Biomedical subjects

B Bermejo

Publications and source records attributed to B Bermejo.

At least 19 recordsLinked to original sources

PubMed1999

[The prognostic value of eicosanoids in the acute respiratory distress syndrome].

BACKGROUND: There is a great number of agents involved in the acute respiratory distress syndrome (ARDS) physiopathology, and some of them may have a prognostic value. The objective of the present study has been to analyse the prognostic value of eicosanoids in this syndrome. MATERIAL AND METHOD: A prospective study with 21 consecutive ARDS patients admitted to the intensive care unit of a therapy hospital in Barcelona, Spain, was carried out. In the first 48 h of the ARDS diagnosis, at baseline, the plasma levels, (in peripheral arterial and pulmonary arterial samples) of thromboxane B2 (TXB2), prostaglandin F1-alpha) (PGF1-alpha) and leukotriene B4 (LTB4) were analysed by RIA. Simultaneously we measured different pulmonary and systemic hemodynamical variables, as well as the pulmonary gas exchange data. We also studied the venous levels of the same eicosanoids in 17 healthy adults, used as reference. RESULTS: Plasma levels of eicosanoids in the ARDS patients were higher than reference subjects (p < 0.05). No differences were observed between systemic arterial and pulmonary arterial values. From all the eicosanoids, only LTB4, (in both systemic arterial and pulmonary blood), was correlated with LIS (r = 0.49, p < 0.05; and r = 0.45, p < 0.05, respectively). Patients who did not survive presented a lower systemic-pulmonary arterial gradient of eicosanoids levels than survivors (-1.27 vs -0.10 ng/ml; p < 0.01). CONCLUSIONS: In our ARDS patients only LTB4 plasma levels correlated with the severity of respiratory failure. Patients who did not survive presented a lower LTB4 gradient than survivors.

Adult↗

PubMed1998

Prognosis of "clandestine" myocardial ischemia, silent myocardial ischemia, and angina pectoris in medically treated patients.

The aim of this study was to assess the prognosis of medically treated patients with "clandestine" myocardial ischemia (perfusion defect without angina and no ST depression > 1 mm during exercise test) compared to those with silent myocardial ischemia (ST-segment depression > 1 mm, without angina) and those with angina pectoris. One hundred twelve patients without previous myocardial infarction were included. All patients underwent a symptom-limited exercise test on a bicycle ergometer, myocardial perfusion technetium-99m-methoxy-isobutyl-isonitrile single-photon emission computed tomography (SPECT), and coronary angiography. They were classified into 3 groups (angina group, 34 patients; silent group, 20 patients; and the clandestine group, 58 patients). The mean follow-up was 3.6 years (range 6 months to 5.5 years). Patients with clandestine ischemia had a lower scintigraphic and angiographic score than patients with silent ischemia (25+/-8 vs 31+/-9 and 24+/-8 vs 29+/-7, p = 0.008, respectively), but the prognosis was similar. Only angina and severe reversible SPECT defects were predictive for cardiac events: death + myocardial infarction + revascularization. We conclude that in medically treated patients without previous myocardial infarction, angina and severe reversible SPECT defects are predictive for cardiac events only when the need for revascularization is included as a cardiac event.

Angina Pectoris↗

PubMed1998

[Factors associated with mortality and gait impairment in elderly patients with hip fractures].

BACKGROUND: Hip fractures are a major source of mortality and morbidity among the elderly. The aim of the present study is to try to identify predictors of death and of non-deambulation during the period of acute treatment. PATIENTS AND METHODS: Consecutive prospective study of 459 patients older than 65 years admitted to our hospital with acute proximal femoral fractures with 12 months follow-up. RESULTS: The mean length of hospital stay was 26.6 days, it exists a highly percentage of non-ambulatory patients at discharge from hospital (44.3%), a low percentage of mortality in the immediate postoperative period (6.1%) and a larger percentage of mortality at 6 months (26.15%). Factors associated with risk of death at hospital are male sex (OR = 2.38; 95% CI = 1.04-5.47), deteriorated mental status (OR = 2.62; 95% CI = 1.01-6.76) and no previous personal independence (OR = 3.16; 95% CI = 1.19-8.38). Age over 80 years (OR = 2.27; 95% CI = 1.43-3.60), deteriorated mental status (OR = 7.90; 95% CI = 3.83-16.3), no walking ability before fracture (OR = 3.72; 95% CI = 2.33-5.91) and type of fracture (OR = 1.84; 95% CI = 1.15-2.95) are shown as the determinants of gait capacity. CONCLUSIONS: Mortality in the immediate postoperative period is associated with sex, dementia and previous personal independence. The hospital stay is extended and functional recovery at discharge is low, therefore, new programs for these patients should be considered.

