RESUMEN
BACKGROUND: We aimed to: (1) examine relationships between the Functional Oral Intake Scale (FOIS), Eating Assessment Tool-10 (EAT-10), and objective measures of swallowing (Modified Barium Swallow Impairment Profile [MBSImP©] and penetration-aspiration scale [PAS]) in patients with head and neck cancer, (2) compare outcomes between oral intake vs tube-dependent patients, and (3) compare outcomes across time points. METHODS: A total of 58 patients with head and neck cancer completed the FOIS, EAT-10, and underwent a standardized videofluoroscopy (VFSS). VFSS were analyzed using the PAS and MBSImP©. Nonparametric analyses were performed. RESULTS: A relationship between the FOIS and EAT-10 (r = -0.46; P < .001) was revealed. No other associations were observed (P < .05). Feeding status did not impact PAS or MBSImP©; however, patients with head and neck cancer who were tube dependent demonstrated higher (worse) EAT-10 scores (P = .01). CONCLUSIONS: In this cohort, a relationship between patient-perceived swallowing impairment and functional oral intake was revealed; however, no associations were observed between the FOIS and objective measures of swallowing impairment or swallowing safety.
Asunto(s)
Trastornos de Deglución/diagnóstico por imagen , Trastornos de Deglución/etiología , Ingestión de Alimentos/fisiología , Neoplasias de Cabeza y Cuello/cirugía , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía , Grabación en Video/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Bases de Datos Factuales , Deglución/fisiología , Femenino , Fluoroscopía/métodos , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Estados UnidosRESUMEN
This article provides a framework speech-language pathology services to optimize functional outcomes of patients with oral cavity and oropharyngeal cancers. Key principles include (1) a proactive rehabilitation model that minimizes intervals of disuse or inactivity of speech and swallowing systems, (2) standardized evaluation paradigms that combine objective instrumental assessments with patient-reported outcome measures, and (3) systematic methods for surveillance and intensive rehabilitation for late dysphagia.
Asunto(s)
Neoplasias de la Boca/rehabilitación , Neoplasias Orofaríngeas/rehabilitación , Patología del Habla y Lenguaje/métodos , Humanos , Neoplasias de la Boca/fisiopatología , Neoplasias Orofaríngeas/fisiopatologíaRESUMEN
The Eating Assessment Tool-10 (EAT-10) represents a validated, easy to administer patient report dysphagia severity scale. Although its ability to detect swallowing impairment has been investigated in other patient populations, the utility of this instrument in individuals with head and neck cancer (HNC) has not been studied. The aim of the current investigation was to determine the relationship between patient ratings of swallowing impairment (EAT-10) and objective clinical ratings of swallow physiology in individuals with HNC. Forty-four HNC participants completed the EAT-10 and a standardized videofluoroscopy swallow study. Blinded raters determined airway safety using the penetration-aspiration scale (PAS) and swallowing function using the modified barium swallow impairment profile (MBSImP™©). Participants were stratified into three groups (pre-treatment through 1 year post-treatment, 1-5 years post-treatment, and >5 years post-treatment). Independent t tests, Pearson's and Spearman's Rho correlations, and a Bonferroni correction for multiple comparisons were performed. EAT-10 scores were significantly higher in HNC patients with unsafe swallowing (M 24.45, SD 8.32) compared to those with safe swallowing (M 16.20, SD 12.14), t(21) = -2.36, p < 0.04. Significant correlations were revealed between EAT-10 scores and the MBSImP™© (pharyngeal composite), and PAS scores (p < 0.05) for the pre-treatment to within 1 year post-treatment group. No associations, however, were observed for HNC patients in the time groups representing greater than 1-year post cancer treatment.
Asunto(s)
Deglución/fisiología , Ingestión de Alimentos/fisiología , Fluoroscopía/estadística & datos numéricos , Neoplasias de Cabeza y Cuello/fisiopatología , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Femenino , Fluoroscopía/métodos , Neoplasias de Cabeza y Cuello/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Estadísticas no ParamétricasRESUMEN
Head and neck cancer is a unique cause of dysphagia. Altered swallow function can be secondary to the mechanical effects of a tumor invading normal anatomy needed for deglutition, or as a direct sequela of cancer treatment (surgery and/or radiation ± chemotherapy). This article outlines the incidence of head and neck cancer, effects of anatomic changes associated with common surgical intervention, and the consequences of treatment-induced dysphagia. Assessment and rehabilitation techniques applicable for this population are discussed.
