Conservation of neuron number and size in entorhinal cortex layers II, III, and V/VI of aged primates

Past dogma asserted that extensive loss of cortical neurons accompanies normal aging. However, recent stereologic studies in humans, monkeys, and rodents have found little evidence of age-related neuronal loss in several cortical regions, including the neocortex and hippocampus. Yet to date, a complete investigation of age-related neuronal loss or size change has not been undertaken in the entorhinal cortex, a retrohippocampal structure essential for learning and memory. The aged rhesus macaque monkey (Macaca mulatta), a species that develops beta-amyloid plaques and exhibits cognitive deficits with age, is considered the best commonly available model of aging in humans. In the present study, we examined changes in total neuron number and size in layers II, III, and V/VI of the intermediate division of the entorhinal cortex in aged vs. nonaged rhesus monkeys by using unbiased stereologic methods. Total neuron number was conserved in aged primates when compared with nonaged adults in entorhinal cortex layer II (aged = 56,500 +/- 12,100, nonaged adult = 48,500 +/- 10,900; P = 0.37), layer III (aged = 205, 600 +/- 50,700, nonaged adult = 187,600 +/- 60,300; P = 0.66), and layers V/VI (aged = 246,400 +/- 76,700, nonaged adult = 236,800 +/- 69,600; P = 0.87). In each of the layers examined, neuronal area and volume were also conserved with aging. This lack of morphologically evident neurodegeneration in primate entorhinal cortex with aging further supports the concept that fundamental differences exist between the processes of normal "healthy" aging and pathologic age-related neurodegenerative disorders such as Alzheimer's disease.

Frequency of the prolificacy gene in flocks of Indonesian thin tail sheep: a review

Indonesian thin tail (ITT) sheep have a major prolificacy gene (FecJ(F)), the frequency of which is higher in the new born lambs, than in the remainder of the flock when mating is random, because carrier ewes produce more progeny than do non carriers. The frequency of the gene may vary between flocks, but remains relatively stable in flocks with established husbandry procedures. The countermanding selection pressures maintaining the equilibrium value for the frequency of FecJ(F) are mainly those deriving from higher mortality rates of lambs in larger litters. Embryo survival is not significantly different across the range of ovulation rates in ITT ewes, in contrast to observations in other prolific breeds. Generation intervals and the incidences of metabolic and infectious diseases in ewes carrying larger litters can also affect the frequency of FecJ(F) in flocks. In turn, each of the factors affecting the frequency of FecJ(F) is modulated by the level of nutrition and management in each flock. The distribution of prolificacy genotypes in the ewes of a standard flock is calculated as FecJ(F)FecJ(F)/12; FecJ(F)FecJ(+)/44; FecJ(+)FecJ(+)/44 giving a frequency of 0.34 for FecJ(F). The frequency of FecJ(F) is then 0.43 in the lambs at birth, when their numbers have been amplified in the carrier ewes. There are heavier metabolic demands on ewes carrying larger litters and the foetuses constitute a higher proportion of weight gain during pregnancy. Consequently, more of the lambs of carrier ewes are smaller and weaker at birth, and the reserves of the ewes for colostrum and milk production are depleted. When low lamb survival rates in larger litters are considered, the frequency of FecJ(F) falls to 0.35 in the lambs at weaning in lean years and 0.38 in middling years. At a high level of husbandry, ewe weight gains during pregnancy and lamb survival rates improve substantially, and after 3 years, the frequency of FecJ(F) in the lambs at birth is estimated to have risen to 0.49; and 0.47 at weaning.

Tuberculosis screening of new entrants; how can it be made more effective?

BACKGROUND

The importance of extending TB screening to all new entrants has been shown by the occurrence of cases of active TB and high rates of those needing prophylaxis or BCG protection. TB is particularly likely to be prevalent in populations with large numbers of refugees, but high rates in immigrants have been reported consistently both in this country and elsewhere in Europe.

METHOD

This paper examines possible reasons for a low uptake of screening by immigrants in the United Kingdom and describes initiatives, some of which have already been launched in East London, by which access to screening could be increased.

RESULTS

Screening at the new patient check-up by general practitioners has been shown to be practicable and effective in an East London pilot. This screening method could be expanded throughout East London and is applicable to other areas. Other ways of improving access to screening through other agencies have also been found to be acceptable.

CONCLUSION

No one screening system is likely to be effective and pilots of methods of extending the access to new entrants need to be carried out and evaluated urgently.

