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2.
Reumatol. clín. (Barc.) ; 12(5): 282-284, sept.-oct. 2016. ilus
Artigo em Espanhol | IBECS | ID: ibc-155879

RESUMO

Los síndromes paraneoplásicos pueden presentarse de múltiples maneras, dentro de las cuales destacan las manifestaciones endocrinológicas, reumatológicas, hematológicas y nefrológicas. Si bien la mayoría de las publicaciones describen los tumores sólidos como responsables de dichos cuadros, las neoplasias hematológicas son causa importante a considerar como parte del diagnóstico diferencial. Se presenta el caso de un varón de 46 años con un cuadro de poliartritis simétrica seronegativa de grandes y pequeñas articulaciones, asociado a glomerulonefritis membranoproliferativa con depósitos de inmunocomplejos y deterioro agudo de la función renal, como parte de un síndrome paraneoplásico secundario a un linfoma de Hodgkin clásico con invasión medular, el cual revirtió completamente con el tratamiento de quimioterapia (AU)


Paraneoplastic syndromes can be presented in multiple ways, which include endocrinological, hematologic, rheumatologic and nephrologic manifestations. While most of the publications described solid tumors as responsible for these manifestations, hematologic neoplasms are important cause to consider as part of the differential diagnosis. We report the case of a 46 year-old man with seronegative symmetric polyarthritis of large and small joints associated with membranoproliferative glomerulonephritis with deposits of immune complexes and acute impairment of renal function, as part of a paraneoplastic syndrome secondary of a classical Hodgkin lymphoma with bone marrow invasion, which reversed completely with chemotherapy treatment (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artrite/complicações , Artrite/diagnóstico , Artrite/tratamento farmacológico , Glomerulonefrite/complicações , Glomerulonefrite/tratamento farmacológico , Doença de Hodgkin/complicações , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/patologia , Diagnóstico Diferencial , Doxorrubicina/uso terapêutico , Febre/complicações , Pancitopenia/diagnóstico , Pancitopenia/terapia , Bleomicina/uso terapêutico , Vimblastina/uso terapêutico
4.
Clin. transl. oncol. (Print) ; 17(8): 612-619, ago. 2015. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-138176

RESUMO

Purpose. The cure rate in Hodgkin lymphoma is high, but the response along with treatment is still unpredictable and highly variable among patients. Detecting those patients who do not respond to treatment at early stages could bring improvements in their treatment. This research tries to identify the main biological prognostic variables currently gathered at diagnosis and design a simple machine learning methodology to help physicians improve the treatment response assessment. Methods. We carried out a retrospective analysis of the response to treatment of a cohort of 263 Caucasians who were diagnosed with Hodgkin lymphoma in Asturias (Spain). For that purpose, we used a list of 35 clinical and biological variables that are currently measured at diagnosis before any treatment begins. To establish the list of most discriminatory prognostic variables for treatment response, we designed a machine learning approach based on two different feature selection methods (Fisher’s ratio and maximum percentile distance) and backwards recursive feature elimination using a nearest-neighbor classifier (k-NN). The weights of the k-NN classifier were optimized using different terms of the confusion matrix (true- and false-positive rates) to minimize risk in the decisions. Results and conclusions. We found that the optimum strategy to predict treatment response in Hodgkin lymphoma consists in solving two different binary classification problems, discriminating first if the patient is in progressive disease; if not, then discerning among complete and partial remission. Serum ferritin turned to be the most discriminatory variable in predicting treatment response, followed by alanine aminotransferase and alkaline phosphatase. The importance of these prognostic variables suggests a close relationship between inflammation, iron overload, liver damage and the extension of the disease (AU)


