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1.
Am J Clin Oncol ; 40(3): 223-227, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25350465

RESUMO

BACKGROUND: Central nervous system (CNS) hemangiopericytomas are rare mesenchymal tumors of the brain. In the absence of randomized clinical trials or large studies, the only information we have about the natural history and the management is from isolated clinical case series. They have suggested that surgery is beneficial, with conflicting results on the role of complete resection and adjuvant radiation. We have conducted a systematic review of clinical case series of CNS hemangiopericytoma analyzing the biology of the tumor and the best follow-up and management strategy. METHODS: Fifteen pertinent clinical case series on newly diagnosed CNS hemangiopericytoma were selected by a review of literature. A total of 523 patients were analyzed for age, sex, mode of recurrence and metastases, and survival after complete/incomplete resection with or without radiation. RESULTS: The mean age was found to be 44.17 (±3.59) years. The incidence was higher in male individuals younger than 45 years and in older female individuals. Complete resection and adjuvant radiation significantly improved survival in comparison with incomplete resection and no radiation, respectively (P<0.0001). Furthermore, a significant trend of the tumor to recur locally compared with extraneural and neural axis metastases was noted (P<0.0001). The mean time for distant metastases was seen to be 91.33 (±12.66) months. CONCLUSIONS: Complete resection followed by adjuvant radiation improves survival. Extraneural metastases, especially to lung, bone, and liver, are not uncommon and can occur late in the disease course for which continued follow-up is required. There is also a need to establish a systemic treatment regimen to control the distant metastases.


Assuntos
Neoplasias Abdominais/secundário , Neoplasias do Sistema Nervoso Central/radioterapia , Neoplasias do Sistema Nervoso Central/cirurgia , Hemangiopericitoma/radioterapia , Hemangiopericitoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Abdominais/diagnóstico por imagem , Adulto , Fatores Etários , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/patologia , Feminino , Hemangiopericitoma/diagnóstico por imagem , Hemangiopericitoma/secundário , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Neoplasia Residual , Radioterapia Adjuvante , Fatores Sexuais , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Clin Lymphoma Myeloma Leuk ; 15(8): 451-7, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25816933

RESUMO

Despite the improvement in overall survival in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era, the occurrence of central nervous system (CNS) relapse heralds a very poor prognosis. The evidence is conflicting on the incidence and pattern of CNS relapse in the rituximab era compared with before the rituximab era and on the role of CNS prophylaxis. We conducted a systematic analysis of the data from 7 prospective studies, studying the incidence and type of CNS relapse, the role of prophylaxis, and survival after CNS relapse, with and without rituximab-based chemotherapy. No statistically significant difference was found in the incidence of CNS relapse with the use of rituximab-based chemotherapy compared with CHOP (cyclophosphamide, doxorubicin, vincristine [Oncovin], prednisone) chemotherapy. Leptomeningeal disease was more common and the survival after CNS disease was better in the rituximab era. No difference was found in the incidence of isolated CNS relapse. Chemoprophylaxis significantly decreased the incidence of CNS recurrence. The use of rituximab has not influenced the incidence of CNS relapse compared with the use of CHOP. Chemoprophylaxis plays a significant role in high-risk patients with DLBCL in decreasing CNS recurrence. Large randomized clinical trials are warranted to differentiate between intrathecal and systemic chemoprophylaxis.


Assuntos
Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Rituximab/uso terapêutico , Idoso , Neoplasias do Sistema Nervoso Central/mortalidade , Neoplasias do Sistema Nervoso Central/patologia , Feminino , Humanos , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Rituximab/administração & dosagem , Análise de Sobrevida
3.
Nutr Cancer ; 67(2): 197-202, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25625592

RESUMO

Breast cancer, the most common female malignancy in the world, has a strong association with obesity and insulin resistance. The importance of these risk factors goes up significantly in patients already affected by this cancer as they negatively affect the prognosis, recurrence rate, and survival by various mechanisms. The literature on the role of physical activity and aerobic exercise on modifying the above risks is debatable with data both for and against it. In this article, we have reviewed the risks of obesity and insulin resistance in breast cancer patients and the controversy associated with the impact of exercise. Ultimately, we have concluded that a randomized control trial is necessary with an individualized aerobic exercise program for a minimum duration of 20 wk on breast cancer patients, who are undergoing or recently completed chemotherapy, to study its effects on insulin resistance, weight, and clinical outcome.


Assuntos
Neoplasias da Mama , Exercício Físico , Resistência à Insulina , Obesidade/complicações , Obesidade/prevenção & controle , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/etiologia , Neoplasias da Mama/metabolismo , Feminino , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Proteínas de Membrana/metabolismo , Prognóstico , Fatores de Risco , Aumento de Peso
4.
Crit Rev Oncol Hematol ; 91(3): 292-303, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24698003

RESUMO

Overall survival in diffuse large B-cell lymphoma (DLBCL) has significantly improved in the last decade, especially after the incorporation of rituximab. Involvement of the central nervous system (CNS) at presentation or at recurrence is an uncommon event, but carries a dismal prognosis with median survival of less than 6 months. Although prophylactic CNS directed therapy is a widely used approach to prevent this complication, randomized clinical trials have been very limited. CNS prophylaxis has inherent toxicities; therefore, identifying the population of patients who would receive most benefit is of utmost importance. From an extensive review of current literature, we report the incidence of CNS relapse in DLBCL and describe the role of CNS prophylaxis in the post-rituximab compared to the pre-rituximab era. We also review the current modalities of CNS prophylaxis and attempt to identify the high-risk patients who would benefit. Lastly, we present a treatment algorithm that defines the role of CNS prophylaxis in the management of patients with DLBCL.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias do Sistema Nervoso Central/prevenção & controle , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Anticorpos Monoclonais Murinos/administração & dosagem , Neoplasias do Sistema Nervoso Central/secundário , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Humanos , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/patologia , Metotrexato/administração & dosagem , Prednisona/administração & dosagem , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Rituximab , Análise de Sobrevida , Vincristina/administração & dosagem
5.
Kardiol Pol ; 71(10): 1073-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24197589

RESUMO

We describe the management of a young patient who had experienced a cocaine overdose. The patient presented with altered mental status and seizures and subsequently developed a wide complex arrhythmia with a rare alternating bundle branch block pattern. Intravenous lipid emulsion was administered following initial resuscitation and endotracheal intubation, because conservative methods of treating the persistent cardiac arrhythmias failed.


Assuntos
Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/terapia , Bloqueio de Ramo/induzido quimicamente , Cocaína/intoxicação , Overdose de Drogas/complicações , Emulsões Gordurosas Intravenosas/uso terapêutico , Adulto , Eletrocardiografia , Humanos , Infusões Intravenosas , Intubação Intratraqueal , Masculino , Ressuscitação/métodos , Convulsões/induzido quimicamente
6.
Am J Ther ; 20(6): e723-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-21822117

RESUMO

Idiopathic thrombocytopenic purpura (ITP) is characterized by premature platelet destruction in the reticuloendothelial system due to the presence of autoantibodies against the platelet membrane proteins. Patients who are resistant to the traditional treatment options that include the administration of steroids, IV immunoglobulin, and antirhesus D immunoglobulin and the performance of a splenectomy are diagnosed to have refractory chronic ITP. Management options in these patients are not well defined. Long-term steroids, rituximab, danazol, azathioprine, and cyclophosphamide have variable efficacy and at the same time carry significant side effects. We present the case of a patient treated effectively with dapsone, a drug that is much safer than other drugs and which can be used before resorting to splenectomy; we also include a review of the literature establishing its role in the management of ITP.


Assuntos
Anti-Inflamatórios/uso terapêutico , Dapsona/uso terapêutico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Anti-Inflamatórios/efeitos adversos , Dapsona/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Púrpura Trombocitopênica Idiopática/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
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