Preliminary results on the clinical efficacy and safety of androgen inhibition by an LHRH agonist alone or combined with an antiandrogen in the treatment of prostatic carcinoma

We have used the paradoxical antigonadal effects of LHRH agonists as a chemical castration in advanced prostatic cancer. We report early results of a phase II study on the clinical efficacy of the LHRH agonist D-Ser (TBU)6, des-Gly-NH2(10) LHRH administered to patients with stage D prostatic carcinoma. Following dose-range finding studies using either intranasal (IN) (200 micrograms twice/day or 500 micrograms twice/day) or subcutaneous (SC) administration (50 micrograms once/day, we developed a sequential combination of SC (500 micrograms three times/day for seven days) and IN regimen that was administered for 3 to 16 months to a group of 23 patients with stage D prostatic carcinoma. Initiation of therapy was associated with a clinical flare in one patient during the first week of treatment. Mean serum testosterone levels were already decreasing at one week and remained inhibited to levels inferior to 1 ng/ml after the first four weeks of treatment. Overall assessment shows that within the first six months of treatment, 26% patients were improved, 39% were stabilized, and 35% were nonresponders. Fourteen patients were followed during the next six months: 29% continued to respond, 29% escaped, 21% remained stable, and 21% were nonresponders. Histologic studies from castrated patients showed changes in spermatogenesis correlating to the degree and duration of suppression of testicular steroidogenesis without signs of toxicity. Preliminary observations on the combination of the pure antiandrogen RU 23908 with Buserelin (n = 5) or castration (n = 3) suggest that the addition of an antiandrogen does not seem to improve the patients nonresponding to other hormonal suppressive therapy (Buserelin) administered before (n = 3) or concomitantly with the antiandrogen (n = 2). Three relapsing castrate patients responded to the antiandrogen, but the response was temporary in two (eight to nine months of therapy). No side effects other than hot flashes and decreased potency are related to LHRH agonist alone or to the low-dose antiandrogen. Multicenter trials will be necessary to delineate the place of LHRH agonist alone or LHRH agonist combined with an antiandrogen in the treatment of prostatic cancer.

Protein synthesis in rabbit reticulocytes: characteristics of CO-eIF-2 protein complex

A high molecular weight reticulocyte protein factor, named Co-eIF-2, contains Co-eIF-2A, Co-eIF-2B, and Co-eIF-2C activities and stimulates Met-tRNAf binding to eIF-2 both in the presence and absence of Mg2+. Some characteristics of this stimulation in the absence of Mg2+ are: (1) Stimulation is most pronounced at low eIF-2 levels. (2) Stimulation is partially resistant to heat and NEM treatment, and thus appears to be due to the combined action of both heat and NEM-insensitive Co-eIF-2A, and heat and NEM-sensitive Co-eIF-2C activities. (3) [3H]GDP bound in eIF-2 . [3H]GDP complex is rapidly displaced by unlabelled GTP during ternary complex formation Co-eIF-2 stimulates Met-tRNAf binding to eIF-2 even when added after the [3H]GDP from eIF-2 . [3H]GDP has been completely displaced. This indicates that Co-eIF-2-stimulation is not due to GDP displacement from eIF-2 . GDP. We propose that eIF-2 molecules become inactive in the presence of Mg2+ and at high dilution, and Co-eIF-2 restores the inactive eIF-2 molecules into an active form.

Kidney graft survival: role of blood transfusions and lymphocytotoxic antibodies

In 121 primary cadaver kidney grafts, a significant increase in graft survival has been observed in recipients transfused prior to transplantation, whatever the number of units received or the time of administration. This beneficial effect of blood transfusion was shown to be independent of the recipient's sex, blood group, HLA-A, B match grade and dialysis time. In longitudinal screenings, the incidence of post-transplant antibodies did not differ according to transfusion status of recipient. However, the graft survival was significantly improved in transfused patients without antibody or with an IgM anti-B (cold) antibody (95% survival at 4 years) as compared to nontransfused with the same characteristics. Patients with IgG anti-B (warm), anti-T or anti-PBL antibodies IgG/IgM shared a uniformly poor graft prognosis whether or not they had been transfused.

Marital and family issues in patients with chronic pain. A review

This paper attempt to review the relevant literature pertaining to the family issues in chronic pain. To begin with, a rationale is developed for adopting a family approach to the understanding of physical and psychosomatic disorders. Pain literature is examined to demonstrate the significance of family factors in the etiology, perpetuation and treatment of chronic pain. Overall research in this entire field remains somewhat weak and thus the findings are of a tentative nature. On the other hand, the clinical significance of family factors in chronic pain are critical and cannot be ignored. The need for better designed research in this field is of utmost importance.