Asunto(s)
Carcinoma de Células Escamosas , Trastornos de Deglución , Quimioterapia/métodos , Neoplasias de Cabeza y Cuello , Enfermedades de la Boca/complicaciones , Infecciones por Papillomavirus/complicaciones , Radioterapia/métodos , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/fisiopatología , Carcinoma de Células Escamosas/terapia , Terapia Combinada/métodos , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/rehabilitación , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/etiología , Neoplasias de Cabeza y Cuello/fisiopatología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Incidencia , Estadificación de Neoplasias , Evaluación de Resultado en la Atención de Salud , Tonsila Palatina/patología , Lengua/patología , Estados UnidosRESUMEN
Nosocomial infections due to MDR P. aeruginosa are an increasing problem. Therapeutical options are few. We describe two haematological patients with severe neutropenia and systemic infection due to MDR P. aeruginosa treated successfully with colistin plus ceftazidime. Severe adverse events were not described.
Asunto(s)
Bacteriemia/tratamiento farmacológico , Ceftazidima/uso terapéutico , Colistina/uso terapéutico , Leucemia Mieloide/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Infecciones por Pseudomonas/tratamiento farmacológico , Enfermedad Aguda , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Anciano , Anemia Refractaria con Exceso de Blastos/complicaciones , Antibacterianos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bacteriemia/etiología , Ceftazidima/administración & dosificación , Colistina/administración & dosificación , Colitis/etiología , Colitis/cirugía , Susceptibilidad a Enfermedades , Farmacorresistencia Bacteriana Múltiple , Quimioterapia Combinada , Resultado Fatal , Femenino , Humanos , Infusiones Intravenosas , Leucemia Mieloide/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Masculino , Persona de Mediana Edad , Neoplasias Primarias Secundarias/complicaciones , Peritonitis/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/microbiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Infecciones por Pseudomonas/etiología , Traumatismos por Radiación/etiología , Traumatismos por Radiación/cirugía , Neoplasias de la Columna Vertebral/tratamiento farmacológico , Neoplasias de la Columna Vertebral/radioterapia , Tiflitis/complicacionesRESUMEN
PURPOSE: To investigate the use of a nonmyeloablative fludarabine-based immunosuppressive regimen to allow engraftment of HLA-sibling donors' mobilized stem cells and induction of a graft-versus-lymphoma effect for patients with advanced resistant Hodgkin's disease and non-Hodgkin's lymphoma. PATIENTS AND METHODS: Fifteen patients with Hodgkin's disease (n = 10) and non-Hodgkin's lymphoma (n = 5) were studied. All patients received cyclophosphamide and granulocyte colony-stimulating factor to mobilize autologous hematopoietic stem cells (HSCs). Subsequently, they received high-dose therapy with carmustine, etoposide, cytarabine, and melphalan and reinfusion of HSCs. At a median of 61 days after engraftment, patients were given fludarabine 30 mg/m(2) with cyclophosphamide 300 mg/m(2) daily for 3 days. Donor-mobilized HSC collections were prepared for fresh infusion and were not T-cell depleted. Methotrexate and cyclosporine were used to prevent graft rejection and as graft-versus-host disease (GVHD) prophylaxis. RESULTS: Combined treatment was well tolerated. After mini-allografting, hematologic recovery was prompt. Thirteen patients had 100% donor cell engraftment. Eleven patients achieved complete remission (CR) after the combined procedure. Nine patients, who were in partial remission after autografting, achieved CR after mini-allografting. Seven patients developed >/= grade 2 acute GVHD (aGVHD) and two developed extensive chronic GVHD (cGVHD). Three patients who received the highest number of donor lymphocyte infusions (DLIs) developed grade 3 GVHD (two patients) and extensive cGVHD (one patient). Ten patients are currently alive, and five are in continuous CR. Seven patients received DLI, with five CRs. Five patients died: one of progressive disease, two of progressive disease combined with aGVHD or cGVHD, one of extensive cGVHD, and one of infection. CONCLUSION: Fludarabine/cyclophosphamide was well tolerated and allowed consistent engraftment in lymphoma allografted patients. Response rates were high in this group of refractory and heavily pretreated patients. This dual procedure seems to be most promising in patients with end-stage malignant lymphomas.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Efecto Injerto vs Tumor/inmunología , Trasplante de Células Madre Hematopoyéticas , Enfermedad de Hodgkin/terapia , Inmunosupresores/uso terapéutico , Linfoma no Hodgkin/terapia , Vidarabina/análogos & derivados , Adulto , Carmustina/administración & dosificación , Ciclofosfamida/administración & dosificación , Ciclosporina/uso terapéutico , Citarabina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Movilización de Célula Madre Hematopoyética , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/inmunología , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/inmunología , Masculino , Melfalán/administración & dosificación , Metotrexato/uso terapéutico , Persona de Mediana Edad , Proyectos Piloto , Factores de Riesgo , Tasa de Supervivencia , Quimera por Trasplante/inmunología , Vidarabina/administración & dosificaciónRESUMEN
