RESUMO
Treatment of bone metastases differs depending on whether the original cancer was diagnosed, whether it is hormone sensitive or chemosensitive, whether metastases are exclusively found in bones and thus unique, or multiple, whether they also occur in viscera and depending on the diathesis. In the last few years, treatment has benefited from a better knowledge of the efficacy of bisphosphonates, radioisotopes, percutaneous vertebroplasty and the development of new hormone therapies and chemotherapies. Given the uncertain life prognosis in the short or longer term, it remains true that cautious use of these methods is essential to reduce as far as possible the number and duration of hospitalizations.
Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , HumanosRESUMO
The advent of factor VIII and IX replacement therapy has radically changed the physiognomy of hemophilia. In patients with no inhibitors, early replacement therapy shortens the immobilization and decreases the structural and functional alterations related to recurrent hemarthrosis. Routine prophylactic replacement therapy before or after the first episode of hemarthrosis is still rarely used in France. Recurrent hemarthrosis in the same joint can cause synovitis and chronic arthropathy. Injection synovectomy is now the preferred treatment, as opposed to secondary prophylactic replacement therapy and to arthroscopic or open synovectomy. The palliative treatment of chronic arthropathy is difficult and rests on analgesics and rehabilitation therapy, with orthotic devices and/or surgery where appropriate. The treatment of hemophilia is far more difficult in patients with inhibitors and, consequently, considerable hope is being placed in gene therapy, whose first results are encouraging.
Assuntos
Hemartrose/terapia , Hemofilia A/terapia , Sinovite/terapia , Doença Crônica , Terapia Genética , Hemartrose/etiologia , Hemofilia A/complicações , Humanos , Injeções Intra-Articulares , Articulações/cirurgia , Cuidados Paliativos , Sinovectomia , Sinovite/etiologiaRESUMO
Although less common than hemarthroses, muscle hematomas nearly always threaten limb function and can threaten life. Their treatment is not as well standardized as that of hemarthrosis but also rests on clotting factor replacement, prevention of contractures, and rehabilitation. Pseudotumors raise even greater treatment challenges and usually require surgery in adults. Presence of an inhibitor is no longer a contraindication to surgery. In HIV-infected patients, surgery is possible only if the CD4+ count is sufficiently high.