Memory and psychomotor impairment following high-dose interferon treatment in amyotrophic lateral sclerosis

Patients with amyotrophic lateral sclerosis were treated with high-dose intravenous infusion of human leukocyte interferon for six days. Neuropsychological examinations were carried out before, during and after the treatment. Marked reversible dysfunction was detected in immediate memory functions, coordination of hand movements, and drawing. Motor perseveration, micrographia, and slowing of behaviour were also observed. Changes appeared four to 12 days after start of treatment, with the peak on days six to eight. Recovery was almost complete by day 15. Intellectual ability, as measured by three WAIS subtests, praxis of hand movements, visuognostic functions, speech, reading, writing, and calculation remained essentially unaffected. The profile of the neuropsychological deficits observed, the absence of defects typical of focal posterior cortical lesions, the simultaneously slowed electroencephalographic activity with frontal accentuation, and the increased central conduction times of brain stem auditory evoked potentials suggest frontobasal involvement.

A cross-over comparison of nabilone and prochlorperazine for emesis induced by cancer chemotherapy

An anti-emetic drug, nabilone, a synthetic cannabinoid, has been compared with prochlorperazine in 24 lung cancer patients receiving cancer chemotherapy. Each of the drugs studied was given orally every 12 hours, starting the night before chemotherapy, during one of two consecutive identical chemotherapy cycles in accordance with a double-blind cross-over random order assignment. Single doses were 2 mg of nabilone, or 15 mg of prochlorperazine. The chemotherapeutic regimens given included the following drugs in various combinations: cis-platinum, vincristine, cyclophosphamide, adriamycin, vindesine, and etoposide (VP16). Nabilone was significantly superior to prochlorperazine in the reduction of vomiting episodes. Side effects, mainly vertigo, were evident in nearly half of the patients after nabilone, and three patients were withdrawn from the study due to decreased coordination and hallucinations after nabilone. Side effects from prochlorperazine were limited to mild drowsiness in one patient. Two-thirds of the patients preferred nabilone to prochlorperazine. We conclude that nabilone is a moderately effective anti-emetic drug, but that the unpredictability of its side effects call for careful patient information, especially with elderly outpatients. We recommend that at least after the first dose of nabilone, the patient should be kept under close observation during 4 hours.

Human leukocyte interferon as part of a combined treatment for previously untreated small cell lung cancer

Human leukocyte interferon, HuIFN-alpha (LE), has been tested in combination with radiotherapy and chemotherapy for previously untreated small cell lung cancer. Nine patients with limited disease received high-dose IFN followed by a low-dose regimen; and six patients had a low-dose regimen from the beginning. The high dosage of IFN consisted of 800 X 10(6) IU given as a continuous intravenous infusion for 5 days, followed by 6 X 10(6) IU i.m. three times weekly. If the first site of disease progression was local or in a central nervous system location, radiotherapy (55 Gy/20 F/7 weeks locally and/or 30 Gy/10 F/2 weeks whole brain) was applied and IFN was continued. Chemotherapy was administered only if there was disease dissemination outside the chest. Three patients achieved minor response for as long as 20, 25, and 42 weeks, respectively, with IFN alone. Three of five complete responders to IFN-radiotherapy died 18, 33, and 41 weeks from the start of IFN treatment without chemotherapy. Autopsy did not reveal macroscopic or microscopic tumor at any site, but there was severe radiation pneumonitis. Four of nine patients were administered chemotherapy subsequent to IFN-radiotherapy because of disease dissemination. The median length of survival of the entire group was 41 weeks. On the low-dose regimen, one patient achieved partial response with IFN alone (duration, 12 weeks); of five evaluable patients three achieved complete remission and two partial remission to IFN-radiotherapy, and one of the three complete responders to IFN-radiotherapy died of severe radiation pneumonitis at 21 weeks from the start of IFN treatment. No tumor was detected at autopsy. The study is in progress. Average survival at present is 33 weeks. The results derived from both our studies suggest a growth-delaying effect of HuIFN-alpha (Le) on small cell lung cancer. They also suggest potentiation of radiation by HuIFN-alpha (Le). Memory and psychomotor dysfunction, fatigue, and anorexia were dose limiting with both short-duration, high-dose and long-duration, low-dose IFN therapy. We feel that IFN, as part of a combined multimodality treatment of small cell lung cancer, may play a role by delaying metastatic dissemination.

