Biomedical subjects

J Mardiak

Publications and source records attributed to J Mardiak.

At least 19 recordsLinked to original sources

PubMed2005

Prevention of febrile neutropenia in cancer patients by probiotic strain Enterococcus faecium M-74. Phase II study.

Febrile neutropenia (FN) remains a potentially life-threatening complication of anticancer chemotherapy. Bacterial translocation via intestinal mucosa is a significant mechanism of FN development. Competitive inhibition of bowel colonization by pathogenic microorganisms by lactic acid bacteria could be a useful prevention of FN. The aim of the study was the prevention of FN by probiotic strain Enterococcus faecium M-74 enriched with selenium in leukemic patients. Fourteen (six males/eight females) patients with myelogenous leukemia treated by induction or consolidation chemotherapy were included in the study. Patients received prophylaxis with E. faecium M-74 during one cycle of chemotherapy. The daily dose was 36 x 10(9) CFU tid. Prophylaxis started between day -2 and day +2 of chemotherapy and continued until the absolute neutrophile count (ANC) was >1,000/microl. All patients experienced febrile neutropenia. During 231 days of severe neutropenia, 30 febrile episodes occurred. No any febrile episode or infection provoked by the strain tested was noticed. Tolerance of therapy was excellent without significant adverse effects. Our results demonstrate the safety of the probiotic strain E. faecium M-74 enriched with selenium in leukemic patients with severe neutropenia. However, its administration was not effective in the prevention of febrile neutropenia, but this does not preclude the protective effect of other probiotic strains.

Adult↗

PubMed2005

Prevention of febrile neutropenia in cancer patients by probiotic strain Enterococcus faecium M-74. Pilot study phase I.

Febrile neutropenia (FN) remains a potentially life-threatening complication of anticancer chemotherapy. Bacterial translocation via intestinal mucosa is a significant mechanism of FN development. Competitive inhibition of bowel colonization by pathogenic microorganisms by lactic acid bacteria could be a useful prevention of FN. The aim of the study was the evaluation of dose and safety of probiotic strain Enterococcus faecium M-74 enriched with organic selenium in patients with solid and hematological malignancies. Eleven (9 M/2F) patients were included in the study. In the first phase six patients with germ cell tumors treated by chemotherapy were included. They received prophylaxis by nonpathogenic strain E. faecium M-74 during 2 cycles of chemotherapy. The planned daily dose was 6 x 10(9) bacteria. Regarding the insufficient colonization of the gut, the dose was further increased up to 18 x 10(9) tid. After safety evaluation, five patients were included with relapse of acute leukemia. In patients with germ cell cancer, severe neutropenia G3/4 was noted in 10 of 12 cycles of chemotherapy. The febrile episode was not observed in any of the patients. The gut colonization by enterococci reaches 10(6) CFU/g stool. In 5 patients with acute leukemia during 127 days of severe neutropenia 12 febrile episodes occurred. There was not noted any febrile episode or infection provoked by the tested strain. Tolerance of therapy was excellent without significant undesirable effects. Optimal dose was assessed and safety of probiotic strain was evaluated in neutropenic patients with solid, or hematological malignancies. Based on these results we plan phase II study to evaluate the effectiveness of this strain in FN prophylaxis.

Administration, Oral↗

PubMed2005

Gemcitabine plus cisplatine and paclitaxel (GCP) in second-line treatment of germ cell tumors (GCT): a phase II study.

The aim of the study was to determine the efficacy and toxicity of gemcitabine, cisplatin and paclitaxel (GCP) combination as a first salvage treatment of patients with relapsed GCT. Four courses of paclitaxel 175 mg/m(2) and cisplatin 50 mg/m(2), both on day 1, and gemcitabine 1000 mg/m(2), on days 1 and 8, every 3 weeks, were given to 12 consecutive patients who had failed standard 1st line treatment. Six patients (50%; 95% CI 21-79%) achieved favourable response and two of them are maintained 38+ and 29+ months. Median survival time was 16 months (range, 0.77-38+). All, but two patients had hematological toxicity Gr3-4 with infectious complication seen only in 6 courses of therapy. GCP is an active second-line combination regimen for relapsed GCTs with acceptable toxicity profile. However the results of this study did not show expected treatment efficacy and we raise the idea of cisplatin dosage relevance in this combination.

