Partial Remission Period Research Articles

Th2 cell clonal expansion at diagnosis in human type 1 diabetes

Soon after diagnosis with type 1 diabetes (T1D), many patients experience a period of partial remission. A longer partial remission is associated with a better response to treatment, but the mechanism is not known. The frequency of CD4+CD25+CD127hi (127-hi) cells, a cell subset with an anti-inflammatory Th2 bias, correlates positively with length of partial remission. The purpose of this study was to further characterize the nature of the Th2 bias in 127-hi cells. Single cell RNA sequencing paired with TCR sequencing of sorted 127-hi memory cells identifies clonally expanded Th2 clusters in 127-hi cells from T1D, but not from healthy donors. The Th2 clusters express GATA3, GATA3-AS1, PTGDR2, IL17RB, IL4R and IL9R. The existence of 127-hi Th2 cell clonal expansion in T1D suggests that disease factors may induce clonal expansion of 127-hi Th2 cells that prolong partial remission and delay disease progression.

Primary CNS Lymphoma in an Immunocompetent Patient: An Unusual Case Illustrating the Usual Problems Facing Brain Tumour Management in a Lower-Middle-Income Country

Primary central nervous system lymphoma (PCNSL) is a rare extra-nodal non-Hodgkin lymphoma (NHL). It primarily affects the immunocompromised but is rarely seen in immunocompetent individuals. The pitfalls in the healthcare system of lower-middle-income countries produce many obstacles, impeding timely diagnosis, timely treatment, and optimal quality of care. A 57-year-old immunocompetent, diabetic female presented with progressive generalised fatiguability, forgetfulness, and subtle behavioural changes for the last one and a half years. MRI revealed an area of gyri from dense post-contrast enhancement in the right posterior parietal region. Her symptoms kept aggravating with periods of partial remission as steroids were being administered. Reasons for delays in diagnosis and hence timely treatment include lack of primary care referral, conflicting neurosurgical opinion, and absence of multidisciplinary team management. A right posterior parietal parasagittal craniotomy was performed to excise the lesion. The patient was subsequently referred for adjuvant therapy. We use our patient's clinical journey to exemplify the structural barriers to providing optimal and timely care for brain tumour patients in a developing country. Primary CNS Lymphomas in immunocompetent patients are rare. Poor infrastructure and referral pathways contribute to delayed diagnosis. Lack of multi-disciplinary care owing to organisational issues is a major problem faced by brain tumour patients in a lower-middle-income country like ours. Brain tumour management requires a specialist multidisciplinary team approach to ensure timely diagnosis and optimal treatment

1286-P: Plasma-Induced Signatures Measured at Type 1 Diabetes (T1D) Onset Correlate with Post-onset Beta-Cell Function

Significant phenotypic diversity exists among T1D patients, supporting the existence of distinct disease endotypes (e.g. duration of the post-onset partial remission period) . To broaden our understanding of T1D heterogeneity and its relationship to disease progression and therapeutic responsiveness, we studied 566 new onset T1D patients (241 females, 325 males; mean age 16.5 +/- 8.2 years) that had participated in TrialNet clinical trials: TN02/MMF DZB; TN05/anti-CD20; TN08/GAD-alum; TN09/CTLA4-Ig; TN14/Canakinumab; and TN19/ATG-GCSF. Baseline samples were analyzed with a sensitive bioassay, where subject plasma is used to induce transcription in a well-controlled peripheral blood mononuclear cell population. The response was measured with a microarray, data were normalized, and transcripts exhibiting the highest median absolute deviation within each trial were identified. Weighted gene correlation network analysis was used to cluster patterns of variation into modules of co-expressed transcripts. Co-expression networks were correlated with clinical data collected over the 24-months following clinical onset. In the placebo arms of all 6 trials, we identified modules that significantly correlated with post-onset C-peptide AUC, post-onset insulin dose, Insulin-Dose Adjusted A1c, and/or the rate of C-peptide decline. This suggests that the baseline analyses identified modules that differentiated subjects in terms of post-onset beta-cell function, supporting the existence of T1D endotypes. While TN02, TN08, and TN14 did not show overall efficacy in slowing post-onset C-peptide decline, the module correlations with phenotypes related to beta-cell function were fewer in number and of lesser statistical significance in the treatment arms of all 6 trials. This suggests that there was greater beta-cell function in the treatment arms of all trials, and that varying degrees of immunomodulation had occurred even in those trials that did not show efficacy. Disclosure A.Bedrat: None. S.Jia: None. M.Roethle: None. K.Dew: None. S.M.Cabrera: None. C.Lin: None. M.Hessner: None. Funding National Institutes of Health (R01DK121528)

