Asunto(s)
Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Melanoma/patología , Melanoma/cirugía , Biopsia del Ganglio Linfático Centinela , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Colorantes , Femenino , Humanos , Italia , Ganglios Linfáticos/diagnóstico por imagen , Metástasis Linfática , Masculino , Melanoma/diagnóstico por imagen , Persona de Mediana Edad , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Cintigrafía , Radiofármacos , Estudios Retrospectivos , Colorantes de Rosanilina , Neoplasias Cutáneas/diagnóstico por imagenRESUMEN
Solitary fibrous tumors (SFTs) are rare neoplasms with a probable mesenchymal origin that were first reported in the pleura but can occur in different sites. We report a case of SFT arising in the inguinal region of a 55-year-old woman. The patient presented with a mass in the left groin; she underwent wide excision of the lesion which was well-circumscribed and without evidence of adjacent soft tissue involvement. The histological, immunohistochemical and electron microscopic criteria for SFT were found. She had an uneventful recovery and she is alive without evidence of disease five years after operation. To our knowledge, this neoplasm has never been reported in this location.
Asunto(s)
ADN de Neoplasias/análisis , Conducto Inguinal/patología , Neoplasias de Tejido Fibroso/patología , Femenino , Citometría de Flujo , Humanos , Inmunohistoquímica , Microscopía Electrónica , Persona de Mediana Edad , Neoplasias de Tejido Fibroso/genética , Neoplasias de Tejido Fibroso/metabolismoRESUMEN
OBJECTIVES: Two-hundred eighteen patients with TNM stage II-III resectable rectal cancer, enrolled into a randomized clinical trial, were assessed for efficacy and toxicity of adjuvant postoperative radiation therapy (RT) vs. those of combined RT and chemotherapy (CT), with 5-fluorouracil (5-FU) plus levamisole. End points were overall survival, disease-free survival, the rate of loco-regional recurrence, and treatment-related toxicity. METHODS: Patients in arm I underwent RT (50 Gy) in daily fractions of 2 Gy, 5 days/week for 5 weeks. Patients in arm II began with 5-FU (450 mg/m(2)/day intravenous bolus, days 1-5) plus levamisole (150 mg/day orally, days 1-3); postoperative RT was delivered during week 2 at the same dosage and schedule as in arm I. The other five cycles of CT (5-FU every 28 days and levamisole every 15 days for the length of 5-FU administration) continued after the end of RT if clinical and hemato-biochemical parameters were normal. RESULTS: RT was completed or modified in 170 (90%) of 189 evaluable patients undergoing RT (both treatment groups). Only 44 (59%) of 75 evaluable patients of arm II completed or had an adjustment of the CT schedule; the remaining 31 patients (41%) had to stop or never started the CT regimen. Patients undergoing combined RT and CT had more severe toxicity (enteritis, P = 0.03). There was one CT-related death (gastrointestinal bleeding) in this subset. No significant difference was observed in outcome of patients in the two study groups, nor for pattern of recurrence (heterogeneity chi(2) = 4.82; d.f. = 2; P = 0.08). CONCLUSIONS: These preliminary findings suggest a similar efficacy, coupled with less morbidity, of postoperative RT alone compared with a combined regimen of postoperative RT and CT in patients undergoing radical surgery for stage II-III rectal cancer.