Adult↗

PubMed2005

Paclitaxel plus ifosfamide and cisplatin in second-line treatment of germ cell tumors: a phase II study.

The aim of this study was to determine efficacy and toxicity of TIP combination (paclitaxel, ifosfamid, cisplatin) as first salvage treatment in patients with relapsed germ cell tumours (GCTs). Excellent results were achieved from TIP combination with a dose 250 mg/m(2) of paclitaxel [5]. Our hypothesis was that comparable efficacy with less toxicity could be achieved even with a lower dose of 175 mg/m(2) paclitaxel in TIP. In 17 consecutive patients with failed standard 1st line treatment, we used four to six courses of paclitaxel 175 mg/m(2) on day 1 and ifosfamide 1,200 mg/m(2) plus cisplatin 20 mg/m(2), both on day 1 through 5, every 3 weeks. Eleven patients achieved favorable response (65%; 95% confidence interval, 42 to 87%) with 7 complete responses (41%). Estimated 2-year disease free survival is 47% (95% CI, 23-71%). Treatment combination was well tolerated and myelosupression was major toxicity. Granulocytopenia Gr3-4 was observed in 8% and febrile neutropenia in 7% of the courses. No case of severe neurotoxicity or treatment-related death was observed. In our study, TIP combination had good toxicity profile. The results however, did not show expected treatment efficacy and we raise the idea of paclitaxel dosage relevance in TIP.

Adult↗

PubMed2005

Treatment strategy of early-stage breast cancer.

The treatment options for early stage breast cancer include local-regional and systemic therapy. Surgery and radiotherapy can minimize the risk of local recurrence, while systemic adjuvant chemotherapy and hormonal treatment is related to prolongation of survival rate. Several prognostic factors were identified. The dominant prognostic factor is lymph node involvement with cancer. The decision regarding treatment must be made according to risk versus benefit for every patient. The absolute benefit of systemic treatment is major in patients with intermediate and poor prognosis (Tab. 3, Fig. 2, Ref. 10).

Breast Neoplasms↗

PubMed2003

Retrocaval ureter with ureteral carcinoma.

The authors report a rare congenital anomaly, retrocaval ureter (RCU) with carcinoma. The patient had recurrent pyelonephritis, hematuria and renal colic. Urography shows no function on right side. Abdominal ultrasound revealed marked right hydronephrosis. Antegrade ureterography through nephrostomy revealed a RCU. Helical C.T. confirmed the RCU and also revealed a defect in contrast medium in the upper ureter. We performed percutaneus antegrade nephro-ureteroscopy and found carcinoma of the retrocaval ureter. This may be the first case of tumor in the RCU. We did not find any other in the literature. (Fig. 3, Ref. 14.).

Carcinoma↗

PubMed2002

Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin.

BACKGROUND: Alpha-I blockers decrease the tension and release the spasm of smooth muscles and thus lessen the obstruction and irritation symptoms in the lower urinary tract (LUTS). They make a faster passing of calculi from the terminal part of the ureters possible. OBJECTIVES: The goal of this study was to objectively assess the improvement of difficulties caused by obstructions in ureterolithiasis localized in the lower part of the ureters of 104 randomly chosen patients (pts.) in a double-blind study. METHODS: During a period of 2 and half years (June 1999-January 2002) 104 pts. suffering from ureterolithiasis of the lower urinary tract were treated and observed. Patients were divided into two groups: A (n:53; later only 51 were evaluated) which was subjected to standard treatment and group B (n:51) where the standard treatment was supplemented by the alpha-1 blocker. As alpha-1 blocker one capsule of Tamsulosin/OMNIC 0.4/ was administered daily. RESULTS: With alpha-1 blocker, we have registered a more speedy passing of calculi from the terminal parts of ureters in 17.6% of pts. Recurrence of renal colics was less frequent and occurred in one of eight pts. as compared with group A (without the alpha-1 blocker) where a recurrence of the renal colic was observed in about every fifth pts. In group A (n:51), 62.8% of the pts. passed the calculi, whereas in group B (n:51), where standard treatment was supplemented by the administration of the alpha-1 blocker Tamsulosin, this percentage increased to 80.4%. CONCLUSION: The treatment by alpha-1 blockers considerably decreased not only LUTS but also helped to accelerate the passing of minor calculi from the terminal parts of the ureters of 80.4% of pts. It seems that alpha-1 blockers potentiate the spasmoanalgetic action of drugs used in standard methods of treatment.

