A Clinical Screening Cooperative Group phase II evaluation of lobaplatin (ASTA D-19466) in advanced head and neck cancer

Summary We evaluated the efficacy and tolerability of lobaplatin, a new platinum compound, given at the dose of 50 mg/m² by i.v. bolus every 4 weeks, in 49 patients with advanced and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). One complete and 2 partial responses were observed in 43 eligible patients for an overall response rate of 7% (95% confidence interval: 1–19%). The duration of responses was 11, 16 and 32 weeks. Toxicities of WHO grade 3 were hematologic: thrombocytopenia in 26%, granulocytopenia in 12% and anemia in 12% of patients. There was no therapy-related death. Nausea/vomiting, diarrhoea and paresthesia were mild and rare. In conclusion, lobaplatin was well tolerated, but its efficacy in advanced SCCHN at the presented dose and schedule, was marginal.     

Wagner vitreoretinal degeneration with genetic linkage refinement on chromosome 5q13-q14

· Background: It has been previously described that Wagner disease is linked to chromosome 5q13-q14. This study was carried out to describe the ophthalmological aspects and report the results of genetic linkage analysis in a large pedigree affected by Wagner disease. · Methods: Fourty members of one same family agreed to be examined. · Results: Twenty patients presented vitreoretinal degeneration in both eyes without any extra-ocular abnormalities. In young patients, visual acuity was usually normal after correction of frequent mild myopia. Presenile cataracts progressed by the third decade and required removal for visual rehabilitation. The primary disorder involved an abnormal vitreous. A few avascular vitreous bands were usually the only optical feature in the mostly empty vitreous cavity. A circumferential vitreous condensation formed in contact with the retina on many spots. Less common retinal findings included retinal detachment, abnormal retinal pigmentation, progressive atrophy of the RPE simulating choroideremia and lattice degeneration. Genetic analysis revealed a highly significant linkage (lod score >5.0) between the disease and 10 markers of the chromosome 5q13-q14 region. Two recombination events allowed us to refine the linked interval to 20 cM between the D5S650 and D5S618 markers. · Conclusion: Ophthalmological aspects of Wagner’s disease appear to progress with age. Regular ophthalmological examination is important for detecting retinal abnormalities. The gene involved in Wagner’s disease lies in a 20 cM interval on chromosome 5q13-q14. Received: 30 June 1998 Revised version received: 5 October 1998 Accepted: 6 October 1998     

The diagnostic value of bone scintigraphy in patients with low back pain

Bone scintigraphy has been studied in two groups of patients presenting with low back pain. In one group of 38 patients suffering "nonspecific" back pain, bone scintigraphy and laboratory findings were negative in 24. There were abnormal laboratory findings in all of the remaining 14 and 7 had positive bone scans indicative of clinically significant disease. Selection of patients for bone scintigraphy in this group should therefore be influenced by abnormal laboratory findings and elevation of the erythrocyte sedimentation rate in particular. By comparison, the bone scans were reviewed from another group of patients suffering previously known malignancy. Out of 138 patients, nearly 40% showed a positive bone scan due to subsequently proven metastasis. Bone scintigraphy was positive in a further 14% as a result of osteoporotic rib fracture and vertebral body collapse. In half of these, it was not possible to exclude malignancy by scintigraphy. The present findings indicate that bone scintigraphy is not a useful procedure in patients with long-standing low back pain who have normal radiographs and normal laboratory findings.     

Surgical anatomy and anatomical surgery of the liver

The morphologic anatomy of the liver is described as 2 main and 2 accessory lobes. The more recent functional anatomy of the liver is based on the distribution of the portal pedicles and the location of the hepatic veins. The liver is divided into 4 sectors, some of them composed of 2 segments. In all, there are 8 segments. According to the anatomy, typical hepatectomies (or réglées) are those which are performed along anatomical scissurae. The 2 main technical conceptions of typical hepatectomies are those with preliminary vascular control (Lortat-Jacob's technique) and hepatectomies with primary parenchymatous transection (Ton That Tung's technique). A good knowledge of the anatomy of the liver is a prerequisite for anatomical surgery of this organ.

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Résumé L'anatomie morphologique du foie permet d'individualiser 2 lobes principaux et 2 lobes accessoires. L'anatomie fonctionnelle du foie, plus récemment décrite, est fondée sur la distribution des pédicules portaux et sur la localisation des veines sus-hépatiques. Le foie est divisé en 4 secteurs, eux-mÊmes composés en général de 2 segments. Au total, il y a 8 segments.Selon les données anatomiques, les hépatectomies typiques (ou réglées) sont celles qui sont réalisées le long des scissures anatomiques. Les deux conceptions principales des exérèses hépatiques typiques sont, du point de vue technique, les hépatectomies avec contrÔle vasculaire préalable (technique de Lortat-Jacob) et les hépatectomies avec abord transparenchymateux premier (technique de Ton That Tung). Une connaissance approfondie de l'anatomie du foie est une condition préalable à la réalisation d'une chirurgie anatomique de cet organe.

     

Comparative patterns of i-antigen expression, F-cell frequency and Hb A2 level in acute myeloid leukemia and in acute lymphoid leukemia

Hb F, Hb A₂ and i-antigen expression were investigated in adulthood acute leukemias. The study of i-antigen expression by immuno-agglutination and immunofluorescence showed that it is preferentially increased among AML patients. A similar result was obtained for F-cell frequency which was often increased in AML, while it was normal in ALL. Hb A₂ level was significantly lower in AML than in ALL. These differences between AML and ALL red cell patterns further suggest that the leukemic clone involves the erythroid lineage in AML but not in ALL.     

