Multiple primaries among gynecologic malignancies

Seventy-eight synchronous or metachronous tumors among 2362 patients followed by the Downstate Gynecologic Tumor Registry are reviewed. Significant synchronous tumor pairs include cervix (invasive and in situ)-ovary, cervix (in situ)-uterus, cervix (in situ)-kidney, endometrium-ovary, endometrium-rectosigmoid and ovary-breast. Significant metachronous pairs include cervix (invasive and in situ combined)-lung, cervix (invasive and in situ combined)-upper alimentary tract, and cervix (invasive)-rectosigmoid. In the case of in situ and invasive cervical cancer-lower genital tract, significance was determined for both synchronous and metachronous pairs. Long survival is an important factor in the appearance of a second tumor as demonstrated in patients with cervical carcinoma. Synchronous data prove to be valuable in assessing risk of second primaries in patients surviving for short periods. The roles of cigarette smoking, hormones, immunosuppression, radiotherapy, and screening are discussed.     

Glucagon suppression with low-dose intramuscular insulin therapy in diabetic ketoacidosis.

The effects of low-dose intramuscular insulin therapy on endogenous glucagon secretion in diabetic ketoacidosis were compared prospectively with a conventional regimen. Ten patients, 4 to 15 years of age, who had 13 episodes of diabetic ketoacidosis, were alternately assigned to either group. Either 0.1 unit/kg regular insulin was given every two hours im, or 1.0 unit/kg regular insulin was given, half subcutaneously and half intravenously, every 4 hours. In both groups, a significant and equal fall in both serum glucose and glucagon concentrations was observed. No complications were encountered. It is concluded that 0.1 unit/kg of regular insulin given im every two hours is as effective in correcting hyperglycemia and hyperglucagonemia of diabetic ketoacidosis as is conventional therapy, and avoids the risks of secondary hypoglycemia known to occur when the larger insulin dosages are employed.     

Late-onset nonketotic hyperglycinemia and spinocerebellar degeneration.

Investigation of a 15-year old boy with progressive optic atrophy and spinocerebellar degeneration revealed elevated plasma, cerebrospinal fluid, and urine glycine concentrations. During an oral glycine loading test, the patient's plasma glycine concentration rose to a higher level than control values, although the initial rate of rise was slower; there was no concomitant rise in the plasma serine concentration. An oral serine loading test resulted in a prompt rise of both glycine and serine serum concentrations. The renal glycine clearance was elevated, and the renal tubular glycine reabsorption was diminished. These findings of decreased intestinal uptake and increased renal tubular glycine clearance suggest that a generalized derangement of glycine entry into cells may account for the phenotypic manifestations of the disorder.     

Hepatitis B infection in pediatric dialysis and transplant patients: significance of e antigen

We examined the clinical significance of hepatitis Be antigenemia in 36 HBsAg positive pediatric dialysis and renal transplant patients. One hundred twenty-seven sera were tested for HBeAg and anti-HBe. Seventy-three sera (57%) from 29 patients (81%) contained HBeAg. The presence of HBeAg was associated with an increased titer of HBsAg (P < 0.005) and with the presence of the HBsAg carrier state (P < 0.001). HBeAg was found in 40% of specimens taken from dialysis patients, and in 70% of specimens from transplant patients (P < 0.001). No serum contained anti-HBe, although 28 of 29 sera (97%) tested had antibody to HBcAg. No association was found between the presence of HBeAg and serum aminoleucine transferase levels or the histologic evidence of chronic active hepatitis. Fifteen HBeAg negative sera from patients persistently positive for HBsAg were tested for HBV-specific DNA polymerase activity; 7 (47%) had significant activity. Since both HBeAg and DNA p are indicators of infectivity, many HBeAg negative sera from immunosuppressed HBsAg carriers may be infectious.     

Mixed connective tissue disease in childhood: A clinical and serologic survey

Mixed connective tissue disease is a syndrome with overlapping clinical features of SLE, scleroderma, and polymyositis. Only one other child with MCTD has been described in detail. In this study 14 children with MCTD are described. Each had overlapping clinical findings that evolved over an extended period of observation, and all 14 had high serum titers of speckled ANA and antibodies to RNP. A serologic survey of 127 children with various rheumatic diseases confirmed the specificity of high titer of speckled ANA and antibodies to RNP for MCTD in children. Significant cardiac and renal involvement, and thrombocytopenia, may be more common in affected children than in adults with MCTD, may lead to longer therapy with higher doses of a corticosteroid, and may contribute to a more serious prognosis than in adults.     

Heat-stable enterotoxigenic Escherichia coli and necrotizing enterocolitis: lack of an association.

During an outbreak of diarrhea in a special care nursery caused by heat-stable enterotoxigenic Escherichia coli (serotype 078:H11:K80), nine (4.3%) of the 205 infants in the nursery developed necrotizing enterocolitis. Cases of necrotizing enterocolitis were not significantly more common in infants colonized or infected with these organisms; heat-stable enterotoxigenic E. coli was isolated from 5(56%) of nine cases of necrotizing ecterocolitis and from 27(38%) of the 71 infants without necrotizing enterocolitis who were also cultured. Our findings suggest that caution should be taken in implicating enterotoxigenic E. coli as a cause of necrotizing enterocolitis.     

Diagnosis of exocrine pancreatic insufficiency in cystic fibrosis by the synthetic peptide N-benzoyl-L-tyrosyl-p-aminobenzoic acid.

The synthetic peptide N-benzoyl-L-tyrosyl-p-aminobenzoic acid is specifically cleaved by chymotrypsin to Bz-Ty and PABA. The liberated PABA is absorbed and excreted in the urine. Accordingly, PABA recovery reflects intraluminal chymotrypsin activity and is an index of exocrine pancreatic function. This test was evaluated in 24 patients with cystic fibrosis to determine its role in the diagnosis of exocrine pancreatic insufficiency. Cumulative percent PABA recovery in six hours was significantly lower in CF patients compared with the control group. No overlap was noted between the two groups. There was good correlation between PABA recovery, fecal chymotrypsin activity, and coefficient of fat absorption. These findings indicate that PABA recovery is significantly reduced in patients with CF and steatorrhea and may prove a practical and reliable test of pancreatic insufficiency.