Clinical Diagnostic Application of111In-DTPA-Octreotide Scintigraphy in Small Cell Lung Cancer

Some years ago it was proved that a good percentage of small cell lung cancers, classified among cancers of the APUD system, produces somatostatin receptors that can be detected in vivo by scintigraphy with 111In-DTPA-octreotide. With the method in the whole body it is possible to identify the principal neoformation and the probable metastases. The authors present a study of 21 patients afflicted with small cell lung cancer diagnosed histologically. The study, carried out between January 1995 and December 1997, compared the radiologic iconography of the CT scan with the scintigraphic map obtained by a planar scintigraphy and in SPECT 1, 4 and 24-hr after iv injection of 110 MBq of 111In-DTPA-octreotide. The comparison was made with reference to the principal neoplasm and probable metastases. A scintigraphic study, a CT of restaging and a follow-up, done after 3 and 6 months of chemotherapy, on 15 patients with cancer that produces somatostatin receptors proved that the neoplasm sometimes regresses and sometimes progresses. In the latter case, it is possible to identify cerebral, mediastinal and hepatic metastases with the administration of 200 microg of octreotide 3 times a day for 7 days before the scintigraphy. In fact, the administration lowers background activity. The authors concluded that scintigraphy with 111In-DTPA-octreotide plays an important part in the study of patients afflicted with small cell lung cancer. Scintigraphy identifies the subgroups of patients who can be cured with somatostatin analogues together with chemotherapy. Scintigraphy presents a good sensibility in the re-staging and in the follow-up of patients who are treated, even though it is difficult to identify subdiaphragmatic metastases where liver, spleen and kidney show an increase in 111In-DTPA-octreotide.

A phase II study on the efficacy and safety of procedural analgesia with fentanyl buccal tablet in cancer patients for the placement of indwelling central venous access systems

Background

Pain in cancer patients is often related to oncologic therapies and diagnostic procedures. The placement of fully implantable venous access systems is a very common procedure in oncology patients. Local anaesthesia is the method most commonly used to overcome pain related to this surgical procedure, but the local anaesthetic may be unable to completely eradicate all pain. This study investigates the effectiveness and safety of fentanyl buccal tablet (FBT), administered by OraVescent® technology, in reducing procedural pain related to the placement of indwelling central venous access systems (Ports) in opioid-naïve cancer patients.

Methods

Inpatients who required an indwelling vascular access (Port) were preoperatively assessed with a self-assessment questionnaire on anxiety and pain. A 100 μg FBT was administered 10 min before preparation of the operating field. A self-assessment scale for pain experienced during the procedure was administered at the end of the procedure. Vital signs and the presence of any side effects or bothersome symptoms were monitored during the procedure, at the end, and 4 h later.

Results

From October 2012 to June 2014, 65 patients were enrolled in the study. A total of 61 (93.9 %) patients perceived no or a little pain during the procedure. Four patients (6.2 %) reported a lot of pain. No patient reported very severe pain. This data is significant in terms of the lower than expected presence of pain (Fisher test p = 0.0018) as assessed in our previous experience without procedural analgesia. The most common side effects of FBT was drowsiness, experienced by 28 patients at the end of the procedure (43.1 %), significantly reduced (p < 0.01) to 8 patients after 4 h (12.5 %). Nausea was present in 6 cases at the end of the procedure (9.2 %) and in 7 cases 4 h later (10.9 %). Vomiting was present in 3 cases at the end (4.7 %) and in 2 other patients after 4 h (7.8 %). No significant change of vital parameters was observed between the baseline and the subsequent measurements in all patients studied.

Conclusions

The significant improvement in the number of patients experiencing little or no pain, accompanied by a lower number of non-severe side effects, suggests that FBT is a valid, practical and safe method of procedural analgesia. It will be necessary to perform further studies, taking into account the need for standard antiemetic pre-medication to minimise the incidence of nausea and vomiting.

Early and short-term acenocumarine or dalteparin for the prevention of central vein catheter-related thrombosis in cancer patients: a randomized controlled study based on serial venographies

BACKGROUND

We evaluated efficacy and safety of early and short-term prophylaxis with acenocumarine or dalteparin in the prevention of non-occlusive or occlusive central vein catheter-related thrombosis (CVCrT).

PATIENTS AND METHODS

Consecutive cancer patients scheduled for chemotherapy randomly received: acenocumarine 1 mg/day for 3 days before and 8 days after central vein catheter (CVC) insertion; dalteparin 5000 IU 2 h before and daily for 8 days after CVC insertion; no anticoagulant treatment (NT). All patients underwent venography on days 8 and 30, some of them on days 90, 150 and 210 after CVC.

