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1.
J Surg Oncol ; 121(8): 1298-1305, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32239529

RESUMO

BACKGROUND: Peritoneal carcinomatosis of colorectal adenocarcinoma (CRC) origin is common and is the second-most frequent cause of death in colorectal cancer. There is survival benefit to surgical resection plus hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with metastatic CRC. However, there remains controversy between oxaliplatin (Oxali) and mitomycin C (MMC), as the agent of choice. METHODS: A review of our 285 patients prospective HIPEC database from July 2007 to May 2018 identified 48 patients who underwent cytoreductive surgery plus HIPEC with MMC or Oxali. Patients were stratified based on preoperative and postoperative peritoneal cancer indices (PCI). The primary outcomes of survival and progression-free survival were compared. RESULTS: Type of HIPEC chemotherapy was not found to be predictive of overall survival. Preoperative PCI (P = .04), preoperative response to chemotherapy (P = .0001), and postoperative PCI (P = .05) were predictive for overall survival. CONCLUSIONS: MMC or Oxali based HIPEC chemotherapy are both safe and effective for the management of peritoneal only metastatic CRC. Both perfusion therapies should be considered with all patients receiving modern induction chemotherapy.


Assuntos
Neoplasias do Colo/terapia , Hipertermia Induzida/métodos , Mitomicina/administração & dosagem , Oxaliplatina/administração & dosagem , Neoplasias Peritoneais/terapia , Antineoplásicos/administração & dosagem , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia , Estudos Prospectivos , Taxa de Sobrevida
2.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 112-124, Jan.-Mar. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1090547

RESUMO

Abstract Introduction Mitomycin C is a natural antibiotic that has been used to inhibit the proliferation of fibroblasts in scar tissue. Objective To evaluate the effectiveness and safety of topical Mitomycin C as an adjuvant in the endoscopic treatment of laryngotracheal stenoses. Data synthesis A systematic review of experimental or observational studies that have evaluated the treatment of laryngotracheal stenoses with the use of topical Mitomycin C was performed. Databases researched: LILACS, PubMed, Embase, Cochrane and Web of Science. Outcomes: resolution (symptom-free time ≥ one year), number of procedures required, and complications resulting from the procedure. A total of 15 studies (involving 387 patients) were selected. Mitomycin C was administered to every patient in 11 studies, and in 4 other studies, the patients were separated into 2 groups, 1 receiving mitomycin C, and the other not. The resolution of the stenosis evaluated in 12 studies in which the patients received mitomycin C was of 69% (95% confidence interval [95%CI]: 61-76%; I2 = 17.3%). A total of 52% of the patients (95%CI: 39-64%, 11 studies; I2 = 64.7%) were submitted to a single endoscopic procedure, and 48% (95%CI: 36-61%, 11 studies; I2 = 64.7%) were submitted to more than 1 procedure. Complications (mediastinal and subcutaneous emphysema, dysphonia, laceration or vocal fold paralysis and acute light obstruction) were reported in 9% of the patients (95%CI: 3-18%, 9 studies; I2 = 79.8%). Conclusions The evidence suggests that mitomycin C is an effective and safe option in the endoscopic treatment of laryngotracheal stenosis.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Estenose Traqueal/terapia , Laringoestenose/terapia , Mitomicina/uso terapêutico , Laringoscopia/métodos , Administração Tópica , Resultado do Tratamento , Mitomicina/administração & dosagem , Terapia Combinada
3.
Br J Radiol ; 93(1110): 20190407, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32142364

RESUMO

OBJECTIVE: To evaluate the feasibility, efficacy and safety of transcatheter arterial chemoembolization (TACE) with HepaSphere for patients with pulmonary or mediastinal metastases from hepatocellular carcinoma (HCC). METHODS: Between June 2009 and January 2018, 14 patients with pulmonary or mediastinal metastases from HCC were treated with TACE with a combination of 1-3 chemotherapeutic drugs followed by HepaSphere embolization. As first end point, local tumor response and adverse events were evaluated after the first session of TACE, with Response Evaluation Criteria In Solid Tumors v. 1.1 and Common Terminology Criteria for Adverse Events v. 4 criteria, respectively. Overall survival was evaluated as secondary end point. TACE was repeated on-demand. RESULTS: TACE with HepaSphere was well tolerated with acceptable safety profile and no 30 day mortality. 1 month objective response and disease control rate were calculated to be 7.1 and 100%, respectively. Mean tumor size reduction rate was 15.6±9.5% at the first month. Two Grade 3 cytopenia events were seen (14.3 %), however none of the Grade 2 or more post-embolization syndrome was observed. The median overall survival time was 15.0 months and the 1 year, 3 year and 5 year survival rate were, 57.1%, 28.6%, 19.1%, respectively. CONCLUSION: Early experience showed that the transarterial treatment with HepaSphere is safe and effective treatment for patients with pulmonary or mediastinal metastases from HCC. ADVANCES IN KNOWLEDGE: Currently, the effects of molecular targeted drugs on HCC metastases are limited and side-effects are relatively frequent. In the present study, transarterial treatment might be a promising treatment for HCC metastasis.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/terapia , Neoplasias do Mediastino/terapia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/secundário , Cisplatino/administração & dosagem , Estudos de Viabilidade , Feminino , Fluoruracila/administração & dosagem , Humanos , Neoplasias Pulmonares/secundário , Masculino , Neoplasias do Mediastino/secundário , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Retratamento , Carga Tumoral , Adulto Jovem
4.
Cochrane Database Syst Rev ; 1: CD011935, 2020 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-31912907

