ABSTRACT
A 79-year-old female was admitted to our hospital because of a malignant pleural effusion following mastectomy 4 years ago. In the patient's history arterial hypertension and previous inferior myocardial infarction have been known. Two doses of 20 mg mitoxantrone were installed intrapleurally at an interval of 4 weeks. Six hours after the second mitoxantrone application and the patient had increasing dyspnea with consecutive left heart failure, pulmonary congestion, and a drop of blood pressure. The white-cell count was 14800/mm3. The levels of creatinine phosphokinase (CPK), lactate dehydrogenase (LDH) and serum aspartate aminotransferase (SGOT) were in the normal range. Transthoracic echocardiography showed concentric left ventricular hypertrophy and a markedly decreased fractional shortening, but no left ventricular dilatation. The electrocardiogram showed newly appeared down-sloping ST-segments and inverted T-waves. Clinical recovery was achieved after 6 days by application of oxygen, dobutamine and furosemide followed by angiotensin converting enzyme inhibition and digitalis. In the echocardiographic control examination 14 days later left ventricular function had normalized. The changes of electrocardiogram normalized 4 weeks later.
Subject(s)
Antineoplastic Agents/adverse effects , Breast Neoplasms/drug therapy , Carcinoma, Ductal, Breast/drug therapy , Carcinoma, Lobular/drug therapy , Heart Failure/chemically induced , Mitoxantrone/adverse effects , Neoplasm Recurrence, Local/drug therapy , Neoplasms, Multiple Primary/drug therapy , Pleural Effusion, Malignant/drug therapy , Ventricular Dysfunction, Left/chemically induced , Aged , Antineoplastic Agents/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Electrocardiography/drug effects , Female , Heart Failure/diagnosis , Humans , Instillation, Drug , Mitoxantrone/administration & dosage , Ventricular Dysfunction, Left/diagnosis , Ventricular Function, Left/drug effectsABSTRACT
The comparing examinations of patients suffering from a sarcoidosis of the lungs by the help of roentgenograms, scintigraphies of lung perfusion of 67-gallium and bioptic examinations admit to conclude as follows: In the stages I and II the activity-accumulation of radioactive gallium corresponds nearly to the alterations becoming visible in the X-ray-graph. Consequently, increases of lymph nodes and active granulomatous interstitial or centriform infiltrations may be presented. In case of a successful treatment the activity-incorporation is not to be proved anymore. As to time the alterations also coincide with the radiogram. In single cases the epithelioid nodule may be proved bioptically and microscopically when the active process already has stabilized spontaneously or by a treatment. In these cases the radioactive gallium is incorporated no more. The proof of 67-Ga-activity has a special signification in case fibrotic alterations have already appeared. The examinations prove that a granulomatosis may continue to exist when already distinct X-ray-symptoms of a fibrosis are present. Consequently, the granulomas may appositionally develop and cause an additional fibrosis. Therefore, in case of an existing infiltration of the lungs the combination of a definite lesion in the form of a fibrosis and a persisting formation of granulomas rather means a rule than an exception. A perfusion scintigram may be altered pathologically by a granuloma as well as by a fibrosis. Disorders in perfusion caused by granulomas are reversible.
