Netherlands Journal

More documents

Recommendations

Info

netherlands journal of critical care Figure 3. (400X HE) postmortem lung microscopy showing characteristic signs of lung fibroses. Figure 4. (400x, HE) postmortem lung microscopy showing characteristic signs of cytotoxic therapy: atypical type II pneumocyte (arrow). this patient’s group is poor, with a 5 year progression-free survival of 40% [20,21] and a 5 year-survival of 48 %[20,21]. Because of its infrequent occurrence and often complicated multidisciplinary treatments, the best results are obtained in specialized centres [21]. Bleomycin therapy is associated with Bleomycin Induced Pneumonitis (BIP) which can lead to potentially lethal pulmonary fibrosis [3]. The incidence of BIP is, depending on the criteria used for the diagnosis, 0-46% [1], the mortality of all the patients treated with bleomycin is 3%. Clinical diagnosis of BIP is difficult due to its resemblance to other conditions such as pneumonia and pulmonary metastases. Clinical signs are non-productive cough, exert ional dyspnoea and fever. Physical examination is not conclusive, and chest radiographs often show bilateral infiltrates and/or lobar consolidations[1,2]. Lung function changes are found in half of the patients treated with bleomycin [3], but it is not possible to use these symptoms to accurately predict patients likely to develop BIP [1,3,6]. The diagnosis of BIP is therefore only made by the exclusion of other diseases. The pathogenesis of BIP has mainly been investigated in animals. The antitumour effect of bleomycin works through inhibition of tumour angiogenesis and induction of tumour cell death. The mechanisms of the toxic effect are not known in detail, but the formation of free radicals and cytokines may lead to endothelial damage. Free radicals that are produced directly after oxidation of the Bleomycin- Fe II complex cause dysfunction of the antioxidant system activity and subsequently lead to DNA damage from unopposed endogenous super oxide production [1,3,14]. Bleomycin also has some potential for direct DNA-cleaving [1,5,15] and this damaging effect on DNA might be involved in late-onset, previously asymptomatic lung damage following bleomycin administration[1]. A five fold increase has been shown with 70% supplemental oxygen versus ambient air in animal studies [8]. However in humans, clear data showing an increased risk of BIP with concomitant oxygen supplementation are lacking [1]. Bleomycin is mainly eliminated by the kidneys and deactivated by the enzyme bleomycin hydrolase, which is produced in the liver, spleen, bone marrow and intestine, but not in the lungs or skin. This is why toxicity occurs mainly in these organs [1,3,8,12]. Genetic variance in the enzyme setup may partially explain individual difference in susceptibility [12,19]. Risk factors for development of BIP are: cumulative doses of bleomycin (> 400 U), age >40 years, a creatinine clearance
netherlands journal of critical care References 1. Sleijfer S, Bleomycin-induced Pneumonitis; Chest 2001; 120; 617-624. 2. Einhorn L.H., Curing metastatic testicular cancer; PNAS; 2002 April 2; vol 99; no 7; 4592-4595. 3. O’Sullivan J.M., Huddart R.A., Norman A.R., Nicholls J., Dearnaley D.P., Hrowich A.; Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours; annals of oncology 2003; 14: 91-96. 4. Kaye S., Mead G., Fossa S., Cullen M., de Wit R., Bodrogi I., Intensive induction sequential chemotherapy with BOP/VIP-B compared with treatment with BEP/EP for poor prognosis metastatic non-seminomateus germ cell tumor: a randomised MRC/EORTC study; J.Clin. Oncol 1998; 16: 692-701. 5. Azambuja E., Fleck J.F., Batista R.G., Menna Barreto S.S.; Bleomycin lung toxicity: who are the patients with increased risk?; Pulm.Pharmacol. Ther. 2005; 18 ( 5 ): 363- 366. 6. Maher J., Daly P., Severe bleomycin lung toxicity: reversal with high dose corticosteroids; Thorax 1993; 48 : 92-94. 7. Joselson R., Warnock M., Pulmonary veno-occlusive disease after chemotherapy. Hum. Pathol> 1983; ( 14 ):88-91. 8. Tryka A., Godleski J., Brain J., Differences in effects of immediate and delayed hyperoxia exposure on bleomycin- induced pulmonary injury. Cancer treatment reports 1984; 68 ( 5): 759-764. 9. Holoye P., Luna M., Mackay B., Bleomycin hypersensitivity pneumonitus. Ann Intern. Med. 1978; 88: 47-49. 10. Bakowska J., Adamson I., Collagenase and gelatinase activities in bronchoalveolar lavage fluids during bleomycin-induced lung injury. J. Pathol. 1998; 185 ( 3 ): 319-323. 11. Phan S, Armstrong G, Sulavik M, Schrier D, Johnson K, Ward P. A Comparative Study of Pulmonary Fibrosis Induced by Bleomycin and an O2 Metabolite Producing Enzyme System. Chest 1983; 83(5):44-45. 12. Sogal R, Gottlieb A, Boutros A, Ganapathi R, Tubbs R, Satariano P et al. Effect of oxygen on bleomycininduced lung damage. Cleve Clin J Med 1987; 54:503- 509. 13. Cooper J, White D, Matthay R. Drug-induced pulmonary disease. Am Rev Respir Dis 1986; 133:321-340. 14. Chandler D. Possible Mechanisms of Bleomycin-Induced Fibrosis. Clin Chest Med 1990; 11(1):21-30. 15. Iacovino J, Leitner J, Abbas A, Lokich J, Snider G. Fatal Pulmonary Reaction from low doses of bleomycin : an idiosyncratic tissue response. JAMA 1976; 235(12):1253- 1255. 16. Cersosimo R, Matthews S, Hong W. Bleomycin pneumonitis potentiated by oxygen administration. Drug Intelligence and Clinical Pharmacy 1985; 19:921-923. 17. Borzone G, Moreno R, Urrea R, Meneses M, Oyarzun M, Lisboa C. Bleomycin-induced chronic lung damage does not resemble human idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2001; 7(163):1648-1653. 18. Krakoff I, Cvitkovic E, Currie V. Clinical pharmacologic and therapeutic studies of bleomycin given by continuous infusion. Cancer 1977;(40):2027-2037. 19. Dunsmore S, Roes J, Chua F, Segal A, Mutsaers S, Laurent G. Evidence that neutrophil elastase-deficient mice are resistant to bleomycin-induced fibrosis. Chest 2001;(120):35-36. 20. www.cancernet.nci.nih.gov. 21. Hinton S, Catalano P, Einhorn L. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors; final analysis of an intergroup trial. Cancer 2003, 97; 1869-75. neth j crit care • volume 10 • no 5 • october 2006 541
Page 1 and 2: Netherlands Journal Netherlands Jou
Page 3 and 4: netherlands journal of critical car
Page 17: netherlands journal of critical car
Page 47: Bacteriën, opgepast! Krachtige, sn
Page 55 and 56: Surviving Sepsis Campaign Netherlan
Page 57 and 58: voor verpleegkundigen en artsen Int
Page 59 and 60: j a a r p r o g r a m m a n v i c a
Page 61 and 62: j a a r p r o g r a m m a n v i c a
Page 63 and 64: Balanced Solutions
Page 69 and 70:
netherlands journal of critical car
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Zorg kent vele gezichten VieCuri, M
Page 81 and 82:
603 r e g i str ati e f o r m u l i
Page 83:
Een nieuw antibioticum doet de rond
show all

Netherlands Journal

Create successful ePaper yourself

Delete template?

Save as template?