Platinum-based chemotherapy in metastatic breast cancer : the Leicester (UK) experience

Aims: After failure of anthracycline- and taxane-based chemotherapy in metastatic breast cancer, treatment options until recently were limited. Until the introduction of capecitabine and vinorelbine, no standard regimen was available. We conducted a retrospective study to determine the efficacy and toxicity of platinum-based chemotherapy in metastatic breast cancer. Materials and methods: Forty-two women with metastatic breast cancer previously treated with anthracyclines (93%) and/or taxanes (36%) received mitomycin-vinblastine-cisplatin (MVP) (n = 23), or cisplatin-etoposide (PE) (n = 19), as first-, second- and third-line treatment at a tertiary referral centre between 1997 and 2002. Chemotherapy was given every 3 weeks as follows: mitomycin-C (8 mg/m 2) (cycles 1, 2, 4, 6), vinblastine (6 mg/m 2), and cisplatin (50 mg/m 2) all on day 1; and cisplatin (75 mg/m 2) and etoposide (100 mg/m 2) on day 1 and (100 mg/m 2) orally twice a day on days 2-3. Results: The response rate for 40 evaluable patients (MVP: n = 23; PE: n = 17) was 18% (95% confidence interval [CI]: 9-32%). The response rate to MVP was 13% (95% CI: 5-32%, one complete and two partial responses) and to PE 24% (10-47%, four partial responses). Disease stabilised in 43% (26-63%) and 47% (26-69%) of women treated with MVP and PE, respectively. After a median follow-up of 18 months, 37 women (MVP: n = 19; PE: n = 18) died from their disease. Median (range) progression-free survival and overall survival were 6 months (0.4-18.7) and 9.9 months (1.3-40.8), respectively. Median progression-free survival for the MVP and PE groups was 5.5 and 6.2 months (Log-rank, P = 0.82), and median overall survival was 10.2 and 9.4 months (Log-rank, P = 0.46), respectively. The main toxicity was myelosuppression. Grades 3-4 neutropenia was more common in women treated with PE than in women treated with MVP (74% vs 30%; P = 0.012), but the incidence of neutropenic sepsis, relative to the number of chemotherapy cycles, was low (7% overall). The toxicity-related hospitalisation rate was 1.2 admissions per six cycles of chemotherapy. No treatment-related deaths occurred. MVP and PE chemotherapy have modest activity and are safe in women with metastatic breast cancer. © 2005 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Randomized phase II trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer administered as first-line treatment : the M77001 study group

Purpose: This randomized, multicenter trial compared first-line trastuzumab plus docetaxel versus docetaxel alone in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). Patients and Methods: Patients were randomly assigned to six cycles of docetaxel 100 mg/m 2 every 3 weeks, with or without trastuzumab 4 mg/kg loading dose followed by 2 mg/kg weekly until disease progression. Results: A total of 186 patients received at least one dose of the study drug. Trastuzumab plus docetaxel was significantly superior to docetaxel alone in terms of overall response rate (61% v 34%; P = .0002), overall survival (median, 31.2 v 22.7 months; P = .0325), time to disease progression (median, 11.7 v 6.1 months; P = .0001), time to treatment failure (median, 9.8 v 5.3 months; P = .0001), and duration of response (median, 11.7 v 5.7 months; P = .009). There was little difference in the number and severity of adverse events between the arms. Grade 3 to 4 neutropenia was seen more commonly with the combination (32%) than with docetaxel alone (22%), and there was a slightly higher incidence of febrile neutropenia in the combination arm (23% v 17%). One patient in the combination arm experienced symptomatic heart failure (1%). Another patient experienced symptomatic heart failure 5 months after discontinuation of trastuzumab because of disease progression, while being treated with an investigational anthracycline for 4 months. Conclusion: Trastuzumab combined with docetaxel is superior to docetaxel alone as first-line treatment of patients with HER2-positive MBC in terms of overall survival, response rate, response duration, time to progression, and time to treatment failure, with little additional toxicity. © 2005 by American Society of Clinical Oncology.

Chemotherapy for upper gastrointestinal tumours

The aim of this review is to identify current chemotherapy treatment for tumours of the oesophagus, stomach, pancreas, and liver. The role of both neoadjuvant, adjuvant, and palliative chemotherapy regimens will be discussed. This review will be of interest to oncologists in clarifying current issues regarding chemotherapy, and to physicians in other medical specialties, to increase their general understanding of benefits and drawbacks of chemotherapy in this patient group.

