scholarly journals Treatment of patients with isoniazid-resistant pulmonary tuberculosis using an adjuvant therapy

2019 ◽  
Vol 29 (4) ◽  
pp. 443-447 ◽  
Author(s):  
Z. K. Rakisheva ◽  
G. S. Balasanyants ◽  
N. S. Solov’yeva
Keyword(s):  
Adjuvant Therapy ◽  
Pulmonary Tuberculosis ◽  
Multiple Drug Resistance ◽  
Multiple Drug ◽  
Once Daily ◽  
Sputum Conversion ◽  
Group 3 ◽  
Group 2 ◽  
Antituberculosis Chemotherapy ◽  
Group 1

The purpose of the study was to assess the efficacy of glutamyl-cysteinyl-glycine disodium (Glu) as adjuvant therapy in patients with isoniazid resistant pulmonary tuberculosis. Methods. This was a randomized placebo-controlled blind study. The study involved 67 patients who was randomly assigned to the treatment with Glu and antituberculosis cchemotherapy (group 1; n = 23), or placebo (group 2; n = 10), or antituberculosis chemotherapy (group 3; n = 34). All patients were positive for M.tuberculosis (MBT). The treatment included a standard intensive chemotherapy in a hospital (DOTS strategy) during 5 months (2S 3–5HRZE/5RSE). Glu was administered intramuscularly in the dose of 60 mg once daily during 10 days followed by 60 mg once daily every other day during 20 days; the total course included 20 doses. Results. Single-drug resistant MBT was detected in 26.1%, 20.0%, and 8.8% of patients in groups 1, 2, and 3, respectively. Multiple drug resistance was detected in 73.9%, 77.8%, and 91.2%, respectively. Sputum conversion was achieved in 26.1%, 52.2%, and 21.7% of group 1 patients in one, two and three months of the treatment, respectively. Sputum conversion in group 2 was achieved over 3 months of the treatment only (n = 3 at 3 months, n = 4 at 4 months, and n = 2 at 5 months); two patients were still MBT-positive to the end of the treatment. In group 3, sputum conversion was achieved in 18 patients (53.0 %) at 3 months, in 6 patients (18%) at 4 months, and in 5 patients (14.7%) at 5 months; 5 patients remained MBT-positive to the end of the treatment. Median time to sputum conversion was 62, 114, and 100 days in groups 1, 2, and 3, respectively. Conclusion. The adjuvant treatment with Glu in patients with isoniazid-resistant pulmonary tuberculosis was associated with earlier sputum conversion. This strategy can shorten the duration of the intensive treatment.

scholarly journals Ethanolic Extract of Herb Pugun Tanoh (Picria fel-terrae Lour.) Modulates TCD4+ and TCD8+ Cell Profile of Doxorubicin-Induced Immuno-Suppressed Rats

2019 ◽  
Vol 7 (22) ◽  
pp. 3774-3776
Author(s):  
Mustafa Ridwan Lubis ◽  
Reny Haryani ◽  
Safriana Safriana ◽  
Denny Satria
Keyword(s):  
Ethanolic Extract ◽  
Immune Functions ◽  
Sprague Dawley ◽  
Immunomodulatory Effects ◽  
Once Daily ◽  
Sprague Dawley Rats ◽  
Group 3 ◽  
Group 2 ◽  
Cell Profile ◽  
Group 1

AIM: To evaluate the immunomodulatory effects of ethanolic extract of herb pugun tanoh on TCD4 and TCD8 cells in Doxorubicin-induced rats. METHODS: Fifteen male Sprague Dawley rats were divided into five groups consisting of six rats each as follows: Group 1, DOX-treated rats (4.67 mg/kg BW body weight on day 1 and 4) and were administered normal saline 0.9% orally once daily for 7 consecutive days, Group 2, receiving Ethanolic Extract of Herb Pugun Tanoh (Picria fel-terrae Lour.) of dose 150 mg/kg BW orally, Group 3, receiving dose Ethanolic Extract of Herb Pugun Tanoh (Picria fel-terrae Lour.) 300 mg/kg BW orally. The rats of group 2-3 were intramuscularly administered with doxorubicin at a dose of 4.67 mg/kg BW at the days 1-4 to suppress immune functions. RESULTS: Treatment of 300 mg/kg BW of Ethanolic Extract of Herb Pugun Tanoh (Picria fel-terrae Lour.) succeeded in reducing side effect doxorubicin based on increasing the TCD4+ and TCD8+ blood level. CONCLUSION: Ethanolic Extract of Herb Pugun Tanoh (Picria fel-terrae Lour.) could increase the level of TCD4+ and TCD8+ in rats which induced by doxorubicin.

