New approach in treatment of cardiac decompensation in U. S. S. R.

Based on Meerson's fundamental work^3,4 on the genesis of ventricular hypertrophy and decompensation, Russian investigators supplemented the conventional therapy of cardiac decompensation with preparations related to the synthesis of protein and nucleic acids. The merit of the supplemental treatment was shown in the clinical course as well as in various objective criteria (blood chemistry, hemodynamics, systolic parameters, ECG). The reported results are highly significant and their method merits trial in other centers.     

Miconazole in coccidioidomycosis. I. Assays of activity in mice and in vitro.

Administration of miconazole to mice infected with Coccidioides immitis prevented death in all cases; the infecting doses killed 60%-100% of the untreated animals. The drug's anticoccidioidal influence was also demonstrated by its capacity to limit fungal proliferation in the lungs. The endospore phase of C. immitis, which predominates in lesions, was more susceptible to miconazole than were the saprophytic arthrospore and mycelial phases. The drug was lethal to endospores in vitro in the presence or absence of human plasma, but plasma decelerated the rate of killing. A sensitive quantitative assay (using endospores) for the drug in plasma was developed, and the inefficacy of determining the sensitivity of strains with mycelia was demonstrated.     

E.L.I.S.A. in human coccidioidomycosis]

An E.L.I.S.A. test for antibody detection, with an exo-antigen of Coccidioides immitis was standardized in 67 humans sera diluted in 1/1000, 1/2000, 1/4000 and 1/8000. Eighteen sera from mycologically proved cases of coccidioidomycosis were studied: 5 were negative and 13 were positive in some dilutions. 3/26 sera of healthy persons who presented positive skin tests with coccidioidin were positive and the other 23 sera did not have positive reactions. None of the 15 sera of healthy human exhibited positive E.L.I.S.A. Serum samples of 8 patients suffering other deep mycosis were studied, 4 of them presented cross-reactions in E.L.I.S.A. tests. E.L.I.S.A. test seems to be a useful serologic technique for antibody detection in anticomplementary serum samples or when a low concentration of antibodies should be detected. As it is very sensitive, cross-reactions with other mycoses are frequent, thus the use other more specific serologic technique together E.L.I.S.A. is recommended.     

Non-Hodgkin's lymphomas in children. II. Treatment.

The prognosis of non-Hodgkin's lymphoma (NHL) in childhood has improved steadily in the last 2 decades. This is primarily the result of increasingly effective chemotherapy regimens tailored to defined and relatively homogeneous prognostic categories and tested in prospective clinical trials. Surgical excision remains of prognostic benefit only when near-total resection can be performed without delay of chemotherapy. The role of radiation therapy is now limited to the treatment of overt central nervous system (CNS) lymphoma, disease unresponsive to chemotherapy, and certain emergencies. Effective 'prophylactic' treatment of the CNS has been achieved in most series by intrathecal and systemic chemotherapy alone. The most relevant modality of treatment is chemotherapy and a very large number of protocols have been published. The origins of current multi-agent regimens stem both from early experience with cyclophosphamide in endemic Burkitt's lymphoma and from therapeutic studies of acute lymphoblastic leukaemia. Sub-stratification of non-localized NHL has produced protocols designed for either lymphoblastic (mostly T cell) or non-lymphoblastic (mostly B cell) categories. While the cure rate for lymphoblastic lymphoma now exceed 70%, the non-localized non-lymphoblastic disease remains a major obstacle to cure. These patients frequently present with large abdominal primaries and are prone to regional as well as hematogenous dissemination. In particular, involvement of the CNS is now considered to be the most adverse prognostic variable in this group. Recently, highly intensive regimens are addressing these obstacles. On the other hand, NHL defined as localized has been shown to be curable in up to 95% of children with the use of simple chemotherapy regimens as short as 6 months in duration. Salvage of patients who relapse during or after chemotherapy remains bleak but cures are possible with regimens incorporating bone marrow transplantation from either an autologous or allogeneic source. Experimental methods, including biologic and immune response modifiers may also offer future promise.     

Strongyloides ratti infections in rats. I. Immunopathology.

The elimination of adult parasites from the intestines of rats after a first and second infection of Strongyloides ratti was studied. Expulsion after a second infection was anamnestic, indication that the response is immunologic. Intestinal mast cell responses accompanied damage and expulsion of worms, the secondary mast cell response being more rapid but less intense that the first. Antithymocyte serum suppressed expulsion as well as both the intestinal mast cell and circulating eosinophil responses to primary infection.     

Rheumatoid arthritis in Kenya. II.Serological observations.

Sera from 48 Kenyan Africans with rheumatoid arthritis, 43 patients with other diseases, and 98 blood donors were tested for the presence of rheumatoid factor by latex fixation tests using human European, human African, and rabbit immunoglobulin, and a sheep cell haemagglutination test. In the patients with rheumatoid arthritis the frequency of rheumatoid factor was comparable to that reported in series from Europe and the USA, thus differing from the findings in West Africa. In the control patients and blood donors a high frequency of positive tests for rheumatoid factor was found; a similar result has been obtained from population studies in other African countries. Broadly similar results were obtained with each of the latex tests, and these were found to be less specific for rheumatoid arthritis than the sheep cell haemagglutination test.     

Rheumatoid arthritis in Kenya. I. Clinical observations.

76 Kenyan Africans with classical or definite rheumatoid arthritis are described. Their age, sex ratio, and pattern of joint involvement closely resembled that seen in Europe and the USA and differed from that described in West Africa and rural South Africa. However, they showed a marked lack of systemic nonarticular complications, with relatively little functional incapacity. Radiological grading was carried out on 58 cases, and the changes were found to resemble more closely those seen in an English series than in a Nigerian series.