RESUMEN
BACKGROUND: Chemotherapy (CHT), surgery and radiotherapy (RT) are essential modalities in the treatment of pancreatic malignancies. Their use in practice may be influenced by a number of factors. PATIENTS AND METHODS: Retrospective analysis of CHT, surgery and RT indications and CHT results in patients reported with pancreatic tumor in Pilsen in 2012-2016. RESULTS: A total of 348 patients with median age 68 (19-89) years with newly diagnosed pancreatic tumor, resp., with histology/cytology verified carcinoma in 74.5% cases, with v. s. carcinoma without verification in 21% and with other malignancy not further analyzed here in 4.5% (mostly neuroendocrine tumor). In patients with generalized malignancy (n = 195), exploratory laparotomy was performed in 23% to get tissue samples or verify staging - palliative anastomoses were done in 25% of operated patients, CHT was performed in 29% of the generalized tumors, palliative RT of tumor was performed in 1 patient, and RT of metastases in 3 patients. In patients with local or regional nodal affection (n = 137) laparotomy was done in 59%, R0 resection in 34 (42%) of 81 operated, R1 in 6%, palliative anastomoses were done in 17% and irreversible electroporation in one patients, CHT or radiochemotherapy after R0 and R1 resections was provided in 61% operated patients. The most commonly used CHT was monotherapy with gemcitabine or FOLFIRINOX. The indication of CHT in cytology/histology verified generalized cancers and with excluding patients refusing CHT was proposed in 2012 to 16%, in 2014 to 49% and in 2016 to 84% of patients. In the case of a local or regional nodal involvement the CHT was proposed to 40, 55 and 86% of patients. Median overall survival in generalized tumor patients receiving CHT (n = 137) vs. not-receiving CHT (n = 56) was 2 vs. 8 months (p = 0.0001), and in the local or regional nodal involvement patients receiving CHT (n = 74) vs. not-receiving CHT (n = 62) was 5 vs. 16 months (p = 0.0001). CONCLUSION: CHT and surgery are the dominant treatment modalities. There has been a marked increase in the CHT and histology/cytology verifications indications, with a major factor being a clinician evaluation of a patient to be fit for CHT and its benefit or to complete pancreatic tumor verification. With still very limited results in pancreatic cancer treatment, a careful assessment of each patients indication, respecting patients desire, is always required, knowing that even in the case of advanced disease, CHT can bring benefit, albeit limited.Key words: pancreas - carcinoma - chemotherapy The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. This study was supported by the grant of Ministry of Health of the Czech Republic - Conceptual Development of Research Organization (Faculty Hospital in Pilsen - FNPl, 00669806).Submitted: 13. 3. 2018Accepted: 18. 4. 2018.
Asunto(s)
Neoplasias Pancreáticas , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapéutico , Fluorouracilo/uso terapéutico , Humanos , Irinotecán/uso terapéutico , Leucovorina/uso terapéutico , Persona de Mediana Edad , Oxaliplatino/uso terapéutico , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/cirugía , Adulto Joven , Gemcitabina , Neoplasias PancreáticasRESUMEN
BACKGROUND: Oral mucositis, mTOR associated stomatitis, is a major complication in everolimus (EVE) treatment with an incidence of 44-64%. The management of it in the daily practice has not been described enough, so far. PATIENTS AND METHODS: Retrospective analysis of patients treated with EVE in 2016 at our center, n = 42 patients (69% female), median age 66 (37-81) years, breast cancer in 20 (48%) and renal cell carcinoma in 22 (52%), starting EVE dose of 10mg/day in 34 (81%) and 5mg/day in 8 (19%) patients. RESULTS: Discomfort and/or dysgeusia without mucosa defects (grade 1 NCI-CTC) was in 4/34 (12%) patients, mucosal defects without oral intake limitation (grade 2) in 6/34 (17.5%), mucosal defects limiting oral intake (grade 3) in 7/34 (20.5%) patients. ACTIONS TAKEN: in grade 1 EVE dose reduced to 5mg/day in 1/4 affected patients, in grade 2 locally administered dexamethasone solution recommended in 2/6, reduction of EVE to 5mg/day in 4/6 (in two cases the reduced dose left because of complications recurrences), in grade 3 locally administered dexamehasone solution recommended in 5/7, transient reduction of EVE to 5mg/day in 1/7, permanent reduction of EVE in 5/7 (recurrent aphthous lesions), EVE terminated in 1/7. In patients with EVE starting dose of 5mg/day there was one case (1/8, 12.5%) of grade 2 complication requiring no intervention. The complications