A randomized trial of cisplatin versus cisplatin plus methotrexate in advanced cancer of the urothelial tract

One hundred eight patients with recurrent or metastatic transitional cell carcinoma of the urothelial tract were randomized to receive cisplatin (C) 80 mg/m2 on day 1 every 4 weeks, or methotrexate (M) 50 mg/m2 on days 1 and 15 plus C 80 mg/m2 on day 2 every 4 weeks (C + M). Fifty-three eligible patients were randomized to C + M and 55 to C. In the C + M arm, 45% of patients responded (complete response [CR], 9%) and 31% (CR, 9%) in the C arm (P = .18). In the C arm, 20 patients failing or relapsing after C received M. Two patients responded, and four with progressive disease (PD) and one with a previous partial response (PR) showed no change. The median survival was 8.7 months (C + M arm) and 7.2 months (C arm), P = .7. Relapse-free survival was not significantly different, but C + M was associated with a significantly increased time to disease progression (median, 5.0 months, v 2.8 months for C arm). The response of untreated patients (37%) was not different from those with prior treatment (39%). On the C + M arm, 92% of patients and 96% of patients on the C arm received 85% or more of the scheduled C dose. Significantly more grade 3 or 4 hematological toxicity (27% v 2%; P = .01) and mucositis (20% v 0%; P = .0005) occurred in patients on the C + M arm. Although the initial response rates seen on the combination arm look superior, and the time to disease progression is increased, these effects have not translated into a clinically important increase in the duration of survival and were associated with increased toxicity.

Automated quantification of rat plasma acute phase reactants in experimental inflammation

Methods are described for the quantification of certain acute phase reactants (albumin, iron, fibrinogen, seromucoid, haptoglobin, and ceruloplasmin) in small amounts of plasma using the COBAS-BIO centrifugal analyzer. These methods have been applied to determine the concentrations of these acute-phase reactants (APRs) in rat plasma during the first 5 days of adjuvant-induced arthritis. The levels of the APRs alter with the degree of inflammation in a dose-related manner. Administration of the antiinflammatory and antirheumatic drugs (indomethacin, dexamethasone, and clobuzarit [CLOZIC]) during the course of the adjuvant-induced arthritis reduced the inflammatory response as judged by the measurement of oedema. These compounds, however, show differential effects on the profile of APRs as systemic measurements of the inflammatory disease. The present study shows that specific classes of drug have defined effects on acute-phase protein concentration. We believe that the multiple analysis of APR levels during the course of inflammation may help to distinguish between and elucidate the mechanisms of action, of antiinflammatory and antirheumatic drugs.

Detection of mammary serum antigen in sera from breast cancer patients using monoclonal antibody 3E1.2

Murine monoclonal antibody 3E1.2, made against human breast cancer cells, detects a glycoprotein (Mr greater than 300,000) called mammary serum antigen (MSA) which is elevated in the serum of patients with breast cancer. An enzyme immunoassay was developed to detect MSA in human serum and used to detect MSA in subjects with breast cancer and other diseases. Raised levels of MSA (greater than 300 inhibition units) were found in the serum of 1.9% of 2406 blood donors, in 18% of sera from 40 subjects with benign breast disease, and in 16% of sera from 222 subjects with non-breast cancers. However, in patients with a diagnosis of breast cancer, 76% (84 of 110) of Stage I and II, and 86% (142 of 166) of Stage III and IV had levels of greater than 300 inhibition units. Nineteen % of patients, classified clinically disease free, had raised MSA levels. In 34 of 37 (92%) patients followed over 2 to 11 mo the level of MSA correlated with the clinical course of disease. Changes in MSA levels not only corresponded to changes in the clinical course of disease, but also preceded the clinical detection of progressive disease. Immunoblotting has detected a heterogeneous molecule of Mr greater than 300,000 and been used to confirm the elevation of MSA in breast cancer patients. Determination of MSA level may be useful for the detection of breast cancer and for monitoring progress of disease and response to therapy.