A comparison of glycemic parameters and their relationship with C-peptide and Proinsulin levels during partial remission and non-remission periods in children with type 1 diabetes mellitus - a cross-sectional study

BackgroundCurrently, there is a lack of data relating to glycemic parameters and their relationship with C-peptide (CP) and proinsulin (PI) during the partial remission period (PRP) in type 1 diabetes mellitus (T1D). The aim of this study was to evaluate glycemic parameters in children with T1D who are in the PRP using intermittently scanned continuous glucose monitoring systems (isCGMS) and to investigate any relationships between CP and PI levels.MethodsThe study included 21 children who were in the PRP and 31 children who were not. A cross-sectional, non-randomized study was performed. Demographic, clinical data were collected and 2 week- isCGMS data were retrieved.ResultsThe Serum CP showed a positive correlation with time-in-range in the PRP (p:0.03), however PI showed no correlations with glycemic parameters in both periods. The Serum CP and PI levels and the PI:CP ratio were significantly higher in the PRP group than in the non-PRP group. In the non-PRP group, the PI level was below 0.1 pmol/L (which is the detectable limit) in only 2 of the 17 cases as compared with none in the PRP group. Similarly, only 2 of the 17 children in the non-PRP group had CP levels of less than 0.2 nmol / L, although both had detectable PI levels. Overall time-in-range (3. 9-1.0 mmol/L) was significantly high in the PRP group. In contrast, the mean sensor glucose levels, time spent in hyperglycemia, and coefficient of variation levels (32.2vs 40.5%) were significantly lower in the PRP group.ConclusionsAlthough the mean glucose and time in range during the PRP was better than that in the non-PRP group, the glycemic variability during this period was not as low as expected. While the CP levels showed an association with TIR during the PRP, there was no correlation between PI levels and glycemic parameters. Further studies are needed to determine if PI might prove to be a useful parameter in clinical follow-up.

Symptom load assessment of Ph chromosome/BCR-ABL fusion gene negative myeloproliferative tumor patients at different efficacy evaluation periods

