Chemotherapy-induced peripheral neuropathy: review for clinical practice / Neuropatia periférica induzida por quimioterapia: revisão para a prática clínica

ABSTRACTBACKGROUND AND OBJECTIVES:Chemotherapy-induced peripheral neuropathy is the most common neurological syndrome secondary to antineoplastic therapy primarily affecting patients being treated with taxanes and platinum derivatives. Sensory neuropathy is the most frequent type. This study aimed at carrying out a narrative review of the literature on the pathophysiology, clinical manifestations, impact, evaluation, diagnosis treatment and prevention of chemotherapy-induced peripheral neuropathy.CONTENTS:Recent studies have shown association among inflammatory molecules, oxidative stress and development of chemotherapy-induced peripheral neuropathy. Most frequent symptoms are limbs numbness and tingling, with neuropathic pain having significant impact on the functionality of patients submitted to antineoplastic therapy. Several evaluation tools have been tested, being electroneuromyography considered the golden standard for chemotherapy-induced peripheral neuropathy diagnosis. There are different pharmacological strategies for its therapy and prevention.CONCLUSION:It is known that chemotherapy-induced peripheral neuropathy is a frequent syndrome negatively interfering with cancer patients’ treatment and quality of life. Different drugs are associated to different risk levels, which show its neurobiological complexity. Prevention, diagnostic and treatment strategies have to greatly evolve to minimize its frequency and severity.

RESUMOJUSTIFICATIVA E OBJETIVOS:A neuropatia periférica induzida por quimioterapia é a síndrome neurológica mais comum secundária à terapêutica antineoplásica e acomete principalmente pacientes que necessitam de tratamento com taxanes e derivados da platina. A neuropatia sensorial é o tipo mais frequente. O objetivo deste estudo foi realizar uma revisão narrativa de literatura sobre a fisiopatologia, manifestações clínicas, impacto, avaliação, diagnóstico, tratamento e prevenção da neuropatia periférica induzida por quimioterapia.CONTEÚDO:Estudos recentes têm demonstrado associação entre moléculas inflamatórias, estresse oxidativo e o desenvolvimento da neuropatia periférica induzida por quimioterapia. Dentre os sintomas, queixas de dormências e formigamentos nos membros são as mais frequentes, sendo a dor neuropática quadro de significativo impacto na funcionalidade dos pacientes em terapia antineoplásica. Diversos instrumentos de avaliação têm sido testados, sendo a eletroneuromiografia considerada o padrão ouro para o diagnóstico de neuropatia periférica induzida por quimioterapia. A terapêutica e a sua prevenção contam com diferentes estratégias farmacológicas.CONCLUSÃO:Reconhece-se que a neuropatia periférica induzida por quimioterapia é uma síndrome frequente e que interfere negativamente no tratamento e na qualidade de vida do paciente com câncer. Fármacos diferentes estão associados a graus variáveis de risco, o que mostra sua complexidade neurobiológica. As estratégias de prevenção, diagnóstico e tratamento precisam evoluir sobremaneira no sentido de minimizar a sua ocorrência e a gravidade.

Implante de stent em bifurcaçäo coronária / Stents for bifurcational coronary lesion

Descrevem-se dois casos de angioplastia transluminal coronária (ATC) com implante de stents em bifurcaçäo de coronária descendente anterior (DA) com artéria diagonal (DI), destacando-se as técnicas utilizadas. No caso 1, implantou-se na DA um flexistent Gianturco-Roubin (GR) e através de suas hastes, um Palmaz-Schatz (PS) no óstio de DI, com suceso. O reestudo angiográfico em sete meses mostrou ausência de reestenose. No caso 2, implantou-se metade de um stent PS em DA e outro PS em DI, nesta ordem, também com sucesso. No seguimento clínico de seis meses, paciente encontra-se assintomático.

Tratamento percutâneo de lesão de tronco de coronária esquerda não-protegido. Novas perspectivas com o advento dos stents coronários / Percutaneous Approach for the Treatment of Unprotected Left Main Stenosis. New Perspectives with the use of Coronary Stents

We describe a case of coronary stenosis located in an unprotected left main coronary artery, treated primarily and electively with the placement of a coronary stent. As a function of the large mass of myocardium involved, this patient would be considered a classical candidate for direct surgery, because the inherent risk involved with conventional balloon angioplasty, mainly due to the eventual occurrence of acute closure during the procedure. Since the previsibility of the immediate results with the use of coronary stents was significantly improved, we propose this new therapeutic approach for this traditionally surgical case, that has been performed with success and without any complication. This strategy for the treatment of unprotected left main lesions with the elective placement of Palmaz-Schatz stents, has not yet been proposed or applied in our country, and may represent a new universe of indication of percutaneous treatment of coronary artery disease, no longer approaching the left main stem only in special or emergency situations, usually a result of complications of left main manipulation during angioplasty of the coronary system. The patient involved in this case did not show any contraindication for the treatment with conventional open heart surgery.

Angioplastia coronária pela via radial / Coronary Angioplasty by Transradial Approach

We describe a coronary angioplasty procedure performed by transradial approach, on a 53 year old male with a reestenotic lesion in his right coronary artery, done 19 months after the initial dilatation. This is a new technique and has not been applied in our country.