Haemodialysis does not affect the pharmacokinetics of nifedipine

To establish dosage recommendations in patients with end-stage renal disease undergoing chronic haemodialysis, nifedipine kinetics were studied between and during haemodialysis sessions. In eight patients, during the interdialytic period, peak plasma concentrations of nifedipine (29-332 ng/ml) were reached 0.5-1.0 h after administration of a single 10 mg oral dose. Elimination half-life and oral plasma clearance were respectively 2.6 +/- 0.5 h and 1 176 +/- 412 ml/min. Nifedipine plasma protein binding was decreased in uraemic patients (88.8 +/- 0.3% vs 94.4 +/- 0.1%) but not affected by haemodialysis. Removal by haemodialysis was low: the dialyser extraction ratio and the dialysis clearance were respectively 2.3 +/- 0.8% and 2.8 +/- 0.9 ml/min.

Treatment of nasopharyngeal carcinoma with human leukocyte interferon

Nasopharyngeal carcinoma (NPC) is a human neoplasm closely associated with Epstein-Barr virus (EBV). Human leukocyte interferon (IFN) has known antiviral and antineoplastic properties. After initial IFN treatment in one NPC patient demonstrated acceptably low toxicity, 12 additional patients were treated on a protocol with IFN, 10 X 10(6) units intramuscularly (IM) daily for 30 days. IFN did not affect serum anti-EBV antibody titers (IgA and IgG antiviral capsid and early antigens). Of six patients tested, none was found to excrete EBV in saliva before, during, or after IFN. Four patients had measurable tumor regression (two partial responses and two minor responses), three had stable disease, and five patients plus the initial preprotocol patient had progressive disease. Toxicity included fever, fatigue, and myalgias in all patients, thrombocytopenia in two patients, and neutropenia in three patients. Three patients were withdrawn from the study, one each for severe fatigue, neutropenia, and hypotension. This study demonstrates that IFN has sufficient activity in advanced NPC to justify further investigation.

[Treatment of chronic renal insufficiency in the diabetic by dialysis and transplantation]

The number of diabetics with end stage renal disease (ESRD) is growing. The best treatment at the lowest cost possible should be offered to all diabetics if therapeutic facilities are available. Such a policy requires that all dialysis methods and transplantation should be available and that transfer from one method to another should always be allowable. Results observed among insulin and non insulin-dependent diabetics are improving steadily, even in the older age group. However they are inferior to those observed in non diabetic people of the same age. Adequate medical care, including excellent control of high blood pressure and good control of blood glucose levels should reduce the frequency of severe complications including cardiac, ocular and peripheral vascular lesions. In diabetic patients under forty years of age, renal transplantation using a kidney from a cadaver or a related donor should be the first choice. However, for most patients dialysis methods are required as the only treatment or while waiting for a transplant. Very encouraging results are obtained with both hemodialysis and peritoneal dialysis. If home dialysis is considered, continuous ambulatory peritoneal dialysis (CAPD) offers the opportunity to treat many insulin-dependent or non dependent diabetics at home even those in the high risk population because of age and/or cardio-vascular instability. CAPD offers excellent control of blood glucose levels using the intraperitoneal route to administer insulin. Results obtained are discussed from data in the literature and from a survey of 124 insulin-dependent diabetic cases with ESRD treated in the Department of Nephrology of the Hospital de La Pitié from 1973 to 1984.

