Versuch der Differenzierung zwischen kortikoidinduzierter Osteopenie und periartikul�rer Demineralisation mit Hilfe der Digitalen Radiogrammetrie (DXR) bei Patienten mit rheumatoider Arthritis

PURPOSE

To investigate a new bone densitometric technology based on digital radiogrammetry (DXR) with respect to its ability to measure severity-dependent variations of bone mineral density (BMD) in patients with rheumatoid arthritis and to differentiate between corticoid-induced and periarticular bone mineral density loss.

PATIENTS AND METHODS

A total of 153 randomly selected patients suffering from verified rheumatoid arthritis underwent digitally performed plain radiographs of the non-dominant hand and also measurements of dual-energy X-ray absorptiometry (DXA) regarding total femur and lumbar spine in 102 patients and peripheral quantitative computed tomography (pQCT) regarding the distal radius in 51 patients. Using DXR the radiographs of the non-dominant hand were analyzed for cortical bone mineral density calculation. The severity was classified in the DXA group using the Ratingen score. Furthermore, both study populations were divided into patients with and without corticoid therapy.

RESULTS

Correlations between BMD determined by DXR and by DXA (R=0.44 for lumbar spine and R=0.61 for total femur) versus pQCT (0.46<R<0.59) were all significant. An appropriate association was confirmed between pQCT and DXA (R=0.61 for total femur and 0.73 for LWS). In the subgroup of patients with corticoid therapy (mean dose: 5 mg/d for a period of more than 6 month), our data showed-similar to the collective of all patients-significant correlations (0.34<R<0.59) between DXR and the other methods. In contrast to pQCT (0.37<R<0.59) the study revealed a poor association between DXR- and DXA-parameters in the subgroup of patients without corticoid therapy; only the correlation between DXA-BMD of total femur and DXR-BMD achieved a significant level (R=0.38, p<0.05). The mean value of BMD measured by DXR decreased severity dependently from 0.59 g/cm(2) (Stage 1) to 0.46 g/cm(2) (Stage 5). Similar results were verified for the metacarpal index (DXR). The relative decrease of BMD between the highest and lowest score was 21% (p<0.05). Otherwise the reduction of bone mineral density using DXA revealed no significant results.

CONCLUSION

The DXR-based BMD calculation can distinguish severity and progress of disease-related periarticular demineralization in contrast to those of DXA. In this context, DXA primarily measures the systemic (corticoid-induced) osteoporosis and pQCT partially estimates disease-related bone mineral density loss, whereas DXR can predominantly analyze and quantify the periarticular demineralization, which often shows a manifestation at an early stage of rheumatoid arthritis. Therefore DXR seems to be a diagnostic tool in the course of rheumatoid arthritis.

[Medical treatment of cancer in the elderly]

Paralleling increasing life expectancy, the number of cases of cancer in our population is also on the increase. The question as to whether chemotherapy for the treatment of a tumor in the elderly is appropriate or not, and if so what doses are required, depends in particular on the potentially increased toxicity of the drug in the old patient. The consequence is that alternative substances may have to be sought. When planning treatment, however, additional factors have to be taken into account, such as the possibility of differences in the physiology of the tumor in the elderly, the general state of health of the patient, the presence of concomitant diseases, possible interactions with other medications, and the patient's social environment.

The helminth parasites of Melomys cervinipes (Rodentia : Muridae : Hydromyinae)

Melomys cervinipes Gould is one of four melomys species native to Australia. There have been no systematic surveys of parasite distribution and prevalence, or parasite community structure, for any species of Melomys. We present a comprehensive summary of the parasites of M. cervinipes by location in Queensland and northern New South Wales from published records, examination of museum specimens and data from an intensive sampling of hosts from four localities within central Queensland. An updated list prepared on the basis of these data and other published records is included.New host records include one cestode (Riallietina celebensis), one trematode (Platynosomum australiense) and 21 nematodes. Trichostrongyloid nematodes (Odilia spp.) were the dominant helminth group, with Odilia melomyos (Mawson, 1960) and O. mackerrasae (Mawson, 1960) being the core components of the helminth community. The structure of this community, with endemic and cosmopolitan elements, appears to have developed through both coevolution of hosts and parasites and host-switching events. Multidimensional scaling analysis of parasites from four central Queensland localities suggests considerable differences in community composition on a relatively small spatial scale. An island locality had a significantly different community structure and greater species diversity than nearby mainland sites. These results emphasise the importance of comparative studies of parasites among localities, and especially between island and mainland communities.

