RESUMO
OBJECTIVE: No-visitor policies adopted to prevent coronavirus disease-19 (COVID-19) spread in hospital wards have deeply impacted communication with patients and their relatives. Whereas in pre-COVID-19 era family-clinician meetings were held in person, during the pandemic interactions often took place over the phone, frequently causing feelings of uncertainty and distress to the close ones at home. The goal of this study was to assess and improve the effectiveness of structured telephone-based communication with hospitalized onco-hematological patients' relatives in COVID-19 era. METHODS: After no-visitor policy was adopted in the Onco-Hematological Unit of Modena, inpatients' relatives were contacted daily for clinical updates. After discharge, a telephone satisfaction survey was administered to all contact people of patients consecutive admitted between December 2020 and January 2021 (n = 97). Mean score of response and potential statistically significative differences depending on respondents' characteristics were assessed. RESULTS: Most relatives were satisfied with the communication received with a mean total score of 4.69 on a 5-point Likert scale (standard deviation: 0.60). Results showed high satisfaction rate with both the informative (mean ± SD: 4.66 ± 0.64) and emotional (mean ± SD: 4.66 ± 0.58) content, with no significant difference depending on respondents' demographic characteristics (p > 0.05). CONCLUSION: A structured telephone-based communication may be a reasonable substitute for face-to-face meetings; especially if regular in time, conducted by the same doctor and integrated with video calls. Our findings might assist health workers in implementing measures to minimize the psychological effects of no-visitor policies during hospitalization. Clinical updates delivery through structured phone calls and video calls could become an opportunity also in post-COVID era.
Assuntos
COVID-19 , Neoplasias , Comunicação , Humanos , Neoplasias/terapia , SARS-CoV-2 , Inquéritos e Questionários , TelefoneRESUMO
Here we describe the first case of a biopsy-proven Cytomegalovirus ulcero-hemorrhagic colitis, associated with Clostridium Difficile co-infection, occurring during standard induction chemotherapy for common B cell acute lymphoblastic leukemia. We discuss the case and focalize clinical management and diagnostic issues arising from it.
Assuntos
Clostridioides difficile , Colite Ulcerativa/microbiologia , Colite Ulcerativa/virologia , Infecções por Citomegalovirus/patologia , Enterocolite Pseudomembranosa/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adulto , Clostridioides difficile/isolamento & purificação , Colite Ulcerativa/patologia , Citomegalovirus/isolamento & purificação , Humanos , MasculinoRESUMO
A t(11;20)(p15;q11) is a rare but recurrent chromosomal aberration, reported in one case of polycythemia vera and a few cases of de novo acute myelocytic leukemia (AML) and therapy-related myelodysplastic syndrome (t-MDS). In t-MDS cases, the translocation resulted in the NUP98/TOP1 fusion transcript. The NUP98 gene has been suggested as the target for therapy-related malignancies. The reciprocal TOP1/NUP98 chimera, however, has not yet been encountered. We report a further case of de novo AML, subtype M2 in the French-American-British (FAB) classification, in which the reverse-transcriptase polymerase chain reaction (RT-PCR) revealed the NUP98/TOP1 chimera and also, for the first time, its reciprocal TOP1/NUP98. The literature review disclosed that, among six cases of de novo AML with t(11;20), the NUP98 gene was shown to be involved in one case and the NUP98/TOP1 chimera was detected in another. The translocation seems to be frequently associated with the FAB M2 subtype, younger age, hyperleukocytosis, and poor prognosis; thus, this translocation may identify a subset of not-therapy-related AML patients with shared clinical features.
