PULMONARY TOXICITY OF CHEMOTHERAPY

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PULMONARY TOXICITY OF CHEMOTHERAPY FATAL
PNEUMONITIS RESULTING FROM TREATMENT WITH GEMZAR
2
?????? ?"? ?????? ???????"? ???? ??-????????
?????????? ??"? ?????
3
?????? ????? ?? GEMZAR
4
???? ????? ?? 73, ????? ?-11.03
??STAGE IV NON SMALL CELL CARCINOMA ?? ????
?????. ???? ????? ????, ???? ????? ????
????? ???? ????? ?????? CISPLATINUM50 ?? / ?"?
/???
????? 1,2
GEMZAR 1000 ?"?.
?"? /???
????? 1,8
?? 21 ???.
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????? 1 . 30.11.2003 .????? 2 . 21.12.2003
.?????? ???? ????? ????? ?????? ?????
????????.
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  28.12.03 - ???? ???? ???? ???? ?-GEMZAR
??????   ????? ????
????? ?????? ??   29.12.03 - ??? ????? ??????
???????   ?????? ??? 36 ????? ?????? ???
??- 120/80 ?"? ?????   ????- 110 ????
???? 20 ?????? ????   ??? ???? ???
?????? ??????   ????? ?? ??????, ??????, ???
??????, ??? ????? ??????????.   ?????- ?????
????? ?????? ????? ???? ?????
7
29.12.03 ????? ??? - ????? ???? ???????? ?????
?????? ?????. ????? ?? ????? ???? ????
????? ????? ??????. ?????????? ???? ?????
?????? ?? ??? ???? ????.
?.?.?.- ??? ?????, ???????? - 100 ????,
LAHB ?????? ????? WBC-10.700, ???????- 86,
HGB-13.7, PLT-146.000
????? ??? ????? pH- 7.5, pO2-127, pCO2- 22.6,
HCO3-18 ?? ??? ???? .   GLUCOSE- 164 MG/DL,
UREA- 17 MG/DL, CREATININE -1.3 MG/DL , NA-
134 MMOL/L, K-4.28 MMOL/L , CA-8.8 MMOL/L.


???? ????? ?????, ATENOLOL, VABEN ??? ????.
8
?????? ???? ????? ( 31.12.03 ) - ????? ????
??????. ?? ??? ????. ???? ???? 63 . ???
???? ??? ??????. ??????? ???????? ????????? ???
??? ??????. ????? ??? - ????? ????? ?? ?????
?-RLL. ????? ????? ???????? ??????? ?-LLL.
?????AZENIL MAXCEF, DEXAMETHASONE 20 ?"? IV,
?????? ( FUSID ) ???? ?????? ? CLEXANE
. ??????? ????? ??? ???? ??????? ?????, ????
????? ??? ?- 79-88 ?? ??? ????. ????? ??? -
2.1.2004 - ?????? ????????? ?????? ??????? ??
????. ???? ???? ??????? ????? ??????? ?????
???????, ????? ????????? ?? ???? ????? ??????
????. ?? ???? ????? ???? ?????.
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?????? 03
10
29.12.03
11
31.12.03
12
2.1.04
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• ?????? ?????? ? GEMCITABINE - ??? ??????
• ?????? ?? ?????? ?????? ??? ( ???? 3 4 ???
  WHO ) ???? ??? GEMZAR ?????? ?"? ???? ELI LILLY
  ? 2003 .
• ?????? ???????? ??????? 0.27-0.45 ( ????
  4448 ????? ) ,
• ???????? ?????? 0.02-0.06 ( ???? 217,000
  ????? , ??? ????? )
• ?????? ?? ????, ???? ??????? , ???? ????? ,
  SYSTEMIC CAPILLARY LEAK SYNDROME . ???? ???????
  ????? ??????.
• ????? ?????? ?????? ???? ??? ???? ?????? ??
  ?????? ??????
• ?????? ?- GEMZAR, ?? ????? ????? ?? ?????? ???
  ??? ???? ?????
• ?????.
• ????? ?????? ??? ???? ?????? ????? .

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• ????? ?????? ???? ????? ??? ?????, ?????,
  ????? ????????.
•  
• ?????? ???????? ????? ??? - ???????
  ??????????????? ???????- ?????????,
•   ????? ?? ?????? ?????.
• CT ?????? ???????????? ???? ??? ???
  ?????????.
• ?????? ?????????????? ??? ????????? ????? ,
  ?????? ?? ARDS .

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• ????? ?????
• ????? ???????? ?????? ?? ???? ????? ????????
  ???????
•  
• ??-????? ??
• ????? ?????.
• ???? ?????.
• LYMPHANGITIS CARCINOMATOSIS
• ?????
• ????? ????? ! ( ?????? ????? ?????? ?? ???
  ????? ???????
• ?????? ) .
• ????? - GEMZAR .
• ??? ????????? ?????? ????.
• ??? ?????? .
• ??? ????.

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• Pulmonary toxicity of chemotherapy.
• Direct cytotoxic effect
•  Diffuse endotelial inflammation or capillary
  leak
• Hypersensitivity or allergic reaction
  
• Bronchospasm
  

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Types of injuries with common chemotherapeutic
agents De-Vita ????
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????? ?????

• 1 . Joerger M.
• Gemcitabine related pulmonary
  toxicity
• Swiss med. Wkly 132 17 ,
  2002.
• 2 . De-pas T.
• Gemcitabine-induced systemic
  capillary leak syndrome.
• Ann. Oncology 12 1651,
  2001.
• 3 . Pavlakis N.
• Fatal pulmonary toxicity resulting
  from treatment with
• gemcitabine.
• Cancer 80 286 ,
  1997.
• 4 . Gupta N.
• Gemcitabine induced pulmonary
  toxicity a case report and review of
• the literature.
• Am. J. Clin. Oncol. 25 96 ,
  2002.
• 5 . Roychowdhury DF
• A report on serious pulmonary
  toxicity associated with
• gemcitabine-based therapy.
• Invest. New Drugs 20 311 ,
  2003.