$141,220/QALY versus orchiectomy. Changes in key variables in the sensitivity analyses did not affect the ranking of the treatment strategies, suggesting that the model was robust. CONCLUSIONS: LAs were dominated by orchiectomy in the base case analysis and most sensitivity analyses. Combination therapy displayed incremental cost effectiveness ratios over orchiectomy ranging from approximately $30,000 to over $100,000 per QALY. Orchiectomy was more effective, had fewer severe adverse reactions, and cost slightly more than DES, the least expensive treatment. However, due to potential psychological impact, further research is warranted to examine its acceptance by patients. Despite robustness, the utilities used in the model warrant further research.

Purpose/Objective: Patient decision-making is enhanced with knowledge of what others going through similar treatments prefer and what the impact on quality of life (QL) is with different treatment alternatives. This study assessed the preferences, utilities and QL in patients treated with 3DCRT for prostate cancer, as well as predictors of these variables. Materials/Methods: Patients participating in a prostate cancer risk registry recruited through the Department of Radiation Therapy were analyzed. Preferences for health states of impotence (IP) and incontinence (IC) associated with prostate cancer therapies were elicited using a modified Time Trade-off (TTO) interview. Utility (a number between 0, death and 1, best possible health) for health states were calculated from stated preferences. QL (using the Functional Assessment of Cancer Therapy-Prostate, FACT-P; made up of a general QL scale, FACT-G and a prostate specific subscale), sexual adjustment (via a modified Sexual Adjustment Questionnaire, SAQ), and urinary function (using the AUA-Symptom Problem Index, SPI) were evaluated in patients with prostate cancer receiving 3DCRT. Stepwise multiple regressions were used to assess predictors (sociodemographics and pretx and treatment characteristics) of utilities and QL. Results: Fifty-six men (mean age 63 yrs.) treated between 12/90 and 2/99 with 3DCRT (mean dose 73 Gy) and a mean follow-up of 55 mos (range 17-131) completed the TTO. 83% were stage T1-T2 and 30% were on hormones. 33/56 (59%) pts completed the FACT and 38-39/56 (68%) pts completed the SAQ & SPI. Utilities followed a linear trend with declining scores for increasing risk of poorer health states. Men showed an increased preference and higher utility for health states associated with radiotherapy as compared to surgery or hormone therapy (Table 1). Global QL scores were higher than reports of a population of 466 mixed cancer patients (Cella, '94). SAQ scores were low but urinary function scores were excellent. Predictors of utilities for IP included marital status with being married associated with higher utilities, and for IC younger age and higher income were associated with higher utilities. The only treatment variable that predicted utilities for either IP or IC was RT dose, with higher dose associated with higher utilities. QL scores did not predict utilities. Predictors of sexual function included hormone therapy, while higher RT dose predicted worse urinary function, higher income predicted better global QL and higher tumor grade predicted worse FACT-P subscale scores.Table 1Utility Values for Prostate Cancer Treatment Related Health States and QL Scores of Men Treated with 3DCRTUtilities Health StateIncontinence(IC)Impotence(IP)(IP)% Risk of Health State10% Risk30% Risk40% Risk80% Risk99% RiskUtility Value, Mean (SD).9321 (.21).8961 (.22).9415 (.14).9043 (.15).8750 (.16)Qualtiy of LifeInstrumentFACT- GGlobal QL#higher scores are better;FACT-P Subscale#higher scores are better;FACT-P Total#higher scores are better;SAQ#higher scores are better;SPI∗lower scores are betterPossible Score Range0–1120–480–1608–10028-0QL Score Mean (SD)97 (13.2)37.8 (8.1)134.8 (19.5)39.5 (15.8)4.28 (5.66)# higher scores are better;∗ lower scores are better Open table in a new tab Conclusions: Men in this study treated with 3DCRT had relatively high utility for health states associated with treatment and higher utilities for health states associated with RT than hypothetical health states associated with surgery or hormonal therapy. All aspects of QL were quite good with the exception of sexual function. Predictors of both utilities and QL can assist in identifying patients at risk for poorer outcomes.

The radiochemical yields of nine N,N-dimethyl-2-(substituted phenyl)-isopropylamines (amphetamine analogues) were determined following reaction with [18F]acetyl hypofluorite in a 0.1 M HCl solution at room temperature. The meta-dimethoxy substituted amphetamines gave the highest radiofluorination yields (24–32%, at EOB). Purification of the 18F-labelled amphetamines was achieved in 10–20 min. 5-18F-2,4-Dimethoxy-N,N-dimethylamphetamine (5-18F-2,4-DNNA) was utilized to determine brain and lung uptake in rats. Positron emission tomography studies were conducted in a dog to determine the dynamic brain uptake and retention of this agent. The 5-18F-2,4-DNNA exhibited decreased initial uptake and more rapid loss of radioactivity in cerebral tissue compared to the iodinated homologue.

A 122Xe122I generator system is described that produces 122I extraction efficiencies of ∼60%. Radiocontaminants were less than 0.1% at the time of 122I removal following a 10 min ingrowth period. The chemical form of 122I was identified as [122I]iodide, and the [122I]iodide was remotely incorporated into radiopharmaceuticals for PET studies with an overall efficiency of as much as 40%.

