Phase I single-dose study of intracavitary-administered Nimotuzumab labeled with 188 Re in adult recurrent high-grade glioma.

Radioimmunotherapy (RIT) may improve the management of malignant gliomas. A Phase I clinical trial was performed to evaluate, for the first time, the toxicity and clinical effect of an intracavitary administration of a single dose of Nimotuzumab (h-R3) labeled wit (188)Re. Nimotuzumab is a humanized monoclonal antibody directed against epidermal growth factor receptors. Three patients with anaplastic astrocytoma (AA) and 8 with glioblastoma multiforme (GBM) were intended to be treated with 3 mg of mAb labelled with 10 or 15 mCi of (188)Re. In patients treated with 10 mCi (n=6) transitory worsening of pre-existing neurological symptoms were observed. Two patients treated with 15 mCi (n=4) developed early severe neurological symptoms and one also developed late severe toxicity (radionecrosis). In the group treated with 10 mCi, 1 GBM patient died in progression 6 months after the treatment, 2 patients (1 GBM and 1 AA) developed stable disease during 3 months. One GBM patient had partial response for more than 1 year and 2 patients (1 GBM and 1 AA) were asymptomatic and in complete response after 3 years of treatment. Maximal tolerated dose of the radioimmunoconjugate (188)Re-Nimotuzumab was 3 mg of the h-R3 labelled with 10 mCi of (188)Re. The radioimmunoconjugate showed a high retention in the surgical created resection cavity and the brain adjacent tissues with a mean value of 85.5 % of the injected dose one hour post-administration. This radioimmunoconjugate may be relatively safe and a promising therapeutic approach for treating high grade gliomas.

Intramyocardial gene transfer of vascular endothelial growth factor 121 improves myocardial perfusion and function in the ischemic porcine heart

Vascular endothelial growth factor (VEGF) is an endothelial cell-specific mitogen that is angiogenic in vitro and in vivo. Several studies report on gene transfer of VEGF121 to promote angiogenesis in the ischemic myocardium of animals and patients. We hypothesized that intramyocardial administration of naked plasmid DNA encoding VEGF121 could improve myocardial perfusion and function in a porcine model of myocardial ischemia. Yorkshire swine underwent thoracotomy and placement of an ameroid constrictor on the circumflex coronary artery. Four weeks later, pVEGF121 plasmid was administered into the ischemic myocardium. Four weeks after gene transfer, SPECT imaging demonstrated significant reduction in the ischemic area in pVEGF121-treated animals compared with controls. In the pVEGF121 group, most of the animals evolved from light ischemia to a normal perfusion. In contrast, control animals exhibited similar or impaired ischemic conditions. Our results indicate that intramyocardial gene transfer of VEGF121 as naked plasmid DNA results in significant improvement in myocardial perfusion and function.

[Bronchoalveolar lavage technique in patients with alveolar proteinosis]. / Técnica del lavado broncoalveolar total en pacientes con proteinosis alveolar.

Bronchoalveolar Lavage (BAL) was first described more than fifteen years ago; it is still the treatment of choice in Alveolar Proteinosis. Despite several clinical therapeutic trials, for new therapeutics none of them has achieved the results of Bronchoalveolar Lavage. It has been proved that, not only are they ineffective, but they can also have dangerous consequences. Alveolar proteinosis is a rare lung illness that implies the patient's hypoxia and progressive incapacity, being clinical dyspnea its most frequent characteristic. The BAL. with sodium chloride by filling and emptying the lungs allows to wash the fosfolipid material. That its on the alveoli giving the patient a great improve in short space of time. The aim of our work is to describe the technique used in Bronchoalveolar Lavage as well as the changes that have taken place since the beginning of its practice in our Critical Care Unit for the last fifteen years and so the nursing work that it is on this technic. This procedure needs to be made on a UCI for the need of mechanical ventilation. The time of instance on UCI is 24 h. In our experience we are able to make the BAL. in both lungs in the same session, there are no important complications and there is no need of readmission. We conclude that there is evidence that these treatment is effective.

Técnica del lavado broncoalveolar total en pacientes con proteinosis alveolar / Bronchoalveolar lavage technique in patients with alveolar proteinosis

El lavado broncoalveolar total, descrito por primera vez hace más de 30 años, continúa siendo el tratamiento de elección en la proteinosis alveolar. A pesar de la realización de múltiples ensayos terapéuticos, ninguno ha conseguido superar los resultados del lavado, habiendo demostrado que aquellos no sólo son ineficaces sino que pueden tener consecuencias peligrosas. La proteinosis alveolar es una enfermedad pulmonar rara, que conlleva una incapacidad progresiva del paciente, siendo la disnea la característica clínica más frecuente. El lavado broncoalveolar total, mediante la introducción y vaciado de líquido en los pulmones, permite la salida del material fosfolipídico presente en los alveolos, proporcionando al paciente una notable mejoría en un corto espacio de tiempo. El objetivo de este trabajo es describir la técnica utilizada para el lavado, con las modificaciones realizadas desde el inicio de su utilización en nuestra unidad, hace más de 15 años, así como las actividades de enfermería que acompañan al procedimiento. El paciente necesita ingresar en la Unidad de Cuidados Intensivos (UCI) por la necesidad de ventilación mecánica durante la técnica. La estancia media del paciente en la UCI es menor de 24 h. En nuestra experiencia es posible realizar el lavado de ambos pulmones en una única sesión, no habiendo encontrado complicaciones mayores ni necesidad de reingreso y se concluye que existe evidencia de la efectividad del tratamiento (AU)