Aged↗

PubMed1998

Severe acute pancreatitis: treatment with somatostatin.

OBJECTIVE: To investigate the efficacy of somatostatin for the treatment of severe acute pancreatitis. DESIGN: Prospective, randomized and unblinded study. SETTING: A general intensive care unit (ICU) in a university hospital. PATIENTS: 50 patients with severe acute pancreatitis. INTERVENTIONS: All patients received the conventional treatment for this clinical condition. The study group received, in addition, somatostatin over a 10-day period. MEASUREMENTS AND RESULTS: We evaluated age, gender, etiology of the pancreatitis, severity of the illness, complications, length of hospitalization, and mortality in the ICU. The patients were classified as severe (Acute Physiology and Chronic Health Evaluation II score, Ranson's criteria, and computed tomography Balthazar classification). Biliary lithiasis was the most common etiologic factor (63.6% in the control group, 37.5% in study group; NS). The study group required fewer overall surgical interventions than the control group (45.8 vs 86.4%; p = 0.005). Late surgical procedures related to the evolution of pancreatic necrosis were more common in the controls (63.6 vs 37.5%; p = 0.07). No differences in length of stay in hospital or mortality in the ICU were observed. CONCLUSION: The only advantage of somatostatin administration in the patients studied was a slight reduction in the need for surgery due to local complications.

APACHE↗

PubMed1998

Gas exchange and pulmonary haemodynamic responses to fat emulsions in acute respiratory distress syndrome.

OBJECTIVE: To investigate the gas exchange and pulmonary haemodynamic responses to two different intravenous fat emulsions in patients with acute respiratory distress syndrome (ARDS). DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Intensive care unit in a university-affiliated hospital. PATIENTS: 21 patients with ARDS [mean age, 57 +/- 3 (SEM) years; Acute Physiology and Chronic Health Evaluation II, 20 +/- 3; Murray's score, 2.85 +/- 0.12] consecutively admitted. INTERVENTIONS: Patients were assigned to three groups (n = 7 each): group A (LCT) received long-chain triglycerides (20% LCT), group B (MCT/LCT), medium-chain triglycerides/long-chain triglycerides (20% MCT/LCT: 50/50) and group C placebo (0.9% sodium chloride, NaCl). The infusion was always given at the rate of 2 mg/kg min over a total period of 12 h, with a volume infusion of 500 ml in each group. MEASUREMENTS: Data were collected before, immediately after and 12 h after infusion ceased. Pulmonary and systemic haemodynamic and gas exchange variables were measured at each time point. Serum triglyceride cholesterol, and non-esterified fatty acids levels were measured. RESULTS: During LCT infusion, cardiac output, oxygen consumption and oxygen delivery increased (all p < 0.05), whereas pulmonary haemodynamics, arterial oxygen tension, mixed venous partial pressure of oxygen and venous admixture ratio remained essentially unaltered. No changes were observed following MCT/LCT infusion. CONCLUSIONS: The administration of LCT emulsion given at a slow rate did not alter arterial oxygenation because of the beneficial effect of a high cardiac output, hence offsetting the detrimental effect of increased O2 consumption.

Adult↗

PubMed1998

[Prognosis of patients with angina pectoris or silent ischemia: exercise 99mTC-MIBI SPECT].

