Neocarzinostatin versus m-AMSA or doxorubicin in hepatocellular carcinoma.

Sixty-one of 76 patients entered on a prospective randomized trial of neocarzinostatin ( NCZ ) versus m-AMSA or doxorubicin were eligible for analysis. Among these 61 patients at least one episode of severe toxicity was documented in 39% of patients on NCZ and 58% on m-AMSA. Fifty-one of the 61 patients were previously untreated with chemotherapy. Among these 51 patients objective response was documented in two of 25 patients treated with NCZ , none of 17 treated with m-AMSA, and one of nine treated with doxorubicin. Among previously untreated North American and European (NA/E) patients the median survival times were: NCZ 11 weeks and m-AMSA 12 weeks. The data on South African (SA) patients with similar entrance criteria entered on earlier Eastern Cooperative Oncology Group trials were analyzed with that from the randomized trial and show that for SA patients the median survival times were: NCZ , 11 weeks (31 patients); m-AMSA, 13 weeks (33 patients); and doxorubicin, 15 weeks (29 patients).

Retrospective determination of HIV-1 status by a PCR method on paraffin wax embedded sections.

AIM: To develop a simple but reliable polymerase chain reaction (PCR) method to determine the HIV-1 status of patients on formalin fixed, paraffin wax embedded lymph node tissue. METHODS: Fifty lymph node specimens, 20 from HIV-1 seropositive and 30 from HIV-1 seronegative patients, were analysed. Lymph nodes with a variety of disease conditions were included in the study. Tissue sections were treated with a DNA extraction buffer containing proteinase K and the crude cell lysate was used in PCR analysis. Nested primers were used to amplify HIV-1 DNA sequences coding for gag, pol and env proteins. PCR products were demonstrated by polyacrylamide gel electrophoresis. Results were then compared with HIV-1 serology of the patients from whom the tissue was obtained. RESULTS: The PCR method yielded a specificity of 100%, a sensitivity of 95%, a positive predictive value of 100%, and a negative predictive value of 97% when compared with HIV-1 serology. The kappa statistic (0.958) showed an excellent agreement between the PCR method and serology. Furthermore, HIV-1 DNA was demonstrated in lymph node tissue from a serologically unconfirmed acquired immunodeficiency syndrome case necropsied in 1982. CONCLUSION: This PCR method is a simple and reliable means of retrospectively determining the HIV-1 status of patients using formalin fixed, paraffin wax embedded lymph node tissue.

A randomized phase II study of acivicin and 4'deoxydoxorubicin in patients with hepatocellular carcinoma in an Eastern Cooperative Oncology Group study.

We analyzed 56 of 75 previously untreated patients with hepatocellular carcinoma who entered on a prospectively randomized trial of acivicin versus 4'deoxydoxorubicin (esorubicin). At least one episode of severe toxicity was documented in 23% of the patients on acivicin and 45% of those on 4'deoxydoxorubicin. Two patients responded to 4'deoxydoxorubicin. One response was partial, lasting 58 weeks, and one was complete, lasting more than 4 years. The 90% confidence interval for response is 1-20%. In view of a 45% rate of severe or worse toxicity with 4'deoxydoxorubicin, this drug cannot be recommended as treatment. There were no responses on acivicin.

A destructive arthropathy following Chikungunya virus arthritis--a possible association.

Chikungunya virus arthritis is an acute severe polyarthritis following upon the bite of infected mosquitoes in endemic areas. With rapid air transport an increasing number of tourists are being exposed to potential infection. Whether tourists returning home in the incubation viremic stage can infect local mosquito populations in their home countries is unknown. Most cases recover from the severe joint pains within several weeks but up to 12% retain some residual joint symptoms for years. A case report is given of probable Chikungunya arthritis progressing to joint destruction before ultimately subsiding after 15 years leaving a sequela of destroyed metatarsal heads and late osteoarthritic changes in the ankles.

A complication of mesenteric lymphangioma: case report and brief review of literature.

Mesenteric lymphangioma (ML) has only rarely been reported in the literature. These cases are rare enough to arouse interest when encountered. Usually, the cases are asymptomatic but may present with acute or chronic intestinal obstruction. We report an additional case of ML associated with intermittent intestinal volvulus in a 5 years old boy.

Membranous obstruction of the inferior vena cava and hepatocellular carcinoma in South Africa.

