Allogeneic bone marrow transplantation for patients with acute nonlymphocytic leukemia

Seventy patients with acute nonlymphocytic leukemia (ANLL) underwent allogeneic bone marrow transplantation following cytoreduction with total body irradiation and cyclophosphamide. Thirty patients underwent transplantation in first remission, 11 in second remission, 3 in third remission, and 26 in relapse. At a median follow-up of 30 mo, 17 of those in first remission and 7 of those in second remission survive in continuous remission, compared to 1 in third remission and 3 in relapse. The 3-yr Kaplan-Meier probability of disease-free survival among the various groups was 55% (+/- 9.2%) for the first remission transplants, 64% (+/- 14.5%) for second remission, 33% (+/- 20%) in third remission, and 10.3% (+/- 6.3%) in the relapse group. Statistical analysis showed a similar survival in the first and second remission groups that was significantly better than that seen in the third remission and relapse groups (p less than 0.01). The improved survival seen in the early remission groups was due to a significant decrease in the incidence of relapse posttransplant (p less than 0.01). These results confirm observations that a significant number of patients transplanted in first remission may achieve extended disease-free survival and document similar results for patients transplanted in second remission.

Auditory brainstem responses: masking related changes in wave VI

Auditory brainstem responses (ABRs) were recorded in a group of nine normally-hearing subjects. Wide-band clicks were delivered at 70, 80 and 90 dB SL, both with and without 50 dB SL of contralateral masking. The amplitude of wave VI was significantly reduced in the presence of masking for the 90 dB SL stimulus but there was no effect at the lower stimulus levels. A possible explanation for this is that the observed response, to a 90 dB SL stimulus without masking, is a summation of the ipsilateral wave VI and a wave V elicited from the contralateral ear. Supporting evidence is provided and the implications of this result are discussed.

Clinical and technical aspects of continuous ERA recordings

The recording of consistent ERA responses of maximum amplitude is dependent upon various clinical and technical factors. These are discussed in detail in relation to continuous patient monitoring. Particular attention is paid to electrode quality and care and techniques for chloriding and impedance measurement are described.

Hyperfractionated total body irradiation for bone marrow transplantation. Results in seventy leukemia patients with allogeneic transplants

From May, 1979 to March, 1981, 76 leukemia patients were prepared for bone marrow transplantation (BMT) with a new hyperfractionated total body irradiation (TBI) regimen (1320 cGy in 11 fractions, 3x/day), followed by cyclophosphamide, 60 mg/kg, for two days. Partial lung shielding was done on each treatment, with supplemental electron beam treatments of the chest wall to compensate, and of the testes, a sanctuary site. This regimen was initiated to potentially reduce fatal interstitial pneumonitis as well as decrease leukemic relapse. These patients were analyzed in May, 1982, for a minimum follow-up of 14 months. Overall actuarial survival at 1 year for acute non-lymphocytic leukemia (ANLL) patients is 63%, while relapse-free survival at 1 year is 53%. For those ANLL patients who underwent BMT while in remission (first, second, and third combined), relapse-free survival is 61% at 1 year compared with 40% for those patients who had their BMT at the time of relapse (greater than or equal to 10% blasts in marrow). On the other hand, for acute lymphocytic leukemia (ALL) patients, there is no significant difference between relapse or remission patients with regard to overall survival or relapse-free survival, when relapse is defined as greater than 5% blasts in the marrow at the time of cytoreduction. Overall actuarial survival at 1 year for ALL is 61% and relapse-free survival is 45% at 1 year. Patients with ALL who had their BMT cytoreduction at the time of relapse have a survival equal to that of our remission patients, and greater than that of patients in relapse cytoreduced with a single dose as reported by others. However, patients with greater than or equal to 10% blasts have not fared as well, having only a 22% 1 year relapse-free survival compared with a 68% 1 year relapse-free survival for patients with less than 10% blasts. Fatal interstitial pneumonitis has dropped to 18% compared with 50% in our previous single-dose TBI regimen (1000 cGy), in which the same doses of cyclophosphamide were given prior to TBI. In conclusion, not only has fatal interstitial pneumonitis been reduced by hyperfractionation and partial lung blocking, but there may be a survival advantage in ALL patients in relapse, who have a survival equal to that of remission patients. This may indicate a greater cell kill with the higher dose (1320 cGy) attained with this regimen, in these patients with a higher leukemic cell burden.

