Characterization of Biostable Atomic Layer Deposited (ALD) Multilayer Passivation Coatings for Active Implants.

The next generation of flexible, electrically active implants, such as brain implants or retina chips require a flexible, biostable as well as biocompatible passivation, ensuring a degradation-free usage for long time periods on the order of several years. Until today, these passivations are prepared mostly by polyimides or parylene, both of which are water vapor permeable to a certain degree. To remedy this deficiency, Atomic Layer Deposited (ALD) thin films are characterized regarding their electrical passivating features under conditions of accelerated aging, such as elevated temperatures in a liquid environment. The initial electrical passivation by various ALD deposited multilayers, combining alternating thin Al2O3 and TiO2 layers is the goal of this research as well as the stability of these layers under induced degradation. Such layers, in combination with a parylene passivation, would ensure a water vapor impermeable and biocompatible coating.

Intensive chemotherapy with idarubicin, cytarabine, etoposide, and G-CSF priming in patients with advanced myelodysplastic syndrome and high-risk acute myeloid leukemia.

In an attempt to improve the complete remission (CR) rates and to prolong the remission duration especially in elderly patients > 50 years of age, we have used a combination chemotherapy of idarubicin (10 mg/m2 IV x 3 days), cytarabine (AraC, 100 mg/m2 CIVI x 7d), and etoposide (100 mg/m2 x 5 days) in combination with granulocyte colony-stimulating factor (G-CSF) priming [5 mg/kg SQ day 1 until absolute neutrophil count (ANC) recovery] for remission induction. Responding patients received two consolidation courses of idarubicin, AraC, and etoposide, followed by a late consolidation course of intermediate-dose AraC (600 mg/m2 IV every 12 h x 5 days) and amsacrine (60 mg/m2 IV x 5 days). A total of 112 patients (57 male/55 female) with a median age of 58 years (range: 22-75) have been entered and are evaluable for response: 19 refractory anemia with excess of blast cells in transformation (RAEB-T), 84 acute myeloid leukemia (AML) evolving from myelodysplastic syndrome (MDS), and 9 secondary AML after chemotherapy/radiotherapy. The overall CR rate was 62%, partial remission (PR) rate 10%, treatment failure 16%, and early death rate 12%. The CR rate was higher in patients < or = 60 years (68 vs 55%), mainly due to a lower early death rate (5 vs 21%, p<0.001). After a median follow-up of 58 months, the median overall survival is 14.5% and median duration of relapse-free survival 8 months. After 60 months, the probability of CR patients to still be in CR and alive is 16% (20% in patients < or = 60 years and 13% in patients >60 years), while the probability of overall survival is 12% (15% in patients < or = 60 years and 9% in patients > 60 years). Compared to our previous trial (AML-MDS Study 01-92) which was done with identical chemotherapy but no G-CSF priming in 110 patients with RAEB-T, AML after MDS, or secondary AML (identical median age, age range, and distribution of subtypes), the CR rate in all patients, as well as CR rate, overall survival, and relapse-free survival in patients > 60 years have significantly been improved. Thus, intensive chemotherapy with G-CSF priming is both well tolerated and highly effective for remission induction in these high-risk patients.

100 years after grignard: where does the organometallic chemistry of the heavy alkaline Earth metals stand today?

Even a century after the discovery of the Grignard reagents, similar compounds of the heavy alkaline earth metals are still lacking. Owing to the industrial need for such compounds (in particular as anionic polymerization catalysts), the last few years have been marked by a rapid, extensive development which has culminated in the first structurally characterized alkylbarium derivatives such as the crown ether complex of bis(triphenylmethyl)barium (1). hmpt=hexamethylphosphoric acid triamide.

Polyhedral members of the Mg2nP2m family derived from dimeric magnesium trialkylsilylphosphandiide.

The magnesiation of tri(tert-butyl)silylphosphane in THF yields tetrameric (tetrahydrofuran-O)magnesium tri(tert-butyl)silylphosphandiide 1. The central moiety is a slightly distorted Mg4P4 cube with tetracoordinate magnesium and phosphorus atoms. The reaction of dibutylmagnesium with H2PSitBu3 in toluene gives tetramagnesium tetrakis[mu-tri(tert-butyl)silylphosphanide] bis[mu 4-tri(tert-butyl)silylphosphandiide] 2. The central fragment is a Mg4P2 octahedron with the phosphorus atoms in a trans position. The Mg...Mg edges are bridged by the phosphanide substituents. Crystallographic data of 1: C68H148Mg4O5P4Si4, monoclinic, P2(1)/c, a = 13.454(1) A, b = 26.123(1) A, c = 24.539(2) A, beta = 96.53(1) degrees, Z = 4; crystallographic data of 2: C72H166Mg4P6Si6, monoclinic, P2(1)/n, a = 13.951(1) A, b = 14.269(1) A, c = 24.209(2) A, beta = 102.415(1) degrees, Z = 2.

