Maximal upstroke velocity as an index of available sodium conductance. Comparison of maximal upstroke velocity and voltage clamp measurements of sodium current in rabbit Purkinje fibers

We compared the maximal upstroke velocity of action potentials in short rabbit Purkinje fibers with sodium currents measured with a two-microelectrode voltage clamp. The number of sodium channels available to open during a sudden depolarization was varied either by blockade with tetrodotoxin or by inactivation with steady depolarizations. In both cases, the maximal upstroke velocity was found to be a very nonlinear measure of the number of available sodium channels. For example, 3 microM tetrodotoxin blocks 85% of the sodium channels, but reduces the maximal upstroke velocity by only 33%. Voltage clamp and upstroke velocity experiments were reconstructed with a computer model of the rabbit Purkinje fiber preparation that was closely based on experimental measurements of passive cable properties and sodium channel characteristics. The simulations indicate that our voltage clamp measurements of sodium current accurately report changes in channel availability, but they also show that the maximal upstroke velocity is a strongly nonlinear index of available sodium conductance. Most of the nonlinearity arises from the activation kinetics of the sodium channels: as the pool of available channels decreases, a greater percentage of those channels activate and contribute inward current at the time of the maximal upstroke velocity. Simulations predict that the maximal upstroke velocity-available sodium conductance relationship would still remain nonlinear at 37 degrees C or under different stimulus conditions that give uniform or continuously propagated action potentials. The nonlinearity may invalidate inferences based on earlier maximal upstroke velocity experiments: the existence of two types of sodium channels with different tetrodotoxin sensitivity, steady state voltage dependence of tetrodotoxin block, voltage range over which sodium channels inactivate, and rapid, then slow recovery of sodium channel availability following a sudden repolarization. All of these conclusions need to be reevaluated.

Multidrug treatment of advanced and recurrent endometrial carcinoma: a Gynecologic Oncology Group study

Patients (358) with advanced (FIGO stages III and IV) or recurrent endometrial cancer were treated with one of two regimens: 1) melphalan and 5-fluorouracil daily for four days, repeated every four weeks with megace daily for eight weeks and 2) adriamycin, 5-fluorouracil, and cyclophosphamide, intravenous bolus every 21 days with megace daily for eight weeks. All patients were randomized except for 63 with known cardiac disease who were assigned to regimen 1 (to avoid adriamycin) and studied separately. Stratification was effected for performance status, history of previous progestational therapy, presence or absence of measurable disease, and stage of disease. The objective response rate in those with measurable disease was 36.8% in both groups; 36.8% of each group had stable disease, and only 26.4% progressed on treatment. Response was unaffected by site of recurrence, time to first recurrence, presence or absence of previous treatment by progestational or radiation therapy, or age. Grade of tumor and performance status did affect response, although 44 of 57 objective responders had undifferentiated tumors. The two combinations achieved response rapidly, required careful supervision, and were especially useful in treating patients with usually poor prognostic features.

Use of indwelling right atrial catheter in gynecological oncology: a preliminary report

Experience with the utilization of an indwelling right atrial catheter in patients with gynecological cancer is reviewed. The technique of placement is described and the complications in 21 patients are presented. Fever was the major complication in 5 out of 21 patients of whom 2 had positive blood cultures. The catheter had to be removed in 3 patients. The median duration of catheter placement was 45 days, the shortest being 8 hr and the longest being 1 year. Most of the patients were myelosuppressed or had no other venous sites accessible. A safe regimen for management of the catheter and indication for its removal are presented.

Lidocaine block of cardiac sodium channels

Lidocaine block of cardiac sodium channels was studied in voltage-clamped rabbit purkinje fibers at drug concentrations ranging from 1 mM down to effective antiarrhythmic doses (5-20 muM). Dose-response curves indicated that lidocaine blocks the channel by binding one-to-one, with a voltage-dependent K(d). The half-blocking concentration varied from more than 300 muM, at a negative holding potential where inactivation was completely removed, to approximately 10 muM, at a depolarized holding potential where inactivation was nearly complete. Lidocaine block showed prominent use dependence with trains of depolarizing pulses from a negative holding potential. During the interval between pulses, repriming of I (Na) displayed two exponential components, a normally recovering component (tauless than 0.2 s), and a lidocaine-induced, slowly recovering fraction (tau approximately 1-2 s at pH 7.0). Raising the lidocaine concentration magnified the slowly recovering fraction without changing its time course; after a long depolarization, this fraction was one-half at approximately 10 muM lidocaine, just as expected if it corresponded to drug-bound, inactivated channels. At less than or equal to 20 muM lidocaine, the slowly recovering fraction grew exponentially to a steady level as the preceding depolarization was prolonged; the time course was the same for strong or weak depolarizations, that is, with or without significant activation of I(Na). This argues that use dependence at therapeutic levels reflects block of inactivated channels, rather than block of open channels. Overall, these results provide direct evidence for the "modulated-receptor hypothesis" of Hille (1977) and Hondeghem and Katzung (1977). Unlike tetrodotoxin, lidocaine shows similar interactions with Na channels of heart, nerve, and skeletal muscle.

