Single, sequential, and multiple alkylating agent therapy for multiple myeloma: a CALGB Study.

Four intravenous (IV) alkylating agent regimens were tested in 615 previously untreated patients with multiple myeloma. Patients were randomized to receive melphalan, cyclophosphamide, and carmustine in combination (MCBP), sequentially (Seq-MCBP), or in combination with doxorubicin (MCBPA). The fourth group received IV melphalan (MP) as the only alkylating agent.

Insulin-induced factitious hypoglycemic coma.

Hypoglycemia due to the ingestion of oral hypoglycemic agents or injection of insulin is a common way for chronic factitious disorder to present to physicians. Despite this fact, factitious hypoglycemic coma is rare. Because hypoglycemia is potentially fatal, with numerous sequelae, physicians need to be aware of its occurrence and method of detection.

Comparison of immunoblot analyses of spherule-endospore-phase extracellular protein and mycelial-phase antigen of Coccidioides immitis.

The extracellular proteins produced by Coccidioides immitis during growth of the spherule-endospore-phase and mycelial-phase antigen (coccidioidin) were studied by polyacrylamide gel electrophoresis followed by immunoblot analysis to detect specific serologic function. Filtrates obtained from 28- and 120-h growth of the spherule-endospore phase were compared with each other and with coccidioidin by using negative, immunoglobulin M (IgM) precipitin-positive, or complement fixation-positive pooled and single human sera followed by peroxidase-labeled anti-human IgA, IgE, IgG, or IgM (heavy chain specific) or peroxidase-labeled concanavalin A to detect the reaction. A total of 35 bands was seen in the stained gels.

Effect of L-tryptophan on electroconvulsive therapy seizure time.

L-Tryptophan, the amino acid precursor of serotonin and several other monoamines, has frequently been employed as an adjunct with tricyclic antidepressants and monoamine oxidase inhibitors to increase their effectiveness in treating affective disorders. Combined use of L-tryptophan with electroconvulsive therapy (ECT) has generally not been successful and, in fact, may actually have a deleterious effect upon treatment. A case of decreased seizure duration due to an L-tryptophan-ECT interaction is presented and its implications discussed.

Alprazolam withdrawal delirium unresponsive to diazepam: case report.

A case is presented in which a 68-year-old man became delirious after being withdrawn from a low dosage of alprazolam. The delirium was not affected by administration of alprazolam. The authors suggest that alprazolam may have enhanced specificity for a subpopulation of benzodiazepine receptors.

Sleep apnea in Alzheimer's dementia: correlation with mental deterioration.

In a prospective study of sleep-disordered breathing among healthy elderly controls (N = 23), major depressives (N = 17), and demented patients with probable Alzheimer's disease (N = 21), sleep apnea (defined as an apnea index of 5 or more) was found in 42.9% of demented patients, 17.6% of depressives, and 4.

The role of lumbar puncture in the evaluation of dementia: the University of Pittsburgh Study.

In a retrospective study of 80 patients over 55 years old, the efficacy of lumbar puncture in evaluating elderly demented patients was examined. Despite a cost of $381 per procedure, in addition to cerebrospinal fluid (CSF) evaluation, no diagnosis was made on the basis of the information obtained in any of the patients (53 per cent) who underwent lumbar puncture. The only abnormalities found were 11 cases of nonspecific elevations in CSF protein and one case of abnormal cellularity not related to bacterial infection.

EEG sleep in elderly depressed, demented, and healthy subjects.

In a prospective study of EEG sleep patterns in 25 elderly depressives, 25 elderly demented patients, and 25 healthy, elderly control subjects, the sleep of depressives was characterized by reduced REM sleep latency, increased REM percent and first REM period density, and altered temporal distribution of REM sleep, as well as by diminished sleep maintenance (correlated significantly with Hamilton ratings of depression: multiple R = -0.42, p less than 0.05).

Cultural phenomenology and residency training revisited: a personal account.

A field experience in the Northern Galilee area of Israel is described by a Senior American Resident in Psychiatry, with emphasis on the cultural aspects of the experience as well as the benefits related to professional maturation. The author discusses the field experience as part of a residency education, invites other such experiences, and compares his own experiences with others described in the literature.

Pathogenicity of the basidiospores of Filobasidiella neoformans.

The pathogenicity of the purified basidiospores of Filosbasidiella neoformans was determined. The basidiospores were purified by successive filtration and inoculated into white Swiss female mice via the intracranial and intravenous route. At autopsy, infection was seen with as few as fifty inoculated cells.

Pathogenicity of the hyphae of Filobasidiella neoformans.

The pathogenicity of the purified hyphae of Filobasidiella neoformans was determined. The hyphal particles were inoculated into white Swiss female mice via the intracranial and intravenous route. Upon autopsy, infection was seen with as few as 25 hyphal elements.

In vitro synergistic activity of ethambutol, isoniazid, kanamycin, rifampin, and streptomycin against Mycobacterium avium-intracellulare complex.

Strains of Mycobacterium avium-intracellulare complex often exhibit in vitro resistance to common antimycobacterial agents. Combinations of etambutol, isoniazid, kanamycin, rifampin, and streptomycin were tested to determine if synergism occurred. Ninety-six percent of the strains were susceptible to a combination of ethambutol and rifampin at concentrations attainable clinically.

Quantitative studies of the secretion of complement component C3 by resident, elicited and activated macrophages. Comparison with C2, C4 and lysosomal enzyme release.

To quantitate the secretion of complement component C3 by guinea pig peritoneal macrophages an enzyme-linked immunosorbent assay was developed. C3 secretion was studied in resident, elicited and activated macrophages and compared with release of hemolytically active C2 and C4, as well as the lysosomal enzyme beta-D-2-acetamido-2-deoxyglucosidase. Resident macrophages secreted about 6 ng C3/10(6) cells/h into culture supernatants over a period of 12 h.

Technique for the purification of the hyphae of Filobasidiella neoformans.

A technique for the purification of the hyphae of Filobasidiella neoformans is described. Cultural conditions and strains for maximal hyphal production were determined. Blastospores were separated from hyphae by sonification of mycelial suspensions.

Rapid selective urease test for presumptive identification of Cryptococcus neoformans.

A rapid simplified screening method that selectively detected the urease activity of 99.6% of 286 isolates of Cryptococcus neoformans within 15 min was developed for use in clinical microbiology laboratories.