Leiomyosarcoma of the Inferior Vena Cava Level II Including Both Renal Veins : Surgical Approach

A 66 years old male developping an acute lower right limb oedema due to an extended venous thrombosis of the common femoral and iliac veins was diagnosed to have a leiomyosarcoma of the inferior vena cava (IVC) involving both renal veins. The characteristics and management of this level II IVC leiomyosarcoma are discussed with particular attention to the renal vein reconstruction and neo-adjuvant therapy.

Leiomyosarcoma of the Inferior Vena Cava Level II Including Both Renal Veins: Surgical Approach

A 66 years old male developping an acute lower right limb oedema due to an extended venous thrombosis of the common femoral and iliac veins was diagnosed to have a leiomyosarcoma of the inferior vena cava (IVC) involving both renal veins. The characteristics and management of this level II IVC leiomyosarcoma are discussed with particular attention to the renal vein reconstruction and neo-adjuvant therapy.

Histological and ultra-structural effects of rapid muscle expansion through intramuscular administration of carbon dioxide: an intra-operative study in an animal model

INTRODUCTION

Carbon dioxide (CO2) therapy refers to trans-cutaneous or sub-cutaneous administration of CO2 for therapeutic purposes, and recent studies have pointed out that it produces a vasodilation effect after it is locally injected, which helps amplify the reconstructive potentiality of an expanded-muscle flap.

MATERIALS AND METHODS

Thirty male Wistar rats, weighting between 350 and 400 g, were randomly divided into three groups of 10. In the first group, single intra-operative rapid expansion was carried out under the right latissimus dorsi muscle. In the second group, for five days prior to surgery, a pre-treatment with intramuscular injections of CO2 was performed. The third group served as controls. For each group, the latissimus dorsi muscle was fixed as soon possible after mice died, and ultrathin sections of it examined with transmission electron microscope.

RESULTS

In the treated group, the majority of expanded muscles showed a normal striation pattern, whereas a few fibers showed mild disorganization of the myo-filaments in the sarcomeres, which appeared overstretched (average 2.37 µm).

CONCLUSIONS

This evidence could demonstrate a greater capacity of muscle recovery after treatment by CO2 expansion.

Antibiotic Prophylaxis in Surgery: An Observational Prospective Study Conducted in a Large Teaching Hospital in Naples

This was a 9-month observational prospective study conducted in two steps to evaluate surgical prophylaxis procedures used by surgeons in several departments of the Second University of Naples (SUN). In step 1 (4 months), we collected and analyzed data on surgical interventions and antibiotic prophylaxis. Surgeons were informed of the analysis outcome and were given an antibiotic prophylaxis protocol based on international guidelines. In step 2 (5 months), we collected data on surgical interventions and antibiotic prophylaxis, and compared them with step 1 data. The analysis of 354 forms (step 1) showed that third-generation cephalosporins were the preferred prophylactic antibiotics. The analysis of 369 forms (step 2) showed that ceftriaxone and ampicillin were the most frequently used antibiotics. Surgeons did not comply with guidelines for antibiotic prophylaxis as regards type of antibiotic and treatment duration but implementation of antibiotic prophylaxis protocols resulted in more appropriate and better timing of antibiotic prophylaxis.

Unusual cause of severe anaemia in a patient with metastatic haemangiopericytoma

Haemangiopericytoma is a rare tumor of vascular origin. We report the case of patient with severe refractory anaemia due to peripheral destruction of red blood cells by spleen metastases. Anaemia was successfully treated by splenectomy. Afterwards, our patient developed liver and lung metastases and was treated, in a clinical trial, with gefitinib that stabilised the disease during nine years. These interesting features are discussed.

[Ophthalmological signs in thyroid pathology: our experience]

AIM

The aim of our study was to highlight the palpebral and ocular signs in patients with thyroid dysfunction. These patients are sometimes poorly evaluated in routine check ups. This information is useful both to the practicing ophthalmologist but also to the specialist in endocrinology.

PATIENTS AND METHODS

100 patients were enrolled. The patients had been diagnosed with the Basedow-Graves-Flajani syndrome or had hypothyroidism or thyroidits. Orbital, adnexal and ocular signs were recorded in all patients.

RESULTS

Seventeen oculopalpebral signs were observed in a total of 100 patients (73 females and 27 males). These were as follows: Dalrymple, Von Graefe, Rosenbach, Inglese, Gifford, Enroth, Jellinek, Stellwag, Jeffroy, Topolansky, Moebius, Suker, Sattler, Sainton, Ballet, Cowens, Exphothalmos.

