Use of long-acting somatostatin analog, lanreotide, in neuroendocrine tumors

Somatostatin and its analogues have been reported highly effective in reducing the clinical syndrome in endocrine tumours. The effects of a long-acting analogue of somatostatin, lanreotide, were evaluated in 10 patients with neuroendocrine tumours. In patients with carcinoid tumour, a relief of flushing was achieved in 7 of 8 patients, of diarrhoea in 7 of 7 patients and of bronchoconstriction in 2 of 2 patients. In 5 of 8 patients there was a decrease of more than 50% of 5-hidroxyindolacetic acid excretion. The activity on tumour size was assessed in all the patients. No objective responses were observed. The tolerance to lanreotide was excellent. For the high symptomatic effect and mild toxicity lanreotide seems to be an appropriate treatment in symptomatic patients.

Endocrine treatment of prostate cancer: standard treatment and new perspectives

The hormonal treatment of advanced prostate cancer is still a controversial matter although new drugs are being tested in clinical trials all over the world. The results of these trials are the subject of dispute for reasons related to the natural history and clinical evolution of prostate cancer.

[Therapeutic use of metadoxine in chronic alcoholism. Double blind study of patients in a department of general medicine]

Sixty patients, recognized as chronic alcoholics on the grounds of the case history and with a score above 11 of the Munich Alcoholism Test (MALT) have been treated with metadoxine or placebo for thirty days according to a double blind randomized design. In the group treated with active drug there has been a significant reduction higher than in the controls of the scores relating to the abstinence symptomatology, in particular regarding the neuropsychic residual symptomatology (anxiety, depression, insomnia) after the first week of treatment, a reduced requirement of benzodiazepines and/or neuroleptics, and a significant decrement higher than in the controls of the score of MALT at the end of treatment. Furthermore, metadoxine seems to make easy the maintenance of abstinence, at least at short term.

The impact of received dose intensity on the outcome of advanced ovarian cancer

It has been demonstrated that the prognosis of ovarian cancer is influenced by the dose intensity of cytotoxic treatment. The impact of received dose intensity of platinum-based combination chemotherapy on disease outcome was analysed in 226 stage III-IV ovarian cancer patients entered into two prospective randomised trials. All patients received either cisplatin or carboplatin and cyclophosphamide with or without doxorubicin for six courses after primary surgery. The impact of the received dose intensity of each drug (RDI), the average received dose intensity of the treatment regimen (ARDI) and the relative total drug dose (RTD) on progression-free survival (PFS) and survival were analysed. In the 198 patients receiving the full six courses of treatment, RDI of cisplatin or carboplatin, ARDI and RTD were > 0.76 in 74.2, 61.1 and 65.1% of cases, respectively. Although the differences were not significant, pathological complete response was more frequently observed in the group of patients with ARDI < 0.75, whereas the partial response rate was higher in the ARDI > or = 0.76 group. Median survival and PFS were 19 and 13 months; 22 and 10 months; 23 and 13 months for the groups of patients receiving chemotherapy at a ARDI of < 0.75, > or = 0.76-0.99 and > 1.00, respectively (P = not significant). It appears that modest dose modifications and brief treatment delays during first-line platinum-based chemotherapy do not affect response rate, survival and PFS in advanced ovarian cancer patients.

Goserelin acetate with or without flutamide in the treatment of patients with locally advanced or metastatic prostate cancer. The Italian Prostatic Cancer Project (PONCAP) Study Group

From March 1987 to December 1990, 373 patients with stage C and D prostate cancer were randomized to receive either goserelin acetate alone or goserelin acetate plus flutamide. At a median follow-up time of 24 months, there was no significant difference in the response rate, progression-free and overall survival between the two treatment groups. In particular, median time to progression was 18 months in the goserelin arm and 24 months in the combined treatment arm (P = 0.09). However, median time to progression in stage D patients was 12 months in both treatment groups. Median time to death was 32 and 34 months, respectively. The combination regimen produced a more rapid normalisation of prostatic acid phosphatase levels and a prompt relief of bone pain. However, significantly more patients in the combination arm experienced treatment-related side-effects such as diarrhoea and increases in transaminase levels. The concurrent use of goserelin acetate and flutamide does not seem to significantly improve the results that can be achieved with goserelin acetate alone.

