RESUMEN
Nephroblastoma is the most frequent renal tumor in childhood population. Rarely, it can occur in adults. In this case, the diagnosis is frequently challenging for pathologists. No standard guidelines are available for this neoplasm in adults. It needs multidisciplinary collaboration for optimal management. Herein we report a 26-year-old man presenting with a non-metastatic right nephroblastoma. He underwent a radical nephrectomy. He is currently in complete remission after a follow-up of 18 months.
RESUMEN
INTRODUCTION: MSC1992371A is an aurora kinase inhibitor with potential antitumor activity. METHODS: This trial established the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of oral MSC1992371A given before or after gemcitabine (1,000 mg/m(2)) in a 21-day cycle in patients with advanced malignancies. In schedule 1 (n = 31), gemcitabine was administered on days 1 and 8 followed by escalating doses of MSC1992371A on days 2 and 9. In schedule 2 (n = 35), MSC1992371A was given on days 1 and 8 followed by gemcitabine on days 2 and 9. Patients had a range of solid tumors, the most frequent of which was colorectal (n = 19). RESULTS: In both schedules, the 37 mg/m(2) dose level was defined as the MTD. The main DLT was grade 4 neutropenia. Adverse events consisted of neutropenia, thrombocytopenia, asthenia, fatigue, nausea, vomiting, anorexia, and diarrhea. Administration of MSC1992371A prior to gemcitabine had no effect on the metabolism or elimination of gemcitabine. Time to reach maximum plasma concentration and area under the plasma concentration-time curve for MSC1992371A increased proportionally with dose. Exploration of drug-target-related and tumor biomarkers did not identify predictors of biologic activity or response. Two patients (1 with lung carcinoma and 1 with hepatocellular carcinoma) had durable partial responses in schedule 2, and 5 patients had stable disease (SD) lasting 6 - 14 months. CONCLUSION: Oral MSC1992371A can be administered at a MTD of 37 mg/m(2) in combination with the standard 1,000 mg/m(2) dose of gemcitabine, but hematologic toxicity requires careful monitoring. Preliminary signs of efficacy were indicated by durable responses and SD.
Asunto(s)
Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias/tratamiento farmacológico , Norbornanos/uso terapéutico , Inhibidores de Proteínas Quinasas/uso terapéutico , Pirimidinas/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/efectos adversos , Antineoplásicos/sangre , Antineoplásicos/farmacocinética , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/sangre , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Demografía , Desoxicitidina/análogos & derivados , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Masculino , Dosis Máxima Tolerada , Persona de Mediana Edad , Neoplasias/sangre , Norbornanos/efectos adversos , Norbornanos/sangre , Norbornanos/farmacocinética , Inhibidores de Proteínas Quinasas/efectos adversos , Inhibidores de Proteínas Quinasas/sangre , Inhibidores de Proteínas Quinasas/farmacocinética , Pirimidinas/efectos adversos , Pirimidinas/sangre , Pirimidinas/farmacocinética , Adulto Joven , GemcitabinaRESUMEN
Aurora kinase inhibitors (AKIs) are a class of antimitotic, small-molecule anticancer agents. MSC1992371A is an AKI being evaluated for the treatment of patients with solid tumors. This phase I, open-label, dose-escalation study determined the maximum tolerated dose (MTD) of MSC1992371A in different dosing schedules in patients with locally advanced or metastatic solid tumors. MSC1992371A was administered on days 1 and 8 (schedule 1) or on days 1, 2, and 3 (schedule 2) of a 21-day cycle. The study was expanded with a third schedule (study drug on days 1-3 and 8-10). Adverse events were monitored throughout the study. Antitumor efficacy, drug pharmacokinetics, and pharmacodynamics were evaluated. Ninety-two patients were enrolled. MSC1992371A was dosed over eight levels in schedules 1 and 2, and the MTD was determined as 74 mg/m(2) per cycle for both schedules and as 60 mg/m(2) in schedule 3, albeit only in three patients due to discontinuation of the study. Overall, the most common grade 3 or 4 treatment-emergent adverse events were neutropenia, febrile neutropenia, thrombocytopenia, anemia, and fatigue. The most frequent dose-limiting toxicity over all schedules was neutropenia. MSC1992371A plasma concentrations tended to increase with increasing dose levels. Although no complete or partial responses were seen, stable disease ≥3 months was observed in 11 patients. Analysis for markers of target modulation and pharmacodynamics effects was unsuccessful. MSC1992371A was generally well tolerated in patients, with mainly transient hematologic toxicities apparent at an MTD of 60-74 mg/m(2)/21-day cycle, independent of dosing frequency.
