Multiple abscesses caused by Gardnerella vaginalis in an immunocompetent man.

Gardnerella vaginalis causing significant infection in men is rare. We report a case of sepsis in a previously well man, who developed a perinephric abscess and empyema. G. vaginalis was isolated after prolonged culture of samples from both sites. The microbiological features of the case are discussed.

Neuropsychological test scores, academic performance, and developmental disorders in Spanish-speaking children.

Limited information is currently available about performance of Spanish-speaking children on different neuropsychological tests. This study was designed to (a) analyze the effects of age and sex on different neuropsychological test scores of a randomly selected sample of Spanish-speaking children, (b) analyze the value of neuropsychological test scores for predicting school performance, and (c) describe the neuropsychological profile of Spanish-speaking children with learning disabilities (LD). Two hundred ninety (141 boys, 149 girls) 6- to 11-year-old children were selected from a school in Bogotá, Colombia. Three age groups were distinguished: 6- to 7-, 8- to 9-, and 10- to 11-year-olds. Performance was measured utilizing the following neuropsychological tests: Seashore Rhythm Test, Finger Tapping Test (FTT), Grooved Pegboard Test, Children's Category Test (CCT), California Verbal Learning Test-Children's Version (CVLT-C), Benton Visual Retention Test (BVRT), and Bateria Woodcock Psicoeducativa en Español (Woodcock, 1982). Normative scores were calculated. Age effect was significant for most of the test scores. A significant sex effect was observed for 3 test scores. Intercorrelations were performed between neuropsychological test scores and academic areas (science, mathematics, Spanish, social studies, and music). In a post hoc analysis, children presenting very low scores on the reading, writing, and arithmetic achievement scales of the Woodcock battery were identified in the sample, and their neuropsychological test scores were compared with a matched normal group. Finally, a comparison was made between Colombian and American norms.

Psychoactive substance use: some associated characteristics.

A questionnaire designed to assess the prevalence of psychoactive substance use and its relation with: (a) central nervous system risk factors, (b) associated disorders (allergies, migraine-type headaches, developmental dyslexia history, smoking, suicide attempt, and sleep disorders), and (c) cognitive-type symptoms, was given to a general population sample of 1,879 university students (mean age = 24.0) from Bogotá (Colombia, South America). A prevalence of 3.4% of self-reported psychoactive substance use was found. Results indicated that the incidence of some risk factors of minor brain injury or dysfunction, smoking, suicide attempt, and headache was higher among the self-reported psychoactive substance users than among nonusers. Cognitive-type symptoms, except suicide ideation, did not differ between drug users and nonusers. Current results point to a significant association between psychoactive substance use and depressive symptoms, and there was no significant association between psychoactive substance use and psychotic ideation.

Cognitive impairments in adolescent drug-abusers.

A basic neuropsychological test battery was given to 64 adolescents (57 males and seven females; mean age = 15.5) divided in two groups: (1) drug-abusers ("experimental group," n = 26), and (2) non drug-abusers ("control group," n = 38). Psychoactive substances included marijuana, "crack," solvent inhalation, gasoline sniffing, and alcohol. The following tests were used: (1) language, (2) perceptual recognition, (3) memory, and (4) praxic abilities. In general, performance was mildly (but nonsignificantly) lower in the experimental than in the control group. Only some neuropsychological test scores correlated with lifetime and amount of psychoactive drugs used. It was proposed that cognitive impairments in this sample of young drug-abusers may have been not evident because: (1) lifetime use was limited, due to the age of the subjects; and (2) in adolescents and pre-adolescents, toxic effects of drug-abuse might be manifested as a decrease in the rate of cognitive development rather than as a general cognitive decline.

An epidemiologic study of stuttering.

