RESUMO
The energy spectrum of cosmic-ray antiprotons (p's) from 0.17 to 3.5 GeV has been measured using 7886 p's detected by BESS-Polar II during a long-duration flight over Antarctica near solar minimum in December 2007 and January 2008. This shows good consistency with secondary p calculations. Cosmologically primary p's have been investigated by comparing measured and calculated p spectra. BESS-Polar II data show no evidence of primary p's from the evaporation of primordial black holes.
RESUMO
In two long-duration balloon flights over Antarctica, the Balloon-borne Experiment with a Superconducting Spectrometer (BESS) collaboration has searched for antihelium in the cosmic radiation with the highest sensitivity reported. BESS-Polar I flew in 2004, observing for 8.5 days. BESS-Polar II flew in 2007-2008, observing for 24.5 days. No antihelium candidate was found in BESS-Polar I data among 8.4×10(6) |Z|=2 nuclei from 1.0 to 20 GV or in BESS-Polar II data among 4.0×10(7) |Z|=2 nuclei from 1.0 to 14 GV. Assuming antihelium to have the same spectral shape as helium, a 95% confidence upper limit to the possible abundance of antihelium relative to helium of 6.9×10(-8)} was determined combining all BESS data, including the two BESS-Polar flights. With no assumed antihelium spectrum and a weighted average of the lowest antihelium efficiencies for each flight, an upper limit of 1.0×10(-7) from 1.6 to 14 GV was determined for the combined BESS-Polar data. Under both antihelium spectral assumptions, these are the lowest limits obtained to date.
RESUMO
Dumon Y-stents and Dynamic stents are used to treat carinal stenosis, but their placement severely impairs the expectoration of secretions, making frequent bronchoscopic aspiration necessary. We report here five patients with terminal lung cancer who had stenosis of the lower trachea and main bronchi treated using spiral Z-stents. A long tapered spiral Z-stent was placed in the lower trachea and one main bronchus, and a short straight spiral Z-stent in the contralateral main bronchus. No patients required bronchoscopic aspiration of secretions after stenting. Before stenting, all of the patients were severely dyspnoeic, requiring oxygen and having to sit in the orthopnoeic position. After stenting, the patients' dyspnoea improved, with one patient becoming ambulant without the need for oxygen support. These results suggest that the use of spiral Z-stents in stenosis of the tracheal carina in advanced lung cancer is effective in reducing the need for bronchoscopic aspiration and enhancing quality of life.
Assuntos
Brônquios , Constrição Patológica/terapia , Neoplasias Pulmonares/terapia , Implantação de Prótese/métodos , Stents , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/cirurgia , Dispneia/prevenção & controle , Dispneia/terapia , Feminino , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do TratamentoRESUMO
The BESS-Polar Collaboration measured the energy spectra of cosmic-ray protons and helium during two long-duration balloon flights over Antarctica in December 2004 and December 2007, at substantially different levels of solar modulation. Proton and helium spectra probe the origin and propagation history of cosmic rays in the galaxy, and are essential to calculations of the expected spectra of cosmic-ray antiprotons, positrons, and electrons from interactions of primary cosmic-ray nuclei with the interstellar gas, and to calculations of atmospheric muons and neutrinos. We report absolute spectra at the top of the atmosphere for cosmic-ray protons in the kinetic energy range 0.2-160 GeV and helium nuclei 0.15-80 GeV/nucleon. The corresponding magnetic rigidity ranges are 0.6-160 GV for protons and 1.1-160 GV for helium. These spectra are compared to measurements from previous BESS flights and from ATIC-2, PAMELA, and AMS-02. We also report the ratio of the proton and helium fluxes from 1.1 GV to 160 GV and compare to ratios from PAMELA and AMS-02.
RESUMO
A supernatant obtained from the culture of recombinant human interleukin 2-activated lymphocytes was added to granulocyte (G)-, macrophage (M)-, and granulocyte-macrophage (GM)-progenitor assays using a plasma clot culture method. The supernatant was found to exert a suppressive influence on the colony and cluster formations of the G progenitors. This suppressive influence of the supernatant was almost completely neutralized by the addition of a combination of anti-human tumor necrosis factor alpha (HuTNF-alpha) and anti-human interferon gamma (HuIFN-gamma) antibodies, and it has been speculated that this suppressive influence of the supernatant is probably due to TNF-alpha and IFN-gamma. The numbers of M and GM progenitors increased remarkably in the assays in which the supernatant was added when compared to assays without the supernatant; this suggests that these progenitors were resistant to TNF-alpha and IFN-gamma. Among the bone marrow mononuclear cells (BMNC) excluding erythroid-rosette-forming (ERFC) or adherent cells, the influence of the supernatant on these progenitors was not significantly different. The results of our study have shown that ERFC and the adherent cells in BMNC hardly affected the appearance of the suppressive influence.
