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Introduction: Bladder cancer is a frequently occurring tumour in Spain and usually affects elderly patients with renal impairment. The development of new combination therapies for such patients is thus of vital importance. Patients and Methods: Between 1997 and 1998, 17 patients with locally advanced non-surgical or metastatic bladder tumours were treated at our centres. Treatment consisted of 1,000 mg/m² of gemcitabine administered on days 1 and 8, and carboplatin (area under the concentration curve = 5) on day 1, every 21 days. Results: The mean age of the patients [4 females (26%) and 13 males] was 69 years (range: 54–78 years). The average Karnofsky performance status was 80% (range: 50–100%). Mean creatinine clearance was 45.4 ml/min (range: 21–55 ml/min). There were 2 complete responses, 7 partial responses (RO: 56%; range 31–81%), 6 patients had stable disease and 1 disease progression. Haematological toxicities were as follows: grade I anaemia in 2 patients, grade III in 3; grade I granulocytopenia in 2 patients, grade III–IV in 4 patients; grade III thrombocytopenia in 3 patients. Toxic death occurred in the course of one grade IV neutropenic event. Non-haematological toxicities were as follows: grade I–II vomiting in 3 patients and grade III in 1. One patient had grade III hepatic toxicity. One patient had grade III renal toxicity, and 3 patients grade II alopecia. Conclusions: The above-mentioned treatment has low toxicity, is easy to administer and offers promising results in this group of patients.

The aim of this study was to evaluate the effect of a structured teaching/treatment programme on the clinical and metabolic control of non-insulin-dependent (type 2) diabetic patients. The programme was aimed at improving the overall treatment quality in these patients through measures involving self-care, diet, exercise and weight reduction. Four theoretical-practical teaching units were given once a week to group of 5-8 ambulatory patients by previously trained general practitioners. Clinical and biochemical parameters were recorded at the beginning of the course and 1 year after its completion in 40 patients attending the programme and in 39 patients of similar clinical characteristics under conventional diabetes treatment, but receiving no structured teaching before or during the survey period (control group). The drop-out percentage in the intervention group (25%) was significantly lower than in the control group (45%, P < 0.05), suggesting an incentive toward greater compliance in the former. At the end of the 1-year follow-up, the mean differences observed in the control and in the intervention groups were: body weight loss -2.4 +/- 0.5 kg vs -0.4 +/- 0.5 (P < 0.001); haemoglobin HbA1 -0.2% +/- 0.4% vs +0.8% +/- 0.4% (NS); number of daily oral hypoglycaemic agent intake -1.4 +/- 0.2 vs +0.9 +/- 0.2 tablets (P < 0.001). Our results strongly suggest that this programme, applied through family doctors, may constitute an efficient tool to improve the compliance and clinico-metabolic control of type 2 patients at the primary health care level.

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