Adolescent↗

PubMed2001

Fournier's gangrene: can aggressive treatment save life?

Fournier's gangrene (FG) is a rapidly progressive, fulminant infection of the scrotum, perineum and the abdominal wall. FG is caused by synergic aerobic and anaerobic organisms. Modern surgical series report mortality of up to 67%. This originally rare disease has become more frequent. Aggressive treatment including antibiotics, antigangrenous serum, and treatment of all accompanied diseases and disorders can be successful. Treatment also includes debridement and plastic corrections. Authors describe management of 8 patients with FG. Treatment of FG and all accompanied diseases was in all cases successful. Treatment costs of this kind of patients were approximately 20 times higher than treatment of patients with other urologic diseases.

Adult↗

PubMed2000

Alpha 2-b interferon and farmarubicin in the prophylaxis of recurrence of superficial transitional cell carcinoma of the urinary bladder.

OBJECTIVE: To ascertain the effect of intravesical instillation of Alpha 2-b Interferon (IFN a-2) 10 million I.U. in 50 ml physiological saline as a monotherapy and in combination with Farmarubicin (FRC) 50 mg dissolved together in 50 ml of physiological saline. These substances were administered four times during the first month after TUR-BT and then once monthly for one year either in the form of an IFN a-2 monotherapy or as an IFN a-2 and FRC combination in the therapy of recurrence of transitional cell carcinoma (TCC) of the urinary bladder after transurethral resection of the bladder tumor (TUR-BT). THEORETICAL CONSIDERATION: One of the causes of malignancy is an irreversible shift in the balance between protooncogens and tumor supressorgens. In the genetical process of the control of cell apoptosis, an important role is played by the tumor-supressorgen p 53. By the means of mutation of protooncogenes, cellular oncogenes(C-MYC) are formed, inducing the proliferation of cells of the tumor and via feedback induce also the p53 mutation. By the reduction of cellular oncogenes, IFN a-2 and FRC intervene by blocking the proliferation of tumor cells. PATIENTS AND METHODS: Authors have checked and treated 33 patients (pts) with recurrent TCC. The first group of 20 pts were after TUR-BT with BCG unsuccessful intravesical therapy, and 13 pts in the second group were with recurrence of TCC, but contraindicated for BCG treatment. These 33 pts (the first and second groups) were compared with 33 pts of the third group after TUR-BT but without intravesical instillation therapy. The pts of the third group did not suffer from any other significant ailment. IFN a-2 monotherapy (10 mill. I.U./or a combination of IFN a-2 + FRC (50 mg/50 ml solution were administered for 2 hours, 1 week after TUR-BT. During the first month, instillations were done weekly, from the second to the twelfth month only once monthly. The results were evaluated for 12 to 33 months (median: 24 months). RESULTS: Group I: From 20 pts after TUR-BT + unsuccessful BCG + IFN a-2 monotherapy recurrence was registered in 4 pts (20%). Group II: Out of 13 pts after TUR-BT + IFN a-2 + FRC, recurrence was registered in 3 pts (23%). Group I + II: Recurrence in both groups was observed in 7 pts (21.2%). Group III: Out of 33 pts after TUR-BT without immuno- et chemotherapy recurrence was registered in 18 pts (54.5%). After one year of treatment, patients were checked for 24 months. The transition into an invasive tumor was observed in 4 pts (12.1%). In the comparative group of 33 pts without instillation after TUR-BT, recurrence was detected after one year in 18 pts (54.5%) and the transition into an invasive tumor was observed in 7 pts (21.2%). CONCLUSION: Intravesical instillation of BCG used to be the most frequently applied therapy following TUR-BT. The toxicity of this vaccine as well as the contraindication of this treatment in some diseases, and also the primary or secondary resistance of TCC to BCG have challenged the search for alternative possibilities of the intravesical instillation treatment. IFN a-2 monotherapy and IFN a-2 in combination with FRC are new alternative approaches in the improvement of TCC treatment. This therapy is also supported by research of molecular genetics. (Ref.18.)

