The Hematologic Response to Anti-apoptotic Cytokine Therapy: Results of Pentoxifylline, Ciprofloxacin, and Dexamethasone Treatment for Patients with Myelodysplastic Syndrome

TNF-alpha mediated apoptosis of the hematopoietic cells has been thought to contribute to the ineffective hematopoiesis observed in myelodysplastic syndrome (MDS). The combination of pentoxifylline (P) and ciprofloxacin (C) has been shown to reduce the serum levels of TNF-alpha, and an earlier trial of P and C with dexamethasone (D) provided good palliation for patients with MDS. The purpose of this study is to assess the hematologic response to PCD therapy for patients suffering with MDS. 21 of 25 patients who completed at least of 12 weeks of treatment were evaluable for the treatment efficacy. At baseline, the patient's median age was 60 yr (range: 18-75 yr). The diagnoses according to WHO classification included: RA (n=5), RCMD (n=10), RARS (n=1), RCMD/RS (n=1), RAEB (3), and CMML (n=1). 11 patients (52%) had at least single lineage response. 3 patients (11%) showed improvement of triple lineage cytopenia. There were no differences in the response rates between the FAB subtypes. The median time to response was 4 weeks (range: 2-12 weeks), and it is interesting that 9 of 11 patients who had a response remained without relapse for a median of 177 days (range: 78-634 days). These preliminary results indicate that anti-cytokine therapy with PCD is an effective and well tolerated palliative treatment for patients with MDS.

Hemorragia digestiva alta: atualização do tratamento clínico / Acute digestive hemorrhage: updating of the clinical treatment

Trabalho de atualização relativo ao atendimento inicial de pacientes vitimados por hemorragias digestivas agudas, com ênfase à imediata reposição volêmica, de qualidade judiciosamente selecionada. A análise das propriedades farmacológicas da medicação anti-hemorrágica e os bons resultados obtidos dirimem dúvidas e controvérsias relativas ao emprego das mesmas. A listagem de medicamentos e procedimentos que devem ser suprimidos no atendimento de pacientes que sangram e mesmo naqueles cuja hemorragia tenha cessado constitui importante alerta para os que, inadivertidamente, praticam essas iatrogenias. As bases fisiopatológicas apresentadas endossam a advertência. O tratamento endoscópico direto e o uso do balão de Sengstaken-Blakemore serão abordados em futura publicação