Use of palliative chemotherapy in patients aged 80 years and over with incurable cancer: experience at three Sydney cancer centres.

BACKGROUND: Octogenarians represent a growing population reviewed in medical oncology clinics, yet there is a paucity of data on how chemotherapy is tolerated in this age group. AIM: To describe the use of palliative first-line chemotherapy in patients 80 years and over and factors associated with its use. METHODS: We identified all new patients aged 80 years or older diagnosed with incurable advanced solid organ cancer and seen in one of three Sydney medical oncology outpatient clinics between January 2009 and December 2013. Patient, disease and treatment details were summarised and factors associated with chemotherapy use explored. RESULTS: Of 420 eligible patients, 100 (24%) started first-line chemotherapy. Younger age at diagnosis was the only factor associated with receiving chemotherapy (median 82.9 vs 84.1 years, P = 0.002). A total of 78% of patients had single-agent chemotherapy, and 41% received a full dose for the first cycle. During treatment, 54% experienced toxicity, necessitating dose reduction, delay or omission, and 32% were hospitalised. These events were associated with receipt of combination chemotherapy (OR 5.1; P = 0.04) and full-dose chemotherapy for cycle 1 (OR 3.5; P = 0.02). Radiological disease control was achieved in 60%. Chemotherapy was stopped because of progressive disease (48%), toxicity (37%) or completion of planned course (17%). CONCLUSION: A quarter of patients 80 years and older received first-line palliative chemotherapy. Despite most receiving a modified dose, one third were hospitalised during treatment. These findings highlight the need for careful clinical assessment and selection of older cancer patients for chemotherapy.

Local outbreak of hepatitis E: a rare cause of viral hepatitis in Australia.

Hepatitis E is a not uncommon cause of viral hepatitis globally but is relatively rare in Australia. Here, we report a case of acute hepatitis E that was acquired in Sydney and was part of a cluster believed to be infected locally. This is to our knowledge the first known outbreak of locally acquired hepatitis E in Australia. We discuss pathogenesis, clinical features and means by which further spread of infection can be limited.

Dangerous liaisons: doctors-in-training and the pharmaceutical industry.

Interaction between doctors and the pharmaceutical industry is long-standing and ingrained in modern practice. Doctors-in-training are at a vulnerable stage of their careers, both in requiring knowledge and forming lasting relationships. There is evidence that limiting contact between industry and junior doctors has a positive effect on subsequent clinical behaviour. Currently in Australia, there is no limitation on pharmaceutical representatives approaching doctors-in-training, and the majority of education sessions are sponsored by pharmaceutical companies. This purposefully creates a sense of reciprocity, which may have adverse long-term consequences on attitudes, behaviours and patient care. Several guidelines exist that may assist junior doctors in navigating these potential interactions, most notably the Royal Australasian College of Physicians' own Guidelines for Ethical Relationships between Physicians and Industry. Despite this, there is no reflection of its importance or necessity within subspecialty curricula. This should be rectified, to the benefit of both the profession and public.

[Use of external photoprotective agents in children living in the area of Prague]. / Pouzívání zevních fotoprotektivních prostredku u detí prazské aglomerace.

BACKGROUND: Development of skin melanoma is related to the higher exposition to ultraviolet light, namely to the repeated sun burning of children. Because no valid information on the use of photoprotection in children can be found, an extensive search on the use of such measures, their galenic form and protective features was undertaken in order to evaluate the situation and to suggest necessary improvements. METHODS AND RESULTS: A group of 140 children aged 3 to 15 years, part of the group living in Prague, another part living outside the city was examined whether they use some local photoprotection during longer exposition to sun. If the answer was positive, it was followed in which season the photoprotection is used and whether it was used repeatedly. We also questioned on the forms of the local photoprotectives and the value of solar protective factor. CONCLUSIONS: Beside the description of sun tanning characteristics of children, we were informed by their parents that 59% of children use the photoprotection regularly, 41% only occasionally. The age of the first use of protection was 3.75 years. Photoprotection was used once a day in 28% of children, repeated use (during bathing, seashore stay, tourism) was reported in 72% of cases. The galenic form of photoprotective was most frequently a sun tanning creme (42%), a sun tanning milk (30%), both forms alternatively (8%), an oil (8%) or some other form (14%). The value of photoprotective factor was reported by 108 out of 131 parents and it was less than 10 in 9 children, 11 to 22 in 60 children, 21 to 40 in 36 children and over 40 in 3 children.

Production of materials with alumina and ashes from incineration of chromium tanned leather shavings: environmental and technical aspects.

