bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of octreotide in symptom management in oncology and palliative care
Authors: Gilbar Peter J. 
Published: January 2007

Objective. To provide an overview of the role of octreotide for managing symptoms in oncology and palliative care.Data Sources. A search of MEDLINE and IDIS databases from 1985 to 1999 and CANCERLIT from 1993 to 1999 was conducted using the terms octreotide, cancer and palliative care. The reference lists from selected articles were also reviewed. Clinical trial databases on the Internet were searched. Oncology and palliative care textbooks were also used to obtain additional references.Data Extraction. The retrieved literature was reviewed to discuss the pharmacology, pharmacokinetics, adverse effects, indications and principally, the clinical use of octreotide for controlling a number of symptoms encountered in the oncology and palliative care population.Data Synthesis. The unique inhibitory activity of octreotide lends itself to many possible indications, including diarrhoea from a number of causes, bowel obstruction, nausea and vomiting, bleeding, death rattle, gastrointestinal fistulae, pain and hypercalcaemia. However, convincing pieces of evidence from large prospective clinical trials are required to realise its full potential in oncology and palliative care. Completed studies and clinical experience suggest that octreotide has a role in the treatment of a number of difficult-to-manage conditions, particularly bowel obstruction and diarrhoea due to disease or treatment-related causes. Proposed benefits of octreotide must be weighed against the possible adverse effects and cost effectiveness of treatment.
Docetaxel: use in non—small cell lung cancer and metastatic breast cancer and formulation update
Authors: Crown John , Palmby Wendy 
Published: January 2007

Objective. To summarize the systematic development of docetaxel as a new and effective treatment option for advanced non-small cell lung cancer (NSCLC) and breast cancer patients, and to discuss the physical and chemical stability, compatibility with drugs commonly used in cancer patients, and administration issues with the new docetaxel formulation. Data Sources. A MEDLINE search was conducted using carboplatin, cisplatin, compatibility, docetaxel, doxorubicin, metastatic breast cancer (MBC), NSCLC, and stability as search terms. Reference lists, bibliographies of pertinent articles, and abstracts from the American Society of Clinical Oncology and the European Society for Medical Oncology annual meetings were also identified and reviewed. Information related to the new docetaxel formulation was obtained from the manufacturer. The clinical literature was reviewed and analyzed. Data Synthesis. Docetaxel has recently emerged as an active agent in the treatment of advanced NSCLC and MBC. Results of phase II and III studies of single-agent docetaxel and docetaxel combinations, both as first- and second-line therapy, have produced impressive response rates and improved survival times compared with current standards of care. Docetaxel has a unique toxicity profile that includes hypersensitivity reactions, skin toxicities, and fluid retention. Because docetaxel's toxicity profile differs from that of the platinum analogs and the anthracyclines, combinations with these agents for NSCLC and MBC are well tolerated. Docetaxel was recently reformulated, allowing for improved stability, shelf-life, and storage requirements. Compatibility studies of docetaxel with 81 commonly used drugs in cancer patients were recently reported, showing that docetaxel is compatible with all but three drugs studied—amphotericin B, nalbuphine hydrochloride, and methylprednisolone sodium succinate—when administered as Y-site injections into existing intravenous lines. With the increasing use of this agent, the new docetaxel formulation and compatibility data should facilitate ease of administration.
How to protect environment and employees against cytotoxic agents, the UZ Ghent experience
Authors: Vandenbroucke Johan , Robays Hugo 
Published: January 2007

Objective. To compare two different systems for the reconstitution and preparation of cytotoxic drug-containing infusion bags. The Classical System (open) uses Luer lock syringes and needles, and the PhaSealA System (closed) uses special devices. Methods. Both wipe samples of the Biological Safety Cabinet (BSC) plus surroundings and urine analysis of technicians and pharmacists involved in the preparatory activities were used. Analyses were performed using gas chromatography in tandem with mass spectroscopy. Results. An important difference has been found in the surface contamination rate and in the number, periods and values of contaminated urine samples in favour of the closed PhaSealA System. J Oncol Pharm Practice (2001) 6, 146-152.
Presurgery labelling of breast tumours with a charcoal suspension for intratumour injection
Authors: Mathieu Marie-Christine , Bonhomme-Faivre Laurence , Travagli Jean-Paul , Seiller Monique , Contesso Geneviève 
Published: January 2007

