RESUMO
Clinical studies were performed with a recombinant mutant adenovirus with an E1B 55-kDa deletion, dl1520, to assess its toxicity and efficacy in patients with irresectable primary and secondary liver tumors. A phase I study showed that dl1520 was well tolerated when administered directly intratumorally, intraarterially, or intravenously up to a dose of 3 x 10(11) PFU. Ultrastructural examination of tissue showed the presence of adenovirus in cell cytoplasm around the nucleus and revealed two dissimilar end points of cell death after virus infection: a preapoptotic sequence and necrosis. A phase II study showed that the combination of dl1520 and 5-fluorouracil (5-FU), when infused into the hepatic artery, was well tolerated. Further improvement in the recombinant vector design will be needed in order to achieve better clinical response.
Assuntos
Adenoviridae/genética , Proteínas E1B de Adenovirus/genética , Terapia Genética/métodos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antimetabólitos Antineoplásicos/uso terapêutico , Apoptose , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/ultraestrutura , Núcleo Celular/metabolismo , Cromatina/ultraestrutura , Terapia Combinada , Citoplasma/metabolismo , Feminino , Fluoruracila/uso terapêutico , Deleção de Genes , Humanos , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Necrose , Metástase NeoplásicaRESUMO
A pilot study, to assess the therapeutic potential of percutaneous injection of wild-type p53 (wt-p53) in five patients with primary hepatocellular carcinoma is reported. Three of the five patients showed objective tumor response with reduction of the tumor volume on computed tomographic (CT) scan measurements as well as a significant fall of serum alphafetoprotein. Much further work will be needed to elucidate the mechanism of action.
Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Plasmídeos/uso terapêutico , Proteína Supressora de Tumor p53/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Sequência de Bases , Carcinoma Hepatocelular/diagnóstico por imagem , Febre/etiologia , Seguimentos , Humanos , Injeções Intralesionais , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas Experimentais/química , Neoplasias Hepáticas Experimentais/terapia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Pessoa de Meia-Idade , Dados de Sequência Molecular , Projetos Piloto , Plasmídeos/efeitos adversos , Plasmídeos/análise , Tomografia Computadorizada por Raios X , Proteína Supressora de Tumor p53/efeitos adversos , Proteína Supressora de Tumor p53/análiseRESUMO
Liver transplantation is an effective therapy for end stage liver disease. Nevertheless in many areas of the world organ availability remains a major problem. We report here the success of the first living-related liver transplantation in Africa. The left lateral lobe of the mother was transplanted orthotopically to her 6 year old child suffering from liver cirrhosis complicating glycogen storage disease. The social and medical problems encountered are discussed. Living-related liver transplantation is a viable option in countries where cadaveric organ donation is either illegal or socially unacceptable.
Assuntos
Transplante de Fígado/métodos , Doadores de Tecidos , Adulto , Criança , Egito , Feminino , Doença de Depósito de Glicogênio/complicações , Doença de Depósito de Glicogênio/cirurgia , Hepatectomia/métodos , Humanos , Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Masculino , Cuidados Pós-OperatóriosRESUMO
The aim of this retrospective study was to determine the incidence of the complications in one thousand consecutive cholecystectomies performed in three district general hospitals. Major post-operative complications occurred in 63 patients (6.3 per cent) and were responsible for 12 deaths (1.2 per cent operative mortality) and 31 reoperations. The incidence of retained stones was 5.8 per cent (10 patients) for those who underwent exploratory choledochotomy, and 10.9 per cent in those who were managed by common bile duct exploration and stone extraction. There were four cases of iatrogenic biliary trauma (0.4 per cent), all in cases operated by junior registrars. All (except one) occurred during elective 'non-complicated' cholecystectomy.
