Combination antifungal therapy for cryptococcal meningitis

Two patients with Hodgkin's disease and cryptococcal meningitis are described. Both patients were treated with a combination of the two antifungal agents, amphotericin B and flucytosine. Nephrotoxicity was easily reversible in both patients and clinical improvement was seen with this combination therapy. Intrathecal therapy with amphotericin B was used in both patients. The optimal treatment of this disease may prove to be a combination of oral flucytosine, with amphotericin B given by intrathecal injection as well as rapid low dose intravenous injection.

Prophylactic granulocyte support in experimental septicemia

The purpose of this study was to determine the value of prophylactic granulocyte transfusions in preventing death from sepsis. An intravenous dose of 10(9) Escherichia coli was lethal when given to granulocytopenic rats 6 days following irradiation with 750 rads. Only one of 22 irradiated animals survived the septicemia. Although normal (nonirradiated) animals experienced a transient leukopenia from this dose of organisms, it was less than LD10 for the normal host. There were no deaths in a group of animals receiving irradiation only. A group of 14 irradiated animals was given a single granulocyte transfusion 2 hr before the septic inoculum, and 57% of these animals survived (p less than 0.01). No antibiotic therapy was administered to any of these animals. Irradiated animals who received granulocytes and recovered from sepsis had earlier granulocyte reconstitution than animals irradiated but not given the septic challenge. Platelet reconstitution was the same in both groups. In the rat model, prophylactic granulocyte support of septc animals led to improved survival. It was concluded that granulocyte prophylaxis may be of value in selected patients with transient bone marrow failure who are therefore at high risk from sepsis.

Adriamycin/cyclophosphamide and adriamycin/melphalan in advanced L1210 leukaemia

Adriamycin and cyclophosphamide are active agents in human and experimental tumours. Using the L1210 murine leukaemia, their effectiveness alone and in combination was studied. The combination is highly synergistic in this tumour, resulting in a greater than 50% survival rate when the agents used alone at optimal doses are not curative. DNA synthesis by tumour cells is substantially inhibited and the total ascitic population much reduced. In contrast, DNA synthesis in sensitive host tissues is less disturbed. There is no major difference in the pharmacology of the agents whether given alone or in combination. In very advanced disease the combination is no better than treatment with cyclophosphamide alone. The combination of adriamycin and melphalan in L1210 leukaemia also produces superior results to those obtained using either drug alone at its optimal dosage.

The effect of sleep deprivation on signal detection parameters

Twelve subjects performed a high signal rate vigilance task, once after a night's sleep, and once after a night without sleep. Raw scores were transformed into the signal detection parameters, d′ and β. After sleep deprivation, detection performance was significantly impaired. This was reflected in a fall of d′, whereas β was not significantly altered. Analysing the control data alone for comparison with other vigilance studies revealed a decrement in % signals detected and d′, and an increase in β from the first to the second half of the test.