Hematology/oncology clinics of North America
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Hematol. Oncol. Clin. North Am. · Feb 1990
ReviewThrombotic thrombocytopenic purpura and related disorders.
This article provides us with background information on the disease. Clinical features, variants and classification, laboratory findings, and pathology are discussed. Knowledge of the disease's pathogenesis has increased recently and specific causes discussed are predisposing factors, triggering agents, endothelial damage, defective PGI2 bioavailability, FVIII/vWF multimeric structure abnormalities, platelet activation, and hemolytic anemia. Proposed specific therapies discussed are steroids, heparin, antiplatelet agents, prostacyclin, splenectomy, immunosuppressive agents, plasma infusion, and plasma exchange.
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Elevated platelet counts may be encountered as a reactive phenomenon secondary to a variety of systemic conditions (thrombocytosis) or may represent a primary disorder of the bone marrow (thrombocythemia). The diagnosis of essential thrombocythemia is difficult and relies on exclusion of other myeloproliferative states and nonhematologic illnesses associated with increased platelet number. The paradoxic clinical complications of hemorrhage and thrombosis, the presence of splenomegaly, and the finding of various qualitative platelet abnormalities point to existence of the neoplastic disorder. Although treatment of the symptomatic patient with platelet lowering agents or antiplatelet drugs may be indicated and effective, the role of therapy in the asymptomatic individual remains highly controversial.
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This article discusses the presentation and evolution of therapy of pediatric Hodgkin's disease, contrasted with developments in adults. The issues of staging, treatment, and toxicity of radiotherapy, chemotherapy, and combined modality therapy are discussed. Recommendations for therapy are presented.
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Hematol. Oncol. Clin. North Am. · Jun 1989
ReviewSecond neoplasms in Hodgkin's disease: current controversies.
Aggressive, multimodal treatment of Hodgkin's disease has led to dramatic increases in survival but not without significant early toxicity and late complications. The most serious late complication is the development of a secondary neoplasm. These secondary cancers include acute nonlymphocytic leukemia, non-Hodgkin's lymphoma, and various solid tumors.
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Hematol. Oncol. Clin. North Am. · Jun 1989
ReviewNonmalignant complications of therapy for Hodgkin's disease.
Patients successfully treated for Hodgkin's disease provide the oncologist with an opportunity and a responsibility to evaluate long-term adverse effects of staging procedures and treatment regimens. This is necessary both to better understand the often unique clinical problems that develop long after completion of treatment for Hodgkin's disease and to more critically evaluate new treatment programs by comparison with existing effective but toxic regimens. Long-term survivors of Hodgkin's disease have various, often subclinical, cardiac abnormalities that result from both radiation and chemotherapy. ⋯ A variety of immunologic disturbances exists before and after treatment and predisposes to significant viral and bacterial infections. Finally, hypothyroidism and premature gonadal failure may follow therapy and require long-term hormone replacement. Further therapeutic advances for Hodgkin's disease will continue to alter this spectrum of complications, which, if unrecognized, may produce significant ongoing morbidity for long-term survivors.