ABSTRACT
We describe a patient with limited systemic sclerosis who presented with a large pericardial effusion with tamponade on echocardiogram, requiring pericardiocentesis to drain 1.2 l of fluid. She had a rapid re-accumulation of pericardial fluid and subsequently required a pericardial window. Although small pericardial effusions are common in patients with systemic sclerosis it is rare to have hemodynamic compromise. Previously reported large pericardial effusions have been seen in patients with pulmonary hypertension and renal failure however these were absent in our patient.
Subject(s)
Cardiac Tamponade/etiology , Pericardial Effusion/etiology , Scleroderma, Limited/complications , Female , Humans , Middle Aged , Pericardial Effusion/surgery , Pericardial Window Techniques , RecurrenceABSTRACT
BACKGROUND: Mitomycin C has been found clinically useful in the treatment of colorectal cancer when administered via the hepatic artery. In a prospective therapeutic trial, we studied the effect of superselective intra-arterial chemotherapy with mitomycin C in patients with hepatic metastases from colorectal cancer. METHODS: Forty-six patients with hepatic metastases from colorectal cancer received intra-arterial chemotherapy with mitomycin C (SIAC) between 1981 and 1991. The results of a 5-year follow-up were compared with 46 control patients standardized by sex, age, and tumor distribution. RESULTS: The overall response rate to intra-arterial chemotherapy was 20%. The median survival time for responders was 26 months and that for nonresponders 12 months (P < 0.003). The median survival period after intra-arterial chemotherapy was 15 months, compared with 9 months in controls (P < 0.004). The cumulative 5-year survival rate was 6% for patients treated by SIAC and 5% for controls. Cessation of chemotherapy was necessary in 39 of the 46 patients: in 28 because of tumor progression, in 9 because of toxicity, in 1 because of catheterization difficulties, and in 1 because of patient refusal. CONCLUSIONS: Superselective intra-arterial mitomycin C therapy had a poor effect on hepatic metastases from colorectal cancer because of the low response and long-term survival rates.
Subject(s)
Antibiotics, Antineoplastic/administration & dosage , Colorectal Neoplasms/pathology , Liver Neoplasms/drug therapy , Mitomycin/administration & dosage , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Hepatic Artery , Humans , Infusions, Intra-Arterial , Liver Neoplasms/mortality , Liver Neoplasms/secondary , Male , Middle Aged , Prognosis , Prospective Studies , Risk Factors , Survival RateABSTRACT
Thirty-six patients with primary hepatocellular carcinoma were treated by superselective intra-arterial chemotherapy with mitomycin C (SIAC) between 1981 and 1990, either as primary chemotherapy without operation (28) or as additional therapy after resective surgery (8). During the same period 10 patients were resected radically and 26 patients treated conservatively. The overall response rate to SIAC was 25% (9/36), comprising two complete and seven partial responses. The cumulative 5-year survival rate was significantly related to the percentage of hepatic replacement (PHR) (P < 0.01) and to resective surgery (P < 0.01). Overall 5-year survival was only 4% and all the patients with PHR over 75% died within 2 or 3 years. Cessation of chemotherapy was necessary in 72% of cases (26/36), because of tumour progression in 20 cases, chemotherapy toxicity in four and one technical error in one and patient refusal in one. The results of the use of SIAC as a chemotherapeutic agent for hepatocellular cancer may be regarded as disappointing, as the response rate remained low and the medication was unable to prevent tumour progression in most cases. We intend to use SIAC only for stage I-II tumours and as additional therapy after surgery when the radicality remains uncertain.
