Comparative efficacy of palliative radiotherapy dose schedules in advanced bladder cancer-associated gross hematuria.

Introduction: Gross hematuria (GH) in advanced/inoperable bladder cancer patients causes significant morbidity. Patients frequently need multiple transfusions. Hypofractionated radiotherapy (RT) has been shown to be effective in symptom palliation. In this study, we explore the efficacy of various fractionation regimens in these patients. Methods: This single institute retrospective analysis was conducted on 60 consecutive patients treated with palliative RT. Fractionation (single versus multiple) and biologically equivalent doses (BED; high ≥36 Gy versus low <36 Gy) were used to compare the efficacy of various fractionation regimens. The primary outcome was the difference in objective response rate (ORR) between various strata at 2, 4, 8 and 12 weeks. Major secondary outcomes were differences in ORR according to Eastern Cooperative Oncology Group (ECOG) performance status (PS) and tumour node metastases (TNM) stage, and the proportion of patients requiring re-transfusion(s) at 12 weeks. Data were analysed using SPSS 23. Results: Overall ORR at 2, 4, 8 and 12 weeks was 86%, 77%, 67% and 55%, respectively. There was no statistically significant difference in response rates between single or multi-fraction, or high versus low BED groups (All p = >0.05). Moreover, ECOG PS (p = 0.11) or TNM stage (p = 0.58) also had no impact on the response rate at 12 weeks. Nearly one-third (31%) of patients required further transfusions at 12 weeks. Conclusion: RT is an effective modality to control GH. No difference in ORR was found between single fractions versus multiple fractions, or high versus low BED regimens. Single fraction RT can be offered to these patients considering low cost, patient convenience and minimal side effects.

Investigation of Dielectric Properties of Polymers and their Discrimination Using Terahertz Time-Domain Spectroscopy with Principal Component Analysis.

Polymers are among the most commonly used materials in our everyday life. They are generally transparent to terahertz (THz) radiation, but are quite difficult to differentiate using optical techniques as few or no characteristic features exist in the spectral range of <2.0 THz for small and portable radiation systems. In this work, we report experimental measurement of refractive indices and absorption coefficients of styrene acrylonitrile (SAN) and Bakelite in the spectral range of 0.2-2.0 THz for the first time. Additionally, we demonstrate that by combining principle component analysis (PCA) with THz time-domain spectroscopy one can differentiate such polymers. In this analysis, the first three principle components PC1, PC2, and PC3 depict >94% variance with a distribution of 72.45%, 11.52%, and 9.38%, respectively.

Cutis verticis gyrata secondary to infiltrating ductal carcinoma breast.

Cutis verticis gyrata is a long lasting and progressive condition in which there is hypertrophy and folding of the scalp skin. It typically affects the vertex and occipital region; however, it may involve the entire scalp. Classically, it has been divided into primary and secondary forms. Primary has been sub-divided into primary essential and non-essential. Secondary forms are commonly due to systemic diseases, inflammatory dermatoses, underlying nevoid abnormalities or trauma. The association between cutis verticis gyrata and malignancy is rare. It has been described in patients of leukemia, endocrine tumours and malignant melanoma. We present a case of cutis verticis gyrata in a patient of carcinoma breast.

An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method.

OBJECTIVE: The lack of generally accepted diagnostic criteria for neuroleptic malignant syndrome (NMS) impedes research and clinical management of patients receiving antipsychotic medications. The purpose of this study was to develop NMS diagnostic criteria reflecting a broad consensus among clinical knowledge experts, represented by an international multispecialty physician panel. PARTICIPANTS: Eleven psychiatrists, 2 neurologists, 2 anesthesiologists, and 2 emergency medicine specialists participated in a formal Delphi consensus procedure. EVIDENCE: A core bibliography consisting of 12 prominent, current reviews of the NMS literature was identified by an objective, comprehensive electronic search strategy. Each panel member was given a copy of these references and asked to examine them before commencing the survey process. CONSENSUS PROCESS: After reviewing the core bibliography, panel members were asked to list any clinical signs or symptoms or diagnostic studies that they believed, on the basis of their knowledge and clinical experience, were useful in making a diagnosis of NMS. In subsequent survey rounds, panel members assigned priority points to these items, and items that failed to receive a minimum priority score were eliminated from the next round. Information about individual panel member responses was fed back to the group anonymously in the form of the group median or mean and the number of members who had ranked or scored each survey item. The a priori consensus endpoint was defined operationally as a change of 10% or less in the mean priority score for any individual item, and an average absolute value change of 5% or less across all items, between consecutive rounds. The survey was conducted from January 2009 through September 2009. RESULTS: Consensus was reached on the fifth round regarding the following criteria: recent dopamine antagonist exposure, or dopamine agonist withdrawal; hyperthermia; rigidity; mental status alteration; creatine kinase elevation; sympathetic nervous system lability; tachycardia plus tachypnea; and a negative work-up for other causes. The panel also reached a consensus on the relative importance of these criteria and on the following critical values for quantitative criteria: hyperthermia, > 100.4°F or > 38.0°C on at least 2 occasions; creatine kinase elevation, at least 4 times the upper limit of normal; blood pressure elevation, ≥ 25% above baseline; blood pressure fluctuation, ≥ 20 mm Hg (diastolic) or ≥ 25 mm Hg (systolic) change within 24 hours; tachycardia, ≥ 25% above baseline; and tachypnea, ≥ 50% above baseline. CONCLUSIONS: These diagnostic criteria significantly advance the field because they represent the consensus of an international multispecialty expert panel, include critical values, provide guidance regarding the relative importance of individual elements, and are less influenced by particular theoretical biases than most previously published criteria. They require validation before being applied in clinical settings.