No disponible


Assuntos
Idoso , Humanos , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/terapia , Ferritinas/uso terapêutico , Alanina Transaminase , Fosfatase Alcalina/uso terapêutico , Bleomicina/uso terapêutico , Vimblastina/uso terapêutico , Dacarbazina/uso terapêutico , Doxorrubicina/uso terapêutico , Estudos Retrospectivos , Estudos de Coortes , Prognóstico , Estimativa de Kaplan-Meier
8.
Clin. transl. oncol. (Print) ; 13(4): 281-286, abr. 2011. tab
Artigo em Inglês | IBECS | ID: ibc-124436

RESUMO

INTRODUCTION: To assess the efficacy and safety profile of biweekly vinorelbine and tegafur/uracil (UFT) as treatment in patients with metastatic breast cancer previously treated with anthracyclines and taxanes. PATIENTS AND METHODS: Patients with histologically confirmed breast cancer, measurable disease, no more than one prior chemotherapy regimen for metastatic disease, an Eastern Cooperative Oncology Group (ECOG) performance status ≤2, and adequate bone marrow, renal and liver function were eligible. Patients received vinorelbine (30 mg/m(2) on day 1) and UFT (250 mg/m(2) daily) every two weeks for 12 cycles unless progression or unacceptable toxicity was observed. RESULTS: Thirty-seven patients were included and received 311 cycles of chemotherapy. Efficacy and toxicity analyses were carried out on an intention-to-treat basis. The overall response rate was 35% (95% CI: 20-53). With a median follow-up of 18.6 months (95% CI: 1.0-74.3), the median time to progression was 7.0 months (96% CI: 5.2-8.9) and the median overall survival was 19.4 months (95% CI: 11.1-27.8). The most common severe toxicities were neutropenia (38% of patients) and asthenia (11% of patients). CONCLUSION: The combination of biweekly vinorelbine and UFT in patients with metastatic breast cancer pretreated with anthracyclines and taxanes is a well tolerated and effective regimen. AEMPS Trial Registration No.: 00-0534 (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos Fase II como Assunto , Estudos Multicêntricos como Assunto , Intervalo Livre de Doença , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Tegafur/uso terapêutico , Uracila/uso terapêutico , Vimblastina/análogos & derivados , Antraciclinas/uso terapêutico , Estimativa de Kaplan-Meier , Taxoides/uso terapêutico , Tegafur/administração & dosagem , Tegafur/efeitos adversos , Uracila/administração & dosagem , Uracila/efeitos adversos , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos , Vimblastina/uso terapêutico
9.
Rev. esp. cardiol. (Ed. impr.) ; 64(2): 159-162, feb. 2011. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-84942

RESUMO

Los stents farmacoactivos se asocian con retraso en la endotelización y fenómenos inflamatorios persistentes demostrados histológicamente. En la superficie luminal, mediante microscopio electrónico de barrido se observan también cúmulos de células inflamatorias. Para cuantificar esta respuesta inflamatoria se implantaron un stent de acero y dos stents farmacoactivos con distintas dosis de vinblastina y el mismo polímero en las coronarias de 12 cerdos domésticos. Se analizó 3 y 7 días después la densidad de células inflamatorias por área representativa (100 x 100 mm). La endotelización del stent de acero fue más completa que en los stents farmacoactivos a los 3 días (p=0,016) y a los 7 días (p=0,0001). Los stents farmacoactivos indujeron un grado de inflamación mayor que los stents de acero a los 3 días (11,8±3.5% frente al 4,5±2%; p=0,001) y a los 7 días (26,3±4,4% frente al 1,2±1,5%; p=0,0001), con un patrón opuesto: la respuesta inflamatoria aumentaba con el tiempo en los stents farmacoactivos, al contrario de lo que sucedía con los stents de acero (AU)


