Phase II trial of intraperitoneal mitoxantrone in the management of refractory ovarian cancer

To define both the toxicity and efficacy of intraperitoneal mitoxantrone in the treatment of refractory ovarian carcinoma, 31 patients were entered onto a phase II trial of this agent delivered in a 2 L treatment volume on a monthly basis. Due to excessive local pain at the initial dose level (30 mg/m2), the amount of drug delivered with each treatment course was reduced to 20 mg/m2. Despite this reduction, 74% of patients required narcotic analgesia during treatment. In addition, there were four episodes of bowel obstruction (one requiring surgical intervention) during therapy, and two patients developed bowel obstruction and intraabdominal abscesses following the completion of treatment. Six of 18 evaluable patients (33%) whose largest tumor diameter was less than or equal to 1 cm at protocol initiation experienced surgically documented responses, compared with one of 11 patients (9%) whose largest tumor was greater than 1 cm in diameter. If the two patients exhibiting what we called a mixed response to treatment are included, seven of 21 patients previously treated with intraperitoneal cisplatin responded to this treatment program, including four patients who had failed to respond to intraperitoneal cisplatin. No responding patient has demonstrated clinical evidence of relapse with a median follow-up of 7 months (range, 3+ to 13+ months) from response laparotomy. Intraperitoneal mitoxantrone is an active treatment program in patients with small-volume refractory ovarian carcinoma, but local toxicity can be severe. Due to the toxicity encountered with this specific program, its use cannot be recommended for standard clinical practice. However, in view of the activity observed in refractory ovarian carcinoma, including responses in patients who had previously failed intraperitoneal cisplatin, it is important to continue to explore alternative therapeutic regimens using intraperitoneal mitoxantrone to reduce local toxicity while maintaining or improving efficacy.

Changing trends in drug use: the second follow-up of a local heroin using community

The first Seadown study documented the way in which police action in closing down the cohort's central point for meeting and drug distribution had effectively destroyed the long established heroin distribution network. Throughout the period of low heroin availability the social network of the cohort was preserved as members developed a whole range of alternative coping styles (displacement activities) in compensation for the enforced abstinence caused by the heroin drought. During the period of observation heroin returned to Seadown initially through a small, unstable and informal distribution co-operative and stayed in this phase until a new central meeting place had been established. Thereafter once a pyramidal distribution network developed, most cohort members were able to modify or stop their displacement activities to accommodate the re-availability of heroin.

Treatment of high-risk gestational trophoblastic disease with chemotherapy combinations containing cisplatin and etoposide

The authors have treated 22 patients with high-risk gestational trophoblastic disease (GTD) by cisplatin-etoposide-containing combinations. Sixteen patients were treated with dactinomycin, platinum, and etoposide combination (APE regimen) and six patients had platinum and etoposide combination (PE regimen). Fourteen patients were treated for resistant or relapsing GTD after first-line therapy, and eight patients initially. All 22 patients were high risk according to the World Health Organization prognostic score values. Sustained complete remission was achieved in 19 patients (86%). All eight patients who received treatment as initial therapy were cured (100%) whereas only 11 patients were cured among the 14 patients who failed prior chemotherapy (78%). Hematologic and renal toxicities were limited and no treatment-related deaths occurred in this group of patients. Cisplatin and etoposide could be more widely used in chemotherapeutic combinations for high-risk gestational trophoblastic disease.

Haemorrhagic pseudocyst of the adrenal in an adult (a case report)

An adult female patient presenting with a cystic abdominal mass and intermittent fever, was found at surgery to have a large cyst of the left adrenal gland. The imaging findings and pathology of this uncommon entity are discussed.

[Dobutamine during anesthesia of patients at risk for heart failure. A controlled prospective multicenter study of 93 surgical patients over 64 years of age]