A questionnaire designed to assess the prevalence of stuttering and its relation with: (a) central nervous system risk factors; (b) associated disorders (allergies, migraine-type headache, developmental dyslexia history, smoking, and drug abuse), and (c) depression symptoms, was given to a general population sample of 1879 Spanish-speaking university students (mean age = 24.0). A prevalence of 2% of self-reported stuttering was found. Results indicated that the prevalence of minor brain injury or dysfunction, developmental dyslexia history, word-finding difficulties, and depressive symptoms was higher among the self-reported stutterers than among the nonstutterers.

Factorial structure of cognitive activity using a neuropsychological test battery.

A general neuropsychological test battery was assembled and individually given to a 98-subject sample, aged 11-12 years old. The battery included some basic and common tests routinely used in the evaluation of language, memory, spatial abilities, concept formation, and praxic abilities. Twenty-five different scores were calculated. A factor analysis with varimax rotation disclosed nine different factors, accounting for about 70% of the variance. Factor I was measured by a Sequential Verbal Memory test and Verbal Fluency subtests ("verbal factor"). Factor II was measured by the Wechsler Memory Scale Visual Memory subtests (immediate and delayed reproduction), and the Rey-Osterrieth Complex Figure (copy and immediate reproduction) ("non-verbal memory and constructional factor"). Factor III was measured by the WMS Logical Memory subtests (immediate and delayed; "verbal memory factor"). Factor IV was associated with fine movements (tapping subtests, right and left hand; "fine movements factor"). Factor V was specially measured by the Information subtest of the WMS and the Boston Naming Test ("verbal knowledge"). Factor VI represented a "praxic ability factor" (ideomotor praxis tests). Delayed Associative Learning subtest measured Factor VII; and Digits measured Factor VIII. Factor IX was a "mental control factor" (Mental Control subtest of the Wechsler Memory Scale). The implications of these results to theories relating to the structure of cognitive activity are discussed.

Combination versus sequential single agent chemotherapy in advanced breast cancer: associations with metastatic sites and long-term survival. The Western Cancer Study Group and The Southeastern Cancer Study Group.

Two hundred and twenty-two patients with advanced breast cancer were randomised in two separate trials of similar design to either concomitant combination treatment or sequential use of the same drugs given as single agents changed only at disease progression. Both trials used cyclophosphamide, methotrexate, 5-fluorouracil and prednisone; the WCSG using triiodothyronine and the SECSG using vincristine as the remaining agent. A common data base was generated for these trials and combined for analysis. Considering all patients, combination treatment was associated with a significantly increased response (46 versus 25%, P less than 0.05) but not survival improvement. For the 141 patients without liver involvement, survival was closely comparable in both treatment arms. Combination therapy did result in significant survival benefit for patients with liver involvement (P less than 0.05). These studies demonstrate: (1) in the majority of breast cancer patients, sequential single agent therapy can result in survival comparable to combination treatment; and (2) sole consideration of response frequency does not represent the optimal criterion to compare therapeutic approaches in advanced breast cancer.

Long-term survival following levamisole or placebo adjuvant treatment of colorectal cancer: a Western Cancer Study Group Trial.

In 1976, the Western Cancer Study Group initiated a prospectively randomized, double-blind trial of an 18-month adjuvant program comparing levamisole with placebo treatment following surgical resection in patients with colorectal adenocarcinoma. After stratification for site of disease (colon vs. rectum) and stage (B vs. C), 78 patients were entered. The levamisole schedule was 2.5 mg/kg/day given on days 1 and 2 of each week. The median follow-up of entered patients is now 7.5 years. Toxic effects of treatment were minimal. However, no long-term survival advantage was associated with levamisole compared to placebo administration in this population with resected large-bowel adenocarcinoma.

Doxorubicin and methotrexate on a weekly schedule in patients with sarcomas.