High Pressure Liquid Chromatographic Determination of Fensulfothion: Collaborative Study

A method for analyzing fensulfothion was tested by 10 collaborators. Formulations were dissolved, or extracted from inerts, in methanol. Benzophenone was used as an internal standard. The solution was diromatographed on a Partisil-10 ODS-2, or equivalent, reverse phase column, and detected at 230 nm. A mobile phase of methanol-water-phosphoric acid was used. The ratio of fensulfothion peak height to benzophenone peak height was calculated from the UV response and compared to the standard material for quantitation. A 15% granular formulation was analyzed as a matched pair. The results of one collaborator were outliers by the Dixon test. The coefficient of variation for the granular formulation was 1.6%. A matched pair of 63% spray concentrate samples was analyzed by 10 collaborators. The difference in results was an outlier for one collaborator; the coefficient of variation for the other collaborators was 1.5%. The method has been adopted official first action.

Improved therapy with cisplatin regimens for patients with ovarian carcinoma (FIGO Stages III and IV) as measured by surgical end-staging (second-look operation)

Between 1974 and 1982, 273 patients with epithelial cancer of the ovary (International Federation of Gynaecology and Obstetrics Stages III and IV) were randomized in four therapeutic trials. In Trial I Adriamycin plus cisplatin versus cisplatin alone versus thiotepa plus methotrexate was tested. The superiority of Adriamycin plus cisplatin in producing the best response rate led to its use as the reference arm in subsequent trials. All investigational arms included cisplatin plus other drugs (cyclophosphamide, Adriamycin, hexamethylmelamine, and thiotepa) in various combinations. Eligibility for second look required complete clinical remission and completion of at least 10 cycles of chemotherapy. To date, 73 second-look operations have been performed on randomized patients. An additional 43 nonrandomized patients underwent second-look procedures and are analyzed separately. Between 40% and 46% of patients treated with cisplatin regimens had no disease at second look. Cell differentiation and volume of postoperative disease did not influence response.

Cisplatin regimens and improved prognosis of patients with poorly differentiated ovarian cancer

Patients with advanced ovarian carcinoma, Stage III or IV (International Federation of Gynaecology and Obstetrics), were randomized to primary chemotherapy with doxorubicin (Adriamycin) and cisplatin plus or minus hexamethylmelamine, and cyclophosphamide (CHAP). The four-drug CHAP regimen produced a 57% complete clinical response rate and a 26% partial response rate for clinically evaluable patients. The median survival of CHAP patients is 25 months. The two-drug Adriamycin-cisplatin (AP) regimen produced a 43% complete response rate and a 35% partial response rate. The median survival is 18 months. The four-drug regimen produced a significantly longer median survival (28 versus 18 months) for patients with poorly differentiated tumors than for patients with well-differentiated tumors on either treatment. Examination of treatment failure or death by treatment, histology, and size of largest residual tumor and comparison to similar patients treated with AP in this and two preceding controlled trials also suggest that CHAP is superior to AP for patients with poorly differentiated tumors.

Histologic correlates of virulence in ovarian adenocarcinoma. II. Morphologic correlates of host response

Original histologic slides were reviewed from 87 patients with advanced ovarian carcinoma, all of whom had been treated with cisplatin, alone or in combination. The degree of lymphocyte infiltration in the tumor was not related to histologic or cytologic tumor differentiation. However, the degree of lymphocyte infiltration was related to improved survival.

Histologic correlates of virulence in ovarian adenocarcinoma. I. Effect of differentiation

The original histologic material of 87 patients with Stage III or IV ovarian adenocarcinoma was reviewed. These patients had been treated with cisplatin, alone or in combination. There was a significant association among the morphologic parameters of histologic differentiation, mitotic activity, and cellular pleomorphism. However, none of these was associated either with survival or with maximum response of the tumor among the cisplatin-treated patients. The possible significance of these findings is discussed.

