Early blindness and coma during intrathecal chemotherapy for meningeal carcinomatosis

Article Abstract:

The injection of methotrexate directly into the subarachnoid space of the meninges is regarded as the treatment of choice for metastatic tumors growing in the meninges, the membranes that enclose the brain and spinal cord. Although there have been reports of serious complications, including sudden death, from this treatment, complications are sufficiently rare that the treatment is widely regarded as safe. In one case history, however, a complication was observed in which degeneration of nerve axons and deterioration of their myelin sheath lead to blindness, coma and death in a 35-year-old woman. Initially the patient was treated for breast cancer with methotrexate and cytosine arabinoside. Two weeks after the sixth course of chemotherapy she developed symptoms which ultimately led to the discovery of metastatic tumor cells in the meninges. In response to this finding, methotrexate was injected as necessary to maintain a constant concentration in the cerebrospinal fluid. Over three weeks, a total of 70 milligrams of methotrexate was administered. During the first two weeks, a reduction in tumor cells in the cerebrospinal fluid was observed, indicating a positive response to the treatment. During the third week, however, signs of deterioration occurred, including confusion, apathy, and blurred vision. A CT scan showed no abnormalities. The patient stopped speaking, but apparently remained conscious, and developed episodes of roving eye movements. She become stuporous, and complete blindness developed. Myoclonic jerks ensued, along with episodes of hiccups. The patient became comatose with irregular breathing and died within six weeks of the initiation of methotrexate infusion. Post-mortem examination of the central nervous system revealed no evidence of metastases which could account for the symptoms. There was demyelination in the optic nerve, spinal cord, and brain which was similar to that seen in disseminated necrotizing leukoencephalopathy. Although some cases of transient paralysis have been attributed to the presence of preservatives in the methotrexate, the agent used for this patient contained no preservatives. It is important to note that since neurological symptoms may be attributed to the tumor in cases of meningeal cancer, and the demyelinating lesions observed here are not visible upon gross examination, the contribution of chemotherapy to the neuropathology may easily be overlooked unless the possibility is remembered and considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Methotrexate, Coma, Coma (Medicine), Nervous system cancer

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Combined occurrence of chyloperitoneum and chylothorax after surgery and chemotherapy for Wilms' tumor

Article Abstract:

Chyloperitoneum is a very rare complication of trauma or surgery in which chyle, a milky suspension absorbed from the intestine, leaks out into the peritoneal cavity (space between the membranes of the abdominal wall and abdominal organs) rather than into the venous system. It is even more rare as a consequence of surgery in children; only five such cases have been described previously. This case study describes a 10-month-old boy with Wilms' tumor, a primitive tumor of the kidney, who had his right kidney removed. Two weeks after surgery he developed chylothorax, or chyle in the space between the membranes of the chest wall and the lungs, followed by chyloperitoneum. It is thought that all cases of chylothorax result from a defect in the diaphragm that permits peritoneal fluid to move into the pleural, or lung, cavities. In this case, as usually occurs, the condition resolved after the patient was placed on total parenteral nutrition, which permits the healing of whatever alimentary damage caused the chyloperitoneum. Because parenteral feedings provide all nutrients intravenously, the intestine heals without the interference of foodstuffs, or the further creation of chyle. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Surgery, Nephroblastoma, Chylothorax, Peritoneal cavity

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The role of low-dose cytosine arabinoside and aggressive chemotherapy in advanced myelodysplastic syndromes

Article Abstract:

Myelodysplastic syndromes (MDS) are a collection of disorders of the blood-producing cells in the bone marrow. Most cases are fatal, either by hemorrhage, infection, or progression to leukemia. Patients with MDS have a median survival time of 4.5 to 18 months; half of the patients with MDS survive for shorter or longer periods of time. Although it is still experimental, the conventional therapy for MDS is low-dose cytosine arabinoside (ara-C). It is generally regarded that aggressive chemotherapy is not indicated in these patients, but there is little experimental data to support this point. In a preliminary investigation involving 51 patients with MDS, the survival rate of patients treated with ara-C was no better than that achieved with supportive care alone. Furthermore, serious side effects were experienced. Patients receiving postremission chemotherapy fared better. Some MDS patients may have a good chance of successful remission when treated with aggressive chemotherapy prior to possible transformation to overt leukemia. The general notion that aggressive chemotherapy is contraindicated for MDS patients should be reconsidered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Chemotherapy, Myelodysplastic syndromes, Cytarabine

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