Persistent pulmonary infection with an azole-resistant Coccidioides species.

We report a case of a life-threatening, recurrent, and azole-resistant pulmonary coccidioidomycosis in a patient receiving long-term fluconazole therapy for a history of coccidioidal meningitis. Since this diagnosis, the patient has received weekly amphotericin B for more than four years and remains in remission with a stable serum Coccidioides complement fixation antibody titer.     

Isochromosome 17q in primitive neuroectodermal tumors of the central nervous system

We have prepared karyotypes from 22 primitive neuroectodermal tumors (PNETs) from pediatric patients ranging in age from 10 months to 16 years. Twenty-one cases were newly diagnosed, primary, posterior fossa tumors. One case was a recurrent tumor in a patient previously treated with radiation. Cytogenetic results were obtained from direct preparations and/or short-term (1-10 day) culture. Three tumors had apparently normal karyotypes. Nineteen tumors demonstrated numerical and/or structural abnormalities. The most frequent structural chromosomal changes were deletions and nonreciprocal translocations. Four tumors contained double minutes. Several chromosomes appear to be nonrandomly involved in PNETs. These include chromosomes 5, 6, 11, 16, 17, and a sex chromosome. The most consistent change, however, was an i(17q), present in one-third (8/22) of the cases. Strikingly, in three of these eight tumors, the i(17q) was the only structural abnormality observed. An i(17q) is not specific for pediatric PNETs, as it is also seen in leukemias and other solid tumors. However, in PNETs it may be a primary change related to tumor development and/or progression. Clinically, there was no correlation of the cytogenetic findings with histologic features of the tumors, size of the tumor, extent of metastasis, or surgical resection.     

An antigen processing polymorphism revealed by HLA-B8-restricted cytotoxic T lymphocytes which does not correlate with TAP gene polymorphism

In previous studies of antigen presentation through HLA-B27, we identified a healthy person whose lymphoblastoid cells do not present three B27-restricted viral epitopes to specific cytotoxic T lymphocytes (CTL), despite adequate cell surface expression of HLA-B2702 of normal sequence. Similar findings were observed in all members of his family sharing the HLA-A3-B2702 haplotype. The original donor, NW, carries HLA-B8 on his other class I haplotype, which his daughter, HW, has inherited. We now report a failure to present an HLA-B8-restricted epitope from influenza nucleoprotein following viral infection of NW cells, although exogenous added peptide is still presented normally. However, cells from HW, which do not carry the A3-B2702 haplotype, present the expected epitope after viral infection. Another B8-restricted epitope, from human immunodeficiency virus-gag, is presented equally well by both cell lines when infected with gag-vaccinia. This antigen processing phenotype does not correlate with any of the known human TAP-1 and TAP-2 polymorphisms.     

Trying to stop smoking: Effects of perceived addiction,attributions for failure,and expectancy of success

This paper reports the results of a postal questionnaire completed by 2343 smokers who had contacted a television company for help with stopping smoking. Of these, 1848 (78.9%) completed a follow-up questionnaire 1 year later. This indicated that 797 had tried to stop, 709 had tried to cut down, and 164 had become abstinent. Analyses show that the intention to try to stop smoking was dependent not only on the perceived health benefit, but also on the subjects' confidence that they would succeed if they tried to stop. As predicted by Weiner's [(1979). J. Educ. Psychol.71: 3–25] model of achievement motivation, those who attributed other smokers' failures at quitting to stable factors had lower expectancies of success, as had those who saw themselves as more addicted. When the follow-up data are considered, reported attempts at quitting were strongly related to previously declared intentions, and reported abstinence was related to previous confidence (expectancy of success) and perceived addiction. There is no support for hypotheses concerning self-other differences in attribution, or defensive attribution, in subjects' attributions for their own failures at cessation. Implications for antismoking interventions are discussed.This research was facilitated to various extents by grants from the British Council, the Department of Health and Social Security, the Medical Research Council, and the Social Science Research Council, London. When the data were collected, all authors were at the Addiction Research Unit, Institute of Psychiatry, University of London.     

