[Surgical procedure in non-Hodgkin's lymphomas of the digestive system--a status quo analysis]

A total of 329 patients were registered in the Münster multicenter study, "Gastrointestinal Lymphomas", including 118 different centers since October 1992. Primary surgical intervention was performed in 135 cases. In contradiction to the prospective results of other oncological centers, the preoperative diagnosis of non-Hodgkin lymphoma was only known in 44.4% of cases. R0 resection was achieved in only 62 of the 135 patients (46%). This study reveals the realistic situation of operative treatment of non-Hodgkin lymphomas in everyday practice.

Gemcitabine: clinical and economic impact in inoperable non-small cell lung cancer

This study assesses retrospectively the clinical and economic impact of gemcitabine monotherapy on the management of inoperable stage III/IV non-small cell lung cancer in Germany. Based on current methods of clinical practice and using the best outcome data available, the costs and benefits of gemcitabine were compared to a dual therapy (ifosfamide/etoposide). While the two treatments showed broadly equivalent efficacy in terms of tumour response rate and survival, a cost analysis showed the potential for savings with gemcitabine. These largely related to hospital hotelling costs, due to the fact that gemcitabine may be given as an out-patient therapy. Further savings were found in investigative procedures and the management of treatment toxicity. Excluding the cost of the chemotherapy, gemcitabine was associated with potential savings of DM3,026 over two cycles of therapy, which included a 40% decrease in hospitalization costs and a 54% decrease in the cost of managing adverse events. We conclude that gemcitabine monotherapy could offer considerable cost savings while offering the potential for improved quality of palliative treatment compared to existing in-patient treatments, and it may have a place in shifting care from an in-patient to an out-patient setting in line with recent health care reforms.

Oral lichenoid lesions, mercury hypersensitivity and combined hypersensitivity to mercury and other metals: histologically-proven reproduction of the reaction by patch testing with metal salts

We report 11 patients seen between 1991 and 1994 with oral lichenoid lesions (OLL). In 10 cases, there was contact with dental amalgam fillings, and in patient no. 10 with both amalgam restorations and a gold crown. The last patient had, in addition to her OLL, lichen planus of the skin and genital mucosa. In 5 cases, combined sensitization to mercury and other metal salts, particularly gold sodium thiosulfate (GST) and palladium chloride (PDC), was observed. In 10 patients, the lesions considerably improved or totally cleared within 1 to 9 months of replacement of restoration materials. Histological examination of biopsies from the test sites of amalgam, mercuric chloride, GST and PDC, taken 10 or 17 days after application of patch tests, showed lichenoid changes in 7 patients with at least 1 of the allergens. As at least 2 patients had inflammatory lesions of the oral mucosa related to both amalgam and gold restorations, combined sensitization to inorganic and organic mercury derivatives, GST and, in 1 case, PDC, a "dental restoration metal intolerance syndrome" is proposed.

No evidence of contact sensitization to acyclovir in acute dermatitis of the lips following local application of Zovirax cream

We report 4 patients with acute contact dermatitis of the lips following application of Zovirax cream. Patch tests with pure acyclovir, and combinations of the ingredients of the cream base, with and without acyclovir, provided no evidence of sensitization to any constituents of the cream.

[Verruciform palmoplantar keratoderma as a characteristic marker of hidrotic ectodermal dysplasia of the Clouston type]

We report on a 23-year-old man with hidrotic ectodermal dysplasia of the Clouston type showing a severe expression of his gene defect. As a prominent feature of this case, we describe the presence of verruciform keratoderma of hands and feet, and we visualize these skin changes by means of a new imprinting technique.

Baculovirus expression of human P450 2E1 and cytochrome b5: spectral and catalytic properties and effect of b5 on the stoichiometry of P450 2E1-catalyzed reactions

