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1.
Breast Cancer Res Treat ; 177(1): 53-60, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31127467

RESUMO

PURPOSE: The most frequent adverse effects of aromatase inhibitors (AI) are arthralgia and bone loss induction. These reduce the quality of life of patients and their adherence to the treatment. This study evaluates the early AI cessation caused by AI intolerance, and the evolution of joint pain and health-related quality of life (HRQoL) during AI treatment until 1-year after AI completion. METHODS: Data of 910 women diagnosed with early breast cancer and candidates for AI were recruited in B-ABLE cohort. AI discontinuation was analyzed by survival analysis, including Kaplan-Meier estimation and Cox regression. Patients were distributed in three groups of the study according to previous tamoxifen (TAM) exposure and length of AI treatment: TAM-2yAI, TAM-3yAI, and 5yAI. Evolution of joint pain and HRQoL in osteoporosis was evaluated using Visual Analog Scale (VAS) and ECOS-16 tests, respectively, from baseline to 1-year after AI completion through repeated-measures ANOVA. RESULTS: Risk of AI discontinuation was increased in patients previously exposed to tamoxifen compared to non-exposed (adjusted HR 5.30 [95% CI 2.23 to 12.57]). VAS and ECOS-16 scores of TAM-2yAI and TAM-3yAI groups increased during AI treatment, mainly during the first 3-12 months. After 1-year from AI completion, values tend to decrease to baseline levels. In 5yAI group, VAS and ECOS-16 levels increased at three months, and VAS remained significantly higher at 1-year post-treatment. CONCLUSIONS: AI therapy increased joint pain and reduced HRQoL, mainly during the first year of treatment. Patients previously treated with tamoxifen experienced greater pain when they switched to AI therapy and had an excess risk of discontinuation during the first 12 months. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03811509. Registered 28 January 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03811509 .

2.
Rev. esp. patol ; 51(4): 267-270, oct.-dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-179175

RESUMO

Los hibernomas cardiacos son muy infrecuentes, y generalmente son infra-diagnosticados pre-mortem debido a su similitud clínico-radiológica con otras lesiones intracardiacas ocupantes de espacio. Además, los hibernomas cardiacos pueden ser asintomáticos y pueden escapar a la detección en los estudios radiológicos. Presentamos el caso de una mujer de 81 años quien falleció como consecuencia de embolismo tumoral pulmonar. Reportamos este caso con el fin de familiarizar a residentes y patólogos con las neoplasias intracardiacas. Se discute su dificultad diagnóstica, además de la embolia tumoral pulmonar como complicación de las neoplasias intracardiacas


Not only ae cardiac hibernomas rare, ante-mortem diagnosis is poor, due to the clinical and radiological similarity with other intracardiac masses. Furthermore, cardiac hibernomas can be asymptomatic and thus escape detection with imaging studies. We present a case of an 81-year-old woman who died as a result of pulmonary tumor embolism. This unusual case highlights the necessity for clinicians and pathologists to be familiar with intra-cardiac neoplasms. We discuss its diagnostic difficulty and the complication of pulmonary tumor embolism


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Lipoma/patologia , Neoplasias Cardíacas/patologia , Embolia Pulmonar/patologia , Neoplasias Pulmonares/patologia , Insuficiência Respiratória/etiologia , Diagnóstico Diferencial , Neoplasias Cardíacas/complicações
3.
Rev Esp Patol ; 51(4): 267-270, 2018 Oct - Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-30269781

RESUMO

Not only ae cardiac hibernomas rare, ante-mortem diagnosis is poor, due to the clinical and radiological similarity with other intracardiac masses. Furthermore, cardiac hibernomas can be asymptomatic and thus escape detection with imaging studies. We present a case of an 81-year-old woman who died as a result of pulmonary tumor embolism. This unusual case highlights the necessity for clinicians and pathologists to be familiar with intra-cardiac neoplasms. We discuss its diagnostic difficulty and the complication of pulmonary tumor embolism.

4.
Bone ; 117: 54-59, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30223134

RESUMO

INTRODUCTION: Breast cancer patients treated with aromatase inhibitors (AIs) experience increased bone loss during their treatment. However, there is little information about bone mineral density (BMD) after completing AI-treatment. The present study aimed to assess BMD changes one year after AI-therapy completion. METHODS: Data were collected from 864 postmenopausal women treated with AI during 5 years (5y-AI group), or during 2-3 years after taking tamoxifen therapy (pTAM-AI group). Participants with osteoporosis were treated with oral bisphosphonates (BP). BMD changes in lumbar spine (LS), femoral neck (FN) and total hip (TH) between baseline, end of treatment, and at one year post-treatment were assessed using repeated-measures ANOVA. RESULTS: At the end of AI-treatment, 382 patients had available BMD values and 316 also had post-treatment BMD values. As expected, BMD levels were decreased at AI-completion in non-BP treated patients. After one year, LS BMD increased in both groups (5y-AI: +2.11% [95%CI: 1.55 to 2.68], p < 0.001; pTAM-AI: +1.00% [95%CI: 0.49 to 1.51], p < 0.001) compared with the end of AI-therapy, while values at FN and TH remained stable. On the other hand, BMD values of BP-treated patients were increased or maintained at the end of AI-treatment and also at post-treatment. CONCLUSIONS: At one year after AI-completion, FN and TH BMD remained reduced in non-BP treated women, while LS BMD was recovered in the 5y-AI group and partially recovered in the pTAM-AI group. BP treatment increased or maintained BMD values at the end of therapy and at one year post-treatment.