Fifty-five sarcoma patients with advanced measurable disease were treated with a doxorubicin and methotrexate combination in which both drugs were given on a weekly schedule. Patients received doxorubicin and methotrexate at three prospectively evaluated treatment levels with doxorubicin dosage ranging from 0.5 to 0.725 mg/kg/week and methotrexate dosage ranging from 0.25 to 0.375 mg/kg/week. Objective responses were seen in 11 of 39 (28%) patients receiving the two higher doxorubicin-methotrexate treatment levels where doxorubicin dose was greater than 0.5 mg/kg/week compared to only 2 of 16 (12%) patients receiving lower doxorubicin levels (p less than 0.05), suggestive of a dose-response relationship. Toxicity of this regimen was manageable but stomatitis was appreciable, seen in 30% of patients. These results support the activity of weekly doxorubicin in sarcoma therapy. However, no apparent improvement was associated with addition of conventional dose methotrexate to weekly doxorubicin treatment.

Effect of selective and non-selective beta blockade on pulmonary function and tracheobronchial mucociliary clearance in healthy subjects.

A controlled, double blind, crossover study was carried out to ascertain the effect of single doses of selective (100 mg atenolol) and non-selective (160 mg propranolol) beta blocker on pulmonary function and tracheobronchial mucociliary clearance. The study group comprised 12 healthy, young subjects. Adequate and comparable blockade was achieved with both drugs, the administration of which resulted in significantly lower pulse rates (at least up to eight hours after administration of the drug) and systolic blood pressures (three hours after drug administration) than were found with placebo. Small (of the order of 5%) but nevertheless statistically significant falls in FEV1 and forced vital capacity accompanied the administration of both beta blockers (but not the placebo) and were measurable up to eight hours after administration of the drug. Indices of pulmonary function had returned to normal by the next day. Peak expiratory flow and indices of small airways function remained unaltered after beta blockade. Mean tracheobronchial mucociliary clearance was depressed after administration of both beta blocking drugs, although the reduction was significant (p less than 0.05) only when propranolol was compared with placebo.

Long-term survival following relapse after 5-FU but not CMF adjuvant breast cancer therapy.

Beginning in 1974, patients with greater than or equal to 4 nodes positive following mastectomy were randomized to receive either 5-FU i.v. weekly or CMF i.v. every 2 weeks, both given for 12 months. Median follow-up now exceeds 112 months with nine year results below: (table; see text) Early results based on relapse-free survival favored CMF, but more patients currently are alive on the 5-FU arm. As the survival curves cross at 40 months, the 20% survival advantage for 5-FU did not achieve statistical significance. For 34% of patients failing adjuvant 5-FU, use of combination chemotherapy after relapse (commonly with CMFVP or CMF) resulted in long term survival. In contrast, long-term survival for patients failing adjuvant CMF was unusual. Relapse was detected while under weekly observation in a greater proportion of patients on 5-FU (36%) compared to CMF (6%) adjuvant treatment (p less than 0.05), potentially influencing tumor burden at recurrence. Hormonal therapy or radiation therapy as initial therapy after relapse was ineffective, with no long term survivors resulting on either arm. Weight increase on adjuvant chemotherapy was commonly seen, with weight increase greater than 10 kg associated with a poor prognosis. We conclude that initial improvement in relapse-free survival may not predict long term survival in adjuvant breast cancer trials since both the specific adjuvant therapy given pre-relapse as well as the type of salvage therapy given post-relapse may influence ultimate patient outcome.

Is driving gas flow rate clinically important for nebulizer therapy?

Ten patients with stable asthma were studied to see whether the flow rate used to drive a nebulizer was clinically important. Each received 1 mg of salbutamol in 2 ml of physiological saline via a Sandoz 'Lifeline' nebulizer driven by piped oxygen at 8, 6 and 4 litres/min on separate randomly allocated occasions. Although the time for nebulization was significantly longer as flow rate was reduced, there was no significant difference in the bronchodilator response.

Tracheobronchial mucociliary clearance in asthma: impairment during remission.

