Lethal skin cancers in hairy cell leukemia (two case reports)

2 patients with hairy cell leukemia (HCL) complicated by multiple cutaneous and other malignancies are described. The second malignancies behaved in a much more aggressive fashion than would be expected in an immunocompetent population, and were lethal in both patients. The literature regarding second malignancies in immune compromised patients, and in HCL in particular, is reviewed.

Central nervous system complications of a newly recognized subtype of leukemia: AMML with a pericentric inversion of chromosome 16

Ten patients with acute myelomonocytic leukemia (AMML) and inversion of chromosome 16 who had CNS involvement were identified at M.D. Anderson Hospital between January 1972 and December 1984. The nervous system signs and symptoms were evaluated in detail. CT scans, CSF cytologies, and treatment modalities were reviewed. Two patients underwent biopsies of lesions that proved to be granulocytic sarcomas. AMML with inversion 16 carries a much higher (33%) incidence of CNS involvement in the form of leptomeningeal metastasis and/or granulocytic sarcoma than all other acute nonlymphocytic leukemias (5%). The reason for this appears to be related to the chromosomal aberration and not to prolonged survival.

The kinetics of monosaccharide absorption by human jejunal biopsies: evidence for active and passive processes

The kinetics of initial rates of uptake of glucose, galactose, arabinose and mannitol have been measured in jejunal biopsies from normal subjects in order to investigate the existence of multiple uptake systems. Glucose kinetics fitted best a model of a saturable uptake system (app Kt = 2.06 +/- 0.33 mM, app Jmax = 93.85 +/- 1.19 nmol/10 min/mg dry weight), together with a linear uptake indistinguishable from the passive uptake of arabinose and mannitol (app Kd = 0.80 +/- 0.05 nmol/10 min/mg dry weight/mM for glucose, 0.75 +/- 0.03 for arabinose, and 0.83 +/- 0.03 for mannitol). The saturable uptake, but not the linear uptake, was inhibited by phlorizin and by the absence of sodium. Cytochalasin B and phloretin had no effect on overall uptake. Galactose kinetics in the absence of inhibitors fitted best a model of a single saturable uptake system (app Kt = 11.05 +/- 0.12, app Jmax = 201.9 +/- 1.13) with no evidence of linear uptake. In the presence of phlorizin, or in the absence of sodium, uptake was predominantly linear with app Kds of 0.84 +/- 0.03 and 0.79 +/- 0.01, not significantly different from the linear component of glucose uptake. We conclude that hexose uptake in human jejunum in vitro occurs by both active and passive routes, and that the active uptake of galactose appears to be inhibited at high galactose concentration.

Energy expenditure in chronic alcoholics with and without liver disease

Chronic alcoholism activates metabolic pathways, resulting in wasteful expenditure of energy (Pirola and Lieber, J Nutr 1975;105:1544-8). To study this hypothesis, we measured oxygen consumption (VO2), carbon dioxide production (VCO2), and resting energy expenditure (MREE) utilizing indirect calorimetry in 8 chronic alcoholics with (group I) and 11 chronic alcoholics without (group II) clinical or biochemical evidence of alcoholic liver disease. Seven healthy volunteers served as controls. A statistically increased MREE was observed in group II subjects (p less than 0.05, MREE 999.7 +/- 111.4 kcal X day X m2) as compared to normals (MREE 842.3 +/- 42.1 kcal X day X m2) and group I subjects (MREE 813.4 +/- 101.4 kcal X day X m2). VO2 and VCO2 were also significantly higher (p less than 0.05) in group II than in group I and normals. The predicted resting energy expenditure as calculated by the Harris-Benedict equation was similar in both groups and normals. Theories to explain the increased MREE in group II subjects are presented.

