Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises

STUDY GOAL

To compare the efficacy and safety of single 1 g oral azithromycin with doxycycline, 100 mg twice daily for seven days for treatment of uncomplicated urogenital chlamydial infection.

STUDY DESIGN

Randomised, unblinded, comparative trial, involving 597 patients demonstrating clinical evidence of genital chlamydia and a positive non-culture assay for Chlamydia trachomatis.

RESULTS

Among the azithromycin- and doxycycline-treated patients 61% and 60%, respectively, were asymptomatic within one week after the first dose. At two weeks, these figures increased to 86% and 83%, respectively. Bacteriological eradication, based on a negative assay, occurred in 338 (97%) of 347 azithromycin-treated patients and 161 (99%) of 163 doxycycline-treated patients.

CONCLUSION

Treatment of uncomplicated chlamydial cervicitis and urethritis with single 1 g oral azithromycin is equivalent to standard therapy with doxycycline. Drug-related adverse events were approximately twice as common as previously reported for both drugs.

Bone marrow metastases

This article discusses the clinical significance of bone marrow metastases and the current methods being used to detect tumor cells in marrow. The strategies being investigated for eradicating cancer cells from marrow in patients receiving hematopoietic cell autografts also are reviewed.

A phase I/II study of high-dose cyclophosphamide, cisplatin, and thioTEPA followed by autologous bone marrow and granulocyte colony-stimulating factor-primed peripheral-blood progenitor cells in patients with advanced malignancies

The purpose of the present study was to determine the maximally tolerated dose of thioTEPA given with fixed high-dose cyclophosphamide (CPA) and cisplatin (cDDP) followed by autologous bone marrow (ABM) with or without granulocyte colony-stimulating factor (G-CSF)-primed peripheral-blood progenitor cells (PBPCs) in patients with advanced malignancies. Patients were required to have histologically documented malignancies and adequate renal, hepatic, pulmonary, and cardiac function. CPA was given at 1,875 mg/m2 per day as a 1-h i.v. infusion for 3 consecutive days, and cDDP was given at 55 mg/m2 per day as a 24-h continuous i.v infusion over 3 days concurrently with CPA. ThioTEPA was given once as a 1-h i.v. infusion (300-900 mg/m2) either following (the first 13 patients) or prior to CPA and cDDP. In all, 31 patients received PBPCs. A total of 46 patients were treated. There were 6 deaths among the 15 patients who did not receive PBPCs (13 received thioTEPA following CPA and cDDP). Among the other 31 patients who received PBPCs (all of whom also received thioTEPA prior to CPA and cDDP), there were 4 deaths, all involving patients with refractory ovarian carcinoma. The main toxicities were mucositis, esophagitis, hepatotoxicity, and nephrotoxicity. The median time required to achieve an absolute neutrophil count of 500 microliter was 10 days (range, 9-12 days) for those who received PBPCs and 15 days (range, 15-34 days) for those who did not receive PBPCs. Altogether, 47% of the major organ toxicities (grades 3 and 4 renal, hepatic, and cardiac toxicities) occurred among the 15 patients who did not receive PBPCs, although these patients received thioTEPA at the lowest 2 dose levels. There were 3 complete responses and 22 partial responses among 35 evaluable patients (overall response rate, 71%), with the median duration of response being 3.5 months (range, 2-17 months). The maximally tolerated dose of thioTEPA was 600 mg/m2 given as a 1-h i.v. infusion on the day prior to CPA and cDDP administration, The combination of high-dose CPA, cDDP, and thioTEPA is a well-tolerated regimen when thioTEPA is given prior to CPA and cDDP and when the combination also includes PBPCs in addition to ABM. This regimen is active in a variety of malignancies.

