[Is there an indication for adjuvant or neoadjuvant systemic therapy in prostate cancer?]

In the meantime prostate cancer has become the most common malignancy in the male population. Due to the shift in age at the time of first diagnosis in favour of younger men with a high life expectancy and a maximum of physical and sexual activity it would be desirable to have neoadjuvant or adjuvant therapy concepts at hand which lead to an improvement of therapeutic success. So far the results of studies for adjuvant and neoadjuvant hormonal ablation therapy concepts have not led to a clear therapeutic reference. Only before radiation therapy is neoadjuvant hormonal ablation a standard part of therapy at most centres. Existing data for chemotherapeutic concepts are limited to androgen-independent advanced prostate cancer. An international study using docetaxel as an adjuvant drug is currently being performed, but the results are not yet available.

[Does cigarette smoking influence the survival of patients with prostate cancer?]

In the last few years, prostate cancer has become one of the most common causes of mortality worldwide. It is therefore important to detect possible risk factors for this malignant disease. Besides risk factors which increase incidence, attention should be paid to factors which have a possible influence on the course of the disease. In our analysis, we demonstrate a worse course for the disease in patients with prostate cancer who smoked cigarettes at the time of first diagnosis. In spite of comparable staging, grading and PSA values at the time of primary diagnosis, individuals who smoked had a threefold higher risk of dying from prostate cancer. This effect is probably caused by metabolic changes which are activated by cigarette smoking and promote tumor growth and the development of metastases.

Einsatz der Siliziumchiptechnologie zur Detektion von Tumormarkern auf Proteinbasis beim Harnblasenkarzinom

The protein structure of human tumor tissue has a significant influence on the molecular attributes. It was demonstrated that the individual prognosis of tumor patients is among other things dependent on molecular tumor tissue characteristics.A promising marker is E-cadherin, an adhesion glycoprotein which plays a central role in the mediation of cell-cell contacts. Aberrant E-cadherin expressions were described in several tumors such as in bladder cancer. This was also found to be correlated with tumor invasion and survival. There are hardly any fast, quantitative and easily automated protein assays in everyday practice which can analyze several markers at the same time. With silicon chip technology we have a new detection and measurement method which makes it possible to give a quantitative analysis of numerous different proteins in tissue, urine, or serum in a few minutes.

Immuntherapie des metastasierten Nierenzellkarzinoms mit Interleukin-2, Interferon-α2a und Erythropoetin-β

BACKGROUND

The combination of interferon-alpha2a (IFN-alpha2a) and interleukin-2 (IL-2) induces objective responses in patients with metastatic renal cell carcinoma (MRCC). Anaemia is associated with poor cancer control and reduced quality of life. The aim of the study was to investigate response rate and quality of life in patients with MRCC receiving the combination of Erythropoetin, IFN-alpha2a and IL-2.

MATERIAL AND METHOD

Patients with MRCC received epoetin beta (150 IU/kg and haemoglobin <130 g/l or 75 IU/kg and haemoglobin >or=130 g/l) three times weekly, from 14 days before and continuing throughout immunotherapy. In weeks 3-6 the patients received IFN-alpha2a 6 x 10(6) IU/m2 and IL-2 4.5 x 10(6) IU/m2 three times weekly on days 1, 3 and 5. The treatment was repeated two times and in the case of success a third cycle was added. The quality of life was assessed with the FACT questionnaire for fatigue, before, during and after therapy.

RESULTS

A total of 21 patients were treated, 19 of whom could be evaluated concerning response, toxicity and quality of life. We observed 1 complete remission, 2 partial remissions, 5 cases of stable disease and 11 with progressive disease. The overall response rate was 16%. Toxicity was mild to moderate; there were no WHO grade III or IV toxicity. The quality of life increased in ten patients, nine of whom exhibited an increase in their haemoglobin during therapy. Five of the nine patients with decreased quality of life also experienced a decrease in their haemoglobin. The correlation of increased haemoglobin and quality of life was significant (p<0.05).

CONCLUSION

The combination of IFN-alpha2a, IL-2 and epoetin beta resulted in objective remissions with mild to moderate toxicity. The quality of life correlates significantly with increasing haemoglobin.

