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At least 919 records · Page 51Linked to original sources
PubMed2004

Oxaliplatin plus high-dose leucovorin and 5-fluorouracil (FOLFOX 4) in platinum-resistant and taxane-pretreated ovarian cancer: a phase II study.

OBJECTIVE: A prospective phase II study was conducted to evaluate the efficacy and toxicity of oxaliplatin plus 5-fluoruracil (5-FU) and high-dose leucovorin (LV) (FOLFOX-4) in patients with platinum-resistant, taxane-pretreated recurrent ovarian cancer. PATIENTS AND METHODS: Thirty-eight patients, with a median age of 58 years (range 33-77), were treated with oxaliplatin 85 mg m(-2) as a 2-h infusion on day 1, LV 200 mg m(-2) day(-1) as a 2-h infusion followed by bolus 5-FU 400 mg m(-2) day(-1) and a 22-h infusion of 5-FU 600 mg m(-2) day(-1) for 2 consecutive days. Treatment was repeated every 3 weeks. Patients were evaluated for response every two cycles. RESULTS: The vast majority of patients had performance status 0 or 1 and 76.3% had > or = 2 metastatic sites. A median number of four cycles per patient (range, 1-8) were administered. Based on an intention-to-treat analysis, 3 patients (7.9%) achieved a complete response (CR) and 8 (21.1%) achieved a partial response (PR), for an overall response rate of 29%. Another 29% of patients had stable disease (SD). The median relapse-free survival was 5.2 months (range 2.5-17), the median time to tumor progression was 4.8 months (range 0.6-19), and the median overall survival was 10.1 months (range 0.2-36). Toxicity was mild to moderate. Grade 3/4 neutropenia and thrombocytopenia occurred in 29% and 21.1% of patients, respectively. Febrile neutropenia was encountered in 3 patients (7.9%), who were successfully treated. Grade 3/4 neurotoxicity developed in 15.8% of patients; neurotoxicity gradually declined after treatment discontinuation. Alopecia, nausea-vomiting, diarrhea, mucositis, and asthenia were not a serious problem. There were no treatment-related deaths. CONCLUSION: The combination of oxaliplatin and 5-FU/LV (FOLFOX-4) appears to be an effective regimen with a good toxicity profile for the treatment of platinum-resistant, taxane-pretreated ovarian cancer.

Adult↗
PubMedDate not supplied

[Scurvy: follicular purpura as a diagnostic sign].

Scurvy is a set of clinical manifestations characterized by general weakness, anemia, gingivitis and cutaneous bleeding, caused by a lack of ascorbic acid in the diet. This pathology is currently a clinical rarity, although it can still be seen in cases of malnutrition associated with alcoholism or with dietary deficiencies, especially in childhood and old age. We present the case of a 45-year-old male who consulted his physician because of lower limb edema with follicular purpura, accompanied by asthenia, polyarthralgia and bleeding gums. After treatment with 1 g/day of vitamin C was initiated, the patient's symptoms quickly improved. The diagnosis of scurvy was based on the patient's clinical symptoms, dietary history and the rapid resolution of the symptoms when vitamin C supplements were initiated.

Humans↗
PubMed1976

Adrenergic beta blockade and ECG changes in the systolic click murmur syndrome.

In an attempt to elucidate the ECG changes associated with the SCMS, we have applied the propranolol test in 35 of our patients suffering from this syndrome. To the best of our knowledge this is the first such report in the English literature. Twenty-eight patients showed improvement and this points against an ischemic etiology. The test may be applied to differentiate ischemic ST-T changes from those associated with the SCMS. We have suggested the possibility of sympathetic overactivity and autonomic imbalance as the basis for the ECG and other features related to the SCMS. We have noted the striking similarities in the symptomatology and ECG changes associated with the SCMS and those of neurocirculatory asthenia. The implication of this was discussed.

Adolescent↗
PubMed1999

Effects of radiofrequency catheter ablation on quality of life in patients with atrial flutter.