Compulsive buying and risky behavior among adolescents

Using a scale designed to measure compulsive buying of adolescents, a survey was conducted to assess the relationships of compulsive buying with several risky behaviors among 111 adolescents between the ages of 12 to 19 years. The correlations suggest that self-report measures of cigarette smoking, alcohol use, drug use, and likelihood of engaging in premarital sex were all significantly associated (rs = .30 to .32) with compulsive buying among teenagers. Implications of the results are discussed, and directions for research are offered.

Measuring social support in pregnancy: can it be simple and meaningful?

BACKGROUND

It is important to determine the level of a woman's social support at the booking-in interview for prenatal care, but measurement tends to be ad hoc and nonquantifiable. The purpose of this study was to describe the Maternity Social Support Scale and the relationship between support scale ratings and the Edinburgh Postnatal Depression Scale and other health and service use outcomes.

METHODS

Women (n = 901) who attended the antenatal clinic at the Royal Women's Hospital in Brisbane, Australia, were asked to complete a support scale as part of their booking-in interview. Participants were contacted at 16 weeks postpartum and invited to complete a follow-up questionnaire. Relationships between the scale and study outcomes were explored using analysis of variance and chi-square tests.

RESULTS

Women with low social support in pregnancy were more likely than well-supported women to report poorer health during pregnancy (p = 0.006) and postnatally (p < 0.001), to book later for prenatal care (p = 0.000), to seek medical help more frequently (p = 0.004), and to be more depressed postnatally (p = 0.0001).

CONCLUSION

Social support during pregnancy can be measured in a meaningful and simple way through the use of a short questionnaire administered at the prenatal booking-in visit.

Enhanced image detail using continuity in the MIP Z-buffer: applications to magnetic resonance angiography

In this paper a new algorithm is presented for the segmentation and display of blood vessels from images obtained with magnetic resonance angiography (MRA) and other three-dimensional (3D) angiographic imaging techniques. The algorithm developed is based on the observation that vessels are strongly evident in the maximum intensity projection (MIP) Z-buffer as regions of high continuity and low local roughness. Roughness is measured here by the minimum chi2 value of a low-order local least-squares fit in the principal directions through each point in the MIP Z-buffer. Although some background pixels in the Z-buffer exhibit low local roughness, the size of the connected region is nearly always much smaller than even the very smallest vessels that appear in the MIP image. It is shown that by applying connectivity to the regions of low roughness, there is nearly complete separation between vascular detail and background. When connectivity is further applied in the original 3D image, vascular bed segmentation becomes nearly complete. The algorithm consists of three basic steps: a) determination of the minimum local roughness at each point in the MIP Z-buffer; b) connection of all neighboring points of low local roughness; and c) connection of all points in the original 3D image matrix that are connected to the points determined in the MIP Z-buffer and that are above an intensity threshold. The algorithm as presented is not optimized but demonstrates a very strong potential for improved portrayal of vascular detail.

A three-coil comparison for MR angiography

The purpose of this work was to compare intracranial magnetic resonance angiography (MRA) image quality using three different radiofrequency coils. The three coil types included a reduced volume quadrature birdcage coil with endcap, a commercially available quadrature birdcage head coil, and a four-element phased-array coil. Signal-to-noise ratio (SNR) measurements were obtained from comparison studies performed on a uniform cylindrical phantom. MRA comparisons were performed using data acquired from 15 volunteers and applying a thick-slab three-dimensional time-of-flight sequence. Analysis was performed using the signal difference-to-noise ratio, a quantitative measure of the relative vascular signal. The reduced-volume endcap and phased-array coils, which were designed specifically for imaging the intracranial volume of the head, improved the image SNR and vascular detail considerably over that obtained using the commercially available head coil. The endcap coil configuration provided the best vascular signal overall, while the phased-array coil provided the best results for arteries close to the coil elements.

Escherichia coli O157:H7; an economic assessment of an outbreak

BACKGROUND

The aim of the study was to assess the impact of an outbreak of Escherichia coli O157:H7 that occurred in 1994 in a rural community, with a population of approximately 107,000, to the west of Edinburgh.

METHODS

The impact of the outbreak was assessed during the acute phase of the illness and in the subsequent 12 months. The method involved three surveys of confirmed cases using general practice notes, hospital records and interviews with cases. Key persons involved in the investigation and control of the outbreak were also interviewed. The impact of the illness on cases and their families was estimated and the resources used to treat cases and to control the outbreak were costed and long-term costs projected.

