Chemoradiation for inoperable non small cell lung cancer: a phase II study using a regimen with acceptable toxicity.

Over the past few years there have been numerous schedules of combined modality therapy proposed as being useful in the management of inoperable non-small cell lung cancer (NSCLC). These have generally involved the use of high dose radiation therapy to doses of the order of 60 Gy combined with chemotherapy given prior to or concurrently with the radiation. Concurrent chemotherapy has been given with the intention of being both active in NSCLC and with the role of being a possible radiosensitiser. The most commonly employed drugs have been cisplatin, etoposide, 5-fluorouracil, vindesine and mitomycin. Although response rates of the primary tumour to the combined therapy have been optimistic, there has not been a great survival benefit with the median survival in most series remaining at just over 12 months. In this study we have prospectively treated a group of patients with non-metastatic inoperable NSCLC with a regimen of known acceptable toxicity. These patients were inoperable because they were unfit for surgery or had locally advanced disease. The local radiological response rate was 86% and the median survival for the whole group was 13 months. Adenocarcinomas appeared to do significantly worse than squamous cell carcinomas. Toxicity was acceptable and lower than reported in other similar series. There was one treatment related death. We feel that this combination of radiation therapy and chemotherapy is a reasonable compromise for a disease which still has a very poor outlook.

Lung dose rate and interstitial pneumonitis in total body irradiation for bone marrow transplantation.

The effect of dose rate to the lungs and development of interstitial pneumonitis (IP) was evaluated in 114 bone marrow transplant patients receiving fractionated total body irradiation (TBI) (1200 rads TD in 6 fractions twice daily over 3 days) as part of their pre-conditioning regimen. The tumour dose (TD) was calculated as the mean lung dose as previously described (1). A 6MV linear accelerator at a mid-line dose rate of 7.5 rads/minute was used between March 1981 and June 1985 and a Co-60 source at 5 rads/minute thereafter. This resulted in a range of dose rates to the lung of between 6.9 and 8.9 rads/minute and 2.9 and 6.5 rads/minute respectively. In the majority of patients the aetiology of IP was investigated by lung biopsy with histology and culture. There was no statistically significant difference in the incidence of IP over the two sets of dose rates. Our study suggest that the incidence of IP using fractionated TBI is not influenced by dose rates below 8.9 rads per minute.

Low birthweight and mortality in Australian Aboriginal babies at the Royal Darwin Hospital: a 15 year study.

A retrospective analysis was made of all births at the Royal Darwin Hospital from 1 January 1969 to 31 December 1983. The births were divided into weight categories and racial groups (Aboriginal and non-Aboriginal). The study showed that there was a 23.2% incidence of low birthweight (LBW) babies (less than 2500 g) in Aboriginals compared with an incidence of 6.4% in non-Aboriginals. It was found that Aboriginals had a better chance of surviving the neonatal periods than non-Aboriginals of the same birthweight for all birthweights up to 2500 g. It is suggested that this occurred because most LBW Aboriginals were more mature than their birthweight would have suggested. The perinatal and neonatal mortality, however, remains high in the Aboriginal babies and this can also be attributed to the high incidence of LBW babies in this group, and perhaps to the limited use of antenatal care by the Aboriginal mothers.

Norwegian scabies in Australian Aborigines.

Norwegian scabies is a rare, but distinctive, variant of scabies. The infestation by the parasite is massive, and the lesions consist of hyperkeratotic plaques affecting the skin of the whole body. Predisposition to this form of scabies occurs in association with a variety of conditions. Three cases of Norwegian scabies, which occurred in full-blood Australian Aborigines, and were managed in the Royal Darwin Hospital, are reported.

Epidemic of acute poststreptococcal glomerulonephritis in aboriginal communities.

During 1980, an epidemic of acute glomerulonephritis occurred in a number of Aboriginal communities in the Northern Territory, affecting several hundred people. Clinical and laboratory studies of children admitted to the paediatric wards of Darwin Hospital, and of a larger number of individuals in the communities, have established that the nephritis was preceded by a streptococcal infection, and a recognised nephritogenic streptococcal strain was isolated from a number of children. The clinical course of the disease was mild in the majority of those affected and none had had serious complications. Serological results indicate the importance of measuring antideoxyribonuclease B levels as well as antistreptolysin O titres when seeking evidence of antecedent streptococcal infection.

Wound botulism.

It is well recognized that food contamination can result in botulism either from ingestion of performed toxin, in classical botulism, or through absorption of toxin from bacteria within the gut, in infant botulism. Botulism due to contamination of wounds with Clostridium botulinum is not commonly recognized. We report a case of wound botulism occurring in an eight-year-old boy, characterized by early ptosis, dysphagia and dysarthria and then followed by progressive generalized paralysis and fixed dilated pupils, but with intact sensorium. Management consisted of early wound debridement and prolonged intensive respiratory and nutritional support. Recovery was complete.