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  • 1
    ISSN: 1433-7339
    Keywords: Key words Neutropenia ; Fungal infection ; Amphotericin B ; Fluconazole ; Itraconazole
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Considering the limited data available, there is clearly a need for thorough, well-designed clinical research on the epidemiology, diagnosis, treatment and prevention of invasive fungal infection in patients who are treated for cancer. Our knowledge has increased, but the information obtained so far is patchy and not generally applicable, as it is influenced by local problems and circumstances. New diagnostic tools have become available, but they are still insufficient in many cases. Until the value of the presently available chemoprophylaxis has been established beyond doubt, the strategy should be one of wait-and-see for patients with a low or moderate risk of developing infection. In bone marrow transplant recipients fluconazole has shown favourable results in eliminating yeast infections, but in patients at high risk of mould infections early initiation of intravenous treatment with amphotericin B at a therapeutic dose remains the best approach. The question of the optimal time point to start empirical antifungal treatment remains and has even been extended by the dispute about what antifungal drugs should be used for this purpose. Amphotericin B is still the drug of choice for the treatment of disseminated fungal infection, but its lipid formulations seem to offer a safer, though far more expensive, alternative. Head-to-head comparisons between the different formulations are required before a final conclusion on their respective efficacies and toxicities can be drawn, and it is questionable whether a higher dose will produce better results. Fluconazole appears very useful against the majority of Candida infections, whereas itraconazole is effective against both yeast and moulds, providing that adequate resorption can be ensured. The results of the first clinical trial of voriconazole in pulmonary aspergillosis have proved very promising.
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  • 2
    ISSN: 1432-0584
    Keywords: Thrombocythemia ; Interferon-alpha ; Interferon-gamma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Recombinant interferon-gamma with a starting dose of 0.5 mg 3×/week subcutaneously, was administered to 6 patients with essential thrombocythemia (median platelet count 1172×109/1, range 602–1564). Four of the patients had received alkylating agents previously. Hematological remission, defined as a decrease in platelet counts to ≤ 350×109/l, was observed in none of these patients. Subsequently 4 of these 6 patients, supplemented by 2 others were treated with interferonalpha2c at a dose of 5×106 U daily subcutaneously. Five patients showed hematological remission. In case of hematological remission the interferonalpha dosis was reduced to 5× an thereafter to 3× weekly 5×106 U. During an observation period ranging from 12–41 weeks platelet counts remained normal in all patients. Side-effects were mild and consisted of fever, myalgias, malaise and itching occurring mainly during the first month of treatment. No dose adaptation was required. The patients treated previously with interferon-gamma experienced the side effects from this drug less tolerably than those from the alpha-compound. These observations suggest that recombinant interferonalpha may be an effective drug in treating essential thrombocythemia resulting in a sustained response.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0584
    Keywords: Sweet's syndrome ; Hairy cell leukemia ; Mycobacterial disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A patient with Sweet's syndrome and leukopenia is reported. Hematological evaluation revealed hairy cell leukemia (HCL). The clinical picture was dominated by persistent fever, which is a common feature of both Sweet's syndrome and HCL. Since fever frequently reflects concomitant infection in HCL, a thorough search for infectious disease was performed. Blood cultures grewMycobacterium kansasii. The patient recovered after treatment with recombinant interferon-α (r-IFN-α) and tuberculostatic drugs. Remarkably, the skin lesions completely regressed within 1 week after the start of r-IFN-α. In the literature, Sweet's syndrome is rarely mentioned as a feature of HCL. Mycobacterial disease, especially atypical mycobacteria, is relatively often seen in HCL.
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  • 4
    ISSN: 1432-0584
    Keywords: ARDS ; Streptococcus mitis ; Cytarabine Corticosteroids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Adult respiratory distress syndrome (ARDS) complicatingStreptococcus mitis bacteremia is a major cause of mortality in patients undergoing therapy for leukemia. In order to try to prevent the development of ARDS in 11 patients withS. mitis bacteremia following chemotherapy including cytarabine, high doses of corticosteroids were administered pre-emptively. None of these patients developed ARDS. In a historical control group of 21 comparable patients who had not been given corticosteroids, the incidence of ARDS was high (38%), with a death rate of 14%. Preemptive administration of high-dose corticosteroids appeared to be highly effective in suppressing the mechanisms that induce ARDS in patients withS. mitis bacteremia after cytarabine treatment. The results suggest that ARDS complicatingS. mitis bacteremia is not merely a microbiological problem but may, at least in part, represent an immunologically mediated phenomenon.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Annals of hematology 70 (1995), S. 223-225 
    ISSN: 1432-0584
    Keywords: Key words Autoimmune granulocytopenia ; Cyclosporine ; Idiopathic neutropenia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A case history is presented concerning a 59-year-old female patient with chronic autoimmune neutropenia complicated by recurrent skin infections, mucositis, and conjunctivitis. For subjective reasons she refused treatment with prednisone, but eventually cyclosporine led to an important clinical improvement and an increase of the peripheral granulocyte count. Treatment modalities of autoimmune neutropenia are briefly discussed.