Familial schwannomatosis: exclusion of the NF2 locus as the germline event

BACKGROUND

Schwannomatosis is a recently recognized disorder, defined as multiple pathologically proven schwannomas without vestibular tumors diagnostic of neurofibromatosis 2 (NF2). Some investigators have questioned whether schwannomatosis is merely an attenuated form of NF2.

METHODS

The authors identified eight families in which a proband met their diagnostic criteria for schwannomatosis. Archived and prospectively acquired tumor specimens were studied by mutational analysis at the NF2 locus, loss of heterozygosity analysis along chromosome 22, and fluorescent in situ hybridization analysis of NF2 and the more centromeric probe BCR. Linkage analysis could be performed in six of eight families.

RESULTS

Clinical characterization of these kindreds showed that no affected family member harbored a vestibular tumor. Molecular analysis of 28 tumor specimens from 17 affected individuals in these kindreds revealed a pattern of somatic NF2 inactivation incompatible with our current understanding of NF2 as an inherited tumor suppressor gene syndrome. Linkage analysis excluded the NF2 locus in two kindreds, and showed a maximum lod score of 6.60 near the more centromeric marker D22S1174.

CONCLUSIONS

Schwannomatosis shows clinical and molecular differences from NF2 and should be considered a third major form of neurofibromatosis. Further work is needed to identify the inherited genetic element responsible for familial schwannomatosis.

Molecular study of frequency of mosaicism in neurofibromatosis 2 patients with bilateral vestibular schwannomas

Neurofibromatosis 2 (NF2) is a severe autosomal dominant disorder that predisposes to multiple tumours of the nervous system. About half of all patients are founders with clinically unaffected parents. The purpose of the present study was to examine the extent to which mosaicism is present in NF2 founders. A total of 233 NF2 founders with bilateral vestibular schwannomas (BVS) were screened by exon scanning. NF2 mutations were detected in the blood samples of 122 patients (52%). In 10 of the 122 cases, the ratio of mutant to normal alleles was obviously less than 1, suggesting mosaicism. Tumour specimens were available from 35 of the 111 subjects in whom no mutation could be detected in blood specimens. Mutational analysis by exon scanning detected typical NF2 mutations in 21 of the 35 tumours. In nine subjects, the alterations found in tumours could be confirmed to be the constitutional mutation based on finding of identical mutations in pathologically and/or anatomically distinct second tumours. In six other subjects with only a single tumour available, allelic loss of the NF2 gene was found in addition to the mutation in each tumour, suggesting that either the mutation or the deletion of the NF2 gene is probably the constitutional genetic alteration. Our results suggest that failure to find constitutional mutations in blood specimen from these 15 patients was not because of the limitation of the applied screening technique, but the lack of the mutations in their leucocytes, best explained by mosaicism. Extrapolating the rate (15/35 = 43%) of mosaicism in these 35 cases to the 111 NF2 founders with no constitutional NF2 mutations found in their blood, we inferred 48 mosaic subjects (111 x 0.429). Adding the 10 mosaic cases detected directly in blood specimens, we estimate the rate of mosaicism to be 24.8% (58/233) in our cohort of 233 NF2 founders with bilateral vestibular schwannomas.

Rectangular to hexagonal columnar phase transition exhibited by a biforked mesogen

We present the structural study of a biforked compound exhibiting a Colr-Colh phase transition. This study was performed by means of DSC, optical microscopy, X-ray diffraction, dilatometry and molecular modelling. The molecular packing within the two columnar mesophases of this compound is discussed. For the first time, it is shown that the clusters of adjacent molecules which form the elementary section of a column are tilted with respect to the columnar axis in the rectangular mesophase. From the whole set of experimental data, the number of molecules in a columnar section is found to be about 5 in the rectangular mesophase, and 4 in the hexagonal one. The transition between the two columnar mesophases is discussed with respect to its slow kinetics.