scholarly journals Steady-State Pharmacokinetics of Tenofovir-Based Regimens in HIV-Infected Pediatric Patients

2011 ◽  
Vol 55 (9) ◽  
pp. 4290-4294 ◽  
Author(s):  
Jennifer R. King ◽  
Ram Yogev ◽  
Patrick Jean-Philippe ◽  
Bobbie Graham ◽  
Andrew Wiznia ◽  
...  
Keyword(s):  
Fixed Dose ◽  
Target Range ◽  
Pharmacokinetic Parameters ◽  
Time Interval ◽  
Minimum Concentration ◽  
Once Daily ◽  
Daily Group ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ABSTRACTHIV-infected children are treated with tenofovir in combination with other, potentially interacting, antiretroviral agents. We report the pharmacokinetic parameters of tenofovir in combination with efavirenz, darunavir-ritonavir, or atazanavir-ritonavir in HIV-infected children. HIV-infected patients 8 to 18 years of age receiving a tenofovir (300 mg)-based regimen containing efavirenz (300 or 600 mg) once daily (group 1), darunavir (300 or 600 mg)-ritonavir (100 mg) twice daily (group 2), or atazanavir (150 to 400 mg)-ritonavir (100 mg) once daily (group 3) were enrolled. Plasma samples were collected over a 24-h time interval. The 90% confidence intervals (90% CI) of the geometric means for the area under the plasma concentration-time curve (AUC) and the minimum concentration of drug in serum (Cmin) of each antiretroviral were computed and checked for overlap with intervals bracketing published values obtained in adult or pediatric studies demonstrating safety and/or efficacy. Group 1 efavirenz plasma concentrations were observed to be higher in patients receiving fixed-dose combination tablets compared with subjects receiving the individual formulation. In group 2, tenofovir and darunavir exposure was observed to be lower than expected. In group 3, tenofovir and atazanavir administered concomitantly produced exposures similar to those published for adult patients. The 90% CI of AUC andCminfor tenofovir overlapped the target range for all combinations. Informal comparisons of treatment groups did not indicate any advantage to any combination with respect to tenofovir exposure. Further study of exposures achieved with antiretrovirals administered in combination is warranted.

scholarly journals Prominent features of platelet count, plateletcrit, mean platelet volume and platelet distribution width in pulmonary tuberculosis

2012 ◽  
Vol 7 ◽  
Author(s):  
Füsun Şahin ◽  
Esra Yazar ◽  
Pınar Yıldız
Keyword(s):  
Platelet Count ◽  
Pulmonary Tuberculosis ◽  
Advanced Stage ◽  
Platelet Distribution Width ◽  
Platelet Volume ◽  
Acute Phase Reactants ◽  
Distribution Width ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: We aimed to investigate the relation of platelet count (PLT) and plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) with other acute phase reactants and radiological extent in pulmonary tuberculosis (PTB). Methods: One hundred patients with PTB (Group 1), 50 patients with community-acquired pneumonia (Group 2) and 28 healthy control individuals (Group 3) were included in this analytic study. Results: WBC (White Blood Cell), ESR (Eritrocyte Sedimentation Rate), CRP (C-Reactive Protein), PLT and PCT values were both in Group 1 and Group 2 than in Group 3. PDW values were significantly higher in Group 1 than Group 3. WBC, ESR and CRP values were lower, while PLT and PCT values were higher in the Group 1 compared to Group 2 (p < 0.001). PLT was positively correlated with CRP and ESR values in the tuberculosis group (p < 0.001), while it was not correlated with CRP and ESR in the pneumonia group (p > 0.05). ESR, CRP, PLT and PCT values were found higher in radiological advanced stage (Stage 3) patients with PTB, while hemoglobin (Hb) was found lower (p < 0.05). Higher WBC, ESR, CRP and PCT values as well as radiological advanced stage were more common in PTB patients with thrombocytosis compared to the patients with normal platelet count, whereas Hb was found lower in these patients. Conclusions: This study indicates that reactive thrombocytosis and higher PCT and PDW develop frequently in PTB and there is a relation between thrombocytosis and acute phase reactants, that is the inflammatory response. In addition, tuberculosis with radiological advanced stage is seen more frequently in the patients with thrombocytosis and higher PCT, drawing attention to the possible role of platelets in the cell-based immune process of tuberculosis.

