Toxicity of hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric patients with sarcomatosis/carcinomatosis: early experience and phase 1 results

BACKGROUND

Intra-abdominal metastasis is a rare form of tumor dissemination in children. Complete surgical resection is usually deemed impossible. Children are frequently offered palliative care only. We adopted an aggressive approach for these cases which includes removal of dozens to hundreds of tumor nodules followed by perfusion of the abdominal cavity with hyperthermic chemotherapy (HIPEC) with a curative intent.

METHODS

We evaluated toxicity in 23 children and young adults undergoing 27 HIPEC procedures using cisplatin. Disease diagnoses included rhabdomyosarcoma (RMS), non-RMS soft tissue sarcoma, (NRSTS), desmoplastic small round cell tumor, (DSRCT), mesothelioma, Wilms tumor, melanomatosis, and adenocarcinoma. Patients underwent cytoreductive surgery followed by cisplatin at 40.5-41 °C, for 90 minutes. A subset of these patients was enrolled on our phase 1 study and as part of dose escalation cohort received 150 mg/m(2) of cisplatin. All toxicities were recorded.

RESULTS

Maximum tolerated dose was 100 mg/m(2). Dose limiting toxicity was grade 3 renal failure. In five of 27, 18% had grade 3 or higher renal failure. One patient developed a subclinical decrease in hearing and there were 2 grade 3 hematologic toxicities, 2 grade 3 hepatic toxicities, and one grade 3 ileus. One patient suffered grade3 cardiotoxicity. There were no operative/perioperative mortalities. Surgical complications occurred in 5/27 (18%) of patients. With a follow-up of 6-60 months, seven patients (26%) had no recurrence.

CONCLUSIONS

HIPEC is reasonably tolerated in pediatric patients with extensive abdominal metastasis. More study is needed to determine for which histologies HIPEC is most efficacious.

Improvement is needed in the documentation and HIV testing of children of HIV-positive women

We assessed our unit's documentation of the HIV status of 146 identifiable existing children of 146 women audited, out of our total cohort of 329 HIV-positive women. For 23 women (16%) there was no documentation of the presence or absence of children. For 81 children of 43 (29%) women the HIV status was unknown. Of these children, at least eight (5.5%) reside in the UK and could be accessed for testing. It is essential that documentation and testing of children of HIV-positive women takes place to prevent potentially fatal late-stage presentations of AIDS and onward transmission of HIV as young people become sexually active.

Increasing cervical cytology uptake in Glasgow HIV cohort

We present an audit of cervical smear uptake in our HIV-positive cohort in Glasgow. Uptake was favourable in comparison with the general population in the rest of Scotland (75% versus 73.4%); however, much lower than the British Association for Sexual Health and HIV (BASHH) recommended standard of 95%. A significant number of patients were incorrectly identified as only requiring three-yearly smears when they attended non-specialist services which may contribute to reduced uptake.

An X-ray Microtomographic Study of Natural White-spot Enamel Lesions

White-spot enamel lesions are an early presentation of dental caries and are ideally managed by non-invasive procedures. The aim of this study was to characterize white-spot enamel lesions by x-ray microtomography. In particular, mineral content across the lesion from the surface to the base of the lesion was measured and surface layers defined. Molars with long buccal white-spot enamel lesions were collected, photographed, and each sectioned to produce 3 500-µm-thick sections. The sections were mounted and imaged by quantitative x-ray microtomography at a 15-µm voxel size. We analyzed line profiles through the middle of each 3D image to determine mineral content and depth. The surface layer thickness of the lesions ranged from 35 to 130 µm, with the maximum mineral content in this layer being 74% to 100% of that of sound enamel. The average mineral content across the lesions ranged from 1.73 to 2.48 g/cm3. No significant differences could be found between lesions clinically categorized as active and those categorized as inactive. However, for depth-matched active and inactive lesions, the active lesions exhibited a more porous surface layer than the inactive lesions. White-spot enamel lesions are highly variable, with surface layers of considerable thickness.

A European Core Curriculum in Cariology: the knowledge base

This paper is part of a series of papers towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a joint workshop of the European Organization for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE), which was held in Berlin from 27 to 30 June 2010. This paper presents a closer look at the knowledge base as presented in the European Core Curriculum in Cariology. It comprises not only traditional basic sciences, such as anatomy and histology, but also emerging sciences such as molecular biology and nanotechnology and also fields such as behavioural sciences and research methodology. The different supporting competences are elaborated and explained. The problems of implementing a curriculum that truly integrates this foundation knowledge into the clinical teaching are discussed.

Effect of intracranial bleeds on the neurocognitive, academic, behavioural and adaptive functioning of boys with haemophilia

Brain insults are a risk factor for neuropsychological and academic deficits across several paediatric conditions. However, little is known about the specific effects of intracranial haemorrhage (ICH) in boys with haemophilia. The study compared neurocognitive, academic and socio-emotional/behavioural outcomes of boys with haemophilia with and without a history of ICH. Of 172 consecutive patients seen at a Pediatric Comprehensive Care Hemophila Centre, 18 had a history of ICH. Sixteen boys between the ages of 3 and 17 years were available for study and were matched to controls with haemophilia of the same age and disease severity and on the basis of maternal education. Groups were compared on neuropsychological and academic outcomes. Attention, socio-emotional function and executive skills were compared using data from parent questionnaires. Differences were found in intellectual function, visual-spatial skill, fine motor dexterity and particularly language-related skills, including vocabulary, word reading and applied math problem solving. Despite these group differences, outcomes were within the average range for most boys with ICH. No group differences were found in behavioural and socio-emotional functioning. Although ICH in haemophilia is not benign, it was not associated with significant cognitive and academic consequences for most boys. Early neuropsychological assessment may be indicated when there is a history of ICH. Investigation of age at ICH and quantitative measures of brain in relation to neurocognitive outcomes in larger groups of boys with ICH would be useful.

