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Plzeň, Czech Republic

Vokurka S.,University Hospital in Pilsen | Skardova J.,University Hospital in Pilsen | Hruskova R.,University Hospital in Pilsen | Kabatova-Maxova K.,University Hospital in Pilsen | And 4 more authors.
Medical Science Monitor | Year: 2011

Background: Gelclair is an oral lubricating gel used in the management of oral mucositis (OM). We evaluated its effcacy, tolerance and impact on oral cavity microbial colonization in patients with OM after allogeneic hematopoietic stem cells transplantation. Material/Method: Gelclair was administered in a group of 22 patients with active OM. A control group of 15 patients used other rinsing solutions (chlorhexidine, benzydamine, salvia). Tests with oral cavity swabs for microbiology analysis were performed once a week. Results: The characteristics of OM in both groups were comparable, and rinsing solutions had satisfactory tolerability. There was no difference in the median improvement of oral intake and OM-related pain relief, which was assessed mostly as "slight effect". In the Gelclair group, the effect duration was longer (median 3 [0-5] vs. 1 [0-3] hours, p=0.001). There was signifcant increase of Enterococcus faecalis and Candida sp. colonization of the oral cavity over the course of the hospitalization and signifcantly reduced incidence of such colonization in patients with OM in the Gelclair group: 1/22 (5%) vs. 6/15 (40%), p=0.01. In vitro tests showed inhibited growth of Enterococcus faecalis and Candida sp. colonies within the area of the Gelclair application. Conclusions:Gelclair may be individually helpful in the management of OM and pain in patients after alloge-neic stem cells transplantation. Its use did not lead to worsened oral bacterial and yeast colonization and probably even helped to protect mucosa from Enterococcus and Candida sp. Further studies based on larger cohorts are needed. © Med Sci Monit.

Fiala O.,University Hospital in Pilsen | Pesek M.,University Hospital in Pilsen | Finek J.,University Hospital in Pilsen | Benesova L.,Applied Genomics | And 2 more authors.
Neoplasma | Year: 2013

Molecular targeted therapy based on EGFR tyrosine kinase inhibitors (EGFR-TKI) is currently a state of the art option for management of advanced stage NSCLC. Activating EGFR mutations are preferable for a good treatment response to EGFR-TKI. The presented retrospective study evaluated a clinical observation of EGFR-TKI aiming at its efficacy and safety in comparison to a standard chemotherapy in the first-line treatment of advanced stage NSCLC. Total number of patients with advanced stage (IIIB, IV) EGFR mutation-positive NSCLC was 54 of which 23 were treated with EGFR-TKI and 31 patients with various chemotherapy regimens in the first line. The treatment efficacy was characterized in terms of disease control rate (DCR), progression-free survival (PFS) and overall survival (OS). The comparison of DCR was performed using Fisher's exact test and the differences in survival were tested using log-rank test. DCR for EGFR-TKI treatment was 95.6% vs. 70.9% for chemotherapy (p=0.032). Median of PFS in patients treated with EGFR-TKI was 7.2 months vs. 2.5 months in patients treated with chemotherapy (p<0.001). Median of OS was 14.5 months vs. 21.4 months (p=0.729). EGFR-TKI was associated with higher incidence of skin rash and diarrhoea; chemotherapy was associated with higher incidence of haematologic adverse events and nausea or vomiting. The analysis results showed a favourable DCR and PFS in patients treated with EGFR-TKI in the first line. The nonsignificant difference in OS could be attributed to a cross-over during the patient follow-up as well as the differences in performance status and age between both groups. EGFR-TKI is the optimal choice for the first-line treatment of EGFR mutation-positive NSCLC.

Vojtisek R.,University Hospital in Pilsen | Muzik J.,University Hospital in Pilsen | Slampa P.,Masaryk Memorial Cancer Institute in Brno | Budikova M.,Masaryk University | And 4 more authors.
Reports of Practical Oncology and Radiotherapy | Year: 2014

