Childhood acute promyelocytic leukemia: a rare variant of nonlymphoid leukemia with distinctive clinical and biologic features

Of 251 consecutive cases of childhood acute nonlymphocytic leukemia (ANLL) seen at St. Jude Children's Research Hospital over a 12-year period, 16 (6.4%) were classified as promyelocytic according to the French-American-British definition. Patients with this form of leukemia were older at diagnosis than the group representing all other ANLL subtypes (median age, 14.8 vs. 9.0 years); they had lower leukocyte counts (median, 4.5 vs. 25.9 x 10(9)/liter), and a higher percentage were girls (68% vs. 44%). They also were much more likely to have a coagulation abnormality (75% vs. 13%). Only 44% of the promyelocytic group achieved complete remission, compared with 79% of the remaining patients (p = 0.001); however, after a median follow-up of 3.5 years, all but two of the responding patients with promyelocytic leukemia remain in complete remission. The majority of induction failures in the promyelocytic group (six of nine) resulted from complications that developed during periods of marrow hypoplasia or before hypoplasia was induced; whereas in the comparison group, more than half of the patients who failed had evidence of absolute or relative drug resistance. It is concluded that acute promyelocytic leukemia in children differs sufficiently from other subtypes of childhood ANLL to justify clinical trials of selective therapy. Recommendations for the use of heparin and blood component support in these patients are given.

Effects of anaesthesia on mental performance in the elderly

It has been known for a long time that mental impairment may occur in elderly patients following surgery and this has been attributed to anaesthesia. However, until recently, little systematic research has been carried out in this area. One problem has been that many factors apart from anaesthesia influence the mental function of elderly surgical patients. This paper describes a study in progress which is attempting to isolate the effects of anaesthesia per se on mental function, and identify which aspect of anaesthesia may be responsible. Results from the study indicate that advanced age itself does not predispose to marked postoperative impairment of reaction time, but they do support the idea that patients with some pre-operative mental impairment may be vulnerable to effects of anaesthesia. Thus it appears that the biological age of the brain rather than its chronological age may influence vulnerability to anaesthesia.

Dose of fluphenazine, familial expressed emotion, and outcome in schizophrenia. Results of a two-year controlled study

Issues regarding the side effects of antipsychotic medication and the possible contribution of the environment to dose requirements led to a two-year controlled dosage study of maintenance antipsychotic medication and familial environment among recently discharged schizophrenic patients. Seventy stable patients, living in high- or low-expressed emotion (EE) households, were randomized, double blind, to receive a standard dose of fluphenazine decanoate (average, 25 mg every two weeks) or a minimal dose representing 20% of the dose prescribed (average, 3.8 mg every two weeks). No differences in relapse were observed among dose, EE, or dose and EE. Patients in the minimal dose/high-EE condition experienced more minor but aborted episodes in year 2. Side effects were fewer on the minimal dose after one year, and low-EE patients were better adjusted than high-EE patients. Over time, minimal-dose recipients were significantly more improved in their instrumental and interpersonal role performance than were standard-dose recipients.

Severe obstructive sleep apnea in a child with osteopetrosis

The clinical features of a 5-year-old patient with osteopetrosis and severe obstructive sleep apnea are presented. The patient responded to tonsillectomy, adenoidectomy, uvulectomy, and tracheostomy. The tracheostomy was later removed. Osteopetrosis, while rare, may be added to the list of causes of obstructive sleep apnea.

Quantifying discontent in the nursing profession: a study of staff mobility in Victorian nursing homes

Two problems facing the Australian health system are discontent within the nursing profession and matching limited resources to a growing aged population. It is argued in this paper that the solutions to these two problems can only be evaluated by quantifying the scale of the problem. Three measures are used to demonstrate how to measure the size of the problem: participation rates, staff turnover rates and proportion of permanent/casual staff. These three measures are useful to monitor both at a systems level and at the level of individual health services. The discussion refers in particular to staffing in Victorian geriatric nursing homes.