Brave New World of Health

"Within contemporary society the meaning of 'health' is surprisingly unstable. Guiding principles that once seemed self-evident have been challenged by new social, scientific and economic forces. This book argues that the foundational terms and concepts, which form the basic building blocks of dialogue about health, are now in flux. While the forces in play differ, and the pace of change is varied, there is now a 'brave new world' of health which characterises policy debate about health (and illness or disability). This permeates even the more narrow technical issues within clinical medicine, the law and medical science. This construction and reconstruction of health has important implications for the development of law and policy. The book draws on international and local experts to explore these issues. It opens with consideration of the economic and social forces of 'globalisation' - the macro level forces which now shape the 'lived realities' of health for the world's people. This is then contextualised through a series of detailed 'case studies' of more localised examples including; pharmaceuticals, preimplantation genetic diagnosis, body modification, abortion, anorexia and post-traumatic stress disorder. The book also interrogates the way modern health research influences public conceptions of health. Across these issues the book canvasses the social forces at work in the construction of health, disability and illness in shaping our understandings of such concepts by the public, by individuals, by the courts, and by international bodies. Brave New World of Health is an important contribution to advancing that understanding."--Publisher's website.

Field cases of aflatoxicosis in pigs

Five cases of aflatoxicosis in pigs in southern Queensland are described. One peracute case where aflatoxin concentrations of up to 5000pg aflatoxin B,/kg were demonstrated in stomach contents was presumed to be caused by consumption of mouldy bread. High levels of toxins were also present in the livers. Two cases of acute toxicity were caused by feeding mouldy peanut screenings containing 22000~9 aflatoxin B,/kg. One case of subacute and one of chronic toxicity were caused by sorghum grain based rations with lower aflatoxin levels (4640 and 255 pg/kg). Peracute toxicity caused collapse and deaths within several hours, acute toxicity caused deaths within 12 h and with subacute toxicity deaths occured after 3 weeks on a toxic ration. Anorexia and ill thrift affecting only growing animals were seen with chronic toxicity. Extensive centrilobular liver necrosis and haemorrhage occured with peracute toxicity and in cases of acute poisoning there was hepatic centrilobular cellular infiltration, hepatocyte swelling and bile stasis. With subacute toxicity hepatocyte vacuolation together with bile stasis and bile ductule hyperplasia were seen.

Progress towards the eradication of three melastome shrub species from northern Australian rainforests

To eradicate a weed incursion, its extent must be delimited and each infestation extirpated. Measures for delimitation and extirpation are utilized to assess the progress of eradication programs currently targeting three melastome shrub species (Clidemia hirta, Miconia nervosa and M. racemosa) in north-eastern Australia. The main infested area for each species was determined during the year after initial detection, but expanded surveys have led to the discovery of isolated, smaller outlying patches. Programs are refining survey methods (including search frequency) to prevent reproduction. Weed incursions that are limited to single infestations represent a prime opportunity for eradication. However, population and dispersal data indicate that eradication will require an ongoing investment for some time for all three species. Highly persistent seed and dispersal by frugivores suggest that eradication may prove extraordinarily difficult should any of these species spread or be discovered at more locations.

Afrikkalaisen sikaruton mahdollisia maahantuloreittejä

Afrikkalainen sikarutto on lakisääteisesti vastustettava helposti leviävä sikojen ja villisikojen virustauti, jolla on myös vakavia sosioekonomisia vaikutuksia. Akuutissa tautimuodossa eläimillä esiintyy syömättömyyttä, korkeaa kuumetta, verenpurkaumia iholla, veristä ulostetta sekä mahdollisesti ripulia. Kuolleisuus on lähes 100 % ja tauti johtaa kuolemaan 7-10 vrk tartunnan jälkeen. Tauti ei tartu ihmisiin. Tautia esiintyy sekä kesy- että villisioissa suurimmassa osassa Saharan eteläpuolista Afrikkaa ja Sardiniassa. Vuodesta 2007 lähtien tautia on esiintynyt Kaukasuksen alueella ja vuonna 2011 lähellä Suomen rajaa: Leningradin alueella ja Kuolan niemimaalla. Tässä riskiprofiilissa kartoitetaan reitit ja tapahtumasarjat, jotka voivat johtaa siihen, että afrikkalainen sikarutto tulee Suomeen ensimmäisen kerran. Näistä oleellisimmat ovat: maahantulo infektioalueella matkustaneiden ihmisten mukana, infektoituneen lihan tai lihatuotteen mukana, elävien kesysikojen ja sperman mukana, kontaminoituneiden eläinkuljetusajoneuvojen mukana, kansainvälisen liikenteen ruokajätteen mukana ja Suomeen vaeltavan infektoituneen villisian mukana. Tilatason tautisuojaus sekä tehokas ja kohdennettu tiedottaminen taudin vaaroista ovat avainasemassa, kun halutaan suojata Suomen sikaelinkeinoa afrikkalaiselta sikarutolta.

