- Email: [email protected]
"MAINTENANCE TREATMENT" FOR ACUTE LEUKAEMIA
1154 attachment was loose. Histological examination confirmed the presence of degenerating chorionic villi. The other, intrauterine pregnancy is now continuing normally. To our knowledge, this is the first report of primary intraabdominal pregnancy after GIFT. We cannot say whether an oocyte spilled into the uterovesical pouch or whether the fertilised oocyte escaped from the fallopian tube back to the pouch; the pregnancy may even have resulted from the fertilisation of an uncollected oocyte that was retained in the uterovesical pouch.
values
at
20 and 30 min did
not
show any
Our results suggest that production of prostacyclin by the vascular endothelium of the patients with Beh4;et’s disease under in vitro conditions may be significantly impaired-either by impaired biosynthesis by vascular endothelial cells affected by vasculitis or because of rapid degradation of prostacyclin. Impairment of prostacyclin biosynthesis may contribute to the pathogenesis of the thrombotic complications observed in Behcet’s disease.
H. I. ABDALLA IVF Unit, Cromwell Hospital, London SW5 0TU
K. K. AHUJA N. MORRIS
J. LYNN
1. Asch
RH, Balmaceda JP, Ellsworth LR, Wong PC. Pregnancy after translaparoscopic gamete intrafallopian transfer. Lancet 1984; ii: 1034. 2. Asch RH, Balmaceda JP, Ellsworth LR, Wong PC. Preliminary experiences with gamete intrafallopian transfer (GIFT) Fertil Steril 1986; 45: 366-71. 3. Ahuja KK, Smith W, Tucker M, Craft I. Successful pregnancies from the transfer of pronucleate embryos in an outpatient in vitro fertilisation programme. Fertil Steril 1985; 44: 181-84.
IMPAIRED PROSTACYCLIN SYNTHESIS BY VESSEL WALLS IN BEHÇET’S DISEASE
SIR,-In Behçet’s disease both superficial and deep veins and arteries of all sizes may be affectedl but vessel occlusions and thrombophlebitis have not been explained. We have found significantly reduced plasma levels of prostacyclin (6-keto-PGF) in the venous blood of patients with Behçet’s disease even without thrombophlebitis,2 and have taken our study a stage further by looking at prostacyclin biosynthesis by vascular endothelial cells. We studied 8 patients (7 males and 1 female) with active Behçet’s disease, 3 with thrombophlebitis, and 1 with neuro-Behcet’s disease and 4 healthy adult volunteer staff members (3 males and 1 female). All gave their written consent for forearm vein biopsy and had taken no drugs for at least 4 weeks before. The skin and subcutaneous tissues were anaesthesised and a 1 cm segment of vein was removed from the antecubital fossa by transverse incision, the vein segment was placed immediately in ice-cold Ringer’s solution (pH 7-4) and sectioned into rings within 15 min. Three rings were transferred into fresh Ringer’s solution at 37°C and samples of supernatant were removed during the next 30 min for assay of 6-keto-PGF,,, a stable metabolite of prostacyclin2, by radioimmunoassay (New England Nuclear) and expressed as pg/mm2 endothelium.3. -
significant increases
(p<0’05).
Faculty of Medicine, and School of Pharmacy, Hacettepe University, Ankara; Turkey
E. KANSU G. SAHIN F. SAHIN B. SIVRI I. SAYEK
F. BATMAN
E, Özer FL, Akalin E, et al. Behçet’s syndrome with obstruction of the venae Quart J Med 1972; 162: 151-68. Hizli N, Sahin G, Sahin F, et al Plasma prostacyclin levels in Behçet’s disease. Lancet
1. Kansu
cavae.
2.
1985; i: 1454 3. Preston FE, Whipps S, Jackson CA, et al Inhibition of prostacyclin and platelet thromboxane A2 after low-dose aspirin. N EnglJ Med 1981; 304: 76-79 4. Clark GM, Cooke D, eds. Basic course in statistics. London: Edward Amold, 1984 173-75.