The long-term effects of radiofrequency catheter ablation on quality of life in patients with typical atrial flutter are still unknown. This study included 100 consecutive patients with clinically documented typical atrial flutter. Subjective perception of quality of life was assessed by a semiquantitative questionnaire before, and 1 and 6 months after ablation. Ablation of typical atrial flutter was associated with a significant improvement in the general quality of life, frequency of significant symptoms, and symptoms during attacks. The frequency of hospital admission and emergency room visits, and number of antiarrhythmic drugs significantly decreased after ablation. Activity capacity significantly improved after ablation in patients with depressed left ventricular function. All improvements after ablation were maintained over 6-month follow-up. However, patients with atrial fibrillation compared with those without atrial fibrillation before ablation had less improvement in the general quality of life, frequency of significant symptoms, and symptoms during attacks (including palpitation, asthenia, effort, dyspnea, rest dyspnea, and dizziness). Furthermore, patients with atrial fibrillation before ablation needed more antiarrhythmic drugs, and had a higher frequency of hospital admission and emergent room visits at 6-month follow-up (all variables p <0.01). Multivariate analysis demonstrated that only the presence of atrial fibrillation before ablation could independently predict improvement in general quality of life (p = 0.03), frequency of significant symptoms (p = 0.03), symptoms during attacks (p = 0.04), and decrease in the consumption of health care resources including antiarrhythmic drugs (p = 0.01), hospital admission (p = 0.02), and emergency room visits (p = 0.02). Ablation of typical atrial flutter could significantly improve quality of life, but patients who had atrial flutter associated with atrial fibrillation before ablation had less improvement than those without atrial fibrillation.

Activities of Daily Living↗
PubMed1997

Zidovudine toxicity in uninfected healthcare workers. Italian Registry of Antiretroviral Prophylaxis.

To evaluate the toxicity of zidovudine (ZDV) prophylaxis in human immunodeficiency virus (HIV)-exposed healthcare workers (HCWs) in Italy, a national protocol for postexposure prophylaxis has been implemented and a national registry has been established. All Italian clinical centers licensed to dispense ZDV participate. As of December 1995, data from 674 individuals who received ZDV prophylaxis have been collected. In three cases ZDV was used in combination with either didanosine (DDI) or dideoxycytidine (DDC). In 556 cases (82%), the daily dose of ZDV was 1,000 mg/day; 21 HCWs (3%) were treated with 300-800 mg/day, and in 72 persons (11%) the dose was 1,200-3,000 mg/day. A total of 332 (49%) HCWs reported at least one adverse effect; 132 (20%) discontinued prophylaxis because of side effects (40% of those reporting side effects). Nausea was reported in 243 cases; other side effects included vomiting, gastric pain, diarrhea, asthenia, and headache. Most constitutional adverse effects were reported during the first week of prophylaxis. Grade 1 anemia (hemoglobin 9.5-11 g/dL) occurred in 10 cases (3%); in 2 cases, the neutrophil count decreased to <1,000 cells/mm3. A transient increase of serum alanine aminotransferase to three times the upper limit of normal was observed in 7 persons. All side effects were reversible after the prophylaxis was stopped. Among those reporting at least one side effect the mean duration of treatment was 22 days; for HCWs reporting hematologic or liver adverse effects the mean length of treatment was 34 days. A total of 351 HCWs (54.6%) ceased the treatment before the scheduled 1-month period. In the 132 persons who discontinued treatment because of side effects, the mean length of prophylaxis was 8 days. One HCW seroconverted after conjunctival exposure to blood. The short-term toxicity of ZDV prophylaxis is frequent, mild, dose related, and reversible. Further studies are needed to assess the risk of long-term sequelae of this treatment as well as of prophylaxis with combinations of antiretroviral drugs.

Anti-HIV Agents↗
PubMed2001

[Comparison of the antihypertensive efficacy of and tolerance to 2 imidazoline receptor agonists: moxonidine and rilmenidine in monotherapy].

Two hundreds mild to moderate hypertensive patients (mean age 54 +/- 10, 115 males, 85 females) were randomised in a multicentre, double blind, two parallel groups trial in order to compare the efficacy of moxonidine (0.2 mg od) and rilmenidine (1 mg od), two selective I1 receptor agonists. The dosage had to be shifted after a four-week treatment period (moxonidine 0.4 mg od or rilmenidine 2 mg bid) if DBP > 90 mmHg. More than half of the patients had to be shifted to a double dose. The blood pressure was normalised (DBP < or = 90 mmHg) for 47% of the moxonidine patient's and 50% of the rilmenidine patients. The DBP decrease reached 7.3 mmHg in the moxonidine group and 8.0 mmHg in the rilmenidine group (P = 0.28). The SBP decrease was the same in the two groups (7.6 mmHg). Both drugs were well tolerated. The great affinity of moxonidine and rilmenidine for the I1 receptors and the weak affinity for the alpha 2 receptors were probably responsible of the small number of adverse events which are generally linked to the centrally acting antihypertensive drugs (asthenia, somnolence, oedema). Because moxonidine and rilmenidine are often to be prescribed at double dose and are often associated with other antihypertensives, moxonidine whose dosage could be shifted without having to increase the number of daily intakes could enhance the patient's comfort and make the compliance easier.

