mesna and Postoperative-Complications

To date, surgical dissection is based only on mechanical forces. The use of a chemical product that is able to ease tissue dissection represents an important advance. MESNA (sodium-2-mercaptoethanesulfonate) has recently been validated for chemically assisted tissue dissection during surgery or invasive procedures. No other drugs are available for this.. An extensive literature search was conducted that included published articles and abstracts on the use of MESNA during surgery or invasive procedures in the experimental and clinical setting, since 1997. Clinically validated settings are ear, nose and throat (ENT), gynecological and orthopedic fields.. A state-of-the-art overview of intraoperative applications of MESNA, and a consideration of the possible mechanisms underlying chemically assisted tissue dissection.. MESNA has been successfully used to ease abdominal myomectomies and excision of endometrial cysts; in ENT surgery, topical MESNA could be widely used, from ear and skull base to head and neck diseases, in both outpatient and operating-room settings. In revision lumbar spine surgery, its use resulted in significantly easier surgery and reduction of postoperative complications. Given the high efficacy and favorable complications rate, future applications in the surgical field are expected to increase.

Topics: Animals; Dissection; Humans; Mesna; Postoperative Complications; Protective Agents; Surgical Procedures, Operative

Haemorrhagic cystitis (HC) is an uncommon but potentially devastating complication of chemotherapy and bone marrow transplantation in children. We aimed to test the hypothesis that early recognition, sodium pentosan polysulfate (SPP), and avoidance of urethral catheterisation improve outcomes in children with HC.. A retrospective case note review was performed of all patients treated for HC in our hospital from 2002 to 2010. A protocol for the management of HC was introduced in 2007 advocating early detection, use of SPP, and avoidance of urethral catheterisation. Data collected on each patient included primary condition, medications at onset, blood transfusions, duration of symptoms, catheter usage, and outcome. Statistical analysis was performed using the Mann-Whitney U test, and Fisher's Exact test as appropriate, P < .05 being significant.. Five patients were treated using protocol with 5 historical controls. There was no significant difference between the ages of the group, diagnosis, and treatment at onset of HC. In the historical group, 4 of 5 died with HC, but all recovered in the protocol group (P < .05). Blood transfusion requirements were also significantly reduced after protocol introduction (P < .05).. Early identification, avoidance of urethral catheterisation, and use of SPP significantly reduces blood transfusion requirements and mortality from HC.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; BK Virus; Child; Combined Modality Therapy; Cyclophosphamide; Cystitis; Fanconi Anemia; Female; Hematopoietic Stem Cell Transplantation; Hematuria; Herpesviridae Infections; Humans; Immunocompromised Host; Leukemia; Male; Mesna; Pentosan Sulfuric Polyester; Polyomavirus Infections; Postoperative Complications; Prospective Studies; Ultrasonography; Urinary Catheterization

Topics: Bone Marrow Transplantation; Cyclophosphamide; Cystitis; Hemorrhage; Humans; Mesna; Postoperative Complications; Protective Agents

A prospective randomised study was carried out to compare the effect of mesna (2-mercaptoethane sulphonate sodium) with that of forced diuresis in preventing cyclophosphamide induced haemorrhagic cystitis in marrow transplant recipients. Sixty-one consecutive BMT recipients were randomised for treatment with forced diuresis or mesna. The incidence of macroscopic haematuria was significantly lower in the mesna treated group (chi 2 = 4.03, P less than 0.05). No specific side effects of mesna were detected. The lymphopenia induced by cyclophosphamide in the aplastic recipients was similar in the mesna and forced diuresis groups suggesting that mesna has no effect on the lymphocytotoxic activity of cyclophosphamide, although 6 out of 7 episodes of graft failure documented in the study occurred in mesna treated patients. As a result of this study our present policy is to use mesna in all BMT recipients but to continue careful documentation of the incidence of graft failure.

