Photochemotherapy (PUVA) in the tumour stage of mycosis fungoides: a report from the Scandinavian Mycosis Fungoides Study Group

Twenty-five patients with mycosis fungoides in the tumour stage were treated with oral 8-Methoxypsoralen followed by UVA (PUVA), sometimes in combination with topical or systemic chemotherapy. In 17 patients the disease was confined to the skin, in 7 lymph nodes also were involved, and one had visceral involvement. Complete and partial remission was achieved in 14/17 patients with the disease limited to the skin (82%), and partial remission of the skin lesions in 5/8 patients with extracutaneous location.

Renal side effects of lithium: the importance of the serum lithium level

Patients given long-term treatment with lithium often develop an impairment of renal water reabsorption which may lead to clinically significant adverse reactions. A convenient measure of this impairment may be obtained using the ratio of urine volume (V) divided by lithium clearance (CLi). When data from a large group of patients were recalculated, this ratio showed a statistically significant correlation with the serum lithium level. This finding supports the suggestion that patients might advantageously be maintained at lower serum levels than those commonly employed.

Photochemotherapy (PUVA) in the pretumour stage of mycosis fungoides: a report from the Scandinavian Mycosis Fungoides Study Group

Fifty-one patients with mycosis fungoides of pretumour stage were treated with oral 8-MOP and UVA photochemotherapy (PUVA). Complete remission was induced within 2--3 months in 58% of the cases. Twenty-seven patients are still in remission on maintenance therapy 9--53 months after starting treatment. In 9 cases PUVA treatment was stopped due to therapeutic failure and in another 15 cases due to various side effects. Maintenance therapy was given weekly, monthly, or at even longer intervals. Maintenance at long intervals seems preferable.

Combination chemotherapy in the tumour stage of mycosis fungoides with cyclophosphamide, vincristine, vp-16, adriamycin and prednisolone (cop, chop, cavop): a report from the Scandinavian mycosis fungoides study group

Combination chemotherapy with cyclophosphamide, vincristine, VP-16, adriamycin and prednisolone was given in 9 cases of mycosis fungoides in the tumor stage

Azathioprin in the treatment of airborne contact dermatitis from compositae oleoresins and sensitivity to UVA

No abstract available

Renal response to potassium infusion in rats given lithium for prolonged time

The effects of infusion of potassium chloride was studied in Wistar rats given lithium by the food for more than 3 weeks. The animals were anaesthetized with amytal and three clearance periods were run. During periods 1 and 3 0.15 M NcCl was infused at a rate of 0.02 ml/min. for 60 min. and in period 2 0.5 M KCl was infused at the same rate for 90 min. Potassium infusion led to an increase of potassium excretion. Sodium excretion and urine flow were positive linear correlated to the potassium excretion but in rats given lithium the effect of potassium on sodium excretion was about eight times higher and the effect on urine flow about thirteen times higher than the effects on control rats not given lithium. The concentration of Na and K in the urine of the lithium-treated group were within a narrow range and almost unaffected by potassium infusion. Lithium clearance and the fractional excretion of lithium rose significantly during potassium infusion. Inulin clearance was almost unaffected by the potassium infusion. The results indicate that potassium infusion in rats given lithium for prolonged time leads to an increase of renal sodium, water and lithium excretion.

Potassium-induced renal loss of sodium in lithium-treated rats

A high intake of potassium prevents lithium-induced renal water and sodium losing conditions. In order to investigate a probable curative effect of potassium against these conditions Wistar rats were given lithium by the food (80 mmol/kg). The animals had access to water and a 0.46 M NaCl solution. The potassium content of the food was 100 mmol/kg during the pretreatment period of about 4 weeks, then 500 mmol of KCl per kg food was added. Potassium administration did not significantly influence the intake of water but led to a temporary rise of the intake of 0.46 M NaCl. The intake rose from 100 mu to 500 mumol/hr/100 g body weight in the course of 2-3 days and then gradually declined during three weeks. The increase of the sodium intake was not superfluous but due to a renal loss of sodium. If the animals were not allowed to replace the lost sodium by drinking more NaCl solution, plasma renin rose, body weight, lithium clearance, and water intake fell. It is concluded that a high potassium intake was unable to cure lithium-induced water and sodium losing conditions in rats. Prolonged lithium administration interferes with the mechanism for selective renal excretion of potassium. A high potassium intake resulted in a temporary renal loss of sodium.