Tracheobronchial mucociliary clearance was measured in eight non-smoking patients with asthma in complete remission. The patients were symptom free and required no medication whatsoever for one to six months before assessment. Mucociliary clearance was measured with an objective, radioaerosol technique. For comparison, mucociliary clearance of eight non-smoking, healthy subjects with physical characteristics and pulmonary function similar to those of the asthmatics was also measured on two occasions. In their first assessment the healthy subjects inhaled the tracer radioaerosol under experimental conditions similar to those used for the asthmatics; in the second assessment they inhaled the radioaerosol rapidly to simulate the asthmatic pattern of deposition. Under similar experimental conditions the radioaerosol was deposited more proximally in the asthmatic subjects than in the normal subjects and the difference was statistically significant (p less than 0.01). When, however, the depth of radioaerosol lung penetration was similar in the two groups, there was evidence of a significantly (p less than 0.01) poorer mucociliary clearance six hours after radioaerosol inhalation in the asthmatic than in the healthy group. These findings raise the question whether asthma ever remits completely.

Influence of nutritional status on circulatory ribonuclease C levels in patients with cancer.

The influence of a variety of clinical and biochemical parameters on the activities in serum of ribonuclease (RNAse) selective for polycytidylic acid (RNAse C) were examined in 90 adult patients with cancer. The clinical data base determined on each patient included: RNAse C level, carcinoembryonic antigen (CEA) level, age, sex, race, presence (or absence of metastases, type of cancer, site of metastasis, renal function blood urea nitrogen [BUN], creatinine), hepatic function (bilirubin, alkaline phosphatase), and nutritional status (percent ideal body weight, percent weight loss, and albumin). Common tumor types studied included: colon (21), lung (18), breast (15), and hepatocellular carcinoma (10). For comparison, 175 nonmalignant control patients were studied to establish the normal range for RNAse. In patients with cancer, RNAse levels were increased in 57% and CEA levels were above 10 ng/dl in 36%. Although patients with BUN greater than 25 mg/dl or creatinine greater than 1.5 mg/dl were not entered on the study, nonetheless, RNAse was significantly (P less than 0.05) associated with both BUN and creatinine. Nutritional status also had an important influence on RNAse levels as both percent weight loss and percent ideal body weight were significantly (P less than 0.05) associated with circulatory RNAse: weight loss resulted in higher RNAse levels. These results account in part for the increased RNAse levels seen in those malignant conditions such as pancreatic and lung cancer commonly associated with weight loss in advanced stage. The possibility that circulatory RNAse C determination will provide a sensitive means for assessing nutritional status in cancer patients will require prospective evaluation.

Cyclophosphamide plus 5-FU versus 5-FU alone in advanced gastric carcinoma.

30 patients with advanced metastatic gastric adenocarcinoma, having a measurable indicator lesion, were randomized (1:2) to receive (intravenously) either weekly 5-fluorouracil alone (15 mg/kg) or combination treatment with cyclophosphamide (20 mg/kg) given on day 1 and 5-FU (15 mg/kg) given weekly on weeks 2-5, beginning on day 8. The combination cycle was repeated at 6-week intervals. Although the toxic effects of therapy were similar in both arms, the addition of cyclophosphamide to the single-agent 5-FU regimen did not increase either the frequency of objective response (5-FU 18%, combination 16%) or improve the median survival of patients with advanced measurable gastric carcinoma (5-FU 4.4 months, combination 5.2 months). Patients with pretreatment weight loss greater than 10% had significantly (p less than 0.05) shorter median survival (2.8 versus 5.6 months) compared to patients without weight loss.

The influence of transbronchial lung biopsy and bronchoalveolar lavage on arterial blood gas changes occurring in patients with diffuse interstitial lung disease.

Serial arterial blood gases were measured during fibreoptic bronchoscopy in 26 patients with diffuse interstitial lung disease. All those having transbronchial biopsy with or without bronchoalveolar lavage, performed breathing room air, showed significant falls in PaO2, at the time of passage of the bronchoscope through the vocal cords both at the beginning and end of the procedure. Patients having bronchoalveolar lavage and transbronchial biopsy performed with supplementary oxygen at least maintained their basal PaO2 levels. Cessation of the supplementary oxygen 30 minutes after withdrawal of the bronchoscope did not result in rebound hypoxaemia. Bronchoalveolar lavage and transbronchial biopsy can be performed safely in patients with diffuse interstitial lung disease without significant hypoxaemia developing, if oxygen is started before the procedure and continued for 30 minutes after withdrawal of the bronchoscope.