[Evolution of the bacteria responsible for surgical infection. n 8-year study in our department]

Since 1981 we monitored all the bacteria strains isolated from patients bearing a surgical infection and hospitalized in our department. We also tested the susceptibility of the isolated strains to different antibiotics. The observed results at three different intervals (1981, 1984, 1987-1988) reveal an increase in Gram+strains. Among the tested antibiotics Imipenem and Amikacin showed the highest antibacterial activity in recent years (1987-1988).

[Sulbactam-ampicillin in surgery. Our experience]

The bacterial infections constitute a serious problem for the surgeon: the choice of antibiotic drugs is really important and, as often as possible, should be guided by antibiotic sensitivity tests. In this study we used sulbactam-ampicillin (Unasyn) who is an antibiotic combination between sulbactam, inhibitor of beta lactam and ampicillin. The preliminary results were as follows: Unasyn was administered to 21 hospitalized selected patients, 16 women and 5 man, who had clinical signs of intraabdominal infection, wound infection and subphrenic abscess after digestive surgery. In these patients were isolated the following organisms: Staphylococcus epidermidis (8), Staphylococcus aureus (11), serratia (1), streptococcus (3), E. coli (3). The daily dosage of Unasyn was 3-12 g/die administered in three to four divided doses, and was determined by the severity of infection, the antibiotic susceptibility of the causative organism(s) and the condition of the patient. Each dose was given by slow i.v. infusion in 15-30 minutes. Our success rate was 100%, and neither systemic nor local side effects were recorded.

Vaccination of pregnant cynomolgus monkeys with whole formalin-inactivated SIVmac251

Five pregnant (two to three and one-half months) Macaca fascicularis seroconverted following immunization with sucrose-gradient purified and formalin-inactivated whole simian immunodeficiency virus (SIVmac251). No untoward effects on fetal maturation were observed during the immunization of the mothers. Antibodies to SIVmac251 (also those with in vitro neutralizing activity) were passively transferred to the offspring but disappeared within two to six months after birth. Antibodies to env glycoprotein (gp130) lasted longer than those against viral gag proteins (p26,p60).

Reference blood values of iron metabolism in cynomolgus macaques

Iron deficiency anemia is a human health problem of global significance, particularly as it affects pregnant women and infants. While the study of nonhuman primates has resulted in valuable knowledge about iron metabolism, hematologic and biochemical reference ranges for the parameters of iron metabolism are difficult to document in healthy monkeys. At our institution, we maintain a large breeding colony of healthy cynomolgus monkeys (Macaca fascicularis). Data compiled after sampling nonpregnant females and male members of this colony are presented as reference ranges for red cell number, hemoglobin, hematocrit, mean cellular volume, mean cellular hemoglobin, mean cellular hemoglobin concentration, serum iron, total iron-binding capacity, serum transferrin, and serum ferritin.

The incidence of narcotic-induced emesis

Epidemiologic studies of the incidence of emesis induced by narcotic analgesics are lacking. The histories of 260 cancer patients receiving oral narcotic analgesics prescribed at the Pain Clinic of our Institute from December 1988 to December 1989 were reviewed. Of the 260 patients, 120 were women, median age 61 (range 30-90) yr and 140 were men, median age 62 (range 30-82) yr. Nausea and vomiting associated with assumption of the various narcotics were buprenorphine 8.3% and 22.7%, morphine 18.3% and 28%, codeine 16.2% and 29.7%, and oxycodone 10% and 40%, respectively. Since the use of narcotic analgesics can effectively relieve pain and improve quality of life in cancer patients, it is important to be aware of the incidence of narcotic-induced emesis in order to use appropriate prophylactic antiemetic therapy.

Analysis and purification of DNA restriction fragments by high-performance liquid chromatography

The purification and analysis of restriction fragments play a very important role in molecular biology but the traditional assay methods of DNA fragments, based on gel electrophoresis and caesium chloride gradient centrifugation, are time-consuming and difficult to quantify. High-performance liquid chromatography provides an alternative method which allows the direct quantitation of picogram amounts of eluents in short time. In the present work we report the separation of different restriction fragments, the purification of some fragments and the relationship between the length of double-stranded DNA fragments and peak areas.

