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Query: UMLS:C0019829 (Hodgkin's disease)
 30,247 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The combination of chemotherapy and radiotherapy in Hodgkin's disease has been associated with iatrogenic effects. Forty adult patients were studied to evaluate the early toxicity following three courses of ABVD (cumulative dose of doxorubicin [Adriamycin] 150 mg/m2, and bleomycin 60 mg) and mediastinal irradiation at 40 Gy. Cardiopulmonary toxicity was assessed from six months to three years after completion of irradiation. Of the 40 patients, all of whom were in complete remission from Hodgkin's disease, 6 experienced dyspnea on exertion. In studies related to Cardiac toxicity, the left ventricular ejection fraction ranged from 50 to 77% (mean 63%); 8 patients had a minor pericardial effusion, 4 had valvular calcification, and 6 had minimal cardiac abnormalities. With regard to pulmonary toxicity, CT scan showed a small pleural effusion with pleural thickening in 19 patients and mediastinal or apical fibrosis in 15 patients. The total pulmonary capacity value was low (less than 80%), in 19 patients, and decreased carbon monoxide diffusion capacity (less than 70%) was found in 10 patients. We conclude that early cardiac toxicity was absent despite the use of Adriamycin and mediastinal irradiation. Pulmonary toxicity was present but minor, and it may decrease with the use of smaller fraction sizes for mantle field irradiation.
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PMID:Cardiopulmonary toxicity after three courses of ABVD and mediastinal irradiation in favorable Hodgkin's disease. 171 Sep 23

Pediatric patients presenting with anterior mediastinal masses between January 1980 and November 1988 were reviewed to assess the correlation between tracheal cross-sectional area and anesthetic risks. Forty-two patients had evaluable computed tomography (CT) scans and underwent a surgical procedure. Thirty-four patients had Hodgkin's disease, six had non-Hodgkin's lymphoma, and two had mediastinal teratoma. Tracheal cross-sectional areas were greater than 75% of expected in 19 cases, greater than 50% to 75% in 16 cases, greater than 25% to 50% in five cases, and less than or equal to 25% in two cases. The presence or extent of symptoms did not correlate well with the degree of tracheal narrowing shown by CT scan except for orthopnea. Local anesthesia was used primarily in patients with significant tracheal narrowing (tracheal size was less than or equal to 56% in 5 of 6 patients). General anesthesia with spontaneous ventilation by mask was performed in four patients with tracheal areas of 33%, 73%, 76%, and 98% of expected. General endotracheal anesthesia was utilized in the remaining 32 patients, only three of whom had tracheal areas of less than 50% of expected (down to 30%, 26%, and 24% of expected) and one received preoperative radiotherapy (26%). None of these 32 patients had symptoms of orthopnea or dyspnea at rest, and only one had dyspnea on exertion. All tolerated anesthesia without difficulty. No patient in this series suffered respiratory or cardiovascular collapse during surgery. Adequate biopsy material was obtained in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:CT quantitation of tracheal cross-sectional area as a guide to the surgical and anesthetic management of children with anterior mediastinal masses. 202 69

The aim of the present study was to assess late pulmonary sequelae after treatment for Hodgkin's disease with various treatment modalities. Pulmonary function was studied in 142 patients per median 8 years after treatment for Hodgkin's disease with mantle-field irradiation (54 patients), chemotherapy (26 patients) or mantle-field irradiation followed by chemotherapy (62 patients). Mantle-field irradiation was associated with a primary obstructive and minor restrictive lung function impairment, whereas chemotherapy and combined modality therapy were associated with a restrictive lung function impairment. The number of patients with impaired lung function and the number of patients with complaints of dyspnea, however, were almost the same in the three treatment groups. 5% of the 142 patients had a pathologically low total lung capacity, i.e. values less than 2 standard deviations below predicted values. Pathologically low values of forced vital capacity and forced expiratory volume in 1 second were seen in 33% and 27% of the patients. 33% of the smokers (n = 80) had a pathologically low diffusion capacity in contrast to 8% of the non-smokers (n = 62). Dyspnea on exertion was present in 24% of the 142 patients and was more frequent among patients with pulmonary functional abnormalities. In conclusion, late pulmonary sequelae after treatment for Hodgkin's disease do not provide a basis for choice between otherwise equally effective treatment regimes.
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PMID:Late effects on pulmonary function of mantle-field irradiation, chemotherapy or combined modality therapy for Hodgkin's disease. 232 89

A 39-yr-old woman developed progressive exertional dyspnea 13 yr after receiving mediastinal irradiation for Hodgkin's disease. Chest roentgenogram showed a hyperlucent right lung. Pulmonary blood flow was markedly reduced on the right by ventilation-perfusion scanning. Pulmonary angiography showed attenuation and diffuse atrophy of the right pulmonary artery and its branches. This case represents a late and uncommon complication of mediastinal irradiation manifesting as a unilateral hyperlucent lung.
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PMID:Unilateral lung hyperlucency after mediastinal irradiation. 335 4

