Medication management in people with Parkinson's disease during surgical admissions.

BACKGROUND: Patients with Parkinson's disease (PD) may experience problems in hospital, with their medication being withheld or inappropriate medication being prescribed. Since surgical admissions present particular risks, the authors examined the management of patients with PD on surgical wards. METHODS: All patients with PD admitted to surgical departments in Aberdeen Royal Infirmary during an 18-month period were identified. Medical and nursing notes were reviewed retrospectively, and drug prescription and administration were studied in detail. All documented complications were recorded. RESULTS: 59 surgical admissions (51 receiving PD medication, median duration 6 days) were studied. 71% had missed doses of PD medication, with 34% missing over 10% of prescribed doses. Values were similar for levodopa and agonists. Overall, 12% of all prescribed PD medication was missed (mean 0.7 missed doses per patient per day). No reason for missed doses was recorded in 64% of cases, while inappropriate reasons included 'out of stock' (12%) and 'nil by mouth' (8%). Centrally acting antidopaminergic drugs (mainly antiemetics) were prescribed in 41% of cases, and administered in 22%. Complications, most commonly neuropsychiatric, were documented in 69% of non-day-case admissions. CONCLUSION: Poor prescribing and incomplete drug administration are common in patients with PD on surgical wards. Measures to improve management are identified.

Cisplatin-based chemotherapy in advanced basal and squamous cell carcinomas of the skin: results in 28 patients including 13 patients receiving multimodality therapy.

This study reports the results of cisplatin (CDDP)-based chemotherapy (CT) as sole therapy and as neoadjuvant (NA) therapy in 28 consecutive patients (pts) with advanced basal cell (BC) and squamous cell (SC) cancers of the skin. CT in 24 pts consisted of CDDP 75 mgm/m2 and doxorubicin (Dox) 50 mg/m2 intravenously (IV) every 3 weeks with Dox being omitted in four pts due to severe preexisting cardiac disease. Thirteen of the 28 pts received CT in the NA setting, five before surgery and eight before radiation therapy (RT). Response rates to CT were complete remission (CR) in eight of 28 (28%) pts, partial remission (PR) in 11 of 28 (40%) for an overall response rate of 68%. Thirteen pts received a second treatment modality with five of 13 pts having a CR to CT alone before the second modality and seven converting to CR postsecond modality for a total CR rate of 12 of 13 (92%) in the multimodality group. Duration of responses in the CT-only group ranged from 4 to 82 months; however, only two patients remain in remission in this group. Of the twelve CRs from the multimodality therapy group, 11 of 12 (91%) pts remain in CR with duration of response ranging from 3 to 81 months. Toxicities were manageable, with no toxic deaths and only five pts stopped CT secondary to side effects. This study suggests the combination of CDDP and Dox is highly effective in BC and SC cancers of the skin and by itself can produce long unmaintained remissions, but when combined with a second modality of therapy, it is capable of producing not only long unmaintained CRs but probable cures in the majority of pts.

Carcinoma of the nasopharynx in young patients.

PURPOSE: To provide an analysis of eighteen cases of adolescent nasopharyngeal carcinoma treated between 1971 and 1989. METHODS AND MATERIALS: Between 1971 and 1989, 48 cases of nasopharyngeal carcinoma were evaluated at the Medical College of Georgia Hospital and Clinics. Eighteen patients between the ages of 9 and 29 years were treated at the Georgia Radiation Therapy Center. All patients presented for treatment with (AJCC) Stage IV disease. Fifteen patients with lymphoepithelioma and three with squamous cell carcinoma histologies received definitive radiation therapy to a median dose of 64.8 Gy. Males outnumbered females by more than 2:1 and the majority of patients (67%) were black. Nine patients received multiagent adjuvant chemotherapy. RESULTS: Thirteen patients are alive from 7 to 166 months (median 32 months) including three with disease at 17, 24, and 132 months. Overall and disease-free survival at 5 and 10 years were 63% and 54%, respectively. Five patients died from disease; four patients had pulmonary metastases while one had CNS metastasis. Eighty percent of relapses occurred within the first 2 years following treatment. Acute and chronic toxicities were limited, consisting primarily of mucositis and xerostomia. Radiation doses of 65 Gy or more (p = 0.049) and age greater than 20 years (p = 0.005) were positive prognosticators for survival. Adjuvant chemotherapy, race, and sex were not found to be of prognostic value. Disparities in the distribution of patients with lymphoepithelioma and squamous cell histologies and the presentation of advanced regional disease precluded analysis for prognostic significance of histology and nodal status in this series. CONCLUSION: The results of the present series compare favorably with those published from other institutions. High doses of radiation and a high systemic failure rate continue to be the fundamental obstacles to effective management and enhanced survival for patients with nasopharyngeal carcinoma.

