Measurements of magnetic field fluctuations in TJ-II plasmas with new in-vessel helical arrays of magnetic coils.

This paper describes two new helical arrays of magnetic coils recently installed inside the TJ-II vacuum vessel. Their main objective is the precise measurement of the spatial periodicity of the magnetohydrodynamic perturbations usually found in the TJ-II plasmas. Given the high probability of coil failures due to the harsh plasma environment and in view of the extremely difficult access to the TJ-II vessel interior for maintenance, the coil system has been divided in two quasi-identical helical arrays. Both arrays consist of 32 triaxial sensors measuring orthogonal components of the local magnetic field along an ideal helical path whose trajectory runs close to the plasma edge. A description of the main characteristics of coils and arrays as well as their nominal positioning along an ideal helical path, inside the vessel, is given. A precise experimental determination of the real spatial orientation of the coils is performed by comparing the signals measured in current ramp-up and ramp-down experiments with calculations based on a filamentary model for the TJ-II magnetic coils. After this fine calibration procedure, it is possible to analyze the dependence of the amplitude of the measured magnetic field and its fluctuations as a function of the coil distance to the last closed flux surface. The study of the phase evolution of the parallel and perpendicular oscillatory components is also enabled. Finally, two examples of mode number determination are shown. One corresponds to a low frequency mode appearing in pure electron cyclotron resonance heating plasma, and the other one shows several modes observed during combined injection of both co and counter neutral beams and identified as shear Alfvén waves.

[Efficacy and safety of transcranial magnetic stimulation in patients with non-fluent aphasia, following an ischaemic stroke. A controlled, randomised and double-blind clinical trial]. / Eficacia y seguridad de la estimulacion magnetica transcraneal en pacientes con afasia no fluente, posterior a ictus isquemico. Ensayo clinico controlado, aleatorizado y doble ciego.

INTRODUCTION: Non-fluent aphasia is a frequent complication in post-ischemic stroke patients, with repetitive transcranial magnetic stimulation (rTMS) being one of the possible treatment alternatives. AIM: To assess the efficacy and safety of rTMS in patients with non-fluent after-ischemic stroke aphasia. PATIENTS AND METHODS: Double blind, randomized controlled clinical trial in post-stroke patients who were assigned to receive 10 sessions (one daily) of active treatment or placebo of rTMS, without the addition of language therapy. The baseline characteristics were compared initially and the efficacy between the active group versus the placebo group at day 30 was evaluated through a Mann-Whitney U test. RESULTS: 82 patients were included: active group (n = 41) and placebo group (n = 41). At baseline, statistically significant differences were found between the groups in favor of the placebo in the domains of the Boston test of auditory compression (p = 0.024), denomination (p = 0.014) and praxis (p = 0.026), and also occurred on the 30th day in the naming domains (p = 0.037) and reading (p = 0.001). There were 39 adverse reactions: 23 (26.83%) in the active group vs 16 (21.96%) in the placebo group (p = 0.290); the majority corresponded to episodes of mild headache. CONCLUSION: rTMS is a safe therapy, however, given the conditions of this study, we could not demonstrate the efficacy of rTMS versus placebo in patients with non-fluent aphasia with involvement of Broca's area after an ischemic stroke.

