[The quality of life of patients after cystectomy for cancer].

Quality of life was assessed in 60 cystectomized patients with bladder cancer versus method of urine derivation. Surgery had been ended with formation of "wet" stoma in 39 cases (ureterocutaneostomy--in 30 patients and operation after Bricker--in 9) whereas in 21 cases "dry" stoma had been formed with derivation of the urine into large bowel reservoir assuring controlled voiding. Only as few as 9 (23.1%) "wet" stoma patients retained the pretreatment activity as compared to 100% of those in the other treatment group. One-third of the "wet" stoma patients were unsatisfied with functional results of surgery and preferred formation of the reservoir which assured controlled voiding and allowed freedom from urinal.


[The humoral immunity indices of patients with malignant skin melanoma using the viral immunomodulator rigvir].

The effect of a viral immunomodulator rigvir on humoral immunity was studied in patients with skin malignant melanoma. Peripheral blood levels of B-lymphocytes, IgA, G and M and circulating immune complexes were assayed and immunoglobulin/B-cell ratio (Ig/B) calculated. Preoperative treatment with rigvir brought the indexes of humoral immunity to normal. Response of melanoma patients to rigvir treatment was different from that seen in healthy subjects and was determined by the course of disease.


[The cellular immunity indices of patients with malignant melanoma using the viral immunomodulator rigvir].

The effect of rigvir, an immunomodulator of the viral origin, on cell-mediated immunity was studied in patients with skin malignant melanoma. Rosette formation and monoclonal antibody techniques were used to measure blood immunocompetent cell levels in patients with the above pathology, cases of benign skin tumors and healthy subjects. Rigvir was shown to influence natural resistance by raising blood monocyte and large granule-containing lymphocyte levels. It potentiated recruitment of pre-T-lymphocytes and young active T-lymphocytes to the peripheral blood.


[The lymphocyte immunological phenotype of young and middle-aged breast cancer patients].

The immunologic phenotype of lymphocytes of young and middle-aged patients with breast cancer was identified using ICO monoclonal antibodies. The parameters were compared to that of healthy subjects of the corresponding age groups. Breast cancer patients of both age groups were shown to have lower T-cell level as compared to donors. Parameters of T-cell-mediated immunity did not differ significantly between the young and middle-aged patients, although the former group tended to have lower level of mature T-lymphocytes. A significant decrease in parameters of B-cell-mediated immunity was observed in young patients as compared to donors whereas in middle-aged patients B-lymphocyte and monocyte levels were 4 times those in donors. B-lymphocyte level in young patients tended to be lower than in middle-aged ones.


[The effect of indomethacin and leukinferon on the thromboxane B2 level in the blood plasma of patients with endometrial cancer in the perioperative period].

The paper discusses the effect of indomethacin, leukinferon as well as their combined effect on blood thromboxane B2 (TxB2) level in 40 endometrial cancer patients in the perioperative period. Perioperative treatment with indomethacin was followed by a significant decrease in blood TxB2 level before surgery and in the postoperative period. Treatment with leukinferon exerted similar effect which, however, was less pronounced than that of indomethacin. The effect was most apparent when the two drugs were combined. The influence of indomethacin and leukinferon on metabolism of arachidonic acid in tumor cells and those of the immune system of endometrial cancer patients are discussed as well possible role of eicosanoids in the pathogenetic mechanism of growth and dissemination of reproductive tumors.


[The role of monoclonal antibodies to the epithelial membrane antigen in the diagnosis of human tumors].

The paper discusses the possibility of the use of the Soviet-made ICO 25 monoclonal antibodies to membrane antigen of lipid globules of the human milk for differential diagnosis of human tumors. ICO 25 monoclonal antibodies reliably detected the above antigens in normal epithelial and breast cancer cells. However, these antigens cannot be considered strictly specific for breast tissue. They were found in various human epithelial tissues, in the majority of epithelial tumors and lymph node metastases. Staining for ICO 25 monoclonal antibodies was negative in non-epithelial tumors. The above antibodies proved a useful marker for the identification of epithelial origin of primary tumors and their metastases showing unclear histology. They can be used to differentiate between epithelial and non-epithelial malignancies as well as to detect micrometastases and areas of microinvasion. Paraffin-embedded samples can be used for immunohistochemical examination.


[Androgen receptors in the cytosol fraction of a spontaneous osteogenic sarcoma in dogs].

The paper discusses results of the assay of androgen receptors in the cytosol fraction of osteogenic sarcoma (primary tumor and metastases) in 17 dogs. In some cases, osteogenic sarcoma and its metastases revealed androgen receptors in a wide range of concentrations (15-340 fmol/mg protein). Metastatic tumors appeared to have the highest receptor levels. Possible role of sex steroid hormones, particularly, androgens in the pathogenesis of osteogenic sarcoma development as well as the use of antiandrogens for the treatment of the tumor are discussed.


[Ultrasonic tomography of the mediastinum in the staging of lung cancer].

Results of standard X-ray tomography, computed tomography and ultrasonic tomography (UT) used for detecting mediastinal metastases from lung cancer were compared in 50 patients who were later operated on. UT sensitivity in the diagnosis of paravasal lymph node involvement proved superior to that of X-ray tomography and only slightly yielded to that of computed tomography. As regards bifurcation lymph node assessment, results of the radiation imaging techniques were similar to those obtained by surgery. Ultrasonographic signs of tumor spreading to the mediastinum were observed in cases of stage IIIa-IIIb tumors only. UT assured detection of metastases in normal-sized lymph nodes of the upper mediastinum. Combined application of standard X-ray and ultrasonic tomography of the mediastinum assured better staging of tumor roughly in half the patients. Absence of X-ray signs of mediastinal lymph node enlargement is considered a direct indication for UT.


[The intraoperative irradiation of tumors].

Intraoperative irradiation of tumor was performed in 40 patients with cancer of the lung, stomach, breast, bone and soft tissues. It included irradiation of the bed of tumor removed. Fast electron beam was produced by a small betatron (collimator size--5 x 6 cm and 8 x 12 cm) installed in the operating room. Radiation was given to a single or to multiple fields in a single dose of 10-20 Gy to each field. Location of the radioactive source in the operating room proved technically, economically and medically advantageous since it was cheaper, assured a shorter period of the treatment and delivered from patient transportation to a radiotherapy department and ensuing complications. The procedure did not interfere with postoperative period. The efficacy of the treatment modality will be evaluated as soon as sufficient end results have been obtained.


[Experience with the use of a low-calorie diet in breast cancer patients to prevent metastasis].

The paper discusses results of three-year follow-up of breast cancer patients keeping to a low-calorie diet after radical mastectomy and chemotherapy. The diet was planned according to age, energy expenditures and body weight and was aimed at a 15% decrease in the total caloricity as compared to corresponding individually-tailored norms for healthy people. This was achieved by reduction in fat (by 30%) and carbohydrates (by 9%). To assure the diet on the domiciliary basis, patients were provided with a table of nutrients for all food products available. Regular examination failed to show any adverse effects of the dietary restrictions on the general status of patients. However, an inhibiting effect of the diet on progression of disease was established, with recurrence being registered in 25% of controls (in 13 out of 52 patients) and only 7% of the study group (in 4 out of 56 cases).


[An analysis of the work activities and survival of patients operated on for stomach cancer].

The paper deals with the analysis of dynamics of working activity of 146 radically treated gastric cancer patients examined by the Oncological Commission for Ability Expertise of Novosibirsk in 1984-1988 and then followed for 2-5 years. The percentage of patients returning to work was the highest during the first and third years posttreatment. This was attributed to extension of temporary invalidity period and rehabilitation of group 2 invalids, respectively. Lethality among patients returning to work was 8.2 +/- 2.3% as compared to 62.6 +/- 2.5% in a group of 385 patients who did not work. Labor activity did not adversely influence the clinical course of disease. The unfavorable course was attributed to biological properties of tumor such as low degree of differentiation and infiltrative pattern of growth.


[Malignant tumors of the anal canal].

Results of treatment of 381 cases of various malignancies of the anal canal were analysed. The above tumors were classified according to clinical course, histology and stage. Various treatment modalities, peculiarities of early diagnosis, causes of tumor advancement and end results of treatment of cancer of the anal canal are discussed.


[The indications for second-look laparotomy in ovarian cancer patients].

Data on 304 patients with ovarian malignancies (mostly epithelial-72.0%) who had undergone second-look surgery were analysed to develop indications and assess the clinical value of the procedure. Second-look operations were performed 10-22 months after primary surgery in the following clinical settings: (1) clinical remission if wash-offs from the Douglas' pouch peritoneum revealed tumor cells or a high blood-CA-125 level was established (8 patients with stage I-II cancer), (2) remission after 6-10 courses of combination chemotherapy (13 patients with stage III-IV tumor), (3) remission following non-radical primary surgery (117 cases), (4) patients with suspected relapse (144), and (5) cases who were not suspicious for relapse but required laparotomy for concomitant surgical pathology such as, for instance, ventral hernia (22). Intra- and postoperative complications were encountered in 29 out of 304 (9.5%) patients and operative lethality rate was 0.9%. It was shown that improvement in noninvasive methods of monitoring allows to limit indications for second-look surgery in stage III cancer.


[The search for amplification of the ERBB-2 oncogene in human tumors].

The occurrence of ERBB-2 (HER-2/NEU) oncogene amplification was studied in 203 DNA samples obtained from 175 cancer patients. Amplification of ERBB-2 oncogene was established in 14 out of 63 (22%) patients with breast cancer, 1 out of 23 cases of ovarian tumor, 1 out of 19 cases of large bowel cancer and 1 out of 27 patients with cancer of the thyroid. Patients with lung cancer (34), soft tissue sarcoma (6) and malignant melanoma (3) failed to reveal any changes in the above oncogene. A tendency was established for ERBB-2 oncogene amplification to be associated with lymph node involvement in female patients with breast cancer: amplification was observed in 9 out of 28 patients presenting with lymph node metastases and only in 5 out of 29 metastases-free cases. To summarize, ERBB-2 oncogene is fairly often activated in human tumors but a high occurrence of the gene amplification was observed in female patients with breast cancer only.


[The reaction of the T-immunity system in patients with malignant skin melanoma and stomach cancer to active nonspecific immunotherapy].

Changes in E-receptor-bearing T-lymphocyte level (total and that of active T-lymphocytes) were studied in peripheral blood and resected material obtained from skin malignant melanoma and gastric cancer patients treated with rigvir, an original immunomodulator of the viral origin. Injection of rigvir into peripheral blood was followed by an increase in active T-lymphocyte level and stimulated their migration into tumor. The latter was determined by stage and rate of tumor advancement.