Non-Hodgkin's lymphomas of head and neck extranodal sites

The initial staging, therapy and course of 156 patients with non-Hodgkin's lymphomas of head and neck extranodal sites were analyzed to determine whether they have a natural history which differs from primary nodal disease. The sites involved were: Waldeyer's ring-103 patients (tonsil-60, nasopharynx-25, base of tongue-18), and extralymphatic sites-53 patients (salivary gland-20, paranasal sinus-20, oral cavity-10, and larynx-3). Seventy-six percent had unfavorable histologies and 24% had favorable histologies. Fifty-three percent had pathologic Stages I-II and 47% had Stages III-IV. The 5-year survival was influenced by primary sites: salivary gland-61%, oral cavity-57%, tonsil-49%, base of tongue-47%, nasopharynx-36% and paranasal sinus-12%. The 5-year survival was also influenced by histology: unfavorable histologies-39%, favorable histologies-69%. The Ann Arbor staging system was more useful than TNM for determining outcome. For patients with Stage I-II unfavorable histologies treated with radiation alone, the 5-year survival was: involved field-24%, extended field-42%, total lymphoid irradiation-52%. The majority of patients who failed did so in extranodal sites. Forty-one patients with advanced disease received a variety of chemotherapy regimens as the sole treatment. There was a high percentage of CNS recurrence with paranasal sinus lymphoma, and CNS prophylaxis may be necessary. For head and neck extranodal lymphomas, limited radiation is inadequate, and combined modality programs should be considered.

A controlled family study of anorexia nervosa

A family study of eating disorders in first and second-degree relatives of anorexia nervosa and nonanorexic psychiatrically ill control probands found increased rates of anorexia-nervosa, bulimia nervosa, and subclinical anorexia nervosa in relatives of anorexic probands. The pattern of familial clustering suggests that these disorders may represent variable expressions of a common underlying psychopathology, although restricter and bulimic subforms of eating disorder may segregate within families. Implications of these findings for understanding factors important to the pathogenesis and subclassification of eating disorders are discussed.

The potential benefits of therapeutic splenectomy for patients with Hodgkin's disease and non-Hodgkin's lymphomas

Thirty-four patients with Hodgkin's disease and non-Hodgkin's lymphoma underwent therapeutic splenectomies to improve hematologic tolerance for chemotherapy. The mean age was 40 years; there were 16 males and 18 females. Fourteen had Hodgkin's disease, 19 had non-Hodgkin's lymphoma, and 1 had malignant histiocytosis. Nineteen had palpable splenomegaly, 19 had marrow involvement and 20 had splenic involvement by lymphoma. The following data were analyzed before and after splenectomy: mean white blood cell count (WBC) and platelet count on planned first day of cycle, delay ratio of chemotherapy delivery and percent maximal dose rate. Thirteen patients had non-Hodgkin's lymphoma, splenomegaly and positive bone marrow and showed significant benefit in all of the aforementioned parameters. Of the patients with prior irradiation, only those who completed their radiation greater than six months prior to splenectomy showed benefit. Ten patients had Hodgkin's disease, negative bone marrow and no splenomegaly. This group showed significant improvement in mean platelet count but more limited benefit in delay ratio and percent maximal dose rate. Thus, selected patients with lymphoma who are experiencing delays in chemotherapy because of poor count tolerance may benefit from splenectomy.

Inhibition of cis-diamminedichloroplatinum secretion by the human kidney with probenecid

The renal handling of cis-diamminedichloroplatinum (CP) was investigated by measuring the renal clearance of creatinine, inulin, and free platinum in ten cancer patients. Free platinum clearances exceeded the glomerular filtration rate in all time periods. For example, at 1 to 2 hr, the mean clearance of free platinum was 224 +/- 32 (S.E.) ml/min compared to a mean creatinine clearance of 94 +/- 15 ml/min or a mean inulin clearance of 94 +/- 17 ml/min (p less than 0.01), indicating secretion of CP or a metabolite. Seven additional cancer patients were treated with probenecid prior to CP. Fractional platinum clearances, calculated as a ratio of free platinum clearance to creatinine clearance, were reduced significantly in the probenecid-treated group (158 +/- 17%) compared to controls (270 +/- 57%) (p less than 0.03). Fractional platinum clearances, calculated as a ratio of free platinum clearance to inulin clearance, were also significantly reduced in the treated group (154 +/- 14%) compared to controls (271 +/- 47%) (p = 0.04). These results suggest that cisplatin is secreted by the human kidney, and this can be inhibited by probenecid. Such maneuvers may be helpful in improving the therapeutic index of this important chemotherapeutic agent.

[The effect of the injection of water-soluble triiodized monomer contrast media for intravenous urography on glomerular filtration, uricemia and urinary elimination of uric acid in normal subjects]

One mechanism suggested as being the cause of nephrotoxicity following the administration of triiodized contrast media is intratubular urate precipitation. Thirty healthy volunteers were investigated by IVU using three different media. The iodized injections (0,56 g/kg) failed to produce significant modifications of glomerular filtration and were followed by only very moderate variations in blood and urine uric acid levels.

