Nephrotoxicity of high-dose ifosfamide/carboplatin/etoposide in adults undergoing autologous stem cell transplantation.

The objective of this study was to evaluate nephrotoxicity in adult patients treated with high-dose ifosfamide, carboplatin, and etoposide followed by autologous stem cell transplantation. We conducted a retrospective analysis of clinical and laboratory data from 131 patients with various malignancies who received treatment with escalating doses of ifosfamide, carboplatin, and etoposide followed by autologous stem cell transplantation as part of a phase I/II therapeutic trial. Abnormalities in glomerular filtration were evaluated by measuring peak creatinine levels and tubular dysfunction by the lowest recorded serum levels of potassium, magnesium, and bicarbonate, at different time periods after administration of ifosfamide, carboplatin, and etoposide, and after autologous stem cell transplantation. For the entire group of 131 patients, peak creatinine levels were > 1.5 mg/dL but < 3.0 mg/dL in 37% and levels were > 3.0 mg/dL in 11% at some time during their hospital stay. At the time of discharge, creatinine levels were 1.6 mg/dL to 3.0 mg/dL in 25% of patients and were > 3 mg/dL in 5%. Immediately after high-dose therapy, peak creatinine levels were significantly higher in patients receiving higher doses of ifosfamide compared to those receiving lower doses (P < 0.00001) and those receiving intermediate doses (P < 0.005). There was a dramatic decrease in serum bicarbonate, potassium, and magnesium levels immediately after chemotherapy, and they remained significantly decreased throughout the patient's hospital stay, despite massive replacement efforts (P ranging between < 0.008 and < 0.001). This is the largest adult population study documenting the incidence and severity of ifosfamide/carboplatin/etoposide-associated acute nephrotoxicity. Renal dysfunction was dose related and reversible in the majority of patients.

A preliminary study of partial hospital management of severe obsessive-compulsive disorder.

OBJECTIVE: The study examined the effectiveness of a partial hospital treatment program combining behavioral therapy, medication, and psychosocial intervention for severe and treatment-resistant obsessive-compulsive disorder. METHODS: A total of 58 patients with a primary diagnosis of obsessive-compulsive disorder who underwent treatment in a partial hospital program were assessed at baseline, at program discharge, and at six-, 12-, and 18-month follow-ups. Obsessive-compulsive symptoms, depression, anxiety symptoms, and global functioning were rated. RESULTS: The majority of patients (71 percent) met the criterion for a successful outcome, which was a 25 percent decrease in score on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Fifty-five percent finished the program with YBOCS scores of 16 or less, indicating only mild symptoms. Most of these patients sustained their improvement at six, 12, and 18 months after discharge, and many showed further improvement with continued outpatient management. CONCLUSIONS: The partial hospital treatment program for obsessive-compulsive disorder appears to be an effective intervention that should be implemented and investigated further.

Chronic mucocutaneous candidiasis with widespread dermatophyte infection: the trailing scale sign.

The hallmark of cutaneous dermatophyte infection is scaling over an erythematous border. Widespread or recalcitrant dermatophyte infections may occur when there is underlying immunosuppression. A trailing fringe of scale has been noted in these infections. A patient with chronic mucocutaneous candidiasis and widespread dermatophyte infection demonstrating trailing scale is presented.

Familial multiple upper gastrointestinal leiomyoma.

This report describes three adult members of a family who developed leiomyomas in the muscularis propria of their upper gastrointestinal tract. When in their thirties, numerous leiomyomas were present in ileum and jejunum. In their sixties, multiple and confluent esophageal leiomyomas formed the clinical picture of esophageal leiomyomatosis. Presenting symptoms were esophageal obstruction and hemorrhage. This is the first case in the published literature describing an association of familial multiple upper gastrointestinal leiomyomas with esophageal leiomyomatosis.

Phonoangiography by autocorrelation.

Phonoangiography, as a noninvasive quantitative analysis of arterial bruits, was conducted just prior to standard invasive radiographic angiography in 135 patients. Sound records from 162 carotid arteries were analyzed with a new processing technique employing a high speed analog acoustic analyzer, the autocorrelator. In 18 arteries with carotid stenosis, a correlation coefficient of 0.87 resulted between phonoangiographic diameter predictions and radiographic diameter estimates. Bruit analysis identified two patients with patent lumen diameters, but tortuous carotid vessels. One hundred thirty-three carotid arteries had no bruits that could be analyzed, but angiograms showed no extracranial stenosis. Four arteries from which bruits could not be analyzed were found to be totally occluded. Carotid phonoangiography appears applicable in approximately one of seven patients now requiring angiography of head and neck vessels. When applicable, phonoangiography is significantly correlated with angiographic findings.