Objectives. To evaluate reasons for discontinuing intraperitoneal (IP) chemotherapy, and to compare characteristics of patients who did versus did not successfully complete six cycles of IP chemotherapy. Methods. In a...Objectives. To evaluate reasons for discontinuing intraperitoneal (IP) chemotherapy, and to compare characteristics of patients who did versus did not successfully complete six cycles of IP chemotherapy. Methods. In a phase III trial, women with optimal stage III ovarian or peritoneal carcinoma were randomly allocated to receive IP therapy (paclitaxel 135 mg/m2 intravenously (IV) over 24 h, cisplatin 100 mg/m2 IP day 2, paclitaxel 60 mg/m2 IP day 8) every 21 days for six cycles. Patients unable to receive IP therapy were treated with the alternate (IV) regimen. Variables compared included surgical procedures prior to enrollment, timing of IP catheter insertion, and primary and contributing reasons for discontinuing IP therapy. Results. Among 205 eligible patients randomly allocated to the IP arm, 119 (58% ) did not complete six cycles of IP therapy. Forty (34% ) patients discontinued IP therapy primarily due to catheter complications and 34 (29% ) discontinued for unrelated reasons. Hysterectomy, appendectomy, small bowel resection, and ileocecal resection were not associated with failure to complete six cycles. IP therapy was not initiated in 16% of patients who did versus 5% of those who did not have a left colon or rectosigmoid colon resection (P = 0.015). There was no association between timing of catheter insertion and failure to complete IP therapy. Conclusions. In this multi- institutional setting, it was difficult to deliver six cycles of IP therapy without complications. There appears to be an association between rectosigmoid colon resection and the inability to initiate IP therapy. Catheter choice, timing of insertion, and how surgical treatment of ovarian cancer influences the successful completion of intraperitoneal chemotherapy require further study.展开更多
Background: Perinatal stress is thought to underlie the Barker sequelae of low birth weight, of which precocious pubarche may be a manifestation.Aims: To explore whether prematurity as well as smallness for gestationa...Background: Perinatal stress is thought to underlie the Barker sequelae of low birth weight, of which precocious pubarche may be a manifestation.Aims: To explore whether prematurity as well as smallness for gestational age (SGA) predisposes to precocious pubarche, and the potential role of excess weight gain during childhood.Methods: Retrospective chart review of 89 children (79 girls) with precocious pubarche.Results: Sixty five per cent were overweight/obese at diagnosis, compared with 19-24%of Australian children.Thirty five per cent had a history of SGA and 24%of prematurity.Weight SDS increased from birth to diagnosis in 91%of children.The mean change in weight SDS from birth to diagnosis was greater in those who were SGA (2.8, 95%CI 2.2 to 3.4) versus AGA (1.7, 95%CI 1.3 to 2.2), with no difference in the incidence of over weight/obesity.The latter was lower among children born premature (40%versus 72%term) but was associated with a mean increase in weight of 1.3 SDS during childhood.Nine out of ten girls and boys with precocious pubarche had at least one of the three risk factors studied.Conclusions: Both prematurity and SGA were associated with precocious pubarche, as was overweight/ obesity, irrespective of size or gestation at birth.Excess weight gain in childhood may predispose to precocious pubarche in susceptible individuals.展开更多
文摘Objectives. To evaluate reasons for discontinuing intraperitoneal (IP) chemotherapy, and to compare characteristics of patients who did versus did not successfully complete six cycles of IP chemotherapy. Methods. In a phase III trial, women with optimal stage III ovarian or peritoneal carcinoma were randomly allocated to receive IP therapy (paclitaxel 135 mg/m2 intravenously (IV) over 24 h, cisplatin 100 mg/m2 IP day 2, paclitaxel 60 mg/m2 IP day 8) every 21 days for six cycles. Patients unable to receive IP therapy were treated with the alternate (IV) regimen. Variables compared included surgical procedures prior to enrollment, timing of IP catheter insertion, and primary and contributing reasons for discontinuing IP therapy. Results. Among 205 eligible patients randomly allocated to the IP arm, 119 (58% ) did not complete six cycles of IP therapy. Forty (34% ) patients discontinued IP therapy primarily due to catheter complications and 34 (29% ) discontinued for unrelated reasons. Hysterectomy, appendectomy, small bowel resection, and ileocecal resection were not associated with failure to complete six cycles. IP therapy was not initiated in 16% of patients who did versus 5% of those who did not have a left colon or rectosigmoid colon resection (P = 0.015). There was no association between timing of catheter insertion and failure to complete IP therapy. Conclusions. In this multi- institutional setting, it was difficult to deliver six cycles of IP therapy without complications. There appears to be an association between rectosigmoid colon resection and the inability to initiate IP therapy. Catheter choice, timing of insertion, and how surgical treatment of ovarian cancer influences the successful completion of intraperitoneal chemotherapy require further study.
文摘Background: Perinatal stress is thought to underlie the Barker sequelae of low birth weight, of which precocious pubarche may be a manifestation.Aims: To explore whether prematurity as well as smallness for gestational age (SGA) predisposes to precocious pubarche, and the potential role of excess weight gain during childhood.Methods: Retrospective chart review of 89 children (79 girls) with precocious pubarche.Results: Sixty five per cent were overweight/obese at diagnosis, compared with 19-24%of Australian children.Thirty five per cent had a history of SGA and 24%of prematurity.Weight SDS increased from birth to diagnosis in 91%of children.The mean change in weight SDS from birth to diagnosis was greater in those who were SGA (2.8, 95%CI 2.2 to 3.4) versus AGA (1.7, 95%CI 1.3 to 2.2), with no difference in the incidence of over weight/obesity.The latter was lower among children born premature (40%versus 72%term) but was associated with a mean increase in weight of 1.3 SDS during childhood.Nine out of ten girls and boys with precocious pubarche had at least one of the three risk factors studied.Conclusions: Both prematurity and SGA were associated with precocious pubarche, as was overweight/ obesity, irrespective of size or gestation at birth.Excess weight gain in childhood may predispose to precocious pubarche in susceptible individuals.