Novel Philadelphia variant t(Y;9;22)(q12;q34;q11) in a case of chronic myeloid leukemia.

A novel Philadelphia (Ph) variant translocation, t(Y;9;22)(q12;q34;q11), was detected in a 63-year-old man with a newly diagnosed chronic myeloid leukemia (CML). Reverse transcription polymerase chain reaction (RT-PCR) analysis revealed a b3a2 fusion transcript. Fluorescence in situ hybridization (FISH) utilizing library probes, subtelomeric cosmid probes, and probes hybridizing to the ABL and BCR genes showed a reciprocal three-way translocation involving Yq12, 9q34, and 22q11, and a BCR-ABL fusion signal on der(22). The subtelomeric Yq probe hybridizing centromerically to the IL9 receptor gene and covering the centromeric portion of the SYBL1 gene was found to be translocated to der(9).

Effective biomodulation by leucovorin of high-dose infusion fluorouracil given as a weekly 24-hour infusion: results of a randomized trial in patients with advanced colorectal cancer.

PURPOSE: To determine whether high-dose infusional fluorouracil (FU) is effectively modulated by leucovorin (LV), interferon (IFN) alpha-2b, or both when given to patients with metastatic colorectal cancer. PATIENTS AND METHODS: Patients (n = 236) with progressive, measurable disease were randomized to three groups and received FU 2,600 mg/m2 as a 24-hour continuous infusion (CI) weekly for 6 weeks with 2 weeks rest (FU24h) and LV 500 mg/m2 as a 2-hour infusion before FU or IFN 3 x 10(6) U subcutaneously 3 times weekly or both. Treatment continued until progressive disease or unacceptable toxicity was observed. Pairs of treatment arms were analyzed sequentially to detect equivalence or a 25% difference in response rates. RESULTS: The rate of objective remission in patients who received FU24h/LV (44%; 40 of 91) was significantly higher than in patients who received FU24h/IFN (18%; 16 of 90; P < .05). The response rates of patients who received FU24h/LV versus FU24h/LV/IFN (27%; 13 of 49) were statistically equivalent. Significant differences were observed for time to tumor progression (TTP) (FU24h/LV, 7.1 months; FU24h/IFN, 3.9 months; FU24h/LV/IFN, 6.3 months; global P value < .009) and survival (16.6 months, 12.7 months, 19.6 months, respectively; global P value < .04). Unpredictable and life-threatening toxicity in the FU24h/LV/IFN arm required dose reduction of FU to 2,000 mg/m2/day and early stoppage of this arm. Toxicity was manageable in patients who received both FU24h/LV (grade 3 to 4 diarrhea, 21%) and FU24h/IFN (grade 3 to 4 diarrhea, 15%). CONCLUSION: Response rate, TTP, and overall survival were superior for LV-containing regimens compared with IFN modulation alone. The addition of IFN to high-dose infusional FU plus LV offers no advantage and may increase toxicity. The regimen of high-dose infusional FU24h/LV warrants further evaluation in patients with metastatic colorectal cancer.

Synthesis of Tris(1,2-dimethoxyethane-O,O')barium Bis(2,2,5,5-tetramethyl-2,5-disilaphospholanide) and the Monomer-Dimer Equilibrium in Toluene Solution.

