Remission Maintenance Therapy for Meningeal Leukemia: Intrathecal Methotrexate vs. Intravenous bis-Nitrosourea

Central nervous system infiltrates havebecome a major cause of morbidityamong leukemic children and may constitute a site from which a remissionmarrow is again infiltrated. Conventionalintrathecal methotrexate (IT MTX) therapy produces excellent palliation andcomplete reversal of abnormal cerebrospinal fluid findings for periods rangingfrom 6 to 414 days (median 87 days).The CNS remission maintenance potential of (1) IT MTX, 12 mg/sq m, every6-8 wk, and (2) bis-nitrosourea (BCNU),100 mg/sq m intravenously, every 6-8wk were compared with "no therapy"maintenance. Only those children inCNS remission 6-8 wk following induction therapy were eligible for randomization to the maintenance study. Theduration of CNS remission for BCNU-maintained and "no therapy" patients wassimilar, with a median length of remission of 96 days and 112 days, respectively. The median duration of remissionfor the MTX maintenance group was 472days. The differences in length of CNSremission between the MTX group andthe other two groups were statisticallyhighly significant (p < 0.01 for bothcomparisons). Headache, fever, and/orvomiting occurred in 38% of the childrenafter one or more of the intrathecal maintenance treatments and, in general,symptoms tended to worsen as maintenance continued.

Submitted on May 4, 1971 Revised on June 24, 1971 Accepted on June 29, 1971     

ASHY DERMATOSIS AND LICHEN PLANUS PIGMENTOSUS: A CLINICOPATHOLOGIC STUDY OF 31 CASES

The clinical and histopathologic characteristics of patients with ashy dermatosis (n = 20) and lichen planus pigmentosus (n = 11) were analyzed. We found significant clinical differences between both dermatoses, supporting our opinion that they are two separate conditions. Both dermatoses were histologically similar.     

Concurrent occurrence of three primary neoplasms with different hystotype in the same kidney, associated with an adenoma of the omolateral adrenal gland: First case report

We present an unusual case of concurrent occurrence of three synchronous primary tumors in the same kidney (oncocytoma, chromophobe renal cell carcinoma, angiomyolipoma) associated to an adenoma of the omolateral adrenal gland in a patient with no evident clinical symptoms. The immunohistochemistry showed a positivity for KIT in oncocytoma and chromophobe cell carcinoma, and a weak positivity in the angiomyolipoma, only in the cells positive for HMB-45. This is the first report of this kind of presentation.     

Effect of secondary structure on the rate of deamidation of several growth hormone releasing factor analogs

The objective of this study was to determine whether the rates of deamidation of Asn⁸ in selected growth hormone releasing factor (GRF) analogs were related to the peptide's secondary structures in solution. Bovine or human [Leu²⁷]GRF(1–32)NH₂ (both having Gly at position 15), [Ala¹⁵ Leu²⁷]bGRF(1–32)NH₂ and [Pro¹⁵ Leu²⁷]bGRF(1–32)NH₂ were used as model peptides. The peptide helical content (assessed by CD) increased with the increasing methanol concentration and was as follows: 7, 12 and 18% in 0% MeOH; 24, 48 and 52% in 40% MeOH; and 41, 77 and 81% in 80% MeOH for Pro¹⁵ Leu²⁷ bGRF(1–32)NH₂, [Leu²⁷]hGRF(1–32)NH₂, and Ala¹⁵ Leu²⁷ bGRF(1–32)NH₂, respectively. 2D NMR studies done in the presence of 40% CD₃OH indicated more helical structure for the Ala¹⁵ analog as compared to [Len²⁷]hGRF(1–32)NH₂. In both these peptides Asn⁸ was included in the helical region. In contrast, the lack of conformational information for the Pro¹⁵ analog indicated little helical structure around Asn⁸. The peptides’ deamidation rates decreased and their half-lives increased with increasing MeOH concentrations. At 40% MeOH, the least helical Pro¹⁵ bGRF analog (t_1/2= 10.78 h) deamidated 1.5 and 2 times faster than its Gly¹⁵ (t_1/2= 15.74 h) and Ala¹⁵ (t_1/2= 21.53 h) counterparts, respectively. This study indicates that helical environment around Asn⁸ in GRF makes this residue less prone to deamidation.     

Pseudoatrial Flutter: Artifact Simulating Atrial Flutter Caused by a Transcutaneous Electrical Nerve Stimulator (TENS)

A patient with previous actual atrial flutter had what appeared to be atrial flutter seen on Holter monitoring during treatment with a transcutaneous electrical nerve stimulation (TENS) unit. This proved to be artifact caused by the unit rather than a true arrhythmia. The artifact was reproduced in a normal volunteer by application of a TENS unit.     

Clinical and vestibulometric status following labyrinthectomy or vestibular nerve section for Meniere's disease *

A clinical and vestibulometric comparison of 10 patients following labyrinthectomy, 5 following vestibular nerve section, and 10 control subjects was undertaken in order to evaluate the long-term effectiveness of these procedures. Testing was performed a mean of 8.5 years after surgery. Vestibulometry assessed time constants, gain, and phase advance of the vestibulo-ocular reflex (VOR) in both horizontal and vertical planes of head movement. Loss of the anticipated increase in phase advance in the vertical VOR of the labyrinthectomy group, significantly different from the vestibular nerve section group (P < 0.05 and P < 0.01 for each direction of rotation), suggests that posterior and superior semicircular canal function remains intact following per-meatal labyrinthectomy. Although stabilometry suggested that balance in the labyrinthectomy group was poorer than in the two other groups (P < 0.025 without optic fixation), clinical assessment demonstrated excellent functional results. Per-meatal labyrinthectomy remains a safe and effective procedure for the relief of vestibular symptoms, although vestibular nerve section may provide more complete removal of contributory end-organ function.