DISCUSSION

The specialist in endocrinology has many laboratory and clinical tools in the diagnosis of patients with thyroid dysfunction. However, with a better awareness of the oculopalpebral signs both the ophthalmologist and the endocrinologist can work together in a multidisciplinary team towards the management of these patients.

Effectiveness of vision rehabilitation treatment through MP-1 microperimeter in patients with visual loss due to macular disease

PURPOSE

To evaluate the effectiveness of biofeedback treatment for low-vision rehabilitation in patients affected by macular disease.

MATERIALS AND METHODS

171 eyes of 99 patients (42 female and 57 male) between 50 to 75 years old (mean age: 64.6) were included in this study. All patients were suffering from age-related macular degeneration (AMD) (122 eyes) or macular myopic degeneration (MMD) (49 eyes). All patients underwent an assessment of examinations including visual acuity, reading speed test, slit lamp examination and tonometry, ophthalmoscopic fundus examination, microperimetry, fixation test, retinal sensitivity, fluorangiography (FAG), optical coherence tomography (OCT). The treatment was divided in 16 sessions, the patients underwent other examination assessment at 6 and 12 months, except for FAG and OCT. Statistical analysis was performed using Student's t-test, and p-value <=0.05 was considered statistically significant.

RESULTS

After training 130 eyes of 171 in the study group (76.02%) had a statistically significant improvement of the distant visual acuity (p<0.01): 38 eyes suffering from MMD and 92 eyes suffering from AMD. After 12 months of follow-up a group of 25 eyes of 130 (19.23%) had a loss of benefits that were observed at the end of the treatment sessions: 16 eyes and 9 eyes were suffering from MMD and AMD respectively. Examination assessment during follow-up showed that 4 eyes and 2 eyes of the group that lost benefits had a worsening of MMD and AMD primary disease respectively.

CONCLUSIONS

It is not yet understood how biofeedback produces amelioration of visual function. According to the 'Eccentric fixation' theory, with biofeedback rehabilitation patients are trained to use the non-damaged retina areas to develop a new preferred retinal locus. In our study group we found a significant improvement in both visual acuity and fixation.

New drugs in medical oncology: new difficulties to distinguish drug-induced side effects from cancer complications: a case-report

We report the case of a woman with a metastatic breast cancer, who started a third-line treatment with dasatinib, a new oral tyrosine kinase inhibitor, and who developed, one week later, a progressive breathless sensation. Workup demonstrated pleuropericardial effusion that turned out to be a side effect of this new investigational drug. Although this dasatinib-induced side effect is well known, this case clearly illustrates the importance of an accurate diagnosis and adequate treatment of complications of new agents which are easy to use since most of them are orally taken, and the difficulty to clearly separate drug origin and cancer morbidities. The patient recovered completely one month after discontinuation of dasatinib. In this report, we will review the differential diagnosis and management of pleuropericardial effusion.

A pilot clinical study on the effectiveness of mesoglycan against diabetic retinopathy

PURPOSE

A double-blind placebo-controlled study on 68 patients suffering by Diabetic Retinopathy was aimed in order to evaluate the effectiveness of Mesoglycan in this pathology. This drug is particularly interested in treatment of disorders of microcirculation.

MATERIALS AND METHODS

The two treatments were randomly assigned to each patient, using a 100 mg/day dosage of Mesoglycan, and both treatments were prescribed for 6 months. The efficacy of both treatments was based on clinical and instrumental check.

RESULTS

The clinical results that emerged in the group treated with Mesoglycan were excellent, although observations are on a limited number of patients appears a direct action of Mesoglycan on the endothelium retinal blood vessels and circulation. Indeed, in the observed patients, was detected a significant reduction of microhemorrhages, microaneurysms and exudates. The same cannot be said of the placebo group; none of patients of that group showed signs of clinical improvement at the end of the study.

CONCLUSION

Data emerging from our study show a direct action of Mesoglycan on endothelium retinal blood vessels and circulation, as we observed in patients we found a significant reduction in the number of microhemorrhages, microaneurysms and exudates. This action can be explained by the characteristics of drug as antithrombotic profibrinolytic and anti-edema, already found in vitro and experimentally. We conclude that our preliminary study showed an encouraging clinical efficacy, together with excellent tolerability, and therefore our objective has been met, which was to verify the existence of the prerequisites for a larger clinical study.

