Methicillin-resistant coagulase-negative staphylococcal osteomyelitis and its relationship to broad-spectrum oral antibiosis in a predominantly diabetic population.

Awareness of the virulence of coagulase-negative Staphylococci, previously regarded as saprophytes with minimal pathogenicity, has steadily increased. Eighty-seven individual patients diagnosed with acute osteomyelitis, as confirmed by microbiologic and pathologic analysis, were included in this study. Of these patients, 82% (71/87) were known to have diabetes mellitus. The prevalence of coagulase negative Staphylococcus was 40% (35/87) in deep bone cultures, 63% (22/35) of which were methicillin resistant. When the coagulase negative Staphylococcus group was assessed for prior long-term (> 2 week) oral antibiotic treatment with ciprofloxacin, it was found that 54% (12/22) of the methicillin-resistant coagulase-negative Staphylococcal infected patients had received such treatment, compared with 15% (2/13) of patients with methicillin-sensitive coagulase-negative Staphylococcal osteomyelitis (p < 0.034). When the group was analyzed for prior long-term antibiotic treatment with amoxicillin/clavulanate, 23% (5/22) of the methicillin-resistant patients had received oral amoxicillin/clavulanate, compared with 23% (3/13) of patients with methicillin-sensitive coagulase-negative Staphylococcal osteomyelitis (p > 0.05). Prevalence of polymicrobial infections, which constituted 29% (25/87) of all individual patients, was also analyzed. Of those patients with coagulase-negative isolates, 29% (10/35) were polymicrobial (p > 0.05). The results from this study suggest that infections of bone caused by coagulase-negative Staphylococci are associated with a high prevalence of methicillin resistance. This study also raises the question of whether injudicious prolonged use of ciprofloxacin may, in fact, promote proliferation of resistant organism strains.

Phenotypical and functional analyses of mononuclear cells during rejection of a transplanted murine fibrosarcoma.

Repeated injections of mitomycin C-treated T2 fibrosarcoma cells into tumor-sensitized mice cause regression of a secondary tumor graft and more than 90% of the mice are cured. In the data presented here, an enhancement of the cytolytic cell-mediated activities measured in vitro against the specific T2 targets is shown in lymph nodes draining the tumor and in the spleen during the process of tumor rejection. Histopathologic studies revealed a rapid and marked accumulation of mononuclear cells mostly at the periphery of the rejected tumor tissue. A significant increase of CD8-positive, asialo GM1-positive and acid phosphatase-positive cells was observed in the rejected tumors whereas CD4-positive cells were similarly detected in both progressing and rejected tumor tissue. As macrophages seemed to be the population presenting the most persistent variation after immunization, the production of TNF-alpha was studied within the tumor site and in the lymphoid tissues during the regression process. Firstly, the presence of TNF-alpha within the cytoplasm of most of the adherent cell fractions isolated from the spleen and the tumor of immune mice was demonstrated by immunocytochemistry. Next, TNF-alpha mRNA-containing cells were determined by in situ hybridization of frozen tumor sections and identified essentially as tumor infiltrating macrophages. Finally, the macrophage populations isolated from tumors and from the spleen of immune mice were able to produce in vitro large quantities of TNF-alpha without exogenous stimulation. These findings support the role of TNF-alpha in the effector mechanisms contributing to the tumor regression process.

Abnormal thymocyte subpopulations in split dose irradiated C57BL/Ka mice before the onset of lymphomas. Effects of bone marrow grafting.

Fractionated whole-body X irradiation (4 x 1.75 Gy at weekly intervals) induces a high percentage of thymic lymphomas in C57BL/Ka mice. The present work reports the phenotypic alterations of thymocyte subpopulations during the preleukemic period: there were a decrease of CD4+ CD8+ cells and an increase of CD4- CD8- and CD4- CD8+ cells. Marrow grafting early after irradiation that prevents lymphoma development restores the thymocyte subpopulations. In many instances, transplantation of 'preleukemic thymocyte inoculate' gives rise to an active and long lasting repopulation of recipient thymuses. However in all cases, donor lymphomas can develop after inoculation of 'preleukemic thymocyte inoculate'.

[Possibilities of treatment of reduction in Hodgkin's disease. III. Can polychemotherapy when combined with radiotherapy of localised stages be reduced? (author's transl)]. / Möglichkeiten einer Therapiereduktion bei Morbus Hodgkin III. Kann die Polychemotherapie bei einer kombinierten Chemo-Strahlentherapie lokalisierter Stadien verringert werden?

The effectiveness of three and six cycles of MOPP (chlormethine, vincristine, procarbazine and prednisolone) as initial chemotherapy in 108 patients with Hodgkin's disease at clinical stages II nA, IIB, IIIA and B was compared in a study of two groups, one of them treated in six cycles (October, 1972--December, 1976), the other in three cycles (January, 1977--October, 1979). The clinically complete remissions obtained by this schedule and findings at exploratory splenectomy were chosen as measures of effectiveness. The frequency of clinically complete remission was similar in both groups. In 96% (97% for the second group) of patients in whom the three (six) MOPP cycles of cytostatic treatment achieved clinically complete remission, exploratory splenectomy failed to reveal any infradiaphragmatic involvement. In patients in stage IIA and IIB one can, therefore, consider reducing primary cytostatic treatment to three MOPP cycles. Exploratory splenectomy and prophylactic infradiaphragmatic radiotherapy can be omitted in these patients, if one accepts the 5% risk of infradiaphragmatic involvement. Splenectomy can also be omitted in patients in stage III, but not infradiaphragmatic radiotherapy, including that no the spleen.