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/radioterapia , Adyuvantes Inmunológicos/administración & dosificación , Adulto , Anciano , Análisis de Varianza , Antimetabolitos Antineoplásicos/administración & dosificación , Quimioterapia Adyuvante , Supervivencia sin Enfermedad , Femenino , Fluorouracilo/administración & dosificación , Humanos , Levamisol/administración & dosificación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Eighty-eight consecutive patients (48 men and 40 women; mean age, 58.9 years; range, 16-84 years) with clinically localized cutaneous melanoma involving the trunk, extremities or head and neck underwent lymphatic mapping at our institution. The primary melanoma had a mean thickness of 2.74 mm (range, 0.95 to 9 mm). Patients were divided into two groups: group A (39 patients) underwent only vital blue dye (VBD) mapping, while group B (49 patients) underwent lymphatic mapping with VBD and radio-guided surgery (RGS) combined. In all patients 1-1.5 mL of VBD was injected subdermally around the biopsy scar 10-20 min before surgery. In group B 37 MBq in 150 microL of 99mTc-HSA nanocolloid was additionally injected intradermally 18 h before surgery (3-6 aliquots injected perilesionally). In all lymphatic basins where drainage was noted the sentinel lymph nodes (SNs) were identified and marked with a cutaneous marker. Final identification of the SN was then performed externally by a hand-held gamma probe. After the induction of anesthesia 0.5-1-0 mL of patent blue V dye was injected intradermally with a 25-gauge needle around the site of the primary melanoma. SNs were examined by routine hematoxylin and eosin (H&E) staining and immunohistochemistry. Patients with histologically positive SN(s) underwent standard lymph node dissection (SLND) in the involved lymph node basin. The SN was identified in 37/39 patients (94.9%) of group A and in 48/49 patients (98.0%) of group B. Blue dye mapping failed to identify the SN in 5 of the 88 patients (5.8%), while the radioisotope method failed in only 1 of 49 patients (2.0%). Similar results were obtained with the combined use of the two probes. The average number of SNs harvested was 1.9 per basin sampled, which does not differ significantly from the numbers reported by other authors. The SN was histologically positive in 18 patients (20.5%). None of the 12 patients with a Breslow thickness less than 1.5 mm had positive SNs, whereas 18 of the 77 patients (23.4%) with a Breslow index exceeding 1.5 mm showed metastatic SNs with H&E or immunohistochemistry. The latter all underwent SLND of the affected basin. In 10 patients (55.6%) the SN was the only site of tumor invasion; eight patients (44.4%) with positive SNs had one or more metastatic lymph nodes in the draining basin.
Asunto(s)
Cámaras gamma , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/cirugía , Melanoma/diagnóstico por imagen , Melanoma/cirugía , Biopsia del Ganglio Linfático Centinela/métodos , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colorantes , Femenino , Humanos , Periodo Intraoperatorio , Ganglios Linfáticos/patología , Masculino , Melanoma/patología , Persona de Mediana Edad , Cintigrafía , Colorantes de Rosanilina , Neoplasias Cutáneas/patología , Agregado de Albúmina Marcado con Tecnecio Tc 99mRESUMEN
The role of elective lymph node dissection (ELND) for the treatment of cutaneous melanoma has been debated for many years. Actually, the value of ELND is seriously questioned because an increasing of overall survival rates has not been demonstrated. The lymphatic mapping technique, initially performed by an intradermic injection of vital blue dye, subsequently improved by the use of radioguided surgery (RGS), proved effective for the detection of clinical occult lymph node metastasis. We performed a sentinel node biopsy on 71 patients with stage pT2/T3N0M0 melanoma. Vital blue dye mapping alone was performed on 39 patients; the remaining 32 patients had a combined lymphatic mapping with both blue dye and RGS. The sentinel node (SN) was complexively identified in 69/71 (97.2%) patients. Sixteen patients (23.2%) were found to have metastatic melanoma cells in their SN(s); all these patients underwent lymph node dissection of the affected basin. Our experience confirmed that the intraoperative detection of sentinel nodes using both blue dye and radio-guided surgery is an effective and reliable technique for selecting patients to be submitted to lymph node dissection.