Victoria's review of registration for health practitioners

This article discusses some of the issues raised in the Interim Report of the current Review of Registration of Health Practitioners being conducted for the Victorian Health Department. The Report attempts to develop the framework in which the registration Boards will operate as part of a cohesive registration system. It proposed a mechanism and criteria for the registration of new groups as well as principles which can be applied to the ongoing review of each existing Board. The Review takes the perspective that registration of health practitioners carries with it both advantages and disadvantages for the general community. Under the proposed new system the controls exercised over health care providers by Registration Boards would be evaluated on the basis of to what extent the benefits to the public outweighed the potential costs. It is in this context that the Report addresses issues such as consumer complaints handling, registration of individual practitioners and controls over professional advertising and other business practices.

Conventional reanastomosis versus laser welding of rat uterine horns

In this study we compared conventional surgical techniques with those of low-power CO2 lasers (output 140 mW; spot size 0.4 mm) used to weld transected rat uterine horns. On one side a microanastomosis was made by standard surgical technique of 8-0 nylon; the other side was "welded" either after doing the anastomosis with 8-0 sutures or without any anastomotic sutures. Histologic sections obtained from rats' uteri treated with conventional and laser surgery showed that on the laser-treated sutured side there was less necrosis and inflammatory and giant cells. The animals that underwent laser welding without suturing had no necrosis, suppuration, or granulation; giant cells were not present. We conclude that in the tissue from the laser-treated animals, when compared with conventional and laser-with-suture surgery, histologic features indicate healing process by primary intention via an aseptic noninflammatory reaction.

Anti-complementary action of polymorphic "solubility forms" of particulate inulin

Inulin crystallizes in a series of polymorphic forms with different solubility rates, ranging from one instantly soluble at 23 degrees C (beta 0(23) inulin) through a form soluble at 37 degrees C with a half-time of 8 min (alpha 8(37) inulin) to a form virtually insoluble at 37 degrees C (gamma inulin). All forms are interconvertible, the more soluble and unstable progressing on standing to less soluble and more stable forms, only reversible by complete solution followed by recrystallization. The end product is the stable gamma inulin, only formed by polymers greater than 8000 mol. wt. A method is given for preparing pure "gamma inulin for injection", comprising insoluble ovoids of less than 1 micron diameter free of soluble inulin and endotoxin. An assay developed for complement action by the alternative pathway showed that gamma inulin was the most potent activator polymorph, more active than killed S. aureus and zymosan. Dissolved inulin and the more soluble polymorphs were inactive and in a mixture hindered alternative pathway activation by the gamma form.

The anti-melanoma activity of inulin in mice

Finely divided, insoluble inulin (gamma polymorph), given intraperitoneally (i.p.) to C57BL mice 1-3 days after i.p. B16 melanoma cells, very significantly increased their mean survival time (MST) in low doses (less than or equal to 40 and less than or equal to 100 micrograms/mouse in 50 and 80% of tests, respectively). The gamma inulin was pure and free of endotoxin and soluble inulin, and was developed as a potent reagent specific for activating the alternative pathway of complement (APC). Its antitumour action paralleled its in vitro APC activation, namely, both activities were sharply dose-dependent up to a threshold dose above which they were dose-independent; dissolved inulin was inactive in vitro and in vivo, decreased the MST of the mice and in a mixture antagonized the in vitro and in vivo activities of gamma inulin; the more soluble (alpha) polymorphs were active in proportion to their gamma content but the effects were blocked at higher doses presumably by dissolved inulin. In addition, depletion of host APC with cobra venom factor or inulin before giving B16 cells increased their malignancy and abrogated the subsequent antitumour action of gamma inulin. The minimum i.p. dose of gamma inulin found to activate serum APC in vivo was 50 micrograms (2.5 mg/kg), i.e. close to the minimum antitumour dose. These close correlations and the specificity of the reagent indicate that activation in vivo of the APC (cellular or humoral) is an important first contact in stimulating host antitumour defences in this mouse model.

