Square Meter Of Body Surface Research Articles

CRITICAL REVIEW OF MEDA DHATU AND OBESITY IN REFERENCE TO AYURVEDIC LITERATURE


 Obesity is one of the santarapanajanya vyadhi, originated as a result of deteriorated life style which includes sedentary daily routine and junk food habits. It occurs when the consumption of calories becomes more than its expenditure. It serves as an etiological factor for many diseases. It has reached to the epidemic proportion, affecting majority of the urban population. Obesity can be estimated by various scales among which Body Mass Index (BMI) and skin fold measurements are most common. Obesity is indirectly proportional to Basal Metabolic Rate (BMR). BMR is the amount of energy required to do the involuntary work of the body which is around 47 calories per hour per square meter of body surface in males and 37 in females, but may vary with temperature as a rise in 1o F of body temperature may lead to an average increase of 7% of BMR1. Prior to the management of this disorder, it is obligatory to reach to its roots. Ancient scholars tried to elaborate the causes, pathology, types, complications and management of obesity in their own way, and this description is scattered here and there. The present article will try to assemble these references, and find out a common conclusion.

Descripción de la dinámica circulatoria en el corazón y pulmones de habitantes del nivel del mar y de las grandes alturas por medio de la técnica de dilución del colorante

La técnica de dilución ha sido usada para la descripción de la dinámica circulatoria en el corazón y pulmones de habitantes del nivel del mar y de las grandes alturas. El principal propósito de este trabajo ha sido la medida de la cantidad de sangre contenida en los pulmones de estos grupos de personas, por medio de la fórmula de Newman, con objeto de demostrar si los nativos de las grandes alturas tienen una mayor cantidad de sangre en los pulmones. Los siguientes cálculos se hicieron: tiempos circulatorios, volumen de expulsión del corazón, volumen sanguíneo intralorácico (Hamilton), volumen central (Newman) y volumen sanguíneo total. Al nivel del mar se estudiaron 20 hombres y 15 mujeres. En la altra (4,540 mts.) se estudiaron 10 hombres que habían nacido y seguían viviendo a 4,540 mts. Cuando los valores se corrigen por metro cuadrado de superficie corporal , no hay diferencia marcada entre hombres y mujeres a nivel del mar, aparte de las conocidas diferencias hematológicas. Los nativos de la altura muestran tiempos circulatorios más prolongados, un volumen de expulsión ligeramente mayor, mayor volumen sanguíneo y mayor cantidad de sangre contenida en los pulmones. Cuando el volumen de sangre pulmonar, calculado con la fórmula de Newman, se expresa como porcentaje del volumen sanguíneo total, el grupo de altura también muestra cifras mayores que los individuos del nivel del mar.

The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy

Objective To evaluate the efficacy of methotrexate treatment for extrauterine pregnancy and define criteria for prediction of success. Methods Of 829 patients with an ectopic pregnancy admitted to E. Wolfson Medical Center, Holon, Israel, from January 1997 through December 2009, 238 had asymptomatic tubal pregnancies and increasing serum β-human chorionic gonadotropin (βhCG) levels. These patients were treated with a single intramuscular injection of 50 mg of methotrexate (MTX) per square meter of body surface. Success was defined as undetectable βhCG levels without the need for a surgical intervention. Results The groups of patients successfully treated (n = 167 [70%]) and unsuccessfully treated (n = 71 [30%]) were compared. They were similar regarding age and gravidity. The initial serum βhCG level was significantly higher in the latter group than in the former (3798 mIU/mL vs. 1601 mIU/mL, P < 0.01). The success rate was 88% when initial βhCG levels were less than 1000 mIU/mL, 71% when they were between 1000 and 2000 mIU/mL, and only 59% when they were between 2000 and 3000 mIU/mL. Conclusion Methotrexate treatment is a safe and effective alternative to surgery. However, patients with initial βhCG levels higher than 2000 mIU/mL should only be offered the surgical approach.

