Organic trace minerals and 25-hydroxycholecalciferol affect performance characteristics, leg abnormalities, and biomechanical properties of leg bones of turkeys

Leg problems and resulting mortality can exceed 1% per week in turkey toms starting at approximately 15 wk of age. Dietary supplementation of organic trace minerals (MIN) and 25-hydroxycholecalciferol (HyD) may improve performance, decrease incidence of leg abnormalities, and increase bone strength. Nicholas 85X700 toms were assigned to 4 treatments consisting of a factorial arrangement of 2 concentrations of MIN (0 and 0.1% of Mintrex P(Se), which adds 40, 40, 20, and 0.3 mg/kg of Zn, Mn, Cu, and Se, respectively) and 2 concentrations of HyD (0 and 92 microg/kg of HyD). Diets were formulated to be equal in nutrient content and fed ad libitum as 8 feed phases. Feed intake and BW were measured at 6, 12, 15, 17, and 20 wk of age. Valgus, varus, and shaky leg defects were determined at 12, 15, 17, and 20 wk of age. Tibia and femur biomechanical properties were evaluated by torsion and bending tests at 17 wk of age. There were no treatment effects on BW. Only MIN significantly improved feed conversion ratio through to 20 wk of age. Cumulative mortality at 3 wk of age was greater among the MIN birds, but it was lower by 20 wk (P = 0.085). The MIN decreased the incidence of varus defects at 17 wk of age; shaky leg at 12, 15, and 17 wk of age; and valgus defects at 15, 17, and 20 wk of age. There were no MIN x HyD interaction effects on individual gait problems. Maximum load and the bending stress required for tibias to break in a 4-point assay were increased with MIN supplementation, especially when HyD was also added. Maximum shear stress at failure of femoral bones in a torsion assay was increased by supplementation with both MIN and HyD together. Dietary supplementation of MIN and HyD may improve biomechanical properties of bones. Dietary MIN supplementation may improve feed conversion of turkeys, likely by decreasing leg problems.

Determining the methionine activity of Mintrex organic trace minerals in broiler chicks by using radiolabel tracing or growth assay

Mintrex Zn, Mintrex Cu, and Mintrex Mn organic trace minerals contain 16% Zn, 15% Cu, and 13% Mn with 80, 78, and 76% 2-hydroxy-4-(methylthio)butanoic acid (HMTBA) by weight as the organic ligand, respectively. Our objective was to determine if HMTBA from Mintrex was fully available as a Met source. In experiment 1, thirty-six broilers (7 to 10 d old) were orally gavaged with methyl-(14)C-labeled HMTBA, either as free HMTBA (Alimet feed supplement) or Zn bis(-2-hydroxy-4-methylthiobutyrate) (Mintrex Zn). Radiolabel incorporation from either source into protein was measured as a marker of bioavailable Met activity. Results demonstrated that the HMTBA from Mintrex Zn was equally available as free HMTBA to support protein synthesis. In experiment 2, five hundred seventy-six 1-d-old broilers were allotted to 12 dietary treatments (TRT) for a 21-d growth assay. A TSAA-deficient diet containing 0.70% total TSAA (TRT 1) was supplemented with 0.05, 0.10, 0.15, and 0.20% free HMTBA (TRT 2 to 5) to establish the standard Met response curve. Treatment 6 was analogous to TRT 2 but had an additional 160 ppm Zn, 80 ppm Cu, and 160 ppm Mn as sulfates. Treatments 7 to 12 were identical to TRT 2 but supplemented with 40 or 160 ppm Zn from Mintrex Zn, 20 or 80 ppm Cu from Mintrex Cu, or 40 or 160 ppm Mn from Mintrex Mn, respectively. For TRT 1 through 6, growth performance increased due to increasing Met addition (P < 0.01) but not to increasing inorganic trace minerals. For Mintrex Zn, Cu, and Mn (TRT 7 to 12), there was a linear increase in cumulative gain:feed ratio (P < 0.04), and for Mintrex Zn and Mn, there was a linear increase in cumulative gain (P < 0.03) to increasing Mintrex addition. A 1-slope broken-line model was used to calculate bioavailable Met activity from Mintrex for comparison with actual intake values. Results indicated that HMTBA from Mintrex was fully available as a Met source.