Assuntos
Células-Tronco Hematopoéticas/efeitos dos fármacos , Interleucina-2/farmacologia , Linfócitos/efeitos dos fármacos , Células Cultivadas , Fatores Estimuladores de Colônias/farmacologia , Meios de Cultura/farmacologia , Ensaio de Imunoadsorção Enzimática , Eritrócitos/citologia , Eritrócitos/efeitos dos fármacos , Eritrócitos/imunologia , Fator Estimulador de Colônias de Granulócitos , Fator Estimulador de Colônias de Granulócitos e Macrófagos , Substâncias de Crescimento/farmacologia , Células-Tronco Hematopoéticas/citologia , Células-Tronco Hematopoéticas/imunologia , Humanos , Interferon gama/imunologia , Interferon gama/farmacologia , Leucócitos/citologia , Leucócitos/efeitos dos fármacos , Leucócitos/imunologia , Linfócitos/citologia , Linfócitos/imunologia , Monócitos/citologia , Monócitos/efeitos dos fármacos , Monócitos/imunologia , Proteínas Recombinantes/farmacologia , Formação de Roseta , Fator de Necrose Tumoral alfa/imunologia , Fator de Necrose Tumoral alfa/farmacologiaRESUMO
The cell surface markers on the leukemic cells of 76 patients with adult acute myeloid leukemia (AML) have been analyzed by indirect immunofluorescence, and the presence of CD56+ leukemic cells was detected in ten of these patients. Four of these 10 CD56+ AML patients developed extramedullary myeloblastomas and in two of them an intracranial myeloblastoma. In contrast, in the remaining 66 CD56- AML patients, only one patient developed a myeloblastoma formation of the subcutaneous. It may be that the CD56 antigen which is an isoform of the neural cell adhesion molecule (NCAM), expressed on neurons, satellite cells of skeletal muscle cells, and on stromal cells, binds these tissues by a homophilic mechanism. CD56+ leukemic cells are capable of invading and of surviving in extramedullary tissues, where they proliferate and develop into a myeloblastoma. Because of this possibility, CD56+ AML patients should be carefully monitored for signs of myeloblastoma formation.
Assuntos
Neoplasias Encefálicas/patologia , Leucemia Mieloide Aguda/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD/análise , Antígenos de Diferenciação Mielomonocítica/análise , Antígenos de Diferenciação de Linfócitos T/análise , Antígenos de Neoplasias/análise , Antígenos de Superfície/análise , Neoplasias Encefálicas/imunologia , Antígenos CD2 , Antígeno CD56 , Feminino , Imunofluorescência , Humanos , Leucemia Mieloide Aguda/imunologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Receptores Imunológicos/análise , Lectina 3 Semelhante a Ig de Ligação ao Ácido SiálicoRESUMO
We examined the responsiveness of leukemic cells to colony stimulating factors (CSFs) as determined by 3H-TdR incorporation and surface phenotypes of leukemic blasts. In acute myeloid leukemia (AML), CD13 and/or CD33 positive and HLA-DR negative M1 and M3 cases tended to show high response to G-CSF, GM-CSFs and IL-3, however, all HLA-DR positive M1, M2, M4 and M5 cases were unresponsive to CSFs but showed high autonomous growth. In acute lymphocytic leukemia (ALL), no response was observed to any CSFs but high autonomous growth was found in mixed leukemia cases. Sole T or B lineage cases showed low autonomous growth. These results suggest the varied nature of the proliferative state in leukemia and the existence of a subgroup in M1.
