Febrile neutropenia(FN) is responsible for significant morbidity and mortality. It can also be the reason for delaying or changing potentially effective treatments and generates substantial costs. It has been recogniz...Febrile neutropenia(FN) is responsible for significant morbidity and mortality. It can also be the reason for delaying or changing potentially effective treatments and generates substantial costs. It has been recognized for more than 50 years that empirical administration of broad spectrum antibiotics to patients with FN was associated with much improved outcomes; that has become a paradigm of management. Increase in the incidence of microorganisms resistant to many antibiotics represents a challenge for the empirical antimicrobial treatment and is a reason why antibiotics should not be used for the prevention of neutropenia. Prevention of neutropenia is best performed with the use of granulocyte colonystimulating factors(G-CSFs). Prophylactic administration of G-CSFs significantly reduces the risk of developing FN and consequently the complications linked to that condition; moreover, the administration of G-CSF is associated with few complications, most of which are not severe. The most common reason for not using G-CSF as a prophylaxis of FN is the relatively high cost. If FN occurs, in spite of prophylaxis, empirical therapy with broad spectrum antibiotics is mandatory. However it should be adjusted to the risk of complications as established by reliable predictive instruments such as the Multinational Association for Supportive Care in Cancer. Patients predicted at a low level of risk of serious complications, can generally be treated with orally administered antibiotics and as out-patients. Patients with a high risk of complications should be hospitalized and treated intravenously. A short period of time between the onset of FN and beginning of empirical therapy is crucial in those patients. Persisting fever in spite of antimicrobial therapy in neutropenic patients requires a special diagnostic attention, since invasive fungal infection is a possible cause for it and might require the use of empirical antifungal therapy.展开更多
The involvement of the heart in metastatic cancer is a very rare clinical diagnosis with poor prognosis given to the major risk of cardiac failure. They are frequently asymptomatic or symptoms, when present, may be at...The involvement of the heart in metastatic cancer is a very rare clinical diagnosis with poor prognosis given to the major risk of cardiac failure. They are frequently asymptomatic or symptoms, when present, may be attributed to other causes. The most common, among the latter, are intrathoracic cancers, lymphomas, leukemias, melanoma, and rarely sarcomas. The echocardiography is the gold standard for diagnosis, but scanner and magnetic resonance imaging (MRI) can be helpful for determination of exact location and composition of lesions. Cardiac metastases occur generally in advanced stage in poly-metastatic patients. Treatment is often in a palliative strategy but should be discussed in multidisciplinary approach for each case. We report a case of cardiac metastasis occurring in a 47 years old woman, treated for epitheloid sarcoma of the buttock. The aim of this work is to show the rarity of the heart location, describing the epidemiological, clinical, radiological, and prognostic features of these metastases and finally discussing the therapeutic strategy.展开更多
文摘Febrile neutropenia(FN) is responsible for significant morbidity and mortality. It can also be the reason for delaying or changing potentially effective treatments and generates substantial costs. It has been recognized for more than 50 years that empirical administration of broad spectrum antibiotics to patients with FN was associated with much improved outcomes; that has become a paradigm of management. Increase in the incidence of microorganisms resistant to many antibiotics represents a challenge for the empirical antimicrobial treatment and is a reason why antibiotics should not be used for the prevention of neutropenia. Prevention of neutropenia is best performed with the use of granulocyte colonystimulating factors(G-CSFs). Prophylactic administration of G-CSFs significantly reduces the risk of developing FN and consequently the complications linked to that condition; moreover, the administration of G-CSF is associated with few complications, most of which are not severe. The most common reason for not using G-CSF as a prophylaxis of FN is the relatively high cost. If FN occurs, in spite of prophylaxis, empirical therapy with broad spectrum antibiotics is mandatory. However it should be adjusted to the risk of complications as established by reliable predictive instruments such as the Multinational Association for Supportive Care in Cancer. Patients predicted at a low level of risk of serious complications, can generally be treated with orally administered antibiotics and as out-patients. Patients with a high risk of complications should be hospitalized and treated intravenously. A short period of time between the onset of FN and beginning of empirical therapy is crucial in those patients. Persisting fever in spite of antimicrobial therapy in neutropenic patients requires a special diagnostic attention, since invasive fungal infection is a possible cause for it and might require the use of empirical antifungal therapy.
文摘The involvement of the heart in metastatic cancer is a very rare clinical diagnosis with poor prognosis given to the major risk of cardiac failure. They are frequently asymptomatic or symptoms, when present, may be attributed to other causes. The most common, among the latter, are intrathoracic cancers, lymphomas, leukemias, melanoma, and rarely sarcomas. The echocardiography is the gold standard for diagnosis, but scanner and magnetic resonance imaging (MRI) can be helpful for determination of exact location and composition of lesions. Cardiac metastases occur generally in advanced stage in poly-metastatic patients. Treatment is often in a palliative strategy but should be discussed in multidisciplinary approach for each case. We report a case of cardiac metastasis occurring in a 47 years old woman, treated for epitheloid sarcoma of the buttock. The aim of this work is to show the rarity of the heart location, describing the epidemiological, clinical, radiological, and prognostic features of these metastases and finally discussing the therapeutic strategy.
