scholarly journals Temozolomide hypersensitivity – A story of success

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv18-iv19
Author(s):  
Lanka Alagiyawanna ◽  
Stephanie Prince ◽  
Debbie Wright ◽  
Enrico Clarke ◽  
Jeng Ching
Keyword(s):  
Treatment Options ◽  
Treatment Interruption ◽  
Tumour Resection ◽  
Diffuse Astrocytoma ◽  
Who Grade ◽  
Once Daily ◽  
The Third ◽  
Primary Brain Tumours ◽  
Radiological Response ◽  
A Minor

Abstract Aims Background: Temozolomide is an oral chemotherapy drug widely used in the treatment of glial tumours. This is generally well tolerated however, immediate and delayed hypersensitivity reactions have been described, necessitating treatment interruption that could significantly impact survival. Method Case description: We report a case of a 39-year-old young woman with WHO grade 2 IDH1mutant diffuse astrocytoma (MGMT promoter methylated) of the left temporal lobe. She had tumour resection in 2012 followed by radical radiotherapy. Afterwards, she had close surveillance with regular brain imaging. The tumour started to progress in early 2020. We agreed to commence on temozolomide to control tumour growth. She developed an itchy rash with easy bruising towards the end of the first cycle. It responded to a course of prednisolone. We proceeded with the second cycle and she developed a worsening rash on the third day. However she did not have signs or symptoms of anaphylaxis. This episode was again managed by a course of steroids and oral antibiotics. Since Temozolomide was the optimal treatment to control the disease progression at this stage, we agreed to persevere with temozolomide using a rapid desensitisation protocol. Results On the first day of third cycle, she was brought to the day chemotherapy unit and given prednisolone 30mg, fexofenadine 180mg and ondansetron 8mg, 30 minutes before the treatment. Our protocol was as follows; 5mg, 10mg, 20mg, 30mg, 50mg and 90mg of temozolomide at an interval of 30 minutes between the doses. She was advised to follow the same regime for the next four days of the third cycle. On days 6 -28, she has been advised to take fexofenadine 180mg once daily. Although there was a minor rash appeared on days 6/7, they subsided gradually. She tolerated the treatment without sinister symptoms or signs. We proceeded with the next 4 chemotherapy cycles adhering to the same protocol. The intensity of the rash gradually improved, and she became almost completely asymptomatic by the 7th cycle. It was also encouraging to see the radiological response of the tumour with the treatment. Conclusion Although the published literature is minimal, rapid desensitisation is shown to be a safe and effective method to counteract temozolomide hypersensitivity. In an era where there is still a paucity of systemic treatment options for primary brain tumours, adopting rapid desensitisation to induce tolerability to temozolomide, a drug which has shown to improve survival, would be a valuable addition in managing our patients. Further, our experience suggests that this protocol is safe, effective, and does not necessitate inpatient admission.

scholarly journals Ecological Effects of Perorally Administered Pivmecillinam on the Normal Vaginal Microflora

2005 ◽  
Vol 49 (1) ◽  
pp. 170-175 ◽  
Author(s):  
Åsa Sullivan ◽  
Aino Fianu-Jonasson ◽  
Britt-Marie Landgren ◽  
Carl Erik Nord
Keyword(s):  
Escherichia Coli ◽  
Candida Albicans ◽  
Antimicrobial Agents ◽  
Ecological Impact ◽  
Menstrual Cycles ◽  
The Third ◽  
Vaginal Microflora ◽  
Normal Microflora ◽  
Facultative Anaerobic ◽  
A Minor

ABSTRACT The knowledge of the effects of antimicrobial agents on the normal vaginal microflora is limited. The objective of the present study was to study the ecological impact of pivmecillinam on the normal vaginal microflora. In 20 healthy women, the estimated day of ovulation was determined during three subsequent menstrual cycles. Microbiological and clinical examinations were performed on the estimated day of ovulation and on day 3 in all cycles and also on day 7 after ovulation in cycles 1 and 2. Anaerobic and facultative anaerobic gram-positive rods, mainly species of lactobacilli and actinomycetes, dominated the microflora. One woman was colonized on the third day of administration with a resistant Escherichia coli strain, and Candida albicans was detected in one woman on days 3 and 7 in cycle 2. No other major changes in the normal microflora occurred during the study. Administration of pivmecillinam had a minor ecological impact on the normal vaginal microflora.

