title: [Adverse systemic reactions in intensive care medicine after isolated limb perfusion with melphalan and hyperthermia: case report].
abstract: OBJECTIVE
  The presence of adverse reactions, inherent to all treatments, justifies the necessity of deep knowledge, by the medical team of the prevention and treatment of occasional organic dysfunctions, reducing its impact. The purpose of this paper is to report a case comprising the several systemic adverse reactions after perfusion of limb with melphalan and hyperthermia.
  
  
  METHODS
  A white female, 64-years old patient with diagnosis of melanoma in the medial malleoli region of the left lower limb. Six months after surgical removal of wound, an isolated perfusion of limb was carried out with melphalan and hyperthermia in order to curb the possible metastatic process in evolution. At admission in the ICU, the patient presented systemic inflammatory response syndrome (SIRS) with refractary hemodynamic instability to volemic expansion. During internation the patient evolved to acute lung edema and myocardial dysfunction, all reverted successfully.
  
  
  CONCLUSIONS
  The potential presence of adverse reactions, inherent to all treatments, justify the necessity of knowledge by the intensive care team in the prevention and treatment of occasional organic dysfunctions, reducing the impact of morbidity and mortality.
authors.affiliation: EPM, UNIFESP.
authors.forename: Fernando Oetterer
authors.initials: FO
authors.lastname: Arruda
authors.affiliation: UTI, EPM, UNIFESP.
authors.forename: Hélio Penna
authors.initials: HP
authors.lastname: Guimarães
authors.affiliation: EPM, UNIFESP.
authors.forename: Luiz Fernando Dos Reis
authors.initials: LF
authors.lastname: Falcão
authors.affiliation: EPM, UNIFESP.
authors.forename: Patrícia Helena Rocha
authors.initials: PH
authors.lastname: Leal
authors.affiliation: UTI, EPM, UNIFESP.
authors.forename: Renato Delascio
authors.initials: RD
authors.lastname: Lopes
authors.affiliation: EPM, UNIFESP.
authors.forename: Ivan Dunshee de Abranches Oliveira
authors.initials: ID
authors.lastname: Santos
authors.affiliation: EPM, UNIFESP.
authors.forename: José Luiz Gomes do
authors.initials: JL
authors.lastname: Amaral