The leather tannery industry produces a significant amount of solid and hazardous wastes. Chromium-containing wastes like tanned shavings used to be incinerated in order to recover energy. The incineration process generates ashes that must be disposed of. This paper is a report on the results of the evaluation of technological properties and environmental compatibility of products made of alumina and ashes from incinerated chrome tanned shavings. The raw materials, tannery ashes and alumina were mixed together in different proportions. The ceramic bodies were molded using a hydraulic press and fired with a heating rate of 100 K/h until 1400 degrees C for 4 h in a muffle furnace. The ceramic specimens were characterized regarding physical, mechanical and thermal properties. Leaching tests, according to Brazilian, German and Dutch regulations, were performed on ceramic bodies containing different additions of ash. Results show that the ceramic materials produced are acceptable for refractory applications.

Immunosuppressive treatment of Crohn's disease with fistulae.

The rise of fistulae in Crohn's disease has been classed with the disorder complications, although it is a possible component of natural development of the so-called A type (De Dombal classification) or aggressive-perforating type (Greenstein's classification) of this idiopathic intestinal inflammation. Fistulae are accompanying colic localization of Crohn's disease in 20%, ileocolic affection in 40%, where 35% of them are perianal fistulae, and about 34% entero-enteral or entero-cutaneous ones. Other complications (urogenital tract, biliary tract) are mentioned infrequently in literature. Besides surgical approaches in the therapy, dominant post in the conservative area is taken up by an antitumor necrotizing factor, antibiotics and immunosuppressives whose position is, however, the most problematic although the literature references about the effectiveness of azathioprine, 6-mercaptopurine, cyclosporine, tacrolime and methotrexate have had nearly 25-years tradition. The authors present their own experience with applying a combination of cyclosporine, azathioprine in the treatment of perianal fistulae in a set of 21 patients from the period of 1995-2000. In their opinion, the therapy success is limited especially by early starting the treatment (11 cases of effective therapy) and choosing a resolute method that is, according to them, sequential immunosuppression. (Tab. 2, Ref. 32.)

Severe complications following intravesical BCG instillation.

In patients with urinary bladder carcinoma, the intravesical BCG instillation is widely used. We present two cases of severe pulmonary afflictions developed during this treatment. The possible mechanisms of etiology are discussed and the classification of the intravesical BCG treatment side effects is suggested.

On the generation of point groups in spaces of various dimensions.

In this paper the use of Clifford algebra in the parametrization of point groups in spaces of various dimensions is shown. Higher-dimensional spaces are of great interest especially when modulated crystals or quasicrystals are studied. While the quaternion units, which are useful to parametrize rotations in 3 dimensions, can be identified with rotations, the basic Clifford units may be regarded as mirrors from which all proper and improper symmetry operations can be generated. The practical implementation of this method of parametrization is demonstrated for the group of the hypercube in the 4-dimensional space, and generalisations to spaces of dimensions higher than 4 are suggested.

Association of a fluorescent amphiphile with lipid bilayer vesicles in regions of solid-liquid-disordered phase coexistence.

The effects of solid-fluid phase separations on the kinetics of association of a single-chain fluorescent amphiphile were investigated in two different systems: pure DMPC (dimyristoylphosphatidylcholine) and a 1:1 mixture of DMPC and DSPC (distearoylphosphatidylcholine). In pure DMPC vesicles, solid (s) and fluid (l(d)) phases coexist at the phase transition temperature, T(m), whereas a 1:1 mixture of DMPC and DSPC shows a stable s-l(d) phase separation over a large temperature interval. We found that in single-component bilayers, within the main phase transition, the experimental kinetics of association are clearly not single-exponential, the deviation from that function becoming maximal at the T(m). This observation can be accounted for by a rate of desorption that is slower than desorption from either fluid or solid phases, leaving the rates of insertion unchanged, but a treatment in terms of stable fluid and solid domains may not be adequate for the analysis of the association of an amphiphile with pure DMPC vesicles at the T(m). In DMPC/DSPC mixtures with solid-fluid phase coexistence, association occurs overall faster than expected based on phase composition. The observed kinetics can be described by an increase in the rate of insertion, leaving the desorption rates unchanged. The fast kinetics of insertion of the amphiphile into two-phase bilayers in two-component vesicles is attributed to a more rapid insertion into defect-rich regions, which are most likely phase boundaries between solid and fluid domains. A two-component mixture of lipids that shows a stable phase separation between l(d)-s phases over a large temperature interval thus behaves very differently from a single-component bilayer at the T(m), with respect to insertion of amphiphiles.

Commercial polymerase chain reaction test (Amplicor set) in the diagnosis of smear-negative pulmonary tuberculosis from sputum and bronchoalveolar lavage.