In response to a need for an extracted brain blood flow tracer for positron tomograhy, the authors have developed from our original iodoamphetamine an I-122 radiopharmaceutical produced from a 20h Xe-122 generator and have demonstrated its application in animals and humans. The I-122 (t1/2 3.6m) is collected in the reaction vessel by a 10 min ingrowth from the Xe-122. The radiopharmaceutical, 2,4-dimethoxy-N,N-dimethyl-5(I-122)iodophenylisorpropylamine (5-(I-122)-2,4-DNNA), is synthesized using I-122 and chloramine-T, purified and sterilized for injection in 3 min. Synthesis can be repeated every 20-30 min. The diamine HIPDM was also labeled with I-122 by an exchange reaction for comparison. Using the Donner 280 crystal tomography system, anesthetized dogs showed rapid uptake of the activity in the brain using 5-(I-122)-2,4-DNNA and I-122 HIPDM. The ratio of activity in the brain to surrounding tissue was 6.1 and the distribution was the same as that from 18-FDG injected 30 min later.

The radioiodine-labeled amines currently available as brain-imaging agents, based on our previous work and that of others, are prepared either by exchange labeling or by direct iodination of a protected intermediate. The intrinsic slowness of these processes limits their potential for use with the positron-emitting 122I, as it has a half-life of only 3.6 min. This isotope has advantages of a low dose to the patient and availability from a generator containing the parent 20-h 122Xe. To develop a radiopharmaceutical in which 122I could be utilized, we prepared a number of secondary and tertiary amines (maintaining the 2,5-dimethoxy substitution pattern which allows direct iodination at the 4-position) with 131I. The organ distributions of these compounds were studied, and the best properties were found in the N,N-dimethyl homologue (2,5-dimethoxy-N,N-dimethyl-4-iodoamphetamine). This compound was successfully synthesized in a matter of seconds, with a chemical yield and radioactive purity both in excess of 90% and an incorporation efficiency of radioiodine of about 40%.

A rationale is presented for the investigation of the synthesis and pharmacology of 3-methoxy-4,5-methylenedioxyphenyl isopropylamine (MMDA) as a potential psychodysleptic compound; these experiments are reported. The chemical synthesis and physical properties of this compound are described. The pharmacologic effects of MMDA in several animal species are presented, as are its clinical effects in man. The animal pharmacology was generally unremarkable, except for a hypotensive effect in the dog, and the therapeutic index (LD50 rat/MED50 human) was 85. The subjective effects of MMDA in man include an enhancement of feeling and of eyes-closed visual imagery, but no hallucinogenesis or other disturbance of the sensorium. Reality testing and environmental contact are not affected except for a tendency to withdraw into a state of drowsiness, or into a world of fantasy and visual imagery. The induced state of increased availability of emotion was easily manipulated in the psychotherapeutic setting used, and appeared to lead to an enhanced insight into subconscious content.

A new centrally active halo-amine, 4-bromo-2,5 dimethoxyphenylisopropylamine, is described. In clinical evalua tion it proved to enhance effectively both emotional and in tellectual perception, without the imagery and perceptual distortions commonly encountered with many of the chemically related psychotomimetics. These properties suggest a potential valuable role in conjunction with psychotherapy.

Our report today has been divided into two separate portions. The discus sion of nutmeg and its composition, and of the possible involvement of its chemical components. The psychotropic intoxication has a natural division into two areas of presentation. The first is a brief description of the plant; a presentation of the methods and procedures for the isolation and the identifi cation of the many components in the oil from the plant, and a careful defini tion of those components that are most probably involved in the intoxicative syndrome. The extension of these components in to the corresponding amphetamines, their effectiveness in humans, and the likelihood of their being an acceptable explanation of the effects of the total nutmeg, will constitute the latter part of this report. In the previous paper there was presented some of the history of nutmeg, and a description of the style and extent of its usage in various cul tures. In the reports that will follow, specific descriptions of the human syn drome of intoxication, and some of the pharmacological ramifications of its study, will be presented. At this point we would like to present a factual description of the various chemical materials that have been found to make up the volatile (and pre sumed active) fraction of nutmeg. On the hypothesis that one or more com ponents may be appropriately assigned the responsible role for the nutmeg intoxication, there is a need for an exact chemical definition of nutmeg. But even before this, we must define in botanical terms just what is meant by the name nutmeg. Properly the nutmeg tree is any plant found in the Genus Myristica. Two species are known to be native to India. M. malabarica produces a seed some four centimeters long and elliptically shaped, and M. canarica produces a small spherical seed about two centimeters across. Both contain primarily fats and myristic acid, and being virtually without odor or volatile oil have achieved no position of importance. In the East Indies the seeds of M. suecedanea, known as "Pala Maba" in the Indonesian areas, are also small and quite elongate in shape, but they have proven valuable as rich sources of the nutmeg essential oils. Another species, M. argentea, has actually been used