Two case-reports are used to examine the various options for the treatment of asthma in children. The rationale for monotherapy or combined treatment with br onchodilators, corticosteroids and leukotriene inhibitors a...Two case-reports are used to examine the various options for the treatment of asthma in children. The rationale for monotherapy or combined treatment with br onchodilators, corticosteroids and leukotriene inhibitors according to type, cir cumstances, severity and frequency of attacks is analyzed.展开更多
Objective. We assessed the antineoplastic effect and adverse reaction s of pacl itaxel monotherapy with paclitaxel 210 mg/m2 given every 3 weeks by 3-h infusio n on patients with endometrial cancer given as a 3-h infu...Objective. We assessed the antineoplastic effect and adverse reaction s of pacl itaxel monotherapy with paclitaxel 210 mg/m2 given every 3 weeks by 3-h infusio n on patients with endometrial cancer given as a 3-h infusion. Methods. This st udy was a multi-center, open-label phase II clinical trial of paclitaxel 210 m g/m2 given every 3 weeks by 3-h infusion. Patients with advanced or recurrent e ndometrial cancer were enrolled. The primary endpoint for efficacywas tumor resp onse rate. The secondary endpoints were duration of response and adverse drug re actions. Results. Among 23 patients evaluated for efficacy, partial remission (P R) was achieved in 7, no change (NC) in 10, progressive disease (PD) in 5, and n ot estimable (NE) in 1. The overall response ratewas 30.4%(7/23 cases). In seve n PR cases, median duration of response was 130 days (100-245 days). Subjective or objective symptoms ≥grade 3 included febrile neutropenia and constipation i n 8.7%(2/23 cases) each; and nausea, vomiting, fatigue, pain, urinary tract inf ection, lowered oxygen saturation, anorexia, arthralgia, myalgia, neuropathy, we ight loss, dyspnea, and need for red cell transfusion in 4.3%(1/23) each. Labor atory test abnormalities ≥grade 3 included neutropenia (78.3%, 18/23), leucope nia (47.8%, 11/23), lowered hemoglobin (13.0%, 3/23), decreased potassium (8.7 %, 2/23), and decreased sodium (4.3%, 1/23). All adverse reactions were succes sfully managed by prolonging treatment interval, dose reduction, interrupting ad ministration, discontinuation, and administration of G-CSF. Conclusion. Three- hour intravenous infusion of paclitaxel 210 mg/m2 is useful for endometrial canc er. Antineoplastic effect was achieved and adverse reactions were clinically man ageable.展开更多
Intestinal transplantation has developed to become the standard of care for patients with irreversible intestinal failure who are not responding to total parenteral nutrition. Once considered experimental, it has take...Intestinal transplantation has developed to become the standard of care for patients with irreversible intestinal failure who are not responding to total parenteral nutrition. Once considered experimental, it has taken time and much effort for the procedure to become a clinical reality, with final acceptance primarily because of the vastly improved outcomes. Advances and novel modifications in immunosuppression have been at the forefront of these improvements. The authors review their evolutionary experience with intestinal transplantation, particularly relating changes in immunosuppression protocols to improved outcomes. From July 1990 to December 2003, 122 children received 129 intestinal containing allografts (70 liver/intestine, 42 isolated intestine, 17 multivisceral). Mean age was 5.3 ±5.2 years, and 55%were boys. Indications for transplantation were mostly short gut syndrome. The allografts were cadaveric, ABO identical (except one), with no immunomodulation. Bone marrow augmentation was used in 29%of the recipients since 1995. T-cell lymphoctytotoxic crossmatch was positive in 24%cases. Immunosuppression protocols can be divided into 3 categories: (i) maintenance tacrolimus and steroids (n = 52, 1990-1995, 1997-1998); (ii) addition of induction therapy with cyclophosphamide (n = 16, 1995-1997) then daclizumab (n = 24, 1998-2001). A third immunosuppressive agent was added in either group where increased immunosuppression was indicated; (iii) pretreatment/induction with antilymphocyte conditioning and steroid-free posttransplantation tacrolimus monotherapy (n = 37, 2002-2003). In this later group, if clinically stable at 60 to 90 days posttransplantation, and no recent rejection, the tacrolimus was weaned by decreasing frequency of dosing. The overall Kaplan-Meier patient/graft survival was 81%/76%at 1 year, 62%/60%at 3 years, and 61%/51%at 5 years. Survival continues to improve, with 1-year patient/-graft survival being 71%/62%, 77%/75%, and 100%/100%for groups (i), (ii), and (iii), respectively. Acute intestinal allograft rejection has decreased markedly in group (iii). The rate of infectious diseases, such as cytomegalovirus and Epstein-Barr virus, is lowest in group (iii). Graft-versus-host disease has not significantly increased with the latest protocol. Most importantly, the overall level of immunosuppression requirements has decreased markedly, with most patients in group (iii) being on monotherapy. Of these, most had their monotherapy weaned down to spaced doses, something never systematically attempted or achieved in pediatric intestinal transplantation. Intestinal transplantation has progressed markedly over the last 13 years. Although there have been modifications in all aspects of the procedure, the story of intestinal transplantation has been the evolution of successful immunosuppression regimens. Our latest pretreatment/induction conditioning and posttransplantationmonotherapy strategy improves graft acceptance and lowers subsequent immunosuppression dosing requirements. It is expected this will overcome many of the complications related to the previously high immunosuppression requirements. Minimization of immunosuppression with avoidance of steroid therapy offers profound long-term benefits, especially in the pediatric population. The patients still remain challenging and complex in every aspect; however, these advances offer signifi-cant hope to both patients and caregivers alike.展开更多
文摘Two case-reports are used to examine the various options for the treatment of asthma in children. The rationale for monotherapy or combined treatment with br onchodilators, corticosteroids and leukotriene inhibitors according to type, cir cumstances, severity and frequency of attacks is analyzed.
