Evaluating the Cost-Effectiveness of Hydrogel Rectal Spacer in Prostate Cancer Radiation Therapy

Purpose

A hydrogel rectal spacer (HRS) is a medical device that is approved by the U.S. Food and Drug Administration to increase the separation between the prostate and rectum. We conducted a cost-effectiveness analysis of HRS use for reduction in radiation therapy (RT) toxicities in patients with prostate cancer (PC) undergoing external beam RT (EBRT).

Bronchial adenoma: a review of 51 patients

The cases of 51 patients with bronchial adenomas were reviewed. There were 43 bronchial carcinoids, 5 adenoid cystic carcinomas, 2 mixed tumors, and 1 mucoepidermoid carcinoma. The carcinoid group was divided into typical (31, 72%) and atypical (12, 28%) subgroups. Nine carcinoids (20%) were categorized as metastasizing adenomas; in this group, 7 lesions were atypical and 2 were typical. Thirty-two lobectomies, 7 bilobectomies, 8 pneumonectomies, 2 sleeve resections, and 2 tracheal resections were performed. Ten-year survival was 88% for patients with typical carcinoids and 59% for those with atypical carcinoids. In the group with adenoid cystic carcinoma, 1 patient died postoperatively, 1 had recurrence of the tumor, 2 were alive and free from disease 16 and 23 years later, and 1 died of heart disease at 11 years. The patient with mucoepidermoid carcinoma was alive without recurrence 15 years after operation. In conclusion, bronchial adenomas of the carcinoid type are potentially malignant. Their prognosis depends on the histology of the tumor, and on the presence of metastasis to the regional lymph nodes and distant organs.     

Hypercalcemia in coccidioidomycosis

Two patients with disseminated coccidioidomycosis and hypercalcemia are presented. One patient studied showed normal levels of 25-hydroxyvitamin D with depressed levels of 1 alpha,25-dihydroxyvitamin D. The serum calcitonin level was appropriate for the level of serum calcium, and the serum parathyroid hormone level was suppressed with elevation of the nephrogenous cAMP level. Intestinal absorption of calcium was elevated at 63 percent. Hypercalcemia and hypercalciuria persisted despite a 300 mg calcium diet. An osteotropic substance similar to the humoral hypercalcemia of malignancy is postulated.     

Empiric antibiotic therapy for suspected infection in granulocytopenic cancer patients: a comparison between the combination of moxalactam plus amikacin and ticarcillin plus amikacin

Moxalactam is a new cephalosporin with a broad spectrum of activity which includes Pseudomonas aeruginosa in addition to Klebsiella species Escherichia coli, and Staphylococcus aureus. Moxalactam was combined with amikacin (M + A) compared to ticarcillin plus amikacin (T + A) in a prospective, randomized double-blind trial of empiric therapy for febrile episodes among granulocytopenic cancer patients. One hundred and ninety-one epidoses were evaluated; T + A, 93 episodes and M + A, 98 episodes. Median granulocyte count of initiation of therapy was less than 100/microliters. Overall response rates were good. In the T + A group, 21 of 29 (72 percent) microbiologically documented infections, including seven of 14 (50 percent) bacteremias, and 24 of 27 (89 percent) clinically documented infections improved. In the M + A group, 20 of 28 (71 percent) microbiologically documented infections, including 11 of 18 (61 percent) bacteremias, and 25 of 25 (96 percent) clinically documented infections resolved. Adverse effects were minimal and equivalent in both groups. Hypokalemia (decrease in serum potassium of greater than 11 mEq/liter from baseline) occurred in 14 of the 93 episodes in the T + A group and in 10 of the 98 episodes in the M + A group with decline in mean serum potassium level of 0.5 and 0.4 mEq/liter respectively. Nephrotoxicity (increase in serum creatinine greater than 0.04 mg/dl) occurred in only one patient in the T + A group and in two patients in the M + A group. Moxalactam plus amikacin has a broader in vitro spectrum, is as effective, and is no more toxic than ticarcillin plus amikacin as empiric therapy for febrile granulocytopenic cancer patients.     

Hypersensitivity reactions associated with botulinal antitoxin

During an 11-year period (1967 through 1977) CDC monitored reactions of hypersensitivity to botulinal antitoxin of equine origin. Of 268 persons given botulinal antitoxin, 24 (9.0 percent) had nonfatal acute (5.3 percent) or delayed (3.7 percent) hypersensitivity reactions to a skin test or therapeutic dose. The over-all rate of reaction did not differ with the age or sex of the recipient or with the type (AB or ABE) of antitoxin administered. Serum sickness occurred significantly more frequently in persons who received more than 40 ml of serum antitoxin (p < 0.02). The over-all reaction rate was higher than that associated with other equine serum products and probably cannot be substantially reduced. This risk, however, would be substantially reduced if not eliminated by using botulinal immune globulin obtained from hyperimmunized human donors.     

Lessons learned from surveillance cultures in patients with acute nonlymphocytic leukemia. Usefulness for epidemiologic, preventive and therapeutic research

In 135 consecutive patients with acute nonlymphocytic leukemia (ANLL), who were admitted to the Baltimore Cancer Research Program (BCRP) for their first induction chemotherapy shortly after initial diagnosis and who had received no recent antibiotic therapy, surveillance cultures were obtained of specimens from the nose, gingiva, axillas and rectum twice during the first week of hospitalization and then twice weekly thereafter. All organisms which were morphologically distinct on routine culture media were fully identified, and Pseudomonas aeruginosa was serotyped. Baseline surveillance cultures indicated that there was a higher than expected incidence of colonization with gram-negative bacilli in the nose, gingiva and axillas along with the expected colonization by gram-negative bacilli in the rectum. Among these colonizing gram-negative bacilli, Ps. aeruginosa and, to a lesser extent, Klebsiella pneumoniae, Escherichia coli and Proteus mirabilis were most likely to be associated with a subsequent bacteremia during periods of mucosal damage and granulocytopenia. Follow-up surveillance cultures indicated that new organisms were acquired at a rate of 0.5 organism per patient per week with many of these acquired organisms being gram-negative bacilli of the type likely to cause infection in these patients. Compared to similar surveillance cultures obtained in a previous group of patients not subjected to vigorous infection prevention techniques, the rate of new organism acquisition was less and the development of infection subsequent to colonization was reduced. Surveillance cultures also indicated those patients at highest risk of having yeast infections such as those caused by Torulopsis glabrata or Candida species. Results of nasal surveillance cultures detected a subpopulation of patients at greatest risk for colonization and subsequent infection with Aspergillus flavus. Surveillance cultures have been utilized for the design of systemic therapeutic antibiotic protocols and for the monitoring of oral nonabsorbable antimicrobial regimens for alimentary canal microbial suppression. Despite the usefulness of surveillance cultures for research in the epidemiology, prevention and treatment of infection in patients with acute leukemia, their routine use in a nonresearch setting would not be advised.