Ribociclib-associated organising pneumonia

2021 ◽  
Vol 14 (12) ◽  
pp. e245187
Author(s):  
Arjun Rajendran ◽  
Akhilesh Kunoor ◽  
Roshini Pushpa Ragahavan ◽  
Pavithran Keechilat
Keyword(s):  
Breast Cancer ◽  
Drug Administration ◽  
Left Breast ◽  
Exertional Dyspnoea ◽  
Lower Zone ◽  
Steroid Use ◽  
X Ray ◽  
Superior Efficacy ◽  
Function Test ◽  
Chest X Ray

A 63-year-old woman with grade 2 infiltrating left breast carcinoma who was started on ribociclib complained of exertional dyspnoea along with dry cough. There were bilateral interscapular crackles and chest X-ray evidence of bilateral mid and lower zone non-homogeneous opacity. The patient’s pulmonary function test (PFT) showed moderate restrictions and desaturation. CT was suggestive of organising pneumonia and drug administration was stopped. The patient was treated with steroids in tapering doses, which led to improvements. The drug was restarted with the probability of other aetiologies for interstetial lung disease (ILD). It was also considered the superior efficacy of ribociclib in managing breast cancer. But due to evidence indicating the reappearance of organising pneumonia following drug administration, it was again stopped, and steroid use was restarted for treatment. The patient showed improvements in subsequent follow-ups.

AB0796 THE EVALUATION OF LUNG DIAGNOSTIC PROCEDURE AT THE ONSET OF INFLAMMATORY RHEUMATIC DISEASES WITH INTERSTITIAL LUNG DISEASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1422.3-1423
Author(s):  
T. Hoffmann ◽  
P. Oelzner ◽  
F. Marcus ◽  
M. Förster ◽  
J. Böttcher ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Interstitial Lung Disease ◽  
Lung Function ◽  
Lung Disease ◽  
Sensitivity And Specificity ◽  
Lung Function Test ◽  
Inflammatory Rheumatic Diseases ◽  
X Ray ◽  
Function Test ◽  
Chest X Ray

Background:Interstitial lung disease (ILD) in inflammatory rheumatic diseases (IRD) is associated with increased mortality. Moreover, the lung is one of the most effected organs on IRD. Consequently, screening methods were required to the detect ILD in IRD.Objectives:The objective of the following study is to evaluate the diagnostic value of lung function test, chest x-ray and HR-CT of the lung in the detection of ILD at the onset of IRD.Methods:The study is designed as a case-control study and includes 126 patients with a newly diagnosed IRD. It was matched by gender, age and the performance of lung function test and chest x-ray. The sensitivity and specificity were verified by crosstabs and receiver operating characteristic (ROC) curve analysis. The study cohort was divided in two groups (ILD group: n = 63 and control group: n = 63). If possible, all patients received a lung function test and optional a chest x-ray. Patients with pathological findings in the screening tests (chest x-ray or reduced diffusing capacity for carbon monoxide (DLCO) < 80 %) maintained a high-resolution computer tomography (HR-CT) of the lung. Additionally, an immunological bronchioalveolar lavage was performed in the ILD group as gold standard for the detection of ILD.Results:The DLCO (< 80 %) revealed a sensitivity of 83.6 % and specificity of 45.8 % for the detection of ILD. Other examined parameter of lung function test showed no sufficient sensitivity as screening test (FVC = Forced Vital Capacity, FEV1 = Forced Expiratory Volume in 1 second, TLC = Total Lung Capacity, TLCO = Transfer factor of the Lung for carbon monoxide). Also, a combination of different parameter did not increase the sensitivity. The sensitivity and specificity of chest x-ray for the verification of ILD was 64.2 % versus 73.6 %. The combination of DLCO (< 80 %) and chest x-ray showed a sensitivity with 95.2 % and specificity with 38.7 %. The highest sensitivity (95.2 %) and specificity (77.4 %) was observed for the combination of DLCO (< 80 %) and HR-CT of the lung.Conclusion:The study highlighted that a reduced DLCO in lung function test is associated with a lung involvement in IRD. DLCO represented a potential screening parameter for lung manifestation in IRD. Especially patients with suspected vasculitis should receive an additional chest x-ray. Based on the high sensitivity of DLCO in combination with chest x-ray or HR-CT for the detection of ILD in IRD, all patients with a reduced DLCO (< 80%) should obtained an imaging of the lung.Disclosure of Interests:None declared

scholarly journals What is the Utility of Routine Complete Blood Count, Liver Function Tests, and Chest X-ray in the Evaluation of Patients with Clinically Node-Negative Breast Cancer?

