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Tomassen P, Newson RB, Hoffmans R, Lötvall J, Cardell LO, Gunnbjörnsdóttir M, Thilsing T, Matricardi P, Krämer U, Makowska JS, Brozek G, Gjomarkaj M, Howarth P, Loureiro C, Toskala E, Fokkens W, Bachert C, Burney P, Jarvis D. Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis--a GA² LEN study. Allergy 2011; 66:556-61. [PMID: 21083566 DOI: 10.1111/j.1398-9995.2010.02503.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic, endoscopic, and radiologic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies, the definition is based on symptoms only. We aimed to assess the reliability and validity of a symptom-based definition of CRS using data from the GA(2) LEN European survey. METHODS On two separate occasions, 1700 subjects from 11 centers provided information on symptoms of CRS, allergic rhinitis, and asthma. CRS was defined by the epidemiological EP3OS symptom criteria. The difference in prevalence of CRS between two study points, the standardized absolute repeatability, and the chance-corrected repeatability (kappa) were determined. In two centers, 342 participants underwent nasal endoscopy. The association of symptom-based CRS with endoscopy and self-reported doctor-diagnosed CRS was assessed. RESULTS There was a decrease in prevalence of CRS between the two study phases, and this was consistent across all centers (-3.0%, 95% CI: -5.0 to -1.0%, I(2) = 0). There was fair to moderate agreement between the two occasions (kappa = 39.6). Symptom-based CRS was significantly associated with positive endoscopy in nonallergic subjects, and with self-reported doctor-diagnosed CRS in all subjects, irrespective of the presence of allergic rhinitis. CONCLUSION Our findings suggest that a symptom-based definition of CRS, according to the epidemiological part of the EP3OS criteria, has a moderate reliability over time, is stable between study centers, is not influenced by the presence of allergic rhinitis, and is suitable for the assessment of geographic variation in prevalence of CRS.
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Valero A, Pereira C, Loureiro C, Martínez-Cócera C, Murio C, Rico P, Palomino R, Dávila I. Interrelationship between skin sensitization, rhinitis, and asthma in patients with allergic rhinitis: a study of Spain and Portugal. J Investig Allergol Clin Immunol 2009; 19:167-172. [PMID: 19610258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Allergic rhinitis can determine the presence and type of asthma. The main aim of this study was to evaluate the link between allergic rhinitis, asthma, and skin test sensitization in patients with allergic rhinitis. METHODS Patients with allergic rhinitis, aged 10 to 50 years, were consecutively enrolled at different allergy centers in Spain and Portugal. All the patients underwent skin prick tests with a panel of 20 biologically standardized aeroallergens. Allergic rhinitis was classified according to etiology and the Allergic Rhinitis and its Impact on Asthma guidelines and asthma was classified according to the Global Initiative for Asthma guidelines. RESULTS A total of 3225 patients, with a mean age of 27 years, were evaluated. House dust mites and grass and olive tree pollens were the most common aeroallergens. The mean (SD) number of positive skin tests per patient was 6.5 (4), the mean wheal size was 42.3 (28) mm2, and the mean atopy index was 6.5 (2). Forty-nine percent of the patients had concomitant asthma. Asthma severity was associated with a longer time since onset (P < .04) and allergic rhinitis severity (P < .001). Patients with concomitant asthma had a significantly higher number of aeroallergens and sensitization intensity than those without asthma (P < .001). CONCLUSIONS In this broad population sample, the presence and type of asthma was influenced by skin sensitization and both time since onset and severity of allergic rhinitis.