Incidence and short-term outcome of children with symptomatic presentation of organic acid and fatty acid oxidation disorders in Germany

OBJECTIVE

To determine the incidence of symptomatic children with inherited organic acid disorders (OADs) and fatty acid oxidation disorders (FAODs) in Germany.

METHODS

An active surveillance of symptomatic children with inherited OADs and FAODs was conducted during a time period of 24 months (1999-2000) in Germany. Monthly inquiries were sent to all Departments of Pediatrics by the German Pediatric Surveillance Unit (ESPED) and quarterly to all specialized metabolic laboratories. Newly diagnosed patients were added to the database, recording clinical and biochemical information via a standardized questionnaire.

RESULTS

Prospective surveillance enrolling 844 575 children identified a total of 57 symptomatic children with newly diagnosed OADs or FAODs in states with conventional neonatal screening, resulting in an estimated cumulative incidence of 1:14 800. The most frequent diagnosis among these children was medium-chain acyl-CoA dehydrogenase deficiency (n = 20). The majority of symptomatic children revealed clinical symptoms during the first year of life (n = 36), frequently presenting with acute metabolic crises (n = 31). Eight children died during these crises. Notably, 47 of the symptomatic children suffered from diseases potentially detectable by expanded neonatal screening programs. This subgroup included 29 children presenting with metabolic crises and 7 of the 8 deaths.

CONCLUSIONS

Despite increased clinical awareness of OADs and FAODs, the mortality and morbidity for these children remains high, if they are diagnosed after manifestation of clinical disease. An introduction of nationwide neonatal screening programs would change the focus for organic acid analysis from patients presenting with acute metabolic crises to more chronic clinical presentations, especially the cerebral organic acid disorders.

Population pharmacokinetic and dynamic analysis of the topoisomerase I inhibitor lurtotecan in phase II studies

Population pharmacokinetic-dynamic analysis was prospectively integrated in a broad phase II program of lurtotecan (GI147211), a novel camptothecin derived topoisomerase I inhibitor, to determine the population pharmacokinetic profile in a larger population, to estimate individual pharmacokinetic parameters and to investigate relationships with clinical outcome. A sparse sampling method was applied during course one, which involved two sampling time-points. A Bayesian algorithm was used to estimate individual pharmacokinetic parameters, in particular total plasma clearance (CL) and volume of distribution. In total, samples were collected of 109 (63%) of 173 patients. Pharmacokinetic-dynamic evaluation could be carried out successfully in 85 (78%) of the sampled patients. CL of lurtotecan showed substantial variability (mean 87 +/- 28 L/h) and was of the same magnitude as in the phase I studies where full pharmacokinetic curves were used. Residual variability in the population estimate of CL was 9.9%. No significant relationships were observed between exposure parameters and toxicity nor likelihood of tumor response, however the latter relationship may well have been obscured by the heterogeneity of the studied population. Prospective implementation of large scale population pharmacokinetic-dynamic analysis is feasible and important to establish whether interpatient variability in drug exposure is a major determinant of toxicity or activity.

Gilbert damping in single and multilayer ultrathin films: role of interfaces in nonlocal spin dynamics

Unique features of the Gilbert damping in magnetic multilayers were investigated by ferromagnetic resonance (FMR) using magnetic single and double layer structures prepared by molecular beam epitaxy. The FMR linewidth for the Fe films in the double layer structures was larger than the FMR linewidth in the single Fe films having the same thickness. The additional FMR linewidth scaled inversely with the film thickness, and increased linearly with increasing microwave frequency. These results demonstrate that a transfer of electron angular momentum between the magnetic layers leads to additional relaxation torques.

Geometrical and compositional structure at metal-oxide interfaces: MgO on Fe(001)

The geometric structure of MgO deposited on Fe(001) in ultrahigh vacuum by electron evaporation was determined in detail by using surface x-ray diffraction. In contrast to the common belief that MgO grows in direct contact on the Fe(001) substrate, we find an FeO interface layer between the substrate and the growing MgO structure which has not been considered thus far. This result opens new perspectives for the understanding of the Fe/MgO/Fe(001) interface and the tunneling magnetoresistance effect in general.