Antihypertensive Agents↗
PubMedDate not supplied

[Heart involvement in carcinoid syndrome: report of a case].

The authors report the case of tricuspid and pulmonary disease, revealing a carcinoid syndrome in a 32 years-old young man who was admitted for asthenia and an effort hepatology. The carcinoid syndrome was confirmed by hormonal proportioning, and by an anatomopathologic and immunohistochimic study of a hepatic metastatic biopsy. The check-up to search the primitive tumor was negative. The clinicals, paraclinicals and therapeutics aspects of the carcinoid heart were reported in this work.

Adult↗
PubMed2003

[Primary and bilateral non-Hodgkin's lymphoma of the adrenal gland (a case report and literature review)].

Primary non-Hodgkin's lymphoma of the adrenal gland is rare. We report the case of a 31-years-old patient hospitalized with asthenia and adrenal insufficiency. The CT scan showed a bilateral adrenal mass. A scano-guided biopsy suspected an endocrinoid tumor. The surgical exploration demonstrated a huge mass invading the retroperitoneal space, and the biopsy concluded to a central follicular phenotype B rmalignant lymphoma with a high rank of malignity. The thoracic CT scan did not show any lymph node. The medullar biopsy eliminated a secondary lymphoma. The patient was treated by chemotherapy and radiotherapy with a good result during 16 months.

Adrenal Gland Neoplasms↗
PubMed2006

[Nonotologic osteomyelitis of the middle skull base].

OBJECTIVES: The study goals were to determine the patient demographics, identify predisposing factors, and determine efficacy of treatment for nonotologic osteomyelitis of the middle skull base. MATERIAL AND METHODS: Symptoms and treatment of five patients (sex ratio: 3/1; mean age: 57,1 ans) with osteomyelitis of the middle skull base treated from 1991 to 2005 are analyzed. All patients with a biopsy-proven diagnosis of osteomyelitis of the skull base were retrospectively evaluated. RESULTS: Four patients presented with asthenia, weight loss, headache, and fever. No patient presented with neurologic deficits associated with a destructive lesion of the osseous skull base. Three patients had an underlying immunocompromising condition (diabetes mellitus, steroid and immunosuppressor use). CT scan and MRI demonstrated central skull base abnormality, mainly at the level of the clivus. Systemic antibacterial/antifungal therapy, aggressive debridement of involved bone, and medical optimization remain important in the treatment of this group of patients. CONCLUSION: The interpretation of the results is performed after an analysis of the literature.

Adult↗
PubMed2005

[Treatment of precocious puberty by GnRH agonists].

The objective of GnRH agonist treatment in precocious puberty is to block pubertal development, and to reduce the action of sex steroids on bone maturation in order to restore normal long-term growth of the skeleton. Currently available studies show a positive benefit-risk ratio of GnRH analogs in the treatment of precocious puberty. Adult heights obtained are in average greater than those predicted in the absence of treatment and close to the normal target height. The side effects observed during treatment such as headaches, asthenia or hot flushes, are related to sex steroid deprivation and are observed in 20 to 30% of cases. Questions remain concerning the impact of these treatments on intellectual development and body composition. Finally, to assess the impact on fertility, IPSEN laboratories decided to organize a prospective study on patients treated in the 1980-1990s. In pediatrics, a reduction in the number of injections is an important objective to improve compliance. "Depot" formulations with prolonged release over three months, already used in adult indications, represent a useful progress in pediatrics and have recently been assessed. The efficacy and safety of triptorelin acetate (Decapeptyl) administered at a dose of 11.25 mg every trimester for one year were evaluated in a European multicentre open trial including 54 girls and 10 boys. The LH peak during the GnRH test at three months was used as primary end-point. This slow release triptorelin was shown to be effective, similarly to delayed-acting leuprorelin. The auxological effects, in particular on adult height, were not evaluated in this study.

Body Composition↗
PubMed2001

Fracture-embolization of duromedics valve prosthesis and microscopic uncommon lesions.

We report a sudden leaflet fracture of a Duromedics mitral valve 6 years after implantation. The patient had cardiogenic shock and complained of asthenia, orthopnea, and tachycardia. Transesophageal echocardiography showed the lack of one leaflet of the prosthesis and regurgitation. An emergency mitral replacement was successfully performed. Angiographic computed tomography scan localized the sequestrum that embolized the common iliac arteries. Examination of the deficient prosthesis showed multiple lesions and, in particular, a subsurface lesion that may be characteristic of carbon pyrolytic valves.

