Paclitaxel activity for the treatment of non-Hodgkin's lymphoma: final report of a phase II trial

In order to determine the activity of paclitaxel in patients with relapsed or refractory non-Hodgkin's lymphoma (NHL), we conducted a phase II clinical trial in which eligible patients received paclitaxel 200 mg/m² intravenously over 3 h. Treatment was repeated every 3 weeks. Patients achieving complete or partial responses after two courses of paclitaxel continued to receive therapy for a maximum of eight courses, otherwise they were removed from the study. Of 96 evaluable patients, 45 (47%) had primary refractory disease, and 51 (53%) had relapsed lymphoma. The median number of prior treatment regimens was two (range one to 10 regimens). 45 patients had low-grade, 44 had intermediate-grade, and seven had mantle cell lymphoma. 24/96 patients responded (10 complete and 14 partial remissions) for an overall response rate of 25% (95% CI 17–35%). Patients with relapsed lymphoma had a higher response rate than those with primary refractory disease (19/51=37% v 5/45 =11%; P  < 0.01), and patients with relapsed intermediate-grade lymphoma had a higher response than those with relapsed low-grade lymphoma (9/18=50% v 10/31 = 32%; P  = 0.22). The treatment was very well tolerated with the most common side-effects being alopecia (100%), peripheral neuropathy (35% of ≥ grade II), and arthralgia/myalgia (25% of ≥ grade II). After the first course of paclitaxel, grade III/IV thrombocytopenia and neutropenia were observed in 21% and 23% of the patients respectively. 23 episodes of neutropenic fever developed after 250 courses of paclitaxel therapy (8%). We conclude that paclitaxel, at this dose and schedule, is an active new drug for the treatment of non-Hodgkin's lymphoma. The activity of paclitaxel combination programmes are currently under investigation.     

Cost-effectiveness of ambulatory surgery in Cali, Colombia

To compare the cost and effectiveness of a system of simplifiedambulatory surgery against traditional in-patient surgery, westudied a surgical procedure commonly performed in both settings- non-recurrent elective inguinal herniorrhaphy. We comparedthe 17 operations performed in an ‘intermediate healthunit’ (IHU) or outpatient hospital in Cali, against the15 performed in a traditional secondary hospital from mid-Januarythrough mid-April, 1989. Pre-surgical characteristics of thepatients were similar. After the operation, the IHU patientshad few complications, were more satisfied, and resumed theirusual activities sooner than the hospital patients (34 versus52 days, respectively). The average cost per procedure was US$39.12in the IHU as compared to US$148.76 in the hospital-a four-folddifference. Intermediate health units seem to offer importantadvantages for uncomplicated surgery in both cost and outcome.     

Angiomyofibroblastoma-like tumors (cellular angiofibroma)

Angiomyofibroblastoma-like tumor (cellular angiofibroma) is a rare, circumscribed, slow-growing mesenchymal tumor that occurs predominantly in the vulva, perineum, and pelvis of women. We report two cases of this tumor in men arising as paratesticular masses of the scrotum, summarize the history of this tumor, and discuss why efforts should be made to differentiate it from aggressive angiomyxoma. Recommended treatment is complete surgical excision with long-term follow up exams, as local recurrence may occur many years after resection of the lesion.     

Reconstructive Techniques for Rheumatic Aortic Valve Disease

Aortic valve reconstruction is still at an early stage of development. We report techniques that can be applied in the repair of rheumatic aortic valve disease in patients with concomitant mitral valve disease. The techniques described are: (1) commissurotomy, (2) cusp free edge unfolding, (3) annuloplasty, and (4) supraaortic crest enlargement. Fifty patients operated on between January 1974 and January 1986 with a hospital mortality of 6% were followed for a mean period of 7.7 years. Reoperation due to failure of mitral surgery was required in twelve patients, tricuspid regurgitation in two, and significant aortic regurgitation in four. These techniques, although applicable to a limited number of patients, have enabled us to avoid the problems of aortic valve replacement in many patients.     

DERMATOFIBROSARCOMA PROTUBERANS

Background. Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive soft tissue sarcoma in which recurrences are common. It usually affects middle-aged individuals with the most common location being the trunk. Sex distribution varies among published series. Mohs surgery is the treatment of choice. Immunostaining for CD34 facilitates the diagnosis of DFSP and aids in indicating the surgical margins of the tumor; however, the sensitivity of this marker is variable. Materials and Methods. This is a retrospective review of 16 cases of DFSP treated with Mohs surgery at Duke University Medical Center between 1981 and 1994. Clinical and histologic features are analyzed. Immunohistochemical stains for CD34 were performed in one case. Results. Twelve of the 16 patients were women with four younger than 20 years. The most common location was the trunk. No recurrences following Mohs surgery have been documented. The average number of stages during Mohs surgery was 3.3. Surgical wounds were repaired by complex layered closure in 11 cases. Stains for CD34 were negative on the initial biopsy, but were positive on frozen sections. Conclusions. Both sexes and all age groups are affected by DFSP. Mohs surgery is the treatment of choice and offers a significant improvement in cure rates with the cosmetic advantage of smaller postoperative wounds. Immunostains for CD34 appear to be an important adjunct to facilitate tumor removal, but the variable expression of CD34 antigen by DFSP tumors can lead to variable staining patterns.     