A randomized phase III study of cisplatin with or without methotrexate for recurrent squamous cell carcinoma of the head and neck. A Northern California Oncology Group study

Eighty patients with recurrent squamous cell cancer of the head and neck were randomized to cisplatin (80 mg/m2) every 3 weeks or cisplatin plus weekly methotrexate (250 mg/m2) with leucovorin. The overall response rate to cisplatin was 18%, with 10% complete responses. The overall response to the combination was 33% with 18% complete responses (P = 0.11). There was no difference in response duration, time to progression, or survival. There was no difference in renal toxicity between the 2 arms (creatinine greater than 2 mg/dl in 6% of the patients). There was significantly more leukopenia (64%), thrombocytopenia (18%), anemia (18%), and mucositis (33%) in the combination arm. This combination of two of the best agents for head and neck cancer did not improve response, but resulted in added toxicity.

Mechanism of cisplatin nephrotoxicity

cis-Diamminedichloroplatinum II (cisplatin) is widely used in cancer treatments. Renal dysfunction is the major toxic effect of this drug. Micropuncture studies suggest that cisplatin reduces single-nephron glomerular filtration rate (GFR) and causes a significant backleak of inulin across the renal tubule. Pathological alterations are localized to the S3 segment of the proximal tubule situated in the outer stripe of the outer medulla. Renal clearance studies in humans demonstrate that the free platinum clearance exceeds the GFR, which suggests that cisplatin or a platinum metabolite is actively secreted by the kidney. Studies with renal cortex slices indicate that platinum is accumulated by renal tissue against a concentration gradient. This uptake is blocked by metabolic inhibitors and the organic base triethanolamine. Heavy metals are thought to produce renal damage because of interaction with renal sulfhydryl (SH) groups. After cisplatin administration to rats, total renal SH groups decreased by 14% owing to a decrease of protein-bound SH groups. The greatest decline of SH groups occurred in the mitochondrial and cytosolic fractions. These fractions also had the highest platinum concentrations. These results suggest that the nephrotoxic effects of cisplatin may be related to depletion of SH groups, but a cause and effect relationship has not been definitively established.

Phase I trial of intravenous L-phenylalanine mustard plus the sensitizer misonidazole

Misonidazole (MISO), a hypoxic cell radiosensitizer, has been shown in vivo to enhance tumor cell killing by melphalan (LPAM) with little or no enhancement of normal tissue injury. A Phase I trial was conducted using MISO p.o. 2 hr before i.v. LPAM. The highest doses used were the single maximum tolerated doses of MISO, 4 g/sq m, and LPAM, 0.6 mg/kg. Thirty-five patients were entered; 30 were evaluable for assessment of hematological toxicity, which was predicted to be the dose-limiting toxicity. The median age was 60 years (range, 28 to 72 years). Mild to moderate nausea and vomiting occurred in 80% of patients. Five developed serious hematological toxicity defined as nadir white blood cell count less than 1000/cu mm, platelets less than 20,000/cu mm or 4-week posttreatment white blood cell count less than 2000/cu mm, platelets less than 50,000/cu mm. Four of the toxicities occurred at the LPAM dose of 0.6 mg/kg but were independent of MISO dose. One patient died of infection. Two patients whose tumor demonstrated an objective response to therapy and 10 others with disease stabilization received additional courses. Four patients developed mild MISO neuropathy. Pharmacokinetic studies demonstrated that MISO did not appear to affect the pharmacokinetics of LPAM in plasma. Both LPAM and MISO can be given safely at their individual maximum tolerated dose. This combination will proceed to Phase II trials.