RESULTS

A total of 450 patients were randomized, 348 underwent at least two venography. Both acenocumarine and dalteparin reduced venography-detected CVCrT rate [21.9% acenocumarine versus 52.6% NT, odds ratio (OR) 0.3, P < 0.01; 40% dalteparin versus 52.6% NT, OR 0.6, P = 0.05]. Acenocumarine was more effective than dalteparin (OR 0.4, P = 0.01). The rate of occlusive CVCrT was not different in the three groups (0.9% acenocumarine, 3.3% dalteparin, 1.8% NT; P = 0.40). Most CVCrTs (95.6%) were observed on day 8 after CVC insertion and were non-occlusive.

CONCLUSIONS

In this study of early and short-term prophylaxis, acenocumarine was more effective than dalteparin on non-occlusive and asymptomatic CVCrT events. The first days following CVC insertion represent the highest risk for CVCrT.

Neurinoma of the hypoglossal nerve in the submandibular space: case report and review of the literature

Neurinomas of the hypoglossal nerve extending extra-cranially are rare; a schwannoma in a 63-year-old woman causing nerve palsy is reported. The tumour presented as a slow-growing mass in the right submandibular space; a surgical approach with transcervical exploration was performed. The post-operative course was uneventful.

Short-term acenocumarine (A) or dalteparine (D) for the prevention of central venous catheter-related thrombosis (CVCrT) in cancer patients. A randomized controlled study based on serial venographies

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Background: Timing and frequency of non occlusive (nO) or occlusive (O) CVCrT in cancer patients (pts) remain unclear. In this randomized controlled trial we studied these points and evaluated the efficacy and safety of short-term prophylaxis with A or D in the prevention of CVCrT. Methods: Consecutive cancer pts without contraindications to short-term anticoagulation, scheduled for chemotherapy via CVC, were randomly assigned to receive: A 1 mg/day for 3 days before and 8 days after CVC insertion; D 5,000 IU 2 hours before and daily for 8 days after CVC insertion; no anticoagulant treatment (NT). All pts underwent venography (V) at day 8 and 30 after CVC insertion and then every two months until CVC removal . The primary endpoint was V detected CVCrT, evaluated as nO or O when it was partially or completely occlusive of the vein lumen, respectively. Bleeding episodes were recorded. Proportions were compared using chi-square test together with odds ratio (OR). Results: 450 pts were randomized, 348 of whom (120/150 A, 114/150 D, and 114/150 NT) underwent V (median number of procedures 4, range 2–8). Both A and D reduced the frequency of V detected CVCrT (21.9% A vs 55.3% NT, OR= 4.35 (95% CI 2.43–7.69), p<0.001; 40% D vs 55.3% NT, OR= 1.85 (95% CI 1.10–3.13), p=0.02). A was more effective than D (OR= 2.37 (CI 1.34–4.22), p= 0.003). The frequency of O CVCrT was not different in the 3 groups (0.9% A, 5.0% D, 4.4% NT; p= 0.18). Overall, 5.1% of pts with CVCrT were symptomatic, all presenting O CVCrT (42% of pts with O CVCrT were not symptomatic). Most CVCrTs (95.6%) were observed at day 8 after CVC insertion. No major bleeding or pulmonary embolism occurred. Conclusions: In this study, acenocumarine was more effective than dalteparine in reducing V detected CVCrT. The doses of prophylactic agents used in this study proved to be safe. Symptomatic CVCrT evaluation alone underestimates the actual CVCrT frequency. The first days following CVC insertion are at highest risk for CVCrT. Short term thrombosis prophylaxis appears to be superior to no treatment without the expenses and inconveniences inherent in long-term prophylaxis.

No significant financial relationships to disclose.

New Metastatic Models in Vivo of Prostate Cancer

Experimental prostate cancer bone metastases are difficult to form in vivo, and some typical clinical patterns remain irreproducible. In our work we describe new metastatic models in vivo using different experimental approaches.

Methods

We injected prostate cancer cells in the left cardiac ventricle or in the medullar cavity of tibia of male nude mice.

Results

Mice were monitored by x-ray analysis and 70% of them revealed osteolytic lesions 40 days after heart injection. By scintigraphy and alu-PCR we were able to identify early a higher number of metastatic loci than by x-ray.

Conclusions

Heart and intratibial injection of prostate cancer cells in nude mice may represent a good experimental model to investigate the pathophysiology of bone and bone marrow metastases in vivo.

