RESUMO
A patient with chronic phase Philadelphia chromosome positive CML, developed severe protracted bone marrow hypoplasia after interferon therapy. This complication did not respond to two courses of immunosuppressive therapy with anti-thymocyte globulin, cyclosporin A and prednisone. The patient continued to be transfusion dependent with persistence of Philadelphia chromosome. Allogeneic BMT restored normal hematopoeisis.
Assuntos
Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/cirurgia , Transplante de Medula Óssea , Medula Óssea/anormalidades , Interferon-alfa/efeitos adversos , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Adulto , Doenças da Medula Óssea/induzido quimicamente , Doenças da Medula Óssea/patologia , Feminino , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Transplante HomólogoRESUMO
An unco-operative patient requiring daily radiation therapy presents a difficult clinical problem. After reviewing the paediatric oncology literature addressing the use of general anaesthesia for short medical procedures, we have developed checklists of procedural guidelines and monitoring equipment for the safe use of daily anaesthesia in adult patients who require a fractionated course of radiation therapy. We illustrate this by describing the successful treatment of a woman with autism and Hodgkin's disease who required daily general anaesthesia for immobilization during a 4-week course of radiation therapy. Propofol was used as the primary drug and was not associated with any adverse side-effects. There was no development of tolerance.
Assuntos
Anestesia Intravenosa/métodos , Anestésicos Intravenosos/uso terapêutico , Doença de Hodgkin/radioterapia , Neoplasias do Mediastino/radioterapia , Propofol/uso terapêutico , Adolescente , Anestésicos Intravenosos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transtorno Autístico/complicações , Bleomicina/administração & dosagem , Terapia Combinada , Dacarbazina/administração & dosagem , Fracionamento da Dose de Radiação , Doxorrubicina/administração & dosagem , Feminino , Diretrizes para o Planejamento em Saúde , Doença de Hodgkin/tratamento farmacológico , Humanos , Neoplasias do Mediastino/terapia , Propofol/administração & dosagem , Recusa do Paciente ao Tratamento , Vimblastina/administração & dosagemRESUMO
METHODS AND RESULTS: Autologous embryos from in vitro-fertilized ova were successfully implanted in a 29-year-old woman, 2 years after successful allogeneic bone marrow transplant (BMT) for chronic myeloid leukemia (CML). A second pregnancy, similarly initiated, is in progress at 4 years posttransplant. CONCLUSION: Our experience offers a fertility-salvaging technique to some women after cytotoxic therapy, where time permits ovarian hyperstimulation before the need for definitive myeloblative therapy of their malignancy, and where the risk of subsequent infertility is high.
Assuntos
Transplante de Medula Óssea , Transferência Embrionária/métodos , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Adulto , Feminino , Fertilização in vitro , Humanos , Recém-Nascido , Masculino , Período Pós-Operatório , GravidezRESUMO
We studied the distribution of HLA-A, -B, and -C antigens in 94 juvenile-onset diabetic patients and of HLA-DR antigens in 62 of these patients. The frequencies for HLA-B15, -B40, and -Cw3 were significantly increased in the patient group as compared with the control group. With respect to the B-cell specificities, DRw4 was significantly increased in the patients. Analysis of the data to detect the possible presence of primary and secondary associations between HLA alleles and diabetogenic gene(s) indicated that DRw4 possessed a primary association with the diabetogenic gene(s). As a result, B15, B40, and Cw3 possessed secondary associations.