The 5q- syndrome: a single-institution study of 43 consecutive patients

A favorable prognosis and a low rate of leukemic transformation has been attributed to the 5q- syndrome, a myelodysplastic syndrome (MDS) characterized by macrocytic anemia, hypolobulated micromegakaryocytic hyperplasia, and an interstitial deletion of chromosome 5. We examined the characteristics and outcome of 43 consecutive patients in our institution strictly defined by morphologic criteria and a solitary 5q- cytogenetic defect. The median age at diagnosis was 68 years, with a clear female predominance (7:3). Eighty percent of the patients were red blood cell transfusion-dependent at diagnosis and all untransfused patients had macrocytic indexes. In contrast, significant neutropenia or thrombocytopenia was rare. The French-American-British (FAB) class distributions were RA (72%), RARS (7%), RAEB (16%), and RAEB-IT (5%). At a median follow-up of 31 months, 56% of the patients survive, with a projected median survival of 63 months. The incidence of acute leukemia was 16% and was uniformly fatal. Clinical hemosiderosis occurred in 28% of the patients, resulting in two deaths. Neither survival nor the risk of leukemic transformation was predictable from initial clinical parameters, including FAB classification, Bournemouth score, and degree of aneuploidy. The lack of significant neutropenia and thrombocytopenia seemed to account for a very low incidence of infection and bleeding resulting in a prognosis equal or superior to historical patients with MDS. Therapeutic endeavors, including the use of corticosteroids, androgens, cis-retinoic acid, pyridoxine, and danazol, were largely unsuccessful.

[Evaluation of routine gas determinations in umbilical cord blood at cesarean section]

From 1985 to 1989, analysis of the umbilical cord blood gas in 546 cases of cesarean section delivery under spinal anesthesia was carried out to evaluate its relationship with neonatal asphyxia, and the following results were obtained. (1) The UApH of a normal newborn with an Apgar score > 7 was 7.28 +/- 0.04. Acidosis occurred in 33.3% of the infants born with an Apgar score < 7, but the incidence was only 3.9% in those with an Apgar score > 7. Sixteen% of the acidosis was metabolic and 84% belonged to the mixed type. The UApH and Apgar scores were most significantly related. (2) The abnormal UVpH was 4.9% (< M - 2SD). (3) There was no significant difference in UApH between cesarean section performed before and after the onset of labor. (4) The short term morbidity included: one death, 2 cases of convulsions, 2 cases of cerebral edema, and one case of periventricular leukomalacia. (5) The long term morbidity in the 29 cases referred to NICU included: 18 cases of normal growth, 2 cases of severe cerebral palsy, 3 cases of mild cerebral palsy, and 6 cases of mental retardation. (6) In view of the long term morbidity of the newborn, as seen in the correlation between the Apgar score and UApH, it was considered that, the critical points in neonatal asphyxia were Apgar score < or = 3 and UApH < 7.10. My results suggested that the umbilical cord blood gas analysis was helpful for the diagnosis of neonatal asphyxia, and the prognosis of the newborn.

Treatment of ovarian cancer in elderly women. Mayo Clinic-North Central Cancer Treatment Group studies

BACKGROUND

With a 25% reduction in ovarian cancer mortality rate between 1973 and 1988 among younger American women, the overall control of ovarian cancer appeared to be improving. Unfortunately, American women older than 65 years of age experienced a 16% increase in mortality from this disease during that same interval. We examined our therapeutic outcomes following systemic chemotherapy administered to women of various ages accepted for treatment on phase III Mayo Clinic and North Central Cancer Treatment Group protocols between 1974 and 1988.

METHODS

Three randomized studies of chemotherapy for Stage III and IV epithelial ovarian carcinoma were analyzed for possible effects of age on the results of treatment. All of the patients, regardless of age, had been enrolled and treated according to standard accession and dosage adjustment criteria.

