excretion similar to pentagastrin were observed; there were no significant changes in plasma renin activity, plasma calcium concentration, blood pressure, effective renal plasma flow or glomerular filtration rate. The pharmacological renal effects of pentagastrin in conscious water-loaded rabbits resemble vasopressin. In contrast, CCK8's most striking effect was vasodilatation and was unusual in inhibiting rather than stimulating renin release. In man the net changes in urine composition found during infusion of these peptides are similar to those produced by the potassium-sparing diuretics, amiloride and triamterene. However the generally weak renal effects observed, even at pharmacological doses, indicate that these peptides are unlikely to influence renal function under normal physiological conditions.

Lymphocyte subsets in lung cancer

Altered cellular immune function has been demonstrated in patients with lung cancer, including decreased numbers of circulating lymphocytes and changes in the percentage of lymphocytes in various functional subsets. We quantitated lymphocyte subsets in 54 patients with lung cancer including patients with limited (stages 1 and 2) nonsmall cell lung cancer (NSCLC, n = 23), advanced (stage 3) NSCLC (n = 16), and small cell cancer (SCLC, n = 15). Serum albumin was decreased in 15 lung cancer patients, and lymphocyte subsets were separately evaluated in these patients. Lymphocyte populations in cancer patients were compared to those of nonsmokers and a smoking patient population. No difference from smokers was noted in patients with limited NSCLC. Patients with SCLC and advanced NSCLC had significantly decreased numbers of T-helper and T-suppressor cells (p less than 0.05). Patients with lung cancer and hypoalbuminemia had the greatest decrease in number of circulating T-helper cells (p less than 0.001). B-lymphocytes were also decreased in patients with advanced NSCLC and patients with hypoalbuminemia (p less than 0.05). A decrease in population of T-lymphocytes subsets is frequent in patients with SCLC, advanced NSCLC, and lung cancer patients with hypoalbuminemia.

Disruption of ejaculates by male copulation in deer mice (Peromyscus maniculatus)

Six experiments were conducted to analyze possible disruption of sperm transport occurring when one male deer mouse copulates soon after another male ejaculates. When a second male mated soon after the first, females had significantly fewer uterine sperm 1 hr later than when a delay of 7 or 15 min was imposed between males. However, it was impossible to detect any effect of such disruption on pregnancy initiation. Similarly, artificial stimulation soon after an ejaculation was ineffective in disrupting pregnancy initiation. No effect of a rapid resumption of copulation could be detected on litter composition in a sperm competition situation. Although it is clear, from these and other data, that the phenomenon of ejaculate disruption occurs in deer mice, technical difficulties may interfere with experimental analysis.

Hepatic artery aneurysm

We describe a 58 year old woman who had an aneurysm involving the common hepatic artery, the right and left hepatic arteries and the cystic artery which had ruptured into the liver. It was successfully treated by proximal ligation. The features and management of hepatic artery aneurysm are discussed.

Multiple symmetrical lipomatosis in a patient with Hürthle cell carcinoma of the thyroid: a case report

Multiple symmetrical lipomatosis is a rare disorder of fat distribution which generally affects middle age men of Mediterranean origin. Hürthle cell carcinoma is an uncommon variety of follicular carcinoma which invades locally and metastasizes hematogenously to bone, lung, and other distant organs. This report describes a patient who developed multiple symmetrical lipomatosis after undergoing total thyroidectomy for Hürthle cell carcinoma of the thyroid. Type IV hyperlipidemia, hyperuricemia, frequent ethanol usage, and macrocytosis were features previously associated with multiple symmetrical lipomatosis which were present in this patient. Fourteen years after the initial surgery, metastatic Hürthle cell carcinoma was detected in the superior mediastinum. The location of the metastasis and the long disease free interval are unusual features of this case. A possible association between Hürthle cell carcinoma and multiple symmetrical lipomatosis is considered.

