A phase I/II study of high-dose cyclophosphamide,cisplatin, and thioTEPA followed by autologous bone marrow and granulocyte colony-stimulating factor-primed peripheral-blood progenitor cells in patients with advanced malignancies

 The purpose of the present study was to determine the maximally tolerated dose of thioTEPA given with fixed high-dose cyclophosphamide (CPA) and cisplatin (cDDP) followed by autologous bone marrow (ABM) with or without granulocyte colonystimulating factor (G-CSF)-primed peripheral-blood progenitor cells (PBPCs) in patients with advanced malignancies. Patients were required to have histologically documented malignancies and adequate renal, hepatic, pulmonary, and cardiac function. CPA was given at 1,875 mg/m² per day as a 1-h i.v. infusion for 3 consecutive days, and cDDP was given at 55 mg/m² per day as a 24-h continuous i.v. infusion over 3 days concurrently with CPA. ThioTEPA was given once as a 1-h i.v. infusion (300–900 mg/m²) either following (the first 13 patients) or prior to CPA and cDDP. In all, 31 patients received PBPCs. A total of 46 patients were treated. There were 6 deaths among the 15 patients who did not receive PBPCs (13 received thioTEPA following CPA and cDDP). Among the other 31 patients who received PBPCs (all of whom also received thioTEPA prior to CPA and cDDP), there were 4 deaths, all involving patients with refractory ovarian carcinoma. The main toxicities were mucositis, esophagitis, hepatotoxicity, and nephrotoxicity. The median time required to achieve an absolute neutrophil count of 500 μl was 10 days (range, 9–12 days) for those who received PBPCs and 15 days (range, 15–34 days) for those who did not receive PBPCs. Altogether, 47% of the major organ toxicities (grades 3 and 4 renal, hepatic, and cardiac toxicities) occurred among the 15 patients who did not receive PBPCs, although these patients received thioTEPA at the lowest 2 dose levels. There were 3 complete responses and 22 partial responses among 35 evaluable patients (overall response rate, 71%), with the median duration of response being 3.5 months (range, 2–17 months). The maximally tolerated dose of thioTEPA was 600 mg/m² given as a 1-h i.v. infusion on the day prior to CPA and cDDP administration. The combination of high-dose CPA, cDDP, and thioTEPA is a well-tolerated regimen when thioTEPA is given prior to CPA and cDDP and when the combination also includes PBPCs in addition to ABM. This regimen is active in a variety of malignancies. Received: 15 February 1995/Accepted: 22 May 1995     

Chemical characterization and bioactivity of polycyclic aromatic hydrocarbons from non-oxidative thermal treatment of pyrene-contaminated soil at 250-1,000 degrees C

In this paper we report yields, identities, and mutagenicities of products from heating a polycyclic aromatic hydrocarbon (PAH)-contaminated, Superfund-related synthetic soil matrix without exogenous oxygen. We heated batch samples of soil pretreated with 5.08 wt% (by weight) pyrene in a tubular furnace under a constant flow of helium gas at 250, 500, 750, and 1,000 +/- 20 degrees C. Dichloromethane (DCM) extracts of cooled residues of heated soil and of volatiles condensed on a cold finger after 1 sec residence time at furnace temperature were assayed gravimetrically and analyzed for PAH by HPLC, HPLC coupled to mass spectrometry, and gas chromatography coupled to mass spectrometry. All four temperatures volatilized pyrene and generated other PAHs, including alkylated pyrenes. We detected bioactive PAHs in the product volatiles: cyclopenta[cd]pyrene (CPP) at 750 and 1,000 degrees C and benzo[a]pyrene (BaP) at 1,000 degrees C. We found a clean soil residue, i.e., no pyrene or other DCM extracts, only at 750 degrees C. Control experiments with uncontaminated soil, pyrene, and Ottawa sand plus 4.89 wt% pyrene revealed no CPP or BaP production from soil itself, but these experiments imply that pyrene interactions with soil, e.g., soil-bound silica, stimulate CPP and BaP production. We detected mutagenicity to human diploid lymphoblasts (in vitro) in volatiles from 1,000 degrees C heating of soil plus pyrene and sand plus pyrene, and in the residue from 500 degrees C heating of soil plus pyrene. Three plausible pathways for pyrene conversion to other PAHs are a) a reaction with light gas species, e.g., soil- or pyrene-derived acetylene; b) loss of C(2)-units followed by reaction with a PAH; and c) dimerization with further molecular weight growth via cyclodehydrogenation. This study shows that thermal treatment of PAH-polluted soil may generate toxic by-products that require further cleanup by oxidation or other measures.     

