An open multicentre comparative study of the efficacy, safety and tolerance of fluconazole and itraconazole in the treatment of cancer patients with oropharyngeal candidiasis

Oropharyngeal candidiasis is a frequent infection in cancer patients who receive cytotoxic drugs. In this study, the efficacy, safety and tolerance of fluconazole and itraconazole were compared in non-neutropenic cancer patients with oropharyngeal candidiasis. Of 279 patients who were randomised between the two treatment groups, 252 patients were considered to be eligible (126 in each group). The clinical cure rate was 74% for fluconazole and 62% for itraconazole (P=0.04, 95% Confidence Interval (CI): 0.5-23.3%). The mycological cure rate was 80% for fluconazole and 68% for itraconazole (P=0.03, 95% CI: 1.2-22.6%). The safety and tolerance profile of both drugs were comparable. This study has shown that in patients with cancer and oropharyngeal candidiasis, fluconazole has a significantly better clinical and mycological cure rate compared with itraconazole.

Multiple prepubertal growth spurts in children of the Fels Longitudinal Study: comparison with results from the Edinburgh Growth Study

BACKGROUND

Contrary to the common assumption of a single midspurt, the heights of children measured at 6-monthly intervals in the Edinburgh Growth Study appear to show multiple prepubertal growth spurts of 2-3 years duration. The Edinburgh study relied on inspection of empirical accelerations to identify the spurts.

AIM

The work aimed to study this phenomenon with velocity maxima and minima of kernel-smoothed heights in the more extensive 6-monthly data from the Fels Longitudinal Growth Study. Velocity maxima and minima for two sets of triplets in the Fels data were also examined for concordance of prepubertal growth patterns in the identical and fraternal members.

SUBJECTS

Subjects were 167 boys and 152 girls with complete or nearly complete 6-monthly height measurements from 2 to 18 years of age.

METHODS

Because the number of spurts detected by kernel smoothing was found to be sensitive to the bandwidth of the smooth, a preliminary study to determine the best choice of bandwidth was carried out. With the chosen width, 2.0 years, the number and locations of up to five maxima and preceding minima of growth velocity were determined for each case. Statistics for the distribution of age of occurrence, height, and velocity at each turning point were computed for cases having no or one to four prepubertal growth spurts.

RESULTS

Good agreement with the Edinburgh results was found. Numbers of prepubertal spurts varied from zero to four in both boys and girls. Later maturing children tended to have more spurts. Among the Fels triplets, the patterns of prepubertal growth of the identical members of each set did not appear more concordant with each other than with the fraternal member.

CONCLUSIONS

The finding of similar appearing prepubertal multiple growth spurts over 2-3-year intervals by different analytical methods in two widely separated populations strongly supports the generality of this phenomenon. The timing and duration of the spurts do not suggest, however, a systematic origin. Rather, they appear to be episodes of random change in rate of growth prior to the onset of adolescence, under the constraint of the genetically determined growth potential.

Vancomycin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy

This prospective, double-blind trial assessed whether the addition of a glycopeptide would be able to reduce the time to defervescence in neutropenic patients with cancer who had persistent fever 48-60 h after the initiation of empirical piperacillin-tazobactam monotherapy. Of 763 eligible patients, 165 with persistent fever were randomized to receive piperacillin-tazobactam therapy plus either vancomycin therapy or placebo. Defervescence was observed in 82 (95%) of 86 patients in the vancomycin group and in 73 (92%) of 79 patients in the placebo group (P=.52). The distributions of the time to defervescence were not statistically significant between the 2 groups (estimated hazard ratio, 1.03; 95% confidence interval, 0.75-1.43; P=.75). The number of additional episodes of gram-positive bacteremia and the percentage of patients for whom amphotericin B was empirically added to their therapy regimen were also similar in both groups. This study failed to demonstrate that the empirical addition of vancomycin therapy to the treatment regimen is of benefit to persistently febrile neutropenic patients with cancer.