[The heterogeneity of the immunological phenotype and of the proliferative characteristics of the lymphoid cells in chronic B-cell lympholeukemia].

Patients with stage III and IV (according to Rai) B-cell chronic lymphocytic leukemia (B-CLL) were shown to differ in the expression of markers such as HLA-DR, RFB-1, CD-18, CD-21, activated B-lymphocyte antigen and B-lymphocyte differentiation antigen on mononuclear fraction cells (MFC). Also, differences in the level of MFC proliferation activity during a 72-hour culturing in vitro were established. Some patients with B-CLL showed an increase in lymphocyte proliferation activity in response to treatment with growth factor recombinant interleukin (IL-2) alone and in combination with phytohemagglutinin and phorbol ester. Those changes most often occurred in cases with decreased spontaneous proliferation in culture.


[The determination of beta-casein gene expression and the assessment of hormonal homeostasis in gynecomastia patients and in breast cancer in men].

beta-Casein genes expression in breast epithelium was studied in male patients with various forms of gynecomastia and cancer. Blood serum levels of pituitary, sex and glucocorticoid hormones were assayed in 29 patients with gynecomastia and 22 cases of breast cancer, and in 25 of them beta-casein genes expression was evaluated additionally. Activation of the above genes was established in the tissues studied. Their level proved to be in a correlation with that of prolactin.


[The mitotic regimen of breast cancer in men].

Mitotic regimen of tumor was studied in 75 male and 50 female patients with breast cancer. Mitotic index (9.7 and 14.3%, respectively) and number of pathologic mitoses (28 and 25%) did not differ significantly between the two groups. However, retardation of chromosome movement in meta-, ana- and telophase was 3 times more frequent in males. This suggests that breast carcinoma in males tends to become more aneuploid than in females. The latter reflects the rate of tumor progression. Clinically, breast cancer in males is characterized by rapid growth, early dissemination and resistance to treatment.


[Carcinogenesis induced by the neonatal administration of 5-bromo-2'-deoxyuridine (BUDR) and subsequent exposure to urethane in BALB/c mice].

Male and female BALB/c mice were subcutaneously injected with 1 mg 5-bromo-2'-deoxyuridine (BDU) on days 1, 3 and 7 after birth and/or given 0.1 ml 5% urethane solution 5 times every 3 days starting at the age of 3 months. Treatment with BDU alone was followed by retardation of growth, loss of body weight and liver mass but had no significant impact on tumor occurrence. Combined application of BDU and urethane was found to potentiate the effect of the latter agent resulting in an increase in the occurrence and multiplicity of lung adenoma. Male mice treated with the above combination showed a significantly higher occurrence of lung adenocarcinoma and hemoblastoses as compared to the other animal groups. It is suggested that genome instability caused by neonatal BDU treatment potentiates the carcinogenic effect of urethane.


[Changes in the adhesion between enterocytes in short-term exposures to blastomogens, retinol acetate and indomethacin].

The study was concerned with the effect of carcinogens and anticarcinogens on the rate of cell loss in the large bowel epithelium of mice. Intestinal carcinogens such as N-methyl-N-nitrosourea and 1.2-dimethylhydrazine were shown to cause a long-lasting decrease in enterocyte loss. Conversely, retinol acetate and indomethacin treatment enhanced cell loss both under normal conditions and in the presence of the carcinogens. The protective effect against N-methyl-N-nitrosourea was more apparent than against 1.2-dimethylhydrazine. The effect was more pronounced in Balb/c mice compared to AKR/J. A close correlation between the protective and the anticarcinogenic effects of the drugs was established. The data obtained suggest that retinol acetate and indomethacin cause reversion of specific early reaction of the large bowel epithelium to carcinogens and are most effective in application in the promotion phase of carcinogens.


[An analysis of the connection between the inhibition of NAD biosynthesis and the antitumor activity of drugs].

The study was concerned with a relationship between a decrease in NAD concentration and inhibition of precursor utilization for NAD biosynthesis, on the one hand, and inhibition of Ehrlich ascitic carcinoma growth in response to treatment with embichin, cyclophosphamide, thiophosphamide, adriablastin and methotrexate, on the other. The antitumor effect of drugs was found to be determined by degree of inhibition of precursor utilization for NAD biosynthesis but not by a decrease in NAD level. A relationship between alteration of synchronous induction of NAD and poly (ADP-ribose) biosynthesis rates and reversibility of the antitumor effect of drugs is discussed.


[Skin cancer morbidity among a constant contingent of the population].

A study of skin cancer morbidity in the population followed within 1985-1989 showed skin epithelioma to be the most frequent cancer over the whole period making up 18.2-22.5% of the total number of malignancies. A tendency to an increase in the number of newly diagnosed skin cancers was established (mainly owing to patients in older age groups) with an average growth rate of 9.6%.


[Improving the efficiency of detecting central lung cancer at a polyclinic].

Suggestions for restructuring organization of the photoroentgenographic part of the polyclinical diagnostic service are presented. A model of central lung cancer detection was developed which consists of the following basic elements: (1) a program of identification of high risk groups in the ambulatory population, and (2) differentiated standardized X-ray and photoroentgenographic examination in combination with other diagnostic methods.


[The role of laparoscopy in assessing the resectability of cancer of the esophagus and proximal stomach].

Laparoscopic findings obtained in patients with cancer of the thoracic part of the esophagus (321) and proximal part of the stomach (383) were analysed. As a result of laparoscopy, unjustified surgery was withheld in 14.9 and 19.3% of cases, respectively. Tumor resectability in the laparoscopy negative group was 92.8 and 84.5% for cancer of the lower and mid-third of the esophagus, respectively, and 76.2% for cancer of the proximal part of the stomach. Laparoscopy yielded false-negative results in 1.9% of cases and failed to be instrumental in diagnosis-in 4.5%.


[The role of tumor receptor status in choosing adjuvant therapy for breast cancer patients of reproductive age].

Estrogen (ER) and progesterone (PR) receptor levels were assayed in primary tumor samples from 271 premenopausal patients suffering T1,2N1M0 (stage II) breast cancer. Four clinical groups were identified according to steroid receptor levels in which results of adjuvant treatment (chemotherapy or complex treatment) were assessed. ER and PR positivity was associated with longer disease-free and overall survival. Adjuvant hormone therapy proved beneficial in ER+PR+ tumor patients. The latter group was also characterized by a lower relapse rate, particularly, in those aged over 40. It is recommended that: (1) T1,2N1M0 breast cancer patients be given adjuvant chemotherapy whatever tumor receptor status, (2) these patients should not be given adjuvant hormone therapy unless tumor receptor status has been established since prophylactic oophorectomy and subsequent hormone therapy are not justified for operable breast cancer, (3) complex therapy be administered to premenopausal patients aged over 40 years with ER+PR+ tumors only, and (4) PR-positivity be considered a good predictor of hormone sensitivity of cancer.


[The assessment of cellular immunity parameters in patients with breast cancer and lymphogranulomatosis during dynamic treatment].

The paper discusses the value of various immunologic techniques for the assessment of status of T-cells and their main subpopulations in patients with breast cancer and Hodgkin's disease in the course of treatment. The immunologic parameters can be used as additional criteria of relapse and grade of response as well as to roughly monitor treatment effect.


[The effect of experimental hepatopathy on the nature of the spontaneous metastasis of Lewis lung carcinoma].

The paper deals with the effect of carbon tetrachloride-induced hepatopathy on pattern of spontaneous dissemination of Lewis tumor transplanted to C57B1/6 mice. Antitumor drugs vincristine and rubomycin prevented dissemination to the liver but failed to arrest spreading to the lung.


[Latent cancerous pathology of the thyroid].

Postmortem morphologic examination of the thyroid was performed in 122 residents of the Minsk Region, Byelorussian Republic. Various pathology underdiagnosed during life was found in 68%. Fourteen papillary carcinomas were detected in 11 (9.9%) of cases whereas 27 (22.1%) subjects revealed 46 follicular adenomas. Nodular goiter was established in 52.5%, thyroiditis--6.5% and cancer metastases--in 5.7% of cases. The male/female ratio for microcarcinoma was 8:3. All tumor-bearing subjects were over 41 years of age. Occurrence of the occult thyroid pathology in different regions of the country can be used to compare potential radiation and other hazards.


[The combined magnetoradiotherapy of breast cancer].

Preoperative magnetoradiation therapy of stage II-III breast cancer patients was followed by pronounced regression of tumor and axillary lymph node metastases in all cases. The treatment modality had been previously substantiated by establishing the optimal sequence and time intervals for magnetic and radiation fields. Complete regression of primary tumor and metastases verified by histologic and cytologic examination of surgical and biopsy material was observed in 20%. The best results were obtained for edematous-infiltrative form of cancer. In the control group (radiation alone), regression of tumor was only slight, nor did lymph node metastases regress. Magnetoradiation therapy did not involve either immediate or delayed adverse side-effects.


[The active detection of tumors of the large intestine by using automated screening].

A system for automated screening for early detection of proctologic pathologies is described. Questionnaire-based data, formation of high risk groups using a computer and results of examination of 1660 office and professional workers of an industrial enterprise according to a given program are discussed. After filled questionnaires had been processed using a computer, 134 (8%) subjects were selected to group 1, 454 (27%) subjects-to group 2, 383 (23%) subjects-group 3 and 689 (42%) subjects-to group 4. Proctologic pathologies were detected in all persons of group 1, 83% of those in group 2 and in 30% cases of group 3. Asymptomatic proctologic pathology was established in 630 (37.8%) screenees of whom 10 revealed large bowel tumors, 5 early cancers included, whereas 49-large bowel polyps.


[The use of extraperitoneal colorectal anastomoses in complicated cancer of the rectum and sigmoid].

The paper deals with the issue of primary restoration of intestinal continuity in complicated colorectal cancer using extraperitoneal colorectal anastomoses. The study is based on the experience of treatment of 35 cases of complicated colorectal cancer. It was concluded that, to assure primary restoration of intestinal continuity, the risk of surgery must be weighed with respect to extent of disease, and adequate anesthesiologic and postoperative intensive care is required. The procedure should be performed at a specialized surgical institution.


[The work of the Kemerovo Interregional Department of Pediatric Oncology].

The Department of Pediatric Oncology, Kemerovo, has operated as an interregional center since 1976. Cancer morbidity and epidemiology in children in the Kuzbass region have been studied. Complex treatment yielded good results: 2-20-year survival rate is 89.6% for Hodgkin's disease, nephroblastoma--75.4% and neuroblastoma--38.5%. The improvement in the results obtained makes the case for establishing a department for patient rehabilitation. To function properly, the center needs more beds. It must be in a position to carry out organizational and educational activities in catchment areas. The status of the center must be supported by official documents.


