PubMed · 5588546
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H Unger. 1967. [Amputation and artificial limbs].. https://pubmed.ncbi.nlm.nih.gov/5588546/
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BACKGROUND: After excision of primary tumors, initiation of chemotherapy for micrometastases is often delayed for 2 to 4 weeks to permit patient recovery and early healing of the surgical wound. However, studies using murine tumors have indicated that removal of a primary tumor may cause increased cell proliferation within micrometastases during the first 7 to 10 days after surgery, potentially rendering the micrometastases more susceptible to chemotherapy. Clinical trials assessing the value of early postoperative initiation of chemotherapy for human breast carcinoma have yielded conflicting results. Osteosarcoma of dogs is a naturally occurring model for human tumors likely to have micrometastases at the time of diagnosis. METHODS: Before surgery, 102 dogs with osteosarcoma were randomized to receive cisplatin and doxorubicin chemotherapy beginning either 2 days or 10 days after amputation. Survival analysis was performed for each treatment group and for a historic control group comprised of 162 dogs treated by amputation alone. RESULTS: Median survival times for dogs treated by amputation alone and for dogs receiving chemotherapy beginning 2 or 10 days after surgery were 5.5, 11.5, and 11.0 months, respectively. Survival was significantly longer for each of the two groups of dogs receiving chemotherapy than for control dogs (P < 0.0001). There was no significant difference in survival between treatment groups (P = 0.727). CONCLUSIONS: These results do not disprove the theory that removal of a primary tumor alters the growth kinetics of metastases, but do imply that there is no substantial advantage to early postoperative initiation of adjuvant chemotherapy for spontaneous tumors of large species.
Chronic arterial insufficiency of the lower limbs is characterized by intermittent claudication often localized to the calf. These early clinical symptoms are the results of the atherosclerotic process of the vasculature of the lower extremities. The treatment is aimed at reducing or eliminating the ischemic pain and at preventing progression of the atherosclerotic disease. Whether surgical or nonsurgical measures are used, the cornerstone of patient care lies in correction of the risk factors. Smoking cessation and exercise therapy remain the fundamental measures in medical treatment of intermittent claudication. percutaneous transluminal angioplasty is an appropriate therapeutic option under certain criteria, especially for the iliac arteries. In the absence of randomized studies, surgery remains the treatment of choice for peripheral revascularization in presence of limb-threatening ischemia or ischemic ulcers. New procedures and materials are presently under trial to test the safety and efficacy of alternative methods or revascularization that would provide better long-term patency rates and shorter hospitalization periods.
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