Detection of Chlamydia trachomatis in individual and pooled endocervical and urethral scrapes by a commercially available polymerase chain reaction.

The aim of this study was to compare a commercially available PCR kit (Amplicor, Roche) with our present routine analysis (SYVA EIA) for the detection of genital C. trachomatis infection in females. Furthermore, we wished to investigate the possibility of pooling samples for PCR analysis. Two hundred and sixty-eight consecutive female patients attending two gynecology clinics in Copenhagen, Denmark were included in this study. Compared to the number of samples regarded as true positives, PCR had a sensitivity of 100% (18/18) and EIA a sensitivity of 83.3% (15/18). The specificity of the PCR analysis was 99.2% (248/250) compared to 100% (250/250) for the EIA. By pooling patient samples (five patient samples in each pooled sample), a 39% reduction in reagent costs was obtained without affecting the sensitivity. In conclusion, the implementation of a standardized commercially available C. trachomatis PCR kit leads to a marked increase in analytical sensitivity compared to EIA without affecting the specificity. When pooled samples were analyzed, the cost per patient sample was reduced, but further large-scale studies are needed to rule out the possibility of a reduced sensitivity due to the dilution of individual patient samples.

Carboplatin and etoposide in extensive small cell lung cancer.

The combination of carboplatin and etoposide was evaluated in 61 previously untreated patients with extensive small cell lung cancer. Treatment was given at four-week intervals with 450 mg/m2 of carboplatin intravenously (i.v.) on day 1 and etoposide 100 mg/m2 i.v. on days 1-3. The response was complete in 5 (9%) and partial in 28 (50%) of the 56 evaluable patients (overall response rate 59%). The median time to progression after response as well as the median survival time in all evaluable patients was 4.6 months. WHO grade 3 and 4 leukopenia and thrombocytopenia occurred in 8% and 11% of the courses respectively. Two treatment-related deaths were registered. The combination of carboplatin and etoposide used in the present study produced acceptable response rate and toxicity, but duration of response and median survival were shorter than expected from earlier studies.

Cefetamet pivoxil in pediatric otitis media.

Cefetamet, an oral 3rd-generation cephalosporin, was investigated in 40 children with acute otitis media in a comparative randomized trial. The efficacy of 20 mg/kg cefetamet syrup in 20 patients was compared with that of 20 mg/kg cefaclor in another 20, both drugs being given orally twice daily for 7 days. Tympanocentesis was performed for every child before the initiation of antimicrobial treatment. After 7 days treatment with cefetamet pivoxil, clinical cure was obtained in 12 patients, 3 were failures and 5 could not be assessed. In the cefaclor group, 10 patients were cured, 1 improved and 9 were failures. No severe adverse events were observed with either drug.

Carboplatin and etoposide (CarE) combined with radiotherapy and vincristine, doxorubicin and cyclophosphamide (VAC) in limited small cell lung cancer. A phase II study.

Sixty-eight patients with limited small cell lung cancer were treated between April 1988 and October 1990 with combination carboplatin 450 mg/m2 i.v. on day 1 and etoposide 100 mg/m2 i.v. on days 1-3 (CarE) for two courses, followed by thoracic radiotherapy (TRT) 50 Gy, and then vincristine 1 mg/m2, doxorubicin 50 mg/m2 and cyclophosphamide 750 mg/m2 on day one (VAC) for four courses. Prophylactic cranial irradiation (30 Gy) was given to patients with CR after completion of chemotherapy. Sixty patients (89%) achieved an objective response (40% complete responses). The median time to progression was 8.5 months and median survival time 12.1 months. Predicted one- and two-year survival was 50% and 12% respectively. Myelosuppression was the main toxicity, with WHO grade 3 and 4 leukopenia occurring in 32% of VAC courses. There were 5 (7%) treatment-related deaths, all of them during VAC. We conclude that the present combination is active in terms of response rate, but it did not demonstrate any superiority in survival. The frequency of haematological toxicity was substantial during VAC courses.

Vincristine, doxorubicin and cyclophosphamide with and without etoposide in limited small cell lung cancer.

A total of 80 patients with limited disease of small cell lung cancer were randomized to receive either vincristine 1 mg/m2 (max. 2 mg), doxorubicin 50 mg/m2 and cyclophosphamide 750 mg/m2 (VAC) i.v. on day 1, or the same drugs and etoposide 80 mg/m2 i.v. daily for 3 days (VACE) every 3 weeks for nine courses. Chest irradiation was given in both regimens after the second course. The response rate was 84% for VAC (41% complete responses) and 75% for VACE (46% complete responses). The median survival time was 10 months with VAC regimen, and 14 months with VACE (difference statistically not significant). The median duration of remission was 8 months with VAC and 14 months with VACE (p = 0.03), and the median survival for complete or partial responders was 12 months and 20 months respectively (p = 0.006). Myelosuppression was significantly greater in the VACE group, and there was one treatment related death in the group receiving VACE. In this study the addition of etoposide to VAC improved the duration of response, but did not lead to longer survival of patients with limited disease of small cell lung cancer.

Combination chemotherapy in metastatic or recurrent non-small cell bronchogenic carcinoma. 5-year results.

