Two daily doses of sucralfate or cimetidine in the healing of gastric ulcer. A comparative randomized study

A double-blind, randomized study compared the healing of gastric ulcer during a twice-daily regimen of 2 g sucralfate or 400 mg cimetidine. The patients received the tablets one-half hour before breakfast and one-half hour before bedtime. The study included 76 patients with endoscopically proven gastric ulcer. Patients with ulcers less than 3 cm from the pyloric ring and patients with ulcers less than 3 mm in diameter were excluded from the study. Sixty-four patients completed the study. Healing was endoscopically assessed at four-week intervals for 12 weeks. After four, eight, and 12 weeks, the healing rates for cimetidine were 55, 81, and 94 percent, respectively; the healing rates for sucralfate were 52, 79, and 91 percent, respectively. No statistically significant difference was found between the two regimens. At 12 weeks, the risk of overlooking a difference in favor of one of the two dosage regimens was less than 20 percent. The results suggest that 2 g sucralfate twice daily is as effective in the healing of gastric ulcer as 400 mg cimetidine twice daily.

Intralesional application of recombinant human tumor necrosis factor alpha induces local tumor regression in patients with advanced malignancies

Fourteen patients with different advanced solid tumors were treated by intratumoral application of recombinant human tumor necrosis factor alpha. In five patients, local tumor regression occurred. However, the duration of response was short, implying a rapid development of resistance to rTNF-alpha application. The main clinical side-effects, including chills, fever, anorexia and fatigue, were similar to systemic rTNF-alpha treatment. Cardiovascular, pulmonary or metabolic toxicities were not observed. This study demonstrates that a high concentration of rTNF-alpha at the tumor site has the potential to induce local tumor regressions and, therefore, seems more reasonable for further clinical investigations, especially in combination with other cytokines.

Experience of a German multicenter study group with ifosfamide in small cell lung cancer

In three German multicenter randomized trials, which included 718 patients, the activity of ifosfamide in small cell lung cancer (SCLC) was tested. In study 1, IE (ifosfamide, 1.5 g/m2, days 1 through 5; etoposide, 120 mg/m2, days 3 through 5) alternating with CAV (cyclophosphamide, 600 mg/m2, days 1 and 2; doxorubicin, 50 mg/m2, day 1; vincristine, 2 mg, day 1) was compared with a response-oriented treatment with IE therapy up to maximum response and subsequently an immediate switch to CAV. After chemotherapy, patients with limited disease received chest irradiation with 45 Gy. Prophylactic cranial irradiation (30 Gy) was given to all patients who achieved complete response (CR). A total of 324 patients were evaluable. Total response rate (CR + partial response [PR]) was 75% v 78% for the two treatment groups; the CR rate was 29% for both groups. Survival was nearly identical in both arms, with a median survival of 10.0 months for all patients, 12.0 months for those with limited disease (LD), and 7.5 months for those with extensive disease (ED). The 2-year survival rate was 11%. In study 2, IE was compared with PE (cisplatin, 90 mg/m2, day 1; etoposide, 150 mg/m2, days 3 through 5). A total of 141 patients were evaluable. Total response (CR + PR) rate was 65% for PE and 68% for IE; the CR rate for PE was 32% v 20% for IE. Survival favored PE with a median survival of 11.6 months v 9.4 months for all patients, 14.8 months v 11.0 months for LD, and 8.9 months v 7.5 months for ED. Two-year survival rates were 12% v 9% for all patients, 23% v 10% for those with LD, and 5% v 9% for those with ED. From these trials, we conclude that IE is an active and well-tolerated regimen for SCLC, and that PE may be superior to IE in limited-stage disease. Taking these results into account, we modified our chemotherapy protocols in study 3 and compared IAV (ifosfamide, 2 g/m2, days 1 to 5; doxorubicin, 25 mg/m2, days 1 and 2; vincristine, 2 mg, day 1) alternating with either PE or JE (carboplatin, 300 mg/m2, day 1; etoposide, 120 mg/m2, days 1 to 3). Interim results of 253 evaluable patients are as follows: CR + PR rate after 4 cycles was 68%; the CR rate was 28%; median survival was 11.6 months for all patients, 14.8 months for LD, and 10.2 months for ED.(ABSTRACT TRUNCATED AT 400 WORDS)

[Results of 2 multicenter therapy studies in inoperable non-small cell bronchial cancer]