RESULTS

There were 71 cases whose ages ranged from 7 months to 84 years. The mortality rate was 1.4 per hundred cases. There were 10 cases of haemolytic uraemic syndrome (HUS) and one case of thrombotic thrombocytopenia purpura (TTP). Two children were on long-term dialysis. Co-morbidity involving the immune system was associated with hospital admission. The illness lasted on average 6.9 weeks. Twenty-six per cent of cases reported symptoms 12 months later. The average cost per HUS case was 62,353 pound sterlings, the TTP case cost 21,422 pound sterlings, non-HUS and non-TTP cases cost 1,030 pound sterlings. The costs of investigating and controlling the outbreak were 171,848 pound sterlings. The costs of cases projected over 30 years were 11.9 million pound sterlings, or 168,032 pound sterlings per case.

CONCLUSIONS

The impact on the health of cases was considerable and the costs were high. Every effort should be made to prevent the disease and to identify and control outbreaks quickly.

Differences in daily stress, mood, coping, and eating behavior in binge eating and nonbinge eating college women

This study investigated differences between binge eaters and controls on measures of daily stress, mood, coping, and eating behavior. The same measures were also used to compare binge days to nonbinge days for the binge group. Participants included 20 college women who reported binge eating at least two times per week and 20 women who reported no disturbance in their eating behavior. They were asked to self-monitor their daily stress, coping, mood, and eating behavior for three weeks. Results indicated that the binge group reported more stress and negative mood over the three weeks than the control group. The binge group reported experiencing a similar number of stressful events on binge days as compared to nonbinge days, however, the impact of those events was much greater on binge days. The binge eaters also reported less positive mood and more episodes of eating on binge days. The groups did not differ in the number of coping strategies used. Stress and negative mood appear to be common antecedents for binge eating. The role of coping responses and daily eating behavior (i.e., restraint) on binge eating is somewhat less clear.

Mediastinal atypical carcinoid and neurofibromatosis type 1

We report a case of mediastinal atypical carcinoid in a 63-year-old woman with neurofibromatosis type 1 (NF-1), who presented with shortness of breath and a bulky mediastinal mass. Initial consideration was given to a neurogenic tumor. However, on thoracoscopic biopsy, the histologic appearance was consistent with an atypical carcinoid. Carcinoid tumors have been reported in association with NF-1 previously, but commonly in such unusual sites as the ampulla of Vater and duodenum and not in the thorax. The bulky, extensive, and highly vascular nature of the lesion precluded resection or debulking surgery. To our knowledge, there are no previous reports of atypical carcinoid of the lung or mediastinum in a patient with neurofibromatosis. This case report, therefore extends the spectrum of solid neoplasia in general and carcinoid tumors in specific, as they occur in association with NF-1.

Dielectric behavior of SrTiO3 and YiBa2CU3Ox at 10.6 GHz using a microwave resonant cavity as a probe

A cylindrical microwave resonant cavity operating in the TE011 mode was used to study the dielectric response of SrTiO3 and YiBa2CU3Ox. The microwave dielectric response of the powdered samples of these materials is studied as a function of temperature at a frequency of 10.6 GHz. For this study, a very precise heating and cooling system was designed to control the temperature accurately to a tenth of a degree. The real and imaginary parts of the complex permittivity were studied using Slater's Perturbation equations. The relaxation times of these materials are derived using Debye's equations for polar molecules.

Economic aspects of food-borne outbreaks and their control

This paper begins with a discussion of the definition of an outbreak. It considers the portion of outbreaks in the general pattern of food-borne infectious disease. The methods used to identify outbreaks are described and the importance of the potential benefits and the economic impact of outbreak recognition and control and are discussed. The paper concludes by illustrating the economic impact of intervention using three infectious diseases botulism, Salmonella and Escherichia coli O157 as case studies of outbreaks.

Soil compaction. A role for ethylene in regulating leaf expansion and shoot growth in tomato?

