Chemioterapia : international journal of the Mediterranean Society of Chemotherapy最新文献

In an open, prospective, non-randomised study involving 112 patients undergoing elective colorectal surgery, the effect of perioperative prophylaxis with cefotetan was investigated. Cefotetan (2g) was administered, pre- and intra-operatively only. Preoperative bowel preparation was done by the standardised "Würzburg Method" i.e. oral metronidazole pre and post orthograde lavage. Mucosal biopsies were obtained from the resected colon and simultaneously serum samples were taken to determine tissue and serum levels respectively. Antibiotic serum and gut mucosal levels were well in excess of the minimum inhibitory concentration (MIC90) levels of the isolated bacteria. Wound infections occurred in only 2 patients. Cefotetan was well tolerated and no adverse events were noted. In prolonged colorectal surgery, an antibiotic such as cefotetan with a long half-life is to be recommended.

304 strains of R-plasmid harbouring enterobacteria resistant to aminoglycosides were studied for their susceptibilities to a range of antibiotics, including cefotetan. Cefotetan and latamoxef were the most active of the four cephamycins tested and all were stable to the beta-lactamases produced by these strains. No new beta-lactamases (SHV-2, CTX-1, TEM-4, CAZ-1) were found in these strains capable of hydrolysing third generation cephalosporins. The activity of cefotetan against these multi-resistant, beta-lactamase producing strains may be of clinical value.

The in-vitro activity of three long-acting cephalosporins (cefotetan, cefonicid and ceftriaxone) was compared against 206 clinical isolates of Bacteroides fragilis, Peptostreptococcus species and Clostridium perfringens, using an agar dilution procedure to determine minimum inhibitory concentrations (MICs). Clindamycin was included as a comparator. Cefotetan was much more active than the two other cephalosporins against strains of Bacteroides fragilis (MIC90 16 mg/l compared with greater than 128 mg/l for the other two agents). Cefotetan also demonstrated superior activity against anaerobic cocci. All three compounds showed good activity against strains of Clostridium perfringens. Clindamycin was active against all of the test strains.

The authors have evaluated the behavior of the interaction between cefotetan, a new cephalosporin with long acting resistance to the action of beta-lactamases, and gentamicin, amikacin and netilmicin against methicillin-susceptible and -resistant staphylococci. In 65.8% of the cases, drug combinations showed synergic effects. Results were subdivided for susceptibility or resistance to the drugs used in combination. In general, when both drugs were tested against methicillin-susceptible strains the results showed synergism.

In order to evaluate the predictive potential of a short-term antimetabolic assay for acute non-lymphocytic leukemia cells, the activity of daunomycin and cytosine arabinoside in suppressing [3H]-uridine uptake was tested in peripheral blood samples from 31 patients. Independently of the in vitro results, the patients were treated with standard combinations including the two drugs or with cytosine arabinoside alone. The clinical response to chemotherapy, and the in vitro [3H]-uridine uptake inhibition were compared retrospectively. A significant decrease of [3H]-uridine uptake after in vitro exposure to both drugs occurred in 12 patients who achieved complete remission after combination therapy, and was particularly evident for 5 patients who needed only one course of therapy. A similar result was obtained in patients treated with cytosine arabinoside alone. This method may represent a useful tool in clinical practice, by indicating a fraction of leukemic patients particularly sensitive to therapy.

Taking into account previous results with epirubicin in colorectal cancer, in January, 1985, an oriented Phase II trial was started in patients with measurable rectal cancer, previously untreated with chemotherapy. Ten patients were treated with 80 mg/m2 every 3 weeks, and another 10 patients with 100 mg/m2 every 3 weeks. One patient from the 80 mg/m2 group and 3 from the 100 mg/m2 group reached partial remission for 4, 9+, 15 and 72+ weeks. Median survival for all patients was 16 months. Hematological toxicity was not a limiting factor. Anemia was significantly more frequent in the higher dose group; clinical cardiotoxicity was not observed. The incidences of nausea/vomiting and mucositis were low. Considering the low toxicity and the responses observed, additional studies seem to be indicated with an increase in the epirubicin dose.

Six female patients with medullary thyroid carcinoma were treated with doxorubicin (50 mg/m2) and cis-diammine dichloroplatinum (70 mg/m2) every three weeks. No patient responded to therapy as was suggested by serial serum calcitonin concentrations before and after treatment.

Twenty patients with documented chronic active hepatitis B were randomized in equal numbers to either an alpha-2b interferon treatment group or a control group with no treatment. Patients in the first group received 5 IU interferon three times weekly by subcutaneous injection for 16 weeks. All 20 patients were HBeAg positive at the beginning. All 10 patients in the interferon-treated group lost their initial e antigen while only 2 patients in the control group turned HBeAg negative. Six patients in the treated group acquired HBe antibodies in comparison with two patients only in the untreated group. Other markers of suppression of viral replication as well as a 24-month follow-up are ongoing at the moment for final assessment of the value of interferon therapy in chronic active hepatitis B.

Infective complications not only remain the major factor in preventing a large proportion of cancer patients from achieving a complete remission, but also greatly influence the outcome of immunosuppressed transplant recipients and are a prominent problem in subjects affected by AIDS. We report the results of 73 patients, 54 males and 19 females with a mean age of 61.4 +/- 15.1 years affected by solid cancer (64 pts), AIDS (6 pts) or with kidney transplant (3 pts), treated with ciprofloxacin 250 mg bid (21 pts) or 500 mg bid (52 pts) for respiratory tract infections (41 cases), urinary tract infections (22), septicemia (5) or other infections (5). The mean course of therapy was 9.6 +/- 5.7 days and led to a complete resolution of symptoms in 66 (90.4%) patients, improvement in 6 (8.2%), while the clinical picture was unaffected in 1 (1.4%). Candida superinfection occurred in one case and only four patients experienced side effects. Ciprofloxacin results to be an effective antibacterial agent in a high risk population.

The purpose of this experimental study was to evaluate the possible synergistic effect of hyperthermia (HPT) and methotrexate (MTX) in Wistar rats transplanted with Walker sarcoma. HPT was induced by microwaves of 432 MHZ frequency transmitted through a source of 2 x 5.5 cm2 surface. The temperature in the tumor was maintained at 43 degrees C which was controlled by an intratumor thermocouple connected with an electronic thermometer. Three experiments were performed. First, in 5 rats HPT only was applied and one rat was used as control. Second, HPT and MTX in combination were given to 6 rats. Third, MTX alone was given to 6 rats. In the first experiment all 5 rats had 50% reduction of their tumors compared to control. In the second experiment complete disappearance of the tumor was noticed and in the third experiment the tumor increased in size. Histologically, in the responding tumors extensive necrosis was seen with thrombosed vessels. We conclude that HPT and MTX are synergistic in treating Walker sarcoma in Wistar rats.