Advanced renal cell carcinoma

Opinion statement For most patients with advanced renal cell carcinoma, treatment remains palliative. Standard chemotherapy used in the treatment of other types of cancers has proven ineffective in the treatment of this disease. High-dose interleukin-2 (IL-2) is the only regimen that has consistently shown benefit in advanced renal cell carcinoma. However, only a minority of patients is eligible for this treatment due to its toxicity, and only 15% to 20% of eligible patients respond with 7% long-term complete responses. Most investigational strategies in the treatment of advanced renal cell carcinoma are evaluating immunotherapeutic approaches, but participation of patients in clinical trials evaluating new novel cytotoxic agents or antiangiogenic agents remains an important option.     

Management of extensive leukoplakia of bladder

A case of extensive leukoplakia of the bladder is presented. The occurrence is unusual and the management controversial. Cystectomy should be considered in men with extensive vesical leukoplakia.     

Transurethral resection of prostate via perineal urethrostomy. Prospective study.

A controlled, prospective clinical study was undertaken to determine the incidence and cause of urethral strictures after transurethral resection. Patients were assigned to 1 of 3 groups. Group A consisted of patients in whom it was considered preferable for various reasons to perform prostatic resection through perineal urethrostomy; therefore, these were excluded from randomization. All other patients were randomized using a sealed-envelope method into Group B who underwent resection via perineal urethrostomy and Group C who underwent resection via the entire urethra. Strictures occurred in 6 of 42 patients in Group C postoperatively while patients in Group B remained free of strictures. This difference was statistically significant (p less than 0.05). It was concluded that strictures which occur result from the use of the resectoscope through the entire urethra and not from the use of indwelling catheters, and that performing prostatic resection via perineal urethrostomy is valuable in preventing the occurrence of such strictures.     

Phase I trial of spiromustine (NSC 172112) and evaluation of toxicity and schedule in a murine model

Phase I evaluation of spiromustine was performed using an every-3-week schedule and a weekly X 3 schedule. Neurotoxicity was the dose-limiting toxicity presenting as alterations in cortical integrative functions (orientation, language, coordination), leading to a decrease in the level of consciousness. Traditional criteria for grading neurotoxicity poorly characterized these toxicities. The maximum tolerated dose was 6 mg/m2 every 3 weeks and 3 mg/m2 weekly X 3. Concurrent murine studies confirmed spiromustine as a schedule independent drug with toxicity correlating with peak plasma levels. Physostigmine had little effect on decreasing neurotoxicity in the murine model. The solvating agent used was not responsible for the neurotoxicity. Injection of spiromustine on a split-dose schedule decreased the acute neurological toxicity in mice and allowed a larger total dosage to be delivered (compared to single bolus dosage). Based on these results a split-dose schedule is suggested for future clinical trials.     

New baccalaureate graduates in care of AIDS patients: perceptions of preparedness and information accessibility

Responding to an American Association of Colleges of Nursing's national survey, deans of baccalaureate nursing schools indicated that they are in a process of building curricula and clinical experiences to prepare practitioners who are skilled and confident in the care of acquired immunodeficiency syndrome (AIDS) patients. On the average, their student nurse participants in the study reported moderate feelings of preparedness. If given a choice of patient assignment, two thirds of student respondents readily would provide direct care for a patient diagnosed with AIDS, taking appropriate precautions.     

Management of neoplasms in vesical diverticula.

Two cases of neoplasms occurring in vesical diverticula are presented, and the pertinent literature is reviewed. It is suggested that a patient with a neoplasm in a vesical diverticulum be staged by surgical exploration and be accorded the same aggressive management as any patient with an infiltrating vesical neoplasm.     

Low efficacy radiography of children

Radiographic procedures performed at a 100-bed pediatric hospital were reviewed jointly by a radiologist and the primary physician staff. The reviewers judged several procedures to be performed unnecessarily, with undue patient risk or cost. Low efficacy examinations were divided into two categories: (1) low-yield examinations with significant gonadal radiation as well as significant cost, and (2) low-yield examinations with low gonadal radiation but significant cost. A joint policy recommendation was then delivered to the house staff concerning appropriate indications for the performance of these low-yield procedures. This active review process is submitted as a model for other medical facilities that seek to reduce risk and cost to the pediatric patient.