DIFFUSE HEPATIC HEMANGIOMATOSIS IN THE ELDERLY

SUMMARY The first documented case of massive hepatic haemangiomatosis to present in an elderly patient (who survived to the age of 82).     

Platelet-activating factor antagonists

Conclusions The great number of PAF antagonists reviewed in this article clearly shows the tremendous effort made in the last 20 yr to explore the complex biological background of the mechanism of action of PAF and the potential clinical benefit of its antagonists. It is obvious that now highly potent, long-acting, and perorally applicable PAF-receptor antagonists are developed, and available for preclinical and clinical research. Another important fact is that the progress in the biochemical research designed to explore the structure of PAF receptors is impressive. This work has been expected to answer numerous questions concerning the tissue specificity of several PAF antagonists. For example, among the synthetic hetrazepine PAF-receptor antagonists developed by the Beaufour-IPSEN group, BN 50727 exhibits higher efficacy in the gastrointestinal tract (67) than in other tissues; alternatively, BN 50730 exerts more potent effect in the lung (66) than in other organs. At the present state of knowledge, the interpretation of these differences is unclear. Better knowledge about the PAF-receptor structure in the gastrointestinal tract may shed more light on the background of drug-receptor interactions responsible for tissue specificity. This may lead to more successful clinical development of PAF receptor antagonists in the near future.     

Dermal graft for protection of the pharyngeal suture line in cancer surgery of the head and neck

We studied the effect of free buried dermal grafts to primary pharyngeal closures among 24 nonirradiated patients undergoing radical head and neck surgery to determine if this technique would reduce the incidence of postoperative pharyngocutaneous fistula. For a control group we selected 23 patients who had undergone similar operations as the patients in the study group, but who did not have dermis used for pharyngeal protection. Our results indicate that dermal grafts do not alter the incidence of fistulization following cancer surgery of the head and neck.     

Is there a case for PAF antagonists in the treatment of ischemic states?

It is becoming clear that PAF plays an important role in a variety of life-threatening pathologies including shock, asthma, graft rejection and ischemia-induced damage. Pierre Braquet and colleagues analyse recent reports on PAF and ischemia and propose a hypothesis based on the catastrophe theory to explain why PAF antagonists are effective in countering ischemic injury and many other disorders. PAF antagonists, perhaps in combination with other agents, may consequently prove to have extensive therapeutic potential.     

Plasma vasopressin levels in induced migraine attacks

Vasopressin (aVP) at low concentrations functions as an antidiuretic hormone and has vasoconstrictive effects. To investigate the possible role of aVP in the pathogenesis of migraine, six patients with a history of induced migraine were given 100 g chocolate, and blood samples for plasma aVP were taken before ingestion and every hour for 4 h. In one patient who presented with severe headache and nausea the base-line plasma aVP concentration was 15.2 pg/ml; it fell to 3.2 pg/ml at 2 h before rising to 10 pg/ml at 3 h and 4 h as the symptoms worsened. In the five patients with moderate or no headache plasma aVP concentrations remained in the normal range (less than 3 pg/ml) throughout. The results suggest that aVP does not have a role in the aetiology of migraine. The possibility exists that during severe attacks of nausea there is release of aVP, which may be responsible for the facial pallor, antidiuresis, and coagulation abnormalities occasionally observed in migraine.     

Needle aspiration and core biopsy of prostate cancer: comparative evaluation with biplanar transrectal US guidance

Biplanar, transrectal ultrasound (US) guidance of needles was used in the transperineal biopsy of possibly malignant prostatic lesions in 80 patients (83 biopsies). A 22-gauge cytologic needle was used to locate and fixate the lesion, and aspiration specimens for cytologic and histologic evaluation were obtained (with 22- and 14-gauge needles, respectively). Twenty-one 19-gauge needle core biopsies were also performed. Forty-nine patients (61%) had histologically prove adenocarcinoma. The rate of cancer diagnosis was 53% with cytologic evaluation and 54% with histologic evaluation (combined yield, 61%). This included 34% of cancers less than 1.0 cm in diameter and 56% of those 1.0-1.5 cm. Thirteen of 23 (57%) of these lesions were nonpalpable or equivocal on digital rectal examination. These results suggest that transrectal US guidance of thin-needle biopsies is useful in diagnosing early prostate cancer.