Aspects of the treatment of mycosis fungoides. A report from the Scandinavian Mycosis Fungoides Study Group

The Scandinavian Mycosis Fungoides Study Group includes dermatologic clinics in Denmark, Norway, and Sweden. The results of the first three years of activity are presented herein. In plaque stage, topical nitrogen mustard was highly effective. Preceding intravenous tolerance induction seems to be of no value. PUVA induced equally high remission rates. Both modalities were also highly effective in cutaneous tumor stage. In advanced tumor stage and in case of extracutaneous involvement systemic chemotherapy was given. Topical treatment alone was more effective on the cutaneous lesions including tumors than systemic chemotherapy alone. Therefore a combination of topical and systemic treatment is recommended in advanced stages of mycosis fungoides.

Clofazimine in the treatment of pyoderma gangrenosum

Ten patients with pyoderma gangrenosum, seven female and three male, 25 to 94 years old, mainly with multiple lesions, have been treated with clofazimine, 100 mg three times daily. Associated disease was registered in three patients: diabetes mellitus, a previous adenocarcinoma of the colon treated by hemicolectomy, and pustulosis palmoplantaris. In a further patient, M-component was found in the serum. In seven cases the lesions were completely healed by two to five months of therapy, and in three cases the ulcers healed partially. Side effects were redness of the skin in seven cases and dryness of the skin in two patients. No hematological side effects occurred. The working mechanism is still obscure.

The effect of water deprivation on lithium clearance and lithium excretion fraction in lithium-polyuric rats

The effect of water deprivation on lithium clearance was studied in rats with lithium-induced polyuria. During a 3-hr period of water deprivation, the rats lost water in amounts corresponding to about 10% of body weight. Lithium clearance fell to about 25% of the level observed in rats which were not water deprived. During shorter periods of water deprivation, the fall of lithium clearance was less. The decrease of lithium clearance was partly due to a fall of inulin clearance and partly due to a fall of fractional excretion of lithium. The decrease of the two variables contributed to the same extent to the decrease of lithium clearance. The findings support the suggestion that insufficient intake of water in patients with lithium-induced polyuria may lead to a rapid lowering of lithium clearance and, hence, to a rise of the serum lithium concentration and development of intoxication.

Beta-carotene in erythropoietic protoporphyria: 5 years' experience

36 patients from 19 families with erythropoietic protoporphyria were treated for about 5 years during the summer months with beta-carotene alone or beta-carotene plus canthaxanthin in daily doses of 50-200 mg. The effect of the treatment was evaluated clinically on the basis of information provided by the patients regarding the period of time they could stay in the sun. 18 patients became completely free of symptoms, 16 patients improved to some extent, and 2 patients noted a slight effect. Apart from the carotenaemia, no side-effects were recorded.

Malignant atrophic papulosis: treatment with aspirin and dipyridamole

On electron microscopy of the endothelial cells of a patient with cutaneous and CNS symptoms of malignant atrophic papulosis, paramyxovirus-like particles could be seen in the cytoplasm. These particles were interpreted as degenerative changes that were due to ischemia. Coagulation studies showed increased thrombocyte aggregation, and treatment with the platelet-suppressive drugs, aspirin and dipyridamole, was instituted. This treatment resulted in a normal thrombocyte aggregation after eight months and complete clinical remission, which still persisted four months after cessation of therapy.

Lithium-induced focal interstitial fibrosis in the rat kidney

An early stage of focal cortical interstitial fibrosis and nephronic atrophy was found by light microscopy in the kidneys of nine out of twelve rats which had received lithium for 9 weeks. The animals had excessive polyuria and increased requirement for sodium. The histological changes were in their distribution and the morphological structure similar to the lesions recently found in renal biopsy specimens from patients on long-term lithium treatment.

Bone marrow involvement in mycosis fungoides demonstrated by needle biopsy

A bone marrow needle biopsy was performed in 19 patients with mycosis fungoides (MF). Two patients, one previously classified as stage 4 and the other with diffuse erythroderma had pathological bone marrow findings. Seventeen patients showed no evidence of bone marrow involvement, 10 of these were in the plaque stage. Bone marrow biopsy can be of value in assessing the stage of the disease.

