Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019829 (Hodgkin's disease)
 30,247 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe the case of a patient (pt) treated with radiotherapy for Hodgkin's lymphoma at the age of 17. Two years later he presented an apical AMI and underwent coronary angiography (CA) for postinfarction angina. A 40% stenosis of the left anterior descending (LAD) was found in the proximal portion and the vessel was occluded at the middle level. Septal and diagonal branches supplied collaterals to the distal LAD and left ventricular function was only mildly reduced (EF angio-ventriculographic = 52%). We successfully performed a first PTCA, but the pt was re-admitted to our hospital few days later for a new large anterior myocardial infarction with refractory hypotension and low output condition. An intraaortic balloon catheter was inserted and CA demonstrated proximal LAD occlusion; a new PTCA was then performed and the opening of the vessel was obtained after 90' from symptoms' onset. The subsequent course was uneventful and the pt was discharged after 20 days. The ejection fraction was 39%. Thirty days after, a third PTCA with Palmaz-Schatz stent implantation was necessary for unstable angina due to a restenosis of the proximal LAD. After ten months follow-up the pt is asymptomatic with negative exercise test and an angioscintigraphic EF = 47%. CA and intravascular ultrasound demonstrated nor restenosis or progression of the disease, with a good minimal luminal diameter (MLD). A review of the literature on this topic is presented. Moreover we discuss the mechanism of coronary stenosis and occlusion and the reasons for choosing PTCA in the various settings.
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PMID:[A case of radiation-induced coronary occlusion treated with elective and emergency PTCA]. 755 36

Occult or overt but delayed cardiac disease after thoracic radiotherapy for Hodgkin's disease may be common. Detailed cardiac evaluation was performed in 108 patients, mean age 46 +/- 6.2 years, with Hodgkin's disease at 175 +/- 43 months after irradiation. The study protocol included clinical examination, graded treadmill exercise test and echocardiography. Some patients with angina pectoris, previous myocardial infarction and an abnormal ECG were studied by thallium-201 scintigraphy, cardiac catheterization and coronary angiography. Cardiac disease was found in 12 patients (11%). Three patients had angina pectoris, one patient had myocardial infarction, two complained of dyspnea on effort and two had congestive heart failure. At catheterization, constrictive pericarditis was diagnosed in four patients; in two additional patients an occult constrictive pericarditis was found. One patient had both mitral and tricuspidal regurgitation and one had mitral regurgitation alone. Eight patients (7.4%) had severe coronary artery disease; four of these had associated constrictive pericarditis. Four patients had a pericardiectomy and another four had undergone coronary artery by-pass graft. Two patients died after operation from persistent pericardial constriction. It is concluded that the incidence of delayed cardiac disease after radiotherapy is relatively high; chronic pericardial disorders and coronary artery disease are the most frequent manifestations of this disease. Standard surgical treatment may be beneficial because of the relative youth of these patients.
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PMID:Cardiac disease after chest irradiation for Hodgkin's disease: incidence in 108 patients with long follow-up. 760 65

Three male patients, aged 43, 41 and 44 years, were referred to the cardiologist because of complaints of angina pectoris; one of them also had an aortic valve stenosis. Nine to 22 years before, they had received radiotherapy on the mediastinum because of Hodgkin's disease. Coronary angiography showed severe stenoses of the ostium of the right coronary artery or of the main left coronary artery, following which the patients were treated with coronary artery bypass surgery, aortic valve replacement and (or) drugs. These locations are very unusual in patients with angina who did not receive any radiation therapy, but they are seen frequently in patients who have received radiotherapy on the mediastinum. The pathogenesis of these lesions is not exactly known. The normal risk factors for atherosclerosis plus free oxygen radicals are probably involved. The free oxygen radicals, generated by radiation, locally activate coagulation via various hypothetical mechanisms. The damaging effect of radiotherapy could therefore be prevented by antioxidants. However, the therapeutic effect of radiation would most likely decrease as well. A more rational approach to prevent these vascular lesions would be to reduce the radiation load, to treat the risk factors for atherosclerosis and to give platelet aggregation inhibitors such as acetylsalicylic acid.
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PMID:[Coronary stenosis following successful radiotherapy for Hodgkin disease]. 956 61

