Abatement of Sézary syndrome lesions following treatment with acyclovir.

Sézary syndrome is a malignant form of cutaneous T cell lymphoma in which patients characteristically present with generalized pruritic erythroderma and large numbers of circulating Sézary cells in the peripheral blood. Several previous studies have proposed that viruses may play a role in the cause of cutaneous T cell lymphoma. This report describes a 68-year-old man with Sézary syndrome who received a seven-day course of intravenous acyclovir for treatment of disseminated herpes zoster and was noted to have almost complete disappearance of generalized erythroderma and pruritus. Since acyclovir has been shown to selectively inhibit viral DNA polymerase, the observed clinical response is strong evidence that viruses play a role in the cause of cutaneous T cell lymphoma. Mechanisms that could explain the observed response are discussed, and further studies on the utility of antiviral agents for treatment of cutaneous T cell lymphoma and on possible inhibitory effects of acyclovir on retroviruses are recommended.

Heparin-induced thrombocytopenia in patients with cerebrovascular ischemic disease.

We studied 137 patients who were treated with heparin for cerebral infarction (73), partially reversible ischemic neurologic deficit (22), or transient ischemic attack (42). Platelet counts were performed before therapy, twice weekly, and at cessation of therapy. Platelets decreased in 118 patients (86%). In 21 (15.3%), platelets dropped greater than or equal to 40%; 9 of 14 new ischemic events and three of six deaths occurred in this group of patients. Because there was a significant association between poor outcome and platelet drop greater than or equal to 40% (p less than 0.001), we believe that platelets should be monitored frequently when patients are treated with heparin for ischemic cerebrovascular disease.

Pain syndromes associated with cancer. Achieving effective relief.

Pain occurs frequently in patients with cancer and, if uncontrolled, may lead to depression, deep anxiety, insomnia, and progressive mental and physical deterioration. Pain can be effectively relieved in the majority of cases by balanced use of pharmacologic agents and other treatment modalities, including surgery, chemotherapy, and radiation therapy. A thorough evaluation of the patient's complaints and an accurate diagnosis of the causes and mechanism of pain are mandatory for the formulation of an effective and individualized treatment plan. Continuing emotional support is essential to the relief of suffering in patient and family.

Decreased T cell function in mice exposed to chronic, low levels of lead.

The immune responsiveness of mice given low levels of lead acetate (1300 p.p.m.) in their drinking water for 8 weeks was determined. Mean percentages of splenic T and B lymphocytes in lead-exposed mice were slightly lower than in controls. Mean mitogen response to phytohaemmaglutinin and concanavalin A in mice exposed to lead was significantly decreased compared to controls. The response to lipopolysaccharide on the other hand was not significantly mitogenic response to phytohaemagglutinin and concanavalin A is impaired in mice exposed chronically to low concentrations of lead.

Active rosette-forming T cells in the elderly.

The numbers and percentages of active rosette-forming T cells were measured in two age groups, to assess the effects of aging. The study included 21 healthy persons in the 20--40 age group and 25 persons without major disease in the 60--85 age group. In the younger subjects the number of rosette-forming cells (RFC) averaged 1430 +/- 463/cu mm (mean and S.D.), a count not significantly different from that in the older subjects (1443 +/- 398/cu mm). Likewise, the active RFC count in the 20--40 age group (526 +/- 185/cu mm) and that in the 60--85 age group (558 +/- 197/cu mm) were not significantly different. There was no difference for the percentage total RFC (young 78 +/- 4%, elderly 78 +/- 6%) or the percentage active RFC (young 29 +/- 7%, elderly 30 +/- 6%). For the total lymphocyte count or the B lymphocyte count, there was no difference between the two groups of subjects. It is concluded that T lymphocytes, measured as total and active rosette-forming cells, are not decreased in healthy older persons.

Induction of myeloperoxidase deficiency in granulocytes in lead-intoxicated dogs.

Lead interferes with heme synthesis in erythrocytes and has a deleterious effect on red cell membranes. We measured myeloperoxidase (MPO) enzyme activity in the granulocytes of dogs fed increasing quantities of lead. Concurrently, iodination capability and in vitro bactericidal activity were measured. Blood lead levels were monitored. Three of 4 dogs poisoned with lead developed significant decreases in MPO enzyme activity in their granulocytes. The decline in MPO activity correlated with cumulative lead toxicity as judged by blood lead levels and clinical signs of lead poisoning. Iodination ability in all 4 dogs decreased with cumulative lead toxicity. After discontinuation of lead administration, recovery of granulocyte MPO activity preceded recovery of iodination ability. This observation suggests the possibility of separate effects of lead on iodination ability and MPO activity. Moderate impairment of bactericidal capacity developed in 3 of 4 dogs with severe lead poisoning. Clinical infections were not observed during the course of the study.

T lymphocyte rosette formation after major burns.

The ability of lymphocytes to form rosettes with sheep erythrocytes was studied in the acute burn period to quantitate T lymphocytes. Seventeen adult patients with burns of greater than 15% body surface area were studied serially and compared to normal controls. The absolute number of total rosette-forming cells (RFC) averaged 1,229.1 +/- 92.8/cu mm (SEM) for controls. In patients, a comspicuous decrease in absolute number of total RFC occurred at days 3 to 5 postburn (578.0 +/- 144.2/cu mm) (P less than .001) and during days 6 to 10 (799.8 +/- 106.1/cu mm) (P less than .01). Similarly, the percentage total RFC in patients at days 6 to 10 (48.9% +/- 3.3%) was significantly lower than controls (73.9% +/- 0.7%) (P less than .01). The decrease in total RFC did not correlate with the total lymphocyte count or the cortisol level. These findings suggest that T lymphocytes are decreased or have altered rosette-forming ability in the early postburn period and are in accordance with other reports of impaired cellular immunity following burns.

Acceleration of hepatic sterol synthesis after a single dose of the porphyrogenic chemical allylisopropylacetamide.

Hepatic sterol synthesis is accelerated in animals after a single dose of allylisopropylacetamide, a chemical known to be porphyrogenic. Evidence is provided to show that enhanced sterol biosynthesis is due to an increased formation of mevalonic acid, indicating that the primary site of action of the chemical is on one or more steps in the pathway from acetate to mevalonate.