Evaluation of initial dofetilide dosing recommendation based on actual body weight in overweight and obese patients.

WHAT IS KNOWN AND OBJECTIVE: The dofetilide label recommends using actual body weight (ABW) to calculate the Cockcroft-Gault creatinine clearance (CrCl) for the determination of the initial dose; however, few studies have attempted to evaluate this dosing recommendation in overweight and obese patients. We evaluated whether the current dofetilide dosing recommendation based on ABW is appropriate in overweight and obese patients. METHODS: This is a retrospective cohort study conducted at two large academic medical centres in the United States on overweight and obese patients (body mass index ≥ 25 kg/m(2)) who were newly started on dofetilide based on ABW. Patients were categorized into (i) the different-dose group if their CrCl calculated based on the ideal body weight (IBW) resulted in a lower initial dofetilide dose compared with ABW-based CrCl and (ii) the same-dose group if they would have the same initial dose based on IBW and ABW. The primary outcome was dofetilide dose reduction or discontinuation due to prolongation of the corrected QT interval during the first 3 days of dofetilide therapy. Multivariable logistic regression analysis was performed to identify factors predicting the risk of primary outcome. RESULTS AND DISCUSSION: Of the 132 patients included in the study, 29 (22·0%) were in the different-dose group and 40 (30·3%) had the primary outcome. The per cent of patients with the primary outcome was not statistically significantly different between the different-dose and same-dose groups (37·9% vs. 28·2%; P = 0·31). Diabetes mellitus was a significant predictor for the primary outcome (odds ratio 2·54; 95% confidence interval 1·05-6·15). WHAT IS NEW AND CONCLUSION: Our study provides the evidence on the safety of the current dofetilide dosing recommendation in overweight and obese populations in clinical practice. Current ABW-based dofetilide dosing is reasonable in overweight and obese patients.

[Radiotherapy of nasopharyngeal carcinoma--analysis of 1379 patients].

This paper presents 1379 patients with nasopharyngeal carcinoma treated in our hospital from March 1958 to December 1978. The stage I and II lesions comprised 22% and stage III and IV lesions, 78%. 220 KV X-ray was used before 1960 and 60Co was predominant from 1961 through 1978. The overall 5 year survival rate was 41.4% (571/1379). Young adults and female patients gave better results. The 5 year survival rate was, according to pathological type, 45.1% for poorly differentiated squamous cell carcinoma and 13% for adenocarcinoma; according to clinical stage, 85.7% for stage I lesion, 59.5% for stage II, 45.8% and 29.2% for stages III and IV; according to period of treatment, 31.3% in the sixties and 48.6% in the seventies; according to tumor dose at the primary focus, 48.2% for 40-49 Gy, 55.6% for 60-69 Gy and 67.3% for 90 Gy or more; according to with or without prophylactic radiation in the neck region, 53.8% for the former and 23% for the latter. It implies that prophylactic radiation of the neck is necessary regardless of the presence of cervical lymph node metastasis or not. For those who had residual tumor at 70 Gy, the total dose may be boosted to more than 90 Gy with the cone down technic or the dose, at which the primary lesion disappears grossly, is added with 20 Gy. The common complications are radiation myelitis, trismus and otitis media. As in certain patients, the lesion would still recur 5 years after radiotherapy, the authors believe that the nasopharyngeal cancer patients should be followed for ten years at least.

The use of free flaps in burn patients: experiences with 70 flaps in 65 patients.

A series of 70 microvascular free flaps employed in 65 burn patients is presented. The total survival incidence of the flaps was 87 percent. Satisfactory wound healing was achieved in 80 percent of a total of 54 flaps in fresh burn patients. In the 16 patients with healed burns, flap survival was 100 percent with satisfactory functional and cosmetic results. The cruxes of dealing with difficult fourth-degree burns by using microvascular free flaps and our special considerations about the indications and overall morbidities of the donor site are discussed. This large-series report confirms other occasional reports on the use of free flaps in burn patients. It is our belief that the microvascular free flap is the most expeditious means of dealing with refractory burn wounds, even when more conventional techniques are available. In certain cases, the microvascular procedure is the only method that can salvage an extremity.

Analysis of 1379 patients with nasopharyngeal carcinoma treated by radiation.