Objective To observe the disease type and the changes of symptom load during treatment of patients with Ph chromosome/BCR-ABL fusion gene negative myeloproliferative neoplasm (MPN). Methods A total of 84 patients with MPN diagnosed from May 2017 to January 2019 in People′s Hospital of Longhua District of Shenzhen were selected, and were divided into polycythemia vera (PV) group, essential thrombocyhemia (ET) group, and myelofibrosis (PMF) group according to their subtypes, with 28 cases in each group. The scores of MPN-SAF-TSS were compared among the three groups. Besides, the scores of the scale (myeloproliferative neoplasm symptom assessment form total symptom score, MPN-SAF-TSS) in different treatment periods (at the time of the visit, when the disease progressed, when the disease was stable, when the clinical improvement was made, when the partial remission was completed, at the time of remission and recurrence) were also compared. Results At the time of initial diagnosis, there were significant differences in the incidences of symptom burdens among the three groups of MPN patients with abdominal fullness (χ2=6.095, P=0.047), abdominal discomfort (χ2=7.342, P=0.025), poor mobility (χ2=13.029, P=0.001), inattention (χ2=6.099, P=0.047), pruritus (χ2=6.956, P=0.031), bone pain (χ2=7.807, P=0.020), fever (χ2=8.000, P=0.018) and weight loss (χ2=27.340, P<0.001). The incidences of poor mobility (85.71%, 24/28), inattention (67.86%, 19/28) and weight loss (82.14%, 23/28) in PMF group were significantly higher than those in PV group [42.86% (12/28), 39.29% (11/28), 35.71% (10/28)] and ET group [46.43% (13/28), 39.29% (11/28), 14.29% (4/28)] (all P<0.05). The incidences of abdominal discomfort (75.00%, 21/28) and bone pain (60.71%, 17/28) in PMF group were higher than those in PV group [39.29% (11/28), 25.00% (7/28)] (both P<0.05). The incidences of abdominal fullness (89.29%, 25/28) and fever (42.86%, 12/28) in PMF group were higher than those in ET group [60.71% (17/28), 10.71% (3/28)] (both P<0.05). The incidence of pruritus in PV group (71.43%, 20/28) was higher than that in ET group (42.86%, 12/28) and PMF group (39.29%, 11/28) (both P<0.05). Symptom load scores of patients with fatigue (χ2=368.594, P<0.001), abdominal fullness (χ2=261.312, P<0.001), abdominal discomfort (χ2=195.629, P<0.001), poor mobility (χ2=217.862, P<0.001), lack of concentration (χ2=280.664, P<0.001), night sweats (χ2=239.650, P<0.001), pruritus (χ2=254.418, P<0.001), bone pain (χ2=180.291, P<0.001), fever (χ2=231.613, P<0.001) and weight loss (χ2=227.831, P<0.001) were significantly different during different therapeutic periods. The fatigue symptom load score was higher when the disease progressed than that at the time of the visit (P<0.05), and the symptom score of abdominal fullness was lower than that at the time of visit (P<0.05). Symptom load scores of weakness and pruritus when the condition was stable was lower than those when the disease progressed (both P<0.05). When the clinical improvement was made, symptom load scores of weakness, abdominal discomfort, inattention, night sweats, weight loss were lower than those when the disease was stable (all P<0.05). Symptom load scores of abdominal fullness, poor mobility, inattention, night sweats and pruritus in partial remission period decreased compared to temporary improvement period (all P<0.05). Compared to the partial remission period, the symptom load scores of weakness, abdominal fullness, night sweats, pruritus, bone pain and weight loss in complete remission period were lower (all P<0.05). At last, symptom load scores of weakness, abdominal fullness, abdominal discomfort, poor mobility, inattention, night sweats, pruritus, bone pain, fever and weight loss in recurrence period were higher than those in complete remission period (all P<0.05). Conclusion There are several differences in the main clinical symptoms among patients with different MPN subtypes, and there are significant changes in the main clinical symptoms as the disease progresses or turns around. Key words: Bone marrow neoplasms; Myeloproliferative disorders; Polycythemia vera; Thrombocythemia, essential; Primary myelofibrosis; Myeloproliferative neoplasm symptom assessment form total symptom score

Racial/Ethnic Minority Youth With Recent-Onset Type 1 Diabetes Have Poor Prognostic Factors.

To compare races/ethnicities for characteristics, at type 1 diabetes diagnosis and during the first 3 years postdiagnosis, known to influence long-term health outcomes. We analyzed 927 Pediatric Diabetes Consortium (PDC) participants <19 years old (631 non-Hispanic white [NHW], 216 Hispanic, and 80 African American [AA]) diagnosed with type 1 diabetes and followed for a median of 3.0 years (interquartile range 2.2-3.6). Demographic and clinical data were collected from medical records and patient/parent interviews. Partial remission period or "honeymoon" was defined as insulin dose-adjusted hemoglobin A1c (IDAA1c) ≤9.0%. We used logistic, linear, and multinomial regression models, as well as repeated-measures logistic and linear regression models. Models were adjusted for known confounders. AA subjects, compared with NHW, at diagnosis, were in a higher age- and sex-adjusted BMI percentile (BMI%), had more advanced pubertal development, and had higher frequency of presentation in diabetic ketoacidosis, largely explained by socioeconomic factors. During the first 3 years, AA subjects were more likely to have hypertension and severe hypoglycemia events; had trajectories with higher hemoglobin A1c, BMI%, insulin doses, and IDAA1c; and were less likely to enter the partial remission period. Hispanics, compared with NHWs, had higher BMI% at diagnosis and over the three subsequent years. During the 3 years postdiagnosis, Hispanics had higher prevalence of dyslipidemia and maintained trajectories of higher insulin doses and IDAA1c. Youth of minority race/ethnicity have increased markers of poor prognosis of type 1 diabetes at diagnosis and 3 years postdiagnosis, possibly contributing to higher risk of long-term diabetes complications compared with NHWs.

