Monday, March 23, 2009

Pall-Pourri; Austin, Neoplastic Meningitis, NEJM, PHN

My guess is the blog will be quiet (other than the twitter sidebar) until the AAHPM convention in Austin is over. Please stop me and say Hi if you see me. Christian and I are talking at the awards lunch on Thursday - we're looking forward to a chance to talk about the blog publicly, and to thank all who continue to support it. I remain amazed, and humbled, and grateful for the support and enthusiasm many Pallimed readers (including in the Academy) have shared with us about the blog - thanks.

And of course - please join us Friday night at Pete's Dueling Piano Bar after 7:30 (see here).

1)
Cancer has published a paper about neoplastic meningitis (whose findings supplement these which I blogged about a couple months back). This study provides some further prognostic data for (treated) neoplastic meningitis, and suggests that patients with negative CSF cytology do a little better in the short term.

The purpose of the study was to compare outcomes/survival in patients diagnosed with neoplastic meningitis who have positive CSF cytology (cancer cells which can be detected in the CSF) vs. those who don't (for whom the diagnosis was made on imaging, clinical findings, and/or abnormal CSF findings short of positive cytology). The data come from a single US cancer center and involve 84 patients (median age 47 years). Importantly, all patients had Karnofsky performance statuses of 70 or greater, and were treated with intraventricular cathethers and intraventricular chemotherapy (explaining the better-but-still-crummy survival in this series than the last one I blogged about).

Median survival was in the 18-20 week range for both groups, with 3 and 6 month survivals better in the negative cytology group (this was not statistically significant, although the numbers here are low): 90% vs. 40% for 3 month survival in the negative and positive groups, and 80% vs. 33% for 6 month survival. 12 month survival was 10% in both groups.

2)
NEJM has published the polling results about how
to proceed in a case involving a protracted conflict about treatment goals in a brain-injured patient (free full-text here; my blog post about this here). Overall, most readers 'voted' for withdrawing life-prolonging treatments in the patient - with notable geographic variation. This is obviously not a scientific sample, but the geographic variations are not too surprising, with lower rates of readers endorsing withdrawing life-prolonging treatments in Asia and South America than Europe or North America. There's a handy interactive map for country-by-country results, too (click on the map).

3)
Mayo Clinic Proceedings has a concise, practical review on shingles and post-herpetic neuralgia (free full-text here). It's pretty basic, but a good one for the teaching file. It seems to stumble a bit on its discussion of opioids in the treatment in PHN, playing up The Controversy, despite the fact that there's good data supporting their use (as good as opioid data goes which means solid efficacy/safety data for up to a couple months).

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