Bisantrene hydrochloride in gastric adenocarcinoma: a Southwest Oncology Group Study

Because "the standard" chemotherapy for advanced gastric adenocarcinoma, the FAM combination of 5-fluorouracil, adriamycin, and mitomycin, is only minimally effective, there is a clear need for other choices. Therefore, the Southwest Oncology Group tested the new adriamycin analog, bisantrene, hoping that it might be more effective than the "parent drug." Twenty-six patients with gastric adenocarcinoma were treated on a program of every-3-week 2-hour bisantrene infusions. The starting dose was 260 mg/m2 (208 if poor risk), with subsequent doses based on prior toxicity. The regimen caused sufficient toxicity (especially local phlebitis with pain and swelling) to assure an adequate test. One person (3.8% of eligible patients) experienced a clinically useful 3-month response. He had previously had progressive disease on FAM. Nevertheless, we conclude that bisantrene is not an addition to the small list of drugs useful in the management of gastric adenocarcinoma.

Therapeutic alternatives in patients with esophageal cancer

The records of 52 patients treated either with surgery alone (Group A), preoperative radiotherapy (Group B), or combined preoperative chemotherapy and radiotherapy (Group C) were reviewed to determine the optimal management of patients with squamous cell carcinoma of the esophagus. There was a significant difference in the number of patients with stage III disease between Groups A and C (100 percent and 48 percent, respectively). With the decrease in patients with stage III disease, both resectability rates in Groups A and C (21 percent and 62 percent) and 2 year cumulative survival (0 and 52 percent) increased. Eleven patients in Group C (53 percent) had apparent total resolution of the primary tumor after preoperative therapy. Microscopic tumor was present but was not detected by repeat endoscopy in 35 percent of these patients. The survival rate was higher in patients with apparent total tumor regression who underwent esophageal resection. These results suggest that patients with squamous cell carcinoma of the esophagus are best treated with preoperative chemotherapy and radiotherapy followed by esophagectomy regardless of their response to preoperative therapy.

Pharmacokinetic and biochemical studies on acivicin in phase I clinical trials

Acivicin pharmacokinetics were studied in Phase I patients receiving i.v. treatment on single-dose or daily x5 (daily times five doses) regimens repeated every 3 weeks. In 14 patients, the time course of plasma concentrations was characterized by a biexponential equation with a terminal (elimination-phase) half-life of 9.92 +/- 3.91 h (mean +/- SD), distribution phase half-life of 0.32 +/- 0.28 h, total body clearance of 1.69 +/- 0.48 liters/h/m2, and volume of distribution of 21.79 +/- 2.94 liters/m2. Acivicin kinetics appeared to be dose-independent over the range of 8.5-150 mg/m2/day. Urinary excretion of intact acivicin in nine patients ranged from 2-42% in the first 24 h following administration; interpatient variability in urinary excretion was large, but daily urinary recovery within patients on the daily x5 schedule was quite consistent. Measurements of acivicin effects on the activity of carbamyl phosphate synthetase II (CPS II) were conducted using leukocytes and/or malignant ascites of three colon cancer patients. Acivicin given to one patient at 8.5 mg/m2/day on the daily x5 schedule caused a 70% reduction in leukocyte CPS II activity within 5 h after therapy was initiated. Leukocyte CPS II activity remained suppressed at this level over the 5-day dosing regimen. In this patient, CPS II activity in malignant ascitic cells had decreased by 75% on day 4 of the daily x5 regimen. On the single dose schedule, treatment of two patients with 100 mg/m2 caused leukocyte CPS II activity to decrease by greater than 90% within 4 h of treatment with gradual recovery over the next 2 days.

Phase II trial of 1,4-dihydroxy-5,8-bis((2-((2-hydroxyethyl)amino)ethyl)amino 9,10-anthracenedione dihydrochloride)(NSC 301739, DHAD) in patients with metastatic malignant melanoma. A Southwest Oncology Group pilot

Mitoxantrone, an anthracenedione derivative, was administered by members of the Southwest Oncology Group to thirty patients with metastatic malignant melanoma. The drug was administered as an intravenous infusion over 30 min at a starting dose of 12 mg/m2 and repeated every three weeks. Myelosuppression was the major toxicity. As administered, mitoxantrone is not an effective agent in the treatment of malignant melanoma.

