Nosocomial nontyphoidal salmonellosis after antineoplastic chemotherapy: reactivation of asymptomatic colonization?

An increased frequency of nontyphoidal salmonellosis is well established in cancer patients, but it is unclear whether this represents increased susceptibility to exogenous infection or opportunistic, endogenous reactivation of asymptomatic carriage. In a retrospective study, a simple case definition was used to identify the probable presence of reactivation salmonellosis in five cancer patients between 1996 and 2002. Reactivation salmonellosis was defined as the development of nosocomial diarrhea >72h after admission and following the administration of antineoplastic chemotherapy in an HIV-seronegative cancer patient who was asymptomatic on admission, in the absence of epidemiological evidence of a nosocomial outbreak. Primary salmonellosis associated with unrecognized nosocomial transmission or community acquisition and an unusually prolonged incubation period could not entirely be ruled out. During the same time period, another opportunistic infection, Pneumocystis pneumonia, was diagnosed in six cancer patients. Presumably, asymptomatic intestinal Salmonella colonization was converted to invasive infection by chemotherapy-associated intestinal mucosal damage and altered innate immune mechanisms. According to published guidelines, stool specimens from patients hospitalized for longer than 72h should be rejected unless the patient is neutropenic or ≧65 years old with significant comorbidity. However, in this study neutropenia was present in only one patient, and four patients were <65 years old. Guidelines should thus be revised in order not to reject stool culture specimens from such patients. In cancer patients, nosocomial salmonellosis can occur as a chemotherapy-triggered opportunistic reactivation infection that may be similar in frequency to Pneumocystis pneumoni

Intensification of chemotherapy for the treatment of solid tumours: feasibility of a 3-fold increase in dose intensity with peripheral blood progenitor cells and granulocyte colony-stimulating factor.

Dose intensity may be an important determinant of the outcome in cancer chemotherapy, but is often limited by cumulative haematological toxicity. The availability of haematopoietic growth factors such as granulocyte colony-stimulating factor (G-CSF) and of peripheral blood progenitor cell (PBPC) transplantation has allowed the development of a new treatment strategy in which several courses of high-dose combination chemotherapy are administered for the treatment of solid tumours. PBPCs were mobilised before chemotherapy using 12 or 30 micrograms kg-1 day-1 G-CSF (Filgrastim) for 10 days, and were collected by 2-5 leucaphereses. The yields of mononuclear cells, colony-forming units and CD34-positive cells were similar at the two dose levels of Filgrastim, and the numbers of PBPCs were sufficient for rescue following multiple cycles of chemotherapy. High-dose chemotherapy (cyclophosphamide 2.5 g m-2 for 2 days, etoposide 300 mg m-2 for 3 days and cisplatin 50 mg m-2 for 3 days) was administered sequentially for a median of three cycles (range 1-4) to ten patients. Following the 30 evaluable cycles, the median duration of leucopenia < or = 0.5 x 10(9) l-1 and < or = 1.0 x 10(9) l-1 was 7 and 8 days respectively. The median time of thrombopenia < or = 20 x 10(9) l-1 was 6 days. There was no cumulative haematological toxicity. The duration of leucopenia, but not of thrombopenia, was inversely related to the number of reinfused CFU-GM (granulocyte-macrophage colony-forming units). In the majority of patients, neurotoxicity and ototoxicity became dose limiting after three cycles of therapy. However, the average dose intensity delivered was about three times higher than in a standard regimen. The complete response rate in patients with small-cell lung cancers was 66% (95% CI 30-92%) and the median progression-free survival and overall survival were 13 months and 17 months respectively. These results are encouraging and should be compared, in a randomised fashion, with standard dose chemotherapy

Current status and updated recommendations for diagnosis and treatment of plasma cell myeloma in Switzerland

The availability of drugs such as thalidomide, bortezomib and lenalidomide changed the landscape in myeloma treatment and has extended the median survival up to 10 years with a substantial improvement in quality of life. This development prompted a Swiss expert panel to re-evaluate the current status and formulate updated clinical recommendations for the diagnosis and treatment of plasma cell myeloma. These recommendations should help clinicians in their decision making to achieve the best outcome based on currently available data

Investigation of the Planetary Boundary Layer in the Swiss Alps Using Remote Sensing and In Situ Measurements

The development of the planetary boundary layer (PBL) has been studied in a complex terrain using various remote sensing and in situ techniques. The high-altitude research station at Jungfraujoch (3,580m a.s.l.) in the Swiss Alps lies for most of the time in the free troposphere except when it is influenced by the PBL reaching the station, especially during the summer season. A ceilometer and a wind profiler were installed at Kleine Scheidegg, a mountain pass close to Jungfraujoch, located at an altitude of 2,061ma.s.l. Data from the ceilometer were analyzed using two different algorithms, while the signal-to-noise ratio of the wind profiler was studied to compare the retrieved PBL heights. The retrieved values from the ceilometer and wind profiler agreed well during daytime and cloud-free conditions. The results were additionally compared with the PBL height estimated by the numerical weather prediction model COSMO-2, which showed a clear underestimation of the PBL height for most of the cases but occasionally also a slight overestimation especially around noon, when the PBL showed its maximum extent. Air parcels were transported upwards by slope winds towards Jungfraujoch when the PBL was higher than 2,800ma.s.l. during cloud-free cases. This was confirmed by the in situ aerosol measurements at Jungfraujoch with a significant increase in particle number concentration, particle light absorption and scattering coefficients when PBL-influenced air masses reached the station in the afternoon hours. The continuous aerosol in situ measurements at Jungfraujoch were clearly influenced by the local PBL development but also by long-range transport phenomena such as Saharan dust or pollution from the south

Kommt eine niedrig dosierte Radiotherapie (2 × 2 Gy) bei primären bilateralen follikulären Bindehaut-Lymphom infrage? [Can Low Dose Radiation Therapy (2 × 2 Gy) be Used in Primary Bilateral Conjunctival Follicular Lymphoma?]

Kommt eine niedrig dosierte Radiotherapie (2 × 2 Gy) bei primären bilateralen follikulären Bindehaut-Lymphom infrage? Can Low Dose Radiation Therapy (2 × 2 Gy) be Used in Primary Bilateral Conjunctival Follicular Lymphoma