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 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recently, a randomized study conducted by the Gynecologic Oncology Group (GOG 111) demonstrated that, given by a 24-hour infusion, the combination of cisplatin and paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) is superior to combination cisplatin/cyclophosphamide in previously untreated patients with advanced ovarian cancer. This combination, however, necessitates hospitalization. Combination paclitaxel/carboplatin would be expected to induce fewer nonhematologic side effects but may be more myelotoxic. Thus, we started a phase I dose-escalation study to determine the maximal tolerated dose of paclitaxel given as a 3-hour infusion in combination with carboplatin, both drugs administered every 21 days. The paclitaxel dose was escalated by increments of 25 mg/m2, starting at 135 mg/m2 (level 1), 160 mg/m2 (level 2), 185 mg/m2 (level 3), and 210 mg/m2 (level 4). Carboplatin was administered to achieve an area under the concentration-time curve of 5, using the Calvert formula For study levels 5 and 6, the carboplatin dose was targeted at area under the concentration-time curves of 6 and 7.5, respectively, and was combined with a fixed paclitaxel dose of 185 mg/m2. Thirty previously untreated patients with stage IIC to IV ovarian cancer were enrolled. Nonhematologic toxicity, including nausea/vomiting and arthralgia/myalgia, was mild. Across all dose levels, a total of 16 patients developed peripheral neurotoxicity (World Health Organization grades 1 and 2). At dose level 5, one patient experienced reversible grade 4 neurotoxicity. Neutropenia was the principal dose-limiting hematologic toxicity. During 33 (31%) of 106 courses, World Health Organization grade 4 neutropenia was observed. Granulocyte colony-stimulating factor was required in only 7.6% of courses. Thrombocytopenia was less than that expected when carboplatin is given alone. Clinical responses were observed in eight of 14 patients, for an overall response rate of 57%. The combination of carboplatin plus paclitaxel was found to be an active regimen. This trial demonstrates that carboplatin dosed by the Calvert equation and 3-hour paclitaxel can be combined safely at full therapeutic doses for six or more courses in patients with advanced epithelial ovarian cancer.
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PMID:Paclitaxel combined with carboplatin in the first-line treatment of advanced ovarian cancer: a phase I trial. 904 30

A flavivirus related to the tick-borne encephalitis complex was isolated from the blood of 6 male butchers, aged 24-39 years, in Jeddah, Saudi Arabia in November and December 1995. Two of the patients died and the other 4 recovered completely. Four more patients, 3 males and 1 female, were diagnosed serologically by immunoglobulin M capture enzyme-linked immunosorbent assay and seroconversion in acute and convalescent blood samples examined by indirect immunofluorescent test using Vero cells infected with the isolated virus. The virus identity was confirmed at the Centers for Disease Control and Prevention, Fort Collins, Colorado, USA, by the polymerase chain reaction; it was closely related to Kayasanur Forest disease virus. All infected patients had similar clinical and laboratory symptoms and signs, including fever, headache, generalized body aches, arthralgia, anorexia, vomiting, leucopenia, thrombocytopenia, elevated liver enzymes (serum glutamic oxalacetic and serum glutamic pyruvic transaminases), elevated creatinine phosphokinase, and elevated blood urea. One patient developed symptoms of encephalitis, but survived without any sequel. Skin rash developed in 2 patients, morbilliform on the hands, feet, and lower abdomen of one patient and purpuric associated with melaena in the second patient. Eight of the 10 confirmed patients were working with sheep, and the disease may be a zoonotic viral infection.
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PMID:Isolation of a flavivirus related to the tick-borne encephalitis complex from human cases in Saudi Arabia. 919 62

Sixty patients with previously untreated non-small cell lung cancer of stages III and IV were treated with a 210 mg/m2 dose of paclitaxel by means of a 3-hour infusion. The objective response rate was 32% (95% confidence interval, 20-45%): 1 complete response and 18 partial responses. The median duration of response was 15 weeks, and the projected median survival duration of all patients was 30 weeks. Grade 3-4 neutropenia occurred in 73% of patients. Other grade 3-4 adverse events included anemia (5%), vomiting/nausea (8%), peripheral edema (2%), alopecia (7%), elevation of AST (2%), peripheral neuropathy (3%), allergic reaction (2%), arthralgia/myalgia (3%), and interstitial pneumonitis (3%). Paclitaxel administered at 210 mg/m2 by means of a 3-hour infusion every 3 weeks demonstrated a notable activity against previously untreated advanced non-small cell lung cancer, with a 32% major response rate. Major toxicity was neutropenia. Hypersensitivity, neurotoxicity, arthralgia/myalgia and cardiac toxicity were mild and easily managed.
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PMID:Phase II study of 3-hour infusion of paclitaxel in patients with previously untreated stage III and IV non-small cell lung cancer. West Japan Lung Cancer Group. 921 54

