mesna and Lung-Diseases

Inhaled mucoactive agents are used in respiratory disease to improve mucus properties and enhance secretion clearance. The effect of mannitol, recombinant human deoxyribonuclease/dornase alfa (rhDNase) and hypertonic saline (HS) or normal saline (NS) are not well described in chronic lung conditions other than cystic fibrosis (CF). The aim of this review was to determine the benefit and safety of inhaled mucoactive agents outside of CF. We searched Medline, Embase, CINAHL and CENTRAL for randomized controlled trials investigating the effects of mucoactive agents on lung function, adverse events (AEs), health-related quality of life (HRQOL), hospitalization, length of stay, exacerbations, sputum clearance and inflammation. There were detrimental effects of rhDNase in bronchiectasis, with average declines of 1.9-4.3% in forced expiratory volume in 1 s (FEV

Topics: Acetylcysteine; Administration, Inhalation; Bronchiectasis; Chronic Disease; Deoxyribonuclease I; Expectorants; Forced Expiratory Volume; Humans; Lung Diseases; Mannitol; Mesna; Mucociliary Clearance; Quality of Life; Recombinant Proteins; Saline Solution, Hypertonic; Symptom Flare Up; Vital Capacity

In a phase II trial of ifosfamide 2 g/m2 days 1 to 4 with mesna uroprotection in 124 patients who had previously failed treatment for sarcomas, 3% achieved a complete response (CR), and 18% had a CR or partial response (PR). In the subset of patients with soft-tissue sarcomas, the response rate for the 64 patients who received bolus administration was 26% compared with 9% for the 60 patients who received a continuous infusion (Cl) schedule (P = .03). When mesna was unavailable, the incidence of hematuria was significant in patients, with three of four patients affected. Microscopic hematuria was uncommon in patients receiving mesna. Hematuria in the group as a whole was not associated with prior treatment with cyclophosphamide, pelvic radiotherapy, age, or a bolus versus Cl schedule. Thus, this and other studies confirm that ifosfamide is active in failed sarcomas. In sequential phase I/II trials, 111 patients who were previously untreated for metastatic or inoperable sarcomas received doxorubicin, ifosfamide, dacarbazine at doses of 60, 7,500, and 900 mg/m2, respectively, by Cl over 72 hours; myelosuppression was dose-limiting. Eleven patients (10%) achieved CRs, with an overall response rate of 47%. Most responses (approximately 70%) were observed within two cycles, and median times to progression were 10 and 9 months for CR and PR, respectively. Following CR, two patients remained disease-free at 32 and 16 months. Of 15 additional patients rendered disease-free with surgery following at least a minor response to chemotherapy, two remained disease-free at 30 and 18 months with no further therapy. Central nervous system (CNS) metastases developed in 11 patients, all of whom had high-grade sarcomas; seven of these patients were still responding systemically (three CRs). This regimen is undergoing evaluation in a randomized trial versus doxorubicin and dacarbazine alone in untreated advanced sarcoma and is being compared with observation in the adjuvant treatment of high-grade sarcomas.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Central Nervous System Diseases; Child; Child, Preschool; Combined Modality Therapy; Dacarbazine; Doxorubicin; Drug Administration Schedule; Female; Heart Diseases; Humans; Ifosfamide; Lung Diseases; Male; Mesna; Middle Aged; Randomized Controlled Trials as Topic; Sarcoma; Survival Analysis; Urologic Diseases

Eighty intensive care patients requiring mucolytic therapy because of pulmonary mucus retention after chest (28 cases) or thoracic (52 cases) surgery were given the drug mesna by three different methods: bronchial lavage with a mixture of mesna (5% to 10%) and lidocaine (1%) in 15 to 20 ml, 10 to 20 times a day (10 cases); instillation into the bronchial tree of 15 to 20 ml of a 5% to 10% mesna solution three to five times a day (20 cases); continuous aerosolization of four to five ampules of mesna per 24 hours with a Bennett nebulizer (50 cases). The duration of mesna therapy ranged from 2 to 21 days. The drug was found to be highly effective in all three methods; rapid fluidization of bronchial secretions was observed and aspiration of the latter was considerably facilitated. Tolerance was excellent and there were no side effects, even in cases with bronchial asthma. A particularly good effect was seen on blood-contaminated mucus. Samples of aspirated mucus were investigated by the electron spin resonance (ESR) technique to obtain structural information about the effects of mesna as compared with N-acetylcysteine. Mucolytics decrease with ESR signal, and the rate of reduction is supposed to measure the rupture of disulphide bridges and, consequently, the degree of mucus fluidization. The rate of decrease of the ESR signals is much higher after mesna.

Topics: Aerosols; Clinical Trials as Topic; Expectorants; Humans; Lidocaine; Lung Diseases; Mercaptoethanol; Mesna; Postoperative Complications; Thoracic Injuries

Topics: Acetylcysteine; Adolescent; Adult; Aged; Bronchoscopy; Evaluation Studies as Topic; Expectorants; Furagin; Humans; Lung Diseases; Mesna; Middle Aged; Sodium Chloride; Therapeutic Irrigation

Mistabron is the trade-name of a new mucolytic agent, that has certain advantages over older mucolytic agents. This drug has been used to a great extent in patients with tracheobronchial secretions in the department of intensive care medicine. Its application makes expectoration easier while its preventive administration diminishes greatly the incidence of lung complications.

Topics: Humans; Intensive Care Units; Lung Diseases; Mercaptoethanol; Mesna