[The clinical manifestation of malignant neoplasms of the small intestine].

The paper discusses the findings of a retrospective analysis of 8294 case histories of intestinal tumors. Tumors of the small intestine were detected in 140 cases (1.6%). Five clinical forms of manifestations of tumors of the small intestine were identified on the basis of case histories and clinical course.


[The attitude of medical institute students to cancer patients].

One hundred and twenty-eight fourth-year and 106 fifth-year medical students were questioned to evaluate their attitude to cancer patients. After taking a course in oncology, 11.3% of students considered cancer "contagious" or "likely to be contagious" and half the students considered cancer prevention "ineffective" or "likely to be ineffective". They distance themselves from cancer patients in family relations and their relations were closer in every day life and with friends.


[Thymus endocrine function and the immune system indices of cancer patients after neutron and gamma therapy].

Patients with head and neck and locomotor system tumors received neutron therapy in the total doses of 4-8 and 12-14 Gy which was followed by a pronounced dose-dependent decrease in the serum thymus factor and total blood-lymphocyte levels. The latter changes were predominantly due to a decrease in the non-T-non-B cell concentration. Following the treatment, a rise in the level of circulating immune complexes and those of IgA and IgG was observed. Changes in the immune system proved less apparent in patients with locomotor system cancer who had been given 20 Gy of gamma-ray radiation.


[Adenogenous cancer of the esophagus].

Bioptates and resected material from patients treated for cancer of the esophagus at the Kazakh Research Institute of Oncology in 1980-1989 were analysed. Adenogenic tumors made up 6.0% of the 1671 cases of esophageal cancer studied. A gradual increase in the percentage of adenogenic cancers was established (P < 0.05). A group of 100 cases of adenogenic cancers was examined in detail. Adenocarcinoma made up 5.3%, adenosquamous cancer--0.5 and adenocystic cancer--0.2%. Adenogenic cancers most often occurred in the lower thoracic part of the organ. Poorly differentiated adenocarcinoma predominated (56.8%), with a tendency to an increase in the tumor occurrence in the upper and mid-thoracic parts. The enhanced morbidity from adenogenic cancers is attributed to a high occurrence of esophagitis in the majority of regions of Kazakhstan.


[The characteristics of eicosanoid synthesis in osteogenic sarcoma in children at puberty].

Levels of prostaglandin E (PGE), prostaglandin F2 alpha, prostacyclin A2, thromboxan B2 and leucotriene B4 assayed radioimmunologically were compared in 42 samples of osteogenic sarcoma and 22 samples of benign tumors and tumor-like lesions from children at the pubertal period. In osteogenic sarcoma samples, PGE and prostaglandin F2 alpha levels were higher than those of thromboxan B2, prostacyclin A2 and leucotriene B4. Osteogenic sarcoma revealed higher levels of the eicosanoids as compared to benign tumors and tumor-like lesions of the bone. An inverse correlation was established between PGE level and time of dissemination of osteogenic sarcoma. The role of eicosanoids in the pathogenesis of growth and dissemination of osteogenic sarcoma is discussed. The use of non-steroid anti-inflammatory drugs in complex treatment of osteogenic sarcoma of children at the pubertal period is suggested.


[Neoadjuvant chemotherapy in combined treatment of breast cancer].

The paper deals with results of complex treatment of 387 patients with stage III breast cancer assigned to either neoadjuvant chemotherapy and preoperative radiotherapy or radiation alone. A study of immediate and end results showed combination of the two modalities to be more effective than each method alone in terms of degree of regression of primary tumor and, particularly, lymph node metastases and duration of recurrence-free period.


[The possible carcinogenic properties of riboxin (inosie F)].

Long-term treatment of rats and mice with riboxyn failed to reveal the carcinogenic effect of the drug. Chronic experiments showed the drug to improve resistance of the animals to intercurrent infections.


[A comparative study of the individual characteristics of the excretion of metabolites of benzo(a)pyrene and its carcinogenic effect in rats].

Nineteen outbred LIO rats received a single intraperitoneal injection of 200 mg/kg benzo(a)pyrene (BP) in sunflower oil. Levels of excretion of a BP activation product 7.8-BP-dihydrodiol and deactivation product 3-hydroxy-BP showed significant individual variations. Half the animals developed intraperitoneal sarcoma at various stages of the experiment. A direct correlation between urine 7.8-BP-dihydrodiol excretion level and tumor latency was established. The value of metabolite excretion level monitoring for making individual prognosis of BP carcinogenic effect is discussed.


[The anticarcinogenic effects of fumaric acid on models of carcinogenesis in the esophagus, nervous system and kidney].

Anticarcinogenic effects of the fumaric acid was studied in two rat models of carcinogenesis. Tumors of the esophagus, forestomach, tongue and throat were induced by peroral instillation of 35 mg/kg body weight N-methyl-N-benzylnitrosamine, and neurogenic and renal ones--by transplacental injection of 75 mg/kg body weight N-ethyl-N-nitrosourea. The fumaric acid given in drinking water in the dose of 1 g/l at the postinitiation stage of the carcinogenesis was shown to inhibit the development of esophageal papilloma, brain glioma and mesenchymal tumors of the kidney.


[The individual characteristics of the activity of the DNA-repair enzyme O(6)-alkylguanine-DNA alkyltransferase in the stomach of monkeys exposed to the gastric carcinogen N-ethyl-N1-nitro-N-nitrosoguanidine].

Variations in the activity of a DNA repair enzyme 0(6)-alkylgianine-DNA alkyltransferase (AGT) were studied in gastric mucosa samples obtained from 15 M. fascicularis monkeys chronically exposed to a gastrocarcinogen N-ethyl-N'-nitro-N-nitrosoguanidine. Marked interindividual difference in the enzyme activity before and in the course of the exposure was observed. The value of AGT activity assay to predict individual susceptibility to alkylating carcinogens is discussed.


[Approaches to the study of the incidence of benign tumors in the pediatric population].

Occurrence of benign tumors in large pediatric population have never been studied. Basing on the data on the pediatric population of Khabarovsk, the authors developed a method of improved analysis of benign tumor morbidity. The method suggests the use of case histories as well as medical check-up data. Mathematical modelling was employed to compare primary incidence and occurrence indexes. The improved mean incidence of benign tumors in children for 1985-1989 was 66.8 cases and improved occurrence--174.2 per 10,000 children. The values are by the order of magnitude higher than those reported by hospitals.


[The role of the day hospital in providing diagnostic and therapeutic care for children with malignant tumors].

The day hospital proved effective for diagnosis and treatment of pediatric cancer. It is more cost-effective and less emotionally traumatic for patients than the usual hospital.


[The use of low-energy lasers for preventing and treating postoperative and radiation-induced complications in patients with head and neck tumors].

The efficacy of low-energy helium-neon and copper vapor lasers for prevention and treatment of postoperative and irradiation complications was assessed in 195 patients with locally advanced tumors of the head and neck. The control group included 118 patients. Intravenous laser irradiation of the blood was associated with a higher percentage of wound healing by first intention and better course of the postoperative period. Laser treatment of skin irradiation fields was shown to improve skin tolerance to the neutron beam. The study failed to establish tumor growth stimulation by the laser irradiation in terms of recurrence and metastasis development. The data obtained showed low-energy laser irradiation to offer promise for prevention and treatment of postoperative and irradiation complications.


[The practical use of the determination of relative 32P accumulation in the tumor in breast cancer].

The level of relative accumulation of a 32P radionuclide was measured in 180 tumor samples obtained from 148 patients with stage I--IV breast cancer. Mean initial relative accumulation level (IRAL) was 1477 +/- 174% whereas that following effective conservative treatment (posttreatment) (PRAL)--486 +/- 81% (P < 0.01). The prognostic value of IRAL was established: in a group of stage III breast cancer, those with a high IRAL survived 2 years with no evidence of disease in 55.1 +/- 12.1% whereas those with a low IRAL--in 94.1 +/- 5.7% (P < 0.02). In patients undergoing conservative treatment, low PRAL proved predictive of complete response while high PRAL--of tumor progression. In patients with stage III breast cancer who had responded to preoperative treatment and had had a low PRAL, two-year locoregional recurrence rate was only 13% as compared to 68% in a similar group of patients with high PRAL (P < 0.02).


[Increased risk factors for the occurrence of bladder cancer].

Risk factors of bladder cancer development were studied in a population-based case-control epidemiological study performed in Moscow. Relative risk (RR) indexes appeared to be increased in smokers (4.2) and ex-smokers (3.5) with statistically significant trends for two most important factors such as duration of smoking and duration of withdrawal. A pronounced although insignificant increase in the RR indexes was established for drivers (3.0) and a slight insignificant rise-for gas arc welding operators (1.5). The indexes were increased in subjects with a family history of cancer. The relative risk of cancer was significantly lower in beta-carotene consumers. A preventive effect of polyunsaturated fatty acids and oil and margarine used for frying was established. Risk of bladder cancer tended to increase with a rise in dietary protein. A dose-effect type inhibition of advancement of the disease by vitamin C was observed.


[The inhibiting effect of phytoadaptogenic preparations from bioginseng, Eleutherococcus senticosus and Rhaponticum carthamoides on the development of nervous system tumors in rats induced by N-nitrosoethylurea].

The study was concerned with the inhibitory effect of officinal preparations of phytoadaptogenic drugs such as bioginseng and Eleutherococcus senticosus and Rhaponticum carthamoides root extracts on the carcinogenesis induced by transplacental administration of N-nitrosoethylurea. The phytodrugs were given orally over a year. The administration of the drugs was followed by longer survival of the rats and lower occurrence and/or multiplicity of tumors (mainly those of the central nervous system). The drugs were placed in the order of decreasing anticarcinogenic activity as follows: bioginseng, Rhaponticum carthamoides extract and Eleutherococcus senticosus extract.


[An experimental study of the tumor affinity of gallium-67-labelled sphingomyelin liposomes].

The level of accumulation of sphingomyelin liposomes with 67-Ga-labelled aqueous phase in tumor tissue proved higher than that of the vesicles with labelled lipid phase. Presence of cholesterol in sphingomyelin liposome membranes failed to influence liposome accumulation in tumor tissue. Neutral sphingomyelin vesicles with 67-Ga-labelled aqueous phase offer promise in scintigraphic imaging of tumors.


[The effect of the time of methotrexate administration over 24 hours on the antitumor activity of the preparation, its concentration in the blood and in the tumor in Pliss' lymphosarcoma in rats].

