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Biomedical subjects

C Jara

Publications and source records attributed to C Jara.

At least 19 recordsLinked to original sources
PubMed2006

Fixed dose-rate infusion of gemcitabine in combination with cisplatin and UFT in advanced carcinoma of the pancreas.

BACKGROUND: Gemcitabine is currently considered the standard treatment for advanced pancreatic cancer (APC). Cisplatin and a fluoropyrimidine have some activity in the treatment of this cancer. The aim of this trial is to evaluate the efficacy and toxicity of a fixed dose-rate infusion of gemcitabine associated with cisplatin and UFT in patients with APC. PATIENTS AND METHODS: Forty-six chemotherapy-naïve patients with APC that was either unresectable or metastatic were included in this phase II study. All of them had Karnofsky performance status > or =50 and unidimensionally measurable disease. Treatment consisted of gemcitabine 1,200 mg/m2 given as a 120-min infusion weekly for three consecutive weeks, cisplatin 50 mg/m2 on day 1 and oral UFT 400 mg/m2/day (in two to three daily doses) on days 1 to 21; cycles of treatment were given every 28 days. RESULTS: A total of 208 cycles of chemotherapy were given with a median of 4 per patient. Fourteen patients (30%) achieved partial responses (95% CI 19-48%) and 17 (37%) had stable disease. The median time to progression was 5 months, and the median overall survival 9 months. Nineteen patients (49%; 95% CI 32-64%) had a clinical benefit response. Grade 3-4 WHO toxicities were as follows: neutropaenia in 26 patients (57%), with 5 cases of febrile neutropaenia (11%), thrombocytopaenia in 15 (33%), anaemia in six (13%), diarrhoea in 5 (11%), asthenia in 2 (4%) and mucositis in 1 (2%). Seven patients required hospitalisation for treatment-related complications. CONCLUSION: A fixed dose-rate infusion of gemcitabine associated with cisplatin and UFT is active in patients with APC, though at the cost of considerable toxicity.

Adult↗
PubMed2004

Epirubicin-cyclophosphamide adjuvant chemotherapy plus tamoxifen administered concurrently versus sequentially: randomized phase III trial in postmenopausal node-positive breast cancer patients. A GEICAM 9401 study.

BACKGROUND: A prospective randomized clinical trial was implemented to assess whether the concomitant or the sequential addition of tamoxifen to chemotherapy provides improved clinical benefit in the adjuvant treatment of breast cancer in postmenopausal patients. PATIENTS AND METHODS: Four-hundred and eighty-five patients with node-positive operable disease were randomized to receive tamoxifen (20 mg/day) concomitantly (CON) or sequentially (SEQ) to EC chemotherapy (epirubicin 75 mg/m(2) + cyclophosphamide 600 mg/m(2) on day 1, every 21 days for four cycles). RESULTS: In the 474 fully evaluable patients there were 96 events; eight being second neoplasms and 88 being related to the breast cancer. Of these, 48 of 88 occurred in the CON arm and 40 of 88 in the SEQ arm. The Kaplan-Meier estimation of disease-free survival (DFS) at 5 years was 70% in the CON and 75% in the SEQ group (log-rank test, P = 0.43). Adjusted hazard ratio for treatment was 1.11 (95% confidence interval 0.71-1.73; P = 0.64). CONCLUSION: This study fails to show an advantage of one treatment arm over the other, but a trend, albeit non-significant, appears to favor the sequential addition of tamoxifen to epirubicin + cyclophosphamide and, as such, warrants further investigation.

Aged↗
PubMed1999

Small-cell lung cancer in the elderly--is age of patient a relevant factor?