Cerebral blindness in association with cis-platinum chemotherapy for advanced carcinoma of the fallopian tube

A 62-year-old woman with a diagnosis of metastatic fallopian tube carcinoma was treated with cis-platinum and doxorubicin (Adriamycin) at a dosage of 50 mg/m2 intravenously every 3 weeks. After the 10th course of cis-platinum and doxorubicin, she complained of headache and inability to see. Physical examination was compatible with cortical blindness. The brain scan and computed tomographic scan were normal. Visual evoked potentials showed a delay in latency. Visual acuity completely returned over the next months, but right homonymous hemianopia persists. The temporal relationship between the findings and the treatment with platinum implicates this drug as the possible causative agent in the cortical blindness.

Increase in intracellular sodium ion activity during stimulation in mammalian cardiac muscle

Changes in stimulation rate alter the electrical and mechanical characteristics of myocardial cells. We have investigated the possibility that intracellular sodium activity (aiNa) changes with stimulation and correlates with changes in contraction strength. Two kinds of liquid membrane Na+-selective microelectrodes were used to measure aiNa in guinea pig and sheep ventricular muscle and in sheep Purkinje strands. Stimulation produced a rate- and time-dependent elevation of aiNa. Small increases in aiNa were seen at stimulation rates as slow as 0.2 Hz, and faster rates of stimulation elevated aiNa by over 30%. The changes seen in Purkinje strands and ventricular muscle were similar. Following a period of stimulation, aiNa and Vm returned to their pre-stimulus levels with the same time courses. This is consistent with the suggestion that the post-stimulation hyperpolarization is the result of an increased rate of electrogenic Na+ extrusion. The effects of stimulation on aiNa and tension were compared with those of ouabain. The comparison suggests that rapid stimulation could produce increased contraction strength as the result of a substantial gain in intracellular calcium via a Na-Ca exchange mechanism, but that this is only one of several factors determining the force-frequency relationship.

Treatment of recurrent and persistent germ cell tumors with cisplatin, vinblastine, and bleomycin

Four patients were treated with vinblastine, cisplatin, and bleomycin for recurrent or persistent germ cell tumors. In all patients a clinical response was achieved. In 2 patients complete response was attained and they are free of disease following second-look laparotomy. One had a mixed germ cell tumor that persisted as dysgerminoma following primary chemotherapy. The other was a true hermaphrodite with pure dysgerminoma. In patients with endodermal sinus tumor transient response was achieved, but the tumors recurred and the patients died within 6 months.

Heterogeneity of intracellular potassium activity and membrane potential in hypoxic guinea pig ventricle

The relationship between membrane potential (Em) and the potassium equilibrium potential (EK) was investigated in hypoxic guinea pig papillary muscle. After more than 8 hours of hypoxia, cells with near normal Em (-86.2 +/- 0.9 mV) and action potentials were observed. However, the intracellular potassium concentration ([K+]i) based on chemical analysis and the assumption that potassium was homogeneously distributed was 41.8 +/- 4.3 mM; the apparent EK was -55.7 +/- 2.9 mV, significantly positive to Em. Measurements with potassium ion-selective microelectrodes revealed that prolonged hypoxia results in at least two populations of cells with different characteristics. The first population had an intracellular potassium activity (aiK) of 101.5 +/- 1.9 mM, and EK was 4.7 mV negative to Em. In contrast, EK was 33.4 +/- 1.3 mV negative to Em in the second population. These cells also exhibited a reduced sensitivity to changes in bath potassium, and calculations suggest aiK was about 18 mM. The existence of cell populations with a near normal and very low aiK can explain the intermediate value of [K+]i calculated assuming a homogenous potassium distribution. Cells with near normal Em and action potentials represent the population with near normal aiK. Hypoxia may also cause non-uniform changes in other cellular characteristics.

