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Cultures of normal lymphocytes were induced to transform by pokeweed mitogen (PWM). Inhibition of transformation was observed when these cultures contained sera isolated from children with acute lymphoblastic leukemia (ALL). The inhibition of transformation of normal lymphocytes was best demonstrated when the concentration of the leukemic serum in the culture medium was relatively high (60 percent); however, the inhibition was also observed with a more standard serum concentration (20 percent). Not all leukemic sera were inhibitory. Pretreatment sera from newly diagnosed patients with leukocyte counts greater than 50,000/mm3 were significantly inhibitory. Pretreatment sera from newly diagnosed patients with leukocyte counts less than 50,000/mm3, and sera from patients in remission or relapse had no significant effect. The inhibition observed with the sera of the high leukocyte count group was not believed to be related to cytotoxicity. The significance of this inhibitor in relation to clinical prognosis needs to be investigated.

A patient with a 14 year history of sarcoidosis developed a progressive left cerebral hemisphere lesion. The clinical diagnosis of progressive multifocal leucoencephalopathy was confirmed by brain biopsy and remission occurred after treatment with cytosine arabinoside.

The treatment of two pregnant thyrotoxic patients with propranolol alone is discussed. One patient had a spontaneous remission during pregnancy wile taking propranolol. In the other patient treatment with propranolol allowed postponement of definitive therapy until after delivery, when the fetus was no longer at risk. There were no complications of therapy in either patient and both infants were normal. The use of propranolol in thyrotoxicosis is discussed and the pertinent literature is reviewed. Regional anesthesia is preferred over general anesthsia in patients taking propranolol. Patients taking propranolol who require general anesthesia for delivery should have continuous monitoring of electrocardiogram and central venous pressure. To this date no method of therapy has been free of fetal side effects. Surgical treatment is associated with occasional abortion or premature labor; antithyroid medication occasionally results in fetal goiter or cretinism.

A consecutive series of 18 patients with toxic megacolon has been managed with a policy of early operative intervention if optimal medical therapy has failed to effect a rapid remission. One patient achieved a sustained remission on medical management alone. Seventeen patients underwent ileostomy and colectomy. There was one death (5.6% mortality rate) in a complication of ulcerative colitis in which the average reported mortality rate has been 23.1%. It is suggested that surgical intervention be used early enough to prevent colonic perforation and the progressive metabolic deterioration that prolonged nonoperative medical management may produce. The ominous prognosis of toxic megacolon and of its surgical management in the past can be overcome by resort to earlier surgical intervention. Colectomy, rather than decompressive enterostomy, is advocated as the operative treatment of choice.

A study of the thymidine labelling index (TLI) of bone marrow blast cells in 58 untreated patients with acute myelogenous leukemia showed no correlation with remission rate but there was a strong correlation between labelling index and remission length in the 21 patients who achieved remission. The median remission length of the patients was 33 weeks. Of the 12 patients with initial labelling indices greater than 10%, only 2 had remissions longer than 33 weeks whereas 8 of the 9 patients with labelling indices less than 10% had remissions longer than 33 weeks. No correlation could be found between the degree of cytological differentiation and remission induction, remission length or survival. No correlation was found between the TLI and the degree of cytological differentiation. Age and initial platelet count were confirmed to be important factors influencing complete remission rate, but these factors did not correlate with remission length. Sixteen patients had their pretreatment sera assayed for mouse marrow colony stimulating activity and inhibitor levels but there was no correlation with subsequent response to treatment, although the number of patients examined was clearly too small for any definite conclusions to be drawn.

Of 39 patients undergoing chemotherapy for gestational trophoblastic disease, 92 per cent are in remission. More than half of the patients treated (54 per cent) had metastatic disease on admission to the hospital, and 85 per cent of these are in remission. An inordinately large number of patients were in the high-risk category (71.4 per cent), yet 80 per cent of these patients are in remission. Early diagnosis, monitoring of therapy, and determination of onset of remission require sensitive gonadotropin assays capable of detecting low levels of activity caused by small amounts of persisting tumor. Patients are subjected to unwarranted risks when monitoring is done with routine pregnancy tests alone. The predictability of drug toxicity and the need for close clinical and laboratory monitoring are stressed. Delay of therapy, change in choice of drug or dosage, and attentive supportive care are required if fatal toxic reactions are to be avoided.

