Clinical validation of a prognostic tool in a population of outpatients treated for incurable cancer undergoing anticancer therapy: PRONOPALL study.

BACKGROUND: In 2008, a study of the characteristics of hospitalised patients led to the development of a prognostic tool that distinguished three populations with significantly different 2-month survival rates. The goal of our study aimed at validating prospectively this prognostic tool in outpatients treated for cancer in terminal stage, based on four factors: performance status (ECOG) (PS), number of metastatic sites, serum albumin and lactate dehydrogenase. PATIENTS AND METHODS: PRONOPALL is a multicentre study of current care. About 302 adult patients who met one or more of the following criteria: life expectancy under 6 months, performance status ≥ 2 and disease progression during the previous chemotherapy regimen were included across 16 institutions between October 2009 and October 2010. Afterwards, in order to validate the prognostic tool, the score was ciphered and correlated to patient survival. RESULTS: Totally 262 patients (87%) were evaluable (27 patients excluded and 13 unknown score). Median age was 66 years [37-88], and women accounted for 59%. ECOG PS 0-1 (46%), PS 2 (37%) and PS 3-4 (17%). The primary tumours were: breast (29%), colorectal (28%), lung (13%), pancreas (12%), ovary (11%) and other (8%). About 32% of patients presented one metastatic site, 35% had two and 31% had more than two. The median lactate dehydrogenase level was 398 IU/l [118-4314]; median serum albumin was 35 g/l [13-54]. According to the PRONOPALL prognostic tool, the 2-month survival rate was 92% and the median survival rate was 301 days [209-348] for the 130 patients in population C, 66% and 79 days [71-114] for the 111 patients in population B, and 24% and 35 days for [14-56] the 21 patients in population A. These three populations survival were statistically different (P <0.0001). CONCLUSION: PRONOPALL study confirms the three prognostic profiles defined by the combination of four factors. This PRONOPALL score is a useful decision-making tool in daily practice.

Failed treatment of abdominal pregnancy with methotrexate. A case report.

BACKGROUND: Methotrexate is an effective, safe, low-cost alternative to surgery for treating tubal pregnancies. To our knowledge, there have only been two other reported attempts at treating abdominal pregnancy with methotrexate. CASE: Despite two courses of treatment with methotrexate, the pregnancy persisted, and laparoscopy permitted a tissue diagnosis of abdominal pregnancy. CONCLUSION: Although treatment with methotrexate was not successful in this case, its potential use in abdominal pregnancies merits further investigation.

Is chemiluminescent immunoassay an appropriate substitution for radioimmunoassay in monitoring estradiol levels?

OBJECTIVE: To determine the correlation between serum estradiol measurements by chemiluminescent immunoassay (CIA) vs. radioimmunoassay (RIA) in two groups: patients treated with gonadotropins and patients treated with oral estrogen. DESIGN: Prospective study. SETTING: Assisted Reproductive Technology (ART) program based in a university-affiliated hospital in Manhasset, New York. PATIENT(S): Three hundred forty-eight patients undergoing gonadotropin stimulation and 63 patients receiving oral estrogen between July and December, 1997. INTERVENTION(S): Estradiol levels were measured concomitantly on all patients undergoing gonadotropin stimulation for IVF and all patients receiving oral estrogen for a frozen-thaw cycle. MAIN OUTCOME MEASURE(S): RIA:CIA ratio. RESULT(S): In the group undergoing gonadotropin stimulation, the median RIA:CIA ratio was 0.92, RIA = 1.26 x CIA(0.96), r = 0.98. In the group receiving oral estrogen, the median ratio was 3.93, RIA = 2.9 x CIA(1.05), r = 0.89. CONCLUSION(S): Estradiol levels determined by CIA correlate closely with RIA results for patients being treated with gonadotropins. Conversely, for patients receiving oral estrogen, CIA levels are one-third or less of the RIA level.

Abnormal sperm morphology is highly predictive of pregnancy outcome during controlled ovarian hyperstimulation and intrauterine insemination.

PURPOSE: The purpose of this study was to assess the predictive value of a modified form of Kruger's strict criteria for sperm morphology for pregnancy outcomes after intrauterine insemination (IUI) and controlled ovarian hyperstimulation (COH) in the presence of normal sperm concentration and motility. MATERIALS AND METHODS: A retrospective review of 42 couples undergoing COH/IUI was stratified by favorable or unfavorable sperm morphology. End points were pregnancy or failure of treatment as defined by four or more cycles of COH/ IUI without pregnancy. RESULTS: An unfavorable morphology (< 4%) was highly predictive of failure during COH-IUI (94.45%; 17/18). A normal PIF was a sensitive indicator of those patients who became pregnant (93.8%; 15/16) and had a fair specificity for failure to achieve pregnancy after four cycles of treatment (65.4%; 17/26). Couples with a favorable sperm morphology were 28.3 times as likely to achieve a pregnancy within four cycles of treatment as those with unfavorable sperm morphology [95% confidence limits, 3.2 to 250.5; P < 0.001]. CONCLUSIONS: Abnormal strict morphologic assessment is both sensitive and specific for pregnancy outcomes in couples undergoing COH/IUI. Couples with persistently unfavorable sperm morphology should be counseled appropriately and would be better served by more aggressive treatment with in vitro fertilization and embryo transfer.

[Lymphopoietic function of mice with alloxan diabetes]. / Sostoianie limfopoéza u myshei s alloksanovym diabetom.

Alloxan diabetes (sucrose blood concentration greater than or equal to 14 mmol/l) induced lymphocytopenia in noninbred male mice, resulting from the decrease in the number of both T and B lymphocytes differentiated by their reaction to acid phosphatase. At the same time thymic bone marrow lymphopoiesis in mice with diabetes was depressed. Nodular and splenic lymphopoiesis remained virtually unchanged. These disturbances became apparent on the 3rd week after diabetes induction. Alloxan itself has no inhibitory effect on lymphopoiesis.