Regional procarbazine delivery reduces testicular toxicity.

Procarbazine has been implicated as a cause of infertility. Regionalization of drug delivery is a potential method to avoid this problem. We investigated the protective effect of testicular circulatory isolation (TCI) on gonadal toxicity during procarbazine administration in the Sprague-Dawley rat. Four groups (n = 10/group) were used. Animals in group 1 received no treatment. Rats in groups 2 and 3 were anaesthetized and received TCI of the left testis by clamping of the spermatic cord and gubernaculum immediately before a bolus of intravenous procarbazine (400 mg kg-1). The clamping was maintained for 15 min after procarbazine administration in group 2 and for 45 min in group 3. Rats in group 4 received sham surgery immediately before procarbazine administration. On day 70, all rats were killed and necropsied. Testicular toxicity was evaluated qualitatively by histology and quantitatively by measurements of testicular weight, sperm head count, repopulation index, and epididymal index. The results indicated that 15 min of TCI did not mitigate testicular toxicity; 45 min of TCI provided moderate protection against procarbazine-induced testicular toxicity.

Small cell undifferentiated carcinoma of the pancreas. Report of a patient with tumor marker studies.

BACKGROUND: Small cell undifferentiated carcinoma of the pancreas is a rare type of pancreatic neoplasm. METHODS: The authors report the clinical and pathologic aspects of a patient with this malignant lesion and an extensive serologic and immunohistochemical survey of potential ectopically produced hormones or tumor markers. RESULTS: Neuron-specific enolase (NSE) emerged as a tumor marker. CONCLUSIONS: NSE could be valuable in the diagnosis and management of other patients with this rare disease.

Chemo-irradiation induced aortoesophageal fistula.

A patient with squamous cell carcinoma of the esophagus developed fatal aortoesophageal (AE) fistula following a preoperative course of combined chemotherapy plus radiation therapy. This is the first reported case of AE fistula following preoperative chemoradiotherapy. This complication is potentially correctable if suspected early, since the massive hemorrhage characteristic of AE fistula is usually preceded by an initial sentinel hemorrhage. The cause of this complication is not clear, but it may be due to inflammation of the vasa vasorum with necrosis of the aortic wall. The concomitant use of fluorouracil and cisplatin with radiation therapy acts as a radiosensitizer and may have potentiated the radiation effect on the aortic wall.

Male pelvic hemangiopericytoma on computed tomography.

A case of hemangiopericytoma in the male pelvis is presented in which computed tomography demonstrated a well-circumscribed, homogeneous enhancing mass with feeding vessels.

Comparative efficacy of adenine arabinoside 5' monophosphate and prednisone withdrawal followed by adenine arabinoside 5' monophosphate in the treatment of chronic active hepatitis type B.

Thirty-eight patients with chronic active hepatitis type B received antiviral therapy. In one trial, 22 patients were randomized to either no treatment or treatment with a 28-day cycle of adenine arabinoside 5' monophosphate (ARA-AMP); in a second trial, 13 patients were randomized to no treatment or treatment with two 28-day cycles of ARA-AMP separated by a 4-wk rest interval; during a third trial, 11 individuals were treated with 8 wk of prednisone therapy followed by 28 days of ARA-AMP therapy. The response rate (73%) to the regimen with prednisone was significantly greater than that achieved in the first or second trial (0% and 15%, respectively). The data indicate that the combination of short-term prednisone and ARA-AMP therapy may offer more promise for successful treatment of chronic active hepatitis type B than does ARA-AMP alone. Synergism may possibly occur by the combined effects of immune rebound provided by corticosteroid withdrawal and the inhibition of viral proliferation by ARA-AMP.

Postirradiation flap infection about the oral cavity.

Postirradiation alteration of oral flora is well documented in the literature. Infection as a complication leading to partial or complete loss of a flap used to reconstruct a defect in the oral cavity is a worrisome outcome. We describe how a flap that was judged clinically to be viable became overwhelmingly infected with the Klebsiella oxytoca, an oral cavity pathogen encountered in this patient following irradiation. Local and systemic changes led to detachment of the flap. This complication may be explained, in view of the absence of venous congestion or arterial ischemia both clinically and pathologically, by the proven contamination of the flap by the Klebsiella pathogen. Local factors resulted in lower resistance and subsequent overwhelming infection. Discussion of the case, review of pertinent literature, and proposed solutions are presented.

Condyloma acuminatum of the tongue.

Condyloma acuminatum, an autoinoculable infectious growth that usually involves the anogenital regions, occurs very rarely in the oral cavity, including the first histologically proven case, reported by Knapp and Mohara in 1967, a total of 7 cases have been documented in the English literature. This report describes an oral condyloma acuminatum not associated with anogenital lesions.

Candidiasis of the duodenum and jejunum.

Infection of the small bowel with Candida species has previously been noted to occur in as many as 20% of autopsy cases with histologically demonstrated gastrointestinal candidiasis. Antemortem diagnosis, however, has been difficult and not previously reported. A renal transplant recipient presented with esophageal, duodenal, and jejunal candidiasis, and the correct antemortem diagnosis of small bowel involvement was suggested by radiologic and endoscopic findings. Antifungal therapy resulted in complete resolution of these findings.

Xenon-133 retention in hepatic steatosis-correlation with liver biopsy in 45 patients: concise communication.

This study presents the results of comparison of hepatic fat content with hepatic xenon retention in 45 patients. The degree of hepatic Xe-133 retention was measured during pulmonary ventilation studies. The amount of hepatic steatosis was graded 0 to 4+ on histologic liver sections obtained by needle or surgical biopsy. There was agreement between the amount of hepatic xenon retention determined scintigraphically and the degree of steatosis determined histologically. These results suggest that Xe-133 retention in the liver provides a simple means of evaluating fatty infiltration of the liver. The potential of this technique as a noninvasive means of investigating hepatic fatty infiltration is discussed.