EFFECTS OF SOFTFNFD AND UNSOFTFNED FABRICS ON INFANT SKIN

Background. The effects of softened and unsoftened fabrics on the skin of infants of 1–12 months of age were evaluated under real life conditions of skin contact with fabrics. Methods. During 4 weeks, 24 infants wore cotton fabrics washed with a granular detergent on one side of their lower back, and on the other side, cotton fabrics washed with the same detergent and softened with a liquid fabric softener. Skin effects were evaluated by visual grading for redness, dryness, and smoothness, by skin stripping and measuring of Chroma C* (squamometry), by measurements of elasticity and bioelastic ratio, and by instrumental measurements of skin parameters (pH, capacitance, transepidermal water loss (TEWL), and erythema by colorimetry). Results. No deleterious effects were observed in any infant. A decrease in squamometry (Chroma C*) and an increase in capacitance were detected in skin exposed to softened fabrics relative to unsoftened ones. Values of pH tended to be higher in the sites treated with softened versus unsoftened fabrics (pH 6.06 and 5.87, respectively, at end of study). All other parameters showed no significant differences in the two treatment groups. Conclusions. Neither softened nor unsoftened fabrics produced any adverse effects on the skin of infants after continuous wearing during 29 days. A slight beneficial effect on the infants' skin was observed with softened relative to unsoftened fabrics. Methods measuring the structure and function of the stratum corneum were more sensitive discriminators of the effects of fabrics on the skin than traditional methods of visual clinical evaluation.     

PANCURONIUM BROMIDE: AN INDIRECT SYMPATHOMIMETIC AGENT

In the dog, pancuronium 0.2 mg/kg increased left ventricularsystolic pressure and systemic arterial pressure, but did notchange central venous pressure. Repeated doses produced diminishingresponses and eventually no change in arterial pressure. Aftertachyphylaxis was established, a pressor response to pancuroniumcould be induced by an i.v. infusion of noradrenaline. Desipramine,a noradrenaline blocking agent, prevented the restoration ofthe pressor effect of noradrenaline. Guanethidine and reserpineabolished the restoration of the pressor response to pancuroniumby noradrenaline. These findings are consistent with the hypothesisthat pancuronium acts on the postganglionic nerve endings andcauses release of noradrenaline     

Idiopathic guttate hypomelanosis

Idiopathic guttate hypomelanosis is usually associated with guttate hyperkeratosis, xerosis, and lentiginosis not related to the patient's age. Histologically, hypopigmented macules show remarkably decreased melanin, decreased DOPA-oxidase activity and a decreased number of melanosomes in the melanocytes with predominance of Stages I and II and small sizes. The epidermis is always atrophic. When scales are removed by scraping, hyperkeratotic lesions show, clinically and histologically, variable degrees of hypomelanosis; thus suggesting a relationship with the hypopigmented macules. These data suggest that idiopathic guttate hypomelanosis is the result of an early aging of the skin.     

Cryoplasty for the Treatment of Coronary Bifurcation Stenoses Following Main Vessel Stenting

Objectives

This retrospective study sought to assess the safety and clinical efficacy of cryoplasty for treatment of side‐branch stenoses following main vessel stenting in coronary bifurcation lesions.

Background

Cryoplasty prevents restenosis by reducing smooth muscle proliferation and extracellular matrix synthesis. Clinical effectiveness has been demonstrated in the peripheral circulation. Treatment of coronary bifurcation lesions remains a challenge. We used a novel strategy of main vessel stenting combined with side‐branch cryoplasty to treat high‐grade stenoses following main vessel stenting.

Methods

Eighteen patients with bifurcation lesions had significant plaque shift into a side branch after main vessel intervention. Drug‐eluting stents were placed in the main vessel and cryoplasty was performed on the side‐branch vessel. Quantitative coronary analysis was performed on all side‐branch vessels both pre– and post–main vessel stenting. All patients had clinical follow‐up 3 months or more after cryoplasty including either nuclear stress testing or diagnostic coronary angiogram.

Results

Mean percent stenosis decreased from 80.6% post main vessel stenting to 24.8% following cryoplasty (P < 0.0001). Of the 17 patients who had pre‐cryoplasty nuclear stress testing 1 patient had ischemia identified in the distribution of the treated vessel at follow‐up. Five patients had follow up angiography. One patient had restenosis, the other 2 were unchanged. There was a low incidence of MACE.

Conclusions

In this first report of its use in the coronary circulation, cryoplasty for bifurcation side‐branch disease was safe and associated with a low rate of clinical recurrence in carefully selected patients. (J Interven Cardiol 2013;26:239–244)