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Chau I, Park JO, Ryoo BY, Yen CJ, Poon R, Pastorelli D, Blanc JF, Kudo M, Pfiffer T, Hatano E, Chung HC, Kopeckova K, Phelip JM, Brandi G, Ohkawa S, Li CP, Okusaka T, Hsu Y, Abada PB, Zhu AX. Alpha-fetoprotein kinetics in patients with hepatocellular carcinoma receiving ramucirumab or placebo: an analysis of the phase 3 REACH study. Br J Cancer 2018; 119:19-26. [PMID: 29808014 PMCID: PMC6035236 DOI: 10.1038/s41416-018-0103-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/04/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Post-hoc analyses of AFP response and progression and their relationship with objective measures of response and survival were performed in patients from REACH. METHODS Serum AFP was measured at baseline and every 3 cycles (2 weeks/cycle). Associations between AFP and radiographic progression and efficacy end points were analysed. RESULTS Median percent AFP increase from baseline was smaller in the ramucirumab than in the placebo arm throughout treatment. Time to AFP progression (HR 0.621; P < 0.0001) and to radiographic progression (HR 0.613; P < 0.0001) favoured ramucirumab. Association between AFP and radiographic progression was shown at 6 (OR 6.44, 95% CI 4.03, 10.29; P < 0.0001) and 12 weeks (OR 2.28, 95% CI 1.47, 3.53; P = 0.0002). AFP response was higher with ramucirumab compared with placebo (P < 0.0001). More patients in the ramucirumab arm experienced tumour shrinkage and AFP response compared with placebo. Survival was longer in patients with AFP response (13.6 months) than in patients without (6.2 months), irrespective of treatment (HR 0.457, P < 0.0001). CONCLUSIONS Treatment with ramucirumab prolonged time to AFP progression, slowed AFP increase and was more likely to induce AFP response. Similar benefits in radiographic progression and response correlated with AFP changes.
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Affiliation(s)
- Ian Chau
- Department of Medicine, Royal Marsden Hospital, Sutton, Surrey, SM2 5PT, UK.
| | - Joon Oh Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Chia-Jui Yen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan
| | - Ronnie Poon
- Departmentof Surgery, The University of Hong Kong, Pokfulam, Hong Kong
| | - Davide Pastorelli
- Department of Oncology, Santa Maria del Prato Hospital, Feltre (Belluno), 32032, Italy
| | - Jean-Frédéric Blanc
- Department of Hepato-Gastroenterology and Medical Oncology, CHU de Bordeaux, Hôpital Haut-Lévêque, 33604, Pessac, France
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, 589-8511, Japan
| | - Tulio Pfiffer
- Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, 01246-000, Brazil
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Hyun Cheol Chung
- Department of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Katerina Kopeckova
- Department of Oncology, University Hospital Motol, 2nd Faculty of Medicine of Charles University, 150 00, Praha, Czech Republic
| | - Jean-Marc Phelip
- Department of Gastroenterology and Digestive Oncology, University Hospital of St Etienne, 42100, Saint Etienne, France
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, University Hospital S. Orsola, 40138, Bologna, Italy
| | - Shinichi Ohkawa
- Division of Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, Yokohama, 241-0815, Japan
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
- National Yang-Ming University School of Medicine, Taipei, 112, Taiwan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, 104-0045, Japan
| | - Yanzhi Hsu
- Eli Lilly and Company, New York, NY, 10016, USA
| | | | - Andrew X Zhu
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, 02114, USA
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Branco F, Alencar RSM, Volt F, Sartori G, Dode A, Kikuchi L, Tani CM, Chagas AL, Pfiffer T, Hoff P, Carrilho FJ, Mattos AA. The Impact of Early Dermatologic Events in the Survival of Patients with Hepatocellular Carcinoma Treated with Sorafenib. Ann Hepatol 2017; 16:263-268. [PMID: 28233750 DOI: 10.5604/16652681.1231585] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The presence of dermatologic reaction as an adverse event to sorafenib treatment in patients with unresectable hepatocellular carcinoma has been indicated as a prognostic factor for survival in a recent prospective analysis. To date, this is the only clinical predictor of treatment response, which can be evaluated earlier in the treatment and, therefore, contribute to a better and more individualized patient management. MATERIAL AND METHODS This retrospective study included 127 patients treated with sorafenib under real-life practice conditions in two hepatology reference centers in Brazil. Demographic data, disease/medical history and time of sorafenib administration as well as adverse events related to the medication were recorded in a database. RESULTS Cirrhosis was present in 94% of patients, 85.6% were Child-Pugh A, 80.3%BCLC-C, 81% had vascular invasion and/or extrahepatic spread and 95% had a performance status 0 to 1.The median duration of treatment was 10.1 months (range: 0.1-47 months).The most common adverse event within the first 60 days of treatment were diarrhea (62.2%) and dermatological reaction (42%).The median overall survival for the cohort was 20 months, and it was higher for patients who developed dermatological reactions within the first 60 days compared to those who did not present this adverse event. CONCLUSION This retrospective analysis showed the use of sorafenib in patients selected according to BCLC staging, and it is the first external validation of early dermatologic adverse events as a predictor of overall survival in patients with advanced hepatocellular carcinoma.
