A phase I trial of intrapleural recombinant human interferon alpha (rHuIFN alpha 2b) in patients with malignant pleural effusions

The use of intrapleural sclerosing agents to control reaccumulation of pleural fluid in patients with malignant effusions has been widely investigated. A phase I trial of intrapleural recombinant human interferon alpha (rHuIFN alpha 2b) was initiated to determine the toxicity and maximal tolerated dose in this group of patients. rHuIFN alpha 2b was instilled as a single dose following chest tube (15/16) or percutaneous (1/16) drainage of cytologically proven malignant effusions. Doses of rHuIFN alpha 2b were escalated from 25 x 10(6) to 200 x 10(6) U/m2 in cohorts of three to four patients. Toxicity was mild to moderate, and included chills, fever and chest pain, and resembled that produced by systemic administration of rHuIFN alpha 2b. Dose-limiting toxicity occurred at 200 x 10(6) U/m2 and consisted of hepatic enzyme elevations and renal failure. Partial control of the effusions was noted in two patients, with two additional patients having stable disease. Phase II trials of rHuIFN alpha 2b should utilize up to 150 x 10(6) U/m2 for intrapleural instillation.

Phase I/II trial of dipyridamole, 5-fluorouracil, leukovorin, and mitoxantrone in metastatic breast cancer

Based upon the hypothesis that dipyridamole would potentiate the cytotoxicity of mitoxantrone and the combination of 5-fluorouracil (5-FU) and leukovorin, we performed a phase I/II trial of the combination of dipyridamole, 5-FU, leukovorin, and mitoxantrone in patients with metastatic breast cancer. The dose of dipyridamole was fixed at 175 mg/m2 by mouth every 6 h (700 mg/m2/day), based upon a previous phase I trial of oral dipyridamole with 5-FU and leukovorin. Dipyridamole therapy began 24 h prior to the first dose of chemotherapy and continued until 24 h after the last dose of chemotherapy for each course of treatment. At the initial dose level, leukovorin 200 mg/m2 was given intravenously immediately prior to 5-FU 375 mg/m2 intravenously on days 1-5. Mitoxantrone 6 mg/m2 was given as a single dose on day 3. Unacceptable toxicity was observed at this dose level, leading to successive dose decrements rather than dose increments. The maximum tolerated dose was leukovorin 200 mg/m2 days 1-2, 5-FU 375 mg/m2 days 1-2, mitoxantrone 6 mg/m2 on day 2, and dipyridamole 175 mg/m2 every 6 h on days 0-3. Two responses were produced in 15 patients. This regimen is not recommended for further investigation in the treatment of breast cancer.

Tracheal sleeve resection for iatrogenic stenoses (subglottic laryngeal and tracheal)

Since 1975 200 tracheal sleeve resections for iatrogenic tracheal and subglottic laryngeal stenoses have been performed in our institution. Preoperative Nd:YAG laser is of paramount help in opening the stenoses. Tracheography is usually performed to specify the length of the stenosis and the distance from the vocal cords. Operative procedures are described. One hundred seventy five (87.5%) patients are definitely cured, but in this group 16 patients required a Montgomery tube for 6 months to 1 year to recover a normal tracheal diameter. Two patients needed a second tracheal sleeve resection. Nine (4.5%) patients died, and 16 (8%) had recurrent stenoses. Stenoses in these patients were treated with use of a tracheostomy tube, a permanent Montgomery tube, or an endotracheal stent. Partial anterior cricoid resections performed in 21 patients have had the same results as those of the whole series. Twenty one laryngeal releases were performed and proved to be efficient and safe. In our experience complications can be avoided by good selection and preparation of the patients, accurate identification of the level and length of the stenosis, and meticulous technique.

[Sonography in Crohn disease--the conclusions of an experts' group]

Sonography is adding a new dimension to diagnosis of Crohn's disease: the analysis of the transmural and peri-intestinal manifestations of the chronic inflammation. Distortions in the structure of intestinal wall are recognizable, the impact on transport of intestinal content can be judged, penetration of inflammation into the bowel surrounding as fistula, abscess, mesenteriitis und peritonitis is safely seen. Differential diagnosis on a strictly sonographic basis is difficult. The paper represents the results of an expert meeting held at the University of Frankfurt/M.

[Real-time sonography in deep thrombosis of the pelvic and leg veins. A prospective comparison to phlebography]

Real-time B mode ultrasound is a well accepted diagnostic procedure in the non-invasive vascular examination. In a prospective study we examined 101 patients with clinical suspected deep vein thrombosis of the pelvis or leg using ultrasound and contrast venography within 24 hours and we compared the results of both examinations. All veins of the pelvis and lower extremities were scanned in transverse and longitudinal planes. 113 venograms were obtained; they demonstrated the presence of isolated proximal vein thrombosis in seven patients, seven isolated calf vein thromboses and 43 thromboses of both proximal and calf veins. The sensitivity of ultrasonography for detecting deep vein thrombosis in the proximal veins of the lower extremity was 98%, the specificity was also 98%. In the veins of the pelvis the sensitivity was 78%, the specificity 98% and in calf veins 60% and 97% respectively. The sensitivity for the detection of isolated calf vein thrombosis was only 14%. We conclude that ultrasonography has a very good sensitivity for detecting proximal vein thrombosis of the lower extremity and thrombosis of the pelvic veins. Phlebography remains the better method in detecting isolated calf vein thrombosis because of the difficult visualisation of the small calf veins by ultrasonography.

