Impact of self-reported environmental mould exposure on COPD outcomes

BACKGROUND

Indoor and outdoor mould exposure can affect respiratory symptoms, but its contribution to COPD outcomes such as exacerbation rates or antibiotics courses is not well defined. Some patients with COPD develop chronic pulmonary aspergillosis (CPA), but the contribution of environmental exposure is not known.

METHODS

We correlated activities or exposures related to mould with COPD outcomes in patients with COPD with or without CPA using a questionnaire.

RESULTS

One hundred and forty patients were included and 60 had CPA in addition to COPD. Seventy-six were male and mean age was 66.9 years (range 40-87). Thirty-nine (28%) were active cigarette smokers. On multivariate analysis, occupational contact with agricultural resources (p = 0.017), vacuuming once weekly or more often (p = 0.026) and not asking visitors to remove shoes on home entry (p = 0.035) were significantly more common in participants reporting ≥ 4 office visits for COPD symptoms in the last year. Living within one mile of industrial composting sites (p = 0.013), vacuuming once weekly or more often (p = 0.016) and not asking visitors to remove shoes on home entry (p = 0.028) were significantly more common in participants reporting ≥4 antibiotics courses in the last year. Patients with CPA showed a trend for residence within one mile of farms or agricultural areas (P = 0.088, OR 2, 95% CI 0.9-4.4).

CONCLUSION

Activities potentially leading to mould exposure were common in a population with COPD with or without CPA and were associated with adverse COPD outcomes. Environmental mould exposure may play a role in the development of CPA in patients with COPD.

Invasive Aspergillosis among Haematological Malignancy Patients in Ghana: A Pilot Study on Prevalence and Antifungal Prophylaxis at the National Referral Hospital

BACKGROUND

Invasive aspergillosis (IA) among haematological malignancy patients is rarely diagnosed or studied in many African countries. Aspergillus galactomannan (GM) enzyme immunoassay (EIA) utilized in aiding diagnosis is not readily accessible in Ghana. Previous studies have evaluated the IMMY sōna Aspergillus GM lateral flow assay (LFA) and suggested it as a potential alternative to the GM EIA.

OBJECTIVES

We aimed to use the LFA in international (EORTC/ MSGERC) definitions to obtain preliminary data on IA among patients with haematological malignancies in Ghana with a focus on the prevalence and antifungal prophylaxis.

METHODS

We conducted a pilot study among patients with haematological malignancies at the Korle-Bu Teaching Hospital, Ghana using the LFA, culture and computed tomography scan to screen for and classify IA cases according to international definitions.

RESULTS

A total of 56 adult patients were recruited including acute leukaemia 14 (25.0%), chronic leukaemia 38 (67.9%), and lymphoma 4 (7.1%). Nine (16.1%) patients had a history of severe neutropenic episodes. All patients were on at least one chemotherapy drug. Three (5.4%) patients met the criteria for IA, comprising two probable IA in acute myeloid leukaemia and one possible IA in non-Hodgkin's lymphoma and constitutes one of five (20%) patients with ongoing severe neutropenia. The LFA was diagnostic in two IA patients. The IA cases were among 49 (87.5%) patients who did not receive antifungal prophylaxis.

CONCLUSION

Proactive diagnostic approaches to IA and effective antifungal prophylaxis may be significant in the management of haematological malignancy patients with severe neutropenia in Ghana.

Prevalence of morphometric vertebral fractures in osteoporotic patients in Greece: the Vertebral Integrity Assessment (VERTINAS) study

Our purpose was to assess the prevalence of morphometric vertebral fractures (VFs) in osteoporotic patients in our country. We found that 25.4% of patients had sustained a VF, and the majority of them (76.6%) were undiagnosed prior to inclusion in this study.

INTRODUCTION

We assessed the prevalence of morphometric vertebral fractures (VFs) in osteoporotic patients in our country.

METHODS

Patients were recruited via announcements by the national media, their attending physicians or the National patients' Society. Inclusion criteria were (1) age > 50 years, (2) postmenopausal status > 2 years (women), (3) > 1-year use of medication for osteoporosis and (4) lack of radiological vertebral assessment for > 1 year. Exclusion criteria were (1) bone metabolic diseases other than osteoporosis, (2) patients with secondary osteoporosis, (3) patients with inability to stand/walk, (4) previous high-energy VFs. All patients performed lateral X-rays of the thoracic and lumbar spine that were evaluated separately both by certified radiologists on site as well as 3 consultant orthopaedic surgeons remotely through a specifically designed web database system. The Genant semi-quantitative method was used for the classification and grading of VFs and statistical analysis of the results was performed.

