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Biomedical subjects

A Awada

Publications and source records attributed to A Awada.

134 records · Page 8Linked to original sources
PubMedDate not supplied

Remaining controversies in the upfront management of advanced ovarian cancer.

Ovarian cancer (OC) is one of the leading causes of cancer-related death in women. In the last decades, a lot of energy and resources have been put into a number of clinical trials, with some success. Nevertheless, the prognosis of patients diagnosed with advanced disease remains extremely poor. As research moved forward, some crucial questions with regard to the optimal upfront management of patients with advanced OC (AOC) have remained unanswered. In this article, we review the rationale behind these controversial issues, and provide the levels of evidence supporting the current recommendations for AOC management.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Intraperitoneal cisplatin versus no further treatment: 8-year results of EORTC 55875, a randomized phase III study in ovarian cancer patients with a pathologically complete remission after platinum-based intravenous chemotherapy.

First-line intravenous chemotherapy (CT) following debulking surgery is associated with prolonged survival, in particular in patients who achieve a pathological complete remission (pCR) at second-look surgery but in whom a high rate of relapses still occurs. Between 1988 and 1997, 153 patients in pCR following platinum-based intravenous CT were randomized between four courses of intraperitoneal cisplatin (P) (90 mg/m2 every 3 weeks) or observation. Overall survival (OS) was the primary endpoint, while progression-free survival (PFS) was a secondary endpoint. This intent-to-treat analysis includes 16 patients who were not eligible and 17 patients who had protocol violations. The two groups were well balanced in terms of age (median = 55 years), performance status (78% P.S. O), FIGO stage (96% stage III), histology (serous in 66%), grade (2 or 3 in 80%), and residuum before intravenous CT (>1 cm in 40%). Intraperitoneal CT was delivered mainly through intraperitoneal catheters (Port-a-Cath 61% and Tenckhoff 25%). Side effects of intraperitoneal cisplatin included vomiting [> or =grade 2 (82%)], rise in serum creatinine [> or =grade 2 (14%)], abdominal pain [grade 1-2 (38%)], and neurotoxicity [grade 2-3 (15%)]. After a median follow-up of 8 years, 80 patients (52%) have progressed with no difference in the pattern of relapse between the two groups and 75 patients (49%) have died; the respective hazard ratios for PFS and OS with 95% CI are 0.89 (0.59-1.33) and 0.82 (0.52-1.29). These results are suggestive of a treatment benefit but do not support a change in clinical practice. Other randomized clinical trials of intraperitoneal CT are reviewed and briefly discussed.

Adult↗
PubMedDate not supplied

Stroke register: experience from the eastern province of Saudi Arabia.

A stroke registry was established in the Eastern Province of Saudi Arabia with an estimated population of 750,000 inhabitants of whom 545,000 are Saudi citizens. The register started in July 1989 and ended in July 1993. The Gulf war led to its interruption from August 1990 to August 1991. Four hundred eighty-eight cases (314 males, 174 females) of first-ever strokes affecting Saudi nationals were registered over the 3-year period. The crude incidence rate for first-ever strokes was 29.8/100,000/year (95% CI: 25.2-34.3/100,000 year). When standardized to the 1976 US population, it rose up to 125.8/100,000/year. Ischemic strokes (69%) predominated as in other studies but subarachnoid hemorrhage (SAH) was extremely rare (1.4%). The important risk factors were: systemic hypertension (38%), diabetes mellitus (37%), heart disease (27%), smoking (19%) and family history of stroke (14%). Previous transient ischemic attacks (3%) and carotid bruits (1%) were uncommon. The 30-day case fatality rate was 15%. The study showed that the age-adjusted stroke incidence rate for Saudis in this region is lower than the rates reported in developed countries but within the range reported worldwide. The pattern of stroke in Saudi Arabia is not different from that reported in other communities with the exception of the low incidence of SAH. The risk factors are similar to findings in other studies except for the high frequency of diabetes mellitus in our cases. The lower mortality rate was probably due to the younger age of the population and the availability of free medical services for management of cases.

Adult↗
PubMedDate not supplied

A cerebrovascular accident with unusual features.

A 64 y/o man experienced during 2 weeks TIA's or TIA's like episodes, once or twice a day, with or without contralateral pain in the head. CT Scans showed peculiar enhanced areas appended to the superior sagittal sinus. Angiography was refused. Twenty-seven months later during mild exertion a left frontal hematoma developed. Among frontal symptoms and signs laconism, abulia and a striking whispering were prominent. Angiography showed a dural arteriovenous fistula draining into cortical veins on the inner aspect of the left hemisphere. The fistula was successfully operated.

Angiography↗
PubMedDate not supplied

[New trends in the management of common solid malignant tumors].

Evidence-based medicine has become a requisite for novel therapies. It requires demonstration, in well performed clinical trials, that a benefit for the patients can be obtained by changing what is considered as a standard treatment. The present review deals with the clinical trials in the field of cancer therapy which have been published, during 2004, mainly in the New England Journal of Medicine (NEJM). We selected this mode of operation since the NEJM publishes highly selected papers after thoroughful peer review; moreover, the selection of the paper published by the NEJM is intended for general practionners in the different areas of medicine and critical editorial comments are offered for major contributions.

Clinical Trials as Topic↗
PubMedDate not supplied

Pseudotumor cerebri in renal transplant recipients: a diagnostic challenge.

We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the course of their follow-up. They illustrate the diagnostic challenge in such situations. Patients with renal transplants usually have many other associated conditions which may lead to headache, visual disturbances or papilledema. A high index of suspicion is necessary for prompt diagnosis and management of this rare and serious but treatable combination.

Adult↗
PubMedDate not supplied

Absence status: an overlooked cause of acute confusion in hemodialysis patients.

Epileptic seizures are a known complication of uremia, but non-convulsive seizures appear to be rare. We describe a patient with absence status presenting with acute confusion who responded well to intravenous diazepam. Attention is drawn to this rare cause of acute confusional state in the hemodialysis population.

Acute Disease↗