Hypogonadism following prostate-bed radiation therapy for prostate carcinoma.

BACKGROUND: The degree of testicular damage resulting from primary treatment of prostate carcinoma by external beam radiation therapy (EBRT) to the prostate bed has not been determined. If significant testicular damage has occurred, the resulting endocrine changes may result in modified tumor behavior, contribute to postradiation impotence, and may aggravate other signs and symptoms of hypogonadism, potentially influencing a patient's choice of primary treatment for his tumor. METHOD: Three to eight years after primary treatment for localized prostate carcinoma, serologic evaluation for hypogonadism was undertaken in 33 men who had received EBRT and in 55 similar men who had received radical prostatectomy (RP). No subjects had developed recognized tumor recurrence, and none had undergone hormonal treatment since primary therapy. RESULTS: Among men of similar age, prior treatment with EBRT was associated with significantly more frequent hypogonadism than prior treatment with RP. In men with EBRT, total testosterone levels averaged 27.3% less, free testosterone levels 31.6% less, dihydrotestosterone levels 33.4% less, luteinizing hormone (LH) levels 52.7% greater, and follicle-stimulating hormone (FSH) levels 100% greater than those values in men who had prior treatment with RP. Differences between postradiation and postsurgical men in LH and FSH levels were most prominent in men older than 70 years. CONCLUSIONS: Three to eight years after primary treatment for prostate carcinoma, striking hormone differences were present between men who had received EBRT to the prostate bed and those with prior RP. These differences strongly suggested that prominent and permanent testicular damage was sustained during EBRT, frequently severe enough to cause hypogonadism.

Estrogen therapy for depression in postmenopausal women.

OBJECTIVE: To look at the modification in depressive mood in postmenopausal depressed women after estrogen replacement therapy (ERT). METHOD: Twelve depressed patients divided into two groups of six women each were studied. One group received conjugated equine estrogens (CEE) 0.625 mg/day; the other did not receive any treatment (control group). Mood was assessed in all the subjects at baseline and at 6 months with Hamilton Rating Scale score and considered as depression when it was > 15. Differences between groups were determined by Mann-Whitney U-test, and in each group between baseline and 6-month values with Wilcoxon test. RESULTS: The ERT group had a statistically significant decrease in depressive mood (21 vs. 13 points, P < 0.03), while in the control group no significant change was found. Final Hamilton scale scores were significantly lower (P < 0.05) in those under ERT, when compared with those in the control group. CONCLUSION: Depressive mood decreased after 6 months with CEE, so the prescription of ERT can be useful in postmenopausal women with depressive mood.

Complete hematologic remissions in chronic-phase, Philadelphia-chromosome-positive, chronic myelogenous leukemia after 2-chlorodeoxyadenosine.

BACKGROUND: 2-Chlorodeoxyadenosine (Cladribine, Leustatin, Ortho Biotech, Raritan, NJ) (2-CdA) is a purine analog with activity in the treatment of lymphoid neoplasms. Interferon induces cytogenetic remissions in chronic myeloid leukemia (CML) and partial remissions in hairy cell leukemia, a disorder in which single courses of 2-CdA induce complete remissions. In vitro clonal growth of immature myeloid progenitors from normal marrow is markedly inhibited by 2-CdA. METHODS: 2-CdA was administered to 12 patients with Philadelphia-chromosome-positive CML, 11 chronic phase, and 1 accelerated phase, at 0.1 mg/kg/day by continuous intravenous infusion for 7 days every 28-35 days, until maximum peripheral hematologic response. RESULTS: Of 12 patients, 10 (83%) achieved complete hematologic responses and 2 (17%) partial hematologic responses after a median of two courses of 2-CdA. The median first hematologic response duration was 3 months. Of the seven patients who relapsed and were retreated with a median of two further courses of 2-CdA, five obtained responses (four complete and one partial) and two did not respond. The median second hematologic response duration was 4 months. No patient had significant Philadelphia-chromosome suppression. Reversible myelosuppression and severe cumulative T-cell immunosuppression associated with opportunistic infections in four patients were the principal toxicities. CONCLUSIONS: 2-CdA is active in CML, inducing complete hematologic responses, but the absence of cytogenetic responses and severe immunosuppression may limit its clinical use.

A less costly regimen of alglucerase to treat Gaucher's disease.

