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Table 4. Multivariate analysis for prognostic factors of LTLS and CTLS. CTLS Prognostic factor LDH Uric Acid Creatinine WBC Exp B ; 2.06 1.52 1.56 P value 0.001 0.005 LTLS Exp B ; 1.6 1.8 2.32 P value 0.009 0.001.
J clin oncol 1997; 20 4 ; : 383- hernes eh, rossa sd, vaage s, et al epirubicin combined with estramustine phosphate in hormone-resistant prostate cancer: a phase ii study
Structural studies of Group 12 p-bonded complexes have as usual ; been few and far between in 2005.99101 Following on from the dramatic report of the synthesis of the first molecular species containing a ZnZn bond [Cp * ZnZnCp * ] 34 ; [compound 46 ref. 54 ; in the report for 2004], a more efficient method of synthesis has been reported involving the reaction of [Cp * 2Zn] with KH in thf at room temperature.99a Significantly, the new procedure involves a one-pot reaction of a mixture of [Cp * K], ZnCl2 and KH 2: 1: equivalents, respectively ; , giving 34 in 6080% yield. DFT calculations show that the ZnZn bond is comparatively strong ca. 60 kcal mol1 ; and composed mainly of Zn 4s character with very little involvement of the 4p orbitals. p-Arene interactions are responsible for the interesting loose dimerisation of the Zn complex 35 Fig. 16 ; , containing a bifunctional pyrrolylaldiminato ligand. Both 35 and its Mg analogue 36 are monomeric in benzene solution, however, in the case of the Mg complex dimerisation occurs via MN bonds as opposed to p-arene Mg interactions.100 Like Grignard and related Mg reagents, organozinc compounds are key reagents that are frequently encountered in organic synthesis.102104 One of the interesting developments recently introduced has been the use of bis iodozincio ; methane [CH2 ZnI ; 2] 37 ; in the stereospecific and selective preparation of 2- 1-hydroxyalkyl ; -1-alkylcyclopropanols 39 ; from a, b-epoxy ketones 38 ; Scheme 14 ; .101 A fundamental study using neutron and anomalous X-ray scattering shows that 37 is essentially a monomer in thf solution.103
15. Lorusso, V., Pollera, C. F., Antimi, M., Luporini, G., Gridelli, C., Frassineti, G. L., Oliva, C., Pacini, M., and De Lena, M. A Phase II study of gemcitabine in patients with transitional cell carcinoma of the urinary tract previously treated with platinum. Italian Co-operative Group on Bladder Cancer. Eur. J. Cancer, 34: 1208 1212, Moore, M. J., Tannock, I. F., Ernst, D. S., Huan, S., and Murray, N. Gemcitabine; a promising new agent in the treatment of advanced urothelial cancer. J. Clin. Oncol., 15: 34413445, 1997. Laufer, M., Romalingam, S., Schoenberg, M. P., Haisfield-Wolf, M. E., Zuhowski, E. G., Trueheart, I. N., Eisenberger, M. A., Nativ, O., and Egorin, M. J. Intravesical gemcitabine therapy for superficial transitional cell carcinoma of the bladder: a Phase I and pharmacokinetic study. J. Clin. Oncol., 21: 697703, 2003. Torelli, F., Catanzaro, F., Conti, G., Comeri, C. G., Risi, O., Pino, R., Lissoni, G., Borin, R., Minocci, D., Monesi, G., Baresi, A., Perego, S., Caruso, G. M., and Scardino, G. High-dose epirubicin in the prophylactic treatment of T1G2 superficial bladder tumors. Eur. Urol., 39: 1114, 2001. Nomata, K., Noguchi, M., Kanetake, H., Tsuda, N., Hayashi, M., Yamashita, S., Sakuragi, T., Kusaba, Y., and Skindo, K. Intravesical adjuvant chemotherapy for superficial transitional cell bladder carcinoma: results of a randomized trial with epirubicin comparing shortterm versus long-term maintenance treatment. Cancer Chemother. Pharmacol., 50: 266 270, Bassi, P., Spinadin, R., Longo, F., Saraeb, S., Pappagallo, G. L., Zattoni, F., and Pagano, F. Delayed high-dose intravesical epirubicin therapy of superficial bladder cancer. A way to reduce the side effects and increase the