Tegafur and uracil plus leucovorin in advanced colorectal cancer: a phase II trial

The objective of this study was to evaluate the activity and toxicity of tegafur and uracil (UFT; 1:4 molar ratio) plus leucovorin (LV) in patients with advanced colorectal cancer. One hundred forty-one patients were entered into the study. The treatment schedule consisted of UFT 300 mg/m2/day (in three divided doses) plus oral LV 150 mg/day (50 mg t.i.d.) over 28 days. The treatment cycle was repeated every 5 weeks until progression or unacceptable toxicity was observed. The treatment was interrupted if grade 3/4 toxicity appeared and was resumed at the same dosage on recovery. One hundred thirty-six patients were evaluable for response and 141 were evaluable for toxicity. The response rate was 19.9% (95% confidence interval: 12%-28%). The total number of patients without progression (objective response + stable disease) was 76 (55.9%). The median time to progression was 5.6 months, and the overall survival was 11.6 months. The toxicity profile was low, with 11% of patients experiencing grade 3/4 nausea and vomiting, while 17% had grade 3/4 diarrhea. Oral administration of UFT modulated with LV is a comfortable regimen of chemotherapy for patients with advanced colorectal cancer.

[Role of tumor necrosis factor-a, nitric oxide and markers of clinical progression in the nutritional status of children with vertically-acquired hiv-1infection]

OBJECTIVE

To study the correlation between the immunologic and virologic markers of clinical progression and the nutritional status of children with vertically acquired HIV-1infection.

MATERIAL AND METHODS

We performed an anthropometric study in 34 HIV-1infected children. T cell subpopulations were analyzed by flow cytometry. Viral load (VL) was quantified by a standard commercial molecular assay. Tumor necrosis factor (TNF-) and nitric oxide (NO) concentrations were quantified by enzyme immunoassay.

RESULTS

Z-weight, Z-height, Z-Quetelet index, Z-tricipital pleat, Z-arm perimeter, Z-cephalic perimeter, and McLaren's nutritional index were negatively correlated with VL. These anthropometric parameters were positively correlated with the percentage of CD4T lymphocytes but the correlation between these parameters and VL was lower. HIV-1infected children with a VL> 5 log 10 showed higher TNF- and NO concentrations and lower anthropometric scores. TNF- and NO concentrations were significantly higher in HIV-1infected children with a VL>5 log 10 than in those with a VL<5 log 10. TNF- and NO concentrations were significantly lower in HIV-1infected children undergoing antiretroviral treatment than in untreated HIV-1infected children. TNF- and NO concentrations were significantly higher in the HIV-1infected children than in the control group.

CONCLUSIONS

Our data suggest an association between anthropometric characteristics indicating the nutritional status of HIV-1infected children and immunologic and virologic markers of clinical progression (percentage of CD 4T lymphocytes and VL). Moreover, TNF- and NO play a significant role in the nutritional status and neurological alterations of these children.

Regulation of Id2 gene expression by the insulin-like growth factor I receptor requires signaling by phosphatidylinositol 3-kinase

The Id proteins play an important role in proliferation, differentiation, and tumor development. We report here that Id gene expression can be regulated by the insulin-like growth factor I receptor (IGF-IR), a receptor that also participates in the regulation of cellular proliferation and differentiation. Specifically, we found that the IGF-IR activated by its ligand was a strong inducer of Id2 gene expression in 32D murine hemopoietic cells. This activation was not simply the result of cellular proliferation, as Id2 gene expression was higher in 32D cells stimulated by IGF-I than in cells exponentially growing in interleukin-3. The up-regulation of Id2 gene expression was largely dependent on the presence of insulin receptor substrate-1, a major substrate of the IGF-IR and a potent activator of the phosphatidylinositol 3-kinase (PI3K) pathway. The role of PI3K activity in the up-regulation of Id2 gene expression by the IGF-IR was confirmed by different methods and in different cell types. In 32D cells, the up-regulation of Id2 gene expression by the PI3K pathway correlated with interleukin-3 independence and inhibition of differentiation.

Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial

OBJECTIVE

To compare chemotherapy given at home with outpatient treatment in terms of colorectal cancer patients' safety, compliance, use of health services, quality of life, and satisfaction with treatment.

DESIGN

Randomised controlled trial.

SETTING

Large teaching hospital.

PARTICIPANTS

87 patients receiving adjuvant or palliative chemotherapy for colorectal cancer.

INTERVENTIONS

Treatment with fluorouracil (with or without folinic acid or levamisole) at outpatient clinic or at home.

MAIN OUTCOME MEASURES

Treatment toxicity; patients' compliance with treatment, quality of life, satisfaction with care, and use of health resources.