The baculovirus (BV)-insect cell expression system has been successfully used to express high levels of mammalian proteins. Here we report the baculovirus-mediated expression of human P450 2E1 and cytochrome b5 in Sf9 insect cells. The BglI-EcoRI fragment of the human P450 2E1 cDNA (Umeno et al., Biochemistry 27, 1988) was used for the expression of P450 2E1. Human cytochrome b5 cDNA was obtained by the polymerase chain reaction using human liver cDNA as template. Infection of Sf9 insect cells with a recombinant 2E1-BV resulted in the expression of a protein which comigrated with human liver P450 2E1 on SDS gels and cross-reacted with a polyclonal antibody against rat liver P450 2E1. Inclusion of hemin in the cell growth medium greatly enhanced the spectral activity of expressed 2E1. Expression levels of 1.5 nmol/mg cell lysate were obtained after 7 days of infection. However, maximal turnover numbers (min-1) were observed after 48 h of infection. The lambdamax of the CO:reduced CO difference spectrum of human P450 2E1 was found to be 451.1 nm. In the presence of exogenous hemin, BV-expressed human b5 showed a typical reduced-oxidized difference spectrum with lambdamax and lambdamin of 425 and 409 nm, respectively. With saturating levels of purified rat liver NADPH:P450 oxidoreductase and rat liver cytochrome b5 included in the incubations, expressed human P450 2E1 showed high catalytic activity for the metabolism of p-nitrophenol (PNP), ethoxycoumarin, N-nitrosodiethylamine, and N-nitrosodimethylamine (NDMA). The presence of b5 in the incubations increased the activities several-fold. The Km and kcat values for the N-demethylation of NDMA to HCHO in the presence of rat b5 by expressed 2E1 were 36.0 microM and 8.3 min-1, respectively. In the absence of extra added b5, the Km was increased sixfold and the kcat decreased fourfold. In the presence of extra added b5 expressed 2E1 showed a Km for PNP metabolism of 86 microM and a kcat of 7.8 min-1. Simultaneous infection of Sf9 insect cells with both 2E1 and human bE recombinant BV resulted in membrane fraction (2E1:b5) containing both proteins at a ratio of b5 to P450 of approximately 1.8:1. The Km and kcat values for NDMA demethylase activity by the 2E1:b5 membrane fraction were similar to those with exogenously added b5.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergic contact dermatitis from purified eosin

We report on a patient, seen in 1993, who developed sensitization to eosin from topical preparations. The patient had a positive patch test reaction to pure tetrabromofluorescein but not to its impurities separated by thin-layer chromatography. Our findings suggest that the allergen was eosin itself.

Erythema-multiforme-like, urticarial papular and plaque eruptions from bufexamac: report of 4 cases

4 patients developed an erythema-multiforme-like reaction following acute contact dermatitis from 2 different bufexamac-containing topical preparations. Histologically, the lesions did not show changes that were typical of erythema multiforme. Patch testing gave positive reactions to bufexamac at 1, 2, 3 and 4 days. The histological picture of 2 positive test reactions was suggestive of a drug reaction in the 1st, and of an acute eczematous reaction in the 2nd, case. A systemic allergic reaction with spread of lesions could have been involved, following percutaneous absorption of the allergen.

Synthesis, radiochemistry and biological evaluation of a new somatostatin analogue (SDZ 219-387) labelled with technetium-99m

A new derivative of octreotide SDZ 219-387 [PnAO-(D)Phe(1)-octreotide] was synthesized, which binds specifically and with high affinity to somatostatin receptors in vitro (pKi = 9.79 +/- 0.16). This new somatostatin analogue chelates technetium-99m under mild labelling conditions in good yields. The resulting [99mTc]SDZ 219-387 was stable up to 6 h after labelling and could be isolated in a pure radiochemical and chemical form by high-performance liquid chromatographic purification. The intravenous administration of purified [99mTc]SDZ 219-387 revealed that the radioligand was rapidly cleared from circulation, and tumour uptake of 0.38% ID/g was observed at 1.5 h post injection. [99mTc]SDZ 219-387 specifically interacted with somatostatin binding sites on the tumour. However, the radioligand is highly lipophilic and excreted mainly through the hepatobiliary system. As a consequence, [99mTc]SDZ 219-387 exhibits increased background activity and therefore is not appropriate for the in vivo visualization of somatostatin receptor-positive tumours and/or their metastases in the abdomen.

Dexa-BEAM in patients with Hodgkin's disease refractory to multidrug chemotherapy regimens: a trial of the German Hodgkin's Disease Study Group

PURPOSE

A prospective phase II study was conducted to evaluate the efficacy of dexamethasone, carmustine, etoposide, cytarabine, and melphalan (Dexa-BEAM) as salvage chemotherapy for patients with Hodgkin's disease.