[Nutrition, lifestyle, physical activity, and supportive care during chemotherapeutic treatment]

With improvements in cancer survival rates, more patients with cancer are living longer and the influence of nutrition, lifestyle, physical activity as well as supportive care during and after chemotherapy is of increasing interest. In several malignancies smoking cessation increases cancer survival. Similar effects are expected by healthy nutrition. Regular physical activity of cancer patients reduces drug interactions of chemotherapy, decreases the number of comorbid conditions, and helps patients maintain independence as long as possible. For supportive care during chemotherapy the 5-HT3 receptor antagonists are more effective for the prevention of chemotherapy-induced nausea and vomiting. There are several colony-stimulating factors (e.g. GCSF, erythropoietin) for hematopoietic recovery post-chemotherapy. Altogether supportive care of chemotherapy reduces toxicity and increases efficacy.

Was muss ich praktisch bei der Umsetzung einer Chemotherapie beachten?

The patient stands at the center of a chemotherapy. The aim of the curative or palliative treatment is not only the death of the tumor cells, but also the maintenance or improvement of the patient's physical condition, especially the improvement of quality of life. Before starting the therapy, it is necessary to determine, for example, the patient's general condition and motivation, and to carry out a consultation. Examinations, for example, blood tests, audiograms, renal function and lung function should also be made. Thus, the patient's tolerance for even the most onerous chemotherapy can be investigated and patients can be individually prepared for the treatment.

Protective effect of group I metabotropic glutamate receptor activation against hypoxic/hypoglycemic injury in rat hippocampal slices: timing and involvement of protein kinase C

Excessive release of glutamate during ischemia leads to sustained neuronal damage. In this study we investigated the influence of metabotropic glutamate receptor (mGluR) activation on neuronal recovery from a hypoxic/hypoglycemic event in hippocampal slices from rats. The slices were transiently exposed to an oxygen- and glucose-free environment in an interface chamber and the synaptically evoked population spike in the CA1 region was taken as a measure of neuronal viability. Under control conditions the population spike amplitude recovered to 41.4% of baseline value within 1 h after hypoxia/hypoglycemia. The specific mGluR group I agonist 3,5-dihydroxyphenylglycine (DHPG, 10 microM) increased the recovery rate to 88.3% of baseline value when applied from 20 min before until 10 min after the event. Similar recovery rates were obtained when DHPG was present only 10 or 20 min before hypoxia/hypoglycemia (89.3% and 79.3% of baseline value, respectively). However, when applied later, DHPG had no protective effect. Co-application of the protein kinase C (PKC) inhibitors staurosporine (100 nM) or chelerythrine (30 microM) prevented the protective effect of DHPG. Our data suggest that group I mGluR agonists are only protective when present prior to the onset of the hypoxic/hypoglycemic event and that the activation of PKC is a critical step of the protective mechanism.

Analysis of the tetanic and post-tetanic components of intradendritic Ca2+ signals in hippocampal CA1 neurons

The importance of both the activation of second messenger cascades and an increase of the intracellular Ca2+ concentration for the induction of synaptic plasticity in hippocampal CA1 neurons is well established. Using the dye Calcium Green-1, we analysed the Ca2+ increases evoked by different 100-Hz tetanization paradigms commonly used to induce long-term potentiation. We found that the normalized total area of fluorescence intensity changes (F/F0) was correlated with both the strength and the duration of tetanization. Furthermore, the normalized area of fluorescence intensity changes during the time of tetanization (tetanic component) correlated strongly in a linear manner with the tetanization duration. Moreover, the tetanic component strongly determined the area of the post-tetanic Ca2+ signal. Interestingly, the normalized relationship of the post-tetanic Ca2+ signal to the total Ca2+ change decreased with prolonged tetanizations. In contrast, with an increased stimulation strength, a positive correlation of the relationship of the post-tetanic component to the total amount Ca2+ could be obtained. The time constants of the Ca2+ extrusion depend linearly on both the tetanization duration and the amount of the tetanic Ca2+ signal. Our data demonstrate that augmenting the stimulation strength leads to a respective increase of the post-tetanic Ca2+ portion within the total Ca2+ signal, whereas a prolongation of the tetanization duration does not. Thus, no further significant prolongation of the Ca2+ signal occurs during increased durations of tetanization.