[Exposure of distal internal carotid artery through mandibular vertical ramus osteotomy]

Exposure of the distal internal carotid artery at the level of the second cervical vertebra required manoeuvers such as division of digastric muscle or mandibular subluxation. These increase the exposure but may not provide adequate access and are associated with significant cranial nerves or temporal mandibular joint complications. Vertical Ramus Osteotomy (VRO) provided access of the internal carotid artery (ICA) up to the base of the skull, with low incidence of cranial nerve injury temporo-mandibular joint (TMJ) pain and no preincision preparation. We report two cases in which vertical division of the mandibular ramus provided access of the ICA up to the base of the skull. Preoperative Duplex Scan examination and in the second case the arteriography revealed ICA preocclusive stenosis within 1.5 cm of the skull base. VRO was performed trouhgh a standard neck incision and miniature titanium plates were used to reapproximate the mandible after vascular procedure. There were no death, cranial nerve injury, mandibular nonunion, malocclusion or TMJ pain. We found that VRO is useful when carotid artery pathology extends beyond the usual field of exposure, avoiding nerve injury or TMJ lesion and requires no additional pre-incision preparation.

[Lymph node metastases in paranasal sinus carcinoma: prognostic value and treatment]

The purpose of this report is to assess, on the basis of a sizeable study, the prognostic value of lymph node metastases in paranasal sinus carcinoma and, in particular, in squamous cell carcinoma of the maxillary sinus. We have reviewed the charts of 601 cases of paranasal sinus carcinoma between 1970 and 1999. All of the patients were treated surgically, alone or associated with chemotherapy and/or radiotherapy. The maxillary sinus tumors numbered 379 (153 squamous cell carcinomas, 15 undifferentiated carcinomas, 94 adenoid cystic carcinomas, 19 adenocarcinomas, 98 mesenchymal tumors and rare forms) and the ethmoidal tumors were 222 (117 adenocarcinomas, 27 squamous cell carcinomas, 16 adenoid cystic carcinomas, 13 undifferentiated carcinomas, 49 other histological forms). Lymph node metastases in ethmoidal tumors were rare, with the exception of undifferentiated carcinoma (46.1%). The percentages of metastatic squamous cell carcinoma of the maxillary sinus upon presentation were: T2 15.5%, T3 7%, and T4 4%. All these patients underwent lymph node excision. The metastases successive to treatment of the primary tumor were: T2 16.9%, T3 8.8%, and T4 12%. 75% of these late metastases occurred contemporaneously with a recurrence of T and only 5 (25%) constituted the single reawakening of disease; four of these patients underwent neck surgery and were cured operatively. One had fixed, inoperable metastases. The NED survival rate at least two years after T therapy in patients free from metastases was 50.4%, against 25% in those with initial or distant metastases (T2 72.9% vs. 30.4%, T3 37.5% vs. 22.2%, and T4 28.6% vs. 0%). In conclusion, squamous cell carcinomas of the maxillary sinus which have extended to the oral cavity (T2) show greater lymph node propagation than those of the superoposterior portion (T3-T4). The presence or successive appearance of lymph node metastases indicates elevated malignancy of the tumor, with a very negative prognosis. N, however, is rarely the cause of death for these patients. Prophylactic lymph node excision in N0 patients is therefore not indicated.

TMJ biomechanical constraints: the disc and the retrodiscal tissue

The temporo-mandibular-joint is a highly particular and complex anatomical entity in terms of both its structure and functions, which include the opening, closing, protrusion and lateral movement of the jaw. On the base of some papers previously published on the anatomy and physiology of the Temporo-Mandibular-Joint, the Authors have studied the functional dynamics of the TMJ. The correct postural and functional relationships between the various components of the joint are controlled by a series of biomechanical restrictions that guide and condition its movements. The role of biomechanical restriction played by such articular components, influences decidedly the therapeutical treatment aimed to the resolution of the Temporo-Mandibular joint pathology. In this article, the authors examine and analyze the role of the Temporo-Mandibular ligament, Disk Lateral Ligament, Articular disk, Retrodiskal Zone and of the Synovial Fluid in the functional dynamics of the Temporo-Mandibular-Joint.

Surgical techniques in the treatment of pleomorphic adenoma of the parotid gland: our experience and review of literature

This paper presents a retrospective study carried out on a sample of 100 patients affected by pleomorphic adenoma of the parotid gland and treated at the Department of Maxillofacial Surgery at the University of Rome "La Sapienza" between January 1, 1989 and December 31, 1997. For the diagnosis of this neoformation, cytological tests were performed on material taken from the neoformation using fine needle aspiration and ultrasound scan. In some selected cases, a CT examination of the head and neck with medium contrast or Nuclear Magnetic Resonance (NMR) was carried out. This study sets out to examine the most suitable treatment to be followed for the removal of the pleomorphic adenoma of the parotid gland. In 56 cases the patients underwent a superficial, conservative parotidectomy. Forty one patients had a total parotidectomy with the facial nerve left intact and one patient had a total parotidectomy where the marginal mandibular nerve of the facial nerve was damaged. The remaining two patients involved in the study were suffering from a recurrent pleomorphic adenoma and in these two cases a total parotidectomy was performed where the facial nerve was killed. The removal of the cranial nerve VII in these patients proved necessary because the nerve fibers had adhered to the surrounding scar tissue of the tumor, either after previous surgery or due to repeated chronic phlogosis of the gland.

