RESUMEN
Intraventricular drug administration via the IR is often used in the therapy of leukemic and carcinomatous meningitis. We reviewed our 10-year experience with 32 patients, with IR placed for intraventricular chemotherapy to characterize infectious complications associated with IR. Infectious complications occurred in 9 patients (27.1%). Local cellulitis (S. aureus) occurred at the site of IR in 2 patients. Seven patients (21.8%) had 12 episodes of bacteriologically proven or clinically suspected meningitis, or positive IR CSF cultures without symptoms (4-P. acnes). While patients with local infection may require IR removal, more than half of those with meningitis may be treated with antibiotics alone without IR removal. Patients with positive cultures in the absence of symptoms may require no therapy at all.
Asunto(s)
Infecciones Bacterianas/etiología , Inyecciones Intraventriculares/efectos adversos , Meningitis Bacterianas/etiología , Neoplasias/tratamiento farmacológico , Infecciones Estafilocócicas/etiología , Adolescente , Adulto , Celulitis (Flemón)/etiología , Niño , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
A patient seeking dental care was diagnosed with acute myelomonocytic leukemia and referred to a hematologic-oncologic service for confirmation and treatment. The typical oral findings and a discussion of the disease process of acute leukemia are presented.
Asunto(s)
Hiperplasia Gingival/etiología , Leucemia Mielomonocítica Aguda/complicaciones , Adulto , Femenino , Hiperplasia Gingival/patología , Humanos , Leucemia Mielomonocítica Aguda/patologíaRESUMEN
Drug administration via an intraventricular reservoir is useful in the treatment of leukemic and carcinomatous meningitis that occurs in patients who have previously received lumbar intrathecal chemotherapy. The intraventricular route, however, is associated with a higher incidence of infectious complications compared with therapy given by the lumbar route. To characterize the infectious complications associated with such reservoirs, we reviewed the 10-year experience of the Pediatric Branch, National Cancer Institute, National Institutes of Health, and Children's Orthopedic Hospital, Seattle, WA, with 61 patients (49 with leukemia, 8 with lymphoma, 4 with solid tumors) who had intraventricular reservoirs placed for administration of chemotherapy. The reservoirs were in place for a median of 36 weeks and were punctured a median of 29.5 times, Infectious complications occurred in 14 of 61 patients (23%) and Propionibacterium acnes was the most common organism recovered from cultures. Twelve patients (19.7%) had 19 episodes of clinically suspected and microbiologically documented meningitis or of positive intraventricular reservoir cerebrospinal fluid cultures without symptoms which were treated successfully. Local cellulitis occurred at the site of intraventricular reservoir placement in 2 patients (3.3%) and removal of the intraventricular reservoir was necessary for successful management. Nine patients had their intraventricular reservoir removed (5 because of associated infection and 4 because of malfunction unassociated with infection).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Infecciones Bacterianas/etiología , Inyecciones Intraventriculares/efectos adversos , Meningitis/tratamiento farmacológico , Neoplasias/complicaciones , Adolescente , Adulto , Antibacterianos/administración & dosificación , Bacterias/aislamiento & purificación , Celulitis (Flemón)/etiología , Niño , Preescolar , Femenino , Humanos , Lactante , Leucemia/complicaciones , Linfoma/complicaciones , Masculino , Meningitis/etiologíaRESUMEN
To assess the efficacy of single-agent therapy relative to standard combination antibiotic therapy for the initial management of fever and neutropenia in cancer patients, we conducted a randomized trial comparing ceftazidime alone with a combination of cephalothin, gentamicin, and carbenicillin. Of 550 evaluable episodes of fever and neutropenia, 282 were treated with ceftazidime alone and 268 with the combination. All episodes were evaluated for responses at 72 hours after the start of treatment and at resolution of the neutropenia. Of the patients with unexplained fever who were given ceftazidime alone, 99 percent were alive at 72 hours and 98 percent were alive when the neutropenia resolved, as compared with 100 percent and 98 percent, respectively, of those given combination therapy. Of the patients with documented infection who were given ceftazidime alone, 98 percent were alive at 72 hours and 89 percent when the neutropenia resolved, as compared with 98 percent and 91 percent, respectively, of those given combination therapy. The majority of episodes of documented infection in both treatment groups necessitated additional antimicrobial treatment or other modifications of the initial regimen, as compared with only 22 percent of the episodes of unexplained fever. We conclude that initial single-agent therapy with certain beta-lactam antibiotics is a safe alternative to standard combination antibiotic therapy, although patients with documented infection or protracted neutropenia are likely to require additional or modified treatment.
