Pharmacokinetics of mitomycin C after resection of peritoneal carcinomatosis and intraperitoneal chemohyperthermic perfusion.

Over the last few years surgery on patients with abdominal malignancies has become more aggressive but the majority of patients present locoregional recurrence as peritoneal dissemination. Cytoreductive surgery followed by intraperitoneal chemohyperthermic perfusion (ICHP) has been described for treatment and prevention of locoregional cancer spread from various origins. This paper reports our study of the pharmacokinetics of mitomycin C (MMC) administered by intraperitoneal chemohyperthermic perfusion (ICHP) in patients with peritoneal carcinomatosis. 28 patients received MMC 20 mg/m2 intraperitoneally as a perfusion over 60 min. MMC was determined in perfusate, plasma and urine samples with a UV-HPLC method. A compartmental model was used to fit the drug concentrations in plasma and perfusate. Our results showed a mean maximum plasma concentration (Cmax) of 0.14 +/- 0.086 microg/ml with a peak time (Tmax) of 48..7 +/- 5.61 min. The mean area under the curve (AUC) and terminal half-life (t1/2) were 15.8 +/- 9.8 mg x min/L and 83.7 +/- 31.74 min respectively. Clearance (CL) was estimated by fitting the data by a compartmental model and the mean value was 72 +/- 66 L/h. The percent of the dose absorbed was very variable and ranged between 14 and 57% (mean 37 +/- 14%). The mean percentage of dose recovered unchanged in the urine during 24 hours was 7.21 +/- 3.73%. We conclude that ICHP in patients with peritoneal surface malignancies seems to have clinical value since it gives high peritoneal and tumor MMC concentrations with limited systemic exposure and toxicity.

Axial length increase in lid-sutured rabbits.

Using eyelid sutures, we induced axial elongation in 20 15-day-old rabbits. When the eyelid sutures were opened, the eyes revealed a slight increase in their axial length. This evident axial elongation continued to evolve despite restitution of functional integrity to the previously sutured eyes. We suspect that because the lid sutures altered visual input and inhibited the retina from maintaining control of ocular growth, the retina instigated excessive eye growth, resulting in the initial consequent axial elongation that was evident on removal of the sutures. Additionally, poor quality of the retinal image, probably resulting from the noncorrected myopic ametropia caused by the lid sutures, could be the cause of the continued axial length increase observed after the lid sutures were removed.

[The use of high resolution computerized tomography (HRCT) for the diagnosis of rejection and for monitoring air-way anastomosis in patients who have undergone lung transplantation. Preliminary study]. / L'impiego della Tomografia Computerizzata ad alta risoluzione (HRCT) per la diagnosi di rigetto e per il monitoraggio dell'anastomosi sulla via aerea nei pazienti sottoposti a trapianto di polmone. Studio preliminare.

March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent high-resolution CT (HRCT) of the lung in a complex follow-up program to identify specific abnormalities of acute and chronic rejection (bronchiolitis obliterans) and to monitor the resolution of the bronchial anastomosis. Twenty-two HRCT exams were performed. In patients with acute rejection HRCT failed to identify specific abnormalities of lung parenchyma. In contrast, in one patient with pathological evidence of early bronchiolitis obliterans HRCT showed decreased peripheral vascularization. In the study of the bronchial anastomosis, HRCT showed optimal anastomosis resolution in 4 patients, whereas in one patient with a granuloma demonstrated by fibrobronchoscopy it confirmed the lesion showing also a small pneumomediastinum. Even though the HRCT finding of decreased peripheral vascularization does not appear to be specific for bronchiolitis obliterans, it may be of value in suggesting the diagnosis of early bronchiolitis obliterans in lung transplant. HRCT should be used in all patients with bronchoscopic diagnosis of bronchial complication to study the lesion and its mediastinal spread.

[Thoracic localizations of extramedullary erythropoiesis]. / Localizzazioni toraciche dell'eritropoiesi extramidollare.

