RESUMEN
The response rates in metastatic renal cell cancer (RCC) after chemotherapy, hormonal treatment, or immunotherapy rarely exceed 15%. Recently, interferon alpha (IFN alpha) was used for treatment of this disease in several studies which also demonstrated response rates of 15%. In order to test whether IFN therapy combined with hormones would result in higher response rates we compared single agent IFN therapy with a combined therapy of rIFN alpha 2C plus medroxyprogesterone acetate (MPA) in a randomized multicenter trial. The rIFN alpha 2C (2MU) was given s.c. 5 times per week for 8-12 weeks and subsequently once weekly until week 48. In the combined treatment, 750 mg MPA was given p.o. daily until week 48 in addition to the IFN as described. The overall response rate in 93 evaluable patients was 5.4% corresponding to 2 complete and 3 partial responses. Median survival was 7 months in both treatment groups. These data confirm the ineffectivity of low IFN doses for treatment of RCC. The low response rate is not increased by addition of MPA to IFN. The analysis of other IFN studies suggests that not only IFN doses but also IFN sources may influence response rates in metastatic RCC.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Renales/tratamiento farmacológico , Interferón Tipo I/uso terapéutico , Neoplasias Renales/tratamiento farmacológico , Medroxiprogesterona/análogos & derivados , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Células Renales/mortalidad , Ensayos Clínicos como Asunto , Femenino , Humanos , Interferón Tipo I/administración & dosificación , Interferón Tipo I/efectos adversos , Neoplasias Renales/mortalidad , Masculino , Medroxiprogesterona/administración & dosificación , Acetato de Medroxiprogesterona , Persona de Mediana Edad , Pronóstico , Distribución Aleatoria , Proteínas Recombinantes/uso terapéuticoRESUMEN
Gas gangrene is a rare infection of grave consequences. It is caused by obligatory anaerobic bacteria. Its appearance in urology is extremely rare. The infection can be acquired either from the outside or from enteral invasion of saprophytes, which are common in body cavities. Very often resistance-weak patients are attacked. In acute cases with typical signs of sepsis in addition to local signs of infection, a fatal outcome cannot be prevented in all cases despite adequate early therapy. Search for bacteria is mostly in vain. The 3 cases demonstrate that absolute asepsis and hygienic rules in simple manipulations (e.g. catheterizing as well as in major urologic operations are absolutely necessary. Traumatic lesions must be reduced to a minimum. Therapy must be started immediately.
Asunto(s)
Gangrena Gaseosa/diagnóstico , Infección de la Herida Quirúrgica/diagnóstico , Enfermedades Urológicas/cirugía , Anciano , Carcinoma de Células Renales/cirugía , Terapia Combinada , Gangrena Gaseosa/cirugía , Humanos , Neoplasias Renales/cirugía , Masculino , Complicaciones Posoperatorias/cirugía , Hiperplasia Prostática/cirugía , Cálculos de la Vejiga Urinaria/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Cateterismo UrinarioRESUMEN
To eliminate urine production of one Kidney transcatheter embolization of the renal artery was performed in 11 patients with mallignant tumors in the area of the pelvis; in addition to the abave procedure in 9 patients a urinary; diversion by transrenal catheter and a ureteric ligation of the opposite side was also carried out. The therapy is of palliative character and signifies the smallest intervention possible to most treat effectively involuntary urination caused by urine fistulas, painful pollakisuria caused by shrinking bladders, and to treat painful hydronephrosis caused by tumors and the like.
Asunto(s)
Embolización Terapéutica , Derivación Urinaria/métodos , Anciano , Femenino , Humanos , Neoplasias Renales/complicaciones , Masculino , Cuidados Paliativos , Arteria Renal , Trastornos Urinarios/terapia , OrinaRESUMEN
Experiences with a new radiological technique, namely embolisation of the renal artery with a spiral from Gianturco, are reported. Continuous epidural block has been found to be the best method of anaesthetic management. The technique of embolisation was used in 17 patients. As a preoperative measure it facilitates tumournephrectomy, saves blood and reduces the danger of dissemination of tumour-cells during operation.
Asunto(s)
Anestesia Epidural , Embolización Terapéutica , Arteria Renal , Anciano , Humanos , Neoplasias Renales/cirugía , Neoplasias Renales/terapia , Nefrectomía , Cuidados PreoperatoriosRESUMEN
Spiral embolisation of a renal artery by the Gianturco method was carried out in eight patients. Our early experience with this technique is described. In seven patients it was possible to occlude arterial flow to the kidney completely, or almost completely. In one patient, faulty technique lead to an avoidable complication resulting in dislocation of the spiral into the femoral artery. The Gianturco method has advantages compared with other embolisation techniques, being simple, rapid, complete and permanent. In addition to its pre-operative and therapeutic use with renal tumours, the method can be used to abolish function in one or both kidneys.
Asunto(s)
Embolización Terapéutica/métodos , Arteria Renal , Adulto , Anciano , Aortografía/métodos , Estudios de Evaluación como Asunto , Femenino , Humanos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/terapia , Masculino , Persona de Mediana Edad , Cuidados PreoperatoriosRESUMEN
Transcatheter coil embolization (according to the method of Gianturco) was performed in 18 patients. It resulted in prompt and permanent occlusion of the renal artery without considerable effort and with acceptable risk. The favourable benefit of this procedure is technical facilitation of tumornephrectomy, cutting down the time of surgery, reducing intraoperative hemorrhage and danger of venous displacement of tumor-cells. The same favourable results will not be achieved by preoperative short-time radiation. Preoperative long-term radiation delays the necessary tumor-nephrectomy. Arterial embolization is preferred because it offers the wanted benefits of sufficient radiotherapy avoiding its disadvantages.