Lege Artis Medicinae

[Treatment of maligant tumors with attenuated newcastle disease virus vaccine a phase II trial]

CSARÁRY László1, ECKHARDT Sándor2, CZEGLÉDY Ferenc2, BUKOSZA István3, FENYVESI Csaba4

JULY 27, 1994

Lege Artis Medicinae - 1994;4(07)

[Newcastle disease virus (NDV) vaccine has been shown to be beneficial in patients with malignancies. The aim of this study was to assess the safety and efficacy of inhaled vaccine. Thirty three patients with therapy-resistant malignant tumors were treated with attenuated NDV/MTH-68 vaccine in an open placebo-controlled (26 patients) trial. The vaccine was administered for 6 months. All patients were considered terminally ill. They received conventional therapy, but cytostatic agents were stopped for 3 months before vaccine therapy. The results were evaluated by changes in size of the tumors and metastases, performance status and subjective parameters. Progression was predominant in the placebo group, subjective parameters also deteriorated, meanwhile in the vaccine-treated group the majority of patients entered a stable disease state or even showed signs of tumor regression. The number of cases with stabilisation or regression was significantly higher in the NDV group. A favourable response in subjective parameters occurred in a significantly higher percentage of the NDV group. The performance status improved in the NDV group and significantly deteriorated in the placebo group. In a small percentage of patients, fever or low-grade fever occurred not necessitating from withdrawal treatment. No other side effects were recorded. This treatment modality is promising and merits further studies. ]

AFFILIATIONS

  1. United Cancer Research Institute, Alexandria, VA, USA
  2. Országos Onkológiai Intézet Budapest
  3. Haynal Imre Egészségtudományi Egyetem, Budapest
  4. MÁV Kórház, Budapest

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[Ultrasonic signs of suspected fetal chromosomal aberration]

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[The authors summarize the relevant ultrasonic findings in case of suspected fetal chromosomal aberration. Some of these signs are detectable during routine ultrasonic screening examinations. In high-risk cases, prenatal chromosomal analysis is recommended. The following ultrasonic findings indicate a situation of high risk: disturbances of the lymphatic and amniotic fluids (e.g. hydrops, hygroma colli, polyhydramnios, nuchal edema), certain skull and brain alternations, abnormalities of the thorax and abdomen, and „minor” findings such as a single umbilical artery, choroid plexus cyst, pyelectasy, or changes in the size or shape of the long tubular bones, if these signs are accompanied by other anomalies or growth retardation.]

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[The two types of endoscopes presently available for examination and treatment of the esophagus are the traditional open tube esophagoscope and the flexible endoscope. Despite the many advantages offered by the flexible endoscope, its limitations should not be forgotten. The open tube esophagoscope should not be thought of as out-of-date, since its new variations have important therapeutic applications. The authors examine the advantages and disadvantages of the two types of esophagoscopes as discussed in the literature. ]

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[An update on obstructive sleep apnea]

METES Ágnes, HIRSCHBERG Andor

[Obstructive sleep apnea, which occurs in approximately 2% of the adult population, is the more common of the two major forms of sleep apnea. The conse quences and dangers of excessive daytime sleepiness are emphasized along with the other well-known characteristics of sleep apnea syndrome. Both the decreased upper airway muscle tone during sleep and the negative pressure due to breathing through the obstructed airways may cause upper air ways to collapse. The history has a very important role in the clinical assessment, while the role of the physical examination is limited. An exact and reliable diagnosis may be arrived at through laboratory evaluation, e. g. polysomnography (PSG), Multiple Sleep Latency Test (MSLT), or radiologic examinations. Among conservative treatments, reduction of the body weight is usually effective in mild to moderate cases. In severe apneas, nasal continuous positive airway pressure (nCPAP) is the current treatment of choice. The efficacy of surgical intervention is still controversial. According to most authors, uvulopalatopharyngoplasty (UPPP) has a 50% success rate. Most recently good results have been obtained with maxillo-facial surgery in a variety of selected patients. ]

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[Our goal was to evaluate which diagnostic and therapeutic approaches could provide a better chance of survival. Between January 1, 1987, and December 7, 1992, 772 patients with acute myocardial infarction were treated in the Hungarian Institute of Cardiology. Cardiac rupture was investigated by the retrospective analysis of clinical data, electrome chanical dissociation, echocardiographic signs and autopsy findings. Ventricular free wall rupture was found in 28 cases. The diagnosis was confirmed by autopsy in 23, by intraoperative findings in 4 cases, and by echocardiography and pericardiocentesis in 1 case. Pericardial effusion was detected in 12 of 14 cases undergoing emergency echocardiography. Seven of these had pericardiocentesis and 2 patients underwent surgical pericardial fenestration. Following this 4 patients were referred to surgery. All 4 patients died: 2 during and 2 shortly after operation. The bleeding stopped in 1 case, after pericardiocen tesis and continous drainage and during the 12 month follow-up the patient is alive and well. In acute myocardial infarction, electromechanical dissociation or signs of tamponade are indications for emergency echocardiography, and if pericardial effusion can be visualized, pericardiocentesis should be performed. This can lead to a temporary haemodynamic improvement, providing sufficient time for emergency surgery.]

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