A mixed fullerene-ferrocene thermotropic liquid crystal: synthesis, liquid-crystalline properties, supramolecular organization and photoinduced electron transfer

Grafting of a ferrocene-containing liquid-crystalline malonate derivative to C60 led to the mixed fullerene-ferrocene material 1 which gave rise to a smectic A phase. Cholesterol was used as liquid-crystalline promoter. X-ray diffraction experiments and volumetric measurements indicated that 1 is organized in double layered structures. The corresponding supramolecular organization within the mesomorphic lamellar phase is characterized by a microsegregation of the different units (ferrocene, fullerene, and cholesterol) in distinct sublayers. In such a smectic A phase, C60 imposes the arrangement of the other molecular moieties. Photophysical studies revealed that electron transfer occurs from the donor ferrocene to the electron accepting fullerene. The formation of a long-lived radical pair, with lifetimes of the order of several hundred nanoseconds, was confirmed by time-resolved spectrometry, especially in the near infrared region, in which the radical anion of the fullerene moiety displays its characteristic fingerprint absorption.

Dendromesogens: liquid crystal organizations of poly(amidoamine) dendrimers versus starburst structures

A new series of liquid crystalline poly(amidoamine) (PAMAM) dendrimers is described. These dendrimers are made by attaching to the 0-, 1-, 2-, 3-, and 4-generation of PAMAM-terminal promesogenic units that carry two decyloxy chains in the 3- and 4-positions of their peripheral aromatic ring. X-ray diffraction studies show that all the compounds display a hexagonal columnar mesophase. A high density of aliphatic chains imposes a curved interface with the promesogenic units that forces the molecules to adopt a radial conformation, and therefore, the columnar structure. A model for the supramolecular organization of the different generations within the columnar mesophase is proposed based on the variation of some of the structural parameters.

A liquid crystalline supramolecular complex of C60 with a cyclotriveratrylene derivative

Cyclotriveratrylene (CTV) derivatives substituted with 9 (1) or 18 (2) long alkyl chains have been prepared. Whereas no liquid crystalline behavior has been observed for 1, the CTV derivative 2 has mesomorphic properties. Indeed, at room temperature compound 2 exhibits a nematic phase characterized by cybotactic groups with a local lamello-columnar order. Both CTV derivatives 1 and 2 are able to form supramolecular complexes with C60 in the solid state. In both cases, the 2:1 host-guest species have been obtained as brown compounds. No liquid crystalline behavior was observed for the supramolecular complex [C60 is included in (1)2]. In contrast, observation of the brown product obtained from C60 and the CTV derivative 2 directly after preparation by polarized optical microscopy revealed a fluid birefringent phase at room temperature. When the sample is heated above 70 degrees C, the birefringence of the texture under the microscope disappears and the X-ray diffraction pattern is transformed into a pattern characteristic of a cubic phase. For the first time in thermotropic liquid crystals, the space group of this cubic phase can be assigned as I4(1)32.

Activity and toxicity of GI147211 in breast, colorectal and non-small-cell lung cancer patients: an EORTC-ECSG phase II clinical study

BACKGROUND

GI147211 is a water-soluble synthetic analogue of camptothecin showing promising in vivo and in vitro antitumor activity and an acceptable toxicity profile.

PATIENTS AND METHODS

Between April 1995 and November 1996, 67 eligible patients with pretreated breast cancer (25 patients) and chemo-naïve colorectal (19 patients) and non-small-cell lung cancer (23 patients) were entered into three multicentric, non-randomized phase II trials. Treatment schedule consisted of intravenous GI1147211 administered at a dose of 1.2 mg/m2/day for five consecutive days every three weeks.

RESULTS

Hematological toxicity was common with grade 3-4 neutropenia in 54% of patients and neutropenic fever together or not associated with infection in 14.5% of patients. Grade 3-4 thrombocytopenia and grade 2-4 anemia were observed in 20% and in 68% of patients, respectively. Non-hematological toxicity was generally mild to moderate and consisted mainly of gastrointestinal toxicity, asthenia and alopecia. A dose-escalation to 1.5 mg/m2/d was feasible in 17 (25%) patients. The antitumor activity of GI1147211 was moderate in breast cancer patients (3 partial responses (PRs), response rate (RR) 13%) and minimal in non-small cell lung cancer patients (2 PRs, RR 9%). No objective responses were obtained in colorectal patients.

