melphalan and Hypesthesia

Isolated limb infusion (ILI) for the treatment of in-transit melanoma was originally described more than 10 years ago. Response rates of 45-53% have been reported in U.S. series. Long-term quality of life outcomes after this procedure have not been described. We hypothesized that ILI is rarely associated with long-term limb morbidity.. ILIs performed at our institution between July 2005 and June 2009 were reviewed. Patients were contacted cross-sectionally at 2 time points. During these interviews, response to treatment and postoperative limb function were assessed.. Thirty-two ILIs were performed during the time period. Twenty-seven patients were treated for in-transit melanoma; 5 were treated for recurrent Merkel cell carcinoma. The 30-day mortality was 0%. Three patients (9%) required fasciotomy. Durable complete responses were achieved in 41% of patients, with mean follow-up time of 19.4 ± 9.6 months after infusion; after this period, 53% reported progression of disease. The most common postprocedure symptoms were edema (88%), numbness (59%), and pain (59%). By 3 months and at the time of last follow-up, the most common symptoms were edema (82%), numbness (65%), and stiffness (35%). No patients reported impaired limb function at the time of last follow-up compared to baseline. Median survival was 19.2 ± 4.2 months after infusion.. ILI for melanoma and Merkel cell carcinoma is associated with postprocedure symptoms in most patients, most commonly edema, color change, and numbness. At last follow-up, no ILI patients had residual functional impairment in the treated limb.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Arm; Carcinoma, Merkel Cell; Cross-Sectional Studies; Dactinomycin; Edema; Female; Follow-Up Studies; Humans; Hypesthesia; Infusions, Intravenous; Leg; Length of Stay; Male; Melanoma; Melphalan; Neoplasm Recurrence, Local; Quality of Life; Skin Neoplasms; Survival Rate

The clinical course and biopsy and autopsy findings in a patient with asymmetrical polyneuropathy in Waldenström's disease are reported. Under steroid therapy the patient developed mild diabetes mellitus. In the light of the course of the disease, a causal relationship between the hematologic disease and the peripheral neuropathy is assumed. Although a peripheral nerve could not be examined on autopsy, strong lymphocytic infiltration in the autonomic nerves seems to point to a similar pathogenetic mechanism in the development of polyneuropathy. The other possible causal factors are discussed with reference to the small number of reports in the literature.

Topics: Autonomic Nervous System; Humans; Hypesthesia; Immunoglobulin M; Lymphocytes; Male; Melphalan; Middle Aged; Myocardium; Neurologic Manifestations; Paralysis; Pulmonary Edema; Waldenstrom Macroglobulinemia

Topics: Aged; Amyloidosis; Biopsy; Bone Neoplasms; Cell Nucleus; Cyclophosphamide; Electromyography; Female; Humans; Hypesthesia; Melphalan; Microscopy, Electron; Multiple Myeloma; Muscles; Muscular Atrophy; Musculocutaneous Nerve; Myelin Sheath; Neural Conduction; Reflex, Abnormal