Bretylium in hypothermia-induced ventricular fibrillation in dogs

We undertook a study to determine the ability of intravenous bretylium to cause "chemical defibrillation" or facilitate electrical defibrillation of hypothermia-induced ventricular fibrillation in the dog. Two groups of ten dogs were cooled to 22 C and placed into ventricular fibrillation. Following initiation of cardiopulmonary resuscitation, bretylium 15 mg/kg or normal saline was administered and the dogs were defibrillated according to a standard protocol. Both groups were equivalent in mean arterial pressure and arterial blood gases throughout the investigation. Seven dogs in each group were converted from ventricular fibrillation to an organized cardiac rhythm (P greater than .05). Despite the possible value of prophylactic bretylium in the setting of hypothermia, its use as active treatment for hypothermia-induced ventricular fibrillation in dogs does not seem to be beneficial.

Complications of treatment of small cell carcinoma of the lung

Improvements in therapy for small cell carcinoma of the lung have been achieved with treatment regimens that result in significant toxicity. The workshop of the International Association for the Study of Lung Cancer focused on the following complications of chemotherapy and radiotherapy: leukopenia and resultant infections, esophagitis, pneumonitis and pulmonary fibrosis, cardiac toxicity, second malignancies, neurologic complications, and psychosocial effects. The data regarding the incidence and management of these complications are briefly reviewed, and recommendations for further studies are noted.

Mild intravasal haemolysis associated with flu-syndrome during intermittent rifampicin treatment

Sixteen patients were given high-dose intermittent rifampicin treatment (900 mg twice weekly) in order to record side-effects of the flu-type. Three patients who experienced a febrile reaction were re-challenged under strict hospital supervision with a single dose (900 mg) of rifampicin. Two patients showed a distinct febrile response together with rapidly subsiding symptoms typical of the rifampicin-induced flu-syndrome, whereas the third patient's reaction was clinically different. During the challenge, the changes in a number of laboratory tests were indicative of a mild haemolytic reaction in the two patients with flu-syndrome. Plasma haemoglobin steeply increased within a few hours following the ingestion of the dose. This was associated with an acute increase in the total bilirubin and with a gradual decrease in the blood haemoglobin and haematocrit values. In further support of a drug-induced haemolysis was the findings that both patients showed a distinct reticulocyte response several days after the challenge. No such changes were seen in the third patient, whose reaction was later demonstrated to be related to isoniazid. The flu-syndrome thus may represent a first warning sign of intravasal haemolysis, which, if massive enough, eventually could lead to haemolytic crises and renal failure.

Comparison of ketotifen, disodium cromoglycate and placebo in the treatment of adult patients with mild extrinsic asthma

Sixty-four patients with mild of moderate extrinsic asthma were treated with placebo for 1 month and thereafter with ketotifen (1 mg twice daily, orally), disodium cromoglycate (inhalation of 20 mg, four times daily), or placebo for 2 subsequent months. The trial was performed at four different centres and the treatments were compared using double-blind technique. We found no difference between the effect of ketotifen, disodium cromoglycate and placebo on the patients' daily measurements of evening peak expiratory flow, daily score values or respiratory symptoms of the number of salbutamol puffs required to control symptoms. There was no difference between the treatment groups with regard to the patients' estimates of changes in airway sensitivity to different non-specific stimuli: fumes, tobacco smoke, cold air, and exercise. The only significant effect of DSCG was a minor (4%) increase in the mean morning value for peak expiratory flow. The findings suggest that the addition of ketotifen or disodium cromoglycate to the regimen is unlikely to give further benefit in asthmatic patients, whose symptoms are reasonably well controlled by small doses of bronchodilating drugs.

Prognostic value of doubling time in lung cancer

The volume doubling time (DT) of 27 measurable primary pulmonary carcinomas was calculated. The prognostic value of the DT was analysed in relation to survival, age, initial size of the tumour, histology, duration of symptoms, and treatment. The survival was longest in slow-growing carcinomas. Small-cell carcinomas and other anaplastic carcinomas had the shortest DT. A close correlation was found between DT, survival, and Feinstein's symptom-staging.

