ABSTRACT
The management of invasive aspergillosis in patients with hematological malignancies remains controversial. A major problem is how to manage patients who had invasive aspergillosis during remission induction and consolidation therapy and then undergo SCT. Indeed in these patients the mortality rate related to invasive aspergillosis recurrence remains unacceptably high. We report two cases of patients who underwent remission induction for AML, developed invasive aspergillosis during antifungal prophylaxis with itraconazole, failed amphotericin B deoxycholate and liposomal amphotericin B treatment, were successfully treated with voriconazole and eventually underwent SCT with voriconazole prophylaxis without reactivation of invasive aspergillosis.
Subject(s)
Aspergillosis/drug therapy , Bone Marrow Transplantation/adverse effects , Deoxycholic Acid/analogs & derivatives , Leukemia, Megakaryoblastic, Acute/therapy , Leukemia, Myelomonocytic, Acute/therapy , Lung Diseases, Fungal/drug therapy , Peripheral Blood Stem Cell Transplantation/adverse effects , Pyrimidines/therapeutic use , Triazoles/therapeutic use , Adult , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Aspergillosis/etiology , Aspergillosis/prevention & control , Combined Modality Therapy , Cytarabine/administration & dosage , Cytarabine/adverse effects , Daunorubicin/administration & dosage , Daunorubicin/adverse effects , Deoxycholic Acid/administration & dosage , Deoxycholic Acid/therapeutic use , Drug Combinations , Drug Resistance, Fungal , Etoposide/administration & dosage , Etoposide/adverse effects , Fatal Outcome , Humans , Immunocompromised Host , Itraconazole/therapeutic use , Leukemia, Megakaryoblastic, Acute/complications , Leukemia, Megakaryoblastic, Acute/drug therapy , Leukemia, Myelomonocytic, Acute/complications , Leukemia, Myelomonocytic, Acute/drug therapy , Liposomes , Male , Middle Aged , Recurrence , Remission Induction , Salvage Therapy , Transplantation Conditioning/adverse effects , Transplantation, Autologous/adverse effects , Transplantation, Homologous/adverse effects , VoriconazoleABSTRACT
In the last few years, Computed Tomography (CT) has emerged as the most sensitive and reliable imaging technique to diagnose acute pancreatitis (AP). Besides assessing the extent of damage to the pancreas and to periglandular tissue. CT can recognize the major early and late complications of the disease promptly and with extreme accuracy. We investigated the diagnostic capabilities of CT in controlling AP development and tried to assess the role of interventional radiology as a therapeutic support after or instead of surgery in treating the necrotic forms of pancreatitis complicated by sepsis. From 1989 to 1995, acute pancreatitis mostly due to biliary tract disease and alcoholism was diagnosed in 228 patients. Necrotic processes were identified in 105 of them since disease onset; septic complications developed in 57 patients. Surgery was performed in 42 patients, but the result was poor in 11 of them (30%) and CT showed the persistence of some infectious pancreatic exudate which had been drained insufficiently. Since sepsis persisted in these patients, the exudate was aspirated percutaneously after positioning appropriate drainage means guided by abdominal CT. Sepsis resolved completely in 10 patients, while one required subsequent surgery. Percutaneous drainage catheters were positioned in 15 patients as the treatment of choice, under CT and US guidance. Sepsis resolved in 7 cases only (45%), while 3 of the extant patients died and 5 needed surgery. The results of our experience demonstrate the effectiveness of percutaneous drainage under CT guidance. However, this technique should be used after and as a support to surgery, the latter remaining the treatment of choice for infectious necrotic AP. Thus, in our experience, the use of percutaneous aspiration instead of surgery proved to be a less effective tool in curing this condition and its use should therefore be limited to high-risk surgical patients.
Subject(s)
Pancreatitis/diagnostic imaging , Pancreatitis/therapy , Acute Disease , Adult , Aged , Decision Trees , Drainage , Female , Hemorrhage/etiology , Humans , Male , Middle Aged , Necrosis , Pancreatitis/complications , Pancreatitis/microbiology , Pancreatitis/pathology , Tomography, X-Ray ComputedABSTRACT
This study was performed to confirm the high sensitivity of CT during arterial portography (CTAP) versus US and dynamic CT in the diagnosis of liver metastases from colorectal cancer. Ninety patients with 108 colorectal cancers underwent US, dynamic CT and CTAP to investigate the presence of liver metastases. US depicted 39 metastases in 26 patients, dynamic CT 46 metastases in 29 patients and CTAP 54 lesions in 34 patients. CTAP detected 8 metastases missed at dynamic CT; 4 of them were < 1 cm in diameter, 3 ranged 1-2 cm and one metastasis > 2 cm in diameter. After preoperative investigations only 7 patients were considered for hepatic resection. At surgery, palpation and intraoperative US of the liver detected two more metastases in the same patients. Our experience, in agreement with recent studies, confirms CTAP as the most sensitive preoperative method in detecting liver metastases and its superiority to be most apparent in lesions < 1 cm in diameter. Therefore, we consider CTAP an essential imaging technique for planning the correct treatment of liver metastases.
