Decreased serum phosphate levels after high-dose estrogens in metastatic prostate cancer. Possible implications

Hypophosphatemia and osteomalacia have been described in patients with metastatic prostate cancer. The mechanism of hypophosphatemia in prostate cancer is not known. A decrease in serum phosphate levels was observed in 16 of 18 patients with metastatic prostate cancer treated with high-dose diethylstilbestrol diphosphate. To determine if the fall in serum phosphate was indeed due to diethylstilbestrol diphosphate, the data from several similar groups of patients treated with chemotherapy and combined chemohormonal therapy that included diethylstilbestrol diphosphate were re-examined. Fifty-eight patients were treated with doxorubicin, doxorubicin plus cis-platinum, doxorubicin plus diethylstilbestrol diphosphate, or diethylstilbestrol diphosphate alone. A significant decrease in serum phosphate levels was seen only in patients treated with diethylstilbestrol diphosphate. Hypophosphatemia and possibly osteomalacia in metastatic prostate cancer may be related to estrogen therapy.     

Merkel cell carcinoma of the tongue and head and neck oral mucosal sites.

Merkel cell carcinoma (MCC) is an uncommon primarily dermal malignancy of relatively aggressive biologic course. Several presentations in the mucosa of the head and neck region have been reported in the literature, and 3 such patients have recently been seen at our institution. We review this recent experience and present the first reported primary lingual MCC in a 57-year-old caucasian man. We provide a review of oral mucosal MCC and guidelines for histopathologic and immunohistochemical diagnosis. Merkel cell carcinoma should be included in the differential diagnosis of head and neck mucosal lesions, especially if the tumor is submucosal, and MCC may involve the tongue. Mucosal MCC is aggressive, and there is a high risk for local recurrence and regional and distant metastasis. Fulminating courses are often seen. We discuss our treatment policies based on the current literature.     

Studies of women eating diets with different fatty acid composition. I. Plasma lipoproteins and steroid excretion

Moderate changes in dietary fat composition have been recommended to improve plasma cholesterol status. Such changes have not been studied extensively in women. This research evaluates plasma lipoprotein and steroid excretion changes in young women who consumed a diet similar to US average consumption in 1974 [40 en% fat, polyunsaturated (P) to saturated fatty acid (S) ratio, P/S = 0.3, US74] or a diet modified to contain 30 en% fat, P/S = 1.0 (MOD). Following a preexperimental period of self-selected diets, young women were fed the diets for 28-day periods in a crossover design with 10 women at the University of Nebraska, Lincoln, and 10 at Iowa State University, Ames. Plasma lipoproteins and steroid excretion were quantitated and the compositions determined. Data were analyzed for race (five Chinese, 14 Caucasians) and for diet carryover effects, as well as for primary diet effects. In the Chinese women, the US74 diet raised total and very-low-density lipoprotein (VLDL) cholesterol compared to prior self-selected or modified diets; in the Caucasian women the MOD diet lowered total, low-density lipoprotein (LDL), and VLDL cholesterol. The diet carryover was evident in total high-density lipoprotein (HDL) and HDL3 cholesterol. Total HDL and HDL3 cholesterol in response to the US74 diet were unchanged from the MOD diet when the US74 diet followed the MOD diet, but were lower than modified when the US74 diet followed self-selected diets. The US74 diet resulted in greater neutral sterol excretion than the MOD diet; this response was more marked in the self-selected, US74, MOD sequence than in the self-selected, MOD, US74 sequence.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thrombogenicity of intravenous 5-fluorouracil alone or in combination with cisplatin

Acute myocardial infarction was observed in two patients receiving standard intravenous doses of 5-fluorouracil (5-FU)-based chemotherapy. Therefore, the authors prospectively assessed the thrombogenicity of this agent by studying ten patients, six with head and neck cancer and four with gastrointestinal malignancies, receiving 5-FU (1 g/m2/day) as a constant intravenous infusion over a 4-day or 5-day period. The six patients with head and neck cancer also received a single dose of 100 mg/m2 of cisplatin on day 1. Blood samples were obtained preinfusion, 24 hours into the infusion, and postinfusion. Samples were assayed for fibrinopeptide A (FpA) by enzyme-linked immunoassay, for protein C activity (PCa) using a chromogenic substrate (Spectrozyme PCa), and protein C (PCag) and free protein S antigen (PSag) by electroimmunoassay. No patient experienced a thrombotic event. A significant increase was observed in FpA levels during the infusion which returned toward baseline at the conclusion of the infusion. After infusion of 5-FU, the PCa value was significantly lower than the PCag (37 +/- 17 versus 69 +/- 24%; P less than 0.002). No effect on protein S was observed. The changes in the patients receiving 5-FU alone were comparable to those who also received CDDP. The authors conclude that during the infusion of 5-FU, the rise in FpA activation and reduction in PCa as compared to PCag are compatible with activation of coagulation.     