TITLE: Eficacia y seguridad de la estimulacion magnetica transcraneal en pacientes con afasia no fluente, posterior a ictus isquemico. Ensayo clinico controlado, aleatorizado y doble ciego.Introduccion. La afasia no fluente es una complicacion frecuente en pacientes postictus isquemico y la estimulacion magnetica transcraneal repetitiva (EMTr) representa una de las posibles alternativas de tratamiento. Objetivo. Evaluar la eficacia y la seguridad de la EMTr en pacientes con afasia no fluente postictus isquemico. Pacientes y metodos. Ensayo clinico controlado doble ciego, aleatorizado, en pacientes postictus isquemico que fueron asignados a recibir 10 sesiones (una diaria) de tratamiento activo o placebo de EMTr, sin adicion de terapia del lenguaje. Las caracteristicas basales fueron comparadas inicialmente, y la eficacia entre el grupo activo frente al grupo placebo el dia 30 se evaluo a traves de una prueba U de Mann-Whitney. Resultados. Se incluyo a 82 pacientes: grupo activo (n = 41) y grupo placebo (n = 41). Se encontraron diferencias basales estadisticamente significativas entre los grupos a favor del placebo en los dominios del test de Boston de compresion auditiva (p = 0,024), denominacion (p = 0,014) y praxis (p = 0,026), e igualmente ocurrio el dia 30 en los dominios de denominacion (p = 0,037) y lectura (p = 0,001). Se presentaron 39 reacciones adversas, 23 en el grupo activo (26,83%) frente a 16 (21,96%) en el grupo placebo (p = 0,290), y la mayoria correspondia a episodios de cefalea leve. Conclusion. La EMTr es una terapia segura, pero dadas las condiciones de este estudio, no pudo demostrarse la eficacia de la EMTr frente al placebo en pacientes con afasia no fluente con afectacion del area de Broca posterior a un ictus isquemico.

Comparison of plasma ctDNA and tissue/cytology-based techniques for the detection of EGFR mutation status in advanced NSCLC: Spanish data subset from ASSESS

Purpose: The analysis of epidermal growth factor receptor (EGFR) mutations in many patients with advanced non-small-cell lung cancer (aNSCLC) has provided the opportunity for successful treatment with specific, targeted EGFR tyrosine kinase inhibitors. However, this therapeutic decision may be challenging when insufficient tumor tissue is available for EGFR mutation testing. Therefore, blood surrogate samples for EGFR mutation analysis have been suggested. Methods: Data were collected from the Spanish cohort of patients in the large, non-interventional, diagnostic ASSESS study (NCT01785888) evaluating the utility of circulating free tumor-derived DNA from plasma for EGFR mutation testing. The incidence of EGFR mutation in Spain and the level of concordance between matched tissue/cytology and plasma samples were evaluated. Results: In a cohort of 154 eligible patients, EGFR mutations were identified in 15.1 and 11.0% of tumor and plasma samples, respectively. The most commonly used EGFR mutation testing method for the tumor tissue samples was the QIAGEN Therascreen® EGFR RGQ PCR kit (52.1%). Fragment Length Analysis + PNA LNA Clamp was used for the plasma samples. The concordance rate for EGFR mutation status between the tissue/cytology and plasma samples was 88.8%; the sensitivity was 45.5%, and the specificity was 96.7%. Conclusions: The high concordance between the different DNA sources for EGFR mutation testing supports the use of plasma samples when tumor tissue is unavailable

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Comparison of plasma ctDNA and tissue/cytology-based techniques for the detection of EGFR mutation status in advanced NSCLC: Spanish data subset from ASSESS.

PURPOSE: The analysis of epidermal growth factor receptor (EGFR) mutations in many patients with advanced non-small-cell lung cancer (aNSCLC) has provided the opportunity for successful treatment with specific, targeted EGFR tyrosine kinase inhibitors. However, this therapeutic decision may be challenging when insufficient tumor tissue is available for EGFR mutation testing. Therefore, blood surrogate samples for EGFR mutation analysis have been suggested. METHODS: Data were collected from the Spanish cohort of patients in the large, non-interventional, diagnostic ASSESS study (NCT01785888) evaluating the utility of circulating free tumor-derived DNA from plasma for EGFR mutation testing. The incidence of EGFR mutation in Spain and the level of concordance between matched tissue/cytology and plasma samples were evaluated. RESULTS: In a cohort of 154 eligible patients, EGFR mutations were identified in 15.1 and 11.0% of tumor and plasma samples, respectively. The most commonly used EGFR mutation testing method for the tumor tissue samples was the QIAGEN Therascreen® EGFR RGQ PCR kit (52.1%). Fragment Length Analysis + PNA LNA Clamp was used for the plasma samples. The concordance rate for EGFR mutation status between the tissue/cytology and plasma samples was 88.8%; the sensitivity was 45.5%, and the specificity was 96.7%. CONCLUSIONS: The high concordance between the different DNA sources for EGFR mutation testing supports the use of plasma samples when tumor tissue is unavailable.

