Approved drugs for unapproved indications: some clouds on the horizon.
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Biomedical subjects
Publications and source records attributed to S I Lamberg.
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We report a case of pneumococcal septicemia in an asplenic, otherwise healthy, 31-year-old patient. He presented with a viral prodrome and skin findings of purpura and livedo reticularis. Blood cultures identified Streptococcus pneumoniae. Rapid initiation of appropriate therapy resulted in resolution of the infection and clearing of all skin signs.
Newborn mouse epidermal cells proliferate when cultured in 0.05 mM Ca++ medium and terminally differentiate when the Ca++ is increased to about 1.2 mM, the level found in most cell culture media. We found that hyaluronic acid and proteoglycans were synthesized by isolated cultured newborn mouse epidermal cells and that quantitative and qualitative changes in these macromolecules appeared when proliferating epidermal cultures were induced to differentiate by calcium. A major change that occurred with differentiation was a reduction in synthesis of hyaluronic acid while synthesis of proteoglycans and glycoproteins increased. The proteoglycans synthesized in these cultures were heparan sulfate-proteoglycan (90%) and chondroitin sulfate-proteoglycan (10%), regardless of the calcium level.
The Mycosis Fungoides Cooperative Group has been following patients with cutaneous T-cell lymphoma, including mycosis fungoides and the Sézary syndrome variant. Previous analyses identified the extent of skin involvement and the number of sites of clinically enlarged lymph nodes as important prognostic variables. These two variables were used to classify 340 patients into four clinical stages. Repeat analysis based on additional followup data shows the usefulness of this clinical staging system for identifying patients with differing survival experience. An alternative grouping suggested by fitting a survival model to the data also has been studied. Staging systems based only on skin involvement and lymph nodes are recommended for general use because the information needed is readily available, requiring only physical examination.
Of 526 consecutive patients with cutaneous T-cell lymphomas, 21 had first-degree relatives with lymphoproliferative or hematopoietic malignancies. Twenty-nine such tumors occurred in the 21 kindreds. Hodgkin's disease accounted for one-third of this total, with various leukemias (11 cases), non-Hodgkin's lymphoma (five cases), and multiple myeloma (three cases) comprising the remainder. These data suggest that genetically-determined immunoregulatory abnormalities may represent a shared pathway of oncogenesis in diverse lymphoproliferative and hematopoietic malignancies.
The prognostic importance of various factors was analyzed for 347 patients registered by the Mycosis Fungoides Cooperative Group (MFCG). Extent of skin involvement at the time of registration and number of sites of clinically enlarged lymph nodes were clearly the most important prognostic variables, and were combined into a single variable, TN stage, for adjusted analyses of other factors. Sex, history of tonsillectomy, immunoglobulin E, and telangiectasia did not significantly affect survival. The effects of race and allergic history were questionable and need further study. Age, pruritus, burning, alopecia, ulcers, and erosion were important when studied alone, but their effects were no longer statistically significant after adjustment for TN stage. Chills and malaise, the latter a symptom of debility, retained prognostic significance after such adjustment. This analysis demonstrates the importance of considering the joint effects of multiple prognostic factors rather than analyzing them one at a time.
A radioreceptor assay for human epidermal growth factor-urogastrone (EGF-URO) employing mouse EGF-URO as tracer and calibration standards and human placental receptor as binding protein is compared with a radioimmunoassay for human EGF-URO. Results employing the receptor assay indicated similar values for urinary concentrations (1-16 nmol/l) for healthy control subjects and for patients with psoriasis. Lower values were obtained for bed-ridden patients with burns or patients recovering from orthopaedic surgery. The results obtained by radioimmunoassay were somewhat higher and correlated poorly (r = 0.5) with those obtained with the radioreceptor assay. The reason for this discrepancy is discussed.
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Cells cultured from calf ligamentum nuchae produce extracellular microfibrils identical to those of intact elastic tissue as determined by ultrastructural appearance, degradative enzyme susceptibilities and amino acid composition. A method to isolate large amounts of the microfibrillar component using fluorescein mercuric acetate is described. The cultures do not appear to synthesize the amorphous component, elastin, in that radioactive desmosine and isodesmosine were not detected after incubating cultures with labeled lysine nor was elastin seen ultrastructurally.
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This is an interim report of a double-blind multi-institutional study to examine the effect of chemotherapeutic agents applied topically to patients with mycosis fungoides. To date, 41 patch tests have been completed using 15 drugs. Five of the drugs produced some improvement, four were highly irritating, and six had no effect. This patch-testing study is a prelude to more extensive therapy trials.
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The frequency and prognostic importance of various characteristics of patients registered by the Mycosis Fungoides Cooperative Group between November 1974 and December 1977 are reported. Variables which were considered include demographic and historical factors, symptoms, extent of disease, and other physical findings. A staging system which is based on the extent of skin involvement and the number of nodal sites clinically involved is described. Finally, a description of therapeutic results to date for patients randomized into Mycosis Fungoides Cooperative Group protocols is presented.
An analysis of cases from a multi-hospital, pathologically verified clinical series and of deaths from US mortality statistics available at the county level for 1950--1975 (excluding 1972) was made in order to obtain information on the etiology of mycosis fungoides (MF). Despite the absence of an appropriate comparison group, the cases seemed to have a high frequency of antecedent allergies, fungal and viral skin infections, sun sensitivity, familial aggregation of lymphoma and leukemia, and employment in a manufacturing occupation (especially petrochemical, textile, metal, and machinery industries). The mortality survey revealed a predominance among males, nonwhites, and residents of the northeastern US, the latter due partly to an association between MF mortality and population size. The influence of occupational exposures was suggested by the excessive MF mortality rates in counties where petroleum, rubber, primary and fabricated metal, machinery, and printing industries were located.
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Fibroblasts cultured from patients with Marfan's disease show metachromasia with toluidine blue and accumulate increased amounts of glycosaminoglycan (GAG). Compared to fibroblasts from controls, more of the newly synthesized GAG is hyaluronic acid. Cycloheximide has a modest inhibiting effect on GAG accumulation compared to protein inhibition while serum depletion has a greater effect on inhibiting GAG accumulation than on reducing synthesis of new protein. Exogenous hyaluronic acid restores new accumulation of hyaluronic acid in serum depleted Marfan-derived cultures towards baseline while having almost no effect on cultures derived from controls. The effect is specific for hyaluronic acid as chondroitin sulfate or dextran sulfate are not stimulatory and is not due to stimulation of new protein synthesis.
A nasopharyngeal carcinoma occurred in a 41-year-old white woman who had received Fowler's solution (potassium arsenite) almost yearly for more than 20 years for the treatment of psoriasis. Palmar and plantar keratoses were present. Because of the rarity of this malignant neoplasm in white people, a relationship with arsenic ingestion is suggested.