(1,2-Dimethoxyethane-O,O')lithium phosphanide (dme)LiPH(2) reacts with 1,2-bis(chloro-dimethylsilyl)ethane to give 2,2,5,5-tetramethyl-2,5-disilaphospholane, 1, as well as 1,1,4,4-tetramethyl-1,4-bis(2,2,5,5-tetramethyl-2,5-disilaphospholanyl)-1,4-disilabutane, 2 (P(2)Si(6)C(18)H(48), space group P&onemacr;, a = 943.3(2) pm, b = 1278.3(3) pm, c = 1413.3(2) pm, alpha = 72.45(1) degrees, beta = 78.13(1) degrees, gamma = 70.83(1) degrees, d = 1.081 g cm(-)(3), Z = 2, wR2 = 0.1553 at 6548 F(2) values). The reaction of 2,2,5,5-tetramethyl-2,5-disilaphospholane 1 and barium bis[bis(trimethylsilyl)amide] in 1,2-dimethoxyethane yields nearly quantitatively tris(1,2-dimethoxyethane-O,O')barium bis(2,2,5,5-tetramethyl-2,5-disilaphospholanide), 3A, which crystallizes in the monoclinic space group C2/c (BaP(2)Si(4)O(6)C(24)H(62), a = 2152.3(1) pm, b = 1381.5(1) pm, c = 1459.7(1) pm, beta = 113.73(1) degrees, d(calc) = 1.268 g cm(-)(3), Z = 4, wR2 = 0.0989 at 5220 F(2) values). Due to the high coordination number of eight of the barium center, rather long Ba-P distances of 333 pm are observed. With loss of the complexating ether solvent this compound forms a dimer 3B of the type R(dme)Ba(&mgr;-R)(3)Ba(dme)(2) in toluene or benzene solution as can be proven by (31)P{(1)H}-NMR spectroscopy ((2)J(P-P) = 6.7 Hz) and by X-ray structure analysis (Ba(2)P(4)Si(8)O(6)C(48)H(106), space group P2(1)/n, a = 1256.3(2) pm, b = 2000.0(3) pm, c = 2986.9(2) pm, beta = 98.929(9) degrees, d(calc) = 1.257 g cm(-)(3), Z = 4, wR2 = 0.1334 at 11580 F(2) values). The Ba-P bond lengths vary between 318 and 338 pm.

Azure B-eosin APAAP staining: a method for simultaneous hematological and immunological cell analysis.

Azure B-eosin APAAP staining allows simultaneous analysis of peripheral blood and bone marrow cells for hematological characteristics and immunological cell marker profiles. A defined sequence of staining procedures maintains characteristic components of the Romanowsky-Giemsa stain whereas cell antigens can be detected immunologically using the alkaline phosphatase-anti-alkaline phosphatase (APAAP) detection system. Antigens are visualized by the staining product of the substrate-naphthol AS GR phosphate and variamine blue salt. The usefulness of the azure B-eosin APAAP method was demonstrated on blood and bone marrow smears of patients with various hematological disorders.

From ill-defined extracts to the immunomodulatory lectin: will there be a reason for oncological application of mistletoe?

There is an obvious discrepancy between the popularity of mistletoe extracts and their classification as a non-conventional treatment modality with unproven efficacy in oncology. The commercial preparations suffer from several major drawbacks: lack of precise declarations for the molecular characteristics and the concentrations of diverse extract constituents; the composition of extracts can even be influenced by the different methods of preparation, the time of harvest, and the type of host tree; lack of experimentally substantiated instructions for the dose of supposedly effective substance(s) and the schedule of applications to clinically trigger an undisputably documented antitumoral activity; lack of thorough clinical studies according to the generally accepted criteria as the measure for responsible recommendations. To provide the indispensable set of data for a rational decision, the immunomodulatory galactoside-specific lectin was biochemically characterized and its antitumoral/antimetastatic activity was documented in three murine tumor model systems, occurring within a narrow dose range. Biweekly treatment with s.c. injections of a lectin dose of 1 ng/kg caused no notable harmful side-effects in patients, who showed modulation of selected immune parameters. In a group of 23 patients with advanced cancer no at least partial remission was seen. In principle, enhancement of factors like cytokine availability or NK-cell activity is not necessarily linked to therapeutic benefit. Factors such as growth promotion of certain tumor cell lines by cytokines, occurrence of respective insensitivity in advanced stages or varying levels of target sensitivity to cell-mediated cytotoxicity with significant interindividual differences deserve attention. Each tumor class has to be considered separately for its responsiveness.(ABSTRACT TRUNCATED AT 250 WORDS)

Feasibility study of postoperative adjuvant chemotherapy and radiotherapy for soft-tissue sarcoma.