Most anaesthetic agents cause cardiac depression possibly hazardous in the elderly, especially in presence of a poor cardiac reserve. Ninety-three patients undergoing non cardiac surgery lasting more than 90 min. were entered in a double-blind multicentre randomized trial. They were 65 year old or more and unaffected by evolutive angina pectoris. After insertion of a Swan Ganz catheter and an arterial cannula, anaesthesia was induced by thiopentone, fentanyl and 02/nitrous oxide (50%). Forty-five patients were infused dobutamine 7 micrograms.kg-1.min-1 (group D) from 10 min. after induction till the completion of surgery. Forty-eight patients received a placebo (group P). Haemodynamic parameters were recorded throughout anaesthesia and at its emergence. After induction, heart rate, pulmonary capillary wedge pressure and mean pulmonary artery pressure did not change significantly; mean arterial pressure, cardiac index, stroke index and left ventricular stroke work index decreased by 21, 33, 28 and 42% respectively (p less than 0.001); systemic and pulmonary arterial resistances increased by 12 and 37% respectively (p less than 0.001). In group P, these changes persisted throughout the procedure but, 30 min after extubation, cardiac index returned to control levels due to a 25% increase in heart rate; in this group 4 patients presented with both perioperative low cardiac output and persistent postoperative confusion. With dobutamine, haemodynamic parameters returned to preoperative values and heart rate increased by 12 b.min-1. More arrhythmias and hypertensive episodes but less hypotensions occurred in group D. Substantial haemodynamic changes occur during anaesthesia and surgery in elderly patients. Dobutamine corrects the peroperative decrease in cardiac output and blood pressure, and might prevent postoperative neurological disorders.

DNA repair mechanisms affecting cytotoxicity by streptozotocin in E. coli

Mechanisms underlying cytotoxicity by the monofunctional nitrosourea streptozotocin (STZ) were evaluated in DNA repair-deficient E. coli mutants. Strains not proficient in recombinational repair which lack either RecA protein or RecBC gene products were highly sensitive to STZ. In contrast, cells that constitutively synthesize RecA protein and cannot initiate SOS repair mechanisms because of uncleavable LexA repressor (recAo98 lexA3) were resistant to this drug compared to a lexA3 strain. Further, E. coli cells lacking both 3-methyladenine DNA glycosylases I (tag) and II (alkA) also were highly sensitive to STZ. DNA synthesis was most inhibited by STZ in recA and alkA tag E. coli mutants, but was suppressed less markedly in wild-type and recBC cells. DNA degradation was most extensive in recA E. coli after STZ treatment, while comparable in recBC, alkA tag, and wild-type cells. Although increased single-stranded DNA breaks were present after STZ treatment in recA and recBC mutants compared to the wild type, no significant increase in DNA single-stranded breaks was noted in alkA tag E. coli. Further, DNA breaks in recBC cells were repaired, while those present in recA cells were not. These findings establish the critical importance of both recombinational repair and 3-methyladenine DNA glycosylase in ameliorating cytotoxic effects and DNA damage caused by STZ in E. coli.

Whole abdominal irradiation following chemotherapy in patients with minimal residual disease after second look surgery in ovarian carcinoma

From January 1981 through December 1985, 65 patients with epithelial carcinoma of the ovary were treated with the following protocol: surgery, combination chemotherapy, second-look surgery documenting tumor less than or equal to 2 cm, and whole abdominal irradiation. Chemotherapy consisted of a combination of cyclophosphamide, adriamycin, and cisplatinum in 89% of the patients. The median number of cycles was eleven. Second-look surgery documented no residual tumor in 23 patients, microscopic disease in three patients, and macroscopic disease less than or equal to 2 cm in 39 patients. Whole abdominal irradiation was given with an open field technique up to 20 Gy without renal or hepatic shield. A pelvic boost of 15-30 Gy was subsequently added in 17 patients with macroscopic disease in the pelvis at the time of second-look surgery. Fifteen patients received complementary chemotherapy mostly hexamethylmelamine. All but two patients completed whole abdominal irradiation: one refused further radiotherapy after 3 Gy and one developed disease progression with bowel obstruction after 1 Gy. The median follow-up was 69 months. The 3-year and 6-year no evidence of disease survival rates were 60% (95% CI: 48-71) and 33% (95% CI: 21-46), respectively. The 3-year and 6-year recurrence rates were 33% (95% CI: 22-45) and 54% (95% CI: 40-67), respectively. The 3-year and 6-year metastasis rates were 22% (95% CI: 13-34) and 43% (95% CI: 30-58), respectively. A multivariate analysis showed that residual disease after second-look surgery was the only significant prognostic factor with a relative risk of death or local or distant failure of 4.2 (95% CI: 1.9-9.5, p less than 10(-4)). Two patients developed mean-term gastrointestinal complications (small bowel obstructions requiring surgery). Survival remains poor with high level of failure even with aggressive multimodal treatment.