Despite androgens and intensive supportive care, satisfactory survival in severe aplastic anemia remains at 20% or less. Histocompatible bone marrow transplantation can restore normal hematopoiesis in approximately 40% of similarly severe individuals. Delay of transplantation for 3 wk after diagnosis allows time for proper evaluation and for many spontaneous recoveries. Further delay increases risks of fatal complications and decreases chances for successful transplantation while the incidence of spontaneous remission declines. When available, early histocompatible bone marrow transplantation may be the treatment of choice for severe aplastic anemia.

The effect of certain disease parameters on remission and survial time was evaluated in 482 patients with multiple myeloma treated with intermittent courses of melphalan-prednisone combinations. Increasing degrees of anemia, hypercalcemia, azotemia, and high serum myeloma protein levels were associated with progressive lifespan shortening. The short survival of patients with anemia and hypercalcemia was associated with short remissions in responding patients with these abnormalities. The extent of tumor mass was defined from specific laboratory parameters reported by Durie to be associated with large numbers of plasma cells. More advanced stages of myeloma were associated with higher frequencies and degrees of normal immunoglobulin depression. The response rate was not affected by the tumor mass grade, but increasing tumor mass was associated with a shorter lifespan. Greater degrees of tumor reduction were associated with longer remission and survival times. Patients in whom a marked tumor reduction was rapid had shorter survival and remission times than patients who responded more slowly.

Three patients with an unusual clinicopathologic picture and a striking response to splenectomy are described. All three presented with fever and severe systemic symptoms, pancytopenia and splenomegaly. Two of the patients had hypogammaglobulinemia and absent delayed hypersensitivity. Atypical lymphohistiocytic proliferation consistent with lymphoma was present in the spleen in all three patients, and also in the bone marrow and abdominal lymph nodes in two. Splenectomy led to prompt and prolonged clinical remissions in all three patients, possibly of a permanent nature in one.

Seventy-five consecutive children with acute lymphoblastic leukemia (ALL) were treated with a combination drug protocol (L-2) consisting of three phases: remission induction, consolidation, and maintenance. Induction was achieved with prednisone, vincristine (VCR), and Daunorubicin (DNR). For consolidation, arabinosylcytosine (Ara-C), and 6-thioguanine (TG) followed by L-asparaginase and 1,3-bis (2-chloroethyl)-I-nitrosourea (BCNU) were used. Maintenance consisted of administration of TG, cyclophosphamide, hydroxyurea, DNR, methotrexate (MTX), BCNU, Ara-C, and VCR, given as 5-day courses. Patients received periodic injections of intrathecal MTX for “prophylaxis” of the central nervous system (CNS) leukemia throughout the treatment course which was 3 years. Seventy-four children achieved remission. Two died early in remission with serum hepatitis and I was lost to followup. Twelve patients have relapsed; in 2, the relapse was confined to CNS; in l, bone marrow and CNS relapse were concurrent. The remaining 59 have continued in complete remission from 1–42 months. Ten of the 12 children (excluding the hepatitis cases) who were registered on the L-2 protocol for periods of 36 months or more remain free of disease. The height of the initial white blood cell count was found to be strongly related to the duration of complete remission. Tolerance to this regimen was generally good, the main side effect being hematologic depression. The results represent a 43-month trial of L-2 protocol. Conclusion as to the eventual duration of remissions awaits longer followup. Cancer 33:1490–1490, 1974.

