Rapidly progressing hypercorticism was observed in 2 patients with malignant neoplasms, a 72-year-old man with anaplastic small cell carcinoma and a 48-year-old woman with a primary apudoma of the liver. Both patients were treated with chemotherapy in conventional doses. Both patients developed acute dyspnea and sudden death, 7 and 10 days, respectively, after chemotherapy was given. The possibility that patients with ectopic adrenocorticotropic hormone (ACTH) secretion are excessively vulnerable to chemotherapy is raised and judicious management urged.
Objective. To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx.Methods. Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible.Results. The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus.
Conclusion.Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is
Seventy‐three patients with disseminated melanoma were given chemotherapy at the University of California Hospitals, San Francisco. The chemotherapeutic regimens employed in their approximate chronological order over the 9‐year period were as follows: 1. pyrimidine nucleosides 5‐iodo‐2'‐deoxyridine (IUDR), 5‐fluoro‐2'‐deoxyuridine (FUDR), or a combination of both; 2. alkylating agents, nitrogen mustard, cyclophosphamide, phenylalanine mustard, or chlorambucil; 3. trimethylcolchicinic acid methyl ether d‐tartrate (TMCA); 4. a combination of vincristine and cyclophosphamide; 5. a combination of 1, 3 bis (2‐chloroethyl)‐, l‐nitrosourea (BCNU) and vincristine, and 6. a “miscellaneous” group which included hydroxyurea, cytosine arabinoside, and vinblastine. Objective remissions (50% reduction in tumor size) were observed in 6 patients (20%) treated with TMCA and in 1 patient (4%) treated with phenylalanine mustard. Partial responses were observed in 5 patients (17%) treated with TMCA and in 14 patients (19%) treated with other agents. Toxic effects from TMCA (pancytopenia, stomatitis, nausea and vomiting) were rapidly reversed by stopping the drug. In this series, TMCA proved to be a drug which was easily administered, on an outpatient basis, and produced significant remission rates. It is suggested that TMCA receive more extensive drug trials.
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