Outcome of 3 pregnancies in a patient with chronic myeloid leukemia who received 3 types of tyrosine kinase inhibitors each in different pregnancy: Follow-up of the case with a review of published reports
Alizadeh H.,Kaposi Mor Teaching Hospital |
Jaafar H.,Tawam Hospital |
Kajtar B.,University of Pecs
Annals of Saudi Medicine | Year: 2015
The management of patients with chronic myeloid leukemia (CML) during pregnancy remains a matter of continuous debate. Tyrosine kinase inhibitors (TKIs) have become the standard of care in managing patients with CML. These drugs have a good safety profile, but animal studies have shown that they are potentially teratogenic. Therefore, these drugs are not recommended for use during pregnancy or if a female patient plans to conceive. Despite the extensive clinical experience with TKIs, the available information about the effects of TKIs on fertility, pregnancy, and outcome of babies who were exposed to TKIs during pregnancy and lactation is limited. We reported on 1 female CML patient who conceived 3 times while being on different types of TKIs in each pregnancy. All 3 pregnancies were uneventful, and only 1 of the babies was diagnosed with a minor cardiac malformation at the age of 30 months, which was corrected surgically. © 2015 Annals of Saudi Medicine.
Kolto G.,Kaposi Mor Teaching Hospital |
Vuolteenaho O.,University of Oulu |
Szokodi I.,University of Pecs |
Faludi R.,University of Oulu |
And 6 more authors.
Clinical and Experimental Rheumatology | Year: 2014
Objective. Cardiac involvement is an important determinant of prognosis in systemic sclerosis (SSc). The identification of patients with high risk is of great importance. Our aim was to investigate the diagnostic and prognostic value of circulating concentrations of N-terminal fragments of A- and B-type natriuretic peptides (NT-proANP and NT-proBNP) in patients with SSc. Methods. We prospectively studied 144 patients with SSc and followed them up for five years. Blood was collected for natriuretic peptide measurement at the time of the yearly scheduled cardiological check-up. The occurence of clinically significant cardiac disease was measured as the composite of pulmonary arterial hypertension, cardiac revascularisation, development of left ventricular dysfunction or death. Results. Patients diagnosed with heart ivolvement during the study had significantly higher levels of NT-proANP and NT-proBNP (791.4±379.9 pmol/l vs. 608.0±375.8 pmol/l, p<0.05 and 183.1±162.6 vs. 125.7±117.5 pmol/l, p<0.05, respectively). Receiver-operator-characteristic analysis identified <822.5 pmol/l as the best NT-proANP and <154.5 pmol/l as the best NT-proBNP threshold (sensitivity 56.3%, specificity 79.5%, negative predictive value: 86.4% and sensitivity 50.0%, specificity 76.8%, negative predictive value: 83.7%, respectively). During the follow-up, lower NT-proANP levels were significantly associated with a longer event-free survival (p<0.05), similar but a non-significant trend regarding NT-proBNP levels was also shown (p=0.052) Conclusion. In our cohort, NT-proANP had a supplementary prognostic value for cardiac involvement in systemic sclerosis. In addition, the high negative predictive value of natriuretic peptides supports the more extensive use in identifying SSc patients with high risk of future cardiac involvement. © Clinical and Experimental Rheumatology 2014.
Borka P.,Health-U |
Gyurkovits K.,Kaposi Mor Teaching Hospital |
Bodis J.,University of Pecs
Acta Physiologica Hungarica | Year: 2012
The objective of the study was to investigate the effect of positive expiratory pressure (PEP) and Flutter on expectoration in cystic fibrosis (CF) patients. Data was gathered through 260 treatments with 10 patients (5 female; 19.2 years; BMI: 18.0). Two methods were used alternately, first the patients started with Flutter and proceeded with PEP, and the next occasion they exercised in the reverse order, starting with PEP then continuing with Flutter. During each phase, 5 sets of 10 exhalations were performed. Sputum weight was measured after the use of the first device, and at the end of the treatment. During sessions starting with Flutter 4.0 ± 4.0 g sputum was expectorated, continuing with PEP, an additional 5.2 ± 5.0 g was produced, altogether 9.2 ± 8.2 g. At sessions starting with PEP 7.4 ± 3.7 g was expectorated, continuing with Flutter an additional 0.8 ± 1.4 g, that is 8.2 ± 4.1 g. Comparing the two devices by themselves, PEP proved to be significantly more efficient then Flutter. Comparing the two treatment types it is statistically not proven, which one is preferable using both devices. Conclusively, PEP is significantly more efficient than the Flutter in sputum expectoration among CF patients. The Flutter is a useful supplementary device. © 2012 Akadémiai Kiadó, Budapest.
