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Inpatient and community-based care can be complementary in relation to the management of HIV disease. Medical records from 200 inpatients of Chikankata Hospital near Lusaka, Zambia and 200 home based patients were examined and compared for the common symptoms of presentation of HIV disease, associated opportunistic infections, and treatment protocols. Drug costs of both groups were also compared. The most common respiratory symptoms in the 2 groups are cough, chest pains, weight loss, and hemoptysis. Treatment employed for these symptoms were cortimoxazole, penicillin V, erthromycin, and tetracycline. Acetyl saliclic acid and paracetamol were used for pain relief in both groups. Gastointestinal system symptoms for both groups were diarrhea, weight loss, abdominal pain, and vomiting. Cotrimoxazole and metronidazole were used in treating diarrhea. Additional treatment protocol for the 2 patient samples included oral rehydration therapy for dehydration, antacid or bismuth subsalicylate for diarrhea and enteritis, and mycostatin for oral candidiasis. Central nervous system symptomatology included headache, dementia, neckace, and lethargy. Chloramphenicol was employed in treating bacterial meningitis. Diazepam and chlorpromazine were effective for restless patients. Genito-urinary system symptomatology for the 2 groups included dysuria, genital ulcers, hematuria, viral warts, and buboes. Antibodies were used for sexually transmitted diseases and infections. Skin symptomatology included rash and dermatitis, herpes zoster, abscess, kaposi's sarcoma, ulcers, furunculosis, and discharging anal sinus. In treating these symptoms, hospital based care and home based care were similar. Overall, it was found that hospital treatment protocols were detailed, expensive, and time consuming. Furthermore, hospital treatment for HIV positive patients is more expensive than HIV negative patients; hospital costs for 50 HIV negative patients totaled US$415.94 compared to US$1204.98 HIV positive/PTB negative patients and US$1705.62 for HIV positive/PTB positive patients. Drug cost/patient admission is increased by 469% if HIV positive. (author's modified).
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PMID:Clinical care as part of integrated AIDS management in a Zambian rural community. 248 94

A three-year-old girl injured her right eyelid with a toothbrush. The wound was sutured. Swelling of the eyelid, high fever and vomiting developed in spite of oral antibiotics for seven days. The findings of the cerebrospinal fluid (CSF) were white blood cells (WBC) 26,368/mm3 (90% polymorphs), protein 127 mg/dl, and sugar 0 mg/dl. Although Gram negative organisms were seen on the smear, aerobic culture was sterile. Later culture of CSF on admission grew anaerobic bacteria: Veillonella parvula. Intravenous administration of penicillins with cefotaxime (CTX), or of fosfomycin (FOM) were ineffective. Chloramphenicol (CP) cured the patient without neurological sequelae. There were no abnormal findings on brain CT scan. This is the first report of Veillonella meningitis. V. parvula appeared to have invaded the CSF from the abscess of the eyelid. It is necessary to consider anaerobic meningitis when there is a preceding pyogenic infection in the head.
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PMID:Bacterial meningitis caused by Veillonella parvula. 251 42

Experience with typhoid fever in 111 children over a 5-year period was reviewed. There were 66 boys and 45 girls, ranging in age from 1 to 11.5 years. The symptoms of typhoid fever were quite non-specific. Fever was the most common presenting symptom (in 98.3%). Other common presenting features were diarrhoea (25.7%), constipation (22%), vomiting (21.1%), cough (25%), abdominal pain (27.5%), headache (9.2%), epistaxis, meningism and convulsions. Rose spots were detected in 20% of cases, occurring mainly during the first 2 weeks of illness. Significant Widal reactions were present in 84.7% of cases. Blood and stool cultures were positive in 57% and 44% of cases, respectively. Peripheral blood white cell counts were not found to be of great diagnostic value. Chloramphenicol remained the drug of choice in the treatment of typhoid fever. It was more effective than ampicillin or co-trimoxazole. Complications were uncommon, occurring in only two patients. There were two deaths; both were admitted late and in moribund state. Early diagnosis and treatment is vital in typhoid fever and, as the presenting features are non-specific, a high index of suspicion is required.
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PMID:Typhoid fever in Hong Kong children. 278 7

