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From July 1983 to January 1991 a total of 622 patients were randomized (585 eligible) to compare the effects of hydroxyurea, interferon alpha (IFN), and busulfan on the duration of chronic phase, and survival. Further goals included the determination of prognostic parameters. 598 CML patients were documented and 575 evaluable. The Ph-status was known for 547 patients. 89.4% of the patients were Ph-positive (+). 11% had additional chromosome aberrations. The median survival of Ph+ patients by now is 4.2 years, that of Ph-patients 1.4 years. Ph-negative patients are older, tend to have lower cell counts and, as a group are more ill at diagnosis. A survival difference of about one year is expected between busulfan and hydroxyurea treated patients. Prospectively evaluated age, organomegaly related symptoms, Karnofsky index, extramedullary manifestations, number of erythroblasts and percent of circulating blasts proved to be of prognostic significance. A prognostic score (score 1) was determined which was superior to Sokal's score in the study population. 164 patients were randomized to receive IFN. In 54 patients (33%) IFN had to be terminated because of adverse effects, therapy resistance or other reasons. Clinically relevant neutralizing antibodies were detected in 9 cases. Most frequent adverse events were flu-like symptoms in 74%, gastrointestinal symptoms in 52%, and neurologic-psychiatric symptoms in 30% of patients. Reduction of the Ph-chromosome was observed in 13% of evaluable patients (10 of 75). In 4 patients complete cytogenetic remissions were observed, in three of these ongoing. Cytogenetic responders have a survival advantage. Interferon treated Philadelphia-negative CML patients have no survival disadvantage. The study is expected to allow statements as to the advantages or disadvantages of the use of busulfan, hydroxyurea and IFN in the treatment of CML as well as to the reliability of prognostic markers.

The first experience with the training program carried out in the University of Ulm presents a number of problems which could be important for its realization in teaching hospitals. The seminar and course program should be related to practice and be organized with the active cooperation of the students. The quality of the training to a great extent depends on the didactic skill, willingness to teach and a not inconsiderable expense of time for the chief physician, the assistant chief physician and the physician in charge of the wards during visits and when working in the ward. The omission of the "Junior Intern" status seems to be a disadvantage to the teaching organization. Condensing the seminar sessions into one month in a three-month period is possibly a logical compromise to guarantee the necessary continuity of the ward work and additional theoretical preparation for the final examination which the student requires.

The prevalence of antibodies to human T-lymphotropic virus III was determined in acquired immunodeficiency syndrome (AIDS) risk groups by an enzyme linked immunosorbent assay and confirmatory tests in four different areas in West Germany. Twenty-four of 28 homosexual AIDS patients (86%), 24 of 33 homosexual patients with lymphadenopathy syndrome or AIDS related complex (73%), and 44 of 113 asymptomatic homosexuals at risk for AIDS (39%) were seropositive. In three groups of hemophiliacs, 8 of 35 in 1983 (23%), 25 of 65 in early 1984 (39%), and 19 of 23 in late 1984 (83%) showed positive results. Two sera from 36 polytransfused patients were also positive, whereas 36 selected blood donors, and 32 healthy laboratory and clinical personnel were all negative. Also no human T-lymphotropic virus III antibodies were detected in sera of 187 prostitutes in the Munich area.

The prevalence of antibodies to human T-lymphotropic virus III (HTLV-III) was determined in a total of 140 hemophiliacs and 36 polytransfused patients from three medical centers by an enzyme linked immunosorbent assay (ELISA) and confirmatory tests. 58 hemophiliacs (41.4%) were seropositive. In all instances where the origin of the coagulation factors given to these patients could be determined, blood products came from the United States. In addition, 2 of 36 polytransfused patients, mostly with acute leukemias, who were transfused with blood products from local donors were positive for HTLV-III antibodies. No HTLV-III antibodies were detected in 237 blood donors selected in part from the donor pool of the polytransfused patients.

From 1967 to 1972, 70 patients with aplastic anemia were observed and followed up to death or at least two years. 3 cases of pure red cell anemia, and 2 cases of amegakaryocytic thrombocytopenia are included. Detailed investigation of drugs taken within 6 months before onset of the disease revealed chloramphenicol in 20, butazones in 11 cases. Acute viral hepatitis preceded the hemopoietic failure in 2 patients. In addition to various combinations of anemia, granulocytopenia and thrombocytopenia, monocytes were diminished in 35 and lymphocytes in 12 cases. Acid serum or sucrose tests were consistently negative. The patients were treated by short-term prednisone, long-term androgens and red cell and platelet substitution as needed. 2 years after onset of the disease, 33 per cent were in partial or complete remission, 30 per cent survived without remission, and 35 per cent had decreased. Correlation of various parameters with remission and survival showed the presence of a subgroup at risque, comprising patients with low marrow cellularity and clinically relevant diminution of all three cell lines at the time of diagnosis. Absolute lymphopenia and increase of plasma cells in the bone marrow were of poor prognostic significance. In this subgroup two years after the onset of the disease only 32 percent survivors and 16 per cent remissions were recorded. There was no conclusive evidence for the therapeutic value of prednisone or androgens in our series. The present situation in severe aplastic anemia requires more effective forms of treatment and justifies experimental therapies like bone marrow transplantation.

Thirty patients with severe drug-induced agranulocytosis were admitted to the Ulm University Hospital between January, 1968 and October, 1976. All of 13 already infected patients treated with antimicrobial decontamination in a plastic isolation bed system survived. But nine of 17 patients treated in the open ward died. The cases were not randomised and there was a difference in age between the two groups, but nevertheless the results suggest that antimicrobial decontamination and isolation is superior to treatment in an open ward.