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[PMID]:29277797
[Au] Autor:Falkenstein TA; Götze TO; Ouaissi M; Tempfer CB; Giger-Pabst U; Demtröder C
[Ad] Endereço:Basic Research Laboratories of the Department of Surgery, St. Mary's Hospital, Ruhr University Bochum, Herne, Germany.
[Ti] Título:First Clinical Data of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) as Salvage Therapy for Peritoneal Metastatic Biliary Tract Cancer.
[So] Source:Anticancer Res;38(1):373-378, 2018 01.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients suffering from peritoneal metastasis of biliary tract cancer were treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC). PATIENTS AND METHODS: This was a study carried out at a single institution, tertiary referral center certified for therapy of peritoneal disease. Retrospective data analysis was performed of prospective data for PIPAC with intra-peritoneal low-dose doxorubicin (1.5 mg/m ) and cisplatin (7.5 mg/m ) delivered at intervals of 6 weeks. The outcome criteria were microscopic pathological response, survival, and adverse events [Common Terminology Criteria of Adverse Events (v4.0)]. RESULTS: A total of 13 patients (male/female=8/5) with a mean age of 58 (range=37-75) years underwent 17 PIPAC procedures without intraoperative complications. The mean number of PIPAC applications was 1.3 (range=0-3). Due to non-accessibility of the abdominal cavity in two patients (15.4%) and rapid clinical deterioration in six patients (46%), five patients underwent two or more PIPAC applications and were, therefore, eligible for histological analysis to assess carcinoma regression. Overall tumor regression of any degree was determined in 4/5 patients. An overall median survival of 85 days (95% confidence interval(CI)=59.2-110.4 days) after the first PIPAC application was observed. No complications greater than Common Terminology Criteria of Adverse Events (v4.0) level 2 occurred. CONCLUSION: PIPAC can induce objective regression of systemic chemotherapy-resistant peritoneal metastasis of biliary tract cancer. However, due to a rapid clinical deterioration of the patients, almost two-thirds of the patients cannot undergo repetitive PIPAC courses.
[Mh] Termos MeSH primário: Antibióticos Antineoplásicos/uso terapêutico
Neoplasias do Sistema Biliar/patologia
Infusões Parenterais/métodos
Neoplasias Peritoneais/tratamento farmacológico
Neoplasias Peritoneais/secundário
Terapia de Salvação/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Neoplasias do Sistema Biliar/tratamento farmacológico
Cisplatino/uso terapêutico
Doxorrubicina/uso terapêutico
Feminino
Seres Humanos
Masculino
Meia-Idade
Neoplasias Peritoneais/mortalidade
Peritônio/patologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibiotics, Antineoplastic); 80168379AG (Doxorubicin); Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171227
[St] Status:MEDLINE


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[PMID]:28456089
[Au] Autor:Desiderio J; Chao J; Melstrom L; Warner S; Tozzi F; Fong Y; Parisi A; Woo Y
[Ad] Endereço:Department of Surgery, City of Hope National Medical Centre, Duarte, CA, USA; Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni, Italy.
[Ti] Título:The 30-year experience-A meta-analysis of randomised and high-quality non-randomised studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer.
[So] Source:Eur J Cancer;79:1-14, 2017 07.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:IMPORTANCE: Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used within various multimodality strategies for the prevention and treatment of gastric cancer peritoneal carcinomatosis. OBJECTIVE: To systematically evaluate the role of HIPEC in gastric cancer and clarify its effectiveness at different stages of peritoneal disease progression. DATA SOURCES: Medline and Embase databases between January 1, 1985 and June 1, 2016. STUDY SELECTION: Randomised control trials and high-quality non-randomised control trials selected on a validated tool (methodological index for non-randomised studies) comparing HIPEC and standard oncological management for the treatment of advanced stage gastric cancer with and without peritoneal carcinomatosis were considered. DATA EXTRACTION AND SYNTHESIS: A random-effects network meta-analysis. MAIN OUTCOMES AND MEASURES: The primary outcomes were overall survival and disease recurrence. Secondary outcomes were overall complications, type of complications, and sites of recurrence. RESULTS: A total of 11 RCTs and 21 non-randomised control trials (2520 patients) were included. For patients without the presence of peritoneal carcinomatosis (PC), the overall survival rates between the HIPEC and control groups at 3 or 5 years resulted in favour of the HIPEC group (risk ratio [RR] = 0.82, P = 0.01). No difference in the 3-year overall survival (RR = 0.99, P = 0.85) in but a prolonged median survival of 4 months in favour of the HIPEC group (WMD = 4.04, P < 0.001) was seen in patients with PC. HIPEC was associated with significantly higher risk of complications for both patients with PC (RR = 2.15, P < 0.01) and without (RR = 2.17, P < 0.01). This increased risk in the HIPEC group was related to systemic drugs toxicity. Anastomotic leakage rates were found to be similar between groups. CONCLUSIONS: Our study demonstrates a survival advantage of the use of HIPEC as a prophylactic strategy and suggests that patients whose disease burden is limited to positive cytology and limited nodal involvement may benefit the most from HIPEC. For patients with extensive carcinomatosis, the completeness of cytoreductive surgery is a critical prognostic factor for survival. Future RCTs should better define patient selection criteria.
