Significant pain relief with loading dose zoledronic acid in bone metastases is only seen in patients with elevated initial serum C telopeptide (CTX).

In symptomatic bone metastases with significant pain, refractory to standard analgesics and radiotherapy, loading dose zoledronic acid (ZA) represents a simple and nontoxic treatment to obtain significant pain relief in a very short time. Its analgesic effect is limited to patients with massive osteoclast activation with high initial serum C-telopeptide (CTX). The pain reduction is proportionally correlated with the reduction of CTX.

Complete response of a metastatic gastroesophageal adenocarcinoma on irinotecan-based chemotherapy in a dialysis patient.

We present the first case report of a complete response of metastatic gastroesophageal cancer in a chronic hemodialysis patient with irinotecan-based chemotherapy. An elderly dialysis patient presented with diffuse liver metastases by a gastroesophageal adenocarcinoma. He received combination chemotherapy with 5 fluorouracil and irinotecan. After six months of chemotherapy, liver scans show complete remission. The principles, practice, and experience of chemotherapy with irinotecan during dialysis are discussed.

Weekly cisplatin may reverse liver dysfunction and jaundice caused by diffuse liver metastases of solid tumors.

Few data are available on patient management in jaundice caused by liver metastases of solid tumors (nonbreast and noncolon origin). We report the first patient series consecutively treated with cisplatin weekly in patients with severe jaundice and liver failure due to underlying metastatic neoplasms. In 4 out of 8 cases, liver function tests were reversed and jaundice disappeared, permitting subsequent standard chemotherapy. The other 4 patients died 3 to 5 weeks after admission, illustrating the extent and severity of the underlying neoplasm.

Mitomycin C and vinblastine in combination with amifostine in metastatic breast cancer. A feasibility study of the EORTC--Investigational Drug Branch for Breast Cancer (IDBBC).

Mitomycin C (MMC)-vinblastine (VBL) is a regimen that has commonly been used as salvage therapy for advanced breast cancer for many years. The hematologic toxicity of this combination is one aspect that limits its usefulness. Amifostine, an organic thiophosphate, has been developed as a selective chemoprotective agent. In this pilot study, we tested the feasibility of MMC/VBL administration in combination with amifostine and we monitored the hematologic toxicity closely. Patients having failed one or two chemotherapy regimens for advanced breast cancer, with a good performance status scored at 2 or better and measurable or evaluable lesion(s), were eligible. They were treated according to the following schedule: mitomycin C 10 mg/m2 i.v. day 1, vinblastine 5 mg/m2 i.v. day 1 and 15, amifostine 910 mg/m2 in short i.v. infusion prior to MMC. Premedication consisted of dexamethasone 3 x 20 mg, haloperidol 2 x 0.5 mg p.o., hydration with 11 of normal saline, metoclopramide 1.5 mg/kg in short infusion and procyclide HCl 10 mg i.v. Cycles were repeated every 4 weeks. In all, 14 cycles were administrated to six heavily pretreated patients. Following the first cycle, five of the six patients experienced grade 3 or 4 neutropenia on day 15, and consequently did not receive the second vinblastine administration as planned. Three out of four patients receiving two or more cycles had moderate thrombocytopenia. There were no patients with neutropenic fever or major bleeding problems. The MMC/VBL+amifostine regimen was well tolerated regarding other toxicities. Neither amifostine-related acute vomiting nor any significant decrease in blood pressure was observed. Administration of amifostine in combination with MMC/VBL was feasible but in this group of heavily pretreated patients there were no hints of a protective effect of amifostine on the hematologic toxicity profile of this chemotherapy regimen.

A simple and efficient urine sampling method for bacteriological examination in elderly women.

AIM: to determine how collecting urine voided directly into a container compares with urine obtained by suprapubic aspiration. METHOD: urine samples were collected in a sterile recipient placed in the toilet or in the bed-pan during voiding, after the vulval region had been cleaned by water. These samples were compared with samples of the same urine obtained by suprapubic aspiration. The samples were examined for pyuria and bacteriuria. Applying the Kass criteria on the voided urine specimen and assessing the presence of leucocyturia, it was possible to differentiate urinary tract infection, asymptomatic bacteriuria and contamination. RESULTS: all 13 cases of infection found on suprapubic aspiration were also identified by this sampling technique. The technique produced four false-positive results. CONCLUSION: this simple sampling method may not only obviate the need for suprapubic aspiration but also for bladder catheterization in the diagnosis of urinary tract infection in many elderly women.

Acquired haemophilia in the elderly.

The occurrence of an acquired inhibitor of F VIII coagulant activity is a rare cause of a sometimes important bleeding diathesis. Antibodies against F VIII:C can spontaneously occur, mostly in elderly patients. Four elderly patients with such a typical clinical and biological syndrome are reported. No identifiable underlying disease was found and they responded favourably to an immunosuppressive treatment. In one patient plasmapheresis was successful.

Successful plasmapheresis in corticosteroid-resistant hemolysis in infectious mononucleosis: role of autoantibodies against triosephosphate isomerase.

A 19-year-old girl fell ill with a high temperature and cervical lymphadenopathy. The detection of heterophile antibodies as well as Epstein-Barr-virus-specific antibodies confirmed the diagnosis of infectious mononucleosis. In the course of the infection, the patient developed severe hemolytic anemia with her hemoglobin falling from 14 to 8 g/dl. High-dose corticosteroid therapy did not stop hemolysis; this could only be achieved by seven plasmapheresis sessions. Antibodies against triosephosphate isomerase (TPI) and the blood group marker 'i' were found in the patient's serum. Anti-i cold agglutinins were not active at 37 degrees C, whereas antibodies against TPI caused increased 51Cr release from marked patient's erythrocytes in vitro. Plasmapheresis removed the autoantibodies effectively and stopped the hemolysis. After 8 weeks, the patient gradually recovered.