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At least 1,045 records · Page 58Linked to original sources
PubMed1996

Treatment costs in Hodgkin's disease: a cost-utility analysis.

The aim of this study was to estimate costs of treatment for Hodgkin's disease (HD) and the outcome in health in terms of quality-adjusted life-years (QALYs), and compare these to a constructed nontreatment alternative. All 55 patients treated for HD at the oncological unit of the University Hospital of Tromsø between 1985 and 1993 were included. The total treatment costs (medication, hospital stay, hospital hotel stay, radiotherapy, travelling, loss in production, i.e. work) were retrospectively estimated for all patients. In December 1994, the 49 survivors were sent a EuroQol questionnaire recording quality of life: 42 responded. The mean quality of life score was 0.78 on a 0-1 scale, and the mean total cost of treatment was pounds 12512. The total treatment costs were significantly higher in patients with advanced clinical stages of the disease (P = 0.0006), B-symptoms (fever, sweats, weight loss) (P = 0.0027) and relapse (P < 0.0001). The costs of one QALY (with production gains included and using a 10% discount rate) were estimated at pounds 1651. When excluding production gains and using a 5% discount rate, the figures became pounds 1327. This makes HD one of the most cost-effective malignancies to treat.

Adolescent↗
PubMedDate not supplied

Clinical and epidemiological aspects of abdominal angiostrongyliasis in southern Brazil.

Most of the cases of abdominal angiostrongyliasis in Brazil were reported from the southern States of São Paulo, Paraná, Santa Catarina and Rio Grande do Sul (RS). A study in 27 cases from RS revealed a distinct local epidemiology. Peasants were usually affected, either adults or children, from the mountainous areas in the north of the State. There was a seasonal increase in the number of cases, from late spring to autumn, that does not coincide with the rainy season. Besides the most common clinical features of abdominal pain, fever and eosinophilia in the leukogram, painful relapsing episodes were detected in some patients. The abdominal pain could be either localized or diffuse during the rapid evolution to a surgical abdominal condition, with a lethality of 7.4%. The use of a serological test and the greater awareness of physicians working in endemic areas is expected to improve the recognition of uncomplicated and benign courses of the disease. This study confirms the known clinical manifestations of abdominal angiostrongyliasis and demonstrates the diversity of its epidemiology.

Abdomen↗
PubMedDate not supplied

Adjuvant sequential dose-dense doxorubicin, paclitaxel, and cyclophosphamide (ATC) for high-risk breast cancer is feasible in the community setting.

PURPOSE: This study evaluated the feasibility, when given in the community, of dose-dense, sequential ATC (doxorubicin, paclitaxel, cyclophosphamide) as adjuvant therapy for breast cancer with four or more metastatic axillary lymph nodes. PATIENTS AND METHODS: Patients were recruited after definitive breast cancer surgery if four or more axillary nodes were involved by metastatic cancer and if distant metastases were not present on computed tomographic scan or bone scan. Forty patients received doxorubicin, 90 mg/m2 every 14 days for three cycles; paclitaxel, 250 mg/m2 every 14 days for three cycles; and cyclophosphamide, 3 g/m2 every 14 days for three cycles with filgrastim support. Chemotherapy was administered by the referring physician. RESULTS: Mean dose intensity was 99% for doxorubicin, 96% for paclitaxel, and 99% for cyclophosphamide. Grade 3 toxicities included mucositis (13%), nausea/vomiting (10%), neuropathy (13%), and myalgia/arthralgia (10%). Thirteen patients had neutropenic fever. One patient developed acute leukemia. Three relapses have occurred. Ninety percent of patients are alive and disease-free at a median follow-up of 24 months. DISCUSSION: ATC can be administered in the community at full doses with acceptable toxicity. Preliminary efficacy data suggest that this high-dose, intensively scheduled regimen warrants comparison with standard therapy for high-risk patients.

Adult↗
PubMed2001

Irinotecan in relapsed or refractory non-Hodgkin's lymphoma.

Irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity. Various schedules and doses have been studied, and major complications were delayed diarrhea and myelosuppression. We explored the activity of irinotecan in patients with relapsed or refractory non-Hodgkin's lymphoma, using a 3-week schedule of administration. Eligible patients had histologically proven relapse, had received no more than two previous regimens, were > or = 15 years and < or = 75 years old, had normal renal function, neutrophil count > 1,500/microL, platelet count > 100,000/microL, and no human immunodeficiency virus infection or central nervous system involvement. Patients were treated with irinotecan 300 mg/m2 i.v. every 21 days with intensive loperamide management of diarrhea. Responders received up to six treatment cycles. Of 25 patients registered so far, 22 are evaluable for response. The median age was 67 years (range: 25 to 74 years) and 11 were male. The median number of previous regimens was 2 (range: 1 to 4 regimens), and 16 patients had disease that was refractory to their last regimen. Serum lactate dehydrogenase level was high in 75%, and beta2-microglobulin was > 3.0 mg/L in 26% of patients. Responses were seen in 8 of 22 (36%) patients with non-Hodgkin's lymphoma. Response rates were 40% for indolent, 0% for mantle cell, 45% for relapsed aggressive, and 33% for refractory aggressive lymphomas. Grade 3/4 toxicities included myelosuppression, neutropenic fever, and delayed diarrhea. Irinotecan appears active and relatively well tolerated in patients with relapsed aggressive non-Hodgkin's lymphoma. Accrual to this study is continuing for better determination of the response rate in all histologic subtypes of non-Hodgkin's lymphoma.

Adult↗
PubMed2003

[Menstrual staphylococcal toxic shock is still a reality].

INTRODUCTION: Staphylococcal toxic shock replies to precise clinical-biological criteria; but can be difficult to diagnose. Today, the nonmenstrual form of shock is the most frequent. The incidence of menstrual shock is low but their potential severity must be recalled. OBSERVATIONS: A young 14 year-old girl and a 33 year-old woman presented with menstrual shock that was treated successfully. A relapse in the form of staphylococcal scarlet fever occurred in the second patient. In both cases, the strain Staphylococcus aureus, which produces the TSST-1 toxin, had been identified. CONCLUSION: The possibility of the occurrence of a menstrual staphylococcal shock in the year 2002 must be known. The polymorphism of the clinical and biological manifestations must be underlined. The search for a toxin can be conducted in an appropriate centre.

Adolescent↗
PubMed1991

[Effectiveness of etoposide on reactive histiocytosis and refractory state to platelet transfusion during therapy of leukemia: case report].

The patient is 11-year-old girl who was diagnosed as having hybrid acute leukemia (myeloid and lymphoid) from morphological (cytochemistry) findings, immunophenotype and genotype. During reinduction therapy after a second relapse, she presented hepatosplenomegaly and the remittent fever unresponsive to the intensified antibiotics. The diagnosis of reactive histiocytosis was made because of the remarkable elevation of serum ferritin value and proliferation of mature histiocytes in the bone marrow. Treatment with etoposide resulted in the disappearance of her fever and other symptoms. The subsequent refractoriness to platelet transfusion was also overcome by etoposide (p.o.) therapy. The results suggested that the treatment with etoposide might be effective for reactive histiocytosis and the related refractory state to platelet transfusion during therapy for leukemia.

Blood Component Transfusion↗
PubMed1993

Still's disease relapse with severe pneumonitis after prolonged remission.

A 20-year-old woman who had suffered from Still's disease was admitted for fever and progressive pneumonitis after long-term remission. High spiking fever, leukocytosis, splenomegaly and an extremely high serum ferritin concentration strongly suggested a relapse of Still's disease. Intensive therapy with high-dose methylprednisolone, cyclophosphamide and gamma globulin was required for the severe pneumonitis, which was thought to be a rare manifestation in Still's disease.

Adult↗
PubMed1993

[Outbreak of typhoid fever in a family].

We describe a small epidemic of typhoid fever in a family who came originally from Pakistan. In 1992 six members (mother and five children) of a family of ten were admitted to our department with typhoid fever within a nine-day period. The index case was an 18 months old girl who had been hospitalized and treated elsewhere for typhoid fever. Two weeks after completing antibiotic treatment she was admitted to our hospital with a relapse. The source of her first infection is unknown. The rapid spread of typhoid fever in the family was most likely due to insufficient hygienic precautions and inadequate antibiotic treatment of the index case. Several coexisting factors such as poor housing conditions and cultural barriers may also have influenced the outcome. There is obviously a need for strict guidelines and proper coordination of treatment and follow-up of this and other similar contagious diseases.

Adult↗
PubMedDate not supplied

[Changes in the incidence and clinical picture of rheumatic fever in 6 communities in the Istrian Subregion (1962-1986)].