Administration, Intravesical↗

PubMed2000

Sequential intermediate high-dose therapy with etoposide, ifosfamide and cisplatin for patients with germ cell tumors.

Intermediate high dose VIP (etoposide, ifosfamide, cisplatin) achieved comparable efficacy and improved tolerance in comparison with high-dose chemotherapy plus PBSC in poor risk germ cell tumors. The aim of this study was to confirm the effectivity and tolerance of this regimen in clinical practice. Twenty-five consecutive patients, 9 previously untreated with poor prognosis and 16 relapsed, were treated with 1.6 VIP or 1.9 VIP+PBSC. A relative dose intensity of 1.6 VIP was used in 14 patients and 11 patients received the intensity of 1.9 VIP. Clinical response was achieved in 56% of patients. Fifty-eight percent of patients have survived more than 1 year and 44% more than 2 years. No significant difference was noted between previously treated and untreated patients, as well as between the patients on 1.6 VIP and 1.9 VIP, with the exception of improved 1-year survival of patients on 1.9 VIP. One of four cisplatin-refractory patients achieved durable partial remission with a normal level of tumor markers. Serious non-hematological toxicity was rare. Myelotoxicity of 1.9 VIP was less serious in comparison with 1.6 VIP regimen, but the difference was not significant. Sequential intermediate high-dose therapy is an effective and tolerable regimen for patients with poor risk germ cell tumor as well as for relapsed patients.

Adolescent↗

PubMed2000

Carboplatin and cyclophosphamide in the treatment of metastatic seminoma.

Cisplatin-based chemotherapy is highly effective in advanced seminoma, but at the cost of a considerable toxicity. The response rate of carboplatin is comparable with cisplatin combinations but the relapse rate is higher. Our study assesses the efficacy and the toxicity of the combination of carboplatin and cyclophosphamide in patients with advanced seminoma. Nineteen consecutive patients received 6 cycles of intravenous cyclophosphamide 750 mg/m2 and carboplatin 350 mg/m2, repeated every 21 days. The overall objective response rate was 100%, 11 patients (58%) achieved a complete response and 8 patients (42%) showed a partial response. At median follow up of 4.2 years 3 patients (15%) relapsed. The 2-year disease-free survival and the overall survival are 72 and 94%, respectively. This outpatient treatment was well tolerated and the toxicity was mild. One patient had granulocytopenic fever and one patient had grade 3 cystitis. The combination therapy with carboplatin and cyclophosphamide is an effective and tolerable regimen in advanced seminoma.

Adolescent↗

PubMed2000

Adjuvant clodronate therapy in patients with locally advanced breast cancer--long term results of a double blind randomized trial. Slovak Clodronate Collaborative Group.

Between March 1990 and May 1993 seventy three patients with previously untreated breast cancer, Stage III or IV without osseal metastases were randomized to sodium clodronate 1600 mg daily p.o.(arm A = 37 patients) or placebo (arm B = 36 patients) over 2 years, additionally to standard therapy. Ten patients were not evaluable for response because of short duration of therapy (less than 2 months). Bone metastases developed in 30% of patients in arm A and 23% patients in arm B. Median time to appearance of bone metastases was 13 months in arm A and 28 months in arm B. Non-bone metastases appeared in 48% patients in arm A and in 48% patients in arm B. Time to development of non-bone metastases was 20 months in arm A and 16 months in arm B. Five-year survival was 41% in arm A and 39% in arm B. There were no significant differences between the treated and control arms.