Cisplatin puls oral vinorelbine as first-line treatment for advanced non-small-cell lung cancer: a prospective study confirming that the day-8 hemogram is unnecessary

INTRODUCTION: Cisplatin plus oral vinorelbine, one of the standard treatments for metastatic non-small-cell lung cancer (NSCLC), is associated with a high rate of neutropenia, and a hemogram is performed on day 8. We analyzed the oncologists' opinions and the result of the hemogram on day 8 to address the question of whether this hemogram could be avoided. MATERIALS AND METHODS: Fifty-eight chemotherapy-naive, advanced NSCLC patients were included. Each received intravenous doses of 75 mg/m(2) cisplatin on day 1 plus oral vinorelbine [60 mg/m(2) in the first cycle (80 mg/m(2) in subsequent cycles) on days 1 and 8], every 3 weeks, for a maximum of six cycles. RESULTS: Out of 257 cycles analyzed, oral vinorelbine was administered on day 8 in 214 (83.2 %) and the dose was canceled in 6 cycles (2.3 %) due to hematological toxicity. On analyzing the patients to whom chemotherapy had been administered on day 8, based on medical opinion without the doctor knowing the hemogram result, we found that the cycle had been administered with a hemogram showing fewer than 1,500 × 10(6) neutrophils in only 3 of the 185 evaluable cycles [event rate of 1.6 %, with confidence interval 95 % = (0.34-4.67 %)]. CONCLUSION: The hemogram on day 8 can be avoided and oral vinorelbine administered in relative safety in patients with good performance status, when confirmed by the clinician's perception, thereby making this regimen more comfortable for the patient. This is the first prospective study to examine this issue (AU)

[The role played by the autonomic nervous system in the relation between depression and cardiovascular disease]. / Papel del sistema nervioso autónomo en la relación entre depresión y enfermedad cardiovascular.

INTRODUCTION: Findings from several epidemiological studies have revealed that major depression is associated with an increased risk of developing cardiovascular diseases (CVD) and presenting complications and new events in subjects with already-established CVD. The pathophysiological mechanisms responsible for this increased cardiovascular risk in major depression remain unclear. DEVELOPMENT: The aim of this work is to review the literature on the possible pathophysiological mechanisms involved in the relation between major depression and CVD, with special emphasis on the studies dealing with cardiovascular autonomic dysfunction and heart rate variability. Likewise, recent hypotheses concerning the neural mechanisms underlying autonomic dysfunction in subjects with major depression are also discussed. CONCLUSIONS: The evidence that is currently available allows us to hypothesise that there are anomalies in the functioning of the central autonomic neural network in subjects with major depression, and more specifically in the hippocampus, prefrontal cortex and the brain stem nuclei. Such abnormalities, in association with lower central levels of serotonin give rise to a predominance of the sympathetic flow and a loss of cardiac vagal tone. The resulting cardiovascular autonomic dysfunction could be the main cause of the increased cardiovascular risk observed in major depression. In the future, studying the autonomic nervous system may be a useful tool in the development of new therapeutic strategies aimed at reducing cardiovascular morbidity and mortality in subjects with depression.

