The classification of chronic pancreatitis

To make the II Marseilles Classification of Pancreatitis more applicable to everyday clinical practice, a new systemic approach is suggested basing on clinical, laboratory, CT and ultrasound evidence. Upon examination of 182 chronic sufferers with pancreatitis, interstitial--edematous, parenchymatous, fibrous--sclerotic (indurative), hyperplastic (pseudotumorous) and cystic variants of the disease were established in 34.6%, 30%, 21.1%, 4.4% and 9.9%, respectively. Clinical features typical for each variant of the disease and most common complications are reviewed.     

What is the optimal medical management of ischemic heart failure?

Ischemic heart disease is an important and common contributor to the development of heart failure. Theoretically, all patients with heart failure may benefit from treatment designed to retard progressive ventricular dysfunction and arrhythmias. Patients with ischemic heart disease may also theoretically benefit from the relief of ischemia, the prevention of coronary occlusion, and revascularization. However, there is little evidence to show that the presence or absence of coronary disease modifies the benefits of effective treatments such as angiotensin-converting enzyme inhibitors and beta-blockers. Moreover, there is no evidence that treatment directed specifically at myocardial ischemia or coronary disease alters outcome in patients with heart failure. Treatments aimed at relieving painless myocardial ischemia have not been shown to alter prognosis. Lipid-lowering therapy is theoretically attractive for patients with heart failure and coronary disease; however, theoretical concerns also exist about the safety of such agents, and patients with heart failure have been excluded from large outcome studies very effectively. Some agents, such as aspirin, designed to reduce the risk of coronary occlusion seem ineffective or harmful in patients with heart failure, although warfarin may be safe and possibly effective. There is no evidence yet that revascularization improves prognosis in patients with heart failure, even in patients who are shown to have extensive myocardial hibernation. On current evidence, revascularization should be reserved for the relief of angina. Large-scale, randomized controlled trials are currently underway that are investigating the role of specific treatments targeted at coronary syndromes. The Carvedilol Hibernation Reversible Ischemia Trial: Marker of Success study is investigating the effects of carvedilol in a large cohort of patients with and without hibernating myocardium. The Warfarin and Antiplatelet Therapy in Chronic Heart Failure study is comparing the efficacy of aspirin, clopidogrel, and warfarin. The Heart Revascularization Trial-United Kingdom study is assessing the effect of revascularization on mortality in patients with heart failure and myocardial hibernation. Smaller scale studies are assessing the safety and efficacy of statin therapy in patients with heart failure. Only once the outcomes to these and other planned trials are known can the medical community know how best to treat their patients.     

The therapeutic efficacy and toxicity of the liposomal form of daunorubicin (Daunoxome) in lymphosarcoma patients

AIM: To evaluate toxicity and efficacy of CDxOP regimen in the treatment of primary non-Hodgkin's lymphoma (PNHL). MATERIAL AND METHODS: The study included 8 males and 6 females who had large B-cell lymphoma (n = 11), follicular lymphoma, predominantly large cell (n = 1), mantle cell lymphoma (n = 1) and peripheral T-cell lymphoma (n = 1). Seven patients were over 60. PNHL stage IV, III and II was diagnosed in 7, 5 and 2 patients, respectively. Daunoxome dose was 80 mg/m2 with an increase up to 100 mg/m2 in case of slow response and good tolerance. The other drugs were used in standard doses. RESULTS: 6 patients achieved complete remission (43%) and 5 patients--partial response (36%), the overall response was 79%. Three patients did not respond to therapy and died. Six patients are still in complete and two in partial remission, median follow-up being 22 months. The rest 3 patients were treated with other modalities, one of them died of infection. As to complications that might be related to daunoxome, there was myelodepression (6% of profound neutropenia < 1000 microl). No patients had deterioration of the left ventricular ejection fraction (ultrasound measurements) or clinical signs of congestive heart failure (median follow-up for 10 patients was 22 months) including those in whom high cumulative doses were used (640-840 mg/m2). One patient with compromised heart function had frequent ventricular extrasystole immediately after daunoxome infusion. CONCLUSION: Tolerance of CDxOP is acceptable. The results of the treatment are comparable with those of standard chemotherapy. Further comparative studies are needed for determination of efficacy and maximal tolerated dose of daunoxome in combination with other drugs and irradiation, of long-term side effects. This drug may be beneficial for elderly patients.