2019 ◽  
Vol 85 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Ameliay Merrill ◽  
Mary M. Garland ◽  
Marissa Howard-Mcnatt ◽  
Mena Isnassuos ◽  
Kathleen C. Perry ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Blood Count ◽  
Complete Blood Count ◽  
Liver Function Tests ◽  
Screening Tests ◽  
Occult Metastasis ◽  
Preoperative Screening ◽  
Node Negative ◽  
X Ray ◽  
Chest X Ray

National Comprehensive Cancer Network guidelines suggest a selective workup of early-stage breast cancer with complete blood count (CBC) and liver function tests (LFTs) and no longer recommend chest X-ray (CXR) to screen for occult metastasis. We evaluated the utility of routine preoperative screening tests in patients with clinically node-negative (cN0) breast cancer. We identified 1611 patients with cN0 breast cancer treated at our institution between October 1998 and December 2015; 94.4 per cent of the patients underwent at least one preoperative screening test: 90.8 per cent CBC, 89.4 per cent LFTs, and 63.6 per cent CXR. Thirty-six per cent of CBCs, 13.1 per cent of LFTs, and 6.7 per cent of CXRs were abnormal. Abnormalities led to 17 CTscans, and one found an occult metastasis. Eleven patients (0.7%) were diagnosed with metastatic disease post-operatively, but only half had abnormal preoperative screening tests. Positive predictive values of preoperative CBC, LFTs, and CXR for occult metastasis are 1.3 per cent, 1.1 per cent, and 1.5 per cent, respectively. Preoperative screening in cN0 breast cancer is of low yield. Even when abnormalities are found, metastasis is present in less than 1 per cent of patients, and a normal study does not rule out metastasis. Routine preoperative determination is not warranted, and staging studies should be limited to patients with signs or symptoms.

scholarly journals Absence of major fibrotic adverse events in hyperprolactinemic patients treated with cabergoline

2010 ◽  
Vol 162 (4) ◽  
pp. 667-675 ◽  
Author(s):  
M Lafeber ◽  
A M E Stades ◽  
G D Valk ◽  
M J Cramer ◽  
F Teding van Berkhout ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pulmonary Function ◽  
Pulmonary Function Test ◽  
Adverse Reactions ◽  
Valvular Regurgitation ◽  
X Ray ◽  
Increased Risk ◽  
Function Test ◽  
Additional Imaging ◽  
Chest X Ray

BackgroundCabergoline, a dopamine agonist used to treat hyperprolactinemia, is associated with an increased risk of fibrotic adverse reactions, e.g. cardiac valvular fibrosis, pleuropulmonary, and retroperitoneal fibrosis.ObjectiveThis study evaluated the prevalence and risk of fibrotic adverse reactions during cabergoline therapy in hyperprolactinemic and acromegalic patients.DesignA cross-sectional study was conducted in a University Hospital.PatientsA total of 119 patients with hyperprolactinemia and acromegaly who were on cabergoline therapy participated in the study.MethodsAll patients were requested to undergo a cardiac assessment, pulmonary function test, chest X-ray, and blood tests as recommended by the European Medicine Agency. Matched controls were recruited to compare the prevalence of valvular regurgitation. Cardiac valvular fibrosis was evaluated by assessing valvular regurgitation and the mitral valve tenting area (MVTa). The risk of pleuropulmonary fibrosis was assessed by a pulmonary function test, a chest X-ray, and if indicated, by additional imaging studies.ResultsThe prevalence of clinically relevant valvular regurgitation was not significantly different between cases (11.3%) and controls (6.1%; P=0.16). The mean MVTa was 1.27±0.17 and 1.24±0.21 cm2 respectively (P=0.54). Both valvular regurgitation and the MVTa were not related to the cumulative dose of cabergoline. A significantly decreased pulmonary function required additional imaging in seven patients. In one patient, possible early interstitial fibrotic changes were seen. Lung function impairment was not related to the cumulative cabergoline dose.ConclusionCabergoline, typically dosed for the long-term treatment of hyperprolactinemia or acromegaly, appears not to be associated with an increased risk of fibrotic adverse events.

scholarly journals Characteristics of Chest X-Ray in Patients with Cancer at the Dharmais Cancer Hospital Emergency Room during the COVID-19 Pandemic

2021 ◽  
Vol 15 (4) ◽  
pp. 195
Author(s):  
Bima Taruna Sakti ◽  
Rosalina Rosalina ◽  
Jaka Pradipta
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Pleural Effusion ◽  
Pleural Effusions ◽  
Hospital Emergency ◽  
X Ray ◽  
Patients With Cancer ◽  
Cancer Hospital ◽  
Hospital Emergency Room ◽  
Chest X Ray

