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A Nosari

Publications and source records attributed to A Nosari.

34 records · Page 2Linked to original sources
PubMed1996

Anaplastic large cell (CD30/Ki-1+) lymphoma in HIV+ patients: clinical and pathological findings in a group of ten patients.

We compared the clinical and pathological features of 10 HIV+ CD30+ anaplastic large cell lymphoma (ALCL) patients with 28 HIV+ CD30- non-Hodgkin's lymphoma (NHL) patients. The incidence of ALCL among 38 HIV+ systemic NHL patients was 26%. Clinical features were similar in all the HIV-related NHL cases, but ALCL patients seemed to differ from HIV+ CD30- systemic NHL only in the greater frequency of lung tumours (40% v 21%) without concomitant mediastinal mass, bone marrow (75% v 18%) and gastroenteric involvement (40% v 25%). Among the HIV+ ALCL patients, histologic subtypes did not differ in frequency from ALCL in the general population. The B phenotype was predominant (50%) as in other HIV-related NHL. EBV genoma, studied in all HIV+ ALCL patients, was present in 3/10 by in situ hybridization (ISH) and in 5/10 cases using PCR. The clinical course of lymphomas was similar in CD30 positive and negative NHL patients. Overall survival also was short in our series, particularly in HIV+ ALCL (84 v 188 d), probably because of profound immunodepression of the ALCL patients. Our findings suggest that severe immunodepression due to HIV infection determines-more than any other factor-the clinical features of HIV+ ALCL, making them very similar to those of other high-grade systemic HIV+ NHL.

Adult↗
PubMed1996

Localization of aspergillosis to the central nervous system among patients with acute leukemia: report of 14 cases. Gruppo Italiano Malattie Ematologiche dell'Adulto Infection Program.

We retrospectively studied a consecutive series of 100 patients with acute leukemia and aspergillosis to evaluate the clinical findings and risk factors for colonization of the central nervous system (CNS) by Aspergillus species. The diagnosis of CNS aspergillosis was made in 14 patients on the basis of the following criteria: neurological signs of CNS involvement (13 of 14 patients); cerebral CT scan findings (9 of 12); microbiological findings (6 of 12); and histological findings at autopsy (11 of 11). The majority of patients had severe neurological complications (i.e., hemiparesis or seizures), due mainly to brain abscesses or mycetomas. Autopsies were performed on 11 of 14 patients and provided evidence that CNS localization was secondary to invasive aspergillosis; in each case, the most likely primary focus of infection was the lung. Although all patients had received oral antimycotic prophylaxis and had received timely empirical antifungal treatment, they all died within a median time of 5 days from the onset of neurological symptoms. Analysis of the characteristics of patients with invasive aspergillosis did not reveal any difference between those with CNS localization and those without CNS localization.

Acute Disease↗
PubMed1996

Intravenous gamma globulin in refractory thrombotic thrombocytopenic purpura.

We report the case of a young woman with refractory thrombotic thrombocytopenic purpura (TTP), treated with different therapies (standard therapy with plasma exchange, prostacyclin infusion, vincristine sulfate) and responding to these for brief periods. High-dose immunoglobulin (400 mg/kg/day for 5 days), on the other hand, yielded a complete response which has lasted for 14 months up to the time of this report.

Adult↗
PubMed1995

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)

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.

Acute Disease↗
PubMed1993

Aggressive course of angiofibroma in an HIV-positive patient.

We report nasopharyngeal angiofibroma in a 13 year old boy treated with embolization, surgical excision and radiotherapy, which recurred 13 years later. No features of sarcomatous transformation were found, but the tumor had a locally aggressive course, possibly due to the HIV-positivity of the patient who then died of AIDS. The relations between the clinical course of the tumor and severe immunodeficiency are discussed.

Adolescent↗
PubMed1993

Comparison of two dose regimens of zidovudine in an open, randomized, multicentre study for severe HIV-related thrombocytopenia.