Differences and similarities of postprandial lipemia in rodents and humans

BackgroundThe rat has been a mainstay of physiological and metabolic research, and more recently mice. This study aimed at characterizing the postprandial triglyceride profile of two members of the Muridae family: the Wistar rats (Rattus norvegicus albinus) and C57BL/6 mice (Mus musculus) plus comparing them to the profile obtained in humans.MethodsThirty-one male and twelve female Wistar rats, ten C57BL/6 male and nine female mice received a liquid meal containing fat (17%), protein (4%) and carbohydrates (4%), providing 2 g fat/Kg. Thirty-one men and twenty-nine women received a standardized liquid meal containing fat (25%), dextromaltose (55%), protein (14%), and vitamins and minerals (6%), and providing 40 g of fat per square meter of body surface. Serial blood samples were collected at 2, 4, 6, 8 and 10 h after the ingestion in rats, at 1, 2, 3, 4, 5 and 6 h in mice and in humans at 2, 4, 6 and 8 h. Wilcoxon and Mann-Whitney tests were used.Results/DiscussionThe triglyceride responses were evaluated after the oral fat loads. Fasting and postprandial triglyceridemia were determined sequentially in blood sample. AUC, AUIC, AR, RR and late peaks were determined.ConclusionsRats are prone to respond in a pro-atherogenic manner. The responses in mice were closer to the ones in healthy men. This study presents striking differences in postprandial triglycerides patterns between rats and mice not correlated to baseline triglycerides, the animal baseline body weight or fat load in all animal groups.

Abstract P6-12-06: Oral Vinorelbine and Capecitabine Plus Bevacizumab in Recurrent Inflammatory Breast Cancer: Gene Profiling and Response to Treatment

Abstract Background: Therapies that target vasculolymphatic processes - angiogenesis, lymphangiogenesis, and vasculogenesis — have shown potential in the treatment of inflammatory breast cancer. Methods: We randomly assigned 46 patients to receive oral vinorelbine 55 mg per square meter of body surface on days 1 and 3 and capecitabine 2000 mg per square meter on days 1 to 14 every 3 weeks either concurrent or sequential to bevacizumab 15 mg per kilogram of body weight on days 1 and 21 (BEVIX). The primary end point was progression-free survival; the response rate and overall survival were a secondary end point. For correlative studies we collected baseline tissue and blood samples of all patients. Gene expression profiling was performed using Affymetrix HG-U133 Plus 2.0 arrays. Data were analyzed using Partek Genomic Suite 6.4 and GeneSpring 7.0. Tissue from normal breast was used as control. Results: From July 2007 through January 2010, a total of 46 patients were enrolled. Concurrent oral vinorelbine and capecitabine plus bevacizumab significantly increased the objective response rate as compared to the sequential treatment (11.1% vs. 46.4%, p=0.025). No difference in progression-free survival was observed between the two arms (median time to progression 4.3 vs. 4.7 months, p=0.69; Hazard Ratio: 0.86, 95% CI: 0.41-1.80). The median overall survival was 9.1 months in concurrent arm and 15.8 months in sequential arm, (p=0.43). Global gene expression was analyzed in tumor samples from 18 pts bearing a triple negative phenotype. This cohort displayed a specific gene expression profile, including high expression levels of several cytokeratins, Aurora kinase A, Cyclin E and others, similar to the basal-like subtype. This profile did not include genes previously reported as differentially expressed in inflammatory breast cancers. We identified a set of 75 genes whose expression correlates with response to bevacizumab base therapy. Conclusions: BEVIX is an active treatment for patients with recurrent inflammatory breast cancer. These tumors showed a gene expression pattern similar to that of basal-like type. We identified a set of 75 genes whose expression levels predict the response to BEVIX. The validity of this expression signature is currently being assessed. Supported by Roche and Associazione Italiana per la Ricerca sul Cancro (AIRC) grants. Data partially submitted to 2010 ASCO Meeting Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-12-06.

