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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The toxicity of a new chemotherapeutic regimen for CNS tumors using eight anticancer agents administered in a 12-hour period was evaluated in 34 children with newly diagnosed and recurrent tumors treated at the Children's Hospital and Medical Center in Seattle. The chemotherapy included methylprednisolone, vincristine, lomustine (CCNU), procarbazine, hydroxyurea, cisplatin (CDDP), and either cyclophosphamide or imidazole carboximide (DTIC). The first five patients additionally received high-dose methotrexate (HDMTX), but because of excessive toxicity this was replaced by cytarabine. Of 125 courses administered without HDMTX, red cell transfusions were required in 15% of the courses and platelet transfusions were required in 8%. Hospitalization for empiric treatment of fever associated with neutropenia occurred in 6% of courses. Three episodes of documented sepsis occurred. Virtually all hematologic toxicity occurred in patients with recurrent disease. Renal toxicity occurred in 14% of patient courses. One patient died of renal failure and sepsis following therapy. Neurologic and hepatic complications were infrequent. High-frequency hearing loss above the voice range was common, but clinically significant hearing loss occurred in only three patients. Severe nausea and vomiting were infrequent. Overall, the toxicity of "eight in one" chemotherapy in newly diagnosed patients was minimal; toxicity was greater in patients with recurrent disease.
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PMID:Eight drugs in one day chemotherapy in children with brain tumors: a critical toxicity appraisal. 337 69

We report 50 immunocompromised patients with pulmonary infiltrates who underwent fibreoptic bronchoscopy, including bronchoalveolar lavage, on 56 occasions. The underlying diseases were mostly lymphoma, leukemia, other malignancies and renal failure. The commonest immunodeficiency factors were chemotherapy, steroids and neutropenia. A positive diagnosis could be made from analysis of the bronchoalveolar lavage on 59% (33/56) occasions. This was a comparable yield to transbronchial lung biopsy 57% (16/27), and superior to proximal airways wash 24% (13/55), or bronchial brushings 29% (10/34). Open lung biopsy added additional diagnostic information in three of the four cases in which it was performed. The most common final diagnoses were bacterial, viral or Pneumocystis carinii pneumonia and recurrent malignancy. We conclude that bronchoalveolar lavage is a safe procedure with a high diagnostic yield in the immunocompromised host with suspected opportunistic pneumonia.
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PMID:The role of bronchoalveolar lavage in the diagnosis of suspected opportunistic pneumonia. 350 11

Diseases affecting host defense mechanisms include neutropenia, aplastic anemia, leukemia, lymphocytopenia (B- and T-lymphocyte abnormalities), deficiencies of complement, splenectomy, diabetes mellitus, renal failure, and autoimmune diseases. Immunocompromised patients face frequent life-threatening complications of infections, particularly when they are hospitalized and receiving cytotoxic myelosuppressive drugs. Oral antimicrobial agents affect the flora of the host's alimentary tract, enhancing colonization by resistant, potentially pathogenic, strains and species, especially in a hospital environment. Nalidixic acid, oxolinic acid, pipemidic acid, polymyxins, co-trimoxazole, polyene antibiotics, and framycetin, which preserve anaerobic colon flora, do not affect the host's colonization resistance and can be given in oral doses high enough to suppress and clear susceptible potential pathogens from the intestinal tract. Such prophylactic treatment permits patients to stay hospitalized in ward conditions. In the compromised host who has fever and suspected septicemia, a decision concerning treatment should be made within an hour of notification of the patient's condition. In acute stages of life-threatening infection, the principal aim of antimicrobial chemotherapy is to provide the most potent treatment; at this stage, the accompanying side effects are less important. An essential component of therapy should be an aminoglycoside paired with a beta-lactam antibiotic. Because the incidence of staphylococcal resistance to antibiotics is high, preliminary sensitivity-testing is essential when staphylococcal sepsis threatens the life of a compromised host. Despite aggressive antibiotic therapy, more than half of immunocompromised patients and patients with severe underlying diseases die when gram-negative bacteria invade their blood. In these patients, medical or surgical removal of the septic focus is a major part of management, but plasma or plasma fractions should be given to correct hypovolemia, and an agent such as dopamine should be administered if volume replacement fails to restore adequate blood pressure. A high dose of corticosteroids should have a beneficial effect, and, for neutropenic patients with gram-negative bacteremia or fever, transfusion with functional neutrophils improves survival.
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PMID:Infections in immunocompromised patients. II. Established therapy and its limitations. 385 79

