Possible role of glutathione in predicting radiotherapy response of cervix cancer.

PURPOSE: To see if changes in tumor/blood glutathione (GSH) levels after one fraction of radiotherapy can be correlated with the treatment response in patients with carcinoma of the uterine cervix. METHODS AND MATERIALS: The study was done on 45 patients with squamous cell carcinoma of the uterine cervix, FIGO Stages IIB (17 patients) and IIIB (28 patients). Stage IIB patients received 35 Gy of cobalt-60 external radiotherapy (RT) in 16 fractions over 4 weeks with a concurrent high-dose-rate intracavitary dose of 8.5 Gy to point A once a week. Stage IIIB patients were given 45 Gy of RT in 20 fractions over 5 weeks, followed by two doses of intracavitary therapy once a week. Blood and tumor samples were collected before and after one dose of RT and GSH was estimated. Tumor response was assessed clinically at 1 month after treatment. RESULTS: Glutathione levels in both blood and tumor showed a significant decrease after one fraction of RT, but the degree of decrease varied among patients. There was a good correlation between the extent of GSH decrease and the tumor response. All patients who had complete response (CR) (seven Stage IIB and eight Stage IIIB) showed > or =70% decrease in both tumor and blood GSH, while those who had <50% regression (NR) (five Stage IIB and 13 Stage IIIB) showed <50% decrease in GSH. The partial responders recorded an intermediate level (50-70%) of depletion in blood and tumor GSH. CONCLUSIONS: The results indicate that the changes in tumor/blood GSH levels after one fraction of RT could serve as an index of tumor response to therapy and may help in identifying radioresistant tumors, at least in the case of cervix carcinoma.

Mother-son folie a deux: a case report.

A case of folie a deux is presented in which the child is the dominant psychotic partner and his mother is the passive partner in whom a paranoid psychosis is induced. The conditions under which folie a deux may occur, the diagnosis, and the treatment of the disorder are discussed.

Tissue Raman spectroscopy for the study of radiation damage: brain irradiation of mice.

Radiotherapy is routinely employed in the treatment of head and neck cancers. Acute cell death, radiation-activated chemical cascades, and the induction of genes coding for protective factors like cytokines are considered to be the major processes involved in radiation damage and repair. It should be possible to follow these processes by monitoring the biochemical interactions initiated by radiation. We have carried out Raman spectroscopy studies on tissue from mice subjected to brain irradiation to identify the biochemical changes occurring in tissue and brain as a result of radiation injury. These studies show that brain irradiation produces drastic spectral changes even in tissue far removed from the irradiation site. The changes are very similar to those produced by the stress of inoculation and restraint and the administration of an anesthetic drug. While the changes produced by stress or anesthetics last for only a short time (a few hours to 1 or 2 days), radiation-induced changes persist even after 1 week. The spectral changes can be interpreted in terms of the observation of new spectra that are dominated by bands due to proteins. The results thus support the hypothesis that various protective factors are released throughout the body when the central nervous system (CNS) is exposed to radiation.

Seizures during lithium-amitriptyline therapy.

Epileptiform seizures occurred in a 34-year-old woman who was receiving amitriptyline and lithium carbonate therapy for treatment of endogenous depression. While receiving amitriptyline maintenance therapy, she was given lithium on two separate occasions, and despite serum levels of lithium in the therapeutic range, grand mal seizures developed. The seizures may represent a toxic reaction either to lithium or to combined drug therapy. Controlled studies are needed to evaluate both the efficacy and toxicity of combined drug therapy in affective disorders.

Prognostic factors for spinal cord myelitis--an analysis of compiled literature data.

The effectiveness of radiotherapy in the treatment of malignant tumors in the head and neck, thorasic and upper abdominal regions is frequently limited by the tolerance of the spinal cord. Therefore knowledge of the factors that influence the tolerance of the spinal cord to radiation is of the upmost important. Safe limits for irradiation of the spinal cord determined in a number of clinical studies is on the conservative side from the point of view of tumor control probability. The bioeffect of a physical dose takes into account the treatment variables and the radiobiological characteristics of the relevant tissue; hence deciding spinal cord tolerance on the basis of bioeffect models would be better approach. The aim of the present study was to analyze the relationship of the prognostic factors with percentage incidence of spinal cord myelitis and to arrive at a spinal cord tolerance bioeffect dose TDF and ERD for optimum incidence of radiation myelitis.

ECT in the treatment of recurrent psychotic depression.

Two cases of recurrent psychotic depression are reported in which ECT (electroconvulsive therapy) was administered with good results for previous episodes of depression, but treatment of the current episode with combined drug therapy (antidepressant and antipsychotic drugs) in one case and antidepressant chemotherapy in the other resulted in failure to improve. The patients were transferred to another facility, and improved when ECT was administered. Pertinent literature on ECT and drug treatment of depression is reviewed, and the conditions for which ECT is probably the treatment of choice are enumerated.

Remediable causes of dementia.

Studies show that many clinicans "write off" elderly patients as demented, when in fact many of these patients are not suffering from chronic organic brain syndrome but have medical disorders that may respond positively to appropriate treatment. The key to differentiation is comprehensive diagnostic evaluation.

Electroconvulsive therapy: an overview.

Modifications in technique, including the use of anesthesia and muscle-relaxing drugs, make electroconvulsive therapy safe and easy to administer. There are few contraindications, complications are rare, and efficacy is well-documented.

Multiple sclerosis masquerading as lithium toxicity.

The author presents a case report of a manic-depressive patient who developed dysarthria and ataxia while on lithium maintenance. These symptoms were erroneously attributed to lithium toxicity occurring at therapeutic serum levels. However, the symptoms persisted despite diminution in lithium dosage and a neurological consultation revealed the diagnosis of multiple sclerosis. The author concludes that lithium therapy is effective with manic-depressive patients, that adverse side effects are infrequent and can occur at toxic or therapeutic serum lithium levels, and that the exceptional patient may have a second illness incorrectly attributed to lithium toxicity.