RESULTS

One thousand six hundred fifty-two patients (1516 female, 70.02 ± 8.28 years; 136 male, 74.78 ± 8.25 years) were included in the final analysis. The prevalence of VFs was 25.4%, 76.6% of fractured patients were previously undiagnosed, and of these 39.9% had > 1 VFs. The most common fracture was T12, most fractures were found to be mild (grade 1) across all age groups, and patients 70-79 years and > 80 years were found to have a statistically significantly higher number of fractures than younger patients (p < 0.001).

CONCLUSIONS

Our results of the high prevalence of morphometric VFs emphasise the need for baseline assessment of vertebral fragility in patients receiving treatment for osteoporosis, as well as follow-up radiographs at specified time periods while on therapy.

The 2018 Guidelines for the diagnosis and treatment of osteoporosis in Greece

We report the updated guidelines for the management of osteoporosis in Greece, which include guidance on fracture risk assessment, diagnosis-pharmacological treatment-follow-up of osteoporosis based on updated information, and national evidence from Greek clinical practice and the healthcare setting.

PURPOSE

The purpose of this report was to update the Guidelines for the Management of Osteoporosis in Greece that was published in 2011.

METHODS

In line with the GRADE system, the working group initially defined the main clinical questions that should be addressed when dealing with the diagnosis and management of osteoporosis in clinical practice in Greece. Following a literature review and discussion on the experience gained from the implementation of the 2011 Guidelines transmitted through the national electronic prescription network, the Hellenic Society for the Study of Bone Metabolism (HSSBM) uploaded an initial draft for an open dialogue with the relevant registered medical societies and associations on the electronic platform of the Greek Ministry of Health. After revisions, the Central Health Council approved the final document.

RESULTS

The 2018 Guidelines provide comprehensive recommendations on the issues of the timing of fracture risk evaluation and dual-energy X-ray absorptiometry (DXA) measurement, interpretation of the DXA results, the diagnostic work-up for osteoporosis, the timing as well as the suggested medications for osteoporosis treatment, and the follow-up methodology employed during osteoporosis treatment.

CONCLUSIONS

These updated guidelines were designed to offer valid guidance on fracture risk assessment, diagnosis-pharmacological treatment-follow-up of osteoporosis based on updated information and national evidence from clinical practice and the healthcare setting. Clinical judgment is essential in the management of every individual patient for the purpose of achieving the optimal outcome in the safest possible way.

Ultrafast laser pulse chirp effects on laser-generated nanoacoustic strains in Silicon

Nanoacoustic strains are generated in Silicon by chirped femtosecond laser pulses using thin Titanium films as transducers. We investigate the effect that the generating laser pulse chirp has on the amplitude of the induced strains, manifested as Brillouin oscillations observed in degenerate femtosecond pump-probe transient reflectivity measurements. The strain amplitude is larger when negatively chirped pulses are used, which is attributed to the more efficient conversion of laser pulse light into acoustic strain in the Titanium transducer. Our present studies clearly show that the dependence of the Brillouin amplitude and the lattice strain is a non-monotonous function of the laser chirp parameter. An optimum negative laser pulse chirp is found for which the strain amplitude is maximized. A detailed thermomechanical model satisfactorily supports the experimental findings. In such a way, it is possible to suppress or enhance the induced nanoacoustic strain amplitude, thus all-optically controlling it by at least a factor of two.

The effect of veno-venous ECMO on the pharmacokinetics of Ritonavir, Darunavir, Tenofovir and Lamivudine

INTRODUCTION

To our knowledge, there is no published data on the pharmacokinetic (PK) profile of antiretroviral (ART) drugs on patients undergoing extracorporeal membrane oxygenation (ECMO) therapy. We present PK analyses of Ritonavir, Darunavir, Lamivudine and Tenofovir in a patient with HIV who required veno-venous ECMO (VV ECMO).

METHODS

Plasma concentrations for Ritonavir, Darunavir, Tenofovir and Lamivudine were obtained while the patient was on ECMO following pre-emptive dose adjustments. Published population PK models were used to simulate plasma concentration profiles for the drugs. The population prediction and the observed plasma concentrations were then overlaid with the expected drug profiles using the individual Bayesian post-hoc parameter estimates.

RESULTS

Following dose adjustments, the PK profiles of Ritonavir, Darunavir and Tenofovir fell within the expected range and appeared similar to the population prediction, although slightly different for Ritonavir. The observed data for Lamivudine and its PK profile were completely different from the data available in the literature.