文摘Objective. We assessed the antineoplastic effect and adverse reaction s of pacl itaxel monotherapy with paclitaxel 210 mg/m2 given every 3 weeks by 3-h infusio n on patients with endometrial cancer given as a 3-h infusion. Methods. This st udy was a multi-center, open-label phase II clinical trial of paclitaxel 210 m g/m2 given every 3 weeks by 3-h infusion. Patients with advanced or recurrent e ndometrial cancer were enrolled. The primary endpoint for efficacywas tumor resp onse rate. The secondary endpoints were duration of response and adverse drug re actions. Results. Among 23 patients evaluated for efficacy, partial remission (P R) was achieved in 7, no change (NC) in 10, progressive disease (PD) in 5, and n ot estimable (NE) in 1. The overall response ratewas 30.4%(7/23 cases). In seve n PR cases, median duration of response was 130 days (100-245 days). Subjective or objective symptoms ≥grade 3 included febrile neutropenia and constipation i n 8.7%(2/23 cases) each; and nausea, vomiting, fatigue, pain, urinary tract inf ection, lowered oxygen saturation, anorexia, arthralgia, myalgia, neuropathy, we ight loss, dyspnea, and need for red cell transfusion in 4.3%(1/23) each. Labor atory test abnormalities ≥grade 3 included neutropenia (78.3%, 18/23), leucope nia (47.8%, 11/23), lowered hemoglobin (13.0%, 3/23), decreased potassium (8.7 %, 2/23), and decreased sodium (4.3%, 1/23). All adverse reactions were succes sfully managed by prolonging treatment interval, dose reduction, interrupting ad ministration, discontinuation, and administration of G-CSF. Conclusion. Three- hour intravenous infusion of paclitaxel 210 mg/m2 is useful for endometrial canc er. Antineoplastic effect was achieved and adverse reactions were clinically man ageable.
文摘Intestinal transplantation has developed to become the standard of care for patients with irreversible intestinal failure who are not responding to total parenteral nutrition. Once considered experimental, it has taken time and much effort for the procedure to become a clinical reality, with final acceptance primarily because of the vastly improved outcomes. Advances and novel modifications in immunosuppression have been at the forefront of these improvements. The authors review their evolutionary experience with intestinal transplantation, particularly relating changes in immunosuppression protocols to improved outcomes. From July 1990 to December 2003, 122 children received 129 intestinal containing allografts (70 liver/intestine, 42 isolated intestine, 17 multivisceral). Mean age was 5.3 ±5.2 years, and 55%were boys. Indications for transplantation were mostly short gut syndrome. The allografts were cadaveric, ABO identical (except one), with no immunomodulation. Bone marrow augmentation was used in 29%of the recipients since 1995. T-cell lymphoctytotoxic crossmatch was positive in 24%cases. Immunosuppression protocols can be divided into 3 categories: (i) maintenance tacrolimus and steroids (n = 52, 1990-1995, 1997-1998); (ii) addition of induction therapy with cyclophosphamide (n = 16, 1995-1997) then daclizumab (n = 24, 1998-2001). A third immunosuppressive agent was added in either group where increased immunosuppression was indicated; (iii) pretreatment/induction with antilymphocyte conditioning and steroid-free posttransplantation tacrolimus monotherapy (n = 37, 2002-2003). In this later group, if clinically stable at 60 to 90 days posttransplantation, and no recent rejection, the tacrolimus was weaned by decreasing frequency of dosing. The overall Kaplan-Meier patient/graft survival was 81%/76%at 1 year, 62%/60%at 3 years, and 61%/51%at 5 years. Survival continues to improve, with 1-year patient/-graft survival being 71%/62%, 77%/75%, and 100%/100%for groups (i), (ii), and (iii), respectively. Acute intestinal allograft rejection has decreased markedly in group (iii). The rate of infectious diseases, such as cytomegalovirus and Epstein-Barr virus, is lowest in group (iii). Graft-versus-host disease has not significantly increased with the latest protocol. Most importantly, the overall level of immunosuppression requirements has decreased markedly, with most patients in group (iii) being on monotherapy. Of these, most had their monotherapy weaned down to spaced doses, something never systematically attempted or achieved in pediatric intestinal transplantation. Intestinal transplantation has progressed markedly over the last 13 years. Although there have been modifications in all aspects of the procedure, the story of intestinal transplantation has been the evolution of successful immunosuppression regimens. Our latest pretreatment/induction conditioning and posttransplantationmonotherapy strategy improves graft acceptance and lowers subsequent immunosuppression dosing requirements. It is expected this will overcome many of the complications related to the previously high immunosuppression requirements. Minimization of immunosuppression with avoidance of steroid therapy offers profound long-term benefits, especially in the pediatric population. The patients still remain challenging and complex in every aspect; however, these advances offer signifi-cant hope to both patients and caregivers alike.
