Angiomyolipoma: Postembolization liquefaction and percutaneous drainage

A case of renal angiomyolipoma is reported, in which embolotherapy was followed by liquefaction of virtually the entire tumor. The liquified lesion was drained percutaneously.     

Hemodynamic effect of norepinephrine and serotonin with and without indomethacin

Injections of serotonin (5-HT) into the aortic arch of rats caused greater reductions of blood pressure (BP) and less increases in renal vascular resistance (RVR) than that into jugular veins, in contrast to norepinephrine (NE) which tended to cause larger increases in BP and RVR by the intra-aortic route. Indomethacin (INDO) enhanced renal vasoconstrictor responses to NE, but did not affect those of 5-HT. These data support a central nervous system (CNS) hypotensive effect of 5-HT not shared by NE, and a less interaction with vasodilator prostaglandins for 5-HT, when compared with NE.     

Adjuvant treatment in colorectal cancer: An update

Analysis of current and recently completed trials of adjuvant therapy for colorectal cancer permit a few very broad generalizations. Survival of patients initially treated by resection has improved during the past 2 decades, unrelated to adjuvant therapy. While pilot, uncontrolled, and historically controlled studies often suggest a treatment benefit, controlled trials have, to date, failed to show any advantage for adjuvant therapy in colon cancer. For rectal cancer, only those trials including radiation therapy alone or in combination with chemotherapy have provided enhanced patient survival. Superiority of preoperative versus postoperative radiotherapy has not been demonstrated. Of interest is the current United States intergroup trial in colon cancer which is evaluating levamisole in combination with 5-fluorouracil, based on preliminary experience in a smaller study of the North Central Cancer Treatment Group which suggests that levamisole and 5-fluorouracil may be a potentially beneficial adjuvant combination. Recent reports of pharmacologic modulation of 5-fluorouracil resulting in significantly enhanced response rates in advanced metastatic colorectal cancer invite a trial of this pharmacologic concept for surgical adjuvant therapy.

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Resumen El análisis de los ensayos clínicos actuales y de aquellos recientemente concluidos sobre terapia adyuvante en cáncer colorrectal permite plantear algunas generalizaciones. La supervivencia de los pacientes tratados inicialmente mediante resección ha mejorado en el curso de las últimas 2 décadas, sin que esto tenga relación con la quimioterapia adyuvante. A pesar de que estudios piloto, no controlados o históricamente controlados, con frecuencia sugieren un beneficio terapéutico, los ensayos clínicos controlados, hasta la fecha, no demuestran ventaja alguna del uso de la terapia en cáncer de colon. En cáncer rectal, sólo aquellos ensayos que incluyen radioterapia, sola o en combinación con quimioterapia, han mostrado incremento en las tasas de supervivencia. La superioridad de la radioterapia preoperatoria versus la postoperatoria no ha sido comprobada.Es de interés el estudio interinstitucional que actualmente se desarrolla en los Estados Unidos para valorar el uso de levamisol en combinación con 5-fluoruracilo, fundamentado en la experiencia preliminar con un estudio de menor envergadura realizado por el North Central Cancer Group, el cual sugiere que el levamisol y el 5-fluoruracilo pueden significar una combinación adyuvante potencialmente beneficiosa. Informes recientes sobre la modulación farmacológica del 5-fluoruracilo que resulta en un significativo incremento de las tasas de respuesta en cáncer colorrectal metastático avanzado invitan a la realización de un ensayo clínico sobre la aplicación de este concepto farmacológico en la terapia adyuvante de la cirugía.

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Résumé L'analyse récente ou en cours d'essais de thérapeutiques complémentaires du cancer colo-rectal a permis d'en tirer certaines leçons. La survie des opérés traités par résection s'est améliorée au cours des dernières décennies indépendamment des traitements complémentaires. Alors que des études anciennes contrôlées ou incontrôlées ont suggéré que ces traitements pouvaient être bénéfiques, des essais récents ont fait la preuve qu'ils n'entrainaient aucune amélioration du pronostic du cancer du colon. En ce qui concerne le cancer du rectum, seuls les essais associant la radiothérapie isolée ou combinée à la chimiothérapie ont démontré une amélioration relative de la durée de la survie sans que la supériorité de la radiothérapie pré-opératoire par rapport à la radiothérapie post-opératoire ait été démontrée.En revanche, l'essai intergroupe conduit aux Etats-Unis utilisant l'association levamisole-5-FU, essai reposant sur une expérience préliminaire menée par le Groupe Nord-Central du Traitement du Cancer, suggère que ces deux agents médicamenteux peuvent constituer un traitement complémentaire à potentiel bénéfique. Des rapports récents faisant état de modulations pharmacologiques du 5-FU qui entrainent une amélioration des taux de réponse en cas de cancer colo-rectal avancé et compliqué de métastases, invitent à poursuivre cet essai de thérapeutique complémentaire.