efficacy: a Phase II trial. Urol. Int., 68: 216 219, Kawasaki, T., Tomita, Y., Bilim, V., Takeda, M., Takahashi, K., and Kumanishi, T. Abrogation of apoptosis induced by DNA-damaging agents in human bladder-cancer cell lines with p21 WAF1 CIP1 and or p53 gene alterations. Int. J. Cancer, 68: 501505, 1996. Skehan, P., Storeng, R., Scudiero, D., Monks, A., Mc Mahon, J., Vistica, D., Warren, J. T., Bokesch, H., Kenney, S., and Boyd, M. R. New colorimetric cytotoxic assay for anticancer drug screening. J. Natl. Cancer Inst. Bethesda ; , 13: 11071112, 1990. Camaggi, C. M., Strocchi, E., Tamassia, V., Martoni, A., Giovanni, M., Lafelice, G., Canova, N., Marraro, D., Martini, A., and Pannuti, F. Pharmacokinetic studies of 4 -epidoxorubicin in cancer patients with normal and impaired renal function and with hepatic metastases. Cancer Treat. Rep., 66: 1819 1824, Abbruzzese, J. L., Grunewald, R., Weeks, E. A., Gravel, D., Adams, T., Nowak, B., Mineishi, S., Tarassof, P., Satterlee, W., Rabewr, M. N., and Plunkett, W. A Phase I clinical plasma, and cellular pharmacology study of gemcitabine. J. Clin. Oncol., 9: 491 498, Monks, A., Scudiero, D., Skehan, P., Shoemaker, R., Paull, K., Vistica, D., Hose, C., Langley, J., Cronise, P., Vaigro-Wolff, A., GrayGoodrich, M., Campbell, H., Mayo, J., and Boyd, M. Feasibility of a high-flux anticancer drug screen using a diverse panel of cultured human tumor cell lines. J. Natl. Cancer Inst. Bethesda ; , 83: 757766, 1991. Chou, T. C., and Talalay, P. Quantitative analysis of dose-effect relationship: the effect of multiple drugs or enzyme inhibitors. Adv. Enzyme Regul., 22: 2755, 1984. Duthie, S. J., and McMillan, P. Uracil misincorporation in human DNA detected using single gel electrophoresis. Carcinogenesis Lond. ; , 18: 1709 1714, Sternberg, C. N. The treatment of advanced bladder cancer. Ann. Oncol., 6: 113126, 1995. Hinotsu, S., Akaza, H., Isaka, S., Kagava, S., Koiso, K., Kotake, T., Machida, T., Matsumura, Y., Niijima, T., Obata, K., Ohashi, Y., Ohe, H., Shimazaki, J., and Tashiro, K. Intravesical instillation of doxorubicin or epirubicin for chemoprophylaxis of superficial bladder cancer: the fifth study of the Japanese Urological Cancer Res. Group for Adriamycin Farumorubicin. Gan To Kagaku Ryoho, 29: 73 80, Carmichael, J. The role of gemcitabine in the treatment of other tumours. Br. J. Cancer, 78: 2125, 1998.
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The first generation of clinical trials was basically designed to compare preoperative chemotherapy to other approaches, generally with the same regimen administered postoperatively. In many of these trials, survival and recurrence were the primary objectives, a tendency that seems to be changing over time, as a number of surrogates of outcome have become available. Results of these trials are shown in Table 1. Mauriac et al. [3] randomised 272 breast cancer patients to either mastectomy followed by three cycles of epirubicin 50 mg m2 ; , methotrexate and vincristine and three cycles of mitomycin C, thiotepa and vindesine given to only 76% of the patients ; , or six cycles of the same regimen followed by adjusted loco-regional therapy. Overall response and complete clinical response cCR ; rates were 81% and 33%, respectively. Sixty-three per cent of the patients benefited from breastconserving surgery BCS ; after PC, although these rates decreased to 45% after a median follow-up of 124 months. No differences were seen in terms of disease-free survival DFS ; or overall survival OS ; . In Russian trial, 271 breast cancer patients were randomised to either radiotherapy followed by mastectomy and chemotherapy, consisting of six cycles of thiotepa, methotrexate and 5-fluorouracil 5-FU ; TMF ; , or chemoradiation and eplerenone.