Tetrodotoxin block of sodium channels in rabbit Purkinje fibers. Interactions between toxin binding and channel gating

Tetrodotoxin (TTX) block of cardiac sodium channels was studied in rabbit Purkinje fibers using a two-microelectrode voltage clamp to measure sodium current. INa decreases with TTX as if one toxin molecule blocks one channel with a dissociation constant KD approximately equal to 1 microM. KD remains unchanged when INa is partially inactivated by steady depolarization. Thus, TTX binding and channel inactivation are independent at equilibrium. Interactions between toxin binding and gating were revealed, however, by kinetic behavior that depends on rates of equilibration. For example, frequent suprathreshold pulses produce extra use-dependent block beyond the tonic block seen with widely spaced stimuli. Such lingering aftereffects of depolarization were characterized by double-pulse experiments. The extra block decays slowly enough (tau approximately equal to 5 s) to be easily separated from normal recovery from inactivation (tau less than 0.2 s at 18 degrees C). The amount of extra block increases to a saturating level with conditioning depolarizations that produce inactivation without detectable activation. Stronger depolarizations that clearly open channels give the same final level of extra block, but its development includes a fast phase whose voltage- and time-dependence resemble channel activation. Thus, TTX block and channel gating are not independent, as believed for nerve. Kinetically, TTX resembles local anesthetics, but its affinity remains unchanged during maintained depolarization. On this last point, comparison of our INa results and earlier upstroke velocity (Vmax) measurements illustrates how much these approaches can differ.

Infrared Spectrophotometry Method for Methazole Formulations: Collaborative Study

An infrared method was developed for the analysis of Probe 75% wettable powder formulation for methazole content. The procedure involves an extraction of the powder by agitation with acetone. The suspension is centrifuged, and the clear supernatant liquid is measured for absorbance at 755 cm−1. A collaborative study was conducted with 10 laboratories participating. One laboratory omitted the centrifugation, which resulted in a low assay. Statistical analysis of the data showed no significant variances. The coefficient of variation for 10 laboratories analyzing 2 samples in duplicate was 1.29%. The method has been adopted interim official first action.

Improved chemotherapy for ovarian cancer with cis-diamminedichloroplatinum and adriamycin

In a prospective controlled randomized trial, patients with advanced ovarian carcinoma (FIGO Stage III or IV) were treated with cis-diamminedichloroplatinum (II), (DDP), alone, DDP and Adriamycin (ADM), or Triethylenethiophosphoramide (ThioTEPA) and methotrexate (MTX). DDP alone produces objective responses in 31% of evaluable patients, ThioTEPA and MTX in 36%. The combination of DDP and ADM produces the best response rate, 80% (.01 less than P less than 0.25). The risk of progression or death is substantially reduced for the two DDP regimens combined when compared with ThioTEPA-MTX (P = .03). Multivariate analysis further suggests the superiority of the two DDP regimens because poorly differentiated tumors and large, greater than 2 cm, residual tumors failed to produce their usual adverse effect on prognosis when patients were treated with the two DDP regimens. Patients with poorly differentiated tumors or tumors of unknown grade treated with platinum or DDP-ADM experienced better survival than similar patients treated with ThioTEPA (P = .01).

A liquid ion-exchanger alternative to KCl for filling intracellular reference microelectrodes

We have developed a filling solution for silanised microelectrodes consisting of potassium tetrakis (p-chlorophenyl) borate in octanol. Microelectrodes filled with this reference liquid ion-exchanger (RLIE) have equal selectivities to Na and K, and give the same membrane potential as do KCl-filled microelectrodes. The RLIE microelectrodes are more stable, less damaging to the cell membrane and do not leak Cl- ions. Their high resistance, however, makes them unsuitable for recording rapid potential changes or for passing current.

Intraperitoneal infusion of doxorubicin in the treatment of gynecologic carcinomas

Intraperitoneally administered doxorubicin yields high local concentrations that are expected to deliver higher doses to clinically important peritoneal and lymphatic metastatic sites. Two infusions of 20 mg and 30 mg in a patient with residual microscopic intraperitoneal ovarian cancer eradicated her disease. Quantification of serum doxorubicin by HPLC revealed significant levels of the drug and its major metabolite lasting 72 hours. A 50-mg infusion induced complete remission in endometrial carcinoma; the patient died in 6 months without evidence of abdominal tumor. Complications due to subcutaneous infiltration of doxorubicin and possible systemic effects of sustained high levels of the drug need further investigation to enable the full exploitation of this modality.

Combination chemotherapy for advanced carcinoma of the fallopian tube

Two patients with advanced adenocarcinoma of the fallopian tube were treated with cis-diamminedichloroplatinum, adriamycin, and progestins. Cyclophosphamide was added to the treatment of 1 patient. Both regimens achieved surgically proved complete remission. No severe drug-related toxicity occurred.

Bronchial carcinoid tumor with ovarian metastasis: a light microscopic and ultrastructural study

An unusual case of brochial carcinoid tumor with skin and bilateral metastases is presented. Histochemical stains and electronmicroscopic findings confirmed the diagnosis. The peculiar pathologic features and unique clinical characteristics are described.

