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The aim of this study was assess the activity of thalidomide in patients with progressive relapsed or platinum-refractory germ-cell tumours (GCT). Between April 2002 and January 2003, 15 patients with inoperable progressive GCT were treated with escalated daily doses of 200-600 mg thalidomide. All patients had failed first-line and salvage chemotherapy with a median of 6 (range 4-12) cisplatin-based treatment cycles, 13/15 (87%) patients had received high-dose chemotherapy (HDCT) and 8/15 (53%) patients were considered platinum-refractory or absolute refractory; 8/15 (53%) patients had previously received other palliative chemotherapy regimens. No patient achieved a complete remission (CR) or partial remission (PR). However, 5/15 (33%) patients achieved serological PR and 1 additional patient had stable disease for 3 months. The median duration of remissions was 3 months (range 2-12 months) including 2 patients with a progression-free survival of 9 and 12 months. Responses occurred mainly in patients with a low tumour burden, slow disease progression and alpha-foetoprotein (AFP) elevations. Responses to thalidomide were independent from platinum-sensitivity. Toxicity was mild, with lethargy and constipation in the majority of patients. Skin rash grade II developed in 2 patients and peripheral neurotoxicity grade II/III developed in 4 patients. One responding patient died suddenly from an unknown cause. It is concluded that thalidomide shows single-agent activity in patients with heavily pre-treated GCT, AFP elevations and slowly progressive disease.

Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years. Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively. The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion. Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient. However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure. Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations. Since this guideline is based on the highest evidence level available today, a deviation from these proposals should be a rare and justified exception

Local variations of the phase transition temperatures are important for the functionality of actuators based on NiTi shape memory alloys. Mechanical distortions induced by process treatment can suppress the phase transition from the austenitic to the martensitic structure. In this work, local changes of the phase transition have been investigated by time-dependent IR thermography. For the quantitative interpretation of the thermographical measurements, information about the IR emissivity is important. In this work a new thermal wave method based on two detection techniques is presented, which can be used to measure both the IR emissivity and the thermal transport properties.

We studied 128 patients with chronic myeloid leukemia (CML) relapsing after allogeneic stem cell transplantation (SCT). Disease at the time of treatment with Imatinib was in chronic phase (CP) in 51 patients, accelerated phase (AP) in 31 and blastic crisis (BC) in 46. Of the 51 patients in CP, 14 were in cytogenetic and two in molecular relapses. The median interval between relapse and Imatinib therapy was 5 months (0–65). A total of 50 patients had failed treatment with donor lymphocyte infusions prior to Imatinib. The overall hemato-logical response rate was 84% (98% for patients relapsing in CP). The complete cytogenetic response (CCR) was 58% for patients in CP, 48% for AP and 22% for patients in BC. Complete molecular responses were obtained in 25 patients (26%), of whom 21 were in CP or AP. With a median follow-up of 9 months, the estimated 2-year survival for CP, AP and BC patients was 100, 86 and 12%, respectively. Out of 79 evaluable patients, 45 (57%) achieved full donor and 11 (14%) mixed chimerism after Imatinib. We conclude that Imatinib has significant activity against CML in relapse after allogeneic SCT. Durable cytogenetic and molecular remissions are obtainable in patients in CP.

The present paper summarizes the results of the second German consensus meeting on immunogenetic donor search for allotransplantation of hematopoietic stem cells held in Essen in November 1999 under the auspices of the German Society for Immunogenetics (DGI) and the German Working Party for Blood and Marrow Transplantation (DAG-KBT). Immunogeneticists and transplant physicians from all over the country agreed to update the national standards for: (1) search strategy including the role of unrelated and extended family donor search after unsuccessful core family donor search, (2) histocompatibility loci to be typed, (3) histocompatibility typing techniques to be used (HLA serology vs DNA-based HLA typing, cellular tests, serum cross-match), and (4) acceptable HLA mismatches in the context of a defined underlying disease, donor type, and conditioning regimen.

