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Biomedical subjects

F Ayala

Publications and source records attributed to F Ayala.

At least 37 records · Page 2Linked to original sources
PubMed1998

Weekly continuous infusion of 5-fluorouracil with oral leucovorin in metastatic breast cancer patients with primary resistance to doxorubicin.

Doxorubicin-resistant metastatic breast cancer (MBC) is a very poor prognosis scenario, where only taxanes have shown activity, often at the expense of severe toxicity that compromises palliation. This study was undertaken to test the antitumor activity and tolerability of infusional 5-fluorouracil (5-FU) modulated with low-dose oral leucovorin (LV), in heavily pretreated patients with stringent criteria of primary resistance to doxorubicin, visceral involvement, and suboptimal performance status. Twenty-six patients with measurable MBC and primary resistance to anthracyclines received a weekly outpatient 48-hour infusion of high-dose 5-FU with low dose oral leucovorin. All patients were assessable for response and toxicity. Eight partial responses were seen (30% response rate) in soft tissue and visceral sites, with a median response duration of eight months (5 + to 12). 98% of the cycles were minimally toxic or non-toxic. Toxicities included mucositis, diarrhea, and plantar-palmar-syndrome. Our results suggest that this schedule of LV-modulated infusional 5-FU can produce a substantial number of long-lasting responses and meaningful palliation to this very poor prognosis population.

Administration, Oral↗
PubMed1998

[Endovascular stent implantation in the treatment of coronary artery disease: angiographic, and immediate and late clinical results].

BACKGROUND: Coronary revascularization allows a better survival and quality of life in high risk patients with coronary artery disease. AIM: To report the experience in stent placement as treatment for obstructive atherosclerotic coronary artery disease. PATIENTS AND METHODS: A prospective analysis of 105 stent placements. A morphological and quantitative analysis of coronary angiograms, using an electronic caliper, was performed. Patients were followed during their hospital stay and after discharge. RESULTS: In four of 112 coronary lesions, it was not possible to liberate the stent and in 108, it was successfully placed (48 in anterior descending, 19 in circumflex, 36 in right coronary arteries and 5 in saphenous aortocoronary by-pass. Lesions with stent implantation were type A in 11%, B1 in 30%, B2 in 44% and C in 15%. Reference diameter was 3.13 +/- 0.58 mm. After placement, luminal diameter increased from 0.95 +/- 0.43 to 2.99 +/- 0.46 mm, with a final stenosis of 7.2 +/- 10.1%. Angiographic success was obtained in 99% and procedure success in 98%. Hospital mortality was 0.98%. After a mean of eight months follow up, 91% of patients is free of major cardiac events. In 17% angina recurred and 5% required a new revascularization. There were no late cardiac deaths, acute stent thrombosis or infarction in relation to the treated lesion. CONCLUSIONS: In these patients, stent placement has had excellent immediate and late results.

Adult↗
PubMed1998

Immediate results of the Inoue mitral valvotomy in patients with previous surgical mitral commissurotomy. Preliminary report.

BACKGROUND: The objective of this study is to evaluate the immediate result of the percutaneous mitral valvotomy in patients with previous surgical mitral commissurotomy, compared with patients considered ideal for the performance of the procedure. METHODS: The authors of this paper compared the immediate results of the percutaneous mitral valvotomy (PMV) performed on two groups of patients. Group I included 20 patients who were good candidates for PMV, with an echocardiographic score of < or = 8, without evidence of left atrial thrombus, and with no recent embolic event. Group II included seven patients with previous mitral commissurotomy (MC). RESULTS: According to the Wilcoxon non-parametric t test analysis, the hemodynamic variables changed significantly in the patients of group I: the mitral area increased from 1.21 +/- 0.41 to 2.62 +/- 0.75 cm2 (P = < 0.001); the mean left atrial pressure decreased from 17.2 +/- 7.2 mmHg to 9.2 +/- 4.5 mmHg (P = < 0.001), and the pressure transmitral gradient decreased 12.4 +/- 6.8 to 3.3 +/- 1.26 mmHg (P = < 0.001). No statistically significant difference in the hemodynamic changes of the patients of group II after the PMV was found: the mitral area increased from 1.2 +/- 0.2353 to 1.96 +/- 0.57 cm2; the mean left atrial pressure decreased from 17.42 +/- 10.35 to 12.42 +/- 7.3 mmHg, and the pressure mitral gradient decreased from 11.47 +/- 6.5 to 5.7 +/- 4.8 mmHg. The mitral area determined by echocardiographic procedure showed the same tendency in patients with previous MC. CONCLUSIONS: In spite of this tendency, during the follow-up after PMV the NYHA functional class decreased from II-IV to I in the patients with previous MC. Because a second surgical MC results in higher mortality, PMV is indicated in patients with previous MC, delaying or avoiding a second MC or valve replacement.

