RESUMEN
Mitomycin is a cytotoxic antibiotic that was first introduced into clinical use in 1958. Not until twenty years later was it recognised that haemolytic uremic syndrome could develop after treatment with mitomycin. It can be asked whether this condition was undiagnosed in previous years, since its frequency is now reported to be 4-15%. The disease appears to be dose-related, since it rarely occurs in patients who have received mitomycin < 30 mg/m2. No effective therapy has been established. We describe two patients with breast cancer in remission after treatment with mitomycin in combination with 5-fluorouracil. Both developed haemolytic uremic syndrome with fatal outcome.
Asunto(s)
Antibióticos Antineoplásicos/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Síndrome Hemolítico-Urémico/inducido químicamente , Mitomicinas/efectos adversos , Adulto , Antibióticos Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Femenino , Fluorouracilo/administración & dosificación , Síndrome Hemolítico-Urémico/sangre , Síndrome Hemolítico-Urémico/patología , Humanos , Persona de Mediana Edad , Mitomicinas/administración & dosificaciónRESUMEN
BACKGROUND: Due to the possibility of a synergistic effect between Interferon (IFN-alpha) and 5-fluorouracil (5-FU), a phase II trial was conducted in metastatic renal cell carcinoma (MRCC) combining recombinant IFN-alpha, 5-FU and prednisone. Prednisone has been shown to decrease IFN-alpha-related toxicity without reducing the response rate. PATIENTS AND METHODS: Thirty-one patients with measurable MRCC were entered into the trial; 16 of them had lung metastases only. In 26 patients (nos. 6-31) the following dose schedule was applied during an 8-week treatment cycle: IFN-alpha (Roferon, Roche, Basel, Switzerland): 12 x 10(6)U s.c. 3 times weekly; Days 1-5: 5-FU: 600 mg/m2/day continuous i.v. infusion; Weeks 3-8: 5-FU 600 mg/m2 x 1 weekly (bolus i.v.); prednisone: 10 mg x 2 per os daily for 2 weeks, and thereafter 5 mg x 2. In the first 5 patients higher doses of 5-FU led to unacceptable toxicity and subsequent dose alteration of the trial schedule. All 31 patients were evaluable for response. Seventy treatment cycles were given. RESULTS: One complete and 6 partial responses were observed (response rate: 23%, 95% CI: 10%-41%), with a median response duration of 11 months. Except in one patient, hematological toxicity was confined to grades I and II. Eight patients developed grade III oral mucositis. Adverse cardiac events were observed in 3 patients. Dose modifications of 5-FU were necessary in 16 cycles. The IFN-alpha doses were transiently reduced during 8 cycles. CONCLUSION: The assessed combination of IFN-alpha, 5-FU and prednisone is moderately active in MRCC, with response rates similar to those seen in patients on IFN-alpha monotherapy. The latter treatment approach seems preferable, as 5-FU-related toxicity (mucositis, cardiac toxicity) is averted.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/secundario , Neoplasias Renales/tratamiento farmacológico , Adolescente , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Esquema de Medicación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Interferón-alfa/administración & dosificación , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Resultado del TratamientoRESUMEN
A 54-year-old female with a 3 year history of coeliac disease suddenly deteriorated. Clinical investigation and bone marrow aspirate were consistent with malignant histiocytosis. The patient died and the following postmortem examination confirmed the diagnosis. The significance of the concomitant occurrence of coeliac disease and malignant histiocytosis is discussed.
Asunto(s)
Enfermedad Celíaca/complicaciones , Histiocitosis de Células de Langerhans/complicaciones , Enfermedad Celíaca/patología , Femenino , Histiocitosis de Células de Langerhans/clasificación , Histiocitosis de Células de Langerhans/patología , Humanos , Persona de Mediana EdadRESUMEN
A female patient with lymphomatoid granulomatosis (LYG) involving lung, liver and spleen is described. Our case presented with signs and laboratory data indicating severe hepatic failure. It is not clear if this disorder represents a distinct pathological or clinical entity. In this report the differences between LYG and the two disease groups which it most resembles, Wegener's granulomatosis and malignant lymphoma are discussed.
Asunto(s)
Hepatopatías , Enfermedades Pulmonares , Trastornos Linfoproliferativos , Enfermedades del Bazo , Diagnóstico Diferencial , Femenino , Humanos , Hígado/patología , Hepatopatías/patología , Pulmón/patología , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Trastornos Linfoproliferativos/diagnóstico por imagen , Trastornos Linfoproliferativos/patología , Persona de Mediana Edad , Radiografía , Bazo/patología , Enfermedades del Bazo/patologíaAsunto(s)
Adenocarcinoma/inmunología , Antígeno Carcinoembrionario/análisis , Carcinoma de Células Transicionales/inmunología , Neoplasias Uretrales/inmunología , Neoplasias de la Vejiga Urinaria/inmunología , Adenocarcinoma/terapia , Adulto , Anciano , Carcinoma de Células Transicionales/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/inmunología , Pronóstico , Recurrencia , Factores de Tiempo , Neoplasias Uretrales/terapia , Neoplasias de la Vejiga Urinaria/terapiaRESUMEN
A female patient is described with multiple papillary transitional cell tumours involving left renal pelvis, left ureter, bladder and urethra with metastases to uterine cervix, uterine cavity and left ovary with cyst formation. The surgical management and possible explanations of the pathogenesis are discussed.