Low dose fractionated cisplatin plus gemcitabine for elderly patients with advanced non small cell lung cancer: a retrospective analysis.

The aim of the study was to evaluate safety and efficacy of gemcitabine-cisplatin in elderly patients with advanced non small cell lung cancer (NSCLC). This study included 59 patients aged >70 years consecutively admitted to our Department. treatment consisted of gemcitabine 1000 mg/m(2) on days 1 and 8, and low-dose fractionated cisplatin 20 mg/m(2) on days 1, 2, 3 of a 21-day cycle. Toxicity was graded according to the world Health Organization (WHO) criteria.A total of 281 cycles was administered. Hematological toxicities of grade 3 and 4 were seen in 17% and 5% of patients, respectively. Grade 3 gastrointestinal toxicity was 3%, grade 2 neuropathy was 2%. Twenty-nine partial responses with an objective response rate of 49% were obtained. No complete responses were observed. The median progression-free survival (PFS) and overall survival (OS) were 7.8 and 15.5 months respectively. Cisplatin-based combination chemotherapy at low doses appears to be safe and active in older patients with advanced NSCLC.

Hyperthermia induced by microwave diathermy in the management of muscle and tendon injuries.

INTRODUCTION: Hyperthermia induced by microwave diathermy raises the temperature of deep tissues from 41 degrees C to 45 degrees C using electromagnetic power. Microwave diathermy is used in the management of superficial tumours with conventional radiotherapy and chemotherapy and, recently, its use has been successfully extended to physical medicine and sports traumatology in Central and Southern Europe. METHODS: We searched the literature for relevant studies. Most of the published studies in these fields have used 434 and 915 microwave diathermy, as these wavelengths are most effective. RESULTS: Hyperthermia induced by microwave diathermy into tissue can stimulate repair processes, increase drug activity, allow more efficient relief from pain, help in the removal of toxic wastes, increase tendon extensibility and reduce muscle and joint stiffness. Moreover, hyperthermia induces hyperaemia, improves local tissue drainage, increases metabolic rate and induces alterations in the cell membrane. CONCLUSIONS: The biological mechanism that regulates the relationship between the thermal dose and the healing process of soft tissues with low or high water content or with low or high blood perfusion is still under study. Microwave diathermy treatment at 434 and 915 MHz can be effective in the short-term management of musculo-skeletal injuries.

Comparison of incidence of sepsis in cancer patients that underwent systemic or loco-regional chemotherapy.

In this retrospective non controlled trial we evaluated the incidence of sepsis in cancer patients in two different periods (January-June 2003 versus January-June 2004). The main difference in these two periods was that in our oncology department we changed from systemic chemotherapy to loco-regional chemotherapy using less myelosuppressive drugs and developed the domiciliary assistance. The aim of the study was to assess the incidence of sepsis in order to demonstrate a reduction of the infection related to the change of chemotherapy. In addition, this study may be able to describe the epidemiology of sepsis in cancer patients afferent to our oncology department. The incidence of sepsis was reduced in the second period from 24.3% to 6.2%. The pathogens more frequently isolated in this study were coagulase-negative staphylococci (CNS) followed by Escherichia coli and Staphylococcus aureus. Less invasive therapy may reduce infective complication of chemotherapy. The epidemiology of sepsis may be very helpful to design empiric therapeutic protocol for febrile patients that have received chemotherapy.

Aborted implantable cardioverter defibrillator shock during facial electrosurgery.

A patient with a fourth-generation transvenous implantable cardioverter-defibrillator system nearly received an inappropriate defibrillation discharge while undergoing electrofulguration of keratotic facial skin lesions. The incident was confirmed by analyses of the implantable cardioverter-defibrillator's time/date stamped event log and stored electrogram record. Therapy was withheld by the noncommitted implantable cardioverter-defibrillator as the pulsed electrocautery was not continued beyond the charging period.

Assessment of the efficacy of a last-generation polyvalent immunoglobulin in the treatment of idiopathic thrombocytopenic purpura.