There is histological evidence that drug-eluting stents are associated with delayed endothelialization and a persistent inflammatory state. Moreover, clusters of inflammatory cells have been observed on luminal surfaces by scanning electron microscopy. With the aim of quantifying this inflammatory response, we implanted one bare-metal stent and two drug-eluting stents containing different doses of vinblastine embedded in the same polymer into the coronary arteries of 12 domestic pigs. The density of inflammatory cells in a representative area (100 x 100 mm) was quantified at 3 and 7 days. Endothelialization was more complete in bare-metal stents than in drug-eluting stents at both 3 days (P = .016) and 7 days (P = .0001). The degree of inflammation induced by the drug-eluting stents was higher than that induced by the bare-metal stents at both 3 days (11.8 +/- 3.5% vs. 4.5 +/- 2%; P = .001) and 7 days (26.3 +/- 4.4% vs. 1.2 +/- 1.5%; P = .0001). In addition, the time sequence was inverted: the inflammatory response increased over time with the drug-eluting stents, while the opposite occurred with the bare-metal stents (AU)


Assuntos
Animais , Masculino , Feminino , Suínos , Microscopia Eletrônica de Varredura/métodos , Microscopia Eletrônica de Varredura , Stents Farmacológicos , Vimblastina/uso terapêutico , Vimblastina/administração & dosagem , Modelos Animais , Stents Farmacológicos/classificação , Stents Farmacológicos/tendências
12.
Actas urol. esp ; 33(4): 447-449, abr. 2009. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-60063

RESUMO

El carcinoma sarcomatoide de vejiga es una neoplasia de alto grado, que representa aproximadamente el 0,3% de todas las neoplasias vesicales y tiene su origen en las células transicionales de la vejiga. El carcinoma sarcomatoide se caracteriza por presentar un componente epitelial y un componente sarcomatoide, consistente en células fusiformes que solamente expresan marcadores de estirpe epitelial. Presentamos el caso de una mujer de 26 años diagnosticada de un carcinoma sarcomatoide de vejiga estadio III (T3aN0M0) tratada con cistectomía parcial seguida por 4 ciclos de quimioterapia adyuvante con metotrexato, vinblastina, adriamicina y cisplatino (AU)


Sarcomatoid bladder carcinoma is a high-grade neoplasm and accounts for approximately 0,3% of all bladder malignancies. Sarcomatoid carcinoma originates from transitional cells of the bladder. Sarcomatoid carcinoma is charactericed by a epithelial component and a sarcomatoid component, consisting of spindle cells, that is only epithelial marker-positive. We report a 26 year-old woman diagnosed of stage III sarcomatoid bladder carcinoma (T3aN0M0) treated with partial cistectomy followed by 4 cycles of adjuvant chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin (AU)


Assuntos
Adulto , Feminino , Humanos , Carcinoma de Células de Transição/patologia , Imuno-Histoquímica , Queratinas/genética , Tratamento Farmacológico , Metotrexato/uso terapêutico , Cisplatino/uso terapêutico , Vimblastina/uso terapêutico , Doxorrubicina/uso terapêutico
14.
Arch. esp. urol. (Ed. impr.) ; 61(4): 499-506, mayo 2008. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-64492

RESUMO

Objetivo: Estudiar la clínica, el diagnóstico, el tratamiento, y la evolución de los tumores del tracto urinario superior. Métodos: Se realizó un estudio retrospectivo de los tumores del aparato urinario superior tratados en nuestro centro, HCU Valladolid, entre 1994 y 2007. Resultados: Se diagnosticaron 65 tumores, de los cuales sólo 59 entraron en el estudio. La edad media de los pacientes fue de 68 años (intervalo entre 46 y 88 años). Nos encontramos 47 varones frente a 12 mujeres. La hematuria fue el signo clínico inicial más frecuente, apareciendo en el 79,9% de los casos. La Urografía fue la técnica diagnóstica más utilizada (96,6%). La técnica quirúrgica más empleada fue la nefroureterectomía con desinserción endoscópica del uréter, realizada en 28 ocasiones. En 9 pacientes se aplicó tratamiento conservador vía percutánea con una única recidiva y en 2 tratamiento ureteroscópico. El 50,9% de los tumores fueron superficiales. Hubo un 37% de afectación vesical concomitante. La supervivencia a los cinco y diez años fue del 55 y 47% respectivamente. Conclusiones: Los tumores de aparato urinario superior son una entidad rara, que aparece en la edad media-avanzada de la vida. La nefroureterectomía radical es hoy por hoy el tratamiento estandar, ya sea vía abierta o laparóscopica. El tratamiento endóscopico cada vez tiene más importancia y presenta excelentes resultados en casos seleccionados (AU)


