BACKGROUND. Despite advances in first‐line therapy, there are few data on treatment of glioblastoma multiforme (GBM) at recurrence. Temozolomide (TMZ) is well tolerated and may have activity despite prior TMZ exposure if novel dose schedules are used. METHODS. The authors reviewed their experience with a continuous TMZ schedule (50 mg/m2 daily), given at progression after conventional 5‐day TMZ. Patients were reported in 3 groups: 1) GBM after progression on conventional TMZ; 2) GBM at first recurrence after completion of standard concomitant and adjuvant TMZ; and 3) patients with other anaplastic gliomas at second relapse on conventional TMZ. RESULTS. In Group 1, 21 patients with a median age of 54 years (range, 33 years‐68 years) received a median of 3 cycles (range, 2‐12 cycles) of continuous TMZ at 50 mg/m2. Overall clinical benefit (complete response, partial response, and stable disease) was 47%, with 6‐month progression‐free survival (PFS) of 17%. In Group 2, 14 patients with GBM, median age 52 years (range, 38 years‐62 years) received continuous TMZ at progression after initial TMZ/radiotherapy (RT) and adjuvant TMZ. The median interval after adjuvant TMZ was 3 months (range, 2 months‐10 months). A median of 5 cycles of TMZ was given, and 6‐month PFS was 57%. In Group 3, 14 patients with a median age of 49 years (range, 34 years‐56 years) received continuous TMZ; 2 partial responses and 6 with stable disease were seen, with a 6‐month PFS of 42%. Toxicities were mild and well tolerated; lymphopenia was common but no serious opportunistic infections were identified. CONCLUSIONS. Although retrospective, our results demonstrate that continuous daily administration of TMZ is an active regimen despite prior TMZ therapy. The excellent tolerability of this regimen may allow future combination with other alkylating agents or with novel therapies. Cancer 2008. © 2008 American Cancer Society.
Background: Recent studies have strongly indicated the benefits of endovascular therapy for acute ischemic stroke, but what remains a continued debate is the role for general anaesthesia versus conscious sedation (CS) for such procedures. Retrospective studies have found poorer neurological outcomes in patients who underwent general anesthesia (GA); however, some have revealed worse baseline stroke severity in these patients. Methods: This study is a retrospective cohort study aimed at comparing mortality and morbidity of GA versus CS in patients treated with endovascular intervention in acute ischemic stroke. Chi-square and t-test analyses were used. Results: Patients in the GA (n = 42) group were more likely to be deceased than those in the CS (n = 67) group at hospital discharge, 3 months, and 6 months poststroke onset. Morbidity, as defined by modified Rankin Score, was significantly greater in the GA group at hospital discharge, and a similar trend was seen in morbidity at 3 months postdischarge. Conclusion: General anesthesia for endovascular intervention in acute ischemic stroke was associated with increased mortality and poorer neurological incomes compared with conscious sedation. In our study, age, gender, history of hypertension, history of diabetes, and baseline National Institute of Health Stroke Scale were not significantly different between the groups. Although the need for a randomized, prospective study on this topic is clear, our study represents further corroboration of the safety and efficacy of conscious sedation in these procedures.RÉSUMÉ: Résultats de l'anesthésie générale et de la sédation consciente dans le traitement endovasculaire de l'accident vasculaire cérébral. Contexte : Des études récentes ont montré clairement les bénéfices du traitement endovasculaire de l'accident vasculaire cérébral aigu ischémique (AVCI). Cependant le débat sur l'utilisation de l'anesthésie générale versus la sédation consciente (SC) lors de telles interventions se poursuit. Des études rétrospectives ont révélé que les résultats neurologiques étaient moins bons chez les patients qui avaient subi une anesthésie générale (AG). Cependant, selon certaines études, l'AVC était plus sévère chez ces patients. Méthodologie : Nous avons effectué une étude de cohorte rétrospective dans le but de comparer la mortalité et la morbidité de l'AG et celle de la SC chez des patients qui avaient subi une intervention endovasculaire pour un AVCI. Nous avons utilisé le test du chi-carré et le test de t pour analyser les données. Résultats : Les patients du groupe AG (n = 42) étaient plus susceptibles d'être décédés que ceux du groupe SC (n = 67) soit au moment du congé hospitalier, 3 mois et 6 mois après le début de l'AVC. La morbidité, évaluée au moyen du score modifié de Rankin, était significativement plus importante dans le groupe AG au moment du congé hospitalier et on notait une tendance similaire 3 mois après le congé hospitalier. Conclusion : L'anesthésie générale lors d'une intervention endovasculaire pour un ...
Background: Hereditary hemochromatosis (HH) is a genetic disorder causing pathological iron deposition and functional impairment of various organs, predominantly the liver. We assessed patients with HH for the presence of movement disorders. Methods: We reviewed the charts of 616 patients with HH who attended hemochromatosis clinic at London Health Sciences Centre, London, ON, Canada, from 1988 to 2015. Results: We found three HH patients with movement disorders, without any other major systemic manifestation. One had parkinsonism, another had chorea, and the third had tremor. All three patients had evidence of iron deposition in the brain, affecting the basal ganglia in the first two, and the dentate nucleus, red nucleus, and substantia nigra in the third patient. In addition to the C282Y homozygous mutation in the HFE gene, two of our patients had non-HFE gene mutations. Conclusion: HH should be considered in the differential diagnosis of movement disorders with pathological brain iron deposition. We report for the first time chorea in a patient with HH. Non-HFE gene mutations may predispose HH patients to iron deposition in the brain.RÉSUMÉ: Troubles du mouvement associés à l'hémochromatose. Contexte : L'hémochromatose héréditaire (HH) est une maladie génétique qui entraîne des dépôts pathologiques de fer et des altérations fonctionnelles au niveau de différents organes, particulièrement au niveau du foie. Nous avons examiné la présence de troubles du mouvement chez des patients atteints de HH. Méthodologie : Nous avons revu les dossiers de 616 patients atteints de HH traités à la clinique d'hémochromatose du London Health Sciences Centre de London, Ontario, Canada, de 1988 à 2015. Résultats : Nous avons identifié 3 patients atteints de HH qui présentaient des troubles du mouvement sans autre manifestation systémique importante. Un patient présentait du parkinsonisme, un autre de la chorée et le troisième du tremblement. Ces trois patients avaient des dépôts de fer dans le cerveau, soit au niveau des noyaux gris centraux chez les deux premiers et dans le noyau dentelé, le noyau rouge et le locus niger chez le troisième patient. En plus de la mutation homozygote C282Y dans le gène HFE, deux de nos patients avaient des mutations génétiques qui n'étaient pas dans le gène HFE. Conclusion : L'HH devrait être incluse dans le diagnostic différentiel des troubles du mouvement chez les patients qui présentent des dépôts pathologiques de fer dans le cerveau. Nous rapportons pour la première fois de la chorée chez un patient atteint d'HH. Des mutations dans des gènes autres que HFE pourraient prédisposer les patients atteints d'HH à la formation de dépôts de fer dans le cerveau.
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