Phase II trial with dose titration of paclitaxel for the therapy of human immunodeficiency virus-associated Kaposi's sarcoma.

PURPOSE: To investigate the antitumor activity and safety of paclitaxel in patients with advanced human immunodeficiency virus (HIV)-associated Kaposi's sarcoma (KS). PATIENTS AND METHODS: Twenty-nine patients with advanced HIV-associated KS were enrolled. The patients were overall quite immunosuppressed (median CD4 count, 15 cells/microL). Paclitaxel was initially administered at 135 mg/m2 over 3 hours every 3 weeks without filgrastim support; the dose was increased as tolerated to a maximum of 175 mg/m2. Patients who failed to respond or progressed could then receive filgrastim support or paclitaxel administered over 96 hours. RESULTS: Of 28 assessable patients, 20 had major responses (18 partial responses [PRs], one clinical complete response [CR], and one CR), for a major response rate of 71.4% (95% confidence interval [CI], 51.3% to 86.8%). Each of the five patients with pulmonary KS responded, as did all four assessable patients who had previously received anthracycline therapy for KS. Of six patients who went on to receive a 96-hour infusion of paclitaxel, five had major responses. Neutropenia was the most frequent dose-limiting toxicity; possible novel toxicities included late fevers, late rash, and eosinophilia. Two patients developed an elevated creatinine concentration and one cardiomyopathy. CONCLUSION: Paclitaxel has substantial activity against advanced HIV-associated KS as a single agent, even in patients with pulmonary involvement or who had previously received anthracyclines. Further research is needed to define the optimal treatment schedule and its role vis-a-vis the other available therapies for this disease.

[Changes in nutritional state, metabolic control and treatment of type 1 diabetes in the last 20 years]. / Diferencias de estado nutricional, control metabólico y tratamiento de la diabetes tipo 1 en dos décadas.

OBJECTIVE: The aim of this study is to describe changes in anthropometric characteristics, metabolic control, treatment and prevalence of overweight in diabetic children (DM1) from 2007 compared with another similar group from 1986. PATIENTS AND METHODS: Observational retrospective study of two groups of diabetic children (n=90). The collection of variables has been made at two cross-sections, 1986 and 2007. The studied variables were: age, years of DM1, sex, weight, height, BMI (and their Z values), HbA(1c) and treatment with insulin (type, number of doses, IU/day and IU/kg/day). RESULTS: In 2007 group there is a significant increase in Z-weight and Z-BMI (P=.001) when compared with the 1986 group. There was a negative relationship between the years with DM1 and Z-height (P=.05) in the 1986 group. The value of HbA(1c) was lower in the 2007 group (P=.001), but the dose of insulin (IU/day and IU/kg/day) was similar in both groups. The number of daily doses of insulin was higher in the 2007 group (P<.001), the use of insulin analogues dominated overall. A statistically significant relationship between HbA(1c) and treatment with insulin (dose injections, insulin type) was not found. The prevalence of overweight (14.6% vs 2.4%) was significantly higher in the 2007 Group (P=.001). CONCLUSIONS: The metabolic control (HbA(1c)) had improved and the use of multiple daily doses of insulin has been become the standard, but the prevalence of overweight has increased. We must monitor the emergence of insulin resistance and cardiovascular risk factors in this sensitive population to prevent early cardiovascular disease.

[Bacteremia caused by Streptococcus agalactiae in adults. Presentation of 6 cases]. / Bacteriemia por Streptococcus agalactiae en adultos. Presentación de 6 casos.

The incidence of Streptococcus agalactiae (SA) bacteremia in adults has increased in recent years, particularly in patients with severe underlying diseases. However SA is still an unusual pathogen in adults. We report 6 cases of SA bacteremia in adults, seen during 18 months. The microorganism was only isolated from the blood in 3 cases, and from blood and other locations in the remaining three cases. The age of the patients ranged from 35 to 70 years. Both sex were affected in the same proportion. In all cases except in one there was a previous underlying disease.