ABSTRACT
OBJECTIVES: To describe the diagnostic tests used and their comparative performance in dogs diagnosed with sinonasal aspergillosis in the United Kingdom. A secondary objective was to describe the signalment, clinical findings and common clinicopathologic abnormalities in sinonasal aspergillosis. MATERIALS AND METHODS: A multi-centre retrospective survey was performed involving 23 referral centres in the United Kingdom to identify dogs diagnosed with sinonasal aspergillosis from January 2011 to December 2021. Dogs were included if fungal plaques were seen during rhinoscopy or if ancillary testing (via histopathology, culture, cytology, serology or PCR) was positive and other differential diagnoses were excluded. RESULTS: A total of 662 cases were entered into the database across the 23 referral centres. Four hundred and seventy-five cases met the study inclusion criteria. Of these, 419 dogs had fungal plaques and compatible clinical signs. Fungal plaques were not seen in 56 dogs with turbinate destruction that had compatible clinical signs and a positive ancillary test result. Ancillary diagnostics were performed in 312 of 419 (74%) dogs with observed fungal plaques permitting calculation of sensitivity of cytology as 67%, fungal culture 59%, histopathology 47% and PCR 71%. CLINICAL SIGNIFICANCE: The sensitivities of ancillary diagnostics in this study were lower than previously reported challenging the clinical utility of such tests in sinonasal aspergillosis. Treatment and management decisions should be based on a combination of diagnostics including imaging findings, visual inspection, and ancillary testing, rather than ancillary tests alone.
Subject(s)
Aspergillosis , Dog Diseases , Dogs , Animals , Dog Diseases/diagnosis , Dog Diseases/microbiology , United Kingdom/epidemiology , Retrospective Studies , Aspergillosis/veterinary , Aspergillosis/diagnosis , Male , Female , Sensitivity and SpecificityABSTRACT
OBJECTIVES: To report clinical and laboratory features, treatment responses and outcome in dogs diagnosed with sterile steroid-responsive lymphadenitis in the United Kingdom. MATERIALS AND METHODS: Medical records of dogs diagnosed with sterile steroid-responsive lymphadenitis from 2009 to 2016 at six specialist referral centres were evaluated retrospectively. RESULTS: The study included 49 dogs. Springer spaniels appeared to be over-represented (16 of 49 dogs). Young dogs (median age: 3 years and 9 months) and females (31 of 49) were frequently affected. Clinical presentation was variable, with pyrexia (39 of 49), lethargy (35 of 49) and anorexia (21 of 49) the most commonly reported clinical signs. Lymph node cytology or histopathology demonstrated neutrophilic, pyogranulomatous, granulomatous or necrotising lymphadenitis without a detectable underlying cause in all cases. Because a sterile immune-mediated aetiology was suspected, all dogs received prednisolone, which was followed by rapid resolution of clinical signs and lymphadenopathy in most cases. CLINICAL SIGNIFICANCE: Sterile steroid-responsive lymphadenitis should be considered in dogs with pyrexia of unknown origin with inflammatory lymphadenopathy if no underlying cause can be found and often responds well to immunosuppressive corticosteroid therapy.
Subject(s)
Dog Diseases , Lymphadenitis/veterinary , Animals , Dogs , Female , Prednisolone , Retrospective Studies , United KingdomABSTRACT
OBJECTIVES: To investigate the prevalence of leishmaniasis in dogs in the UK and to describe clinical presentation, clinicopathological abnormalities, therapeutic protocols and outcome in this non-endemic country. MATERIALS AND METHODS: Medical records of dogs diagnosed with leishmaniasis at seven referral centres in the UK were retrospectively reviewed. RESULTS: The prevalence was between 0·007 and 0·04% with a higher number of cases in southern England. All dogs had a history of travel to or from an endemic country. Lethargy, dermatological disease, decreased appetite and lameness were the most common reasons for presentation. Allopurinol was used alone for treatment in the majority of cases. CLINICAL SIGNIFICANCE: Although rare, leishmaniasis should be considered in dogs in the UK if they have compatible clinical signs and history of travel to or from endemic areas.
