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Hasnis E, Dahan A, Khoury W, Duek D, Fisher Y, Beny A, Shaked Y, Chowers Y, Half EE. Intratumoral HLA-DR -/CD33 +/CD11b + Myeloid-Derived Suppressor Cells Predict Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer. Front Oncol 2020; 10:1375. [PMID: 32903466 PMCID: PMC7435035 DOI: 10.3389/fonc.2020.01375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/30/2020] [Indexed: 12/16/2022] Open
Abstract
Capecitabine-based neoadjuvant chemoradiation therapy (nCRT) is currently the mainstay of treatment for locally advanced rectal cancer (LARC), prior to surgical tumor removal. While response to this treatment is partial, it carries significant risk of side effects. As of today, there is no accepted model to predict tumor response, and allow for patient stratification. The level of circulating Myeloid-derived suppressor cells (MDSCs), a subpopulation of early myeloid cells (EMCs), has been shown to correlate with prognosis and response to therapy in advanced colon cancer, but their role in LARC is not clear. We sought to study the effect of intratumoral and circulating levels of different EMCs subpopulations including MDSCs on response to nCRT. We analyzed tumor, normal mucosa, and peripheral blood samples from 25 LARC patients for their different EMCs subpopulation before and after nCRT, and correlated them with degree of pathologic response, as determined postoperatively. In addition, we compared LARC patient to 10 healthy donors and 6 metastatic patients. CD33+HLA-DR−CD16−CD11b+EMCs in the circulation of LARC patients were found to inhibit T-cell activation. Furthermore, elevated levels of CD33+HLA-DR− myeloid cells were found in the tumor relative to normal mucosa, but not in the circulation when compared to healthy subjects. Moreover, intratumoral, but not circulating levels of MDSCs correlated with clinical stage and response to therapy in patients treated with nCRT, with high levels of MDSCs significantly predicting poor response to nCRT. Importantly, therapy by itself, had significant differential effects on MDSC levels, leading to increased circulating MDSCs, concomitantly with decreasing intratumoral MDSCs. Our results suggest that high levels of intratumoral, but not circulating MDSCs may confer drug resistance due to immunomodulatory effects, and serve as a biomarker for patient stratification and decision-making prior to nCRT.
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Affiliation(s)
- Erez Hasnis
- Department of Gastroenterology, Rambam HealthCare Campus, Haifa, Israel.,Cancer Center, Sanford-Burnham-Prebys Medical Discovery Institute, San Diego, CA, United States
| | - Aviva Dahan
- Department of Gastroenterology, Rambam HealthCare Campus, Haifa, Israel
| | - Wissam Khoury
- Department of Colorectal Surgery, Rambam HealthCare Campus, Haifa, Israel
| | - Daniel Duek
- Department of Colorectal Surgery, Rambam HealthCare Campus, Haifa, Israel
| | - Yael Fisher
- Department of Pathology, Rambam HealthCare Campus, Haifa, Israel
| | - Alex Beny
- Department of Oncology, Rambam HealthCare Campus, Haifa, Israel
| | - Yuval Shaked
- Department of Cell Biology and Cancer Science, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam HealthCare Campus, Haifa, Israel
| | - Elizabeth E Half
- Department of Gastroenterology, Rambam HealthCare Campus, Haifa, Israel
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Fuchs CS, Shitara K, Di Bartolomeo M, Lonardi S, Al-Batran SE, Van Cutsem E, Ilson DH, Alsina M, Chau I, Lacy J, Ducreux M, Mendez GA, Alavez AM, Takahari D, Mansoor W, Enzinger PC, Gorbounova V, Wainberg ZA, Hegewisch-Becker S, Ferry D, Lin J, Carlesi R, Das M, Shah MA, Karaseva NA, Kowalyszyn RD, Hernandez CA, Csoszi T, De Vita F, Pfeiffer P, Sugimoto N, Kocsis J, Csilla A, Bodoky G, Garnica Jaliffe G, Protsenko S, Madi A, Wojcik E, Brenner B, Folprecht G, Sarosiek T, Peltola KJ, Bono P, Ayala H, Aprile G, Gerardo CG, Huitzil Melendez FD, Falcone A, Di Costanzo F, Tehfe M, Mineur L, García Alfonso P, Obermannova R, Senellart H, Petty R, Samuel L, Acs PI, Hussein MA, Nechaeva MN, Erdkamp F, Won E, Bendell JC, Gallego Plazas J, Lorenzen S, Melichar B, Escudero MA, Pezet D, Phelip JM, Kaen DL, Reeves JAJ, Longo Muñoz F, Madhusudan S, Barone C, Fein LE, Gomez Villanueva A, Hebbar M, Prausova J, Visa Turmo L, Vidal Barrull J, Yilmaz MKN, Beny A, Van Laarhoven H, DiCarlo BA, Esaki T, Fujitani K, Geboes K, Geva R, Kadowaki S, Leong S, Machida N, Raj MS, Ramirez Godinez FJ, Ruzsa A, Ford H, Lawler WE, Maisey NR, Petera J, Shacham-Shmueli E, Sinapi I, Yamaguchi K, Hara H, Beck JT, Błasińska-Morawiec M, Villalobos Valencia R, Alcindor T, Bajaj M, Berry S, Gomez CM, Dammrich