5-Fluorouracil, 4-epidoxorubicin, and mitomycin C (FEM) combination chemotherapy for advanced gastric carcinoma. A phase-II trial by the "chemotherapiegruppe gastrointestinaler tumoren (CGT)"

In a phase-II-trial 40 patients with advanced gastric cancer were treated with 5-fluorouracil, 4-epidoxorubicin, mitomycin C (FEM) combination therapy. Twenty-five out of 30 patients with measurable disease were evaluable for response after 8 weeks of treatment. Seven patients achieved a partial remission (PR), suggesting a response rate of 28%. Ten patients had no change (NC) and 8 patients showed progression (P). The median time to progression for patients with PR was 7.2 months and for patients with NC 6.3 months. Median survival time for all patients was 5.3 months, for patients with PR and NC 9.9 months. WHO grade 3 toxicity appeared in 3% (WBC and nausea/vomiting) and 15% (alopecia) of patients. The data suggest that this regimen is not more active, but is better tolerated than the original FAM schedule. Therefore it seems suitable for out-patient treatment, for elderly patients and for those who cannot be treated by more aggressive drugs.

Four systems develop regionally organized HMO

Plans to establish HealthPlus HMO, Inc.--a joint venture of the Sisters of St. Francis Health Services, Ancilla Systems, Daughters of Charity Health Systems-East Central, and Holy Cross Health System--began in 1984 with a feasibility study to assess the potential for an HMO in Indiana. Goals set by the four systems included protecting and expanding hospitals' market share and physicians' patient bases; establishing local HMO ownership; and providing health education, preventive care, and comprehensive treatment at affordable costs. During the organizational phase, participants created a 12-member board of directors with three representatives from each system, selected the name HealthPlus, and contracted with a management company to direct the HMO's planning and development phases. HealthPlus adopted a regional organizational structure, which allows financial risk to be shared among three regions, and a primary care physician model for the delivery of services. As of January 1987, the joint venture had 16 participating hospitals, 345 primary care physicians, more than 1,000 consulting specialists, and a membership of 13,100. HealthPlus now offers a triple-option product in partnership with a preferred provider organization and an insurance carrier and has developed non-health-related products with the insurance carrier as well.

Dose dependence of breath hydrogen and methane in healthy volunteers after ingestion of a commercial disaccharide mixture, Palatinit

Breath hydrogen and methane were determined by gas chromatography in eleven normal individuals given a low-fibre, mixed diet (control) and after ingestion of 20-50 g Palatinit/d, an equimolar mixture of D-glucosyl-alpha(1----1)-D-mannitol and D-glucosyl-alpha(1----6)-D-glucitol (Isomalt). A linear relation was found (r 0.85; P less than 0.001) between the amount of Palatinit ingested and breath H2 per 10 h in subjects who did not exhale methane. If methane was formed in addition to H2, the sum of both gases followed a linear dose-effect relation. The mouth-to-caecum time, indicated by the first increase in breath H2 after ingestion, was shortened by about half, yet no sign of diarrhoea was observed. Stool weight and stool frequency did not change significantly. The linear relation between a dose of 20-50 g Palatinit and exhalation of H2 (eventually plus methane) indicated that a relatively constant fraction of the dose given underwent cleavage and absorption in the small intestine, the remainder being transported into the large bowel. Microbial gas formation in the colon as well as the fractional transfer of these gases into the expiratory air occurred at fixed proportions, thus allowing an insight into colonic microbial contributions to carbohydrate utilization in the human large bowel.

Effect of Acarbose on the production of hydrogen and methane and on hormonal parameters in young adults under standardized low-fibre mixed diets

Short and middle term effects of Acarbose were studied in volunteers on a standardized, low-fibre, mixed diet for the development of tolerance phenomena with gas exhalations and some peptide hormone levels as main parameters. Both hydrogen and methane were measured quantitatively as diurnal profiles. Acarbose caused an about 20-fold increase of H2 exhalation and had only moderate effects on methane production, indicating the presence of fermentable carbohydrates in the large bowel. Methanogenic individuals exhaled significantly less H2 than did non-methanogenic subjects. Changes in blood glucose, serum insulin, GIP, gastrin, and plasma glucagon, caused by Acarbose, reflected delayed glucose absorption and were plausible within the regulatory framework of carbohydrate assimilation. When the Acarbose regime was maintained for 5 weeks on a controlled diet, abdominal sensations like e.g. meteorism declined remarkably while carbohydrate fermentation remained high and lowered GIP was sustained. Thus functional responses of the gastro-intestinal tract to altered carbohydrate supplies, elicited by Acarbose, were found by 3 independent parameters: anaerobic gas production, peptide hormone levels, and subjective abdominal sensations. The objective parameters seem to remain constant in the longer run, while subjective parameters show long-term adaptation.

[Accidents on circular bench saws (author's transl)]

For an expert opinion in a lawsuit regarding the suspicion of self-mutilation the physical data of an accident on a circular saw bench have been investigated. The result was as follows: The time required for severing a human forearm of 6 cm diameter is 40 to 80 ms depending on the feeding power. The impulse of 13 to 15 Ns necessary for severing an arm in only 1/10 to 2/10 of the impulse a slipping person exerts when striking the disk. The standard time data for such accidents indicated in the scientific literature are much too high.