Randomized double-blind placebo-controlled trial of cisplatin and etoposide plus megestrol acetate/placebo in extensive-stage small-cell lung cancer: a North Central Cancer Treatment Group study.

PURPOSE: Megestrol acetate has been reported to improve appetite and quality of life and to decrease nausea and vomiting in patients with cancer anorexia/cachexia. The present trial was formulated to evaluate the impact of megestrol acetate on quality of life, toxicity, response, and survival in individuals with extensive-stage small-cell lung cancer who received concomitant chemotherapy. PATIENTS AND METHODS: Patients were randomized to receive megestrol acetate 800 mg/d orally or placebo. In addition, all patients were scheduled to receive a maximum of four cycles of cisplatin and etoposide chemotherapy. Quality of life was self-assessed at entry onto study, with every cycle of chemotherapy, and 4 months thereafter with a linear visual analog scale. Toxicity was evaluated by patient questionnaire and investigator reports. RESULTS: A total of 243 eligible patients were randomized. Those who received megestrol acetate had increased nonfluid weight gain (P = .004) and significantly less nausea (P = .0002) and vomiting (P = .02). Significant thromboembolic phenomena occurred more often in patients who received megestrol acetate versus placebo (9% v 2%, P = .01). Patients who received megestrol acetate had more edema (30% v 20%, P = .002), an inferior response rate to chemotherapy (68% v 80%, P = .03), and a trend for inferior survival duration (median, 8.2 v 10.0 months, P = .49). These findings may have been influenced by a poorer quality of life of the megestrol acetate group at study initiation. There were no significant changes in quality of life scores over time between either of the study arms. CONCLUSION: Megestrol acetate cannot be routinely recommended for all patients with small-cell lung cancer at the time of chemotherapy initiation. Rather, its therapeutic ratio may be more favorable for patients with problematic cancer anorexia/cachexia.

Differences between sporadic pheochromocytoma and pheochromocytoma in multiple endocrime neoplasia, type 2.

We studied the gross and microscopic pathology of the adrenal gland in 69 cases of sporadic phenochromocytoma in order to develop a profile of the neoplasm to compare with that of pheochromocytoma observed in the syndrome of multiple endocrine neoplasia, type 2 (MEN 2). The results showed that sporadic pheochromocytoma was a unicentric (93%), unilateral (100%) neoplasm, which was associated with normal extratumoral adrenal medulla (100%). The findings contrast with those encountered in the adrenal gland in MEN 2, in which the tumor involvement is frequently multicentric, usually bilateral, and associated with extratumoral medullary hyperplasia in cases of early involvement. Therefore, the interpretation of the results of pathologic examination of a pheochromocytoma should be immediately communicated to the surgeon.

A TDPAC study of static and dynamic magnetic behaviour.

The a-FexHf100-x system is used to explore the application of TDPAC (the time differential perturbed γ-γ angular correlation technique) to non-trivial anisotropic magnetic relaxation. The effect of fluctuations in this system is primarily to cause a decay of the zero-frequency component, which is characterized by the phenomenological decay rate λ. The zero-field magnetic phase diagram, constructed from both static and dynamic features of the data, and the temperature dependence of λ are both fully consistent with the physics of partial bond frustration. The results demonstrate that the magnetic fluctuations are meaningfully characterized by simple spectrum features, and are not obscured by large static fields or severe disorder.

Molds on vegetables at the time of harvest.

The mean numbers of colony-forming units of molds present on vegetables at the time of harvest were in the range of 4.2 X 10(3) to 6.7 X 10(3)/g for all vegetables except cucurbits and asparagus. The numbers were not influenced by cultivars within species, duration of the growing season, distant separation of the growing fields, or elevation above ground. Numbers increased with rainfall during either of 3 days before harvest and decreased when the mean daily temperature exceeded 24 degrees C. The most frequently isolated fungi were Aureobasidium pullulans, Fusarium species, Alternaria tenuis, Epicoccum nigrum, Mucor species, Chaetomium fimeti, Rhizopus nigricans, and Phoma species, in decreasing order. All other molds comprised less than 2% of the isolates. Aspergilli and penicillia occurred sporadically and in low numbers. Fusarium species were dominant on cucurbits.

