An unusual case of North American blastomycosis

A patient with a laryngeal tumor first diagnosed as squamous cell carcinoma was subsequently found to have North American blastomycosis. Diagnosis of this condition eventuated in eradication of the lesion as well as removal of a tracheostomy, which was thought to be permanent.     

Association of crescentic glomerulonephritis with membranous glomerulonephropathy: a report of three cases

Association of membranous glomerulonephropathy with crescentic glomerulonephritis is apparently extremely rare. We report three patients who had this combination. One patient had biopsy-proven membranous glomerulonephropathy thirteen months prior to sudden and rapid decline in renal function necessitating hemodialysis. A repeat renal biopsy showed a superimposed crescentic nephritis and antiglomerular (GBM) antibodies were demonstrable in the serum. A second patient had proteinuria of unknown duration and then developed renal failure. Renal biopsy showed crescentic nephritis with a fine granular glomerular immunofluorescence for IgG typical of membranous glomerulonephropathy. Anti-GBM antibodies were present in this patient's serum. The third patient presented with acute renal failure of moderate severity. A renal biopsy revealed crescentic nephritis, granular deposits of immunoglobulins, and epimembranous electron-dense deposits typical of membranous glomerulonephropathy. Although his creatinine clearance improved spontaneously, nephrotic syndrome has persisted and a repeat renal biopsy showed a progression of the membranous glomerulonephropathy with the disappearance of the crescentic lesions. The reason for this peculiar association of membranous glomerulonephropathy and crescentic glomerulonephritis is unclear. It is possible that deposition of immune-complexes along glomerular basement membrane may render the glomerulus more susceptible to additional injury from a variety of other agents. Alternatively, depostis formed in one disease could initiate release of normal or altered basement membrane material and lead to formation of anti-GBM antibodies and subsequent development.     

Behavioral treatment of childhood neurosis

The effects of zinc sulphate pretreatment on the formation of gastric ulcers, changes in intragastric pressure and changes in the gastric mucosal mast cell count induced by electrical vagal stimulation were studied in anaesthetized rats. Vagal stimulation produced a high gastric glandular ulcer incidence and ulcer index, increased the intragastric pressure, and reduced the number of granulated mast cells in the gastric mucosa and submucosa. Pretreatment with zinc sulphate (22, 44 ot 88 mg/kg), injected i.p. 48 h beforehand, reversed the changes in these parameters in a dose-related manner. These observations suggest that the inhibitory effects of zinc sulphate on mucosal mast cell degranulation may account for its ability to antagonise vagal-induced gastric glandular ulceration. The mechanisms involved in the aetiology of this type of gastric ulcer are discussed in the light of these results.     

Stimulus complexity and rate of alternation in binocular rivalry

Pairs of random figures representing four levels of complexity were presented in a binocular-rivalry situation to 12 student volunteer observers. The effect of different levels of complexity on the rate at which complete alternations of the rivalry stimuli occurred was assessed. Rate of alternation was significantly inversely related to the level of stimulus complexity.     

Reappraisal of eight representative carcinogenic and non-carcinogenic compounds in a new medium-term rat liver bioassay using D-galactosamine

Tuberculosis incidence and mortality rates are rising steeply, reflecting economic hardship and the deterioration of the health infrastructure. The human and technical resources needed to reverse this trend are on hand, but cannot be used effectively without an adequate financial input. The cost of controlling tuberculosis now is modest compared with the cost of allowing it to increase.     

Photodynamic therapy using mono-L-aspartyl chlorin e6 (Npe6) for the treatment of cutaneous disease: a Phase I clinical study

The activity of a new photosensitizer, mono-L-aspartyl chlorin e6 (Npe6), was assessed in an ascending dose Phase I study for patients with superficial tumor. Eleven patients, with a total of 14 tumor sites, were treated with photodynamic therapy (PDT) using Npe6. Lesions included recurrent adenocarcinoma of the breast, basal cell carcinoma, and squamous cell carcinoma. The phototherapy protocol consisted of a single i.v. injection of 0.5-3.5 mg/kg Npe6, followed 4 h later by 25-100 j/cm2 at 664 nm of light. PDT using Npe6 caused no significant toxicity with the exception of temporary generalized skin photosensitivity. In all cases, light treatment caused immediate tissue blanching, followed by a marked necrosis of the tumor mass. Regression of tumor occurred over 24-48 h after the light treatment and was followed by the formation of a heavy eschar over the tumor site. Tumor regression was short-lived at Npe6 doses of 1.65 mg/kg and below. In two of three patients, tumor regression was either incomplete or tumors recurred within the 12-week observation period. Increasing the Npe6 dose to 2.5 or 3.5 mg/kg combined with 100 J/cm2 of light energy resulted in better control of tumor regrowth with 66% (6/9) of sites remaining tumor-free through 12 weeks observation. This increased tumor response came at the expense of the tissue selectivity observed at Npe6 doses of 1.65 mg/kg and below. There was no apparent selectivity for destruction of tumor compared with normal skin at Npe6 doses of 2.5 mg/kg and above. These data demonstrate that Npe6 is both an effective and safe photosensitizer for use in PDT and provide the impetus for continued study in Phase II clinical trials.     

The effects of GM-CSF on myeloperoxidase release in normal and myelodysplastic neutrophils

When purified control neutrophils were primed with GM-CSF, a significant increase in FMLP-induced MPO release was observed (mean +/- S.E.M., 3.4 +/- 0.8 mU/10(7) unprimed cells compared to 6.5 +/- 1.1 mU/10(7) primed cells, p < 0.001). This MPO release was greatly augmented by Cytochalasin B (Cy B), but after the addition of Cy B the priming effects of GM-CSF became less obvious. Exposure to GM-CSF without FMLP did not enhance MPO release. Within whole blood, FMLP produced negligible MPO release, but priming with GM-CSF prior to FMLP always resulted in a significant increase in MPO release. Myelodysplastic neutrophils released similar amounts of MPO in response to FMLP, compared with control cells (3.4 +/- 0.8 mU/10(7) control cells compared to 2.7 +/- 0.3 mU/10(7) MDS cells, p > 0.05). Priming with GM-CSF produced an increase in FMLP-stimulated MPO release comparable with control cells. In terms of total MPO content, although some MDS patients exhibited low levels, as a group there was no significant difference from controls (169 +/- 21 mU/10(7) control cells compared with 157 +/- 19 mU/10(7) MDS cells). These findings suggest that MPO activity is not a universal defect in MDS and cannot account for the defects in respiratory burst activity in these neutrophils.     

Effect of intravenous pyridoxine on plasma prolactin in hyperprolactinemic subjects

Intravenous pyridoxine has been reported to lower plasma PRL in normal subjects and in patients with the amenorrhea-galactorrhea syndrome. We tested the effect of pyridoxine (300-mg iv bolus) on plasma PRL in nine patients with hyperprolactinemia due to a variety of causes. There was no effect of pyridoxine on elevated plasma PRL in any of the nine hyperprolactinemic subjects. The potential utility of pyridoxine in the long term treatment of the galactorhea-amenorrhea syndrome will require further study.