Palliative treatment of malignant ascites by intraperitoneal bleomycin after dialytic ultrafiltration with haemofilter

Dialytic ultrafiltration with haemofilter was performed in 16 patients with malignant ascites refractory to treatment with sodium restriction, diuretic and systemic chemotherapy. A continuous flow of ascitic fluid at a rate of 300–400 ml/min through a haemofilter was maintained by a blood pump. The protein-rich ascitic fluid was re-infused into the peritoneal cavity with sodium and water removed. An average of 5.2 1 of filtrate was removed over a mean interval of 3.5 h. Bleomycin (60 mg) was administered intraperitoneally following the procedure. Complete response was observed in six patients (37.25%) and partial response occurred in four (25%). The remaining patients showed no response. Complications of the dialytic ultrafiltration procedure and toxicity of intraperitoneal administration of bleomycin were minimal. The technique of dialytic ultrafiltration is simple, safe and cost-effective and could be used as an adjuvant therapy for intraperitoneal chemotherapy.     

The Clinico-pathologic Features of Hepatitis B Virus-associated Glomerulonephritis

The frequency of hepatitis B Surface antigen (HBsAg) was studiedin the sera of 311 patients with various forms of primary glomerulonephritisand 43 patients with lupus nephritis. HBs antigenaemia was detectedin 69 of the 311 patients (22 per cent) with primary glomerulonephritisand this prevalence of HBaAg carrier was significantly higherthan that in the general population (p<0. 001). These patientshad no clinical or biochemical findings to suggest acute orchronical liver disease. A higher HBs antigenaemia carrier ratewas not observed in patients with lupus nephritis. Three glomerulopathologicalentities, membranous nephropathy. IgA nephropathy, and mesangialproliferative glomerulonephrities, were found to be associatedwith a higher prevalence of HBs antigenaemia compared with thegeneral population (p<0. 001). Glomerular deposits of HBsAgand/or hepatitics core antigen (HBcAg) were detected in 41,61, and 60 per cent of renal biopsy specimens from patientswith membranous nephropathy, Iga nephropathy, and mesangialproliferative glomerulonephritis associated with persistentHBs antigenaemia respectively. During the mean study periodof 40 months (range 12–180), 14 per cent of these patientswith hepatitis-associated glomerulonephrities developed progressiverenal failure, althrough none required maintenanece dialysis.Our study suggests that hepatitis B virus antigenaemia may playa significant role in the developement of specific forms ofglomerulonephritis and that these hepatities B virus-associatedglomerulonephritides can run an indolent but relentless progressiveclinical course.     

Twelve-year follow up of a randomized prospective trial comparing bacillus Calmette-Guerin and epirubicin as adjuvant therapy in superficial bladder cancer

AIM: To compare bacillus Calmette-Guerin (BCG) with epirubicin in adjuvant therapy of superficial bladder transitional cell carcinoma, with respect to recurrence, progression and survival. Prognostic factors are also evaluated. METHODS: Between October 1991 and September 1999, all patients harboring superficial bladder cancers (Ta or T1) with any of the relevant criteria (stage>a, grade>1, size>1 cm, multiple or recurrent tumors), after complete transurethral resection were randomized to receive either 81 mg Connaught strain BCG or 50 mg epirubicin. Patients with recurrences were eligible to crossover, even repeatedly, until progression. Recurrence, progression and survival were analyzed in relation to initial treatment, patient characteristics and tumor characteristics. RESULTS: There were 209 patients included in the study, 149 men and 60 women. The mean age was 69.9 years (range, 24-92). The BCG group consisted of 102 patients and the epirubicin group contained 107 patients. Final analysis was made at a median follow up of 23, 47 and 61 months for recurrence, progression and survival, respectively. The 10-year Kaplan-Meier estimates for recurrence-free, progression-free and disease-specific survival were 61%, 78% and 80%, respectively, for the BCG group. The corresponding figures were 32%, 74% and 92%, respectively, for the epirubicin group. Time to recurrence differed significantly between two treatment groups (P=0.0004). Multiplicity increased the risk of recurrence, while grading influenced recurrence, progression and disease specific survival. CONCLUSIONS: Bacillus Calmette-Guerin prolonged time to recurrence when compared with epirubicin. Grading was shown to be a universal prognostic factor for recurrence, progression and disease specific survival.     

Effects of methylprednisolone on the Fc-receptor function of human reticuloendothelial system in vivo

Abstract. To determine whether the Fc-receptor function of reticuloendothelial system (RES) is modified by corticosteroid administration, we studied the spleen to liver uptake ratios of autologous, ⁹⁹Tc-labelled heatdamaged or IgG-coated erythrocytes, injected intravenously into 10 normal volunteers, 4 h after receiving a single dose of 32 mg of methylprednisolone by mouth.
In standard conditions, quantitative scans indicated that the spleen to liver uptake ratios, calculated per unit area 40 min after the injection of labelled erythrocytes, were 13·4 ± 0·6 and 31·2 ± 1·5 (mean values ± -SEM), for the heat-damaged ( n = 7) and IgG-coated red cells ( n = 5) respectively. Four hours after corticosteroid administration, the spleen to liver uptake ratios were significantly reduced in five of ten volunteers. Abnormal ratios correlated with the Fc-receptor function of monocytes measured in vitro using IgG-coated erythrocytes. Indeed, 2–6 h after methylprednisolone was given, the Fc-receptor binding activity of monocytes isolated from the same five subjects was reduced by at least 50%, spontaneously returning to a rather normal value 4–6 h later. The C3-receptor binding activity of these monocytes remained normal, after otherwise identical experimental conditions.
These results show a transient, specific impairment of the Fc-receptor function of RES after methylprednisolone administration, and may therefore explain, in part, the infectious complications occurring in some patients treated by corticosteroids.