ABSTRACT
AIM: To determine predictors for decision-making on a differential approach to choosing glucocorticosteroids (GCS) for children and adolescents with acute lymphoblastic leukemia (ALL). SUBJECTS AND METHODS: The analysis covered 1064 primary patients aged to 1 to 18 years with ALL who had been registered at the clinics of Russia and Belorussia in April 2002 to November 2006. Before induction therapy, the patients were randomized into a dexamethasone (DEXA) 6 mg/m2 group (n=539) and a methylprednisolone (MePRED) 60 mg/m2 one (n=525). RESULTS: The entire group showed no statistically significant differences in survival rates between the patients receiving DEXA or MePRED. However, an analysis of age groups revealed the benefits of DEXA in children younger than 14 years (the event-free survival (EFS) was 76±2 and 71±2%, respectively (p=0.048); the overall survival (OS) was 81±2 and 77±2%, respectively (p=0.046); therapy-induced mortality was 6.4% (DEXA) andl 1.1% (MePRED) (p=0.01 4); the rate of isolated extramedullary relapses was 1.5% (DEXA) and 4.4% (MePRED) (p=0.009). At the same time, EFS and OS in 14-to-18-year-old adolescents were statistically significantly higher than in those who used MePRED (EFS, 65±6 and 52±6%, respectively (p=0.087); OS, 72±6 and 61±6%, respectively; (p=0.l 7). CONCLUSION: The findings suggest that it is possible that the choice of a GCS for ALL therapy must be also based on a patient's age. There is a need for further studies of this matter in prospective randomized multicenter trials in children and adolescents.
Subject(s)
Dexamethasone/therapeutic use , Methylprednisolone/therapeutic use , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Adolescent , Age Distribution , Age Factors , Child , Child, Preschool , Female , Glucocorticoids/therapeutic use , Humans , Incidence , Infant , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Prospective Studies , Republic of Belarus/epidemiology , Russia/epidemiology , Survival Rate/trends , Treatment Outcome , Young AdultSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Dexamethasone/administration & dosage , Dexamethasone/adverse effects , Humans , Methylprednisolone/administration & dosage , Methylprednisolone/adverse effects , Multicenter Studies as Topic , Randomized Controlled Trials as Topic , Russia , Time FactorsABSTRACT
Experience with the surgical treatment of 263 patients with acalculous cholecystitis is presented. Planned and postponed operations were fulfilled on 188 patients. 75 operations were performed for urgent indications. Gangrenous cholecystitis was found in 25 of the patients, phlegmonous cholecystitis--in 46 patients, catarrhal acalculous cholecystitis in 4 patients. Three patients died from severe concomitant diseases. The authors point to the considerable incidence of destructive forms of acute cholecystitis (especially in elderly and senile patients) which requires active surgical measures after failure of a complex medicamental treatment of the attack.
Subject(s)
Cholecystectomy/methods , Cholecystitis/surgery , Acute Disease , Adult , Age Factors , Aged , Cholecystitis/complications , Common Bile Duct/surgery , Constriction, Pathologic/surgery , Duodenum/surgery , Emergencies , Female , Gallstones/surgery , Humans , Male , Middle AgedABSTRACT
An analysis of immediate results of the operative treatment of 186 patients (choledochoduodenoanastomosis - in 86 patients, tight suture of the common bile duct - in 94 patients, external drainage of the hepatocholedocus - in 4 patients, papillosphincterotomy - in 2 patients) showed them to have no substantial difference in using choledochoduodenoanastomosis and tight suture of the common bile duct.
