Multidisciplinary management of metastatic colorectal cancer

When colorectal cancer metastasizes to distant organs, usually multiple sites are involved and treatment consists primarily of systemic chemotherapy and supportive care. Chemotherapeutic agents effective against metastatic colorectal cancer include 5-fluorouracil, often used in combination with leucovorin or methotrexate, and irinotecan (CPT-11). Median survival with optimal chemotherapy regimens ranges from 10 to 15 months. Less frequently, colorectal cancer metastasizes only to the liver or lung. In a minority of these cases, surgical resection can be performed and results in a median survival of 28-46 months for hepatic resections and 24-25 months for pulmonary resections. Five-year survival rates range from 24 to 38% and 21 to 44% for hepatic and pulmonary resections, respectively. For isolated liver metastases that are not surgically resectable, other regional therapies that can be considered are hepatic cryosurgery, radiofrequency ablation, and hepatic arterial infusion chemotherapy. Median survival following cryosurgery is between 26 and 30 months, while median survival following radiofrequency ablation has not been established in large series. Hepatic arterial infusion chemotherapy, especially with newer combination drug regimens, may increase survival in patients with isolated liver metastases compared to systemic chemotherapy, but this must be confirmed in randomized, prospective trials. Colorectal cancer metastases to the brain can be treated with radiation therapy or surgical resection, but median survival with treatment is less than one year.     

The effect of angiotensin II on haemodynamic and plasma noradrenaline responses to tyramine infusion in man

Summary Six normal volunteers were studied on four separate occasions. On each occasion they received two concomitant infusions which were either placebo/placebo, placebo/tyramine, angiotensin II/placebo or angiotensin II/tyramine. Angiotensin II infusion was given at a constant rate of 2ng/kg/min whereas the tyramine infusion consisted of 10 min increments at 1.25, 2.5, 3.75, 5, 7.5 and 10 g·kg^–1·min^–1.Tyramine infusion caused a dose dependent increase in systolic blood pressure with increases in diastolic blood pressure and plasma noradrenaline only at the highest doses. These changes were not affected by concomitant angiotensin infusion.We have therefore found no evidence to support the enhancement of haemodynamic or plasma noradrenaline responses to tyramine infusion by low dose infusion of angiotensin II in man.     

Crisnatol mesylate: Phase I dose escalation by extending infusion duration

Summary Crisnatol mesylate is a rationally designed cytotoxic arylmethylamino-propanediol with broad spectrum cytotoxic activity. A phase I study with an unconventional escalation scheme was developed using a constant drug infusion rate (mg/m²/hr) and prolonging the infusion duration from 6 to 96 hours. Sixty-five patients received crisnatol at doses from 18 mg/m² in 6 hrs to 3400 mg/m² in 72 hours. The dose-limiting toxicity in two of five patients at 2700 mg/m² and two of three patients at 3400 mg/m² was neurologic and consisted of a syndrome of confusion, agitation, and disorientation. Phlebitis mandated the use of a central line. The mean terminal phase half-life (T_1/2 ) was 3.3 hours with a total body clearance (CL) of 22.8 L/hr/m² and a volume of distribution (Vd_ss) of 53 L/m². The median steady-state peak plasma concentration (C_ss) at 2700 mg/m²/72 hours was 2.7 g/ml and at 3400 mg/m²/72 hours was 3.8 g/ml. No responses were seen. The maximum tolerated dose (MTD) on this schedule is 2700 mg/m²/72 hours in patients with no liver disease and good performance status.     

Long-term observation of chronic subsutaneous administration of lisuride in the treatment of motor fluctuations in parkinson's disease

Summary Twenty-nine patients with advanced Parkinson's disease were treated with subcutaneous lisuride infusion in addition to a basic therapy consisting of levodopa + PDI in all, and deprenyl in some patients. At the time of the report, 13 patients are still receiving lisuride infusion after 5–36 months, while 16 have dropped out after 0.5–30 months one because of psychosis, three because of insufficient efficacy, three due to death unrelated to treatment, three because of difficulties in handling the pump as outpatients, and six for other reasons. Off-periods and parkinsonian disability in off and in on were reduced significantly. These improvements remained constant throughout the observation period. Once the optimal dose regimen is established, only minor adjustments of the doses of lisuride and levodopa are required in the individual case.     

Devices for the treatment of diabetes: today

Although single or multiple daily subcutaneous injections of insulin with syringes are the mainstay of insulin delivery techniques for the treatment of diabetes mellitus, several other methods are now available. The present paper will review the main problems occurring with the classical subcutaneous insulin therapy and the possible solutions given by the use of new devices, including more particularly insulin jet injectors, pens, and portable pumps. This review has to be considered as an introduction to the presentations of this symposium devoted to implantable pumps, glucose sensors, and artificial pancreas, respectively.     

