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Am J Clin Oncol ; 15(4): 340-3, 1992 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-1514532


Administration of high-dose IL-2 results in hemodynamic changes that are similar to those seen in septic shock. These include a decrease in systemic vascular resistance (SVR) with a resultant drop in mean arterial pressure (MAP). Hypocalcemia is seen in septic shock and with IL-2 administration. Calcium replacement in septic shock has been reported to result in hemodynamic improvement; we therefore administered calcium to patients receiving high dose IL-2 to correct ionized hypocalcemia. Five consecutive patients underwent invasive hemodynamic monitoring before and during IL-2 administration. Calcium chloride was administered to correct ionized hypocalcemia, and hemodynamic parameters were monitored before and after calcium administration. Ionized hypocalcemia was associated with an elevation in parathyroid hormone levels. There was no toxicity related to the administration of calcium. An improvement in the MAP and SVR was seen early and late (after a dose of IL-2 was held) in the IL-2 treatment cycle; there were minimal effects at other points. Because of the potential hemodynamic benefit of calcium replacement, we recommend that ionized hypocalcemia be corrected in patients receiving high-dose IL-2.

Cloruro de Calcio/uso terapéutico , Hemodinámica/efectos de los fármacos , Interleucina-2/efectos adversos , Adulto , Cloruro de Calcio/administración & dosificación , Carcinoma de Células Renales/fisiopatología , Carcinoma de Células Renales/terapia , Femenino , Humanos , Interleucina-2/antagonistas & inhibidores , Interleucina-2/uso terapéutico , Neoplasias Renales/fisiopatología , Neoplasias Renales/terapia , Células Asesinas Activadas por Linfocinas , Masculino , Melanoma/fisiopatología , Melanoma/secundario , Melanoma/terapia , Persona de Mediana Edad
Am J Med Sci ; 274(2): 179-88, 1977.
Artículo en Inglés | MEDLINE | ID: mdl-602958


One hundred and thirty-nine febrile episodes in 120 patients were treated with sisomicin after a combination of carbenicillin and a cephalosporin antibiotic had failed. These patients were randomized to receive sisomicin either by continuous or by intermittent infusion. The response rate for patients treated with sisomicin was 61 percent by continuous infusion and 46 percent by intermittent infusion, which was not statistically significant. Pneumonia, septicemia, and soft tissue infections were the most frequent infections. Most (96 percent) of the identified pathogens were gram-negative bacilli with the most frequent being Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. The response rate was higher in those patients whose neutrophil count increased or remained the same while on therapy. The worst response was obtained if there was a decrease in the neutrophil count during therapy. The major toxicity of sisomicin was found to be azotemia and occurred in 17 percent of episodes treated by continuous infusion and in 21 percent treated by intermittent infusion. Hearing loss in the high frequency range occurred in five patients. Sisomicin is effective in the treatment of gram negative infections in neutropenic cancer patients.

Gentamicinas/administración & dosificación , Sisomicina/administración & dosificación , Adolescente , Adulto , Anciano , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/tratamiento farmacológico , Femenino , Humanos , Infusiones Parenterales , Inyecciones Intravenosas , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Neutropenia/complicaciones , Sisomicina/efectos adversos , Sisomicina/uso terapéutico , Uremia/inducido químicamente
Am J Med Sci ; 273(2): 177-84, 1977.
Artículo en Inglés | MEDLINE | ID: mdl-860733


Amikacin is a new aminoglycoside antibiotic related chemically to kanamycin. It has broad spectrum activity against most gram-negative bacilli. The most important advantage of this aminoglycoside is its activity against gram-negative bacilli which are resistant to gentamicin. Amikacin was given to 22 cancer patients with 24 serious infections produced by gram-negative bacilli resistant to gentamicin and 13 (54 per cent) were cured. Response to amikacin was related to the patients's neutrophil count at the time of infection; neutropenic patients having a lower response rate (30 per cent vs 71 per cent). Side effects included nephrotoxicity (12 per cent) and audiotoxicity (5 per cent). Amikacin is an effective new antibiotic for patients with severe infections produced by gram-negative bacilli resistant to gentamicin.

Amicacina/uso terapéutico , Bacterias/efectos de los fármacos , Infecciones Bacterianas/tratamiento farmacológico , Gentamicinas/farmacología , Kanamicina/análogos & derivados , Adulto , Anciano , Amicacina/sangre , Amicacina/farmacología , Evaluación de Medicamentos , Farmacorresistencia Microbiana , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad