Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It has been traditional to exclude patients with radiation-recurrent carcinoma of the uterine cervix or other pelvic neoplasms, incapacitating pelvic pain, postirradiation fistulas, hemorrhage, or malodorous draining tumor necrosis from pelvic exenteration if cure of the malignant disease is not achievable. This negative attitude is a direct result of the reported high morbidity, prohibitive mortality, and low salvage rate previously associated with pelvic exenteration, the only acceptable surgical approach to these diseases. A recent experience with eighteen patients who underwent pelvic exenteration for advanced primary or recurrent carcinoma of the cervix, urinary bladder, or rectum has led us to challenge several traditional concepts regarding this operative procedure. We have observed but one operative death and our morbidity has been minimal. This may reflect our belief that an aggressive pelvic lymphadenectomy in those patients with direct visceral involvement from radiation-recurrent carcinoma of the pelvic viscera is not advantageous since no significant survival has ever been documented for patients with pathologic visceral involvement and positive lymph nodes. In addition, significant morbidity has always been associated directly with pelvic lymphadenectomy in the irradiated pelvis, and elimination of this phase of the operation in selected patients with radiation-recurrent carcinoma is indicated. Moreover, the considerable decrease in morbidity and the minimal mortality observed have led us to adopt a very liberal attitude toward preoperative selection criteria, and we regularly now use pelvic exenteration not only for cure but as intentional palliation in selected patients. We strongly believe that elimination of pain, fistulas, pelvic sepsis, hemorrhage, and malodorous areas of tumor necrosis are important for improving the quality of life for both the patient and family.
 ...
PMID:Pelvic exenteration as palliation of malignant disease. 5 24

Combined cisplatin, ifosfamide and bleomycin (PIB) chemotherapy was given to 14 (11 recurrent and 3 advanced and metastatic) cervical carcinoma patients. At least 2 cycles of chemotherapy were given before assessment of tumour response. The overall response rate was 28.6%; the complete response rate was 14.3%. Sites of response included cervical lymph nodes and the lung. Toxicity was common. Alopecia was universal. Other toxicity included suppression of haematopoiesis (73%), leucopenia (71%) and nausea and vomiting. Two patients died from sepsis during the myelosuppressive phase. The role of PIB in the management of advanced and recurrent carcinoma of the cervix should be evaluated in a randomized-controlled trial.
 ...
PMID:Combined chemotherapy using cisplatin, ifosfamide and bleomycin (PIB) in the treatment of advanced and recurrent cervical carcinoma. 128 Jan

From June 1961 to Jan. 1989 (28 & 1/2 years) a total of 627 patients were subjected to radical hysterectomy with bilateral pelvic node dissection (Meigs Operation). The main indication was cancer of the uterine cervix, which comprised 96%. There were 6 surgical deaths, with a mortality rate of 0.9%. The causes of death were hemorrhage, sepsis, atelectasis, and blood transfusion reaction. In the unirradiated group, the most common postoperative complication was infection, which was encountered in 23.8%. The most common site of infection was the urinary tract, 13.6%, followed by the incision (5.5%), and the pelvis (4.7%). One of the most distressing complications of the operation, ureterovaginal fistula, occurred in 7 patients, a rate of 1.3%, which is quite low. All except one were repaired successfully. There were 3 vesicovaginal fistulas (0.5%), and two of these healed spontaneously. In the irradiated group, the complication rate was much higher and more serious. The incidence of serious infection was 48.4%, which was more than double the unirradiated group. In addition, there were six cases of rectovaginal fistula (9.7%), two cases of vesicovaginal fistula, and 1 case of ureterovaginal fistula. The 3 year survival rate for stage I cancer of the cervix was 68.5%, stage IIa, 52.8%, recurrent cervical cancer, 25.8% and for stage II endometrial cancer, 89%.
 ...
PMID:Radical hysterectomy with bilateral pelvic node dissection. Our experience at the Philippine General Hospital. 208 26

Percutaneous nephrostomies were used in 34 patients with ureteral obstruction caused by gynecologic diseases. Group 1 consisted of 12 patients with untreated cervical carcinoma; group 2 consisted of six patients with recurrent cervical carcinoma; group 3 consisted of seven patients with complications of urinary conduits, and group 4 consisted of eight patients with a variety of malignant and benign gynecologic diseases causing ureteral obstruction. One perinephric hematoma and one perinephric abscess (4%) occurred during primary percutaneous nephrostomy diversion of 53 renal units. One (3%) percutaneous nephrostomy-related death caused by sepsis was observed in 34 patients. Only four (12%) patients with significant intrinsic renal disease did not have effective normalization of renal function by percutaneous nephrostomy. Percutaneous nephrostomies allow rapid and reliable urinary diversion without the morbidity and mortality of operative techniques. Percutaneous nephrostomy should be considered for relief of ureteral obstruction in patients with untreated cervical carcinoma who may enjoy prolonged palliation or cure, in patients with complications of previous urinary conduits as a temporizing method of urinary diversion, and in patients with benign or chemotherapy-sensitive pelvic malignancies causing ureteral obstruction. The use of percutaneous nephrostomy in patients with recurrent carcinoma of the cervix should be individualized on the basis of expectations for prolonged functional palliation.
 ...
PMID:Percutaneous nephrostomy in gynecologic oncology patients. 245 17

