Faculty Bibliography

Over the past decade there have been several important new treatment options for hairy cell leukemia (HCL). These changes have centered around the emergence of new medicines starting with Alpha Interferon in the early 1980's, then Pentostatin, and finally in the early 90's with 2-CDA. The object of this study was to ascertain the treatment preference, reasons for selection, and ramifications of these new therapies on community-based oncologists. A questionnaire study was sent to 300 medical oncologists taken from the American Society of Clinical Oncology Membership Listings for New York, New Jersey and Connecticut. Questions ranging from demographic information of these physicians, choice of treatment for HCL reasons for their selections and the impact of these selections on the treatment of other diseases, as well as future research on HCL were asked. Seventy-eight percent of responding physicians considered 2-CDA the treatment of choice. Belief that this was the most effective treatment was their reasoning. Eighty percent felt that further research in HCL was still beneficial and needed. Perhaps some of this was based on the response that developments in the treatment of HCL had interfaced with the potential treatments of other diseases.

A "code-no code" resuscitation classification was recently instituted at Memorial Sloan Kettering Cancer Center. Physician compliance was voluntary. Of 48 subsequent cardiopulmonary arrests, 7 patients (14.6%) were discharged from hospital. They included 4 of 17 patients (23.5%) previously assigned "code" status and 1 of 27 patients (3%) whose resuscitation status had not been designated. Reluctance on the part of the primary physician to withhold resuscitation was clearly evident in this group, of whom more than half had widespread malignancy. Stage of disease did not influence the 50% rate of successful resuscitations but no patient with metastatic or uncontrolled cancer left hospital. The discharge rate among arrest patients with recently diagnosed or localized cancer was 32%. These observations justify continued efforts to restrict cardiopulmonary resuscitation (CPR) to those with a reasonable prognosis for worthwhile palliation or cure.

Two patients had fatal episodes of massive hemoptysis secondary to invasive aspergillosis, complicating in one with acute leukemia and in the other with lung carcinoma. Review of the literature reveals that these cases are among the very few in which invasive aspergillosis has been documented as the etiology of massive hemoptysis in cancer patients. Both patients had been previously treated with corticosteroids and/or other immunosuppressive agents. In one of the two patients, the diagnosis was made ante mortem and antifungal therapy instituted, but dissemination progressed despite treatment.

A diet deficient in zinc resulted in a significant decrease in the number of inbred BALB/c female mice developing transplantable plasmacytoma TEPC-183 compared to pair-fed and ad libitum-fed control mice. The size of the tumor relative to body weight was decreased in the zinc-deficient group. Whereas the uptake of [3H]thymidine into tumor cells did not differ between the groups, the incorporation of [3H]thymidine into tumor cells was significantly reduced in the animals maintained on a zinc-deficient diet.

The finding at autopsy of typical pathologic features of hypertrophic heart disease (idiopathic hypertrophic subaortic stenosis, IHSS) and mitral valve prolapse (MVP) in a single patient prompted study of a number of close relatives of this patient. Several additional cases of IHSS or MVP were found. The HLA typing of this kindred revealed that four out of seven members tested had the Bw 35 antigen. Although the association might be due to chance, this kindred, together with prior reports of similar bizarre myocardial cellular disarray in HISS and MVP, suggest the hypothesis that in some instances, IHSS and MVP may represent a continuum of hereditary cardiac disorders.

A 78-year-old nondiabetic woman was admitted to the hospital with salicylate-induced hypoglycemia. Ketosis was present with a moderate metabolic acidosis and primary respiratory alkalosis. The patient's mental status improved immediately following intravenous administration of glucose. The case illustrates salicylate's hypoglycemic activity, and that the metabolic acidosis may have exacerbated symptoms of cerebral glucopenia.