Hepatic encephalopathy induced by flutamide administered for the treatment of prostatic cancer

Amphotericin B has been associated with multiple adverse effects; however, clinically it may be the best or only drug of choice for certain infections. This antifungal has traditionally been administered in D5W solutions over 4 to 6 hours with pre- and/or post-hydration and other medications to minimize the renal toxicity and other side effects. There have been studies using amphotericin infused in a 20% lipid emulsion with the hope of decreased side effects. By changing the diluent to lipids, the volumes to be infused over shorter periods was a challenge. This article will examine administration protocols of the D5W mixture and the lipids emulsion solution and does not advocate the use of lipid solutions.     

Finasteride and flutamide in the treatment of hirsutism

BACKGROUND: The aim of this work was to evaluate the efficacy of two new antiandrogen drugs, finasteride and flutamide, in 80 hirsute patients: 44 with Polycystic Ovary Syndrome (PCOS) and 36 with Idiopathic Hirsutism (IH). METHODS: The study was conducted in a randomized way and randomization was carried out according to hospitalization. Before and after the treatment, all of the patients underwent hematochemical tests, hormone assays and assessment of hirsutism with the Ferriman Gallway score (F.G. score) and with measurement of the hair diameter in four different body areas. Finasteride was administered per os to 40 women at the dose of 5 mg/die; flutamide per os to 40 women at the dose of 250 mg twice daily. Both drugs were employed for 6 consecutive months. RESULTS: Both finasteride and flutamide significantly reduced the F.G. score and hair diameter. CONCLUSIONS: Abdominal hairs were more sensitive to the therapy.     

Nose deformation as a result of birth injury

The authors have compared the frequency of occurrence of nasal septum deformation in two groups of newborns, using the simplest testing methods for: 1. newborns born by spontaneous labor (254 newborns), 2. newborns born by caesarean section (52 newborns). The deformation from the central position of the nose were found in 2 newborns from group 2 (3.9%) and in as many as 50 newborns from group 1 (approx. 20%) providing the evidence that most deformations occur as a result of birth injury (during labor). 32 deformations (26 in the cartilaginous section of the nasal septum and 6 in the osseous section) have been tested repeatedly in the third or fourth week of life. 19 out of 26 deformations of the cartilaginous section of the nasal septum (73%) have been repositioned automatically. All deformations in the osseous section detected after birth were also analyzed physically in the third or fourth week of life.     

Right-sided pneumothorax as a result of a left-sided chest tube

Chest tubes are inserted for a variety of reasons, and a number of complications have been associated with their use. We report a case of traumatic hemopneumothorax in which the chest tube crossed the mediastinum into the contralateral lung causing a pneumothorax. Its position was not apparent on portable chest radiographs.     

Comparison of flutamide and spironolactone in the treatment of hirsutism: a randomized controlled trial

OBJECTIVE: To compare the clinical efficacy and safety of the pure antiandrogen flutamide and the steroidal derivative spironolactone in the treatment of hirsutism in women. DESIGN: Fifty-three premenopausal women suffering from moderate to severe hirsutism were randomized into two groups and received either flutamide or spironolactone in association with a triphasic oral contraceptive (OC) pill. Hirsutism, acne, seborrhea, alopecia, and side effects were monitored monthly for a treatment period of 9 months and a follow-up after treatment period of 6 months. Blood samples were taken at each visit for assessment of endocrine, biochemical, and hematologic parameters. RESULTS: After only 6 months of therapy, flutamide caused a maximal reduction in the hirsutism score to a value within almost normal range; during the same period, spironolactone caused only a 30% reduction of the hirsutism score. Whereas flutamide caused a dramatic (80%) decrease in total acne, seborrhea, and hair loss score after only 3 months of therapy, spironolactone caused only a 50% reduction in acne and seborrhea, with no significant effect on the hair loss score. Four patients in the spironolactone group but only one in the flutamide group stopped the medication because of adverse side effects. CONCLUSION: The present data obtained in a randomized prospective study clearly demonstrate that the pure antiandrogen flutamide is superior to spironolactone in the treatment of female hirsutism and its related androgen-dependent symptoms and signs in women.     

Adrenal insufficiency as a manifestation of disseminated non-Hodgkin's lymphoma

OBJECTIVE: To analyze the clinical characteristics, laboratory features, and outcome in five patients who had biochemically proven adrenal insufficiency attributable to pathologically confirmed non-Hodgkin's lymphoma (NHL). MATERIAL AND METHODS: We retrospectively reviewed the medical records of all patients at Mayo Clinic Rochester during the period from 1976 to 1994 to identify those with both NHL, as listed in the surgical pathology tissue registry, and adrenal insufficiency. Histologically, the patients were classified on the basis of the working formulation and the revised European-American lymphoma classification. RESULTS: Three patients had diffuse large cell NHL, one patient had small noncleaved NHL, and one patient had cutaneous T-cell NHL. All five patients had stage IV disease. Adrenal insufficiency was confirmed by morning and evening determinations of serum cortisol levels and cosyntropin stimulation tests. All patients demonstrated loss of circadian rhythm. The median age of the patients was 77 years (range, 60 to 89). Three of the five patients died without treatment from 5 to 22 days after assessment. One patient died of a cerebrovascular accident. Despite initiation of chemotherapy, two patients died of progressive NHL at 7 weeks and 7 months. CONCLUSION: In our experience, biochemically proven adrenal insufficiency in patients with NHL is a manifestation of clinically advanced disease in elderly patients. A stepwise diagnostic approach is critical for the appropriate management of such patients.     