Behavior of cancer patients: a randomized study of the effects of education and peer support groups

Two prospective, controlled studies were conducted to determine if psychological and social functioning could be enhanced in patients with Hodgkin's disease by either education or participation in a peer support therapy group. Eighty-one patients were evaluated with the Cancer Patient Behavior Scale prior to and following intervention. Following education, patients experienced significant improvement in the frequency of Anxiety, Treatment Problems, Depression, and Life Disruption (p less than or equal to 0.1) compared to a control group. Following participation in peer support groups, patients showed no improvement in any of 10 areas of life functioning. Thus education represents an effective, efficient, and inexpensive means of improving psychological and social behavior in patients with Hodgkin's disease. Participation in this peer support therapy group did not result in significant behavior change.

Expression of pp60c-src protein kinase in adult and fetal human tissue: high activities in some sarcomas and mammary carcinomas

An endogenous protein of human cells pp60c-src, which is closely related to the product of the transforming gene of Rous sarcoma virus, pp60v-src, has been quantitated by measuring its enzymatic activity in an immunoglobulin G protein kinase assay. The influence of normal developmental processes on pp60c-src expression was assessed by comparative analysis of various adult and fetal human tissues. The maximal difference detected was a 2- to 3-fold-enhanced activity in fetal muscle compared with adult muscle. Organ-specific variations in the enzyme level were observed. Highest activity was found in brain, followed by kidney, lung, muscle, and connective tissue. Since overexpression of the cellular counterparts of viral-transforming genes may play a role in carcinogenesis, pp60c-src kinase was measured in nine spontaneous human sarcomas and 21 mammary carcinomas. Compared with the respective normal tissues and human diploid fibroblasts, 4- to 20-fold-enhanced activities were observed in one-third of the sarcomas and carcinomas. The remainder showed no or insignificantly elevated activity. The enzymes from normal and malignant tissues were indistinguishable from the virus-coded enzyme with respect to specificity for divalent cations and a predominance of phosphorylation in tyrosine. Patients carrying tumors with high pp60c-src protein kinase activity did not develop kinase-reactive antibodies against pp60c-src or pp60v-src.

Plasma platinum levels: relationship to cisplatin dose and nephrotoxicity

Renal dysfunction is the dose-limiting toxic effect for many patients receiving cisplatin (CP). Despite hydration and/or forced diuresis, some patients develop nephrotoxicity, and patients at risk cannot be easily identified. We studied 77 patients with several types of carcinoma who received 115 cycles of CP, by 24-hour infusion, at doses of 40-100 mg/m2. Blood samples for platinum (Pt) analysis were obtained during and after CP infusion; plasma Pt levels were dose- and time-dependent. A significant rise in serum creatinine was seen after the first cycle and cumulatively over subsequent CP cycles. The largest subgroup of patients, those who received 80 mg/m2, was analyzed for predictors of nephrotoxicity. Twenty-five percent of patients exhibited nephrotoxicity (greater than 30% rise in serum creatinine or greater than 30% fall in creatinine clearance). These nephrotoxic patients had significantly higher plasma Pt levels during CP infusion than did nonnephrotoxic patients. Age, sex, cycle number, and pretreatment creatinine did not predict nephrotoxicity. Patients predisposed to nephrotoxicity with CP chemotherapy may be identifiable, on the basis of elevated plasma Pt, early in the course of CP infusion.

Use of methotrexate and 5-FU for recurrent head and neck cancer

Thirty patients with recurrent squamous cell carcinoma of the head and neck were treated with methotrexate (250 mg/m2) followed 1 hour later by 5-FU (600 mg/m2). One patient had a complete response and four had partial responses, for an overall response rate of 16%. The response rate in patients with no prior chemotherapy was 21%. Toxic effects included neutrophenia in ten patients, with one associated death from infection; severe mucositis in three patients; and severe diarrhea in seven patients. Three patients had acute abdominal pain requiring hospitalization, with one associated death. The combination of methotrexate and 5-FU as given in our study was not superior to methotrexate alone and had substantial toxicity.