Lakosi F.,University of Kaposvar |
Antal G.,University of Kaposvar |
Vandulek C.,University of Kaposvar |
Kovacs A.,University of Kaposvar |
And 6 more authors.
Pathology and Oncology Research | Year: 2011
The aim of our pilot study was to demonstrate the feasibility and dosimetric quality of MR-guided HDR prostate brachytherapy in a low-field 0.35T open MRI scanner and to present our initial clinical experiences. 16 patiets with intermediate-to high-risk localized prostate cancer were treated with 46-60 Gy of external beam radiotherapy preceded and/or followed by an 8 Gy MR-guided HDR boost. For interventions an MR compatible custom-made system, coaxial needles and plastic catheters were used. Template reconstruction, trajectory planning, image guidance, contouring and treatment planning were exclusively based on MR images. For treatment planning, dose-point-and anatomy-based inverse planning optimization was used. Image quality was found to be good to excellent in almost all cases. The mean catheter placement accuracy modeled by Rayleigh distribution was 2.9 mm with a sigma value of 2.3 mm. The mean and standard deviation (SD) of the dosimetric results for the target volume were the following: V100:94.2±4.3%, V150:43.9±6.8%, V200:18.5±5.9%. The mean D0.1, D1 and D1 values for the intraprostatic urethra were 117.6±12.5%, 98.5±19.9% and 122.3±16.4%, respectively. Regarding the rectal wall the mean D0.1, D1 and D2 values were 77.3±7.2%, 64.8±7.5%, and 53.2±9.1%, respectively. The mean maximum dose for the inner rectal surface was 53.5±9.2%. No RTOG Grade 3 or worse acute toxicities were observed. Our method seems to be a promising approach for performing feasible, accurate and high-quality MR-guided HDR prostate brachytherapy. To determine the long term side effects and outcome higher number of patients, additional follow-up is needed. © Arányi Lajos Foundation 2011.
Sulkowski M.S.,Johns Hopkins University |
Cooper C.,Ottawa Hospital |
Hunyady B.,Kaposi Mor Teaching Hospital |
Jia J.,Beijing Friendship Hospital |
And 5 more authors.
Nature Reviews Gastroenterology and Hepatology | Year: 2011
HCV infects approximately 2-3% of the global population and is a leading cause of end-stage liver disease and hepatocellular carcinoma. Treatment of HCV infection with Peg-IFN in combination with ribavirin can eradicate HCV infection in 40-90% of patients; however, a major barrier to treatment uptake and delivery is the association of this therapy with frequent and, at times, serious adverse effects. Recognition and effective management of these adverse effects are critical components of the successful treatment of chronic HCV infection. In clinical trials, approximately 10-15% of patients discontinue Peg-IFN and ribavirin therapy due to adverse effects; however, in clinical practice, the rate of treatment discontinuation has been reported to be substantially higher. The off-target effect of Peg-IFN and ribavirin impacts most, if not all, organ systems; the most common adverse effects are hematologic, dermatologic, neurologic, immunologic, gastrointestinal, pulmonary, cardiovascular, and ocular. Regional and global variability exists in the nature of these adverse effects and the strategies employed to ameliorate their impact. This article provides a comprehensive literature review that systematically describes the adverse effects of Peg-IFN-α and ribavirin on various organ systems and, more importantly, recommends consensus approaches to managing those effects. © 2011 Macmillan Publishers Limited. All rights reserved.