[Cardiac metastasis as cause of therapy-resistant heart failure]

Ultrasonography revealed a renal tumour (4 x 4 cm) in a 67-year-old man with right-sided lumbar pain and macrohematuria. In addition he had marked nocturnal dyspnoea with dry cough. He had lost about 10 kg in weight. On admission he had atrial fibrillation with an irregular ventricular rate (140 beats/min) and engorgement of the neck veins. Two-dimensional echocardiography, undertaken because of signs of increasing heart failure and a fall of systolic blood pressure to below 100 mm Hg, demonstrated a space-occupying lesion in the right ventricle, 4 x 2 x 1 cm, indicating an intracardiac thrombus or solid tumour. The heart failure continued to worsen, despite treatment with cardiac glycosides, verapamil and diuretics. Hence an exploratory thoracotomy was performed. This revealed an intracardiac tumour which had markedly displaced the right ventricular inflow tract and infiltrated the entire myocardium, but not the tricuspid valve. As much of the tumour as possible was resected, but the patient died postoperatively of heart failure. The intracardiac tumour proved to be a metastasis from the papillary carcinoma of the kidney. This had infiltrated the renal capsule and pelvis and invaded the branches of the right renal vein.

Total skin electron beam and total nodal irradiation of cutaneous T-cell lymphoma

Nineteen patients with cutaneous T-cell lymphoma (CTCL) limited to the skin and/or lymph nodes were treated at Hahnemann University with a combination of total skin electron beam and total nodal irradiation (TSEB + TNI). The patients were classified as Stage Ib (1 patient), Stage IIa (8 patients), Stage IIb (5 patients), and Stage IVa (5 patients). Treatment resulted in a complete response in 100% (14/14) of patients with Stage Ib, IIa, and IIb disease, and a CR in 60% (3/5) of patients with Stage IVa disease. The Stage Ib and IIa patients had an overall survival of 100% and a disease-free survival of 44% at 6 years. Four of the five patients with Stage IIb CTCL relapsed within 3 months after completing TSEB + TNI with an overall survival in the group of 40% at 5 years. The Stage IVa patients all relapsed within 7 months and died of their disease within 50 months of completing treatment. The acute effects of TSEB + TNI were well tolerated, but three patients developed second malignancy (lung, kidney and skin) and one patient developed myelodysplasia, possibly the result of radiotherapy.

Iodide-induced hypothyroidism in patients after thyroid resection

The purpose of this investigation was to determine whether an intrinsic defect in thyroid hormone production is required for the development of iodide-induced hypothyroidism or does it also develop in TSH-stimulated normal thyroid tissue. To answer this question, we studied the response to iodine administration (180 mg iodide daily for 3-4 months) in eight euthyroid patients who had had partial thyroidectomies 2 months to 10 years previously for benign thyroid nodules, and in three euthyroid control subjects. In all 11 euthyroid patients, basal serum TSH concentrations increased during iodide administration. In six of the eight patients who had previous thyroid operations and in two of the three control patients, basal serum TSH concentrations increased into the abnormal range (greater than 6 U ml-1). Increased serum TSH concentrations were noted as early as 1 week after potassium iodide had been started and the increased levels persisted during the period of iodide administration. Although basal values for serum TSH concentration were initially within the normal range, those patients with highest basal serum TSH values developed the greatest increase in TSH in response to potassium iodine. Among the eight patients treated by partial thyroidectomy, serum T4 concentrations decreased in five, serum T3 concentration decreased in three and all five developed mild symptoms of hypothyroidism while receiving iodide. Serum T4 concentrations also decreased slightly in two of the three control patients. Serum total iodine levels increased from 7.0 +/- 0.5 to 315.7 +/- 108.6 g dl-1 (mean-+/- standard error) during potassium iodide administration, but there was no correlation between the level of serum iodide concentration achieved and inhibition of thyroid function.(ABSTRACT TRUNCATED AT 250 WORDS)

