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By Z. Sven. State University of New York College at New Paltz. 2017.

Most of the drugs used in cancer treatment have a thera- peutic index that approaches unity order tetracycline 500 mg with amex, exerting toxic effects on both normal and tumor tissues even at optimal CANCER THERAPY AND THE IMMUNE dosages buy 500 mg tetracycline otc. Rapidly pro- Although manipulation of the host immune response in liferating normal tissues, such as bone marrow, gastroin- animal tumor models has at times yielded impressive testinal tract, and hair follicles, are the major sites of therapeutic results, attempts to extend these results to acute toxicity of these agents. The most commonly Several proteins that stimulate subsets of lympho- encountered toxicities of antineoplastic agents are de- cytes involved in various aspects of the immune re- scribed in the following section; more detailed informa- sponse are now produced by recombinant DNA tech- tion on individual agents is presented in Chapter 56. Bone Marrow Toxicity Interleukin (IL) 2, originally described as a T-cell growth factor, induces the production of cytotoxic lym- Chemotherapy may result in the destruction of actively phocytes (lymphokine-activated killer cells, or LAK proliferating hematopoietic precursor cells. IL-2 produces remissions in 10 to 20% of patients blood cell and platelet counts may in turn be decreased, with melanoma or renal cell carcinoma when infused at resulting in an increased incidence of life-threatening high doses either alone or with lymphocytes that were infections and hemorrhage. Maximum toxicity usually is previously harvested from the patient and incubated observed 10 to 14 days after initiation of drug treat- with IL-2 in vitro. In contrast, the ni- The ability of certain anticancer agents to suppress trosourea drugs exhibit hematological toxicity that is both humoral and cellular immunity has been exploited delayed until 4 to 6 weeks after beginning treatment. In particular, the alkylating agents cy- clophosphamide and chlorambucil have been used in toxicity or hypoplastic state may develop after long-term this context, as have several of the antimetabolites, in- treatment with nitrosoureas, other alkylating agents, and cluding methotrexate, mercaptopurine, azathioprine, mitomycin C. Thus, patients frequently will require a pro- gressive reduction in the dosages of myelosuppressive drugs when they are undergoing long-term therapy, since such treatment may result in chronic pancytopenia. These symptoms are ameliorated by treatment with phenothiazines and other centrally acting Detoxification Tubulins antiemetics. Although this symptom is distressing to patients, it is rarely severe enough to re- quire cessation of therapy. Continuous in- Damage to the normally proliferating mucosa of the fusion or frequent administration of cytarabine hy- gastrointestinal tract may produce stomatitis, dyspha- drochloride is superior to intermittent injection of the gia, and diarrhea several days after treatment. Bleomycin is another drug for which continuous cerations, esophagitis, and proctitis may cause pain and infusion may increase therapeutic efficacy.

The design of PICC catheters can vary buy generic tetracycline 500mg, and the operator should be famil- iar with the features of the device (attached hub or detachable hub designs) 500mg tetracycline with mastercard. Position the pa- tient in a sitting or reclining position with the elbow extended and the arm in a depen- dent position. Most PICC lines have an attached hub, and the distal end of the catheter is cut to the proper length. Insert the catheter and introducer needle (usually 14-gauge) into the chosen arm vein as detailed in the section on IV techniques (page 279). Place the PICC line in the catheter and advance (use a forceps if provided by the manu- facturer of the kit to advance the PICC line). Remove the inner stiffening wire slowly once the catheter has been adequately advanced. Always document the type of PICC, the length inserted, and the site of its radiologically confirmed place- ment. If vein cannulation is difficult, a surgical cutdown may be necessary to cannulate the vein. Patient must be instructed to evaluate the PICC site for signs and symptoms of infection. Patient must also be instructed to come to the emer- gency room for evaluation of any fevers. For venous samples, a specimen of at least the catheter volume (1–3 mL) must first be withdrawn and then discarded. Always measure the length of the catheter and check prior documentation to ensure that the PICC line has been removed in its 13 Bedside Procedures 295 entirety. If a piece of a catheter is left behind, an emergency interventional radiology consult is in order. Complications Site bleeding, clotted catheter, subclavian thrombosis, infection, broken catheter (leakage or embolization), arrhythmia (catheter inserted too far) PERITONEAL LAVAGE Indications • Diagnostic peritoneal lavage (DPL) is used in the evaluation of intraabdominal trauma (bleeding, perforation) (Note: Spiral CT of the abdomen has largely replaced this as an initial screening for intraabdominal trauma in the emergency setting. Relative contraindications include multiple abdominal proce- dures, pregnancy, known retroperitoneal injury (high false-positive rates) cirrhosis, morbid obesity and any coagulopathy. Materials • Prepackaged diagnostic peritoneal lavage or peritoneal dialysis tray Procedure 1.

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Bile acid is produced during the breakdown of cho- peroxisomes to be able to bring newly created peroxiso- lesterol order tetracycline 500mg mastercard. Babies with Zellweger syndrome have severe devel- The peroxisome membranes may be present cheap 500mg tetracycline amex, but are opmental retardation and impairment of their central empty, like the wood frame of an empty house. They lack muscle tone (hypotonia), and empty peroxisomes have been called peroxisome are often blind or deaf. They will frequently have jaundice in the new- born period that is more serious and lasts longer than usual. Jaundice is a yellow discoloration of the skin and The frequency of this condition is estimated to be 1 eyes caused by too much bilirubin in the blood. There is no reported difference in the inci- a symptom of many disorders including liver disease. The characteristic facial features of Zellweger syn- drome include: Zellweger syndrome is an autosomal recessive con- dition. This means that in order to have the condition, an • high forehead individual needs to inherit one copy of the for • widely spaced eyes (hypertelorism) Zellweger syndrome from each parent. An individual • low, broad, or flat nasal bridge who has only one copy of the gene is called a carrier for the condition and does not have any signs or symptoms • “full” cheeks of the condition. When two parents are carriers for • small chin (micrognathia) Zellweger syndrome, they have a 25% chance, with each • forward tilting (anteverted) nostrils pregnancy, for having an affected child. They have a 50% chance for having a child who is a carrier for the condi- • vertical fold of skin over the inner corner of the eye tion and a 25% chance for having a child who is neither (epicanthal fold) affected nor a carrier for Zellweger syndrome. There are many gene mutations that have been identified that Other characteristics include, but are not limited to: are involved with the creation of functioning peroxi- • breech presentation at birth (feet first) somes.

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