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Misjudge. Screening for diseases such as cancer saves both lives and money, but there is a tendency within the general population to not correctly assess their risk of disease and thus to not have regular check ups. Many people are only willing to pay a doctor when they are sick, even though this care may be far more expensive than regular preventative care would have been. The one exception is when extensive publicity, such as that for mammograms, is undertaken. Making regular appointments cheaper, or even free as is done in public systems ; , has been shown to reduce both rates of illness and costs of health care. Conversely, placing the cost of a visit to a general practitioner too low will lead to excessive visits wasting both a patient's and a doctor's time. Thus while some experts believe free doctor visits produce ideal results, most believe that forcing people to pay some fraction of the cost of an appointment is better. When a claim is made, particularly for a sizeable amount, the use of paperwork and bureaucracy can allow insurance companies to avoid payment of the claim or, at a minimum, greatly delay it. Some people simply give up pursuing their claims with their insurance provider. This is a cost-cutting technique employed by some companies; fighting claims legally is actually less expensive in some instances than paying the claims outright. Insurance companies usually do not announce their health insurance premiums more than one year in advance. This means that, if one becomes ill, he or she may find that the premiums have greatly increased. This largely defeats the purpose of having insurance in the eyes of many. However, this is not a concern in many group health plans because there are often laws that prevent companies from charging a single individual in the plan more than others who are enrolled in the same insurance plan. Health insurance is often only widely available at a reasonable cost through an employersponsored group plan. This means that unemployed individuals and self-employed individuals are at an extreme disadvantage and will have to pay for more for their health care. Experimental treatments are generally not covered. This practice is especially criticized by those who have already tried, and not benefited from, all standard medical treatments. Because insurance companies can avoid paying claims for experimental procedures, this has lead some insurers to claim that procedures are still experimental well after they have become standard medical practice. This phenomenon was especially prevalent among private insurance companies after organ transplants, particularly kidney transplants, first became standard medical practice, due to the tremendous costs associated with this procedure and other organ transplantation. This approach to avoiding paying premiums can also undermine medical advances. Health Maintenance Organizations or HMO ; types of health insurance are often criticized for excessive cost-cutting policies that include accountants or other administrators making medical decisions for customers. Rather than allowing such decisions to be made by health care professionals who know which procedures or treatments are necessary, these health plan administrators are dictating medical practice through their refusal to cover claims. As the health care recipient is not directly involved in payment of health care services and 210 and epogen.
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Where t, and rh are the changes in temperature and relative humidity from the standard condition. Kouchiwa's original formula Eqn. 4 has been plotted for two temperatures 20 C and 40 C over the range of relative humidity in Fig. 5. The transition temperatures of PMMA are relatively low at 266 K for glass, 399 K for rubber, while the range for melting is at 433-473 K Pethrick, 1991. The e ects on refractive index induced by changes in temperature and relative humidity for Fresnel lenses in actual applications can be neglected, as the e ects are small, unless very high accuracy in imaging devices is required. The lens may serve as outer cover of the collector, and is air cooled.
Abnormalities of glucose homeostasis, primarily insulin resistance, are common in patients on antiretroviral therapy, with a greater frequency of abnormalities observed in patients receiving PIs. The mechanisms of these abnormalities remain largely undefined. Management includes encouraging weight loss for overweight individuals. Treatment with insulin-sensitizing agents may be beneficial; diabetes treatment guidelines should be followed in HIV-infected individuals. Recent findings in this area include an association of hyperinsulinemia with the dorsocervical fat deposit termed "buffalo hump" in HIV-infected patients Mallon et al, J Acquir Immune Defic Syndr, 2005 ; . This finding indicates that patients with buffalo hump should be closely followed for insulin resistance and diabetes. It also suggests that caution should be exercised when using human growth hormone for treating buffalo hump, since growth hormone is associated with hyperinsulinemia and epoprostenol.
