Additional experience with empiric radiotherapy for presumed human immunodeficiency virus-associated primary central nervous system lymphoma

BACKGROUND

In light of the steadily improving capability to treat opportunistic infections, the authors reviewed their recent experience with short course empiric radiotherapy for the treatment of human immunodeficiency virus (HIV)-associated presumed central nervous system (CNS) lymphoma.

METHODS

Medical records were reviewed of 32 previously unreported HIV-infected patients who had computed tomography and/or magnetic resonance imaging findings consistent with lymphoma, whose lesions had failed to respond to antitoxoplasmosis therapy and therefore subsequently treated with empiric radiotherapy to the cranium and meninges, nearly always 3000 cGy in 10 fractions.

RESULTS

The majority of patients were in poor general condition (median Karnofsky score = 50) when radiotherapy was initiated. Fifty percent improved during or after radiation. Median survival was 2.1 months.

CONCLUSIONS

Despite progress made in the past several years in the treatment of opportunistic infections and brief clinical response to radiotherapy, patients with acquired immunodeficiency syndrome who have a presumed diagnosis of CNS lymphoma continue to have extremely poor survival. Early biopsy in patients with lesions that fail to respond to empiric antitoxoplasmosis treatment or with lesions radiographically most consistent with lymphoma may improve outcome.

Detection of foreign bodies in the hand

Fresh cadaver hands were used to compare the ability of routine x-ray, xeroradiography, computerized tomography, and magnetic resonance imaging to identify a variety of foreign bodies including glass, gravel, plastic, and wood in the soft tissue of the hand. All types of glass were easily seen by all imaging methods. Gravel foreign bodies were visible with all methods except magnetic resonance imaging where ferromagnetic streak artifacts obscured visualization. Plastic, although not seen by routine x-ray or xeroradiography, was faintly seen by computed tomography, and easily detected by magnetic resonance imaging. Wooden foreign bodies, especially when wet, were seen only by computed tomography and magnetic resonance imaging. Xeroradiography had no benefit over plain films in identifying foreign bodies and should be discarded in favor of computed tomography or magnetic resonance imaging when plain films are unrevealing. A practical guide for identifying foreign bodies in the soft tissues of the hand is presented.

Unexplained excess risk of bladder cancer in men

In nearly all populations studied, the risk of bladder cancer is two to four times as great in men as in women. We estimated what the gender-specific incidence rates would be in the absence of exposure to known carcinogenic factors. The data used were obtained from interviews with 2,806 white individuals with bladder cancer and 5,258 white controls in the National Bladder Cancer Study and from incidence data for 1978 from the National Cancer Institute Surveillance, Epidemiology, and End Results Program. The total age-adjusted incidence of bladder cancer was 27.5 cases per 100,000 person-years for men and 7.0 for women, yielding a ratio of 3.9. Even in the absence of exposure to cigarettes, occupational hazards, or urinary tract infection, the gender-related risk persisted; the incidence of bladder cancer was 11.0 in men and 4.1 in women, yielding a ratio of 2.7. Possible explanations for the excessive risk in men include environmental and dietary exposures not yet identified and innate sexual characteristics such as anatomic differences, urination habits, or hormonal factors.

A pharmaceutical manufacturer's perspective on reporting adverse drug experiences

The important cooperative roles that pharmacists and manufacturers can play in submitting and evaluating adverse drug experience (ADE) reports are described. Hoffmann-La Roche receives approximately 100,000 drug-related reports and inquiries annually. These reports must be evaluated, and ADEs must be distinguished from anecdotal reports, queries, lack-of-effectiveness reports, or product complaints. An ADE report should include information about (1) the patient, including history and demographics; (2) the drug, including dosage and concomitant medications; and (3) the onset, resolution, and outcome of the event, which may be a reaction, an abnormal laboratory value, or a finding that the drug did not work as expected. Complete and accurate reports are more valuable, but reports of all potential ADEs should be submitted. The evaluation process that occurs at Hoffmann-La Roche when an ADE report is received is described. Possible outcomes include reports submitted to FDA, site visits (if clusters of reactions are reported), and introduction of new product labeling with stronger warnings. Pharmacists and other healthcare professionals should report ADEs to manufactures as well as to FDA.