A mismatch between a circadian rhythm of blood-methotrexate level and that of the drug concentration in rat transplanted lymphosarcoma tissue was established. The drug proved 3 times more effective when given at the time of the day when its concentration in tumor tissue was likely to be the highest.


[The growth and metastatic characteristics of Lewis lung carcinoma during reproductive dysfunction in male C57BL/6 mice].

Results of a study of the pattern of spontaneous dissemination of Lewis lung carcinoma in male mice with reproductive system dysfunction showed that removal of the gonads followed by substitution treatment with testosterone failed to influence tumor metastatic potential. The data suggested that the androgen lacked a modulating effect on growth and dissemination of Lewis lung carcinoma.


[The possibilities for organ-preserving treatment in retinoblastoma in children].

One-hundred pediatric patients with uni- and bilateral retinoblastoma (140 tumors on the whole) received a combination of radio- and chemotherapy. Radiation was delivered by gamma-ray units and an electron accelerator. The single and total focal doses used were 1.5-2.0 Gy and 40-55 Gy, respectively, depending on tumor stage. Simultaneously, chemotherapy with vincristine, cyclophosphamide and adriamycin were given intravenously in standard doses. As a result, 85 out of 95 (89.5%) children including 43 cases of bilateral tumor are alive. Partial response or no change were registered in 72 tumors (51.4%). Progression was observed in 28 tumors (20%) at the average of 6-8 months following the start of treatment. Forty tumors (28.6%) responded completely, with remissions lasting for a follow-up period of 2-6 years. Not a single case of organ-sparing surgery developed distant metastases. To summarize, a combined treatment modality for retinoblastoma according to TNM stage was developed and indications for organ-sparing surgery outlined. The standard treatment modality for bilateral retinoblastoma was revised.


[The forming of uniform groups of patients with peripheral lung cancer: the methodological bases and clinical importance].

In a group of 268 cases of operable peripheral lung cancer, subgroups homogeneous for major prognostic factors were formed which differed in end results of radical treatment, rate of dissemination and response to additional radiotherapy. The method allows to choose optimal diagnostic and therapeutic options for an individual patient.


[An assessment of the efficacy of preoperative radio- and thermoradiotherapy in treating rectal cancer].

Immediate results of combined and surgical treatment of 415 patients with stage III rectal cancer were analysed. Combined treatment including intensive preoperative irradiation and preoperative thermoradiotherapy was not associated with higher postoperative lethality as compared to surgery alone, the indexes being 1.9 +/- 0.9%, 3.8 +/- 2.6% and 2.7 +/- 1.3%. Pyoinflammatory complications developed in 40.7 +/- 3.3% and 45.6 +/- 6.8% of cases in the two combined treatment groups, respectively, and in 33.2 +/- 3.8% in the control group. In patients subjected to preoperative irradiation in combination with microwave hyperthermia, no increase in the occurrence of pyoinflammatory complications was observed, but surgical wounds took longer to heal. The rate of complications following sphincter-sparing procedures, whether used alone or in combination treatment, was similar. It is concluded that the use of combined modality treatment should not bar sphincter-sparing surgery.


[Errors in the diagnosis of tumors of the retroperitoneal space of nonorganic origin].

The analysis of case histories of 152 patients with non-visceral tumors of the retroperitoneal space established misdiagnosis of tumor in 45.7%. Some patients (38.1%) presented with tumor, swelling and/or severe pain in the ipsilateral leg. Tumor proved inoperable in 50.4%. Diagnosis of tumor is complicated mainly by the diversity of patterns and peculiarities of clinical course. Also, lack of knowledge about the pathology and unawareness of cancer may account for misdiagnosis by general practitioners.


[Cystectomy in bladder cancer patients].

Within the last 12 years, 125 patients have been subjected to cystectomy which makes up 18.0% of the total of 691 surgical patients. The majority of patients were at T3 (64) or T2 stage (50) whereas T1 and T4 tumors were observed in 8 and 3 cases, respectively. Four patterns of urine derivation were used after cystectomy: ureterosigmoid anastomosis--in 8 patients, one-stage cystectomy with ileocystoplasty--23, double-stage cystectomy with ileocystoplasty--48 and ureterocutaneostomy--in 46 cases. Ileocystoplasty proved the best procedure for urine derivation. Depending on patient condition, it may follow cystectomy immediately or be carried out in 2 stages: cystectomy with ureterocutaneostomy followed by ileocystoplasty 2-4 months after the first operation.


[The fate of bladder cancer patients who refused radical treatment].

Survival of 117 operable male patients who had refused treatment was compared to that of 267 male patients who had undergone radical therapy. It was shown that treatment did not influence five-year survival of patients with T cancer. The same tendency was observed for T4 tumors. Radical treatment was associated with a significantly longer survival in T2-3 cancer patients. In the T1-2 tumor group, mean survival following diagnosis was affected by patient age whereas the relationship was far less apparent in cases of T3-4 cancer.


[Prevalence of gallbladder lithiasis in a Uruguayan population].

Ultrasound examinations were carried out in 693 volunteers from the health care personnel of the Hospital de Clinicas of Montevideo, with the aim of studying the prevalence of gallbladder gallstones in Uruguay, the proportion of symptomatic and asymptomatic people and its association to some definite risk factors. The prevalence found was 10.4%, which, according to the sample's size, is representative of the general population with a confidence of 99%. Sixty five per cent of gallstones carriers were asymptomatic. A statistically significant association with the following factors was found: people between 31 and 50 years old, slight obesity, and, for women, to have children. A marked tendency with the following factors was found, though it was not statistically significant: female sex, and a familiar history of mother carrying gallstones. Considering all these factors as a whole, the probability of having gallstones reached 19%. Results are discussed and compared with those of foreign publications. It is concluded that uruguayan people with more possibilities of having gallstones are: women between 31 and 50 years old, obese, with children, and whose mother has or had the same disease.


[Achalasia and esophageal cancer].

During the period included between January 1970 and December 1990, we studied 242 patients with manometric and radiological diagnosis of esophageal achalasia. Eight of these patients (3.3%) developed during the evolution of their disease an esophageal carcinoma. Eight cases showed histologic type of epidermoid carcinoma: 3 differentiated, 3 semi-differentiated and 2 anaplastic. Therapy for achalasia was: one patient, Heller myotomy, 4 patients, dilatations with bougies in numerous opportunities, and the other two patients receive no treatment for achalasia. Two patients reported tracheobronchial fistulas as complication of carcinoma. Treatment received for carcinoma included: three patients, radiotherapy (4000 rads); one patient, chemotherapy; one patient, chemotherapy and radiotherapy, one resection surgery and two patients feeding gastrostomy. All of the eight patients died within the year of diagnosis of epidermoid carcinoma.


Clonidine treatment of acute pancreatitis: report of five cases.

We report five consecutive cases of patients with acute pancreatitis resistant to conventional treatment who improved dramatically with clonidine. All patients showed greatly elevated noradrenaline, adrenaline and cortisol plasma levels (physiological indicators of stress) which fell abruptly upon initiation of clonidine therapy. The clonidine test performed in the patients showed a hyper-response in all, a reaction consistent with uncoping stress situation. Therefore, we postulate that stress might play a role in the pathogenesis of these patients pancreatic inflammatory disease.


[Adenoacanthoma of the upper esophagus. Report of a case].

We report a 72 year-old woman, with adenoacanthoma of the upper esophagus who was admitted in Hospital Israelita "EZRAH" in April of 1991. We performed a review of the literature on this rare tumour, that is the reason of presenting this case.


[Ascariasis of the gallbladder. Report of 2 cases and review of the literature].

Two patients who complained of a clinical picture compatible with cholelithiasis; and in whom the diagnosis of ascariasis of the gallbladder was made sonographically, are reported. In the first patient, cholecystectomy was curative and corroborated the presence of the roundworm. In the second patient, piperazine citrate was given. A second sonogram performed after therapy showed no roundworm within the gallbladder; and the patient remains asymptomatic until now. The usefulness of ultrasonography in the diagnosis of gallbladder ascariasis, and during surveillance in those patients who are managed with medical therapy only, is emphasized.


[Treatment with extracorporeal shockwave (ESWL) in lithiasis of the common bile duct].

During 2 years (1988-1990) 373 patients were studied by ERCP in order to establish the etiology of cholestasis. Biliary duct stones were found in 190. Thirty-nine were treated surgically and 151 by endoscopic sphincterotomy and different extraction techniques. In 12 patients of the last group (9 women, 3 men, mean age 71 years, 9 had undergone cholecystectomy and 3 has their gallbladders in situ), ESWL was used as additional treatment to fragment the stones that could not be removed with the Dormia basket or with mechanical lithotripsy. Four patients had only one stone in their biliary ducts, 5 had two, and 3 had more than two stones. The size of the stones was greater than 2.5 cm. in 11 patients, only 1 patient had a 1 cm. diameter stone. In each session between 1200 and 5000 shock waves were administered (mean 1400). In 8 patients (66%), the fragmentation was successful to achieve their spontaneous passage or their extraction with a basket. In 4 who received only one session of ESWL, the procedure failed to break the stones. Side effects were observed in 3 cases: mild haemobilia in 1, skin petechiae and pain in 2 patients. No complications were observed in the long term follow-up. We conclude that ESWL is useful in the treatment of biliary duct stones which cannot be extracted through sphincterotomy with a basket or mechanical lithotripsy.


[Fluidity of hepatic microsomal membrane and its relation with aging].

The effect of aging on hepatic microsomal membrane phospholipid composition was studied composition was studied in both young (2 months) and mature (6 months) Wistar rats. When total microsomal phospholipid content was analysed the aged group showed a significant increment (73%). Microsomal phospholipid pattern also showed a different behavior between both groups, with a significative increase in phosphatidylcholine (62%), phosphatidylserine (124%), phosphatidylinositol (31%) and sphingomyelin (10%) and appearance of phosphatidylethanolamine and phosphatidylglycerol in the six-month group. A higher microsomal membrane fluidity in the aged animals was revealed by the increase in PC/EM index (47%). This increment jin fluidity during aging process may reflect an adaptative response resulting in changes on the enzyme activities responsible for drug and carcinogen metabolism.


Fecal alpha 1-antitrypsin clearance in the differential diagnosis of steatorrhea.