D, Patel R, Taieb J, Ten Tije A, Burkes RL, Cabanillas F, Firdaus I, Chua CC, Hironaka S, Hofheinz RD, Lim HJ, Nordsmark M, Piko B, Verma U, Wadsley J, Yukisawa S, Gutiérrez Delgado F, Denlinger CS, Kallio R, Pikiel J, Wojcik-Tomaszewska J, Brezden-Masley C, Jang RWJ, Pribylova J, Sakai D, Bartoli MA, Cats A, Grootscholten M, Dichmann RA, Hool H, Shaib W, Tsuji A, Van den Eynde M, Velez-Cortez H, Asmis TR. Ramucirumab with cisplatin and fluoropyrimidine as first-line therapy in patients with metastatic gastric or junctional adenocarcinoma (RAINFALL): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2019; 20:420-435. [PMID: 30718072 DOI: 10.1016/s1470-2045(18)30791-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND VEGF and VEGF receptor 2 (VEGFR-2)-mediated signalling and angiogenesis can contribute to the pathogenesis and progression of gastric cancer. We aimed to assess whether the addition of ramucirumab, a VEGFR-2 antagonist monoclonal antibody, to first-line chemotherapy improves outcomes in patients with metastatic gastric or gastro-oesophageal junction adenocarcinoma. METHODS For this double-blind, randomised, placebo-controlled, phase 3 trial done at 126 centres in 20 countries, we recruited patients aged 18 years or older with metastatic, HER2-negative gastric or gastro-oesophageal junction adenocarcinoma, an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and adequate organ function. Eligible patients were randomly assigned (1:1) with an interactive web response system to receive cisplatin (80 mg/m2, on the first day) plus capecitabine (1000 mg/m2, twice daily for 14 days), every 21 days, and either ramucirumab (8 mg/kg) or placebo on days 1 and 8, every 21 days. 5-Fluorouracil (800 mg/m2 intravenous infusion on days 1-5) was permitted in patients unable to take capecitabine. The primary endpoint was investigator-assessed progression-free survival, analysed by intention to treat in the first 508 patients. We did a sensitivity analysis of the primary endpoint, including a central review of CT scans. Overall survival was a key secondary endpoint. This study is registered with ClinicalTrials.gov, number NCT02314117. FINDINGS Between Jan 28, 2015, and Sept 16, 2016, 645 patients were randomly assigned to receive ramucirumab plus fluoropyrimidine and cisplatin (n=326) or placebo plus fluoropyrimidine and cisplatin (n=319). Investigator-assessed progression-free survival was significantly longer in the ramucirumab group than the placebo group (hazard ratio [HR] 0·753, 95% CI 0·607-0·935, p=0·0106; median progression-free survival 5·7 months [5·5-6·5] vs 5·4 months [4·5-5·7]). A sensitivity analysis based on central independent review of the radiological images did not corroborate the investigator-assessed difference in progression-free survival (HR 0·961, 95% CI 0·768-1·203, p=0·74). There was no difference in overall survival between groups (0·962, 0·801-1·156, p=0·6757; median overall survival 11·2 months [9·9-11·9] in the ramucirumab group vs 10·7 months [9·5-11·9] in the placebo group). The most common grade 3-4 adverse events were neutropenia (85 [26%] of 323 patients in the ramucirumab group vs 85 [27%] of 315 in the placebo group), anaemia (39 [12%] vs 44 [14%]), and hypertension (32 [10%] vs 5 [2%]). The incidence of any-grade serious adverse events was 160 (50%) of 323 patients in the ramucirumab group and 149 (47%) of 315 patients in the placebo group. The most common serious adverse events were vomiting (14 [4%] in the ramucirumab group vs 21 [7%] in the placebo group) and diarrhoea (11 [3%] vs 19 [6%]). There were seven deaths in each group, either during study treatment or within 30 days of discontinuing study treatment, which were the result of treatment-related adverse events. In the ramucirumab group, these adverse events were acute kidney injury, cardiac arrest, gastric haemorrhage, peritonitis, pneumothorax, septic shock, and sudden death (n=1 of each). In the placebo group, these adverse events were cerebrovascular accident (n=1), multiple organ dysfunction syndrome (n=2), pulmonary embolism (n=2), sepsis (n=1), and small intestine perforation (n=1). INTERPRETATION Although the primary analysis for progression-free survival was statistically significant, this outcome was not confirmed in a sensitivity analysis of progression-free survival by central independent review, and did not improve overall survival. Therefore, the addition of ramucirumab to cisplatin plus fluoropyrimidine chemotherapy is not recommended as first-line treatment for this patient population. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Charles S Fuchs
- Yale Cancer Center, Smilow Cancer Hospital, New Haven, CT, USA.
