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At least 973 records · Page 54Linked to original sources
PubMed2006

Concurrent radiotherapy does not affect adjuvant CMF delivery but is associated with increased toxicity in women with early breast cancer.

We evaluated whether concurrent radiotherapy (RT) affected delivery and toxicity of adjuvant intravenous CMF (cyclophosphamide, methotrexate and 5-fluorouracil) in women with operable breast cancer. The medical charts of 321 consecutive breast cancer patients who received CMF either alone for 6 cycles, or for 4 cycles following of an anthracycline (A-CMF) were reviewed. One hundred forty-four women underwent radiotherapy concurrently with CMF. Optimal CMF delivery (success as opposite to failure) was defined as the combined achievement of an average relative dose intensity (aRDI) > or = 85% and an average percent of the total dose (aPTD) > or = 90% for the three drugs in the CMF regimen. Multivariate logistic regression analysis showed that concurrent-RT did not affect CMF delivery (OR for success 1.391 p=0.230). The sequential A-CMF regimen (OR for success 0.208, 95% C.I. 0.120-0.360, p<0.001) and age > or = 56 (OR for success 0.351, 95% C.I. 0.200-0.161, p<0.001) were independently associated with suboptimal CMF delivery. Moreover, concurrent RT was independently associated with increased leukopenia, thrombocytopenia, upper abdominal pain, mucositis and fatigue. Our retrospective analysis suggests that concurrent-RT has no impact on optimal CMF delivery, but it increases the burden of CMF-related toxicity.

Adult↗
PubMed2004

Pulmonary resection after curative intent radiotherapy (>59 Gy) and concurrent chemotherapy in non-small-cell lung cancer.

BACKGROUND: Pulmonary resection after chemotherapy and concurrent full-dose radiotherapy (>59 Gy) has previously been associated with unacceptably high morbidity and mortality. Subsequently neoadjuvant therapy protocols have used reduced and potentially suboptimal radiotherapy doses of 45 Gy. We report a series of 40 patients with locally advanced non-small-cell lung cancer who successfully underwent pulmonary resection after receiving greater than 59 Gy radiation and concurrent chemotherapy. Operative results and midterm survival follow-up are presented. METHODS: Data were reviewed from 40 consecutive patients who underwent lung resection after receiving high-dose radiotherapy and concurrent platinum-based chemotherapy between January 1994 and May 2000. The follow-up closing interval for this study was until August 2003 or time of death. RESULTS: Preoperative stage was IIb (7 patients), IIIA (21 patients), IIIB (10 patients), and IV (2 patients with isolated brain metastasis). Thirteen patients exhibited Pancoast tumors. Median time from completion of induction therapy to surgery was 53 days. Twenty-nine lobectomies and 11 pneumonectomies (7 right, 4 left) were performed. There were no postoperative deaths. Intercostal muscle flaps were used prophylactically in all but one pneumonectomy patient. Seven patients required perioperative transfusions. Median intensive care unit (ICU) time averaged 2 days and the total length of stay was 6 days. One patient exhibited postpneumonectomy pulmonary edema and a bronchopleural fistula developed in another patient (not receiving an intercostal muscle flap). Thirty-four of 40 patients (85%; 95% CI: 70%-94%) were downstaged pathologically, 33 out of 40 patients (82.5%, 95% confidence interval [CI]: 67%-93%) indicated no residual lymphadenopathy, and 18 out of 40 patients (45%, 95% CI: 29%-61%) exhibited a complete pathologic response. Median follow-up was 2.8 years. The 1-, 2-, and 5-year overall survival rates were 92.4%, 66.7%, and 46.2%, respectively. Disease-free 1-, 2-, and 5-year survival rates were 73.0%, 67.2%, and 56.4%, respectively. Median disease-free survival has not been reached. CONCLUSIONS: Pulmonary resection may be performed safely after curative intent concurrent chemotherapy and radiotherapy to greater than 59 Gy. High pathologic complete response rates and sterilization of mediastinal lymph nodes were observed accompanied by highly favorable survival rates. This experience, though promising, will require confirmation in a prospective multiinstitutional clinical trial.

Adult↗
PubMed2003

Stevens-Johnson syndrome/toxic epidermal necrolysis in a patient receiving concurrent radiation and gemcitabine.

A patient with stage IV malignant melanoma treated with daily radiotherapy and low-dose (100 mg/m2) daily gemcitabine developed a blistering skin eruption, fever and neutropenia consistent with overlap Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). The diagnosis was confirmed by skin biopsy of an affected area. The case history is described, and the literature relating to the development of SJS/TEN in association with chemotherapy and radiotherapy administration is reviewed. This report describes a serious potential complication of concurrent gemcitabine and radiotherapy.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

Gestational trophoblastic tumor in pregnancy: a case report and review of the literature.