Dysgerminoma of the ovary associated with true hermaphroditism

A dysgerminoma of the left gonad exhibiting malignant features was diagnosed at laparotomy in a 33-year-old virginal phenotypic female who had a normal menstrual history. Pathologic examination of the contralateral (right) gonad revealed an ovotestis. The nonaffected residual portion of the tumor-bearing left gonad exhibited only ovarian stroma. The ovotestis was characterized by a nodule of testicular parenchyma composed of partly hyalinized seminiferous tubules without evident spermatogenesis. The ovotestis was contiguous to normal ovarian elements, including a cystic corpus luteum and primordial follicles. Proliferative endometrium was found lining the small uterus. The findings are indicative of true hermaphroditism. The occurrence of dysgerminoma and other tumors in association with various forms of gonadl dysgenesis is discussed. To the authors' knowledge, this is the first reported case of dysgerminoma occurring in a phenotypic female hermaphrodite.

Uterine fibroleimoyomata with aortic lymph node metastases

This is a report of extensive metastases of histologically benign uterine leiomyomas to para-aortic lymph nodes in a 32-year-old woman. The pathologic features and clinical characteristics are described, and the previously recorded experience with this rare entity is reviewed.

Combination chemotherapy for advanced endometrial adenocarcinoma

Two patients with measurable recurrent endometrial adenocarcinoma achieved complete remission proven by second-look operation. Both patients were treated with a combination of melphalan, 5-fluorouracil and medroxyprogesterone acetate.

Pseudo-Meigs syndrome with resulting papillary adenocarcinomas of the ovary and fallopian tube

The pseudo-Meigs syndrome is clinically important because it resembles metastatic pelvic cancer. However, the prognosis is much more favorable when the syndrome is associated with a benign tumor. The authors point out that a woman with this condition can expect full recovery after surgery.

Leukocyte migration enhancement as an indicator of immunologic enhancement. III. Common denominators of pregnancy and malignancy

Leukocyte migration enhancement (LME), a common denominator of pregnancy and malignancy, was investigated in order to determine the immunologic factors and processes involved in this in vitro assay. Reproducibility of results was confirmed by parallel investigations of single patients in an independent laboratory. Preliminary evidence also suggests that the phenomenon of LME is observable not only with the leukocyte migration assay, as performed in the present study, but also with the "indirect" migration inhibitory factor (MIF) assay. Highly significant correlation between results obtained with plasma (PL) and amniotic fluid (AF) was observed (p less than 0.00089). No significant correlation between LME and IgG concentrations as well as complement (C3) concentrations in AF and PL could be detected. C3 concentrations correlated significantly to gravity (p less than 0.007) and parity (p less than 0.003). No immune complexes were detected in either AF or PL samples. An unspecific protein effect as the cause of LME was ruled out in showing no significant correlation between LME and protein concentrations of AF and PL. A highly significant correlation between antigen concentration in PL and migration area was demonstrated (p less than 0.00001). It is suggested that leukocyte migration inhibition (LMI) represents a state of antigen excess, while LME represents antibody excess. Through selective removal of the IgG immunoglobulins LME could be converted into LMI, indicating an IgG subfraction as the responsible immunoglobulin in the phenomenon of LME.

Leukocyte migration enhancement as an indicator of immunologic enhancement. I. Pregnancy

Leukocyte migration studies with amniotic fluid (AF) were performed in 47 pregnant women and 24 control patients. Previous reports about the enhancing effect of AF on leukocyte migration during pregnancy were confirmed (p less than 0.003). No enhancing effect was observed with first-trimester leukocytes. Maximal enhancement occurred during the second trimester (p less than 0.0001). It decreased during the third trimester (p less than 0.01) and lost significance in the postpartum period (p less than 0.072). Fifteen pregnant and control patients were investigated with autologous plasma. Leukocyte migration enhancement (LME) was significant with pregnancy plasma (PL) (p less than 0.03). Again LME was the largest during the second trimester (p less than 0.006). It is concluded that an immunologically active factor is present in AF and PL which in term induces the enhancing activity of a predetermined effector cell subgroup. This process is absent in conjunction with male leukocytes and is lacking in the majority of patients with toxemia of pregnancy.