| | - Kohei Shitara
- National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | - Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KULeuven, Belgium
| | - David H Ilson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Alsina
- Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Ian Chau
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Jill Lacy
- Yale Cancer Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Michel Ducreux
- Gustave Roussy Cancer Centre, Grand Paris, Villejuif, France; Université Paris-Saclay, France
| | | | | | | | | | | | | | - Zev A Wainberg
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - David Ferry
- Eli Lilly and Company, New York City, NY, USA
| | - Ji Lin
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Mayukh Das
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Manish A Shah
- Weill Cornell Medical College, NY, USA; New York Presbyterian Hospital, New York, NY, USA
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Ben-Yaacov A, Zendel A, Adileh M, Shapiro R, Aderka D, Shacham-Shmueli E, Beny A, A. arishe, Nissan A. Perioperative and long-term results of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy and synchronous liver metastases resection. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
A 65-year-old male with lung adenocarcinoma received radiotherapy to the mediastinum and right upper lobe, followed by chemotherapy with gemcitabine. Radiation recall dermatitis developed in the area corresponding to the radiotherapy portal. This is one of just a few cases reported recently concerning radiation recall dermatitis stemming from gemcitabine.
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Affiliation(s)
- G Bar-Sela
- Department of Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
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Kakiashvili E, Yshai OB, Almog R, Beny A, Kluger Y. "Many ways to skin gastric cancer" - Robotic versus laparoscopic versus open gastrectomy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dux J, Rayman S, Zendel A, Segev L, Hoffman A, Ben Yaacov A, Marom G, Aderka D, Shacham Shmueli E, Beny A, Ayala H, Grenader T, Brenner B, Purim O, Gutman M, Venturero M, Nissan A. 117. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal surface malignancies in the elderly. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kakiashvili E, Brauner E, Ben Ishai O, Beny A, Almog R, Kluger Y. P-255 "Many ways to skin gastric cancer" - Robotic versus laparoscopic versus open gastrectomy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gouzman J, Cohen M, Ben-Zur H, Shacham-Shmueli E, Aderka D, Siegelmann-Danieli N, Beny A. Resilience and psychosocial adjustment in digestive system cancer. J Clin Psychol Med Settings 2015; 22:1-13. [PMID: 25605269 DOI: 10.1007/s10880-015-9416-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The study aims to investigate the contributions of resilience, affective reactions and post traumatic growth (PTG) to psychosocial adjustment and behavioral changes among digestive system cancer patients in Israel. A sample of 200 participants, 57.5 % men (from the 46 to 70-year age range), 1-4 years following diagnosis, completed an inventory assessing demographic and medical information, resilience, current positive affect (PA) and negative affect (NA), PTG, psychosocial adjustment and retrospective report of behavioral changes following cancer treatment. Resilience, PA and NA, and PTG were related to adjustment and/or reported behavioral changes, and PA, NA and PTG mediated some of the effects of resilience on adjustment and/or reported behavioral changes. The data underline the importance of resilience, affect, and PTG in the adjustment of digestive system cancer patients. Future studies are needed to better understand the associations of resilience with psychosocial adjustment and behavioral changes. This knowledge may help improve cancer survivors' adjustment.