Subject(s)
Disease Outbreaks/veterinary , Dog Diseases/epidemiology , Leishmaniasis/veterinary , Allopurinol/therapeutic use , Animals , Disease Reservoirs/veterinary , Dog Diseases/drug therapy , Dog Diseases/parasitology , Dogs , England/epidemiology , Female , Leishmaniasis/epidemiology , Male , Medical Records , Zoonoses/prevention & controlABSTRACT
Three UK bred Border collie puppies were presented for investigation of pyrexia and severe lameness with associated joint swelling. Investigations revealed neutropenia, radiographic findings suggesting metaphyseal osteopathy, and polyarthritis and all dogs were subsequently confirmed with trapped neutrophil syndrome. Clinical improvement was seen after treatment with prednisolone and antibiotics and the dogs all survived to adulthood with a good short- to medium-term outcome. Trapped neutrophil syndrome is an important differential diagnosis for young Border collie dogs in the UK presenting with pyrexia, neutropenia and musculoskeletal signs.
Subject(s)
Dog Diseases/diagnosis , Neutropenia/veterinary , Animals , Anti-Bacterial Agents/therapeutic use , Arthritis/diagnosis , Arthritis/drug therapy , Arthritis/genetics , Arthritis/veterinary , Dog Diseases/drug therapy , Dog Diseases/genetics , Dogs , Female , Fever/diagnosis , Fever/drug therapy , Fever/genetics , Fever/veterinary , Leukocyte Count/veterinary , Male , Neutropenia/diagnosis , Neutropenia/drug therapy , Neutrophils , Prednisolone/therapeutic use , Syndrome , United KingdomABSTRACT
Glucose transport across the enterocyte brush border membrane by sodium/glucose cotransporter-1 (SGLT1, coded by Slc5a1) is the rate-limiting step for intestinal glucose transport. The relevance of SGLT1 expression in predisposition to diabetes mellitus and to obesity was investigated in dogs. Cultured Caco-2/TC7 cells were shown to express SGLT1 in vitro. A 2-kbp fragment of the Slc5a1 5' flanking region was cloned from canine genomic DNA, ligated into reporter gene plasmids, and shown to drive reporter gene expression in these cells above control (P < 0.001). To determine the effect of the 3 known SNPs in this region on promoter function, new promoter/reporter constructs (all permutations of these 3 SNPs) were created by site-directed mutagenesis. No significant differences in promoter function were seen, suggesting that these SNPs do not have a significant effect on the constitutive transcription of SGLT1 mRNA in dogs. A search for novel SNPs in this region in dogs was made in 2 breeds predisposed to diabetes mellitus (Samoyed and cairn terrier), 2 breeds that rarely develop diabetes (boxer and German shepherd), and 2 breeds predisposed to obesity (Labrador retriever and cocker spaniel). The Slc5a1 5' flanking region was amplified from 10 healthy individuals of each of these breeds by high-fidelity PCR with the use of breed-labeled primers and sequenced by pyrosequencing. The sequence of the Slc5a1 5' flanking region in all individuals of all breeds tested was identical. On this evidence, variations in Slc5a1 promoter sequence between dogs do not influence the pathogenesis of diabetes mellitus or obesity in these breeds.
Subject(s)
Diabetes Mellitus/veterinary , Dog Diseases/metabolism , Obesity/veterinary , Sodium-Glucose Transporter 1/metabolism , Animals , Biological Transport , Caco-2 Cells , Cloning, Molecular , Diabetes Mellitus/genetics , Diabetes Mellitus/metabolism , Dog Diseases/genetics , Dogs , Genetic Predisposition to Disease , Humans , Mutagenesis, Site-Directed/veterinary , Obesity/genetics , Obesity/metabolism , Polymerase Chain Reaction/veterinary , Polymorphism, Single Nucleotide , Promoter Regions, Genetic , Sequence Analysis, DNA , Sodium-Glucose Transporter 1/genetics , Transfection/veterinaryABSTRACT
We have employed a unique spectroscopic approach, a resonant inelastic soft x-ray scattering (RIXS) map, to identify and separate electron-hole correlation effects in core-level spectroscopy. With this approach, we are able to derive a comprehensive picture of the electronic structure, separating ground state properties (such as the HOMO-LUMO separation) from excited state properties (such as the C 1s core-exciton binding energy of C(60)). In particular, our approach allows us to determine the difference between core- and valence exciton binding energies in C(60) [0.5 (±0.2) eV]. Furthermore, the RIXS map gives detailed insight into the symmetries of the intermediate and final states of the RIXS process.
