On the prediction of Hodgkin lymphoma treatment response

PURPOSE

The cure rate in Hodgkin lymphoma is high, but the response along with treatment is still unpredictable and highly variable among patients. Detecting those patients who do not respond to treatment at early stages could bring improvements in their treatment. This research tries to identify the main biological prognostic variables currently gathered at diagnosis and design a simple machine learning methodology to help physicians improve the treatment response assessment.

METHODS

We carried out a retrospective analysis of the response to treatment of a cohort of 263 Caucasians who were diagnosed with Hodgkin lymphoma in Asturias (Spain). For that purpose, we used a list of 35 clinical and biological variables that are currently measured at diagnosis before any treatment begins. To establish the list of most discriminatory prognostic variables for treatment response, we designed a machine learning approach based on two different feature selection methods (Fisher's ratio and maximum percentile distance) and backwards recursive feature elimination using a nearest-neighbor classifier (k-NN). The weights of the k-NN classifier were optimized using different terms of the confusion matrix (true- and false-positive rates) to minimize risk in the decisions.

RESULTS AND CONCLUSIONS

We found that the optimum strategy to predict treatment response in Hodgkin lymphoma consists in solving two different binary classification problems, discriminating first if the patient is in progressive disease; if not, then discerning among complete and partial remission. Serum ferritin turned to be the most discriminatory variable in predicting treatment response, followed by alanine aminotransferase and alkaline phosphatase. The importance of these prognostic variables suggests a close relationship between inflammation, iron overload, liver damage and the extension of the disease.

Formation, characterization, and stability of methaneselenolate monolayers on Au(111): an electrochemical high-resolution photoemission spectroscopy and DFT study

We investigated the mechanism of formation and stability of self-assembled monolayers (SAMs) of methaneselenolate on Au(111) prepared by the immersion method in ethanolic solutions of dimethyl diselenide (DMDSe). The adsorbed species were characterized by electrochemical measurements and high-resolution photoelectron spectroscopy (HR-XPS). The importance of the headgroup on formation mechanism and the stability of the SAMs was addressed by comparatively studying methaneselenolate (MSe) and methanethiolate (MT) monolayers. Density Functional Theory (DFT) calculations were performed to identify the elementary reaction steps in the mechanisms of formation and decomposition of the monolayers. Reductive desorption and HR-XPS measurements indicated that a MSe monolayer is formed at short immersion times by the cleavage of the Se-Se bond of DMDSe. However, the monolayer decomposes at long immersion times at room temperature, as evidenced by the appearance of atomic Se on the surface. The decomposition is more pronounced for MSe than for MT monolayers. The MSe monolayer stability can be greatly improved by two modifications in the preparation method: immersion at low temperatures (-20 °C) and the addition of a reducing agent to the forming solution.

Mitochondrial bioenergetics and dynamics interplay in complex I-deficient fibroblasts

BACKGROUND

Complex I (CI) deficiency is the most frequent cause of OXPHOS disorders. Recent studies have shown increases in reactive oxygen species (ROS) production and mitochondrial network disturbances in patients' fibroblasts harbouring mutations in CI subunits.

OBJECTIVES

The present work evaluates the impact of mutations in the NDUFA1 and NDUFV1 genes of CI on mitochondrial bioenergetics and dynamics, in fibroblasts from patients suffering isolated CI deficiency.

RESULTS

Decreased oxygen consumption rate and slow growth rate were found in patients with severe CI deficiency. Mitochondrial diameter was slightly increased in patients' cells cultured in galactose or treated with 2'-deoxyglucose without evidence of mitochondrial fragmentation. Expression levels of the main proteins involved in mitochondrial dynamics, OPA1, MFN2, and DRP1, were slightly augmented in all patients' cells lines. The study of mitochondrial dynamics showed delayed recovery of the mitochondrial network after treatment with the uncoupler carbonyl cyanide m-chlorophenyl hydrazone (cccp) in patients with severe CI deficiency. Intracellular ROS levels were not increased neither in glucose nor galactose medium in patients' fibroblasts.

CONCLUSION

Our main finding was that severe CI deficiency in patients harbouring mutations in the NDUFA1 and NDUFV1 genes is linked to a delayed mitochondrial network recovery after cccp treatment. However, the CI deficiency is neither associated with massive mitochondrial fragmentation nor with increased ROS levels. The different genetic backgrounds of patients with OXPHOS disorders would explain, at least partially, differences in the pathophysiological manifestations of CI deficiency.