scholarly journals Current Treatment Options in CLL

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2468
Author(s):  
Moritz Bewarder ◽  
Stephan Stilgenbauer ◽  
Lorenz Thurner ◽  
Dominic Kaddu-Mulindwa
Keyword(s):  
Treatment Options ◽  
Current Treatment ◽  
Lymphocytic Leukemia ◽  
Minor Role ◽  
Targeted Agents ◽  
Advantages And Disadvantages ◽  
New Therapeutic Approaches ◽  
Phosphoinositide 3 Kinase ◽  
Anti Cd20 ◽  
A Minor

After impressive developments in recent years with the rise of new targeted agents, chemoimmunotherapy (CIT) only plays a minor role in the treatment of patients with chronic lymphocytic leukemia (CLL). Inhibitors of the Bruton tyrosine kinase (BTK), such as ibrutinib or more recently acalabrutinib, are highly effective, even in poor-risk or chemo-refractory patients. Venetoclax, an inhibitor of the anti-apoptotic BCL2 protein and, to a lesser extent, phosphoinositide-3 kinase (PI3K) delta inhibitors, add to the armamentarium of targeted agents for the treatment of CLL. Furthermore, anti-CD20 monoclonal antibodies are used very successfully either alone or in combination with BTK, BCL2 or PI3K inhibitors. Despite these advances, there is still an ongoing pursuit for new therapeutic approaches in the treatment of CLL. An even bigger challenge poses the determination of the optimal combination and sequence of those drugs. Here, we give an overview of current treatment options in CLL, weighing the advantages and disadvantages of each approach in the light of different clinical settings.

Fiddly Fives: Management of Impacted Second Premolars

Dental Update ◽  
2021 ◽  
Vol 48 (5) ◽  
pp. 385-392
Author(s):  
Othman Hameed ◽  
Elizabeth Crawford ◽  
Nigel G Taylor
Keyword(s):  
Treatment Planning ◽  
Clinical Relevance ◽  
Treatment Options ◽  
Third Molar ◽  
Maxillary Canine ◽  
The Third ◽  
Topic Knowledge ◽  
Assessment And Treatment ◽  
General Dentists

Second premolars are the third most likely teeth to be affected by impaction after third molar and maxillary canine teeth. Although the presence of an impacted second premolar is relatively common, and is a situation that often presents to general dentists in practice, there is relatively little published regarding this topic. Knowledge of this condition is essential for all those involved with the management of these cases. This article explores the aetiology, assessment and treatment options available to manage this condition, using examples from cases treated within our department. CPD/Clinical Relevance: An understanding of the aetiology, assessment and various treatment options available to manage impacted second premolars will inform better treatment planning.

scholarly journals The Expression of Progesterone Receptors in Meningiomas of Different Grades

2019 ◽  
Vol 8 (2) ◽  
pp. 65-69
Author(s):  
Mohammad Tahir ◽  
Tehreem Atif ◽  
Summaya Sohail ◽  
Arfa Nawazish ◽  
Huma Mushtaq
Keyword(s):  
Progesterone Receptor ◽  
Treatment Options ◽  
Progesterone Receptors ◽  
Lower Grade ◽  
Immunoperoxidase Method ◽  
Nuclear Staining ◽  
Who Grade ◽  
Grade Ii ◽  
Who Grade Iii ◽  
Grade Iii

Background: Meningiomas are slow growing intracranial and intraspinal neoplasms with a tendency to recur locally. WHO grades them as I (benign), II (atypical) and III (anaplastic) in order of their increasing aggressiveness, based on histological parameters and brain parenchymal invasion. Progesterone receptors (PR) are more prevalent amongst the lower grade meningiomas. The objective of this study was to determine the immunohistochemical expression of progesterone receptors in meningiomas of different grades.Material and Methods: A total of 100 cases were selected over a period of 2.5 years. Three to five microns’ thick sections stained with Hematoxylin and Eosin were examined microscopically by a team of two Histopathologists and graded into grades I, II and III, according to 2016 WHO classification criteria. Another section of the original tumor was stained with progesterone receptor antibody using the conventional immunoperoxidase method. Stained slides were than examined by the same team of Histopathologists and declared positive (if nuclear staining was observed in more than 10% of tumor cells) or negative. Statistical analysis was done using SPSS version 21.Results: Out of a total of 100 cases of meningioma, there were 79 cases of benign/typical WHO grade I, 15 cases of atypical/ WHO grade II and 6 cases of anaplastic/ WHO grade III tumor. PR status was positive in 89.8 % (71/79) of grade I meningiomas and 46.6 % (7/15) of grade II/Atypical meningiomas. The 06 cases of Anaplastic/WHO grade III tumors were negative for PR. There was a higher prevalence of Progesterone receptors in female patients (89.8%; 53/59) as compared to male meningioma patients (60.9%; 25/41).Conclusion: We observed a decreased expression of progesterone receptor in higher grades of meningioma in this study. It is an effort to explore conservative treatment options for inoperable lesions, as anti-progesterone therapy may hold a promise as a new treatment option in the near future.

