RESUMO
BACKGROUND: Two previous GINECO elderly specific studies in advanced ovarian cancer (AOC) patients highlighted the prognostic value of geriatric covariates for overall survival (OS). PATIENTS AND METHODS: This open-label prospective trial was designed to identify the impact of geriatric covariates on OS in AOC patients ≥70 years treated with first-line carboplatin. RESULTS: Geriatric covariates of the 111 patients included median age 79 years (≥80 years: 41%); performance status (PS) ≥2: 47%; ≥3 major comorbidities: 24%; ≥4 comedications: 68%; activities of daily living (ADL) score <6: 55%; instrumental activities of daily living (IADL) score <25: 69%; Hospital Anxiety and Depression Scale (HADS) >14: 37%. The median OS was 17.4 months. Overall, 74% of patients completed the six planned chemotherapy cycles. Grade 3-4 haematological toxic effects were frequent (50%) but manageable. Grade 3-4 non-haematological toxicities included fatigue (15%), anorexia (12%), infections (9%) and thrombosis (2%). A survival score = exp(0.327*GVS) was developed, where the geriatric vulnerability score (GVS) is the sum of the following (each assigned a value of one): albuminaemia <35 g/l; ADL score <6; IADL score <25; lymphopaenia <1 G/l; and HADS >14. With a cut-off ≥3, GVS discriminated two groups with significantly different OS, treatment completion, severe adverse events and unplanned hospital admissions rates. CONCLUSIONS: The GVS is a valuable tool for identifying vulnerable patients when treating an elderly AOC population.
Assuntos
Carboplatina/administração & dosagem , Avaliação Geriátrica , Neoplasias Ovarianas/tratamento farmacológico , Prognóstico , Idoso , Idoso de 80 Anos ou mais , Carboplatina/efeitos adversos , Comorbidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Ovarianas/classificação , Neoplasias Ovarianas/patologia , Estudos Prospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
INTRODUCTION: Much has been written about the short term effects of air pollution on health. In contrast, long term effects, which may be highly significant such as lung cancer, have been addressed in only a few cohort studies. STATE OF THE ART: Long term effects of air pollution on mortality have been evaluated in three American and three European prospective cohort studies. These studies consistently demonstrate associations between ambient fine particulate air pollution and elevated risks of both cardiopulmonary and lung cancer mortality. They indicate that diesel exhaust especially contributes to the human lung cancer burden. PERSPECTIVES AND CONCLUSIONS: Although long-term health effects of air pollution are of relatively small magnitude at the individual level when compared to that of tobacco smoking, their consequences are considerable in terms of public health.
Assuntos
Poluição do Ar/efeitos adversos , Neoplasias Pulmonares/epidemiologia , Humanos , Neoplasias Pulmonares/etiologia , Saúde PúblicaRESUMO
INTRODUCTION: Metastatic involvement of the peritoneum from a lung cancer is infrequently encountered. METHODS: We present the case report of a patient with bronchial adenocarcinoma whose course is complicated by the occurrence of a peritoneal carcinomatosis, as documented by FDG-PET. CONCLUSION: Unexplained abdominal pain in a lung cancer patient may be a peritoneal carcinomatosis. The diagnosis can be helped by PET-scan. However, the therapeutic opportunities are very limited.
Assuntos
Adenocarcinoma/secundário , Neoplasias Pulmonares/patologia , Neoplasias Peritoneais/secundário , Dor Abdominal/etiologia , Adenocarcinoma/complicações , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/complicaçõesRESUMO
INTRODUCTION: Passive smoking is the involuntary inhalation by a non-smoker of smoke generated in his neighbourhood by one or more smokers. BACKGROUND: The effect of this exposure is already generally recognised in children. In adults the induction of chronic obstructive lung disease has not been demonstrated. This is no longer the case for ischaemic heart disease and lung cancer where the effect of passive exposure of non-smokers to cigarette smoke is recognised. The biological plausibility together with the concordance of results obtained over successive years, as well as the large numbers of patients included in the studies, lead to a confident conclusion that the risks in adult non-smokers are increased by the order of 25%. CONCLUSIONS: There is no evidence that bias affects the conclusions reached and the World Health Organisation has recently classified passive smoking as being carcinogenic in man. As a result of these data prevention of passive exposure to cigarette smoke should be part of a larger framework of smoking prevention, especially among the young.