Mapping of a restriction fragment length polymorphism associated with defective DR beta 4 chain expression to the HLA-DRB1 gene

The HLA-DR beta 4 chain, encoded by the DRB4 gene, carries two DRw53 determinants normally expressed by DR4, DR7, and DR9 individuals. However, some DR7 individuals (DR7, Dw11) fail to express the DR beta 4 chain. At the genomic level, a HindIII restriction fragment length polymorphism can be detected in these individuals with a DR beta cDNA probe. The association of this altered HindIII fragment with defective beta 4 chain expression suggested the possibility that the polymorphic fragment was derived from the DRB4 gene and might, therefore, be related to the defect in expression. However, detailed Southern blot analysis has now mapped the polymorphic fragment to the 3' end of the DRB1 gene, approximately 100 kb away from the defective DRB4 gene. Although the alteration in the DRB1 gene might involve sequences important in regulating the expression of the DRB4 gene, it is more likely that the association results from strong positive linkage disequilibrium between these DR beta chain genes.     

Regulation of in vitro cytotoxic T lymphocyte generation. II. Demonstration of noncytotoxic alloantigen-specific suppressor T lymphocytes

Both allospecific suppressor T lymphocytes (TsS) and nonspecific suppressor T lymphocytes (TsN) are activated in alloantigen-stimulated mixed leukocyte cultures (MLC). TsS and TsN can suppress cytotoxic T lymphocyte (CTL) induction upon transfer to fresh (second) MLC stimulated by the same alloantigens as in the first MLC (TsS or TsN) or by third-party alloantigens (TsN only). Evidence that TsS and TsN functions are performed by different T cell sets has been restricted to radioresistance of the former but not the latter. Separation of TsS from CTL has proven even more difficult. Methods are reported here which have allowed in vitro induction and functional separation of TsS from CTL and TsN in a totally allogeneic system. TsS are resistant to combined exposure to pyrilamine, a histamine1 antagonist and local anesthetic, during suppressor cell induction, and to X or gamma irradiation thereafter, while CTL precursors (CTL-P) and TsN are more sensitive to such treatments. This allowed us to use these treatments to generate TsS that are not contaminated with functional CTL, CTL-P or TsN. These data show that TsS regulate CTL induction by interacting with responding cell populations, rather than by cytotoxic depletion of stimulator cells.     

Results of a study to correlate serum prostate specific antigen and reproductive hormone levels in patients with localized prostate cancer.

This cross-sectional study was undertaken to determine whether serum hormones (free testosterone, androstenedione, luteinizing hormone, or prolactin) have any influence on serum prostate specific antigen (PSA) levels in patients with stage A-C prostate cancer. Blood samples were collected prior to any treatment in 36 patients; in 19 (group 1), three blood samples were collected 10 minutes apart between 9:00 AM and 9:30 AM for each patient and pooled together to avoid diurnal and episodic variation in serum testosterone values. In the remaining patients, only one sample could be collected (group 2). Free testosterone, androstenedione, luteinizing hormone, prolactin, and PSA levels were determined with appropriate radioimmunoassay techniques. Statistical analyses were performed separately for groups 1 and 2, and then with pooled data. None of the hormones in any of the analyses showed any association to serum PSA values except for prolactin for the pooled data and for group 2. This statistical significance for prolactin disappeared on multivariate analysis. There were 21 African-American men and 15 whites in the study; no racial differences in hormonal levels were found except for lower luteinizing hormone levels in African Americans in group 2 and pooled data. No differences were found between group 1 and group 2 in the mean serum prolactin and luteinizing hormone values. Serum free testosterone, androstenedione, and luteinizing hormone appeared to have no influence on serum PSA values in nonmetastatic cancer patients. Serum prolactin values were inversely associated with PSA values in univariate analysis for the pooled data; this disappeared in multivariate analysis. Unlike other studies that found higher serum testosterone levels in African-American college students than whites, no such differences were seen in this age group. Luteinizing hormone was lower in African-American men than in whites in the pooled study population. Further studies are needed to clarify our findings.