A case of gestational trophoblastic tumor (GTT) concurrent with an intrauterine pregnancy is reported in a 21-year-old gravida 2 para 0 (0010) who presented with dyspnea, orthopnea, headache, and blurring of vision at 33 weeks age of gestation. She had a history of hydatidiform mole for which curettage was done. Chest radiograph showed pulmonary metastases, with pleural effusion on both lungs. Serum beta subunit of human chorionic gonadotropin was abnormally elevated for age of gestation. Due to worsening maternal pulmonary condition, the patient underwent primary, low segment cesarean section and was subsequently started on multidrug chemotherapy. This is the first reported case of GTT in pregnancy in the Philippines in which both the mother and the infant survived. Several hypotheses regarding its origin, its diagnosis, and its management and prognosis are presented. This case report emphasizes the importance of early diagnosis and treatment to improve the prognosis of both the mother and the infant.

Adult↗
PubMed1988

Reproductive disorders in the periparturient dairy cow.

Incidence, predisposing factors, and implications of various reproductive disorders (dystocia, twinning, stillbirth, retained placenta, cystic ovaries, anovulation, infections of the reproductive tract, metritis, and abnormal health status) are reviewed as to their inter-relationships and collective impact on reproductive performance, milk yield and predisposition to other diseases or disorders in the periparturient dairy cow. All reproductive disorders reviewed reviewed reduce reproductive performance either directly or indirectly. Concurrent milk yield was reduced marginally in a few studies as a consequence of twinning, retained placenta, cystic ovaries, metritis, or other uterine disorders, and in cows with an abnormal health status. There is strong evidence for associated losses in milk yield following surgical delivery of a stillborn calf. We conclude that most periparturient disorders occur as a complex, rather than as a single abnormality. Cows with one disorders are at increased risk for other disorders, including metabolic ones. In contrast, actual milk yield or potential for high production generally does not predispose cows to increased risk for any of the reproductive disorders. The literature suggests that prophylactic measures to prevent occurrence of the one disorder might decrease the risk and incidence of other related disorders, either directly or indirectly.

Animals↗
PubMed1993

Review of the etiopathomechanism of vitiligo: a convergence theory.

Vitiligo is an acquired melanin pigmentary disorder manifesting itself by expanding depigmented lesions of the skin. To date, the etiopathomechanism of vitiligo has not been convincingly elucidated and a number of seemingly mutually opposed hypotheses with equal likelihood still coexist. Concurrent theories on vitiligo etiology, together with supportive evidence, are reviewed here. Due to the observed variation in clinical manifestations of the disease, it seems likely that the etiology of vitiligo may differ among patients. Therefore several theories on vitiligo etiopathogenesis have been combined to formulate a convergence theory for vitiligo, also presented in this article. This theory states that stress, accumulation of toxic compounds, infection, autoimmunity, mutations, altered cellular environment and impaired melanocyte migration and/or proliferation can all contribute to vitiligo etiopathogenesis in varying proportions.

Autoimmune Diseases↗
PubMed2002

Molecular biology of endotoxin antagonism.

The development of new therapies for the treatment of gram-negative bacterial sepsis has been the focus of extensive investigation. Molecular and cellular biologic techniques have led to important advances, including (1) identification of naturally occurring lipopolysaccharide (LPS)-binding proteins; (2) generation of novel LPS-binding antibodies, proteins, and peptides; and (3) characterization of the molecular determinants of LPS binding. In composite, these advances have facilitated comprehension of the manner in which gram-negative bacterial infection and concurrent endotoxemia exert detrimental effects on the mammalian host. The purpose of this review was to examine recent information regarding molecular determinants of LPS binding and the initial cellular signal transduction events, which lead to the local and systemic cytokine response and sepsis syndrome. Concurrently, the status of studies examining the effects of various endotoxin antagonists is reviewed. Data from these studies provide an indication of potential sites for therapeutic intervention as well as increasingly detailed understanding of the molecular mechanism of endotoxin antagonism. Taken together, these advances can be expected to further the development of the next generation of novel, adjuvant therapies for the treatment of sepsis syndrome caused by gram-negative bacterial infection and endotoxemia.

Animals↗
PubMed2005

Review of the evidence linking protein and energy to mental development.

