ABSTRACT
OBJECTIVE: To report the experience of the Hospital General de Mexico on the use of the Indiana continent urinary reservoir in cystectomized patients. METHODS: From January 1995 to September 1997, 32 Indiana continent urinary reservoirs were performed in 22 men and 12 women with a median age of 46.1 years. Operating time, immediate, early and late complications, reservoir function and capacity, and social integration of the patient after the procedure were evaluated. RESULTS: The most frequent underlying disease was bladder cancer followed by neurogenic bladder. The mean operating time was 5.5 hours for performing cystectomy and the Indiana pouch. The most frequent immediate, early and late complications were urinary tract infection (12 patients, 35%), metabolic acidosis (4 patients, 11%), one case of total pouch necrosis, one case of pouch lithiasis, one case of uretero-colonic anastomosis dehiscence and two cases of septic shock. Reservoir function was evaluated clinically, radiologically and urodynamically. CONCLUSIONS: The Indiana continent urinary reservoir is a good alternative in patients undergoing cystectomy, regardless of the underlying cause. Technical dexterity significantly reduces the operating time and surgical complications.
Subject(s)
Colon/surgery , Cystectomy , Urinary Reservoirs, Continent , Acidosis/epidemiology , Acidosis/etiology , Adult , Carcinoma, Transitional Cell/surgery , Evaluation Studies as Topic , Female , Humans , Incidence , Male , Patient Acceptance of Health Care , Postoperative Complications , Shock, Septic/epidemiology , Shock, Septic/etiology , Surgical Wound Dehiscence/epidemiology , Time Factors , Urinary Bladder Neoplasms/surgery , Urinary Bladder, Neurogenic/surgery , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiologyABSTRACT
Bleomycin is a powerful antitumoral antibiotic whose utilization has been limited by pulmonary toxicity. At the Medical Oncology Department of the Hospital General de Mexico, SS, 17 patients with high-risk testicular cancer were treated with therapeutic regimens based on cisplatin and bleomycin in continuous infusion. The mean bleomycin dose was 813 mg. Adequate renal function was observed in all patients during and after chemotherapy. During a minimum 4-year follow-up period, no patient experienced pulmonary toxicity; 3 patients died due to tumoral progression. The remaining 14 patients are alive and none of them had shown x-ray abnormalities nor a significant reduction in pulmonary vital capacity (PVC) or carbon monoxide diffusion capacity (DLCO). Bleomycin in continuous infusion can be an appropriate alternative for reducing pulmonary toxic effects. Therefore, randomized controlled studies should be conducted in order to determine if this treatment regime could enhance the therapeutic index.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bleomycin/adverse effects , Testicular Neoplasms/drug therapy , Adolescent , Adult , Bleomycin/administration & dosage , Follow-Up Studies , Humans , Infusions, Parenteral , Kidney Function Tests , Lung/diagnostic imaging , Male , Radiography , Remission Induction , Respiratory Function TestsABSTRACT
Se analiza el uso de tres esquemas distintos de quimioterapia en cáncer testicular de alto riesgo. El grupo I incluyó 21 pacientes tratados entre 1976 y 1980 que recibieron vinblastina y blemicina (esquema VBII); el grupo II, 15 pacientes manejados de 1981 a 1985 con cisplatino, vinblastina y bleomicina (esquema PVB); y el grupo III, 17 pacientes atendidos entre 1986 y 1990 con cisplatino, ciclofosfamida y adriamicina, en ciclos alternos con vinblastina y bleomicina (esquema CISCA II/VBIV). Se obtuvieron, respectivamente, respuestas completas de 19.0, 46.7 y 76.5 por ciento (p= 0.0003), lo cual se elevó a 59.8 por ciento en el grupo II y a 100.0 por ciento en el gurpo III, con cirugía citorreductiva (p=0.0000). Después de 104 semanas de seguimiento, el 33.0 por ciento de los pacientes del grupo II y el 94.0 por ciento del grupo III sa encontraban libres de enfermedad (p= 0.0002). Los efectos tóxicos fueron mayores en el tercer grupo; sin embargo no hubo diferencia estadística. Las características inherentes a los distintos períodos en que fueron tratados los grupos imposibilitan una comparación objetiva. La experiencia adquiridad perfila una curva positiva de aprendisaje. Con cada etapa se lograron mejores resultados; sobre todo al implantar regímenes más agresivos de quimioterapia, que implican mayor número de grogas efectivas, administradas en un lapso menor, con un manejo adecuado de los efectos secundadios
