Cases reported "Neoplasms"

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1/55. review of mononuclear cell leukemia in F-344 rat bioassays and its significance to human cancer risk: A case study using alkyl phthalates.

    Elevated incidences of mononuclear cell leukemia (MNCL) have been observed in a number of chronic bioassays in the F-344 rat. As this tumor type is unique to the rat and is only common in the F-344 strain, its significance for human cancer risk is unclear. For this reason, a survey of the published literature was undertaken to assess the occurrence and etiology of MNCL in F-344 rats and to evaluate its potential significance to humans using alkyl phthalate data as an example. It was found that MNCL occurs in untreated, aged F-344 rats at a high and variable rate, it is uncommon in most other rat strains, and its background incidence has increased significantly over time. This complicates retrospective data interpretation. MNCL has not been found in other mammalian species and no histologically comparable tumor is found in humans. In general, a statistically significant increase in frequency of a common tumor in the F-344 rat is an insufficient basis for determining that a chemical presents a carcinogenic hazard to humans, particularly when that tumor is not observed in other species. As one example, the alkyl phthalates constitute one group of substances which has been associated with increased MNCL frequency in the F-344 rat after high dietary doses. In evaluating the significance of this increase in MNCL, an extensive toxicological database for phthalates indicates that toxicological effects occur only at relatively high doses, and tumor development (including MNCL) occurs only after an apparent threshold is exceeded. Phthalates are not genotoxic as a class, further supporting the hypothesis of the existence of a threshold. When these considerations are collectively evaluated, it can be concluded that a finding of increased MNCL in F-344 rats exposed for a lifetime to a nongenotoxic chemical is not toxicologically relevant to humans, even when MNCL is observed at an increased incidence that is statistically significant. Thus, the increased incidence of MNCL observed in F-344 rats exposed to some alkyl phthalates is likely a strain-specific effect of little or no relevance for humans, and characterization of these chemicals as carcinogens based on increased MNCL in F-344 rats is not scientifically supported.
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2/55. dermatomyositis associated with malignancy. 12 case reports.

    dermatomyositis (DM) is an idiopathic inflammatory disease of unknown etiology which manifests itself with symmetrical proximal muscle weakness and typical heliotrope skin rash. Internal malignancy is a specific trigger for some cases of DM. The aim of this study is to find predictive signs of cancer in dermatomyositis patients. Twelve (2 males and 10 females) (24%) out of 50 adult patients with DM (10 males and 40 females between 21 and 81 years old) had associated with malignancy (paraneopastic dermatomyositis, PDM). The male: female ratio in patients with idiopathic dermatomyositis (IDM) was 1:3.75 and for PDM it was 1:5. The frequency of dermatomyositis increases with age. PDM is most frequent between 40 and 69 years of life. Associated malignancies were respiratory tract carcinomas in males, genital and breast carcinomas in females. DM preceded the carcinoma in 5 cases (41.7%); 7 patients (58.3%) had already been treated for malignancy. In conclusion PDM in our country is more frequent in females and in the age after 40 years. association of dermatomyositis with malignancy is relatively high.
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3/55. delirium in terminal cancer: a prospective study using daily screening, early diagnosis, and continuous monitoring.

    A pilot prospective cohort study was conducted to determine delirium frequency and outcome in cancer patients consecutively hospitalized for terminal care (median stay: 12 days). Screening for delirium symptoms was performed daily, using the confusion Rating Scale. patients positive on screening had a diagnostic assessment within 24 hours using the confusion Assessment Method. Monitoring of symptoms was continued until death. Eighteen (20%) of the 89 study patients were positive on screening at admission. Among the 71 patients free of delirium at admission, the incidence of confirmed delirium was 32. 8% (95% CI, 21.3-44.3%). patients positive on screening received a higher mean equivalent parenteral daily dose of morphine than other patients (72 mg vs. 41 mg, p = 0.08). Significant symptom improvement occurred in 16 (50%) of the 32 delirious cases. delirium is a serious and frequent complication in terminal cancer whose outcome may not be as poor as previously considered.
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4/55. incidence of occult cancer in children presenting with musculoskeletal symptoms: a 10-year survey in a pediatric rheumatology unit.

