Concurrent chemotherapy and radiotherapy for cervical cancer

OBJECTIVE

To compare the results obtained following treatment, from a group of patients with locally advanced cervical cancer (Stage IB or higher) treated with concurrent chemotherapy and radiotherapy in relation to a group of patients treated exclusively with radiotherapy.

MATERIAL AND METHOD

All patients treated with concurrent chemotherapy and radiotherapy at the Gynaecologic Oncology Unit of the University Hospital Materno Infantil of the Canaries between 1999 and 2000, both inclusive, were included. The first group to be considered was formed by patients who received combined treatment. The second group of patients received radiotherapy exclusively, having been treated in previous years (1997-1998 period). The results were compared in relation to survival in the two following years from treatment (2000-2001) in the group of combined treatment and years 1999-2000 in the group that received only radiotherapy. To compare the survival of both groups the chi-square test and Odds Ratio were utilised.

RESULTS

The groups compared are homogeneous when looking at the stage of the disease when diagnosed, the histological type of tumour and its degree of cellular differentiation, the CAT results and tumoral markers. Survival of more than two years was observed in the group treated with concurrent chemotherapy and radiotherapy in relation to the group treated exclusively with radiotherapy; chi-square 9.92, p < 0.01, OR: 0.1 (0.01-0.6).

Rat liver lysosomal and mitochondrial activities are modified by anabolic-androgenic steroids

PURPOSE

The aim of this study was to examine the separate and combined effects of an 8-wk treatment with high doses of 17alpha-alkylated anabolic-androgenic steroids (AAS) and exercise training on selected lysosomal and mitochondrial enzyme activities in rat liver.

METHODS

Sedentary and treadmill-trained (25 m x min(-1), 45 min x d(-1), 5 d x wk(-1)) male rats were treated with fluoxymesterone, methylandrostanolone, or stanozolol (2 mg x kg body weight(-1), 5 d x wk(-1)) for 8 wk.

RESULTS

Acid phosphatase, arylsulfatase, beta-glucuronidase, and beta-galactosidase activities were increased in liver homogenates of sedentary and trained AAS-treated rats. The mitochondrial respiratory chain activities rotenone-sensitive NADH-cytochrome c reductase (NCCR), succinate cytochrome c reductase (SCCR), and cytochrome oxidase (COX) showed a significant decrease in steroid-administered rats, whereas citrate synthase (CS), a matrix enzyme, exhibited no changes in activity, pointing to a selective effect of AAS on mitochondrial membrane complexes. In vitro studies in mitochondrial fractions isolated from the liver of control rats showed that COX and CS activities were insensitive to the AAS, whereas NCCR and SCCR activities were partly inhibited. On the other hand, the mean values of serum parameters related to hepatic function were within normal ranges in all the experimental groups of animals.

CONCLUSIONS

The present data show that 8-wk ingestion of three different anabolic-androgenic steroids, either with or without concurrent exercise training, affects lysosomal hydrolases and mitochondrial respiratory chain electron transport in rat liver without modifying classical serum indicators of hepatic function.

Abnormal filling pattern of the left ventricle and outcome in acute myocardial infarction

BACKGROUND

The pattern of left ventricular filling by Doppler examination is frequently abnormal in myocardial infarction.

PURPOSE

To relate the different patterns of left ventricular filling to the clinical course of acute myocardial infarction.

PATIENTS AND METHODS

We have studied 133 patients with acute myocardial infarction. Three different patterns of mitral flow were defined by Doppler examination: Type I has an E/A ratio lesser than one, and a deceleration time of the E wave longer than 180 ms; Type II has either an E/A ratio greater than one or a deceleration time shorter than 180 ms; Type III has an E/A ratio greater than 1.6 and a deceleration time shorter than 180 ms. We also determined the pulmonary wedge pressure through a pulmonary artery catheter simultaneously with the Doppler examination on 22 occasions in 11 patients.