scholarly journals Wilkie’s Syndrome Following Weight Loss in a Trauma Patient

2020 ◽  
pp. 1-3
Author(s):  
George Oosthuizen ◽  
George Oosthuizen
Keyword(s):  
Weight Loss ◽  
Trauma Patient ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Treatment Options ◽  
Rare Condition ◽  
Feeding Tube ◽  
Significant Weight Loss ◽  
The Third ◽  
Wilkie’S Syndrome

Wilkie’s syndrome, or superior mesenteric artery syndrome, is a rare condition of duodenal obstruction caused by compression of the superior mesenteric artery on the third part of the duodenum. The diagnosis should be considered in a patient who has experienced significant weight loss and now presents with persistent vomiting, especially if the vomiting occurs with the patient in the supine position and is alleviated by the lateral or prone position. The diagnosis can be confirmed by imaging studies demonstrating compression of the third part of the duodenum, and the main aim of treatment should be to pass a feeding tube beyond the point of obstruction to allow enteral feeding. The condition improves spontaneously with weight gain. Further treatment options include parenteral feeding and operative bypass in select cases. Here we present a case of Wilkie’s syndrome in a trauma patient with significant weight loss, together with a review of the literature on this interesting topic.

scholarly journals CTNI-22. RETROSPECTIVE ANALYSIS OF THE COMBINED TREATMENT OF VINCRISTINE, ACNU, CARBOPLATIN AND INTERFERON-β PLUS RADIOTHERAPY (VAC-FERON-R)IN PATIENTS WITH DIFFUSE ASTROCYTOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii47-ii47
Author(s):  
Yoshiki Arakawa ◽  
Yasuhide Makino ◽  
Takeshi Kawauchi ◽  
Masaharu Tanji ◽  
Yohei Mineharu ◽  
...  
Keyword(s):  
Combined Treatment ◽  
Diffuse Astrocytoma ◽  
Wild Type ◽  
Interferon Β ◽  
Mutant Type ◽  
Who Grade ◽  
Integrated Diagnosis ◽  
Significant Difference ◽  
Favorable Clinical Outcome ◽  
The Impact

Abstract OBJECTIVE Diffuse astrocytomas are classified as WHO grade II and its median overall survival (mOS) is 10 to 11 years. The efficacy of chemoradiation in the high-risk feature has been reported. The prognosis is associated with IDH and TERT promoter (TERTp) mutations. Here, we retrospectively analyzed the patients with diffuse astrocytoma treated with vincristine, ACNU, carboplatin and interferon-β plus radiotherapy (VAC-feron-R)in our institute. PATIENTS AND METHODS Between December 2003 to January 2016, 44 patients were diagnosed as diffuse astrocytoma with integrated diagnosis of histological and molecular analysis. The average age was 43.1 years (22–71 years). They received VAC-feron-R as initial treatment in our institute. We analyzed the IDH1/2 and the TERTp mutation using Sangar sequencing and determined the 1p/19q codeletion by the fluorescence in situ hybridization or the multiplex ligation-dependent probe amplification. RESULTS Median follow-up period was 76.5 months, mPFS was 126 months, mOS did not reach, and 10-year survival rate was 60%.IDH status was determined in 29 patients, 9 mutant and 20 wild types. There was no significant difference in PFS and OS between the two groups. TERTp status was determined in 18 patients with IDH wild type, 6 mutant and 12 wild types. mPFS of patients with TERTp wild type did not reach, but that with TERTp mutant type was 34.5 months (p = 0.0356). CONCLUSION Compared with previous clinical studies, VAC-feron-R showed a favorable clinical outcome in diffuse astrocytoma. The impact of TERTp status on prognosis was identified but not IDH status in this cohort.