Background: Conventional chest X-ray (chest X-ray) in Dharmais Cancer Hospital emergency room (ER) is still the primary modality to diagnose patients with cancer with dyspnoea complaints. Chest X-ray was also carried out to screen inpatients at the Dharmais Cancer Hospital ER at the beginning of the COVID-19 pandemic in Indonesia. It was essential because patients in the Dharmais Cancer Hospital ER were patients with cancer, with low immunity and a high risk of being exposed to various infections. Thus, the purpose of this study was to determine the characteristics of chest X-rays in patients with cancer at the Dharmais Cancer Hospital ER during the COVID-19 pandemic in February-May 2020. Methods: This was a descriptive study. The population involved was all patients at the Dharmais Cancer Hospital ER who received chest X-ray support, with the inclusion criteria for diagnosing lung cancer, breast cancer, cervical cancer, colorectal cancer, and blood cancer (Leukemia) from February to May 2020. Data analysis employed univariate analysis by utilizing tables and graphs in presenting the data.Results: 289 samples met the research criteria. The highest visits were patients with breast cancer (41.2%). The most common thoracic images were pleural effusion (34.3%), followed by bronchopneumonia (31.1%), normal lung (16.6%), lung mass (7.6%), pneumonia (5.2%), and others (5.2%), consisting of atelectasis, bronchitis, fibrosis/chronic pulmonary process, pulmonary emphysema, cardiomegaly, and specific process. Besides, the chest x-ray bronchopneumonia was 31.1% (90 samples), accompanied by pleural effusion of 44.4%. From the chest X-ray, pleural effusions were 34.3% (99 samples), with lung cancer being the most common with pleural effusions (48.4%).Conclusions: More than 80% of chest x-ray performed in the ER are abnormal. Also, breast cancer is the highest in the Dharmais Cancer Hospital ER cases, with the highest chest x-ray of pleural effusion.

scholarly journals Low QRS Voltage in Limb Leads Indicates Accompanying Precordial Voltage Attenuation Resulting in Underestimation of Left Ventricular Hypertrophy

2021 ◽  
Vol 18 (24) ◽  
pp. 12867
Author(s):  
Hye-Bin Gwag ◽  
Su-Hyun Lee ◽  
Hyeon-Jun Kim ◽  
June-Soo Kim ◽  
Young-Keun On ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Healthy Population ◽  
Primary Analysis ◽  
X Ray ◽  
Function Test ◽  
Chest X Ray ◽  
Voltage Attenuation

Low QRS voltage (LQRSV) in electrocardiography (ECG) often occurs in limb leads without apparent cause. However, its clinical significance is obscure in healthy populations. We reviewed patients aged over 60 who were scheduled for non-cardiac surgery in two hospitals. Patients underwent pre-operative ECG, echocardiography, pulmonary function test, and chest X-ray. Patients with LQRSV isolated to limb leads and patients without LQRSV were selected from separate hospitals. Among the 9832 patients screened in one hospital, 292 (3.0%) showed LQRSV in limb leads. One-hundred and ninety-four without LQRSV were selected as the control from the 216 patients screened at the other hospital. For primary analysis, patients with structural heart disease or classic etiologies of LQRSV were excluded. Patients with LQRSV had a higher proportion of male and a greater body mass index. Precordial QRS voltages were smaller, whereas left ventricular mass index and the prevalence of echocardiographic left ventricular hypertrophy (LVH) was higher in patients with LQRSV than in those without. Consequentially, diagnostic performance of precordial voltage criteria for LVH was particularly poor in patients with LQRSV in limb leads. LQRSV in limb leads frequently occurs without apparent etiologies. ECG voltage criteria may underestimate LVH in a relatively healthy population with LQRSV in limb leads.

scholarly journals Adherence to Monitoring Guidelines of Amiodarone Adverse Reactions

2019 ◽  
Vol 6 ◽  
pp. 233339281984463 ◽  
Author(s):  
Ophir Lavon ◽  
Ron Goldman
Keyword(s):  
Clinical Guidelines ◽  
Chart Review ◽  
Adverse Reactions ◽  
Retrospective Chart Review ◽  
X Ray ◽  
Liver Functions ◽  
Function Test ◽  
Improve Compliance ◽  
Amiodarone Treatment ◽  
Chest X Ray

Background: Amiodarone treatment frequently causes adverse reactions. Clinical guidelines warrant a comprehensive assessment prior to chronic treatment with amiodarone and repeated monitoring for the appearance of adverse reactions. Objective: To evaluate adherence to these guidelines. Methods: A retrospective chart review of electronic medical records of adult patients treated with oral amiodarone for at least 12 months. Results: One hundred patient records were analyzed; 97% of patients were evaluated for thyroid and liver functions prior to treatment. Liver functions were properly monitored every 6 months in 96% of patients and thyroid function in only 59%. Most (84%) patients completed a chest X-ray before treatment; only 2% completed a respiratory function test. None have performed a chest X-ray annually. Sixty-four percent of the patients were examined by an ophthalmologist prior to treatment; periodic ophthalmic surveillance was not consistent. Neurological and dermatological evaluations were not recorded for any of the patients, unless symptoms appeared. Only 50% were adherent to annual cardiac reassessment. Conclusions: Adherence to recommended clinical guidelines for monitoring amiodarone adverse reactions is poor. Interventions to improve compliance with these guidelines are needed.

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