The study presents experience with polymerase chain reaction (PCR) in the diagnosis of tuberculosis (TB) and compares the results obtained in sputum and bronchoalveolar lavage fluid (BALF). A total of 1,097 samples from 846 smear-negative patients with suspected TB was examined using PCR and culture during a period of 40 months. TB was the final diagnosis in 160 patients, based on the evidence of mycobacteria in 90 patients and on clinical criteria in the remaining 70. The PCR test had high specificity (98% and 99%, respectively) but poor sensitivity (37% and 34%, respectively) regardless of whether sputum or BALF was examined. Surprisingly, the sensitivity of culture (44% and 35% in sputum and BALF, respectively) was higher than that of PCR in this group. The contribution of BAL to establishing the diagnosis of tuberculosis was rather limited, yet substantial in some patients. The results obtained in this study were compared with the results published in the literature, and it was concluded that further clinical studies are necessary to establish an appropriate role for the polymerase chain reaction in the diagnosis of tuberculosis.

Kinetics of amphiphile association with two-phase lipid bilayer vesicles.

We examined the consequences of membrane heterogeneity for the association of a simple amphiphilic molecule with phospholipid vesicles with solid-liquid and liquid-liquid phase coexistence. To address this problem we studied the association of a single-chain, fluorescent amphiphile with dimyristoylphosphatidylcholine (DMPC) vesicles containing varying amounts of cholesterol. DMPC bilayers containing 15 mol% cholesterol show a region of solid-liquid-ordered (s-l(o)) coexistence below the T(m) of pure DMPC (23.9 degrees C) and a region of liquid-disordered-liquid-ordered coexistence (l(d)-l(o)) above the T(m). We first examined equilibrium binding and kinetics of amphiphile insertion into single-phase vesicles (s, l(d), and l(o) phase). The data obtained were then used to predict the behavior of the equivalent process in a two-phase system, taking into account the fractions of phases present. Next, the predicted kinetics were compared to experimental kinetics obtained from a two-phase system. We found that association of the amphiphile with lipid vesicles is not influenced by the existence of l(d)-l(o) phase boundaries but occurs much more slowly in the s-l(o) phase coexistence region than expected on the basis of phase composition.

Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind, randomized, placebo-controlled study.

OBJECTIVES: In 1994, the Massachusetts Male Aging Study presented an inverse correlation of the serum levels of dehydroepiandrosterone (DHEA) and the incidence of erectile dysfunction (ED). We evaluated the efficacy of DHEA replacement in the treatment of ED in a prospective, double-blind, randomized, placebo-controlled study. METHODS: The inclusion criteria included ED, normal physical and neurologic examinations, serum levels of testosterone, dihydrotestosterone, prolactin, and prostate-specific antigen (PSA) within the normal range, and a serum DHEA sulfate level below 1.5 micromol/L. Also all patients had a full erection after a pharmacologic erection test with 10O microg prostaglandin E1; pharmacocavernosography showed no visualization in corporeal venous structures. Forty patients from our impotence clinic were recruited and randomly divided into two groups of 20 patients each. Group 1 was treated with an oral dose of 50 mg DHEA and group 2 with a placebo one time a day for 6 months. The International Index of Erectile Function (IIEF), a 15-item questionnaire, was used to rate the success of this therapy. RESULTS: Therapy response was defined as the ability to achieve or maintain an erection sufficient for satisfactory sexual performance according to the National Institutes of Health Consensus Development Panel on Impotence. DHEA treatment was associated with higher mean scores for all five domains of the IIEF. There was no impact of DHEA treatment on the mean serum levels of PSA, prolactin, testosterone, the mean prostate volume, and the mean postvoid residual urine volume. CONCLUSIONS: Our results suggest that oral DHEA treatment may be of benefit in the treatment of ED. Although our patient data base is too small to do relevant statistical analysis, we believe that our data show a biologically obvious trend that justifies further extended studies.

[Prevalence of Helicobacter pylori infection in the Czech Republic--the South Moravia Region]. / Prevalence infekce Helicobacter pylori v CR--region jizní Morava.

