Spiromustine and intracarotid artery cisplatin in the treatment of glioblastoma multiforme

Glioblastoma multiforme is a highly malignant and rapid-growing primary brain tumor. It constitutes one-fourth of all intracranial tumors and about half of all gliomas. Survival rate following conventional treatment is only 12 to 18 months. At the National Institutes of Health, two promising therapies are currently undergoing clinical trials. Spirohydantoin mustard (spiromustine) is a combination of a nitrogen mustard and a derivative of phenytoin, an anticonvulsant drug that rapidly penetrates the blood-brain barrier and localizes in brain tumors. Intracarotid administration of cis-diamminedichloroplatinum (cisplatin) increases drug delivery to the tumor and, through hemodialysis, systemic exposure is reduced. Nursing management of patients receiving these two agents requires precise planning and implementation of an individualized plan of care to ensure a successful chemotherapeutic regimen.

Pineal region brain tumors

Pineal region brain tumors occur in and around the pineal gland, a small cone-shaped structure in the posterior portion of the diencephalon. Pineal tumors can be divided into four basic categories: 1) germ cell tumors, 2) pineal tumors, 3) supporting cell tumors, and 4) cysts, or non-malignant conditions. Germinomas, one type of germ cell tumors, are the most common type of pineal region tumor. In overall incidence, pineal region tumors are relatively uncommon; however, because these tumors are mainly diagnosed in childhood and young adulthood, the incidence in that age group has been reported as high as nine percent. Pathophysiology and signs and symptoms are discussed as well as medical treatment and nursing care. The case study is a presentation of a 22-year-old male with a pineal region tumor.

A patient with Lindau-von Hippel disease--a nursing challenge

After six weeks participation in the rehabilitation program, D.K. was ready for discharge. He was receiving medications for symptomatic treatment: fluorocortisone acetate, cortisone acetate, and cimetidine. Rehabilitation goals were met to some degree; his strength was increased significantly and both motor control and balance were slightly better than at admission. He and his family recognized the need for ongoing care and agreed to be seen for follow-up treatment at the rehabilitation center.