Histamine’s vasoactive properties improving response rates in solid tumor treatment

Soft tissue sarcomas account for approximately 5000 new cases per year in Europe. 60% of them occur in the extremities and are often large at first diagnosis with a high propensity for hematogenic spread so that half of the patients die of disseminated disease. The use of aggressive approaches, such as amputation has no positive impact in survival rates, as compared to conservative approaches. In this sense, Isolated limb perfusion (ILP) plays a major role, consisting of the regional administration of high doses of drugs to an isolated limb. TNF/melphalan (TM-ILP) leads to overall response rates of circa 100% for melanoma patients and circa 70% for sarcoma patients, with a limb salvage index of approximately 75%. The mechanism of action of TNF is first a higher tumor drug uptake and secondarily the destruction of the tumor associated vasculature (TAV). Based on this success, there was a renewed interest in organ perfusion, unfortunately, the use of TNF in t! hese settings remains controversial with lack of confirmatory positive or synergistic responses in lung perfusion and with unacceptable hepatotoxicity in liver perfusion. In the Experimental Surgical Oncology experimental rat models of ILP and Isolated Hepatic Perfusion (IHP) were developed for a better understanding of the mechanism of action of these techniques and for the evaluation of new drugs. The aim of our study was to evaluate the potential use of Histamine, IL-2 and their combination, in the regional setting as an alternative to TNF. Hi showed a synergistic effect, when combined to doxorubicin in the experimental ILP, and when combined to melphalan in the experimental ILP and IHP. IL-2 also had a synergistic effect when combined to melphalan in the experimental ILP. Yet, the combination of Hi and IL-2 to melphalan in the ILP led to decreased response rates as compared to each agent alone combined to melphalan. The mechanism of action of Hi in the regional setting was very similar to the mechanism of action of TNF with a better tumor drug uptake, TAV destruction, and best responses seen with its combination to chemotherapeutic drugs.! Additionally, Hi had a direct cytotoxic effect against both tumor cells and TAV

One hundred consecutive isolated limb perfusions with TNF-alpha and melphalan in melanoma patients with multiple in-transit metastases

OBJECTIVE: The aim of this study is to describe the experience with 100 TNF-based ILP for locally advanced melanoma and to determine prognostic factors for response, time to local progression, and survival. METHODS: One hundred TNF-based ILPs were performed between 1991 and 2003 in 87 patients for whom local control by surgery of in-transit melanoma metastases was impossible. In total, 62 iliac, 33 femoral, and 5 axillary ILPs were performed in mild hyperthermic conditions with 2 to 4 mg of TNF and 10 to 13 mg of melphalan per liter of limb volume. RESULTS: Overall response was 95%, with 69% complete response, 26% partial response, and 5% no change. Complete response rate differed significantly for patients with IIIA disease versus IIIAB and IV. Local and systemic toxicity was mild to moderate in almost all cases, with no treatment-related death and one treatment-related amputation. Five-year overall survival was 32%; local progression occurred in 55% after a median of 16 months. In complete response patients, 5-year survival was 42% with local progression in 52% at a median of 22 months. Response rate and survival were significantly influenced by stage of disease; (local progression free) survival was influenced by response rate. CONCLUSIONS: TNF-based ILP results in excellent response rates in this patient population with unfavorable characteristics. Response on ILP predicts outcome in patients and reflects aggressiveness of the tumor

