Assuntos
Neoplasias Ósseas/terapia , Cisplatino/uso terapêutico , Hipertermia Induzida , Osteossarcoma/terapia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Quimioterapia Adjuvante , Quimioterapia do Câncer por Perfusão Regional , Criança , Cisplatino/administração & dosagem , Cisplatino/farmacocinética , Terapia Combinada , Doxorrubicina/administração & dosagem , Feminino , Neoplasias Femorais/tratamento farmacológico , Neoplasias Femorais/patologia , Neoplasias Femorais/cirurgia , Neoplasias Femorais/terapia , Fíbula/cirurgia , Seguimentos , Humanos , Infusões Intra-Arteriais , Masculino , Metotrexato/administração & dosagem , Necrose , Osteossarcoma/tratamento farmacológico , Osteossarcoma/patologia , Osteossarcoma/cirurgia , Tíbia/cirurgia , Distribuição Tecidual , Resultado do TratamentoRESUMO
This study was conducted to obtain information about the critical temperature of the spinal cord in hyperthermia produced by radiofrequency waves applied to the spine. The first component of the spinal cord evoked potential was analyzed as an indicator of spinal cord function. The spinal cords were heated by radiofrequency waves to a maximum of 47 degrees C momentarily or for 30 minutes. The temperatures were measured with a thermosensor in the epidural space. In momentary heating, the reductions in amplitude were almost parallel with the increases in temperature. In maintained heating for 30 minutes, at 44 degrees C and below, the amplitudes decreased by one-quarter to three-quarters of the control value in the first 5 minutes and recovered to over three-quarters of the control value in 30 minutes. The amplitudes returned to almost the control value after restoration of normal spinal cord temperatures. At 45 degrees C and above, however, the amplitudes were prominently reduced or disappeared in the first 5 minutes and remained depressed during the remainder of the heating. On normalizing the temperature, the amplitudes did not return to the control value. These results suggest that 44 degrees C in the epidural space is the highest tolerable temperature for normal spinal cord function.
Assuntos
Hipertermia Induzida/efeitos adversos , Medula Espinal/fisiopatologia , Temperatura , Animais , Potenciais Evocados/fisiologia , Concentração Máxima Permitida , CoelhosRESUMO
Since 1960 isolation perfusion chemotherapy has been performed as a preoperative procedure combined with surgery in 226 patients with malignant tumor of the extremities in our department. In this report we presented the result of isolation perfusion chemotherapy using cisplatin (CDDP) for 27 patients since 1983. The histologic classification of the malignant tumor was osteosarcoma in 17 patients, malignant fibrous histiocytoma (MFH) of bone in 8, and other tumor in 2. The extremity was perfused with CDDP (100 micrograms/ml) for 60 minutes. Of 27 patients, 11 were treated with hyperthermic isolation perfusion. The two-year survival rate of the 15 patients with osteosarcoma was 80%, and that of the 7 patients with MFH of bone 71%. The tumor was microscopically analyzed, and the ratio of necrotic to viable tumor cells was calculated. The degree of tumor necrosis was classified as excellent (greater than or equal to 95%), good (80-94%), fair (50-79%), and poor (less than 50%). Of 16 patients, 7 were excellent, 5 good, 3 fair and 1 poor. We concluded that isolation perfusion chemotherapy using CDDP is an effective procedure combined with surgery for malignant tumor of the extremities.