Acute toxicity and first clinical results of intensive postinduction therapy using a modified busulfan and cyclophosphamide regimen with autologous bone marrow rescue in first remission of acute myeloid leukemia [see comments]

The combination of high-dose busulfan (16 mg/kg) and 200 mg/kg cyclophosphamide is gaining increasing significance as a preparative regimen prior to autologous, syngeneic, or allogeneic marrow transplantation. A new regimen of high-dose busulfan in conjunction with a reduced dose of 120 mg/kg cyclophosphamide has recently been described as a preparative regimen prior to allogeneic transplantation. To determine the drug-related nonhematologic toxic effects of this new regimen without confounding factors associated with allogeneic transplantation, we conducted a pilot study using this new regimen in 20 patients with acute myeloid leukemia (AML) in first remission prior to autologous unpurged marrow transplantation. All patients experienced transient non-life-threatening acute drug-related toxicity with skin reactions in 20 (100%), nausea and vomiting in 20 (100%), oral mucositis in 18 (90%), hepatic functional impairment in 17 (85%), hemorrhagic cystitis in three (15%), and generalized seizures in two (10%) of these patients, respectively. Two procedural, fatal complications resulted from infectious causes that were not directly related to the speed of hematopoietic reconstitution or the toxicity of the preparative regimen. The 3-year event-free survival estimate (55% +/- 11%) and probability of leukemic recurrence (38% +/- 11%) attained with this new regimen in recipients of autografts in first remission of AML are promising and challenge comparisons with preparative regimens employing combinations of cytotoxic agents or total body irradiation (TBI).     

Repellency of tsetse-refractory waterbuck (Kobus defassa) body odour to Glossina pallidipes (Diptera: Glossinidae): Assessment of relative contribution of different classes and individual constituents

Our earlier studies on the comparative behavioural responses of caged savanna tsetse (Glossina morsitans morsitans and Glossina pallidipes) on a preferred host (ox) and a non-host (waterbuck) suggested the presence of allomonal constituents on the latter. Follow up comparison of the compositions of odours of waterbuck with those of ox and buffalo led to the identification of a series of compounds (15) specific to waterbuck, including straight chain carboxylic acid (C₅–C₁₀), phenols (guaiacol and carvacrol), 2-alkanone homologues (C₈–C₁₂), geranylacetone and δ-octalactone. Behavioural studies in a windtunnel in the laboratory suggested that G. m. morsitans was repelled by a synthetic blend of waterbuck-specific constituents. In the present study, the effects of different blends of these compounds on catches of mixed sexes of G. pallidipes in attractant-baited NG2G traps were evaluated in the field. Each multicomponent class of constituents (acids, ketones and phenols) was found to reduce fly catches, but a 14-component blend of all these compounds was more effective (reduced catches by 79–85%), indicating that each of these classes of compounds contributes incrementally to the repellency of the waterbuck odour. However, subtractive assays showed some redundancy within each class of compounds, with some even demonstrating attractive properties. Addition of (RS)-δ-octalactone to the 14-component significantly increased the repellency of the resulting blend. A 5-component blend of compounds selected on the basis of their relative performance in subtractive assays (δ-octalactone, guaiacol, geranylacetone, hexanoic and pentanoic acid) showed substantial reduction in fly catches (84%) relative to the baited control. In separate sets of experiments involving an ox tethered in the middle of an incomplete ring of electric screens in the presence or absence of 15-component or 5-component blends, comparable levels in the reduction of fed flies (94 and 96%, respectively) were obtained with the two blends. The chemo-ecological significance and practical implication of these results are highlighted.     

Drain site evisceration of fallopian tube, another reason to discourage abdominal drain: report of a case and brief review of literature

Placement of a drain following abdominal surgery is common despite a lack of convincing evidence in the current literature to support this practice. The use of intra-abdominal drain is associated with many potential and serious complications. We report a drain site evisceration of the right fallopian tube after the removal of an intra-abdominal drain. The drain was placed in the right iliac fossa in a patient who underwent a lower segment Caesarean section (LSCS) for meconium liquor with fetal distress. The Pfannenstiel incision made for LSCS was reopened and the protruding inflamed fimbrial end of the right fallopian tube was excised. The patient made an uneventful recovery. Routine intra-abdominal prophylactic drain following an abdominal surgery including LSCS should be discouraged.     

Pulmonary embolectomy with use of pediatric bronchoscope for the detection of residual emboli: an innovative surgical technique

Pulmonary embolectomy in the treatment of massive pulmonary embolus has been in doubt since the introduction of thrombolytic therapy. Recent indications for surgical intervention are- contraindication to thrombolysis, failed medical treatment and severe Right Ventricular (RV) dysfunction. A 54-year male came to us with complaints of palpitation, tachypnea and repeated syncope . Transthoracic echocardiography and Computed Tomography pulmonary angiogram demonstrated- Biatrial mass with right atrial mass extending into right ventricle and main pulmonary artery. Pulmonary embolectomy was performed. Residual emboli of bilateral pulmonary arteries were detected with a fiberoptic pediatric bronchoscope and removed. Bronchoscopic evaluation appears to be safe and useful for direct visual detection of emboli.     

Orthopaedic surgeon＇s nightmare： iatrogenic fractures of talus and medial malleolus following tibial nailing

Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures.The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily...     

Psychological distress in men with prostate cancer receiving adjuvant androgen-deprivation therapy

ObjectivesTo compare the occurrence of depression, anxiety, self body image perception, sleep disturbances, and diminished quality of life in prostate cancer patients undergoing adjuvant androgen-deprivation therapy (ADT) as opposed to patients in follow-up alone.Methods and materialsHospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Restless Legs Syndrome Study Group essential diagnostic criteria, Body Image Scale and Functional Assessment of Cancer Therapy Prostate were administered to consecutive prostate cancer patients who underwent radical prostatectomy or radiation therapy and are presently either under adjuvant ADT or included in a follow-up program.ResultsOf the 103 patients enrolled, 49 (47.6%) were receiving adjuvant ADT and 54 (52.4%) were not. Compared with the controls, the patients undergoing ADT showed higher levels of depression (P = 0.002), worse self body image perception (P = 0.001), worse quality of life (P = 0.0001) and worse sleep quality (P = 0.04). ADT was significantly associated with depression at multivariate analysis after adjustment for age, stage, Gleason score, as well as demographic and social variables (P = 0.001). Depression scores showed a strong inverse correlation with quality of life scores (P < 0.01).ConclusionsAdjuvant ADT is associated with depression, worse quality of life, and altered self body image in prostate cancer patients.