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1.
Breast ; 25: 69-74, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26614548

RESUMEN

BACKGROUND: Serum levels of 25-OH vitamin D3 (vitamin D) have been shown to be prognostic for disease-free survival in patients with breast cancer. We investigated the predictive value of these levels for pathological response after neoadjuvant chemotherapy in patients with breast cancer taking part in the NEOZOTAC phase-III trial. Additionally, the effect of chemotherapy on vitamin D levels was studied. MATERIALS AND METHODS: Serum vitamin D was measured at baseline and before the last cycle of chemotherapy. The relationship between these measurements and clinical outcome, as defined by pathological complete response in breast and lymph nodes (pCR) was examined. RESULTS: Baseline and end of treatment vitamin D data were available in 169 and 91 patients, respectively. Median baseline vitamin D values were 58.0 nmol/L. In patients treated with chemotherapy only, serum vitamin D levels decreased during neoadjuvant chemotherapy (median decrease of 16 nmol/L, P = 0.003). The prevalence of vitamin D levels < 50 nmol/L increased from 38.3% at baseline to 55.9% after chemotherapy. In the total population, baseline and end of therapy vitamin D levels were not related to pathological response. No associations were found between pCR and vitamin D level changes. CONCLUSION: The significant decrease in vitamin D post-neoadjuvant chemotherapy suggests that vitamin D levels should be monitored and in case of decrease of vitamin D levels, correction may be beneficial for skeletal health and possibly breast cancer outcome.


Asunto(s)
Neoplasias de la Mama/sangre , Neoplasias de la Mama/patología , Calcifediol/sangre , Ganglios Linfáticos/patología , Terapia Neoadyuvante/efectos adversos , Adulto , Anciano , Biomarcadores Farmacológicos/sangre , Neoplasias de la Mama/tratamiento farmacológico , Quimioterapia Adyuvante/efectos adversos , Supervivencia sin Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Pronóstico , Resultado del Tratamiento
2.
J Thromb Haemost ; 12(7): 1116-20, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24819040

RESUMEN

INTRODUCTION: Treatment of acute venous thromboembolism (VTE) in cancer patients is challenging, owing to a high risk of recurrent VTE and bleeding complications. The anticoagulants of choice are low molecular weight heparins (LMWHs), because of a proven higher efficacy than vitamin K antagonists (VKAs) and a similar bleeding profile. The recently introduced new oral anticoagulants (NOACs) have the potential to be alternative options for these patients, as these drugs share practical advantages with LMWH, are administered orally, and had similar efficacy to VKAs but a lower bleeding risk in phase 3 studies in the general VTE population. METHODS: A systematic literature search was performed to identify phase 3 trials investigating NOACs for the treatment of VTE. The efficacy outcome was recurrent VTE, and the safety outcome was major and clinically relevant non-major bleeding. Pooled incidence rates and risk ratios (RRs) were calculated for cancer patients and non-cancer patients separately. RESULTS AND DISCUSSION: Five studies were included, with 19 060 patients, of whom 973 (5.1%) had active cancer. The pooled incidence rates of recurrent VTE were 4.1% (95% confidence interval [CI] 2.6-6.0) in cancer patients treated with NOACs, and 6.1% (95% CI 4.1-8.5) in patients treated with VKAs (RR 0.66, 95% CI 0.38-1.2). The pooled incidence rates of major or non-major clinically relevant bleeding were 15% (95% CI 12-18) in cancer patients treated with NOACs, and 16% (95% CI 9.9-22) in patients treated with VKAs (RR 0.94, 95% CI 0.70-1.3). These results form a solid basis for the initiation of a head-to-head comparison of NOACs with LMWH in cancer patients.