"MAINTENANCE TREATMENT" FOR ACUTE LEUKAEMIA
SiR,—Dr Pritchard and Dr Chessells (Oct 4, p 805) express dissatisfaction with the term "maintenance treatment" for therapy of acute leukaemia in remission. I share this concern, especially since the terminology may have led over the years to some inappropriate treatment strategies. Freireichl has suggested that the post-induction treatment of acute leukaemia be regarded as "adjuvant" therapy. Most, if not all, acute leukaemia patients in remission have micrometastases and need further treatment, but the duration and details of this adjuvant treatment should not be inferred simply because terms such as "consolidation", "intensification", and "maintenance" have been popular in the past. To the extent that certain agents can induce differentiation of leukaemic cells, long-term drug treatment might maintain a state of differentiation with the appearance of continuing remission. In most cases, however, a strategy based on adjuvant treatment, with the details to be sorted out by controlled clinical trials, would seem more
appropriate.
Division of Hematology and Oncology, University of Alabama at Birmingham,
University Hospital, Birmingham, Alabama 35233, USA 1. Freireich
GEORGE A. OMURA
EJ. Oncology. JAMA 1980; 243: 2199
CALCIUM AND BLOOD PRESSURE
SIR,-Dr Grobbee and Dr Hofman’s paper (Sept 27, p 703) seems lack some important information. The higher the intake of salt (NaCI) the higher the losses of calcium (Ca) in urine from dogs’ and man.2 The osmotic diuresis produced by a high salt intake also increases the urinary losses of phosphate/ magnesium, and potassium.3 The explanation for the potentiation of the blood-pressure lowering effect in the group with parathyroid hormone levels (PTH) above the median could be the effect of a higher intake of salt in this group. With the greater losses of Ca, plasma Ca" - will fall; increased secretion of PTH will bring the plasma Cm - - to normal
to
Prostacyclin synthesis by vein segments obtained from Behrefs disease patients and controls. In all four venous samples from controls prostacyclin synthesisis increased over the 30 min of incubation (figure). Prostacyclin generation was much impaired in seven patients with Behçet’s disease. In 5 patients, there was a progressive and notable decline in the biosynthesis indicated by appreciably lower levels after 30 min of incubation. No synthesis was observed in 2 patients and only 1 patient showed increasing prostacyclin synthesis. The differences between pairs of results at 10, 20, and 30 min were compared by Wilcoxon signed rank test (paired).’ In the 4 controls prostacyclin synthesis significantly increased between the 10 min periods (p < 005). However, in the Behçet’s disease the
and again increase the losses of phosphate in urine.’ Thus the metabolism or balance of phosphate may be a crucial "missing link" in the explanation of raised blood pressure. A significant negative correlation between blood phosphate and blood pressure has been reported,S,6and in our study on the metabolic effect of potassium magnesium phosphate in severely obese women,’ there was at baseline a significant negative correlation between plasma
values
at
20 and 30 min did
not
show any
Our results suggest that production of prostacyclin by the vascular endothelium of the patients with Beh4;et’s disease under in vitro conditions may be significantly impaired-either by impaired biosynthesis by vascular endothelial cells affected by vasculitis or because of rapid degradation of prostacyclin. Impairment of prostacyclin biosynthesis may contribute to the pathogenesis of the thrombotic complications observed in Behcet’s disease.
H. I. ABDALLA IVF Unit, Cromwell Hospital, London SW5 0TU
K. K. AHUJA N. MORRIS
J. LYNN
1. Asch
RH, Balmaceda JP, Ellsworth LR, Wong PC. Pregnancy after translaparoscopic gamete intrafallopian transfer. Lancet 1984; ii: 1034. 2. Asch RH, Balmaceda JP, Ellsworth LR, Wong PC. Preliminary experiences with gamete intrafallopian transfer (GIFT) Fertil Steril 1986; 45: 366-71. 3. Ahuja KK, Smith W, Tucker M, Craft I. Successful pregnancies from the transfer of pronucleate embryos in an outpatient in vitro fertilisation programme. Fertil Steril 1985; 44: 181-84.
IMPAIRED PROSTACYCLIN SYNTHESIS BY VESSEL WALLS IN BEHÇET’S DISEASE
SIR,-In Behçet’s disease both superficial and deep veins and arteries of all sizes may be affectedl but vessel occlusions and thrombophlebitis have not been explained. We have found significantly reduced plasma levels of prostacyclin (6-keto-PGF) in the venous blood of patients with Behçet’s disease even without thrombophlebitis,2 and have taken our study a stage further by looking at prostacyclin biosynthesis by vascular endothelial cells. We studied 8 patients (7 males and 1 female) with active Behçet’s disease, 3 with thrombophlebitis, and 1 with neuro-Behcet’s disease and 4 healthy adult volunteer staff members (3 males and 1 female). All gave their written consent for forearm vein biopsy and had taken no drugs for at least 4 weeks before. The skin and subcutaneous tissues were anaesthesised and a 1 cm segment of vein was removed from the antecubital fossa by transverse incision, the vein segment was placed immediately in ice-cold Ringer’s solution (pH 7-4) and sectioned into rings within 15 min. Three rings were transferred into fresh Ringer’s solution at 37°C and samples of supernatant were removed during the next 30 min for assay of 6-keto-PGF,,, a stable metabolite of prostacyclin2, by radioimmunoassay (New England Nuclear) and expressed as pg/mm2 endothelium.3. -
significant increases
(p<0’05).
