() INDIUM-CAPROMAB PENDETIDE IN THE EVALUATION OF PATIENTS WITH RESIDUAL OR RECURRENT PROSTATE CANCER AFTER RADICAL PROSTATECTOMY

Purpose

Standard diagnostic methods are limited for detecting distant metastases in patients with prostate cancer in whom the only evidence of disease after radical prostatectomy is a detectable prostate specific antigen (PSA) level. We evaluated the role of immunoscintigraphy with the radiolabeled monoclonal antibody,¹¹¹ indium (¹¹¹) In)-capromab pendetide, to differentiate between local and distant recurrence in this patient population.

Materials and Methods

We enrolled 183 men who had undergone radical prostatectomy in whom PSA later increased. Gamma camera images were acquired twice after infusion of a single dose of¹¹¹ In-capromab pendetide.

Results

Immunoscintigraphy revealed disease in 108 of 181 patients (60%) with interpretable scans. The antibody was localized most frequently to the prostatic fossa (34% of the cases), abdominal lymph nodes (23%) and pelvic lymph nodes (22%). Of the 181 men the scan localized the antibody outside the prostatic fossa in 42%. Half of the positive localizations in the fossa were confirmed by biopsy.

Conclusions

These findings suggest that immunoscintigraphy with¹¹¹ In-capromab pendetide can assist in determining the extent of disease in patients who have increasing PSA after prostatectomy.     

Nonadditive Developmental Toxicity in Mixtures of Trichloroethylene, Di(2-ethylhexyl) Phthalate, and Heptachlor in a 5x5x5 Design

In order to identify nonadditive effects on development, threecompounds were combined using five dosages of each agent (a5x5x5 full-factorial design). Trichloroethylene (TCE), di(2-ethylhexyl)phthalate (DEHP), and heptachlor (HEPT), in corn oil, were administeredby gavage to Fischer-344 rats on Gestation Days 6–15.Dose levels were 0, 10.1, 32, 101, and 320 mg/kg/day for TCE;0, 24.7, 78, 247, and 780 mg/kg/day for DEHP; and 0, 0.25, 0.8,2.5, and 8 mg/kg/day for HEPT. The dams were allowed to deliverand their pups were weighed and examined postnatally. Maternaldeath showed no main effects but DEHP and HEPT were synergistic.For maternal weight gain on Gestational Days 6–8, maineffects for all three agents were observed, as well as TCE-DEHPsynergism, and DEHP-HEPT antagonism. Maternal weight gain onGestational Days 6–20 adjusted for litter weight showedmain effects for TCE and HEPT, but no interactions. Main effectsfor all three agents were evident for full-litter resorptionsand prenatal loss. The HEPT main effects were unexpected andwere interpreted as reflecting potentiation by HEPT of the otheragents. For full-litter loss, the TCE-HEPT and DEHP-HEPT interactionswere antagonistic, perhaps due to a "ceiling" effect. For prenatalloss, the TCE-DEHP interaction was synergistic. Postnatal lossshowed DEHP and HEPT main effects but no interactions. Analysisof pup weights on Day 1 revealed TCE and DEHP main effects andDEHP-HEPT antagonism; on Day 6, DEHP and HEPT main effects,DEHP-HEPT antagonism, and TCE-DEHP synergism were evident. Microphthalmiaand anophthalmia incidences revealed TCE and DEHP main effectsbut no interactions. This extensive examination of a full-factorialdesign elucidates the complexities of studying and interpretingmixture toxicity. The data are available for further analysis.     

Mesotherapy and Phosphatidylcholine Injections: Historical Clarification and Review

BACKGROUND: Mesotherapy was originally conceived in Europe as a method of utilizing cutaneous injections containing a mixture of compounds for the treatment of local medical and cosmetic conditions. Although mesotherapy was traditionally employed for pain relief, its cosmetic applications, particularly fat and cellulite removal, have recently received attention in the United States. Another treatment for localized fat reduction, which was popularized in Brazil and uses injections of phosphatidylcholine, has been erroneously considered synonymous with mesotherapy. Despite their attraction as purported "fat-dissolving" injections, the safety and efficacy of these novel cosmetic treatments remain ambiguous to most patients and physicians. OBJECTIVE: To distinguish mesotherapy from phosphatidylcholine injections by reviewing their history and the relevant experimental or clinical findings. METHODS: A comprehensive search of Medline indexed literature and conference proceedings. RESULTS: All the published studies evaluating the clinical efficacy of traditional mesotherapy currently originate from Europe. These reports focus primarily on musculoskeletal pain and vascular disease, rather than cosmetic applications. Although experimental data suggest that a number of traditional mesotherapy ingredients may theoretically reduce fat, these effects have not been supported in peer-reviewed studies. An increasing number of reports demonstrate that subcutaneous injections of a formula containing phosphatidylcholine combined with its emulsifier, deoxycholate, are effective in removing small collections of adipose tissue. Cell lysis, resulting from the detergent action of deoxycholate, may account for this clinical effect. CONCLUSIONS: Mesotherapy is distinct from a method of treating adipose tissue with subcutaneous injections of deoxycholate alone or in combination with phosphatidylcholine. Additional clinical and experimental studies are necessary to more definitively establish the safety and efficacy of these treatments.     

External Non-invasive Cardiac Pacing: A Comparative Hemodynamic Study of Two Techniques with Conventional Endocardial Pacing

Out-of-hospital therapy for cardiac arrest due to bradyarrhythmias or asystole is pharmacologic and the outcome is uniformly dismal. Optimal therapy for the latter disturbances may be artificial cardiac pacing, but conventional invasive pacing techniques are not employed or are of limited value in the out-of-hospital and emergency department setting. This investigation compared the hemodynamic effects of two techniques of non-invasive external pacing: 1) transcutaneous transthoracic pacing (TTP) and 2) tongue-to-epigastrium pacing (TEP), with conventional transvenous right ventricular endocardial pacing (RVEP) in a closed-chest, chronic heart block canine model. All techniques significantly increased (p less than .001) cardiac output (CO). However, CO and mean arterial pressure (MAP) measured during external pacing with either non-invasive technique were significantly greater than that during RVEP (p less than .001). TEP produced vigorous skeletal muscle stimulation and, in the canine model, it produced contraction resulting in impaired ventilation, hypoxemia, and a decrease in systemic vascular resistance. TTP in this model resulted in improved MAP and CO when compared with control and RVEP values and did not affect arterial or mixed venous blood gas values. Thus, this study demonstrates that noninvasive TTP is comparable to RVEP in its hemodynamic effects. TTP may offer definitive non-invasive therapy for a subset of victims of out-of-hospital cardiac arrest.