In vitro lymphocyte transformation (14C-thymidine incorporation rate following stimulation by PHA) was studied in 19 patients with histologically proven chronic aggressive hepatitis. In the majority of the cases measurements were performed prior to and during a combined (azathioprine/corticosteroid) immunosuppressive therapy. In comparison to normal controls, the majority of the patients showed a significantly reduced lymphocyte transformation before the treatment started. During the immunosuppressive therapy there was a normalization of PHA-responsiveness in most of the patients, or an improvement, at least. Bioptic control seems to be the most reliable parameter to prove a therapeutic effect, since the histologic criteria for a decrease of the inflammatory activity were the last to occur. After transient cessation of the therapy, in 4 out of 6 cases a decrease of lymphocytic PHA-responsiveness was developed again, paralleled by histologic activation of the process where biopsy could be performed. This observation favours a long-term therapy for at least several years.

Goodpasture's syndrome occurred in six patients (four men and two women) aged 18-32 years. Haemoptysis, anaemia and abnormal urinary findings with erythrocyturia were the first signs of the disease in five instances, in one the renal signs predominated. In five patients the disease took a malignant course with uraemia developing within six weeks. One patient is in a spontaneous remission eleven months after the onset of the disease. Three patients died of recurrent haemoptysis (non-nephrectomised), two nephrectomised patients are still alive half a year and three and a half years later, respectively. A typical linear IgG-, beta1A, alpha2D and beta1E deposition along the glomerular capillaries was demonstrated immunohistologically in all subjects. Of three lung biopsies one also had typical IgG and beta1A-positive linear fluorescence along the alveolar basal membrane. Immunoglobulins with basal membrane antibody activity were eluted from renal homogenates in two patients, basal membrane antibody activity in serum was demonstrated only in one of three patients.

Diaminodichloroplatinum was studied in a Phase I trial. Two dose schedules were explored. In Schedule I, a maximum dose of 100 mgJM2 given once was reached, and this proved too toxic for further use. The maximum dose in Schedule 11, 24 mg/M2 daily for 5 days, was also too toxic, so 20 mg/M2 per day for 5 days was the dose selected for further exploration. Responses were seen in 1 patient with anaplastic thyroid carcinoma, 1 with transitional cell carcinoma of the bladder, and 1 with breast cancer. In patients with testicular tumors, responses were seen in 9 of 11 patients. There were 3 complete regressions seen, 1 in seminoma, 1 in embryonal cell carcinoma, and 1 in male choriocarcinoma. Three partial regressions, and three cases of objective improvement were also seen in this series. These were also distributed over different tumor types. The possibility that diaminodichloroplatinum has a specific effect on tissues arising from the genitourinary anlage is suggested. Cancer 33:1219-1225, 1974. HE DISCHARGE OF AN ELECTRIC CURRENT T from a platinum electrode through a nutrient broth containing E. coli was found to be associated with the inhibition of bacterial replication by Rosenberg et al. The same investigators isolated several compounds containing platinum from the culture medium, and demonstrated that these agents were responsible for the alteration in the growth pattern of the organisms.8

Seventy-one adults with acute leukemia were randomized for treatment with a combination of cyclophosphamide, cytosine arabinoside, and prednisolone, with (CAPA) or without (CAP) the addition of L-asparaginase. Remissions were induced with CAPA in 9 patients (33%) with AML, and 8 patients (67%) with ALL, and with CAP in 10 patients (40%) with AML, and 4 patients (57%) with ALL. Thus, the addition of L-asparaginase did not improve the response significantly. The over-all complete remission rate was significantly higher in females (45%) than in males (23%), and the rate below 50 years of age tended to be higher (45%) than above this age (27%). There was a slight tendency for a longer first remission time in AML with L-asparaginase (284 days) than without (74 days), but no such difference between the two ALL groups. Hyper-sensitivity reactions, nausea, vomiting, psychiatric disturbances, and liver dys-function were more common side effects in patients treated with L-asparaginase.

An enzyme activity with the characteristics of reverse transcriptase was detected in marrow from patients with leukaemia in relapse and in firm haematological remission. The endogenous enzyme activities increased following culture, and in remission patients the enzyme activities reached levels equal to or exceeding those found in relapse.

