RESUMO
INTRODUCTION: Management of elderly patients with cancer has become a global issue. We investigated the safety and tolerability of lenvatinib in hepatocellular carcinoma (HCC) patients ≥80 years old. METHODS: We retrospectively evaluated 61 HCC patients and divided them into 2 groups: an elderly group (n = 13, ≥80 years old) and a younger group (n = 48, <80 years old). We compared the adverse events (AEs), administration period, dose intensity, objective response, and progression-free survival (PFS) between the two groups. RESULTS: The discontinuation of lenvatinib due to AEs was more frequent in the elderly group (8/13, 61.5%) than in the younger group (10/48, 20.8%) (P = 0.0043). Fatigue and appetite loss accounted for half of the cases discontinued due to AEs in the elderly group. The elderly group had a significantly lower 8-week-delivered dose intensity/body surface area ratio (147.2) and 8-week-relative dose intensity (50.0%) than those in the younger group (267.4, 67%) (P = 0.003, 0.029). The objective response rate was significantly lower in the elderly group (15.4%) than in the younger group (61.5%) (P = 0.021). The PFS in the elderly group tended to be shorter than that in the younger group (P = 0.058, hazard ratio [HR] 1.98). The modified albumin-bilirubin (mALBI) grade (hepatic function) (HR, 2.60; P = 0.01) and objective response (HR, 0.41; P = 0.011) were independently associated with the PFS in the multivariate analysis. CONCLUSION: The management of AEs is crucial for adherence and maintaining the dose intensity of lenvatinib in elderly HCC patients.
Assuntos
Antineoplásicos , Carcinoma Hepatocelular , Neoplasias Hepáticas , Quinolinas , Humanos , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Estudos Retrospectivos , Antineoplásicos/efeitos adversos , Compostos de Fenilureia/efeitos adversos , Quinolinas/efeitos adversosRESUMO
BACKGROUND/AIM: We aimed to investigate the association between The Geriatric Nutritional Risk Index (GNRI) and the tolerability of lenvatinib in patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS: We retrospectively evaluated 61 HCC patients treated with lenvatinib and compared those with low GNRI (≤98, n=26) to those with high GNRI (>98, n=35). RESULTS: The discontinuation of lenvatinib due to adverse events was more frequent in the low GNRI group (46.2%) than in the high GNRI group (17.1%) (p=0.014). Multivariate analysis revealed that low GNRI (p=0.014), hypothyroidism (model 1 p=0.021, model 2 p=0.013), and advanced age (p=0.026) were independently associated with the discontinuation of lenvatinib. The progression-free survival in the low GNRI group was significantly shorter than that in the high GNRI group (p=0.047). CONCLUSION: The GNRI might be independently associated with the tolerability of lenvatinib in patients with HCC.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Idoso , Carcinoma Hepatocelular/tratamento farmacológico , Avaliação Geriátrica , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Avaliação Nutricional , Estado Nutricional , Compostos de Fenilureia , Prognóstico , Quinolinas , Estudos Retrospectivos , Fatores de RiscoRESUMO
We report the first use of endoscopic submucosal dissection (ESD) for the treatment of a patient with adenoid cystic carcinoma of the esophagus (EACC). An 82-year-old woman visited our hospital for evaluation of an esophageal submucosal tumor. Endoscopic examination showed a submucosal tumor in the middle third of the esophagus. The lesion partially stained with Lugol's solution, and narrow band imaging with magnification showed intrapapillary capillary loops with mild dilatation and a divergence of caliber in the center of the lesion. Endoscopic ultrasound imaging revealed a solid 8 mm × 4.2 mm tumor, primarily involving the second and third layers of the esophagus. A preoperative biopsy was non-diagnostic. ESD was performed to resect the lesion, an 8 mm submucosal tumor. Immunohistologically, tumor cells differentiating into ductal epithelium and myoepithelium were observed, and the tissue type was adenoid cystic carcinoma. There was no evidence of esophageal wall, vertical stump or horizontal margin invasion with pT1b-SM2 staining (1800 µm from the muscularis mucosa). Further studies are needed to assess the use of ESD for the treatment of patients with EACC.