The I allele of the ACE gene is associated with improved exercise capacity in women with McArdle disease

BACKGROUND

McArdle disease is an uncommon metabolic disorder usually characterized by marked exercise intolerance although great individual variability exists in its phenotypic manifestation.

OBJECTIVE

The purpose of this study was to determine the association between angiotensin-converting enzyme (ACE) genotypes and indices of exercise capacity (peak oxygen uptake (VO(2)peak), ventilatory threshold (VT) and gross mechanical efficiency (GE)) in patients with McArdle disease. Based on previous research, it was hypothesized that the I allele might favourably influence exercise capacity.

METHODS

Forty-four Spanish patients (23 males, 21 females) and 44 age-matched and gender-matched controls (23 males, 21 females) performed a graded cycle-ergometer test until exhaustion (for VO(2)peak and VT determination) and a 12 min constant-load test at the power output eliciting the VT (for GE determination).

RESULTS

No significant difference (p>0.05) was found in indices of exercise capacity between ID + II genotypes and DD homozygotes in the group of male patients, male controls and female controls. However, in the group of female patients, the ID + II group (n = 11) had a higher VO(2)peak than DD homozygotes (n = 10) (15.8 (SEM 1.6) ml/kg/min versus 11.9 (SEM 0.9) ml/kg/min, respectively; p<0.05).

CONCLUSIONS

The I allele of the ACE gene is associated with a higher functional capacity in female patients, and might partly explain the individual variability in the phenotypic manifestation of McArdle disease.

Disturbances of the sarcoplasmic reticulum and transverse tubular system in 24-h electrostimulated fast-twitch skeletal muscle

Chronic low-frequency stimulation of rabbit tibialis anterior muscle over a 24-h period induces a conspicuous loss of isometric tension that is unrelated to muscle energy metabolism (J.A. Cadefau, J. Parra, R. Cusso, G. Heine, D. Pette, Responses of fatigable and fatigue-resistant fibres of rabbit muscle to low-frequency stimulation, Pflugers Arch. 424 (1993) 529-537). To assess the involvement of sarcoplasmic reticulum and transverse tubular system in this force impairment, we isolated microsomal fractions from stimulated and control (contralateral, unstimulated) muscles on discontinuous sucrose gradients (27-32-34-38-45%, wt/wt). All the fractions were characterized in terms of calcium content, Ca2+/Mg2+-ATPase activity, and radioligand binding of [3H]-PN 200-110 and [3H]ryanodine, specific to dihydropyridine-sensitive calcium channels and ryanodine receptors, respectively. Gradient fractions of muscles stimulated for 24 h underwent acute changes in the pattern of protein bands. First, light fractions from longitudinal sarcoplasmic reticulum, enriched in Ca2+-ATPase activity, R1 and R2, were greatly reduced (67% and 51%, respectively); this reduction was reflected in protein yield of crude microsomal fractions prior to gradient loading (25%). Second, heavy fractions from the sarcoplasmic reticulum were modified, and part (52%) of the R3 fraction was shifted to the R4 fraction, which appeared as a thick, clotted band. Quantification of [3H]-PN 200-110 and [3H]-ryanodine binding revealed co-migration of terminal cisternae and t-tubules from R3 to R4, indicating the presence of triads. This density change may be associated with calcium overload of the sarcoplasmic reticulum, since total calcium rose three- to fourfold in stimulated muscle homogenates. These changes correlate well with ultrastructural damage to longitudinal sarcoplasmic reticulum and swelling of t-tubules revealed by electron microscopy. The ultrastructural changes observed here reflect exercise-induced damage of membrane systems that might severely compromise muscle function. Since this process is reversible, we suggest that it may be part of a physiological response to fatigue.

Responses of rat myocardial antioxidant defences and heat shock protein HSP72 induced by 12 and 24-week treadmill training

AIM

The purpose of this study was to determine the effects of both a short (12 weeks) and a long-term (24 weeks) endurance treadmill-training programme on the levels of oxidative stress markers, the activity of the enzymatic antioxidants, and the content of the 72 kDa heat shock protein (HSP72) in rat myocardium.

METHODS

Thirty male Wistar rats were randomly assigned to exercise trained (n = 16) and sedentary (n = 14) groups. After 12 week of training, eight rats were killed while the remaining eight continued the training programme until 24 week.