Asunto(s)
Procedimientos Quirúrgicos Electivos , Escisión del Ganglio Linfático/métodos , Metástasis Linfática/diagnóstico , Melanoma/cirugía , Neoplasias Cutáneas/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antígenos de Neoplasias , Biomarcadores de Tumor/análisis , Biopsia , Colorantes , Eosina Amarillenta-(YS) , Estudios de Evaluación como Asunto , Femenino , Secciones por Congelación , Hematoxilina , Humanos , Inmunohistoquímica , Cuidados Intraoperatorios , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/patología , Masculino , Melanoma/química , Melanoma/patología , Antígenos Específicos del Melanoma , Persona de Mediana Edad , Proteínas de Neoplasias/análisis , Estadificación de Neoplasias , Radiología Intervencionista , Cintigrafía , Colorantes de Rosanilina , Proteínas S100/análisis , Neoplasias Cutáneas/química , Neoplasias Cutáneas/patología , Coloración y Etiquetado , Agregado de Albúmina Marcado con Tecnecio Tc 99mRESUMEN
The magnetic resonance (MR) findings in malignant melanoma of soft tissues, also called clear cell sarcoma of tendons and aponeuroses, have been described as a focal abnormality with a specific MR pattern of increased signal intensity (relative to normal muscle) on T1 weighted sequences and variably decreased signal intensity on T2 weighted sequences (relative to surrounding fat). We have reported here a case of malignant melanoma of soft tissues of the foot, studied with ultrasonography (US) and MR, in which MR showed T1-hypointensity, T2-hyperintensity and marked gadolinium uptake. We have described the relationship between the intracytoplasmic melanin amount of and these atypical MR findings.
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Enfermedades del Pie/diagnóstico , Imagen por Resonancia Magnética , Sarcoma de Células Claras/diagnóstico , Adolescente , Femenino , Enfermedades del Pie/diagnóstico por imagen , Enfermedades del Pie/patología , Enfermedades del Pie/cirugía , Humanos , Sarcoma de Células Claras/diagnóstico por imagen , Sarcoma de Células Claras/patología , Sarcoma de Células Claras/cirugía , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
BACKGROUND: On the basis of our previous experience, we designed this study to determine the activity and toxicity of outpatient treatment with autologous tumor-infiltrating lymphocytes (TIL) together with intermediate-dose recombinant interleukin-2 (rIL-2) and low-dose recombinant interferon alfa-2a (rIFN-alpha2a), for patients with metastatic melanoma. METHODS: Between April 1992 and October 1994, we processed 38 melanoma samples derived from 36 patients with metastases. Proliferative cultures of expanded lymphocytes (TIL) were infused only once into patients with metastatic melanoma. rIL-2 was administered subcutaneously for 1 month, starting on the day of TIL infusion, at an escalating dose of 6-18 x 10(6) IU/m2/day for the first week and at the maximum-tolerated dose for the subsequent 3 weeks and then, after a 15-day interval, for 1 week/month for 3 months. rIFN-alpha2a was administered subcutaneously at 3 X 10(6) IU three times each week until progression. RESULTS: Of 38 melanoma samples, 19 (50%) resulted in proliferative cultures and were infused. The median number of expanded lymphocytes was 18 x 10(9) (range, 1-43 x 10(9)), and the median period of culture was 52 days (range, 45-60). rIL-2 was administered at doses ranging between 6 and 18 x 10(6) IU/m2/day. Toxicity was mild or moderate, and no life-threatening side effects were encountered. Two of 19 treated patients experienced complete responses of their metastatic sites (soft tissue), 10 had stable disease, and 7 showed progressive disease. The response rate was 11% (95% confidence interval, 2-35%). CONCLUSIONS: Outpatient treatment with TIL plus rIL-2 and rIFN-alpha2a is feasible, although, within the context of the small sample size, the activity of the combination was no different from the reported activity of any of the components used alone.