Adult↗
PubMed1997

[High-dose chemotherapy with four drugs and peripheral blood progenitor cell autologous transplantation in disseminated breast cancer].

OBJECTIVE: To evaluate the therapeutic efficacy (in terms of overall survival [OS] and progression-free survival [PFS]) of a high-dose chemotherapy protocol including four drugs and peripheral stem cell rescue (PSCR) plus posttransplant G-CSF (filgrastim) in disseminated breast cancer patients. PATIENTS AND METHODS: Fifty-three metastatic breast cancer patients were treated with a four-drug program of high-dose chemotherapy including cyclophosphamide (6 g/m2), thiotepa (500 mg/m2), carboplatin (800-1,600 mg/m2) and mitoxantrone (20-60 mg/m2) with autologous peripheral blood progenitor cell support followed by filgrastim. Most cases (92%) had previously received conventional induction chemotherapy with anthracycline-containing combinations. RESULTS: After a median follow-up of 27 months (range 12-43 months) from transplant, the median survival of the overall group was 25 months, with an OS projected at 43 months of 31%. Patients in complete remission after induction chemotherapy or status NED (no evidence of disease: surgical resection of metastases) presented the best outcome, with a projected PFS of 50% at 43 months. Patients intensified without complete response had a poor outcome. The most important extramedullary toxicity was mucositis. Four patients (7.5%) died as a consequence of treatment (2 with sepsis-associated ARDS, one with venooclussive disease of the liver, one with congestive cardiac failure). CONCLUSIONS: The outcome of metastatic breast cancer patients in complete remission after induction chemotherapy or NED status seems to be good with our high-dose chemotherapy including four drug and PSCR. On the other hand, patients intensified without complete response presented a bad outcome and do not seem candidates for future trials with this therapeutic approach.

Adult↗
PubMed1997

Contact sensitization to 6 alpha-methylprednisolone aceponate.

Increasing attention has been focused on contact sensitization to topical corticosteroids in the past several years. In most cases, allergy to topical corticosteroids occurs in patients with long-lasting eczematous diseases. Cross-allergy between topical corticosteroid molecules is very common, and four groups of cross-reacting molecules have been recognized. In this report, we describe a girl with atopic dermatitis and sensitized to hydrocortisone-17-butyrate who became sensitized to 6 alpha-methylprednisolone aceponate. Cross-sensitization between the two molecules is suggested.

Administration, Topical↗
PubMed1997

Preliminary results. UFT/methotrexate/leucovorin for breast Ca patients in progression after HDCT/PBPC support.

Twenty-four patients with metastatic breast cancer that had progressed after high-dose chemotherapy with peripheral blood progenitor cell (PBPC) support were given intramuscular methotrexate in combination with oral UFT (tegafur and uracil) and oral leucovorin (the MUL regimen). Of the total treated, 21 patients are currently evaluable for response and toxicity. All patients had received extensive prior chemotherapy, including a high-dose regimen with PBPC support. Of the 21 assessable patients, 8 obtained either a complete response (1) or partial response (7), for an overall objective response rate of 38%. Another 7 patients had stable disease for 3 or more months. Therefore, the MUL regimen was able to stop disease progression for 3 or more months in nearly 75% of patients. The median time to progression and median overall survival from the start of MUL were 6 and 9 months, respectively. The toxicity was mainly gastrointestinal; 6 patients (29%) had World Health Organization grade 2/3 diarrhea, leading to a UFT dose reduction. Emesis was mild and easily manageable with thiethylperazine. In conclusion, MUL chemotherapy is active and well tolerated in patients with metastatic breast cancer in progression after high-dose chemotherapy. Further studies with this regimen, either as salvage chemotherapy or as maintenance chemotherapy after high-dose chemotherapy with PBPC, are warranted.

Adult↗
PubMed1996

Is the addition of ECG gating to technetium-99m sestamibi SPET of value in the assessment of myocardial viability? An evaluation based on two-dimensional echocardiography following revascularization.