A controlled clinical trial was performed to test two different chemotherapy regimens (doxorubicin + cyclophosphamide + vincristine versus CCNU + vincristine) in 100 patients with metastatic or recurrent non-small cell bronchogenic carcinoma. There was no significant difference between treatment groups in survival or in response. Only 4 patients had a partial remission and there were no complete responders. Median survival was 7 months and 8 patients lived over two years, one patient is still alive (65 + months). The benefit of combined chemotherapy in non-small cell bronchogenic carcinoma remains minimal.

Maintenance of cochlear function with artificial oxygen carriers.

By means of vascular perfusion via the anterior inferior cerebellar artery with a blood substitute containing the perfluorochemical FC 47 as oxygen carrier, it is possible to maintain normal or near normal levels of the cochlear microphonics and the endolymphatic potential of the guinea pig for perios of 90 min, or longer. Following 60 min. of perfusion with artificial blood, the levels of ATP and 5' AMP in the stria vascularis and the organ of Corti are comparable to those of nonperfused control animals maintained at optimal metabolic conditions. Following the same period of perfusion, the appearance of the organ of Corti is normal, but small vacuoles, presumably deposits of FC 47, are visible in the marginal cells of the stria vascularis. Preliminary experiments concerning the survival time and the revival time of the cochlear potentials, as well as the response to furosemide, ouabain, and mersalyl are presented to illustrate the value of this method in elucidating various biochemical and pharmacological problems of the cochlea.

Distribution of cyclic nucleotides in the organ of Corti.

Recent developments in radioimmunoassay technology have made possible measurements of cyclic nucleotides in individual specimens of the organ of Corti and its subdivisions. Steep longitudinal and transverse gradients of glycogen are known to exist in the organ of Corti of the guinea pig, with preferential accumulation in the outer hair cells of the apical turns. However, no significant longitudinal gradient of cyclic AMP was detectable in the organ of Corti, and the concentration of the compound was found to be nearly equal in the inner and outer hair cell layers. This is indirect evidence against the concept that cyclic AMP plays a role as "second messenger" in the control of glycogen metabolism of the organ of Corti. By contrast, the concentration of cyclic GMP was found to be consistently higher in the inner layer than in the outer layer of the organ of Corti, and to increase significantly in basal direction. This trend is remarkably similar to the distribution patterns of acetylcholinesterase, which may be considered as indirect evidence in favor of a possible role of cyclic GMP in the mediation of cholinergic effects.

Noxious effects upon cochlear metabolism.

The influence of various toxic substances and of drugs with ototoxic side effects upon energy generation, energy utilization, and membrane processes of the cochlea were studied. None of the drugs tested interfered with energy generation to as great an extent as did anoxia or cyanide and 2,4-dinitrophenol. Ouabain produced a pronounced interference with energy utilization of the stria vascularis. The "loop" diuretics ethacrynic acid and furosemide produced a reduction of energy utilization of a lesser degree than did ouabain. The "loop" diuretics do not seem to exert their toxic action upon strial Na+K+-ATPase, but may act by interfering with strial adenylate cyclase. Aminoglycoside antibiotics and diuretic and nondiuretic mercurials seem to exert their primary noxious action upon cochlear function by interfering with membrane processes of the structures bounding the cochlear duct.

Chemotherapy in bronchogenic carcinoma.

The effects of three different chemotherapeutic treatment regimens on the survival of one hundred inoperable lung cancer patients was studied in a randomized clinical trial. Of the patients 36 received cyclophosphamide as a single agent, 31 patients actinomycin D--vincristine combination and 33 patients cyclophosphamide--methotrexate--vincristine combination. Epidermoid carcinoma was the most sensitive to the actinomycin D--vincristine combination, whereas small cell anaplastic carcinoma responded to cyclophosphamide alone, and to the cyclophosphamide--methotrexate--vincristine combination. In spite of shrinkage of the tumour no differences were, however, observed in the survival times of the eifferent groups.

Tuberculosis of the cervical lymph nodes : a clinical, pathological and bacteriological study.

Biopsies taken from the lymph nodes of 59 consecutive patients with cervical lymph node tuberculosis were examined bacteriologically and histologically. The series consisted of 18 men (mean age 40 years) and 41 women (mean age 46 years). Mycobacteria were isolated from 41 specimens (69 per cent), M. tuberculosis from 40 patients and a mycobacterium of the M. avium-M. intracellulare complex from one. All the M. tuberculosis strains were sensitive to streptomycin, isoniazid and PAS. No mycobacteria were isolated from the biopsy specimens of the 10 patients who had received anti-tuberculosis drug previously. Mycobacteria were isolated equally often from caseating and non-caseating lymph nodes. In 10 specimens acid-fast bacilli could be demonstrated by staining, but attempts at isolation were unsuccessful. Nine of these 10 patients had been treated with anti-tuberculosis drugs previously. Histological examination of the specimen from which a growth of 'atypical' mycobacteria had been obtained failed to show any distinctive features. The results of treatment are given over a follow-up period of 2 years. Primary chemotherapy was not entirely successful. Of 52 patients treated in this way only 38 responded well. By contrast 19 patients were treated by a combination of chemotherapy and surgery and the outcome was satisfactory in all but one.