[Implantable catheter system for ambulatory parenteral antibiotic chemotherapy. A prospective study]. / Implantierbares Kathetersystem zur ambulanten parenteralen antimikrobiellen Chemotherapie. Eine prospektive Studie.

17 patients with infectious diseases needed a long-term parenteral antibiotic therapy. Therefore a subcutaneous catheter system (Port-a-Cath) was implanted for intravenous application of the antibiotic drugs. With a total dwelling-time of 952 patient/days no catheter super-infection was observed. Due to postoperative hematoma in an anticoagulated patient one catheter system was not functioning temporarily. One had to be removed on suspicion of a fungous colonization which could not be verified after bacterial examination. Quality of life for all patients was unaltered so that ambulant therapy was possible in almost 20%.

[Implantable catheter systems. Experience with 205 patients]. / Implantierbare Kathetersysteme. Erfahrungen bei 205 Patienten.

In a five-year period (1983-1988) catheters were implanted in 205 patients (118 venous, 31 peritoneal, 29 arterial, 25 epidural and 2 pleural), using the same system (Port-a-Cath). Total implant duration was 88,345 patient days (242 patient years). On average there was one catheter complication per 2000 patients days. The only catheter-system infections occurred with peritoneal catheters. This relatively low complication rate was probably due to the use of only one system, a uniform implantation technique practised by only three surgeons, and strict postoperative supervision by the oncology nursing team.

Intraperitoneal chemotherapy in peritoneal malignancy: impact of intensive system care on practicability.

In a group of 31 patients a port-a-cath-system for intraperitoneal chemotherapy was installed. From 23 evaluable patients 9 showed a tumor remission, but only 1 was a patient with gastrointestinal carcinoma. All others were patients with ovarial carcinoma. The median survival rate of all patients was 9 months after implantation of the intraperitoneal catheter. 50% of all patients with gastrointestinal carcinoma died within the first 6 months, only 1 of 11 patients with ovarial carcinoma died in this period.

[A total subcutaneously implantable venous catheter system. 4 years' experience in cancer patients]. / Vollständig subkutan implantierbares venöses Kathetersystem. Vier Jahre Erfahrung bei onkologischen Patienten.

A totally implantable venous access system (Port-a-Cath) was inserted in 48 cancer patients. The devices were utilized for the administration of chemotherapy, antibiotics and blood products, as well as for blood drawing. Implantation was possible on an outpatient basis. The system provided full physical activity and good quality of life for the patient. Complications related to the Port-a-Cath were one subclavian vein thrombosis, one catheter thrombosis, two catheter dislocations, one dislocation of the "port" and reduced blood aspiration in two cases. It is stressed that no catheter related infections were seen. With increasing experience of the team the complication rate was significantly reduced.

Prevention of cytotoxic drug induced skin ulcers with dimethyl sulfoxide (DMSO) and alpha-tocopherole.

Accidental subcutaneous extravasation of several antineoplastic agents may provoke skin ulcerations for which there has been no simple and effective treatment. Since January 1983 we have treated all patients in our institution sustaining extravasation by a cytotoxic drug with a combination of DMSO and alpha-Tocopherole. During the first 48 hr after extravasation a mixture of 10% alpha-Tocopherole acetate and 90% DMSO was topically applied. The bandage was changed every 12 hr. So far eight patients with extravasation of an anthracycline or Mitomycin were treated on this protocol. No skin ulceration, functional or neurovascular impairment occurred in any of these patients. The only toxic effect observed by this treatment was a minor skin irritation. The combination of DMSO and alpha-Tocopherole seems to prevent skin ulceration induced by anthracyclines and Mitomycin.