The radiation therapy of early stage cutaneous T-cell lymphoma

Results of different radiotherapy schedules used for early stage (T1-2, N0-1, M0) cutaneous T-cell lymphoma (CTCL) are compared in a series of 45 patients (22 patients treated with high dose total skin electron beam therapy (TSEB) with curative intent, 18 patients treated with palliative radiotherapy, and 5 patients treated with high dose local electron beam). At 3, 5, and 10 years after diagnosis the high dose TSEB treatment group had a probability of overall survival of 91%, 86%, and 75%, respectively, compared with 94%, 88%, and 88% for the palliative treatment group. The complete response (CR) rate for the high dose TSEB treatment group was 82% (18/22), compared with a 57% (4/7) complete response rate for seven patients in the palliative group who received low dose TSEB (less than 25 Gy in 6-7 weeks) followed by daily application of topical mechlorethamine hydrochloride (HN2). However, the probability of continued remission at 3, 5, and 10 years was 44%, 44%, and 33%, respectively, for the high dose TSEB group and 25%, 25%, and 0%, respectively, for the low dose TSEB + HN2 group. The median disease-free survival was 17.5 months for the high dose TSEB group versus 5.5 months for the low dose TSEB + HN2 group. The five patients who were treated with high doses of local electrons to a single local field had an overall survival rate of 80%, a median survival rate of 64 months, and a median length of continued remission of 31 months. These results indicate that high-dose electron beam can result in long-term disease-free survival in patients with localized and limited extent skin involvement with cutaneous T-cell lymphoma.

Acute measles encephalitis of the delayed type in an immunosuppressed child

The authors described a case of an immunosuppressed child with acute measles encephalitis of the delayed type (AMED). The authors also discussed the relationship between the AMED, epilepsia partialis continua and the neuroradiological picture, in which bilateral putaminal lucency was evident.

Fluperlapine vs haloperidol: a comparison of their neuroendocrinological profiles and the influence on serum lipids

Twelve male patients suffering from acute paranoid schizophrenia, randomly receiving fluperlapine - a new dibenzodiazepine very similar to clozapine - or haloperidol were included in a double blind study. Plasma levels of triglyceride, cholesterol and HDL-cholesterol, prolactin, thyroxine, triiodothyronine, ACTH and cortisol were determined. There was no evidence, that fluperlapine has any relevant influence on those hypothalamic-pituitary axis mediated hormones with the possible exception of plasma lipids. These findings, together with the clinical experiences, suggest that fluperlapine might have a different mode of action than conventional neuroleptics.

Cefotaxime and desacetyl-cefotaxime blood levels in hepatic dysfunction

Serum levels of cefotaxime and desacetyl-cefotaxime were studied in 18 patients with hepatic cirrhosis after an intravenous bolus injection of 2 g of cefotaxime. Blood levels were independent of the degree of hepatic dysfunction and did not differ from those reported in normal individuals.

A clinical guide to the diagnosis and treatment of heroin-related sexual dysfunction

It is apparent that a significant degree of sexual concern exists in male and female heroin addicts in the predrug, drug and postdrug periods. The Sexual Concerns and Substance Abuse Project recommends that each opiate abuser entering in to treatment has a brief sex history taken and, if a primary or secondary sexual dysfunction is discovered, then additional evaluation is indicated. Furthermore, the Project stresses the importance of educating the patient to the physiological, as well as psychological, relationship between heroin-related sexual dysfunction and concomitant side effects. For example, in women chronically abusing high doses of heroin, one may not only see a reduction of sexual desire and performance, but also irregular menstrual cycles, and occasionally, amenorrhea, as a result of the depressive effects of the opiate on pituitary hormones. The woman may misinterpret this physiological effect and believe that such changes in her menstrual cycle are irreversible, and that she is sterile. Following the evaluation and patient education phase, the findings obtained from the evaluation of the drug cycle, as it relates to the sociosexual response cycle, should be incorporated into the overall treatment approach for counseling the opiate abuser. When a specific sexual dysfunction exists, particularly if it predates the heroin involvement, referral to a qualified sex therapist is often indicated, to work in co-therapy with the drug counselor and the referring physician. Greater awareness of heroin-related sexual dysfunction may help reduce the relapse rate back to heroin as well as improve the quality of the individual's life during the recovery period.

[Chronic lymphatic leukemia of B-cell type: clinical and morphological investigations for diagnostic differentiation (author's transl)]

Chronic lymphatic leukemia (CLL was diagnosed in 71 patients based on clinical data. Most of the patients were in the stages 0, I and II, only 18% were in the stages III and IV according to Rai. In all cases, the disease was characterized by an increased number of B lymphocytes (B-CLL). The B cells mostly expressed a weak fluorescence intensity when tested for membrane bound immunoglobulins (Ig). In accordance to that, the quantitative measurement of Ig in the serum revealed a decrease of one or more Ig classes in 72% of the patients. No correlation existed between the number of b lymphocytes (and T lymphocytes) or the Ig concentration in the serum and the stage of the disease. To distinguish the CLL from related lymphoproliferative disorders, especially the immunocytic lymphoma, lymph node biopsies were examined histologically and immunomorphologically for intracytoplasmic Ig. This examination confirmed the diagnosis of CLL in 33 out of 40 cases. Six lymph nodes were classified as immunocytic lymphoma of the lymphoplasmacytoid type. In three of the latter, the immunocytic lymphoma was clinically associated with decreased Ig concentrations in the serum. These findings emphasize that the clinically established diagnosis of CLL should be corroborated by immunomorphology.

