RESUMO
Therapy-related acute promyelocytic leukemia (t-APL) is a rare but known complication of chemotherapy and/or radiation therapy. Approximately 200 cases of t-APL have been reported in the literature up until now. The development of t-APL after radioiodine therapy is very rare, keeping in mind the very low doses of radiation exposure of the patient. We present a case of a 47-year-old woman with t-APL t15;17(q22;q21) developed after radioiodine treatment for thyroid carcinoma. The patient was treated with chemotherapy and achieved complete response lasting for 3(+) years. The patient's excellent response to treatment supports the data of the relevant literature that t-APL is associated with a better therapeutic result than the other subtypes of secondary acute myeloid leukemia (AML).
Assuntos
Radioisótopos do Iodo/efeitos adversos , Leucemia Promielocítica Aguda/etiologia , Neoplasias Induzidas por Radiação/etiologia , Neoplasias da Glândula Tireoide/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Humanos , Leucemia Promielocítica Aguda/tratamento farmacológico , Leucemia Promielocítica Aguda/genética , Leucemia Promielocítica Aguda/patologia , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/tratamento farmacológico , Neoplasias Induzidas por Radiação/genética , Neoplasias Induzidas por Radiação/patologia , Prognóstico , Neoplasias da Glândula Tireoide/cirurgia , Resultado do TratamentoRESUMO
Patients with bleeding oesophageal varices represent 5% of cases of upper GIT bleeding. Varices develop and bleed as a result of portal hypertension which is a complication occurring in 30% of patients who suffer from chronic liver diseases. The mortality rate for the first bleeding episode is 50% and 30% for subsequent episodes. Almost 100% of those who survive the first episode, bleed again within the following two years. The risk of rebleeding is higher with varices increasing their number, length and extension, varices of III and IV degrees, portal pressure over 16 mm Hg. Despite of some recent advances the endoscopic sclerotherapy still remains the initial treatment of choice in patients with bleeding oesophageal varices. Authors report of having achieved control over bleeding in 80 to 90% of patients. Over the next few days of the same hospitalisation 10 to 20% of those patients rebleed and require a second sclero-therapy session. When the latter fails in controlling the hemorrhage, the mortality rate is estimated as high as 100% which prompts more invasive surgical and radiological interventions.