Design, synthesis, and correlation analysis of 7-substituted 4-hydroxyquinoline-3-carboxylic acids as inhibitors of cellular respiration.

Fifteen 7-substituted 4-hydroxyquinoline-3-carboxylic acids have been designed to minimize covariance between the physicochemical substituent parameters: pi, MR, and sigmap. The molecules have been synthesized and evaluated for their ability to inhibit the respiration of Ehrlich ascites cells as a whole cell model and for their ability to inhibit malate dehydrogenase as an intracellular target enzyme model. Correlation analysis indicates that ascites cell inhibition is linearly related to pi and that malate dehydrogenase inhibition is linearly related to MR.

4-hydroxyquinoline-3-carboxylic acids as inhibitors of cell respiration. 2. Quantitative structure-activity relationship of dehydrogenase enzyme and Ehrlich ascites tumor cell inhibitions.

Studies on dehydrogenase enzyme inhibition have been extended with the design, synthesis, and correlation analysis of 7-[(substituted-benzyl)oxy]-, 7-[(substituted-phenethyl)oxy]-, and 7([substituted-phenoxy)ethoxy]-4-hydroxyquinoline-3-carboxylic acids. Sixteen new congeners and the fifteen molecules previously synthesized have been tested against cytoplasmic malate dehydrogenase and lactate dehydrogenase, as well as against mitochondrial malate dehydrogenase. The lipophilic congeners show a clear specificity for inhibition of the mitochondrial enzyme. Correlation analysis of the data on the three enzymes allows a comparison of the binding sites in quantitative terms, while examination of the data on inhibition of ascites tumor cell respiration affords an indication of membrane transport. A newly developed high-pressure liquid chromatography based retention index is compared to the octanol-water pi constant as a model for hydrophobic interactions.

Busulphan lung in childhood.

A child receiving busulphan treatment for adult-type chronic myeloid leukaemia responded well for four years before the onset of complications leading to "busulphan lung'. Pulmonary function tests (PFT) were useful in monitoring the development of this condition and we recommended regular PFT for patient receiving busulphan treatment.

Invasive squamous cell carcinoma of the vagina: a 14-year study.

A retrospective review was conducted of patients with squamous cell carcinoma of the vagina managed at one institution over a 14-year period. The 28 cases of squamous cell vaginal carcinoma constituted 3.1% of all female genital tract cancers. Forty-six percent of the patients had undergone a previous hysterectomy for benign disease or for cervical intraepithelial neoplasia; 14.2% had had irradiation. Disease of stage III or greater occurred in 43% of the study group. The majority of patients were treated by radiation therapy. The overall survival was 42.8%. This review indicates that patients who have had a previous hysterectomy should remain under close surveillance.

Orbital tuberculosis in childhood.

An 11-year-old Indian girl living in England developed proptosis due to tuberculosis of the orbit. The proptosis regressed and she recovered fully after chemotherapy. While malignancy, developmental anomalies, and nontuberculous infections are commoner causes, a tuberculin test should be included among the investigations of children with proptosis.

Renal lesion in Jeune's syndrome.