The gastrointestinal microbiota and its role in monogastric nutrition and health with an emphasis on pigs: Current understanding, possible modulations, and new technologies for ecological studies

The gastrointestinal microbiota is an incompletely defined, dynamic community of several hundred species of primarily anaerobic bacteria. Species composition and bacterial numbers vary depending on animal age, the gastrointestinal location and a variety of nutritional and environmental factors. The microbiota positively and negatively impacts host physiology and performance in many important ways. This review will examine the establishment and composition of the normal microbiota; its beneficial and deleterious effects on the host; and methods by which to modify the microbiota. In addition, recent advances in methodology using the techniques of molecular biology to measure and describe the microbiota are discussed. Finally, recent results using the polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) technique to examine the microbiota of pigs at different ages, different intestinal sites, and after treatment with selected feed additives will be described. Key words: Microbiota, gastrointestinal tract, PCR-DGGE, animal nutrition/health, 16S rRNA

Comparative in vitro and in vivo absorption of 2-hydroxy-4(methylthio) butanoic acid and methionine in the broiler chicken

Poultry diets are typically supplemented with DL-2-hydroxy-4(methylthio) butanoic acid (HMTBA, or the hydroxy analog of methionine) or DL-methionine (DLM). Although HMTBA and DLM provide methionine activity, they are structurally distinct molecules with different physiological characteristics until they are converted to L-methionine. The relative rates of intestinal HMTBA vs. DLM absorption have been controversial, and it has been claimed that HMTBA is not fully absorbed. We measured the uptake of HMTBA and DLM in an in vitro everted intestinal slice model. Sections of intestinal slices (jejunum and ileum) were incubated with 0.1 to 50 mM HMTBA that was radiolabeled or DLM that was radiolabeled, and absorption was measured by scintillation counting. The HMTBA uptake was equal to or greater than DLM absorption in each tissue and at every time point with one exception. Furthermore, the rates of HMTBA absorption were always equal to or significantly greater than DLM uptake. In a separate in vivo experiment, absorption of HMTBA and L-methionine was monitored along the entire gastrointestinal (GI) tract. Broilers were fed commercial-type corn-soy diets supplemented with 0.21% HMTBA. Digesta was collected from crop, proventriculus, gizzard, duodenum, jejunum, ileum, large intestine, and cloaca and analyzed for the concentration of free HMTBA and free methionine in each compartment. These studies demonstrated that HMTBA is absorbed completely and along the entire GI tract, especially the upper GI tract. Furthermore, there was a higher concentration of free L-methionine than HMTBA in the digesta from every segment distal to the gizzard.

A comparison of knee braces during walking for the treatment of osteoarthritis of the medial compartment of the knee

In this cross-over study, we evaluated two types of knee brace commonly used in the conservative treatment of osteoarthritis of the medial compartment. Twelve patients confirmed radiologically as having unilateral osteoarthritis of the medial compartment (Larsen grade 2 to grade 4) were studied. Treatment with a simple hinged brace was compared with that using a valgus corrective brace. Knee kinematics, ground reaction forces, pain and function were assessed during walking and the Hospital for Special Surgery scores were also determined.

Significant improvements in pain, function, and loading and propulsive forces were seen with the valgus brace. Treatment with a simple brace showed only significant improvements in loading forces. Our findings suggest that although both braces improved confidence and function during gait, the valgus brace showed greater benefit.

Antibiotic growth promoters in agriculture: history and mode of action

This report will review the history of antibiotic growth promoter (AGP) use in the animal industry, concerns about development of antimicrobial resistance, and response in the European Union and United States to these concerns. A brief description of the history of legislation regarding feed use of antimicrobials in Denmark and the experience of animal producers following the 1998 ban will serve to illustrate the consequences on animal performance and health of withdrawing the approval for this use. The biological basis for antibiotic effects on animal growth efficiency will consider effects on intestinal microbiota and effects on the host animal and will use the germ-free animal to illustrate effects of the conventional microflora. The probability that no single compound will replace all of the functions of antimicrobial growth promoters will be considered, and methods to consolidate and analyze the enlarging database will be discussed.

A comparison of knee kinematic characteristics of stroke patients and age-matched healthy volunteers

OBJECTIVE

To investigate which knee kinematic characteristics show the greatest differences between stroke patients with minimal residual disability and age-matched healthy volunteers as a first step towards the development of a sensitive, objective measure of performance of movement for use in the clinical setting.

DESIGN

A comparative study.

SETTING

A movement analysis laboratory.

SUBJECTS

Ten patients between 6 and 12 months post stroke aged between 65 and 74 years and 10 age-matched healthy volunteers. All patients had made a good recovery and were able to complete all of the functional tasks.

INTERVENTIONS

Each subject had reflective markers placed on anatomical landmarks and was filmed performing three movement tasks: sit-to-stand, walking, and step on block.

MAIN OUTCOME MEASURES

Knee kinematic characteristics involving timing, joint angle and angular velocity at key points during each task.

