Asunto(s)
Carcinoma Hepatocelular/tratamiento farmacológico , Etanol/uso terapéutico , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/tratamiento farmacológico , Vena Porta , Trombosis de la Vena/complicaciones , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/diagnóstico por imagen , Etanol/administración & dosificación , Estudios de Seguimiento , Humanos , Inyecciones Subcutáneas , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Factores de Tiempo , Ultrasonografía Doppler , Trombosis de la Vena/diagnóstico por imagenAsunto(s)
Antineoplásicos/administración & dosificación , Etanol/administración & dosificación , Neoplasias Hepáticas/tratamiento farmacológico , Anciano , Femenino , Humanos , Inyecciones Intralesiones/métodos , Masculino , Soluciones Esclerosantes/administración & dosificación , Técnicas EstereotáxicasAsunto(s)
Leucemia-Linfoma de Células T del Adulto/etnología , Adulto , Femenino , Francia , Humanos , Marruecos/etnologíaRESUMEN
Eighteen dogs were studied to determine the presence, extent and evolution of tissue lesions related to extracorporeal lithotripsy of the gallbladder under conditions similar to those encountered in clinical practice (electrohydraulic generator, ultrasonographic localization, prone positioning and 2,500 shocks delivered per session). Twelve dogs underwent lithotripsy 14 days after implantation of a 9 to 14 millimeter human stone in the gallbladder. The dogs were sacrificed one, 14 and 28 days after lithotripsy (four dogs at each date). Two dogs underwent implantation of stone but not lithotripsy and were sacrificed 14 days later. The last four dogs received only shock wave therapy and were sacrificed one (two dogs) and 14 (two dogs) days later. All calculi were completely fragmented into pieces less than 5 millimeters. Increases in leukocyte count (11 +/- 3.7 10(9) per liter) and alanine and aspartate aminotransferase levels (206 +/- 139 and 156 +/- 164 international units per deciliter, respectively) were seen after lithotripsy (p less than 0.05), but returned to normal during the next four weeks. Macroscopic hemorrhages were noted only in the dogs having undergone lithotripsy and were exclusively located in the organs lying in the path of the shock wave. Macroscopic hemorrhages were found in all six dogs sacrificed the day after lithotripsy and in two of the six dogs sacrificed 14 days later; one dog of the four sacrificed 28 days after lithotripsy still showed a large hemorrhage in the wall of the gallbladder. Microscopic abnormalities included congestion and hemorrhage of the same organs; although more discrete, congestion and hemorrhage were still present one month after shock wave therapy. Early and localized pulmonary fibrosis at the hypercellular stage was noted in two of the four dogs sacrificed at 28 days. The clinical implications for biliary lithotripsy upon humans include the necessity for intact coagulation parameters, strict avoidance of the bases of the lungs in targeting the stone and performing an ultrasonographic assessment of the wall of the gallbladder before repeating lithotripsy sessions, month apart.
Asunto(s)
Colelitiasis/terapia , Enfermedades de la Vesícula Biliar/etiología , Hemorragia Gastrointestinal/etiología , Litotricia/efectos adversos , Alanina Transaminasa/sangre , Animales , Aspartato Aminotransferasas/sangre , Perros , Enfermedades de la Vesícula Biliar/patología , Hemorragia Gastrointestinal/patología , Hemorragia/etiología , Hemorragia/patología , Enfermedades Renales/etiología , Enfermedades Renales/patología , Recuento de Leucocitos , Hepatopatías/etiología , Hepatopatías/patología , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/patologíaRESUMEN
Forceps biopsies of biliary stenoses are difficult to direct under fluoroscopy and for this reason may give spurious results. In addition, fluoroscopy does not prevent the electrohydraulic lithotripsy (EHL) probe from damaging the bile duct wall. Retrograde biliary endoscopy with the ultrathin endoscope (UTE) was tested in 12 patients to guide biopsies and in 6 patients to guide EHL. Results of biopsies were confirmed by surgery or the disease course in each of the 12 patients. Only one stone could not be fragmented and removed because the EHL probe could not be properly placed. The diagnosis of biliary stenosis may be markedly enhanced by using a UTE although at the risk of an endoscopic sphincterotomy and subsequent biliary infection. EHL with UTE is difficult and time consuming but further technical development may make it more practical immediately following sphincterotomy.