The renal handling of lithium: relation between lithium clearance, sodium clearance and urine flow in rats with diabetes insipidus

In order to study the renal handling of lithium, I examined the relation between the lithium clearance and the urine flow in rats which had hereditary lack of vasopressin production and which had been given a test dose of lithium. The two variables were altered by varying the sodium intake. Rats with a low, medium and high sodium intake had a mean lithium clearance of 0.04, 0.22, and 0.40 ml/min./100 g body weight, respectively. When the sodium intake was increased from a medium to a high level, the lithium clearance and the urine flow rose in proportion to each other (r=0.90). When the sodium intake was decreased from a medium to a low level, the lithium clearance fell relatively more than the urine flow so that the proportion between the two was changed. The experiments show that when vasopressin-induced alterations of the urine flow are excluded and when the sodium intake is not extremely low, proportionality may occur between the lithium clearance and the urine flow. This suggests that the lithium clearance varies in proportion to and is determined by the delivery of sodium from the proximal tubules.

Prevalence of vitiligo. Epidemiological survey on the Isle of Bornholm, Denmark

The prevalence of vitiligo was 0.38% in 47,033 people in a representative region in Denmark. Both sexes were equally affected. No significant difference was found in the distribution of 179 patients with vitiligo among five municipalities or between urban and rural districts. The age-specific prevalence increased from 0.09% under the age of 10 years to 0.90% in the age group 60 to 69 years. After the age of 70, the prevalence declined. This fall might reflect an increased incidence of vitiligo during the past few decades. The number of new cases of vitiligo increased steadily with advancing age, its onset being most often between the ages of 40 and 60 years. It is assumed that the prevalence of vitiligo in Denmark applies also to the northwestern part of Europe.

Airborne contact dermatitis from Compsoitae oleoresins simulating photodermatitis

American ragweed (Ambrosia) dermatitis has an airborne pattern and is caused by lipid soluble oleoresins of pollens. A similar weed dermatitis has been described in India and Australia. The weeds involved were all of the Compositae family and contain sesquiterpene lactones with one common antigenic determinant. This study reports seven Danish patients treated for many years under the diagnosis of photodermatitis, who eventually proved to suffer from Compsoitae oleoresin dermatitis. Probably, Compsitae dermatitis is a world-wide disease, although aften misdiagnosed as has happened in Scandinavia.

Renal elimination of lithium in rats with lithium intoxication

The relation between urine flow (V), lithium clearance (CLi) and sodium clearance (CNa) was studied in rats given food containing lithium in amounts leading to inhibition of distal reabsorption of water and sodium. Maximum inhibition of the reabsorption of water was reached at serum lithium concentrations of about 1 mM. At higher serum lithium levels the rats developed intoxication due to a lowering of CLi and a consequent rise of the serum lithium concentration. The intoxication was characterized by a proportional decrease of V and CLi. The decrease of V and CLi was not related to changes of CNa. The results indicate that lithium is reabsorbed in the proximal tubules in parallel with sodium and that the lowering of CLi is due to increased fractional proximal reabsorption of lithium and sodium compensatory to inhibition of the distal reabsorption of sodium.

[Progress and change in geriatric gynecological surgery (author's transl)]

Two periods of geriatric gynecological surgery (1947-1959 and 1960-1972) at the University Women's Hospital in Hamburg-Eppendorf were compared in regard to the age of the patient, surgical indications, surgical procedure, anesthetic technique, preoperative and postoperative morbidity, length of hospitalization and mortality rate. During a period of 26 years, 1514 women over the age of 60 were treated surgically. During the first period, 489 women were treated, and in the second period, 1,025. This 109.6% increase has been confirmed statistically. The increase in geriatric surgical cases stems basically from the increase in the number of surgical patients over the age of 70. The increase in breast carcinoma during the second period (from 43 to 348 operations) is most conspicuous. This is an increase of 809.3%. On the basis of this disproportionately large increase in breast surgery, more women were treated surgically in the University Women's Hospital in Hamburg-Eppendorf for breast carcinoma during the second period, than for carcinoma of the reproductive organs. Vulva carcinoma and craurosis vulvae were also more frequently considered to be an indication for surgical treatment. The total number of women who were surgically treated for prolapsed uterus and vagina remained more or less constant. In the analyzing the surgical records, it should be emphasized that, in the second observation period, two-thirds of these cases were treated by performing a vaginal hysterectomy with anterior and posterior vaginoplasty. For older patients, palliative surgical measures for prolapsed uterus and vagina were abandoned in favor of more definitive methods. The postoperative morbidity and mortality rate remained more or less constant for both periods. The postoperative period of hospitalization was slightly longer while the preoperative period was slightly shorter. The statistically confirmed increase in geriatric surgery during the last 13 years at the University Women's Hospital in Hamburg-Eppendorf clearly shows how important geriatric surgery has become. The immediate consequences are an increased workload for physicians, nursing staff and physical therapists.

