1/49. Whole body hyperthermia: a secure procedure for patients with various malignancies?OBJECTIVE: To establish the safety of systemic Cancer Multistep Therapy (sCMT) including whole body hyperthermia, by means of hemodynamic, laboratory and clinical investigations. DESIGN: Prospective study. SETTING: University clinic. patients: 12 patients with various cancers (with sCMT), a second group of 20 patients with colorectal carcinoma treated with chemotherapy (without sCMT). INTERVENTIONS: 25 treatments with sCMT for 60 min at 41.8 degrees C (including chemotherapy) were given in addition to induced hyperoxemia and hyperglycemia under general anesthesia. MEASUREMENTS AND RESULTS: Invasive monitoring of systemic and pulmonary hemodynamics as well as pulmonary gas exchange was used at 37 degrees C, 40 degrees C, 41.8 degrees C and 39 degrees C. In addition, laboratory parameters were measured before and within 4 days of therapy. At 41.8 degrees C, invasive monitoring showed characteristic signs of hyperdynamic circulation. In addition, right-to-left shunt, oxygen consumption, oxygen delivery and lactate levels were significantly different from pretreatment values. At the end of therapy, lactate levels and the extravascular lung water index increased, whereas all other parameters showed a clear tendency to return to initial values. Within the first day after sCMT, we measured a slight but significant reversible increase in serum creatinine compared to pretreatment values, but found no significant alterations of other chemical parameters. Between the sCMT group and controls, there was only a temporary significant difference in aspartate aminotransferase levels 2 days after therapy. CONCLUSIONS: sCMT, including whole body hyperthermia, accompanied by suitable anesthesiological management and monitoring, does not lead to any serious or sustained organ dysfunction and can therefore be regarded as a safe therapy.- - - - - - - - - - ranking = 1keywords = hyperthermia (Clic here for more details about this article) |
2/49. Phase I evaluation of ISIS 3521, an antisense oligodeoxynucleotide to protein kinase c-alpha, in patients with advanced cancer.PURPOSE: To determine the maximum-tolerated dose (MTD) and pharmacologic behavior of ISIS 3521 (ISI 641A), an antisense phosphorothioate oligonucleotide to protein kinase c-alpha. patients AND methods: Thirty-six patients with advanced cancer received 99 cycles of ISIS 3521 (0.15 to 6.0 mg/kg/d) as a 2-hour intravenous infusion administered three times per week for 3 consecutive weeks and repeated every 4 weeks. plasma and urine sampling was performed during the first week of treatment and subjected to capillary gel electrophoresis to determine full-length antisense oligonucleotide in addition to chain-shortened metabolites. RESULTS: Drug-related toxicities included mild to moderate nausea, vomiting, fever, chills, and fatigue. Hematologic toxicity was limited to thrombocytopenia (grade 1, four patients; grade 2, one patient; grade 3, one patient). There was no relationship between dose, maximum concentration of the drug (C(max)), or area under the plasma concentration versus time curve (AUC) and coagulation times or complement levels. Dose escalation was discontinued because of the attainment of peak plasma concentrations, which approached that associated with complement activation in primates. Two patients with non-Hodgkin's lymphoma who completed 17 and nine cycles of therapy achieved complete responses. The pharmacokinetic profile of ISIS 3521 revealed a short elimination half-life (18 to 92 minutes), as well as a dose-dependent decrease in clearance and dose-dependent increases in C(max), AUC, and elimination half-life. CONCLUSION: No dose-limiting toxicity of ISIS 3521 was identified, and clinical activity was observed. A short elimination half-life was identified, which suggests that alternate schedules with prolonged administration may be necessary for further clinical development.- - - - - - - - - - ranking = 0.00016339192453045keywords = fever (Clic here for more details about this article) |
3/49. immunotherapy of cancer patients with bacillus Calmette-Guerin: summary of four years of experience in japan.Active immunotherapy with living BCG was conducted on 98 patients with various types of cancer. The candidates for this therapy were patients with residual or inoperable cancer of the colorectum, liver, breast, biliary tract, lung, and other organs with a follow-up of 4-58 months. Eleven of the 98 (11%) were able to survive for as long as 37-58 months (mean survival time 42.5 months) because of this treatment and are still living. Another 11 patients are also alive more than 24 months after starting treatment. Thirty-seven patients, however, succumbed within 12 months despite BCG immunotherapy. On the other hand, 37 patients in the control group, who shared the same clinical status and did not receive BCG therapy during this period, underwent unhappy courses for 2-12 months (mean survival time 8.7 months). The pretreatment immunoresponsiveness of these 98 patients was suppressed, as measured by the following immunologic parameters: T-cell subpopulation in the peripheral blood, stimulation index of PHA, and skin tests to DNCB, KLH, PPD, and PHA. All of these parameters improved shortly after initiation of BCG injections in 22 patients who survived more than 24 months. In contrast, in patients who died within 12 months, immunoresponsiveness remained suppressed throughout the course. This result has suggested that there was an apparent correlation between the effectiveness of BCG and immunoresponsiveness. In addition, a good correlation was observed between the duration of inflammatory reactions at BCG injection sites