Faculty of Medicine, and School of Pharmacy, Hacettepe University, Ankara; Turkey
E. KANSU G. SAHIN F. SAHIN B. SIVRI I. SAYEK
F. BATMAN
E, Özer FL, Akalin E, et al. Behçet’s syndrome with obstruction of the venae Quart J Med 1972; 162: 151-68. Hizli N, Sahin G, Sahin F, et al Plasma prostacyclin levels in Behçet’s disease. Lancet
1. Kansu
cavae.
2.
1985; i: 1454 3. Preston FE, Whipps S, Jackson CA, et al Inhibition of prostacyclin and platelet thromboxane A2 after low-dose aspirin. N EnglJ Med 1981; 304: 76-79 4. Clark GM, Cooke D, eds. Basic course in statistics. London: Edward Amold, 1984 173-75.
"MAINTENANCE TREATMENT" FOR ACUTE LEUKAEMIA
SiR,—Dr Pritchard and Dr Chessells (Oct 4, p 805) express dissatisfaction with the term "maintenance treatment" for therapy of acute leukaemia in remission. I share this concern, especially since the terminology may have led over the years to some inappropriate treatment strategies. Freireichl has suggested that the post-induction treatment of acute leukaemia be regarded as "adjuvant" therapy. Most, if not all, acute leukaemia patients in remission have micrometastases and need further treatment, but the duration and details of this adjuvant treatment should not be inferred simply because terms such as "consolidation", "intensification", and "maintenance" have been popular in the past. To the extent that certain agents can induce differentiation of leukaemic cells, long-term drug treatment might maintain a state of differentiation with the appearance of continuing remission. In most cases, however, a strategy based on adjuvant treatment, with the details to be sorted out by controlled clinical trials, would seem more
appropriate.
Division of Hematology and Oncology, University of Alabama at Birmingham,
University Hospital, Birmingham, Alabama 35233, USA 1. Freireich
GEORGE A. OMURA
EJ. Oncology. JAMA 1980; 243: 2199
CALCIUM AND BLOOD PRESSURE
SIR,-Dr Grobbee and Dr Hofman’s paper (Sept 27, p 703) seems lack some important information. The higher the intake of salt (NaCI) the higher the losses of calcium (Ca) in urine from dogs’ and man.2 The osmotic diuresis produced by a high salt intake also increases the urinary losses of phosphate/ magnesium, and potassium.3 The explanation for the potentiation of the blood-pressure lowering effect in the group with parathyroid hormone levels (PTH) above the median could be the effect of a higher intake of salt in this group. With the greater losses of Ca, plasma Ca" - will fall; increased secretion of PTH will bring the plasma Cm - - to normal
to
Prostacyclin synthesis by vein segments obtained from Behrefs disease patients and controls. In all four venous samples from controls prostacyclin synthesisis increased over the 30 min of incubation (figure). Prostacyclin generation was much impaired in seven patients with Behçet’s disease. In 5 patients, there was a progressive and notable decline in the biosynthesis indicated by appreciably lower levels after 30 min of incubation. No synthesis was observed in 2 patients and only 1 patient showed increasing prostacyclin synthesis. The differences between pairs of results at 10, 20, and 30 min were compared by Wilcoxon signed rank test (paired).’ In the 4 controls prostacyclin synthesis significantly increased between the 10 min periods (p < 005). However, in the Behçet’s disease the
and again increase the losses of phosphate in urine.’ Thus the metabolism or balance of phosphate may be a crucial "missing link" in the explanation of raised blood pressure. A significant negative correlation between blood phosphate and blood pressure has been reported,S,6and in our study on the metabolic effect of potassium magnesium phosphate in severely obese women,’ there was at baseline a significant negative correlation between plasma