Infectious complications in neutropenic cancer patients

Cancer patients are at risk of infectious complications due to neutropenia following chemotherapy or early post-HSCT (Hemato Stem Cell Transplantation). The first episode of fever during recent onset neutropenia is caused mostly by bacteria, while subsequent episodes are mainly fungal in nature. Proper management of infectious complications in neutropenic cancer patients requires classification into the appropriate risk category and knowledge of the local epidemiology of infections, of the causative organisms and their resistance phenotype.     

Infectious complications of cancer chemotherapy in HIV patients

The outcome for HIV-infected patients with cancer has dramatically improved in the highly active antiretroviral therapy (HAART) era, probably due to improvements in immune status and bone marrow function that allow the possibility of increased drug-dose intensity with a higher complete remission rate. Although data regarding the optimal management of these cancers are lacking, current studies suggest that patients with HIV-associated malignancies could be treated using approaches similar to those for their counterparts in the general population (ie, with chemotherapy, radiation, and appropriate use of supportive measures). In the HAART era, the AIDS-related mortality rate has decreased by approximately 70%, and so the cause of the growing number of reports of cancers in HIV patients is unclear. Clearly, non-AIDS-defining malignancies account for more morbidity and mortality than AIDS-defining malignancies. Prevention strategies are needed to adequately deal with HIV-associated cancers in an aging and growing HIV-positive population.     

兔肝动脉插管技术的方法学及DSA表现

目的:探讨实验兔肝动脉插管的实验方法.方法:大耳白兔24只,随机等分为2组,实验组,经股动脉穿刺插管至肝动脉;对照组,剖腹下直视穿刺插管至肝动脉,比较2组的手术操作时间及手术成功率.结果:实验组的手术成功率为91.67%(11/12),对照组为75%(8/12),两者相比无显著性差异(P>0.05);实验组的手术操作时间为41.5±3.6min,对照组为58.6±5.4 min,两者相比有显著性差异(P<0.05).结论:实验兔进行股动脉穿刺插管进行肝动脉灌注的方法简单、容易掌握、成功率高,适用于研究药物或细胞悬液经肝动脉灌注对肝脏的作用.     

Femoral artery catheterization complications: A study of 503 consecutive patients

This report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids.     

Infectious complications of endoscopic procedures in bone marrow transplant recipients

The prevalence of clinically relevant bacteremia after endoscopic procedures in bone marrow transplant recipients was assessed retrospectively. Bacteremia, within 24 hr of procedure, was defined as positive blood cultures, while hypotension and temperature greater than 38° C were taken as possible indicators of bacteremia. Sixty-seven procedures were performed in 53 endoscopic sessions (upper endoscopy 37, flexible sigmoidoscopy 7, upper endoscopy + flexible sigmoidoscopy 8, colonoscopy 1). Twenty-five endoscopic sessions were performed in patients receiving broad-spectrum antibiotics and 28 sessions in patients not receiving antibiotics. Both groups were comparable with respect to patient characteristics, procedures performed, and immune status. No patient in either group developed hypotension. One patient developed fever after flexible sigmoidoscopy; no source of fever was identified. We conclude that: (1) there were no episodes of clinically relevant bacteremia attributable to endoscopic procedures, and (2) not all bone marrow transplant recipients require routine antibiotic prophylaxis prior to endoscopic procedures.     

抗中性粒细胞胞质抗体相关血管炎合并感染患者的临床特征

目的:回顾性分析抗中性粒细胞胞质抗体(ANCA)相关血管炎(AAV)治疗过程中合并感染患者的流行病学特点、临床特点、危险因素及预后。方法:1996年1月至2013年12月确诊AAV伴肾脏损害的患者255例,其中男性103例,女性152例,年龄14~78岁(中位年龄55岁)。诱导治疗方案包括单用激素、激素联合间断环磷酰胺静脉冲击疗法(IV-CTX)或吗替麦考酚酯(MMF)、多靶点疗法或雷公藤多苷(TW)。感染诊断依据临床症状、实验室和微生物检查,收集治疗过程中出现的多种中度以上感染患者,分析感染发生的时间、部位、发生率及危险因素。结果:在中位随访15月(1~155月)期间,共86例(33.7%)发生103次感染。单用激素(n=65)、MMF(n=77)、IV-CTX(n=66)和TW(n=40)诱导治疗期内感染发生率分别为38.5%、39.0%、33.3%和22.5%。76次(73.8%)感染发生在治疗6个月内,其中3个月内66次(64.1%)。感染最常见部位为肺(n=74),其次为皮肤、消化道和泌尿道,6例发展为脓毒症;感染病原体以细菌最常见(78.6%),其次为真菌(12.6%)和病毒(8.7%)。COX回归模型显示前驱感染(RR=4.105,95%CI=2.557~6.592)、血清肌酐≥530.4μmol/L(RR=1.179,95%CI=1.090~1.276)和使用CTX治疗(RR=1.889,95%CI=1.020~3.500)是感染发生的独立危险因素。肺部影像学征象表现以大叶性肺炎(51.4%)最为多见,依次为弥漫间质性肺炎(28.4%)或多发结节样病灶(17.6%)。12例(11.7%)患者均死于肺部感染。结论:AAV治疗过程中并发感染的发生率高且好发于治疗前3个月内,病变部位以肺最为常见,病原体以细菌感染比例最高。前驱感染、严重肾功能不全和使用CTX治疗是感染发生的独立危险因素。     

Pulmonary artery catheterization in 9071 cardiac surgery patients: a review of complications]