Papel del sistema nervioso autónomo en la relación entre depresión y enfermedad cardiovascular / The role playedby the autonomic nervous system in the relation between depression and cardiovascular disease

Introducción. Los resultados de varios estudios epidemiológicos han revelado que la depresión mayor está asociada con un riesgo incrementado de desarrollar enfermedades cardiovasculares (ECV) y presentar complicaciones y nuevos eventos en sujetos con ECV establecida. Los mecanismos fisiopatológicos responsables de este aumento del riesgo cardiovascular en la depresión mayor aún no se han esclarecido. Desarrollo. El objetivo del presente trabajo es revisar la literatura sobre los posibles mecanismos fisiopatológicos involucrados en la relación entre la depresión mayor y las ECV, con énfasis en los estudios relacionados con disfunción autonómica cardiovascular y variabilidad de la frecuencia cardíaca. Asimismo, se exponen hipótesis recientes acerca de los mecanismos neurales que subyacen en la disfunción autonómica en sujetos con depresión mayor. Conclusiones. La evidencia disponible permite establecer la hipótesis de que sujetos con depresión mayor presentan anormalidades en el funcionamiento de la red neuronal autonómica central, específicamente en el hipocampo, corteza prefrontal y núcleos del tallo cerebral, que asociadas a la disminución de los niveles centrales de serotonina ocasionan un predominio del flujo simpático y una pérdida del tono vagal cardíaco. La disfunción autonómica cardiovascular resultante podría ser la causa principal del riesgo cardiovascular aumentado observado en la depresión mayor. En el futuro, el estudio del sistema nervioso autónomo puede ser una herramienta útil en el desarrollo de nuevas estrategias terapéuticas enfocadas a disminuir la morbilidad y mortalidad cardiovascular en sujetos deprimidos

Introduction. Findings from several epidemiological studies have revealed that major depression is associated with an increased risk of developing cardiovascular diseases (CVD) and presenting complications and new events in subjects with already-established CVD. The pathophysiological mechanisms responsible for this increased cardiovascular risk in major depression remain unclear. Development. The aim of this work is to review the literature on the possible pathophysiological mechanisms involved in the relation between major depression and CVD, with special emphasis on the studies dealing with cardiovascular autonomic dysfunction and heart rate variability. Likewise, recent hypotheses concerning the neural mechanisms underlying autonomic dysfunction in subjects with major depression are also discussed. Conclusions. The evidence that is currently available allows us to hypothesise that there are anomalies in the functioning of the central autonomic neural network in subjects with major depression, and more specifically in the hippocampus, prefrontal cortex and the brain stem nuclei. Such abnormalities, in association with lower central levels of serotonin give rise to a predominance of the sympathetic flow and a loss of cardiac vagal tone. The resulting cardiovascular autonomic dysfunction could be the main cause of the increased cardiovascular risk observed in major depression. In the future, studying the autonomic nervous system may be a useful tool in the development of new therapeutic strategies aimed at reducing cardiovascular morbidity and mortality in subjects with depression

Carcinoma neuroendocrino de células grandes de pulmón. Análisis de una serie de once casos en un hospital universitario / Lung large-cell neuroendocrine carcinoma. Analysis of a series of eleven cases in a universitary hospital

Propósito: Los tumores pulmonares con diferenciación neuroendocrina (DN) son un grupo heterogéneode neoplasias que incluyen tumores carcinoides típicos, carcinoides atípicos, carcinomas neuroendocrinosde células grandes (CNCG) y carcinoma pulmonar de células pequeñas. Los CNCGconstituyen menos del 5% de los carcinomas pulmonares no células pequeñas (CPNCP). En este trabajose describe una serie de CNCG, tratados en un solo centro a lo largo de 10 años.Material y métodos: Se analizan 11 pacientes diagnosticados de CNCG (5 con histologías mixtas).Resultados: La edad media de los pacientes fue de 66 años, 5 fueron varones, 4 tuvieron enfermedadlocalizada, 5 localmente avanzada y 2 diseminada. Siete pacientes, con tumores localizados,fueron tratados con cirugía radical, 2 de ellos recibieron quimioterapia adyuvante; 1 quimioterapia yradioterapia y los otros 3 solo quimioterapia. La mediana de supervivencia de la serie es de 24 meses,y la supervivencia global a 2 y 5 años del 45% y 27% respectivamente.Conclusión: Los datos de nuestra serie corroboran las recomendaciones de que el manejo de losCNCG debe hacerse de forma similar al del resto de los CPNCP. La cirugía radical es el tratamientofundamental en los tumores localizados. No hay datos suficientes que indiquen una peor respuesta alos tratamientos de quimioterapia o radioterapia en este tipo de tumores