Pneumotrabeculoplasty as treatment for primary open angle glaucoma: critical review of the literature

PURPOSE

To evaluate with criticism the available evidence shown in the literature about the efficacy of pneumotrabeculoplasty (PNT) as a treatment for primary open angle glaucoma.

MATERIALS AND METHODS

PNT is a recent non-surgical and noninvasive technique to safely reduce the intraocular pressure (IOP) in eyes suffering from ocular hypertension or primary open angle glaucoma. The technique consists in the application on the ocular surface of a disposable suction ring that induces a temporary trabecular meshwork stretching, increasing outflow of aqueous humor in the Schlemm's canal. In our study, we compared the results on the efficacy and safety of this treatment published to date in the literature.

RESULTS

During follow-up, Authors have observed significant reductions in IOP in about 70% of treated eyes. The first treatment consists in 3 applications at day 0, 7 and 90, repeatable every 90 days. Immediately after suction ring application there is a significant elevation of IOP, however, of short duration and without demonstrable visual field worsening. Side effects observed are of little clinical significance and spontaneously resolving in a short time.

CONCLUSIONS

The PNT is a safe and effective technique to reduce IOP in patients with ocular hypertension or open-angle glaucoma. It is repeatable, but can not replace drug treatment in patients already receiving topical therapy for glaucoma; however, it has proven effectiveness in maintaining an IOP target over time if accompanied with only a single topical drug, favoring a reduction of antiglaucoma drugs in polytherapy and increasing the compliance with treatment.

Forearm reconstruction with bone allograft following tumor excision: a series of 10 patients with a mean follow-up of 10 years

BACKGROUND

After a tumor resection, the reestablishment of the bone continuity at the forearm remains a challenge for restoring the biomechanics of hand and elbow. Bone allograft might be one option to consider amongst other suitable alternatives but there are insufficient data available to substantiate its value.

PATIENTS AND METHODS

We retrospectively investigated a series of 10 consecutive patients that had presented a bone tumor at the forearm. After bone excision, the segmental loss was replaced either by a bone allograft or an osteochondral allograft. Patients were reviewed clinically and with radiographs.

RESULTS

The mean follow-up was 110 ± 99 months. Fracture of the allograft was the most prevalent complication occurring in four patients, mainly in the osteoarticular group. Four patients were surgically revised: two of them had a fracture of the allograft that required a new one, another one had a painful stiff wrist requiring removal of the allograft and arthrodesis with autograft and the fourth one had a non-union of an intercalary allograft that was treated by a distal ulnar joint resection. Intercalary allograft had fewer complications than osteoarticular allografts and they had a better functional MSTS score with an average of 79% of a normal function compared to osteoarticular allografts with an average score of 62%. There was no infection. At the latest follow-up, one reconstruction of the forearm with an allograft failed and concerned the distal radius joint.

DISCUSSION

A bone allograft when available can be considered as one amongst other suitable options for the reconstruction of the forearm skeleton.

Affective temperaments are associated with higher hopelessness and perceived disability in patients with open-angle glaucoma

AIM

The aims of the study were to study: (i) affective temperaments in open-angle glaucoma (OAG) patients with some degree of functional visual impairment; (ii) psychological well-being and perceived disability, and their associations with affective temperaments; and (iii) associations between visual impairment, affective temperaments and psychological well-being.

METHOD

Participants were 91 outpatients (39 women, and 52 men) with open-angle glaucoma (OAG) who were assessed for Visual Field Index, Mean Defect and Pattern Standard Deviation. Patients were also administered the Beck Hopelessness Scale, the TEMPS-A (Rome), the Gotland Male Depression Scale, the Emotional Well-being Scale, the Perceived Disability Questionnaire and the Suicidal History Self-Rating Screening Scale.

RESULTS

Open-angle glaucoma patients (compared with a non-clinical sample of university students) had higher scores on the TEMP-A dysthimic and hyperthimic traits and lower scores on cyclothimic, irritability and anxiety traits. Such temperament variability was not linked to differences in severity of glaucoma. We did not find strong evidence supporting the fact that measures of visual impairment were linked to emotional well-being and depression. However, logistic regression analysis revealed that patients may have different patterns related to their illness according to specific temperaments.

CONCLUSION

Patients with OAG may have different temperament profiles than non-clinical individuals. Such categorisation may be useful for predicting how they face the illness, for providing better care as well as for early recognition of mood disorders symptoms.