RESULTS

Seven sedentary controls were killed together with each trained group. Levels of thiobarbituric acid-reactive substances (TBARS), protein carbonyls, and total and oxidized glutathione (tGSH and GSSG) in myocardial homogenates were unchanged by training irrespective of the protocol duration. However, an increased content of the oxidative stress biomarkers was detected in hearts from both the 24-week trained rats and their sedentary controls when compared with their corresponding 12-week groups. The antioxidant enzymatic activities total and mitochondrial superoxide dismutase (tSOD and mtSOD, respectively), glutathione peroxidase (GPX) and glutathione reductase (GR), remained unchanged after the 12-week training period whereas a significant increase in tSOD and mtSOD activities (18%, P < 0.05) was observed in heart homogenates of 24-week trained animals as compared with their sedentary controls. HSP72 expression levels were not significantly modified after 12 week of training but a threefold increase was detected after 24 week (P < 0.05).

CONCLUSION

These results demonstrate that a long-term endurance training (24 weeks) induced discrete increases in antioxidant enzyme activities in rat myocardium and elicited a marked enhancement in HSP72 expression levels. However, a shorter training programme (12 weeks), was not effective in increasing heart antioxidant defences.

[Care of patients with the sleep apnea syndrome in the Czech Republic]

In the Czech Republic, for ten million inhabitants there are eight sleep laboratories (two neurological, one otorhinolaryngological and five pneumological), equipped with twelve units monitoring four or eight parameters. The first OSAS laboratory was established in 1991. In 1994, health insurance began providing patients with CPAP and doctors began publicising sleep syndromes. Since 1994, 3,860 patients were examined. Patients were referred: by general practitioners (34%), by otorhinolaryngologists (16%), by pneumologists (15%) or by neurologists (12%) and 24% came voluntarily. The ratio was eight men to one woman. Nearly all came because partners requested it. Of the 3,860 examined, 740 (around 19%) began using CPAP. The criteria for using CPAP are following: an oxygen saturation in the blood below 90% for more than 20% of the sleeping period. In very serious cases BiPAP was used (27 patients--0.7%). 185 patients (4.8%) underwent surgery on soft palate.

Cobaltocenium-functionalized poly(propylene imine) dendrimers: redox and electromicrogravimetric studies and AFM imaging

The first four generations of cobaltocenium-functionalized, diaminobutane-based poly(propylene imine) dendrimers DAB-dend-Cb,(PFb)x (x = 4, 8, 16, and 32; Cb=[Co(eta5-C5H4CONH)(eta5-C5H5)] (1-4) have been synthesized and characterized. The redox activity of the cobaltocenium centers in 1-4 has been characterized by using cyclic voltammetry and the electrochemical quartz-crystal microbalance (EQCM). All of the dendrimers exhibit reversible redox chemistry associated with the cobaltocenium/cobaltocene redox couple. Upon reduction. the dendrimers exhibit a tendency to electrodeposit onto the electrode surface, which is more pronounced for the higher generations. Pt and glassy carbon electrodes could be modified with films derived from 1-4,exhibiting a well-defined and persistent electrochemical response. EQCM measurements show that the dendrimers adsorb, at open circuit, onto platinum surfaces at monolayer or submonolayer coverage. Cathodic potential scanning past -0.75 V at which the cobaltocenium sites are reduced, gave rise to the electrodeposition of multilayer equivalents of the dendrimers. The additional material gradually desorbs upon re-oxidation so that only a monolayer equivalent remains on the electrode surface. Changes in film morphology as a function of dendrimer generation and surface coverage were studied by using admittance measurements of the quartz-crystal resonator on the basis of its electrical equivalent circuit, especially in terms of its resistance parameter. In general, we find that films of the lower dendrimer generation 1 behave rigidly, whereas those of the higher generation 4 exhibit viscoelastic behavior with an intermediate behavior being exhibited by 2 and 3. Using tapping-mode atomic force microscopy (AFM). we have been able to obtain molecularly resolved images of dendrimer 4 adsorbed on a Pt(111) electrode.

Thyrotoxic periodic paralysis in caucasians. Report of 8 cases

BACKGROUND

Periodic paralysis is a well known complication of thytotoxicosis in Chinese and Japanese patients, but has been considered extremely rare in caucasians.

PATIENTS AND METHODS

Between 1991 and 1996, we admitted 8 caucasian patients to our Hospital due to thyrotoxic periodic paralysis. We retrospectively analysed their clinical manifestations.

