In the year 1976, 9614 outpatient throat cultures were received in the Babies Hospital Bacteriology Laboratory. Cultures were plated on sheep blood a ar with bacitracin disc f applied and incubated overnight at 35 C. in a GASPAK anaerobic jar. 60% had no beta hemolytic colonies. Of the 40% with beta hemolytic colonies, 16% requircd further identification. 7% by replate, 9% by fluorescent antibody (PA). 21% of all cultures and 52% of all cultures with beta hemolytic colonies were presumptive Group A Strep (group 3). The incidence of PCP at the University of Florida during the 12 months period 10175 to 10176 was 6.8%(10/147 children treated with intensive chemotherapy). Primary diagnoses included: 7 leukemia and 3 solid tumor patients. 417 ALL patients were in remission(median duration 91.5 days); 3 leukemia and 2 solid tumor patients were in relapse.Presenting symptoms: fever-10110; cough-9/10; tachypnea-6/10 and dyspnea-3/10. In 9/10 cases an interstitial pneumonitis was revealed on x-ray and a lung biopsy was performed within 24 hours following this finding. In one child, first in our series, an abnormal x-ray was present 4 weeks before biopsy.The method of diagnosis, thoracoscopy, was performed under intram! ~cular anesthesia, without endotracheal tube. It allowed for direct observation and intrathoracic biopsy. Equipment utilized for this procedure was the Karl Stolls peritoneoscope set employing the Hopkins fibroscope and biopsy forceps. The method proved safe even in seriously ill patients and complications were minimal. 1 case of pneumothorax was resolved by reposition of tubing and there was 1 case of mild subcutaneous emphysema.All patients were treated with TPM 20mglkgld and SMX 100mglkgId 7 patients recovered, symptoms improved within 4 days after therapy was begun. 3 patients died, 2 patients had progressive tumors. 1 was complicated by sepsis. The cure rate in this incidence was 70%. Analysis of the data demonstrated a small false positive (F.P.) but a marked false negative (F.N.) rate for Bac-U-Dip (BUD). The false negative rate for Bacturcult (B/C) was zero and the false positive rate, when compared to a no-growth culture (NG) was also low (1170).The combination of Bacturcult and Bac-U-Dip provides both low false positive and false negative rates. Previous studies have shown that latex particles coated with glucose oxidaae (GO) would partially correct the metabolic defects in CGD polymorphonuclear leukocytes (Pm). UTILIZATION OF LIPOSOIBS FOR CORRECTION OF THE W T A - BOLIC DEFICIENCIES IN CHRONIC GRANULOMATOUS DISEASE (CCDIn order to develop a technique with better therapeutic advantage, we studied the efficacy of preparing liposomes (LP) containing the hydrogen peroxide (11202) generating ?a. The activity of GO incorporated within the LP could only be demonstrated after treatment of the LP with Triton X-100. LP were coated with heataggregated human IgC, thereby increasing their cs ability to be phagocytized hp PMN. CCD PMN oxidized glucose-l-f4C upon phagocytosis of GO-containing LP at levels 4-f...

A study was designed to determine whether a one‐week course of intensive chemotherapy and 2400 rads craniospinal irradiation prolonged complete remission of acute lymphocytic leukemia (ALL) in children. Of 110 patients entered into the study, 104 (94%) attained complete remission, 94 of whom were available for the 2 randomizations. They were randomly assigned to receive or not receive one week of high‐dosage intravenous chemotherapy and, 4 weeks later, were again randomized to receive or not receive 2400 rads cobalt‐60 craniospinal irradiation. Patients randomized for no irradiation were to receive identical radiotherapy only if and when central nervous system (CNS) leukemia developed. The one week of intensive chemotherapy had no effect on the duration of remission or on the frequency or site of relapse, but irradiation had a marked effect. Complete remission was terminated by CNS leukemia in only 2 of 45 children who received “prophylactic” craniospinal irradiation compared to 27 of 49 not irradiated. Five of the 25 children who were given “therapeutic” irradiation for demonstrated CNS leukemia have already had recurrences despite continuous hematologic remission. Under the conditions of this study, we conclude that one week of intensive chemotherapy does not prolong remission, that 2400 rads craniospinal irradiation early in remission prevents or delays CNS leukemia and prolongs complete remission, and that once CNS leukemia develops, 2400 rads craniospinal irradiation is not sufficient to eradicate it.

During the past 10 years, 1962 to 1972, we have administered irradiation to the central nervous system (CNS) during the first few weeks of remission of acute lymphocytic leukemia (ALL) as an integral part of a treatment plan aimed at cure of ALL. Its purpose has been to eradicate residual leukemia in the CNS and thus prevent CNS relapse. The results indicate that craniospinal irradiation alone, 2400 rads, or cranial irradiation, 2400 rads, with simultaneous intrathecal methotrexate is effective in ‐preventing CNS relapse. This results in marked improvement in complete remission duration and a 50% frequency of long‐term leukemia‐free survival and possible cure. Although intermittent intrathecal methotrexate during remission is said to reduce the incidence of CNS relapse by one half, a 15‐fold reduction results from adequate preventive CNS irradiation. Until a better method is found, all children with ALL should receive adequate CNS irradiation early during remission in order to prevent CNS relapse and to prolong complete remission.

In a randomized, double-blind, placebocontrolled study to evaluate the efficacy of trimethoprim-sulfamethoxazole for the prevention of Pneumocystis carinii pneumonia, we studied 160 patients with cancer who were at high risk for this pneumonia over a two-year period. Seventeen of the 80 patients receiving a placebo acquired P. carinii pneumonitis, whereas none of the 80 given 150 mg of trimethoprim and 750 mg of sulfamethoxazole per square meter per day had the infection P less than 0.01). Bacterial sepsis, pneumonia other than that caused by P. carinii, acute otitis media, upper-respiratory-tract infections, sinusitis and cellulitis occurred less frequently in recipients of the drug than in the placebo group (P less than 0.01 in each case). Oral candidiasis was the only adverse effect ecountered from trimethoprim-sulfamethoxazole administration. The study shows the combination to be highly effective in the prevention of P. carinii pneumonitis.