Long-term outcomes and central nervous system relapse in extranodal natural killer/T-cell lymphoma

To elucidate the long-term outcomes of non-anthracycline-containing therapies and central nervous system (CNS) events in patients with extranodal NK/T-cell lymphoma, nasal type (ENKTL), the clinical data of 313 patients with ENKTL diagnosed between 2000 and 2013 in a nationwide retrospective study in Japan were updated and analyzed. At a median follow-up of 8.4 years, the 5-year overall survival (OS) and progression-free survival (PFS) were 71% and 64%, respectively, in 140 localized ENKTL patients who received radiotherapy and dexamethasone, etoposide, ifosfamide, and carboplatin (RT-DeVIC) in clinical practice. Nine (6.4%) patients experienced second malignancies. In 155 localized ENKTL patients treated with RT-DeVIC, 10 (6.5%) experienced CNS relapse (median, 12.8 months after diagnosis). In 5 of them, the events were confined to the CNS. Nine of the 10 patients who experienced CNS relapse died within 1 year after CNS relapse. Multivariate analysis identified gingival (HR, 54.35; 95% CI, 8.60-343.35) and paranasal involvement (HR, 7.42; 95% CI, 1.78-30.89) as independent risk factors for CNS relapse. In 80 advanced ENKTL patients, 18 received dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) chemotherapy as first-line treatment. Patients who received SMILE as their first-line treatment tended to have better OS than those who did not (P = 0.071). Six (7.5%) advanced ENKTL patients experienced isolated CNS relapse (median, 2.6 months after diagnosis) and died within 4 months of relapse. No second malignancies were documented in advanced ENKTL patients. In the entire cohort, the median OS after first relapse or progression was 4.6 months. Twelve patients who survived 5 years after PFS events were disease-free at the last follow-up. Of those, 11 (92%) underwent hematopoietic SCT. Our 8-year follow-up revealed the long-term efficacy and safety of RT-DeVIC and SMILE. The risk of CNS relapse is an important consideration in advanced ENKTL. This article is protected by copyright. All rights reserved.

[Digitalis for the treatment in patients with heart failure]

Digitalis glycosides are the first-choice drugs in the treatment of the patients with congestive heart failure and atrial fibrillation. Recently, it has been shown that digitalis glycosides have potentially beneficial neurohumoral modulating effects by decreasing excessive neurohumoral responses directly or by improving baroreflex mechanisms in congestive heart failure. Accordingly, there are many investigators who believe that digitalis glycosides are neurohormonal modulating agents in heart failure. There may be a dissociation between hemodynamic and neurohormonal effects in response to digitalis glycosides. The activation of the neurohormonal system may be present in patients with asymptomatic left ventricular dysfunction. Digitalis glycosides may therefore be used, not only to improve symptomatic congestive heart failure, but also to protect against the progressive deterioration of asymptomatic cardiac dysfunction.

[Analgesic effects of epidurally administered fentanyl for postoperative pain relief--comparison with buprenorphine]

We did a retrospective study on 177 patients after upper and lower abdominal surgery, and compared the efficacy of epidural administration of fentanyl and that of buprenorphine for postoperative pain relief. In fentanyl (F) group, 73 patients received fentanyl 0.1 mg with saline 8 ml epidurally after operation, followed by a constant rate infusion of 0.025 mg.hr-1 for 18-24 hrs. In buprenorphine (B) group, 104 patients, received buprenorphine 0.2 mg with saline 9 ml epidurally. After upper abdominal surgery, 33 patients (76.7%) in F group and 27 patients (52.9%) in B group obtained satisfactory analgesia (P < 0.05). The difference of the degree of analgesia after lower abdominal surgery was not significantly different in both groups. Respiratory depression occurred in 19 patients in B group and 5 patients in F group (P < 0.05). It is concluded that epidural fentanyl delivered by continuous infusion offers a significant advantage compared with epidural buprenorphine for postoperative pain relief following upper abdominal surgery.

[Combined therapy with prostaglandin E1 ointment and lumbar sympathetic ganglion block on intractable skin ulcers accompanied by Bürger's disease]

For the 2 patients with intractable skin ulcers and pain accompanied by thromboangiitis obliterans (Bürger's disease), we applied combined therapy with lumbar sympathetic block, continuous epidural block and prostaglandin E1 ointment. Prostaglandin E1 (PGE1) was prepared as a topical ointment by mixing with Plastibase (polyethylene resin, 5%, liquid paraffin, 95%) at a concentration of 10 micrograms.g-1. The ointment was kept in a refrigerator until use. Following debridement and washing of the surface of ulcers as required, the ointment was applied evenly onto the surrounding and over the surface of each ulcer 2 times daily after sterilization. With this therapy the ulcers were cured completely in 10 days after the start of treatment. No side effect was observed both locally and systemically. Although the combined therapy we used with prostaglandin E1 ointment was a noninvasive method, a remarkable shortening of the period of treatment was achieved.

Clinical studies of enalapril treatment for patients with severe congestive heart failure

The clinical efficacy of enalapril was investigated in 21 patients with severe heart failure. For each subject, the following parameters were compared before and one month after enalapril maintenance treatment. NYHA functional class, Killip's class, cardiothoracic ratio (CTR), left ventricular (LV) function estimated by echocardiography and gated equilibrium radionuclide angiography, Holter ECG recordings, serum digoxin concentration (SDC), plasma remin activity, plasma aldosterone concentration, plasma norepinephrine concentration (PNE), etc. Short- and long-term hemodynamic responses to enalapril were also studied, with simultaneous measurement of enalapril concentration by radioimmunoassay. After maintenance therapy, patients showed a significant improvement as judged by NYHA functional class, Killip's class, and CTR. The LV fractional shortening and the ejection fraction significantly increased. The frequency of ventricular tachycardia showed a significant tendency to decrease after the therapy. The SDCs were unchanged, which indicates no pharmacokinetic drug interaction between digoxin and enalapril. Hemodynamic assessment showed a reduction in systemic vascular resistance, a reduction in mean blood pressure, and an increase in the cardiac index. No major side effects were observed during the study period. According to a multivariate analysis, the coefficient of determination of PNE was the highest for the final global improvement rating. This may reflect the neurohormonal improvement of congestive heart failure by enalapril therapy. In conclusion, enalapril is recommended for treating patients with severe CHF.

Genetic variations in albumin and transferrin as species markers in plasma of Callithricidae

Albumin (Alb) and transferrin (Tf) polymorphism in plasma of Callithricidae was investigated by means of starch gel electrophoresis. In 52 blood samples of three species (Saguinus mystax, S. oedipus and S. labiatus), four Alb phenotypes (Alb 1, Alb 2, Alb 3 and Alb 2-3) and two Tf phenotypes (Tf 1 and Tf 2) were observed. No Alb variant was found in S. oedipus and S. mystax.