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Effects of anti-neoplastic therapy on tooth and bone formation : clinical and experimental studies /Näsman, Margareta, January 1900 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.
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Kardiotoksični efekat hemioterapije kod obolelih od nemikrocelularnog karcinoma bronha sa uznapredovalim stadijumom bolesti / Cardiotoxic effects of chemotherapy in patients with advanced non-small cell lung cancerBursać Daliborka 24 March 2015 (has links)
<p>Hemioterapija koja se koristi za lečenje karcinoma utiče i na kardiovaskularni sistem. Ciljevi istraživanja su: u tvrditi uticaj kardiotoksičnosti na reživljavanje bolesnika sa uznapredovalim stadijumom NSCLC; utvrditi učestalost pojave kardiotoksičnosti kod bolesnika koji su lečeni hemioterapijom prve linije (gemcitabin/cisplatin i paclitaxel/carboplatin) sa i bez prethodnih kardiovaskularnih oboljenja i utvrditi učestalost pojave kardiotoksičnosti u toku primene protokola docetaxel/cisplatin kao hemioterapije druge linije, u odnosu na primenu protokola gemcitabin/ cisplatin i paclitaxel/carboplatin, kao terapije prve linije. Istraživanjem je obuhvaćeno 270 bolesnika sa citološki ili patohistološki dokazanim NSCLC kliničkog stadiju ma III i IV. Dobijeni su rezultati koji ukazuju da je preživljavanje bolesnika u III i IV stadijumu NSCLC koji su imali pojavu kardiotoksičnosti tokom hemioterapije prve i druge linije kraće u odnosu na bolesnike bez pojave kardiotoksičnosti, sa statističkom značajnošću nakon prvog, drugog, četvrtog ciklusa hemioterapije i nakon šest meseci (p=0.004, p=0.020, p=0.030 i p<0.0005. respektivno). Kardiotoksičnost kod bolesnika u III i IV stadijumu NSCLC koji su primali hemioterapiju prve linije prema protokolu gemcitabin/cisplatin se češće javila ukoliko su imali prethodne kardiovaskularne bolesti, ali statistička značajnost nije utvrđena. Kardiotoksičnost kod bolesnika u III i IV stadijumu NSCLC koji su primali hemioterapiju prve linije prema protokolu paclita xel/carboplatin se češće javila ukoliko su imali prethodne kardiovaskularne bolesti, a statistička značajnost utvrđena prilikom prvog kontrolnog pregleda kod bolesnika u III stadijumu (p=0.037). Kod bolesnika u III i IV stadijumu NSCLC koji su primali hemioterapiju prve linije prema protokolima gemcitabin/cisplatin paclitaxel / carboplatin kardiotoksičnost se češće javila ukoliko su imali prethodna kardiovaskularna oboljenja, ali je statistička značajnost ustanovljena samo pri prvom kontrolnom pregledu , (p=0.022). Kod bolesnika koji su primali hemioterapiju druge linije kardiotoksičnost značajno češće javila u toku prvog ciklusa hemioterapije (p=0.049) u odnosu na bolesnike koji su primali hemioterapiju prve linije. Kod bolesnika koji su imali prethodne kardiovaskularne bolesti u toku druge linije hemioterapije kardiotoksičnost se statistički značajno češće javila u odnosu na prvu liniju hemioterapije u toku četvrtog ciklusa hemioterapije (p=0.020). Uspostavljanje ravnoteže između efektivnosti hemioterapije i rizika od oštećenja kardiovaskularnog sistema zahteva blisku saradnju onkologa i kardiologa , sa ciljem kreiranja individualne terapije za svakog bolesnika.</p> / <p>Lung cancer chemotherapy affects the cardiovascular system as well. The research objectives were to establish: the effects of cardiotoxicity on the survival of advanced NSCLC patients; the frequency of cardiotoxicity in the patients treated with the first - line chemotherapy (gemcitabine/cisplatin and paclitaxel/carboplatin), with or without the history of cardiovascular comorbidities, and the frequency of cardiotoxicity registered in the course of the second - line chemotherapy with docetaxel/cisplatin, as compared to the first - line chemotherapy with gemcitabine/cisplatin and paclitaxel/carboplatin. The investigation included 270 patients with citologically or histopathologically confirmed NSCLC at the clinical stages III and IV. The obtained research results suggest the patients with stage III and IV NSCLC who developed cardiotoxicity in the course of the first – and second - line chemotherapy had a shorter survival than those without cardiotoxicity, with the statistical significance registered after the first, second, and fourth chemotherapy course, as well as six months later (p=0.004, p=0.020, p=0.030 and p<0.0005 respectively). Stage III and IV NSCLC patients receiving the first - line chemotherapy with gemcitabine/cisplatin developed cardiotoxicity more frequently if they had a former history of cardiovascular diseases, but with no statistical significance registered. Stage III and IV NSCLC patients on the first - line chemotherapy protocol with paclitaxel/carboplatin developed cardiotoxicity more frequently if they had a former history of cardiovascular diseases, and the statistical significance was registered at the first control examination in stage III NSCLC patients (p=0.037). Stage III and IV NSCLC patients receiving the first-line chemotherapy protocols with gemcitabine/cisplatin and paclitaxel/carboplatin developed cardiotoxicity more frequently if they had former cardiovascular diseases, but the statistical significance was registered at the first control examination only, one month after chemotherapy application (p=0.022). The patients receiving the second - line chemotherapy developed cardiotoxicity much more often during the first chemotherapy course (p=0.049), as compared to the patiens receiving the first - line chemotherapy. Among the patients with a former history of cardiovascular diseases, those receiving the second – line chemotherapy developed cardiotoxicity during the fourth chemotherapy course significanly more freequently than the patients on the same course of the first-line chemotherapy (p=0.020). To achieve the balance between chemotherapy efficacy and the risk of the cardiovascular system damage requires a close cooperation of an oncologist and a cardiologist, aimed at designing a unique, individual therapy for each patient.</p>
