Inhibition of growth of androgen-independent DU-145 prostate cancer in vivo by luteinising hormone-releasing hormone antagonist Cetrorelix and bombesin antagonists RC-3940-II and RC-3950-II

The aim of this study was to test the antagonist of LH-RH (Cetrorelix), agonist [D-Trp6]LH-RH (triptorelin) and new bombesin antagonists RC-3940-II and RC-3950-II for their effect on the growth of an androgen-independent prostate cancer cell line, DU-145, xenografted into nude mice. Xenografts were grown in male nude mice, and after 4 weeks, the animals were treated either with saline (control) or with one of the analogues. One group of mice was given a combination of Cetrorelix and RC-3950-II. Treatment was given for 4 weeks. Tumour and body weights, and tumour volumes were measured. At sacrifice, tumours were dissected for histological examination and receptor studies. Serum was collected for measurement of hormone levels. The final tumour volume in control animals injected with saline was 577 +/- 155 mm3 and that of animals treated with Cetrorelix only 121.4 +/- 45 mm3 (P < 0.01). Bombesin antagonists RC-3940-II and RC-3950-II also significantly reduced DU-145 tumour volume in nude mice to 84.9 +/- 19.9 and 96.8 +/- 28 mm3, respectively. Agonist [D-Trp6]LH-RH did not significantly inhibit tumour growth. Serum levels of LH were decreased to 0.08 +/- 0.02 ng/ml (P < 0.05) in the Cetrorelix treated group as compared to 1.02 +/- 0.1 ng/ml for the controls, and testosterone levels were reduced to castration levels (0.01 +/- 0.01 ng/ml). Specific receptors for EGF and LH-RH in DU-145 tumours were significantly downregulated after treatment with Cetrorelix, RC-3940-II and RC-3950-II. Although LH-RH could be a local regulator of growth of prostate cancer, the fall in LH-RH receptors is not fully understood and the inhibitory effects of Cetrorelix and bombesin antagonists on DU-145 tumour growth might be attributed at least in part to a downregulation of EHF receptors. Since Cetrorelix and bombesin antagonists inhibit growth of androgen-independent DU-145 prostate cancers, these compounds could be considered for the therapy of advanced prostate cancer in men, especially after relapse.

[Selective regional lymphadenectomy in malignant melanoma using a gamma probe]

The accurate excision of the first tumour draining lymph node (sentinel lymph node SLN) can prevent extended surgery intervention in many patients with malignant melanoma. The aim of our study was to test the practicability of the SLN dissection using a gamma probe. In a total of 52 patients, mostly with high-risk melanoma, a selective lymph node dissection was performed. We injected intracutuneously about 50 MBq Tc-99m colloid around the tumour or scar followed by dynamic and late static imaging. The site of SLN was localized with a gamma probe and marked on the skin. This was followed by the dissection of the SLN using the gamma probe. In 51 of 52 patients the SLN could be found intraoperatively using the gamma probe. The SLN contained microscopic metastases in 13 patients (24%). The rate of positive SLN was 40% in patients with high-risk melanoma (Breslow thickness more than 1.5 mm). In case of positive SLN a second surgical intervention with radical lymph node dissection was followed. We conclude that dynamic lymphscintigraphy and the selective lymph node dissection using the gamma probe is a simple and minimally invasive method which can improve the survival probability in patients with micrometastases.

[Anaphylactic shock after repeated injection of 99mTc-labeled CEA antibody]

In a 64-year old patient with a recurrent rectal carcinoma, immunoscintigraphies with 99mTc-labelled monoclonal antibody against CEA (BW 431/26) were performed in an interval of 14 months. A few minutes after the second injection the patient reacted with anaphylactic shock which could be controlled by epinephrine and cortisone. As far as we know, there is no report in the literature on an anaphylactic reaction to this antibody. An investigation for human anti-mouse antibodies before the second injection was negative with one method and positive with another method.

