An unusual case of coccidioidomycosis

Dissemination of coccidioidomycosis is rare. The skin, musculoskeletal system, and central nervous system have been described as the most common sites of extrapulmonary disease. We present a case of an asymptomatic patient in whom the diagnosis of coccidioidomycosis was made on a lymph node biopsy. The biopsy was performed because of an abnormal mammogram and physical findings suggestive of malignancy.

Ras oncogene point mutations in bladder cancer resistant to cisplatin

Bladder tumors respond to cisplatin-based chemotherapy in 68% of cases, but only 30% will have a durable response. Recent studies have suggested that ras point mutations may produce cisplatin drug resistance in cell lines. To determine the role of ras point mutations in human tumors resistant to cisplatin, we evaluated ten tumors exposed to cisplatin and eight untreated bladder tumors for ras point mutations. Using polymerase chain reaction DNA amplification and allele-specific oligo-hybridization, we found that only one of the ten treated tumors and none of the untreated tumors harbored a ras point mutation. We conclude that ras point mutations occur infrequently in untreated bladder tumors and do not appear to correlate with cisplatin drug resistance in vivo.

Antibodies and their role in interleukin-1 research

The preceding paragraphs describe several uses of specific antibodies to IL-1. Standard radioimmunoassays and ELISA procedures were developed with demonstrated utility in studies attempting to quantitate the cytokine in cell culture fluids. In part, antibody-based assays circumvent the problems associated with bioassays. Bioassays are difficult to perform, often lack specificity due to the presence of competing cytokines and are insensitive when used with complex biological fluids due to non-specific protein binding and the presence of IL-1 antagonists. Thus, bioassays have not been broadly applicable with specimens in a clinical setting. In contrast, monoclonal antibodies and polyclonal antisera have provided a means of identifying functionally important regions of the IL-1 molecule, monitoring the post-translational processing of IL-1 which may include biologically inactive moieties, and developing new assays as illustrated by cell blot procedures.

Detection of posttransplant minimal disease chronic myelogenous leukemia by bcr rearrangement analysis

Until recently, cytogenetic detection of the Philadelphia chromosome (Ph) was the only reliable test to diagnose chronic myelogenous leukemia (CML) and detect minimal disease or early relapse following treatment. However, the recently developed ability to detect the Ph chromosome as a rearrangement in the bcr gene of chromosome 22 permits identification of the leukemic clone comprising as little as 5% of the cell population. We present results of simultaneous cytogenetic and DNA rearrangement studies in 28 CML patients considered for or treated with bone marrow transplantation. Our results show that the molecular method is significantly more sensitive than the cytogenetic method in the detection of minimal disease Ph-positive clones.

Evaluation of a new triphasic oral contraceptive in private practice

We evaluated the clinical and metabolic effects of a new triphasic regimen developed in the continuing attempt to reduce the dose of estrogen and progestogen in oral contraceptives. A combination of ethinyl estradiol (EE) and levonorgestrel (LNg) was used (six tablets with 30 micrograms EE + 50 micrograms LNg, five tablets with 40 micrograms EE + 75 micrograms LNg, and 10 tablets with 30 micrograms EE + 125 micrograms LNg), also known as Triphasil (Wyeth). In a private practice, 409 subjects participated in 7,286 treatment cycles. Three pregnancies occurred, all due to subject failure. Menstrual regulation was excellent and the incidence of side effects extremely low. Withdrawals from the study for possibly drug-related medical reasons totaled 9.0% through 56 cycles of treatment. Metabolic changes also were evaluated in 14 of these women over a 6-month period. The only statistically significant increase in carbohydrate values occurred at 6 months. The mean glucose level at 30 minutes of the oral glucose tolerance test was above the baseline mean value, but serum insulin levels showed no statistically significant deviation. Lipid values presented are total lipids, total cholesterol, triglycerides, alpha-, beta-, and pre-beta-lipoproteins, and high density and low density lipoprotein cholesterol. There was no statistically significant difference between the mean values at baseline and those during treatment for any lipid variable. These results indicate that this triphasic oral contraceptive has a high degree of efficacy, a low incidence of side effects, excellent cycle control, and high subject compliance, and would seem to indicate a minimal influence on the metabolism of lipids and carbohydrates in the small number of subjects studied.