Hepatocellular carcinoma. Diagnostic and prognostic features in North American patients.

Diagnostic and prognostic characteristics of 121 North American patients with hepatocellular carcinoma seen in one metropolitan area over a 6-year period were assessed using multivariate analysis. Presenting symptoms commonly included abdominal pain (53%) or mass (34%), anorexia (31%), and ascites (20%); however, the ability to make an early diagnosis was complicated by a variety of unusual symptoms accounting for 25% of presentations. While cirrhosis (63%) and hepatitis B surface antigen (HBsAg) positivity (52%) were common associated findings, the majority of patients (67%) had no prior diagnosis of liver disease. Despite the vascular nature of these malignancies, percutaneous biopsy procedures performed in 66 patients provided diagnostic material in over 85% of cases with little morbidity. Histologic diagnosis was made by blind percutaneous biopsy (41 done, 83% positive), peritoneoscopy with directed percutaneous biopsy (25 done, 88% positive), laparotomy (42 done, 98% positive), or autopsy (19). Percutaneous hepatic biopsy procedures were associated with no mortality and rare bleeding (three cases). Overall median survival was only 18 weeks; multivariate analysis indicated increased bilirubin or presence of pulmonary metastases adversely influenced outcome. Unexpectedly, patients younger than 45 years of age had a significantly (P less than 0.01) greater survival (median, 40 versus 9 weeks) than did older patients with this disease. We conclude: (1) hepatocellular carcinoma can be rapidly and safely diagnosed using percutaneous biopsy procedures; (2) North American patients with hepatocellular carcinoma younger than 45 years of age have a more favorable prognosis.

Radionuclide demonstration of ventilatory abnormalities in mild asthma.

The distribution of 5 microns 99mTc aerosol particles deposited in the lungs was compared with that of 81mKr gas in 20 asthmatic subjects (FEV1.0 greater than or equal to 75% predicted) whose asthma was mild or in remission. Sixteen normal non-smokers and 14 'normal' cigarette smokers were studied as control subjects. Radioaerosol lung penetration in the 'normal' smokers was the same as in the normal non-smokers but was reduced in the asthmatic subjects. Radioaerosol penetrated better than 81mKr to the lung apices of normal non-smokers and asthmatic subjects; it penetrated better than 81mKr to the lung bases of the asthmatic subjects. Uneven distribution of aerosol relative to 81mKr related strongly to maximal mid-expiratory flow rate (MMFR) in the asthmatic subjects. Aerosol deposition abnormalities in symptom-free asthmatic subjects may reflect basal airways closure at functional residual capacity and abnormal patterns of lung filling.

Peripheral airways mucus clearance in stable asthma is improved by oral corticosteroid therapy.

Inhaled 99mTc-labelled particles have been used to assess mucus clearance from peripheral, intermediate and inner lung zones of 12 patients with stable asthma. The method of analysis relies on a ventilation image with 81mKr to estimate the distribution of radioaerosol alveolar deposition so that clearance from each zone can be related just to particles deposited in the ciliated conducting airways. In calculating clearance from intermediate and inner lung zones, allowance is made for particles transported into these zones from more distal regions of the lung. Peripheral zone clearance in the asthmatic subjects improved significantly (p less than 0.01) after four weeks of corticosteroid treatment (two weeks on 15 mg prednisolone orally each day, plus two weeks on 30 mg). No significant change occurred in clearance from the inner zone when all patients were considered together. However, the six patients who prior to treatment coughed relatively infrequently did show a significant (p less than 0.05) increase in clearance from the inner zone as well as from the peripheral zone.