Patients with advanced carcinomas of the hypopharynx or upper esophagus have among the worst prognoses in head and neck oncology. We developed a treatment regimen of rapidly alternating multi-agent chemotherapy and accelerated interrupted radiotherapy as follows: Three cycles of chemotherapy were delivered [day 1, cisplatin 100 mg/m2; days 1-4, 5-fluorouracil (5-Fu) 900 mg/m2] and repeated every 3 weeks. On day 8 of each chemotherapy cycle radiotherapy was started, consisting of 10 fractions of 200 cGy delivered twice daily, for 5 days. The total dose of radiotherapy was 6,000 cGy over 7 weeks, and the total duration of chemotherapy and radiotherapy was 8 weeks. Nineteen patients with locally advanced, epidermoid carcinoma of the hypopharynx (9 patients) or upper esophagus (10 patients) were treated on this protocol. Minimum follow-up was 1 year. Twelve patients had tumors judged technically unresectable, whereas 7 had tumors considered resectable only with total laryngectomy, which was unacceptable to the patients. One patient died of nadir sepsis during treatment, but otherwise the acute toxicity was relatively mild (grade I/II in 16 patients, grade III/IV in 3 patients). The complete response rate was 83% (15 of 18 patients), and the partial response rate was 17% (3 of 18). No patient failed to respond. The survival rate was 80% at 1 year and 73% at 18 months. At 1 year, 89% of the patients remained in remission and at 18 months, 74% Late complications occurred in 4 patients. These included laryngeal necrosis, pneumonitis, esophageal stricture, and tracheoesophageal fistula.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

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Differentiation of alpha-amylase from various sources: an approach using selective inhibitors.

A radial diffusion assay in an agarose/starch gel utilizing crude kidney bean extract and a commercially prepared alpha-amylase inhibitor isolated from wheat seeds was developed and assessed to determine its ability to differentiate alpha-amylase from various sources. Kidney bean extract was found to have a greater inhibitory effect on AMY2, while the wheat lectin inhibitor was found to have a greater inhibitory effect on AMY1. Neither inhibitor was found to have any effect on commercially prepared bacterial alpha-amylase extract in both liquid preparations and dried stains. Mixtures of varying concentrations of pancreatic and salivary extracts also gave interpretable results. Additionally, dried stains prepared from human body fluids having high levels of AMY2 were differentiated from dried stains prepared from human body fluids containing high levels of AMY1.

Bacteria↗

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The active pivot shift: the role of the popliteus muscle.

Ligament insufficiency due to athletic injury is widely recognized and reported as an etiological factor in knee joint instability. It was recognized that a patient presenting with knee joint instability due to past hockey injury to the anterior cruciate ligament, subsequently verified surgically, was able to voluntarily and actively perform the pivot shift maneuver with his knee as a result of his anterolateral rotatory instability. During a subsequent 6 month period, three other patients with similar anterior cruciate deficiencies presented with this same active pivot shift maneuver phenomenon. A study was designed to determine the active muscle or muscles involved in this abnormal active motion in the knee joint with anterolateral rotatory instability. Electromyographic studies with needle electrodes were conducted on a variety of muscles in four subjects presenting with the instability. Results indicated that the popliteus muscle plays a major role in the active performance of the pivot shift maneuver.

Electromyography↗

PubMedDate not supplied

A mouse model for delayed-type hypersensitivity skin changes in chronic renal failure.

Cellular immunity in mice with chronic renal failure was assessed by delayed-type hypersensitivity (DTH) skin testing. Normal, sham-operated, and C57BL/6 mice with chronic renal failure were sensitized and challenged with oxazolone, a contact-sensitizing agent. The magnitude of the DTH response was determined by sequential measurements of ear thickness following local challenge. Consistently lower DTH responses were observed in mice with chronic renal failure. DTH responses in mice with renal failure were highest at 48 hr postchallenge (9.3 +/- 1.3) but still significantly lower (p less than 0.05) than those in both sham-operated (12.9 +/- 0.7) and normal mice (12.6 +/- 1.0). When compared with those of the other groups, DTH responses of sham-operated animals were brisker (24 hr), while those of normal mice were more sustained (72 hr). These results confirm previously reported observations in end-stage renal disease patients. The mouse, along with appropriate skin testing, appears to be a useful model for studying cellular immunity in chronic renal failure.