RESULTS

Significant differences were found between patients and volunteers for only some of the timing and joint angle characteristics but for all angular velocity characteristics for which the mean differences ranged from 31.85 degrees/s for sit-to-stand (p = 0.013) to 82.5 degrees/s (p = 0.014) for the swing phase of gait.

CONCLUSIONS

These preliminary findings suggest that angular velocity of the knee during functional tasks might have potential as a sensitive, objective measure of performance of movement after stroke for patients with minimal residual disability.

Yeast vectors for integration at the HO locus

We have constructed new yeast vectors for targeted integration of desired sequences at the Saccharomyces cerevisiae HO locus. Insertion at HO has been shown to have no effect on yeast growth, and thus these integrations should be neutral. One vector contains the KanMX selectable marker, and integrants can be selected by resistance to G418. The other vector contains the hisG-URA3-hisG cassette, and integrants can be selected by uracil prototrophy. Subsequent growth on 5-FOA permits identification of colonies where recombination between the hisG tandem repeats has led to loss of the URA3 marker and return to uracil auxotrophy. We also describe several new bacterial polylinker vectors derived from pUC21 (ampicillin resistance) and pUK21 (kanamycin resistance).

Inhibition of the MEK/ERK signaling pathway blocks a subset of B cell responses to antigen

Signal transduction initiated by B cell Ag receptor (BCR) cross-linking plays an important role in the development and activation of B cells. Therefore, considerable effort has gone into determining the biochemical signaling events initiated by the BCR and delineating which events participate in specific biological responses to Ag. We used two inhibitors of mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK) 1 and MEK2, PD98059, and U0126, to assess the role the Ras-mitogen-activated protein kinase pathway plays in several BCR-induced responses. PD98059 or U0126 treatment substantially inhibited the BCR-induced activation of the extracellular signal-regulated kinase (ERK) forms of mitogen-activated protein kinase in the immature B cell line WEHI-231, in immature splenic B cells, and in mature splenic B cells. However, MEK-ERK inhibition did not block BCR-induced growth arrest or apoptosis of WEHI-231 cells or apoptosis of immature splenic B cells, indicating that the MEK-ERK pathway is not required for these events. In contrast, PD98059 and U0126 treatment did inhibit the up-regulation of specific BCR-induced proteins, including the transcription factor Egr-1 in WEHI-231 and mature splenic B cells, and the CD44 adhesion molecule and CD69 activation marker in mature splenic B cells. Moreover, both inhibitors suppressed BCR-induced proliferation of mature splenic B cells, in the absence and in the presence of IL-4. Therefore, activation of the MEK-ERK pathway is necessary for a subset of B cell responses to Ag.

The biology of banded (Lagostrophus fasciatus) and rufous (Lagorchestes hirsutus) hare-wallabies (Diprotodontia : Macropodidae) on Dorre and Bernier Islands, Western Australia

Sex ratio, reproduction, body condition and morphology of banded (Lagostrophus fasciatus) and rufous (Lagorchestes hirsutus) hare-wallabies were assessed on Dorre and Bernier Islands. Data are derived from 236 banded hare-wallabies and 161 rufous hare-wallabies captured between 1959 and 1999. The sex ratio of captured banded hare-wallabies tended to be female-biased (0.79: 1 male: female) but was not a significant departure from parity. In contrast, pouch young tended towards a male bias at 1.35: 1. Females produced 1–2 young per year. They were capable of producing young at 1000 g, but the incidence of females carrying pouch young or lactating increased from 39% for females of 1000–1400 g to 80% for females of 1401–1800 g, then decreased slightly to 76% for females >1800 g. Births occurred throughout the year but there was some indication of a decline in the latter half of the year. Captured banded hare-wallabies ranged in weight from 850 to 2300 g. Animals on Dorre Island were in significantly better body condition than those on Bernier Island, although this could be an artefact of their shorter pes length. There was no evidence of sexual dimorphism and no differences in morphological measurements taken, other than pes length, between the two island populations. The sex ratio of captured rufous hare-wallabies was close to parity at 0.99: 1 and for pouch young tended to be male-biased at 2: 1. The smallest female with young weighed 1215 g, but the incidence of females carrying pouch young or lactating increased from 43% for females of 1215–1660 g to 61% for females of 1661–2015 g and 100% for females >2015 g. Females carried pouch young in all months sampled (March–September) and one incidence of twinning was noted. Captured rufous hare-wallabies weighed 600–2550 g. Body condition was similar for males and females and between islands, but smaller females of reproductive age were in poorer body condition than larger females. There was no evidence of sexual dimorphism but pes lengths of animals on Dorre Island were significantly shorter, head lengths longer and tail lengths shorter, than those on Bernier Island. Rufous hare-wallabies appear to show regional variation in body size, being smaller in the wetter and warmer Tanami/Alice Springs region and larger on the drier and cooler Shark Bay islands.

Ecology of the western barred bandicoot (Perameles bougainville) (Marsupialia: Peramelidae) on Dorre and Bernier Islands, Western Australia

Population structure, reproduction, condition, movements and habitat preference were assessed for western barred bandicoots (Perameles bougainville) on Dorre and Bernier Islands over seven trapping sessions between 1988 and 1995. Data comes from 372 captures of bandicoots in 2535 trap-nights (an average of 14·7 captures per 100 trap-nights). Trap success was 5.7–25.8% on Dorre and 5.7–7.6% on Bernier. Recaptures within a trip made up 29% of bandicoot captures. The overall sex ratio (excluding recaptures) was skewed heavily towards males at 1.7: 1 for trapped animals, but varied between male and female dominance at any time according to reproductive status of females. Sex ratio of pouch young was 1.2: 1. Production of young was concentrated in the wetter winter months. The smallest western barred bandicoot with pouch young weighed 175 g. Bandicoots showed a pattern of increasing litter size with size of mother. Females with young had an average litter size of 1.8, with young reaching independence at about 100 g body weight. Large testes size relative to body size in males suggested a promiscuous mating system. Body condition could be predicted by sex (females were typically in better condition than males) and by rainfall over the previous 2 months. Some sexual dimorphism was evident, with females having longer heads and typically being heavier than males. There was no detected dimorphism between island populations. Movements of bandicoots appeared limited, with the median distance moved by animals captured more than once within a 9–11-day trapping session being 154 m. There was no significant difference in movements between the sexes, with males moving a median distance of 160 m and females 138 m within trapping sessions. The greatest movement by a male was 1020 m while the greatest distance moved by a female was 490 m. Only 13% of recorded movements were greater than 400 m. Home ranges overlapped, with 51% of traps catching more than one individual and as many as five males being caught at the same trap site. Bandicoots were widely dispersed through all habitats surveyed. Bandicoots appeared to suffer a substantial reduction in numbers on Dorre Island in a prolonged drought extending from October 1986 to April 1989, reducing overall trap success to less than 6% in the 1988 survey.

Reconstitution of B cell antigen receptor-induced signaling events in a nonlymphoid cell line by expressing the Syk protein-tyrosine kinase

B cell antigen receptor (BCR) cross-linking activates both Src family and Syk tyrosine kinases, resulting in increased cellular protein-tyrosine phosphorylation and activation of several downstream signaling enzymes. To define the role of Syk in these events, we expressed the BCR in the AtT20 mouse pituitary cell line. These nonlymphoid cells endogenously expressed the Src family kinase Fyn but not Syk. Anti-IgM stimulation of these cells failed to induce most of the signaling events that occur in B cells. BCR-expressing AtT20 transfectants were generated that also expressed Syk. Syk expression reconstituted several signaling events upon anti-IgM stimulation, including Syk phosphorylation and association with the BCR, tyrosine phosphorylation of numerous proteins including Shc, and activation of mitogen-activated protein kinase. In contrast, Syk expression did not reconstitute anti-IgM-induced inositol phosphate production. A catalytically inactive Syk mutant could associate with the BCR and become tyrosine phosphorylated but could not reconstitute downstream signaling events. Expression of the Src family kinase Lck instead of Syk also did not reconstitute signaling. Thus, wild type Syk was required to reconstitute several BCR-induced signaling events but was not sufficient to couple the BCR to the phosphoinositide signaling pathway.

Operation Desert Shield/Storm performance of soldiers enrolled in the alcohol and drug abuse prevention and control program

This article explores the Operation Desert Shield/Storm performance of soldiers receiving predeployment treatment in the Alcohol and Drug Abuse Prevention and Control Program (ADAPCP). It describes the impact that ADAPCP soldiers' performance has on their units, both from the soldiers' and the leadership's points of view. Examination of the ADAPCP's predeployment and deployment role indicates that the ADAPCP can do more for soldiers who, while attempting to overcome substance abuse problems, face the new challenge of coping with the upheaval of deployment to a war zone. Suggestions are also made for developing an ADAPCP peace-to-war transition plan.