5.
Bone ; 103: 64-69, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28655603

RESUMO

BACKGROUND: Some patients experience fractures while receiving oral bisphosphonates (BPs) treatment. Clinical risk factors, advanced bone density loss, and microarchitecture deterioration have been associated with such fractures but bone tissue properties other than bone mineral density (BMD) have not been assessed. METHODS: In a cross-sectional study of postmenopausal women on bisphosphonates for at least 4years with good adherence to treatment, 21 patients with incident fractures were compared with 18 treated patients without new fractures. Demographic and clinical variables, BMD, laboratory tests, and bone material strength index (BMSi) assessed by impact microindentation at the tibial diaphysis were recorded for all participants. RESULTS: Clinical and laboratory results did not differ between patients taking BPs with incident fractures and those without new fractures. However, BMSi was significantly lower (mean±SD) in those who fractured (73.76±6.49) than in no-fracture patients (81.64±6.26; p=0.001). Lumbar spine (LS) BMD was also lower in fractured patients (p=0.03). Adjusted models including age, body mass index, years on BP treatment, and LS-BMD confirmed an increase in fracture risk per BMSi standard deviation decrease: adjusted OR 23.5 [95% CI 2.16 to 255.66], p=0.01. ROC analyses showed an area under the curve of 0.82 (95% CI 0.68 to 0.95) for BMSi, higher than that for BMD at any location, which ranged from 0.64 (95% CI 0.47 to 0.82) for femoral neck (FN) BMD to 0.71 (95% CI 0.55 to 0.87) for LS-BMD. CONCLUSIONS: Patients who fracture while receiving BPs treatment have worse BMSi scores than BP-treated patients without fractures. The potential for BMSi to provide an additional osteoporosis treatment target should be explored.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Osso e Ossos/fisiopatologia , Fraturas por Osteoporose/epidemiologia , Administração Oral , Idoso , Área Sob a Curva , Densidade Óssea , Estudos Transversais , Difosfonatos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa , Fraturas por Osteoporose/prevenção & controle , Curva ROC , Sensibilidade e Especificidade
6.
Endocr Relat Cancer ; 23(4): 303-12, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26911377

RESUMO

The aim of the study was to evaluate the progression of bone mineral density (BMD) during 3 years of aromatase inhibitors (AI) therapy in actual practice conditions. This prospective, clinical cohort study of Barcelona-Aromatase induced Bone Loss in Early breast cancer (B-ABLE) assessed BMD changes during 3 years of AI treatment in women with breast cancer. Patients with osteoporosis (T score < -2.5 or T score ≤ -2.0) and a major risk factor and/or prevalent fragility fractures were treated with oral bisphosphonates (BPs). Of 685 women recruited, 179 (26.1%) received BP treatment. By the third year of AI therapy, this group exhibited increased BMD in the lumbar spine (LS; 2.59%) and femoral neck (FN; 2.50%), although the increase was significant only within the first year (LS: 1.99% and FN: 2.04%). Despite BP therapy, however, approximately 15% of these patients lost more than 3% of their baseline bone mass. At 3 years, patients without BP experienced BMD decreases in the LS (-3.10%) and FN (-2.79%). In this group, BMD changes occurred during the first (LS: -1.33% and FN: -1.25%), second (LS: -1.19% and FN: -0.82%), and third (LS: -0.57% and FN: -0.65%) years of AI treatment. Increased BMD (>3%) was observed in just 7.6% and 10.8% of these patients at the LS and FN, respectively. Our data confirm a clinically relevant bone loss associated with AI therapy amongst nonusers of preventative BPs. We further report on the importance of BMD monitoring as well as calcium and 25-hydroxy vitamin D supplementation in these patients.


Assuntos
Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/fisiopatologia , Osteoporose/induzido quimicamente , Idoso , Inibidores da Aromatase/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Difosfonatos/uso terapêutico , Feminino , Colo do Fêmur/fisiologia , Quadril/fisiologia , Humanos , Vértebras Lombares/fisiologia , Pessoa de Meia-Idade , Osteoporose/fisiopatologia , Osteoporose/prevenção & controle , Estudos Prospectivos
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