Clinical zinc deficiency during long-term total enteral nutrition

Zinc deficiency during long-term total parenteral nutrition has been well reported in the literature. However, there is limited information available on zinc deficiency occurring during total enteral nutrition. Two cases of clinical zinc deficiency in patients on long-term enteral feedings are presented. Nutritional assessment of these two patients on admission revealed hypoalbuminemic malnutrition. Nutritional support in the form of nasogastric tube feedings were initiated in both patients due to altered mental status. The formula used was Ensure (Ross Labs, Columbus, OH), which provided greater than 150% of the RDA for zinc. However, four months and seven months after initiation of adequate nutritional support, both patients developed skin rashes around the groin and under the breasts and axilla. Serum zinc levels were depressed in both patients, to 42 and 54 mg/dL, respectively (normal for the authors' laboratory, 66 to 120 mg/dL). Supplementation with zinc sulfate 220 mg per day via nasogastric tube resulted in disappearance of the rash with return of serum zinc to normal levels. The authors suggest close observation of patients on long-term enteral nutrition for clinical manifestation of zinc deficiency, especially an unexplained skin rash. Further studies are needed to establish minimum daily zinc requirements in patients on long-term enteral feedings.

Clinical pharmacology of polyethylene glycol-L-asparaginase

Polyethylene glycol (PEG)-L-asparaginase, at doses ranging from 500 to 8000 units/m2, was infused iv over 60 min in 31 patients of whom 27 were evaluable pharmacokinetically. The plasma disappearance of PEG-L-asparaginase is described by a monophasic curve with a mean half-life of 357 +/- 243 hr which is much longer than that of the unconjugated enzyme (half-life of approximately 20 hr). The rate of total clearance (128 +/- 74 ml/m2 X day) is much slower than that of L-asparaginase (2196 +/- 1098 ml/m2 X day). The volume of distribution is 2093 +/- 643 ml/m2, which is similar to that of L-asparaginase, indicating that PEG-L-asparaginase is mainly localized in the plasma. No enzyme could be measured in urine samples taken from nine patients for a period of up to 4 days. Additionally, no enzyme was measurable in one patient's pleural fluid obtained at the end of infusion and 6 days after infusion of a 1000-unit/m2 dose; the corresponding concentrations in plasma were 0.64 and 0.62 units/ml, respectively. In general, the plasma enzyme concentrations at the end of the 1-hr infusion and at 14 days after drug administration were proportional to the dose given. However, in two patients, a sudden disappearance of enzyme levels occurred which preceded anaphylactic reactions during subsequent treatment. A third patient developed severe bronchospasm 30 min after the first dose, but his enzyme levels were within the normal range.

Lactose digestion by human jejunal biopsies: the relationship between hydrolysis and absorption

The relationship between lactose hydrolysis and absorption of released glucose was investigated by determining the kinetics of lactose digestion by jejunal biopsies incubated in vitro. Lactase activity in intact biopsies correlated with conventional assay of tissue homogenates (r = 0.85, p less than 0.001), and glucose uptake from 28 mM lactose was directly proportional to lactase activity (r = 0.95, p less than 0.001) in 21 subjects with normal lactase levels, six with hypolactasia (primary or secondary to coeliac disease) and two with lactose intolerance but normal lactase activity. Kinetic analysis at 0.56-56 mM lactose in five normal subjects showed saturable kinetics for hydrolysis (app Km = 33.9 +/- 2.2 mM; app Vmax = 26.5 +/- 1.1 nmol/min/mg dry weight) but glucose uptake could be fitted to a model either of saturable uptake (app Kt = 47.2 +/- 0.3 mM; app Jmax = 14.1 +/- 0.2 nmol/min/mg) or saturable uptake plus a linear component (app Kt = 21.3 +/- 1.15; app Jmax = 4.59 +/- 0.12; app Kd = 0.093 +/- 0.010 nmol/min/mg/mM). The proportion of glucose taken into the tissue did not significantly exceed 50% of the total released at any lactose concentration suggesting the lack of an efficient capture mechanism for the released glucose. The results suggest that lactose hydrolysis is the rate limiting step in the overall absorption of glucose from lactose in vitro, and that the relationship between hydrolysis and absorption is the same in normal subjects and in hypolactasic subjects.