[Mh] Termos MeSH primário: Antineoplásicos/administração & dosagem
Carcinoma/tratamento farmacológico
Hipertermia Induzida/métodos
Neoplasias Gástricas/tratamento farmacológico
[Mh] Termos MeSH secundário: Carcinoma/mortalidade
Carcinoma/cirurgia
Ensaios Clínicos como Assunto
Progressão da Doença
Seres Humanos
Hipertermia Induzida/efeitos adversos
Hipertermia Induzida/mortalidade
Infusões Parenterais
Recidiva Local de Neoplasia/etiologia
Recidiva Local de Neoplasia/mortalidade
Neoplasias Peritoneais/mortalidade
Neoplasias Peritoneais/prevenção & controle
Neoplasias Peritoneais/cirurgia
Complicações Pós-Operatórias/induzido quimicamente
Complicações Pós-Operatórias/mortalidade
Ensaios Clínicos Controlados Aleatórios como Assunto
Neoplasias Gástricas/mortalidade
Neoplasias Gástricas/cirurgia
Taxa de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Antineoplastic Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171230
[Lr] Data última revisão:
171230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:28468476
[Au] Autor:Ezat B; Pihlstrøm L; Aasly J; Tysnes OB; Egge A; Dietrichs E
[Ad] Endereço:Nevrologisk avdeling Oslo universitetssykehus og Det medisinske fakultet Universitetet i Oslo.
[Ti] Título:Use of advanced therapies for Parkinson's disease in Norway.
[Ti] Título:Bruk av avansert behandling ved Parkinsons sykdom i Norge..
[So] Source:Tidsskr Nor Laegeforen;137(9):619-623, 2017 05.
[Is] ISSN:0807-7096
[Cp] País de publicação:Norway
[La] Idioma:eng; nor
[Ab] Resumo:BACKGROUND: Many patients with Parkinson's disease with severe motor fluctuations benefit from advanced therapies ­ either deep brain stimulation or continuous infusion therapy with levodopa-carbidopa intestinal gel or apomorphine. In Norway, deep brain stimulation is provided as a shared national or multi-regional service. The treatment is currently available at Oslo University Hospital and St. Olavs Hospital; prior to 2012 it was also available at Haukeland University Hospital. Infusion therapy has no similar geographical restrictions. We therefore wished to examine geographical differences in the use of the two most common forms of advanced therapy for Parkinson's disease. MATERIAL AND METHOD: The county of residence of all patients receiving deep brain stimulation or infusion therapy with levodopa-carbidopa intestinal gel in the period 2009 ­ 2013 was recorded using data from hospital episode statistics and the Norwegian Prescription Database, respectively. RESULTS: A total of 262 patients with Parkinson's disease began advanced therapy, 146 with deep brain stimulation and 116 with levodopa-carbidopa infusion. Four counties differed significantly from the others in their use of the two methods. Møre og Romsdal, Nordland and Sør-Trøndelag treated a significantly greater proportion of patients with deep brain stimulation, while Rogaland treated a significantly greater proportion with levodopa-carbidopa infusion therapy. INTERPRETATION: Advanced therapies for Parkinson's disease are offered throughout Norway, but there are significant geographical differences in the type of therapy initiated. One possible explanation is that patients in different counties receive different information about the therapeutic options available.
