Stability and compatibility of topotecan hydrochloride with selected drugs.

The physical and chemical compatibility of topotecan 56 microg/mL (as the hydrochloride) with 18 other drugs during simulated Y-site injection was studied. A vial of topotecan hydrochloride was reconstituted under aseptic conditions with sterile water for injection to yield a solution containing 1 mg of topotecan base per milliliter and further mixed with 0.9% sodium chloride injection or 5% dextrose injection. Equal volumes of topotecan solution and each secondary drug, also prepared in 0.9% sodium chloride injection or 5% dextrose injection, were mixed in sterile vials. All mixtures were stored at 20-23 degrees C under normal fluorescent light. Samples were taken initially and at four hours for analysis by high-performance liquid chromatography, visual inspection, and pH measurement. With a few exceptions, the drug combinations exhibited no visible change in color or clarity initially or after four hours, and the concentration of topotecan hydrochloride and of the secondary drugs was 95% or more of the initial concentration. The concentration of topotecan hydrochloride dropped to 88.7% of the initial concentration after four hours when the drug was mixed with ticarcillin disodium and with clavulanate potassium in 5% dextrose injection. An intense yellow color and a slight haze developed immediately after topotecan hydrochloride was mixed with dexamethasone sodium phosphate or with fluorouracil in 0.9% sodium chloride injection. The topotecan-mitomycin combination in both diluents became pale purple immediately and turned dark pink-lavender within four hours, after which analysis showed 15-20% degradation of mitomycin. During simulated Y-site injection, topotecan hydrochloride was physically and chemically compatible with 15 of 18 drug products.

Stability and compatibility of granisetron hydrochloride in i.v. solutions and oral liquids and during simulated Y-site injection with selected drugs.

The stability and compatibility of granisetron hydrochloride in common i.v. fluids and oral liquids and during simulated Y-site injection with selected drugs were studied. One milliliter of solution containing granisetron 1 mg (as the hydrochloride salt) was added to 50 mL of 5% dextrose injection, 5% dextrose and 0.9% sodium chloride injection, 5% dextrose and 0.45% sodium chloride injection, or 0.9% sodium chloride injection in polyvinyl chloride (PVC) bags and to 5 mL of 5% dextrose injection, 0.9% sodium chloride injection, or bacteriostatic water for injection in polypropylene syringes and stored at room temperature (20 degrees C) for 24 hours. One milliliter of the granisetron hydrochloride injection was added to 50 mL of apple juice, orange juice, cola, or an electrolyte replacement solution and stored for 60 minutes at room temperature. Twenty-nine drugs were mixed with the granisetron hydrochloride injection in 0.9% sodium chloride injection in volumes simulating Y-site injection and stored at room temperature. Finally, dexamethasone sodium phosphate injection 0.5 mL and 1 mL of the granisetron hydrochloride injection were added to 50 mL of 0.9% sodium chloride injection in a PVC bag and stored for 60 minutes. Drug concentrations were determined by high-performance liquid chromatography, and color, clarity, and pH were evaluated. Granisetron hydrochloride was stable in and compatible with all the i.v. solutions and oral liquids. Neither granisetron nor any of the drugs it was tested with during simulated Y-site injection showed any physical changes except for a slight Tyndall effect in the granisetron hydrochloride-doxorubicin hydrochloride combination; all the drugs retained at least 96% of initial concentrations. Granisetron and dexamethasone sodium phosphate were stable and compatible in the admixture. Granisetron 1 mg (as the hydrochloride salt) was stable for 24 hours in four i.v. infusion fluids in PVC bags and in 5% dextrose injection, 0.9% sodium chloride injection, and bacteriostatic water for injection in polypropylene syringes; for 1 hour in four oral liquids; for 4 hours in the presence of each of 29 drugs during simulated Y-site injection; and for 1 hour when mixed with dexamethasone sodium phosphate in 0.9% sodium chloride injection in a PVC bag.

Tissue CEA in colorectal carcinoma.

Immunoperoxidase method can be used to detect cellular or tissue CEA. Forty formalin-fixed paraffin-embedded specimens of colorectal carcinoma, 19 from patients who survived for five years after resection, and 21 from patients who died within five years were studied. Cellular CEA was present in 100 per cent of the specimens. Accurate quantitative evaluation of cellular CEA is currently not feasible. Therefore, the mere presence of cellular CEA has no prognostic value.

Rectovaginal fistula: a review of 11 years experience.

The records of 22 patients at Temple University Hospital with a diagnosis of rectovaginal fistula, from January 1970 to December 1980, were reviewed. The age at the time of diagnosis ranged from 18 to 75 years with an average of 47.3 years. Most had symptoms and signs which included fecal incontinence, flatus passage per vagina, tenesmus, distressing diarrhea and urinary tract infection. The majority of the fistulas were present for more than a year before the corrective operative procedure was attempted. The patients were divided into two groups: postirradiation fistulas and non-irradiation fistulas. The former resulted from the treatment of carcinoma of the cervix, urinary bladder, urethra, or rectum. The latter resulted from inflammatory bowel diseases, diverticulitis, or trauma from obstetric procedures. The former group were usually treated conservatively, either no operation or defunctioning colostomy. The latter group were treated more aggressively, either by direct repair or resection of the diseased segment.