The effect of hyaluronidase on akinesia during cataract surgery

The ability of hyaluronidase to improve akinesis in retrobulbar anesthesia was evaluated in a double-masked study. Forty consecutive patients undergoing cataract surgery were anesthetized with 3 ml of a 1:1 mixture of 4.0% lidocaine and 0.75% bupivacaine solution. In a predetermined randomized fashion, 2 ml of hyaluronidase (300 USP units) were added to half of the syringes, and 2 ml of saline to the remaining half. The level of akinesia was graded in six different positions of gaze. Seventy percent of the hyaluronidase group exhibited complete akinesis, while only 40% of the control group did. The mean scores for four out of six positions of gaze were significantly higher in the hyaluronidase patients than in the control group. Similarly, the hyaluronidase subjects showed a significantly higher sum score for the six sectors than did the control subjects (p = .0001). These results show that hyaluronidase significantly enhances akinesia. It is therefore recommended that it be included in the anesthetic regimen for such surgeries.

Long-term use of an LH-RH agonist in the management of uterine leiomyomas: a study of 17 cases

Seventeen nonmenopausal women with symptomatic uterine myomas, diagnosed by clinical examination and confirmed by pelvic ultrasonography, were treated with a delayed-release microcapsule preparation of D-Trp-6-LH-RH (Decapeptyl) injected intramuscularly, every 28 days. The microcapsules were designed to release 100 micrograms/day for 30 days. The mean duration of treatment was 4.7 months (range, 1-11). In all patients, the pituitary-ovarian axis was suppressed after 1 month of treatment, and mean serum estradiol levels fell to 17.3 pg/mL (range, 5-80). There were no significant changes in serum LH and FSH levels. Fifteen patients (83%) experienced an improvement of such symptoms as abdominal pain and bleeding. Enlarged uteri decreased in 81% of patients during the treatment, and in 38% of them the decrease in uterine volume was more than 50%. Among the 12 myomas found in 10 women, 2 disappeared and 9 decreased in volume during the treatment; for 7 myomas the decrease was more than 50%. After Decapeptyl, eight patients did not require any additional therapy, four underwent surgery, and the others were treated with progestins. The side effects were mild, consisting mainly of hot flushes. Our findings suggest that Decapeptyl may be useful for the treatment of uterine myomas.

Phase II trial of mitozolomide in patients with advanced ovarian cancer. A study of the EORTC Gynecological Cancer Cooperative Group

Twenty-seven fully evaluable patients with advanced ovarian cancer and documented disease progression despite cytotoxic treatment were treated with mitozolomide (NCS-353451) 90 mg/m2 as a 1-h infusion once every 6 weeks. None of the patients responded, one had stabilization of disease for 4 months. Haematologic toxicity was the major side effect with a nadir or white blood cell counts around day 40. Two patients died with severe leukopenia and septic shock. We conclude that mitozolomide is not active in this poor-risk group of patients.

Open-heart surgery in a patient with a high oxygen affinity haemoglobin variant

A man in heart failure with a high oxygen affinity haemoglobin variant (Hb Rainier) underwent a mitral commissurotomy with the aid of cardiopulmonary bypass. Pre-operatively, a total blood exchange transfusion was carried out to prevent potential hypoxic and thrombo-embolic complications. No complications occurred in the postoperative period.

Prognostic factors in gestational trophoblastic tumors. A multivariate analysis

One hundred sixty-two gestational trophoblastic tumors (GTT) were treated at the Institute Gustave-Roussy, Villejuif, France, from 1975 to 1985. Sustained complete remission (CR) was obtained in 146 patients (90%). All 97 patients with no histologic diagnosis of choriocarcinoma were cured, including 19 patients considered at high risk initially. Among 65 histologic chariocarcinoma patients, 16 died (CR, 75.5%) including seven initially nonmetastatic patients. Using a univariate analysis, all factors tested in the whole group of patients were more or less significant except for age and parity. However, when the same variables were tested in patients considered at high risk initially, only three factors were statistically significant. Those three factors were the only ones associated with a statistically significant higher relative death risk (RR) on multivariate analysis and are as follows: an antecedent nonmolar pregnancy (RR = 4.3; P less than 0.01); initial presentation with more than one metastatic organ (RR = 7.4; P less than 0.01); and primary resistance to single agent (RR = 18.8; P less than 0.0001) or multi-agent chemotherapy (RR = 26.1; P less than 0.0001). It seems that those three factors, together with a histologic diagnosis of choriocarcinoma, are the prognostic factors that discriminate patients with unfavorable outcomes among the high-risk group.