The course of histoplasmosis in patients with childhood leukemia is poorly understood. Past attempts to characterize the disease have relied on single case reports, without benefit of a series of patients with similar types of leukemia and chemotherapy. Described here are the clinical course of infection, laboratory findings, and therapy in six children with acute lymphocytic leukemia and disseminated histoplasmosis. A diagnosis of histoplasmosis was most commonly encountered during remission of the leukemia in patients presenting with fever, hepatosplenomegaly, variable chest roentgenogram findings, leukopenia, and/or neutropenia. Bone marrow cultures revealed the presence of Histoplasma capsulatum in each. All six children were treated with amphotericin B and recovered from the infection.

In 12 patients suffering from ulcerative colitis the small-intestinal disaccharidase activity has been determined during an acute exacerbation of the disease as well as after remission. The lactase activity was significantly lower during the acute stage. No case of transitoric lactose malabsorption was found.

Twenty-four diabetic patients were treated with porcine protamine-insulin (NPH-insulin) containing 7–13 mmol proinsulin per mol insulin and 27 diabetic patients were treated with porcine protamine-insulin (HP-insulin) containing 0.36 mmol proinsulin per mol insulin. 75 % of the patients treated with NPH-insulin and 15 % of the patients treated with HP-insulin formed detectable insulin-binding antibodies. The difference in the antibody titre in the two groups was significant. As a group, patients treated with HP-insulin did not have a significant rise in the plasma insulin-binding capacity when compared to pre-treatment values. When comparing patients with antibodies and patients without detectable antibodies no difference in the degree of regulation could be demonstrated between the two groups. Young patients with antibodies had a higher insulin requirement per kg per day than patients without detectable antibodies. Among patients in remission those without detectable antibodies had a longer remission period than those with antibodies. Apart from the difference in antibody formation and hence a different distribution in the groups compared, the patients treated with NPH-insulin and HP-insulin did not differ with regard to the degree of regulation, the insulin requirement or the duration of the remission period.

Leukocyte migration inhibition (LMI) by choroid, retina, and uveal tract antigens was studied in patients with active and quiescent chorioretinal disease. LMI by retina was more frequent in both groups of patients, occurring in 9 of 16 patients with active disease and in 8 to 15 patients with disease in remission. Choroid was tested in 15 patients with active inflammation and led to LMI in 7 of them when they were off steroid therapy; it produced LMI in 3 of 13 patients whose disease appeared healed. Significant LMI was detected in three of six patients with active chorioretinitis and in one of five patients with evidence of past chorioretinopathy when their cells were tested with antigen made from pooled uveal tract tissue. The LMI test, regarded as an indicator of cell-mediated immunity, is briefly discussed. LMI by retina in over one-half of patients with chorioretinopathies appears to be a secondary event, and cellular immunity to retina may be of pathophysiological importance in the chronicity of the disorder.

A clinical trial of megestrol acetate (MEGACE) in 30 women with progressive disseminated breast cancer was made. The drug is a potent oral progestin with antiestrogenic activity. It was given orally 40 mg after each meal and at bedtime for 160 mg daily. No toxic reaction was observed. The drug was discontinued if no improvement was seen after 6 weeks (criteria of the Cooperative Breast Cancer Group). 7 patients showed improvement and had average objective remissions of 5.5 months. 2 continue in remission. Most of the 7 responders had prior trials with a sex hormone and with 1 or more cytotoxic compounds. 3 had had a modified Coopers 5-drug combination. Megestrol treatment following cytotoxic drugs permitted an adequate recovery of the depleted bone marrow which was often present. Megestrol acetate appears to be a useful addition to the treatment of advanced breast cancer. Results of present studies warrant extension of investigation by others.