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Affiliation(s)
- Julia Gouzman
- Faculty of Social Welfare and Health Services, School of Social Work, University of Haifa, Mount Carmel, Haifa, Israel,
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Kakiashvili I, Brauner E, Ben Yshai O, Almog R, Beny A, Kluger Y. 2279 Robotic versus laparoscopic versus open gastrectomy for gastric cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Hasnis E, Dahan A, Duek D, Beny A, Chowers Y, Half E. P-239 Characterization of Myeloid – Derived Suppressor Cell Subpopulations in Localized Colorectal Adenocarcinoma Patients. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shachar Y, Adileh M, Keidar A, Eid L, Hubert A, Temper M, Azam S, Beny A, Grednader T, Khalaileh A, Yuval JB, Stojadinovic A, Avital I, Nissan A. Management of Inguinal Involvement of Peritoneal Surface Malignancies by Cytoreduction and HIPEC with Inguinal Perfusion. J Cancer 2015; 6:243-6. [PMID: 25663941 PMCID: PMC4317759 DOI: 10.7150/jca.10325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/26/2014] [Indexed: 11/25/2022] Open
Abstract
Background: Achieving complete cytoreduction of peritoneal surface malignancies (PSM) can be challenging. In most cases, delivery of heated intra-peritoneal chemotherapy (HIPEC) is straightforward. However, using the closed technique in some cases may be technically challenging; for example, in patients requiring abdominal closure using a large synthetic mesh. In cases where groin hernias are present, it is imperative to resect the hernia sac, since it may contain tumor deposits. In cases with major inguinal involvement where disease may spread out of the hernia sac or in cases where a hernia repair was performed while disease is present, inguinal perfusion should be considered. Aim: To describe our experience with combined intra-peritoneal and inguinal perfusion of HIPEC following cytoreductive surgery. Patients and Methods: This is a retrospective review of all patients who underwent cytoreductive surgery (CRS) and HIPEC at our institution. A prospectively maintained database containing data of patients treated by CRS and HIPEC (n=122) was reviewed. All patients with macroscopic inguinal involvement by PSM with complete cytoreduction perfused by HIPEC were included. Results: We identified five cases who underwent CRS and combined intraperitoneal and inguinal perfusion after resection of large inguinal tumor deposits (n=4) or after a recent hernia repair with hernial sac involvement by mucinous adenocarcinoma (n=1). All five patients were successfully perfused using an additional outflow catheter placed in the groin. Discussion: In cases of inguinal involvement by PSM, complete cytoreduction should be achieved and perfusion of the involved groin considered as it is feasible and safe.
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Affiliation(s)
- Yair Shachar
- 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Mohamed Adileh
- 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Assaf Keidar
- 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Luminita Eid
- 2. The Department of Anesthesiology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Ayalah Hubert
- 3. The Department of Oncology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Mark Temper
- 3. The Department of Oncology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Salah Azam
- 3. The Department of Oncology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Alex Beny
- 4. The Department of Oncology, Rambam Medical Center, Haifa, Israel
| | - Tal Grednader
- 5. The Department of Oncology, Sha'arei Tzedek, Medical Center, Jerusalem, Israel
| | - Abed Khalaileh
- 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Jonathan B Yuval
- 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | | | | | - Aviram Nissan
- 1. The Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
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Wilke H, Clingan P, Ananda S, Kurteva G, Suuroja T, Folprecht G, Beny A, Pastorelli D, Cesas A, Toganel C, Bodoky G, Lipatov O, Limon M, Cunningham D, Cummins S, Wainberg Z, Ko A, Emig M, Chandrawansa K, Van Cutsem E. Rainbow: A Global, Phase 3, Double-Blind Study of Ramucirumab Plus Paclitaxel Versus Placebo Plus Paclitaxel in the Treatment of Gastric Cancer Following Disease Progression: Western Population Subgroup. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cohen M, Baziliansky S, Beny A. The association of resilience and age in individuals with colorectal cancer: an exploratory cross-sectional study. J Geriatr Oncol 2013; 5:33-9. [PMID: 24484716 DOI: 10.1016/j.jgo.2013.07.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 06/14/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies generally report lower emotional distress in older patients with cancer than in younger patients with cancer. The personality construct of resilience was previously found to be higher with age, but has not been assessed in relation to emotional distress in older patients with cancer. OBJECTIVE To assess the mediating effect of resilience on the associations between age and emotional distress in patients with colorectal cancer (CRC). PATIENTS AND METHODS An exploratory cross-sectional study of 92 individuals, aged 27-87 years, diagnosed with CRC stage II-III, 1-5 years prior to enrollment in the study. They completed the Wagnild and Young's resilience scale and Brief Symptoms Inventory-18, cancer-related problem list, and demographic and disease-related details. RESULTS Older age, male gender, and less cancer-related problems were associated with higher resilience and lower emotional distress. A Structural Equation Modeling (SEM) analysis and mediation tests showed that, while controlling for cancer-related problems, resilience mediated the effects of age and gender on emotional distress. CONCLUSIONS The study enlarges the explanation for the consistent previous findings on the better adjustment of older patients with cancer. Increased professional support should be provided for patients with low resilience levels.