Asunto(s)
Anticoagulantes/uso terapéutico , Neoplasias/complicaciones , Trombosis de la Vena/complicaciones , Trombosis de la Vena/tratamiento farmacológico , Enfermedad Aguda , Administración Oral , Hemorragia , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Morfolinas/uso terapéutico , Neoplasias/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Riesgo , Rivaroxabán , Tiofenos/uso terapéutico , Resultado del Tratamiento
3.
Ned Tijdschr Geneeskd ; 148(22): 1086-91, 2004 May 29.
Artículo en Holandés | MEDLINE | ID: mdl-15198061

RESUMEN

Nutritional therapy in the intensive care unit exerts favourable effects on morbidity and mortality. Enteral nutrition is preferable to parenteral nutrition. Only perforation or total obstruction of the gastrointestinal tract, proven mesenteric ischaemia and toxic megacolon are absolute contra-indications to enteral nutrition. Early enteral nutrition is effective in decreasing infectious complications and reducing the length of stay in the hospital. Nutrition that is enriched with specific ingredients in order to modulate the immune response is referred to as immunonutrition. The use of immunonutrition, notably in surgical intensive care patients, has a favourable effect on the incidence of infectious complications, the duration of artificial respiration and the length of hospital stay. The addition of glutamine to parenteral nutrition may reduce mortality compared to standard parenteral nutrition. Implementation of a simple feeding algorithm in the intensive care unit, with special attention for the treatment of delayed gastric emptying, is cost-effective and leads to an improvement in the nutritional parameters.


Asunto(s)
Cuidados Críticos/métodos , Nutrición Enteral , Adyuvantes Inmunológicos/uso terapéutico , Glutamina/uso terapéutico , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación
4.
Int J Hyperthermia ; 19(4): 402-13, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12850926

RESUMEN

INTRODUCTION: The aim of this prospective study was to describe quality of life (QoL) in patients with locally advanced prostate carcinoma treated with conventional radiotherapy and to evaluate the influence of adding regional or interstitial hyperthermia. MATERIALS AND METHODS: All patients were irradiated using a CT-planned conventional three field technique, administering 70 Gy to prostate and vesicles. In two different phase I studies, hyperthermia was added to the radiotherapy. Twelve patients were treated with one interstitial hyperthermia treatment, lasting 60 min. Fourteen patients have been treated with five regional hyperthermia treatments, lasting 75 min each. In both hyperthermia studies, the body, bladder and rectum temperatures remained below safety limits. Patients treated with radiotherapy alone (n = 58) or combined with regional (n = 8) or interstitial hyperthermia (n = 12) completed the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (C30 + 3), the EORTC prostate cancer module (PR25) and the Rand 36 health survey before treatment and 1 and 6 months after completion of treatment. Analysis of Variance (ANOVA) for repeated measurements has been performed to describe the data. RESULTS: All patient groups were comparable concerning patient characteristics. No significant interaction or difference in QoL has been noticed between the two hyperthermia patient groups and the patient group without hyperthermia. Therefore, all groups were analysed together (n = 78) to detect QoL changes in time. A deterioration of QoL has been measured from baseline to 1 month after treatment. Fatigue, pain, urinary symptoms, bowel symptoms and financial difficulties increased significantly. Social, physical and role functioning worsened significantly. No differences in QoL were measured 6 months after treatment compared to the baseline measurement, except for a decrease in sexual activity. CONCLUSIONS: After radiotherapy with or without hyperthermia only a temporary deterioration of QoL occurs, concerning social, psychological and disease related symptoms. Additional hyperthermia does not seem to decrease QoL.


Asunto(s)
Hipertermia Inducida , Neoplasias de la Próstata/fisiopatología , Neoplasias de la Próstata/terapia , Calidad de Vida , Radioterapia , Anciano , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/psicología , Encuestas y Cuestionarios
5.
Ned Tijdschr Geneeskd ; 145(6): 249-51, 2001 Feb 10.
Artículo en Holandés | MEDLINE | ID: mdl-11236369

RESUMEN

Three men, aged 36, 16 and 66 years, had suffered for several years from muscular weakness; after a low serum potassium level had been established, supplementary examination revealed hypokalaemic periodic paralysis. A woman aged 25 had suffered since youth from muscular stiffness on sudden movements; she suffered from hereditary myotonia of the recessive type (Becker's disease). Both rare skeletal muscle ion channel diseases are characterized by the fact that the variable clinical expression complicates making the diagnosis. Since the causal mutations are known, genetic analysis is an essential step in confirming the diagnosis. Additional EMG procedures may be of diagnostic value, even in cases that cannot be clarified genetically.