RESULTS

Among our 383 patients, 107 (28%) were 65 years of age or older. Although the elderly women tolerated our five different chemotherapy regimens nearly as well as did the younger patients, we found that progressively greater dose reductions were required for treatment continuation with advancing age between groups aged 44 years or younger, 45-64 years, and 65 years and older. When nonserous histology, Stage IV, ECOG performance status above 0, tumor grade above 1, and extent of residual disease greater than 2 cm were considered, our Cox model analysis yielded no firm evidence that age 65 years and older per se (P = 0.58) was a negative prognostic factor for survival.

CONCLUSIONS

Elderly women eligible for randomized clinical trials tolerated Stage III and IV epithelial ovarian carcinoma and its chemotherapy nearly as well as did younger women. Among this population of women accepted for study in our three clinical trials, age 65 years and older per se was not proven to be a negative prognostic factor in our multivariate analysis.

Phase II trial of intravenous hexamethylmelamine in patients with advanced ovarian cancer

A Phase II trial of an intravenous preparation of Hexamethylmelamine was performed in ovarian cancer. Patients who had received prior Platinum based chemotherapy and had measurable disease were eligible. Among 15 evaluable patients, there were no objective responses. Two patients did show clinical and laboratory evidence of improvement. Toxicity was predominantly nausea and vomiting with minimal other toxicity. This intravenous form of Hexamethylmelamine has not shown meaningful activity in ovarian cancer patients who have failed prior platinum treatment.

A phase II study of recombinant human alpha-interferon in advanced hormone-refractory prostate cancer

To determine the efficacy of recombinant human leukocyte alpha-interferon (IFL-RA) in advanced hormone-refractory prostate cancer, the authors treated 40 patients with IFL-RA administered intramuscularly at a dose of 10 x 10(6) U/m2 three times weekly. Toxicity was substantial and necessitated at least a 50% dose reduction in all but five patients during the first 1-2 months of therapy. No responses were observed in patients with bone metastases, but complete and partial regression of nodal disease were observed in two patients with extraosseous disease (overall response rate, 5%; 95% confidence interval, 0.64-17.75%). The authors conclude that IFL-RA cannot be recommended at this dose and schedule in patients with advanced prostate cancer, but additional study of its use in patients with nodal disease may be warranted.

Splenectomy in advanced chronic lymphocytic leukemia: a single institution experience with 50 patients

PURPOSE

To assess the efficacy of splenectomy in the treatment of refractory cytopenias associated with advanced chronic lymphocytic leukemia (CLL).

PATIENTS AND METHODS

The histories of 57 patients with CLL who underwent splenectomy at the Mayo Clinic between 1975 and 1991 were retrospectively reviewed. Of the 57 patients, 50 underwent splenectomy for reasons directly related to their disease process such as cytopenias or symptomatic splenomegaly. The histories from these 50 patients were studied to assess the response to splenectomy and the operative morbidity and mortality.

RESULTS

Ninety-four percent of patients were in Rai stage III or IV with extensive marrow infiltration, massive splenomegaly, and cytopenias refractory to chemotherapy. A positive response to splenectomy was defined at 3 months of follow-up as: (1) a hemoglobin level of 11 g/dL or greater in a patient with a preoperative value less than 11 g/dL; or (2) a platelet count of 100 x 10(3)/mm3 or greater in a patient with a preoperative value less than 100 x 10(3)/mm3. A positive response was achieved in 77% of patients with anemia, 70% of patients with thrombocytopenia, and 64% of patients with both anemia and thrombocytopenia. The response was sustained at 1 year of follow-up in 86%, 84%, and 85% of the patients, respectively. Postoperative transfusion requirements decreased correspondingly. The operative morbidity was 26%, and the operative mortality was 4%. The mean duration of hospitalization was 9.8 days (median: 9 days; range: 5 to 24 days). The actuarial median survival after splenectomy was 41 months in responders and 14 months in nonresponders. We found no preoperative parameters that were clearly predictive of a poor hematologic response. In particular, outcome was not affected by preoperative spleen size or the degree of marrow infiltration by CLL. All patients with symptomatic splenomegaly had an improved sense of well-being.

