Low-dose vincristine-associated bilateral vocal cord paralysis.

BACKGROUND: Vincristine-associated peripheral neuropathy is a well-described entity. We describe a case of vincristine-induced vocal cord paralysis, which is a rare complication of this drug. We report herein the second case of bilateral vocal cord paralysis in a patient receiving conventional doses of vincristine. OBJECTIVE: To present a case report of vincristine-associated vocal cord paralysis and to review the relevant English language literature on this subject. DESIGN: Report and review of the literature. SETTING: Outpatient community cancer center. PATIENT: A 58-year-old female with a diffuse large cell lymphoma stage IV receiving cyclophosphamide, doxorubicin, vincristine, and prednisone. RESULTS: Bilateral vocal cord paralysis occurred in this patient receiving vincristine as part of her chemotherapy regimen. In addition to this case there have been a total of 25 prior reports, which are reviewed in the text. CONCLUSION: The incidence of bilateral vocal cord paralysis in patients receiving vincristine on the usual low-dose schedule is low. Prompt withdrawal of the offending agent results in prompt recovery without untoward long-lasting sequela.

Safety and costs of treating neutropenic fever in an outpatient setting.

PURPOSE: The purpose of this study is to analyze the safety of outpatient treatment for cancer patients with chemotherapy-induced neutropenic fever in a community hospital setting and to compare the costs of outpatient treatment with those of inpatient treatment for such patients. PATIENTS AND METHODS: We reviewed charts and charges for 32 consecutive patients initially treated for neutropenic fever with broad-spectrum antibiotics in the offices of Hematology/Oncology Associates (HOA) at the Bennett Cancer Center in the Stamford Hospital January 1997-June 1998. We also reviewed charts and charges for eight consecutive HOA patients with neutropenic fever who met the criteria for outpatient treatment but were initially hospitalized for other reasons during this period. We compared these two groups with respect to mean nadir absolute neutrophil count (ANC), mean number of days when ANC < 1,000 cells cu mm, and mean number of days of intravenous antibiotic treatment. We compared costs for ambulatory and hospital care of the two groups using Health Care Financing Administration (HCFA) payments in 1998 as a proxy for costs. RESULTS: Of 32 patients with neutropenic fever initially treated in the outpatient setting, only four required hospitalization. No patients in either group died in connection with neutropenic fever. Although outpatients received an average of 3.6 days and inpatients only 2.5 days of antibiotic treatment, outpatient treatment was significantly less costly than inpatient treatment. CONCLUSION: In a community hospital setting most cancer patients with neutropenic fever who meet certain criteria can be safely, effectively, and inexpensively treated as outpatients.

Multiple myeloma protein with three light chains.

A case of immunoglobulin G (kappa) myeloma showed, in addition to the monoclonal IgG(kappa) arc, two kappa chains in the serum. The urine specimen contained 7.75 g of kappa chains per liter. The electrophoretically fast-moving kappa chain in serum was shown by immunoelectrophoresis and Ouchterlony immunodiffusion to be a complex of kappa chains and alpha 1-antitrypsin. This complex, which was detected only transiently in the patient's blood, was composed of a monomeric kappa chain bound to the antitrypsin by a disulfide bond. The predisposing factor for the formation of this complex is unclear, but patients showing this complex usually have kappa type myeloma protein and excrete kappa chain in urine at more than 1 g/L. The relationship between chemotherapy and formation of the kappa chain-antitrypsin complex needs further investigation.

Effect of drug-induced platelet dysfunction on surgical bleeding.

Two hundred patients scheduled to undergo a variety of surgical and gynecologic procedures were studied to determine whether increased surgical bleeding occurred in those who had drug-induced platelet dysfunction. Twelve of 55 patients (22 percent) who had a positive drug history and abnormal platelet aggregation were judged to have excessive bleeding at surgery or postoperatively, compared with 7 of 97 patients (7 percent) with a negative drug history and normal platelet aggregation (p less than 0.02). The data suggest that drug-induced qualitative platelet dysfunction predisposes to excessive surgical bleeding.

Posttransfusion purpura. Case report with observation on antibody detection and therapy.

A case of posttransfusion purpura was notable for the manner of antibody detection and response to therapy. The antibody failed to fix complement but was detected by platelet aggregometry studies and confirmed by the chromium 51 release assay. The course was unaffected by plasmapharesis.