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PubMed1998

[Ocular changes in primary hematologic diseases].

Ocular manifestations can be the presenting symptom of hematological diseases. Ocular changes can be found in up to 90% of the patients depending on the underlying disease. Most patients with ocular manifestations however are asymptomatic. Hematological disorders can manifest in all structures and adnexa of the eye. The most common manifestations are conjunctival pallor and hemorrhages, intraretinal hemorrhages and cotton wool spots. Retinal infiltrates, manifestations in the lids, anterior segment, optic nerve, orbit and adnexa are rare. Different ocular manifestations in anemia, leukemia, malignant Non-Hodgkin lymphoma, Hodgkin's disease, chronic myeloproliferative diseases, plasmocytoma, myelodysplastic syndromes, coagulopathies, and reticulo-histiocytic diseases are described. Not only the underlying disease but also chemotherapy, bone marrow transplantation can lead to ocular complications.

Eye Diseases↗
PubMed2003

Urologic manifestations of hematologic disease sickle cell, leukemia, and thromboembolic disease.

Advances in medicine are allowing patients with hematologic disease to live longer and healthier lives than ever before. As these patients age, however, manifestations of their disease processes may develop as complications in other organ systems. We discussed the major genitourinary complications of sickle cell anemia, leukemia, and thromboembolic disease. These range from the benign inability to concentrate urine that is seen in sickle cell disease to renal infarction that results from nephrotic syndrome. Our ability to treat and prevent these complications will improve as our understanding of these disease processes and their pathophysiology grows. Additionally, it is important for urologists to understand the underlying pathophysiology of hematologic disease to best serve the patients. For example, it may be the urologist who makes the diagnosis of ovarian vein thrombosis in a pregnant woman with right lower quadrant pain and fever. This diagnosis, with the proper treatment of antibiotics and anticoagulation, could prevent the potential development of septic thrombophlebitis. Urologists will increasingly be called upon to deal with the manifestations of these complex diseases as these patients are living longer. It is our duty to educate ourselves about these disease processes so that we can make the best clinical decisions for our patients.

Adrenergic alpha-Agonists↗
PubMed1996

Laparoscopic splenectomy in patients with hematologic diseases.

OBJECTIVE: The authors review their initial experience with laparoscopic splenectomy in patients with hematologic diseases. Efficacy, morbidity, and mortality of the technique are presented, and other patient recovery parameters are discussed. SUMMARY BACKGROUND DATA: Laparoscopic splenectomy is performed infrequently and data regarding its safety and efficacy are scarce. Factors such as a high level of technical difficulty, the potential for sudden, severe hemorrhage, and slow accrual of operative experience due to a relatively limited number of procedures are responsible. The potential patient benefits from the development of a minimally invasive form of splenectomy are significant. METHODS: Clinical follow-up, a prospective longitudinal database, and review of medical records were analyzed for all patients referred for elective splenectomy for hematologic disease from March 1992 to March 1995. RESULTS: Laparoscopic splenectomy was attempted in 43 patients and successfully completed in 35 (81%). Therapeutic platelet response to splenectomy occurred in 82% of patients with immune thrombocytopenic purpura and hematocrit level increased in 60% of patients with autoimmune hemolytic anemia undergoing successful laparoscopic splenectomy. The morbidity rate was 11.6% (5 of 43 patients), and the mortality rate was 4.7% (2 of 43 patients). Return of gastrointestinal function occurred in patients 23.1 hours after laparoscopic splenectomy and 76 hours after conversion to open splenectomy (p < 0.05). Mean length of stay was 2.7 days after laparoscopic splenectomy and 6.8 days after conversion to open splenectomy (p < 0.05). CONCLUSION: Laparoscopic splenectomy may be performed with efficacy, morbidity, and mortality rates comparable to those of open splenectomy for hematologic diseases, and it appears to retain other patient benefits of laparoscopic surgery.

Adolescent↗
PubMed1986

[Splenectomy: surgical indications in malignant hematologic diseases].

Indications for splenectomy in malignant hematological diseases are discussed for relief of symptoms (splenomegaly, cytopenias), for staging (M. Hodgkin) or improvement of survival (hairy cell leukemia). The role of splenectomies is also evaluated for Non-Hodgkin lymphomas, chronic lymphatic leukemia, myelofibrosis and for chronic myeloic leukemia.