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Affiliation(s)
- Miri Cohen
- Department of Gerontology, University of Haifa, Haifa, Israel.
| | | | - Alex Beny
- Oncology Institute, Rambam Health Care Campus, Haifa, Israel
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Kennedy AS, Nutting C, Jakobs T, Cianni R, Notarianni E, Ofer A, Beny A, Dezarn WA. A first report of radioembolization for hepatic metastases from ocular melanoma. Cancer Invest 2009; 27:682-90. [PMID: 19219675 DOI: 10.1080/07357900802620893] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ocular melanoma (OM) metastasizes to the liver and is rapidly fatal despite aggressive therapy. Yttrium-90 microspheres (radioembolization) delivered via the hepatic artery is an established and effective approach for primary and metastatic hepatic tumors, although (90)Y use in OM has not been reported previously. METHODS A retrospective review was performed for all patients with OM who received radioembolization at 5 centers. RESULTS 11 patients received 12 treatments with a median activity of 1.55 GBq delivered per treatment. Toxicity was minimal, with PET/CT at 3 months posttreatment showing a response in all patients; 1 patient had a complete response. CONCLUSIONS Radioembolization can control hepatic metastases of OM with very few side effects.
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Bosset JF, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier JC, Collette L. Preoperative radiation (Preop RT) in rectal cancer: Effect and timing of additional chemotherapy (CT) 5-year results of the EORTC 22921 trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3505] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. F. Bosset
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
| | - G. Calais
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
| | - L. Mineur
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
| | - P. Maingon
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
| | - L. Radosevic-Jelic
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
| | - A. Daban
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
| | - E. Bardet
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
| | - A. Beny
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
| | - J. C. Ollier
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
| | - L. Collette
- Besançon Univ Hosp, Besançon, France; CHU, Tours, France; Clinic, Avignon, France; Cancer Ctr, Dijon, France; Institute for Oncologia, Belgrade, Serbia and Montenegro; CHU, Poitiers, France; Cancer Ctr, Nantes, France; Rambam Medcl Ctr, Haifa, Israel; Ctr Paul Strauss, Strasbourg, France; EORTC Data Ctr, Brussels, Belgium
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16
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Bosset JF, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Collette L, Briffaux A. Does the addition of chemotherapy (CT) to preoperative radiotherapy (preopRT) increase the pathological response in patients with resected rectal cancer : Report of the 22921 EORTC phase III trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J.-F. Bosset
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
| | - G. Calais
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
| | - L. Mineur
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
| | - P. Maingon
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
| | - L. Radosevic-Jelic
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
| | - A. Daban
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
| | - E. Bardet
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
| | - A. Beny
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
| | - L. Collette
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
| | - A. Briffaux
- Besançon University Hopsital, Besançon, France; Tours University Hospital, Tours, France; Clinique Sainte Catherine, Avignon, France; Cancer Center Dijon, Dijon, France; Institute of Radiology & Oncology, Belgrade, Yugoslavia; Poitiers University Hospital, Poitiers, France; Centre René Gauducheau, Nantes, France; Rambam Medical Center, Haïfa, Israel; EORTC, Brussels, Belgium
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17
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Cohen Y, Shulman K, Idelevich E, Ben-Shachar M, Honnigman J, Haiat H, Zidan J, Hubert A, Kuten A, Beny A. Irinotecan (CPT-11) combined with UFT as first line treatment of advanced colorectal carcinoma-A phase II study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Y. Cohen
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
| | - K. Shulman
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
| | - E. Idelevich
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
| | - M. Ben-Shachar
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
| | - J. Honnigman
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
| | - H. Haiat
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
| | - J. Zidan
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
| | - A. Hubert
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
| | - A. Kuten
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
| | - A. Beny
- Soroka Medical Center, Beer Sheva, Israel; Rambam Medical Center, Haifa, Israel; Kaplan Medical Center, Rehovot, Israel; Nahariya Medical Center, Nahariya, Israel; HaEmek Medical Center, Afulla, Israel; Wolfson Medical Center, Holon, Israel; Ziv Medical Center, Sefad, Israel; Hadassah Medical Center, Jerusalem, Israel
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18
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Caraceni A, Martini C, Zecca E, Portenoy RK, Ashby MA, Hawson G, Jackson KA, Lickiss N, Muirden N, Pisasale M, Moulin D, Schulz VN, Rico Pazo MA, Serrano JA, Andersen H, Henriksen HT, Mejholm I, Sjogren P, Heiskanen T, Kalso E, Pere P, Poyhia R, Vuorinen E, Tigerstedt I, Ruismaki P, Bertolino M, Larue F, Ranchere JY, Hege-Scheuing G, Bowdler I, Helbing F, Kostner E, Radbruch L, Kastrinaki K, Shah S, Vijayaram S, Sharma KS, Devi PS, Jain PN, Ramamani PV, Beny A, Brunelli C, Maltoni M, Mercadante S, Plancarte R, Schug S, Engstrand P, Ovalle AF, Wang X, Alves MF, Abrunhosa MR, Sun WZ, Zhang L, Gazizov A, Vaisman M, Rudoy S, Gomez Sancho M, Vila P, Trelis J, Chaudakshetrin P, Koh MLJ, Van Dongen RTM, Vielvoye-Kerkmeer A, Boswell MV, Elliott T, Hargus E, Lutz L. Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med 2004; 18:177-83. [PMID: 15198130 DOI: 10.1191/0269216304pm890oa] [Citation(s) in RCA: 219] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of BKP as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures. The observer-rated information included demographic and tumor-related data, the occurrence of BKP, and responses on checklists of pain syndromes and pathophysiologies. The clinicians reported BKP in 64.8% of patients. Physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes. Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed.