The recently described species Candida dubliniensis has been recovered primarily from superficial oral candidiasis in HIV-infected patients. No clinically documented invasive infections were reported until now in this patient group or in other immunocompromised patients. We report three cases of candidemia due to this newly emerging Candida species in HIV-negative patients with chemotherapy-induced immunosuppression and bone marrow transplantation.

High-dose chemotherapy (HDCT) is a promising treatment for patients with germ cell tumours and a poor prognosis. The selection of patients who may profit from this intervention is challenging for the urologist, as the indication has to be carefully established. Exclusion criteria primarily concern impaired organ functions. Prior to HDCT haematopoietic stem cells are obtained after the administration of conventional-dose chemotherapy plus G- or GM-CSF stimulation. HDCT consists of a combination of carboplatin, etoposide and ifosfamide or cyclophosphamide. After HDCT, haematologic monitoring and maximal supportive care are essential. It is therefore recommended that HDCT only be administered at specialized centres.

Vehicle-to-grid (V2G) describes a system where electric vehicles (EV) and plug-in hybrid electric vehicles (PHEV) can connect to the electric grid an participate in markets managed by grid system operators. This paper evaluates the opportunities for V2G-enabled EVs and PHEVs to realize revenues from the regulation market that offset operating costs, making them more cost competitive with conventional vehicles. We built a ten-year net cash flow model for a fleet of delivery trucks to assess the costs and benefits of adopting this technology. To project potential V2G revenue, we modified and adapted a simulation model developed by a grid system operator. Based on exploration of numerous scenarios we determined which combination of factors produced the lowest total cost of ownership. Additionally, we conducted sensitivity analysis on battery size. Our results indicate that EV and PHEV fleets offer lower operating expenses for urban pickup and delivery services than internal combustion engine vehicles (ICE). In addition, fleet managers can expect to offset 5–11% of the total cost of ownership with V2G revenue.

Haemopoietic growth factors are accepted as accelerating haemopoietic recovery after bone-marrow grafting, yet no large randomised trials have been published that convincingly show benefit. Lenograstim (glycosylated recombinant human granulocyte colony-stimulating factor) was given to 315 patients after bone-marrow transplantation in a prospective randomised placebo-controlled multicentre trial. 1 day after bone-marrow infusion, 163 patients received lenograstim 5 micrograms/kg per day by 30-min infusion, and 152 patients received placebo daily for 28 days or until neutrophil recovery. 137 patients had lymphoma, 35 myeloma, 85 acute lymphoblastic leukaemia, and 58 a solid tumour. Patients were stratified by age and by type of bone-marrow transplantation (BMT). Neutrophil recovery to above 10(9)/L for 3 consecutive days was seen earlier in lenograstim-treated patients (16 vs 27 days, p0.001). Time to neutrophil recovery above 0.5 x 10(9)/L was reduced (14 vs 20 days, p0.001). The difference was significant both in autograft (20 vs 14 days, p0.001) and allograft (20 vs 14 days, p0.01) patients, in children (20 vs 13 days, p0.001), and adults. Lenograstim-treated patients had fewer days of infection, and of antibiotic administration, and also spent less time in hospital. However, clinical and microbiological sepsis was similar in both groups. There was no significant toxicity ascribed to lenograstim. Survival was the same at days 100 and 365. In patients undergoing autologous or allogeneic BMT for neoplastic disease, lenograstim significantly reduced duration of neutropenia and led to earlier hospital discharge.

