ABSTRACT
INTRODUCTION: The safety and efficacy of CRS + HIPEC combined with urinary tract resection and reconstruction are controversial. This study aims to summarize the clinicopathological features and to evaluate the safety and survival prognosis of CRS + HIPEC combined with urinary tract resection and reconstruction. METHODS: The patients who underwent urinary tract resection and reconstruction as part of CRS surgery were retrospectively selected from our disease-specific database for analysis. The clinicopathological characteristics, treatment-related variables, perioperative adverse events (AEs), and survival outcomes were studied using a descriptive approach and the K-M analysis with log-rank comparison. RESULTS: Forty-nine patients were enrolled. Perioperative serious AEs (SAEs) were observed in 11 patients (22.4%), with urinary SAEs occurring in 3 patients (6.1%). Additionally, there were 23 cases (46.8%) involving urinary adverse events (UAEs). The median overall survival (OS) in the entire cohort was 59.2 (95%CI: 42.1-76.4) months. The median OS of the UAE group and No-UAE group were 59.2 months (95%CI not reached), and 50.5 (95%CI: 11.5 to 89.6) months, respectively, with no significant difference (P = 0.475). Furthermore, there were no significant differences in OS based on the grade of UAEs or the number of UAEs (P = 0.562 and P = 0.622, respectively). CONCLUSION: The combination of CRS + HIPEC with urinary tract resection and reconstruction is associated with a high incidence of Grade I-II UAEs, which do not have an impact on OS. The safety profile of this combined technique is acceptable. However, this is a retrospective single-center single-arm analysis, with limitations of generalizability and potential selection bias. The findings need high-level validation.
Subject(s)
Cytoreduction Surgical Procedures , Hyperthermia, Induced , Hyperthermic Intraperitoneal Chemotherapy , Humans , Retrospective Studies , Female , Male , Middle Aged , Survival Rate , Prognosis , Aged , Hyperthermia, Induced/methods , Hyperthermia, Induced/adverse effects , Hyperthermia, Induced/mortality , Hyperthermic Intraperitoneal Chemotherapy/methods , Follow-Up Studies , Adult , Cytoreduction Surgical Procedures/methods , Cytoreduction Surgical Procedures/adverse effects , Cytoreduction Surgical Procedures/mortality , Combined Modality Therapy , Peritoneal Neoplasms/therapy , Peritoneal Neoplasms/mortality , Peritoneal Neoplasms/pathology , Urinary Tract/surgery , Urinary Tract/pathology , Urologic Surgical Procedures/methods , Plastic Surgery Procedures/methods , Postoperative Complications/etiologyABSTRACT
Purpose The aim of this study is to assess for the first time, the role of regional deep hyperthermia in combination with radiotherapy and systemic therapy in patients with poor prognosis of brain metastases (GPI ≤ 2.5). Methods Patients with confirmed cerebral metastases and classified as GPI score ≤ 2.5 were included in this prospective study. Pretreatment stratification was defined as patients with 01 GPI score (Group A) and patients with 1.52.5 GPI score (Group B). HT was applied twice a week, 60 min per session, during RT by regional capacitive device (HY-DEEP 600WM system) at 13.56 MHz radiofrequency. Results Between June 2015 and June 2017, 15 patients and a total of 49 brain metastases were included in the protocol. All patients received all HT sessions as planned. RT and systemic therapy were also completed as prescribed. Tolerance to treatment was excellent and no toxicity was registered. Patients with HT effective treatment time longer than the median (W90time > 88%) showed better actuarial PFS at 6 and 12 months (100% and 66.7%, respectively) compared to those with less HT effective treatment time (50% and 0%, respectively) (p < 0.031). Median OS was 6 months (range 136 months). Stratification by GPI score showed a median OS of 3 months (CI 95% 2.493.51) in Group A and 8.0 months (CI 95% 5.1510.41) in Group B (p = 0.035). Conclusions Regional hyperthermia is a feasible and safe technique to be used in combination with RT in brain metastases patients, improving PFS and survival in poor prognostic brain metastasis patients (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Brain Neoplasms/drug therapy , Brain Neoplasms/mortality , Cranial Irradiation/methods , Hyperthermia, Induced/methods , Antineoplastic Agents/therapeutic use , Brain Neoplasms/secondary , Combined Modality Therapy , Cranial Irradiation/mortality , Disease Progression , Feasibility Studies , Hyperthermia, Induced/mortality , Prognosis , Progression-Free Survival , Radiotherapy Dosage , Prospective StudiesABSTRACT
El Síndrome Neuroléptico Maligno es una enfermedad rara pero con alta mortalidad, por lo cual es conveniente tenerla presente ante la aparición de un cuadro de hipertermia inducido por drogas. En ocasiones la presentación clínica suele ser indistinguible de una Hipertermia Maligna, si bien su mecanismo fisiopatológico es completamente diferente. Sus características clínicas comprenden hipertermia, rigidez muscular, elevación de la creatininfosfoquinasa (C.P.K.) además de mioglobinemia y mioglobinuria, como consecuencia de la rabdomiólisis. En esta recopilación mencionaremos su fisiopatología, etiología, criterios clínicos, su relación con Hipertermia maligna y los detalles de su tratamiento.