Assuntos
Carcinoma Adenoide Cístico/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Esofágicas/cirurgia , Esofagoscopia/métodos , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Adenoide Cístico/diagnóstico , Carcinoma Adenoide Cístico/patologia , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Endossonografia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Esôfago/cirurgia , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Mucosa/patologia , Mucosa/cirurgia , Imagem de Banda Estreita , Resultado do TratamentoRESUMO
We are reporting a rare case of acute liver injury that developed after an internal hemorrhoid treatment with the aluminum potassium sulfate and tannic acid (ALTA) regimen. A 41-year-old man developed a fever and liver injury after undergoing internal hemorrhoid treatment with a submucosal injection of ALTA with lidocaine. The acute liver injury was classified clinically as hepatocellular and pathologically as cholestastic. We could not classify the mechanism of injury. High eosinophil and immunoglobulin E levels characterized the injury, and a drug lymphocyte stimulation test was negative on postoperative day 25. Fluid replacement for two weeks after hospitalization improved the liver injury. ALTA therapy involves injecting chemicals into the submucosa, from the rectum to the anus, and this is the first description of a case that developed a severe liver disorder after this treatment; hence, an analysis of future cases as they accumulate is desirable.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Hemorroidas/terapia , Injeções Intralesionais/efeitos adversos , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Adulto , Compostos de Alúmen/administração & dosagem , Compostos de Alúmen/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/sangue , Febre/sangue , Febre/etiologia , Humanos , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Fígado/efeitos dos fármacos , Testes de Função Hepática , Masculino , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Taninos/administração & dosagem , Taninos/efeitos adversosRESUMO
A 76-year-old woman was referred to our hospital with anorexia. Computed tomography revealed a tumor lesion measuring 110mm in the liver at S4/5 with calcification and swelling of a paraaortic lymph node. The gallbladder was not visualized. Histological examination of a biopsy specimen from the liver tumor revealed squamous cell and undifferentiated carcinomas, and several tumor markers were elevated. Therefore, we diagnosed the patient with gallbladder adenosquamous cell carcinoma T3N2M0 stage III. Because the serum parathyroid hormone-related protein (PTHrP) and granulocyte-colony stimulating factor (G-CSF) levels were significantly elevated, we suspected that PTHrP and G-CSF production occurred because of adenosquamous cell carcinoma in the gallbladder. We initiated chemotherapy with S-1.
Assuntos
Carcinoma Adenoescamoso/química , Neoplasias da Vesícula Biliar/química , Neoplasias da Vesícula Biliar/patologia , Fator Estimulador de Colônias de Granulócitos/sangue , Proteína Relacionada ao Hormônio Paratireóideo/sangue , Idoso , Biópsia , Carcinoma Adenoescamoso/diagnóstico por imagem , Evolução Fatal , Feminino , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Fator Estimulador de Colônias de Granulócitos/biossíntese , Humanos , Proteína Relacionada ao Hormônio Paratireóideo/biossínteseRESUMO
A 60-year-old man was admitted to our hospital complaining of fever, headache and vertigo. Neurological examination on admission showed mild ataxic gait. Brain magnetic resonance imaging showed linear high intensity in the left parietal lobe on diffusion-weighted imaging (DWI) and laboratory data revealed elevated serum lactate dehydrogenase and soluble interleukin-2 receptor. Although intravascular lymphoma was suspected from these findings, bone marrow and skin biopsies were negative. Two months later, he presented with sensory disturbance of the left upper limb, and new lesions in the right frontal and bilateral parietal lobes were detected on DWI. A systemic evaluation showed multiple low-density lesions in the bilateral kidneys on computed tomography. Based on the results of a renal biopsy, we made a histological diagnosis of intravascular large B-cell lymphoma (IVLBCL). As IVLBCL is quite rare and often has a poor prognosis, a systemic evaluation to determine the proper biopsy site is needed for early diagnosis.
Assuntos
Biópsia , Rim/patologia , Linfoma de Células B/diagnóstico , Linfoma de Células B/patologia , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/patologia , Anticorpos Monoclonais Murinos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores/sangue , Ciclofosfamida/administração & dosagem , Imagem de Difusão por Ressonância Magnética , Doxorrubicina/administração & dosagem , Transtornos Neurológicos da Marcha/etiologia , Cefaleia/etiologia , Transplante de Células-Tronco Hematopoéticas , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/terapia , Masculino , Pessoa de Meia-Idade , Lobo Parietal/patologia , Prednisolona/administração & dosagem , Receptores de Interleucina-2/sangue , Indução de Remissão , Rituximab , Transtornos de Sensação/etiologia , Neoplasias Vasculares/complicações , Neoplasias Vasculares/terapia , Vertigem/etiologia , Vincristina/administração & dosagemAssuntos
Hemangioma/patologia , Infarto/patologia , Diagnóstico Diferencial , Feminino , Hemangioma/complicações , Hemangioma/diagnóstico , Hemangioma/terapia , Humanos , Infarto/complicações , Infarto/diagnóstico , Infarto/terapia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Brain hypoxia or ischemia causes acidosis and the intracellular accumulation of Ca(2+) in neuron. The aims of the present study were to elucidate the interaction between intracellular pH and Ca(2+) during transient acidosis and its effects on the viability of neuronal and glial cells. Intracellular Ca(2+) and pH were measured using the fluorescence of fura-2 and 2',7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein acetoxymethyl ester in neuroblastoma (IMR-32), glioblastoma (T98G), and astrocytoma (CCF-STTG1) cell lines. The administration of 5 mM propionate caused intracellular acidification in IMR-32 and T98G cells but not in CCF-STTG1 cells. After the removal of propionate, the intracellular pH recovered to the resting level. The intracellular Ca(2+) transiently increased upon the removal of propionate in IMR-32 and T98G cells but not in CCF-STTG1 cells. The transient Ca(2+) increase caused by the withdrawal of intracellular acidification was abolished by the removal of external Ca(2+), diminished by a reduction of external Na(+), and inhibited by benzamil. Transient acidosis caused cell death, whereas the cells were more viable in the absence of external Ca(2+). Benzamil alleviated cell death caused by transient acidosis in IMR-32 and T98G cells but not in CCF-STTG1 cells. These results suggest that recovery from intracellular acidosis causes a transient increase in cytosolic Ca(2+) due to reversal of Ca(2+) transport via Na(+)/Ca(2+) exchanger coactivated with Na(+)/H(+) exchanger, which can cause cell death.