Among 195 nephrotic children, ten developed resistance to prednisone therapy after responding to this drug on one or more occasions (late nonresponders). All were found to have "minimal lesions" on renal biopsy. Nine of these patients went into remission: one responded to further prednisone therapy, one went into remission while receiving azathioprine, and the remaining seven children responded to cyclophosphamide. Five of these seven patients subsequently relapsed; three of them have continued to respond to prednisone. The other two eventually became steroid resistant a second time, but in both instances a second course of cyclophosphamide again induced a remission. These nine patients have been followed for periods ranging from 6 months to 9.5 years (median = 53 months); all are doing well and have normal renal function. The tenth patient died from sepsis four months after the onset of steroid resistance.

Summary. Thirty-nine children with acute lymphoblastic leukaemia were divided into three groups according to proportion of macrolymphoblasts (MLb) (> 12 μm) in the pretreatment bone marrow: Group 1: 10 patients with MLb less than 10%; Group 11: 17 patients with 11–25% MLb; Group 111: 12 patients with MLb over 26%. The miorphologic findings were correlated with the clinical data, and it was noted that none of Group I patients had relapses for a median period of observation of 57 mth. In Group 11, 14 of 16 patients (one patient was lost to follow-up for first remission duration) had relapses, with a median first remission duration of 15 mth. In Group 111, 11 of 12 patients had relapses with a median first remission duration of 12 mth. Our data indicate that the microlymphoblastic variety of ALL has a better prognosis (P < 0.01) when the proportion of MLb in the pretreatment bone marrow is 10% or less.

The results of radiation therapy in 212 patients with stages I and II Hodgkin's disease treated between 1963 and 1973 show that approximately 60% remain disease-free following treatment. Multiple node involvement in stage II, particularly associated with infraclavicular node disease, is identified as a group where the relapse rate is high. This presentation is associated particularly with NS. In a group of 78 patients treated with radiotherapy following staging laparotomy and splenectomy approximately 80% remain in complete remission. The preliminary results of treatment in PS IIIa patients are substantially the same as those for PS I and II; the results of treatment for NS and MC disease are similar. The significance of involvement of the spleen is discussed. Although it is probable that Hodgkin's disease spreads to the spleen through the blood stream it is suggested that splenic involvement does not necessarily indicate that the involvement of other extralymphatic structures such as liver and marrow has occurred. However, when the nodes in the porta hepatis are involved splenic Hodgkin's disease may well be associated with an increased risk of occult hepatic infiltration.

SUMMARY Of 142 patients with psoriasis who attended a dermatological clinic in 1966, ninety were interviewed and re-examined 7 years later. Twenty-eight patients (29%) had been treated at home, fifty-eight (64%) had been treated with the Ingram regime as out-patients, and sixteen (17%) had been admitted. It was concluded that those treated as out-patients had a longer duration of remission than those treated at home. In these out-patients, the only significant indicator of the outcome was the type of psoriasis at presentation. Those presenting with guttate psoriasis had a better prognosis.

Summary After establishing the diagnosis of rheumatoid arthritis one should determine the extent to which synovitic or structural lesions are responsible for the symptoms. Because structural lesions lack the potential for recovery, a plan should be laid out for their management, by either surgical correction or acceptance of the disability. In regard to the synovitis, one should determine whether it is likely to undergo a spontaneous remission. If a remission seems likely, the physician can manage the disease with a suppressive agent, usually salicylates. If a spontaneous remission seems unlikely and the patient's function is deteriorating, a clinical trial of either gold, hydroxychloroquin, or penicillamine is in order (in conjunction with a suppressive agent). If the first drug fails, one of the others should be tried next. There is no rationale for repeating a trial of one of these drugs if it has previously failed. If all three agents fail to produce a remission, the suppressive agent should be continued, and the physican serves as the patient's “friend” and frequently will be called upon to advise the patient about the need for reconstructive surgery.