CONCLUSIONS

To our knowledge, this is the first study reporting the PK profile of ART drugs during ECMO therapy. Based on our results, dose adjustment of ART drugs while on VV ECMO may be advisable. Further study of the PK profile of Lamivudine is required.

Probing the dynamics of highly excited toluene on the fs timescale

Investigation of the dynamics of toluene-h8 (C6H5CH3), toluene-d8 (C6D5CD3) and toluene-α,α,α-d3 (C6H5CD3) has been performed utilizing the VUV pump-IR probe technique on the fs timescale. Using the 5th harmonic (∼160 nm) of a Ti:sapphire laser as the pump beam, two superimposed electronic states, the valence S3 and the Rydberg 4p, were excited by one-photon absorption, followed by ionization and dissociation induced by the probe beam (800 nm). Analysis of the transient signal of the parent (P(+)) and fragment ions ([P-H](+) or [P-D](+)) implies the existence of two different relaxation processes: (i) from the Rydberg and (ii) from the S3 valence state. Using a rate equation model, the decay times have been determined and comparison between the different isotopologues has been made. Conclusions on the relaxation path, the relative displacements of the potential energy surfaces and the activation energies needed have been drawn from the decay times. The signals corresponding to the fragment ions present a small in amplitude, but nonetheless, unambiguous periodical modulation, which is attributed to out-of-plane bending oscillation, involving also the methyl group. The dynamics of the H- and D-loss channels has been investigated. Especially for the case of toluene-α,α,α-d3, where both channels are in operation, it was found that the ratio of the abundance of H/D-loss dissociation reactions decreases as the pump-probe delay time increases.

Full Dose Paclitaxel Plus Vinorelbine as Salvage Chemotherapy in Anthracycline-Resistant Advanced Breast Cancer: A Phase II Study

This phase II trial studied the efficacy and toxicity of full dose paclitaxel plus vinorelbine, as salvage chemotherapy in patients with metastatic breast cancer resistant to anthracyclines. Patients received vinorelbine (30 mg/m2) followed 1 hour later by full dose paclitaxel (175 mg/m2) every 3 weeks for a maximum of 8 cycles or until disease progression. Because of the heavy pretreatment of the patients, prophylactic granulocyte-colony stimulating factor (5 microg/kg) was administered daily for 5-10 days. To minimize potentially cumulative neurotoxicity due to both agents, amifostine was given prior to chemotherapy. Thirty-four patients: 8 with tumors primary resistant and 26 with tumors recurring within 3-6 months after anthracycline treatment, were evaluable for efficacy and toxicity. Objective responses occurred in 11 patients [32%; 95% confidence interval (CI): 16.3-47.7%), all partial responses. Responses were observed in lung and liver. The median response duration was 4 months (range 3-7), median time to progression was 5 months (range 3-9) and median overall survival was 8 months (range 4-24). Neutropenia was dose limiting (35% grade 3-4 toxicity). The left ventricular ejection fraction, measured and followed in 18 patients, fell less than 20% below baseline level in 9 patients (50%), but only one patient developed congestive cardiac failure. The paclitaxel-vinorelbine regimen was moderately tolerated and moderately effective in poor prognosis breast cancer patients with visceral metastases and tumors resistant to anthracyclines. The combination at these doses and schedules should be considered in the design of regimens for advanced breast cancer.

Breast cancer metastatic to the rectum: a case report

INTRODUCTION

Patients with breast cancer may present with systemic recurrence in any organ, primarily the bones, lungs, lymph nodes, liver, pleura, and adrenal glands. We report a case of rectal tumor, metastatic from breast cancer, which represents an unusual location of metastasis.

CASE PRESENTATION

A 74-year-old woman, operated for lobular breast cancer 5 years ago, but not compliant with the annual follow-up, presented with severe constipation and pseudodiarrhea. Digital examination and anoscopy revealed a mass at the lower rectum, 2 cm distant from the anal verge. CT and MRI scan of the abdomen confirmed this finding and did not reveal metastatic lesions elsewhere. The patient underwent abdominoperineal resection.

RESULTS

The postoperative period was uneventful, and the patient was discharged on the 7th postoperative day. The histopathological findings revealed rectal cancer, metastatic from the known invasive lobular breast cancer.

CONCLUSIONS

Rectal metastasis from breast cancer is very rare. The presented case emphasizes the need to keep in mind this possibility and at all times associate the emergency condition with the related history of breast cancer.