[Mh] Termos MeSH primário: Antiparkinsonianos
Estimulação Encefálica Profunda/estatística & dados numéricos
Uso de Medicamentos
Disparidades em Assistência à Saúde
Doença de Parkinson
[Mh] Termos MeSH secundário: Antiparkinsonianos/administração & dosagem
Antiparkinsonianos/uso terapêutico
Apomorfina/administração & dosagem
Apomorfina/uso terapêutico
Carbidopa/administração & dosagem
Carbidopa/uso terapêutico
Combinação de Medicamentos
Géis
Seres Humanos
Infusões Parenterais
Levodopa/administração & dosagem
Levodopa/uso terapêutico
Noruega/epidemiologia
Doença de Parkinson/tratamento farmacológico
Doença de Parkinson/epidemiologia
Doença de Parkinson/terapia
Educação de Pacientes como Assunto/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiparkinson Agents); 0 (Drug Combinations); 0 (Gels); 0 (carbidopa, levodopa drug combination); 46627O600J (Levodopa); MNX7R8C5VO (Carbidopa); N21FAR7B4S (Apomorphine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.4045/tidsskr.16.0711


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[PMID]:27771168
[Au] Autor:Chan JK; Java JJ; Fuh K; Monk BJ; Kapp DS; Herzog T; Bell J; Young R
[Ad] Endereço:Division of Gynecologic Oncology, California Pacific-Palo Alto Medical Foundation Sutter Research Institute, 3838 California Street #410, San Francisco, CA 94115, United States. Electronic address: chanjohn@sutterhealth.org.
[Ti] Título:The association between timing of initiation of adjuvant therapy and the survival of early stage ovarian cancer patients - An analysis of NRG Oncology/Gynecologic Oncology Group trials.
[So] Source:Gynecol Oncol;143(3):490-495, 2016 Dec.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To determine the association between timing of adjuvant therapy initiation and survival of early stage ovarian cancer patients. METHODS: Data were obtained from women who underwent primary surgical staging followed by adjuvant therapy from two Gynecologic Oncology Group trials (protocols # 95 and 157). Kaplan-Meier estimates and Cox proportional hazards model adjusted for covariates were used for analyses. RESULTS: Of 497 stage I-II epithelial ovarian cancer patients, the median time between surgery and initiation of adjuvant therapy was 23days (25th-75th%: 12-33days). The time interval from surgery to initiation of adjuvant therapy was categorized into three groups: <2weeks, 2-4weeks, and >4weeks. The corresponding 5-year recurrence-free survival rates were 72.8%, 73.9%, and 79.5% (p=0.62). The 5-year overall survival rates were 79.4%, 81.9%, and 82.8%, respectively (p=0.51; p=0.33 - global test). As compared to <2weeks, the hazard ratio for recurrence-free survival was 0.90 (95%CI=0.59-1.37) for 2-4weeks and 0.72 (95%CI=0.46-1.13) for >4weeks. Age, stage, grade, and cytology were important prognostic factors. CONCLUSIONS: Timing of adjuvant therapy initiation was not associated with survival in early stage epithelial ovarian cancer patients.
[Mh] Termos MeSH primário: Adenocarcinoma de Células Claras/tratamento farmacológico
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Carcinoma Endometrioide/tratamento farmacológico
Quimioterapia Adjuvante/métodos
Procedimentos Cirúrgicos de Citorredução/métodos
Neoplasias Císticas, Mucinosas e Serosas/tratamento farmacológico
Neoplasias Epiteliais e Glandulares/tratamento farmacológico
Neoplasias Ovarianas/tratamento farmacológico
[Mh] Termos MeSH secundário: Adenocarcinoma de Células Claras/patologia
Carboplatina/administração & dosagem
Carcinoma Endometrioide/patologia
Cisplatino/administração & dosagem
Ciclofosfamida/administração & dosagem
Feminino
Seres Humanos
Infusões Intravenosas
Infusões Parenterais
Estimativa de Kaplan-Meier
Meia-Idade
Análise Multivariada
Estadiamento de Neoplasias
Neoplasias Císticas, Mucinosas e Serosas/patologia
Neoplasias Epiteliais e Glandulares/patologia
Neoplasias Ovarianas/patologia
Paclitaxel/administração & dosagem
Prognóstico
Modelos de Riscos Proporcionais
Taxa de Sobrevida
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
8N3DW7272P (Cyclophosphamide); BG3F62OND5 (Carboplatin); P88XT4IS4D (Paclitaxel); Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171214
[Lr] Data última revisão:
171214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28776441
[Au] Autor:Psaltikidis EM; Silva END; Bustorff-Silva JM; Moretti ML; Resende MR
[Ad] Endereço:a Health Technology Assessment Department , Clinical Hospital of State University of Campinas , Campinas , Brazil.