Epidermal growth factor receptor targeted therapies for solid tumours

The majority of human epithelial cancers is frequently characterized by a functional activation of the epidermal growth factor receptor (EGFR)-driven-pathways. Today, two classes of EGFR inhibitors are routinely used in the clinic: anti-EGFR monoclonal antibodies such as cetuximab and panitumumab and small-molecule inhibitors of the EGFR tyrosine kinase activity such as erlotinib and gefitinib. Anti-EGFR therapies have been approved in several countries for the treatment of metastatic nonsmall-cell lung cancer, colorectal cancer, squamous-cell carcinoma of the head and neck, and pancreatic cancer. This article summarizes the clinical evidence of the anticancer activity of anti-EGFR treatment, and considers the current, and controversial, clinical issues with respect to their optimal use in the treatment of patients with cancer. Mechanisms of resistance to anti-EGFR treatment are also briefly discussed.

Nonadherence to imatinib treatment in patients with gastrointestinal stromal tumors: the ADAGIO study

AIM

To determine imatinib nonadherence rates in patients with gastrointestinal tumors (GIST) over 90 days.

PATIENTS AND METHODS

A prospective 90-day observational, open-label, multicenter study was carried out of 28 evaluable GIST patients on imatinib. Nonadherence behavior was measured using a 4-item patient interview. Clinicians, patients, and collaterals rated perceived patient adherence on a 0-100 VAS scale.

RESULTS

Nonadherence rates in the 4 weeks prior to baseline and follow-up were 29% (95% CI=26-32) and 24% (95% CI=21-27, p>0.05). Mean VAS ratings of perceived adherence ranged from 95.2 ± 10.2 to 97.3 ± 4.8 (p>0.05 for time and source of rating). Correlations between perceptions of and actual adherence behavior were negative.

CONCLUSION

In this first study on imatinib nonadherence in GIST patients, rates were similar to those observed in patients with chronic myeloid leukemia, higher than clinically expected and exceeding meta-analytic estimates for cancer. Nonadherence rates were consistent across the 90-day period. Nonadherence behavior should be assessed by clinicians.

Stickler syndrome in Pierre-Robin sequence prenatal ultrasonographic diagnosis and postnatal therapy: two cases report

The Pierre-Robin Syndrome (PRS) is a rare congenital abnormality, with an approximately 1/30,000 estimated rate, characterized by the presence of the combination of mandibular hypoplasia (micrognathia or small jaw), glossoptosis (retrusion of the tongue into the pharyngeal airway) and, often, a posterior cleft of the secondary palate. It may be an isolated occurrence or part of a more complex syndrome and it is associated with long-term respiratory, nutritional, and developmental difficulties. Stickler syndrome (SS) is a rare autosomal dominant connective tissue disorder estimated to affect approximately 1/7500 newborns. It is diagnosed clinically and, at present, there is no consensus on a minimal clinical diagnostic criterion. The most frequent diagnosis in patients with syndromic Pierre Robin sequence is Stickler syndrome, which may be complicated by congenital high myopia and substantial risk of retinal detachment. However, cases of Stickler syndrome with probable visual complications are rarely identified among this group of patients by members of the cleft team. The patient had an acute unilateral hydrops, with a monolateral keratoconus. The ocular abnormalities included: severe myopia, abnormalities of the vitreous, and high risk of retinal detachment (with subsequent blindness). We report two extremely rare cases of prenatal diagnosis of PRS and SS, prematurely identified by prenatal ultrasonography and successively managed by oculists ophthalmogists.

Nociceptin modulates bronchoconstriction induced by sensory nerve activation in mouse lung