Evolution of right ventricular performance after CABG

34 patients scheduled for coronary artery bypass graft (CABG) surgery were studied during postoperative period. Right ventricular performance was specially performed with use of cardiac output computer REF-1 Edwards Lab., before Anaesthesia (T1) and at 6 investigation times after surgery during and after mechanical ventilation. The sixth first postoperative hours were marked by a decrease of cardiac index (2.56 +/- 0.4 to 2.41 +/- 0.41.mn-1.m2) and right Ventricular Ejection Fraction (RVEF) (0.48 +/- 0.07 to 0.37 +/- 0.09). The second period was the weaning period with a further drop of RVEF (0.43 +/- 0.1 to 0.36 +/- 0.07) without change in cardiac index (2.80 +/- 0.51.mn-1.m2, suggesting a ventricular post-operative and weaning depression, as previously described for the left ventricle. In addition, postoperative tachycardia (Heart rate = 59 +/- 9 at T1 to 95 +/- 14 at T7) may contribute to myocardial ischemia.

Feasibility study of an alternating schedule of radiotherapy and chemotherapy in advanced uterine cervical carcinoma

From July 1981 to April 1982, 36 patients with advanced cervical carcinoma stage III (24 patients) and stage IV (12 patients) entered a feasibility study of a radiotherapy and chemotherapy combination. The first three chemotherapy courses consisted of cis-platinum alone (50 mg/m2) and were interdigitated with radiotherapy. Six more courses composed of an association of cis-platinum (50 mg/m2) and cyclophosphamide (400 mg/m2) were given after the completion of radiotherapy. Radiotherapy was delivered in two courses of 25 Gy separated by a gap of 2 weeks. The overall 4-year survival rate was 35% (95% CI: 22%). The 4-year survival rate, cumulative loco-regional failure rate, and cumulative metastasis rate were respectively 44% (95% CI: 20%), 56% (95% CI: 21%), and 30% (95% CI: 21%) in stage III and 28% (95% CI: 27%), 83% (95% CI: 21%) and 74% (95% CI: 30%) in stage IV. The incidence of immediate and late complications was low: no patient had her radiotherapy stopped because of an intolerance and two patients had their chemotherapy stopped because of an haematological intolerance. Only one patient presented a severe late clinical complication (small bowel injury).

Carboplatin in combination therapy for ovarian cancer

Cisplatin today is a cornerstone of combination chemotherapy for ovarian cancer. Carboplatin seems equal to cisplatin in antitumour activity, but has a different toxicity profile. After a feasibility study, a randomized phase III study in ovarian cancer stage II, III, and IV was undertaken, comparing carboplatin with cisplatin in combination with cyclophosphamide, doxorubicin and hexamethylmelamine. Preliminary analysis of this study reveals no statistically significant difference in response rate. Notwithstanding equal haematological toxicity, the other side effects evoked by carboplatin in combination treatment are much milder than those evoked by cisplatin. Further analysis will be necessary to draw definite conclusions about the results obtained.

Purification of serotype I antigen from nutritionally variant streptococci

The nutritionally variant streptococci (NVS) are a fastidious group of bacteria first recognized in the early 1960s in the blood cultures of patients with subacute bacterial endocarditis. Since that time, the NVS have been implicated in 5 to 6% of all cases of human bacterial endocarditis. The NVS possess membrane-associated amphipathic molecules different from those described for other streptococci. Unitl recently, chemical characterization of these new amphipathic polymers was hampered by unsuccessful attempts at isolating large quantities of these molecules in a form free from other bacterial components. Presently, stationary-phase-culture supernatants provide an optimum source of crude material for amphiphile purification procedures. Hydrophobic-interaction chromatography in conjunction with immunoaffinity chromatography yields an NVS serotype I amphiphile preparation free of contaminants, as determined by immunoelectrophoretic and chemical analyses. Tandem crossed immunoelectrophoresis of the purified extracellular NVS amphiphile demonstrated that it is immunologically similar to the intracellular amphiphile. Finally, this amphiphile serves as the NVS serotype I antigen.

Nutritionally variant streptococcal serotype I antigen. Characterization as a lipid-substituted poly(ribitol phosphate)

Initial characterization of the nutritionally variant streptococcal serotype I amphipathic polymer indicated an estimated m.w. of 360,000 for the aggregated form of the molecule, whereas the dissociated form had an estimated m.w. of 38,000 based on dextran m.w. standards. In addition, SDS-PAGE indicated an amphiphile with a stepladder appearance made up of several components with m.w. larger than the major electrophoresis components of LPS or lipoteichoic acid. Chemically, the serotype I amphiphile appeared to be a lipid-substituted poly(ribitol phosphate) with galactose and alanine substitution on the ribitol phosphate backbone. This report represents the first characterization of a bacterial amphiphile with a chemical composition and structure as proposed here. As is the case with other bacterial amphiphiles, the nutritionally variant streptococcal serotype I amphiphile was found both intra- and extracellularly. Finally, immunofluorescence studies demonstrated that the amphiphile was expressed on the cell surface.

