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Biomedical subjects

K H Lin

Publications and source records attributed to K H Lin.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

Chemotherapy-related side effects in children with acute lymphocytic leukemia in Taiwan: a nursing perspective.

The purpose of this study was to understand the pattern of side effects experienced by children with acute lymphocytic leukemia (ALL) who were receiving the induction and consolidation phases of a specific chemotherapy regimen. One hundred and one children with ALL in treatment centers throughout Taiwan in June 1990 through June 1991 served as the sample for this study. Children had been divided into two groups, a standard risk group (SR) and a high risk group (HR), which received different therapeutic regimens. Of 101 children, 52 in SR and 27 in HR completed the induction and consolidation phases of treatment. Among sources of data for the study were nurses' prospective close observations in the natural care setting of each child. Chemotherapy-related side effects are multifaceted and intrusive, including changes in hematopoietic function, body function and body appearance. The most common side effects with regard to body function were elevation of body temperature, ulceration of oral mucous membrane, poor appetite, nausea and vomiting, ulceration of anus, diarrhea, impaired mobility. Side effects were greatest during the first through third weeks of the chemotherapy regimen. Twenty percent of the children developed infection. The findings stressed that nurses should be aware of such patterns of side effects so that they can provide optimal care to patients receiving chemotherapy.

Adolescent↗
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Acute myelofibrosis terminating in acute lymphoblastic leukemia: report of one case.

A four-year-old boy suffered from acute myelofibrosis which became acute lymphoblastic leukemia during the course of the disease. Histologic and immunophenotypic studies revealed that the leukemic cells were lymphoblasts. Immunophenotypic examination also excluded the possibility of acute megakaryoblastic, monocytic and myeloid leukemia. Thus terminal leukemic transformation, in some cases of acute myelofibrosis, may be of a lymphoid nature.

Acute Disease↗
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In vivo and in vitro productions of interleukin-2, interleukin-2 receptor and gamma-interferon in multitransfused thalassemic patients.

In vivo and in vitro productions of interleukin-2 (IL-2), IL-2 receptor (IL-2R) and gamma-interferon (gamma-IFN) in 64 multi-transfused thalassemic patients and 20 healthy children were studied. The results were: 1) Increased serum concentrations of IL-2 and IL-2R, and decreased serum concentration of gamma-IFN were found in thalassemic patients when compared to controls. 2) In in vitro study, productions of IL-2, IL-2R and gamma-IFN were much lower in thalassemic patients than in controls. The possible mechanisms for the altered lymphokine productions are discussed.

Adolescent↗
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[Blood exchange transfusion as an emergency treatment for hyperleukocytosis in leukemia: report of one case].

An extreme leukocytosis imposes immediate and potential catastrophic problems, which warrant the use of intensive means to reduce the excessive leukocytes. Blood exchange transfusion has been used for emergency management of hyperleukocytosis. With few complications the procedure can rapidly reduce an excessive leukocyte burden, correct concomitant anemia and improve associated metabolic abnormalities. The greatest advantage of this procedure is that it can be performed in the shortest time, with minimal equipment and technical skill. This is a report of an 11-month-old male patient with acute lymphoblastic leukemia who had hyperleukocytosis, then received emergency blood exchange which reduced the leukocyte count from 630,000/ul to 70,000/ul in two hours. The course was smooth and the patient tolerated the procedure well. Remission was attained after the induction and consolidation chemotherapy, and the child is now under maintenance therapy.

Acute Disease↗
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Isolated thrombocytopenia after bone marrow transplantation in Cooley anemia: report of one case.

A nine-year-old boy, victim of Cooley anemia, received allogeneic bone marrow transplantation with his younger brother serving as the histocompatible donor. The myeloid and erythroid series recovered very quickly, but his platelet count never reached 10(5)/mm3 until the 220th day. Platelet-associated IgG (PAIgG) was checked on the 137th and 305th day with the level of 31.75 fg/pl and 6.84 fg/pl, respectively. Immune mediated process was considered to be the cause of his prolonged thrombocytopenia.

Animals↗
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Clinical observation of Wilms' tumor.

