RESUMEN
High plasma levels of homocysteine are associated with an increased risk for thromboembolic events. Neuraxial anesthesia techniques may be relatively contraindicated in anticoagulated patients, and nitrous oxide may exacerbate the condition by inhibiting the conversion of homocysteine to methionine. We describe the anesthetic implications and management of a patient with hyperhomocysteinemia undergoing an nonemergent cesarean delivery.
Asunto(s)
Anestesia Raquidea , Anticoagulantes/administración & dosificación , Coagulación Sanguínea/efectos de los fármacos , Cesárea , Homocisteína/sangre , Hiperhomocisteinemia/tratamiento farmacológico , Parto/sangre , Complicaciones Hematológicas del Embarazo/tratamiento farmacológico , Adulto , Anestésicos por Inhalación/efectos adversos , Pruebas de Coagulación Sanguínea , Pérdida de Sangre Quirúrgica , Esquema de Medicación , Enoxaparina/administración & dosificación , Femenino , Heparina/administración & dosificación , Humanos , Hiperhomocisteinemia/sangre , Nacimiento Vivo , Óxido Nitroso/efectos adversos , Embarazo , Complicaciones Hematológicas del Embarazo/sangreRESUMEN
This prospective randomized trial was undertaken to determine the added efficacy of (32)P in treating locally advanced unresectable pancreatic cancer. Thirty patients with biopsy proven locally advanced unresectable adenocarcinoma of the pancreas were assessable after receiving 5-fluorouracil and radiation therapy with or without (32)P, followed by gemcitabine. Intratumoral (32)P dose was determined by tumor size and volume and was administered at months 0, 1, 2, 6, 7, and 8. Tumor cross-sectional area and liquefaction were determined at intervals by computed tomography scan. Tumor liquefaction occurred in 78% of patients receiving (32)P and in 8% of patients not receiving (32)P, although tumor cross-sectional area did not decrease. Serious adverse events occurred more often per patient for patients receiving (32)P (4.2 +/- 3.1 vs. 1.8 +/- 1.9; p = 0.03) leading to more hospitalizations. Death was because of disease progression (23 patients), gastrointenstinal hemorrhage (4 patients), and stroke (1 patient). One patient not receiving (32)P and one receiving (32)P are alive at 28 and 13 months, respectively. (32)P did not prolong survival (7.4 +/- 5.5 months with (32)P vs. 11.5 +/- 8.0 months without (32)P, p = 0.16). (32)P promoted tumor liquefaction, but did not decrease tumor size. Intratumoral (32)P was associated with more serious adverse events and did not improve survival for locally advanced unresectable pancreatic cancer.
Asunto(s)
Adenocarcinoma/radioterapia , Neoplasias Pancreáticas/radioterapia , Radioisótopos de Fósforo/uso terapéutico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/patología , Anciano , Femenino , Fluorouracilo/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/patología , Radioisótopos de Fósforo/administración & dosificación , Radioisótopos de Fósforo/efectos adversos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The purpose of this study was to determine risk factors for development of malignant ascites and its prognostic significance in patients with pancreatic cancer. METHODS: A prospective database was queried to identify patients with pancreatic cancer who develop ascites. Stage at presentation, size, and location of primary tumor, treatment received and length of survival after onset of ascites were determined. RESULTS: A total of 15 patients were identified. Of which 4 patients (1 stage II, 3 stage III) underwent pancreaticoduodenectomy and manifested with ascites 2, 3, 24 and 47 months after surgery (tumor size 2.9 +/- 1.32 cm). All but one of the remaining 11 patients (tumor size 4.4 +/- 3.38 cm) presented with metastatic disease, and all developed malignant ascites 9 months after diagnosis, dying 2 months later. Resected patients lived longer before the onset of ascites, but not after. CONCLUSION: Once diagnosed, ascites in pancreatic cancer patients heralds imminent death. Limited survival should be considered when determining the aggressiveness of further intervention.