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Burney P, Potts J, Makowska J, Kowalski M, Phillips J, Gnatiuc L, Shaheen S, Joos G, Van Cauwenberge P, van Zele T, Verbruggen K, van Durme Y, Derudder I, Wohrl S, Godnic-Cvar J, Salameh B, Skadhauge L, Thomsen G, Zuberbier T, Bergmann KC, Heinzerling L, Renz H, Al-Fakhri N, Kosche B, Hildenberg A, Papadopoulos NG, Xepapadaki P, Zannikos K, Gjomarkaj M, Bruno A, Pace E, Bonini S, Bresciani M, Gramiccioni C, Fokkens W, Weersink EJM, Carlsen KH, Bakkeheim E, Loureiro C, Villanueva CM, Sanjuas C, Zock JP, Lundback B, Janson C. A case-control study of the relation between plasma selenium and asthma in European populations: a GAL2EN project. Allergy 2008; 63:865-71. [PMID: 18588552 DOI: 10.1111/j.1398-9995.2008.01716.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma. METHODS The GA(2)LEN network has organized a multicentre case-control study in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12 months. RESULTS All cases and controls were selected from the same population defined by age and place of residence. Mean plasma selenium concentrations among the controls ranged from 116.3 microg/l in Palermo to 67.7 microg/l in Vienna and 56.1 microg/l among the children in Oslo. Random effects meta-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 microg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally significant adverse effect in Amsterdam (OR: 1.68; 95% CI: 0.98-2.90) and Ghent (OR: 1.35; 95% CI: 1.03-1.77). CONCLUSION This study does not support a role for selenium in protection against asthma, but effect modification and confounding cannot be ruled out.
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Shaheen S, Potts J, Gnatiuc L, Makowska J, Kowalski ML, Joos G, van Zele T, van Durme Y, De Rudder I, Wöhrl S, Godnic-Cvar J, Skadhauge L, Thomsen G, Zuberbier T, Bergmann KC, Heinzerling L, Gjomarkaj M, Bruno A, Pace E, Bonini S, Fokkens W, Weersink EJM, Loureiro C, Todo-Bom A, Villanueva CM, Sanjuas C, Zock JP, Janson C, Burney P. The relation between paracetamol use and asthma: a GA2LEN European case-control study. Eur Respir J 2008; 32:1231-6. [PMID: 18579547 DOI: 10.1183/09031936.00039208] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking. As part of a multicentric case-control study organised by the Global Allergy and Asthma European Network (GA(2)LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20-45 yrs) and place of residence. In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma. These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.
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Shaheen S, Potts J, Gnatiuc L, Makowska J, Kowalski ML, Joos G, van Zele T, van Durme Y, De Rudder I, Wöhrl S, Godnic-Cvar J, Skadhauge L, Thomsen G, Zuberbier T, Bergmann KC, Heinzerling L, Gjomarkaj M, Bruno A, Pace E, Bonini S, Fokkens W, Weersink EJM, Loureiro C, Todo-Bom A, Villanueva CM, Sanjuas C, Zock JP, Janson C, Burney P. The relation between paracetamol use and asthma: a GA2LEN European case-control study. Eur Respir J 2008. [PMID: 18579547 DOI: 10.1183/09031936.00039208.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking. As part of a multicentric case-control study organised by the Global Allergy and Asthma European Network (GA(2)LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20-45 yrs) and place of residence. In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma. These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.
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Rimbot A, Mounayer C, Loureiro C, Queiroz C, Kadziolka K, Spelle L, Piotin M, Bozorg-Grayeli A, Moret J. [Preoperative mixed embolization of a paraganglioma using Onyx]. J Neuroradiol 2007; 34:334-9. [PMID: 17988740 DOI: 10.1016/j.neurad.2007.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Paragangliomas, or glomus tumors, are highly vascular benign tumors of the head and neck. Clinical symptoms are essentially progressive and neurological, involving infiltration of the regional cranial nerves. The usual treatment is surgery, which itself is a challenge because of the close proximity of vital structures and the considerable blood loss. Preoperative embolization can reduce morbidity, and several techniques have been described using arterial injection of particles or of cyanoacrylate directly into the tumor. This case report is of a patient treated by surgery using a new technique-preoperative embolization involving both the arteries and veins, and injection of Onyx, resulting in complete devascularization of the tumor's arteriovenous network.
