RESUMEN
OBJECTIVES: Seasickness corresponds to all of the clinical symptoms experienced by a subject at sea related to boat movements. The objective of this study was to evaluate the efficacy of optokinetic training versus placebo in the treatment of seasickness. MATERIAL AND METHODS: Fifteen subjects were randomized to either an optokinetic training arm or a placebo arm. The impact of seasickness was evaluated for each subject before and after optokinetic training using the Graybiel scale. RESULTS: Among the trained subjects, 71.4% were improved by optokinetic training versus 12.5% of control subjects. A significant difference was observed for Graybiel scores before and after optokinetic training in the training arm. CONCLUSION: Optokinetic training appears to be an effective modality for the management of disabling seasickness. This training can be further improved by more global patient management.
Asunto(s)
Mareo por Movimiento/terapia , Nistagmo Optoquinético , Adulto , Electronistagmografía , Femenino , Humanos , Cinestesia , Masculino , Personal Militar , Mareo por Movimiento/fisiopatología , Orientación , Estimulación Luminosa , Equilibrio Postural , Propiocepción , Método Simple Ciego , Grabación en VideoRESUMEN
We studied clinical outcome and clinico-virological factors associated with hepatitis B virus reactivation (HBV-R) following cancer treatment in hepatitis B virus surface antigen (HBsAg)-negative/anti-hepatitis B core antibodies (anti-HBcAb)-positive patients. Between 11/2003 and 12/2005, HBV-R occurred in 7/84 HBsAg-negative/anti-HBcAb-positive patients treated for haematological or solid cancer. Virological factors including HBV genotype, core promoter, precore, and HBsAg genotypic and amino acid (aa) patterns were studied. Patients presenting with reactivation were men, had an hepatitis B virus surface antibody (HBsAb) titre <100 IU/L and underwent >1 line of chemotherapy (CT) significantly more frequently than controls. All were treated for haematological cancer, 3/7 received haematopoietic stem cell transplantation (HSCT), and 4/7 received rituximab. Using multivariate analysis, receiving >1 line of CT was an independent risk factor for HBV-R. Fatal outcome occurred in 3/7 patients (despite lamivudine therapy in two), whereas 2/4 survivors had an HBsAg seroconversion. HBV-R involved non-A HBV genotypes and core promoter and/or precore HBV mutants in all cases. Mutations known to impair HBsAg antigenicity were detected in HBV DNA from all seven patients. HBV DNA could be retrospectively detected in two patients prior cancer treatment and despite HBsAg negativity. HBV-R is a concern in HBsAg-negative/anti-HBcAb-positive patients undergoing cancer therapy, especially in males presenting with haematological cancer, a low anti-HBsAb titre and more than one chemotherapeutic agent. HBV DNA testing is mandatory to improve diagnosis and management of HBV-R in these patients. The role of specific therapies such as rituximab or HSCT as well as of HBV aa variability deserves further studies.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Hepatitis B/epidemiología , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Trasplante de Células Madre/efectos adversos , Activación Viral , Anciano , Anticuerpos Monoclonales de Origen Murino/efectos adversos , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , ADN Viral/genética , Femenino , Genotipo , Hepatitis B/mortalidad , Anticuerpos contra la Hepatitis B/sangre , Antígenos del Núcleo de la Hepatitis B/genética , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/genética , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Regiones Promotoras Genéticas , Rituximab , Resultado del TratamientoRESUMEN
BACKGROUND: The aim of this study was to identify factors predictive of a complete endoscopic/histopathological response to chemoradiotherapy in patients with esophageal cancer. PATIENTS: Clinical and histopathological factors (Ki67, p53 and EGFR expression) were studied in 56 patients presenting with esophageal cancer between September 2000 and March 2006 (35 squamous cell carcinomas, 20 adenocarcinomas, one undifferentiated carcinoma). The response to chemoradiotherapy was evaluated endoscopically and by histological examination in 16 patients who underwent surgical resection. RESULTS: Independent factors predictive of a complete endoscopic response were good performance status (RR=15.75; CI: 1.74-142.58; P=0.01) and overexpression of Ki67 (RR=4.46; CI: 1.08-18.31; P=0.04). In patients who underwent surgery, a major histopathological response was associated with complete endoscopic response (P<0.01), complete CT-scan response (P=0.04) and good performance status (WHO=0) (P=0.04). The mean survival was 40 months. Adenocarcinoma histology (RR=3.18, CI: 1.13-8.54; P=0.02) and an impaired performance status (RR=4.79; CI: 1.07-21.41; P=0.04) were independently associated with poor survival. CONCLUSION: In the present study, good performance status and overexpression of Ki67 were two independent factors for complete endoscopic response after chemoradiotherapy for esophageal cancer. Independent risk factors for poor survival were adenocarcinoma histological type and impaired performance status. Further prospective studies are necessary to complete the present results.
