91 research outputs found
Vinblastine, bleomycin, and methotrexate chemotherapy plus irradiation for patients with early-stage, favorable Hodgkin lymphoma - The experience of the gruppo italiano studio linfomi
BACKGROUND. The acknowledged effectiveness of vinblastine, bleomycin, and methotrexate (VBM) chemotherapy in patients with early-stage Hodgkin lymphoma has been associated with conflicting toxicity reports. METHODS. One hundred forty-three patients were evaluated clinically and had favorable Stage IA or IIA Hodgkin lymphoma. Ninety-three patients were treated with the standard VBM schedule combined with extended-field radiotherapy (EFRT), leaving the choice of the therapeutic sequence free. Fifty subsequent patients were treated with a slightly modified VBM schedule (VbMp) combined with RT limited to involved fields (IF-RT) and delivered only after the end of chemotherapy. In the VbMp schedule, intervals between cycles were 21 days instead of 28 days, bleomycin doses were reduced, small doses of prednisone were given orally, and the interval before RT was prolonged. RESULTS. Clinical response was complete in 96% of patients who were treated with VBM plus EF-RT and in 94% of patients who were treated with VbMp plus IF-RT. Recurrence rates were nearly identical (12% and 11%, respectively) over necessarily different follow-up (91 months and 33 months, respectively). Hematologic toxicity was tolerable in both trials, and pulmonary side effects were moderate in the first trial and negligible in the second. On the whole, treatment was tolerated better when RT followed chemotherapy. CONCLUSIONS. The VBM regimen was confirmed to be effective in patients with early-stage Hodgkin lymphoma. Administration of all cycles before RT improved tolerance; pulmonary toxicity probably is mitigated further by reduced bleomycin doses, mild prednisone therapy, and a more prolonged resting interval before RT. A slightly higher recurrence rate was expectable in the VBM plus IF-RT trial despite the actual intensification of vinblastine and methotrexate
ΠΠΎΠ»Π³ΠΎΡΡΠΎΡΠ½ΠΎΠ΅ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ ΠΏΠΎΡΠ»Π΅ Π»Π΅ΡΠ΅Π½ΠΈΡ Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΎΠ΄Π½ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎΠ΅ ΠΎΠ±ΡΠ΅ΡΠ²Π°ΡΠΈΠΎΠ½Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅)
Patients may experience long-term physical, psychological and cognitive impairment after intensive care unit (ICU) discharge, a condition commonly described as post-intensive care syndrome. The relative contribution of each of these components to long-term quality of life was never investigated.The aim of this study is to identify the type and severity of disability and QoL at the discharge from ICU and up to following 6 months.Material and Methods. All patients (n=218) discharged from a university hospital ICU between April 2016 and July 2017 were eligible. Exclusion criteria included: age <18 years, brain or spinal injury, life expectancy <90 days, and ICU stay <12 hours. The Short Form Health Survey (SF-36), and 5-level EuroQoL-5D (EQ-5D-5L) questionnaires were administered at ICU discharge, and at 30-, 90- and 180-days. We compared patients requiring short-term ICU monitoring (IM, Intensive Monitoring, n=109) or patients requiring ICU treatment (IT, Intensive Treatment, n=109).Results. All dimensions of SF-36 and EQ-5D-5L parameters increased from ICU discharge to 180-days, except for the SF-36 Synthetic index linked to mental health (P=0.08). All EQ-5D-5L parameters improved significantly in the IT group, while only Visual Analog Scale Health Perception improved in the IM group.Conclusion. ICU survivors suffer long-term physical and psychological sequelae. The perception of Quality of Life is reduced after ICU discharge. The psychological and cognitive dimensions were more compromised than physical ones. Patients discharged from the ICU may benefit from specific intensive care follow-up clinics addressing their needs in term of psychological and cognitive support.