[Bioavailability of theophylline in a new oral sustained-release preparation (author's transl)]

On the basis of biopharmaceutic-pharmacokinetic and galenic aspects a new sustained-release preparation of theophylline according to the "divided-dose" principle was developed. The technological procedure used allows a reproducible manufacture of a stable product with narrow limits of pharmaceutical quality. The bioavailability of the sustained-release pellets in a dose corresponding to 350 mg active principle is examined in comparison to an aqueous solution or retard-tablet formulation on the marked (containing 260 mg drug/dose), respectively, after single or multiple dose administration to 7 healthy volunteers. The relative bioavailability of the new formulation is about 100%. During chronic application the controlled drug delivery from the sustained-release pellets warrants only slight fluctuations of plasma levels by avoiding peak concentrations. Formulations with a dosage of 200, 350 or 500 mg, respectively, allow adaptation of continuous plasma levels in the therapeutic range between 5--20 micrograms/ml according to the therapeutic necessities of a patient.

[Acute-phase proteins in women with a copper IUD (author's transl)]

Acute-phase (AP) proteins haptoglobin, alpha1-antitrypsin and C-reactive protein were measured in 50 women before and 10 to 30 weeks after insertion of a copper T-200. No statistically significant increase in AP proteins was found. Since these proteins are synthesized in the liver, the results indicate the lack of a systemic humoral reaction of the organism in women with a copper-containing IUD.

Quantitative determination of single serum proteins during acute hepatitis in childhood

Fifteen serum proteins were estimated by linear immunodiffusion in blood samples from children with acute hepatitis. Blood was drawn at the beginning of the disease and three weeks later. The results were compared with results obtained from a group of age-matched normal children. At the beginning of the disease prealbumin and beta-2-glycoprotein I were depressed, whereas alpha-1-acid-glycoprotein, alpha-1-antitrypsin, cerloplasmin and alpha-2-HS-glycoprotein were found to be elevated. Alpha-2-macroglobulin, transferrin and beta-lipoprotein showed a significant elevation after three weeks. Beta-1-A/C, IgM and IgG remain elevated during time of observation. Albumin, haptoglobin and IgA were similar in patients and controls and did not change during the period of observation.

[Haptoglobins in gynecologic tumors (author's transl)]

Serum concentrations of haptoglobins were checked in 100 women with benign or malign gynecologic tumors. Typification of haptoglobins was determined by starch gel electrophoresis, quantification by single radial immunodiffusion. Cases with malignancies showed significant increased levels in comparison to healthy women. In cases with cervical carcinoma, a significant increase of the haptoglobin level was evaluated according to advanced carcinoma.

[Mixed lymphocyte culture (MLC) as a histocompatibilty test for allogen grafts. Part I: HLA-D locus: genetics and typing (author's transl)]

The importance of the HLA-gene complex is discussed and, in particular, of the HLA-D locus with respect to the clinical outcome of allografts. The genetic situation is deduced from an evaluation of population and family studies using the mixed lymphocyte culture (MLC). Further methods for the typing of gene products of HLA-D or closely-linked loci are described.

[Mixed lymphocyte culture (MLC) as a histocompatibility test for allogen grafts. Part II. technique, significance and applications (author's transl)]

This study introduces mixed lymphocyte culture (MLC) as a clinical method for prognostic assessment in allogen grafts. The principle and technical data are discussed. The technical variance and biological reproducibility of the MLC was tested by means of the recommendations of the Sixth International Histocompatibility Workshop 1975. The individual data show fluctuation, but the relative values and the order of rank are important. The order of rank is reproducible.

Chaotropic anions and the surface potential of bilayer membranes

The chaotropic anions perchlorate and thiocyanate adsorb to artificial phospholipid membranes. The negative electrostatic potential they produce at the surface of the membranes was measured by two independent techniques. The conductance produced by neutral carriers of cations and anions was measured to estimate changes in the surface potentials of planar black lipid films and the electrophoretic mobility of phospholipid vesicles was used to monitor changes in the zeta potentials of spherical bilayer membranes. Qualitatively similar results were obtained with the two techniques. The results, moreover, agreed with the change in surface potential produced by these anions at an air water interface, as measured directly with an ionizing electrode (Randles, J. E. B. (1957) Discuss. Faraday Soc. 24, 194-199). The results obtained with artificial bilayers may explain the observation (Wieth, J. O. (1970) J. Physiol. 207, 581-609) that thiocyanate increases the sodium or potassium and decreases the sulfate permeability of erythrocyte membranes.