Improved survival in patients with locally advanced esophageal cancer utilizing a multidisciplinary approach

14130 Background: Locally advanced esophageal cancer studies have reported a three year overall survival rate of 32% with a median survival of 16 months. These patients were treated with combined chemotherapy and radiation with surgery, when applicable. We conducted this study to determine whether using an individualized, multidisciplinary approach affected survival outcomes in patients treated for locally advanced esophageal cancer. Methods: All patients treated for locally advanced esophageal cancer were retrospectively identified from our database at The Cancer Institute of New Jersey at Cooper University Hospital. All patients were presented and discussed in a multidisciplinary gastrointestinal tumor board conference. After a consensus was obtained, a treatment plan was established for each patient based on his or her respective clinical characteristics: stage, performance status, medical suitability for surgery and resectabilty. Results: A total of 23 patients (median age: 66 years [range, 55–88 years]) were identified, the histopathologic diagnosis was adenocarcinoma in 13 and squamous cell carcinoma in 10 cases. TNM staging was as follows: 18 (78.3%) stage II or III and 5 (21.7%) stage IV. Initial management included esophagectomy for 9 (39.1%), 6 of which received preoperative chemotherapy (5-FU) and three received postoperative adjuvant chemotherapy, 14 (60.9%) received only combined chemotherapy (average four cycles of 5FU 1000 mg per square meter of body surface + Cisplatin 75 mg per square meter of body surface) and radiation at doses 50–64 Gy. Overall median survival was not reached since only five patients (21.7%) have died. The 1- year and 2-year survival rates were 87% and 74% respectively. Median follow-up for patients who received combination chemotherapy and radiation vs. surgery with preoperative therapy was 29 and 41 months, respectively. Conclusion: This retrospective analysis shows promising outcomes compared to published data supporting the role of an individualized, multidisciplinary approach in the management of each patient with esophageal cancer. No significant financial relationships to disclose.

Intraperitoneal Cisplatin and Paclitaxel in Ovarian Cancer

This randomized, phase III trial by the Gynecologic Oncology Group (GOG) was designed to compare treatment with intravenous paclitaxel plus cisplatin with intravenous paclitaxel plus intraperitoneal cisplatin and paclitaxel in patients with stage III ovarian cancer. study. End points were the progression-free and overall survival. Eligibility criteria included a primary diagnosis of stage III ovarian cancer with no residual mass greater than 1.0 cm after surgical treatment, at least a moderate activity level, normal blood counts, and adequate renal and hepatic function. Patients randomized to the intravenous therapy group received 135 mg intravenous paclitaxel per square meter of body surface area over a 24-hour period on day 1 and 75 mg intravenous cisplatin per square meter on day 2. Patients in the intraperitoneal therapy group were given 135 mg intravenous paclitaxel per square meter of body surface for 24 hours followed by 100 mg intraperitoneal cisplatin per square meter on day 2 and 60 mg intraperitoneal paclitaxel per square meter on day 8. New cycles were not started until neutrophil counts were greater than 1500 cells/mm 3 , platelet counts were ≥1,000,000 cells/mm 3 , and creatinine levels were ≤2.0 mg/dL. Participants were removed from the study when new cycles were delayed for more than 3 weeks. In the intraperitoneal group, patients who experienced grade 2 abdominal pain were given lower doses of the intraperitoneal drug. Persistent grade 2 abdominal pain, or grade 3 abdominal pain, or complications involving the intraperitoneal catheter resulted in a conversion to intravenous therapy for the remaining cycles. Carboplatin replaced cisplatin if severe toxicity resulting from cisplatin developed. Of the 415 women who met all eligibility criteria, 210 were randomized to the intravenous group, and 205 were assigned to the intraperitoneal group. Ninety percent of patients in the intravenous group completed six cycles of chemotherapy, and 83% received six cycles of the assigned intravenous therapy. In comparison, 83% of women in the intraperitoneal group completed six cycles of chemotherapy, but only 42% received all six cycles of the assigned intraperitoneal therapy. Compared with the intravenous group, the intraperitoneal therapy group had significantly more grade 3 or 4 adverse events, the most severe of which were fatigue, pain, or hematologic, gastrointestinal, metabolic, or neurologic toxic effects (P ≤.001 for all). After a median follow up of 48.2 months for the intravenous group and 52.6 months for the intraperitoneal therapy group, the median progression-free survivals were 18.3 months and 23.8 months, respectively (Fig. 1). The median overall survival was 49.7 months in the intravenous group compared with 65.6 months for the intraperitoneal group (Fig. 2). Quality-of-life assessments were made at baseline, before the fourth cycle, 3 to 6 weeks after the sixth cycle, and 12 months after the sixth cycle. After adjustments for confounding factors, the patients receiving intraperitoneal therapy reported lower quality-of-life scores at the prefourth cycle assessment (P <.001) and 3 to 6 weeks after completion of therapy (P =.009) compared with the patients in the intravenous group. However, 12 months after treatment, there were no differences in quality of life between the two groups.