Different management procedures for diagnosis and treatment of small-cell lung cancer (SCLC) and other tumours in the elderly have been reported, but there is a lack of data from a communal hospital perspective. Information on clinical parameters such as weight loss, co-morbidity, performance status and investigative procedures for staging of disease and inclusion in clinical trials was recorded for patients in the province of Albacete (Spain). Patients' ages were categorized in two groups: under 70 years and 70 years or more, and a comparison of treatment variables, toxicities, response and time to event measures was carried out. Ninety-five patients were referred to our Unit for treatment. Of these patients, 62% were under 70 years of age and 38% were in the older age category. Clinical variables and staging procedures did not differ between groups. Trial assignment showed a bias in favour of younger patients (11 vs. 1, p = 0.02). No differences in the number of patients without treatment were found, but the older group presented fewer cases of optimal (> or = 4 cycles) therapy, less chemotherapy delivery (smaller mean total doses of cisplatin and etoposide) and smaller mean total dose of radiotherapy (57/45 Gy). The response to treatment (46%/50%) toxicity registered and overall survival did not differ between age categories. Age does not seem to be a relevant prognostic factor in this disease. Carefully calculated dose reductions for chemotherapy in elderly patients based on initial performance status and/or toxicity during treatment may be a useful policy without detrimental implications on outcome.

Age Factors↗
PubMed1998

Effect of clonidine on heart rate variability in congestive heart failure.

In patients with congestive heart failure, abnormal heart rate variability is a predictor of total mortality and sudden cardiac death. Drugs that improve heart rate variability may have a potential role for improving the survival among these patients. The effects of clonidine were studied in 24 patients with congestive heart failure, sinus rhythm, a left ventricular ejection fraction <0.40, and systolic blood pressure > 115 mm Hg. A 6-minute corridor walk test and 24-hour Holter monitoring were performed before and 42+/-24 days after initiation of clonidine therapy (Catapres-TTS patch, mean dose: 0.33+/-0.21 mg). Changes in other medications used at baseline were not allowed. One patient died suddenly. Two patients did not complete the protocol due to worsening congestive heart failure, which required changes in medications, 1 patient discontinued due to hypotension, and 2 for personal reasons. Among the 18 patients who completed the protocol, the mean RR interval of sinus beats increased from 760+/-106 to 822+/-125 ms (p=0.001) and the distance covered during the 6-minute walk test increased from 1,148+/-277 to 1,255+/-359 feet (p=0.042). Systolic blood pressure decreased from 139+/-15 to 119+/-10 mm Hg (p <0.0001). The following increases were noted in the heart rate variability measurements: high-frequency power in 0.15 to 0.40 Hz: 4.58+/-1.07 to 4.94+/-1.17 In (ms), p=0.002; SD: 47.0+/-16.9 to 52.5+/-18.4 ms, p=0.034; SD of the mean of all RR intervals in 24 hours: 116+/-94 to 130+/-19 ms, p=0.033; SD of all 5-minute mean RR intervals: 106+/-44 to 124+/-66 ms, p=0.042; root-mean square of difference of successive RR intervals: 28.8+/-10.7 to 34.1+/-14.2 ms, p=0.017. Clonidine improves heart rate variability in the patients with congestive heart failure by increasing the parasympathetic tone. It is well tolerated by most patients with heart failure and may have a beneficial effect on exercise capacity.

Adrenergic alpha-Agonists↗
PubMed1998

[Medical care costs for HIV-positive and AIDS patients in four hospitals in Santiago, Chile].

BACKGROUND: Medical care of HIV infected and AIDS patients may represent an important economical burden for public hospitals. AIM: To assess direct and indirect costs of medical care for HIV infected and AIDS patients in public hospitals of the Metropolitan Region of Chile. MATERIAL AND METHODS: Between August 1994 and February 1995, information about outpatient and hospitalized medical care of 417 HIV infected patients was gathered (representing approximately 16% of the seropositive population). Patients were divided as having or not having AIDS. The latter were those included in groups I, II, III and category C2 of group C (group 4). The cost of medications, procedures and examinations of these patients was calculated. RESULTS: Thirty six percent of studied patients had AIDS. The annual cost of care for AIDS patients was US$3760 compared to US$1450 for HIV infected patients without AIDS. Medications represented 75% and 65% of total costs in patients with and without AIDS respectively. The figures for examinations and procedures were 17% and 22% and for medical attentions were 7.5% and 8.8% respectively. CONCLUSIONS: Medical care of patients with AIDS has higher costs than that of HIV infected patients without AIDS. Thus, the retardation of the progression of the disease would have social, humanitarian and economical benefits. Our costs are similar to those of other countries with a similar level of economic development.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Neuronopathy due to cisplatin].