Forty-two cases with Wilms' tumor encountered in the National Taiwan University Hospital from 1978 through 1989 were retrospectively reviewed. Included were 19 boys and 23 girls, with an age range at diagnosis from 7 days to 10 years; a majority were in the first 6 years of life. The presenting symptoms and signs included: abdominal mass (89.2%), hypertension (57.9%), hematuria (28.2%), gastrointestinal symptoms (26.3%), fever (24.3%), and body weight loss (21.6%). The initial laterality of tumor was 28 right and 14 left, with one contralateral and one ipsilateral relapse. One extrarenal Wilms' tumor (right inguinal lymph nodes) was encountered. Every case was confirmed by pathology. Histologic findings included typical Wilms' tumor (35/42), rhabdoid (3/42), anaplastic (3/42), and clear cell (1/42) types. The common sites of metastasis were lung, liver and bone. Major complications during or following therapy were severe pancytopenia, ileus, sepsis or pneumonia, delayed wound healing and tumor rupture with hemorrhage. Rare complications included irradiation hepatitis (venooclusive disease) and colitis. There were 20 deaths. The causes of death were respiratory or hepatic failure due to tumor metastasis, sepsis and internal hemorrhage. Mortality (19/20) usually occurred within two years after diagnosis and therapy. The two-year's relapse-free survival and two-year's survival rates were 51.2% and 53.7%, respectively.

Cause of Death↗
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Clover-leaf nucleus of atypical lymphocytes in CMV-mononucleosis syndrome: report of one case.

Atypical lymphocytes with clover leaf nucleus are a frequent finding in adult type T-cell leukemia, and are occasionally seen in an overnight blood sample. This type of cell has apparently never previously been reported in cytomegaloviral infection. The case of a thirty-seven-day-old female infant presented with cytomegalovirus induced mononucleosis syndrome; her blood smear revealed atypical lymphocytes with clover leaf nucleus.

Cell Nucleus↗
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Immature mediastinal teratoma in early infancy: report of one case.

Immature mediastinal teratomas are rare, found in only 1% of all mediastinal teratomas; those occurring in the neonatal period are even more rare. A male baby suffering from tachypnea, weak crying and hoarseness since birth was noted, from a chest radiograph, to have a superior mediastinal mass. This mass enlarged progressively to an extent that the airway was threatened by one month of age. After resuscitation, intubation and mechanical ventilation, the infant became respirator-dependent. Chest computed tomography and ultrasonography revealed a heterogeneous cystic tissue mass containing focal calcifications. A well-encapsulated tumor, measuring 6 x 4 x 4 cm in size, located anterior to the thymus, was successfully removed at 58 days of age. The pathology showed an immature teratoma. After operation, respiratory distress dramatically improved. However, a superior mediastinal mass reappeared on a chest roentgenogram four months later. After a short course of chemotherapy, the infant received another operation to excise a mass composed of hypertrophic thymic tissue and a small nodular mature teratoma. The patient has remained well for more than nine months now.

Humans↗
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[Wilson disease presenting as fulminant hepatic failure, acute hemolytic anemia and renal failure: report of one case].

Wilson disease presenting as fulminant hepatic failure, severe hemolysis and renal failure is rare in the literature. A ten-year-old boy--complaining of abdominal pain, jaundice, tea-colored urine, and anemia was admitted to this hospital; examination showed Kayser-Fleischer rings, anemia associated with hemolysis, mildly elevated serum transaminases, extremely elevated bilirubin levels, low serum ceruloplasmin level, slightly elevated serum copper, excessive 24-hour urine copper excretion, and severe renal function insufficiencies. Under the impression of Wilson disease with fulminant hepatic failure, the patient was treated by oral D-penicillamine 1 gm per day, intravenous zinc sulphate (about 8 mg per day elemental zinc), and given other supportive treatment. Unfortunately, the patient died of hepatic failure complicated with septic shock 21 days after the onset of symptoms. Autopsy found liver copper content was 586.92 ug/gm dry weight and kidney copper content: 300.19 ug/gm dry weight, abnormally high as compared with normal tissue. A review of the literature led to conclusion that the best treatment for Wilson fulminant hepatic failure is liver transplantation.