29 episodes of suspected septicaemia in patients with acute leukemia were treated empirically with tobramycin 180--240 mg/day intravenously together with cephalothin 12 g/day. Patients without documented infection who did not respond to antibiotics and whose fever developed after a course of cytotoxic drugs, were given the provision of high dose corticosteroid therapy. Infection was documented microbiologically or clinically in 13/29 episodes. Septicaemia was proven in 7, and 6 had pneumonia. Neutropenia was present in 18/29 episodes. A satisfactory response to initial therapy was achieved in 7/13 with documented infection and in 9/16 without proven infection. The overall good response was 55%, 5/7 cases with septicaemia, but only 2/6 with pneumonia responded well. The 2 septicaemia patients who did not respond had Pseudomonas aeruginosa sepsis. In 16 episodes without documented infection 7 did not respond to initial therapy. To 4 of them, who were subject to recent cytotoxic drug administration, high dose corticosteroid therapy was given, and 3 of them responded well. Of the remaining 3 non-responders, one became afebrile after cytostatic and one after prednisolone treatment. Serum assays of tobramycin were done on the 1st and 5th day of therapy and no difference in concentration was observed on these 2 occasions. Five patients developed renal failure, but this was attributed to antibiotic therapy only in 1, who initially had an elevated serum creatinine. It is concluded, that in hospitals where pseudomonas is not a dominating pathogen, tobramycin--cephalothin may be a good combination to start empiric therapy with. In patients without proven infection, who have recently been subjected to cytotoxic therapy, and who do not respond to the initial course of antibiotics, a high dose of corticosteroids may be tried, provided the patient is monitored for the hazard of bacterial infection.
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PMID:Empiric treatment of fever in acute leukaemia with tobramycin-cephalothin, and the escape clause provision of corticosteroids. 737 25

In a prospective study of 210 consecutively seen patients receiving nafcillin, no patient's therapy was discontinued because of clinically manifested or suspected nephritis. Administration of nafcillin was discontinued because of an adverse reaction in only two patients, one with a rash and one with neutropenia. In seven of the ten patients in whom renal dysfunction developed during treatment, renal function improved while the patients continued to receive nafcillin. In the remaining three patients, renal failure was attributed to other factors including rhabdomyolysis and myoglobinuria, gastrointestinal hemorrhage and hypotension, and what appeared to be aminoglycoside toxicity. No renal biopsy studies were done because none were clinically indicated. Although the results of this study do not rule out the possibility that nafcillin may induce nephritis, if it does occur it appears in such a mild form-manifested solely as urinary sediment abnormalities-or so infrequently that it was not detected in this group of patients. In four patients, leukopenia could not be explained on any basis other than nafcillin administration.
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PMID:Absence of nafcillin-associated nephritis. A prospective analysis of 210 patients. 746 7

In the treatment of serious infection by aminoglycoside antibiotics multiple daily treatment with netilmicin is considered to be the least toxic. Studies comparing netilmicin with gentamicin using the less toxic once-daily schedule are lacking. A randomized prospective study was designed to evaluate the efficacy and toxicity of once-daily netilmicin with gentamicin treatment in patients with serious infections. Consecutive patients with serious infections were randomized between gentamicin 4 mg/kg q24h iv or netilmicin 5.5 mg/kg q24h iv. Exclusion criteria were neutropenia or severe renal failure. A good clinical response was observed in 50 of the 54 evaluable patients (92.6%) treated with gentamicin and in 48/52 (92.3%) netilmicin treated patients. Nephrotoxicity developed in 5/72 (6.9%) gentamicin patients and in 10/69 (14.5%) treated with netilmicin. Audiometry was performed with high-frequency audiometry when possible; no significant differences were found between the two aminoglycosides. We conclude that with once-daily treatment no benefit of netilmicin over gentamicin regarding nephro- or ototoxicity could be demonstrated.
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PMID:Ototoxicity and nephrotoxicity of gentamicin vs netilmicin in patients with serious infections. A randomized clinical trial. 763 15

