Radical radiotherapy in prostatic carcinoma

During the years 1978-1986 111 fairly elderly patients with prostatic carcinoma in clinical stages B, C, or D, and usually having tumours that were poorly differentiated, received radical radiotherapy to the prostate and bladder and to the adjacent lymph node regions. The side effects were comparable to those reported in the literature. During the follow-up 72% of the patients sooner or later (actuarial analysis) developed local recurrence or distant metastases. The projected survival rate at 8 years was 25%, and should be compared with the 65% expected for an age-matched Swedish male population. After 3 years the two survival curves became rather parallel, indicating a 'cure' rate of the order of 49%. There was a significant difference in survival between patients clinically judged to have only intracapsular carcinoma and those considered to have extracapsular carcinoma. The relatively modest survival figures in the present series reflect the malignant nature of poorly differentiated carcinoma of the prostate.     

Vancomycin and netilmicin as first line treatment of peritonitis in CAPD patients

The first line treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in our hospital was recently altered from a combination of gentamicin and clindamycin, given as continuous peritoneal lavage, to one of vancomycin and netilmicin given in peritoneal dialysis fluid with prolonged dwell time (4-6 h). The change was prompted by the emergence of multiply resistant Staphylococcus epidermidis among CAPD patients and nursing staff. In 9 of 19 episodes of peritonitis treated with gentamicin/clindamycin, the infecting organism could still be isolated from peritoneal fluid 5-15 days after commencement of therapy. All of 35 culture verified episodes treated with vancomycin/netilmicin were cleared bacteriologically within 3 days (P less than 0.0005). The vancomycin and netilmicin serum levels achieved were 6.5-37.0 mg/l and 1.0-8.1 mg/l, respectively. Apart from an asthmatic reaction, possibly triggered by vancomycin, no side effects were seen. However, audiometry was not performed regularly and the possible effect of netilmicin on the residual renal function was not systematically investigated.     

The Moore vitallium femoral-head prosthesis in fractures of the femoral neck.

A follow-up is given of early and late results in 109 arthroplasties with the self-locking Austin T. Moore vitallium femoral head prosthesis in fractures of the femoral neck on 106 patients. Operative indication was usually fresh medical fracture of the femoral neck in an elderly woman, or its late complication. The surgery was performed in a unit for general surgery also engaged in pre- and postgraduate teaching activities. Many operations were performed by residents engaged in general surgery or orthopaedics. Point scores according to a modification of Merle D'Aubigné's classification showed excellent or at least good results in 81 per cent of the 69 mobile patients. Because of deteriorated general physical condition 11 patients were chronically bed-ridden. Five patients could not be reached. In three instances the prosthesis was removed. 21 patients died, three during the stay in hospital and 18 later for reasons not connected with the operative procedure. The mortality during 40 months of observation corresponded fairly well to that expected in the age group for the population as a whole.     

New dystonic syndrome associated with butyrophenone therapy

Summary An acute syndrome in 3 elderly women with presenile dementia appeared as a side effect to treatment with methylperone (Buronil) and/or haloperidol (Haldol). In every case a tonic flexion of the trunk to the side was observed. Also a slight rotation of the trunk in the sagittal plane was noted. The rotation increased with walking and then the patients had a tendency to turn in a direction opposite to the path of walking. Postural and gait disturbances occurred as isolated symptoms and were different from the previously reported symptoms of acute dystonia with phenothiazine treatment. The symptoms were reversible and were improved by antiparkinson medication.The similarity in chemical structure of the butyrophenone preparations suggests a common, central mechanism of origin for the symptoms. A reversible functional disturbance in the monoamine transmission in the basal ganglia is a probable explanation.

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Zusammenfassung Als Nebenwirkung der Behandlung mit Methylperon (Buronil) und/oder Haloperidol (Haldol) wurde ein akutes Haltungssyndrom bei 3 älteren Frauen mit präseniler Demenz beobachtet. In jedem Falle kam es zu einer tonischen Flexion des Rumpfes zu einer Seite sowie zu einer leichten Rotation in der sagittalen Ebene. Die Rotation verstärkte sich beim Gang, wobei die Patienten die Tendenz hatten, sich in einer Richtung entgegen der Ganglinie zu drehen. Haltungs- und Gangstörungen kamen als isolierte Symptome vor und sind verschieden von den früher beobachteten und beschriebenen Symptomen der akuten Dystonie bei Phenothiazin-Behandlung. Die Symptome waren reversibel und wurden durch Anti-Parkinson-Medikamente gebessert. Die Ähnlichkeit in der chemischen Struktur der Butyrophenon-Medikamente macht einen gleichen zentralen Mechanismus in der Entstehung der Symptome wahrscheinlich. Als Erklärung kann man eine reversible Funktionsstörung in der Monoamin-Transmission der Stammganglien annehmen.

     

Biologic therapy for psoriasis: an update on the tumor necrosis factor inhibitors infliximab, etanercept, and adalimumab, and the T-cell-targeted therapies efalizumab and alefacept

Psoriasis is a chronic skin disorder that affects approximately 2% of the US and European population. Over the last several years, one of the major focuses in psoriasis research has been the development of biologic therapies for this disease. The aim of these therapies is to provide selective, immunologically directed intervention with fewer side effects than traditional therapies. The goal of this article is to update the progress of the tumor necrosis inhibitors which are available, or under investigation, for clinical use in psoriasis: infliximab, etanercept, and adalimumab, as well as the T-cell-targeted therapies efalizumab and alefacept (Table 1).     

Radiofrequency ablation in the liver close to the bile ducts: can intraductal cooling offer protection?

Background One complication of radiofrequency ablation (RFA) of the liver is biliary duct damage. Intraductal cooling (IDC) has been proposed as a means of protection.Methods In the first experiment, designed to evaluate the influence of IDC on the RFA procedure per se and on lesion formation, lesions were created in vivo in pig liver with and without IDC. The RFA needle was placed with a 1.5-cm safety margin from the bile ducts. In the second experiment, designed to evaluate the potential protective effects of IDC, lesions were created close to a bile duct with and without IDC.Results With the safety margin, the RFA parameters and lesion size were not negatively affected by IDC. Microscopic examination revealed that IDC had a protective effect in most of the lesions created close to a bile duct.Conclusions The IDC procedure was feasible and had no negative effect on the RFA procedure or the lesions. However, the protective effect of IDC was not statistically significant (p = 0.12).