Efficacy of radical neck dissection for the control of cervical metastasis after radiotherapy for nasopharyngeal carcinoma

Fifty-one patients who had persistent or recurrent neck disease from nasopharyngeal carcinoma after radiotherapy underwent radical neck dissection. The follow-up period ranged from 0.5 to 9 years (median: 2 years). Multiple cervical lymph node involvement was present in 51% of the patients (26 of 51). Malignant cells were detected in 88% of the resected specimens (45 of 51). The clinical sign of fixation of lymph node is the only factor that affects the successful control of neck disease (p = 0.04). Extracapsular extension of the nodal disease was present, and 35% of the lymph nodes were adherent to surrounding structures at operation (18 of 51). There was one hospital mortality and the overall morbidity was minimal. The actuarial survival at 5 years was 38%, and the probability of control of neck disease was 66%. Radical neck dissection is effective in controlling post-irradiation cervical metastasis from nasopharyngeal carcinoma.     

Analysis of clozapine response and polymorphisms of the dopamine D4 receptor gene (DRD4) in schizophrenic patients

We have examined the hypothesis that a variable number of tandem repeats in the third cytoplasmic loop of the dopamine D4 receptor influences clinical response to clozapine using a sample of 189 schizophrenic patients. Alleles of the 48-bp repeat, which range from two to ten copies in the normal human population, were analysed by the polymerase chain reaction using genomic DNA as template. Association between these alleles and response to clozapine was tested using the difference in pre-and post-treatment GAS scores as a measure of response. We found no statistically significant variation between genotypic groups and response by analysis of variance. We conclude that the variation of the number of 48-bp repeats alone does not determine response to clozapine. Larger studies are underway to determine if there is a more subtle relationship with sequence variation within the repeats or at other polymorphic sites within the gene that may provide evidence for a component of clozapine's action being at D4 receptors. © 1995 Wiley-Liss, Inc.     

Arbeitsunfähigkeit im ersten Jahr der chronischen Polyarthritis. Ein Vergleich mit Pflichtmitgliedern der gesetzlichen Krankenversicherung

Zusammenfassung Obwohl Arbeitsunf?higkeit (AU) eine direkte Folge der durch die Erkrankung reduzierten Arbeitskraft ist, wurde sie im Frühstadium der chronischen Polyarthritis (cP) kaum untersucht. Deshalb wurden die H?ufigkeit und die Dauer der AU in einer multizentrischen Querschnittsstudie von Patienten im Frühstadium der cP (≤12 Monate Krankheitsdauer) im Vergleich zu Pflichtmitgliedern der gesetzlichen Krankenversicherung ermittelt. 134 ambulante erwerbst?tige Patienten erfüllten die Kriterien des American College of Rheumatology für die cP von 1987: 85 Frauen (63% von 134 Patienten), Alter im Median 50 Jahre. AU wurde entsprechend den Patientenangaben zur „Krankschreibung“ dokumentiert. Bei der im Median 7 Monate bestehenden Erkrankung trat bisher wenigstens einmal AU wegen cP bei 102 Patienten (76%) auf. Sie bestand bei den M?nnern für ca. 11 Tage pro Monat, d.h. ca. ein Drittel der Krankheitszeit, und bei den Frauen für 8 Tage pro Monat entsprechend ca. einem Viertel der seit Beginn der cP vergangenen Zeit. AU wegen cP dauerte fast fünfmal l?nger als aufgrund der Referenzdaten zu erwarten war. über die „Krankschreibung“ wegen cP hinaus waren diese Patienten wegen anderer Erkrankungen etwa im gleichen Ausma? wie in die Referenzpopulation arbeitsunf?hig. Der gro?e Anteil der von Arbeitsunf?higkeit wegen cP betroffenen Patienten und die Dauer der AU verdeutlichen das Ausma? gravierender Beeintr?chtigungen der Erwerbst?tigkeit bereits im ersten Jahr der cP. Eingegangen: 21. M?rz 1996 Akzeptiert: 11. November 1996     

Mechanism-based inhibition of thioredoxin reductase by antitumor quinoid compounds.

Quinoids undergo metabolism by a number of flavoenzymes. Reactive species formed during the metabolism of some quinoids might be anticipated to inhibit flavoenzyme activity. Several quinoids have been tested for their ability to inhibit rat liver thioredoxin reductase (TR). The antitumor quinones diaziquone and doxorubicin, and the quinoneimine 2,6-dichloroindophenol, were found to be inhibitors of the reduction of 5,5'-dithiobis-2-nitrobenzoic acid (DTNB) by TR. The inhibition was most marked after incubation of the quinoid with NADPH and the enzyme for 60 min before adding DTNB, with Ki values of 0.5 microM for diaziquone, 0.5 microM for doxorubicin, and 0.07 microM for 2,6-dichloroindophenol. The three quinoids all produced a time-dependent and first order loss of TR activity. There was formation of electron spin resonance-detectable semiquinoid free radicals upon incubation of diaziquone, doxorubicin and 2,6-dichloroindophenol with TR and NADPH under anaerobic conditions. Oxygen radicals formed by redox cycling of the quinoids did not make a major contribution to the inhibition of TR by the quinoids, as shown by the absence of significant reversal of the inhibition by anaerobic incubation conditions and the lack of effect of the oxygen radical scavengers dimethyl sulfoxide, superoxide dismutase and catalase. It was not possible to demonstrate NADPH-dependent covalent binding of radiolabeled diaziquone or doxorubicin to the TR apoprotein. It is possible that the quinoids bind noncovalently to the enzyme apoprotein, or bind to the FAD prosthetic group. The results of the study suggest that some antitumor quinoids are mechanism-based inhibitors of TR showing metabolism- and time-dependent irreversible inhibition of enzyme activity.     

Dynamic gadolinium-enhanced echo-planar MR imaging of the liver: Effect of pulse sequence and dose on enhancement

To develop guidelines for clinical magnetic resonance imaging of the liver, the authors undertook an animal study to investigate the effect of dose and pulse sequence on liver signal intensity in gadopentetate dimeglumine—enhanced echo-planar imaging. Serial imaging of the liver was performed in anesthetized rats after intravenous administration of five different doses (0.01, 0.05, 0.1, 0.2, and 0.5 mmol/kg) of contrast agent, with six different pulse sequences. The results show that gadopentetate dimeglumine—enhanced echo-planar images obtained during the perfusion phase can yield either positive (due to increased T1 relaxation rates) or negative (due to susceptibility-induced increased T2 relaxation rates) liver enhancement depending on choice of pulse sequence and dose. At the current clinically recommended dose of 0.1 mmol/kg, maximal liver signal enhancement was seen with a T1-weighted inversion-recovery sequence, while maximal liver signal diminution was seen with a T2*-weighted gradient-echo sequence. The authors conclude that gadopentetate dimeglumine—enhanced echo-planar imaging can provide T1, T2, and T2* contrast that may be exploited for both lesion detection and lesion characterization.     

Acute post-streptococcal glomerulonephritis followed shortly by acute rheumatic fever

A 16 year old girl with post-streptococcal glomerulonephritis developed acute rheumatic fever 19 days afterwards. Previous publications on concurrent post-streptococcal glomerulonephritis and acute rheumatic fever are reviewed.