Factors predictive of response and survival in patients with metastatic colorectal cancer in Taiwan

5-Fluorouracil in combination with leucovorin has been shown to be active in therapeutic trials of metastatic colorectal carcinoma. In this study, we administered these drugs to 72 patients with metastatic colorectal carcinoma. Thirty-six of them without previous exposure to 5-fluorouracil were treated with weekly bolus injections of 5-fluorouracil (425 mg/m2) and leucovorin (25 mg/m2) supplemented with oral levamisole. Another 36 patients with or without prior 5-fluorouracil treatment received 5-fluorouracil 3,000 mg/m2 and leucovorin 300 mg/m2 in a 48-hour continuous infusion every two weeks. Clinical efficacy and toxicity were assessed by WHO criteria. Variables were tested for relations to response and survival by univariate and multivariate analysis. The response rate was 19.4% in weekly bolus arm and 13.9% in biweekly high-dose infusion arm (P = 0.527). Median survivals in the two arms were 18.4 months (weekly) and 21 months (biweekly) respectively (P = 0.708). Gastrointestinal side effects including nausea, vomiting, diarrhea and mucositia were the major toxicities of these regimens. By multivariate analysis, the only factor to influence response rate was the site of metastases (P = 0.009). The only factor to affect survival was performance status of the patient (P = 0.0001). We concluded that the two 5-fluorouracil based regimens are well-tolerated and shown to have a response rate comparable with previous reports of similar regimens in patients with metastatic colorectal cancer. Only liver metastases seemed to have a better response to therapy. Performance status is the most important prognostic factor in patients with metastatic colorectal cancer.      

Langerhans' cell histiocytosis with thyroid involvement masquerading as thyroid carcinoma

A 28-year-old woman was admitted to our Hospital with a chief complaint of progressive gingival swelling and loosening of teeth over about a year. According to past history, she had received total thyroidectomy 2 years previously due to thyromegaly. The thyroidectomy specimen was at first interpreted as 'poorly differentiated carcinoma of the thyroid'. One year ago, she began to be aware of gingival swelling and loosening of teeth. A gum biopsy was taken and the pathologic features were similar to her 'thyroid carcinoma'. Subsequent investigations, including immunohistochemical stain, showed the gum was heavily infiltrated with histiocyte-like Langerhans' cells which were positive for S-100 protein. Ultrastructural examination of the cells under electron microscope revealed many typical intra-cytoplasmic Birbeck granules. Langerhans' cell histiocytosis was diagnosed. Langerhans' cell histiocytosis with thyroid involvement is extremely rare and may run a relatively indolent course. Even on a retrospective examination, it may easily be confused with poorly differentiated carcinoma of the thyroid. We suspect that this error may have been made on other occasions and that the occurrence of this condition may be underreported.      

Histidinaemia: a benign metabolic disorder

Histidinaemia is a relatively common inherited metabolic disorder with an incidence similar to phenylketonuria. This paper reports the long term outcome of patients diagnosed by newborn screening in the north west of England. Between 1966 and 1990, 108 infants were diagnosed as having histidinaemia by a regional neonatal screening programme (incidence 1:11,083). A further five children were detected following diagnosis in a sibling. Of the 113, nine were lost to follow up. Infants diagnosed before 1981 (n = 47) were placed on a low histidine diet (225 mg/kg/d) for an average period of 21 months (SD 4.5). All patients were reviewed regularly, Griffiths developmental quotients (DQ) were assessed at 2 and 4 years, and WISC-R intelligence quotients (IQ) at 8, 12, and 18 years. IQ data were converted to standard deviation scores (IQ SDS) to account for increasing IQ norms with time. Neither DQ nor IQ correlated with plasma histidine at diagnosis or with the mean plasma histidine throughout life. Growth was normal in all patients. There was no apparent benefit from a low histidine diet in early childhood. In contrast to other studies, there was no excess of clinical symptoms. On the basis of these findings, histidinaemia is a benign metabolic disorder that does not require treatment.     

Lingual thyroid gland: sonographic appearance

Thyroid dysgenesis is often manifested by a lingual or sublingual location of the thyroid gland. If radionuclide studies are not readily available or are contraindicated, ultrasound (US) may be used to locate the gland. The US appearance of a lingual thyroid gland and the role of US in the evaluation of suspected thyroid dysgenesis are described.     

