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A 7-year-old girl with an acute leukemia was reported whose blasts showed conversion from a T-lymphoid to a myeloid phenotype. At the onset of the disease, the blasts were negative for peroxidase and displayed FAB L1 morphology. Surface marker analysis revealed only CD7 antigen. Although complete remission was achieved, an extramedullary relapse was identified as having a several subcutaneous tumors 15 months later. Tumor cells showed the same marker expression as that of the blasts at the onset. After short term culture without an addition of any differentiation stimulators, the blast cells expressed CD2, CD3, CD4, CD8, and CD25 antigens. The karyotype was 46, XX, t(12; 21) (p11; q22). The intensive chemotherapy and radiation therapy were carried out, however, a hematological relapse occurred 12 months later. At this time, the blasts were strongly positive for peroxidase and expressed HLA-DR and CD33 antigens with disappearance of the CD7 antigen. Chromosome analysis revealed the additional abnormalities (del (7) (p15), -17, +der (17) t (17;?) (p13;?].

Intracranial anastomosis between the distal anterior cerebral arteries (ACA's) was performed on two patients. One patient had isolated occlusion of the proximal ACA on one side causing monoparesis in the leg, and the other patient suffered from occlusion of the internal carotid artery and a small anterior communicating artery. The weakness of the legs improved immediately after surgery and cerebral angiography revealed a good filling of the bilateral ACA's. Technical aspects and indications for the procedure are discussed.

Post 5-fluorouracil-treated murine marrow cells were infected with a retroviral vector (MPZen) bearing a multi-potential colony stimulating factor (Multi-CSF) cDNA insert and then transplanted into lethally irradiated syngeneic recipients to study the effects of autocrine production of Multi-CSF in normal hematopoietic cells. Extremely high levels (14,000 U/mL) of Multi-CSF were detected in the sera and in media conditioned by various hematopoietic tissues of the transplanted animals. While spleen, peritoneal, and peripheral blood cellularity increased approximately 10-fold, 10-fold, and 50-fold, respectively, bone marrow cellularity decreased twofold. Progenitor numbers were depressed twofold in the bone marrow but elevated more than 100-fold in the spleen and peritoneum. The majority (80%) of transplanted mice died within 5 weeks of transplantation and showed extensive neutrophilic infiltration of the spleen, lung, liver, and muscle, often with mast cell foci; a phenomenon also seen in the skin and intestine. Neither the infected cells from hematopoietic tissues of the primary mice, nor autonomous mast cell-lines that grew from these cells in liquid culture produced any overt disease when transplanted into normal or sublethally irradiated secondary recipients. In contrast, injection into mice of autonomous FDC-P1 cells transformed by the same retroviral construct led to tumor formation in vivo within 4 weeks. Thus, dysregulated Multi-CSF expression by normal hematopoietic cells produces a fatal but nonneoplastic myeloproliferative syndrome.

Two types of acellular pertussis vaccine have been used in Japan since their introduction in 1981. They are different in their antigen content and immunogenicity. To assess the type-specific efficacy of acellular pertussis vaccine commercially available in Japan, 442 households of patients with pertussis were surveyed from 1981 to 1987. The secondary attack rates in children 2 through 8 years of age were 61.3% (46/75) in unimmunized children, 7.5% (4/53) in children fully immunized by the filamentous hemagglutinin predominant type acellular pertussis vaccine, 14.3% (1/7) in children fully immunized by the pertussis toxin-filamentous hemagglutinin type vaccine, and 13.5% (7/52) in children given whole-cell pertussis vaccine. The estimated efficacy was 87.7% for the filamentous hemagglutinin predominant type vaccine and 76.7% for the pertussis toxin-filamentous hemagglutinin type vaccine in children aged 2 through 8 years. Both types of acellular pertussis vaccine were similarly effective, without any statistically significant differences, and their efficacy was not different from that of whole-cell vaccines. This survey also indicated that adults are a major source of infection, with a high secondary attack rate of 7.8%.

A physician has an ethical duty to hold in confidence communications made to him by his patient. A legal recognition of this ethical duty is found in the concept of privilege, which is the subject of this article. January 1967 will bring to California physicians a new protection for patients' communications. The physician-patient privilege has been redefined to include confidential communications made during diagnostic evaluation, those made to non-licensed physicians, interns and medical aides, and those overheard by eavesdroppers. There has been added a psychotherapist-patient privilege designed to facilitate communications required in psychotherapy as well as in behavioral research. This paper first presents a brief historical background and discusses the protections and limitations afforded by the new California Evidence Code. There follows a section on the psychotherapist-patient privilege with the recommendation that in the context of psychotherapy, patients of physicians who are not psychiatrists should be afforded the additional benefits of the psychotherapist-patient privilege. Lastly, advice is given concerning the physician's conduct in relation to his duty to claim privilege under the new code.

A vertometer for spherical ophthalmic lenses was designed that is automated in focusing a target, in centering a lens being tested, and in marking its center within specified limits of tolerances. Light from the target is introduced into a scanning unit that detects the three-dimensional deviation of its image from a desired position and generates three signals to drive simultaneously the target and the lens so that the image of the target may come to the desired position. This procedure is followed by an automatic measurement of the deviation and marking the center, with an accuracy some five times greater than is attainable by visual examination. The working principle and experimental results are described in detail.