The effects of contralateral masking upon brainstem electric responses

Brainstem electric responses (BSER) were recorded simultaneously to give records which were ipsilateral and contralateral to the test ear. Eight normally hearing subjects were presented with a fixed stimulus level in one ear and various levels of masking in the other ear. Responses to binaural stimulation were also recorded. It appears from the analysis of results that, for normal subjects, contralateral masking has no statistically significant effect upon the BSER. For the responses obtained from the stimulated side the analyses of variance showed a significant subject effect but no significant masking level effect from 0 to 80 dB Sensation Level of masking. For the responses obtained from the masked side the same conclusions seem to apply. As contralateral masking has no adverse effect upon the BSER in normal subjects and has had considerable use on clinical patients, with no significant problem, the normal audiometric use of masking is recommended for BSER recording.

Allogeneic bone marrow transplantation for patients with acute lymphoblastic leukemia

Fifty-two patients with acute lymphoblastic leukemia (ALL) underwent allogeneic bone marrow transplantation following cytoreduction with total body irradiation and cyclophosphamide. Twenty-two patients were in second remission, 15 in a later remission, and 15 were in relapse at the time of the transplant. At a median follow-up of 24 mo, 14 of those in second remission survive in continuous remission compared to 5 in later remission and 4 in the relapse group. Statistical analysis showed an improved disease-free survival for the second remission group (p = 0.09). Patients transplanted in later remission or relapse had a similar survival. The improved survival in second remission resulted from a decreased relapse rate posttransplant, as the early mortality from nonleukemic causes was similar among the groups (p = 0.01). In the second remission patients, no characteristics of the initial leukemia were identified that significantly affected outcome. In the combined later remission and relapse group, poor prognosis posttransplant was associated with initial WBC greater than 20K, age at diagnosis older than 10, or initial remission duration less than or equal to 1 yr. These results suggest that extended disease-free survival may be achieved by second remission transplantation and that improved therapy is necessary for later remission or relapse transplants due to the high rate of posttransplant relapse.

Value of tomographic section views in identifying liver abnormalities by scintigraphy

A previously published prospective trial to assess the value of tomographic transverse section images provided by the Aberdeen Section Scanner has been repeated using gamma camera images. Reports for 192 patients were analysed and compared with the final independent clinical diagnosis. The results were also compared with those of the previous investigation. When the latest results were plotted in the form of receiver operating characteristic curves, they showed some improvement for the 'with tomography' reports. Furthermore, introduction of a diagnostic classification rating showed that for cases with a high level of independent diagnostic evidence that the liver was abnormal, reporting confidence was higher with tomography. However, a simplified analysis of abnormality ratings suggested that the differences were not statistically significant for the numbers of patients examined.

Nuclear magnetic resonance tomographic imaging in renal disease

The non-invasive diagnostic technique of whole body nuclear magnetic resonance (NMR) imaging was evaluated in 60 patients. 30 of these patients were known to have various renal diseases and the remainder had normal renal function. In the demonstration of space-occupying lesions of the kidney, NMR proved to be as diagnostically accurate as ultrasound and intravenous urography; it was, moreover, as specific as ultrasound in differentiating malignant tumours from benign cystic lesions. The specificity of NMR was superior to both ultrasound and IVU in the diagnosis of parenchymal disease in normally situated kidneys and in renal transplants. Hydronephrotic kidneys were readily demonstrated.

Whole-body nuclear magnetic resonance imaging: the first report of its use in surgical practice

This is the first report of whole-body nuclear magnetic resonance (NMR) imaging being of value in clinical surgery. Following aortobifemoral grafting, a 54-year-old man developed a pyrexia and hypotension which did not respond to antibiotic therapy and which was thought to be caused by early graft infection. Whole-body NMR imaging showed the graft and iliac arteries to be normal and an empyema of the gallbladder to be present, NMR imaging is a safe, non-invasive technique for imaging the body in transverse sections and specifically measures the water concentration of tissues, enabling normal and inflamed tissues to be differentiated.

Nuclear magnetic resonance tomographic imaging in liver disease

The non-invasive diagnostic technique of whole-body nuclear magnetic resonance (NMR) imaging was evaluated in 30 patients with established liver disease and 20 patients without liver disease. Comparison with diagnostic ultrasound and radionuclide liver scan shows that NMR easily differentiates malignant tumours from benign cystic lesions and provides useful information in patients with cirrhosis and metastatic deposits. In the demonstration of space-occupying lesions in the liver, NMR is as sensitive as ultrasound and more so than radionuclide liver scans when the metastases are less than 1.5 cm in diameter. In the demonstration of cirrhosis it is more sensitive than both ultrasound and radionuclide liver scan. The specificity of NMR is superior to both ultrasound and radionuclide liver scan, both of which only demonstrate the presence of lesions, whereas NMR tomographic imaging based on the proton spin-lattice time (T1) of tissue accurately indicates the nature of the lesion.