The authors report a case of cardiac malignant non-Hodgkin lymphoma. The initial clinical presentation suggested recurrent angina in a patient who had undergone angioplasty of the left anterior descending artery two years previously. Echocardiography showed severe left ventricular dysfunction with apical and septal akinesia and also allowed visualisation of two oval masses in the right ventricle without dilatation of the right heart chambers. Transoesophageal echocardiography confirmed these abnormal echos which corresponded to tumour invasion of not only the right heart chambers but also the interatrial septum, the left atrial appendage and the descending thoracic aorta. Histological diagnosis of lymphoma was made from an excision biopsy of a mass in the calf muscle. The post-mortem examination confirmed the presence of a highly malignant T-cell non-Hodgkin lymphoma. The patient rapidly deteriorated and died during the first session of chemotherapy.
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PMID:[Malignant cardiac lymphoma. Diagnosis by echocardiography]. 958 48

We assessed cardiovascular disease (CVD) incidence in 1474 survivors of Hodgkin lymphoma (HL) younger than 41 years at treatment (1965-1995). Multivariable Cox regression and competing risk analyses were used to quantify treatment effects on CVD risk. After a median follow-up of 18.7 years, risks of myocardial infarction (MI) and congestive heart failure (CHF) were strongly increased compared with the general population (standardized incidence ratios [SIRs] = 3.6 and 4.9, respectively), resulting in 35.7 excess cases of MI and 25.6 excess cases of CHF per 10 000 patients/year. SIRs of all CVDs combined remained increased for at least 25 years and were more strongly elevated in younger patients. Mediastinal radiotherapy significantly increased the risks of MI, angina pectoris, CHF, and valvular disorders (2- to 7-fold). Anthracyclines significantly added to the elevated risks of CHF and valvular disorders from mediastinal RT (hazard ratios [HRs] were 2.81 and 2.10, respectively). The 25-year cumulative incidence of CHF after mediastinal radiotherapy and anthracyclines in competing risk analyses was 7.9%. In conclusion, risks of several CVDs are 3- to 5-fold increased in survivors of HL compared with the general population, even after prolonged follow-up, leading to increasing absolute excess risks over time. Anthracyclines further increase the elevated risks of CHF and valvular disorders from mediastinal radiotherapy.
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PMID:Late cardiotoxicity after treatment for Hodgkin lymphoma. 1711 14

Cardiotoxicity is one of the most important adverse event related to anthracycline therapy and can lead in about 1-5% of cases to the occurrence of heart failure. In a higher percentage of patients treated with these drugs asymptomatic left ventricular dysfunction can occur, so that guidelines recommend a strict clinical and echocardiographic monitoring. However, the occurrence of left ventricular dysfunction can be multifactorial and the search of other concurrent etiologies, including ischemic heart disease, is pivotal in particular in patients at high cardiovascular risk. Here is reported the case of a young man with metabolic syndrome in whom the presence of ischemic heart disease was suspected six years after the diagnosis of cardiomyopathy following treatment with anthracyclines for an Hodgkin's lymphoma; in fact, he was submitted to angiography only when symptoms of angina occurred in addition to left ventricular dysfunction. In this patient coronary angiography showed severe coronary artery disease which was treated with angioplasty and stenting. The present case suggest that also in young patients treated with anthracyclines developing left ventricular dysfunction, ischemic heart disease should be suspected in particular for those at high cardiovascular risk. To exclude this diagnosis a cardiac stress test or coronary angiography/computed tomography should be recommended.
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PMID:Suspected post-chemotherapy cardiomyopathy hiding severe three-vessel coronary artery disease in a young patient with metabolic syndrome: should an early angiography be recommended? 2327 88


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