We evaluated recombinant human granulocyte-macrophage colony- stimulating factor (rhGM-CSF; Sandoz Pharma [Basel, Switzerland]/Schering-Plough [Kenilworth, NJ]) as an adjunct to a modified (mainly cyclophosphamide and doxorubicin increased 1.5-fold) COP-BLAM regimen in the primary treatment of high-grade malignant non- Hodgkin's lymphomas (NHL). Patients (n = 182; stage II-IV; age, 15 to 73 years) were randomized to rhGM-CSF (400 micrograms) or placebo for 7 days subcutaneously after chemotherapy. Efficacy was analyzed for patients receiving at least 70% of study medication (n = 125). The frequency of clinically relevant infection was reduced by rhGM-CSF (28 v 69 infections, 16 v 30 patients, P = .02) with a cumulative probability of remaining infection free in 70% versus 48% (P = .05 log rank test at 190 days). Periods of neutropenia (P = .01 in 5 of 6 courses), days with fever (2.1 v 4.0, P = .04) and days of hospitalization for infection (3.5 v 8.0 days, P = .01) were significantly reduced. Complete response (CR) rates, assessed by prognostic risk, were 15 of 19 (79%) in treated versus 20 of 21 (95%) in controls in the low-risk group (P = .12). In the high-risk group, 31 of 45 (69%) treated patients achieved CR versus 25 of 52 (48%) of controls (P = .04). No difference in survival has been seen after 1 year. Only injection site reactions (45% treated v 7% controls) and rash (26% v 2%) occurred more frequently in treated patients (n = 176). These data show that rhGM-CSF is well tolerated in most patients with NHL, significantly reduces infection, and improves response.

In the LMCE1 study using a single course of megatherapy most of the relapses occurred during the first 2 years after autologous bone marrow transplantation. A second pilot study (LMCE2) was therefore set up using a double harvest/double graft approach with two different megatherapy regimens. Objectives were to test the role of increased dose intensity on response status, relapse pattern and overall survival. Thirty-three patients (20 boys, 13 girls) with a median age of 53 months at first megatherapy (range, 17-202 months) entered this study. They were cases either with refractory disease in partial response after second line treatment for stage 4 neuroblastoma (n = 25) or after relapse from stage 4 (n = 5) or stage 3 disease (n = 3). All patients received Etoposid and/or Cisplatinum (or Carboplatin) containing treatments before megatherapy. The first megatherapy regimen was a combination of Tenoposid, Carmustine and Cisplatinum (or Carboplatin), the second applied Vincristin, Melphalan and Total Body Irradiation. The first harvest was scheduled 4 weeks after the last chemotherapy, the second 60 to 90 days after megatherapy. All marrows were purged in vitro by an immunomagnetic technique. Median follow up time since first megatherapy is 56 months. Response rates for evaluable patients were 65% (complete response rate: 16%) for megatherapy 1 and 60% (complete response rate: 25%) for megatherapy 2. Considering that only patients with delayed response or relapse were eligible for this pilot study the overall survival was encouraging with 36% at 2 years and still 32% at 5 years. The costs for these survival rates were high in terms of morbidity (four early and four late toxic deaths; toxic death rate: 24%). Double harvesting may have the disadvantage of delayed engraftments related in part to a disturbance of marrow microenvironment by megatherapy 1. This double megatherapy approach achieved a prolonged relapse free interval (median 11 months, range 2-31 months) in patients reaching megatherapy 2 and justifies further evaluation of concepts with consecutive dose-escalation.

Wind energy is the fastest growing energy source in the world. However, due to the inherent issues of intermittency and remoteness the need to complement wind energy with storage is well-recognized. Pumped Hydro Electric Storage units are the established and most widely studied application. Other technologies like flow (ZnBr) and NaS batteries are emerging but are still not considered economically viable. We assess the profitability of a wind plant plus battery storage system from a supply chain perspective. This includes network design decisions (like facility location, market allocation, supply allocation and capacity allocation) and daily operating policies (to manage the inventory of stored energy). We use a Monte-Carlo simulation model that creates realistic conditions for wind plant output, market prices, storage costs and technical characteristics to calculate profits. Our results show significant improvement in profits for certain decisions and also provide target costs and payback period for storage technologies.