[Ti] Título:Economic evaluation of outpatient parenteral antimicrobial therapy: a systematic review.
[So] Source:Expert Rev Pharmacoecon Outcomes Res;17(4):355-375, 2017 Aug.
[Is] ISSN:1744-8379
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Outpatient parenteral antimicrobial therapy (OPAT) consists of providing antimicrobial therapy by parenteral infusion without hospitalization. A systematic review was performed to compare OPAT and hospitalization as health care modalities from an economic perspective. Areas covered: We identified 1455 articles using 13 electronic databases and manual searches. Two independent reviewers identified 35 studies conducted between 1978 and 2016. We observed high heterogeneity in the following: countries, infection site, OPAT strategies and outcomes analyzed. Of these, 88% had a retrospective observational design and one was a randomized trial. With respect to economic analyses, 71% of the studies considered the cost-consequences, 11% cost minimization, 6% cost-benefit, 6% cost-utility analyses and 6% cost effectiveness. Considering all 35 studies, the general OPAT cost saving was 57.19% (from -13.03% to 95.47%). Taking into consideration only high-quality studies (6 comparative studies), the cost saving declined by 16.54% (from -13.03% to 46.86%). Expert commentary: Although most studies demonstrate that OPAT is cost-effective, the magnitude of this effect is compromised by poor methodological quality and heterogeneity. Economic assessments of the issue are needed using more rigorous methodologies that include a broad range of perspectives to identify the real magnitude of economic savings in different settings and OPAT modalities.
[Mh] Termos MeSH primário: Assistência Ambulatorial/economia
Anti-Infecciosos/administração & dosagem
Infecção/tratamento farmacológico
[Mh] Termos MeSH secundário: Anti-Infecciosos/economia
Análise Custo-Benefício
Seres Humanos
Infecção/economia
Infusões Parenterais
Pacientes Ambulatoriais
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Infective Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170805
[St] Status:MEDLINE
[do] DOI:10.1080/14737167.2017.1360767


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[PMID]:28739756
[Au] Autor:Chu H; Du F; Gong Z; Lian P; Wang Z; Li P; Hu B; Chi C; Chen J
[Ad] Endereço:The Central Laboratory, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China.
[Ti] Título:Better Clinical Efficiency of TILs for Malignant Pleural Effusion and Ascites than Cisplatin Through Intrapleural and Intraperitoneal Infusion.
[So] Source:Anticancer Res;37(8):4587-4591, 2017 08.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIM: To evaluate the clinical efficiency of tumor-infiltrating lymphocytes (TILs) compared to cisplatin for malignant pleural effusion and ascites through intrapleural and intraperitoneal infusion. PATIENTS AND METHODS: Thirteen patients with malignant pleural effusion and ascites were divided into a TIL-treated group and a cisplatin-treated group. Patients were given TILs or cisplatin, through intrapleural and intraperitoneal infusion respectively, after drainage of the malignant serous effusion by thoracentesis or abdominocentesis. RESULTS: The overall response rate and disease control rate of the TIL-treated group (33.33% and 83.33%) were higher than that of the cisplatin-treated group (28.57% and 71.43%). The progression-free survival for the TIL-treated group was significantly longer (p=0.002) and better than that of the cisplatin-treated group (66.67% vs. 28.57%). Quality of life apparently improved in the TIL-treated group and was clearly higher than that in the cisplatin-treated group. CONCLUSION: The use of TILs has a better clinical efficiency for malignant pleural effusion and ascites than cisplatin through intrapleural and intraperitoneal infusion without severe adverse effects.