Celiac plexus block: injectate spread and pain relief in patients with regional anatomic distortions

BACKGROUND

The success of the neurolytic celiac plexus block, despite different approaches and methods used, depends on adequate spread of the injectate in the celiac area. This retrospective study was conducted to evaluate the patterns of alcohol spread and pain relief in patients with cancer or therapy-related anatomic distortion of the celiac area.

METHODS

From 177 cancer patients who underwent computed tomography (CT)-guided single-needle neurolytic celiac plexus block via an anterior approach, a radiologist, blind to the aim of the study, retrospectively selected 105 patients with abnormal anatomy of the celiac area as judged by CT images obtained before the block. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into four quadrants: upper right and left and lower right and left, as related to the celiac artery. Results were expressed as the number of quadrants into which contrast spread, ie., four, three, two, or one quadrants with contrast. The patterns of contrast spread according to the number of quadrants with anatomic distortion were analyzed. Patient assessment by visual analog scale was reviewed to evaluate the degree of pain relief. Pain relief 30 days after block was considered long-lasting. Pain relief at 30 days after block was analyzed according to the number of quadrants with contrast.

RESULTS

Overall, four, three, two, and one quadrants with contrast were observed in 9 (8%), 21 (20%), 49 (47%), and 26 (25%) patients, respectively. An inverse correlation was observed between the number of quadrants with anatomic distortion and the number of quadrants with contrast (P < 0.001). Long-lasting pain relief was noticed in nine of nine patients (100%; 95% confidence interval, 66-100) with contrast in four-quadrants, and in 10 of 21 patients (48%; 95% confidence interval, 26-70) with contrast in 3 quadrants (P < 0.01). None of the 75 patients with contrast in two quadrants or one quadrant experienced long-lasting pain relief.

CONCLUSIONS

These findings suggest that, using the single-needle anterior approach, the neurolytic spread in the celiac area is highly hampered by the regional anatomic alterations. It also appears that only a complete (four quadrants) neurolytic spread in the celiac area can guarantee long-lasting analgesia, and that this picture may be obtained in a very limited fraction of patients with regional anatomic alterations.

Abrikossoff's tumor

Abrikossoff's tumor is a disease that more commonly affects the oral cavity but can also occur at other sites. It develops between the second and sixth decades of life, more frequently among women and blacks. The neoplasm can affect all parts of the body. The head and neck areas are affected in 45% to 65% of cases and of these, 70% are located interorally (tongue, oral mucosa, hard palate). The benign form shows polygonal cells with granular, eosinophilic cytoplasm and small nuclei. The malignant form, however, is associated with a high mitotic index and pleomorphic cellular tissue. The clinical aspect of the neoformation is a swelling covered by mucus of normal appearance. Studies of the neoformation show that in addition to the objective examination, further instrumental research is necessary, i.e., with nuclear magnetic resonance or computed tomography with contrast CT scan. However, the only examination that can confirm the clinical diagnosis is the histological examination. The only treatment for Abrikossoff tumor is surgery. The surgical treatment provides for an extirpation of the neoformation with the overhanging mucus and the underlying periosteum. In this work, the authors discuss a case of Abrikossoff tumor affecting the mucus of the right side of the hemipalate in a 53-year-old patient and present a review of the literature.

Serum cholesterol and lipid peroxidation are decreased by melatonin in diet-induced hypercholesterolemic rats

The purpose of this study was to investigate the effect of melatonin, at pharmacological doses, on serum lipids of rats fed with a hypercholesterolemic diet. Therefore, different groups of animals were fed with either the regular Sanders Chow diet or a diet enriched in cholesterol. Moreover, animals were treated with or without melatonin in the drinking water for 3 months. We show that melatonin treatment did not affect the levels of cholesterol or triglycerides in rats fed with a regular diet. However, the increase in total cholesterol and low-density lipoprotein (LDL)-cholesterol induced by a cholesterol-enriched diet was reduced significantly by melatonin administration. On the other hand, melatonin administration prevented the decrease in high-density lipoprotein (HDL)-cholesterol induced by the same diet. No differences in the levels of very low-density lipoprotein (VLDL)-cholesterol and triglycerides were found. We also found that melatonin administration slightly decreased serum uric, bilirubin and increased serum glucose levels. Other biochemical parameters, including total proteins, creatinine, urea, phosphorus, calcium, glutamic oxalacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), gamma-glutamyltranspeptidase (gamma-GT), acetyl cholinesterase (AcCho), and alkaline phosphatase (ALP) were not modified by melatonin treatment. Finally, lipid peroxidation (LPO) was studied in membranes of liver, brain, spleen, and heart as an index of membrane oxidative damage. Results show that hypercholesterolemic diet did not modify the LPO status in any of the tissues studied. However, chronic melatonin administration significantly decreased LPO. Results confirm that melatonin participates in the regulation of cholesterol metabolism and in the prevention of oxidative damage to membranes.

