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  • 1
    Electronic Resource
    Electronic Resource
    Experience with intraperitoneal cisplatin and etoposide and i.v. sodium thiosulphate protection in ovarian cancer patients with either pathologically complete response or minimal residual disease (1997)
    Springer
    Annals of oncology 8 (1997), S. 1235-1241 
    Details
    ISSN: 1569-8041
    Keywords: cisplatin ; epithelial ovarian cancer ; etoposide ; intraperitoneal chemotherapy ; survival analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: High-dose platinum-based regimens can produce responses inpatients not responding to standard chemotherapy. As in many ovarian cancerpatients the disease remains confined to the peritoneal cavity,intraperitoneal (i.p.) chemotherapy has been applied as an alternativeapproach to increase drug exposure. The delivery of cytotoxic agents to theperitoneal cavity can lead to high drug concentrations intraperitoneallywith less systemic toxicity. This study aimed at evaluating the efficacy andtoxicity of high-dose i.p. cisplatin plus etoposide and intravenous sodiumthiosulphate protection in ovarian cancer. Patients and methods: Patients with either a pathologically completeresponse (pCR) after first-line treatment or with persistent disease afterfirst-line platinum-based chemotherapy or abdominal recurrences wereeligible. All intraabdominal lesions had to be 〈2 cm at the start of i.p.treatment. The treatment consisted of etoposide 350 mg/m2 i.p.followed by cisplatin 200 mg/m2 i.p. with intravenous sodiumthiosulphate (4 g/m2 bolus, followed by 12 g/m2over six hours) protection. Four courses of i.p. treatment were administeredin case of pCR and 6 courses otherwise, at four-weekly intervals. Results: The study comprised 29 patients, six patients with pCR, 17patients with persistent disease and six patients with abdominalrecurrences. They received a total of 105 courses of treatment (65%of the scheduled number of courses). Twelve patients completed scheduledtreatment, illustrating its feasibility. In 17 patients treatment had to beprematurely stopped because of inflow obstruction (seven patients), bowelperforation (two patients), renal toxicity (two patients), neurotoxicity(two patients), or malaise and vomiting (four patients). One patient withbowel perforation died of this complication. Severe nausea and vomitingoccurred in 51% of cycles. Leukopenia and thrombopenia grade 3 and 4occurred in 30% and 6% of cycles, respectively. Ototoxicity ofcisplatin was measured by serial tone audiography in 23 patients: only eightpatients (35%) showed significant audiographic changes, although noneof them developed clinical hearing loss. Fifteen patients were evaluable forresponse: four pCR, five PR, two SD, four PD. The median duration of freedomfrom progression was 616 days and the median overall survival 1065 days fromthe start of treatment. Conclusions: High-dose i.p. treatment with cisplatin and etoposide can beassociated with significant toxicities. Major clinical problems are nausea,vomiting, and the formation of intraabdominal adhesions. Intravenous sodiumthiosulphate effectively reduces the systemic toxicity of high-dose cisplatin.The value of high-dose i.p. treatment is uncertain and its routine use cannotbe recommended.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008296202198
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  • 2
    Electronic Resource
    Electronic Resource
    Segmentverschiebung durch kallusdistraktion bei langstreckigen unterschenkeldefekten (1996)
    Springer
    Langenbeck's archives of surgery 381 (1996), S. 82-87 
    Details
    ISSN: 1435-2451
    Keywords: Bone distraction ; Segmental transport ; Corticotomy ; Bone defect ; Open fracture ; Complications ; Limb lengthening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei Unterschenkeldefekten 〉4 cm ist eine Spongiosaplastik oder Rippenspananlage zur Überbrückung nicht mehr ausreichend, so daß wir in diesen Fällen seit 1988 eine Kallusdistraktion nach Ilisarov mit externer Fixierung durch Implantate der AO/ASIF durchführen. Bis zum 1. B. 1995 wurden 15 Patienten mit Unterschenkeldefektfrakturen mit der Kallusdistraktion behandelt. Die durchschnittliche Defektgröße betrug 7 cm, so daß über 1 m Röhrenknochen erzeugt werden konnte. Es handelte sich um 11 Männer und 4 Frauen im Durchschnittsalter von 21,3 Jahren. Bei den Defekten war 3mal eine Knochenresektion bei Tumoren erfolgt und 12mal eine zweit- oder drittgradig offene Fraktur vorausgegangen, davon 6mal mit begleitender Osteomyelitis. Im Mittel waren 5,3 Operationen zum Aufbau erforderlich. Die Komplikationsrate betrug 53% bei einer Behandlungszeit von durchschnittlich 1 Jahr. Bei allen abgeschlossenen Behandlungen waren die Endergebnisse exzellent und gut. Eine Amputation konnte in allen Fällen vermieden werden. Kontraindikation bei Anwendung dieses Verfahrens ist eine fehlende Mitarbeit des Patienten. Durch die Kallusdistraktion besteht eine realistische Chance des Extremitätenerhalts bei schwerem Weichteil- und Knochenschaden. Durch die komplette körperliche Reintegrationsmöglichkeit bei erhaltener Extremität kann eine hohe Motivation bei den Patienten erreicht werden.
    Notes: Abstract In open tibial fractures with defects over 4 cm, spongiosaplasty is considered to be insufficient. Since 1988 we have tried to apply Ilisarov's ideas of callus distraction in combination with modern external fixation devices and AO/ASIF implants. By August 1995, 15 patients with severe tibial fractures had been treated. The bone defect averaged 7 cm. Thus, more than 1 m of tubular bone was produced. Eleven male and 4 female patients, averaging 21.3 years in age, were given this treatment. The defect was caused by resection of a malignancy in 3 cases and a second- or third-degree open fracture in 12 cases, accompanied by osteomyelitis in 6 cases. Reconstruction required an average of 5.3 operations. The complication rate was 53%, and the median duration of treatment was about 1 year. The final results were excellent or good. Amputation could be avoided in all instances. This treatment is contra indicated if the patient exhibits a lack of compliance. There is a realistic chance of salvaging the limb in cases of severe soft tissue and bone defects. In terms of economical considerations, this treatment is cost effective. Physical integrity and mobility without aid is the important motivation for these patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00183937
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    Paper (German National Licenses)
    Fulltext
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