Among 120 consecutive patients with chronic active liver disease (CALD) randomized to different treatments, those receiving maintenance doses of prednisone 20 mg daily (Pred), prednisone in doses given on alternate days and titrated to secure resolution of clinical and biochemical abnormalities (Pred-Titrad), or a combination of prednisone 10 mg and azathioprine 50 mg daily (Comb) survived and underwent resolution of clinical and biochemical features of disease more often than a control group receiving placebo or azathioprine 100 mg daily. Histological remission occurred significantly more often with Pred and Comb than with other regimens. Major side-effects of therapy were commoner with Pred than with Comb or Pred-Titrad, which did not differ. We conclude that Comb is the initial treatment of choice for CALD, since clinical, biochemical, and histological resolution of disease activity occurs as often as with Pred, whereas early side-effects are significantly less frequent.

Immunocompetence was followed serially for 1 yr from the onset of treatment in 55 adult patients with acute leukemia. The tests used were delayed hypersensitivity responses to a battery of five recall antigens (dermatophytin, dermatophytin 0, candida, streptokinase-streptodornase, and mumps) and in vitro lymphocyte blastogenic responses to phytohemagglutinin and streptolysin 0. There was a strong correlation between immunocompetence at the start of treatment and a good prognosis; 32/39 patients who subsequently entered remission were initially immunocompetent compared to 4/15 who failed to enter remission. In the complete remission group there was a decline in competence starting from 2 to 5 mo after the onset of treatment. In those who remained in remission for 1 yr, competence recovered at 6 mo and remained vigorous thereafter. In those who relapsed before 1 yr, the decline in competence occurred 1 mo before relapse and competence continued to decline progressively during the 1 yr follow-up period. These studies suggest that therapeutic approaches which restore immunocompetence or prevent its decline will improve both the remission rate and the remission duration of patients with acute leukemia.

Sixteen patients (11 years to 67 years of age) with hematologic neoplasia refractory to conventional therapy were treated with cyclophosphamide (60 mg per kilogram per day on two occasions), a supralethal dose of total-body irradiation (1000 rads) and a bone-marrow transplant from a normal identical twin. Twelve patients also received immunotherapy consisting of subcutaneous injections of the patients' own leukemia cells lethally irradiated with 10,000 rads and intravenous infusions of peripheral blood lymphocytes from the normal twin. Fourteen patients experienced complete remissions. Six patients (two with acute lymphoblastic leukemia, three with acute myelogenous leukemia, and one with lymphosarcoma-leukemia) remained in complete remission at 11 to 44 months without any maintenance chemotherapy, and two others with acute myelogenous leukemia were in complete remission at two and three months. One patient died of viral hepatitis without leukemia. Five patients relapsed at three to seven months....

Lymphocytes were isolated from the peripheral blood of 21 normal persons and 66 patients with chronic lymphocytic leukemia (CLL), CLL in remission, Hodgkin's disease, Hodgkin's disease in remission, various other tumors, or cardiovascular diseases; The lymphocytes were studied for cap formation and agglutinability by concanavalin A, and for cell attachment to the surface of a petri dish. The frequency of cap formation was lowest in lymphocytes from patients with untreated Hodgkin's disease (2.1 plus or minus 0.8%), next lowest in lymphocytes from patients with CLL who were or were not under treatment (7,0 plus or minus 1;3%), and also low in Hodgkin's disease in remission (10.6 plus or minus 1.2%). The frequencies of cap formation by lymphocytes from patients with various other tumors (19.1 plus or minus 2.5%), with CLL in remission (24.0 plus or minus 0.9%), and with nonmalignant diseases (26.0 plus or minus 2.2%) were more similar to the frequency found in lymphocytes from normal persons (29.4 plus or minus 2.8%). Lymphocytes from all the patients, including those in remission, showed a higher degree of agglutinability by concanavalin A than lymphocytes from normal persons. Cell attachment to a petri dish was highest with CLL, next highest with CLL in remission, and low for normal persons and all the other patients. Lymphocytes from normal persons that consisted predominantly of thymus-derived cells gave similar results to isolated normal bone marrow-derived cells. The results indicate that there were different changes in the surface membrane of lymphocytes from patients with CLL, CLL in remission, Hodgkin's disease, and Hodgkin's disease in remission, and that the patients in clinical remission still showed abnormalities in their lymphocytes.

