430 research outputs found
Spleen sizing by ultrasound scan and risk of pneumococcal infection in patients with chronic GVHD: preliminary observations.
Encapsulated bacteria infections (EBI) can cause severe complications after BMT, usually occurring in patients with chronic GVHD (cGVHD) and attributed to functional hyposplenism. Using ultrasound (US) scan, we measured spleen size in 22 patients transplanted from HLA identical siblings, with or without cGVHD. No patient had received TBI, spleen irradiation or penicillin prophylaxis. Results were correlated with occurrence of EBI during a mean follow-up of 55 months (range 7-93). In the group without cGVHD, the difference between pre- and post-BMT spleen longitudinal diameters was not significant, and no patient developed EBI. In the cGVHD group, post-BMT spleen longitudinal diameters were significantly smaller than those pre-BMT (9.1 ± 1.6 vs 12.3 ± 2.2; P = 0.0005). Out of four patients with cGVHD who showed a major spleen size reduction, two developed a severe infection (an overwhelming sepsis and a pneumococcal meningitis). In our small series, we found a borderline relationship between spleen size reduction and duration of cGVHD (P = 0.06), as well as an increased risk of life-threatening infection in patients with extensive cGVHD and hyposplenism as detected by US scan. We conclude that US scan may be useful to detect spleen size reduction following allogeneic BMT and that penicillin prophylaxis is to be strongly recommended in patients with extensive cGVHD and spleen size reduction, even in those who have not received total body or spleen irradiation
Budd-Chiari syndrome in chronic myeloid leukemia.
A29-year-old Ph-positive patient in accelerated
phase chronic myeloid leukemia (CML) with
marked thrombocytosis developed fever,
abdominal pain and signs of severe acute hepatitis,
although was negative for viral markers. Real-time
and Doppler ultrasound (US) scan showed marked
hepatomegaly, caudate lobe hypertrophy (Figure 1),
failure to visualize hepatic veins and their flow, portal
vein ectasy with slow hepatopetal flow, splenomegaly
and massive ascites. MRI and angiography
confirmed occlusion of all hepatic veins and partial
obstruction of the inferior vena cava hepatic segment,
likely due to disproportionate caudate lobe
enlargement. These findings suggested Budd-Chiari
syndrome (BCS); treatment was diuretics, anticoagulants,
chemotherapy and peritoneum-jugular
shunt. Liver histology, obtained by uncomplicated
percutaneous biopsy, confirmed the diagnosis (Figure
2
Ultrasound exploration in the work-up of unexplained fever in the immunocompromized host: preliminary observations.
In immunocompromized hosts, febrile episodes
have an unknown origin (FUO) in about fifty per
cent of cases. In this preliminary study we evaluated
the role of abdominal and pleural ultrasound
(US) examination for early detection of infectious
sites. US exploration was performed in a cohort of
14 consecutive FUO patients early after fever
onset, at patients’ bedside, by a hematologist
trained in diagnostic ultrasound, and it was
repeated at neutrophil recovery. US exploration
showed abnormal abdominal findings in 7 and
pleural effusion in 3 patients. In all cases but one
the abnormality was found at the first US examination.
Abdominal and pleural US exploration is a
low-cost, easy to use tool for the work-up of FUO
in the immunocompromized host that proved to
be effective in identifying the infection site in about
50% of patients
Improved management of neutropenic enterocolitis using early ultrasound scan and vigorous medical treatment.
Ultrasound scan to detect acalculous cholecystopathy in immunocompromised hosts with unexplained fever.
We found a significant prevalence of acalculous
cholecystopathy in a group of patients with hematologic
malignancies and unexplained fever. Ultrasound
scan (US) detected a case of acute cholecystitis,
two of gallbladder overdistension and biliary
sludge, and one of striated gallbladder wall thickening.
US proved effective in early identification of
abdominal infection site
Evolution and nucleosynthesis of primordial low mass stars
We discuss in detail the evolutionary properties of low mass stars M< 1
M(Solar) having metallicity lower than Z=10^(-6) from the pre- main sequence up
to (almost) the end of the Asymptotic Giant Branch phase. We also discuss the
possibility that the large [C,N/Fe] observed on the surface of the most Iron
poor star presently known, HE0107-5240, may be attributed to the autopollution
induced by the penetration of the He convective shell into the H rich mantle
during the He core flash of a low mass, very low metallicity star. On the basis
of a quite detailed analysis, we conclude that the autopollution scenario
cannot be responsible for the observed chemical composition of HE0107-5240
Combined treatment with amphotericin-B and granulocyte transfusion from G-CSF-stimulated donors in an aplastic patient with invasive aspergillosis undergoing bone marrow transplantation.
Granulocyte transfusions from G-CSF stimulated donors were added to standard anti-infective treatment in preparation for and during allogeneic bone marrow transplantation in a young man affected by very severe acute aplastic anemia and invasive aspergillosis. Nine concentrates with a mean neutrophil content of 18.7x109/L (2.6x 108/kg patient b.w.) were transfused before and after marrow infusion. An impressive clinical improvement was noticed after each granulocyte transfusion, although this was not always paralleled by a neutrophil increase in the peripheral blood. Engraftment (N>0.5x109/L and PIt >25x109/L) was verified at +16 and +40 days, respectively. The patient is currently in complete hematological and microbiological remission 14 months after transplantation. Granulocyte apheresis from G-CSF stimulated donors provides a high number of activated neutrophils. At the dose given (300 ÎĽg/day) donor tolerance to G-CSF was excellent. This new approach is indicated when life-threatening infections develop in patients exposed to prolonged severe neutropenia
Small bowel infarction by Aspergillus.
Primary gut involvement by Aspergillus is a rare and often fatal complication of intensive antileukemic therapy. We describe the case of an adult patient affected by acute leukemia who developed a small bowel fungal thromboembolism without radiographic evidence of lung involvement during the post-induction aplastic phase. The diagnosis was made histologically at laparotomy performed for small bowel perforation. The patient died a week later in spite of amphotericin-B treatment and neutrophil recovery. Anti- Aspergillus prophylaxis and early introduction of amphotericin-B in the treatment of febrile neutropenia is probably advisable in all cases of AML
I learn. You learn. We learn? An experiment in collaborative concept mapping.
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Liver nodular regenerative hyperplasia after bone marrow transplant.
We report an unusual liver disease which may occur after bone marrow transplantation, i.e. the collapse of hepatic lobuli followed by regenerative islets: the resulting clinical picture may mimic GvHD or a viral disease, but histology is diagnostic, showing nodular regeneration in the absence of inflammation or fibrosis
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