Abstract: Mediastinal lymphadenopathy in a patient with previously treated T-cell acute lymphoblastic leukaemia is a diagnostic problem. The differential diagnosis in an adult is sarcoidosis, metastases, lymphoma or, rarely, tuberculosis. Mediastinal lymph node involvement is uncommon in tuberculosis. In view of its relative rarity but good prognosis, it is important to distinguish tuberculous mediastinal lymphadenitis in adults from other causes of mediastinal masses.
Abstract: Background: Echocardiography provides both morphological and functional information offering a potential advantage over nuclear medicine gated blood pool scans which only estimate ejection fraction. This additional information may be relevant to management of patients receiving potentially cardiotoxic cancer treatment. Methods: We retrospectively audited all pre-chemotherapy echocardiograms (ECHO) ordered by medical oncologists at our institution over a 36 months period. The primary objective was to determine the frequency of cardiac abnormality detection on the initial ECHO. We also looked at the frequency of clinically relevant cardiac abnormalities other than ejection fraction abnormalities including diastolic dysfunction, intracardiac shunts, moderate-severe valvular abnormalities, pulmonary hypertension, ventricular hypertrophy, pericardial effusion, wall motional abnormalities, ventricular dysfunction/dilatation, cardiac tumours and congenital anomalies. Results: Baseline ECHOs were analyzed in 217 consecutive patients. Female patients comprised 89% of population and the majority had breast cancer (75.5%). The median age of the patients at the time of ECHO was 55 years (range 16 to 87). 13.4% of patients had at least one clinically relevant abnormality on ECHO. Systolic and moderate diastolic dysfunctions were seen in 5% and 2.7% respectively. Aortic stenosis was seen in 5 (2.3%) patients. Atrial septal defects were seen in 2 patients, moderate mitral regurgitations in 2 patients and left atrial tumour in 1 patient. A total of 7.4% of patients had abnormalities, which would not have been detected by gated blood pool scan (GBPS). The ECHO resulted in change in chemotherapy plan in 2.8% and referral to cardiology in 3.7%. Conclusions: Our retrospective analysis suggests that pre-chemotherapy ECHO can provide more useful clinical information than the GBPS, which may impact on clinical management of cancer patients.
Abstract: Background: Small cell lung cancer (SCLC) is an aggressive malignancy associated with early metastasis and mortality. However, its exquisite sensitivity to chemotherapy and radiotherapy allows for durable clinical responses being achieved even in advanced stage. Multimodality approach through combination chemotherapy and radiotherapy remains the cornerstone for its treatment. Methods: Records of patients with extensive stage SCLC treated at our institution from 2003 to 2006 were analyzed. Their responses and time to disease progression were analyzed retrospectively. Results: A total of 26 patients with extensive stage SCLC were available for analysis. All patients were males with age between 44 and 73 years (Median-60 years). Twenty three patients (82.1%) were smokers. Eighteen patients (64.2 %) had distant metastasis at diagnosis with the adrenal gland being the commonest site (39%). Two patients presented with symptoms of superior venacaval obstruction. Twenty six patients (92.8%) received 6 cycles of palliative chemotherapy with 19 (67.8%) receiving Irinotecan -Cisplatin and 7 (25%) receiving Etoposide-Cisplatin combination. Of the 26 patients treated, complete response (CR), partial response (PR) and progressive disease (PD) were seen in 23% (n=6), 30.7% (n=8) and 23% (n=6) respectively, giving an overall response rate (ORR) of 53.8%. Nine patients (34.6%) in either CR or good PR were given prophylactic cranial irradiation (PCI). At a median follow up of 6 months (Range 10 days -25.5 months), 7.1% (n=2) patients remained disease free. The median relapse free survival was 6.44 months (CI- 5.6-7.3 months). Disease progression after an initial response was seen in 65.3% patients (n=12). Two patients died due to chemotherapy related toxicity and six patients were lost to follow up. Conclusions: Chemotherapy can induce good overall responses in extensive stage SCLC. The initial responses are excellent with short time to progression which is highlighted in our series too. The CR rates are comparable to most published series and PCI may offer an advantage in a those patients who do achieve an excellent partial or complete response.
Abstract: Background: IFI is a common cause of morbidity & mortality in hematolymphoid malignancy. This study was initiated to document the profile of IFI and to test LA in diagnosis. Methods: Prospective study of IFI in acute leukemia, high grade lymphoma and stem cell transplant with high risk FN. Sample size was calculated to be 270 with an assumed probability of 20% IFI. Consecutive consenting patients, without serious comorbid conditions were included. In a subset of 96 patients serial serum samples were tested for GM,CM. Endpoints were afebrile for 2 days, neutrophil > 1,000/cumm and clearance of infection or death. Episodes were classified as proven, probable, possible IFI and nonIFI based on the EORTC/MSG criteria. Results: From Feb 2006 to Jan 2007, 269 high risk FNs were studied. 85% of the episodes had acute leukemia. 14 (5.2%), 12 (4.5%) and 78 (29%) episodes had proven, probable and possible IFI. Halo sign, nodules and cavity were seen in 22%, 17% and 15% of chest CT scans and liver, spleen or kidney hypodensities in 5, 7 and 3 episodes respectively by abdominal imaging (n-37) in IFI group. Blood culture grew candida in 14 and mold in 4 in IFI. 3/64 respiratory (all IFI) and 7/84 stool samples also cultured candida (3 IFI). 2/3rd of the candida were non albicans. A total of 39 and 57 patients underwent LA assay in IFI and nonIFI group respectively. Sensitivity and specificity were 31%, 88% for GM and 5%,91% for CM detection respectively. The predictive values were 63%-65% for GM and 29%-61% for CM. In multivariate model presence of infectious focus, prolonged neutropenia and fever, poor PS and albumin <3.5gm/dl were associated with increased risk of IFI. Conclusion: IFI is on rise in hematolymphoid malignancy as chemotherapy regimens get more aggressive. LA for GM, CM detection is a simple test but had a low predictive value and sensitivity in our experience. IFI % (n: 104) * Non IFI % (n:165)
Focus of infection Any 100 60
Chest 90 28
Abnormal Chest Xray 64 8
Abnormal Chest CT scan 97(n: 69) 40(n:20)
Neutropenia > 10days 92 51
Fever > 10days 65 23
Death 33 1
*p value <.001 in all