We reviewed the fecal fat excretion and alpha 1-antitrypsin clearance results of 160 patients with steatorrhea in whom a final diagnosis was obtained, based on history, physical examination, and radiological, functional and morphological tests. Twenty-two patients had pancreatic diseases and 138 had steatorrhea due to gastrointestinal diseases. alpha 1-antitrypsin clearance was invariably normal in chronic pancreatitis, but there was only a 23 to 50% of correct etiological classification when the combination of steatorrhea and normal alpha 1-antitrypsin clearance was present. However, none of our patients diagnosed of chronic pancreatitis had abnormal alpha 1-antitrypsin clearance. The combination of steatorrhea and normal clearance of alpha 1-antitrypsin was a modest clue for diagnosis of pancreatic malabsorption.


Prostaglandin synthetase inhibitor treatment and the regulatory role of prostaglandins on organ perfusion.

Prostaglandin synthetase inhibitors (PGIs) are increasingly used in anesthetic practice and postoperative care. The influence of these agents on the hemodynamics and organ perfusion control remains largely unknown. This review attempts to assess the role of endogenous prostaglandins on the regulation of the microcirculation in different organs and to identify disease states in which PGIs may have deleterious effects. Prostanoids participate to the regulation of blood pressure as vascular tone is subject to the continuous relaxing influence from endogenous vasodilating prostaglandins or related substances. Prostacyclin (PGI2), probably the most important physiologic modulator, decreases blood pressure with concomitant increase in cardiac output and reduction of systemic vascular resistance related to the peripheral vasodilation. Also splanchnic, pulmonary and coronary vasodilation are observed with increased blood flows in the mesenteric, renal and coronary beds. These changes in regional blood flows have been linked to the inhibition by PGI2 of the vasoconstrictor response to sympathetic stimulation and pressor hormones (noradrenaline, angiotensin II). Other prostaglandins exert their effects by inhibiting the release of noradrenaline at the noradrenergic terminals of the sympathetic system. PGIs appear to provide hemodynamic stability during intra-abdominal surgery. Data suggest that the underlying mechanism is an increase in systemic vascular resistance. PGIs have beneficial effects in hemorrhagic shock models in animals and humans but can also exacerbate hemodynamic and metabolic derangements in acute hypovolemic hypotension. In animal models these agents reduce regional blood flow in the ischemic myocardium and may increase infarct size.(ABSTRACT TRUNCATED AT 250 WORDS)


Epidural bupivacaine versus epidural sufentanil anesthesia: hemodynamic differences during induction of anesthesia and abdominal dissection in aortic surgery.

The present study was designed to compare the hemodynamic changes of epidural bupivacaine (EB) with epidural sufentanil (ES), supplemented by general anesthesia, in patients scheduled for abdominal aorto-iliac surgery. Twenty-eight ASA Grade 2 patients randomly received bupivacaine 0.5%, 1-1.5 mg kg-1 (n = 14) or sufentanil 150 micrograms (n = 14) epidurally at T12-L1, combined with light general anesthesia. Hemodynamics were measured before (T1) and after (T2) injection of EB or ES, after induction of general anesthesia (T3), and during the aortic dissection period (T4). EB or ES injection both produced a significant decrease in systolic, mean and diastolic blood pressure, left ventricular stroke work index (LVSWI) and coronary perfusion pressure (CPP). The induction of general anesthesia caused a significant fall in heart rate (HR) and cardiac index (CI) in the ES group. Abdominal dissection restored systemic pressure and cardiac index in the ES group. It was concluded that both ES and EB provided adequate analgesia and hemodynamics during tracheal intubation and abdominal dissection for aorto-iliac surgery.


Propofol to provide sedation after coronary artery bypass surgery. A comparison of two fixed rate infusion regimens.

Propofol (2,6, di-isopropylphenol) was given by continuous intravenous infusion to provide sedation following coronary artery bypass surgery. The need for additional sedation, analgesia and hypotensive agents was assessed at two propofol infusion rates (10 or 25 micrograms/kg/min). Both rates provided clinically satisfactory conditions. There were no differences in the requirements for analgesia or vasodilators between the groups. The higher infusion rate of 25 micrograms/kg/min was associated with a lower requirement for additional sedation but a more frequent need to stop the infusion temporarily to prevent hypotension.


Double burst stimulation for monitoring profound neuromuscular blockade: a comparison with posttetanic count and train of four.

Double burst stimulation (DBS) is a new nerve stimulation pattern introduced to facilitate tactile evaluation of recovery from neuromuscular blockade. DBS consists of two bursts of high frequency stimulations separated by a short time interval. The relationships between DBS, post-tetanic count (PTC) and train-of-four (TOF) on the evoked twitch response was investigated in 16 surgical patients and 7 intensive care patients given atracurium for muscle relaxation. A significant correlation between the twitch height of the first response to DBS and the number of post-tetanic responses was demonstrated when PTC was more than five (r = 0.47, p < 0.0003). When the first twitch of TOF was still not measurable, the first twitch of DBS ranged from 0 to 20% of the TOF-control twitch height. Furthermore the DBS ratio was significantly correlated to the TOF ratio (r = 0.92-0.96, p < 0.0002). It is concluded that DBS not only can be used for monitoring of recovery from neuromuscular blockade, but also for monitoring of intense degrees of neuromuscular blockade.


Anti-neutrophil cytoplasm antibodies in patients with giant cell arteritis and/or polymyalgia rheumatica.

Anti-neutrophil cytoplasm antibodies (ANCA) were detected at low titers by indirect immunofluorescence in 1 out of 13 patients with giant cell arteritis (GCA) alone, 7 out of 30 with polymyalgia rheumatica (PMR) alone and 4 out of 15 with GCA plus PMR (8, 23 and 27%, respectively). Anti-myeloperoxidase antibodies were also demonstrated by an enzyme-linked immunosorbent assay in 4 patients with GCA alone (31%), 13 with PRM alone (42%) and 5 with GCA plus PRM (33%). The C-reactive protein response was significantly higher (p < 0.05) in ANCA-positive than in ANCA-negative patients.


[Anti-cardiolipin antibodies in Horton's disease].

A prospective study on 11 patients with temporal artery biopsy-proven arteritis examined the frequency and significance of anti-cardiolipin antibodies. Antibody levels in 7 patients were higher than 20 units but were not correlated with an inflammatory syndrome, as assessed by measurement of 4 inflammatory proteins (fibrinogen, C-reactive protein, orosomucoid and haptoglobin). These 7 patients were treated with steroids and their antibody levels returned to the normal range after 4 to 16 weeks of therapy, later than the inflammatory proteins. Two patients had slight increases of their anti-cardiolipin antibody levels, but no signs of clinical relapse or increases of inflammatory proteins were observed. In this study, no correlation was found between the presence of anti-cardiolipin antibodies and the occurrence of ischemic complications in 6 of the 11 patients.


[Bolus of cyclophosphamide and methylprednisolone in uveitis in Behçet's disease. Preliminary results with the use of new criteria of evaluation].

In a prospective open trial, the effect of pulse cyclophosphamide or methylprednisolone in the treatment of Behçet's disease uveitis was studied. The therapeutic effect was evaluated based on two scores: one evolutive, reflecting ocular inflammation and calculated for each eye before and after therapy; and the other, a measure of disease severity, which took into consideration the irreversible damage. Patients who received cyclophosphamide pulse therapy (n = 8) had significantly lower evolutive scores (16.12 +/- 3.95, vs 10.37 +/- 8.53, p < 0.01) than the patients receiving classical methylprednisolone pulse therapy (n = 20), who had no significant changes in their evolutive scores (12.95 +/- 8.55, vs 10.05 +/- 8.56, p > 0.05).


[Non-surgical treatment of kidney abscesses. Apropos of 12 cases].

Twelve renal abscesses were treated with percutaneous aspiration (6 patients), percutaneous drainage (3 patients) or antibiotics alone (3 patients). The diagnosis was established based on computed tomography-guided aspiration in 9 cases and on radiographic findings and follow-up in the remaining 3. A bacterium was isolated in 2 out of 9 blood cultures, 2 out of 11 urine cultures and in all cultures of pus obtained by percutaneous aspiration. All patients had a good outcome. Our findings confirm the efficacy of percutaneous aspiration in the treatment of renal abscesses. Percutaneous drainage should only be considered when the abscess is very large or aspiration has failed.


Removal of circulating tumor necrosis factor. Its role in septic shock treatment.

The tumor necrosis factor (TNF) is a polypeptide secreted by macrophages in response to endotoxins, especially from Gram-negative bacteria. Previous investigations suggest that TNF plays a prominent role in septic shock and meningococcal disease toxicity. A positive correlation was found between the initial serum TNF level and the patient's outcome. Despite the progress made in intensive care management and antibiotic therapy, the prognosis of septic shock remains very poor. Because of the implication of TNF in the pathogenesis of septic shock, we suggest that neutralization or elimination of this cytokine by plasma or blood exchanges could contribute to the treatment of severe forms of this syndrome. Five plasma exchanges and two blood exchanges were performed in 6 patients admitted for septic shock or purpura fulminans. Serum TNF levels were measured by immunoradiometric assay (Medgenix, ERIA Pasteur) before and after exchange. Serum TNF levels were found to be decreased by an average of 62% after the exchange. We conclude that exchange therapies are efficient in removing plasma TNF. Nevertheless, because of the limited number of patients treated, it is not possible to evaluate the clinical efficacy of such techniques.


Plasma manipulation in hemolytic uremic syndrome and thrombotic thrombocytopenic purpura.

The hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are syndromes of microangiopathic hemolytic anemia dominated by renal failure in children and by neurological signs in adults. Microvascular thrombosis is the typical lesion and endothelial injury is likely the initial event. Over the last 40 years, the prognosis has significantly improved, probably as the result of better supportive management of anemia, renal failure, hypertension, and electrolyte and water imbalances, but still remains poor in adults with renal arteriolar thrombosis and neurological involvement. Many specific therapies have been used and, based on reports of a few cases, a consensus has been reached empirically that recognizes antiplatelet agents and plasma manipulation as the most appropriate therapy for adult HUS and TTP. Their effectiveness, however, still remains to be formally tested in prospective controlled trials. Recently, we saw a 23-year-old man with a history of recurrent episodes of HUS in childhood and of TTP since the age of 21. HUS always disappeared following blood transfusions, whereas prompt remissions of the episodes of TTP were obtained with plasma exchange. In order to avoid the use of plasma, alternate forms of therapy were tried. However, aspirin (50 mg/day), prednisone (1 mg/kg bw/d), and human immunoglobulins (0.5 mg/kg/d) were ineffective, and plasma exchange was needed to obtain remission. During two more recent relapses, fresh-frozen plasma was infused as the initial therapy and produced a complete remission within few days, thus preventing the need for plasma exchange. During the last relapse, plasma exchange with albumin and saline failed to induce remission and plasma infusion was required.(ABSTRACT TRUNCATED AT 250 WORDS)


Adult hemolytic uremic syndrome with renal microangiopathy. Outcome according to therapeutic protocol in 53 cases. French Cooperative Study Group for Adult HUS.

