Alteration of chemotherapy (cisplatin and 5-FU) and radiotherapy in the management of advanced or recurrent head and neck cancer: a phase II study

Between July '84 and July '85, 20 patients with very advanced or relapsing carcinomas of the upper aerodigestive tract were treated with polychemotherapy (cisplatin 20 mg/m2 days 1 to 5, and 5-fluorouracil 200 mg/m2 days 1 to 5, q. 3 weeks), alternated with radiation (3 split courses, 20 Gy each). Toxicity was moderate and in particular, mucositis and other relevant side effects including leukopenia, thrombocytopenia and nausea, were rare. Antitumoral activity consisted of nine complete responses and six partial responses (75% objective responses). Our conclusions are that cisplatin and 5-FU can be alternated with radiation with acceptable toxicity. The treatment has shown interesting antitumoral activity. Its role in cancer management must be investigated with controlled clinical trials.

Decreased beta-adrenergic sensitivity in insulin-dependent diabetic subjects

To study beta-adrenergic sensitivity in diabetes mellitus, we performed isoproterenol sensitivity tests in 34 insulin-dependent diabetic patients and 10 age-matched normal subjects. beta-adrenergic sensitivity [defined as the dose of isoproterenol required to increase the resting heart rate by 25 beat/min, (I25)] was significantly higher in the diabetic group (4.07 +/- 1.4 micrograms, mean +/- SD) than in the normal group (2.02 +/- 1.49 micrograms). A comparison of I25 of normal subjects and diabetic patients as a function of age showed that the latter were significantly less sensitive to beta-adrenergic stimulation at all ages (P less than 0.01). In diabetic patients, beta-adrenergic sensitivity also increased with the duration of diabetes (r = 0.64, P less than 0.0005), but the correlation was stronger when the age of the patients and the duration of the diabetes were both taken into consideration (r = 0.72, P less than 0.0005). We conclude that beta-adrenergic sensitivity is diminished in patients with type I diabetes mellitus of all ages.

[Exploration of left ventricular function in insulin-dependent diabetics (relation with retinopathy)]

Non invasive methods for the exploration of myocardial function permit the demonstration of preclinical diabetic cardiomyopathy. In this study, we have tried to define the relationship between the degree of diabetic retinopathy and the presence of myocardial dysfunction. We have recorded echocardiogram and phonomechanograms on thirty two insulin dependent diabetics (IDD) less than 50 years of age, without evidence of arteriosclerosis. All patients had a normal baseline electrocardiogram and a normal bicycle exercise test. These diabetics were assigned to three groups: I = no retinopathy (9 patients); II = minimum retinopathy (12 patients); III = marked retinopathy (11 patients). They were compared to ten non-diabetic control subjects of similar age (group 0). None of the parameters of systolic function was modified in the different groups of diabetics in comparison with the control group. We found, however, a very significant reduction of the maximum rate of enlargement of left ventricule and reduction of the maximum narrowing rate of the left ventricular posterior wall during the protodiastolic period in group III, v.s. group 0, I and II. Group III contained 3 patients with borderline hypertension and 5 patients with diabetic glomerulopathy. Our results indicate a diminution of myocardial compliance and relaxation in those IDD with marked retinopathy, but it raises the question of the role of borderline elevations of arterial pressure or hypertension during physical exercise, which are frequently found in diabetics with retinopathy in causing these abnormalities.

[Role of the polyol pathway in the occurrence of degenerative complications of diabetes]

The activity of the polyol pathway--a non insulin-dependent metabolic pathway of glucose--is increased in diabetic patients. Polyol accumulation is involved, by a myoinositol-dependent mechanism, in the pathogenesis of some degenerative complications of diabetes. Thus, sorbitol accumulation in the eye lens and in nerves seems to be an important factor in the development of cataract and in the slowing down of nerve conduction. Recent studies suggest that the polyol pathway may play a role in early structural abnormalities of retinal and renal microangiopathy. Synthetic aldose reductase inhibitors could be used for a physiopathogenic treatment of these complications, but the first trials in diabetic neuropathy proved disappointing. Further studies, prolonged and well controlled, are necessary to pronounce on the future of this new category of drugs.

[Blood glucose and insulin secretion after meals rich in simple and complex carbohydrates, in non-insulin-dependent diabetics]

In 10 well controlled non insulin-dependent diabetics, 25 g of complex sugars were replaced by the same amount of simple sugars in each of two isocaloric meals identical in their lipid, protein and carbohydrate contents. This had no detrimental effect on postprandial glycaemic and insulin responses. There were no statistically significant changes in areas under the curve and kinetics of glycaemic, insulin and peptide C responses after ingestion of limited amounts of simple sugars. It appears from these results that well controlled, non insulin-dependent diabetic patients without marked postprandial fluctuations in glycaemia (as confirmed by self-performed capillary blood tests) can be authorized to take 25 to 40 g of simple sugars (preferably fructose) during meals.

Combined polychemotherapy and radiotherapy in advanced inoperable squamous cell carcinoma of the head and neck

Between August 1979 and August 1984, 46 untreated, inoperable patients with advanced squamous cell carcinoma of the head and neck were submitted to a combined modality of treatment based on four courses of polychemotherapy (vincristine, bleomycin, and methotrexate), rotated with three courses of radiotherapy, 20 Gy each. Forty-six patients entered the study: 45 were evaluable for their response to the treatment and 46 for toxicity effects. We observed 26 complete responses (57.7%) and 14 partial responses (31.1%); overall actuarial survival was 28% at 55 months. Mucositis occurred in 11 patients, 3 patients suffered from nausea and vomiting, 2 patients developed fever, and 1 had a platelet count of 50,000/mm3. One toxic death occurred: one patient developed an acute renal failure related to Methotrexate.

