A phase II study of feasibility and toxicity of bevacizumab in combination with temozolomide in patients with recurrent glioblastoma.

PURPOSE: The aim of this prospective and multicentric phase II study was to evaluate the efficacy and safety of temozolomide (TMZ) and bevacizumab (BV) in patients (pts) with recurrent glioblastoma (GB), previously treated with chemoradiotherapy and at least three cycles of adjuvant TMZ. PATIENTS AND METHODS: Patients with GB at first relapse received BV 10 mg/kg day every 2 weeks and TMZ 150 mg/m(2) days 1-7 and 15-21, every 28 days. Patients underwent brain magnetic resonance imaging every 8 weeks. RESULTS: Thirty-two evaluable pts were recruited in 8 sites. Fourteen pts (44%) had gross total resection. O(6)-methylguanine-DNA methyltransferase (MGMT) promoter was methylated in 12 pts, unmethylated in 6 pts, and missing in 14 pts. The estimated 6-month progression free survival (PFS) rate was 21.9% (95% CI 9.3-40.0%). The median PFS and overall survival (OS) were 4.2 months (95% CI 3.6-5.4 months) and 7.3 months (95% CI 5.8-8.8 months), respectively. No significant association with MGMT status was found in terms of OS or PFS. Six of 32 pts (19%; 95% CI 7.2-36.4) were long-term survivors, with a median PFS and OS (50% events) of 9.5 months (95% CI 7.9-23.6) and 15.4 (95% CI 8.9-NA), respectively: no differences in baseline characteristics were identified in comparison with total population. No unexpected toxicities or treatment-related deaths were observed. CONCLUSIONS: This regimen showed to be feasible and well tolerated in pts with recurrent GB pretreated with TMZ. Further investigation is warranted to identify subpopulations that are more likely to benefit from addition of BV to GB therapy.

Intoxicación con etilenglicol. Presentación de casos y revisión de la literatura / Intoxication with ethylene glycol. Presentation of cases and review of literature

El etilénglicol es un producto utilizado en la industria química. La ingesta o aspiración de esta sustancia es una emergencia médica que se debe diagnos� ticar y tratar de inmediato. Inicialmente produce un cuadro conocido como "embriaguez sin aliento alcohólico", seguido de toxicidad cardiopulmonar y renal con grave acidosis metabólica con brecha aniónica aumentada. En la mayoría de los Centros, no es posible determinar la concentración de eti� lénglicol en sangre, por lo que el diagnóstico inicial se basa en la anamnesis y en la presencia de acidosis metabólica grave con brecha aniónica elevada. El tratamiento consiste en soporte vital, adecuada infusión de fluidos y bicar� bonato de sodio, administración de etanol o fomepizol para antagonizar la enzima alcohol deshidrogenasa y, en algunos casos, hemodiálisis.(AU)

The ethylene glycol is a product used in the chemical industry. The intake or inhalation of this substance is a medical emergency that should be diagnosed and treated early. Initially it causes a condition known as "drunkenness with� out alcoholic breath", followed by cardiopulmonary and renal dysfunctions with severe metabolic acidosis and increased anion gap. Determination of blood levels is not available in most health care centers, so initial diagnosis should be based on history and the presence of metabolic acidosis with el� evated anion gap. Treatment consists of vital support, adequate fluid and bicarbonate infusion, administration of ethanol o fomepizole to antagonize the � genase and, in some cases, hemodialysis.(AU)

[Use of methylene blue in the treatment of vasoplegic syndrome of post-operative heart surgery]. / Utilización de azul de metileno en el tratamiento del síndrome vasopléjico del postoperatorio de cirugía cardíaca.

Vasoplegia is a frequent complication in post-operative heart surgery and determines a significant increase in morbidity-mortality. When vasoplegia persists in spite of optimized fluid therapy with the use of Swan-Ganz catheter, we have a safe, effective and economical alternative, methylene blue. We present the case of a patient who developed vasoplegia refractory to treatment and shock in the scheduled post-operative period of myocardial revascularization. The use of a single dose of methylene blue resolved the hemodynamic instability and allowed for total discontinuation of vasoactive drugs. Thus, we present this new indication of methylene blue, still not approved by the corresponding bodies, for which no national publications have been found and its clinical management and the absence of adverse effects after its use.

Factors determining the actual received dose intensity in a program of multicyclic dose-intensive alternating chemotherapy with sequential stem cell support.

Dose intensity has been related to clinical outcome in several solid tumors. We studied the influence of clinical and cellular parameters on dose intensity received in a series of 53 patients with metastatic breast cancer or advanced ovarian cancer. They received courses of cisplatin 120 mg/m(2) plus etoposide 600 mg/m(2) alternating every 14 days with ifosfamide 8 g/m(2) plus paclitaxel 200--350 mg/m(2). Blood stem cell support was administered after every course except for the first one. Patients with excellent mobilization underwent immunomagnetic selection of CD34+ cells. We found a significant inverse correlation between the CD34+ cell dose infused and the delay for the administration of the next cycle. A CD34+ cell dose between 1.5 and 5 x 10(6)/kg per cycle was found to be feasible and was followed by a median delay of 1 day (not different from doses above 5 x 10(6)/kg). Three factors independently predicted the actually received dose intensity in a multiple regression model (R(2) = 0.4): previous autologous transplantation, eligibility for immunomagnetic selection (excellent response to mobilization) and median CD34+ cell dose received along the treatment.

Results and complications of the low contact stress knee prosthesis.

We present the midterm results and complications of 101 low contact stress total knee replacements performed in 94 patients and reviewed at an average follow-up of 5.2 years (range, 4-8 years). The mean age at the time of surgery was 66 years (range, 53-76 years). Meniscal bearings were used in 83 knees and a rotating platform in the remaining 18 cases; cemented fixation was used only for 16 tibial components. At most recent follow-up, average knee and function scores were 93 and 78 points. None of the knees was revised because of loosening. Five knees showed distal femoral stress shielding. Complications included infection, supracondylar fracture, patellar component dislodgment, meniscal dislocation (2 cases), catastrophic wear of polyethylene, and progressive osteolysis (2 cases).

Rupture of the quadriceps tendon after total knee arthroplasty. A case report.

Reported herein is the case of a 45-year-old woman with knee involvement due to rheumatoid arthritis. She had a total knee arthroplasty with a rupture of the quadriceps tendon 1 month later. Surgical repair of the rupture was performed following the Scuderi technique plus reinforcement with Dacron (Lig Aid, Levallois, Cedex, France) tape cerclage. An above-knee walking-plaster cast was applied with the knee in full extension for 6 weeks. The functional result was good 1 year after surgery.