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This study was designed to assess the activity of oral topotecan (TPT) in patients with advanced non-small cell lung cancer previously untreated with chemotherapy. Eligible patients had inoperable stage III or stage IV non-small cell lung cancer and were chemotherapy-naive. Other inclusion criteria were Eastern Cooperative Oncology Group performance status 0, 1, or 2, adequate bone marrow, and renal and hepatic function. Of 30 patients, 29 were assessable for response. Oral TPT was administered for 5 days every 21 days for up to six cycles unless disease progression or unacceptable toxicity occurred. Patients received a dose of 2.3 mg/m2/day for the first cycle. Dose modification for subsequent cycles was based on tolerability. Patients completed symptom questionnaires every 3 weeks. Pharmacokinetics were evaluated in all patients during cycle 1. Three patients had radiological responses with a reduction in tumor size of 30-40%. No patients achieved complete or partial responses to treatment. Thirteen patients had a stable disease (43.3%), and the median survival was 39.9 weeks with a 1-year survival of 33.3%. At the time of analysis, 27 patients had died. Median time to progression was 12.3 weeks. Treatment was well tolerated. A total of 125 cycles of treatment were completed. Twelve patients (40%) experienced grade III/IV neutropenia. Five patients (16.6%) had grade III/IV anemia. There were two episodes of grade III/IV thrombocytopenia. The main nonhematological toxicities consisted of grade III nausea (13%) and grade III vomiting (13%). The most frequently reported disease-related symptoms at baseline were dyspnea, cough, and fatigue. There was a subsequent improvement in patient scores of dyspnea in 17% of patients, 31% showed improvement in cough, and 32% showed improvement in fatigue. The mean area under the curve of TPT following 2.3 mg/m2 p.o. was 51.6 ng.h/ml (%SD, 25%). The area under the curve of TPT on day 1 of the first cycle was correlated with the percentage fall in leukocytes. Although oral TPT at the applied dose and schedule showed modest activity as a single agent, almost one-half of the patients had a stable disease, and median time to progression was 12.3 weeks. The overall median survival was a promising 39.9 weeks, and useful palliation of symptoms was seen.

Aim: To identify adult inguinal lymph node anatomical subgroups using magnetic resonance imaging (MRI), to derive a normal range for nodal number and size and to describe their morphology., Materials and Methods: Eighty-three oncology patients with low stage pelvic tumours had inguinal lymph node assessment by MRI. Nodes were divided into proximal superficial (PS), distal superficial (DS) and deep inguinal (DI) subgroups, their number counted in two planes, and their transaxial short axis diameter recorded. Consistency of the largest node was recorded for each anatomical subgroup and two vertical distances measured, between the skin surface and the ipsilateral pubis, and between the skin surface and the deepest node., Results: Transaxial plane maximum nodal number at the three sites was: PS 5, DS 8, DI 3; and in the coronal plane: PS 7, DS 5, DI 3. Nodal size ranges were: PS 3-10 mm (mean 4 mm), DS 3-15 mm (mean 6 mm) and DI3-10 mm (mean 6 mm). There was no correlation between nodal size or number and age or gender. Nodes were usually uniformly solid (PS 44%; DS 37%, DI 45%), or fatty (PS 39%; DS 33%; DI 25%). The range of distances between the skin and deepest lymph node was 2.5-16 cm depending on patient fatness., Conclusion: The mean number of nodes counted in the axial plane was six and in the coronal plane five. A maximum short axis diameter of 15 mm was recorded for inguinal lymph nodes., (Copyright 2000 The Royal College of Radiologists.)

We aimed to determine if the trend in substance use in this central core of a large inner-city area confirmed an increase in marijuana use among young women < 22 years of age as childbearing years were beginning or if marijuana use and harder drug use were greatest among women beyond the teens and the early second decade of life and to describe one prenatal care intervention. Statistical reports for the Special Prenatal Clinic, a Harlem clinic for women with a current or past history of substance use, were reviewed from 1985 (the clinic's inception) through March 1996 to determine the trends, patterns, and types of drug use. Findings chronicled the beginning and rise in crack cocaine use, especially after 1986, confirmed an increase in marijuana use by adolescents since 1992, and suggest that the risk for use of hard drugs increases with age, predominantly in the childbearing years. Intervention by the Special Prenatal Clinic aided case-finding, allowed for comprehensive care, offered women opportunities for behavior change, and increased their chances of keeping their babies after delivery.

The health care industry is a massive system that is changing so rapidly that it is reinventing itself. With these changes, added demands have been placed on the knowledge base and practice of nurse-midwifery with emphasis on primary care, administration, and research as well as traditionally accepted nurse-midwifery practice. The American College of Nurse-Midwives (ACNM) has a history of being alert to consumer demands, sociopolitical forces, and the health care industry itself as stimuli for change after full dialogue with the membership and appropriate study. Because the ACNM Division of Accreditation will be requiring a baccalaureate degree upon entrance or completion of each midwifery education program by June 1999, dialogue should begin now about the benefits of requiring a masters degree as the entry-level credential.

A retrospective analysis was performed of the safety and efficacy of selective splenic artery catheterization for infusion of the immunotherapeutic agent interleukin-2 (IL-2). Fifty-one patients with metastatic melanoma had 103 successful catheterizations out of 113 attempts (91%). In nine patients preferential contrast flow was obtained into the splenic artery. When satisfactorily placed, the catheter position remained stable during the period of infusion in 98% of examinations. The incidence of major arteriographic complications was 4.5% and of minor complications 8.9%. The main problems encountered were thrombosis (3.6%) or persistent bleeding/hematoma formation (2.7%), in a patient population at high risk of malignant coagulopathy. Subintimal contrast injection occurred in five examinations (4.5%).

Thirty-four patients with a presumptive diagnosis of carcinoma of the bladder diagnosed at EUA and cystoscopy have been staged by MRI and the findings correlated with pathology in 15 patients and clinical follow-up, including repeat cystoscopy, in the remainder. MRI is accurate in identifying tumours confined to the bladder wall or extending beyond the wall to involve perivesical fat or adjacent organs. Whilst it is not possible to distinguish between T1, T2 or early T3a tumours they can be distinguished from advanced T3a lesions and this may affect management. MRI is superior to clinical staging, particularly in detecting lymphadenopathy and provides information for optimal radiotherapy planning. The problem of distinguishing between the effects of radiotherapy and suspected recurrent tumour is discussed.