Hematologic Diseases↗
PubMed2005

[Efficacy of intravenous administration of itraconazole on fungal infections in immunocompromised patients with hematological diseases].

OBJECTIVE: To investigate the efficacy of intravenous administration of itraconazole on fungal infections in immunocompromised patients with hematological diseases according to stratified diagnoses. METHODS: Twenty-five patients with hematological diseases who were diagnosed according to the criteria of European Organization for Research and Treatment of Cancer (EORTC), including 6 cases with confirmed diagnosis diagnosis, 12 cases with clinical diagnosis, and 7 cases with recommended diagnosis, underwent intravenous injection of itraconazole 125 approximately 200 mg bid for 2 days and then qd for at most 2 weeks and then oral administration of itraconazole 0.4 g/day for at most 2 weeks, and then the repeated regimen with a course of treatment of 1 approximately 3 months from 2002 to 2004. Eighteen cases were diagnosed with lung infection, 1 case with sinuses and trachea infection, and the infection sites were not documented for other 7 cases. The clinical results were analyzed. RESULTS: The effective rates of the patients with confirmed diagnosis, with clinical diagnosis, and with recommended diagnosis were 66.7% (4/6), 83.3% (10/12), and 14.3% (1/7) respectively. The effective rates of the patients with major imaging signs and those with secondary imaging signs were 90.0% (9/10) and 97.1% (4/7). There was a significant difference between the curative effects of the patients with confirmed diagnosis and those with recommended diagnosis (P = 0.006). CONCLUSION: Fungal infections in immunocompromised patients with hematological diseases can be successfully treated with intravenous administration of itraconazole.

Adolescent↗
PubMed1990

A 10-year survey of clinically significant blood culture isolates and antibiotic susceptibilities from adult patients with hematological diseases at a major Swedish hospital.

In patients treated with cytotoxic drugs granulocytopenia and septicemia are commonly seen. In this 10-year survey 324 blood culture isolates from 184 patients with hematological diseases and septicemia were studied. The distribution of microbiological diagnoses in patients with hematological diseases as well as acute leukemia 1980-1986 was significantly different (p less than 0.01) from an unselected blood culture material from the same period. The differences are mainly seen between Enterobacteriaceae other than Escherichia coli, Pseudomonas aeruginosa and staphylococci. The microbiological spectrum for patients with hematological disease 1987-1989 was also significantly different (p less than 0.05) from the spectrum of the same group of patients 1980-1986 due to higher frequencies of coagulase-negative staphylococci and alpha-streptococci and lower frequency of E. coli in the latter period. 40% of the isolates were gram-positive cocci during the first period and increased to 50% during the second period. The susceptibility testing indicates that trimethoprim/sulfonamide is not as good a choice as ciprofloxacin or norfloxacin for oral antibiotic prophylaxis. For intravenous therapy imipenem/cilastatin or the combinations of an aminoglycoside/piperacillin or aminoglycoside/third generation cephalosporin have advantages over aminoglycoside/trimethoprim/sulfa in combination. However, addition of isoxazolylpenicillin or vancomycin now seems necessary to cover the increasing part of gram-positive bacteria causing septicemia in patients with hematological disease.

4-Quinolones↗
PubMedDate not supplied

Laparoscopic splenectomy in the management of hematological diseases.

The indications for splenectomy in hematological diseases are well known. In particular, they include idiopathic thrombocytopenic purpura (ITP), hereditary spherocytosis (HS) and Hodgkin's disease (HD) (as a part of subdiaphragmatic staging). We present here our initial experience of 10 cases (6 ITP, 2 HS and 2 HD) managed with a laparoscopic approach as opposed to the traditional laparotomy. Advantages over the open operation include decrease of post-operative pain, pulmonary sequelae and infections, cosmetic advantages, faster recovery and reduced hospitalization.

Adult↗
PubMed1993

Thrombosis of the portal venous system after splenectomy for pediatric hematologic disease.