Acute Disease↗
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[Disseminated cryptococcosis mimicking lymphoreticular malignancy: report of one case].

Disseminated cryptococcosis is a rare and often fatal disease in children. The majority of cases usually occur in individuals with defective cell-mediated immunity. We herein reported a 10-year-old boy who presented with fever, body weight loss, lymphadenopathy and marked hepatosplenomegaly. He was admitted under the impression of Hodgkin's disease. However lymph node biopsy revealed diffuse infiltration with polynuclear giant cell and macrophage. Numerous ovoid-shaped microorganisms were found in the cytoplasma of those cells. Cultures of blood, CSF, lymph node, bone marrow and urine all yielded cryptococcus neoformans. The cryptococcal antigen titer of blood was 1:1024 X and that of CSF was 1:64 X. The immune function in terms of T-cell number, mitogen responses, serum immunoglobulin and complement was normal. After the diagnosis of disseminated cryptococcosis was established, the patient was treated with amphotericin B (0.6 mg/kg/day) and 5-fluorocytosine (150 mg/kg/day) for 6 weeks. The patient responded to the treatment very well. Lymphadenopathy and hepatospelomegaly disappeared and no more recurrence was found during the follow-up period of more than 18 months.

Child↗
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Bone marrow transplantation for severe aplastic anemia in children: conditioning with cyclophosphamide and total lymphoid irradiation.

We used preparative regimens consisting of cyclophosphamide and total lymphoid irradiation in 4 children with severe aplastic anemia undergoing allogeneic bone marrow transplantation. All 4 children engrafted successfully in spite of the number of donors exposed in the previous blood components transfusion. Three of 4 transplanted children have survived for 390 days, 540 days, and 1,235 days respectively. One child died of graft-versus-host disease related sepsis. The actual survival rate was 75% at one year. Further efforts must be aimed at the elimination of graft-versus-host disease and the control of fatal infections.

Adolescent↗
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Cyclosporin in the treatment of severe aplastic anemia: report of one case.

According to recent reports, cyclosporin (CsA) has been proven to be a cure for some patients with severe aplastic anemia (SAA). The use of CsA to treat SAA is based on both experimental and clinical evidences showing that this disease is sometimes caused by immune-mediated mechanisms. This report describes a fourteen-year-old boy who recovered from SAA after being treated with CsA, together with to a lesser extent prednisolone. In June of 1986, when he failed to improve after receiving six months of corticosteroid treatment, CsA was introduced. Following three weeks of CsA therapy no further blood transfusion was needed. Danazol was added on the 28th day of CsA therapy. On the 105th day the blood counts began to improve, and on the 375th day bone marrow aspirate revealed normal hematopoiesis. Along with these improvements, however, some side effects from the CsA treatment were observed. These included: hirsutism, hypertension and gingival hyperplasia, all of which eventually subsided on tapering and finally terminating CsA. For the time being, no side effects have been observed in the six-months period since CsA was stopped and the patient is leading a normal life.

Adolescent↗
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An analysis of risk factor and survival in childhood acute lymphoblastic leukemia.

To study the survival and prognostic factor of childhood acute lymphoblastic leukemia, 78 newly-diagnosed cases between January 1982 and June 1987 in National Taiwan University Hospital were reviewed and analyzed. They were stratified into two groups, i.e. standard-risk (SR) and high-risk (HR), according to their pre-treatment leukocyte count and age. Following induction therapy, 97% of the SR patients and 80% of the HR patients attained complete remission. In the SR group, the 2- and 3-year failure-free survival rates were 37% and 24%, with a median survival of 16 months. In the HR group, failure-free survival at the second and third year were 11% and 4%, respectively, with a median survival of 5.3 months. Three factors are strongly related to induction failure, i.e. high leukocyte counts (greater than 50*10(9)/1), massive hepatomegaly and large lymph nodes. Univariate analysis of failure-free survival showed six variables with significant detrimental effects on eventual outcomes, i.e. high leukocyte counts (greater than 50*10(9)/1), meningeal leukemia, marked lymphadenopathy, age younger than 2 years and older than 10 years, massive hepatomegaly (greater than 6 cm), and high LDH level (greater than 800 u/1). However, statistical survival models should also determine the joint effects of the prognostic factors so that the relative importance of each factor can be assessed. High initial leukocyte count, disclosed by multivariate analysis, was the single most important factor detrimental to the continuance of complete remission (P = 0.0004). Preliminary results also revealed poor compliance and early relapse in this study. Possible causes of early failure are discussed. Conceptual education for family members, as well as management with effective cytoreductive therapies are urgently needed.

