Combining intraoperative carmustine wafers and Stupp regimen in multimodal first-line treatment of primary glioblastomas.

BACKGROUND: The study investigated if intraoperative use of carmustine wafers, particularly in combination with Stupp regimen, is a viable and safe first-line treatment option of glioblastomas. METHODS: Eighty-three consecutive adult patients (50 men; mean age 60 years) with newly diagnosed supratentorial primary glioblastomas that underwent surgical resection with intraoperative carmustine wafers implantation (n = 7.1 ± 1.7) were retrospectively studied. RESULTS: The median overall survival (OS) was 15.8 months with 56 patients dying over the course of the study. There was no significant association between the number of implanted carmustine wafers and complication rates (four surgical site infections, one death). The OS was significantly longer in Stupp regimen patients (19.5 months) as compared with patients with other postoperative treatments (13 months; p = 0.002). In addition patients with eight or more implanted carmustine wafers survived longer (24.5 months) than patients with seven or less implanted wafers (13 months; p = 0.021). Finally, regardless of the number of carmustine wafers, median OS was significantly longer in patients with a subtotal or total resection (21.5 months) than in patients with a partial resection (13 months; p = 0.011). CONCLUSIONS: The intraoperative use of carmustine wafers in combination with Stupp regimen is a viable first-line treatment option of glioblastomas. The prognostic value of this treatment association should be evaluated in a multicenter trial, ideally in a randomized and placebo-controlled one.

The epidemiology of acute rheumatic fever in Northland, 2002-2011.

AIM: An audit of rheumatic fever surveillance in Northland was carried out for the period 2002-2011. The aim of the audit was to establish the accuracy and completeness of surveillance of Acute Rheumatic Fever in Northland, and to provide a robust baseline for future comparison given current rheumatic fever prevention efforts. METHODS: Cases of acute rheumatic fever (2002-2011) were identified and evaluated through auditing Northland hospital discharges, the Northland Rheumatic Fever secondary penicillin prophylaxis register and the national EpiSurv database. Cases were included in the audit if they met diagnostic criteria according to the 2008 Heart Foundation guidelines. RESULTS: A total of 114 acute rheumatic fever cases met the audit criteria, an annualised incidence of 7.7/100,000 in Northland. 95% of all cases were Maori with a large disparity between Maori (24.8/100,000) and non-Maori (0.6/100,000). Acute rheumatic fever cases were strongly associated with living in high deprivation areas. This audit noted both under- and over-notification of acute rheumatic fever. CONCLUSION: Acute rheumatic fever rates in Northland Maori children aged 5-14 (78/100000) are similar to those seen in developing countries and nearly double the rates seen other New Zealand audits. The findings highlight the urgent need to address crowding, poverty and inequitable primary care access if rheumatic fever is to be eliminated.