Purpose: Lung carcinomas with neuroendocrine differentiation are a heterogeneous group oftumors related to typical and atypical carcinoids, neuroendocrine large-cell carcinomas (NLCC) andsmall-cell lung cancer (SCLC). NLCC comprises less than 5% of non small-cell lung cancer (NSCLC).In this report, we describe a series of NLCC treated in a single institution in the last ten years.Material and methods: Eleven patients diagnosed as having NLCC (5 of them with mixedhistology).Results: At diagnosis, the mean age of the patients was 66 years (5 males and 6 females); 4 hadlocalized disease, 5 locally advanced disease, and 2 metastatic disease. Seven patients underwent initialradical surgery (2 of them followed by adjuvant chemotherapy), 1 patient received chemotherapy andradiotherapy, and 3 patients only chemotherapy. Median overall survival for the whole series was 24months, and the overall 2-year and 5-year survival were 45% and 27% respectively.Conclusion: Our data corroborate the general recommendation of treating NLCC in a similar wayas the rest of the non small-cell lung cancer (NSCLC) are treated. Radical surgery is the maintreatment for localized tumors. There are no data indicating a worse response of these tumors toradiation therapy or chemotherapy

Polymorphisms in DNA repair genes modulate survival in cisplatin/gemcitabine-treated non-small-cell lung cancer patients.

BACKGROUND: Impaired DNA repair capacity may favorably affect survival in cisplatin/gemcitabine-treated non-small-cell lung cancer (NSCLC) patients. We investigated the association of survival with genetic polymorphisms in X-ray repair cross-complementing group 1 and group 3 (XRCC3), xeroderma pigmentosum group D (XPD), excision repair cross-complementing group 1, ligase IV, ribonucleotide reductase, TP53, cyclooxygenase-2, interleukin-6, peroxisome proliferator-activated receptor gamma, epidermal growth factor, methylene-tetra-hydrofolate reductase and methionine synthase. PATIENTS AND METHODS: One hundred and thirty-five stage IV or IIIB (with malignant pleural effusion) NSCLC patients treated with cisplatin/gemcitabine from different hospitals of the Spanish Lung Cancer Group were genotyped for 14 different polymorphisms in 13 genes. Polymorphisms were detected by the TaqMan method, using genomic DNA extracted from baseline blood samples. RESULTS: Median survival was significantly increased in patients harboring XRCC3 241 MetMet: 16 months versus 10 months for patients with ThrMet and 14 months for those with ThrThr (P = 0.01). The risk of death ratio was significantly lower for MetMet than for ThrMet patients (hazard ratio, 0.43; P = 0.01). In the multivariate Cox model, XRCC3 241 remained an independent prognostic factor (hazard ratio: XRCC3 241 MetMet, 0.44; P = 0.01), and XPD 751 and XRCC1 399 also emerged as significant prognostic factors (hazard ratios: XPD 751 LysGln, 0.46, P = 0.03; XRCC1 399 ArgGln, 0.61, P = 0.04). No other association was observed between genotype and survival. CONCLUSION: XRCC3 241 MetMet is an independent determinant of favorable survival in NSCLC patients treated with cisplatin/gemcitabine. A simple molecular assay to determine the XRCC3 241 genotype can be useful for customizing chemotherapy.

Preoperative high-dose cisplatin versus moderate-dose cisplatin combined with ifosfamide and mitomycin in stage IIIA (N2) non small-cell lung cancer: results of a randomized multicenter trial.