OBJECTIVE: To compare the effect of two dose regimens of zidovudine in the treatment of severe HIV-related thrombocytopenia (TP). DESIGN: Eighty-four patients with severe HIV-related TP and platelet counts < 50 x 10(9)/l were enrolled in an open study at six centres. Patients were randomized into two groups to receive zidovudine (group A, 500 mg per day; group B, 1000 mg per day) for 6 months. METHODS: Platelet counts were determined monthly and patients categorized as complete responders (CR; platelets > 100 x 10(9)/l), partial responders (PR; platelets > 50 to < 100 x 10(9)/l), or failures (F; platelets to < 50 x 10(9)/l). CD4+ and CD8+ lymphocytes, HIV antigenaemia, beta 2-microglobulin, white blood cells, mean cell volume and haemoglobin were also determined. RESULTS: Seventy-one patients (35 and 36 in groups A and B, respectively) completed the study; 11.4% of group A patients were CR and 45.7% PR; 38.9% of group B were CR and 33.3% PR. Increase in mean platelet counts was dose-related, more rapid in the higher dose group and remained significantly higher after 6 months of treatment (56.4 x 10(9)/l in group A versus 98.2 x 10(9)/l in group B; P < 0.01). CONCLUSIONS: The results confirm the efficacy of zidovudine in the treatment of severe HIV-related TP. The average for CR and PR in the two groups was 64.8%; the higher dose of zidovudine was more effective at increasing platelet counts.

Adult↗
PubMed1990

HIV-related severe thrombocytopenia in intravenous drug users: prevalence, response to therapy in a medium-term follow-up, and pathogenetic evaluation.

Severe thrombocytopenia (TP) accounted for 5.3% of cases in a consecutive series of 380 HIV-infected intravenous drug users (IVDUs) at presentation. Forty-one of 53 subjects with severe TP showed haemorrhages and were treated as follows: ten were splenectomized, 17 were given high-dose intravenous immunoglobulins (HDIg), and 10 received anti-Rh(D) immunoglobulins (anti-Rh Ig). Splenectomy induced a complete clinical response in all cases: four out of 10 patients maintained platelet counts greater than 100 x 10(9)/l. HDlg gave a good clinical response in all patients, but eight out of 17 suffered haemorrhages during the follow-up and recall treatments were necessary. Six out of 10 patients treated with anti-Rh lg maintained platelet counts greater than 30 x 10(9)/l, but in two cases the treatment was interrupted because of severe haemolysis. No patient progressed to overt AIDS during the follow-up. Splenectomized patients in particular did not show adjunctive risks of worsening of the HIV-related clinical picture. A platelet kinetic study performed in 20 patients with severe HIV-related TP suggests a possible role for platelet sequestration in TP of HIV-infected IVDUs, in which a liver involvement is very frequent.

Adult↗
PubMedDate not supplied

Incidence of sepsis in central venous catheter-bearing patients with hematologic malignancies: preliminary results.

BACKGROUND: Indwelling central venous catheters (CVCs) are essential devices in the management of patients with hematological disorders treated with chemotherapy. However, their nature predisposes patients to unwanted complications. METHODS: CVC-related complications were retrospectively analyzed in 227 hematologic patients who were consecutively admitted to our hematology department between May 2002 and April 2004. Patients' diagnoses comprised acute myeloid leukemia (36.8%), acute lymphoid leukemia (7.3%), lymphoproliferative disorders (28.3%), multiple myeloma (19.5%), myeloproliferative syndromes (5%) and others (3.1%). The CVCs used were polyurethane three lumen 7-Fr (111 patients) for chemotherapy and 12-Fr (114 patients) for chemotherapy and peripheral blood stem cell apheresis, plus two tunneled catheters. RESULTS: The pathological events were: bacteriaemias (n=46); occlusions (n=10); exit tunnel infections (n=8); thrombosis (n=6); lung emboli (n=2). Among febrile patients the bacteriemia frequency was 20%, of which 13.6% were CVC-related (with a higher incidence in leukemia patients (p=0.027). Among the isolates, gram-positive bacteria were found in 29 cases (23 CVC-related cases), and gram-negative bacteria in 16 cases (8 CVC-related cases). Only one patient had Candida albicans sepsis. At univariate and multivariate analysis significant risk factors for infection (p<0.0001) were only the number of days/catheters and neutropenia duration. CONCLUSIONS: In our hematologic patients, the CVC complications were mainly septic, with only 10.1% of CVC-related bacteriemias, despite prolonged catheterization duration. Acute leukemia patients were at major risk for sepsis, probably due to a more severe neutropenia and prolonged catheterization duration.

Journal Article↗
PubMedDate not supplied

HIV-related thrombocytopenia: four different clinical subsets.

