Angela Torres

In order to determine the frequency of HIV seropositivity of sera from patients attending our hospital emergency department (ED) we used a HIV screening system based on the use of pooled sera. To determine the reliability of this marker we collect all ED serum samples during two different intervals of a week. From 577 sera analyzed by this method we detected 1.38% of HIV positive samples (95% confidence interval from 0.43% to 2.33%) with 74% benefit on reactives. We did not find significative differences between the rates of HIV seropositivity in the two period of analyzing (1.6% in October 1990 vs 1.2% in February 1991). The consistency of this method for anonymous HIV testing could be applied to a large number of samples from cohorts of expected low HIV prevalence rates and indirectly using this marker to control the spreading of HIV in a given population.

Melanoma will affect over 62,000 people in the United States this year, and approximately 8,000 of them will die as result of metastatic implants. The outcome of this common malignancy is almost invariably fatal when disseminated to distant tissues. None of the currently therapies approved by the Food and Drug Administration has demonstrated to improve the survival. Treatment with a combination of chemotherapy (cisplatin, dacarbazine, vinblastine) and biological modifiers (interleukin-2 and interferon αb) may induce durable complete responses. However, several clinical trials have failed to demonstrate a survival benefit. The lack of established biological and molecular markers to predict subsequent response to therapy and the serious toxicities associated with the regimen are major limitations to its routine use. This report briefly describes the case of a 47 year old male with metastatic melanoma involving mediastinal lymph nodes and periorbital tissues, and mesenteric tissues treated with concurrent biochemotherapy (cisplatin, vinblastine, temozolamide, interleukin-2, and interferon αb) during four consecutive cycles until complete remission was attained. A fifth course using a combination of temozolamide, interleukin-2 and interferon α2b was administered to consolidate the anti-tumor response. The patient remains without evidence of disease six months after completing therapy. Side effects included fever, fatigue, nausea, vomiting, diarrhea, erythema, pruritus, vitiligo, mucositis, anasarca, hypotension, azotemia, myelosupression, bacteremia, confusion, and peripheral neuropathy. All toxicities completely resolved except for Grade 1 neuropathy. This article also visits controversial aspects of this form of therapy and its associated toxicities.

Melanoma will affect over 62,000 people in the United States this year, and approximately 8,000 of them will die as result of metastatic implants. The outcome of this common malignancy is almost invariably fatal when disseminated to distant tissues. None of the currently therapies approved by the Food and Drug Administration has demonstrated to improve the survival. Treatment with a combination of chemotherapy (cisplatin, dacarbazine, vinblastine) and biological modifiers (interleukin-2 and interferon αb) may induce durable complete responses. However, several clinical trials have failed to demonstrate a survival benefit. The lack of established biological and molecular markers to predict subsequent response to therapy and the serious toxicities associated with the regimen are major limitations to its routine use. This report briefly describes the case of a 47 year old male with metastatic melanoma involving mediastinal lymph nodes and periorbital tissues, and mesenteric tissues treated with concurrent biochemotherapy (cisplatin, vinblastine, temozolamide, interleukin-2, and interferon αb) during four consecutive cycles until complete remission was attained. A fifth course using a combination of temozolamide, interleukin-2 and interferon α2b was administered to consolidate the anti-tumor response. The patient remains without evidence of disease six months after completing therapy. Side effects included fever, fatigue, nausea, vomiting, diarrhea, erythema, pruritus, vitiligo, mucositis, anasarca, hypotension, azotemia, myelosupression, bacteremia, confusion, and peripheral neuropathy. All toxicities completely resolved except for Grade 1 neuropathy. This article also visits controversial aspects of this form of therapy and its associated toxicities.