Radiogenic risks from hysterosalpingography

The aim of this study was to determine ovarian dose, effective dose and associated radiogenic risks from hysterosalpingography (HSG), and to provide data for the estimation of radiogenic risks related to HSG studies performed in any laboratory. The fluoroscopy time, number of radiographs taken and entrance surface dose were measured in a series of 78 consecutive patients undergoing HSG as part of their infertility work-up. Organ-dose values per radiograph and per minute of fluoroscopy were separately determined using an anthropomorphic phantom and thermoluminescence dosimetry. The radiogenic risk for deleterious effects on a possible future embryo and the radiogenic risk for cancer induction on the patient undergoing HSG were estimated. The average HSG procedure in our laboratory involves a mean fluoroscopic time of 0.3 min and a mean number of radiographs of 3.2. The dose to female gonads from an average HSG procedure was 2.7 mGy and the patient effective dose was 1.2 mSv. The risk for radiogenic anomalies in a future embryo of the woman undergoing an average HSG procedure and the risk for radiogenic fatal cancer induction in the exposed woman were estimated to be less than 10^–3 of the correspondent nominal risks. Radiation risks from a typical HSG are low, but they may be elevated if fluoroscopic and/or radiographic exposures are prolonged for any reason. Present data allow the estimation of radiogenic risks associated with HSG procedures performed in other laboratories with use of different equipment, screening time and number of radiographs taken.     

Lead-induced behavioral disorders in the rat: effects of amphetamine

The effects of d-amphetamine on several measures of activity and spontaneous alternation were evaluated in rats chronically exposed to a low level of lead acetate via maternal milk during the neonatal period. Alterations in the amphetamine responses of lead-treated rats were observed with some measures of activity and exploration but not with others. 'Paradoxical' responses were observed with postural rearing and spontaneous alternation. No drug response was seen in lead-treated animals with respect to center field activity in contrast to a large increase seen in controls. Normally, amphetamine reduces grooming behavior, but since this reduction was greater in lead-reared than in control rats, the data suggest that for this measure the lead-reared rat may posses an increased sensitivity to amphetamines. These results were discussed in terms of the behavioral parallels found between lead poisoning and childhood hyperactivity, and the potential of this model as an animal analog of minimal brain dysfunction hyperactivity.     

Pegylated liposomal doxorubicin in combination with vinorelbine as salvage treatment in pretreated patients with advanced breast cancer: a multicentre phase II study

Purpose: To investigate the activity and tolerance of pegylated liposomal doxorubicin in combination with vinorelbine in pretreated patients with metastatic breast cancer. Patients and treatment: Thirty-six women with metastatic breast cancer were enrolled. The median age was 64 years, 80% of the patients had a performance status of 0–1, 30 (83%) had visceral disease and 83% had received prior taxanes while 50% anthracyclines. Treatment consisted of pegylated liposomal doxorubicin (40 mg/m² on day 1) and vinorelbine (25 mg/m² on days 1 and 15) every 4 weeks. Results: In an intention-to-treat analysis 2 (6%) complete and 12 (33%) partial responses were observed (overall response rate 39%; 95% CI: 23–54.8%); 8 (22%) and 14 (39%) patients experienced stable and progressive disease, respectively. The median TTP was 6.5 months and the median survival time 14.2 months. The 1-year survival rate was 54.1%. Grade 3 and 4 neutropenia occurred in 21 (58%) patients, grade 3–4 anemia in four (11%) and grade 4 thrombocytopenia in one (3%). Two (6%) patients developed febrile neutropenia. Non-hematologic toxicity was mild and easily manageable. There was no clinically important cardiac toxicity or treatment-related deaths. Conclusions: The combination of pegylated liposomal doxorubicin and vinorelbine is an active and well tolerated salvage regimen in patients with metastatic breast cancer which merits further evaluation.     

Oxaliplatin as first-line treatment in inoperable biliary tract carcinoma: a multicenter phase II study

BACKGROUND: A multicenter phase II study was conducted in order to evaluate the efficacy and safety of oxaliplatin as first-line treatment of patients with locally advanced or metastatic carcinoma of the biliary tract. PATIENTS AND METHODS: Twenty-nine chemo-na?ve patients with locally advanced or metastatic biliary tract carcinoma received oxaliplatin 130 mg/m(2) i.v. every 21 days. Patients were treated until tumor progression or unacceptable toxicity. RESULTS: An objective response (3 complete responses, 3 partial responses) was achieved in 6 patients (20.6%, 95% CI 5.95-35.4). Disease control (complete response, partial response and stable disease) was observed in 14 patients (48.2%). The median time to tumor progression was 3 months (range 0.7-39) and the median overall survival was 7 months (range 1-39). The 1-year survival rate was 32%. Toxicity was mild. CONCLUSION: Oxaliplatin is an active agent against biliary tract carcinoma and therefore should be further investigated in combination with other cytotoxic drugs.     