[Mh] Termos MeSH primário: Antineoplásicos/administração & dosagem
Ascite/terapia
Cisplatino/administração & dosagem
Imunoterapia Adotiva
Linfócitos do Interstício Tumoral/transplante
Derrame Pleural Maligno/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Antineoplásicos/efeitos adversos
Ascite/diagnóstico
Ascite/mortalidade
Biomarcadores Tumorais
Cisplatino/efeitos adversos
Feminino
Seres Humanos
Imunoterapia Adotiva/efeitos adversos
Imunoterapia Adotiva/métodos
Infusões Parenterais
Linfócitos do Interstício Tumoral/imunologia
Linfócitos do Interstício Tumoral/metabolismo
Masculino
Meia-Idade
Derrame Pleural Maligno/diagnóstico
Derrame Pleural Maligno/mortalidade
Qualidade de Vida
Análise de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Biomarkers, Tumor); Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE


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[PMID]:28709944
[Au] Autor:Bezerra CF; Mota ÉF; Silva ACM; Tomé AR; Silva MZR; de Brito D; Porfírio CTMN; Oliveira AC; Lima-Filho JV; Ramos MV
[Ad] Endereço:Instituto Federal de Educação, Ciência e Tecnologia do Estado do Rio Grande do Norte, Pau dos Ferros, Rio Grande do Norte, Brazil. Electronic address: bfmila@yahoo.com.br.
[Ti] Título:Latex proteins from Calotropis procera: Toxicity and immunological tolerance revisited.
[So] Source:Chem Biol Interact;274:138-149, 2017 Aug 25.
[Is] ISSN:1872-7786
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Many thousands of plants are disseminated worldwide in traditional and folk medicines based on the belief that their leaves, roots, seeds, bark or secretions, when adequately handled, can treat, alleviate or ameliorate numerous disease symptoms. Calotropis procera (Apocynaceae) is a popular medicinal plant and the claims of this shrub's phytomedicinal properties have been scientifically validated. In this study, further prospects towards the in vivo toxicity and oral immunological tolerance of phytomodulatory proteins isolated from the latex of C. procera are reported. Acute toxicity was determined in mice by oral and intraperitoneal administration of latex proteins (LP) and was followed behavioral, hematological and histological analyses. Oral immunological tolerance to LP was assessed by intraperitoneal immunization in mice that had received LP orally before. Animals given 5000 mg/kg orally exhibited only discrete behavioral alterations and augmentation of monocytes. Death was not notified 14 days after exposure. However, all animals receiving LP 150 mg/kg by i.p. died in 1 h. Death (20%) was documented when LP (75 mg/kg) was given in the peritoneum and signs of harmful effects were observed in the survivors (80%). Oral immunological tolerance was observed in animals previously given LP orally, when they were further immunized/challenged with peritoneal exposure to different doses of LP. This was confirmed by the lowering of IgE and IgG in the serum, IL-4 and IFN-γ in spleen homogenates and the absence of anaphylaxis signs. It is therefore concluded that LP exhibited quite discrete adverse effects when orally administrated at higher concentrations and this route of administration did not stimulate adverse immunological reactions. Instead it was observed immunological tolerance. The present study contributes very important information concerning the safe use of C. procera as a phytotherapeutic agent.
[Mh] Termos MeSH primário: Calotropis/metabolismo
Tolerância Imunológica/efeitos dos fármacos
Látex/toxicidade
Proteínas de Plantas/toxicidade
[Mh] Termos MeSH secundário: Administração Oral
Anafilaxia/etiologia
Animais
Feminino
Hipersensibilidade Tardia/etiologia
Imunoglobulina E/sangue
Imunoglobulina G/sangue
Infusões Parenterais
Interferon gama
Interleucina-4/metabolismo
Rim/efeitos dos fármacos
Rim/patologia
Látex/imunologia
Látex/metabolismo
Camundongos
Proteínas de Plantas/imunologia
Plantas Medicinais/metabolismo
Baço/efeitos dos fármacos
Baço/metabolismo
Baço/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immunoglobulin G); 0 (Latex); 0 (Plant Proteins); 207137-56-2 (Interleukin-4); 37341-29-0 (Immunoglobulin E); 82115-62-6 (Interferon-gamma)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170716
[St] Status:MEDLINE


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[PMID]:28658135
[Au] Autor:Hsieh MC; Lu CY; Chang WW; Wu SY; Hsiao PK; Liu TJ
[Ad] Endereço:aDivision of General Surgery, Department of Surgery, Wan Fang Hospital bDivision of General Surgery, Department of Surgery, School of Medicine, College of Medicine cDepartment of Radiation Oncology, Wan Fang Hospital dDepartment of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University eInstitute of Toxicology, College of Medicine, National Taiwan University, Taipei fDepartment of Biotechnology, Hungkuang University, Taichung, Taiwan.