Preoperative chemotherapy has become an accepted treatment for stage IIIA (N2) non small-cell lung cancer (NSCLC). The majority of induction regimens employ cisplatin, although the importance of cis-platin dose in combination is unclear. A randomized trial was conducted to address whether higher pre-operative cisplatin doses result in improved survival and increased pathologic complete response in NSCLC. Patients with stage IIIA clinically enlarged and biopsy-proven N2 lesions were randomly assigned to receive either high-dose cisplatin (HDCP) (100 mg/m2) or moderate-dose cisplatin (MDCP) (50 mg/ m2) in combination with ifosfamide (3 g/m2) and mitomycin (6 mg/m2). Disease was restaged after 3 cycles, and those patients with response or stable disease underwent thoracotomy. From March 1993 to February 1997, 83 patients were randomized: 46 received HDCP, and 37 received MDCP. Clinical characteristics were well matched. Radiographic response rate was 59% for HDCP patients and 30% for MDCP patients (P = 0.01). Thoracotomy was performed in 71 patients (86%), 58 of whom had resectable disease. Complete resection rate was 61% in the HDCP group, and 51% in the MDCP group (P = 0.5). Postoperative mortality was 11%. Pathologic complete response was observed in one patient who received MDCP. Median survival in the HDCP and MDCP groups was 13 and 11 months, respectively (P = 0.3). In conclusion, higher radiographic response rate is observed in patients who receive HDCP, but this study fails to show any significant improvement in either overall survival or pathologic complete response in this group of patients.

Modified weekly regimen with vinorelbine as a single agent in unresectable non-small cell lung cancer.

After a 26% response rate was reported with a 20/mg/m2/week vinorelbine (VRL) dose, a multicenter phase II trial of a modified weekly VRL treatment protocol (30 mg/m2 days 1 and 8 every 21 days) for unresectable non-small cell lung cancer (NSCLC) was designed to determine its clinical activity, toxicity, and survival of treated patients. As myelotoxicity frequently precludes the administration of VRL, by suppressing the dose that would correspond to day 15 of a weekly protocol, we allowed bone marrow recovery to take place and avoided the administration of the drug at the nadir of the cycle. The trial included 71 consecutive, previously untreated patients with unresectable and measurable disease. A total of 297 three-week treatment courses were administered with an average of 4 courses per patient (range 1-11). Results showed that in spite of attaining a median dose intensity of 19 mg/m2/week, this modified weekly VRL treatment regimen has a low level of activity (7.5% response rate) in NSCLC. Although a more tolerable level of toxicity is achieved, in order to maintain its antitumor activity, the recommended dose of VRL when given alone for NSCLC treatment (30 mg/m2/weekly) should not be decreased.

Phase II study of mitonafide in non-small cell lung cancer (NSCLC).

BACKGROUND: The new intercalative agent Mitonafide was shown in early clinical trials to be toxic to the central nervous system when administered as a short intravenous infusion, but not when given as a 120-hour continuous infusion. Thus, clinical development in different tumor types was pursued using only this administration schedule. PATIENTS AND METHODS: Forty-nine patients with previously untreated non-small cell lung cancer (NSCLC) and at least one measurable site received Mitonafide as a 120-hour continuous (5 days) infusion every 3 weeks. The starting dose was 170 mg/m2/day x 5 in the first 26 patients and 200 mg/m2/day x 5 in the remainder. Patients were evaluated for toxicity after each course and for response every two courses and remained on treatment until excessive toxicity or disease progression were observed. A special test, the "Mini-mental state", was used to assess patients' cognitive functions. RESULTS: Of the 49 patients entered, 42 were evaluable for response and toxicity. Toxicity consisted mainly of myelosuppression and no neurologic side effects were observed. Only one patient presented a partial response. CONCLUSIONS: Although definitively safe with this schedule of administration, Mitonafide is not active in NSCLC.

[Chemotherapy in prostatic carcinoma]. / Quimioterapia en el carcinoma prostático.

