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PubMed2002

Prospective study of carboplatin-based chemotherapy for pediatric germ cell tumors.

BACKGROUND: Survival of pediatric patients with malignant germ cell tumors has improved dramatically with the use of cisplatin-based chemotherapy, though patients are at high risk of significant long-term complications. In a prospective study, carboplatin was substituted for cisplatin in an attempt to minimize nephro- and oto-toxicities, while achieving excellent disease-free survival. PROCEDURE: All consecutive patients with malignant germ cell tumors at The Children's Hospital of Philadelphia were treated between 1989 and 1998. After pathologic confirmation of disease and pretreatment evaluation of pulmonary, renal, and otologic function, patients received etoposide 150 mg/m(2) days 1, 2, 3; carboplatin 600 mg/m(2) day 2; and bleomycin 10 mg/m(2) day 3 for at least four courses. RESULTS: Twenty-three patients were entered for study, and were available for evaluation. All patients achieved either a complete or partial remission following therapy with surgery and chemotherapy. With a median of 58 months of follow-up, overall survival is 91% and event-free survival is 87%. Therapy was given as an outpatient, and well tolerated, with 20 admissions for fever and neutropenia. Ototoxicity and nephrotoxicity, when evaluated, have been extremely limited. Three patients, all with stage III disease, have relapsed; one of these remains alive and disease free. CONCLUSIONS: Carboplatin can successfully substitute for cisplatin during the treatment of pediatric germ cell tumors without sacrificing response or survival. Long-term effects, especially nephrotoxicity and ototoxicity, were rare or mild among the small number of patients evaluated. Carboplatin appears to be a safe and efficacious alternative in the treatment of germ cell tumors, and should be considered as primary therapy for pediatric patients.

Adolescent↗
PubMedDate not supplied

Tolerability of piperacillin/tazobactam in children and adolescents after high dose radio-/chemotherapy and autologous stem cell transplantation.

The combination of piperacillin with tazobactam (PIP/TAZ) extends the activity of piperacillin against gram-positive, gram-negative, and anaerobic bacteria. The broad-spectrum of this formulation, together with its low degree of organ toxicity observed in adults, makes PIP/TAZ a tempting choice for children with radio-/chemotherapy-induced neutropenia. However, the use of PIP/TAZ is not yet approved for children under 12 years of age. The tolerability of PIP/TAZ was assessed in 19 children and adolescents between 2 and 18 years of age who developed a fever during aplasia after high dose radio-/chemotherapy and autologous stem cell transplantation (HD-SCT) for primary multifocal or relapsed solid tumours. Treatment with PIP/TAZ was initiated on average 3 days after HD-SCT, and the treatment was continued for approximately 10 days. Both clinical observation and laboratory studies showed no relevant alterations that would have been attributable to PIP/TAZ treatment. These results indicate that PIP/TAZ appears to be well tolerated in children during the acute phase of HD-SCT.

Adolescent↗
PubMed1999

Goethe almost died of urosepsis.

In the year of 1805, Goethe almost died of urosepsis. His urological problems were not diseases arising from full health but a new variation in a life accompanied by illnesses. Some sources date the first colics he experienced to the year 1795 and others say 1805. The most dramatic period in the course of his illness was in February, when he suffered from fever of such an extent that one could speak of urosepsis. Recovery took place slowly and was accompanied by minor relapses. Nothing about this is written down in his work. On the advice of his doctors, Goethe undertook a cure in Lauchstädt in July and August. The report of his consultant, Professor Johann Christian Reil, on his problems in the field of urology remained undiscovered until 1937. Professor Reil recommended treatment with thermae carolinae, aqua calcis, soap soda crystallisata, herbae subastringentes, and uva ursi, among other measures. With increasing age, Goethe's colics disappeared. The passing of a stone has never been described. Whereas Goethe hinted about medical problem other than those reported herein, the urological problems discussed in this article were left unmentioned. Nonetheless, literature that deals with Goethe's diseases is interesting from the aspect of both the history of medicine and the history of culture.

Bacteremia↗
PubMed2003

Effective treatment of relapsing idiopathic nodular panniculitis (Pfeifer-Weber-Christian disease) with mycophenolate mofetil.