A proposed alveolar model for adult human lungs: the regular dodecahedron

In an endeavor to delineate an alveolar configuration that would reasonably mirror the natural state, polygonal shapes of normal alveoli were tabulated in histological sections from inflation-fixed specimens of 16 men aged 16-48 years. The resulting alveolar population varied from three- to ten-sided polygons with a preponderance of tetragons, pentagons, and hexagons. These observations were compared with the possible combinations of polygonal sections through various polyhedral models proposed by other workers and the five classical regular polyhedrons. The potential types of sections through the regular dodecahedron, i.e., a twelve-sided shape with faces consisting of pentagons, seemed to fit best with present findings, and this is suggested as an idealized configuration that might be useful in various geometric determinations, e.g., estimates of alveolar surface area and volume.

Fatal pancarditis in a patient with coexistent Lyme disease and babesiosis. Demonstration of spirochetes in the myocardium

A 66-year-old man developed fever, chills, myalgias, three erythematous skin lesions, and transient left eyelid lag. Because of persistent fever, he was hospitalized 4 weeks after the onset of disease; a peripheral blood smear showed Babesia microti in 3% of his erythrocytes. Eighteen hours later, he died unexpectedly. Autopsy showed pancarditis with a diffuse lymphoplasmacytic infiltrate, and spirochetes were found in the myocardium. Antibody titers to both the Lyme disease spirochete Borrelia burgdorferi and Babesia microti were elevated. The finding of spirochetes in the myocardium and the elevated antibody titers to Borrelia burgdorferi suggest that the patient died from cardiac involvement of Lyme disease.

Site predilection of airway inflammation by emphysema type

To elucidate interrelations of airway inflammation and emphysema, bronchi from subjects with severe panlobular and centrilobular disease and normal lungs were compared. This disclosed an intense infiltration with chronic inflammatory cells, mucous gland hypertrophy, and thickening of bronchi, primarily in association with emphysema having a panlobular configuration. These changes complement a generalized thickening and inflammation of nonrespiratory bronchioles previously observed in these cases. We conclude that the panlobular pattern may be a close function of inflammatory thickening of the conductive airways to respective lungs and lung parts, but centrilobular emphysema is not reliant on these changes. The precursory defect for the centrilobular lesion instead has been shown to be a more peripherally oriented respiratory bronchiolitis around the centers of lobules.

Self-limited babesiosis in a splenectomized child

This report describes a self-limited babesia infection in a splenectomized child with hereditary spherocytosis. This is the first report of infectious babesiosis in a child and the second case of babesiosis reported on Cape Cod. The infection manifested itself 6 weeks after a 4-hour exposure to Nantucket. Hemolysis lasted only 4 days and resolved without specific treatment. Parasitemia was documented after resolution of symptoms.

Small airways in severe panlobular emphysema: mural thickening and premature closure

Histological measurements in cases of severe paniobular and centrilobular emphysema and in normal lungs disclosed a generalized thickening of the walls of small airways in the panlobular group. With mathematical models, this was depicted as a potential basis for airway closure at higher than normal lung volumes and trapping of air. Lungs with mixtures of panlobular and centrilobular emphysema predominate in the general population, and the obstructive component of airways in this setting is likely a net result of multiple lesions. These may be common in varying degrees to both varieties of disease but especially characteristic of one form. Bronchiolar thickening is one such general process. Present findings suggest that this is prone to be linked to emphysema with a panlobular pattern.

Affixment arrangements of peribronchiolar alveoli in normal and emphysematous lungs

Our investigation of the radially affixed alveoli of nonrespiratory bronchioles showed that the interalveolar interval was basically constant for normal bronchioles of all sizes, with a mean value of 0.146 mm. The mean interalveolar interval increased significantly to 0.173 and 0.209 mm, respectively, in the two most severe grades of emphysema. The pattern of alveolar affixment to the walls of bronchioles was also altered in emphysema, with irregular interruptions, variations in size and shape of abutting luminal spaces, and loss of alveolar attachment surface. These changes reflected the disruptive phase of emphysema and corroborated previous studies. A dominant extrinsic force normally responsible for bronchiolar patency is thus compromised. Any bronchiole so affected would logically be prone to collapse or contracture of its wall, luminal deformities, diminution of luminal caliber, and retarded airflow.

Labetalol steady-state pharmacokinetics in hypertensive patients

1 During chronic treatment of hypertensive patients observed mean steady-state plasma labetalol levels in ten patients were consistently and significantly higher than predicted from initial acute pharmacokinetic analysis. 2 Mean steady-state levels varied from 36 to 183 ng/ml on a chronic dose of 200 mg twice daily. 3 Patients with lower steady-state levels on a fixed dose of labetalol usually required higher maintenance doses to control blood pressure.

An analysis of the blood pressure response to labetalol in hypertensive patients

1. Blood pressure measurements were made in hypertensive subjects after single intravenous and oral doses of labetalol and subsequently during chronic administration.