In patients with small central recurrences following radiation therapy for cervical cancer the surgeon may have to make a judgment as to when radical hysterectomy is preferable to exenteration. During the years 1968-1984 there were 21 radical hysterectomies performed at Memorial Sloan-Kettering Cancer Center for recurrent cervical cancer. The original clinical stage distribution is as follows: IB-4, IIA-4, IIB-11, IIIB-1, IVA-1. The median interval from initial diagnosis to recurrence was 10 months. There were two operative deaths; both were from sepsis. Ten of the 21 patients developed postoperative fistulas, with 9 requiring surgical diversion of the urinary or both urinary and intestinal tracts. Thirteen of 21 patients (62%) have survived with a median follow-up of 73 months. Seven patients suffered recurrences following radical hysterectomy. All developed recurrence in the central pelvis. Four had sidewall disease as well, but none had distant disease at the time recurrence was diagnosed. Of 11 patients with cervical tumors of 2 cm or less in size at the time of radical hysterectomy, none experienced recurrence, while among 10 patients with tumor size of greater than 2 cm, 7 had recurrence. All patients whose initial clinical stage was IB or IIA have survived without recurrence. There was only 1 survivor among 5 patients with positive parametrial or vaginal margins. Six of the 13 survivors required urinary diversion, and 2 required colostomy as well. Radical hysterectomy for this indication is a morbid procedure which should be undertaken only by the most experienced of pelvic surgeons and limited to patients of early clinical stage with central recurrences of less than 2 cm in size.
 ...
PMID:Radical hysterectomy for recurrent cervical cancer following radiation therapy. 362 30

The purpose of this study was to evaluate the efficacy and the toxicity of mitomycin, ifosfamide, and cisplatin in patients with recurrent carcinoma of the cervix. Between July 1992 and March 1995, 20 patients with recurrent cervical cancer were enrolled in this study. No patients had received prior chemotherapy for metastatic disease, except some were exposed to cisplatin as a radiosensitizer at the time of their diagnosis. Mitomycin-C 6 mg/m2, ifosfamide 3 g/m2, and cisplatin 50 mg/m2 were given intravenously every 3 weeks. All patients were assessible for response and toxicity, and none was lost to follow-up. All patients except one had squamous cell carcinoma. The overall response rate was 45% (2 complete remissions and 7 partial remissions). The mean response duration was 35 months, and the median survival from treatment for the whole group was 14 months. Fifteen percent of all cycles produced grade 3 or 4 myelosuppression, and the main nonhematologic toxicity was nausea and vomiting, which was reported in 11.5% of all cycles. One death occurred secondary to chemotherapy-induced septicemia. Three patients are still alive, two with a complete response and one with a partial response. In conclusion, mitomycin, ifosfamide, and cisplatin have a good activity in recurrent carcinoma of the cervix and are comparable to other combination chemotherapy.
 ...
PMID:A phase II trial of mitomycin, ifosfamide and cisplatin in recurrent carcinoma of the cervix. 1124 Jun 76

The activity and toxicity of topotecan in women with recurrent cervical cancer are described from a case series of women with recurrent cervical cancer who had measurable disease and were not amenable to cure by surgery or radiation. All patients had prior platinum-based chemotherapy and developed progressive disease. Topotecan was given as 1 mg/m2/day over 30 min for 5 days every 3 weeks until progression of disease or prohibitive toxicity. Between July 1998 and July 1999, 12 patients received a total of 20 cycles of topotecan. Median age was 41 years (range 21-62), and 11 (92%) patients had prior whole pelvic radiation. The mean number of topotecan cycles was 1.5 (median 1, range 1-3). There were two partial responses (16.7%; 95% CI, 2% to 48%), both in prior radiation fields. Five patients required red blood cell transfusions, four had grade II nausea and vomiting, two developed sepsis (one with neutropenia), one developed fever, and one reported hyperpigmentation. There were no treatment-related mortalities. Although topotecan appears to exhibit modest activity in recurrent cervical cancer after radiation and platinum-based therapy, bone marrow toxicity may limit the utility of this regimen without hematopoietic growth factor support.
 ...
PMID:Topotecan for recurrent cervical cancer after platinum-based therapy. 1124 Jun 88