Vitamin C supplementation and fear-reduction in Japanese quail: short-term cumulative effects

1. Fear-related behaviour was measured in individually-housed Japanese quail which had received either untreated drinking water (UDW) or a vitamin C solution (ascorbyl-2-polyphosphate, APP, 1 g L-ascorbic acid/1 for 1 or 4 d. Behavioural tests were carried out at 24 or 27 d of age. Water consumption was measured daily and plasma ascorbic acid (AA) content was assayed after differential treatment for 1 or 4 d. 2. The quail in the APP treatment groups drank significantly more than did those receiving untreated drinking water. 3. Supplementation with APP raised plasma AA concentrations substantially above those found in UDW quail. The lower AA concentrations found after APP treatment for 4 d rather than one may have reflected either inter-assay variation or limited intestinal absorption following excess ingestion. 4. Quail treated with APP showed less home-cage avoidance of a novel object and shorter tonic immobility fear reactions than did the UDW birds. The UDW quail showed remarkably similar avoidance and TI scores on test days 1 and 4. Conversely, continued treatment with APP further reduced avoidance scores but, although TI durations fell slightly with continued treatment there were no significant day effects. 5. It was concluded that APP supplementation can reduce underlying fearfulness but that it may not be necessary to continue treatment for longer than 24 h immediately prior to a known frightening event.

High-dose chemotherapy with autologous hematopoietic progenitor cell support for metastatic and high-risk primary breast cancer

High-dose chemotherapy (HDCT) is being evaluated in the treatment of metastatic and high-risk primary breast cancer. The actuarial 2-year disease-free survival rate for patients with stage IV breast cancer is approximately 15% to 20%. A single metastatic site and achievement of a complete response to induction chemotherapy may be favorable prognostic indicators for disease-free survival after HDCT. Phase II studies in patients with primary breast cancer and > or = 10 and four to nine involved axillary nodes are encouraging. Prospective randomized trials are ongoing in these patient groups. Various strategies are being investigated to reduce the incidence of relapse after HDCT.

Immunocytochemical detection of breast cancer cells in marrow and peripheral blood of patients undergoing high dose chemotherapy with autologous stem cell support

Detection of small numbers of breast cancer cells is important in staging the disease and can be helpful in assessing the efficacy of purging regimens prior to autologous stem cell infusion. Immunohistochemical methods are potentially useful and broadly applicable for this purpose since they are simple to perform, sensitive, and may be quite specific. We have used a combination of four monoclonal antibodies [260F9, 520C9, 317G5 (Baxter Corp); BrE-3 (Dr. R. Ceriani)] against tumor cell surface glycoproteins in a sensitive immunocytochemical assay to identify breast tumor cells in bone marrow and peripheral blood. Immunostained cytospin preparations were fixed prior to staining to preserve cytological details of immunopositive cells. After immunostaining, slides were counterstained with hematoxylin to confirm the identify of labeled cells. In cytocentrifuge experiments in which small numbers of CAMA human breast tumor cells were added to bone marrow mononuclear cells, a linear relationship between the number of tumor cells added and the number of tumor cells detected was obtained over a broad range of tumor cell concentrations. The probability of detecting tumor cells was dependent on the number of cytocentrifuge slides examined. When ten slides (5 million cells) were examined, the probability of detecting tumor at a concentration of 4 tumor cells per million bone marrow mononuclear cells was 98%. In clinical specimens, tumor cells were detected in marrow aspirates from 73 of 240 (30%) patients undergoing autologous transplantation, including 70 (37%) of 190 patients with clinical stage IV disease, 0 of 7 patients with clinical stage III disease, and 3 of 43 (7%) patients with clinical stage II disease. Seventy-three of 657 peripheral blood specimens from 26 of 155 patients (17%) contained breast cancer cells with counts ranging from 1 to 97 tumor cells per million leukocytes. Tumor cells were most frequently found in the blood of patients with stage IV disease [21 of 107 (20%)] but were also found in a substantial number [5 of 44 (11%)] of patients with stage II disease. Positive selection of CD34-positive hematopoietic progenitor cells as well as negative purging methods such as incubation with 4-hydroxyperoxy-cyclophosphamide (4-HC) were evaluated with respect to tumor cell depletion. Selection of CD34-positive progenitor cells from bone marrow or peripheral blood resulted in log reduction of 1 to > 4 tumor cells reinfused at autologous transplantation. A lesser log reduction (up to 1) was demonstrated following 4-HC purging. We conclude that properly performed and controlled immunocytochemical staining of bone marrow and peripheral blood cytospins is a sensitive and simple way to detect and quantitate breast cancer cells in hematopoietic specimens harvested for autotransplantation and that CD34-positive progenitor cell selection results in significant reduction in the number of breast cancer cells reinfused with marrow or peripheral blood stem cells.