Mediastinal tumor and Klinefelter's syndrome

Klinefelter's syndrome with karyotype 47,XXY in patients with primary extragonadal germ cell tumors rarely occurs. The endocrinology of Klinefelter's syndrome is changed; elevated beta-human choriomic gonadotropin levels are present. Chemotherapy and thoracic surgery brought complete remission in a patient with lung metastases.

99mTc-DTPA aerosol for same-day post-perfusion ventilation imaging: results of a multicentre study

A multicentre study was performed in an attempt to evaluate a submicronic technetium-99m diethylene triamine penta-acetic acid aerosol generated by a newly developed delivery system, the aerosol production equipment (APE nebulizer), for same-day post-perfusion ventilation imaging in patients with clinically suspected pulmonary embolism. Quantitative comparison between the DTPA aerosol and krypton gas demonstrated a close correlation with respect to regional pulmonary distribution of activity and peripheral lung penetration (n = 14, r = 0.94, P < 0.001 and r = 0.75, P < 0.0025, respectively). In 169 consecutive patients, DTPA aerosol images performed immediately following perfusion (inhalation scan I) were compared to those carried out on the next day (inhalation scan II) with respect to image quality and assessment of perfusion-ventilation matches or mismatches. Agreement between inhalation scans I and II with respect to perfusion defects matched or mismatched to ventilation was found in 166/169 (98%) studies. The image quality of inhalation scan I was equal to that of scan II in 72%; inhalation scan I was superior in 11% of cases, while scan II was superior in 17%. This submicronic 99mTc-labelled DTPA aerosol is well suited for fast same-day post-perfusion ventilation imaging in patients with clinical suspicion of pulmonary embolism.

[Value of preoperative fine needle puncture cytology in the diagnosis of highly malignant thyroid tumors]

Highly malignant thyroid tumours are frequently diagnosed only at an advanced stage where radical resection is no longer feasible. By the wide application of fine needle aspiration biopsy as a diagnostic tool in nodular thyroid diseases occasionally early stages of these tumours can be diagnosed. Despite early detection in 23% of our patients with anaplastic carcinomas and sarcomas of the thyroid gland and subsequent radical resection an improvement in the long-term outcome was not achieved. In contrast, thyroidectomy and appropriate oncologial therapy may result in long-term survival of patients with early stages of thyroid lymphomas.

Hyperthyroidism and concurrent thyroid malignancies

In a 17-year period 1848 patients with hyperthyroidism were operated on. Fourteen (0.76%) had a coexisting thyroid malignancy. Preoperative scintiscan and pathologic diagnoses were compared: 10 malignancies were in cold nodules, two were unidentifiable preoperatively due to small size, and two were in hot areas. Five patients had papillary cancer, four follicular, three anaplastic, and two medullary. Patients with uninodular toxic goiter had a low rate of associated malignancy (0.27%, 3/1108). In contrast, patients with multinodular toxic goiter had an incidence of 1.63% (11/676). No patient with Graves' disease (n = 64) had a carcinoma. Extensive use of fine-needle aspiration biopsy enabled preoperative diagnosis in a majority of the cases (9/14, 64%). We conclude that the incidence of coexisting thyroid malignancy and hyperthyroidism is rare in our endemic iodine-deficiency goiter area.

Pulsatile luteinizing hormone-releasing hormone treatment of male hypogonadotropic hypogonadism

Luteinizing hormone-releasing hormone (LH-RH) secretion from the hypothalamus follows a rhythmic pattern, inducing pulsatile luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion from the pituitary gland. Consideration of this physiologic principle led to the introduction of pulsatile LH-RH therapy via infusion pump for the treatment of different forms of hypogonadotropic hypogonadism. We report on 10 male patients, 16 to 28 years of age, suffering from idiopathic hypogonadotropic hypogonadism (IHH) including Kallman's syndrome (n = 2) and delayed puberty (n = 2). All presented with complete eunuchoidism and had undergone no treatment for their conditions during the previous 2 years. LH-RH was administered in subcutaneous pulses of 4 to 16 micrograms, with a portable infusion pump (ZYKLOMAT, Ferring Corp., Kiel, FRG); treatment periods ranged from 6 to 24 months. With therapy, the subjects improved secretion of LH, FSH and testosterone. Testicular volumes and penis size increased; all patients developed normal secondary sexual characteristics. Spermatogenesis was induced in all patients. The time to onset of spermatogenesis ranged from 3 to 15 months. No major side effects were observed, and no patient dropped out of the study. The results indicate that pulsatile LH-RH therapy is an highly effective treatment for IHH and delayed puberty.

