Toxic shock syndrome due to group C streptococci. A case report.

BACKGROUND: Streptococcal toxic shock-like syndrome is a life-threatening illness which is on the increase. In early reports, only group A beta-hemolytic streptococcus was associated with the disease, but recent evidence indicates non-A streptococci groups are also involved. OBSERVATIONS: We describe the first reported case of streptococcal toxic shock-like syndrome caused by a group C strain in Italy. Prior to the disease, the patient, a 46-year-old man, had been in good health and had only a 3-day history of sore throat, low grade fever, vomiting, diarrhea, and myalgia before admission. Initially, diagnosis was based only on clinical evidence: shock, multiorgan failure, profound hypothermia, and no apparent signs of infection. Toxic cardiomyopathy was also present. RESULTS: Positive throat swab and blood culture confirmed a "definite case" following established criteria. Anamnesis showed a diagnosis of monoclonal gammopathy. Antibiotic treatment was begun immediately on admission of the patient, who was discharged 20 days later in good health. CONCLUSIONS: This case illustrates how an early diagnosis and prompt antibiotic therapy can determine a more favorable outcome.

Sequential biochemotherapy for metastatic colorectal cancer using fluorouracil, folinic acid, thymopentin and interleukin-2: clinical and immunological effects.

BACKGROUND: A phase II study was performed to evaluate the clinical and immunological effects of a regimen of fluorouracil (5-FU) and folinic acid (FA) combined with thymopentin (TP-5) and interleukin-2 (IL-2) in the treatment of patients with metastatic colorectal cancer. PATIENTS AND METHODS: Forty-five evaluable patients with measurable colorectal cancer and no prior therapy for metastatic disease were treated with 5-FU 400 mg/m2/d and FA 200 mg/m2/d i.v. on days 1-5, TP-5 50 mg s.c. on days 8-11, and IL-2 9 MU/m2 s.c. twice daily on days 12-16. Cycles were repeated at 4-week intervals if toxicity had resolved. Immunological changes were evaluated in 13 patients and compared with a well matched series of 13 patients treated with the same regimen without TP-5. RESULTS: Two complete responses and 17 partial responses were seen (42%; 95% confidence interval, 28% to 56%). Fifteen patients (33%) had stable disease. The median time to progression was 8.5 months and the median survival 13 months. Treatment was reasonably well tolerated, and there was no overlapping toxicity or interference between chemotherapy and biotherapy. Hematological and immunological changes during treatment were qualitatively similar to those expected with IL-2 +/- chemotherapy. Quantitatively, significant changes (higher levels of IL-2, CD25 and IFN-gamma, and lower levels of sIL-2R) were observed in patients given TP-5. CONCLUSION: The combination of 5-FU + FA and TP-5 + IL-2 is effective in advanced colorectal cancer with acceptable toxicity. Immunological data suggest that TP-5 may modulate the action of IL-2 in the clinical setting. However, improved treatment approaches are needed, and the interactions between thymic hormones and cytokines should be further explored.

Biochemotherapy with thymosin alpha 1, interleukin-2 and dacarbazine in patients with metastatic melanoma: clinical and immunological effects.

BACKGROUND: DTIC and interleukin-2 (IL-2), as single agents, have a limited anti-tumor activity in patients with metastatic melanoma. Experimentally, thymosin alpha 1 (TA1) may modulate the action of IL-2. We investigated the clinical and immunological effects of a combination with these three agents. PATIENTS AND METHODS: Forty-six patients with measurable metastatic melanoma were treated with DTIC 850 mg IV on day 1, TA1 2 mg s.c. on days 4 to 7, and IL-2 18 MU/m2/d by continuous intravenous infusion on days 8 to 12. Cycles were repeated every 3 weeks. RESULTS: Objective responses were obtained in 15 (36%) of 42 evaluable patients (CI at 95%: 22%-50%). Two patients experienced complete responses, and stable disease was observed in five. The median time to progression was 5.5 months and median survival was 11 months. Side effects were predominantly caused by IL-2. Treatment was tolerated reasonably well, and there was no overlapping toxicity or interference between chemotherapy and biotherapy. Baseline sCD4 levels seem to correlate to tumor burden. Patients benefiting from treatment had lower sCD4 and higher sCD8 than did progressing patients. CONCLUSIONS: The combination of DTIC + TA1 + IL-2 is active in the treatment of advanced melanoma, with acceptable toxicity. However, even more active regimens are needed, and the interactions between thymic hormones and cytokines should be further explored.

