ABSTRACT
A 57-year-old man with acute myeloid leukemia (AML) French-American-British (FAB) 4 developed disseminated invasive cerebral and pulmonary aspergillosis during postinduction aplasia. According to international consensus, infection was categorized as probable (two host factors: deep neutropenia for >10 days and refractory fever for >96 h; major clinical criteria of lower respiratory tract and CNS invasive fungal infection; positive results for galactomannan antigen in three blood samples). After the failure of standard amphotericin-based therapy, the spectacular regression of multifocal brain and lung lesions was rapidly achieved under a caspofungin acetate/voriconazole combination. Further permanent caspofungin maintenance with voriconazole added during aplasia periods permitted two consolidation courses and autograft-based intensification without any delay.
Subject(s)
Antifungal Agents/administration & dosage , Aspergillosis/drug therapy , Leukemia, Myelomonocytic, Acute/microbiology , Peptides, Cyclic , Peptides/administration & dosage , Pyrimidines/administration & dosage , Triazoles/administration & dosage , Aspergillosis/diagnostic imaging , Caspofungin , Drug Therapy, Combination , Echinocandins , Humans , Lipopeptides , Male , Middle Aged , Radiography , Treatment Outcome , VoriconazoleABSTRACT
The radiation dose to the lens during CT of the paranasal sinuses was measured in 20 patients. In 10 patients, a "standard" technique with axial and coronal sections was used. In the remaining 10 patients, overlapping axial sections for bidimensional reconstruction were obtained. Radiation dose was measured using thermoluminescent dosimeters. The mean dose was 22 mGy in patients who underwent "standard" CT and 42 mGy in those who underwent CT with overlapping sections. Dose was dependent on the total number of slices and of transorbital axial sections. Coronal sections did not statistically increase the radiation dose to the lenses. Although these doses were significantly below the critical dose for cataracts, CT with overlapping sections gives a considerably higher radiation dose. We recommend the bidimensional reconstruction technique only for selected cases (e.g. preoperative assessment of the roof of the ethmoid sinuses or in patients who can or should not maintain the hyperextended position required for coronal views.