OBJECTIVE: To examine the evidence as to whether the relationship between undernutrition and poor child development is causal. DESIGN: Selected studies from developing countries were discussed. Observational studies were first considered then experimental studies of preventative and remedial supplementation. The type of functions affected, the presence of sensitive periods and the role of protein and energy versus that of micronutrients were reviewed. RESULTS: Childhood undernutrition is generally associated with concurrent and longer term deficits in cognition, behaviour and motor skills, although the relationship is likely to be confounded by socio-economic factors. Supplementation trials have had many design problems. However, those beginning at any age from pregnancy up to 24 months have consistently had concurrent benefits suggesting a causal relationship. Supplement begun in older children had little or no effect, albeit there are too few studies to conclude with confidence. The limited evidence suggests that benefits are more likely to be sustained if supplementation begins in late pregnancy or at birth and is continued until the child is at least 24 months old. Deficits in cognition tend to be global and there is insufficient evidence of specific deficits. There is some evidence that the first 2 years of life are most sensitive to the effects of undernutrition. Most studies have failed to separate the effects of energy and protein from those of micronutrients. One study showed that energy and/or protein affects children's development. Psychosocial stimulation has had consistent benefits on undernourished children's development. CONCLUSIONS: Public health nutrition programmes should include a component in which children who are at risk are targeted during the first 2 years of life with combined interventions involving nutrition, health care and early stimulation.

Age Factors↗
PubMed2000

Sensory and motor interfering influences on somatosensory evoked potentials.

The interfering influences by which the different components of the early somatosensory evoked potentials are modified are reviewed from both neurophysiologic and clinical perspectives. Special consideration is given to the specific differences between sensory and motor interferences. In this context, the specific effect of the mental movement simulation task on the frontal N30 component is discussed in relation to the involvement of this evoked wave as a physiologic index of the dopaminergic motor pathways. Relevant interfering approaches, including concurrent events ranging from tactile stimulation to locomotion, are reviewed and discussed insofar as these data provide insights into the neurophysiologic processes of interaction between competing internal models controlling motor acts and sensory information.

Afferent Pathways↗
PubMed2006

Multiagent concurrent chemoradiotherapy for locoregionally advanced squamous cell head and neck cancer: mature results from a single institution.

PURPOSE: A retrospective review with long-term follow-up is reported from the Cleveland Clinic Foundation studying radiation and concurrent multiagent chemotherapy in patients with locoregionally advanced squamous cell head and neck cancer. PATIENTS AND METHODS: Between 1989 and 2002, 222 patients were treated with 4-day continuous infusions of fluorouracil (1,000 mg/m2/d) and cisplatin (20 mg/m2/d) during weeks 1 and 4 of either once daily or twice daily radiation therapy. Primary site resection was reserved for patients with residual or recurrent primary site disease after chemoradiotherapy. Neck dissection was considered for patients with N2 or greater disease, irrespective of clinical response, and for patients with residual or recurrent neck disease. RESULTS: With a median follow-up of 73 months, the Kaplan-Meier 5-year projected overall survival rate is 65.7%, freedom from recurrence rate is 74.0%, local control without the need for surgical resection rate is 86.7%, and overall survival rate with organ preservation is 62.2%. Including patients undergoing primary site resection as salvage therapy, the overall local control rate is 92.4%. Regional control rate at 5 years is 92.4%. Among patients with N2-3 disease, regional control was significantly better if a planned neck dissection was performed. Distant control at 5 years was achieved in 85.4% of patients and was significantly worse in patients with hypopharyngeal primary sites and patients with poorly differentiated tumors. CONCLUSION: Concurrent multiagent chemoradiotherapy can result in organ preservation and cure in the majority of appropriately selected patients with locoregionally advanced, nonmetastatic, squamous cell head and neck cancer. Distant metastatic disease was the most common cause of treatment failure. Late functional outcomes will require further investigation.

Adult↗
PubMed1989

Chemotherapy for head and neck cancer: progress and controversy in the management of patients with M0 disease.

The overall survival of patients with advanced squamous cell carcinoma of the head and neck (SCCHN) has not changed despite recent advances in surgical and radiotherapeutic techniques. For most patients with advanced disease, the morbidity associated with conventional surgery or radiotherapy is unacceptably high while the probability of locoregional and distant control of disease is low. The use of chemotherapy with surgery or radiotherapy for patients with SCCHN remains a controversial but highly promising treatment that attempts to improve locoregional control and overall survival or facilitate reductions in the locoregional treatment required for control of disease. Since the early 1960s, numerous trials have evaluated the impact of induction and adjuvant chemotherapy or concurrent chemotherapy and radiotherapy in the management of patients with advanced, but potentially curable, (M0) lesions. While a specific role for chemotherapy in the treatment of patients with SCCHN has not been confirmed by prospective randomized trials, considerable progress in the development of effective therapies has been achieved recently. This progress is characterized by the definition of chemotherapy with increased activity against squamous cell carcinomas and the organization of clinical trials with sufficient power to reach significant conclusions. This article reviews the experience with induction and adjuvant chemotherapy and concurrent chemotherapy and radiotherapy in the multidisciplinary treatment of patients with advanced SCCHN. The potential advantages as well as clinical experience with chemotherapy in these settings are presented.