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Todo-Bom A, Loureiro C, Almeida MM, Nunes C, Delgado L, Castel-Branco G, Bousquet J. Epidemiology of rhinitis in Portugal: evaluation of the intermittent and the persistent types. Allergy 2007; 62:1038-43. [PMID: 17686106 DOI: 10.1111/j.1398-9995.2007.01448.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of rhinitis is rapidly increasing in recent years and has become a major public health problem in developed countries. A new classification of allergic rhinitis has been proposed by the allergic rhinitis and its impact on asthma group. In this study we aimed to evaluate the prevalence of rhinitis, including different rhinitis subtypes and to describe the severity, rate of diagnosis and use of medication in this pathology. METHODS A cross-sectional, population-based study including 6,859 questionnaire responses was performed. RESULTS The estimated prevalence of rhinitis was 26.1% (48% for intermittent vs 52% for persistent rhinitis). Only about one-third of the rhinitis cases (31.9%) had done skin prick tests (35.3% for persistent rhinitis vs 21.5% for intermittent rhinitis: P < 0.001) or had medication prescribed in the last year (34%), (35.6% for persistent rhinitis vs 20.1% for intermittent rhinitis : P < 0.001). The prevalence of rhinitis was higher in women (28.2 vs 22.2%; P < 0.001). Intermittent/persistent rhinitis showed the following percentages : <or=25 years (65.6 vs 34.5, P = 0.001); 25-65 years (50.2 vs 49.5) >or= 65 years (52.1 vs 47.9). The estimated prevalence of rhino conjunctivitis was 18.4%. In a severity scale from 0 to 10, the mean value was 6.1 points (6.4 for persistent rhinitis vs 4.8 for intermittent rhinitis: P < 0.001). CONCLUSION A significant prevalence of rhinitis and rhino conjunctivitis was identified in all age groups. The severity, the frequency and duration of the symptoms which classify the persistent type should be considered to establish a more effective treatment and improve the quality of life of the patients with rhinitis.
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Spelle L, De Paula Lucas C, Queiroz C, Loureiro C, Mounayer C, Piotin M, Moret J. Stratégies de sacrifice du tronc basilaire pour le traitement des anévrismes complexes de l'artère basilaire. J Neuroradiol 2007. [DOI: 10.1016/j.neurad.2007.01.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Piotin M, Mounayer C, Spelle L, Loureiro C, Moret J. La mise en place de stents réduit la recanalisation des anévrismes embolisés à l'aide de coils. J Neuroradiol 2007. [DOI: 10.1016/j.neurad.2007.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Maia Filho M, Hammami N, Mounayer C, Loureiro C, Spelle L, Piotin M, Moret J. Le ballonnet: accessoire de navigation et d'occlusion des malformations artérioveineuses cérébrales. J Neuroradiol 2007. [DOI: 10.1016/j.neurad.2007.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pereira C, Valero A, Loureiro C, Dávila I, Martinez-Cócera C, Murio C, Rico P, Palomino R. Iberian study of aeroallergens sensitisation in allergic rhinitis. Eur Ann Allergy Clin Immunol 2006; 38:186-94. [PMID: 16929745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is a prevalent allergic disease in Iberian countries, but there are no recent epidemiological studies that characterize this pathology according to clinical classification and aeroallergens sensitisation. This is a clinical study, representative of each country METHODS Descriptive, observational cross-sectional, population-based study carried-out in Portugal and Spain. 3397 consecutive patients (5 regions in Spain and 3 regions in Portugal) were selected for clinical observation and skin prick tests were carried out using the same panel of standardized aeroallergens. RESULTS 3225 patients (aged 10-50 years old) completed the study (IC 95%, SE 15). Intermittent rhinitis makes up 36% of the entire sample. Of them, intermittent AR mild forms represented 82% in Spain and 92% in Portugal that is, 87% for Iberian countries. Persistent types of rhinitis showed exactly the same rate of severity in Portugal and Spain, 44% mild and 56% moderate/severe. Seasonal forms represent 37% while 63% were perennial. BA was present in 49% of AR patients. There were significant differences between aeroallergens according to the different regions considered. Mites and grass pollens are the most relevant aeroallergens in Spanish and Portuguese AR patients, while Alternaria showed higher positive rates among 10-20 year old patients. CONCLUSIONS This study characterizes the AR patients in Iberian countries according to the ARIA classification. No correlation was observed between this classification and the conventional (seasonal/perennial). Our results also characterize the allergic cutaneous pattern of aeroallergen sensitisation using the same panel of standardized allergens and show differences between the different regions analysed.