Assuntos
Fator Estimulador de Colônias de Granulócitos/farmacologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/farmacologia , Interleucina-3/farmacologia , Leucemia/patologia , Fator Estimulador de Colônias de Macrófagos/farmacologia , Divisão Celular/efeitos dos fármacos , Humanos , Imunofenotipagem , Técnicas In Vitro , Leucemia/classificação , Leucemia/imunologia , Células Tumorais CultivadasRESUMO
BACKGROUND: The purpose of this investigation was to evaluate the efficacy of a solution (Ep4) for long-term hypothermic pulmonary allograft preservation in a primate model using both functional and histopathologic criteria. METHODS: Twenty-seven Japanese monkeys were divided into donor group and three study groups. The animals in group I underwent acute left lung transplantation (n = 5). Group II consisted of animals which received left pulmonary allografts preserved for 24 hours by simple hypothermic immersion in Ep4 solution (n = 6). The temporary contralateral (right) pulmonary artery occlusion test was performed immediately after transplantation and on postoperative day 7 to assess lung function in the allografts. This test was also performed in the control group (group III, n = 5). The recipient animals in groups I and II were also subjected to serial open lung biopsies and bronchoscopic assessments after transplantation. RESULTS: Temporary right pulmonary artery occlusion did not show any significant differences in gas exchange capacity and pulmonary hemodynamics between groups I and II. Histopathologic examination did not show significant differences in the pulmonary allografts between groups I and II for a period of 4 weeks after transplantation. Serial bronchoscopic and histologic examinations also showed no significant differences in bronchial healing between these two groups. CONCLUSIONS: Long-term hypothermic pulmonary allograft preservation with Ep4 solution does not impair pulmonary function immediately after transplantation. The results of this study indicate that extracellular electrolyte composition solutions such as Ep4 should be subjected to clinical trials.
Assuntos
Dextranos , Glucose , Heparina , Transplante de Pulmão , Pulmão/patologia , Pulmão/fisiologia , Preservação de Órgãos/métodos , Fosfatos , Prednisolona , Animais , Pressão Sanguínea , Temperatura Baixa , Terapia de Imunossupressão , Pulmão/diagnóstico por imagem , Complacência Pulmonar , Macaca , Oxigênio/sangue , Circulação Pulmonar , Radiografia , Soluções , Fatores de Tempo , Transplante Homólogo , Resistência VascularRESUMO
In an attempt to develop a new intensive chemotherapy for adults with untreated acute lymphoblastic leukemia (ALL), 3 sequential programs were designed for 62 patients (age range, 15 to 74 years; median age, 32 years) consisting of the LVP-79 (1979-1984, 27 patients), LVP-85 (1984-1986, 14 patients), and LVP-87 (1987-1989, 21 patients) regimens. The influence of clinical and biologic characteristics on the patient outcome was also examined. L-asparaginase (L-asp), vincristine, and prednisolone, defined collectively as LVP, were administered for induction chemotherapy in all protocols. After achieving complete remission (CR), patients underwent 2 years of multi-agent consolidation, intensification, and maintenance therapy consisting of various combinations. No significant differences were noted between the 3 groups regarding CR rate or survival. In total, 47 of 62 patients (75.8%) achieved CR. The median overall survival (OS) and median CR durations were 550 days and 341 days, respectively. Overall, the estimated survival rate at 20 years was 18.1%. The disease-free survival rate at 20 years was 26.2%. According to univariate analysis, the most favorable pretreatment characteristic for achieving CR was age. A younger age (<40 years of age), platelet count >30 x 10(9)/L, having L1 morphology (French-American-British [FAB]classification subtype), female sex, and the absence of chromosomal abnormalities also helped improve survival rate. According to multivariate analysis, presence of Ph chromosome was found to be a major influencing factor for OS. Although higher doses of L-asp were administered than those used in previous studies, the adverse effect of L-asp was rarely identified. Therefore, it should be considered one of the key drugs for treatment of adult ALL. Further strategies still need to be developed to obtain better survival in adult ALL.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Asparaginase/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Prednisolona/administração & dosagem , Indução de Remissão , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento , Vincristina/administração & dosagemRESUMO
The susceptibility of selected oral bacteria, including suspected periodontopathogens, to a commonly employed Chinese herbal medicine Huang-chin (HC, Scutellaria baicalensis) was tested in vitro. The minimum inhibitory concentration (MIC) and minimum bactericidal concentrations (MBC) were determined. HC was also compared with tetracycline, alexidine, and stannous fluoride. HC decoction, at a concentration of 2%, was bacteriostatic in eight of 11 bacteria tested, but a concentration of 3.13% or greater was required for bactericidal effect. Among the tested bacteria, Bacteroides melaninogenicus ss intermedius was the most sensitive (MIC = 1.57%, MBC = 2%); Actinomyces viscosus was the least sensitive (MIC = 6.25%, MBC = 12.5%). Tetracycline, alexidine, and SnF2 were bactericidal in vitro in all bacteria tested at concentrations lower than those used clinically.
