Brain natriuretic peptide as a cardiac marker of transient radiotherapy-related damage in left-sided breast cancer patients: A prospective study.

PURPOSE: Our study evaluated brain natriuretic peptide (BNP) changes over time after adjuvant radiotherapy (RT) in women with left-sided breast cancer investigating its correlation with heart dosimetric parameters. METHODS: Forty-three patients underwent clinical cardiac examination, electrocardiogram (ECG), echocardiography and BNP measurement before RT (T0) and 1 (T1), 6 (T6) and 12 months (T12) after. After T12 cardiac assessment was performed annually in each patient. Mean values and standard deviation (SD) of BNP, left ventricular ejection fraction (LVEF), V20, V25, V30, V45 and mean dose were calculated. Normalized BNP (BNPn) was calculated as follows: BNPnT1 = BNPT1/BNPT0, BNPnT6 = BNPT6/BNPT0, BNPnT12 = BNPT12/BNPT0. Absolute BNP and BNPn values were used for data analysis. RESULTS: Median follow-up from the end of RT to the last check-up was 87 months (range 37-120 months). Minimum follow-up was 74 months except for two patients, who died at respectively 37 and 47 months after RT. In all patients LVEF did not change significantly (p = 0.22) after RT. BNP increased significantly (p < 0.001), particularly 1 and 6 months after RT. It slightly decreased after 12 months. BNP did not correlate with V20, V25, V30, V45, mean dose and MHD. All BNPn correlated significantly (p < 0.05) with V20, V25, V30, V45, mean dose and MHD. Four patients had a cardiac event; in the only subject who developed myocardial infarction, V20, V25, V30 and V45 were the highest and BNP increased from T1 and persisted high even at T12. CONCLUSION: Our results confirm that BNP could be a useful minimally invasive marker of early RT related cardiac impairment.

[An update on parathyroid surgery]. / Attualità in tema di chirurgia delle paratiroidi.

The operative management of patients with hyperparathyroidism is controversial. High rates of persistent hypercalcemia and postoperative hypoparathyroidism are seen in multiple hyperplasia and bilateral neck exploration. Patients undergoing unilateral neck exploration with removal of a single parathyroid adenoma have a rapid clearance of PTH which declines within hours after surgery. There is a sensitive immunometric assay (IRMA) for the intact molecule which demonstrates a decline in 15 minutes during surgery. Intraoperative measurement of PTH may be complementary to surgical skill and histopathologic information and may modulate extension of neck exploration.

[Changes in IGFBP-3 in relation to administration of rGH to deficient children]. / Modificazione dei livelli di IGFBP3 in rapporto alla somministrazione di rGH in bambini deficitari.

Serum IGFBP3 levels were tested in 7 GHD children before the rGH therapy, at the end of the same therapy and 1, 2, 4, and 8 weeks later. The IGFBP3 concentration returned to the pre-therapy levels only 6 weeks after the end of the therapy.

[IGFBP3 in the assessment of growth hormone defects]. / IGFBP3 nella valutazione dei difetti dell'ormone della crescita.

Evaluation of growth hormone dependent IGFBP3, stable in time and with no circadian variations is a useful parameter for diagnosing growth hormone deficit. The IGFBP3 was evaluated using sera, collected and kept at -20 degrees C, from subjects classified according to auxologic characters and response sup. or inf. to 8 ng/ml GH after two stimulation tests and median nocturnal GH sup. or inf. to 3 ng/ml. Two groups were studied: 1) Small stature GHD (growth hormone deficiency): 14 cases; 2) Constitutional small stature (RCC,BSF): 12 cases. A third group composed of 8 normal height, weight and disease-free children formed the control group. The IGFBP3 values were below the 5th percentile in 86% of GHD cases, between the 5th and 95th percentile in 66.6% of constitutionally short stature children and in all normal controls was about the 50th percentile. The IGFBP3 also shows a statistically significant correlation between median nocturnal GH, both in deficient and constitutionally short stature groups (p < 0.01).

Pharmacokinetics of vincristine in cancer patients treated with nifedipine.

The pharmacokinetics of vincristine (VCR) after an intravenous bolus dose of 2 mg were studied in patients with cancer with and without a concomitant treatment with the calcium-entry blocker nifedipine (NIF). VCR concentrations were determined by a sensitive radioimmunoassay. Pharmacokinetic data were analyzed by a nonlinear weighted least-square regression program (SAS-NLIN). A tri-exponential model fitted the raw data better than a bi-exponential model in five of 14 (35%) patients treated with VCR alone and in seven of 12 (58%) patients treated with VCR plus NIF (P = NS). The T1/2 alpha was shorter in NIF-treated patients, whereas the T1/2 gamma was longer in the NIF-treated group. The NIF-treated group showed an increase in the AUC O-infinity and AUC 1 to 96 hours, and a decrease in the AUC 0 to 1 hour. Total plasma clearance of VCR and 7-day urinary excretion of VCR was reduced in the NIF-treated patients. These data suggest that, when VCR is administered to NIF-treated patients with cancer, there is a decrease in VCR clearance from the body. Theoretically, a greater cytotoxicity may be anticipated.