Antitumor activity of suramin in hormone-refractory prostate cancer controlling for hydrocortisone treatment and flutamide withdrawal as potentially confounding variables

BACKGROUND: A prospective Phase II clinical trial was conducted to assess the clinical activity of a pharmacokinetically guided suramin regimen in patients who had documented progression of metastatic prostate cancer after hydrocortisone plus antecedent or simultaneous withdrawal of flutamide. METHODS: Fifty-four patients whose disease had progressed after castration and flutamide administration were enrolled on this trial. The study was divided into two parts. Initially, 52 patients received hydrocortisone (30 mg/day) and for those patients receiving flutamide, at study entry (34 patients) flutamide was simultaneously discontinued. Forty-three patients whose disease progressed on hydrocortisone received suramin for 6-8 weeks. Six patients who progressed on hydrocortisone became ineligible for suramin due to clinical deterioration, four patients are still responding to hydrocortisone at more than 1 year, and one patient elected to postpone initiation of suramin. Suramin was given as intermittent infusions at fixed doses on days 1-5 and thereafter dosing was guided by adaptive control with feedback to maintain plasma suramin concentrations between 300-175 micrograms/ml. Antitumor activity was assessed by prostate specific antigen (PSA) decline and soft-tissue disease response. RESULTS: Ten patients (19%; 95% CI, 9.6%-32.5%) responded to hydrocortisone therapy with either a 50% or greater PSA decline for at least 4 weeks (9 patients) and/or a partial response of measurable soft-tissue disease (2 patients). Five of these patients (10%) demonstrated a 80% or greater PSA decline. All responders to hydrocortisone had simultaneous flutamide withdrawal, and had been receiving flutamide as part of initial combined androgen blockade. Seven of 37 evaluable patients (19%; 95% CI, 8.0%-35.2%) responded to suramin with a 50% or greater decline in PSA for 4 weeks or longer. One patient (3%) had a 80% or greater decline in PSA. There were no soft-tissue disease responses to suramin. The median time to progression was 1.9 months for hydrocortisone therapy and 2.6 months for suramin therapy. The median survival for all patients was 14.6 months. CONCLUSION: Suramin has antitumor activity in metastatic prostate carcinoma independent of the therapeutic effect of hydrocortisone administration or flutamide withdrawal. The role of prior flutamide withdrawal and hydrocortisone replacement should be taken into account in future studies of suramin.     

Cracking of zircaloy as a result of unusual localized texturing

Microcracks in rolled Zircaloy have been observed at an angle of 35 deg to the plate normal in relatively fine-grained bands within a matrix of coarser grains. The fine-grained regions show a different crystallographic orientation than the matrix when observed under polarized light. This duplex “crack-prone” structure results from a rolling schedule of many light passes. A fewer number of heavier passes alleviates the problem. Starting with a single Zircaloy ingot, thermomechanical processing is varied according to three different schedules: light, normal, and heavy reductions per rolling pass. Samples obtained at several stages during each of the three rolling schedules are examined for crystallographic texture and fatigue strength. A computer program is used to generate inverse pole figures, histograms of basal pole inclination vs volume percent of grains and/numbers from X-ray diffraction data. The /numbers define the effective fraction of basal poles aligned in the directions of interest. These results are used to illustrate the texture changes and their influence upon the cracking sensitivity of Zircaloy during the various stages of reduction, and thermal treatments of the three rolling schedules. A significant effect on cracking sensitivity due to hot and cold rolling pass schedules is shown, and a tendency for light hot rolling passes to align basal poles normal to the rolling plane is demonstrated.     

Successful acute aortomesenteric bypass as a result of favorable circumstances

The author presents an account of a case-history involving ischaemia of the entire small intestine, an acute vascular episode, caused by occlusion of the cranial mesenteric artery. The successful aortomesenteric bypass is presented as an example of the coincidence of favourable circumstances in the solution of the case.     

Pulmonary edema as a result of chronic upper airway obstruction

This is the first case of an adult who developed recurrent pulmonary edema as a result of unrecognized chronic upper airway obstruction due to polyarticular juvenile rheumatoid arthritis. The case highlights the importance of considering upper airway involvement in the differential diagnosis of sedentary patients with arthritic joint disease and breathing difficulties.