Assuntos
Pneumopatias/etiologia , Infarto do Miocárdio/etiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , HumanosRESUMO
Common-variable immunodeficiency (CVI) patients develop non-Hodgkin's lymphomas (NHL), mainly B-lineage diffuse large-cell lymphomas (DLCL), with a high relative risk. The molecular pathogenesis of CVI-related NHL (CVI-NHL) is unknown. Here we aimed at providing a detailed molecular characterization of CVI-NHL. Rearrangements of BCL-6 were detected in two thirds of CVI-NHL cases examined. All 3 CVI-NHL also harbored point mutations of the BCL-6 5' noncoding regions, which constitute a marker of B-cell transit through the germinal center (GC). The number and molecular pattern of BCL-6 mutations in CVI-NHL were similar to that detected in DLCL of immunocompetent hosts and in DLCL arising in other immunodeficiency settings. Microsatellite instability occurred in one CVI-NHL devoid of a BCL-6 rearrangement. All CVI-NHL scored negative for genetic lesions of BCL-2, p53, c-MYC, REL as well as for viral infection by EBV and HHV-8. Overall, these data indicate that: similarly to other immunodeficiency-related NHL, involvement of BCL6 occurs frequently also in CVI-NHL; and because BCL-6 mutations are acquired by B cells during GC transit, their occurrence in CVI-NHL suggest that these lymphomas are histogenetically related to GC B cells.
Assuntos
Imunodeficiência de Variável Comum/complicações , Proteínas de Ligação a DNA/genética , Linfoma não Hodgkin/genética , Linfoma não Hodgkin/patologia , Mutação , Proteínas Proto-Oncogênicas/genética , Fatores de Transcrição/genética , Adulto , Rearranjo Gênico , Humanos , Linfoma não Hodgkin/complicações , Masculino , Repetições de Microssatélites , Reação em Cadeia da Polimerase , Proteínas Proto-Oncogênicas c-bcl-6RESUMO
AIDS-related non-Hodgkin's lymphomas (AIDS-NHL) are classified into Burkitt's lymphoma, diffuse large cell lymphoma (DLCL), and body cavity based lymphoma. The molecular pathogenesis of AIDS-NHL is complex and involves the genetic alteration of several cancer related genes, including the BCL-6 proto-oncogene. BCL-6 encodes a zinc finger transcription factor which is selectively expressed by germinal center (GC) B-cells, but not by pre-GC or post-GC B-cells. Genetic alterations of BCL-6 occur frequently among B-cell NHL and comprise gross rearrangements as well as small mutations of the 5' noncoding region of the gene. Gross rearrangements of BCL-6 among AIDS-NHL cluster with 20% AIDS-DLCL. Conversely, mutations of the 5' noncoding region of BCL-6 occur at sustained frequency throughout the clinico-pathologic spectrum of AIDS-NHL and represent the most common genetic alteration presently detectable in these lymphomas. The frequency of BCL-6 mutations, as well as their location in the proximity of the BCL-6 regulatory regions, suggest that they may play a pathogenetic role in AIDS-related lymphomagenesis. Beside their pathogenetic implications, the occurrence of BCL-6 mutations among AIDS-NHL bears histogenetic relevance because BCL-6 mutations are regarded as a marker of B-cell transition through the GC. Thus, it is conceivable that a large fraction of AIDS-NHL is histogenetically related to GC or post-GC B-cells. This notion is further confirmed by the observation that AIDS-NHL frequently express the BCL-6 protein, which stains selectively GC B-cells throughout B-cell differentiation.
