Srp Ark Celok Lek
-
The Working Formulation Classification (for clinical use) divides non-Hodgkin's lymphoma (NHL), according to the nature of the disease and response to therapy into the low, medium and high risk lymphomas. Although these subgroups include different pathohistological types of NHL, they are considered sufficiently homogenous for joint therapy planning [1]. The first generation protocol (CHOP) managed to achieve complete remission (CR) in 50-55% of patients with 30-35% of survival rate [2]. A large four-branch comparative study of SWOG group compared CHOP as the first generation protocol with the third generation protocols ProMACE CytaBOM, m-BACOD and MCOD-D. The results have shown a similar CR and survival rates, so that CHOP is considered a gold standard for the treatment of aggressive NHL [6]. In the light of individual reports stating a high CR rate in the treatment of aggressive NHL by ProMACE CytaBOM [3-5] we present our experience and observations related to the use of this protocol. ⋯ The fact that a half of adult patients with disseminated aggressive NHL can be cured with combined chemotherapy is the major oncological achievement in the last 20 years. The protocol combines 4-8 drugs, and the joint report of the SFOG group for lymphoma in over 1200 patients with lymphoma has shown that the second and third generation protocols are not more effective than the standard CHOP or CHOPBleom protocols [6]. The optimum therapeutic protocol in the treatment of aggressive lymphoma is still unpredictable due to the fact that it is inadequate to compare the results of individual institutions with the results of collaborative groups; there is also a significant difference in the prognostic factors in different research groups; there is no sufficient complete and published results that suggest the lower CR than the original reports (which may be related to the evaluation of tumour and remission). There are not sufficient data on the incidence of secondary carcinoma and leukaemia [1]. The decision on the therapy should be based on two lines of information: those related to each particular patient (age, associated diseases) and those related to the tumour (large mass, immunophenotyping, cytoge
-
Nephrolithiasis is a common disorder and a significant problem because of incidence, recurrence and severe consequences. Stone disease is a surgical as well as a medical problem. Major progress has been made recently in understanding the pathophysiological disturbances responsible for stone formation as well as in the techniques of stone removal. ⋯ Fasting urinary calcium is used to detect renal calcium leak, and calciuric response to oral calcium load provides an indirect measure of intestinal calcium absorption. Diagnostic criteria for major forms of stone disease [8] are presented in Table 1. There are some still unsolved questions: does time after passage of stones or urological intervention influence the frequency of urine abnormalities that can be detected; are there differences in 24-h urine composition between weekdays and weekends: what is the prevalence of the most important urinary risk factors of recurrent idiopathic calcium nephrolithiasis: do male patients differ from females with respect to urinary risk factors or recurrent idiopathic calcium nephrolithiasis? [7].
-
Fluorouracil (5-FU) has remained the mainstay of treatment of advanced colorectal cancer disease for nearly 40 years, and despite the implementation of various strategies to increase response rates no substantial improvement in survival has been achieved. 5-FU efficacy has been enhanced by modulating its cytotoxicity with leucovorin (LV) or by administering it as a continuous intravenous infusion. These regimens resulted in a few-fold improvement of tumour response rate in patients with metastatic disease compared with standard 5-FU treatment. The figures are still low (25%), and survival is affected only modestly [1, 2]. Cisplatin and carboplatin are also able to modulate 5-FU cytotoxicity in experimental systems [3]. Recent results of experimental studies suggested that high doses of carboplatin were necessary to achieve biochemical modulation of 5-FU cytotoxicity in vivo [6]. The use of chronobiologically determined drug over a 24-hour period may allow an increase in antitumour effect and a decrease in side effects. Experiments in animals revealed large changes in the toxic effects of 5-FU and platinum analogues, depending on the circadian rhythm of drug administration [9, 10]. The aim of the study was to investigate the toxicity and efficacy of combination of high dose carboplatin, fluorouracil and leucovorin in patients with advanced colorectal adenocarcinoma. Carboplatin and 5-FU were administered in circadian-dependent rhythm regimen in a 4-h infusion. ⋯ Carboplatin is able to modulate 5-FU cytotoxicities [3]. A high dose of carboplatin is necessary to achieve biochemical modulation of 5-FU cytotoxicities in vivo [6]. The studies of colon tumour cell lines demonstrated sensitivities to carboplatin when used at clinically achievable dose level [4]. Clinical studies of carboplatin, as a single agent or in combination, in the treatment of colorectal cancer, reported controversial results [19, 20]. Animal studies indicated large and predictable changes in the toxic effects of carboplatin and 5-FU, depending on the circadian rhythm of drug administration. Mechanisms included 24 h changes in the activities of several enzymes involved in 5-FU and carboplatin catabolism or in the anabolism of its cyt
-
Skin tests are the most useful single modality for demonstrating an IgE-mediated mechanism underlying clinical symptoms. Skin reactivity to an allergen depends on person's exposure and genetic factors influencing the IgE response. However, the reproducibility of allergy skin tests has been shown to be variable depending, among other things, on the allergen extract employed and the kind of technique used. These variations have led to controversy regarding clinical relevancy of allergy skin testing [1-7]. We examined the relationship of skin-prick test and serum allergen-specific IgE in pollen susceptible adult persons. We estimated changes in the immediate skin reactivity to pollen-allergens by testing patients on more than one occasion: a) during and out of pollen season; b) before and after completing specific immunotherapy, and c) who had been tested with diverse concentrations of the same pollen-allergen. We correlated the degree of skin reactivity at the initial and subsequent testings with the aim of estimate diagnostic relevancy of such performed allergy skin testings. ⋯ In the study it has been shown that serum concentration of allergen-specific IgE positively correlated with the skin reactivity to pollen-extract. In addition, allergen specific immunotherapy as well as the concentrations of the used allergenic extract influenced significantly local skin reactivity. On the contrary, season when testing had no influence. According to our results, it seems that skin reactions (papule), equal or larger than 6 mm in diameter, could be of diagnostic value concerning pollen-monotest application (Table 1). Meanwhile, with significance of 95% we could postulate that in persons tested with the lowest concentration of allergen-solution (5000 AU/ml), skin prick reactivity defined by the papule of 4 mm or larger can replace in vitro
-
Neuro-toxic effects of aluminium, with disorders mainly in motor coordination, have been proved in epidemiological studies of subjects professionally exposed to aluminium. However, there is, as yet, no adequate evidence that neurotoxicity of aluminium leads to progressive dementia and Alzheimer's disease. It is likely that long-term use of drinking water with a high aluminium concentration, with pH about or less than 7.0, and with low fluoride concentration, is associated with the increased relative risk of Alzheimer's disease. ⋯ Results of the studies concerning aluminium concentrations in the brain of patients with Alzheimer's disease are incoherent. To resolve this scientific problem it is necessary to follow-up the prognosis of neurotoxic disorders caused by aluminium. It should be clarified as well whether aluminium in neuro-pathological findings of Alzheimer's disease is an artefact caused by alumino-silicates present in most reagents for tissue-staining.