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OBJECTIVE-- Detecting and grading of diabetic retinopathy (DR) by means of digital retinal images sent via the Internet RESEARCH DESIGN AND METHODS-- Four nonstereoscopic digital retinal images (45° field each) [...]

Renal dysfunction in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) indicates a poor long-term prognosis. However, the prognostic value of the improvement or stabilisation of renal function during follow-up has not yet been assessed. This study aimed to investigate the long-term predictive impact of the improvement or stabilisation of renal function after one year of follow-up in patients with STEMI undergoing pPCI with renal dysfunction at discharge.

Analizar los patrones de recidiva y supervivencia de 13 pacientes con tumores de células germinales (TCG) con refractariedad parcial a cisplatino o en segunda recidiva que recibieron quimioterapia a dosis altas (QDA) y soporte con células progenitoras hematopoyéticas periféricas. La mediana de ciclos de quimioterapia (QT) convencional con cisplatino previa era de 9 (3–13). Tratamiento: a) inducción: QT tipo EPI (VP16 120 mg/m2, ifosfamida 1,3 g/m2, cisplatino 25 mg/m2×4 días); b) movilización de células progenitoras con factor estimulante de colonias de granulocitos (G-CSF) (10 ug/kg/día) en 2 pacientes o EPI+G-CSF, y c) QDA (carboplatino 350 mg/m2, ciclofosfamida 1.500 mg/m2, VP16 4.00 mg/m2×3 días). Se administró G-CSF (5 µg/kg) hasta el injerto hematopoyético (neutrófilos > 1×109/l). Edad media: 32 años (rango 20–52). Origen: mediastino 2, testicular 11 (1 seminoma). Criterio de inclusión: no respuesta completa (RC) con QT convencional en 5 pacientes, tumor mediastínico en 1, primera recidiva tras QT con cisplatino e ifosfamida en 2 casos y segunda y tercera recidivas en 5 pacientes. Nueve de trece pacientes estaban en RC al inicio de la QDA. Un paciente que se incluyó en el análisis de supervivencia no continuó a QDA por progresión precoz cerebral. La mediana de supervivencia libre de progresión fue de 19 m, global 40 m; 2 pacientes están libres de progresión a 36 y 80 m. Todos los pacientes transplantados en respuesta parcial (RP) progresaron en el primer año. Cinco de once pacientes en áreas afectas como única localización. Rescate: consistió de VP16 oral, EMA-CO o CBDCA/taxol, y proporcionó 6 de 10 respuestas, una de ellas mantenida a 4 años. La QDA como rescate de pacientes no curables con QT convencional y no quirúrgicos proporcionó 20% de largos supervivientes. No observamos beneficio en el tratamiento con QDA cuando sólo se obtuvo RP con el tratamiento convencional. La mayoría de las recidivas tuvieron lugar en áreas previamente afectas y en la mayoría de los pacientes fueron aún quimiosensibles. To evaluate survival and relapse patterns in 13 patients with recurrent, or refractory, germ-cell tumours treated with high-dose chemotherapy (HDC) and with peripheral blood stem-cell support. All patients were treated in a single centre and received a median of 9 cycles (range 3–13) of cisplatinum-based chemotherapy (CT). The protocol consisted of: a) induction with ifosfamide-based CT (EPI: VP16 120 mg/m2, ifosfamide 1.3 g/m2, cisplatinum 25 mg/m2×4 days); b) mobilisation of PBSC with of either G-CSF (10 ug/kg/day) in 2 patients or EPI plus G-CSF, and c) HDC (carboplatin 350 mg/m2, cyclophosphamide 1500 mg/m2, VP16 400 mg/m2×3 days). G-CSF (5 µg/kg) was administered until haematopoietic graft. Median age=32 years (range 20–52); tumours=10/11 testicular (1 seminoma), 2 mediastinal. HDC was administered 21 months (range 6–66) post-diagnosis. Inclusion criteria: failure to achieve CR with conventional CT (n=5 patients), poor-prognosis mediastinal tumour (n=1), first recurrence after cisplatinum and ifosfamide-based CT (n=2) and second or third relapse (n=5). At the conclusion of HDC, 9/13 patients were in CR, 1 patient did not receive HDC because CNS progression but was included for survival analysis. Median times to graft were 9 and 13 days for leukocytes and platelets, respectively. Non-haematological toxicity was low and no therapy-related deaths occurred. Median disease free and overall survival were 19 and 30 months, respectively. Currently, 2 patients have not relapsed at 36 and 80 months. Previously-affected sites of disease were the unique sites of relapse in 5/11 (50%), concomitant distant relapse in 4/11 patients, CNS metastases in 1 patient. Rescue CT consisted of either oral VP16 or CBDCA/Taxol, which induced a new response in 6/10 patients. HDC achieves 20% improved survival in patients refractory to conventional chemotherapy and non-resectable tumours. No benefit was observed in HDC treatment in patients having only partial response to conventional chemotherapy. Relapse following HDC occurred mainly at previously affected sites.

Epidermal growth-factor-responsive rat mesencephalic precursor cells incubated in differentiation media produce only a small number of dopaminergic (DA) cells. Supplementation of the differentiation medium with N-acetylcysteine (NAC) induced a marked increase (∼400) in the number of tyrosine hydroxylase (TH)-positive cells. Treatment with interleukin-1α also induced a significant increase (∼300) in the number of TH-positive cells. However, we did not find additive effects between these drugs. The results suggest that NAC is effective in the production of DA cells from precursors, and that this may be related to enhancement of generation and/or survival of DA cells.