Nutritionally variant streptococcal serotype I antigen. Characterization as a lipid-substituted poly(ribitol phosphate)

Initial characterization of the nutritionally variant streptococcal serotype I amphipathic polymer indicated an estimated m.w. of 360,000 for the aggregated form of the molecule, whereas the dissociated form had an estimated m.w. of 38,000 based on dextran m.w. standards. In addition, SDS-PAGE indicated an amphiphile with a stepladder appearance made up of several components with m.w. larger than the major electrophoresis components of LPS or lipoteichoic acid. Chemically, the serotype I amphiphile appeared to be a lipid-substituted poly(ribitol phosphate) with galactose and alanine substitution on the ribitol phosphate backbone. This report represents the first characterization of a bacterial amphiphile with a chemical composition and structure as proposed here. As is the case with other bacterial amphiphiles, the nutritionally variant streptococcal serotype I amphiphile was found both intra- and extracellularly. Finally, immunofluorescence studies demonstrated that the amphiphile was expressed on the cell surface.

Unruptured aneurysm of the sinus of Valsalva presenting with ventricular tachycardia

We report a case of a large unruptured aneurysm of the right sinus of Valsalva which caused severe right ventricular outflow tract obstruction and presented dramatically with a life threatening ventricular tachycardia. Despite severe aortic incompetence prior to surgery it was possible to resect the aneurysm and repair the aortic root without resort to aortic valve replacement and thus return the anatomy to normal.

[Vascular effects of nicergoline]

The vascular effects of nicergoline, a post-synaptic alpha receptor antagonist, were studied using a total haemodilution non pulsatile normothermic cardiopulmonary bypass with a bubble oxygenator during cardiac surgery. Anaesthesia was induced with fentanyl 30 micrograms.kg-1 and diazepam 0.25 mg.kg-1 and maintained with incremental doses of fentanyl. All the patients were intubated using pancuronium bromide (0.1 mg.kg-1) and artificially ventilated (FIO2 = 1). Nine patients randomly selected received 10 ml of saline (group 1) and 11 other 5 mg nicergoline (group 2) into the venous line of the extracorporeal circuit. Pump flow remained constant during 10 min. Arteriolar resistance was assessed by mean arterial pressure recording and venous capacitance by the level of venous reservoir. Statistical analysis was carried out using analysis of variance and the Newman-Keuls test. In group 1, arteriolar resistance increased by 17.0 +/- 21.8% at 10 min (not significant), whereas in group 2 it decreased by 22.8 +/- 8.1% at 2 min (p less than 0.05) and then increased slowly. It then remained 18% lower than in group 1 at 10 min. In group 1, venous capacitance decreased regularly by 1 ml.kg-1.min-1 during 10 min (-10.0 +/- 6.2 ml.kg-1 at 10 min), whereas in group 2 it decreased up to the 6th min (-4.2 +/- 3.3 ml.kg-1) and then remained stable, with a 5.4 ml.kg-1 difference with group 1 at 10 min (p less than 0.05). Therefore, nicergoline seemed to cause venoconstriction during cardiopulmonary bypass, possibly through a baroreflex mechanism.

["After-reintervention" in ovarian cancer]

Reoperation in ovarian cancer, following the initial surgery and the subsequent general chemotherapy, is currently agreed upon by most authors: it permits to evaluate the results of chemotherapy; when new lesions appear or lesions that have been left in place increase in size, re-operation enables excision of these lesions. But, after this surgical stage, opinions regarding treatment differ. In the case of complete remission, macroscopic and microscopic, it is possible to do nothing, to resume chemotherapy, to perform an abdomino-pelvic radiotherapy in limited doses. In the case of an incomplete microscopic remission and the persistence or aggravation of previous lesions, only a different type of chemotherapy is performed. Its chances of success are very remote. On the whole, chemotherapy is seldom used; chemotherapy may and must be used, especially in case of minor lesions. It must be emphasized that remission does not mean cure, and that incomplete remission does not obligatorily imply a poor prognosis.

Do trophectoderm and inner cell mass cells in the mouse blastocyst maintain discrete lineages?