    OBJECTIVES: To assess the frequency and types of cancer found in children presenting to our Unit with musculoskeletal symptoms over a 10-year period. methods: The medical records of patients with musculoskeletal symptoms and a final diagnosis of cancer were reviewed. In each case age, gender, presenting symptoms, laboratory data, diagnostic procedures, provisional and final diagnoses, and time between clinical onset and correct diagnosis were reviewed. RESULTS: An underlying neoplasia was found in 10 of 1,254 patients (<1%) complaining of musculoskeletal symptoms. The types of malignancies found included acute lymphocytic leukemia (ALL) (6 cases), lymphoma (2 cases), neuroblastoma (1 case), and Ewing's sarcoma (1 case). The mean time between disease onset and final diagnosis was 3.2 months. The most common presenting feature was monoarthritis, involving the larger joints such as the elbows, knees or ankles. Juvenile idiopathic arthritis (JIA) was the most frequent provisional diagnosis. In the preliminary hematologic evaluation, eight patients had an increased erythrocyte sedimentation rate (ESR) or c-reactive protein (CRP) value. White blood cell (WBC) count was normal in almost all children, with a normal differential count. Lactic dehydrogenase (LDH) was raised in all children. bone marrow aspirates and lymph node or bone biopsies were necessary to reach the final diagnosis. CONCLUSIONS: A malignancy should always be excluded in children with musculoskeletal symptoms, especially when the clinical pattern is not characteristic of a specific rheumatic disease. Routine laboratory tests may be misleading. The simultaneous presence of high LDH or alpha-hydroxybutyric dehydrogenase (alpha-HBDH) levels and raised ESR or CRP, even with normal blood cell counts, should lead to additional investigations. RELEVANCE: All patients presenting with arthritis or other musculoskeletal symptoms should have a thorough clinical examination. Disproportionate pain levels and an atypical pattern of "arthritis," especially in the presence of systemic manifestations, suggest a possible underlying malignancy.
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5/55. adult Henoch-Schonlein purpura associated with malignancy.

    OBJECTIVE: Malignancies are among the well-established causes of vasculitis. We studied the association between adult Henoch-Schonlein purpura (HSP) and malignant neoplasms. methods: We retrospectively reviewed 14 cases of adult HSP diagnosed during a 6-year period and found a malignant neoplasm in four. Fifteen reports of adult HSP with malignant disease were identified in the literature. These 19 cases were compared with 158 adults who had HSP but no malignancy and who where reported in the literature. RESULTS: Most (63%) of the malignant neoplasms associated with adult HSP were solid tumors: lung, n = 6; prostate, n = 2; breast, n = 1; renal, n = 1; stomach, n = 1; and small bowel, n = 1. Hematologic malignancies (37%) included non-Hodgkin lymphoma, n = 2; hodgkin disease, n = 2; IgA multiple myeloma, n = 1; myeloproliferative disease, n = 1; and myelodysplastic syndrome, n = 1. patients with malignancy were older (median age, 59 years), were more likely to be male (M/F = 8.5), had joint involvement more frequently (95%), and had a lower frequency of prior acute infection than those without malignancy. A typical paraneoplastic course was documented in only two cases. CONCLUSIONS: Epidemiological studies are needed to determine the association between adult HSP and malignancy. In practice, it may be wise to suspect a malignancy in men older than 40 years of age who develop HSP in the absence of a precipitating factor. Pathogenic hypotheses involve tumor antigens or abnormal IgA production leading to immune complex formation.
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6/55. coccidioidomycosis in compromised hosts. Experience at Stanford University Hospital.