HPLC测定益肤霜中红霉素和地塞米松的含量

采用ＨＰＬＣ测定益肤霜中红霉素和地塞米松的含量，控制制剂的质量。色谱条件：固定相为Ｋｒｏｍａｓｉｌ Ｃ１８柱；流动相为乙腈－０．２ｍｏｌ／Ｌ醋酸铵－水，流速０．８ｍｌ／ｍｉｎ；检测波长２１５ｎｍ。以ｃ对峰面积Ａ作直线回归，红霉素在１．５－２４ｇ／Ｌ地塞米松在２０－３００ｍｇ／Ｌ的范围内，其浓度与峰面积呈直线关系。红霉素回收率为９９．６９％；地塞米松的回收率为１００．２８％。本法操作简便，结果准确，     

Quality assessment and assurance in diagnostic imaging. Theoretical and practical considerations and a quality audit of the excretory urogram

Concepts necessary to an understanding of the basics of quality assurance audits are presented. Included are specific examples that bridged theory and practice by applying the protocol to a real-life diagnostic imaging situation. This method meets the present requirements of the Joint Commission of the Accrediation of Hospitals.     

Tagesprofile von Plasmaaldosteron,-Cortisol, -Renin, -Angiotensinogen und -Angiotensinasen bei Normalpersonen

Zusammenfassung An 6 normalen männlichen Freiwilligen im Alter von 20–26 Jahren wurden Plasmacortisol und -renin stündlich, Plasmaaldosteron, -angiotensinogen und -angiotensinasen alle 3 Std über jeweils 24 Std unter Kontrollbedingungen und anschließend unter Suppression der ACTH-Freisetzung durch Dexamethason gemessen.Die höchsten Cortisolspiegel fanden sich gegen 7 Uhr, die niedrigsten zwischen 21 und 1 Uhr. Die Gabe von Dexamethason führte zu konstant niedrigen Cortisolkonzentrationen.Aldosteron war unter Kontrollbedingungen und unter Dexamethason gegen 4 Uhr am höchsten und zeigte niedrigste Werte zwischen 16 und 22 Uhr. Zwischen den mittleren Aldosteronkonzentrationen entsprechender Zeitpunkte der Kontroll- und der Dexamethasonperiode bestanden keine signifikanten Unterschiede.Ähnlich dem Aldosteron zeigte das Plasmarenin Maximalwerte gegen 4 Uhr. Alle Mittelwerte entsprechender Zeitpunkte zwischen 7 und 23 Uhr und die jeweiligen 24 Std-Mittelwerte jedes einzelnen Probanden waren unter dem Einfluß von Dexamethason signifikant erhöht.Für die Existenz circadianer Rhythmen des Angiotensinogens und der Angiotensinasen konnte kein Anhalt gewonnen werden. Dexamethason bewirkte keine signifikanten Veränderungen dieser Parameter.Die Ergebnisse deuten darauf hin, daß die circadianen Rhythmen von Aldosteron und Renin miteinander vergleichbar, jedoch nicht exakt mit dem des Cortisols synchronisiert sind. Unter der Hemmung der ACTH-Freisetzung durch Dexamethason steigt die Reninaktivität an, der Aldosteronspiegel bleibt unverändert. Angiotensinogen und die Angiotensinasen, Parameter, die die aktive Konzentration des Angiotensin II beeinflussen können, scheinen an der Regulation des Aldosterons nicht beteiligt zu sein.Die Ergebnisse wurden auf dem 21. Symposiom der Deutschen Gesellschaft für Endokrinologie und auf dem Symposiom Aktuelle Probleme der Hochdruck- und Nierenkrankheiten anläßlich des 75. Geburtstages von Herrn Prof. Dr. E. Wollheim vorgetragen.     

Prekallikrein-Kallikrein conversion rate as a predictor of contrast material catastrophies

An in vitro is described that attempts to detect patients with a potential for adverse systemic reactions to contrast material. This test involves measuring the rate of conversion of prekallikrein to kallikrein under certain standard conditions. In a preliminary retrospective study, the test could be used to identify such patients with a sensitivity of 88%, a specificity of 82%, and a predictive value of 79%.