A 30-year-old woman with Stage IIIA diffuse non-Hodgkins lymphoma was treated with doxorubicin, cyclophosphamide, vincristine, and prednisone (CHOP) every 3 weeks. When the cumulative doxorubicin dosage after nine courses of chemotherapy was 515 mg/m2 (average, 57 mg/m2/course and 19 mg/m2/week), the doxorubicin was discontinued. She relapsed 4.5 months later while receiving vincristine, prednisone, and an escalated dosage of cyclophosphamide (CVP) every 3 weeks. Single-agent chemotherapy consisting of weekly doxorubicin was administered for 15 courses (average dose 29 mg/m2/week) and resulted in a complete remission after nine courses. The cumulative dosage of doxorubicin was 955 mg/m2 at the end of the 15 courses. Mild cardiomyopathy was noted on left ventricular gated scan and electrocardiogram (ECG) at the cessation of therapy. Mild congestive heart failure occurred shortly after the discontinuation of the doxorubicin. It responded to treatment with digoxin and diuretics. At present, she has no dyspnea on exertion and no evidence of cardiomegaly on chest x-ray films; she continues to use digoxin alone. She remains in complete remission 29 months after discontinuation of intensive, weekly, single-agent doxorubicin administration (compared to a remission of only 4.5 months from the end of less intensive administration of doxorubicin every 3 weeks as part of combination chemotherapy). This case illustrates that intensive doxorubicin administration may be superior to conventional doxorubicin administration for the treatment of lymphomas, and raises the possibility that weekly administration could be superior to administration of doxorubicin every 3 weeks. Further studies investigating the efficacy of weekly versus conventional scheduling of doxorubicin are warranted in non-Hodgkin's lymphoma, particularly in light of published evidence that weekly doxorubicin administration is also less cardiotoxic than treatment given every 3 weeks.
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PMID:The importance of dose intensity of doxorubicin administration in non-Hodgkin's lymphoma. A case report. 375 69

A 30-year-old man with mild exertional dyspnea of recent (2 months) onset was found to have a massive pericardial effusion. The patient had received mediastinal irradiation for Hodgkin's disease over 9 years previously. No evidence of recurrent lymphoma or other causes of pericarditis could be found. Following subtotal pericardiectomy, the patient developed a syndrome characterized by precordial discomfort, low-grade fever, tachycardia, and friction rubs. The electrocardiogram, normal preoperatively, showed diffusely negative T waves. Antimyocardial antibodies appeared in the serum. The syndrome, a hitherto unrecognized sequela of pericardiectomy, is interpreted as a mediastinoepicarditis, of possibly autoimmune origin.
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PMID:Postpericardiectomy syndrome in a patient with radiation-induced pericardial effusion. 661 11

A patient with a history of Hodgkin's lymphoma presented with recurrent left pleural effusions and dyspnea on exertion 27 years after radiation therapy. Further evaluation disclosed suspected radiation-induced constrictive pericarditis, aortic stenosis and regurgitation, and severe coronary artery disease. He underwent successful 3-vessel coronary artery bypass grafting, aortic valve replacement, and pericardiectomy.
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PMID:Three-vessel coronary artery disease, aortic stenosis, and constrictive pericarditis 27 years after chest radiation therapy: a case report. 1684 29

Primary cardiac lymphoma (PCL) is an extremely rare diagnosis. We present a case of a 38-year-old immunocompetent female who presented with dyspnea on exertion and chest pain and the echocardiography revealed a mass in the left atrium (LA) causing moderate mitral regurgitation and mimicking a left atrial myxoma. The patient was managed with excision of the mass and mitral valve replacement followed by chemotherapy. The histopathology revealed B-cell non-Hodgkin lymphoma (NHL) with tumor cells showing immunoreactivity with CD20 and negative for CD45RO.
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PMID:Left atrial primary B cell lymphoma presenting with mitral regurgitation. 2238 58

Non-Hodgkin lymphoma generally affects the thorax in nearly half of the cases, but endobronchial non-Hodgkin lymphoma is rare. A 65-year-old man presented with refractory cough and progressive dyspnea on exertion of 2 months' duration. The patient denied fever, weight loss, or night sweats. A chest x-ray revealed bilateral lower lobe infiltrates. A computed tomography scan of the chest revealed large matted mediastinal lymph nodes without clear margination. Bronchoscopic examination revealed bilateral endobronchial diffuse nodular lesions. Bronchial mucosal biopsy demonstrated B-cell lymphoma. The patient was treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen with near-total resolution of endobronchial and parenchymal lesions.
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PMID:Endobronchial involvement in non-Hodgkin lymphoma. 2320 59

The long-term sequelae of mantle radiotherapy include lung disease and cardiac disorders. Dyspnea on exertion is a common complaint and can be due to one or more pathologies. We describe a case of mantle radiotherapy-induced mitral stenosis, characterized by aorto-mitral continuity calcification and absent commissural fusion which precludes balloon valvotomy. The latency period is long, and this patient presented 42 years after radiotherapy. Importantly, as previously described with radiation-induced valve disease, significant mitral stenosis developed 10 years after surgery for significant aortic stenosis. Two-dimensional and three-dimensional transthoracic and transesophageal echocardiography should be considered during assessment of symptomatic survivors of Hodgkin's disease where the index of suspicion for valvular stenosis increases over time. Given the natural history of mantle radiation valvular disease, a lower threshold for surgical intervention in radiation-induced mitral stenosis may need to be considered if cardiac surgery is planned for other reasons in order to avoid repeated sternotomy in patients with prior irradiation.
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PMID:Echocardiographic Assessment of Mantle Radiation Mitral Stenosis. 2649 26


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