Antineoplastic Agents↗
PubMed1998

Frequency and clinical significance of cytogenetic abnormalities in pediatric T-lineage acute lymphoblastic leukemia: a report from the Children's Cancer Group.

PURPOSE: Nonrandom chromosomal translocations are frequently observed in pediatric patients with acute lymphoblastic leukemia (ALL). Specific translocations, such as t(4;11) and t(9;22), identify subgroups of B-lineage ALL patients who have an increased risk of treatment failure. The current study was conducted to determine the prognostic significance of chromosomal translocations in T-lineage ALL patients. MATERIALS AND METHODS: The study included 169 children with newly diagnosed T-lineage ALL enrolled between 1988 and 1995 on risk-adjusted protocols of the Children's Cancer Group (CCG) who had centrally reviewed cytogenetics data. Outcome analyses used standard life-table methods. RESULTS: Presenting features for the current cohort were similar to those of concurrently enrolled patients for whom cytogenetic data were not accepted on central review. The majority of patients (80.5%) were assigned to CCG protocols for high-risk ALL and 86.4% had pseudodiploid (n = 80) or normal diploid (n = 66) karyotypes; modal chromosome number was not a significant prognostic factor. Overall, 103 of 169 (61%) patients had an abnormal karyotype, including 31 with del(6q), 29 with 14q11 breakpoints, 15 with del(9p), 11 with trisomy 8, nine with 11q23 breakpoints, nine with 14q32 translocations, and eight with 7q32-q36 breakpoints. Thirteen patients had the specific 14q11 translocation t(11;14)(p13;q11) and all were classified as poor risk. Patients with any of these translocations had outcomes similar to those with normal diploid karyotypes. CONCLUSION: Chromosomal abnormalities, including specific nonrandom translocations, were frequently observed in a large group of children with T-lineage ALL, but were not significant prognostic factors for this cohort. Thus, contemporary intensive treatment programs result in favorable outcomes for the majority of T-lineage ALL patients, regardless of karyotypic abnormalities, and such features do not identify patients at higher risk for relapse.

Adolescent↗
PubMed2001

Taxanes in lung cancer: a review with focus on the European experience.

The introduction of new agents in the treatment of lung cancer raised in the past few years new interest in clinical research on this topic. The use of taxanes as paclitaxel and docetaxel may represent a significant progress in the treatment of lung cancer. Taxanes used as single agents show a substantial activity in lung cancer and, because of their unique mechanism of action, it is possible to combine these drugs with other non-cross-resistant agents. Taxanes share a radiosensitizing effect and their use with concurrent radiotherapy appears to become a new standard. This review will focus on the European clinical experience in the treatment of lung cancer with the two compounds.

Antineoplastic Agents, Phytogenic↗
PubMedDate not supplied

Solid-pseudopapillary tumors of the pancreas: case report and literature review.

Solid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms of low malignant potential that mostly affect young women. These tumors are of unclear pathogenesis, are slow growing, and can become considerably large before causing symptoms. Complete resection is curative in most cases. This is the case of a 39-year-old African-American woman undergoing evaluation for Roux-en-Y gastric bypass, who was found to have a pancreatic mass. Image-guided biopsy revealed SPT. The patient underwent complete excision of the tumor and had an open Roux-en-Y gastric bypass performed concurrently. The patient had an uneventful postoperative course. A review of the literature is presented.

Adult↗
PubMed2003

Construction and characteristics of the RxRisk-V: a VA-adapted pharmacy-based case-mix instrument.