One thousand three hundred seventy-nine nasopharyngeal carcinoma (NPC) patients were treated from March 1958 to December 1978. Twenty-two percent had stage I or II and 78% Stage III or IV had lesions. Two hundred twenty-Kv radiographs were used before 1960; and telecobalt was used from 1961 to 1978. Factors influencing the 5-year survival rate favorably are youth of patient, being female, pathologic condition (poorly differentiated carcinoma, 45.1% versus adenocarcinoma, 13%), stage (Stage I, 86%, Stage II, 59.5%; Stage III, 45.8%; Stage IV, 29.2%), decade admitted for treatment in the past (31% in the 1950s, 48.6% in the 1970s), total dose delivered to the nasopharynx (40 to 49 Gy, 46%; 70 to 79 Gy, 54.1%; 90 Gy or more, 64%) and prophylactic radiation to the neck regions (with prophylactic irradiation, 53.8%, without prophylactic irradiation, 23%). This implies that prophylactic radiation of the neck is crucial even without positive clinical metastasis. For those who have a residual tumor in the primary site when 70 Gy has been delivered, the total dose may be boosted to more than 90 Gy with the cone-down technique or on basis of adding 20 Gy to the dose at which the primary lesion disappeared grossly. The common postirradiation complications are: radiation myelitis, trismus, and otitis media. Because disease recurred in some patients after the fifth year, NPC patients should be followed for at least 10 years.

Microskin grafting. II. Clinical report.

A technique for microskin grafting for treating extensively burned patients is presented. Eight extensively burned patients were treated in this way with encouraging results. The recipient area covered by microskin grafts ranged from 2.5 per cent to 44 per cent of the total body surface area (TBSA). The expansion ratio of the micrografts was 15:1 maximum. The micrografts took well in seven patients with the healing time ranging from 22 to 45 days post-operatively. One case failed because of sloughing of the homograft. The advantages of the microskin grafting are: (1) economical use of autografts, (2) the procedure is simple, (3) there is less scar on the recipient site. This new technique is effective, simple and feasible in extensive burns.

[Carcinoma of esophagus treated by 8MV X-ray and checked by simulator].

From January 1, 1978 to December 31, 1983, 570 patients with carcinoma of esophagus were treated by 8 MV X-ray and checked by the Philips simulator. In order to assess their value, a series of 3,798 patients reported previously was used for comparison. To further evaluate the effect of 8 MV X-ray and simulator separately, a series of 154 patients was treatment by non-8 MV X-ray during the same period. The results showed that the 1 and 3 year survival rates of 8 MV X-ray series were better than the 3,798 series (P less than 0.01). It means that after the use of simulator and 8 MV X-ray the survival rates were improved. As compared to the radiation other than 8 MV X-ray, there was no difference between 8 MV X-ray and non-8 MV X-ray series, which means that the improvement may have been due to the better localization by the simulator. Having more importance, no radiation myelitis was found after the use of simulator. The sex, age, length, location, X-ray type, NSD and causes of failure were compared in these groups.

Candida infection in severe burns.

Candida infection has become an important cause of morbidity and death in burned or immunosuppressed patients. Two patients with extensive burn complicated with Candida infection are presented, along with the risk factors, diagnostic procedures, and current methods of treatment.

[A statistical analysis of the life expectancy of the residents of our country, 1973-75].

PIP: Statistical analysis of life expectancy is important in assessing population health and its characteristics and in studying human diseases and natural population changes. Life tables are constructed and statistical analysis is performed retrospectively on data accumulated over a 3-year (1973-1975) period. The data were supplied by the Office of Cancer Prevention and Treatment of the Ministry of Health, which originated from 24 provinces, representing an accumulated population of 2.04 billion, with a total mortality of 15.29 million. Results show that life expectancy in China has greatly improved since Liberation. Thus, in 1935, the average life expectancy for Nanjing residents was under 35 years. In 1951, the average life expectancy for male and female residents of Shanghai were 42.74 and 46.76 years respectively. But for the 1973-1975 period, the average Chinese life expectancy was 63.62 years for males and 66.31 years for females, with higher life expectancy for coastal provinces than for inland provinces. Cardiovascular diseases (excluding arteriosclerotic heart diseases), malignant tumors, and cerebrovascular diseases were the major causes of death in regions with higher life expectancy, while respiratory diseases, infectious diseases, and diseases of the newborn were the major causes of death in regions with lower life expectancy.^ieng