Faculty Bibliography

We hypothesized that cyclophosphamide and cis-platinum, without adriamycin, which had been used in previous studies, may be equally efficacious, but less toxic. We treated 27 patients with non-small cell bronchogenic carcinoma with the combination of cyclophosphamide and cis-platinum. We report six responses (25% response rate), with median survival of 79 weeks as compared to 28 weeks in nonresponders (p less than 0.01). Our regimen had acceptable hematologic toxicity and tolerable gastrointestinal toxicity. However, cumulative nephrotoxicity and neurotoxicity were observed. We conclude that cyclophosphamide and cis-platinum may compare favorably to the cyclophosphamide, adriamycin and cis-platinum combination, with respect to response and toxicity

A cannulation set has been designed for repeated short-term infusion of vesicant chemotherapeutic agents via the femoral vein. The major complication was thrombophlebitis in 2.1% of infusions. The procedure provides reliable venous access when therapeutic plans are changed or when the inability to provide catheter care makes an indwelling catheter unwarranted

Thrombotic occlusion remains a major cause of central venous catheter removal prior to completion of therapy. Injection of a dilute solution of a potent fibrinolytic agent, urokinase or streptokinase, into the occluded Silastic central venous catheter consistently reestablishes its patency. This procedure was performed on 352 occluded silicone elastomer central venous catheters with only one failure and one minor complication. We recommend this technique for restoring patency of occluded silicone elastomer central venous catheters

A 48 year old man with extensive cutaneous and subcutaneous metastatic malignant melanoma responded to treatment by repeated plasma exchanges, partial surgical debulking of tumor masses, and intravenous Corynebacterium parvum. Circulating immune complexes were measured by the serum C1q binding method. Tumor regression coincided with serum C1q binding reduction to normal levels. Clinical relapse was preceeded by recurrent elevation of serum C1q binding activity

PIP: This letter briefly reports a case linking the appearance of overt diabetes mellitus to progestational therapy, and is intended as an addition to the literature associating insulin-dependent diabetes with progestational therapy. A 51-year-old white woman, who had undergone masectomy and prophylactic oophorectomy, had no history of glucose intolerance and was given Prednisolone (15 mg daily) postoophorectomy. Interval clinical evaluations of glucose levels were between 184 and 223 mg/dl during estrogen therapy. Tumor recurrence 12 years later forced withdrawal of estrogen therapy, and the patient was placed on trial therapy with megestrol acetate (40 mg, 4 times daily). 6 weeks after initiation of progestational therapy, the patient was admitted with a glucose level of 400 mg/dl and a 4+ acetone reading in her urine. Insulin therapy was instituted; megestrol acetate was withdrawn; but the diabetes was not reversed and insulin treatment continues. The author compares this case with others previously reported where medroxyprogesterone acetate was the progestational agent apparently causing irreversible diabetes mellitus. O