The role of ethylene in regulating growth in tomato (Lycopersicon esculentum Mill.) during compaction stress was examined using wild-type (cv Ailsa Craig) and transgenic (ACO1(AS)) genotypes; the latter has a reduced capacity to produce ethylene. Ethephon or silver ions were applied to increase ethylene production or block its action. Shoot growth in both genotypes was comparable in uncompacted (1.1 g cm(-3)) and uniformly compacted soil (1.5 g cm(-3)). However, a 1.1/1.5-g cm(-3) split-pot treatment invoked marked genotypic differences: growth was reduced in cv Ailsa Craig but was comparable to uncompacted control plants in ACO1(AS). As xylem sap abscisic acid levels were similar, abscisic acid was not responsible for inhibiting growth in cv Ailsa Craig. These genotypic differences in growth were accompanied by increased ethylene evolution in cv Ailsa Craig, suggesting that the ability of ACO1(AS) to maintain growth in the split-pot treatment reflected its lower ethylene levels, a view supported by the observation that excising the roots in the compacted compartment reduced ethylene evolution and restored shoot growth in cv Ailsa Craig. Treatment with silver restored shoot growth in cv Ailsa Craig, whereas treatment with ethephon reduced growth in ACO1(AS). Thus, ethylene apparently has a key role in determining growth when tomato plants encounter differential soil compaction.

Management of pyelonephritis and upper urinary tract infections

The most frequent cause of upper urinary tract infection remains E. coli. Other organisms are found in complicated infections associated with diabetes mellitus, instrumentation, stone, and immunosuppression. The pathogenesis of acute pyelonephritis is reviewed herein, with an emphasis on the virulence factors responsible for its initiation, including urothelial adhesion by P-fimbriae of E. coli and other common factors including hemolysin and aerobactin. Renal damage does not always ensue following such infection. It is seen when toxic oxygen radicals are released during the ischemic episode and the respiratory burst of phagocytosis is marked and prolonged. These events occur when effective antibacterial treatment is delayed when the diagnosis is not made early or when socioeconomic factors prevent treatment. The scarring of chronic pyelonephritis leads to the loss of renal tissue and function and may progress to end-stage renal disease. With effective antibacterial therapy, the immune response by both T and B lymphocytes leads to antibodies that assist in bacterial eradication. Therapy must be both rapid and effective. In many instances, antibacterial agents may be used as outpatient therapy. If the Gram stain shows only gram-negative organisms and if the infection is community acquired, oral outpatient therapy with trimethoprim/sulfamethoxazole or a fluoroquinolone may suffice if the patient has no nausea. When the patient is septic, hospitalization and treatment with parenteral antibiotics are needed. Both ceftriaxone and gentamycin are cost-effective parenteral therapy because only once-daily dosing is needed. If gram-positive organisms are found, an enterococcus should be suspected, and a beta-lactam penicillin such as piperacillin or a third-generation cephalosporin such as ceftriaxone is indicated. If penicillin allergy exists, vancomycin should be used. If the patient does not improve rapidly, diagnostic studies including ultrasound and CT will assist in the diagnosis of obstruction, abscess, or emphysematous pyelonephritis. Most of these complications are now rapidly treated percutaneously, with surgical therapy following as needed. Complicated infections, such as those occurring in patients with anatomic abnormalities, stone, or immunosuppression, are often caused by organisms other than E. coli, and long-term antibacterial therapy often leads to fungal infections such as candidiasis. A recrudescence of tuberculosis is occurring, often with resistance to antituberculous drugs. The increased incidence has been associated with the immunosuppression of AIDS but is also occurring in intravenous drug users, perhaps because of poor nutrition but also owing to noncompliance with treatment. The symptoms of renal tuberculosis are usually limited to fever, frequency, urgency, and dysuria. Hematuria with sterile pyuria is the usual laboratory finding. The young urologist should remember this renal disease in the differential diagnosis of hematuria, because medical therapy can provide a cure.

The economic aspects of hepatitis C-- implications for haemophilia

This paper considers the literature relating to the course of hepatitis C infection and its implications for those with haemophilia. It goes on to discuss a model that assessed the economic aspects of treating hepatitis C cases with interferon-alpha, discusses recent changes in recommended treatment of hepatitis C and critically reviews the model and its application to patients with haemophilia.

Expression of p53 in epithelial carcinoma of the ovary after chemotherapy

OBJECTIVE

To compare the expression of p53 protein before and after chemotherapy in epithelial carcinoma of the ovary.

STUDY DESIGN

Thirty patients were identified during a 10-year period with both their primary surgery and laparotomy after chemotherapy at the same institution. Tissue was processed from paraffin blocks, exposed to an antihuman p53 monoclonal antibody, then stained. Patient records were reviewed for survival data.

RESULTS

Twelve of 30 (40%) patients' tissue initially stained positive for p53. Seventeen of 30 (56.7%) were negative, and one (3.3%) was mixed. Eight of 12 (66.7%) initially positive remained so after chemotherapy, 2 converted to negative, and 2 converted to mixed expression. One patient with mixed expression converted to positive after chemotherapy. Seventeen tissues initially negative remained unchanged.

