Psychological impact of Crohn's disease on patients in remission: anxiety and depression risks

BACKGROUND

the role of anxiety and depression in CD patients in remission has been poorly investigated.

OBJECTIVE

the aim of the study was to evaluate the frequency of anxiety and depression symptoms in CD patients in remission, and potential factors influencing the development of these symptoms.

METHODS

CD patients older than 18 years in remission for at least 6 months before study entry were included. CD remission was defined as a Crohn s Disease Activity Index (CDAI) < 150 points together with C-reactive protein < 5 mg/L. A demographic questionnaire was filled in, and all patients were clinically classified. The therapy maintaining remission was also recorded. A Hospital Anxiety and Depression scale (HAD) was administered to all patients. Results are shown as OR and 95% CI, and analyzed by logistic regression.

RESULTS

92 consecutive patients were included (48 male, mean age 37 years, range from 18 to 71 years). One patient failed to correctly fill in the questionnaire. Anxiety and depression symptoms were present in 36 (39%) and 22 (24%) patients, respectively. Infliximab therapy was the only factor associated with anxiety (OR = 3.11; 95% CI: 1.03-9.43; p < 0.05). In contrast, the presence of depressive symptoms is less frequent in patients under infliximab therapy (OR = 0.16; 95% CI: 0.02-0.97; p < 0.05).

CONCLUSIONS

despite clinical remission, an important number of CD patients present with anxiety or depressive symptoms. Infliximab therapy in CD patients is associated to more anxiety but fewer depressive symptoms. CD patients in remission would probably benefit from psychological support.

Docetaxel and carboplatin followed by sequential capecitabine as first line treatment in patients with locally advanced or metastatic breast cancer

Abstract #2155

Background: Anthracyclines and docetaxel (D) are the most active agents in metastatic breast cancer (BC). New regimens are being assesed to improve chemotherapy efficacy. D and carboplatin (C) has shown to be an active treatment in metastatic BC. Capecitabine (X) and D is also an active combination, despite the fact the toxicity profile needs to be improved. Sequential administration of D and X could lead to an improved toxicity profile compared with concomitant administration. We designed this study to evaluate activity and toxicity profile of treatment with D and C followed by sequential X in patients with locally advanced or metastatic BC.&#x2028; Methods: Patients with locally advanced or metastatic BC, at least one measurable lesion, age ≥ 18 years, ECOG PS ≤ 2, and adequate bone marrow and hepatic functions, were included in the study. Prior chemotherapy or radiotherapy for advanced disease was not allowed. Patients received 6 cycles of D 75 mg/m2 iv D1 and C AUC5 iv D1, every 21 days followed by 12 cycles of X 2000 mg/m2/day o.r. D1-14 in a 21 days course.&#x2028; Results: twenty patients have been analyzed. Median age was 55 years old (range 36-73), ECOG PS 0-1 94.4%; 90.0% of patients had infiltrating ductal carcinoma and 57.9% of patients had stage I-II at diagnosis. Main sites of metastatic disease were bone (35.0%), liver (25.0%) and lung (25.0%). Conservative surgery was performed in 35% of patients and mastectomy in 40%. Previous radiotherapy and chemotherapy was administered in 50.0% and 70.0% of patients, respectively. A total of 108 cycles of D and C (median 6, range 2-6) and 71 cycles of X (median 6, range 2-10) were administered. Median relative dose intensity was 96% for D and C and 95% for X. Over 17 evaluable patients for efficacy, 2 achieved complete response and 4 partial response; the ORR was 35.3% (95% CI:12.6-58.1). During D and C treatment, grade III/IV toxicities per patient were neutropenia (25.0%), leucopenia (10.0%), mucositis (5.0%), oedema (5.0%), febrile neutropenia (5.0%) and thrombophlebitis (5.0%). Most common grade II toxicities were nausea (20.0%), vomiting (15.0%) and asthenia (20.0%). During X treatment, grade III/IV toxicities per patient were neutropenia (7.1%) and hand-foot syndrome (7.1%). Main grade II toxicity was hand-foot syndrome (14.3%). Two patients finished treatment after 2 and 6 cycles of X due to diarrhea, oedema and anorexia, and hand-foot syndrome.&#x2028; Conclusion: In this preliminary analysis, D and C followed by sequential X seems to be an active and well-tolerated regimen as first line treatment in patients with locally advanced or metastatic BC.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2155.