BACKGROUND: Many factors have been considered in the pathogenesis of HIV-related Thrombocytopenia (HIV-rel TP): immunological destruction, retroviral infection of megakaryocytes and altered reticulo-endothelial function. Nevertheless the pathogenesis is still controversial. MATERIALS AND METHODS: We reviewed 52 patients (all intravenous drug users) with HIV-rel TP (< 100 x 10(9)/L) by evaluating bone marrow morphology, antiplatelet antibodies (28/52), kinetic studies with 111In Oxine and response to therapy. RESULTS: Seventeen percent of TP were evaluated as "acute ITP-like", and 40% as "chronic ITP-like"; 35% were evaluated as "pooling" TP and 8% as "hypoplastic" TP. Twenty-four patient with moderate TP (> 30 x 10(9)/L) were followed for a mean time of 27 months and no hemorrhages were seen during the period of observation despite the fact that no treatment was given; twenty-eight others with severe TP (< 30 x 10(9)/L) were treated in different ways: 18% responded to steroids and/or HDIg, 70% to splenectomy and 56% to zidovudine. CONCLUSIONS: The term "HIV-related thrombocytopenia" should include more than one kind of TP: "Acute ITP-like" TP, "chronic ITP-like" TP, "pooling" TP and "hypoplastic" TP have to be evaluated differently for pathogenesis, clinical manifestations and treatment.

Acute Disease↗
PubMedDate not supplied

T AILD-like non Hodgkin lymphoma complicated by malignant mesenchymal ocular neoplasia: a case report.

We report a case of T AILD-like NHL in a 50-year-old man who partially responded to combined therapies. The course of the disease was complicated by a malignant mesenchymal ocular neoplasia. The patient died because of severe infections and lymphoma dissemination. The association between T AILD-like NHL and carcinomas has been described: no case of concomitant malignant mesenchymal neoplasia is reported in literature.

Combined Modality Therapy↗
PubMedDate not supplied

Infections in haematologic neoplasms: autopsy findings.

BACKGROUND AND METHODS: Infections are the main cause of death in most haematologic malignancies. We studied 95 autopsies of patients who died from haematologic neoplasms in the period 1980-1989 at Niguarda Cà Granda Hospital. RESULTS AND CONCLUSIONS: Infections were the cause of death in 63% of patients. In this group of patients bacterial infections accounted for 43% of deaths; fungal infections were frequent too (28%), mainly among leukemic patients; viral (9%), mycobacterial (7%) and polymicrobic infections (11%) were also documented. Haemorrhages were less frequently fatal (12%) due to the availability of haemocomponents. A high number of fatal haemorrhages were associated with fungal infections. Neoplastic progression was the real cause of death in only a few cases, and cardiovascular and pulmonary complications were fatal in the great majority of the other patients.

Agranulocytosis↗
PubMedDate not supplied

Pulmonary and myocardial infarction secondary to arterial occlusion by Aspergillus fumigatus in ANLL.

UNLABELLED: Secondary invasive Aspergillosis is a well-recognized complication of the immunocompromised patient. This case concerned a 52-y.o. male patient affected by ANLL (FAB: M2). On day 10 after induction therapy the patient, previously apyretic and asymptomatic, had an episode of acute dyspnea with fever (39 degrees C). Chest X-ray and pulmonary scintigram were compatible with a diagnosis of pulmonary embolism, and the patient was started on heparin. On day 24 the patient had persistent anginal pain with an ECG compatible with myocardial infarction. The patient was transferred to the coronary unit and died on day 35 after a downhill course. Autopsy findings. Gross examination: multiple infarction involving the whole left lung, the septal and anterior myocardial walls, the left kidney and the spleen. HISTOLOGY: arterial occlusion due only to intravascular hypha growth (Aspergillus fumigatus). This case emphasizes how much astrary the clinical picture can be and how far the fungal dissemination can extend.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Untunnelled central venous catheters in the treatment of acute leukemia.

Ninety-eight untunnelled central venous catheters were positioned in the subclavian or internal jugular vein in 42 patients with acute leukemia. The procedure was feasible at bedside and carried a risk of catheter-related infection of 21%, similar to that of tunnelled catheters. The persistence of exit-point infection is the main route of infection and requires catheter removal.

Acute Disease↗