Carbon Dioxide Digital Subtraction Angiography in Oncological-Interventional Radiology

Aims and background

The aim of this work is to demonstrate the usefulness of carbon dioxide, used as contrast agent, in special indications in vascular interventional oncological procedures.

Methods

We studied 40 patients with digital subtraction angiography enhanced with CO2 as a contrast agent. At the same time we utilized also, in all cases, jodinated contrast agent to evaluate the different opacification gradient, the different viscosity range and the different perfusion.

Results

The low viscosity of CO2 allows demonstration of the presence of even minimal blood losses in gastrointestinal tumors and enhances arteriovenous shunts in hepatocellular carcinoma. Carbon dioxide can also be employed to assess the patency of small-sized catheters for chemotherapy infusion which do not allow easy injection of the traditional iodinated contrast agents characterized by high viscosity.

Conclusion

Carboangiographic study combined to digital subtraction angiography can clear some diagnostic problems and is further method to assess the outcome of angiographic interventional procedures in oncology.

Citalopram concentrations and response in obsessive-compulsive disorder. Preliminary results

OBJECTIVE

Citalopram, a highly potent SSRI, is effective in the treatment of depressive disorders and obsessive-compulsive disorder (OCD); however, very few studies have reported concentration-effect relationships for SSRIs. The aim of this study was to investigate the relationship between citalopram concentrations and clinical response in patients with OCD.

METHODS AND STUDY DESIGN

Fifteen patients (aged 18-65 years) with a DSM-IV diagnosis of OCD were included in this open-label, single-blind study. Citalopram was started at a dosage of 20 mg/day; the dosage was increased to a maximum of 60 mg/day by the third week, on the basis of clinical need and tolerability. The dosage then remained unchanged until the end of the 10-week study. Clinical assessments were made at baseline, weekly for the first four weeks and then at weeks 6, 8 and 10. The assessment scales used were the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Clinical Global Impression Scale (CGI) and the Hamilton Depression Rating Scale (HDRS). Plasma citalopram concentrations were determined using a high performance liquid chromatography method after solid phase extraction.

RESULTS

One patient was withdrawn from the study because of poor compliance. Of the 14 patients who completed the study, nine did not meet the treatment response criterion of an improvement of >25% from the baseline total Y-BOCS score and a score of < or =3 for the global improvement item of the CGI (these patients were termed non-responders), while five did (responders). There were no differences in the main demographic and baseline clinical variables between responders and non-responders. Steady-state citalopram concentrations were similar in the two groups, suggesting that the anti-obsessional effects of citalopram were not related to pharmacokinetic differences between responders and non-responders. There was no linear relationship between steady-state citalopram concentrations and response. The citalopram concentrations and Y-BOCS scores of individual responders obtained at baseline and various study timepoints showed a sigmoid relationship when analysed using the E(max) (maximum change in Y-BOCS score) model, with a mean EC(50) value (drug concentration that elicits 50% of the E(max)) of 152 microg/L, whereas a similar analysis of the non-responders generated a flat line.

CONCLUSION

The results of this preliminary study suggest that plasma citalopram concentrations may be related to the clinical response in responders, but do not seem to account for the lack of clinical effect in non-responders. These data, as well as the usefulness of the model in relating plasma concentrations to response, even after repeated administration, need to be validated by further investigations.

Pharmacokinetics and distribution of sodium 3,4-diaminonaphthalene-1-sulfonate, a Congo Red derivative active in inhibiting PrP(res) replication