A controlled study on the preventive effect of ketotifen, an antiallergic agent, on methacholine-induced bronchoconstriction in asthmatics

We studied the preventive effect of ketotifen, an oral drug with antianaphylactic and antihistaminic properties on methacholine-induced bronchoconstriction in controlled cross-over experiments in twenty-six adult patients with extrinsic asthma. Both a single dose of 1 mg ketotifen and 4 weeks treatment of ketotifen, 1 mg twice daily, failed to reduce the methacholine-induced drop in peak expiratory flow. The spirometric findings remained unchanged during ketotifen treatment. There was no difference between treatments with ketotifen and placebo with regard to the patients assessment of the severity of asthma or airway sensitivity to tobacco smoke, fumes or dusts, or exercise. The results suggest that treatment during 4 weeks with ketotifen does not reduce unspecific broncial hyperreactivity in patients with extrinsic asthma.

Preventive effect of ketotifen, a new antiallergic agent, on histamine-induced bronchoconstriction in asthmatics

The preventive effect of ketotifen, a new drug with anti-histaminic and antiallergic properties, on histamine-induced bronchoconstriction was studied by open assessment in twenty-four adult patients with extrinsic asthma. A single oral dose of 1 mg ketotifen reduced the post-histamine mean drop in peak expiratory flow from 33 to 16% of the basal values (P less than 0.001). After a 4 weeks' regimen of 1 mg ketotifen twice daily the post-drug histamine-induced fall in PEF was further significantly reduced (P less than 0.001). Tests performed after 8 and 12 weeks of treatment showed no additional decrease in bronchial reactivity to histamine. Tests performed 1 week after cessation of treatment showed return of bronchial reactivity to the pretreatment level. The results suggest that a single dose of ketotifen has a marked preventive effect on histamine-induced bronchoconstriction and that this effect is enhanced during continued treatment.

Pulmonary infections after renal transplantation

The prevalence of pulmonary infections has been assessed in a series of 93 patients who succumbed after renal transplantation. Pneumonia was considered to be the immediate cause of death in 15 patients; microscopic examination revealed further 10 cases, with pneumonic foci in the lungs. Consequently, the prevalence of pulmonary infections was 27%. Pneumonia was diagnosed on chest X-ray in only 48%, with "uraemic lung" as the most common confounding diagnosis. Clinical microbiology disclosed pathogenic bacteria in the sputum in 40% of the cases. It is concluded that the diagnostic yield would be enhanced by more frequent chest X-rays and presumably with more invasive methods of acquiring specimens for microbiological studies. It is also possible that the application of more stringent criteria for the use of high-dose intravenous steroids for supposed rejection will lead to less pneumonia in patients with renal transplants.

Determination of specific airway conductance by a simplified plethysmographic procedure

Attention is drawn to the fact, obvious for simple mathematical reasons, that in patients that airway obstruction the values for specific airway conductance (SGaw) calculated directly from the flow-pressure loop registered during quiet breathing with a constant-volume body plethysmography closely approximate the values obtained by the conventional plethysmographic method which includes temporary interruption of the airflow. The simplified procedure may be useful e.g. in serial determinations of SGaw in situations where simultaneous measurement of the lung volume is not considered essential.

Three cases of pulmonary sarcoidosis associated with aspergilloma

Three cases of parenchymal sarcoidosis with aspergilloma are described. Emphysematous bullae due to the basic disease were thought to predispose to aspergillomas. The roles possibly played by disturbances in cell-mediated immunity, associated with sarcoidosis, and by corticosteroid therapy are discussed. Antimycotics were effective in this difficult combination of diseases. Although the aspergillomas were not completely cured, a decrease in the amount of sputum and in the frequency of haemoptysis was noted for long periods. These drugs may also be useful as protective medication against invasive aspergillosis during corticosteroid therapy in patients with aspergilloma.

Controlled study of the bronchoconstriction effect of pindolol administered intravenously or orally to patients with unstable asthma

Pindolol, a beta-blocking drug, was given intravenously (0.2 mg) to 4 patients and orally (15 mg) to 4 patients, all in remission after acute exacerbation of asthma. In all cases it induced chest tightness and marked decrease in specific airway conductance, FEV1 and FVC and maximum expiratory flow at low lung volumes. The increase in airway obstruction after pindolol was not reversed by inhalation of a beta-sympathomimetic aerosol. The results suggest that conventional doses of pindolol may cause significant worsening of asthma in patients with unstable disease.

Use of a new simple device, the airflometer, in detecting changes in airways obstuction

A simple device for measuring ventilatory function, the airflowmeter, was found to be at least as sensitive as the Wright peak-flow meter in detecting histamine-induced bronchoconstriction in asthmatic patients. The apparatus also was found suitable for monitoring ventilatory function by the patients themselves at home.