Allogeneic bone marrow transplantation for Hodgkin's and non-Hodgkin's lymphoma

We studied 23 consecutive patients, median age 34 years, with relapsed or resistant aggressive lymphoma who underwent allogeneic BMT at the UCLA Medical Center Bone Marrow Transplantation Unit from 1 November 1984 to 30 March 1993. All patients were < 50 years of age and had sibling donors who were matched at the HLA-A, B and DR loci. Nine patients had Hodgkin's disease (HD) and 14 had non-Hodgkin's lymphoma (NHL); three of these had low grade histology and 11 had intermediate or high grade lymphoma histology. After a median follow-up of 34 months, eight patients are alive, seven without recurrent lymphoma. Five patients had early deaths. The disease-free survival for the entire group is 26% with an overall survival of 29%. There was no difference in survival rate on the basis of disease or histology. Comparing preparative regimens containing TBI to those without there was no difference in survival rate (P = 0.35). Neither age nor sex was a significant determinant of outcome (P = 0.63 and 0.36, respectively). Disease status at the time of transplantation proved to be the important determinant of outcome. Patients transplanted with chemotherapy sensitive disease (n = 9), defined as a partial or complete response to salvage chemotherapy, had a survival rate of 42%, which was significantly better than those who had refractory disease at transplantation (n = 14), who had a survival rate of 21% (P = 0.006). However, this small, but significant fraction of patients with refractory disease was curable. Thus, our data demonstrate that allogeneic bone marrow transplantation is an effective means of treatment for relapsed or aggressive Hodgkin's and non-Hodgkin's lymphoma.

Intrapleural chemotherapy without pleurodesis for malignant pleural effusions. LCSG Trial 861

Malignant pleural effusions are a common and significant problem in patients with advanced malignancies. In contrast to traditional sclerosing agents, intrapleural chemotherapy has the potential advantage of treating the underlying malignancy, in addition to treating the effusion. The Lung Cancer Study Group evaluated intrapleural cisplatin and cytarabine in patients with malignant pleural effusions from a variety of solid tumors. Forty-six patients with cytologically proven symptomatic and previously untreated malignant pleural effusions were entered. Cisplatin, as a single dose of 100 mg/m2, plus cytarabine 1,200 mg, were instilled into the pleural space via a chest tube that was then immediately removed. The overall response rate, complete plus partial at 3 weeks, was 49% (18/37 patients). One patient experienced reversible grade 3 renal toxic reactions, four patients had grade 3 hematologic toxic reactions, and five patients had grade 3 cardiopulmonary toxic reactions. Median length of response was 9 months for a complete remission and 5.1 months for a partial remission. Although chemotherapy has the potential advantage of treating the underlying malignancy in addition to controlling the malignant effusion, intracavitary cisplatin and cytarabine therapy as administered in this trial appears inferior to existing sclerosing agents for the control of malignant pleural effusions. Although administration is safe, it cannot be recommended for the standard control of malignant pleural effusions, but it may have a role incorporated into combination modality therapies for diseases such as malignant pleural mesothelioma.

[BCG vs interferon A for prevention of recurrence of superficial bladder cancer. A prospective randomized study]

A total of 78 patients with superficial bladder carcinoma were prospectively randomized to two groups following complete transurethral resection (TUR). Each received 12 intravesical instillations of 10(7) units interferon A or 120 mg BCG Connaught for 1 year starting 6 weeks post-TUR. After a mean observation period of 24 (13-31) months in the BCG and 25 (6-32) months in the IFN group 5/32 (15.6%) recurrences in the BCG versus 21/35 (60%) in the IFN group were observed (P = 0.0003). In the IFN group 18.4% of the patients had dysuria and 2.6% fever; in the BCG group 35% had fever, 60% cystitis, 1 patient granulomatous epididimoorchitis and 1 patient pneumonitis with granulomatous prostatitis. With our instillation regimen interferon A had few side effects but also no prophylactic effect, whereas BCG had tolerable-seldom severe--side effects and was very effective in preventing recurrences. Perhaps IFN should be given earlier after TUR and in a higher dosage.

The areas of language: critical analysis

To determine the degree of linguistic maturity of a child, a series of areas that are usually formally tested in the assessment of language were analyzed. Specifically, an individual test of the assessment of language was applied to a sample of 204 children of Granada (Spain) ranging in age from 2.6 to 6.6 years. This test consists of six areas: comprehension, memory, fluency, vocabulary, knowledge, and judgement and intelligence. A factorial analysis of the data was carried out to check the classification of the above-mentioned areas. It is found that in the three following factors the analyzed variables get saturated: 'learned behaviors', 'behaviors which are being learned' and 'memory'.