Detection of HLA antibodies by platelet crossmatching techniques

Thirty-seven monospecific HLA antibodies directed against all common HLA-A and -B loci and reactive by the microlymphocytotoxicity assay (LCT) were tested against platelets carrying the corresponding antigen by three platelet crossmatch methods, the platelet immunofluorescence test (PIFT), platelet enzyme-linked immunosorbent assay (P-ELISA), and platelet radioimmunoassay (P-RIA). Positive reactions were obtained with the PIFT in 67 percent, the P-ELISA in 41 percent, and the P-RIA in 49 percent of 85 cell-serum pairs. The same cell-serum combinations gave 49 percent positive reactions in the lymphocyte immunofluorescence test. Three multispecific HLA antisera were positive in nine of nine cell-serum combinations by all four methods. Thirteen transfusions were given to eight patients with known HLA antibodies. All donor-recipient pairs were LCT positive, six were PIFT positive, and seven were PIFT negative. Three of seven PIFT-negative and none of six PIFT-positive transfusions were successful. Thus, platelet crossmatching is less sensitive than the LCT for the detection of complement-binding monospecific HLA antibodies. The platelet crossmatch, however, is able to identify some potentially successful HLA-incompatible donors for patients with multispecific HLA antibodies and limited access to HLA-identical donors.

Evaluation of directed coughing in cystic fibrosis

Supervised directed coughing was compared to conventional physiotherapy (postural drainage, vibration and/or percussion and coughing) in 38 patients with cystic fibrosis aged 9-18 years admitted to hospital with an exacerbation of their pulmonary symptoms. Assessment included objective measures of pulmonary function and sputum characteristics. Both treatment groups showed significant improvement at the end of the 2-week period. When the patients were graded according to their pulmonary disease, those with mild-moderate disease demonstrated a significant improvement in both treatment groups whereas those with severe lung disease showed little improvement with either treatment. Directed coughing is as effective as conventional physiotherapy in the management of patients with cystic fibrosis admitted to hospital for treatment of an exacerbation of their pulmonary symptoms.

Transient platelet and HLA antibody formation in multitransfused patients with malignancy

Fifty-nine patients receiving platelet transfusions for bone marrow failure secondary to malignancy were screened at regular intervals for the presence of antibodies to human leucocyte (HLA) and platelet specific antigens. HLA antibodies occurred in 19 patients, 10 of whom also developed platelet specific antibodies. The HLA antibodies disappeared in 10 of 15 patients followed for periods of 2-14 months. In two patients this occurred whilst still receiving platelet transfusions. Antibody reappeared in only two of six patients subsequently transfused. Antibodies to platelet specific antigens were detected in 28 patients. They were transient, often appeared in association with infection, and in 50% of cases tested demonstrated autoantibody activity. There was no association with antibiotic drug therapy, or PFA/EDTA-dependent cryptantigens. Platelet recovery at 1 h or 20 h post transfusion was not significantly reduced in the presence of platelet specific antibodies. These findings have important implications for the selection of platelet donors for alloimmunized recipients.

Magnetic resonance images of chronic patellar tendinitis

Chronic patellar tendinitis can be a frustrating diagnostic and therapeutic problem. This report evaluates seven tendons in five patients with chronic patellar tendinitis. The etiologies included "jumper's knee" and Osgood-Schlatter disease. In all cases magnetic resonance images (MRI) showed thickening of the tendon. Some of the tendons had focal areas of thickening which helped establish the etiology. All cases had intratendinous areas of increased signal which, in four cases, proved to be chronic tendon tears. MRI is useful in evaluating chronic patellar tendinitis because it establishes the diagnosis, detects associated chronic tears, and may help determine appropriate rehabilitation.

Heterogeneous cytogenetic abnormalities in small cell lung cancer cell lines

Ten cell lines were established from different biopsies from nine patients with small cell lung cancer (SCLC). These were established from metastases in the marrow (7), breast (1), pleural fluid (1), and spinal cord (1) and had been in culture for periods varying from 1 to 11 months. All cell lines exhibited typical cytological features of SCLC, and produced neuron specific enolase. All lines examined (5) contained dense core granules and were tumorigenic when injected intracranially into nude mice. None of the six cell lines tested had an amplified oncogene (c-myc or n-myc) previously reported to be amplified in SCLC. Detailed chromosome analyses were undertaken and showed that a structural abnormality of chromosome 3(p11p23) was a frequent (6 of 10) but not invariable finding. Our study and one other indicate that there is not a unique chromosome abnormality present in all cases of SCLC, although loss of chromosome 13 and structural abnormalities of chromosome 3 were frequently found. A feature of these SCLC cell lines established from metastatic deposits was the complexity of the karyotypes due to numerical and structural chromosomal abnormalities.