Asunto(s)
Agranulocitosis/complicaciones , Antibacterianos/administración & dosificación , Infecciones Bacterianas/prevención & control , Ceftazidima/uso terapéutico , Fiebre/tratamiento farmacológico , Neoplasias/complicaciones , Neutropenia/complicaciones , Adolescente , Adulto , Anciano , Antibacterianos/efectos adversos , Carbenicilina/administración & dosificación , Ceftazidima/administración & dosificación , Ceftazidima/efectos adversos , Cefalotina/administración & dosificación , Niño , Preescolar , Ensayos Clínicos como Asunto , Esquema de Medicación , Quimioterapia Combinada , Femenino , Fiebre de Origen Desconocido/tratamiento farmacológico , Gentamicinas/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Distribución Aleatoria , Recurrencia , Sepsis/prevención & controlRESUMEN
Of the first 14 patients with acute or chronic leukemia to undergo bone marrow transplantation at our hospital, 9 (64%), all good-risk, are still alive in remission at 18 to 42 months of follow-up (mean, 29 months) with their Karnofsky performance status between 80% and 100%. The conditioning regimen of fractionated-dose irradiation and high-dose chemotherapy eradicated their disease; only two patients relapsed after transplantation. Toxicity was acceptable. Acute graft-versus-host disease developed in six patients (43%) (grade I or II in four, grade IV in two) and progressed to chronic graft-versus-host disease in four. Viral pneumonitis developed in three patients (21%), but none had idiopathic interstitial pneumonitis. The mean hospital charge was $54,355. These preliminary results suggest that good-risk patients with acute or chronic leukemia can be treated with bone marrow transplantation in a university affiliated hospital with appropriate staff and support facilities and achieve results comparable to those in research institutions at a competitive cost.
Asunto(s)
Trasplante de Médula Ósea , Leucemia/terapia , Adolescente , Adulto , Niño , Terapia Combinada , Femenino , Enfermedad Injerto contra Huésped/prevención & control , Hospitales Universitarios , Humanos , Leucemia/mortalidad , Leucemia Linfoide/mortalidad , Leucemia Linfoide/terapia , Leucemia Mieloide/mortalidad , Leucemia Mieloide/terapia , Leucemia Mieloide Aguda/mortalidad , Leucemia Mieloide Aguda/terapia , Masculino , RiesgoAsunto(s)
Micosis/patología , Anfotericina B/uso terapéutico , Trasplante de Médula Ósea , Niño , Fusarium/aislamiento & purificación , Humanos , Tolerancia Inmunológica , Cetoconazol/uso terapéutico , Leucemia Linfoide/complicaciones , Leucemia Linfoide/inmunología , Masculino , Micosis/tratamiento farmacológico , Micosis/etiologíaRESUMEN
Thrombocytopenia in patients with multiple myeloma is usually due to chemotherapy or marrow replacement with myeloma cells. Two patients with multiple myeloma who fulfilled criteria for the diagnosis of immune thrombocytopenic purpura are presented. The etiologic and therapeutic implications of this unusual association are discussed.
Asunto(s)
Mieloma Múltiple/complicaciones , Púrpura Trombocitopénica/etiología , Anciano , Plaquetas/inmunología , Femenino , Humanos , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Mieloma Múltiple/inmunología , Púrpura Trombocitopénica/inmunologíaRESUMEN
During a 5 1/2-year period, 34 of 829 episodes of granulocytopenia during which broad spectrum antibiotics were being administered for fever and/or infections were complicated by the development of new pulmonary infiltrates. In 12 patients the infiltrates were due to fungal pneumonia, while in 6 patients the infiltrates were due to a variety of other causes. In the remaining 16 cases the etiology of the infiltrates was not determined. Time to development of infiltrate, radiographic appearance of the infiltrate, patient temperature and absolute granulocyte count failed to predict the etiology of the infiltrate. Conversely, development of the infiltrate or its radiographic progression in the absence of bone marrow recovery correlated significantly with the diagnosis of fungal pneumonia. While empiric alterations of antibiotics at the time that the infiltrate appeared were not associated with improved survival, the early use of amphotericin B was associated with a significant decrease in fatal fungal pneumonia. We suggest that the diagnostic and therapeutic approach to the febrile, granulocytopenic patient who develops a new pulmonary infiltrate while receiving broad spectrum antibiotic therapy may be guided by the state of marrow recovery at the time of infiltrate appearance. Patients developing an infiltrate coincident with granulocyte recovery may be managed conservatively while patients whose infiltrate develops or progresses in the absence of granulocyte recovery should be considered to be at high risk for fungal pneumonia and if possible undergo a diagnostic lung biopsy and/or empiric antifungal therapy.
