Aconselhamento telefônico: identificação de sintomas em pacientes com linfoma em quimioterapia antineoplásica / Consulta telefónica: identificación de síntomas en pacientes con linfoma en quimioterapia antineoplásica / Telephone counseling: identification of symptoms in patients with lymphoma undergoing antineoplastic chemotherapy

Resumo Objetivo Identificar os sinais e sintomas apresentados por pacientes com Linfoma de Hodgkin submetidos ao protocolo quimioterápico composto por Doxorrubicina, Bleomicina, Vimblastina e Dacarbazina (ABVD) por meio de aconselhamento telefônico e comparar os escores de gradação dos sinais e sintomas apresentados nos ciclos do protocolo. Métodos Descritivo, prospectivo, quantitativo. Sete pacientes receberam aconselhamento telefônico, em 24 tempos de chamadas programadas e não programadas, correspondentes a 6 ciclos de quimioterapia com protocolo ABVD. Utilizou-se o Inventário de Sintomas do M.D Anderson e o Critério Comum de Terminologia para Eventos Adversos, para a gradação dos sintomas e um protocolo de condutas. Realizou-se análise descritiva e analítica. Resultados Duzentas e oitenta e seis chamadas telefônicas geraram1.870 queixas sintomáticas. Nas chamadas programadas, as queixas com maior prevalência foram fadiga, preocupações, falta de apetite, vômitos e náuseas. Quanto a interferência nas atividades de vida diária, os itens relacionados a atividades em geral, no trabalho e dificuldade para caminhar, além de alterações no humor foram relatados em maior frequência. Nas chamadas não programadas, a falta de apetite e desregulação menstrual foram as queixas mais recorrentes. Na análise da progressão dos sintomas, observou-se aumento de náuseas e vômitos (p=0,02), diminuição da fadiga e falta de ar (p≤0,03), melhora do sono (p=0,02) e diminuição do estresse (p=0,02). Conclusão A fadiga, náusea, vômito e alteração nas atividades de trabalho foram relatados frequentemente. Houve progressão de náuseas e vômitos, mas regressão da fadiga e do estresse. O aconselhamento telefônico permitiu a comunicação e o manejo rápido de um número expressivo de sintomas.

Resumen Objetivo Identificar los signos y síntomas presentados por pacientes con linfoma de Hodgkin sometidos al protocolo quimioterápico compuesto por doxorrubicina, bleomicina, vinblastina y dacarbazina (ABVD) mediante consulta telefónica, y comparar los puntajes de graduación de los signos y síntomas presentados en los ciclos del protocolo. Métodos Descriptivo, prospectivo, cuantitativo. Siete pacientes recibieron asesoramiento telefónico en 24 momentos de llamadas programadas y no programadas, correspondientes a 6 ciclos de quimioterapia con protocolo ABVD. Se utilizó el Inventario de Síntomas de M. D. Anderson y el Criterio de Terminología Común para Efectos Adversos, para la puntuación de lis síntomas, y un protocolo de conductas. Se realizó análisis descriptivo y analítico. Resultados Doscientas ochenta y seis llamadas telefónicas determinaron 1.870 quejas sintomáticas. En las llamadas programadas, las quejas más prevalentes fueron: fatiga, preocupaciones, falta de apetito, vómitos y náuseas. Respecto a interferencia en actividades cotidianas, los ítems relacionados con actividad en general, laboral y dificultad para caminar, además de cambios del humor, fueron informados con mayor frecuencia. En llamadas no programadas, la falta de apetito y la irregularidad menstrual resultaron las quejas más habituales. En el análisis de progresión de los síntomas se observó aumento de náuseas y vómitos (p=0,02), disminución de fatiga y falta de aire (p≤0,03), mejora del sueño (p=0,02) y disminución del estrés (p=0,02). Conclusión Hubo informe frecuente de fatiga, náuseas, vómitos y cambios en actividades laborales. Existió progresión de náuseas y vómitos, y regresión de fatiga y estrés. La consulta telefónica permitió comunicación y rápido manejo de una expresiva cantidad de síntomas.