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Loureiro C, Chieira C, Guilherme M, Arrobas A, Branco GC, Inácio F, Pinto P, Afonso A, Branco M, Borges F, Trindade M. Desloratadine is Effective in Relieving the Nasal and Non-Nasal Symptoms of Perennial Allergic Rhinitis (PAR) in Patients With or Without Concurrent Respiratory Tract Conditions. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Spelle L, Piotin M, Mounayer C, Rimbot A, Loureiro C, Deguchi J, De Paula Lucas C, Moret J. CO-59 - Résultats angiographiques à long terme des anévrysmes traités avec les hydrocoils. J Neuroradiol 2006. [DOI: 10.1016/s0150-9861(06)77178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Piotin M, Mounayer C, Spelle L, Deguchi J, Morishima H, Loureiro C, Queiroz C, Rimbot A, Moret J. CO-58 - Coils nus, Matrix et hydrocoils : comparaison des résultats du suivi angiographique dans le traitement des petits anévrysmes. J Neuroradiol 2006. [DOI: 10.1016/s0150-9861(06)77177-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ducreux D, Lepeintre JF, Fillard P, Loureiro C, Tadié M, Lasjaunias P. MR diffusion tensor imaging and fiber tracking in 5 spinal cord astrocytomas. AJNR Am J Neuroradiol 2006; 27:214-6. [PMID: 16418387 PMCID: PMC7976075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Spinal cord astrocytomas are rare neoplasms that can result in alteration of the spinal cord structural integrity, which can be assessed by using diffusion tensor imaging methods. Our objective was to visualize the deformation of the posterior spinal cord lemniscal and corticospinal tracts in 5 patients with low-grade astrocytomas compared with 10 healthy volunteers by using 3D fiber-tracking reconstructions.
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Galrinho A, Rosário L, Loureiro C, Mourão L. A case of heart failure with an uncommon etiology. Rev Port Cardiol 2001; 20:681-4. [PMID: 11525076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Silva A, Cupido L, Loureiro C, Vergamota S, Varela P, Santos J, Manso M, Serra F, Meneses L, Tavares M, Nunes I, Kurzan B, Suttrop W, Grossman V. New developments of the ASDEX Upgrade tokamak microwave reflectometer. FUSION ENGINEERING AND DESIGN 1999. [DOI: 10.1016/s0920-3796(99)00039-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Varandas C, Carvalho B, Correia C, Loureiro C, Malaquias J, Rodrigues A, Sousa J. On-site developed components for control and data acquisition on next generation fusion devices. FUSION ENGINEERING AND DESIGN 1997. [DOI: 10.1016/s0920-3796(97)00021-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Levine AM, Sullivan-Halley J, Pike MC, Rarick MU, Loureiro C, Bernstein-Singer M, Willson E, Brynes R, Parker J, Rasheed S. Human immunodeficiency virus-related lymphoma. Prognostic factors predictive of survival. Cancer 1991; 68:2466-72. [PMID: 1933784 DOI: 10.1002/1097-0142(19911201)68:11<2466::aid-cncr2820681124>3.0.co;2-g] [Citation(s) in RCA: 175] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In an attempt to determine factors predictive of survival in patients seropositive for human immunodeficiency virus (HIV) with acquired immune deficiency syndrome (AIDS)-related lymphoma, the authors studied 60 such patients, all of whom were treated with curative intent. Eleven patients presented with lymphoma primary to the brain (P-CNS); the remaining 49 had systemic AIDS-related lymphoma. Patients with P-CNS lymphoma had more severe underlying HIV-related disease than did patients with systemic lymphoma as evidenced by a higher incidence of AIDS before the diagnosis of lymphoma (73% versus 37%; P = 0.04), and lower median number of CD-4-positive lymphocytes in peripheral blood at diagnosis of lymphoma (30/dl versus 189/dl; P = 0.005). Median survival of such patients was 2.5 months versus 6.0 months for patients with systemic lymphoma (P = 0.04). Forty patients with systemic AIDS-related lymphoma have died; three factors were strongly associated with shorter survival: (1) Karnofsky performance status (KPS) of less than 70% (multivariate relative survival risk [RSR] = 3.1); (2) history of AIDS before the diagnosis of lymphoma (multivariate RSR = 3.0 for opportunistic infection plus Kaposi's sarcoma); and (3) bone marrow involvement (RSR = 3.1)). All three factors (KPS of less than 70%, prior AIDS diagnosis, and marrow involvement) were associated with early demise attributed to AIDS, whereas death attributed to lymphoma per se was associated with only two factors (KPS of less than 70% and marrow involvement). In the absence of all three risk factors, a "good prognosis" group of 17 patients was