Estrogen receptor negative and progesterone receptor positive primary breast cancer: Pathological characteristics and clinical outcome

The expression of estrogen (ER) and progesterone (PgR) receptors was analyzed in a retrospective series of 3000 patients who had operable primary breast cancer. Patients were stratified according to ER and PgR status and the study was focused on the two groups (ER–PgR+ and ER–PgR–) of patients whose tumors contained low levels of ER (< 15 fmol/mg protein), regarding potential response to endocrine therapy. The comparison of clinical or histological characteristics between ER–PgR+ and ER–PgR– patients was analyzed as well as the disease-related death and survival. The mean follow-up was 86.3 months. Among the 529 ER–patients, 62 were PgR+ (12%), whereas 467 were PgR– (88%). The ER–PgR+ and ER–PgR– populations represented 2% and 15.6% of the overall population, respectively. In ER– tumors, the PgR status was significantly related to: age, menopausal status, tumor size, SBR grade, and histological type, but not to the type of surgical treatment or to lymph node involvement. ER–PgR+ tumors had smaller size (64% T1 vs 43%) (p=0.004) and were more frequently grade I (28% vs 12%) than ER–PgR– ones (p < 0.001). In addition, the patients with ER–PgR+ tumors were significantly younger (49.4 years vs 58.4 years; p < 0.0001), and were more frequently premenopausal (76% vs 36%; p < 0.001). The disease-free interval and the metastasis-free survival tended to be worse for ER–PgR– than for ER–PgR+ patients, but the difference was not statistically significant at 10 years. However, a small but significant difference in overall survival, in favor of the PgR+ group, was observed between the two groups during the first 5 years (p=0.03).We conclude that in combination with ER, PgR status defines a group of patients with clinical and biological specificity, which could be considered for specific endocrine therapy.     

Association between parity and autoimmune thyroiditis in a general female population

Background: Autoimmune thyroid disease (AIT) is more common in females than in males. Furthermore, it is well documented that the risk of thyroid autoimmunity increases during pregnancy and in the postpartum period. The objective of the present study was to analyse the association between parity and AIT by using ultrasound and serological data.

Methods: The study population included 2156 women, aged 20–79 years. Serum thyroperoxidase antibodies (anti-TPO) and thyrotropin levels were measured and thyroid ultrasonography was performed. AIT was defined according to the combined presence of a hypoechogenic thyroid pattern and positive anti-TPO levels (>200 IU/ml). Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results: The analyses revealed an association between parity and AIT. Women with at least one pregnancy had increased odds for AIT (OR 4.6 [95%-CI 1.4–15.1], p < 0.05) compared to women who have never been pregnant. Similar results were observed using hypoechogenic thyroid pattern (OR 1.7 [95%-CI 1.0–2.9], p < 0.05) and positive anti-TPO levels (OR 1.8 [95%-CI 1.0–3.3], p = 0.05) as separate dependent variables or using number of births as alternate independent variable.

Conclusion: In this female population we found an association between parity and AIT and conclude that parity appears to be a potential risk factor for AIT.     

Predicting health-related quality of life in dialysis patients: Factors related to negative outcome expectancies and social support

ObjectivesDialysis patients report a low health-related quality of life (HRQOL) due to high disease burden and far-reaching consequences of dialysis treatment. This study examined several cognitive-behavioral and social factors, with a focus on negative outcome expectancies, that might be relevant for HRQOL in end-stage kidney disease (ESKD) patients treated with dialysis.MethodsPatients treated with hemodialysis or peritoneal dialysis were recruited from Dutch hospitals and dialysis centers. Patients completed self-report questionnaires at baseline (n = 175) and six months follow-up (n = 130). Multiple regression analyses were performed.ResultsHigher scores on factors related to negative outcome expectancies at baseline, especially helplessness and worrying, and less perceived social support were significantly related to worse HRQOL six months later. When controlling for baseline HRQOL, besides sex and comorbidity, helplessness remained significantly predictive of worse HRQOL six months later, indicating that helplessness is associated with changes in HRQOL over time.ConclusionsNegative outcome expectancies and social support are relevant markers for HRQOL and/or changes in HRQOL over time.Practice implicationsNegative outcome expectancies could be prevented or diminished by enhanced treatment information, an improved patient-clinician relationship, and interventions that promote adaptive and realistic expectations. Additionally, increasing supportive social relationships could be a relevant treatment focus.     

Influence of Fermentation and Drying Materials on the Contamination of Cocoa Beans by Ochratoxin A

Ochratoxin A (OTA) is a mycotoxin produced mainly by species of Aspergillus and Penicillium. Contamination of food with OTA is a major consumer health hazard. In Côte d’Ivoire, preventing OTA contamination has been the subject of extensive study. The current study was conducted to evaluate the influence of fermentation and drying materials on the OTA content in cocoa. For each test, 7000 intact cocoa pods were collected, split open to remove the beans, fermented using 1 of 3 different materials, sun-dried on 1 of 3 different platform types and stored for 30 days. A total of 22 samples were collected at each stage of post-harvesting operations. The OTA content in the extracted samples was then quantified by high-performance liquid chromatography. OTA was detected in beans at all stages of post-harvesting operations at varying levels: pod-opening (0.025 ± 0.02 mg/kg), fermentation (0.275 ± 0.2 mg/kg), drying (0.569 ± 0.015 mg/kg), and storage (0.558 ± 0.04 mg/kg). No significant relationships between the detected OTA level and the materials used in the fermentation and drying of cocoa were observed.