University Hospital Bulovka Prague

Prague, Czech Republic

University Hospital Bulovka Prague

Prague, Czech Republic
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Halamka M.,University of Ostrava | Cvek J.,University of Ostrava | Kubes J.,University Hospital Bulovka Prague | Zavadova E.,Charles University | And 4 more authors.
Oral Oncology | Year: 2011

Celebrex and radiotherapy in advanced head and neck cancer. This phase I dose-escalation study seeks to determine the phase II recommended dose of cyclooxygenase type 2 (COX-2) inhibitor in patients with locally advanced squamous cell head and neck (H&N) cancer, treated with accelerated radiotherapy. Anti-vasculogenic effect of this treatment on serum vascular endothelial growth factor (VEGF) is examined. Patients were irradiated with curative intent (72 Gy in 6 weeks). Celecoxib was administered throughout the radiotherapy course. Serum VEGF level were tested during radiotherapy and in follow-up. Tumor specimens were stained to quantify the COX-2 expression. Thirty-two patients completed the treatment. The dose of celecoxib was escalated (200, 400 and 800 mg bid, then de-escalated to 600 mg bid). The acute toxicity related to the treatment in the first and second cohort did not reach grade III; in the third cohort three patients had grade III radiation toxicity and one had celecoxib-related toxicity. In the last fourth cohort the toxicity was acceptable. Significant VEGF level drop (p = 0.011) was found between radiation day 1 and post-treatment visit. Significant decrease (p = 0.022) of the VEGF level was shown in patients with high COX-2 expression in the tumor. Phase II recommended dose of celecoxib combined with accelerated radiotherapy in advanced H&N cancer was 600 mg bid. A significant decrease of the post-treatment serum VEGF level compared to the initial level was noticed only in patients with high COX-2 expression in tumors. © 2011 Elsevier Ltd. All rights reserved.


PubMed | University Hospital Bulovka Prague
Type: Case Reports | Journal: Klinicka mikrobiologie a infekcni lekarstvi | Year: 2011

In common practice, toxoplasmosis may be a source of frequent diagnostic and therapeutic dilemmas. Three case reports are presented, illustrating the most frequent non-standard situations resulting in erroneous interpretation of findings and therapeutic decisions. The first case was false or non-specific positivity of antibodies of several classes, leading to a heavy mental burden and wrong prenatal therapy in a pregnant patient. In the second case, persistent low IgG avidity was not interpreted in the context of other results, leading to a hasty decision to terminate the pregnancy. The third case report describes a wrong combination of therapy resulting in the development of numerous adverse effects in a young patient with repeated abortions.


PubMed | University Hospital Bulovka Prague
Type: Case Reports | Journal: Klinicka mikrobiologie a infekcni lekarstvi | Year: 2011

Inhalation of fluticasone is usually devoid of systemic side-effects. The authors describe a case of a young HIV positive woman treated concomitantly with fluticasone and inhibitors of HIV protease ritonavir and lopinavir in which developed a serious endocrine side-effect - an iatrogenic Cushings syndrome. Plasma concentration of cortisol < 5.5 nmol/l was very low (norm 250-650 nmol/l) and plasmatic ACTH was even not detectable. The administration of fluticasone and both inhibitors of HIV protease was stopped and substitution therapy with decreasing dose of hydrocortisone was initiated. Twenty weeks later resolved both clinical and laboratory symptoms of Cushings syndrome, and the substitution therapy with hydrocortisone was terminated. Two years later became the patient pregnant and gave birth to a healthy child.

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