The main goal of this study was to evaluate whether the addition of ECG gating to technetium-99m sestamibi single-photon emission tomographic (SPET) perfusion imaging assists the prediction of recovery of regional wall motion abnormalities after revascularization. Thirty-six patients with coronary artery disease were included in the study. All had wall motion abnormalities, and 31 (86%) had a clinical history of myocardial infarction. Coronary artery bypass surgery was performed in 18 patients and angioplasty in the remainder. All underwent ECG-gated and non-gated SPET at rest and after intravenous dipyridamole. Two-dimensional echocardiography was performed at a mean of 27 days before revascularization and at a mean of 69 days following revascularization to assess segmental wall motion changes. Perfusion prior to revascularization was analysed qualitatively and quantitatively on gated and non-gated SPET, and the results compared with those of echocardiography. Bullseye parameters were obtained from a normal database, generated from data in 40 normal volunteers, using dipyridamole ECG-gated and non-gated sestamibi SPET. There was good concordance between gated and non-gated qualitative analysis (79% with kappa=0.65) for normal, viable or necrotic segments. Gated SPET predicted functional recovery in 27 of 35 (77%) segments showing echocardiographic improvement while non-gated SPET did so in 30 of 39 (77%) such segments. Gated SPET predicted no functional recovery in 20 of 45 (44%) segments that did not show improved wall motion after revascularization, while with non-gated SPET the figure was 18 of 51 (35%). The positive predictive values of gated and non-gated SPET with regard to the recovery of wall motion following revascularization were 52% and 48%, while the negative predictive values were 71% and 67%, respectively. 99mTc-sestamibi had a low predictive value for recovery of function if visual assessment was used in the analysis of SPET data. Quantitative bullseye sestamibi parameters (defect extension and severity, reversibility and percentage change in extension), from gated or non-gated studies, appear best to distinguish which segments will display improved motility on the echocardiogram after revascularization. The addition of ECG gating does not significantly increase the predictive value of SPET imaging with regard to recovery of function.

Angioplasty, Balloon, Coronary↗
PubMed1996

Statistical evaluation of the persistence of acquired hypersensitivity by standardized patch tests.

Numerous studies have focused attention on the influence of various biological and environmental factors on contact hypersensitivity. In order to evaluate the persistence and/or modification of allergic contact sensitivity to a number of common contact sensitizers, the same standardized patch tests were repeated on 174 subjects with contact sensitivity after a time lapse of 5 years (1987-1992). In 18.4% of the cases, 1 or more sensitivities were lost; 28.7% of the patients had a higher number of positive patch tests after 5 years, while the remaining 52.9% of the patients showed no change in the number of positive patch tests. In 88%, the positive allergens were unchanged, whereas in the remaining 12% of the subjects, they showed 1 or more variations. The association between the allergens most often positive was calculated for both the 1st and the 2nd patch test results. Moreover, to evaluate the frequency of an allergen's positivity, we studied the disappearance of old sensitivities and the appearance of new sensitivities by the McNemar test. Cobalt chloride was the only allergen with a significant frequency of new positivities over the period of observation (p < 0.01). Logistic regression analysis was performed to evaluate the possible influence of positive tests to other allergens, and of some clinical findings associated with contact dermatitis, on the sensitivity to cobalt chloride in 1987 and in 1992.

Adult↗
PubMed1996

Coronary fistula associated with double mitral valve disease. A case report.

The authors report a case of a 54-year-old white male with a coronary fistula associated with double mitral valve disease. The patient was studied by invasive and non-invasive cardiac methods including coronary angiogram in order to reach the correct diagnosis and to define the successful surgical treatment that included the closure of the fistula, partial resection of the left atrium and insertion of a mechanical mitral valve prosthesis. It is concluded that this case represents a very rare association between coronary fistula and double mitral valve disease.

Atrial Fibrillation↗
PubMed1995

Single agent Taxol, 3-hour infusion, in untreated advanced non-small-cell lung cancer.

Currently, only a few chemotherapeutic agents have consistently produced single agent response rates greater than 15% in patients with non-small-cell lung cancer (NSCLC). Taxol has been reported in two phase II studies to have significant activity in NSCLC with response rates of 21% and 24%. Schedule infusion of 24 hours has been used to reduce allergic reactions. The study reported here was a phase II trial of Taxol given by 3-hour intravenous infusions at a 210 mg/m2 dose every three weeks in outpatients setting. It was conducted simultaneously at three centers on chemotherapy-naïve patients medicated with unresectable stage III or metastatic NSCLC. Sixty-two patients were initially enrolled; all were premedicated with dexametasone (20 mg), cimetidine (330 mg) and diphenilhydramine (50 mg), given prior to initiation of paclitaxel infusion. Fifty patients were evaluated for toxic effects and 47 for response. Sixteen partial responses (34) and one complete response (2%) were observed, for an overall response rate of 36% (95% confidence internal, 22% to 50%). Taxol was well-tolerated and none of the patients experienced allergic reaction. Granulocytopenia was generally mild. Therapy was interrupted in only two patients because of the development of grade 3 neuropathy. In our experience Taxol is one of the most active cytotoxic drugs targeting non-small-cell lung cancer.

Adult↗