Computed tomography‐guided intraluminal brachytherapy in recurrent bronchogenic carcinoma: A clinical trial in a small group

AbstractObjectiveThe overall survival (OS) of lung cancer patients has been significantly extended as a consequence of chemotherapy and targeted drug utilization, which has resulted in an increase in local recurrences. The present study followed patients to evaluate the short‐term and long‐term efficacies and the safety of high‐dose rate intraluminal brachytherapy (ILBT) in recurrent bronchogenic carcinoma patients, and investigate the factors that influence prognosis.MethodsThe clinical records, treatment, curable effects, and adverse events of 15 patients treated in the First Affiliated Hospital of Soochow University, Suzhou, China, who were diagnosed with recurrent bronchogenic cancer between 1 June 2009 and 30 September 2015 were reviewed, and survival analysis was assessed by the Kaplan–Meier method.ResultsA total of 15 recurrent bronchogenic carcinoma patients received ILBT, and information on curable effects and safety was available. The group consisted of two complete response (2/15), 11 partial response (11/15), one stable disease (1/15) and one progression disease (1/15). The response rate was 86.7% (13/15), and disease control (complete response + partial response + stable disease) was 93.3% (14/15). The dyspnea indexes of the patients decreased significantly in weeks 1, 2, 4, and 8 after ILBT treatment (P &lt; 0.001). The average post‐ILBT partial remission period was 5.27 ± 3.35 months, and the median partial remission period was 3.24 months. The combination therapy of ILBT and bronchofiberscope (P = 0.013), and a total ILBT dose of ≥20 Gy could produce a partial effective rate. The progress‐free survival of patients was 9.5 months (95% CI 12.2–16.5 months), average progress‐free survival was 15.8 ± 14.4 months, median OS was 32.0 months (95% CI 25.0–30.0 months), 1‐year OS was 93.3% (14/15), and 3‐year OS was 40.0% (6/15). The main adverse events were bronchospasm and hemoptysis (grade III); others were grade I–II.ConclusionComputed tomography‐guided ILBT is a safe, effective palliative treatment for recurrent bronchogenic carcinoma, but it requires further study in larger groups.

The application of laser therapy for the medical rehabilitation of the children presenting with chronic osteomyelitis

The objective of the present study was to develop a scientifically sound rationale for the application of infrared laser radiation (IRLR) either separately or in the combination with fluctuation magnetic therapy in the medical rehabilitation of the children presenting with chronic hematogenous osteomyelitis. Another objective was to evaluate the clinical effectiveness of this therapeutic modality. Two achieve these goals, the clinical observations and special research studies were conducted in two directions with the participation of 95 patients at the age varying from 1 to 15 years. The study has demonstrated the effectiveness of the inclusion of IRLR in the medical rehabilitation program for the children with chronic hematogenous osteomyelitis in different periods of the disease. It was shown that the transcutaneous infrared irradiation of the affected area during the exacerbation of chronic osteomyelitis had a well apparent immunostimulatory effect and reduced the activity of the inflammatory process. The application of IRLR in combination with fluctuation magnetic therapy during the period of partial remission, had a more pronounced influence on the microcirculation and stimulated the regenerative and trophic processes.

