Long-duration intracavitary infusion of methotrexate with systemic leucovorin protection in patients with malignant effusions

18 patients with malignant effusions were treated with continuous intraperitoneal, intrapleural, or intrapericardial infusion of methotrexate (MTX) 30 mg/m2 per d combined with simultaneous intravenous administration of leucovorin at a dose rate calculated to yield an equimolar concentration in the serum. In the serum the geometric mean steady-state MTX concentration was 0.95 microM, whereas it was 24 microM in the peritoneal, 213 microM in the pleural, and 434 microM in the pericardial cavities. Mean clearance was 6.6 ml/min from the peritoneal cavity, 2.6 ml/min from the pleural cavity, and 0.14 ml/min from the pericardial cavity. Leucovorin provided sufficient protection to allow the duration of infusion to be escalated from 24 to 120 h before myelosuppression was encountered. Marrow thymidylate synthetase activity was inhibited by an average of 46% compared to 86% inhibition in malignant cells in the effusions. Flow cytometric analysis showed no perturbation of the cell cycle phase distribution of marrow cells. All eight of the evaluable patients have responded: three received no other form of therapy, five also received systemic hormonal or chemotherapy. This study demonstrated that tumors confined to third space body fluids can be given very high concentration x time exposures to MTX with minimal systemic toxicity.

[Periodontal treatment requirements, motivation and information levels in a groups of 35-year-old Zurich residents]

A representative sample of 35-year old residents of Zurich was examined with the PTN-system to determine their periodontal treatment needs. 8.8% required no periodontal treatment. An additional 7.0% required only oral hygiene instruction and motivation to restore their gingival health. 37.1% of the sample needed removal of marginal irritants. 47.1% of the sample population had periodontal pockets in two or more quadrants, in need of surgical treatment (curettage, flap surgery). Responses to a questionnaire completed by all participants in the study revealed a strong desire on their part to retain their teeth. However, knowledge of periodontal prophylactic measures and individual oral hygiene was inadequate.