Antitumor activity of prolonged as compared with bolus administration of 2′,2′-difluorodeoxycytidine in vivo against murine colon tumors

2′,2′-Difluorodeoxycytidine (gemcitabine) is a cytidine analogue with established antitumor activity against several experimental tumor types and against human ovarian and non-small-cell lung cancer. Both preclinical studies and most clinical trials involving patients with solid tumors have focused on short-term administration schedules; however, mechanistic studies indicate that a continuous-infusion schedule may be more effective. We determined the maximal tolerated dose (MTD) of gemcitabine in mice using various schedules. At these MTDs we observed considerably better antitumor activity of gemcitabine in two of three murine colon carcinoma lines using a prolonged administration as compared with a standard bolus protocol (i.p. 120?mg/kg q3d×4). On the latter schedule, Colon 26–10 grown in BALB/c mice was the most sensitive tumor line, showing a growth-delay factor (GDF, number of doubling times gained by the treatment) of 6.7, whereas Colon 38 (grown in C57/B16 mice) was the least sensitive tumor, displaying a GDF of 0.9. Prolonged treatment (q3d×6) of Colon 26–10 at a lower dose (100?mg/kg) enhanced the antitumor activity (GDF 9.6) while producing similar toxicity. A similar weight loss was found following the continuous infusion (c.i.) of gemcitabine using Alzet osmotic pumps s.c. for 3 or 7 days (2?mg/kg), but the GDF increased to 2.4 in Colon 38 (C57/B16) as compared with that provided by the bolus injections. Continuous infusion of gemcitabine at 15?mg/kg per 24?h q7d×2 i.v. via the tail vein was more effective than bolus injection against Colon 26–10, with the GDF being >17.7 and 73% of the tumors regressing completely. However, against Colon 38 tumors this schedule was not effective (GDF 0.4), even with a 25% higher dose. The plasma pharmacokinetics of gemcitabine was determined after one bolus dose (120?mg/kg). The peak concentration of gemcitabine was 225?μM and that of the deaminated catabolite 2′,2′-difluorodeoxyuridine (dFdU) was 79?μM. The elimination of gemcitabine was much faster than that of dFdU, with the t _1/2ß values being 15?min and 8?h, respectively. For the c.i. schedules, plasma concentrations were below the detection limit of the assay (<0.5?μM). Our results suggest that prolonged infusion of gemcitabine can give a better antitumor activity than bolus injections and shows promise of being active in clinical trials.     

Clinical picture and course of children with CHARGE association

Four children are described who presented malformations according to CHARGE-Association. The primary abnormalities were choanal atresia and/or Coloboma. All four cases exhibited esophageal malformations: atresia and/or fistulas. At autopsy, three children showed arhinencephaly which is rarely observed in patients with CHARGE-Association. Patients with the main features of CHARGE-Association have a very poor prognosis depending on the severity of the malformations.     

The Vertical Birthing Position of the Trobrianders, Papua New Guinea

During an ethnomedical field study the author succeeded in participating and photographing 4 traditional birthgivings among the Trobrianders/Papua New Guinea. Their various vertical postures are described with special reference to specific Trobriand practices and discussed by literature review. The results suggest that vertical birthing positions are advantageous to horizontal ones and should be reconsidered by modern Western obstetrics.     