Objectives: To study the clinical presentation, diagnosis, treatment, and evolution of upper urinary tract tumours. Methods: We carried out a retrospective study on the upper urinary tract tumours treated in our centre, HCU Valladolid, between 1994 and 2007. Results: 65 tumours were diagnosed, although only 59 were valid for the study. Mean patient age was 68 years (interval between 46 and 88 years). 47 were men and 12 women. The most common symptom on presentation was hematuria (79,9%). Urography was the most frequently used diagnostic technique (96,6%) and nephroureterectomy with transurethral resection of the intramural ureter was the most common surgical treatment performed, carried out in 28 cases. 9 patients underwent percutaneous treatment with only one recurrence, and 2 patients received ureteroscopic treatment. 50,9 % of the lesions were classified as superficial tumours. The 5 and 10-year survival rates were 55 and 47%. Conclusions: Upper urinary tract tumours are an unusual disease characteristic of medium-advanced ages. Nowadays nephroureterectomy by open surgery or laparoscopy is the standard treatment. Conservative endoscopic procedures have more and more importance and present excellent results in highly selected cases (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias Urológicas/diagnóstico , Neoplasias Urológicas/terapia , Urografia/métodos , Carcinoma de Células Escamosas/complicações , Ureteroscopia/métodos , Tomografia Computadorizada de Emissão , Sistema Urinário/patologia , Sistema Urinário/cirurgia , Sistema Urinário , Estudos Retrospectivos , Endoscopia , Cisplatino/uso terapêutico , Vimblastina/uso terapêutico
15.
An. med. interna (Madr., 1983) ; 25(2): 85-89, feb. 2008. tab
Artigo em Espanhol | IBECS | ID: ibc-64080

RESUMO

Ascites is rare in patients with multiple myeloma (MM). It may be due to diverse mechanisms, most frequently because of an increased permeability of the peritoneum or because of portal hypertension due to liver infiltration. Myelomatous ascites occurs more frequently in patients having Ig-G or Ig-A paraprotein and their prognosis is poor. It is submitted the case of a female patient aged 50 years with IgA-kappa MM, who evolved with cardiac failure (CF), plasma cells leukemia and ascites of mixed cause, because of peritoneal infiltrate of myelomatous cells, hepatic compromise and CF. A review of the different causes of ascites in patients with MM is performed. There are also summarized all myelomatous ascites cases published in the literature. Our report presents the first case of myelomatous ascites in a patient with plasma cells leukemia


Los pacientes con mieloma múltiple (MM) raramente presentan ascitis. La misma puede responder a diversos mecanismos, siendo las causas más frecuentes el aumento de permeabilidad del peritoneo y la hipertensión portal por infiltración hepática. La ascitis mielomatosa (AM) ocurre con más frecuencia en pacientes con paraproteína de tipo Ig-G e Ig-A y su pronóstico es sombrío. Se presenta el caso de una paciente de sexo femenino de 50 años con diagnóstico de MM IgA-kappa que evoluciona con insuficiencia cardíaca (IC), leucemia de células plasmáticas y ascitis de causa mixta, por infiltración peritoneal por células mielomatosas, compromiso hepático e IC. Se realiza una revisión de las distintas causas de ascitis en pacientes con MM. Asimismo se resumen todos los casos publicados en la literatura mundial de AM. Nuestro reporte representa el primer caso de AM en un paciente con leucemia de células plasmáticas