Monocyte phagocytic activity in sickle cell disease

The phagocytic activity of peripheral blood monocytes from sickle cell disease patients and normal controls was studied using a monocyte monolayer assay. Phagocytosis of antibody-coated red cells by monocytes from patients in stable condition and in normal controls did not differ significantly (7.1 +/- 1.5 vs. 5.3 +/- 0.9%). However, monocytes from sickle cell disease patients during vasoocclusive crises demonstrated increased phagocytic activity compared to the normal controls (11.0 +/- 2.7 vs. 5.3 +/- 0.9%, p less than 0.025). Numerous defects in immune response have been described in association with sickle cell disease. However, monocyte phagocytic activity is not deficient and is not a factor in the predisposition to infections.

Invasion of human embryo by Enterobius vermicularis

Two Enterobius vermicularis organisms invading a macerated embryo 2 cm in length were found in the tissue from an endometrial curettage performed for missed abortion in a pregnant woman. Ova from the helminths were recovered from the vagina and endometrium of the patient. This most unusual case provides further evidence for the invading capacity of E vermicularis.

Dysgerminoma of the ovary

Dysgerminomas of the ovary are rare germ cell tumors. They are more common at puberty. Surgery followed by irradiation has resulted in excellent cure rates in early stages of this disease. This paper is a review of six patients with a diagnosis of dysgerminoma who were treated at the Department of Radiation Oncology, University of Louisville. The controversy on the use of irradiation in Stage Ia tumor is discussed in detail. A review of the literature is also done in this paper.

[Psychopathological aspects of children on hemodialysis]

Psychological effects of hemodyalisis in children with chronic renal failure are studied based on the significance of micturition and chronic disease in child's mind. The condition is analyzed in three stages: dietetics, fistula on the beginning of treatment and long-term hemodyalisis.

Progressive isolated segmental anhidrosis

A patient had progressive segmental anhidrosis, which proved after extensive neurologic and autonomic workup to be an isolated abnormality. Intradermal acetylcholine produced localized sweating in areas of thermoregulatory anhidrosis five months after the onset of symptoms but failed to do so at two years. These findings are consistent with a preganglionic sympathetic lesion affecting a functionally defined subset of sympathetic cells and/or fibers. The alteration of the sudomotor response to intradermal acetylcholine during the course of the illness suggests that the diagnostic utility of pharmacologic sweat tests may be time dependent, limited to a relatively early period following onset of anhidrosis.

[Electrocardiographic evaluation of the cardiotoxicity of N-methylglucamine antimonate (R glucantime)]

The heart toxicity of N-Methyl-glucamine antimoniate (R glucantime) was studied by electrocardiographic readings in 16 patients with acute cutaneous Leishmaniasis. All patients studied came from the town of Tovar and it's surrounding areas, in the district of Tovar, Merida State, Venezuela. A dosage of 25 to 50 mg/kg/day of N-Methyl-glucamine in two or three treatment series, produced the healing of the cutaneous sore, without electrocardiographic alterations which could be interpreted as signs of myocardial toxicity.

Failure of indomethacin to affect arginine-induced C-peptide and glucagon release in insulin-treated diabetics. Major role of residual B cell function in conditioning the magnitude of the blood glucose rise after intravenous arginine

Fourteen insulin-treated diabetics were submitted to an arginine infusion test performed with either 11.7 or 5.85 mg kg-1 min-1 arginine monohydrochloride infused during 40 min with or without previous oral administration of a low (75 + 50 mg) or a high (75 mg + 3 mg/kg) dose of indomethacin. Blood glucose, plasma non-esterified fatty acids, insulin, C-peptide and glucagon were determined at regular intervals before, during and after the arginine infusion. These parameters were totally unaffected by the two doses of indomethacin both in the basal state and during the arginine infusions at the two loads tested. Eight subjects had a basal C-peptide level above 0.07 pmol/ml and a mean (+/- SEM) maximal rise of 0.21 +/- 0.04 pmol/ml during the arginine infusion, whereas the remaining six patients had virtually zero values throughout the tests. The arginine-induced plasma glucagon rise was similar for the two rates of arginine infusion; the sum of the increments in plasma glucagon averaged 877 +/- 120 and 647 +/- 92 pg/ml (p greater than 0.1) for the high and low rates of arginine infusion, respectively. The magnitude of the blood glucose rise appeared independent of the amount of arginine infused. Confirming previous reports, we found that the blood glucose rise after arginine was three to four times higher in subjects without C-peptide than in subjects with C-peptide. The mean glucagon response did not differ significantly between subjects with or without C-peptide. Thus, residual B cell function determines the magnitude of the blood glucose rise but not the glucagon response after intravenous arginine.