CONCLUSION

Chemotherapy did not permanently alter the expression of p53 detected by immunohistochemical staining in the majority (83.3%) of patients with epithelial ovarian cancer; 16.7% (all initially over-expressing p53) did show some decrease. This may have been due to deactivation of the mutated p53 gene, spontaneous mutation, selective growth within a heterogeneous population or alteration of p53 protein.

Magnetic resonance angiography with sliding interleaved projection reconstruction (SLIPR) acquisition

In this paper, we report on the development of a novel multiple thin-slab projection-reconstruction acquisition technique. To eliminate the slab boundary artifact, the slabs are highly overlapped and only a small fraction of the projection view angles are sampled at each slab position. After Fourier transformation in the slice direction, there are sufficient numbers of projection measurements at each slice position to obtain very high resolution MR angiograms. The technique presented has all of the advantages of multiple overlapping thin slab acquisition (MOTSA) with no evidence of slab boundary artifact. J. Magn. Reson. Imaging 1999;10:569-575.

The long-acting beta2-agonist salmeterol xinafoate: effects on airway inflammation in asthma

Salmeterol xinafoate is an inhaled long-acting beta2-adrenoceptor agonist recently introduced for the treatment of asthma. Both in vitro and animal studies suggest that it may have anti-inflammatory activities of benefit in this disease. To assess this directly, the effects of 6 weeks' treatment with salmeterol on indices of clinical activity, airway dysfunction and inflammation in subjects with stable atopic asthma were investigated. In a double blind study, asthmatic patients were randomized to 6 weeks' treatment with either salmeterol 50 microg twice daily (n=14) or placebo (n=12). They underwent bronchoscopy with bronchoalveolar lavage (BAL) and bronchial biopsy immediately before starting treatment and again after 6 weeks. Treatment with salmeterol improved clinical indices of asthma activity, but there were no changes in BAL differential cell counts or mediator levels, and no change in T-cell numbers or activation status. In the biopsy specimens there were no changes in numbers of inflammatory cells, sub-basement membrane collagen deposition or mast cell degranulation. Regular treatment with salmeterol improves clinical indices of asthma but has no effect on the underlying inflammatory process. These findings strengthen guideline recommendations that long-acting beta2-agonists should not be prescribed as sole antiasthma medication.

Bladder infection in the menopausal monkey

PURPOSE

The highest incidence of urinary tract infection in females occurs in elderly women. This study was done to determine whether this is due to the declining immune response that occurs during advancing age, or the menopausal state in the aged.

MATERIALS AND METHODS

Adult female monkeys (average age 19 years) were studied, half being subjected to bilateral oophorectomy to produce the menopause. In addition, old females (average age 29 years) already at menopause were studied before and after hormonal replacement with estradiol and progesterone. Bacterial adherence to vaginal cells was studied prior to and after urethral infection with E. coli. Plasma estradiol and progesterone levels were done, as well as white blood counts, plasma cytokine assays and serum antibody titers.

RESULTS

Bacteriuria was not prolonged, nor was there a significant difference in bacterial adherence to vaginal cells due to menopause. Interleukin-1 levels were depressed after surgical menopause but not as much as found in the old menopausal females and this low level was not corrected by hormonal replacement. The initial interleukin-2 levels were higher after spontaneous menopause, but the increasing plasma levels seen in cycling animals after infection did not occur in the aged menopausal females following infection even after hormone replacement. The antibody titers to the E. coli infection showed a trend to a lessened response to infection after menopause but were not significantly decreased.

CONCLUSIONS

The deficient Il-1, Il-2 and antibody response following infection was not corrected by hormone replacement and thus appears to be due to aging rather than lack of female hormones. These facts may be explained by the T cell senescence known to occur in aged individuals.