RESUMO

BACKGROUND: People with urothelial carcinoma of the bladder are at risk for recurrence and progression following transurethral resection of a bladder tumour (TURBT). Mitomycin C (MMC) and Bacillus Calmette-Guérin (BCG) are commonly used, competing forms of intravesical therapy for intermediate- or high-risk non-muscle invasive (Ta and T1) urothelial bladder cancer but their relative merits are somewhat uncertain. OBJECTIVES: To assess the effects of BCG intravesical therapy compared to MMC intravesical therapy for treating intermediate- and high-risk Ta and T1 bladder cancer in adults. SEARCH METHODS: We performed a systematic literature search in multiple databases (CENTRAL, MEDLINE, Embase, Web of Science, Scopus, LILACS), as well as in two clinical trial registries. We searched reference lists of relevant publications and abstract proceedings. We applied no language restrictions. The latest search was conducted in September 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared intravesical BCG with intravesical MMC therapy for non-muscle invasive urothelial bladder cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the literature, extracted data, assessed risk of bias and rated the quality of evidence according to GRADE per outcome. In the meta-analyses, we used the random-effects model. MAIN RESULTS: We identified 12 RCTs comparing BCG versus MMC in participants with intermediate- and high-risk non-muscle invasive bladder tumours (published from 1995 to 2013). In total, 2932 participants were randomised. Time to death from any cause: BCG may make little or no difference on time to death from any cause compared to MMC (hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.79 to 1.20; participants = 1132, studies = 5; 567 participants in the BCG arm and 565 in the MMC arm; low-certainty evidence). This corresponds to 6 fewer deaths (40 fewer to 36 more) per 1000 participants treated with BCG at five years. We downgraded the certainty of the evidence two levels due to study limitations and imprecision. Serious adverse effects: 12/577 participants treated with BCG experienced serious non-fatal adverse effects compared to 4/447 participants in the MMC group. The pooled risk ratio (RR) is 2.31 (95% CI 0.82 to 6.52; participants = 1024, studies = 5; low-certainty evidence). Therefore, BCG may increase the risk for serious adverse effects compared to MMC. This corresponds to nine more serious adverse effects (one fewer to 37 more) with BCG. We downgraded the certainty of the evidence two levels due to study limitations and imprecision. Time to recurrence: BCG may reduce the time to recurrence compared to MMC (HR 0.88, 95% CI 0.71 to 1.09; participants = 2616, studies = 11, 1273 participants in the BCG arm and 1343 in the MMC arm; low-certainty evidence). This corresponds to 41 fewer recurrences (104 fewer to 29 more) with BCG at five years. We downgraded the certainty of the evidence two levels due to study limitations, imprecision and inconsistency. Time to progression: BCG may make little or no difference on time to progression compared to MMC (HR 0.96, 95% CI 0.73 to 1.26; participants = 1622, studies = 6; 804 participants in the BCG arm and 818 in the MMC arm; low-certainty evidence). This corresponds to four fewer progressions (29 fewer to 27 more) with BCG at five years. We downgraded the certainty of the evidence two levels due to study limitations and imprecision. Quality of life: we found very limited data for this outcomes and were unable to estimate an effect size. AUTHORS' CONCLUSIONS: Based on our findings, BCG may reduce the risk of recurrence over time although the Confidence Intervals include the possibility of no difference. It may have no effect on either the risk of progression or risk of death from any cause over time. BCG may cause more serious adverse events although the Confidence Intervals once again include the possibility of no difference. We were unable to determine the impact on quality of life. The certainty of the evidence was consistently low, due to concerns that include possible selection bias, performance bias, given the lack of blinding in these studies, and imprecision.


Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Carcinoma de Células de Transição/tratamento farmacológico , Mitomicina/uso terapêutico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Antibióticos Antineoplásicos/administração & dosagem , Vacina BCG , Humanos , Mitomicina/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Eur J Ophthalmol ; 30(3): NP1-NP6, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30841750