and clinical prognoses. Moreover, it was shown that a relatively high amount of BCG (20-80 mg as an initial dosage) and repeated injections of living BCG were necessary to obtain a sufficient enhancing effect on the immunocompetency of these late-stage cancer patients. The most conventional criterion used to determine an optimal time for booster injections of BCG was measurement of the PPD-evoked skin reaction at the BCG injection site, that is, Koch's phenomenon. When a marked flare-up reaction of more than 2.5 X 2.5 cm in size was observed, the effect of BCG was considered to be continuing, and no additional booster injection was needed. The mean interval between the first and second BCG injections was 6.2 /-1.1 months in patients who survived more than 2 years. In contrast, the duration of this reaction was only transient in ineffective cases. The most frequent side effects of this therapy were fever and malaise; these complications occurred in 62% of the cases. No severe side effects, such as dissemination, anaphylactic shock, or granulomatous hepatitis, have been experienced throughout this study, even in patients to whom a total dosage of more than 200 mg of living BCG were injected.- - - - - - - - - - ranking = 0.00016339192453045keywords = fever (Clic here for more details about this article) |
4/49. incidence of seizures in pediatric cancer patients treated with imipenem/cilastatin.Proconvulsive tendency of imipenem/cilastatin is one of its well-known side effects. Most studies report incidence rates ranging from 1.5 to 3%. There is no study on the incidence rate among children with systemic malignancies. Eighty-two patients with various malignancies who received imipenem/cilastatin 143 times for neutropenic fever between March 1994 and October 1999 in Department of Pediatric Oncology, Gazi University, were identified. Three of these patients had convulsions attributed to imipenem/cilastatin; 3.6% of the patients had seizure, or 2% of imipenem/cilastatin administrations was followed by a seizure attack.- - - - - - - - - - ranking = 0.00016339192453045keywords = fever (Clic here for more details about this article) |
5/49. A fast algorithm to find optimal controls of multiantenna applicators in regional hyperthermia.The goal of regional hyperthermia is to heat up deeply located tumours to temperatures above 42 C while keeping the temperatures in normal tissues below tissue-dependent critical values. The aim of this paper is to describe and analyse functions which can be used for computing hyperthermia treatment plans in line with these criteria. All the functionals considered here can be optimized by efficient numerical methods. We started with the working hypothesis that maximizing the quotient of integral absorbed power inside the tumour and a weighted energy norm outside the tumour leads to clinically useful power distributions which also yield favourable temperature distributions. The presented methods have been implemented and tested with real patient data from the Charite berlin. Campus Virchow-Klinikum. The results obtained by these fast routines are comparable with those obtained by relatively expensive global optimization techniques. Thus the described methods are very promising for online optimization in a hybrid system for regional hyperthermia where a fast response to MR-based information is important.- - - - - - - - - - ranking = 1.1666666666667keywords = hyperthermia (Clic here for more details about this article) |
6/49. Complete spontaneous regression of cancer: four case reports, review of literature, and discussion of possible mechanisms involved.Spontaneous regression or remission (SR) of cancers has been defined as the disappearance of the malignancies without any treatment or with obviously inadequate treatment. Four case reports are presented. These include a case of pleomorphic liposarcoma with bilateral lung metastases, a case of recurrent squamous cell carcinoma of the esophagus following esophagectomy a year earlier, a case of a squamous cell carcinoma of the scalp, and a case of a ruptured hepatocellular carcinoma with an emergency right hepatic lobectomy but with some gross cancer remaining in the left hepatic lobe. The literature of SR of cancers was reviewed and various mechanisms possibly involved in the disappearance of the cancers were discussed. Although immune modulation has been stated to be the most likely process causing SR, other mechanisms, such as genetic therapy, withdrawal of carcinogens, infection, fever and vaccine roles, apoptosis, antibody, antiangiogenesis and maturation mechanisms, withdrawal of therapy, natural killer activity, endocrine, hormonal, and pregnancy factors, and prayers or psychoneuro-religious participation were also mentioned. Induction and inhibition of malignant protein expression and repair of gene damage may prove to be the more important processes in cancer regression. It was also pointed out that the pulmonary metastases of the liposarcoma and the recurrent squamous cell carcinoma of the esophagus may be the very first cases of their kind to be described and that it is rare indeed to find 4 cases of SR's in a solo practice. Finally, it is likely that SR is rarer than previously believed and that the incidence may be one in every 140,000 cases of cancer rather the one per 60,000 to 100,000 cancer cases as earlier thought.- - - - - - - - - - ranking = 0.00016339192453045keywords = fever (Clic here for more details about this article) |