Splanchnic bed vascular malformations and the development of portal hypertension

The vascular lesions, angiomas, and arteriovenous malformations are known to be associated with a number of complications. These lesions, when present in the liver, may precipitate heart failure in infants. Recent reports suggest that although the prognosis is good for the majority of infants who survive the neonatal period, the lesions are capable of causing portal hypertension later in life. We have encountered three patients whose vascular lesions were in continuity with the portal circulation who subsequently went on to develop portal hypertension. One patient had angiomas of the liver, one splenic and colonic angiomas, and the third had diffuse arteriovenous malformations of the intestine. Data are presented and literature is reviewed, which suggest that any vascular lesion that is capable of substantially increasing portal blood flow may lead to the development of portal hypertension. The treatment of such lesions should be aggressive. If surgical management is not possible, alternative treatments such as embolization should be attempted early in order to increase the chance for successful therapy.

Relapsing pseudomembranous colitis

Pseudomembranous colitis secondary to C. difficile and its toxin(s) is a well-recognized disease in children and usually responds to treatment with oral vancomycin. There are well-documented reports of relapse in adults after initial successful treatment with vancomycin. This report documents relapse in a child who developed diarrhea following treatment of pseudomembranous colitis. Stool cultures were negative for C. difficile at the end of the initial course of treatment, but the organism was isolated from the stool when the diarrhea recurred. The symptoms improved following a second course of treatment with vancomycin and have not recurred during 8 months of follow-up monitoring.

Adrenergic control of insulin release from isolated islet tissue in the rainbow trout, Salmo gairdneri R

Immunoreactive insulin levels (IRI) were measured by a homologous fish insulin radioimmunoassay. An in vitro pancreatic islet superfusion technique was employed to monitor the changes in IRI in the presence and absence of specific adrenergic agonists and antagonists. Exogenous adrenaline at low concentrations (10(-10) M) inhibited IRI release but evoked an IRI stimulation at high concentrations (10(-6) M). The stimulation of IRI by adrenaline is thought to involve beta-adrenoceptors located postsynaptically on the beta-cell membrane as the effect of adrenaline was mimicked by the beta-agonist, isoproterenol, and abolished by the beta-antagonist, propranolol. Phentolamine (an alpha-antagonist) potentiated the adrenergic stimulation of IRI, whereas yohimbine (an alpha 2-antagonist) was without effect. Phenylephrine (alpha 1-adrenoceptor agonist) inhibited IRI release suggesting the presence of alpha 1-inhibitory adrenoceptors which exert a modulatory influence on adrenaline-stimulated insulin release.

A unique pattern of central nervous system leukemia in acute myelomonocytic leukemia associated with inv(16)(p13q22)

Twenty-six patients with inv(16)(p13q22) or del(16)(q22) in association with acute myelomonocytic leukemia (AMML-M4, FAB classification), and abnormal marrow eosinophils have been treated at this institute. Initial bone marrow eosinophilia (greater than or equal to 4%) was observed in 22 of 26 patients (85%), and abnormal eosinophil morphology, characterized by immature cells with some interspersed basophilic granules, was evident in 26 of 26 (100%). Giemsa-banded chromosome analysis performed in all patients revealed 16 cases with inv(16)(p13q22) alone, and ten cases with additional chromosome changes. Twenty-five patients received combination induction chemotherapy, and 23 (92%) achieved complete remission (CR). The median duration of remission was 18 months (range, six to 72 + months), and the median duration of survival was 34 months (range, 0.5 to 133 months). Nine patients (35%) relapsed in the CNS at a median time of 19 months (range, six to 133 months) from first marrow CR. All patients had leptomeningeal disease, and in addition, six of nine (66%) demonstrated two or more enhancing lesions on computed tomography brain scan, consistent with intracerebral myeloblastomas. Review of 384 Giemsa-banded patients with acute myeloid leukemia revealed no other morphologic or cytogenetic subgroup with either an equivalent incidence of CNS leukemia or documented intracerebral myeloblastomas. This series of inv(16)(p13q22)/del(16)(q22) AMML reports a favorable prognosis for such patients and associates a specific clonal cytogenetic subgroup of acute leukemia with a distinct propensity for CNS relapse, manifesting as leptomeningeal disease and intracerebral myeloblastomas.