RESUMO

INTRODUCTION: To report the first case of bilateral ocular decompression retinopathy after uneventful non-perforating deep sclerectomy with mitomycin C in a child with tubulointerstitial nephritis and uveitis syndrome. CASE DESCRIPTION: An 8-year-old girl affected by tubulointerstitial nephritis and uveitis syndrome developed ocular hypertension (45 mmHg in the right eye and 42 mmHg in the left eye) associated with recurrent episodes of uveitis and chronic use of steroids despite maximum hypotensive medical treatment. Bilateral non-perforating deep sclerectomy with mitomycin C (0.2 mg/mL, 1 min) was performed under general anesthesia without complications. The first postoperative day, the visual acuity was reduced to 0.6 in the right eye and 0.05 in the left eye and the intraocular pressure was 3 mmHg in both eyes. Fundoscopy revealed bilateral optic nerve swelling and diffuse retinal hemorrhages, some of them with scattered-white centers. About 2 months after surgery, the visual acuity was normal and the fundus examination showed complete resolution. CONCLUSION: The ocular decompression retinopathy is an uncommon complication after non-perforating deep sclerectomy. This is the first case of bilateral ocular decompression retinopathy reported after non-perforating deep sclerectomy in a child with ocular hypertension secondary to recurrent uveitis and chronic use of steroids associated with tubulointerstitial nephritis and uveitis syndrome.


Assuntos
Alquilantes/administração & dosagem , Mitomicina/administração & dosagem , Nefrite Intersticial/terapia , Papiledema/etiologia , Hemorragia Retiniana/etiologia , Esclerostomia/efeitos adversos , Uveíte/terapia , Transtornos da Visão/etiologia , Criança , Terapia Combinada , Feminino , Humanos , Pressão Intraocular , Nefrite Intersticial/tratamento farmacológico , Nefrite Intersticial/cirurgia , Papiledema/diagnóstico , Papiledema/fisiopatologia , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/fisiopatologia , Tonometria Ocular , Uveíte/tratamento farmacológico , Uveíte/cirurgia , Transtornos da Visão/diagnóstico , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia
6.
Urol Clin North Am ; 47(1): 55-72, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757301

RESUMO

Non-muscle-invasive bladder cancer can be a challenging disease to manage. In recent years, hyperthermia therapy in conjunction with intravesical therapy has been gaining traction as a treatment option for bladder cancer, especially if Bacillus Calmette-Guerin might not be available. Trials of intravesical chemotherapy with heat are few and there has been considerable heterogeneity between studies. However, multiple new trials have accrued and high-quality data are forthcoming. In this review, we discuss the role of combined intravesical hyperthermia and chemotherapy as a novel approach for the treatment of bladder cancer.


Assuntos
Hipertermia Induzida/métodos , Mitomicina/administração & dosagem , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Antibióticos Antineoplásicos/administração & dosagem , Humanos , Resultado do Tratamento
7.
J Glaucoma ; 29(2): 77-80, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876870

RESUMO

PRECIS: Hypotony keratopathy is a potential complication of hypotony following trabeculectomy and successful treatment depends on increasing intraocular pressure (IOP). PURPOSE: To evaluate corneal decompensation in patients following trabeculectomy with adjuvant mitomycin C (MMC). We propose "hypotony keratopathy" as a descriptive term. METHODS: Patients with trabeculectomy and follow-up performed by the authors were included in this retrospective single-center study. Patients were included if they had evidence of corneal decompensation (Descemet membrane folds or corneal edema) the following trabeculectomy with MMC with concurrent hypotony. Outcome measures included best-corrected visual acuity, average IOP at time of diagnosis, and changes in central corneal thickness. Clinical outcomes for the treatment of hypotony keratopathy were noted when performed. RESULTS: A total of 14 eyes from 12 patients were included in the series. Hypotony developed an average of 5 years after trabeculectomy, and hypotony keratopathy was diagnosed 7.5 years after trabeculectomy. Hypotony keratopathy ranged from nonvisually significant Descemet membrane fold without increased corneal thickness to visually significant corneal edema. Best-corrected visual acuity decreased 0 to 6 Snellen lines after diagnosis of hypotony keratopathy. Lower IOP was associated with increased corneal thickness. Vision improved after trabeculectomy revision (6 eyes) and cataract extraction with an intraocular lens implant (1 eye) but did not improve after Descemet stripping automated endothelial keratoplasty (2 eyes). CONCLUSIONS: Hypotony keratopathy is a poorly described but potentially treatable complication of trabeculectomy with MMC. Hypotony keratopathy may be related to endothelial dysfunction secondary to hypotony.


Assuntos
Edema da Córnea/etiologia , Glaucoma de Ângulo Aberto/cirurgia , Hipotensão Ocular/etiologia , Trabeculectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Alquilantes/administração & dosagem , Edema da Córnea/diagnóstico , Edema da Córnea/cirurgia , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Hipotensão Ocular/diagnóstico , Hipotensão Ocular/cirurgia , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Terminologia como Assunto
8.
In Vivo ; 34(1): 275-282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882489