Phase I study of epirubicin given on a weekly schedule

Epirubicin was studied in a phase I setting to find the maximum tolerated dose when given weekly for 3 of 4 weeks. Forty-one evaluable patients were treated in groups at doses increasing from 20 to 45 mg/m2. The highest dose level produced the maximum degree of myelosuppression (lowest neutrophil count, 1.9 X 10(9)/L; range, 0-3.7) recorded on Day 22. This was well-tolerated in this group of mainly pretreated patients. Nonhematologic side effects were minimal. This dose schedule allows a greater dose per unit time to be administered than other recommended schedules for epirubicin.

Phase I and pharmacokinetic study of tiazofurin (NSC 286193) administered by 5-day continuous infusion

A phase I and pharmacokinetic study of tiazofurin (NSC 286193), a C-nucleoside that inhibits IMP dehydrogenase, has been completed. The drug was administered by continuous infusion over 5 days. The maximum tolerated dose was 1650 mg/m2 per day, neurological toxicity being the dose-limiting factor. Gastrointestinal and hematological toxicity were mild. A definite relationship exists between dosage and steady-state levels. The plasma clearance was 29.13 (+/- SD 4.05) ml/min per m2. No complete or partial remissions were demonstrated among the 18 patients treated at five dose levels between 550 mg/m2 and 2200 mg/m2 per day.

Chemotherapy in metastatic melanoma: phase II studies of amsacrine, mitoxantrone and bisantrene

In a phase II study 20 patients with measurable metastatic melanoma were treated with amsacrine 120 mg/m2 every 3 weeks. No objective responses were observed. In a separate study 29 patients received mitoxantrone 12-14 mg/m2 every 3-4 weeks. One objective partial response was seen. The drug was well tolerated. Seventeen patients were treated with bisantrene 135-200 mg/m2 weekly. No objective responses were observed. Phlebitis was the major non-hematologic toxicity of bisantrene. These agents are not recommended for treatment of malignant melanoma.

A 45-kb DNA domain with two divergently orientated genes is the unit of organisation of the murine major urinary protein genes

The multigene family which codes for the mouse major urinary proteins (MUPs) consists of approximately 35 genes. Most of these are members of two different groups, Group 1 and Group 2, which can be distinguished by nucleic acid hybridisation. By screening a Charon 4A library of mouse DNA with probes from the 5'-flanking region of a MUP gene, we have isolated clones that contain both a Group 1 and a Group 2 gene, orientated in a divergent fashion, with 15 kb of DNA between the 5' ends of the genes. We show that this pairwise arrangement is the predominant organisation of MUP genes in the BALB/c genome. We argue that the head-to-head gene pair is the unit both of DNA organisation and of evolution. Taking into account the genes themselves, the intervening 15 kb and the homologous 3'-flanking regions, this unit is approximately 45 kb long. We also show that some MUP genes may be linked in a tail-to-tail fashion with 26-28 kb between the 3' ends of two genes. This suggests that the minimum distance between successive 45-kb units is approximately 7 kb.

Effect of primary and secondary radicals on chain breaks in ribosomal RNA in E. coli ribosomes

Chain breaks in ribosomal RNA have been observed on gamma-radiation-induced inactivation of E. coli ribosomes. These breaks are caused by .OH and .H radicals, but not by e-aq and tertiary butanol-peroxy radicals.

Presence and distribution of immunoreactive and bioactive FMRFamide-like peptides in the nervous system of the horseshoe crab, Limulus polyphemus

FMRFamide immunoreactivity was detected in all regions of the Limulus nervous system, including the brain (6.5 +/- 0.6 pg FMRFamide/mg), cardiac ganglion (2.06 +/- 0.67 pg FMRFamide/mg), and ventral nerve cord (5.8 +/- 0.7 pg FMRFamide/mg). The distribution of immunoreactive FMRFamide (irFMRFamide) was mapped by immunofluorescence and the distribution corresponded to regional RIA data. A good proportion of the CNS and cardiac ganglion neuropile contained irFMRFamide, and fluorescent cell bodies were observed in several areas. High performance liquid chromatography (HPLC) was employed to separate and characterize the FMRFamide-like peptides from extracts of Limulus brains. HPLC fractions were analyzed using coincidental radioimmunoassay and bioassay (the radula protractor muscle of Busycon contrarium). There appear to be at least three FMRFamide-like peptides in the Limulus brain, including one similar to clam FMRFamide. FMRFamide acts on Limulus heart in a biphasic manner at relatively high concentrations (10(-5)M), but has no effect on the activity of the isolated ventral nerve cord. These data suggest that in Limulus FMRFamide-like peptides are acting as neurotransmitters, or neuromodulators.

