ABSTRACT
We report our experience concerning bronchoalveolar lavage (BAL) in adult patients affected by haematological malignancies. BAL was performed in patients with documented pulmonary diseases not responding to empirical antibiotic and antifungal therapies. Overall, 25 bronchoscopies were performed in 24 patients. This technique led to pathogen identification in 11 out of 24 patients (45 percent). In particular, we identified four cases of tuberculosis, four of aspergillosis, two of pneumocystosis, two bacterial pneumonia and one pneumonia sustained by CMV (in two cases, pneumonia was polymicrobial). In three cases, where microbiological diagnosis had been obtained by means of other exams (blood culture, urinary antigens), BAL negativity allowed us to exclude alternative diagnoses. Pulmonary location of haematological disease was diagnosed in seven patients. BAL drove a switch therapy in 54 percent of patients. When performed by expert operators, BAL is useful and safe also in frail patients, such as those affected by onco-haematological malignancies.
Subject(s)
Bronchoalveolar Lavage , Bronchoscopy , Hematologic Neoplasms/complications , Hematologic Neoplasms/diagnosis , Immunocompromised Host , Pneumonia/diagnosis , Pneumonia/microbiology , Adult , Aged , Aged, 80 and over , Bronchoalveolar Lavage/methods , Bronchoalveolar Lavage Fluid/microbiology , Bronchoalveolar Lavage Fluid/virology , Bronchoscopy/methods , Cytomegalovirus Infections/diagnosis , Female , Humans , Male , Middle Aged , Pneumonia/virology , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/microbiology , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/microbiology , Pulmonary Aspergillosis/diagnosis , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Tuberculosis, Pulmonary/diagnosisABSTRACT
We describe the case of a 36 old woman with a right massive hydrothorax resulting from Controlled Ovarian Hyperstimulation (COH) for infertility. This complication is defined as Ovarian Hyperstimulation Syndrome (OHSS) which usually includes abdominal pain, nausea and ascites, rarely involving the respiratory apparatus. The usual determining factors of OHSS are the presence of high serum estradiol levels and pregnancy. In the case that we describe the serum estradiol levels during COH were monitored and were slightly higher than the COH alarm threshold and the patient was not pregnant.
Subject(s)
Hydrothorax/etiology , Ovarian Hyperstimulation Syndrome/diagnosis , Adult , Estradiol/blood , Female , Humans , Ovarian Hyperstimulation Syndrome/classification , Ovarian Hyperstimulation Syndrome/complicationsABSTRACT
16 patients with advanced small cell lung cancer were treated with a combination of cyclophosphamide (1000 mg/m2 day 1), epidoxorubicin (60 mg/m2 day 1) and vincristine (1.4 mg/m2 day 1) every 14 days for six cycles followed by a combination of cisplatin (40 mg/m2 days 1 & 2) and etoposide (100 mg/m2 days 1-3) every 14 days for four cycles. Shortening of intervals was obtained with the prophylactic employment of granulocyte colony-stimulating factor (filgrastim, 300 mcg subcutaneously from day 5 to dsy 10). In 11 patients ratio between actually delivered dose intensity and planned dose intensity of > 80% was obtained. Toxicity was acceptable and no life-threatening toxicities were observed. An objective response (partial or complete) was observed in 11 patients. The new regimen, incorporating the concepts of dose-intensification and sequential administration of regimens, is feasible and may be considered for further studies.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Small Cell/drug therapy , Granulocyte Colony-Stimulating Factor/therapeutic use , Lung Neoplasms/drug therapy , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carcinoma, Small Cell/pathology , Cisplatin/administration & dosage , Cyclophosphamide/administration & dosage , Drug Administration Schedule , Epirubicin/administration & dosage , Etoposide/administration & dosage , Female , Filgrastim , Hemoglobins/analysis , Humans , Leukocyte Count , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Metastasis , Platelet Count , Recombinant Proteins , Vincristine/administration & dosageABSTRACT
Twenty-nine patients with advanced non-small-cell lung cancer (NSCLC) were treated with a combination of cisplatin 20 mg/m2 days 1-3, ifosfamide 1500 mg/m2 days 1-2 (plus mesna as uroprotector) and vinorelbine 25 mg/m2 days 1 and 5; filgrastim was given at the dose of 300 microg subcutaneously from day 8 to day 15. A response rate of 28% was observed. The activity of this combination in an outpatient setting, with acceptable toxicity, has been demonstrated.