Splenic, portal, or mesenteric venous thrombosis after splenectomy for hematologic disease has not been reported in the pediatric literature. It is a rare complication associated with significant morbidity and mortality in adult reports. Between 1981 and 1991, 3 patients (13-year-old boy with hereditary elliptocytosis [HE], 13-year-old boy with thalassemia intermedia [TI], and 18-year-old girl with idiopathic thrombocytopenic purpura [ITP]) presented with abdominal pain, nausea, with or without fever, at 4, 11, and 13 days postsplenectomy, respectively. Abdominal Doppler ultrasound (US) and/or computed tomography (CT) showed: (1) an intraluminal filling defect with partial obstruction to flow in the right branch of the portal vein with the remaining vessels patent (HE); (2) splenic vein thrombosis with complete occlusion of the main portal vein and proximal superior mesenteric vein (TI); and (3) complete thrombosis of the splenic vein, proximal superior mesenteric vein and portal vein (including central radicles), with retrogastric collateralization (ITP). Subsequent imaging showed either complete resolution of vascular obstruction on no treatment (patient 1), or portal venous cavernomatous transformation with hepatofugal flow after 6 months of systemic anticoagulation (patients 2 and 3), and all 3 patients are currently asymptomatic. Postoperative sonographic evaluation of a consecutive series of pediatric splenectomies for hematologic disease (n = 16), was performed at a median of 51 days (range, 3 to 124). This demonstrated one case of asymptomatic left portal venous thrombosis with subsequent recanalization in the absence of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Clinical evaluation of imipenem/cilastatin sodium against infections in compromised children (malignancy, hematological disease, collagen disease)].

Eighteen immuno-compromised children (malignancies, hematological diseases, collagen diseases) with neutropenia and infections were treated with imipenem/cilastatin sodium (IPM/CS), and the efficacy and the safety of the drug were evaluated. 1. Responses to IPM/CS were excellent in 13 patients, good in 1, and fair in 4. None of the patients displayed a poor response to the treatment thus the efficacy rate was 77.8%. 2. Of 5 patients with sepsis, 4 had excellent or good responses. IPM/CS was effective against sepsis caused by Enterococcus faecalis and Pseudomonas aeruginosa. 3. In patients with severe neutropenia (WBC less than 100/mm3), the efficacy rate was 70%. 4. As for side effects, elevations of GOT and GPT were observed in 1 patient with liver cirrhosis. These results indicate that IPM/CS is safe and effective in immuno-compromised children with neutropenia and infections.

Adolescent↗
PubMedDate not supplied

The kidney in hematologic disease. A review.

The kidney is involved in a variety of systemic diseases and conditions including collagen, endocrine, liver, infectious, neoplastic, and cardiac diseases, as well as pregnancy. Renal involvement in hematologic diseases has not been stressed. In this review we will summarize the role of coagulation in the pathophysiology of renal disease and present renal involvement in sickle cell anemia, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, leukemia, and other less common hematologic diseases.

Adolescent↗
PubMed1989

[Scintigraphic imaging of the bone marrow in hematologic diseases].

The scintigraphy of the bone marrow can supply information for its distribution in the body and for its functional state as well. The purpose of the study is to assess the efficacy of the scintigraphic imaging of the bone marrow by means of radiopharmaceutical drugs--99mTc-sulfur colloid for imaging the monocytic macrophagal system and 111In-chloride for imaging of erythroid cells--and to determine its characteristics in some hematologic diseases. 72 patients with hematologic diseases and 10 healthy controls were examined. The results lead to the conclusion that bone marrow scintigraphy is a useful method which helps the physician in the diagnosis of hematologic diseases, the determination of the stage of the disease, the assessment of the efficacy of the treatment applied and in all cases of discrepancy between the bone marrow histology and the clinical status of the patient.

Adolescent↗
PubMed1989

[Changes in the rheologic properties of erythrocytes in various hematologic diseases].

Some rheological properties of red blood cells were investigated in certain hematological diseases, considering the factors inducing disorders in red blood cell aggregation, deformability and viscosity. It has been shown that these disorders are responsible for increased blood viscosity and microcirculatory disorders in some blood diseases. The changes in red blood cell rheological properties play a significant role in the pathogenesis of thrombohemorrhagic complications in certain hematological diseases. The study of rheological mechanisms regulating blood circulation is necessary for successful development of optimal programs for combined treatment of hematological patients.

Anemia, Aplastic↗
PubMed1985

Hematologic disease in scleroderma syndromes.

Review of 4 430 patients with a diagnosis of scleroderma, morphea, or eosinophilic fasciitis has revealed 16 patients with one of a variety of serious hematologic diseases. Although it is not possible to comment on the exact relationship between the dermatologic disease and the hematologic disorder, in seven patients there appeared to be a close temporal relationship between the onset of the two conditions. The development of a serious hematologic disease, especially a lymphoproliferative process, may rarely be seen not only in patients with eosinophilic fasciitis but also in those with systemic or localized scleroderma.