A multicenter pilot study of adjuvant docetaxel, epirubicin and cyclophosphamide (TEC) in patients (p) with stage II/III and node-positive breast cancer (BC)

11029

Background: Based on wide experience with docetaxel, adriamicin and cyclophosphamide (TAC regimen) for adjuvant therapy of node-positive BC but taking into account the high incidence of febrile neutropenia and mucositis, we performed the present study with TEC aiming for a better toxicity profile at doses equipotent to TAC. Methods: 300 p with histological diagnosis of stage II-III BC, positive axillary lymph nodes, age 18 year old, ECOG PS 0–2 and adequate bone marrow, renal, hepatic and cardiac function were accrued after surgery. Prior chemotherapy, hormone therapy and radiotherapy for BC were not allowed. Treatment: T 75 mg/m2 iv d1, E 75 mg/m2 iv d1 and C 500 mg/m2 iv d1 every 21 days for 6 cycles. G-CSF 5 mcg/Kg /day s.c. was given on days 5 to 9. Results: Two hundred and one p having completed adjuvant therapy have been evaluated in this interim analysis. Median age: 53 years (range 25–77), ECOG PS 0/1 89%/11%, infiltrating ductal carcinoma 77%. Hormone receptor status was ER+ 79% and PR+ 60%. Surgery was mastectomy in 49% and conservative surgery in 51% of pts. Median number of positive axillary lymph nodes was 3. To date, 1,085 cycles were administered (median 6). Median relative dose intensity was 99% for T and 98% for E and C. There were 11 dose reductions for non- hematological toxicity and 4 for hematological toxicity. Toxicity: grade 3–4 neutropenia occurred in 15 p (7.5%), 8 of them were episodes of febrile neutropenia (4.0%). Other grade 3–4 toxicities per p were: leukopenia (7.0%), thrombocytopenia (0.5%), asthenia (6.5%), vomiting (4.5%), nausea (3.5%) and diarrhoea (3.0%). Four p (2.0%) discontinued therapy due to toxicity: 1 p with toxicodermic reaction, 1 p with hematological toxicity, 1 p with febrile neutropenia and 1 p with an allergic reaction to T. After study treatment, radiotherapy was administered to 63% of p and hormonotherapy to 66% of p. Conclusions: These preliminary results show that adjuvant TEC in p with stage II/III BC and positive axillary lymph nodes is feasible and well tolerated.

No significant financial relationships to disclose.

Lipid and fatty acid content in wild white seabream (Diplodus sargus) broodstock at different stages of the reproductive cycle

The lipid and fatty acid content of the gonads, liver and muscle of wild white seabream males and females was studied at different stages of the reproductive cycle. Samples were taken from mature white seabream at pre-spawning (November), mid-spawning (March) and post-spawning (June) stages. The results showed that lipid accumulates in gonads and muscle from November to March. The gonadosomatic index (GSI) was also increased during this period. Male gonads showed a greater increase in polar lipid (PL) than neutral (NL), while female gonads displayed the reverse. The increase in both neutral and polar lipid was higher in the muscle of males than in females. In the same period, male livers showed no changes either in lipid content or the hepatosomatic index (HSI), while female livers registered an increase in both lipid content and HSI. Between March and June, in both males and females, total, neutral and polar lipid decreased sharply in the gonads and muscle. Muscular lipid content reduction was more pronounced in males than females. On the other hand, the lipid content of the liver in males and females remained relatively constant. In general terms, the amounts of major fatty acids (16:0, 18:1n-9, 20:5n-3 and 22:6n-3) in gonadal and muscular polar and neutral lipid in both males and females increased from November to March and declined thereafter. Variations of the liver fatty acid content were less extreme. In the period from mid-spawning to post-spawning, the presence of 20:4n-6 in polar and neutral lipid increased to a notable extent in all organs studied.

Association of NOD2/CARD15 mutations with previous surgical procedures in Crohn's disease

OBJECTIVE

The aim of this study is to assess the importance of NOD2/CARD15 gene mutations as prognostic factors for surgical indications in Crohn's disease. PATIENTS AND EXPERIMENTAL DESIGN: A total of 165 Crohn s disease patients were studied, considering previous surgery related to Crohn's disease. We analyzed for previous surgery in global procedures as well as separately for the two main surgical indications: ileal resection and fistula treatment. The need for appendectomy was also studied. All patients were genotyped for the three CARD15 mutations, and association studies were developed using Chi-square statistics and Fisher's exact test whenever appropriate.

RESULTS

Carriers of the G908R or 1007fs mutation needed surgery more frequently, both for ileal resection and fistula repair. In contrast, appendectomy was not associated with CARD15 mutations.