Carcinoma of the prostate has been treated by monochemotherapy, polychemotherapy, intraarterial chemotherapy, combined chemo and hormone therapy and growth factor antagonists. Difficulties exist in evaluating the efficacy of chemotherapy due to the scant number of patients treated and the different criteria used to assess response. Monochemotherapy has achieved a response rate (complete and partial) of less than 20% in randomized studies and that obtained with polychemotherapy is only slightly higher. The studies that have been conducted comparing these two treatment modalities have not clearly demonstrated the superiority of the latter. The duration of response is short and is measured in weeks. There is no standard treatment. Adriamycin, fluorouracil and cyclophosphamide appear to be the most effective cytostatic agents. There is no evidence that chemotherapy improves survivorship, and in comparison to symptomatic treatment, the former has been superior. The combination of chemotherapy with hormone therapy as a first line of treatment can improve the response rate slightly and enhance survivorship, although further studies are warranted to determine this definitely. Recruitment with androgens increases the response, but may entail risks. The growth factor antagonists have extended the therapeutic possibilities in prostate carcinoma, but further studies are warranted to determine its true value.

[Subacute paraneoplastic cerebellar degeneration in microcytic carcinoma of the lung. Presentation of 2 cases]. / Degeneración subaguda cerebelosa paraneoplásica en el carcinoma microcítico de pulmón. Presentación de dos casos.

Subacute paraneoplastic cerebellous degeneration is a rare syndrome which is found in less than 1% of patients with cancer. Small cell cancer of the lung and of the ovary are the two neoplasms most frequently associated to this entity. Two patients with small cell lung cancer who initially had a cerebellous syndrome in which no sign of macroscopic cerebellous lesion could be demonstrated by either computerized tomography or nuclear magnetic resonance of the head are presented. One of the patients was evaluated at autopsy. Both patients were treated with polychemotherapy with which partial response was obtained. Neurologic symptomatology was not alleviated in the first patient with death due to bronchopneumonia at 5.5 months of initiation of the disease, while improvement of the cerebellous paraneoplastic syndrome was achieved in the second patient. The different evolution of subacute paraneoplastic cerebellous degeneration in two patients in whom antibodies were not demonstrated and in whom initial response of the tumor to chemotherapy was achieved may be explained by the second patient having undergone prolonged treatment of 6 cycles suggesting a strict relation ship between the tumor and subacute cerebellous degeneration which, to date, remains unknown.

[Chemotherapy with cisplatin, adriamycin, etoposide and ifosfamide in microcytic lung carcinoma]. / Quimioterapia con cisplatino, adriamicina, etopósido e ifosfamida en el carcinoma microcítico pulmonar.

BACKGROUND: The aim of this study was to analyze the results obtained in the treatment of small cell lung cancer (SCLC) with the PAVI chemotherapy protocol (cisplatin, adriamycin, etoposide and ifosfamide). METHODS: Over a period of 3 years, 41 patients with a mean age of 57 years were treated. Twenty-two patients were considered as having limited disease (LD) and 19 disseminated disease (DD). Survival was studied by the Kaplan and Meier method. RESULTS: The percentage of complete response (CR) achieved was 42%, LD 52% and 27% for DD, with partial responses (PR) being achieved in 50%, 43% in LD and 60% in DD. With a mean follow up of 32 months, the mean 2 length of response was 13 months in the patients with CR and 9 months in those with PR. The median of survival in LD was 22 months and 10 months for patients with DD. Prolonged survival of over 2 years, was only achieved in LD (16%). Five patients died in relation with the treatment. Hematologic toxicity was doses-limited with the greatest toxicity being found in patients with DD under the Karnofsky index (KI). CONCLUSIONS: The PAVI protocol is effective in the treatment of small cell lung cancer and a good median of survival may be achieved in patients with limited disease. Toxicity is elevated and is fundamentally found in patients with disseminated disease and under the Karnofsky index, with its use not being recommended in these cases.

[The results of a selective program to detect intraepithelial neoplasms of the vulva]. / Resultados de un programa selectivo de detección de la neoplasia intraepitelial de la vulva.