Disorder of adrenal gland function in chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is defined as constellation of the prolonged fatigue and several somatic symptoms, in the absence of organic or severe psychiatric disease. However, this is an operational definition and conclusive biomedical explanation remains elusive. Similarities between the signs and symptoms of CFS and adrenal insufficiency prompted the research of the hypothalamo-pituitary-adrenal axis (HPA) derangement in the pathogenesis of the CFS. Early studies showed mild glucocorticoid deficiency, probably of central origin that was compensated by enhanced adrenal sensitivity to ACTH. Further studies showed reduced ACTH response to vasopressin infusion. The response to CRH was either blunted or unchanged. Cortisol response to insulin induced hypoglycaemia was same as in the control subjects while ACTH response was reported to be same or enhanced. However, results of direct stimulation of the adrenal cortex using ACTH were conflicting. Cortisol and DHEA responses were found to be the same or reduced compared to control subjects. Scott et al found that maximal cortisol increment from baseline is significantly lower in CFS subjects. The same group also found small adrenal glands in some CFS subjects. These varied and inconsistent results could be explained by the heterogeneous study population due to multifactorial causes of the disease and by methodological differences. The aim of our study was to assess cortisol response to low dose (1 microgram) ACTH using previously validated methodology. We compared cortisol response in the CFS subjects with the response in control and in subjects with suppressed HPA axis due to prolonged corticosteroid use. Cortisol responses were analysed in three subject groups: control (C), secondary adrenal insufficiency (AI), and in CFS. The C group consisted of 39 subjects, AI group of 22, and CFS group of nine subjects. Subject data are presented in table 1. Low dose ACTH test was started at 0800 h with the i.v. injection of 1 microgram ACTH (Galenika, Belgrade, Serbia). Blood samples for cortisol determination were taken from the i.v. cannula at 0, 15, 30, and 60 min. Data are presented as mean +/- standard error (SE). Statistical analysis was done using ANOVA with the Games-Howell post-hoc test to determine group differences. ACTH dose per kg or per square meter of body surface was not different between the groups. Baseline cortisol was not different between the groups. However, cortisol concentrations after 15 and 30 minutes were significantly higher in the C group than in the AI group. Cortisol concentration in the CFS group was not significantly different from any other group (Graph 1). Cortisol increment at 15 and 30 minutes from basal value was significantly higher in C group than in other two groups. However, there was no significant difference in cortisol increment between the AI and CFS groups at any time of the test. On the contrary, maximal cortisol increment was not different between CFS and other two groups, although it was significantly higher in C group than in the AI group. Maximal cortisol response to the ACTH stimulation and area under the cortisol response curve was significantly larger in C group compared to AI group, but there was no difference between CFS and other two groups. Several previous studies assessed cortisol response to ACTH stimulation. Hudson and Cleare analysed cortisol response to 1 microgram ACTH in CFS and control subjects. They compared maximum cortisol attained during the test, maximum cortisol increment, and area under the cortisol response curve. There was no difference between the groups in any of the analysed parameters. However, authors commented that responses were generally low. On the contrary Scott et al found that cortisol increment at 30 min is significantly lower in the CFS than in the control group. Taking into account our data it seems that the differences found in previous studies papers are caused by the methodological differences. We have shown that cortisol increment at 15 and 30 min is significantly lower in CFS group than in C group. Nevertheless, maximum cortisol attained during the test, maximum cortisol increment, and area under the cortisol response curve were not different between the C and CFS groups. This is in agreement with our previous findings that cortisol increment at 15 minutes has the best diagnostic value of all parameters obtained during of low dose ACTH test. However, there was no difference between CFS and AI group in any of the parameters, although AI group had significantly lower cortisol concentrations at 15 and 30 minutes, maximal cortisol response, area under the cortisol curve, maximal cortisol increment, and maximal cortisol change velocity than C group. Consequently, reduced adrenal responsiveness to ACTH exists in CFS. In conclusion, we find that regarding the adrenal response to ACTH stimulation CFS subjects present heterogeneous group. In some subjects cortisol response is preserved, while in the others it is similar to one found in secondary adrenal insufficiency.