7/49. High incidence of penicillin resistance among alpha-hemolytic streptococci isolated from the blood of children with cancer.OBJECTIVES: To survey the susceptibility profiles to several beta-lactam antibiotics and to identify factors related to resistance among blood isolates of alpha-hemolytic streptococci (AHS) obtained from children with cancer. STUDY DESIGN: All pediatric oncology patients with AHS bacteremia occurring from January 1996 through June 1999 at one cancer center were identified. Isolates were categorized based on the minimum inhibitory concentration as susceptible, intermediate, or resistant to several beta-lactam antibiotics. Demographics and potential factors related to antibiotic resistance were obtained from the medical record. RESULTS: Thirty-eight AHS isolates were obtained from 33 patients. Penicillin susceptibility testing revealed that only 8 (21%) isolates were susceptible, 16 (42%) were intermediate, and 14 (37%) were resistant. All 14 of the penicillin-resistant isolates were also resistant to the 3 cephalosporins tested. ceftriaxone and ceftazidime were the most active cephalosporins. Antibiotic resistance correlated with the recent use of systemic antibiotics, number of prior infectious episodes, and species type. CONCLUSIONS: blood culture isolates of AHS obtained from children with cancer are frequently resistant to beta-lactam antibiotics. These results indicate that clinically relevant AHS isolates should be tested for antibiotic susceptibility and that beta-lactam antibiotics may not be optimal empiric therapy for fever and neutropenia in children with cancer who have a high risk of AHS infections.- - - - - - - - - - ranking = 0.00016339192453045keywords = fever (Clic here for more details about this article) |
8/49. hypersensitivity and idiosyncratic reactions to oxaliplatin.BACKGROUND: Oxaliplatin is a third-generation platinum analog that is used to treat a variety of solid tumors, particularly colorectal carcinoma. patients may develop hypersensitivity reactions, although this complication occurs infrequently. methods: Three patients developed hypersensitivity reactions to oxaliplatin while undergoing treatment on a Phase I trial of oxaliplatin and capecitabine. An Entrez pubmed search was performed to identify other cases. RESULTS: Two patients experienced the abrupt onset of erythema alone or with pruritis during the 9th and 11th infusions of oxaliplatin, whereas the other patient developed fever and mild dyspnea a few hours after the 9th oxaliplatin infusion. All 3 patients were rechallenged successfully for at least 1 additional oxaliplatin infusion by using oral dexamethasone, 20 mg orally, 6 and 12 hours before the administration of oxaliplatin and by administering intravenously 125 mg of solumedrol, 50 mg of diphenhydramine, and 50 mg of cimetidine 30 minutes before oxaliplatin. The literature review suggests two distinct patterns of reactions: classic hypersensitivity (as experienced by the first two patients) and idiosyncratic reactions (as experienced by the third patient). CONCLUSIONS: patients who develop mild to moderate hypersensitivity to oxaliplatin may be pretreated with steroids and antagonists of Type 1 and 2 histamine receptors, whereas patients who develop severe reactions are unlikely to tolerate further therapy.- - - - - - - - - - ranking = 0.00016339192453045keywords = fever (Clic here for more details about this article) |
9/49. A suspected case of delayed onset malignant hyperthermia with desflurane anesthesia.Desflurane has been identified as a weak triggering anesthetic of malignant hyperthermia that, in the absence of succinylcholine, may produce a delayed onset of symptoms. The prolonged interval after exposure may occur more than 6 h after the induction of anesthesia. The unintended underdosing of this patient with dantrolene and the prompt reversal of symptoms may be an attribute of the genetic expression of a weak triggering volatile anesthetic such as desflurane. IMPLICATIONS: There are multiple genetic variations for malignant hyperthermia (MH) at the ryanodine receptor. Desflurane, as a sole trigger of MH, is weak, and on two occasions in the literature (including this case), less than optimal doses of dantrolene were given with a good result. There may be possible to engineer the risk of MH out of an anesthetic once the genetics of the ryanodine receptor are better understood.- - - - - - - - - - ranking = 1keywords = hyperthermia (Clic here for more details about this article) |
10/49. Clinical significance of Roseomonas species isolated from catheter and blood samples: analysis of 36 cases in patients with cancer.This report analyzes 36 cases of bacteremia or catheter-related infection caused by Roseomonas species, a group of pink, slimy, waterborne, gram-negative coccobacilli. The causative species included the newly described Roseomonas mucosa (22 cases [61%]) and Roseomonas gilardii subspecies rosea (8 cases [22%]) and known species R. gilardii subspecies gilardii (5 cases [14%]) and Roseomonas genomospecies 4 (1 case [3%]). Twenty-nine (81%) of the cases were symptomatic, with fever being the most common symptom (in 27 [75%] of the cases). Twenty (56%) of the infections were monomicrobic. Six cases (17%) involved persistent catheter colonization, and 5 of these cases required removal of the catheter to clear the infection. All infections resolved, most with empirical antibiotic treatment. A summary of the antibiotic susceptibility pattern of these strains and other reported series show that Roseomonas species are consistently susceptible to amikacin and imipenem and frequently susceptible to ciprofloxacin and ticarcillin, but essentially nonsusceptible to ceftazidime and cefepime. This result may guide future therapy for infections due to Roseomonas species.- - - - - - - - - - ranking = 0.00016339192453045keywords = fever (Clic here for more details about this article) |
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