Predictive values of serum tumour markers tetranectin, OVX1, CASA and CA125 in patients with a pelvic mass

Our objective was to compare the predictive value of the well-established tumour marker CA125 with the newer tumour markers tetranectin (TN), OVX1 and CASA in distinguishing benign and malignant pelvic masses in women. Participants included 185 women, 19 years or older, with a pelvic mass planned for surgical exploration. Significantly different CA125 levels were found between benign tumours and localised ovarian cancer (OC), advanced OC and other non-OCs. Significantly different TN levels were found between benign tumours and advanced OC (stage III/IV), between benign tumours and other cancers and between all OCs and other cancers. For CASA, significant differences were found between benign tumours and all OCs as well as advanced OC. No significant differences could be demonstrated for OVX1. Significant correlations for the 44 OC patients were found between CA125, TN and CASA. No significant correlations were found for OVX1, possibly because of the method used for collection and handling of serum samples. None of the new markers had any additional predictive value compared to CA125. TN and CASA levels correlated with FIGO stage and could be used to discriminate between benign and advanced OC. However, in comparison to the performance of CA125, the additional discriminative value of TN and CASA was minor.     

Selenium and prostate cancer prevention.

Prostate cancer is the second leading cause of cancer deaths in men, therefore it is increasingly important to understand its biology and epidemiology. New approaches for the primary and secondary prevention of prostate cancer are needed, including innovative uses of chemoprevention. This review provides an overview of the epidemiological data suggesting that higher intakes of selenium may reduce the risk of prostate cancer. In addition, a discussion of preclinical data is presented. Special emphasis is placed on the following areas: (1) chemical forms of selenium and antitumorigenic activity, (2) in vitro effects of selenite versus monomethylated selenium, and (3) current clinical intervention trials with selenium in prostate cancer. Chemoprevention, especially with dietary forms of selenium, is a promising new approach that presently is undergoing intensive investigation.     

Methotrexate and azathioprine treatment of childhood dermatomyositis.

Modern treatment of childhood dermatomyositis with corticosteroids has resulted in greatly improved prognosis and style of life. The immunosuppressive drugs methotrexate and azathioprine have been utilized as ancillary agents in life-threatening disease and in children whose disease could not be adequately controlled with prednisone alone. Two patients are completely well without medication two and seven years after onset; two have received no medications for more than two years and have only subtle signs of any residual illness although they had been profoundly ill for two to three years after the onset of dermatomyositis. A fifth patient, completing the third year of disease, remains ill and continues to require medications but has improved sufficiently to return to regular class in school.     

Remifentanil in the horse: identification and detection of its major urinary metabolite

Remifentanil (4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic acid methyl ester) is a mu-opioid receptor agonist with considerable abuse potential in racing horses. The identification of its major equine urinary metabolite, 4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic+ ++ acid, an ester hydrolysis product of remifentanil is reported. Administration of remifentanil HCl (5 mg, intravenous) produced clear-cut locomotor responses, establishing the clinical efficacy of this dose. ELISA analysis of postadministration urine samples readily detected fentanyl equivalents in these samples. Mass spectrometric analysis, using solid-phase extraction and trimethylsilyl (TMS) derivatization, showed the urine samples contained parent remifentanil in low concentrations, peaking at 1 h. More significantly, a major peak was identified as representing 4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic+ ++ acid, arising from ester hydrolysis of remifentanil. This metabolite reached its maximal urinary concentrations at 1 h and was present at up to 10-fold greater concentrations than parent remifentanil. Base hydrolysis of remifentanil yielded a carboxylic acid with the same mass spectral characteristics as those of the equine metabolite. In summary, these data indicate that remifentanil administration results in the appearance of readily detectable amounts of 4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic+ ++ acid in urine. On this basis, screening and confirmation tests for this equine urinary metabolite should be optimized for forensic control of remifentanil.     

Does the pill cause post-pill amenorrhoea?

