RESUMEN
Among the several different combination chemotherapy regimens for the treatment of patients with metastatic colorectal cancer, oxaliplatin plus raltitrexed has shown encouraging therapeutic results and a fairly good toxicity profile. Here, we report on two patients with metastatic colorectal cancer receiving this combination therapy, which leads to severe enterocolitis and neutropenia resulting in death in one patient. One patient was a 67-year-old woman suffering from an adenocarcinoma of the sigmoid colon with multiple liver metastases. The other patient was a 74-year-old woman with colon cancer, and metachronous multiple pulmonal and hepatic metastases. In both patients, palliative chemotherapy consisted of oxaliplatin 130 mg/m2 in combination with raltitrexed 3 mg/m2 on day 1 every 21 days. Both patients developed neutropenia in combination with severe enterocolitis after the fourth and the second chemotherapy cycle, respectively. Despite antibiotic treatment, diarrhea persisted in both patients for weeks. One patient died 17 days after hospital admission because of enteric sepsis with bleeding of the colonic mucosa and multiorgan failure. The other patient recovered completely and was discharged from hospital after 8 weeks. Severe enterocolitis, a hitherto infrequently recognized adverse event, which has been described in association with 5-fluorouracil/leucovorin and oxaliplatin chemotherapy, may also occur with raltitrexed and oxaliplatin. Physicians should be aware of this rare, although potentially lethal, gastrointestinal toxicity.
Asunto(s)
Antimetabolitos Antineoplásicos/efectos adversos , Enfermedades Gastrointestinales/inducido químicamente , Compuestos Organoplatinos/efectos adversos , Quinazolinas/efectos adversos , Tiofenos/efectos adversos , Adenocarcinoma/complicaciones , Adenocarcinoma/tratamiento farmacológico , Anciano , Antimetabolitos Antineoplásicos/uso terapéutico , Neoplasias de la Mama/patología , Colonoscopía , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Complicaciones de la Diabetes , Diabetes Mellitus Tipo 1 , Quimioterapia Combinada , Enterocolitis/inducido químicamente , Enterocolitis/patología , Resultado Fatal , Femenino , Enfermedades Gastrointestinales/complicaciones , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/secundario , Compuestos Organoplatinos/uso terapéutico , Oxaliplatino , Quinazolinas/uso terapéutico , Tiofenos/uso terapéuticoRESUMEN
By use of microdialysis we assessed the concentrations of telithromycin in muscle and adipose tissue to test its ability to penetrate soft tissues. The ratios of the area under the concentration-versus-time curve from 0 to 24 h to the MIC indicated that free concentrations of telithromycin in tissue and plasma might be effective against Streptococcus pyogenes but not against staphylococci and human and animal bite pathogens.
Asunto(s)
Antibacterianos/farmacocinética , Cetólidos/farmacocinética , Adolescente , Adulto , Antibacterianos/sangre , Área Bajo la Curva , Proteínas Sanguíneas/metabolismo , Cromatografía Líquida de Alta Presión , Semivida , Humanos , Indicadores y Reactivos , Cetólidos/sangre , Masculino , Microdiálisis , Músculo Esquelético/metabolismo , Unión Proteica , Estándares de Referencia , Piel/metabolismoRESUMEN
Hydroxy-methylglutaryl coenzyme A reductase-inhibitors (HMG-CoA [statins]) are currently the most effective method to pharmacologically decrease total plasma cholesterol levels. A number of multicenter studies have demonstrated, that statins administered for several years lead to a significant reduction of cardiovascular events and mortality compared with placebo. Apart from the well known LDL- and cholesterol lowering effect, statins have been postulated to exert beneficial effects on mortality due to so called 'non-lipid effects'. There is circumstantial evidence from a number of experimental studies that statins can improve endothelial function, exert anti-inflammatory and anti-oxidative effects, stabilize arteriosclerotic plaque and inhibit proliferation and activation of smooth muscle cells. However, the clinical implications of these beneficial 'non-lipid effects' are unclear, but appear to exert only a minor role in comparison to the lowering effect of statins on total plasma cholesterol levels.