Common aspects of immunologic tolerance in pregnancy and malignancy

The fetoplacental allograft and the malignant neoplasm represent the only 2 biologic conditions in which antigenic tissue is tolerated by a seemingly intact immune system. Recent investigations in the fields of tumor and pregnancy immunology have resulted in the recognition of a variety of immunologic mechanisms which are common to both systems. These common denominators are reviewed and a thesis suggesting a common mechanism in the nonrejection of pregnancy and malignancy, based on the presence of embryonic antigens in both systems, is presented.

A blocking factor in amniotic fluid causing leukocyte migration enhancement

Amniotic fluid was found to cause significant leukocyte migration enhancement during the second and third trimester of pregnancy and in the early postpartum period when compared to the migration area obtained with an ovarian tumor homogenate antigen (p less than 0.01), choriocarcinoma spent medium (p less than 0.01), and placental pool homogenate (p less than 0.01). Only borderline significance (p less than 0.1) was obtained when migration enhancement with AF was compared between pregnant and nonpregnant female control patients, indicating minimal unspecific activity of AF. Migration enhancement with autologous amniotic fluid was slightly larger than with homologous amniotic fluid, but the difference did not reach significance (p less than 0.4). None of the control antigens caused migration enhancement; placental pool homogenate in concentrations above 4 mg. per cent caused migration inhibition but did not in lower concentrations. The enhancing effect of AF could be abolished by dilution but not by addition of excessive antibody to estrogen of HCG. It is suggested that a blocking factor is present in AF preventing recognition of fetoplacental antigen by the maternal immune system. Thus in vitro leukocyte migration enhancement may correlate to in vivo graft enhancement.

Carcinoid of the uterine cervix: a case report with light and electron microscopic studies

The case of a 33-year-old woman with primary carcinoid of the uterine cervix is reported. Primary carcinoid tumor is well known to occur in organs such as the gastrointestinal tract, lung and gonads. However, its occurrence in the uterine cervix is rare. To our knowledge, primary carcinoid of the uterine cervix has not been reported from the United States, although it has been well documented by non-American authors. Light microscopically, the tumor was characterized by formation of solid nests, trabeculae and glands. The cells therein showed argyrophil granules but were negative for argentaffin reaction. Electron microscopy revealed the presence of numerous neurosecretory granules and microfilaments. On the basis of light microscopic ultrastructural and cytochemical properties, the tumor is believed to arise from the normal argyrophil cell of the cervix and is regarded as an endocrine tumor, a member of the group of neoplasms called apudomas.

Familial malignant melanoma of the female genitalia: a case report and review

An additional case of familial occurrence of malignant melanoma is presented, involving mother and son. This is the fourth case of familial occurrence of malignant melanoma in the female genitalia and the first occurring in the vagina reported in the literature. We present a review of the literature concerning the hereditary property of malignant melanoma, including a list of all 92 families and 240 patients reported. The importance of a family history of malignant melanoma for the early diagnosis of this disease in relatives at risk is stressed.

Combination chemotherapy for ovarian carcinoma with cyclophosphamide, adriamycin, and cis-dichlorodiammineplatinum(II) after failure of initial chemotherapy

Twenty-four patients who had stage III or IV ovarian adenocarcinoma and had failed prior chemotherapy were treated with cyclophosphamide, adriamycin, and cis-dichlorodiammineplatinum(II) every 3 weeks. Twelve patients had objective responses and an additional six had subjective improvement. The median duration of survival for responders is 9 months. There were no instances of nephrotoxicity. Fluid management consisted of 1000-2000 ml of iv fluid without Lasix- or mannitol-induced diuresis. Patients responded after having failed radiotherapy or multiple-drug chemotherapy, including some who were 70-75 years of age or were greater than 50% bedridden. Patients with one- or two-drug prior chemotherapy had a higher response rate (ten responses among 17 patients) than those previously treated with three or more drugs (two responses among seven patients).

Treatment of advanced ovarian cancer with cis=dichlorodiammineplatinum(II): poor-risk patients with intensive prior therapy

Nineteen patients with advanced ovarian adenocarcinoma were treated with cis-dichlorodiammineplatinum(II) (DDP), 50 mg/m2 as an iv bolus once every 3 weeks. Prior treatment had exhausted other chemotherapeutic options or damaged the bone marrow sufficiently to contra-indicate treatment with standard drugs. All patients had evaluable tumors and evidence of failure of prior therapy. DDP produced objective responses, relieved symptoms due to tumor, and improved the patients' quality of survival. There were no serious hematologic complications due to therapy except anemia.