This study was undertaken to establish the frequency of membranous obstruction of the inferior vena cava in South Africa, to characterize the pathology of the lesion and to define its relationship to hepatocellular carcinoma. Over a 9-yr period 101 cases of membranous obstruction of the inferior vena cava into the right atrium was occluded in all cases in which it was examined, and two basic patterns of the abnormality in the hepatic portion of the inferior vena cava have been described. The histologic picture in the liver was a chronic congestive fibrosis. In 44 cases of congestive fibrosis, diagnosed from liver biopsy specimens from black patients over a 5-yr period, vena caval membranes were demonstrated on cavography in 38 (86.4%). Hepatocellular carcinoma developed in 48 of the 101 cases (47.5%), indicating the importance of this defect in the pathogenesis of hepatocellular carcinoma in South Africa.

The causes and consequences of chronic hepatic venous outflow obstruction.

The causes of chronic hepatic venous outflow obstruction are membranous obstruction of the inferior vena cava (group 1), hepatic venous ostial obstruction (group 2) and partial hepatic venous ostial obstruction (group 3). At the H. F. Verwoerd and Kalafong Hospitals, Pretoria, 155 cases have been diagnosed, almost all in the first group. Over 50% of the patients in this series had hepatocellular carcinoma; this association appears to be a constant finding world-wide. The most likely cause is a chronic hepatocaval thrombosis with organisation, leading to fibrous stenosis or membranous occlusion of the involved veins.

Non-Hodgkin's lymphoma in pregnancy.

Non-Hodgkin's lymphoma associated with pregnancy is rare. To date, only 1 case in which lymphoma was diagnosed and treated during pregnancy, with normal pregnancy outcome, has been reported. We describe another case where life-threatening, diffuse, poorly differentiated lymphocytic lymphoma was diagnosed during the 13th week of pregnancy. Combination chemotherapy (cyclophosphamide, vincristine, bleomycin, and prednisone) resulted in remission and a health full-term infant was born.

Exogenous ochronosis and pigmented colloid milium from hydroquinone bleaching creams.

An outbreak of ochronosis and colloid milium is described after the use of strong hydroquinone bleaching creams. These phenomena developed only after a few years, and took place when the melanocytes had overcome the bleaching influence. Sun-exposure and thorough inunction of the cream were required for the more advanced changes. Analogous changes have been seen when the skin is exposed to certain crude fuels in individuals working in the sun, and phenolic components in the fuels are suspected. The study presented here covers the clinical, histological, histochemical, electron microscopical and pathogenetic features as seen in thirty-five cases of hydroquinone damage to the dermis in South Africa.

Bizarre parosteal osteochondromatous proliferation of a phalanx.

A rare proliferative osteochondromatous malformation of a proximal phalanx is described. This malformation may mimic the appearance of a sessile osteochondroma or parosteal osteosarcoma on X-rays and may be mistaken for a low-grade osteosarcoma on histology, with disastrous therapeutic consequences. We found that cryotherapy followed by local excision was adequate to remove the tumour.

Cardiovascular causes of death at Tshepong Hospital in 1 year, 1989-1990. A necropsy study.

Cardiovascular disease is the third most common cause of death in Tshepong Hospital in the western Transvaal, and the most common cause of death in patients older than 35 years. A prospective study was undertaken which included limited necropsies in 90 of the 167 cardiovascular disease deaths over 1 year. A reliable mortality pattern for cardiovascular deaths is described. Additionally, attention is paid to co-existing conditions. Conditions relating to cardiovascular disease, such as hypertension, benign hypertensive nephrosclerosis, atherosclerosis and obesity, were also evaluated. Cerebrovascular conditions were found in 32% of cardiovascular deaths. Intracerebral haemorrhage was found in 50% and cerebral infarction in 29% of cases. Fifty-seven per cent of cardiovascular deaths were due to cardiac conditions, the most common being pulmonary hypertension (31%), dilated cardiomyopathy and chronic rheumatic valvular disease (17% each) and hypertensive heart disease (14%). Forty-nine per cent of subjects were hypertensive, while 40% exhibited benign nephrosclerosis and only 3% of the examined vessels had signs of severe atherosclerosis. Tuberculosis was present in 13% of cases. The clinical diagnosis was the same as the final necropsy diagnosis in 38% of cases. These results emphasise the importance of performing necropsies to obtain reliable mortality statistics.

Gross anatomic features of hepatocellular carcinoma from three disparate geographic areas. Proposal of new classification.