Signal transduction by the B-cell antigen receptor

The antigen receptor of B lymphocytes (BCR) plays important roles in recognition of foreign antigens and self-components to allow the immune system to make appropriate antibody responses. The BCR is a complex between membrane immunoglobulin and the Ig-alpha and Ig-beta heterodimer. Site-directed mutagenesis experiments have shown that the mu heavy chain transmembrane domain plays a key role in the association of mIgM with Ig-alpha/Ig-beta. In the absence of complex formation, mIgM is retained in the endoplasmic reticulum, and this function is also specified by the mu chain transmembrane domain. The ability of various mutant mIgM molecules to associate with Ig-alpha/Ig-beta correlates well with their ability to induce signal transduction reactions such as protein tyrosine phosphorylation and phosphoinositide breakdown. Thus, the signaling ability of the BCR appears to reside in the Ig-alpha/Ig-beta heterodimer. The cytoplasmic domains of Ig-alpha and Ig-beta each contain an ITAM sequence, which is defined by its limited homology with subunits of the T-cell antigen receptor and of Fc receptors. Moreover, chimeric proteins containing these ITAMs and surrounding sequences from the cytoplasmic domains of Ig-alpha or Ig-beta exhibit signaling function characteristics of the intact BCR. The Ig-alpha and Ig-beta chimeras are each capable of inducing all of the BCR signaling events tested and thus represent redundant functions. Cross-linking these chimeras leads to their phosphorylation and to binding of the intracellular tyrosine kinases Lyn and Syk. The BCR expressed in the nonlymphoid AtT20 cells, which express the Src-family tyrosine kinase Fyn but not Syk, was not able to trigger vigorous signaling reactions. Introduction of the active form of Syk into these cells restored some signaling events. These results are consistent with a model in which the ITAMs act to initiate the BCR signaling reactions by binding and activating tyrosine kinases.

Autologous bone marrow transplantation in multiple myeloma: a single centre experience of 23 patients

We report the complications and outcome of high-dose melphalan and TBI combined with ABMT used in the treatment of multiple myeloma at a single centre. Twenty-three patients, aged 65 years or less, who underwent the procedure are reviewed. All had chemosensitive disease. Response to ABMT assessed at 3 months showed 75% of evaluable patients to have further tumour cytoreduction of at least 50%, with 24% of patients who entered ABMT with residual disease eventually achieving CR. There was one toxic death. The overall survival is 60% and the progression-free survival is 49.8% at a median follow-up time of 17 months. Relapse or disease progression has occurred in 27% of patients, of whom half have died. No significant prognostic factors affecting survival were found although those patients with IgG myeloma had a better outcome. Patients transplanted in first plateau appeared to do significantly better if they had been resistant to their first-line chemotherapy but had then responded to further conventional chemotherapy (p = 0.029).

Surface-plasmon excitation using a polarization-preserving optical fiber and an index-matching fluid optical cell

Existing experimental configurations to excite surface plasmons are reviewed, and a new experimental method for exciting surface plasmons is described. A transverse magnetic polarized wave is guided by a polarization-preserving optical fiber, collimated by a gradient-index lens, and launched into an optical cell filled with index-matching fluid. The wave is reflected off of a rotating mirror and excites a surface plasmon on a dielectric-metal interface by attenuated total reflection. The reflectance and incidence angles are measured simultaneously with a position-sensitive photodiode. The main advantages of this new method, compared with existing methods, are the low equipment costs and the ease with which a variety of surface-plasmon experiments can be performed.

Double hemibody irradiation (DHBI) in the management of relapsed and primary chemoresistant multiple myeloma

In view of increasing controversy regarding the role of double hemibody irradiation (DHBI) in the treatment of multiple myeloma, we have analysed the use of this technique at our institution over a 6-year period. Fifty-five patients with multiple myeloma were treated with both upper and lower hemibody irradiation between January 1985 and January 1991; 42 had relapsed post-plateau and 13 were chemoresistant to initial therapy. Fifteen patients received alpha IFN-2b maintenance therapy post-DHBI, at a dose of 3 Mu three times per week, as part of a randomized trial. Ninety-five per cent of patients experienced symptomatic improvement in bone pain post-DHBI, 21% of whom discontinued opiate analgesics altogether; 63% had a minor biochemical response and 38% had a partial biochemical response. The overall survival (OS) and progression free survivals (PFS) in all patients were 11 months and 8 months respectively. No significant difference was noted in either OS or PFS, according to whether patients were chemoresistant or had relapsed post-plateau. alpha IFN did not appear to prolong survival (OS or PFS) post-DHBI. Cytopenia was a significant problem, such that only 60% of patients had counts adequate enough to be eligible for alpha IFN. We conclude that DHBI is an effective treatment in patients with relapsed multiple myeloma and in those who are chemoresistant to initial therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Granulocytic sarcomas of small intestine and brain are associated with acute myelomonocytic leukaemia with abnormal eosinophils and inversion of chromosome 16

We report two cases of acute myelomonocytic leukaemia with abnormal eosinophils (M4Eo) in which the presenting feature was small bowel obstruction. We suggest there is a unique clinicopathological association between small intestine involvement with leukaemia and the M4Eo subtype. Central nervous system involvement by myeloblastoma occurred in one of the two cases which is a recognised feature of M4Eo and should necessitate prophylaxis with intrathecal therapy. Inversion of chromosome 16 which is a cytogenetic marker for M4Eo was demonstrable in one of the two cases.