RESULTS

All the patients were males. Their attacks started at night or early after awakening, frequently triggered by a high carbohydrate diet and physical exertion. Myalgias and flaccid weakness predominated over proximal leg muscles, sparing bulbar and respiratory musculature. Reflexes were brisk at the onset of the attack and reduced or absent during the course of the episode. Prior to diagnosis patients presented 1-5 attacks of thyrotoxic periodic paralysis each lasting 1-96 hours. Hypokalemia was documented in 6 patients. The episodes of periodic paralysis led to the diagnosis of a previously unsuspected thyrotoxicosis in 6 patients. In the other 2 patients the diagnosis of the thyroid dysfunction preceded the periodic paralysis. Attacks resolved after treatment of the hyperthyroid state.

CONCLUSIONS

Thyrotoxic periodic paralysis is an under-diagnosed but probably frequent complication of hyperthyroidism in caucasians. Early recognition of the attacks is essential to investigate and treat the underlying thyroid dysfucntion whose symptoms are usually mild. The episodes of periodic paralysis resolve with the correction of the hyperthyroidism.

Short-term effects of marathon running in master runners: no evidence of myocardial injury

The purpose of this investigation was to analyze the short-term effects of marathon running on serum levels of cardiac markers in a group of master runners (> 60 yrs). Ten marathoners (9 male and 1 female; 63+/-4 yrs) were enrolled in the study. All of them completed the Madrid Marathon (1998). Venous blood was drawn from each subject three times during the study (48 h before the race, immediately after the race, and 24 h post-competition) for the determination of the several biochemical markers, such as total creatine kinase catalytic activity (total CK), mass concentration of creatine kinase isoenzyme MB (CK-MB mass), and cardiac troponin I (Tnl-c). The most important finding was that in each sample (pre- or post-race) serum Tnl-c was below the commonly accepted level of 0.1 ng x m(-1) indicative of myocardial injury. Although further research is needed using more complete methodology, our results suggest that marathon running does not have an acute deleterious effect on the hearts of the elderly.

Short-term effects of marathon running: no evidence of cardiac dysfunction

PURPOSE

The purpose of this study was to analyze the short-term effects of a marathon race (Madrid Marathon) on both markers of cardiac damage and echocardiographic parameters in a group of 22 runners (17 male and 5 female; 34 +/- 5 yr; VO2max: 55.7 +/- 9.1 mL x kg(-1) x min(-1) with a wide range of fitness levels.

METHODS

Venous blood samples were collected from each subject 48 h before the race, at race finish, and 6, 24, and 48 h postexercise for the determination of myoglobin, total creatine kinase catalytic activity (total CK), mass concentration of creatine kinase isoenzyme MB (CK-MB mass), and cardiac isoforms of troponin T and I (TnT-c and TnI-c, respectively). In addition, echocardiographic parameters (M-mode two-dimensional and Doppler analysis) indicative of both left ventricular (LV) systolic and diastolic function were obtained three times from each runner: 2-5 d before the race, at race finish, and 24-36 h after exercise.

RESULTS

Except in one subject, levels of TnT-c and TnI-c were within normal limits (<0.1 ng x mL(-1)) in all the samples collected before or after the race. Overall LV systolic function was not altered by marathon running. Finally, LV diastolic function was transiently altered after the race since the ratio between peak early and late transmitral filling velocities (E/A) was significantly reduced at race finish (P < 0.01) and returned to resting levels after 24-36 h.

CONCLUSIONS

Our findings suggest that marathon running does not adversely affect the hearts of healthy individuals independently from their training status.

Chronic and acute exercise do not alter Ca2+ regulatory systems and ectonucleotidase activities in rat heart