Purpose To assess the role of residual tumor resection performed after high-dose chemotherapy (HDCT) in patients with relapsed or refractory germ cell tumors (GCT). Patients and Methods Between July 1987 and October 1999, postchemotherapy resections of residual tumors were performed in 57 patients who had been treated with HDCT for relapsed or refractory GCT and who had achieved a partial remission to this treatment. Results Complete resections of residual masses were achieved in 52 (91%) of 57 patients who were rendered disease free; in five (9%) of 57 patients, the resections were incomplete. Resection of a single site was performed in 39 (68%) of 57 patients, and the remaining 18 (32%) of 57 patients required interventions at two or more residual tumor sites. Necrosis was found in 22 (38%) of 57 patients, mature teratoma with or without necrosis was found in nine (16%) of 57 patients, and viable cancer with or without additional necrosis or mature teratoma was found in 26 (46%) of 57 patients. Viable cancer consisted either of residual germ cell or undifferentiated cancer in 22 (85%) of 26 patients, with additional non-GCT histologies in the remaining four patients. Patients with viable cancer had a significantly inferior outcome after surgery compared with patients with necrosis and/or mature teratoma even if all cancer was completely resected. Pulmonary lesions with a diameter of more than 2 cm were the only predictive variable for viable cancer in univariate analysis. Conclusion Resections of all residual tumors should be attempted in patients with relapsed or refractory GCT and partial remissions after HDCT.

We assessed the influence of amifostine on immune reconstitution after conventional-dose paclitaxel, ifosfamide, cisplatin and high-dose carboplatin, etoposide and thiotepa followed by autologous peripheral blood progenitor cell (PBPC) rescue in patients with germ cell tumor (GCT). A total of 40 patients were treated with one cycle of paclitaxel and ifosfamide (TI) followed by granulocyte-colony stimulating factor (G-CSF) to mobilize PBPC, three cycles of paclitaxel, ifosfamide and cisplatin (TIP) and one course of high-dose carboplatin, etoposide and thiotepa (CET) plus PBPC rescue. Patients were randomized to receive an absolute dose of 500 mg amifostine (group A, n=20) on each day of chemotherapy or no amifostine (group B, n=20). Prior to each cycle of chemotherapy, after hematologic engraftment from CET, 6 weeks and 3 months after transplantation the subpopulations of lymphocytes were phenotyped. Between the two study groups no statistically significant differences were observed concerning reconstitution of lymphocyte subpopulations. Throughout treatment with TIP or CET lymphocyte counts and their subpopulations remained low without severe clinical complications. Delayed reconstitution of the CD4(+) cell compartment after PBPC rescue was observed in both study groups, but did not result in any severe or atypical infections. Treatment with amifostine administered at this dose did not significantly influence the reconstitution of lymphocyte subpopulations. Low numbers of lymphocytes during chemotherapy and delayed reconstitution of CD4(+) cells and other lymphocyte subpopulations after PBPC rescue had no clinical relevance for patients with GCT.

Standard fuel contains up to 0.2 ml water per litre, of which is more than enough for microbial activity. The development of microorganisms mainly occurred when aqueous condensate collected in oil tanks. Studies have shown that the troubles of clogged filters, fuel tank corrosion, breakdown of tank coatings and engines are connected to the microorganisms. It is important and necessary to stop the bacterial growth with specific use of biocides. This paper will describe some experiences in overcoming this problem using a cost effective and environmentally friendly biocide as well as preventive measures.

Apart from the use of high-efficacy particulate air (HEPA) filtration, no established strategy for the prevention of invasive aspergillosis (IA) exists to date, and several attempts with topical or systemic prophylaxis have failed. However, in animal studies as well as in early phase I/II trials in humans, prophylactic aerosol amphotericin B showed promising results. An ongoing open-label, randomized, multicenter trial is investigating the efficacy of this approach.

