RESUMO
At present, no effective therapy is available for hepatocellular carcinoma, when local treatments have failed. We reported the results obtained with prolonged, ultra-low-dose (1 MIU/d until progression), subcutaneous interleukin-2 (IL-2) in a series of 18 consecutive patients (14 men and 4 women, median age 66 years, range 49-82 years) with advanced, histologically proven HCC on liver cirrhosis. During a median follow-up time of 19.5 months, two complete responses (11.1%), lasting 35 and 46 months, respectively, and one partial response (5.5%) were recorded (overall response rate: 16.6%; 95% CI: 0-33.8%). Thirteen patients (72.3%; 95% CI: 61.6-82.7) had stable disease lasting at least 4 months; 1 of these patients obtained a complete response on lung metastases. Median time to progression was 15.3 months (95% CI: 10-33). Median overall survival was 24.5 months (95% CI: 12-43). Two patients (11.1%) progressed during therapy. Toxicity was only local (usually pain and pomphus in the site of injection). Low-dose IL-2 can be considered an active and well-tolerated treatment for unresectable hepatocellular carcinoma. Future studies on large numbers of patients are necessary to confirm these results.
Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/tratamento farmacológico , Interleucina-2/administração & dosagem , Neoplasias Hepáticas/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Feminino , Humanos , Injeções Subcutâneas , Interleucina-2/uso terapêutico , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Terapia de Salvação , Análise de SobrevidaRESUMO
INTRODUCTION: Pre-impaired glucose tolerance (pre-IGT) or compensated hyperinsulinemia, is defined as normal glucose, and elevated insulin two hours after a 75-gram oral glucose load. It is characteristic of the early stages of diabetes mellitus (DM), where beta cells compensate for insulin resistance by increasing insulin secretion to maintain normoglycemia. With continuing beta cell failure, insulin secretion eventually fails, leading to the progression to diabetes. Nonalcoholic fatty liver disease (NAFLD), a common feature of insulin resistance, is found in 50-75% and 42-55% of DM and pre-diabetes patients. We determined if NAFLD was present in patients with pre-IGT.METHOD: A study on the determination of NAFLD - diagnosed by liver ultrasound in pre-IGT patients at a university hospital.Descriptive statistics, Chi square test of independence, 2x2 Fischer Exact test, Z test of difference in proportion, were used for statistical analysis with a p-value set at 0.05?.IBMSPSS ver 21 was used as software.RESULTS:The mean age of 22 patients was 29.95 years, with average BMI of 25.73 kg/m2;77.3% were female. Average lipid panels were within optimal limits; kidney and liver functions were normal. The mean insulin level was 58.36 uIU/mL. NAFLD was identified in eight of the subjects. CONCLUSION: Although pre-IGT is a subclinical phase in the diabetes spectrum, 36% already have NAFLD.This prevalence was lower compared to diabetics and pre-diabetics, but higher compared to the general population.There was a noticeable trend of increasing insulin levels with increasing severity of fatty liver.
Assuntos
Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Adulto , Intolerância à Glucose , Resistência à Insulina , Hepatopatia Gordurosa não Alcoólica , Hiperinsulinismo , Estado Pré-Diabético , Células Secretoras de Insulina , Insulinas , Glucose , LipídeosRESUMO
INTRODUCTION:Radioactive iodine(I131) therapy is an established definitive treatment for Graves' hyperthyroidism.However,the optimal method of determining the radioiodine treatment dose remains controversial.OBJECTIVE: To compare the efficacy of fixed dose versus calculated dose regimen in the treatment of Graves' hyperthyroidism among Filipinos METHODOLOGY: Diagnosed Graves' disease patients underwent thyroid ultrasound to estimate thyroid size. Patients were randomized to either fixed or calculated dose of radioiodine treatment. For fixed dose group,the WHO goiter grading was utilized: Grade 0 (5mCi), Grade 1 (7mCi), Grade2 (10mCi), Grade 3 (15mCi). For calculated dose group the following formula was used: Dose(mCi)= 160uCi/g thyroid x thyroid gland weight in grams x 100 / 24-hour RAIU(%)Thyroid function test (TSH,FT4) was monitored every three months for one year. RESULTS: Of the 60 patients enrolled, 45 (fixed dose; n= 27, calculated dose; n= 18) completed the six months follow-up study. Analysis was done by application of the intention-to-treat principle. The percentage failure rate at third month in the fixed vs. calculated dose group was: 26 v. 28% with a relative risk (RR) value of 0.93. At six months post-therapy, there was a noted reduction in the failure rates for both study groups (11 vs. 22%, respectively), with a further reduction in the relative risk value (0.67), favoring the fixed dose group.CONCLUSION: Fixed dose radioiodine therapy for Graves' disease is observed to have a lower risk of treatment failure (persistent hyperthyroidism) at three and six months post-therapy compared to the calculated dose.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Radioisótopos do Iodo , Iodo , Análise de Intenção de Tratamento , Doença de Graves , Hipertireoidismo , Bócio , Testes de Função Tireóidea , Falha de TratamentoRESUMO
BACKGROUND AND OBJECTIVES: B-cell MALT lymphoma is a well-recognized entity and its characterization as low-grade (LG) and high-grade (HG) lymphoma has been widely accepted. In the present study we reviewed a series of 95 surgical specimens of primary gastric MALT lymphoma selected between 1979 and 1998. Immunohistochemical expression of p53, bcl-2, and Ki67 and Helicobacter pylori (Hp) infection was evaluated, along with a correlation with clinical outcome. METHODS: A morphologic and immunohistochemical analysis, including p53, bcl-2, and Ki67 expression, was carried out in all cases. A complete follow-up was obtained in 49 patients and in these cases a survival analysis was performed. RESULTS: bcl-2 protein was highly expressed in 25 of 25 assessed LG tumors and in 20 of 24 assessed HG tumors. p53 protein was expressed in 13 of 25 assessed LG tumors and in 21 of 24 assessed HG tumors. High proliferation rate as expressed by Ki67 was detected in 15 of 25 assessed LG tumors and in 23 of 24 assessed HG tumors. Hp infection was detected in 11 of 16 assessed LG tumors and 2 of 10 assessed HG tumors. Median survival rates were 72 months for LG tumors and 24 months for HG tumors. CONCLUSIONS: A significant inverse relationship between Hp infection and histological grade was found. High p53 expression and high-proliferation rate correlated with HG tumors. However, a correlation between p53, bcl-2, and Ki67 expression with clinical outcome was not found.