We gathered data on adult patients suffering from hemolytic uremic syndrome with renal biopsy-proven thrombotic microangiopathy (n = 85) and excluded those associated with cancer, lymphoma, progressive systemic sclerosis and AIDS (n = 32). The 53 patients selected had a follow-up of more than 6 months (m = 38 months; range: 6-180 months). The aim of the study was to analyze the therapy-dependent outcome in these 53 patients. In such a retrospective and multicentric survey, different therapeutic protocols were used, including plasma exchange (PE), infusions of fresh-frozen plasma, corticosteroids, IV immunoglobulins or supportive therapy alone; all were used differently. The 5 year patient and kidney survival rates were 90 and 60%, respectively, for the selected group. A better patient survival rate was observed in the PE-treated group, compared to all other patients without PE therapy (p < 0.03). In addition, for patients requiring dialysis at presentation, renal improvement was better in the PE-treated group compared to patients receiving only supportive therapy (p = 0.05). When looking at the therapy-dependent outcome of renal function according to the pathologic type (glomerular, arteriolar or mixed), we observed that all PE-treated patients with pure glomerular lesions recovered, unlike those with arteriolar or mixed lesions (p = NS). On the other hand, no long-term beneficial effects of "active therapy" (37 patients) compared to supportive therapy alone (16 patients) were observed on renal function, but the 2 groups were not completely comparable.(ABSTRACT TRUNCATED AT 250 WORDS)


Incidence and clinical profile of microvascular complications in renal allografted patients treated with cyclosporine.

The incidence of cyclosporine (CsA) vascular toxicity is open to debate. We attempted to evaluate the incidence of hemolytic accidents in our series of patients taking all clinical forms into consideration. From January, 1989, to December, 1990, 117 patients received kidneys from cadaver donors and were treated with CsA. Five patients presented hemolytic uremic syndrome (HUS) accompanied by a rejection crisis; 6 patients presented hemolytic anemia associated in 2 cases with marked thrombocytopenia without any evidence of rejection. Cytomegalovirus (CMV) infection was diagnosed in 2 patients and bacterial infection preceded hemolysis in 2 other cases, suggesting a triggering factor. In addition, when we systematically determined haptoglobin levels after introduction of CsA treatment, we found asymptomatic hemolytic episodes more frequently. Our incidence of hemolytic accidents was approximately 10%. Hemolysis could indicate ischemic vascular damage leading to arteriolar medial hyalinosis preceding fibrosis in CsA nephrotoxicity. Thus, it would be interesting to detect asymptomatic forms of hemolysis by monitoring haptoglobin levels. This approach could lead to a reduction of the CsA dose in patients presenting low haptoglobin levels, even in the absence of evidence of nephrotoxicity.


Anti-HLA antibodies depletion on protein A-sepharose columns in hyperimmunized patients awaiting renal transplantation.

To reduce anti-HLA immunization, 15 patients waiting for a renal graft received the following treatment: 5 to 7 immunoadsorption sessions on protein A-Sepharose columns, immunosuppressive drugs (corticosteroids 1 mg/kg (bw/day+cyclophosphamide 2 mg/kg bw/day) and iv polyclonal immunoglobulins. Before this treatment, panel-reactive antibodies ranged from 65 to 100% and antibody titers varied from 1/8 to 1/128. In all patients, antibody, titers were decreased. However, antibody resynthesis was incompletely blocked by this protocol. Eight out of 12 grafted patients had a functional kidney transplant 3 months to 3 years post-grafting. There early kidney failures occurred in the subgroup of 5 patients who had had historical positive cross matches prior to treatment. This treatment did not seem to increase the frequency of infectious complications before or after grafting.


Anti-major histocompatibility complex antibody removal assay in a swine model.

A swine model of anti-MHC (SLA) immunization by skin grafting was established with the aim of removing preformed anti-MHC antibodies and preventing their resynthesis, in a situation close to that of hyperimmunization in humans. Plasma exchange therapy with or without associated immunosuppressive therapy was used. The feasibility of this animal model in terms of anti-MHC immunization and its therapeutic management have been proven. However, frequent early deaths of animals still mar the experimental protocol. Synchronization of plasma exchange and subsequent cyclophosphamide pulses seemed to abolish the antibody rebound phenomenon and cause marked drop of anti-MHC antibodies. Restimulation by a new skin graft is responsible for an intense polyclonal antibody stimulation, which suggests that we have to be careful in grafting patients with positive historical crossmatches and negative current ones.


Effects of plasma-protein A immunoadsorption on idiopathic nephrotic syndrome recurring after renal transplantation.

Patients with end-stage renal failure secondary to idiopathic nephrotic syndrome are at risk of initial disease recurrence after kidney transplantation (30%). Selective proteinuria can appear immediately after transplantation and focal glomerular sclerosis with graft loss can occur in 10% of patients with recurrence. Current immunosuppressive protocols do not seem to influence the recurrence rate in adult patients and the efficacy of therapeutic plasma exchanges remains controversial. We have previously demonstrated that plasma exchanges, proposed early before glomerular sclerosis, were able to significantly reduce proteinuria without affecting albuminemia or glomerular filtration. We report here on three patients who suffered immediate recurrence after transplantation and were treated with plasma immunoadsorption onto protein A column (Excorim, Lund); these patients had prior histories of steroid-resistant focal glomerular sclerosis. This procedure is more specific than plasma exchange in that it cleared the serum of immunoglobulins, significantly decreased proteinuria in only two cases (from 14 to 5 g/d and 2.5 to 0.8 g/d) and eliminated it in the third case (from 3 to 0.1 g/d). The modifications of proteinuria levels appeared as early as the second immunoadsorption sequence and returned to pre-immunoadsorption values within 2 to 8 weeks. These observations argue for the protein A binding of plasmatic factor(s) involved in idiopathic, nephrotic syndrome and allow us to progress to the characterization of this(ese) factor(s).


Plasma exchange therapy in pediatric patients. Plasma filtration with a unipuncture technique.

Therapeutic apheresis in children is limited by technical considerations, such as circuit blood volume, venous access and hemodynamic instability. Here we report our experience with 310 plasma-filtration sessions in 44 children (aged 9 months-17 years). We used a miniaturized circuit with a unipuncture technique and a "balancing system" which assured a permanent fluid equilibrium. This procedure is well adapted to children and always made pediatric plasma exchange therapy easier and safer. The more common indications remain Guillain-Barré syndrome and acute severe glomerular diseases.


A new device for specific extracorporeal immunoadsorption of anti-DNA antibodies. In vitro and in vivo results.

Selective removal of anti-DNA antibodies could be an alternative to therapeutic plasma exchange in patients with active systemic lupus erythematosus. The method is based on the immobilization by covalent binding of double-stranded, calibrated, 0.3-kb DNA fragments on a microporous, methylated, polyacrylonitrile membrane. This enables linkage of 60 micrograms of DNA per cm2 of apparent surface area. In vitro, perfusion of 100 ml of plasma maintained at 37 degrees C through 650 cm2 of dsDNA linked to the membrane, at a flow rate of 1.5 ml/min for 60 min, resulted in the removal of 49-89% of anti-DNA IgG without any changes in plasma protein or IgG levels. During a therapeutic plasma exchange, perfusion of the plasma through 1.5 m2 of membrane, at a flow rate of 25 ml/min, initially removed 92% of the anti-dsDNA antibodies entering the adsorbent and 25% at 120 min, indicating a progressive saturation of the binding capacity. Clinical immunoadsorption, at a plasma flow rate of 20-40 ml/min through 2 m2 of membrane, removed more than 50% of anti-dsDNA IgG within 60 min. Microporous membranes are able to irreversibly bind large amounts of antigenic ligands, and enable the selective removal of pathogenetic immunoglobulins or circulating factors.


[What role is left to surgery in portal hypertension?].

The place of surgery in the treatment of gastrointestinal haemorrhage in cirrhotic patients remains controversial. Emergency surgery may be considered when other haemostatic techniques fail. In this situation, the decision to operate must be taken rapidly, as the prognosis depends on the patient's preoperative status and the degree of hepatocellular failure (HCF). Elective surgery for portal hypertension completes with long-term sclerotherapy, and randomised prospective comparative studies have not been able to clearly distinguish between the two methods. The objective of the various operations proposed is to prevent recurrent haemorrhage without inducing any mortality or major morbidity (particularly encephalopathy). Partial, selective anastomoses and devascularisations appear to satisfy these objectives. The choice of technique depends on the portal flow rate, the type of varices, the degree of HCF and the surgeon's experience. Lastly, liver transplantation should be considered when portal surgery is decided in order to select a procedure which does not compromise the possibility of future transplantation and also as an alternative to portal surgery, particularly in young subjects with already severely impaired liver function.


[Calibrated latero-lateral portacaval anastomosis in the treatment of digestive hemorrhages by portal hypertension in the cirrhotic patient].

The calibrated side to side portocaval shunt was described in 1979 by P. Marion. This type of shunt preserves a hepatopedal blood flow by maintaining portocaval pressure gradient superior to halve of the initial gradient. Twenty nine shunts were performed from 1981 to 1989 in patients with hemorrhagic liver cirrhosis alcoholic in 83 percent of cases). Two patients were in Child Pugh C class (7%), six procedures were performed as an emergency (21%). The operative mortality was nil. The hepatopedal blood flow assessed by direct venous angiography was maintained in 66% of cases at one year and 22% at five years. The actuarial survival rate without recurrent bleeding was 96% at two years, 88% at five years. Severe chronic encephalopathy was noted in three cases (10.3%). One patient was successfully treated by surgical anastomotic tightening with disappearance of the hepatic encephalopathy. The actuarial survival rate without encephalopathy was 82.7% at five years. The side to side calibrated shunt is a technically easy procedure with low mortality, low incidence of thrombosis and clinical results similar to the results of Warren's procedure. For these reasons, we have decided to include this procedure in our local protocol of management of hemorrhagic liver cirrhosis.


[Prophylactic drainage after thyroidectomy: a randomized trial].

A randomized clinical trial of surgical drainage in thyroid surgery was performed with 97 patients. Using equivalence testing it is reported that morbidity was not significantly different between the two groups and the length of hospital stay was shorter in the undrained group. It is possible to perform thyroidectomy without drainage in a selected population.


[Esophagectomy for advanced malpighian cancer of the thoracic esophagus. Esogastric anastomosis in the neck or in the thorax? Late results of a "randomized" prospective study].