Sodium 3,4-diaminonaphthalene-1-sulfonate (CRA) is a compound, synthesised by our group from Congo Red (CR), that is active in preventing the pathological conversion of normal prion protein (PrP). As the precise mechanisms controlling the ways in which prions are distributed and infect the brain and other organs are not fully understood, studying the pharmacokinetics of drugs that are active against prions may clarify their targets and their means of inhibiting prion infection. This paper describes the pharmacokinetics of CRA in plasma, spleen and brain after single or repeated intraperitoneal or subcutaneous administration, as determined by means of specific and sensitive fluorimetric HPLC. A single intraperitoneal administration led to peak plasma CRA concentrations after 15 min, followed by biphasic decay with an apparent half-life of 4.3 h. After subcutaneous administration, T(max) was reached after 30 min, and was followed by a similar process of decay: Cmax and the AUC0-last were 25% those recorded after intraperitoneal administration. The mean peak concentrations and AUCs of CRA after a single intraperitoneal or subcutaneous administration in peripheral tissue (spleen) were similar to those observed in blood, whereas brain concentrations were about 2% those in plasma. After repeated intraperitoneal or subcutaneous doses, the Cmax values in plasma, brain and spleen were similar to those observed at the same times after a single dose. After repeated intraperitoneal doses, CRA was also found in the ventricular cerebrospinal fluid at concentrations of 1.8 +/- 0.2 microg(-1) mL, which is similar to, or slightly higher than, those found in brain. Brain concentrations may be sufficient to explain the activity of CRA on PrP reproduction in the CNS. However, peripheral involvement cannot be excluded because the effects of CRA are more pronounced after intraperitoneal than after intracerebral infection.

Neurochemical and behavioural modifications induced by scrapie infection in golden hamsters

Scrapie-infected hamsters were tested for spontaneous motor activity and passive avoidance at various times after infection. After testing, some animals were killed and their whole brains assayed for norepinephrine, dopamine, serotonin and their metabolites. The apparent rate of turnover was estimated in terms of metabolite/amine concentrations. After 70 days, there was a decrease in passive avoidance and dopamine and serotonin. Passive avoidance correlated with the apparent rate of turnover of dopamine, whereas motor activity correlated with that of serotonin and dopamine.

Determination of sodium 3,4-diaminonaphthalene-1-sulfonate, a Congo Red derivative, in plasma and brain of hamsters by high-performance liquid chromatography after solid-phase extraction and ultraviolet absorbance

In the search for compounds with similar or greater activity than Congo Red (CR) in protecting normal prion protein from being converted into the pathological form, we have synthesized various compounds which derive from CR. One of these is the sodium 3,4-diaminonaphthalene-1-sulfonate (RCA) which has an activity similar to CR in preliminary experiments. This study describes a method to determine RCA in plasma and in brain tissue by high-performance liquid chromatography (HPLC), using a solid-phase extraction and UV detection. RCA is an amphoteric molecule difficult to separate from biological matrices. Extraction was achieved by solid-phase extraction (ENV+ columns) together with the use of a counter ion. The resulting solid-phase extraction is efficient and rapid. RCA was separated on a Symmetry C18 250 x 4.6 mm I.D. 5 lm column at 1 ml/min using a 50 mM NaSO4 in 5 mM tetra-n-butylammoniumiodide (TEBA) in water-methanol (82:18, v/v) mobile phase. Retention times of RCA and I.S. were 21 and 24 min. The UV detector was set at 210 nm. The limit of quantitation was 0.5 microg/ml. The method has intra-assay and inter-assay accuracies higher than 95%, coefficients of variation ranging between 2.8 and 8.6%, and recovery rates between 74.3 and 80.1% in plasma and in brain tissue. A linear response to quantities of RCA from 0.5 to 100 microg/ml or 10 microg/g in plasma or brain was obtained. The present method allows the study of the pharmacokinetics of RCA in plasma after i.p. administration, and the distribution of the compound into the brain at the peak time.

Phagocytosis and killing of Candida albicans of polymorphonuclear cells in patients with organ transplant of periodontal disease

BACKGROUND

The easiest defence system carried out by the organism, the inflammatory response, happens with the support of phagocyting cells: the polymorphonuclear leukocytes (PMNL) or neutrophils are the most important cell line acting as the first defence of the organism against bacterial agents. Previous studies have shown a correlation between a reduction of the immune function and development of periodontal disease. Furthermore, it is well known that transplant patients show a variety of oral lesions as a consequence of their therapy, in particular to immunosuppressive drugs. The aim of this study is to evaluate the phagocytosis and killing functions of PMNL in transplant patients and in patients with periodontal disease in comparison with a group of healthy subjects.

