D. Emrich

Heparin therapy, deep-vein thrombosis and pulmonary embolism after intracerebral hemorrhage

SummaryA prospective randomized pilot study of subcutaneous low-dose heparin in the prevention of deep-vein thrombosis and pulmonary embolism war carried out in patients admitted to hospital after intracerebral hemorrhage. A high incidence of deep-vein thrombosis and lung embolism was detected by phleboscintigraphy and lung perfusion scintigraphy, respectively. There was no significant reduction of deep-vein thrombosis and pulmonary embolism in the therapy group. Heparin did not increase the risk of rebleeding.

Comparison of Tumor Uptake and Kinetics of Different Radiopharmaceuticals Under Experimental Conditions

Using the transplantable Yoshida sarcoma in the rat, radiation activity concentrations were determined in tumor, blood, and muscle at various times for / sup 67/Ga-citrate, /sup 99m/Tc-pertechnetate, /sup 75/Seselenite, /sup 203/HgCl/ sub 2/, /sup 197/Hg-H-albumin, /sup 197/Hg-BMHP, /sup 20 3/Hg-chlormerodrin, and / sup 131/I-H-albumin. Gallium-67 exhibited the highest tumor uptake and the most favorable tumor/blood ratio. For some radiopharmaceuticals the extent of tumor uptake correlated with their biologic half life in the blood. There is some evidence that the model might be comparable with the human. (auth)

Megestrolazetat in verschiedenen Dosierungen bei der Behandlung des metastasierenden Mammakarzinoms — Klinische und endokrinologische Untersuchungen

SummaryBoth medroxyprogesterone acetate (MPA) and megestrol acetate (MA) are effective in the treatment of metastatic breast cancer. Although the dose-dependent mode of actions of MPA have been extensively clarified, there is still some uncertainty regarding the mode of actions and dosage of MA. Thirty-three patients with metastatic breast cancer were treated with various dosages of MA under a phase-II study. Eight patients were given 200 mg, 9×400 mg, 10×600 mg and 6×800 mg MA daily per os. The LH, FSH, TBI, T3, T4, TSH, ACTH, aldosterone, testosterone, prolactin and cortisol levels were determined regularly during treatment to enable the investigation of the pharmacodynamics of MA. A complete remission was achieved in two patients, a partial remission in seven patients and there was no change in eight patients (total responder rate 51.5%). The clinical and endocrine changes therefore suggest that the dose-dependent mode of actions of MPA and MA are identical. Equivalent dosages of MPA are 1000–1500 mg per os and of MA 160–200 mg. Furthermore, similar relationships between the endocrine changes and remission behaviour of MA and MPA have been observed. Persisting tumour remissions are inevitable under cortisol suppression and normal prolactin, aldosterone and ACTH levels.Both medroxyprogesterone acetate (MPA) and megestrol acetate (MA) are effective in the treatment of metastatic breast cancer. Although the dose-dependent mode of actions of MPA have been extensively clarified, there is still some uncertainty regarding the mode of actions and dosage of MA. Thirty-three patients with metastatic breast cancer were treated with various dosages of MA under a phase-II study. Eight patients were given 200 mg, 9 X 400 mg, 10 X 600 mg and 6 X 800 mg MA daily per os. The LH, FSH, TBI, T3, T4, TSH, ACTH, aldosterone, testosterone, prolactin and cortisol levels were determined regularly during treatment to enable the investigation of the pharmacodynamics of MA. A complete remission was achieved in two patients, a partial remission in seven patients and there was no change in eight patients (total responder rate 51.5%). The clinical and endocrine changes therefore suggest that the dose-dependent mode of actions of MPA and MA are identical. Equivalent dosages of MPA are 1000-1500 mg per os and of MA 160-200 mg. Furthermore, similar relationships between the endocrine changes and remission behaviour of MA and MPA have been observed. Persisting tumour remissions are inevitable under cortisol suppression and normal prolactin, aldosterone and ACTH levels.

Clinical application of a cytochemical bioassay for the determination of thyroid stimulating hormone

Thyroid stimulating hormone (TSH) was measured using a highly sensitive cytochemical bioassay (CBA) technique in normal subjects, in patients with Graves’ disease (untreated and treated) and in patients with euthyroid goiter and negative thyrotropin-releasing hormone (TRH)-test. Plasma TSH levels of normal subjects and of subjects with untreated Graves’ disease were reduced after the plasma had been incubated with a specific antibody to human TSH, indicating that the thyroid stimulating substance measured with this assay was likely to be TSH. Basal TSH levels in patients with Graves’ disease and in a special group of patients with euthyroid goiter and negative TRH test were low but detectable. They did not rise after TRH administration. Increased TSH release (4.5- to 10-fold) after TRH stimulation was demonstrated, however, in two formerly hyperthyroid patients after treatment. This increase was not detected by radioimmunoassay (RIA) due to limited sensitivity.

