Methemoglobinemia induced by topical anesthetic (benzocaine).

Methemoglobinemia is a condition in which more than 2% of the hemoglobin of the blood has been oxidized to the ferric form, a molecule which is incapable of binding oxygen or carbon dioxide. Clinically, the patient appears lethargic, cyanotic, and does not respond to oxygen. We describe a patient with esophageal carcinoma who developed severe methoglobinemia following application of benzocaine in spray for local anesthesia prior to intraluminal irradiation. Review of the literature is presented.

Palliative hemiskeletal irradiation for widespread metastatic prostate cancer: a comparison of single dose and fractionated regimens.

Between 1986 and 1987 patients with hormone refractory metastatic adenocarcinoma of the prostate were treated with hemiskeletal irradiation. One group of 15 patients was treated with a fractionated regimen of 2500-3000 cGy in 9 to 10 fractions. A second group of 14 patients received a single dose of 600 cGy or 800 cGy depending upon whether the upper or lower hemiskeleton was irradiated. Both groups were similar with respect to their initial Karnofsky performance status and extent of disease. With the exception of one patient in the single dose group, all patients treated achieved complete or partial relief shortly after completion of their respective courses of therapy. Of the patients treated with single dose therapy, 10 of 14 (71%) ultimately needed retreatment in the region initially irradiated because of recurrent bone pain or spinal cord compression. In contrast, only 2 of 15 (13%) of the patients receiving the fractionated treatment course needed retreatment (p = .001). Although the median survival of both groups from the time of initial treatments was similar (10 and 11 months), the median duration for palliation was greater for those patients receiving the fractionated regimen as compared with single dose therapy (8.5 months vs 2.8 months). The incidence of treatment related toxicity was similar for both groups. We conclude that fractionated hemiskeletal radiation is a more effective means of palliation when compared to single dose therapy.

Treatment planning for permanent and temporary percutaneous implants with custom made templates.

Nine patients who were presented at MSKCC with primary or recurrent pelvic or head and neck tumors and for whom surgery or further external radiation were excluded, were treated with percutaneous permanent or temporary implants, with individual pre-treatment planning and custom made templates. The tumor dose distributions achieved were as good as for implants performed at the time of surgical exploration. No serious complications have been encountered.

Lung tumors: percutaneous implantation of I-125 sources with CT treatment planning.

Seven patients with lung tumors underwent percutaneous implantation of iodine-125 sources into the tumor. Needle placement and seed implantation were effected with biplane fluoroscopy and a computer planning model based on computed tomography. No complications were encountered. Five of the seven patients underwent the procedure at the outpatient center and were discharged the same day. Follow-up radiologic evaluations were available for six patients; in all six the examination demonstrated tumor shrinkage, and in four tumor shrinkage was essentially complete.