[Ti] Título:Experiences with cytoreduction surgery plus hyperthermic intraperitoneal chemotherapy in Taiwan.
[So] Source:Medicine (Baltimore);96(26):e7306, 2017 Jun.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Our hospital was the first institution to offer cytoreduction surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in Taiwan. Therefore, we report our experience and outcomes among patients who underwent HIPEC.Since 2002, 164 eligible patients underwent HIPEC, and we excluded cases of laparoscopic or prophylactic HIPEC. The cases were categorized according to whether they were treated before 2012 (Period 1: 80 cases) or after 2012 (Period 2: 84 cases).The rates of surgical morbidity were 46.3% during Period 1 and 20.2% during Period 2 (P < .01), and the rates of severe complications were 25% during Period 1 and 9.5% during Period 2 (P < .01). The 5-year overall survival rate was 35.8%, with rates of 13.4% for gastric cancer, 27.3% for colon cancer, 70.0% for appendiceal cancer, and 52.4% for ovarian cancer (median follow-up: 34 months). The survival rate was 42.1% when we achieved a cytoreduction score of 0/1, compared with 21.1% in the group with a cytoreduction score of 2/3 (P < .01). Severe complications were associated with a 5-year survival rate of 23.4%, compared with 37.9% among cases without severe complications (P = .01). Complete cytoreduction was achieved in 78.6% of the patients if they underwent their first surgery at our hospital.We have become an experienced hospital for CRS plus HIPEC. Although our complication rate for CRS plus HIPEC was high, it was within the acceptable range. Long-term survival was achieved in a few cases.
[Mh] Termos MeSH primário: Antineoplásicos/administração & dosagem
Procedimentos Cirúrgicos de Citorredução
Neoplasias Peritoneais/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Antineoplásicos/efeitos adversos
Terapia Combinada/efeitos adversos
Procedimentos Cirúrgicos de Citorredução/efeitos adversos
Feminino
Temperatura Alta
Seres Humanos
Infusões Parenterais
Masculino
Meia-Idade
Neoplasias Peritoneais/diagnóstico por imagem
Neoplasias Peritoneais/mortalidade
Neoplasias Peritoneais/secundário
Estudos Retrospectivos
Análise de Sobrevida
Taiwan
Centros de Atenção Terciária
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Antineoplastic Agents)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007306


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[PMID]:28614364
[Au] Autor:Mungroop TH; van Samkar G; Geerts BF; van Dieren S; Besselink MG; Veelo DP; Lirk P; POP-UP trial group
[Ad] Endereço:Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
[Ti] Título:Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial.
[So] Source:PLoS One;12(6):e0178917, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Continuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine at the start of laparotomy, similar to the bolus given with epidural analgesia. METHODS: This was a comparative study within a randomized controlled trial (NTR4948). Patients undergoing hepato-pancreato-biliary surgery received either a pre-peritoneal bolus of 30ml bupivacaine 0.25%, or an epidural bolus of 10ml bupivacaine 0.25% at the start of laparotomy. In a subgroup of patients, we sampled blood and determined bupivacaine serum levels 20, 40, 60 and 80 minutes after bolus injection. We assumed toxicity of bupivacaine to be >1000 ng/ml. RESULTS: A total of 20 patients participated in this sub-study. All plasma levels measured as well as the upper limit of the predicted 99% confidence intervals per time point were well below the toxicity limit. In a mixed linear-effect model both groups did not differ statistically significant (p = 0.131). The intra-operative use of opioids was higher with CWI as compared to epidural (86 (SD 73) µg sufentanil vs. 50 (SD 32). CONCLUSIONS: In this exploratory study, the pre-peritoneal bolus using bupivacaine resulted in serum bupivacaine concentrations well below the commonly accepted toxic threshold. With CWI more additional analgesics are needed intraoperatively as compared to epidural analgesia, although this is compensated by a reduction in use of vasopressors with CWI. TRIAL REGISTRATION: Netherlands Trial Register NTR4948.