METHODS

PMNL, were isolated by spontaneous sedimentation from heparinized blood and centrifugation of plasma on density medium. Phagocytosis rate was expressed as the percentage of Candida albicans phagocyted after 20' incubation and phagocyting PMNLs. Intracellular killing was expressed as the percentage of yeast cells killed.

RESULTS

We did not find a significant decrease of phagocytosis in transplant patients and patients with periodontal disease while these two groups of patients showed a decrease of PMNL killing activity in respect to healthy controls, an effect which was unrelated to the severity of periodontal disease.

CONCLUSIONS

These results suggest that a reduction of killing activity, either spontaneous or drug-induced, would contribute to the development of periodontal disease.

Adaptation to oxidative stress: effects of vinclozolin and iprodione on the HepG2 cell line

It is well known that the dicarboximide fungicides, vinclozolin and iprodione, induce lipid peroxidation by means of oxygen activation in fungi, but their action on mammalian cells is not yet clear. We therefore investigated the effect of 1- and 24-h treatments with vinclozolin at concentrations of 25, 50, 100 microg/ml and iprodione at concentration of 62.5, 125, 250 microg/ml on malonaldehyde and free radical production and on reduced glutathione levels in the human HepG2 hepatoma cell line. The concentrations were chosen on the basis of neutral red cytotoxicity assays. One-hour treatment with the different concentrations of either vinclozolin or iprodione increased both malonaldehyde and free radical content, and decreased reduced glutathione levels, whereas 24-h treatment decreased malonaldehyde content and free radical production, and increased reduced glutathione concentration. These results suggest that the mammalian cells respond to the initial oxidative damage caused by the two dicarboximide fungicides by means of a characteristic adaptative phenomenon within 24 h. This hypothesis is supported by the antagonized effects caused by treatment with the two dicarboximide fungicides and buthionine sulfoximine 0.5 mM, a specific and irreversible inhibitor of reduced glutathione synthesis. The data confirm that the two dicarboximide fungicides maintain their specific action in mammalian cells, although this action is masked by adaptation.

Carbendazim and n-butylisocyanate: metabolites responsible for benomyl double action on cytochrome P450 in HepG2 cells

Changes in the cytochrome P450 monooxygenase system were investigated in HepG2 cells treated for 24 h with 1.25, 2.5, 5, 10 and 20 microg/ml of carbendazim (MBC) and n-butylisocyanate (BIC), the principal benomyl metabolites. The results show that n-butylisocyanate leads to a decrease in both ethoxyresorufin deethylase (P4501A1) (EROD) and ethoxycoumarin deethylase (P4502B) (ECOD), whereas MBC has no effect on EROD and increases ECOD. The decrease in ECOD and EROD activities after BIC treatment can be attributed to the detrimental action of this substance. The MBC-induced increase in ethoxycoumarin can be considered an enzyme-specific inductive phenomenon. This hypothesis was confirmed by Western immunoblot analysis and treatment with actinomycin D 8 x 10(-4) microM: the first showed an increase in P4502B isoenzyme content and the second evidence of a partial block of the increase in ECOD activity induced by MBC. Given these results, MBC and BIC seem to be the metabolites responsible for the double opposite action of their parent compound benomyl. Data deriving from an equimolar mixture of the two metabolites suggest that benomyl activity on some cytochrome P450 isoenzymes is the result of a balance between the action of the single metabolites (Radice et al., 1996).

Cytotoxic activity and mechanism of action of 5-Aza-2'-deoxycytidine in human CML cells

