RESUMO
From the beginning of the cardiovascular surgery to the endovascular era restenosis represents the main problem of several spreading vascular disciplines. It can be considered as an excessive wound healing reaction of target vessel of revascularization procedures, that leads to a new narrowing of the vascular lumen. Restenosis still represents the main limiting factor of the long-term success of revascularization procedures. Prevention and strict follow-up are well established techniques in order to reduce restenosis rate and clinical impact of this condition. New drugs as cilostazol have been proven beneficial for patients with de novo lesions of peripheral arteries and cilostazol seems to avoid restenosis process in the majority of patients.
Assuntos
Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/prevenção & controle , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Animais , Cilostazol , Constrição Patológica/etiologia , Constrição Patológica/prevenção & controle , Humanos , Prevenção Secundária , Tetrazóis/uso terapêutico , Vasodilatadores/uso terapêuticoRESUMO
Twenty-two patients with recurrent melanoma of the limbs, underwent Hyperthermic Antiblastic Perfusion (HAP). HAP lasted 60 min, with maximal local temperature of 40.5-42 degrees C and melphalan 10 mg/L limb volume as antiblastic agent. Fourteen patients had in-transit metastases and 8 local recurrences. Regional nodes were involved in 6 patients. Systemic leakage monitored with 125I or 99Tc ranged between 5 and 30% (mean 19%). No operative mortality nor major complications occurred. Local toxicity scored Wieberdink grade I in 6 patients, grade II in 11 and III in 5. Response rate (UICC) in the 9 patients treated with unexcised lesions was 88% (55% complete responses). After a median follow-up of 27 months (1-92) 9 patients relapsed after a median time of 17 months, and 15 patients are currently disease free, 4 of them being re-excised and one reperfused. Actuarial 5 year survival is 67%, with 45% disease free to the first relapse. Our results are consistent with the literature indicating HAP as a safe procedure with a high evidence of clinical responses.
Assuntos
Antineoplásicos/uso terapêutico , Febre , Melanoma/terapia , Perfusão/métodos , Neoplasias Cutâneas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Perna (Membro) , Metástase Linfática , Masculino , Melanoma/tratamento farmacológico , Melanoma/secundário , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Perfusão/efeitos adversos , Perfusão/mortalidade , Estudos Retrospectivos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
Five patients with intraabdominal ovarian cancer, 4 of whom with concomitant ascites, refractory to cisplatin-containing combination chemotherapy were treated with intraperitoneal cisplatin. Cisplatin, 90 mg/m2, was administered intraperitoneally in 2 liters of warm 0.9% NaCl with a 4-hour dwelling time on day 1 q 21 days. Platinum concentrations in plasma, ascites, ultrafiltrates of plasma and ascites, and urine were assayed by flameless atomic absorption spectrophotometry and determinations were verified by neutron activation analysis. Peak total and ultrafiltrable plasma platinum levels were 1.63 +/- 0.6 and 0.76 +/- 0.3 microgram/ml, respectively. Peritoneal clearance of total platinum (PA) was 21 ml/min whereas body clearance of total platinum was on the average 13.8 times PA, varying from 171 to 429 ml/min; the mean AUC (peritoneum) to AUC (plasma) ratio was 11 +/- 3. In 2 patients control of ascites was obtained, in 1 of these patients prior positive cytology became negative after her first intraperitoneal course. No nephrotoxicity was observed and gastrointestinal toxicity was mild. No catheter-related infections were observed. Intraperitoneal cisplatin therapy is well tolerated, pharmacokinetically rational and may be useful in managing ovarian cancer patients with malignant ascites or minimal residual disease at second-look laparotomy.
Assuntos
Cisplatino/farmacocinética , Neoplasias Ovarianas/tratamento farmacológico , Idoso , Cisplatino/administração & dosagem , Feminino , Humanos , Injeções Intraperitoneais , Pessoa de Meia-Idade , Neoplasias Ovarianas/metabolismoRESUMO
Thirteen uraemic patients having undergone chronic haemodialysis from a minimum of 16 months to a maximum of 15 years (mean 6.5 years) with unsuitable peripheral vessels for standard arteriovenous fistulae, received Hemasite, a new vascular access device which provides vascular access without needle puncture. Eight devices are still being used routinely with enthusiastic acceptance by the patients. Three subjects died because of unrelated causes, two of whom had a functioning device. Nine thromboses occurred in five patients. Thrombectomy was successful in three subjects. There were two cases of infection with loss of one device. In conclusion, the main advantage of Hemasite is the possibility of performing haemodialysis without needles, thus potentially maintaining the longevity of graft fistula. The only disadvantage of the device is its cost.