Nociceptin/orphanin FQ (N/OFQ), the endogenous ligand for the N/OFQ peptide receptor (NOP), inhibits tachykinin release in the airway of several animal models. The aim of this study was to investigate the role of the N/OFQ-NOP receptor system in bronchoconstriction induced by sensory nerve activation in the isolated mouse lung. We used C57BL/6J NOP(+/+), NOP(-/-), and Balb/C mice sensitized (or not) to ovalbumin. Bronchopulmonary function coupled with measurements of endogenous N/OFQ levels before and after capsaicin-induced bronchoconstriction in the presence or absence of NOP-selective agonists/antagonists are presented. N/OFQ significantly inhibited capsaicin-induced bronchoconstriction in both naive and sensitized mice, these latter animals displaying airway hyperresponsiveness to capsaicin. The inhibitory effect of N/OFQ were not observed in NOP(-/-) mice, and were mimicked/abolished by the selective NOP agonist/antagonist University of Ferrara Peptide (UFP)-112/UFP-101 in NOP(+/+) mice. UFP-101 alone potentiated the effect of capsaicin in naive mice, but not in sensitized mice. Endogenous N/OFQ levels significantly decreased in sensitized mice relative to naive mice. We have demonstrated that a reduction in endogenous N/OFQ, or the lack of its receptor, causes an increase in capsaicin-induced bronchoconstriction, implying a role for the N/OFQ-NOP receptor system in the modulation of capsaicin effects. Moreover, for the first time, we document differential airway responsiveness to capsaicin between naive and sensitized mice due, at least in part, to decreased endogenous N/OFQ levels in sensitized mice.

A dose-finding and pharmacokinetic study of I.V. vinflunine in combination with doxorubicin as first line treatment of metastatic breast cancer

Abstract #6124

Background: VFL is a novel bifluorinated tubulin-targeted agent of the vinca alkaloids class. In a phase II study in anthracycline and taxane pretreated MBC patients (pts), an ORR of 30% observed. Given activity shown by DXR or VFL in MBC, we conducted a phase I study of the combination, define maximum tolerated dose (MTD), recommended dose (RD), safety (NCI CTC 2.0), PK interaction and efficacy (Recist).&#x2028; Methods: 2 schedules investigated (VFL D1 with DXR D1, every 3 weeks and VFL Ds 1 and 8, with DXR Ds 1 and 8, every 3 weeks). Eligibility: Pts with MBC, previously untreated for metastatic disease; could have received adj/neoadjuvant with anthracycline-containing regimen, cumulative doses &lt; 250 mg/m² for DXR, 450 mg/m² for EPI. Dose escalation used 3+3 design; PK samples were obtained for VFL and DXR to investigate potential interaction.&#x2028; &#x2028; Results: 32 patients were enrolled (15 patients in schedule 1 and 17 in schedule 2) and received escalating doses of VFL and DXR.&#x2028; In schedule 1, 2 dose levels (DL) were investigated; At DL VFL250/DXR50, 8 pts were treated with 6 patients evaluable for DLT, where 2 DLTs were identified consisting of neutropenia &lt; 0.1x109/l &gt; 3 days and a neutropenic infection; then this DL was considered MTD; at the DL VFL250/DXR40, 7 pts were treated without developing DLTs then considered RD. 73 cycles were administered (median 6); Most frequent haematological toxicity was neutropenia, gr 3 in 1 pt and gr 4 in 11 pts. Main non-haematological adverse events were: nausea 80%, fatigue 73.3%, constipation 40%, vomiting 40%, anorexia 33.3%, stomatitis 20%, dyspnea 13.3%. Clinical activity: 7 pts (46.7%) had PR, and 4 pts (26.7%) SD. No PK interaction was detected.&#x2028; In schedule 2, at DL VFL150/DXR25, 6 of 9 pts were evaluable in whom 2 Gr 4 neutropenia &gt; 7 days occurred, (DL considered as MTD). In the DL below VFL120/DXR25, 6 of 8 pts were evaluable, only 1 Gr 4 neutropenia &gt; 7 days occurred, (DL considered RD). A total of 89 cycles (median 6) were administered; neutropenia was the main haematological toxicity, with Gr ¾ in 14 pts (82.4%); main non-haematological toxicities: fatigue 82.4%, constipation 76.5%, nausea 76.5%, vomiting 64.7%, stomatitis 41.2%, dyspnea 41.2%, anorexia 35.3%; no episode of Gr 4 occurred.&#x2028; Among 17 treated pts, 8 (47.1%) had PR and 6 (35.3%) SD. PK analysis ongoing.&#x2028; Conclusion: RD for schedule 1 is VFL250/DXR40 on day 1, Q3W, for schedule 2, VFL120/DXR25 on days 1 and 8, Q3W. Overall VFL/DXR combination is feasible and toxicity was manageable, where haematological toxicity was frequent but reversible. Promising antitumour activity was detected.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6124.

Prospective randomized study comparing docetaxel, estramustine, and prednisone with docetaxel and prednisone in metastatic hormone-refractory prostate cancer

PURPOSE

To assess the efficacy and toxicity of the addition of estramustine to docetaxel (D) for the treatment of metastatic hormone-refractory prostate cancer.