Effects of high and low doses of methimazole in patients with Graves' thyrotoxicosis

In spite of the long-established use of antithyroid drugs, there are many unsettled questions connected with this treatment of Graves' disease. There is a lack of controlled prospective trials studying the results of antithyroid drug therapy while considering the many variables such as disease heterogeneity, regional differences, drug dosage and duration of treatment. Therefore, a multicenter study has been set up in order to compare the effects of two fixed doses of methimazole (10 vs 40 mg) with thyroid hormone supplementation on the clinical, biochemical and immunological course of Graves' disease and on remission rates. Experience accumulated so far suggests that treatment is safe using either 10 or 40 mg of methimazole. While there is a tendency for an advantage of the higher dose within the first weeks (higher effectiveness in controlling hyperthyroidism), this difference is not significant. The impact of dosage on remission rates remains to be shown.

[Should the iodination of table salt be increased in Austria?]

Since the main reason of endemic goiter is the avoidable iodine deficiency, this in an unnecessary disease. In Austria an exemplary iodized salt prophylaxis was introduced in 1963. Thanks to this iodized salt prophylaxis endemic cretinism has died out. The incidence of hypothyroidism in newborns is currently 1 : 4600, goiter frequency in the first school year now only 1.1 to 1.5%. In contrast the goiter incidence in girls in the twelfth school year increases to 13.4% and up to one third of adults are afflicted by goiter. Studies of iodine excretion in Feldkirch, Innsbruck, Salzburg, Graz and Vienna on a total of 2627 patients showed an iodine excretion of less than 100 micrograms J/g creatinine in the majority of the patients. This proves that there is still an inadequate iodine supplement. The Austrian Nuclear Medicine Society therefore recommends an increase in the potassium iodide content from the present 10 mg potassium iodide/kg to 20 mg potassium iodide/kg table salt, in keeping with the procedure introduced in Switzerland in 1980. Through this measure a decrease in the goiter frequency to less than 3% is to be expected over a longer period. This will result in a considerable reduction in the costs of diagnosis and therapy for this disease. There might be a temporary increase in hyperthyroidism for a certain period as a result of the increase of the content of iodide in the table salt.

[Complete regeneration of the right liver after hemihepatectomy]

Right hemi-hepatectomy was performed in two patients because of metastases in one and a malignant hepatoma in the other. After five and six months, respectively, a right hepatic lobe was again demonstrated, at first by ultrasound, then by isotope scanning. Further studies by coeliacography, 99Tc hepatobida, CT scan and liver-biopsy histology from the regenerated lobe revealed a functionally and morphologically normal picture of a right hepatic lobe, the external form of the regenerated right lobe being identical with the original one. A histologically and functionally unchanged residual liver is considered the prerequisite for satisfactory regeneration after resection. Liver regeneration, as far as regulating factors are concerned, seems to be under similar hormonal control mechanism as external wound healing.

[Iodine deficiency in Salzburg in spite of iodized table salt prophylaxis]

Urinary iodine excretion was determined in 293 medical technical and nursing students in hospitals of the province Salzburg. The average urinary iodine excretion amounted to 46.6 +/- 18 micrograms iodine per gram creatinine. 67.6% of the students showed a deficiency of iodine II, whilst 98.3% had a deficiency of iodine I according to WHO criteria. Urinary iodine levels and natriuria are closely correlated, indicating that iodized table salt probably constitutes the most important source of iodine. 73 of the students had a palpable giotre, 10 of these being nodular. Our investigations, together with those of Innsbruck, Graz and Vienna, demonstrate the existence of generalized iodine deficiency in spite of iodized salt prophylaxis, which has been legally enforced in all of Austria since 1963. Iodized table salt prophylaxis has, thus, led to a drastic decrease in goitres in children, but is not sufficient to eliminate iodine deficiency in adults. An increased level of iodization of table salt, as has been put into force in Switzerland, must be called for in Austria, too.

