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Megestrol acetate given at 480 mg/day is useful palliation in patients with endocrine-insensitive advanced cancer. It improves appetite, mood and overall quality of life in these patients, although not through a direct effect on nutritional status.

PURPOSE To determine the antitumor activity and toxicity of paclitaxel administered as a 3-hour infusion in patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Fifty-one patients with advanced measurable or assessable NSCLC and performance status 0 to 2 who had not received prior chemotherapy were treated with paclitaxel 175 mg/m2 over 3 hours with premedication. Cycles were repeated every 3 weeks for a maximum of nine cycles. Most patients had prior radiotherapy (57%), extrathoracic metastatic disease (65%), and measurable disease (75%). Twenty-two percent had previously untreated stage III disease. RESULTS The objective response rate was five of 51 (10%; 95% confidence interval, 3% to 21%). No subgroup with a higher response rate could be identified. There were no complete responses (CRs) and all responses lasted less than 5 months. Treatment was well tolerated with brief World Health Organization (WHO) grade IV neutropenia in only 16% of patients. Grade III/IV myalgia/athralgia occurred in 22% of patients. No significant hypersensitivity reactions occurred. CONCLUSION The antitumor activity of this dose and schedule appears inferior to that reported in previously published phase II trials in NSCLC that used higher doses of paclitaxel infused over 24 hours, although confidence intervals for response overlap. Determining the optimal dose and schedule for using paclitaxel in NSCLC requires further investigation, and these results should caution against using shorter infusions outside appropriate clinical trials.

In 44 out of 758 patients (5.8%) with non-Hodgkin's lymphoma presenting between 1971 and 1982, the central nervous system (CNS) was involved. Patients with a diffuse histology had a 7.6% (34/449) incidence of CNS involvement compared to 3.9% (10/257) for patients with nodular lymphoma. In 63% of patients there was evidence of progressive systemic lymphoma at the time of diagnosis of CNS disease and in 23% CNS relapse occurred in clinical remission. Bone marrow was involved in 34% of patients at diagnosis and in 52% at some time prior to the onset of CNS complications. Cerebrospinal fluid cytology was positive in 63% and an elevated protein level was found in 95% of patients. The median length of survival of the 44 patients was only 3.2 months, but patients who responded to treatment of CNS lymphoma survived significantly longer than those who showed no response or progressed on therapy. Complete response to CNS treatment was achieved in five patients, of whom none relapsed in the CNS and two are long-term disease-free survivors. CNS prophylaxis appears justified for patients with lymphoblastic lymphoma, Burkitt's tumour, and diffuse undifferentiated lymphoma, who are at high risk of developing CNS complications. Patients with diffuse histiocytic, and diffuse poorly differentiated lymphocytic, lymphoma who have bone marrow involvement may also benefit from CNS prophylaxis.

BRITISH MEDICAL JOURNAL 26 JULY 1980 275 properties at high blood concentrations. MacLeod and Lamberts3 have shown the dopamine agonist effects of high concentrations of haloperidol and pimozide on prolactin release. Seeman4 has shown that very high concentrations of some antipsychotic drugs may enhance presynaptic release of neurotransmitters, including dopamine. Altematively, at high concentrations of antipsychotic drugs maximal dopaminergic blockade may occur. Additional dosage increments would not produce further dopamine blockade, but other pharmacological effects, such as anticholinergic activity, might continue to increase and might be responsible for the presentations described. Toxic psychoses have been associated with high doses of anticholinergic drugs,5 usually combined with moderate doses of antipsychotic drugs. The episodes reported in these studies also appear to have been characterised by excitement and aggression, as in our cases.Requests for reprints to Dr Bridges. In the case of Pseudomonas aeruginosa this susceptibility has been associated with the administration of broad-spectrum antibiotics, pre-existing immunosuppression, and corticosteroids.1Gross-infection has often been by way of contaminated ventilator equipment. This may be due to inadequate disinfection of the apparatus after use.2 Dilution of topical anaesthetics with deionised tap water has produced an outbreak of Ps cepacia respiratory tract infection.3 Pseudomonas species are of a low order of pathogenicity and are rarely implicated as a cause of clinical infection. Nevertheless, they have been known to cause a granulomatous pneumonitis under certain circumstances.4 Patients and methodsDuring routine twice-weekly bacteriological monitoring of an intensive therapy unit Ps fluorescens was consistently isolated from the tracheal aspirates of those patients who had been ventilated for four days or more. Twenty-nine consecutive admissions for mechanical ventilation were finally analysed. Only seven of these patients were ventilated for four days or more, and from all these Ps fluorescens was isolated. Ps fluorescens was identified by means of both the analytical profile index (API Products Ltd) and fluorescein-pyocyanin production. All isolates had the same analytical profile index number, produced fluorescein only on King's medium, and had the same antibiogram.On more detailed bacteriological examination of the intensive therapy units, Ps fluorescens was isolated from the humidifier water of all the ventilators in use, from the inspiratory tubing, and from the pre-filter expiratory tubing. At this time it was also noted that the temperature of the humidifiers, which are connected between the ventilator and the patient, was between 38°C and 41°C. Bacteriological examination was then performed on the humidifiers, humidifier water, and ventilator tubing before use. Only the distilled water, used to fill the humidifiers, yielded Ps fluorescens (20 organisms/i). The distilled water was delivered from the pharmacy in 8-litre plastic co...

Lorazepam was compared to placebo to assess its control of nausea and vomiting in patients receiving cytotoxic chemotherapy and prochlorperazine. The study design was a randomized, double-blind crossover in which three consecutive chemotherapy courses were compared so that each patient acted as his or her own control. Of 107 patients entered, 80 were evaluable for analysis. Lorazepam significantly reduced the severity and duration of nausea, the severity of vomiting, and the number of vomiting episodes when compared to placebo. Anxiety was reduced during lorazepam courses but not significantly when compared to placebo. There was significantly more sedation with lorazepam courses. Overall, patients preferred lorazepam courses although this preference was significant only in the patient subset receiving doxorubicin and cyclophosphamide. Lorazepam is a useful adjunct to prochlorperazine in patients receiving cytotoxic chemotherapy.

The aims of this study were to evaluate the feasibility, practicality, efficacy and safety of the delivery of accelerated partial breast irradiation using the MammoSite for the boost phase. Six patients aged 53-69 years with stage T1N0, T2N0, Grade I-II invasive ductal carcinoma received 9-10 Gy prescribed at 1 cm from the MammoSite balloon surface in two fractions of 4.5-5 Gy 6 h apart. The MammoSite was inserted 20-37 days postoperatively. External beam radiation therapy to the whole breast commenced 1-5 days after accelerated partial breast irradiation. The maximum skin dose ranged from 3 to 9 Gy. The skin-cavity distance ranged from 7 to 19 mm. Local discomfort resolved as the scar healed spontaneously within 3-5 days. No Grade III or higher acute toxicity or local infection was recorded. The ease of insertion and accuracy of dosimetry makes the MammoSite suitable for use in properly selected women with early-stage breast cancer in a trial setting.

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