RESUMO

BACKGROUND/AIM: Hepatic arterial infusion chemotherapy (HAIC) is a treatment option for metastatic breast cancer (MBC) patients with extensive liver metastasis (LM); however, the appropriate regimen and the treatment effects have not been discussed. The aim of this study is to evaluate the efficacy and safety of HAIC with the 5-FU, epirubicin, and mitomycin-C (FEM) regimen. PATIENTS AND METHODS: We reviewed MBC patients with critical LM who were resistant to standard systemic chemotherapies and had received HAIC with an FEM regimen. RESULTS: We identified 57 patients who received HAIC between 2003 and 2017. The patient characteristics were as follows: i) median age=56 (30-80), and ii) Eastern Cooperative Oncology Group Performance Status, 0/1/2=43/11/3. The median number of LMs was 8 (range 1 to ≥20), the median diameter of LM was 5.2 cm (range=1.6 to 20.1). The median overall survival from the initiation of HAIC was 11.3 months (95% confidence interval=8.5-15.6). The objective response rate of LM was 63%. CONCLUSION: HAIC with an FEM regimen is an effective salvage treatment for MBC patients with advanced LM.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Resistencia a Medicamentos Antineoplásicos , Artéria Hepática , Infusões Intra-Arteriais/métodos , Neoplasias Hepáticas/tratamento farmacológico , Terapia de Salvação , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/tratamento farmacológico , Carcinoma Lobular/patologia , Epirubicina/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
9.
BMC Ophthalmol ; 19(1): 253, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31830935

RESUMO

BACKGROUND: XEN® gel stent (Allergan, Dublin/Republic of Ireland) is a relatively new microinvasive glaucoma device providing an ab-interno approach to the subconjunctival space for aqueous drainage and reduction of intraocular pressure. It is thought to be less invasive, reduce surgical time and post-operative infection rates compared with traditional glaucoma procedures. Little information however, has been published regarding complications and subsequent management. CASE PRESENTATION: The authors highlight five complicated cases of XEN® stent insertion, how they were managed and key learning points. Cases include: entire stent found at the bottom of the anterior chamber several months after uncomplicated insertion, stent broke into multiple pieces during manipulation within subconjunctiva, XEN45 stent migrated into the anterior chamber 7 months post-operatively and a case of limbal-based conjunctival dissection during open revision which lead to additional scarring around the stent and subsequent raised intraocular pressure. CONCLUSIONS: We present some new and interesting complications of XEN implant as well as potential management options. This can assist clinical decision-making and enable better pre-operative discussions with patients regarding risks of surgery.


Assuntos
Segmento Anterior do Olho/patologia , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma de Ângulo Aberto/cirurgia , Idoso , Idoso de 80 Anos ou mais , Alquilantes/administração & dosagem , Segmento Anterior do Olho/cirurgia , Humor Aquoso/fisiologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Procedimentos Cirúrgicos Oftalmológicos , Implantação de Prótese , Stents/efeitos adversos , Tonometria Ocular
10.
Clin Exp Metastasis ; 36(6): 511-518, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31541325

RESUMO

Pseudomyxoma peritonei (PMP) is a rare cancer commonly originating from appendiceal neoplasms that presents with mucinous tumor spread in the peritoneal cavity. Patients with PMP are treated with curative intent by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The value of adding HIPEC to CRS has not been proven in randomized trials, and the objective of this study was to investigate the efficacy of intraperitoneal mitomycin C (MMC) and regional hyperthermia as components of this complex treatment. Xenograft tissue established from a patient with histologically high-grade PMP with signet ring cell differentiation was implanted intraperitoneally in 65 athymic nude male rats and the animals were stratified into three treatment groups; the cytoreductive surgery group (CRSG, CRS only), the normothermic group (NG, CRS and intraperitoneal chemotherapy perfusion (IPEC) with MMC at 35 ºC), and the hyperthermic group (HG, CRS and IPEC at 41 ºC). The main endpoints were survival and tumor weight at autopsy. Adequate imitation of the clinical setting and treatment approach was achieved. The median survival was 31 days in the CRSG, 60 days in NG and 67 days in HG. The median tumor weights at autopsy were 34 g in CRSG, 23 g NG and 20 g in HG. In conclusion, the addition of IPEC with MMC after CRS doubled the survival time and reduced tumor growth compared to CRS alone. Adding regional hyperthermia resulted in a modest improvement of treatment outcome.


Assuntos
Cistadenocarcinoma Mucinoso/mortalidade , Procedimentos Cirúrgicos de Citorredução/mortalidade , Hipertermia Induzida/mortalidade , Mitomicina/administração & dosagem , Neoplasias Peritoneais/mortalidade , Pseudomixoma Peritoneal/mortalidade , Animais , Antibióticos Antineoplásicos/administração & dosagem , Terapia Combinada , Cistadenocarcinoma Mucinoso/patologia , Cistadenocarcinoma Mucinoso/terapia , Feminino , Humanos , Injeções Intraperitoneais , Masculino , Camundongos Endogâmicos BALB C , Modelos Teóricos , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Pseudomixoma Peritoneal/patologia , Pseudomixoma Peritoneal/terapia , Ratos Nus , Taxa de Sobrevida , Ensaios Antitumorais Modelo de Xenoenxerto
11.
Int J Mol Sci ; 20(18)2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31509978

