By Jean Klastersky, Stephen C. Schimpff, Hans-Jorg Senn
A dialogue of the a number of techniques caregivers take to alleviate the emotional and actual pain of sufferers struggling with neoplasia. This variation comprises new chapters on complementary and replacement clinical options for melanoma aid care and on melanoma care within the home.
summary: A dialogue of the a number of ways caregivers take to alleviate the emotional and actual pain of sufferers struggling with neoplasia. This variation comprises new chapters on complementary and substitute scientific thoughts for melanoma aid care and on melanoma care in the house
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Extra info for Supportive care in cancer : a handbook for oncologists
The value of aerosolized AmB is disputed. The diagnosis of pulmonary aspergillosis and other similar fungal infections is very difficult; one should have a high degree of diagnostic suspicion in patients who are predisposed to these complications. High-resolution chest computed tomographic scanning combined with microbiological examination of the product of BAL probably represents the best chance for precise diagnosis (30). AmB at 1 mg/kg/d IV, for a total dose of 2 g, is the therapy of choice.
The demonstration by Talcott et al. (23) that among febrile neutropenic patients a subgroup exists with a better prognosis in terms of mortality opened the way for ambulatory therapy of febrile neutopenia. This group represents about 25% of patients with febrile neutropenia. Outpatient treatment either in a day care facility ($285 daily) or under close supervision at home ($148) with ceftriaxone/amikacin, an active regimen that can be given once a day, reduces daily cost substantially as compared to the administration of the same regimen within the hospital.
The mortality rate from established CMV pneumonia has decreased from 90% before the advent of ganciclovir to about 25%. The presence of CMV in a BAL specimen or a CMV-positive buffy coat obtained on day 35 after transplantation were significant factors associated with CMV pneumonia. These investigations are currently performed routinely on day 30 to 35 after bone marrow transplantation in most units, and recent studies suggest that ganciclovir should be given as soon as CMV is detected. Newer methods such as antigen detection and PCR have shortened significantly the delay of diagnosis in BAL; the testing of blood by these techniques is very specific but less sensitive than testing in BAL (45).