P1-22-3 - A Case of Relapsed Lymphoplasmacytic Lymphoma with Marked Response of Bendamustine Hydrochloride

A 66-year-old woman was diagnosed with lymphoplasmacytic lymphoma (LPL) in 2007, and her clinical stage was IIIA. She also had Sjogren syndrome and rheumatoid arthritis before. Eight courses of CPA, THP, VCR, and PSL therapy was applied. After 10 months of complete remission (CR), the relapse was revealed by CT in 2008. Fludarabine alone therapy was then introduced as a second-line therapy. Because the progression was proved after 4 courses of the therapy, re-biopsy of right inguinal lymph node (LN) showed the same diagnosis as LPL except for the CD20 positivity. The third-line chemotherapy of rituximab, IFO, MIT, VDS, and PSL was applied and completed 8 courses. After a short period of partial remission, systemic LNs enlarged gradually, and then the watch and wait strategy was chosen. In 2012 she reported fever, general fatigue, and night sweats. The examinations showed low platelet count, elevation of LDH and generalized lymphoadenopathy, especially abdominal paraaortic LNs showing higher metabolic activities in PET-CT. Right inguinal LN biopsy revealed many large B cells and plasmablastoid cells, but still the diagnosis did belong to LPL. However, we believed the clinical transformation of LPL to aggressive B cell lymphoma, possibly to diffuse large B cell lymphoma (DLBCL) because of more aggressive clinical features. Bendamustine plus rituximab was applied as fourth line. After completion of 6 courses, complete metabolic remission was confirmed by PET-CT in 2013, and the disease still keeps CR state until now. Bendamustine is now one of an active agent to relapsed or refractory indolent B cell lymphoma in Japan. Based on the knowledge published in western countries, a salvage treatment with bendamustine can be effective and safe for heavily pretreated patients with relapsed or refractory DLBCL. Our case also showed that bendamustine plus rituximab can be a promising option for the treatment of relapsed or refractory aggressive B cell lymphoma.

Etanercept Treatment in Children With New-Onset Type 1 Diabetes: Pilot Randomized, Placebo-Controlled, Double-Blind Study

We thank Dr. Peters (1) for his thoughtful comments regarding our study (2). Dr. Peters suggests that etanercept may effect the partial remission period of type 1 diabetes by mediating declines in autoantibodies, GAD-65 in particular. Clinical data supports the concept that titer and number of autoantibodies correlates with accelerated β-cell demise and a lower likelihood of clinical remission compared with individuals who tested negative for diabetes-associated …

New Definition for the Partial Remission Period in Children and Adolescents With Type 1 Diabetes

OBJECTIVETo find a simple definition of partial remission in type 1 diabetes that reflects both residual β-cell function and efficacy of insulin treatment.RESEARCH DESIGN AND METHODSA total of 275 patients aged <16 years were followed from onset of type 1 diabetes. After 1, 6, and 12 months, stimulated C-peptide during a challenge was used as a measure of residual β-cell function.RESULTSBy multiple regression analysis, a negative association between stimulated C-peptide and A1C (regression coefficient −0.21, P < 0.001) and insulin dose (−0.94, P < 0.001) was shown. These results suggested the definition of an insulin dose–adjusted A1C (IDAA1C) as A1C (percent) + [4 × insulin dose (units per kilogram per 24 h)]. A calculated IDAA1C ≤9 corresponding to a predicted stimulated C-peptide >300 pmol/l was used to define partial remission. The IDAA1C ≤9 had a significantly higher agreement (P < 0.001) with residual β-cell function than use of a definition of A1C ≤7.5%. Between 6 and 12 months after diagnosis, for IDAA1C ≤9 only 1 patient entered partial remission and 61 patients ended partial remission, for A1C ≤7.5% 15 patients entered partial remission and 53 ended, for a definition of insulin dose ≤0.5 units · kg−1 · 24 h−1 5 patients entered partial remission and 66 ended, and for stimulated C-peptide (>300 pmol/l) 9 patients entered partial remission and 49 ended. IDAA1C at 6 months has good predictive power for stimulated C-peptide concentrations after both 6 and 12 months.CONCLUSIONSA new definition of partial remission is proposed, including both glycemic control and insulin dose. It reflects residual β-cell function and has better stability compared with the conventional definitions.