BACKGROUND: Alglucerase (Ceredase) provides effective enzyme-replacement treatment for patients with Gaucher's disease, but at the usually recommended dose of 60 U per kilogram of body weight every two weeks (130 U per kilogram per month), it costs $382,200 per year for a 70-kg patient. Theoretical considerations suggest that more frequent administration would be more efficient. METHODS: Fourteen patients with type 1 Gaucher's disease that was moderately severe to severe were given 30 U of alglucerase per kilogram per month, in divided doses given either daily or three times weekly, or 120 U given three times weekly. The effect of the treatment on the size of the liver and spleen and on blood counts was compared with published data on patients who received a total dose four to five times as large as the lower dose we used and who received treatment every two weeks. RESULTS: The response to 30 U of alglucerase per kilogram per month, fractionated into three or seven doses weekly, was approximately the same as that reported after the administration every two weeks of a dose four or five times as large, given in the large infusions usually recommended. A fourfold increase in the dose given three times weekly, from 2.3 to 9.2 U per kilogram, did not substantially increase the rate of improvement. CONCLUSIONS: The treatment of Gaucher's disease with smaller total doses of alglucerase given more frequently yields satisfactory results. A dose of 2.3 U per kilogram three times weekly yields major financial benefits with no sacrifice of therapeutic effect. Even taking into account the increased ancillary costs of more frequent administration, this method of administering alglucerase reduces the annual cost of the drug for a 70-kg patient to about $100,000.

[The nutritional and health status of the Latin American woman]. / La situación nutricional y de salud de la mujer latinoamericana.

Latin America is a region where countries have various levels of socioeconomic development. Thus, the living standards and health status of its people differ significantly in the midst of a mosaic of social, ethnic, cultural and economic realities. Social inequalities and extreme poverty determine significant differences, not only in the magnitude of health indicators, but also in the type of pathology prevalent. People in the high socioeconomic levels are affected by nutritional diseases characterized by excessive food intake, while people from the low socioeconomic levels are affected by undernutrition and its associated pathology. Undernutrition occurs fundamentally among the age groups at higher risk in the population segments with low income, low food intake, illiteracy and poor access to the health care and preventive medicine centers. Among families exposed to undernutrition, women are usually in worse condition than men. This is due to the long working hours and the increased nutritional requirements caused by frequent gestations and prolonged lactation. It is estimated that one fourth of newborns in Latin America are affected by low birth weight, which has been associated to adolescent mothers, their excessive physical work, anemia, low maternal pregestational weight, low weight gain during gestation, and frequent maternal infections. Nutritional anemia due to iron deficiency is highly prevalent among pregnant women in Latin America. In some countries, the prevalence of folate deficiency during pregnancy appears to have increased significantly in the past 15 years and is becoming a nutritional problem that needs preferential attention. Diets generally are inadequate and, in the case of pregnant and lactating women, usually deficient in calories, protein, iron and folic acid. It is urgent that the health and nutritional status of Latin American women of low socioeconomic condition be given special attention, particularly mothers during gestation and lactation. Otherwise, women will not be able to altogether fulfill their important role in the home and within the family, nor will they successfully participate in the economic development of their countries.

Chronic malnutrition, dental caries, and tooth exfoliation in Peruvian children aged 3-9 years.

A cross-sectional evaluation of dental caries in primary teeth and nutritional status was conducted involving 285 Peruvian children from low socioeconomic conditions aged 3-9 y. Forty-nine percent of the children were found to be chronically malnourished (stunted) whereas acute malnutrition (wasting) was infrequent (2%). Stunted children showed a delayed exfoliation of primary teeth. The caries prevalence curve as a function of age (ie, a plot of decayed, extracted, and filled teeth vs age) was found to be shifted to the right by approximately 15 mo in stunted children as compared with well-nourished children. Children aged 7-9 y with stunted growth showed a significantly higher percentage of carious teeth than did well-nourished children of the same age (40 and 29%, respectively; p less than 0.005). Nutritional deficits that lead to chronic malnutrition not only may affect tooth exfoliation but also appear to render the primary teeth more susceptible to caries attack later in life.

Chromosome studies in human subjects chronically exposed to arsenic in drinking water.

A two-year study was carried out on human subjects of various ages and backgrounds who had been drinking water containing more than 0.05 mg/liter (0.05 ppm) arsenic for a period of at least five years. The main aim was to correlate the frequency of chromosome aberrations and sister chromatid exchanges in the lymphocytes with the amount of arsenic in the water. In addition, we explored the incidence of skin cancer, fetal wastage, and genetic or developmental abnormalities. Several other variables--eg, coffee, wine, and cigarette consumption; sex; residence (rural vs urban); and exposure to chemicals, smelters, or pesticides--were also taken into consideration. The data on chromosome aberrations (104 exposed and 86 control individuals) and on sister chromatid exchanges (98 exposed and 83 control individuals) did not show that arsenic at concentrations used by our population (greater than 0.05 mg/liter) has any effect on these parameters. Similarly, no other health effects of arsenic at these concentrations were found.

Sequence of centromere separation: lack of Colcemid effect on the Chinese hamster genome.

This study describes the sequence of centromere separation in the Chinese hamster genome and the lack of any effect of Colcemid on this sequence. Analysis of bone marrow cells using sequential Giemsa staining and Q-banding established the sequence of centromere separation in cells derived from four Colcemid-treated and three untreated animals. Treatment of the data by use of the ANOVA test showed that the sequences established in the Colcemid-treated group did not differ from those in the untreated animals. The sequence of centromere separation in the Chinese hamster, as expressed by the pooled data from all seven animals, is chromosomes 1 and 2, followed by 3, 4, X, Y, 8, 9, 10, 5, 6, and 7.