The purpose of this investigation was to examine the effects of chronic and acute exercise on the main components involved in excitation-contraction coupling and relaxation in rat heart. Sixty male Wistar rats were divided into a sedentary (S) and three 12-wk treadmill-trained groups (T-1, moderate intensity; T-2, high intensity; T-3, interval running). After 12-wk, 15 rats from the S group and 15 rats from the T-2 group were subjected to a single treadmill-exercise session until exhaustion before being killed at 0, 24, or 48 h (acute exercise). The remaining animals were killed 48 h after the last standard exercise session (chronic exercise). The efficacy of the training programs was confirmed by an increase in treadmill endurance time and in skeletal muscle citrate synthase activity. None of the exercise programs modified heart weight or cardiac oxidative capacity. [(3)H]PN200-110 and [(3)H]ryanodine binding to cardiac homogenates indicated that the density of L-type and sarcoplasmic reticulum (SR) Ca(2+) channels was the same in S and trained rats. The SR Ca(2+)-ATPase activity was also unmodified. Finally, the activities of the ectoenzymes Mg(2+)-ATPase and 5'-nucleotidase, which are involved in degradation of extracellular nucleotides, were not affected by either of the running programs. After the acute exercise session, no changes were detected in either of the tested parameters in heart homogenates of S and T-2 animals. We conclude that neither treadmill-exercise training for 12 wk nor exhaustive exercise alters the density of Ca(2+) channels involved in excitation-contraction coupling or the SR Ca(2+)-ATPase and the ectonucleotidase activities in rat heart.

Rat liver lysosomal and mitochondrial activities are modified by anabolic-androgenic steroids

PURPOSE

The aim of this study was to examine the separate and combined effects of an 8-wk treatment with high doses of 17alpha-alkylated anabolic-androgenic steroids (AAS) and exercise training on selected lysosomal and mitochondrial enzyme activities in rat liver.

METHODS

Sedentary and treadmill-trained (25 m x min(-1), 45 min x d(-1), 5 d x wk(-1)) male rats were treated with fluoxymesterone, methylandrostanolone, or stanozolol (2 mg x kg body weight(-1), 5 d x wk(-1)) for 8 wk.

RESULTS

Acid phosphatase, arylsulfatase, beta-glucuronidase, and beta-galactosidase activities were increased in liver homogenates of sedentary and trained AAS-treated rats. The mitochondrial respiratory chain activities rotenone-sensitive NADH-cytochrome c reductase (NCCR), succinate cytochrome c reductase (SCCR), and cytochrome oxidase (COX) showed a significant decrease in steroid-administered rats, whereas citrate synthase (CS), a matrix enzyme, exhibited no changes in activity, pointing to a selective effect of AAS on mitochondrial membrane complexes. In vitro studies in mitochondrial fractions isolated from the liver of control rats showed that COX and CS activities were insensitive to the AAS, whereas NCCR and SCCR activities were partly inhibited. On the other hand, the mean values of serum parameters related to hepatic function were within normal ranges in all the experimental groups of animals.

CONCLUSIONS

The present data show that 8-wk ingestion of three different anabolic-androgenic steroids, either with or without concurrent exercise training, affects lysosomal hydrolases and mitochondrial respiratory chain electron transport in rat liver without modifying classical serum indicators of hepatic function.

[Use of EEG in electroconvulsive therapy]

BACKGROUND

From the point of view of time we can divide the use of EEG in the electroconvulsive therapy into 1) screening before starting the treatment, 2) the EEG correlates of the ECT: recording of the paroxysm, immediate postparoxysmal recording, interparoxysmal recording during a series of ECT, and persistent changes after finishing the series of ECT.

METHODS AND RESULTS

EEG screening has shown that the patients with abnormal EEG do not respond well to ECT. In the recording of the paroxysm EEG correlates with therapeutic effect of ECT are looked for--particularly the length of the paroxysm on the EEG, intensity and pattern of the paroxysmal activity, and the suppression of the EEG curve in the terminal part of the paroxysm. The suppression models are in the focus of interest also in the immediate postparoxysmal recording. In the interparoxysmal recordings during a series of ECT the associations of the generalised slowing in the range of the theta and delta activity with the therapeutic effect were looked for, particularly in the past. Persistent changes after finishing the ECT are usually examined especially to look if ECT does not cause persistent abnormalities of the EEG recording which would be an evidence for brain damage or for epileptic kindling. The results in this direction have been negative so far.

Bis-naphthalimides 3: synthesis and antitumor activity of N,N'-bis[2-(1,8-naphthalimido)-ethyl] alkanediamines

The bis-naphthalimides are a new class of antitumor agent. Previously, we have described initial synthetic series which established that two naphthalimide chromophores joined by polyamine linkers can produce agents with antitumor activity. We now extend these studies to describe the synthesis of a N,N'-bis[1,8-naphthalimido)-ethyl]alkanediamine series and examine the alkyl linker and chromophore substitution requirements for optimal antitumor activity. As a result, a bis-naphthal-imidoethyl derivative with no chromophore substitution and a NH-(CH2)3-NH bridge was identified. This agent (LU 79553) had both potent cellular cytotoxicity (IC50 = 0.014 microM) and was curative against MX-1 tumors grown in athymic mice. It has now been selected for clinical development.