Optical encoding by plasmon-based patterning: hard and inorganic materials become photosensitive

The photosensitivity of nanocomposite AlN films with embedded silver nanospheres is reported. It stems from localized surface plasmon resonances (LSPR) whose modulation is photoinduced by laser annealing that induces a combined effect of metallic nanoparticle enlargement and dielectric matrix recrystallization; the photoindunced changes of the refractive index of the matrix result in strong spectral shift of LSPR. We demonstrate the utilization of this process for spectrally selective optical encoding into hard, durable, and chemically inert films.

Carcinoid tumors of the duodenum and the ampulla of Vater: current diagnostic and therapeutic approach in a series of 8 patients. Case series

AIM

To describe the specific characteristics of duodenal/perivaterian carcinoids and to analyze the diagnostic/therapeutic approach.

MATERIAL AND METHODS

Eight patients were included in our study. Symptoms on admission included dyspepsia, upper gastrointestinal (GI) bleeding and anemia. All patients underwent upper GI endoscopy and gastrointestinal peptides (gastrin) and neuroendocrine markers (Chromogranin-A, CgA) measurement. Imaging studies were performed in all patients, including OCTREOSCAN, while in patients with ACs MRCP or ERCP was also performed, when necessary. Definite diagnosis was confirmed by histopathologic examination.

RESULTS

Polypoid masses (carcinoids) were revealed at duodenal bulb and ampulla of Vater, in 5 and 3 patients, respectively. Serum gastrin was moderately increased in 4 patients, while in one patient it was more than 1000 pg/ml. Serum CgA was moderately increased in one patient, in whom OCTREOSCAN detected a solitary hepatic metastasis. Two patients with DC, of less than 1 cm of diameter, were treated by endoscopic polypectomy, while all the other patients underwent surgery. The patient with hepatic metastasis and positive OCTREOSCAN received also Octreotide LAR, resulting in stabilization of disease. No recurrence or metastases were observed during follow-up (range : 1.5-9.6 years).

CONCLUSIONS

In DC tumors <1 cm endoscopic excision with close follow-up is an adequate treatment, while in tumors >1 cm and in AC, surgical resection is the treatment of choice. In metastatic tumors, resection of the primary lesion with administration of somatostatin analogues may stabilize the disease and improve patient's quality of life.

In silico genetic correlations of multidrug efflux pump gene expression in Staphylococcus aureus

Regulatory mechanisms for chromosomal genes encoding multidrug resistance (MDR) efflux pumps (EPs) in Staphylococcus aureus are poorly defined. Microbiological, quantitative gene expression, mRNA half-life and genome data for 11 strains of S. aureus combined with bioinformatic analyses were used to identify correlates of increased MDR EP gene expression. The presence of qacA/B and/or increased expression of one to two MDR EP genes were identified in eight strains. Microbiological and gene expression data correlated in four instances, existing knowledge of the substrate specificity of NorC resulted in correlation in two others, and a transcriptional/translational disconnect is possible for the remaining two. In silico analyses and mRNA half-life determinations linked insertions of nucleotide repeats 3' to the -10 motif of the norA promoter with increased promoter activity. Mutations in the 5'-untranslated and/or coding regions were identified that may affect transcription efficiency. Substitutions of residues in the helix-turn-helix (HTH) motif of NorG may augment its positive regulation of norB. The correlations proposed provide a guide for further experimentation leading to a better understanding of MDR EP gene expression in this important pathogen.

Daptomycin: pharmacology and clinical use

IMPORTANCE OF THE FIELD

Infections caused by Gram-positive organisms have increased in frequency and severity. Daptomycin offers a therapeutic option in an era of increasing resistance.

AREAS COVERED IN THIS REVIEW

Literature from 1986 to present was reviewed for pharmacological, preclinical and clinical studies on daptomycin.

WHAT THE READER WILL GAIN

The pharmacological properties, resistance mechanisms and clinical applications of daptomycin are discussed. Recommendations are offered on the use of this agent for the treatment of resistant Gram-positive infections.

TAKE HOME MESSAGE

Daptomycin is a reliable agent for the treatment of Gram-positive infections. It has been shown to be effective in bacteremia and endocarditis, as well as in soft-tissue infections caused by Gram-positive organisms. Its role in the treatment of bone and joint infections is not well-defined. Resistance is currently uncommon in clinical isolates. However, emergence of resistance during therapy is a concern. This may be prevented by use of higher doses.