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Affiliation(s)
- Augusto Caraceni
- Neurology Unit-Pain Therapy and Palliative Care Unit, National Cancer Institute of Milan, Via Venezian 1, Milan, Italy.
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Tsalic M, Bar-Sela G, Beny A, Visel B, Haim N. Severe toxicity related to the 5-fluorouracil/leucovorin combination (the Mayo Clinic regimen): a prospective study in colorectal cancer patients. Am J Clin Oncol 2003; 26:103-6. [PMID: 12576935 DOI: 10.1097/01.coc.0000017526.55135.6d] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Mayo Clinic regimen of leucovorin 20 mg/m followed immediately by 5-fluorouracil 425 mg/m administered for 5 consecutive days every 4 weeks is commonly used in the treatment of colorectal cancer. This study was aimed at prospectively determining the incidence and pattern of severe toxicity associated with this regimen. We evaluated prospectively 243 patients with colorectal cancer treated in our department with the Mayo Clinic regimen for the incidence of severe toxicity (defined as toxicity requiring hospitalization). Of the 243 patients, 32 (13%) were hospitalized for chemotherapy-related toxicity. Major toxicities included neutropenic fever in 21 (9%), grade III/IV mucositis in 25 (10%) and grade III/IV diarrhea in 20 (8%). There were five (2%) treatment-related deaths. Female patients exhibited a higher incidence of severe toxicity (18%) and toxic death (4/105) than did male patients (9% and 1/138, respectively). Elderly patients (> or =70 years) had a higher incidence of severe toxicity than younger patients did (24% versus 7%, < 0.001). Toxic death occurred in 4 of 89 patients aged 70 years or more compared to 1 of 154 in younger patients. Most episodes of severe toxicity (56%) and toxic deaths (4/5) were observed after the first cycle. We conclude that the Mayo Clinic regimen can be associated with severe toxicity, usually occurring after the first cycle. Female gender and advanced age predict severe toxicity; therefore, dose reduction in high-risk patients should be considered, especially during the first cycle.
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Affiliation(s)
- Medy Tsalic
- Department of Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel of Technology, Haifa, Israel
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20
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Abstract
BACKGROUND Travelers may return from the tropics with psychological problems. The literature regarding features and associations of these psychological problems is limited. METHODS Case histories of 15 consecutive returning travelers seen at our psychiatric service during the last 8 years. RESULTS The median age of this group was 25 years, 10 were males, and the length of trip ranged from 10 days to 8.5 months. None of these travelers had prior psychopathology. The most common presentation was anxiety (with or without depression, n = 11), 3 suffered from acute psychosis, and 1 had pure depression. Eight of the travelers have used illicit drugs, which in 5 cases probably served as a trigger. Antimalarials may have played a role in 3 travelers. Six travelers needed antidepressants and supportive therapy, 3 neuroleptics, and 1 psychotherapy. These treatments lasted for 6 months and over in 6 of the travelers. CONCLUSION Psychiatric problems among travelers to the tropics are multifarious in nature, multifactorial, have a strong relation to drug abuse, and may require a long and intensive therapy. Travelers should be better educated about the risks of using illicit drugs.