Changing role of chemotherapy in treatment of head and neck cancer

The role of chemotherapy in the management of head and neck cancer includes treatment for recurrent disease and as an adjunct to conventional therapy with radiation and/or surgery in the primary treatment program. The best single agents, methotrexate and cisplatin, used for recurrent disease give response rates of 20 to 50 percent but of short duration. Results may be improved with combination chemotherapy, but often with increased toxicity. Prognostic factors that influence response are discussed. A newer role of chemotherapy in this disease is in the initial treatment program. Pretreatment chemotherapy can debulk these lesions prior to surgery and/or irradiation in up to 80 percent of patients. Controlled trials are in progress to determine the effect on cure rates. Chemotherapy utilized during radiotherapy has resulted in survival benefit in several studies. Post-treatment adjuvant chemotherapy still needs to be evaluated. The potential advantages and disadvantages of chemotherapy used in the initial treatment are discussed. Major strides have been made in the last decade in the treatment of head and neck cancer, and chemotherapy is assuming an increasingly important role.

Dialysis treatment and psoriasis in Europe

One hundred and fifty out of 944 European dialysis centers reported experience with patients suffering from psoriasis. Ninety-three centers returned special questionnaires on 97 patients with end stage renal failure (ESRF patients) and on 49 patients dialyzed for psoriasis but who had normal renal function (NRF patients). Improvement of skin disease was reported in 17 out of 27 NRF patients according to both "objective criteria" and the patients' personal opinions. However, most of these patients had been on dialysis for less than one year (9.9 +/- 11.1 months) which is too short to allow for the spontaneous recurrence of psoriasis. In contrast, 60% of ESRF patients had been on dialysis for 45 +/- 3.1 months. Skin disease definitely improved in 20% of these patients after commencement of dialysis. This proportion is greater than the expected spontaneous long-term remission of psoriasis.

Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study

A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospectively followed up in the computerized Diaphane Dialysis Registry. 198 deaths (overall mortality = OM) were registered, of which 87 (43%) were secondary to cardiovascular complications (cardiovascular mortality = CVM). Risk factors for OM and CVM (p values less than 0.05) were age, male sex, nephroangiosclerosis or diabetic nephropathy as the primary renal disease, elevated systolic and diastolic blood pressure and two weekly dialysis rather then three. In contrast with the results observed for the general population, a high body mass index and elevated cholesterol, triglycerides and uric acid were not found to be associated with significantly increased CVM or OM. On the contrary, low body mass index (less than 20 kg/m2), low cholesterol (less than 4.5 mmol/l) and low mean predialysis blood urea (less than 4.6 mmol/l) were associated with increased OM and CVM, and more especially with high stroke mortality. Results for urea but not for cholesterol remain significant after adjustment for age, sex, weekly dialysis schedule and body mass index. They suggest that, in addition to elevated blood pressure, a poor nutritional state and/or low protein intake may be important factors for explaining the high cardiovascular mortality, particularly for strokes, observed in dialyzed patients.

Management of the pregnant patient with Hodgkin's disease

Fifteen pregnant women with Hodgkin's disease were followed. Five patients had irradiation, 1000 to 3000 rad to the neck, mediastinum, or both, during the second or third trimester with normal outcome of pregnancy. One patient had a spontaneous abortion in the first trimester after radiotherapy of 4400 rad to the breast, an estimated fetal dose of 9 rad. One patient who received chlorambucil throughout pregnancy delivered a normal infant. Six patients had therapeutic abortions; one had early induction of labor. In one patient previously treated for supradiaphragmatic Hodgkin's disease, detection of a supradiaphragmatic relapse was delayed because of pregnancy. We recommend abortion for patients who develop Hodgkin's disease early in pregnancy or who have received chemotherapy or irradiation during the first trimester. During the latter half of pregnancy, asymptomatic disease may be closely followed but early delivery is recommended. Supradiaphragmatic, symptomatic disease can be treated with modified irradiation. For subdiaphragmatic, symptomatic, or extranodal disease, single-agent chemotherapy may be preferable. Treatment requires individualization to insure that the patient will be cured and the fetus protected.

Dielectric square bandpass design

Two concepts new in square bandpass design make the design process easier and more systematic. One is the use of adjacent high-order rejection bands. The second is the use of effective index ratio. This paper extends the work of L. I. Epstein [J. Opt. Soc. Am. 42 806 (1952): "The Design of Optical Filters"] and A. Thelen [J. Opt. Soc. Am. 50 1533 (1966): "Equivalent Layers in Multilayer Filters"].

