RESUMO
Cerebral insults of cardiac origin are often of great functional importance. The most common cause is atrial fibrillation. Other sources of cerebral embolies, even if rare, such as cardiac tumors, must not be ignored. Many of these patients present neurologic symptoms. The diagnosis is established on ecco-cardiography. Surgical management is the treatment of choice. We discuss a young patient with multiple cerebral insults and a papillary cardiac tumor.
Assuntos
Cardiopatias/complicações , Embolia e Trombose Intracraniana/etiologia , Adulto , Ecocardiografia , Feminino , Cardiopatias/diagnóstico , Neoplasias Cardíacas/complicações , Humanos , Embolia e Trombose Intracraniana/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
In a randomized study of 92 previously untreated patients with multiple myeloma, the intention was to document the possible beneficial effect of combination chemotherapy including vincristine, carmustine, alkylating agents and prednisone, as compared to conventional therapy with melphalan and prednisone. Major prognostic factors did not differ significantly between the treatment groups. With the 2-drug therapy and 5-drug combination therapy, 48 and 54% of the patients achieved remission, respectively. Median survival for patients treated with the 2-drug regimen and 5-drug regimen was 29 and 33.5 months, respectively. No significant difference was found between the survival curves for stage III patients treated with the two regimens. After 12 months, patients who had achieved remission were randomized to have treatment discontinued or to have maintenance treatment. The numbers of relapses, remission duration and survival of the two groups were similar.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Análise Atuarial , Idoso , Ensaios Clínicos como Assunto , Seguimentos , Humanos , Mieloma Múltiplo/mortalidade , Noruega , Distribuição Aleatória , Indução de RemissãoRESUMO
67 previously untreated patients with multiple myeloma were entered on a randomized clinical trial to determine whether the use of combination chemotherapy including vincristine, carmustine, alkylating agents, and prednisone was more effective than conventional therapy with melphalan and prednisone. The treatment groups did not show significant differences with respect to major prognostic factors. With the 2-drug combination therapy and 5-drug combination therapy, 67 and 74% of the patients achieved remission, respectively. Moreover, no significant difference was found between the two treatment schedules in terms of median survival (30+ months). The survival curves for stage III patients treated with the two regimens did not differ significantly. After 12 months, patients who had achieved remission were randomized to have treatment discontinued or to have maintenance treatment. 7 of 15 patients on maintenance therapy relapsed, whereas 9 of 14 patients who had their therapy discontinued relapsed, and the survival of the two groups was similar.