The prevalence of Helicobacter pylori is influenced in a significant way by geographical conditions and depends to a certain extent also on the economic standard of different countries. Some published work provides evidence that Helicobacter pylori infections in eastern European countries are in general more frequent than in western European countries. It cannot be ruled out, however, that in different countries there are regional differences as far as Helicobacter pylori is concerned. In a group of 309 subjects, none of those treated previously to eradicate H.pylori, at least three weeks before blood sampling no preparations of the type of H2 blockers, proton pump blockers or drugs containing bismuth were administered. In these patients serological examinations of H.pylori antibodies were made, using kits of TEST-LINE Brno. The examined subjects were divided into six age groups by decades, starting at the age of 20 years. The general prevalence of H.pylori in the examined group was 58.8%, in the group of 20-year-old ones less than 46%. The highest prevalence was recorded in subjects aged 50-59 years and amounted to 67.3%. The authors compare their own results with findings assembled in the Czech Republic and abroad and draw attention to the necessity of an extensive epidemiological survey of H.pylori prevalence in the Czech Republic. The survey should be done by regions, using the same diagnostic method.

Sperm analysis and serum follicle-stimulating hormone levels before and after adjuvant single-agent carboplatin therapy for clinical stage I seminoma.

OBJECTIVES: During the past 25 years, radiotherapy has been considered the standard adjuvant treatment for clinical Stage I seminoma after orchiectomy. However, the late effects of this treatment have prompted a re-examination of the alternatives, including surveillance and adjuvant administration of carboplatin. To our knowledge, the present clinical study is the first to report the effects of two adjuvant courses of single-agent carboplatin on the pituitary-testicular axis and on sperm analysis. METHODS: Twenty-two patients with clinical Stage I seminoma participated in a prospective investigation of gonadal function before and after carboplatin therapy. After orchiectomy but before chemotherapy, blood samples for determination of follicle-stimulating hormone (FSH) serum levels were obtained from all 22 patients. Seventeen patients provided a semen sample at the same time, but 5 were unable to do so. At the end of chemotherapy, all 22 patients provided repeated semen samples starting 1 year after the termination of treatment and continuing at intervals of 12 months. FSH serum levels were determined at the same time. The study period was 48 months. RESULTS: Before chemotherapy, 2 patients (12%) had azoospermia, 9 (53%) had oligospermia, and 6 (35%) had normospermia. During the study period, sperm counts continued to increase in all patients. After 4 years, 7 patients (32%) had oligospermia and 15 (68%) normospermia. The mean prechemotherapy FSH level (15.5 IU/L) was increased in accordance with subnormal spermatogenesis, but a constant trend toward normalization was observed thereafter. CONCLUSIONS: Our results show recovery of spermatogenesis after adjuvant single-agent carboplatin for clinical Stage I seminoma in a remarkably high percentage of patients.

[Erythropoietin in non-specific intestinal inflammation]. / Erytropoetin u nespecifických strevních zánetu.

In 39 patients with non-specific intestinal inflammations the authors examined the erythropoietin level. They found a significantly higher level of serum erythropoietin in patients during relapse, when the organism responds to more severe anaemia by increased erythropoietin production. The idea that the reactivity of the bone marrow or effectiveness of erythropoietin is influenced by mediators of the inflammation is supported by the fact that the group comprised patients with high erythropoietin values of 102, 106.6, 109 and 445 ImU/l but their anaemia did not improve markedly. The theory on an inadequate erythropoietin secretion is supported by the fact that four patients in relapse with relatively severe anaemia had low erythropoietin levels and six patients had despite a significant drop of haemoglobin normal erythropoietin levels. Contrary to other diseases, in non-specific intestinal inflammations the erythropoietin secretion depends not only on the severity of the inflammation but probably on many other factors, incl. immunological ones.

Suicide prediction revisited.

Data from a 1983 prospective study of suicide in a cohort of 4800 psychiatric inpatients were reanalyzed using logistic regression, which is more appropriate for a binary outcome. The results were the same as in the previous study: too few of the subsequent suicides were identified and there were too many false positives to make this procedure useful. Several additional "artificial" logistic regression analyses were done: one series randomly removed increasing numbers of nonsuicide cases to increase the base rates; another series added an increasingly powerful hypothetical "test." Both of these maneuvers helped, but fell well short of perfection.

The effect of Hylak drops on symptomatology in persons with irritable bowel syndrome. / Vliv preparátu Hylak kapky na symptomatologii osob s drázdivým tracníkem.

The authors present an account on the therapeutic effect of Hylak drops of Merckle Co. in patients with irritable bowel syndrome. They assume that in the pathophysiological mechanism of the disease an important part is played by intestinal dysmicrobia. After two weeks' administration Hylak, 3 x 40 drops, they recorded in 20 patients with the exception of one female patient (where ex post lactose intolerance was revealed which is a contraindication of this treatment), partial or complete regression of subjective complaints in particular as regards intestinal discomfort and the number of imperative bowel movements. As to objective indicators, they proved changes in the pH of faeces and qualitative as well as quantitative changes of the microbial spectrum in faeces.