A stereospecific synthesis of oxazolinyloxiranes

Lithiooxiranes 3a and 3b, generated by deprotonation of oxiranes 2a and 2b with s-BuLi at -100 degrees C in Et(2)O, were found to be chemically very stable. trans-Lithiooxirane 3a was also configurationally stable and reacted stereospecifically with electrophiles to give 4a--k. In contrast, cis-lithiooxirane 3b was found to be configurationally much less stable and reacted with electrophiles affording mixtures of diastereomers 4, 7, and 8. After only a very short reaction time, 3b too reacted with electrophiles highly stereospecifically. Deprotonation--deuteration and deprotonation--alkylation of chiral oxazolinyloxiranes 12a and 12b to give oxiranes 12c and 12d were also examined. Semiempirical and ab initio calculations were carried out in an effort to explain the observed stereochemistry.

Results of a low aggressivity chemotherapy regimen (CVP/CEB) in elderly Hodgkin's disease patients

BACKGROUND

Hodgkin's disease (HD) after the age of 65 years is uncommon and there are no published data on chemotherapy regimens devised for elderly HD patients.

PATIENTS AND METHODS

From 1990 to 1993, 25 elderly HD patients were treated with the CVP/CEB regimen: chlorambucil 6 mg/sqm p.o. days 1 through 7, vinblastine 6 mg/sqm i.v. on day 1, procarbazine 100 mg/sqm p.o. days 1 through 7, prednisone 30 mg/sqm p.o. days 1 through 7, cyclophosphamide 500 mg./sqm i.v. day 15, etoposide 70 mg/sqm i.v. day 15, bleomycin 10 mg/sqm i.v. day 15. Each course was repeated every 4 weeks. Stage I and II patients were treated with 3 courses followed by involved field radiotherapy, while more advanced stage patients received 6 courses and radiotherapy was limited to bulky areas. The results of the CVP/CEB regimen are retrospectively compared to those of 74 elderly patients treated between 1982 and 1989 and subdivided into the following 2 groups: 32 patients treated according to the same therapy used at that time in younger patients, and 42 patients given alternative low aggressivity or palliative treatment.

RESULTS

CVP/CEB is a well-tolerated regimen, with only 1 (4%) toxic death and 2 (8%) protocol violations/interruptions. The CVP/CEB complete remission rate (73%) compares favorably with our previous groups of patients, mainly because of the lower toxic death rate. However, the CVP/CEB relapse-free survival rate is lower than that of patients treated with more aggressive conventional regimens (47% vs. 77%, p < 0.02). The CVP/CEB overall survival and event-free survival rates are 55% and 32%, respectively, and they are not statistically different from those of patients treated before 1990.

CONCLUSIONS

CVP/CEB is a well-tolerated low toxicity regimen with a high CR rate. The relapse rate is high and event-free survival is comparable to that of patients treated conventionally. Our results suggest the need for individualized treatment criteria for older patients with HD.

Renovascular hypertension: a non-invasive Duplex scanning screening

A Duplex-Scanner was used to screen 62 patients with severe hypertension, queried renovascular. Ten results were technically unsatisfactory and in the remaining 52 highlighted flow alterations in the renal arteries of 29 patients were found. Control angiographies confirmed renal artery stenosis in 27 cases. Comparative statistical analyses proved the test to be both highly sensitive and specific, considering other screening methods currently used in diagnosing renovascular hypertension--which include endovenous digital subtraction angiography. Results confirmed the Duplex-Scanner as a reliable renovascular hypertension screener as well as being a non-invasive method with no potentially toxic effects.

[Budd-Chiari syndrome. Description of 2 cases]

The causes of Budd-Chiari syndrome are quickly reviewed with reference to the pathology described in series from various parts of the world. In the West the syndrome is caused by obstruction of the Inferior Vena Cava in its retrohepatic course with or without concomitant obstruction of the suprahepatic veins attributable to fibrous regression of the vessel wall and subsequent endoluminal thrombosis. In the Far East and South Africa the syndrome is caused by the presence of a thin fibrous septum obstructing the vein immediately upstream of the right atrium. Of the two cases of Budd-Chiari syndrome described, one presented high grade stenosis of the Vena Cava caused by fibrous regression of the vessel wall and the other a fibrous septum situated transversally to the lumen. The description of the first case is particularly interesting because before the clinical picture was correctly understood, a succession of major complications induced incorrect diagnosis and treatment. In contrast the second was a classic case of rapid diagnosis and successful treatment. The discussion of the two cases highlights the primary role currently played by abdominal echography with Doppler ultrasound, examination with lower cavography using a contrast medium in documenting a caval flow pathology of this kind. CAT scanning, arteriography of the Celiac tripod and closed hepatic needle biopsy appear to be much less decisive.

Echo-Doppler velocimetry in the diagnosis of renal artery stenosis on transplanted kidney

Renal artery stenosis is one of the most important complications in the natural history of kidney transplantation. Particular care has to be taken in the use of angiography techniques because of the invasiveness and of the potential toxicity of radiopaque contrast material, even in the less invasive radiological tests, like endovenous sequential angiourography with image subtraction (SAU) and digital subtraction angiography (DSA). Fifty-one patients have been examined with echo-Doppler velocimetry (EDV) and also with SAU in order to verify the previous status of the artery. EDV exhibits a 100% sensitivity: all SAU detected stenosis have been formerly identified via EDV. The non-invasiveness and possibility of early repetition allows an early diagnosis capability for all transplanted patients. In this way, a surgical intervention may quite often be prevented by a precocious use of endoluminal angioplasty.

[Changes in the in vitro antibody formation in B lymphoproliferative diseases]

Peripheral blood mononuclear cells from three patients with multiple myelomas (M.M.), four patients with Essential Mixed Cryoglobulinaemia (E.M.C.) and four normal adults as controls were cultivated with or without poke weed mitogen (PWM); in vitro immunoglobulin (Ig) production was measured after seven days using the enzyme-linked immunosorbent assay method (ELISA). No significant differences in Ig production were noted between patients and controls: E.M.C. patients, on the other hand, displayed considerable spontaneous IgM production (without appreciable differences, however, between spontaneous and PWM-stimulated production). M.M. patients, on the other hand, displayed only scanty spontaneous IgM production and in two cases the PWM response was completely lacking. These results were then integrated and correlated with a parallel study of similar groups of patients and controls carried out with the aim of investigating modifications in the distribution of B and T lymphocyte subpopulations. Possible interpretations of the results are discussed.