Phase II study on weekly bolus topotecan in advanced or recurrent cervical cancer.

OBJECTIVE: It was the aim of our study to evaluate the efficacy and safety of weekly topotecan in patients with advanced or recurrent cervical disease. METHODS: Topotecan was administered intravenously as a weekly infusion at a dose of 3.5 mg/m(2) on days 1, 8 and 15 of a 28-day cycle. After the second cycle, the dose was increased to 4 mg/m(2) if no grade >2 toxicity occurred. Treatment was continued until disease progression or unacceptable toxicity. RESULTS: Twenty-one patients were enrolled, but only 18 were evaluable for response and toxicity. Ten patients (56%) had received primary surgery + chemoradiation, 6 patients (33%) had previously received surgery + chemotherapy and 2 patients (11%) exclusive chemoradiation. Patients received a mean of 3.5 courses (range 1-6). No complete or partial responses were reported. Two patients (11%) presented disease stabilization as maximum response. Median progression-free survival was 11 weeks (95% CI 15-25), and median overall survival was 28 weeks (95% CI 24-72). The treatment was generally well tolerated. CONCLUSIONS: This trial did not report any activity of weekly bolus topotecan in the treatment of advanced or recurrent cervical cancer. Actually, there is no evidence to recommend this therapy in this patient population.

Intensive treatment strategies may not provide superior outcomes in mantle cell lymphoma: overall survival exceeding 7 years with standard therapies.

BACKGROUND: Reported median overall survival (OS) in patients with mantle cell lymphoma (MCL) has been reported to be just 3-4 years. As a consequence, first-line treatment has become more aggressive. Single-center studies with R-Hyper-CVAD and/or autologous stem-cell transplant (ASCT) have produced 3-year OS rates >80%, prompting many to adopt their use. We evaluated outcomes from a single-center cohort managed in a more traditional fashion. METHODS: We identified patients with MCL evaluated at Weill Cornell Medical Center since 1997, and included those with known date of diagnosis. An online social security database was used to verify survival. RESULTS: We identified 181 patients with MCL, and date of diagnosis could be determined in 111. Three-year OS from diagnosis was 86% [95% confidence interval (CI) 78% to 92%]. Median OS was 7.1 years (95% CI 63-98 months). Adequate information on therapy was available for 75 patients. Only five were treated upfront with (R)-Hyper-CVAD or ASCT while an additional four patients received one of these regimens subsequently. Treatment type had no significant effect on OS. CONCLUSION: Outcomes with standard approaches can yield similar survival to that achieved with more intensive approaches. Biases may account for the perceived superiority of aggressive strategies.

Phyto-oestrogens in the prophylaxis of menstrual migraine.

BACKGROUND: Falling levels of estrogen is the major provocative factor in migraine associated with menstruation. OBJECTIVE: We assessed the efficacy of the combination of two phyto-oestrogens, as perimenstrual, prophylactic treatment of menstrual migraine and tested their effect on cerebral haemodynamic. SUBJECTS AND METHODS: Women with a history of menstrual migraine (i.e., attacks occurring exclusively on day 1+/-2 days of menstruation and at no other time of the cycle) were included in the study. Eleven women fulfilling the inclusion criteria underwent to a 3-month cyclic treatment with 56 mg of genisteine and 20 mg of diadzeine per day. Transcranial doppler evaluation (TCD) was performed at baseline and after treatment. RESULTS: Among the ten women who completed the study the average number of days with migraine during the baseline period decreased significantly after 3 months of therapy (P < 0.005). There were no major side-effects. Therapy did not affect cerebral blood flow velocities. CONCLUSIONS: Phyto-oestrogens appear to be an effective treatment in menstrual migraine prophylaxis. This effect seems to be unrelated to cerebral hemodynamic. Placebo-controlled trials on larger number of patients are necessary to confirm our findings.

[Abdominal actinomycosis and retroperitoneal fibrosis. Considerations on a clinical case]. / Actinomicosi addominale e fibrosi retroperitoneale. Considerazioni su di un caso clinico.

Abdominal actinomycosis is a rare disease which often resembles an acute suppurative infection or/and abdominal tumour causing abscesses, fistulas and massive fibrosis. The preoperative diagnosis is difficult and surgical exploration is always needed because of major involvement of visceral and retroperitoneal structures. The disease can be diagnosed with certainty only on the basis of findings of bacterial colonies in histopathologic sections and typical sulphur grains in secretions from fistulas. The authors describe a case of abdominal actinomycosis involving the caecum and right colon, causing extensive retroperitoneal fibrosis and a fistula tract with an external cutaneous orifice at the level of the right iliac crest. These features resembled an acute appendicitis at first, and several surgical explorations were required before a correct diagnosis could be achieved. Abdominal actinomycosis can be treated by simple administration of antibiotics. With a correct diagnosis, medical therapy alone has proved effective in a substantial percentage of patients, thus avoiding the need for surgery, if important visceral or retroperitoneal structures are not involved. Abdominal actinomycosis always requires a careful differential diagnosis and must be considered in patients presenting abdominal tumours associated with abscesses and/or fistulas since early and efficient medical therapy, along with surgical intervention, where necessary, can lead to definitive recovery. Useful diagnostic tools are abdominal CT and selective FNAB.