Objectives. A main goal of neoadjuvant chemotherapy (CT) in locally advanced breast carcinomas (clinical size >3 cm) is to decrease the tumour volume to permit conservative surgery. In about 10% of the cases, the tumour nodule is not clinically palpable after CT and it is necessary to tattoo the initial site in order to guide the surgeon for the resection of any residual tumour. We have developed a charcoal suspension for injection into human breast tumours. The aim is to enable the pathologist to guide the surgeon during excision of the residual tumour, which is not otherwise visible, after CT. Pharmacological and toxicological studies in animals have indicated that the suspension is well tolerated. Methods. We investigated the efficacy and tolerability of a charcoal suspension in a group of eight patients with a palpable breast tumour of clinical size 1.5-4 cm, which was removed 24 hours to 4 days after the injection of 1 mL of 4% charcoal suspension into the tumour. Results. This preliminary clinical study shows that the injection of charcoal is well tolerated by patients and is a good method of tattooing tumour. The charcoal was seen in or at the periphery of the nodule in the surgical specimen. No inflammatory reaction or diffusion was observed. Conclusions. Based on these results, this suspension appears suitable for tattooing breast carcinomas over a period of 3 months for patients programmed to receive preoperative CT.
A retrospective review of gemcitabine use in advanced epithelial ovarian cancer
Authors: Spina Sean , Nakashima Lynne , Swenerton Ken 
Published: January 2007

Background. In North America, epithelial ovarian cancer (EOC) is the fifth most common cause of cancer death among women. Many drugs are used in the treatment of EOC, with gemcitabine showing recent promise. The objective of this study was to determine whether gemcitabine is a beneficial treatment option for patients with EOC. Methods. The charts of 20 heavily pretreated women (median: four previous treatment protocols, range: 1-6) with a histological diagnosis of EOC were retrospectively reviewed to determine response. Eligible patients were treated with gemcitabine at a starting dose of 800 mg/m2 as an intravenous infusion on days 1, 8, and 15 of each 28-day cycle. The patients had a median age of 56 years (range 37-81). Results. Response to treatment was assessed both clinically and serologically (CA-125 tumor marker was monitored). Of the 20 enrollees, 17 were evaluable clinically and 16 were evaluable serologically (2 were not evaluable by either technique). There were two (12%) patients with a clinical partial response, six (35%) patients with clinical stable disease, nine (53%) patients with clinical progressive disease, and three patients that were not evaluable clinically. There were four (25%) patients with sero-logical partial response, six (38%) patients with stable serological disease, six (38%) patients with serological progressive disease, and four patients that were not evaluable serologically. Physician-reported toxicity included fatigue; however, this information was recorded inconsistently. Conclusion. Gemcitabine showed modest activity in heavily pretreated EOC with a 12% clinical partial response rate and a 25% serological partial response rate. No serious toxicities were encountered.
Vascular viewpoint
Authors: Anand Sonia S 
Published: January 2007

Objectives: To determine the relative effectiveness of intra-arterial thrombolysis compared with surgery for the treatment of lower-limb ischemia. Methods: MEDLINE and EMBASE were searched for randomized controlled trials related to thrombolysis. The search was limited to English-language articles or trials which provided a detailed English summary of trial design and results, and trials that were published after 1980. Hand searching and review of citations was used to identify other papers. Randomized controlled trials (RCTs) only were included in the analysis; a quality score was given to each trial using the CONSORT statement. Data extraction was performed independently by two reviewers. A random effects model was used. Outcomes: Mortality, amputation, major bleeding. Results: A total of 34 papers were retrieved: 10 were RCTs and the remaining 24 were review articles, case series, or cohort studies. Seven were RCTs that compared surgery to thrombolysis. No significant differences in the rates of death or amputation were observed between patients who were randomized to thrombolysis compared to surgery. The odds ratios comparing thrombolysis to surgery for death at 30 days, and 6 and 12 months were 1.07, p = 0.73; 1.11, p = 0.72; and 0.59, p = 0.49, respectively. The odds ratios comparing thrombolysis to surgery for amputation at 30 days, and 6 and 12 months were 1.08, p = 0.78; 1.18, p = 0.38; and 1.14, p = 0.49, respectively. A significant excess of major bleeding was observed in the thrombolysis group. The odds ratio comparing thrombolysis to surgery for major bleeding at 30 days was 2.95 (95% CI: 1.62-5.36, p = 0.001). The 6 and 12 months odds ratios for bleeding were not reported. Conclusion: The authors conclude that there is insufficient evidence to justify the widespread use of thrombolytic therapy in patients with leg ischemia, although subgroup analyses suggest benefit of thrombolysis in patients who have synthetic graft occlusions, and in patients who receive therapy after a short duration of ischemic symptoms, i.e. less than 14 days.
Long-term, low-dose warfarin among venous thrombosis patients with and without factor V Leiden mutation: rationale and design for the Prevention of Recurrent Venous Thromboembolism (PREVENT) trial
Authors: Ridker Paul M ,   PREVENT Investigators
Published: January 2007