Mood and pulmonary function in adult asthmatics: a pilot self-monitoring study

The relationship between mood and fluctuations in peak expiratory flow rate (PEF) was studied in seven mildly asthmatic adult men and seven non-asthmatic controls. Participants completed visual analogue mood scales and measured PEF four times per day for 24 days, and the Profile of Mood States was also filled in at the end of each day. Significant correlations between mood and PEF were found in six of the asthmatics. No specific asthma-related profile was identified, since each person showed idiosyncratic associations between mood and pulmonary function. The non-asthmatics did not show consistent correlations above a level expected by chance. Possible explanations of these results and their relevance to the management of asthma are discussed.

The development of a homologous teleost insulin radioimmunoassay and its use in the study of adrenaline on insulin secretion from isolated pancreatic islet tissue of the rainbow trout, Salmo gairdinerii (R.)

A homologous teleost insulin radioimmunoassay (RIA) employing bonito insulin RIA components is described. The RIA sensitivity and specificity was sufficient to measure endogenous immunoreactive insulin (IRI) levels in trout serum, pancreatic islet tissue extract and in vitro culture medium. Adrenaline at 10(-6)M evoked a marked stimulation of basal insulin release from isolated islets; whereas adrenaline at 10(-10)M evoked an inhibition of basal insulin release.

A coralline hydroxyapatite bone graft substitute. Preliminary report

Experimental histologic and biomechanical studies were performed in 52 dogs by use of a bone substitute composed of hydroxyapatite converted from sea coral calcite. The results demonstrate some potentially useful practical applications. The material was totally incorporated in bone. Although initially too weak to tolerate physiologic stresses, once incorporated it becomes almost as strong as the native bone. Clinical experience with internal fixation of fractures with hydroxyapatite in 18 patients is encouraging.

Genetic marker patterns of inbred strains of mice at the Cancer Research Institute, Bombay

36 genetic markers were examined in 14 inbred strains of mice maintained at the Cancer Research Institute, Bombay. The genetic marker profiles of these strains when compared with the profiles of similar strains maintained elsewhere revealed discrepancies in 4 of them which are reported and discussed. The results emphasize the importance of genetic monitoring of inbred strains.

A serum-free, chemically-defined medium for function and growth of primary neonatal rat heart cell cultures

A serum-free, chemically defined medium for supporting rhythmic contraction, maximum survival, and moderate growth of cardiac cells was achieved by using a combination of hormones and growth supplements in a mixture of equal volumes of Ham's F12 and Dulbecco's modified Eagle's medium. The hormones and growth supplements included insulin, transferrin, selenium, fetuin, bovine serum albumin, hydrocortisone (HC), L-thyroxine (T4), and epidermal growth factor (EGF). Cardiac cells were grown on fibronectin-precoated plates using the above serum-free medium. Cells grown in this medium exhibited a higher beating rate and were maintained for a longer time compared to those cells grown in serum. The effects of T4, EGF, and HC on beating rate and survival time of both cultures of mixed cell population and enriched myoblast cell population were studied. In the enriched myoblast cell cultures grown in serum-supplemented medium, the beating rate ranged from 40 to 200 beats/min, and these cultures survived for 30 d. When these enriched cell cultures were grown in serum-free hormone-supplemented medium, the beating rate ranged from 190 to 240 beats/min, and these cultures survived for more than 90 d. These results show that some hormones affect growth, whereas others affect function.

On the synthesis and incorporation of catalase and urate oxidase into the peroxisomes of mouse liver

The processes associated with the biogenesis of peroxisomes in mouse liver have been studied by following the incorporation of radiolabelled leucine into major enzymic components of this organelle. Maximal incorporation of label into peroxisomal catalase and urate oxidase occurred within 2 hr, with the urate oxidase being labelled before catalase, but subsequent to the incorporation of phospholipid into this organelle. Subsequently, immunoprecipitation of catalase from the large granular fraction of mouse liver was shown to result in the isolation of a catalase molecule which had lost a peptide of approx. 2000 dalton from each subunit by comparison with the newly-synthesized enzyme. It was observed that the modification of catalase was obviated by the presence of leupeptin and iodoacetamide and this information has enabled the purification of both modified and unmodified forms of the enzyme. The possible significance of these data has been discussed and the major features incorporated into a working model of peroxisomal biogenesis.