Biochemotherapy of advanced metastatic renal-cell carcinoma: results of the combination of interleukin-2, alpha-interferon, 5-fluorouracil,vinblastine, and 13-cis-retinoic acid

Summary We conducted a phase I/II clinical trial evaluating the sequential outpatient combination of S.C. recombinant human interleukin-2 (rIL-2; given at 10 MIU/m² b.i.d. on days 3–5 of weeks 1 and 4 and at 5 MIU/m² on days 1, 3, and 5 of weeks 2 and 3), s.c. recombinant human alpha-interferon (rIFN-; given at 6 MIU/m² on day 1 of weeks 1 and 4 and on days 1, 3, and 5 of weeks 2 and 3 and at 9 MIU/m² on days 1, 3, and 5 of weeks 5–8), i.v. bolus 5-fluorouracil (5-FU; given at 1,000 mg/m² once weekly during weeks 5–8), and i.v. bolus vinblastine (given at 6 mg/m² once weekly during weeks 5 and 8) in conjunction with p.o. 13-cis-retinoic acid (13-C-RA; given at 35 mg/m² daily during weeks 1–8). Therapy was always given in the outpatient setting. Grade 3 constitutional symptoms (malaise, chills, fevers, anorexia) were observed in 4%–8% of treatment cycles and required a 50% reduction in the doses of rIL-2 and rIFN-. None of the patients experienced major 5-FU-related toxicities such as severe diarrhea and/or stomatitis; up to 20% of patients developed vinblastine-associated peripheral polyneuropathy, which was reversible after the cessation of therapy. 13-cis-Retinoic acid produced no significant side effect; no toxic death occurred. Among 24 patients with progressive metastatic disease, there were 4 complete remissions (lung, lymph nodes) and 6 partial remissions (lung, pleura, liver, lymph nodes, and peritoneal carcinosis), for an overall objective response rate of 42% (95% confidence interval, 22%–63%). An additional 13 patients achieved disease stabilization (54%). The median time to response was 3–4 months (range, up to 6 months); all responses are continuous. In summary, although the potential synergy of biochemotherapy plus 13-cis-retinoic acid requires further preclinical investigation, the current outpatient combination regimen (rIL-2, rIFN-a, 5-FU, vinblastine, and 13-C-RA) proved to be both safe and highly effective in patients with advanced metastatic renal-cell carcinoma. A current multiinstitutional prospectively randomized trial is comparing biochemotherapy with and without concomitant 13-C-RA against rIFN- plus vinblastine.     

Preliminary evaluation of pelvic vascular bed isolation chemotherapy in the treatment of advanced cervical carcinoma

ＰｒｅｌｉｍｉｎａｒｙｅｖａｌｕａｔｉｏｎｏｆｐｅｌｖｉｃｖａｓｃｕｌａｒｂｅｄｉｓｏｌａｔｉｏｎｃｈｅｍｏｔｈｅｒａｐｙｉｎｔｈｅｔｒｅａｔｍｅｎｔｏｆａｄｖａｎｃｅｄｃｅｒｖｉｃａｌｃａｒｃｉｎｏｍａＪｉａｎｇＳｅｎａｎｄＰｏｓｔｇｒａｄｕａｔｅ...     

Cowden's disease

A 24-year old male patient developed multiple lesions of keratoacanthoma in the epidermal verrucous naevus. He also had multiple papillomatous lesions on the lips, buccal mucosa, gingiva and tongue, with positive family history of similar lesions. He also had multiple skin tags and patchy palmoplantar keratoderma and minimal kyphoscoliosis.     

