Clinically meaningful treatment responses after switching to galantamine and with addition of memantine in patients with Alzheimer's disease receiving donepezil.

Clinical trials have shown the benefits of acetylcholinesterase inhibitors, such as donepezil and galantamine, and an N-methyl-D-aspartate receptor antagonist, memantine, in patients with Alzheimer's disease (AD). However, little is known regarding the effects of switching from donepezil 5 mg/day to galantamine 16 or 24 mg/day, or regarding the effects of adding memantine to established therapy compared with increasing the dose of donepezil. This report discusses two studies conducted to evaluate treatment with galantamine and memantine with respect to cognitive benefits and caregiver evaluations in patients with AD receiving donepezil 5 mg/day for more than 6 months. Patients with mild or moderate AD (scores 10-22 on the Mini-Mental State Examination) were enrolled in the Galantamine Switch study and switched to galantamine (maximum doses 16 mg versus 24 mg). Patients with moderate to severe AD (Mini-Mental State Examination scores 3-14) were enrolled in the Donepezil Increase versus Additional Memantine study and either had their donepezil dose increased to 10 mg/day or memantine 20 mg/day added to their existing donepezil dose. Patients received the study treatment for 28 weeks and their Disability Assessment for Dementia, Mental Function Impairment Scale, Cohen-Mansfield Agitation Inventory, and Neuropsychiatric Inventory scores were assessed with assistance from their caregivers. For the Galantamine Switch study after 8 weeks, agitation evaluated by the Cohen-Mansfield Agitation Inventory improved in both the 16 mg and 24 mg groups compared with baseline. However, there were no significant differences between the two galantamine groups. Agitation was also less in patients in the additional memantine group than in the donepezil increase group. In summary, switching to galantamine from donepezil and addition of memantine in patients with AD receiving donepezil were both safe and meaningful treatment options, and particularly efficacious for suppression of agitation.

Mortality for gastric cancer in elderly patients.

BACKGROUND: The aim of this study was to clarify the surgical outcome in elderly patients with gastric cancer. METHODS: The clinicopathological features of elderly patients (80 (3.7%), over 80 years, elderly group) were reviewed retrospectively and compared with those of younger patients (2095 (96.3%), 23-79 years, control group). RESULTS: The elderly group had a significantly higher prevalence of concomitant disease (P < 0.0001), while the prevalence of T1 primary tumor, N0 lymph node metastasis, and stage I was lower (P = 0.0125, P = 0.0004, P < 0.0001). The rates of resected cases and curative operation (R0) were significantly lower in the elderly group (P < 0.0001, P = 0.0021). The mortality from other diseases was 16.3% in elderly patients and 4.4% in control patients (P < 0.0001). The 5-year survival of stage I and stage IV were not significantly different between the two groups (P = 0.1266 and P = 0.2490). The overall survival and disease-specific survival for all patients in the elderly group were significantly lower than those in the control group (P < 0.0001, P = 0.0102). However, disease-specific survival for resected cases was not significantly different between the two groups (P = 0.0725). CONCLUSIONS: In elderly patients, the reason for the poor prognosis is the high rate of advanced stage and the high rate of death from other diseases.

Docetaxel plus 5-fluorouracil for terminal gastric cancer patients with peritoneal dissemination.

BACKGROUND/AIMS: There are few reports on chemotherapy for poor prognosis terminal patients with peritoneal dissemination of gastric cancer, especially in those with renal dysfunction, because of the possibility of severe toxicity. We conducted a study of the combination of docetaxel and 5-fluorouracil for the treatment of these patients to improve quality of life because of its low toxicity. METHODOLOGY: Five patients were treated in this study. All patients had a large volume of carcinomatous fluid in the abdomen, without liver or distant metastasis. The respective doses of docetaxel and 5-fluorouracil were 60 mg/m2 on day 1 and 370 mg/m2 on days 1 to 5 by intravenous infusion. Patients received this treatment 2-7 times every 2-3 weeks. RESULTS: Grade III/IV toxicity occurred, consisting of neutropenia (100%) and diarrhea (40%). No patients developed renal dysfunction. Carcinomatous fluid volume diminished for 15-96 days. Quality of life questionnaire score and performance status scale was significantly improved from 75-86 to 51-61 (p = 0.041) and 3-4 to 0-1 (p = 0.039), respectively. All patients were able to leave hospital after this treatment. Four of five patients died and median survival time was 223 days. Two of five patients achieved partial response and three patients showed no response (response rate 40%). CONCLUSIONS: This new combination therapy had benefit for terminal patients with peritoneal dissemination of gastric cancer.

Pheochromocytoma presenting as an abdominal emergency: association with perforation of the colon.

A pheochromocytoma is a rare tumor derived from the adrenal medulla (or from chromaffin cells of sympathetic ganglia). Its symptoms derive mostly from the excessive release of catecholamines (adrenaline and noradrenaline). Hypertension is the most recognized feature of this disease, but gastrointestinal manifestations can on rare occasions be just as serious and life threatening. This report describes a rare case of a 70-year-old woman with pheochromocytoma who developed an acute abdominal emergency with shock and panperitonitis as a result of perforation of the descending colon which was effectively treated by surgical removal of the tumor and the perforated colon. There have been 2 such cases in the English literature in whom a pheochromocytoma was associated with perforation of the colon. Successful surgical removal of such a pheochromocytoma has been not reported previously. Our case demonstrates the importance of recognizing that a pheochromocytoma presents with a wide spectrum of manifestations, and rapid treatment brings improvement to the patient.