Abstract Background: Data from the literature have suggested that bortezomib is the only effective agent in the treatment of plasma cell leukemia (PCL), a type of plasma cell dyscrasia characterized ...by poor prognosis despite conventional chemotherapy including autologous and allogeneic transplantation. Objective: This case series examined the antineoplastic activity of the bortezomib-based regimens in a small cohort of patients with PCL. Case summaries: We describe a retrospective review of the 3 cases of PCL diagnosed at Antonio Perrino Hospital, Brindisi, Italy, between July 2004 and October 2006 (2 women and 1 man, all white, ages 71, 64, and 42 years; 2 with primary PCL and 1 with secondary PCL). These patients were treated with bortezomib variously combined with other drugs outside of clinical trials. Patients 1 and 2 received bortezomib-based regimens (bortezomib 1.3 mg/m2 IV once daily on days 1, 4, 8, and 11; dexamethasone 20 mg IV once daily on days 1–4 and 8–11; oral cyclophosphamide 50 mg once daily on days 1–21, every 28 days) after 2 previous chemotherapeutic treatments. Patient 3 received a bortezomib-based regimen (bortezomib 1.3 mg/m2 IV once daily on days 1, 4, 8, and 11; doxorubicin 9 mg/m2 IV once daily on days 1–4; and dexamethasone 40 mg IV once daily on days 1–4, 8–11, and 15–18 during cycle 1 and days 1–4 during subsequent cycles) after one previous chemotherapeutic regimen. In all 3 patients, circulating plasma cells persisted. Patients 1 and 2 were not considered candidates for autologous peripheral blood stem cell transplantation (PBSCT) because of their nonresponse to the bortezomib-based regimens and severe deterioration of their clinical conditions (kidney and liver failure) due to disease progression. The overall survivals after administration of the bortezomib- based regimens were 4 months in patient 1 and 1 month in patient 2. After further treatment according to the modified protocol for patients with acute lymphatic leukemia (cyclophosphamide 800 mg/m2 IV on day 1 and 200 mg/m2 IV on days 2–5; vincristine 1.5 mg/m2 IV once daily on days 1, 8, and 15; doxorubicin 40 mg/m2 IV on day 1; methotrexate 1200 mg/m2 /h IV + 240 mg/m2 /h IV for 23 hours modified CODOX-M protocol) due to the unavailability of a human leukocyte antigen-identical donor, patient 3 received high-dose (200 mg/m2 ) melphalan with autologous PBSCT, obtaining partial remission lasting 9 months. The patient died 5 months later because of disease progression. Conclusion: These 3 patients with primary or secondary PCL who received a bortezomib-based regimen as rescue medication did not respond to treatment.
Surgical treatment of hydatidosis Loi, A; Mannu, B; Montisci, R ...
Annales chirurgiae et gynaecologiae,
1991, Letnik:
80, Številka:
1
Journal Article
Hydatidosis is particularly widespread in some geographic areas. Among these Sardinia presents one of the highest incidences. The authors examine the results obtained of 382 patients submitted to ...surgery between 1973 and 1989. The average age was 38.9 years. Liver involvement was observed in 215 cases, lung involvement in 167 cases, while localizations in other organs were rare. Forty liver cysts and 54 lung cysts were complicated preoperatively. The patients were submitted predominantly to total or subtotal cysto-pericystectomy (270 cases), parenchymal resection (75 cases), simple cystectomy (40 cases). Total postoperative mortality was 2.35%. Postoperative time was significantly shorter after cysto-pericystectomy and after parenchymal resection than after simple cystectomy. Patients suffering from multiple or complicated cysts were given supplementary chemotherapy.
Short-term heart rate variability (HRV) analysis in supine and tilting conditions is commonly performed using linear methods, while nonlinear techniques are usually applied to long-term time series. ...We investigated in post-myocardial infarction patients and normal subjects the changes induced by tilting on quantitative indexes derived from Poincare plots and symbolic dynamics patterns and compared these changes to those observed using classical spectral parameters. We found that Poincare indexes provide more sensitive information than spectral indexes in assessment of changes of cardiac autonomic outflow, following the tilting maneuver in post-MI patients and although symbolic dynamics indexes were not able to detect these changes, they clearly indicated a structurally different pattern of HRV between normal and pathological subjects.
Voluntary control of breathing (CB) has been proposed as a means to standardize short-term investigations on cardiovascular variability (CVV). In this study, we assessed the changes induced by CB on ...ventilatory and cardiovascular parameters in 17 chronic heart failure (CHF) patients. We recorded the instantaneous lung volume (ILV), R-R interval (RR), systolic arterial pressure (SAP) and end-tidal CO/sub 2/ (ETCO/sub 2/, 10 patients only) during 8 minutes of spontaneous breathing (SB) and 8 minutes of CB at 0.22 Hz. CB caused a 14% reduction in respiratory rate, a 57% increase in tidal volume, a 27% increase in minute ventilation and a 7% decrease in ETCO/sub 2/. A negligible change was observed in mean RR and SAP. No significant change was observed in the low-frequency (LF) power of RR and SAP and in baroreflex sensitivity, whereas the high-frequency (HF) power increased markedly. Hence, CB in CHF patients causes a mild hyperventilation but does not seem to influence autonomic cardiovascular control. Only respiratory-related oscillations of CVV signals are affected by CB.
Nonlinear analysis of HRV, particularly 1/f method and Poincare plots, has been recognized to provide valuable information for the prognostic stratification in cardiac patients. We analyzed 24h ECG ...Holter recordings in 75 CHF patients to assess (1) the correlation between power-law and both qualitative and quantitative indexes of abnormality of Poincare plots, and (2) the association between the two nonlinear indexes and hemodynamic function, exercise performance and neurohumoral activation. We found a clear association between 1/f slope and the visually-classified shape of Poincare patterns but just a poor correlation between 1/f indexes and morphological parameters of Poincare maps. Moreover 3D Poincare parameters were shown to be independently associated to plasma norepinephrine level, indicating that they "contain" the information of 1/f indexes and better explain norepinephrine variability.
Non-invasive baroreflex sensitivity (BRS) by the classical transfer function (TF) method very often cannot be assessed in chronic heart failure (CHF) patients, due to a lack of coherence between the ...heart period and the systolic pressure. On the grounds of a previous investigation, we devised a new BRS index based on the whole-band average (WBA) of the TF in the whole low-frequency band (WBA-BRS), which does not require a coherence check. In this study, we assessed the clinical relevance of this index by testing its prognostic value in a population of 149 CHF patients. During a 20/spl plusmn/ 2 months follow-up, 28 patients died or were urgently transplanted. The univariate relation of the WBA-BRS index with mortality was assessed by the Cox proportional hazards model, and survival functions were estimated using the Kaplan-Meier method. We also investigated the independent effect of WBA-BRS, adjusting for the NYHA (New York Heart Association) class, LVEF (left ventricular ejection fraction), peak V/sub O2/ and Na/sup +/. WBA-BRS showed a significant univariate association with the risk of cardiac events. When its predictive value was assessed in multivariate analysis, WBA-BRS displayed independent prognostic information (risk ratio=3.0, 95% confidence interval: 1.1-7.9, p=0.03). These preliminary data suggest that BRS assessed by a modified version of the classical TF method is a potential prognostic marker in CHF patients.
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