Publisher Summary This chapter elaborates the high-dose chemotherapy plus stem cell support for poor risk testicular cancer or as salvage therapy for patients with relapsed disease. In a phase I/II-study, the German Testicular Cancer Working Group investigated a protocol of high-dose carboplatinum/etoposide/ifosfamide plus bone marrow or peripheral stem cells in 68 patients who underwent two cycles of standard dose cisplatinum/etoposide/ifosfamide (PEI) salvage chemotherapy and who did not progress during this salvage chemotherapy. Fifty-one percent achieved either CR, NED, or PR with marker normalization. The overall survival is about 4 0% after a 2 year median follow-up. These results indicate a possible superiority of a salvage regimen including at least 1 cycle of mega-dose chemotherapy. A dose escalation protocol was developed for the primary treatment of patients with poor risk criteria. Dose level 3 included 150 mg/m2 cisplatinum, etoposide 1000 mg/m2 and ifosfamide 1.6g/m2 per cycle q d 22 × 4, plus GM-CSF. The survival in 44 patients at dose level 3 is 79% after follow-up of 20 months, indicating a possible role for escalated doses in the primary treatment of poor risk patients.

The pharmacokinetics and applicability of aerosol amphotericin B administrations were studied in 40 neutropenic patients and 4 healthy volunteers. Particle size was measured and pulmonary deposition was demonstrated by radioisotope studies. Inhalations were easy to administer and were well tolerated, with minimal systemic absorption of the drug.

In spite of the increasing knowledge of risk factors in childhood ALL [1] and risk-adapted chemotherapy [2], the prognosis of high-risk ALL remains extremely poor. High-risk factors include abnormal cytogenetics, no response to conventional chemotherapy (CC), relapse within 18 months of diagnosis, relapsed T-ALL and multiple relapses. By CC continuous complete remission (CCR) is achieved in less than 10% of patients (pts.). Allogeneic bone marrow transplantation in CR2 ALL leads to leukemia-free survival in about 30% of pts. [3]. In children without a suitable marrow donor the same or an even more aggressive antileukemic treatment and autologous BMTmay offer a chance for long-lasting CR or even cure. Stimulated by early promising results in high-risk ALL in CR1 and CR2 [4,5], we started a clinical study using a new and well-tolerated conditioning regimen and ABMT. The regimen, which was introduced by BLUME for allogeneic BMT, consisted of HD VP-16 and F TBI [6]. So far, 23 children in first, second, or subsequent remission have entered the study.

Angioimmunoblastic lymphadenopathy- (AILD)-type T-cell lymphoma is a rare lymphoproliferative disorder which predominantly occurs in elderly patients. It is characterized by generalized lymphadenopathy, hepatosplenomegaly, and, frequently constitutional symptoms such as fever, night sweats, and weight loss. Many patients exhibit a pruritic skin rash and anemia [1, 2]. Histological examination shows an effaced lymph node architecture with infiltration of lymphocytes; immunoblasts, plasma cells, and histiocytes and prominent vascularization by arborizing postcapillary venules. The etiology and the underlying pathophysiological mechanisms of this disease are still unknown, although it is generally believed that AILD develops on the background of an abnormal immune reaction, since patients frequently exhibit a history of allergic reactions to various drugs or viral infections [3]. Immunohistological tests did not provide an answer to the question whether AILD is a clonal disorder or not. Therefore the disease was considered to be a benign disease potentially progressing into overt malignancy. Cytogenetic analyses, however, showed that the majority of cases of AILD are clonal disorders with nonrandom chromosome anomalies such as trisomy 3 or 5 being found in about half of the cases studied [4, 5], and more recently of rearrangements of the T-cell receptor genes (TCR) in 70%–80% [6].