Assuntos
Bactérias/efeitos dos fármacos , Flavonoides/farmacologia , Doenças Periodontais/microbiologia , Biguanidas/farmacologia , Humanos , Testes de Sensibilidade Microbiana , Extratos Vegetais/farmacologia , Tetraciclina/farmacologia , Fluoretos de Estanho/farmacologiaRESUMO
OBJECTIVE: We examined the soluble CD23 (sCD23) molecules in sera and saliva from patients with Sjögren's syndrome. METHODS: The determination of sCD23 and other soluble molecules were made by the enzyme-linked immunosorbent assay. RESULTS: The amounts of sCD23 in the sera/saliva were significantly increased in the patients compared to the controls and the levels were significantly correlated with sialoectasis. CONCLUSION: The findings suggest that increased sCD23 molecules in saliva from patients with Sjögren's syndrome may reflect active sialoectasis.
Assuntos
Receptores de IgE/biossíntese , Saliva/química , Glândulas Salivares/metabolismo , Glândulas Salivares/patologia , Adulto , Feminino , Humanos , Imunoglobulinas/análise , Pessoa de Meia-Idade , Receptores de IgE/sangue , Saliva/imunologia , Síndrome de SjogrenRESUMO
Humoral responses were examined in idiopathic juvenile periodontitis (IJP) including antibody titers to representative strains of the five groups of periodontosis-associated bacteria. Titers as determined by indirect immunofluorescence were compared in IJP, non-IJP family members, periodontitis and periodontally healthy subjects. Serum concentrations of IgG, IgA, IgM and IgE were also assayed. Antibody titers to the periodontosis-associated bacteria were generally low. Some disease specificity was observed in that titers to Groups II and III bacteria were highest in IJP. These titers in IJP were significantly higher (P less than 0.01) than in the other subjects. Titers to Group I bacteria were similar in all periodontal groups except the periodontally healthy subjects where titers were the lowest. Titers to Group I bacteria were significantly higher (P less than 0.01) than in the periodontally healthy subjects. Titers to Groups IV and V were uniformly low in all periodontal groups. Immunoglobulin concentrations of IgA, IgM and IGE were similar in IJP and non-IJP. The IgG concentrations in IJP, while within the normal range were significantly higher in IJP compared to non-IJP family members.
Assuntos
Anticorpos Antibacterianos/biossíntese , Bactérias/imunologia , Doenças Periodontais/imunologia , Adolescente , Adulto , Anticorpos Antibacterianos/análise , Formação de Anticorpos , Criança , Feminino , Humanos , Imunoglobulina A/análise , Imunoglobulina E/análise , Imunoglobulina G/análise , Imunoglobulina M/análise , Masculino , Pessoa de Meia-Idade , Doenças Periodontais/microbiologia , Periodontite/imunologiaRESUMO
To assess the value of adenosine triphosphate (ATP) for ex vivo purging of leukemic cells in autologous bone marrow transplantation, its biological effects on the murine leukemic cell lines (WEHI3B and L1210) and normal murine bone marrow hemopoietic stem cells (CFU-C and CFU-S) were studied. After treatment with 4 mM of ATP for 6 h, the number of viable WEHI3B cells decreased to less than 0.1% of that of the control. Furthermore, 3H-thymidine incorporations were also completely inhibited in both WEHI3B cells and L1210 cells. These phenomena were related to the concentration and exposure period of ATP. Treatment of bone marrow mononuclear cells with ATP under the same condition reduced the number of CFU-C, day 9 CFU-S and day 12 CFU-S to only 58.5 +/- 8.7%, 92.6 +/- 8.2% and 83.5 +/- 28.5%, respectively, with no change in the number of marrow nucleated cells. Although the effect of ATP is not entirely specific to leukemic cells, these findings provide evidence that ATP is useful for purging residual tumor cells in autologous bone marrow transplantation.
