618 research outputs found
Deelt u deze persoonsgegevens niet!?:Een reflectie op het al dan niet opzijzetten van het Toestemmingsvereiste om gegevens te kunnen delen.
Informal caregivers’ views on the division of responsibilities between themselves and professionals:A scoping review
Informal caregivers’ judgements on sharing care with home care professionals from an intersectional perspective: the influence of personal and situational characteristics
Report on short-term side effects of treatments with 177Lu- octreotate in combination with capecitabine in seven patients with gastroenteropancreatic neuroendocrine tumours
Purpose: Treatment with the radiolabelled somatostatin analogue177Lu-octreotate results in tumour remission in 47% of patients with gastroenteropancreatic neuroendocrine tumours. Adding capecitabine to177Lu-octreotate, as a radio-sensitiser, may enhance these anti-tumour effects. We now present the short-term toxicity profile of this novel combination. Methods: Seven patients were treated with 7.4 GBq177Lu-octreotate and capecitabine (1650 mg/m2per day) for 2 weeks with an intended number of four cycles. Toxicity, and especially haematological and renal parameters, were monitored on a weekly basis for the first two cycles and 4 and 6 weeks after subsequent cycles. Results: None of the patients had hand-foot syndrome. One patient had grade 1 stomatitis occurring after one of four cycles. Grade 3 or 4 leukopenia or neutropenia did not occur. One patient had grade 3 anaemia, but none had grade 4 anaemia. One patient had grade 2 thrombocytopenia after the fourth cycle, and one had grade 3 thrombocytopenia. Grade 4 thrombocytopenia did not occur. No significant changes in serum creatinine levels were observed. None of the patients had symptoms of cardiac ischaemia. Conclusions: Treatment with the combination of177Lu-octreotate and capecitabine was feasible and safe considering acute and subacute side effects. We therefore started a randomised, controlled clinical trial to compare this combination with177Lu-octreotate as single agent with regard to anti-tumour effects and side effects
Епоха "пост": людина в перспективі "нової духовності"
Розглянуто основні проблеми сучасного суспільства, пов’язані із антропологічною кризою, кардинальними змінами у темпоральності, способі буття людини. Проаналізовано ситуацію заміни попередніх гуманістичних ціннісних систем на більш “технізовані”, що призводить до виникнення нового типу людини – “постлюдини”. Посилюється вплив на людей “світу віртуальної реальності”. Нове штучне середовище “сканує”, приймає лише інформаційний аспект людини, вводячи її як цілісну істоту в стан кризи. Доведено актуальність відповідей на смислові запитання епохи, пов’язані із світоглядом, духовністю та цінностями.The main problems of modern society, related to the anthropological crisis, fundamental changes in temporality, ways of human being are considered. There is an analysis of situation of replacing the previous humanistic value systems on a more “technicized”, which causes a new type of man – “posthuman”. The impact on “the world of virtual reality” people is growing. New artifi cial environment “scans”, takes only informational aspect of human, introducing it as complete being in a state of crisis. The urgency of responses to semantic question of the epoch, related to the outlook, spirituality and values is justifi ed
Peptide receptor radionuclide therapy
Peptide receptor radionuclide therapy is a new treatment modality for patients with inoperable or metastasised neuroendocrine gastroenteropancreatic tumours. After the successful implementation of somatostatin receptor scintigraphy in daily clinical practice, the next logical step was to increase the radiation dose of the administered radiolabelled somatostatin analogue in an attempt to induce tumour shrinkage. Since then, an increasing number of patients has been successfully treated with this approach, resulting in a substantial numbers of patient with objective tumour shrinkage. Serious side-effects have been rare. This article reviews the effectiveness of the different radiolabelled somatostatin analogues used, the currently known side-effects and the survival data available. Furthermore, clinical issues, including indication and timing of therapy, are discussed. Finally, important directions for future research are briefly mentioned to illustrate that, although the currently available results already suggest a favourable outcome compared with other systemic therapies, new strategies are being developed to increase efficacy
Hormonal crises following receptor radionuclide therapy with the radiolabeled somatostatin analogue [177Lu-DOTA0,Tyr3]octreotate
textabstractIntroduction: Receptor radionuclide therapy is a promising treatment modality for patients with neuroendocrine tumors for whom alternative treatments are limited. The aim of this study was to investigate the incidence of hormonal crises after therapy with the radiolabeled somatostatin analogue [177Lu-DOTA0,Tyr3]octreotate (177Lu-octreotate). Materials and methods: All177Lu- octreotate treatments between January 2000 and January 2007 were investigated. Four hundred seventy-six patients with gastroenteropancreatic neuroendocrine tumors and three patients with metastatic pheochromocytoma were included for analysis. Results: Four hundred seventy-nine patients received a total of 1,693 administrations of177Lu-octreotate. Six of 479 patients (1%) developed severe symptoms because of massive release of bioactive substances after the first cycle of177Lu-octreotate. One patient had a metastatic hormone-producing small intestinal carcinoid; two patients had metastatic, hormone-producing bronchial carcinoids; two patients had vasoactive intestinal polypeptide-producing pancreatic endocrine tumors (VIPomas); and one patient had a metastatic pheochromocytoma. With adequate treatment, all patients eventually recovered. Conclusion: Hormonal crises after177Lu- octreotate therapy occur in 1% of patients. Generally,177Lu- octreotate therapy is well tolerated
