Tamoxifen may lead to bothersome side effects contributing to non-compliance and decreased quality of life. Patients searching for relief are increasingly turning to cannabinoids such as CBD-oil. ...However, CBD-oil might affect tamoxifen pharmacokinetics (PK) through CYP2D6 inhibition. The aims of this open-label, single-arm study were (1) to determine the PK profile of tamoxifen when using CBD-oil, and (2) to subsequently investigate whether CBD-oil has a beneficial influence on side effects. Study patients had to have steady-state endoxifen concentrations ≥16 nM (conservative threshold). PK sampling and side effect assessment was done at initiation of CBD-oil and 28 days thereafter. Bio-equivalence could be concluded if the 90% confidence interval (CI) for the difference in endoxifen AUC fell within the -20%; +25% interval. The effect of CBD-oil on side effects was evaluated using the FACT-ES questionnaire. Endoxifen AUC decreased after CBD-oil by 12.6% (n = 15, 90% CI -18.7%, -6.1%) but remained within bio-equivalence boundaries. The endocrine sub-scale of the FACT-ES improved clinically relevant with 6.7 points (n = 26, p < 0.001) and health-related quality of life improved with 4.7 points after using CBD (95% CI + 1.8, +7.6). We conclude that CBD-oil, if of good quality and with a dosage below 50 mg, does not have to be discouraged in patients using it for tamoxifen-related side effects. Clinical trial registration: International Clinical Trial Registry Platform (NL8786; https://www.who.int/clinical-trials-registry-platform ).
PURPOSE: Radiotherapy(RT) induced carotid artery vasculopathy and ischemic strokes are long-term complications after radiotherapy of the neck. The exact underlying pathofysiology of this RT induced ...atherosclerosis is not understood. The current study evaluated the presence and MRI characteristics of radiotherapy induced long-term carotid wall and cerebral complications in survivors of head and neck cancer (HNC). METHODS: Prospective multicenter long-term cohort study of 43 patients (mean age 60 years, SD 13) treated with RT of the neck because of head and neck cancer. Cerebrovascular risk factors were assessed at baseline (before RT). At follow-up (mean 7 years after RT) patients were evaluated with a MRA / MRI of the carotid arteries and the brain. First endpoint was frequency and characteristics (degree of stenosis, location, composition) of vessel wall changes. Secondary endpoints were frequency of white matter lesions, atrophy and (silent) brain infarctions. RESULTS: We found a vessel wall thickening in 55% of the irradiated common carotid arteries versus 18% in the non-irradiated. (p = 0.003). In the internal carotid arteries vessel wall thickening was found in 24% of the irradiated versus 6% of the non-irradiated arteries. (p = 0.02). Mean length of vessel wall thickening in the irradiated common and internal carotid arteries was 48.9 and 20 mm, respectively. In 50% of the irradiated common carotid arteries degree of stenosis was between 0 and 50%. MRI of the brain showed focal white matter lesions in 47% and mild atrophy in 33% of patients. CONCLUSION: Our study showed a significant increase in vessel wall changes on a long carotid segment in irradiated versus non-irradiated carotid arteries with a follow-up of 7 years after radiotherapy. An important proportion of patients also had intracranial vascular brain changes.
Pigtail stent for gallbladder drainage Boogerd, L S F Noor; Perk, Lars E; van Acker, Gijs J D
Nederlands tijdschrift voor geneeskunde,
2014, Letnik:
158
Journal Article
Endoscopic transpapillary gallbladder drainage is a new, relatively non-invasive treatment for patients with symptomatic gallbladder disease and a high surgery risk. Placement of an internal pigtail ...stent is an alternative treatment for percutaneous gallbladder drainage. This procedure can be performed in patients with a temporary contra-indication - in preparatory process to a cholecystectomy - as well as in patients with a prolonged contra-indication where the pigtail stent can remain in situ for a longer period of time. This technique appears to be an effective and safe procedure for patients with acute cholecystitis or symptomatic gallbladder disease and a high surgery risk.