Pulmonary involvement in tuberous sclerosis complex: presentation of a case

A clinical case of a pulmonary involvement in Tuberous Sclerosis Complex is reported. This rare involvement (1%) is characterized by either interstitial disease or bullae; therefore, pneumothorax is likely to happen in lung parenchyma. Furthermore this complication induces a progressive serious respiratory failure until the death of the patient.

Temporomandibular joint biomechanical restrictions: the fluid and synovial membrane

The authors analyze the functions of the synovial membrane and the chemical-physical properties of synovial fluid. In particular they evaluate the role played by synovial fluid in the complex mechanism of the temporomandibular joint. Every single part that belongs to the temporomandibular joint, together with the stomatognathic apparatus, plays a specific and particular role according to the dynamics and to the preservation of the correct temporomandibular joint physiology. The physiological postural and functional relationship between the various parts of the temporomandibular joint is guaranteed by a number of biomechanical restrictions that lead and influence the regular execution of the articular movements. The most involved biomechanical restrictions in the temporomandibular joint are the temporomandibular ligament, the lateral disc ligament, the bilaminar zone or retrodiscal tissue, the synovial membrane, and the synovial fluid.

Pharmacokinetic and pharmacodynamic effects of high-dose continuous intravenous verapamil infusion: clinical experience in the intensive care unit

OBJECTIVE

Our study aimed at evaluating the pharmacokinetic, cardiovascular, and metabolic effects of high-dose verapamil continuous intravenous infusion in cancer patients.

DESIGN

Prospective clinical and pharmacokinetic study.

SETTING

Intensive care unit of a Cancer Research Institute.

PATIENTS

Nine patients (age range 31 to 57 yrs) with progressive cancer disease and without cardiovascular, renal, or hepatic dysfunctions.

INTERVENTIONS

After a loading dose (0.15 mg/kg followed by 12 hrs of continuous intravenous infusion at 0.20 mg/kg/hr), the infusion rate of verapamil was increased every 24 hrs (0.25, 0.30, 0.35, and 0.40 mg/kg/hr). The highest rate was maintained for 48 hrs. Doxorubicin was given from the 60 th to the 108 th hr. Hydrochlorothiazide (25 mg/day) and potassium (36 mmol/day) were given orally. Altogether, 17 courses were completed.

MEASUREMENTS AND MAIN RESULTS

Steady state concentration (C(SS) and systemic clearance of verapamil and nor-verapamil (active metabolite) for each infusion rate were calculated. Mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), PR, QT and QTc intervals, and left ventricular ejection fraction (LVEF) were measured, as well as daily body weight, blood glucose and potassium. C(SS) of verapamil and nor-verapamil increased more than proportionally to the infusion rate (p<.001). Systemic clearance of verapamil decreased over the range of the infusion rate (p<.005). MAP and HR decreased at the 12th hr (p<.001) and then plateaued. CVP increased (p<.01). The relationship between MAP, HR, CVP, and verapamil plasma concentrations was significant (r2 = .25, .14, and .35, respectively; p<.0001). LVEF did not change. Six patients (11 courses) developed junctional rhythm. Three patients (six courses) showed a PR interval increase (p<.05). Patients with junctional rhythm had higher Css of verapamil (p<.009). Overall, QT and QTc intervals increased (p<.01). A linear relationship was observed between verapamil plasma concentrations and QT intervals (r2 = .09, p<.01). Cardiovascular side effects did not determine treatment withdrawal in any patient. Body weight, blood glucose, and potassium did not show significant changes.

CONCLUSIONS

Our data suggest a capacity-limited clearance of high-dose verapamil. In the absence of heart disease, following a step by step increase of the dosage, the high plasma verapamil concentrations (617 to 2970 ng/mL) produce frequent but well tolerated hemodynamic and electrocardiogram changes.

Rotary tangential spray technique for aqueous film coating of indobufen pellets

Indobufen pellets, previously prepared by direct pelletization employing the rotary tangential spray fluidized bed (Rotoprocessor), were coated using the same equipment setup as for the film coating process. Different amounts of the aqueous-based ethylcellulose dispersion (Aquacoat) were easily applied on the active cores of different compositions with no spray blocking or pellet sticking. The coating process was not influenced by changing the ethylcellulose (Aquacoat ECD-30) formulation with soft acrylic resin (Eudragit NE 30D) or by adding water-soluble polymers (Pharmacoat 606 and PEG 6000) to the coating dispersions. Simple setup, flexibility of operation, and short manufacturing times were the advantageous features of the tangential spray equipment. These benefits were verified during the pellet coating process. The composition of the cores and membranes were confirmed as the determining parameters with respect to the performances in terms of the drug release rate. The morphological and functional results clearly demonstrated the tangential spray rotary system as a promising one-step technique for the preparation of indobufen prolonged-release multiple-unit dosage forms.