RESUMO

Tumorous metastasis is a difficult challenge to resolve for researchers and for clinicians. Targeted delivery of antitumor drugs towards tumor cells' nuclei can be a practical approach to resolving this issue. This work describes an efficient nuclear-targeting delivery system prepared from trans-activating transcriptional activator (TAT) peptide-functionalized graphene nanocarriers. The TAT peptide, originally observed in a human immunodeficiency virus 1 (HIV-1), was incorporated with graphene via an edge-functionalized ball-milling method developed by the author's research group. High tumor-targeting capability of the resulting nanocarrier was realized by the strong affinity between TAT and the nuclei of cancer cells, along with the enhanced permeability and retention (EPR) effect of two-dimensional graphene nanosheets. Subsequently, a common antitumor drug, mitomycin C (MMC), was covalently linked to the TAT-functionalized graphene (TG) to form a nuclear-targeted nanodrug MMC-TG. The presence of nanomaterials inside the nuclei of ocular choroidal melanoma (OCM-1) cells was shown using transmission electron microscopy (TEM) and confocal laser scanning microscopy. In vitro results from a Transwell co-culture system showed that most of the MMC-TG nanodrugs were delivered in a targeted manner to the tumorous OCM-1 cells, while a very small amount of MMC-TG was delivered in a non-targeted manner to normal human retinal pigment epithelial (ARPE-19) cells. TEM results further confirmed that apoptosis of OCM-1 cells was started from the lysis of nuclear substances, followed by the disappearance of nuclear membrane and cytoplasm. This suggests that the as-synthesized MMC-TG is a promising nuclear-target nanodrugfor resolution of tumorous metastasis issues at the headstream.


Assuntos
Neoplasias da Coroide/tratamento farmacológico , Sistemas de Liberação de Medicamentos/métodos , Grafite/química , Melanoma/tratamento farmacológico , Mitomicina/administração & dosagem , Peptídeos/química , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/química , Linhagem Celular , Linhagem Celular Tumoral , Núcleo Celular/efeitos dos fármacos , Núcleo Celular/metabolismo , Núcleo Celular/ultraestrutura , Neoplasias da Coroide/metabolismo , Neoplasias da Coroide/patologia , Portadores de Fármacos/química , Humanos , Melanoma/metabolismo , Melanoma/patologia , Microscopia Eletrônica de Transmissão , Mitomicina/química , Nanoestruturas/administração & dosagem , Nanoestruturas/química , Nanoestruturas/ultraestrutura , Produtos do Gene tat do Vírus da Imunodeficiência Humana/química
12.
Cir Cir ; 87(S1): 28-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501620

RESUMO

Background: The successful performance of ostomies for the treatment of different diseases has been described since 1706. We report herein the first case of successful ostomy utilizing a synthetic stoma created in a patient with peritoneal carcinomatosis. Clinical case: A 40-year-old woman presented with abdominal carcinomatosis due to psammomatous papillotubular adenocarcinoma consistent with primary ovarian carcinoma. The patient had negative estrogen and progesterone receptors and Ki-67 proliferative activity was 83%. She was initially treated with cytoreduction therapy, chemotherapy, and hyperthermic intraperitoneal chemotherapy. Because the patient presented with enteric perforations and the extensive tumor invasion and adhesions in all the intestinal segments made it impossible to create autologous decompression stomas, a synthetic stoma was constructed. Conclusions: Synthetic stomas can be a good treatment option when autologous stomas can not be created.


Assuntos
Adenocarcinoma Papilar/secundário , Drenagem/instrumentação , Neoplasias Intestinais/secundário , Perfuração Intestinal/cirurgia , Neoplasias Ovarianas/cirurgia , Estomas Cirúrgicos , Adenocarcinoma Papilar/tratamento farmacológico , Adenocarcinoma Papilar/etiologia , Adenocarcinoma Papilar/cirurgia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Coagulação com Plasma de Argônio , Bevacizumab/administração & dosagem , Carboplatina/administração & dosagem , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Docetaxel/administração & dosagem , Doxorrubicina/administração & dosagem , Doxorrubicina/análogos & derivados , Evolução Fatal , Feminino , Humanos , Hipertermia Induzida , Neoplasias Intestinais/tratamento farmacológico , Neoplasias Intestinais/etiologia , Neoplasias Intestinais/cirurgia , Perfuração Intestinal/etiologia , Mitomicina/administração & dosagem , Polietilenoglicóis/administração & dosagem
13.
Urol Int ; 103(3): 285-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31461726

RESUMO

BACKGROUND: Topical therapy of nonmuscle-invasive bladder cancer (NMIBC) is based on immunotherapy with Bacillus Calmette-Guerin and chemotherapy administered by passive instillation, but an active drug administration achieves a better concentration of the drugs in the bladder. AIM: This study aimed to investigate the effectiveness of electromotive drug administration (EMDA) of mitomycin C (EMDA/MMC) in intermediate- and high-risk NMIBC patients 6 months after the end of induction treatment. MATERIALS AND METHODS: Sixty-five patients diagnosed with histologically confirmed NMIBC, with a complete transurethral resection of all visible tumors underwent EMDA/MMC. Primary endpoint was the proportion of responders at 3 or 6 months. RESULTS: Data on follow-up were available for 62 subjects at 3 months and 45 at 6 months. EMDA was effective in intermediate- and high-risk patients: because of the small number of cases no conclusions can be drawn on the efficacy in the low-risk group. No difference in the response to treatment between intermediate- (83.3%) and high-risk (84%) patients could be seen. CONCLUSIONS: EMDA/MMC is a useful technique for an effective and safe treatment of primary and recurrent NMIBC, and a valuable therapeutic option in intermediate- and high-risk NMIBC patients.


Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Eletroquimioterapia , Mitomicina/administração & dosagem , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/prevenção & controle , Administração Intravesical , Idoso , Feminino , Humanos , Masculino , Invasividade Neoplásica , Estudos Retrospectivos , Medição de Risco , Neoplasias da Bexiga Urinária/patologia
14.
World J Surg Oncol ; 17(1): 145, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420046

RESUMO

BACKGROUND: We aimed to evaluate the efficacy and safety of 5-fluorouracil-based neoadjuvant chemoradiotherapy (NACRT) in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma (PDAC). METHODS: This retrospective study investigated the clinicopathological features and > 5-year survival of patients with T3/T4 PDAC who underwent NACRT at our institute between 2003 and 2012. RESULTS: Seventeen resectable and eight borderline resectable patients were included. The protocol treatment completion and resection rates were 92.0% and 68.0%, respectively. Two patients failed to complete chemotherapy owing to cholangitis or anorexia. Common grade 3 toxicities included anorexia (12%), neutropenia (4%), thrombocytopenia (4%), anemia (4%), and leukopenia (12%). Pathologically negative margins were achieved in 94.1% of patients who underwent pancreatectomy. Pathological response according to Evans' classification was grade IIA in 10 patients (58.8%), IIB in 5 patients (29.4%), and IV in 2 patients (11.8%). Postoperative pancreatic fistulas were observed in four patients (23.5%), delayed gastric emptying in one patient (5.9%), and other operative morbidities in four patients (23.5%). The 1-, 2-, 5-, and 10-year overall survival rates were 73.9%, 60.9%, 60.9%, and 39.1%, respectively (median follow-up period, 80.3 months). CONCLUSIONS: NACRT is tolerable and beneficial for resectable/borderline resectable PDAC, even in the long-term.


Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Ductal Pancreático/terapia , Quimiorradioterapia/mortalidade , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/terapia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/patologia , Cisplatino/administração & dosagem , Terapia Combinada , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
15.
GM Crops Food ; 10(3): 181-190, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31366287

RESUMO

Glyphosate tolerant soybeans represent a large portion of soybeans grown and fed to farm animals around the world. Despite their widespread use for many years, some have raised questions regarding their safety because the soybeans were genetically modified. The CP4 EPSPS gene which imparts resistance to topical application of the herbicide glyphosate was introduced into soybeans. Application of glyphosate to soybean fields will reduce weed pressure and increase soybean yield. To assess their safety on the rat reproduction system, male Sprague Dawley rats were fed either glyphosate-tolerant (GM) soybean (40-3-2) or near-isogenic, non-GM (A5403) (control) soybean meal. The processed soybean meal was added to formulated rodent diets at 20% (w/w) and fed to rats for 90 days. Some rats from the control group were separately administered mitomycin C for 40 days and served as positive controls in the sperm abnormality test. Body weights and behavior were monitored daily, serum enzymes and histologic and EM appearance of the testis, and sperm morphology were also examined. After 90 days of feeding, no adverse effects were observed in rats fed glyphosate-tolerant soybeans.


Assuntos
Glicina/análogos & derivados , Herbicidas/efeitos adversos , Soja/genética , Testículo/efeitos dos fármacos , Ração Animal , Animais , Comportamento Animal/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Glicina/efeitos adversos , Resistência a Herbicidas , Masculino , Mitomicina/administração & dosagem , Mitomicina/farmacologia , Plantas Geneticamente Modificadas/crescimento & desenvolvimento , Ratos , Ratos Sprague-Dawley , Soja/crescimento & desenvolvimento
16.
Ann Ital Chir ; 82019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31310243

RESUMO

BACKGROUND: Radiotherapy currently plays a key role in pelvic malignancies' management. Excellent outcomes have been reported on its association with chemotherapy for the treatment of the anal carcinoma. Despite that, the combined use of chemo- and radiotherapy and the high doses administered seem to be strongly associated with early and late onset side effects. METHODS: We reported a case of a 72 years old woman, affected by anal squamous cell carcinoma. She underwent chemotherapy, and then radiotherapy, with good results. RESULTS: During a regular MR control, the patient developed anaphylactic reaction to Gadolinium, and after that a rectosigmoid ischemia with total necrosis of the posterior rectal wall was diagnosed and surgically treated with Hartmann procedure. CONCLUSION: In our case we faced with the rapid and severe degeneration of pelvic anatomy determined by the sum of vascular alterations following hypovolemic shock and pelvic tissues alteration after radiotherapy. It seems essential not to underestimate the exponential outcome of a similar unusual combination of events. KEY WORDS: Anal carcinoma, Hypovolemic shock, Pelvic radiotherapy, Rectal necrosis.


