Same-day pegfilgrastim and chemotherapy

Pegylated filgrastim is a new formulation of a neutrophil colony-stimulating factor that has a long circulating half-life, permitting a single dose of filgrastim per cycle of chemotherapy. The pegylated filgrastim is recommended to be administered not less than 24 hours following chemotherapy and not less than 14 days prior to chemotherapy based on the theoretic concern that marrow suppression would be accentuated. This schedule of usage for pegylated filgrastim may compromise its application for weekly chemotherapy schedules. We have treated 80 patients with pegylated filgrastim administered on the same day as chemotherapy; the latter delivered on a weekly schedule. Twenty-four patients had non-small cell lung cancer (NSCLC) and were treated with one of two weekly chemotherapy regimens alternating triplets [AT] taxane, cisplatin, irinotecan alternating with gemcitabine, cisplatin, vinorelbine or alternating doublets [AD] taxane, cisplatin alternating with gemcitabine, vinorelbine; four of these patients also received weekly taxane and carboplatin with concomitant thoracic radiation. A consistent pattern emerged in which leukocytosis was observed at Day 8; median WBC 15,800/uL (range 7,200 to 35,000/uL); at Day 14, the median WBC was 9,300/uL (range 1,100 to 17,400/uL). Pegylated filgrastim can be given safely simultaneously with chemotherapy in weekly chemotherapy schedules. The pegfilgrastim can be administered on an every two week (fortnightly) schedule to maintain a weekly chemotherapy schedule.     

Bioassessment of an Appalachian Headwater Stream Influenced by an Abandoned Arsenic Mine

Recent debate concerning the modification of safe drinking water standards for arsenic (As) has led to increased awareness of the risks As poses to both humans and the environment. However, few studies have examined the effects of As on the diversity and composition of aquatic assemblages in streams. Benthic macroinvertebrate surveys, chemical analysis of water column and sediment, and laboratory toxicity tests were conducted to assess effects of an abandoned As mine on a headwater stream, and to determine the primary component of toxicity. The average 48-hr LC50 value for Daphnia magna was 4316 μg As/L, and the average 96-hr LC50 value for Lepidostoma spp. was 2138 μg As/L. Reproduction was significantly reduced for D. magna at concentrations ≥312 μg As/L in water column laboratory bioassays, and for treatments in bioassays with sediments containing elevated As (≥2630 mg/kg). These results support the findings of the in-stream benthic macroinvertebrate survey as the density and percent Ephemeroptera + Plecoptera, + Trichoptera (EPT) were substantially lower at sites downstream of the mine compared to upstream reference sites. Results of bioassays comparing the toxicity of As-contaminated site water and upstream reference water spiked with As salts suggest that As is the primary component of toxicity impacting the stream. Measured As concentrations at downstream sites were above the recommended Criterion Maximum Concentration of 340 μg As/L and Criterion Continuous Concentration of 150 μg As/L for protection of aquatic life published by the United States Environmental Protection Agency. At the study site, elevated As concentrations likely prevent recruitment of benthic macroinvertebrates and recovery of the perturbed headwater stream.     

Incidence and evolution of inferior alveolar nerve lesions following lower third molar extraction

OBJECTIVES: To calculate the incidence of inferior alveolar nerve (IAN) damage due to lower third molar extraction and to describe the evolution of IAN sensitivity and the prognosis of IAN damage based on preoperative data. STUDY DESIGN: A retrospective study of 4995 lower third molar extractions in 3513 outpatients. RESULTS: Fifty-five extractions (1.1%) resulted in IAN impairment. Cox regression analysis showed age to be a risk factor for the persistence of IAN injury due to lower third molar extraction. The sensation recovery rate was higher in the first 3 months. Fifty percent of the patients showed full recovery after 6 months. CONCLUSIONS: Most cases of IAN impairment following lower third molar extraction recover within 6 months, though in some cases recovery takes more than 1 year. Older patients are at an increased risk of incomplete recovery of chin and lip sensibility after third molar extraction.     