Supratentorial recurrences in medulloblastoma

Four children with medulloblastoma had massive supratentorial recurrences in the region of the cribriform plate after adequate craniospinal irradiation. The pathogenesis of these recurrences is probably related to underdosage to this region by shielding of the eyes. This hypothesis was corroborated by autopsy findings in two other patients in whom subfrontal implants were histologically different from recurrences elsewhere. Two possible solutions to avoid this problem in the future are suggested.

Oesophageal carcinoma demonstrated by whole-body nuclear magnetic resonance imaging

The quality of the images produced by nuclear magnetic resonance (NMR) imaging has steadily improved over the past five years. Images of the head, thorax, and abdomen have clearly shown the normal anatomy. A clinical trial of NMR imaging has therefore been started in Aberdeen to assess its diagnostic accuracy and compare it with conventional radiography and other imaging technique. The first patient examined by whole-body NMR imaging had carcinoma of the oesophagus diagnosed on barium meal examination. A technetium-99m-sulphur colloid liver scan also showed hepatic metastases. NMR imaging showed a large tumour in the lower third of the oesophagus, and areas of increased proton spin-lattice relaxation time (T1) on a section through the liver corresponded with the metastases shown on the radionuclide scan. Increased areas of T1 were present in some vertebrae, and a technetium-99m bone scan confirmed the presence of bone metastases. The NMR images in this patient compared well with the images from other techniques. The continuing clinical trial may show that NMR is an accurate diagnostic aid which will complement existing techniques for diagnosing intrathoracic and intra-abdominal conditions.

A clinical trial of the value of a tomographic section view to identify liver abnormalities by radionuclide imaging, with special reference to metastatic disease

A prospective trial was carried out to assess the value of a radionuclide transverse section view in addition to conventional radionuclide scans of the liver. Reports for 373 patients were analysed and compared with the final independent clinical diagnosis. Although several individual cases were more accurately diagnosed using the tomographic section view, the trial did not demonstrate a significant increase in accuracy of diagnosis in liver disease. Some possible reasons for this are discussed, mainly the difficulty of identifying and quantifying truly abnormal features of liver radioisotope scans.

Adsorption and growth of Vibrio cholerae on chitin

Incubation of Vibrio cholerae of O-group serotype 1 with chitin particles resulted in adsorption of vibrios onto chitin; chitin-adsorbed V. cholerae survived exposure to acid better than nonadsorbed vibrios. V. cholerae multiplied in dialyzed chitin suspended in 4.2% NaCl, suggesting that adherence to ingested chitin of crustacea might be of epidemiological significance by providing a substrate for vibrio multiplication as well as protection from gastric acid during stomach transit.

Effects of betamethasone on the stimulation of corticosterone secretion in rats

The effects of betamethasone on the elevation of rat plasma corticosterone levels by nicotine (400 microgram/kg s.c.), urethane anaesthesia and psychological stress have been studied. Betamethasone pretreatment (5 mg/kg given in the drinking water over 24 hr) initially suppressed the response to all three stimuli but, after 24 hr, only the response to urethane remained totally suppressed. Nicotine administered at this time to the urethane anaesthetised rats caused an increase in plasma corticosterone, apparently by stimulation of the autonomic nervous system. The results suggest that, following betamethasone, there is a prolonged delay in the recovery of the specific mechanism through which urethane stimulates pituitary-adrenal function rather than a total blockade of the effects of all stressful or chemical stimuli on ACTH secretion.

Multiple primary cancer risk after therapy for Hodgkin's disease

Forty-four antecedent, synchronous, and metachronous multiple primary cancers were identified among 41 patients who constituted 4.0% of 1028 patients initially treated for Hodgkin's disease during the years 1950-1954, 1960-1964, and 1968-1972. At 5 years post-therapy the cumulative probabilities of developing a multiple primary cancer for patients treated in 1950-1954, 1960-1964, and 1968-1972, were 1.14%, 1.48%, and 4.43%, respectively. At 10 years the cumulative probability of a multiple primary cancer was 2.54% for the 1950-1954 treatment group and 6.52% for the 1960-1964 treatment group. Among those patients 16-39 years of age, initially treated during the period 1960-1964, who had survived 6-10 years after receiving radiation plus single agent chemotherapy, we observed a significant 18-fold increase in the number of multiple primary cancers. A significant occurrence of two multiple primary cancers in a relatively small group of patients treated with chemotherapy only during the period 1968-1972 was also noted. Continued surveillance of patients extensively treated with combination chemotherapy and radiotherapy will enable assessment of the oncogenic potential of these modern therapeutic approaches to the management of Hodgkin's disease.