Randomized trial of 5-fluorouracil and high-dose folinic acid with or without alpha-2B interferon in advanced colorectal cancer

We evaluated the role of low-dose alpha-2b interferon, added to chemotherapy, for advanced colorectal cancer; we randomized patients, to either a combination chemotherapy of 5-fluorouracil (5-FU) and high-dose folinic acid (HDFA) or the same regimen plus interferon. Between January 1990 and March 1992, 100 untreated patients (PTS) with advanced colorectal cancer, 53 men and 47 women, with an ECOG performance status (PS) of < or = 3, were randomized to either HDFA 200 mg/m2 iv bolus and 5FU 370 mg/m2 in 15-min iv infusion days 1-5 every 4 weeks (arm A), or the same chemotherapy plus IFN 3 x 10(6) IU subcutaneously three times a week in chemotherapy intervals (arm B). A total of 97 PTS are evaluable for response, toxicity, and survival; 3 PTS are not evaluable in arm B for major protocol violations. PTS characteristics were well balanced in both arms for age (median, 64 years), disease-free survival, and disease site. ECOG PS was 0 in 28% of PTS in arm A and in 13% in arm B. Response rates were as follows: arm A, 40%; and arm B, 23%. Median time to failure was as follows: 10.2 months arm A versus 9 months arm B. Median survival was as follows: 13.3 months arm A versus 10.9 months arm B. Grade 3 haematological toxicity was 9% of PTS in both arms. Gastrointestinal toxicity was as follows: 17% arm A versus 22% arm B. The cost of drugs expressed per m2/month was $60 in arm A and $390 in arm B. The results show that IFN at the schedule and doses employed adds no benefit to the combination of 5FU/HDFA.

Effect of Tolrestat on oesophageal transit time and cholecystic motility in type 2 diabetic patients with asymptomatic diabetic neuropathy

The aim of the present study was to investigate the influence of Tolrestat, an aldose-reductase inhibitor, on both oesophageal and cholecystic motility in Type-2 diabetic patients with asymptomatic diabetic neuropathy. Sixty-six patients were randomly assigned to receive Tolrestat 200 mg once daily (33 patients) or were left without specific treatment (33 patients) for 12 months. Efficacy and safety evaluation were done at 4.5 and 12 months by persons blinded to the patient treatment regimen. Scintigraphic evaluation of oesophageal motility showed significant changes in transit time for Tolrestat at 12 months (p < 0.001). There was no significant effect of Tolrestat on cholecystic function in cholecystography, although diabetic patients taking Tolrestat showed a trend toward improvement. The vibration perception threshold at two sites of the dominant leg improved by at least 3 volts in the Tolrestat group and remained unchanged or slightly deteriorated in the control group. Tendon reflexes and blood pressure fall after standing were improved in the Tolrestat group. In conclusion, one-year treatment with Tolrestat significantly improved oesophageal motility and vibration perception in Type-2 diabetic patients with asymptomatic diabetic neuropathy.

Primary pulmonary hypertension in a HIV+ patient

Recent reports have suggested a possible association between HIV infection and primary pulmonary hypertension (PPH). We report the case of a HIV+ patient, without manifestations of the acquired immune deficiency syndrome (AIDS), who presented with signs of elevated pulmonary arterial pressure.

[Cigarette smoking and hormonal changes in the course of the menstrual cycle]

ACTH, cortisol and PRL plasma levels were determined on day 7, 14, and 21 of the menstrual cycle in 20 females with hypertrichosis of whom 10 were smokers and 10 non-smokers. Significantly raised levels of all hormones considered were found in smokers throughout the cycle. These findings suggest a possible relationship between objective symptoms (hypertrichosis) and nicotine, mediated by complex changes in the endocrine pattern and presumably also due to the action of nicotine on the central nervous system.

A multicenter double-blind study comparing lovastatin and gemfibrozil in the treatment of primary hypercholesterolemia