[Elution of sensitized erythrocytes with chloroquine]

The results of erythrocyte elutions sensitized either in vitro or in vivo with a 15% solution of Chloroquine indicate that at a low degree of sensitization it is possible in more than half of the tested cases to release incomplete antibodies from the red cell surface without causing damage of the group receptors. This makes it possible to assess the phenotypes of the majority of erythrocyte characteristics, although some may be weakened by elution.

[A rare case of paternity elimination based only on the HLA-C locus in the HLA system]

The authors describe a rare paternity suit where paternity was ruled out in the HLA system only in locus HLA-C. The absence of HLA-Cw2 antigen on the lymphocytes was proved by the negative results confirmed by the same result on examination of the erythrocytes Ss system.

[The importance of comprehensive immunohematologic tests in paternity disputes]

The authors describe four cases of paternity suits where the paternity was not ruled out according to HLA antigens and was ruled out in signs of erythrocyte, serum and enzyme systems, although the capacity of the HLA system was high, in two instances above 98%. From the results ensues that it is useful to supplement the examination by erythrocyte, serum and enzyme systems in those instances where HLA typing was performed first and the man was not ruled out.

[Immunologic monitoring of bone marrow transplantation. Experience with 16 cases]

HLA-A, B antigens and the ABO group were examined in 184 patients with aplasia of bone marrow and leukaemia and in 373 of their relatives, mostly siblings. A HLA-A, B donor, identical or compatible, was found for 35.87% patients, a HLA-DR identical for 84.21% of 38 patients who had a HLA-A, B identical relative. Bone marrow was transplanted to 16 patients (10 with bone marrow aplasia, 6 with acute or chronic leukaemia), with one exception bone marrow from a sibling. The bone marrow was accepted in all patients but two where the transplantation was made despite MLC positivity. From the results ensues that it is essential for successful transplantation of bone marrow to ensure maximal identity between donor and recipient as regards the ABO group, HLA antigens and negativity of the MLC reaction. The negativity of the MLC reaction is more important than HLA-DR identity; when assessing only one HLA-DR antigen in a donor identical with the patient, it cannot be ruled out that on the lymphocytes of the donor there exists another one which was not detected. The authors discuss the causes of different results of the MLC reaction and HLA-A, B, DR typing.

Bone marrow transplantation for childhood Ki-1 lymphoma

Two children with Ki-1 antigen-positive, non-Hodgkin's lymphoma received high-dose chemotherapy, fractionated total body irradiation (TBI), and allogeneic bone marrow transplantation. Both patients had relapsed multiple times on conventional chemotherapy and radiation therapy. Following transplantation, there was successful engraftment with disappearance of clinical signs and symptoms of their disease. As of June 1, 1989 they are in continuous unmaintained complete remission, 56 and 40 months, respectively, after bone marrow transplantation.

[Colonic neoplasms and skin fibromas: common determinants and their significance]

To find common factors for colonic-neoplasias and skin-tags, 157 inpatients, who consecutively had a coloscopy because of intestinal complaints, were intensively examined dermatologically. Regression-analyses showed that the number of colonic polyps were age- (p = 3 x 10(-8)) and sex-dependent (1.9 x 10(-2)) and skin-tags had no influence on the number of colonic polyps. The size of colonic polyps also showed a clear age dependency (p = 3 x 10(-8)). The number of skin-tags were dependent on weight (p = 9 x 10(-3)) and age (p = 1.3 x 10(-2)), its size on the interaction of sex and triglyceride-levels (p = 3 x 10(-8)). Discriminant-analyses identified the following factors as important: age and triglyceride-concentration to recognize a patient with colonic polyps; age, positive Haemoccult-test and number of skin-tags to recognize a patient with tubulovillous adenomas or colonic carcinomas. The essential common factor of colonic polyps and skin-tags was the age. For the recognition of a patient with colonic polyps the age was the most essential factor, skin-tags, on the contrary, were unimportant. The association between colonic polyps and skin-tags therefore was merely an effect of age.

[Duffy blood groups and HLA antigens in hereditary motor-sensory neuropathy]

The Duffa system (Fya Fyb) and HLA antigens were examined in 86 subjects (39 affected, 47 healthy) in 17 families with HMSN type I, II and III. They recorded the incidence of autosomal dominant as well as recessive (possibly sporadic) forms. In the autosomal dominant form of HMSN type I a close relationship was detected between genes coding the investigated disease and blood cell signs Fya and Fyb. Recombination was found only in 9.1% of the cases. Investigation HLA antigens revealed marked reduction of the B27 antigen in the investigated patients. A striking sign in families with the autosomal dominant form of HMSN type I was an identical haplotype of the majority of parents.

