Giant tuberculin reaction associated with the homeopathic drug tuberculinum: a case report.

Giant reactions to the tuberculin skin test are extremely rare and have been previously reported almost exclusively in patients with lepromatous leprosy. We herein report a giant tuberculin reaction associated with the homeopathic drug Tuberculinum in a patient with no evidence of active tuberculosis or leprosy.

Pulmonary blastoma with submandibular, scrotum and adrenal metastases: case report.

A 62-year-old patient diagnosed with pulmonary blastoma with submandibular, scrotum and adrenal metastases was admitted to Sotiria General Hospital in Athens. No other such case has been published to date. The patient started receiving chemotherapy, but the scrotum metastasis grew rapidly and erupted. This led to sepsis despite surgical excision of infected and necrotic tissues and intravenous antibiotics. Treatment strategy in pulmonary blastoma should be defined by a multidisciplinary team, and surgical treatment should be considered as quickly as possible when such a tumor is suspected.

Hypersensitivity reactions to docetaxel: retrospective evaluation and development of a desensitization protocol.

BACKGROUND: Docetaxel (DT) is an extensively used taxane, frequently associated with hypersensitivity reactions. The aim of this study was to record the epidemiological and clinical features of hypersensitivity to DT in non-small cell lung cancer patients in order to obtain useful information concerning the management of these patients. We also developed a desensitization protocol and evaluated its clinical application. METHODS: We retrospectively reviewed records of 620 non-small cell lung cancer patients treated with DT-containing regimens in the adjuvant, first-, second- or next-line setting. Data from 102 patients who had exhibited hypersensitivity reactions were analyzed according to the Common Toxicity Criteria for Adverse Events version 3.0. Five patients were chosen for the desensitization protocol. We applied the standard protocol for parenteral desensitization to ß-lactam antibiotics, and DT treatment was carried out with a series of 10-fold dilutions in sufficient volume to administer the total dose. RESULTS: One hundred and two patients (16.5%) were recorded as having hypersensitivity to DT. Reactions were observed after approximately 2.5 ± 1.0 cycles. Only 14 patients (14/620, 2%) developed grade 3-4 hypersensitivity. Reactions were more likely in patients during second- or third-line chemotherapy, but no other correlation (age, gender, atopic status) was observed. Five patients completed a parenteral desensitization protocol and continued their treatment uneventfully. CONCLUSIONS: Hypersensitivity reactions to DT respond quickly to discontinuation along with appropriate supportive care. Premedication and increased infusion time may allow readministration. The desensitization protocol that we developed provides a reliable alternative to permanent discontinuation of DT.

Rapid infusion of ibandronate in lung cancer patients with bone metastases.

BACKGROUND: The high prevalence of bone metastases in stage IV non-small cell lung cancer (NSCLC) patients contributes substantially to the burden of the disease by resulting in significant skeletal morbidity. Ibandronate is a new generation of bisphosphonates (BPs) with demonstrated clinical benefit in breast and prostate cancer patients with bone metastases. PATIENTS AND METHODS: In 32 patients with newly diagnosed NSCLC and bone metastases, 4 mg of ibandronate were administered, as a rapid 20-minute intravenous infusion every 3-4 weeks. RESULTS: A total of 189 infusions were administered over a 24-month period, during which a statistically significant decrease in calcium serum levels (p=0.03) was observed. The serum levels of alkaline phosphatase (ALP) were also decreased, but not significantly. With regard to clinical efficacy, 24 of our patients stabilized or reduced their need for analgesic treatment. The reduced time of infusion (20 min vs. 2 h) did not correlate with any side-effects, including vital sign deterioration and renal dysfunction. CONCLUSION: The rapid infusion of ibandronate in lung cancer patients with bone metastases is a safe and convenient procedure that may be administered in a day-clinic setting.

Bi-weekly administration of docetaxel and gemcitabine as first-line therapy for non-small cell lung cancer: a phase II study.

BACKGROUND: The standard treatment for advanced non-small cell lung cancer (NSCLC) currently consists of platinum-based, combination chemotherapy of limited efficacy and possible toxicity. The bi-weekly administration of docetaxel and gemcitabine for advanced NSCLC was evaluated in a phase II study (objective response rate, median survival, median duration of response and safety). PATIENTS AND METHODS: A total of 170 cycles were administered to 31 patients with advanced NSCLC and a median age of 66 years (range 47-75 years). Patients received docetaxel 80 mg/m2 and gemcitabine 1000 mg/m2 on days 1 and 14 of a 28-day cycle. RESULTS: Sixteen patients achieved a PR (16/31, 55.2%), 3 patients had SD (3/31, 10.3%) and 10 (10/31, 34.5%) had PD. The median time to disease progression was 3 months (range 0-12 months) with a mean survival of 10 months (range 3-31 months). Haematological and non-haematological toxic effects were generally mild to moderate and manageable: Grade 3 neurotoxicity and allergy occurred in 2 patients (6.4%) and 1 patient (3.2%), respectively. Peripheral neuropathy, mostly grades 1 and 2, was reported in 24 patients (77.4%). CONCLUSION: The bi-weekly administration of a docetaxel/gemcitabine combination with G-CSF support constitutes a tolerable and convenient regimen for the treatment of advanced NSCLC, with efficacy similar to that reported in other regimens.

Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection.

Lung resection is still the only potentially curative therapy for patients with localized non-small lung cancer (NSCLC). However, the presence of cardiovascular comorbidities and underlying lung disease increases the risk of postoperative complications. Various studies have evaluated the use of different preoperative tests in order to identify patients with an increased risk for postoperative complications, associated with prolonged hospital stay and increased morbidity and mortality. In this topic review, we discuss the role of cardiopulmonary exercise testing (CPET) as one of the preoperative tests suggested for lung cancer patients scheduled for lung resection. We describe different types of exercise testing techniques and present algorithms of preoperative evaluation in lung cancer patients. Overall, patients with maximal oxygen consumption (VO2max) <10 mL/kg/min or those with VO2max <15 mL/kg/min and both postoperative FEV1 and DLCO<40% predicted, are at high risk for perioperative death and postoperative cardiopulmonary complications, and thus should be offered an alternative medical treatment option.