Aim: To compare radiotherapy plans made according to CT and PET/CT and to investigate the impact of changes in target volumes on tumour control probability (TCP), normal tissue complication probability (NTCP) and the impact of PET/CT on the staging and treatment strategy. Background: Contemporary studies have proven that PET/CT attains higher sensitivity and specificity in the diagnosis of lung cancer and also leads to higher accuracy than CT alone in the process of target volume delineation in NSCLC. Materials and methods: Between October 2009 and March 2012, 31 patients with locally advanced NSCLC, who had been referred to radical radiotherapy were involved in our study. They all underwent planning PET/CT examination. Then we carried out two separate delineations of target volumes and two radiotherapy plans and we compared the following parameters of those plans: staging, treatment purpose, the size of GTV and PTV and the exposure of organs at risk (OAR). TCP and NTCP were also compared. Results: PET/CT information led to a significant decrease in the sizes of target volumes, which had the impact on the radiation exposure of OARs. The reduction of target volume sizes was not reflected in the significant increase of the TCP value. We found that there is a very strong direct linear relationship between all evaluated dosimetric parameters and NTCP values of all evaluated OARs. Conclusions: Our study found that the use of planning PET/CT in the radiotherapy planning of NSCLC has a crucial impact on the precise determination of target volumes, more precise staging of the disease and thus also on possible changes of treatment strategy. © 2013 Greater Poland Cancer Centre.

Brodska P.,University Hospital in Pilsen | Brodska P.,University Hospital rich | Panzner P.,University Hospital in Pilsen | Pizinger K.,University Hospital in Pilsen | Schmid-Grendelmeier P.,University Hospital rich
Dermatitis | Year: 2014

Background: Atopic dermatitis (AD) is a common chronic inflammatory skin disease. Malassezia, the predominant skin microbiota fungus, is considered to exacerbate AD, especially in a subset of patients with head and neck type AD (HNAD). In the present study, the relationship between AD and sensitization to Malassezia antigens was investigated. Methods: We assessed 173 patients with AD. The severity of eczema was determined with Eczema Area and Severity Index (EASI); the type of AD, namely, head and neck type, was reported as well. The total serum IgE and specific IgE to Malassezia were determined and correlated with clinical picture of AD, sex, age, and the EASI. Results: Total IgE was elevated in 77.7% of patients. Specific IgE to Malassezia was positive (≥0.35 kU/L) in 49.1% of patients. Men were significantly more often sensitized to Malassezia antigen (58% of men vs 42% of women; P value, 0.04). Concurrently, 58% of patients with HNAD versus 42% non-HNAD patients had higher levels of specific IgE to Malassezia, this difference being nearly significant (P value, 0.06). Patients with atopy were also more frequently sensitized to Malassezia. No significant relationship between EASI and the level of total IgE or specific IgE to Malassezia was observed. Conclusions: In our population, IgE-mediated sensitization was found in up to 49% of all patients with AD, most common in men and in head and neck type. © 2014 American Contact Dermatitis Society. All Rights Reserved.

Ulc I.,University Hospital in Pilsen | Vancura V.,University Hospital in Pilsen
Cor et Vasa | Year: 2013

In patients with heart failure, left ventricular systolic dysfunction and prolonged QRS complex, cardiac resynchronization therapy (CRT) is a treatment method aimed at restoration of myocardial depolarization synchronicity. However, the extent of clinical and echocardiographic improvement depends on anatomical relations in individual patients, on structural changes in the heart, on intrinsic electrical activation, and on the position of pacing leads. Many parameters of CRT devices may be changed in order to tailor the function of CRT to the needs of a particular patient; the most important among them is AV and VV interval. The largest trials studying CRT used various methods for optimization of these intervals but unequivocal proof of the benefit brought by optimization is still lacking. Many methods were evaluated, most frequently based on echocardiography and intracardiac electrogram interval measurement. However, drawbacks in statistics make the studies of limited value for establishing a reference method or guidance for daily practice. Echocardiography has inherent variability of results and is highly operator dependent. Optimization based on intracardiac electrogram intervals has not proved yet to be of clear benefit above arbitrary AV interval. The most promising method is hemodynamic assessment by finger plethysmography. Measured data are highly reproducible and operator-independentA randomized multicenter double-blind study using finger plethysmography is needed to prove the value of this method and of CRT optimization in general. The measurement of information content in any data suitable for CRT optimization, analysis of reproducibility and general usage of confidence intervals may show other methods appropriate for it, too. The cooperation with a statistician is oftentimes a necessity. © 2013 Published by Elsevier Urban & Partner Sp. z o.o. on behalf of The Czech Society of Cardiology.

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