RESULTS

Mortality rate was 13%, 9% and 35% respectively in Type I, II and III (P=0.007). After logistic regression analysis of determinants of death, including all eight variables related with mortality on an univariate analysis, only Killip class and the presence of a Type III pattern of the mitral flow remained significant (P=0.0004 and P=0.019 respectively). Pulmonary wedge pressure was 8.4+/-6.1 mmHg in Type I, 21.0+/-7.3 mmHg in Type II, and 22.4+/-7.1 mmHg in Type III (P=0.0017).

CONCLUSION

Type III pattern of left ventricular filling is an independent predictor of death. Type I and II had no significant differences on prognosis. Type I is associated with a normal pulmonary wedge pressure.

[A new classification of lower infarcts with important prognostic significance]

BACKGROUND

The initial therapy of acute myocardial infarction is often determined by the electrocardiogram.

OBJECTIVE

To evaluate a classification of inferior myocardial infarctions according to the first electrocardiogram.

DESIGN AND SETTING

Prospective study in a coronary care unit.

PATIENTS

116 patients admitted due to a first acute myocardial infarction of the inferior wall.

METHODS

"Type 1" electrocardiogram was defined as ST segment elevation without distortion of the QRS. Patients were considered "type 2" when, besides ST segment elevation, they presented a distortion of the terminal portion of the QRS complex in two inferior leads.

MAIN RESULTS

Twenty-nine patients (25%) were considered "type 2". These patients were older and had worse Killip class than "type 1". The mortality rate was 1.2% in "type 1", and 24.1% in "type 2" (p = 0.0002). After multivariate analysis, which included Killip class, age, smoking, type of electrocardiogram and fibrinolysis, the type of electrocardiogram remained significantly predictive of death (p = 0.014).

CONCLUSIONS

We conclude that "type 2" electrocardiogram is an independent predictor of adverse outcome in inferior infarctions. Further investigation is needed concerning its implications in the clinical management of these patients, although reperfusion therapy is warranted.

The initial electrocardiogram pattern is a strong predictor of outcome in acute myocardial infarction

We analyzed the significance of the initial electrocardiogram on the clinical outcome of 205 consecutive patients with a first myocardial infarction. Three different patterns of the electrocardiogram were defined: (A) Tall symmetric T waves in the involved leads; (B) ST segment elevation > 0.1 mV in two or more adjacent leads; and (C) ST segment elevation together with distortion of the terminal portion of the QRS complex in two or more adjacent leads. Twelve patients were considered to have an initial 'A' electrocardiogram, 151 an initial 'B' electrocardiogram, and 42 an initial 'C' electrocardiogram. Four factors were significantly related to mortality: age, ST, Killip class and electrocardiographic pattern. The mortality rate was 0% in group A, 7.9% in group B, and 26.2% in group C (P = 0.0019). Patients with type C electrocardiograms had a significantly worse Killip classification and a significantly higher sum of ST segment elevation. Among patients with inferior infarction, the mortality rate was 1.4% in type B vs. 24.1% in type C (P = 0.0005). Among patients with anterior infarction, the mortality rate was 13% in type B vs. 30.8% in type C (P = 0.089). We conclude that the pattern of the initial electrocardiogram is a strong predictor of outcome in acute myocardial infarction, especially if it is inferior.

Dihydropyridine receptors in transverse tubules from normal and dystrophic chicken skeletal muscle