Simultaneous localized 915 MHz external and interstitial microwave hyperthermia to heat tumors greater than 3 cm in depth

A technique for heating superficial lesions extending to a depth greater than 3 cm using 915 MHz electromagnetic energy is described. It is well established that with external microwave applicators operating at 915 MHz, it is only possible to heat adequately up to a maximum depth of 3 cm. However, it is demonstrated that by implanting additional layers of interstitial microwave antennas (1.5 cm spacing) at required depths greater than 3 cm, and by simultaneously exciting these applicators as well as an external applicator, it is possible to extend the depth of heating at this frequency. A large neck node was successfully heated when this combined technique was used. The details of the method and the equipment used are described. Specific Absorption Rate (SAR) values and temperature distributions obtained during the four treatments delivered to the patient are also presented. This technique can be used in situations where it is not possible to perform extensive interstitial implantation, and in institutions where hyperthermia equipment for heating deeper lesions is not available.     

Cisplatin and 5-fluorouracil in the primary management of squamous esophageal cancer

A combined treatment program consisting of chemotherapy with cisplatin and infusion 5-fluorouracil (5-FU) for three cycles followed by esophagectomy or radiation, or both, has been conducted in 26 patients with squamous cancer of the esophagus localized to the primary site. Eleven patients had objective evidence of partial or complete response to the chemotherapy. Fourteen patients were operated on and ten underwent total esophagectomy. Drug toxicity was considerable with severe mucositis and myelosuppression occurring in 11 and seven patients, respectively. There were no drug-related deaths. Median survival is 17.8 months. Ten patients have lived more than 2 years. Six of these patients have undergone total thoracic esophagectomy after the induction chemotherapy. Determination of the ultimate benefits of combined modality therapy may require prospective randomized trials isolating the major treatment components but our data suggest that chemotherapy contributes to improved results in this disease and that drug therapy is emerging as an integral component of combined therapy.     

Mechanism of demyelination in the guinea pig

Experimental allergic encephalomyelitis (EAE), accompanied by demyelinating central nervous system (CNS) lesions, can be induced in guinea pigs sensitized with whole guinea pig CNS tissue, but not in animals sensitized with purified myelin basic protein (BP). This type of chronic demyelinating EAE is presumably a result of a combination of a cell-mediated immune response to the encephalitogenic BP and a separate response to other nonencephalitogenic CNS antigens. We report here that demyelinating EAE can be induced when separate sensitizations are used to induce a cell-mediated response to BP and a second immune response to nonencephalitogenic CNS antigens. Animals sensitized in separate sites with guinea pig BP and whole chicken brain develop CNS demyelinating lesions. Animals sensitized only to BP or chicken brain do not develop demyelination. The antigen(s) responsible for demyelination are found in the myelin fraction of chicken brain.     

Beeinflussung des Risikoprofils von adip?sen essentiellen Hypertonikern durch das Gruppenprogramm ?Hypertonie im Gespr?ch?

Zusammenfassung Das Programm «Hypertonie im Gespräch» ist ein Gruppenbehandlungsprogramm für adipöse essentielle Hypertoniker in der ärztlichen Praxis auf verhaltenstherapeutischer Grundlage. In einer kontrollierten Studie wurden die Effekte des Programms zur Beeinflussung des Risikoprofils für Koronarerkrankungen an 137 Patienten von 9 in der Allgemeinversorgung tätigen ärzten überprüft, wobei 81 Patienten der Versuchsgruppe und 56 Patienten einer nicht mit dem Programm behandelten Kontrollgruppe zugeordnet wurden. Versuchs- und Kontrollgruppe sind hinsichtlich soziodemographischer, psychologischer und medizinischer Parameter strukturgleich. Als Ergebnis der Studie zeigt sich 3 Monate nach Beendigung des Programms ein spezifischer Effekt sowohl bei den psychologischen Erfolgskriterien (Befinden, Gesundheitswissen, Gesundheitsverhalten, Salzen und Compliance) als auch bei der Reduktion des diastolischen Blutdrucks trotz einer Reduktion der antihypertensiven Medikation. Blutfettspiegel (Cholesterin und Triglyceride) sowie Blutzuckerspiegel werden günstig beeinflusst. Patienten der Versuchsgruppe haben im Mittel ihr Gewicht um 5,6 kg reduziert, Patienten der Kontrollgruppe ausschliesslich um 0,8 kg. Insgesamt zeigt sich in der Versuchsgruppe eine deutliche Reduktion des Anteils von Patienten mit mehreren Risikofaktoren, so dass dem Programm ein präventiver Effekt zugeschrieben werden kann.