Early detection and treatment of preinvasive neoplasias decrease the incidence and mortality of the subsequent invasive cancers. This paper presents the results of a selective program to detect vulvar intraepithelial neoplasia (VIN). The program was selective because only "relative high risk" women were included, i.e. women with one or more of the following items: a) age more than 50 years; b) past history of epidermoid cervical or vaginal cancer (included intraepithelial stages); c) past history of genital radiation; d) past or actual history of genital condyloma; and e) past or actual history of hyperplasic or mixed vulvar dystrophy. Detection was made with the test described by Collins et al., staining the vulva with a toluidine blue aqueous solution and decoloring it with acetic acid. All positive sites (areas retaining the blue color) were biopsied under local anesthesia. Histopathology diagnosis served as gold standard for the program's evaluation. Patient with negative tests and those with NIV I were rescreened each 6 months. From March 1984 to September 1986, 212 patients were admitted in this program and 318 tests were performed. Individual tests varied from 1 (105 patients) to 5 (3 patients). The group was followed-up until March 1989, when the program was evaluated. There were 77 positive tests, among them 21 cases of NIV. Three women with NIV I progressed to NIV II during the observation period. NIV cases were classified as: NIV I, 7 cases (33.3%); NIV II, 10 cases (47.7%); and NIV III, 4 cases (19.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Carcinoid tumor of the bronchi. An infrequent tumor. Clinical study of 12 cases]. / Carcinoide bronquial. Tumor poco frecuente. Estudio clínico de doce casos.

Twelve patients with a bronchial carcinoid tumor seen over the past 10 years, were retrospectively analyzed. The age, symptoms, smoking habit, previous respiratory conditions, X-ray and extension of the tumor, bronchial endoscopy, treatment and survival were studied. The mean age of these patients was 42.5 years with a male predominance of 2:1. More than half of the patients were smokers (58.3%). The most common symptoms were hemoptysis, costal pain, pneumonia and fever. Two of the patients were asymptomatic (16.6%) and their tumor was detected in a routine health control. Almost half of the patients (41.6%) complained of respiratory symptoms for 3 years previous to diagnosis (mean 7.8 years with a range of 3 to 11 years). 75% of the cases were centrally located. The left lung was most frequently affected (75%). Fiberbronchoscopy was carried out in nine patients; in eight of them the tumor was localized and information was obtained about the segment involved. However, the biopsy was positive in only one case (14.2%). Two patients presented endocrine symptoms with a syndrome similar to the carcinoid. The disease was disseminated with adrenal metastasis in two cases, one of which had also bone and liver metastasis. An immunohistochemical study was performed in eight cases with a positive result for ACTH and calcitonin in one patient. Ten patients were treated with surgery; one with chemotherapy and the other was treated with palliation. Two patients were lost in the follow up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Vaginal intraepithelial neoplasia. Report of 14 cases.

From 1978 to 1985 we have found 14 cases of vaginal intraepithelial neoplasia (VAIN) in patients previously hysterectomized. VAIN was detected by an abnormal cytology; diagnostic process included a second cytology, colposcopy, Schiller test, and directed biopsies. VAIN was classified as grade I in 5 patients (35.7%); grade II in 5 patients (35.7%); and grade III in 4 patients (28.6%). Pathogenic classification of VAIN was: VAIN de novo 9 cases (64.3%); VAIN after vaginal irradiation, 3 cases (21.4%); VAIN following incomplete removal of a cervical intraepithelial neoplasia, one case (7.1%); and VAIN as manifestation of a multicentric neoplasia of the lower genital tract, one case (7.1%). The mean time between hysterectomy and VAIN diagnosis was 6.9 years; this time was larger for those women hysterectomized by benign uterine diseases (9.0 years vs. 2.4 years). Our conclusion is that patients who have lost their uterus by malignant or benign diseases should be followed-up with periodic vaginal cytology in order to detect vaginal neoplasia in its pre-invasive stages.