Carboplatin/etoposide is an active regimen in the treatment of small cell lung cancer. This phase II trial evaluated whether adding paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) to this two-drug combination might increase its efficacy. Since April 1996, 55 patients were entered into the ongoing protocol. To date, 35 patients are evaluable for efficacy and toxicity. Most of the evaluable patients are male (28). The patients' median age is 60 years (range, 36 to 74 years); 32 patients have Eastern Cooperative Oncology Group performance status ratings of 1, and the balance are Eastern Cooperative Oncology Group performance status 0. All patients had limited-stage disease. Patients received paclitaxel 175 mg/m2 via 1-hour intravenous infusion on day 1, carboplatin dosed to an area under the concentration-time curve of 5, also on day 1, and oral etoposide 100 mg on days 2 through 8. Overall, 31 patients responded to paclitaxel/carboplatin/etoposide therapy, including complete response in 13 patients (37.1%) and partial response in 18 patients (51.4%). Disease was stable in three patients (8.6%) and disease progressed in one (2.0%). Hematologic toxicity included neutropenia (World Health Organization grade 3 in 24.1% of patients, grade 4 in 31.3%), anemia (4% grade 3, no grade 4), and thrombocytopenia (3.2% grade 3, 2.1% grade 4). Nonhematologic adverse events included minor nausea/vomiting (1.5% grade 3, 9.2% grade 2), polyneuropathy (2.3% grade 2, 17.5% grade 1), and myalgia/arthralgia (8.2% grade 2, 16.4% grade 1). Paclitaxel/carboplatin/etoposide is active in small cell lung cancer with moderate toxicity and good subjective tolerance. There were no life-threatening hematologic or nonhematologic complications in this phase II trial.
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PMID:Paclitaxel, carboplatin, and oral etoposide: a phase II trial in limited-stage small cell lung cancer. 933 Nov 41

Monthly disease summary sheets from 1986-1992 of 60 dispensaries, clinics and hospitals in Narok district, Kenya were reviewed for the occurrence of brucellosis and other diseases with "flu-like symptoms". Diseases with these symptoms accounted for about 52% of the 1,037,875 cases reported for the time period. These were classified as malaria (79.3%), rheumatism (7.1%), PUO (2.4%), and brucellosis (0.8%). Brucellosis was diagnosed by a positive Rose Bengal (RB) test routinely conducted in seven out of the 60 health units. In these units, 55% of flu-like cases were classified as malaria and 21.2% as brucellosis. Individual case records of patients at four dispensaries using the RB test during 1991-92 were assessed for specific predictor symptoms. For 625 RB tested patients, a positive test result was associated with joint pain, headache, and the combinations of joint pain with headache and lameness with headache. A logistic regression model correctly predicted the RB test result in 62.3% of the time. For the 465 patients examined by the blood smear examination, identification of malaria parasites was associated with, headache, joint pain and combinations of emesis with pale mucous membranes. This regression model correctly predicted positive results 67.2% of the time. Both models indicate that selected clinical predictors represented significantly increased odds of being positive to the respective tests. However, for both diseases, clinical signs alone appear insufficient for reliable diagnosis and differentiation probably due to resemblance in symptomatology between these two and other diseases.
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PMID:Criteria for better detection of brucellosis in the Narok District of Kenya. 933 12

Epidemiological and clinical data are presented on 165 cases of Venezuelan hemorrhagic fever (VHF), a newly emerging viral zoonosis caused by Guanarito virus (of the family Arenaviridae). The disease is endemic in a relatively circumscribed area of central Venezuela. Since its first recognition in 1989, the incidence of VHF has peaked each year between November and January, during the period of major agricultural activity in the region of endemicity. The majority of cases have involved male agricultural workers. Principal symptoms among the patients with VHF included fever, malaise, headache, arthralgia, sore throat, vomiting, abdominal pain, diarrhea, convulsions, and a variety of hemorrhagic manifestations. The majority of patients also had leukopenia and thrombocytopenia. The overall fatality rate among the 165 cases was 33.3%, despite hospitalization and vigorous supportive care.
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PMID:Venezuelan hemorrhagic fever: clinical and epidemiological studies of 165 cases. 950 47