When are class I metabotropic glutamate receptors necessary for long-term potentiation?

The involvement of metabotropic glutamate receptors (mGluRs) in hippocampal long-term potentiation (LTP) is a matter of controversial debate. Using [Ca2+]i measurements by confocal laser scanning microscopy and field recordings of EPSPs (fEPSPs) in the hippocampal CA1-region, we found that the efficacy of the broad-spectrum mGluR-antagonist (S)-alpha-methyl-4-carboxyphenylglycine (MCPG) and of (S)-4-carboxy-phenylglycine (4-CPG), a selective antagonist at class I mGluRs, in LTP is contingent on the tetanization strength and the resulting [Ca2+]i response. As indicated by experiments in which we blocked voltage-dependent calcium channels (VDCCs) and intracellular Ca2+ stores (ICSs), the functional significance of class I mGluRs in LTP is confined to certain types of potentiation, which are induced by weak tetanization protocols and require the release of Ca2+ from ICSs for induction. During strong tetanic stimulation, this Ca2+ source is functionally bypassed by activating VDCCs.

Forty years' experience with a special, non-tumorous application of radiotherapy for the eye

This paper recapitulates experience made over 40 years with a special nontumorous radiotherapy for the eye. Following a review of the development of therapy, which began with the pendular convergence x-ray machine and later changed to the linear accelerator, an overview is presented of the most important indications for the safe use of x-rays in exudative inflammatory processes in the posterior segment of the eye. We show that in many cases radiotherapy can achieve a permanent improvement for years or at least the preservation of the status quo, while also protecting the important visual cells, especially if it is administered at the earliest possible stage alone. However, it is even more effective in combination with retrobulbar injection therapy that is adjusted individually. Statistics on the results in cases of disciform macular degeneration, doubtlessly the most frequent indication for non-tumorous radiotherapy in the eye, exemplify its efficacy.

Endogenous noradrenaline impairs the prostaglandin-induced inhibition of noradrenaline release

The effects of prostaglandin E2 (PGE2) on electrically evoked noradrenaline release in rat brain cortex were studied under conditions under which autoinhibition of release was avoided. When stimulation was carried out with 36 pulses at 3 Hz, 1 mumol/l PGE2, produced about 50% inhibition of release. In the presence of the alpha 2-adrenoceptor antagonist yohimbine (1 mumol/l) the effect of PGE2 was markedly increased. When release was elicited by 3 pulses/100 Hz the period of stimulation was too short to permit development of autoinhibition by released noradrenaline. Then the concentration-response-curve for PGE2 was very similar to that obtained under the above conditions (36 pulses/3 Hz, in the presence of yohimbine). These data suggest that both the alpha 2-adrenoceptor and the PGE2-receptor are linked to a common pathway. Since indometacin (10 mumol/l) did not enhance evoked transmitter release, an influence of endogenous PG's on in vitro release of noradrenaline from rat brain cortex slices can be excluded.

[Preoperative localization of myocardial areas requiring revascularization in coronary artery disease (author's transl)]

At the time of preoperative coronary angiography in 44 patients left ventricular angiograms immediately after high frequency stimulation and after administration of nitroglycerin were performed. For interpretation we used the shortening (in percentage) of 8 vertical semi-diameters and of longitudinal axis in biplane angiograms. The data found in 15 healthy persons were used for comparison. Looking at the rate of shortening after high frequency stimulation myocardial areas endangered by hypoxia could be unmasked. By giving nitroglycerin thereafter we were able to differentiate between reversibly and irreversibly damaged areas. In 7 patients this has already been proven by postoperative examination. In preoperatively reversibly damaged myocardial areas no hypokinesis could be observed any more after successful revascularization. In contrast there was no improvement seen in preoperatively irreversibly damaged areas in spite of graft patency. The described preoperative angiography-test allows: 1. to unmask myocardial areas endangered by hypoxia. 2. to differentiate preoperatively between reversibly and irreversibly damaged areas. 3. more precise indication as well as better control of the results of revascularization.