Neurological improvement during bioartificial liver sessions in patients with acute liver failure awaiting transplantation.

Brain edema is the main cause of death in acute liver failure patients awaiting transplantation. We assessed the HepatAssist 2000, a liver-assist system containing porcine hepatocytes, as a bridge to transplantation in patients with acute liver failure. Thirteen patients suffering from acute liver failure with criteria for transplantation entered an open baseline-controlled study, with liver-assist treatment sessions at 24-hr intervals until transplantation. Neurological status was regularly evaluated using the Glasgow Coma Scale. Three patients were not treated: one had an immediate transplantation and two improved spontaneously. Ten patients received one to three courses of HepatAssist. A significant neurological improvement (mean Glasgow Coma Scale before and after treatment: 6.5+/-3.7 and 9.6+/-4.4, respectively, P<0.02) was observed, which was related to the volume of plasma processed per square meter of body surface. A significant decrease was observed in mean levels of bilirubin (P=0.0005) and transaminases but not in the other indicators of liver function. Six patients had transient episodes of hemodynamic instability, and five had bleeding complications. Two patients died after transplantation. Eight patients survived with a mean follow-up of 24.3 (18-32) months. The HepatAssist 2000 is well tolerated, improves cerebral function, and may be used as a bridge to transplantation for patients with liver failure.

Semen quality during vincristine treatment in dogs with transmissible venereal tumor

The aim of this study was to evaluate the direct effects of vincristine on semen quality in dogs with transmissible venereal tumor (TVT). We examined the semen of 17 dogs suffering from TVT during vincristine treatment. Each animal received 0.6 mg, iv vincristine sulphate per square meter of body surface, per week for 4 wk until complete regression of the tumor. The following semen parameters were evaluated: semen volume (second fraction), sperm concentration, total spermatozoa per ejaculate, percentage of progressively motile spermatozoa, percentage of dead spermatozoa, percentage of swollen spermatozoa (hypo-osmotic swelling test) and percentage of morphologically abnormal spermatozoa (primary and secondary defects). Semen was collected and evaluated prior to the beginning of treatment, 3 d after each vincristine injection and 15 d after the last injection. Semen characteristics transiently deteriorated during treatment, but returned to normal 15 d later. These changes were attributed to a direct effect of vincristine on the extragonadal spermatozoal reserves contained in the epididymis and ductus deferens. A GnRH stimulation test was also performed after each semen collection in order to assess the function of the hypothalamic-pituitary-Leydig cell axis. No effect was noted on the above axis.