Gemcitabine plus oxaliplatin combination (GEMOX regimen) in pretreated patients with advanced non-small cell lung cancer (NSCLC): a multicenter phase II study

PURPOSE: To evaluate the activity and tolerance of gemcitabine in combination with oxaliplatin (GEMOX regimen) in pretreated patients with advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Thirty-two patients with advanced NSCLC who had disease progression after a cisplatin- and taxane-based front-line regimen were treated with gemcitabine (1500 mg/m(2) on days 1 and 8) and oxaliplatin (130 mg/m(2) on day 8) every 3 weeks. The patients' median age was 62 years and the performance status (WHO) was 0 for 11, 1 for 17 and 2 for 4 patients. The treatment was second line for 22 (69%) and >or=third line for 10 (31%) patients. RESULTS: Partial response was achieved in 5 (16%) patients, stable disease in 8 (25%) and progressive disease in 19 (59%). Two patients with stable disease and one patient with progressive disease while on previous chemotherapy experienced a partial response with GEMOX regimen. The median duration of response was 2.5 months (range, 1-11.5), the median time to tumor progression 3 months (range, 1-18) and the median survival 5.6 months (range, 1-31). Grade III neutropenia occurred in five (16%) patients, grade III thrombocytopenia in two (6%) and grade III anemia in three (9%); moreover, grades II-III asthenia was reported in eight (25%) patients and grades II-III neurotoxicity in three (9%). CONCLUSION: The GEMOX combination is a relatively active and well tolerated second-line regimen in NSCLC patients pretreated with a taxane- and/or platinum-based chemotherapy.     

Paclitaxel and vinorelbine combination in advanced inoperable adenocarcinoma of the lung: a phase II study

BACKGROUND: The purpose of this study was to determine the efficacy of paclitaxel (PCT) combined with vinorelbine (VRL) in adenocarcinoma of the lung. PATIENTS AND METHODS: Untreated inoperable patients with metastatic disease were enrolled and underwent front-line treatment with a new combination as follows: a 30-minute infusion of VRL at a dose of 25 mg/m2 followed by a 3-hour infusion of PCT 135 mg/m2. Chemotherapy was repeated every 2 weeks with the intention of administering 9 cycles. RESULTS: Fifty-four out of 58 enrolled patients were assessable; the median age was 63 years (range 48-81). All patients were chemotherapy-na?ve and all had histologically- or cytologically- confirmed adenocarcinoma. Twenty-seven patients (50%) responded: 5 with complete response (9.3%) and 22 with partial response (40.7%); 17 patients had stable disease (31.5%) and 10 showed disease progression (18.5%). Median response duration was 6 months (range 2-14.5) and median survival was 10 months (range 2-35+). The main adverse reaction was myelotoxicity in 87% of the patients, of whom only 8 (14.8%) had grade 4 neutropenia which in 4 cases (7.4%) was febrile. No patient required dose reduction, but treatment was postponed by one week in 4 patients a total of nine times. Patients received 98.6% of the planned dose. CONCLUSION: The PCT and VRL combination is an active first-line treatment for lung adenocarcinoma. These two cytotoxic drugs produce acceptable toxicity when repeated every 2 weeks.     

Empty follicle syndrome associated with ovarian torsion in an in vitro fertilization program.

We report a very rare case of ovarian torsion following controlled ovarian stimulation for in vitro fertilization in which no oocytes were obtained at the time of ovum retrieval from the left torsed ovary. The patient was a 33-year-old nulligravida female undergoing controlled ovarian stimulation. On day 14, the patient complained of lower left abdominal pain with nausea. Transvaginal oocyte retrieval from the right ovary was performed. The patient subsequently underwent laparoscopy 6 hours following oocyte retrieval. A portion of the left ovary was observed. The ovary was detorsed at the time of laparoscopy followed by peritoneal lavage.     

Infertility: Five years' follow-up in two patients with borderline tumours of the ovary hyperstimulated by gonadotrophin therapy for in-vitro fertilization

In two women (36 and 30 years old) during infertility evaluationby ultrasound, an ovarian cyst was found on the left side (5x7and 6x9cm respectively). In both cases, it was decided to performa unilateral salpingo-oophorectomy, keeping the other ovary(after a negative biopsy) for a future in-vitro fertilization(IVF) procedure with their own oocytes. The histology reportfor each patient showed the cyst was an epithelial borderlinetumour. The first woman achieved a pregnancy and delivered ahealthy baby after the first IVF attempt, while the second iscurrently undergoing her third attempt. This paper reports ona follow-up 5 years after the first IVF attempt.     

Serious Intrapelvic Bleeding without a Major Pelvic Fracture

Abstract The case of a 73-year-old woman with pelvic trauma and without a recognizable pelvic fracture or pelvic ring disruption on the initial ATLS pelvic X-ray is presented. Hyperselective embolization of the left obturator artery was performed in order to control hemodynamic instability. Even phenomenologically trivial injuries could be associated with severe bleeding.     

Simultaneous double video mediastinoscopy and video mediastinotomy--a step forward.

Mediastinal lymph node biopsy plays a fundamental role in diagnosis, staging and management of lung cancer. We describe a novel method of using the video-mediastinoscope for concurrent cervical mediastinotomy and anterior mediastinoscopy. We have performed five concurrent procedures using this system in the last 14 months. In four cases, we assessed the aorto-pulmonary (A-P) window lymph nodes. In the fifth case, we performed a cervical mediastinoscopy for para-tracheal and sub-carinal lymphadenopathy followed by an anterior videomediastinotomy, video assisted intrapericardial assessment, direct tumour sampling and A-P window lymph nodal biopsies. Due to the excellent visualisation afforded by the Videomediastinoscope, we were able to avoid an open procedure in all cases. We believe that this represents a major benefit of the videomediastinoscope in select cases.