Adult↗
PubMed2003

Assessment of spontaneous pneumomediastinum: experience with 12 patients.

BACKGROUND: The aim of this study is to report a series of spontaneous pneumomediastinum in a population of young, tall, and thin patients with a history of thoracic hyper pressure, and to analyze the assessment required in such patients. METHODS: A retrospective study of an unicentric series and a review of the literature from 1980 to 2002 were performed. RESULTS: Between December 1996 and January 2002, 12 patients (mean age, 25 years old; mean height, 172 cm; and mean weight, 63 kg) were admitted with spontaneous pneumomediastinum. In all patients, high intrathoracic pressure by cough or acute effort was the precipitating factor. Most frequent complaints were acute chest pain, asthenia, and subcutaneous emphysema. The following assessment was performed: chest roentgenogram in 12 of 12 patients (12/12); computer tomography (CT) scan in 8/12; bronchoscopy in 7/12; esophagoscopy in 6/12; esophagography in 2/12. Outcome was always uneventful without any recurrence. Hospital stay ranged from 0 to 6 days. The Medline research revealed that articles consist mainly of case reports. Two articles only report a multicentric series of 25 and 36 cases, respectively. No organ perforation was found either in our series or in our review of the literature. CONCLUSIONS: Spontaneous pneumomediastinum follows alveolar rupture in the pulmonary interstitium. The dissection of gas towards the hilum and mediastinum is produced by an episode of acute high intrathoracic pressure. It affects mostly young people, and this is the case in our series. Endoscopic thoracic assessment may be risky and is not always necessary. Chest CT or esophageal contrast study should be performed in case of diagnostic doubt of esophageal perforation.

Acute Disease↗
PubMed2003

Effect of a low-dose oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel on dysmenorrhea.

This observational study evaluated the effect of a low-dose oral contraceptive (OC), containing 20 mug ethinylestradiol and 150 mug desogestrel (20EE/150DSG) on dysmenorrhea. Of the 346 women enrolled, 301 (87%) completed the three-cycle study. All participants (mean age: 22.6 years) wished to use oral contraception and had dysmenorrhea for at least 3 months. Dysmenorrhea was assessed using both the adapted verbal multidimensional scoring system (VMSS-A) and a visual analogue scale (VAS) to rate pain intensity. General dysmenorrhea symptoms and the use of analgesics were also assessed. The mean total combined scores on the VMSS-A scale decreased from 5.4 to 1.4 (p < 0.001), during the three cycles of OC use. The mean VAS pain-intensity score decreased from 6.8 to 1.8 (p < 0.001). During treatment there were substantial improvements in most individual parameters of dysmenorrhea. The percentage of women with dysmenorrhea lasting > or =2 days decreased from 81% at baseline to 14% at cycle 3. The percentage of women reporting generalized dysmenorrhea symptoms (e.g., lumbago, asthenia) decreased from 79% to 21% and the percentage needing analgesics dropped from 100% to 41%. The percentage of women for whom dysmenorrhea interfered with daily activities decreased from 73% to 10%. The results indicate that 20EE/150DSG can statistically and clinically significantly reduce the incidence and severity of dysmenorrhea, and its impact on daily activities.

Activities of Daily Living↗
PubMed1985

Superficial esophageal carcinoma: a report of 12 cases.

Twelve cases of superficial carcinoma of the esophagus, representing 4.9% of patients with carcinoma of the esophagus, were evaluated. All the patients were male smokers who drank alcohol excessively. The main clinical features were dysphagia, asthenia, anorexia, and weight loss. Most of the lesions were elevated and all endoscopic biopsies were positive for cancer. Half of the cases showed invasion of the submucosa; the remainder involved mucosa only. Ten patients are alive and free of metastatic disease.

Aged↗
PubMed2000

Splenic littoral cell angioma in an infant.

A 1-year-old girl presented with fever, asthenia, and splenomegaly with hypersplenism. Abdominal ultrasound scan and magnetic resonance imaging showed multiple nodular cystic masses in an enlarged spleen. The histological examination of the resected spleen showed a novel type of vascular tumor called littoral cell angioma. The histopathologic and immunohistochemical features of this rare lesion are described. Distinction from other splenic vascular tumors is stressed because the clinical behavior of this new entity seems to be benign.