The extent to which trophectoderm (TE) and inner cell mass (ICM) lineages in the mouse blastocyst remain distinct during the period from the commencement of cavitation up until 48 h later in culture was investigated. Fluorescent latex microparticles were used to label exclusively all TE cells in nascent blastocysts and the position of labelled progeny in cultured blastocysts was examined by disaggregation, by serial sectioning and by whole-mount analyses. The results indicate that, in most blastocysts (80–90%), TE and ICM lineages are entirely separate during this period while in the remainder lineage crossing is limited usually to only one or two cells of either tissue.

Mitochondrial DNA of the extinct quagga: relatedness and extent of postmortem change

Sequences are reported for portions of two mitochondrial genes from a domestic horse and a plains zebra and compared to those published for a quagga and a mountain zebra. The extinct quagga and plains zebra sequences are identical at all silent sites, whereas the horse sequence differs from both of them by 11 silent substitutions. Postmortem changes in quagga DNA may account for the two coding substitutions between the quagga and plains zebra sequences. The hypothesis that the closest relative of the quagga is the domestic horse receives no support from these data. From the extent of sequence divergence between horse and zebra mitochondrial DNAs (mtDNAs), as well as from information about the fossil record, we estimate that the mean rate of mtDNA divergence in Equus is similar to that in other mammals, i.e., roughly 2% per million years.

Phase II trial of anaxirone (1,2,4-triglycidylurazol, TGU) in patients with advanced ovarian carcinoma: an EORTC Gynecological Cancer Cooperative Group Study

Sixteen patients with advanced ovarian carcinoma were treated with anaxirone (1,2,4-triglycidylurazol, TGU), 600 mg/m2 every 4 weeks. Anaxirone was the second or later line of therapy. All patients had evaluable tumors and evidence of failure of prior therapy. None of the patients responded. Two had stabilization of the disease for 4 months. In one patient WHO grade 4 leukopenia and grade 4 thrombocytopenia were observed after the second TGU cycle starting on day 41 and persisted until the patient died due to tumor progression (day 50). No patient experienced thrombophlebitis.

C-myc proto-oncogene expression and prognosis in early carcinoma of the uterine cervix

Expression of the c-myc gene was studied by northern blot and slot blot hybridisation in 72 specimens of stage I or II squamous cell carcinoma of the uterine cervix. In 25 of the 72 tumours c-myc proto-oncogene was overexpressed (ie, at levels 4-20 times higher than in normal tissues). Patients whose tumours showed c-myc overexpression had an eight-fold greater incidence of early relapse than the other patients (p = 0.001). The 18-month relapse-free survival rates were, respectively, 49% and 90% for these two groups of patients.

[Value of magnetic resonance imaging of cancers of the uterine cervix and corpus. Preliminary study apropos of 9 cases of cancer of the corpus and 20 cases of cancer of the cervix]

We studied nine cases of endometrial carcinoma and twenty of cervix carcinoma. Correlation with histology is made after curietherapy in 8 cases of endometrial carcinoma. Tumor is not always seen and particularly when there is no mass effect on macroscopic examination. Myometrial invasion is not seen with accuracy: the interruption of "junctional zone" is not a good sign. The cervix tumors are well seen on T2 sequences before any treatment. There extra uterine extension is difficult to appreciate. The best results of RMI were in the follow-up after radiotherapy. Therefore it appears actually to us the best indication of RMI.

Elevation of CA 125 in patients with benign and malignant ascites

The presence of CA 125, an ovarian cancer-associated antigen, was assessed in serum and ascites from patients with ovarian cancer (n = 47), hepatocellular carcinoma (n = 21), and liver cirrhosis (n = 40). Abnormal levels of serum CA 125 were observed in 49% of ovarian cancer patients, and in 89% of these same patients with ascites. In all cases of cirrhosis or hepatocellular carcinoma with ascites, CA 125 levels were above 35 U/ml. The specificity and sensitivity of CA 125 measurement for detecting ascites in chronic liver diseases were 73% and 100%, respectively. Furthermore, the CA 125 level was always higher in ascites than in serum. The authors conclude that CA 125 is a nonspecific marker of ascites. This result must be considered in the interpretation of CA 125 elevation in patients with ovarian cancer. Moreover, CA 125 may be of value in the diagnosis and monitoring of peritoneal diseases.