scholarly journals An exploratory pilot study evaluating the supplementation of standard antibiotic therapy with probiotic lactobacilli in south African women with bacterial vaginosis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Harold Marcotte ◽  
Per Göran Larsson ◽  
Kasper Krogh Andersen ◽  
Fanglei Zuo ◽  
Lasse Sommer Mikkelsen ◽  
...  
Keyword(s):  
Pilot Study ◽  
Bacterial Vaginosis ◽  
South African ◽  
Oral Antibiotic ◽  
Once Daily ◽  
Group 3 ◽  
Group 2 ◽  
Probiotic Lactobacilli ◽  
Cure Rates ◽  
Group 1

Abstract Background To reduce acquisition and relapse of bacterial vaginosis (BV), lactobacilli must be maintained in the vaginal microbiome. Probiotic lactobacilli may aid this purpose. We investigated whether vaginal probiotics (containing Lactobacillus rhamnosus DSM 14870 and Lactobacillus gasseri DSM 14869) would result in vaginal colonisation with lactobacilli in women with and without BV. Methods This prospective, partially randomised, exploratory pilot study was conducted in Soweto, South Africa. Thirty-nine sexually-active, HIV negative women were enrolled from October 2014 to May 2016 into three arms. Women who did not have BV (Group 1, n = 13) self-administered probiotic capsules vaginally once daily for 30 days, then once a week until Day 190. Women diagnosed with BV were randomized into Group 2 (n = 12) or Group 3 (n = 14) and treated with the triple oral antibiotic combination for vaginal discharge syndrome per South African guidelines (cefixime 400 mg stat, doxycycline 100 mg BD for 7 days and metronidazole 2 g stat). Immediately after antibiotic treatment, women in Group 2 self-administered probiotic capsules vaginally once daily for 30 days then vaginally once a week until Day 190. Women in Group 3 were not given lactobacilli. Results During the study, L. rhamnosus DSM 14870 or L. gasseri DSM 14869, were isolated in 5/13 (38.5%) women in Group 1 compared to 10/12 (83.3%) women in Group 2 (p = 0.041). The 1-month and 6-month BV cure rates were similar (P >  0.05) between Group 2 (42 and 25%) compared to Group 3 (36 and 25%). In Group 2, no correlation was observed between the frequency of isolation of the two Lactobacillus strains and the 1-month or 6-month cure rate. Conclusions Supplementation with vaginal probiotic capsules resulted in colonisation of the vagina by the Lactobacillus strains (L. rhamnosus DSM 14870 and L. gasseri DSM 14869) contained in the capsules. We observed low initial cure rates of BV after a stat dose of metronidazole and that the probiotic did not improve BV cure rates or alleviate recurrence which could be due to treatment failure or very limited power of the study. Trial registration Registered at the Pan African Clinical Trial Registry (www.pactr.org) on April 13, 2018 (retrospectively registered). Trial identification number: PACTR201804003327269.

Dynamics of life quality in patients with pulmonary tuberculosis against the background of the appointment of an essential amino acids complex