CONCLUSIONS

As previously reported in this population, the R702W mutation does influence parameters of disease or need of surgery. The need for Crohn's disease-related surgery is higher in carriers of the G908R or 1007fs CARD15 mutation in the Galician population. Nevertheless, the frequency of these mutations does not allow their use to predict the course of disease.

Lipid dynamics and plasma level changes of 17β-estradiol and testosterone during the spawning season of gilthead seabream (Sparus aurata) females of different ages

The present study was undertaken to evaluate whether the age of brood stock females of Sparus aurata affects the mobilization of lipids from muscle and liver towards the gonads to aid in oocyte development. Taking into account the role some hormones play in lipid mobilization the production of 17beta-estradiol (E2) and testosterone (T) was also measured throughout the spawning season. Four groups of fish were established consisting of 3-, 4-, 5- and 6-year-old females (1.3, 1.5, 2.3 and 2.8 kg average weight, respectively), maintained in separate tanks together with a number of two-year-old males. The results for all four groups showed no variations in fish total length between the beginning and end of the experimental period. However, losses were recorded both of body weight and condition factor. In general terms, there were no significant differences in the plasma levels of E2, T and the gonadosomatic (GSI) and hepatosomatic (HSI) index among the four groups throughout the spawning season. In all groups, the plasma levels of E2, T, GSI and HSI were at their lowest at the end of spawning. Between December (pre-spawning) and March (mid-spawning), all groups suffered depletion of the lipid content of liver and muscle, while gonad lipid content remained constant. The mobilization of lipids from liver and muscle to contribute to the upkeep of the gonadal lipid involved the mobilization of all the fatty acid groups, saturates, monoenes, n-6, n-3, and n-3 HUFA. A good correlation existed between the percentage of the various fatty acid groups transferred from muscle and the age of the reproductive females. However, the greater lipid mobilization from muscle matching the greater age of the reproductive females did not result in greater lipid gonadal reserves or greater body size, suggesting that reproduction on the part of older females requires greater effort. Despite this, the results as a whole indicated that lipogenic capacity, considered as the mobilization of lipids from muscle and liver towards the gonad for the development of oocytes, is unaffected by age in reproductive 3- to 6-year-old gilthead seabream females.

Schistosoma: Cross-reactivity and antigenic community among different species

It is not unusual to find common molecules among different species of the genus Schistosoma. When those molecules are antigenic, they may be used in immunodiagnosis and vaccines, but they could also be applied to taxonomic and evolutionary studies. To study cross-reactivity and antigenic community among different species of schistosomes, plasmas from laboratory animals infected with Schistosoma bovis, S. guineensis, S. rodhaini, S. haematobium, and four strains of S. mansoni were evaluated with a crude extract of adult worms of S. mansoni by Western blot. Using the multiple antigen blot assay, plasmas from these infected animals were exposed to a selected group of synthetic peptides from Sm28GST, Sm28TPI, Sm elastase, Sm97, Sm32, Sm31, and Sm Cathepsin L. The results presented herein demonstrate differential cross-reactivity and antigenic community among the Mansoni and Haematobium groups of schistosomes, which is of relevance as an additional new tool for phylogenetic studies of schistosomes as well as for diagnosis and vaccine purposes.

Single (B or C), dual (BC or BD) and triple (BCD) viral hepatitis in HIV-infected patients in Madrid, Spain

INTRODUCTION

There are very limited data about the prevalence of multiple hepatitis virus infections in HIV infected individuals. In HIV uninfected individuals with triple BCD hepatitis, hepatitis D virus (HDV) appears to be the dominant virus. However, in HIV infected patients with triple hepatitis it is not known if HDV replication inhibits hepatitis B virus (HBV) and/or hepatitis C virus (HCV) replication.

METHODS

We calculated the prevalence of single (B or C), dual (BC) and triple (BCD) hepatitis in 423 HIV-infected patients with positive HCV serum antibodies and/or positive serum HBsAg. In patients with multiple infections we performed an evaluation of serum markers of HBV, HCV and HDV replication.

RESULTS

The prevalence of multiple hepatitis was 4.7% (95% confidence interval, 2.7-6.7%). Multiple hepatitis occurred only among patients who acquired HIV through injection drug use. The most common multiple hepatitis was triple BCD. Patients with hepatitis BC and past or chronic hepatitis D were significantly more likely to have cirrhosis and a negative serum HBeAg and HCV PCR than patients with single hepatitis B or hepatitis C. Patients with chronic hepatitis D showed uniform suppression of HBV and HCV replication markers.