Large volume ex vivo expansion of CD34-positive hematopoietic progenitor cells for transplantation

A large volume culture system was developed for the ex vivo expansion of CD34 positive (+) hematopoietic progenitors, using cell donated by 15 patients receiving high-dose chemotherapy with autologous hematopoietic progenitor cell support (AHPCS). Substantial expansion of myeloid (181-fold) and megakaryocyte (41-fold) progenitors cells was demonstrated, using the conditions that we determined to be optimal: CD34+ progenitors cultured unperturbed for 7 (marrow) or 10 (blood) days in Teflon-coated bags with X-Vivo-10 medium containing 10% autologous plasma, 100 ng/ml, respectively, of recombinant stem cell factor (SCF), interleukin 3 (IL-3), interleukin 6 (IL-6), and granulocyte colony-stimulating factor (G-CSF). The studies demonstrated that (a) CD34 selection was necessary to obtain large, clinically relevant numbers of hematopoietic progenitors, (b) the addition of G-CSF to the baseline regimen of SCF/IL-3/IL-6 significantly enhanced the expansion of myeloid progenitors, (c) the addition of IL-1 to SCF/IL-3/IL-6 did not significantly enhance myeloid progenitor cell expansion, (d) CD34+ G-CSF-mobilized peripheral blood progenitor cells (PBPC) produced higher numbers of myeloid progenitors in culture than CD34+ marrow cells, and (e) long-term tissue culture (LTC) assays demonstrate the preservation of long-term initiating cells in ex vivo culture. The short-term and long-term reconstituting capability of CD34+ PBPC cultured in this system remains to be determined and will be evaluated in a clinical trial where they will be used as the sole source of AHPCS following high-dose therapy.

Stem cell isolation

High-dose chemotherapy with autologous hematopoietic progenitor cell support is increasingly used to treat a variety of malignant diseases. A drawback of this technique is the potential for infusing clonogenic tumor cells with the autograft, producing relapse of the disease in the patient. The use of positive selection techniques to isolate stem cells and thus reduce or eliminate tumor cell contamination has been extensively studied over the past few years. Preliminary clinical results have demonstrated that these procedures deplete 2 to 7 logs of tumor cells and do not impair engraftment. It is too early to assess the ultimate clinical benefit of this strategy. Additional applications of CD34-selection include ex vivo expansion of and gene transfer into hematopoietic progenitor cells and T-cell depletion of allogeneic grafts to reduce the incidence of graft-versus-host disease.

CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain

Anterior knee pain is commonly associated with patellofemoral malalignment. Both conventional radiographic measurements and CT measurements have been proposed to define and confirm the sometimes difficult clinical diagnosis of anterior knee pain secondary to patellofemoral malalignment. Using CT imaging with computerized technique to measure anatomic relationships, we evaluated patients (n = 50) with anterior knee pain for excessive lateralization of the tibial tubercle. The symptomatic knee of each patient was compared with their asymptomatic knee as well as with the knees of patients with other causes of anterior knee pain (n = 10) and with the knees of asymptomatic controls (n = 10). The symptomatic knee of patients with suspected patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle (12.2 +/- 0.5 mm) than did the asymptomatic knee (9.0 +/- 0.7 mm). The symptomatic knees of patients with patellofemoral malalignment also demonstrated significantly greater lateralization of the tibial tubercle than did the knees of patients with other causes of anterior knee pain (5.9 +/- 0.9 mm). When a control population was added to the analysis, the patients with symptomatic patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle than did the controls (6.4 +/- 0.4 mm). Using a critical value of 9 mm lateralization, the CT diagnosis of patellofemoral malalignment had a specificity of 95% and a sensitivity of 85%. We conclude that CT determination of tibial tubercle position assists the diagnosis of patellofemoral malalignment.

Open-field and tonic immobility responses in domestic chicks of two genetic lines differing in their propensity to feather peck

1. The open-field and tonic immobility reactions of female domestic chicks of 2 genetic lines which showed high (HP) or low (LP) levels of feather pecking were compared. 2. Chicks of the LP line showed less freezing, and vocalised and walked sooner and more in the open field than did their HP counterparts. 3. There were no differences between lines in the durations of their tonic immobility responses, at least in the present study. 4. The pattern of results may reflect line divergence in underlying social motivation rather than fearfulness.

Rapid antigen detection assay for identification of Chlamydia trachomatis infection

A rapid antigen detection test was compared with direct fluorescent-antibody staining and with tissue culture isolation for the detection of Chlamydia trachomatis infections in 507 women. The sensitivities observed were 75, 76, and 84%, respectively, with specificities of > 99%.

Respiratory failure in acute pancreatitis

There are a number of important pulmonary complications of acute pancreatitis which make a significant contribution to the morbidity and mortality of the condition. The pathophysiology and management guidelines are given for each and approaches towards better treatment in the future are discussed.

The effect of relative humidity on mouse allergen levels in an environmentally controlled mouse room

To determine the effect of humidity on the levels of the mouse allergen Mus m 1, an experimental animal room was constructed to control environmental variables. The sex, strain, age, and number of mice was constant in the room, so that the average daily production of Mus m 1 would not vary greatly. Six different levels of relative humidity from 15% to 65% were maintained for a minimum of a week each. Daily collections of airborne particulates were eluted from filters and Mus m 1 content measured by immunological assay. Increasing relative humidity caused a decrease in Mus m 1 levels from a high of 3 ng/m3 at 15% humidity to a low of 0.5 ng/m3 at 65% humidity. Thus, reduction of airborne allergen levels can be achieved by careful attention to humidity control, especially during the winter heating season when humidity levels may be low. This experimental room can be used to measure the effect of other variables such as ventilation rate, caging, bedding, and work practices on the levels of mouse allergen in an animal facility.

MR and proton spectroscopy of white matter disease induced by high-dose chemotherapy with bone marrow transplant in advanced breast carcinoma

PURPOSE

To determine whether the MR-detectable white matter changes associated with high-dose chemotherapy and bone marrow transplant in patients with advanced breast carcinoma are accompanied by neurochemical disturbances detectable by proton MR spectroscopy.

METHODS

MR studies were obtained in 13 patients, and single-voxel proton MR spectra were acquired in vivo in 12 of these 13 for comparison with 13 age- and sex-matched control subjects.

RESULTS

Considerable white matter change determined with MR was found in 10 of 13 patients with volume white matter change ranging from 1 to 153 cm3 (mean, 49 cm3; SD, 50 cm3). Single-voxel spectra successfully acquired in 12 patients revealed no significant difference in patients compared with control subjects for the spectral ratios N-acetyl aspartate to creatine or N-acetyl aspartate to choline at either short or long echo times (30 and 136 milliseconds).

CONCLUSION

Extensive, late-stage white matter change induced by high-dose chemotherapy is not accompanied by measurable disturbances in the putative neuronal marker N-acetyl aspartate, suggesting that chemotherapy-induced white matter disease is predominantly a water space and possibly an extraneuronal process rather than a primary neuronal (axonal) disease. The MR spectroscopic examination, accomplished at the time of the MR imaging examination, complements the MR imaging study by increasing the specificity of the MR-based clinical evaluation.

Effect of age and presence of perches during rearing on tonic immobility fear reactions of broiler breeder pullets

Broiler breeders were housed in pens in an all-litter house with an 8-h photoperiod from hatching to 20 wk of age. They were reared either in the presence or absence of perches (7 cm per bird) and on either a 14% or a 17% CP diet. The duration of the tonic immobility (TI) fear response was measured in 15- and in 20-wk-old birds; each pullet was tested individually and once only. There was an apparent age-related increase in the duration of TI, which was attenuated by the provision of perches during rearing. The results are discussed in terms of maturational and environmental influences on the development and alleviation of fear.

Restraint, fear, and distress in Japanese quail genetically selected for long or short tonic immobility reactions

Japanese quail genetically selected for long (LTI) rather than short (STI) tonic immobility reactions showed more pronounced overt fear-responses in a number of putatively frightening situations. Greater fear has also been found in Japanese quail selected, in an independent program, for exaggerated (HS, high stress) rather than reduced (LS, low stress) plasma corticosterone response to brief mechanical restraint. The present study examined tonic immobility (TI) and adrenocortical responses in male and female quail of the LTI, STI and CON (control) lines which had either remained undisturbed or had been briefly exposed to a mechanical restraint stressor similar to that used for selection of the HS and LS lines. Behavioral strategies during restraint differed across lines, i.e., struggling followed the pattern STI > CON > LTI. The LTI quail showed more pronounced TI reactions than did CON and STI birds. Mechanical restraint prolonged subsequent TI responses and markedly elevated plasma corticosterone concentrations in all lines, but there were no line x treatment interactions. The results are discussed in terms of the parallels between the four selected lines and of the likelihood that the independent selection programs may have affected the same intervening variable.

Future strategies for the treatment of advanced epithelial ovarian cancer using high-dose chemotherapy and autologous bone marrow support

The response and long-term disease-free survival rates with standard-dose salvage chemotherapy for advanced ovarian cancer are commonly reported to be less than 20 and 10%, respectively. More than 200 women with advanced, refractory, ovarian cancer have received high-dose chemotherapy regimens with autologous bone marrow support (ABMS) for their disease. A feature of the vast majority of the studies is the strikingly high response rates of 70-82% achieved when marrow-supported intensive therapy is administered to women with refractory ovarian cancer. Applying such high-dose therapy earlier in the disease course when the tumors are less resistant will likely produce durable antitumor effects. To further evaluate the effectiveness of high-dose therapy, the Southwest Oncology Group (SWOG) has initiated a phase II study for stage III/IV ovarian cancer with residual disease (microscopic up to 3 cm) following one cisplatin- or carboplatin-based induction regimen (SWOG 9106). Patients will be randomized to receive one of two high-dose regimens with ABMS: cyclophosphamide, cisplatin, and thiotepa or cyclophosphamide, carboplatin, and mitoxantrone. This initial trial is a feasibility study to evaluate whether such high-dose regimens can be given in a cooperative group setting to the ovarian cancer patient population. If the trial is successfully completed, one of the two regimens will be chosen (based on lesser toxicity) to use in a phase III randomized trial of high-dose therapy and ABMS versus standard therapy for high-risk ovarian cancer patients.

White matter changes in patients with breast cancer treated with high-dose chemotherapy and autologous bone marrow support

PURPOSE

To study MR changes in the white matter of the brain in patients with breast cancer treated with a widely used protocol of high-dose chemotherapy and autologous bone marrow support.

METHODS

Thirteen patients with high-risk stage II or stage IV breast cancer treated with high-dose cyclophosphamide, cisplatin, carmustine, and bone marrow support underwent posttransplant MR examination of the brain. Serial posttransplant MR examinations were performed in 5 of the 13 patients and single MR examinations in 8. The severity of the white matter change was evaluated by two neuroradiologists and rated mild, moderate, or severe.

RESULTS

In 9 of the 13 patients, central and peripheral cerebral white matter changes were observed. Four patients had severe changes, extending from the ependyma of the lateral ventricles to the gyri. An additional 4 patients had moderate white matter change at the last observation. One had mild change, and 4 had no white matter change. In all patients, there was sparing of inferior frontal, posterior inferior occipital, and anterior temporal lobes, and of the centrosylvian brain.

CONCLUSIONS

White matter change occurred in patients treated with a high-dose chemotherapy and bone marrow support protocol. Most of the changes, and the more severe ones, occurred 5 or more months after the transplants. There was no apparent relationship between these changes and central nervous system function. Because of the increased longevity with this treatment, it is important to appreciate these white matter changes, recognizing however that their expression may be subclinical.