Anuario Argentino de Derecho Canónico, 2007, Vol. XIV (número completo)

Contenido: La anorexia y la bulimia como causas psicopatológicas de nulidad matrimonial / C. Baccioli – El acuerdo de 1957 / R. Bosca – Algunas consideraciones acerca de las presunciones jurídicas : aportes de la filosofía del derecho canónico / A. D. Busso – Los nuevos movimientos eclesiales y su encuadramiento canónico en la Iglesia particular / M. D. Colombo – Las relaciones diplomáticas entre el gobierno argentino y la Santa Sede : notas históricas sobre un posible concordato (1853-1892) / J. G. Durán – Abusos sexuales cometidos por clérigos y admisión al Orden Sagrado ¿un problema de homosexualidad? / R. D. Medina – Obispos y sexualidad : los cánones de Elvira como instrumento de disciplinamiento social / S. Panzram – Requisitos de prueba, la exigencia de un mínimo de prueba y la notoriedad en el derecho procesal medieval (siglos IX-XII) / M. Schmoeckel – Algunas consideraciones alrededor del canon 221 / H. A. von Ustinov – Notas – Documentos – Sentencias – Actualidad – Recensiones

Prudentia Iuris, 2004, n° 58 (número completo)

Contenido: Editorial – Derecho de familia : Garantías de la libertad y la internación de enfermos mentales / José Atilio Álvarez – Concubinato / Julio César Capparelli – Cooperación jurisdiccional contra el tráfico internacional de niños / María Susana Najurieta – El nombre y la protección de la identidad / Mario J. A. Oyarzábal – El proceso de adopción y el derecho a la identidad : reflexiones acerca de la aplicación de los artículos 321, inciso h, y 328 del Código Civil / María Cristina Diez – Topografía elemental de los procesos de familia / Hernán Pagés – Violencia familiar : la exclusión del hogar conyugal como medida cautelar autosatisfactiva en los procesos de familia / Maximiliano Camus – El régimen de comunicación de los hijos con el padre no conviviente : consecuencias y posibles soluciones de las denuncias por abuso sexual de uno de los padres contra el otro / Diego Iparraguirre – La anorexia : su relación con el art. 203 del Código Civil / María Elisa Petrelli ; María Egidia Galíndez – La lesión subjetiva y la ancianidad / María Elisa Petrelli de Aliano – Los tribunales de familia como operadores de crisis : entrevista con el Dr. Lucas C. Aón – Crecer persona / Enrique E. Fabbri SJ – In Memoriam -- Recensiones

Revista de Psicología, 2005, Vol. 1 N°1 (número completo)

Una aproximación al estudio de las relaciones interfuncionales entre la conciencia, la afectividad y la imaginación. El modelo de Vygotsky y el dualismo interaccionista / Gustavo Daniel Beláustegui -- La evaluación de la personalidad desde la perspectiva cognitiva: el proceso atribucional / Cristina Richaud de Minzi -- Los valores conyugales y familiares y la psicoterapia de las perturbaciones de la valoración / Francisco Abbate ; Héctor Carlos Dasso -- Fragilidad y Fiabilidad en las sociedades post-industriales / María Lucrecia Rovaletti -- Reflexiones sobre el diagnóstico de déficit de atención / Héctor Fulgenzi ; Patricia Ortiz Frágla ; Cecilia Coppolillo ; Viviana Massot ; Guillermo Thomas -- El abordaje psicoterapéutico de la Anorexia Nerviosa: técnica y artesanía / Eduardo Chandler -- Perspectiva de Tiempo Futuro, Valores, Instrumentalidad y Auto concepto entre los Adolescentes de las Escuelas Secundarias Privadas y Públicas y las Universidades en Lima / Willy Lens ; Dora Herrera -- Recensiones bibliográficas

A cátedra e a tribuna : sociologia, política e língua em Gilberto Freyre

Rastreia os pontos de contato e de afastamento entre duas atividades fundamentais na trajetória de Gilberto Freyre. Destas, uma é trabalho de praticamente toda a vida - a sociologia e a antropologia. A outra é atividade bissexta - a atuação parlamentar no período 1946/1950. Por um lado, tem-se que o trabalho do cientista é moroso e altamente reflexivo. A atividade parlamentar, ao contrário, é nervosa e na maioria das vezes perpassada dos sentimentos da hora. A linguagem empregada e os fins a que se destinam, aparentemente, são igualmente diversos. Verifica a pertinência ou não desses estereótipos, ou, ao contrário, se os pronunciamentos do deputado e a obra do acadêmico confluem em um ou mais aspectos.