We investigated the cytotoxic activity and some aspects of the mode of action of 5-aza-2'-deoxycytidine (Aza-dC) in 21 primary cultures of leukemic cells freshly obtained from patients with chronic myeloid leukemia (CML) in blast crisis. The cytotoxic potency of Aza-dC was comparable or even greater than that of 1-beta-D-arabinofuranosylcytosine (Ara-C) in most cases, suggesting that this drug has potential in the therapy of blast crisis of CML. Drug incorporation into DNA was evaluated by exposing leukemic cells simultaneously to 3H-Aza-dC at the concentration of 0.1 micrograms/ml and 14C-thymidine (TdR) used as internal standard. Incorporation of Aza-dC into DNA was detectable in all cases. In 17 samples we evaluated the DNA integrity of leukemic cells exposed to Aza-dC using alkaline elution techniques. The drug caused a detectable amount of DNA alkali labile sites (ALS). DNA-ALS increased in cells exposed to Aza-dC concentrations from 0.1 to 1 microgram/ml but did not further increase at 10 micrograms/ml. A plateau in the levels of DNA-ALS was also seen in human K562 cells exposed to increasing concentrations of Aza-dC from 5 to 10 micrograms/ml, whereas in these cells Aza-dC incorporation into DNA increased with increasing Aza-dC concentrations. Therefore, DNA-ALS caused by Aza-dC are not simply the result of the chemical decomposition of azacytosine molecules incorporated into DNA, but are presumably the result of a saturable DNA repair mechanism (e.g., glycosylases) leading to formation of the apyrimidinic sites.

Infection and antibiotic therapy in 4000 burned patients treated in Milan, Italy, between 1976 and 1988

The pathogenic flora, isolated from burn wounds of patients admitted to a burn care unit during the years between 1976 and 1988 were typed and the in vitro susceptibility to antibacterial agents was recorded. Between 1976 and 1988 the general therapeutic approach was changed three times, in congruence with the prevalent nosocomial bacterial resistance. The most frequent isolates were: Pseud. aeruginosa, Staphylococcus aureus, Enterococcus spp., Proteus mirabilis, Escherichia coli, Enterobacter cloacae, Klebsiella spp. and other Enterobacteriaceae, such as Acinetobacter, Citrobacter. The most striking finding was the increase in antibiotic-resistant Enterococcus isolates. Staph. aureus, Klebsiella and E. cloacae showed susceptibility to cephalosporins, imipenem, pefloxacin, vancomycin; Enterococcus susceptibility to pefloxacin and vancomycin, and Pseud. aeruginosa sensitivity to piperacillin, amikacin, tobramycin was generally good. E. coli showed a satisfactory susceptibility on average, and P. mirabilis showed a good sensitivity to piperacillin, cephalosporins, amikacin, tobramycin, aztreonam and imipenem. Thus, the general bacterial flora and susceptibility have remained mostly unchanged over the years, with the conspicuous exception of Enterococcus spp. and E. cloacae, which demonstrated a marked increase in incidence, with a concomitant dramatic decrease in the sensitivity of Enterococcus spp. to antibiotics.

Primary pharmaco-toxicological evaluation of 2-iodomelatonin, a potent melatonin agonist

Series of experiments aimed at a primary pharmaco-toxicological evaluation of 2-iodomelatonin, a high-affinity melatonin analogue, were performed. In the rat ovulation-inhibition model, 2-iodomelatonin was much more potent than either melatonin or 6-chloromelatonin. The acute toxicity was extremely low and close to, though slightly higher than that reported previously for melatonin. In the rat, 2-iodomelatonin was slowly metabolized in vivo; its apparent elimination half-life was about 60 minutes, much longer than that reported for melatonin. The in vitro mutagenesis tests demonstrated clearly that 2-iodomelatonin in concentrations, exceeding the dose range employed in the in vivo studies, was actually devoid of mutagenic effects. The obtained results suggest that 2-iodomelatonin deserves a detailed pharmaco-toxicological evaluation and could be eventually used in pharmacokinetic and pharmacodynamic studies in humans.

Studies of the differentiation properties of camptothecin in the human leukaemic cells K562

Camptothecin, a specific inhibitor of topoisomerase I, caused erythroid differentiation of the human leukaemia cell-line K562, as assessed by benzidine staining at 70 h recovery following a 60 min treatment of the cells. Differentiation was confirmed by increased levels of epsilon-globin and gamma-globin mRNA in the treated cells and was accompanied by down-regulation of c-myb mRNA. Synchronisation of K562 cells by non-cytotoxic doses of methotrexate increased the differentiation induced by camptothecin, without affecting the camptothecin-induced inhibition of cellular proliferation. Camptothecin induction of differentiation and inhibition of proliferation may occur by independent mechanisms.