Carlo Tremolada

Cisplatin, bleomycin and methotrexate in the treatment of advanced oesophageal cancer

From February 1981 to September 1982, 34 patients with metastatic or locally advanced (inoperable) epidermoid carcinoma of the oesophagus were treated with a combination of cisplatin, bleomycin and methotrexate. Thirty-one patients are now evaluable for response: 16 of 31 (52%) experienced some improvement, but only eight (26%) obtained major responses (one complete and seven partial). Responses were obtained rapidly within the first two courses. The median duration of responses was 5 months. The median survival from start of therapy was 8 months for responsive and 5 months for non-responsive patients. Gastrointestinal toxicity (cisplatin-related) and mild myelosuppression were the most prominent side-effects. This combination chemotherapy proved to be only of small efficacy in the long-term control of advanced oesophageal cancer. However, because the responses were obtained rapidly, it is conceivable that a similar regimen (with increased dosage of cisplatin) applied before surgery to patients with limited disease could obtain a reduction of the bulky tumour, with a possible increase of the resectability rate and destruction of micrometastases.

Substrate availability other than glucose in the brain during euglycemia and insulin-induced hypoglycemia in dogs

Alternative substrates other than glucose could be used by the brain. In this study we hypothesized that lactate and ketone bodies can provide a significant portion of oxidative brain substrates in insulin-dependent diabetes mellitus (IDDM). Six control (C) and six insulin-treated streptozotocin diabetic (IDDM) dogs were studied during euglycemia (EU) and acute insulin induced hypoglycemia (HYPO). During EU for similar plasma glucose concentration (5.5 +/- 0.4 v 5.2 +/- 0.2 mmol/L in IDDM dogs showed a higher baseline lactate concentration (1.5 +/- 0.25 v 0.74 +/- 0.10 mmol/L; P less than .05). The ketone body concentrations were also increased in IDDM dogs but this increase was not statistically significant. The brain glucose uptake was 6.9 +/- 0.6 mumol/kg/min in C and 5.4 +/- 0.7 in IDDM. Lactate was released by the brain both in IDDM dogs (11.36 +/- 1.8 mumol/kg/min) and in C dogs (3.87 +/- 0.9; P less than .05). The brain ketones rate of disappearance (Rd) was 0.3 +/- 0.05 mumol/kg/min in IDDM dogs and 0.19 +/- 0.08 in C dogs. During HYPO the glucose uptake across the brain was 2.88 +/- 0.7 mumol/kg/min in IDDM and 3.12 +/- 0.5 in C dogs. We observed an overall brain lactate release (3.21 +/- 1.7 mol/kg/min) in C dogs and a net uptake (13.44 +/- 1.1; P less than .01) in IDDM (P less than .01). The brain ketones Rd was 0.1 +/- 0.2 mumol/kg/min in IDDM and 0.1 +/- 0.1 in C dogs.(ABSTRACT TRUNCATED AT 250 WORDS)

Pyogenic liver abscess: Is drainage always possible?

The treatment of pyogenic liver abscess generally involves antibiotic therapy and radiological percutaneous drainage or aspiration. Surgical drainage is rarely advisable. We report a case of multiloculated liver abscess that was not suitable for either percutaneous drainage or open surgical drainage. The only successful approach was a left hepatectomy.

Systemic Chemotherapy with Cisplatin, 5-Fluorouracil and Allopurinol in the Management of Advanced Epidermoid Esophageal Cancer

About 60% of patients with esophageal cancer have an advanced tumor at diagnosis, and for these patients neither surgery nor radiotherapy can offer anything more than palliation. This fact has led, in the past 10 years, to an increase in the number of studies of chemotherapy as a possible alternative treatment.

Recurrence of Esophageal Achalasia: Diagnosis and Treatment

Heller’s myotomy is a widely accepted operation for relief of dysphagia in patients with esophageal achalasia, giving excellent to good results in 80%-95% of cases [1–3]. In the remaining cases, presenting with recurrence of esophageal symptoms and requiring further treatment, the causes of failure of myotomy are usually related either to imperfect surgical technique or to late complications of the myotomy [3–5]. The present study was undertaken in an effort to define a variety of causes for postmyotomy disability and also to establish criteria for diagnosis and treatment.

Patterns of Neoplastic Recurrence After Radical and Palliative Resection of Cancer of the Esophagus

Surgery is the single most effective therapeutic approach to esophageal cancer. However, the long-term prognosis has not changed significantly over the past 2 decades despite the increased resectability rates and the developments of technique [2, 5]. This is mainly due to the high recurrence rate. Therefore, a better understanding of the natural history of this tumor and of pitfalls of surgery is of primary importance for a better planning of therapy.