Assuntos
Trifosfato de Adenosina , Purging da Medula Óssea/métodos , Transplante de Medula Óssea , Leucemia Experimental/cirurgia , Trifosfato de Adenosina/farmacologia , Animais , ATPase de Ca(2+) e Mg(2+)/metabolismo , Morte Celular/efeitos dos fármacos , Membrana Celular/metabolismo , Células-Tronco Hematopoéticas/efeitos dos fármacos , Leucemia L1210/enzimologia , Leucemia L1210/cirurgia , Leucemia Experimental/enzimologia , Masculino , Camundongos , Transplante AutólogoRESUMO
A 41-year-old woman with chronic myelogenic leukemia was scheduled to undergo transplantation of bone marrow. The patient complained of nausea and vomiting following the initiation of chemotherapy. One day prior to the planned termination of chemotherapy, the patient developed left-sided abdominal pain. Physical examination and imaging examination indicated the possibility of acute abdomen associated with bleeding or herniation. For therapeutic and diagnostic purposes, an emergency operation was performed. A 6 x 5 cm hematoma was detected within the left rectus abdominis muscle. It is suggested that the gastrointestinal symptoms should be carefully controlled in patients undergoing bone marrow transplantation.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Hematoma/etiologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Vômito/complicações , Adulto , Transplante de Medula Óssea , Feminino , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/etiologia , Reto do Abdome , Vômito/induzido quimicamenteRESUMO
The clinical efficacy and the safety of concomitant therapy with fluconazole and recombinant human granulocyte colony stimulating factor (rhG-CSF) was compared with fluconazole monotherapy in neutropenic patients with hematological disorders. The clinical efficacy rate was 73.5% (25/34) in the combination therapy and 48.1% (37/77) in monotherapy. The difference between the two is statistically significant. Side effects were not observed in the combination group, but laboratory abnormalities were found in 6 patients with an incident rate of 11%. The combination therapy with fluconazole and rhG-CSF may be selected as empiric therapy for systemic fungal infection associated with hematological disorders, since this combination therapy showed high efficacy and low incident of side effects. Some patients, however, did not show increased neutrophil counts in spite of rhG-CSF administration.
Assuntos
Antifúngicos/administração & dosagem , Fluconazol/administração & dosagem , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Micoses/tratamento farmacológico , Infecções Oportunistas/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Quimioterapia Combinada , Feminino , Filgrastim , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Micoses/complicações , Neutropenia/complicações , Infecções Oportunistas/complicações , Proteínas RecombinantesRESUMO
Current EIA for PIVKA-II is not sensitive enough to detect small Hepatocellular Carcinoma (HCC). In an attempt to increase the diagnostic threshold, the current EIA was modified in two different ways: 1) immunoreaction of PIVKA-II in the sample with its monoclonal antibody was carried out overnight at 5 degrees C instead of for two hours at room temperature (the overnight method), 2) Avidin-Biotin technique was used for the second reaction(the ABC method);and their diagnostic values were determined as compared with the current EIA(2hr method) in a total of 138 patients including 36 patients with HCC. In 27 patients with HCC(< 3 cm in diameter), the rates of abnormal values obtained by the 2hr-, the overnight- and the ABC method were 14.8, 25.9 and 29.6% respectively. False positive rates of these three methods in 69 patients with liver cirrhosis were 1.4, 8.6 and 22.9% respectively. Thus, these two modifications improved the sensitivity of the current EIA and the overnight method appears to be superior to the ABC method in terms of specificity and simplicity. This conclusion was confirmed by ROC analysis.
Assuntos
Biomarcadores , Carcinoma Hepatocelular/sangue , Neoplasias Hepáticas/sangue , Precursores de Proteínas/metabolismo , Protrombina/metabolismo , Humanos , Técnicas Imunoenzimáticas , Curva ROC , Sensibilidade e EspecificidadeRESUMO
Twenty one patients with Philadelphia chromosome positive CML were treated with natural interferon alpha. All patients were in the chronic phase, 5 were untreated and 16 had been previously treated with busulfan or hydroxyurea. Eight patients in complete remission (CR) were given IFN subcutaneously at a dose of 5 x 10(6) unit per day as maintenance therapy, whereas 13 non-CR patients were given 2. 5 approximately 10 x 10(6) units for remission induction. Doses and intervals of IFN were adjusted to maintain the WBC count below 5 x 10(9)/l, but additional drugs were given when the WBC count could not be controlled with IFN alone. Six out of 10 evaluable non-CR patients attained CR with IFN only and 4 others achieved with additional drug. Cytogenetic responses were evaluated in 15 patients. CCR, PCR and MCR were attained in 5, 2 and 1 patients respectively. Southern blotting method showed that the BCR gene rearrangement disappeared in 5 out of 13 patients. Cytogenetic response rate was not different between untreated and previously treated patients, however it differed between patients with or without additional drug. The time to first cytogenetic effect was within 12 months in almost all effective cases. Fever and general fatigue were seen in almost all patients. IFN administration was discontinued only patients with severe skin eruption (3 patients) and bone marrow aplasia (1 patient).