ΠΠΎΡΠ»Π΅ Π²ΡΠΏΠΈΡΠΊΠΈ ΠΈΠ· ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΌΠΎΠΆΠ΅Ρ ΡΠ°Π·Π²ΠΈΠ²Π°ΡΡΡΡ Β«ΡΠΈΠ½Π΄ΡΠΎΠΌ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠΉ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈΒ», Π²ΠΊΠ»ΡΡΠ°ΡΡΠΈΠΉ Π΄ΠΎΠ»Π³ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅, ΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΡΠ΅ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ. ΠΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π²ΠΊΠ»Π°Π΄ Π΄Π°Π½Π½ΡΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ Π² Π΄ΠΎΠ»Π³ΠΎΡΡΠΎΡΠ½ΠΎΠ΅ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π½Π΅ ΠΈΠ·ΡΡΠ΅Π½.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ ΡΠΈΠΏ ΠΈ ΡΡΠ΅ΠΏΠ΅Π½Ρ ΡΡΠΆΠ΅ΡΡΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ
ΡΠ°ΡΡΡΡΠΎΠΉΡΡΠ² ΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ ΠΏΡΠΈ Π²ΡΠΏΠΈΡΠΊΠ΅ ΠΈΠ· ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΠ ΠΠ’) ΠΈ Π½Π° ΠΏΡΠΎΡΡΠΆΠ΅Π½ΠΈΠΈ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΡ
6 ΠΌΠ΅ΡΡΡΠ΅Π².ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠΈΠ»ΠΈ 218 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π²ΡΠΏΠΈΡΠ°Π½Π½ΡΡ
ΠΈΠ· ΠΠ ΠΠ’ ΡΠ½ΠΈΠ²Π΅ΡΡΠΈΡΠ΅ΡΡΠΊΠΎΠΉ Π±ΠΎΠ»ΡΠ½ΠΈΡΡ Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΌΠ΅ΠΆΠ΄Ρ Π°ΠΏΡΠ΅Π»Π΅ΠΌ 2016 ΠΈ ΠΈΡΠ»Π΅ΠΌ 2017 Π³Π³. ΠΡΠΈΡΠ΅ΡΠΈΠΈ ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΈΡ: Π²ΠΎΠ·ΡΠ°ΡΡ ΠΌΠ»Π°Π΄ΡΠ΅ 18 Π»Π΅Ρ, ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠ΅ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΈΠ»ΠΈ ΡΠΏΠΈΠ½Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°, ΠΎΠΆΠΈΠ΄Π°Π΅ΠΌΠ°Ρ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΆΠΈΠ·Π½ΠΈ ΠΌΠ΅Π½Π΅Π΅ 90 Π΄Π½Π΅ΠΉ, ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΏΡΠ΅Π±ΡΠ²Π°Π½ΠΈΡ Π² ΠΠ ΠΠ’ ΠΌΠ΅Π½Π΅Π΅ 12 ΡΠ°ΡΠΎΠ². ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊΠΈ SF-36 (ΠΊΡΠ°ΡΠΊΠ°Ρ ΡΠΎΡΠΌΠ° ΠΎΡΠ΅Π½ΠΊΠΈ Π·Π΄ΠΎΡΠΎΠ²ΡΡ) ΠΈ 5-ΡΡΠΎΠ²Π½Π΅Π²ΡΠΉ EQ-5D-5L (ΠΠ²ΡΠΎΠΏΠ΅ΠΉΡΠΊΠΈΠΉ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° Π² 5 ΠΎΠ±Π»Π°ΡΡΡΡ
), ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π·Π°ΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΠΏΡΠΈ Π²ΡΠΏΠΈΡΠΊΠ΅ ΠΈ ΡΠ΅ΡΠ΅Π· 30, 90 ΠΈ 180 Π΄Π½Π΅ΠΉ ΠΏΠΎΡΠ»Π΅ Π½Π΅Π΅. ΠΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΡΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ ΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΎΡΡ ΠΊΡΠ°ΡΠΊΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ΅ ΠΏΡΠ΅Π±ΡΠ²Π°Π½ΠΈΠ΅ Π² ΠΠ ΠΠ’ (Π³ΡΡΠΏΠΏΠ° ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ, n=109), ΠΈ ΡΠ΅Ρ
, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΡΠΎΡΠ»ΠΈ ΠΊΡΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ Π² ΠΠ ΠΠ’ (Π³ΡΡΠΏΠΏΠ° ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, n=109).Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π§Π΅ΡΠ΅Π· 180 Π΄Π½Π΅ΠΉ Π²ΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊΠΎΠ² SF-36 ΠΈ EQ-5D-5L ΠΏΠΎΠ²ΡΡΠΈΠ»ΠΈΡΡ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΌΠΎΠΌΠ΅Π½ΡΠΎΠΌ Π²ΡΠΏΠΈΡΠΊΠΈ, Π·Π° ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΏΡΠΈΡ
ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π·Π΄ΠΎΡΠΎΠ²ΡΡ SF-36 (p=0,08). Π Π³ΡΡΠΏΠΏΠ΅ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΡΠ»ΡΡΡΠΈΠ»ΠΈΡΡ Π²ΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ EQ-5D-5L, Π² ΡΠΎ Π²ΡΠ΅ΠΌΡ ΠΊΠ°ΠΊ Π² Π³ΡΡΠΏΠΏΠ΅ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ ΡΠ»ΡΡΡΠΈΠ»ΠΈΡΡ ΡΠΎΠ»ΡΠΊΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ Π²ΠΈΠ·ΡΠ°Π»ΡΠ½ΠΎ-Π°Π½Π°Π»ΠΎΠ³ΠΎΠ²ΠΎΠΉ ΡΠΊΠ°Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ Π·Π΄ΠΎΡΠΎΠ²ΡΡ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊΠ°.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π²ΡΠΏΠΈΡΠ°Π½Π½ΡΡ
ΠΈΠ· ΠΠ ΠΠ’, Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ ΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠ΅ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΡ. ΠΠΎΡΠ»Π΅ Π²ΡΠΏΠΈΡΠΊΠΈ ΠΈΠ· ΠΠ ΠΠ’ ΡΠ½ΠΈΠΆΠ°Π΅ΡΡΡ ΠΎΡΠ΅Π½ΠΊΠ° ΡΠΎΠ±ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ. ΠΠ°ΡΡΡΠ΅Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡΠΈΡ
ΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΡΡ ΠΈ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΡΡ ΡΡΠ΅ΡΡ, Π±ΡΠ»ΠΈ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΌ, ΡΠ΅ΠΌ Ρ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². Π‘ΠΈΡΡΠ°ΡΠΈΡ ΠΏΠΎΠΌΠΎΠΆΠ΅Ρ ΠΈΡΠΏΡΠ°Π²ΠΈΡΡ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π²ΡΠΏΠΈΡΠ°Π½Π½ΡΡ
ΠΈΠ· ΠΠ ΠΠ’, Π² ΡΠΏΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΠΏΠΎΡΡΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ°Ρ
Ρ ΡΠΏΠΎΡΠΎΠΌ Π½Π° Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ ΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
Long-term Quality of Life After Intensive Care Unit Admission (a Single-Center Observational Study)
Patients may experience long-term physical, psychological and cognitive impairment after intensive care unit (ICU) discharge, a condition commonly described as post-intensive care syndrome. The relative contribution of each of these components to long-term quality of life was never investigated.The aim of this study is to identify the type and severity of disability and QoL at the discharge from ICU and up to following 6 months.Material and Methods. All patients (n=218) discharged from a university hospital ICU between April 2016 and July 2017 were eligible. Exclusion criteria included: age <18 years, brain or spinal injury, life expectancy <90 days, and ICU stay <12 hours. The Short Form Health Survey (SF-36), and 5-level EuroQoL-5D (EQ-5D-5L) questionnaires were administered at ICU discharge, and at 30-, 90- and 180-days. We compared patients requiring short-term ICU monitoring (IM, Intensive Monitoring, n=109) or patients requiring ICU treatment (IT, Intensive Treatment, n=109).Results. All dimensions of SF-36 and EQ-5D-5L parameters increased from ICU discharge to 180-days, except for the SF-36 Synthetic index linked to mental health (P=0.08). All EQ-5D-5L parameters improved significantly in the IT group, while only Visual Analog Scale Health Perception improved in the IM group.Conclusion. ICU survivors suffer long-term physical and psychological sequelae. The perception of Quality of Life is reduced after ICU discharge. The psychological and cognitive dimensions were more compromised than physical ones. Patients discharged from the ICU may benefit from specific intensive care follow-up clinics addressing their needs in term of psychological and cognitive support
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