Combination cyclophosphamide, adriamycin, and cis-platinum in recurrent and metastatic cervical carcinoma

Thirty evaluable patients with recurrent and/or metastatic cervical cancer were treated with a combination of cyclophosphamide, adriamycin, and cis-platinum. We observed no complete response and three partial responses (10%). One year survival rate was 45%. CAP combination did not prove to be more effective than single agent cis-platinum.

[Computed tomography of uterine and ovarian cancer]

The authors try to specify the place of Tomodensitometry in utero-ovarian cancers. The examination technique presents no particularities: at best, the interval and the depth of the cuts must be selected. In cervical cancers, the poor appreciation on TDM of adnexal and vaginal involvement renders this examination unsuitable for staging. On the contrary, it is absolutely necessary in order to make the diagnosis of recurrences. In cancers of the body of the uterus, almost always operated on, TDM presents very little interest for the initial work-up except for patients who are difficult to examine or are going to undergo irradiation. As for ovarian tumors, TDM may be useful to detect intra-hepatic metastases before the first operation, to monitor patients undergoing chemotherapy: peritoneal carcinosis is inconstantly detected and TDM cannot replace a second look.

Elevation of CA 125 in patients with benign and malignant ascites

The presence of CA 125, an ovarian cancer-associated antigen, was assessed in serum and ascites from patients with ovarian cancer (n = 47), hepatocellular carcinoma (n = 21), and liver cirrhosis (n = 40). Abnormal levels of serum CA 125 were observed in 49% of ovarian cancer patients, and in 89% of these same patients with ascites. In all cases of cirrhosis or hepatocellular carcinoma with ascites, CA 125 levels were above 35 U/ml. The specificity and sensitivity of CA 125 measurement for detecting ascites in chronic liver diseases were 73% and 100%, respectively. Furthermore, the CA 125 level was always higher in ascites than in serum. The authors conclude that CA 125 is a nonspecific marker of ascites. This result must be considered in the interpretation of CA 125 elevation in patients with ovarian cancer. Moreover, CA 125 may be of value in the diagnosis and monitoring of peritoneal diseases.

[Is it necessary to discontinue captopril before heart surgery?]

Interaction between kininase II and anaesthesia is not well described. Twenty two patients treated by kininase II for congestive heart failure are studied during anaesthesia for cardiovascular surgery. A first group of seventeen homogeneous hemodynamic data are reported. High cardiac index contrasts with severe clinical cardiac failure. A second group of inhomogeneous patients are separately described. Vasoconstrictor can be codified in the situation of low systemic resistance with high cardiac index. Preoperative treatment can be continued, under requirement of hemodynamic monitoring.

Mitochondrial DNA evolution in the genus Equus

Employing mitochondrial DNA (mtDNA) restriction-endonuclease maps as the basis of comparison, we have investigated the evolutionary affinities of the seven species generally recognized as the genus Equus. Individual species' cleavage maps contained an average of 60 cleavage sites for 16 enzymes, of which 29 were invariant for all species. Based on an average divergence rate of 2%/Myr, the variation between species supports a divergence of extant lineages from a common ancestor approximately 3.9 Myr before the present. Comparisons of cleavage maps between Equus przewalskii (Mongolian wild horse) and E. caballus (domestic horse) yielded estimates of nucleotide sequence divergence ranging from 0.27% to 0.41%. This range was due to intraspecific variation, which was noted only for E. caballus. For pairwise comparisons within this family, estimates of sequence divergence ranged from 0% (E. hemionus onager vs. E. h. kulan) to 7.8% (E. przewalskii vs. E. h. onager). Trees constructed according to the parsimony principle, on the basis of 31 phylogenetically informative restriction sites, indicate that the three extant zebra species represent a monophyletic group with E. grevyi and E. burchelli antiquorum diverging most recently. The phylogenetic relationships of E. africanus and E. hemionus remain enigmatic on the basis of the mtDNA analysis, although a recent divergence is unsupported.

Predictability of course of illness in manic patients positive for life events

The intention of this study was to examine the possibility of predicting course of illness in manic patients, using a stress variable as a predictor, together with other more traditional indices. On the basis of information on three easily available parameters--family history, age at onset, and stress intensity--20 manic patients who had independent life events preceding an index admission were allocated into various risk groups and predictions were then made with regard to future course of illness for 5 years. On follow-up, the predictions were found to be correct in 85% of cases overall, and two high-risk factors were totally predictive.

