[Acute hypercalcemia as an oncological emergency. Pathogenesis, clinical aspects, therapy].
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Biomedical subjects
Publications and source records attributed to R Becher.
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A 57-year-old woman with inoperable bladder cancer received radiation treatment. Thirteen years later she relapsed at locoregional, retroperitoneal, and mediastinal sites. During treatment with cis-dichlorodiamineplatinum II (DDP) (30 mg/day for 5 days repeated every 4 weeks) she achieved a partial remission. After seven courses of DDP-chemotherapy she complained of numbness of her hands and legs and of diminished visual acuity of both eyes. After 4 weeks these symptoms grew less but intensified severely after another DDP-treatment. The temporal relationship of neurologic symptoms and their intensification by the last administration of DDP suggest this drug to be the causative agent for peripheral neuropathy and ophthalmologic toxicity.
Twenty-five patients with measurable lesions of advanced malignant melanoma received a combined chemotherapy containing cis-dichlordiammineplatinum (II) (cisplatin) 30 mg daily at days 1, 3, 5, 7, 9, and ifosfamide 45 mg/kg at days 2, 4, 6, 8, and 10. Most of the patients had been previously treated with DTIC or DTIC-containing combinations. An objective response was observed in 10 patients including three complete and seven partial remissions. Medium survival was 3 months for nonresponders and 6 months for responders. Nausea and vomiting during chemotherapy could be reduced effectively be the use of levomepromacine (Neurocil). Hematologic toxicity was considerable in extensively pretreated patients and made it necessary to postpone subsequent courses in two cases.
The sister chromatid exchange (SCE) frequency in bone-marrow cells of 12 untreated patients with chronic myelocytic leukemia (CML) was analysed and compared with the SCE frequency in bone-marrow cells of nine healthy persons. In normal persons the SCE ranged from 3.64 to 5.15 per cell. In CML patients the SCE was significantly lower, ranging from 2.32 to 3.44 per cell. The differences found were unrelated to patients' age and contraction state of the chromosomes. It is suggested that the leukemic process could account for the low SCE rate.
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In a randomised, multicentre study the effect of changing the combined cytostatic treatment with VAC (vincristin, adriamycin, cyclophosphamide) to FMC (fluorouracil, methotrexate, cyclophosphamide) was tested, as well as the effect of active non-specific immune stimulation with Corynebacterium parvum, and compared with a control group. In 59 of 120 patients (49%) in whom the results could be analysed there was a measurable significant regression of tumour size to less than 50% of its initial value. The course was stabilized in a further 43 (36%) women. Further tumour-growth progression or death in the early phase of treatment occurred in only 18 women (15%). Average remission was 16 months. Median survival time from start of the study in all analysable patients averaged 22 months. Patients with an ulcer at the site of application of Corynebacterium parvum had a clearly prolonged survival time. In all, immune stimulation with Corynebacterium parvum was no better, either with regard to the remission rate, remission duration or survival time.
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15 patients with metastasing melanoblastoma of stage III and IV were treated with a combination of cis-platinum (II)-diamminodichloride and ifosfamide. In 3 cases complete remission occurred, in 5 partial remission with tumour regression of more than 50%. The response rate is around 50% at present. Two cases showed no change after 6 months of chemotherapy.
Sister chromatid exchange (SCE) was studied in bone marrow cells of six healthy individuals. Compared with peripheral blood lymphocytes, a remarkably low and constant rate of SCEs was observed, ranging from 3.64 to 4.65 per metaphase. The lower incidence of SCE can be related only partly to the higher contraction of bone marrow cells and the shorter exposure time to BUdR. Rather, a cell-specific phenomenon is suggested.
An anonymous questioning of 200 patients with urinary calculi concerning the observation of the general and special measures of the metaphylaxis of urinary calculi resulted in the fact that in particular the measures of the general metaphylaxis (bodily movement, diet, dilution of the urine) are not or only parlty obeyed by a large part of the patients. The examinations show that for the improvement of the understanding of the disease and the behaviour of the patients concerning their health further on a great attension must be paid to the quality of the information by the physician and to the communication between physician and patient. An insufficient cooperation of the patients in the metaphylaxis of the urinary calculi would call in question the effectivity of all efforts and measures concerning the prevention of relapses.
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Report of 2 cases of systemic complications many years after inappercept infection with amoeba histolytica. Amoebiasis being a rare affection in Switzerland, diagnosis was missed and not revealed till operation. One case with multiple liver abscesses, healed after drainage and chemotherapy with metronidazol and dehydroemetine. In the other case with colonic perforation and multiple liver abscesses combined surgical and drug therapy failed, the patient died in hepatotoxic coma. Short cut of clinics and therapy in amoebiasis, pointing out that surgery is reserved for the complications as great liver abscess, colonic perforation or fistula between abdominal and pleural cavity.
Comparative studies on human lymphocyte cultures yielded a certain specificity of the anticlastogenic action of the SH compounds l-cysteine, cysteamine, and beta-aminoethylisothiouronium (AET) as well as of the amide l-asparagine and the amino acid l-methionine. This specific anticlastogenic activity manifested itself in specific changes of the spectrum of aberration types induced by the clastogens and of the pattern of intercellular distribution of the induced aberrations. It was clearly dependent on the concentration of the anticlastogens but was also influenced by the used clastogen. The use of different culture media yielded some quantitative influences on the anticlastogenic activity, but fundamental changes in the spectrum of anticlastogenic action have not been observed except with cysteamine. The patterns of activity ascertained for the different anticlastogens specifically differed from those changes in the spectrum and pattern of distribution of aberrations induced by a mere reduction of the concentration for instance of Trenimon. Therefore a direct reaction between the protectors and the clastogen Trenimon as the cause of the observed anticlastogenic action was again excluded. The presented data are also discussed under the aspects of the hypotheses of aberration induction as well as of their importance for further antimutagen research.
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