Assuntos
Anafilaxia/induzido quimicamente , Neoplasias do Ânus/terapia , Carcinoma de Células Escamosas/terapia , Carcinoma/radioterapia , Quimiorradioterapia/efeitos adversos , Colo Sigmoide/irrigação sanguínea , Meios de Contraste/efeitos adversos , Gadolínio/efeitos adversos , Isquemia/etiologia , Protectomia , Lesões por Radiação/etiologia , Fístula Retovaginal/etiologia , Reto/irrigação sanguínea , Choque/etiologia , Idoso , Anafilaxia/complicações , Carcinoma/tratamento farmacológico , Colo Sigmoide/diagnóstico por imagem , Colo Sigmoide/efeitos da radiação , Colo Sigmoide/cirurgia , Terapia Combinada , Feminino , Fluoruracila/administração & dosagem , Parada Cardíaca/etiologia , Humanos , Isquemia/patologia , Isquemia/cirurgia , Mitomicina/administração & dosagem , Necrose , Fístula Retovaginal/diagnóstico por imagem , Fístula Retovaginal/cirurgia , Reto/diagnóstico por imagem , Reto/efeitos da radiação , Reto/cirurgia , Tomografia Computadorizada por Raios X
17.
J Coll Physicians Surg Pak ; 29(7): 639-643, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31253215

RESUMO

OBJECTIVE: To investigate the effect of pterygium morphology on recurrence with preoperative subconjunctival injection of mitomycin-C in primary pterygium surgery. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Eye Department, Combined Military Hospital, Malir Cantt, Karachi, from February 2017 to February 2018. METHODOLOGY: On the basis of pterygium morphology, 165 eyes of 165 patients were equally divided into three equal groups of atrophic, intermediate and fleshy pterygia. In each morphology group, length was graded into three groups using limbus, pupil margin and midiris as landmarks. All pterygia received 0.1 ml of mitomycin-C injection in a concentration of 0.15 mg/ml at 24 hours prior to undergoing a bare sclera surgical excision technique in all cases. All patients were followed up for 12 months. The recurrence rate was recorded in each morphology group. Pearson Chi-Square test was used to compare recurrence rate and morphology group. Fisher's exact test was applied to compare recurrence rate with length and age in each type of morphology. RESULTS: Among the three morphology groups, the recurrence rate was statistically significant between fleshy and atrophic pterygia (p=0.01) and no significant association was found among other morphology comparisons. Age less than 40 years had a significant effect on recurrence in all morphology groups. Length did not affect the recurrence rate in any of morphology types. CONCLUSION: Recurrence of primary pterygium is related to fleshiness of the pterygium and is a significant risk factor for recurrence after preoperative subconjunctival injection of mitomycin-C given at 24 hours before sclera excision.


Assuntos
Alquilantes/administração & dosagem , Mitomicina/administração & dosagem , Cuidados Pré-Operatórios , Pterígio/patologia , Pterígio/cirurgia , Adulto , Fatores Etários , Estudos de Coortes , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Paquistão , Recidiva , Fatores de Risco , Resultado do Tratamento
18.
Indian J Ophthalmol ; 67(7): 1080-1084, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238416

RESUMO

Purpose: The purpose of this study is to evaluate the efficacy and safety of Trabeculectomy with Mitomycin C in Open angle glaucoma versus Angle closure glaucoma. Methods: The medical records of patients who underwent Trabeculectomy with Mitomycin C were reviewed and followed for three years, divided into two groups: group 1: Open Angle Glaucoma (n = 41) and group 2: Angle Closure Glaucoma (n = 67). Success criterion was measured as Intraocular Pressure ≤21 mmHg with (qualified) or without (complete) use of Antiglaucoma medications. Results: A total number of 108 eyes of 137 patients were undertaken. Mean preoperative Intraocular pressure in group 1 was 31.4 ± 10.5 mmHg and in group 2 was 33.1 ± 9.4, which reduced to 10.5 ± 3.4, 10.5 ± 2.6, 11.6 ± 3.6, 11.0 ± 2.7, 11.0 ± 2.7 in group 1 and 10.9 ± 2.8, 12.0 ± 3.8, 12.8 ± 4.9, 12.4 ± 3.9, 12.4 ± 3.7 in group 2 with P value = 0.566, 0.032, 0.168, 0.049, 0.049 at three, six months, one, two, three years, respectively, with P < 0.001 at each visit. The number of Antiglaucoma medications was reduced from 0.75 ± 0.89 to 0.43 ± 0.55 at 3 yrs (P = 0.002). At 36 months follow-up, overall, 50.0% and 48.2% of eyes achieved complete and qualified success, respectively. Sub-group analysis showed that the success rate was higher in group 1 (68.3%) compared to group 2 (55.2%). Overall, complications such as hypotony (1.8%), choroidal detachment (2.8%), encapsulated bleb (2.8%), and bleb leakage (1.8%) were encountered. Conclusion: Primary Trabeculectomy with Mitomycin C is a safe and effective means of controlling Intraocular Pressure in both groups with good success and low rates of sight-threatening complications.