Urinary monoamine metabolite excretion in disorders of movement. Effects of amantadine and levodopa

We have studied the urinary excretion of 1,4-methylhistamine (1,4-MeHm), 5-hydroxyindole-3-acetic acid (5-HIAA) and homovanillic acid (HVA) in patients with Parkinson's disease, choreiform movements and essential tremor. The effect of amantadine on urinary excretion has been measured in each group of patients as well as the effect of levodopa in patients with Parkinson's disease. In patients with Parkinson's disease, excretion of 1,4-MeHm and HVA was significantly lower than in controls. Patients with choreiform movements had a reduced excretion of HVA but trends toward low levels of 1,4-MeHm and, in patients with Huntington's chorea, elevated excretion of 5-HIAA, were not significant. In patients with essential tremor, urinary excretion of the amine metabolities studied did nof differ significantly from controls. Administration of amantadine to patients with Parkinson's disease was not followed by increased excretion of monoamine metabolites except in those patients who were already receiving anticholinergic drugs. This increase is not significant and there was no effect in other groups of patients. These findings lend no support to the view that amantadine has a general amine-releasing action although there is limited evidence for such an effect in Parkinson's disease. In addition to the expected increase in HVA excretion, administration of levodopa to Parkinsonian patients was followed by significantly reduced excretion of 1,4-MeHm and 5-HIAA. However, if amantadine and levodopa were given together, excretion of 5-HIAA was still reduced, but that of 1,4-MeHm was normal. Levodopa may thus modify the turnover of histamine, which appears to be reduced in Parkinson's disease, and this effect may be modified by amantadine.

The pharmacology of Avena sativa

The pharmacology of Avena sativa has been investigated in laboratory animals following a report that tincture of Avena sativa reduced the craying for cigarettes in man. The tincture, evaporated to dryness, craving for cigarettes in man. The tincture, evaporated to dryness, re-constituted in an equal volume of water and administered by stomach tube or intraperitoneal injection, antagonized the antinociceptive effect of morphine in two separate test (hot-plate and tail flick). Compared with animals made depedent on morphine alone, mice pretreated with repeated injections of morphine plus extract passed a smaller number of stools and tended to jump less after administration of nalorphine. The pressor response to intravenously administered nicotine in urethane-anaesthetized rats was also antagonized by prior administration of Avena sativa. However, the aqueous extract prepared from the tincture did not affect the seizure threshold to bemegride or nicotine or the sleeping time induced by barbitone sodium.

Effect of moderate dosage of chlorpropamide in pregnancy on fetal outcome

The outcome of 19 pregnancies is reviewed in women receiving daily doses of at least 200 mg chlorpropamide for varying degrees of glucose intolerance. 4 required insulin in late pregnancy. In 13 mothers who had chlorpropamide during the first 13 weeks of pregnancy no fetal abnormality occurred. There were 2 intrauterine deaths, 1 neonatal death, 6 babies with birthweights greater than the 90th centile, and 2 with birthweights below the 10th centile. The total dosage taken during pregnancy varied from 5 to 105 g and the duration of administration varied from 3 to 39 weeks. Though the severity of diabetes loosely correlated with the daily chlorpropamide dosage, no constant relation existed between high daily dosage of chlorpropamide and obstetric or neonatal complications. It is concluded that it is more likely to be the poor control of the maternal diabetes in pregnancy than a pharmacological effect of the chlorpropamide on the fetal pancreas which is responsible for the poor results reported. 6 infants had intravenous glucose tolerance tests done within 3 hours of birth and the rate of glucose disposal and insulin response was found to be greater than in infants of untreated mothers with less severe diabetes.

Similarity in several properties of psychorophilic bacteria grown at low and moderate temperatures

Several properties of psychrophilic pseudomonads were studied with cells grown in batch culture in nutrient broth at 2 and 30 C. No differences were observed in the size, catalase activity, deoxyribonucleic acid, ribonucleic acid, or protein content of cells grown at either temperature. The importance of comparing physiologically similar cells is discussed.