The efficacy and tolerability of lovastatin and gemfibrozil were compared in a randomized double-blind 12-week study including 182 patients with primary hypercholesterolemia, from 7 hospitals in Spain. Inclusion criteria were total-cholesterol of at least 250 mg/dl and triglycerides less than 350 mg/dl. Patients were stratified in two groups: group 1, cholesterol less than 300 mg/dl, and group II, cholesterol equal to or more than 300 mg/dl. Patients were randomized to gemfibrozil (600 mg b.i.d.) or lovastatin (20 mg q.p.m., group I and 40 mg q.p.m., group II). If after 6 weeks of treatment cholesterol remained above 200 mg/dl, lovastatin does were doubled. In group I, lovastatin decreased cholesterol by 20%, LDL-C by 28%, and triglycerides by 17%, and increased HDL-C by 8%. In group II the results were: -26%, -33%, -19% and +6% respectively. The corresponding results with gemfibrozil were: -8%, -9%, -28% and +14% (group I); and -13%, -14%, -33% and +9% (group II). In both groups, lovastatin was more effective in reducing cholesterol and LDL-C (P less than 0.001) and gemfibrozil in reducing triglycerides (P less than 0.05 group I and P less than 0.01 group II). Both drugs were well tolerated. Thus, lovastatin and gemfibrozil are effective lipid-lowering agents; lovastatin has more pronounced effects in patients with hypercholesterolemia.

Influence of physical activity on gastric emptying of liquids in normal human subjects

Liquid gastric emptying has been evaluated in 17 normal human subjects during basal conditions, after mild physical stress at 50% of the maximum predictable heart rate, and after maximal physical stress at 70% maximum heart rate. Each subject exercised on a treadmill for 30 min, its speed and inclination varied in order to obtain the desired heart rate. Immediately after the exercise, 400 ml of mineral water were drunk by each subject. Gastric emptying was evaluated by real-time ultrasonography (11 subjects) and scintigraphy (six subjects) through previously described methods. The results show similar data with both techniques. Gastric emptying of the water, considered either as reduction in gastric measurements at ultrasonography or decay in radioactivity in the region of interest corresponding to the stomach at scintigraphy, follows a linear relationship under basal conditions and during physical stress. Compared with basal conditions, gastric emptying of water after maximal stress was prolonged; after mild stress, gastric emptying of the water was accelerated. These findings may support the common belief that mild physical activity favors the digestive process.

Salt and water retention and calcium blockade in uremia

Blood pressure, echocardiography, and aortic and peripheral arterial pulse-wave velocity were studied in 40 hypertensive patients on long-term hemodialysis during a 24-week administration of nitrendipine (1,4-dihydro-2,6-dimethyl-4-[m-nitrophenyl]-3,5-pyridine-dicarboxylic acid ethyl methylester) monotherapy. In a double-blind placebo-randomized study, nitredipine effectively lowered the blood pressure (p less than 0.001) before hemodialysis without causing postdialysis hypotension. The antihypertensive effect of nitrendipine was greater in patients with significant salt and water retention, as indicated by interdialytic body weight gain (delta BW), that is, a significant correlation was observed between delta BW and the decrease in blood pressure (r = 0.72; p less than 0.001). The antihypertensive effect was not related to age, pretreatment plasma renin activity, or serum-ionized calcium concentration. After nitrendipine, a time-related decrease in aortic (p less than 0.005) and femoral (p less than 0.05) pulse-wave velocity was observed with a significant time-treatment interaction (p less than 0.01). Nitrendipine treatment did not influence left ventricular mass (which was positively correlated with delta BW; p less than 0.01) but was associated with an increase in the left ventricular ejection fraction. The increase in ejection fraction was correlated with changes in aortic pulse-wave velocity (r = 0.548; p less than 0.02) but not with changes in blood pressure (r = 0.352; p = 0.19) or delta BW.(ABSTRACT TRUNCATED AT 250 WORDS)

Association between aluminum accumulation and cardiac hypertrophy in hemodialyzed patients

In order to investigate the possible role of aluminum accumulation on the myocardium, 50 stable asymptomatic hemodialysis patients were studied. Patient cardiac status was assessed by echocardiography. A deferroxamine (DFO) test, together with a bone biopsy, was performed to determine the magnitude of AI accumulation. Thus, an increase in serum AI after DFO (delta AI DFO) and stainable cortical bone aluminum (SCBA) were taken as parameters of AI load. Fourteen of 50 patients had no SCBA. They differed from the 36 patients with SCBA in that they had lower left ventricular mass (LVM) (P less than 0.001), increased velocity of circumferential fiber shortening (Vcf) (P less than 0.001), and higher mitral E-F slope (P less than 0.01). In the overall population there was a mild increment in serum AI and in delta AI DFO. The duration of dialysis treatment was correlated with SCBA and delta AI DFO (P less than 0.001). A correlation was observed between LVM and delta AI DFO (P less than 0.001) and between LVM and SCBA (P less than 0.001). Multivariate correlations analysis indicated that these relationships were independent of the duration of dialysis treatment. The present data suggest that, in hemodialysis patients aluminum accumulation may be associated with increased LVM.