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Affiliation(s)
- Fernanda Branco
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Regiane S M Alencar
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Fernanda Volt
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Giovana Sartori
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Andressa Dode
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Luciana Kikuchi
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Claudia M Tani
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Aline L Chagas
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Tulio Pfiffer
- Oncology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Paulo Hoff
- Oncology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flair J Carrilho
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Angelo A Mattos
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
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Shriver A, Rudnick S, Intagliata N, Wang A, Caldwell SH, Northup P, Tani CM, Chagas AL, Pfiffer T, Hoff P, Carrilho FJ, Alves de Mattos A. A Randomized Controlled Trial of Procedural Techniques for Large Volume Paracentesis. Ann Hepatol 2017; 16:279-284. [PMID: 28233752 DOI: 10.5604/16652681.1231587] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study is to investigate large volume therapeutic paracentesis using either a z-tract or axial (coxial) technique in a randomized controlled trial. MATERIALS AND METHODS In this randomized, single blind study, patients with cirrhosis undergoing outpatient therapeutic paracentesis were randomized to the z-tract or the modified angular (coaxial) needle insertion technique. Subject and procedure characteristics were compared between the groups with ascites leakage as quantified by need for dressing changes with standardized sized gauze pads as a primary endpoint and subject procedural discomfort, operator preference, and procedure complications as secondary endpoints. RESULTS 72 paracenteses were performed during the study period: 34 to the z-tract and 38 to the coaxial insertion technique. Following exclusions, a total of 61 paracenteses were analyzed: 30 using the z-tract technique and 31 using the coaxial technique. There were equal rates of post-procedural leakage of ascites between groups (13% in both groups, p = 1.00). Using the visual analog scale (0 - 100), there was a statistically significant increase in the subject reported pain score with the z-tract compared with the coaxial method [26.4 (95% CI 18.7 - 34.1) vs. 17.2 (95% CI 10.6 - 23.8), p = 0.04]. Mean physician rated procedure difficulty (1 - 5) was significantly higher for the z-tract versus the coaxial technique [2.1 (95% CI 1.6 - 2.6) vs. 1.5 (95% CI 1.2 - 1.8), p = 0.04]. CONCLUSION When compared to the z-tract technique, the coaxial insertion technique is superior during large volume paracentesis in cirrhosis patients.
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Affiliation(s)
- Amy Shriver
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Sean Rudnick
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Nicolas Intagliata
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Amanda Wang
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stephen H Caldwell
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Patrick Northup
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
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Riechelmann R, Coutinho AK, Weschenfelder RF, Andrade DE Paulo G, Fernandes GDS, Gifoni M, Oliveira MDL, Gansl R, Gil R, Luersen G, Lucas L, Reisner M, Vieira FM, Machado MA, Murad A, Osvaldt A, Brandão M, Carvalho E, Souza T, Pfiffer T, Prolla G. GUIDELINE FOR THE MANAGEMENT OF BILE DUCT CANCERS BY THE BRAZILIAN GASTROINTESTINAL TUMOR GROUP. Arq Gastroenterol 2017; 53:5-9. [PMID: 27276097 DOI: 10.1590/s0004-28032016000100003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
The Brazilian Gastrointestinal Tumor Group developed guidelines for the surgical and clinical management of patients with billiary cancers. The multidisciplinary panel was composed of experts in the field of radiology, medical oncology, surgical oncology, radiotherapy, endoscopy and pathology. The panel utilized the most recent literature to develop a series of evidence-based recommendations on different treatment and diagnostic strategies for cholangiocarcinomas and gallbladder cancers.