In three children, presenting in chronic renal failure at the ages of six, four and three years radiology suggsested the diagnosis of Jeune's syndrome (asphyxiating thoracic dysplasia). In each case the skeletal survey showed widespread diagnostic features of this condition. The syndrome is characterized by varying degrees of repiratory distress in infancy and early childhood, with osseous dl three children in this study died from juvenile nephronopthisis. The correct diagnosis is essential for patient management and prognosis and also for genetic counselling. This report emphasizes the importance of the renal lesions in older children with Jeune's syndrome.

Ultrasound findings in children with cystic fibrosis.

The results of a prospective study using ultrasound to assess abdominal complications in 76 children with proven cystic fibrosis are reported. Fifty-six patients (74%) had normal liver ultrasound scans. The most striking abnormality was an irregular, inferior edge to the liver occurring in 85% of abnormal liver scans and in 70% there was corresponding clinical and biochemical evidence of abnormal liver function. This finding has been only briefly mentioned before. Increased reflectivity in abnormalities of the pancreas and gallbladder is also described.

Computed tomography of Grave's ophthalmopathy. Diagnosis, management, and posttherapeutic evaluation.

Computed tomography (CT) is emphasized in the diagnosis and management of Grave's ophthalmopathy. This report illustrates the value of CT in evaluating the extent of disease, choice and timing of treatment, radiation therapy planning, and posttreatment follow-up of nine patients with Grave's ophthalmopathy. Eight patients had bilateral disease, and three patients had evidence of optic nerve compression. Postirradiation follow-up CT was done in three patients. Eight patients treated with radiation obtained good response.

Beckwith-Wiedemann syndrome: role of ultrasound in its management.

There is a well-recognised association between Beckwith-Wiedemann syndrome (BWS), hemi-hypertrophy of a limb and childhood malignancies. Ten children with BWS were seen over a period of 14 years. Their ages ranged from newborn to 14 years and the maximum follow-up extended to 14 years. Three children also had hemi-hypertrophy of the lower limb. In one child Wilms' tumour was diagnosed at the age of 4 years; she was successfully treated with surgery and chemotherapy and has been disease-free for the past 7 years. One patient died in infancy, while the remaining nine children were regularly followed up, including 3-monthly ultrasound scans of the kidneys and upper abdomen. Ultrasonic features of nephromegaly, lobulated margin, corticomedullary cysts and nodules of mixed echogeneity and pelvi-calyceal distension are illustrated. Ultrasound is a non-invasive, non-ionising and safe modality with very little discomfort to the patient and is ideal for regular and frequent follow-up of infants and children with conditions predisposed to malignancy.

Necrotising entero-colitis following umbilical vein catheterisation.

Fifteen cases of neonatal necrotising entero-colitis (NEC) following umbilical vein catheterisation are reported. Their clinical and radiological features are briefly described and the proper course of a catheter through the umbilical vein--ductus venosus--inferior vena cava segment is demonstrated. The significance of mal-position of the catheter and its association with NEC is discussed. It is suggested that the abdominal radiographs be taken in the antero-posterior and lateral projections with a portable X-ray machine to check the position of the radio-opaque catheter prior to the commencement of transfusion of infusion.

Unusual sites of acute osteomyelitis in childhood.

In children osteomyelitis is common in the long hours of femur, tibia and humerus. This study reports 16 children, aged 2-13 years, with osteomyelitis at unusual sites: in the bones of the thoracic cage including three involving the clavicle; in the spine, foot and elsewhere. In one case, multifocal involvement of the vertebral body and the knee occurred. In two large series reported previously, the incidence of osteomyelitis was 1-3% in the clavicle, 3-8% in the calcaneus and less than 1% in the ribs. Four out of 16 cases (two involving clavicles, one rib and one with multifocal sites of the lesion) required open biopsies and histological examination to achieve the final diagnosis of osteomyelitis; in three of these patients the causative agent was not identified on culture. Staphylococcus aureus was the infective organism in 50% of cases where cultures were obtained. In five cases there was no growth on culture and specific search for less common organisms, including mycobacteria tuberculosis (AAFB), proved negative. It is suggested that in such situations diagnostic problems may present as the clinical and radiological findings may not be specific or conclusive. In such cases early biopsy is mandatory.