RESUMO
Among new highly potent antagonistic analogs of luteinizing hormone-releasing hormone (LH-RH), containing neutral hydrophilic D-ureidoalkyl amino acids such as D-Cit and D-Hci at position 6 and free of edematogenic and anaphylactoid reactions, Ac-D-Nal(2)1, D-Ph(4Cl)2, D-Pal(3)3, D-Cit6, D-Ala10 (LH-RH) (SB-75; Cetrorelix) was shown to be one of the most powerful. In this trial, we evaluated the response to 500 micrograms SB-75 given every 12 hr subcutaneously (sc) for 4 weeks in 11 patients with benign prostatic hyperplasia (BPH), and 6 weeks in 6 prostatic cancer patients (2 stage C, 4 stage D2). In patients with BPH presenting with prostatism and urinary outflow obstruction, there was a noticeable clinical improvement after the first week of SB-75 administration. This improvement continued during the course of treatment. Before therapy with SB-75, the serum levels of prostate-specific antigen (PSA) (6.73 +/- 1.46 ng/ml), acid phosphatases, total (12.67 +/- 1.15 U/l), and prostatic (2.27 +/- 0.34 U/l), were mildly elevated, but declined to normal values at 4 weeks: (2.13 +/- 0.59 ng/ml; P < 0.01), (7.68 +/- 0.89 U/l; P < 0.01), and (1.39 +/- 0.18 U/l; P < 0.01), respectively. Mean prostatic volume assessed by ultrasonography showed a significant decrease in all patients from 67.84 +/- 8.86 to 37.92 +/- 8.52 cm3; P < 0.01, which represents a reduction of 44%. In patients with prostate cancer, after the first week of therapy with SB-75, we observed a significant decrease in bone pain, relief in urinary outflow obstruction, and reversal of the signs of prostatism. Subjective improvement continued during the following weeks of treatment, so that the patients no longer needed analgesics. PSA, acid, and alkaline phosphatases gradually fell, achieving nearly normal values at 6 weeks. Initial serum testosterone levels in BPH and prostatic cancer patients were within normal limits, but during treatment with the antagonistic analog SB-75, fell to castration values. A major fall in free testosterone levels was observed after the first dose; the maximal inhibition was seen after 6-12 hr, with a simultaneous decrease in levels of both gonadotropins. Our results show that antagonist SB-75 can be safely administered for prolonged periods of time. The rapid shrinkage of the prostate and concomitant improvement in obstructive symptoms of prostatism obtained with antagonistic analog SB-75 in patients with BPH may decrease the morbidity of prostatic surgery and offer a therapeutic alternative in men who are considered poor surgical risks.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Hiperplasia Prostática/tratamento farmacológico , Neoplasias da Próstata/tratamento farmacológico , Fosfatase Ácida/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Hormônio Foliculoestimulante/sangue , Hormônio Liberador de Gonadotropina/administração & dosagem , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Infusões Intravenosas , Estudos Longitudinais , Hormônio Luteinizante/sangue , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/efeitos dos fármacos , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/sangue , Neoplasias da Próstata/sangue , Testosterona/sangue , Ultrassonografia , Micção/efeitos dos fármacosRESUMO
A prospective study to determine if subcutaneous edema interferes with insulin absorption was performed. Forty-six patients entered the study. Three groups were formed. Twenty patients with generalized edema (Group 1), ten of them with non-insulin dependent diabetes mellitus (NIDDM). Twenty patients without edema (Group II). 10 of them with NIDDM; and six patients with mild edema (Group III). The disappearance of I125-insulin was measured throughout 360 minutes. The rate of absorption in group I was significantly lower and delayed than in group II. The amount of insulin absorbed at 360 minutes was 3 to 4 fold lower in group I than in group II (p 0.001). Group III had intermediate values. The peak of plasma I125-insulin level was 3 to 4 fold lower in group I than group II. The impairment of insulin absorption in subjects with edema was more evident in those with NIDDM. In conclusion, this study demonstrates that subcutaneous edema impairs insulin absorption. Insulin absorption from subcutaneous tissue varies due to several conditions, resulting in a difficult glycemic control. Previous studies have shown that insulin absorption is affected by several factors as the site of injection, room and skin temperature, physical exercise, the thickness of adipose tissue, local massage, and local degradation of insulin. Edema due to chronic complications such as nephropathy and cardiopathy often occurs in long-standing diabetic subjects. However, the effects of edema of the skin and subcutaneous tissue on insulin absorption has not been previously examined. The aim of this study was to assess if edema affects the absorption of insulin.
Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Edema/metabolismo , Insulina/farmacocinética , Dermatopatias/metabolismo , Abdome , Absorção , Adulto , Diabetes Mellitus Tipo 2/tratamento farmacológico , Edema/etiologia , Feminino , Insuficiência Cardíaca/complicações , Humanos , Injeções Subcutâneas , Insulina/administração & dosagem , Insulina/sangue , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dermatopatias/etiologiaAssuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos/uso terapêutico , Glicemia/fisiologia , Hormônio Liberador de Gonadotropina/análogos & derivados , Neoplasias da Próstata/tratamento farmacológico , Adenocarcinoma/sangue , Adenocarcinoma/fisiopatologia , Teste de Tolerância a Glucose , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Insulina/sangue , Masculino , Neoplasias da Próstata/sangue , Neoplasias da Próstata/fisiopatologia , Pamoato de TriptorrelinaRESUMO
The Aortic Scanning with 99mTc was done initially by powell in 1966. This radioisotope is the ideal for dinamic studies. In this paper we purpose a new method in order to label erythrocytes, which allows the radiactive bolus sended for the vascular tree to be more compact (TCK-11 99mTc). Seventy abdominal aortic scanning in normal persons were done, fifty with TCK-11 and twenty with 99mTc with Powell's technique. The images were obtain from video-tape recorder. By this way it was possible to get cuantitative determinations from Aorta, Renal and Iliac arteries. These terminations can be very useful for diagnosis of several arterial abnormalities.