Real-time analysis of hippocampal neural activity in the intervals between interictal spikes

Previously the electroencephalogram (EEG) was modeled as consisting of faster, smaller waves superimposed on larger, slower waves. The intent of this study is to modify the program to sample neural activity over specific intervals of time following detection of a distinct wave pattern. The use of conditional sampling is illustrated by considering wave detection following epileptic interictal spikes in the rabbit hippocampus. To create an epileptic focus, small pellets of sodium penicillin suspended in agar were placed on the rabbit hippocampus. This produced regularly recurring, spontaneous, large amplitude discharges, or interictal spikes, at the site of application. Following detection of an interictal spike, the program delayed the onset of a sample period for either 1.0 s or 6.0 s. The neural activity was then sampled for 5.1 s, and fast and slow waves were detected over the sample period. The frequency distribution of waves in four of these 5.1 s intervals was calculated. Comparison of the frequency distributions following the 1.0 s and 6.0 s delays showed no discernible differences. The data illustrate that not all types of neural activity are markedly modified by interictal spikes and suggest that hippocampal cellular populations generate similar waves 1.0 s and 6.0 s after such a spike. Moreover, this experiment illustrates adaptation of the program to sample activity over a limited period of time following detection of a specific cortical waveform.

[Results of one year (1978) of kidney transplantation (author's transl)]

Kidney transplantation in France is not as common as both patients and health authorities would wish. While at least 1 000 transplantations would be required each year, only 550 were done in 1978. The authors report on the experience of a team which for the first time was able to perform 75 transplantations in one year, and bring to the pull of transplantation 74 cadaver kidneys. The 75 patients will be followed up by the same group which operated upon them not only during the post-operative period, but also for many years to come. As far as possible, the team endeavours to transplant kidneys from local donors or sent directly to the surgeons. Such a "regionalisation" of kidney transplantations suffers from the drawback of lesser compatibility, but makes it possible to obtain the expected results.

[Acute renal failure during indomethacin treatment. 6 cases (author's transl)]

Acute renal failure (ARF) was observed in 6 patients under indomethacin treatment. Before receiving the drug 3 patients had normal, and the other 3 slightly elevated plasma creatinine levels. All patients were also treated with diuretics. ARF developed within the first 48 hours of therapy. Four patients had clear-cut oliguria. The renal disorders proved completely and rapidly reversible after treatment was discontinued, except in one female patient who had to undergo peritoneal dialysis for 12 days and in whom moderate aggravation of the pre-existing renal insufficiency persisted on follow up. The ARF was attributed to a sudden fall in renal blood flow due to the inhibitory effect of indomethacin on prostaglandin synthetase. This complication occurs exclusively in patients with renal hypoperfusion secondary to hypovolaemia, with cardiac insufficiency or with intrarenal vascular lesions. Sodium depletion induced by previous or concomitant diuretic treatment increases the risks. The possibility of ARF warrants careful monitoring of urinary output and renal function at the onset of non-steroidal anti-inflammatory therapy in patients with altered or precarious haemodynamics.

Mechanism of cis-platinum nephrotoxicity: I. Effects of sulfhydryl groups in rat kidneys

cis-Diamminedichloroplatinum (CP), an important chemotherapeutic agent, produces acute renal failure by an unknown mechanism. Other heavy metals, such as mercury, are thought to be nephrotoxic by reacting with sulfhydryl (SH) groups. To investigate the mechanism of CP nephrotoxicity, F344 rats were injected once with 6 mg of CP per kg. After 96 hr, the blood urea nitrogen rose to 140 mg/100 ml. The SH concentration in control kidneys was 20.4 +/- 0.1 muml/g wet weight. Total renal SH groups decreased to a maximum of 14% at 120 hr (P less than .01). The fall in SH groups was entirely due to a decrease of protein-bound SH groups. Cell fractionation studies showed that the greatest decline of SH groups occurred in the "mitochondrial" and "cytosol" fractions. These fractions also had the highest Pt concentrations. There was no stoichiometric relationship between Pt accumulation and the change in SH groups. Furthermore, in vitro studies demonstrated that CP does not directly interact with SH groups. To determine if the change in renal SH groups was nonspecific effect of acute injury, renal failure was induced with glycerol (5 g/kg i.m.). Total SH groups per kidney increased after glycerol. These results indicate that the decrease in renal SH groups produced by CP is not due to nonspecific tubular necrosis. The present findings suggest the possibility that the nephrotoxic effects of CP may be related to depletion of SH groups. However, a direct cause-effect relationship has not been established.

