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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although early survival following transplantation for primary hepatic cancer is excellent, previously reported high recurrence rates have generally discouraged liver replacement for this indication. Since the inception of the Boston Center for Liver Transplantation (BCLT) in 1983, 33 of 383 (8.6%) liver allograft recipients have undergone orthotopic transplantation as definitive treatment for otherwise unresectable cancer. Diagnoses included hepatocellular carcinoma (HCCA) in 24 patients (73%), and cholangiocarcinoma (CHCA) in 9 patients (27%). Actuarial survival rates for patients with hepatocellular carcinoma were 71%, 56%, and 42% at 1, 2, and 3 years, respectively. The actuarial survival rates for patients with cholangiocarcinoma were 89% at 6 months, and 56% at 1, 2, and 3 years. Of the nine patients with cholangiocarcinoma, 56% (5/9) developed recurrent disease. Although this recurrence rate is disheartening, because of the lack of other morbidity, long-term survival in these patients is comparable to patients with HCCA. In contrast, recurrent hepatocellular carcinoma developed in 25% of recipients (5/20) who survived longer than 3 months posttransplantation. Other causes of death in patients with hepatocellular carcinoma included perioperative complications, 16.6% (4/24); sepsis, 8.3% (2/24); coronary artery disease, 4.2% (1/24); and lymphoma, 4.2% (1/24). Favorable prognostic factors included: primary tumor less than 3 cm in size and absence of associated cirrhosis. These results emphasize that orthotopic liver transplantation can provide a long-term cure for approximately 50% of patients whose primary hepatic malignancy is unresectable by conventional procedures.
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PMID:Liver transplantation for primary hepatic cancer. 131 Aug 23

Ten years' results of 56 patients with high grade osteogenic sarcoma are reported. Fifty-two patients had M0 disease. Immediately after open biopsy the patients were treated with chemotherapy using modified Rosen's protocols T4, T7 and T10. The primary tumor was adequately removed in most patients. Six children were treated with limb saving. The actuarial and disease-free survival was 80% after 1 year, and 73% to 8 years. Two patients died because of toxic side effects of chemotherapy, one of septicemia, the other of late cardiac failure secondary to doxorubicin.
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PMID:Ten years' experience in patients with osteogenic sarcoma in Finland. 169 Nov 10

This study evaluated combined 5-fluorouracil (5FU) and doxorubicin as postoperative adjuvant chemotherapy for patients who had undergone potentially curative resection of a primary gastric adenocarcinoma. One hundred twenty-five eligible and evaluable patients were stratified according to extent of surgical resection, location of the primary tumor within the stomach, and lymph node status. They were then randomized to either receive three cycles of chemotherapy or be observed. The median time from patient entry was 7 years. Results showed no significant difference in time to recurrence. The 5-year survival rate was 33% for the observation arm and 32% for the adjuvant therapy arm. The data excluded a 16% improvement in the 5-year survival rate for patients receiving chemotherapy with a P value less than 0.05. There were two drug-related fatalities due to sepsis. These results demonstrate no substantive benefit for this chemotherapy regimen as postoperative adjuvant treatment of resected gastric cancer.
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PMID:A prospective, randomized evaluation of intensive-course 5-fluorouracil plus doxorubicin as surgical adjuvant chemotherapy for resected gastric cancer. 201 45

One hundred and twenty-five previously untreated patients bearing metastatic or advanced recurrent (inoperable) colorectal carcinoma and measurable disease were prospectively randomized. Those in arm A received 5-fluorouracil (5-FU), 1,200 mg/m2 i.v. infusion over 2 h, while those in arm B received methotrexate (MTX), 200 mg/m2 i.v. (push injection), followed 20 h later by 5-FU, 1,200 mg/m2 i.v. infusion over 2 h, plus calcium leucovorin (LV), 25 mg i.m. every 6 h for eight doses beginning 24 h after MTX administration. Cycles were repeated every 15 days. All patients receiving treatment were evaluable for toxicity and survival, and 118 patients were evaluable for response. The objective regression rate (complete plus partial response) was 12% (7 of 58) in arm A and 28% (17 of 60) in arm B (p = 0.049). No change was observed in 24% (14 of 58) in arm A and in 35% (21 of 60) in arm B (p = 0.28), while progressive disease was registered in 64% (37 of 58) and 37% (22 of 60) in arms A and B, respectively (p = 0.006). Median duration of response was 3 months in arm A and 5 months in arm B (p = 0.39). The median survival was 8.3 months in arm A and 11.2 months in arm B (p = 0.25). No statistically significant differences were found when objective regression and survival were related to site of primary tumor, performance status, and number of involved organs. There were two drug-related deaths in arm B due to severe myelosuppression followed by mucositis and sepsis. Of nonhematologic toxicities, diarrhea was more frequently observed in arm B, as were mucositis and infectious complications. Our results indicate that the sequential schedule MTX-5-FU-LV with 20-h intervals between MTX and 5-FU is superior in terms of objective regression to 5-FU alone given at the dose and schedule used in the present study. However, MTX-5-FU-LV did not have a significant impact on survival.
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PMID:Advanced colorectal carcinoma. A prospective randomized trial of sequential methotrexate, 5-fluorouracil, and leucovorin versus 5-fluorouracil alone. 203 8