ABSTRACT
Epithelial cells lining the inner surface of the intestinal epithelium are in direct contact with a lumenal environment that varies dramatically with diet. It has long been suggested that the intestinal epithelium can sense the nutrient composition of lumenal contents. It is only recently that the nature of intestinal nutrient-sensing molecules and underlying mechanisms have been elucidated. There are a number of nutrient sensors expressed on the luminal membrane of endocrine cells that are activated by various dietary nutrients. We showed that the intestinal glucose sensor, T1R2+T1R3 and the G-protein, gustducin are expressed in endocrine cells. Eliminating sweet transduction in mice in vivo by deletion of either gustducin or T1R3 prevented dietary monosaccharide- and artificial sweetener-induced up-regulation of the Na+/glucose cotransporter, SGLT1 observed in wild-type mice. Transgenic mice, lacking gustducin or T1R3 had deficiencies in secretion of glucagon-like peptide 1 (GLP-1) and, glucose-dependent insulinotrophic peptide (GIP). Furthermore, they had an abnormal insulin profile and prolonged elevation of postprandial blood glucose in response to orally ingested carbohydrates. GIP and GLP-1 increase insulin secretion, while glucagon-like peptide 2 (GLP-2) modulates intestinal growth, blood flow and expression of SGLT1. The receptor for GLP-2 resides in enteric neurons and not in any surface epithelial cells, suggesting the involvement of the enteric nervous system in SGLT1 up-regulation. The accessibility of the glucose sensor and the important role that it plays in regulation of intestinal glucose absorption and glucose homeostasis makes it an attractive nutritional and therapeutic target for manipulation.
Subject(s)
Dietary Carbohydrates/metabolism , Enteric Nervous System/metabolism , Glucose/metabolism , Intestinal Mucosa/metabolism , Signal Transduction , Animals , Homeostasis , Humans , Receptors, G-Protein-Coupled/metabolism , Sodium-Glucose Transporter 1/metabolism , Transducin/metabolismABSTRACT
The domestic cat (Felis catus), a carnivore, naturally eats a very low carbohydrate diet. In contrast, the dog (Canis familiaris), a carno-omnivore, has a varied diet. This study was performed to determine the expression of the intestinal brush border membrane sodium/glucose cotransporter, SGLT1, sweet receptor, T1R2/T1R3, and disaccharidases in these species adapted to contrasting diets. The expression (this includes function) of SGLT1, sucrase, maltase and lactase were determined using purified brush border membrane vesicles and by quantitative immunohistochemistry of fixed tissues. The pattern of expression of subunits of the sweet receptor T1R2 and T1R3 was assessed using fluorescent immunohistochemistry. In proximal, middle, and distal small intestine, SGLT1 function in dogs was 1.9- to 2.3-fold higher than in cats (P = 0.037, P = 0.0011, P = 0.027, respectively), and SGLT1 protein abundance followed an identical pattern. Both cats and dogs express T1R3 in a subset of intestinal epithelial cells, and dogs, but not cats, express T1R2. In proximal and middle regions, there were 3.1- and 1.6-fold higher lactase (P = 0.006 and P = 0.019), 4.4- and 2.9-fold higher sucrase (both P < 0.0001), and 4.6- and 3.1-fold higher maltase activity (P = 0.0026 and P = 0.0005), respectively, in the intestine of dogs compared with cats. Dogs have a potential higher capacity to digest and absorb carbohydrates than cats. Cats may suffer from carbohydrate malabsorption following ingestion of high-carbohydrate meals. However, dogs have a digestive ability to cope with diets containing significant levels of carbohydrate.
Subject(s)
Cats/metabolism , Diet , Disaccharidases/metabolism , Dogs/metabolism , Intestinal Mucosa/metabolism , Receptors, Cell Surface/metabolism , Sodium-Glucose Transporter 1/metabolism , Amino Acid Sequence , Animals , Carbohydrate Metabolism/physiology , Female , Glucose/metabolism , Male , Microvilli/metabolism , Molecular Sequence DataABSTRACT
We study the electronic structure of zinc phthalocyanine (ZnPc) and 1,4-octa-decyl substituted zinc phthalocyanine [(Dec)(8)PcZn] thin films (approximately 6-15 nm) using resonant photoemission spectroscopy and X-ray absorption spectroscopy (XAS) at room temperature and at liquid He temperature. From XAS we conclude that the probability amplitude of the lowest unoccupied molecular orbital is located predominantly at the inner C and N atoms of the molecules. Nonlinear energy shifts in resonant photoemission were observed; large shifts are explained by reduced electrical conductivity of inhomogeneously oriented molecules.
