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Query: UMLS:C0023418 (leukemia)
 93,477 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five children in remission from acute lymphoblastic leukaemia developed bronchiectasis when on chemotherapy. Persistent collapse or consolidation on chest radiographs was helpful in suggesting the diagnosis. Necropsy established the diagnosis in one child who died of massive haemoptysis when in complete remission, and bronchography confirmed the diagnosis in three. In a further child the diagnosis was based on clinical and chest X-ray findings alone. The surviving children were treated with prophylactic rotating antibiotics. Routine chest radiographs are recommended in children with acute lymphoblastic leukaemia, as bronchiectasis may otherwise be underdiagnosed.
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PMID:Bronchiectasis in acute leukaemia. 27 Mar 86

Infection, hemorrhage and adult respiratory distress syndrome (ARDS) are pulmonary complications occurring after remission induction therapy for acute leukemia. The aim of this study was to analyze the incidence of these causes by serial roentgenogram, clinical, microbiological and laboratory tests in 21 patients (pts) with relapsed acute leukemia (18 X myeloid, 3 X lymphoblastic), an AML-pt (acute myeloid leukemia) suffering from secondary leukemia, and three pts with primary refractory leukemia following treatment with intermediate (IM) and high-dose cytosine arabinoside (HD-Ara C), in combination with amsacrine (AMSA)(n = 19), etoposide (VP 16) (n = 5) or Mitoxantrone (n = 1). Eleven out of 25 pts developed pulmonary complications, one of them with massive hemoptysis and roentgenographic signs of pulmonary bleeding, one suffering from protracted shock after a tumor lysis syndrome, two pts showing symptoms of a cardiogenic pulmonary edema complicating severe Candida pneumonia in one case and legionnaires' disease in the other. Seven of the eleven pts had a non-cardiogenic pulmonary edema with respiratory failure 1-14 days after cessation of induction or consolidation therapy. In six of the seven, there were no signs of cardiogenic, infectious or metabolic reasons, including fluid overload, for the pulmonary edema, one had as a contributing factor a Candida infection of the lung. Three of the seven patients recovered, four died (two following IM and two after HD-Ara C). Other adverse side effects, clearly attributable to HD-Ara C, included delirious state (n = 3), generalized erythema (n = 3), acute pancreatitis (n = 2), acute abdomen (n = 1) and conjunctivitis in almost all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Non-cardiogenic pulmonary edema complicating intermediate and high-dose Ara C treatment for relapsed acute leukemia. 336 72

The etiologic factors of major (greater than or equal to 200 ml/24 hr) and massive (greater than or equal to 1,000 ml/24 hr) hemoptysis may well affect the outcome and, therefore, the treatment of this often life-threatening problem. the decline in the incidence of tuberculosis (TB) and bronchiectasis, along with the increase in bronchitis and neoplasia, have led to a strong institutional bias against operating on patients with major and massive hemoptysis. A retrospective case study and an extensive literature review were undertaken to critically evaluate this policy. Fifty-nine consecutive patients with major hemoptysis, 26 of whom had massive hemoptysis, were identified from 887 patients seen in our institution over a 10-year period. Only four of these 59 patients underwent surgery, while 55 were managed conservatively. Etiologic factors, operability, and bleeding rate all appeared to play a major role in outcome. No patients with bronchitis, bronchiectasis, tuberculosis, or who were on anticoagulation therapy died compared to a mortality rate of 59% in patients with carcinoma (CA) of the lung and 71% in patients with leukemia. Eleven percent of operable patients treated conservatively died compared to a 46% mortality rate for nonoperable patients. And, 9% of patients with bleeding rates less than 1,000 ml/24 hr died compared to 58% of those with greater than or equal to 1,000 ml/24 hr. Conservative management appears to have a low mortality in patients with non-tuberculosis-related major hemoptysis as well as in many patients with massive hemoptysis, especially those patients who are operable and those without neoplastic disease.
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PMID:Major and massive hemoptysis: reassessment of conservative management. 342 80