Extensive liver metastasis of gastric cancer effectively treated by hepatic arterial infusion of 5-fluorouracil/cisplatin.

Most gastric cancer patients with jaundice caused by extensive liver metastasis show no tumor shrinkage response to systemic chemotherapy, while often showing severe adverse reactions. Their prognosis is very poor. We experienced two patients for whom hepatic arterial infusion (HAI) of 5-fluorouracil (5-FU) and cisplatin through an implantable port was effective for treating extensive liver metastasis. One patient had jaundice (serum bilirubin level before HAI therapy, 12.4 mg/dl) caused by metachronous liver metastasis, and prior systemic chemotherapy with 5-FU and irinotecan had not been effective. The other patient had gastric cancer with synchronous liver metastasis and also exhibited jaundice (serum bilirubin level before HAI therapy, 11.8 mg/dl). Both patients were treated with HAI of cisplatin, 20 mg/m(2) for 30 min on day 1, and continuous intraarterial infusion of 5-FU, 300 mg/m(2), from day 1 to day 4 every week. Their metastatic liver tumors were significantly reduced in volume and the jaundice disappeared. They survived for 30 and 27 weeks, respectively. A pharmacokinetic study conducted during the period of partial remission revealed that the extraction ratios of 5-FU and cisplatin in the liver were 0.89 and 0.024, respectively, suggesting a favorable first-pass effect of 5-FU. Although our findings here suggest that the successful local control of liver metastasis could improve the deteriorated condition and prolong the survival in some patients with far advanced cancer, it is essential to pay much attention to possible adverse effects during the treatment.

P14 The importance of the therapeutic scheme in the induction of the partial remission period in the children with diabetes mellitus type I

P14 The importance of the therapeutic scheme in the induction of the partial remission period in the children with diabetes mellitus type I

MAI Osteomyelitis 18-Year Scintigraphic Follow-Up

Mycobacterium avium-intracellulare osteomyelitis is an infrequently reported entity, especially in immunocompetent patients. When multifocal, the imaging findings can be confusing, simulating metastatic disease or other bone lesions. An immunocompetent patient with multifocal Mycobacterium avium-intracellulare osteomyelitis is presented who has been followed for 18 years and experienced episodes of exacerbations and further dissemination of her disease, followed by periods of partial remission and clinical quiescence. Bone scintigraphy was very useful in evaluating the extent of involvement and monitoring response to treatment.

Remission In Diabetic Children In Riyadh

Few data are available about temporary remission in insulin dependent mellitus in Riyadh. Thirty-seven out of 115 (32.1%) diabetic children diagnosed over five and a half years (1985 to mid-1990) in Suleimania Children's Hospital were retrospectively studied. Partial temporary remission rate was 30.4% (35/115). Total temporary remission rate was 1.7% (2/115), lasting 18 months in a seven-year-old patient. The partial remission rate was higher in children above five years of age (36.9%), in children of unrelated parents (34.3%) and in female patients (51.4%). Of these, 64.8% were Saudi. Fifty-four percent of these patients presentd at onset without diabetic ketoacidosis and mean duration of symptoms before diagnosis was short (9.2 days). Mean time of occurrence was five weeks and mean duration of remission was nine weeks. Mean initial insulin dose was 1.35 unit/kg/day, while mean dose during the remission was 0.34 unit/kg/day. Mean glycosylated hemoglobin at onset was 12.3% and 7.4% during remission. Mean C-peptide level improved markedly from 0.16 nmol/L at onset to 0.29 nmol/L during remission and rose to 0.61 nmol/L following glucagon intravenous injection demonstrating the temporary recovery of pancreatic B-cell function. Finally, our low figures of remission (32.1%) are probably related to the young age distribution at onset in our series and perhaps to a different pattern of severity of insulin dependent diabetes mellitus in our community.