developed within 2-20 weeks after EVE initiation (median of 8 weeks). CONCLUSION: The incidence of stomatitis and its severity in this cohort is comparable with published trials data, it confirms the significant incidence of damage affecting the quality of life, oral intake and anti-cancer treatment in daily practice. The interventions used in groups of similarly affected patients appears slightly heterogeneous, influenced by individual physician approach. There is tendency not to interrupt the EVE treatment and keep it either in a dosage of 10 or 5mg/day if the oral damage is tolerable. Local treatment with dexamethasone is not yet fully exploited.Key words: everolimus - stomatitis - mucositis - oral cavity Supported by the grant of Ministry of Health of the Czech Republic - Conceptual Development of Research Organization (Faculty Hospital in Pilsen - FNPl, 00669806) and National Sustainability Program I (NPU I) No. LO1503 provided by the Ministry of Education Youth and Sports of the Czech Republic. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 27. 2. 2017Accepted: 26. 3. 2017.
Asunto(s)
Antineoplásicos/efectos adversos , Everolimus/efectos adversos , Estomatitis/inducido químicamente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/efectos de los fármacos , Estudios RetrospectivosRESUMEN
The authors investigated the frequency of squamous intraepithelial lesions (SIL) in young women, in particular university students with special attention to morphological signs of the presence of human papilloma virus (HPV) in SIL low grade-SIL, LG-HPV. As compared with data in the world literature, they revealed a significantly lower rate of SIL LG, HPV-2.81% as compared with 5.5% reported in WHO studies of young women. The authors analyzed the biological behaviour of SIL, LG-HPV. As compared with data in the literature on known values of spontaneous regression which are 50-62% in the course of three years, they demonstrated during a time interval from 3 months to 2 years spontaneous regression in 39.1%. Further possibilities of regression in a longer time interval are expected in the group of clinically latent cytologically persistent LG lesions (18.1%) and in the group of patients which after termination of their studies were lost from the records (24.3%). During the investigated time interval no case of progression to a higher grade lesion was recorded. The authors reflect on diagnostic and therapeutic procedures with regard to the application of results of HPV typing.
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Displasia del Cuello del Útero/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Adolescente , Adulto , República Checa , Femenino , Humanos , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/diagnóstico , Estudiantes , Infecciones Tumorales por Virus/complicaciones , Infecciones Tumorales por Virus/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/virología , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/virologíaRESUMEN
Inverted papilloma is a relatively rare benign tumour of nasal mucosa and paranasal sinuses which approx. in 15% is connected with malignancy. The morphology, occurrence, etiology and biological behaviour of this tumour are dealt with. A group of 8 patients is presented. The significance of nasal polyps routine histologic investigation for early detection of these tumours is stressed. Various treatment possibilities are discussed and a therapeutic procedure based on radical surgery is suggested.
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Neoplasias Nasales , Papiloma , Neoplasias de los Senos Paranasales , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Nasales/etiología , Neoplasias Nasales/patología , Neoplasias Nasales/terapia , Papiloma/etiología , Papiloma/patología , Papiloma/terapia , Neoplasias de los Senos Paranasales/etiología , Neoplasias de los Senos Paranasales/patología , Neoplasias de los Senos Paranasales/terapiaRESUMEN
Monoclonal antibodies against several human leucocyte cell surface antigens were prepared and characterized: B2M-02, a non-cytotoxic antibody against beta-2-microglobulin; MEM-09 and MEM-40, against immunoglobulin kappa-type light chains; MEM-12, MEM-24G and MEM-32B, all against a monomorphic determinant in MHC class II antigens, presumably HLA-DR, dependent on the association of alpha and beta chains; MEM-15 and MEM-18, against a monocyte antigen of 55 kDa; MEM-28, against a 200 kDa antigen expressed on all leucocytes; MEM-31, against the T8 antigen of the cytotoxic/suppressor T-lymphocyte subpopulation; MEM-32, against the T1 antigen of T lymphocytes.