The air crescent sign is regarded as an important diagnostic finding in invasive pulmonary aspergillosis (IPA). This study examined the incidence, clinical importance, and natural history of air crescents in 25 patients with acute leukemia and IPA. Twelve (50%) of the patients had cavities (ten with an air crescent) that appeared an average of 15 days after the initial infiltrate. The diagnostic utility of the air crescent sign was relatively minor; cavities developed after the diagnosis was established in 50% of cases and after therapy was started in 75% of cases. In each case, the pneumonia improved at the time of cavitation. In six patients (50%), the cavities resolved over 2-8 months. Three patients (25%), however, experienced massive hemoptysis. Air crescent formation, previously shown to be dependent on granulocyte recovery, was associated with improved survival (67%) compared with the group without cavitation (8%). In the latter group, the pneumonia in ten (77%) of 13 patients progressed to diffuse disease. In patients with leukemia, the diagnostic value of the air crescent sign is limited by cavities that develop relatively late, as the infection improves after white blood cell recovery; cavities that do not occur in patients who remain neutropenic; and associated hemorrhage, at times life-threatening, that obscures the air crescent. The diagnosis of IPA should not await observation of air crescents in these patients.
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PMID:Invasive pulmonary aspergillosis and acute leukemia. Limitations in the diagnostic utility of the air crescent sign. 405 47

We report the case of a 32-year-old man with a mycotic aneurysm of the left subclavian artery. This patient had immunosuppression caused by chemotherapy administered for treatment of leukemia. This aneurysm was revealed by two episodes of hemoptysis caused by a lung parenchyma fistulization. The patient was treated successfully by simple ligation and exclusion via a thoracotomy with partial lung resection. Histologic examination confirmed the presence of aspergilloma filaments in the false aneurysm. We suspect that aspergilloma could have been the cause of the mycotic aneurysm in this particular case. The literature on subclavian artery mycotic aneurysms is reviewed.
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PMID:Mycotic aneurysm of the left subclavian artery presented with hemoptysis in an immunosuppressed man: case report and review of literature. 770 74

A retrospective study on a consecutive series of 116 patients affected by acute leukaemia with documented pulmonary filamentous mycosis (FM) admitted between 1987 and 1992 to 14 tertiary-care hospitals in Italy was made in order to evaluate the characteristics of those patients who developed fatal massive haemoptysis. In 59/116 cases of pulmonary FM the infection was the principal cause of death and in 12 of these patients a massive haemoptysis was responsible for death. The diagnosis of FM infection was made ante-mortem in only four out of these 12 patients. The autopsy was performed in 11/12 patients and documented a FM infection. The mycetes isolated were: Hyphomycetes spp. (three patients), Mucorales spp. (two patients), Aspergillus spp. (seven patients). At the time of the massive haemoptysis the mean neutrophil count was 7.2 x 10(9)/l, and no patient had relevant thrombocytopenia (mean 184 x 10(9)/l, range 28-350) or coagulative abnormalities. The mean time which elapsed between resolution of chemotherapy-induced neutropenia (WBC < 10(9)/l) and occurrence of haemoptysis was 7 d. No signs or symptoms predictive of this fatal complication were identified. Massive haemoptysis can be the cause of death in patients with acute leukaemia and pulmonary FM which in the majority of patients was not diagnosed in vivo. This complication occurs most frequently shortly after the recovery from chemotherapy-induced aplasia. The mechanism of lesion is unknown, but it may involve the vascular tropism of FM and the release of leucocyte enzymes. Better preventive and therapeutic antifungal treatments are needed to avoid this serious, albeit rare, complication.
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PMID:Fatal haemoptysis in pulmonary filamentous mycosis: an underevaluated cause of death in patients with acute leukaemia in haematological complete remission. A retrospective study and review of the literature. Gimema Infection Program (Gruppo Italiano Malattie Ematologiche dell'Adulto) 875 37