Assuntos
Interferon-alfa/administração & dosagem , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Adulto , Rearranjo Gênico , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/sangue , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Pessoa de Meia-Idade , Oncogenes/genética , Indução de RemissãoRESUMO
A 51-year-old male diagnosed as having Evans's syndrome in 1991 was treated with 25 mg of prednisolone, but his anemia and thrombocytopenia progressed. Thus, in November 1993, treatment was begun with Sairei-to, a Chinese herbal medicine consisting of several water-soluble plant extracts. Following administration of 9.0 g/day of Sairei-to granules along with prednisolone, the platelet count increased from 6.1 x 10(4)/microliters to 12.3 x 10(4)/microliters after one week, while hemoglobin levels rose from 9.5 g/dl to 12.0 g/dl after three weeks. The patient maintained a good physical condition after the prednisolone dose was reduced, although Coomb's test and PAIgG levels remained positive. Sairei-to-seems to be a promising therapeutic agent for steroid-resistant ITP and AIHA, and seems to have no side effects.
Assuntos
Anemia Hemolítica Autoimune/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , SíndromeRESUMO
A 47-year-old female was admitted in October 1988 because of anemia and lymphoblastic cells in peripheral blood. A bone marrow aspirate was hypercellular with 93.9% lymphoblasts negative for peroxidase staining. The case was diagnosed as ALL (L2), and treated with JALSG ALL-87 regimen. She developed spiky fever and endotoxin shock due to bacteremia caused by pseudomonas aeruginosa, then was treated with several antibiotics. With the recovery of leukocytes, the chest X-ray showed an infiltrative shadow and a cavity forming lung abscess resembling aspergilloma in her left lung. The cavity improved of transbronchial infusion following amphotericin B (AMPH-B). Although she achieved complete remission, she felt severe lumbago accompanied by a marked erosion of the vertebral body with disc space narrowing on her X-ray. Then she underwent surgery to remove a disc abscess, and 1 colony of the aspergillus species was cultured from the specimen. She was treated with intravenous AMPH-B, and post remission therapies were performed under the injection of anti-fungal agents. No remarkable symptoms of complications were recognized during the chemotherapy. AMPH-B is useful and safe for the management of aspergillus discitis.
Assuntos
Aspergilose/etiologia , Discite/etiologia , Vértebras Lombares , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Aspergilose/terapia , Discite/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Oportunistas/terapia , Indução de RemissãoRESUMO
This paper reports a relapsed case of acute myeloid leukemia with intracranial, testicular and intestinal tumor formation. A-56-year-old male, diagnosed as M1 on September, 1988, entered complete remission on October 14, 1988, aided by JAL-SG and AML-85 regimen. Blast cells with Auer rods demonstrated 8;21 translocation lacking 11q with 30 of 30 analyzed bone marrow cells, and the following antigen pattern: CD5+, CD19+, CD33+, CD56+, HLA-DR+. After 4 courses of post remission therapy, the maintenance therapy was discontinued because of his liver dysfunction. He was discharged on May, 1989, and was seen as an out patient. He complained of left hemiplegia and was re-admitted on September 30, 1989. Though the bone marrow was in complete remission on September 4th, CT scan and MRI demonstrated intracranial tumor formation. Bone marrow relapse occurred on October 27th, eventually resulting in his death on November 18th. Autopsy showed intracranial, testicular and intestinal tumor formation and blast cell invasion into the liver, spleen and kidneys. We analyzed the characteristics of 14 cases with intracranial tumor formation previously reported. The focal neurological symptoms reflecting the intracranial tumor mass effect were considered to be important initial signs. CT scan was a useful tool for diagnosis. The average age of the 14 cases was 38, 9 and the male/female ratio was 9:5. Six of 9 cases, diagnosed by FAB classification, were M2 and one of the 6 cases in whom chromosomes of blast cells were examined had t(8;21). Though irradiation seemed effective for the reduction of tumor mass, the patients' prognosis was poor.(ABSTRACT TRUNCATED AT 250 WORDS)