melphalan and Paralysis

Hyperthermic isolated limb perfusion (ILP) (2 mg, TNF-alpha and 100mg, melphalan) was performed for an irresectable right thigh desmoid tumor with calf extension in a 49-year-old man. The patient had a history of four resections since the age of 19 years. Local ILP toxicity appeared with extensive edema and common peroneal neurologic impairment including paresis that remained severe 10 months later. One of the most troublesome side effects of perfusion is peripheral nerve damage, which has been reported at a rate of between 1 and 48% of perfused patients. ILP is an effective treatment in recurrence situations or where resection threatens loss of function; it, however, requires administration in specialized centers, progress in standardization and close monitoring to avoid locoregional toxicity, the mechanisms of which merit further investigation. Emergency compartmental pressure measurement may indicate fasciotomy, can be of great interest.

Topics: Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Cancer, Regional Perfusion; Electromyography; Fibromatosis, Aggressive; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Melphalan; Middle Aged; Neoplasm Staging; Paralysis; Peroneal Nerve; Risk Assessment; Severity of Illness Index; Soft Tissue Neoplasms; Thigh; Treatment Outcome; Tumor Necrosis Factor-alpha

The incidence of long-term (> or = 3 months) neuropathy in 350 melanoma patients treated with single normothermic or 'mild' hyperthermic perfusion with melphalan in the period 1978 to 1990 was studied. Long-term neuropathy was encountered in 14 patients; in 10/51 patients (20%) after perfusion at the axillary level and in 4/247 patients (2%) after perfusion at the iliac level. After brachial and femoro-popliteal perfusions no long-term neuropathy was observed. Neuropathy, mainly consisting of paresis/paralysis of the hand and/or fingers, anaesthesia, and/or paraesthesiae, improved over a mean period of 16 (3-43) months in eight patients, but three patients still had serious neuropathy one year after perfusion. In another six patients little improvement was seen and four died with permanent neuropathy. Acute regional toxicity after perfusion and the application of 'mild' hyperthermia did not seem to influence the incidence of long-term neuropathy. This complication is probably a result of the isolating Esmarch rubber bandage being applied too tightly during perfusion at a proximal level. At the axillary level, where the brachial plexus lacks the protection from enveloping tissues, nerve damage is especially prone to occur. We recommend applying this bandage no tighter than is necessary to maintain the isolation of the circuit. This implies meticulous surgical isolation of the vascular system and accurate monitoring of leakage.

Topics: Adolescent; Adult; Aged; Arm; Chemotherapy, Cancer, Regional Perfusion; Female; Fever; Humans; Leg; Male; Melanoma; Melphalan; Middle Aged; Paralysis; Paresis; Peripheral Nervous System Diseases; Retrospective Studies; Sensation Disorders; Skin Neoplasms; Time Factors

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Blood Viscosity; Carmustine; Cyclophosphamide; Humans; Hypercalcemia; Male; Melphalan; Multiple Myeloma; Paralysis; Plasmapheresis; Prednisone; Seizures; Serum Globulins; Vincristine

Topics: Chemotherapy, Cancer, Regional Perfusion; Dactinomycin; Drug Therapy, Combination; Extremities; Female; Hot Temperature; Humans; Male; Melanoma; Melphalan; Paralysis; Remission, Spontaneous; Sarcoma; Soft Tissue Neoplasms

A disease in an IgD (lambda) plasmocytoma is described, where after therapy with Alkeran and prednisone a disappearance of all clinical and laboratory findings indicating an activity could be observed. However, there was a progressive development of a picture of encephalomyelitic and polyradicular neuritic syndrome in the female patient with all signs of a recidivous temporary intracranial hypertension which could not be cured. The aetiology of these processes could only be found by the autopsy which revealed an isolated massive infiltration of the meninges and the sheaths of the spinal cord nerves with atypical plasma cells. No signs of the tumour could be identified in other organs. Such localization of the disease, as it is described here, is the first observation of its king. Problems of clinical diagnosis and treatment are discussed.

Topics: Encephalomyelitis; Female; Humans; Hypertension; Immunoglobulin D; Melphalan; Middle Aged; Neurologic Manifestations; Paralysis; Plasmacytoma; Polyradiculopathy; Prednisone

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: Burns; Chemotherapy, Cancer, Regional Perfusion; Edema; Extremities; Fasciotomy; Humans; Melphalan; Muscular Diseases; Neoplasms; Paralysis; Peripheral Nervous System Diseases; Temperature