Subject(s)
Humans , Diagnosis, Differential , Dopamine Antagonists/adverse effects , Hyperthermia, Induced/adverse effects , Hyperthermia, Induced/mortality , Recurrence , Neuroleptic Malignant Syndrome/etiology , Neuroleptic Malignant Syndrome/physiopathology , Neuroleptic Malignant Syndrome/therapy , Antipsychotic Agents , Antipsychotic Agents/adverse effects , Cholinergic Antagonists/toxicity , Catatonia/diagnosis , Catatonia/mortality , Dantrolene/therapeutic use , Encephalitis, Viral/diagnosis , Muscle Rigidity/etiology , Risk Factors , Serotonin Syndrome/congenitalABSTRACT
El Síndrome Neuroléptico Maligno es una enfermedad rara pero con alta mortalidad, por lo cual es conveniente tenerla presente ante la aparición de un cuadro de hipertermia inducido por drogas. En ocasiones la presentación clínica suele ser indistinguible de una Hipertermia Maligna, si bien su mecanismo fisiopatológico es completamente diferente. Sus características clínicas comprenden hipertermia, rigidez muscular, elevación de la creatininfosfoquinasa (C.P.K.) además de mioglobinemia y mioglobinuria, como consecuencia de la rabdomiólisis. En esta recopilación mencionaremos su fisiopatología, etiología, criterios clínicos, su relación con Hipertermia maligna y los detalles de su tratamiento. (AU)
Subject(s)
Humans , Neuroleptic Malignant Syndrome/etiology , Neuroleptic Malignant Syndrome/physiopathology , Neuroleptic Malignant Syndrome/therapy , Hyperthermia, Induced/adverse effects , Hyperthermia, Induced/mortality , Dopamine Antagonists/adverse effects , Diagnosis, Differential , Recurrence , Muscle Rigidity/etiology , Dantrolene/therapeutic use , Antipsychotic Agents , Antipsychotic Agents/adverse effects , Risk Factors , Catatonia/diagnosis , Catatonia/mortality , Serotonin Syndrome/congenital , Encephalitis, Viral/diagnosis , Cholinergic Antagonists/toxicityABSTRACT
El auge de la Drogadicción en las últimas décadas, ademas de evidenciar una intensa problemática social, ha dado lugar a la aparición de una serie de nuevas patologías, las cuales requieren constante investigación. Presentamos en este trabajo la historia clínica de un paciente adicto al Basuco (pasta de coca) en quien se estudio la aparición de granulomas a cuerpo extraño, en tejido linfático cervical. Estos granulomas, han sido aislados en otros tejidos como Celular Subcutáneo, Hígado, Médula Osea, Bazo y Gánglios Linfáticos de diversa localización. Al ser estudiados con luz polarizada, se hallaron cristales birrefringentes en su parte central. Dichos cristales serían resultados del depósito de restos de Hidróxido de Magnesio, contenido en la cocaína no refinada, procesada con diversas sustancias para el logro de la pasta de coca (Basuco o Crack). Para producir granulomas una partícula debe medir entre 1 y 100 Nm en su forma colonial, tomando la transformación de silicato, varios años. Otro aspecto de interés en el caso presentado, lo constituye la coexistencia de Mielofibrosos con la ya mencionada; demostrado una vez más la afectación sistemica producida porla droga. Pensamos que para el Internista de hoy, así como para el médico de otras especialidades, reviste gran interés la descripción de cuadros de este tipo, el cual puede servir de punto de partida para investigaciones ulteriores, en la lucha contra este gran flagelo de la sociedad