Chemotherapy in stage II testicular tumours

Summary Twenty-six patients with stage II testicular teratomas (metastatic spread to the retroperitoneal lymph nodes only) were treated after retroperitoneal lymph node dissection (RLD) by cytostatic chemotherapy with or without radiotherapy.So far, eight patients (30.5%) have recurrent disease, with a median interval of 21 months from time of diagnosis to relapse. The 3-year survival rate for the total group (relapse-free and relapsed patients) was 85.7%. The median survival is not yet reached after 36 months.The own results and reports of the literature show an advantage of early cytostatic treatment over its institution in widespread disease only. It remains to be clarified whether chemotherapy in stage II disease prevents or only delays metastatic spread.

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Frühe Cytostaticatherapie bei Hodentumoren: Vorläufige Mitteilung

Zusammenfassung Bei 26 Patienten mit malignen Hodenteratomen im Stadium II (Metastasierung in die retroperitonealen Lymphknoten) wurde im Anschluß an die retroperitoneale Lymphadenektomie sofort oder nach einer zusätzlichen Bestrahlung des Retroperitoneums mit einer Cytostaticatherapie begonnen.Bis heute zeigten 8 Patienten (30,5%) ein Rezidiv. Die mittlere Dauer vom Zeitpunkt der Diagnose bis zum Nachweis des Rezidivs betrug 21 Monate. Die 3-Jahres-Überlebensrate liegt bisher bei 85,7%. Die mittlere Überlebenszeit beträgt mehr als 36 Monate.Die eigenen Ergebnisse sowie bisherige Literaturmitteilungen zeigen einen Vorteil des frühen Chemotherapiebeginns gegenüber der Einleitung einer Cytostaticatherapie erst bei Nachweis einer disseminierten Metastasierung. Ob die frühe Cytostaticatherapie eine Fernmetastasierung ganz verhindern kann oder lediglich deren Hinauszögerung bewirkt, läßt sich z. Z. noch nicht entscheiden.

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Supported by Landesamt für Forschung, Ministerium für Wissenschaft und Forschung des Landes Nordrhein-Westfalen. Düsseldorf.     

Osteonecrosis in patients with testicular tumours treated with chemotherapy

The role of antiemetics is invaluable in allowing cancer patients to complete, otherwise possibly intolerable, chemotherapy. In the Perugia Consensus Conference it was decided that the recommended antiemetic regimen in the prevention of acute emesis induced by a single high, low and repeated doses of cisplatin is a serotonin receptor antagonist plus dexamethasone. We describe three testicular cancer patients who were cured with chemotherapy but developed bilateral osteonecrosis of the femoral head 17, 22 and 55 months after chemotherapy. It is very likely that the dexamethasone used in the antiemetic drug regimen contributed to the development of osteonecrosis in these patients. Osteonecrosis is a serious side effect of antiemetic treatment with dexamethasone and this serious complication should be incorporated in the current guidelines. Patients should be informed about the risk of osteonecrosis when taking dexamethasone as an antiemetic drug. A recommendation to add corticosteroids to serotonin receptor antagonists only after demonstrated nausea in chemotherapy regimes with low-dose cisplatin (20 mg/m2) for five days seems justified.     

Chemotherapy in stage II testicular tumours: preliminary communication.

Twenty-six patients with stage II testicular teratomas (metastatic spread to the retroperitoneal lymph nodes only) were treated after retroperitoneal lymph node dissection (RLD) by cytostatic chemotherapy with or without radiotherapy. So far, eight patients (30.5%) have recurrent disease, with a median interval of 21 months from time of diagnosis to relapse. The 3-year survival rate for the total group (relapse-free and relapsed patients) was 85.7%. The median survival is not yet reached after 36 months. The own results and reports of the literature show an advantage of early cytostatic treatment over its institution in widespread disease only. It remains to be clarified whether chemotherapy in stage II disease prevents or only delays metastatic spread.     

Human chorionic gonadotropin (HCG) in monitoring the course of testicular tumours

Summary In 29 patients with metastasising testicular tumours serial determination of HCG was performed for monitoring cytostatic chemotherapy. Clinical remissions and stable disease were accompanied by normalisation of elevated HCG values in 85% and 80% of all cases, respectively. Despite the normalisation of HCG levels,no complete disappearance of clinically detectable tumour lesions could be seen in the herein presented cases. Seventeen percent of the patients showed normal HCG levels, although they had progressive disease. Recurrent disease was associated with preceding increase of HCG in only 33% of the cases. Because of the frequency of mixed tumour tissues in teratomas, additional methods for monitoring therapy should be used.

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Choriongonadotropin (HCG) in der Verlaufsbeurteilung der Hodentumoren

Zusammenfassung Bei 29 Patienten mit metastasierenden Hodentumoren wurde regelmäßig eine Bestimmung des HCG-Spiegels während einer Cytostaticatherapie durchgeführt. Patienten mit Remissionen zeigten in 85%, solche mit Krankheitsstillstand in 80% der Fälle eine Normalisierung des HCG-Spiegels. Trotz der nachweisbaren Normalisierung der HCG-Werte konnte in keinem der hier beschriebenen Fälle ein vollständiger Rückgang der Metastasen verzeichnet werden.17% der Patienten mit progredienter Metastasierung zeigten normale HCG-Werte. Erneute Krankheitsprogression nach vorausgegangener Remission war nur in 33% der Fälle von einem vor dem klinischen Nachweis erkennbaren HCG-Anstieg begleitet.Wegen der Häufigkeit von Mischtumoren bei malignen Teratomen des Hodens müssen weitere Methoden zur Beurteilung eines Therapieerfolges herangezogen werden.