Assuntos
Linfoma Relacionado a AIDS/genética , Proto-Oncogenes , Rearranjo Gênico , Humanos , Mutação , Proto-Oncogene Mas , Fatores de Transcrição/genética , Dedos de ZincoAssuntos
Anticorpos Monoclonais/efeitos adversos , Antineoplásicos/efeitos adversos , Hemorragia/etiologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Trombocitopenia/etiologia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Murinos , Antineoplásicos/administração & dosagem , Feminino , Humanos , Infusões Intravenosas , Leucemia Linfocítica Crônica de Células B/complicações , Leucemia Linfocítica Crônica de Células B/patologia , Infiltração Leucêmica , Pessoa de Meia-Idade , Rituximab , EsplenomegaliaRESUMO
Protection at work should be intended as the whole measures which tend to study and improve the relationship between the individual and the work environment. A satisfactory work is important fos psychic health: it gives gratifications and may induce sense of personal fulfillment. The application of preventive safety rules can only reduce or limit, but never annul, the occurrence of dangerous events even if all the work safety rules are strictly enforced and observed. Stress factors in working environment are listed in the text. For tumours it is often necessary to apply to more or less consolidate, though sometimes debatable, presumptive criteria in the identification of casual relation. The identification of the connection with work implies the necessity to consider causal relations between work factors and diseases. Nature, modality of work and work conditions in which the worker acts: risk connected to the above mentioned conditions and probability for detrimental events to occur. Influence of environmental characteristics on the risk of occurrence of tumours and the problem of the relations between tumour and subject are discussed. Direct invasiveness of neoplastic tissue is related to alterations of the immunologic control and functional remote alterations caused by the tumour itself. Tumour illness is a general phenomenon, conditioned by tissue specific and immunological modifications. Relation between cranial traumas and tumour needs all the elements collected during the study of the case reported to be evaluated. Exploitation of every single element must be evaluated with a supple mind. There is need for rules which more rigorously regulate and control the hazards in the work environment.
Assuntos
Doenças Profissionais/prevenção & controle , Tecnologia , Humanos , Neoplasias/etiologia , Neoplasias/prevenção & controle , Doenças Profissionais/etiologia , Segurança , Tecnologia/métodos , Tecnologia/normasRESUMO
Twenty-seven lymphomas of mucosa-associated lymphoid tissue (MALT) derived from distinct anatomical sites were tested for the presence of genetic lesions commonly involved in B-cell lymphomagenesis, including activation of proto-oncogenes (BCL-1, BCL-2, BCL-6, and c-MYC), disruption of tumor suppressor loci (p53, 6q), and infection by viruses [Epstein-Barr virus (EBV), and Kaposi's sarcoma-herpesvirus/human herpesvirus-8 (KSHV/HHV-8)]. Sixteen low-grade and 11 high-grade MALT-lymphomas were included in the study. The presence of genetic lesions was tested by a combination of molecular approaches, including Southern blot hybridization, polymerase chain reaction (PCR), and PCR-single strand conformation polymorphism followed by DNA direct sequencing. Alterations of BCL-1, BCL-2, or c-MYC, as well as infection by KSHV/HHV-8, scored negative in all MALT-lymphomas analysed. Conversely, rearrangements of BCL-6 and mutations of p53 clustered with a fraction of high-grade MALT-lymphomas. Deletions of 6q occurred in selected cases of both low- and high-grade MALT-lymphomas, whereas a monoclonal infection by EBV was restricted to one single patient. These data corroborate the notion that the molecular pathogenesis of MALT-lymphomas differs substantially from that of nodal B-cell lymphomas. Occasionally, however, a proportion of high-grade MALT-lymphomas may harbor selected genetic lesions among the ones commonly involved in nodal B-cell lymphomagenesis.