Chemotherapy in bone and joint tuberculosis

Bone and joint tuberculosis, as all other types of tuberculosis is generally treated with antituberculotic combination chemotherapy. This has to be continued for a minimum of six months, or nine months in case of extensive spreading. A two- to three-month initial phase with four or five different drugs (H, R, Z, and additionally E and/or S) is followed by a four- to six-month therapy with H and R alone, provided the pathogen is fully susceptible to a standard regimen. The main side effects are hepatotoxic or allergic reactions. A frequent contra-indication is existing, often toxicity-induced, liver damage. The main local complications requiring surgery are spinal instability or neurologic deficiencies.

[Chemotherapy of osteoarticular tuberculosis]

Bone and joint tuberculosis, as all other types of tuberculosis is generally treated with antituberculotic combination chemotherapy. This has to be continued for a minimum of six months, or nine months in case of extensive spreading. A two- to three-month initial phase with four or five different drugs (H, R, Z, and additionally E and/or S) is followed by a four- to six-month therapy with H and R alone, provided the pathogen is fully susceptible to a standard regimen. The main side effects are hepatotoxic or allergic reactions. A frequent contra-indication is existing, often toxicity-induced, liver damage. The main local complications requiring surgery are spinal instability or neurologic deficiencies.

[Malignant lymphoma associated with HIV infection]

The course of disease in 119 HIV-infected patients (117 men, 2 women; median age 38.5 years) with malignant tumours other than Kaposi's sarcoma was analyzed in a multi-centre retrospective study. This was conducted to obtain initial information concerning the incidence, clinical features and results of therapy in HIV-associated neoplasms, especially malignant lymphomas. The most frequent tumour was malignant non-Hodgkin's lymphoma (98 patients, 82.5%), seven patients had Hodgkin's disease, five had solid tumours, four a polyclonal lymphoproliferative syndrome, three an acute lymphocytic leukaemia, and two had other lymphoproliferative diseases. 58% of the non-Hodgkin's lymphomas occurred in patients with marked immunodeficiency, 85% were high grade malignancies and 47% had primary extranodal disease. 56% of primary nodal lymphomas also had visceral spread (Stage IV). Lymphoblastic non-Hodgkin's lymphoma was more common in patients with favourable immunological status, presented less frequently with primary extranodal disease, was diagnosed earlier than other non-Hodgkin's lymphomas, and appeared to carry a better prognosis. 78 out of the 98 patients with non-Hodgkin's lymphoma had been treated, 66 with cytotoxics. The median survival time was 6 months. Longer remission periods, of at least 12 months, were seen in ten of the 78 patients (13%). Despite the overall poor prognosis and the pre-existing immune defect, palliative (chemo-)therapeutic measures are both justified and promising, and may also result in life-prolonging remissions.

HIV-related malignant lymphomas. A clinical and pathological study of 13 cases

The clinical and laboratory records of 13 patients with HIV-related lymphomas diagnosed between 1983 and 1987 are reviewed. 8 cases were classified as high-grade Non-Hodgkin-lymphomas (NHL), 4 as low-grade NHL (including 2 plasmocytomas), and one as Hodgkin's disease (HD). 11 of the 12 NHL were of the B-cell lineage. The mean patient's age was 39 years. At initial staging evaluation extranodal disease was present in 10 patients, in one of them as primary central nervous system (CNS) lymphoma; 9 patients presented with stage III or stage IV involvement. 9 patients were eligible for multidrug chemotherapy. In 5 cases an initial complete remission (CR) was observed, followed, however, by CNS relapse within a few months in 3 patients. 3 patients did not respond to chemotherapy and died within 4 to 6 weeks. Of the 9 patients treated chemotherapeutically, 5 died within 1 to 5 months, 1 is still alive in CR and 3 are still alive in partial remission (PR).

Lymphocyte activation by phytohaemagglutinin and pokeweed mitogen. Identification of proliferating cells by monoclonal antibodies

Using a two-colour immunofluorescence technique, we have investigated the mitogenic effects of phytohaemagglutinin-M (PHA-M) and of pokeweed nitrogen (PWM) on human lymphocyte subsets. These were identified by CD1, CD3, CD4, CD8, and CD16 monoclonal antibodies, and proliferation was demonstrated by a polyclonal anti-transferrin antibody. Evidence has been obtained for the generation of a population expressing both the CD4 and CD8 antigens simultaneously, in short-term cultures of peripheral blood mononuclear cells in the presence of PWM and of PHA-M.