Asunto(s)
Inmunoterapia Adoptiva/métodos , Interferón-alfa/uso terapéutico , Interleucina-2/uso terapéutico , Linfocitos Infiltrantes de Tumor , Melanoma/terapia , Neoplasias Cutáneas/terapia , Adulto , Anciano , Quimioterapia Combinada , Femenino , Humanos , Interferón alfa-2 , Metástasis Linfática , Masculino , Melanoma/secundario , Persona de Mediana Edad , Proyectos Piloto , Proteínas RecombinantesRESUMEN
One hundred thirty-six patients with colorectal and breast cancer were enrolled in a retrospective study using radioimmunoguided surgery (RIGS) with Iodine-125 (I125) radiolabeled B72.3 (Group A, 73 patients) and F023C5 (Group B, 63 patients) monoclonal antibodies (MAbs). The correlation between intraoperative tumor-to-normal tissue (T/NT) gamma-detecting probe (GDP) counts ratio and the expression of tumor-associated glycoprotein (TAG)-72 (GroupA patients) and carcinoembryonic antigen (CEA; Group B patients) tumor-associated antigens (TAA) expression of 209 resected or biopsy tumor specimens was assessed. Ex vivo radioimmunolocalization index (R.I.) was carried out on the same specimens as a control of intraoperative GDP ratio values. RIGS positive definition of tumor occurred in 80/113 (70.8%) tumor sites of Group A patients and in 84/96 (87.5%) tumor sites of Group B patients. Mean percent B72.3 TAA expression of 113 tumor sites of Group A patients was 62.74 +/- 28.79% vs. 73.00 +/- 26.28% of 96 tumor sites of Group B patients (P < 0.05). The higher incidence of positive RIGS results was observed in tumor sites with the higher expression of the relative TAA. A statistically significant correlation between RIGS ratios and B72.3 and CEA expression was observed in the 113 tumor sites of Group A (P < 0.05) and in the 96 tumor sites of Group B (P < 0.01), respectively. The role of a preoperative evaluation of TAA expression in patients undergoing RIGS is discussed. Its assessment, whenever possible, may help to select those patients who will benefit more from this immunodiagnostic technique.
Asunto(s)
Antígenos de Neoplasias/análisis , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/cirugía , Radioinmunodetección , Anticuerpos Monoclonales , Antígenos de Neoplasias/inmunología , Neoplasias de la Mama/patología , Neoplasias Colorrectales/patología , Femenino , Humanos , Inmunohistoquímica , Radioisótopos de Yodo , Masculino , Selección de Paciente , Estudios RetrospectivosRESUMEN
Radioimmunoguided surgery (RIGS) with radiolabeled monoclonal antibodies (MoAbs) has been reported as useful in second-look colorectal cancer procedures to improve surgical decision-making by helping avoid needless extensive surgery and expanding curative resection to sites of recurrence that have been missed previously. Sixteen asymptomatic patients with an history of colorectal cancer surgery underwent second-look surgery using the RIGS system, solely on the basis of rising serum levels of carcinoembryonic antigen (CEA). All patients were injected preoperatively with the anti-tumor-associated glycoprotein (TAG) 125I-labeled MoAb B72.3. Both traditional and RIGS exploration were used to determine the extension of a possible recurrence and its resectability for cure. Recurrent disease was observed in 14 of the 16 patients as the result of this combined exploration. Exploration alone showed the presence of recurrent disease in 9 of 16 patients (56.2%). Thus, RIGS found overlooked tumor in five patients (31.2%). All the additional RIGS-detected tumor sites were locoregional recurrences resectable for cure; conversely, no diagnostic improvements were shown in patients with liver metastases. Resection for cure was obtained by this approach in 9 of 16 patients (56.2%). Two patients without disease at the exploratory laparotomy recurred within 2 months at sites away from the abdomen. RIGS improved the results of colorectal cancer CEA-guided second-look procedures in asymptomatic patients by recruiting one-third of patients to curative resections.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/cirugía , Antígeno Carcinoembrionario/análisis , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/cirugía , Radioinmunodetección , Adenocarcinoma/patología , Anciano , Anticuerpos Monoclonales , Neoplasias Colorrectales/patología , Femenino , Humanos , Periodo Intraoperatorio , Radioisótopos de Yodo , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico , Reoperación , Resultado del TratamientoRESUMEN
The role of elective lymph node dissection (ELND) for treatment of cutaneous melanoma is still debated. Initially, lymphatic mapping technique was performed by an intradermic injection of vital blue dye; subsequently, it was improved by the use of radioguided surgery (RGS). Preliminary experience with this technique proved effective for detection of clinical occult lymph node metastasis; it may also enable the surgeon to perform a selective lymph node dissection (SLND) to concentrate on pathologic node-positive patients for the same potential benefits that have been provided by ELND. We performed sentinel node biopsy on 48 patients with stage pT3N0M0 melanoma. Vital blue dye mapping only was carried out on 39 patients; the remaining nine patients had a combined lymphatic mapping with both blue dye and RGS. The sentinel lymph node (SLN) was identified in 46 of 48 patients (95.8%). Ten patients (20.8%) were found to have metastatic melanoma cells in their SLN(s); all these patients underwent SLND of the affected basin. Our findings confirm that the intraoperative lymphatic mapping of the SLN using both blue dye and radiodetection is an appropriate and simple technique for selecting patients who are more likely to benefit from lymph node dissection.