CONCLUSIONS

GI147211, at the dose and schedule employed in this study, showed an acceptable safety profile but a modest antitumor activity in the examined tumor types.

Combined radiochemotherapy with docetaxel in patients with unresectable locally advanced head and neck tumors

BACKGROUND

As the treatment with docetaxel in metastatic head and neck cancer resulted in an encouraging response rate, the following phase-I study examined the effects of a combined radiochemotherapy with weekly docetaxel in patients with inoperable advanced head and neck tumors.

PATIENTS AND METHODS

Six patients with Stage IV head and neck cancer were included into the study. Within the treatment regimen the primary tumor and the involved lymph nodes were irradiated up to a total dose of 70 Gy, the non involved cervical and supraclavicular lymph nodes received 50 Gy in conventional fractionation. Simultaneously docetaxel was given 1 hour before radiotherapy. The initial dose was 15 mg/m2.

RESULTS

A dose escalation was impossible because of several dose limiting toxicities (NCI-CTC) already in the first dose level. Two patients showed skin reactions Grade 4, 2 patients pulmonary complications Grade 4, 2 patient neurologic side effects Grade 3 and 1 a thrombocytopenia Grade 3. The response rate resulted in 3 complete and 1 partial remission, 1 death, 1 patient was not evaluable.

CONCLUSION

Unexpectedly already in the first dose level several dose limiting toxicities were evaluated. For that reason the treatment scheme is not feasible.

Investigations of Thin Films with Amphiphilic Dendrimers Bearing Peripheral Fullerene Subunits

In spite of a molecular mass of 7704.6 g mol(-1), third-generation compound G3 (shown schematically; Z=C(8)H(17)) is able to form stable Langmuir films. In a systematic study, the amphiphilic properties of the corresponding dendrimers of first (G1) and second generation (G2), with one and two peripheral fullerene units, respectively, were investigated and a model could be proposed for the multilayer films obtained from G1.

Article

The interface magnetic energy in fcc Cu/Co/Cu(001) and Pd/Co/Pd(001) and the interlayer exchange coupling in bcc Fe/Cu/Fe(001) will be discussed and compared to recent theoretical models. The effect of interface magnetostriction and interface magnetic anisotropy will be described using a model proposed by Victora and MacClaren. The Victora-MacLaren theory of magnetic anisotropies is based on a generalized Néel pair interaction model that allows one to express the total interface energy in terms of the interface anisotropy and interface magnetoelastic contributions. It will be argued that the change in the sign of the interface anisotropy Ks as a result of replacing Cu atoms by Pd atoms is caused primarily by the enhanced role of the spin-orbit interaction in the Co-Pd pair interaction and in the tendency of Pd to acquire a significant magnetic moment in the proximity of ferromagnetic atoms. It will be shown that the interface lattice separations play an important role and the balance between these two magnetoelastic terms determines the total magnetoelastic contribution to the interface energy. The magnetoelastic interface contributions to Ks are +0.08 ergs/cm2 and +0.17 ergs/cm2 for the fcc Cu/Co/Cu(001) and Pd/Co/Pd(001) structures, respectively. The interlayer exchange coupling has been investigated in bcc trilayer structures Fe/Cu/XcCu1 - c/Cu/Fe where XcCu1 - c represents an alloyed atomic layer with X = Fe, Cr, Ag. The purpose of these studies was to determine the effect of foreign atoms inside a nonmagnetic spacer on the direct interlayer exchange coupling between the outside Fe layers mediated by the valence electrons of the Cu spacer. The experimental results will be compared with recent first principles calculations using the Layer Korringa-Kohn-Rostoker (LKKR) method. It will be shown that the local electron potential of the foreign atoms affects the spin transport across the spacer and is chiefly responsible for the observed behavior of the interlayer exchange coupling in Fe/Cu/XcCu1 - c/Cu/Fe. The interlayer e cxchange coupling depends very strongly on the magnetic state of the foreign atoms within the spacer. For foreign atoms with no long-range ferromagnetic order the exchange coupling is mainly affected by the 3d valence band electrons. Foreign atoms that are isoelectronic with the spacer atoms modify the strength of the exchange coupling only due to lattice relaxations that are associated with their atomic size.Key words: ultrathin metallic magnetic films, magnetic anisotropy, exchange interaction, Molecular Beam Epitaxy.