Calcium overload is a fundamental pathogenic event associated with chronic muscle degeneration in muscular dystrophies. The possibility that L-type voltage-dependent calcium channels were involved in the etiology of chicken muscular dystrophy was investigated by studying the dihydropyridine receptors in transverse tubule membranes isolated from skeletal muscle of normal (line 412) and dystrophic (line 413) chickens. The yield of T-tubular protein from dystrophic muscle was considerably increased compared with that from normal muscle (2.51 +/- 0.18 vs 1.04 +/- 0.31 mg protein x 100 g muscle-1). The binding of the calcium channel antagonist (+) [3H]PN200-110 to the dihydropyridine receptor in transverse tubule preparations was relatively slow, markedly affected by temperature and required divalent cations. (+) [3H]PN200-110 equilibrium binding assays revealed a single class of high-affinity sites and showed that maximum binding capacity (Bmax) (3.17 +/- 0.47 for normal and 3.51 +/- 0.52 pmol x mg protein-1 for dystrophic transverse tubules) and dissociation constant (Kd) (0.32 +/- 0.07 and 0.26 +/- 0.09 nM, respectively) were not significantly different in normal and dystrophic membranes. Kinetic studies indicated that normal and dystrophic transverse tubules did not differ significantly in association (2.54 x 10(6) and 2.27 x 10(6) M(-1)s(-1), respectively) and dissociation (8.5 x 10(-4) and 9.3 x 10(-4)s(-1), respectively) rate constants. Since dissociation kinetics for both preparations were monoexponential under all the experimental conditions employed, no low-affinity binding sites for (+) [3H]PN200-110 could be detected in chicken transverse tubules membranes. However, immunoblot assay, using a monoclonal antibody, revealed that dystrophic transverse tubules as compared with normal membranes were enriched twofold with the alpha 1-subunit of the dihydropyridine receptor. Therefore, although dihydropyridine-binding sites were not altered in transverse tubule membranes from dystrophic chicken skeletal muscle, both the increased yield in T-tubule vesicles and the enhanced immunodetection of the alpha 1-subunit of the dihydropyridine receptor, suggest that total content in dihydropyridine receptor is higher in dystrophic than in normal muscle.

Regulation of dihydropyridine receptor levels in skeletal and cardiac muscle by exercise training

To examine the influence of exercise training on the expression of dihydropyridine (DHP)-sensitive Ca2+ channels in skeletal and cardiac muscle, we have determined DHP receptor levels by [3H]PN200-110-binding and immunoblot analysis in homogenates and microsomal fractions of slow- and fast-twitch muscles and heart from rats subjected to a 12-week programme of moderate endurance training. We found that exercise increases the amount of DHP receptor in homogenates of the slow-twitch soleus (42%) and the fast-twitch extensor digitorum longus (60%). Comparable increases in DHP receptor density with training were also observed in the microsomal fractions isolated from both skeletal muscles; these increases were not due to differences in the membrane composition of the microsomal fractions, since the relative proportion of specific enzyme markers was not affected by exercise training. Levels of DHP receptor were not modified in cardiac muscle as a result of the exercise programme. These data suggest an up-regulation of the DHP receptor in the skeletal muscle as a consequence of exercise training, which may play a role in the adaptation of skeletal muscle to increased contractile activity.

Ultrastructural changes induced by anabolic steroids in liver of trained rats

The effects of anabolic steroid treatment in association with endurance training on biochemical serum parameters and liver ultrastructure have been investigated in male rats. Values of serum alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were not significantly affected by administration of high doses of fluoxymesterone or methylandrostanolone. Electron microscopic examination of hepatic tissue from treated animals revealed ultrastructural alterations of hepatocytes. The most prominent changes were swelling of mitochondria, which presented electron-lucent matrix and slightly defined cristae, and a marked increase in the number of lysosomes. These changes were evident in both sedentary and trained treated rats, indicating that liver cell damage is produced by anabolic-androgenic steroids despite the simultaneous realization of physical exercise. The alterations observed were not detected by means of conventional biochemical liver tests.

Effect of training and anabolic-androgenic steroids on drug metabolism in rat liver

The effects of anabolic-androgenic steroid administration and exercise training on various aspects of hepatic function were investigated in sedentary and trained (treadmill for 12 wk) male and female rats treated orally with fluoxymesterone or methylandrostanolone (2 mg.kg-1 body weight, 5 d.wk-1 for 8 wk). The mean values of serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total and direct bilirubin, and total- and high-density lipoprotein-cholesterol remained within normal range in all groups of male animals. The same is true for female rats, except for an increase in alkaline phosphatase activity in the steroid-treated groups. Hepatic microsomal aniline p-hydroxylase activity was reduced in male and increased in female rats by either steroid, whereas no significant effect was detected on 7-ethoxycoumarin deethylase activity. The levels of cytochrome P-450 and cytochrome b5 were markedly decreased by the anabolic-androgenic steroid treatment in male rat microsomes, but neither the steroid administration nor exercise training induced significant changes in the cytochrome levels of female rat livers. Taking into account the significant increase in microsomal protein yield elicited by fluoxymesterone or methylandrostanolone treatment both in males and females, it is noteworthy that the total monooxygenase activities and cytochrome P-450 content, expressed on a per gram liver basis, were significantly increased in female whereas they were apparently unchanged in male rats. In conclusion, the present data show that the prolonged ingestion of high doses of anabolic-androgenic steroids, either with or without concurrent exercise training, can modify in a sex-dependent manner the capacity of rat liver to metabolize drugs without affecting classical serum indicators of hepatic function.