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Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Melanoma/diagnóstico por imagen , Radioinmunodetección , Neoplasias Cutáneas/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Colorantes , Femenino , Humanos , Metástasis Linfática , Masculino , Melanoma/secundario , Melanoma/cirugía , Persona de Mediana Edad , Estadificación de Neoplasias , Selección de Paciente , Valor Predictivo de las Pruebas , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Agregado de Albúmina Marcado con Tecnecio Tc 99mRESUMEN
The clinical features of 10 cases of primary neuroendocrine carcinoma of the skin (Merker cell tumor) are reported. This cancer arises in the dermis and subcutaneous tissues of elderly individuals. Natural history is characterized by local recurrences (30%), regional lymph node metastases (65%) and distant metastases (40%). Surgery is elective treatment, chemotherapy and radiotherapy resulted only to short-term palliative response.
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Carcinoma de Células de Merkel/patología , Carcinoma de Células de Merkel/terapia , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapia , Anciano , Anciano de 80 o más Años , Carcinoma de Células de Merkel/radioterapia , Carcinoma de Células de Merkel/cirugía , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Cuidados Paliativos , Recurrencia , Estudios Retrospectivos , Neoplasias Cutáneas/radioterapia , Neoplasias Cutáneas/cirugíaRESUMEN
The clinical features of 10 cases with the adjunct of a literature review of primary neuroendocrine carcinoma of the skin (Merkel cell tumor) are reported. This cancer arises in the dermis and subcutaneous tissue of elderly individuals. Natural history is characterized by local recurrences (40%), regional lymph-nodes metastases (50%), and distant metastases (60%). Surgery is the elective treatment of primary and locoregional disease and subsequent radiotherapy prevents local recurrences and prolong disease-free survival in literature reports. Chemotherapy and radiotherary resulted in only a short-term palliative response in the metastatic setting.
Asunto(s)
Carcinoma de Células de Merkel/terapia , Neoplasias Cutáneas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células de Merkel/patología , Carcinoma de Células de Merkel/secundario , Supervivencia sin Enfermedad , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias Cutáneas/patologíaRESUMEN
Pseudomixoma peritonei is a rare neoplasm characterized by mucinous ascites and the mucinous involvement of peritoneal surfaces, omentum and bowel loops. Usually pseudomixoma peritonei is associated with benign or malignant mucinous tumor of the appendix or ovary. The diagnosis of pseudomixoma peritonei is difficult because laboratory and radiology results are frequently nondiagnostic. We report a case that was initially mistaken for carcinomatosis of unknown origin and that underwent cytoreductive procedure and omentectomy as the treatment of choice.
Asunto(s)
Neoplasias Peritoneales/diagnóstico , Seudomixoma Peritoneal/diagnóstico , Anciano , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/patología , Seudomixoma Peritoneal/diagnóstico por imagen , Seudomixoma Peritoneal/patología , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Adoptive immunotherapy with in vitro expanded tumor infiltrating lymphocytes (TIL) and recombinant interleukin-2 (rIL-2) is a recent option in the treatment of advanced melanoma resistant to conventional chemotherapy. In the course of a protocol of treatment of advanced melanoma with in vitro expanded TIL and rIL-2, we obtained 38 samples from 27 different patients. Lymphocytes derived were cultured in the presence of rIL-2 in vitro for a 4-6 week period and 23 resulted in proliferative cultures. Eighteen samples were infused in the course of the clinical trial. The median number of lymphocytes obtained was 18x10(9) (range 1-43x10(9)) cells. Phenotypic analysis showed that all samples contained a pure population of T cells. These data confirm that lymphocytes can be expanded from advanced metastatic sites, have peculiar characteristics and are suitable to be infused in vivo.
