Retrospective study of alemtuzumab vs ATG-based conditioning without irradiation for unrelated and matched sibling donor transplants in acquired severe aplastic anemia: a study from the British Society for Blood and Marrow Transplantation

This retrospective national study compared the use of alemtuzumab-based conditioning regimens for hematopoietic SCT (HSCT) in acquired severe aplastic anemia with antithymocyte globulin (ATG)-based regimens. One hundred patients received alemtuzumab and 55 ATG-based regimens. A matched sibling donor (MSD) was used in 87 (56%), matched unrelated donor (MUD) in 60 (39%) and other related or mismatched unrelated donor (UD) in 8 (5%) patients. Engraftment failure occurred in 9% of the alemtuzumab group and 11% of the ATG group. Five-year OS was 90% for the alemtuzumab and 79% for the ATG groups, P=0.11. For UD HSCT, OS of patients was better when using alemtuzumab (88%) compared with ATG (57%), P=0.026, although smaller numbers of patients received ATG. Similar outcomes for MSD HSCT using alemtuzumab or ATG were seen (91% vs 85%, respectively, P=0.562). A lower risk of chronic GVHD (cGVHD) was observed in the alemtuzumab group (11% vs 26%, P=0.031). On multivariate analysis, use of BM as stem cell source was associated with better OS and EFS, and less acute and cGVHD; young age was associated with better EFS and lower risk of graft failure. This large study confirms successful avoidance of irradiation in the conditioning regimens for MUD HSCT patients.

An analysis of the duration of fentanyl and its metabolites in urine and saliva

This study was undertaken to determine if metabolites of fentanyl might be useful in the detection and monitoring of substance abuse. The presence of fentanyl and two of its metabolites in the urine and saliva of seven female patients receiving small doses (110 +/- 56 micrograms) of fentanyl was studied up to 96 h from the time of administration. Fentanyl and its two metabolites (norfentanyl and despropionylfentanyl) were extracted from samples and analyzed by gas chromatography/mass spectrometry. Unchanged fentanyl was detectable in urine in all patients immediately postoperatively and in 3 of 7 patients at 24 h. By 72 h, fentanyl was undetectable. Norfentanyl was present in larger quantities than fentanyl immediately postoperatively and was detected in all patients at 48 h and in 4 of 7 patients at 96 h. Despropionylfentanyl was not detected in any of the urine specimens tested. Neither fentanyl nor its metabolites could be detected consistently at any time in saliva. Saliva testing does not appear to be a viable alternative to urine testing based on this study. Urinary norfentanyl might be considered as the substance of choice when testing for fentanyl abuse.

Holistic care of the patient with cervical cancer

Participation by women in screening programs for cervical cancer is far from optimal, and many lives are lost because of this. Cervical cancer is common, and is easily detected and treated. It has a good prognosis for cure if detected early in its course. Effective screening has been shown to have a major role in decreasing the morbidity and mortality associated with cervical cancer. Therefore, there is a need for increased public health education and availability of screening programs for women. It is particularly important that public health efforts reach women in the lower socioeconomic groups who are less apt to exhibit health promotive behaviors. Women of Latin American heritage are at particularly high risk because of cultural barriers to the discussion of sexual practices. Until public health interventions are more successful, cervical cancer will continue to pose a major threat to women who are either too embarrassed or too misinformed to understand that prevention is an integral part of women's health care. Nurses view patients in a holistic way. It is this philosophy of care that offers women who are diagnosed with cervical cancer a means to adapt successfully to the psychologic and physiologic stresses associated with the diagnosis. Nurses need to recognize this strength and to offer holistic approaches to women in crisis. No two patients deal with a diagnosis of cancer in the same manner. A major challenge to nurses across a hospital community continuum is to provide comprehensive psychologic and physiologic assessment of a women's response to a diagnosis of cervical cancer and to provide effective and holistic intervention when necessary.

Quantitative determination of phenelzine in human fluids by gas chromatography with nitrogen specific detection

A quantitative gas chromatographic assay for the determination of phenelzine in plasma or other fluids is presented. A stable derivative is formed by cyclization with acetylacetone, and the derivative is separated, purified, and concentrated by liquid-liquid solvent extraction. Analysis of the extracts is by capillary gas chromatography with nitrogen specific detection. Detection limits of less than 1 ng/mL and CVs of 5% at the 10-ng/mL level are attainable with a 2-mL sample and benzylhydrazine as the internal standard.