Asunto(s)
Conducto Colédoco/patología , Endoscopía/métodos , Cálculos Biliares/terapia , Litotricia , Anciano , Anciano de 80 o más Años , Biopsia , Colangiografía , Conducto Colédoco/diagnóstico por imagen , Enfermedades del Conducto Colédoco/diagnóstico por imagen , Enfermedades del Conducto Colédoco/patología , Enfermedades del Conducto Colédoco/terapia , Constricción Patológica/patología , Femenino , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
This 4 year study reports on a pharmacokinetic study for the widely used regimen of cis-platin plus continuous 5-day 5-FU as first-line chemotherapy of head and neck cancer, and the benefit of such data for real-time therapy management. Pharmacokinetic analysis of 177 cycles for 77 patients from a group of 89 patients (group 1; 228 cycles) revealed that both the time-concentration product (AUC) for the entire cycle and the half-cycle AUC (AUC0-3 days) were predictive of cycle toxicity. Real-time analysis of individual AUC0-3 days was used to decide whether to reduce the dose during the second half of the cycle for a total of 249 cycles (81 patients; group 2). The dose in the second half of the course was reduced in 40% of the group 2 courses. There was a statistical difference in complete response rates between group 1 (31%) and group 2 (47%), (0.02 less than P less than 0.05) and a statistically significant reduction was observed in the incidence of toxic cycles (greater than grade 2, group 1 = 20% versus group 2 = 12.4%; 0.02 less than P less than 0.05). Pharmacokinetic follow-up of these patients has proved to be an objective means to improve therapeutic index significantly.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Fluorouracilo/farmacocinética , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Esquema de Medicación , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
The authors report a case of mycotic osteitis of the upper maxillary bone due to Candida Albicans occurring in a 56 year old female patient under treatment for chronic myeloid leukemia. The etiologically difficult diagnosis could only be confirmed after deep surgical biopsy with mycological study of a fragment. A review of the literature confirmed the rarity of upper maxillary involvement by Candida Albicans. Particularly when there is isolated involvement and no evidence of a distant primary focus. The differential diagnosis essentially includes centro-facial malignant granuloma.
Asunto(s)
Candidiasis/complicaciones , Huesos Faciales , Osteítis/etiología , Anfotericina B/uso terapéutico , Candidiasis/diagnóstico , Candidiasis/terapia , Diagnóstico Diferencial , Femenino , Flucitosina/uso terapéutico , Granuloma Letal de la Línea Media/diagnóstico , Humanos , Síndromes de Inmunodeficiencia/complicaciones , Persona de Mediana Edad , Osteítis/diagnóstico , Osteítis/terapiaRESUMEN
The aim of this study was to test cisplatinum and 5-FU chemotherapy. Thirty-five patients with epidermoid or undifferentiated lung carcinoma were entered in a multicentric phase II trial, in an attempt to further define the activity and toxicity of this association. None of them had been previously treated by chemotherapy. The dosage schedule was cisplatinum 100 mg/m2 D1 and 5-FU 1 g/m2 D1 to D5 every 3 weeks for 3 courses before evaluation. There were CR: 2, PR: 10, for a total response rate of 35%. Median survival was 7 months. Tolerance was acceptable. We conclude that this association can be safely administered, but that the results are not superior to others previously reported. Further studies are required to define the activity of a cisplatinum, 5-FU and radiotherapy association.
Asunto(s)
Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Escamosas/tratamiento farmacológico , Cisplatino/administración & dosificación , Fluorouracilo/administración & dosificación , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Pequeñas/radioterapia , Carcinoma de Células Escamosas/radioterapia , Cisplatino/efectos adversos , Cisplatino/uso terapéutico , Terapia Combinada , Fluorouracilo/efectos adversos , Fluorouracilo/uso terapéutico , Humanos , Neoplasias Pulmonares/radioterapia , Persona de Mediana Edad , Estudios Multicéntricos como AsuntoAsunto(s)
Enfermedades de las Vías Biliares/terapia , Drenaje/instrumentación , Endoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de las Vías Biliares/radioterapia , Enfermedades de las Vías Biliares/cirugía , Terapia Combinada , Femenino , Humanos , Masculino , Prótesis e Implantes , Férulas (Fijadores)RESUMEN
In 11 patients stones in the common bile duct or in intrahepatic bile ducts could not be extracted by the retrograde route after endoscopic sphincterotomy. Electro-hydraulic lithotripsy was then attempted, using the retrograde route in 4 cases, the transhepatic route in 3 cases and the extracorporeal shock wave technique in 7 cases. The stones could be divided into fragments small enough to be extracted in all patients. The respective indications of the 3 types of electro-hydraulic biliary lithotripsy are discussed.