2. Oral therapy can be as effective as intravenous therapy in achieving acute blood pressure reduction.

3. Blood pressure control with chronic labetalol monotherapy was satisfactory in 11 of the 12 subjects.

4. High dose therapy with labetalol and 49 diuretic produced greater postural blood pressure falls.

Smoking, mortality, and six in a community hospital necropsy population

Analysis of 344 necropsies at a community hospital disclosed a male to female ratio of 1.9:10 and a smoking incidence over twice that of the general population. Overall longevity for men was less than for women. Intragroup comparisons showed an inverse relationship between smoking and longevity. Smokers in general and subsets of male and female smokers thus died earlier than respective nonsmokers. Trends for nonsmoking men and women were not different. However, smoking women surprisingly died earlier than smoking men at comparable pack-year exposure levels. Conversely, nonsmokers were most likely to achieve old age with freedom from diseases usually associated with smoking. We conclude that smoking predisposes to hospitalization, with premature death. Men suffer the most, probably because of traditionally heavier usage. For reasons unclear, however, women who do smoke may exhibit excessive vulnerability in some situations.

Legal abortions and trends in fetal and infant mortality rates in the United States

Using states as the units for analysis, we found no evidence that during the early 1970s in the United States the legalization of abortions influenced trends in infant mortality rates. If fetal deaths were reduced by legal abortions during that period then the influence was modest and brief. These conclusions differ substantially from all earlier studies of the relationship between legal abortions and pregnancy outcomes in the United States which examined trends in areas with many legal abortions while ignoring areas with relatively few legal abortions.

Thickness and composition of nonrespiratory bronchiolar walls in normal and emphysematous lungs with some functional implications

The thickness and composition of the walls of nonrespiratory bronchioles were quantitatively assessed in groups of normal and emphysematous lungs. In both the groups there was a gradual increase in the thickness of the walls of nonrespiratory bronchiles with increasing caliber, but this change was not proportionate. Smaller bronchioles possessed thicker walls in both the groups. Bronchioles of comparable internal diameter were also found to be slightly thicker than normal in emphysematous specimens at all levels of caliber. Through a system of schematic models, it was shown that the relatively thicker walls of smaller bronchiles in normal and emphysematous lungs would enhance airflow in the proper direction both during expiration and inspiration. The slightly thicker walls of bronchioles in emphysema would result in their closure at substantially higher lung volumes than would occur with the somewhat thinner walled bronchioles of corresponding diameters in normal lungs. Although such thickening might only be focal in emphysema, this would interfere with expiratory airflow and result in air-trapping. This investigation failed to demonstrate differences in the composition in the walls of nonrespiratory bronchioles of normal and emphysematous lungs.

Pharmacokinetics and pharmacodynamic studies of labetalol in hypertensive subjects

1 The pharmacokinetics of labetalol were studied in twelve hypertensive patients, ten of whom were not receiving other therapy. 2 Following intravenous administration there was a three- to fourfold variation in terminal elimination half-life, volume of distribution and total plasma clearance. The mean elimination half-life was 3.25 hours. 3 Following oral administration the drug was absorbed rapidly. Systemic availability varied from 11-86% (mean 33%). 4 Plasma levels correlated poorly with the acute effect on BP, raising the possibility of labetalol acting in a deep tissue compartment or alternatively an active metabolite contributing to its effect.

Further observations on luminal deformity and stenosis of nonrespiratory bronchioles in pulmonary emphysema

In an endeavour to elucidate the anatomical basis for the increased resistance to airflow which characterises the most peripheral conducting air passages in pulmonary emphysema, lumina of nonrespiratory bronchioles of lungs with mainly centrilobular disease were assessed for two- and three-dimensional features by: (1) determination of percentage conformity of the lumina of individual bronchioles in histological sections to hypothetical planes through cylinders (ie, ellipses with the same areas and circumferences), and (2) comparison of luminal areas at regular intervals along bronchiolar longitudinal axes. The lumina of most nonrespiratory bronchioles from normal lungs conformed closely to their respective ellipses, thus corroborating previous observations that they are normally cylindroid. In contrast, there was a substantial excess of plane section deformities in the lumina of nonrespiratory bronchioles from the emphysematous specimens. The incidence of stenotic bronchioles (by both diameter and area determinations) was also greatly increased in emphysema. Since there was a strong positive association between such stenotic lesions and bronchiolar deformity, the latter was concluded to be a major factor in bronchiolar restriction. Furthermore, these characteristics seemed to have three-dimensional expression, for the lumina of stenotic bronchioles in emphysema were irregular in a longitudinal fashion.