A total of 166 patients with non-small cell lung cancer (NSCLC) were included in two multicenter trials testing different treatment regimens. In study I, 116 patients received 4 cycles of aggressive polychemotherapy consisting of cis-platinum 100 mg/m2 (day 1), etoposide 100 mg/m2 (days 4-6), and vindesine 3 mg/m2 (day 1) (CEV); patients without distant metastases subsequently received chest irradiation with 50 Gy. In study II, 50 patients were treated with monochemotherapy consisting of etoposide 250 mg/m2 (days 1-3), and ifosfamide 5 g/m2 as 24-h infusion (day 29). While this program was repeated in responders with extensive disease (ED), patients with limited disease (LD) subsequently received chest irradiation with 50 Gy using 20 mg/m2 cis-platinum weekly as a radiosensitizer. Response rates (CR + PR) to chemotherapy were higher in study I than in study II, and were 26% (CR 3%) vs. 8% (CR 0%) for all patients, 18% (CR 0%) vs. 4% (CR 0%) for ED, and 45% (CR 11%) vs. 13% (CR 0%) for LD. The increase in response rates by radiotherapy was marginal in study I (CR + PR 47%, CR 18%), but remarkable in study II (CR + PR 42%, CR 29%). While median survival was slightly longer in study I than in study II for ED (7.7 vs. 6.6 months) and LD (14.4 vs. 12.0 months), the 2-year survival rate was in favor of study II (10% vs. 25%). Toxicity was clearly more pronounced in study I, including 3 lethal complications and 16 discontinuations of therapy due to side effects or refusal. Thus, while in ED the efficacy of both treatment regimens was very restricted, in LD radiotherapy with cis-platinum as a radiosensitizer achieved a relatively high 2-year survival rate which justifies further testing of this treatment strategy.

[Incidence of recurrence and long-term survival in small cell bronchial carcinoma]

Analyses of relapse in small cell lung cancer (SCLC) were performed in 443 evaluable patients included in two multicenter trials. The time to first progression mainly depended on best response to therapy. Nearly all patients with no change (NC) suffered from progression within 6 months. In patients with partial remission (PR), progression occurred within 12 months in nearly all cases. If complete remission (CR) was achieved, no relapse was seen within the first 6 months after the onset of treatment. Between the 6th and 8th month a slowly increase and after the 8th month a rapid increase of relapse was noticed. In the majority of patients with limited disease relapse was localized in the area of the primary tumor, whereas in patients with extensive disease relapse mostly was due to the development of distant metastases. Of the 443 patients, 35 achieved 2-year survival (8%). Main prognostic factors for the achievement of 2-year survival were extent of disease and sex. Patients with distant metastases and CR had a poor chance of achieving a 2-year survival, while patients without distant metastases and CR had a 30% chance. Females with limited disease and a Karnofsky score of 70% or more had a 40% chance of achieving 2-year survival, the corresponding probability for males was less than 10%. Because of the high frequency of relapse in SCLC, the stabilization of best response has to be considered as a main objective in therapy. In our opinion, two different strategies may be useful in order to achieve higher 2-year survival rates: a) periodic controls and renewal of therapy as soon as possible after relapse has occurred or b) reinduction therapy in intervals of about 8 weeks or more in order to delay or prevent the development of relapse. To find out if one of these strategies is superior to the other, is one of the objectives of our new randomized trial in SCLC.

Cisplatin/etoposide versus ifosfamide/etoposide combination chemotherapy in small-cell lung cancer: a multicenter German randomized trial