Adult↗
PubMed1989

[Sepsis in patients with hematological diseases].

Sepsis is one of the important complications on the treatment of severe hematological diseases. In this report, we analyzed sepsis in 309 patients with hematological diseases who were admitted to the First Department of Internal Medicine of Yokohama City University Hospital from 1979 to 1986. Positive blood culture were found in 17.8% (55/309 cases) and total positive cases were 73 including recurrent patients. Positive rate by underlying diseases was 30.3% in acute leukemia, 20.8% in chronic myelocytic leukemia, 17.2% in aplastic anemia, 8.0% in multiple myeloma, 6.0% in malignant lymphoma and 6.5% in others. The organisms causing sepsis were as follows; gram negative bacilli 56.4%, gram positive organisms 34.6%, fungus 6.4% and anaerobic bacteria 2.6%. Pseudomonas aeruginosa was found in 19.2%. The mortality rate of patients with sepsis was 34.2% (25/73 cases). The significant prognostic factors in patients with sepsis were the degree of neutropenia, duration of neutropenia (500 less than microliters), the species of organisms, simultaneous complication with shock and the site of other infections.

Hematologic Diseases↗
PubMed2000

Human herpesvirus 6 in hematologic diseases in China.

BACKGROUND AND OBJECTIVE: The prevalence and pathogenic role of human herpesvirus 6 (HHV-6) in various benign and malignant hematologic diseases remain largely unknown. The aim of this study was to search for a possible involvement of HHV-6 in the pathogenesis of hematologic diseases. DESIGN AND METHODS: The presence of HHV-6 DNA sequences was examined by polymerase chain reaction (PCR) in bone marrow mononuclear cells from 241 patients with benign and malignant hematologic diseases in China. Platelet-associated immunoglobulin (PAIg) of 66 idiopathic thrombocytopenic purpura (ITP) patients was measured by competitive enzyme-linked immunosorbent assay. The presence of HHV-6 DNA in sera from 31 ITP patients was examined by PCR. Paired serum samples from 19 ITP patients were analyzed for anti-HHV-6 IgG titers using an indirect immunofluorescence assay. RESULTS: HHV-6 DNA was detected in 41% and 37.5% of ITP and acute leukemia patients respectively, but in only 6.7% of patients with iron deficiency anemia. HHV-6 positivity for ITP patients with excessive PAIgG was significantly higher than in patients with a normal level of PAIgG. HHV-6 DNA was not detected in any of the serum samples from ITP patients. None of the 19 cases of ITP showed a significant increase in anti-HHV-6 antibody titers during the convalescent phase compared with the onset phase. INTERPRETATION AND CONCLUSIONS: Our results indicate that HHV-6 infection might be associated with excessive PAIgG in some cases of ITP, and that the virus persists in a latent state. The pathogenic role of HHV-6 in ITP needs to be confirmed by further investigations.

Acute Disease↗
PubMed1986

[Clinical investigation of the therapeutic effects of cefmenoxime in the treatment of infections complicated by hematological diseases].

Therapeutic effects on cefmenoxime hemihydrochloride (CMX, Bestcall), a new synthetic cephem antibiotic, were examined in the treatment of various infections complicated with hematological diseases. The number of patients treated with CMX was 37 including 5 cases of sepsis or suspected sepsis, 14 cases of pneumonia or suspected pneumonia, 5 cases of upper respiratory diseases, 2 cases of urinary tract infections and 11 cases of other infections. All of these infections were complicated with hematological diseases: Acute leukemia, 13 cases; chronic myelocytic leukemia, 1 case; adult T cell leukemia, 3 cases; malignant lymphoma, 8 cases; Hodgkin's disease, 2 cases and myeloma, 3 cases. CMX were administered by a single intravenous injection or by a drip infusion. The dose was between 2 and 6 grams per day. Good to excellent clinical results were obtained in 25 out of 37 cases, total effective rate of 67.6%. No clinical side effects or abnormal laboratory findings attributable to CMX were observed except for light diarrhea in 2 cases. By the clinical investigation, it was demonstrated that CMX was one of safe and effective antibiotics for treating infections in the compromised hosts complicated with hematological diseases.

Acute Disease↗