Leukaemia cells were collected from the blood of 72 untreated patients using a continuous-flow blood cell separator. The yield of cells was proportional to the number circulating in the patient, and up to 1 x 10(12) could be obtained in three hours. Complications of the procedure were mild, consisting of chills and shivering in 18% of patients. Leucopheresis at the time of diagnosis is an essential part of setting up a specific immunotherapy programme for patients with acute myelogenous leukaemia, and the lack of harmful side effects makes the collection of these cells ethically justified. The need for a centralized service to provide cells for this form of therapy is emphasized.

Summary. Megakaryocyte polyploidy was studied in six cases of preleukaemic acute leukaemia (PL), and in acute leukaemia (AL), five cases in the overt phase and three during complete remission. The megakaryocyte polyploidization was determined cytophotometrically and in some cases also by in vitro labelling with tritiated thymidine (3H-TdR). The results obtained in PL and untreated AL. demonstrate an impairment of the 3H-TdR labelling index and altered megakaryocyte polyploidy such as decrease of the maximum polyploidization capacity (five cases), evidence of diploid megakaryocytes (two cases) and of hyperploid megakaryocytes (six cases). These disturbances reflected the cytological abnormalities (microkaryo-cytes, polykaryocytes) observed in most of the cases studied. In contrast, in cases studied during complete remission of AL. a normal labelling index and polyploidy composition was observed, suggesting that the polyploidization disturbances are reversible. A strict correlation of the polyploidization defect and the platelet production could not be established from the patients investigated.

Three cases are presented of spontaneous regression of peripelvic renal cysts. The lesions were manifested by lateral extrinsic pressure defects in the renal pelvis and major calices (all 3 cases), and selective renal angiography showing stretching of vessels plus sharply defined defects in the nephrographic phase (2 patients). In 1 case the mass disappeared following trauma to the flank, while in the remaining 2 cases it disappeared spontaneously.

Seven patients with hemangiomatosis of the liver are presented together with 100 cases reported in the literature. Six of seven patients survived; four with supportive treatment only. Follow-up is from 2 to 11 yr. Hepatomegaly, heart failure, and cutaneous angiomas constitute the classical clinical triad. Arteriography is the best method for diagnosis; biopsy should be avoided. Clinical features and histologic examination of these benign vascular tumors seem to confirm the theory that hemangioendothelioma and hemangioma represent only different developmental stages of one disease. These lesions can regress spontaneously if left alone. Despite contrary prevailing opinion, the authors recommend nonoperative treatment as the first choice of the clinician.

Clinical remissions were observed in the majority of Lewis rats with experimental allergic encephalomyelitis (EAE) treated with cyclophosphamide (CY) at levels of 10 mg/kg or 20 mg/kg for 2–3 wk. Clinical relapses occurred in most survivors soon after the drug was stopped. Beneficial effects of CY therapy would appear to lie largely in helping rats survive the acute phases of EAE, but are offset by a high incidence of spontaneous remission of disease in untreated animals and the inevitable effects of drug toxicity. CY treatment at a dose of 5 mg/kg for 10 days may reverse both clinical signs and cellular infiltrates of EAE but does not inhibit the neurofibrin deposits characteristic of the disease. Remission of EAE in CY-treated and untreated Lewis rats is discussed in terms of multiplicity of immune responses to different neuroantigenic determinants.

A 21-yr-old female with a diffuse goiter, hypothyroidism, elevated thyroid autoantibodies, and chronic lymphocytic thyroiditis on needle biopsy, was subsequently nongoitrous and euthyroid with normal antibody titers during pregnancy. Following delivery, the goiter reappeared, autoantibody titers rose and hypothyroidism recurred. Chronic lymphocytic thyroiditis may undergo spontaneous remission during pregnancy.

