Americans are clearly losing the battle against malignant melanoma. In 1930, it was estimated that one in 1,500 people would develop melanoma sometime during their lifetimes, but by the year 2000, one in 75 people in the United States will develop the disease. Although the individual case prognosis is improving, the death rate has doubled in the last 35 years. The rising mortality rate has to be attributed to an escalating incidence that is not offset sufficiently by improved diagnosis and treatment. Malignant melanoma is a disease that lends itself to early detection and screening programs. Melanoma is highly prevalent and causes considerable morbidity and mortality. The natural history of the disease is known and it is well established that the earlier diagnosis of "thinner" lesions can reduce morbidity and mortality. There is also an acceptable, safe, inexpensive, and noninvasive screening test for melanoma, the skin examination. This work reviews the current evidence that melanoma screening may be effective, compares screening projects for this cutaneous tumor with other screening programs, and outlines a proposed project for melanoma screening.

Humans↗

PubMedDate not supplied

The pharmacologic effects of recombinant, human colony-stimulating factors and their modulation by theophylline.

STUDY OBJECTIVES: To investigate the effect of colony-stimulating factors (CSFs) on drug metabolism using theophylline as a substrate (phase I), and to evaluate the influence of theophylline on endogenous serum cytokine concentrations (phase II). DESIGN: Open-label, prospective study. SETTING: The bone marrow transplant unit of a tertiary university teaching hospital. PATIENTS: Thirty-seven women with breast cancer (28 phase I, 9 phase II). INTERVENTIONS: Patients received aminophylline 0.58 mg/kg either as a 30-minute intravenous infusion before receiving recombinant CSFs or after several days of CSF therapy, just before high-dose chemotherapy (phase I) or as a continuous intravenous infusion after bone marrow transplantation (phase II). MEASUREMENTS AND MAIN RESULTS: Clearance of theophylline was significantly higher after CSF administration (0.76 vs 0.99 ml/min/kg, p = 0.019). Continuous infusion of aminophylline resulted in elevations of serum macrophage-CSF and interleukin 6. CONCLUSIONS: Administration of CSFs before autologous bone marrow transplantation for priming progenitor cells may alter drug metabolism. Studies should be conducted to evaluate the potential effects of CSFs on the disposition of chemotherapeutic agents.

Adult↗

PubMedDate not supplied

Extravasation of liposomal daunorubicin in patients with AIDS-associated Kaposi's sarcoma: a report of four cases.

PURPOSE/OBJECTIVES: To report on four patients with AIDS-related Kaposi's sarcoma who were treated with liposomal daunorubicin (DaunoXome, NeXstar Pharmaceuticals, Inc., San Dimas, CA) as part of phase I/II and phase III clinical trials and who experienced extravasation during IV infusion. DATA SYNTHESIS: All patients were treated with ice as an immediate intervention. In addition, two patients received treatment with multiple subcutaneous injections of steroids. Two patients experienced erythema, swelling, and pain after the extravasation. Two patients who were treated aggressively reported erythema and swelling without pain. Three patients observed changes in the texture of their skin that was accompanied by decreased sensation, which developed after 8-16 weeks. These changes completely resolved in all patients receiving intervention after six months. None of the patients suffered tissue necrosis. CONCLUSIONS: Extravasation with liposomal daunorubicin is notable for the absence of tissue necrosis that typically is observed with anthracyclines. Long-term effects were limited to skin discoloration and decreased sensation, both of which resolved in all patients. IMPLICATIONS FOR NURSING PRACTICE: The lack of observed skin necrosis with daunorubicin suggests a treatment advantage with a reduction in the required aggressive extravasation procedures for free anthracyclines as well as increased safety for the patient. Additional data is needed to confirm these observations.

Acquired Immunodeficiency Syndrome↗