In a nonrandomized trial, postoperative, adjuvant, combined chemotherapy and radiotherapy were given to 17 patients with high-grade soft-tissue sarcomas. All patients had undergone conservative limb-sparing surgery. Soft-tissue sarcomas were localized in the extremities (13 patients), superficial trunk (3), and neck (1). In all, 13 patients received 50 mg/m2 doxorubicin and 5 g/m2 ifosfamide with mesna uroprotection for a total of 6 cycles and 4 patients received CYVADIC (cyclophosphamide/vincristine/doxorubicin/dacarbazine). Chemotherapy was started immediately after wound healing. Irradiation using the shrinking-field technique was commenced 3-7 days following chemotherapy; a total dose of 65 Gy was applied. The major side effects of chemotherapy were nausea and vomiting [17 of 17 patients, 5 experiencing World Health Organization (WHO) grade 3 toxicity and 1, WHO grade 4], leukopenia of <3.0 x 10(9)/l (17 patients), and leukopenia of <1.0 x 10(9)/l (7 patients). The median leukocyte nadir was reached on day 11 (range, days 7-16). The duration of critical leukopenia did not exceed 1 week. Reversible alopecia occurred in all patients. Temporary cardiomyopathy was recorded in 1 patient. Following radiotherapy, 11 episodes of epitheliolysis and 1 case of moderate lymphedema were documented. There was no life-threatening condition. After a follow-up of 58 months, the outcome was as follows: disease-free survival, 9 patients; distant metastases, 7; local recurrence, 1. Excluding 3 patients who entered the study after undergoing surgery for local relapse, the rate of distant metastases was 36%. In summary, the postoperative use of chemotherapy/radiotherapy is feasible, producing relevant but manageable toxicity. This combination results in effective local tumor control with good functional results following limb-sparing surgery. The incidence of distant metastases, however, is high.

Treatment results of the thioether lipid ilmofosine in patients with malignant tumours.

In a multicentre study patients with liver metastases stratified to the histology of the primary tumour were investigated. A total of 102 patients with colorectal adenocarcinoma, non-small-cell lung cancer, pancreatic cancer, primary liver carcinoma and malignant melanoma were treated with the thioether lipid ilmofosine. The drug was administered orally as a tablet at a dosage of 150-300 mg/day (75 mg/tablet). The tolerability of ilmofosine was poor. There was a dose-limiting gastrointestinal toxicity with nausea, vomiting and loss of appetite (WHO grade II-IV) in 67% of patients. During the period of therapy (1-29 weeks, 8.5 weeks mean) no complete remission and no partial response were observed. We thus conclude that treatment with oral ilmofosine is not effective in patients with liver metastases due to various malignancies.

[Malignant lymphoma associated with HIV infection]. / Mit der HIV-Infektion assoziierte maligne Lymphome.

The course of disease in 119 HIV-infected patients (117 men, 2 women; median age 38.5 years) with malignant tumours other than Kaposi's sarcoma was analyzed in a multi-centre retrospective study. This was conducted to obtain initial information concerning the incidence, clinical features and results of therapy in HIV-associated neoplasms, especially malignant lymphomas. The most frequent tumour was malignant non-Hodgkin's lymphoma (98 patients, 82.5%), seven patients had Hodgkin's disease, five had solid tumours, four a polyclonal lymphoproliferative syndrome, three an acute lymphocytic leukaemia, and two had other lymphoproliferative diseases. 58% of the non-Hodgkin's lymphomas occurred in patients with marked immunodeficiency, 85% were high grade malignancies and 47% had primary extranodal disease. 56% of primary nodal lymphomas also had visceral spread (Stage IV). Lymphoblastic non-Hodgkin's lymphoma was more common in patients with favourable immunological status, presented less frequently with primary extranodal disease, was diagnosed earlier than other non-Hodgkin's lymphomas, and appeared to carry a better prognosis. 78 out of the 98 patients with non-Hodgkin's lymphoma had been treated, 66 with cytotoxics. The median survival time was 6 months. Longer remission periods, of at least 12 months, were seen in ten of the 78 patients (13%). Despite the overall poor prognosis and the pre-existing immune defect, palliative (chemo-)therapeutic measures are both justified and promising, and may also result in life-prolonging remissions.

Oral administration of idarubicin as first line cytostatic therapy in patients with metastasized breast cancer and favourable prognosis. A trial of the phase II study group of the Association for Medical Oncology of the German Cancer Society.

