Urinary neopterin and kynurenine in patients submitted to surgical stress with different inhalational anesthetics (halothane or isoflurane).

Measurements were taken of urinary levels of neopterin (NPT) and kynurenine (KYN), using an HPLC method for their simultaneous analysis in patients submitted to anesthetical surgical stress with two different inhalational anesthetics (halothane and isoflurane). We studied twenty-one women affected by uterine fibromyomatosis and submitted to total hysterectomy (mean age of 42.7+/-5.4 years). They showed the same pre-operative evaluation (ASA-1), and underwent the same i.v. anesthetic treatment. Our patients were randomized in two groups: Group A: 11 patients had halothane as an inhalational anesthetic drug for the maintenance of the anesthetic induction (mean time= 1 h). Group B: 10 patients had isoflurane. A significant decrease in urinary NPT and KYN, parallel to serum-NPT, was found 4 h after anesthetic induction. Raised NPT levels appeared 24 h after A.I. with significant increased levels after 7 days. A strong correlation between urinary and serum NPT levels was seen (Rs= 0.74; p < 0.001). Significantly low KYN levels were observed both 4 h and 24 h after A.I.. In addition to the delayed increase of the excretory KYN levels, significantly raised KYN levels in Group B (isoflurane) 48 h after A.I. (10.59+/-14.31 vs 5.99+/-7.17 micromol/mol creat.; p < 0.01) were shown, whereas in Group A (halothane) we observed a progressive increase as compared to the pre-surgery values starting from 72 h after surgery. Our data seem to show that: (a) it is possible to have a biochemical and non invasive monitoring of the anesthetical-surgical stress on MM "priming" activity; (b) the activation of the phagocyte compartment is one of the earlier immunological events after surgery (NPT), but the efficiency of this "priming" appears to be delayed (KYN); (c) isoflurane appears to induce an earlier recovery in MM activation.

Significance of methotrexate serum level achieved in patients with gastrointestinal malignancies treated with sequential methotrexate, L-folinic acid and 5-fluorouracil.

Twenty-one patients affected by advanced carcinoma of the digestive tract, all but 2 previously treated, received on day 1 every 2 weeks a 2-hour intravenous (i.v.) infusion of methotrexate (MTX), 250 mg/m2, followed 24 h later by a 2-hour i.v. infusion of L-folinic acid (LFA), 250 mg/m2, and 5-fluorouracil (FU), 600 mg/mg2 as an i.v. bolus. Only 1 previously untreated patient obtained a partial response. The MTX serum level assessed 24 h after its infusion (24-hour sMTX) ranged from 0.3 to 5.7 (median: 0.9) microM, and in only 8/21 patients reached a concentration > or = 1 microM. A further 46 patients (of whom 22 had been previously treated) received the same treatment as above but with a double dosage (500 mg/m2) of MTX. Twelve of these 46 patients (26%, 95% confidence interval = 14-41%) achieved a partial response with this regimen. Responses were obtained in chemotherapy-naive patients (8/24) and in previously treated patients (4/22). The 24-hour sMTX ranged from 1.2 to 9.5 microM)(median: 2.3) and was > or = 2 microM in 30/46 patients. Among patients showing a 24-hour sMTX value > or = 2 microM, the response rate was 39% (45% in previously untreated patients), while no patient with a 24-hour sMTX value below 2 microM at 24 h obtained a major response (p = 0.0017). Our findings demonstrate that 500 mg/m2 of MTX given as a 2-hour i.v. infusion is required to reach a serum concentration of at least 1 microM for 24 h. Furthermore, the double biochemical modulation of FU may obtain an objective response in patients previously treated with fluoropyrimidines.

High serum HDL-cholesterol in pre- and post-menopausal women with breast cancer in southern Italy.

Up until now, conflicting results have been reported on the association between serum cholesterol and risk of breast cancer in women. In this study, the serum concentrations of cholesterol, HDL-cholesterol, triglycerides and total lipids in women with breast cancer (BC) have been compared to those of women with benign breast disease (BBD). BC women had higher serum concentration of HDL-cholesterol both in pre- and in post-menopausal age. No difference was observed in the serum concentration of total cholesterol, triglycerides and total lipids. These findings could be explained by an increased estrogen activity which is believed to be involved in the development of breast cancer, and in the modulation of lipid metabolism (lowering LDL-cholesterol and increasing HDL-cholesterol). High serum HDL-cholesterol could be a biochemical index of increased risk of having breast cancer.

[Bacterial infections in cancer patients without neutropenia. Comparison between 2 antibiotic combinations (aztreonam and oxacillin versus cefoxitin and tobramycin)]. / Infezioni batteriche in pazienti neoplastici non neutropenici. Confronto tra due associazioni di antibiotici (aztreonam + oxacillina versus cefoxitina + tobramicina).

In the treatment of infections arisen in neoplastic patients without neutropenia, 2 antibiotic combinations (aztreonam + oxacillin vs tobramycin + cefoxitin), have been compared with regard to therapeutic effectiveness and tolerability. Twenty patients (age: 30-75) have been studied. Tolerability of both combinations was excellent. Results of this study showed a lower percentage of superinfections and a higher percentage of cure in patients treated with the combination aztreonam + oxacillin, even if the data were not statistically significant.