Ambulatório Pais-Bebês: experiência em um hospital escola

The objective of this article is to present the work developed at the parent-baby clinic(Ambulatório Pais-Bebês) at Hospital de Clínicas de Porto Alegre, so as to emphasizethe importance of this assistance modality to professionals of related areas within thehospital environment. The authors emphasize the experience developed by aninterdisciplinary group of professionals who are dedicated to research, teaching andproviding assistance for babies and their families for about 10 years. It is hoped thatthe both research and practice will be stimulated in this area of childhood and adolescentpsychiatry, still little explored in Brazil. This collaboration among professionals resultedfrom the need to assist a growing number of babies who present development-relatedhealth problems, as well as to prevent gaps in the relationship with the caretakers. Ingeneral, although most cases are serious, intervention tends to be brief and withfavorable results. The authors believe that this may result from the fact that, between0 and 3 years of age, babies are extremely responsive to environmental changes.Therapeutic interventions that focus on such changes elicit responses from the babieswho, in turn, also stimulate their caretakers to provide better qualified care. The clinicalexperience throughout our experience has shown that the cost of such interventionsis extremely low, and as a consequence such actions should be prioritized as part ofthe effort to prevent mental problems in children.O presente artigo tem por objetivo apresentar o trabalho que vem sendo realizado noambulatório pais-bebês, enfatizando a importância desta modalidade de atendimentopara os profissionais de áreas afins, em âmbito hospitalar. Os autores destacam aexperiência desenvolvida por um grupo multidisciplinar de profissionais, que se dedicaà pesquisa, ao ensino e ao atendimento de bebês e suas famílias há cerca de 10anos. Visa-se estimular a prática e a pesquisa nessa área de conhecimento dapsiquiatria da infância e adolescência, ainda pouco exploradas em nosso país. Surgiuda necessidade de atender uma demanda crescente de bebês com problemas desaúde em diversas áreas do desenvolvimento, bem como de prevenir falhas na relaçãocom seus cuidadores. Em geral, apesar dos casos serem graves, as intervençõescostumam ser breves e com bons resultados. Os autores acreditam que isso possaocorrer em função de que, entre 0 e 3 anos de idade, os bebês são muito responsivosàs mudanças em seu ambiente. Intervenções terapêuticas, que focalizam taismudanças, provocam respostas nos bebês que, por sua vez, também estimulam seuscuidadores a proporcionarem uma maternagem mais qualificada. A experiência clínica,ao longo deste tempo, tem demonstrado que tais intervenções são de baixíssimocusto e, conseqüentemente adquirem uma magnitude prioritária na prevenção deproblemas mentais em crianças

Isolated Hypoxic Hepatic Perfusion with Retrograde Outflow in Patients with Irresectable Liver Metastases; A New Simplified Technique in Isolated Hepatic Perfusion

Background: Isolated hepatic perfusion with high-dose chemotherapy is a treatment option for patients with irresectable metastases confined to the liver. Prolonged local control and impact on survival have been claimed. Major drawbacks are magnitude and costs of the procedure. We developed an isolated hypoxic h

lnfluence of early separation on the interaction between mother and newborn infant

O presente estudo tem como objetivo avaliar a interação mãe-bebê a partir de diferentes tempos de contato no período pós-parto imediato. A idéia inicial do estudo era a comparação de dois grupos: um que seguiria a rotina do Centro Obstétrico do Hospital de Clínicas de Porto Alegre e outro ao qual se ofereceria um tempo extra de contato. Devido à ocorrência de efeito Hawthorne, perdeu-se o grupo-controle (não houve diferença no tempo de contato das duplas em cada um dos grupos durante o período sensível). Assim, as 29 duplas que efetivamente entraram na pesquisa foram acompanhadas, sendo avaliadas as interações, como um único grupo, já que o tempo extra de contato e o apoio às mães no período de pósparto imediato foram os mesmos, o que pode ter contribuído para os bons resultados das interações. Após o primeiro, o sexto e o 12º meses de vida do bebê, as duplas apresentaram, respectivamente, taxa de 95%, 100% e 92,8% de boas e muito boas interações. Investigações futuras nesta área, com amostras maiores, devem ser realizadas, fornecendo outras contribuições aos profissionais da saúde, gerando conhecimento capaz de auxi liar na prevenção de doenças mentais, abandono e abuso, a baixo custo.The aim of the study was to assess mother-infant interaction regarding different amounts of contact during the immediate post partum period. The original idea was to compare two groups: one lha! would follow normal routine of the Obstelrical Center of Hospital de Clínicas de Porto Alegre, and the other that would receive additional time together. Due to the loss ofthe control group (Hawthorne effect), the 29 dyads that consisted the sample were followed as a whole group. After the first, sixth and twelveth months, lhe dyads presented a rate of95%, 100% and 92.85%, respectively, of good and very good relationships. Once matched the groups, there is evidence that the interventian (extra time together and support to mothers during the immediate post partum period) might have contributed to the good results on the interaction. Future research on this area, with larger samples, will be needed in order to allert health professionals of developing countries to this possibility of low cost prevention of mental disorders