High serum levels of TNF-α and IL-6 predict the clinical outcome of treatment with human recombinant erythropoietin in anaemic cancer patients.

BACKGROUND: A number of anaemic cancer patients are not responsive to treatment with recombinant human erythropoietin (rHuEPO). The aim of the present study is to investigate whether serum levels of tumour necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta, IL-6 and additional laboratory parameters, together with clinical variables, can predict the clinical outcome of treatment with rHuEPO in anaemic cancer patients. PATIENTS AND METHODS: Thirty-five cancer patients and 25 healthy controls were enrolled in this study. Patients were treated with epoetin alfa at the dose of 150 IU/kg s.c. three times a week for 12 weeks. If the haemoglobin (Hb) level failed to improve at least 2 g/dl above baseline by week 6 of treatment, dose was increased to 300 IU/kg s.c. for the remainder of the treatment period. All patients filled out the Brief Fatigue Inventory (BFI), a questionnaire for the self-evaluation of cancer-related fatigue. Serum samples from patients and control groups were frozen at -80 degrees C and TNF-alpha, IL-1beta and IL-6 were later examined by enzyme-linked immunosorbent assay. RESULTS: Fatigued cancer patients had significant higher levels of circulating TNF-alpha, IL-1beta and IL-6 than healthy controls. Responders (Rs) to erythropoietin had significant lower medium levels of TNF-alpha and IL-6 than nonresponders (NRs). Fatigued patients with a general BFI score > or =6 presented higher medium level of cytokines than nonfatigued patients (general BFI score <6), but each group responded similarly to treatment with rHuEPO. CONCLUSIONS: High serum levels of TNF-alpha and IL-6 at the baseline are significantly correlated with a negative response to administration with rHuEPO. Thus, pretreatment evaluation of TNF-alpha and IL-6 serum levels can help to select those patients who are most likely to benefit from treatment with rHuEPO. On the contrary, Hb level, red blood cell count, lactate dehydrogenase and BFI score do not predict the outcome of treatment with rHuEPO.

Leydig cell tumor of the testis: a case diagnosed by fine-needle sampling without aspiration with histologic, immunohistologic, and electron microscopic analysis.

Fine-needle sampling without aspiration was performed in a patient with a testicular mass. The cytologic diagnosis was consistent with Leydig cell tumor. Cytologic features included abundant grey-blue cytoplasms with spherical or oval nuclei in May-Grünwald-Giemsa-stained smears. Intranuclear inclusions were observed but no Reinke's crystals were detected. Histologic findings confirmed the diagnosis and tumor cells were positive for vimentin. Electron microscopic analysis of the tumor showed abundant smooth endoplasmic reticulum and mitochondria with tubulovesicular cristae but no Reinke's crystals.

Nephrotic syndrome associated with pleural mesothelioma. An unusual paraneoplastic event.

A case of association between nephrotic syndrome (membranous glomerulopathy) and pleural mesothelioma is presented. It is suggested that this association is a true paraneoplastic syndrome.

[Endoscopic and histopathologic changes in the gastric mucosa in Billroth II gastrectomy and in Roux-en-Y]. / Alterações endoscópicas e histopatológicas da mucosa gástrica na gastrectomia a Billroth II e em Y de Roux.

The gastric mucosa changes induced by enterogastric reflux remain to interest, thus, 20 patients with surgical duodenal ulcer disease were studied, and after raffle, they consisted in 2 groups of 10 patients each, in which were performed antrectomy and truncal vagotomy, with reestablishment of the gastrointestinal continuity, in the group I, through a Billroth II gastrojejunostomy, and, in the group II, by a Roux-en-Y gastrojejunostomy. In the preoperative course, all the patients were undergone to endoscopic and histopathologic studies, when body gastric mucosa biopsies were analysed; after an average time of follow-up about 7.3 months for the group I, and 8.9 months for the group II, these studies were repeated in an attempt to check, in these 2 groups, the presence of gastric mucosa changes on the gastric remnant induced by reflux of alkaline juices. According to Fisher's exact test the outcome of these searches were significants when had compared the bile reflux into the stomach (p = 0.0549), gastritis (p = 0.00) and anastomosis changes (p = 0.0899) at endoscopic study, and were not significants when it comes to the condition of chronic gastritis (p = 0.6672) present at histopathologic study.

[N-dealkylation of chlorimipramine and chlorpromazine in patients undergoing chronic treatment with both drugs: preliminary results]. / Studio della N-dealchilazione di clorimipramina e clorpromazina in pazienti sottoposti a trattamento cronico con i due farmaci: risultati preliminari.

Data obtained in this preliminary study show that in patients chronically treated either with Chlorimipramine (n = 6) or with Chlorpromazine (n = 2), significant amounts of the corresponding Nor1- and Nor2-metabolites were detected in plasma. The role of these metabolites in the overall therapeutic effect is under investigation.

Treatment of depression with L-5-hydroxytryptophan combined with chlorimipramine, a double-blind study.

A double-blind clinical trial was carried out involving 26 hospitalized, depressed patients who were randomized into two groups. Patients in each group received chlorimipramine (50 mg/day), combined with L-5-HTP (300 mg/day) in Group A, and with placebo in Group B. The trial lasted 28 days. Two Group B patients dropped out. All the patients were evaluated by HRSD each week, and by ZDSI and CGI at the beginning and end of treatment. Several statistical analyses of the mean HRSD scores of each item presenting initial positive response and of ZDSI scores for both reactive and endogenous depression were performed, using Student's t-test. To evaluate the efficacy of the chlorimipramine +L-5-HTP combination versus control therapy the Mann-Whitney test was applied to the reduction in HRSD scores, showing 0.05 significance. The results for both types of pathology were quantitatively and qualitatively more positive for Group A than for Group B. Cluster analysis of HRSD item scores alone and between this scale and ZDSI, according to Carrol's correlation method for the symptoms of the cluster (mood, anxiety and somatic symptoms), was carried out to confirm the above results.