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder of a neoplastic transformed pluripotent stem cell. The disease can be divided into three phases:a chronic “treatable” phase of 1–4 years duration followed by an accelerated phase of 3–6 months and finally an acute phase (blast crisis) inevitably leading to death in about 2–4 months [1]. Chemotherapy of CML in chronic phase improves the quality of life, but only slightly delays the onset of blast crisis. At present, the only way to possibly cure patients with CML is to eradicate the neoplastic stem cells by high-dose marrow ablative chemotherapy and allogeneic bone marrow transplantation (BMT). Patients transplanted in chronic phase have a 50%–70% chance to be in complete remission (CR) after 3 years, in accelerated or blastic phase the probability of survival in CR is reduced to about 35% and 10%, respectively [2]. With regard to the high rate of complete hematological and clinical remissions after BMT in chronic phase it is surprising that 30%–40% of these patients show persisting minimal residual leukemic cells by cytogenetic techniques [3].

Further improvement of chemotherapy for acute myeloid leukemia (AML) requires an evaluation of alternative treatment strategies as investigated in adequate prospective multicenter trials. Since no superior new drugs are available, treatment can be improved only by finding superior treatment strategies and combining them successfully, if possible. The major treatment strategies to be discussed here are a) long-term cylic myelosuppressive chemotherapy concepts (maintenance) and b) intensified postremission or preremission chemotherapy concepts (intensification).

Preliminary results of a cooperative pilot study on the effect of fibroblast interferon in 10 patients with NHL of low-grade malignancy are presented. In eight patients lymphoma progression forced a discontinuation of therapy. At the end of interferon treatment one patient with CBCC showed a stable disease, one patient with CBCC a minor partial remission.

Between 1978 and 1983 a total of 33 patients with non-Hodgkin's lymphoma (NHL) involving the gastrointestinal tract were seen in our institution. Pathological classification was performed according to Kiel. Low grade NHL was diagnosed in 17, high grade NHL in 16 patients. The most frequent histological entity was lymphoplasmocytoid immunocytoma (11 patients). The most common sites of origin were the stomach (23 patients) and the ileocecal region (6 patients). The majority of patients presented with stage I and II disease (20 of 33 patients). As a rule primary therapy consisted of surgery with curative intent. Most of the patients received additional chemotherapy or radiotherapy. Patients with limited disease and complete tumour resection showed long-term survival from 12+ to 57+ months (mean 32.9+ months). Patients with advanced disease (stage III and IV) and only palliative surgery or with lymphoblastic lymphoma had a probability of survival of less than 12 months.

In a prospective multicenter therapy trial the remission-inducing potential of the COP-BLAM (5 courses) and the possibly not cross-resistant IMVP-16 (2 courses) regimen for advanced diffuse large cell lymphomas were investigated. Inadequately responding patients were switched early after 2-3 courses to the IMVP-16 protocol. Between January 1986 and August 1988 349 previously untreated patients were recruited who fulfilled the entry criteria: age 15-75 (mean 56 years), stage II-IV. A first restaging after 3 courses of chemotherapy was documented for 280 cases, a second restaging following 7 courses of chemotherapy or a final report was available for 221 patients, 130 of which where in CR (59%). These figures include 29 cases who died already during induction-chemotherapy of progressive disease (n = 17) as well as of therapy-related complications in CR (n = 12). Thirty-three patients were switched early to IMVP-16 due to incomplete response at the first restaging; 13 of those achieved CR by the new regimen (39%), 9 achieved a partial remission which was turned into CR by additional radiotherapy in 5 cases. Dose reductions and interval prolongations were necessary at increasing rates with subsequent chemotherapy courses (20-50% of the cycles). Relapses have occurred in 32 patients so far (14 early, 18 after stop of treatment). The median survival was 24 months (n = 309 patients). These data show that this treatment strategy is effective in a large unselected group of patients of relatively high age. However, patients showing only delayed response with this protocol probably need more aggressive regimens to obtain durable remissions.

Results of the BMF study group trials ALL-REZ 83 and 85 for relapsed acute lymphoblastic leukemia (ALL) are presented. For children with late marrow relapse, remission rates of about 90% were seen in both studies. In children treated for early marrow relapse, the remission rate in study ALL-REZ 85 was superior (86% vs 62%). The probability of event-free survival for all patients and for those with early marrow relapse was also statistically significant (P less than 0.05). Children with T-cell ALL had an extremely unfavourable prognosis in both studies.

