clozapine and Lung-Neoplasms

Trapeziometacarpal osteoarthritis is associated with more pain and restrictions than other hand osteoarthritis due to the functional importance of the thumb. While the effectiveness of surgical and pharmacological interventions has been widely examined, there is a lack of specific evidence about conservative non-pharmacological trapeziometacarpal osteoarthritis therapies. The objective of this systematic review was to provide evidence-based knowledge on the effectiveness of physiotherapy and occupational therapy on pain, function and quality of life.. A literature search of Medline, CINAHL, PEDro, OTseeker, EMB Dare Cochrane Database of Systematic Reviews and Cochrane CENTRAL was performed. Randomized and quasi-randomized controlled trials and corresponding systematic reviews, observational studies, pragmatic studies and case-control studies were included. The risk of bias was assessed.. Physical and occupational therapy-related interventions, especially multimodal interventions, seem to be effective to treat pain in patients with trapeziometacarpal osteoarthritis. Pre-fabricated neoprene splints and custom-made thermoplastic splints may reduce pain equally. Single interventions seem not to be effective. Significant evidence for effectiveness on function and quality of life could not be found.. The sole Na. The SUV. Genetic variants of

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Topics: Adrenergic alpha-Antagonists; Antipsychotic Agents; Clozapine; Epinephrine; Gastroesophageal Reflux; Hemodynamics; Humans; Hypotension; Intraoperative Complications; Lung Neoplasms; Male; Middle Aged; Schizophrenia; Tobacco Use Disorder; Vasoconstrictor Agents; Vasopressins

Small-cell lung cancer is a highly aggressive carcinoma, with poorer prognosis in patients with brain metastases. We present the case of a 49-year-old woman diagnosed with a cerebellar tumour which, following surgery, was revealed to be a metastatic small-cell lung carcinoma. Subsequent CT and PET scanning showed a small, isolated 8 mm nodule in the upper lobe of the right lung. The patient was suffering from schizophrenia and has been treated with clozapine for 17 years. Because of the unusual presentation, there was no therapy given for the primary tumour at the time, and systemic therapy or surgery was discussed. However, 18 months later, the nodule was slightly larger (14 mm), and surgery was performed. On pathology examination, the tumour was presented as a typical small-cell carcinoma. Standard chest irradiation with systemic chemotherapy was given. At the time of writing, 39 months after diagnosis of metastatic small-cell carcinoma, the patient is disease free. However, this case is unusual in that a long-term observation of a small stable primary tumour in the lung took place without any therapy being given. This case strongly supports the thesis that small-cell lung cancer may comprise a heterogeneous group of tumours with different biological properties. The proapoptotic effect of clozapine may be also taken into account.

Topics: Antineoplastic Combined Chemotherapy Protocols; Antipsychotic Agents; Brain Neoplasms; Carboplatin; Clozapine; Disease-Free Survival; Etoposide; Female; Humans; Lung Neoplasms; Middle Aged; Radiotherapy; Schizophrenia; Small Cell Lung Carcinoma; Tomography, X-Ray Computed

Despite the frequent use of the antipsychotic medication, clozapine, in chronic treatments of psychiatric patients, there is limited clinical evidence available to guide clinicians in the problematic situation of a chemotherapy-induced blood dyscrasia.. To perform a literature review and add a case report to the available clinical evidence.. We gathered evidence through literature searches on Medline and with the assistance of a medical information specialist from Novartis who searched their internal database. We also report the case of a patient maintained on clozapine treatment despite full-dose chemotherapy (cisplatin and etoposide) for an extensive lung cancer.. The searches returned seven clinically relevant references. These references do not establish a synergistic effect of clozapine and chemotherapy on blood counts. However, it has been shown that clozapine exposure activates common apoptotic pathways shared with anticancer drugs.. Although the meagre clinical evidence precludes drawing any general conclusion as to the safety of maintaining clozapine administration during chemotherapy, it does not point to an obvious worsening of the haematological outcomes.

Topics: Agranulocytosis; Antineoplastic Combined Chemotherapy Protocols; Antipsychotic Agents; Carcinoma, Small Cell; Cisplatin; Clozapine; Comorbidity; Cooperative Behavior; Drug Interactions; Etoposide; Humans; Leukocyte Count; Lung Neoplasms; Neoplasm Staging; Palliative Care; Patient Care Team; Quality of Life; Referral and Consultation; Remission Induction; Schizophrenia, Paranoid

Topics: Agranulocytosis; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Small Cell; Clozapine; Drug Therapy, Combination; Homicide; Humans; Informed Consent; Lung Neoplasms; Male; Middle Aged; Neutropenia; Schizophrenia; Schizophrenic Psychology; Treatment Refusal