Mammographic wire localization in diagnosis and treatment of occult carcinoma of breast

The use of screening mammography has increased dramatically, leading to the discovery of suspicious, nonpalpable mammary lesions. Mammographic wire localization (MWL) is currently being used to facilitate the biopsy of these lesions. We reviewed 104 patients undergoing 106 biopsies after MWL during a 14 month period to determine the usefulness of MWL. The average age of the patients was 58 +/- 14 years, with a range of 38 to 83 years. Abnormal mammographic findings consisted of microcalcifications (48 per cent) or mass and density (43 per cent), or both (9 per cent). Lesions of the right side (55 per cent) and upper and outer quadrant (49 per cent) were predominant. An average of 1.4 (range of one to four) specimens taken at biopsy per patient were required to remove the lesion. The mean duration of the biopsy was 34 minutes, with a range of ten to 75 minutes, and the mean total time in the operating room was 63 (range 31 to 115) minutes. The average cost of the procedure did not differ significantly between local and general anesthesia ($1,030 versus $1,142, respectively). Pathologic findings included fibrocystic disease (77 per cent), carcinoma (12 per cent) and fibroadenoma (7 per cent). Normal mammary tissue was found in 4 per cent of the biopsies. Five of the 13 carcinomas were in situ and seven were either in situ (five) or microinvasive only (two); only six lesions were frankly invasive. Ten patients were treated with modified radical mastectomy while three had segmental resection. All patients had in situ or Stage I carcinoma. MWL effectively localized nonpalpable mammary lesions and allowed accurate diagnosis and treatment of early stage carcinoma of the breast.

Synergistic use of direct manipulation and natural language

This paper shows how the integration of natural language with direct manipulation produces a multimodal interface that overcomes limitations of these techniques when used separately. Natural language helps direct manipulation in being able to specify objects and actions by description, while direct manipulation enables users to learn which objects and actions are available in the system. Furthermore, graphical rendering and manipulation of context provides a partial solution to difficult problems of natural language anaphora.

The partial dependency of human prostatic growth factor on steroid hormones in stimulating thymidine incorporation into DNA

Growth factors stimulating DNA synthesis in mouse 3T3, human DU145, and LNCaP were partially purified from human benign hyperplastic and cancerous prostates. These factors have a high affinity for heparin sepharose and are eluted from the heparin-sepharose column, at 1.2 to 1.9 M NaCl. In normal prostates, the high affinity human prostatic growth factor occurred only in extremely small amounts. The high affinity growth factors stimulate DNA synthesis in 3T3, DU145, and LNCaP. Stimulation was significantly enhanced by 5 alpha-dihydrotestosterone and 17 beta-estradiol in the androgen sensitive LNCaP cell line. SDS-PAGE and isoelectrofocusing confirmed that the partially purified factors had a molecular weight of 18 kDa and acidic isoelectric points of pH 3.6 and 4.7.

Priapism: review of 34 cases

One hundred ninety-seven cases of priapism have been recorded in the medical files of Charity Hospital Louisiana in New Orleans from 1938-1982. One hundred seventy-two adults and 25 children were registered in this series. Ninety-three per cent of the patients with priapism were black, and 86 patients of this group underwent 93 surgical procedures. The cases of 34 patients treated between July 1, 1981, and December 31, 1982, were thoroughly reviewed. Sixteen patients had a previous history of priapism. Average delay between onset of symptoms and presentation to the hospital for treatment was thirty hours. Sickle cell screens were obtained in 28 patients and were positive in 17. Twenty-nine patients were initially treated conservatively, with 17 priapisms eventually resolving, but the remaining 12 patients required surgical intervention. Overall, 50 per cent of the 34 patients had surgery. All of the surgical cases resolved satisfactorily with the Winter procedure. Complications with this procedure were uncommon, but postoperative bandaging was the chief cause of morbidity. Follow-up for at least six months revealed comparable sexual potency (80-83%) in either conservatively or surgically managed patients.

Urinary tract infection and risk of bladder cancer

In an epidemiologic study of 2982 bladder carcinoma patients and 5782 population controls from 10 geographic areas of the United States, the role of urinary tract infection and inflammation in the etiology of this neoplasm was evaluated. A history of urinary tract infection significantly elevated the risk of bladder cancer, particularly in individuals who reported three or more infections (relative risk (RR) = 2.0). Significantly increased bladder cancer risk was also found for bladder stones (RR = 1.8), while kidney stones showed no relation. A history of three or more urinary tract infections was strongly related to squamous cell carcinoma in particular (RR = 4.8).

The effects of intonation on infant attention: the role of the rising intonation contour

The study was designed to investigate 2-month-old infant preferential attention to a feature found to be characteristic of mothers' speech to their infants. A modified infant-control auditory preference paradigm was employed to assess infants' differential attention to synthetically generated and naturally produced rising and falling intonation contours. Analysis of these data revealed that the infants attended more to the rising naturally produced intonation contour. A reverse pattern of greater attention to the falling contour was found with the synthetically generated stimuli. In addition, inspection of the results permitted the conclusion that the infant-control preference paradigm was a viable method for assessing the 2-month-old infant's preferential attention to auditory stimuli. The results are discussed in terms of their relevance to the study of the infant's developing language reception abilities.