Current determination of lithium-induced minimum sodium requirement in rats

Lithium administration raises the minimum sodium requirement of the organism. Lithium treated-rats drink spontaneously a hypertonic sodium chloride solution and thereby protect themselves against the toxic effects of lithium. In the present paper it was studied whether the consumption of sodium chloride can be used as a quantitative measure of the sodium requirement. Rats given different amounts of lithium with food for about 2 months were given free access to water and a 0.46 M NaCl solution, and the 24-h intake of the latter was followed. It was found that the consumption of hypertonic sodium chloride increased with the lithium dosage and the serum lithium level. The consumption showed the following characteristics: (a) It was sufficient to prevent death from lithium poisoning. (b) When access to hypertonic chloride was discontinued for 48 h, the rats lost body weight; the body weight was reestablished within 1 h when the rats again had access to sodium chloride solution. (c) When sufficient amounts of sodium were given with the food, the lithium-treated rats drank no more sodium chloride solution than did the control rats. (d) When lithium administration was discontinued, the consumption of sodium chloride solution fell within 10 days to the control level. (e) The lithium-treated rats developed polyuria, but this was not the cause of the extra intake of sodium chloride. (f) The lithium-treated rats did not drink more of the hypertonic sodium chloride solution than was necessary to cover the minimum sodium requirement. The results indicate that the intake of hypertonic sodium chloride solution can, in fact, be used as a measure of the minimum sodium requirement in lithium-treated rats.

Effect of prolonged lithium ingestion on the response to mineralocorticoids in rats

The effect of long-term lithium administration on the response to mineralocorticoids was studied in rats which were adrenalectomized in order to avoid the effects of endogenous hormone. The hormone response was estimated from the changes in urinary excretion of sodium and potassium in rats on low and high sodium intake and from the consumption of a hypertonic NaCl solution by rats given a free choice between this and demineralized water. Lithium was found to lower the response to aldosterone and deoxycorticosterone acetate both in acute and chronic experiments. It was further found that in adrenalectomized rats given no hormone, those given lithium consumed significantly more NaCl solution than those given no lithium. The experiments therefore provide evidence that lithium induces a sodium requirement beyond that induced by the inhibition of the response to mineralocorticoids.

A preventive effect of potassium against fatal lithium intoxication in rats

The effect of potassium against lithium intoxication was studied in two groups of rats given food containing 100 mmol of sodium and 100 or 1,100 mmol of potassiam/kg dry weight. After 1 week 80 mmol of lithium chloride/kg dry weight was added to both diets. Four days later the body weight, serum lithium concentration, and urinary lithium clearance were all significantly higher in the high potassium group than in the other group. After 15 days the lithium clearance had fallen to one fifth in the lowest potassium group but was unaltered in the high potassium group. All rats in the low potassium group continued to lose weight and died of lithium intoxication within 20 days, while the rats given high potassium survived and gained weight. A high potassium content of the food was able to prevent a fatal lithium-induced loss of sodium and to maintain a normal lithium clearance. It is suggested that also a lithium-induced loss of potassium was counteracted.

Administration of lithium to rats by different routes

Rats were given identical doses of lithium chloride, 4 mmol/kg body weight/day for 8 days, by different routes. Intraperitoneal administration led to a high serum lithium peak and the development of pronounced polyuria-polydipsia. Subcutaneous administration led to a lower serum peak and the development of less pronounced polyuria-polydipsia. Administration by gastric tube led to a nearly constant serum lithium concentration without any peak and the development of moderate polyuria-polydipsia. Our study shows that the route by which lithium is administered affects the lithium concentration pattern and may influence lithium effects.

Glomus jugulare tumours. (A series of 21 cases)

Twenty-one cases of glomus jugulare tumours were analysed in retrospect. Six had been treated surgically, ten by irradiation, and five by a combination of incomplete surgical excision followed by irradiation. Recurrences appeared in four cases, but no patient has died of the tumour during the follow-up period which is from a few months to eleven years. Metastases were not found in any case. The optimal time of irradiation in combined treatment is discussed.