A Novel Transdermal Application for Clearing Skin Colonization by Candida auris.

BACKGROUND. Candida auris has demonstrated the ability to colonize the skin of hospitalized patients, possibly contributing to nosocomial spread. OBJECTIVE. The objective was to determine whether two novel transdermal agents could clear skin colonization established by C. auris METHODS. A murine skin colonization model was first optimized and then used to test fungal burden reduction following treatment with 1% terbinafine or 1% clotrimazole in a proprietary Advanced Penetration Technology formulation (APT™). RESULTS. Both treatments significantly reduced fungal burden compared to control groups. CONCLUSION. These novel agents show promise as a topical means of preventing skin colonization by C. auris.

The clinical behavior of localized and multicentric Castleman disease.

BACKGROUND: Castleman disease, an unusual condition of unknown cause consisting of a massive proliferation of lymphoid tissue, remains a clinicopathologic diagnosis. Three histologic variants (hyaline vascular, plasma-cell, and mixed) and two clinical types (localized and multicentric) of Castleman disease have been described. OBJECTIVE: To analyze the clinical features, management, and outcome of patients with Castleman disease. DESIGN: Case series. SETTING: University referral hospitals. PATIENTS: All patients with Castleman disease who were seen at Texas Medical Center, Houston, Texas, between 1977 and 1995. INTERVENTIONS: Surgical excision for localized disease; surgery, combination chemotherapy, or prednisone for multicentric disease. MEASUREMENTS: Patients were identified according to initial presentation as having localized or multicentric Castleman disease. Patients within each group were further subdivided according to whether they had hyaline vascular, plasma-cell, or mixed disease. RESULTS: Data from 15 patients were analyzed. All 7 patients with localized disease underwent surgical excision and remain free of disease. The 8 patients with multicentric disease were further subdivided according to initial treatment: Three patients who received combination chemotherapy are currently alive and free of disease; 2 patients treated with prednisone are alive but have needed intermittent maintenance therapy for disease reactivations; and 2 patients treated with surgery only have died, 1 of infectious complications and 1 of non-Hodgkin lymphoma. CONCLUSIONS: Localized and multicentric Castleman disease are different clinical disorders with overlapping histologic features. Localized disease can be cured with surgery, but complete remissions in patients with multicentric disease have been achieved only with chemotherapy or prednisone given at the time of diagnosis.

Remission with carboplatin of paclitaxel resistant primary peritoneal papillary serous carcinoma: case report.

Primary peritoneal papillary serous adenocarcinoma is histologically identical to ovarian papillary serous adenocarcinoma. This diagnosis is made if the ovaries are of normal size with either no tumor or only minimal surface involvement. We describe a patient with a primary peritoneal papillary serous adenocarcinoma which was resistant to initial therapy with paclitaxel, but subsequently achieved a partial response with carboplatin-based chemotherapy. Accordingly, carboplatin therapy should be considered in paclitaxel resistant primary peritoneal papillary serous carcinoma.

Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma.

The purpose of this study was to correlate physical examination and sonographic and mammographic measurements of breast tumors and regional lymph nodes with pathological findings and to evaluate the effect of neoadjuvant chemotherapy on clinical Tumor-Node-Metastasis stage by noninvasive methods. This was a retrospective analysis of 100 patients with locally advanced breast cancer registered and treated in prospective trials of neoadjuvant chemotherapy. All patients received four cycles of a doxorubicin-containing regimen and had noninvasive evaluation of the primary tumor and regional lymph nodes before and after neoadjuvant chemotherapy by physical examination, sonography, and mammography and underwent breast surgery and axillary dissection within 5 weeks after completion of neoadjuvant chemotherapy. The correlations between clinical and pathological measurements were determined by Spearman rank correlation analysis. A proportional odds model was used to examine predictive values. Eighty-three patients had both a clinically detectable primary tumor and lymph node metastases. Sixty-four patients had a decrease in Tumor-Node-Metastasis stage after chemotherapy. For 54% of patients, there was concordance in clinical response between the primary tumor and lymph node compartment; for the rest, results were discordant. Physical examination correlated best with pathological findings in the measurement of the primary tumor (P = 0.0003), whereas sonography was the most accurate predictor of size for axillary lymph nodes (P = 0.0005). The combination of physical examination and mammography worked best for assessment of the primary tumor (P = 0.003), whereas combining physical examination with sonography gave optimal evaluation of regional lymph nodes (P = 0.0001). In conclusion, physical examination is the best noninvasive predictor of the real size of locally advanced primary breast cancer, whereas sonography correlates better with the real dimensions of axillary lymph nodes. The combination of physical examination with either mammography or sonography significantly improves the accuracy of noninvasive assessment of tumor dimensions.

Characterization of patients with androgen-independent prostatic carcinoma whose serum prostate specific antigen decreased following flutamide withdrawal.

PURPOSE: We confirmed the reported rate of prostate specific antigen (PSA) suppression after flutamide withdrawal in patients with metastatic prostatic carcinoma, increasing serum PSA and tumor progression following treatment with total androgen blockade (castration and flutamide). The value of clinical variables in predicting the rate of PSA decrease after flutamide withdrawal was assessed and adrenal androgen metabolism was correlated with the rate of PSA suppression following flutamide withdrawal. MATERIALS AND METHODS: A total of 41 consecutive patients with metastatic prostatic adenocarcinoma and an increasing serum PSA while effectively castrated (plasma testosterone level less than 50 ng./ml.) who were receiving 250 mg. flutamide 3 times daily was evaluated prospectively before cessation of the flutamide. Responses were determined at 6 weeks. Only 2 of the 41 study patients (3%) had stable disease at 6 weeks, that is they had not met objective criteria for response or progression at analysis. RESULTS: Of 39 patients studied 11 (28.2%, 95% confidence internal 14 to 45%) had a PSA decrease (more than 50% from baseline) following flutamide withdrawal and they were treated with initial complete androgen blockade. Median duration of PSA decrease was only 13 weeks (range 7 to 52), and 3 of the 11 patients had continued suppression of serum PSA concentrations at 12+, 13+ and 20+ weeks. The serum PSA decrease was associated with improved clinical symptoms, although objective regression of the disease was found in only 1 to 2 patients with measurable disease. No statistical correlation between endocrine studies or serum bombesin secretion and PSA decrease was found, although patients with a PSA decrease after flutamide withdrawal tended to have a lower dehydroepiandrosterone concentration than those with PSA progression. No correlation between known prognostic variables and decreased serum PSA after flutamide withdrawal was detected. CONCLUSIONS: We confirmed the existence of the reported paradoxical PSA decrease in patients with androgen-independent carcinoma of the prostate, and that the delivery of simultaneous initial flutamide with castration predicts for PSA decrease. Individual patients appear to benefit from flutamide withdrawal although the overall impact was slight. The differences in frequency compared to those reported by others may be accounted for by patient selection and the number of patients receiving sequential castration therapy followed by flutamide.

Thrombolytic therapy in MI: a retrospective study.

Of 123 patients with acute myocardial infarction, 82 percent did not receive thrombolytic therapy; 27 percent of those were because of time delays on patients' part in seeking medical attention. There is a clear need for patient education and public awareness of prodromal symptoms and early intervention.