Photochemotherapy in mycosis fungoides.

Abstract

Blood lactate conzcetrationis-Thc mean fasting blood lactatc concentrations were higher in patients taking hypoglycaemic tablets (table II). None of the drugs produced any significant fall in fasting blood lactate concentrations. During hypoglycaemia the control mean blood lactate concentration rose by 76 "O at 90 minutes in diet-treated subjects and by 67",, in tablct-treated subjects. Acebutolol impaired this blood lactate response in tablet-treated subjects (P < 0 05) with a rise of only 33 ", at 90 minutes. Propranolol slightly reduced the inc-emental area of blood lactate response in diet-treated subjects (P < 005). Atenolol had no significant effects on blood lactatc concentrations in either group.Blood NEFA conicenitrations-All drugs significantly lowered fasting blood NEFA concentrations in diet-treated subjects, and acebutolol also lovered them in drug-treated subjects (table III). After intravenous insulin administration the blood NEFA concentrations fell in all groups. The placebo blood NEFA concentration fell by 56",, at 30 minutes in drug-treated subjects, and by 52",, at 30 minutes in diettreated subjects. The secondary rise of blood NEFA concentrations from adrenaline-mediated lipolysis was reduced in acebutolol-and propranolol-treated diet-controlled subjects. No significant effects on blood NEFA concentrations were observed in the tablet-treated subjects. DiscussionThe results show that these beta-adrenoreceptor blocking drugs differ in their effects on the metabolic responses during insulin-induced hypoglycaemia, and this probably reflects differences in pharmacological selectivity and ancillary properties. Propranolol delayed glucose recovery, as it does in normal subjects. Acebutolol potentiated the hypoglycaemic action of insulin in drug-treated diabetics in a manner similar to that found in normal subjects. Throughout the recovery phase the mean blood glucose concentration remained on average 0 7 mmol/l (12 6 mg/100 ml) lower when patients were taking acebutolol than when they were taking placebo, the incremental area being identical with that for control and atenolol curves. This implies that the magnitude of the adrenaline-induced glycogenolytic response was unaffected but that acebutolol impaired hepatic glucose output in some other way.The beta-adrenoreceptors of the liver and skeletal muscle are thought to be predominantly of the beta2 type. Hence the beta2 adrenoreceptor blockade of the non-selective drugs might be expected to antagonise adrenaline-mediated glycogenolysis whereas the beta,-blocking drugs should have no such effect.Hepatic glycogenolysis may, however, also be stimulated directly by a low blood glucose concentration. Studies on liver preparations and exercising normal subjects have shown that drugs with a membrane-stabilising action inhibit glucose release from the liver in response to a low blood glucose concentration. 9 Thus propranolol, possessing this action, impaired postexercise recovery of the blood glucose, whereas metoprolol, without membrane-stabilising activi...

Ultraviolet A1 Phototherapy in the Treatment of Early Mycosis Fungoides

“…The rates of CR varied from 60 to 100% in studies of 4 to 19 patients [16,17,[19][20][21][22][23]26] and from no response to complete healing in case reports [14,15,18,24,25] . Forty years after the first use of PUVA in MF [27] , several heterogeneous studies with differences in patient selection, treatment protocols, and outcome variables have established the efficacy of PUVA and narrowband UVB in the treatment of MF [3] . When 2-4 treatments per week are administered, the rates of CR vary from 64 to 89% for PUVA and from 54.2 to 91% for narrowband UVB [1][2][3] .…”

PUVA Treatment in Mycosis Fungoides

“…While some favourable reports on PUVA treatment in mycosis fun goides have recently been published [1][2][3], our own observations of the development of the condition have not been encouraging. The clinical and histopathological course of the disease is shown in table I. Histopathologically the patients may be grouped into three stages.…”

La chimiothérapie par voie generate dans le traitement du mycosis fongoïde

“…A ce stade, et même au stade plus avancé des plaques généralisées, le traitement par la méchloréthamine en badigeonnages de tout le revêtement cutané, répétés chaque jour pendant de longues périodes [27], et l'irradiation totale par les électrons [7] sont capables de faire disparaître toutes les lésions, peut-être d'induire des guérisons définitives. Sur 192 cas traités par l'ypérite azotée en badigeonnages, des rémissions complètes se maintenant sans rechute depuis plus de 3 ans, ont été observées chez 14 malades [27], Avec l'électronthérapie, des guérisons apparentes d'une durée de 3 à 14 années ont été obtenues dans 14 cas sur 132, et cela sans traitement d'entretien [7], Au stade tumoral, ces deux types de traitement, de même que la photo chimiothérapie [8,11,22], sont beaucoup moins efficaces: les rémissions sont incomplètes et de courte durée. C'est à ce stade, et probablement dès les débuts de ce stade, que devrait être tentée la chimiothérapie, éventuellement associée aux traitements dermatologiques.…”

“…Cela tient sans doute à sa lenteur d'évolution, à l'efficacité -du moins durant les stades initiaux de la maladie -de traitements purement dermatologiques, comme l'application cutanée d'agents chimiothérapiques [9,27,29], le «bain» d'électrons [7], et la photochimiothérapie qui combine l'administration de méthoxsalène par voie orale et de rayons UV de grande longueur d'onde [8,11,22]; cela tient surtout à sa rareté qui empêche de réunir dans un seul centre, pendant un temps relativement court, un nombre suffisant de malades.…”