Multiple primary malignant melanomas of the oral cavity

Malignant melanoma comprises 2% of all the cancers (Waldron, 1970) and the lesion is very rare in the oral cavity (Jackson and Simpson, 1975), and constitutes only 7% of the total head and neck melanomas. Chaudhari et al (1958) were able to trace out 105 cases of oral melanoma in their exhaustive survey of the literature, but they did not mention the occurrence of multiple lesions in the oral cavity. In 1975, Liversedge collected 65 cases from the literature after Chaudhuri’s classic review, who again did not report the incidence of multiple lesions. These reviews show that primary malignant melanoma at multiple sites in the oral cavity is extremely rare. The multiplicity of the lesion and unusual presentation of an oral melanoma make the present case clinically interesting.     

PAEDIATRIC DRUG THERAPY I—MEDICATION USE IN HOSPITALIZED PATIENTS

Medication use was studied prospectively in 97 hospitalized paediatric patients at a children's hospital. An average of 4.8 scheduled drugs were used per patient. Antibiotics and anticonvulsants were the two most commonly used drug classes. Penicillins, anticonvulsants, aminoglycosides, cephalosporins, and theophylline were most frequently prescribed in our patients. A wide range of doses was used for drugs with narrow therapeutic indices. Most potential drug-drug interactions involved an anticonvulsant with another drug. These data may assist in targeting drug utilization review studies and educational programs justifiably to retain existing positions or create new opportunities within the departments of pharmacy to optimize patient care.     

Ketamine for conscious sedation in pediatric emergency care

The literature concerning the efficacy and safety of ketamine for conscious sedation during procedures in pediatric emergency departments was reviewed. Data were obtained from the Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures developed by the American Academy of Pediatrics Committee on Drugs, and from a MEDLINE search (January 1966-July 2004). Search terms were conscious sedation, ketamine, and emergency department; articles relevant to pediatric age group were selected. Clinical end points were efficacy and adverse effects associated with ketamine. Ketamine was effective for conscious sedation in 89-100% of patients in various studies using intravenous, intramuscular, or oral routes of administration. The efficacy of ketamine was similar to or greater than that of other drugs, such as midazolam and the combination of meperidine, promethazine, and chlorpromazine. The main adverse effects of ketamine were emesis, recovery agitation, and emergence phenomena. Ketamine appears to be an effective and well-tolerated agent for conscious sedation in pediatric patients. Overall physician and parent satisfaction with the administration of this agent for conscious sedation was high.     

Personal space smoking restrictions among African Americans

OBJECTIVES: This paper investigates the association between implementing a personal space smoking restriction for the home or automobile, and various sociodemographic, social, behavioral, and attitudinal variables. METHODS: Approximately 1000 African-American adults (aged >18 years) residing in non-institutionalized settings were randomly selected using a cross-sectional stratified cluster sample of ten U.S. congressional districts represented by African Americans. RESULTS: A 62.0% and 70.4% ban was found, respectively, on smoking in homes and cars. Multivariate analysis revealed that region, marital status, number of friends who smoked, beliefs about environmental tobacco smoke (ETS), and smoking status predicted home smoking bans, while age, number of children in household, number of friends who smoked, and beliefs about ETS and smoking status predicted car smoking bans. CONCLUSIONS: Results suggest that a substantial segment of African Americans have accepted and translated public policy concerns about ETS into practice and reveal other variables that could be targeted in future interventions to increase implementation of personal space smoking restrictions.     

