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3565. Chemotherapy of small cell lung cancer.
Selection of appropriate treatment is now possible on the basis of prognostic indices. For patients with a "poor" prognosis, therapy should be minimally toxic, for palliative purposes only. For patients with a "good" prognosis, intensive treatment is recommended with combinations comprised from C, A, V, VP-16, and CP. For patients obtaining a remission, consolidation is recommended with radiation treatment if this has not been part of the initial induction program with or without chemotherapy. Consolidation may be intensified by using high-dose chemotherapy in association with autologous bone marrow transplantation or possibly the use of hematopoietic growth factors. The major problem limiting further improvements in survival in this disease remains the emergence of drug resistance, which is now the subject of intensive investigations both in the laboratory and in the clinic.
3579. Nutritional support in the critical care setting (Part 1).
Over the past two decades nutritional support has rapidly become an integral part of the medical care of critically ill patients. As scientific evidence accumulates supporting the important role of underlying nutritional status in determining the eventual outcome of many illnesses, aggressive nutritional intervention has become commonplace in our medical and surgical ICUs. However, nutritional support, particularly parenteral alimentation, is expensive and associated with important morbidity and even mortality. Furthermore, definite evidence of its clinical efficacy under certain specific conditions is often lacking and in need of properly done prospective studies. This review summarizes the basic principles of nutrition as applied to the critically ill patient in the clinical setting. Special emphasis is on practical considerations regarding cost, efficacy (or lack thereof), and potential advantages, disadvantages, and risk of complications of each proposed approach.
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