A randomized, multicentre, open-label, phase II study compared temozolomide (TMZ), an oral second-generation alkylating agent, and procarbazine (PCB) in 225 patients with glioblastoma multiforme at first relapse. Primary objectives were to determine progression-free survival (PFS) at 6 months and safety for TMZ and PCB in adult patients who failed conventional treatment. Secondary objectives were to assess overall survival and health-related quality of life (HRQL). TMZ was given orally at 200 mg/m 2 /day or 150 mg/m 2 /day (prior chemotherapy) for 5 days, repeated every 28 days. PCB was given orally at 150 mg/m 2 /day or 125 mg/m 2 /day (prior chemotherapy) for 28 days, repeated every 56 days. HRQL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 [+3]) and the Brain Cancer Module 20 (BCM20). The 6-month PFS rate for patients who received TMZ was 21%, which met the protocol objective. The 6-month PFS rate for those who received PCB was 8% ( P = 0.008, for the comparison). Overall PFS significantly improved with TMZ, with a median PFS of 12.4 weeks in the TMZ group and 8.32 weeks in the PCB group ( P = 0.0063). The 6-month overall survival rate for TMZ patients was 60% vs. 44% for PCB patients ( P = 0.019). Freedom from disease progression was associated with maintenance of HRQL, regardless of treatment received. TMZ had an acceptable safety profile; most adverse events were mild or moderate in severity. © 2000 Cancer Research Campaign

Valve reconstruction in postthrombotic reflux can yield clinical results similar to those in "primary" reflux. Although any of the several described techniques can produce similar clinical results, Doppler competence suggests the following order for choice of procedures: (1) internal valvuloplasty, (2) prosthetic sleeve in situ, (3) external valvuloplasty, and (4) axillary vein transfer.

Among 211 limbs with nonobstrucfive chronic venous insufficiency, valve reflux of the deep system was the predominant (more than 70%) pathologic condition. Superficial venous or perforator incompetence when present invariably occurred in combination with valve reflux of the deep veins, suggesting that the latter is a common denominator for symptom production. Single level-single system reflux was only occasionally symptomatic (10%), whereas the incidence of single level-mnltisystem reflux (25%) and mnltilevelmnltisystem reflux (65%) in symptomatic limbs was much higher. Our experience with 107 venous valve reconstructions with a 2-to 8-year follow-up is described. Different techniques of valve reconstruction employed are detailed. The most common pathologic feature is a redundant valve with malcoaptation probably of nonthrombotic origin. Valsalva foot venous pressure elevation is a usefifl hemodynamic technique for assessing surgical results. Vah~tloplasty may be superior to other reconstruction techniques in relieving symptoms of stasis, including stasis ulceration.