ABSTRACT
The excitement of nano-test-tube chemistry in a single-walled carbon nanotube is exemplified in our study on electron doping in carbon nanotubes. Electron doping through the 1D van Hove singularity of single-walled carbon nanotubes is realized via a chemical reaction of an encapsulated organocerium compound, CeCp3. The decomposition of CeCp3 inside the carbon nanotubes increases the doping level and greatly enhances the density of conduction electrons. The transition of the cerium encapsulating semiconducting tubes to metallic results in enhanced screening of the photoexcited core hole potential. This fact illustrates the importance of many body effects in understanding core-level excitation process in carbon nanotubes.
ABSTRACT
We present a high-resolution photoelectron spectroscopy investigation of condensed films of benzene, naphthalene, anthracene, tetracene, and pentacene. High spectroscopic resolution and a systematic variation of the molecular size allow a detailed analysis of the fine structures. The line shapes of the C 1s main lines are analyzed with respect to the different contributions of inhomogeneous broadening, vibronic coupling, and chemical shifts. The shake-up satellite spectra reveal trends, which give insight into the charge redistribution within the molecule upon photoexcitation. In particular, the shake-up between the highest occupied molecular orbital (HOMO) and the lowest unoccupied molecular orbital (LUMO) increases in intensity and moves closer toward the C 1s main line if the size of the aromatic system is increased. An explanation is given on the basis of the delocalization of the aromatic system and its capability in screening the photogenerated core hole. A comparison of the HOMO-LUMO shake-up position to the optical band gap gives additional insight into the reorganization of the electronic system upon photoexcitation.
ABSTRACT
We report a substantial prevalence study in symptomatic pet dogs of important zoonotic parasitic enteric infections. A total of 4526 dogs which had a faecal sample submitted to a diagnostic laboratory in the UK between 2003 and 2005 were included in the study. The most common parasite was Giardia spp., which was found in 380/4526 dogs (8.4%, 95% CI 7.6-9.2%). Surprisingly, Cryptosporidium spp. infection was detected in only 29/4526 (0.6%, 95% CI 0.4-0.9%). Toxocara canis was found in 63/4526 dogs (1.4%; 95% CI 1.1-1.8%). Prevalence of Giardia (P < 0.001) was significantly higher in dogs <12 months of age, with nearly one-fifth of all symptomatic dogs under 6 months being infected with Giardia. Some seasonality was detected with a higher prevalence of Cryptosporidium oocyst shedding found from October to December. These data are of importance for veterinarians in judging the likelihood of enteric parasitic infection in an individual with clinical signs. Moreover, they provide information to direct future work in determining the risk to the human population from parasitic zoonoses of dogs.
Subject(s)
Dog Diseases/epidemiology , Dog Diseases/transmission , Intestinal Diseases, Parasitic/veterinary , Animals , Dog Diseases/etiology , Dog Diseases/parasitology , Dogs , Feces/parasitology , Female , Giardia/isolation & purification , Humans , Intestinal Diseases, Parasitic/epidemiology , Intestinal Diseases, Parasitic/transmission , Male , Prevalence , Retrospective Studies , Seasons , Toxocara canis/isolation & purification , United Kingdom/epidemiology , ZoonosesABSTRACT
We present x-ray photoemission spectroscopy and highly resolved near-edge x-ray absorption fine structure spectroscopy measurements taken on pentacene thin films of different thicknesses deposited on a spin coated poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) substrate. Thin films of pentacene were prepared by using organic molecular beam deposition in situ using strictly controlled evaporation conditions. Our investigations show that pentacene thin films on PEDOT:PSS are characterized by upright standing molecules. Due to the strong dichroic behavior, the calculated values of the molecular orientation give a clear indication not only of the real molecular arrangement in the films but also of a high orientational order. This high degree of molecular orientation order is a characteristic already of the first layer. The films show the tendency to grow on the PEDOT:PSS substrate following an island-fashion mode, with a relatively narrow intermixing zone at the interface between the pentacene and the polymer blend. The peculiarity of the growth of pentacene on PEDOT:PSS is due to the fact that the substrate does not offer any template for the nucleated films and thus exerts a lateral order toward the crystal structure arrangement. Under these conditions, the upright orientation of the molecules in the films minimizes the energy required for the system stability.