INTRODUCTION: Cisplatinum is a cytotoxic agent used in the treatment of different types of cancer. It often has side-effects, including a pure sensory syndrome with conservation of pain and temperature sense which is very disabling. CLINICAL CASES: We present the case of a woman with cancer of the ovary and a man with oat cell carcinoma, who were treated with cisplatinum. After the course of chemotherapy was finished, with accumulated dosages of 500 mg/m2, they both developed paraesthesia of all four extremities, reduced control of fine movements and unstable gait. On physical examination there was distal hypoaesthesia with conservation of temperature and pain sensation, areflexia and sensory ataxia. The patient with ovarian cancer also had continuous pseudo athetotic movements. On neurophysiological studies, there was absence of peripheral and central sensory potentials and of H reflexes, normal electromyogram, normal motor conduction and normal mixed silent period. DISCUSSION: The target organ in cisplatinum neurotoxicity has been identified, in experimental and human studies, as the dorsal root ganglion. Our patients had a syndrome which clinically and neurophysiologically suggested diffuse involvement of the dorsal ganglion (neuropathy) in which absence of sensory and H reflex potentials showed that the larger cells had been damaged. However, the normal mixed silent period suggested that the small myelinic cells were not altered, in accordance with the preservation of pain and temperature sensation. CONCLUSIONS: We discuss the differential diagnosis between neuropathy due to cisplatinum and to paraneoplasia. We consider that there may be a tendency for certain heavy metals to damage posterior root ganglia.

Antineoplastic Agents↗
PubMed1997

Experience of Oncopaz Cooperative Group with oral fluoropyrimidines in tumors of the stomach, lung, head and neck, and breast.

The Oncopaz Cooperative Group designed a chemotherapy regimen to modulate UFT (Tegafur and Uracil) with leucovorin. The regimen consisted of a high intravenous dose of leucovorin, followed by oral UFT and oral leucovorin twice daily for 14 days. Based on the promising results obtained with this regimen in patients with advanced colorectal cancer, the Oncopaz group performed several phase II trials using this combination with other drugs to treat advanced gastric, lung, head and neck, and breast cancers. When combined with etoposide in gastric cancer, the regimen was shown to be active and well tolerated. However, when used with cisplatin to treat non-small cell lung cancer, a low response rate and high toxicity precluded its recommendation for further study. The addition of carboplatin in the treatment of head and neck cancer demonstrated moderate activity with low toxicity. In an ongoing trial of advanced breast cancer, preliminary results indicate that the combination of idarubicin, UFT, and leucovorin is active, with moderate, primarily hematologic toxicity. Trials of new combinations are warranted to take advantage of the pharmacokinetic properties and oral bioavailability of UFT and leucovorin.

Adenocarcinoma↗
PubMed1996

Determination of trace level impurities in uranium compounds by ICP-AES after organic extraction.

The determination was studied of Al, B, Be, Cd, Ca, Co, Cu, Mg, Mn, Mo, Pb, Si, Sn, V, Cr, Ni, and Fe as trace level impurities in uranium compounds by ICP-AES after extraction of uranium with three different mixtures of di-(2-ethyl-hexyl) phosphate (D2EHP) and tri-(2-ethyl-hexyl)-phosphate (T2EHP) in solvents like toluene, carbon tetrachloride, hexane and cyclohexane. The study was carried out in presence of different concentrations of HCl and HNO(3). A single extraction with D2EHP in cyclohexane using nitric acid as matrix was sufficient to reduce the U(3)O(8) concentration from 100 g/l to 100 microg/ml. The ICP-AES instrumentation applied, allowed the determination of metal concentrations ten-times lower than those usually found in nuclear grade U(3)O(8). To check the efficiency of the extraction and the accuracy of the proposed method, Certified Reference Materials were used in the dissolution and extraction steps. The method described can be used for the determination of trace metals in nuclear grade U(3)O(8).

Journal Article↗
PubMed1996

Treatment of metastatic malignant melanoma with cisplatin plus tamoxifen.