A study of infectious intestinal disease in England: plan and methods of data collection

The Committee on the Microbiological Safety of Food, set up in 1989 by the Department of Health in response to national epidemics of foodborne infection, considered the available evidence and commissioned a study of infectious intestinal disease (IID) in England. Seventy practices (with 489,500) patients overall) recruited from the Medical Research Council's General Practice Research Framework between August 1993 and January 1995 collected data for one year. The practice populations were representative of practices in England by area and urban/rural location, but with fewer small and affluent practices. There were five main components. i) A population cohort of 9776 (40% of those eligible) were enrolled to estimate the incidence and aetiology of IID in the community, and a large proportion were followed up. A median of 10% of patients on practice age-sex registers had moved away or died. ii) A nested case control component based on cases ascertained in the cohort was used to identify risk factors for IID in the community. iii) In a case control component used to identify risk factors and to estimate the incidence and aetiology of IID presenting in 34 general practices 70% of the 4026 cases returned risk factor questionnaires, 75% submitted stools, and matched controls were found for 75% of cases. iv) An enumeration component was used to estimate the incidence of IID presenting to general practitioners (GPs) in 36 practices and the proportion of specimens sent routinely for microbiological examination. v) In a socioeconomic costs component used to estimate the burden of illness of IID in the community and presenting to GPs 63% of those who returned a risk factor questionnaire also returned a socioeconomic questionnaire and were representative by age, sex, and social class. Despite variable enrolment and compliance the study sample had sufficient power for the multivariable analysis. The characteristics associated with low enrollment and compliance must be considered in the interpretation of the main study results.

Estrogen receptor immunoreactivity in the adult primate brain: neuronal distribution and association with p75, trkA, and choline acetyltransferase

The neuroactive steroid hormone, estrogen, has been implicated in both the prevention and treatment of Alzheimer's disease. Interactions between estrogen and neurotrophic systems may partially explain the beneficial effects of estrogen therapy. Previous studies have identified estrogen binding sites colocalized with neurotrophin-related proteins and mRNA within the rodent brain. Extending these studies to a model more relevant to human systems, we have mapped the distribution of estrogen receptor alpha (ER-alpha)-immunoreactive neurons in adult nonhuman primate brains. In addition, we used double-label immunohistochemistry to examine colocalization of ER-alpha with the low- and high-affinity neurotrophin receptors, p75 and trkA, and with the cholinergic marker choline acetyltransferase. Large numbers of ER-alpha-immunoreactive cells were detected in several amygdaloid and hypothalamic nuclei. ER-alpha-labeled cells were also found in the lateral septum, nucleus of the stria terminals, subfornical organ, and periaqueductal gray. Only rare, scattered ER-alpha-immunoreactive cells were noted in the cholinergic basal forebrain. In contrast to rodents, no cells exhibited ER-alpha and p75 or ER-alpha and trkA double-labeling. However, ER-labeled neurons in the amygdala, a region containing putative nerve growth factor-producing cells and exhibiting a role in memory, were densely and specifically invested with cholinergic terminals projecting from the basal forebrain. Estrogen-labeled neurons were also present in the lateral septal nucleus, a system that receives hippocampal inputs and projects to the neurotrophin-sensitive medial septum. Thus, interactions between neurotrophin-sensitive neurons and ER-bearing neurons exist in the primate brain, providing a potential paracrine basis for estrogen-state modulation of vulnerability to Alzheimer's disease.

Phase II trial of vinorelbine in recurrent and progressive epithelial ovarian cancer

OBJECTIVE

A phase II, multicenter trial was conducted to define the efficacy and safety of vinorelbine (Navelbine (vinorelbine tartrate) injection, NVB) in the treatment of advanced epithelial ovarian cancer (EOC).

METHODS

Patients with persistent or recurrent EOC who had received one prior platinum-based chemotherapy regimen were eligible. NVB was administered at 30 mg/m2 as a weekly outpatient intravenous infusion.

RESULTS

Using an intent-to-treat analysis of the 38 patients who received at least one dose, 11(29%, 95% confidence limits 15-46%) objective responses (4 complete, 7 partial) were observed. The median duration of response was 19 weeks. For all 38 patients, the median time to treatment failure and median survival were 12 and 60 weeks, respectively. Four of the 12 patients with platinum-resistant disease responded, while 7 of the 24 patients with platinum-sensitive disease responded. Toxicity was evaluable in all 38 patients. During course 1, 15 patients required dose reduction and 21 required dose delays. Grade 3-4 granulocytopenia occurred in 23 (62%) of 37 reporting patients. Grade 3-4 anemia and thrombocytopenia occurred in 16 and 5%, respectively. The most common nonhematologic toxicities were nausea (grade 3 or less, in 34%), constipation (grade 3 or less, in 29%), and asthenia (grade 2 or less, in 24%). No life-threatening adverse effects were reported.

CONCLUSIONS

NVB is an effective, palliative agent for women with recurrent EOC. Dose-limiting granulocytopenia is substantial, yet manageable.