Relapsing idiopathic nodular panniculitis is the term used to describe a group of diseases that presents as subcutaneous inflammatory nodules, fever and systemic symptoms and histopathologically displays inflammation within the fat lobules. There is no specific test for diagnosis and extensive investigations are required to exclude systemic causes of panniculitis. No uniform effective therapy is available and various drugs used include mainly corticosteroids alone or in combination with other immunosuppressive agents. Presented in this paper is an intractable case of idiopathic nodular panniculitis whose corticotherapy failed and could not be continued because of serious adverse effects. The rapid and good therapeutic response of the patient to mycophenolate mofetil monotherapy is discussed.

Acrocephalosyndactylia↗
PubMed1999

A comparative study of ofloxacin and cefixime for treatment of typhoid fever in children. The Dong Nai Pediatric Center Typhoid Study Group.

BACKGROUND: Despite concerns about safety in children, fluoroquinolone antibiotics have become the treatment of choice in patients with multidrug-resistant typhoid fever in Vietnam. However, quinolone-resistant strains of Salmonella typhi have recently been reported from Vietnam; and if quinolone resistance becomes established, alternative oral treatment options will be needed. OBJECTIVE: Cefixime, an orally administered third generation cephalosporin, was compared with ofloxacin for the treatment of uncomplicated typhoid fever in children. METHODS: In an open trial children with suspected typhoid fever were randomized to receive either ofloxacin (10 mg/kg/day in two divided doses) for 5 days or cefixime (20 mg/kg/day in two divided doses) for 7 days. RESULTS: S. typhi was isolated from 82 patients (44 in the cefixime group, 38 in the ofloxacin group) and 70 (85%) of the isolates were multidrug-resistant. Median (95% confidence interval, range) fever clearance times were 4.4 (4 to 5.2, 0.2 to 9.9) days for ofloxacin recipients and 8.5 (4.2 to 9, 1.8 to 15.2) days for cefixime-treated patients (P < 0.0001). There were 11 treatment failures (10 acute and one relapse) in the cefixime group and 1 acute treatment failure in the ofloxacin group (mean difference, 22%; 95% confidence interval, 9 to 36%). CONCLUSION: Short course treatment with cefixime may provide a useful alternative treatment in cases of uncomplicated typhoid fever in children, but it is less effective than short course treatment with ofloxacin.

Adolescent↗
PubMed1993

Safety and efficacy of teicoplanin for bone and joint infections: results of a community-based trial.

To evaluate the efficacy and safety of teicoplanin in the treatment of gram-positive bone and joint infections, parenteral teicoplanin was used once daily in an average dose of 10.1 mg/kg (range 6 to 12 mg/kg) after loading to treat patients with acute or chronic osteomyelitis and septic arthritis. From the 66 patients who met criteria for initial enrollment, 60 gram-positive isolates were recovered from bone and joint fluid, and each was sensitive to teicoplanin at < or = 2 micrograms/mL (median 0.25 microgram/mL). Teicoplanin was more active in vitro against these isolates than either vancomycin or oxacillin. Among the 43 patients in whom microbiologic efficacy could be assessed, the initial pathogen was eradicated in 37 (86%). Clinically, 45 patients infected with staphylococci (including oxacillin-susceptible and oxacillin-resistant Staphylococcus aureus and coagulase-negative staphylococci) met predetermined criteria for completed adequate therapy. Of these, 39 (87%) responded favorably and became free of all signs of infection; 6 (13%) failed to respond or suffered relapse. Overall, 36 patients completed teicoplanin therapy at home. Adverse reactions necessitated discontinuance of therapy in 12 patients and included fever, rash, hepatic function test abnormalities, and renal insufficiency. We found teicoplanin to be effective and generally well tolerated for treatment of bone and joint infections by gram-positive organisms in a community setting.

Acute Disease↗
PubMed1992

[A psoas abscess in a patient with Crohn's disease].

We report a case of Crohn's disease diagnosed 13 years ago, complicated by a psoas abscess. The main symptoms were flexion deformity of the hip, pain and fever. Diagnosis was made by CT-scan. Surgical and CT-guided percutaneous drainage was ineffective and the abscess relapsed. Surgical resection of the affected bowel with abscess drainage, provided patient's healing.

