Intestinal and pulmonary cryptosporidiosis in an infant with severe combined immune deficiency

Small intestinal biopsy established the diagnosis of cryptosporidiosis in a 6-month-old male infant with severe combined immune deficiency. Scanning and transmission electron microscopy revealed the ultrastructural details of Cryptosporidium in several stages of development within the patient's small intestine. The organism was resistant to all antibiotics used, and the patient died in the 5th month of his illness, despite receiving parenteral alimentation and undergoing thymus transplantation. His clinical course was similar to that of other patients with fatal immune deficiencies and cryptosporidiosis. Autopsy demonstrated organisms attacking the epithelium of the small intestine, pancreatic duct, and bronchioles. Multiple organ involvement in this patient negates the view that Cryptosporidium is site-specific for a given host or is alimentary-canal-specific in humans.     

Effects of resistive training and chromium picolinate on body composition and skeletal muscle size in older women

This study assessed the effect of resistive training (RT), with or without highdose chromium picolinate (Cr-pic) supplementation, on body composition and skeletal muscle size of older women. Seventeen sedentary women, age range 54-71 years, BMI 28.8 +/- 2.4 kg/m2, were randomly assigned (double-blind) to groups (Cr-pic, n = 9; Placebo, n = 8) that consumed either 924 micrograms Cr/d as Cr-pic or a low-Cr placebo (< 0.2 microgram Cr/d) during a 12-week RT program (2 day/week, 3 sets.exercise-1.d-1, 80% of 1 repetition maximum). Urinary chromium excretion was 60-fold higher in the Cr-pic group, compared to the Placebo group (p < .001), during the intervention. Resistive training increased maximal strength of the muscle groups trained by 8 to 34% (p < .001), and these responses were not influenced by Cr-pic supplementation. Percent body fat and fat-free mass were unchanged with RT in these weight-stable women, independent of Cr-pic supplementation. Type I and type II muscle fiber areas of the m. vastus lateralis were not changed over time and were not influenced by Cr-pic supplementation. These data demonstrate that high-dose Cr-pic supplementation did not increase maximal strength above that of resistive training alone in older women. Further, these data show that, under these experimental conditions, whole body composition and skeletal muscle size were not significantly changed due to resistive training and were not influenced by supplemental chromium picolinate.     

Day case rhinoplasty

Rhinoplasty is considered by many to be an inpatient surgical procedure. This may be because the operation is thought to be traumatic with a risk of epistaxis and periorbital haematoma. Since 1992 rhinoplasty surgery at St George's hospital has been routinely performed on a planned day case basis. The hospital records of 97 patients were examined of which 17 patients (18%) underwent planned admission and 12 (12%) unplanned admission. No patients were re-admitted to hospital after discharge. With the advances in day case surgical practice within the UK we consider that the practice of day case rhinoplasty is likely to have its place. Such surgery should ideally be performed in a dedicated day case unit and provision for admission overnight should be available.     

Safety and pharmacokinetic effects of TNP-470, an angiogenesis inhibitor, combined with paclitaxel in patients with solid tumors: evidence for activity in non-small-cell lung cancer.