Mini-BEAM followed by BEAM and ABMT for very poor risk Hodgkin's disease

High dose chemotherapy and autologous bone marrow transplantation (ABMT) is an effective form of salvage therapy in patients with relapsed or resistant Hodgkin's disease. Patients with large tumour masses at the time of ABMT have a poorer prognosis and we have therefore administered intermediate dose BCNU, etoposide, cytarabine and melphalan (mini-BEAM) prior to high dose therapy with the same agents (BEAM) and ABMT in such patients. In addition we have used the same strategy in patients with bone marrow infiltration at the time of relapse in an attempt to clear the bone marrow for transplant. A total of 23 patients received mini-BEAM and 21 proceeded to BEAM and ABMT. Platelet engraftment was delayed compared to BEAM recipients who had not received mini-BEAM (P = 0.008) but there was only one procedure related death. Responses to BEAM and ABMT were not predicted by the response to mini-BEAM indicating a dose response effect at the upper end of the dose intensity spectrum. At 2 years, the overall survival and progression free survival are 61% and 46% respectively for this group of Hodgkin's patients with extremely poor prognosis.

The use of radioisotopes in haematology

Radioisotopes used in haematology may be divided into four groups: 1. those used for in vivo studies, involving the labelling of cells in the blood or bone marrow and the use of labelled plasma albumin; 2. investigations involving surface counting over organs such as the bone marrow, spleen, liver and heart; 3. in vitro use of radioisotopes in the haematology laboratory and 4. isotopes used as part of imaging procedures. The shorter the half life of the isotope, the more limited patient exposure to radioactivity will be, but the greater the problems of starting and completing the investigation before the isotope has decayed. Isotopes studies should not be carried out in children or pregnancy unless there are exceptional clinical indications.

Prospective randomised study of double hemi-body irradiation with and without subsequent maintenance recombinant alpha 2b interferon on survival in patients with relapsed multiple myeloma

Immediately before first hemi-body irradiation, 59 patients with relapsed multiple myeloma were randomised to receive or not to receive subsequent alpha-2b interferon maintenance. 13 patients (22%) [8 of 31 (26%) controls, 5 of 28 (18%) in the interferon arm] received single hemi-body irradiation alone due to progressive disease and/or persistent cytopoenias following the initial procedure. Mean time between upper and lower hemi-body irradiation was 69 days (range 35-294). Of 23 patients randomised to receive interferon and completing double hemi-body irradiation, 15 (65%) achieved peripheral blood counts adequate to allow interferon administration as per study criteria commencing at a mean 116 days (61-241) from time of study entry. The mean period of interferon therapy, starting at a mean 65 days (26-160) post second hemi-body irradiation, is 16.4 months (2-33.5). There was no significant difference in median survival durations (10 months) from time of initial radiotherapy between control and interferon patients.

Effects of discrimination by sex and race on the early careers of British medical graduates during 1981-7

OBJECTIVE

To examine the possible effects of discrimination by sex and race on the career patterns of doctors up to six years after qualifying.

DESIGN

Postal questionnaire follow up survey.

PARTICIPANTS

1572 Doctors who graduated from five British medical schools in 1981, 1983, and 1985, including 587 women and 131 doctors from ethnic minorities.

MAIN OUTCOME MEASURES

Reported success rates of applications for training posts.

RESULTS

Comparison of the career patterns of women and men yielded no evidence of discrimination against women in competition for posts. In contrast, there were striking differences in career patterns between graduates of native European origin and those of ethnic minority origin. Graduates from ethnic minorities reported lower success rates and more difficulty in obtaining house officer posts, registrar posts, and places in vocational training schemes in general practice. Most of this discrimination seemed to occur at the stage of shortlisting for interview. Graduates from ethnic minorities were more likely than graduates of native European origin to have experienced spells of unemployment while seeking work. They were also more likely to have changed their original choice of career because of difficulty in obtaining suitable training posts or unfavourable career prospects.

CONCLUSIONS

Discrimination against ethnic minorities occurs in the competition for training posts among graduates from British medical schools. There was no evidence of discrimination against women graduates. Shortlisting procedures based on objective scoring systems may help to ensure equality of opportunity in future.