Adult↗
PubMed1990

[Multiple liver abscesses due to Candida albicans in a patient with acute promyelocytic leukemia: percutaneous transhepatic intraportal administration of amphotericin B].

A 36-year-old male with acute promyelocytic leukemia in second relapse was admitted to receive reinduction therapy in June, 1985, and entered into third complete remission, but he developed spiky fever after chemotherapy. Ultrasonic tomography revealed multiple liver abscesses and culture of the aspirates demonstrated Candida albicans in the abscesses. He was treated with intravenous administration of amphotericin B (AMPH-B) but the effect on the liver abscesses was unsatisfactory and consolidation therapy was difficult to start. AMPH-B (30 mg/day) was administered by percutaneous transhepatic intraportal administration (PTIA). About two months later, multiple liver abscesses disappeared. No remarkable complications such as severe fever, chill and renal dysfunction were recognized during PTIA of AMPH-B. So PTIA of AMPH-B is considered to be useful and safe for the management of fungal liver abscesses.

Adult↗
PubMed1995

A case of acute lymphoblastic leukemia accompanied with the production of parathyroid hormone-related protein.

Hypercalcemia accompanied with malignant tumors is generally classified into two categories, namely with or without bone metastasis. As for the latter, bone resorption-stimulating factors produced by tumor cells, such as parathyroid hormone-related protein (PTHrP), show hormone-like effects and promote a bone resorption. Many cases have been reported regarding the production of TPTHrP in adult T cell leukemia (ATL), but few have been reported with acute lymphoblastic leukemia (ALL). We report here a similar case with ALL. A 12-year-old male presented with fever, petechiae and thrombocytopenia, and was diagnosed as ALL. We started the induction therapy and confirmed complete remission. Later, he relapsed 3 times without symptoms apart from hypercalcemia at the beginning. Elevation of the serum calcium level followed by a rise of lymphoblastic cells was recognized. Bone metastasis was excluded since bone mineral density and serum mid region PTH were normal and no abnormal findings were noticed on X rays and 99mTc bone scintigraphy. However, his urinary PTHrP level was high, and his lymphoblastic cells staining immunocytochemically with the monoclonal antibodies against the C-terminal region of PTHrP showed a positively brownish color. Finally, he died of pulmonary aspergillosis. Hypercalcemia was not related to serum PTH or bone metastasis. ATL viral infection reported as a cause of PTHrP production was also excluded from several experimental data. Therefore, we concluded that lymphoblastic cells directly produced PTHrP, and that this PTHrP played an important role in the induction of hypercalcemia.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[JOMOL--immunostimulation and rejection of tumor cells?].

Jomol contains cell wall fragments of the bacterium Nocardia opaca composed of 40% oligopeptides, 40% lipids, 10-15% polysaccharides, and 5-10% peptidoglycans. Technetium labeled--Jomo tech--and Indium-labeled--Jomo in--preparations are used for diagnosing cancer. Jomol is promoted to cure any cancer, except Non-Hodgkin lymphoma and ovarian cancer. It is claimed that Jomol has no side effects, however chills and high fever have been observed. Following initial intensive therapy with daily injections of Jomol, a maintenance therapy is recommended to prevent relapses. One vial of Jomol or Jomo-tech costs 450.--DM. Dr. U. Ehrenfeld, an oral surgeon, developed the aqueous extract of Nocardia opaca and patented it in 1983 under the name of Jomol. Ehrenfeld is promoting Jomo-tech and Jomo-in for qualitative and semi-quantitative cancer diagnosis with whole body scintigraphy. The following action of mechanisms of Jomol are claimed: 1. Unspecific stimulation of cellular immune mechanisms, 2. xenogenization of tumor cells towards a bacterial surface by adhesion of Jomol and then attraction and activation of macrophages. Despite the positive claims of the promoters the preclinical and clinical investigations are insufficient or missing, therefore a routine treatment of malignancies with Jomol is not justified except in study protocols. Jomol is not registered at the Intercantonal Office for Drug Control in Switzerland and is not approved by the Public Health Department in Germany and is not reimbursed by most of the state health insurances.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1997

Interferon alpha in the therapy of multiple myeloma.

