271. Tuberkulose nach lebertransplantation

Zusammenfassung Bei einem 55jährigen Mann wurde 7 Monate nach orthotoper Lebertransplantation eine Lungentuberkulose diagnostiziert. Die tuberculostatische Therapie erfolgte mit Isoniazid (3 x 0,2 g/Wo) und Ethambutol (1,6 g/d) über 11 Monate. Nach 3 Monaten waren keine Mycobakte rien mehr nachweisbar, und der Patient ist im 3. Jahr nach Transplantation ohne Zeichen einer aktiven Tuberkulose in gutem Gesundheitszustand bei guter Transplantatfunktion. Die Tuberculostatica-Dosierung sollte je nach Metabolisierungsleistung des Transplantats reduziert werden. Bei Beachtung dieses Kardinalpunktes könnte eine Tuberkulose nach Lebertransplantation erfolgreich behandelt werden.     

Phase I study of high-dose cytosine arabinoside and etoposide in patients with advanced malignancies

Summary Cytosine arabinsodie (ara-C) and etoposide (VP-16) display synergy in the laboratory. Twenty-six patients participated in a phase I study of high-dose ara-C in combination with VP-16. The dose of VP-16 was held constant at 50 mg/m² as an intermittent infusion over 33 h; escalating doses of ara-C were given as infusions during hours 9–12 and 21–24. Myelosuppression was the dose-limiting toxicity and occurred with doses considerably less than those expected from studies of the two drugs as single agents. The suggested initial doses for phase II trials with this schedule are 750 mg/m²×2 doses of ara-C and 50 mg/m² of VP-16. Nonhematologic toxicity was minimal; therefore, further dose escalation is feasible in patients in whom myelosuppression is acceptable.Supported in part by grants from the National Cancer Institute (CA-12197 and CA-09422) and the American Cancer Society CF-85-182     

A case report of inflammatory breast cancer effectively treated with cis-platinum

A 50-year-old woman with bilateral inflammatory breast cancer (T4, N1b, M1, Stage IV) underwent right extended radical mastectomy and left modified radical mastectomy following pre-operative administration of carcinostatics (ADM, 5-FU) and irradiation. However, tumor recurrence was observed at the skin and right pleural cavity after the operation. Adriamycin-containing combination chemotherapy and radiation therapy were performed, but no significant response was obtained. CDDP was then administered intravenously at a daily dose of 62.5 mg/m2 at intervals of 60 days. The pleural effusion disappeared and the extent of skin metastasis was reduced, resulting in partial response which lasted for 90 days. The serum CEA level decreased from 13.1 ng/ml to 2.3 ng/ml. As the side effects of this therapy, slight nausea, vomiting and general fatigue were observed. This result suggested that CDDP is an effective drug for inflammatory breast cancer.     

4-Aminopyridine affects synaptosomal protein phosphorylation in rat hippocampal slices

Rat brain hippocampal slices were incubated with or without the convulsant 4-aminopyridine (4-AP). From these slices a crude mitochondrial/synaptosomal membrane fraction was prepared and analyzed for endogenous protein phosphorylation. 4-AP (10(-5) M) stimulated the phosphorylation of a 50 kDa protein by 86%. The phosphorylation of this 50 kDa protein is Ca2+/calmodulin-dependent and we suggest that this protein is the lower molecular weight subunit of Ca2+/calmodulin-dependent protein kinase II (CaMK II).     

Operations on the saccus endolymphaticus and vestibular nerve: have they fulfilled their promise?

The rationale for operations on the saccus and vestibular nerve in patients incapacitated by Meniere's disease as a replacement for total labyrinthectomy, has been the expectancy that less radical procedures will protect these patients from total auditory incapacity. Aware of postoperative hearing losses in some patients after 3 years, we have studied the results in 21 Shambaugh saccus decompression (SD) and 29 middle fossa vestibular nerve section (VNS) operations, in order to assess the claims made for these procedures. We found that while control of vertigo was similar to that reported elsewhere, worse hearing (AAOO criteria) developed in many cases. With SD this increased from 14% at 1 year to 58% at 10 years, and with VNS it increased from 17% at 1 year to 48% at 10 years, when the worse preoperative audiogram was used. Only 17% of SD and 11% VNS ears with serviceable best preoperative hearing had retained this at 10 years. Nineteen percent developed audiometric evidence of contralateral disease during the first 10 postoperative years. It is concluded that although, regrettably, neither of these surgical therapies appears to have the capability of preventing the progress of hearing loss, the reality of bilateral disease justifies the continued use of SD or VNS by adequately trained surgeons.     

Investigation of basic imaging properties in digital radiography. 8. Detection of simulated low-contrast objects in digital subtraction angiographic images

We investigated the effects of imaging and display conditions on the detectability of low-contrast objects in digital subtraction angiographic (DSA) images. The test images were produced by superimposition of low-contrast objects on a uniform noisy background obtained with a DSA system. We employed 18-alternative forced-choice (18-AFC) experiments and predictions based on statistical decision theory to study the dependence of the threshold contrasts of the test objects on the object size, incident x-ray exposure, display window width, and display medium. The results indicated that the threshold contrast decreased with increasing object size, and that the detectability of an object of a given size increased with increasing incident x-ray exposure and decreasing width of the display window. We found that the signal-to-noise ratio (SNR) obtained from the perceived statistical decision theory model, which includes the observer's internal noise, can accurately predict the detectability of low-contrast objects in DSA images. The threshold SNR corresponding to 50% correct detection in the 18-AFC experiments had a constant value of 3.8, in agreement with results reported previously for screen-film systems. The theoretical model will be useful for prediction of the performance of a DSA system based on its physical characteristics, and for evaluation of the tradeoff between patient exposure and diagnostic accuracy for a given DSA unit.