Dengue is a mosquito-transmitted acute disease caused by any of four dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4) and characterized by the sudden onset of fever, headache, myalgia, arthralgia, rash, nausea, and vomiting. This disease is endemic in most tropical areas of the world and has occurred in U.S. residents returning from travel to such areas. CDC maintains a laboratory-based passive surveillance system for imported dengue among U.S. residents. This report summarizes information about cases of imported dengue among U.S. residents for 1996, which indicated that most persons for whom travel history was known probably acquired infection in the Caribbean islands or Asia.
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PMID:Imported dengue--United States, 1996. 967 16

The differentiation of malaria from other causes of fever in the absence of microscopy is notoriously difficult. Clinical predictors of malaria have been studied in an area of low and unstable transmission on the western border of Thailand. In 1527 children aged 2-15 years who were followed prospectively for 7 months, 82% (1254) had at least one febrile episode. Malaria caused 24% (301) of the first febrile episodes (Plasmodium falciparum 128, P. vivax 151, P. malariae 1, mixed infections with P. falciparum and P. vivax 21). Each malaria case was matched with the next child of similar age presenting to the dispensary with another cause of fever. Clinical symptoms or signs associated with a final diagnosis of malaria were: confirmed fever (> or = 38 degrees C) (odds ratio [OR] 1.6, 95% confidence interval [95% CI] 1.4-1.9), headache (OR 1.5, 95% CI 1.3-1.9), muscle and/or joint pain (OR 2.0, 95% CI 1.6-2.8), nausea (OR 1.7, 95% CI 1.4-2.3), clinical anaemia (OR 1.4, 95% CI 1.3-3.3), palpable spleen (OR 1.3, 95% CI 1.1-1.7), palpable liver (OR 1.4, 95% CI 1.1-2.1), absence of cough (OR 1.6, 95% CI 1.4-2.0), and absence of diarrhoea (OR 1.5, 95% CI 1.2-2.4). None of these signs alone or in combination proved a good predictor of malaria. The best diagnostic algorithms (history of fever and headache without cough, and history of fever with an oral temperature > or = 38 degrees C [sensitivity 51% for both, specificity 72 and 71%, respectively]) would result in prescription of antimalarial drugs in 28-29% of the non-malaria febrile episodes, and only 49% of the true malaria cases. Thus half of the potentially life-threatening P. falciparum infections would not be treated. Although multivariate analysis identified vomiting, confirmed fever, splenomegaly and hepatomegaly as independent risk factors for a diagnosis of falciparum malaria, use of these signs to differentiate falciparum from vivax malaria, and thus to determine antimalarial treatment, was insufficiently sensitive or specific. Malaria diagnosis should be confirmed by microscopical examination of a blood slide or the use of specific dipstick tests in areas of low transmission where highly drug-resistant P. falciparum coexists with P. vivax.
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PMID:Clinical features cannot predict a diagnosis of malaria or differentiate the infecting species in children living in an area of low transmission. 969 50

Dengue is an acute, mosquito-transmitted viral disease characterized by fever, arthralgia, myalgia, rash, nausea, and vomiting and caused by any of four different serotypes of the virus (DEN-1, DEN-2, DEN-3, and DEN-4).1 The disease is endemic in most tropical areas of the world and has been reported in international travelers returning from such areas.2 The incidence of epidemic and endemic dengue has increased substantially in the Americas since 1977, and various epidemics have occurred.1-4
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PMID:Evidence of dengue virus infection in a german couple returning from hawaii 977 17

The incidence of dengue increased sharply in Martinique from the end of 1995 into 1996. Virological tests performed jointly on 36 serum samples by the Pasteur Institute in French Guyana and the Center for Disease Control in Puerto Rico led to identification of serogroups 1, 2, and 4 for six dengue virus. Between January 1995 and December 1996, the Departmental Hygiene Laboratory of Martinique carried out screening tests to detect specific IgM by the immunocapture method (MAC ELISA) in patients with suspected dengue. Results were positive in 701 of the 2,143 patients tested (32.7%). Symptoms were studied in 421 of these positive cases. The most frequent presentation was a flu-like syndrome with hyperalgia. Nausea, vomiting, joint pain, and retroocular pain were frequent. At least one clinical sign of coagulation disturbance was noted in 83 patients (19.7%). Dengue hemorrhagic syndrome was diagnosed according to the criteria of the World Health Organization in six patients including one who developed circulatory collapse and died. This fatality was the first to be reported in Martinique. The incidence of typical dengue as well as of the hemorrhagic form is probably underestimated in Martinique because specific serological tests are not routinely requested and application of WHO criteria for diagnosis of hemorrhagic forms is often impractical.
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PMID:[Dengue in Martinique in 1995-1996]. 979 93


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