Results of surgical treatment of lung cancer in patients over 70 years old

Results of surgical treatment of 345 patients (210 men--61%; 135 women--39%) over 70 years with non-small-cell lung cancer were analyzed. Central lung cancer was diagnosed in 141 (40.9%), peripheral--in 204 (59.1%) patients. Squamous cell cancer was seen in 233 (67.3%), glandular--in 67 (19.4%), dimorphic--in 22 (6.5%), large-cell--in 23 (6.8%) patients. Stage I of the disease was diagnosed in 121 (35.1%); stage II--in 49 (14.1%); stage III--in 175 (50.8%) patients. Rate of postoperative complications in the study group was 27.8%, lethality--6.4%. The highest lethality was after combined pneumonectomy. The most frequent postoperative complications were pneumonia (7.5%), arrhythmia (10.1%), pulmonary-heart insufficiency (4.9%). Five-year survival after radical surgery in patients over 70 years with lung cancer was 49%, in patients with stage I of the disease this parameter was the highest--71.4%.     

Modulation of neuronal nicotinic receptor function by the neuropeptides CGRP and substance P on autonomic nerve cells

1. One classical example of how neuropeptides can affect the function of ligand-gated receptors is the modulation of neuronal nicotinic receptors (nAChRs) by substance P. The present review updates current understanding of this action by substance P and compares it with other neuropeptides more recently found to modulate nAChRs in the autonomic nervous system. 2. Calcitonin gene-related peptide (CGRP) and its N-terminal fragments have been shown to exert complex inhibitory as well facilitatory actions on nAChRs. Fragments such as CGRP(1-4), CGRP(1-5) and CGRP(1-6) rapidly and reversibly enhance agonist sensitivity of nAChRs without directly activating those receptors. Longer fragments or the full-length peptide potently inhibit responses mediated by nAChRs via an apparently competitive-type antagonism. This phenomenon differs from the substance P-induced block, which is agonist use-dependent and preferential towards large nicotinic responses. 3. It is argued that the full-length peptides CGRP and substance P might play distinct roles in the activity-dependent modulation of cholinergic neurotransmission, by inhibiting background noise in the case of CGRP or by reducing excessive excitation in the case of substance P. Hence, multiple neuropeptide mechanisms may represent a wide array of fine-tuning processes to regulate nicotinic synaptic transmission. 4. The availability of novel CGRP derivatives with a strong enhancing action on nAChRs may offer new leads for the drug design targeted for potentiation of nAChRs in the autonomic nervous system as well as in the brain, a subject of interest to counteract the deficit of the nAChR function associated with neurodegenerative diseases like Alzheimer's and Parkinson's diseases.     

Modulation of P2X3 receptors by Mg2+ on rat DRG neurons in culture

On nociceptive neurons the commonest response to ATP is a rapidly desensitizing current mediated by P2X(3) receptors and believed to be involved in certain forms of pain. P2X(3) receptor recovery from desensitization is a slow process. We studied whether Mg(2+) might modulate such ATP-evoked currents on rat cultured DRG neurons, and thus account for its analgesic action in vivo. Transient increases in extracellular Mg(2+) strongly and reversibly depressed ATP currents which had not recovered from desensitization. Ca(2+)-free solution had the same action as Mg(2+). High Mg(2+) or Ca(2+)-free modulation depended on exposure length to modified divalent cation solutions, whereas it was independent from membrane potential or intracellular Ca(2+) buffering. Paired-pulse protocols showed that high Mg(2+) or Ca(2+)-free medium delayed ATP receptor recovery from desensitization, while leaving desensitization onset apparently unchanged. Tests with various concentrations of Ca(2+) and Mg(2+) showed that the depressant action by Mg(2+) was primarily due to functional antagonism of a facilitatory effect of Ca(2+) on ATP receptor function. The present results suggest that, on sensory neurons, P2X(3) receptors could be inhibited by high Mg(2+) or lack of Ca(2+), representing a negative feedback process to limit ATP-mediated nociception.     