Abstract Objective To identify through telephone counselling the signs and symptoms presented by patients with Hodgkin's Lymphoma undergoing chemotherapy with the protocol composed by doxorubicin, bleomycin, vinblastine and dacarbazine and to compare severity scores of the signs and symptoms presented in the cycles of the protocol. Methods Descriptive, prospective, quantitative study. Seven patients received telephone counselling in 24 scheduled and unscheduled calls, corresponding to 6 ABVD chemotherapy cycle. The MD Anderson Symptom Inventory and the Common Terminology Criteria for Adverse Events were used for scoring the symptoms, along with a conduct protocol. A descriptive and analytical analysis was conducted. Results Two hundred and eighty-six telephone calls generated 1,870 symptomatic complaints. In scheduled calls, the most prevalent complaints were fatigue, distress, lack of appetite, vomiting and nausea. As for the interference in daily life activities, the items related to general activities, work, difficulty walking, and mood changes were reported more frequently. In unscheduled calls, lack of appetite and irregular menstruation were the most recurring complaints. The analysis of the progression of symptoms showed an increase in nausea and vomiting (p=0.02), decrease in fatigue and shortness of breath (p≤0.03), improvement in sleep (p=0.02) and decrease of stress (p=0.02). Conclusion Fatigue, nausea, vomiting and alterations in work activities were frequently reported. There was progression of nausea and vomiting but regression of fatigue and stress. Telephone consultation allowed a rapid communication and management of an expressive number of symptoms.

The efficacy of 2-nitrovinylfuran derivatives against Leishmania in vitro and in vivo

Despite recent advances in the treatment of some forms of leishmaniasis, the available drugs are still far from ideal due to inefficacy, parasite resistance, toxicity and cost. The wide-spectrum antimicrobial activity of 2-nitrovinylfuran compounds has been described, as has their activity against Trichomonas vaginalis and other protozoa. Thus, the aim of this study was to test the antileishmanial activities of six 2-nitrovinylfurans in vitro and in a murine model of leishmaniasis. Minimum parasiticide concentration (MPC) and 50% inhibitory concentration (IC50) values for these compounds against the promastigotes of Leishmania amazonensis, Leishmania infantum and Leishmania braziliensis were determined, as were the efficacies of two selected compounds in an experimental model of cutaneous leishmaniasis (CL) caused by L. amazonensis in BALB/c mice. All of the compounds were active against the promastigotes of the three Leishmania species tested. IC50 and MPC values were in the ranges of 0.8-4.7 µM and 1.7-32 µM, respectively. The compounds 2-bromo-5-(2-bromo-2-nitrovinyl)-furan (furvina) and 2-bromo-5-(2-methyl-2-nitrovinyl)-furan (UC245) also reduced lesion growth in vivo at a magnitude comparable to or higher than that achieved by amphotericin B treatment. The results demonstrate the potential of this class of compounds as antileishmanial agents and support the clinical testing of Dermofural(r) (a furvina-containing antifungal ointment) for the treatment of CL.

Idiopathic hyperammonemia after chemotherapy with vinorelbine, topotecan, and cisplatin in a patient with acute lymphocytic leukemia

Idiopathic hyperammonemia [IHA] had been reported in some patients with hematological malignancy after receiving intensive chemotherapy, following bone marrow transplantation, or after using 5-fluorouracil for some solid tumors. The chemotherapeutic agents involved include cytarabine, daunomycin, cyclophosphamide, vincristine, amsacrine, etoposide, asparaginase, busulfan, and methotraxate, all used for treating hematological malignancies. No previous reports have described the association between idiopathic hyperammonemia and combined chemotherapy with vinorelbine, topotecan, and cisplatin. We describe a 20-year-old girl with normal liver function and relapsed precursor B-lymphoblastic leukemia receiving the modified TVTG [topotecan, vinorelbine, thiotepa, dexamethasone, and gemcitabine] protocol to control her disease. We used cisplatin [30 mg/m[2]/day] to replace thiotepa on day 3 because thiotepa was not available in Taiwan. The patient developed acute idiopathic hyperammonemia after 5 days of chemotherapy and died 9 days after chemotherapy. To our knowledge, this patient is the first report of the association of hyperammonemia and chemotherapy with vinorelbine, topotecan, and cisplatin in the English literature

Radiotherapy versus radiotherapy enhanced by vinorelbine in locally advanced non-small cell lung cancer

Experimental studies have shown that vinorelbine is a powerful radiosensitizer in vitro.In this study, 173 patients with inoperable non-small cell lung cancer, Stage III, were entered into arandomized trial comparing radiotherapy only [RT][45 Gy/15 fractions/3 weeks][arm A] versus RT and a dailylow dose of vinorelbine [4 mg/m2][arm B].An overall response rate of 58.9% was observed in arm A and%0.6%in arm B, respectively. Nodifferences in the pattern of relapse were noted between the two treatment groups. Median time to progression was10.6 months for arm A and 14.2 months for arm B. Median survivals were 10.3 months and 9.97 months,respectively. Toxicity was acceptable and no treatment-related death occurred in either treatment schedule. In thisstudy no significant advantage of the combined treatment over radiation therapy only was found.The encouraging, results achieved in some trials together with the intractability of the disease suggestthat further effects efforts should be made to optimize clinical trial protocols, perhaps by reviewing theradiobiological and pharmacological basis of the combined treatment.Non-small cell lung cancer, vinorelhine, Radiotherapy, Radiosensitizer

Treatment of advanced non-small cell lung cancer with vinorelbine in elderly Thai patients.