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Affiliation(s)
- A Beny
- Psychiatric Service, Bnai Zion Medical Center, 47 Golomb St., Technion, Haifa 31048, Israel
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21
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Abstract
BACKGROUND Chemotherapy-induced diarrhea (CID) is a common side effect of a number of chemotherapeutic agents. Conventional therapy for severe CID with opioids or loperamide is moderately effective. A prospective trial was conducted using octreotide acetate for treatment of severe CID refractory to loperamide. PATIENTS AND METHODS Thirty-two patients with grade 2 and 3 CID refractory to loperamide were treated with octreotide at a dosage of 100 microg subcutaneously 3x/day for three days followed by 50 microg 3x/day for three days. Previous chemotherapy consisted of regimens containing fluorouracil, leucovorin, CPT-11, cyclophosphamide, methotrexate and cisplatin. Primary tumors were colorectal (n = 23), gastric (n = 3), and other cancers (n = 6). RESULTS Complete resolution of diarrhea was obtained in 30 of 32 patients (94%); 5 within 24 hours, 14 within 48 hours, and 11 within 72 hours of treatment. Nineteen patients were treated as outpatients. Thirteen were hospitalized for a median of three days. Response was unaffected by age, gender, performance status, previous chemotherapy or primary tumor site. No side effects related to octreotide were observed. CONCLUSIONS Octreotide 100 microg subcutaneously 3x/day for three days is an effective, safe treatment for CID given primarily or as a second-line therapy after loperamide failure.
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Affiliation(s)
- J Zidan
- Oncology Unit, Sieff Government Hospital, Safed, Israel.
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22
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Abstract
Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is an uncommon complication of treatment with the new class of antidepressant agents, the selective serotonin reuptake inhibitors (SSRIs). Most of the reported cases were associated with fluoxetine; only 2 have previously been described in association with citalopram. We describe an elderly woman who presented with severe symptomatic hyponatremia caused by the SIADH during therapy with citalopram. Because the use of SSRIs is becoming more popular among elderly depressed patients, the present case and the other 2 reported previously emphasize the need for greater awareness of the development of this serious and potentially fatal complication also in association with citalopram therapy and suggest that serum sodium levels should be monitored closely in elderly patients during treatment with citalopram.
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Affiliation(s)
- M Odeh
- Department of Internal Medicine B, Bnai Zion Medical Center, and Technion Faculty of Medicine, Israel Institute of Technology, Haifa
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23
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Abstract
BACKGROUND The prevalence and features of travel associated neuropsychiatric problems (NPP) and their relation to previous psychological consultations, antimalarials and recreational drug use have not been adequately studied. METHODS A two-phase postal and telephone survey has been conducted among 2,500 young travelers to tropical countries. We measured the rate and duration of NPP, characterized their features, and their association with previous psychological profiles, itinerary, type of travel, consumption of recreational drugs, and malaria prophylaxis. RESULTS First phase: Out of 1,340 respondents, 151 (11.3%) indicated that they had NPP during travel, in contrast with 2.3% who needed psychological consultation before travel (p<.001). Second phase: 117 of 151 responded to the study questionnaire. The mean age of the respondents was 24.4 years, 54.7% were female, and the mean stay abroad was 5.3 months. The most common NPP were sleeping disturbances (52.1%), fatigue (48.7%) and dizziness (39.3%). Thirty-three travelers (2.5%) had severe symptoms, and 16 (1.2%) had symptoms lasting more than 2 months. Seven travelers had pure or mixed depressive symptoms. Consumption of recreational drugs was admitted by 22.2%. Mefloquine was used significantly more often by those who suffered NPP, than by the entire cohort (98.2% vs. 70.7%; p<.001). CONCLUSIONS Long-term travel to the tropics was associated, in this cohort, with a considerable rate of neuropsychiatric symptoms. The majority of the responding travelers were females, used mefloquine as prophylaxis, and at least one fifth used recreational drugs.
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Affiliation(s)
- I Potasman
- Infectious Diseases Unit and Travel Clinic, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Abstract
With hopes of alleviating discomfort and improving the tolerance of patients undergoing endoscopy, we have assessed the influence of various background conditions in the endoscopy room. Two hundred twenty-one candidates for upper endoscopy were randomly allocated to four groups, each with one of the following conditions in the endoscopy room: background music and conversation related to the patient's complaints (n=50); background music and conversation unrelated to the patient (n=53); background music only, with the staff maintaining silence (n=49); and complete silence (n=47). Before endoscopy patients answered a 26-item questionnaire that included an evaluation of their degree of anxiety before the examination. Conscious sedation was induced by using 3 mg midazolam. After complete recovery from sedation, patients answered another set of questions. Patients in all four groups felt quite comfortable with the atmosphere in which gastroscopy was performed. Neither music, conversation, nor silence had a great effect on patients as far as improving tolerance or diminishing anxiety. Therefore, endoscopists and nurses may have a free hand in choosing the prevailing conditions during the examination. This conclusion may be valid for both patients and the staff involved in other invasive procedures performed under light sedation.