Recent cohort trends in malignant melanoma by anatomic site in the United States.

The incidence of malignant melanoma has been increasing steadily in the United States. The increase may be due to lifestyle changes in subsequent generations or birth cohorts. The nine population-based tumor registries in the Surveillance, Epidemiology, and End Results program (SEER) have been in existence for a sufficient time to begin to investigate cohort trends for the US population. Cases were the 18,787 Caucasians aged 20 to 84 years, who reported to SEER registries with a diagnosis of melanoma in 1974-86. Among men born between 1890 and 1919, each subsequent five-year birth cohort experienced 45 to 57 percent increases in age-adjusted melanoma incidence of the arm and trunk, and 14 to 20 percent increases were experienced across each site (arm, leg, head, and trunk) for the 1920-44 cohorts of men. Among women born between 1890 and 1919, 24 to 29 percent increases were seen for melanoma of the trunk, arms, and legs for each subsequent five-year birth-cohort, followed by six to 29 percent increases in the 1920-44 cohorts. Recent birth cohorts, 1945-64, have shown stabilizing rates, even after an attempt to adjust for the increasing tendency for diagnoses to be made in doctors' offices. Thus, the dramatic birth-cohort effects appear to have ended beginning with those born in 1945. However, melanoma rates will continue to rise until those born after 1945 represent the majority of the population. Furthermore, for the most recent cohorts, the trunk has become the most common site (per square meter of body surface) for men and the second most common site for women.(ABSTRACT TRUNCATED AT 250 WORDS)

α- and γ-interferon versus α-interferon alone in chronic hepatitis B: A randomized controlled study

Thirty-two patients with chronic hepatitis B were randomly assigned to two groups. Sixteen patients received 10 million units of alpha-interferon per square meter of body surface (MU/m2), three times weekly for 4 months. Sixteen patients were treated simultaneously with gamma-interferon at a dose of 2 MU/m2, and 10 MU/m2 of alpha-interferon. At the end of the study (13th month), hepatitis B virus DNA was negative in 50% of the patients treated with alpha-interferon and in only 25% of those treated with alpha- and gamma-interferon. A similar trend was observed with respect to the hepatitis B e antigen negativization (31% and 19% of HBeAg negativization in patients treated with alpha- and gamma-interferon, respectively). In summary, these data demonstrate that, at the doses used in this study, the combination of alpha- and gamma-interferon does not give better results than the administration of alpha-interferon alone. The tolerance to simultaneous alpha- and gamma-interferons is poor and may decompensate the liver disease.

Treatment With Interferon Gamma Versus Interferons Alfa and Gamma in Children With Chronic Hepatitis B

Thirty-five children with chronic hepatitis B were randomly assigned to three groups: group 1 (n = 12), untreated; group 2 (n = 11), treated with 1 million units of interferon gamma per square meter of body surface (MU/m2), three times a week for 24 weeks; and group 3 (n = 12), treated with interferon alfa at a dose of 5 MU/m2, three times a week for 12 weeks followed by 1 MU/m2 of interferon gamma with the same schedule. At the end of the treatment (6th month), hepatitis B virus DNA was negative in 16.5% of the control group, in 9% of the children treated with interferon gamma, and in 16.5% of those treated with interferons alfa and gamma. No child had lost the hepatitis B e antigen by this time. No basal differences in the serum hepatitis B virus DNA concentration among the groups were observed. At follow-up (15th month), viral genome was negative in 25% of the untreated children, in 36% of the group treated with interferon gamma, and in 41.5% of the children who had received interferons alfa and gamma. Hepatitis B e antigen was negative in 25% of the children who belonged to groups 1 and 3 and in 27% of the children treated with interferon gamma only. These data suggest that interferon gamma does not have a powerful antiviral effect on chronic hepatitis B in children. However, it is well tolerated.