Standard therapy for patients with deep venous thrombosis and pulmonary embolism typically includes anticoagulation for a 3-6-month period with full dose warfarin. However, patients following this regimen experience high rates of recurrent thrombosis, re-hospitalization and mortality in the years immediately following cessation of anticoagulation. This is true for patients at average risk of disease recurrence, and for patients at elevated risk due to the presence of inherited defects of anticoagulation such as factor V Leiden mutation. Unfortunately, no clinical regimen currently available has proven to have sufficient benefit to support long-term prophylaxis. In particular, full dose warfarin is associated with substantially increased risks of hemorrhage when used on a long term basis. In contrast, while targeted low-dose warfarin (INR 1.5-2.0) is safe for long-term therapy, the efficacy of this approach in the prevention of recurrent venous thromboembolic disease has remained untested. The Prevention of Recurrent Venous Thromboembolism (PREVENT) trial will evaluate the efficacy of prolonged treatment with low-dose warfarin in the secondary prevention of venous thromboembolism (VTE). Patients with a history of documented idiopathic venous thrombosis who have completed a standard course of anticoagulation therapy will be enrolled in a randomized, double-blind, placebo-controlled trial comparing usual care plus targeted low-dose warfarin to usual care plus placebo for a period of up to 4 years. Trial endpoints will include recurrent VTE, major bleeding episodes and all-cause mortality in the total patient population and separately in those patients with factor V Leiden. The potential clinical impact of the PREVENT trial is broad since a positive finding would strongly support chronic low-intensity anticoagulation among patients with venous thrombosis who are at risk for recurrence following cessation of standard outpatient anticoagulation.
An objective method to estimate the severity of Raynaud phenomenon: digital blood pressure response to cooling
Authors: Maricq Hildegard R , Valter Ivo , Maricq John G 
Published: January 2007

The treatment efficacy of patients with Raynaud phenomenon (RP) is determined from the decrease in severity of this condition, usually based on a decrease in frequency of RP attacks as reported by patients in a diary. Although subjective, this method is still the main endpoint measure in clinical trials. The results of patients' digital blood pressure responses to cooling were compared with the reported RP attack frequency to determine whether the former could be used to estimate the severity of RP. The effect of local finger cooling on the digital systolic blood pressure was tested at 30°C, 20°C, 15°C and 10°C on 136 subjects with RP. The RP attack frequency was dichotomized into daily versus less than daily attacks. The frequency of attacks and the digital systolic pressure (DSP) showed a significant association at all cooling temperatures (those with daily attacks showed lower DSP than those with less frequent attacks). In addition, patients experiencing daily attacks of RP showed a zero reopening pressure at higher local temperatures than those with less frequent RP attacks. These results demonstrate that the response of the digital systolic blood pressure to cooling is closely associated with the RP attack frequency and therefore can be considered as an objective estimate of RP severity. This physiological measurement should be most useful in evaluating the clinical course of RP and the effect of its treatment, provided it is measured under standardized conditions.
Endovascular manipulation to restrict restenosis
Authors: Gershlick AH 
Published: January 2007