Phase I-II trial with cisplatin and 5-FU in recurrent head and neck cancer: an effective outpatient schedule

Thirty patients with squamous cell carcinoma of the head and neck were treated with a combination of cisplatin (20 mg/m2) and 5-FU (400-200 mg/m2) by iv push on Days 1-5 every 21 days. All patients but two had relapsed disease. Twenty-seven patients were evaluable for response: there were four complete responses and 12 partial responses (objective response rate, 59.2%). The response rate falls to 53.3% if it is calculated on the total number of patients entered. Twenty-seven patients were evaluable for toxicity: myelosuppression occurred in ten patients (37%), while renal toxicity, nausea and vomiting, and stomatitis were quite rare and moderate. These results look encouraging and suggest the need for further studies.

Antidiuretic hormone response to volume depletion in diabetic patients with cardiac autonomic dysfunction

Thirty-three insulin-dependent diabetic patients were separated into two groups from the results of three different tests for cardiac vagal neuropathy: heart rate response to deep breathing, Valsalva manoeuvre and heart rate response to postural change. Seventeen patients were considered as without ('intact' patients) and 16 as with ('denervated' patients) cardiac autonomic dysfunction. One patient with a transplanted heart was also studied. Plasma antidiuretic hormone (ADH), plasma aldosterone and plasma renin activity (PRA) were measured immediately before and 60 min after intravenous administration of frusemide and passage from lying to standing. The kinetics of hormonal responses were analysed more precisely (five blood collections) in six patients of each group who were studied again. Heart rate and blood pressure were recorded before each blood collection. Volume depletion estimated from the rise in plasma protein (+ 11.9 and + 12.2% in 'denervated' and 'intact' patients respectively) and heart rate response (+ 1.06 and + 14.7%) were similar in both groups. Mean blood pressure was unchanged in the 'intact' patients whereas it fell in the 'denervated' patients (-13.5%). PRA (+ 161.5 and + 231.2% in 'denervated' and 'intact' patients respectively) and plasma aldosterone (+ 318.2 and 279%) increased in both groups whereas plasma ADH was stimulated only in 'intact' patients (+ 55.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Granulomatous histiocytosis in a 70-year-old woman, revealed by prolonged fever ; osseous lesions in the femur and tibia were associated with diabetes insipidus and hypernatremia (author's transl)]

The different patterns of histiocytosis X are usually classified into three forms according to their clinical and pathological expression. One form is acute and disseminated ; the two others are chronic, unifocal or multifocal. Borderline cases and intermediate forms can be seen. For instance, onset can be acute or subacute in chronic disseminated forms, such as Hand-Schüller-Christian disease ; acute or subacute exacerbations may occur during the course of the disease. We report an observation of this type which is remarkable for three reasons. Fever was the initial manifestation and remained apparently isolated for one year. Subsequent osseous involvement was limited to the femur and tibia. Hypernatremia developed as a result of both diabetes insipidus and disrupted thirst control. These unusual features of our case-report led us to review previously published data.

[Inclination of the visual field and postural deviations induced in CD1 mice. 2]

The effect of conflicting visual and kinesthetic information on body position in the mice has been investigated. Riess et al. (1950) reported that rats posture was different for 10 degrees to the right us. 10 degrees to the left inclination of the visual field. Neither this nor other effects on body position were observed submitting random breed mice to a similar procedure suggesting that a cognitive difference exists between the two species.

[Vertical discrimination in a pure strain of mice (DBA). I]

With the perspective of developing a model of field dependence in small mammals, 10 DBA mice were tested for their ability to choose between a vertical and 25 degree tilted alley in a tridimensional maze. Results have shown that when alternative strategies are prevented, mice have considerable difficulty in discriminating verticality on the basis of kinesthetic and visual cues.

[Comparative evaluation of several methods of determining anti-streptolysin O]

The Authors have carried out some experiences on four tests for the detection of anti O streptolysin, determining in 210 samples of sera: 1. the antistreptolysin titer according to Rantz and Randall; 2. the antistreptolysin titer according to the latex reaction; 3. five different antistreptococcal antibodies (ASO, ASK, ASHA, ADN-aseB, NAD-ase) with a rapid multi-purpose test for a simultaneous detection; 4. the antistreptolysin titer according to Aso Quantum method. The results obtained on the 210 samples of sera were compared. The relationship between the four methods were examined.

[Infections and immunosuppressive agents in rheumatology]

The authors review the problem of infection occurring in patients with chronic inflammatory rheumatism, e.g. rheumatoid arthritis, and lupus erythematosus, treated with cytolytic drugs for immunodepressive reasons. From their investigation, it seems that there is a high frequency of bacterial and mycotic and viral infections in these patients, but controlled investigations seem to show quite definitely that the frequency of these infections depends on the disease itself. The risk does not seem to be increased by cytolytic drugs. The only exception is herpes which appears in 10 to 20% of patients treated with immunosuppressive agents, as against 2% in a controll series. The other virus diseases did not have an abnormally high frequency. The conclusions are, of course, only of value for the types of treatment used in rheumatology.