Molecular cytogenetic analysis of 10;11 rearrangements in acute myeloid leukemia

MLLT10 (previously called AF10) is a moderately common MLL fusion partner predominantly occurring in acute monoblastic leukemia (AML-M5). 10;11 rearrangements require at least three breaks in order to generate an in-frame MLL-MLLT10 fusion as a result of the opposite orientations of both genes on the respective chromosome arms. In this study, we describe a detailed molecular cytogenetic analysis of MLL-MLLT10 positive 10;11 rearrangements in two patients. We observed an as yet unreported chromosomal mechanism with at least four breakpoints, leading to MLL-MLLT10 gene fusion in a 24-year-old male. An inversion of 11q13-q23 with a breakpoint in the MLL gene was followed by an additional break 3' of MLL prior to insertion of the 11q segment into MLLT10. In a second patient, a 37-year-old male with AML-M5b, molecular cytogenetic analysis of an apparent 10;11 reciprocal translocation showed an intrachromosomal inversion of 3'MLLT10followed by a reciprocal translocation between 10p12 and 11q23. Review of the literature showed that all cases were the result of an inversion of either 10p or 11q followed by translocation 10p;11q or insertion of the inverted segment into MLLT10 or MLL.

Febrile neutropenia in allogeneic transplantation

Infections post allogeneic bone marrow transplant (BMT) are a major problem. Post BMT, three periods with infectious complications are discerned: pre-engraftment and early recovery, mid recovery and late recovery. In the first period mucosal damage and neutropenia are the major host defence deficits. Bacterial infections with Gram-positive and Gram-negative organisms, and fungal infections are seen in this period. In the mid recovery phase graft versus host and its treatment contribute to diminished host defences. Viral infections and fungal infections predominate. In the late recovery phase chronic graft versus host reaction impairs the monocyte macrophage function and CD4 counts are low. In this phase patients are at risk for infections with encapsulated bacteria, fungi, Pneumocystis carinii and Toxoplasma. Strategies for the management of febrile neutropenia are similar to those in 'high risk' neutropenic patients: immediate broad spectrum I.V. antibiotics (3rd or 4th generation cephalosporin+/-aminoglycoside or carbapenem) and early amphothericin B (lipid formulation) if fever persists beyond 5 days despite adequate I.V. antibiotics. Cytomegalovirus (CMV) prophylaxis or better preemptive therapy guided by viraemia is accepted practice. Prevention of infection measures, antimicrobial, antifungal and viral prophylaxis are generally accepted strategies but would differ from center to center. The post transplant infection history will change with different transplant techniques and evolving prophylactic and preemptive treatments.

Itraconazole oral solution for primary prophylaxis of fungal infections in patients with hematological malignancy and profound neutropenia: a randomized, double-blind, double-placebo, multicenter trial comparing itraconazole and amphotericin B

Systemic and superficial fungal infections are a major problem among immunocompromised patients with hematological malignancy. A double-blind, double-placebo, randomized, multicenter trial was performed to compare the efficacy and safety of itraconazole oral solution (2.5 mg/kg of body weight twice a day) with amphotericin B capsules (500 mg orally four times a day) for prophylaxis of systemic and superficial fungal infection. Prophylactic treatment was initiated on the first day of chemotherapy and was continued until the end of the neutropenic period (>0.5 x 10(9) neutrophils/liter) or up to a maximum of 3 days following the end of neutropenia, unless a systemic fungal infection was documented or suspected. The maximum treatment duration was 56 days. In the intent-to-treat population, invasive aspergillosis was noted in 5 (1.8%) of the 281 patients assigned to itraconazole oral solution and in 9 (3.3%) of the 276 patients assigned to oral amphotericin B; of these, 1 and 4 patients died, respectively. Proven systemic fungal infection (including invasive aspergillosis) occurred in 8 patients (2.8%) who received itraconazole, compared with 13 (4.7%) who received oral amphotericin B. Itraconazole significantly reduced the incidence of superficial fungal infections as compared to oral amphotericin B (2 [1%] versus 13 [5%]; P = 0.004). Although the incidences of suspected fungal infection (including fever of unknown origin) were not different between the groups, fewer patients were administered intravenous systemic antifungals (mainly intravenous amphotericin B) in the group receiving itraconazole than in the group receiving oral amphotericin B (114 [41%] versus 132 [48%]; P = 0.066). Adequate plasma itraconazole levels were achieved in about 80% of the patients from 1 week after the start of treatment. In both groups, the trial medication was safe and well tolerated. Prophylactic administration of itraconazole oral solution significantly reduces superficial fungal infection in patients with hematological malignancies and neutropenia. The incidence of proven systemic fungal infections, the number of deaths due to deep fungal infections, and the use of systemic antifungals tended to be lower in the itraconazole-treated group than in the amphotericin B-treated group, without statistical significance. Itraconazole oral solution is a broad-spectrum systemic antifungal agent with prophylactic activity in neutropenic patients, especially for those at high risk of prolonged neutropenia.

