Tailoring treatment for classical Kaposi's sarcoma: comprehensive clinical guidelines.

Classical Kaposi's sarcoma (CKS) is a rare indolent proliferative disease which is particularly prevalent among Jews of Ashkenazi and Mediterranean origin. To define guidelines for its comprehensive management, we conducted a retrospective analysis of 123 patients, focusing mainly on treatment modalities. The CKS-related mortality was 4% (5 patients). Of the 39 patients for whom observation only was the primary approach, 15 (38%) remained progression-free for 1-83 months (median, 4 months). Twenty-nine of the 52 (56%) patients who underwent surgery as the primary approach remained recurrence-free for 1-162 months (median, 15 months). Radiotherapy achieved an objective response in 74 courses (85%), including 50 (58%) complete responses. Symptomatic relief was reported in 95% of the patients. Vinblastine (27 series) achieved an objective response in 73% of series, including 22% complete responses. Multivariate analysis of time to progression with observation alone identified immunosuppression as the only significant independent factor that predicted disease progression. Our study suggests that observation alone may be sufficient for immunocompetent asymptomatic patients; symptomatic resectable lesions are suitable for simple excision; and more advanced disease or unresectable lesions require radiotherapy. If disease is extensive or the other approaches fail, chemotherapy is appropriate. Tailoring the treatment for CKS is an integrative process, requiring good understanding of the role of each available modality in the different clinical disease settings.

The occurrence of chlamydial and gonococcal salpingitis during the menstrual cycle.

We evaluated 104 women hospitalized with a diagnosis of acute salpingitis to compare the relationship between the menstrual cycle and onset of acute chlamydial and/or gonococcal salpingitis and acute salpingitis associated with other facultative aerobic and anaerobic bacteria. Neisseria gonorrhoeae was recovered from 42 women (40%), Chlamydia trachomatis from 28 (27%), and nongonococcal, nonchlamydial organisms only from the upper genital tract in 48 (46%). Among 37 cases with symptoms of acute salpingitis within seven days of onset of menses, 30 (81%) had chlamydial and/or gonococcal infection. Of 35 cases with onset after 14 days postmenses, 23 (66%) had nongonococcal, nonchlamydial organisms only. Of the 28 women with chlamydial infection, 17 (57%) had the onset of disease within one week from the first day of their last menstrual period. Similarly, 23 (55%) of gonococcal infections had onset of symptoms within one week from onset of menses. However, only seven (14%) of the women with nongonococcal, nonchlamydial salpingitis reported onset of symptoms within one week. The temporal pattern of onset of chlamydial or gonococcal acute salpingitis showed significant differences when compared with the time of onset for nongonococcal, nonchlamydial acute salpingitis.