A total of 133 patients with advanced or metastatic adenocarcinoma of the kidney were stratified according to performance status and time from initial diagnosis to recurrence and were then randomized to one of three different drug treatment arms or the crossover secondary treatment. The study drugs (combination vinblastine-CCNU and single-agent triazinate or dactinomycin) failed to provide any meaningful antitumor activity for these patients with advanced renal cell cancer.

Adenocarcinoma↗

PubMedDate not supplied

Phase II study in advanced sarcoma: randomized trial of pyrazofurin versus combination cyclophosphamide, doxorubicin, and cis-dichlorodiammineplatinum(II) (CAP).

Twenty-eight patients with various histologic types of measurable metastatic sarcoma were randomly assigned to receive treatment with combination cyclophosphamide, doxorubicin (Adriamycin), and cis-dichlorodiammineplatinum(II) (CAP) or the single-agent, pyrazofurin. Patients who failed one arm of the protocol were eligible for cross-over treatment. Six of 24 patients treated with CAP achieved objective tumor regressions (25%), with a median duration of 11 months. None of 21 patients receiving pyrazofurin achieved a response. CAP is an effective, well-tolerated combination for the treatment of advanced sarcoma.

Amides↗

PubMedDate not supplied

Hypokalemia from intercostal nerve block.

BACKGROUND AND OBJECTIVES: Hypokalemia may arise from adrenergic stimulation during regional anesthesia. The authors studied the effects of adding epinephrine to the local anesthetic solution and of upper abdominal surgery on the hypokalemia following intercostal nerve block. METHODS: Intercostal block was induced with bupivacaine 0.5% in 10 female volunteers. Bupivacaine 0.5% with epinephrine 1:200,000 was used for another intercostal nerve block in the same volunteers and in eight women who had just undergone cholecystectomy. Plasma concentrations of potassium, epinephrine, glucose, and bupivacaine were measured and the ECG was recorded. RESULTS: The decrease in the plasma potassium level during the experiment with plain bupivacaine was 0.10 +/- 0.09 mmol/L (mean +/- SEM). With bupivacaine and epinephrine, the decrease was 0.26 +/- 0.06 mmol/L in the volunteers and 0.58 +/- 0.07 mmol/L in the patients. After surgery the drug absorption was facilitated and the concentration-response relationship between epinephrine and potassium was maintained. The epinephrine-containing local anesthetic was associated with minor ECG changes. CONCLUSIONS: The hypokalemic effect of intercostal nerve block with bupivacaine 0.5% and epinephrine 1:200,000 is doubled after upper abdominal surgery performed under general anesthesia.

Acid-Base Equilibrium↗

PubMedDate not supplied

Training in obstetric sonography in family medicine residency programs: results of a nationwide survey and suggestions for a teaching strategy.

BACKGROUND: Obstetric sonography is a valuable diagnostic procedure for family physicians who provide obstetrics; however, physicians tend to use technology that was effectively modeled during residency. The purpose of this study was to learn how many family medicine residency program directors had an interest in and a need for training in obstetric sonography, as well as whether they were willing to commit faculty and finances for adding the technology to their programs. METHODS: All program directors listed in the 1989 American Academy of Family Physicians (AAFP) Directory of Family Practice Residency Programs (n = 379) received a five-item questionnaire about obstetric services and use of sonograms in their programs and their desire for training in obstetric sonography. RESULTS: More than 81 percent of respondents said their programs provided obstetrics. Sixty-eight percent of these respondents used sonograms, and 53 percent indicated a need for training in obstetric sonography. Forty-five percent of all respondents, regardless of whether their programs offered obstetrics, indicated a desire for training. CONCLUSIONS: The high level of interest in obstetric sonography can be explained, in part, by the 81 percent of respondents whose programs provided obstetrics. These figures suggest a need to establish a training curriculum in obstetric sonography for family medicine residency programs. Our training program, designed to reach faculty, residents, and practicing physicians, is described.

Education, Medical, Graduate↗

PubMedDate not supplied

Correlation of emergency department radiographs: results of a quality assurance review in an urban community hospital setting.

BACKGROUND: The study objective was to compare the accuracy of radiograph interpretation by emergency and family physicians with radiologists' overreadings. METHODS: We undertook a historical chart review of patients seen consecutively during a 1-year period at an inner-city emergency department of a medium-volume community hospital. The participants were a racially mixed group of 22,141 patients for whom 12,083 radiographs had been ordered. We compared interpretations by emergency and family physicians with those of radiologists who performed overreadings within 24 hours. This intervention was performed retrospectively. Measurements consisted of descriptive statistics, such as percentages and chi-square analysis. RESULTS: The main result was an overall discrepancy rate (ODR) of 1.1 percent. This figure is significantly different (P < 0.0001) from the lowest reported overall discrepancy rate to date (2.8 percent). CONCLUSIONS: Consistently low overall discrepancy rates have specific implications for the medical practice and reimbursement of primary care physicians for radiograph interpretation.

Clinical Competence↗

PubMedDate not supplied

Phase II study of pyrazofurin in advanced colorectal carcinoma.

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Adenocarcinoma↗

PubMedDate not supplied

Chemotherapy for advanced germinal cell neoplasms: preliminary report of an Eastern Cooperative Oncology Group Study.

A series of 45 evaluable patients with stage III germ cell tumors have been treated between July 1977 and May 1978, with two cycles of an intensive five-drug regimen including cyclophosphamide, actinomycin D, vinblastine, bleomycin, and cis-dichlorodiammineplatinum(II) (cis-platinum). The patients were randomly assigned to receive the cis-platinum as a high dose 1-hour infusion with mannitol diuresis or as a low-dose 8-hour infusion without diuresis. The overall response rates were 36% complete response (CR) and 47% partial response (PR) after two cycles of induction therapy. Patients who achieved a CR or PR after two cycles were randomized to continue treatment with either a three-drug program of vinblastine, actinomycin D, and cis-platinum or a cyclic crossover regimen of three regimens (each containing three drugs) given in sequence at 3-week intervals with the entire sequence repeated at 9 weeks. During continuing treatment a minimum of five patients improved from PR to CR, so that the minimum CR rate will be 47%. A major determinant of response was extent of disease, with limited-disease patients having an 83% CR rate and advanced-disease patients having 22% CR rate. At present, there are no statistically significant differences between response rates for the two induction regimens. Patients have not been followed long enough on the continuing treatment arms to allow evaluation of improvement from PR to CR, duration of response, or duration of survival. Hematologic and renal toxiciity were not significantly different on the two induction treatment arms.

Antineoplastic Agents↗

PubMedDate not supplied

The transurethral resection syndrome--not yet a finished story.

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Humans↗