Biomedical subjects
Publications and source records attributed to S A Armentrout.
An 18-year-old woman with severe pancytopenia secondary to chemotherapy given in the third trimester of pregnancy and who delivered an infant with normal peripheral blood counts is reported. The literature is reviewed, and recommendations for the method of delivery in this setting are discussed.
Two patients with aplastic anemia evolving from cellular bone marrows with severely diminished megakaryocytes are reported. During this evolution a plasma inhibitor of in vitro granulocyte-macrophage colony formation was demonstrated associated with non-A, non-B hepatitis in one patient. The second patient had abnormal liver function that corrected after the delivery of a normal newborn but there was persistence of pancytopenia without evidence of a plasma inhibitor.
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This report describes a patient with carcinoid metastatic to the liver in whom a hepatic artery catheter was placed for infusion therapy. This resulted in a previously unreported complication of a hepatic artery-biliary fistula. The clinical presentation of this complication and mode of management are described. The etiologic factors responsible for this complication are discussed. It is speculated that as more aggressive therapy for hepatic metastases is undertaken, this potential complication will be seen more frequently.
A humoral factor having many of the physical properties of a glycoprotein and lacking many of the characteristics of other immunosuppressants has been detected in the serum and plasma of patients with active multiple sclerosis. Kinetic studies indicate that the earliest biochemical event inhibited by LTIF is the incorporation of labeled nucleotides into acid insoluble ribonucleic acid. This material, designated lymphocyte transformation inhibition factor (LTIF), inhibits blast transformation in mitogen-stimulated T lymphocytes. The serum factor is usually associated with active multiple sclerosis but is also detected in some lymphoproliferative disorders. Partial purification has separated this material from serum immunoglobulins, but these procedures led to an accelerated loss of biological activity.
Activated partial thromboplastin time after heparin removal (aPTT/HR), a test employing anion exchange chromatography, was devised as an alternative to the prothrombin time after heparin removal (PT/HR) to monitor simultaneous anticoagulation with heparin and coumarins. The potential utility of the aPTT/HR was assessed by performing parallel PTs and aPTTs on 62 consecutive plasmas from coumarin-treated outpatients. All samples had 0.2 units/ml of heparin added and then removed to see if the maneuver influenced therapeutic group assignment. In no instance did reassignment occur. A conditional Irwin-Fisher test (P = 0.000604) and a special multinomial trial analysis (P = 0.002) indicated that the aPTT would be at least comparable to the PT for following coumarin antithrombotic prophylaxis. Since the heparin removal procedure had no influence on therapeutic categorization, the same statistical proof could be applied to the relationship between aPTT/HR and PT/HR. This study indicates that the aPTT can be used to monitor all stages of heparin and /or coumarin anticoagulation.
Human serum and the sera of a number of other mammalian species contain a naturally occurring macroglobulin with antibody-like properties which, in the presence of complement, is cytotoxic to murine Ehrlich ascites tumor cells in vitro. The serum of guinea pigs, rats and mice lack this macroglobulin activity but serve well as complement sources. The cytotoxic activity was demonstrated in short-term tissue cultures of Ehrlich ascites tumor cells by the marked and immediate inhibition of nucleic acid and protein synthesis. The cytotoxic activity is independent of the lytic antibody system which reacts against neuraminidase-treated lymphocytes.
Eighteen patients with small cell carcinoma of the lung treated with doxorubicin hydrochloride and hexamethylmelamine are presented. Fifteen of these patients had extensive disease at presentation. Four patients in this group died after one or fewer courses of chemotherapy. The median duration of survival for the entire group of patients is 15 months. Six patients are alive from 18 to 56 months without evidence of disease. Drug toxicity was minimal and well tolerated, which permitted this regimen to be given in an outpatient setting.
A 26-year-old patient with acute lymphatic leukemic conceived while on systemic chemotherapy. This patient experienced relapse during the second trimester, and a second complete hematologic remission was achieved with doxorubicin hydrochloride, vincristine, and prednisone. A 2400-gram, but otherwise normal, male infant was delivered by Caesarean section during the 36th gestational week. Growth and development of this child is normal at six months.
Lymphocyte transformation inhibition factor (LTIF) found in the serum of patients with active multiple sclerosis (MS) inhibits the mitogen-induced blast transformation of human lymphocytes. The results of these experiments demonstrate the relative specificity for the T lymphocyte by LTIF. The inhibitory effect of patient's serum on normal mitogen-stimulated lymphocytes was correlated with the level of clinical disease activity.
Two patients with multiple myeloma with large retroperitoneal myelomatous masses are discussed. This extraosseous extension of disease caused obstructive uropathy in both patients. This complication has not been previously recognized in multiple myeloma and must be added to the potential casues of renal failure in this disease.
This report descibes our experience with 40 evaluable patients with high-grade malignant astrocytomas. Eleven patients were treated with surgery and radiotherapy; 29 patients were treated with surgery, radiotherapy, and BCNU chemotherapy. Ten of these 29 patients are two-year survivors. Their mean survival is over 57.3 months, and they have been off chemotherapy for one to 27 months, mean 13.7 months. Seven of these patients received 800 to 1,100 mg/m2 of BCNU; three other long survivors received greater amounts of BCNU. Our current recommendation is that patients with high-grade malignant astrocytomas be treated with surgery, radiotherapy, and at least 800 mg/m2 of BCNU.
Two patients with acquired pure red cell aplasia associated with malignancy are presented. One patient has breast cancer and the other had poorly differentiated nodular lymphoma; neither patient had evidence of a serum inhibitor of hemoglobin synthesis and both achieved complete hematologic remission following prolonged immunosuppressive therapy. The literature describing the association of pure red cell aplasia and nonthymic malignancy is reviewed and potential for responsiveness discussed.
A factor in the sera of multiple sclerosis patients inhibits RNA, protein and DNA synthesis in actively metabolizing mitogen stimulated lymphocytes. Inhibition of macromolecular synthesis precedes cell death by 24 to 36 hours. The factor is effective on cells which are already committed to transformation by previous exposure to mitogen and cells which are simultaneously exposed to the factor and mitogen. Previous exposure of unstimulated cells to the factor does not alter their subsequent response to mitogen. The factor does not inhibit RNA synthesis of unstimulated lymphocytes isolated on a Ficoll-Hypaque gradient, nor is it toxic to these cells.
We have surveyed septicemic episodes occuring in individuals with acute leukemia and have found two factors favorably influencing survival, mainly granulocyte counts over 1,000 mm3 and gram-positive bacteremias. In contrast, blood cultures persistently positive for longer than 48 hours were a bad prognosticator. Significantly, patients with gram-positive bacteremia had received less antibiotics in the week prior to septicemia than had patients with gram-negative bacteremia.
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