Chromogranin a levels in diagnosis, treatment and follow-up of 42 patients with non-functioning pancreatic endocrine tumours

BACKGROUND/AIMS

Non-functioning pancreatic endocrine tumours (NFPET) constitute the largest component (35-50%) of pancreatic endocrine tumours. They are characterized by the absence of symptoms of hormone hypersecretion and frequently have clinical manifestations similar to the more common exocrine pancreatic adenocarcinoma. The present studyaims toevaluate the clinical features, diagnostic approach and, in particular, the significance of serum chromogranin A levels (CgA) in the management and outcome of 42 patients with NFPET (from a series of 121 patients with pancreatic endocrine tumours).

METHODS

Twenty-five males and 17 females were included, and the mean age at diagnosis was 52.3 years (range: 26-68 years). The diagnosis for each patient was established by histopathological examination and immunohistochemistry. After the histopathological confirmation of diagnosis and during the follow-up period, patients were evaluated clinically and radiologically (including OctreoScan), whilst fasting gut hormones (including CgA) were also estimated. At diagnosis, all patients were checked for the presence of multiple endocrine neoplasia type I syndrome. The follow-up was complete and ranged from 12 to 86 months (mean: 49 months).

RESULTS

Dyspepsia (66.5%) and weight loss (47.6%) were the most common symptoms at diagnosis, while in 21.4% of patients tumour lesions were revealed incidentally. Plasma CgA levels were significantly or moderately elevated in all patients with liver metastases at diagnosis (64.3%). The levels also reflected tumour progression or response to treatment during the follow-up period. OctreoScan showed avid uptake in 77.8% of patients with hepatic metastases. Moreover, in 2 patients OctreoScan revealed unexpected metastatic mesenteric deposits, which had not been found by the other studies. However, it was negative in 6 patients with liver metastases, in whom tumours were proved to be poorly differentiated (high-grade).

CONCLUSIONS

(1) NFPET may present with clinical manifestations similar to those of an exocrine pancreatic tumour; (2) plasma CgA levels reflect tumour load, and also seem to correlate with tumour progression or response to treatment; (3) surgeryin patients with localized disease at presentation can be curative, while it can also reduce tumour burden in patients with metastases; (4) long-acting somatostatin analogues provide good quality of life and temporary disease stabilization in patients with low-grade tumours; (5) systemic chemotherapy or chemoembolization seem to be beneficial in high-grade and progressive tumours.

Forty-four years' experience (1963-2006) in the management of primarily infected hydatid cyst of the liver

BACKGROUND AND AIM

The aim of this study was to report our 44-year experience (1963-2006) in the management of primarily infected hydatid cyst of the liver. This is a retrospective review of demographic data, clinical presentation, diagnostic work-up, surgical management, and long-term outcome of patients treated at our center.

MATERIAL AND METHODS

There were 77 patients with operated infected liver cysts. In the same period, a total of 460 cases with liver hydatidosis were treated surgically. Of those with suppurated cysts, 27 were men and 50 were women, with a mean age 54.5 years.

RESULTS

Clinical manifestations of an abscess were identified in 75% of the patients. In the earlier cases of the study, the diagnosis was made from the clinical picture, laboratory studies, in combination with plain X-ray, hepatic scintigraphy, and in the later cases with US (ultrasonography), CT (computed tomography) or MRI (magnetic resonance imaging), and ERCP (endoscopic cholangiopangreatography). Abdominal and, rarely, thoracic and abdominal or thoracoabdominal incisions were used. Total cystopericystectomy in 8 patients and partial pericystectomy and proper drainage with one or two drainage tubes of the cystic cavity in the other 69 patients were carried out. Hospital stay was between 13 and 146 days with 5 re-operations. Two patients with grossly suppurated cysts and coexistent medical problems died. The disease recurred in five patients. CONCLUSIONS. We conclude that, under good perioperative antibiotic and metabolic coverage, the infected hydatid cysts have to be completely evacuated and properly drained. The application of "conservative" surgical procedures should be preferred. Further studies are needed to solve the clinical and therapeutic problems of this serious complication.

Ongoing epidemic of blaVIM-1-positive Klebsiella pneumoniae in Athens, Greece: a prospective survey

OBJECTIVES

To determine the current frequency and study the characteristics of VIM-1-producing Klebsiella pneumoniae isolates from bloodstream infections in Greek hospitals.

METHODS

All blood isolates of K. pneumoniae were prospectively collected during 2004-06 in three teaching hospitals located in Athens. MICs of antibiotics were determined by the Etest. Extended-spectrum- (ESBL) and metallo-beta-lactamase (MBL) production was examined by clavulanate- and EDTA-based techniques, respectively. Isolates were typed by PFGE of XbaI-digested genomic DNA. Detection of bla(VIM-1) and mapping of the VIM-1-encoding integrons were performed by PCR and sequencing. Beta-lactamase activities were analysed by IEF and imipenem hydrolysis was assessed by spectrophotometry. VIM-1-encoding plasmids were transferred to Escherichia coli by conjugation and transformation and characterized by Inc/rep typing and RFLP.