FLAG-IDA in the treatment of refractory/relapsed acute leukaemias: single centre study.

OBJECTIVE: To evaluate the efficacy and toxicity profile of the combination of fludarabine, high dose cytarabine, idarubicin, and granulocyte colony stimulating factor in refractory relapsed cases of acute leukaemia, a study is being conducted at Armed Forces Bone Marrow Transplant Centre (AFBMTC) Rawalpindi since January 2003. Data up to June 2004 (early report) is being presented. METHODS: Twelve Patients with refractory/relapsed (Ref/Rel) acute leukaemia (AL) were treated with fludarabine 30 mg/m2 and cytosine arabinoside (AraC) Arac 2 g/m2 for 5 days, idarubicin 10 mg/m2 for 3 days, and granulocyte colony stimulating factor G-CSF 5 micro g/kg from day 0 till neutrophil recovery (ANC > 1.0 x 10(9)/1). Response was evaluated by bone marrow examination on day 20-post chemotherapy. RESULTS: Patients included were refractory acute lymphoblastic leukaemia (ALL) (n=2), relapsed ALL (n = 3), refractory acute myeloid leukaemia (AML) (n = 3), secondary AML (n=2) relapsed AML (n = 1) and acute undifferentiated leukaemia (AUL) (n = 1). Complete remission (CR) was achieved in 8 (66.6%) patients. Three (25%) patients died of post chemotherapy complications and one patient failed to achieve remission. Out of 8 patients who achieved CR, 4 underwent allogeneic bone marrow transfusion (BMT), 1 is being evaluated for the same, 1 received idorubicin, AraC and etopuside (ICE) and high dose AraC, 1 did not receive further chemotherapy and 1 relapsed two months after remission. Seven patients are still in CR after a median follow up of 8 months (range 3-18). Major complications encountered were diarrhoea, mucositis, toxic ileus, transient hepatic toxicity, fungal and bacterial infections. CONCLUSION: In our experience, FLAG-IDA is well tolerated and effective regimen in relapsed/refractory acute leukaemias. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation procedures.

Improvements in SSRI/SNRI-induced sexual dysfunction by switching to escitalopram.

Antidepressants, especially serotonin reuptake inhibiting agents, are associated with sexual dysfunction. The newest drug of this class, escitalopram, claims greater tolerability than older alternatives. This study evaluated patient experiences with switching from one serotonin enhancing antidepressant to escitalopram in individuals who already were complaining of antidepressant-induced sexual dysfunction. We found that 68.1% of patients experienced improvement with their sexual function. The ability to obtain a satisfactory clinical response at relatively low doses may explain this finding. We performed gender, phase of sexual response,and dose analyses. This article discusses results and significance.

Toxicity profile and objective response of paclitaxel in metastatic breast cancer.

OBJECTIVE: To evaluate the efficacy and toxicity of 1-hour weekly Paclitaxel in metastatic breast cancer along with evaluation of overall survival. DESIGN: A phase II interventional trial. PLACE AND DURATION OF STUDY: Oncology Department, Combined Military Hospital, Rawalpindi, between August 2001 to July 2003. PATIENTS AND METHODS: Thirty-six patients were enrolled in the study. All patients with histologically confirmed and bi-dimensionally measurable metastatic breast cancer who had received previously either chemotherapy or hormone therapy were included in the study. Paclitaxel was administered in 1-hour weekly infusion in a dose of 100 mg/m2 for 12 doses. RESULTS: All patients had received previous chemotherapy with either CAF or CMF. Twenty-five patients had also received hormone therapy, 61% had two or more metastatic sites involved, and lung was the common site of involvement. Complete response was observed in 4 (11.1%) patients, partial response in 14 (38.8%) patients, with an overall response rate of 50.0%. Clinical benefit was 94.4% and median overall survival was 11 months. Treatment was well-tolerated with no grade 3 or 4 toxicity. Common side effects were arthralgias, myalgias and neutropenia. CONCLUSION: Treatment with 1-hour weekly infusion of Paclitaxel is a well-tolerated chemotherapy with a substantial degree of efficacy in patients with metastatic breast cancer.

Efficacy of letrozole for advanced breast cancer in postmenopausal patients.

OBJECTIVE: To evaluate the clinical benefit and tolerability of letrozole after tamoxifen failure in locally advanced, recurrent or metastatic breast cancer in postmenopausal patients. DESIGN: A phase II non-randomized trial. PLACE AND DURATION OF STUDY: Oncology Department, Combined Military Hospital, Rawalpindi, from March 1999 to February 2001 over a period of 2 years. PATIENTS AND METHODS: One hundred and seventeen patients with tamoxifen failure were treated with letrozole 2.5 mg once daily, through oral route. All the accrued patients were either estrogen/progesterone receptor positive or unknown with KPS of more than 50%. Patients who had prior hormone therapy other than tamoxifen, or more than one chemotherapy for recurrent or advanced disease were not enrolled in the study. Time to progression (TTP) was the primary objective, whereas objective response (OR), duration and rate of clinical benefit (complete response + partial response + stable disease >6 months), tolerability and effects on quality of life were the secondary end points. RESULTS: The clinical benefit was 47.0% with an objective response of 28.2%. The objective response and median time to progression in soft tissue disease was better than in the visceral and bone disease. The median time to progression for patients having positive estrogen receptor / progesterone receptors (ER / PR) was 9.5 months which is slightly higher than in patients having unknown ER / PR status. The treatment with letrozole was well-tolerated with side effects observed in only 14 patients. CONCLUSION: Letrozole is an effective hormone therapy after tamoxifen failure since it has significant clinical benefit and objective response. It can be safely used as second line hormone therapy in postmenopausal patients with locally advanced or metastatic breast cancer.