The clinical course of a 37-year-old white man with idiopathic pulmonary hemosiderosis is presented. This patient is unusual in that he has had repeated exacerbations and remissions over a period of seven years and remains currently in spontaneous remission with no therapy. Routine sections of the lung biopsy revealed characteristic findings. Immunofluorescence staining of the lung was negative, and electron microscopic studies showed only nonspecific findings. While in remission, 51chromium-labelled red-blood-cell survival studies and 59iron kinetic studies were performed; the results were normal.

The clinical, endoscopic, and biochemical effects of metiamide, a histamine H2-receptor antagonist, in therapeutic dosage have been studied in a 28-day open trial in patients with duodenal ulcer disease. A good symptomatic response, combined with a 72% ulcer healing rate was observed. There were small but significant rises in plasma creatinine, serum glutamic oxaloacetic transaminase, and serum lactate dehydrogenase during treatment. Small quantities of amino acids appeared in the urine, and the heart size increased slightly. It is concluded that histamine H2-receptor antagonism may be an important therapeutic approach to duodenal ulcer disease.

Eight patients with acute lymphosarcoma cell leukemia or acute lymphoblastic leukemia received infusions of plasma containing a lymphotoxic factor. The lymphotoxic factor induced a transient fall in the number of "blast" cell forms in the peripheral blood in six of the eight patients but did not produce sustained remissions. Previous investigations have demonstrated that this lymphotoxic factor, found in the plasma of patients with active multiple sclerosis, is of low molecular weight and does not have the properties normally associated with an antibody. This factor appears to selectively interfere with ribonucleic acid synthesis in the thymus-derived lymphocyte. Lymphotoxic factor activity was demonstrated in the serum of one patient during a remission in leukemia induced by a viral illness.

Indications for thymectomy in myasthenia gravis have been recently expanded to include all cases with extraocular symptoms as a result of the minimal morbidity and negligible mortality of the transcervical approach. As increasing numbers of patients with myasthenia gravis, covering the entire spectrum of generalized disease, have been added to the thymectomy population, a more accurate evaluation of the effects of the operation is possible. Our experience with 353 patients who have undergone thymectomy indicates that early thymectomy, particularly in patients who do not have germinal centers, is followed by early remission of the disease. Delayed remission after thymectomy is related to the duration and severity of the disease, and to presence of thymic germinal centers. Germinal centers were found more frequently in patients with long duration of the disease and in patients in whom the disease had progressed to respiratory involvement. Marked improvement in electromyographic findings immediately after thymectomy was observed in the majority of patients who had had the disease for 1 year of less and where germinal centers were absent. The percentage of malignant thymomas was higher in patients who underwent thymectomy 1 year or more after the onset of symptoms of myasthenia gravis. These data indicate the importance of early thymectomy while the disease is still in the mild stages. Transcervical thymectomy is the treatment of choice as it is followed by a higher percentage of remissions and by less morbidity than other forms of treatment.

Patients in a general medical practice who had scored above a cut off point on the Cornell Medical Index Health Questionnaire indicating emotional disorder were contacted for a retest. The 59 respondents who had had no formal psychotherapy were grouped according to length of time lapsed since their first questionnaire: less than 12 months (8 patients), 12 to 23 months (9 patients), 24 to 35 months (12 patients), 36 to 47 months (21 patients), and 48 or more months (9 patients). An analysis of variance showed no significant test-retest differences for length of time elapsed. A further analysis eliminating older patients showed a test-retest difference (regression artifact?) but no effect of length of time elapsed.

A fresh preparation of BCG (Istituto Vaccinogeno Antitubercolare, Milano) having a bacterial charge of 0.5 mg/ml was injected intranodularly in cutaneous and subcutaneous metastases of malignant melanoma of 22 patients. A total of 85 nodules were treated. Caseous necrosis was observed in 17 patients equal to 68 nodules. The side-effects were modest and cleared up in a short time. The results obtained were localized at the treated nodules, without giving rise to a therapeutic action on those not injcted. The evolution of the disease was not modified.