Interpretation of a full-information item-level factor analysis of the MMPI-2: normative sampling and nonpathognomonic descriptors

An exploratory item-level full-information factor analysis was performed on the normative sample for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). This method of factor analysis, developed by Schilling and Bock (Bock & Schilling, 1997) and based on item response theory, works directly with the response patterns and avoids the artifacts associated with phi coefficients and tetrachoric coefficients. Promax rotation of the factor solution organizes the clinical scale items into 10 factors that we labeled Distrust, Self-Doubt, Fitness, Serenity, Rebelliousness, Instrumentality, Irritability, Artistry, Sociability, and Self-Reliance. A comparison was made to the results of Johnson, Butcher, Null, and Johnson (1984), who performed a principal-component analysis on an item set of 550 items from the previous version of the MMPI (Hathaway & McKinley, 1943). Along with version changes and sampling differences, the essential differences between Johnson et al.'s results and ours may be attributed to differences between the Schilling and Bock method, which uses all information in the item responses, and the principal-component analysis, which uses the partial information contained in pairwise correlation coefficients. This study included 518 of the complete 567 items of the MMPI-2, versus Johnson et al.'s retention of 309 of the initially included 550 items of the previous MMPI. The full-information analysis retained all 518 initially included items and more evenly distributed the items over the 10 resulting factors, all sharply defined by their highest loading items and easy to interpret. Sampling effects and factor label considerations are discussed, along with recommendations for research that would validate the clinical utility of the implied scales for describing normal personality profiles. The full-information procedure provides for Bayes estimation of scores on these scales.

Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy. International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer

BACKGROUND

Intravenously administered antimicrobial agents have been the standard choice for the empirical management of fever in patients with cancer and granulocytopenia. If orally administered empirical therapy is as effective as intravenous therapy, it would offer advantages such as improved quality of life and lower cost.

METHODS

In a prospective, open-label, multicenter trial, we randomly assigned febrile patients with cancer who had granulocytopenia that was expected to resolve within 10 days to receive empirical therapy with either oral ciprofloxacin (750 mg twice daily) plus amoxicillin-clavulanate (625 mg three times daily) or standard daily doses of intravenous ceftriaxone plus amikacin. All patients were hospitalized until their fever resolved. The primary objective of the study was to determine whether there was equivalence between the regimens, defined as an absolute difference in the rates of success of 10 percent or less.

RESULTS

Equivalence was demonstrated at the second interim analysis, and the trial was terminated after the enrollment of 353 patients. In the analysis of the 312 patients who were treated according to the protocol and who could be evaluated, treatment was successful in 86 percent of the patients in the oral-therapy group (95 percent confidence interval, 80 to 91 percent) and 84 percent of those in the intravenous-therapy group (95 percent confidence interval, 78 to 90 percent; P=0.02). The results were similar in the intention-to-treat analysis (80 percent and 77 percent, respectively; P=0.03), as were the duration of fever, the time to a change in the regimen, the reasons for such a change, the duration of therapy, and survival. The types of adverse events differed slightly between the groups but were similar in frequency.

CONCLUSIONS

In low-risk patients with cancer who have fever and granulocytopenia, oral therapy with ciprofloxacin plus amoxicillin-clavulanate is as effective as intravenous therapy.

Maintenance of remission with human recombinant interferon alfa-2a in patients with stages III and IV low-grade malignant non-Hodgkin's lymphoma. European Organization for Research and Treatment of Cancer Lymphoma Cooperative Group

PURPOSE

Interferon alfa has shown significant activity in patients with low-grade malignant non-Hodgkin's lymphoma (NHL). In 1985, we initiated a prospective randomized study in which the potential benefit of interferon alfa given as maintenance treatment was investigated after tumor load reduction was achieved with chemoradiotherapy in patients with advanced low-grade malignant non-Hodgkin's lymphoma.

