RESUMEN
OBJECTIVE: To evaluate the feasibility and the tolerance of Peritonectomy Procedure (PP) combined with Intraperitoneal Chemohyperthermia (IPCH) in patients with peritoneal carcinomatosis, a phase I-II study has been realised from January 1997 to September 1998. METHODS: Eighteen patients were included for peritoneal carcinomatosis from colorectal cancer (13), ovarian cancer (2), gallbladder cancer (1), gastric cancer (1) and peritoneal mesothelioma (1). Peritoneal carcinomatosis were mainly advanced disease (16 stage 3 and 4, 2 stage 2). All the patients underwent surgical resection of their primary tumor with PP as described by Sugarbaker and IPCH (with Mitomycin C, Cisplatinum or both). IPCH used in this study was a "closed sterile circuit" device with inflow temperatures ranging from 46 to 48 degrees C. IPCH was performed on the same day as PP (8118) or delayed (10/18). RESULTS: Significant down-staging of peritoneal carcinomatosis was achieved for 16 patients. One patient died postoperatively, while the morbidity rate was 6/18 (long postoperative ileus, grade 3 leucopenia and anastomotic leakage). CONCLUSIONS: Combination of PP and IPCH could achieve significant tumoral volume reduction in peritoneal carcinomatosis. This aggressive treatment must be employed selectively because of its morbidity. Larger phase III studies are now needed.
Asunto(s)
Neoplasias Abdominales/secundario , Neoplasias Abdominales/terapia , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/uso terapéutico , Hipertermia Inducida , Mesotelioma/terapia , Mitomicina/uso terapéutico , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/terapia , Neoplasias Abdominales/mortalidad , Neoplasias Abdominales/cirugía , Adulto , Anciano , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Terapia Combinada , Neoplasias del Sistema Digestivo/mortalidad , Neoplasias del Sistema Digestivo/patología , Neoplasias del Sistema Digestivo/terapia , Femenino , Humanos , Hipertermia Inducida/efectos adversos , Mesotelioma/mortalidad , Mesotelioma/patología , Mesotelioma/cirugía , Persona de Mediana Edad , Mitomicina/administración & dosificación , Mitomicina/efectos adversos , Estadificación de Neoplasias , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Neoplasias Ováricas/terapia , Selección de Paciente , Neoplasias Peritoneales/mortalidad , Neoplasias Peritoneales/cirugía , Tasa de Supervivencia , Factores de TiempoRESUMEN
The treatment of severe burns requires repeated and various surgical procedures under general anaesthesias. Requirements differ according to the evolution phase of the burnt lesion. Three first post-traumatic days are marked by a major oedema and a large haemodynamic instability. Hypovolemia during 12 to 24 hours is followed by an hyperkinetic phase. The secondary period can last several weeks to several months before the cutaneous recovery is complete. Septic risk is then major and dénutrition constant. Problems raised by surgery differ according to the type of surgery: early excision of deep bums, bath therapy, skin graft, dressing. These procedures are often haemorrhagic and painful. Thermal status is constantly threatened. This type of pathology interferes with the pharmacology of anaesthetic drugs. Hypoprotidemia and change of protein-binding modify drug kinetics. Continuous use of opiates and sedatives is source of tolerance and tachyphylaxis. The number of acetylcholine receptors is increased, contraindicating the use of depolarizing muscle relaxants and often induces a resistance to the nondepolarizing muscle relaxants. The knowledge of these alteration leads to discuss indications of anaesthetics, analgesics and muscle relaxants most frequently used in these patients. During anaesthesia the positioning of the patient takes into account the surgical needs. Hypothermia prevention is mandatory. Peroperative resuscitation is dominated by maintenance of haemodynamic balance, compensation of hydroelectrolytic and blood losses, treatment of septic complications. Should be the same who has in change the patient in the intensive care unit.
Asunto(s)
Anestesia General/métodos , Quemaduras/terapia , Anestésicos/administración & dosificación , Balneología , Quemaduras/fisiopatología , Desbridamiento , Humanos , Cuidados Intraoperatorios , Ketamina/administración & dosificación , Propofol/administración & dosificación , Choque/prevención & control , Trasplante de PielRESUMEN
Some calcium entry blockers seem to improve the neurological survival of anoxic comas. The early monitoring of intracranial pressure shows the frequency of intracranial hypertension. A calcium channel blocker has been shown to increase the cerebral blood flow which can potentially lead to deleterious increases of the intracranial pressure. This study presents 39 out-of-hospital cardiac arrests resuscitated with success. The intracranial pressures were registered by means of an extra dural screw set up as soon as possible. Nineteen patients received an early continuous 5 days nimodipine treatment (0.58 gamma/kg weight/min. after a 12.3 gamma/kg weight bolus). The other 20 patients did not receive any calcium entry blocker. The two groups were similar in terms of age, origin and electrical type of cardiac arrest, duration of cardiac arrest before BLS and before ACLS, principles of the treatment, initial neurological status and biological values. The maximum and mean intracranial pressures of the nimodipine group were always lower than the intracranial pressure of the control group. The cerebral perfusion pressure was never significantly different in both groups. If the nimodipine treatment proves to be efficient on neurological survival, it would be all the more interesting because it seems to limit the intracranial hypertension phenomenon which aggravates the neurological prognosis.