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Biomedical subjects

L Pagano

Publications and source records attributed to L Pagano.

143 records · Page 8Linked to original sources
PubMedDate not supplied

Rhinocerebral zygomycosis in acute lymphoblastic leukaemia.

We describe a patient with acute lymphoblastic leukaemia who developed rhinocerebral zygomycosis during the aplastic phase induced by antineoplastic chemotherapy. The patient was treated with fluconazole intravenously (400 mg daily) for 30 days and underwent surgical debridement. As a result of this treatment a complete remission of the zygomycosis-associated symptoms was observed. The possibility of treating zygomycosis with fluconazole is discussed.

Adult↗
PubMedDate not supplied

In vitro susceptibility of Candida species isolated from patients with haematological malignancies.

Candida spp. (83 isolates including C. (Torulopsis) glabrata) were tested in vitro for their susceptibility to 5-fluorocytosine, amphotericin B, ketoconazole, itraconazole, fluconazole, and miconazole. The yeasts were isolated from clinical specimens, mostly from the lower respiratory tract, of 30 oncologic patients, 27/30 with haematological malignancies, during a 6-month period (December 1991-May 1992). Minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC) values of the 6 drugs were obtained for each yeast using a microdilution broth method developed in our laboratory. Amphotericin B, and 5-fluorocytosine were active against the majority of the yeasts with MIC90/MFC90 values within achievable serum concentrations (3.12/6.25 micrograms ml(-1) and 0.625/0.625 micrograms ml(-1) respectively). Azole derivatives showed a species-specific activity. MFC values were two to four times higher than those of the MICs, confirming the fungistatic rather than fungicidal activity of azole derivatives. An interesting correlation was found when the in vitro susceptibility values of the isolates were compared with data of patients with or without antifungal prophylaxis or therapy during that period. In general, with respect to fluconazole, C. albicans strains isolated from patients who received no treatment showed MIC and MFC values lower than those obtained from patients who were under prophylaxis or treatment with this drug. Fluconazole administration appears to influence in vitro susceptibility testing.

Antifungal Agents↗
PubMedDate not supplied

Serum lactate dehydrogenase isoenzyme pattern in non-Hodgkin's lymphomas.

Serum lactate dehydrogenase (S-LDH) and its isoenzyme pattern were assayed in 63 non-Hodgkin's lymphoma (NHL) patients, 37 at diagnosis, 15 at relapse and 11 in complete remission (CR). S-LDH in NHL patients with active disease was higher than in normal subjects and CR patients (p less than 0.001). Among the isoenzymes, LDH-2 and LDH-5 showed no remarked differences; LDH-1 was reduced and LDH-3 and LDH-4 raised in comparison to the normal group (p less than 0.001). S-LDH levels and isoenzymes 1 and 4 were influenced by the stage, the histological subgroup and by the presence of general symptoms. In fact, cases in stage IV, with "high-grade malignancy" and with general symptoms, had higher S-LDH levels and more evident LDH-1 and LDH-4 changes than the other stages, the other histopathological subgroups and the cases classified as "A". S-LDH was the same as in normal subjects in the "low-grade" and "intermediate-grade" malignancies as was LDH-1 in stage II and LDH-4 in stages II and III, in "low-grade" malignancy and in the A cases. In contrast, LDH-3 was always high, with no significant difference in relation to the variables considered. Thus, in NHL, LDH-3 seems to be a reliable marker of the presence of the disease in any case, whereas S-LDH is more related to the spread of the lymphoma.

Adolescent↗
PubMedDate not supplied

Oral idarubicin plus cytosine arabinoside in the treatment of acute non lymphoblastic leukemia in elderly patients.

Eighteen acute nonlymphoblastic leukemia patients greater than 60 yr., 12 at diagnosis and 6 in first relapse, were treated with the association of oral Idarubicin and subcutaneous Aracytin. One patient was not evaluable. Eight out of 17 patients achieved complete remission (47%), 4 patients died in induction and 5 proved resistant to treatments. Mucocutaneous and gastrointestinal toxicity was mild. The most frequent extra-hematological complications were infections. We observed an important hepatic toxicity in 1 case.

Administration, Oral↗
PubMedDate not supplied

Idarubicin combined with intermediate-dose cytosine arabinoside in the treatment of refractory acute leukemia.

From December, 1985 to October, 1987, 16 patients aged from 14 to 62 (median 34) with acute leukemia in relapse (10 affected by ANLL and 6 by ALL) were treated with the following regimen: Idarubicin 12 mg/m2/day on days 1-2-3, Ara-C 600 mg/m2 twice a day from day 1 to 6. Twelve patients (75%) achieved complete remission (C.R.). Two (12%) died during the induction phase from alveolar pneumonitis. One patient was resistant. The median duration of C.R. and survival was respectively 12 (range 6 to 100 +) and 23 weeks (4 to 108 +). The median duration of granulocytopenia was 16 days (range 10 to 24 days). The most frequent non-hematological complications consisted of nausea, vomiting, diarrhea and mucositis. Four patients had hepatic and splenic microabscesses of suspected mycotic etiology, and one showed a transient cardiac arrhythmia. The C.R. rate obtained in this series may be considered satisfaying since all but 3 patients were on treatment at the time of relapse. Yet the short duration of C.R. suggests the opportunity of performing consolidation cycles or suprelethal therapy followed by bone marrow transplantation.

Adolescent↗
PubMedDate not supplied

An evaluation of some inflammatory, coagulative and immune factors in progressive systemic sclerosis.

Thirty-five patients affected by Progressive System Sclerosis (PSS) (20 acrosclerosis and 15 diffuse sclerosis) were subjected to the following laboratory tests: Beta 2 microglobulin (B2m), Fibronectin, C3c, C4, Fibrinogen, Factor VIII Coagulant (F. VIII:C), Factor VIII related Antigen (F. VIII:Ag), IgG, ESR, Antithrombin III (AT III), alpha 1 Antitrypsin (alpha 1AT) and alpha 2 Macroglobulin (alpha 2M). The results showed that no difference was observed between the normal group and the groups of PSS patients with respect to alpha 1AT, alpha 2M, and AT III. In contrast the B2m, ESR, IgG, F. VIII:Ag results were significantly higher in the PSS patients, while Fibrinogen and C3c results were slightly higher, but no high enough to be of statistical significance. The two PSS patient subgroups did not produce significant results, only the C4 values were lower in the Diffuse Sclerosis subgroup. From these results it seem that the tests used are not very useful indifferentiating the two subgroups of the PSS patients.

Adult↗
PubMedDate not supplied

Factor VIII complex in progressive systemic sclerosis.

Factor VIII complex and its related activities (Coagulant, Antigen and Ristocetin Cofactor) have been investigated in 23 patients with Progressive Systemic Sclerosis (PSS) divided into two groups: acrosclerosis and diffuse sclerosis. All Factor VIII-related activities were higher in PSS patients than in normal subjects. No difference in F. VIII-related Antigen (F. VIIIR:Ag), F. VIII-related Ristocetin Cofactor (F. VIIIR:Co) and F. VIII Coagulant activity (F. VIII:C) was found comparing the patient groups. F. VIII:C was increased significantly less than F. VIIIR:Ag and F. VIIIR:Co in both patient groups. Some hypotheses about the pathogenesis of this increase are discussed.

Adult↗
PubMedDate not supplied

Combination of 6-mercaptopurine, vincristine, methotrexate, and prednisone in resistant or relapsed acute nonlymphoid leukemia.

Twenty-six adults with acute nonlymphoid leukemia (ANLL) relapsed or resistant after first-choice chemotherapy including cytarabine and/or anthracyclines were treated with a modified POMP (6-mercaptopurine, vincristine, methotrexate, and prednisone) combination. Complete remission (CR) was achieved in five of eight resistant patients (62%) and in nine of 18 relapsed patients (50%). Intermittent cycles of chemotherapy including daunorubicin, cytarabine, 6-thioguanine, and etoposide were then administered. In the resistant group CR lasted from 11 to 126 weeks (median, 86), with two patients remaining in CR 126 and 108 weeks after remission induction; in relapsed patients, CR lasted from 9 to 50 weeks (median, 31).

Acute Disease↗
PubMedDate not supplied

Salvage chemotherapy with pentostatin in prolymphocytic leukemia.

We report 4 cases of prolymphocytic leukemia (PLL) resistant to conventional chemotherapy that were treated with pentostatin. We obtained 1 complete remission (CR) and 2 partial remissions (PR). Our data confirm the effectiveness of this drug in the treatment of prolymphocytic leukemia.

Aged↗
PubMedDate not supplied

Return to normal values of lipid pattern after effective chemotherapy in acute lymphoblastic leukemia.

In the present work we investigated HDL-C and its subfractions HDL2 and HDL3 as well as total cholesterol (TC), triglycerides (TG), LDL-C, VLDL-C, apolipoproteins A1 (ApoA1) and B (ApoB) and lipoprotein (a) (Lp(a) in 25 patients with newly diagnosed acute lymphocytic leukemia (ALL) before and after induction treatment. The mean basal plasma levels of TC, HDL-C and its subfractions, LDL-C, and ApoA1 were significantly lower than the mean values observed in normal subjects, whereas TG and VLDL-C were significantly higher. The patients (n = 22) who achieved complete remission after chemotherapy showed a significant increase of TC, HDL-C, HDL2, HDL3, ApoA1 and a significant decrease of TG and VLDL-C. These data suggest that ALL patients are characterized by a lipid metabolic derangement mainly of HDL and TG-rich lipoproteins, that is reversed by effective treatment of disease.

Adolescent↗
PubMedDate not supplied

Bacteremia in patients with hematological malignancies. Analysis of risk factors, etiological agents and prognostic indicators.

BACKGROUND AND OBJECTIVE: Patients with hematological malignancies are at increased risk for developing bacteremia. No previous study has investigated the risk and prognostic indicators of bacteremia in such patients using a statistical approach. METHODS: A case-control study was performed in 106 patients with hematological malignancies (group A). Two hundred and twelve patients were included as controls and divided into two groups: 106 patients with hematological malignancy without bacteremia (group B) and 106 HIV-infected patients with bacteremia (group C). RESULTS: At univariate analysis, bacteremia risk factors in group A were: neutropenia for more than six days (p = 0.03 vs. group B), central venous catheter usage (p = 0.04) and absence of antibiotic prophylaxis (p = 0.03). At multivariate analysis, the use of CVC and neutropenia were independent bacteremia risk factors. The most frequent etiological agents were: Staphylococcus epidermidis and Pseudomonas aeruginosa. Comparing groups A and C, the distribution of Staphylococcus spp. was different, with S. epidermidis being prevalent in hematological patients only. As regards gram-negative organisms, it is of note that no episode of NT-Salmonella bacteremia was observed in group A, unlike group C, where they represent the second leading etiological agents. In group A, 14% of the patients died. Persistent neutropenia (p = 0.01) and the presence of relapsed neoplasm (p = 0.04) were prognostic indicators of bacteremia. INTERPRETATION AND CONCLUSIONS: Our findings suggest that bacteremia in patients with hematological malignancies strictly correlates with the intensity and length of neutropenia and CVC usage. Although we observed a low mortality rate, we stress that this clinical condition requires special attention from the physician, who must recognize and treat it promptly.

Adult↗