Brief psychiatric hospitalization of borderline patients is often necessary to avert the disintegration of therapy and the likelihood of suicide. Such hospitalization almost inevitably arouses ...intense countertransference reactions in therapists and other hospital staff members. If properly used, these reactions provide a significant opportunity to achieve change in a patient's underlying character disturbance. The author presents a detailed case report of a patient's 3 1/2-week hospitalization to illustrate how efforts to work through a transference-countertransference impasse prevented the premature dissolution of the patient's outpatient psychotherapy.
Abstract only
2052
Background: MGMT methylation status has been found to be an important prognostic factor in glioblastoma patients (pts). However, further data on the epigenetic feature are needed ...before its role in rare diseases such as anaplastic astrocytomas (AA) can be established. Methods: A retrospective analysis was made on a database of 139 AA pts followed prospectively from January 1995 and August 2008. We evaluated only pts who met the following inclusion criteria: age >18 years; PS 0–2; histological diagnosis of AA; postoperative radiotherapy (RT) and chemotherapy (CT). MGMT status was determined with methylation specific PCR. The study aim was to evaluate the role of MGMT methylation status in AA. The log-rank test was employed to evaluate the significance of the prognostic variables. Results: 80 pts (m/f: 46/34, median age: 41 years, range: 18–71 years) were enrolled. MGMT was assessable in 71 of 80 pts (88.8%), being methylated in 30 (42.9%), and unmethylated in 41 (57.7%) pts. Median PFS was 48.6 months (95% CI: 33.7 - 63.5), being 96 months (95% CI: 29–163) and 38 months (95%CI: 18.9–57.2) in MGMT methylated and unmethylated pts, respectively (p = 0.09). At univariate analysis, complete resection (p = 0.02), age (p = 0.002), and KPS (p = 0.003) were significantly correlated with PFS. At multivariate analysis only age remains correlated with PFS (p = 0.01). Median survival (OS) was 93.7 months (95% CI: 63.5–123.8), being not reached and 77 months (95% CI: 20–134.2), in MGMT methylated and unmethylated pts, respectively (p = 0.03). MGMT methylation (p = 0.03), age (p = 0.0003), and KPS (p = 0.03) were significantly correlated with OS at univariate analysis. At multivariate analysis, age (p = 0.0002) and MGMT methylation (p = 0.01) were correlated with a better OS. Conclusions: MGMT methylation status is an independent prognostic factor together with age in AA. This datum should provide the background to improve the therapeutic index with temozolomide concurrent with and adjuvant to RT in AA.
No significant financial relationships to disclose.
Background
In immunosuppression after transplantation, several multi-drug approaches are used, involving calcineurin inhibitors (
CNI: tacrolimus-TAC or cyclosporine-CsA
), antimetabolites (
antiMs
...), mammalian target of rapamycin inhibitors (
mTORis
), and corticosteroids. However, data on immunosuppressive therapy by organ and its space–time variability are lacking.
Methods
An Italian multicentre observational cohort study was conducted using health information systems. Patients with incident transplant during 2009–2019 and resident in four regions (Veneto, Lombardy, Lazio, and Sardinia) were enrolled. The post-transplant immunosuppressive regimen was evaluated by organ, region, and year.
Results
The most dispensed regimen was triple-drug therapy for the kidneys tacrolimus (TAC) + antiM + corticosteroids = 41.5% and heart cyclosporin + antiM + corticosteroids = 36.6% and double-drug therapy for liver recipients (TAC + corticosteroids = 35.4%). Several differences between regions and years emerged with regard to agents and the number of drugs used.
Conclusion
A high heterogeneity in immunosuppressive therapy post-transplant was found. Further studies are needed in order to investigate the reasons for this variability and to evaluate the risk–benefit profile of treatment schemes adopted in clinical practice.
To assess the short-term effects of a methylxanthine (doxofylline) on respiratory mechanics in mechanically ventilated patients
with airway obstruction and respiratory failure, nine consecutive ...patients were examined within three days from the onset
of mechanical ventilation. Flow, changes in pulmonary volume, and Paw were measured using a ventilator (Servo 900C). End-expiratory
and end-inspiratory airway occlusion was performed to measure PEEPi, Cstrs, Rrsmax, and Rrsmin. Measurements were performed
before and at 5, 15, and 30 minutes after an intravenous loading dose of doxofylline (5 to 6 mg/kg). We found that doxofylline
determined, on the average, a marked decrease in respiratory resistance (Rrsmax and Rrsmin, -27.2 percent and -36.5 percent,
respectively) without significant changes in Cstrs and Pmax. The PEEPi, reflecting pulmonary dynamic hyperinflation, was also
significantly decreased by doxofylline (-41 percent, on the average). The Pmax was not reliable for evaluation of a single
patient, since changes in the elastic pressure can offset changes in the resistive one. No patient experienced significant
side effects due to doxofylline. We conclude that (1) the effects of therapy can be assessed noninvasively at bedside in critically
ill patients; (2) doxofylline is a rapid and efficient bronchodilator in mechanically ventilated patients with ARF and airflow
obstruction; and (3) the decrease in the respiratory resistance and PEEPi, associated with an improved mechanical efficiency
of the respiratory muscles at a lower pulmonary volume, can provide better conditions for the patient-ventilator interaction
and for weaning.