2021 ◽  
pp. 15-24
Author(s):  
O.S. Shevchenko ◽  
O.O. Pohorielova
Keyword(s):  
Amino Acids ◽  
Pulmonary Tuberculosis ◽  
Life Quality ◽  
Essential Amino Acids ◽  
Tablet Form ◽  
Pathogenetic Therapy ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective — to investigate the dynamics of life quality in patients with pulmonary tuberculosis against the background of the appointment of an essential amino acids complex. Materials and methods. The study included 100 patients with pulmonary tuberculosis who received treatment and diagnosis in accordance with the WHO recommendations and current state protocols. The patients were divided into 3 groups: group 1 (n = 50) did not receive additional complex of amino acids in pathogenetic therapy; group 2 (n = 25) received a complex of amino acids in tablet form for 30 days; group 3 (n = 25) received injectable amino acids complex for 10 days and then was transferred to tablet form for 20 days. At the beginning of treatment, after 30 days and after 60 days, the patients were interviewed using the SF-36 questionnaire. Also, the patients were measured the level of Human-beta-defensine-1 in the blood plasma by ELISA at the beginning of treatment. Results and discussion. After 30 doses of anti-tuberculosis treatment, better quality of life parameters were observed in groups 2 and 3 than in group 1. Thus, the PF in group 1 was 54.73 ± 2.99, in group 2 — 80.87 ± 2.82, in group 3 — 66. 4.23; RP was in group 1 — 20.27 ± 3.47, in group 2 — 81.52 ± 3.92, in group 3 — 55.00 ± 7.07; GH was 16.68 ± 1.79 in group 1, 45.48 ± 3.09 in group 2, 34.04 ± 3.35 in group 3; VT was in group 1 — 13.38 ± 1.55, in group 2 — 45.87 ± 2.86, in group 3 — 33.60 ± 3.68; SF was 43.45 ± 2.39 in group 1, 69.02 ± 2.06 in group 2, and 60.50 ± 3.53 in group 3; RE was in group 1 — 27.03 ± 4.80, in group 2 — 95.65 ± 3.18, in group 3 — 73.33 ± 7.69; MH was in group 1 — 39.22 ± 1.36, in group 2 — 60.00 ± 2.12, in group 3 — 56.00 ± 2.71, p < 0.05. This ratio between the groups remained at 60 doses of chemotherapy: PF was 62.17 ± 3.47 in group 1, 82.95 ± 2.39 in group 2, and 76.52 ± 3.42 in group 3; RP in group 1 was 28.33 ± 4.90, in group 2 — 90.91 ± 3.09, in group 3 — 66.30 ± 7.14; GH was 22.97 ± 2.13 in group 1, 52.63 ± 3.14 in group 2, 46.78 ± 4.22 in group 3; VT was 19.33 ± 1.91 in group 1, 50.68 ± 2.72 in group 2, and 40.87 ± 3.98 in group 3; SF was 50.67 ± 2.31 in group 1, 75.00 ± 2.18 in group 2, and 68.48 ± 3.84 in group 3; RE was 36.67 ± 6.26 in group 1, 98.49 ± 1.52 in group 2, 82.61 ± 6.91 in group 3; MH was 42.73 ± 1.62 in group 1, 63.82 ± 2.01 in group 2, 59.83 ± 2.75 in group 3, p < 0.05. Conclusions. The appointment of a complex of amino acids as an additional pathogenetic therapy in patients with pulmonary tuberculosis improves the quality of life, and the appointment of an injectable form of amino acids accelerates patients’ adaptation and increases adherence to treatment, which is one of the key factors in the effectiveness of therapy.

scholarly journals Analysis of treatment outcomes for destructive pulmonary tuberculosis in patients with multiple drug resistance of M. tuberculosis

2020 ◽  
Vol 98 (10) ◽  
pp. 23-27
Author(s):  
Yu. A. Sheyfer ◽  
I. S. Gelberg
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Clinical Cure ◽  
Multiple Drug Resistance ◽  
Group Versus ◽  
Multiple Drug ◽  
Continuation Phase ◽  
Intensive Phase ◽  
Tuberculosis Patients ◽  
Sputum Conversion

The objective of the study: to analyze treatment outcomes in patients with pulmonary destructive MDR tuberculosis who completed the intensive phase of treatment and had healed or persisting cavities.Subjects and methods. Treatment outcomes were retrospectively analyzed in 191 patients suffering from destructive pulmonary MDR tuberculosis who underwent the intensive phase of chemotherapy in in-patient settings in 2009-2012 and 2013-2015 (treated by different regime ns);  in each of those cohorts, groups were formed depending on persistence/healing of destruction (cavities) during the intensive phase of chemotherapy:  (CV-) ‒ the destruction healed, (CV+) – the destruction persisted.Results. In 24 months, treatment was found to be effective only in 19/68 (27.9%) in the (CV+) group versus 31/40 (77.5%) in the (CV-) group, p < 0.05 (cohort 2009-2012); 17/42 (40.5%) versus 29/41 (70.7%), respectively, p < 0.05 (2013-2015 cohort). Within 48 months, treatment outcomes were as follows: clinical cure in the (CV+) group was 38.2% (26/68 people), and in the (CV-) group – 72.7% (29/40 people), p < 0.05 (2009- 2012) and 23/42 (54.7%) and 33/41 (80.5%), respectively, p < 0.05 (2013-2015 cohort).Conclusion. Considering the above, when assessing treatment in the intensive phase of chemotherapy in destructive pulmonary tuberculosis patients, it is necessary to take into account the rate of cavity healing but not being limited to sputum conversion. Patients with persisting cavities should not be transferred to the continuation phase, the surgery or collapse treatment should be considered for such patients.

scholarly journals COMPARISON OF INFLUENCE OF VARIOUS REGIMENS OF DRUG INTAKE ON 24 HOUR bLOOD  PRESSURE, CENTRAL AORTIC PRESSURE AND VASCULAR WALL STIFFNESS IN SYSTEMIC  HYPERTENSION PATIENTS WITH ISCHEMIC STROKE