Use of hair dyes and risk of bladder cancer

The relation between use of hair dyes and risk of bladder cancer was assessed using data from a case-control study of bladder cancer. Incident cases (2982) and general population controls (5782) were interviewed. The overall estimate of relative risk of bladder cancer for users of hair dyes was 1.0 (95%) confidence interval, 0.9 to 1.2) compared to nonusers. No consistent pattern of association was detected between bladder cancer risk and various indices of timing or intensity of exposure to hair dyes. Various explanations of the lack of association are discussed.

Epidemiologic survey of bladder cancer in greater New Orleans

Primary ancestry of the patients and controls in this study was not statistically different but the Jewish population had a significantly increased incidence of bladder cancer. Over-all, a significantly greater number of patients smoked filtered cigarettes, began drinking artificially sweetened beverages at an earlier age, drank artificially sweetened beverages for a greater number of years, consumed a greater number of glasses of artificially sweetened beverages weekly and related a history of urinary tract infections. A significantly increased incidence of bladder cancer was noted in individuals employed by certain types of companies, by certain job titles and by certain job material handled. Analysis of the data failed to show any significant difference in years of consumption of coffee, amount of various types of coffee or tea consumed, consumption of various nonalcoholic and alcoholic beverages, including source of drinking water, use of hair dye, incidence of diabetes mellitus, family history of urinary cancer and a history of pelvic irradiation or bladder stones.

Complications of ureteroileal conduit with radical cystectomy: review of 336 cases

Review of complications of the ileal conduit in patients undergoing radical cystectomy for bladder cancer showed a statistically significant increase in renal calculi, ureteral obstruction, acute and chronic pyelonephritis and deterioration of renal function by 60 months postoperatively. Ureteroileal fistulas occurred in 3.3 per cent, stomal stenosis in 5.1 per cent, intestinal fistulas in 5.4 per cent, severe intestinal obstruction in 6 per cent and abdominal wound infection or dehiscence in 20.2 per cent of the cases. The over-all operative mortality was 13.7 per cent, with 8 per cent of the deaths attributed to complications from the ileal conduit. Comparison of colonic conduits to ileal conduits as a means of urinary diversion with radical cystectomy for bladder cancer demonstrated no convincing evidence of its superiority.

Flutamide therapy for carcinoma of the prostate

In our three-year experience with the use of flutamide for the treatment of carcinoma of the prostate, 20 patients with previously untreated stage D carcinoma of the prostate were enrolled in a 12-week double-blind study. Seven patients received 1.5 gm of flutamide daily, seven patients received 0.75 gm of flutamide daily, and six patients received 1.0 mg of diethylstilbestrol daily. Two patients receiving flutamide did not complete the 12-week study. Six patients receiving flutamide and three patients receiving diethylstilbestrol had objective evidence of improvement. Of the patients receiving flutamide, 50% were alive at one year, and 43% were alive at two years. Three of the original 14 patients started on flutamide are alive at 36, 33, and 24 months. In addition, we continued clinical evaluation of flutamide as an open study, enrolling six other patients (four with stage D and two with stage C carcinoma of the prostate). All except one of these patients had received previous hormonal therapy. At present, four are still being followed up at 13, 15, 20 and 24 months, demonstrating that flutamide can give positive results to some patients whose condition is deteriorating despite diethylstilbestrol therapy.

Nitrofurantoin, sulfamethizole and cephalexin urinary concentration in unequally functioning pyelonephritic kidneys

Nitrofurantoin, sulfamethizole and cephalexin peak urinary drug concentrations were studied in patients and non-human primates with unequally functioning pyelonephritic kidneys. The peak urinary drug concentration of the poorly functioning kidney in comparison to the better kidney was greater than its percentage relative blood flow or creatinine clearance but variable in its relationship to creatinine concentration, osmolality and sodium concentration. Although for each unit of creatinine clearance the poorly functioning kidney had a higher peak urinary drug concentration than the better functioning kidney, for each kidney the peak urinary drug concentration seemed to be directly proportional to the creatinine clearance, the drug dosage and the renal mechanisms of drug excretion. Nitrofurantoin in the usual recommended dosage did not reach minimal inhibitory urinary drug concentration below a unilateral creatinine clearance of 20 ml. per minute. Whereas, sulfamethizole and cephalexin reached peak urinary drug concentrations greater than the minimal inhibitory concentration at the lowest studied unilateral creatinine clearance of 4 and 11 ml. per minute, respectively.