Structure of mouse major urinary protein genes: different splicing configurations in the 3′-non-coding region

The multigene family which codes for the mouse major urinary proteins (MUPs) consists of approximately 35 genes. Most of these are members of two different groups, Group 1 and Group 2, which can be distinguished by nucleic acid hybridisation. Here we describe the structure of a Group 1 gene and show that two size classes of MUP mRNA which are found in mouse liver result from different splicing events in the 3'-non-coding region and contain different polyadenylation sites. Short mRNA is approximately 750 nucleotides long, contains six exons, and is the main product of the Group 2 genes. Long mRNA is approximately 880 nucleotides long, contains seven exons and is the main product of the Group 1 genes. Five exons and part of the sixth are common to long and short mRNA and contain the coding region. This codes for an acidic protein of 180 amino acids containing an 18 residue signal peptide. A comparison of the mouse sequence with a homologous rat alpha 2u-globulin sequence shows that the rate of evolutionary divergence of the two proteins has been high. Silent sites have diverged four times more rapidly than replacement sites, showing that there has been selection against change in the protein sequence.

Detection of platelet alloimmunity with a platelet-associated IgG assay

A quantitative immunofluorescence PA-IgG assay was used to detect alloimmunity to platelets. The assay identified serum alloantibodies in 10 out of 14 multitransfused patients and for two of three infants with neonatal thrombocytopenia. The correct separation of all multitransfused patients into alloimmune and nonalloimmune groups by the PA-IgG assay was substantiated with chromium-51--labeled platelet survival studies. The allogeneic nature of the serum antibodies was demonstrated by progressive absorption of the antibody with increasing numbers of allogeneic platelets but not with autologous platelets. The sensitivity of the PA-IgG assay for detection of serum alloantibodies was superior to that of platelet aggregation, platelet serotonin release, and lymphocytotoxicity testing. In dilution experiments with alloimmune serum, elevated levels of serum PA-IgG could still be detected on donor platelets when platelet aggregation and serotonin release tests became negative. Platelet survival studies with selected platelets performed in the 10 alloimmunized, multitransfused patients confirmed the results of the PA-IgG assays, predicting alloimmunity to the donor platelets. In contrast, platelet aggregation, platelet serotonin release, and lymphocytotoxicity testing indicated alloimmunity for 50% or less of the patients. Reduced platelet survival times were also seen with HLA A- and HLA B-matched donor platelets when donor-recipient incompatibility was demonstrated by the PA-IgG assay. Thus the PA-IgG assay provides a sensitive method to detect serum platelet alloantibodies and may offer a technique in platelet crossmatching.

Surgical correction of the splayfoot: the Giannestras procedure

Clinically, the splayfoot is characterized by valgus of the great toe with bunion formation in association with a relative varus position of the first metatarsal. On the lateral side of the foot, there is varus of the fifth toe with a relative valgus position of the fifth metatarsal and resultant bunionette formation. Radiographically, splayfoot is characterized by an intermetatarsal angle between the first and second metatarsals of greater than 12 degrees, and an intermetatarsal angle between the fourth and fifth metatarsals of greater than 8 degrees. The Giannestras splayfoot procedure consists of excision of the bunion and bunionette, adductor tenotomy, opening-wedge osteotomy of the first and fifth metatarsal bases, and realignment of the first and fifth toes. One-hundred and sixteen splayfoot operations were performed in 72 patients, with an average follow-up of 5.2 years. Results were considered excellent in 33% (39 feet), good in 45% (52 feet), fair in 14% (16 feet), and poor in 8% (9 feet). The primary cause of a fair or poor result was collapse of the bone graft at the base of the first metatarsal, causing recurrent varus and symptomatic hallux valgus.