2018 ◽  
pp. 56-66 ◽  
Author(s):  
V. V. Skibitsky ◽  
A. V. Fendrikova ◽  
S. V. Opolskaya
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Vessel Wall ◽  
Vascular Wall ◽  
Aortic Pressure ◽  
Once Daily ◽  
Wall Stiffness ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim. To assess and compare the efficacy of combination antihypertension drugs influence with various dosage regimens during 24 hour, on the parameters of daily blood pressure (BP) profile, central aortic pressure (CAP) and vessel wall stiffness in arterial hypertension (AH) patients with ischemic stroke (IS).Material and methods. To the study, 177 AH patients included, with IS within last 4 weeks. All patients were randomized to 3 groups depending on the regimen of antihypertensive drugs combination intake during 24 hours. At baseline and in 12 months of therapy all patients underwent 24 hour BP monitoring (ABPM), CAP measurement and vessel wall stiffness evaluation. Results. In 8 weeks of antihypertension therapy, target pressure level achievement was significantly more common in b. i.d. valsartan (group 3) comparing to once daily in the morning (group 1) or evening (group 2) (p<0,05). In all groups there were statistically significant positive changes in ABPM, CAP and stiffness. Also, in the group 2 there was significantly (p<0,05) more prominent decrease of the main ABPM, CAP and stiffness parameters than in the group 1. Valsartan b. i.d. led to significantly more prominent (p<0,05) improvement of the main ABPM, CAP and stiffness parameters improvement comparing to both variants of its once daily regimens. In 12 months of chronopharmacotherapy, in all groups, there was significant (p<0,05) increase of “dipper” 24 hour BP profile patients. Differences of the groups of “dippers” and “non-dippers” by the 12th month of treatment were significant for 3rd and 1st (p=0,0004), 3rd and 2nd (p=0,04) groups with the benefit for group 3.Conclusion. Two times a day or only evening intake of valsartan with thiazidelike diuretic in the morning facilitated more significant improvement of the main parameters of ABPM, CAP and vascular wall rigidity comparing to just morning intake. B.i.d. valsartan regimen led to significantly (p<0,05) more commonly reached target BP level, improved normalization of 24 hour BP in most of patients, led to more significant improvement of the main ABPM, CAP and vascular stiffness parameters comparing to once daily morning or evening regimen.

Retrospective analysis of outcomes in patients with non metastatic cholangiocarcinoma: A single network experience.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15643-e15643
Author(s):  
Jyothika Mamadgi ◽  
Kristina Lundeen ◽  
Shaakir Hasan ◽  
Sunita Patruni ◽  
Ahmed Khattab ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Therapy Group ◽  
Progression Free Survival ◽  
Distant Recurrence ◽  
Treatment Modalities ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

e15643 Background: Biliary tract cancers are rare cancers with an annual incidence of about 8,000. In resected non-metastatic BTCs (NM-BTCs), cure rates decrease significantly due to local and distant recurrence. However, guidelines to use adjuvant therapies are not well established due to the lack of well-structured phase three randomized trials, given the rarity of the disease. We present a retrospective study analyzing outcomes of NM-BTCs managed within Allegheny Health Network (AHN) with specific focus on patients who underwent resection and received different adjuvant treatment modalities. Methods: Data of all patients with NM-BTCs treated at AHN from January 2012 to December 2017 was collected and outcomes analyzed for patients treated with surgery vs no surgery We then sub-stratified the patients who received surgery into three groups based on the modality of adjuvant therapy. Group 1 included patients with no additional therapy , Group 2 with adjuvant chemotherapy and Group 3 with adjuvant chemotherapy+radiation. We compared Mean Progression-Free Survival (PFS) and Overall Survival (OS) in these three groups. Results: Of the 59 NM-BTCs treated at AHN, 32(52.4%) underwent surgery. The OS for surgical vs non-surgically treated patients was 23 vs 17 months (p = 0.008) and PFS 26 vs 19 months (P = 0.06) respectively. Of the resected –patients, PFS for patients in Group1 vs Group2 vs Group3 was 16 vs 21 vs 34 months (pooled P = 0.05) and OS was 19 vs 22 vs 19 months respectively (pooled P = 0.5). PFS for patients in Group1 vs Group (2+3),i.e, patients treated surgery only vs surgery+ any adjuvant treatment was 16 vs 28 months (P = 0.1), OS was 19 vs 22 months (P = 0.7)respectively. PFS in patients in Group 3 vs Group (1+2),i.e, patients treated with adjuvant chemotherapy+radiation vs others was 34 vs 19 months. (p = 0.0183) respectively. Conclusions: This analysis revealed a statistically significant improvement in OS in patients with NM-BTCs who received surgery. There was a trend towards improvement in PFS/OS in patients who received adjuvant therapy, though not statistically-significant. Use of adjuvant chemotherapy+radiation resulted in statistically significant improvements in PFS as compared to other treatment modalities.