RESULTS

42 patients were treated at outpatient clinic and 45 at home. The two groups were balanced in terms of age, sex, site of cancer, and disease stage. Treatment related toxicity was similar in the two groups (difference 7% (95% confidence interval -12% to 26%)), but there were more voluntary withdrawals from treatment in the outpatient group than in the home group (14% v 2%, difference 12% (1% to 24%)). There were no differences between groups in terms of quality of life scores during and after treatment. Levels of patient satisfaction were higher in the home treatment group, specifically with regard to information received and nursing care. There were no significant differences in use of health services.

CONCLUSIONS

Home chemotherapy seemed an acceptable and safe alternative to hospital treatment for patients with colorectal cancer that may improve compliance and satisfaction with treatment.

Age and gender differences in basal and isoprenaline protocols for head-up tilt table testing

AIMS

Syncope is a common occurrence, the prevalence of which increases with age, and among the multiple causes of syncope, neurally mediated syncope is thought to be a frequent cause in the young and in the elderly. Head-up tilt table testing (HUT) has become the diagnostic test of choice for neurally mediated syncope, the response to which varies clearly with age. The purpose of this study is to report the differences among patients suffering syncope referred for HUT, and the influence of age and gender on HUT results (percentage of positive responses and response patterns) in two study protocols (basal and isoprenaline).

METHODS AND RESULTS

One thousand, two hundred and nineteen patients with syncope were referred to the authors' Cardiology Department for HUT from September 1990 to April 2000; 1061 undergoing basal HUT (Group A) and 158 undergoing isoprenaline tilt table testing (Group B). Complications were noted in neither protocol. Females were more frequent among young people, and males in the elderly (P<0.05). Head-up tilt table testing was abnormal in 259 (24.4%) patients in Group A and in 85 (53.7%) patients in Group B (P<0.05), and no gender differences were observed. The positive rate of tests in men and women significantly declined with age in Group A (P<0.05), but not in Group B (P=ns). There were no differences in the patterns of haemodynamic collapse in both groups.

CONCLUSIONS

In the study of syncope, basal HUT has a high positive rate in young people; a decrease in positive rate with age suggests, however, the need for using another protocol with a similar diagnostic accuracy in the elderly.

Limited redundancy of survival signals from the type 1 insulin-like growth factor receptor

The type 1 insulin-like growth factor receptor (IGF-IR) is effective in protecting cells from a variety of apoptotic injuries. In 32D murine hemopoietic cells, the IGF-IR sends three separate survival signals, through insulin receptor substrate-1, Shc, and mitochondrial Raf translocation. We report here that these three pathways for survival have a limited redundancy. If one of these pathways is blocked, the IGF-IR can still protect 32D cells from apoptosis induced by interleukin-3 withdrawal. However, when two of the three pathways are inactivated, the receptor is no longer capable to protect cells from apoptosis. The survival signal can use any two pathway combinations.

[Pregnancy and partum in the woman with a spinal cord lesion in chronic phase]

A 34-year-old pregnant paraplegic woman with a T12 medullary lesion in chronic phase underwent cesarean delivery in the thirty-seventh week due to pelvic-cephalic disproportion. After failure of epidural anesthesia related to technical difficulties, general anesthesia was provided. A hypertensive crisis developed during surgery but was resolved within minutes after administration of hydralazine. No further complications arose. Pregnancy in a patient with medullary lesion in chronic phase is considered high risk, requiring special care due to extraordinary changes in pathophysiology caused by the lesion in addition to changes directly related to gestation. The main complications that arise are decreased respiratory volume and arterial pressure, increased incidence of thromboembolic events, anemia, urinary tract infections, premature birth, unusual progression of delivery and autonomic hyperreflexia, which is the most serious. When a hypertensive peak develops in such patients, the anesthesiologist must first rule out autonomic hyperreflexia, which has an incidence of 85% in lesions over T7 and has also been described in patients with lower lesions.

Membranous nephropathy associated with hepatitis B in Spanish children

AIM

To examine retrospectively long-term evolution and treatment of pediatric membranous nephropathy (MN) cases associated with hepatitis B (HB) in the hospital "La Paz".

MATERIAL AND METHODS

The clinical records of 12 children diagnosed with HB-associated MN in our hospital between 1970 and 1996.