Asunto(s)
Aurora Quinasa A/antagonistas & inhibidores , Neoplasias/tratamiento farmacológico , Norbornanos/administración & dosificación , Inhibidores de Proteínas Quinasas/administración & dosificación , Pirimidinas/administración & dosificación , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Interacciones Alimento-Droga , Humanos , Masculino , Dosis Máxima Tolerada , Persona de Mediana Edad , Metástasis de la Neoplasia , Neoplasias/metabolismo , Neoplasias/patología , Norbornanos/efectos adversos , Norbornanos/farmacocinética , Inhibidores de Proteínas Quinasas/efectos adversos , Inhibidores de Proteínas Quinasas/farmacocinética , Pirimidinas/efectos adversos , Pirimidinas/farmacocinética , Resultado del Tratamiento , Adulto JovenRESUMEN
Infectious complications of finger-joints in association with hand burns are common and dominated by osteoarthritis. However, this issue has hardly ever been addressed in the literature. This ailment can either be identified while patients with extensive burns are undergoing intensive care, or during patient rehabilitation. In the former instance, it is difficult to recognize because patient sedation means the clinical signs are not obvious. In the latter phase, however, the pain, swelling (tumefaction), stiffness and radiological signs are clear. These infections should be diagnosed as soon as possible in order to preserve the function of the hand.
Asunto(s)
Antituberculosos/efectos adversos , Isoniazida/efectos adversos , Enfermedad de la Neurona Motora/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto , Humanos , Masculino , Enfermedad de la Neurona Motora/fisiopatología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Tuberculosis Pulmonar/complicaciones , TúnezRESUMEN
OBJECTIVE: The objective is to study the rehabilitation management and to assess autonomy in daily life activities as well as walking recovery in patients with complicated Pott's disease. PATIENTS AND METHODS: Retrospective study in nine patients over a period of 8 years extending from 2000 to 2008, collated in the Department of Physical Medicine and Functional Rehabilitation, CHU Sahloul, Sousse, Tunisia. RESULTS: The mean age of our patients was 43.8 years; sex ratio was 5/4. The spine involvement of tuberculosis was dorsal in seven cases, dorso-lumbar in one patient, and multiple (cervical, dorsal and lumbar) in one case. All patients were paraplegic with a neurological involvement of the bladder. They had prior antituberculosis chemotherapy for at least 8 months. Decompression surgery was performed in six cases. Two female patients presented disorders of spinal posture during treatment requiring surgical revision with osteosynthesis. All patients received additional rehabilitation care. Following a mean duration of hospitalisation in the Rehabilitation department of 47 days with twice-daily sessions of tailored physiotherapy, three patients remained in complete paraplegia, autonomous in wheel-chair and with vesical and sphincter incontinence. The measure of functional independence (MFI) was at admission/discharge 71/92. CONCLUSION: Rehabilitation takes an important place in the medico-surgical management in Pott's disease, to limite or compensate the disabilities and handicap related to this pathology.