Between April 1982 and March 1988, 28 patients with advanced urothelial cancer were treated with combination chemotherapy incorporating cisplatin at our hospital and the response was evaluated. Fourteen of them were managed by the CAP chemotherapy (cyclophosphamide 300-500 mg/m2 day 1, doxorubicin 30-50 mg/m2 day 1, cisplatin 40-90 mg/m2 day 2), 7 by the FAP chemotherapy (fluorouracil 300 mg/m2 day 1-5, doxorubicin 30 mg/m2 day 1, cisplatin 15 mg/m2 day 1-5) and 7 by the MEP chemotherapy (etoposide 100 mg/m2 day 1-3, cisplatin 20 mg/m2 day 1-5, methotrexate 300 mg/body day 6). Four patients (28.6%) responded to the CAP regimen; a complete response was gained in one patient who had pulmonary metastasis of excised ureteral cancer and a partial response in 3 patients with intravesical and nodal (N3, N4) cancer. A partial response was noted in 3 patients (42.9%) in the FAP group. They had intravesical lesions and two of them had regional node metastasis (N3). A higher response rate (85.7%) was obtained by the MEP regimen; a complete response in 2, who had intravesical and nodal (N2, N4) cancer, and a partial response in 4 patients, 1 had intravesical cancer, 1 had nodal (N2) and intravesical cancer and 2 had nodal or lung metastasis of excised renal pelvic cancer. Toxicity included mild to severe vomiting, alopecia, myelosuppression and mild renal or liver dysfunction. High dose metoclopramide provided a high degree of protection against cisplatin induced emesis. The results with the MEP regimen are promising for the advanced, metastatic urothelial cancer.
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PMID:[Results of combination chemotherapy in advanced urothelial cancer]. 324 18

Thirty-one patients with non-small-cell lung cancer (NSCLC), stage III (T3 N2 M 0-1), were treated with cyclophosphamide (400 mg/m2), adriamycin (40 mg/m2) and cisplatin (60 mg/m2) (CAP) every 4 weeks for 8 cycles. Twenty-six patients were evaluable for response. Patients characteristics included: median age, 63 years; median performance status, 70% (range 60%-100%). One hundred and fifty-five cycles of chemotherapy were administered with a median of 5. There were 9 partial responses and 3 complete remissions, for an overall response rate of 46%. The median survival duration was 9 months, and 29% survived 1 year. CAP combination chemotherapy was well tolerated without nephrotoxicity, which can be imputed to the strong saline hydration given. Seventy percent of the patients did not experience emesis due to the antiemetic regimen used.
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PMID:The role of combination cyclophosphamide, doxorubicin and cisplatin (CAP) chemotherapy in advanced non-small-cell lung cancer. 366 Apr 72

A 15 year old boy was admitted to hospital with five days history of fever, headache, vomiting and otorrhea. Findings on physical examination included high fever, purulent drainage from right ear, nuchal rigidity, Brudzinski's and Kernig's signs. Laboratory finding was polymorphonuclear leukocytosis. Computerized tomography (CT) of his brain was normal. A lumbar puncture disclosed purulent CSF. Chloramphenicol and Penicillin G were given intravenously as treatment for the meningitis. After five days of this therapy he continued to be febrile and nuchal rigidity, Brudzinski's and Kerning's signs increased. The second CT demonstrated the presence of an abscess in the cerebellum. The abscess was aspirated during mastoidectomy. In the cultures of the aspiration material Bacteroides species and gram positive micrococci grew out. Metronidazole, 500 mg qid per oral, was added to the therapy. During treatment, his condition was evaluated with serial computerized tomography scans of his brain and these studies showed progressive decrease in the size of the lesion. Metronidazole and antibiotics therapies were continued 45 days. The patient made an uneventful recovery.
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PMID:[A cerebellar abscess caused by anaerobic and aerobic (mixed) microorganisms]. 651 26

Fifty-six evaluable patients with advanced ovarian carcinoma (FIGO III or IV), without prior cytotoxic chemotherapy, were studied to assess the activity of single-agent moderate-dose cyclophosphamide, 40 mg/kg to a maximum dose of 3000 mg, given intravenously as a bolus injection every 3 weeks. All patients were treated as outpatients. Moderate-dose cyclophosphamide resulted in 36 (64%) objective responses (19 CR, 17 PR). Nausea and severe vomiting occurred in all patients, but no patient needed hospitalization for this complication. Other side-effects observed were alopecia (100%), leukocytes less than or equal to 2500/microliters (18%), chemical cystitis (11%) and sepsis (4%). The median duration of response was 11 months, and the estimated median survival by the life-table method for responders was 16 months and for non-responders 4 months (P less than 0.001). Clinical trials previously performed by our group comparing cyclophosphamide alone, either vs cis-platinum, adriamycin and hexamethylmelamine or vs Hexa-CAF, showed a better remission rate with the use of moderate-dose cyclophosphamide alone. Therefore we suggest further investigation of this agent in a moderate dose in disseminated ovarian carcinoma.
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PMID:Moderate-dose cyclophosphamide for disseminated ovarian carcinoma: a phase II study. 668 84