INTRODUCTION: Carotid artery vasculopathy is a long-term complication of radiotherapy (RT) of the neck with an increased risk of cerebrovascular events. We investigated the change in carotid Intima ...Media Thickness (IMT) and the incidence of ischemic stroke in the first 7 years after RT. METHODS: We conducted a multicentre prospective cohort study among patients treated for Head and Neck Cancer (HNC). We assessed carotid Intima Media Thickness at baseline before and after RT with a median follow-up of 7 years. We also assessed cerebrovascular risk factors and incident vascular events. RESULTS: 48 HNC patients underwent IMT measurement at baseline and follow-up (median age 61 years, range 29-87). Mean IMT of the irradiated common carotid arteries was 0.64 mm at baseline and 0.74mm at follow-up (p = 0.002 for change). Mean delta IMT in the irradiated versus non-irradiated common carotid arteries was 0.11 and 0.02 mm (p = 0.03 for difference), respectively. In a subgroup of unilaterally irradiated patients mean change in common carotid IMT from baseline to follow-up was 0.06 mm in the irradiated artery and 0.02 mm in the non-irradiated artery (p = 0.18 for difference). Within a mean follow-up of 3 years after radiotherapy 10 patients had an ischemic event. In these patients mean common carotid IMT increase was 0.08 mm. CONCLUSION: Our study showed an increase in IMT in irradiated carotid arteries in the first 7 years after treatment of HNC, which was significantly larger than in non-irradiated arteries. Patients treated with RT for HNC have a high risk of future stroke. This knowledge needs to be used to improve diagnostic and preventive strategies.
PURPOSE: Radiotherapy(RT) induced carotid artery vasculopathy and ischemic strokes are long-term complications after radiotherapy of the neck. The exact underlying pathofysiology of this RT induced ...atherosclerosis is not understood. The current study evaluated the presence and MRI characteristics of radiotherapy induced long-term carotid wall and cerebral complications in survivors of head and neck cancer (HNC). METHODS: Prospective multicenter long-term cohort study of 43 patients (mean age 60 years, SD 13) treated with RT of the neck because of head and neck cancer. Cerebrovascular risk factors were assessed at baseline (before RT). At follow-up (mean 7 years after RT) patients were evaluated with a MRA / MRI of the carotid arteries and the brain. First endpoint was frequency and characteristics (degree of stenosis, location, composition) of vessel wall changes. Secondary endpoints were frequency of white matter lesions, atrophy and (silent) brain infarctions. RESULTS: We found a vessel wall thickening in 55% of the irradiated common carotid arteries versus 18% in the non-irradiated. (p = 0.003). In the internal carotid arteries vessel wall thickening was found in 24% of the irradiated versus 6% of the non-irradiated arteries. (p = 0.02). Mean length of vessel wall thickening in the irradiated common and internal carotid arteries was 48.9 and 20 mm, respectively. In 50% of the irradiated common carotid arteries degree of stenosis was between 0 and 50%. MRI of the brain showed focal white matter lesions in 47% and mild atrophy in 33% of patients. CONCLUSION: Our study showed a significant increase in vessel wall changes on a long carotid segment in irradiated versus non-irradiated carotid arteries with a follow-up of 7 years after radiotherapy. An important proportion of patients also had intracranial vascular brain changes.
Aleman et al remark on Longo's recent editorial regarding their article on the increased risk of stroke and transient ischemic attack following Hodgkin lymphoma. Longo criticized the use of ...radiotherapy in the treatment of Hodgkin lymphoma and stated that chemotherapy is as effective as combined modality treatment and proven to be safe. They argue that Longo overestimated the efficacy of chemotherapy alone in the treatment of Hodgkin lymphoma while at the same time underestimating the toxicity of this treatment. On the other hand, Longo expresses that as a practical matter, even if one grants the unproven assertion that combined modality therapy is more effective than chemotherapy alone in early-stage Hodgkin's disease, it's clear from the meta analysis that the margin is 10% or less.
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