Asunto(s)
Paraplejía/rehabilitación , Tuberculosis de la Columna Vertebral/rehabilitación , Vejiga Urinaria Neurogénica/rehabilitación , Actividades Cotidianas , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paraplejía/etiología , Pronóstico , Tuberculosis de la Columna Vertebral/complicaciones , Vejiga Urinaria Neurogénica/etiologíaRESUMEN
OBJECTIVE: Our objective is to assess the effect of mechanical and manual intermittent cervical traction on pain, use of analgesics and disability during the recent cervical radiculopathy (CR). METHODS: We made a prospective randomized study including patients sent for rehabilitation between April 2005 and October 2006. Thirty-nine patients were divided into three groups of 13 patients each. A group (A) treated by conventional rehabilitation with manual traction, a group (B) treated with conventional rehabilitation with intermittent mechanical traction and a third group (C) treated with conventional rehabilitation alone. We evaluated cervical pain, radicular pain, disability and the use of analgesics at baseline, at the end and at 1, 3 and 6 months after treatment. RESULTS: At the end of treatment improving of cervical pain, radicular pain and disability is significantly better in groups A and B compared to group C. The decrease in consumption of analgesics is comparable in the three groups. At 6 months improving of cervical and radicular pain and disability is still significant compared to baseline in both groups A and B. The gain in consumption of analgesics is significant in the three groups: A, B and C. CONCLUSION: Manual or mechanical cervical traction appears to be a major contribution in the rehabilitation of CR particularly if it is included in a multimodal approach of rehabilitation.
Asunto(s)
Dolor de Cuello/terapia , Radiculopatía/terapia , Tracción , Adulto , Femenino , Humanos , Masculino , Dimensión del Dolor , Estudios Prospectivos , Método Simple CiegoRESUMEN
INTRODUCTION: Sociocultural factors may influence the impact of chronic low back pain (cLBP) on patients. The goal of this study was to compare pain and disability levels, and psychobehavioural parameters in four French-speaking countries in patients with cLBP. METHODS: Two hundred and seventy-eight patients were included: 83 in France, 36 in Morocco, 75 in the Ivory Coast and 84 in Tunisia. Demographic data were collected; pain was assessed using a visual analogue scale (VAS), disability with the Quebec scale, psychobehavioural factors by the hospital anxiety depression scale (HAD), the fear and avoidance beliefs questionnaire (FABQ) and the coping strategy questionnaire (CSQ). A Student t-test was used to compare means. Anova (covariance) was used to test for a "Country Effect", i.e. the incidence of country on outcomes. OUTCOMES: There was no difference in disability levels between countries. A "country effect" was found (p<0.001) for pain (F=2.707), anxiety (F=3.467), depression (F=5.137), fear and avoidance beliefs regarding professional activity (F=1.974) and physical activity (F=5.076), strategy of distraction, dramatization, efforts to ignore pain, prayer, seeking social support and reinterpretation (p<0.01). Pain level was higher in Morocco (p<0.05); anxiety, depression, fear and avoidance beliefs about physical activities were higher in Tunisia (p<0.05) and fear and avoidance beliefs about professional activities were higher in the Ivory Coast (p<0.01). Among the coping strategies used, distraction, dramatization, prayer and search for social support were used more in the Ivory Coast; reinterpretation in Tunisia; seeking social support was less common in France. CONCLUSION: In this population of patients with cLBP, despite similar disability levels across the four French-speaking countries, there were considerable variations in pain level and psychobehavioural repercussions.