[Sonography in the diagnosis and follow-up of colonic diverticulitis]

17 patients with colonic diverticulitis of various degree were examined by conventional abdominal ultrasound in comparison to either colonoscopy or operation. The sonography of the inflammated region showed an echo-poor enlargement of the colonic wall (normal less than 3 mm) ranging from 5 to 15 mm (mean 7.8 mm) over a short distance. In cases with bowel wall enlargement of more than 11 mm a spontaneous evacuation of pus from the diverticles was endoscopically seen. A sonographic enlargement of the colonic wall of more than 15 mm is very suspicious to be a peridiverticulitis or a beginning abscess. In two patients we were able to show single inflammated diverticula by sonography. Thus ultrasonography seems to be an important noninvasive method to diagnose diverticulitis including the complications (perforation, abscess or fistulation) as well as to control the success of conservative treatment.

[Sonographic findings in silicone-induced granulomas and lymphadenopathy following mammaplastic surgery]

Ultrasound examination of the breast and its lymphatic drainage was undertaken in 78 patients who--after mammoplasty with silicone implants--had palpable lymph nodes, pain and sensation of tension in the area surrounding the implant. Five patients had space-occupying echo-dense inner structures and dense echos from structures dorsal to the space-occupying ones. In this way silicone granuloma could be demonstrated even preoperatively in tissues, musculature or lymph nodes, although the changes were palpable in only two of the five patients. Ultrasonography can thus be of great importance not only in the diagnosis but also in the preoperative localization of silicone-induced granulomas.

[An unusual case of eliminating a man as the father of twins]

The authors describe an uncommon case when despite the great eliminating capacity of the HLA system a man in this system was eliminated only from paternity of one twin; as to the other twin, surprisingly he was eliminated in the Hp serum system.

[Screening for irregular erythrocyte antibodies]

The existence of 20 erythrocytic receptors carried out simultaneously by indirect antiglobulin, agglutination and 3 enzyme tests gave evidence that the most sensitive enzyme test is the ficin test. The enzyme tests reliably detect antibodies of the Rh and P systems with better results than indirect antiglobulin test. They are not suitable for determining the characters of the next seven erythrocytic systems as they disintegrate partly or fully the serologically active structures of the characters. For this purpose the indirect antiglobulin tests is the most reliable reaction for detecting incomplete antibodies. When a mixture of panel erythrocytes was used in screening, a mixture taken from 3 persons proved better than that of 2, as it was possible to achieve a more suitable combination of minimum quantity of receptors needed to attain for optimum sensitivity of the reaction. It was equally proved that the receptive ability of the erythrocytes does not only depend on homo- or heterozygote characters but also on their specific relationship to the reacting antibody.

[A new latex agglutination test for the immunologic detection of occult blood in stool]

An new latex agglutination system was developed for the detection of occult blood in the feces. Antibodies against human hemoglobin were raised in a goat. Blood in concentrations of 0.1 ml-8.0 ml/100 g feces were detected in vitro. The antibodies were separated and adsorbed to latex particles (0.3 microns). After in vitro standardisation of the new test system we compared the efficacy of the commonly used guaiac slide test for detection of occult blood in the stool (hemoccult-test) with the latex test system. A significant higher sensitivity could be reached with the latex test system. In a clinical study 61 patients were tested. In 31 of them occult blood was found with the latex test system while with the guaiac slide-test system no blood was detected using the same stool specimen. 13 of the 31 patients had a neoplastic lesion of the colon - 4 a colon carcinoma and 9 had adenomatous polyps of the large bowel larger than 5 mm in diameter. In the remaining patients the sources of intestinal bleeding were: upper gastro-intestinal bleeding sources in 8 patients and other colonic bleeding sources like diverticular disease, inflammatory bowel disease, hemorrhoids and a rectal ulcer in 8 patients. In 2 of the 61 patients the latex test was positive without endoscopic significance for the bleeding source.

[Endoscopic implantation of a gastric balloon--a method of weight reduction with few complications?]

A gastric balloon was endoscopically implanted in seven over-weight (36-58%) patients to achieve weight reduction on an out-patient basis. During the period of observation four patients spontaneously passed the balloon transanally, one after brief intestinal obstruction with abdominal cramps and vomiting, another with the development of ileus, which responded to eight days of conservative treatment. The occurrence of such not insignificant side effects suggests that at present the use of endoscopic implantation of gastric balloons is not a reasonable way of treating obesity.

[Patients with chimerism--immunologic detection of bone marrow acceptance]

The establishment of the ABO chimerism (two populations of erythrocytes deviating in ABO antigens) following a bone marrow transplantation represents a simple rapid method for the proof of the transplant acceptance. A remarkable case was described in which in a patient with hypoplasia of the bone marrow in the peripheral blood there exist two deviating in ABO antigens populations of erythrocytes (AB blood corpuscles of the patient and B erythrocytes of the donor) still 4 1/2 years after the transplantation of the bone marrow. This fact speaks for the simultaneous existence of the own bone marrow as well as of the bone marrow of the donor in the patient.