[Therapy of thyroid cysts with fine needle aspiration]

In a study extending over a period of 4 years, therapeutic fine-needle aspirations were carried out in 194 thyroid patients with thyroid cysts. The cyst contents of 3-130 ml cyst fluid were completely removed by suction in 2-3 month intervals by 1-17 fine-needle aspirations on an outpatient basis. Malignancy was ruled out in all patients by repeated cytological tests. Complete emptying of the cyst, verified by twice-repeated check at 3-month intervals, was achieved in 86 patients (44.3%). A reduction of the cyst fluid to less than 30% was achieved in 13 patients (6.7%). In 17 patients (8.8%) the cyst fluid diminished to 31-50%. In 44 patients (22.7%) there was no diminution in the cyst fluid or a reduction of less than 50%. There was an increase in cyst fluid compared with the first puncture in 34 patients (17.5%). The success of puncture cannot be predicted, although cysts with brown cyst fluids can be emptied significantly more frequently than cysts with yellow cyst fluids (63% as compared with 43.5%, p less than 0.005). Cyst fluid volume, T3- and T4-contents of the cyst fluid, age and sex had no influence on therapeutic effect. Up to the 5th puncture the prospects of success are approximately constant, but even in cases of more frequent punctures emptying still takes place. Thyroid hormone therapy with 50-100 micrograms 1-T4 daily (n = 134), and a single intracystic injection of 40 mg methylprednisolone-crystal suspension (n = 42) or of 0.02 g hydroxypolyaethoxydodecan 1% (n = 11) did not show better results than the single aspiration. There were no complications except for 2 cases of afterbleeding in the cysts immediately after puncture, and these were easily dealt with. Fine-needle aspiration is a simple, effective and cost-saving method for the elimination of the frequent cosmetically disturbing thyroid cysts in half of patients, thus avoiding surgery.

The influence of fibrin stabilization and fibrinolysis on the fibrin-adhesive system. A clinical study using radioactively marked fibrinogen as a tracer

In many fields of surgery the use of highly concentrated human fibrinogen, which forms a fibrin clot when thrombin is added, is gaining increasing importance for tissue adhesion. A number of experimental and clinical reports on fibrin sealing have been published during recent years. The question underlying our present investigations is as follows: What happens to the tissue adhesive after its application to a wound in clinical use, i.e., how much time is required for complete resorption of the seal due to fibrinolytic processes? Skin graftings of the face (required to close defects caused by the excision of basal or spinal cell carcinomas) were performed by glueing rhomboid flaps or full thickness skin grafts to the wounds with the tissue adhesive to which 125I-marked fibrinogen has been added. Activity counts were recorded daily and CPM were plotted versus time to obtain summation curves. The physiological processes of fibrin stabilization and fibrinolysis are extensively discussed as both factors influence the tissue adhesive and thus have to be accounted for in clinical practice.

[Bromocriptine induced cystic tumour regression in advanced prolactinomas (author's transl)]

Conservative treatment with bromocriptine was performed in three patients with macroprolactinomas and increased prolactin levels. Lowering of prolactin levels to normal or subnormal values was possible in all cases. One extensive prolactinoma with retro- and suprasellar parts showed regression to a large extent and cystic degeneration. Transient occurrence of liquorrhoea is considered as a consequence of tumour regression. In cases of parasellar prolactinoma recurrence and intrasellar prolactinoma diminution and cystic degeneration were observed while on bromocriptine treatment. Bromocriptine dosage varied between 3.75 and 30 mg/d. Treatment was performed between 20 and 26 months. There were no serious side effects. Bromocriptine treatment offers an alternative to surgery in macroprolactinomas and prolactinoma recurrences.