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Spiewankiewicz B.,Klinika Ginekologii Onkologicznej | Osuch B.,Klinika Ginekologii Onkologicznej | Kusnierz J.,Klinika Ginekologii Onkologicznej | Symonides M.,Zaklad Anestezjologii i Intensywnej Terapii | Smorczewska M.,Zaklad Diagnostyki Obrazowej
Current Gynecologic Oncology | Year: 2013

HIPEC (hyperthermic intraperitoneal chemotherapy) is a novel therapeutic modality implemented in selected cases of genital malignancies in the females, mainly in patients with intraperitoneal cancer dissemination. The procedure is an integral part of surgical treatment, because it is done during radical tumor excision or cytoreductive surgery. A prerequisite for HIPEC is excision of all visible tumor foci of over 5 mm. This facilitates penetration of cytostatics to the peritoneum and destruction of persisting viable cancer cells. We present preliminary assessment of effectiveness of cytoreductive surgery combined with intraperitoneal perfusion chemotherapy under hyperthermia in 18 patients with late-stage ovarian cancer, peritoneal mesothelioma and disseminated uterine sarcoma. In our material, in 2 cases only surgery preceding HIPEC consisted in freeing of adhesions and excision of isolated intraperitoneal implants of less than 1 cm. All other patients underwent extensive cytoreduction. In all cases, the HIPEC procedure was performed by closed technique after completion of cytoreductive surgery. Cytostatics used included cisplatin (75 mg/m2) and adriamycin (30 mg/m2), which, depending on diagnosis, were administered alone or combined. After surgery, the predominating complication experienced by over 83% of the patients were nausea and vomiting of varying severity. To date, HIPEC procedure has not won a secure position in the treatment of ovarian cancer, both due to required proper equipment and disposable sets of drains, but mainly because of lack of unequivocally defined and optimal for a particular patient timing of execution. It has not been settled, whether such an optimal moment is completion of first-line adjuvant or neoadjuvant chemotherapy or recurrence of disease after another line of treatment. An indispensable prerequisite for implementation of intraperitoneal chemotherapy is maximal cytoreduction of tumor mass. Based on initial experiences we may state that the HIPEC procedure is a valuable adjunct for other established therapeutic modalities in oncology on the condition of proper, multidisciplinary qualification for the procedure.


Hagmajer E.,Zaklad Anestezjologii i Intensywnej Terapii | Sowinski P.,Zaklad Anestezjologii i Intensywnej Terapii | Lukaszewska A.,Zaklad Anestezjologii i Intensywnej Terapii | Ciszkiewicz E.,Zaklad Anestezjologii i Intensywnej Terapii | Doboszynska D.,Zaklad Anestezjologii i Intensywnej Terapii
Nowotwory | Year: 2010

Introduction. The study presents data regarding nefopam efficacy in the treatment of postoperative pain in cancer patients after colorectal surgery with an evaluation of adverse side effects. Material and methods. 3 2 cancer patients after colorectal surgery were included into the study. Central randomization was used. In the control group (n=16) patients received morphine intravenously by a patient- controlled analgesia pump (PCA). In the treatment group (n=16) patients received additional analgesia with nefopam 20 mg intramusculary every 6 hours. Morphine consumption and postoperative pain intensity assessment acc. to the visual-analogue scale (VAS) were compared during a 24-hour observation period. Adverse side effects, serum transaminase levels, return of intestinal peristalsis and the hospitalization time were also evaluated. Results. We observed statistically significant lower morphine consumption in the treatment group. The incidence of dry mouth, headache, dizziness, drowsiness and shivering were similar in both groups. Sweating was recorded more often in the group treated with nefopam and the difference was statistically significant. We did not observe significant differences in the median values of other measured parameters. Conclusions. Our findings suggest that the combination of nefopam and parenteral morphine can be used for the treatment of postoperative pain. It is important to remember the contraindications for nefopam use, such as concurrent administration of monoamine oxidase inhibitors, antidepressants, epilepsy, glaucoma, coronary artery disease and tachycardia.

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