Intensive short-term chemotherapy in patients with advanced breast cancer

SummaryAiming at a high complete remission rate with an intensive induction regimen, 27 patients with advanced breast cancer were given three cycles of VAC chemotherapy consisting of vinde-sine 3 mg/m2 i.v. on days 1 and 12, adriamycin 40 mg/m2 i.v. on days 1 and 12, and cyclophosphamide 200 mg/m2 p.o. on days 3–6 and 14–17 together with medroxyprogesterone acetate (MPA) 1,500 mg p.o. daily during the induction phase and 1,000 mg p.o. thereafter until relapse. These VAC double cycles were repeated twice with 3-weekly intervals for a total induction period of 15 weeks. In responders, including no change, the chemotherapy was discontinued thereafter, and the patients were observed until relapse with a maintenance therapy of MPA 1,000 mg p.o. daily.A complete remission (CR) was achieved in 8 (29.6%) and a partial remission (PR) in 13 (48.2%) of the 27 patients (CR + PR 77.8%). A no change (NC) status was found in 6 patients (22.2%). There were no nonresponders. The median duration of the CR was 20 (5–42) months with two patients still in CR at 33 and 36 months, of the PR 8.3 (4–13.5) months, and of the NC 6.7 (2–13) months. The treatment was tolerated without life-threatening toxicity or interval prolongation by all patients. No dose-limiting cardiac toxicity was observed in these patients regularly controlled by left ventricular ejection fraction (LVEF). The high response rate of this intensive induction regimen warrants further investigation. Complete remission was achieved only in patients without previous chemotherapy, with marked tumor regression after the first chemotherapy cycle and when there was no extensive bone involvement.

Osteoporose-Diagnostik mit einem125J-Profilscanner bei renaler Osteopathie

SummaryQuantitative transmission profile scanning of the middle phalanx of the left forefinger was performed using the method of Börneret al. Normal ranges, different for sex and age, were established by the investigation of 86 patients showing no evidence of bone disease.The evaluation of this methods reproducibility in 5 normal subjects gave the following results:S. D. at five different days 7–35%S. D. at five continuous determinations 3.5–9.0%. Of 47 patients with severe chronic renal insufficiency, 33 showed signs of osteoporosis evidenced by radiological examination. Only in 13 of them were the absorption coefficients significantly decreased. Of the 14 patients without radiological evidence of osteoporosis 7 had normal and 7 other decreased values.It is concluded that the reproducibility of the method is not sufficient for follow-up studies and that the forefinger might not be representative for bone decalcification caused by chronic renal insufficiency.ZusammenfassungDie quantitative Bestimmung der Absorption einer125J-Strahlenquelle durch die Mittelphalanx eines Fingers soll die frühzeitige Erkennung und Verlaufskontrolle von Skeletkalksalzminderungen gestatten.Der vorläufige Normalwertbereich von 86 Probanden deckt sich mit den Angaben in der Literatur, während die Reproduzierbarkeit der Einzel- als auch der wiederholten Messungen deutlich abweicht. Die radiologische Osteoporose bei chronisch niereninsuffizienten Patienten konnte nur in 33% durch die Messung der Absorption am Finger bestätigt werden.

Tierexperimentelle Untersuchungen zur Bedeutung des Verhältnisses von Thyroxin zu Trijodthyronin

Eine Erhohung des TSH-Spiegels fuhrt beim Tier in Schilddruse und Plasma zu einer systematischen Verschiebung des Thyroxin-Trijodthyroninverhaltnisses und zwar zum Trijodthyronin hin [1, 3, 6, 7]. Dieser Befund stutzt eine zum Teil schon altere Hypothese: die Bevorzugung der Synthese des schneller und in der Zeiteinheit starker wirkenden Trijodthyronins konnte eine Regulationsmoglichkeit darstellen [2, 8]. Auf diese Weise wurde ein Hormondefizit schneller und wirkungsvoller beseitigt als durch die gleichmasige Synthesesteigerung beider Hormone.