Mechanism of cis-platinum nephrotoxicity: II. Morphologic observations

Light microscopy, transmission electron microscopy and scanning electron microscopy were used to characterize the morphologic alterations and to localize the site of injury within the kidney 1, 2, 3, 5 and 7 days after the intraperitoneal injection of cis-diamminedichloroplatinum. Pathologic alterations were evident 3 days after the injection of the drug and were localized to the S3 segment of the proximal tubule situated in the outer stripe of the outer medulla. A spectrum of changes was seen in this S3 segment which included a thinning or focal loss of brush border, cellular swelling, condensation of the nuclear chromatin and focal areas of necrosis. After 5 days, widespread tubular necrosis of the S3 segment in the outer stripe was the predominant finding. Necrotic tubular epithelial cells could be seen detaching from the basal lamina and being sloughed into the tubular lumen. Only a bare basal lamina remained in many areas. Regeneration of the S3 segment was seen after 7 days and was characterized by tubules with widely dilated lumens which were lined by many low-lying epithelial cells. The observation that cis-diamminedichloroplatinum exerts its nephrotoxic effect on the S3 segment of the proximal tubule located in the outer stripe of the outer medulla demonstrates that the pattern of injury produced by this antitumor drug is similar to that associated with other nephrotoxic and ischemic models of acute renal failure.

[Cerebral venous thrombosis, complication of the nephrotic syndrome (author's transl)]

The occurence of arterial and, more frequently, venous thrombosis in patients with the nephrotic syndrome is well documented. Several factors are involved among which the fall in plasma albumin, the rise of several coagulation factors, platelet hyperreactivity, decrease of antithrombin III. We report here the first case, to our knowledge, of a dural sinus thrombosis, complicating a nephrotic syndrome with minimal glomerular changes. The difficulties of such a diagnosis and the key value of carotid angiography to establish it are emphasized. The use of anticoagulants can prevent this complication.

[Society of Nephrology, Computer Technology Commission. Dialysis computer program. VI. - Survival and risk factors]

The sixth report of the "Diaphane Dialyse Informatique" Program concerns 2,518 adult patients (age 15 and over) treated by chronic hemodialysis or hemofiltration in 33 French dialysis centres between June 1972 and December 1978. 1) The number of centers participating to the program is progressively increasing. Overall duration of follow-up represents 4,192 patient-years, allowing precise evolutive studies of terminal renal failure treated by hemodialysis. 2) Mean age at start of treatment continues to increase. Among 709 patients who started treatment in 1977-1978, 8,8 p. 100 of men and 11 p. 100 of women were over 69 years old. 3) Patients with diabetic nephropathy represent 4,4 p. 100 of all patients dialyzed between 1972 and 1978 and 5,9 p. 100 of the patients starting treatment in 1977-1978. 4) The percentage of patients temporarily treated by peritoneal dialysis before hemodialysis decreases from 32,9 p. 100 in 1973-1974 to 15,9 p. 100 in 1977-1978. 5) In 1978, 65,3 p. 100 of patients are dialyzed 3 times a week with a mean weekly duration of 14,0 h for male and 12,9 for female. 73 p. 100 of the patients are dialyzed during the night. 6) Disposable parallel plate hemodialyzers (71,8 per cent of dialysis sessions in 1978) and hollow fiber hemodialyzers (11,6 per cent) progressively replace disposable coil dialyzers and non disposable Kiil dialyzers. 7) Transient hypotensive episodes during dialysis sessions remain the most frequent complications (21,7 per cent of sessions in 1978). Transient hypotensive episodes are more frequently observed with coils than with parallel plate hemodialyzers or with hollow fiber dialyzers. 8) Mean diastolic blood pressure (DBP) +/- SD is 101,9 +/- 21,7 mmHg at start of dialysis and 81,4 +/- 11,8 mmHg when dialysed. During the course of treatment 28,7 per cent of the patients receive long term antihypertensive treatment. In spite of dialysis and antihypertensive treatments 11 per cent of all patients followed up maintain DBP greater than or equal to 95 mmHg. 9) Viral hepatitis remain the most prominent infectious problem with 30 per cent of patients being chronic Hbs antigen carriers. 10) Annual death rate calculated in the 2,518 patients dialyzed between 1972 and 1978 (78/1000) is 12 times superior to the death rate of the French population, adjusted for sex and age to the dialysis population. 43,1 per cent of deaths are of cardiovascular origin. Risk factors for overall mortality are age, sex (male), existence of a vascular or diabetic nephropathy, twice weekly dialysis strategy, elevation of systolic or diastolic blood pressure during the course of dialysis treatment, hypocholesterolemia and to a lesser extent hypotriglyceridemia. On the contrary, hypercholesterolemia, hypertriglyceridemia and hyperuricemia do not appear as risk factors for overall mortality or cardiovascular mortality. These results plead for a perfect control of hypertension and to the extension of thrice weekly dialysis for the whole population of patients treated by maintenance hemodialysis.