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Affiliation(s)
- Rachel Riechelmann
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil, Instituto do Câncer do Estado de São Paulo, São Paulo SP , Brasil.,Hospital Sírio Libanês, São Paulo, SP, Brasil, Hospital Sírio-Libanês, Hospital Sírio Libanês, São Paulo SP , Brazil
| | | | - Rui F Weschenfelder
- Hospital Moinhos de Vento, Porto Alegre, RS, Brasil, Hospital Moinhos de Vento, Hospital Moinhos de Vento, Porto Alegre RS , Brazil
| | - Gustavo Andrade DE Paulo
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil, Instituto do Câncer do Estado de São Paulo, São Paulo SP , Brasil
| | - Gustavo Dos Santos Fernandes
- Oncologia, Hospital Sírio Libanês, Brasília, DF, Brasil, Hospital Sírio-Libanês, Hospital Sírio Libanês, Brasília DF , Brazil
| | - Markus Gifoni
- Clínica Fujiday Oncologia, Fortaleza, CE, Brasil, Clínica Fujiday Oncologia, Fortaleza CE , Brasil
| | | | - Rene Gansl
- Centro Paulista de Oncologia, São Paulo, SP, Brasil, Centro Paulista de Oncologia, São Paulo SP , Brasil
| | - Roberto Gil
- Instituto Nacional do Câncer, Rio de Janeiro, RJ, Brasil, Instituto Nacional do Câncer, Instituto Nacional do Câncer, Rio de Janeiro RJ , Brazil
| | - Gustavo Luersen
- Hospital Moinhos de Vento, Porto Alegre, RS, Brasil, Hospital Moinhos de Vento, Hospital Moinhos de Vento, Porto Alegre RS , Brazil
| | - Lucio Lucas
- Hospital de Base, Brasília, DF, Brasil, Hospital de Base, Brasília DF , Brasil
| | - Marcio Reisner
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil, Universidade Federal do Rio de Janeiro, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ , Brazil
| | - Fernando Meton Vieira
- Instituto COI de Pesquisa, Educação e Gestão, Rio de Janeiro, RJ, Brasil, Instituto COI de Pesquisa, Educação e Gestão, Rio de Janeiro RJ , Brasil
| | - Marcel Autran Machado
- Hospital Sírio Libanês, São Paulo, SP, Brasil, Hospital Sírio-Libanês, Hospital Sírio Libanês, São Paulo SP , Brazil
| | - Andre Murad
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil, Universidade Federal de Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte MG , Brazil
| | - Alessandro Osvaldt
- Hospital de Clínicas, Porto Alegre, RS, Brasil, Hospital de Clínicas, Porto Alegre RS , Brasil
| | - Miguel Brandão
- Clínica AMO, Salvador, BA, Brasil, Clínica AMO, Salvador BA , Brasil
| | - Elisangela Carvalho
- Hospital Português, Salvador, BA, Brasil, Hospital Português, Hospital Português, Salvador BA , Brazil
| | - Tulio Souza
- Hospital Aliança, Salvador, BA, Brasil, Hospital Aliança, Salvador BA , Brasil
| | - Tulio Pfiffer
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil, Instituto do Câncer do Estado de São Paulo, São Paulo SP , Brasil
| | - Gabriel Prolla
- Hospital Mãe de Deus, Porto Alegre, RS, Brasil, Hospital Mãe de Deus, Hospital Mãe de Deus, Porto Alegre RS , Brazil
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5
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Riechelmann RP, Weschenfelder RF, Costa FP, Andrade AC, Osvaldt AB, Quidute ARP, Dos Santos A, Hoff AAO, Gumz B, Buchpiguel C, Vilhena Pereira BS, Lourenço Junior DM, da Rocha Filho DR, Fonseca EA, Riello Mello EL, Makdissi FF, Waechter FL, Carnevale FC, Coura-Filho GB, de Paulo GA, Girotto GC, Neto JEB, Glasberg J, Casali-da-Rocha JC, Rego JFM, de Meirelles LR, Hajjar L, Menezes M, Bronstein MD, Sapienza MT, Fragoso MCBV, Pereira MAA, Barros M, Forones NM, do Amaral PCG, de Medeiros RSS, Araujo RLC, Bezerra ROF, Peixoto RD, Aguiar S, Ribeiro U, Pfiffer T, Hoff PM, Coutinho AK. Guidelines for the management of neuroendocrine tumours by the Brazilian gastrointestinal tumour group. Ecancermedicalscience 2017; 11:716. [PMID: 28194228 PMCID: PMC5295846 DOI: 10.3332/ecancer.2017.716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 11/09/2016] [Indexed: 12/13/2022] Open
Abstract
Neuroendocrine tumours are a heterogeneous group of diseases with a significant variety of diagnostic tests and treatment modalities. Guidelines were developed by North American and European groups to recommend their best management. However, local particularities and relativisms found worldwide led us to create Brazilian guidelines. Our consensus considered the best feasible strategies in an environment involving more limited resources. We believe that our recommendations may be extended to other countries with similar economic standards.