Animals↗

PubMedDate not supplied

Premenstrual distress, anxiety, and palpitations in a dysphoric woman.

Explore the source record for details and available documents.

Adult↗

PubMedDate not supplied

The prevalence of nosocomial and community-acquired infections in Australian hospitals.

The first national survey of the prevalence of nosocomial and community-acquired infections in Australian hospitals was carried out during July 1984. Data were collected on 28,643 patients in rural and metropolitan, public and private acute-care hospitals. The over-all adjusted prevalence of nosocomial infections was 6.3%; the prevalence of community-acquired infection was 9.7%. A total of 5940 infections occurred; 39% were hospital-acquired infections and 61% were community-acquired infections. These occurred at the following sites: the respiratory tract, 35.4% (2100 infections; contributing 19% of hospital-acquired infections and 46% of community-acquired infections); the urinary tract, 15.1% (896 infections; contributing 22% of hospital-acquired infections and 11% of community-acquired infections); surgical wounds, 13.4% (797 infections; contributing 34% of hospital-acquired infections); the gastrointestinal tract, 7.8% (466 infections; contributing 3.4% of hospital-acquired infections and 11% of community-acquired infections); skin, 6.3% (376 infections; contributing 4.4% of hospital-acquired infections and 8% of community-acquired infections); abscesses, 1.9% (113 infections; contributing 0.9% of hospital-acquired infections and 2% of community-acquired infections); traumatic wounds, 1.5% (90 infections; contributing 0.9% of hospital-acquired infections and 2% of community-acquired infections); bacteraemia, 1.5% (89 infections; contributing 1.6% of hospital-acquired infections and 1% of community-acquired infections); burns, 0.2% (14 infections; contributing 0.3% of hospital-acquired infections and 0.2% of community-acquired infections); and other, 16.8% (999 infections; contributing 13.4% of hospital-acquired infections and 19% of community-acquired infections). There was a significant association between hospital size and infection rates. The nosocomial infection prevalence rate increased from 4.2% in hospitals with 50-99 beds to 7.6% in hospitals with 500 or more beds. The prevalence of community-acquired infections was higher in rural (11.5%) than in metropolitan (8.7%) hospitals. After adjusting for hospital size, public hospitals had significantly-higher prevalences of nosocomial (6.7%) and community-acquired (10.6%) infection than did private hospitals (nosocomial infection, 4.8%; community-acquired infection, 6.3%).

Adolescent↗

PubMedDate not supplied

Predictors of surgical wound infection in Australia: a national study.

In July 1984, the first national Australian Nosocomial Prevalence Survey collected data on 12,742 surgical patients from 265 hospitals. This sample represented 59% of public and private hospitals with 50 or more acute-care beds in Australia. The infection control officers at each hospital provided data on patients in a random sample of beds. The over-all surgical wound infection rate was 4.6%. The surgical wound infection rate was twice (5.4%) as high in public than in private (2.8%) hospitals. The infection rates were greater in larger hospitals in both the public and private sector. However, after adjusting for the other predictor factors that are noted below the infection rate did not show any particular pattern for the size of hospital. Clean surgery had a higher (4.8%) infection rate than did clean-contaminated surgery (2.9%). The infection rate for contaminated surgery was 15.0%. Men were found to have nearly twice (6.5%) the infection rate of women (3.4%). Infection rates were lowest in the 15-to-34 years' age-group and highest in those of over 55 years of age. These trends remained even after adjusting for the other risk factors for infection. The cost of surgical wound infections for all hospitals during the year of 1984 was estimated at approximately $60 million. We suggest that a concerted effort should be made to attempt to reduce the infection rate for clean surgery to 1% or less.

Adolescent↗