RESUMEN
BACKGROUND: Angiosarcoma (AS) accounts for 1 to 2% of all soft tissue sarcoma. Both primary and secondary AS may occur, the latter being reported in the upper extremity with lymphedema after extended radical mastectomy for breast cancer (postmastectomy AS) or following radiotherapy of the breast, the thoracic wall, or other sites (radiation-associated AS). The authors report two cases of cutaneous radiation-associated AS and review literature regarding treatment planning and follow-up data to define the most appropriate therapy for cutaneous and noncutaneous radiation-associated AS. METHODS: The clinical records of two patients with radiation-associated AS were analyzed and previously reported cases were reviewed. RESULTS: Case 1: a female age 67 years developed cutaneous AS in the residual breast 27 months after breast-conserving therapy and conventional external beam radiotherapy (EBR). She underwent chemotherapy followed by simple mastectomy and chemotherapy with the same regimen but developed early recurrence that was treated with hyperthermia and EBR, wide excision, and second-line chemotherapy. She died 30 months after primary diagnosis of AS with multiple metastases. Case 2: a male age 59 years developed cutaneous AS in the left groin, 10 years after conservative surgery and EBR for a penile carcinoma. Early recurrence following wide excision was treated with chemotherapy, re-excision, and immunochemotherapy but the patient died 24 months after the primary diagnosis of cutaneous AS with local progression and distant metastases. CONCLUSIONS: The prognosis of radiation-associated AS is dismal, due mostly to its poor differentiation and frequent diagnostic delay. Simple mastectomy is advised for patients with cutaneous AS after breast-conserving surgery with wide tumor-free margins. If primary surgery fails, survival is seriously compromised because adjuvant or palliative treatments are not effective.
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Hemangiosarcoma/etiología , Neoplasias Inducidas por Radiación , Neoplasias de la Mama/radioterapia , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radioterapia/efectos adversosAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/radioterapia , Adulto , Anciano , Quimioterapia Adyuvante , Femenino , Fluorouracilo/administración & dosificación , Humanos , Levamisol/administración & dosificación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Radioterapia Adyuvante , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Resultado del TratamientoRESUMEN
The efficacy and tolerability of both Terlipressin and Octreotide in the treatment of upper digestive haemorrhage (oesophagus, stomach and duodenum) have been compared, at random, on 30 adult patients. Terlipressin dosage was 2 mg/4 hours i.v. during the first 24 hours, 2 mg/6 hours during the following 24 hours. Octreotide dosage was 50 micrograms i.v. and infusional therapy, 25 micrograms/hours, followed. Haemostasis was obtained in 100% of patients treated with Terlipressin and in 73% of patients treated with Octreotide. Rebleeding occurred in 3 patients treated with Terlipressin and 4 patients treated with Octreotide. Side effects occurred in 4 patients treated with Terlipressin and 8 patients treated with Octreotide. Terlipressin proved to have a better efficacy in comparison with Octreotide, and had less side effects.
Asunto(s)
Enfermedades Duodenales/tratamiento farmacológico , Enfermedades del Esófago/tratamiento farmacológico , Hemorragia Gastrointestinal/tratamiento farmacológico , Lipresina/análogos & derivados , Octreótido/uso terapéutico , Gastropatías/tratamiento farmacológico , Adulto , Anciano , Femenino , Humanos , Lipresina/uso terapéutico , Masculino , Persona de Mediana Edad , TerlipresinaRESUMEN
We describe a patient with a k light-chain myeloma revealed by an apparently solitary mixed lytic and sclerotic rib lesion. This rare manifestation may be explained by a still balanced bone remodeling in the early phases of the disease.