BACKGROUND AND OBJECTIVE: The positive results of high-dose chemotherapy followed by rescue with bone marrow progenitor cell transplantation are generally ascribed to the high dose size (DS) of the drugs given. However, a concomitant marked increase in dose intensity (DI) is always involved. With the aim of comparing the role of DS and DI in non-Hodgkin's lymphomas, a variant of Fisher's ProMACE-CytaBOM regimen was designed in which the projected cumulative drug DIs remained the same as in the original schedule but the DSs were tripled. DESIGN AND METHODS: Dosages in mg/m(2), route and days of administration were the following: cyclophosphamide 1,950 i.v. on days 1, 64; methotrexate 360 i.v. days 15, 78; vincristine 1.4 iv days 15, 78, 43, 106; etoposide 360 i.v. days 29, 92; epirubicin 120 i.v. days 29, 92; bleomycin 15 i.v. days 43, 106; cytarabine 900 i.v. days 50, 113. Thirty-six outpatients with intermediate- and high-grade non-Hodgkin's lymphomas entered the pilot study; 29 were untreated and 7 had relapse disease. Clinical stage was I in 1 patient, II in 7, III in 5 and IV in 23; 10 had B symptoms; the IPI score was 0-2 in 29 cases and > or =3 in the remaining 7. RESULTS: Of the 29 previously untreated patients, 16 achieved complete remission, 8 partial remission, 4 developed progressive disease and 1 was withdrawn early from the study because of acute viral hepatitis; subsequently 4 relapsed and 3 died (2 of disease progression, 1 of causes unrelated to the disease). In the pre-treated group 3 patients obtained complete remission, 2 partial remission and in 1 patient the disease progressed; 3 of these pre-treated patients died (1 of progressive disease, 1 of a new relapse, 1 of myocardial infarction during therapy). With a 20-month median follow-up, the 30-month overall and relapse-free survival were 0.58 and 0.70, respectively. G-CSF was administered to all but 2 patients, with median delivery throughout the whole regimen of 8, 400 microg per patient. Actual cumulative DI was 0.82+/-0.11. Grade 3-4 hematologic toxicity consisted of anemia in 3 cases, of leukopenia in 8 and of thrombocytopenia in 2; the same grade of non-hematologic toxicity involved the liver in 2 cases, the heart in 1 (the above mentioned death), the digestive mucosa in 2 and the peripheral nerves in 1 patient. INTERPRETATION AND CONCLUSIONS: The iso-DI sequential variant of the ProMACE-CytaBOM regimen can be considered feasibile, relatively non-toxic, and can be given on an out-patient basis. Limited use of G-CSF is required (about 3 vials after each drug administration). Thus, a randomized trial with the original ProMACE-CytaBOM regimen can be designed.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma no Hodgkin/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anemia/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica/toxicidad , Bleomicina/administración & dosificación , Bleomicina/toxicidad , Ciclofosfamida/administración & dosificación , Ciclofosfamida/toxicidad , Citarabina/administración & dosificación , Citarabina/toxicidad , Supervivencia sin Enfermedad , Relación Dosis-Respuesta a Droga , Doxorrubicina/administración & dosificación , Doxorrubicina/toxicidad , Etopósido/administración & dosificación , Etopósido/toxicidad , Femenino , Humanos , Italia , Linfoma no Hodgkin/complicaciones , Masculino , Metotrexato/administración & dosificación , Metotrexato/toxicidad , Persona de Mediana Edad , Proyectos Piloto , Prednisona/administración & dosificación , Prednisona/toxicidad , Recurrencia , Tasa de Supervivencia , Vincristina/administración & dosificación , Vincristina/toxicidadRESUMEN
To extend our previous findings that a low-Na/high-K salt (S) reduces BP in hospitalized patients, a multicenter study was performed. After a placebo period during which patients were informed by written instruction how to avoid only foods with a high Na content, 143 out-patients (84 males and 59 females, mean age 50.7 years, range 28-69) with DBP greater than or equal to 95 mm Hg randomly received for 4 weeks either metoprolol (M) 200 mg SR qd (67 patients), or S, 2 g bid to add to foods (76 patients). At the end of this period patients with DBP still greater than 90 mm Hg combined the two treatments for a further 4 weeks. Mean blood pressure (mm Hg), HR (bpm), 24-hrs urinary Na and K excretion were measured fortnightly. In comparison to pretreatment values MBP was significantly (P less than 0.01) reduced by both treatments, although to a greater extent in the M group already at the second week, without any further decrement thereafter. In the S group MBP decreased by 4.4 mm Hg and 27/76 patients were responders (DBP less than or equal to 90 mm Hg), while in the M group it was reduced by 9.0 mm Hg and 28/67 patients were responders. In the S group urinary Na excretion was significantly (P less than 0.01) lower than in the M group, and this difference was present until the end of period 1.