PATIENTS AND METHODS

The study involved 347 patients with stage III or IV disease, 315 satisfying the eligibility criteria. All were treated with a regimen of cyclophosphamide, vincristine, and prednisone (CVP) given every 3 weeks for eight cycles. Thereafter, patients were eligible for iceberg irradiation. Finally, all patients were completely restaged, and responding and stable-disease patients were then randomized, 122 to interferon alfa-2a maintenance, 3 million U three times weekly for 1 year; and 120 to no further treatment.

RESULTS

Seventy-nine percent of the patients response to CVP, ie, 45% complete remissions (CR) and 34% partial remissions (PR). In the group of randomized patients, the response rate after CVP plus or minus radiotherapy was 90%. As compared with control patients, patients in the interferon (IFN) maintenance group had a tendency toward a prolonged time to progression (TTP) (median, 132 v 87 weeks; P = .054, adjusted for response to CVP). However, overall survival was similar in both groups. Interferon was well tolerated. The median dose of IFN actually received corresponded to 90% of the planned cumulative dose. The treatment had to be stopped because of toxicity in 16 patients (15% of the patients in whom IFN was started).

CONCLUSION

Interferon maintenance treatment in the phase of minimal residual disease of patients with advanced low-grade malignant NHL increased TTP at the borderline of statistical significance, without remarkable toxicity. However, overall survival was not influenced.

High-dimensional multivariate probit analysis

A computationally practical form of probit analysis for multiple response variables based on an assumed common factor model for the latent tolerances is proposed. Numerical integration over the factor space provides maximum likelihood estimation of the probit regression parameters and of the probabilities of response combinations under the model. The procedure is applied to five variables from the Pneumoconiosis Field Trial, two variables of which were previously analyzed by Ashford and Sowden (1970, Biometrics 26, 535-546).

Comparison of height acceleration curves in the Fels, Zurich, and Berkeley growth data

A new type of smoothing spline designed for nonparametric estimation of growth acceleration curves was applied to longitudinal measures of height from the Fels, Zurich, and Berkeley growth studies. Landmark features of the individual acceleration curves were located and examined for site effects and site by sex interaction. The curves in each group were structurally averaged by transforming the age scale of each child to align the landmarks with overall means. The modal shapes of the structural average curves were found to be highly similar in the three studies, although the relative number of children who conformed to the modal pattern differed among the studies. Significant site by sex interactions were found in the timing of the landmarks associated with the pubertal growth spurt and with the prepubertal 'midspurt'.

Practices for cytomegalovirus diagnosis, prophylaxis and treatment in allogeneic bone marrow transplant recipients: a report from the Working Party for Infectious Diseases of the EBMT

During the past few years major progress has been made in the diagnosis and therapy of CMV infection after allogeneic BMT. The aim of this survey was to investigate the use of diagnostic techniques, use of prophylaxis and the therapeutic strategies among members of the EBMT. Seventy centers from 20 countries responded to the survey. Sixty-seven centers (96%) routinely tried to diagnose CMV from the blood. Fifty-seven centers used standard or rapid isolation techniques. Thirty-seven centers used one of the newly developed techniques, antigenemia detection in leukocytes or PCR together with isolation, while 10 centers used one of these two techniques without standard isolation. Fifty-five centers regularly performed bronchoscopy and bronchoalveolar lavage on the suspicion of CMV pneumonia but only 12 centers required detection of CMV in specimens from the lavage or lungs as the indication to start therapy; 31 centers started therapy on symptoms of pneumonia combined with CMV detection from any site. Prophylaxis was used in 54 centers (84%). The most commonly used regimen was high-dose acyclovir which was used by 42 centers, while seven centers used ganciclovir. The strategy of early therapy was used by 53 centers (76%) and was most frequently based on detection of viremia or CMV antigen in the blood. CMV pneumonia was treated by a combination of ganciclovir and i.v. immunoglobulin by 64 centers, by foscarnet and immunoglobulin in 5 centers and by ganciclovir alone in 5 centers. CMV gastrointestinal disease was treated by antiviral therapy alone in 18 centers and by a combination of antiviral therapy and iv immunoglobulin in 46 centers.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased tumor necrosis factor alpha (TNF alpha), interleukin 1, and interleukin 6 (IL-6) levels in the plasma of stored platelet concentrates: relationship between TNF alpha and IL-6 levels and febrile transfusion reactions