Risk factors for mortality in patients with upper extremity and internal jugular deep venous thrombosis

OBJECTIVE: To elucidate the natural history of upper extremity deep venous thrombosis (UEDVT), we examined factors that may contribute to the high mortality associated with UEDVT. METHODS: Five hundred forty-six patients were diagnosed with acute internal jugular/subclavian/axillary deep venous thrombosis from January 1992 to June 2003 by duplex scanning at our institution. There were 329 women (60%). The mean age +/- SD was 68 +/- 17 years (range, 1-101 years). Risk factors for UEDVT were the presence of a central venous catheter or pacemaker in 327 patients (60%) and a history of malignancy in 119 patients (22%). Risk factors for mortality within 2 months of the diagnosis of UEDVT that were analyzed included age, sex, presence of a central venous catheter or pacemaker, history of malignancy, location of UEDVT, concomitant lower extremity deep venous thrombosis, systemic anticoagulation, placement of a superior vena caval filter, and pulmonary embolism. RESULTS: The overall mortality rate at 2 months was 29.6%. The number of patients diagnosed with pulmonary embolism by positive ventilation/perfusion scan or computed tomographic scan was 26 (5%). The presence of a central venous catheter or pacemaker ( P < .001), concomitant lower extremity deep venous thrombosis ( P = .04), not undergoing systemic anticoagulation ( P = .002), and the placement of a superior vena caval filter ( P = .02) were associated with mortality within 2 months of the diagnosis of UEDVT by univariate analysis. Pulmonary embolism ( P = .42), sex ( P = .65), and a history of malignancy ( P = .96) were not. CONCLUSIONS: These data suggest that the high associated mortality of UEDVT may be due to the underlying characteristics of the patients' disease process and may not be a direct consequence of the UEDVT itself.     

Population pharmacokinetics of amlodipine in hypertensive children and adolescents

A population pharmacokinetic study was conducted in 74 hypertensive children (mean age 10.4 +/- 4.4 years [mean +/- SD]) receiving amlodipine (mean dose 0.17 +/- 0.13 mg/kg/d) chronically. Multiple blood samples were obtained from each subject to characterize amlodipine pharmacokinetics. Plasma amlodipine concentrations were determined by liquid chromatography/mass spectrophotometry with multiple-reaction monitoring detection. Population pharmacokinetic analysis was performed using NONMEM. Amlodipine concentrations were similar in subjects dosed either once or twice daily. Amlodipine pharmacokinetics were well described by a 1-compartment model with first-order absorption and elimination. For a subject at the population median weight (45 kg), predicted apparent clearances (CL/F) were 23.7 L/h for males and 17.6 L/h for females, and the apparent volume of distribution (V/F) was 25.1 L/kg. Dosing frequency did not appear to affect amlodipine concentrations in children. Weight-adjusted CL/F and V/F of amlodipine in younger children were significantly greater than in older children, suggesting a need for higher doses when treating young children with amlodipine.     

The impact of CNS-directed treatment on quality of life in childhood cancer survivors

Purpose

Pediatric cancer survivors may have lower quality of life (QoL), but most research has assessed outcomes either in treatment or long-term survivorship. We focused on early survivorship (i.e., 3 and 5 years post-diagnosis), examining the impact of CNS-directed treatment on child QoL, as well as sex and age at diagnosis as potential moderators.

Methods

Families of children with cancer (ages 5–17) were recruited at diagnosis or relapse (N?=?336). Survivors completed the PedsQL at 3 (n?=?96) and 5 years (n?=?108), along with mothers (101 and 105, respectively) and fathers (45 and 53, respectively). The impact of CNS treatment, sex, and age at diagnosis on child QoL was examined over both time since diagnosis and time since last treatment using mixed model analyses.

Results

Parent-report of the child’s total QoL was in the normative range and stable between 3 and 5 years when examining time since diagnosis, while child reported QoL improved over time (p?=?0.04). In terms of time since last treatment, mother and child both reported the child’s QoL improved over time (p?=?0.0002 and p?=?0.0006, respectively). Based on parent-report, males with CNS-directed treatment had lower total QoL than females and males who did not receive CNS-directed treatment. Age at diagnosis did not moderate the impact of treatment type on total QoL.

Conclusions

Quality of life (QoL) in early survivorship may be low among males who received CNS-directed treatment. However, this was only evident on parent-report. Interventions to improve child QoL should focus on male survivors who received CNS-directed treatment, as well as females regardless of treatment type.