An attempt is made in this paper to analyze the available epidemiological, pharmacological, endocrinological, and clinical data concerning the relationship of amenorrhoea to previous treatment with the oral contraceptive. Amenorrhoea is defined as an interval without vaginal bleeding which has lasted for 180 days (6 months) or more since the last menstrual period. Post-pill amenorrhoea is defined as amenorrhoea occurring immediately following the withdrawal bleed that comes after discontinuation of an oestrogen and progestogen containing oral contraceptive. Although available information on epidemiological grounds is limited, it does not appear likely that previous use of the oral contraceptive is associated with more cases of amenorrhoea than occur in the general population. It is clear that if the pill does cause amenorrhoea the effect is idosyncratic and not related to the specific formulation, dose or duration of therapy. 1 hypothesis to account for these data has been the contraceptive therapy may "bring out" a preexisting tendency, i.e. that post-pill amenorrhoea is likely to occur in a subject with an hypothalamic-pituitary-ovarian axis whose normal function is in some way specially vulnerable to impairment by exogenous sex steroids. Yet, post-pill amenorrhoea does not occur exclusively in women with previously irregular cycles. Also, the clinical and endocrinological information that exists provides no support for an aetiological role for the pill. Moreover, the risks of accepting a causal association are very great. 1st such an explanation may delay diagnosis and treatment of important and often remediable conditions. 2nd, it may deny a woman subsequent contraceptive protection with this highly effective and convenient preparation.     

Prolactin and infertility

Prolactin is a polypetide hormone structurally similar to a growth hormone. It is secreted by lactotrophs in the anterior pituitary gland. The levels rise during pregnancy in response to estrogens formed by the feto-placental unit. Hyperprolactaemia in women causes a characteristic pattern of reproductive disturbance. The most severe form accounts for 15-20% of amennorhoea. Subnormal secretion of estradiol occurs because ovarian follicles do not mature. Symptoms are dyspareunia and dryness during intercourse. Hyperprolactinaemia in men suppresses gonadtropin secretion, and testosterone concentrations may be subnormal. Suppression of prolactin can be achieved by withdrawing drugs which provoke prolactin release, by correcting hypothyroidism and by direct treatment of a prolactin-secreting pituitary tumor. Bromocriptine suppresses prolactin secretion by direct action on the pituitary lactotrophs. It may be possible to avoid procedures such as radiation therapy and surgery in patients with small pituitary tumors who wish to become pregnant, but close cooperation of patients in special units is essential.     

The acute and chronic effects of alcohol on the human immune system.

The immunologic status of 24 male patients admitted for acute alcoholic detoxification was evaluated by in vivo and in vitro parameters. In vivo reactivity, as measured by skin testing with a denovo antigen, dinitrochlorobenzene, as well as a recall antigen, tuberculin, was inact. However, both qualitative and quantitative defects were seen in vitro in the thymus-derived lymphocyte population. These defects were not seen in recovered alcoholics, that is, they appear reversible. The defects seen in the cell-mediated immunity of alcoholics may, in part, be responsible for the high incidence of head and neck cancer observed in this patient population.     

Intestinal perforation during pregnancy

Three cases of bowel perforation were encountered in pregnant women in a community hospital. Two were associated with mechanical obstruction, and one was of unknown etiology. Displacement of abdominal contents by the gravid uterus may predispose pregnant patients to intestinal obstruction in the presence of an underlying bowel abnormality, such as adhesions or malrotation. Prompt diagnosis and appropriate therapy are necessary to avoid a fatal or a severely morbid outcome.     

Combination chemotherapy of ovarian granulosa cell tumor with cis-platinum and doxorubicin

Two patients with metastatic granulosa cell tumors were treated with cis-platinum and doxorubicin, 50 mg/m² of each drug being given by intravenous bolus every 21 days. Both patients attained complete clinical remission. One, who refused second-look surgery, is alive and free of disease 18 months after cessation of treatment. The other patient had minimal gross residual disease at second-look laparotomy. This regimen shows promise in the treatment of disseminated stromal cord tumors.