Reoperation for regional enteritis (Crohn's disease).

Twenty-five patients had major operations for regional enteritis between 1969 and 1981. Of these, 12 patients required subsequent major procedures for recurrent disease. This group consisted of three men and nine women who were operated upon a total of 32 times. Their average age at onset of disease was 27.4 years, compared with 40 years for those patients who were operated upon only once. The reoperated group had an average of 3.5 nonoperative hospital admissions, while, patients in the group with one operation were hospitalized 1.8 times for disease during the period studied. Identification of operated patients who will require reoperation would improve counseling of these patients. Earlier age of onset and more frequent nonoperative admissions seem to be associated with need for reoperation. Extent and type of primary resection seem to be of less predictive value.

Intralesional bleomycin injection in treatment of condyloma acuminatum.

The antitumoral antibiotic, bleomycin, was given by intralesional injection to ten patients with condyloma acuminatum. Our 70 per cent success rate suggests this is a reasonable alternative treatment in the management of anal warts which prove unresponsive to other modalities.

Obstructive colonic cancer.

The clinical courses of 68 patients with obstructive colonic cancers were reviewed. For the majority of patients with an acutely obstructing cancer of the left colon a conventional staged procedure remains the most appropriate treatment. Primary resection is suitable for the more proximal colonic cancer with obstruction. The operative mortality rate was 13.6 per cent, but with the addition of two nonoperative deaths, the figure rises to 16.2 per cent. Only six patients are known to have survived five years.

Procidentia of the rectum after the pull-through operation: an unusual complication and report of two cases.

Procidentia or complete prolapse of the rectum following the pull-through operation is unusual, if not altogether rare. It appears to be a late complication of the procedure. A multitude of factors may be implicated in its genesis, and certainly the inadequacy of the pelvic floor is principal among them. Though the exact mechanism is not entirely clear, we favor an intussusceptive process for the reasons and observations cited. It is surmised that its late appearance is primarily due to the formation of adhesions that effectively fix the bowel to the sacrum. The process of aging and ensuing laxity of tissues subsequently detract from this protective factor. Perineal repair was used in both cases but, in the ultimate analysis, the procedure of choice should be individualized, based upon the surgeon's own judgment and experience and particular circumstances attending procidentia.

Anterior sacral meningocele: report of five cases and review of the literature.

Five new cases of anterior sacral meningocele are presented, including one secondary to neurofibromatosis, a previously undescribed association. The literature is reviewed, drawing attention to the relationship between anterior sacral meningocele, sacral dysgenesis, and other congenital anomalies. Special consideration is given to the clinical features of this entity, as well as to the techniques and results of surgical management.

Carcinoma of the cecum.

During the ten year period of this retrospective study, 66 of 1,451 patients with carcinoma of the colon and rectum had carcinoma of the cecum. The most frequent symptoms were nonspecific and caused by anemia which, in some instances, were treated without adequate investigation. The standard and most appropriate treatment for carcinoma of the cecum is a right hemicolectomy with ileotranversostomy and, when necessary and feasible, en bloc resection of involved parts of the abdominal wall. In the absence of nodal disease or distant metastases, extension to the abdominal wall does not adversely influence the prognosis. The surgeon must remain aware of the possibility of coexisting carcinoma of the cecum and appendicitis. Any patient with a mass or a persistent draining sinus after an appendectomy or drainage of an appendical abscess should be suspected of having carcinoma of the cecum. The over-all five year survival rate in this series is 33%, and if curative resections alone are considered, it is 44%, with an operative mortality of 3%. More recent evidence indicates that there has been a shortening of the delay in treatment, and we believe future studies will show an improvement in these figures.

Nonsuture colonic anastomosis.

Methyl-2-cyanoacrylate was used for nonsuture end-to-end anastomosis of the ascending colon in 35 male Sprague-Dawley rats. The results were studied in seven sacrificed rats and eight rats that died after the procedure. The mortality rate was 22 per cent in a six-month period. Twenty animals are being observed for further studies of the anastomoic site and possible late carcinogenic activity of the monomer. The local histotoxicity of methyl-2-cyanoacrylate, the strong binding capacity, the abundance of scar tissue, and the distraction of the mucosa, as pointed out by several earlier investigators, were confirmed in this work. Also, it was strongly evident that the age of the glue has a significant influence on survival. The use of tissue adhesives as a substitute for standard suture technique or as a reinforcement of an inadequate suture line requires further study. Investigations designed for improving properties of these monomers appear warranted.

A foreign body (chicken bone) in the rectum causing extensive perirectal and scrotal abscess: report of a case.

A case of foreign-body perforation of the rectum with extensive necrotizing fasciitis is presented and the literature briefly reviewed. The peculiarity of the case was brought out because of the nature of the foreign body(chicken bone) and the extensiveness of the process. The increases risk of swallowing a foreign body if dentures are worn is pointed out.