Asunto(s)
Parálisis Periódica Hipopotasémica/diagnóstico , Rigidez Muscular/metabolismo , Debilidad Muscular/metabolismo , Músculo Esquelético/metabolismo , Miotonía Congénita/diagnóstico , Mutación Puntual , Canales de Potasio/genética , Potasio/metabolismo , Adolescente , Adulto , Anciano , Cromosomas Humanos Par 1/genética , Análisis Mutacional de ADN , Diagnóstico Diferencial , Electromiografía , Femenino , Humanos , Parálisis Periódica Hipopotasémica/genética , Parálisis Periódica Hipopotasémica/fisiopatología , Masculino , Rigidez Muscular/genética , Debilidad Muscular/genética , Miotonía Congénita/genética , Miotonía Congénita/fisiopatología , Mutación Puntual/genética , Potasio/sangre , Potasio/uso terapéutico
6.
Ned Tijdschr Geneeskd ; 137(17): 864-7, 1993 Apr 24.
Artículo en Holandés | MEDLINE | ID: mdl-8487900

RESUMEN

OBJECTIVE: To describe the complications in patients with acute carbon monoxide intoxication, if treated with 100% instead of hyperbaric oxygen. DESIGN: Retrospective chart review. PATIENTS: Thirty-three patients with acute-carbon monoxide intoxication admitted to the medical Intensive Care Unit of Leiden University Hospital. RESULTS: The mean carbon monoxide level of all patients was 29.4%. Ten patients had a carbon monoxide level above 40%. Seven patients (21%) were in coma on admission. Most complications occurred in the latter group. All patients were treated with normobaric 100% oxygen. Recovery was usually rapid. No patient showed neurological deficits at discharge. CONCLUSION: The short-term prognosis of patients with acute carbon monoxide intoxication is good, even if they are not treated with hyperbaric oxygen. There is still inconclusive evidence from the literature that hyperbaric oxygen improves the prognosis in these patients.


Asunto(s)
Intoxicación por Monóxido de Carbono/terapia , Terapia por Inhalación de Oxígeno/métodos , Enfermedad Aguda , Adolescente , Adulto , Anciano , Intoxicación por Monóxido de Carbono/sangre , Carboxihemoglobina/análisis , Niño , Preescolar , Cuidados Críticos , Femenino , Humanos , Oxigenoterapia Hiperbárica , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
7.
Ned Tijdschr Tandheelkd ; 97(7): 315-7, 1990 Jul.
Artículo en Holandés | MEDLINE | ID: mdl-2215824

RESUMEN

Ten persons participated in a cross-over study in which the effect of rinsing with Plax and subsequent toothbrushing was compared with water rinsing and subsequent toothbrushing. Plaque was evaluated at baseline and after rinsing and toothbrushing. Bacterial and epithelial cells were counted in the material that was removed by rinsing and brushing. In addition the dry-weight of this material was determined. The differences between Plax and water in plaque reduction, the number of bacterial and epithelial cells in the material removed from the mouth were statistically not significant. The weight of the material removed by the rinsing and brushing was higher after rinsing with Plax. This was caused by the more vigorous removal of epithelial cells by Plax than by water.