Recombinant alpha interferon inmetastatic renal cell carcinoma a cooperative phase II study

A total of 61 evaluable patients with advanced renal cell carcinoma have been treated with 3 x 10(6) IU per square meter of body surface with recombinant alpha 2b interferon three times a week within a Cooperative Phase II Study. Toxic death for terminal renal failure occurred in 1 patient (1.63%), and toxicities greater than WHO grade 2 were present in 10 cases (16%). The overall response rate after six months of treatment was 13.1% (partial response 4, minor response 4). Two complete responses were obtained at nine and fifteen months (3.3%). Long-lasting stabilization of disease was 13.1 percent.

Obesity, Diet and Body Temperature

Studies conducted thus far on the pathogenesis of obesity have not clearly determined the role of body temperature in the energy balance. In an attempt to explore this relationship further, research has been undertaken, a part of which is represented by the present investigation carried out on 22 adult males: 11 having a BMI less than or equal to 25 (group A) and 11 with BMI greater than 25 (group B). Body temperature was measured by mouth and on the skin surface (in 4 points according to Ramanathan) on 2 consecutive days (every 30 min from noon to 6:30 p.m.), the 1st day with the participants fasting and the 2nd day after consumption of a meal whose energy content represented a part (45%) of the 24-hour energy intake of the subjects, as previously ascertained by a survey of their food consumption. The study was carried out under frequently checked microclimatic conditions. During the week prior to the measurements, the alimentary consumption of the subjects was monitored by direct weighing for 5 consecutive days. A significant rise in body temperature, probably due to dietary thermogenesis, was observed in group A (internal temperature: F = 13.05; skin temperature: F = 6.48) as well as in group B (internal temperature: F = 24.88; skin temperature: F = 5.35) after the meal. However in group B the skin temperature showed a smaller increase than in group A (delta t degree 0.31 vs. 0.49) and an earlier trend towards the basal values (nearly 5 vs. 6 h after the meal). In both groups a decrease in the skin delta t degrees is evident at 3 and 3.5 h, respectively, after the meal, followed by a more remarkable increase in this difference between the 4th and the 5th hour. The meaning of this decrease as well as the difference in body temperature versus caloric intake is discussed. Normal weight individuals demonstrated a positive correlation (r = 0.83) between usual caloric intake per square meter of body surface and fasting internal body temperature. This correlation was not observed in subjects with BMI greater than 25.

Dose-toxicity relationship of carboplatin in combination with cyclophosphamide in ovarian cancer patients

A study was undertaken to examine the relationships between carboplatin's pharmacokinetic parameters and the myelotoxicity associated with its administration in combination with cyclophosphamide. An additional aim of the study was to test the applicability of the method proposed by Calvert et al. for calculation of the carboplatin dose to be used in the combination regimen. A total of 24 previously untreated ovarian cancer patients were given a combination of 250-500 mg/m2 carboplatin and 500 mg/m2 cyclophosphamide every 4 weeks for 4 months. The pharmacokinetics of carboplatin and the associated myelotoxicity were investigated in 64 courses. The results showed a significant correlation (r = 0.89) between the AUC calculated for carboplatin and that predicted according to Calvert's formula [carboplatin dose in milligrams = AUC (glomerular filtration rate +25)]. We conclude that the model is a useful guide in the calculation of the carboplatin dose to be given in combination with cyclophosphamide, and it enables a more precise prediction of the carboplatin exposure than does the conventional calculation, which is based on milligrams of drug per square meter of body surface. The AUC for carboplatin was a reliable predictor of the myelotoxicity as measured by the relative decrease in thrombocyte count. However, the relationship between AUC and myelotoxicity changed during the treatment because of increasing bone marrow toxicity. Despite this finding, dose calculation based on carboplatin's AUC appears to provide an improvement in the clinical use of the drug, and the method also seems to be fully applicable in combination chemotherapy with cyclophosphamide.

Determination of physostigmine in plasma and cerebrospinal fluid by liquid chromatography with electrochemical detection.