Automated high-performance liquid chromatographic assay of enzymatic activities

High-performance liquid chromatography (HPLC) is a powerful technique which enables a reliable and quantitative determination of enzyme activities. The purpose of the work reported here was to develop an automatic assay of enzymatic activity. Using an automatic sample processor and injector, a program was developed which allows the complete automation of each step of analysis (calibration, enzymatic reaction, HPLC determination). This program can be adapted to different experimental requirements as each step can be performed independently and each input (time, volume, number of standards) is made by answering questions asked by instrument. Using this approach both kinetic and single-point determinations can be carried out, and in the latter case different samples can be analysed sequentially. This paper reports the automated analysis of trypsin.

Lonidamine in metastatic breast cancer

Lonidamine belongs to a new class of antineoplastics agents, since it does interfere with cell energy processes. When administered as single agent in metastatic breast cancer, it produces moderate therapeutic effects. The pattern of toxicity includes myalgias, asthenia, testicular pain, and gastrointestinal discomfort. No myelosuppression was demonstrated in phase I-II studies. Since the peculiar mechanism of action and side effects are not overlapping with those of standard chemotherapeutic agents, combination of lonidamine with chemotherapy is currently under investigation in advanced breast cancer. Moreover, the potentiation of radiotherapy by lonidamine could be of interest in palliating symptomatic lesions from breast cancer.

Purification of NAD glycohydrolase from Neurospora crassa conidia by a polyclonal immunoadsorbent

NAD glycohydrolase from Neurospora crassa conidia was purified by affinity chromatography on a column of polyclonal antibodies bound to an agarose matrix. The procedure was easy, non-denaturating and suitable for repetitive use of the gel. The enzyme obtained appeared homogeneous by sodiumdodecyl sulphate-polyacrylamide gel electrophoresis.

Automatic computation of enzyme kinetics by HPLC

Enzyme activity can be easily measured by HPLC using traces of the product itself as an internal standard. Our procedure involved the development of an equation using the experimental data obtained in the kinetic assay. The entire procedure can thus be automated and a computer program is presented here for facilitating the assay and saving time. The determination of the activity of NAD kinase is reported as an example.

[Correlations between laboratory and ultrasonic diagnosis and needle biopsy in chronic hepatitis and alcoholic cirrhosis]

A report is presented on patients admitted to hospital with chronic hepatitis or alcoholic cirrhosis of the liver and subjected to diagnostic laboratory tests, ultrasound scans and needle biopsies both non-surgical and during laparoscopy. The laboratory findings were compared with the results of ultrasound scans and biopsies. It was concluded that the diagnostic accuracy of ultrasound scans is sufficient, when backed by anamnestic clinical and laboratory data, to obviate the need for liver biopsy in cases of chronic hepatitis and alcoholic cirrhosis. Nor is biopsy required for differential diagnosis between the two conditions but should be reserved for the setting of diagnostic uncertainty about cancer-cirrhosis, or the presence of hepatoma, liver metastases, ascites or other oedematous forms. It is concluded that the undoubled diagnostic accuracy of biopsy does not compensate for the risk entailed especially for patients of this type.

Thermal induction and temperature control in the hyperthermic antiblastic regional perfusion with extra corporeal circulation

An optimal treatment temperature choice is based on a compromise between the higher values desirable for best synergic effects between heat and drugs and the lower values required to avoid drug inactivation and tissue damage. Temperature uniformity throughout the limb under treatment favors approaching the highest temperature compatible with the above compromise. Several modifications have been introduced in the methodology during our experience consisting of more than 100 perfusions. The induction of true hyperthermic temperatures (41.5-41.8 degrees C) is achieved both heating the perfusate and directly heating the limb by means of a warm-water circulation blanket, thus insuring an optimal thermal flow to the superficial tissues. Devices in the extra-corporeal circuit have also been adopted to obtain a fast and accurate perfusate temperature control. The following results can be obtained: (a) a short delay time is required to reach the therapeutic temperature range; (b) the perfusate temperature is maintained at a value close to 40 +/- 0.5 degrees C during the whole hyperthermic phase of the treatment; (c) the various districts of the limb are maintained at substantially homogeneous hyperthermic temperature.