RESULTS

Sixty-seven (37.6%) of 178 K. pneumoniae blood isolates were bla(VIM-1)-positive (VPKP); 77.8% of these were from ICUs. All VPKP isolates were multidrug-resistant. The MICs of carbapenems for VPKP varied from the susceptible range to high-level resistance overlapping with those of MBL-negative isolates. The EDTA-imipenem synergy methods had reduced sensitivity in detecting VPKP isolates when the MICs were in the susceptible range. ESBL production was common among VPKP isolates (n = 45, 67.2%) as indicated by resistance to aztreonam and confirmed by a clavulanate-based double-disc synergy test. The responsible ESBL was always an SHV-5-type enzyme as indicated by IEF. PFGE identified eight clusters (A-H) of VPKP isolates with related (>80%) patterns, as well as four unique types. Both inter-hospital spread of several clones and genotypic similarities among susceptible, ESBL-positive and VPKP isolates were also observed. Location of bla(VIM-1) and expression of VIM-1 were studied in 12 isolates representing the eight PFGE clusters. In all isolates, bla(VIM-1) was part of a class 1 integron that also carried aacA4, dhfrI, aadA and sulI. In eight isolates (clusters C, D, G and H), the bla(VIM-1) integron was located in transferable IncN plasmids. A cluster F isolate carried a VIM-1-encoding, self-transferable plasmid that was not typeable by Inc/rep typing. VIM-1-encodingreplicons were not identified in three isolates (PFGE clusters A, B and E). VPKP isolates exhibited differences in imipenem-hydrolysing activities which, however, were not correlated with the respective carbapenem MICs.

CONCLUSIONS

A multiclonal epidemic of bla(VIM-1)-carrying K. pneumoniae is under way in the majorhospitals in Greece. Microorganisms producing both VIM-1 and SHV-5 constitute the prevalent multidrug-resistant population of K. pneumoniae in this setting.

Comparative Study of Multielectron Ionization of Alkyl Halides Induced by Picosecond Laser Irradiation

The interaction of C2H5X, 1-C3H7X, 1-C4H9X, where X = I, Br, Cl, with strong (1 x 10(13)-1.2 x 10(14) W/cm2) 35 ps laser pulses at 1064 nm is studied by means of time-of-flight mass spectrometry. The multielectron ionization following the C-X bond elongation has been verified for the studied molecules. By combination of the intensity dependence of the ion yields, the estimated kinetic energies of the released fragment ions, and their angular distributions, we have identified the different dissociation channels of the transient multiply charged parent ions. From the dependence on the laser intensity of the ratio of the doubly charged halogen ions to the singly charged ones, it is concluded that the molecular coupling with the laser field increases with the molecular size.

Docetaxel in combination with irinotecan (CPT-11) in platinum-resistant paclitaxel-pretreated ovarian cancer

The role of combination chemotherapy regimens in the management of ovarian cancer patients with tumors resistant to platinum compounds has not yet been defined. This multicenter prospective phase II study evaluated the activity and toxicity of the docetaxel-plus-irinotecan combination in ovarian cancer patients whose tumors were resistant to platinum compounds and who had been exposed to paclitaxel. Treatment consisted of docetaxel 60 mg/m2 i.v. followed by irinotecan 200 mg/m2 i.v. both on day 1 followed by prophylactic recombinant human granulocyte-colony stimulating factor (rhG-CSF) support from days 2 to 6, every 3 weeks. Thirty-one patients were enrolled in the study. The median age was 60 years, and the median performance status (ECOG) was 1. Eight (26%) patients had primary tumors resistant to platinum, while the rest of the population had tumor recurrence within 6 months from the last cisplatin treatment. Four chemotherapy cycles per patient were administered, with the delivered dose intensity at 75% of the planned dose for both agents. Among 30 patients evaluable for response, there were 2 (7%) complete and 4 (14%) partial responses (overall response rate 20%; (95% confidence interval, CI, 11%-33%). Stable disease was recorded in 8 (28%) patients and progressive disease in 15 (51%). The median response duration was 4.5 months (range, 3-12), the median time to progression 5 months (range, 2-17) and the median survival 11 months (range, 1-40); the 1-year survival was almost 50%. Myelotoxicity was moderate, with grade 3 and 4 neutropenia occurring in 23% of the patients, grade 3-4 thrombocytopenia in 6% and febrile neutropenia in 13%. Grade 3 diarrhea was observed in 2% of the patients. There was one treatment-related death due to sepsis. In conclusion, the combination of docetaxel plus irinotecan with rhG-CSF support, appears to be a moderately effective regimen with acceptable toxicity for platinum-resistant, paclitaxel-pretreated ovarian cancer patients. Further investigation in comparative studies is required to define the role of combination versus single agent chemotherapy in this group of patients.