A series of 8 patients affected with hemolytic beta thalassemia with intrathoracic extramedullary hematopoiesis is reviewed. All patients were studied with conventional radiologic techniques and with CT and MR imaging. There was good correlation between conventional radiology findings and MR and CT results. CT and MR imaging were useful to evaluate not only the topographic localization of the masses of extramedullary hematopoiesis, but also their functional status. On CT, masses in the active phase exhibit high density and marked enhancement after i.v. administration of contrast medium; in the remission phase, the masses are hypodense, due to fat substitution, and unenhanced. On MR images, the active phase is characterized by a relatively low signal in both T1 and T2, while in the remission phase high signal is observed in both T1 and T2. A sign is seen on MR images which is considered as pathognomonic: a peripheral ring with high signal. The use of CT and MR imaging allows detailed information on the evolution of the hemolytic disease to be obtained. These pieces of information cannot be obtained with conventional radiology, which allows, at any rate, the correct diagnosis to be made.

Isolated optic nerve involvement in chronic myeloid leukemia.

Eye involvement in chronic myeloid leukemia is well known. The signs are infiltration of the choroid, the sclera, the episclera, the conjunctiva and the optic nerve. Eye involvement is more common in acute than in chronic forms of leukemia. This paper reports a case of chronic myeloid leukemia in which optic nerve involvement was the only initial sign of the disease.

[Quantitative analysis of the lung CT in normal subjects and in patients with noncardiac pulmonary edema]. / Analisi quantitativa della TC polmonare in soggetti normali e in pazienti con edema polmonare non cardiaco.

A quantitative analysis was performed of the CT images relative to 7 normal human subjects and to 22 patients affected with ARF (Acute Respiratory Failure). The CT scanner image quality was investigated, and the unit was checked with quality control procedures, in order to assure reliability and reproducibility. In every patient the lung was scanned at 3 different levels--basis, hilum and apex. The frequency distribution of CT numbers was studied. The lung areas were calculated for the different conditions, and the data correlated with functional lung data. A method was then tested to evaluate lung weight; the data obtained did not differ from literature data. All the patients were treated with different positive and expiratory pressure (PEEP). For different PEEP values, the quantitative data from CT analysis were correlated with morphofunctional indices.

Attempt to arrest eye growth by means of ocular hypotony.

Attempt to retard growth of the eye in 4 young rabbits by means of prolonged ocular hypotony maintained by timolol-maleate were not successful. The eyes treated with 0.5 timolol twice a day showed a sustained hypotensive response of 4-5 mm Hg which lasted for the 4 months experimental period. No significant differences in size and on rate of growth in the treated and the untreated eyes were noted. In fact, over the 4 months postnatal period, both groups of eyes increased 0.5 mm per week in axial length. Our experiment suggests that in developing rabbit eyes, at least reduction of IOP is not a factor in effecting a smaller globe.

[Role of computerized tomography in the diagnosis and evaluation of aneurysms of the abdominal aorta]. / Ruolo della tomografia computerizzata nella diagnosi e nella valutazione degli aneurismi dell'aorta addominale.

The authors report their experience in CT diagnosis of abdominal aorta aneurysms and surgical complication in synthetic aortic grafts. This work is based on a study of 47 patients. Findings, methods, indications and limits of CT in the pathology of aortic aneurysms are shown and discussed.

The evolution of refraction in the fixing and the amblyopic eye.

The authors describe refractive changes in 61 children with unilateral amblyopia who were followed-up for 10 years. In each case the change was towards myopia. The various factors affecting postnatal development of the eye are discussed.

[Na+ and K+ in the rabbit aqueous humor after treatment with timolol]. / Na+ e K+ nell'umor acqueo di coniglio dopo trattamento con timololo.

The influence of timolol on aqueous humour production has been well documented, nevertheless it is unknown the real mechanism by which timolol produces this process. We have conceived the hypothesis that any alteration of natrium and kalium content following topical treatment of timolol was the main cause of the lowering rate of aqueous humour production. Therefore, we have examined the behaviour of Na+ and K+ amounts after topical administration of one eye of young rabbits with timolol. The experimentation has been conducted by photometer appliance. Our results show the absence of any imbalance between natrium and kalium content. The failure of our purpose indicates that Na+/K+ content does not play a main role in decreasing aqueous humour production by timolol.