warfarin and Hodgkin-Disease

Topics: Administration, Oral; Anticoagulants; Antineoplastic Agents; Breast Neoplasms; Busulfan; Chlorambucil; Clinical Trials as Topic; Cyclophosphamide; Female; Hodgkin Disease; Humans; Leukemia, Myeloid; Lung Neoplasms; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms; Prognosis; Warfarin

Nervous system infections by Cryptococcus neoformans may occur not only in congenital or acquired immunodeficiency syndromes, but also in immunocompetent hosts. Neurological manifestations of C. neoformans infection include meningitis and, less commonly, parenchymal CNS granulomatous disease. This paper provides detailed clinical descriptions of highly unusual neurological manifestations of cryptococcal nervous system infections. Medical records and diagnostic data including magnetic resonance imaging, histopathology, serology, and CSF analysis were reviewed. A conus medullaris abscess was found in a patient infected with the human immunodeficiency virus (HIV). A patient with Hodgkin's disease was diagnosed with cryptococcal meningitis and dermatitis mimicking ophthalmic zoster. An immunocompetent patient presented with recurrent cerebral infarctions in the setting of cryptococcal meningitis. Cryptococcal infections of the nervous system can cause severe neurological disability when diagnosis is delayed. Sensitive and specific tests are readily available and should be considered when an unusual clinical presentation is encountered.

Topics: Abscess; Adult; Aged; Amphotericin B; Anticoagulants; Antifungal Agents; Brain; Central Nervous System Fungal Infections; Cryptococcosis; Cryptococcus neoformans; HIV Infections; Hodgkin Disease; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Spinal Diseases; Tomography, X-Ray Computed; Warfarin

Topics: Adult; Androstenes; Angiography; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Contraceptives, Oral, Synthetic; Cytarabine; Etoposide; Female; Hodgkin Disease; Humans; Immunotherapy; International Normalized Ratio; Lynestrenol; Melphalan; Mineralocorticoid Receptor Antagonists; Risk; Risk Factors; Time Factors; Venous Thrombosis; Warfarin

Two groups of patients were observed for evidence of acute radiation hepatitis during "high dose" radiation to the liver. The first group of 18 patients with metastatic liver disease received an average of 4,050 rad to the whole liver. Half received anticoagulation with warfarin. One patient on anticoagulation developed evidence of acute radiation hepatitis while 2 patients did so without anticoagulation. Eleven patients with Hodgkin's disease received 4,000 rad to the left lobe of the liver during extended field radiation. Four of these 11 patients were anticoagulated to therapeutic range. Only one of the fully anticoagulated patients showed changes on liver scan consistent with radiation hepatitis whereas three did so without anticoagulation. No serious sequelae from anticoagulation occurred in either group. These preliminary data suggest that anticoagulation may be safely administered with high dose hepatic radiation and that further trials with anticoagulation are warranted.

Topics: Adult; Aged; Female; Hepatitis; Hodgkin Disease; Humans; Male; Middle Aged; Neoplasms; Radiation Injuries; Radiation Tolerance; Radiotherapy Dosage; Radiotherapy, High-Energy; Remission, Spontaneous; Warfarin