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Omissão do segundo dia da medicação antiemética como estratégia para a redução do custo da profilaxia de náuseas e vômitos induzidos por quimioterapia: resultados de um estudo fase III / The omission of day 2 of Antiemetic Medications is a cost saving strategy for improving chemotherapy-induced nausea and vomiting control: Results of a randomized phase III trialLajolo, Paula Philbert [UNIFESP] 30 July 2008 (has links) (PDF)
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Publico-10756.pdf: 198016 bytes, checksum: b1b248dd88de1aeab5859b81fa05e4c2 (MD5) / INTRODUÇÃO: Os antagonistas 5HT-3 e corticosteróides são drogas importantes no controle da emese induzida por quimioterapia Apresentam controle de 50-80% da emese aguda porém controlam menos de 50% da emese tardia induzida por quimioterapia. Em estudo prévio realizado em nossa instituição, observou-se que o controle da emese tardia poderia ser melhorado com a omissão do segundo dia dos antagonistas 5HT-3. Reportamos aqui os resultados de um estudo fase III confirmando os achados prévios PACIENTES E MÉTODOS: Estudo fase III randomizado e duplo-cego foi realizado na FMABC Santo André/Brasil. Pacientes submetidos a esquemas quimioterápicos alta e moderadamente emetogênicos pela 1ª vez receberam Ondasetron 16mg e Dexametasona 20 mg IV antes da quimioterapia no Dia 1. Foram então randomizados em dois grupos. Grupo A recebeu metoclopramida VO 10mg 8/8hs, Granisetron VO 0,5mg/dia,e dexametasona VO 8mg /dia por 2 dias, a partir do dia 2 (dias 2 e 3). Metoclopramida VO 10 mg 8/8 hs foi continuada no dia 4. Grupo B recebeu placebo no dia 2 e o mesmo esquema de drogas dia 3 e dia 4. Pacientes foram entrevistados no dia 1 e dia 6. RESULTADOS: 73 pacientes foram incluídos no estudo. Os grupos foram bem balanceados em relação as suas características clinicas com exceção ao melhor controle da emese aguda no grupo A (p=0,04). Proteção completa de náuse a e vômito tardios (do dia 2 ao 5 ), foi semelhante em ambos os grupos (30% vs. 32%; p=0.5). Em análise multivariada, tanto a proteção completa da emese aguda (p=0.001) quanto grupo de estudo (p=0.06) estavam independentemente relacionados à proteção completa da náusea e vômito tardios. Selecionando apenas os pacientes que obtiveram controle completo da emese na fase aguda, pacientes do grupo B obtiveram maior proteção da emese tardia (85% vs 50% ,p=0,02). CONCLUSÃO: A omissão da medicação antiemética no dia 2 representa uma estratégia para redução do custo da profilaxia da emese tardia induzida pela quimioterapia. / BACKGROUND: Nausea and vomiting are important symptoms observed in cancer patients. In a previous study we showed that delayed chemotherapyinduced nausea and vomiting (CINV) control could be potentially improved by skipping the administration of a 5HT3-antagonist on day 2. We report here a trial confirming our previous findings. PATIENTS/METHODS: A phase-IIIrandomized- placebo-controlled trial was conducted in which patients received (IV) ondansetron 16mg, dexamethasone 20mg and ranitidine 50mg before highly/moderately emetogenic chemotherapy (day 1).Starting on day 2, all patients received metoclopramide 10mg PO q8 hours (days 2,3 and 4, Dexamethasone 8mg QD (days 2 and 3) and Ranitidine 150mg q12 hours (days 2 and 3). Patients were randomized to receive either Granisetron 0.5mg PO (days 2 and 3) (Group A) or Placebo instead for Granisetron on day 2 and Granisetron 0.5mg on day 3 and 4 (Group B) RESULTS: 73 patients were enrolled. Groups were similar regarding clinical characteristics, despite better control during the acute phase of CINV in group A (p=0.04). Complete delayed protection from nausea/vomiting (DCPNV) from day 2 to 5 was similar in both groups. (30% vs. 32%; p=0.5). Analyzing DCPNV by logistic regression multivariate analyses, acute complete protection from nausea/vomiting (ACPNV) (p=0.001) and study group (p=0.06) were independently associated with DCPNV. Selecting patients who achieved ACPNV, we observed that group B had a superior DCPNV (85% vs 50%, p=0.02). CONCLUSION: DCPNV can be improved just by skipping day 2 of 5HT3- antagonists. Future studies should compare this inexpensive strategy with NK1- antagonists or second generation 5HT3-antagonists. Key words: delayed chemotherapy-induced nausea and vomiting, tachyphylaxis, cost- saving regimen, antiemetics, Granisetron/administration and dosage. / TEDE / BV UNIFESP: Teses e dissertações
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