Analysis of Variance↗
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Dyskeratosis congenita preceded by severe aplastic anemia: report of one case.

Dyskeratosis congenita is a rare hereditary disease which usually manifests with skin hyperpigmentation, nail dystrophy, and leukoplakia of the mucous membrane (triad). This report describes a six-year-old boy with severe aplastic anemia who was later diagnosed to have dyskeratosis congenita. His unusual presentation was pancytopenia followed by leukoplakia of the tongue, hyperpigmentation of the skin and dystrophy of the nails. Treatment with horse anti-human lymphocyte immunoglobulin (ALG) for his aplastic anemia was not effective.

Anemia, Aplastic↗
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Childhood leukemia mimicking juvenile rheumatoid arthritis.

Arthritis is a known manifestation of childhood leukemia. When it is the sole clinical finding, diagnosis of juvenile rheumatoid arthritis (JRA) may be impressed initially and hence delay diagnosis of the underlying malignancy. This review analysed the clinical pictures of six such patients whose acute lymphoblastic leukemia (ALL) was diagnosed after a variable period of delay, ranging from 2 weeks to 44 months. In general, initial articular and extra-articular symptoms, and responses to conventional treatment, are not helpful in differentiating leukemic arthropathy from juvenile rheumatoid arthritis. However, the six ALL patients did have significantly less leukocytosis (6834 +/- 1586 vs 13365 +/- 8039/mm3, p < 0.05) and relative lymphocytosis (61 +/- 17% vs 30 +/- 13%, p < 0.05) on the initial hemograms when compared with JRA patient findings. JRA patients with initial hemograms showing less leukocytosis and relative lymphocytosis should be followed up with a high index of suspicion. Work-up for leukemia should be performed in any JRA patient with an evolving hemogram showing anemia, thrombocytopenia, leukopenia and lymphocytosis. Those who have an intractable clinical course necessitating immunosuppressive therapy should also receive bone marrow examination to obviate confusion in interpreting follow-up laboratory data. It can not be overemphasized that the differential diagnosis of acute leukemia should be made before JRA is impressed.

Adolescent↗
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Allogeneic bone marrow transplantation for children with acute lymphoblastic leukemia in second remission or relapse.

Most children with acute lymphoblastic leukemia (ALL) are successfully treated by chemotherapy. For those patients, who relapse on therapy, bone marrow transplantation (BMT) is considered most appropriate after a subsequent remission is achieved. Three boys with ALL aged from 9 to 13 years met these criteria and received BMT from their HLA-compatible sisters after marrow ablation with total body irradiation 12 Gy plus high dose cytosine arabinoside 3 gm/m2/12h x 12 doses and graft-versus-host disease (GVHD) prophylaxis with cyclosporine plus short course methotrexate from March 10, 1989 to May 23, 1992. Filgrastim (rhG-CSF) was used to hasten the recovery of granulocyte in one patient. All three patients got full engraftment and two had grade 1 acute GVHD. None of them developed chronic GVHD. Two patients have disease-free survival over 51 and 12 months respectively post BMT without further chemotherapy. One patient died of recurrent refractory leukemia 5 months after BMT. The toxicity of this conditioning regimen included photophobia, conjunctivitis and erythematous skin rashes. One patient who received filgrastim from day 1 to 21 developed severe bone pain. However, this patient had faster recovery of granulocyte count than the other two patients. The preliminary results of this work favors BMT for children with recurrent ALL whose ultimate survival is usually poor when treated with chemotherapy. Further efforts are necessary to investigate new methods for reducing leukemic relapse in ALL patients undergoing BMT.

Adolescent↗