La Clinica terapeutica
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La Clinica terapeutica · Nov 2008
ReviewHelicobacter pylori infection and gastric MALTomas: an up-to-date and therapy highlight.
During the last 20 years Helicobacter pylori (Hp) has been, undoubtly, the star of gastroenterology and microbiology, so much to deserve the "Nobel prize 2005" for biology and medicine to its discoverers. More recently, an increased interest arised on Hp and its linkages with other medical fi elds such as immunology, surgery and dentistry. The outcome of the pathologies due to such bacterium is dependent on many factors, including bacterial genotype, host physiology and genetics, and environmental factors such as diet. ⋯ The development of gastric lymphomas is usually preceded by the acquisition of lymphatic tissue, after inflammatory stimuli and particularly after the infection from Hp, which organizes itself with the characteristics of the MALT. Recently, a number of papers have highlighted the remarkable efficacy of Hp eradicating therapy in patients with low-grade MALT lymphoma of the stomach without other modalities, e.g. surgery and systemic chemotherapy. The aim of this study is to be helpful for a comprehensive understanding the possible connections between Hp and gastric MALT lymphoma, evaluating the best therapy strategies, surgical and non surgical, actually available for its treatment.
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La Clinica terapeutica · Nov 2008
ReviewDocetaxel in the adjuvant therapy of HER-2 positive breast cancer patients.
Considering the clinical benefit of trastuzumab in advanced breast cancer, fi ve prospective adjuvant randomized trials have recently been completed and early results have been published. Two of them, (NSABP-B31 and NCCTG N9831), employed anthracycline-containing regimens with sequential paclitaxel, with or without trastuzumab. The third study, HERA trial, randomized patients after adjuvant chemotherapy into an observational arm, one or two years of trastuzumab. ⋯ Data from the second interim analysis indicate that, in the subgroup of patients without co-amplification of topoisomerase 2 (TOPO-2), the arm without trastuzumab (ACT) showed a DFS significantly poorer that in the other arms; moreover, if we consider the lower toxicity of TCH regimen in comparison with anthracycline-containing arms, the innovative statements offered by BCIRG 006 trial appear evident, and these findings opened an important question about the consolidated employment of anthracyclines in adjuvant setting. The FinHer trial was a small trial testing a short course of trastuzumab (9 weeks) concomitantly with a chemotherapy including docetaxel, and there was a significant advantage in DFS for the trastuzumab based arms, without relevant toxicity and without any cardiotoxicity. Although data from all trastuzumab adjuvant trials, and without particulary from BCIRG-006 and FinHer trials, appear very intriguing, further follow-up is required.
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La Clinica terapeutica · Nov 2008
Review Comparative Study[Alexithymic features and emotional distress in patients with chronic tension-type headache (CTTH) and medication-overuse headache (MOH)].
The study examined the role of alexythimia and emotional distress in patients with diagnosis of chronic headaches (tension-type and medication overuse headache). ⋯ Findings supported a link between alexithymia and emotional distress, as an index of psychological maladjustment in chronic headache patients.
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La Clinica terapeutica · Jul 2008
Review[Scoring of disseminated intravascular coagulation (DIC) in intensive care medicine].
A close association between disseminated intravascular coagulation (DIC) and increased morbidity and mortality of the critically ill has been uncovered in the ongoing validation of newly developed scoring systems of DIC. DIC scoring aims at quantifying and standardizing pathological activation of coagulation in these patients. ⋯ Promising data on targeted modification of DIC by administration of antithrombin has been reported in the past, however, randomized controlled trials on the use of antithrombin for the treatment of DIC are still few. Early detection of DIC by application of novel scores could play a particular role in future DIC trials by defining patient populations most likely to benefit from targeted intervention in their clotting disturbance of critical illness.