The processes that take place following damage to the vessel wall are well understood. Endovascular manipulation by its very nature induces such damage and the repair process can lead to a recurrence of symptoms. There have been many clinical trials of drugs chosen for their known impact on preventing excess vessel wall response. With one or two exceptions none of these trials has shown any benefit, partly because only low doses could be given systemically to avoid side effects. Local drug delivery allows high doses to be given where needed, at the site of the process, without inducing systemic complications. There are various drugs and agents that have been shown to be effective in models of vessel wall damage, including heparin, nitric oxide, inhibitors of platelet function and the antisense oligonucleotides. Some of these agents are now being tested in clinical trials. Methods of delivering the agent include devices that bathe the luminal layer, deliver the agent to the media or inject it into the adventitia where a reservoir can form. Stents improve the outcome after angioplasty, but can also induce a proliferative vessel wall response. To overcome this, stents have recently been considered as local delivery devices with radiation being delivered and polymer coated stents, loaded with agents, being developed.While local drug delivery provides great promise as a way of reducing the adverse effect of response of the vessel wall to damage, the results of clinical trials in humans are awaited.
Medical costs of treating venous stasis ulcers: evidence from a retrospective cohort study
Authors: Olin Jeffrey W , Beusterien Kathleen M , Childs Mary Beth , Seavey Caroline , McHugh Linda , Griffiths Robert I 
Published: January 2007

Venous stasis ulcers (VSU) account for approximately 80-90% of lower extremity ulcerations. Given their prevalence and chronic nature, VSU are thought to impose a significant economic burden on Medicare (the USA's largest health insurance program) and other third party payers. However, comprehensive studies on the costs of VSU treatment are lacking. The objective of this study therefore was to examine comprehensively the direct medical costs of treating patients with a VSU in routine clinical practice. A cohort of 78 patients who presented with a VSU to the Cleveland Clinic Foundation (CCF), a large primary and tertiary referral center, was studied retrospectively. All inpatient and out-patient costs related to VSU treatment that were incurred during the year following VSU presentation or until the ulcer healed, whichever occurred first, were quantified. A total of 71 (91%) patients healed during the study. The average duration of follow-up was 119 days (median: 84 days). The average number of visits per patient was seven (range: 2 to 57). A total of 14 (18%) patients underwent 18 hospitalizations for VSU care. The average total medical cost per patient was $9685 (median: $3036). Home health care, hospitalizations and home dressing changes accounted for 48%, 25% and 21% of total costs, respectively. Total costs were related to duration of active therapy, ulcer size and the presence of at least one comorbidity (p,0.05). VSU are costly to manage, especially when time to healing is prolonged. The present findings reflect an underestimate of VSU costs since indirect costs were not examined. Time absent from work, forced early retirement, loss of functional independence and unquantifiable suffering may be additional factors that contribute to the overall burden of VSU.
Venous thrombus stability during acute phase of therapy
Authors: Caps Michael T , Meissner Mark H , Tullis Michael J , Polissar Nayak L , Manzo Richard A , Zierler Brenda K , Chandler Wayne L , Strandness D Eugene 
Published: January 2007

The purpose of this study was to use serial venous duplex scans to document the status of deep venous thrombi during the early phase of therapy for acute, deep-vein thrombosis (DVT). A total of 71 consecutive participants treated for a first episode of acute DVT were monitored for new venous thrombosis using serial venous duplex scans. An average of 4.6 duplex scans were performed per patient (range, three to seven) during the 3-week study period. The cumulative incidence of contiguous/non-contiguous extension of the DVT at 3 weeks was 26% (95% CI = 14% to 38%). Nine of the 15 (60%) occurrences were asymptomatic. None of the classical risk factors for DVT was significantly associated with the development of new thrombi. The fraction of time during which the level of anticoagulation was considered `adequate' (international normalized ratio >2.0 and/or heparin concentration >0.2 IU/ml) was inversely associated with the risk of extension/new thrombi (p = 0.01, Cox proportional hazards analysis). It was concluded that: (1) the frequency of contiguous/non-contiguous extension of venous thrombosis detectable during the first 3 weeks of therapy was higher than previously reported; (2) the majority of the occurrences were asymptomatic; and (3) the risk of developing this complication was inversely associated with the level of anticoagulation achieved.
ACE inhibition and fibroblast growth factor in cultured human vascular smooth muscle
Authors: Tang Lilong , Both Katrin , Taylor Roger 
Published: January 2007