Idarubicin is a new anthracycline derivative with therapeutic efficacy in metastatic breast cancer. In a phase II trial we treated 23 patients with advanced breast carcinoma and favourable prognostic factors. Oral dose of idarubicin was 15 mg/m2 day 1-3 repeated every 3 weeks. All patients were pretreated with hormones. Idarubicin was administered as first line chemotherapy. 20 patients were evaluable for response: 3 patients achieved partial remission, 12 patients stable disease; tumour progression occurred in 5 patients. 3 patients were not evaluable for response because only 1 treatment cycle was administered. Main toxicites were leukopenia (median WHO-grade: 2,r:0-4), nausea and vomiting (median: 1,r:0-4) and alopezia (median: 1,r:0-3). 1 patient died in septic shock: Immediately after the administration of one idarubicine cycle, she was extensively irradiated because of bone metastasis. The fatal course of the disease in this patient does not depend only on the idarubicin therapy, but also on the extensive bone infiltration and on intensive radiation therapy. Idarubicin proved to be an effective drug in metastatic breast cancer with low systemic toxicity and the advantage of oral administration. The drug is an enrichment of therapeutic armament, especially in patients with soft tissue and bone metastasis.

Acute megakaryoblastic leukemia: a case report.

We present a case of acute megakaryoblastic leukemia identified by electron microscopy and platelet-specific antibodies. The histological examination of bone marrow showed distinct myelofibrosis. In accordance with recent communications, low-dose cytosine arabinoside treatment (20 mg twice daily s.c. over 21 days) was initiated. The subsequent bone marrow examination showed a severe hypoplasia with persistent blasts. Amsacrine and VP-16 were given without success. Finally the patient died of septicemia without proof of pathogen uninfluenced by antibiotic and antiseptic therapy 6 weeks after diagnosis. Our case report confirms the poor prognosis of acute megakaryoblastic leukemia.

Treatment with locally applied mitoxantrone.

In 30 patients mitoxantrone was administered via an intracavitary route intraperitoneally, intrapleurally or intrapericardially. From 13 patients with malignant pleural effusion 5 showed a complete and 3 a partial remission. 2 of 2 patients with pericardial effusion showed a complete remission. From 16 patients with peritoneal carcinosis 4 showed a complete and 3 a partial remission.

Fatal Hodgkin and non-Hodgkin lymphoma associated with persistent Epstein-Barr virus in four brothers.

Three brothers from one family died of Hodgkin disease and a fourth brother from a diffuse malignant non-Hodgkin lymphoma. This patient exhibited a constant deficiency of serum immunoglobulins and elevated antibody titers to Epstein-Barr viral antigens. Epstein-Barr virus DNA sequences were detected in DNA isolated from lymph node biopsies from two of the patients. Initially, no abnormalities in the numbers of B and T cells could be detected. Peripheral blood lymphocytes of the patients did not react in the mixed lymphocyte culture assay. We suggest that an immune deficiency to Epstein-Barr virus may favor the proliferation of malignant lymphocytes after Epstein-Barr viral infection. Monoclonal lymphoid B cell lines established spontaneously in vitro from a lymph node biopsy specimen and from peripheral blood specimens from two of the patients. The cells harbor Epstein-Barr viral DNA sequences in multiple genome equivalents and express Epstein-Barr nuclear antigen. The cells contain a tenfold increased level of c-fgr-related RNA transcripts compared with peripheral blood lymphocytes of healthy adults. No obvious amplifications or translocations of the c-myc, c-abl, or c-fgr gene could be detected.

[Clinical experience with bacterial contamination of Port-A-Cath systems in tumor patients]. / Klinische Erfahrungen mit bakteriell kontaminierten Port-A-Cath-Systemen bei Tumorpatienten.

In 33 cancer patients with subcutaneously implanted Port-A-Cath systems (Pharmacia) who developed bacteremia with rigor and high fever, aerobic and anaerobic cultures were prepared from aspirated chamber blood. Organisms were isolated from 19 patients of whom 10 had fever, but none life-threatening. In seven patients the fever was caused by infected chamber blood, while in three it was impossible to prove whether it was due to chamber contamination or the underlying disease. Almost all of the causative organisms were skin saprophytes, most frequently Staph. epidermidis, Acinetobacter Iwoffi and apathogenic Corynebacteria. The pathway of infection was probably exogenous (iatrogenic) inoculation. Removal of the catheter system was not necessary. Since strict hygienic measures were instituted when using the system no further chamber contamination has occurred.