The present study evaluated the efficacy and toxicity of vinorelbine as single chemotherapy for elderly Thai patients with advanced non-small cell lung cancer (NSCLC). Twenty-eight patients with no prior chemotherapy and ECOG performance status of 0-2 were enrolled in the study. There were 20 males and 8 females with a median age of 72 years, and the median ECOG performance status was 1. Eight cases were stage IIIB and 20 cases were stage IV. Fourteen cases were adenocarcinoma, 13 were squamous cell and one was large cell NSCLC. These patients received vinorelbine 25 mg/m2 on day 1 and 8. This treatment produced partial response in 5 of 25 evaluable patients (20%). Median survival time was 40 weeks. Hematologic toxicity caused 9% grade 3 anemia, 1.5% grade 4 neutropenia and 0.5% grade 4 neutropenia. Conclusion: Chemotherapy is a valuable treatment option for elderly patients with advanced NSCLC. Single agent vinorelbine is able to induce an overall response with a low toxicity level in elderly Thai patients with advanced NSCLC.

Hiperpigmentación cutáneo-mucosa en pacientes HIV positivos / Muco-cutaneous hyperpigmentation in HIV patients

Las alteraciones en la pigmentación cutáneo-mucosa en los pacientes infectados por el virus HIV pueden ser frecuentes, pero su etiología está aún en discusión. Se analizó el seguimiento dermatológico desde 1988 hasta 1995 de 320 casos infectados por el virus del HIV, donde 61 eran mujeres y 259 varones, cuyas edades promedio fueron de 26,6 años en los primeros y 22,2 en los segundos. Del total de casos (320), se observó hiperpigmentación cutáneo-mucosa difusa en el 16,32 por ciento de los casos e hiperpigmentación de mucosa y semimucosa oral exclusivamente en 2 mujeres (0,77 por ciento) y 12 varones (4,18 por ciento). En nuestra experiencia, la hiperpigmentación se comportó como un marcador de mal pronóstico, dado que en menos de 6 meses de su aparición, los pacientes presentaron complicaciones más severas que los llevaron a la muerte

Quimioterapia en cáncer testicular de alto riesgo: experiencia del grupo uro-oncológico del Hospital General de México, SS / Chemotherapy in high risk testicular cancer: experience of uro-oncologic group of the Hospital General of México, SS

Se analiza el uso de tres esquemas distintos de quimioterapia en cáncer testicular de alto riesgo. El grupo I incluyó 21 pacientes tratados entre 1976 y 1980 que recibieron vinblastina y blemicina (esquema VBII); el grupo II, 15 pacientes manejados de 1981 a 1985 con cisplatino, vinblastina y bleomicina (esquema PVB); y el grupo III, 17 pacientes atendidos entre 1986 y 1990 con cisplatino, ciclofosfamida y adriamicina, en ciclos alternos con vinblastina y bleomicina (esquema CISCA II/VBIV). Se obtuvieron, respectivamente, respuestas completas de 19.0, 46.7 y 76.5 por ciento (p= 0.0003), lo cual se elevó a 59.8 por ciento en el grupo II y a 100.0 por ciento en el gurpo III, con cirugía citorreductiva (p=0.0000). Después de 104 semanas de seguimiento, el 33.0 por ciento de los pacientes del grupo II y el 94.0 por ciento del grupo III sa encontraban libres de enfermedad (p= 0.0002). Los efectos tóxicos fueron mayores en el tercer grupo; sin embargo no hubo diferencia estadística. Las características inherentes a los distintos períodos en que fueron tratados los grupos imposibilitan una comparación objetiva. La experiencia adquiridad perfila una curva positiva de aprendisaje. Con cada etapa se lograron mejores resultados; sobre todo al implantar regímenes más agresivos de quimioterapia, que implican mayor número de grogas efectivas, administradas en un lapso menor, con un manejo adecuado de los efectos secundadios