A new species of myxosporean (Sphaeromyxidae), a parasite of lined seahorses, Hippocampus erectus, from the Gulf of Mexico

Sphaeromyxa cannolii sp. n. is described from the bile ducts of aquaria-maintained lined seahorses (Hippocampus erectus) from the Gulf of Mexico. Spores of the new species are linear, 17-18 µm long and 5-6 µm wide, with flattened tips; polar capsules measure 4 × 3 µm. Routine necropsies of H. erectus following planned death revealed liver inflammation, bile duct obstruction, bile accumulation, and myxozoan parasites in the bile ducts of 11 of 40 animals sampled (27.5%). The presence of S. cannolii in an aquaculture setting should prompt keepers to carefully quarantine new animals and exclude annelid fauna, a potential intermediate host of myxozoans.

Importance of inhaler-device satisfaction in asthma treatment: real-world observations of physician-observed compliance and clinical/patient-reported outcomes

INTRODUCTION

It is hypothesized that health and patient-reported outcomes in asthma are positively influenced by the level of patient satisfaction with their inhaler device. This paper uses data from a real-world observational study to investigate the extent of the relationship between inhaler satisfaction and patient compliance, and the influence this has on health and patient-reported outcomes.

METHODS

Data were drawn from the Adelphi Respiratory Disease Specific Programme® (Adelphi, Macclesfield, UK), a cross-sectional study of consulting patients in five European countries undertaken between June and September 2009. A range of clinical and patient-reported outcomes were observed allowing analysis of these and their relationship with patient-reported inhaler satisfaction and patient compliance.

RESULTS

The analysis demonstrates that for the majority of patients the higher the level of satisfaction that the patient reports for their device the more likely the patient is observed to be compliant and to experience better outcomes including quality of life (as measured by EuroQol 5 Dimensions [EQ-5D] utility score, P<0.001), fewer exacerbations (P<0.001), fewer hospital visits (P=0.011), fewer healthcare visits (P=0.001), fewer primary care physician visits (P=0.001), and fewer sleep disturbances (P<0.001).

CONCLUSION

The level of patient satisfaction with their inhaler device is observed to have a positive influence on the treatment goals for asthma through its association with improved compliance.

Characterization of Conductive Anodic Filament (Caf) by X-Ray Microtomography and by Serial Sectioning

X-ray microtomography is used to nondestructively section printed wiring boards in which conductive anodic filaments (CAFs) had grown, Quantification of the spatial distribution of copper is compared for microtomography and for serial sections obtained in SEM with backscattered electrons. The agreement between the techniques is excellent and indicates that microtomography may be used confidently to follow the subsurface growth of CAFs.

Quality of life, distress and self-esteem: A focus group study of people with chronic bronchitis

Chronic bronchitis (a form of chronic obstructive pulmonary disease or COPD) is a common cause of morbidity and mortality resulting in around 5% of deaths in the UK. Over recent years, there has been an increased emphasis on patient-based evaluation of health and social care, which has led to a rapid growth in quality of life measures and an increase in measuring quality of life for COPD patients. However, less attention has been paid to patients' perceptions and experiences of everyday life, specifically their active engagement in the psychological, emotional and social aspects of adjustment and adaptation to living with chronic bronchitis. This study employs a series of four focus groups (N = 20) to identify key experiences of living with chronic bronchitis. The results, obtained through using both thematic and conceptual qualitative analysis, within a broadly symbolic interactionist framework, describe the subjective and sometimes contradictory ways in which the disease leads to psychological distress, dependency on medication, and disruption to social and family relationships, and has a negative impact on self-esteem. The study further argues for greater awareness of qualitative approaches to the broad view of quality of life as complementary to quality of life assessments.

The patient-physician partnership in asthma: real-world observations associated with clinical and patient-reported outcomes

INTRODUCTION

It is hypothesized that a good partnership between asthma patients and their physicians has a direct and positive influence on the patients' clinical and patient-reported outcomes. Conversely, poor partnership has a detrimental effect on clinical and patient-reported outcomes. This paper uses data from a real-world observational study to define partnership through matched physician and patient data and correlate the quality of partnership with observed clinical and patient-reported outcomes.

METHODS

Data were drawn from Adelphi's Respiratory Disease Specific Programme, a cross-sectional study of consulting patients in five European countries undertaken between June and September 2009. A range of clinical and patient-reported outcomes were observed allowing analysis of the partnership between 2251 asthma patients and their physicians.

RESULTS

Analysis demonstrates that the better the partnership between patient and physician, the more likely the patient is to have their asthma condition controlled (P<0.001), to experience fewer exacerbations (P<0.001), to have better quality of life (P<0.001), to have fewer sleep disturbances (P<0.001), and to have fewer patient-reported symptoms (P<0.001). Partnership is also associated with lower impact on lifestyle (P<0.01) and reduced days lost at work/school (P<0.05), and with patient satisfaction with their inhaler device (P<0.05).

CONCLUSION

The patient-physician partnership is a contributory factor in the improvement of asthma treatment, and patient education may lead to improvement in a patient's ability to contribute to this. Device satisfaction is one of the markers of good partnership.