High-dose intravenous immunogammaglobulin (h.d.IgG) has been proposed as a treatment of idiopathic thrombocytopenic purpura (ITP), but the clinical effect is usually short and adverse reactions have been reported in clinical studies using different immunoglobulin (Ig) preparations. In this study, the efficacy of a last-generation polyvalent immunoglobulin in the treatment of ITP in adults and the incidences of adverse reactions of this therapy were evaluated. The reported data were based on various clinical and laboratory parameters evaluated before, during and after therapy, with a follow-up of 6 months. The data showed administration of 400 mg/kg d of intravenous polyvalent intact IgG for 5 days significantly increased the platelet count in all 15 patients, the maximum level occurring on Day 10 and being maintained in some patients for 6 months. Its very rapid onset of action suggests it may be useful for correcting life-threatening thrombocytopenia where bleeding complicates the clinical course, and for severe ITP in seriously immunosuppressed or infected patients in whom corticosteroids or immunosuppressive agents cannot be safely administered. The treatment was also well tolerated. In conclusion, polyvalent Ig may be useful in ITP steroid-refractory patients; further studies are required to evaluate clinical-laboratory parameters related to the long-term response of patients.

Combined third-generation implantable cardioverter defibrillator with permanent unipolar pacemakers: preliminary observations.

UNLABELLED: As implantable cardioverter defibrillators (ICDs) are strictly contraindicated in the presence of unipolar pacemakers, currently available options in patients having such chronic pacing systems include: abandoning the implanted pacemaker and selecting an ICD with ventricular demand (VVI) pacing; or replacing the chronic (dual chamber) unipolar pacing system with a dedicated bipolar version prior to ICD implantation. In three patients with previously implanted unipolar pacemakers, we challenged the premise that all ICD systems are incompatible by combining with a third-generation transvenous ICD system (Medtronic 7217B PCD) incorporating true bipolar sensing, a self-limiting auto-adjusting sensitivity, and a tolerant VF detection algorithm. The potential for pacemaker-ICD interaction was minimized by separating the tip of the ICDs transvenous right ventricular pace/sense-defibrillation coil lead from that of the chronic pacemaker lead by > or = 2-3 cm, and by performing "worst case" intraoperative testing. Although ICD double-counting of the dual chamber pacemaker's atrial and ventricular pacing spikes could be provoked at extreme high output settings, it did not occur at clinically appropriate settings. More importantly, continuous high output asynchronous pacing during ventricular fibrillation (VF) did not interfere with ICD detection. During a mean follow-up period of 18 months, one patient has had VF appropriately terminated by the ICD. In the remaining two patients, proper VF detection and ICD function was reassessed at 3 months and/or at 1 year during noninvasive testing. CONCLUSION: These preliminary findings demonstrate that this transvenous ICD system's VF sensing and detection features combined with careful implant technique, rigorous "worst case" testing for possible pacemaker-ICD interaction with regular follow-up, may permit implantation of this ICD system in patients with chronic unipolar pacing systems. Further studies are needed to validate the long-term clinical safety of this promising revised approach to a currently contraindicated device combination.

Sudden cardiac death.

This article uses a biologic model of sudden cardiac death to identify structural abnormalities that serve as the substrate for sustained arrhythmias and functional changes that are transient and necessary for triggering an arrhythmia. The biologic framework is a valuable tool to use in understanding the relationship between structure and function and in organizing patients' clinical presentations and outcomes.

Advances in ablation surgeries for dysrhythmias associated with Wolff-Parkinson-White syndrome.

Management of dysrhythmias associated with WPW syndrome must be individualized. A detailed EPS in selected patients should be done to assess the location of accessory pathways and the efficacy of antiarrhythmic medications. Palliative treatment used in the prevention of SVT would include a pharmacologic approach or perhaps an antitachycardia pacemaker. Curative methods for treating the SVT associated with accessory pathways of WPW syndrome include ablative techniques. Surgical ablation is currently accepted as the gold standard of treatment, but catheter ablation offers promising hope as an adjunctive therapy in treating patients with WPW syndrome.