[Generic symptoms of Hodgkin's disease in relation to other prognostic criteries (author's transl)]

In 1967-1973, 74 patients with histologic classified Hodgkin's disease were treated in Marburg. We proved the incidence of the most important prognostic criteries: stage, histologic type and clinical symptoms. These criteries are evaluated as equally significant and independent. The B-symptoms, fever, weight loss and night sweats we found in 24 patients, 18 (75%) of them were in stage IV. In the remaining 6 patients in stage II and III, the B-symptoms were followed by relapse or generalisation. We think that the good correlation to the stage means, that clinical symptoms as prognostic signs are not independent.

24-hour infusion of cis-platinum in head and neck cancers

Eighteen patients with advanced squamous cell cancer of the head and neck were treated with cis-diamminedichloroplatinum in a 24-hour infusion. The most frequent dose used was 80 mg/m2 repeated every three weeks. Six were treated preoperatively for Stage III or IV disease, and twelve were treated for recurrent disease. The overall response rate was 72% with one complete remission, greater than 50% regression in six patients, and 25--50% regression in six patients. Toxicity was minimal: creatinine greater than 2 in 6% of courses, leukopenia in 9%, anemia in 29%, vomiting in 76%, and documented minimal hearing loss in one patient. Plasma and urine platinum levels during infusion are presented. The dosage of 80 mg/m2 administered over 24 hours gives a response rate in head and neck cancers equivalent to that reported with higher doses given by rapid infusion, and toxicity is minimal.

Mortality and morbidity of reusing dialysers. A report by the registration committee of the European Dialysis and Transplant Association

The practice of reusing dialysers in renal units in the UK was surveyed by examining the patient questionnaires returned to the EDTA registration committee for 1976 and by a special questionnaire sent to all UK renal units. Altogether 65.6% of the 1785 patients treated with non-disposable dialysers and 49.6% of the 1109 treated with disposable dialysers reused their equipment. Reuse of dialysers caused some morbidity but no mortality. Most centres where disposable dialysers were used accepted that their reuse was necessary because of financial constraints and was ethically defensible.

Cis-platinum chemotherapy in head and neck cancers

Sixteen patients with advanced head and neck carcinomas were treated with cis-diaminedichloro platinum chemotherapy; seven preoperatively and nine for recurrent disease. Cis-platinum was given by 24-hour infusions of 80 mg/m2 every three weeks. There was 50% regression in 38% (6) of the patients; another 38% (6) had 25% to 50% regression. Toxicity was minimal, with vomiting occurring in 75% (12) of the courses, renal toxicity in 6% (2), leukopenia in 13% (4), thrombocytopenia in 9% (3), and anemia in 31% (10). Of the seven patients who had serial audiograms, only one experienced ototoxicity. Cis-platinum, given by 24-hour infusion, was effective in reducing tumor bulk in 75% (12) of the patients, with advanced head and neck carcinomas, without undue morbidity.