Topics: Adolescent; Adult; Bone Marrow Transplantation; Child; Child, Preschool; Colony-Forming Units Assay; Cyclophosphamide; Cystitis; Diuresis; Graft Rejection; Hematuria; Hemorrhage; Humans; Leukocyte Count; Mercaptoethanol; Mesna; Postoperative Complications; Prospective Studies

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

Conservative surgery for soft-tissue sarcoma (STS) within multimodality treatment attempts to reconcile two contradictory requirements: assuring a good oncological outcome through a wide resection and preserving the function. The aim of our study is to verify whether our conservative approach to STS met these objectives.. A retrospective database analysis was performed in adults with primary limb or trunk wall STS operated in a single center from 1989 to 2012. Predictive factors for postoperative complications and functional impairment were tested in a multivariate analysis.. 728 patients were operated (resection R0: 68%). Neoadjuvant chemotherapy (NAC) was given to 28%, postoperative radiotherapy to 70% of patients. Median follow-up was 103 months. At five years, overall survival was 80% and local recurrences 11%. Major postoperative complications occurred in 8% and functional impairment in 13% of the patients. Independent predictive factors for postoperative complications were American Society of Anesthesiologist classes 2 and 3 (OR: 2.3, CI: 1.2-4.5 and 4.0 CI: 1.7-9.3), tumor size >80 mm (OR: 2.5, CI: 1.3-4.9), tumor site (trunk wall/lower limb, OR: 4.1, CI: 1.3-13.6) and multifocal/multicompartmental spread (OR: 2, CI: 1.1-3.6). Independent predictive factors for function impairment were postoperative complications (OR: 5.3, CI: 2.8-10.1), NAC (OR: 3.6, CI: 2.2-5.8), and bone or neurovascular involvement (OR 3.3, CI 2.0-5.3), whereas Early Rehabilitation after Surgery (ERAS) improved outcome (OR: 0.5, CI: 0.3-0.9).. Postoperative complications induced functional impairment. They may be reduced by acting on comorbidity factors and careful tumor evaluation prior to surgery. Furthermore, ERAS measures improved function.

Topics: Abdominal Wall; Activities of Daily Living; Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Cancer, Regional Perfusion; Combined Modality Therapy; Dacarbazine; Doxorubicin; Extremities; Female; Follow-Up Studies; Humans; Ifosfamide; Male; Mesna; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Postoperative Complications; Radiotherapy, Adjuvant; Retrospective Studies; Risk Factors; Sarcoma; Soft Tissue Neoplasms; Survival Rate; Thoracic Wall; Torso; Tumor Burden; Young Adult

We report a novel regimen for refractory post-transplant T-cell lymphoma (PTL). Our patient presented with non-Epstein-Barr virus (EBV) related, T-cell post-transplant lymphoproliferative disease (PTLD) 3.5 years after liver transplantation. Initially diagnosed as polyclonal PTLD, the disease progressed to a monoclonal, T-cell PTL that was refractory to several chemotherapy regimens but responded to a regimen consisting of fludarabine, cyclophosphamide, cytarabine, and alemtuzumab. Consolidation therapy included high-dose chemotherapy, autologous hematopoietic stem cell rescue, and radiation therapy. She remains in remission 2.5 years later. T-cell PTL is a rare disease with a poor prognosis; this regimen provides a novel, potentially curative approach for its treatment.

Topics: Alemtuzumab; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm; Antineoplastic Combined Chemotherapy Protocols; Biliary Atresia; Carboplatin; Carmustine; Cyclophosphamide; Cytarabine; Disease Progression; Doxorubicin; Etoposide; Female; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Transplantation; Humans; Ifosfamide; Immunocompromised Host; Immunosuppressive Agents; Liver Transplantation; Lymphoma, T-Cell, Peripheral; Lymphoproliferative Disorders; Melphalan; Mesna; Postoperative Complications; Prednisone; Radiotherapy, Adjuvant; Transplantation, Autologous; Vidarabine; Vincristine

Topics: Anemia, Aplastic; Bone Marrow Transplantation; Cyclophosphamide; Cystitis; Fluid Therapy; Furosemide; Hemorrhage; Humans; Leukemia; Mercaptoethanol; Mesna; Postoperative Complications