Manometric and clinical evaluation of patients after low anterior resection for rectal cancer

The aim of this study was to examine the anorectal physiological and clinical changes that occur after low anterior resection for rectal cancer. Since 1998, 30 patients underwent laboratory tests of anorectal function, preoperatively and 1 month and 6 months after low anterior resection. Postoperatively all patients presented with increased bowel frequency, 60% of the patients with mild soiling and 30% with urgency for defecation. Six months after surgery there was a significant improvement of these symptoms. The anal resting pressure was significantly decreased postoperatively, while maximum squeezing pressure remained unchanged. The rectoanal inhibitory reflex was absent in 80% of the patients and at 6 months after surgery it tended to recover. Rectal capacity and compliance were reduced in all patients. In the current study, the majority of patients demonstrated manometric anorectal changes and clinical anorectal function disorders during the first year after surgery. We observed that these disorders correlated with the low level of the anastomosis.

Interaction Mechanism of Some Alkyl Iodides with Femtosecond Laser Pulses

The interaction of 1-iodopropane, 2-iodopropane, 1-iodobutane, 2-iodobutane, and 1-iodopentane with (5 x 10(13-)5 x 10(15) W/cm2) femtosecond laser fields is studied by means of a time-of-flight mass spectrometer. It is found that multiphoton ionization (MPI) and field ionization (FI) processes are involved in the molecular ionization. The contribution of these processes can be distinguished using the peak profile of the ions in the mass spectra. Thus, from the mass spectra of 2-iodoropane and 2-iodobutane, it is concluded that MPI processes are taking place even for Keldysh parameter values gamma approximately 0.3. The field ionization process depends on the characteristics of the molecular binding potential well and leads to an asymmetric charge distribution of the transient multiply charged parent ions. In the case of 1-iodobutane, the MPI processes lead to a stable doubly charged parent ion production with a laser intensity threshold higher than that found for I2+ ions. In addition, the isomers studied exhibit distinct differences in their mass spectra and their origin is discussed in detail.

Effect of intermittent administration of 200 IU intranasal salmon calcitonin and low doses of 1α(OH) vitamin D3 on bone mineral density of the lumbar spine and hip region and biochemical bone markers in women with postmenopausal osteoporosis: a pilot study

A 1-year prospective, open, randomized, controlled trial was conducted as a pilot study to examine the effect of intermittent administration of 200 IU intranasal salmon calcitonin and 1alpha(OH) vitamin D3 [1alpha(OH)D3] on bone mineral density (BMD) of the lumbar spine and hip as well as on the markers of bone metabolism in women with postmenopausal osteoporosis. A total of 102 randomly recruited women received either 200 IU intranasal salmon calcitonin (Miacalcic nasal 200, Novartis, Basel, Switzerland) daily, 1 month on-1 month off, 0.25 mug 1alpha(OH)D3, and 500 mg elemental calcium continuously (n=57 women) or only 0.25 mug 1alpha(OH)D3 and 500 mg calcium (n=45 women) for a period of 1 year. BMD of the lumbar spine and hip plus biochemical markers reflecting calcium (Ca) metabolism and bone turnover [serum Ca, serum phosphorus, intact parathormone (iPTH), total and bone-specific alkaline phosphatase, osteocalcin levels, 24-h urinary Ca, morning fasting urinary Ca/creatinine, and Pyrilinks-D/creatinine ratio] were measured at the beginning of the study before treatment and after 6 and 12 months of treatment. Baseline characteristics of participants, including age, body mass index, lumbar and hip BMD, and biochemical markers were similar between the two groups. A total of 91 patients completed the study (50 in the salmon calcitonin nasal spray group and 41 in the other group). Lumbar BMD increased significantly in the salmon calcitonin group from baseline (3.0%, p=0.005) and in comparison to the non-calcitonin-treated group (p=0.009). The salmon calcitonin group also had a significant increase in femoral neck BMD compared with baseline values (3.1%, p=0.0005) and in comparison to the non-calcitonin-treated group (p=0.0005) in Ward's triangle BMD (2.9% from baseline values, p=0.009) and in comparison to the non-calcitonin-treated group (p=0.005) in trochanteric BMD (3.4% from baseline values, p=0.007) and in comparison to the non-calcitonin-treated group (P=0.01). Urinary Ca/creatinine and Pyrilinks-D/creatinine levels were significantly decreased from baseline in the salmon calcitonin-treated group (-6.1 and -6.3%, respectively, p=0.001). Bone-specific alkaline phosphatase levels were also significantly decreased from baseline in the salmon calcitonin-treated group (-3.6%, p=0.003). In the same group, a significant decrease in iPTH serum levels compared to baseline values (-2.5%, p=0.005) and in comparison to the non-calcitonin-treated group (p=0.005) was noted. In conclusion, in this pilot study, 1-year intermittent treatment with 200 IU intranasal salmon calcitonin and low doses of 1alpha(OH)D3 produced a significant effect on bone turnover and BMD in postmenopausal women with osteoporosis.