A phase II study was performed to assess the efficacy and toxicity of the combination of cisplatin (CDDP) and tamoxifen (TAM) in patients with metastatic malignant melanoma (MM). A total of 31 consecutive previously untreated patients with unresectable measurable MM were given 100 mg/m2 CDDP every 21 days and 60 mg TAM every 12 h daily. All courses were given on an outpatient basis. A total of 119 courses of treatment were given. In all, 5 of the 31 patients (16%) had an objective response (95% confidence interval 5.3-34%) and 2 (6%) achieved a clinical complete response. The median duration of response was 7 months. The main side effect was gastrointestinal: 13% of the patients experienced grade 3/4 nausea/vomiting. Hematological or neurological toxicities were mild and rare. In conclusion, the combination CDDP-TAM has limited activity in MM, although its toxicity is tolerable. Our results do not allow us to recommend its use for the treatment of MM.

Adult↗
PubMed1995

Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Chilean postpartum women.

A validity study of the Edinburgh Postnatal Depression Scale (EPDS) against the Research Diagnostic Criteria (RDC) was carried out on a sample of women attending a health care center in Santiago. One hundred and eight middle-class mothers filled in the EPDS and were later interviewed by the main author using the Psychiatric Assessment Schedule (PAS). The internal consistency of the EPDS was reasonably good (Cronbach's alpha 0.77). Validity coefficients for the scale were calculated to determine the best case/non-case threshold which was found to be 9/10. Sensitivity, specificity and positive predictive value for this threshold were 100%, 80% and 37% correspondingly. The same best cut-off point (9/10) was found by other Chilean investigators in a sample of working-class women. The EPDS was shown to be a useful screening instrument for postnatal depression in these settings.

Adult↗
PubMed1994

A single intravenous high dose of cholic acid to a pregnant ewe does not affect fetal well-being.

Cardiovascular variables of both mother and fetus and total bile acid levels were monitored in amniotic fluid and in maternal and fetal plasma after the administration of a single intravenous high dose (29 mg) of cholic acid to a pregnant ewe. We observed the diffusion of significant quantities of cholic acids from the mother to the fetus and amniotic fluid. Nevertheless, cardiovascular parameters (heart rate, blood pressure, PO2, PCO2 and pH) were not affected, neither did intra-amniotic pressure show significant changes compared with the initial experimental conditions. It is concluded that an acute increase in maternal plasma levels of bile acids does not produce important adverse effects in either the mother animal or the fetus and consequently, if bile acids should be deemed responsible for any deleterious effect observed in a preterm fetus in intrahepatic cholestasis, this should be considered as the consequence of a chronic process.

Animals↗
PubMed1994

Debrisoquin oxidation genotype and susceptibility to lung cancer.

The association between the polymorphism of the cytochrome P450 debrisoquin hydroxylase (CYP2D6) and lung cancer is controversial. Previous reports suggested a link between CYP2D6 phenotype and lung cancer, with poor metabolizers having reduced susceptibility. Nevertheless, negative findings have also been published. By using allele-specific amplification, we have studied the frequency of four CYP2D6 (wild type and mutant) alleles in 89 patients with histologically proved bronchogenic carcinoma and in 98 healthy volunteers. Our findings confirm that poor metabolizers are underpresented among patients with lung cancer because of a different genetic background. Our findings also reveal that the rare CYP2D6(C) mutant allele is sixfold more frequent among patients with lung cancer (p < 0.0005). This suggests that the CYP2D6(C) allele could be considered as an additional risk factor because carriers could have higher susceptibility to the development of lung cancer.

Adult↗
PubMed1993

[Combined concomitant chemotherapy and radiotherapy with or without surgery in the treatment of non-metastatic squamous carcinoma of the esophagus].

Between June 1986 and October 1992 two prospective non-randomized and consecutive therapeutic schemes with a curative intent of non-metastatic squamous cell carcinoma of the esophagus were developed. The first scheme consisted of concomitant administration of chemotherapy (cisplatin and 5-fluorouracil, 2 cycles) and radiotherapy (30 Gys) after surgery (esophagectomy) (14 evaluable patients). Without surgery, a higher dose of chemotherapy (4 cycles) and radiotherapy (55 Gys) was given on the second scheme (12 evaluable patients). Complete histological response was 42.6% for the first scheme and 50% for the second one. Toxicity was moderate in both schemes. Palliation was important in the second scheme. Actuarial survival was 28% at 1 year for the first scheme and 71% for the second one. Operative mortality was 27%. Concomitant chemoradiotherapy might be a therapeutic choice for locoregional control of squamous esophageal carcinoma.