Consequences of progestational hypoxia in pregnant rats and its peptide correction (EEG data)

We studied immediate and delayed changes in ECG in female albino rats subjected to acute hypobaric hypoxia on days 4-5 of pregnancy and evaluated the possibility of correction of hypoxia-produced disturbances with some peptides. Acute hypoxia lengthened the mean RR interval, increased heart rate variability, and decreased the monotony index. Hypoxia induced considerable changes in the structure of ECG that reflected the development of arrhythmias and conduction disturbances. These changes in ECG persisted during the posthypoxic period. Intranasal administration of heptapeptides Semax and -casomorphin-7 to pregnant females promoted recovery from acute hypoxia and normalized ECG in the posthypoxic period.     

T1N0/T2N0 glottic carcinoma: A comparison of two fractionation schedules

The aim of this paper is the retrospective comparison of accelerated/hypofractionated radiotherapy regimen (AHFX) with standard fractionation regimen (SFX) for patients with early glottic carcinoma. One hundred and forty‐five patients with T₁–T₂ glottic cancer between 1986 and 1998 were eligible. Before 1992, patients received 60–66 Gy in 30–33 fractions over 6–6.5 weeks (SFX) with ⁶⁰Co and 6‐MV beams. After 1992, patients received 52.5–55 Gy in 20 fractions over 4 weeks (AHFX) using 6‐MV beams. The end‐points were overall survival, laryngectomy‐free survival (LFS), loco‐regional control and toxicity. One hundred and two were stage T₁N₀; 43 were stage T₂N₀. Median follow up was 4.9 years. The 5‐year overall survival was 78%. Five‐year loco‐regional control in T₁N₀ patients was higher in AHFX than in SFX group (95 vs 75%, P = 0.002). Loco‐regional control in T₂N₀ patients was similar for AHFX and SFX (81 vs 80%, P = 0.813). Overall LFS was 88%. T₁N₀ AHFX patients had 5‐year LFS of 95% compared with 75% for SFX (P = 0.003). For T₂N₀ AHFX patients, overall LFS was 92% compared with 80% for the SFX group (P = 0.291). No grade 4 or 5 late toxicity occurred. One AHFX patient developed grade 3 toxicity; two of 51 SFX patients developed grade 2 toxicity versus five of 94 AHFX patients. AHFX using 6‐MV beams for treatment of early glottic cancer resulted in equivalent LFS and toxicity when compared with SFX.     

MRI appearances of the sphenoid sinus at the late follow‐up of trans‐sphenoidal surgery for pituitary macroadenoma

We aimed to demonstrate the appearances of the sphenoid sinus on MRI performed later than 2 years post‐ transsphenoidal surgery (TSS). We retrospectively reviewed 47 patients in whom follow‐up MRI scans had been performed at least 2 years post‐TSS. We specifically reviewed the clinical and imaging of those patients in whom the sphenoid sinus was filled with signal abnormality or masses were present arising from the sinus roof and classified them as tumour or indeterminate abnormalities on imaging criteria. We documented other clinicoradiological details. Twelve of 47 patients demonstrated sphenoid sinus filling or sinus roof masses and in six of 12 patients it was possible to classify them as tumourous using imaging and clinical criteria. The indeterminate and non‐tumourous sphenoid sinus abnormalities most frequently had a T1‐weighted signal similar to subsellar tumour and displayed rim enhancement and thus could not be reliably distinguished from tumourous abnormality on the basis of signal or enhancement characteristics. The presence of a well‐defined surgical defect in the sella floor was associated with resolution of abnormality on MRI follow‐up. We concluded MRI findings of sphenoid sinus filling or sinus roof masses are present in approximately 26% of scans performed longer than 2 years post‐TSS. Half of these are of indeterminate origin and follow‐up is required to discriminate tumour from non‐ tumour with certainty. A well‐defined surgical defect in the sella floor is, however, suggestive of a non‐tumourous abnormality.