RESULTS

All patients were positive for hepatitis B surface antigen (HBsAg); 6 were tested for hepatitis Be antigen (HBeAg) and were also positive. At onset, all of them had proteinuria (8 in nephrotic range), 6 had microscopic hematuria and 4 macroscopic hematuria. Seven of 8 children who started with a nephrotic syndrome received steroids and all of them were steroid-resistant. After 9.95 +/- 5.88 years of follow-up, renal function remained normal and proteinuria and hematuria have disappeared in all of them. A family study for hepatitis B was carried out in 8 cases and 7 of them were positive. Only in one case vertical transmission was demonstrated; this patient remained HBeAg positive. In 7 patients, hepatic biopsy was performed: 3 had a chronic active hepatitis, 3 a persistent chronic hepatitis and one a residual acute hepatitis.

CONCLUSIONS

Membranous nephropathy is a rare pediatric disease in our area and most of the cases are related to hepatitis B (HB). The outcome was excellent with and without treatment but all of them remained HBsAg positive.

Diabetes insipidus revealing acute myelogenous leukaemia with a high platelet count, monosomy 7 and abnormalities of chromosome 3: a new entity?

We describe three cases of acute myeloid leukaemia revealed by diabetes insipidus. The patients were 42, 38 and 39 yr old and they had marked hyperleukocytosis, circulating immature granular cells and a normal or elevated platelet count. The leukaemia was type AML-M2 according to the FAB classification. Cytogenetic studies showed inversion of chromosome 3 (q21;q26) in 2 cases and a translocation (3;3)(q21;q29?) in the remaining case, both associated with monosomy 7. All the cerebral CT scans were normal. Complete remission was never achieved, and all three patients survived less than 14 months. Desmopressin therapy was active but treatment could not be reduced. The association of dysmegakaryopoiesis with a chromosome 3 abnormality and diabetes insipidus is probably not fortuitous and could represent a new entity.

Role of the endogenous cannabinoid system as a modulator of dopamine transmission: implications for Parkinson's disease and schizophrenia

The endogenous cannabinoid system is a new signaling system composed by the central (CB1) and the peripheral (CB2) receptors, and several lipid transmitters including anandamide and 2-arachidonylglycerol. This system is the target of natural cannabinoids, the psychoactive constituents of Cannabis sativa preparations (marijuana, hashish). Acute and chronic cannabis exposure has been associated with subjective feelings of pleasure and relaxation, but also to the onset of psychiatric syndromes, a decrease of the efficacy of neuroleptics and alterations in the extrapyramidal system regulation of motor activity. These actions point to a tight association of the cannabinoid system with the brain dopaminergic circuits involved in addiction, the clinical manifestation of positive symptoms of schizophrenia and Parkinson's disease. The present work discusses anatomical, biochemical and pharmacological evidences supporting a role for the endogenous cannabinoid system in the modulation of dopaminergic transmission. Cannabinoid CB1 receptors are present in dopamine projecting brain areas. In primates and certain rat strains it is also located in dopamine cells of the A8, A9 and A10 mesencephalic cell groups, as well as in hypothalamic dopaminergic neurons controlling prolactin secretion. CB1 receptors co-localize with dopamine D1/D2 receptors in dopamine projecting fields. Manipulation of dopaminergic transmission is able to alter the synthesis and release of anandamide as well as the expression of CB1 receptors. Additionally, CB1 receptors can switch its transduction mechanism to oppose to the ongoing dopamine signaling. Acute blockade of CB1 receptor potentiates the facilitatory role of dopamine D2 receptor agonists on movement. CB1 stimulation results in sensitization to the motor effects of indirect dopaminergic agonists. The dynamics of these changes indicate that the cannabinoid system is an activity-dependent modulator of dopaminergic transmission, an hypothesis relevant for the design of new therapeutic strategies for dopamine-related diseases such as the psychosis and Parkinson's disease.

The diabetic nephropathy and the development of hypertension in rats

The present study was designed to examine the development of hypertension in diabetic rats treated with streptozotocin (STZ, 1 mg/g bw). The rats were studied at 3, 6, 9, 12 and 15 weeks. From the third week the rats were divided in diabetic rats according their glycemias and controls, along 15 weeks. After the third week a group of rats showed increased urinary protein excretion (93, 134, 155 and 191%) compared to controls. In this group of rats the urinary kallikrein excretion was lower than control and the systolic blood pressure became significantly elevated between 3 and 6 weeks and persisted up to 15 weeks. On the other hand a group of diabetic rats were normotensive with urinary protein excretion similar to controls and urinary kallikrein lower compared to control but significantly higher compared diabetic hypertensive rats. These data suggest that the association of progressive diabetic nephropathy with abnormal endothelium-dependent vasodilation may produce a high prevalence of hypertensive diabetes.

cFos induction during conditioned taste aversion expression varies with aversion strength

Fos-like immunoreactivity (FLI) can indicate the location of neurons activated following expression of conditioned taste aversion (CTA). After one conditioning trial FLI has been identified in the intermediate nucleus of the solitary tract (iNTS) with little expression in other brain regions. The present study assessed the effect of increasing aversion strength on the magnitude and anatomical distribution of FLI during CTA expression. When animals received three rather than one conditioning trial, significant FLI was seen not only in the iNTS but also in the parabrachial nucleus (PBN), and the central nucleus of the amygdala (CNA), regions thought to be important in taste aversion learning.