Response rates of 20% were achieved when interferon alpha (IFN) was applied as single agent treatment for multiple myeloma. A synergistic activity was observed when IFN was combined with chemotherapeutic agents in vitro and in vivo. These observations led to a series of randomized trials comparing chemotherapy alone with the combination of IFN and chemotherapy which yielded controversial results. Ludwig et al have analyzed presently available data of randomized trials in a systematic overview. In 16 trials, 2286 patients were randomized either for induction therapy with chemotherapy or IFN combined with chemotherapy. The IFN dose ranged between 4.8 and 18.7 MU/week. The overall response rate was 45.9% for patients treated with chemotherapy alone compared to 54.4% for patients treated with IFN alpha and chemotherapy. The gain of relapse-free survival was 6 months and the gain of overall survival was 5 months for IFN-treated patients. Advances in treatment were due to the expense of more severe side-effects in IFN-treated patients expressed by hematological side-effects, fever, nausea and neurological as well as psychological alterations. IFN maintenance therapy was evaluated from eight trials comprising 929 patients randomized for IFN-treatment or 'wait and see'. IFN maintenance treatment prolonged the average relapse-free survival by 7 months and prolonged the average overall survival by 5 months. Younger patients, patients in good performance status and patients with lower tumor burden seem to benefit most from the addition of IFN to chemotherapy or from IFN maintenance therapy. In conclusion, IFN shows a minor beneficial effect on response rates, progression-free and overall survival in the above mentioned patient group and might be applied when high-dose chemotherapy with transplantation is not feasible. IFN has been shown to be effective for maintenance therapy in patients with lower tumor burden who have responded to induction therapy.

Clinical Trials as Topic↗
PubMed1996

Babesiosis in patients with AIDS: a chronic infection presenting as fever of unknown origin.

Babesiosis is a malaria-like, tick-transmitted zoonosis caused by protozoa of the family Piroplasmorida, which includes Babesia and Theileria species. In the United States, the infection is endemic in the Northeast and upper Midwest, although cases have recently been described in Northern California and Washington State. We report a case of babesiosis in a patient infected with HIV who presented with a prolonged fever of unknown origin; the patient had not undergone splenectomy. Parasitemia persisted despite initial clinical improvement after treatment with quinine and clindamycin. Babesiosis was controlled with a maintenance regimen consisting of clindamycin, doxycycline, and high-dose azithromycin, but the infection was not eradicated. Babesiosis should be considered in the differential diagnosis of HIV-infected patients with fevers and/or anemia in areas where the infection is endemic. HIV-infected patients who are severely immunosuppressed, even those without a history of splenectomy, may present with severe manifestations of babesiosis and develop a chronic infection, which may require therapy to prevent relapse of disease.

AIDS-Related Opportunistic Infections↗
PubMed1998

Paclitaxel plus high-dose cyclophosphamide with G-CSF support in patients with relapsed and refractory aggressive non-Hodgkin's lymphoma.

Based on the single-agent activity of both paclitaxel and cyclophosphamide in the treatment of non-Hodgkin's lymphoma (NHL), we conducted a phase II study to evaluate the efficacy of the combination of the two drugs in patients with refractory and relapsed aggressive NHL. All patients received 900 mg/m2 bolus of cyclophosphamide intravenously daily for 3 consecutive days with a concurrent infusion of 150 mg/m2 of paclitaxel over 72 h (50 mg/m2/d). 24 h after the completion of chemotherapy, patients received subcutaneous injections of 5 microg/kg of granulocyte-colony stimulating factor (G-CSF) daily until white cell count recovery. Treatment was repeated every 3 weeks. Patients who had at least a partial response (PR) after two courses continued to receive a maximum of four courses. Patients with responding disease were allowed to undergo high-dose chemotherapy followed by stem-cell/bone marrow transplantation if they were eligible. Of the 77 patients who were eligible for the study, 74 (96%) were evaluable for toxicity and treatment response. The overall response rate was 45% (95% CI 33-57%). Patients who received treatment after their disease relapsed from a complete response (CR) had an 81% response rate (38% CRs), whereas those with primary refractory disease had a 22% response rate. Toxicities of > grade 2 included alopecia (100%) and stomatitis (25%). Neutropenic fever of grade > 2 occurred after 18% of the courses, and platelet count of < or = 20 x 10(9)/l developed after 20% of the courses. Thus, the combination of paclitaxel plus high-dose cyclophosphamide is an effective new regimen in the treatment of refractory and relapsed NHL.