Dieta berdeari eutsiz. Dietetika Orokorra eta Aplikatua

Duración (en horas): Más de 50 horas. Destinatario: Estudiante

Radiotherapy plus nimotuzumab or placebo in the treatment of high grade glioma patients: results from a randomized, double blind trial

Background The prognosis of patients bearing high grade glioma remains dismal. Epidermal Growth Factor Receptor (EGFR) is well validated as a primary contributor of glioma initiation and progression. Nimotuzumab is a humanized monoclonal antibody that recognizes the EGFR extracellular domain and reaches Central Nervous System tumors, in nonclinical and clinical setting. While it has similar activity when compared to other anti-EGFR antibodies, it does not induce skin toxicity or hypomagnesemia. Methods A randomized, double blind, multicentric clinical trial was conducted in high grade glioma patients (41 anaplastic astrocytoma and 29 glioblastoma multiforme) that received radiotherapy plus nimotuzumab or placebo. Treatment and placebo groups were well-balanced for the most important prognostic variables. Patients received 6 weekly doses of 200 mg nimotuzumab or placebo together with irradiation as induction therapy. Maintenance treatment was given for 1 year with subsequent doses administered every 3 weeks. The objectives of this study were to assess the comparative overall survival, progression free survival, response rate, immunogenicity and safety. Results The median cumulative dose was 3200 mg of nimotuzumab given over a median number of 16 doses. The combination of nimotuzumab and RT was well-tolerated. The most prevalent related adverse reactions included nausea, fever, tremors, anorexia and hepatic test alteration. No anti-idiotypic response was detected, confirming the antibody low immunogenicity. The mean and median survival time for subjects treated with nimotuzumab was 31.06 and 17.76 vs. 21.07 and 12.63 months for the control group. Conclusions In this randomized trial, nimotuzumab showed an excellent safety profile and significant survival benefit in combination with irradiation.

Talla 38

Duración (en horas): De 11 a 20 horas. Destinatario: Estudiante y Docente

O comportamento clínico e neurofisiológico da neuropatia durante os episódios reacionais da hanseníase

A hanseníase, uma doença conhecida por suas lesões de pele anestésicas, é a principal causa de neuropatia periférica nos países endêmicos. Os episódios reacionais são classicamente conhecidos por promover piora da função nervosa através das chamadas neurites que variam de quadros exuberantes a assintomáticos. Estas características da neuropatia tornam o diagnóstico precoce excepcionalmente desafiador assim como a necessidade de se intervir para se prevenir lesões permanentes nos nervos. Este estudo clínico, prospectivo, foi realizado selecionando-se pacientes com hanseníase, independente da forma clínica, no Ambulatório Souza Araujo, Fiocruz, Rio de Janeiro, que apresentavam episódios reacionais. O objetivo foi estudar o perfil neurológico clínico, eletroneurofisiológico e por imagem do nervo antes e após o tratamento das reações. Foram avaliados vinte e cinco pacientes levando-se em conta: exame neurológico, avaliação fisioterápica, estudo de condução nervosa, avaliação de espessura e ecogenicidade nervosa pelo método ultrassonográfico, fluxometria por laser Doppler e teste quantitativo da sensibilidade durante e um ano após o tratamento da reação. Estes pacientes foram divididos em três grupos: oito pacientes com neurite aguda, nove pacientes com neurite silenciosa e oito pacientes com reação cutânea sem neurite. Nos pacientes com episódios reacionais, observou-se predomínio do sexo masculino (60%), do grupo multibacilar (80%) e da forma clínica borderline-lepromatosa (36%). A neurite isolada foi o tipo de reação mais frequente, seguida de neurite associada à reação do tipo1, seguida da neurite associada à reação do tipo 2. O nervo motor mais acometido por neurite foi o fibular seguido pelo ulnar, enquanto o nervo sensitivo mais acometido foi o sural. O padrão eletroneuromiográfico característico dos episódios reacionais foi a mononeurite múltipla. A ultrassonografia, a fluxometria por laser Doppler e o teste quantitativo de sensibilidade, associados à clínica e ao estudo da condução nervosa, foram tidos como exames úteis para avaliação inicial e para acompanhar o tratamento dos episódios reacionais. Após o tratamento, foi constatada melhora nos parâmetros referentes à função motora, mas o mesmo não ocorreu para sensibilidade. Com esse estudo, observa-se a necessidade de acompanhamento multidiciplinar com exames especializados para os pacientes com hanseníase a fim de diagnóstico de reação e tratamento precoce evitando sequelas neurológicas.