INTRODUCTION AND OBJECTIVES: Although different reports have compared the extent of the myocardial ischemia in patients with or without angina during exercise test, there have been few publications which have studied their prognosis. The aim of this study is to analyze the prognostic value of the presence of angina during 99mTc-MIBI SPECT in patients with proven coronary artery disease without previous myocardial infarction. PATIENTS AND METHODS: We studied 82 patients prospectively with at least one coronary stenosis > 70% and with reversible perfusion defects in 99mTc-MIBI SPECT (long protocol). Twenty two of these patients had angina during exercise test. The extension of ischemia was quantified on SPECT and the severity of coronary stenoses on coronary angiography. The mean follow-up period was 3.2 years. RESULTS: The angina patients showed a significantly lower coronary reserve (exercise duration: 6.3 min vs 8 min; p = 0.03), a lower maximal O2 consumption (5.8 METs vs 6.2 METs; p = 0.04), a higher rate of ST depression > 1 mm (64% vs 19%; p = 0.006) and a higher degree of ST depression (0.9 mm vs 0.4 mm; p = 0.01) than those patients without angina. There were no significant differences in the extent of ischemia in SPECT or in the angiographic severity of coronary disease between either groups. During the follow-up period the presence of severe complications (myocardial infarction or death) tended to be higher (27% vs 17%; NS) in patients with angina and the indication of surgical revascularization was also significantly higher (50% vs 17%; p = 0.002) in this group. CONCLUSIONS: Presence of angina during 99mTc-MIBI SPECT portends a higher risk of medium and long term complications, mainly due to surgical revascularization.

Angina Pectoris↗

PubMed1998

[Diagnostic efficacy of myocardial tomographic imaging in the detection of restenosis after coronary angioplasty].

INTRODUCTION AND OBJECTIVES: To analyze the efficacy of single photon emission tomography (SPET) with 99mTc-compounds for the diagnosis of restenosis of previous percutaneous transluminal coronary angioplasty (PTCA). PATIENTS AND METHODS: Seventy-one patients (16 women, median age: 60 years, 35 with multivessel disease, 78 arteries with PTCA) with previous PTCA and with coronary angiography performed after scintigraphy were studied. 99mTc-SPET exercise (53 with MIBI and 18 with tetrofosmin) was performed, for clinical reasons, to all patients between one month and 4 years after PTCA. Intravenous dipyridamole was administered simultaneously to 16 patients who had insufficient exercise. RESULTS: SPET sensitivity, specificity, positive predictive values, negative predictive values and global values were all significantly higher than those obtained with exercise tests (80% vs 63%; p = 0.05; 83% vs 37%; p = 0.001; 91% vs 69%; p = 0.007; 64% vs 31%; p = 0.009, and 81% vs 55%; p = 0.0006, respectively). These results were significantly superior in patients with one vessel disease than in patients with multivessel disease. CONCLUSIONS: SPET exercise with 99mTc-compounds is a test with a high efficacy for the diagnosis of post-PTCA restenosis, mainly in patients with one vessel disease.

Aged↗

PubMed1997

Carboplatin-based versus cisplatin-based chemotherapy in the treatment of surgically incurable advanced bladder carcinoma.

