Reasons for nonenrollment in a clinical trial of acute lung injury.

Background: Enrolling critically ill patients in clinical trials is challenging. We observed that eligible patients at San Francisco General Hospital (SFGH), a public hospital that cares largely for indigent patients, were less likely to be enrolled in a clinical trial of acute lung injury (ALI) than eligible patients at the University of California, San Francisco (UCSF), a university referral center. We examined the reasons for nonenrollment and the impact of the availability of a surrogate decision maker on critical care clinical trials enrollment.

Outpatient combination chemoimmunotherapy for patients with metastatic melanoma. Results of a phase I/II trial.

Background: Few studies have examined the feasibility, safety, and efficacy of an outpatient biochemotherapy regimen of low dose, subcutaneously administered interleukin-2 (IL-2) for patients with metastatic (Stage IV) melanoma.

Methods: Nineteen patients were treated with intravenous cisplatin and dacarbazine (DTIC), oral tamoxifen, and subcutaneous IL-2 and interferon-alpha-2b (IFN). Eligibility requirements included bidimensionally measurable metastatic melanoma, a Karnofsky performance score of 60 or higher, absence of significant cardiac or pulmonary dysfunction, no prior DTIC or cisplatin chemotherapy, and no evidence of central nervous system involvement.

Recombinant human granulocyte macrophage-colony stimulating factor (rhGM-CSF) and autologous melanoma vaccine mediate tumor regression in patients with metastatic melanoma.

In mice, significant immunoprotection was achieved using B16 melanoma cells transfected with granulocyte-macrophage colony-stimulating factor (GM-CSF) as vaccines (Dranoff G, Jaffee E, Lazenby A, et al. Vaccination with irradiated tumor cells engineered to secrete murine granulocyte-macrophage colony-stimulating factor stimulates potent, specific, and long-lasting anti-tumor immunity. Proc Natl Acad Sci USA 1993;90:3539-43).

Biofeedback therapy for children with dysfunctional voiding.

Objectives: Biofeedback therapy has been recognized as a treatment option for children with classic dysfunctional voiding (DV) where there is inadequate pelvic floor relaxation during voiding. However, there are few articles that discuss methodology and limited sites where it is available. In the hope of making biofeedback a more practical and accessible option, we report our indications, easy to duplicate methodology, and results.

A case of composite Hodgkin's disease and chronic lymphocytic leukemia in bone marrow. Lack of Epstein-Barr virus.

We report Hodgkin's disease arising in a 68-year-old patient with a history of chronic lymphocytic leukemia for 8 years. The patient presented with a 4-month history of weakness, loss of appetite, and a 15-pound weight loss. A bone marrow biopsy showed two distinct histologic types of lymphoma: chronic lymphocytic leukemia and Hodgkin's disease.

Lymphomatoid papulosis followed by Hodgkin's lymphoma. Differential response to therapy.

Background: The association of lymphomatoid papulosis (LyP) with Hodgkin's lymphoma or other lymphomas is well recognized. However, the issue as to whether this represents an independent association or a transformation of one proliferative process to the other remains unresolved.

Observation: A woman with LyP subsequently developed Hodgkin's lymphoma.

Continuous infusion of spinally administered narcotics for the relief of pain due to malignant disorders.

The INFUSAID model #400 totally implantable drug delivery system was implanted in 17 patients for the continuous infusion of spinally administered preservative-free morphine sulfate. Sixteen patients had pain of malignant origin, and one patient had pain secondary to meningomyelocele. Over time, there was a consistent mean improvement in analgesia scores ranging from 50% to 70% of the control levels for 16 of the patients with cancer-related pain.

Sequential combination of bleomycin and mitomycin in advanced cervical cancer--an American experience: a Northern California Oncology Group study.

Eighteen evaluable patients with advanced squamous cell carcinoma of the cervix were treated with a sequential combination of bleomycin and mitomycin. We observed no complete responses and only four partial responses (22% response frequency). The median duration of response was only 3.

Adjuvant immunotherapy of high risk stage I melanoma with transfer factor.

Following conventional surgical management, 100 patients with high risk Stage I melanoma were treated with transfer factor to reduce the incidence of disease recurrence. All patients had primary lesions invasive to Clark's level III or deeper and exceeding 1.0 mm in measured thickness.

Priapism and multiple myeloma. Successful treatment with plasmapheresis.

Priapism was associated with multiple myeloma and hyperviscosity in a sixty-year-old black male. Plasmapheresis treatment of the hyperviscosity corrected his priapism, and chemotherapy for the underlying multiple myeloma prevented the recurrence of priapism after a chronic intermittent history of seventeen years.

Post-transfusion thrombocytopenic purpura: a case report.

Post-transfusion thrombocytopenic purpura (PTTP) is a rare syndrome which was first brought to widespread attention by Shulman et al. Eighteen cases have been reported. The present report describes an additional patient, a multiparous female who developed petechia 7 days after blood transfusion.