The authors describe the results of five pediatric patients with nonmetastatic osteosarcoma of an extremity, admitted from 1987 to 1989 to the Hospital Infantil del Estado de Sonora. Four patients presented with their primary tumor located at the distal end of the femur, whereas one had a primary lesion of the humerus. All of them received preoperative chemotherapy consisted of two cycles of cisplatin and adriamycin. One of the patients presented immediate complications after first cicle and died due to overwhelming sepsis by Candida albicans. Surgery was an amputation in one patients and block ressection in three cases. Necrosis was good in three cases, fair in one. Postoperative chemotherapy consisted of bleomycin, cyclophosphamide and dactinomycin every four weeks alternated with cisplatin plus adriamycin. One of the three patients, in which block ressection was made, had a local recurrence 12 months after diagnosis, without metastasis. He underwent desarticulation and died four months later of leukoencephalopathy and no tumor was found on necropsy. Three patients have remained continuously free of disease with follow up of 20, 26 and 31 months after diagnosis and are out of chemotherapy since 5, 12 and 17 months, respectively. In two of them the affected extremity still is safe.
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PMID:[Treatment of osteosarcoma in children with pre- and postoperative chemotherapy and block resection of the tumor]. 206 45

Eighty-five patients with adenocarcinoma of the pancreas were reviewed in order to evaluate the efficacy of our methods of diagnosis and treatment. The most useful diagnostic test was percutaneous transhepatic cholangiography (PTC) with a diagnostic rate of 96%. Pancreaticoduodenectomy (Whipple procedure) and total pancreatic resection were performed in 13 and 2 patients, respectively. The remaining 50 patients underwent various palliative drainage procedures. Twenty patients did not undergo operation for various reasons. The primary tumor was found in the head of the pancreas in 50 patients (59%), the body in 6 patients (7%), and in the tail in 8 patients (9%). Postoperative complications, including sepsis, bleeding, intra-abdominal abscesses, and anastomotic leaks, occurred in 37% of the patients. There were one operative and 9 postoperative deaths. The average survival for those patients undergoing surgical intervention was 6 months. There were no 5-year survivors.
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PMID:Carcinoma of the pancreas: a retrospective review. 223 9

A 42-year-old woman presented with a 25-week pregnancy and stage IV breast cancer with metastases in the skeleton and liver and a T-4 primary tumor. She was treated with two cycles of doxorubicin, methotrexate, and vincristine. Spontaneous labor resulted in a normal female infant, who was successfully treated for sepsis and mild respiratory distress. The placenta showed diffuse chorioamnionitis. There was no doxorubicin demonstrated in the placenta, blood, or fetal lymphocytes 3 weeks after the last treatment. Maternal and fetal chromosomal analyses were unremarkable. The child is functioning normally 2 years after delivery. The literature on anthracycline treatment during pregnancy is reviewed. Adriamycin has been shown to cross the blood-placenta barrier, but has not led to specific fetal abnormalities when given during the second or third trimester. Experience during the first trimester is still limited.
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PMID:Combination chemotherapy and radiation for stage IV breast cancer during pregnancy. 229 17

Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC.
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PMID:Biliary tract obstruction secondary to cancer: management guidelines and selected literature review. 329 31

Since 1978, 41 patients (12 percent of all restorative operations) have undergone peranal coloanal reconstruction following anterior resection (LAR) for cancers of the midrectum. Twenty-seven patients (66 percent) were men and 14 patients (34 percent) were women (mean, 58.8 years). The mean distance of the primary tumor from the anal verge was 6.7 cm and 50 percent of the primary tumors were considered highly mobile. In 29 patients, a hand-sewn anastomosis was performed between the colon and the dentate line. In the 12 most recent patients, the anastomosis was performed using a circular stapling instrument. A diverting colostomy should be employed in all cases and is closed approximately three months later. There has been no operative mortality. Morbidity included anastomotic separation (two patients), minor anastomotic defects (three patients), pelvic sepsis (two patients), and bacteremia of unknown origin (two patients). Where fecal diversion was employed, there were no instances of anastomotic leak. Two patients with hemorrhage were returned to the operating room. Thirty-seven of the 41 patients underwent curative resections. Thirty-three percent of the patients had Dukes' C lesions. With a median follow-up of 31 months for the curative resections, 73 percent remain free of disease. Sixty-four percent of evaluable patients have either excellent or good anorectal function nine to 12 months after colostomy closure. Of 26 operations performed by one surgeon, 22 patients (85 percent) are currently evaluable. Nineteen (86 percent) of the 22 have normal or near-normal bowel function. Four guidelines for performing a functionally successful operation are presented. Coloanal reconstruction following LAR, were pull-through operations were previously required, is an excellent sphincter-preserving operation. The functional results one year after the operation are gratifying, with the majority of patients leading an active life with normal bowel function.
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PMID:Peranal coloanal anastomosis following low anterior resection for rectal carcinoma. 389 52

Forty-two patients with advanced testis carcinoma without previous chemotherapy were treated with VAB-4, and 41 were evaluable. The program consisted of three in-hospital inductions 16 weeks apart, and outpatient treatments every three weeks. Of the patients, 80% achieved complete remissions (CR). Chemotherapy alone induced CR in 61%, partial remissions (PR), in 24% and minor response (MR), in 15%. An additional 20% of patients (six PRs and 2 MRs) achieved CR following resection of residual tumor deposits. With a median follow-up of 27 months, the median duration of CR has not been reached. Of those achieving CR to chemotherapy alone, 12% had relapses. Bulk and extent of metastatic disease, histology of primary tumor, and tumor markers at the beginning of therapy influenced the frequency of CR. Of those with minimal disease, 90% achieved CR. The CR rate was 67% for those with advanced thoracic disease and 29% for those with advanced abdominal disease. Patients who had embryonal carcinoma and those who had no elevation of alpha-fetoprotein had a higher frequency of CRs. Myelosuppression with a leukocyte count drop less than 1000/mm3 occurred in three patients, and no patient had chronic renal failure or pulmonary fibrosis. One patient died from sepsis while in complete remission.
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PMID:VAB-4 combination chemotherapy in the treatment of metastatic testis tumors. 616 66


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