A comparison of the gross pattern of hepatocellular carcinoma (HCC) was made using autopsy material from Japan (378 cases), the United States (90 cases), and South Africa (61 cases). The tumor could be placed in three major gross patterns only if subcategories of each were created. The common major patterns were expanding, spreading, and multifocal. There was a relationship of gross pattern to the presence or absence of prior liver disease, and there were differences in frequency of occurrence of the various gross types in the material from the above-mentioned countries.

Human papillomavirus DNA in aerodigestive squamous carcinomas demonstrated by means of in situ hybridisation.

A series of 10 oesophageal and 10 laryngeal squamous carcinomas was examined by means of immunocytochemistry and in situ DNA hybridisation to demonstrate human papillomavirus (HPV) infection. Changes in the epithelium adjacent to the carcinoma were found in 5 of 10 oesophageal and 7 of 10 laryngeal carcinomas. Viral antigens could not be detected with immunocytochemistry in any of the specimens. HPV 6, 11 and 16 were detected in 3 oesophageal specimens. In one of these, HPV 16 was detected in normal as well as malignant cells. HPV 7 was detected for the first time in a laryngeal carcinoma. Our results confirm previous reports of possible HPV involvement in the pathogenesis of aerodigestive carcinomas.

Hepatitis B surface antigen and primary liver cancer.

Sera of 184 patients were examined to determine the incidence of hepatitis B surface antigen (HBsAg). Ninety-two patients had primary liver cancer (PLC) and there were 92 matched controls. Thirty-one of the 92 patients with PLC and 8 of the 92 patients with no clinical evidence of liver disease had radio-immunoassay-positive tests for HBsAg. The difference was significant (P less than 0,01). In 56 of the patients with PLC it was possible to assess the nature of associated liver disease histologically. HBsAg was found in the sera of 66,6% of patients with postcollapse cirrhosis and in 22,2% of patients with chronic Budd-Chiari syndrome. It is likely that the role played by hepatitis B infection in the pathogenesis of PLC varies according to local circumstances in different geographical areas.

Pachydermatous eosinophilic dermatitis.

We report three South African black teenage girls with extensive pruritic papular lesions arising on a pachydermatous base, resembling severe atopic dermatitis or onchodermatitis. All three had peculiar hypertrophic genital lesions and peripheral blood eosinophilia. Histological studies showed an eosinophil-rich lymphohistiocytic infiltrate and variable fibrosis. Extensive fibrillar extracellular deposition of eosinophil granule major basic protein was demonstrated by an indirect immunofluorescence technique. A beneficial therapeutic effect was obtained using dapsone, prednisolone and cetirizine. The term pachydermatous eosinophilic dermatitis is proposed and its position among other conditions characterized by peripheral blood and skin tissue eosinophilia, is discussed.

Acquired immunodeficiency syndrome. A report of 2 South African cases.

This report documents the first 2 cases of the acquired immunodeficiency syndrome in male homosexuals identified in South Africa. Both patients died of Pneumocystis carinii pneumonia and both had cytomegalovirus infection. Neither had peripheral lymphadenopathy and in both cases the lymph nodes showed cortical and paracortical atrophy with marked plasma cell and histiocytic infiltration. It is suggested that this lymph node pattern represents the morphological expression of the immunological defect in this syndrome.

Causes of death at Tshepong, a rural hospital, 1986-1987.

A prospective study was undertaken to determine causes of death at Tshepong Hospital in the western Transvaal over 1 year. Specific attention was paid to the accurate coding of causes of death; this entailed discussions with the attending doctor as well as 38 autopsies. Only 2.4% of deaths were coded under 'symptoms, signs and ill-defined conditions'. The 1046 deaths followed a typical Third-World pattern when classified according to the International Classification of Diseases (1979). Deaths during the perinatal period were additionally classified according to the recommendations of the Third Conference on Priorities in Perinatal Care in South Africa. The commonest cause of death was conditions originating in the perinatal period (19.2%), followed by infections and parasitic diseases (15.9%), diseases of the circulatory system (14.8%), endocrine, nutritional and metabolic diseases and immune-disorders (12.1%), and neoplasms (8.8%). The other main groups accounted for under 8% each. The commonest cause of death in all age groups above 35 years was diseases of the cardiovascular system, and the commonest cause of death among females aged 15 - 35 years was complications of pregnancy, childbirth and the puerperium. The hospital maternal mortality rate was 4.7/1,000 deliveries and the hospital perinatal mortality rate was 53/1,000 deliveries.