Abstract only
18015
Background: There is increasing evidence that the expression of Cyclo-oxygenase 2 correlates with development and progression of malignant melanoma. Celecoxib (C) has demonstrated ...some kind of activity in monotherapy in melanoma. Temozolomide (T) has consistent activity in melanoma, either as monotherapy or in combination. We designed a phase II study to determine the efficacy and toxicity of the combination of Celecoxib and Temozolomide in advanced melanoma as first line of therapy Methods: From January 2004 to October 2005, 13 patients with metastatic melanoma were enrolled in the study. There were 4 males and 9 females. The median age was 59 years. Patients received Temozolomide 200/mg/mq day po for 5 days every 4 weeks and Celecoxib 400 mg BID for 10 days every 4 weeks. Results: Among 12 evaluable patients there were 4 partial responses (30.8%), no complete response or disease stabilization. Progression occurred in 8 patients (61.5%). The median TTP was 3.14 months and the median survival was 9.06 months. The median number of cycles was 2, only 2 patients completed four cycles of treatment. Most commonly seen toxicities were nausea/vomiting (46%), fatigue (93%), thrombocytopenia (15.3%), leukopenia (7.6%). Two patients discontinued the treatment due to grade 4 thrombocytopenia. Conclusions: The combination of Temozolomide and Celecoxib is safe, manageable and provides clinical benefit, but its activity is not superior to standard therapy.
No significant financial relationships to disclose.
Fourteen consecutive ARDS patients were examined within 24 h from the onset of mechanical ventilation to determine respiratory resistance (Rrs) and compliance (Cstrs), and to assess the influence of ..."intrinsic" positive end-expiratory pressure (PEEPi) on the measurement of Cstrs. Flow, pressure, and changes in lung volume were measured with the transducers of the Servo 900C Siemens ventilator. Airway occlusion was performed with the end-inspiratory and end-expiratory buttons of the ventilator. We found PEEPi (3.0 +/- 2.6 cm H2O) in ten of the fourteen patients. Without the correction for PEEPi, Cstrs was underestimated by 13.9 +/- 10% on average in the group as a whole (fourteen patients), and by 19.5 +/- 5.9% in the ten ARDS patients with PEEPi. Maximum and minimum respiratory resistance (Rrsmax and Rrsmin), and frequency-dependence of Rrs were also measured. On average, there was a marked frequency-dependence of resistance, as manifested by the difference between Rrsmax and Rrsmin, with an increase of both Rrsmin (7.7 +/- 4.2 cm H2O.l-1.s) and Rrsmax (14.3 +/- 5.0 cm H2O.l-1.s). The added resistance of the endotracheal tubes and ventilator tubings was flow dependent, and averaged 13.2 +/- 2.9 cm H2O.l-1.s.
Acute respiratory failure Poggi, R; Masotti, A; Rossi, A
Monaldi archives for chest disease
49, Številka:
6
Journal Article
Recenzirano
Respiratory failure is a severe impairment of pulmonary gas exchange, consequence of lung failure leading to hypoxaemia and/or pump failure causing hypercapnia. Acute respiratory failure (acute lung ...injury and asthma) or acute on chronic respiratory failure (COPD and chest wall disorders) are the two terms proposed to characterize different onset and development. Mechanical ventilation, is often a necessary life-saving treatment in many critically ill patients, it is associated with complications such as infection or barotrauma. Other innovative techniques are mask ventilation and proportional assist ventilation (PAV). The major aim of mask ventilation is to prevent complications related to tracheal intubation, particularly respiratory tract infections and barotrauma.
The aim of this study was to investigate the activity and safety of vinorelbine in patients with low performance status. From March 1992 to June 1993 we studied 14 untreated patients with Stage IV ...non-small-cell lung cancer (NSCLC) and a "performance status" lower than 70% of the Karnofsky score. Treatment was by means of an intravenous administration of vinorelbine (30 mg.m-2) repeated weekly. On the whole, the toxicity was mild. Of 150 cycles administered, we observed 10 cases of Grade 3 leucopenia and 4 cases of Grade 4 leucopenia. A peripheral neurotoxicity (Grade 2-3) was reported in two patients. The objective response rate was 36% partial response. Our data suggest that vinorelbine could be an active and safe treatment for those patients who cannot receive polychemotherapy because of low performance status, and justify further larger studies comparing vinorelbine, either as a single agent or in combination, to other analogues or to assess its efficacy in supportive care.