Interferon has potent antiviral, anti-proliferative, and immunomodulating properties [9, 10]. Leukocyte and fibroblast interferon have been applied in the treatment of human malignancies. Due to the limited availability of interferon, only small numbers of patients have been treated so far. According to the literature a total of 106 patients with malignant lymphomas have been treated, including five patients with Hodgkin’s disease, 65 patients with multiple myeloma, nine patients with acute lymphatic leukemia, 14 patients with chronic lymphatic leukemia, nine patients with nodular poorly differentiated lymphocytic non-Hodgkin lymphoma, and four patients with diffuse histiocytic non-Hodgkin lymphoma. Eight of the 106 patients achieved complete remission and 56 showed partial regression [1, 2, 4, 5, 7, 8, 12–15].

This paper describes how mono1ithical1y integrated transistor pairs are used as hybrid circuit components to produce Gbit/s performance in digital communications equipment. The transistor technology results in a peak fT of 5GHz and includes gold beam-leads for easy circuit assembly. When used as current mode switches the pairs exhibit propagation delays and edge times of 350ps. The circuit technique is demonstrated in a number of key functions for regenerative repeaters and terminal/test equipment. These include clock extraction (phase detector), data regeneration (decision flip-flop), and multiplexing, all performing at IGbit/s. The multiplexer is used to seria1ise four lower speed data streams generated from a commercially available logic family and it is concluded that a new Gbit/s logic family may be unnecessary for this application.

A high speed ECL multiplexing unit which accepts 4 channels of data and control information is described. Compatibility with commercial circuits to facilitate economic interfacing at low speed data rates is an integral design criterion. Built from flip-flops and gates made in a 5 GHz fT chip technology which includes two-level metallisation and gold beam leads, the multiplexer is mounted on a ceramic substrate and contained in a standard DIL package. Dissipating less than 0.75 watt it outputs data faster than 300 Mb/s. Some conclusions concerning the merits of combining hybrid and monolithic technology are drawn.

A 47-year-old male patient suffered from recurrent myalgia, induced by fasting or physical exercise. Later, he developed progressive muscular weakness. Serum levels of creatine phosphokinase (CPK) were elevated to approx. 400 U/1. Muscle biopsies showed lipid storage myopathy and signs of acute fiber necrosis, muscle carnitine was decreased to below 20% of controls, carnitine palmitoyl transferase (CPT) activity was normal. Carnitine was also moderately decreased in a liver biopsy and in plasma. Urine excretion of carnitine was low, no elevation of short-chain dicarboxylic acids could be found. The patient was also found to suffer from a lymphocytic malignant non-Hodgkin lymphoma, a monoclonal immunoglobulin (Ig) G-k in plasma and lymphocytic infiltration of bone marrow were demonstrated. At that time no evidence had been obtained to indicate that these two diseases could be related to each other. Autoantibodies against skeletal muscle could not be demonstrated. Absorption of L-carnitine p.o. was normal, however, plasma levels of carnitine fell again rapidly. Administration of 3 X 2 g L-carnitine per day normalized the patient's plasma carnitine levels and led to an increase of plasma short-chain acylcarnitine and ketone bodies, particularly beta-hydroxybutyrate (B-HOB). However, no significant clinical improvement could be seen. Additional application of prednisone led to normalization of CPK serum levels.

Various intensive induction regimens for adult AML involving a total of 3380 patients produced a median of 60% complete remissions (CR) ranging from 47% to 72% in multicenter [2, 4, 8, 10–12, 14] and major monocenter [5, 6, 9, 13] studies. The probability of continuous CR in these studies ranges from 8% to 45% (median, 24%) at 3 years. Corresponding data projected to 5 years yield a continuous CR rate of 10%–28% (median, 21%). No clear correlation has been found between CR duration and the type of induction or postinduction treatment. In particular, the role of consolidation and long-term maintenance therapy has remained controversial.