PATIENTS AND METHODS

One hundred fifty patients were randomly assigned to D alone (35 mg/m(2) on days 2 and 9, every 3 weeks) or D in combination with estramustine (D/E; 280 mg orally three times a day on days 1 to 5 and 8 to 12, every 3 weeks). All patients received prednisone (10 mg/d). The primary end point was prostate-specific antigen (PSA) response rate, which was defined as a decrease in PSA > or = 50% from baseline. The study was powered to test the hypothesis that D/E would improve the PSA response rate by 25%.

RESULTS

The PSA response rate was not statistically different between the two groups. PSA of less than 4 ng/mL occurred in 29 (41%) of 71 patients receiving D/E and in 17 (25%) of 69 patients receiving D (P = .05). No significant differences were found for median time to PSA progression (D/E, 6.9 months; D, 7.3 months) or median overall survival time (D/E, 19.3 months; D, 21 months). More patients had at least one grade 3 or 4 toxicity with D/E (45%) compared with D (21%; P = .005), mainly as a result of grade 3 or 4 GI toxicity (P = .05). Serious adverse events were more frequent with D/E (n = 20) than with D (n = 9; P = .04).

CONCLUSION

The addition of estramustine to weekly D does not provide any clinically relevant advantage. Both regimens are well tolerated, although the toxicity profile favors D without estramustine.

Bronchobiliary fistula and cholangiocarcinoma: a case report and principles of management

A 64-year-old woman was admitted with fever and cough. At admission, she had jaundice, hepatomegaly, and green-stained sputum. Computed tomography (CT) showed an intrahepatic abscess located near the dome, multiple hepatic metastases, biliary tract dilatation, and a right pleural effusion. Percutaneous transhepatic cholangiography demonstrated a communication between the intrahepatic biliary ducts and the bronchial tree. The patient was treated with antibiotic therapy, pleural and biliary drainages and a percutaneous drainage of the hepatic abscess.

Phase III trial of docetaxel (D), estramustine (E), and prednisone versus docetaxel plus prednisone in patients with metastatic hormone-refractory prostate cancer (HRPC)

5067

Background: D alone or in combination with E improves survival of pts with metastatic HRPC. Whether E is necessary in combination with D is controversial. Preclinical data suggest a synergistic activity between D and E. Phase II as well as small randomized trials support this hypothesis, although indirect comparisons between the large phase III studies are not in favor of D/E combination. We conducted a randomized, prospective, multicentric study to compare D versus D/E. Methods: 150 metastatic HRPC were randomized (minimisation, stratification parameters: PSA level, ECOG, previous E use (38 pts), and center) between D (35 mg/m2 on day 2 and 9, every 3 wks) and D in combination with E (280 mg PO tid on days 1 to 5 and 8 to 12, coumadin 1mg/d). E was the only difference between the two treatment arms. All the pts received prednisone (10 mg/d). The primary endpoint was PSA response rate (decrease in PSA > 50% from baseline) and the study was powered to detect a 25% difference in PSA response rate. Results: No significant difference was found for PSA response (D/E: 50/68 (73%); D: 48/69 (69%)), time to PSA progression (median 205 days for D/E and 210 days for D), duration of PSA response (median 185 days for D/E and 220 days for D), progression-free survival (median 186 days for D/E and 195 days for D), response rate according to RECIST, and overall survival (median 617 days for D/E and 629 days for D). PSA < 4 ngr/mL occurred in 28/68 pts (41%) in D/E and in 17/69 (25%) in D (p=0.04). More pts had at least one grade 3/4 NCI-CTC toxicity in D/E (33/75 pts; 45%) compared to D (16/75 pts; 21%) (p=0.003). The main difference was grade 3/4 digestive toxicity (D/E:15% and D:4%; p=0.017). Serious adverse events were reported more frequently in D/E than D: 20 vs 9 (p=0.03). In D/E, the most frequent grade 3/4 toxicities were digestive (15%) and venous thrombosis (12%). In D, the most frequent grade 3/4 toxicity was anemia (9%) and venous thrombosis (8%). Conclusions: Our study did not show any clinically relevant advantage in term of efficacy for the addition of E to D. Both regimens were well-tolerated although the toxicity profile was in favor of D without E. Our study does not support the addition of E to D to treat pts with HPRC.

