Safe administration of etoposide phosphate after hypersensitivity reaction to intravenous etoposide

Etoposide is commonly used in a variety of malignancies. A well known but rare toxicity are hypersensitivity reactions, usually manifested by chest discomfort, dyspnoea, bronchospasm and hypotension. We report the details of a patient who developed hypersensitivity reactions to intravenous etoposide, but subsequently tolerated the administration of intravenous etoposide phosphate with no sequalae

First-line treatment for advanced ovarian cancer: paclitaxel, platinum and the evidence

Four large randomised trials of paclitaxel in combination with platinum against a platinum-based control treatment have now been published in full, representing around 88% (3588 out of 4057) of patients randomised into the eight known trials of this question. There is substantial heterogeneity in the results of these four trials. Four main explanations for this heterogeneity have been proposed: differences in the extent and timing of ‘crossover’ to taxanes in the control groups; differences in the types of patient included; differences in the effectiveness of the research regimens used; differences in the effectiveness of the control regimens used. In this study we examine whether any of these explanations is consistent with the pattern of results seen in these trials. Each explanation suggests that a particular characteristic of each trial was responsible for the results observed. For each explanation the trials were split into groups according to that characteristic, in order to partition the total heterogeneity into that seen ‘within’ and ‘between’ groups of trials. If a particular explanation was consistent with the pattern of results, we would expect to see relatively little heterogeneity within each group of trial results viewed in this way, with most of the heterogeneity being between groups which are dissimilar with respect to the key characteristic. Heterogeneity ‘within’ and ‘between’ groups was formally compared using the F-ratio. If any explanation appeared to be consistent with the results of the trials, it was considered whether the explanation was also consistent with other evidence available about these regimens. Only one explanation appeared to be consistent with the pattern of results seen in these trials, and that was differences in effectiveness of the control arms used in these trials. This suggests that the very positive results in favour of paclitaxel/cisplatin seen in two of the trials may have been due to the use of a suboptimal control arm. There is no direct evidence about the relative effectiveness of the control arms used in these trials, but indirect evidence is consistent with the conclusion that the cyclophosphamide/cisplatin regimen used in two of the trials may be less effective than the control regimens used in the other trials. Specific concerns about the choice of a cyclophosphamide/cisplatin control arm in the first of these trials to report were raised before the results of the other trials were known, i.e. before any heterogeneity had been observed. Further investigation of this question would be useful. In the meantime, given all of the randomised evidence on the efficacy and toxicity associated with the regimens used in these trials, we conclude that single agent carboplatin is a safe and effective first-line treatment for women with advanced ovarian cancer

Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO Registry

OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS: Up to 19 November 2010 a total of 2439 patients had enrolled into the registry. Most were classified as either limited cutaneous SSc (lcSSc; 52.2%) or diffuse cutaneous SSc (dcSSc; 36.9%). Digital ulcers developed earlier in patients with dcSSc compared with lcSSc. Almost all patients (95.7%) tested positive for antinuclear antibodies, 45.2% for anti-scleroderma-70 and 43.6% for anticentromere antibodies (ACA). The first digital ulcer in the anti-scleroderma-70-positive patient cohort occurred approximately 5 years earlier than the ACA-positive patient group. CONCLUSIONS: This study provides data from a large cohort of SSc patients with a history of digital ulcers. The early occurrence and high frequency of digital ulcer complications are especially seen in patients with dcSSc and/or anti-scleroderma-70 antibodies

Evaluation of spinetoram and spinosad for control of Prostephanus truncatus, Rhyzopertha dominica, Sitophilus oryzae, and Tribolium confusum on stored grains under laboratory tests