During a 2 1/2 year period, 60 consecutive patients with cancer of the thoracic esophagus were randomized to undergo cervical (CA) or thoracic (TA) esophago-gastrostomy. The tumors were staged post-operatively and were almost equally distributed between the two groups. The esophageal specimens were macroscopically studied on the fresh specimens with vital staining, then microscopically. The prevalence of peri-tumoral mucosal and sub-mucosal lesions was confirmed. Microscopic malignant invasions of esophageal sections were more frequent in TA (10) than in CA (3). Resected positive lymph nodes were more numerous in CA (17) than in TA (7). The mortality was identical in the two groups. Respiratory complications and recurrent laryngeal nerve trauma were more frequent in CA. Long-term survivors had N0 disease with a healthy esophageal section. Even though subtotal esophagectomy reduces the prevalence of microscopic esophageal wall invasion at the upper section level and allows more complete unilateral exploration and resection of invaded lymph nodes, it offers no significant benefit concerning survival of patients with advanced cancer and malignant lymphadenopathy, after resection with post-operative radiotherapy.


[Ivor Lewis' operation for epidermoid cancer of the esophagus. Immediate and late results. Apropos of 168 cases].

168 Ivor Lewis operations for squamous carcinoma of the lower esophagus are reviewed. 155 men and 13 women with a mean age of 59 years were operated on. 46 tumors were stage I and II, and 122 were stage III. Operations were considered to be curative for 120 patients and only palliative for 48. An esophagectomy associated with lymphadenectomy was performed through laparotomy and right thoracotomy. Feeding jejunostomy and pyloroplasty were routine. EEA or ILS 25 staplers were used to perform esophagogastric anastomosis and the gastroplasty tube was fashioned by TA 90 stapler. In every case an extended esophagectomy was performed with anastomosis between 3 ans 7 cm below the pharyngo-esophageal junction. Postoperative mortality was 4.7%. There were 10 leaks (6%) and 28 pulmonary complications. Median actuarial survival is 17 months. Actuarial survival at 2 years is significantly greater for stages I and II (68.4%) than for stage III (23.2%) (p < 0.01). Ivor Lewis esophagectomy is a reliable procedure to treat squamous carcinoma of the lower two thirds of the esophagus ensuring a good quality of life.


[Appendiceal carcinoid tumor of systematic detection. When to propose right hemi-colectomy and how to monitor? Thoughts apropos of a case and review of the literature].

In relation to a case of carcinoid tumor of the appendix discovered after appendectomy and already metastatic, we discuss the prognostic factors of these lesions. Size is the most important one. For tumors less than two centimetres diameter, site, mesoappendix and lymph node involvement do not fully summarize the aggressiveness of the disease. We would like to emphasize the poor prognosis of perineural involvement, especially for young patients, in order to discuss the indication for salvage right colectomy. A positive reaction to Neuron-Specific Enolase allows this enzyme to be proposed as a postoperative serum marker.


[Digestive surgery in patients over 80 years of age. Apropos of 690 operations].

Between January 1981 and December 1990, 690 patients over the age of 80 years underwent gastrointestinal surgery. These operations were performed for diseases of the biliary tract in 248 cases (28%), colon or rectum in 238 cases (27%), stomach or duodenum in 130 cases (15%), small bowel in 32 cases (1.6%), oesophagus in 16 cases (1.8%), and for peritoneal carcinologic dissemination in 26 cases (3%). Emergency operation was performed in 43% of patients. Surgery was considered to be curative in 61% of patients. Overall postoperative mortality was 23%. The six following factors were associated with increased mortality: age over 85 years, ASA categories 3, 4, 5; surgery for malignant disease, peritonitis, palliative surgery, emergency surgery.


[One hundred and twenty-five consecutive choledochotomies for suspected lithiasis without mortality. Current state of complications from common bile duct surgery].

The postoperative courses of 125 consecutive surgical common bile duct explorations performed between 1983 and 1990 were analysed. All cases of common bile duct lithiasis, but three, were operated on. Intraoperative cholangiography was performed in 98 percent and cholangioscopy in 92 percent of patients; common bile duct stones were found in 95 patients (76 percent); the common bile duct was sutured without drainage in 78 patients (58 percent). There were no deaths. Morbidity was 14 percent, of which 10 percent were serious. Four percent of common bile ducts retained stones. The specific morbidity was 4 percent. These results confirm the reliability of surgical management of common bile duct stones and therefore should be considered for the evaluation of new procedures, such as laparoscopic treatment of common duct stones, or combined laparoscopic cholecystectomy and endoscopic sphincterotomy.


[Ovarian metastases from colorectal cancers. Current place of prophylactic bilateral ovariectomy].

Ovarian metastases occur in the course of colorectal adenocarcinomas on 3 to 14% of cases. They are bilateral in 50-70% of cases and frequently occult (6 to 25%) and constitute a factor of poor short-term prognosis (median survival: 18 months). After analysing the features of ovarian metastases from colorectal cancers, the authors discuss the current place of prophylactic bilateral oophorectomy in terms of its indications and results. Although this procedure should clearly be performed routinely in postmenopausal patients, it is more controversial in women of reproductive age who, according to some authors, nevertheless constitute a group at high risk of ovarian metastases. The contribution of this prophylactic oophorectomy to the improvement in the prognosis of colorectal neoplasms has not been statistically established to date and needs to be demonstrated by means of prospective studies.


[External biliary fistula after right lateral sectorial hepatectomy for liver injury. Recovery by cholecysto-fistulous anastomosis].

An external biliary fistula persisting for 14 months after right lateral hepatectomy for liver trauma is reported. Recovery was obtained by an unusual technique: the fistulo-cholecystostomy.


[Muir-Torre syndrome. Apropos of a case associated with a familial form of cancer].

We report the case of 41 year-old male patient, in whom multiple and recurrent infrequent cutaneous lesions (sebaceous adenomas) led to suspect the diagnosis of Muir-Torre syndrome. This diagnosis was confirmed when 2 colo-rectal adenocarcinomas were discovered and curatively excised (trans-anal excision, followed by total colectomy). The Muir-Torre syndrome was part of a familial cancer syndrome in this case, as the patient's mother and brother died from colonic cancer before the age of 45. The case-report underlines the diagnostic role of cutaneous lesions in this syndrome, allowing early detection of internal malignancy.


[Signet-ring cell adenocarcinoma involving the bladder and the rectum. Apropos of two cases].

Two cases of primary signet-ring cell carcinoma involving the urinary bladder, with invasion of the rectum, are presented. Pelvic exenterations were performed, followed by a rapidly fatal outcome (6 and 7.5 months). These cases of signet-ring cell carcinoma of the bladder were reviewed with 33 previously reported cases in the literature. The clinical characteristics, histologic findings, pathogenesis, and effectiveness of aggressive treatment of this rare bladder malignancy are discussed.


Rheological leukocyte indexes in diabetes mellitus type II.

Eleven healthy volunteers were examined, as well a thirty-five diabetic subjects divided into three groups according to the presence or absence of macro-microvascular complications and according to whether or not these complications were chronic. The results of our study show a marked unfavorable in cell rheology in the diabetic subjects, as studied using the St. George filtrometer. In particular, polymorphonuclear (PMN) cells, in the diabetic subject showed a substantial decreases in viscosity and elasticity, reflected by decreased IrFr and increased CR values. These changes were most marked in the group of diabetics with acute vascular events, i.e., AMI and stroke. Rheological indexes studied appeared to be independent from the simultaneous blood glucose level.


[Arteritis of the lower limbs in diabetics].

37 cases of diabetic arteritis of lower limbs in diabetic patients were retrospectively studied, from 1988 to 1991. Mean age was 66 years. Masculine predominance was evident with a sex ratio of 1/10. The majority of our patients have consulted at a late stage with trophic disturbance of inferior limbs, indeed 18 patients were seen at the 4th stage. Mortification was observed in 55% cases. Arteriography has allowed to show an elective localization of lesions at the femoralis arteria, profunda femoralis arteria and distal axes. Operative indication was made in 22 patients. Conservative surgery was performed for 50% of the operated patients. Conservative surgery results had been relatively less satisfactory than for others arteritis, particular because of late consultation and the condition of diabetic patients.


[Arrhythmogenic cardiomyopathies of the right ventricle].

Arrhythmogenic cardiomyopathies of the right ventricle (ACRV) are defined by an association of left delayed type ventricular arrhythmias, ranging from apparently uncomplicated extrasystoles to more severe or even potentially lethal arrhythmias such as polymorphous VT and ventricular fibrillation, with an anatomical substrate consisting of adipose or fibro-adipose degeneration of the myocytes of the free wall of the ventricle, which may be either focal (in particular: apex, anterior surface of the infundibulum and the sub-tricuspid region), or more diffuse. It is then accompanied by RV systolic dysfunction with dilatation of the cavity. This apparently well defined clinico-pathological entity is in fact more complex, if only because of the existence of associated lesions of the left ventricle in 1/3 of cases. The distinction from Uhl disease remains blurred, in particular in diffuse forms. It is most probable that more than one etiology is involved. A dysgenetic mechanism with probable autosomal dominant transmission has apparently been shown in familiar forms which are associated with a particularly severe risk of progression. The hypothesis of sequelae of multifocal myocarditis appears to be the most probable in sporadic forms. In the absence of histological criteria, which it is difficult to demand in view of the variability of results and potential dangers of endomyocardial biopsy involving such thin and fragile ventricular walls, the diagnosis of ACRV is based upon the concomitant existence of: (1) electrophysiological criteria: ventricular arrhythmias, in particular sustained monomorphous VT, with the particular feature of a very high degree of sensitivity to adrenergic stimulation (exercise), the existence of late potentials on the high amplification ECG, a highly specific sign, though unfortunately of poor sensitivity in localized froms, those which are most difficult to identify (2); segmentary morphological and kinetic RV abnormalities, most often resulting in localized akinetic or dyskinetic parietal vaulting, with stasis "in situ". Modern imaging methods (echocardiography, angioscintigraphy with phase analysis, nuclear magnetic resonance imaging, etc.) unfortunately do not yet offer an alternative to selective cineangiography of the RV which is the reference investigation when it is performed and interpreted under strict conditions. Several reports of sudden death or of ventricular fibrillation seen in confirmed cases of ACRV, as well as the publication of a number of autopsy registers indicating that this condition is one of the primary causes of sudden death in young individuals and in athletes, have cast doubt on the benign prognosis initially attributed to this condition.(ABSTRACT TRUNCATED AT 400 WORDS)


[Non-invasive imaging in aortic dissection].