To determine if ganciclovir given three times per week post-transplant is tolerable and effective for prevention of cytomegalovirus (CMV) infection in recipients of T cell-depleted marrow from related or unrelated donors, we have used ganciclovir 2.5 mg/kg iv three times daily on days -8 to -2 and 5 or 6 mg/kg iv 3 times per week from engraftment to day 100 as CMV prophylaxis for 51 adults who were CMV-seropositive or had seropositive donors. All patients received iv immunoglobulin 500 mg/kg weekly and CMV-negative or filtered blood products. Blood and urine were tested for CMV at weekly intervals through day 100. All patients received ganciclovir pre-transplant. Ten patients did not receive ganciclovir post-transplant (5 deaths, 3 graft failure, 1 renal failure, 1 required foscarnet). The median time to initiation of ganciclovir was 27 days (range 17-59 days) and the median duration of therapy was 51 days (range 5-83 range). Twelve patients had dose reductions (3 neutropenia and 9 renal insufficiency). Seven patients died before day 100, 2 had indications to change to foscarnet, 15 discontinued ganciclovir because of neutropenia and 17 completed the full ganciclovir course through day 100. G- or GM-CSF was given to 29 patients with neutrophils < 1.5 x 10(9)/l (10 had neutrophils < 0.5 x 10(9)/l) but only 12 of them could continue full-dose ganciclovir. Bacteremia occurred in 12 of the neutropenic patients. At day 120, the actuarial rate of CMV infection was 58% (95% CI 42-74%) and that of CMV disease was 36% (95% CI 21-51%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ganciclovir three times per week is not adequate to prevent cytomegalovirus reactivation after T cell-depleted marrow transplantation. 801 72

Consecutive patients with serious infections were randomized between gentamicin 4 mg/kg once daily i.v. or netilmicin 5.5 mg/kg once daily i.v. (with dosage reduction in case of renal dysfunction). Exclusion criteria were neutropenia or severe renal failure. Median first serum trough and peak concentrations were 0.4/9.5 mg/L and 0.4/12.2 mg/L, for gentamicin and netilmicin respectively. A good clinical response was observed in 50/54 (92.6%) evaluable patients treated with gentamicin and in 48/52 (92.3%) netilmicin-treated patients. Nephrotoxicity (a rise of serum creatinine > or = 45 mumol/L) developed in 5/72 (6.9%) gentamicin patients treated > or = 48 hours and in 10/69 (14.5%) netilmicin patients (difference 7.5%, 95% CI -3.9% to +16.2%). High-tone audiometry was performed when possible; no significant differences were found between the regimens with regard to hearing loss or prodromal signs of ototoxicity. We conclude that with once-daily dosing no benefit of netilmicin over gentamicin regarding nephro- or ototoxicity could be demonstrated.
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PMID:Once-daily gentamicin versus once-daily netilmicin in patients with serious infections--a randomized clinical trial. 805 1

Pulmonary invasive aspergillosis is a frequent and poor prognosis complication of immuno-deficiency and prolonged neutropenia. Its treatment is usually based on amphotericin B (0.7 to 1 mg/kg/d) given as intravenous infusions for at least 2 months. This therapy is limited by the side-effects of the drug including renal failure, myelosuppression, chills and fever. We present here the case of women with pulmonary invasive aspergillosis treated with a different modality of administration. The amphotericin B was given as a continuous infection at 2 mg/kg/d diluted in Intralipid, a triglyceridic mixture used in parenteral nutrition. Given by this way amphotericin B seems to have a good therapeutic efficiency and a mild toxicity limited to transient reduction in creatinine clearance with increased kaliuria. Other current approaches of invasive aspergillosis include the amphotericin B in liposomes, combination of amphotericin B with 5-fluorouracil and the triazolated compounds.
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PMID:[Pulmonary invasive aspergillosis: value of treatment with intravenous amphotericin B administered in a triglyceride emulsion for parenteral usage]. 805 44

We observed a patient who developed severe autoimmune neutropenia, thrombocytopenia, and membranoproliferative glomerulonephritis with severe acute renal failure during the course of an apparent viral illness. Viral inclusion bodies were found on urinary cytopathology and tubular cells in the urine as well as in the renal parenchyma on a renal biopsy. However, all viral cultures and serology were negative or normal. The renal failure improved with rehydration and high-dose intravenous IgG. The neutropenia and thrombocytopenia responded only briefly but were brought into prolonged remission by oral administration of prednisone.
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PMID:Glomerulonephritis, thrombocytopenia, and autoimmune neutropenia probably induced by a virus-like illness: case report and review of the literature. 858 27


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