Two hundred patients up to 13 years of age who were admitted to the Department of Pediatrics, Pula, between 1962 and 1986 with acute rheumatic fever were studied. Of these patients, 21 (10.5%) were in relapse. During the first 12 years of follow-up, 177 patients were treated and during the last 13 years only 23 patients. The average hospital incidence declined from 2.7% in 1963 to 0.3% or less between 1975 and 1986. The average annual incidence of acute rheumatic fever in a group of patients aged 0 to 14 years decreased from 67/100,000 in 1963 to 5.4/100,000 children in 1986. Within the last 13 years of follow-up, no relapse was observed. From 1966, no patient with decompensation of the heart was treated; and from 1961, no mortality was observed as a consequence of acute rheumatic fever. There are a number of factors which influenced these good trends, such as advances in health protection of children, better primary and secondary antirheumatic prophylaxis and, of course, continued improving of the standards of living in this subregion. It is concluded that in spite of the declining incidence and milder course of acute rheumatic fever, the disease still remains a serious public health problem due to a possible cardiac damage.

Acute Disease↗
PubMed1995

Q fever endocarditis.

Q fever is a widespread disease caused by the rickettsia Coxiella burnetii, an obligate intracellular bacteria which man usually acquires through the inhalation of infected dust from subclinically infected animals. Q fever may be acute or chronic. The chronic form mostly presents as endocarditis, which is difficult to diagnose and may ultimately be fatal. Immunocompromised conditions and underlying heart disease are the most important risk factors to consider in cases of Q fever endocarditis. The ultimate diagnosis is based on specific diagnostic tests which include serology, demonstration of C. burnetii in valvular material, isolation of C. burnetii from blood and tissue samples by cell-culture techniques as well as amplification and detection of the bacterial DNA by polymerase chain reaction. Treatment of chronic Q fever endocarditis is complex and requires long-term antibiotic therapy, sometimes associated with heart valve replacement. At the present time neither an optimal antibiotic combination nor the duration of treatment is known and patients with Q fever endocarditis require prolonged follow-up because of the possibility of later relapses.

Coxiella burnetii↗
PubMed2006

[Placement of an expandable metallic stent (Ultraflex) for tracheobronchial stenosis in relapsing polychondritis].

A 57-year-old man was admitted to our hospital because of fever, cough and polyarthralgia. A physical examination revealed polyarthritis and saddle nose. Chest computed tomography showed stenosis of the trachea and both main bronchi. Relapsing polychondritis (RP) was diagnosed, and steroid therapy was started. Dyspnea at rest appeared suddenly. Bronchoscopy showed stenosis from the trachea to both main bronchi. An expandable metallic stent (Ultraflex) was placed in the trachea and both main bronchi. After the procedure, bronchoscopy showed a widely patent airway, and his symptoms were improved. Since airway complications of RP can be fatal, tracheobronchial stent placement should be considered in the management of RP with airway stenosis.

Administration, Oral↗
PubMedDate not supplied

A comparative trial of co-trimoxazole and chloramphenicol in thyphoid and paratyphoid fever.

A comparative trial of co-trimoxazole and chloramphenicol was carried out on 91 patients, 57 having typhoid fever and 34 cases having paratyphoid fever. Co-trimoxazole is an effective drug in the treatment of enteric fevers with respect to clinical cure, absence of relapses and the mild nature of short term toxic drug effects. Unlike some of the earlier reports, treatment failure or non-responsiveness to the drug occurred in just under 10 per cent of the cases and would constitute a drawback of therapy with co-trimoxazole. This feature was not observed in the patients receiving chloramphenicol. The excretion of Salmonellae after drug therapy was more common with chloramphenicol than with co-trimoxazole, again indicating the value of the latter drug in the treatment of enteric fevers.

Adult↗
PubMedDate not supplied

Disturbances of cellular immunity in rheumatic fever.

The alteration of cellular reactivity was investigated in 20 patients with rheumatic fever at the first rheumatic attack or in relapse with confirmed heart damage. The results obtained by studying in parallel ESR, the ASLO titer, IDR to streptococci and the degree of leukocyte migration inhibition proved that the onset of rheumatic attack was preceded by a deep disturbance of the cellular immunity. The migration inhibition values were between 50 and 60% (as compared with 10% in the normal controls) in over 85% of the patients investigated. It is emphasized that the selection of cases of streptococcal angina should be made very carefully and that sometimes it is necessary to use a more specific method for the detection of rheumatic fever in its preclinical stage.

Adolescent↗
PubMedDate not supplied

Antibiotic therapy for typhoid fever.

A retrospective clinical study was conducted to evaluate the efficacies of various kinds of antibiotics on 804 patients with typhoid fever. Of 16 regimens studied, ofloxacin and enoxacin achieved 100 cure rates without relapse or carriage of Salmonella typhi within 3 months. Their good safety profiles and relatively lower costs were very cost-effective for treatment of typhoid fever, and they can be recommended as the first-line choices for routine management of this disease. In addition, our results suggested that ceftriaxone treatment of typhoid fever should be given at higher dose: not less than 3 g once daily, or over a longer period, to reduce the incidence of relapse.