Many faces of depression in patients with chronic pain

Depression is commonly associated with chronic pain patients. How common is it and what are its manifestations? Research findings are unclear. Besides, depression is defined by some as a syndrome and by others as an affect or symptom. This leads to further confusion. This paper attempts to answer those questions by a selected review of the pertinent literature and case examples to demonstrate reactive, clinical and masked depression and also depression as an affect or symptom. Some of the treatment issues are considered.

Influence of HLA-A and HLA-B cross-reactive antigen matching on kidney graft survival

The presence of cross-reactive (CR) antigens of the HLA-A and B specificities between donor and recipient carries a better graft outcome than an HLA match not taking it into account. This influence of CR antigens has been observed in the case of cadaver kidneys matched only for none or one HLA antigen. If two or more antigens are matched this effect is not seen anymore. This improved graft survival could not be explained on the basis of the number of transfusion nor the incidence of cytotoxic antibodies.

Protein synthesis in rabbit reticulocytes. Purification and characterization of a double-stranded RNA-dependent protein synthesis inhibitor from reticulocyte lysates

Reticulocyte lysates contain a latent form of eukaryotic peptide chain initiation factor 2 (eIF-2) kinase (dsI) which becomes activated in the presence of double-stranded RNA and ATP and inhibits protein synthesis. The latent form of dsI has been partially purified from reticulocyte ribosomal salt wash. The purified dsI has been activated by incubation in the presence of poly(rI).poly(rC) and [gamma 32P]ATP and the activated dsI has been further purified to near homogeneity. Upon sodium dodecyl sulfate-polyacrylamide gel electrophoresis, purified [32P]dsI shows an intensely staining 67,000-dalton polypeptide band which corresponds to a single 67,000-dalton radioactive band. During Sephadex (G-200) gel filtration, both the latent form of dsI and the activated dsI elute similarly with a peak corresponding to a molecular weight of 67,000. Purified dsI phosphorylates the 38,000-dalton subunit of eIF-2 and, under conditions of eIF-2 phosphorylation, dsI strongly inhibits AUG-dependent Met-tRNAf binding to 40 S ribosomes. Also, in partial reactions, eIF-2 alpha (P) formed by phosphorylation of eIF-2 using dsI and ATP, is not recognized by two eIF-2 ancillary factors, Co-eIF-2B and Co-eIF-2C. These results are similar to those reported previously for the heme-regulated eIF-2 kinase (Das, A., Ralston, R. O., Grace, M., Roy, R., Ghosh-Dastidar, P., Das H. K., Yaghmai, B., Palmieri, S., and Gupta, N. K. (1979) Proc. Natl. Acad. Sci. U. S. A. 76,5076-5079) and suggest that dsI, like the heme-regulated eIF-2 kinase phosphorylates eIF-2 and eIF-2 alpha (P) thus formed, in both cases, is not recognized by Co-eIF-2B and Co-eIF-2C, and is inactive in some step(s) of Met-tRNAf.40 S initiation complex formation.

Protein synthesis in rabbit reticulocytes. Co-eIF-2A reverses mRNA inhibition of ternary complex (Met-tRNAf.eIF-2.GTP) formation by eIF-2

mRNAs, at low concentrations, drastically inhibit ternary complex formation by eIF-2 (Met-tRNAf.eIF-2.GTP) and, when added to the preformed ternary complex, cause extensive dissociation of the complex. Co-eIF-2A stimulates (2- to 4-fold) Met-tRNAf binding to eIF-2 and, in the presence of excess Co-eIF-2A, the stimulated Met-tRNAf binding to eIF-2 is fully resistant to mRNAs. Other cofactors tested such as Co-eIF-2B and Co-eIF-2C do not reverse mRNA inhibition of ternary complex formation.

Psychological preparation for surgical patients

The prospect of surgery normally evokes anxiety, which, given the idiosyncracies of human nature, will be experienced differently by different individuals. This article examines some of the theoretical considerations of stress in general, proceeds to a discussion of stress as it is experienced by patients facing surgery, then examines the clinical application and benefits of psychological preparation of surgical patients.

A simple and sensitive color test for the detection of human chorionic gonadotropin

A simple, rapid, sensitive, and reliable ELISA test for the detection of urinary human chorionic gonadotropin (hCG) has been developed using penicillinase (EC no. 3.5.2.6) as the label and a microtiter ELISA plate as a solid support for antibody. The results of the test is assessed visually for the dark blue that indicates the presence of hCG. A minimum of 500 mU of hCG/ml of urine can be detected easily and the test can be completed in 2 hours with good precision. Accurate negative results are obtained in urine samples of normally ovulatory women, postmenopausal women, and adult males, suggesting that the physiologic concentrations of luteinizing hormone do not influence the assay results. In samples referred for pregnancy detection 95.5% accurate results were obtained when compared with histopathologic and/or clinical findings. There were 2 false-negative results, and only in 4 of 132 subjects studied were false-positive results obtained. This test, if properly performed, should prove a valuable tool in the detection of hCG as early as 30 to 35 days from the last menstrual period.