Repeated measurement of fractional exhaled nitric oxide is not essential for asthma screening

Background: Older guidelines recommend that fractional exhaled nitric oxide (FeNO) should be checked more than twice during the same session to confirm an asthma diagnosis. Recent studies show the excellent reproducibility of FeNO measurements. Objective: We aimed to determine whether repeated FeNO measurements during the same session are necessary for asthma screening. Methods: We retrospectively reviewed the electronic medical records of adult outpatients who visited the respiratory medicine department for diagnosis of asthma and assessed FeNO measurements obtained from June 2016 to July 2017. Results: Of the 132 patients enrolled, 79 (59.8%) were diagnosed with asthma. Repeated FeNO measurements taken during the same session showed high reproducibility (intraclass correlation coefficient >0.9; P<.001) and a strong correlation (Pearson coefficient >0.9; P<.001), although reproducibility and correlation were slightly weaker in patients with low FeNO values. The value of repeated measurement was not significant; however, the second FeNO measurement was significantly higher than the first measurement in patients with the worst and best lung function. The predictive power of the first measurement of FeNO (sensitivity, 80.5%; specificity, 85.1%) was not inferior to the second (sensitivity, 76.6%; specificity 85.1%). The same was true of the geometric mean of the two. Conclusion: Repeated FeNO measurement during the same session is not essential for asthma screening in cases where the first acceptable FeNO measurement is performed using the proper method

Introducción: Aunque las guías más antiguas recomiendan que el óxido nítrico exhalado (FeNO) se determine más de dos veces en la misma sesión para el diagnóstico de asma, algunos estudios recientes han demostrado la excelente reproducibilidad de las mediciones de FeNO. Objetivo: Nuestro objetivo fue determinar si las mediciones repetidas de FeNO durante la misma sesión son necesarias para el cribado del asma. Métodos: Revisamos retrospectivamente los registros médicos electrónicos de pacientes adultos ambulatorios que visitaron el departamento de neumología para confirmar un diagnóstico de asma durante los meses de junio de 2016 a julio de 2017, y se evaluaron las mediciones de FeNO obtenidas. Resultados: De un total de 132 pacientes estudiados, 79 pacientes (59,8%) fueron diagnosticados con asma. Las mediciones repetidas de FeNO tomadas durante la misma sesión mostraron una alta reproducibilidad (coeficiente de correlación intraclase> 0,9; p <0,001) y una fuerte correlación (coeficiente de Pearson> 0,9; p <0,001); sin embargo, la reproducibilidad y la correlación fueron ligeramente más débiles en sujetos con valores bajos de FeNO. El valor de la medición repetida no fue significativamente diferente entre sí en general; sin embargo, la segunda medición de FeNO fue significativamente más alta que la primera medición en sujetos con valores de la función pulmonar más bajos y más altos. El poder predictivo de FeNO para el diagnóstico de asma medido la primera vez (sensibilidad, 80,5%; especificidad, 85,1%) no fue inferior al medido la segunda vez (sensibilidad, 76,6%; especificidad 85,1%) o la media geométrica uniforme de los dos. Conclusión: La medición repetida de FeNO durante la misma sesión no es esencial para el cribado del asma en los casos en que la primera medición de FeNO es aceptable y se realiza con el método adecuado

A new practical desensitization protocol for oxaliplatin-induced immediate hypersensitivity reactions: a necessary and useful approach

Background and Objective: Desensitization protocols for patients with immediate hypersensitivity reactions (IHSRs) have proven to be effective, but they are not widely used in clinical practice because of impracticalities such as high cost, long procedure duration, and a lack of trained personnel. We aimed to determine the clinical characteristics of oxaliplatin-induced IHSRs and assess measures to protect against these reactions and to validate a new practical desensitization protocol. Methods: We retrospectively reviewed 2640 cases of oxaliplatin IHSRs in 271 oxaliplatin users and prospectively used a newly designed desensitization protocol 32 times in 12 patients with hypersensitivity to platinum-based chemotherapy. The protocol consisted of increases in infusion rate every 15 minutes, regardless of the concentration of the chemotherapy agent in the infusion bags. Results: Of the 271 patients administered oxaliplatin, 45 (16.6%) experienced IHSRs. Of 39 patients who experienced an IHSR but needed to continue oxaliplatin, 6 (15.4%) stopped treatment due to the reaction, and 33 (84.6%) continued despite the risk of further reactions. The new desensitization protocol was successfully completed in 12 patients (100%), but it was ineffective in 3 patients (all with a negative skin prick test), who experienced fever without urticaria. Conclusions: Many patients who experience oxaliplatin-induced IHSRs are required to stop first-line oxaliplatin-based chemotherapy or to continue without desensitization, with the associated risks. Our new desensitization protocol is practical and easy to use in clinical practice (AU)