Assuntos
Feminino , Pessoa de Meia-Idade , Humanos , Ascite/complicações , Ascite/diagnóstico , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Hipertensão Portal/complicações , Pancitopenia/complicações , Pancitopenia/diagnóstico , Talidomida/uso terapêutico , Insuficiência Cardíaca/complicações , Prognóstico , Plasmócitos/patologia , Vimblastina/uso terapêutico , Doxorrubicina/uso terapêutico , Dexametasona/uso terapêutico , Ciclofosfamida/uso terapêutico , Prednisona/uso terapêutico
16.
Clin. transl. oncol. (Print) ; 9(2): 99-105, feb. 2007. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-123274

RESUMO

BACKGROUND: The incidence and prevalence of comorbid conditions in lung cancer patients increase with age. The aim of the study was to determine response and tolerability with the biweekly combination gemcitabine-vinorelbine in elderly non-small-cell lung cancer (NSCLC) patients. In order to characterise the population included in the study well and assess the results achieved properly, an evaluation of the functional status, comorbidity and survival was performed. PATIENTS AND METHOD: Between June 2001, and December 2003, 59 untreated advanced NSCLC patients over the age of 70 years entered the study. Treatment consisted of gemcitabine 1750 mg/m(2) and vinorelbine 30 mg/m(2) on day 1 every two weeks. The response was evaluated every f ive cycles (RECIST guidelines). Comorbidity was evaluated according to the Charlson and Kaplan Feinstein scales. To measure functional status, activities of daily living (ADL) and instrumental ADL (IADL) were considered. RESULTS: Median age was 74; ECOG performance status was >2 in 59.3%; no dependence in ADL or IADL was found in 24.8% and 42.4% of patients, respectively. A total of 381 courses were administered. Grade 3-4 neutropenia was present in 6.8% of these courses and correlated with IADL. Objective response was 22% (95% CI 12-32). Mean global survival and cause-specific survival were 29 weeks (95% CI 19.9-38.1) and 32 weeks (95% CI 23.4-40.8) respectively. Comorbidity displayed no close correlation with functional status, but comorbidity according to the Kaplan Feinstein index correlated with IADL. Performance status, ADL, IADL and weight loss were significantly related to survival in multivariate analysis. CONCLUSIONS: This biweekly combination is feasible in elderly lung cancer patients with a high burden of comorbidity and dependence. Toxicity is acceptable, whereas response rate and survival fall in the range of active regimens. ADL and IADL indices allow the identification of elderly patients with a worse prognosis (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Carcinoma de Pequenas Células do Pulmão/fisiopatologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/fisiopatologia , Atividades Cotidianas , Carcinoma de Pequenas Células do Pulmão/complicações , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Vimblastina/análogos & derivados , Vimblastina/administração & dosagem , Desoxicitidina/análogos & derivados , Desoxicitidina/administração & dosagem , Tratamento Farmacológico/métodos
17.
Clin. transl. oncol. (Print) ; 9(1): 56-58, ene. 2007. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-123264