Free tissue transfer for skull base reconstruction analysis of complications and a classification scheme for defining skull base defects

OBJECTIVE: The role of free flaps in skull base reconstruction is discussed in detail. Twenty-six microvascular free tissue transfers performed in 22 patients are reviewed in detail. A classification scheme for skull base defects is presented. SETTING: Tertiary referral center. PATIENTS: Twenty-two patients with neoplasms that involve the skull base underwent a combined craniotomy and facial approach for resection. The resultant defects were reconstructed with a variety of microvascular free flaps. RESULTS: All 22 patients were ultimately successfully reconstructed with a free flap. One patient required a second free flap following ablative surgery for a recurrent tumor. The initial free flaps in three patients were unsuccessful and a second flap was required. The classification scheme was applied to all defects. CONCLUSIONS: The creation of a functional separation of the intracranial and extracranial cavities can be extremely difficult to accomplish, especially when multiple cavities (nasal, oral, pharyngeal) are violated. Free flaps provide a solution to this problem in select cases. Skull base defects can and should be classified for the purpose of communication, treatment planning, prognosis of reconstruction, and judging therapeutic outcome.     

Complications of preoperative balloon test occlusion of the internal carotid arteries: experience in 300 cases

Treatment of some tumors and aneurysms of the skull base may require internal carotid artery (ICA) sacrifice. Preoperatively to determine the dependence of the cerebral blood flow on a particular vessel, we perform a balloon test occlusion (BTO) by temporarily occluding the vessel in an awake patient. During occlusion, clinical evaluations and cerebral blood flow measurements are assessed. We have performed 300 BTOs. Eleven patients (3.7%) have had complications. Six (2%) were asymptomatic dissections. Five (1.7%) had neurologic deficits that persisted beyond the test period. Of these five, one was back to baseline in less than 24 hours, one recovered completely in a week, and one (0.33%) had a minimal but persistent dysphasia. These latter three cases are unexplained but might have resulted from unrecognized dissections or embolic events. Finally, one patient with a persistent deficit required energency surgery for reasons unrelated to the BTO and was therefore difficult to assess, and one required emergency middle cerebral artery embolectomy and repair of the dissection. The preoperative knowledge of carotid dependence in cases in which the ICA is at risk is essential, since vascular grafts or alternative surgical approaches are necessary in patients unable to tolerate carotid sacrifice. Since approximately 15 to 20% of the population falls into this category, a preoperative BTO appears justified.     

肝癌和肝硬化患者血清一氧化氮水平探讨

目的：探讨一氧化氮（NO）与肝癌及其合并症、肝硬化、肝功能分级及肝硬化并发症的关系。方法：应用化学比色法检测34例肝癌患者，45例肝硬化患者及20例正常人血清NO水平。结果：肝癌组血清NO显著高于肝硬化组及正常对照组；肝癌合并代偿期肝硬化血清NO高于合并慢性肝炎者；肝硬化组血清NO与正常对照组比较，差异有显著性；并且随肝功能Child-Pugh分级的增加而升高，A级与对照组比较无差异，B级与A级、B级与C级比较，差异有显著性。并发肝肾综合征、食管胃底静脉曲张破裂出血者较无并发症肝硬化者NO明显升高。结论：内源性NO在肝癌及肝硬化时合成增加，且与肝癌合并症、肝硬化病情严重程度及并发症的发生密切相关。血清NO测量有助于肝癌及肝硬化病情的临床评估及疗效观察。     

阳离子抗菌肽研究进展

阳离子抗菌肽广泛分布于多种生物 ,越来越多的证据表明它们在机体天然免疫中有着重要的作用。广谱抗菌、抗病毒、抗肿瘤细胞及其它特性也使得其具有潜在的医药价值。对抗菌肽的研究正不断深入。该文从一般性质、作用机制、构效关系、重组表达、应用价值、存在的问题与发展方向等方面 ,对阳离子抗菌肽的最新研究进展进行综述     

正交设计法考察盐酸洛美沙星葡萄糖注射液制备工艺

目的：对盐酸洛美沙星葡萄糖注射液生产工艺过程的影响因素进行实验考察，寻求最佳生产工艺。方法：通过正交设计考察pH、加炭量、温度和加热时间4个因素对盐酸洛美沙星含量的影响，选用L16(4^5)正交表进行实验。结果：实验证明活性炭对盐酸洛美沙星有明显吸附作用，在pH值为4．8，加炭量为0．02％，温度为50℃及加热时间为10 min的优化条件下，活性炭对盐酸洛美沙星的吸附量最小。结论：生产过程中应对上述影响因素进行控制，提高产品质量。