Pheochromocytoma and the normal adrenal medulla: improved visualization with I-123 MIBG scintigraphy

The radiopharmaceutical iodine 131 metaiodobenzylguanidine (I-131 MIBG) has been shown to locate pheochromocytomas scintigraphically with a false-negative rate of approximately 13%. To improve image quality and reduce the false-negative rate, I-123 was examined as a radioactive label for MIBG, as it has many advantages over I-131, including superior dosimetry and better detection efficiency. Diagnostic doses of 0.5 mCi (18.5 MBq) I-131 MIBG and 10.0 mCi (370.0 MBq) I-123 MIBG with nearly equivalent radiation dosimetries were compared in 18 patients with known or suspected pheochromocytomas. Images of superior quality were obtained with I-123 MIBG in 18 of 18 patients, and in eight cases lesions not visualized on I-131 MIBG scintigraphy were portrayed. A further advantage of I-123 MIBG is that it permits single photon emission computed tomography (SPECT). This was performed in six cases and provided additional information in three cases. The adrenal medullae were definitely visualized using I-123 scintigraphy in eight of 14 patients still possessing adrenal glands, whereas I-131 MIBG images portrayed the adrenal medulla in only one of 14 cases. Five remaining patients had multiple abdominal tumor deposits that were difficult to differentiate from normal adrenal medullae.     

The effects of modern cementing techniques on the longevity of total hip arthroplasty

Modern prosthetic design and cementing techniques have dramatically improved femoral component fixation. Compared to studies reported in the 1970s, the incidence of radiographic loosening for periods up to 5 years postoperatively has been reduced by at least a factor of 10. These results are the benchmark by which alternative forms of femoral component fixation must be measured. With the likelihood of increased longevity of total hip arthroplasty resulting from improved fixation, the problems of wear debris from the bearing surfaces and loss of bone stock with time will become preeminent.     

Cisplatin as first-line therapy for metastatic breast cancer

Cisplatin has had only minimal activity when used as second- and third-line chemotherapy for metastatic breast cancer (MBC). There have been no phase II studies in the United States evaluating cisplatin in patients with MBC with no prior chemotherapy. We therefore treated 20 consecutive patients with cisplatin 30 mg/m2/d for four days every 3 weeks for a maximum of six courses. We obtained partial responses in nine of 19 evaluable patients (47%), with responses in liver, lung, and soft tissue indicator lesions. Our data suggest that cisplatin has substantial single-agent activity as front-line therapy in MBC, and should be considered for inclusion in first-line combination chemotherapy regimens.     

Twenty years of systemic therapy for breast cancer

The past 2 decades of systemic therapy for breast cancer have been a period of monumental change, in terms of both theory and technology. Adjuvant therapy developed from two strands of research--one in systemic chemotherapy and one in hormonal therapy--both of which were aided by the application of higher statistical methodology to clinical trials. The agent with the single greatest public health impact in oncology has been tamoxifen, but problems with tamoxifen therapy led to the development of the aromatase inhibitors, and further research led to the use of hormonal therapy in a chemopreventive capacity. The evolution of systemic chemotherapy for breast cancer has been an interplay between theory-driven approaches and new agents. By the late 1980s, accumulating data revealed that overexpression of HER2 (erbB2) played an important role in a substantial portion of breast cancers, which prompted the development of trastuzumab (Herceptin), an agent targeting HER2-positive disease. Determining HER2 status proved essential to assessing patient eligibility for trastuzumab therapy. Decoding of the human genome and application of bioinformatics further revolutionized the possibilities in breast cancer treatment.     

A comparative study of the behavioral effects of scopolamine and 4-(1-naphthylvinyl) pyridine hydrochloride (NVP), an inhibitor of choline acetyltransferase

A selective inhibitor of choline acetyltransferase, 4-(1-naphthylvinyl) pyridine hydrochloride (NVP), was compared with a central cholinergic antagonist, scopolamine, in a number of behavioral procedures in rats. Scopolamine (1 mg/kg, i.p.) caused alterations in performance of animals trained on nondiscriminated avoidance, punishment discrimination and conditioned suppression behavior, and had no effect on discrete avoidance behavior after doses as high as 8 mg/kg. After nonataxic doses (10–50 mg/kg, i.p.), NVP had no inhibitory effects in these behavioral schedules, and only after higher doses (100–200 mg/kg, i.p.) was an inhibitory effect on discrete avoidance obtained. It is suggested that less than complete inhibition of choline acetyltransferase does not provide sufficient attenuation of central cholinergic function to mimic the behavioral effects of a cholinergic antagonist. NVP was found to potentiate the pharmacological effects of chlorpromazine and physostigmine, suggesting an inhibitory action on drug metabolizing enzymes; it also had a protective effect upon maximal electroshock seizures in mice.Presented in part at the 7th International Congress of the Collegium Internationale Neuro-Psycho-Pharmacologicium, Prague, Czechoslovakia, August 1970