Spinetoram and spinosad have been evaluated against certain stored-product insect pests with success but there are no data available on the comparison of the efficacy of these two novel compounds in stored grains. Thus, laboratory bioassays were conducted to compare spinetoram and spinosad as grain protectants against Prostephanus truncatus (Horn) (Coleoptera: Bostrychidae) adults, Rhyzopertha dominica (F.) (Coleoptera: Bostrychidae) adults, Sitophilus oryzae (L.) (Coleoptera: Curculionidae) adults, and Tribolium confusum Jacquelin du Val (Coleoptera: Tenebrionidae) adults and larvae. Factors such as treatment (1 ppm spinetoram, 1 ppm spinosad, 0.1 ppm spinetoram + 0.9 ppm spinosad, 0.5 ppm spinetoram + 0.5 ppm spinosad, and 0.9 ppm spinetoram + 0.1 ppm spinosad), exposure interval (1, 2, 7, and 14 days), temperature (20, 25, and 30 A degrees C), and commodity (barley, maize, rye, and wheat) were evaluated. Progeny production was assessed after 60 days of exposure. Concerning temperatures, for P. truncatus adults, after 14 days of exposure, all adults were dead in treatments except of the case of spinosad alone at 20 A degrees C. Offspring emergence was completely suppressed in all treatments at 20 and 25 A degrees C. For R. dominica adults, after 7 days of exposure, the overall mortality ranged from 92.8 to 100 %. After 14 days of exposure, all adults were dead in all treatments of the combined use of spinetoram and spinosad at 25 and 30 A degrees C. Progeny production was completely suppressed in all treatments at 30 A degrees C. For S. oryzae adults, after 7 days of exposure, all S. oryzae were died at 25 and 30 A degrees C in all treatments except in the case of spinosad alone. Offspring emergence was very low in all treatments and temperatures except in the case of spinosad alone at 30 A degrees C. For T. confusum adults, after 1, 2, and 7 days of exposure, the overall mortality was low in all treatments and temperatures. Concerning commodities, for R. dominica adults, after 7 and 14 days of exposure, the overall mortality was > 97 %. Offspring emergence was very low in all commodities. For S. oryzae adults, after 7 and 14 days of exposure, the overall mortality was increased exceeding 91 % except in the case of spinosad alone 7 days after exposure in barley. Progeny production was high in barley and rye in all treatments. For T. confusum adults, after 7 and 14 days, the overall mortality was low in barley, rye, and wheat. No offspring emergence was recorded in all treatments and commodities. For T. confusum larvae, after 14 days of exposure mortality was further increased, but did not reach 100 % for any of the combinations tested. The results of the present study suggest that the simultaneous application of spinetoram and spinosad was generally equally effective with the use of either spinosad or spinetoram alone. Furthermore, the increase of dose of either compound resulted in the same mortality levels. Thus, no benefits were achieved when spinetoram and spinosad were used simultaneously on grains, regardless of the proportion of each ingredient. These issues should be seriously considered when control measures against stored-product insects are designed

Competition among Species of Stored-Product Psocids (Psocoptera) in Stored Grain

We evaluated the competition among stored-product psocid species by conducting two series of laboratory experiments. In the first series, three species of Liposcelididae were used: Liposcelis bostrychophila, Liposcelis decolor, and Liposcelis paeta. Five adult females of these species were placed in vials containing wheat, either alone or in all possible combinations of two species. The number of adults in the vials was counted after 35, 70, 105, 140, and 175 days. These tests were performed at 25 and 30 degrees C. At 25 degrees C, there were no differences in numbers of L. bostrychophila when this species was reared either alone or with each of the other two species. At 30 degrees C, L. bostrychophila was the dominant species. The presence of L. bostrychophila had a negative effect on the growth of populations of L. decolor and L. paeta. The presence of L. paeta did not affect growth of populations of L. decolor, although the presence of L. decolor occasionally reduced growth of populations of L. paeta. In the second series of tests, L. bostrychophila adult females were placed in vials of wheat either alone or with adult females of Lepinotus reticulatus, at the ratios of (L. bostrychophila:L. reticulatus) 10:0, 9:1, 7:3, 5:5, 3:7, 1:9, and 0:10. These tests were carried out only at 30 degrees C, and the observation periods were the same as for the first series of tests. Liposcelis bostrychophila was the dominant species in this case as well, regardless of the ratio of the parental females. At the end of the experimental period, L. reticulatus was present only in vials that contained this species alone. Our results showed that L. bostrychophila outcompetes the other stored-product psocid species tested