ABSTRACT
We report on a combined experimental and theoretical carbon and nitrogen K-edge near-edge x-ray absorption fine structure investigation on condensed metal-free phthalocyanine (H2Pc). Based on the results from improved virtual orbital calculations, all resonances in the experimental high-resolution data can be assigned to various electronic transitions. The comparison between experiments and calculations further shows that a significant influence of the core hole, which affects both the transition energies and the cross sections, is present and must be considered in theoretical approaches. Moreover, additional fine structure is clearly resolved for the first N 1s-->pi* transition, which can be interpreted as vibronic coupling to the electronic core excitation.
ABSTRACT
CASE HISTORY: A 6-year-old, entire male Flat-coated Retriever was presented with a history of lethargy, polydipsia and seizures. Clinical chemistry had shown marked azotaemia. CLINICAL FINDINGS AND DIAGNOSIS: Radiography and ultrasonography revealed bilateral renomegaly, and cytology of fine needle aspirates from the kidneys was diagnostic of malignant lymphoma. The dog was treated with a modified high-dose cyclophosphamide-, vincristine-, and prednisolone-based chemotherapy protocol, achieved remission, and returned to normal quality of life. Survival time was 346 days from the time of diagnosis. CLINICAL RELEVANCE: Malignant lymphoma in the kidneys of dogs has been considered to carry a uniformly poor prognosis. Long-term remission after medical treatment has not previously been reported. The favourable outcome in this case illustrates the limitations of clinical staging in determining the outcome for individual patients.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Dog Diseases/drug therapy , Kidney Neoplasms/drug therapy , Lymphoma/drug therapy , Animals , Dogs , Male , Neoplasm Staging , Prognosis , Survival Analysis , Treatment OutcomeABSTRACT
The clinical, anaesthetic and surgical records of 142 bitches admitted into the primary care clinic at the Small Animal Hospital, University of Liverpool, between January 2002 and August 2004 for routine ovariohysterectomy by final-year students were analysed for complications during and after the surgery. The time taken to perform the surgical procedure was recorded, to allow assessment of the time involved in one-to-one surgical teaching during live-recovery surgeries of client-owned pets. The types of complications were similar to those reported in earlier studies: nine bitches suffered haemorrhage of the ovarian arteries during surgery, and there were four cases of haemorrhage after surgery, 12 cases of wound inflammation and four other types of complication. The rates of intraoperative, postoperative and total complications were 6.3, 14.1 and 20.6 per cent, respectively.
Subject(s)
Dogs/surgery , Education, Veterinary/standards , Hysterectomy/veterinary , Intraoperative Complications/veterinary , Ovariectomy/veterinary , Postoperative Complications/veterinary , Animals , Clinical Competence , Education, Veterinary/statistics & numerical data , Female , Hemorrhage/epidemiology , Hemorrhage/etiology , Hemorrhage/veterinary , Hysterectomy/adverse effects , Hysterectomy/methods , Intraoperative Complications/epidemiology , Ovariectomy/adverse effects , Ovariectomy/methods , Postoperative Complications/epidemiology , Time FactorsABSTRACT
Insulin-like growth factor-I is a neurotrophic factor and can prevent neurons from ischemic brain injury. However, the large molecular weight and metabolic effects can be problematic in its central delivery. Glycine-proline-glutamate (GPE) is the N-terminal tripeptide of insulin-like growth factor-I, which is naturally cleaved in the plasma and brain tissues. GPE reduces neuronal loss from hypoxic-ischemic brain injury following central administration. Central penetration and the stability of GPE in the plasma and central nervous system were examined in rats using radioimmunoassay and HPLC. GPE was rapidly metabolised in the plasma (8 min) after intraperitoneal administration. Despite having a short half-life in plasma, GPE was detected in the cerebrospinal fluid up to 40 min after intraperitoneal administration. With present of peptidase inhibitors, GPE existed in the brain tissue up to 3 h after intracerebroventricular administration, suggesting a role for peptolysis in its stability. The endopeptidase inhibitors 4- (2-aminoethyl) benzenesulfonyl fluoride hydrochloride (AEBSF) reduced GPE metabolism in the brain tissue while acid peptidase inhibitor pepstatin-A decreased GPE metabolism in the plasma. GPE reduced neuronal loss in the CA1-2 sub-region of the hippocampus given (intraperitoneally) after 30 min of hypoxic-ischemic injury in adult rats, further suggested the effectiveness of GPE central uptake. These results indicated that GPE crosses the blood-CSF and the functional CSF-brain barriers. The longer half-life of GPE in the CNS may be due to its unique enzymatic stability.
