Pegulated liposomal doxorubicin and cisplatin given concurrently with conventional radiotherapy: a phase I dose-escalation trial for patients with squamous cell carcinoma of head and neck and lung.

This is a phase I study of concurrent chemoradiation with pegulated liposomal doxorubicin (PLDH) and cisplatin for patients with squamous non-small cell lung cancer (NSCLC) and head and neck carcinoma (SCCHN). Nine patients with NSCLC and 9 with SCCHN were recruited in two phase I dose-escalation trials. The starting dose of PLDH was 7 mg/m2 once a week and was increased by 5 mg/m2 dose increments for every 3 patients. The standard dose of cisplatin was 20 mg/m2 once a week for 6.5-7 weeks of conventional external irradiation. The total tumor dose was 64 and 70 Gy for NSCLC and SCCHN patients respectively. The maximum tolerated dose of PLDH was 12 mg/m2 for the two cohorts of patients. Grade 3 mucositis was the dose limiting toxicity for NSCLC and SCCHN patients, at the 17 mg/m2 dose level. Three chemoradiation delays of 7 days were confirmed. The median time of follow-up was 17.9 months (range 3-36 months). Four patients died due to local-regional failure combined with distant metastases (3 patients) and pericardial effusion (1 patient). In total, there were 6/18 (33%) CRs (95% confidence interval, 11-55%), and 10/18 (55%), PRs (95% confidence interval, 32-78%). The recommended phase II PLDH dose combined to cisplatin and external irradiation is 12 mg/m2/week. The incorporation of PLDH in concomitant chemoradiation regimens for future treatment of squamous cell carcinoma of the lung and head and neck is warranted.

Successful treatment of rhinocerebral mucormycosis with liposomal amphotericin B and surgery in two diabetic patients with renal dysfunction.

The zygomycetes are a class of fungi that can cause a variety of infections in humans. Rhinocerebral mucormycosis is a rare disease and usually affects diabetic or immunosuppressed patients. The disease progresses rapidly and is usually fatal despite aggressive surgical and medical therapy. We report the management of two cases of rhino-sinusal and orbital mucormycosis in diabetic patients on treatment with corticosteroids, and mild renal impairment, successfully treated with a combination of aggressive surgical debridement and liposomal amphotericin B.

Functional outcome of burst fractures of the thoracolumbar spine managed non-operatively, with early ambulation, evaluated using the load sharing classification.

The purpose of this prospective study was to assess the functional outcome of conservative treatment with early ambulation of thoracolumbar burst fractures, using the Load Sharing classification. From 1997 to 2001, 60 consecutive patients with single-level thoracolumbar spinal injury, with no neurological impairment, were classified according to the Load Sharing scoring and were managed non-operatively. A custom-made thoracolumbosacral orthosis was worn by all patients for six months, and early ambulation was recommended. Several radiological parameters were evaluated; the Denis Pain and Work Scale was used to assess the clinical outcome. The average follow-up period was 42 months (range, 24 to 55 months). During this period the spinal canal occupation was significantly reduced. Other radiological parameters, such as Cobb's angle and anterior vertebral body compression, showed loss of fracture reduction, which was not statistically significant. However, the functional outcome was satisfactory in 55 of 60 patients with no complications recorded on completion of treatment. Load Sharing scoring is a reliable and easy-to-use classification for the conservative treatment and prognosis of thoracolumbar spinal fractures. Because of the three characteristics of the fracture site this classification can also predict the structural results of spinal injury, such as posttraumatic kyphosis, as well as the functional outcome in conservatively treated patients.

Treatment of pancreatic cancer with a combination of docetaxel, gemcitabine and granulocyte colony-stimulating factor: a phase II study of the Greek Cooperative Group for Pancreatic Cancer.

PURPOSE: To evaluate the tolerance and efficacy of front-line docetaxel plus gemcitabine treatment in patients with inoperable pancreatic cancer. PATIENTS AND METHODS: Fifty-four patients with locally advanced or metastatic pancreatic cancer were enrolled. Gemcitabine (1000 mg/m2) was administered on days 1 and 8 and docetaxel (100 mg/m2) on day 8, every three weeks; rh-G-CSF (150 ig/m2 s.c.) was given prophylactically on days 9-15. RESULTS: Seven (13%) patients achieved partial response and 18 (33%) stable disease (intent-to-treat). The median duration of response was 24 weeks, time to tumour progression 32 weeks, and overall survival 26 weeks. Performance status was improved in 33% of patients, pain in 43%, asthenia in 16%, weight gain in 28% and appetite in 27%. Grade 3-4 neutropenia occurred in 17 (31%) patients and grade 3-4 thrombocytopenia in four (4%). Six (11%) patients developed febrile neutropenia and one of them died from sepsis. CONCLUSIONS: This combination is a relatively well-tolerated out-patient regimen for patients with inoperable pancreatic cancer.