scholarly journals Use of Upper-Posterior Thoracoplasty in the Treatment of Patients with Fibrous-Cavernous Pulmonary Tuberculosis

2020 ◽  
Vol 13 (4) ◽  
pp. 326-330
Author(s):  
Sergei A Belov
Keyword(s):  
Pulmonary Tuberculosis ◽  
Clinical Effect ◽  
Mesh Group ◽  
Pulmonary Tissue ◽  
Compression Device ◽  
Intervention Area ◽  
Mesh Prosthesis ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Introduction. SSurgical care for patients with fibrous-cavernous and cavernous pulmonary tuberculosis (TB) most often ends with thoracoplasty due to impossibility to use resection methods of treatment.The aim of study was to assess results of application of various upper-posterior thoracoplasty options in the treatment of patients with fibrous-cavernous pulmonary TB.Materials and methods. The author analyzed results of 233 thoracoplasties performed in patients with fibro-cavernous pulmonary TB in 2012-2018. Group 1 (n = 70) consisted of patients with selective extrapleural upper-posterior thoracoplasty with polypropylene mesh; Group 2 (n = 60) consisted of patients with osteoplastic thoracoplasty according to Bjork; Group 3 (n = 103) consisted of patients with traditional selective extrapleural upper-posterior thoracoplasty. The following parameters were analyzed: elimination of the destruction cavity, stabilization of the specific process and termination of the excretion of Mycobacterium tuberculosis during the year. The results were summarized in groups based on good clinical effect, satisfactory clinical effect, worsening, death.Results. Thoracoplasty treatment option with a compression device (mesh) application resulted in the increased degree of compression in the intervention area by 30%, compared with the traditional upper-posterior thoracoplasty option and osteoplasty according to Bjork (p 0.05), and reduced the number of bronchopulmonary complications by 15% (p 0.05).Conclusions. The use of a mesh prosthesis leads to an increased effective compression of the destruction cavity, creates conditions for healing of the pulmonary tissue defect and reduces the risk of developing bronchopulmonary complications

A simplified staging system in cutaneous melanoma to select patients for adjuvant trials

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19003-19003
Author(s):  
S. L. Beam ◽  
E. G. Elias
Keyword(s):  
Adjuvant Therapy ◽  
Survival Data ◽  
Cutaneous Melanoma ◽  
Target Therapy ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Regional Lymph Nodes ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

19003 Background: Most clinical trials with adjuvant therapy in melanoma concentrate on high-risk patients including those with metastases to regional lymph nodes (LN), stage III and locally advanced T4, i.e., stage IIB and IIC. These trials may be missing the advantageous results in the relatively earlier stages. Methods: We reviewed the new American Joint Committee on Cancer (AJCC) for cancer staging of cutaneous melanoma and Balchs’ data for the prognostic factors. The data was correlated to patients’ survival expressed by the natural history of the disease. Results: We grouped the reported survival data into 3 risk groups, excluding patients with distant metastases. Group 1: 2–4mm deep primary with ulceration, >4mm deep primary without ulceration, micrometastases to 1–3 LN, primary not ulcerated; Group 2: >4mm deep primary with ulceration, micrometastases to 1–3 LN ulcerated primary, macrometastases to 1–3 LN, primary not ulcerated intransit metastases/satellitosis, without LN metastases; Group 3: macrometastases to 1–3 LN, ulcerated primary, metastases to 4 or more LN, matted LN, and/or intransit, metastases/satellitosis with LN metastases. The table summarizes the results. Conclusions: 1. Over one-third of the patients in group 1 died of disease in the first 5 years. They should be considered at intermediate risk and should receive adjuvant therapy. 2. Patient prognosis should determine the intensity of target therapy utilized in the adjuvant arena. While anti-CTLA-4 may be sufficient for group 1, the addition of anti-kinases may be required in group 2 and more so in group 3. [Table: see text] No significant financial relationships to disclose.

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