defined, with a median survival of 11.3 months; the median survival of the remaining patients ("poor prognosis") was 4.0 months (P = 0.0002). Attainment of complete response to therapy (CR) was strongly related to prolonged survival in the patients in the good prognosis group (17.8 months in patients with CR versus 5.0 months in those with less than CR); however, such meaningful prolongation of survival was not seen in patients with poor prognosis who attained CR (6.3 months versus 3.4 months). The patients with poor prognosis may be unable to tolerate the insult of multiagent chemotherapy, experiencing low CR rates (25%) and death caused by lymphoma and AIDS. However, patients in either prognostic category who attained CR remained at risk for dying of AIDS while the lymphoma was in remission. Thus, it is apparent that meaningful prolongation of survival in the patient with AIDS-related lymphoma will require not only effective antineoplastic intervention, but also control of the underlying HIV infection. In addition, future therapeutic trials should stratify patients based upon the prognostic factors defined here in an attempt to clarify the results obtained.
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Rarick MU, Montgomery T, Groshen S, Sullivan-Halley J, Jamin D, Mazumder A, Gill PS, Loureiro C, Levine AM. Intravenous immunoglobulin in the treatment of human immunodeficiency virus-related thrombocytopenia. Am J Hematol 1991; 38:261-6. [PMID: 1746533 DOI: 10.1002/ajh.2830380402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fourteen patients with sexually transmitted human immunodeficiency virus (HIV)-related immune thrombocytopenia were treated with intravenous gammaglobulin (IVIG). The patients were treated with a uniform program consisting of 1 g/kg of IVIG on day 1 and day 2, followed by 1 g/kg on day 15. Most patients had pretreatment bleeding symptoms, which included petechiae, spontaneous and traumatic ecchymoses, gum bleeding, and epistaxis. Median baseline platelet count was 17,000/mm3 (range 3-61,000/mm3). After the infusion of the IGIV, all patients had a resolution of their bleeding by day 8. The median maximum platelet count achieved with the IGIV was 220,000/mm3 (range 76-426,000/mm3). No patient achieved either a sustained complete or partial remission after the conclusion of the IVIG therapy. Toxicities were minimal with the majority being headache and nausea. In conclusion, patients with sexually transmitted HIV infection and immune thrombocytopenia respond favorably to IVIG. This treatment should be considered as first-line therapy for patients with HIV-related immune thrombocytopenia who require immediate but temporary increase in their platelet count, attributable to symptoms or signs of clinical bleeding or because of the need for an invasive procedure.
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Gill PS, Rarick MU, Espina B, Loureiro C, Bernstein-Singer M, Akil B, Levine AM. Advanced acquired immune deficiency syndrome-related Kaposi's sarcoma. Results of pilot studies using combination chemotherapy. Cancer 1990; 65:1074-8. [PMID: 1689209 DOI: 10.1002/1097-0142(19900301)65:5<1074::aid-cncr2820650505>3.0.co;2-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pilot studies were conducted to evaluate the toxicity and efficacy of two relatively marrow-sparing chemotherapy regimens in the treatment of advanced or progressive epidemic Kaposi's sarcoma. Chemotherapy regimens consisted of bleomycin (10 mg/m2), vincristine (1.4 mg/m2, 2 mg maximum) and Adriamycin (doxorubicin) at either 10 mg/m2 (Group I) or 20 mg/m2 (Group II). The therapy was given intravenously, every 2 weeks, until intolerable toxicity or maximum antitumor response. Thirty-three patients were treated. Although the patient populations were similar regarding pretreatment prognostic factors, the patients were not assigned randomly to these two treatment regimens. Major responses (complete or partial remission) were attained in 79% of the cases. The treatment-related toxicities consisted of mild to moderate nausea, hair loss, and peripheral sensory neuropathy. Bone marrow suppression consisted primarily of neutropenia (less than 1000/mm3) which occurred in a third of the patients. Variables significantly associated with shorter survival included hemoglobin (less than 10 g/dl), low Karnofsky performance status (less than 70%), and weight loss. Opportunistic infections occurred in the majority of cases during administration of chemotherapy, and were most likely related to severe cell-mediated immune dysfunction and low CD4-positive lymphocyte counts.