[EEG correlates of therapeutic effects of electroconvulsive therapy]

In a group of 52 patients electroconvulsive treatment by means of a Thymatron apparatus was provided under simultaneous EEG control. In addition to parameters of the EEG curve (type of curve according to intensity of the paroxysmal process, duration of electroconvulsion on EEG, type of termination of paroxysm of EEG) also other variables were investigated in relation to the therapeutic effect. The following were identified as significant predictors for marked clinical improvement: type of EEG curve with more marked paroxysmal activity, shorter cumulative duration of electroconvulsions on EEG before first clinical improvement of the patient and a higher CGI entering score. Other variables proved unimportant, e.g. the patient's age, total number of electroconvulsions, total cumulative duration of electroconvulsions on EEG and type of termination of electroconvulsions on EEG.

EEG in electroconvulsive therapy: is more intensive paroxysmal activity associated with a higher therapeutic response?

EEG records of electroconvulsions were evaluated according to a five-point semiquantitative scale grading the intensity of the paroxysmal activity. A more favorable therapeutic effect of ECT was found to be associated with more pronounced paroxysmal activity on the EEG. The role of this finding for the dosage of energy in the convulsive stimulus is discussed.

Synthesis, structure and antitumor activity of new benz[d,e]isoquinoline-1,3-diones

New benz[d,e]isoquinoline-1,3-diones related to mitonafide (CAS 54824-17-8) and amonafide (CAS 69408-81-7) with double substitution on the chromophore and branched side chains have been synthesized and their biological activity determined. Molecular modeling studies of 3a based on X-ray crystallographic data of mitonafide have shown that the aromatic system intercalates between GC steps of DNA. The in vitro cytotoxic test data using CX-1 and LX-1 cells showed higher cytotoxic activities in disubstituted derivatives compared to both lead compounds. Some of the compounds have been selected for in vivo test using L1210 tumor cells and CX-1 cells. Two of them (3b and 3j) have shown promising activity as good candidates for clinical development.

Calcium restriction induces cardenolide accumulation in cell suspension cultures of Digitalis thapsi L

The removal of calcium ions from Murashige and Skoog culture medium induced a marked increase in the accumulation of cardenolides in cell suspension cultures of Digitalis thapsi. Cell viability was not affected although growth was slightly reduced. Strontium ions could substitute for calcium in inhibiting cardenolide production, this effect of calcium being reversed by the addition of LaCl3 or ethyleneglycol-bis-(β-aminoethyl ether)-N,N'-tetraacetic acid. The results suggest that calcium, apart from its general effects on growth, may play a role in the regulation of cardenolide metabolism in a concentration dependent manner.

[Experience with the Thymatron DG apparatus in determining the duration of electroconvulsions]

Electroconvulsive therapy was administered, using a Thymatron apparatus DG in a group of 29 female patients with a total number of 150 convulsions. The apparatus makes it possible to take an EEG reading and to evaluate it automatically. Moreover, the paroxysm were evaluated clinically and visually from EEG tracings. The authors proved a significant disagreement as regards evaluation of the length of electroconvulsions assessed by the three methods of evaluation (clinical, automatic EEG analyzer and visual EEG evaluation). They identified moreover in the group, using the automatic EEG analyzer, 11.7% abortive convulsions, by visual EEG evaluation 10.3%, while according to clinical evaluation the rate was as high as 59.2%. Conversely on clinical evaluation no convulsion appeared to be protracted, while according to EEG this was the case in 9.6% (automatic analyzer) and in 10.3% (visual evaluation). On qualitative discrimination of abortive and protracted convulsions and convulsions with a satisfactory duration the automatic and visual EEG evaluation did not differ significantly, and the function of the automatic analyzer seems satisfactory for this basic evaluation of electroconvulsions.

Synthesis of new derivatives of flavone-8-acetic acid

The synthesis of new flavone-8-acetic acid derivatives is described. It is studied the influence of a dialkylaminomethyl group in the 3-position on the activity. None of the new compounds showed cytostatic activity.

Bis-naphthalimides: a new class of antitumor agents

A series of bis-intercalators bearing the 1,8-naphthalimide chromophore has been synthesized and in vitro activities determined. Most compounds have higher activities in HT-29 than the leader compounds Mitonafide and Amonafide. One of them (22) was selected for in vivo studies and presents an interesting activity in MX-1 and OVCAR models. (22) also acts as antitopoisomerase II.