Femtosecond laser time-of-flight mass spectrometry of labile molecular analytes: laser-desorbed nitro-aromatic molecules

Femtosecond laser time-of-flight mass spectra of solid samples of trinitrobenzene (TNB), trinitrotoluene (TNT) and trinitrophenol (TNP) have been recorded. Desorption of the solid samples was enacted by the fourth harmonic output (266 nm) of a 5 ns Nd:YAG laser. Subsequent femtosecond post-ionisation of the plume of neutral molecules was achieved using 800 nm laser pulses of 80 fs duration. Mass spectra have been recorded for desorption laser intensities from 2-6 x 10(9) W cm(-2) with ionisation laser intensities between 2 x 10(14) and 6 x 10(15) W cm(-2). Femtosecond laser ionisation has been shown to be capable of generating precursor and characteristic high-mass fragment ions for labile nitro-aromatic molecules commonly used in high-explosive materials. This feature is critical in the future development of femtosecond laser-based analytical instruments that can be used for complex molecular identification and quantitative analysis of environmentally important labile molecules. Furthermore, a comparison of femtosecond post-ionisation mass spectra with standard 70 eV electron impact data has revealed similarities in the spectra and hence the fragmentation processes.

Surgical management of calcified hydatid cysts of the liver

Hydatid disease of the liver is still a major cause of morbidity in Greece. Beside the common complications of rupture and suppuration, calcification of the hepatic cysts represent a not well studied, less frequent and sometimes difficult surgical problem. In the present study 75 cases with calcified symptomatic liver echinococcosis were operated on in the 1st Propedeutic Surgical Clinic between 1964 to 1996. Twenty-eight patients were male and 47 female with ages from 23 to 78 years. The diagnosis was based mainly on the clinical picture and radiological studies. In 5 cases the operative method was cystopericystectomy. We performed evacuation of the cystic cavity and partial pericystectomy and primary closure of the residual cavity in 6 cases, omentoplasty or filling of the residual cavity with a piece of muscle of the diaphragm in 4 cases and external drainage by closed tube, in 60 cases. In 12 of those with drainage, after a period of time, a second operation with easy, removal of most of the calcareous wall plaques was performed. The mortality rate was 2%. Our results could be considered satisfactory. In the calcified parasitic cysts of the liver the proposed technique is cystopericystectomy. An alternative procedure is pericystectomy and drainage with a "planned" reoperation with a bloodless, due to intervening inflammation, chiseling of the calcification.

The onset of coulomb explosions in polyatomic molecules

With the development of high intensity femtosecond lasers, the ionisation and dissociation dynamics of molecules has become an area of considerable interest. Using the technique of femtosecond laser mass spectrometry (FLMS), the molecules carbon disulphide, pyrimidine, toluene, cyclohexanone and benzaldehyde are studied with pulse widths of 50 fs in the near infrared (IR) wavelength region (790 nm). Results are presented and contrasted for laser beam intensities around 10(15) and 10(16) W cm(-2). For the lower intensities, the mass spectra yield dominant singly charged parent ions. Additionally, the appearance of doubly charged parent ions is evident for carbon disulphide, toluene and benzaldehyde with envelopes of doubly charged satellite species existing in these local regions. Carbon disulphide also reveals a small triply charged component. Such atomic-like features are thought to be a strong fingerprint of FLMS at these intensities. However, upon increasing the laser intensity to approximately 10(16) W cm(-2), parent ion dominance decreases and the appearance of multiply charged atomic species occurs, particularly carbon. This phenomenon has been attributed to Coulomb explosions in which the fast absorption of many photons may produce transient highly ionised parent species which can subsequently blow apart. Copyright 1999 John Wiley & Sons, Ltd.