Abstract. Mucosal leishmaniasis is characterized by an intense inflammatory reaction and tissue damage with few parasites in the lesion. On the basis of previous observations that suggest a possible role of tumor necrosis factor alpha (TNF-␣) in the pathology of this disease, an open-label study was performed to evaluate the efficacy of the treatment with an inhibitor of TNF-␣ (pentoxifylline) associated to antimony therapy in 10 patients with refractory mucosal leishmaniasis. Patients were treated with pentavalent antimony (20 mg per kilogram of body weight per day) plus orally administered pentoxifylline 400 mg 3 times daily for 30 days. Nine of 10 patients fulfilled the criteria for cure: they experienced complete reepithelization of the mucosal tissue 90 days after therapy and displayed no evidence of relapse at 1 year of follow-up. The TNF-␣ levels before therapy (776 Ϯ 342 pg/mL) fell to 94 Ϯ 57 pg/mL (P Ͻ 0.05) within 60 days after therapy. Our results indicate that pentoxifylline plus antimony therapy should be considered in all patients with mucosal leishmaniasis that is refractory to treatment.
Sir I read the paper by McDermott, Hughes et al. (Br J Surg 1985; 72: 3 4 7 ) with great interest. I would like to comment on their finding that local recurrence was not as common as evidence of systemic metastases.It has previously been reported' that local recurrence is found with much greater frequency when patients are assessed by necropsy than when they are assessed on purely clinical grounds. The reason for this is that locally recurrent tumour is most often sited outside the bowel lumen and may not become symptomatic until late in its progression. It is difficult to diagnose in life except by CT scanning unless it causes intestinal obstruction. Liver metastases present a different picture. Sensitive biochemical and scanning techniques are available which will detect secondaries in the liver long before they are symptomatic. The result of this discrepancy is that series which are based primarily on clinical observation show a high incidence of hepatic metastases and a low incidence of local recurrence. Series based on necropsy studies show a much higher incidence of local recurrence.I thmk that this offers an explanation for theauthor's statement that 'The finding that local recurrence was not the principal cause of death from recurrent rectal cancer is at variance with several previous reports'.
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