BACKGROUND: The carboplatin-based chemotherapeutic regimen M-CAVI (methotrexate, carboplatin, and vinblastine) is active against bladder carcinoma and can be administered to patients who are ineligible to receive cisplatin or doxorubicin. The authors designed a randomized study to evaluate whether M-CAVI offers a therapeutic advantage over the cisplatin-based regimen M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) in the treatment of patients with surgically incurable advanced bladder carcinoma. METHODS: Patients with surgically incurable advanced bladder carcinoma were enrolled on a randomized trial comparing M-CAVI, which consists of carboplatin (300 mg/m2 on Day 2, adjusted using Calvert's formula for an area under the curve of 5), methotrexate (30 mg/m2 on Days 1, 15, and 22), and vinblastine (3 mg/m2 on Days 2, 15, and 22) administered every 28 days, versus standard M-VAC. The eligibility criteria included histologically proven bladder carcinoma, surgically incurable disease, and no prior chemotherapy. Patients were treated until disease progression or unacceptable toxicity occurred. RESULTS: From January 1989 to January 1994, 47 assessable patients were included. Seventeen patients had lymph node disease and 30 had distant metastatic disease. Twenty-three patients were randomized to receive M-CAVI and 24 to receive M-VAC. Patient characteristics in the two groups were similar. Overall response rates were 39% (95% confidence interval [CI], 20-62%) for M-CAVI and 52% (95% CI, 30-73%) for M-VAC (P = 0.3), with 3 complete responses observed among patients treated with M-VAC and none among those in the M-CAVI group. M-VAC was associated with more gastrointestinal toxicity, stomatitis, alopecia, and Grade 4 neutropenia than M-CAVI. One toxicity-related death occurred in the M-VAC group. There was a statistically significant difference in median disease-related survival time favoring M-VAC (16 months; range, 6 to 22+) versus M-CAVI (9 months; range, 6 to 14+) (P = 0.03). CONCLUSIONS: M-CAVI is less toxic but less active than M-VAC in the treatment of patients with advanced bladder carcinoma. Carboplatin-based regimens in which carboplatin is administered at the dose range used in the current study should be reserved for patients who cannot tolerate cisplatin treatment. Further research is required to assess the impact of high dose carboplatin in the treatment of this disease.

Adult↗

PubMed1997

Eicosanoids and fat emulsions in acute respiratory distress syndrome patients.

Lipid emulsions have been associated with changes in pulmonary function. Although these changes were related to the physical effects of the infusion-induced lipemia on gas exchange, several animal and human studies suggest that the impairment in pulmonary function observed with lipid infusions was mediated by prostaglandins. Prostaglandins are synthesized enzymatically from essential fatty acids. We studied the effects of two lipid emulsions, with different amounts of essential fatty acids (20% long-chain triacylglycerols [LCT] with 55% of linoleic acid and 7% of alpha linolenic acid in 100 g of emulsion, and a physical mixture of 20% medium-chain triacyglycerols [MCT] and LCT with 26% of linoleic acid and 4% of alpha linolenic acid in 100 g of emulsion), on plasma levels of eicosanoids in patients with acute respiratory distress syndrome (ARDS). Although in patients with ARDS, plasma levels of prostanoids were higher than the reference values, neither lipid emulsion, administered at the rate of 2 mg.kg-1.min-1 induced significant changes in the eicosanoids except for a decrease in systemic-pulmonary arterial 6-keto prostaglandin F1 alpha difference.

6-Ketoprostaglandin F1 alpha↗

PubMed1997

Effects of smoking on the presentation and clinical course of inflammatory bowel disease.

OBJECTIVE: To evaluate the influence of regular smoking on the presentation and clinical course of inflammatory bowel disease. METHODS: We performed a case-control study interviewing 160 inflammatory bowel disease patients (63 with Crohn's disease (CD) and 97 with ulcerative colitis (UC)) and 140 first-degree relatives as controls. The risk of developing the disease relative to a smoking habit was calculated as the odds ratio. Furthermore, to evaluate the influence of smoking on the subsequent course of inflammatory bowel disease, we performed a multivariate analysis that included pertinent variables such as the need for surgery, number of hospitalizations and relapses. RESULTS: The pattern of smoking in UC patients was different from that in CD patients. In UC there was a significant predominance of non-smokers and ex-smokers (P = 0.02), whereas smoking habits in CD were not different from those in controls. Giving up smoking was a risk factor to develop UC (odds ratio: 3.2, P = 0.02). In UC, non-smokers and specially ex-smokers need surgery more frequently than smokers (P < 0.01). Otherwise the relapse/year index was not influenced by smoking. In CD there was a non-significant association between smoking habits and the various clinical parameters analysed. UC patients who begin smoking after diagnosis of the disease present a significant reduction in the number of recurrences. CONCLUSION: Smoking habit significantly affects the presentation and clinical course of UC, whereas in CD, a smoking habit does not have any apparent influence on the disease.

