Comparative study of the clinical efficacy of two dosing regimens of flutamide.

PURPOSE: We performed a randomized trial to compare the efficacy and toxicity of a new dose of flutamide (500 mg QD) with the currently recommended dose (250 mg q8h) in the treatment of advanced prostate cancer. The primary endpoints were percent of patients having normalization of prostate specific antigen (PSA), time to normalization, and percent change from baseline. Secondary endpoints were quality of life and toxicity. PATIENTS: Altogether, 440 men aged 46 to 94 years (mean 71 years) with confirmed stage M(1) disease, documented PSA rise >0.2 ng/mL, ECOG status 0 to 2, no second neoplasm, no liver function tests > or = 1.5-fold normal values, and no previous treatment for metastatic disease were entered in the trial. RESULTS: The PSA normalized by week 12 in 71% of the patients receiving 500-mg dose and 75% of those receiving the standard dose. The percent change in PSA was 89% and 96%, respectively. The treatment groups were not significantly different with respect to the incidence of adverse events: 71% v 68% in the 500-mg and 250-mg arms, respectively (P = 0.337). CONCLUSIONS: When combined with castration, 500 mg of flutamide appears to be equally effective in lowering serum PSA and is not significantly more toxic than conventional dosing. The use of 500 mg QD instead of the standard 250 mg q8h would result in a cost savings of 30%.

Results of surgical treatment of renal cell carcinoma with solitary metastasis.

To determine the effect on survival of excision of a solitary metastasis from renal cell carcinoma, the records of 29 patients seen at our institute within the last 15 years (1972 to 1986) who underwent such an operation were reviewed. Metastasis was present at diagnosis in 11 of the 29 patients, while 18 had metastasis 2 months to 11 years after nephrectomy, with an average interval free of disease of 38 months. There were 13 pulmonary metastases, 6 bone lesions and 10 other lesions. The estimated over-all survival rate for this group was 41 per cent at 2 years and 13 per cent at 5 years after excision of the metastasis. Only 2 of the 29 patients currently are alive with no evidence of disease 42 and 53 months since excision of the metastasis. Neither the presence nor absence of a metastasis at diagnosis nor the interval between nephrectomy and the development of a metastasis in patients without metastatic disease at diagnosis appeared to influence survival after excision of the metastasis. Unlike previous reports, these results suggest that the beneficial effects of excision of metastatic renal cell carcinoma are limited to improved short-term survival postoperatively and that surgical cure of patients with metastatic renal cell carcinoma is a relatively uncommon event.

Premenstrual tension syndrome symptom clusters. Statistical evaluation of the subsyndromes.

Premenstrual symptoms were evaluated in a group of women with severe premenstrual tension syndrome. Factor analysis was performed in order to establish the nature of symptom clusters in this sample. Similar to clinical observations reported on before, the results revealed two distinct clusters of emotional/behavioral symptoms and two of physical symptoms.

Bleomycin-induced nodular pulmonary fibrosis masquerading as metastatic testicular cancer.

Bleomycin has become an important component of combination chemotherapy, particularly in the treatment of metastatic testis carcinoma. Pulmonary toxicity is a major risk and irreversible pulmonary fibrosis or even death may result from its use. Rarely diffuse fibrosis may lead to discrete nodularity mimicking pulmonary metastasis. We report such a case, and discuss the various clinical, radiographic and histopathological forms of bleomycin-induced pulmonary toxicity.

Nephrobronchial colonic fistula complicating perinephric abscess.

Perinephric abscess is an uncommon complication of acute pyelonephritis. A nephrobronchial colonic fistula is a rare sequela of perinephric abscesses. We report such a case, review the literature, and discuss the associated morbidity and diagnostic dilemmas.

Comparison of depressed and nondepressed women with severe premenstrual tension syndrome.

There is a need to better understand the relationship between premenstrual tension syndrome (PMS) and premenstrual depression. This research was designed to determine if severely depressed women experience a different kind of premenstrual dysfunction than nondepressed PMS patients. The nature and severity of premenstrual symptoms in both groups were evaluated and compared. The severely depressed women were found to have higher PMS scores, but did not differ from the nondepressed group in selection or ranking of symptoms. Depression appeared to influence the patient's perception and rating of symptoms, but the underlying premenstrual dysfunction was identical.

Fetal chromosome analysis in Virginia: results and complications of 2,288 cases.

In reviewing the results and complications of 2,288 consecutive fetal chromosome analyses at the Medical College of Virginia, we found that 48 abnormal fetuses (2.1%) were detected, with age-specific and indication-specific incidences of particular abnormalities (such as Down's syndrome and structural rearrangement) similar to those found in other large series. An unusual finding was a 5.5% incidence of aneuploidy among 55 patients who had antenatal testing because of a history of neural tube defects. The spontaneous abortion rate after amniocentesis was 2.5% from 1976 to 1981, but only 0.9% in 1982 to 1983. Adequate karyotypes were obtained in 99.6% of patients; there were no laboratory misdiagnoses. We discuss the present impact of fetal karyotyping in Virginia, as well as the implications for pregnancy surveillance in the future of the decreasing morbidity of midtrimester amniocentesis and technologic improvements in obstetrics, such as ultrasonography and chorionic villus biopsy.

Pure intrarenal lipoma--report of a case and review of the literature.

Pure intrarenal lipomas of sufficient size to be of surgical significance are among the rarest of renal tumors. A review of the literature to date revealed only 17 cases reported previously that met the histologic requirements of a pure intrarenal lipoma. We report an additional case in which the large tumor became clinically apparent following blunt trauma and rupture.