Motivation Until recently it was considered that 65 years is cutoff for defining patients as elderly, but newer reports indicate that this age limit shift to 70 years of age. Elderly patients with advanced non small cell lung cancer, associated comorbidities and poor performance status represent a specific population and a challenge for use of chemotherapy. Primary aim was to evaluate the impact of mono therapy with oral etoposide on overall survival in elderly patients (≥ 70 years of age) with advanced non small cell lung cancer and poor performance status (PS) ≥ 2 (clinical stage IIIb and IV ), and as well to evaluate tolerability of this therapy. Secondary aim was to evaluate response rate. Methods Retrospectively, medical records of 79 female and male patients with advanced non small cell lung cancer and poor performance status treated with oral etoposide (2x25 mg 20 days/10 days pause) in period from 2007 till 2010 were checked for relevant data. Data regarding demographics, performance status, overall survival, response rates and drug toxicity were collected. For statistical analysis we used Pearson chi-square test, T-test, Kaplan-Meier product limited method and Cox regression. Results Median overall survival (OS) was 31 weeks, in patients with PS 2 overall survival was 34 weeks, and in group with PS 3 was only 24 weeks. Partial response was registered in 20.2% of patients, stable disease in 41.85 % and disease progression in 38% of patients. Treatment was well tolerated, febrile neutropenia and toxic deaths were not registered. Toxic effects didn't have statistically significant influence on OS. Conclusion Oral etoposide used as mono therapy has been shown as moderate effective and very safe in treating elderly patients with advanced non small cell lung cancer and poor performance status so it represents a good therapy option for treating this specific population., Zoran Andrić, Vladimir Kovčin, Slobodanka Crevar, Zafir Murtezani, Sanja Kostić, and Literatura
Cíl práce: Aktuální pohled na těhotné s roztroušenou sklerózou (RS), analýza výsledků těhotenství těchto nemocných ve FN Motol v letech 2003-2011. Typ studie: Retrospektivní analýza Soubor a metodika: Analýza 76 těhotenství pacientek s relaps-remitentní formou roztroušené sklerózy – posouzení vlivu gravidity na aktivitu onemocnění (použitá analgezie a laktace ve vztahu ke vzniku akutní ataky) a naopak vlivu onemocnění na průběh těhotenství (komplikace, vedení porodu a perinatální výsledky). Výsledky: Akutní ataka v graviditě se v souboru 76 žen vyskytla u 4 z nich (5,3 %, RR 0,08), do půl roku po porodu jsme akutní ataku zaznamenali u 17 žen (22,4 %, RR 0,46). Ataku mělo 18,4 % kojících žen (9/49) ve srovnání s 33,3 % žen (8/24), které nekojily, p = 0,2375 (OR = 0,45, 95 % CI 0,15-1,37). Epidurální analgezii k porodu mělo 13,6 % žen (3/22) s akutní atakou, 25,9 % žen (14/54) s atakou po porodu bylo bez analgezie, p = 0,3648 (OR = 0,45,95 % CI 0,12-1,76). Zhoršení choroby jsme neprokázali (EDSS 1,4, resp. EDSS 1,6). 75 % těhotenství bylo ukončeno nekomplikovaným vaginálním porodem. Výskyt závažných těhotenských komplikací nebyl zvýšen a perinatální výsledky byly srovnatelné s běžnou populací. Závěr: V souladu s recentními studiemi prokazujeme v našem souboru pokles aktivity choroby v graviditě s nárůstem počtu akutních atak po porodu. Ke zhoršení či progresi onemocnění však během 12 měsíců po porodu nedochází. Kojení ani použití epidurální analgezie nemá na vznik akutní ataky vliv, těhotenství probíhají ve většině případů fyziologicky, vedení porodu a novorozenecké výsledky se neliší od běžné populace. Gravidita je tedy pro stabilizované pacientky s relaps-remitentní formou RS bezpečná., Objective: Current view on pregnant women with multiple sclerosis (MS), the analysis of pregnancy outcomes of these women with MS in the Motol Hospital in the years 2003-2011. Design: Retrospective analysis Methods: Analysis of 76 pregnant women with MS – to assess the impact of pregnancy on the activity of the disease (breastfeeding and used analgesia in relation on the relapse rate post partum) and the impact of the disease on the course of pregnancy (pregnancy complications, differences in the management of labor, and perinatal outcomes). Results: Relapse during pregnancy occurred in 4 out of the 76 women (5.3% relapse rate – RR 0.08). 17 women experienced a post partum relapse in the first six months after delivery (22.4%, RR 0.46). 18.4% breastfeeding women (9/49, 18.4%) had post partum relapse in comparison with 33.3% women, who did not breastfeed (8/24, 33.3%), p = 0.2375 (OR=0.45, 95% CI 0.15-1.37). 13.6% women (3/22, 13.6%) with post partum relapse used epidural analgesia (EDA), 25.9% women (14/54, 25.9%) with relapse did not used it, p = 0.3648 (OR = 0.45, 95% CI 0.12-1.76). Pregnancy did not influence the progress of disability (EDSS 1.4 or EDSS 1.6). 75% women had uncomplicated vaginal delivery, the incidence of serious pregnancy complications was not increased, and the perinatal outcomes are comparable with the general population. Conclusion: Consistent with recent studies, we evaluated decreasing relapse rate during pregnancy. In the post partum period the relapse rate has increased, however the pregnancy did not influence the disability progress in 12 months postpartum. Neither breastfeeding nor epidural analgesia correlated with presence of post partum relapses. In most cases, the pregnancies in patients with MS were physiological, the method of delivery and the overall perinatal outcomes are comparable with the general population. There is no need to worry about pregnancy in stabilized patients with MS., P. Hanulíková, R. Vlk, E. Meluzínová, L. Rob, and Literatura