William T. Sawyer

Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancer.

PURPOSE To evaluate the quality of life (QOL) of breast cancer patients who survived 2 to 5 years following initiation of adjuvant cytotoxic and/or hormonal therapy and to characterize relationships between QOL and patient physical symptoms, sexual function, and preferences regarding adjuvant treatment. PATIENTS AND METHODS Eighty-six patients who had completed systemic adjuvant therapy for early-stage breast cancer between 1988 and 1991 were surveyed by written questionnaire and telephone interview. Sociodemographic information was obtained for each patient, and patients were asked to complete the Functional Living Index-Cancer (FLIC), the Symptom Distress Scale (SDS), the Medical Outcomes Study (MOS) Short Form 36 (SF-36), a series of questions regarding sexual function, and a survey about preferences for adjuvant therapy in relation to possible benefit. RESULTS The mean FLIC score among all patients was 138.3 (+/- 12.2), which suggests a high level of QOL. The reported frequency of moderate to severe symptoms was generally low (ie, < 15%), with fatigue (31.4%), insomnia (23.3%), and local numbness at the site of surgery (22.1%) occurring with greatest frequency. Patients reported a wide range of sexual difficulties. Preference assessment showed that more than 65% of patients were willing to undergo 6 months of chemotherapy for a 5% increase in likelihood of cancer cure. CONCLUSION Self-rated QOL in breast cancer patients 2 to 5 years following adjuvant therapy was generally favorable. Less than one third of patients reported moderate to severe symptoms. Selected aspects of sexual function appeared to be compromised. The majority of patients indicated a willingness to accept 6 months of chemotherapy for small to modest potential benefit.

Pharmacokinetics and pharmacodynamics of recombinant factor VIIa

To evaluate the pharmacokinetics and pharmacodynamics of recombinant activated factor VII (rFVIIa).

Quality of life in patients surviving at least 12 months following high dose chemotherapy with autologous bone marrow support

Over the past decade, high dose chemotherapy with autologous bone marrow (HDC‐ABMT) support has been used increasingly in the treatment of patients with breast cancer. In evaluating the results of HDC‐ABMT in patients with breast cancer, an assessment of quality of life can add to the traditional endpoints (toxicity, and disease‐free and overall survival) that are routinely assessed in clinical trials.

Hypokalemia, hyperglycemia, and acidosis after intentional theophylline overdose

Three cases of intentional theophylline overdose in adult patients are described. Among these, hypokalemia, hyperglycemia, and acidosis were found, and markedly elevated initial serum theophylline concentrations (106, 76.2, and 41.4 micrograms/ml) were measured. All patients recovered completely with conservative management. The observed biochemical abnormalities rapidly resolved during maintenance fluid therapy and modest potassium supplementation. In addition, seizures, ventricular arrhythmias, and other serious toxic effects were notably absent.

Comparison of PT, aPTT, and Factor VII Values Obtained by Concurrent Sample Collection by Direct Venipuncture and Peripheral Venous Catheters

Study Objective. To compare prothrombin time (PT), activated partial thromboplastin time (aPTT), and factor VII values in concurrent blood samples obtained by direct venipuncture and from a peripheral venous catheter.

Vancomycin serum concentrations in patients with renal dysfunction : A comparison of fluorescence polarization immunoassay and the enzyme-multiplied immunoassay technique

A study was conducted to determine whether assay-specific quantitative differences exist in the determination of vancomycin serum concentrations obtained from patients with renal dysfunction. Vancomycin serum concentrations were obtained during the first week of therapy for each of three time intervals: 48-96 h, 96-144 h, and 144-192 h after administration of the first dose of vancomycin. Vancomycin serum concentrations were measured using the enzyme-multiplied immunoassay technique (EMIT) and fluorescence polarization immunoassay (FPIA). Twenty patients with an estimated creatinine clearance < 40 ml/min who were receiving intravenous vancomycin were evaluated. Hemodialysis was required in 16 of 20 patients. Fifty samples were included in the data analysis. The mean (+/-SD) serum concentrations obtained with EMIT and FPIA were 10.9 mg/L (+/-5.3) and 12.6 mg/L (+/-5.7), respectively (p = 0.13), and were not statistically different. A linear relationship was observed between EMIT and FPIA (EMIT = 0.89 x FPIA - 0.24; r2 = 0.93). No statistically significant differences were observed in the calculated pharmacokinetic parameters between methods. FPIA and EMIT are comparable methods in determining vancomycin serum concentrations within the first week of vancomycin therapy in patients with moderate to severe renal dysfunction.

Assessment and predictability of renal function in spinal cord injury patients

Creatinine clearance values were determined by duplicate urine collections in 18 patients with spinal cord injury, cerebrovascular accident, or multiple sclerosis. Measured creatinine clearance values were compared with estimates predicted by a urine-free mathematical method for estimation of renal function. Measured creatinine clearance values were considerably lower than would be ordinarily expected on the basis of patient body size, age, sex, and serum creatinine. In addition, creatinine clearances calculated using the urine-free method were considerably higher than measured values, suggesting that techniques for the prediction of creatinine clearance may not be routinely applicable in patients with these conditions.

Digital computer-assisted warfarin therapy: Comparison of two models

Abstract An interactive computer program developed to assist clinicians in selecting appropriate maintenance warfarin doses is described. The program uses two previously described mathematical models to which actual patient data is iteratively fit. Preliminary results of a clinical evaluation of the program and comparison of the two models are presented, and the potential clinical applications are discussed.

A pocket calculator program for prediction of warfarin maintenance dose

A 398 step program, written for the TI59 programmable calculator, has been presented. The procedure allows the user to estimate a patients maintenance warfarin dose requirements after administration of three 10 mg doses or after any series of doses which produces a PT value greater than or equal to 20. The equation used, although based on published literature data, require further evaluation to adequately assess their clinical accuracy. They may, however, provide a starting point for maintenance dose treatment after initial therapy.

Extreme warfarin intoxication secondary to possible covert drug ingestion.

A young adult male patient presented with an excessively prolonged prothrombin time (>90 sec) following approximately two weeks of therapy with oral warfarin sodium, in doses between 2.5 and 5 mg/d. Repeated administration of vitamin K and fresh frozen plasma was required to reverse the anticoagulation and maintain a normalized prothrombin time. Serial warfarin plasma concentration measurements were used to interpret the apparently unusual prothrombin time response profile and to detect the possibility of covert drug ingestion.