Auditory and somatosensory evoked potentials in brain-dead patients

The short latency evoked potentials, allowing to assess the brain stem's function, can supply useful information in the diagnosis of Brain Death (BD). 15 BD patients were submitted to the auditory brain stem response (ABR); in 7 cases somatosensory evoked potentials from the medial nerve (SEP) were also recorded. The ABR was absent in 11 cases (73.3%), while in 3 cases only the I wave was present (20%); in one case the low-voltage I-V waves were present. Regarding the SEP, in 3 cases (42.9%) only the N9-N13 and P9-P13 waves were present, while in another 3 cases (42.9%) a N13/P13 dissociation was observable. In the remaining case, which presented a still reproducible I-V interval, the SEP was normal, thus excluding the diagnosis of BD. The ABR and the SEP, which are not roughly influenced by general anaesthetics and sedatives, are thus helpful in diagnosing BD. The SEP seems able to supply useful information more frequently than the ABR, but their combined use can guarantee maximum security of excluding false positives.

Secondary hyperparathyroidism and cardiac hypertrophy in hemodialysis patients

Echocardiographic assessment of left ventricular function was performed in 66, stable hemodialysis patients and 50 normal controls matched for sex, age and arterial blood pressure. On the basis of bone histology, hemodialysis patients were classified into two groups: (1) patients with normal bone resorption; and (2) patients with active secondary hyperparathyroidism characterized by an increased bone resorption. Left ventricular function of these two subgroups were compared together as well as with the echocardiographic characteristics of normal controls. In comparison with normal controls, hemodialysis patients with normal bone resorption had an increased left ventricular volume (P less than 0.001) and left ventricular mass (P less than 0.001) with a similar left ventricular mass-to-volume ratio. Their systolic arterial pressure--mass-to-volume ratio correlation was similar to that of normal controls, indicating an adequate myocardial hypertrophy. Patients with increased bone resorption had high parathormone and alkaline phosphatase levels; though the left ventricular dilation was similar to that of hemodialysis patients with normal bone resorption, the left ventricular mass was lower (P less than 0.001) and was similar to the left ventricular mass of normal controls. In addition, patients with increased bone resorption had a lower mass-to-volume ratio (P less than 0.001) and their systolic arterial pressure--mass-to-volume ratio correlation exhibited a significant downward shift (P less than 0.001), suggesting an inadequate myocardial hypertrophy. Patients with increased bone resorption and secondary hyperparathyroidism had an increased heart rate, a higher systolic arterial pressure and end-systolic stress. Furthermore, they had an increased velocity of fiber shortening (P less than 0.01) and shorter left ventricular ejection time (P less than 0.001). In summary, present data suggest the possibility that parathormone may exert myocardial effects in hemodialysis patients.

Uremic cardiomyopathy: an inadequate left ventricular hypertrophy

Echocardiographic study of the left ventricle was performed in 57 selected, normotensive hemodialysis patients in comparison to 40 healthy controls matched for sex, age and blood pressure. The statistically significant abnormalities in uremic patients were an enlargement of the left ventricular end-diastolic diameter (LVEDiD) (5.58 +/- 0.60 vs. 5.05 +/- 0.5 cm; P less than 0.001) and an increase in the left ventricular radius to posterior wall-thickness ratio (r/Th) (3.65 +/- 0.68 vs. 3.27 +/- 0.44; P less than 0.001). Enlargement of the ventricle was related to anemia (P less than 0.001) and the hemodynamic effect of arteriovenous fistula. Ventricular radius to wall thickness ratio was inversely related to systolic arterial pressure in controls (P less than 0.001) and patients (P less than 0.01) with a significant upward shift of the regression in dialysis patients (P less than 0.001). In dialysis patients, the left ventricular posterior wall thickness (LVPWT) was inversely correlated to serum parathormone (PTH) level (P less than 0.001), and r/Th ratio was positively correlated to serum PTH (P less than 0.001). Bone biopsy was performed in 28 patients. Histomorphometric indexes of osteitis fibrosa were in dialysis patients, correlated to echocardiographic abnormalities; osteoclasts number was inversely correlated to LVPWT (P less than 0.001) and positively related to r/Th ratio (P less than 0.001). Osteoclastic resorption surfaces and LVPWT were inversely correlated (P less than 0.001), while a positive correlation between r/Th ratio and osteoclastic resorption surfaces was observed (P less than 0.001). Osteoblastic surfaces and tetracycline double-labeled surfaces were also correlated to LVPWT (P less than 0.001) and r/Th ratio (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Histo-radiologic correlations in patients with primary hyperoxaluria]

The use of new dialythic technics has increased the survival times for patients with primary hyperoxaluria. From here the possibility of visualizing X-rays signs specific of oxalosis besides the typical bone lesions of hyperparathyroidism secondary to chronic renal failure. Recent hysto-pathological studies allowed to correlate such radiological findings to a new pathogenetical mechanism that would be responsible of the bone lesion specific for oxalosis and that might be caused by the presence of reabsorption cavities made up by macrophagic cells fagocyting cristals.