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Affiliation(s)
- Rachel P Riechelmann
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | | | | | | | - Alessandro Bersch Osvaldt
- Hospital Moinhos de Vento de Porto Alegre, Porto Alegre 90035-000, Brasil; Departamento de Cirurgia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90040-060, Brasil; Hospital de Clinicas de Porto Alegre, Porto Alegre 90035-903, Brasil
| | - Ana Rosa P Quidute
- Departamento de Fisiologia e Farmacologia da Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza 60020-180, Brasil; Hospital Universitário Walter Cantidio, Ceará 60430-370, Brasil
| | | | - Ana Amélia O Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - Brenda Gumz
- Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - Carlos Buchpiguel
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | | | - Delmar Muniz Lourenço Junior
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | | | - Eduardo Antunes Fonseca
- Hospital Sírio-Libanês, São Paulo 01308-050, Brasil; Department of Surgery, AC Camargo Cancer Centre, São Paulo 01509-010, Brasil
| | | | - Fabio Ferrari Makdissi
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Fabio Luiz Waechter
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Brasil
| | - Francisco Cesar Carnevale
- Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - George B Coura-Filho
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil
| | - Gustavo Andrade de Paulo
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Albert Einstein, São Paulo 05652-900, Brasil
| | - Gustavo Colagiovanni Girotto
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto, São Paulo 15090-000, Brasil; Santa Casa de São José do Rio Preto, São José do Rio Preto 15025-500, Brasil
| | - João Evangelista Bezerra Neto
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - João Glasberg
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil
| | | | | | | | - Ludhmila Hajjar
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Instituto do Coração, Universidade de São Paulo, São Paulo 05403-900, Brasil
| | - Marcos Menezes
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - Marcello D Bronstein
- Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | - Marcelo Tatit Sapienza
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | - Maria Candida Barisson Villares Fragoso
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil
| | | | - Milton Barros
- Medical Oncology, AC Camargo Cancer Centre, São Paulo 01509-010, Brasil
| | - Nora Manoukian Forones
- Disciplina de Gastroenterologia, Universidade Federal de São Paulo, São Paulo 04021-001, Brasil
| | | | | | - Raphael L C Araujo
- Departamento de Cirurgia do Aparelho Digestivo Alto e Hepato-Bilio-Pancreática, Hospital de Câncer de Barretos, São Paulo 14784-400, Brasil
| | | | - Renata D'Alpino Peixoto
- Hospital São José, São Paulo 01323-001, Brasil; Universidade Nove de Julho, São Paulo 02111-030, Brasil
| | - Samuel Aguiar
- Medical Oncology, AC Camargo Cancer Centre, São Paulo 01509-010, Brasil
| | - Ulysses Ribeiro
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Tulio Pfiffer
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
| | - Paulo M Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo 01246-000, Brasil; Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil; Hospital Sírio-Libanês, São Paulo 01308-050, Brasil
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6
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Baeßler K, Aigmüller T, Albrich S, Anthuber C, Finas D, Fink T, Fünfgeld C, Gabriel B, Henscher U, Hetzer FH, Hübner M, Junginger B, Jundt K, Kropshofer S, Kuhn A, Logé L, Nauman G, Peschers U, Pfiffer T, Schwandner O, Strauss A, Tunn R, Viereck V. Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016). Geburtshilfe Frauenheilkd 2016; 76:1287-1301. [PMID: 28042167 PMCID: PMC5193153 DOI: 10.1055/s-0042-119648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/22/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
Abstract
Aims: The aim was to establish an official interdisciplinary guideline, published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). The guideline was developed for use in German-speaking countries. In addition to the Germany Society of Gynecology and Obstetrics, the guideline has also been approved by the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). This is a guideline published and coordinated by the DGGG. The aim is to provide evidence-based recommendations obtained by evaluating the relevant literature for the diagnostic, conservative and surgical treatment of women with female pelvic organ prolapse with or without stress incontinence. Methods: We conducted a systematic review together with a synthesis of data and meta-analyses, where feasible. MEDLINE, Embase, Cinahl, Pedro and the Cochrane Register were searched for relevant articles. Reference lists were hand-searched, as were the abstracts of the Annual Meetings of the International Continence Society and the International Urogynecological Association. We included only abstracts of randomized controlled trials that were presented and discussed in podium sessions. We assessed original data on surgical procedures published since 2008 with a minimum follow-up time of at least 12 months. If the studies included descriptions of perioperative complications, this minimum follow-up period did not apply. Recommendations: The guideline encompasses recommendations for the diagnosis and treatment of female pelvic organ prolapse. Recommendations for anterior, posterior and apical pelvic organ prolapse with or without concomitant stress urinary incontinence, uterine preservation options, and the pros and cons of mesh placements during surgery for pelvic organ prolapse are presented. The recommendations are based on an extensive and systematic review and evaluation of the current literature and include the experiences and specific conditions in Germany, Austria and Switzerland.
