Short topotecan-based induction regimen in newly diagnosed high-risk neuroblastoma

Purpose: Topotecan is an active drug in relapsed neuroblastoma. We investigated the efficacy and toxicity of a topotecan-based induction regimen in newly diagnosed neuroblastoma. Methods: Patients older than 1 year with either metastatic or localised stage 2-3 MYCN-amplified neuroblastoma received 2 courses of high-dose topotecan (HD-TPT) 6 mg/m2 and high-dose cyclophosphamide (HD-CPM) 140 mg/kg, followed by 2 courses of ifosfamide, carboplatin and etoposide (ICE) every 28 days. After surgery on primary tumour, a fifth course with vincristine, doxorubicin and CPM was given, followed by high-dose chemotherapy with stem cell support. Response was assessed in accordance with the International Neuroblastoma Response Criteria. Results: Of 35 consecutive patients, 33 had metastatic disease. The median length of induction phase was 133 days (range 91-207) and time to high-dose chemotherapy was 208 days (range 156-285). The median tumour volume reduction was 55% after two HD-TPT/HD-CPM courses and 80% after four courses. Radical surgery was performed in 16/27 patients after chemotherapy. After the fifth course, 29/34 patients (85%) had achieved a partial remission (12) or a CR/very good partial remission (17). CR of metastases was achieved in 13/32 (41%) and bone marrow was in complete remission in 16/24 patients (67%). Grade 4 neutropenia and/or thrombocytopenia occurred in 100% of HD-TPT/HD-CPM and in 95% of ICE courses, while non-haematological toxicities were manageable. Conclusions: These data indicate that our induction regimen is feasible and well tolerated. A major response rate of 85% with 41% complete metastatic response confirms this regimen as effective induction in high-risk neuroblastoma. © 2011 Published by Elsevier Ltd

Rheoencephalographic observations in migraine

The pathophysiological concept of migraine presently held attributes the major changes to vascular factors. Therefore, it seemed appropriate to use rheoencephalography to test cerebral hemodynamics in cases of migraine. This very harmless and well suited method revealed: (1) on routine tracings during the painless intervall only 1/7 of the cases showed significant changes, while more than 2/3 could be classified with the help of an orthostatic stress test under REG-observation; (2) REG is more often correct for diagnosis than EEG and this does not surprise since REG monitors cerebral hemodynamics directly while EEG records activity for parenchyma and thus only secondarily depends on circulation; (3) similar conditions were previously seen in Meniere's disease where EEG also is less efficient than REG. According to the results of this study, it should be interesting to include REG in the work-up of migrainous patients. In these and under similar conditions, REG will be of diagnostic value

Rheoencephalographic observations in migraine Reoencefalografia: observações na enxaqueca

The pathophysiological concept of migraine presently held attributes the major changes to vascular factors. Therefore, it seemed appropriate to use rheoencephalography to test cerebral hemodynamics in cases of migraine. This very harmless and well suited method revealed: (1) on routine tracings during the painless intervall only 1/7 of the cases showed significant changes, while more than 2/3 could be classified with the help of an orthostatic stress test under REG-observation; (2) REG is more often correct for diagnosis than EEG and this does not surprise since REG monitors cerebral hemodynamics directly while EEG records activity for parenchyma and thus only secondarily depends on circulation; (3) similar conditions were previously seen in Meniere's disease where EEG also is less efficient than REG. According to the results of this study, it should be interesting to include REG in the work-up of migrainous patients. In these and under similar conditions, REG will be of diagnostic value.No conceito fisiopatológico da enxaqueca atribui-se grande importância às alterações vasculares. Por esta razão empregamos a reoencefalografia, método simples e inócuo que nos pareceu o mais adequado para estudar a hemodinâmica cerebral em casos de hemicrania. Nossas conclusões foram as seguintes: (1) nos traçados reoencefalográficos de rotina encontramos, em apenas 1/7 dos casos, alterações qualitativas e quantitivas significantes no período intercrítico da enxaqueca, ao passo que mais de 2/3 dos traçados podiam ser classificados como patológicos e característicos, desde que utilizássemos o teste ortostático de Schellong; (2) a reoencefalografia parece ser mais precisa do que a eletrencefalografia para o diagnóstico de hemicrania; este fato é compreensível pois o reoencefalograma registra diretamente a hemodinâmica cerebral, enquanto que o eletrencefalograma registra a atividade bioelétrica do parênquima a qual, por sua vez, apenas secundariamente depende de circulação sangüínea; (3) resultados semelhantes foram, também, observados em casos de síndrome de Menière nos quais a eletrencefalografia seria, também, menos útil que a reoencefalografia. De acordo com estes resultados, parece-nos ser lícito sugerir a inclusão la reoencefalografia na rotina e no controle terapêutico de pacientes com íemicrânia. Nesta e em outras condições similares a reoencefalografia é im método paraclínico de alto valor