Comparative effects of acute ethanol dosage on liver and muscle protein metabolism

Experiments were performed to address some outstanding issues and investigate possible mechanisms relating to the acute comparative effects of ethanol on liver and skeletal muscle protein metabolism. Ethanol (EtOH)-treated rats were injected (i.p.) with a bolus of EtOH (75 mmol/kg body weight) and sacrificed at 20 min, 1-, 2.5-, 6-, and 24-hr time points. Control rats were injected with saline (Con-Sal; 0.15 mmol/L NaCl). All 24-hr ethanol-treated animals were compared with saline-injected rats subjected to controlled feeding (i.e. pair-fed controls for 24 hr EtOH). At 24 hr, there was no measurable alcohol in the plasma, whereas high levels were seen from 20 min to 6 hr (up to 448 mg/dL). Plasma levels of albumin were reduced at initial time points, and activities of aspartate aminotransferase increased, but there was no histological evidence of overt tissue damage either in muscle or liver. Hepatic protein and RNA contents and indices of tissue (C_s and k_s) and whole-body (V_s) protein synthesis were significantly increased in ethanol-dosed rats relative to saline-injected pair-fed controls at 24 hr. In the liver, four of the seven cytoplasmic proteases investigated (alanyl-, arginyl-, and pyroglutamyl-aminopeptidases and proline-endopeptidase) showed significant increases in activity at 24 hr relative to pair-fed controls; four of the six lysosomal proteases showed significant decreases in activity (dipeptidyl-aminopeptidase II and cathepsins B, L, and H). In skeletal muscle, k_s fell progressively between 1 and 24 hr (−25 to −69%; P < 0.001), but no significant changes in skeletal muscle protease activities were seen at 24 hr. At 24 hr after ethanol dosage in vivo, there were no significant increases in protein carbonyl content in liver or skeletal muscle compared to pair-fed controls (muscle levels actually decreased slightly). However, using either rat or human tissue, both liver and muscle carbonyl increased in vitro in response to superoxide and hydroxyl radicals: muscle was more susceptible to carbonyl formation than liver and both tissues were more sensitive to hydroxyl compared to superoxide radicals. These results show divergent effects of acute ethanol treatment on liver and skeletal muscle protein metabolism, which may not be linked to in vivo free radical-mediated protein damage (as indicated by carbonyl formation), at least in the short term.     

Radiotherapeutic alternatives to standard management of adenocarcinoma of the endometrium

Primary radiotherapy as an alternative management for adenocarcinoma of the endometrium was chosen for 117 patients treated at the University of Michigan Medical Center and University of Virginia Medical Center. Cases were selected for radiation because of contraindications to surgery (52.2%) or by protocol for disease outside the endometrium (47.8%). An overall 5-year actuarial survival rate of 49.6% was attained for all stages, with 55% 5-year survival for disease limited to the uterus or cervix. Stage and grade were the most significant risk factors. The addition of external-beam irradiation did not improve local failure rates or survival. Heyman's uterine packing technique was slightly more successful than uterine "line sources" in controlling local disease (P = 0.08). Treatment-related mortality (0.8%) and morbidity (6.8%) were minimal. Surgery, whenever possible, remains the "best standard therapy" but the radiotherapeutic alternative is of significant benefit for those deemed nonsurgical candidates.     

Recurrent abdominal pain: a psychogenic disorder?

A controlled study of 30 children with recurrent abdominal pain and 30 pain free children failed to show any statistically significant differences between the groups on a variety of psychological variables thought to be associated with psychogenicity. A psychogenic basis has often been assumed as the cause in diagnosis of recurrent abdominal pain when clinical examination and laboratory tests show no organic or medical reason. We emphasise that establishing a psychogenic cause is only indicated where there is positive evidence for psychological factors such as family or school stress, extreme personality characteristics, or modelling of family pain behaviour.     

Repair of vaginal prolapse after hysterectomy

Forty-one women with primary or recurrent prolapse of the vagina following either vaginal or abdominal hysterectomy were treated with a vaginal operation. The retroperitoneal approach of utilization of the perirectal fascia to support the vault of the vagina is described and illustrated. This technique may also be used in selected patients to prevent this complication after vaginal hysterectomy and repair.