PATIENTS AND METHODS

Fifty-five patients progressing on or relapsing after eight- or 10-drug chemotherapy (cyclophosphamide, vincristine, procarbazine, and prednisone plus doxorubicin, bleomycin, vinblastine, and dacarbazine [COPP+ABVD] or COPP+ABV+ifosfamide, methotrexate, etoposide, and prednisone [IMEP]) were treated with Dexa-BEAM. Patients who responded after two cycles of Dexa-BEAM either continued treatment for another two to three cycles or received high-dose chemotherapy/autologous bone marrow transplantation (HDCT/ABMT) with cyclophosphamide, etoposide, and carmustine (BCNU) (CVB) as conditioning regimen.

RESULTS

Seventeen patients (31%) achieved a complete remission and 16 (29%) a partial remission, resulting in a response rate of 60% (95% confidence interval, 46% to 73%). Progressive disease developed in 18 patients. Toxicity of Dexa-BEAM was acceptable with pronounced, but temporary World Health Organization (WHO) grade III/IV granulocytopenia and thrombocytopenia occurring in more than 90% of all courses. Two patients died of sepsis during granulocytopenia. Three prognostic subgroups could be distinguished: (1) patients progressing on initial chemotherapy, (2) patients relapsing within 12 months, and (3) patients with late relapses. The response rates for these groups were 52%, 60%, and 83%, and the median survival duration 12, 29, and 40+ months, respectively. In a nonrandomized comparison, the survival of patients who responded to two cycles of Dexa-BEAM and had additional cycles of Dexa-BEAM (n = 14) was not different from those responding patients who underwent HDCT/ABMT (n = 19). However, the power to detect a 20% survival difference was only 33% in this comparison.

CONCLUSION

Dexa-BEAM is an effective salvage treatment for patients with Hodgkin's disease who fail to respond to multidrug chemotherapy. Efficacy and toxicity are comparable to HDCT/ABMT and underline the need for prospective randomized trials to define better the role of HDCT with and without ABMT in these patients.

Uncertainties in pharmacokinetic modeling for perchloroethylene: II. Comparison of model predictions with data for a variety of different parameters

In this paper we compare expectations derived from 10 different human physiologically based pharmacokinetic models for perchloroethylene with data on absorption via inhalation, and concentrations in alveolar air and venous blood. Our most interesting finding is that essentially all of the models show a time pattern of departures of predictions of air and blood levels relative to experimental data that might be corrected by more sophisticated model structures incorporating either (a) heterogeneity of the fat compartment (with respect to either perfusion or partition coefficients or both) or (b) intertissue diffusion of perchloroethylene between the fat and muscle/VRG groups. Similar types of corrections have recently been proposed to reduce analogous anomalies in the fits of pharmacokinetic models to the data for several volatile anesthetics. A second finding is that models incorporating resting values for alveolar ventilation in the region of 5.4 L/min seemed to be most compatible with the most reliable set of perchloroethylene uptake data.

Use of cytosine arabinoside and total body irradiation as conditioning for allogeneic marrow transplantation in patients with acute lymphoblastic leukemia: a multicenter survey

We report the experience of 14 centers which have used the combination of cytosine arabinoside (ara-C; 24-36 g/m2) and total body irradiation (TBI) to prepare 213 patients with acute lymphoblastic leukemia (ALL) for allogeneic BMT. The overall 3-year disease-free survival (DFS) probability is 38% (95% CI: 31-45%); 75 patients died of complications and 51 relapsed. Multivariate analysis identified three factors independently associated with outcome: age, remission/relapse status and patient-donor relationship. The 3-year DFS probability is 52% (41-63%) for the 106 patients aged 0-11 and 25% (16-33%) for the 104 aged 11+ years; the DFS probability was 54% (34-74%), 41% (32-49%) and 19% (5-33%) for those in first remission, later remissions and relapse respectively. Older patients suffered both more toxic deaths and more relapses than young ones. No other covariate was found to predict for outcome. The results using ara-C-TBI are similar to those achieved using cyclophosphamide plus TBI to prepare ALL patients for BMT, perhaps because a seemingly lower relapse rate is offset by more toxic deaths particularly in older patients. Therapeutic trials should focus on reducing toxicity while maximizing antileukemic efficacy, and should stratify for patient and disease-related factors.