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Dieta , Hipertensión/tratamiento farmacológico , Metoprolol/uso terapéutico , Potasio/administración & dosificación , Sodio en la Dieta/administración & dosificación , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Ensayos Clínicos como Asunto , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , NatriuresisRESUMEN
It has been established that angiotensin II stimulation may limit the antihypertensive potential of diuretic therapy in some patients. It is less clear, however, whether renin-angiotensin II stimulation is the cause of the flat blood pressure dose-response relationship to diuretics. To investigate this, 75 out-patients with essential hypertension were treated with chlorthalidone 12.5, 25 or 50 mg o.d. for 3 weeks, in a double-blind, placebo controlled cross-over study. Chlorthalidone significantly reduced blood pressure in all the groups, a plateau being reached at 25 mg o.d. Similarly, plasma renin activity was increased by each dose level of chlorthalidone, but it showed a different trend, being increased to a comparable extent at 12.5 mg and 25 mg o.d., and still higher at 50 mg o.d. Thus, greater stimulation of renin was coincident with the levelling of the blood pressure response to chlorthalidone. However no significant correlation was found between interindividual plasma renin activity and change in blood pressure, either in the entire series, or in each treatment subset. The data suggest overall that renin stimulation may influence the characteristic dose-hypotensive response relationship to diuretic agents in antihypertensive therapy, but it is unlikely that measurement of individual plasma renin activity will provide an useful guide to the optimal dose of a diuretic agents.
Asunto(s)
Clortalidona/uso terapéutico , Hipertensión/tratamiento farmacológico , Renina/sangre , Adulto , Aldosterona/sangre , Presión Sanguínea/efectos de los fármacos , Ensayos Clínicos como Asunto , Método Doble Ciego , Electrólitos/sangre , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipertensión/sangre , Masculino , Persona de Mediana Edad , Distribución AleatoriaRESUMEN
Circulating immune complexes have been studied with a competitive immune-enzymatic method on 9 controls, on 34 patients with lymphoproliferative disease (41.6 +/- 26.8) and in those with myeloproliferative disease (62.1 +/- 30) have been found significantly higher than in controls (20.3 +/- 14.1). The percentage of incidence of circulating immune complexes with values greater than 35 (normal value greater than 35) is found to be 58.8% in lymphoproliferative disease and 77.7% in myeloproliferative disease. Higher values of circulating immune complexes have been observed in patients with a depressed count of circulating monocytes, of lymphocytes with a dot-like alpha-naphthyl-acetate-esterase reaction and of nitroblue tetrazolium positive granulocytes, suggesting that circulating immune complexes can modulate cellular immune response as blocking factors.
Asunto(s)
Complejo Antígeno-Anticuerpo/análisis , Trastornos Linfoproliferativos/inmunología , Trastornos Mieloproliferativos/inmunología , Adolescente , Adulto , Anciano , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Enfermedad de Hodgkin/inmunología , Humanos , Hipergammaglobulinemia/inmunología , Lactante , Leucemia Linfoide/inmunología , Leucemia Mieloide/inmunología , Leucemia Mieloide Aguda/inmunología , Linfoma/inmunología , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/inmunología , Policitemia Vera/inmunología , Mielofibrosis Primaria/inmunología , Pronóstico , Macroglobulinemia de Waldenström/inmunologíaRESUMEN
The hydrocortisone test has been performed on 20 patients with lymphoproliferative disease (MH, LNH, CLL, MM, BMG) and 12 patients with solid neoplasm to study the "recirculating" lymphocytic population (mainly T lymphocytes with "helper" function). Therefore, as proposed by Fauci and Dale, we counted the basal venous blood lymphocytes in the morning after fasting and then 4 h after the administration of hydrocortisone 400 mg. While the test did not appear to be statistically modified in patients with solid neoplasms as compared to normal controls, it appears particularly compromised in lymphoproliferative diseases, but with different values in each disease. The results are discussed on the basis of lymphocytic kinetic data.