Bone lesions in xanthoma disseminatum

A case of xanthoma disseminatum occurred in association with progressive bone lesions. This association has not been previously emphasized.

Effect of measles virus antibodies on a measles SSPE virus persistently infected C6 rat glioma cell line

Maintenance of measles (SSPE-Lec) virus persistently infected C6 rat glioma cells in medium containing polyclonal measles antiserum resulted in the loss of detectable expression of all measles virus proteins. Removal of these cells from antiserum, however, led to a re-expression of virus proteins and the production of infectious virus. Cloning of antibody-modulated non-expressing cells in the presence of antiserum showed that re-expression of virus proteins was not due to an incomplete curing process following the addition of antiserum, as a large number of non-expressing cell clones developed the capacity to express measles virus antigen at different periods after removal of antiserum. Irradiation of persistently infected cells to give a non-growing culture showed that modulation was not mediated by a selection and outgrowth of a small percentage of non-expressing cells originally present in the culture. Antibody directed against C6 membrane proteins did not lead to modulation and it was also shown that only monoclonal antibodies with neutralizing activity could affect intracellular antigen expression. Immunoglobulin Fab fragments with neutralizing activity also had modulating activity. Although all modulated cell clones were more susceptible to homologous virus infection than control C6 cells, it was not possible to rescue any defective measles virus which may have been maintained in the culture.

Laser-assisted vas anastomosis: a preliminary report

A new technique is described for performing vas anastomoses in experimental animal (rats). A low-power CO2 laser appears to be effective in welding together the cut ends of the divided vas deferens.

Neonatal pyruvate carboxylase deficiency with renal tubular acidosis and cystinuria

This report concerns a patient with severe congenital lacticacidosis associated with proximal renal tubular acidosis and cystinuria. Enzyme studies with cultured skin fibroblasts obtained from the patient revealed zero pyruvate carboxylase activity, but propionyl-CoA carboxylase activity was normal. Administration of various vitamins in large amounts did not improve the clinical condition. In contrast, the patient began to thrive when her diet was supplemented with aspartic acid, asparagine, glutamic acid, and glutamine. The particular dietary treatment used and the biochemical findings merit consideration for management of future cases.

Treatment of hyperargininaemia due to arginase deficiency with a chemically defined diet

A brother and sister aged 11 and 17 years have been reported previously to have hyperargininaemia and arginase deficiency: they were treated with a semi-synthetic diet consisting of fat, carbohydrate, minerals, vitamins and essential amino acids in amounts equivalent to 0.55-0.65 g protein kg-1 day-1 for 2 years. Plasma arginine levels fell from 0.50-0.90 mumol/1 to 0.13-0.30 mumol/1 (normal range 0.02-0.15). Increased concentrations of arginine in the cerebrospinal fluid (CSF) fell from 0.069-0.098 mumol/l to 0.040-0.056 mumol/l (normal mean +/- SD = 0.020 +/- 0.006). Dibasic aminoaciduria returned to normal within 1 week. Substitution of the keto-acid analogues of five essential amino acids in the formula lowered arginine concentrations further, but proved to be unpalatable. Urinary concentrations of orotic acid, uridine and uracil fell toward normal but remained increased, even when the plasma ammonia concentration was measured as normal. Both patients showed a stable clinical improvement.

Ultrasound of the prostate. Analysis of tissue texture and abnormalities

Thirty-nine patients with benign prostatic hypertrophy, prostatic carcinoma, or prostatitis underwent ultrasonography using a transabdominal suprapubic approach. In both benign hypertrophy and prostatitis, the gland was enlarged and exhibited a homogeneous echo pattern, being hypoechoic in prostatitis and either hypo- or hyperechoic in hypertrophy. Carcinoma was characterized by focal areas of increased or decreased echogenicity with irregular margins. The various sonographic appearances are explained by correlation with the histological findings, and the advantages of the transabdominal approach are discussed. The authors suggest that widespread application of this technique will improve early detection of prostatic carcinoma.

