CHOP vs. ProMACE-CytaBOM in the treatment of aggressive non-Hodgkin's lymphomas: long-term results of a multicenter randomized trial.(PETHEMA: Spanish Cooperative Group for the Study of Hematological Malignancies Treatment, Spanish Society of Hematology)

From May 1985 to May 1989, 175 patients with previously untreated aggressive non-Hodgkin's lymphoma were randomized to receive CHOP or ProMACE-CytaBOM. Eligibility criteria included follicular large-cell diffuse small cleaved-cell, diffuse mixed, diffuse large-cell and immunoblastic lymphoma with an Ann Arbor stage II, III or IV. One hundred and forty-eight patients were evaluable. There were no significant differences between the 2 treatments in response rate (83.5% [57.5% CR] for CHOP vs. 88% [62% CR] for ProMACE-CytaBOM), time to treatment failure (29% vs. 31% at 5 yr), or overall survival (42% in both groups at 5 yr). Furthermore, there were no significant differences between the 2 regimens when response rates and outcome were analyzed for different prognostic subgroups. Toxicity was not significantly different between the 2 regimens, although only 1 patient died as result of treatment-related toxicity in the CHOP arm compared to 6 patient in the ProMACE-CytaBOM group (p = 0.126). In conclusion, in this study ProMACE-CytaBOM has not proved to be superior to CHOP in aggressive lymphomas. This trial gives support to the notion that CHOP still is the standard chemotherapy for aggressive lymphomas, and that new treatment approaches for these lymphomas should be compared to CHOP.     

Cortical variations of the dimension of correlation in children with attention deficit hyperactivity syndrome

INTRODUCTION AND OBJECTIVE: The syndrome of deficient attention and hyperactivity affects approximately 5% of children of school age. Clinically it is characterized by deficient attention, impulsiveness and excessive motor activity. Developments in nonlinear dynamic theory have made it possible to think of modelling cerebral activity as a dynamic system of chaotic type. One the most widely standardized measurements is the dimension of correlation (D2). In this paper we study the electroencephalographic traces of a control group of 9 healthy children and another group of 19 children with the syndrome of deficient attention, at rest and whilst carrying out a visuomotor task (Test of perception of differences). MATERIAL AND METHODS: The dimension of correlation was estimated for both groups. Statistical comparison was made between the cortical distributions of the D2 between both types of recordings and between both groups. RESULTS: The children with lack of attention showed a larger number of activated cortical areas than those of the control group when carrying out the same task. However, during the resting state there were no differences in the D2 between the control children and the children with deficient attention. The indicates that both groups have the same basal level of activation. CONCLUSION: The dimension of correlation is a method which permits the demonstration of an increase in neuronal activity in the stimulated areas, in this case in the occipital region.     

Slow skeletal troponin I gene transfer, expression, and myofilament incorporation enhances adult cardiac myocyte contractile function

The functional significance of the developmental transition from slow skeletal troponin I (ssTnI) to cardiac TnI (cTnI) isoform expression in cardiac myocytes remains unclear. We show here the effects of adenovirus-mediated ssTnI gene transfer on myofilament structure and function in adult cardiac myocytes in primary culture. Gene transfer resulted in the rapid, uniform, and nearly complete replacement of endogenous cTnI with the ssTnI isoform with no detected changes in sarcomeric ultrastructure, or in the isoforms and stoichiometry of other myofilament proteins compared with control myocytes over 7 days in primary culture. In functional studies on permeabilized single cardiac myocytes, the threshold for Ca2+-activated contraction was significantly lowered in adult cardiac myocytes expressing ssTnI relative to control values. The tension-Ca2+ relationship was unchanged from controls in primary cultures of cardiac myocytes treated with adenovirus containing the adult cardiac troponin T (TnT) or cTnI cDNAs. These results indicate that changes in Ca2+ activation of tension in ssTnI-expressing cardiac myocytes were isoform-specific, and not due to nonspecific functional changes resulting from overexpression of a myofilament protein. Further, Ca2+-activated tension development was enhanced in cardiac myocytes expressing ssTnI compared with control values under conditions mimicking the acidosis found during myocardial ischemia. These results show that ssTnI enhances contractile sensitivity to Ca2+ activation under physiological and acidic pH conditions in adult rat cardiac myocytes, and demonstrate the utility of adenovirus vectors for rapid and efficient genetic modification of the cardiac myofilament for structure/function studies in cardiac myocytes.     

Isolation of translactone-containing triterpenes with thrombin inhibitory activities from the leaves of Lantana camara

Methanolic extracts prepared from the leaves of Lantana camara have been found to inhibit human thrombin. An assay, in which thrombin activity is measured as a function of clot formation from fibrinogen, was used to guide the fractionation and purification of five principal active constituents (1-5), which were all characterized as 5,5-trans-fused cyclic lactone-containing euphane triterpenes.     

English teaching in the Italian medical faculties: results of a survey

BACKGROUND: Although a compulsory examination in medical English has been present in the medical degree curriculum in Italy since 1990, guidelines indicating what should be learnt and suggesting some means of overcoming the various problems this entails are still lacking. OBJECTIVE: To investigate the main features of teaching English in the Medical Faculties and enquire into how the various problems are solved in the individual English teaching units. METHOD: A questionnaire addressing the above issues was sent out to all the Italian Universities with a Medical Faculty. RESULTS: The first finding of our survey was that response was very poor: less than 30% of the survey volunteered any reply. Within the very reduced sample which responded, there was a high degree of variation among the solutions adopted, although the underlying problems were perceived to be much the same throughout Italy. CONCLUSIONS: The general objective of the English course for medicine should be more precisely defined, together with a series of specific minimum skills the student should possess to pass the final examination. A closer collaboration among the English teaching units might help to standardize these requirements, improve the quality of the teaching and hence the level of proficiency in English for the specific purpose of medical practice.     

Anatomic basis of continuous axillary block of the brachial plexus with thoracic reservoir

Although continuous axillary block is effective for periods of up to four to six weeks, pain clinic patients with severe chronic pain in the upper extremities, mainly resulting from neuropathic disease, can require continuous drug delivery by catheter-reservoir for up to three months or longer. We studied possible locations for implanting reservoirs or catheters from the perivascular axillary space in fresh cadavers, checking for possible vascular or nerve damage after applying the usual technique for reservoir implantation. The ideal location for the reservoir is the subcutaneous tissue of the homolateral infraclavicular space of the anterior side of the thorax. The customary procedures for inserting the catheter along the subcutaneous route that extends from the perivascular axillary space to the reservoir carry no risk of damaging vascular or nerve structures.     

The puncture and catheterization of the peripheral vessels using ultrasonic scanning

1% acetylcholine (5.5 10 M--acetylcholine chloride) applied directly to the cortex of conscious non-immobilized rabbits was established to produce neuroglial reaction in motor area. Following 30 min long application the number of astrocytes was significantly increased. Application lasting for 2 hrs resulted in a reverse effect. The above-mentioned changes were observed in surface and deep cortical layers. They were functional and could be attributed to the cell tinctorial properties.     

Vaginal-sigmoid fistula caused by diverticular disease

A case of a 66 years old patient suffering from a sigmoido-vaginal fistula and diverticulosis, previously treated with a total laparohysterectomy, is reported. Retrograde studies demonstrated the presence of fistula, whereas colonoscopy and barium enema failed. After laparotomy and an appropriate bowel preparation, surgery was restricted to the bowel resection and anastomosis, whereas the vaginal defect was not closed.