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Modifying the risk profile of obese essential hypertensive patients using the group programme Discussions on Hypertension

Summary The programme Discussions on Hypertension is a programme for group treatment of obese essential hypertensives in medical practices on the basis of behavioural therapy. A co-operation model was developed between the Department for General Medicine of the Medizinische Hochschule Hannover, the Institute for Medical Psychology of the Philipps-Universität Marburg and the company Galenus Mannheim and was offered to doctors in general practice. The effects of the programme on the modifying of the risk profile for coronary heart disease was investigated in a controlled study in 137 patients by nine general practitioners, 81 patients were enrolled in the experimental group and 56 patients were assigned to a control group that was not using the programme. The experimental and control groups were comparable with respect to sociodemographic, psychological and medical parameters. Three months after completing the programme, the results of the study was shown in specific effect both on the psychological criteria of success (well-being, health knowledge, healthy behaviour, salt use and compliance) and in a reduction of the diastolic blood pressure in spite of a reduction of the antihypertensive drug treatment. The blood lipid levels (cholesterol and triglycerides) and the blood glucose level were also favourably affected. Patients in the experimental group had reduced their weight by an average of 5,6 kg. The patients in the control group only by 0,8 kg. Overall, there was a marked reduction in the proportion of patients with several risk factors in the experimental group, so that the programme can be attributed a preventitive effect.

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Influence sur le profil de risque chez les hypertendus essentiels obèses par le programme de groupe «Dialogue sur l'hypertension»

Résumé Le programme «Dialogue sur l'hypertension» est un programme thérapeutique de groupe à l'intention des hypertendus essentiels obèses en pratique ambulatoire basé sur une thérapeutique du comportement. Il a été mis au point au sein d'un modèle de coopération entre le service de médecine générale de l'Ecole de médecine de Hanovre, l'Institut de psychologie médicale de l'Université Philipps de Marburg et la Maison Galenus Mannheim, puis mis à la disposition de praticiens. Dans le cadre d'une étude contrÔlée, on a examiné les effets du programme sur le profil de risque de maladies coronariennes chez 137 patients traités en cabinet chez neuf généralistes; 81 patients ont pris part au traitement de groupe, les 56 autres patients ont servi de groupe témoin. En ce qui concerne les paramètres sociodémographiques, psychologiques et médicaux, le groupe traité et le groupe témoin étaient comparables. Trois mois après la clÔture du programme, les résultats de l'étude montrent un effet spécifique du programme aussi bien du point de vue du succès psychologique (état général, prise de conscience de sa propre santé, style de vie, consommation de sel et prise régulière de la médication) que de la réduction de la pression sanguine diastolique (ceci, malgré une diminution de la médication antihypertensive). Les taux de lipides sanguins (cholestérol et triglycérides) et de la glycémie sont également influencés favorablement. Les patients du groupe traité ont réduit leur poids de 5,6 kg en moyenne; les patients du groupe témoin, de 0,8 kg seulement. Dans l'ensemble, on trouve dans le groupe traité une amélioration nette du profil de risque, ce qui fait conclure à un effet préventif du programme testé.

     

Adoptive transfer of experimental allergic encephalomyelitis

We have previously shown that adoptive transfer of experimental allergic encephalomyelitis can be greatly enhanced by culturing sensitized lymph node cells (LNC) with specific antigen, myelin basic protein (BP). In the present study, successful transfer was accomplished with 5×10⁶ Lewis rat LNC after 48 h culture with BP. Disease transfer was inhibited by the addition to culture of dibutyryl adenosine 3’,5’-cyclic monophosphate (Bt₂ cAMP) or the phosphodiesterase inhibitor, isobutyl methylxanthine (MIX), but not by Bt₂cGMP. BP-induced lymphoproliferation was also inhibited, but with a slightly different dose-response relationship. An early step in the lymphocyte activation process appears to be most sensitive to the inhibitory effects of Bt₂cAMP.