    To determine the frequency and clinical characteristics of infection with coccidioides immitis in immunosuppressed patients at Stanford University Hospital, clinical records of 14 years were examined. Thirteen cases met the diagnostic criteria. Half had Hodgkin's disease. In six the infection was disseminated; five of the six died early in the course of their infectious illness, frequently without diagnosis. Conclusions include: 1. The occurrence of coccidioidomycosis in immunosuppressed patients seen at institutions in or adjacent to the endemic area is not as rare as the literature suggests. 2. Dissemination is frequently explosive and the radiographic appearance of pulmonary involvement may appear late. Widespread pulmonary dissemination may occur within 24 hours after a negative x-ray. 3. Although the skin test loses its diagnostic value, the serology remains valid. Thus immunosuppressed patients with febrile illnesses (with or without radiographically evident pulmonary involvement) who have a history of travel to an endemic area should have serological examinations. 4. Lymphocytopenia correlates with risk of dissemination of coccidioidomycosis. 5. The administration of immunsuppressive chemotherapy correlates with such risk while radiotherapy and the malignant or non-malignant nature of the disease do not.
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7/55. Severe abdominal infections in neutropenic patients.

    Abdominal infections are an important cause of morbidity and mortality in neutropenic patients. We present a retrospective series of 16 patients, mostly with acute leukemia, who developed severe abdominal infections during chemotherapy-induced neutropenia between 1991 and 1997. The frequency among patients with acute leukemia was 2.35% (13 of 553). Thirteen patients presented with enterocolitis and 3 patients presented with cholecystitis. Eight patients died. bacteremia was present in 6 patients, 4 patients suffered from proven or strongly suspected fungal infections, and 1 patient suffered from cytomegalovirus infection. Early surgical management was required in a patient with intestinal obstruction, whereas other patients could be managed conservatively. Two patients with acute cholecystitis were treated with antibiotics until the end of neutropenia and then were resected. Severe abdominal injections in neutropenic patients, which are often fatal, were caused by nonbacterial microorganisms in one-fourth of the cases and could be managed conservatively in most instances.
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8/55. Acute deep vein thrombosis in hospital practice.

    A recent cross sectional study on symptomatic acute deep vein thrombosis at the National University Hospital (NUH) in singapore found a frequency rate of 0.79 per 1000 patient admissions. A total of 39 patients were accrued over 18 months, 36 with deep vein thrombosis alone and three complicated by pulmonary embolism. No sex or ethnic predilection was observed in this cohort of hospitalised patients. Twenty-eight (71.8%) patients were 40 years or older. Majority (89.7%) of patients had at least two predisposing factors. While prolonged bedrest and operative procedures featured equally frequently in patients above and below 40 years, neoplasms were predominantly associated with the former and protein c or S deficiency primarily with the latter. The exhaustive laboratory confirmation of an inherent thrombotic tendency is recommended only for patients below 40 years of age.
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9/55. High-dose radiation-induced meningiomas. Report of five cases and critical review of the literature.

    radiotherapy is an important modality for the treatment of tumors and arteriovenous malformations affecting the central nervous system, even though several significant side effects have been described (radionecrosis, tumors, etc.). Meningiomas induced by high-dose radiation therapy are uncommon. In this study we describe five cases treated at our institute and review all previously published reports of meningioma occurring after high-dose radiotherapy. These tumors develop mainly in patients irradiated in childhood; their incidence peaks in the second decade of life, there is a predominance in females and a high frequency of malignant forms. Although rare, meningiomas may represent a late complication of radiation treatment. The behavior of the radiation-induced variety of meningioma seems to differ from that of its "spontaneous" counterpart. The use of radiotherapy should be carefully evaluated for relatively benign or congenital lesions which generally affect young patients with a long life expectancy.
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10/55. Typologies of family reaction to pediatric malignancies.

    The psychologic adaptation of children with malignancies is influenced by the strategies that both the relatives and the other members of the family employ as a reaction towards the disease and the therapeutic progress. Our experience in the Department of hematology of the University "La Sapienza": by carefully observing the communication styles, the distribution of roles, and the modification of the family organization up to the eventual adaptation to the disease, we have been able to identify various reaction typologies of the family, and also to evaluate their frequency and their varying functionality with time. A thorough analysis of these modalities of reaction may allow prompt recognition of problems related with psychologic and social adaptation of both the pediatric patient and his family, and may allow the adoption of pertinent strategies of intervention, in order to guarantee a better compliance throughout the whole therapy.
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