Disposition of a murine monoclonal antibody vinca conjugate (KS1/4-DAVLB) in patients with adenocarcinomas.

The pharmacokinetics of a murine monoclonal antibody vinca conjugate (KS1/4-DAVLB) was investigated in 13 patients with adenocarcinomas who received single intravenous doses ranging from 40 to 250 mg/m2 and in three patients who were administered 1.5 mg/kg every 48 to 72 hours for up to 15 doses. Five patients in the single-dose study also received 100 microCi of [3H]-KS1/4-DAVLB. Overall mean values for the pharmacokinetic variables were as follows: elimination half-life, 31.5 hours; distribution volume, 4.43 L; and clearance, 0.09 L/hr. KS1/4-DAVLB demonstrated linear elimination kinetics in both the single- and multiple-dose studies. Significant concentrations of KS1/4-DAVLB were noted in a pleural effusion. Ten percent of the radioactive dose was recovered in the urine and 20% in the feces over a 5-day period. Small molecular weight vinca species were detected in the feces but not in the serum.

Determining the effectiveness of a clinical-practice intervention in improving the control of pain in outpatients with cancer.

PURPOSE: To determine the effectiveness of a clinical-practice intervention in improving the control of pain in outpatients with cancer. METHOD: Between July 5 and September 30, 1995, a randomized, controlled trial of 510 cancer outpatients and 13 oncologists was conducted at 23 clinics in Indiana. All the patients completed assessments of their pain, their pain regimens, and the degrees of relief received; they were surveyed again by mail four weeks after their clinic visits. The intervention group's clinical charts contained a summary of the completed pain scales; the oncologists who treated these patients were instructed to review the summary sheet prior to an evaluation. This summary was not available for the oncologists treating the patients in the control group. Each patient's pain management index (PMI) was calculated: the patient's pain medication level was rated on a scale of 0 to 3; the patients's pain level was rated on a scale of 0 to 3 and then subtracted from the first rating. A negative PMI was interpreted as representing insufficient treatment. Data were analyzed with several statistical tests. RESULTS: In all, only 320 patients who reported cancer-related pain were used in the analysis: 160 to 260 in the control group and 160 of 250 in the intervention group. The groups were similar with respect to demographics, cancer sites, and performance status. A significant difference (p = .0162) in the physicians' prescription patterns was found. In the control group, prescriptions for 86% of the patients did not change, with no decrease in analgesic prescriptions; for 14% of the patients analgesic prescriptions increased. In the intervention group, analgesic prescriptions changed for 25% of the patients, decreasing for 5% and increasing for 20%. A decrease in the incidence of pain described as more than life's usual aches and pains was found for the intervention group (p = .05). No significant difference was found between the groups for the patients undertreated for pain, as measured by PMIs. CONCLUSION: Although analgesic regimens were altered significantly when the physicians understood more about the patient's pain, cancer pain management remains a complex problem. Future studies should focus on the long-term systematic incorporation of simple pain-assessment tools into daily outpatient oncology practices as well as on innovative ways to address other aspects of managing cancer pain.

Correlation of prosthetic femoral head size and/or design with longevity of total hip arthroplasty.

Sixty-seven Mueller and 84 Charnley total hip arthroplasties were followed up for a minimum of seven years; pain, radiographic radiolucency, and prosthetic component loosening were evaluated. The patients who had Mueller total hip prostheses had significantly more pain at five (p less than 0.021) and seven years (p less than 0.001). No statistical differences were found between the two prosthetic groups in regard to incomplete or complete radiolucency or loosening of the femoral component, or incomplete or complete nonprogressive radiolucency of the acetabular component. The Mueller acetabular cup was loose in 15%, as compared with 4% for the Charnley group (p less than 0.032). A survival analysis at five and seven years revealed that the success rate for Charnley total hip arthroplasties was 94% and 86%, respectively, as compared with 87% and 70%, respectively, for Mueller total hip arthroplasties (p less than 0.003). This difference possibly is due to the large Mueller femoral head; if so, resurfaced hips would also experience earlier acetabular loosening.

The posterior cruciate condylar total knee prosthesis. A five-year follow-up study.

Remarkable results were demonstrated for the nonlinked, semiconstrained total condylar knee prosthesis in the first long-term follow-up study. The posterior cruciate condylar prosthesis, a variation of the basic design, leaves the posterior cruciate ligament intact. Ninety-four consecutive knees were observed for a minimum postoperative follow-up period of five years. Apart from this design modification and a slightly different program of postoperative care, the methods and techniques used were identical to those used with the total condylar knee prosthesis. By the same method of assessment (The Hospital for Special Surgery Knee Rating Scale), 54 of the ninety-four knees (57.4%) were rated excellent; 37 (39.4%), good; two (2.1%), fair; and one (1.0%), poor. The average preoperative score was 48 points, and the average postoperative score was 81 points (85-100 points = excellent). The posterior cruciate condylar total knee prosthesis represents an excellent prosthetic design for a wide variety of knee deformities and maintains the posterior cruciate ligament for supplementary posterior support.