Predictors of stroke outcome in Egyptian patients following acute stroke

Stroke is a major public health problem. Certain clinical factors can predict the prognosis of functional outcome of acute stroke. Identify factors which predict the outcome of stroke Egyptian patients. Hospital-based prospective study included 220 patients with stroke. Data collection was carried out using a pretested questionnaire. The questionnaire was used to record the demographic data, clinical data, the pre hospital delay. Neurological examination with special emphasis on the muscle power was done. The patients were followed up till their time of discharge to record the length of hospital stay, and the functional outcome at time of discharge which was assessed by modified Rankin Scale [mRS]. The mean age of the studied patients was 59.8 +/- 13.2, males constituted 64.1%. Hypertension was the main co morbidity detected in 65%. The degree of weakness of the patient recorded complete paralysis in 6.8%. The median prehospital delay was 6 hours, while median the length of hospital stay was 6 days. 53.2% were independent according to mRS [good outcome] and 46.3% were dependent [bad outcome]. Forward logistic regression analysis demonstrated that motor weakness, older age, female sex and prehospital delay were the only significant predictors with prediction change in the odds equal [12.9, 7.8, 2.6,4.6 respectively]. Our data confirmed that old age, female sex, pre hospital delay, lower manual muscle strength testing score were the independent predictor of poor outcome in Egyptian stroke patients

Biweekly administration of irinotecan [CPT11] and 5-fluorouracil/folinic acid [5FU/FA] "De Gramont" as first line treatment in advanced or metastatic colorectal cancer [CRC]

The combination of CPT11, 5 fluorouracil and folinic acid "De Gramont" is now thought to be the 1st line chemotherapy for advanced or metastatic colorectal cancer. The aim of this study was to evaluate the efficacy and safety profile of the biweekly administration of CPT11 and 5FU/FA as 1[st] line treatment in patients with advanced or metastatic colorectal cancer. Patients with histologically confirmed advanced CRC, >1 measurable metastatic lesion. ECOG PS 0-1 and adequate bone marrow, renal and hepatic function were included. CPT11 [180mg/m[2] was administered on day 1 as 90 minutes infusion] and FA [200mg/m[2]] as 2 hour infusion followed by 5FU [400mg/m[2] bolus and 600mg/m[2] as 22 hours infusion] on days 1 and 2. This schedule was repeated every 2 weeks and each cycle consisted of 6 weeks for 6-9 cycles. Between October 2000 and December 2002, thirty patients were enrolled, M/F [20/10] with a median age of 48 years [40-60] and ECOG PS of 0-1. Primary tumor sites were colon [10 patients], rectum [15 patients], and colorectal [5 patients]. Tumor histology was adenocarcinoma, median number of involved sites was 2 [60% with 2 sites or more], liver [80%], lung [10%], lymph nodes [20%] and local recurrence [50%]. Previous treatment included palliative or radical surgery in 100% of cases, adjuvant chemotherapy in 12 patients [40%] and pelvic radiotherapy in 9 patients [30%]. A total of 235 cycles has been delivered with a median of 8 cycles/patient [6-9 cycles]. All patients were evaluable for toxicity, grade III toxicity was; neutropenia in 2 patients [6.6%], febrile neutropenia in one patient [3.3%] and diarrhea in one patient [3.3%]. Of the thirty patients evaluable, 3 patients [10%] achieved CR, 14 PR [46.6%] 7 SD [23.3%] and 6 patients progressed [20%] resulting in an overall response rate [ORR] of 56.6%. Median time to progression and survival was 12.5 and 21 months respectively. Median duration of response was 14.5 months. Biweekly administration of CPT11 and 5 FU/FA is an active and well tolerated regimen as first line treatment in patients with advanced or metastatic CRC with an ORR of 56.6%

Influence of tumor grade and CD95 expression on progression-free survival following surgery and irradiation for localized intracranial ependymoma

This study was conducted to evaluate the impact of extent of tumor resection, histological grade and CD95 expression on the progression-free survival [PFS] after surgical excision and irradiation [RT] for patients with localized intracranial ependymomas. This study includes thirty four patients with localized intracranial ependymomas with median age of 23.5 [range 2-65] at the time of surgical excision. All patients underwent microsurgical resection followed by RT with or without chemotherapy during the period between January 2000 and June 2003. Ten patients were histologically identified as anaplastic ependymoma [AEP]. Immunohistochemical staining for CD95 was applied as a marker for apoptosis for all specimens of the studied group. The extent of surgical resection was estimated as gross total resection in 21 patients [61.8%], near total resection in 4 patients [11.8%] and subtotal resection in 9 patients [26.5%]. The median dose of RT to the primary site was 55Gy. Only 8 patients received pre RT chemotherapy [CTh]. At a median follow up period of 24.5 months [range 6-51 months], 25 patients were alive, while, at a median follow up of 22 months [range 8-49 months], progression occurred in 15 patients [12 local and 3 local and distant], with a median time to failure after RT of 18 months [range 5-37 months]. There was a significant influence of gross total resection [p=0.003] and tumor grade [p=0.009] on the PFS after RT. The two years PFS rate was 26% +/- 13% for patients with AEP compared with 82% +/- 7% for patients with EP. When correlating these findings with the extent of surgical resection, age less than 4 years, pre-RT CTh and CD95 expression, they remained significant. AEP was more frequent in the supratentorial ependymomas. Five of 9 patients with supratentorial tumors developed recurrence and all were anaplastic type [AEP] and CD95-stained tumors. Progression-free survival was found to be significantly influenced by the extent of surgical resection. Tumor grade and apoptosis have an impact upon the outcome of patients with ependymoma treated with surgery and RT. CTh before RT had a worse effect on the PFS and overall survival.

Evaluation of different treatment modalities in dukes B and C rectal adenocarcinoma

A retrospective analysis of 291 eligible patients with carcinoma of rectum and rectosigmoid was undertaken. The patients were assigned to one of four treatment groups: Preoperative chemoradiotherapy [CRT], followed by postoperative chemotherapy [POCT], postoperative radiotherapy [PORT], postoperative chemotherapy [POCT] and postoperative CRT. The results showed that with a median follow up of 57.2 months, the 5-year overall survival was 47.8%, the 5-year DFS was 42.4%. The 5-year OS was 48.3% in the preoperative CRT group, 42.4% in PORT group, 34.3% for POCT group and 55% in the POCRT group. The 5-year DFS was 44.8%, 39.4%, 31.5% and 50% in the four treatment groups, respectively. Local failure [LF] occurred in 14.1% of the patients and distant metastasis [DM] was observed in 28.9%