Local Chemotherapy (local + chemotherapy)

Distribution by Scientific Domains

Selected Abstracts

The clinical significance of local chemotherapies

William J. Killoy

Periodontitis as an infectious disease: specific features and their implications

A Mombelli
Periodontitis may be viewed as an infectious disease with a number of specific characteristics. Pathogens of the subgingival microbiota can interact with host tissues even without direct tissue penetration. Hence, antimicrobial agents must be available at a sufficiently high concentration not only within the periodontal tissues, but also outside, in the environment of the periodontal pocket. The subgingival microbiota accumulate on the root surface to form an adherent layer of plaque with the characteristics of a biofilm. Several mechanisms, such as diffusion barriers, and selective inactivation of agents lead to an increased resistance of bacteria in biofilms. Mechanical supragingival plaque control is indispensable to prevent the re-emergence of periodontal pathogens and the re-establishment of a biofilm in treated sites. Since specific features have important implications for the use of antimicrobial agents in periodontal therapy, extrapolations from experiences made in the therapy of other infections are only partially valid. The ultimate evidence for the efficacy of systemic or local chemotherapy must be obtained from treatment studies in humans with adequate follow-up. [source]

Treatment of lumbar and lumbosacral spinal tuberculosis with minimally invasive surgery

Xi-feng Zhang MD
Objective:, To evaluate the outcome of computed tomography (CT)-guided percutaneous puncture and local chemotherapy for tuberculosis (TB) of the lumbar or lumbosacral spine. Methods:, From January 2002 to August 2006, 49 patients with lumbar or lumbosacral spinal TB in whom conservative treatment had failed were treated by minimally invasive surgery. There were 21 female and 28 male patients. The mean age of the patients was 47 18 years (range from 12 to 78 years). There were 40 cases with lumbar TB, and 9 with lumbosacral TB. From L1 to S1, the involved vertebral numbers were 8, 26, 19, 19, 21 and 10, respectively. In 3 patients the spinal TB involved a single vertebra, in 39 patients two, in 6 patients three and in only one case four vertebrae. According to the Frankel scale, three patients had grade E incomplete paralysis preoperatively. The outcome, after treatment by CT-guided percutaneous puncture and local chemotherapy, was retrospectively analyzed according to the preoperative and postoperative kyphotic angles and the Oswestry disability index (ODI). Results:, Forty-nine patients were followed up for from one year to 5 years and 8 months (average 35 months). All cases recovered, and there was no recurrence. Preoperatively, the kyphotic angle was 16.47 8.74, and it had decreased to 13.35 8.02 by the final follow-up (t= 5.79, P < 0.001). The average ODI score had improved from 70.12 22.24 to 12.72 8.62 (t= 21.42, P < 0.001). Conclusion:, The majority of cases of lumbar and lumbosacral spinal TB can achieve satisfactory results with minimally invasive surgery. Its clinical application is therefore strongly recommended. [source]

Treatment of classic Kaposi's sarcoma-associated lymphedema with elastic stockings

ABSTRACT Lymphedema of the lower extremities is a frequent complication of Kaposi's sarcoma (KS). Compressive therapy is the basis of treatment for lymphatic disorders, but to the authors' knowledge, there are no controlled trials to evaluate its effectiveness in KS-related lymphedema. Sixty-five patients with classic KS-associated lymphedema limited to below the knee were studied. Fifty patients received below-knee elastic stockings, whereas the remaining 15 did not use any compressive device. Among treated patients, 60% (30/50) experienced a limb volume reduction, while 40% (20/50) had an increase of limb volume. In contrast, all patients (15/15) of the untreated group had an increase of limb volume. No correlation between lymphedema reduction and systemic or local chemotherapy was observed, supporting compressive therapy as the major strategy for the treatment of this condition. Our results suggest that elastic stockings may be important tools for the management of lymphedema associated to classic KS. [source]