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Gill PS, Akil B, Colletti P, Rarick M, Loureiro C, Bernstein-Singer M, Krailo M, Levine AM. Pulmonary Kaposi's sarcoma: clinical findings and results of therapy. Am J Med 1989; 87:57-61. [PMID: 2472743 DOI: 10.1016/s0002-9343(89)80483-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Kaposi's sarcoma occurs commonly in patients with the acquired immunodeficiency syndrome (AIDS). Kaposi's sarcoma may remain localized or disseminate to involve visceral organs such as the lungs. Disseminated pulmonary involvement, when it occurs, is often fatal. Effective therapy may improve survival in such patients. We herein report on 20 patients with disseminated pulmonary Kaposi's sarcoma treated with cytotoxic chemotherapy. PATIENTS AND METHODS Twenty previously untreated patients with pulmonary Kaposi's sarcoma were identified. All were treated with cytotoxic chemotherapy consisting of either Adriamycin alone, a combination of Adriamycin, bleomycin, and vincristine (ABV), or bleomycin and vincristine (BV). The response to therapy and factors affecting prognosis were analyzed retrospectively. RESULTS Twelve (60%) patients showed a favorable response to therapy. The median survival from the initiation of chemotherapy for the 12 responders was 10 months (range: three to 31 + months) versus six months (range: one to 17+ months) for the non-responders. Eleven of the patients showing a response received ABV or BV combination chemotherapy (p = 0.004). Survival was shortened by the presence of either pleural effusion (p = 0.002), T4 lymphopenia of less than 100/mm3 (p = 0.03), or both at study entry. CONCLUSIONS In patients with pulmonary Kaposi's sarcoma, combination chemotherapy consisting of ABV or BV is associated with dramatic clinical and functional improvement. The median survival of 10 months demonstrates the value of combination chemotherapy in this group of patients.
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Gill PS, Loureiro C, Bernstein-Singer M, Rarick MU, Sattler F, Levine AM. Clinical effect of glucocorticoids on Kaposi sarcoma related to the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1989; 110:937-40. [PMID: 2719427 DOI: 10.7326/0003-4819-110-11-937] [Citation(s) in RCA: 101] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Abstract
Autopsies in 20 patients with the acquired immune deficiency syndrome (AIDS)-related lymphoma were studied retrospectively to ascertain the precise cause of death and the extent of lymphomatous disease. Eight patients had primary central nervous system (CNS) lymphoma: two of them were diagnosed antemortem; CNS lymphoma was suspected in three others by computerized tomographic (CT) scan and was confirmed at autopsy. The remaining three were diagnosed incidentally at autopsy. All had concurrent infections at autopsy, including opportunistic infection in six and pyogenic infections in two. Opportunistic infections at autopsy in these patients outnumbered those diagnosed clinically. Twelve patients had systemic lymphoma. Three were diagnosed only at autopsy, two of whom had extensive Kaposi's sarcoma (KS) as well. Eight patients were treated with chemotherapy, but died with disseminated disease. Opportunistic infections were found at autopsy in five patients. Secondary involvement of the CNS by lymphoma was frequent (66%) and was not related to previous bone marrow involvement. The authors conclude that the incidence of lymphoma occurring in AIDS may be more frequent than diagnosed clinically. Similarly, multiple opportunistic infections occur in these patients which are not diagnosed premortem and may contribute to early death.
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