The effects of the angiotensin converting enzyme (ACE) inhibitor, enalaprilat, and basic fibroblast growth factor (bFGF) on DNA synthesis and expression of ACE mRNA were examined in human vascular smooth muscle cells cultured from saphenous vein and internal mammary artery. DNA synthesis was estimated using 3H-thymidine uptake, and ACE mRNA was estimated by rt-PCR. Enalaprilat (0.125 mg/ml, 48 h) decreased 3H-thymidine uptake to 66 - 12% (SE) of the control without enalaprilat (p, 0.05). Basic FGF (10 ng/ml, 24 h) increased uptake by 41 - 12% (p, 0.05) while enalaprilat pretreatment (24 h) decreased uptake to 56 - 12% of this augmented value (p, 0.025). Basic FGF increased ACE mRNA, a process that was time dependent with an approximately 50% increase after 24 h exposure. Pre-exposure to enalaprilat (24 h) before bFGF reduced ACE mRNA to approximately 50% of that found in the presence of bFGF alone. The results indicate that ACE mRNA is present in human vascular smooth muscle cells and that exposure to an ACE inhibitor reduces DNA synthesis. Basic FGF stimulates DNA synthesis and ACE mRNA expression, and both of these effects are reduced by an ACE inhibitor. The results are consistent with the effects of bFGF being exerted through, or alternatively in concert with, angiotensin II. Further, they suggest that ACE inhibition can reduce the activity of the renin-angiotensin system by inhibiting the production of ACE, or at least the expression of ACE mRNA, in addition to producing enzyme inhibition at the ACE level.
Neuroprotection in acute ischaemic stroke. II: Clinical potential
Authors: Davis Michelle , Barer David 
Published: January 2007

In the 4 years since our first article, there has been considerable progress in our understanding of the pathophysiology of acute ischaemic stroke, and the results of well-conducted trials have at last begun to change everyday clinical practice. The timing of the various processes of the ischaemic cascade and the potential time windows for different interventions are better understood. Furthermore, the importance of maintaining cerebral perfusion and optimizing systemic physiological and biochemical factors in order to prevent neurological deterioration (`progressing stroke') is increasingly being realized.Numerous antithrombotic and neuroprotective drugs have been evaluated in clinical trials, and while none has shown unequivocal benefits on its own, prospects for successful intervention are still good. This will probably involve different combinations of treatments targeted on different pathophysiological stroke types, so that the management of acute stroke will offer a considerable challenge to the stroke physicians of the future.
Subfascial endoscopic perforator vein surgery: indications and results
Authors: Gloviczki Peter 
Published: January 2007

Subfascial endoscopic perforator surgery (SEPS) is a new, minimally invasive technique performed in patients with advanced chronic venous insufficiency. The objective of the operation is to interrupt incompetent medial calf perforating veins to decrease venous reflux and reduce ambulatory venous hypertension in critical areas above the ankle where venous ulcers most frequently develop. Patients with stasis skin changes and healed or active venous ulcerations are potential candidates for the operation. Preoperative evaluation is performed with duplex scanning of the superficial, deep and perforator system, to diagnose both obstruction and valvular incompetence. Results of the North American SEPS Registry (NASEPS) as well as experience in several individual centers confirmed that the operation has significantly fewer wound complications than the classic open surgical techniques, and that rapid ulcer healing can be achieved. At the Mayo Clinic an ulcer recurrence rate of 12% was observed, with recurrence significantly more frequent in post-thrombotic limbs than in patients with primary venous valvular incompetence. The NASEPS Registry report confirmed a 2-year cumulative ulcer recurrence rate of 28%; ulcer recurrence was significantly more frequent in post-thrombotic limbs, especially in those with deep venous obstruction. SEPS is a new, low-risk, outpatient procedure that effectively decreases perforator reflux in patients with venous ulcerations, and should be added to our armamentarium to treat patients with advanced chronic venous disease. Long-term prospective and randomized studies are, however, still required to provide level I evidence of late efficacy.