Radioimmunoassay for prostatic acid phosphatase helps discriminate patients with prostatic cancer.

We measured serum prostatic acid phosphatase in ostensibly normal controls and a selected patient population, using both a modified radioimmunoassay and an enzymic method with thymolphthalein monophosphate as substrate. The upper limit of normal for the radioimmunoassay was 2.2 micrograms/L; its sensitivity and specificity for prostatic cancer were 71 and 95%, respectively, vs 51 and 99% for the enzymic method. For both methods the correlation between clinical staging and values for acid phosphatase was poor. Our data suggest that adjunctive use of the radioimmunoassay may help further discriminate those patients requiring needle biopsy.

Microtubule-Based Movements During Ooplasmic Segregation in the Medaka Fish Egg (Oryzias latipes).

We used time-lapse video microscopy to monitor the effects of cytochalasin D (CCD) and demecolcine on cytoplasmic streaming toward the animal pole of the medaka egg, the formation of the blastodisc at the animal pole, the movement of oil droplets in the cytoplasm toward the vegetal pole, and the saltatory movement of small cytoplasmic parcels toward the animal pole and vegetal pole. Cytochalasin D inhibited both cytoplasmic streaming toward the animal pole and the formation of the blastodisc, suggesting a role for microfilaments in these processes. However, CCD had no apparent effect on saltatory movement or on the movement of oil droplets toward the vegetal pole. Thus, the segregation of oil droplets toward the vegetal pole is not the result of the bulk movement of ooplasm toward the animal pole. In eggs treated with demecolcine, oil droplets did not move toward the vegetal pole but instead floated to the uppermost portion of the egg, and saltatory movement was absent, suggesting that microtubules are required for these movements. The effects of demecolcine on oil droplet movement and saltatory movement could be reversed by irradiating the eggs with UV light (360 nm). Using indirect immunofluorescence, we showed that irradiation of demecolcine-treated eggs with UV light regenerated microtubules within the irradiated region. The specificity of the mechanism responsible for the vegetal poleward movement of oil droplets was assessed by microinjecting droplets of five other fluids--mineral oil, silicone oil, vegetable oil, and two fluorinated aliphatic compounds--into the ooplasm. None of these fluids segregated with the endogenous oil droplets. These results suggest that a specific mechanism, probably involving microtubules, is responsible for the segregation of oil droplets to the vegetal pole.

Systemic mast cell disease: a clinical and hematopathologic study of 26 cases.

Systemic mast cells disease (SMCD) is an uncommon disorder that constitutes approximately 10% of all mastocytoses. Diagnosis requires a substantial degree of clinical suspicion, which may not be present if characteristic skin lesions of urticaria pigmentosa are not observed. Lack of well-defined histopathologic features for the disease have delayed or prevented the diagnosis of SMCD. An initial diagnosis of "myeloproliferative disorder," chronic granulocytic leukemia, or myelofibrosis is frequently made. Study of the clinical and pathologic features of 26 cases of SMCD indicated that affected patients are generally middle aged and may have had urticaria pigmentosa for many years. Gastrointestinal symptoms are common, and splenomegaly and hepatomegaly along with radiographic evidence of generalized bone disease are usually noted. Hematologic factors are highly variable. Characteristic histopathologic features of SMCD are described for bone marrow, lymph nodes, liver, and spleen. The authors consider tissue fixation and staining methods to help identify mast cell lesions.

Serum creatine kinase-BB and small cell anaplastic carcinoma of the lung: two case reports.

Recent reports have suggested that serum creatine kinase isoenzyme BB (CK-BB) may be used as a tumor marker for a variety of malignancies, particularly prostatic carcinoma. Two cases of small cell anaplastic carcinoma of the lung (SCAC) had markedly contrasting levels of CK-BB by serum electrophoresis. Retrospective analysis of the index cases, and four additional autopsy cases of SCAC, included: 1) quantitation of CK-B in postmortem tumor and adjacent non-tumor lung tissue; 2) enzymatic and radioimmunoassay serum levels of CK-B; and 3) CK-B immunoperoxidase staining of tumor and non-tumor tissues for CK-B. Serum CK-BB is a non-specific tumor marker, but its presence, in whatever amount, should alert the clinician to the possibility of an associated malignancy, particularly SCAC or metastatic carcinoma.