الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
This study was designed to include forty selected patients suffering from
malignant ascites whether primary or secondary. Group (I) included twenty
patients with cytologically proven malignant ascites and were subjected to
intraperitoneal chemotherapy. Group (II) included twenty patients with
cytologically proven malignant ascites and were subjected to intraperitoneal
chemohyperthermia. All patients were referred to the Tropical Medicine and
Oncology Department, Kasr El-Aini Hospital, Cairo University from April
2004 to September 2005.
The patients included 8 males and 32 females, their ages ranged
between 43 and 68 years.
They were subjected to complete clinical assessment, Laboratory work up
including urine and stools analysis, complete blood pictures, liver function
tests: including Serum bilirubin (total and direct), serum transaminases
(ALT and AST), alkaline phosphatase, total proteins and albumin,
prothrombin time and concentration, kidney function tests including serum
urea and creatinine. Ultrasonography was done for all patients. Serum tumour
markers including alpha-fetoprotein, CA19-9 and CA125 were done for all
patients. Pathological examination of ascitic fluid before and after the
session (1,2,3 and 4 weeks interval).
Twenty patients were subjected to intraperitoneal chemotherapy
(group I) and the other twenty patients who subjected to
intraperitoneal chemohyperthermia (group II). The
chemotherapeutic used was cisplatin 200 mg.
The effect of intraperitoneal chemotherapy versus intraperitoneal
chemohyperthermia was evaluated on the tumor histology, course of
the disease and quality of life in patients with malignant ascites.
There were improvement in quality of life in our patients after the
procedures. This was indicated by the significant decrease in body
weight and abdominal girth which reflect the regression of ascites in
these patients. Patients experienced some relief of ascites related
symptoms as shortness of breath, upper GIT symptoms, low back
ache and fatigue. In both groups, there was a significant lowering of
body weight and abdominal girth four weeks after the procedures.
However the percent change in body weight and abdominal girth
before vs. 4 weeks after the procedures was found significantly
higher in group II than in group I.
Considering ascitic fluid cytology the viable malignant cells were
significantly decreased in both groups after four weeks of the
procedures.
In group I there was no significant difference in percentage of viable,
necrotic or degenerative malignant cells before versus 4 weeks after
the procedure.
However, in those patients undergoing intraperitoneal
chemohyperthermia (Group II) the effects were more pronounced.
This was shown by the significant difference in the percentage of
viable cells over the 4 weeks as well as the percentage of
degenerative and necrotic cells in ascetic fluid cytology.
At the end of the follow up period no significant difference as regard
viability of malignant cells was observed in patients undergoing
intraperitoneal chemotherapy (group I) than before the procedure.
However the difference was still significant in those undergoing
intraperitoneal chemohyperthermia. This was shown also by the
percent change in viability of malignant cells before vs. 4 weeks
after the procedures where it was significantly higher in group II
than in group I.
In the current study the adverse effects noted within the first 48
hours after the procedures were abdominal pain, anorexia, vomiting
and constipation. Slight elevation of body temperature to 38° C was
a significant finding in those undergoing intraperitoneal
chemohyperthermia. Most side effects were relieved by the third day
after the procedures.
There was a significant impairment of renal function indicated by
some elevation of serum creatinine in patients undergoing
intraperitoneal chemotherapy. This effect was not pronounced in
group II of our study.
No significant adverse effects were noted on blood picture or other
blood chemistry profiles in this work.