Subclinical neuropathy associated with chronic obstructive pulmonary disease: possible pathophysiologic role of smoking

Twenty of 23 patients with chronic obstructive pulmonary disease (COPD) showed electrophysiologic evidence of peripheral nerve dysfunction. Abnormalities of sensory nerve conduction were most common, affecting the sural nerve (20 subjects), ulnar nerve (11), radial nerve (eight), and median nerve (seven). Six subjects had impairment of both sensory and motor nerve function, with the common peroneal being the most frequently affected motor nerve. Clinical signs of neuropathy were found in four patients. Cigarette smoking, expressed as pack-years, was correlated significantly with the electrophysiologic abnormalities. These findings indicate that subclinical polyneuropathy commonly occurs in association with COPD and that this COPD-related neuropathy is correlated with cigarette consumption. From these data we suggest that a substance or substances in cigarette smoke, such as nicotine, taken on a long-term basis, may be toxic to peripheral nerves.

Furosemide intravenous infusion in normal man: electrolytic, metabolic and hormonal effects. Lack of changes in basal insulin and glucagon plasma levels

Eight overnight fasted healthy young volunteers received an intravenous infusion of 0.5 mg furosemide per kg body weight administered in 60 min. This period was preceded and followed by two control periods of one hour each during which physiological saline (o.154 mol/l) was administered at a rate of 1 ml/min. Furosemide markedly increased the diuresis and natriuresis which reached 1260 +/- 198 ml and 138.4 +/- 20.9 mmol per hour respectively. This was associated with a significant three fold increase in urinary total catecholamines excretion. Blood glucose, plasma free fatty acids, insulin and glucagon concentrations did not exhibit any significant change during and after furosemide infusion, compared to pre-infusion values. These results demonstrate that, in normal man, doses of furosemide capable of exerting plasma concentrations. It is concluded that the stimulation of insulin and glucagon secretion observed in vitro with high furosemide concentrations (5 mmol/l) are not observed under usual therapeutic conditions.

Congenital bilateral posterolateral and anterior diaphragmatic defects

The occurrence of bilateral posterolateral and anterior diaphragmatic congenital defects has not been previously reported. We present a case with associated abnormalities including pulmonary hypoplasia and interventricular septal defect.

[Remission of diabetes during conventional insulin therapy or therapy controlled by use of an artificial pancreas]

12 recent acute-onset ketotic juvenile diabetics were optimally treated during 5 +/- days by means of an external artificial pancreas. Remission of diabetes occurred in 9 patients (75%). In a comparative group of 28 patients treated by conventional subcutaneous insulin, only 3 (11%) steady remissions were obtained. In a third group of 6 patients treated by insulin infusion without feed-back control, only 1 remission (17%) was obtained. The difference between these two groups and the first group (patients treated by the artificial pancreas) is significant (p less than 0.01). Urinary C-peptide/blood glucose ratio showed a steady improvement of insulin secretion during the remission period. At this time, actuarial analysis shows that the number of patients still in remission decreases during the first 10 months but seems to stabilize after this period. Duration of our remissions is equal to the duration of the "spontaneous" remissions taken from the literature. New treatment able to sustain the residual insulinsecretion during the remission phase (with presently can be induced frequently with our technique) are still to be found.

Sustained insulin-induced remissions of juvenile diabetes by means of an external artificial pancreas

Remission of diabetes was attempted in 12 recent acute onset ketosis-prone juvenile diabetes after short term (5 +/- 1 days) but excellent blood glucose control by the external artificial beta-cell. The comparison group comrised patients undergoing traditional treatment (n = 28). Nine (75%) persistent (over 3-14 months of duration) although partial (oral drugs required) remissions were obtained in the former group as compared to 3 (11%) in the latter group (p less than 0.05). Cases which showed remissions after insulin infusion had a plasma insulin response to IV glucagon still present before insulin infusion, and a daily urinary C-peptide excretion significantly enhanced after (p less than 0.01). Urinary C-peptide/blood glucose remained improved during the remission period. Thus, early effective treatment by means of the artificial pancreas may break the vicious circle hyperglycaemia-insulin depletion-hyperglycaemia and lead to frequent and sustained remissions of juvenile diabetes.

[Cloverleaf cranial anomaly. Report of 2 cases]

Two cases of cloverleaf anomaly are presented. The first one was associated to complete spina bifida and flexion of elbows and knees, and the second to syndactyly of 3rd and 4th fingers of both hands; short, broad and swerved thumbs; rudimentary bilateral preaxial polydactyly, pes varus with broad first metatarsus. Authors agree with the opinion that this anomaly is a sign which may occur in disorders with early craniosynostosis and emphasise the importance of the identification of the underlying disorder because, knowing its pattern of inheritance, a proper genetic advice may be rendered. The neurosurgical procedure can be useful for cosmetic purposes and for encephalitic decompression, but the results are somewhat unsatisfactory because of the severity of the defect.

[Complications of chickenpox]

A patient with typical varicella (chickenpox) developed several complications: nephrotic syndrome following glomerulonephritis, trombocytopenic purpura, gastrointestinal bleeding, disseminated intravascular coagulation, encephalitis and bronchopneumonia. The course was satisfactory having been given antibiotics, heparin and peritoneal dialysis. Recovery was 100%.