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The high recurrence rate and poor prognosis of non-muscle invasive bladder cancer (BC) are challenges that need to be urgently addressed. Transurethral cystectomy for bladder tumors is often combined with bladder perfusion therapy, which can effectively reduce the recurrence and progression rates of BC. The present review integrated and analyzed currently available bladder perfusion drugs, mainly including chemotherapeutic agents, immunotherapeutic agents and other adjuvant perfusion drugs. Bacillus Calmette-Guerin (BCG) perfusion was the pioneering immunotherapy for early BC and still ranks high in the selection of perfusion drugs. However, BCG infusion has a high toxicity profile and has been shown to be ineffective in some patients. Due to the limitations of BCG, new bladder perfusion drugs are constantly being developed. Immunotherapeutic agents have opened a whole new chapter in the selection of therapeutic agents for bladder perfusion. The present review explored the mechanism of action, clinical dosage and adverse effects of a variety of bladder perfusion drugs currently in common use, described combined perfusion and compared the effects of certain drugs on BC.
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BACKGROUND: Antimicrobial agents are administered via intramedullary antibiotic perfusion (iMAP)/intrasoft tissue antibiotic perfusion (iSAP) to infected lesions to control osteoarticular and soft tissue infections. Continuous local antibiotic perfusion (CLAP) has been reported to be useful. This study aimed to investigate the outcomes of DAIR combined with CLAP for chronic PJI after total knee arthroplasty performed at our hospital. SUBJECTS AND METHODS: Six patients (male; one case, female; five cases, mean age 79.5 years (70-94)) underwent CLAP for chronic PJI after TKA at our hospital between July 2020 and June 2022. They were followable for at least one year after surgery. Seven months (17-219), with a mean follow-up of 24.3 months (12-36). In addition to direct debridement and insert exchange, systemic antimicrobial treatment, and CLAP with gentamicin were performed using NPWT. We investigated the organisms causing the inflammation, the duration of iMAP/iSAP implantation, the maximum daily dose of GM, the maximum GM blood concentration, and the presence or absence of GM-induced adverse events. RESULT: Two of six patients had a recurrence of infection at five weeks and five months after initial CLAP and required repeat CLAP treatment, but all patients could preserve their components. The organisms responsible for the flare-ups were MSSA in three cases: ESBL-producing E. coli, mixed MSSA and streptococcal infection, Klebsiella pneumonia in one case each, and unknown pathogens in one case. CLAP therapy for all patients was administered eight times in 6 cases: iMAP, mean: 10.0 days (5-16); iSAP, mean: 19.3 days (15-28); GM dose, mean: 162.5 mg/day (80-240); and GM blood concentration, mean: 1.4 µg/mL (0.2-5.0). Adverse events included one case of reversible acute kidney injury during CLAP in a patient with recurrent infection. DAIR with CLAP for chronic post-TKA infection can be a useful treatment option to preserve components and allow the infection to subside, provided the implant is not markedly loosened.
Subject(s)
Arthroplasty, Replacement, Knee , Humans , Female , Male , Aged , Arthroplasty, Replacement, Knee/adverse effects , Escherichia coli , Gentamicins , Persistent Infection , Anti-Bacterial Agents/adverse effects , PerfusionABSTRACT
OBJECTIVE:To investigate the effects of doxorubicin perfusion therapy on therapeutic efficacy and related indexes in patients with superficial bladder cancer underwent transurethral resection of bladder tumor (TURBT).METHODS:Medical records of 96 patients with superficial bladder cancer were analyzed retrospectively and divided into observation group and control group according to drug use,with 48 cases in each group.Observation group was given perfusion therapy of 0.9％ Sodium choride solution 40 mL containing 20 mg doxorubicin 7 d after surgery.Control group was given TURBT combined with equal amount of 0.9％ Sodium chloride solution.Both groups received treatment for consecutive 10 months,once a week in first 8 weeks,later once a month.The recurrence rate and disease progression of 2 groups were observed and compared,and the levels of sICAM-1 and sVCAM-1,the levels of tumor marker DKK1 and VEGF were observed before and after treatment.The occurrence of ADR was recorded.RESULTS:After 24 months of treatment,remission rate and control rate of observation group were significantly higher than control group,with statistical significance (P＜0.05).There was no statistical significance in the progressive survival rate between 2 groups (P＞0.05).Before treatment,there was no statistical significance in the levels of sICAM-1、sVCAM-1、DKK1 and VEGF between 2 groups (P＞0.05);after treatment,the levels of sICAM-1、sVCAM-1 、DKK1 and VEGF in 2 groups were significantly lower than before treatment,the observation group was significantly lower than the control group,with statistical significance (P＜ 0.05).The recurrence rate,the incidence of frequent/urgent urination,hematuria and dysuria in observation group after treatment were significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:For patients with superficial bladder cancer underwent TURBT,doxorubicin perfusion therapy can significantly reduce recurrence rate,relieve tumor deterioration and reduce tumor activity with good safety.
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Objective To evaluate the clinical value bronchofiberscope and perfusion in the treatment of multi- drug resistant pulmonary tuberculosis (MDR-TB).Methods Forty-two cases were treated by injecting amikacin (0.4 g), ofloxacin (0.4 g), after cleaning up exudation through bronchofiberscope and catheter intervention combined with chemotherapy therapy, while 37 controls were treated by chemotherapy only.Results By the end of 9 months, the sputum tubercle bacillus conversion rate, radiographical improvement rate were 92.9% and 90.5% respectively in the treated groups,while all these indications were higher than those of control group 62.2% and 59.5% (P
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Objective To investigate methods and feasibility of percutaneous regional isolated hepatic perfusion combined with charcoal hemoperfusion(PRIHP-CHP).Methods Four out of 12 dogs underwent the procedure of routine transhepatic arterial infusion(TAI) as control group, 8 underwent PRIHP-CHP as experimental group. Adriamycin was used in our study, the concentration of plasma in hepatic vein and systemic vein was detected in both groups. Results All the procedures were successful in the PRIHP-CHP group eight, but 1 dog died because of air embolization. The average procedure duration for each was (132.3?15.3) minutes. The peak level of adriamycin concentration in hepatic vein and systemic in TAI were (3709.676?385.723) ng/ml and (1576.140?226.933) ng/ml respectively. In PRIHP-CHP, the peak level were (4653.420?430.204) ng/ml and (433.612?40.501) ng/ml. There were statistically significant differences between TAI and PRIHP-CHP (?