Lutetium-labelled peptides for therapy of neuroendocrine tumours
Treatment with radiolabelled somatostatin analogues is a promising new tool in the management of patients with inoperable or metastasized neuroendocrine tumours. Symptomatic improvement may occur with 177Lu-labelled somatostatin analogues that have been used for peptide receptor radionuclide therapy (PRRT). The results obtained with 177Lu-[DOTA0,Tyr3]octreotate (DOTATATE) are very encouraging in terms of tumour regression. Dosimetry studies with 177Lu-DOTATATE as well as the limited side effects with additional cycles of 177Lu-DOTATATE suggest that more cycles of 177Lu-DOTATATE can be safely given. Also, if kidney-protective agents are used, the side effects of this therapy are few and mild and less than those from the use of 90Y-[DOTA0,Tyr3]octreotide (DOTATOC). Besides objective tumour responses, the median progression-free survival is more than 40 months. The patients' self-assessed quality of life increases significantly after treatment with 177Lu-DOTATATE. Lastly, compared to historical controls, there is a benefit in overall survival of several years from the time of diagnosis in patients treated with 177Lu-DOTATATE. These findings compare favourably with the limited number of alternative therapeutic approaches. If more widespread use of PRRT can be guaranteed, such therapy may well become the therapy of first choice in patients with metastasized or inoperable neuroendocrine tumours
Differences in anti-inflammatory actions of intravenous immunoglobulin between mice and men: More than meets the eye
Intravenous immunoglobulin (IVIg) is a therapeutic preparation of polyspecific human
IgGs purified from plasma pooled from thousands of individuals. When administered
at a high dose, IVIg inhibits inflammation and has proven efficacy in the treatment of
various autoimmune and systemic inflammatory diseases. Importantly, IVIg therapy can
ameliorate both auto-antibody-mediated and T-cell mediated immune pathologies. In
the last few decades, extensive research in murine disease models has resulted in
the elucidation of two novel anti-inflammatory mechanisms-of-action of IVIg: induction
of FcγRIIB expression by sialylated Fc, and stimulation of regulatory T cells. Whereas
controversial findings in mice studies have recently inspired intense scientific debate
regarding the validity of the sialylated Fc-FcγRIIB model, the most fundamental question
is whether these anti-inflammatory mechanisms of IVIg are operational in humans treated
with IVIg. In this review, we examine the evidence for the involvement of these antiinflammatory mechanisms in the therapeutic effects of IVIg in humans. We demonstrate
that although several elements of both immune-modulatory pathways of IVIg are activated
in humans, incorrect extrapolations from mice to men have been made on the molecular
and cellular components involved in these cascades that warrant for critical re-evaluation
of these anti-inflammatory mechanisms of IVIg in humans
Chromogranin A as serum marker for neuroendocrine neoplasia: comparison with neuron-specific enolase and the alpha-subunit of glycoprotein hormones
Chromogranin A (CgA) is gaining acceptance as a serum marker of
neuroendocrine tumors. Its specificity in differentiating between
neuroendocrine and nonneuroendocrine tumors, its sensitivity to detect
small tumors, and its clinical value, compared with other neuroendocrine
markers, have not clearly been defined, however. The objectives of this
study were to evaluate the clinical usefulness of CgA as neuroendocrine
serum marker. Serum levels of CgA, neuron-specific enolase (NSE), and the
alpha-subunit of glycoprotein hormones (alpha-SU) were determined in 211
patients with neuroendocrine tumors and 180 control subjects with
nonendocrine tumors. The concentrations of CgA, NSE, and alpha-SU were
elevated in 50%, 43%, and 24% of patients with neuroendocrine tumors,
respectively. Serum CgA was most frequently increased in subjects with
gastrinomas (100%), pheochromocytomas (89%), carcinoid tumors (80%),
nonfunctioning tumors of the endocrine pancreas (69%), and medullary
thyroid carcinomas (50%). The highest levels were observed in subjects
with carcinoid tumors. NSE was most frequently elevated in patients with
small cell lung carcinoma (74%), and alpha-SU was most frequently elevated
in patients with carcinoid tumors (39%). Most subjects with elevated
alpha-SU levels also had elevated CgA concentrations. A significant
positive relationship was demonstrated between the tumor load and serum
CgA levels (P < 0.01, by chi 2 test). Elevated concentrations of CgA, NSE,
and alpha-SU were present in, respectively, 7%, 35%, and 15% of control
subjects. Markedly elevated serum levels of CgA, exceeding 300
micrograms/L, were observed in only 2% of control patients (n = 3)
compared to 40% of patients with neuroendocrine tumors (n = 76). We
conclude that CgA is the best general neuroendocrine serum marker
available. It has the highest specificity for the detection of
neuroendocrine tumors compared to the other neuroendocrine markers, NSE
and alpha-SU. Elevated levels are strongly correlated with tumor volume;
therefore, small tumors may go undetected. Although its specificity cannot
compete with that of the specific hormonal secretion products of most
neuroendocrine tumors, it can have useful clinical applications in
subjects with neuroendocrine tumors for whom either no marker is available
or the marker is inconvenient for routine clinical use
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