ABSTRACT
Apesar de estarmos completando praticamente um século desde a realização da primeira pleurodese, a metodologia não está consensualmente definida. A tendência atual de executarmos procedimentos minimamente invasivos estimulou novas pesquisas com o objetivo de reduzir a agressão, incluindo o uso de novas substâncias, a colocação de drenos mais finos e a redução ou abolição da necessidade de internação hospitalar. Dentre as drogas esclerosantes, o talco tem a preferência mundial. Entretanto, o possível desenvolvimento da síndrome da angústia respiratória, por vezes fatal, fez renascer o interesse por outras drogas. Os quimioterápicos não têm evidente efeito esclerosante e originam importantes efeitos colaterais. Os agentes irritantes hidróxido de sódio e nitrato de prata produzem pleurodese efetiva. Ambos podem ser utilizados em seres humanos
Subject(s)
Humans , Animals , Pleural Effusion/drug therapy , Pleurodesis/methods , Sclerosing Solutions/administration & dosage , Sodium Hydroxide/administration & dosage , Mechlorethamine/administration & dosage , Silver Nitrate/administration & dosage , Talc/administration & dosageABSTRACT
The benefits of radio-chemotherapy in HIV-negative primary central nervous system (CNS) lymphomas were analyzed in 40 patients, who received radiotherapy to the brain or craniospinal axis with the total dose of 4460-5940 cGy to the primary tumor. Radiotherapy was followed by systemic chemotherapy, mainly with the cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) regimen, in 16 of the patients. Follow-up ranged from four to 95 months with a median of 15 months. The relapse rate was 72.5%, and 83% of the relapses occurred within the radiation field. Median survival was 19 months and the two-year survival rate was 41%. Survival was significantly influenced by treatment method and radiation dose when measured by univariate analysis; median survival and the two-year survival rate was 29 months and 63% after radio-chemotherapy, while 13.5 month and 29% after radiotherapy alone (p= 0.027), and 22 months and 49% with doses of 50 Gy or more, but 12.5 months and 13% with doses less than 50 Gy (p=0.009). However, statistical significance was lost in multivariate analysis. These results might suggest the short-term efficacy of radio-chemotherapy, however, cautious observation is needed to confirm long-term effects.
Subject(s)
Adult , Aged , Female , Humans , Male , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Bleomycin/administration & dosage , Central Nervous System Neoplasms/therapy , Central Nervous System Neoplasms/mortality , Cyclophosphamide/administration & dosage , Disease-Free Survival , Doxorubicin/administration & dosage , Epirubicin/administration & dosage , Lymphoma/therapy , Lymphoma/mortality , Mechlorethamine/administration & dosage , Methotrexate/administration & dosage , Middle Aged , Neoplasm Recurrence, Local , Prednisolone/administration & dosage , Procarbazine/administration & dosage , Radiotherapy Dosage , Radiotherapy, Adjuvant/adverse effects , Survival Rate , Treatment Failure , Vincristine/administration & dosageABSTRACT
El tratamiento de la alopecía areata ha cambiado notablemente en la última década. Nuevas opciones terapéuticas están disponibles para los pacientes. Es deber del dermatólogo informar al paciente de todas las alternativas posibles para su caso, sus efectos colaterales y sus cifras de éxito. La decisión final es conjunta, entre el paciente, la familia del paciente (cuando corresponda) y el dermatólogo
Subject(s)
Humans , Adrenal Cortex Hormones/administration & dosage , Adjuvants, Immunologic/administration & dosage , Alopecia Areata/drug therapy , Cyclosporine/administration & dosage , Injections, Intralesional/statistics & numerical data , Inosine Pranobex/administration & dosage , Anthralin/administration & dosage , Azathioprine/administration & dosage , Cryosurgery/statistics & numerical data , Ficusin/administration & dosage , Mechlorethamine/administration & dosage , Minoxidil/administration & dosage , PUVA Therapy/statistics & numerical data , Zinc/administration & dosageABSTRACT
Introducción. En los niños con síndrome nefrótico idiopático corticorresistente (SNCR) se han utilizado diversos tratamientos en base a antimetabolitos como la ciclofosfamida y la mostaza nitrogenada. Este último tratamiento se ha recomendado particularmente en niños con infecciones recurrentes que impiden la indicación de tratamientos prolongados. Material y métodos. Se revisó la respuesta al tratamiento en 10 niños con SNCR que recibieron mostaza nitrogenada durante el período comprendido entre 1988 y 1996. Resultados. Sólo 2 pacientes presentaron remisión del síndrome nefrótico: uno remisión parcial y el otro completa. Dos pacientes presentaron cuadros infecciosos graves (neumonía), en uno de ellos asociado a leucopenia grave. Conclusiones. El tratamiento con mostaza nitrogenada en niños con SNCR no ofrece ventajas aparentes en relación a otros esquemas terapéuticos