Differential solubility of subcomponents of rat glomerular basement membrane

Marked differences were found in the electrophoretic profiles and amino-acid compositions of components prepared from rat glomerular basement membrane (GBM) by a number of different solubilization procedures. Treatment with reducing agent resulted in a simplified electrophoretic pattern which was characterized by the presence of a major collagenous component with a mol.wt. of 150 000. In contrast, detergent solubilized mainly lower-mol.-wt. material which had a more polar amino-acid composition. When both reagents were used together the majority of the basement-membrane material was solubilized within 2 h and components with mol.wts. of 170 000 and 135 000 were predominant in the pro-alpha region of the gel. Treatment for a further 16 h was required to solubilize higher-mol.-wt. material and to achieve maximum solubility of components in the pro-alpha region with mol.wts. of 185 000 and 150 000. These methods provide a means of separating subcomponents of rat GBM while avoiding the problems of degradation inherent in enzymatic procedures.

Particles in small volume injections

The level of particulate contamination in small volume injections has been examined using the light blockage (HIAC) and electrical sensing zone (Coulter counter) techniques, the HIAC system being found to be the more suitable. Particle counts on the same batch of injection showed a large and variable difference between the HIAC and the Coulter counter results, especially below 5 micron. None of the injections examined complied with the British Pharmacopoeia limits for particulates in large volume parenterals, suggesting the unsuitability of the limits for small volume parenterals.

Maternal and embryonic response to a "carbohydrate-free" diet fed to rats

The effects of a carbohydrate-free, fatty acid (CF) diet on pregnant rats and their progeny were examined. A pregnant pair-fed group was included to compensate for the 40% reduction in food intake of the CF dams. Control and CF dams were killed on days 6, 8, 10, 12, or 14 of gestation. Pair-fed dams were killed on day 14. Maternal CF rats were hypoglycemic and hyperketonemic as compared to pair-fed or control dams. Both CF and pair-fed dams had significantly reduced liver glycogen. Diet had no effect on the number of implantation sites. Conceptuses were classified histologically as normal, retarded, malformed, degenerating or resorbed. Numbers of normal CF embryos were significantly reduced from day 6 and, by day 12, all CF embryos had been resorbed. Control and pair-fed dams showed 5.2% and 43.8% resorptions, respectively, on day 14. These data suggest that approximately half of the embryonic loss can be attributed to the reduction in food intake whereas the remaining embryos succumbed to embryolethal conditions more directly related to the metabolic consequences of carbohydrate deprivation.

Particulate contamination of sterile syringes and needles

Commercially available sterile needles and syringes have been examined for particulate contamination using the Hiac light blockage technique. The number of particles delivered was small compared with the total number permitted for large volume parenterals. Where syringes are used in particle counting techniques, the contribution of particles should be taken into account.

Age-related changes in rat glomerular basement membrane

1. The yield of GBM from rat kidney increased with rat age and the membrane became more collagen-like, as judged by the glycine, hydroxyproline, hydroxylysine content and the degree of glycosylation. 2. GBM became progressively less soluble in sodium dodecyl sulphate (SDS) and 2-mercaptoethanol with age. An increase in the lower molecular weight subunits of membranes prepared from older rats was demonstrated by polyacrylamide gel electrophoresis.

Modification of the glomerular basement membrane in sucrose-fed and streptozotocin-diabetic rats

Rats were fed on diets containing either sucrose or starch as the carbohydrate component (55%) for eight months. Diabetes was induced in animals of both groups by injecting streptozotocin (50 mg/kg body weight). Diabetic rats failed to gain weight, had enlarged kidneys, polyuria and elevated blood glucose levels. Starch and sucrose fed rats gained weight normally and had normal blood glucose levels. Sucrose fed rats had enlarged kidneys. Regional thickening of the glomerular basement membrane was present in sucrose-fed and diabetic rats but not in starch-fed controls. Glomerular basement membrane isolated from pooled kidney cortices from rats in the different experimental groups were analysed for amino acid, disaccharide and hexosamine content. Hydroxylysine (9 to 20%), hydroxyproline (21 to 24%), disaccharide (27%) and hexosamine (26%) were increased in membranes insolated from the three experimental groups, compared with starch-fed non-diabetic controls. An increase in low molecular weight components of the glomerular basement membrane of sucrose-fed and diabetic rats was observed using electrophoresis in sodium dodecyl sulphate. Significantly higher (p < 0.001) glucosyltransferase activity was present in kidney supernatants prepared from sucrose-fed (1050 +/- 60 nmol/2h/kidney) compared to starch-fed rats (510 +/- 40 nmol/2h/kidney). Sucrose feeding induces changes similar to those found in diabetes and the induction of diabetes made little difference over the feeding of sucrose alone.

Composition and biosynthesis of glomerular basement membrane in rats fed diets rich in sucrose

1-month-old Sprague-Dawley rats were fed synthetic diets containing 55% sucrose (SU) or starch (ST) as the sole source of carbohydrate for 2, 3 or 8 months. Both the ST and SU fed rats gained weight normally, but SU fed rats had enlarged kidneys. A higher yield of glomerular basement membrane (GBM) was recovered from 9-month-old SU rats. An increase in the hydroxylated amino acid content was found in GBM prepared from SU fed rats and the glycine content was also higher. The increase in the hydroxylation of lysine was accompanied by increased glycosylation and there was 30% more Glc-Gal-Hyl present in GBM from 9-month-old SU rats. GBM was solubilised with sodium dodecyl sulphate (SDS) and 2-mercaptoethanol and subjected to electrophoresis on 5% polyacrylamide gels. There was an apparent fall in the intensity of the bands with molecular weights greater than 200,000 and a concomitant rise in low molecular weight components (50,000-100,000) in GBM from 4-month-old SU rats. These differences between ST and SU membrane were accentuated when the membranes from 9-month-old rats were compared. No significant differences were found in the glucosyl transferase activities of renal cortical homogenates prepared from 3-month-old SU and ST rats, but the activities in SU rats were significantly higher at 4 and 9 months. The feeding of SU-rich diets to rats induces a number of biochemical changes in the kidney which are similar to those found in diabetes. The feeding of SU diets provides a useful animal model with which to study the effect of dietary carbohydrate on renal GBM. SU should not be included in diets fed to diabetic rats because of the similarity of some of its effects and those seen in chemically induced diabetes.

Differential solubility and subunit composition of rat glomerular basement membrane

Glomerular basement membrane (GBM) was prepared from 2- to 3-month-old Sprague-Dawley rats by differential sieving and sonication. 80% of the membrane was soluble in 1% sodium dodecyl sulphate (SDS) and 1% 2-mercaptoethanol. The soluble fraction was resolved into 15 bands in the molecular weight range 30,000 to 300,000 by SDS-polyacrylamide gel electrophoresis. The major bands present had apparent molecular weights of 100,000 and 148,000. Treatment of GBM with SDS alone solubilised mainly low molecular weight components (45,000-150,000) but when the residue was treated with SDS and 2-mercaptoethanol higher molecular weight material was solubilised. Partial solubilisation of GBM was also achieved with pepsin. Digestion for 18 h at 4 degrees C resulted in 20% of the membrane being solubilised but this was increased to 55% at 10 degrees C. The amino-acid composition of pepsin-soluble GBM was more collagen-like than the residue remaining after enzyme digestion. Although the residue was more polar than whole GBM it still contained significant amounts of glycine and hydroxyproline and could be further subfractionated with SDS into a soluble fraction, the amino acid content of which was similar to whole GBM and a collagenous residue containing 317 residues/1,000 of glycine. When pepsin solubilised GBM was subjected to horizontal electrophoresis in SDS-polyacrylamide slab gels the principal bands migrated in the pro-alpha-chain region. This material was heterogeneous and in addition to the principal components, 6 components with apparent molecular weights less than 95,000 were present together with high molecular weight material in the gamma and beta regions of the gel. The band pattern of the pepsin-insoluble material was similar although the intensities of some individual bands varied significantly from that of the pepsin-soluble material. Rat GBM can therefore be fractionated by treatment with SDS alone, SDS together with 2-mercaptoethanol and pepsin digestion. The data reported is compatible with the presence of a mixture of collagen-like and polar regions rather than a major single collagenous component (type IV collagen).

The use of metronidazole in the preparation of the bowel for surgery

A randomized trial was carried out in 120 patients undergoing colonic surgery mainly for carcinoma. Sixty-one patients received metronidazole and Thalazole and 59 received Thalazole alone. Sepsis occurred in 8 (13.1 per cent) of the 61 patients who received metronidazole, compared with 29 (49.2 per cent) of 59 patients who received only Thalazole. Of the 8 patients with sepsis who received metronidazole, none had infection due to anaerobic organisms.

The treatment of haemobilia

This paper describes 4 cases of haemobilia. The use of hepatic arterial ligation in its management is discussed. Attention is drawn to the raised serum amylase level in the 2 patients in whom it was measured.