High-dose chemotherapy and autologous bone marrow transplantation in acute myeloid leukemia

For younger patients with acute myeloid leukemia (AML), an allogeneic transplant from a matched sibling may afford the best chance of cure. In patients who are older or without a matched sibling donor, dose intensification can be achieved with an autologous bone marrow transplant (ABMT). We report here the results of a high-dose chemotherapy regime with nonpurged ABMT in 82 adult patients in first remission of AML with a median follow-up of 31 months. The median age was 40 years (range 16 to 57 years). The median interval between remission and ABMT was 5 months (range 1 to 12 months). Twenty-eight of these patients received a second course of the same high-dose chemotherapy and ABMT. The procedure related mortality rate was 6%. The projected leukemia-free survival (LFS) at 5 years is 48% for all 82 patients and 50% for the 76 patients with no known preceding myelodysplastic syndrome. For those patients with primary AML who received a double ABMT the projected LFS is 67%. The interval between remission and ABMT did not predict for either relapse or LFS. ABMT using a multidrug chemotherapy protocol is less toxic than allogeneic BMT yet results in a similar LFS.

Effectiveness of high-dose combination chemotherapy and autologous bone marrow transplantation for patients with non-Hodgkin's lymphomas who are still responsive to conventional-dose therapy

We commenced a study in September 1981 to investigate the role of high-dose combination chemotherapy in the management of patients with non-Hodgkin's lymphomas who had failed conventional therapy. Fifty patients with diffuse intermediate- and high-grade non-Hodgkin's lymphomas were treated with high-dose combination chemotherapy with autologous bone marrow rescue (ABMT) and have a minimum follow-up of 1 year. Twenty patients had disease that was still responsive to conventional-dose chemotherapy, 15 had achieved a partial response (PR) to first-line therapy, and five were showing PR to salvage therapy after relapse. Twelve of these patients (60%) achieved complete remission (CR) (two following boost radiotherapy) and three patients have nonprogressive masses on computed tomographic (CT) scan as the only abnormality. None of these patients died during the procedure. Twenty-nine patients had disease not responsive to chemotherapy at conventional dosages: 19 had no response to first-line therapy and 10 showed no response to salvage therapy given after relapse. Only three of these patients achieved CR, all of short duration only. Only two patients in this group remain alive more than 2 years after the procedure and both have nonprogressive abnormalities on CT scan. Nine patients (31%) died of sepsis during the procedure. In those patients with disease not responsive to conventional-dose therapy, dose escalation is associated with a high procedure-related mortality and a low response rate. In those patients who still have chemotherapy-responsive disease the response rate is high and mortality is low.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical indications for splenectomy

The spleen, whether anatomically and physiologically normal or diseased, may significantly worsen the clinical picture in a variety of medical disorders. However, splenectomy should be undertaken only after a careful balancing of the short- and long-term risks and potential benefits to the patient, which are discussed in the following review.

Hemibody irradiation. An effective second-line therapy in drug-resistance multiple myeloma

The authors report the results of treatment of 41 patients with melphalan-resistant multiple myeloma using single half-body irradiation (HBI) or double half-body irradiation (DHBI). Patients were grouped using prognostic classification reported by the Medical Research Council. Patients in group I and II showed the best response to therapy with reduction in serum of urinary paraprotein and improvement in symptoms, most notably a marked reduction in bone pain. In these groups five patients have survived over 2 years after therapy. The therapeutic response appeared better in those patients who received DHBI as opposed to those whom treated with single HBI. Patients in group III did not achieve prolonged survival but effective relief of bone pain was a consistent finding in these patients also. Thus HBI represents an alternative to combination chemotherapy as second-line treatment of patients with melphalan-resistant multiple myeloma. A comparative study of HBI versus combination chemotherapy is now indicated to establish which therapeutic approach is most effective.

Renal impairment in myeloma: negative association with isoelectric point of excreted Bence-Jones protein

The isoelectric point (pI) of the major form of Bence-Jones protein excreted by 62 patients with myeloma and six with macroglobulinaemia was measured by combining isoelectric focusing with immunoblotting techniques. The distribution of the pI values for both kappa and lambda type proteins was bimodal, most falling in the ranges 5.0-6.0 and 7.0-7.5. Plasma creatinine and creatinine clearance and the urine excretion of alpha-1-microglobulin and beta-2-microglobulin were measured in 24 of the patients. These patients, who were free of additional factors known to have an association with the development of renal impairment, were followed up for a mean period of 16 months (range three to 28 months). It was found that renal impairment was not related to the pI of the Bence-Jones protein excreted.