Diagnosis, Differential↗
PubMed2000

German open label trial of riluzole 50 mg b.i.d. in treatment of amyotrophic lateral sclerosis (ALS).

UNLABELLED: Riluzole is currently the only drug that holds any hope of prolonging life in amyotrophic lateral sclerosis (ALS) by slowing the rate of disease progression. METHODS AND RESULTS: Between 1995 and 1997 a total of 7916 ALS patients in 39 countries, were given 100 mg riluzole per day for a mean of 7.2 months. The present report focuses on the German results in comparison to the total population. Nine hundred and nineteen patients were treated in 25 German centres; 162 (17.6%) died from the disease during the course of the study. Serious adverse events attributed to the study medication occurred in 16 patients (1.7%). Most frequently these were reversible changes in liver enzymes (0.9%) occurring during the first 3 months, none resulted in death. In all, 413 patients (44.9%) reported an adverse event. The most frequent were reduced lung function (7.3%), nausea (7.1%), asthenia (5.8%), pneumonia (2.5%) and abdominal pain (2.5%). CONCLUSION: The results of the study allow the conclusion that riluzole is well tolerated. The majority of adverse events were symptoms of the underlying disease and were not attributed to riluzole. Overall the safety profile found in the German centres was very similar to the profile seen in the total patient population and was more favourable than in the two published double-blind studies [New Engl J Med 330 (1994) 585; Lancet 347 (1996) 1425].

Amyotrophic Lateral Sclerosis↗
PubMed1999

NXX-066 in patients with Alzheimer's disease: a bridging study.

Reduced cholinergic transmission is a key neurotransmitter dysfunction in Alzheimer's Disease (AD). NXX-066, a physostigmine analog and acetylcholinesterase (AChE) inhibitor, has demonstrated activity in animal models of memory function, and was well tolerated in healthy subjects up to a single dose of 64 mg and multiple doses of 60 mg QD for seven days. Since AChE inhibitors are often tolerated differently in AD patients than in healthy volunteers, a randomized, placebo-controlled, double-blind, single-center, inpatient bridging study was conducted to determine the maximum tolerated dose (MTD) of NXX-066 in the target patient population. Seven consecutive panels of eight AD patients each (6 active, 2 placebo) received fixed oral doses of NXX-066 (20, 30, 40, 50, 60, 70, or 80 mg BID) for seven days. Initiation of each subsequent panel (dose group) was contingent upon the tolerability of lower dose levels. The MTD was determined to be 70 mg BID when four of six patients receiving 80 mg BID were prematurely discontinued from the study due to nausea and/or vomiting, accompanied in some patients by mild to moderate dizziness, headache, asthenia, and gastric symptoms. Wide variability in plasma levels of NXX-066 was observed in all dose panels. AChE inhibition in whole blood correlated with both maximum plasma concentration and dose; however, AChE inhibition was not predictive of adverse events. In this study, AD patients tolerated larger daily doses of NXX-066 on a BID regimen than healthy normal subjects had tolerated with QD dosing. Further studies are warranted to examine whether differing tolerability between patients and healthy subjects or the reduced dosing interval explains these findings.

Aged↗
PubMed2004

[Quick and early diagnostic outpatient unit: an effective and efficient assistential model. Five years experience].

BACKGROUND AND OBJECTIVE: To analyze the applicability of an out-patient Quick and Early Diagnostic Unit (QEDU) to evaluate patients with a potential life-threatening disorder on an out-patient basis. PATIENTS AND METHOD: We analyzed prospectively all patients attended in the unit for five years (1997-2001). We compared patients with lung cancer and colorectal cancer admitted to hospital for conventional study versus patients studied at the unit. RESULTS: We attended 2,748 patients in total Main reasons for consultation were abdominal pain, asthenia-anorexia, neurologic symptoms, anemia and palpable tumors. The most frequent diagnostic category corresponded to gastroenterological diseases and neoplastic diseases. The mean interval (standard error) for the first visit was 4.9 (3.4) days and for diagnosis it was 5.7 (6.5) days. Some 95% patients displayed a high degree of satisfaction by the questionnaire. In patients with cancer of the colon studied at the QEDU, we observed a reduction in the average interval for diagnosis which was highly significant (p = 0.03). The overall costs of final diagnosis were also lower for the QEDU model. CONCLUSIONS: The QEDU unit represents an alternative to in hospital admission for diagnostic workouts, which is fully feasible in our setting. It can result in the same efficacy and a higher efficiency than hospital admission.

Aged↗