[Value of x-ray computed tomography in the monitoring of cancer of the ovary. Apropos of 69 cases]

The authors have studied retrospectively, a group of 69 patients with primitive carcinoma of the ovary who underwent at most one CT examination following the first surgical treatment. In 26 out of these, CT was done within the three months following a second surgical operation. Peritoneal metastases were inconsistently seen (5 true positive, 9 true negative, 0 false positive, 9 false negative). The sensitivity is 36%, the specificity 100% and the accuracy 65%. The score is better in the detection of lymphatic, hepatic and intestinal metastases.

Structural requirements for inducing cardiotoxicity by anthracycline antibiotics: studies with neonatal rat cardiac myocytes in culture

Neonatal rat cardiac myocytes maintained in tissue culture were utilized to screen cardiotoxicity induced by a number of adriamycin and daunomycin analogs. Cell toxicity was assessed by leakage of cytoplasmic enzymes and was confirmed by electron microscopy. A number of modifications of structure of adriamycin and daunomycin markedly altered the incidence of toxicity caused by these drugs. Even though some of these structural alterations markedly altered lipid solubility or reactivity of quinone function, these changes did not always account for the differences in the toxicity induced by anthracycline analogs. The cardiomyocyte culture system used in this simple screening technique should be useful in the development of active anthracycline analog with least cardiotoxic potential.

Outbreak of pulmonary tuberculosis in children

A case of miliary tuberculosis in a 4-year-old child led to contact tracing, revealing 32 children with evidence of tuberculous infection. 3 adult cases were also identified. The source case was a mother who passed on the infection at two Christmas parties. Limited exposure to the organism caused infection, suggesting a virulent strain and a susceptible subgroup. A range of complications of primary tuberculosis in children was seen. Minor side-effects of the chemotherapeutic agents occurred in most children but only 3 suffered substantial toxic effects. The limited range of agents marketed in a presentation suitable for young children was a serious difficulty.

Uterine sarcomas: prognostic factors and treatment modalities--study on 209 patients

From 1975 through 1984, 209 patients with uterine sarcoma were studied in 13 French Oncology Centers. The repartition by histologic type was the following: 31 patients (PTS) with carcinosarcoma, 81 PTS with leiomyosarcoma, 27 PTS with endometrial sarcoma, and 70 PTS with mullerian mixed mesodermal tumors. The prognostic factors were analyzed using a proportional hazards regression model. The analysis of prognostic factors showed that the strongest predictor of survival was menopausal status. Increasing tumor extension and increasing WHO performance status were also prognostic factors. No significant difference for prognosis was found for histologic type, operability, and age. Two-year survival rates were quite similar for all kinds of treatment, being 58.0% for tumor extension T1 and T2 and 35.0% for tumor extension T3 and T4. Two-year recurrence and metastasis rates were lower with addition of radiotherapy or chemotherapy without any benefit on survival rates. Cooperative clinical trials including all histologic types should be undertaken to improve survival. The knowledge of the prognostic factors can help to refine treatment comparisons.

New treatment procedure for stage I endometrial adenocarcinoma

A series of 80 Stage I adenocarcinomas of the endometrium is described. Treatment is based on a more frequent use of surgery and there is greater individualization of the treatment procedure, which combines vaginal or uterovaginal Curie therapy and surgery. Overall 5 year survival rates are 82%, compared with 91.5% for patients having been treated with Curie therapy plus surgery. The patient's age and the size of the uterus were found to be significant from the prognostic standpoint. However, other factors, such as histological type and grade, penetration into the myometrium, and lymph node involvement did not seem especially important. Treatment described here appears to give better results than that used previously; survival rates are higher and complications of treatment are negligible.

Enzyme-linked immunosorbent assay for the detection of antibodies to nutritionally variant streptococci in patients with endocarditis

The viridans streptococci are responsible for 50%-55% of microbial endocarditis. Among these varied species, the nutritionally variant streptococci (NVS) have recently been associated with culture-negative endocarditis and are responsible for 5%-10% of all streptococcal endocarditis. The isolation and identification of these bacteria has been hampered by the extremely fastidious nature of their growth requirements as well as by their slow growth rate. In addition, their antibiotic sensitivity varies greatly, a characteristic leading to a higher rate of morbidity and mortality than is found in patients with non-NVS endocarditis. For these reasons sera from patients with NVS endocarditis were examined for antibodies to the NVS serotype I antigen by using an enzyme-linked immunosorbent assay. Seventy-four percent of patients with NVS endocarditis had elevated titers to this antigen. None of the sera from controls and only 6.7% of the sera from patients with non-NVS streptococcal endocarditis showed increased titers. These results indicate that antibody to the NVS serotype I antigen can serve as a marker for NVS endocarditis.