Adult↗
PubMed2006

Successful treatment of visceral leishmaniasis with liposomal amphotericin B.

We report a case of a 26-year-old female from Kenya who suffered from intermittent fever of unknown origin for one month. The major findings on admission were pancytopenia associated with considerable splenomegaly. The diagnosis was established by visualisation of amastigotes in bone marrow biopsy and by detection of antibodies to Leishmania spp. in blood. The infection was treated intravenously with liposomal amphotericin B for five days. The patient was afebrile after the first infusion. No relapse was reported.

Adult↗
PubMed1992

Optimal duration of therapy for catheter-related Staphylococcus aureus bacteremia: a study of 55 cases and review.

Over the last two decades, the optimal duration of therapy for catheter-related Staphylococcus aureus bacteremia has become the subject of controversy. A review of the literature revealed an occasional association between relapse of the infection and a short course of therapy (less than 10 days of iv antibiotic therapy). From records kept between 1983 and 1989 at the University of Florida's affiliated hospitals, we identified 55 patients with catheter-related S. aureus bacteremia. Nine patients (16%) developed acute early complications (e.g., endocarditis or osteomyelitis) while receiving antibiotics. The results of multivariate analysis showed that an early complicated course was characterized by fever and/or bacteremia that persisted for greater than 3 days after catheter removal (P = .02). The remaining 46 patients were followed up for at least 3 months. During follow-up, three of the 18 patients treated for less than 10 days with iv antibiotics developed relapsing septicemia, whereas none of the 28 patients treated for a longer period developed this condition (P = .05). Fever and/or bacteremia that persists for greater than 3 days after catheter removal and initiation of antibiotic therapy suggests an acutely complicated course requiring prolonged treatment. The duration of iv antibiotic therapy in uncomplicated cases should not be less than 10 days but need not be greater than 2 weeks.

Adolescent↗
PubMed1999

Outcome in three groups of patients with typhoid fever in Indonesia between 1948 and 1990.

The outcome in three groups of patients with bacteriologically confirmed typhoid fever caused by Salmonella typhi, treated during three episodes between 1948 and 1990 in Java, Indonesia, was compared by retrospective analysis of hospital records. The study population consisted of three groups of patients. Group I (n = 50) was treated in Batavia (the present Jakarta) from 1948 to 1950, Group II (n = 61) in Yogyakarta from 1952 to 1956, Group III (n = 105) in Semarang from 1989 to 1990. Main outcome measures were days until defervescence, early relapses during hospitalization, duration of hospital stay, complications and mortality. Group I received supportive treatment only, Group II low doses of chloramphenicol (total 12.5 g) and Group III full doses of chloramphenicol (total 27 g); occasionally other antibiotics were used. In Group I, II and III the mean number of days until defervescence was 16, 8 and 6 and the mean number of days in hospital 43, 47 and 15, respectively. Mortality was 26%, 10% and 5% and complications occurred in 38%, 18% and 13%, respectively. Between Group I and Group II the differences in mortality and complications were statistically significant (P < 0.05). Compared to Group I the proportion of early relapses was higher in Group II, but was zero in Group III. There were significantly fewer gastrointestinal complications in Group II than in Group I (P < 0.01) and even fewer in Group III. When no antibiotic against S. typhi was available, typhoid fever had a protracted course, and only 74% of patients survived. Even with low dosages of chloramphenicol, defervescence was earlier and mortality and complications decreased dramatically, but early relapses were frequent. Full doses of chloramphenicol for a sufficient period of time only slightly reduced mortality and complications further, but eliminated early relapses completely.

Adolescent↗