Adult↗

PubMed1997

Frequent dose delays and growth factor requirements with the sequential doxorubicin-CMF schedule.

Doxorubicin for four cycles plus cyclophosphamide, methotrexate and 5-fluorouracil (CMF) for eight cycles is an effective adjuvant regimen for breast cancer patients with more than three involved axillary lymph nodes. We reviewed the incidence of dose delays and growth factor requirements when this regimen is administered to patients receiving concurrent irradiation. Thirty-six patients with more than three involved axillary lymph nodes were treated with the sequential regimen doxorubicin-CMF and irradiation. Patients with two or more dose delays received G-CSF treatment. Seventy-five percent of the patients required dose delays for day-22 neutropenia, and growth factors were needed for half of the patients in order to maintain a received dose intensity of 0.940. The first delayed cycle occurred in 74% of the patients while receiving concomitant chemoradiotherapy. Frequent dose delays were required when the sequential regimen doxorubicin-CMF was administered along with radiotherapy. Growth factors are needed to maintain dose intensity similar to that achieved in the original trial.

Adult↗

PubMed1997

Seasonal influence in exacerbations of inflammatory bowel disease.

Several epidemiological studies have suggested a possible seasonality in the presentation and course of inflammatory bowel disease. Our aim was to investigate whether in our area there is a seasonality in the presentation and evolution of inflammatory bowel disease. In this retrospective evaluation 255 patients were included, of whom 141 patients were diagnosed with ulcerative colitis and 114 with Crohn's disease according to conventional criteria, with histological confirmation in 225 patients. Relapse was defined as the development of symptoms that required an increase or change in the usual treatment. Periods of activity were related to the month and grouped within one of four seasonal periods: December to February, March to May, June to August and September to November. Bouts of ulcerative colitis and Crohn's disease were most frequently diagnosed in the period June to August (p < 0.05). Both diseases showed similar seasonality, and analysis of the 305 attacks did not show any significant trend. In conclusion, inflammatory bowel disease begins more frequently in the period June to August, but its course does not show consistent seasonal variations.

Adolescent↗

PubMed1996

[Serologic study in patients with streptococcal infective endocarditis].

BACKGROUND: Infective endocarditis is a systemic disease in which there are a continuously antigenic stimulation of immunologic system. Streptococcus is still the most frequent cause of infective endocarditis. PATIENTS AND METHODS: We investigated the presence of antibody (AB), total and IgM by indirect immune fluorescence technique, in four groups of population: streptococcal infective endocarditis (SIE), streptococcal bacteraemia (SB), Staphylococcus aureus endocarditis, and healthy people. Antigens used were: 1) their own strain isolated from the blood of patients with SIE and SB ¿homologous AB¿, and; 2) seven species of Streptococcus: Streptococcus intermedius, Streptococcus salivarius, Streptococcus bovis, Streptococcus sanguis I, Streptococcus sanguis II, nutritional dependent streptococci and Enterococcus faecalis (heterologous AB). RESULTS: Homologous antibodies: titers > or = 1/512 were found in all patients with SIE and only in 2 with SB (sensitivity 100% and specificity 93%). IgM titer (threshold 1/32) was positive only in patients with SIE (sensitivity 75,5% and specificity 100%). The fall of the AB titer was continuous and slow, despite the good clinical evolution of patients. (AB titers were > or = 1/512 and IgM > or = 1/64 in 30% of patients 1 year later). Heterologous AB: in spite of statistically significant difference found in SIE versus the other groups, sensitivity of this test (threshold 1/256) is low, confidence interval include expected random value (50%), specificity is 88%. CONCLUSIONS: The utility of homologous AB for diagnosing infective endocarditis is demonstrated. On the contrary for heterologous AB, antigenic common fractions must be found in the different species.

Adult↗

PubMed1996

Repeated 15-minute coronary occlusions in pigs increase occlusion arrhythmias but decrease reperfusion arrhythmias that are associated with extracellular hypokalemia.

