The role of the surgeon in percutaneous transluminal dilation of coronary stenosis.

Percutaneous transluminal dilation (PTD) of coronary artery stenosis is performed by means of a balloon-tipped catheter introduced from a peripheral artery. It was attempted in 45 patients; stenosis was passed in 33 and was successfully dilated in 28 patients (62%). The method failed in 17 patients: in 6 of them an abrupt closure of a stenosed artery or a beginning infarction necessitated an emergency revascularization. There were no deaths or serious complications, but an infarction developed in 1 patient despite immediate bypass grafting. PTD was successful in 5 out of 7 patients who had recurrent angina after previous coronary bypass grafting: in 2 of them stenosis of a distal coronary artery and in 3 a stenosed bypass graft were dilated. PTD is a new method of treatment of coronary artery disease and is an addition rather than an alternative to coronary bypass grafting. The best results can be expected in patients with single-vessel disease, with a short history of angina (less than 1 year), and with narrow, noncalcified proximal stenosis. Some late complications of bypass grafting are also amenable to this method of treatment.     

Biochemische Aspekte der l-DOPA-Wirkung bei Parkinsonpatienten

Zusammenfassung Es wurde bei 19 Patienten mit Paralysis agitans die Wirkung einer Langzeitbehandlung mit 2500–5000 mg l-DOPA/die untersucht: a) mit Hilfe von klinischen Tests, b) durch Messung der Aminosäurezusammensetzung des Liquor cerebrospinalis. Krankheitsdauer und Ausprägung der Symptome waren verschieden. Der Beobachtungszeitraum betrug 3 Monate bis 2 Jahre.1. Bei 9 Patienten war vor Beginn der Behandlung mit l-DOPA die Aminosäurezusammensetzung im Liquor cerebrospinalis so verändert, wie es bei einer Parkinsonsymptomatik zu erwarten war: Die Konzentrationen von Glycin, Serin, Threonin, Cystein + Cystin und Methionin waren erhöht, die von Glutaminsäure vermindert. Diese Patienten sprachen auf eine Behandlung mit l-DOPA sehr gut bis gut an; das Aminosäurespektrum im Liquor cerebrospinalis normalisierte sich.2. Bei 5 Patienten wich vor Beginn der Behandlung mit l-DOPA die Aminosäurezusammensetzung des Liquors nur wenig vom normalen Durchschnitt ab, der Erfolg der l-DOPA-Therapie war nicht zufriedenstellend.3. Eine Normalisierung der Aminosäurewerte ohne wesentlichen Therapieerfolg wurde nicht beobachtet.4. Von 5 weiteren Patienten sprachen 4 auf l-DOPA gut an; eine Einordnung in die vorgenannten Gruppen erscheint aus verschiedenen Gründen nicht sinnvoll.Die Analyse der Liquoraminosäuren scheint somit eine Prognose zu erlauben, ob eine l-DOPA-Therapie sinnvoll ist oder nicht. Aus den vorgelegten Ergebnissen ist weiters zu folgern, daß das klinische Krankheitsbild Paralysis agitans keine einheitliche Krankheit ist, sondern sich einzelne Formen hinsichtlich der Störung des Stoffwechsels im ZNS voneinander unterscheiden.

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Biochemical aspects of the effect of l-DOPA in patients with Parkinson's disease

Summary We tested the effect of a prolonged l-DOPA therapy in 19 patients suffering from Parkinson's disease, by a) applying medical tests and b) measuring concentrations of free amino acids of cerebrospinal fluid. The period of observation ranged from 3 months up to two years, with doses from 2500 to 5000 mg l-DOPA per day.1. In 9 patients the pattern of free amino acids of CSF was altered according to what we are used to find in Parkinson's disease: the concentrations of glycine, serine, thereonine, cysteine + cystine as well as methionine were increased, that of glutamic acid decreased. The clinical success was very good along with a restoration to normal of the pathological amino acid pattern.2. In 5 patients the amino acid pattern was similar to that of normal controls. Clinically, these cases showed an unsatisfactory response to therapy, the amino acid pattern of CSF also remaining unchanged.3. In no case we did find a normalization of amino acid levels without an improvement of the clinical symptoms.4. Of another 5 patients 4 responded favourably to l-DOPA, one did not. These patients were not considered to belong to the above mentioned groups because of several complicating factors.The estimation of the pattern of free amino acids in CSF seems to be of prognostic value in yielding a biochemical parameter that seems to indicate whether or not a prolonged treatment with l-DOPA might be successful. Patients with a pathological pattern of CSF amino acids run a better chance of therapeutic improvement. We could not find any correlation between levels of amino acids in CSF and the duration of the disease or the severity of symptoms. We conclude that Parkinson's disease is not caused by a single type of disturbed cerebral metabolism.

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Abkürzungen AS Aminosäuren - Arg Arginin - Ala Alanin - Asp Asparaginsäure - Asp-NH₂ Asparagin - Cys Cystein + Cystin - l-DOPA l-Dihydroxyphenylalanin - Glu Glutaminsäure - Glu-NH₂ Glutamin - Gly Glycin - His Histidin - Ileu Isoleucin - Leu Leucin - Lys Lysin - Met Methionin - Phe Phenylalanin - Ser Serin - Thr Threonin - Tyr Tyrosin - Val Valin - ZNS Zentralnervensystem - BTS Brenztraubensäure - GOT Glutamat-Oxalacetat-Transaminase - GPT Glutamat-Pyruvat-Transaminase. Für das Forschungsstipendium, das uns die Durchführung dieser Arbeit ermöglichte, sind wir der Fa. Hoffmann-La Roche, Basel, zu Dank verpflichtet.     

Acral necrosis after inadequate excessive administration of bleomycin in a testicular cancer patient

BACKGROUND: Testicular cancer has a favorable prognosis in the majority of patients due to the excellent susceptibility to chemotherapy with cisplatin, etoposide and bleomycin (BEP), which is commonly administered over 3-4 cycles of treatment. CASE REPORT: A 22-year-old male failed to achieve complete response after unconventional treatment with 6 courses of BEP for intermediate-risk metastasized testicular cancer. The patient developed chemotherapy-induced digital necrosis and substantial loss of digital function after this excessive treatment. This condition resolved with infusional alprostadil combined with oral clonidin and pentoxifyllin. RESULT: Infusional alprostadil adds substantial clinical benefit to combined vasoactive therapy in chemotherapy-induced vascular toxicity, even after the onset of digital necrosis.     

Tumor control probability (TCP) and normal tissue complication probability (NTCP) in head and neck cancer

Clinical radiobiology is concerned with the relationship between a given radiation dose and the resulting biological effect on tumors and normal tissues, as well as with all confounding factors related to the delivery of radiation (e.g. dose per fraction, overall treatment time, volume of tumor/normal tissue irradiated, concomitant use of chemotherapy) and/or associated with preexisting conditions of the host (e.g. diabetes, hypertension, genetic syndromes) that may influence this relationship. This article briefly reviews few of the concepts associated with the dose-effect relationships in both normal tissues and tumors of the head and neck area and presents an operational way to integrate all these concepts into the routine radiotherapy planning processes.