Randomized trial of the use of heliox as a driving gas for updraft nebulization of bronchodilators in the emergent treatment of acute exacerbations of chronic obstructive pulmonary disease.

OBJECTIVE: To determine whether the bronchodilator effects of albuterol and ipratropium bromide are greater if updraft nebulization is driven by 80% helium and 20% oxygen (HELIOX) than if driven by compressed room air (AIR) during the treatment of an acute exacerbations of chronic obstructive pulmonary disease (COPD). SETTING: The emergency department of a 750-bed inner-city community hospital. METHODS: Over a 12-month period, a convenience sample of 50 normoxic patients presenting with signs and symptoms of an acute exacerbation of COPD were prospectively randomized to receive either HELIOX or AIR as the driving gas for updraft nebulization of a mixture of albuterol 2.5 mg and ipratropium bromide 0.5 mg. Additional aerosol treatments with albuterol 2.5 mg were given at 20, 40, and 120 mins after randomization using the assigned gas. Spirometry was obtained while breathing room air before the first treatment (baseline) and at 1 hr and 2 hrs after the initiation of treatment. The primary measure of efficacy was the change in percent of predicted forced expiratory volume in 1 sec (FEV1) over the treatment period. A secondary measure of efficacy was the change in percentage of predicted forced expiratory flow after 25% to 75% of vital capacity had been expelled (FEF25-75). RESULTS: Twenty-five patients were randomized to each treatment group. Three patients (1 HELIOX, 2 AIR) were unable to complete the study. The baseline FEV1was 44% (95% confidence interval, 35% to 52%) of predicted in the HELIOX group and 39 (31% to 46%) of predicted in the AIR group. There were no adverse outcomes observed in either the HELIOX group or the AIR group. There were no significant differences in the change of FEV1 between the two groups by either the 1 hr or 2 hr time point (1 hr, HELIOX + 10% [7% to 13%], AIR + 9% [5% to 13%]; 2 hr HELIOX + 10% [6% to 15%], AIR + 10% [6% to 14%]). The improvement in FEF25-75 was significantly greater in the HELIOX group than in the AIR group at both the 1 hr time point (HELIOX + 14% [7% to 22%] vs. AIR + 7% [3% to 10%], p = .05) and at the 2 hr time point (HELIOX + 15% [8% to 21%] vs. AIR + 7% [4% to 11%], p = .05). CONCLUSION: Use of HELIOX as a driving gas for the updraft nebulization of bronchodilators during the first 2 hrs of treatment of an acute COPD exacerbation failed to improve FEV1 faster than the use of AIR. The faster improvement in FEF25-75 during the first 2 hrs of treatment was small and of uncertain clinical significance.

[Considerations on patient admission to the psychiatric services]. / Considerazioni sull'accoglimento in un servizio psichiatrico.

In this article the authors consider in a psychoanalytic way the theme of the reception inside a psychiatric territorial service. At the beginning, they underline some characteristics about the psychiatric demand and the setting in a public context, then they describe their experience. After examining how the initial time of the relation influences the subsequent evolution of the therapeutic relation, they conclude with the individuation in the style of relation showed by the patient the lived field, that can be changed into a mental and representative space from an acted and fragmentary space. The skill of the service in changing the field of treatment proposed by the patient, in a field which transforms the action into therapeutic trials, becomes essential at the beginning of the relationship.

Afferent spontaneous electrical activity promotes the survival of target cells in the developing retinotectal system of the rat.

This study was undertaken to investigate the role of afferent spontaneous electrical activity in regulating death of target cells in the developing mammalian visual system. We show here that naturally occurring cell death in the rat superior colliculus is greatly augmented when the spontaneous firing of retinal ganglion cells is transiently blocked with TTX. An increased number of dying cells is already observed after 1 hr of afferent blockade. A 50% increase of cell death is reached after 3 hr of blockade, an effect that closely parallels increased cell death caused by eye enucleation after similar intervals of time. These results suggest that, during development, input cells exert a trophic action on target cells, which is prevented by silencing input electrical activity. A likely explanation of this effect is that the spontaneous firing of input cells causes the release by afferent fibers of a trophic agent promoting the survival of target cells.

[Circadian rhythm of retinal critical fusion frequency (CFF)]. / Ritmo cricadiano della frequenza critica di fusione centrale retinica (CFF).

The measure of the fusion critical Frequency investigates the cerebral and retinal blood circulation. It has been carried out by means of Modugno-Rispoli apparatus in 11 subjects with a circadian procedure. A circadian rhythm was detected in right eye, left eye and both eyes with acrophases respectively at 11,57, 11.19 and 11.31 hrs. It is concluded that the existence of the oscillations of the cerebral vascular efficiency could have a practical implications in both diagnosis and therapy of related disease.