Fear of humans in Japanese quail selected for low or high adrenocortical response

Behavioral reactions to a nearby human were recorded in male Japanese quail of two lines selected for reduced (LS; low stress) or exaggerated (HS; high stress) plasma corticosterone (B) response to brief mechanical immobilization. Their adrenocortical responses to one of three treatments were then examined. These were: no human disturbance (undisturbed controls, CON), capture and return to the home cage before recapture and bleeding after 5 min (CR), or capture and manual restraint for 5 min before blood sampling (CREST). Quail of the HS line showed more fear-related behavior (crouching, escape) and avoidance of the experimenter than did their LS counterparts. Plasma B concentrations were markedly elevated following each capture treatment (CREST > CR) and the response appeared to be more pronounced in quail of the HS than the LS line. These findings indicate that HS quail perceived human contact to be more aversive than did those of the LS line. Avoidance scores and the adrenocortical responses to capture were positively correlated within individual birds. Therefore, simple behavioral tests of fear may have predictive value concerning physiological responsiveness to stressful stimulation.

Efficacy of 250 mg trospectomycin sulfate i.m. vs. 250 mg ceftriaxone i.m. for treatment of uncomplicated gonorrhea

BACKGROUND AND OBJECTIVES

Due to the steadily progressive development of resistance to the drugs used for treatment, Neisseria gonorrhoeae remains a medical concern. Trospectomycin sulfate is a 6' propyl analogue of spectinomycin with potent activity against penicillin sensitive and resistant strains of N. gonorrhoeae.

GOAL OF THIS STUDY

To compare the efficacy of 250 mg trospectomycin sulfate i.m. versus 250 mg ceftriaxone i.m. for single dose therapy for men and women with uncomplicated gonorrhea.

STUDY DESIGN

Dual-center, randomized comparative trial.

RESULTS

Among evaluable male patients with urethral gonorrhea, 36 of 40 (90%, 95% confidence interval [95%CI] 76%-97%) who were treated with trospectomycin sulfate were cured, and 22 of 22 patients (100%, [85%-100%]) treated with ceftriaxone were cured. Among evaluable female patients with cervical gonorrhea all were cured following trospectomycin sulfate (23 of 23) and following ceftriaxone therapy (13 of 13). The cure rates for pharyngeal gonorrhea were 67% (8 of 12 patients, 35%-90%) for trospectomycin sulfate therapy, and 100% (2 of 2) with ceftriaxone therapy.

CONCLUSIONS

Trospectomycin sulfate, 250 mg i.m., is effective, and well tolerated. However, for treatment of uncomplicated genital and pharyngeal gonorrhea, it is not as reliable for therapy as other recommended regimens.

A prospective population based study of gender differential in mortality from cardiovascular disease and "all causes" in asymptomatic hyperglycaemics

There have been few prospective epidemiological studies of asymptomatic hyperglycaemia as a risk factor for cardiovascular disease and all causes mortality in women. Gender-specific all causes, cardiovascular disease (CVD), ischaemic heart disease (IHD) and stroke mortality rates and relative risks for asymptomatic hyperglycaemics (top 5%) have been compared to normoglycaemics (bottom 95%) during a mean follow-up of 11.6 years (range 10-14) among 4696 men and 5714 women aged 45-64 at entry in the west of Scotland. Univariate analysis showed that asymptomatic hyperglycaemia was associated with increased risk of all causes, CVD, IHD and stroke mortality in both genders. The degree of this association was greater in women than in men. Using multiple logistic regression (MLR) analysis to take into account differences in age, systolic (SBP) and diastolic blood pressure (DBP), serum cholesterol, body mass index (BMI), and cigarette smoking, high causal blood glucose level was still a significant risk factor for CVD mortality in both genders. It was also a significant risk factor for all causes, IHD and stroke mortality in women but not in men. This study shows that to a lesser degree asymptomatic hyperglycaemia shows the same gender differentials in risk of mortality as have been demonstrated amongst known diabetics.

High-dose therapy with autologous bone marrow transplantation for the treatment of solid tumors

Over the past decade, high-dose chemotherapy followed by autologous bone marrow support (ABMS) has been employed with increasing frequency to treat patients with a variety of solid tumors. This paper explores the rationale and relevant clinical data for the use of this approach to treat patients with breast and ovarian cancer for the solid tumors of which ABMS is most commonly employed.