Adult↗

PubMed1999

Nosocomial candidaemias due to species other than Candida albicans in cancer patients. Aetiology, risk factors, and outcome of 45 episodes within 10 years in a single cancer institution.

Forty-five cases of fungaemia due non-albicans Candida spp. (NAC) in a single National Cancer Institution within 10 years were analysed for aetiology, risk factors and outcome. There had been 12 cases of fungaemia that were due to C. krusei, 14 due to C. parapsilosis, 7 due to C. (T.) glabrata, 6 to C. tropicalis, 2 to C. guillermondii, 2 to C. lusitaniae, 1 to C. stellatoidea, and 1 to C. rugosa. Comparison of 45 NAC fungaemia with 75 episodes of C. albicans fungaemia revealed differences only in two risk factors: previous empiric therapy with amphotericin B (16.0 vs 2.2%, P<0.01) appeared more frequently in cases of C. albicans fungaemia, and prior prophylaxis with fluconazole (8.9 vs 0%, P<0.02) was conversely more frequently observed with NAC. The incidence of other risk factors, such as underlying disease, chemotherapy, antibiotic prophylaxis or therapy, treatment with corticosteroids, catheter insertion, mucositis, cytotoxic chemotherapy, and neutropenia, was similar in both groups. There was no difference either in attributable or in overall mortality between NAC and C. albicans fungaemia in our cancer patients.

Adrenal Cortex Hormones↗

PubMed1998

Predictors of mortality in bacteremic cancer patients: retrospective analysis of 64 deaths occurring among 262 bacteremic episodes.

A total of 262 bacteremic episodes were observed in cancer patients in a single cancer institution during the last 7 years, and the recorded outcome was death in 65. The 65 patients who died (24.8% overall mortality) were divided retrospectively into two subgroups: (a) those who died of underlying disease with bacteremia (45 cases, 16.9% crude mortality) and (b) those who died of bacteremia (20 patients, 7.7% attributable mortality). Comparison of several risk factors in subgroups of patients who achieved a cure (197 cases) and of those who died and whose deaths were attributable (20 cases) revealed six risk factors that were associated with attributable mortality: (1) chemotherapy-induced neutropenia (P < 0.03), (2) Acinetobacter/Stenotrophomonas spp. bacteremias (P < 0.001), (3) liver failure (P < 0.001), (4) inappropriate therapy (P < 0.0001), (5) organ complications (P < 0.003) and (6) multiresistant organisms (P < 0.001). Enterococci and Pseudomonas aeruginosa, surprisingly, were found more frequently in those who died of an underlying disease with bacteremia than among patients who were cured (17.6% vs 7.6%, P < 0.05 and 29.1% vs 13.8%, P < 0.02). Those who died of infection had higher numbers of positive blood cultures, with 2.05 per episode, than did those who died of underlying disease with bacteremia (1.82) or those who were cured (1.51). Other risk factors, such as underlying disease, type of chemotherapy, origin of bacteremia, age, and catheters did not predict either overall or attributable mortality within the study group.

Adult↗

PubMed1998

Bacteremia due to methicillin-resistant staphylococci occurs more frequently in neutropenic patients who received antimicrobial prophylaxis and is associated with higher mortality in comparison to methicillin-sensitive bacteriemia.

Bacteriemia due to coagulase-negative staphylococci (CNS) resistant to methicillin and sensitive only to glycopeptides in 220 cancer patients was prospectively analyzed for risk factors and outcome. A group of 33 cases of bacteriemia with CNS-sensitive only to glycopeptides was compared with a group of 187 cases with CNS sensitive to methicillin. All cases appeared in two affiliated major cancer institutes in Bratislava with the same antibiotic policy. Univariate analysis showed differences in recorded risk factors: acute leukemia (48 vs. 33%, P < 0.05), neutropenia (57 vs. 32%, P < 0.045), previous prophylaxis with quinolones (30 vs. 11%, P < 0.01) and penicillin-V (15 vs. 3%, P < 0.02) and previous colonisation with CNS (27 vs. 3%, P < 0.01) were more frequently associated with bacteriemia resistant to methicillin and sensitive only to glycopeptides. Attributable mortality was also higher in this subgroup in comparison to bacteriemias with CNS sensitive to methicillin (12 vs. 3%, P < 0.05) however, overall mortality was similar. Bacteriemias due to CNS caused by sensitivity only to glycopeptides occurred more frequently in neutropenic patients (1), with acute leukemia (2), receiving quinolone and penicillin prophylaxis (3), and previously colonized (4), patients and had worse prognosis in comparison to those with methicillin-sensitive staphylococcal bacteriemias.