[Sleep apnea syndrome--serious complications in a female patient treated with psychopharmaceutic agents]

The authors present the case-history of a patient treated in the past on account of depressive syndrome who suffered repeatedly from somnolence or even unconsciousness with dyspnoea which called for hospitalization in an anaesthesiological and resuscitation department. The repeatedly expressed suspicion of attempted suicide by drugs was always ruled out by toxicological examination. Based on the clinical picture a preliminary diagnosis of the sleep apnoea syndrome was established confirmed later by polysomnographic examination. The evoking factors of the mentioned serious complications were probably respiratory infections and psychiatric medication, in particular hypnotics--flunitrazepam and triazolam.

Silica and trichloroethylene-induced progressive systemic sclerosis

Several environmental factors and chemicals have been described as being able to induce systemic scleroderma and scleroderma-like diseases. The present work reports 2 male patients with progressive systemic sclerosis and pulmonary silicosis. Both patients had occupational histories of exposure to silica and one of them of handling trichloroethylene as a degreasing agent. The clinical and analytical findings could not be distinguished from those present in idiopathic systemic scleroderma with the exception of interstitial images with calcified hilar lymph nodes in the chest X-ray suggestive of pulmonary silicosis.

Double-blind comparison of diclofenac potassium, ibuprofen and placebo in the treatment of ankle sprains

In a double-blind, placebo-controlled comparative study in 60 patients with ankle sprains suffering from moderate to severe inflammation and tenderness, the efficacy and tolerability of 150 mg/day diclofenac potassium given for 7 days was superior to that of 1.2 g/day ibuprofen which was, in turn, superior to placebo. Efficacy was assessed by volumetric evaluation of inflammation of the injured ankle, tenderness on finger pressure, pain on movement and the severity of the joint injury. Patients used visual analogue scales to assess severity of pain at rest and on walking before and during treatment. Diclofenac potassium was significantly superior (P less than 0.02) to ibuprofen for all measures of efficacy (except severity of joint injury) and ibuprofen was consistently superior to placebo. No serious adverse effects were reported. In conclusion, diclofenac potassium has been demonstrated to be effective in the treatment of acute ankle sprains and it had a rapid onset of action and good tolerability.

[Spontaneous epidural hematoma with cervical localization--report of a case with etiopathologic analysis]

A case of spontaneous spinal epidural hematoma is reported. The 56-year-old man was hospitalized with neck pain followed by right sided Brown-Sequard syndrome at the level of C5-6 with a light rectovesical insufficiency and cervical sympathetic symptomatology. CT scan revealed right sided extradural high density mass. Following emergency operation removing the epidural hematoma ensured good recovery from the illness. The spontaneous spinal epidural hematoma is rare emergency. The exact etiology is unknown. Etiology and pathophysiology of this unusual lesion are described.

An observer-blind comparison of diclofenac potassium, piroxicam and placebo in the treatment of ankle sprains

An observer-blind comparative clinical study was carried out in 108 patients presenting with ankle sprains at an Accident and Emergency department. The efficacy and tolerability of diclofenac potassium (50 mg 3-times daily) was compared with that of piroxicam (20 mg once daily), and placebo. Patients were allocated at random to receive one or other of the three treatments for 7 days. There were 36 patients in each group. The analgesic and anti-inflammatory effects of treatment were assessed from volumetric measurements of inflammation at the injured ankle, tenderness, pain on passive movement, severity of the joint lesion, severity of pain at rest and on movement. The overall reductions in pain and inflammation were assessed at the end of the study. The results in patients treated with diclofenac potassium were significantly better than those in patients treated with piroxicam with respect to the improvement in pain on walking and the overall reduction in pain and inflammation, and both active treatments were superior to placebo. There was no significant difference between diclofenac potassium and piroxicam with respect to inflammation measured by volumetry, tenderness, and severity of pain at rest, but both active treatments were consistently superior to placebo. No serious adverse effects were reported. All the patients treated with diclofenac potassium and all those treated with piroxicam said that they would be willing to take the drug again; this was the case with only 27.8% of the placebo group. Diclofenac potassium can be considered an effective treatment for acute ankle sprains with a rapid onset of analgesic and anti-inflammatory action and good tolerability.