Assuntos
Cromossomos Humanos Par 11 , Cromossomos Humanos Par 20 , Leucemia Mieloide Aguda/genética , Translocação Genética , Adolescente , Sequência de Aminoácidos , Sequência de Bases , Análise Citogenética , DNA Topoisomerases Tipo I/genética , Feminino , Humanos , Cariotipagem , Leucemia Mieloide Aguda/classificação , Dados de Sequência Molecular , Complexo de Proteínas Formadoras de Poros Nucleares/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Deleção de SequênciaRESUMO
Germ cell tumours are the most common malignancy among young men; cryptorchidism is a possible risk factor for the development of testicular cancer. Psycho-oncology studies indicate that diagnostic delay can often be explained by different social conditions and that symptoms worsened under lack of appropriate treatment can lead to an urgent admission to the hospital. Nevertheless, germ cell tumours are considered curable malignancies even in advanced stages since the introduction of a chemotherapy regimen based on bleomycin, etoposide and cisplatin. Cell lines derived from germ cell tumours are sensitive to cisplatin-based treatment more than other solid cancers, which is reflected in the good clinical response. We report an unusual manifestation of malignancy in an adult man presenting with a metastatic seminoma of the left testicle. The large ulcerate and necrotic mass suggested a secondary infection from a tumour site. The patient reported surgical orchiopexy for left cryptorchidism in his childhood. Despite worsening of physical features, he had not sought help at the hospital for social reasons. The patient achieved complete clinical remission after receiving standard chemotherapy, and a good objective response of the primitive mass was clearly visible. Complete response was persistent at the 30-month clinical follow-up. The chemotherapy administration was later complicated by acute haemorrage in the site of the primitive tumour that needed urgent surgical management; in addition to this, the artificial graft material was rejected and the arterial prosthesis had to be removed.This case report can be considered for epidemiologic contribute, for clinical relevance despite diagnostic delay and for psycho-oncology studies.
Assuntos
Neoplasias Cardíacas/patologia , Ventrículos do Coração/patologia , Leucemia Promielocítica Aguda/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Diagnóstico Diferencial , Ecocardiografia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/tratamento farmacológico , Humanos , Imunofenotipagem , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/tratamento farmacológico , MasculinoAssuntos
Mieloma Múltiplo/complicações , Talidomida/efeitos adversos , Trombose/induzido quimicamente , Idoso , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Guias de Prática Clínica como Assunto , Talidomida/uso terapêutico , Trombofilia/complicações , Trombofilia/diagnóstico , Trombose/etiologiaRESUMO
A 77-year-old female with polycythemia vera (PV) showed a sudden, typical chronic myeloid leukaemia (CML), 8 yr after the initial diagnosis, and an intermittent treatment with hydroxyurea (0.5-1 g/d) and phlebotomies. At PV diagnosis, the Ph chromosome was negative and no bcr-abl rearrangement was observed; they were both revealed positive at CML onset. Transition of PV to CML is very rare; only seven substantiated cases had been reported in the literature up until now (six from 1964 to 1993). All patients but one received (32)P or alkylating agents for PV treatment. The pathogenetic mechanisms are briefly discussed.
Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Policitemia Vera/patologia , Idoso , Feminino , Humanos , Hidroxiureia/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológicoRESUMO
Haemostatic abnormalities may occur in 1-2% of patients treated with L-asparaginase. Here, we present the second case of a myocardial infarction, developing in a patient with acute lymphoblastic leukemia (ALL), in the course of L-asparaginase treatment. In our patient and in the only one reported case from the literature, a recent exposure to vincristine and daunorubicin was also reported, but induction chemotherapy program was completed as scheduled, with the only withdrawal of L-asparaginase. Myocardial infarction should be included in the list of thrombotic complications possibly associated with L-asparaginase treatment, or with a combination of L-asparaginase and vinca alkaloids/anthracycline.
Assuntos
Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Asparagina/efeitos adversos , Isquemia Miocárdica/induzido quimicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adulto , Asparagina/administração & dosagem , Daunorrubicina/administração & dosagem , Ecocardiografia , Humanos , Masculino , Resultado do Tratamento , Vincristina/administração & dosagemAssuntos
Neoplasias da Medula Óssea/diagnóstico , Neoplasias de Tecido Muscular/diagnóstico , Corticosteroides/uso terapêutico , Neoplasias da Medula Óssea/tratamento farmacológico , Neoplasias da Medula Óssea/patologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias de Tecido Muscular/tratamento farmacológico , Neoplasias de Tecido Muscular/patologiaRESUMO
Leukaemic infiltration of the lungs may occur in acute myeloid leukaemia (AML). Pulmonary infiltrates are usually microscopic and invariably associated with hyperleucocytosis. Four AML patients with respiratory symptoms and low leucocyte counts underwent standard chest radiography, bronchoscopy with bronchoalveolar lavage and high-resolution computerized tomography (HRCT) of the lungs. HRCT scans showed pulmonary infiltrates with alveolar, interstitial, mixed and peribronchial/perivascular patterns in all patients, including one with negative standard radiographic findings. Infectious agents were excluded. Histology of the lung biopsy/autopsy specimens showed leukaemic infiltrates. Pulmonary leukaemia may be the cause of pulmonary infiltrates, even in non-hyperleucocytosic AML patients with low blast counts.