Antibiotic Prophylaxis↗

PubMed1998

Candida parapsilosis fungemia in cancer patients--incidence, risk factors and outcome.

The paper presents an analysis of fungemia cases which were caused by C. parapsilosis in a cancer center within 10 years, with the aim to compare risk factors and the outcome with fungemias caused by C. albicans and other non-albicans Candida spp. fungemias. Before 1990 (1988-1989) in our institutes C. parapsilosis fungemias were not observed at all. During 1990-1997, the proportion of C. parapsilosis among fungemias increased, in 1990-1993 from 0% to 7.1% in 1996-1997 to 14.2-15%. It represents 25% out of non-albicans Candida spp. fungemias and 7.9% out of all fungemias and is the third commonest pathogen after C. albicans (50.5%) and C. krusei (9.9%). Two from eight (25%) C. parapsilosis fungemias were breakthroughs, one appeared during prophylaxis with ketoconazol and one with fluconazol. Considering the proportion of C. parapsilosis among blood cultures, 13 of 170 blood cultures contained C. parapsilosis (6.6% among all yeasts from blood cultures). C. parapsilosis was the second commonest fungal organism isolated from blood cultures (after C. albicans) in our cancer center. Infected vascular catheters were surprisingly not the major risk factor: central venous catheters were documented as a source in two cases only. The commonest risk factors were similar to those occurring with other fungemias--such as preceding antimicrobial therapy (62.5%), neutropenia (50%) and prior prophylaxis with azoles.

Adult↗

PubMed1997

Fungaemia due to Fusarium spp. in cancer patients.

Five cases of fungaemia due to Fusarium spp. in cancer patients are described. Two were breakthrough cases, despite ongoing therapy with amphotericin B. Three were caused by Fusarium solani, one by F. oxysporum and one by F. dimerum. Four patients died, three of them despite therapy with amphotericin B for between 5-37 days. We describe only the second reported case of F. dimerum fungaemia. Since 1972, 93 cases of systemic infection with Fusarium spp. have been described: 43 had positive blood cultures and the overall mortality was 72%.

Adult↗

PubMed1997

Risk factors, aetiology, therapy and outcome in 123 episodes of breakthrough bacteraemia and fungaemia during antimicrobial prophylaxis and therapy in cancer patients.

One hundred and twenty-three breakthrough bacteraemias (BB) were defined during a 5-year period in a National Cancer Centre, among 9986 admissions and a total of 979 bacteraemic episodes analysed. Of 123 bacteraemias in 103 patients, 77 were polymicrobial and 116 of the 323 organisms isolated were resistant to currently administered antimicrobial agents. Sixty-seven of the bacteraemic episodes were catheter-associated, as confirmed by the isolation of the same organisms from both blood and catheter tip. The strains isolated most frequently were coagulase-negative staphylococci (30.5%), corynebacteria (10%), Pseudomonas aeruginosa (10%), Enterococcus faecalis (9%) and viridans streptococci (8.5%). Gram-positive aerobes accounted for two-thirds of all micro-organisms isolated during breakthrough bacteraemic and fungaemic episodes. Polymicrobial episodes were associated more frequently with vascular catheters and neutropenia, and had a less favourable outcome than monomicrobial infections. Relapse was associated more frequently with catheter-related episodes, but the overall mortality rate was similar and independent of catheter insertion. Breakthrough bacteraemic and fungaemic episodes were associated more frequently with acute leukaemia. Catheter removal, as an independent variable, and modification of antimicrobial therapy were essential for better outcome.

Anti-Infective Agents↗