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Supported by PHS grant number CA 34184-04, awarded by the National Cancer Institute, DHHS.     

Emergency department analgesia without narcotics for adults with acute sickle cell pain crisis: Case reports and review of crisis management

Vaso-occlusive crises are one of the most debilitating features of sickle cell disease. There appears to be no standardization of care for adults with pain crisis, and some commonly utilized regimens, such as those employing intramuscular meperidine, are pharmacologically unsound. Parenteral narcotic use may be associated with respiratory compromise acutely and with dependence over the long term, but nonopioid preparations are often unsatisfactory in relieving pain. We have recently enjoyed success with a combination of a parenteral nonsteroidal anti-inflammatory medication and an oral tricyclic antidepressant. We report four representative cases and review the salient points of the management of pain crisis in adult patients in the emergency department.     

Herniated L4-L5 disc after placement of Harrington instrumentation for a fracture of the thoracolumbar spine

The authors report a case in which L5 radiculopathy developed acutely after surgery for placement of Harrington rod instrumentation for an L1 body fracture. Computed tomographic myelography demonstrated a large L4-L5 herniated disc that had not been present in preoperative studies. An emergency laminectomy was performed, and a large, free, subligamentous disc fragment was removed. The patient subsequently regained L5 sensorimotor function. The postoperative development of lumbar radiculopathy is an uncommon complication of Harrington rod instrumentation that may result from several biomechanical features of the instrumentation. These injuries may not be detected by intraoperative monitoring of somatosensory evoked potentials, and therefore, the postoperative neurological examination assumes a crucial role in the early diagnosis of these lesions. As our case demonstrates, these radicular deficits may be reversible if their cause is promptly recognized and treated.     

Fluid shift and protein leakage corrections in protein binding equilibrium dialysis experiments

Conventional equilibrium dialysis methods used in the estimation of ligand-macromolecule binding parameters (affinities, capacities. unbound ligand fractions, etc.) tacitly assume and require that no ligand-macromolecule binding occurs on the buffer side of the dialysis chamber. Unfortunately, this is almost never a valid assumption, as small amounts of plasma proteins are invariably detected in the buffer chamber. Provided the extent of protein leakage is in the usual region (about 0.1%) and the extent of ligand binding does not exceed approximately 99%. errors associated with conventional free fraction estimations obtained from calculations ignoring the effect of protein leakage are usually small (about 1–10% error). As ligand binding exceeds 99%, significant errors may ensue. A generalized theoretical equilibrium dialysis method is developed which permits the estimation of association constants, the number of binding sites and free fraction determinations for a model employing any number of classes of binding sites. Application of the method requires a minimum of two experimental runs for each class of binding sites; volume shifts are automatically adjusted for by the method.     

Enhancement of ECT benefit by yohimbine

Three patients with major depression who were pretreated with yohimbine 10 mg p.o. showed a dramatic response without major adverse effects following two electroconvulsive treatments (ECT). The hypothesis that the alpha 2-adrenergic antagonist yohimbine accelerates ECT-induced postsynaptic beta-adrenergic receptor down-regulation is discussed.     

T-Independent form of Azophenylarsonate Fails to Reveal “Silent” Idiotype-Positive B Cells in Idiotype-Suppressed Mice

In three distinct chronic Ig-specific suppression systems in which suppression was initiated by injection of mice with anti-idiotype (Id) or anti-allotype sera, evidence has been presented by others that the differentiation of B cells bearing surface Ig with a target marker (Id or allo-type) need not be totally disrupted. Normally “silent” Id⁺ B cells from Id-suppressed mice could be revealed by certain procedures, one of these being to make use of the powerful stimulatory properties of bacterial lipopolysaccharide. We have employed a similar strategy to determine whether cryptic CRI⁺_A B cells exist in significant numbers in hyperimmune, CRI-suppressed (HIS) A/J mice. Thus, following T cell removal, the Ar-specific B cell repertoire from HIS mice was probed using Ar-Brucella abortus as a T-independent Ag. No evidence for “silent” CRI⁺_A B cells was found. The results, taken in conjunction with those of others, suggests that there may exist multiple forms of long-term Ig-specific suppression.