Asunto(s)
Placa Dental/prevención & control , Antisépticos Bucales/uso terapéutico , Higiene Bucal , Humanos
8.
Caries Res ; 23(3): 146-50, 1989.
Artículo en Inglés | MEDLINE | ID: mdl-2736575

RESUMEN

In this study, a mouthrinse containing calcium lactate was tested for its effect on the accumulation of dental plaque and on the concentrations of calcium and phosphorus therein. Human volunteers rinsed four times per day with a calcium lactate (165 mmol/l) solution for 1 week. Plaque samples, collected 16 h after the last rinse, were analyzed chemically. Calcium lactate rinses had no effect on the plaque score, but resulted in approximately twofold increases of calcium and phosphorus in plaque. The incorporation of monofluorophosphate (5 mmol/l) into the rinsing solution failed to show any significant influence on calcium, phosphorus, and fluoride levels in plaque. Increased mineral deposition in the plaque may provide an explanation for the reduced caries development earlier observed in rats fed a diet containing calcium lactate.


Asunto(s)
Placa Dental/etiología , Lactatos/uso terapéutico , Antisépticos Bucales , Adulto , Calcio/análisis , Placa Dental/análisis , Método Doble Ciego , Femenino , Fluoruros/administración & dosificación , Fluoruros/análisis , Fluoruros/uso terapéutico , Humanos , Lactatos/administración & dosificación , Ácido Láctico , Masculino , Fosfatos/administración & dosificación , Fosfatos/uso terapéutico , Fósforo/análisis , Espectrofotometría Atómica
9.
Princess Takamatsu Symp ; 16: 119-37, 1985.
Artículo en Inglés | MEDLINE | ID: mdl-3916191

RESUMEN

Various food products of plant origin were investigated for the occurrence of natural mutagens using the Salmonella/microsome assay. In general, food plants were freeze-dried and subsequently extracted with a number of solvents. Solvents were evaporated and the residues obtained were tested for mutagenicity. In addition to S9-mix, gut flora extracts were applied for metabolic activation. From bracken fern (Pteridium aquilinum) a novel mutagen, designated Aquilide A, was isolated and its chemical structure was identified. Aquilide A requires activation to become mutagenic. This activation occurs spontaneously at pH levels above 6-7. Activated Aquilide A was found to be genotoxic in cultured mammalian cells. Natural mutagens were detected in 4 out of 6 vegetables investigated. In addition, broad beans (Vicia faba) were found to be mutagenic after treatment with nitrite. All mutagenic vegetables showed marked intercultivar variations. From lettuce and string beans quercetin was isolated (after chemical hydrolysis) and in rhubarb emodin, an anthraquinon, was detected. The mutagenic activity of these two compounds was further investigated using cultured mammalian cells. Quercetin and emodin responded negative or weakly positive in the systems applied. The genotoxic properties of a number of pyrrolizidin alkaloids, which are reported to occur in various flowering plants and as a result occur in honey and some herbal preparations, were studied using a cocultivation system of V79 Chinese hamster cells and primary cultures of chick embryo hepatocytes (PCCEH/V79). All four pyrrolizidine alkaloids investigated were found to be potent inducers of SCEs in this test system. Anti-mutagenic effects of butylated hydroxyanisole (BHA) and indole-3-carbinol (I3C) were detected using the PCCEH/V79 cocultivation system. This indicates that the cocultivation system described can be a valuable tool for the screening of various products for potential anti-carcinogenic properties. Extracts of lettuce and string beans, and a number of natural chemicals were found to reduce the mutagenic activity of cigarette smoke condensate and benzo (a) pyrene (BaP) as detected in the Salmonella/microsome assay. Intercultivar variation with respect to the antimutagenic activity observed was less pronounced than the variation noted for the mutagenic activity of these vegetables. Measures which may result in a reduction of the exposure to a number of natural mutagens are discussed.


Asunto(s)
Análisis de los Alimentos , Mutágenos/análisis , Animales , Antineoplásicos/análisis , Células Cultivadas , Embrión de Pollo , Fabaceae , Hígado , Pruebas de Mutagenicidad , Extractos Vegetales/análisis , Plantas Comestibles/análisis , Plantas Medicinales , Alcaloides de Pirrolicidina/toxicidad , Intercambio de Cromátides Hermanas , Verduras
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