Increased interleukin 6 (IL-6) levels were found in 8 of 12 platelet concentrates (PCs) after 3 days of storage and in 10 of 12 PCs after 5 and 7 days of storage. Most of the PCs with an increased IL-6 level also showed increased tumor necrosis factor alpha (TNF alpha) and interleukin 1 beta (IL-1 beta) levels. Levels of IL-6 increased by 3 log10 over the base level during storage. Increased levels were found when the PC white cell count exceeded 3 x 10(9) per L. A linear correlation was found among the levels of TNF alpha, IL-1 beta, IL-1 alpha, and IL-6 in the PCs (r > 0.885). Comparison of the TNF alpha, IL-1 beta, and IL-6 levels in samples taken at various storage times indicates that the increased levels are the result of an active synthesis and release of interleukins during storage. In a second part of the study, 45 transfusions of white cell-reduced PCs were studied. Six transfusions were complicated by a febrile reaction. These reactions were related to high levels of IL-6 and TNF alpha in the PCs (p < 0.0001). These cytokines are known as endogenous pyrogens. These findings indicate that transfusion reactions might be due to the intravenous administration of plasma with high cytokine levels and might not always result from an antigen-antibody reaction.

Reactions to platelet transfusion: the effect of the storage time of the concentrate

Random platelet concentrates were pooled and depleted of leucocytes by centrifugation immediately prior to transfusion. The incidence and severity of reactions to 570 leucocyte-poor platelet transfusions in 74 patients were studied. An overall transfusion reaction rate of 13.7% was observed. The reaction rate to platelets stored for less than 3 days (8.7%) was significantly different from the reaction rate to platelets stored for 3 days or more (17.6%). Minor reactions as well as moderate and severe reactions were more frequent in the latter group. As most of the white blood cells were removed prior to transfusion, it is suggested that the reactions result from the transfusion of pyrogenic and/or vasoactive substances accumulated in the plasma of the concentrate during storage.

[Optic neuritis in non-Hodgkin's lymphoma]

Optic neuropathy during non-Hodgkin lymphoma is a late central nervous system complication of unfavourable prognosis. It appears especially with involvement of the bone marrow. A normal cerebrospinal fluid, lack of any beneficial effect of the chemo-corticotherapy and absence of papilledema suggest paraneoplastic, or iatrogenic (radio and (or) chemotherapeutic) neuropathy with conclusive histopathological proof only at autopsy. More frequently, cerebrospinal fluid containing malignant cells, papilledema and a beneficial effect of the chemocortico-therapy suggests malignant infiltration of the optic nerve as occurs in our case. Optic neuropathy during non-Hodgkin lymphoma may exceptionally precede the systemic disease by several years. Early oculomotor involvement suggests meningeal malignant infiltration as found in meningeal carcinomatosis.

Large granular lymphocyte proliferative disease: 21 Belgian cases and review of the literature

We report the findings in 21 Belgian patients (12 males and 9 females, median age 61 years) with LGLPD. Symptoms at presentation included infection (n = 9), weight loss (n = 5), asthenia (n = 9), pruritus (n = 2) and arthralgia (n = 7). Four patients were asymptomatic. The main clinical findings were hepatomegaly (n = 5), splenomegaly (n = 8), lymph node enlargement (n = 3) and arthritis (n = 5). All patients had an increased LGL count associated with anemia (n = 12), neutropenia (n = 17), often less than 0.5.10(9)/L (n = 10) and thrombocytopenia (n = 6). Three patterns of lymphocyte surface markers were observed: CD3+CD4-8+ (14 patients), CD3+CD4-8+ (5 patients) and CD3+CD4+8- (1 patient). An abnormal karyotype was found in 2 patients. T-cell receptor gene was rearranged in all cases tested (9/9).