CONCLUSIONS

In our geographic area approximately 5% of HIV infected patients with hepatitis suffer multiple hepatitis virus infection. In patients with triple hepatitis BCD virus infection, HDV appears to be the dominant virus causing inhibition of both HBV and HCV replication.

Spinal anesthesia for emergency abdominal surgery in uncontrolled hyperthyroidism

Patients with uncontrolled hyperthyroidism presenting as an emergency are at considerable risk. The anesthetic management of a thyrotoxic patient undergoing incidental emergency surgery is discussed. We focus on the intraoperative problems and, above all, postoperative pain management with regional anesthesia.

Phase II study of a fixed dose-rate infusion of gemcitabine associated with docetaxel in advanced non-small-cell lung carcinoma

PURPOSE

To evaluate the efficacy and toxicity profile of the combination of docetaxel and prolonged gemcitabine infusion in front-line chemonaive patients with advanced non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

A total of 50 chemonaive patients diagnosed with advanced NSCLC according to the AJCC/TNM classification system were included in the present study. Treatment consisted of 1000 mg/m(2) gemcitabine given as a 100-min continuous infusion (10 mg/m(2) per min) on days 1 and 8 of each course and 75 mg/m(2) docetaxel as a 60-min infusion on day 8, repeating each course every 21 days.

RESULTS

The ECOG performance status of the patients were as follows: 0 (10%), 1 (60%), and 2 (30%). All patients had two-dimensionally measurable disease. Their median age was 63 years (range 41-75 years). Of the 50 patients, 28 (56%) had squamous cell carcinoma, 14 adenocarcinoma (28%), and 8 (16%) large-cell carcinoma, and 40% and 60% of patients presented with stage IIIB and IV disease, respectively. Of those with stage IV disease, 33% had more than one metastatic site. A total of 220 courses were administered with a median of five courses per patient. Of 46 patients assessed for response, 12 (26%) had a partial remission (95% CI 13-39%). In 19 patients (41%) the disease remained stable, while disease progression was observed in 15 (33%). The median time to disease progression was 4 months, and median survival time was 7 months. At 1 year, 25% of patients remained alive, and the main grade 3/4 toxicity (according to the WHO scale) consisted of neutropenia ( n=6, 12%), asthenia ( n=4, 8%), peripheral edema ( n=3, 6%), dyspnea ( n=3, 6%), and diarrhea ( n=2, 4%).

CONCLUSIONS

Prolonged gemcitabine infusion combined with docetaxel is well tolerated and its efficacy is similar to that of other chemotherapeutic schemes used for NSCLC treatment. However, the prolonged infusion of gemcitabine did not appear to result in any improvement in outcome or toxicity versus the standard dose rate.

[Study of cancer-associated asthenia: foundation of the ASTHENOS group]

Asthenia in cancer patients is a highly controversial subject. A distinct definition of asthenia in medical literature is lacking as well as its prevalence and incidence. Also, no simple tools for its diagnosis are available. Moreover its etiopathogenesis is complex and multifactorial, thereby making therapeutic approaches difficult. Recently, a Spanish group has been set up for the study and treatment of asthenia in cancer patients. This paper reports on its establishment, objectives and first conclusions.

Clips for the prevention and treatment of postpolypectomy bleeding (hemoclips in polypectomy)

INTRODUCTION

The most accurate method for the prevention and treatment of complications after polypectomy has not been well defined. The prophylactic use of hemoclips may reduce the risk of bleeding, mainly in pedunculated big polyps.

OBJECTIVE

To evaluate the accuracy of hemoclips in the prophylaxis and treatment of bleeding after endoscopic polypectomy.

MATERIAL AND METHODS

Retrospective study of 223 consecutive endoscopic polypectomies performed in our Endoscopy Unit between january and october 2001. Hemoclips were routinely used only for large polyps (15 to 40 mm); all of them were located in the colon except one, a gastric polyp.

RESULTS

From a total of 223 polypectomies (215 patients), hemoclips were used for 34 (15.2%), in 30 of them just before and in 4 just after polypectomy. When used prophylactically no complication was observed, except one mild bleeding episode (3.3%) that stopped with the placing of a second hemoclip. The therapeutic clipping (4 polypectomies) induced immediate haemostasis in all cases.

CONCLUSIONS

The prophylactic use of hemoclips is associated with a very low risk of bleeding after endoscopic resection of big polyps. Therapeutic clipping is an effective measure for polypectomy-related bleeding.