Granulocytic sarcoma of the small intestine preceding acute myelomonocytic leukemia with abnormal eosinophils and inv(16)

We report a case of preleukemic granulocytic sarcoma of the small intestine preceding the development of acute myelomonocytic leukemia with abnormal eosinophils and inversion of chromosome 16, inv(16)(p13q22). A literature review suggests that this is a recurring cytogenetic-clinicopathologic association and carries a favorable prognosis, especially if treated aggressively with antileukemic therapy at the time of diagnosis.

Atypical mycobacterial infection in alpha interferon-treated hairy cell leukaemia

A patient whose hairy cell leukaemia had begun to respond to alpha interferon therapy developed overt atypical mycobacterial infection. This eventually responded to combination antimicrobial therapy. The clinical difficulties involved in this unique case included difficulty in isolation of the organism, failure of an empirical trial of antituberculous therapy and false attribution of the patient's infective symptoms to alpha interferon.

Use of teicoplanin for Hickman catheter associated staphylococcal infection in immunosuppressed patients

Antibiotic-resistant coagulase-negative staphylococci are a frequent cause of infection in indwelling central venous (Hickman) catheters. Teicoplanin has been evaluated in the treatment of 19 immunosuppressed patients with staphylococcal Hickman catheter infections, nine of whom were septicaemic. All infections were eradicated, with minimal side effects. In 16 cases, the catheter was retained until no longer required. Two recurrent infections were eradicated by a second course of teicoplanin. We conclude that teicoplanin is an effective and well-tolerated antibiotic in the treatment of Hickman catheter infections in immunosuppressed patients.

Automated leucocyte differential counts in chronic lymphocytic and hairy-cell leukaemias: a comparison of the Hemalog D, H6000 and Coulter S Plus IV

The automated peripheral blood differential counts produced by the Hemalog D, H6000 and Coulter S Plus IV were analysed and compared in 30 cases of chronic lymphocytic leukaemia (CLL) and 12 cases of hairy-cell leukaemia. All three machines were reliable in identifying CLL and HCL as a 'lymphocytosis' and in estimating neutrophil numbers in the disease. The Hemalog D and H6000 produced accurate monocyte counts in the two diseases, but the Coulter S Plus IV was unreliable in this regard since large lymphoid cells were identified as monocytes. The Haemalog D and H6000 were comparable in consistently identifying modestly raised large unstained cells (LUCs) in CLL. The Hemalog D, but not the H6000, was able to distinguish HCL from CLL on the basis of markedly raised LUCs.

Management of multiple myeloma

This article reviews the diagnostic approach to a patient with suspected multiple myeloma. Studies of chemotherapeutic regimens are reviewed and the alternative therapeutic options available at different stages of disease progression are discussed. These include newer modalities of treatment such as hemi-body irradiation as second-line therapy, bone marrow transplantation in plateau-phase and the role of alpha interferon.

Autologous bone marrow transplantation for patients with acute myeloid leukaemia and acute lymphoblastic leukaemia--a comparison

Forty-two patients with acute leukaemia were treated with autologous bone marrow transplantation (ABMT) using a combination chemotherapy protocol for bone marrow ablation. The response to high-dose chemotherapy and ABMT and its associated morbidity and mortality have been compared in 24 patients with acute myeloid leukaemia (AML) and 18 patients with acute lymphoblastic leukaemia (ALL). In 16 patients with AML treated with ABMT during first complete remission (CR), ten patients (62.5%) remain in unmaintained remission; median follow up is 32 months. In eight patients with ALL treated in first CR, only one remains in remission 32 months post-ABMT, with three patients dying non-leukaemic deaths. Fourteen of 18 patients (AML and ALL) treated after first remission have died of recurrent leukaemia, two died non-leukaemic deaths and two remain well 31 and 55 months post-ABMT; both have ALL. The length of hospital stay and the amount of blood product support were similar in both groups. Haematological recovery post-ABMT was delayed in patients with AML compared to patients with ALL but this difference was not significant. Rapidly progressive lung infection was thought to be the cause of four early deaths (4/18) in patients with ALL but none in patients with AML. Severe gram-negative infections were significantly more common in patients with AML.

Autologous bone marrow transplantation following high dose chemotherapy for the treatment of adult patients with acute myeloid leukaemia

24 adult patients with acute myeloid leukaemia (AML) were treated with intensive chemotherapy followed by autologous marrow rescue. The procedure was repeated twice in eight patients. 11 of 16 patients treated in first remission continue in first unmaintained remission (9-54 months, median 17 months). Eight patients treated at relapse or second remission have relapsed again and died within 14 months of their first autologous bone marrow transplant (ABMT). This form of intensification therapy would appear valuable for adult AML patients in first remission.