Adult↗
PubMed2003

ALK-positive anaplastic large-cell lymphoma: strong T and B anti-tumour responses may cause hypocellular aspects of lymph nodes mimicking inflammatory lesions.

The anaplastic large cell lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma which occurs in children mostly. The ALK protein is highly immunogenic and elicits both humoral and cellular immune responses. A 15-yr-old child presented with fever and adenopathy and did not respond to antibiotics. Biopsy of the enlarged lymph node contained almost no lymphoid element except for a few CD8-positive T cells, plasma cells and isolated CD30-positive blasts. The patient's condition improved following lymphadenectomy but relapse occurred 3 months later with multiple nodes, high fever and an abdominal mass. This time an ALK-positive ALCL was diagnosed and the retrospective analysis of the initial biopsy revealed rare, isolated ALK+ cells. Molecular analysis showed T-cell clones and oligoclonal B cells in both biopsies and peripheral blood of the patient. The tumour cells harbour a t(2;5) translocation, revealing a null phenotype by immunohistochemistry and no evidence for T-cell clonality by Southern blotting. The patient's serum contained anti-ALK antibodies. Our findings suggest that the T-cell clones and anti-ALK antibodies in this patient constitute an anti-tumour response that caused the hypocellularity of the initial lymph node. Hypocellular and oedematous lymph nodes occurring in a child with evocative symptoms should be tested for the presence of ALK.

Adolescent↗
PubMed2005

A prospective evaluation of leflunomide therapy for cytomegalovirus disease in renal transplant recipients.

AIM: A preliminary observation suggests leflunomide is effective in the treatment of cytomegalovirus (CMV) disease in renal transplant recipients. A prospective evaluation was conducted in renal transplant recipients to study the efficacy of leflunomide in the treatment of CMV disease. PATIENTS AND METHODS: With prior approval and informed consent for therapy and follow-up, 17 consecutive consenting renal transplant recipients with proven CMV disease were treated with leflunomide. CMV disease was defined as a clinical syndrome of fever and/or symptoms of organ involvement, leukopenia, and a positive nested CMV quantitative PCR test at 0.001 microg/5 microL template input, with or without histologic evidence of tissue invasion. Leflunomide metabolite concentrations (A77 1726) were monitored. RESULTS: Of the 17 patients, 14 patients were treated for 6 months for CMV disease the first time; the remaining 3 received leflunomide treatment for relapse after ganciclovir treatment, for a year. Seven patients had fever with viremia and no organ involvement, nine had viremia with involvement of gastrointestinal tract, and one had fever with CMV inclusions in the allograft, with no demonstrable viremia. The three patients with relapse treated with leflunomide responded. Overall, 15 patients (88%) clinically responded to leflunomide therapy and with viral clearance from blood and healing of involved organs. The cost of therapy with intravenous ganciclovir (Cymevene, Roche) for 2 weeks was US 721 dollars while that of leflunomide (Cleft, Cipla Ltd) for 6 months was US 64 dollars. CONCLUSION: Leflunomide treatment for CMV disease in renal transplant recipients is effective, simple, and economical.

Adult↗
PubMed1986

[Acute rheumatic fever in New Caledonia. Clinical and epidemiological aspects].

Rheumatic fever is frequently encountered in tropical countries. Its distribution, incidence and consequences, notably on the heart, were studied in Nouvelle-Calédonie (South Pacific) on the basis of 76 patients with acute attack. The data were compared with those obtained in controls of the same age, sex and ethnic origin. Many patients developed carditis (often disabling), and relapses were frequent. The epidemiological data confirmed that rheumatic fever preferentially affects young subjects of both sexes and is more common among Melanesians and Polynesians, probably because of their lower socio-economic status.

Adolescent↗
PubMed2005

[Relapse of Plasmodium malariae malaria 20 years after living in an endemic area].

INTRODUCTION: Malaria has been eradicated in Tunisia since 1979. Although it continues to be evoked in the case of fever after travel to an endemic zone, its diagnosis is however difficult during relapses, notably when they are delayed. OBSERVATION: A 50 year-old man having lived in Mauritania from 1978 to 1982 was hospitalized for interstitial pneumopathy and urarthritis. In spite of treatment with broad spectrum antibiotics, the fever accompanied by abundant sweating persisted. A thick blood drop and blood smear was requested and led to the diagnosis of Plasmodium malariae malaria. DISCUSSION: This observation recalls the possibility of parasitic upsurge of some plasmodial species. It should prompt physicians to be careful and evoke malaria in the case of fever in subjects having stayed, even several years before, in an endemic zone. This would permit early diagnosis and treatment.

Animals↗