Differentiation of normal pressure hydrocephalus and cerebral atrophy by computed tomography and spinal infusion test

Summary The diagnostic value of computed tomography (CT) and spinal infusion test (SIT) was investigated in 27 patients with normal pressure hydrocephalus (NPH) and 35 patients with cerebral atrophy. The most consistent CT finding of NPH was dilatation of the temporal horns, that of cerebral atrophy widening of the convexity sulci. However, 43% of patients with cerebral atrophy demonstrated no cortical atrophy. The SIT showed an excellent relation with isotope cisternography and continuous intracranial pressure recording. NPH and cerebral atrophy were correctly differentiated in 71% by CT and SIT. A normal SIT and a CT scan without the typical features of NPH exclude impairment of cerebrospinal fluid absorption. An abnormal SIT and a CT scan showing ventricular enlargement without dilatation of convexity sulci, require isotope cisternography and possibly intracranial pressure recording to determine the degree of the absorption deficit.

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Zusammenfassung Der diagnostische Wert von Computertomographie (CT) und Spinalen Infusions-Test (SIT) wurde bei 27 Patienten mit Normal Pressure Hydrocephalus (NPH) und 35 Patienten mit zerebraler Atrophie untersucht. Der häufigste CT-Befund des NPH war Erweiterung der Temporalhörner und bei zerebraler Atrophie eine Erweiterung der Konvexitätssulci. Aber 43% der Patienten mit zerebraler Atrophie zeigte keine Rindenatrophie. Der SIT zeigte eine sehr gute Korrelation mit Isotopenzisternographie und kontinuierlicher intrakraniellen Druckmessung. NPH und zerebrale Atrophie wurden korrekt differenziert in 71% mittels CT und SIT. Ein normaler SIT und ein CT-Scan ohne die typischen Merkmale von NPH schließen Liquorrückresorptionsstörungen aus. Ein abnormer SIT und ein CT-Scan, der einen Hydrozephalus ohne Erweiterung der Konvexitätssulci zeigt, erfordern eine Isotopenzisternographie und eventuell intrakranielle Druckmessung zur Ermittlung des Grades der Liquorrückresorptionsstörung.

     

康莱特联合化学药物动脉灌注治疗转移性肝癌的临床研究

目的：观察康莱特联合化学药物动脉灌注治疗转移性肝癌的疗效。方法：152例转移性肝癌患者随机分为治疗组(康莱特联合化学药物动脉灌注)79例、对照组(化学药物动脉灌注)73例。结果：治疗组的稳定率为87．3％，1年生存率为73．4％，2年生存率为50．6％，均明显高于对照组；并可减低血液高凝状态，提高患者的细胞免疫功能，缓解化疗药物的毒副反应，改善患者的生活质量。结论：康莱特联合化学药物动脉灌注治疗转移性肝癌有较好的疗效。     

过期妊娠胎盘滋养细胞Bax、Bcl-2基因表达情况的研究

目的 :通过观察过期妊娠患者促凋亡基因Bax和抑凋亡基因Bcl 2在胎盘滋养细胞层的表达 ,探讨细胞凋亡与过期妊娠的关系。方法 :采用免疫组织化学方法对20例过期妊娠和20例正常足月妊娠产妇的胎盘滋养细胞层Bax和Bcl 2基因表达进行检测和对比研究。结果 :胎盘滋养细胞层Bax和Bcl-2基因表达过期妊娠组分别为 (44 87±3 16) %和 (20 03±3 82) % ,足月妊娠组分别为 (43 89±3 96) %和 (34 14±3 85) %。2组比较Bax表达差别无统计学意义 (P>0 05) ,而Bcl 2表达差别有统计学意义 (P<0 05)。结论 :(1)胎盘滋养细胞层抑凋亡基因Bcl 2表达减少 ,可能与过期妊娠有关。 (2)胎盘滋养细胞层促凋亡基因Bax表达与过期妊娠无明显关系     

两种过滤方法对输液中微粒的影响

目的 :比较超滤法和常规三级过滤法对输液中微粒的影响。方法 :用光阻法检查两种不同的过滤方法滤过的输液中微粒数。结果 :常规三级过滤法滤过的 4 7批次的输液平均微粒数为 6 .5 6个 /ml(>10 μm)和 0 .71个 /ml(>2 5 μm) ,超滤法滤过的 6 3批次的输液平均微粒数为 2 .2 9个 /ml(>10 μm)和 0 .2 8个 /ml(>2 5 μm) ,两种方法有显著性差异 (P <0 .0 0 1)。结论 :超滤法明显优于常规三级过滤法。     

安痫宁冲剂抗惊厥作用的实验研究

目的：研究安痫宁冲剂的抗惊厥作用。方法：选用电惊厥及药物性惊厥法观察惊厥潜伏期、惊厥百分数、死亡率。结果：安痫宁高剂量可明显延长小鼠惊厥潜伏期，中、低剂量有延长小鼠惊厥潜伏期的趋势，安痫宁高剂量组惊厥百分率为75％，与空白组相比有差异。结论：安痫宁具有抗惊厥作用。