Assuntos
Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular/fisiologia , Mitomicina/administração & dosagem , Trabeculectomia/métodos , Adulto , Idoso , Feminino , Seguimentos , Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Inibidores da Síntese de Ácido Nucleico/administração & dosagem , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual
19.
Radiother Oncol ; 140: 84-89, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185328

RESUMO

BACKGROUND AND PURPOSE: Standard treatment of epidermoid anal cancer is 5-fluorouracil (5FU) and mitomycin C (MMC) based chemoradiotherapy (CRT). This phase I study aims to evaluate the addition of panitumumab (Pmab) to CRT and to determine the maximum tolerated dose (MTD) of Pmab and 5-FU in combination with CRT. MATERIALS AND METHODS: Immunocompetent patients with locally advanced tumour without metastases (Stage T2, T3 or T4, whatever N stage; Stage N1-N3 whatever T stage) followed two RT periods (45 Gy in 5 weeks and 20 Gy in 2 weeks, separated by a 2-week break) with concomitant CT sessions of 5FU/MMC at RT weeks 1, 5 and 8. Pmab was administered on RT weeks 1, 3, 5, 8 and 10 according to a predefined dose escalation schedule. RESULTS: Ten patients were enroled. One was excluded due to unmet dose constraints respect. Three patients received dose level (DL) 0 (Pmab 3 mg/kg + 5FU 600 mg/m2/day) and six received DL-1 (Pmab 3 mg/kg + 5FU 400 mg/m2/day). Dose-limiting toxicities occurred in all patients at DL 0 and 2 at DL-1. Most common grade 3-4 toxicities observed at DL 0 were haematologic (100%), dermatitis (67%), and anaemia (67%). No death occurred. Four months after ending CRT, five and two patients had a local complete response and a partial response, respectively. One patient had a colostomy with abdomino-perineal amputation due to a tumour recurrence. CONCLUSIONS: The MTD is 5FU at 400 mg/m2/day, MMC at 10 mg/m2 and Pmab at 3 mg/kg. The effect of the MTD on tumour response is evaluated in the phase 2 study.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Ânus/terapia , Quimiorradioterapia , Receptores ErbB/antagonistas & inibidores , Panitumumabe/administração & dosagem , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Estudos Prospectivos
20.
Medicine (Baltimore) ; 98(25): e16094, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232951

RESUMO

AIM: To evaluate the efficacy and safety of trabeculectomy (Trab) with mitomycin-C (MMC) versus Trab with implant. METHODS: Studies published in different languages were retrieved by systematically searching Embase, PubMed, Cochrane library, China Biology Medicine disc, and Google Scholar from 1966 to April 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered intraocular pressure, glaucoma medications reductions, and success rate. Safety evaluation was measured by relative ratio of complications. RESULTS: A total of 11 studies involving 443 participants were covered in this meta-analysis. The weighted mean difference (WMD) in the percentage of intraocular pressure (IOP) reduction (IOPR%) comparing Ologen group with MMC group was -3.69 (95% CI: -6.70 to -0.68) at 1 month, -2.69 (-5.17 to -0.21) at 3 months, -3.67 (-6.09 to -1.25)at 6 months, -3.24 (-6.08 to -0.41) at 12 months, 1.24 (-9.43 to 11.90) at 24 months, and 1.10 (-10.11 to 12.31) at 60 months, which showed that there was statistically significant difference at 1,3, 6, and12 months after the surgery. A significantly higher incidence of postsurgery hypotony (0.64 (95% Cl: 0.42 to 0.98)) and suture lysis (0.30 (95% CI: 0.10-0.93)) was observed in MMC group. However, there was no significant difference in the reduction in glaucoma medications, success rate, and incidence of other complications.Trab with 0.2 mg/mL MMC presented higher rates of complete success compared with Trab with 0.4 mg/mL MMC (P = .01). CONCLUSION: Trab with MMC was associated with a higher IOP-lowering efficacy and a higher incidence of postsurgery hypotony and suture lysis in contrast to that of Trab with Ologen.


Assuntos
Colágeno/farmacologia , Glicosaminoglicanos/farmacologia , Mitomicina/farmacologia , Próteses e Implantes/normas , Trabeculectomia/instrumentação , Colágeno/administração & dosagem , Colágeno/uso terapêutico , Glicosaminoglicanos/administração & dosagem , Glicosaminoglicanos/uso terapêutico , Humanos , Mitomicina/administração & dosagem , Mitomicina/uso terapêutico , Trabeculectomia/métodos
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