Posted by James
5-FU is a synthetic analogous of pyrimidine. In the body it turns to fluorouridilate first and then to fluo-rodeoxyuridilate. 5-FU gains affectivity after this transformation. Its active metabolite prevents DNA synthesis by inhibiting thymidilate synthetase. Also, fluorouridilate formed in the body participates in the structure of RNA and disturbs this structure and protein synthesis. 5-FU has a stronger cytotoxic affect on proliferating cells than resting ones. After intravenous administration, 5-FU quickly delivers to all tissues. It has a plasma half-life ranging 5-20 minutes.
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Posted by James
Seventy-eight (71.7%) of the courses were given to male and 21 (28.3%) were given to female subjects. Cryotherapy was administered in 45.5% of the courses. After the chemotherapy treatment, mucositis was observed in 24.2% of courses (Table 1).
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Posted by James
In a total of 99 courses, 5-FU and folinic acid combination chemotherapy was given to 40 patients. The mean age of these patients was 54.17 ± 14.19 years (ranged 20-77 years). The cases were carcinomas of the colon, rectum, stomach, head of pancreas, cecum, sigmoid, neuroendocrine tumors, and metastatic tumors of unknown origin of the liver. Every chemotherapy course was considered a single case, and mucositis was judged by a physician on the fifth, 10th, 15th and 21st days of the course according to the World Health Organization’s (WHO) toxicity criteria. The manifestations of mucositis rank from 0 to IV Grade 0: no symptoms; Grade I: painless ulcers, erythema or mild soreness; Grade II: painful erythema, edema or ulcers, but the patient can eat solid meal; Grade III: painful erythema, edema or ulcers, and the patient cannot eat solid meal; Grade IV: requires parenteral or enteral support.
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Posted by James
INTRODUCTION
5-fluorouracil (5-FU) is used in the treatment of solid tumors, including stomach, colon, rectum, breast and pancreas carcinomas. One of the most common and important side effects of 5-FU is mucositis with ulcerations in the oral cavity. The addition of folinic acid to 5-FU increases the efficacy of the drug in the treatment; however, the frequency of mucositis also increases. The prevalence of mucositis in patients undergoing standard-dose chemotherapy is approximately 40%, and this ratio exceeds 50% in high-dose chemotherapy protocols. Mucositis-associated pain is one of the main sources of cancer treatment-related pain. Mucositis prevents oral feeding of the patients and deteriorates their performance. In some of the patients with mucositis, pain and oral dysfunction are of such severity that they require narcotic analgesia and supplemental nutrition. Also, worsening mucositis correlates with longer hospital stays and thereby increases the cost of cancer therapy. There are several studies concerning the prevention of mucositis in patients treated with 5-FU. It was hypothesized that cryotherapy would cause local vasoconstriction and therefore reduce the uptake of chemotherapeutic agents into mucosal cells during the short half-life of 5-FU. Mahood et al. initially tested the efficacy of cooling the oral mucosa with ice chips during bolus application of 5-FU in a randomized crossover trial and observed a 50% reduction in the severity and duration of 5-FU-induced mucositis. Subsequently, Cascinu et al. .conducted a randomized controlled trial in a sample of 84 patients receiving bolus 5-FU and demonstrated that incidence and severity of mucositis is significantly low in cryotherapy group compared with control patients.
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Posted by James
METHODS Over a one-month period, every other patient who attended the general medicine clinics at Grady Memorial Hospital was screened for the presence of CHD. The clinic was staffed by 140 interns and residents from the Emory University Internal Medicine Residency Program under the supervision of 40 general medicine Emory University attendings. Clinics were held daily with morning and afternoon clinic sessions. One-hundred-forty-seven patients with a clinical diagnosis of CHD were identified after excluding 35 CHD patients with dementia, terminal illness or cancer. Clinical and demographic data (age, gender and race) were collected on all patients by a single, trained chart reviewer. A documented diagnosis of CHD was defined by coronary disease proven by cardiac catheterization, a positive stress test or physician documentation of prior myocardial infarction. Read the rest of this entry »
Posted by James
Demographics One-hundred-forty-seven patients were identified as having CHD. The mean age of the patients was 66 ± 11 years, and 54.4% of the patients were women. The majority (91.8%) of the patients were African-American. Most patients were indigent and few had private insurance. The comorbidities of the patients are displayed in Table 1. In general, there was a high incidence of hypertension (99.3%), diabetes (46.2%) and heart failure (29.9%). Read the rest of this entry »
Posted by James
The frequency of lipid-lowering therapy (74.8%) in patients with CHD in this outpatient setting was relatively high but not as high as the frequency of patients on aspirin or antiplatelet therapy (88.4%). More than one-quarter of the patients in this cohort were not on any lipid-lowering therapy. In addition, only 55 patients (45.8%) were at a goal LDL <100 mg/dl. There was a significant proportion of patients that had LDL values from 100-129 mg/dl. At the time of this study, NCEP II provided the current practice guidelines. These recommendations called for an LDL <100 mg/dl for patients with known CHD and to consider drug therapy if LDL was greater than 130 mg/dl. NCEP III recommendations currently published have maintained an LDL goal <100 mg/dl with a consideration of drug therapy for those with LDL levels between 100-129 mg/dl.
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