Mucormycosis is an opportunistic fungal infection that commonly begins by invading the respiratory tract. The purpose of the present study was to define the clinical presentation of pulmonary mucormycosis and to evaluate current treatment regimens. Thirty patients treated at our institution and 225 cases reported in the literature were reviewed. For the combined groups, the mean age at presentation was 41 +/- 21 years and associated medical conditions included leukemia or lymphoma (37%), diabetes mellitus (32%), chronic renal failure (18%), history of organ transplantation (7.6%), or a known solid tumor (5.6%). The in-hospital mortality was 65% for patients with isolated pulmonary mucormycosis, 96% for those with disseminated disease, and 80% overall. The mortality in patients treated surgically was 11%, significantly lower than the 68% mortality in those treated medically (p = 0.0004). The most common causes of death were fungal sepsis (42%), respiratory insufficiency (27%), and hemoptysis (13%). Pulmonary mucormycosis has a high mortality; however, antifungal agents appear to improve survival. In addition, surgical resection may provide additional benefit to patients with pulmonary mucormycosis confined to one lung.
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PMID:Pulmonary mucormycosis: results of medical and surgical therapy. 816 12

Eight patients with acute leukemia (AL) and invasive pulmonary aspergillosis (IPA) developing during previous antileukemic therapy underwent BMT (autologous in 6 cases and allogeneic 2). IPA was treated prior to BMT with full doses of amphotericin B, associated with surgical resection in three cases. One patient was treated with amphotericin B and itraconazole. Prior to BMT, seven patients had minimal residual pulmonary lesions. All patients received amphotericin B (0.5 mg/kg/day) during the aplastic period prior to engraftment. One patient died of Gram-negative septic shock before engraftment. Seven patients achieved complete hematological engraftment without any evidence of IPA reactivation. Amphotericin B was well tolerated with only minimal transient renal dysfunction in three patients. Later pulmonary complications related to IPA were observed in only one patient who developed a self-limited episode of hemoptysis. One patient died of CMV pneumonitis and two of leukemia relapse. Four patients survive disease-free and without complications related to IPA. We conclude that the reactivation of correctly treated IPA can be successfully prevented in BMT patients by use of prophylactic amphotericin B. With this approach, prior IPA is not a contraindication to BMT.
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PMID:Invasive pulmonary aspergillosis prior to BMT in acute leukemia patients does not predict a poor outcome. 824 83

We describe a patient who suffered from a bacterial pneumonia and had a left-sided infiltrate on his chest radiograph. He was found to be cytopenic and acute myeloid leukemia was diagnosed. A complete remission was achieved after chemotherapy, and the patient was scheduled to have autologous bone marrow transplantation. Bronchoscopy was performed because of persistent hemoptysis and a squamous cell carcinoma in the right upper lobe bronchus was found. This small tumor was successfully treated with photodynamic therapy preventing any delay in the treatment of his leukemia, which would have occurred if surgery had been the treatment of choice. The patient is still in complete remission after a follow-up period of 12 months.
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PMID:Photodynamic therapy as an alternative treatment for surgery in a patient with lung cancer undergoing bone marrow transplantation. 840 30

A 44-year-old woman with malignant T-cell lymphoma and secondary leukemia received an allogeneic bone marrow transplant (BMT). She had received BMT conditioning treatment with total body irradiation and chemotherapy. Hemoptysis and progressive dyspnea developed 11 days after the transplant. A chest roentgenogram showed bilateral diffuse infiltrates. Bronchoalveolar lavage fluid was bloody, and diffuse alveolar hemorrhage (DAH) was diagnosed. Respiratory failure progressed despite mechanical ventilation and administration of corticosteroids. The patient died 58 days after the transplant DAH after BMT has been recognized in western countries as a syndrome with high mortality. We draw attention to the fact that DAH is a serious early pulmonary complication of BMT also in Japan.
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PMID:[Diffuse alveolar hemorrhage after allogeneic bone marrow transplantation]. 877 82


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