CAM is a derivative compound of mycophenolic acid produced by Penicillium brevicompactum, and is a new oral Purine antagonistic anticancer agent. The Phase I study was carried out cooperatively in ten hospitals. The results are as follows: The administration method was single administration and the starting dose was 200 mg/m2 (1n). The dose level was escalated according to varied Fibonacci formula. The number of total cases was thirty-one: three cases at 1n level, four at 2n, six at 3.3n, six at 7n and seven at 9n. Side effects were observed in five of thirteen cases over 7n dose levels, such as nausea, vomiting, anorexia and diarrhea. Leukopenia was developed in only one case at 7n dose level. Other side effects such as anemia, thrombocytopenia, and disturbances of liver function and renal function were not observed. It was estimated from above results that a dose limiting factor of CAM is nausea and vomiting. A subtoxic dose was 7n (1,400 mg/m2) and a maximum tolerated dose was 9n (1,800 mg/m2) which corresponded to 2,200-3,000 mg as a single administration.
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PMID:[Phase I study of a new anticancer agent CAM--results of cooperative study]. 718 85

Twenty-seven patients with measurable or evaluable, regionally advanced or metastatic head and neck cancer were given a combination of cyclophosphamide (C), Adriamycin (A), and cis-diamminedichloroplatinum (II) (P). Most patients had received extensive prior surgery and/or radiation therapy. Among 25 evaluable patients, the overall response rate was 64% (16/25) with 3/25 complete responders and 13/25 partial responders. The median survival for the entire group of 25 patients and the median response duration for the subset of 16 patients experiencing tumor regression were 8.1 and 7.0 months, respectively. Responders lived significantly longer than nonresponders (11 months vs. six months, P less than 0.01). According to covariate analysis, the difference seems to reflect the influence of response to treatment and not other confounding variables. Almost all patients experienced anorexia, nausea, vomiting, and a pervasive feeling of ill-health. In fact, six patients declined further treatment and five of these had objective tumor regressions. Recurrent disease was detected three months following discontinuation of chemotherapy in four of these five patients and seven months later in the fifth. Myelosuppression was clinically acceptable and there was in this dosage and schedule no evidence of hepatic or renal impairment. Although the CAP regimen has substantial antitumor activity, the program is clinically rigorous and should remain an investigational treatment modality at the present time.
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PMID:Cyclophosphamide, adriamycin, and cis-diamminedichloroplatinum (II) in the treatment of patients with advanced head and neck cancer. 719 79

From Sep. 1989 to Dec. 1992, 122 evaluable patients with small cell lung cancer (SCLC) treated with chemotherapy combined with radiotherapy in our hospital were analysed. There were 95 men and 27 women. The age ranged from 20 to 70 years. All were proven by pathology or cytology. They all did not receive previous treatment and had a measurable mass. Of them, 83 patients had limited disease (LD) and 39 extensive disease (ED). Using CE-CAP alternating chemotherapy, 48 LD and 27 ED were given two cycles, 35 LD and 12 ED four cycles. In this series, remission time was not evaluated because all patients received radiotherapy shortly after chemotherapy. Of 122 patients, 10 patients (8.2%) achieved CR, 89 (72.9%) PR, 18 (14.7%) S and 5 (4%) P. The total response rate was 81.1% (99/122), which is higher than that of COMVP and PE-CAV regimens. The response rates were 80.0% and 82.9% in two and four cycle groups, respectively. There was no significant difference between the two groups. The main toxicity observed was nausea, vomiting and bone marrow suppression, but were tolerated by the patients. In conclusion, CE-CAP regimen can be recommended as the treatment of choice in SCLC.
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PMID:[Response rate of small cell lung cancer treated with CE-CAP alternating chemotherapy]. 780 63


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