A total of 144 patients with small-cell lung cancer (SCLC) were randomized to receive cisplatin/etoposide (PE) or ifosfamide/etoposide (IE) combination chemotherapy. PE consisted of cisplatin, 80 mg/m2, intravenously (IV) on day 1, and etoposide, 150 mg/m2, IV on days 3 through 5. IE consisted of ifosfamide, 1,500 mg/m2, IV on days 1 through 5, and etoposide, 120 mg/m2, IV on days 3 through 5. Six cycles were administered in 3-week intervals. Nonresponders were switched immediately to CAV, consisting of cyclophosphamide, 600 mg/m2, IV on days 1 and 2, Adriamycin (Adria Laboratories, Columbus, OH), 50 mg/m2, IV on day 1, and vincristine, 2 mg, IV on day 1. Patients obtaining complete remission (CR) received prophylactic cranial irradiation with 30 Gy. After completion of chemotherapy, patients with limited disease received chest irradiation with 45 Gy. No maintenance therapy was given to patients in CR. Minimum follow-up was 2 years. Of the 141 patients evaluable, the overall response rate was 65% in PE therapy and 68% in IE therapy. The CR rate was 32% v 20% for all patients, 50% v 24% for limited disease, and 22% v 18% for extensive disease, all in favor of PE therapy. Median survival for all patients was 11.6 months v 9.4 months, for limited disease 14.8 months v 11.0 months, and for extensive disease 8.9 months v 7.5 months, all preferring PE therapy. The 2-year survival rate was higher in PE therapy than in IE therapy for all patients (12% v 9%) and for limited disease (23% v 10%), but not for extensive disease (5% v 9%). Median progression-free survival was 7.5 months v 6.0 months for all patients, 12.2 months v 8.8 months for limited disease, and 5.9 months v 4.4 months for extensive disease, all in favor of PE. Relapse in the area of the primary tumor was found less often after PE than after IE therapy (25% v 38%). Response to second-line CAV was seen in 30% of patients with prior PE and 43% with prior IE therapy, but was usually short lasting, and only one patient achieved CR. Toxicity included three lethal complications. Nausea, vomiting, diarrhea, and skin lesions occurred more often after PE than after IE therapy. These results suggest that PE is superior to IE chemotherapy in limited-stage, but not in extensive-stage SCLC, and that CAV is cross-resistant to PE, as well as to IE in the majority of patients.

Alternating versus sequential chemotherapy in small cell lung cancer. A randomized German multicenter trial

A total of 306 patients with small cell lung cancer (SCLC) were randomized to receive chemotherapy in a sequential or alternating mode. Sequential chemotherapy consisted of eight cycles of cyclophosphamide, Adriamycin (doxorubicin), and vincristine (CAV) and alternating chemotherapy consisted of three cycles (1, 3, 5) of etoposide, vindesine, and ifosfamide (EVI); three cycles (2, 4, 6) of cisplatin, Adriamycin, and vincristine (PAV); and two cycles (7, 8) of cyclophosphamide, methotrexate, and CCNU (CMC). Responsive patients received prophylactic cranial irradiation after three cycles and chest irradiation after eight cycles of chemotherapy. No maintenance therapy was applied to patients achieving complete remission. Minimum follow-up was 2 years. Of the 302 patients evaluable, overall response rate was 59% in the sequential arm and 70% in the alternating arm. Patients treated with CAV had a complete response rate of 21% in contrast to 36% for those receiving alternating therapy. The median survival for all patients was 9.8 versus 11.3 months, for limited disease 11.1 versus 13.4 months, and for extensive disease 8.9 versus 9.9 months, all in favor of the alternating treatment. Two-year survival rate for all patients was 6% versus 9%, for limited disease 11% versus 14%, and for extensive disease 3% versus 6%, all preferring the alternating treatment mode. Progression-free survival demonstrated a strong correlation to the extent of response irrespective of the treatment regimen applied. Toxicity included 11 lethal and 8 life-threatening complications with a higher frequency in the alternating treatment arm. These results suggest that alternating treatment of SCLC with different drug combinations is more effective than sequential application of CAV.

Two randomized trials for alternating polychemotherapy of small cell lung cancer

Patients with small cell carcinoma of the lung (SCCL) were treated in two multicenter trials with different cytostatic drug regimens including ifosfamide. In the first randomized study, including 306 patients, alternating chemotherapy with VP 16, ifosfamide, vindesine (VPIV), adriamycin, cisplatinum, vincristine (APO), and cyclophosphamide, methotrexate, CCNU (CMCC) was compared against standard treatment with ACO (adriamycin, cyclophosphamide, vincristine). It was shown that the alternating therapy resulted in a higher response rate (88% vs 78%) and a longer median survival time (11 months vs 10 months). Regarding toxicity, VPIV was similar to ACO, whereas APO and CMCC had more side-effects, leading to an increase in the number of drop-outs. In the second randomized study 144 patients were treated either with ifosfamide/VP 16 (IVP) or with cisplatinum/VP 16 (PVP). In the case of no further response, no change, or progression the induction therapy was changed to ACO. Interim analyses show that both regimens have similar therapeutic effects; but higher toxicity was observed in patients treated with cis-platinum/VP 16 than in patients treated with ifosfamide/VP 16. According to the response rate in patients treated with ACO after first-line therapy there was less cross-resistance of IVP than of PVP to ACO.

Sequential methotrexate and 5-FU in breast cancer resistant to the conventional application of these drugs

Methotrexate and 5-FU were given sequentially with a 7-hour interval to 43 evaluable patients with heavily pretreated metastatic breast cancer. Partial remissions were seen in 12 patients (28%), indicating efficacy of this regimen in patients resistant to the conventional simultaneous application of these drugs.