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  • 6
    ISSN: 1432-0584
    Keywords: Ceftazidime ; Cyclosporin-A and lack of Nephrotoxicity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Ceftazidime was used as monotherapy for 30 febrile episodes in 28 patients, who underwent allogeneic bone marrow transplantation and who were treated concomitantly with the immunosuppressive agent cyclosporin-A. Ceftazidime did not enhance the well established nephrotoxicity of cyclosporin-A as measured by serum creatinine levels or creatinine clearnace. Although an increasing number of Gram-positive infections in these patients warrants vigilance, ceftazidime as initial empirical monotherapy proved to be successful in 95% of all febrile post-transplantation patients. All Gram-negative and 69% of the Grampositive infections were cured with ceftazidime alone. The overall clinical cure rate was 72%, with microbiological clearance in 63%. This compares favourably with aminoglycoside containing schedules and avoids the aminoglycoside associated nephrotoxicity.
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  • 7
    ISSN: 1432-0584
    Keywords: Hodgkin's disease ; Lymphocytes ; Spontaneous DNA synthesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Spontaneous lymphocyte transformation in relation to the number of circulating lymphocytes was studied in 54 patients with active Hodgkin's disease. Increased spontaneous DNA synthesis by peripheral lymphocytes was found in 83% of the cases studied. However, no difference was found in comparing a group of lymphopenic patients (〈 1,500 lymphocytes/Μl) to a group with normal lymphocyte count (〉 1,500 lymphocytes/Μl). Implications of these findings are discussed.
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  • 8
    ISSN: 1432-0584
    Keywords: Chronic lymphocytic leukemia ; Immunodeficiency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A 66-year-old female, suffering from recurrent infections of the respiratory tract, developed a severe hypogammaglobulinemia and an impaired cell mediated immunity in combination with abdominal lymphadenopathy and splenomegaly. Considering a lymphoid malignancy, an explorative laparotomy was performed. No malignancy could be established. After a follow-up of 2 years a diagnosis of chronic lymphocytic leukemia could be made. The onset of hypogammaglobulinemia 2 years before the development of chronic lymphocytic leukemia is not yet reported in the literature.
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  • 9
    ISSN: 1432-0584
    Keywords: Granulocytopenia ; Localized infection ; Ceftazidime ; Amikacin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a prospective randomized study, 90 granulocytopenic febrile patients presenting with a localized infection were treated empirically with ceftazidime alone or in combination with amikacin (1.5 g/day). Two thirds had received selective oral antimicrobial prophylaxis before therapy. The treatment groups were comparable in terms of the depth and duration of granulocytopenia as well the distribution of the infection categories and rate of bacteremia. There was no difference with respect to the final response: 53% for the monotherapy group versus 48% for the combination group, and both regimens appeared to be equally safe. The duration of fever, clinical symptoms, antibiotic therapy, and granulocytopenia were comparable for both treatment groups, and approximately 90% of patients survived the infection. Only one patient given monotherapy required amikacin. It is concluded that aminoglycosides are not necessary for the empiric treatment of infectious complications in granulocytopenic patients if antibacterial prophylaxis has been given before-hand.
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  • 10
    ISSN: 1432-0584
    Keywords: Itraconazole ; Acute leukemia ; Diseasefree survival ; Multidrug resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Itraconazole, a triazole antifungal agent, has been reported to reverse drug resistance against daunorubicin in acute leukemia. In a subanalysis from a double-blind, placebo-controlled trial examining the effects of itraconazole on the prevention of fungal infections in neutropenic patients, we studied the effects of itraconazole on remission rate and disease-free survival in patients with acute lymphoblastic (ALL) and acute myelogenous leukemia (AML) receiving remission induction treatment schedules containing daunorubicin (DNR). Eleven ALL and 17 AML patients received itraconazole and 12 ALL and 25 AML patients were given placebo. Among AML patients the remission rate was slightly higher in the itraconazole group, whereas the disease-free survival was higher mong ALL patients given itraconazole. In AML patients DFS was comparable in both groups but the number of high-risk patients in the itraconazole group was higher. These preliminary results may suggest a role for itraconazole in reversing multidrug resistance. Larger trials, however, are required to substantiate these findings and to correlate them with its in vitro effects on multidrug resistance.
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