Beginnings of the New York State Mental Hygiene Medical Review Board 1976-1980

A review is provided of the organization and functions of the New York State Mental Hygiene Medical Review Board and the first 4 years of its investigative activities into sudden, unexpected, mysterious, or unnatural deaths among mental patients. In 4 years 384 such deaths have been investigated, among which natural causes, suicide, and accidents are the most common. Certain medical procedures, laws, and administrative methods have been changed due to findings of the Board.

Excretion and synthesis of basement membrane disaccharide units in Masugi nephritis

During nephrotoxic nephritis in the rat, an increased urinary excretion of glucosyl-galactosyl hydroxylysine and of galactosyl-hydroxylysine has been observed in the autologous phase of the disease. This due mainly to an elevation of the polypeptide-bound fraction of these hydroxylysyl glucosides with a molecular weight over 1,000 daltons. The levels of both urinary hydroxylysyl glucosides were correlated with proteinuria. Their increased excretion appears to originate in the lysed glomerular basement membrane. At the same stage of nephrotoxic nephritis, an increased glucosyl transferase activity could be demonstrated in the isolated glomeruli, correlated with albuminuria, attesting a higher turn-over of the disaccharide units of the glomerular basement membrane.

Unusual presentation of genital tuberculosis

We report two cases of unusual presentation of genital tuberculosis. One patient had an enlarging perineal mass as the only clinical evidence of genitourinary tract involvement. The second had a testicular mass difficult to distinguish clinically from testicular tumor. There was no evidence of upper tract disease.

A new avian influenza virus from feral birds in the USSR: recombination in nature?

Six avian influenza A viruses isolated in the USSR were characterized antigenically by using specific antisera to the isolated surface subunits of the known reference strains. Three of the viruses, all isolated from the same region, were characterized as A/duck/Ukraine/63 (Hav7 Neq2), and a virus isolated from a crow was of the Hong Kong/68 (H3 N2) type. The remaining two viruses were novel in that they possessed Hav7 Nav2 antigens, a combination that has not previously been reported. It is suggested that these new influenza viruses might have arisen by recombination in nature between the A/duck/Ukraine/63 (Hav7 Neq2) and A/tern/So. Africa/61 (Hav5 Nav2) strains of avian influenza viruses.

Apollo 14 and Apollo 16 Heavy-Particle Dosimetry Experiments

Doses of heavy particles at positions inside the command modules of Apollo missions 8, 12, 14, and 16 correlate well with the calculated effects of solar modulation of the primary cosmic radiation. Differences in doses at different stowage positions indicate that the redistribution of mass within the spacecraft could enhance safety from the biological damage that would otherwise be expected on manned, deep-space missions.

Possible biological advantages among schizophrenics' relatives

There is good evidence that genetic factors are necessary, though by no means sufficient, for the development of schizophrenia. Several studies have compared the incidence of schizophrenia in identical and in fraternal twin pairs: these studies are discussed, for example, in the Medical Research Council Annual Report 1965–66 (pp. 54–61), where Essen-Möller's (1963) cumulative figures are quoted: Identical (MZ) pairs: 69 per cent concordant for schizophrenia (both schizophrenic) (194/280 pairs). Fraternal (DZ) pairs: 13 per cent concordant for schizophrenia (both schizophrenic) (59/448 pairs).

Knowledge about sexual matters in delinquent girls

This paper describes a study of the sources and content of ideas concerning sex and reproduction held by adolescent girls in an approved school. The inquiry arose as the result of a question asked in a discussion group of psychiatrists as to how boys and girls normally acquired information about sex.

Immunoradioactive agent against cancer

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