Surgical resection of lung metastases including the role of locoregional therapy.

Although no randomized trials are available, surgical resection is a widely accepted treatment for selected patients with pulmonary metastases. Specific criteria have been well defined and a macroscopic complete resection should be obtained. Important prognostic factors include histology, number of metastases and disease-free interval. However, even after complete resection, 5-year survival rates remain disappointingly low and many patients will have recurrent disease confined to the chest. For this reason, locoregional therapies are extensively investigated at the present time. These include biochemical and biophysical methods. Due to toxicity of high doses of intravenous chemotherapy, the main purpose is to deliver high-dose chemotherapy to the lung without systemic side-effects. Chemo-embolization, pulmonary artery infusion and isolated lung perfusion are most intensively studied. These techniques were found to be feasible and are able to deliver a high local concentration of chemotherapeutic drugs. The results of further phase II trials are awaited for to determine their effect on local recurrence and long-term survival.

Pharmacodynamics and pharmacokinetics after subcutaneous and intramuscular injection of human chorionic gonadotropin.

OBJECTIVE: The pharmacokinetics and efficiency of human chorionic gonadotropin (hCG) after subcutaneous (SC) injection was to clarify in comparison with the intramuscular (IM) mode of administration. DESIGN: In a prospective study, the pharmacokinetics of hCG and the response of serum testosterone (T), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) after an IM and SC injection of 5,000 IU hCG were evaluated up to 144 hours in two randomized groups. SETTING: The study was carried out in a clinical dermatology department providing tertiary care. PARTICIPANTS: Twenty-four healthy male volunteers with a mean age of 22.7 +/- 4.3 years were divided into two groups. INTERVENTIONS: Human chorionic gonadotropin (5,000 IU) was injected IM or SC. MAIN OUTCOME MEASURE: Serum concentration of /b-hCG, T, LH, and FSH were evaluated after IM and SC administration of hCG. Differences between the two groups were determined by t-test. RESULTS: Compared with IM administration of hCG, peak serum drug concentration was significantly delayed (P = 0.01) and serum half-life was prolonged (P = 0.01) after SC injection; however, T, LH, and FSH responses were identical. CONCLUSIONS: Subcutaneous application of 5,000 IU hCG is as effective as IM administration in terms of steroidogenesis.

[Value of perfusion scintigraphy of the testis]. / Wertigkeit der Hoden-Perfusionsszintigraphie.

Perfusion scintigraphy of the testicles has still its place, in addition to scrotal ultrasound imaging, in the investigation of the "acute scrotum". It reveals scintigraphic patterns typical for twisted testicle and acute or subacute epididymitis. Especially in the Bundeswehr, with its large number of young men, this method enhances the diagnostic spectrum and helps in making surgical decisions. However, in the examination of scrotal masses, ultrasound imaging or surgery is to be preferred.

131I-Orthoiodohippurate clearance in the detection of cisplatin nephrotoxicity.

In this study, 26 patients were treated with 20 mg cisplatin (CP)/m2 body surface daily for 5 days as part of a combination therapy for testicular cancer. Simultaneously a vigorous hyperhydration (3000 ml daily) was applied to reduce the nephrotoxic effect induced by the drug, 131I-orthoiodohippurate clearance values obtained by the modified method of Oberhausen did not show any significant evidence of tubular dysfunction after therapy. These results may have been due to the vigorous hydration as well as to the youth of the patients.

[Climatotherapy in chronic inflammations of the uvea]. / Zur Problematik der Klimatherapie bei chronischen Entzündungen der Uvea.

Treatment of uveitis depends on the inhibition of the inflammatory reaction by corticosteroids or immunosuppressive agents. "Climatotherapy" remains a controversial subject and is generally not accepted. To test its efficacy a pilot study was undertaken. Children with chronic iridocyclitis or intermediate uveitis were sent to Israel for 3 weeks. During the follow-up period of 26 months there was an initial regression of the inflammatory reaction in most cases, followed by varied courses depending on the severity of the disease. Although no definite conclusions can be drawn owing to the small number of patients (5) there might been a beneficial effect. It seems very difficult to prove the efficacy of such "treatment", since not only the climate but also many other environmental factors were changed.