[Table: see text]

Naltrexone plus benzodiazepine aids abstinence in opioid-dependent patients

Naltrexone (NTX) is widely used to prevent relapse of opioid-dependent patients but its association with insomnia and "hyperexcitability" can result in treatment withdrawal. We evaluated whether NTX combined with the benzodiazepine prazepam was more effective than NTX in keeping patients opioid-free. We determined the relapse rate over 6 months in 56 opioid-dependent subjects, divided into 4 equal groups. All groups received psychological support and underwent urine tests for drug metabolites twice weekly. Group 1 did not receive pharmacological treatment (controls). Group 2 received NTX alone (one 50-mg tablet daily); group 3 received NTX (one 50-mg tablet daily) plus placebo (one tablet twice daily); and group 4 received NTX (one 50-mg tablet daily) plus prazepam (one 10-mg tablet twice daily). Ten patients of group 1 relapsed within 3 months, one after 6 months and three remained opioid-free. Six patients of group 2 relapsed within three months, two after 6 months, and six remained opioid-free. Seven patients of group 3 relapsed three months, one after 6 months and six patients remained opioid-free. In group 4, one patient relapsed within 3 months and one patient after 6 months; 12 patients of this group remained opioid-free. At urine tests, a significantly higher percent patients of group 4 remained free of Delta(9)-tetrahydrocannabinol versus patients of groups 2 and 3. In conclusion, many patients remained opioid-free on NTX alone or combined with prazepam, with a significant advantage for the NTX plus prazepam group.

Hospital-based intensive monitoring of antibiotic-induced adverse events in a university hospital

Hospital-based monitoring is one of the methods used to collect data about drug prescriptions and adverse events. The aim of this 20-day observational prospective study was to evaluate the frequency and type of adverse reaction to antibiotics, and predisposing risk factors in inpatients in six departments of a university hospital (ophthalmology, paediatrics, internal medicine, general surgery, infectious diseases, anaesthesiology and intensive care). The data on all inpatients undergoing antibiotic treatment were collected by physicians trained by our team and validated by an expert panel. Data were recorded on pre-formatted confidential cards (MIO-card). In the 171 inpatients evaluated (125 adults: 39.5% male, mean age 61.6 years, range 21-93; and 46 children: 50% male; mean age 4.75 years, range 3 months-12 years), cefazolin (19.9%), chloramphenicol (18.6%), ceftriaxone (15.4%) and netilmicin (12.9%) were the most frequently used antibiotics. Adverse events occurred in four adults and three children: one had leucopenia (trimethoprim/sulfamethoxazole), one nephrotoxicity (netilmicin+teicoplanin) and one nephrotoxicity (cefotaxime), one diarrhoea (ceftriaxone), one neurotoxicity (isoniazid), one angioneurotic oedema (piperacillin) and one skin rashes (ceftriaxone). A number of strategies (educative and persuasive, facilitative and restrictive) have been proposed to improve antibiotic use. Our study suggests that hospital-based monitoring is a good method with which to detect links between drug exposure and adverse drug reactions in children and adults.

Adverse drug events in two emergency departments in Naples, Italy: an observational study

The aims of this study, conducted in the emergency departments of two hospitals of Naples (Italy), which differ in type of catchment area and in the number of daily visits, were to determine: (1) the percent of emergency department visits due to adverse drug events (ADEs); (2) the percent of visits requiring hospitalisation due to acute ADEs; (3) the drugs implicated in ADEs; and (4) the types of ADEs and their frequency. We studied all emergency department visits at the A. Cardarelli and Incurabili hospitals between 8.00 a.m. and 8.00 p.m. (prospectively), and between 8.00 p.m. and 8.00 a.m. (retrospectively) for two 10-day periods. When possible, a form was completed for each subject. Patients were asked if they had taken a drug (name, dosage and reason for its use) in the previous 2 weeks. Of the 2442 emergency visits considered, 34 (1.3%) were drug related. Of the 480 patients who were subsequently hospitalised 17 (3.6%) had an ADE. The number increased to 34 (8.9%) in the 379 patients who took drugs in the 2 previous weeks. Non-steroidal anti-inflammatory drugs accounted for 26.5% of cases, antibiotics 23.6%, and antihypertensive agents 17.7%. The most frequent ADEs were gastrointestinal diseases (diarrhea, vomiting and haemorrhagic gastritis) and cutaneous rash (erythema, dermatitis). This study shows that ADEs account for a large percent of hospital admissions and confirms that drug-induced disorders is a notable public health problem.