RESUMO

PURPOSE: To evaluate the response of advanced squamous cell head and neck carcinoma to a combination of induction chemotherapy and radiotherapy. METHODS: We present long-term results of a phase II trial of Induction Chemotherapy with UFT 200 mg/m(2) p.o. days 1 to 21, Vinorelbine 25 mg/m(2) i.v. days 1 and 8 and Cisplatin 100 mg/m(2) i.v. day 1 (UFTVP) each 21 days for 4 courses, followed by Radiotherapy concomitant with UFT 100 mg/m(2) p.o. daily and Carboplatin AUC = 0.5 i.v. weekly (RT/UFTJ) in patients (pts) with Non-Resectable Locally Advanced (Stage IV-B) Squamous Cell Head and Neck Carcinoma (IV-B-SCHNC). Primary endpoint was Complete Response to induction UFTVP and secondary endpoints were Disease Free Status Rate after locoregional treatment and long-term Overall Survival. Between 1994 and 1997, 32 pts were included. RESULTS: Complete Response to Induction UFTVP was 59% (95% CI: 48%-70%). Main toxicity of UFTVP was G 3,4 neutropenia (94% of pts; 25% developed febrile neutropenia and 1 of this pts dead). After Induction Chemotherapy with UFTVP, 30 pts received radiotherapy and 25 of them received concomitant Carboplatin and UFT (RT/UFTJ): main toxicity was mucositis (G3-4: 72%) and one patient died during RT/UFTJ because pneumonia. Twenty-five pts (78%) were alive and disease free at the end of the whole treatment. Actuarial 5 year Overall survival is 32%. CONCLUSION: Although toxicity is important, this approach has interesting activity and deserves further investigation (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/uso terapêutico , Carcinoma de Células Escamosas/radioterapia , Cisplatino/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Neutropenia/induzido quimicamente , Transplante de Células-Tronco/métodos , Uracila/uso terapêutico , Vimblastina/análogos & derivados , Antineoplásicos/efeitos adversos , Carcinoma de Células Escamosas/patologia , Terapia Combinada , Febre/induzido quimicamente , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Prognóstico , Tegafur/uso terapêutico , Fatores de Tempo , Vimblastina/uso terapêutico
18.
Clin. transl. oncol. (Print) ; 8(12): 896-902, dic. 2006. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-126349

RESUMO

Purpose. To assess the toxicity and efficacy of biweekly gemcitabine plus vinorelbine in first-line advanced breast cancer, and to establish whether circulating HER2 ECD levels correlate with the efficacy of the combination. Patients and methods. 52 patients were treated with gemcitabine 2500 mg/m(2) plus vinorelbine 30 mg/m(2), both on day 1 of 14-day cycles, for a maximum of 10 cycles. Baseline serum levels of HER2 ECD were assessed with an ELISA. Results. All patients were evaluable for toxicity, and 50 for efficacy. Overall toxicity was moderate. Grade 3 neutropenia occurred in 35% of patients and grade 4 in 19%. Other grade 3 toxicities were observed in less than 6%. There was one episode of febrile neutropenia, and one death after cycle three. Overall response rate was 52% (95% CI: 38% to 66%), with 2 patients achieving a CR (4%). Response rate did not correlate with HER2 ECD, with 50% of HER2 ECD positive patients responding, vs 48.5% of the HER2 ECD negative. Median overall survival was 24.6 months. Conclusion. Gemcitabine plus vinorelbine, given as an every-two-week schedule, is an active regimen in advanced breast carcinoma. This combination can be an option when anthracyclines and taxanes are not preferred. HER2 ECD has no predictive value in this non-taxane combination (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adenocarcinoma/sangue , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Neoplasias da Mama/sangue , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ensaio de Imunoadsorção Enzimática , Estimativa de Kaplan-Meier , /sangue , Vimblastina/análogos & derivados , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos
19.
Clin. transl. oncol. (Print) ; 8(12): 903-911, dic. 2006. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-126350