The molecular karyotype of the megabase chromosomes of Trypanosoma brucei stock 427

We present the molecular karyotype of the megabase chromosomes of Trypanosoma brucei stock 427, clone 221a. This cloned stock is most commonly used in research laboratories in genetic manipulation experiments and in studies of antigenic variation. Using 116 previously characterised chromosome-specific markers, we identify 11 diploid pairs of megabase chromosomes and detect no loss of synteny in EST and gene marker distribution between this stock and the genome project reference stock TREU 927/4. Nevertheless, the chromosomes of 427 are all larger than their homologues in 927, except chromosomes IIa and IXa. The greatest size variation is seen in chromosome I, the smallest of which is 1.1 Mb (927-Ia) and the largest 3.6 Mb (427-Ib). The total nuclear DNA content of both stocks has been estimated by comparison of the mobility of T. brucei and yeast chromosomes. Trypanosomes of stock 427 contain approximately 16.5 Mb more megabase chromosomal DNA than those of stock 927. We have detected the presence of bloodstream-form expression-site-associated sequences on eight or more megabase chromosomes. These sequences are not found on the same chromosomes in each stock. We have determined the chromosomal band location of nine characterised variant surface glycoprotein genes, including the currently expressed VSG 221. Our results demonstrate both the stability of the T. brucei genome, as illustrated by the conservation of syntenic groups of genes in the two stocks, and the polymorphic nature of the genomic regions involved in antigenic variation. We propose that the chromosomes of stock 427 be numbered to correspond to their homologues in the genome project reference stock TREU 927/4.

Towards guidelines for dialysis in children with end-stage renal disease

There are few data describing the current practices of treatment selection for children with end-stage renal disease (ESRD). In an effort to establish a consensus among Spanish pediatric nephrologists for inclusion and exclusion criteria for renal replacement therapy in children with ESRD, in 1995 we surveyed members of the Spanish Pediatric Nephrology Association. Although only 43% of members responded, pediatric nephrologists and bioethicists studied the results and compiled a list of ten guidelines for treatment of children with ESRD. The proposed guidelines are meant to be a starting point for further discussion. An emphasis on flexibility, individual case assessment, and consideration of the best interests of the patient must remain central to any treatment plan. Decision making should ideally be shared by parents, professionals, the child, when appropriate, and ethics committees, as necessary.

Antihepatotoxic activity of Rosmarinus tomentosus in a model of acute hepatic damage induced by thioacetamide

R. tomentosus is a vegetal species closely related to the culinary rosemary (R. officinalis), a plant reported to contain antihepatotoxic agents. A dried ethanol extract of the aerial parts of Rosmarinus tomentosus (Lamiaceae) and its major fraction separated by column chromatography (fraction F19) were evaluated for antihepatotoxic activity in rats with acute liver damage induced by a single oral dose of thioacetamide. Silymarin was used as a reference antihepatotoxic substance. Pre-treatment with R. tomentosus ethanol extract, fraction F19 or silymarin significantly reduced the impact of thioacetamide toxicity on plasma protein and urea levels as well as on plasma aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase and gamma-glutamyl transpeptidase activities compared with thioacetamide-treated animals (group T). Pre-treatment with R. tomentosus ethanol extract significantly reduced the impact of thioacetamide damage on alkaline phosphatase and gamma-glutamyl transpeptidase activities compared with group T. Silymarin administration significantly reduced alkaline phosphatase and gamma-glutamyl transpeptidase activities compared with group T. Fraction F19 administration reduced only alkaline phosphatase activity compared with group T. According to these data, R. tomentosus extract shows promising antihepatotoxic activity, suggesting the need to isolate the chemical principles responsible for this activity and to study this activity in a model of thioacetamide-induced cirrhosis.

Primary tuberculous chancre caused by Mycobacterium bovis after goring with a bull's horn

A 14-year-old boy was gored by a bull during festival celebrations. The horn of the bull caused a wound on his left hand and after 3 months it was a accompanied by an ulcerated nodule on the left upper arm and an axillary adenopathy. The tuberculin test was positive and a culture of the aspiration biopsy specimen of the axillary lymph node yielded Mycombacterium bovis.