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Taxanes are commonly used anticancer agents with a potential of producing an allergic or hypersensitivity reaction (HSR). We performed a randomized study to evaluate the value of a test dose given prior to the full dose of either paclitaxel or docetaxel.Patients were randomly assigned to either the administration of the full dose or to the prior administration of a 1 mg intravenous test dose of either paclitaxel or docetaxel. The primary endpoints were severity of the HSR and the cost of drug wastage due to a HSR.Two hundred and eighteen patients were randomized from three different treatment sites. The overall incidence of HSR was 6.5% and there was no significant difference in the incidence of HSR in either group. The mean HSR severity grade was 2.8 for patients without a test dose and 2.3 for those receiving a test dose. There was, however, a reduction in the wastage of taxane in the test dose arm. Wastage avoided in the test dose arm was $1573 per patient who had a HSR and $104 per patient treated with a taxane.Although a test dose may not reduce the severity of a HSR with the administration of a taxane, it does reduce the cost associated with drug wastage.

Background Q fever is a widespread zoonotic infection caused by the pathogen Coxiella burnetii that has both acute and chronic manifestations. Q fever may present as a fever of unknown origin (FUO). We examined three cases of Q fever in west Texas and eastern New Mexico: two chronic and one acute that presented as FUO. Q fever usually occurs following exposure to infected animals. Q fever continues to be a diagnostic possibility in patients with FUO and animal exposure in the southwestern United States. Methods Cases review from medical records at our institution 2000-2006. Results: Discussion Q fever may present as an acute or chronic febrile illness, either of which can have nonspecific symptoms and signs. Serologic studies are necessary for the diagnosis. Phase I and phase II serology will differentiate between acute and chronic disease. Although somewhat slow and costly, these studies are key to appropriate diagnosis and therapy. Conclusion Q fever continues to be a diagnostic problem in west Texas and eastern New Mexico.

Idiopathic pulmonary fibrosis (IPF) is a rapidly progressive interstitial lung disease of unknown origin with marked impairment of quality of life and an expected survival after diagnosis of 3.2 to 5 years. It is characterized by multiple foci of fibrotic activity with minimal inflammation. A new approach to treating this disease is needed since no therapeutic regimen including steroids has been demonstrated to be effective. Although the results of a trial using large-dose, injected interferon gamma (IFNg) have been disappointing, there is a good theoretical basis for hypothesizing that interferons might be efficacious. Lung biopsy samples have shown that interferon levels are low while levels of transforming growth factor b 1 (TGF b1 ) are high. Interferon alpha (IFNa) can increase production of IFNg and aquaporins and inhibit (TGF b1 ), fibroblast activity and collagen synthesis. We have been running a trial of low-dose, orally administered IFNa (150 IU three times daily), which has minimal to no side effects. Subjects are evaluated with pulmonary function tests every 3 months and HRCTs at yearly intervals. Of the 9 subjects who have completed at least 1 year, the forced vital capacity has remained stable in 8 and the oxygen saturation after a 6-minute walk has been stable in 7 and improved in 1. One subject showing lack of progression has been followed for over 3.5 years and another for 2 years. The 8 subjects whose pulmonary function tests were stable showed no evidence of disease progression on HRCT scans. Most subjects who entered the study with a cough noted marked improvement within the first few weeks of treatment with corresponding increases in quality of life scores. These results strongly suggest that this regimen can prevent progression according to the criteria defined in the International Consensus Statement published by the American Thoracic Society.

6121 Background: Combination chemotherapy is the mainstay of treatment for a variety of malignancies. The sequence of chemotherapy administration can be important due to the effect of interactions on efficacy, toxicity, pharmacokinetics, or any combination of these. Although many reports have been published on this subject, there is, to our knowledge, no single source that describes the best sequence of administration for various chemotherapy regimens. Therefore, we conducted a review of the literature to identify sequence-dependent interactions to develop administration recommendations. Methods: A comprehensive literature search was conducted through November 2004 in Medline, PubMed, Embase, Cochrane Databases, CINAHL, & International Pharmaceutical Abstracts (IPA) as well as ASCO abstracts from 1995 through 2004. The bibliographies of identified articles were also reviewed for relevant citations. Only in vivo human studies that specifically compared various sequences of a chemotherapy regimen were inclu...