RESUMO

PURPOSE: Organ preservation has been investigated in patients (p) with infiltrating transitional cell carcinoma (TCC) of the bladder over the past decade as an alternative to radical cystectomy. This is a trimodal schedule study, including transurethral resection of bladder tumor (TURB), neoadjuvant chemotherapy and concomitant radiochemotherapy (RTC). PATIENTS AND METHODS: From April 1996 until August 2005, 29 evaluable patients (p) with T2-T3NXM0 bladder cancer were enrolled. After a transurethral resection of bladder tumor (TURB), we administered 2 cycles of induction chemotherapy with CMV (15 p) or Gemcitabine-Cisplatin (14 p) followed by radiotherapy 45 Gy 1.8 Gy/fraction and two cycles of concomitant cisplatin 70 mg/m(2). 2-3 weeks later, a cystoscopy with tumor-site biopsy was performed. If complete histological response, p were treated with consolidation radiotherapy until 64.8 Gy. For p with residual or recurrent tumor, cystectomy was performed. RESULTS: We included 28 men and 1 women (median age 63, range 39-72 years) with PS (ECOG) 0-1. The stage was: 21 p T2; 6 p T3a; and 2 p T3b. Toxicity was higher in CMV compared with Gem- Cis: grade (3/4) neutropenia 4/15 (26%) vs 1/14 (7%); febrile neutropenia 3/15 (20%) vs 1/14 (7%); grade (3/4) trombocytopenia 2/15 (13%) vs 1/14 (7%). Toxicities with concomitant RCT were low-moderate: urocystitis (26%) and enteritis (18%). RESPONSE: microscopically complete TURB was obtained in 20 p (69%), but not in 9 p (31%) (7 microscopic, and 2 macroscopic residual tumor). We found a complete histologic response after induction RCT in 25 p (86%). After a median follow-up of 69.4 months (m) (range: 8-97.7), there were 8 deaths, with a overall survival of 72%. Furthermore 14 of 29 p (48%) were alive with intact bladder, and median survival time with intact bladder was 63.6 m (50.1-77.2); were predictive of best outcome T2 stage vs T3 (p < 0.0001), and complete histologic resection in initial TURB vs residual tumor (p = 0.0004). CONCLUSIONS: Combined treatment provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients with TCC. Patients with T2 stage and complete histologic resection in initial TURB had the best outcome (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/terapia , Cisplatino/administração & dosagem , Estimativa de Kaplan-Meier , Radioterapia/efeitos adversos , Radioterapia/métodos , Metotrexato/administração & dosagem , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/terapia , Procedimentos Cirúrgicos Urológicos/métodos , Vimblastina/administração & dosagem
20.
Actas dermo-sifiliogr. (Ed. impr.) ; 97(9): 594-598, nov. 2006. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-049192

RESUMO

Presentamos el caso de una niña de 10 semanas de edad que presentaba lesiones papulosas eritemato-amarillentas desde el nacimiento con diagnóstico de histiocitosis de células de Langerhans, que se acompañaba de lesiones líticas en cráneo y afectación hepática. Tras varios meses de tratamiento con prednisona y vinblastina, con mejoría cutánea y sistémica, aparecieron varias lesiones papulosas eritemato-amarillentas redondeadas en mejilla derecha; la biopsia mostró un infiltrado histiocitario con positividad para CD68 y tinción negativa para S100 y CD1a, con diagnóstico final de xantogranuloma juvenil. Dicha asociación ha sido previamente descrita en la literatura en pocos casos; aunque se han insinuado varias hipótesis, la relación causal entre ambas entidades aún no ha sido demostrada


We present the case of a 10-week-old girl who had erythematous papules with a yellowish hue from birth with diagnosis of Langerhans cell histiocytosis, that was accompanied by a lytic lesion in the skull and hepatic involvement. After several months of treatment with prednisone and vinblastine with skin and systemic improvement, several rounded erythematous papules with a yellowish hue appeared in the in right cheek. The biopsy showed a histiocytic infiltrate with positivity for CD68 and negative staining for S100 and CD1a, with a final diagnosis of juvenile xanthogranuloma. This association has been previously described in the literature in few cases. Although several hypotheses have been suggested, the causal relationship between both entities has still not been demonstrated


Assuntos
Feminino , Lactente , Humanos , Xantogranuloma Juvenil/complicações , Xantogranuloma Juvenil/diagnóstico , Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/tratamento farmacológico , Prednisona/uso terapêutico , Vimblastina/uso terapêutico , Imuno-Histoquímica/métodos , Diagnóstico Diferencial , Xantogranuloma Juvenil/terapia , Crânio
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