Timing of single daily meal influences relations among human circadian rhythms in urinary cyclic AMP and hemic glucagon, insulin and iron

Relations among circadian rhythms in serum iron, glucagon and insulin and urinary cyclic AMP excretion differ drastically when diurnally active, nocturnally resting human adults consume all daily food for one week as breakfast only and for another week as dinner only - a finding of interest to diverse fields, e.g., for optimizing certain kinds of therapy or for a better utilization of calories.

Quantitative and Qualitative Studies of Bacteria Isolated from Sea Water Used in the Laboratory Culture of the American Oyster, Crassostrea virginica

Quantitative and qualitative bacteriological studies were conducted on sea water utilized in laboratory culture of American oyster larvae (Crassostrea virginica).The generic diversity of bacteria isolated from a laboratory seawater storage tank did not change during a 15-day sampling period, although bacterial numbers increased substantially. The mean number of bacteria in ultraviolet light-irradiated sea water was less than that in nonirradiated sea water, although individual samples varied considerably. Over a 10-day sampling period during which oyster larval cultures were sampled repetitively, bacteria were more numerous at 24 h and 48 h than at 0 h.Pseudomonas was the dominant genus present in stored sea water, irradiated sea water, and sea water from oyster larval cultures.

Enhancement of filterability of sickle cells by cyanate: an effect independent of oxygen saturation

Filterability and morphology of cyanate-treated sickle cells were compared to those of untreated cells at equal oxygen saturations to determine whether carbamylation inhibited sickling by an effect other than by its alteration of the oxygen dissociation curve. Morphology of treated and untreated cells was not significantly different at all levels of oxygen saturation examined. Filterability, on the other hand, was improved significantly by carbamylation. This latter finding indicates that carbamylation enhances deformability of sickle cells by a mechanism(s) in addition to its effect on red cell oxygen saturation. This mechanism(s) may account for the clinical benefit of cyanate therapy with doses which do not significantly affect the oxygen dissociation curve.

Regulations controlling the sale of mild analgesics in Canada

Some mild analgesic preparations are sold only on prescription; others are required to carry specific label warnings. The conditions of sale of some are further restricted by limitations on their dose. The "prescription only" sale of both phenacetin and acetaminophen would leave no "over-the-counter" analgesics available for individuals sensitive to salicylates. Since analgesic nephropathy results from long-term abuse of these preparations, the need is to prevent abuse without inhibiting their proper use.

A partial deletion map of the galactose operon in E. coli K12

We have isolated a number of λdgHFT lysates which carry proximal fragments of the galactose operon. Most of these have been shown to be different, and each terminates in either the kinase or transferase cistron. They divide the kinase cistron genetically into seven blocks of mutants, and the transferase into eight.

When a λdgis used to transduce a bacterium which carries a mutation in a cistron which is intact in the λdgthe transduction frequency is high in the presence of λ-helper. This is attributed to integration of the transducing fragment at the λ-attachment site and complementation between the two operons in the heterogenote. When the same λdgtransduces a mutation lying in the cistron in which the λdgterminates, so that recombination within the galactose operon is obligatory, the transduction frequency is 10 to 1000 times less.

In such cases there is a general increase in transduction frequency between distal mutations (i.e. those lying near the termination of the deletion) and proximal mutations, but the relationship does not hold for many individual pairs of mutants, probably due to physiological differences between the bacterial strains.

The Canadian drug adverse reaction reporting program

The origins and objectives of the Food and Drug Directorate's Drug Adverse Reaction Reporting Program are reviewed. A brief report from (F&D 123), which has been made available to all physicians, provides the means whereby suspected reactions to drugs can be reported to the Directorate. Information contained in these reports is treated as confidential. Twelve Canadian teaching hospitals have entered into a contractual agreement with the Directorate in order to investigate and evaluate suspected drug reactions occurring in the hospital setting. Manufacturers are notified if a problem appears to be arising in connection with a product, and discussions are held before any regulatory action is taken. Also, under the New Drug Regulations of 1963, pharmaceutical manufacturers are required to notify the F.D.D. if any unexpected reactions occur in association with their products. The Food and Drug Directorate is giving considerable thought to the means by which the interest of the profession in this program may be stimulated.