PURPOSE: Preclinical studies suggested that the antiangiogenic agent TNP-470 was synergistic with cytotoxic therapy. TNP-470 was administered with paclitaxel to adults with solid tumors to define the safety and optimal dose of the combination regimen and to assess pharmacokinetic interactions. PATIENTS AND METHODS: Thirty-two patients were enrolled chronologically onto one of two treatment arms. Arm A involved a fixed TNP-470 dose with escalating doses of paclitaxel, and Arm B involved a fixed paclitaxel dose with escalating doses of TNP-470. Paclitaxel and TNP-470 pharmacokinetics were evaluated along with toxicity. RESULTS: The combination of TNP-470 administered at 60 mg/m(2) three times per week and paclitaxel 225 mg/m(2) administered over 3 hours every 3 weeks was defined as both the maximum-tolerated dose and the optimal dose. Myelosuppression was similar to that expected with paclitaxel alone. Mild to moderate neurocognitive impairment was observed; however, the majority of changes were subclinical and reversible as determined by prestudy and poststudy neuropsychiatric test results. A clinically insignificant decrease of paclitaxel clearance was observed for the combination. Median survival for all patients was 14.1 months. Partial responses were reported in eight (25%) of 32 patients and in six (38%) of 16 patients with NSCLC, 60% of whom had received prior chemotherapy. CONCLUSION: The combination of TNP-470 and paclitaxel, each at full single-agent dose, seems well tolerated, with minimal pharmacokinetic interaction between the two agents. Further studies of TNP-470 with chemotherapy regimens are warranted in NSCLC and other solid tumors.     

Paclitaxel Induces Apoptosis in AIDS-Related Kaposi's Sarcoma Cells

Paclitaxel is a microtubule stabilizing drug that causes dividing cells to arrest and then undergo apoptosis. It also has antiangiogenic activity because it alters cytoskeletal structure, affecting migration and invasion. Paclitaxel is an effective treatment for AIDS-related Kaposi's sarcoma (KS). KS is a tumor in which there is marked proliferation of endothelial cells in addition to the tumor cells, which themselves share many markers with activated (proliferating) endothelial cells.We sought to determine the mechanism by which paclitaxel exerts its anti-KS tumor effects. In vitro, KS cells are very sensitive to paclitaxel, with half-maximal growth inhibition observed at 0.8 nM. Inhibition of migration of KS cells was also observed at nanomolar concentrations of the drug. Paclitaxel induced cell cycle arrest with an accumulation of cells in sub-G1.This was accompanied in vitro by various events typical of apoptosis: phosphorylation of two anti-apoptotic proteins Bcl-2 and Bcl-(xL) , release of cytochrome c into the cytoplasm, cleavage and activation of caspase-3. In vitro results were borne out by studies of KS tumor xenografts in nude mice. Paclitaxel (10 mg/kg) inhibited tumor growth by 75% over 21 days. Histological examination of the tumors revealed a decrease in proliferative index, a decrease in the number of mitotic figures and an increase in apoptotic cells compared to tumors from untreated mice.     

Acute myeloid leukemia in adults

Opinion statement The treatment outcome for most adults with acute myeloid leukemia (AML) remains unacceptable. Additional agents or substitution of high-dose cytarabine for conventional-dose cytarabine during induction does not improve the remission rate or overall survival. There is substantial toxicity with high-dose cytarabine during induction. Thus, induction therapy for newly diagnosed patients with AML should consist of cytarabine (100 mg/m² as a continuous intravenous infusion over 24 hours for 7 days) and daunorubicin, darubicin, or mitoxantrone. Meta-analysis demonstrates a modest benefit for idarubicin. Most patients who achieve a remission should receive further therapy with two to four cycles of high-dose cytarabine. Allogeneic stem cell transplant is reserved for patients with poor risk features. There is no role for autologous stem cell transplant in first remission outside a clinical trial. The majority of adults relapse. Salvage therapy usually consists of high-dose cytarabine. Allogeneic or autologous stem cell transplantation is preferred in second or subsequent remission. Uncommon diseases such as AML, for which the outcome remains poor, should be treated on clinical trials whenever possible.     

Colorectal hemangioma: radiologic findings

The authors correlated radiographs with the clinical and histologic data of 12 patients with colorectal hemangioma. All patients presented with rectal bleeding, which was chronic in seven. Phleboliths were also visible in seven cases, which correlated with chronic bleeding in five. On barium studies, three masses were soft and three produced rigid narrowing. The atypical features of rigid luminal narrowing, which might mimic a carcinoma, and hypovascularity correlated with chronic bleeding or visible phleboliths, which suggest the correct diagnosis of colorectal hemangioma.