Introducción y Objetivos: El protocolo de desensibilización en los pacientes con reacciones de hipersensibilidad inmediata a quimioterápicos resulta efectivo, sin embargo no se aplica en muchos hospitales debido a su alto coste, consumo de tiempo y falta de personal entrenado. El motivo de este trabajo fue analizar las características clínicas y las medidas habitualmente adoptadas en esta patología y validar un nuevo protocolo de desensibilización a oxaliplatino. Métodos: Para ello revisamos retrospectivamente 2.640 reacciones de hipersensibilidad inmediata a oxaliplatino en 271 pacientes sometidos a tratamiento con este quimioterápico. De forma prospectiva, aplicamos un nuevo protocolo de desensibilización 32 veces en 12 pacientes con hipersensibilidad inmediata a quimioterapia basada en oxaliplatino. Este nuevo protocolo se realizó con la administración escalonada de la concentración determinada cada 15 minutos. Resultados: En cuanto a los resultados obtenidos, de los 271 pacientes a los que se administró oxaliplatino, 45 (16,6%) presentaron reacciones de hipersensibilidad inmediata. De los 39 que necesitaron seguir el tratamiento con oxaliplatino, 6 (15,4%) abandonaron el tratamiento y 33 (84,6%) continuaron. El nuevo protocolo de desensibilización se completó en 12 pacientes (100%) si bien tres de ellos manifestaron fiebre sin urticaria y una respuesta negativa en la prueba cutánea. Conclusiones: En conclusión, una proporción importante de pacientes que sufren reacciones de hipersensibilidad a oxaliplatino interrumpen el tratamiento o lo mantienen sin ser sometidos a protocolos de desensibilización. El protocolo de desensibilización que proponemos en este estudio es fácil y muestra resultados satisfactorios en la práctica clínica (AU)

Is c-Met oncoprotein expression an adverse prognosticator in extrahepatic bile duct cancer treated with curative resection followed by adjuvant chemoradiotherapy?

Purpose: To analyze the expression of c-Met, and to investigate correlations between the expression of c-Met, clinicopathologic variables, and survival in patients undergoing curative surgery followed by adjuvant chemoradiotherapy for extrahepatic bile duct (EHBD) cancer. Methods: Ninety EHBD cancer patients who underwent curative resection followed by adjuvant chemoradiotherapy were enrolled. Expression of c-Met was assessed with immunohistochemical staining on tissue microarray. The correlation between clinicopathologic variables and survival outcomes was evaluated using Kaplan-Meier method and Cox proportional hazard model. Results: On univariate analysis, 66 patients (76.7 %) showed c-Met expression. c-Met expression had a significant impact on 5-year overall survival (OS) (43.0 % in c-Met(+) vs. 25.0 % in c-Met(-), p = 0.0324), but not on loco-regional relapse-free survival or distant metastasisfree survival (DMFS). However, on multivariate analysis incorporating tumor location and nodal involvement, survival difference was not maintained (p = 0.2940). Tumor location was the only independent prognostic factor predicting OS (p = 0.0089). Hilar location tumors, nodal involvement, and poorly differentiated tumors were all identified as independent prognostic factors predicting inferior DMFS (p = 0.0030, 0.0013, and 0.0037, respectively). Conclusions: This study showed that c-Met expression was not associated with survival outcomes in EHBD cancer patients undergoing curative resection followed by adjuvant chemoradiotherapy. Further studies are needed to fully elucidate the prognostic value of c-Met expression in these patients (AU)

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Locoregional recurrence after curative intent resection for intrahepatic cholangiocarcinoma: implications for adjuvant radiotherapy

Backgrounds. As for intrahepatic cholangiocarcinoma, the most frequent site of failure after curative intent resection is the liver. We identified the risk factors for locoregional recurrence after curative intent resection for intrahepatic cholangiocarcinoma. Methods. Medical records of 115 patients treated with surgical resection alone for intrahepatic cholangiocarcinoma from November 2000 to December 2010 were retrospectively reviewed. Locoregional failure was defined as recurrence within 20 mm from resection margin or regional lymph node. Overall survival and locoregional recurrence rates were analyzed using Kaplan–Meier methods, and the prognostic factors were analyzed using Cox proportional hazards model. Results. Median follow-up duration of surviving patients was 61 months (range 8–139). Sixty-six patients had recurrence, and 45 of 66 patients (68 %) had locoregional recurrence. The 5-year overall survival and locoregional control rates were 49.1 and 51.6 %, respectively. ≥T2b disease and R1 resection were associated with locoregional recurrence in multivariate analysis. Patients were divided into two groups whether these risk factors exist or not. The 5-year locoregional control rates of low (no risk factor n = 64) and high (1 or 2 risk factors n = 51) risk groups were 62.5 and 34.7 %, respectively (P = 0.001). Conclusions. After curative intent resection, locoregional control and survival of patients with intrahepatic cholangiocarcinoma were far from satisfactory. Further studies are needed to evaluate the potential benefit of adjuvant locoregional treatment such as radiotherapy for patients with high-risk factors (≥T2b disease or R1 resection) (AU)

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Exclusive radiotherapy for gliomatosis cerebri: long-term follow-up at a single institution

PURPOSE: To evaluate the efficacy of radiotherapy and factors affecting the prognosis of gliomatosis cerebri. METHODS: Twenty-eight patients with pathologically confirmed gliomatosis cerebri underwent radiotherapy between August 1988 and September 2003. The median age of the patients was 39 years (range 18-67). Performance status was good (ECOG score ≤2) in 23 patients (82 %). The extent of radiotherapy was partial brain in 17 patients, whole brain in 2 patients, and whole brain followed by partial brain in 9 patients. The median radiation dose was 55.8 Gy (range 46.8-70.4). The median duration of follow-up was 136 months for survivors (range 39-191). RESULTS: The median overall and progression-free survival times of all patients were 20 and 11 months, respectively. When initial response to radiotherapy was grouped as improved, stationary, and aggravated, the median overall survival times in patients with improved, stationary, and aggravated responses were 76, 20, and 7 months, respectively (p = 0.0129). However, radiation parameters such as dose and irradiation volume had no impact on overall survival. On multivariate analysis, both performance status and initial response to radiotherapy were significant prognostic factors affecting overall survival (p = 0.0249 and 0.0065, respectively). CONCLUSIONS: This study showed that gliomatosis cerebri could be effectively treated with radiotherapy and that initial response to radiotherapy was a significant prognostic factor affecting the survival (AU)

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