Pyostomatitis vegetans. Report of two cases and review of the literature

Pyostomatitis vegetans (PV) is a rare benign chronic mucocutaneous pustular disorder of unknown etiology, though it is usually associated with chronic inflammatory disease of the bowel-particularly ulcerative colitis. At the oral level PV manifests as an exophytic lesion with an erythematous perimeter and a creamy-yellow surface presenting a friable covering membrane which easily disintegrates, giving rise to the development of small ulcers or superficial erosions. The histology shows epithelial acanthosis and superficial ulceration. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. The present study describes 2 cases of PV associated with ulcerative colitis. The differential diagnosis should be established with Neumann type pemphigus vegetans, since in both cases the lesions are clinically similar and the histology reveals an important eosinophil response, acanthosis, and the formation of intraepithelial miliary microabscesses. The treatment of PV focuses on control of the disease. In the event the orofacial lesions persist, topical oral drugs such as corticoids, with additional antibiotherapy, multivitamin complexes, and nutritional supplements, can be provided.     

The diagnostic possibilities of positron emission tomography (PET): applications in oral and maxillofacial buccal oncology

The principles of positron emission tomography (PET), recently introduced as a diagnostic procedure into the health sciences, are described. The principle clinical applications apply to a particular group of specialties: cardiology, neurology, psychiatry, and above all oncology. Positron emission tomography is a non-invasive diagnostic imaging technique with clinical applications. It is an excellent tool for the study of the stage and possible malignancy of tumors of head and neck, the detection of otherwise clinically indeterminate metastases and lymphadenopathies, and likewise for the diagnosis of relapses. The only tracer with any practical clinical application is fluor-desoxyglucosa-F18 (FDG). PET detects the intense accumulation of FDG produced in malignant tumors due to the increased glycolytic rate of the neoplastic cells. With the introduction of hybrid systems that combine computerized tomography or magnetic resonance with positron emission tomography, important advances are being made in the diagnosis and follow-up of oncologic pathology of head and neck.     

Mechanic's hands: a characteristic cutaneous sign of antisynthetase syndrome

"Mechanic's hands" are a characteristic cutaneous sign of idiopathic inflammatory myositis. We describe the case of a 61-year-old male patient who was diagnosed with idiopathic polymyositis and non-specific interstitial lung disease in 1999, and three years later developed scaly, fissured hyperkeratotic lesions on the lateral and palmar surfaces of the first three fingers of both hands, with little pruritus. The presence of the anti-Jo-1 antisynthetase antibody in the patient's serum, the finding of skin lesions characteristic of "mechanic's hands" and the patient's other systemic clinical manifestations made it possible to establish the diagnosis of "antisynthetase syndrome."     

Immunization Needs of Chronic Liver Disease Patients Seen in Primary Care Versus Specialist Settings

Chronic liver disease patients may benefit from certain vaccines, but their immunization coverage levels have not been widely studied. We examined the serologic and vaccination status of 693 chronic liver disease patients from 37 primary care and specialist centers. Patients in primary care had more often received influenza (47 versus 32%; P < .001) and pneumococcal (39 versus 19%; P < .001) vaccines. Among patients without documented prior exposure, those seeing specialists had more often completed hepatitis A (28 versus 5%; P < .001) and hepatitis B (29 versus 14%; P < .001) vaccination. Coverage was higher in centers with a policy of vaccinating on-site, among non-Hispanic whites, and among patients with hepatitis C and cirrhosis. In summary, most patients were unprotected against one or more vaccine preventable diseases. The higher coverage rates evident in centers vaccinating on-site suggests a breakdown may occur when patients are referred to alternative vaccination venues.     

Development of a fluorescent high throughput assay for tau aggregation

A high throughput assay for measuring tau aggregation using fluorescent resonance energy transfer (FRET) is described. Full-length recombinant tau labeled with Cy3 or Cy5 dye is used as ligand, and the induction of aggregation is accomplished by the addition of arachidonic acid. In the presence of this fatty acid, tau aggregation is measured by FRET in a 384-well format. The nature of tau aggregation is further characterized by competition with unlabeled tau and cross-linking experiments. It is concluded that the FRET observed under the experimental condition is due to the accumulation of tau dimers and tetramers. A model for tau aggregation is presented. The performance of this assay in a high throughput format is demonstrated and can be used to identify inhibitors of tau aggregation.