CONCLUSION

In this, the largest single institution study to date, we found splenectomy to be efficacious in providing durable remissions of refractory cytopenias and in relieving symptomatic splenomegaly in the majority of patients with CLL. The procedure is associated with a low perioperative mortality. Although the impact on survival is uncertain, the improved peripheral blood counts may allow the administration of adequate doses of myelosuppressive chemotherapy.

Effect of dizocilpine maleate on cerebral anoxia and ischemic damage in rodents

The Protective effects of dizocilpine maleate (DM) against anoxia in mice and ischemic damage in rats of 4-vessel occlusion (4-VO) were studied. DM 0.5 or 1.0 mg.kg-1 ip significantly prolonged the survival time of mice in closed containers. DM 0.5 and 1.0 mg.kg-1 ip 30 min prior to 4-VO obviously accelerated the electroencephalographic recovery, reduced the neuronal loss in the hippocampus, and increased the survival rate after 72-h reperfusion. These effects followed a dose-dependent manner. Our results indicate that selective non-competitive N-methyl-D-aspartate receptor blocker DM protects against anoxic and ischemic cerebral damage.

[Kinetics of pharmacologic effects of radix Aconiti Lateralis Preparata and sini decoction]

In the study of analgesic action of Radix Aconiti Lateralis Preparata and Sini Decoction hot-plate method was used and the time-effect relationship was determined. The biological half-lives were 11.05 h and 6.84 h respectively. In the study of the effect on inflammation induced by egg white in the ankle joints of rats, the method of complement ED50 was used. The residual rates of the dosages after an interval of 6 hours were 0.60 and 0.69, and the biological half-lives were 8.11 h and 11.35 h respectively.

Beneficial effect of anisodamine in hemorrhagic shock

Anisodamine , an alkaloid extracted from Anisodus tanguticus , is widely used in China in the treatment of septic shock, but its mechanism of action is unknown. We studied its antishock action in cats in a well controlled model of hemorrhagic shock. A bolus dose of 1 mg/kg was given intravenously 20 min after MABP was stabilized at 40-45 mm Hg, followed by i.v. infusion of 2 mg/kg/h during the oligemic period. Two hours post-reinfusion, MABP was significantly higher (106 +/- 10 mm Hg) in the drug-treated group than in shock cats receiving only vehicle (53 +/- 6 mm Hg, P less than 0.001). Anisodamine treated shock cats exhibited significantly lower cathepsin D activity (P less than 0.02) and amino-nitrogen concentration (P less than 0.001) than untreated shock animals. Plasma myocardial depressant factor (MDF) activity was significantly increased in the untreated shock cats (61 +/- 6 Units/ml), but the plasma accumulation of MDF was significantly blunted by anisodamine (32 +/- 5 Units/ml, P less than 0.01). Anisodamine did not increase superior mesenteric artery flow ( SMAF ) in this model of hemorrhagic shock as there was no significant difference in SMAF between the two shocked groups. Thus, the beneficial effect of anisodamine probably is not due to vasodilation of the splanchnic vasculature. In vitro analysis indicates that the drug has a direct anti-proteolytic action in cat pancreatic homogenates. This may partly explain the mechanism of its action, which appears to be complex.

Influence of sulpiride-induced hyperprolactinemia on baboon menstrual cycles: a longitudinal study

The influence of sulpiride-induced hyperprolactinemia on the hypothalamic-pituitary-ovarian function of the baboon (Papio cynocephalus) was investigated. Plasma levels of prolactin, LH, FSH, estrone, estradiol, 17-hydroxyprogesterone, progesterone and 20 alpha-dihydroprogesterone in control and consecutive treatment cycles (sulpiride i.m. injections 100 mg/day) were determined serially. The hormonal changes indicate that the ovary is the most sensitive site to the direct inhibitory action of sulpiride-induced hyperprolactinemia.