Age changes in adult stature: trend estimation from mixed longitudinal data

Although it is widely accepted that persons become shorter as they grow older, most estimates of the rate of decline are based largely on cross-sectional studies and are confounded by secular changes and individual variation. The present study uses a mixed series of longitudinal physical measurements, obtained by the Busselton Population Studies Group, for nearly the entire adult population of Busselton, Western Australia. All persons in the sample who had a minimum of three measures at 3-year intervals are included in our analysis, regardless of health. Random regressions analysis of the individual height and age data is used to estimate the expected rate of decline of stature with age. A significant sex difference was found, with females declining at a greater rate than males, particularly after the age of 40.

Pulmonary aspergillosis complicated by osteomyelitis

We report on a patient with aplastic anaemia and an invasive aspergillosis of the lung with subsequent osteomyelitis of the ribs. Diagnosis was made by puncture of the soft tissues and isolation of Aspergillus fumigatus. Treatment with amphotericin B induced renal function disturbances. It was successfully replaced by AmBisome. Healing occurred with recovery of the immunity of the patient. The literature on Aspergillus osteomyelitis is reviewed.

Cimetidine induced pancytopenia. Effect on human CFU-MIX colony formation

We describe a 26 year-old male with a pancytopenia possibly due to cimetidine. Using progenitor cell culture techniques we investigated the mechanism of this bone marrow toxicity. Our results show a cimetidine dose-dependent inhibition of normal human CFU-GM colony formation as described by Fitchen and Koeffler in 1980. No differences in growth inhibition were found between the patients' recovery marrow and the controls. Toxicity on normal human CFU-MIX colony formation was, however, far more pronounced. At concentrations as low as 5 micrograms/ml the numbers of CFU-MIX colonies were decreased by almost 20% and more than 30% in cultures of two normal bone marrow samples. A significant decrease in CFU-MIX colony size was measured even at therapeutic levels (0.5 micrograms/ml). No obvious decrease in CFU-GM colony size was noticed at low concentrations. Experiments with T-cell- and monocyte-depleted bone marrow samples gave similar results: a pronounced inhibition of the CFU-MIX colony formation at low concentrations of cimetidine whereas the CFU-GM formation was less affected. It is therefore very unlikely that Accessory cells play part in the cimetidine induced CFU-MIX inhibition. Our results suggest the existence of H2 histamine receptors on human CFU-MIX (= multipotent progenitor cell). Blocking these receptors prevents the multipotent progenitor cell from going into the DNA-synthesis phase of the cell cycle.

Bone marrow cultures and prognosis in primary myelodysplastic syndromes

Bone marrow cultures and survival time were studied in 39 patients with primary myelodysplastic syndromes. We divided the patients into two groups according to the CFU-GM numbers on day 10: type I with low colony (CFU-GM less than 30) and type II with normal to high colony formation (CFU-GM greater than or equal to 30). The median survival time was shorter for patients with an in vitro growth type II (5 months) than it was for patients with an in vitro growth type I (greater than 36 months). No relations was found between growth types and FAB-type, Bournemouth score or initial karyotype. The initial bone marrow blast percentage correlated well with the in vitro growth number.

Porphyric neuropathy and hereditary delta-aminolevulinic acid dehydratase deficiency in an adult

A man without a history of porphyric attacks developed a subacute motor neuropathy at the age of 63. At the same time the first signs of a myeloproliferative disorder were found. He had a homozygous deficiency of erythrocyte delta-aminolevulinic acid dehydratase (ALA-D) with autosomal recessive inheritance. Treatment with parenteral glucose and with hematin had a beneficial influence on the plasma ALA levels. The finding of a motor neuropathy with increased plasma levels of ALA but not of porphobilinogen (PBG) supports the potential role of ALA in the pathogenesis of porphyric neuropathy.

Karyotypic evidence for the leukemic involvement of the erythroblasts in erythroleukemia

With the use of a monoclonal anti-glycophorin A antibody and flow cytometric cell sorting, an erythroleukemic bone marrow sample was separated in highly purified erythroblast and myeloblast fractions. Similar karyotypic anomalies were found in both cell populations as in the unseparated bone marrow. This study confirms that acute nonlymphocytic leukemia can originate at the level of a multipotential hemopoietic stem cell.