[Mh] Termos MeSH primário: Abdome/cirurgia
Bupivacaína/administração & dosagem
Bupivacaína/sangue
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Analgesia Epidural/efeitos adversos
Feminino
Seres Humanos
Infusões Parenterais/efeitos adversos
Laparotomia
Masculino
Meia-Idade
Cuidados Pré-Operatórios
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170915
[Lr] Data última revisão:
170915
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178917


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[PMID]:28610572
[Au] Autor:van Dijk JEW; Dedden SJ; Geomini PMAJ; Meijer P; van Hanegem N; Bongers MY
[Ad] Endereço:Department of Obstetrics and Gynecology, MUMC+, GROW - School for Oncology and Developmental Biology, PO Box 5800, 6202 AZ, Maastricht, the Netherlands. jew.vandijk@gmail.com.
[Ti] Título:POstLAparoscopic Reduction of pain By combining intraperitoneal normal salinE And the pulmonary Recruitment maneuver (POLAR BEAR trial). RCT to estimate reduction in pain after laparoscopic surgery when using a combination therapy of intraperitoneal normal saline and the pulmonary recruitment maneuver.
[So] Source:BMC Womens Health;17(1):42, 2017 Jun 13.
[Is] ISSN:1472-6874
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Shoulder pain and pain in the upper abdomen are common complaints after laparoscopy, sometimes surpassing the pain at incision sites. The incidence of shoulder pain ranges from 35 to 80%. Post-laparoscopic pain is caused by retention of carbon dioxide in the abdomen, which irritates the phrenic nerve and diaphragm, causing referred pain in the shoulder and in the upper abdomen. A promising strategy to reduce this post-laparoscopic pain is the pulmonary recruitment maneuver, which indirectly increases intraperitoneal pressure and thereby facilitates removal of residual carbon dioxide. An alternative strategy is the infusion of intraperitoneal normal saline. With normal saline infusion, carbon dioxide rises and escapes through the port sites. In addition, normal saline offers a physiologic buffer system to dissolve excess carbon dioxide. METHODS/DESIGN: This multicenter randomized controlled trial is conducted in two teaching hospitals in the Netherlands. Women between 18 and 65 years of age, with an ASA classification of I-II who are scheduled to undergo an elective laparoscopic procedure with benign gynecologic indication can participate. Following informed consent, participants are randomly allocated into two groups at the end of the surgical procedure. In the intervention group, the upper abdomen is filled with normal saline infusion with the patient in the Trendelenburg position. Then the anesthesiologist performs a standardized pulmonary recruitment maneuver with a pressure of 40 cm H O. The trocar sleeve valves will be left open, so carbon dioxide can escape the abdominal cavity. With the patient in a neutral position the instruments are removed from the abdomen. In the control group, carbon dioxide is removed from the abdominal cavity at the end of surgery, with gentle abdominal pressure and passive exsufflation through the port sites, with open sleeve valves. The primary outcomes are the incidence and intensity of post-laparoscopic pain in the shoulder, upper abdomen and at the operation sites, at 8, 24 and 48 h after surgery. Secondary outcomes are postoperative use of analgesics, nausea, vomiting and pulmonary complications. DISCUSSION: This study may reduce post-laparoscopic pain in women undergoing laparoscopy. TRIAL REGISTRATION: Dutch trial register, number NTR4812 .
[Mh] Termos MeSH primário: Infusões Parenterais/métodos
Dor Pós-Operatória/prevenção & controle
Pneumoperitônio Artificial/métodos
Cuidados Pós-Operatórios/métodos
Cloreto de Sódio/administração & dosagem
[Mh] Termos MeSH secundário: Dor Abdominal/etiologia
Dor Abdominal/prevenção & controle
Adolescente
Adulto
Idoso
Terapia Combinada
Feminino
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos
Procedimentos Cirúrgicos em Ginecologia/métodos
Seres Humanos
Laparoscopia/efeitos adversos
Laparoscopia/métodos
Meia-Idade
Países Baixos
Medição da Dor
Dor Pós-Operatória/etiologia
Período Pós-Operatório
Dor de Ombro/etiologia
Dor de Ombro/prevenção & controle
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
451W47IQ8X (Sodium Chloride)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170815
[Lr] Data última revisão:
170815
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE
[do] DOI:10.1186/s12905-017-0397-8



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