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Supported by Landesamt für Forschung, Ministerium für Wissenschaft und Forschung des Landes Nordrhein-Westfalen     

Women,Ageing and the Family in Korea

It is expected that in another 30 years, people aged 60 years and over will account for one out of five Koreans. This change will increase the burden on women, the dominant caregivers. In 1990, among people 60 years and over, 3 per cent of men compared with 13 per cent of women lived alone. In rural areas 17 per cent of elderly women lived alone. While sons and daughters are both responsible for care of elderly family members, daughters-in-law usually carry out the duties of sons. Population ageing in Korea poses a grave challenge to the task of improving the status of women     

Human chorionic gonadotropin (HCG) in monitoring the course of testicular tumours.

In 29 patients with metastasising testicular tumours serial determination of HCG was performed for monitoring cytostatic chemotherapy. Clinical remissions and stable disease were accompanied by normalisation of elevated HCG values in 85% and 80% of all cases, respectively. Despite the normalisation of HCG levels, no complete disappearance of clinically detectable tumour lesions could be seen in the herein presented cases. Seventeen percent of the patients showed normal HCG levels, although they had progressive disease. Recurrent disease was associated with preceeding increase of HCG in only 33% of the cases. Because of the frequency of mixed tumour tissues in teratomas, additional methods for monitoring therapy should be used.     

Adrenocortical function tests in dogs with hyperfunctioning adrenocortical tumours.

The response has been studied in nine dogs with hyperadrenocorticism due to adrenocortical tumours to the administration of dexamethasone, insulin, lysine-vasopressin and tetracosactide by measuring the changes in plasma cortisol concentration. Administration of dexamethasone did not produce a decrease in the plasma concentration of cortisol in any of these dogs. Administration of insulin caused slight increases in the plasma concentration of cortisol in four out of eight dogs. Lysine-vasopressin increased the plasma concentration of cortisol in eight out of nine dogs, three responded supranomally. Eight out of the nine dogs responded to tetracosactide administration, three responded supranormally, It is concluded that in the dog, in contrast to man, the lysine-vasopressin test cannot be used to differentiate between pituitary-dependent hyperadrenocorticism and hyperadrenocorticism due to an adenocortical tumour. Apparently pituitary ACTH is not completely depleted in dogs with hyperfunctioning adrenocortical tumours.     

Activity of the hypothalamo-pituitary axis and testicular development in prepubertal ram lambs with induced hypothyroidism or hyperthyroidism

Prepubertal (16 weeks old) ram lambs were used to investigate the effects of hyperthyroidism and hypothyroidism on development of reproductive endocrine function. Over a period of 8 weeks, ram lambs were made hypothyroid (serum T4 less than or equal to 3 ng/ml compared with controls congruent to 30 ng/ml) by daily oral administration of methyl thiouracil or hyperthyroid (serum T4 congruent to 135 ng/ml) by daily sc injection of T4. Hyperthyroidism was associated with decreases in LH pulse frequency (2.25 +/- 0.75/12 h compared with controls 5.75 +/- 0.48/12 h), basal LH, and mean LH concentrations, together with arrested testicular growth and aspermatogenesis. Hypothyroid rams showed normal pubertal development. After iv injection of LHRH, hyperthyroid ram lambs showed similar LH responses to control and hypothyroid rams. Basal testosterone production (5.6 +/- 1.0 ng/min) and plasma testosterone concentrations after human CG (2.0 +/- 0.7 ng/ml) in hyperthyroid rams were significantly lower than in controls (67.5 +/- 24.0 ng/min and 5.2 +/- 1.0 ng/ml, respectively). It is concluded that retarded testicular development in hyperthyroid ram lambs results from changes in hypothalamo-pituitary activity manifested in a decreased LH pulse frequency.     

Energy Metabolism,Nutrition and Ageing

Abstract. Energy metabolism and nutrition have long been suggested to play a role in ageing processes, in age-related disease and in the health of the elderly. This review addresses new insights arising from selected studies of the interplay of these factors. Data on overfeeding and underfeeding in young versus elderly men and women demonstrate a deficit with age in the ability to regulate energy balance. They also indicate that current values of Recommended Daily Allowances of caloric intake underestimate the needs of the elderly. The studies suggest that diminished capacity of energy metabolism with age may have a nutritional component and the involvement of the central nervous system. The contribution of peripheral tissues is suggested by studies of mitochondrial DNA isolated from tissues of humans and rodents. The studies demonstrate age-related and disease-related increases in rates of mutation in some but not all tissues. The further involvement of mitochondrial dysfunction in ageing is suggested by data on oxidative free radical production in mitochondria of birds versus rodents. These elegant studies indicate greatly reduced rates of free radical production in mitochondria of long-lived - birds versus short-lived rodents. They further demonstrate that Complex I of the respiratory chain may be a major factor in these species-specific effects. Restriction of caloric intake (dietary restriction, DR) is the only manipulation known to consistently extend lifespan in a wide variety of species. Previous work shows that extension of lifespan in DR is not necessarily related to reduced metabolic rate per unit metabolic mass. More recent work in exercising DR rats demonstrates consistently high daily metabolic rates together with extended lifespan. Other studies also show altered characteristics of fuel use in DR, indicating the ability of DR rats to maintain appropriate rates of fuel use under conditions less damaging to the organism. All of these new approaches to the interaction of nutrition, energy expenditure and ageing suggest that regulation of energy balance and the characteristics of fuel use play significant roles in ageing and in age-related disease.