Physostigmine (Phy) was determined in plasma and cerebrospinal fluid (CSF) by HPLC with electrochemical detection, with use of a normal-phase column and methanolic sodium acetate buffer, pH 4.6. The detection limit of the method was 0.5 micrograms/L for a 2-mL sample of plasma or 0.5 mL of CSF. Analytical recovery of Phy in the range from 0.5 to 40 micrograms/L was 60% (SD 5%) for plasma and 78% (SD 8%) for CSF. Excellent chromatographic separation of Phy without column deterioration during extended usage and constant recovery for a wide range of Phy concentrations makes the routine monitoring of plasma from patients with Alzheimer's disease economically feasible. Using our method, we measured Phy in 13 such patients' plasmas at 105 and 135 min after a 135-min intravenous infusion of 300, 600, and 900 micrograms of Phy per square meter of body surface. Mean values significantly increased with dose (P = 0.001), but differences between 105 and 135 min (P = 0.229) or between dose and time (P = 0.949) were not significant.

Treatment of Patients With Delta Hepatitis Using Interferon

To the Editor. —Although interferon is being used in a growing number of human studies as a biological response modifier for therapy of malignancy and virus diseases of disparate kinds, the rationale of its use is still riddled with empiricism. Of the main actions of interferon, eg, induction of antiviral state, antineoplastic effect, and natural killer (NK) cell boosting capacity, the latter is well characterized in vitro, but its role in vivo does not seem clear from the results of therapeutic trials, and it has been stated that its changes do not correlate with the clinical results. 1 We describe herein a pilot study whereby severe liver disease due to the hepatitis B virus—dependent delta (HDV) agent 2 in six patients was treated with interferon as recombinant α-2 interferon (Schering-Plough) at 5 mega units per square meter of body surface, three times weekly for three months. All patients had biopsy

Liquid-chromatographic determination of total hydroxyproline in urine.

A reversed-phase "high-performance" liquid chromatographic assay for total hydroxyproline in urine is described. The urine samples are hydrolyzed overnight with acid, evaporated, solubilized, and derivatized with 4-dimethylaminoazobenzene-4'-sulfonyl chloride. The derivatives are chromatographed with a solvent gradient consisting of sodium acetate buffer and acetonitrile, the effluent being monitored at 436 nm. The useful lower limit of sensitivity for quantification is 13 pmol of hydroxyproline per 5-microL injection, corresponding to 33 mumol/L of urine. Either glutamine or cysteic acid is satisfactory as the internal standard. Peak heights and the amounts of hydroxyproline applied to the column are linearly related from 13.3 to 266 pmol. Mean analytical recovery was 83%. For four different concentrations the mean within-assay CV was 9.0% and the between-assay CV 12%. The normal reference interval found for 31 healthy adults was 31 to 177 mumol/24 h per square meter of body surface. We compared results for 10 samples from patients.

Caloric Requirements in Burned Children

The present study evaluated the efficacy of a surface area formula in estimating the daily caloric requirements of 52 severely burned children who were consecutively admitted to the Shriners Burns Institute in Galveston and who survived their injuries. Their ages ranged from 2 weeks to 15 years (X 6.3 years); their burns ranged from 20% to 82% (X 39%); and their hospital stay ranged from 20 to 120 days (X 55 days). Caloric requirements were calculated according to a standard formula (1,800 Kcalper square meter of body surface per day plus 2,200 Kcal per square meter of body surface area burned per day). Most of the calories were suplied in the form of homogenized milk plus a regular house diet.Using the weight on the 14th day postburn as baseline (dry weight), the patients were divided into two groups. Patients in group 1 (40 patients) received calories as recommended by the formula, gained weight, and appeared well nourished. Patients in group 2 (12 patients) failed to receive the number of calories recommended by the formula and lost weight. On the basis of this study, we propose that the formula is accurate and can be used routinely to estimate the minimum caloric requirements of burned children.