OBJECTIVES: We sought to evaluate the effects of repetitive 15-min coronary occlusions followed by 45-min reperfusions on the incidence of occlusion and reperfusion arrhythmias in pigs. BACKGROUND: Brief 2- to 5-min coronary occlusions seem to exert a protective effect on occlusion and reperfusion arrhythmias. However, because clinical ischemic episodes are often longer, it would be appropriate to assess whether such protection also occurs when longer cycles of occlusion-reperfusion are produced. METHODS: Three to four cycles of 15-min coronary occlusions with 45-min reperfusions were performed in 34 pigs, and changes in ST segment and incidence of ventricular arrhythmias were assessed. Plasma potassium ion concentrations in eight pigs and blood gas in six were measured from blood from the ischemic area during reperfusion. RESULTS: Repetitive occlusions were associated with a progressively higher ST segment elevation and a higher incidence of ST segment alternans (p < 0.001) and ventricular fibrillation (VF) (p < 0.01). However, during repetitive reperfusions, normalization of the ST segment was increasingly faster, the incidence of VF was progressively reduced (p < 0.03), and there was progressively less severe regional acidosis ([mean +/- SD] 7.06 +/- 0.12 vs. 7.26 +/- 0.06, p < 0.05) and hypokalemia (1.9 +/- 0.7 vs. 2.3 +/- 0.4 mEq/liter, p = NS). CONCLUSIONS: The progressive electrocardiographic deterioration and increasing incidence of ventricular arrhythmias during repetitive 15-min occlusions in pigs suggest increasing metabolic derangement. However, the progressively faster normalization of the ST segment and the reduced incidence of ventricular arrhythmias during reperfusion suggest an increasingly faster restoration of the metabolic and ionic balance.

Acid-Base Equilibrium↗

PubMed1996

[Cost-effectiveness analysis of serum ferritin screening in periodic physical examinations of women at the fertile age].

BACKGROUND: Fertile-aged women are a population group at special risk for developing ferropenia. In the periodic health care examinations, hemogram, among other tests, are included to detect the most advanced state of iron deficity, ferropenic anemia. Likewise, preanemic ferropenia presents a certain morbidity. The aim of this study was to analyze the cost-effectiveness of screening serum ferritin determination in health care examinations of fertile-aged women. SUBJECTS AND METHODS: An observational transversal study was carried out in 322 women in whom hemogram and serum ferritin were determined. The effects of serum ferritin determination were simulated in a hypothetical cohort of 20-year old women annually examined up to the age of 50 years (mean age of menopause). RESULTS: The prevalence of preanemic ferropenia (serum ferritin < or = ng/ml) was 44.1% and that of ferropenic anemica (Hb < 120 g/l and serum ferritin < or = 25 ng/ml) was 3.4%. Hemogram sensitivity for detection of ferropenia was 7.2% (3.6-12.5). By means of the screening program with serum ferritin avoiding of one year with ferropenia costs 2,428 pesetas. Prolonging the program to longer than 35 years largely increases the marginal cost. Cost-effectiveness analysis is specially sensitive to the cost of the diagnostic tests and disease prevalence. CONCLUSIONS: Ferropenia in fertile-aged women is a frequent disorder. Avoiding ferropenia by early diagnosis may be performed at a relatively low cost.

Adult↗

PubMed1996

Additional elevation of the ST segment: a possible early electrocardiographic marker of experimental myocardial reperfusion.