Subject(s)
Brain/metabolism , Insulin-Like Growth Factor I/metabolism , Leucine/analogs & derivatives , Oligopeptides/metabolism , Oligopeptides/pharmacokinetics , Animals , Cerebrospinal Fluid/chemistry , Drug Stability , Hippocampus/drug effects , Hypoxia-Ischemia, Brain/drug therapy , Kinetics , Leucine/pharmacology , Male , Oligopeptides/administration & dosage , Pepstatins/pharmacology , Peritoneum/drug effects , Protease Inhibitors/pharmacology , Rats , Rats, WistarABSTRACT
Glycine-proline-glutamate (GPE) is the N-terminal tripeptide of insulin-like growth factor-1 and has been shown to be neuroprotective following ischemia-induced brain injury. The pharmacokinetics of GPE were studied in adult rats since GPE is a candidate for use in neuroprotection therapies. To measure plasma concentrations of GPE a novel radioimmunoassay was developed whereby GPE was initially derivatized with Bolton and Hunter reagent before use in a standard homologous assay against the Bolton and Hunter iodinated form. The derivatized GPE radioimmunoassay showed a 83% recovery of unlabeled GPE and complete parallel displacement with rat plasma. The simplicity and speed of the assay described here indicate an exciting new use for a previously described technology. The pharmacokinetic studies were conducted in adult rats using a single bolus intravenous injection of GPE at 30 or 100 mg/kg and showed that GPE was rapidly cleared from the circulation. In addition, evidence of the route of the metabolic degradation of GPE is presented. The findings presented here are the first description of the pharmacokinetics of GPE and suggest that, because of its very short half-life in plasma, continuous intravenous infusion of GPE may be the preferred route of administration for use in future neuroprotection therapies.
Subject(s)
Insulin-Like Growth Factor I/pharmacokinetics , Oligopeptides/pharmacokinetics , Animals , Chromatography, High Pressure Liquid , Insulin-Like Growth Factor I/chemistry , Male , Peptide Fragments/chemistry , Peptide Fragments/pharmacokinetics , Radioimmunoassay , Rats , Rats, Wistar , Sensitivity and SpecificityABSTRACT
A two-dimensional integral full-wave model is used to calculate poloidal forces driven by mode conversion in tokamak plasmas. In the presence of a poloidal magnetic field, mode conversion near the ion-ion hybrid resonance is dominated by a transition from the fast magnetosonic wave to the slow ion cyclotron wave. The poloidal field generates strong variations in the parallel wave spectrum that cause wave damping in a narrow layer near the mode conversion surface. The resulting poloidal forces in this layer drive sheared poloidal flows comparable to those in direct launch ion Bernstein wave experiments.
ABSTRACT
The purpose of this study is to determine the toxicity and efficacy of temozolomide (TMZ) p.o. followed by subcutaneous (s.c.) low-dose interleukin-2 (IL2), granulocyte-monocyte colony stimulating factor (GM-CSF) and interferon-alpha 2b (IFN alpha) in patients with metastatic melanoma. A total of 74 evaluable patients received, in four separate cohorts, escalating doses of TMZ (150-250 mg m(-2)) for 5 days followed by s.c. IL2 (4 MIU m(-2)), GM-CSF (2.5 microg kg(-1)) and IFN alpha (5 MIU flat) for 12 days. A second identical treatment was scheduled on day 22 and cycles were repeated in stable or responding patients following evaluation. Data were analysed after a median follow-up of 20 months (12-30 months). The overall objective response rate was 31% (23 out of 74; confidence limits 20.8-42.9%) with 5% CR. Responses occurred in all disease sites including the central nervous system (CNS). Of the 36 patients with responding or stable disease, none developed CNS metastasis as the first or concurrent site of progressive disease. Median survival was 252 days (8.3 months), 1 year survival 41%. Thrombocytopenia was the primary toxicity of TMZ and was dose- and patient-dependent. Lymphocytopenia (grade 3-4 CTC) occurred in 48.5% (34 out of 70) fully monitored patients following TMZ and was present after immunotherapy in two patients. The main toxicity of combined immunotherapy was the flu-like syndrome (grade 3) and transient liver function disturbances (grade 2 in 20, grade 3 in 15 patients). TMZ p.o. followed by s.c. combined immunotherapy demonstrates efficacy in patients with stage IV melanoma and is associated with toxicity that is manageable on an outpatient basis.