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Anticuerpos Monoclonales/biosíntesis , Antígenos de Superficie/análisis , Antígenos de Superficie/inmunología , Antígenos de Histocompatibilidad Clase II/inmunología , Cadenas kappa de Inmunoglobulina/inmunología , Monocitos/inmunología , Microglobulina beta-2/inmunología , Animales , Anticuerpos Monoclonales/análisis , Antígenos de Diferenciación de Linfocitos T , Cromatografía de Afinidad , Electroforesis en Gel de Poliacrilamida , Ensayo de Inmunoadsorción Enzimática , Epítopos/análisis , Técnica del Anticuerpo Fluorescente , Antígenos HLA-DR , Humanos , Hibridomas/inmunología , Leucocitos/clasificación , Leucocitos/inmunología , Hígado/inmunología , Ratones , Ratones Endogámicos BALB C/inmunología , Linfocitos T/inmunología , Timo/inmunologíaRESUMEN
Twelve cases representing variants of peripheral T malignant lymphoma were described for the first time in this country. Rosette test and immunocytology were crucial for their identification. Convoluted nuclei were a dominant histologiial feature as well as a voluminous water-clear cytoplasm which kept being surprisingly well demarked. Basic features were analogous to the Far East cases. Nevertheless, hypercalcemia and substantial pulmonary lesion were not observed.
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Linfoma/patología , Adulto , Anciano , Femenino , Humanos , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Linfocitos TRESUMEN
Three cases of immunoblastic B sarcoma were found in a group of 38 patients suffering from lymphoepitheloid malignant lymphoma where atypical epitheloid cells did not occur temporarily. Taking some morphological and even histochemical features of tumour cells they reminded of hybrid forms. This stimulating finding was difficult to explain. Persons in the study were of higher age, case histories showed high grade malignancy with a rather good reaction to cytostatic treatment. The picture is to be followed further as a subunit isolated from the wide rank of lymphoepitheloid malignant lymphoma.
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Linfoma/ultraestructura , Epitelio/ultraestructura , HumanosRESUMEN
About 100 illustrative cases of malignant lymphoma and non-tumorous lymph node processes studied by electron microscopy were revised. Some distinguishing features were stressed as about nuclear patterns and intercellular relations of basic lymphatic elements. The centrocyte is unique in a fine chromatin pattern of the cleft nuclei and in varied superficial qualities. It tends to form junctions with dendritic cells and bilateral dense bodies remaining from severed cellular projections. The centroblast and immunoblast represent a different structural line related to plasmacytes and macrophages or epitheloid cells. The T-line tends to form characteristic junctions with interdigitating cells as well as dense invaginations of cytoplasmic membrane on the both sides of junctions. There is a limited number of similar junctions with pericytes. Dense bodies produced at the junction of lymphatic and stromal reticular cells are discussed.
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Linfocitos/ultraestructura , Reticulocitos/ultraestructura , Humanos , Linfoma/ultraestructura , Microscopía ElectrónicaRESUMEN
A more detailed analysis of lymphatic tissue showed its sophisticated cytology. About 35 types of cells shared in structure in a confined space. Their most important diagnostic criteria in the light and electron microscopy, histochemistry, and immunohistology were reviewed. Testing group features in advance seemed to be advantageous beginning with lymphocytes, lymphoplasmatic elements, polymorph lymphatic cells, lymphoblasts, histioreticular and vascular cells. A further subgrouping is mostly feasible especially by electron microscopy.
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Linfocitos/ultraestructura , Tejido Linfoide/citología , HumanosRESUMEN
The second and third cases of this rare entity reported on in Czechoslovak literature were observed in two females, one 59, the other 24 years old. In both, there was typical diffuse pulmonary involvement with honeycomb transformation, recurrent spontaneous pneumothorax, and cor pulmonale decompensation. In the older patient, there was, at the same time, pronounced paraoesophageal node leiomyomatosis. In the younger one, there were associated renal and hepatic angiomyolipomas such as are found in tuberous sclerosis.