[Efficacy of the disinfection of fiber endoscopes]. / Studio sulla efficacia della disinfezione di fibroendoscopi.

The validity of routine disinfection of gastrointestinal fibroscopes is reported. The Authors present their work based on 204 tests performed on gastroscopes and colonoscopes after manual disinfection performed by skilled nurses. All the instruments were kept in a 1:16 solution of glutaraldehyde-phenate for 10 minutes. Microbiological tests were performed half on sterile solution flushed on the outer part of the endoscope and half into the bioptic channel. Different groups of tests are reported. When strict asepsis was observed in handling the endoscopes all tests demonstrated to be sterile. When the endoscopes were handled as in usual routine, i.e. without sterile gloves and so on, 20% of the tests showed the presence of bacteria: these were only of types present in the environment. No real pathogens or antibiotic resistant strains were observed. The total disinfection procedure showed to be easy and quick to perform. No allergic or toxic reactions were observed. The importance of this procedure as a routine one in all endoscopy units is stressed considering also that literature data demonstrate the efficacy of glutaraldehyde-phenate against hepatitis and AIDS viruses.

Dose and schedule effects of cisplatin on the related acute iron changes.

To investigate the relationships between cisplatin and the related erythropoiesis impairment, 14 patients receiving very-high-dose cisplatin (40 mg/m2/day for 5 days) and 17 patients receiving standard-high-dose cisplatin (either a single dose of 100 or 20 mg/m2/day for 5 days) entered this study. Iron, ferritin, hemoglobin, and reticulocyte levels were evaluated before, 4 and 6 days after each course of cisplatin. A complete blood count was obtained weekly. During the 1st week after chemotherapy, iron and ferritin levels significantly increased, and the reticulocyte count decreased. Iron changes depend on the cisplatin dose, but are not related to the different schedules employed. The severity of subacute anemia was found to be dependent on the cisplatin dose administered and on hemoglobin pretreatment levels. Some relationships between cisplatin, iron changes, and the subacute hemoglobin decrease are described.

Chemoprophylaxis of bacterial infections in granulocytopenic cancer patients using norfloxacin.

Sixty-five cancer patients pretreated with chemo or radiotherapy, with granulocytopenia less than 1000/mm3 and without fever, were entered into this study: 30 of them were submitted to prophylaxis with norfloxacin while the remaining 35 patients were used as a control group. 20% of the treated subjects versus 68.6% of the controls presented a subsequent infection (P less than 0.001), the lung representing the most frequent site of the infectious disease in both groups (3/6 and 14/24 respectively). These data strongly suggest the use of norfloxacin as an effective prophylactic drug in nonfebrile, granulocytopenic cancer patients, especially as far as gram-negative infections are concerned. Because of the high prevalence of lung cancer in the patients of our study, and a related prevalence of lung infections, at the present time, a wider use of this antibiotic in every kind of solid tumor cannot be generalized.

[Colorimetric determination of plasma vitamin C: comparison between 2,4-dinitrophenylhydrazine and phosphotungstic acid methods (author's transl)]. / Confronto tra i metodi della 2,4-dinitrofenilidrazina e dell'acido fosfotungstico per la determinazione colorimetrica della vitamina C nel plasma.

The evaluation of a recently published colorimetric method for plasma ascorbic acid determination, using phosphotungstic acid (PTA), was performed by comparison with the largely employed 2,4-dinitrophenylhydrazine (DNPH) procedure. The method has been evaluated according to International Federation of Clinical Chemistry (I.F.C.C.) recommendations. In particular, calibration procedures have been performed and precision, accuracy, linearity, specificity and sensitivity have been studied in biological samples. Linear regression analysis indicates that the two methods do not correlate completely. The PTA method shows a better recovery. The PTA method shares with the DNPH procedure a poor precision at low concentrations of vitamin C in plasma such as to make results less reliable at the clinically significative levels.