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Affiliation(s)
- E Stermer
- Department of Gastroenterology, Bnei Zion Medical Center, Haifa, Israel
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26
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Kopelman D, Beny A, Assalia A, Gaitini D, Klein Y, Hashmonai M. [Combined treatment of hepatic tumors by cryosurgery and resection: first results]. Harefuah 1998; 134:835-7, 920. [PMID: 10909652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Cryosurgery is an old technique which is being used for hepatic tumors as an adjuvant to hepatic resection. We recently treated 7 patients with multiple malignant liver tumors, 5 of whom had colorectal metastases, 1 carcinoid metastases, and 1 multiple hepatic lesions of hepatocellular carcinoma. 6 underwent combined liver resection and cryoablation of lesions in the remaining liver. In the 7th patient, only cryoablation was performed because hepatic resection was rejected and there was an extrahepatic metastasis. The advantages of this treatment are removal or destruction of all liver lesions found by any method, including intraoperative ultrasound examination, maximal preservation of normal liver parenchyma and that it is curative in patients inoperable by standard criteria.
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Affiliation(s)
- D Kopelman
- Dept. of Surgery B, Rambam Medical Center, Haifa
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Abstract
The etiology of hypercalcemia was investigated in a patient with primary isolated non-Hodgkin's lymphoma of the heart. There was no evidence of bone involvement, and parathyroid hormone and calciterol levels were suppressed. Plasma parathyroid-hormone-related protein (PTHrP 1-86) detected by immunoradiometric assay was increased (15 pmol/l compared with < 0.3 pmol/l in a control). We demonstrated that PTHrP was the humoral mediator of severe hypercalcemia in our patient.
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Affiliation(s)
- M Yigla
- Division of Pulmonary Diseases, Northern Israel Oncology of Center, Haifa, Israel
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Abstract
Neuroleptic malignant syndrome is a severe and potentially fatal reaction to neuroleptic drugs. Treatment requires withdrawal of the neuroleptic agent, metabolic and cardiovascular support, physical cooling and treatment with dantrolene sodium and bromcriptine mesylate. We report a therapeutic success of plasmapheresis in a case of neuroleptic malignant syndrome in which conventional therapy had failed. We postulate that plasmapheresis may prove to be a useful tool in treating this frequently fatal disease.
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Affiliation(s)
- L Gaitini
- Department of Anesthesiology, Bnai-Zion Medical Center, Haifa, Israel
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29
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Beny A, Mekori T, Cohen E, Halpern J, Rosenblat E, Kuten A, Robinson E. The pattern of NK cell activity in cancer patients following in vitro irradiation. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91842-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Meisels R, Beny A, Erdreich M, Podoshin L, Fradis M, Ben-David Y. [Psychological aspects of cochlear implantation]. Harefuah 1992; 122:485-7, 552. [PMID: 1398311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Psychological aspects of cochlear implantation were studied in 20 adults and children. Patients were interviewed before admission and were given tests and questionnaires to answer with regard to overall wellbeing, intellectual functioning, hopes and beliefs, expectations with regard to the implant and the support they were getting (last 2 also for a family member). Those who passed the screening were referred for surgery, and those who didn't were referred for therapy. 6 months after implantation the patient and the family member were again interviewed and answered questionnaires with regard to adjustment to the implant and the patient's satisfaction with it. In those who benefitted from the implant there were no psychopathological features, there was good cognitive functioning, a moderate level of concentration and attention span and a great degree of flexibility in personality traits. Crucial to better adjustment was quality of family support. Following cochlear implantation there was considerable improvement in life style.
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Affiliation(s)
- R Meisels
- Psychiatric Service, Bnai Zion Hospital, Haifa
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31
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Abstract
The object of this study was to investigate the assumption that a detailed explanation and description of gastroscopy to a patient reduces his fears of the procedure. In order to check this assumption, 243 consecutive patients who underwent elective gastroscopy were randomly distributed to 4 groups: Group A received a standard brief description of upper G-I endoscopy by the treating physician; Group B patients were given a detailed description by the endoscopist himself; Group C was given a comprehensive explanation and was shown an album of pictures illustrating each stage of the procedure; Group D saw a specially prepared video film of the procedure. A fifth group, E, consisted of patients who had previously undergone upper gastrointestinal endoscopy. Patient anxiety was measured using the "Spielberger State and Trait Anxiety Scales". According to the scoring on these scales there was no significant difference between the groups, thus showing that increasingly detailed description of the procedure did not diminish patients' fear. Neither did ethnic background or age have any significant influence on these results. Higher education had marginal influence on patients' apprehension about the procedure. However, female patients had significantly higher anxiety state and trait anxiety scoring than men. If endoscopy can be taken as typically representative of all invasive procedures, these results may have a much more general application.
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Affiliation(s)
- N Levy
- Gastroenterological Service, Bnei Zion Medical Center, Haifa, Israel
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