Treatment of pancreatic cancer with docetaxel and granulocyte colony-stimulating factor: a multicenter phase II study.

PURPOSE: To determine the efficacy and tolerance of single-agent docetaxel and granulocyte colony-stimulating factor in patients with advanced pancreatic cancer. PATIENTS AND METHODS: Thirty-three chemotherapy-naive patients (median age, 65 years) with histologically confirmed pancreatic cancer were treated, after appropriate premedication, with docetaxel (100 mg/m(2)) and granulocyte colony-stimulating factor (150 microg/m(2)/d subcutaneously days 2 through 10) every 3 weeks. World Health Organization performance status was 0 to 1 in 28 patients (85%) and 2 in 5 patients (15%). Twenty-nine patients had stage III and IV disease. RESULTS: One complete response (3%) and one partial response (3%) were observed for an overall response rate of 6% (95% confidence interval, 2.1% to 14.2%). Nineteen patients (58%) had stable disease and 12 (36%) had progressive disease. The duration of the two objective responses was 10 and 28 weeks, and the median time to tumor progression was 20 weeks. The median overall survival was 36 weeks. The actuarial 1-year survival was 36.4%. The performance status improved in seven of 21 assessable patients (24%) and pain improved in 14 of 21 (67%) assessable patients; five patients (29%) experienced weight gain during treatment. Disease-related asthenia, anorexia, vomiting, and diarrhea improved in 29%, 15%, 67%, and 47% of the assessable patients, respectively. Serum concentrations of CA 19-9 were decreased by more than 50% in seven patients (35%). Grade 3 and 4 neutropenia occurred in four patients (12%) and eight patients (24%), respectively, with two episodes of febrile neutropenia. There were no treatment-related deaths. Grade 3/4 asthenia occurred in three patients. CONCLUSION: Although docetaxel has a marginal objective activity in pancreatic cancer, it seems to have an important effect on tumor growth control, conferring a clinical benefit.

Spontaneous spondylodiscitis caused by Klebsiella pneumoniae.

A rare case of spontaneous spondylodiscitis caused by Klebsiella pneumoniae in a 55-year-old man who presented with thoracolumbar pain is described. Increased erythrocyte sedimentation rate and C-reactive protein level were pertinent laboratory findings. Computed tomography revealed a paravertebral mass and destruction of the 10th and 11th vertebrae. Magnetic resonance imaging (MRI) showed spondylodiscitis in the same area. Culture of a biopsy sample from the mass grew Klebsiella pneumoniae, while histological examination confirmed the inflammation. A combination of ceftazidime, amikacin and ciprofloxacin resulted in disappearance of the pain. Two months later, MRI showed substantial improvement of the lesions.

Needle entrance into the maxillary sinus during retrobulbar anesthesia.

Three patients are presented to whom an accidental needle entrance into the maxillary sinus occurred during retrobulbar anesthesia. In all cases air was aspirated during the aspiration check at the end of needle advancement, and the patients reported a bitter taste after the injection of a small quantity of anesthetic. After withdrawal and careful reinsertion of the needle, maxillary sinus entrance was avoided and a successful retrobulbar block was achieved. Two of the patients had no history of previous facial trauma or surgery, whereas the third had suffered a recent blowout fracture of the orbital floor. The authors suggest that air aspiration or anesthetic passage into the pharynx during retrobulbar anesthesia should raise the suspicion of maxillary sinus entrance, even in patients without any history of facial trauma or surgery. The early recognition of sinus entrance can prevent retrobulbar block failure and reinjection of a second anesthetic dose.

Radiation exposure to the hands of operators during angiographic procedures.

The hands of those undertaking angiographic studies are close to the X-ray beam and may receive high doses. However, during recent years little information is available on these doses. The exposure to the left and right hand was measured with thermoluminescent dose meters during several conventional angiographic procedures. Mean doses to the left hand ranged from 0.24 to 0.96 mSv and to the right hand from 0.12 to 0.71 mSv, related to the type of procedure performed. The protection provided by new flexible lead gloves was estimated. The dose reduction with the glove was 19.5%. Operators can approach the dose limit to hands set by the International Commission on Radiological Protection (ICRP) during high workload. The data presented emphasize the importance of wearing lead gloves.

Features of computed tomography in hydatid cysts of the urinary tract.

The features of computed tomography (CT) in 5 patients with hydatid disease of the urinary tract are described. The diagnosis of hydatid disease was based on the demonstration of unilocular or multilocular cysts with well defined walls which enhanced with contrast, which were often calcified and which contained daughter cysts within the large parent cyst. It is difficult to differentiate between a unilocular hydatid cyst without mural calcification and an infected simple renal cyst.