Clinic audit for long-term survivors of childhood cancer

Follow up for survivors of childhood cancer is considered essential in order to document any continuing impact on growth, fertility and other systems, as well as provide appropriate care and information to individuals themselves. Appropriate follow up needs to take into account the survivors' own views about reasons for attendance and perceived satisfaction with the services provided. Information was sought from 93 survivors (more than five years from diagnosis) and 68 of their parents regarding current attendance, understanding of the purpose of the clinic and satisfaction, and future preferences. Patients' main reasons for attending were to gain reassurance that they were well and information about the disease. There were some discrepancies between the types of information patients would like from clinic attendance and what they remembered being given. Parents were more positive than patients. Our data suggest that (i) knowledge in survivors is poor and (ii) it may be possible to define a subgroup for whom less frequent follow up is appropriate. A key component of care must involve education of patients, both about their past and the implications for future health.     

Phase II study of the oxygen saturation curve left shifting agent BW12C in combination with the hypoxia activated drug mitomycin C in advanced colorectal cancer

BW12C (5-[2-formyl-3-hydroxypenoxyl] pentanoic acid) stabilizes oxyhaemoglobin, causing a reversible left-shift of the oxygen saturation curve (OSC) and tissue hypoxia. The activity of mitomycin C (MMC) is enhanced by hypoxia. In this phase II study, 17 patients with metastatic colorectal cancer resistant to 5-fluorouracil (5-FU) received BW12C and MMC. BW12C was given as a bolus loading dose of 45 mg kg(-1) over 1 h, followed by a maintenance infusion of 4 mg kg(-1) h(-1) for 5 h. MMC 6 mg m(-2) was administered over 15 min immediately after the BW12C bolus. The 15 evaluable patients had progressive disease after a median of 2 (range 1-4) cycles of chemotherapy. Haemoglobin electrophoresis 3 and 5 h after the BW12C bolus dose showed a fast moving band consistent with the BW12C-oxyhaemoglobin complex, accounting for approximately 50% of total haemoglobin. The predominant toxicities--nausea/vomiting and vein pain--were mild and did not exceed CTC grade 2. Liver 31P magnetic resonance spectroscopy of patients with hepatic metastases showed no changes consistent with tissue hypoxia. The principle of combining a hypoxically activated drug with an agent that increases tissue hypoxia is clinically feasible, producing an effect equivalent to reducing tumour oxygen delivery by at least 50%. However, BW12C in combination with MMC for 5-FU-resistant colorectal cancer is not an effective regimen. This could be related to drug resistance rather than a failure to enhance cytotoxicity.     

Consonant enhancement effects on speech recognition of hearing-impaired children

Differences in gain (enhancement, in dB) required to optimize the consonant/vowel intensity ratio in nonsense syllables were determined for stops and fricatives, both voiced and voiceless, in 12 children with congenital moderate to severe sensorineural hearing loss. The test stimuli were vowel/consonant nonsense syllables with various levels of enhancement ranging from 0 dB (for the unprocessed stimulus) to 24 dB of gain, in steps of 3 or 6 dB. Results showed that significant improvements in consonant recognition can be obtained with individualized adjustment of consonant amplitude for children as young as 5 years of age.     

Interventional radiologic procedures in the renal transplant

Percutaneous interventional procedures can be valuable in the evaluation and treatment of urologic complications of renal transplantation. Thirty-three patients underwent percutaneous procedures, including relief of obstruction by catheter nephrostomy, diagnostic antegrade pyelography with Whitaker testing, aspiration of various fluid collections (lymphocele, hematoma, urinoma, and abscess), and renal artery angioplasty, during a three year period at three institutions, to provide temporizing treatment and anatomic data. Surgical intervention was sometimes avoided, but more often it could be deferred to allow the patient to stabilize prior to surgery. Complications that required surgery occurred in two patients.     

Relationships among intravaginal pressure,orgasmic function,parity factors,and urinary leakage

Women's ability to contract pelvic musculature voluntarily was related to reports of ability to have orgasm, parity, and urinary leakage problems. Data collected from 92 women presenting for routine pelvic examinations provided no evidence of a general relationship between strength of voluntary pelvic muscle contractions and orgasmic function. There were negative relationships between strength of voluntary pelvic muscle contractions and parity, weight of the largest baby, and a woman's age.Research supported by a grant to the junior author from the Association for the Advancement of Mental Health Research and Education, Inc.     

Biochemical effects of L-deprenyl in atypical depressives

To examine the biochemical effects of 10-30 mg/day L-deprenyl, measurement of 24-hr urinary output of phenylethylamine (PEA), 3-methoxy 4-hydroxy phenylethyleneglycol (MHPG), and L-deprenyl's amphetamine metabolites were carried out before and during the treatment of atypical depressives. Platelet monoamine oxidase (MAO) activity was also assessed. With L-deprenyl 10-30 mg/day, the expected MAO B inhibition occurred, as indicated by significant increase in urinary PEA excretion and virtual disappearance of platelet MAO activity. Twenty-five to 33% of the daily dose of L-deprenyl was recovered as urinary methamphetamine or amphetamine. Excretion of MHPG was significantly decreased with L-deprenyl 10-20 mg/day. Overall, the results suggest that L-deprenyl's antidepressant effects are mediated by some mechanism other than, or in addition to, MAO B inhibition.     

Fate of soluble carbohydrate in the colon of rats and man.

The fate of glucose in the colon of rats and man was investigated by measuring breath 14CO2 and fecal 14C after direct instillation of 14C-labeled glucose, acetate, and lactate into the cecum. For the 6 h after administration of as much as 400 mg of [U-14C]-glucose to the rat and 12.5 g to man, 14CO2 excretion was as rapid after intracecal as after intragastric instillation. Less than 20% of 14C instilled into the cecum as glucose was recovered in feces and only about 15% of this fecal 14C was in a dialyzable form. The conversion of intracecally administered glucose to CO2 was dependent upon the presence of the colonic flora, as evidenced by the minimal excretion of 14CO2 after administration of [14C]glucose to germ-free rats. In contrast, acetate and lactate, fermentation products of glucose, were converted to CO2 as rapidly in germ-free rats as in their conventional counterparts. Measurement of O2 availability in the colonic lumen indicated that insufficient O2 was available for the aerobic metabolism of glucose by the colonic bacteria. These experiments suggest that the colon bacteria anaerobically metabolize most of the glucose to short-chain fatty acids, which are absorbed and oxidized by the host. Most of the remaining fecal glucose is converted to a larger molecular form that has limited osmotic activity. Thus, the colonic flora benefits the host by reducing the osmotic load of nonabsorbed carbohydrate and by making possible the salvage of a large percentage of the calories of carbohydrate, which is not absorbed in the small bowel.