My nephew was a young and very talented musician. Drugs and alcohol played a deadly game with him. He completed suicide at the age of 20. He is loved and missed by all who knew him. I often wonder if Scott would still be alive today if he had been able to get help for his drug and alcohol abuse. He did try to get help through a program that his job offered, but when he asked for the help, he was told that there wasn't anything available to help him at that time. Two months, later Scott took a handful of pills and drank a lot of beer and then took his life with a 12 gauge shot gun in his mouth. 10-28-1976 ~ 08- 17- 1997 Mississippi , USA Aunt Wanda.
Adriamycin, daunomycin, and epirubicin were gifts from Farmitalia Carlo Erba Milan, Italy ; . Idarubicin hydrochloride was purchased from Pharmacia and Upjohn. HMTA Aldrich, Milwaukee, WI ; was freshly dissolved in Milli-Q water as a 50 stock solution. The anthracyclines were dissolved in Milli-Q water to a stock concentration of approximately 1 mM and stored at 20C. Calf thymus DNA was purchased from and eprosartan.
641 We have found that the MTD of paclitaxel in this combination therapy was 75 mg m2 week level 2 ; . However, the actual dose delivered at level 2 was only 64 mg m2 week, since all six patients experienced at least one episode of grade 4 neutropenia that required dose reduction or delay. Thus, we were able to maintain the standard paclitaxel dose intensity commonly used for the platinumpaclitaxel combination, whilst adding an anthracycline. In contrast, the dose intensity of anthracycline in our study seems low 12.5 mg m2 week ; when compared with the doses used by other groups: 25 mg m2 week in the on-going phase III intergroup trial performed by NSGOEORTCNCIC [11]; and 20 mg m2 week in the recently completed phase III trial by AGOGINECO [12]. It is worth noting however, that the latter two studies use epirubicin for which cumulative cardiotoxicity occurs at considerably higher dose levels than for doxorubicin which was used here. For three-drug combinations including doxorubicin in EOC, comparable doses have been used by others [22]. A reduction in toxicity, one of the rationales for using weekly paclitaxel in this schedule, was not achieved. If the observation that weekly paclitaxel is more effective in EOC than threeweekly paclitaxel [21] is confirmed in future studies, our schedule merits further investigation. Paclitaxel and doxorubicin are both eliminated by biliary excretion mediated via P-glycoproteins, and this can result in an increase in the plasma concentration of doxorubicin and its metabolite doxorubicinol [23], which is thought to be responsible for cardiotoxicity, when both drugs are administered concurrently. This pharmacokinetic interference is dose-dependent [23] and in our weekly paclitaxel schedule the paclitaxel dose administered on the same day as doxorubicin is significantly lower than in the previously described 21-day schedules. This may reduce cardiotoxicity, and in our study no patient developed heart failure. There are numerous different histological subtypes of EOC but generally they tend to be treated by the same first-line chemotherapy, i.e. carboplatinpaclitaxel. In some patients with endometrioid histology there can be doubt about the origin of the primary, if for instance there are tumour deposits in both the ovary and the endometrium. These patients might benefit from the addition of doxorubicin to a carboplatinpaclitaxel regimen, because randomised data suggest that a platinumdoxorubicin combination is superior to single-agent platinum in patients with endometrial cancer [24]. There are no randomised controlled trials supporting the use of carboplatinpaclitaxel in endometrial cancer, although phase II data suggest that paclitaxel is active [25]. In summary, the combination of carboplatin, doxorubicin and paclitaxel in patients with EOC is active and its main toxicity is myelosuppression. No cardiotoxicity was observed; grade 2 or 3 fatigue and neurotoxicity occurred in 57% and 41%, respectively. Weekly administration of paclitaxel allows the delivery of a three-drug combination whilst maintaining dose intensity with equivalent toxicity. A weekly paclitaxel dose of 65 mg m2 is recommended for phase II trials of this three-drug combination.
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Fig. 2 Microscopy of urinary sediment. Typical appearance of RBCs in glomerular hematuria: RBCs are small and vary in size, shape, and hemoglobin content and erbitux.
A lumbar puncture, or spinal tap, is a procedure doctors use to remove a small amount of the fluid that surrounds the brain and spinal cord for testing. This fluid is called cerebrospinal fluid. The cerebrospinal fluid is usually clear and contains small amounts of proteins and sugar.
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