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Affiliation(s)
- K. Baeßler
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - T. Aigmüller
- Universitätsklinik für Gynäkologie und Geburtshilfe, Med Uni Graz, Austria
| | - S. Albrich
- Praxis “Frauenärzte Fünf Höfe” München, München, Germany
| | | | - D. Finas
- Evangelisches Krankenhaus Bielefeld EvKB, Bielefeld, Germany
| | - T. Fink
- Sana Klinikum Berlin Lichtenberg, Berlin, Germany
| | | | - B. Gabriel
- St. Josefʼs Hospital Wiesbaden, Wiesbaden, Germany
| | - U. Henscher
- Praxis für Physiotherapie, Hannover, Germany
| | | | - M. Hübner
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - B. Junginger
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - K. Jundt
- Frauenarztpraxis am Pasinger Bahnhof, München, Germany
| | | | - A. Kuhn
- Inselspital Bern, Bern, Switzerland
| | - L. Logé
- Sana Klinikum Hof GmbH, Hof, Germany
| | - G. Nauman
- Helios Klinikum Erfurt, Erfurt, Germany
| | | | - T. Pfiffer
- Asklepios Klinik Hamburg Harburg, Hamburg, Germany
| | | | - A. Strauss
- Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - R. Tunn
- St. Hedwig Krankenhaus, Berlin, Germany
| | - V. Viereck
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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Guaraldo L, Chagas DA, Konno AC, Korn GP, Pfiffer T, Nasello AG. Hydroalcoholic extract and fractions of Davilla rugosa Poiret: effects on spontaneous motor activity and elevated plus-maze behavior. J Ethnopharmacol 2000; 72:61-67. [PMID: 10967455 DOI: 10.1016/s0378-8741(00)00198-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Davilla rugosa Poiret is commonly used in Brazilian folk medicine. The use as stimulant induced us to study the effects on motor activity and anxiety using an open-field and an elevated plus-maze, respectively. The hydroalcoholic extract of the stems (HE) was fractionated with chloroform (CF), chloroform/ethyl acetate (CAF), ethyl acetate (AF), ethyl acetate/ethanol (AEF), ethanol (EF) and ethanol/water (EWF). Rats were treated orally with HE (7.5, 15, 30 or 60 mg/kg) or fractions (15 mg/kg). In the open-field, HE (15 mg/kg), AEF, EF and EWF increased locomotion frequency and decreased immobility time; the contrary was observed with 30 and 60 mg/kg of HE. These doses also increased defecation. No effects were observed with 7.5 mg/kg of HE, CF, CAF or AF, except for an increase in defecation induced by AF. In the elevated plus-maze, total entries and number of entries into the open and closed arms and the time spent in the open arms and its percentage were increased only with 15 mg/kg of HE. The open-field results suggest that the drug increases motor activity (stimulant effect) and that the active components are in the three more polar fractions. An anxiolytic effect was observed only with the HE.
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Affiliation(s)
- L Guaraldo
- Departamento de Ciências Fisiológicas, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Jr., 61 Santa Cecília, 01277-900 São Paulo SP, Brazil.
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