Clinical phase II evaluation of paclitaxel in combination with cisplatin in metastatic or recurrent squamous cell carcinoma of the head and neck

BACKGROUND

Paclitaxel as single agent has shown marked activity in several malignancies. The aim of the present phase II trial was to determine the activity of paclitaxel/cisplatin in patients with metastatic or recurrent squamous cell carcinoma of the head and neck.

PATIENTS AND METHODS

200 mg/m2 paclitaxel was administered over three hours followed by cisplatin (100 mg/m2), repeated every 22 days. Twenty-eight patients were entered and received a total of 99 cycles (median 2, range 1-6). All patients were evaluable for toxicity, and 25 for response.

RESULTS

Hematologic toxicities included leukopenia CTC grade 3 in 13 patients, and grade 4 in five patients, neutropenia grade 3 in nine patients, and grade 4 in eight patients, grade 3 anemia and grade 2 thrombocytopenia in one patient each. Non-hematologic toxicities included hypotension grade 2 (six patients), grade 3 (four patients), and grade 4 (two patients). A decline in renal function was observed in 15 courses and 10 patients, leading to a median delay of 2.5 days. Neurosensory and neuromotor toxicity grade 1 were observed in 13 patients (grade 2: 12 patients; grade 3: one patient), myalgia grade 3 in one patient, asthenia grade 3 in two and grade 4 in one patient. Partial responses were observed in 12 patients for an overall response rate of 48% (95% CI: 28%-68%) with a median response duration of 6.5 months (range 1-10 months). Stable disease was observed in seven patients, of who two also had clinical benefit.

CONCLUSIONS

Paclitaxel 200 mg/m2 administered over three hours combined with cisplatin 100 mg/m2 is an active regimen warranting further evaluation.

Dose intensity phase I/II trial with carboplatin, ifosfamide, etoposide and vincristine combined with filgrastim in patients with small-cell lung cancer

BACKGROUND

The purpose of the study was to evaluate the feasibility of increasing dose intensity by a stepwise reduction of the time intervals between chemotherapy cycles in separate patient cohorts with small-cell lung cancer. Patients received up to 6 courses of combination chemotherapy with carboplatin, etoposide, ifosfamide and vincristine followed by support with filgrastim. Dose intensity, incidence, duration and severity of neutropenic fever and infections, objective response to chemotherapy, and safety of filgrastim were determined.

PATIENTS AND METHODS

29 patients with small-cell lung cancer (limited disease: 2, extensive disease: 27) were treated with a combination of carboplatin 250 mg/m2 i.v. day 1, ifosfamide 2 g/m2 and etoposide 120 mg/m2 i.v. days 1 and 2, etoposide 120 mg/m2 orally day 3, and vincristine 1.4 mg/m2 day 14. Initially, filgrastim (5 micrograms/kg) was administered subcutaneously from day 7 to 16. With shorter treatment intervals, filgrastim was administered on days 4-16 or 4-14.

RESULTS

An overall increase in dose intensity by a factor of 1.44 was achieved after reducing the treatment interval from 27 to 17 days. Further reduction to 14 days was not feasible due to persistent thrombocytopenia. Six patients (21%) developed a total of 9 febrile episodes, and 14 patients (48%) had to be withdrawn from the study before the completion of six cycles of chemotherapy. The median duration of infectious episodes was 6 days. Overall, a total of 22 of 27 evaluable patients had an objective response. Longer treatment intervals resulted in a lower probability for objective response (> or = 23 days: 10/14 patients vs. < or = 17 days: 7/7 patients).

CONCLUSION

Filgrastim allows for the reduction of treatment intervals in patients with small-cell lung cancer and increased dose intensity with acceptable hematologic and nonhematologic toxicities.