RESUMEN
The use of intermittent outpatient dobutamine infusion has recently been studied as an alternative therapy modality for patients with refractory congestive heart failure. We studied the arrhythmogenic effects of intermittent outpatient dobutamine infusion in two patients with NYHA class IV heart failure. The patients received dobutamine at 5mcg./kg./min. for four hours per day for an eight week period. Ambulatory Holter monitoring was obtained during the infusion periods and compared to infusion-free periods. A significant increase of complex ventricular arrhythmias, including multifocal PVC's and ventricular tachycardias, was observed during the infusion period. The incidence of complex ventricular ectopy was dose related and could be suppressed to baseline levels with appropriate antiarrhythmic therapy. We concluded that dobutamine is extremely arrhythmogenic when used in patients with heart failure and that this effect was controllable with antiarrhythmics. Extreme caution and careful monitoring is required for this new therapeutic modality in the treatment of refractory heart failure.
Asunto(s)
Arritmias Cardíacas/inducido químicamente , Dobutamina/efectos adversos , Atención Ambulatoria , Dobutamina/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Infusiones ParenteralesRESUMEN
Twenty-two patients with metastatic and primary cancer of the liver were treated with 5-fluoro-2'-deoxyuridine (5FUDR), Mitomycin C (Mito C), and 1 (-2-chlorethyl)-4(methyl-cyclohexyl)-1-nitrosourea (MeCCNU). 5FUDR 0.3 mg/kg/day was administered as a continuous infusion via the hepatic artery. Mito C (10 mg/M2) and MeCCNU (50 mg/M2) were given I.V. and orally, respectively, every 8 weeks. Remission of the neoplastic lesions within the liver was seen in 10 patients (4CR, 6PR). Five patients had stabilization of their lesion neoplasm for at least 4 months. The response rate in this study was 6/15 (40%) in patients with colon cancer metastatic to the liver. Toxicity was mainly hematologic and hepatic. Three patients experienced a platelet count below 25,000 and/or white blood count below 1000. Fifteen patients had hepatic toxicity showing elevation in SGOT and SGPT. The SGOT and SGPT returned to normal when the 5FUDR was discontinued. The combination of 5FUDR intraarterially, and Mito C and MeCCNU systemically, demonstrated activity in malignancies of the liver. This study proved that chemotherapy can be administered systemically and regionally with acceptable toxicity.