Tonic, phasic and cortical arousal in Gilles de la Tourette's syndrome

This study explored the hypothesis that Gilles de la Tourette's syndrome involves a disturbance in arousal modulation. The experimental group consisted of 20 unmedicated subjects with the Gilles de la Tourette's syndrome, and the control group of 20 subjects with chronic medical illnesses (haemophilia, von Willebrandt's disease and diabetes). There were differences between groups in the manner in which log conductance level changed over time during sound and light habituation experiments involving mild levels of stimulation with the Gilles de la Tourette group showing less change in arousal level over trials than the control group. No group differences were found in measures of phasic arousal, rate of spontaneous fluctuations and performance on two tasks that have been related to cortical arousal. It is suggested that the slower change in log conductance level in the Gilles de la Tourette group during the sound and light habituation experiments indicates that reticular activity is more persistent in these patients.

A myelodysplastic syndrome preceding acute lymphoblastic leukaemia

The bone marrow of a patient with pancytopenia showed dyserythropoiesis, dysmegakaryocytopoiesis and 13% blasts. The patient was hypertransfused and the pancytopenia resolved completely for 1 month, while the blastic infiltration in the bone marrow remained. Three months later a frank acute lymphoblastic leukaemia developed.

Cytogenetic and DNA-flow cytometric studies of separated blasts

With Percoll density gradients, blasts from peripheral blood and bone marrow could be separated with a significant enrichment, and very often with a high degree of purity. This allowed a study of selected cases, where the separated sample exhibited chromosome abnormalities and/or an abnormal DNA content distribution (as measured by DNA-flow cytometry). The anomalies were shown to be associated with the separated blast fraction.

Low dose cytosine arabinoside (Ara C) in myelodysplastic syndromes

Myelodysplastic syndromes (MDS) are acquired bone-marrow disorders, characterized by a decreased ability of the haemopoietic cell to differentiate, resulting in peripheral cytopenias. The majority of patients will die either from acute myeloid leukaemia or from infection and/or haemorrhage. Thirty-eight courses of low dose Ara C were administered in 26 MDS patients. Nineteen courses (50%) were associated with good (12) or partial (7) response. Three complete remissions were observed. The median duration of response overall was 19.5 weeks, 26 weeks for the good and 10 weeks for the partial responders. A high incidence of treatment failure was seen in patients treated after transition to AML. Major complications were observed during 14 courses and mortality was directly related to therapy in five patients. Platelet transfusions were required during 26 courses. Aggravation of peripheral-blood cytopenia during the first weeks and hypocellularity of bone-marrow aspirates at the end of therapy suggest that low-dose Ara C exerts its main activity by suppression of leukaemic growth, rather than by induction of differentiation in malignant cells. Our results in MDS patients demonstrate that low-dose Ara C can be of value in severe cytopenia and can decrease the proportion of leukaemic cells in the bone marrow, but the danger of treatment should not be underestimated.

Clinical trial of low-dose Ara-C in the treatment of acute leukemia and myelodysplasia

In a multicenter analysis, the effect of low-dose cytosine arabinoside (Ara-C)(10 mg/ m2q 12 h subcutaneously for a minimum of 15 days) has been assessed in 13 patients with acute leukemia (10 myeloid-AML-, 3 lymphocytic-ALL-) and 7 patients with dysmyelopoietic syndromes (DMPS), conditions classified as refractory anemia with an excess of blasts ( RAEB ). Seven patients suffering from acute leukemia and 1 with DMPS in blastic transformation displayed a leukocytosis of more than 10 X 10(9)/1. Three out of 7 DMPS, 1 out of 10 AML achieved a complete remission, 1 out of 3 ALL-patients reached a partial remission twice. Seven patients showed a blast clearing in the bone marrow and peripheral blood, in another 7 instances examination of the bone marrow was not performed after therapy because of early death. The majority of patients were in their late phase of disease and refractory to conventional chemotherapy. Only 5 patients had no pretreatment at first presentation before low-dose Ara-C was initiated. At least for the DMPS-group, this therapeutic approach seems to be of some benefit.

A lod score method for detecting linkage on the X chromosone between a marker locus and a major gene locus for a quantitative

A sequential lod-score method is proposed for detecting linkage on the X chromosome between a marker locus and the locus of a major gene influencing a quantitative trait, The method uses information from sons of doubly heterozygous mothers. The average number of families required to detect linkage is substantially less than that of the fixed sample-size method proposed by Hill.