BACKGROUND: The safety of pulmonary artery catheterization has been questioned. We report our experience on the incidence of complications in a large series of patients requiring cardiac operations by evaluating the learning curve of the operators. METHODS: Since 1988 at our Institution a pulmonary artery catheter (PAC) register records the following data from each patient: type of surgical procedure, insertion site of the venous introducer, type of PAC used, final position of the catheter, and complications associated with central venous access and those determined by PAC positioning and stay. During 16 years (from April 1988 to April 2004) 9071 PACs were registered. RESULTS: Complications associated with the access to the central venous pool consisted of carotid arterial puncture in 191 patients (2.1%) and pneumothorax in 4 patients (0.04%). Complications associated with PAC positioning consisted of runs of ventricular ectopic beats (> 6 s) in 62 patients (0.68%), atrial fibrillation in 2 patients (0.022%), complete atrioventricular block in 2 patients (0.022%), ventricular fibrillation in 1 patient (0.011%), nodal rhythm in 6 patients (0.066%), perforation of the right ventricular wall in 1 patient (0.011%), hematoma of the right ventricular wall in 2 patients (0.022%), anonymous vein lesion in 2 patients (0.022%), and pulmonary artery rupture in 2 patients (0.022%). CONCLUSIONS: Pulmonary artery catheterization performed by experienced team appears to be a safe procedure in cardiac surgery patients.     

Infectious lung complications in patients with HIV/AIDS

PURPOSE OF REVIEW: The aim of this article is to review recent observations in the area of infectious lung complications in individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Since the immunodeficiency was first characterized, it has been associated with enhanced susceptibility to opportunistic infection, and life-threatening infections of the lung in particular. In the past few years there have been a large number of reports documenting the changes to this disease profile in the age of highly active antiretroviral therapy (HAART). Furthermore, there have been considerable advances in our understanding of the immunology and vaccinology of many of the pathogens implicated in pulmonary infections in this context, including Mycobacterium tuberculosis, Streptococcus pneumoniae and Pneumocystis pneumonia. RECENT FINDINGS: In considering the time-course and spectrum of HIV-associated respiratory infections, the field must now be divided into studies undertaken in parts of the world where HAART is accessible and those where it is not. Despite the enormous impact of HAART, it has brought with it a new set of concerns, including the effects of immune restoration disease (IRD), and the complex interplay between HAART and tuberculosis therapy. SUMMARY: The overriding conclusion from recent experience is that HAART, in those parts of the world where it is readily available, has changed the clinical picture of infections associated with HIV, and needs to be available to patients across the developing world as well. Furthermore there have been important developments in vaccination programs against pathogens involved in HIV-associated pneumonia.     

Infectious complications in patients with adult T-cell leukemia]

Between January, 1982, and January, 1992, a total of 112 patients with adult T-cell leukemia (ATL) and 109 patients with non-Hodgkin's lymphoma (NHL) were admitted to our hospital. They were studied for their infectious complications. Infectious complications were seen in 90 patients (80.4%) with ATL, and 51 patients (46.8%) with NHL (p < 0.001). Documented infections were seen in 70 patients (62.5%) with ATL, and 30 patients (27.5%) with NHL (p < 0.001). Pneumonia (p < 0.005), skin infections (p < 0.05), Pneumocystis carinii pneumonia (p < 0.05), fungal infections (p < 0.05), cytomegalovirus infections (p < 0.05) and herpes simplex virus infections (p < 0.01) were identified infections at high risk for patients with ATL. Tuberculosis, listeriosis and salmonella infections were seen only in patients with ATL.     

Hand dysfunction after transradial artery catheterization for coronary procedures

AIM To sythesize the available literature on hand dysfunction after transradial catheterization.METHODS We searched MEDLINE and EMBASE. The search results were reviewed by two independent judicators for studies that met the inclusion criteria and relevant reviews. We included studies that evaluated any transradial procedure and evaluated hand function outcomes post transradial procedure. There were no restrictions based on sample size. There was no restriction on method of assessing hand function which included disability, nerve damage, motor or sensory loss. There was no restriction based on language of study. Data was extracted, these results were narratively synthesized.RESULTS Out of 555 total studies 13 studies were finally included in review. A total of 3815 participants with mean age of 62.5 years were included in this review. A variety of methods were used to assess sensory and motor dysfunction of hand. Out of 13 studies included, only 3 studies reported nerve damage with a combined incidence of 0.16%, 5 studies reported sensory loss, tingling and numbness with a pooled incidence of 1.52%. Pain after transradial access was the most common form of hand dysfunction(6.67%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or any other hand complication was incredibly low at 0.26%. Although radial artery occlusion was not our primary end point for this review, it was observed in 2.41% of the participants in total of five studies included.CONCLUSION Hand dysfunction may occur post transradial catheterisation and majority of symptoms resolve without any clinical sequel.     

Unusual complications of cardiac catheterization via the radial artery

Use of the radial artery for cardiac catheterization has significantly reduced the incidence and severity of complications at the access site. Nevertheless, occasionally unusual complications or atypical responses to treatment are observed. We describe two cases: a radial artery pseudoaneurysm that was unresponsive to compression treatment and a foreign-body inflammatory reaction at the radial artery access site. The characteristics, development and treatment of the 2 cases are described, and the pathogenic mechanisms are discussed.     

Comparison of the risk of vascular complications associated with femoral and radial access coronary catheterization procedures in obese versus nonobese patients

In this retrospective review of 5,234 cardiac catheterizations and percutaneous coronary interventions, the rate of vascular complications was highest in extremely thin and morbidly obese patients and lowest in moderately obese patients, consistent with the previously reported "obesity paradox." The use of transradial access and arterial access closure devices was associated with reduced vascular complications in the population of obese patients.