▾Lisinopril - another ACE inhibitor

1989 ◽  
Vol 27 (8) ◽  
pp. 31-32
Keyword(s):  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Antihypertensive Therapy ◽  
Ace Inhibitor ◽  
Converting Enzyme ◽  
Once Daily ◽  
The Third

Lisinopril (Carace - MSD, Zestril - ICI) has joined captopril and enalapril1 as the third inhibitor of angiotensin-converting enzyme (ACE), for use in hypertension and heart failure. Advantages claimed for lisinopril are that it is not a pro-drug, its once daily dosage and its ability “to retain that zest for life” during antihypertensive therapy.

Woolf’s Imaginarium: Exploring Virginia Woolf’s Legacy to Contemporary Polish Culture

2018 ◽  
Author(s):  
Paulina Pająk
Keyword(s):  
Women Writers ◽  
Comparative Literature ◽  
Contemporary Literature ◽  
Feminist Studies ◽  
Women Intellectuals ◽  
The Third ◽  
Third Phase ◽  
Patriarchal Society ◽  
Polish Culture ◽  
A Minor

In recent years, the popularity of Virginia Woolf’s oeuvre has substantially increased in Poland. There has been little prior attempt to explain this phenomenon, although it could be beneficial to comparative literature and feminist studies. Therefore, the aim of the paper is to examine the significance of Virginia Woolf’s legacy to contemporary Polish culture, as well as the possible causes of the “Woolf’s Renaissance”. As Urszula Terentowicz-Fotyga has pointed out, until the late 1980s., Woolf remained relatively unknown and perceived as a minor modernist writer. Yet, the third phase of her reception (1990s-present) has brought a significant change, which finally led to the outburst of translations and popularity of Woolf’s works. One result of this “Woolf’s Renaissance” is the influence of Woolf’s legacy on contemporary literature and feminism in Poland. Woolf’s imaginairum has inspired many women writers, such as Joanna Bator, Sylwia Chutnik, Izabela Morska, and Maria Nurowska. It would seem that the popularity of Woolf among Polish women intellectuals stems from the similarity between her opposition to Victorian patriarchal society and their resistance against the radical Catholic conservatism and nationalism in Poland. Besides, the polyphony of Woolf’s oeuvre and the complexity of her biography invite the writers to enter the intertextual dialogue with the author.

Pituitary and Neuroendocrine Surgery

2019 ◽  
pp. 213-224
Author(s):  
Douglas A. Colquhoun ◽  
Edward C. Nemergut
Keyword(s):  
Brain Tumours ◽  
Disease Process ◽  
Operative Management ◽  
Neuroendocrine System ◽  
Pituitary Tumours ◽  
Anatomy And Physiology ◽  
The Third ◽  
Primary Brain Tumours ◽  
Operative Evaluation ◽  
Multi Disciplinary Team

Surgeries on the pituitary and neuroendocrine system are commonly encountered in neuroanaesthesia practice. Pituitary tumours are the third most common brain tumour, comprising about 10–15% of all primary brain tumours. Patients with pituitary tumours pose unique challenges to the anaesthestist caring for them in the peri-operative period, and they require the care of a multi-disciplinary team to accurately diagnose and manage their disease process as they undergo surgical resection. This chapter on pituitary and neuroendocrine surgery includes sections on anatomy and physiology, systemic changes associated with pituitary tumours, pre-operative evaluation (including intra-operative management), and common complications (for example, diabetes insipidus).

scholarly journals Cerebellar glioblastoma multiforme in an adult

2006 ◽  
Vol 64 (1) ◽  
pp. 132-135 ◽  
Author(s):  
João Paulo Mattos ◽  
Horacio Armando Marenco ◽  
José Maria Campos ◽  
Andréa Vasconcellos Faria ◽  
Luciano Souza Queiroz ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Literature Review ◽  
Treatment Options ◽  
Rare Tumor ◽  
Imaging Studies ◽  
Brazilian Literature ◽  
The Third ◽  
Pathological Characteristics ◽  
Cerebellar Glioblastoma ◽  
High Degree

Cerebellar glioblastoma multiforme (GBM) is a rare tumor. This is the third case published in Brazilian literature and, the last one has been described more than 15 years ago. The aggressive behavior of GBM prompts for fast treatment, which can be hampered by the fact that the diagnosis of GBM requires a high degree of suspicion. We describe a case of GBM in a 46 years old man. In conjunction, we present a literature review including particular issues, clinical data, advances in imaging studies, pathological characteristics, treatment options and the behavior of such malignant tumor.

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