Assuntos
Acidose/metabolismo , Sinalização do Cálcio/fisiologia , Cálcio/metabolismo , Hipóxia-Isquemia Encefálica/metabolismo , Degeneração Neural/metabolismo , Trocador de Sódio e Cálcio/metabolismo , Acidose/etiologia , Acidose/fisiopatologia , Amilorida/análogos & derivados , Amilorida/farmacologia , Morte Celular/efeitos dos fármacos , Morte Celular/fisiologia , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/fisiologia , Citosol/metabolismo , Líquido Extracelular/metabolismo , Corantes Fluorescentes , Humanos , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Hipóxia-Isquemia Encefálica/fisiopatologia , Degeneração Neural/etiologia , Degeneração Neural/fisiopatologia , Neuroglia/metabolismo , Neurônios/metabolismo , Propionatos/farmacologia , Sódio/metabolismoRESUMO
BACKGROUND AND PURPOSE: Lymphotoxin alpha (LTA), one of the tumor necrosis factor family proteins, is an important proinflammatory cytokine and appears to play a putative role in the inflammatory process of atherosclerosis. Recent genetic studies have suggested that variations in the gene encoding LTA, which affect its expression and biological function, may contribute to the development of vascular diseases. We conducted a case-control study to clarify the association of LTA gene polymorphisms with ischemic stroke in a large Japanese population. METHODS: Genotyping for LTA A252G and C804A polymorphisms was achieved by a rapid-cycle polymerase chain reaction and melting curve analysis using fluorescent probes in 1,044 incident cases of ischemic stroke recruited from the Fukuoka Stroke Registry and 1,044 age- and sex-matched control subjects recruited from the Hisayama Study. RESULTS: The overall distribution of allele and genotype for each polymorphism was similar between stroke patients and control subjects. The allele frequencies of 252G and 804A were slightly lower in stroke patients than in control subjects; however, conditional logistic regression analysis adjusted for potential risk factors found no association between the risk of ischemic stroke and either polymorphism. In terms of stroke subtype, we also found no association of these polymorphisms with any subtypes of ischemic stroke. CONCLUSIONS: Neither the A252G nor C804A polymorphism of the LTA gene was associated with stroke overall and any subtypes of ischemic stroke in the Japanese population.
Assuntos
Povo Asiático/genética , Isquemia Encefálica/genética , Linfotoxina-alfa/genética , Polimorfismo Genético/genética , Acidente Vascular Cerebral/genética , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/etnologia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Frequência do Gene , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Acidente Vascular Cerebral/etnologiaRESUMO
An unruptured intracranial aneurysm is an uncommon but possible embolic source to the brain. We report a young patient who developed recurrent ischemic strokes occurring mainly in the left internal carotid arterial territory within a short interval; the first stroke occurred midway through a long-distance race, and the second stroke occurred immediately following a bowel movement. The angiographical contrast deficit indicated a thrombus in the left anterior cerebral artery as a result of the embolism. A saccular aneurysm of the left distal internal carotid artery was the only detectable potential embolic source. Initially anticoagulant therapy was given, and then surgical clipping of the aneurysm was performed. The patient has been free from stroke recurrence. As a cause of ischemic stroke in young adults, a carotid saccular aneurysm should be considered. Hard exercise and a Valsalva maneuver may be important triggers of thrombus detachment from the aneurysm.
Assuntos
Doenças das Artérias Carótidas/complicações , Aneurisma Intracraniano/complicações , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/etiologia , Doenças das Artérias Carótidas/tratamento farmacológico , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Externa/patologia , Angiografia Cerebral , Fibrinolíticos/uso terapêutico , Humanos , Infarto da Artéria Cerebral Anterior/patologia , Aneurisma Intracraniano/tratamento farmacológico , Aneurisma Intracraniano/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Recidiva , Tálamo/patologia , Procedimentos Cirúrgicos VascularesRESUMO
A 76-year-old diabetic woman received epidural catheterization for sigmoid colectomy. Four months later she started to complain of fever and severe lumbago, and finally fell into coma and tetraplegia. She had severe neck stiffness, and lumbar puncture yielded yellowish pus. Methicilin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus and blood as a causative organism. Magnetic resonance imaging showed extensive abscess in the posterior epidural space at the level between Th1 and L5. We diagnosed her disease as iatrogenic spinal epidural abscess due to epidural catheterization. After emergent laminectomy and evacuation of abscess, inflammation was gradually improved. She returned to normal except for slight gait disturbance. Spinal epidural abscess often develops rapidly after Staphyloccocus aureus infection. In our case, however, neurological deficits appeared 144 days after insertion of epidural catheter. We must remember that spinal epidural abscess is an important cause of lumbago with high fever, even several months after surgical or catheterial intervention to the spine, for immunocompromised patients with diabetes or neoplasm.