Insulin-Dependent Diabetes Mellitus in Children: Familial and Clinical Patterns in Riyadh

Type I diabetes mellitus is probably common in Saudi Arabia, but only a small amount of information on the disease is available and most cases reported so far have been type II diabetes mellitus. Type I diabetes was diagnosed in 110 children who were followed at Suleimania Children's Hospital over a five-year period (1985-1989). Saudis represented 74.5% (82/110) of the patients, and 53.6% (59/110) were female. Consanguinity existed in 42.7% (47/110) of the parents. A first-degree family history was positive for insulin-dependent diabetes mellitus in 28.1% (31/110). Mean age at onset was 5.87 years, which is low compared with other ages cited in the literature. Thirty-three patients (30%) were below three years of age at onset. The most common clinical sign was diabetic ketoacidosis, which was seen in 67.2% (74/110). Duration of symptoms before diagnosis ranged from two days to more than two months, with a mean of 18.2 days. Partial remission was seen in 30.9% (34/110). This low percentage is probably due to the young age distribution at onset and perhaps to a different pattern of severity of the disease in our community. Further studies, including opening a local registry, are needed for confirming the incidence and characteristics of the disease in Saudi Arabia.

Acute Monocytic Leukemia in an Irradiated Beagle

A purebred female Beagle dog that had received 2,000 R of protracted wholebody gamma-irradiation from 60Co when 14 months old had hematologic changes consistent with a myeloproliferative disorder 3 years after the termination of radiation exposure. Peripheral blood and bone marrow findings during the 7-month period before death showed progressive anemia with increased numbers of platelets; immature granulocytes, monocytes and promonocytes. A period of partial remission occurred during which time the peripheral blood was aleukemic, although there was marked thrombocytosis and abnormal erythropoiesis which was evidenced by bizarre circulating nucleated red cells, anisocytosis, poikilocytosis and Howell-Jolly bodies. The dog had a terminal crisis with marked leukocytosis, most cells in the peripheral blood being bizarre monocytes and promonocytes. Tissues obtained at necropsy showed diffuse as well as focal infiltration of the spleen, liver, lymph nodes, heart, kidney and gastrointestinal wall with immature neoplastic cells resembling monocytes and monocytic precursors. The monocytic differentiation of the invasive cell population was confirmed by morphological, cytochemical, histological, ultrastructural and in vitro cell culture studies.

Whither the Chronic Disease Hospital?

RECENT legislation has mandated reclassification of chronic disease hospitals as skilled nursing facilities. This has led to governmental efforts to reduce the costs and extent of care rendered in certain instances. Many diseases run a protracted subacute or chronic course, producing symptoms and disabilities that may last for varying lengths of time or for the rest of the patient's life. Many of these conditions involve slow deterioration, with periods of exacerbation alternating with periods of partial remission. Typical of this category would be rheumatoid arthritis, multiple sclerosis, some forms of chronic pulmonary disease, and chronic renal disease. Other conditions produce rapid onset of severe disability and then tend to stabilize, a characteristic condition being the cerebrovascular accident. A third major group is that of congenital diseases and other conditions requiring prolonged rehabilitation efforts and diseases such as muscular dystrophy that cause progressive deterioration. These categories are by no means all-inclusive,

The early partial remission of juvenilediabetes mellitus: The roles of insulin and growth hormone

Ten children with juvenile diabetes mellitus were studied with oral glucose tolerancetests at the onset of their disease and during the period of partial remission. No significant improvement in carbohydrate tolerance was observed. Free fatty-acid responses improved, but abnormalities were still demonstrable. Fasting growth hormone levels were normal, and no changes were noted in the growth-hormone responses before therapy and during remission. Plasma insulin concentrations were very low at the time of the clinical onset, and no significant improvement in insulin secretion was observed during the phase of partial remission. These data suggest that increased insulin production or changes in growth hormone do not play roles in the early partial remission of juvenile diabetes.