Asunto(s)
Actitud Frente a la Salud/etnología , Costo de Enfermedad , Dolor de la Región Lumbar/etnología , Adaptación Psicológica , Adulto , Anciano , Análisis de Varianza , Ansiedad/etnología , Reacción de Prevención , Enfermedad Crónica , Côte d'Ivoire/epidemiología , Comparación Transcultural , Depresión/etnología , Personas con Discapacidad/psicología , Personas con Discapacidad/estadística & datos numéricos , Miedo/psicología , Femenino , Francia/epidemiología , Humanos , Incidencia , Lenguaje , Dolor de la Región Lumbar/complicaciones , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/prevención & control , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Dimensión del Dolor , Estudios Prospectivos , Encuestas y Cuestionarios , Túnez/epidemiologíaRESUMEN
OBJECTIVE: To assess the efficacy and treatment compliance of a home-based rehabilitation programme for chronic low back pain (CLBP). POPULATION: CLBP outpatients treated in a Physical Medicine Rehabilitation or Rheumatology unit within a university hospital. METHODS: We performed a prospective, comparative study. The participants were randomly assigned to either a home-based rehabilitation programme (Gp A) or a standard physical therapy (Gp B). The programme included four weekly sessions. In each group, we measured pain intensity (on a visual analogue scale, VAS), flexibility and muscle endurance (the Schöber MacRae test, finger-to-floor distance, thigh-leg angle, the Shirado and Sorensen test), functional and psychological repercussions (the Quebec functional index and the Hospital Anxiety and Depression scale) and handicap (on a VAS). Follow-up examinations took place at baseline and four weeks and three, six and 12 months later. RESULTS: One hundred and seven patients (82 women) with a mean+/-standard deviation (S.D.) age of 35.7+/-0.8 years were included (with 54 patients in Gp A). At four weeks, a significant improvement (relative to baseline) was observed for all parameters in both study groups but with a significantly greater difference in Gp A, which was maintained at one year (despite an observed regression of the improvement at six months). At one year, compliance with the home-based rehabilitation programme was good (68.1%) and 59.5% of the patients regarded the programme as useful. CONCLUSION: Our results suggest that a home-based rehabilitation programme is as effective as standard physical therapy. However, this type of programme requires patient motivation and regular follow-up.
Asunto(s)
Terapia por Ejercicio , Dolor de la Región Lumbar/rehabilitación , Adulto , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Ejercicios de Estiramiento Muscular , Pacientes Ambulatorios , Dimensión del Dolor , Cooperación del Paciente , Satisfacción del Paciente , Resistencia Física , Modalidades de Fisioterapia , Rango del Movimiento Articular , Autocuidado , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
BACKGROUND: Hyperhomocysteinemia is known as an independent-risk factor for coronary-artery disease (CAD). However, the effect of homocystein metabolic enzymes polymorphisms on CAD is still controversed. We investigated the relation between homocystein metabolic key enzymes polymorphisms, homocystenemia and coronary stenosis in a Tunisian population. METHODS: Samples were collected from 251 CAD patients documented by angiography. Genotyping were performed for C677T methylene-tetrahydrofolate reductase (MTHFR), A2756G methionine-synthase (MS) and 844ins 68 cystathionine-beta-synthase (CBS). We measured fasting plasma tHcy, folate and vitamin B12. RESULTS: There was significant increase in homocysteinemia for homozygous genotypes of C677T MTHFR (p<0.001) and A2756G MS (p=0.01), but not for 844ins68 CBS (p=0.105). Potential confounders adjusted odds-ratios for significant coronary stenosis, associated with MTHFR TT, MS GG and CBS insertion, were respectively 1.78 (p=0.041); 2.33 (p=0.036) and 0.87 (p=0.823). The effect of mutated MTHFR genotype was more pronounced on homocysteinemia (21.4+/-9.1 micromol/L; p<0.001) and coronary stenosis (OR=2.73; p=0.033) at low folatemia (< or =6.1 ng/mL). CONCLUSION: MTHFR TT and MS GG genotypes increase tHcy concentration and coronary stenosis risk, especially with low folatemia.
Asunto(s)
5-Metiltetrahidrofolato-Homocisteína S-Metiltransferasa/genética , Estenosis Coronaria/genética , Cistationina betasintasa/genética , Homocisteína/metabolismo , Hiperhomocisteinemia/genética , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Polimorfismo Genético , Femenino , Homocisteína/sangre , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , TúnezRESUMEN
OBJECTIVES: The aim of this study was to evaluate infantile cryptosporidiosis prevalence in central Tunisia. POPULATION AND METHODS: Stool samples from 34,020 immunocompetent children were investigated for oocysts through a 12-year study. RESULTS: Cryptotosporidia were detected in 0.32% (108) of samples. Ninety three per cent of children were less than five years old. Incidence was much higher in summer and autumn. Leading clinical symptoms were diarrhea, fever and vomiting. Symptoms spontaneously resolved in all patients. In three cases, infection was asymptomatic. CONCLUSION: Data analysis indicate that cryptosporidiosis is not uncommon in diarrheic central Tunisian children.