BACKGROUND: Assessment of disease burden is the key to many aspects of health care management. Patient diagnoses are commonly used for case-mix assessment. However, issues pertaining to diagnostic data availability and reliability make pharmacy-based strategies attractive. Our goal was to provide a reliable and valid pharmacy-based case-mix classification system for chronic diseases found in the Veterans Health Administration (VHA) population. OBJECTIVE: To detail the development and category definitions of a VA-adapted version of the RxRisk (formerly the Chronic Disease Score); to describe category prevalence and reliability; to check category criterion validity against ICD-9 diagnoses; and to assess category-specific regression coefficients in concurrent and prospective cost models. RESEARCH DESIGN: Clinical and pharmacological review followed by cohort analysis of diagnostic, pharmacy, and utilization databases. SUBJECTS: 126,075 veteran users of VHA services in Washington, Oregon, Idaho, and Alaska. METHODS: We used Kappa statistics to evaluate RxRisk category reliability and criterion validity, and multivariate regression to estimate concurrent and prospective cost models. RESULTS: The RxRisk-V classified 70.5% of the VHA Northwest Network 1998 users into an average of 2.61 categories. Of the 45 classes, 33 classes had good-excellent 1-year reliability and 25 classes had good-excellent criterion validity against ICD-9 diagnoses. The RxRisk-V accounts for a distinct proportion of the variance in concurrent (R2 = 0.18) and prospective cost (R2 = 0.10) models. CONCLUSIONS: The RxRisk-V provides a reliable and valid method for administrators to describe and understand better chronic disease burden of their treated populations. Tailoring to the VHA permits assessment of disease burden specific to this population.

Adolescent↗
PubMed1999

Diplopia secondary to aniseikonia associated with macular disease.

OBJECTIVE: To provide an explanation for diplopia and the inability to fuse in some patients with macular disease. METHODS: We identified 7 patients from our practices who had binocular diplopia concurrent with epiretinal membranes or vitreomacular traction. A review of the medical records of all patients was performed. In addition to complete ophthalmologic and orthoptic examinations, evaluation of aniseikonia using the Awaya New Aniseikonia Tests (Handaya Co Ltd, Tokyo, Japan) was performed on all patients. RESULTS: All patients were referred for troublesome diplopia. Six of the patients had epiretinal membranes and 1 had vitreomacular traction. All 7 patients had aniseikonia, ranging from 5% to 18%. In 5 of the patients the image in the involved eye was larger, and in the other 2 patients it was smaller than in the fellow eye. All patients had concomitant small-angle strabismus and at least initially did not fuse when the deviation was offset with a prism. Response to optical management and retinal surgery was variable. CONCLUSIONS: Aniseikonia caused by separation or compression of photoreceptors can be a contributing factor to the existence of diplopia and the inability to fuse in patients with macular disease. Concomitant small-angle strabismus and the inability to fuse with prisms may lead the clinician to the incorrect diagnosis of central disruption of fusion. Surgical intervention does not necessarily improve the aniseikonia.

Adult↗
PubMed2003

Cytologic features of the nested variant of urothelial carcinoma: a study of seven cases.

BACKGROUND: The nested variant of urothelial carcinoma (NVUC) is a recently described rare variant of urothelial carcinoma with deceptively bland morphologic findings, although it does display aggressive behavior. To the authors' knowledge there is no previous report of cytologic findings in urine specimens from patients with NVUC. METHODS: Urine specimens from patients with histologically confirmed NVUC were reviewed. The specimens evaluated included urine specimens obtained concurrently with or up to 1 month preceding the patients' surgical procedure. All the specimens were analyzed for the presence of cells morphologically similar to the NVUC cells observed in the tissue sections. These cells were evaluated for the following parameters: number of neoplastic cells; cellular arrangement; cell size and shape; cell borders; and cytoplasmic, nuclear, and nucleolar features. RESULTS: Thirteen urine specimens from 7 patients were included in the current study. The authors were able to identify cells that were similar morphologically to the cells present in the nests of NVUC in all cytologic specimens. The neoplastic cells for the most part were medium-sized, round or polygonal, with abundant, dense, slightly granular basophilic cytoplasm and well defined cell borders. The nuclear/cytoplasmic ratio was increased, the nuclear membranes had irregular contours, and the nuclei contained coarse chromatin with occasional prominent nucleoli. CONCLUSIONS: The cytologic features of NVUC are subtle but distinct. A primary diagnosis of NVUC in urine specimens is not recommended in view of the subtleness of the findings. Nonetheless, the presence of cells with the features described earlier should warrant a cystoscopic examination with histologic confirmation in a patient with a previous history of NVUC.

Aged↗
PubMed1993

Sonographically detected testicular microlithiasis and testicular carcinoma.

Testicular microlithiasis is an uncommon abnormality that produces the characteristic sonographic appearance of diffuse, punctate, hyperechoic foci throughout the testicular parenchyma. We have detected this distinctive sonographic pattern in 4 patients during a seven-year period. Three of the patients had proven concurrent testicular carcinoma. We describe our experience and review previous reports of testicular microlithiasis. We conclude that testicular microlithiasis may be associated with testicular neoplasia, and advocate particularly careful evaluation and follow-up of the testes when this abnormality is detected.

Adult↗