Mapping from Space: The Metric Camera Experiment

The Spacelab metric camera experiment acquired stereoscopic high-resolution black-and-white and color infrared photographs of various regions of the world. In total, an area of about 11 million square kilometers was covered. Because of the delay in launching the shuttle until 28 November, illumination conditions were frequently poor over many candidate targets. However, unique high-quality images with a ground resolution of about 20 meters were obtained by increasing camera exposure time. Initial image analysis has shown that these images may be used for earth mapping at the scale 1:100,000.

Systemic histiocytosis: an unusual cause of perianal disease in a child

A male child first presented with chronic perianal skin disease at 33 months of age and later developed gingival disease and loose teeth associated with alveolar bone erosion. Biopsy of gingival and perianal lesions showed histiocytic proliferation. Following therapy with vinblastine, prednisone, methotrexate, and cyclophosphamide, the lesions healed but disease recurred in the mastoid and was successfully treated with vinblastine alone. Although the perianal area is an unusual site of skin involvement in systemic histiocytosis, this disorder should be considered in any child with chronic unexplained perianal disease, and biopsy of these lesions should be obtained.

Organization of microtubules in stabilized meristematic plant cells revealed by a rat monoclonal antibody reacting only with the tyrosinated form of alpha-tubulin

A rat monoclonal antibody against yeast tubulin (clone YL 1/2; Kilmartin et al., 1982) that reacts specifically with mammalian alpha-tubulin carrying a carboxyterminal tyrosine residue (Wehland et al., 1983) was used to localize microtubules in plant cells derived from onion root apices (Allium cepa L.). YL 1/2 reacted with all types of microtubular arrays known to occur in higher plant meristematic cells such as interphase cortical microtubules, pre-prophase bands, the mitotic spindle and phragmoplast microtubules. The specific labeling of microtubules in isolated cells from onion root tips by YL 1/2 indicates that plant cells like animal cells contain tubulin tyrosine ligase, the enzyme which posttranslationally modifies alpha-tubulin. This enzyme could be involved in the dynamic regulation of microtubular arrays in all eukaryotic cells.

[2d interim evaluation of a chemotherapy study on patients with squamous cell carcinomas of the head-neck area. A comparison of 2 therapy regimens: cis-diamminedichloroplatinum (II) and bleomycin versus methotrexate and vindesine]

52 patients with epidermoid cancer of the head and neck region were either treated with cis-DDP and bleomycin (arm A) or with methotrexate and vindesine (arm B). In case of resistance patients were further treated with the alternative regimen (A leads to B or B leads to A). Treatment results are superior in arm A. Complete and partial remission were in A: 54%, in B: 31%, after crossover 46% and 0%, respectively. Status of pretreatment (operation and/or radiotherapy) is of minor importance for arm A than for the "soft" treatment of arm B. Preliminary analysis of survival and remission duration shows no significant difference in regard to A or B and status of pretreatment. However, those patients resistant to B and further treated with A have an increase of median survival from 3 to 9 months (p = 0.02). With primary chemotherapy inoperable tumors can be made operable with curative intention.

Ecthyma gangrenosum

Images

Pioneer 11 Infrared Radiometer Experiment: The Global Heat Balance of Jupiter

Data obtained by the infrared radiometers on the Pioneer 10 and Pioneer 11 spacecraft, over a large range of emission angles, have indicated an effective temperature for Jupiter of 125 degrees +/- 3 degrees K. The implied ratio of planetary thermal emission to solar energy absorbed is 1.9+/-0.2, a value not significantly different from the earth-based estimate of 2.5+/-0.5.

Preliminary Infrared Radiometry of the Night Side of Mercury from Mariner 10

The infrared radiometer on Mariner 10 measured the thermal emission from the planet with a spatial resolution element as small as 40 kilometers in a broad wavelength band centered at 45 micrometers. The minimum brightness temperature (near local midnight) in these near-equatorial scans was 100 degrees K. Along the track observed, the temperature declined steadily from local sunset to near midnight, behaving as would be expected for a homogeneous, porous material with a thermal inertia of 0.0017 cal cm(-2) sec(-(1/2)) degrees K(-1), a value only slightly larger than that of the moon. From near midnight to dawn, however, the temperature fluctuated over a range of about 10 degrees K, implying the presence of regions having thermal inertia as high as 0.003 cal cm(-2) sec-(1/2) degrees K(-1).