Fluorouracil,imidazole carboxamide dimethyl triazeno,vincristine, and bis-chloroethyl nitrosourea (FIVB) in colon cancer

Summary One hundred and sixty patients with advanced metastatic colon cancer were treated with the drug combination of 5-fluorouracil (FU), imidazole carboxamide dimethyl triazeno (ICDT, DTIC), vincristine (VCR), and bis-chloroethyl nitrosourea (BCNU). All the agents were given in each cycle of treatment. The patients also received continuous ethylestranol. Special care was taken to ensure that the ICDT was not at any time exposed to light. Toxic effects included fall in hemoglobin, leukopenia, thrombocytopenia, alopecia, stomatitis, nausea and vomiting, and occasional diarrhea. Among 112 patients who had had no prior exposure to cytostatic agents, complete remission (CR) was recorded in 12, and partial remission (PR) in 31. The median duration of remission in these patients was 5.2 months. The median survival for the whole group was 8.4 months: for responders the median survival was 10 months, and for non-responders, 5.4 months. PR was also documented in 10 of 48 patients who had received prior treatment with FU or FU plus methyl-1,3-cis(2-chloroethyl-1-nitrosourea) (MeCCNU).     

Aortic dissection: magnetic resonance imaging

Fifteen patients with suspected or known aortic dissection were imaged with magnetic resonance (MR). Thirteen of these patients were eventually shown to have dissection. In most instances the diagnosis was established by aortography and/or computed tomography (CT) prior to the MR study. Surgical proof (6/13) and/or aortographic proof (10/13) were available in 11/13 patients with aortic dissection. MR demonstrated the intimal flap and determined whether the dissection was type A or type B. In addition, MR: differentiated between the true and false lumens; determined the origins of the celiac, superior mesenteric, and renal arteries from the true or false lumen in the cases where the dissection extended into the abdominal aorta (8/12); allowed post-surgical surveillance of the dissection; and identified aortoannular ectasia in the three patients who had Marfan syndrome. In addition to the 13 cases with dissection, there were two cases in whom the diagnosis of dissection was excluded by MR. Our early experience suggests that MR can serve as the initial imaging test in clinically suspected cases of aortic dissection and that the information provided by MR is sufficient to manage many cases. Additionally, MR obviates the use of iodinated contrast media.     

Peripheral vascular disease: correlation of MR imaging and angiography

The capability of magnetic resonance (MR) imaging for detecting aortic, iliac, and femoral stenoses and occlusions was evaluated. Multisection spin-echo studies at 0.35 tesla were obtained of the infrarenal aorta to the femoral bifurcation in 24 patients, all of whom had undergone intraarterial angiography within 14 days of imaging. Transaxial MR images were compared with the angiograms. Arterial stenoses and occlusions in these vessels detected by MR imaging correlated with angiographic findings in 91% of the instances. Protrusional atherosclerotic plaques and occlusions and stenoses in the aortoiliac region were demonstrated accurately on MR images; complications of previous vascular surgery, such as aneurysms at sites of previous anastomoses or endarterectomy, were also identified. Due to the limited spatial resolution, MR images failed to demonstrate some femoral stenoses. MR imaging may be used for evaluation of aortoiliac vascular disease and for follow-up study after surgical revascularization. However, the limited spatial resolution, noncomposite display of the aortoiliofemoral circulation, and lack of evaluation of peripheral runoff provided by current MR imaging techniques militate against its replacing angiography prior to vascular intervention.     

Cyclophosphamide, mitoxantrone, vincristine and prednisone in the treatment of non-Hodgkin's lymphoma

Twenty-two patients with histologically confirmed non-Hodgkin's lymphoma received treatment with a chemotherapy combination containing cyclophosphamide, mitoxantrone, vincristine and prednisone. Leukopenia, nausea and vomiting were the most common side effects. A response rate of 77% (17 of 22 patients) was documented. These results indicate that the four-drug combination including mitoxantrone has good therapeutic activity in the treatment of non-Hodgkin's lymphoma.