OBJECTIVE: To analyze the early electrocardiographic changes during experimental coronary reperfusion after 1 to 4 h of coronary occlusion. METHODS: Recordings of epicardial and endocardial DC electrograms were performed in 35 open-chest pigs during coronary occlusions of 1 to 4 h duration followed by 1 h of reperfusion. RESULTS: During occlusion, maximal ST segment elevation was reached between min 10 and 30 which was followed by and a steady decline. During the first 30 min of reperfusion, however, there was a further elevation of the ST segment with a peak at 5 min. Thus, values at the end of occlusion and at 5 min of reperfusion were: (a) group with 1 h occlusion (n = 11), 15.5 +/- 7 and 37.4 +/- 11.4 mm, P < 0.005; (b) group with 2 h occlusion (n = 6), 10.2 +/- 4 and 24.7 +/- 9.4 mm, P < 0.03; (c) group with 3 h occlusion (n = 6), 7.5 +/- 3 and 16.8 +/- 5.6 mm, P < 0.03; and (d) group with 4 h occlusion (n = 12), 6.4 +/- 2.4 and 17.0 +/- 8.9 mm, P < 0.01. In 9 animals from the group with 1 h occlusion, a second cycle of 1 h occlusion and reperfusion also showed re-elevation of ST segment during reperfusion, although to a lesser extent than the first one (from 10.0 +/- 4.9 to 16.3 +/- 7.1 mm, P < 0.01). CONCLUSIONS: Thus, our findings provide experimental evidence of an additional and paradoxical ST segment elevation as the earliest electrocardiographic sign of coronary reperfusion after 1 to 4 h of coronary occlusion. These observations may help to improve the interpretation of early electrocardiographic changes during thrombolysis in acute myocardial infarction.

Animals↗

PubMed1996

M-CAVI, a neoadjuvant carboplatin-based regimen for the treatment of T2-4N0M0 carcinoma of the bladder.

Carboplatin, methotrexate, and vinblastine (M-CAVI) is an active and well-tolerated regimen for bladder cancer patients ineligible for cisplatin-based regimens. We treated 47 T2-4 N0 M0 bladder cancer patients with M-CAVI in a neoadjuvant phase II trial. These 47 patients are evaluable for clinical response and toxicity. Clinical overall response rate was 34%, for a 95% confidence interval (CI95%) of 21-49%. Pathological response was seen in 40% of the patients (CI95%, 26-56%) with a 26.5% rate of pathological complete response (CI95%, 15-42%). Factors associated with the achievement of a response to therapy were the initial TNM stage (pT3a or lower, greater than pT3a, p = 0.001) and a Karnofsky score greater or equal than 90%, which was marginally significant (p = 0.08). With a median follow-up of 14 months, the disease-specific actuarial survival at 2 years is 42%. No patient has relapsed beyond 21 months of follow-up in a disease-free status. Toxic effects have been moderate. In conclusion, M-CAVI is an active and well-tolerated regimen that should be compared in terms of response rate and survival with a cisplatin-based regimen for invasive bladder cancer.

Actuarial Analysis↗

PubMed1996

Five-day course of granulocyte colony-stimulating factor in patients with prolonged neutropenia after adjuvant chemotherapy for breast cancer is a safe and cost-effective schedule to maintain dose-intensity.

PURPOSE: To analyze the safety and efficacy of a short course of granulocyte colony-stimulating factor (G-CSF) to maintain dose-intensity of subsequent cycles of chemotherapy after a prior episode of prolonged neutropenia, without febrile complications, in patients receiving adjuvant treatment for breast cancer. PATIENTS AND METHODS: Thirty-two patients undergoing adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) or doxorubicin-CMF for stages I to II breast cancer were included after having chemotherapy delays due to neutropenia (absolute neutrophil count [ANC] < 1.5 x 10(9)/L) on day 22. G-CSF was administered subcutaneously on days 15 to 19 of each subsequent cycle. RESULTS: None of the patients included in this study had to be admitted to the hospital for fever and neutropenia. The median percentage of the projected dose-intensity for CMF or doxorubicin-CMF on an intent-to-treat basis was 0.994, which was significantly higher than the delivered dose-intensity before the start of G-CSF treatment (P < .0001). Patients who received concomitant G-CSF and radiotherapy achieved a similar dose-intensity as patients who did not undergo radiotherapy. Seven patients discontinued G-CSF treatment due to musculoskeletal pain. These patients had more subsequent cycle delays because of day 22 neutropenia than the 25 patients who followed the G-CSF schedule (P = .0028). CONCLUSION: A 5-day course of G-CSF in patients with prior chemotherapy delays due to prolonged neutropenia seems to be a safe and cost-effective schedule to maintain CMF or doxorubicin-CMF dose-intensity in the adjuvant treatment of breast cancer.

Adult↗