RESUMEN
OBJECTIVES: The primary aims of this pilot study were to establish the feasibility of intraprostatic administration of biological response modifiers (BRMs) and to investigate the toxicity and side effects of recombinant interferon (IFN)-alpha-2b injected into prostate glands harboring cancer. A secondary goal was to perform a preliminary assessment of the antitumor effect of this treatment. METHODS: Nine patients with histologically documented carcinoma of the prostate participated in the study. IFN was administered weekly for 5 weeks, under transrectal ultrasound visualization, with a modified gun that permitted the controlled injection of small volumes initially into the area of the tumor and later into the whole gland. Total doses of IFN ranged between 15 and 100 MU. RESULTS: The procedure resulted in minor local discomfort, comparable to a prostatic biopsy. Side effects from the drug were those anticipated from most BRMs (chills, fever, malaise, headache, fatigue), and in every case they were minor and self-limiting to several hours. Local adverse events were limited to gross hematuria (2 patients [22%]) and hematospermia (1 patient [11%]) and resolved spontaneously within 2 weeks. Antitumor activity, a secondary goal of the study, was noted in 3 (33%) patients with limited follow-up (mean 22.5 months). CONCLUSIONS: The results of this pilot study indicate that the intraprostatic administration of IFN-alpha-2b can be readily accomplished by the method described here and is associated with minor, self-limited toxicity. With the regimen and doses used, IFN demonstrated modest antineoplastic activity. Modifications of the schedule, routes, and amounts administered may result in enhanced therapeutic value.
Asunto(s)
Antineoplásicos/administración & dosificación , Factores Inmunológicos/administración & dosificación , Interferón-alfa/administración & dosificación , Neoplasias de la Próstata/terapia , Anciano , Estudios de Factibilidad , Humanos , Interferón alfa-2 , Masculino , Persona de Mediana Edad , Proyectos Piloto , Proteínas RecombinantesRESUMEN
A study was designed to assess the effect of supplemental oral methyltestosterone in the treatment of impotence associated with low total serum androgen levels. A total of 22 hypogonadal impotent men underwent a comprehensive investigation of erectile dysfunction, including an evaluation of the pituitary-gonadal axis. The patients then received a 1-month course of 2 different commercial preparations of oral methyltestosterone. Hormonal changes induced by the medication were assessed on days 15 and 30 of treatment. The patients kept daily records of sexual activity, and completed visual analogue scales to assess energy levels, mood and sensation of well being on a weekly basis. Supra-physiological levels of total serum testosterone were achieved in every patient but the free fraction of the hormone did not increase proportionally and in many cases a marked decrease was recorded. In all but 1 subject there was a decrease in circulating sex hormone binding globulin. Pituitary gonadotropin levels showed a marked decrease at the end of treatment. The clinical response was disappointing. Only 9% of the patients reported a complete recovery of sexual function. Visual analogue scales did not reveal noticeable changes for any individual in the levels of energy, mood or feeling of well being between pretreatment and posttreatment assessments. Oral methyltestosterone is of limited effectiveness in men with hypogonadal impotence. The positive responses in this study were recorded in men with the most profound deficiency. Exogenous administration of androgens to impotent men should be limited to those with profound hypogonadism as documented by at least 2 abnormal serum free testosterone determinations.
Asunto(s)
Disfunción Eréctil/tratamiento farmacológico , Metiltestosterona/uso terapéutico , Administración Oral , Disfunción Eréctil/sangre , Disfunción Eréctil/etiología , Humanos , Hipogonadismo/complicaciones , Masculino , Distribución Aleatoria , Método Simple Ciego , Testosterona/sangreAsunto(s)
Neoplasias Esofágicas , Leiomioma , Adulto , Endoscopía , Neoplasias Esofágicas/patología , Femenino , Humanos , Leiomioma/patologíaAsunto(s)
Fístula/etiología , Fístula Intestinal/etiología , Absceso Hepático Amebiano/complicaciones , Hepatopatías/etiología , Adulto , Anciano , Biopsia con Aguja , Entamoeba histolytica/aislamiento & purificación , Entamebiasis/complicaciones , Femenino , Fístula/diagnóstico por imagen , Humanos , Fístula Intestinal/diagnóstico por imagen , Absceso Hepático Amebiano/diagnóstico por imagen , Absceso Hepático Amebiano/terapia , Hepatopatías/diagnóstico por imagen , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Radiografía , Infecciones Estreptocócicas/complicaciones , Streptococcus/aislamiento & purificación , UltrasonografíaRESUMEN
This report describes the clinical manifestations and pathological findings in 5 patients with serologically diagnosed acute Q fever. Each patient presented with headache, malaise, spiking fever, and hepatitis. Percutaneous biopsy of the liver in 4 patients revealed granulomatous changes with many lesions containing a dense fibrin ring surrounding a central lipid vacuole. Biopsy of the bone marrow in the fifth patient revealed similar abnormalities. These lipogranulomas should be considered characteristic of Q fever.