Actuarial Analysis↗
PubMed1993

[Depression in pregnancy and puerperium: study of risk factors].

This study was aimed at determining risk factors associated to depression in pregnancy and/or the puerperium. By means of both observer-rated, and self-rated scales a 108-expectant mother sample was assessed by the co-investigators, interviewed by the principal investigator later on. The Psychiatric Assessment Schedule was used to obtain an RDC diagnosis. The same procedure was repeated 2 to 3 months after delivery. A greater exposure to life events, prior consultation for emotional problems as well as economic difficulties arising of late were all associated to depression in pregnancy and the puerperium. Getting separated from significant persons in a woman's life, and/or difficult relationships with either husband or mother have been strongly associated to depression at both periods. As regards puerperium depression, several associations directly related to childbirth (having had a low-weight baby) or the postnatal period (lactation problems) were detected. Anxiety and depressive symptoms during pregnancy have been also clearly linked to postpartum depression. The predictive value of such risk factors is discussed. It is suggested that questions on these factors should be included into ordinary health assessments of both pregnant and puerperal women.

Adult↗
PubMed1992

Cardiorespiratory parameters in draught horses before and after short term draught work pulling loads.

In order to establish the relationship between draught force and cardiorespiratory responses to exercise heart rate (HR), respiratory rate (RR), arterial and venous blood gases, pH, hemoglobin concentration and temperature were measured in five draught horses during rest, immediately after exercise and 30 min post-exercise under field conditions. A wagon equipped with an odometer and a hydraulic dynamometer was used for measuring distance and draught force. The wagon was loaded with 946 kg for the low load, 1,979 kg for the medium load and 2,994 kg for the high load, and drawn for a distance of 1,500 m. Draught force and load weight were linearly related. The response of the draught horse to low and medium load exercise was characterized by a moderate increase in HR, RR and temperature with no significant changes in arterial blood gases and pH. An increase in HR, RR and temperature was observed, whereas no changes in arterial PO2 and increases in venous PO2 were noticed after high load exercise. Slight increase in venous lactic acid concentration as a result of high load exercise was observed, suggesting that some anaerobic work was performed. However this was insufficient to produce changes in blood pH. The increase in metabolic requirements during the three levels of draught exercise was associated with increases in arterial hemoglobin concentration and oxygen content of blood.

Acid-Base Equilibrium↗
PubMed1992

[Functional dysphonia: relation with personality and ICD-10 criteria].

The International Classification of Diseases, 10th. revision (ICD-10) in the category F45 defines the somatoform disorder as a mental disease characterized by the reiterative presentation of somatic symptoms in absence of an organic disease, or the somatic pathology being insufficient to explain the intensity of the symptoms as well as the discomfort and preoccupation of the patient. Fifteen female teachers with functional dysphonia were studied by means of a semistructured interview and psychometric evaluations. Considering dysphonia as the principal symptom, the most frequent diagnosis, in accordance with ICD-10 was "Other somatoform disorder" (F-45.8)(9/15). Five patients were diagnosed as motor dissociative disorder (F-44.4). All the patients had some abnormality of personality (5 with personality disorder and 10 with exacerbation of personality traits). The criteria of ICD-10 to classify the functional dysphonia as Somatoform disorder are discussed. It is suggested that certain personality traits are facilitators for somatization.

Adult↗
PubMed1991

Polymorphic oxidation of debrisoquine in lung cancer patients.

Oxidative polymorphism of debrisoquine (DBQ) was assessed in 84 patients (81 male) with histologically proven bronchogenic carcinoma and in 143 healthy male smokers. 80 (95%) patients and 133 (93%) controls, with a metabolic ratio (MR) below 12.6, were classified as extensive metabolisers of DBQ (no significant difference between patients and controls). Only 1 of the 73 patients with epidermoid or microcytic carcinomas was classified as a poor metaboliser (PM) (P = 0.031 compared with controls). 63 patients (75%) and 110 controls (77%) showed a very fast oxidative rate, with MR values under 1 (not significant). The EM phenotype of DBQ might be a secondary genetic risk factor for developing bronchogenic carcinoma in male smokers.

Aged↗