Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Disappointing results after surgery alone for locally advanced adenocarcinoma of the cardia and the distal oesophagus (stage IIIB/IV) prompted us to combine surgery with neo-adjuvant chemotherapy. With a remission rate of about 70% the combination of etoposide, adriamycin and cisplatin (EAP) has been considered to be the superior treatment, but it has inherent severe toxicity. The authors conducted a phase II study of combined treatment with Carboplatin, 4-Epiadriamycin and Teniposide (CET) to ameliorate this toxicity and to evaluate the effectivity of this regimen in patients with these unresectable tumours. A regimen of 4 cycles of Carboplatin 300mg/m2, 4-Epiadriamycin 80mg/m2 and Teniposide 100mg/m2 was administered intravenously. Treatment cycles were repeated every 3 weeks in patients with initially unresectable adenocarcinoma of the gastro-oesophageal junction proven at laparotomy and/or CT scanning. Nineteen patients were studied and 17 underwent a second laparotomy in an attempt to resect the tumour radically. Eleven patients (65%) of the re-explored group achieved tumour reduction, enabling resection with curative intent. Recurrences, however occurred in 9 patients after a median of 9.5 (4-42) months. One patient died postoperatively as a result of pulmonary embolism. Only one patient remained free of disease after 42+ months. Leucopenia and thrombocytopenia of WHO grade 23 occurred in 58% and 37% of the patients, respectively. This regimen appears to be effective in patients with locally advanced adenocarcinoma of the cardia and the distal oesophagus. Although it can be used in an outpatient setting, the overall toxicity is relatively high and the results are comparable with other less toxic regimens.
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PMID:Neo-adjuvant chemotherapy with carboplatin, 4-epiadriamycin and teniposide (CET) in locally advanced cancer of the cardia and the lower oesophagus: a phase II study. 857 52

Total hip arthroplasty (THA) and total knee arthroplasty (PTG) are surgical interventions aiming at functional improvement. They therefore cannot accommodate any "collateral damage" produced, notably by symptomatic thromboembolic events (STE). Use of the necessary thromboprophylaxis has made STEs rare (<3% after THA and 2% after TKA). Pulmonary embolism (PE) is exceptional (0.3%) and only accounts for 15% of the deaths occurring in the 1st postoperative month. However, atherothrombotic disease is significantly associated with thromboembolic venous disease. The causes of STEs are mechanical, directly related to surgical maneuvers, but also biological (familial or acquired thrombophilia, hypercoagulability, particularly associated with hip surgery). Delayed resumption of walking, which promotes venous stasis, has been improved by modern pain management techniques. There is consensus on the need to prolong thromboprophylaxis after THA, but it is more controversial after TKA and depends on the added risk factors. In France, prolonged prevention is widespread. The relatively low STE rate should be put into perspective with the risk of hemorrhage. The surgeon should be particularly attentive to the risk of bleeding at the operative site because it generates a risk of sepsis, and a risk of stiffness for TKA. The risk of hemorrhage essentially results from the misuse of all the anticoagulants, particularly observed with the anti-vitamin K medications because their use is more restricted. The risk of hemorrhage has become quite comparable to the risk of thromboembolism with prophylaxis. To prevent this event, the prescriber must know the characteristics of each drug : Tmax, half-life, mode of elimination, as well as the risk of accumulation in the patient receiving such treatment (creatinine clearance). Currently, the thrombohemorrhagic risk for each patient must be assessed. Per os treatment with Dabigatran etexilate is highly advantageous because it is easy to use, there is no thrombopenia induced by heparin, and there is no need for complementary monitoring exams, thus reducing costs. Efficacy in terms of prevention and hemorrhagic risk, demonstrated in phase II studies, must be confirmed by widespread used in real-life conditions.
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PMID:[Antithrombotic prophylaxis after THA and TKA: the surgeon's point of view]. 1987 2