Previously with a drastic prognosis, aortic dissection has extensively benefitted from advances in medical and surgical treatment, as well as progress in methods of investigation. While aortography is classically the reference special investigation, non-invasive methods now have a place of choice both during the acute phase (transthoracic and transesophageal echocardiography) and the chronic phase or for the purpose of post-operative monitoring (CT scan, magnetic resonance imaging). In an emergency context, the most important point is to diagnose a type A dissection, involving the ascending aorta, the treatment of which is surgical. In the majority of cases the diagnosis can now be made on the basis of transthoracic and transesophageal echocardiographic findings, which also enable identification of the site of the portal of entry, extension and concomitant lesions, all important features to be taken into consideration regarding surgical tactics.


[Obstructive sleep apnea syndrome in adults and cardiovascular risk].

Sleep obstructive apnea syndrome (SOAS) is a common condition with a strong male predominance. Its incidence is more than 1 percent in the population as a whole. It exists in snorers. Both snoring and SOAS are linked to the presence of abnormalities (congenital or acquired) of the upper respiratory tract. The nocturnal cardiovascular consequences of SOAS are directly linked to apnea. Bradycardia occurs during apnea and tachycardia when ventilation restarts. Paroxysmal nocturnal hypertension is a constant feature. Even in individuals who are normotensive during the day, each restarting of ventilation is accompanied by peaking of blood pressure. The pulmonary artery pressure curve follows that of systemic blood pressure. Complications begin when SOAS has been present for several years: 1) Chronic: permanent systemic hypertension is common (56 percent of SOAS). It is often refractory to antihypertensive treatment. 2) Acute: the onset of myocardial infarction and of cerebrovascular accidents explains the heavy mortality of SOAS (37 percent at 8 years in untreated individuals with a number of episodes of apnea exceeding 20 per hour of sleep). Other acute complications are less common: acute pulmonary edema, nocturnal sudden death. These events may be prevented by treatment suppressing apnea: actuarial survival curves are then superimposable upon those of the population as a whole. Thus SOAS is a cardiovascular risk factor which is remarkably reversible by specific treatment, though which most often passes unrecognized.


[Value of new isotopes in cardiology].

Nuclear Cardiology has seen many advances in the past few years: new indications for tracers already known, but also the appearance of new markers, by single photon imaging or by position emission (PET). With regard to the investigation of myocardial perfusion, thallium remains the most widely used isotope. Its sensitivity in the diagnosis of coronary disease is improved by the use of scintigraphic CT scan (SPECT) and excellent predictive value in terms of the onset of coronary events or mortality has been confirmed in particular. At the same time, the sensitivity and specificity of new technetium markers have been better defined. The investigation of myocardial metabolism, accessible up to now only via PET and confined, in France, to the domain of clinical research, is in the process of becoming a tool suitable for use by clinicians as a result of new SPECT-Thallium protocols (reinjection, late redistribution and rest), but also because of the development of single photon markers of myocardial viability, e.g. iodinated fatty acids. A functional approach to coronary disease, indispensable adjuvant to the anatomical approach, is now possible on a routine basis.


[Pregnancy and cardiovascular agents].

Any treatment used in pregnant women must take into account the effects of the substance in question of the fetus and the particular sensitivity of the latter during the first three months of development. The majority of drugs used in cardiology can be prescribed during pregnancy: digitalis preparations, furosemide, certain beta-blockers, verapamil, nifedipine (except during the first three months), quinidine, disopyramide, lignocaine, flecainide, amiodarone, heparins (non-fragmented and low molecular weight), central antihypertensive agents, dipyridamole and aspirin. In contrast, some drugs should be avoided because of insufficient information regarding their maternal and fetal consequences (bumetamide, modamide, the most recent beta-blockers, cibenzoline, ticlopidine) or because of harmful adverse effects on the fetus (spironolactones, bipyridines, diltiazem) or the newborn infant (angiotensin converting enzyme inhibitors). Finally, with certain medications (propafenone, oral anticoagulants), it is important to be able to compare maternal risks due to the disease and fetal risks induced by the drug. Modification of the conditions of use of these drugs and very careful monitoring of the patient most often suffice to avoid untoward events or complications with potentially serious medicolegal consequences and which may implicate the liability of the prescriber.


[Diagnostic and therapeutic strategy in patients with multiple arterial disease].

Concomitant coronary and peripheral lesions are common, in particular in candidates for peripheral surgery. Coronary lesions dominate the prognosis in all cases. The later mid- and long-term risks of such associations is far greater than the immediate operative risk. Each type of surgery, peripheral or coronary, offers the opportunity for arterial evaluation of the other area in its own right, rather than because of the surgical context. No invasive investigations should be routine. The diagnostic approach is guided by clinical data and to a lesser degree by non-invasive investigations, the discriminant nature of which is unfortunately poor in the context of coronary evaluation. Indications for multifocal simultaneous or sequential revascularization procedures, by surgery or angioplasty, are in fact small in number. They are wide ranging and must be discussed case by case, taking into account age, general condition, the emergency context and the type and severity of lesions.


[Metabolic changes in cardiac failure].

As soon as there is evidence of left ventricular dysfunction, even before clinical signs of chronic cardiac failure (CCF) have developed, intrinsic and extrinsic compensatory mechanisms are brought into play by the body. The majority of these mechanisms are under the influence of neurohumoral systems. When neurohormonal responses persist, as in CCF, they take on a beneficial nature since they participate in adaptation of the cardiovascular system as a whole, but they are also harmful since they worsen the working conditions of the myocardium by their cardiac and peripheral effects. Hyperactivity of the noradrenergic sympathetic nervous system is seen in CCF with levels 2 to 3 times higher as compared with subjects with normal left ventricular function. The circadian rhythm of catecholamines is modified. The increase in circulatory catecholamines is all the greater when cardiac failure is advanced. This release of noradrenaline (NA) is under the control of arterial baroreceptors which normally send to the central nervous system inhibitory inflow from the sympathetic nervous system. Inhibitory tone is released in case of a fall in blood pressure. Noradrenaline acts on beta-predominant myocardial receptors (inotropic and tachycardic) and alpha-predominant vascular receptors, resulting in arteriolar vasoconstriction. There is rapid onset of down regulation of myocardial beta-receptors. This fall essentially concerns beta 1, but beta 2 also, since they may be affected according to the etiology of CCF (ischemia). The Renin Angiotensin System (RAS) is also activated by the fall in systemic blood pressure. This consists of a cascade of reactions leading to the synthesis of angiotensin II responsible for powerful vasoconstriction of all arterial areas, including the coronary vessels.(ABSTRACT TRUNCATED AT 250 WORDS)


[Evaluation of the risk of arrhythmia after infarction].

Evaluation of the risk of arrhythmias after myocardial infarction involves identification of those patients at a high risk of arrhythmic events, i.e. those who fall victim to ventricular tachycardia or sudden death. Such identification is an essential first stage before any treatment can be proposed. It has been clearly shown that the existence of premature ventricular contractions following infarction is an indicator of poor prognosis. In addition to evaluation of premature ventricular contractions, a Holter record can identify sinus variability, a parameter which the prognostic importance is currently being increasingly emphasized. Electrocardiography with averaging and high amplification has now been shown to be of value in the evaluation of arrhythmic risk after infarction. The negative predictive value of this investigation is very high, of the order of 90 percent. In addition to Holter and electrocardiography with averaging, two other non-invasive investigations can be used to determine arrhythmic risks after infarction. Stress testing can seek the presence of premature ventricular contractions related to exercise, while isotope ventriculography measures the value of ejection fraction which, in itself, has a high predictive value in terms of arrhythmic events. Mortality after infarction is proportional to the lowering of ejection fraction and among deaths approximately half are probably due to arrhythmias. Programmed ventricular pacing also has a role to play in evaluation of arrhythmic risk after infarction, but should not be routine. It may be indicated in those patients showing all of the signs of risk, i.e. repetitious forms by Holter, late potentials and low ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)


[Efficacy and tolerability of isoptine LP in mild to moderate hypertension. A multicenter study with 50 patients].

A multicenter open trial involving 50 hypertension patients enabled evaluation of the efficacy and tolerability of Isoptine L.P. (sustained release verapamil) in mild to moderate essential hypertension. Following a 2-week placebo run-in period, patients were given Isoptine L.P. (240 mg/24 h) as a morning dose for 3 months, with a possible dose increase (360 mg/24 h) in case of diastolic blood pressure of 95 mmHg or more at the 30-day evaluation. Blood pressure was measured by mercury sphygmomanometer and, in 20 patients, by a Dinamap type Automatic device. After 3 months of treatment, blood pressure levels in supine and standing position, measured manually and automatically, showed a highly significant decrease, with a mean fall of 18.4 mmHg for systolic (13.7 percent) and 13.2 mmHg diastolic (-14.6 percent). 67 percent of patients were responders after 1 month of treatment and 79 percent at 3 months, including one-fifth at the dose of 360 mg/24 h. Seventeen patients, i.e. 34 percent, reported one or more adverse reactions. Among these, four patients had to stop treatment, twice because of headache and twice for constipation. Adverse events seen most frequently were constipation, headache, tiredness and vomiting. No cardiac adverse events were reported with the exception of one case of atrial premature contractions. The electrocardiogram revealed significant slowing of heart rate, as well as slight prolongation of PR and QT intervals and slight widening of the QRS complex. Tolerability on the basis of laboratory parameters was good.


[My practice of thrombolysis in the acute phase of myocardial infarction in the light of extensive studies].

Hospital mortality due to myocardial infarction has decreased markedly since the 1970's. Intravenous thrombolysis is certainly one of the reasons for this decrease but its precise role cannot be defined. In practice, major therapeutic trials enable definition of the broad lines. It is nevertheless essential to combine our personal experience with their analysis. It is not yet possible at present to say which is the best thrombolytic. Use of the association streptokinase-rtPA has the advantages of both agents and the same risks at a lower cost than that of rtPA alone.


[Genes of resistance to aminoglycoside antibiotics in clinical strains of Serratia marcescens and the enzyme encoded by them].

The patterns of aminoglycoside inactivating enzymes were determined by AGRP in 31 clinical isolated of Serratia marcescens. The results were compared with the data on identification of the aminoglycoside resistance genes by the specific DNA probes. It was shown that all the isolates of Serratia marcescens contained the AAC(6')-Ic gene which was not expressed in some isolates. The other detected aminoglycoside inactivating enzymes were the following: AAC(3)-V in 17 isolates, ANT(2'') in 7 isolates, AAC(3)-I in 4 isolates and APH(3')-I in 13 isolates. Reliability of the methods of AGRP and DNA-DNA hybridization was estimated in the assay of the aminoglycoside resistant clinical strains of Serratia marcescens.