Asunto(s)
Agranulocitosis/complicaciones , Antibacterianos/uso terapéutico , Enfermedades Pulmonares Fúngicas/etiología , Neoplasias/complicaciones , Neumonía/etiología , Adolescente , Adulto , Anfotericina B/uso terapéutico , Carbenicilina/uso terapéutico , Cefalotina/uso terapéutico , Niño , Preescolar , Combinación de Medicamentos/uso terapéutico , Eritromicina/uso terapéutico , Femenino , Flucitosina/uso terapéutico , Gentamicinas/uso terapéutico , Humanos , Terapia de Inmunosupresión , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Masculino , Neumonía/diagnóstico , Neumonía/tratamiento farmacológico , Estudios Retrospectivos , Riesgo , Sulfametoxazol/uso terapéutico , Trimetoprim/uso terapéutico , Combinación Trimetoprim y SulfametoxazolRESUMEN
The principles for management of infectious complications in cancer patients are continuing to evolve. The critical element includes the prompt institution of broad-spectrum antibiotic(s) empirically when granulocytopenic patients become febrile and continuation and modification of the regimen in patients with persistent fever and granulocytopenia. The view is presented that antibiotics provide systemic prophylaxis as well as therapy in persistently granulocytopenic patients and that they should be continued until all signs of infection have cleared or the granulocyte count has recovered. Such aggressive therapy, supplemented by continued evaluation and monitoring of the patient, can significantly reduce infection-relation morbidity and mortality.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Neoplasias/complicaciones , Agranulocitosis/tratamiento farmacológico , Agranulocitosis/inmunología , Anticuerpos Antibacterianos , Formación de Anticuerpos , Infecciones Bacterianas/etiología , Ceftazidima , Cefalosporinas/uso terapéutico , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Sinergismo Farmacológico , Fiebre de Origen Desconocido/tratamiento farmacológico , Cuerpos Extraños/complicaciones , Humanos , Micosis/prevención & control , Penicilinas/uso terapéutico , Infecciones del Sistema Respiratorio/terapia , RiesgoAsunto(s)
Agranulocitosis/complicaciones , Antifúngicos/uso terapéutico , Micosis/complicaciones , Neoplasias/complicaciones , Anfotericina B/uso terapéutico , Carbenicilina/uso terapéutico , Cefalotina/uso terapéutico , Quimioterapia Combinada , Gentamicinas/uso terapéutico , Humanos , Terapia de Inmunosupresión/efectos adversos , Infecciones/complicaciones , Micosis/tratamiento farmacológicoAsunto(s)
Fiebre/etiología , Neoplasias/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Factores de Edad , Agranulocitosis/complicaciones , Agranulocitosis/microbiología , Antineoplásicos/uso terapéutico , Infecciones Bacterianas/complicaciones , Niño , Preescolar , Femenino , Fiebre de Origen Desconocido/etiología , Humanos , Lactante , Leucemia/tratamiento farmacológico , Linfoma/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Neoplasias/microbiología , Neoplasias/terapia , Estudios ProspectivosRESUMEN
During treatment with VM-26 a 20-year-old patient with metastatic medulloblastoma developed an acute, fulminating pulmonary illness. Open lung biopsy revealed advanced alveolar hyaline membrane formation with interstitial round cell infiltrate. This is the first reported case of podophyllotoxin-related pulmonary disease.
Asunto(s)
Podofilotoxina/análogos & derivados , Síndrome de Dificultad Respiratoria/inducido químicamente , Tenipósido/efectos adversos , Adulto , Neoplasias Encefálicas/tratamiento farmacológico , Carmustina/efectos adversos , Humanos , Masculino , Meduloblastoma/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/patologíaRESUMEN
Mixed connective tissue disease (MCTD) has been characterized as a benign rheumatic syndrome with a favorable response to immunosuppressive therapy. Serious renal and pulmonary involvement are reported to be rare in MCTD. We are describing a female adolescent with MCTD in whom fatal cor pulmonale developed due to recurrent thromboembolic primary pulmonary hypertension. Death occurred after two years of therapy with prednisone and azathioprine for an immune-complex glomerulonephritis. Paramesangial and intramembranous electron-dense deposits had been identified in several glomeruli at the start of treatment. Improved renal function and apparent histologic improvement were demonstrated four months after the institution of prednisone and azathioprine therapy, and stable renal function was maintained until death. The pulmonary hypertension was progressive and apparently not altered by either the prednisone or azathioprine. At necropsy, there was no evidence of a pulmonary arteritis or vascular immune-complex deposition to account for the recurrent thromboembolic lesions in the small pulmonary arteries and arterioles. This is a clinical course not previously described in patients with MCTD and may represent an extreme of the clinical spectrum of this syndrome.