Induction chemotherapy with carboplatin and ftorafur in advanced head and neck cancer. A randomized study

From 1987 to 1989, 42 patients with locally advanced squamous cell carcinoma of the head and neck (Stages III-IV, Mo) were randomized to receive radiotherapy (Group A) or three courses of induction chemotherapy followed by radiotherapy (Group B). There were 36 evaluable patients, 17 in Group A and 19 in Group B. The radiotherapy regimen was the same for both groups, 66-74 Gy total tumor doses with standard fractionation scheme of 2 Gy/day. The chemotherapy regimen was a combination of carboplatin 400 mg/m2 by intravenous bolus injection on day 1, and Ftorafur 1,000 mg/m2 orally once a day for 14 days. Cycles were given every 4 weeks. The complete response rate in Group A was 65%; in group B it was 31.5% after induction chemotherapy and 84% after radiotherapy. The 42-month actuarial overall survival rates were 34% for Group A and 47% for Group B (P = NS). Patients from both groups with a complete response had a significantly longer survival time than those with a partial response (P less than 0.001). No significant differences in disease-free survival were found between the two treated groups. The chemotherapy regimen was well tolerated, with moderate hematologic and gastrointestinal toxicity. Increased in radiation toxicity by chemotherapy was not observed.

Treatment with anabolic steroids increases the activity of the mitochondrial outer carnitine palmitoyltransferase in rat liver and fast-twitch muscle

Treatment of male rats with the anabolic steroids fluoxymesterone or methylandrostanolone increased the activity of the outer carnitine palmitoyltransferase in liver and fast-twitch muscle mitochondria. This effect was not potentiated by physical exercise and was not observed in heart and slow-twitch muscle mitochondria. Anabolic steroids did not affect the sensitivity of the liver enzyme to inhibition by malonyl-CoA. The data presented herein suggest that androgens may have an important physiological role in the regulation of fatty acid oxidation in liver and fast-twitch muscle mitochondria. In addition, our results are at odds with the notion that (most of) the metabolic effects of anabolic steroids on muscle are only evident when physical training is parallely performed.

Effect of anabolic steroids on mitochondria and sarcotubular system of skeletal muscle

Soleus and extensor digitorum longus (EDL) mitochondria and sarcotubular system were examined in sedentary and trained (treadmill for 12 wk) male rats that were treated with fluoxymesterone or methandrostanolone (2 mg/kg, 5 days/wk, for 8 wk). Neither physical exercise nor anabolic/androgenic steroid administration resulted in a significant change in muscle wet weight. Treatment with the anabolizing androgens increased succinate dehydrogenase activity in fast-twitch muscle mitochondria; this effect was not enhanced by training and was not observed in soleus mitochondria. On the other hand, the content of the slow-twitch muscle in sarcotubular fraction was increased in sedentary rats by fluoxymesterone or methandrostanolone treatment, whereas no significant changes were found in EDL. The training program affected adenosinetriphosphatase (ATPase) activities in the sarcotubular fraction; Mg2(+)-ATPase was increased in both soleus and EDL, but Ca2(+)-ATPase was decreased only in soleus. However, in sedentary animals only the Mg2(+)-dependent activity of EDL was increased by anabolizing androgen treatment, and this change was not potentiated by additional training. The present data indicate that anabolic/androgenic steroids can affect mitochondrial and sarcotubular enzymes in skeletal muscle. The effects are muscle-type specific.