Antibodies against HTLV I in T-lymphoproliferative diseases of the skin

The possibility that lymphoproliferative diseases may have a viral etiology has been discussed for many years. The first piece of evidence - in combination with convincing epidemiological data - was the detection of a virus of the HTLV group (HTLV I, ATLV) in patients with adult T-cell leukemia in Japan. There have been no comparable observations made in Europe. In 7 of 72 sera of patients with T-lymphoproliferative diseases in Central Europe, we were able to detect antibodies against HTLV I (ELISA and immunoblot), which might be an indication that retroviruses play a role in the etiology of these diseases.     

Thromboplastic activity of cerebrospinal fluid in neurological disease

Estimates of thromboplastic activity in 1100 samples of cerebrospinal fluid indicate that an increased activity of this clotting factor is a nonspecific indicator of abnormality in the central nervous system, much like (e.g.) an increased count of mononuclear cells and an increased protein content. However, the proportion of abnormal results obtained by these three tests can differ markedly in different neurological disorders. Increased thromboplastic activity is about 14-fold more common in bacterial meningitis than in viral meningitis; thus the thromboplastin determination can be of value in discriminating between bacterial and viral meningitis.     

Serial casting: a method for treating burn contractures

The purpose of this study was to assess the effectiveness of serial casting of burn contractures that were resistant to traditional methods of treatment such as paraffin therapy, massage, exercise, and splinting. Serial casting was used to increase the range of motion in 35 joints in 15 patients with burns. A mean increase of 54% was achieved. Casting provided immediate results with minimal complications and was accepted well by patients. Casts were easy to apply and effective even with noncompliant patients. They also delayed or eliminated the need for surgical correction.     

The problem of Social Security disability determination for the burn patient. A report from the Committee on Rehabilitation of the American Burn Association (ABA)

The ABA Rehabilitation Committee has developed a form to be included in the hospital record at discharge that should facilitate the Social Security disability determination process for the burn patient. This form should aid in the disability determination process by guiding the Social Security disability examiner to the pertinent evidence of limitation and chronicity in the often cumbersome medical record and by emphasizing the multiple body system nature of the severe burn injury.     

HLA-identical marrow transplantation during accelerated-phase chronic myelogenous leukemia: analysis of survival and remission duration

Results of HLA-identical allogeneic marrow transplantation were analyzed for 66 patients with accelerated-phase chronic myelogenous leukemia (CML). Multivariate proportional hazards regression models were used to determine disease-related and transplant-related factors associated with posttransplant mortality and relapse. The projected 5- year survival rate was estimated at 18% by the product-limit method. The major causes of death were interstitial pneumonia, infection, and relapse. Splenomegaly at initial diagnosis and longer time interval from diagnosis to transplant were associated with decreased overall survival and event-free survival. Sixteen patients have relapsed between 17 and 1,569 days (median, 486) posttransplant. The use of T- cell-depleted marrow and older age of the donor or recipient were associated with an increased probability of leukemic relapse. Ten of the 16 relapses occurred among the 15 patients who received T-cell- depleted marrow. The actuarial relapse risk 2.5 years posttransplant was 100% in patients administered T-cell-depleted marrow as compared with 25% in patients administered unmodified marrow. The data in this report emphasize the increased risks and relatively poor results that occur when marrow transplantation is deferred until after signs of acceleration appear. When compared with results for patients who received transplants during chronic phase, the poor results seen here in patients administered unmodified marrow stem primarily from increased transplant-related mortality rather than increased relapse risk. The strikingly increased relapse rate associated with the use of T-cell depletion would discourage its use for graft-v-host disease prevention in patients who receive transplants for CML.     

The effects of certain student and institutional characteristics on minority medical student specialty choice.

This article investigates the possible effects of minority status, presence of a Minority Affairs Office or Student National Medical Association (SNMA) Chapter, level of indebtedness, and number of years (4 to 5) to complete medical school on specialty choice of minority medical students. The 5-year experiences of 20 medical schools in the southern region (including three in Puerto Rico) were examined via a questionnaire. Information was sought for African Americans, Afro-Caribbean, Mexican American, other minority, and nonminority students. Minority graduates entered the specialities of internal medicine, pediatrics, and family medicine in far greater numbers than any other speciality. Also, the percentage of minorities who entered these fields was greater than the percentage of non-minorities. Conversely, minorities were significantly underrepresented in the surgical subspecialties and radiology. Additional study is needed to further examine the medical school experience for indications of why the clustering in primary care specialities occurs. Moreover, while most schools had some kind of minority affairs organization, few were active in the writing of the Dean''s letter. Other suggestions to assure adequate minority representation across specialties include early exposure to the different specialties and subspecialties for minority students, a mentorship program with practicing physicians, and stronger recruitment of minorities into underrepresented specialties.